This systematic review and meta-analysis aims to evaluate the predictive value of total atrial conduction time (TACT) assessed by tissue Doppler echocardiography (PA-TDI) in atrial fibrillation (AF) recurrence in patients following a rhythm-control strategy. A systematic approach following Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines was applied in electronic databases (Pubmed, Cochrane Library, and Web of Science), supplemented by scanning through studies’ references. TACT was compared using a random-effects model and presented as a difference in means (MD). The primary endpoint was AF recurrence. Seven publications were included in this systematic review. The mean age of the patients ranged from 55 years to 72 years. Prolonged TACT was associated with AF recurrence [MD, 23.12 msec; 95% confidence interval (CI), 11.54–34.71; I ² = 95%]. Subgroup analysis showed that prolonged TACT was strongly associated with AF recurrence in persistent AF cohorts undergoing electrical cardioversion (MD, 26.56; 95% CI, 15.51–37.6; I ² = 86%), while in patients with paroxysmal AF (PAF) undergoing catheter ablation, the results were not statistically significant (MD, 11.48; 95% CI, −1.19 to 24.14; I ² = 90%). The summary area under the curve (sAUC) using a random-effects model was 0.89 (95% CI, 0.80–0.99). TACT is a valuable echocardiographic parameter that can predict AF recurrence in patients following a rhythm-control strategy. Protocol registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022353018

Cardiac implantable electronic devices (CIEDs) offer the benefit of remote monitoring and decision making and find particular applications in special populations such as the elderly. Less transportation, reduced costs, prompt diagnosis, a sense of security, and continuous real-time monitoring are the main advantages. On the other hand, less physician–patient interactions and the technology barrier in the elderly pose specific problems in remote monitoring. CIEDs nowadays are abundant and are mostly represented by rhythm control/monitoring devices, whereas hemodynamic remote monitoring devices are gaining popularity and are evolving and becoming refined. Future directions include the involvement of artificial intelligence, yet disparities of availability, lack of follow-up data, and insufficient patient education are still areas to be improved. This review aims to describe the role of CIED in the very elderly and highlight the merits and possible drawbacks.

Purpose of Review: Recently developed once-weekly basal insulin analogs, including insulin icodec and insulin efsitora alpha (efsitora), aim to improve treatment adherence and patient convenience compared with daily basal insulin. This systematic review and meta-analysis evaluated the efficacy and safety of once-weekly basal insulin analogs compared with daily basal insulin analogs in adults with type 2 diabetes mellitus (T2DM) and included 14 randomized controlled trials (RCTs), comprising 8,487 subjects. Recent Findings: Evidence supports that once-weekly basal insulin analogs achieve comparable glycemic control to daily basal insulin analogs in adults with T2DM, offering greater reductions in HbA1c and improvements in time in range, with a safety profile similar to that of daily insulin regimens. In our analysis, once-weekly basal insulin resulted in a greater reduction in HbA1c compared with daily basal insulin (mean difference [MD] -0.09%, 95% CI -0.15 to -0.03), greater improvements in time in range (TIR) (MD 1.86%, 95% CI 0.73 to 2.98) and higher odds of attaining an HbA1c < 7.0% (OR 1.32, 95% CI 1.07 to 1.63, I2 64.9%). Rates of level 2 or 3 hypoglycemia did not differ significantly. Summary: Once-weekly basal insulin provides glycemic control comparable to daily basal insulin, with modest improvements in glycemic outcomes and similar hypoglycemia risk. Its primary advantage lies in treatment simplification and reduced injection burden, supporting its role as a convenient alternative to daily basal insulin in adults with T2DM.

Background Although previous studies showed that atrial high-rate episodes (AHREs) are associated with a higher risk of developing incident atrial fibrillation (AF) and thromboembolic events, their clinical significance is still unclear. The purpose of this study was to define whether there is any clinical impact on the occurrence of ischemic and hemorrhagic events in patients with AHREs and initiation of oral anticoagulation (OAC). Methodology Patients with AHREs who had received cardiac implantable electronic devices (CIEDs, i.e., dual-chamber pacemaker [PM] or implantable cardioverter defibrillator [ICD]) were included in the study. OAC initiation was decided by the assistant doctor. Patients who received OACs comprised the OAC group, while patients who were not referred for OAC initiation were included in the control group. The primary endpoint was the time to the event of the occurrence of thromboembolic events (thromboembolic event-free survival). Results A total of 154 individuals (77 in each group) were enrolled in the study, with a mean age of 72.5 years. The mean follow-up period for the OAC group was 19.1 months and for the control group, 18.9 months (P = 0.9). Thromboembolic events were noticed only in seven patients. Six of them were in the control group, and only one in the OAC group (P = 0.05). Major bleeding events were noticed in five patients, one of whom was in the control group and the rest in the OAC group (P = 0.17). Conclusions OAC therapy in patients with AHREs was not associated with a significant difference in the risk of thromboembolic and bleeding events. Baseline patient characteristics and AHRE duration may be useful to intensify the monitoring and management of patients with AHREs. Bleeding events may be indicators of cancer in patients with AHREs receiving OACs.

Background and Objectives: The triglyceride–glucose (TyG) index is an accessible surrogate marker of insulin resistance and has been increasingly investigated for its prognostic relevance in cardiovascular disease. However, evidence regarding its predictive value for major adverse cardiovascular events (MACEs) in patients with acute coronary syndromes (ACSs) remains inconsistent. This study systematically assessed the association between TyG index and the risk of MACEs in individuals with ACS. Materials and Methods: Following PRISMA 2020 guidelines, PubMed, ScienceDirect, and ClinicalTrials.gov were searched through October 2025. Ten observational cohort studies including 32,751 ACS patients were analyzed. Studies reporting fully adjusted hazard ratios (HRs) for the association between TyG index and MACEs were eligible. A random-effects model was used to pool effect sizes expressed as adjusted HRs per 1-unit increase in the TyG index. Heterogeneity, sensitivity analyses, publication bias assessment, and meta-regression were conducted. Results: Higher TyG index values were significantly associated with increased MACE risk (pooled adjusted HR 1.45, 95% CI 1.25–1.68, I² = 80%). Leave-one-out analysis confirmed robustness. Meta-regression analysis suggested a stronger association in cohorts consisting exclusively of patients with type 2 diabetes mellitus, with a trend toward larger effect estimates in smaller studies, potentially contributing to the observed heterogeneity. Despite small-study effects, trim-and-fill-adjusted estimates remained significant (HR 1.26, 95% CI 1.05–1.52). Conclusions: An elevated TyG index is independently associated with higher MACE risk in ACS patients and may be considered as an additive metabolic risk marker in combination with established risk stratification tools, pending further prospective validation.