Background: Atrial fibrillation (AF) recurrence after AF ablation is not uncommon. High sensitivity C reactive protein (hs‐CRP) is a widely used inflammatory marker with a potential property to predict AF recurrence. We conducted a systematic review and a meta‐analysis to find an association between hs‐CRP levels and AF recurrence after ablation.Methods: We searched PubMed, Embase, and Wiley‐Cochrane Library from inception to January 2022 for studies that reported hs‐CRP levels in patients who underwent AF ablation. Weighted mean difference (WMD) was used to evaluate the difference between hs‐CRP levels in post‐ablation AF recurrent and non‐recurrent group. Also, the difference between hs‐CRP levels in pre‐ and post‐ablation was determined.Results: We identified 10 studies, and a total of 789 patients were included (299 recurrent vs. 490 non‐recurrent patients). The mean age was 57.7 years (76.4% male). There was no difference in baseline hs‐CRP levels between AF recurrent and non‐recurrent group (WMD = 0.05, 95% CI = −0.04 to 0.15, p = 0.045). However, higher hs‐CRP levels post‐ablation were found in AF recurrent group (WMD = 0.09, 95% CI = 0.03–0.15, p < 0.001).Conclusion: There is no significant difference in baseline hs‐CRP levels between AF recurrent and non‐recurrent patients after AF ablation. However, higher post‐ablation hs‐CRP level was found in AF recurrent group. High Sensitivity C reactive protein may play a role as a predictor of AF recurrence.

Aims: We conducted a systematic review and meta-analysis on three outcomes. We assessed the efficacy and safety of direct oral anticoagulants (DOAC) compared to vitamin K antagonists (VKA) in morbidly obese patients with atrial fibrillation (AF). We compared the efficacy and safety of DOAC in obese patients and non-obese patients with AF. Finally, we updated the current knowledge of outcomes of AF patients with obesity compared with normal-weight patients regardless of anticoagulation type. Methods and results: Using PubMed and Embase, we searched for literature published from inception to August 2020 for studies conducted in morbidly obese patients with AF who used DOACs and/or VKA for stroke or systemic embolism (stroke/SE) prevention that report efficacy and/or safety data. GRADE assessment was performed to determine the quality of the meta-analysis results. Direct oral anticoagulant was not statistically different from VKA in reducing stroke/SE with relative risk (RR) of 0.85 [95% confidence interval (CI): 0.56–1.29; very low certainty evidence]. Major bleeding risk was lower in the DOAC groups with RR of 0.62 (95% CI: 0.48–0.80; low certainty evidence). Obese patients with AF who used DOACs had lower risk of stroke/SE and similar major bleeding risk compared to non-obese patients with RR of 0.77 (95% CI: 0.70–0.84; low certainty evidence) and 1.02 (95% CI: 0.94–1.09; low certainty evidence), respectively. Obese patients with AF who used any type of anticoagulant had lower risk of stroke/SE compared to normal-weight patients with RR of 0.62 (95% CI: 0.57–0.69; low certainty evidence). Conclusion: The use of DOACs in morbidly obese patients may be reasonable if needed, and more dedicated studies are needed to make a more robust recommendation.

Background: Admission hyperglycemia (AH) has shown to be associated with higher mortality rates in acute myocardial infarction (AMI). Malignant arrhythmia is one of the causes of death in AMI; however, it is unclear whether AH is associated with an increased arrhythmia risk. We conducted this systematic review and meta‐analysis to assess the association between AH and arrhythmias in AMI.Methods: We searched MEDLINE, and Embase databases from inception to September 2021 to identify studies that compared arrhythmia rates between AMI patients with AH and those without. Arrhythmias of interest included ventricular tachyarrhythmias (VA), atrial fibrillation (AF), and atrioventricular block.Results: Thirteen cohort studies with a total of 12,898 patients were included. AH was associated with a higher risk of overall arrhythmias (18% vs 10.3%, pooled odds ratio [OR] = 1.89, 95% confidence interval [CI]: 1.39–2.56, P < .001), VA (16.4% vs 11.1%, pooled OR = 1.56, 95% CI: 1.11–2.18, P = .01), and new onset AF (17.8% vs 6.4%, pooled OR = 2.13, 95% CI: 1.4–3.25, P < .0010. Subgroup analysis of diabetes status regarding overall arrhythmias showed that the increased risk of arrhythmias in the AH group was consistent in both patients with a history of diabetes (18% vs 12.5%, pooled OR = 2.33, 95%CI: 1.2–4.52, P = .004) and without (15.7%. vs 9% pooled OR = 1.35, 95% CI: 1.1–1.66, P = .013).Conclusion: Admission hyperglycemia in AMI was associated with the increased risk of arrhythmias, regardless of history of diabetes mellitus.

We performed a systematic review and meta-analysis to evaluate the association whether the female gender was associated with an increased chance of left ventricular ejection fraction (LVEF) in patients with heart failure with reduced ejection fraction (HFrEF). We searched the databases of MEDLINE and EMBASE from inception to 18 January 2022. Included studies were published studies evaluating or reporting characteristics of patients with HF with recovered LVEF. Data from each study were combined using a random-effects model, the generic inverse variance method of DerSimonian and Laird, to calculate odd ratios (OR) and 95% confidence intervals (CI). Eighteen studies were included in the analysis with a total of 12,270 patients (28.2% female). Female gender was associated with an increased chance of LVEF recovery (pooled OR = 1.50, 95% CI = 1.21–1.86, p-value < 0.001, I² = 74.5%). In our subgroup analysis, female gender was associated with an increased chance of LVEF recovery when defined as LVEF > 50% (pooled OR = 1.78, 95% CI = 1.45–2.18, p-value < 0.001, I² = 0.0%), and LVEF > 40–45% (pooled OR = 1.45, 95% CI = 1.09–1.91, p-value = 0.009, I² = 79.2%), but not in LVEF > 35 (OR = 2.18, 95% CI = 0.94–5.05, p-value = 0.06). Our meta-analysis demonstrated that the female gender is associated with an increased chance of LVEF recovery. This association was not statistically significant in the subgroup that defined LVEF recovery as LVEF > 35%.

Thangjui S, et al. Infect Chemother. 2020 Sep;52(3):360-368. https://doi.org/10.3947/ic.2020.52.3.360

Previous studies have demonstrated gender disparities in mortality and vascular complications after transcatheter aortic valve replacement (TAVR) with early generation transcatheter heart valves (THVs). It is unclear, however, whether gender-related differences persist with the newer generation THVs. We aim to assess gender disparities after TAVR with newer generation THVs. The MEDLINE and Embase databases were thoroughly searched from inception to April 2023 to identify studies that reported gender-specific outcomes after TAVR with newer generation THVs (Sapien 3, Corevalve Evolut R, and Evolut Pro). The outcomes of interest included 30-day mortality, 1-year mortality, and vascular complications. In total, 5 studies (4 databases) with a total of 47,933 patients (21,073 females and 26,860 males) were included. Ninety-six percent received TAVR via the transfemoral approach. The females had higher 30-day mortality rates (odds ratio (OR) = 1.53, 95% confidence interval (CI) 1.31–1.79, p-value (p) < 0.001) and vascular complications (OR = 1.43, 95% CI 1.23–1.65, p < 0.001). However, one-year mortality was similar between the two groups (OR = 0.78, 95% CI 0.61–1.00, p = 0.28). The female gender continues to be associated with higher 30-day mortality rates and vascular complications after TAVR with newer generation transcatheter heart valves, while there was no difference in 1-year mortality between the genders. More data is needed to explore the causes and whether we can improve TAVR outcomes in females.