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This umbrella review synthesizes data from 17 meta-analyses investigating the comparative outcomes of catheter ablation (CA) and medical treatment (MT) for atrial fibrillation (AF). Outcomes assessed were mortality, risk of hospitalization, AF recurrence, cardiovascular events, pulmonary vein stenosis, major bleeding, and changes in left ventricular ejection fraction (LVEF) and MLHFQ score. The findings indicate that CA significantly reduces overall mortality and cardiovascular hospitalization with high strength of evidence. The risk of AF recurrence was notably lower with CA, with moderate strength of evidence. Two associations reported an increased risk of pulmonary vein stenosis and major bleeding with CA, supported by high strength of evidence. Improved LVEF and a positive change in MLHFQ were also associated with CA. Among patients with AF and heart failure, CA appears superior to MT for reducing mortality, improving LVEF, and reducing cardiovascular rehospitalizations. In nonspecific populations, CA reduced mortality and improved LVEF but had higher complication rates. Our findings suggest that CA might offer significant benefits in managing AF, particularly in patients with heart failure. However, the risk of complications, including pulmonary vein stenosis and major bleeding, is notable. Further research in understudied populations may help refine these conclusions. [ABSTRACT FROM AUTHOR]

Introduction: We assessed the effect of the pesticide regulations implemented in 2011 on suicide trend in Kerala state of India. Materials and methods: Data were collected from case records of suicide autopsies done in a single tertiary care hospital in Thrissur district of Kerala in 2001–2020. Linear trends in overall suicide rates were identified using joinpoint regression analysis. We used Poisson regression models to estimate the annual expected number of suicides in 2011–2020 and calculated the rate ratios between the observed number of suicide and that expected according to the linear pre-ban suicide trend (2005–2010). Results: There were a total of 14,593 suicide autopsies (2501 pesticide autopsies) in 2001-2020. Carbofuran was the commonest pesticide identified, followed by quinalphos, zinc phosphide, and chlorpyrifos. In 2011–2020, overall suicide rates were 22%–48% and pesticide suicide rates were 20%–55% lower than those expected according to pre-ban suicide trends (2005–2010), with the only exception of a 16% higher-than-expected pesticide suicide rate in 2011. There was no change in trend in hanging suicides. Conclusion: Lower-than-expected overall and pesticide suicide rates were found in Thrissur district after the 2011 bans of pesticides in Kerala, with no evidence of means replacement to hanging. [ABSTRACT FROM AUTHOR]