The edition · Cardiology
Conduction system pacing matched biventricular pacing after AV node ablation in heart failure with AF
CONDUCT-AF found the same ejection fraction gain with shorter procedures. Also: lipid-rich plaque and preventive PCI, in-hospital arrest survival in China, benzodiazepines and heart failure, and why routine ischaemia screening in diabetes does not pay.
The edition in brief
CONDUCT-AF randomised 82 patients with refractory atrial fibrillation, ejection fraction below 50% and narrow QRS to left bundle branch area pacing or biventricular pacing after AV node ablation. Ejection fraction rose by about 10 to 12 points in both arms at six months; the difference was 0.4 points and met non-inferiority, with shorter procedures and fluoroscopy for conduction system pacing. A post hoc PREVENT analysis of 598 patients found preventive PCI of non-flow-limiting plaques was linked to fewer events only when near-infrared spectroscopy showed a lipid-rich core (adjusted HR 0.23), not otherwise. A Chinese registry of 17,602 in-hospital cardiac arrests reported 9.1% survival to discharge despite CPR within a minute in 96%, with very little post-arrest temperature control or angiography. A meta-analysis of 11 mostly observational studies linked benzodiazepine use to more incident heart failure (HR 1.41) and heart failure admission (HR 1.29). Pooling four trials of screening asymptomatic adults with diabetes for silent ischaemia showed no significant reduction in cardiovascular events (HR/RR 0.76, 0.48 to 1.19). The pearl covers sleep complaints in heart failure.
Left bundle branch area pacing was non-inferior to biventricular pacing after AV node ablation
After AV node ablation in heart failure with AF, conduction system pacing gave the same ejection fraction gain as biventricular pacing with a shorter procedure.
Preventive PCI of non-flow-limiting plaque was linked to benefit only when the plaque was lipid-rich
Lipid-rich plaque, not plaque size, marked the lesions where preventive PCI was associated with benefit; this needs a dedicated trial before it changes practice.
In-hospital cardiac arrest in China: fast CPR, but 9% survival and little post-arrest care
Prompt CPR was not enough: in-hospital arrest survival stayed around 9%, with post-arrest care and advance care planning the clear gaps.
Benzodiazepine use was associated with more incident heart failure and heart failure admissions
Consider benzodiazepine use a possible heart failure risk marker, and review long-term prescriptions in patients at risk.
Poor sleep in heart failure: look for the cause first
In a heart failure patient who cannot sleep, check for congestion, diuretic timing and sleep apnoea before reaching for a hypnotic.
Routine screening for silent ischaemia in asymptomatic diabetes did not reduce cardiovascular events
Do not screen asymptomatic adults with diabetes for silent ischaemia routinely; test only when the result would change management.
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