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Objective: The relationship between different glycaemic variability (GV) indexes and adverse cardiovascular outcomes is not well understood. This study aims to determine whether GV is related to the occurrence of adverse cardiovascular events in patients with acute coronary syndrome (ACS). Methods: PubMed, EMBASE, and Web of Science were comprehensively searched from the establishment of databases to 29 June 2022. The relationship between two important GV indexes, including the mean amplitude of glycemic excursion (MAGE) and standard deviation (SD), and the adverse cardiovascular events in ACS patients were evaluated, respectively. Results: A total of 11 studies with 3709 ACS patients were included. Pooled results showed that patients with higher GV had significantly increased risk of adverse cardiovascular events, including MAGE (relative risk [RR] = 1.76, 95% CI: 1.40 to 2.22, p < 0.001, I2 = 25%) and SD (RR = 2.14, 95% CI: 1.73 to 2.66, p < 0.001, I2 = 0%). Conclusions: Increased GV is related to the poor prognosis in patients with ACS. Additionally, more well-designed studies comparing different indicators of GV with adverse cardiovascular events in ACS patients are still warranted. [ABSTRACT FROM AUTHOR]

Background: His‐Purkinje conduction system pacing (HPCSP) has emerged as an effective alternative to overcome the limitations of right ventricular pacing (RVP) via physiological left ventricular activation, but there remains a paucity of comparative information for His bundle pacing (HBP) and left bundle branch pacing (LBBP). Methods: A Bayesian random‐effects network analysis was conducted to compare the relative effects of HBP, LBBP, and RVP in patients with bradycardia and conduction disorders. PubMed, Embase, Cochrane Library, and Web of Science were systematically searched from database inception until September 21, 2021. Results: Twenty‐eight studies involving 4160 patients were included in this meta‐analysis. LBBP significantly improved success rate, pacing threshold, pacing impedance, and R‐wave amplitude compared with HBP. LBBP also demonstrated a nonsignificant trend towards superior outcomes of lead complications, heart failure hospitalization, atrial fibrillation, and all‐cause death. However, HBP was associated with significantly shorter paced QRS duration relative to LBBP. Despite higher success rates, shorter procedure/fluoroscopy duration, and fewer lead complications, patients receiving RVP were more likely to experience reduced left ventricular ejection fraction, longer paced QRS duration, and higher rates of heart failure hospitalization than those receiving HPCSP. No statistical differences were observed in the remaining outcome measures. Conclusions: This network meta‐analysis demonstrates the efficacy and safety of HPCSP for the treatment of bradycardia and conduction disorders, with differences in pacing parameters, electrophysiology characteristics, and clinical outcomes between HBP and LBBP. Larger‐scale, long‐term comparative studies are warranted for further verification. [ABSTRACT FROM AUTHOR]

Background: Combined ablation and left atrial appendage closure (LAAC) is an alternative for atrial fibrillation patients with a high risk of stroke. However, the long‐term outcomes of this combined procedure remain elusive. Methods: PubMed, Embase, Cochrane Library, and Web of Science were systematically searched from the establishment of databases to 1 January 2021. Studies on the long‐term (defined as a mean follow‐up of approximately 12 months or longer) efficacy and safety outcomes of combined ablation and LAAC were included. Results: A total of 16 studies comprising 1428 patients were enrolled. The pooled long‐term freedom rate from atrial arrhythmia was 0.66 (95% confidence interval [CI]: 0.59–0.71), long‐term successful rate sealing of LAAC was 1.00 (95% CI: 1.00–1.00), and ischemic stroke/transient ischemic attack/systemic embolism during follow‐up was 0.01 (95% CI: 0.00–0.02). Meanwhile, of the periprocedural adverse events, phrenic nerve palsy, intracoronary air embolus, device embolization, and periprocedural death had a rate of 0.00 (95% CI: 0.00–0.00), procedure‐related bleeding events of 0.03 (95% CI: 0.02–0.04), and pericardial effusion requiring or not requiring intervention of 0.00 (95% CI: 0.00–0.01). Moreover, for the long‐term adverse events, device dislocation, intracranial bleeding, pericardial effusion requiring or not requiring intervention, and all‐cause mortality had a rate of 0.00 (95% CI: 0.00–0.00), device embolization of 0.01 (95% CI: 0.00–0.01), and other bleeding events of 0.01 (95% CI: 0.00–0.03). Conclusion: This meta‐analysis suggests that the combined atrial ablation and LAAC is an effective and safe strategy with long‐term benefits. [ABSTRACT FROM AUTHOR]

Cardiac resynchronization therapy with or without a defibrillator (CRT(D)) and implantable cardioverter defibrillator (ICD) may reduce the risk of arrhythmia or heart failure‐specific mortality and improves the prognosis of patients with chronic kidney disease (CKD) or dialysis. The aim of this study was to perform a meta‐analysis investigating the relationship between CRT(D)/ICD and renal insufficiency. Cochrane Library, Web of Science, Embase, and Pubmed were systematically searched from inception to 29 October 2019. We included studies that report all‐cause mortality of patients with renal insufficiency who received CRT(D)/ICD therapy. Twenty‐six studies (n = 119,263) were included, exploring the relationship between CRT(D)/ICD and renal insufficiency from two aspects: (1) Compared with ICD‐only, CRT(D) was associated with lower risk of all‐cause mortality in CKD patients (odds ratios (OR) = 0.67; 95% confidence interval (CI), 0.60 to 0.75). For non‐primary prevention (secondary prevention or both), the analysis revealed a lower risk of all‐cause mortality in the ICD group than in the no‐ICD group (OR = 0.47; 95% CI, 0.40 to 0.55). (2) CKD increased all‐cause mortality in comparison with control group (OR = 2.12; 95% CI, 1.85 to 2.44), and so did dialysis (OR = 2.53; 95% CI, 2.34 to 2.73). Furthermore, compared with CKD3 (eGFR: 30‐59 ml/min/1.73 m2), CKD4/5 (eGFR <30 ml/min/1.73 m2) was observed to have a significantly higher risk of all‐cause mortality (OR = 2.70; 95% CI, 1.93 to 3.80). This review shows a clear association between CRT(D)/ICD and renal insufficiency in the aspect of all‐cause mortality, and may provide a reference for the clinical application of CRT(D)/ICD. [ABSTRACT FROM AUTHOR]

Aims: His‐Purkinje system pacing has been demonstrated as a synchronized ventricular pacing strategy via pacing His‐Purkinje system directly, which can decrease the incidence of adverse cardiac structure alteration compared with right ventricular pacing (RVP). The purpose of this meta‐analysis was to compare the effects of His‐Purkinje system pacing and RVP in patients with bradycardia and cardiac conduction dysfunction. Methods: PubMed, Embase, Cochrane Library, and Web of Science were systematically searched from the establishment of databases up to 15 December 2019. Studies on long‐term clinical outcomes of His‐Purkinje system pacing and RVP were included. Chronic paced QRS duration, chronic pacing threshold, left ventricular ejection fraction (LVEF), left ventricular end‐diastolic volume (LVEDV), left ventricular end‐systolic volume (LVESV), all‐cause mortality, and heart failure hospitalization were collected for meta‐analysis. Results: A total of 13 studies comprising 2348 patients were included in this meta‐analysis. Compared with RVP group, patients receiving His‐Purkinje system pacing showed improvement of LVEF (mean difference [MD], 5.65; 95% confidence interval [CI], 4.38‐6.92), shorter chronic paced QRS duration (MD, − 39.29; 95% CI, − 41.90 to − 36.68), higher pacing threshold (MD, 0.8; 95% CI, 0.71‐0.89) and lower risk of heart failure hospitalization (odds ratio [OR], 0.65; 95% CI, 0.44‐0.96) during the follow‐up. However, no statistical difference existed in LVEDV, LVESV and all‐cause mortality between the two groups. Conclusion: Our meta‐analysis suggests that His‐bundle pacing is more suitable for the treatment of patients with bradycardia and cardiac conduction dysfunction. [ABSTRACT FROM AUTHOR]