Folic acid and plasma lipids: Interactions and effect of folate supplementation.

Dyslipidaemia and hyperhomocysteinemia are known risk factors for cardiovascular disease. While it is evident that optimization of plasma lipid is associated with low risk of cardiovascular disease in the general population, it is not yet fully clear whether reduction of homocysteinemia is associated with an improvement in risk in all subjects. The aim of our narrative review is to highlight eventual effects of folate supplementation on LDL-C levels, LDL-C oxidation and atherosclerosis-related complications. A comprehensive literature search was done in electronic database, including PubMed, Web of Science, Cochrane, and Scopus from inception up to January 2024. Based on the available evidence, epidemiological data, pathophysiological observations and meta-analyses of randomized clinical trials suggest that folic acid supplementation may modestly but significantly improve plasma lipid levels, lipid atherogenicity, and atherosclerosis-related early vascular damage, and that folic acid supplementation may significantly reduce the risk of cerebrovascular disease. Considering the low-cost and high safety profile of folic acid, its long-term supplementation could be considered for dyslypidaemic patients in secondary prevention for cardiovascular disease.

Stepwise ablation approach versus pulmonary vein isolation in patients with paroxysmal atrial fibrillation: Randomized controlled trial.

BACKGROUND: Pulmonary vein isolation (PVI) is a central procedure for the treatment of paroxysmal atrial fibrillation (PAF). However, in patients with PAF and structural atrial disease, PVI may fail and cause progressive atrial remodeling, often leading to persistent/permanent atrial fibrillation. OBJECTIVE: We performed a prospective, single-blind, 2-center randomized controlled trial to compare the efficacy of PVI alone with that of PVI plus stepwise ablation in achieving sinus rhythm and nonatrial arrhythmia inducibility in patients with PAF refractory to antiarrhythmic therapy. METHODS: Patients were randomized to perform a first catheter ablation procedure either through PVI alone or through PVI plus substrate modification in stepwise ablation. Data were recorded at 3, 6, and 12 months after both ablation procedures. Patients who experienced atrial fibrillation/atrial tachycardia (AF/AT) recurrence were encouraged to undergo repeat ablation using the technique of the first ablation procedure. RESULTS: A total of 150 patients were enrolled (mean age 62.8 ± 8.7 years; 92 (61.3%) men; 104 (69.3%) hypertensive; AF mean duration 10.7 months), with 75 patients in each group. After 12 months of the first procedure, patients who were converted to sinus rhythm using stepwise ablation showed a significantly lower rate of AF/AT recurrence (26.7%) than did those who were treated using PVI alone (46.7%; P < .001). Similar results were observed in the 52 patients who underwent a second catheter ablation procedure. After adjusting for several potential confounders, the hazard ratio of 12-month AF/AT recurrence after the first ablation procedure was 0.53 (95% confidence interval 0.30-0.91) for those treated using stepwise ablation. CONCLUSION: In addition to PVI, stepwise ablation achieving sinus rhythm and nonatrial arrhythmia inducibility has relevantly improved the clinical outcome of the PAF control strategy.

A new approach for catheter ablation of atrial tachycardia following atrial fibrillation ablation.

OBJECTIVE: The origin and mechanisms of focal and macro-re-entrant atrial tachycardia occurring after ablation of paroxysmal or persistent atrial fibrillation are difficult to determine and are often the cause of distress for both patients and electrophysiologists. The purpose of this study was to describe a novel practical approach which would be helpful in planning the treatment of atrial tachycardia in patients who had received prior atrial fibrillation ablation. We used an algorithm which aims to facilitate mapping and ablation strategies, using both conventional electrophysiological tools and a three-dimensional electroanatomic approach. METHODS: We investigated a series of 40 patients with atrial tachycardia who had undergone a prior ablation procedure for paroxysmal or persistent atrial fibrillation with a step-wise approach. This approach consisted of four steps: the use of a decapolar catheter to assess the coronary sinus and an entrainment map to evaluate the cavotricuspid isthmus (CTI). If the CTI was not involved, we used a 20-pole dual-loop circular mapping catheter, AFocusII DL, to map the left atrium chamber rapidly during the rhythm of interest. We identified the target entrainment at the putative channels and performed catheter ablation at the critical isthmus of these macrocircuits until the restoration of sinus rhythm. RESULTS: Seventy-five atrial tachycardias were identified in 40 consecutive patients (1.9 ±â€Š1.6 per patient). In 48, the mechanism was macro-re-entry, and the remaining 27 were focal. During 18 months of follow-up, the treated arrhythmia recurred in only three patients, whereas in another four patients, a different atrial tachycardia was observed. The remaining 33 patients maintained sinus rhythm. CONCLUSION: The increased acquisition speed by AFocusII DL facilitated the reconstruction of the geometric chamber, and the generation of an isochronal activation map reduced processing time and fluoroscopy time per patient, together with the radiation exposure and patient radiation dose. A novel algorithm combining both conventional electrophysiology and a three-dimensional electroanatomic approach for rapid diagnosis, accurate mapping and ablation of iatrogenic atrial tachycardias showed high reproducibility and a satisfactory overall success rate.

The beneficial effect of insulin, glucose, and dipyridamole on regional left ventricular function early after acute myocardial infarction.

BACKGROUND: High-dose glucose-insulin-potassium (GIK) solution has beneficial effects on reducing mortality in acute myocardial infarction. Dipyridamole (DIP) is a powerful antioxidant and increases adenosine concentration. Experimentally, GIK and DIP have additive protective effects in ischemia-reperfusion injury. AIM: This work aims to assess the acute effects of DIP alone, GIK alone, and GIK+DIP on left ventricular function in patients evaluated early after an acute myocardial infarction. METHODS: Ten male patients (age 63+/-11 years) with uncomplicated acute myocardial infarction were evaluated within 3 days after admission. All had been treated with systemic thrombolysis and were on full therapy (including beta-blockers) at the time of testing. They underwent stress echocardiography [2D echo, with wall motion score index (WMSI) evaluated in a 16-segment model of the left ventricle, with each segment scored from 1=normal to 4=dyskinetic] during low-dose DIP alone (0.28 mg/kg in 4 min); GIK alone (4-h infusion of glucose 30%, 25 insulin units, and 40 mEq of KCl, at an infusion rate of 1.5 ml/kg/h); and GIK+DIP. RESULTS: Regional systolic function (baseline WMSI=1.69+/-0.2) improved after DIP (1.54+/-0.1), GIK (1.54+/-0.1), and, to a greater extent, after GIK+DIP (1.33+/-0.2; p<0.001 vs. baseline; p<0.05 vs. DIP; p<0.05 vs. GIK). CONCLUSION: High-dose GIK has an acute beneficial effect on regional left ventricular function in patients with acute myocardial infarction. This beneficial effect is potentiated by low-dose DIP coadministration.