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Recommendations for Providing Feedback and Medical Reassurance Following Maximal-Graded Exercise Testing for Exercise Prescription in Cardiac Rehabilitation
No full textNursing News & Views - June 2025
Get PDFNursing News & Views - June 2025https://scholarlycommons.libraryinfo.bhs.org/nursing_newsletters/1045/thumbnail.jp
Safety and outcomes of pulsed field ablation in the management of supraventricular arrhythmia: A systematic review
No full textIntroduction: Pulsed field ablation (PFA) is an emerging non-thermal ablative technology that induces irreversible electroporation to selectively target cardiac tissue while minimizing damage to adjacent structures. While widely studied for atrial fibrillation, its role in managing supraventricular tachycardia (SVT) remains unclear. This systematic review aims to consolidate existing data on the safety and efficacy of PFA for SVT ablation.
Methods: A comprehensive literature search was conducted to identify studies reporting PFA outcomes in SVT. Inclusion criteria encompassed studies involving AVNRT, AVRT, and atrial tachycardia (AT). Data on procedural success, complications, and recurrence rates were extracted and analyzed. The review included 10 studies, comprising 3 case reports and 7 prospective studies, involving a total of 312 patients.
Results: PFA demonstrated a high acute procedural success rate of 97.6 %. Success rates varied by SVT type: AVNRT (99.8 %), AVRT (98.7 %), and AT (96.1 %). Transient atrioventricular (AV) block, primarily during slow pathway ablation for AVNRT, occurred in 19.3 % of cases, with most resolving within 24 h. No permanent AV block or major procedural complications were reported. Recurrence rates were 9.6 % overall after six months, with AT exhibiting a higher recurrence rate of 21.4 %. Challenges with lesion durability, particularly in linear ablations, were noted, sometimes requiring adjunctive radiofrequency catheter ablation (RFCA). PFA\u27s tissue selectivity proved beneficial in complex SVT cases near critical structures like the phrenic nerve and right atrial appendage, where RFCA posed higher complication risks.
Conclusions: PFA shows promise as an effective and safe alternative to RFCA for SVT, particularly in challenging anatomical locations. Despite its high acute success rates and favorable safety profile, concerns about lesion durability and recurrence-especially in AT-necessitate further investigation. Larger, multicenter studies with standardized protocols are essential to optimize outcomes and clarify PFA\u27s role in SVT ablation.
Keywords: Catheter ablation; Outcomes; Pulsed filed ablation; Supraventricular tachycardia
Functional neuroplasticity in chronic post-stroke aphasia following a singing intervention in a cross-over randomised trial
No full textGroup-based singing has been shown to improve language outcomes and induce structural neuroplasticity in chronic post-stroke aphasia (PSA). However, the functional neuroplasticity changes induced by such interventions remain unknown. Here our main aim was to determine these changes using a cross-over randomised trial. Nineteen patients with PSA were randomly allocated to a 4-month multicomponent singing-based intervention (singing group) or standard care (control group). With a pre-post design, we pooled data from both groups and analysed verbal learning and task-based fMRI activation of two novel songs (trained or untrained during intervention) at two time points (pre- and post-intervention). Post-intervention, patients with PSA produced more correct syllables from the trained song and for the trained relative to the untrained song. fMRI results revealed increased activation when singing along to the trained song in the right postcentral gyrus, and in the right posterior superior temporal gyrus (pSTG) when singing along to the trained vs. untrained song. Notably, right pSTG activation increases correlated with improved naming abilities. Collectively, these findings indicate that group-based singing is associated with verbal learning and induces functional neuroplasticity changes in the singing network, derived from demographically matched healthy controls, which are associated to improved naming abilities in chronic PSA. https://www.clinicaltrials.gov , Unique identifier: NCT03501797
Inflammatory pathways in transfusion-associated circulatory overload
No full textTransfusion-associated circulatory overload (TACO) is a leading cause of transfusion-associated mortality. TACO is thought to result from hydrostatic forces in the vascular space, leading to transudative pulmonary edema. Recent studies suggest that TACO is not solely a volume overload phenomenon, but may involve inflammatory processes. This study aimed to further explore the presence of inflammation in patients with TACO. We conducted a retrospective study with 3 cohorts receiving red blood cell transfusion: (1) patients having TACO as defined by a national hemovigilance case surveillance classification (conventional TACO [cTACO], n = 33); (2) patients having symptoms consistent with TACO but not completely meeting reporting criteria (institutional TACO [iTACO], n = 33); and (3) a patient cohort who experienced uncomplicated transfusions (n = 6). Samples from before transfusion, after transfusion, and 8 to 36 hours after transfusion were examined. Samples were analyzed for levels of tumor necrosis factor α, interleukin-1α (IL-1α), IL-6, IL-8, IL-10, C-reactive protein, intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1, atrial natriuretic peptide, cardiac troponin, and N-terminal pro-B-type natriuretic peptide. Patients with cTACO and iTACO had an elevated body temperature, higher heart rate, and lower oxygen saturation after transfusion, whereas only patients with cTACO had higher blood pressures. Levels of key proinflammatory cytokines, IL-6, and IL-8 were elevated in patients with cTACO and iTACO after transfusion, whereas ICAM-1 was elevated only in patients with iTACO after transfusion. Our results suggest that inflammatory pathways may be invoked in patients with TACO. Patients with iTACO showed a more distinctive inflammatory profile, suggesting a gray area between transfusion-related acute lung injury and TACO
Safety of cardioversion without anticoagulation in patients\u27 status post left atrial appendage occlusion: A systematic review and meta-analysis
No full textBackground: Direct current cardioversion (DCCV) is commonly used for rhythm control in atrial fibrillation (AF). Left atrial appendage occlusion (LAAO) provides stroke prevention in patients with contraindications to oral anticoagulation (OAC), but the safety of DCCV without periprocedural anticoagulation in this group remains uncertain.
Objective: To evaluate the safety of performing DCCV without systemic anticoagulation in patients with prior LAAO.
Methods: We conducted a systematic review and meta-analysis following PRISMA guidelines. PubMed, ScienceDirect, and the Cochrane Library were searched (January 2010-April 2025). Studies comparing outcomes of patients undergoing DCCV after LAAO, with versus without subsequent anticoagulation, were included. Primary outcomes were thromboembolic events and clinically significant bleeding. Odds ratios (ORs) were calculated using random-effects modeling, with heterogeneity assessed via I2 statistic.
Results: Five observational studies (1697 DCCV procedures; 965 patients receiving post-DCCV anticoagulation) met inclusion criteria. Thromboembolic events occurred in 3.8 % of patients without OAC versus 1.6 % with OAC, with no statistically significant difference (OR 0.48; 95 % CI 0.16-1.43; p = 0.19; I2 = 17 %). Clinically significant bleeding occurred in 4.1 % without OAC and 4.0 % with OAC, also without significant difference (OR 1.22; 95 % CI 0.75-2.00; p = 0.42; I2 = 0 %). Pre-DCCV imaging protocols varied widely among studies.
Conclusions: In selected patients post-LAAO with no device-related thrombus or significant peri-device leak, DCCV without subsequent anticoagulation demonstrated low thromboembolic and bleeding risks. These findings, derived from limited observational data, require confirmation by randomized controlled trials.
Keywords: Anticoagulation; Direct current cardioversion (DCCV); Left atrial appendage occlusion (LAAO); Stroke prevention
Declining myocardial infarction mortality in young and middle-aged Americans and impact of COVID-19 pandemic
No full textBackground: Acute myocardial infarction (AMI) is a leading cause of cardiovascular disease (CVD) mortality among young and middle-aged individuals in the United States (US). Though AMI mortality overall has been decreasing in the US, contemporary trends in AMI-related mortality in the young and middle-aged population and the impact of the COVID-19 pandemic on these trends are unknown.
Methods: The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database was used to analyze death certificates from 1999 to 2023 for AMI-related deaths among the US population aged 25-64. Age-adjusted mortality rates (AAMRs) per 100,000 people and associated annual percent changes (APCs) were calculated using Joinpoint regression analysis. Mortality trends were stratified by sex, race/ethnicity, census region, and state for comparative analysis.
Results: From 1999 to 2023, there were 970,454 AMI-related deaths among U.S. adults aged 25-64 years. The annual number of AMI-related deaths decreased from 44,040 in 1999 to 31,522 in 2023. The overall AAMR per 100,000 decreased from 31.02 deaths (95 % confidence interval [CI] 30.73-31.31) in 1999 to 15.29 (95 % CI 15.11-15.46) in 2023 (average APC -2.92 %, 95 % CI -3.22 to -2.75). The AAMR per 100,000 declined at a faster rate from 31.02 in 1999 to 19.57 in 2010 (1999-2010, APC -4.26), followed by a slower rate from 19.57 in 2010 to 16.67 in 2019 (2010-2019, APC -1.41). The declining trend was disrupted by a transient increase during the COVID-19 pandemic, with a peak AAMR of 19.73 (95 % CI, 19.53 to 19.93) in 2021 (2019-2021, APC 8.52). The declining trend resumed from 2021 to 2023, with AAMR decreasing to its lowest levels of 15.29 in 2023 (2021-2023, APC -12.58). Heterogeneity across demographic and regional groups narrowed during these 25 years. However, disparities are still prevalent, with men, non-Hispanic (NH) Black or African American, American Indian or Alaska Native, and residents of the Southern United States having higher mortality rates.
Conclusion: AMI-related mortality declined significantly from 1999 through 2023 in the young and middle-aged population of the US. AMI-related mortality rates increased transiently during the COVID-19 pandemic, but the declining trend resumed in 2022. Differences across demographic and regional subgroups narrowed; however, disparities remain prevalent and require comprehensive efforts to improve cardiovascular health, outcomes, and health equity among the young and middle-aged populations of the US.
Keywords: Acute myocardial infarction; COVID-19 pandemic; Healthcare disparities; Mortality; United States; Young population
National Trends in Antibiotic Prescribing for Adults Hospitalized With Coronavirus Disease 2019 and Other Viral Respiratory Infections
No full textBackground: Significant concerns have been raised regarding the overuse of antibiotics among patients hospitalized for coronavirus disease 2019 (COVID-19) and the broad impact of the pandemic on antimicrobial stewardship in acute care. We sought to compare potentially unnecessary antibiotic prescribing over time among patients admitted with symptomatic COVID-19 and non-COVID-19 viral acute respiratory tract infections (ARTIs).
Methods: We conducted a repeated cross-sectional analysis of the monthly antibiotic prescribing rate from March 2020 to December 2023 for COVID-19 admissions and from January 2019 to December 2023 for other viral ARTI admissions to 803 acute care hospitals in the United States that contributed data to the Premier Healthcare Database. Our primary outcome was the receipt of ≥1 dose of an antibiotic during the first 5 days of the admission. Secondary outcomes included days and duration of antibiotic therapy.
Results: This study included 513 698 COVID-19 and 106 932 non-COVID-19 viral ARTI admissions from March 2020 to December 2023. At the onset of the pandemic, \u3e80% of patients admitted for COVID-19 received antibiotics, and antibiotic prescribing for other viral ARTIs increased to nearly 70%. Antibiotic prescribing for these viral infections declined over time, with prescribing for COVID-19 stabilizing around 35% in 2022-2023 and prescribing for other viral ARTIs returning to 2019 seasonal patterns in 2023, with average monthly prescribing around 50%.
Conclusions: Despite improvements since the early part of the COVID-19 pandemic, potentially unnecessary antibiotic prescribing for inpatients with COVID-19 and non-COVID-19 viral ARTIs remains an important antibiotic stewardship target.
Keywords: COVID-19; antibiotic stewardship; pandemic; prescribing trends; respiratory viruses