Background: Direct comparative evidence between redo and primary pericardiectomy for constrictive pericarditis (CP) is limited to small, uncontrolled series. We compared perioperative and mid-term outcomes between the two cohorts and explored factors associated with all-cause death. Methods: In this single-center retrospective cohort study, 137 consecutive patients with CP undergoing radical pericardiectomy between April 2018 and December 2023 were allocated to a primary pericardiectomy cohort (PPC, n = 86) or a redo pericardiectomy cohort (RPC, n = 51). The primary endpoint was all-cause death; secondary endpoints included low cardiac output syndrome (LCOS), unplanned reoperation, acute kidney injury (AKI), atrial fibrillation, and postoperative New York Heart Association class. Survival was analyzed with Kaplan-Meier curves and log-rank tests, prognostic factors with Firth-penalized Cox regression (with baseline adjustment and multiple imputation), and the origin of the survival difference was explored via a sensitivity analysis excluding operative deaths. Results: The RPC had more preoperative atrial fibrillation (64.7% vs. 36.0%, p = 0.002) and a larger left atrial diameter (54.8 vs. 47.0 mm, p < 0.001) than the PPC. Operative mortality was higher in the RPC (15.7% vs. 2.3%; relative risk 6.745, p = 0.006), as was LCOS (13.7% vs. 3.5%, p = 0.026). Seventeen patients died (6 PPC, 11 RPC) over a median follow-up of 3.6 years; cumulative overall survival was lower in the RPC (log-rank p = 0.013; 3-year survival 78.4% vs. 94.2%). Postoperative LCOS was the strongest independent predictor of death (hazard ratio [HR] 22.526, p < 0.001); redo pericardiectomy (HR 3.031; 95% CI 1.034-9.679; p = 0.043) and AKI stage (HR 1.848; 95% CI 1.107-3.088; p = 0.020) were independently associated with death; postoperative albumin showed a borderline protective association (HR 0.913, p = 0.048). Among perioperative survivors, no statistically significant difference in long-term survival was detected (HR 1.275; 95% CI 0.279-5.819; p = 0.753). Conclusions: Redo pericardiectomy was associated with substantially higher perioperative mortality; among perioperative survivors, long-term survival did not differ detectably between cohorts, although estimates were imprecise. Because the excess risk was accompanied by potentially modifiable perioperative events, intensified risk assessment and meticulous perioperative management warrant evaluation as approaches to improving outcomes in this high-risk population.

Background: Pericarditis is an inflammatory heart disease with unclear causal mechanisms. Immune dysregulation is implicated, but observational studies cannot reliably infer causality. Whether plasma metabolites mediate immune-pericarditis pathways remains unknown. Methods: A two-sample Mendelian randomization (MR) study was performed using publicly available summary-level genome-wide association study data. Genetic instruments were selected via significance screening, linkage disequilibrium clumping, and strength evaluation (F-statistic > 10). A relaxed instrument selection threshold of p < 1 × 10[-5] was used for immunophenotypes and metabolites, and a threshold of p < 5 × 10[-6] was applied for pericarditis in reverse MR. Forward MR assessed potential causal effects of immune cells and metabolites on pericarditis; reverse MR tested the opposite direction. Two-step mediation MR evaluated whether metabolites mediated immune-to-pericarditis pathways. The primary method was inverse variance weighting (IVW), complemented by a range of sensitivity analyses. Results: A total of 18,621 SNPs served as instruments for immunophenotypes and 34,843 for metabolites. Forward MR identified 29 immunophenotypes with genetically predicted associations with pericarditis (20 risk, 9 protective). Reverse MR identified 13 immunophenotypes associated with genetic susceptibility to pericarditis, indicating a bidirectional genetic architecture. Ten plasma metabolites showed genetically predicted associations with pericarditis. After false discovery rate (FDR) correction, these key associations remained significant. Mediation analysis identified a putative immunometabolic pathway in which CD25 on IgD+ CD38br B cells increased pericarditis risk partly through downregulation of the protective metabolite cholate (β1 = -0.114, p = 0.002; β2 = -0.419, p = 0.001). The indirect effect was 0.048 (95% CI: 0.012 to 0.097), accounting for 32.8% of the total effect. All key results were robust in sensitivity analyses. Conclusions: This study provides genetic evidence supporting a putative immune cell-metabolite-pericarditis pathway involving CD25-positive B cells and cholate, and suggests potential immunometabolic targets for future investigation.

Hemopericardium is a rare but serious complication of radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF). While prompt pericardial drainage is effective, the long-term clinical course and the role of adjunctive anti-inflammatory therapy remain unclear. In this prospective single-center cohort study, we included patients who developed hemopericardium requiring pericardiocentesis during RFCA for AF. All patients underwent immediate percutaneous drainage. Colchicine (0.6 mg twice daily for 14 days) was prescribed at the operator's discretion. The primary outcome was freedom from AF or atrial tachycardia (AT) at 12 months after a 3-month blanking period. Among 2133 patients undergoing RFCA, 75 (3.5%) developed hemopericardium. Of these, 21 received colchicine and 54 received usual care. During a median follow-up of 367 days, freedom from AF/AT did not differ between groups (76.2% vs. 74.1%, log-rank p = 0.93). Residual pericardial effusion was infrequent and resolved in all patients by 3 months. Although colchicine was not associated with a reduction in atrial arrhythmia recurrence, patients receiving colchicine had lower CRP levels at 3 months than those receiving usual care (p = 0.021). However, treatment-limiting adverse events occurred in 6 of 21 patients (28.6%) receiving colchicine. No cases of constrictive pericarditis were observed. In patients with procedural hemopericardium during AF ablation, prompt pericardial drainage was associated with favorable clinical outcomes and absence of long-term pericardial sequelae. Adjunctive colchicine therapy was not associated with a significant reduction in arrhythmia recurrence; however, given the small sample size and limited number of events, a clinically meaningful treatment effect cannot be excluded.

The European Society of Cardiology (ESC) released new guidelines in 2025 for the management of myocarditis and pericarditis, which include systemic autoimmune rheumatic diseases as one of the potential aetiologies. Myopericardial involvement in systemic autoimmune rheumatic diseases is common and associated with poor outcomes; however, the unique pathophysiology of myopericardial involvement in systemic autoimmune rheumatic diseases poses specific challenges and limits the applicability of the generic diagnostic pathways proposed in the 2025 ESC guidelines to the systemic autoimmune rheumatic disease population. Myopericardial disease in patients with systemic autoimmune rheumatic disease is usually subclinical, often with atypical clinical presentation, and the accuracy of conventional biomarkers including advanced imaging, to detect myopericaridal disease is reduced in this population compared with the general population due to chronic inflamation. Management of myopericardial involvement in patients with systemic autoimmune rheumatic diseases primarily targets the underlying rheumatic disease; however, disease-specific guidance and multidisciplinary care pathways for the management of myopericardial involvement in patients with systemic autoimmune rheumatic diseases are urgently required and should be developed jointly by experts in both rheumatology and cardiology.

Behçet's disease (BD) is a chronic multisystemic inflammatory vasculitis which can cause cardiac involvement in less than 6%. It can affect all cardiac wall giving rise to pericarditis, myocarditis, endocardial lesions with valvular involvement (especially aortic insufficiency), intracardiac thrombosis, coronary arteritis, myocardial infarcts, arrythmia, and aortitis. Clinical presentation can be confusing, silent, or overshadowed, so diagnosis is frequently delayed. Early diagnosis is mandatory and different imaging techniques play a pivotal role to screen the heart. Biological agents, including tumour necrosis factor inhibitors, show promising results. Cardiac surgery must be accompanied by immunosuppressive therapy to prevent iatrogenic or trauma-triggered pseudo aneurysm secondary to arterial hypersensitivity. A multidisciplinary approach and tailored monitoring are essential to improve patient outcome. Strong data are still lacking to define evidence-based diagnostic algorithms, risk-stratification tools, and standardised management strategies for this severe cardiac manifestation. Besides, further studies are needed to determine specific biomarkers to refine early diagnosis, assess therapeutic efficiency, and prognosis. Through a comprehensive literature review, we aim to synthesise current data on the epidemiology, clinical presentation, contemporary imaging modalities, prognosis, and evidence‑based management strategies of cardiac involvement in BD, and to highlight emerging perspectives.

Background: Cardiac sarcoidosis (CS) is a potentially life-threatening manifestation of systemic granulomatous disease, characterized by a heterogeneous spectrum of arrhythmic and conduction disorders that represent the leading cause of CS-related sudden cardiac death (SCD). Clinical cardiac involvement is estimated at 5% of sarcoidosis patients, while silent myocardial infiltration is detected in 20-25% of autopsy series. Diagnosis is difficult because the disease frequently runs a subclinical course and no single test is pathognomonic. Methods: PubMed and Embase were searched to 5 August 2026 for this narrative review, incorporating peer-reviewed articles, international guidelines (HRS 2014, JCS 2016, AHA/ACC/HRS 2017, ESC 2022, AHA 2024, the 2024 European clinical consensus statement and the 2025 ESC guidelines on myocarditis and pericarditis), and registry data. Results: Atrioventricular (AV) block occurs in 23-30% of CS patients and frequently requires permanent pacing. Fatal ventricular arrhythmia rates reach 20.7% at 5 years and 31.9% at 10 years (ILLUMINATE-CS registry, n = 512). Late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) performs well diagnostically (pooled sensitivity 95%, specificity 85%) and is associated with an odds ratio of 10.74 for arrhythmic events. 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) provides complementary value for guiding immunosuppressive therapy and pre-ablation risk assessment. Implantable loop recorders enable early arrhythmia detection in patients not yet meeting implantable cardioverter-defibrillator (ICD) criteria. Conclusion: Optimal management of arrhythmias in CS requires a multimodal diagnostic approach integrating electrocardiography, advanced cardiac imaging, and continuous rhythm monitoring. Risk stratification for SCD remains the central challenge, requiring individualized decision-making that integrates left ventricular ejection fraction (LVEF), imaging biomarkers, and electrophysiological data. Future prospective studies should aim to refine predictive risk algorithms, assess the role of emerging immunomodulatory agents such as JAK/STAT inhibitors, and validate artificial intelligence (AI)-assisted tools intended to identify cardiac involvement and arrhythmic risk earlier in the disease course.