Although sodium–glucose cotransporter 2 inhibitors (SGLT2i) are known to reduce the incidence of atrial fibrillation (AF) and AF-related adverse events, evidence on their prognostic effect in patients undergoing catheter ablation (CA) for AF is limited. In a single center, 614 patients (mean age 58.1 ± 9.9 years, 42.2% female) who underwent CA for AF were retrospectively divided into 2 groups according to SGLT2i treatment after the index procedure and followed up for 24 months. The primary outcome of the study was AF recurrence after the first 90-day blanking period after CA. Two separate Cox regression models were constructed to determine the predictors of AF recurrence. Rates of the primary outcome were 19.4% and 35.7% in the SGLT2i and non-SGLT2i groups, respectively. According to the multivariable model 1, which was established among the clinically relevant variables that were found to be statistically significant in univariable analysis, left atrial diameter (adjusted HR: 1.087, 95% CI, 1.054–1.122, P < 0.001), SGLT2i therapy (adjusted HR: 0.436, 95% CI, 0.286–0.665, P < 0.001), and nonparoxysmal AF (adjusted HR: 1.549, 95% CI, 1.039–2.309, P = 0.032) were independent predictors of recurrence after ablation. In model 2, SGLT2i treatment remained an independent predictor of AF recurrence along with significant variables such as age, heart failure with reduced ejection fraction, and previous stroke (adjusted HR: 0.315, 95% CI, 0.214–0.461, P < 0.001). The favorable efficacy of SGLT2i on the primary outcome was maintained in subgroup analyses. SGLT2i treatment is associated with lower recurrence after CA for AF in subgroups with and without diabetes or heart failure with reduced ejection fraction and in the overall patient population, independent of AF phenotype.

Background and Objectives: Patients with impaired left ventricular ejection fraction (LVEF) undergoing transcatheter aortic valve implantation (TAVI) remain at high risk for adverse outcomes despite successful procedures. Sodium–glucose cotransporter-2 inhibitors (SGLT2i) improve outcomes in heart failure, but their long-term impact after TAVI is not well established. Materials and Methods: This single-center retrospective study included patients with LVEF < 50% who underwent transfemoral TAVI between January 2015 and September 2025. Patients were stratified according to SGLT2i use. The primary outcome was a composite of all-cause mortality and heart failure (HF) hospitalization requiring intravenous diuretics. Secondary outcomes included all-cause mortality, HF hospitalization, and changes in echocardiographic parameters at 6 months. Inverse probability of treatment weighting (IPTW) based on propensity scores was applied to adjust for baseline differences. Time-to-event analyses were performed using IPTW-weighted Cox models and adjusted survival curves. Results: The study included 226 patients (78 SGLT2i users, 148 non-users) with a median follow-up of 37 months. After IPTW adjustment, SGLT2i use was associated with a lower rate of the composite outcome (32.8% vs. 50.8%, p = 0.019) and a lower crude long-term mortality (32.8% vs. 47.4%, p = 0.056). Acute kidney injury after TAVI occurred less frequently among SGLT2i users (3.4% vs. 17.4%, p = 0.013). In IPTW-weighted Cox analyses, SGLT2i use was associated with a reduced risk of all-cause mortality (HR 0.57, 95% CI 0.32–0.98) and the composite outcome (HR 0.56, 95% CI 0.33–0.96). SGLT2i users demonstrated greater reductions in left ventricular end-diastolic diameter at 6 months. Conclusions: In patients with impaired LVEF undergoing TAVI, SGLT2 inhibitor therapy was associated with improved long-term survival, better composite outcome-free survival, and lower rates of post-TAVI acute kidney injury. Larger prospective studies are warranted to confirm these findings.

Background: Atrial fibrillation (AF) is a common arrhythmia in patients with atrial septal defect (ASD). Cryoballoon ablation (CA) is a safe and efficient method for pulmonary vein (PV) isolation in the treatment of AF. Achieving left atrial access may be difficult in patients with atrial septal occluders (ASO) or surgical repair of ASD. The aim of this study was to present our experience with the efficacy and safety of transseptal puncture and AF ablation in CA in this subset of patients. Methods: We retrieved our data about patients with ASO or surgical repair of ASD undergoing cryoballoon AF ablation procedures at our center between August 2019 and January 2022. Results: Nine patients (age 43.88 ± 9.73 years) with AF (5 paroxysmal and 4 persistent) and ASO or surgical repair of ASD were enrolled. All three patients had a 28 mm Amplatzer ASO device which occupied the whole septum, and direct puncture through the ASO was performed. Sequential balloon dilatation was performed in 2 patients with surgical ASD repair and all 3 patients with ASO. Four of 6 patients (66.7%) in the surgical repair group required transesophageal echocardiography during transseptal puncture. The endpoint of the procedure, isolation of all PVs, was achieved in all 9 patients. None of the patients had evidence of an interatrial shunt or pericardial effusion at the end of the procedure. Total procedural time (123 ± 28 minutes vs. 63 ± 21 minutes, P = .024) and total fluoroscopy time (41 ± 5 minutes vs. 23 ± 8 minutes, P = .024) were significantly higher in the percutaneous closure group. Conclusions: In patients with ASO or surgical repair of ASD, CA of AF might be feasible, safe, and effective. The balloon dilatation of the interatrial septum (IAS) might assist transseptal access through the ASO or a surgically repaired thickened IAS.

Background and Objectives: Gestational hypertension (GH) is increasingly recognized as an early manifestation of maternal cardiovascular vulnerability. Ambulatory blood pressure monitoring (ABPM) enables the evaluation of circadian blood pressure behavior, and a non-dipping blood pressure pattern (NDBP), defined as a nocturnal systolic decline of <10%, has been associated with endothelial dysfunction, placental hypoperfusion, and adverse pregnancy outcomes. However, the prognostic value of NDBP for postpartum chronic hypertension (PPCHT) remains insufficiently explored. Materials and Methods: This retrospective observational study included 196 women with gestational hypertension beyond 20 weeks of gestation who underwent ABPM between 2013 and 2025. Patients were classified as dippers (≥10% nocturnal systolic decline) or non-dippers (<10%). The primary outcome was postpartum chronic hypertension, defined as a persistent office blood pressure ≥ 140/90 mmHg or continued antihypertensive therapy at 12-month follow-ups. Secondary outcomes included fetal growth restriction (FGR), preeclampsia, and hypertensive complications. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of PPCHT and FGR. Results: In the cohort, 124 women (63.3%) exhibited a non-dipping blood pressure pattern. At 12 months postpartum, 93 women (47.4%) developed chronic hypertension. Non-dipping was significantly more frequent among women with PPCHT compared with those that remained normotensive (75.3% vs. 52.4%). Non-dippers also demonstrated higher rates of fetal growth restriction and preeclampsia. In multivariable analysis, NDBP remained independently associated with PPCHT after adjustments for age and daytime blood pressure parameters. Furthermore, NDBP and elevated daytime systolic blood pressure were independent predictors of FGR. Conclusions: A non-dipping blood pressure pattern is highly prevalent in gestational hypertension and is independently associated with both fetal growth restriction and postpartum chronic hypertension. Incorporating ABPM-derived circadian blood pressure phenotyping into antenatal assessments may improve risk stratification and support targeted postpartum cardiovascular surveillance strategies.

Background: Whether the initial clip type selected during transcatheter edge-to-edge repair (TEER) of the mitral valve—grasping width and arm length—independently influences procedural and echocardiographic outcomes remains uncertain. Methods: We retrospectively analyzed 138 consecutive patients undergoing mitral TEER. The first implanted clip was classified as narrow standard-length (NT), long narrow-arm (XT), or long wide-arm (XTW). Determinants of initial clip selection and its association with procedural success (residual mitral regurgitation [MR] ≤ 1+), post-procedural transmitral gradient, and the need for ≥2 clips were assessed using multivariable logistic and linear regression. Results: Median age was 74.0 (66.0–80.0), 74.5 (66.0–82.5), and 75.0 (70.0–79.0) years, and median LVEF was 35.0% (30.0–50.0), 30.0% (25.0–45.0), and 40.0% (25.0–45.0), for the NT, XT, and XTW groups, respectively; 66% of patients overall were male. An XTW clip was implanted first in 61.6% of patients. XTW selection was independently associated with larger effective regurgitant orifice area, lower LVEF, longer posterior leaflet length, and secondary MR (all p < 0.05), whereas NT selection favored younger age, smaller orifice, and higher LVEF. After adjustment for these factors, no statistically significant independent association was detected between initial clip type and residual MR ≥2+, post-procedural transmitral gradient, or the need for additional clips (all p > 0.05); however, confidence intervals were wide. On univariable analysis, larger left atrial size and moderate-to-severe tricuspid regurgitation were associated with residual MR ≥ 2+, but neither remained significant after multivariable adjustment. Conclusions: Initial clip selection was associated with valve anatomy, LVEF and MR etiology. No statistically significant independent association between initial clip type and procedural or short-term echocardiographic outcomes was detected in this cohort. Given the observational design, confounding by indication, limited sample size and wide confidence intervals, clinically relevant effects cannot be excluded, and these findings do not establish the superiority or equivalence of any clip-selection strategy.