Outcomes of primary leadless pacemaker implantation: A systematic review.

BACKGROUND: During the last decade, leadless pacemakers (LPMs) have turned into a prevalent alternative to traditional transvenous (TV) pacemakers; however, there is no consolidated data on LPM implantation in emergencies. METHODS: Digital databases were searched for this review and four relevant studies, including 1276 patients were included in this review with procedure duration, fluoroscopic time, major complications, and mortality as primary outcomes and pacing threshold, impedance, sensing of LPM, and hospital stay as secondary outcomes. RESULTS: Gonzales et al. and Marschall et al. showed the duration of the procedure to be 180 ± 45 versus 324.6 ± 92 and 39.9 ± 8.7 versus 54.9 ± 9.8, respectively. Zhang et al. demonstrated the duration of the procedure and fluoroscopy time to be 36 ± 13.4 and 11.1 ± 3.1, respectively. Similarly, Schiavone et al. exhibited intermediate times of implantation at 60 (45-80) versus 50 (40-65) and fluoroscopic times at 6.5 (5-9.7) versus 5.1 (3.1-9). Hospital stay was more with a temp-perm pacemaker as compared to LPM and pacing parameters were not significantly different in all the studies. CONCLUSION: For underlying arrhythmias, whenever appropriate, our review shows that LPMs may be a better option than temporary pacemakers, even as an urgent treatment.

Anxiety and Depression in Heart Failure: An Updated Review.

Anxiety and depression are commonly experienced by individuals with heart conditions, significantly impacting their overall well-being and prognosis. This review aims to provide an updated examination of the relationship between anxiety, depression, and heart disease. The review begins by exploring the prevalence of anxiety and depression in heart patients, highlighting the substantial rates at which these mental health disorders co-occur in this population. It further elucidates the risk factors that contribute to the development and exacerbation of anxiety and depression in individuals with heart conditions, including biological, psychological, and social factors. The impact of anxiety and depression on cardiac outcomes is a central focus of this review. It explores the intricate bi-directional relationship between mental health and cardiovascular health, discussing the mechanisms through which anxiety and depression can lead to adverse cardiac events and worsen existing heart conditions. Additionally, it examines the potential impact of anxiety and depression on treatment adherence, lifestyle modifications, and overall quality of life in heart patients. The review also investigates the diagnostic and assessment methods for anxiety and depression in heart patients, emphasizing the importance of implementing comprehensive screening protocols in clinical settings. In conclusion, this updated review provides valuable insights into the prevalence, impact, assessment, and management of anxiety and depression in heart patients. It underscores the importance of recognizing and addressing these mental health disorders within the context of cardiac care, ultimately aiming to enhance the overall well-being and prognosis of individuals living with heart conditions.

Association of gut microbiome dysbiosis with the progression of atrial fibrillation: A systematic review.

OBJECTIVE: Many clinical and preclinical studies have implicated an association between atrial fibrillation (AF) and its progression to imbalances in the gut microbiome composition. The gut microbiome is a diverse and complex ecosystem containing billions of microorganisms that produce biologically active metabolites influencing the host disease development. METHODS: For this review, a literature search was conducted using digital databases to systematically identify the studies reporting the association of gut microbiota with AF progression. RESULTS: In a total of 14 studies, 2479 patients were recruited for the final analysis. More than half (n = 8) of the studies reported alterations in alpha diversity in atrial fibrillation. As for the beta diversity, 10 studies showed significant alterations. Almost all studies that assessed gut microbiota alterations reported major taxa associated with atrial fibrillation. Most studies focused on short-chain fatty acids (SCFAs), whereas three studies evaluated TMAO levels in the blood, which is the breakdown product of dietary l-carnitine, choline, and lecithin. Moreover, an independent cohort study assessed the relationship between phenylacetylglutamine (PAGIn) and AF. CONCLUSION: Intestinal dysbiosis is a modifiable risk factor that might provide newer treatment strategies for AF prevention. Well-designed research and prospective randomized interventional studies are required to target the gut dysbiotic mechanisms and determine the gut dysbiotic-AF relationship.

Social Determinants of Clinical Visits After Left Main Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting.

This study aims to investigate the social determinants of clinical visits after LM-PCI versus CABG and their impact on post-treatment care and outcomes. We identified all adult patients who underwent LM-PCI or CABG between January 1, 2015, and December 31, 2022, and were in follow-up at our institute. We collected data on clinical visits, including outpatient visits, emergency department visits, and hospitalizations, in the years following the procedure. The study included 3816 patients, of which 1220 underwent LM-PCI and 2596 underwent CABG. The majority of patients were Punjabi (55.8%), males (71.8%), and had low socioeconomic status (69.2%). The strongest predictors of having a follow-up visit were age (OR (95%CI): 1.41 (0.87-2.35); P value = 0.03), female gender (OR (95%CI): 2.16 (1.58-4.21); P value = 0.07), LM-PCI (OR (95%CI): 2.32 (0.94-3.64); P-value = 0.01), government entitlement (OR (95%CI): 0.67 (0.15-0.84); P value = 0.16), high SYNTAX (OR (95%CI): 1.07 (0.83-2.58); P value = 0.02), 3-vessel disease (OR (95%CI): 1.76 (1.05-2.95); P value <0.01), and peripheral arterial disease (OR (95%CI): 1.52 (0.91-2.45); P value = 0.01). Hospitalizations, outpatient, and emergency visits were more in the LM-PCI cohort as compared to CABG. In conclusion, the social determinants of health, including ethnicity, employment, and socioeconomic status were associated with differences in clinical follow-up visits after LM-PCI and CABG.

Social determinants of pacemaker reuse among patients and family members in Pakistan.

OBJECTIVES: This survey aimed to quantify the opinions of CIED reuse among patients and family members in Pakistan and to identify the social determinants which may predict these views. METHODS: A questionnaire formulating attitudes toward PPM reuse was administered to patients and family members at cardiology institutes in Pakistan from 1 July 2022 to 30 September 2022. The eligibility criteria (age > 18 years; inline for PPM placement) were taken into account and incomplete responses were excluded from the final analysis. RESULTS: A total of 9,246 participants recorded their responses, of which 7,152 (78.16%) accepted pre-used PPMs. The lower social class had more PPM reuse acceptance rate than the middle and upper class (92.72% vs. 60.52% vs. 35.38%), respectively. Age ≥ 65 (OR(95%CI): 0.68 (0.41-0.99); P-value = 0.023), male gender (OR(95%CI): 0.55 (0.35-0.72), P-value = 0.016), unemployment (OR(95%CI): 0.47 (0.25-0.64); P-value = 0.007), poor health status (OR(95%CI): 0.72 (0.53-0.92); P-value = 0.041), and lower social class (OR(95%CI): 0.36 (0.28-0.53); P-value = 0.003) were social determinants of PPM reuse acceptance. CONCLUSION: Patients and their family members endorse the concept of PPM reuse in Pakistan who cannot afford new devices.