Centre Hospitalier de Pau

This study aims to report the effects of β-blocker interruption on blood pressure (BP) and heart rate (HR) in the AβYSS trial where patients were randomized to interruption or continuation of β-blocker treatment after a myocardial infarction (MI).

Changes in HR and BP from baseline to post-randomization are reported using linear mixed repeated model, in the 3698 patients of the AβYSS trial with a median follow-up of 3.0 years. Additionally, changes in HR and BP and the impact on the primary endpoint (death, MI, stroke, hospitalization for cardiovascular reason) in the pre-specified subgroups of patients with or without history of hypertension were assessed using linear mixed repeated and adjusted Cox proportional hazards model, respectively.

β-blocker interruption was associated with significant increase {least square mean difference [95% confidence interval (CI)]} in systolic BP [+3.7 (2.6, 4.8) mmHg, P < .001], diastolic BP [+3.3 (2.6, 4.0) mmHg, P < .001], and resting HR [+10 [9, 11) b.p.m., P < .001] at 6 months that persisted over the duration of follow-up despite an increase in antihypertensive drugs in the β-blocker interruption group. The effects were observed in both hypertensive (43% of the population) and non-hypertensive patients. Hypertensive patients were at higher risk of events (25.8% vs. 19.2%) as compared with patients without hypertension (adjusted hazard ratio 1.18, 95% CI 1.01–1.36, P = .03). Patients with hypertension had a particularly marked increase in the primary endpoint (risk difference 5.02%, 0.72%–9.32%, P = .014) when randomized to β-blocker interruption.

Interruption of β-blocker treatment after an uncomplicated MI led to a sustained increase in BP and HR, with potentially deleterious effects on outcomes, especially in patients with history of hypertension.

Numerous studies have investigated the use of cardiac magnetic resonance (CMR) imaging in patients with of myocardial infarction with non-obstructive coronary arteries (MINOCA).

To assess the diagnostic and prognostic yield of CMR in patients presenting with a working diagnosis of MINOCA-like condition.

Between May 2015 and August 2018, 457 consecutive patients with MINOCA-like condition were prospectively enrolled in an observational cohort study in 15 centres affiliated with the Collège National des Cardiologues des Hôpitaux (CNCH). Prior to CMR, the cardiologist established one provisional underlying mechanism. Using CMR findings, the cardiologist reassigned the patient to a final diagnosis.

Overall, 336 of 457 patients underwent CMR. Guided by CMR, the cardiologist provided a diagnosis in 90.5% (95% confidence interval [95% CI]: 87.3-93.6%) of cases and changed the underlying cause in 35.7% (95% CI: 30.6-40.8%) of patients. Specifically, 33.7% (95% CI: 23.7-43.7%) of type 1 myocardial infarctions (MIs) were misdiagnosed prior to CMR. A type 1 MI occurred for three patients (at 3, 4 and 6months of follow-up) with a CMR diagnosis of non-ischaemic underlying cause (1.2%), which is reassuring for therapeutic management guided by CMR. Patients with an inconclusive CMR had a longer median time to complete the CMR (17 vs. 7days; P<0.01) and lower conventional and high-sensitivity troponin values (1.1 vs. 3.6μg/L; P=0.002 and 433 vs. 707ng/L; P=0.007, respectively).

The systematic use of CMR plays a pivotal role in identifying the underlying cause of myocardial injury, impacting patients, health professionals and society at large.

Most data on atrial fibrillation (AF) ablation using the first available pentaspline pulsed field ablation (PFA) catheter (Farapulse, Boston Scientific Inc) come from retrospective center-level registries collected in highly experienced centers.

This study aimed to provide exhaustive and prospective patient-level data on this new ablation modality.

FRANCE-PFA is a nationwide registry (NCT06497933) that included all patients undergoing a first AF ablation using the pentaspline PFA catheter since the introduction of this technology in France. All French centers using this technology participated. Procedural data were prospectively collected at a patient level.

This registry included 5223 patients from 33 centers between March 2021 and February 2024 (mean age 65 ± 11 years, 55.4% paroxysmal AF). The procedure duration was 54 ± 23 minutes. Acute pulmonary vein isolation was achieved in 5211 patients (99.8%). The total number of PFA applications was 50 ± 22 with >70 applications in 746 patients (14.3%). Pulmonary vein isolation only was performed in 64.7% of patients (82.7% of paroxysmal AF, 44.5% of persistent AF, and 26.6% of long-standing persistent AF). The most common location for additional PFA lesion sets was the left atrium posterior wall in 1335 patients (25.6%), left atrium roof in 999 patients (19.1%), and mitral isthmus in 514 patients (9.8%). Major complications occurred in 50 patients (0.96%), with no esophageal complication or symptomatic phrenic nerve palsy reported in past hospital discharge.

In this prospective and nationwide registry, AF ablation using the pentaspline PFA catheter seemed to be safe and acutely efficient, despite considerable heterogeneity in the number of patients treated at each center.

NCT06497933.