Left atrial diameter (LAD) has been considered an independent risk factor for atrial fibrillation (AF) relapse after pulmonary vein isolation (PVI). However, whether LAD or other factors are more predictive of late recurrence in patients with paroxysmal AF remains unclear. We aimed to evaluate the value of pulmonary vein (PV) parameters for predicting AF relapse 1 year after patients underwent cryoablation for paroxysmal AF. Ninety-seven patients with paroxysmal AF who underwent PVI successfully were included. PV parameters were measured through computed tomography scans prior to PVI. A total of 28 patients had recurrence of AF at one-year follow-up. The impact of several variables on recurrence was evaluated in multivariate analyses. LAD and the time from first diagnosis of AF to ablation maintained its significance in predicting the relapse of AF after relevant adjustments in multivariate analysis. When major diameter of right inferior pulmonary vein (RIPV) (net reclassification improvement (NRI) 0.179, CI=0.031–0.326, P<0.05) and cross-sectional area (CSA) of RIPV (NRI: 0.122, CI=0.004–0.240, P<0.05) entered the AF risk model separately, the added predictive capacity was large. The accuracy of the two parameters in predicting recurrence of AF were not inferior (AUC: 0.665 and 0.659, respectively) to echocardiographic LAD (AUC: 0.663). The inclusion of either RIPV major diameter or CSA of RIPV in the model increased the C-index (0.766 and 0.758, respectively). We concluded that major diameter of RIPV had predictive capacity similar to or even better than that of LAD for predicting AF relapse after cryoablation PVI.

Background: Patients with ST‐segment elevation myocardial infarction (STEMI) may have higher hospitalization costs and poorer prognosis than non‐ST‐segment elevation myocardial infarction (NSTEMI).Methods: A single‐center retrospective study was conducted on 758 STEMI patients and 386 NSTEMI patients from January 1, 2020 to May 30, 2023 aimed to investigate the differences in cost and mortality.Results: STEMI patients had higher maximal troponin I (15,222.5 (27.18, 40,000.00) vs. 2731.5 (10.73, 27,857.25), p < 0.001) and lower left ventricular ejection fraction (LVEF) (56% (53%, 59%) vs. 57% (55%, 59%), p < 0.001) compared to NSTEMI patients. The clinical symptoms were mainly persistent or interrupted chest pain/distress in either STEMI or NSTEMI patients. STEMI patients had a significantly higher risk of combined hypotension than NSTEMI patients (8.97% vs. 3.89%, p = 0.002), and IABP was much more frequently used in the STEMI group with a statistical difference (2.90% vs. 0.52%, p = 0.015). STEMI patients have statistically higher hospitalization costs (RMB, ¥) (31,667 (25,337.79, 39,790) vs. 30,506.91 (21,405.96, 40,233.75), p = 0.006) and longer hospitalization days (10 (8, 11) vs. 9 (8, 11), p = 0.001) compared to NSTEMI patients. Although in‐hospital mortality was higher in STEMI patients, the difference was not statistically significant (3.56% vs. 2.07%, p = 0.167). Multivariable logistic regression was performed and found that systolic blood pressure and NT‐proBNP were risk factors for patient death (OR ≥ 1).Conclusion: STEMI patients are more likely comorbid cardiogenic shock, heart failure complications with higher hospitalization costs and longer hospitalization days. And relatively more use of acute mechanical circulatory support devices such as IABP.Trial Registration: ChiCTR2300077885

Compared with paroxysmal atrial fibrillation, persistent atrial fibrillation (AF) is more harmful and difficult to treat, and the efficacy of different catheter ablation for both also varies greatly. So this study aimed to systematically evaluate the efficacy and safety of cryoballoon (CB) and radiofrequency (RF) ablation in the treatment of persistent AF. We searched the PubMed, Embase, and Cochrane library databases for studies comparing the efficacy and safety between CB and RF ablation for persistent AF. All included studies met our inclusion criteria. A total of 11 studies, 2551 patients were enrolled in this study, including 1256 patients in CB group and 1295 patients in RF group. Meta-analysis results showed that the freedom from atrial tachyarrhythmia (ATA) recurrence was similar between the CB and RF groups (OR 1.00, 95% CI 0.85 to 1.18, I² 16%). The results of repeated ablation events in the two groups were similar (OR 0.85, 95% CI 0.64 to 1.12, I²45%), while the operative time in the CB group was shorter than that in the RF group (mean reduction 45.27 min, 95% CI 61.34 to 29.20 min, I² 95%). There was no significant difference in fluoroscopy time between the two groups (mean difference 2.12 min, 95% CI 7.83 to 12.07 min, I² 99%). The incidence of total complications was similar between the two groups (OR 1.08, 95% CI 0.74 to 1.58, I² 0%), but phrenic nerve palsy (PNP) was more likely to occur in the CB group (OR 4.84, 95% CI 1.84 to 12.71, I² 0%). The incidence of pericardial tamponade was not statistically different between the two groups (OR 0.72, 95% CI 00.32 to 1.58, I² 0%). CB can be used as an alternative therapy to RF for persistent AF, both of which have considerable efficacy and safety. CB can significantly reduce the operation time with the probability of high PNP.

Pheochromocytoma (PHEO) is a rare and complex molecularly driven endocrine disease that can present with a variety of clinical manifestations, including paroxysmal hypertension, episodic anxiety, tremors, devastating acute heart failure and acute pulmonary edema. The variety of PHEO-related symptoms increase the difficulty of identifying and diagnosing PHEO. We reported a case of a 27-year-old Chinese male was diagnosed PHEO by CT scan because of upper abdominal pain. The patient complicated with hypertensive crisis and headache following his admission, and he was underwent adrenal tumor surgical resection by carrying out appropriate clinical, laboratory and radiological imaging. Thus, the patient's PHEO-related symptoms were relieved and the blood pressure returned to normal, and discharged from the hospital with a follow-up plan. Although the PEHO-related symptoms are varied and difficult to diagnose, CT examination can be used for the preliminary detection and diagnosis. This case report emphasizes the importance of considering PHEO by CT scan and atypical symptoms, which help others better understand PHEO for early detection and timely surgical treatment to reduce catecholamine-related complications.

Standardized construction of China Chest Pain Center improves outcomes in patients with acute ST-segment elevation myocardial infarction (STEMI). A total 778 patients with a definite diagnosis of STEMI who underwent percutaneous coronary intervention (PCI) in our hospital from March 2017 to November 2022 were selected. Among them, 194 patients admitted from March 2017 to December 2019 were included as the pre-continuous improvement period (control group), and 584 patients admitted from January 2020 to November 2022 were included as the continuous improvement period (study group). Major quality control indicators were compared between the 2 groups. In continuous improvement period, the time of electrocardiograph (ECG) diagnosis, time of dual antiplatelet drug administration, troponin I return time, catheter activation time, and door to wire (D2W) were all significantly shorter than those in the pre-continuous improvement period (P < .05). The reperfusion rate of patients in the continuous improvement period was 98.12%, which was significantly higher than that in the pre-continuous improvement period (92.78%; P < .001). The mortality rate of STEMI patients in continuous improvement period was 3.42%, lower than 4.64% in the pre-continuous improvement period with no statistical difference (P = .439). Age, previous history of coronary artery disease, and high Killip class (Killip III–IV) were derived as independent risk factors for death by logistic regression analysis (OR＞1, P < .05). Continuous improvement of the chest pain center can effectively shorten the treatment time of STEMI patients, improve the reperfusion rate, and improve myocardial blood supply by restoring TIMI blood flow as early as possible.

Introduction: Sinus of Valsalva aneurysm (SOVA), a rare cardiac malformation, is usually congenital and rarely acquired and most commonly occurring in the right coronary sinus. The clinical presentation of patients with SOVA varies. It is usually asymptomatic when it has not ruptured, and when it compresses neighboring structures or ruptures, it can lead to heart failure or shock, at which point urgent surgical intervention is usually required. Rupture of the sinus of Valsalva aneurysm (RSOVA) during pregnancy is really hard to come by, especially if the clinical presentations resemble that of an acute myocardial infarction. This report describes a pregnant woman with severe chest pain and hypotension with aVR and V1 ST-segment elevation due to RSOVA. Patient concerns: Effects of RSOVA on the fetus, disease survival, and prognosis. Diagnosis: RSOVA. Interventions: Open SOVA repair. Outcomes: The patient’s blood pressure returned to normal range and clinical symptoms disappeared after the surgery. After 3 months of follow-up, the patient was hemodynamically stable without chest discomfort, and an echocardiogram showed a normal aortic sinus. Conclusion: Progressive aneurysm dilatation or rupture has a poor prognosis. A thorough history and physical examination are fundamental, with echocardiography being the initial diagnostic tool of choice, and other ancillary tests (e.g., computed tomography) being used to complement and confirm the diagnosis. Surgery remains the current treatment of choice for patients with RSOVA, while the continuation of pregnancy in pregnant patients with RSOVA remains a case-by-case measure.