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BACKGROUND: Limited data exists for outcomes in patients undergoing cardiovascular implantable electronic device (CIED) transvenous lead extraction (TLE) without clear indications for device reimplantation. The implantable loop recorder (ILR) may be an effective strategy for continuous monitoring in select individuals. OBJECTIVE: This retrospective analysis aims to investigate patients who have undergone ILR implant following TLE without CIED reimplantation. METHODS: Clinical data from consecutive patients who have undergone TLE with ILR implant and without CIED reimplantation from October 2016 to May 2020 at a single center were collected. RESULTS: Among 380 patients undergoing TLE, 28 (7.7%) underwent ILR placement without CIED reimplantation. TLE indications were systemic infection (n=13, 46.4%), pain at the site (n=8, 28.6%), device/lead malfunction (n=4, 14.2%), and other. Devices extracted included: dual-chamber and single-chamber pacemaker (n=14, 50%; n=4, 14.2%), dual-chamber implantable cardiac defibrillator (n=10; 35.7%), and cardiac-resynchronization therapy with defibrillator (n=1, 3.5%). Reasons for no reimplantation included no longer meeting CIED criteria (n= 14, 50%), patient preference (n=9, 32.1%), and no clear or inappropriate indication for initial CIED implantation (n= 5, 18%). During an average of 12.3 ± 13.1 months of follow-up, there were no lethal arrhythmias, and 4 (13.3%) patients underwent permanent pacemaker reimplantation due to symptomatic sinus bradycardia and atrioventricular block with syncope as discovered on ILR. Three patients died due to unknown causes (n=1), non-cardiac (n=1), and acute coronary syndrome (n=1). CONCLUSIONS: In patients undergoing TLE without reimplantation, an ILR may be an effective monitoring strategy in patients at low risk for cardiac arrhythmia.

Chronic kidney disease (CKD) has a negative impact on outcomes after transcatheter aortic valve replacement (TAVR). Data on outcomes in renal transplant recipients (RTRs) undergoing TAVR are scarce. We compared the outcomes in RTRs undergoing TAVR with matched patients who have native kidneys and similar kidney function.This retrospective cohort study used data from 16 TAVR centres (13,941 patients). The study cohort included 216 patients (72 RTRs and 144 matched controls).The mean estimated glomerular filtration rate (eGFR) was 39.2 ± 23.6 vs 44.5 ± 23.6 mL/min for RTRs and control patients (P = 0.149), with a similar CKD stage distribution. After TAVR, the eGFR declined among RTRs but remained stable for up to 1 year in controls (P = 0.021). Long-term hemodialysis was required in 19 (26.4%) RTRs and 20 (13.8%) controls (hazard ratio [HR] = 2.09 95% confidence interval [CI], 1.03-3.86; P = 0.039) and was most often initiated during the periprocedural period (14 RTRs vs 16 controls; P = 0.039). After a median follow-up of 2.3 years, risk of death (29.2% vs 31.9%) and death/hemodialysis (40.3% vs 36.8%) was similar between the groups. The contrast volume/eGFR ratio was the strongest predictor of hemodialysis initiation (odds ratio [OR] = 1.64; 95% CI, 1.36-1.97 per 1 unit increase; P0.001), with a greater effect among RTRs than controls (P for interaction = 0.022).s: TAVR appears safe in RTRs with mortality rates similar to matched patients with native kidneys. However, RTRs carry an increased risk of progressive renal impairment and need for hemodialysis initiation after TAVR. Our data highlight the importance of minimizing contrast load during TAVR, particularly in RTRs.

We present 2 patients found to have ovotesticular disorder of sexual development (otDSD) in late adolescence. Two 15-year-old phenotypically male patients presented to a large pediatric hospital with different complaints: 1 with concern for testicular rupture after a straddle injury; 1 with gynecomastia. Further workup, including imaging and laboratory tests, was performed before surgical exploration. The first patient had unilateral ovotestis, contralateral testis, and SRY-negative 46,XX karyotype. The second patient with gynecomastia had unilateral ovotestis with hemi-uterus and fallopian tube, contralateral ovarian tissue, and 46,XX/47,XXY Klinefelter mosaic karyotype. Although rare, phenotypically normal male patients may present later with ovotesticular disorder of sexual development.

Objectives: This study aimed to develop a mortality risk model for percutaneous coronary intervention (PCI) specific to the Out of Hospital Cardiac Arrest (OHCA) population and assess the influence of these patients on currently publicly reported PCI metrics in Washington state. Methods: Our study analyzed 331 out of hospital cardiac arrest patients who underwent PCI in Washington state over a 1-year period. Data was obtained over a 2-year period from the Clinical Outcomes Assessment Program (COAP), a PCI public reporting program for Washington hospitals and Cardiac Arrest Registry to Enhance Survival (CARES), a disease-based OHCA registry. Stepwise multivariate logistic regression was used for model development and bootstrapping was performed. Model performance was analyzed using c statistic and the Hosmer Lemeshow goodness of fit tests. Results: The OHCA model contains seven predictors of mortality: age, GFR, cardiogenic shock, emergency-salvage priority, witnessed arrest, arrest after 911 arrival, and initial shockable rhythm. The C statistics for mortality prediction of the new OHCA, CathPCI ® and COAP PCI models were c=.85 (95% CI .81-.90), c=.82 (95% CI .77-.87) and c=.79 (95% CI .74-.84), respectively. Prediction of mortality in OHCA patients undergoing PCI had an overall difference of .029. No hospitals were reclassified in quality performance based on reversal of observed-to-expected mortality ratios when applying the new model to OHCA patients undergoing PCI. Conclusions: The new OHCA model predicting PCI mortality in the OHCA population demonstrated excellent discrimination using a combination of pre-hospital and baseline features. This improved on the currently utilized model’s sensitivity and specificity for predicted mortality in the OCHA cohort, but the impact of this population on hospitals’ overall performance for PCI mortality was minimal. Even small changes in metric performance have important implications for hospitals and patients in the era of public reporting.

Incidence of secondary metastatic cardiac tumors is about 10% in patients with known malignancies. Cardiac metastasis may cause conduction disturbances leading to arrhythmia, coronary artery invasion or cardiac rupture. A 64-year-old male with diffuse large B cell lymphoma presented for workup of

Amino acid conjugates of quinolone, metronidazole and sulfadiazine antibiotics were synthesized in good yields using benzotriazole methodology. All the conjugates were screened for their antibacterial activity using methods adapted from the Clinical and Laboratory Standards Institute. Antibiotic conjugates were tested for activity in four medically relevant organisms; Staphylococcus aureus (RN4220), Escherichia coli (DH5α), Pseudomonas aeruginosa (PAO1), and Bacillus subtilis (168). Several antibiotic conjugates show promising results against several of the strains screened.