Background The COVID-19 pandemic has disrupted healthcare systems across the world. The rate of acute coronary syndrome (ACS) admissions during the pandemic has varied significantly. Objectives The purpose of this study is to investigate the effect of the pandemic on ACS hospital admissions and to determine whether this is related to the number of COVID-19 cases in each country. Method Search engines including PubMed, Embase, Ovid and Google Scholar were searched from December 2019 to the 15 September 2020 to identify studies reporting ACS admission data during COVID-19 pandemic months in 2020 compared with 2019 admissions. Results A total of 40 studies were included in this multistudy analysis. They demonstrated a 28.1% reduction in the rate of admission with ACS during the COVID-19 pandemic period compared with the same period in 2019 (total of 28 613 patients in 2020 vs 39 225 in 2019). There was a significant correlation between the absolute risk reduction in the total number of ACS cases and the number of COVID-19 cases per 100 000 population (Pearson correlation=0.361 (p=0.028)). However, the correlation was not significant for each of the ACS subgroups: non-ST-elevation myocardial infarction (STEMI) (p=0.508), STEMI (p=0883) and unstable angina (p=0.175). Conclusion There was a significant reduction in the rate of ACS admission during the COVID-19 pandemic period compared with the same period in 2019 with a significant correlation with COVID-19 prevalence.

Sudden cardiac death (SCD) from ventricular arrhythmias (VAs) remains a leading cause of mortality worldwide. Traditional risk stratification, primarily based on left ventricular ejection fraction (LVEF) and other coarse metrics, often fails to identify a large subset of patients at risk and frequently leads to unnecessary device implantations. Advances in artificial intelligence (AI) offer new strategies to improve both long-term SCD risk prediction and near-term VAs forecasting. In this review, we discuss how AI algorithms applied to the 12-lead electrocardiogram (ECG) can identify subtle risk markers in conditions such as hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), and coronary artery disease (CAD), often outperforming conventional risk models. We also explore the integration of AI with cardiac imaging, such as scar quantification on cardiac magnetic resonance (CMR) and fibrosis mapping, to enhance the identification of the arrhythmogenic substrate. Furthermore, we investigate the application of data from implantable cardioverter-defibrillators (ICDs) and wearable devices to predict ventricular tachycardia (VT) or ventricular fibrillation (VF) events before they occur, thereby advancing care toward real-time prevention. Amid these innovations, we address the medicolegal and ethical implications of AI-driven automated alerts in arrhythmia care, highlighting when clinicians can trust AI predictions. Future directions include multimodal AI fusion to personalise SCD risk assessment, as well as AI-guided VT ablation planning through imaging-based digital heart models. This review provides a comprehensive overview for general medical readers, focusing on peer-reviewed advances globally in the emerging intersection of AI, VAs, and SCD prevention.

Aims: Atrioventricular node ablation (AVNA) with permanent pacemaker implantation is an established rate-control treatment approach for patients with AF with uncontrolled ventricular rates. Conduction system pacing (CSP) utilizing His bundle pacing (HBP) or left bundle branch area pacing (LBBAP) has advanced as a treatment alternative to standard right ventricular pacing in addition to biventricular pacing (BVP). This systematic review and meta-analysis aim to provide a comprehensive summary and evaluation of clinical outcomes in the literature for CSP in comparison to BVP in conjunction with AVNA. Methods and results: This study protocol was registered in the PROSPERO registry (CRD42024510974), and the review was conducted as per the PRISMA guidelines. Databases were searched for relevant studies from inception till 11 January 2024. Results were synthesized using a random effects meta-analysis. From a total of 259 references identified, 122 full texts were assessed, and 25 studies were included in the systematic review. Of these included studies, five were used for comparative meta-analysis. A total of 1652 (HBP 1069 and LBBAP 644) and 369 patients received CSP and BVP implantation with AVNA, respectively. Conduction system pacing resulted in a narrower QRS duration (QRSd) with a change of −35.8 ms (95% CI −61.8 to −9.72; P < 0.05; I2 = 96.3%) vs. BVP. Conduction system pacing also resulted in better symptomatic improvement in from of NYHA reduction (MD −0.53, 95% CI −1.01 to −0.04, I2 = 62.1; P = 0.03). For left ventricular ejection fraction, a non-significant weighted mean increases of 3.36% (95% CI −0.75–7.47%; P = 0.11, I2 = 68.5%) was observed following CSP implantation in comparison to BVP. Conduction system pacing showed no significant differences in procedural and fluoroscopy times and had comparable periprocedural complications. His bundle pacing demonstrated a non-significant reduction in the events of acute threshold elevation in comparison to BVP (Log odds ratio −0.69, 95% CI −2.05–0.66, I2 = 0.00; P = 0.32). Conclusion: Conduction system pacing with AVNA is a safe and feasible treatment option for symptomatic (AF) patients undergoing a pace and ablate strategy, offering an alternative to BVP. Overall, CSP results in a narrower QRS duration while providing comparable clinical and echocardiographic outcomes.

Takotsubo syndrome (TS), traditionally associated with emotional or physical stressors, manifests as transient left ventricular (LV) abnormalities mimicking acute coronary syndrome. Surgical procedures, such as pacemaker implantation, have emerged as potential TS triggers. Conduction system pacing (CSP), including His bundle pacing and left bundle branch area pacing (LBBAP), is a novel technique utilizing the heart's intrinsic conduction system. Despite documented cases of TS post-pacemaker implantation, the literature exploring the association between CSP and TS remains sparse. In a case involving a 62-year-old woman with 2:1 atrioventricular block, an uncomplicated de novo LBBAP procedure was followed by post-procedural dizziness and dyspnoea. An initial transthoracic echocardiography revealed moderate–severe LV dysfunction, accompanied by elevated troponin levels. Coronary angiography showed unobstructed coronary arteries, while left ventriculography exhibited a classic apical ballooning. The patient had a favourable recovery, with LV function improvement noted before discharge. Takotsubo syndrome may be triggered by other non-traditional physical stressors including traditional RV pacing and LBBAP. Clinicians should be aware of this potential, albeit rare, complication of LBBAP to ensure timely recognition and management. Increased awareness is vital for optimizing patient care during CSP procedures.