Browsing by Autor "Ashish Kumar"

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Abstract 4145634: Clinical Outcomes of Catheter Ablation for Atrial Fibrillation in Younger Adults: A Systematic Review and Meta-Analysis
(Lippincott Williams & Wilkins, 2024) Sawai Singh Rathore; Ameer Mustafa Farrukh; Sem Josue Nsanh Yao; Vanessa Vidaurre Corrales; Zario Wint; Ibrahim Al Shyyab; Aman Goyal; Hritvik Jain; Ashish Kumar
Background: Catheter ablation has been increasingly used for managing atrial fibrillation (AF), to restore and maintain normal sinus rhythm. Despite its widespread use, it is unclear if there are differences in clinical outcomes, particularly in maintaining rhythm control and safety outcomes, between younger and older adults undergoing catheter ablation. The objective of this meta-analysis was to compare the outcomes following catheter ablation in younger and older adults. Methods: A comprehensive literature search was conducted using the PubMed, Embase, and Google Scholar databases. Using random effect models, mantel-Haenszel odds ratios and associated 95% confidence intervals were calculated to report the overall effect size. The primary endpoints were AF/atrial tachycardia (AT) recurrence and re-ablation requirement. Secondary outcomes included in-hospital complications such as stroke/TIA, cardiac tamponade/pericardial effusion, and vascular complications such as bleeding, hematoma, AV fistula, and femoral pseudoaneurysm. The young adult group varied between studies, ranging from under 30 years to under 45 years. Results: Data from 10 articles, with a sample size of about 126,141 AF patients, were considered. Our analysis indicated that catheter ablation for AF in the younger age group was linked to reduced odds of AF/AT reoccurrence (OR: 0.60; 95% CI: 0.44 to 0.83; p=0.002) and a decreased need for re-ablation after the index procedure (OR: 0.72; 95% CI: 0.53 to 0.97; p=0.03). Furthermore, catheter ablation in younger adults was found to be associated with a lower risk of in-hospital procedural complications like stroke/TIA (OR: 0.59; 95% CI: 0.43 to 0.80; p=0.0008) and cardiac tamponade/pericardial effusion (OR: 0.53; 95% CI: 0.42 to 0.68; p<0.0001). There was no difference between the two groups concerning vascular complications during the procedure (OR: 0.60; 95% CI: 0.28 to 1.27; p=0.18). Conclusion: This meta-analysis demonstrates that younger adults undergoing catheter ablation for atrial fibrillation reported significantly better clinical outcomes than older adults.
Abstract 4145690: Impact of Sodium-Glucose Cotransporter 2 Inhibitors on Atrial Fibrillation Recurrence After Catheter Ablation in Patients with Diabetes: A Systematic Review and Meta-Analysis
(Lippincott Williams & Wilkins, 2024) Sawai Singh Rathore; Ibrahim Al Shyyab; Ameer Mustafa Farrukh; Hamam Aneis; Sem Josue Nsanh Yao; Vanessa Vidaurre Corrales; Zario Wint; Ashish Kumar
Background: Sodium-glucose cotransporter 2 (SGLT2) inhibitors have demonstrated cardiovascular benefits beyond glycemic control, including potential anti-arrhythmic effects. The impact of SGLT2 inhibitors on atrial fibrillation (AF) recurrence following catheter ablation in diabetic patients is an area of emerging interest. The purpose of this meta-analysis was to evaluate the impact of SGLT2 inhibitors on AF recurrence following catheter ablation in patients with diabetes. Methods: A comprehensive literature search was carried out using PubMed, Embase, and Google Scholar databases for the studies comparing SGLT2 inhibitors with other antidiabetic drugs in AF patients undergoing catheter ablation. Using random effect models, Mantel-Haenszel odds ratios and associated 95% confidence intervals were produced to report the overall effect size. Statistical significance was set at p < 0.05. Egger's regression test and Begg-Mazumdar's rank test were used to assess publication bias. The primary endpoint was the reoccurrence of atrial fibrillation after catheter ablation during the follow-up period, which varied between studies and ranged from 12 to 33 months. Results: The analysis included six studies, involving a sample size of around 5,765 AF patients. Our study reported that the use of SGLT2 inhibitors in diabetic patients undergoing catheter ablation for AF was associated with lower odds of AF reoccurrence (OR: 0.46; 95% CI: 0.32 to 0.65; p<0.0001) compared with other antidiabetic medications. This outcome has moderately associated heterogeneity, with I2 of 59%. Egger's regression test and Begg-Mazumdar's rank test showed no evidence of publication bias (p > 0.05). Conclusion: The use of SGLT2 inhibitors was associated with improved outcomes post-catheter ablation for AF diabetic patients. Further large-scale, randomized controlled trials are warranted to confirm these findings and elucidate the underlying mechanisms.
Abstract 4145880: Incidence and Outcomes of Acute Myocardial Infarction (AMI) in Hematological Malignancy Patients: Systematic review and Meta-analysis
(Lippincott Williams & Wilkins, 2024) Sawai Singh Rathore; Ameer Mustafa Farrukh; Sem Josue Nsanh Yao; Ibrahim Al Shyyab; Vanessa Vidaurre Corrales; Zario Wint; Hritvik Jain; Aman Goyal; Ashish Kumar
Background: Patients with hematological malignancies may face increased cardiovascular risks, including acute myocardial infarction (AMI). This systematic review and meta-analysis aims to evaluate the incidence and outcomes of AMI in patients with hematological malignancies compared with the general population. Methods: A comprehensive literature search was conducted using the PubMed, Embase, and Google Scholar databases. Random effect models were utilized to calculate Mantel-Haenszel odds ratios (ORs) with 95% confidence intervals (CIs). The inverse variance method with DerSimonian–Laird (DL) of Tau2 was used to calculate standardized mean differences (SMDs) with CIs. Statistical significance was set at p < 0.05. The primary endpoint was the incidence of AMI, while secondary outcomes included in-hospital mortality, length of hospital stay, likelihood of undergoing invasive procedures, total hospital costs, bleeding events, and stroke outcomes. Results: Twenty-six articles, including approximately 6.33 million patients with hematological malignancies, were included in the meta-analysis. Hematological malignancies were not associated with an increased incidence of AMI compared with the general population (OR = 0.91; 95% CI 0.80 to 1.03; p<0.001). AMI in hematological malignancies was associated with an increased risk of in-hospital mortality (OR = 1.71; 95% CI 1.57 to 1.86; p<0.001), bleeding event (OR = 1.30; 95% CI 1.12 to 1.60; p<0.001), and stroke (OR = 1.24; 95% CI 1.09 to 1.42) compared with AMI in the general population. Patients admitted due to AMI in hematologic malignancies also experienced an increased length of stay (SMD = 0.25; 95% CI 0.20 to 0.28; p<0.001) compared with AMI in the general population. There was no significant difference between the two groups in terms of the likelihood of undergoing invasive procedures (OR = 0.62; 95% CI 0.56 to 0.69) or total hospital expenditure (SMD = 0.09; 95% CI -0.01 to 0.19). Conclusion: While hematological malignancies do not appear to increase the incidence of acute myocardial infarction (AMI), patients who experience AMI episodes are at higher odds of in-hospital complications.