Introduction: Atrial fibrillation (AF) recurrence following pulmonary vein isolation (PVI) ablation has clinical significance. Identifying risk factors for AF recurrence is important. We investigated serum albumin (SA) levels (g/dL) as a prognostic factor for the recurrence of AF following cryoballoon PVI ablation. Methods: We included patients who underwent cryoballoon PVI ablation at our institution between the years 2013 and 2018. The primary outcome was recurrence of AF during follow up. Results: Our cohort consisted of 126 patients (67% males, mean age 61.8 ± 10.0 years). The pattern of AF amongst the cohort was paroxysmal in 62.5%, persistent in 25.4%, and longstanding persistent in 6.3%. Those with lower SA levels had a mean AF duration significantly less than those with higher SA levels (2.81 years, 7.34 years, and 6.37 years for SA levels of <3.8, 3.8–4.1, and ≥4.1, respectively; p = 0.003). Patients with lower SA levels were significantly more likely to have had more previous cardioversions and a larger left atrial area and volume. The mean follow-up was 380 days, in which the AF recurrence rate was 20.6%. Patients with lower SA level had significantly more AF recurrences (47.4%, 16.7%, and 2.2% for SA levels of <3.8, 3.8–4.1, and ≥4.1, respectively; p < 0.001). Upon multivariate analysis, an SA level < 3.8 was associated with a higher risk of AF recurrence (OR = 5.422 95% CI 1.134; 25.910; p < 0.001). Conclusion: SA levels were found to be a strong independent marker for AF recurrence following PVI ablation.

Background: Various hemodynamic changes occur following transcatheter aortic valve implantation (TAVI) that may impact therapeutic decisions. NICaS is a noninvasive bioimpedance monitoring system aimed at hemodynamic assessment. We used the NICaS system in patients with severe aortic stenosis (AS) to evaluate short‐term hemodynamic changes after TAVI. Methods and Results: We performed hemodynamic analysis using NICaS on 97 patients with severe AS who underwent TAVI using either self‐expandable (68%) or balloon‐expandable (32%) valves. Patients were more often women (54%) and had multiple comorbidities including hypertension (83%), coronary artery disease (46%), and diabetes (37%). NICaS was performed at several time points—before TAVI, soon after TAVI, at hospital discharge, and during follow‐up. Compared with baseline NICaS measurements, we observed a significant increase in systolic blood pressure and total peripheral resistance (systolic blood pressure 132±21 mm Hg at baseline versus 147±23 mm Hg after TAVI, P <0.001; total peripheral resistance 1751±512 versus 2084±762 dynes*s/cm ⁵ , respectively, P <0.001) concurrent with a decrease in cardiac output and stroke volume (cardiac output 4.2±1.5 versus 3.9±1.3 L/min, P =0.037; stroke volume 61.4±14.8 versus 56.2±15.9 mL, P =0.001) in the immediate post‐TAVI period. At follow‐up (median 59 days [interquartile range, 40.5–91]) these measurements returned to values that were not different from the baseline. A significant improvement in echocardiography‐based left ventricular ejection fraction was observed from baseline to follow‐up (55.6%±11.6% to 59.4%±9.4%, P <0.001). Conclusions: Unique short‐term adaptive hemodynamic changes were observed using NICaS in patients with AS soon after TAVI. Noninvasive hemodynamic evaluation immediately following TAVI may contribute to the understanding of complex hemodynamic changes and merits favorable consideration.

We examined whether thickness of the basal muscular interventricular septum (IVS), as measured by pre-procedural computed tomography (CT), could be used to identify the risk of conduction disturbances following transcatheter aortic valve replacement (TAVR). The IVS is a pivotal region of the electrical conduction system of the heart where the atrioventricular conduction axis is located. Included were 78 patients with severe aortic stenosis who underwent CT imaging prior to TAVR. The thickness of muscular IVS was measured in the coronal view, in systolic phases, at 1, 2, 5, and 10 mm below the membranous septum (MS). The primary endpoint was a composite of conduction disturbance following TAVR. Conduction disturbances occurred in 24 out of 78 patients (30.8%). Those with conduction disturbances were significantly more likely to have a thinner IVS than those without conduction disturbances at every measured IVS level (2.98 ± 0.52 mm vs. 3.38 ± 0.52 mm, 4.10 ± 1.02 mm vs. 4.65 ± 0.78 mm, 6.11 ± 1.12 mm vs. 6.88 ± 1.03 mm, and 9.72 ± 1.95 mm vs. 10.70 ± 1.55 mm for 1, 2, 5 and 10 mm below MS, respectively, P < 0.05 for all). Multivariable logistic regression analysis showed that pre-procedural IVS thickness (<4 mm at 2 mm below the MS) was a significant independent predictor of post-procedural conduction disturbance (adjOR 7.387, 95% CI: 2.003–27.244, P = 0.003). Pre-procedural CT assessment of basal IVS thickness is a novel predictive marker for the risk of conduction disturbances following TAVR. The IVS thickness potentially acts as an anatomical barrier protecting the underlying conduction system from mechanical compression during TAVR.

Sarcoidosis is a systemic inflammatory disease of unknown etiology, characterized by the presence of non-caseating granulomas in affected organs

Background: Preprocedural contrast-enhanced computed tomography (CT) is essential for planning Transcatheter Aortic Valve Implantation (TAVI), but concerns remain regarding contrast-induced (CI) acute kidney injury, especially in patients with chronic kidney disease. This study aimed to evaluate the incidence of CI-acute kidney injury following contrast-enhanced CT performed before TAVI. Methods: CI-acute kidney injury was defined according to the Kidney Disease—Improving Global Outcomes (KDIGO) guidelines. Nonionic, low-osmolality iodinated contrast material was used for all CT studies. The primary outcome was the incidence of CI-acute kidney injury post-CT. Secondary outcomes included the need for renal replacement therapy and the 30-day post-CT mortality rate. Results: Our study included 359 patients. The median age was 81, and 44% were males. Chronic kidney disease was present in 59.3% of patients, and the overall incidence of CI-acute kidney injury occurred in 24 patients (7%), without a significant difference between patients with and without baseline chronic kidney disease (4.8% vs. 8%, respectively; p = 0.331). Three consecutive creatinine tests within a median of 5.8 days showed that acute kidney injury occurred in only six patients (1.7%). No patients required new dialysis initiation within 30 days. Multivariable analysis did not identify baseline chronic kidney disease or IV contrast volume as independent predictors of CI-acute kidney injury. Conclusions: CI-acute kidney injury following pre-TAVI CT is low, even among patients with chronic kidney disease. Most cases were transient and did not require dialysis. Routine avoidance of CT due to chronic kidney disease may not be warranted.