Immunoglobulin light chain (AL) amyloidosis is a well-recognized complication of multiple myeloma (MM), with important prognostic implications. However, th

Aims: Intracardiac echocardiography (ICE) is a valuable, real-time imaging tool in structural cardiology and electrophysiology, performed without general anaesthesia. However, its safety compared to transesophageal echocardiography (TEE) remains unclear. Objective: To conduct a meta-analysis evaluating outcomes of catheter ablation for atrial fibrillation (AF) with or without left atrial appendage closure (LAAC) guided by TEE vs. ICE. Methods and results: Databases were searched for studies comparing ICE with TEE guidance during AF ablation ± LAAC. Outcomes were pooled using the inverse-variance (IV) random-effects model in R, with risk ratios (RRs) for dichotomous variables and mean or standardized mean differences (MD or SMD) for continuous variables, and 95% confidence intervals (CIs) reported. We included eight studies involving 7671 patients, of whom 3903 (50.9%) underwent procedures with ICE guidance. There were no significant differences between groups in cardiac tamponade risk (RR 0.86; 95% CI 0.44–1.66; P = 0.39), stroke, or transient ischaemic attack (RR 1.00; 95% CI 0.39–2.55; P = 0.57), and vascular complications (RR 0.80; 95% CI 0.51–1.25; P = 0.37). ICE was associated with lower pre-procedure LAA thrombus detection (RR 0.32; 95% CI 0.11–0.94; P = 0.04), radiation dose (SMD −0.47; 95% CI −0.90 to −0.04; P = 0.03), and fluoroscopy time (−4.25 min; 95% CI −6.01 to −2.49; P < 0.01) but the procedure duration was significantly lower only in combined AF ablation + LAAC (MD −19.56 min; 95% CI −24.15 to −14.97; P < 0.01). Conclusion: This meta-analysis indicates that ICE is a safe, effective, and non-inferior alternative to TEE for patients undergoing AF ablation ± LAAC. However, TEE remains an effective tool for detecting LAA thrombus.

Coronary bifurcation lesions are considered among the most challenging lesions to treat with percutaneous coronary intervention (PCI), particularly in cases of extensively diseased branches. In the event of failure of a provisional (one-stent) approach, many two-stent bifurcation techniques can be performed for the treatment of coronary bifurcation lesions. Two techniques (culotte and T/TAP) are suggested by the European Bifurcation Club, but a reverse crush is performed by some operators. This study aims to retrospectively compare these two different approaches (EBC-recommended techniques vs. reverse crush).

Background: Cardiac resynchronization therapy (CRT) improves outcomes in heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF) and a wide QRS complex. However, up to 30–50% of patients fail to respond. The QRS Index, which quantifies QRS shortening after CRT, has emerged as a potential predictor of response. We aimed to perform a systematic review and meta-analysis to evaluate the association between QRS Index and CRT response. Methods: We searched PubMed, Scopus and Cochrane for studies reporting QRS Index values in CRT responders and non-responders. Studies defining response based on clinical, echocardiographic, or combined criteria were included. Heterogeneity was assessed using the I² statistic, and a random-effects model was applied. A meta-regression analysis explored the relationship between baseline echocardiographic parameters and QRS Index. Results: Nine studies with 1274 patients met the inclusion criteria, with 760 (59%) classified as responders and 514 (41%) as non-responders. The weighted mean ± standard deviation was 16.14 ± 13.19 in responders and 7.22 ± 14.96 in non-responders. The QRS Index was significantly higher in the responder group compared to non-responders (mean difference: 8.76; 95% CI: 6.45–11.06; I² = 45%; p < 0.00001). Meta-regression revealed that lower left ventricular end-systolic volume (LVESV) values were associated with even higher QRS Index in responders compared to non-responders (β = −0.0483; 95% CI: −0.0938; −0.0029, p = 0.0372). Conclusions: QRS Index is significantly higher in CRT responders, supporting its role as a predictor of response. Further studies are needed to standardize its clinical use and assess its prognostic impact.