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We report an unusual case of subacute right atrial perforation by a screw-in pacemaker lead that migrated into the right lung causing hemopneumothorax 2 weeks after the procedure. After transvenous simple manual traction and minithoracotomy repair of the right atrial wall, the lead was repositioned without any complications. (Level of Difficulty: Beginner.), Graphical abstract, We report an unusual case of subacute right atrial perforation by a screw-in pacemaker lead that migrated into the right lung causing hemopneumothorax…

As the coronavirus cases continue to surge, the urgent need for universal testing to identify positive cases for effective containment of this highly contagious pandemic has become the center of attention worldwide. However, in spite of extensive discussions, very few places have even attempted to implement it. We evaluated the efficacy of widespread testing in creating a safe workplace in our electrophysiology (EP) community. Furthermore, we assessed the new infection rate in patients undergoing EP procedure, to see if identification and exclusion of positive cases facilitated establishment of a risk-free operating environment. Viral-RNA and serology tests were conducted in 1670 asymptomatic subjects including patients and their caregivers and staff in our EP units along with the Emergency Medical Service (EMS) staff. Of 1670, 758 (45.4%) were patients and the remaining 912 were caregivers, EMS staff, and staff from EP clinic and lab. Viral-RNA test revealed 64 (3.8%) positives in the population. A significant increase in positivity rate was observed from April to June 2020 (p = 0.02). Procedures of positive cases (n = 31) were postponed until they tested negative at retesting. Staff testing positive (n = 33) were retested before going back to work after 2 weeks. Because of suspected exposure, 67 staff were retested and source was traced. No new infections were reported in patients during or within 2 weeks after the hospital-stay. Universal testing to identify positive cases was helpful in creating and maintaining a safe working environment without exposing patients and staff to new infections in the EP units. Trial Registration Number: clinicaltrials.gov : NCT04352764

BackgroundAs the coronavirus cases continue to surge, the urgent need for universal testing to identify positive cases for effective containment of this highly contagious pandemic has become the center of attention worldwide. However, in spite of extensive discussions, very few places have even attempted to implement it. We evaluated the efficacy of widespread testing in creating a safe workplace in our healthcare community including staff and patients.Furthermore, we assessed the rate of new infections in patients undergoing electrophysiology (EP) procedure, to see if identification and exclusion of positive cases facilitated establishment of a risk-free operating environment.MethodsUniversal testing was conducted in subjects with no symptoms of COVID-19 including patients and their caregivers and staff in our electrophysiology units along with the Emergency Medical Service (EMS) staff (n=1670)ResultsOf 1670, 758 (45.4%) were EP patients, and the remaining 912 were caregivers, EMS staff and hospital staff from EP clinic and lab. Viral-RNA test revealed 64 (3.8%) positives in the population. A significant increase in the rate of positives was observed from April to June, 2020 (p=0.02). Procedures of positive cases (n=31) were postponed until they tested negative at retesting on day 14. Staff testing positive (n=33) were retested before going back to work after 2 weeks. Because of suspected exposure, 67 staff were retested and source was traced. No new infections were reported in patients during the hospital stay or within 2-weeks after the procedure.ConclusionUniversal testing to identify positive cases was helpful in creating and maintaining a safe working environment without exposing patients and staff to new infections in the EP unit at the hospital.Trial Registration Numberclinicaltrials.gov: NCT04352764

Aims Functional mitral regurgitation (MR) could be managed by both cardiac resynchronization therapy (CRT) and mitral-valve surgery. Clinical decision making regarding the appropriateness of mitral-valve surgery vs. CRT is a challenging task. This study assessed the prevalence and prognosis of various degrees of functional MR in CRT candidates. Additionally, we sought to identify functional MR patients who either can be adequately managed by CRT only or will need surgery. Methods and results Cardiac resynchronization therapy recipients ( n = 794) were followed-up for 26 ± 18 months. Mitral regurgitation severity was quantified on scale 0–4. Cardiac resynchronization therapy responders were identified based on improvement in the New York Heart Association class and left-ventricular ejection fraction. Severity of MR and LV reverse remodelling were assessed at 3 and 12 months. Predictors of long-term MR change and CRT response were explored with multivariable models. Mitral regurgitation was present in 86%, with 35% prevalence of advanced MR (grade 3–4). Improvement of MR ≥1° after 12 months occurred in 46% of patients. It was relatively more frequent in patients with advanced MR at baseline (63%, P < 0.01). Baseline MR severity and change in MR at 3-month follow-up predicted response to CRT. Patients with ≥1° MR improvement at 12 months had more reverse remodelling compared with those with no change or worsening of MR. Conclusions Mitral regurgitation improvement at 3 months predicts CRT response and MR improvement at 12-month follow-up. This finding could have implications for subsequent MR surgical therapies.

Background— Obstructive sleep apnea (OSA) may be associated with pulmonary vein antrum isolation (PVAI) failure. The aim of the present study was to investigate if treatment with continuous positive airway pressure (CPAP) improved PVAI success rates. Methods and Results— From January 2004 to December 2007, 3000 consecutive patients underwent PVAI. Patients were screened for OSA and CPAP use. Six hundred forty (21.3%) patients had OSA. Patients with OSA had more procedural failures ( P =0.024) and hematomas ( P P P =0.001). At the end of the follow-up period (32±14 months), 79% of the non-CPAP and 68% of the CPAP group were free of atrial fibrillation ( P =0.003). Not using CPAP in addition to having non-PV triggers strongly predicted procedural failure (hazard ratio, 8.81; P Conclusions— OSA was an independent predictor for PVAI failure. Treatment with CPAP improved PVAI success rates. Patients not treated with CPAP in addition to having higher prevalence of non-PV triggers were 8 times more likely to fail the procedure.

ICD with resynchronization therapy can provide information on the intrathoracic fluid status of the pts by measuring transpulmonary electric bioimpedance, Out of 2185 consecutive pts undergoing catheter ablation for AF with an open irrigated catheter, 132 (6p) had heart failure (HF). CRT-D