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Abstract: Background: Corrected QT interval (QTc) on the electrocardiogram is a marker of ventricular repolarization. Recent studies have examined its value in predicting the occurrence of atrial fibrillation (AF). Methods and results: We conducted a meta‐analysis to determine whether alterations in QTc interval are associated with an increased risk of incident AF. The PUBMED and EMBASE databases were searched for all studies that evaluated the incident AF associated with prolonged QTc interval published before December 2016. Sensitivity and subgroup analysis were subsequently performed. A total of six studies including eight data sets for prolonged QTc interval were eligible. Subjects with prolonged QTc interval as a categorical variable had a significantly higher risk of AF during follow‐up (hazard ratio [HR]: 1.16; 95% confidence interval [CI], 1.09–1.24, I2 = 90%) based on Bazett formula. In continuous variable analysis, we found a statistically significant risk for AF (HR, 1.17; 95% CI, 1.09–1.25; I2 = 0) every 10‐ms prolongation in QTc. AF type, QTc cut‐off value, geographical location, follow‐up duration, and study population may be the possible reasons for the significant heterogeneity among the studies. Conclusions: Prolonged QTc interval is associated with an increased risk of AF. And the potential mechanisms underlying this cause‐and‐effect relationship need further investigation. [ABSTRACT FROM AUTHOR]

Background Frailty has been identified as a risk factor for adverse clinical outcomes after cardiac intervention or surgery. However, whether it increases the risk of adverse outcomes in patients undergoing left ventricular assist device (LVAD) therapy has been controversial. Therefore, we conducted a systematic review and meta-analysis of the frailty measures and clinical outcomes of length of stay and mortality in this setting. Methods PubMed and Embase were searched until September 11, 2017, for studies evaluating the association between frailty and clinical outcomes in advanced heart failure patients undergoing LVAD implantation. Results A total of 46 and 79 entries were retrieved from our search strategy. A total of 13 studies involving 3435 patients were included in the final meta-analysis (mean age: 57.7 ± 15.3 years; 79% male, follow-up duration was 13 ± 14 months). Compared to nonfrail patients (n = 2721), frail patients (n = 579) had significantly longer time-to-extubation (n = 3; mean difference: 45 ± 6 hours; I 2 : 0%) and hospital length of stay (n = 4; mean difference: 2.9 ± 1.2 days; P = .001; I 2 : 21%). Frailty was not a predictor of inpatient or short-term mortality [n = 3; hazard ratio (HR): 1.22, 95% confidence interval (CI): 0.66-2.26; P > .05; I 2 : 0%] but predicted long-term mortality (n = 7; HR: 1.44, 95% CI: 1.15-1.80; P = .001; I 2 : 0%). Conclusions Frailty leads to significantly longer time to extubation, hospital length of stay, and long-term mortality in advanced heart failure patients who have undergone LVAD implantation. Older patients being considered for LVAD implantation should therefore be assessed for frailty status. The risk and benefit of the procedure should be explained to the patient, emphasizing that frailty increases the likelihood of adverse clinical outcomes. [ABSTRACT FROM AUTHOR]

Background Frailty has been identified as a risk factor for mortality. However, whether frailty increases mortality risk in patients undergoing percutaneous coronary intervention (PCI) has been controversial. Therefore, we conducted a systematic review and meta-analysis of the frailty measures and mortality outcomes in this setting. Methods PubMed and EMBASE were searched until July 23, 2017 for studies evaluating the association between frailty measures and mortality in individuals who have undergone PCI. Results A total of 141 entries were retrieved from our search strategy. A total of 8 studies involving 2332 patients were included in the final meta-analysis (mean age: 69 years; 68% male, follow-up duration was 30 ± 28 months). Frailty was a significant predictor of all-cause mortality after PCI, with a hazard ratio (HR) of 2.97 [95% confidence interval (CI) 1.56–5.66, P = .001]. This was substantial heterogeneity present ( I 2 : 79%). Subgroup analysis using the Fried score reduced I 2 to 68% without altering the pooled HR (2.78, 95% CI 1.02–7.76; P < .05). Using the Canadian Study of Health and Aging Clinical Frailty Scale reduced I 2 to 0% while preserving the pooled HR (5.99, 95% CI 2.77–12.95, P < .001). Conclusions Frailty leads to significantly higher mortality rates in patients who have undergone PCI. Both the Fried score and Canadian Study of Health and Aging Clinical Frailty Scale are powerful predictors of mortality. These findings may support the notion that an alternative to invasive strategy should be considered in frail patients who are indicated for revascularization. [ABSTRACT FROM AUTHOR]

Background and objectives Inter-atrial block (IAB) is characterized by a delay of inter-atrial conduction and is defined electrocardiographically by a P-wave duration (PWD) > 120 ms. Several studies have implicated IAB in the development of new onset atrial fibrillation (AF), whereas others have reported no significant associations. Moreover, there has been no systematic evaluation of the predictive value of IAB in AF recurrence. Therefore, we conducted a systematic review and meta-analysis to examine whether IAB predicts new onset AF or AF recurrence. Methods PubMed and Embase databases were searched through 30th July 2017 for studies investigating the relationship between IAB and AF. Results The initial search identified 260 studies, of which 16 studies met the inclusion criteria. This meta-analysis included 18,204 patients (mean age 56 ± 13, 48% male) with a mean follow-up period of 15.1 years. IAB significantly predicted new onset AF (hazard ratio [HR]: 2.42, 95% confidence interval [CI]: 1.44 to 4.07, P = 0.001; 84%). For partial IAB, the risk of new onset AF did not reach statistical significance (HR: 1.42, 95% CI: 0.85 to 2.34; P = 0.18; I 2 = 13%). Contrastingly, advanced IAB was a significant predictor of new onset AF with a pooled HR of 2.58 (95% CI: 1.35 to 4.96; P < 0.01; I 2 = 67%). IAB also predicted AF recurrence after ablation (HR: 2.59, 95% CI: 1.35 to 4.96; P < 0.01; I 2 = 67%). Conclusions IAB is a significant predictor of both new onset AF and AF recurrence. [ABSTRACT FROM AUTHOR]

Abstract Objective Frailty is a known risk factor for adverse outcomes after cardiac interventions. However, the extent to which it increases the likelihood of adverse outcomes in heart failure (HF) patients remains unexplored. Therefore, we conducted this systematic review and meta-analysis to quantify the impact of frailty on prognosis in this patient population. Design Meta-analysis. Setting and Participants PubMed and Embase were searched for studies that investigated the relationship between frailty and outcomes in patients with HF. The search period was from the beginning of the databases through to December 3, 2017. Measures A total of 342 and 919 entries were retrieved from PubMed and Embase, respectively. Of these, 20 met our inclusion criteria and were therefore included. Results Frailty significantly increased the risk of all-cause mortality [hazard ratio (HR) = 1.59, 95% confidence interval (CI) = 1.39-1.82, P <.0001, I2 = 55%] and hospitalizations (HR = 1.31, 95% CI = 1.21-1.42, P <.0001, I2 = 0%). Moreover, it was predictive of all-cause mortality after ventricular assist device implantation for advanced HF (HR = 1.62, 95% CI = 1.35-1.94, P <.0001, I2 = 2%). Conclusions/Implications: Frailty is a significant predictor of all-cause mortality and hospital readmissions in HF. Assessment and close monitoring of frailty status of heart failure patients can potentially better guide clinical management of this population. [ABSTRACT FROM AUTHOR]