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AimsThe safety and feasibility of combining percutaneous catheter ablation (CA) for atrial fibrillation with left atrial appendage occlusion (LAAO) as a single procedure in the USA have not been investigated. We analyzed the US National Readmission Database (NRD) to investigate the incidence of combined LAAO + CA and compare major adverse cardiovascular events (MACEs) with matched LAAO-only and CA-only patients.Methods and resultsIn this retrospective study from NRD data, we identified patients undergoing combined LAAO and CA procedures on the same day in the USA from 2016 to 2019. A 1:1 propensity score match was performed to identify patients undergoing LAAO-only and CA-only procedures. The number of LAAO + CA procedures increased from 28 (2016) to 119 (2019). LAAO + CA patients (n = 375, mean age 74 ± 9.2 years, 53.4% were males) had non-significant higher MACE (8.1%) when compared with LAAO-only (n = 407, 5.3%) or CA-only patients (n = 406, 7.4%), which was primarily driven by higher rate of pericardial effusion (4.3%). All-cause 30-day readmission rates among LAAO + CA patients (10.7%) were similar when compared with LAAO-only (12.7%) or CA-only (17.5%) patients. The most frequent primary reason for readmissions among LAAO + CA and LAAO-only cohorts was heart failure (24.6 and 31.5%, respectively), while among the CA-only cohort, it was paroxysmal atrial fibrillation (25.7%).ConclusionWe report an 63% annual growth (from 28 procedures) in combined LAAO and CA procedures in the USA. There were no significant difference in MACE and all-cause 30-day readmission rates among LAAO + CA patients compared with matched LAAO-only or CA-only patients.

Introduction: Tranexamic acid (TXA) is an antifibrinolytic with applications in preventing potentially life-threatening hemorrhage. Case Report: A 39-year-old male presented with massive hemoptysis and, during treatment with TXA, developed a transient left bundle branch block (LBBB). He was recently initiated on warfarin, but then developed a pulmonary hemorrhage. Along with standard treatments, it was decided to administer inhaled TXA to assist with hemodynamic stabilization. On persistent telemetry monitoring in the critical care unit, during administration of his first nebulized dose of TXA, a new onset LBBB was observed. Electrocardiogram (EKG) findings resolved to normal sinus rhythm within 30 minutes of TXA discontinuation. A second round of inhaled TXA was administered 8 hours later during which the LBBB reoccurred. It resolved within approximately 30 minutes without demonstration of troponin increase. Conclusion: To our knowledge, this is the first described instance of EKG changes seen after administration of inhaled TXA; therefore, caution should be exercised particularly in those with concomitant cardiovascular disease.

Defibrillation threshold (DFT) testing is performed in individuals with higher predicted risks of defibrillation failure. Many strategies have been explored to overcome the challenge of high DFT, including an insertion of a defibrillator lead into the azygos vein. We performed a systematic review of the literature to evaluate the safety and efficacy of azygos vein implantable cardioverter-defibrillator insertion for high DFT combined with the analysis of a single-center experience of the procedure at our institution. The literature search was performed in PubMed and Embase from database inception to December 2020 to identify all case reports and case series related to azygos vein defibrillator lead insertion. Our search identified 291 records. After excluding duplicate studies and those without DFT thresholds and non-azygos vascular destinations, 12 studies (23 cases) were reviewed from the current database. We also conducted a retrospective analysis of 5 cases performed at our institution, and a total of 28 patients were included in our final analysis. The mean age of the pooled cohort was 47 years (range, 17-88 years). Men composed 92% of the total cases, and the average body mass index was 34 kg/m

We present a case report of a patient presenting with subarachnoid hemorrhage whose electrocardiogram (ECG) mimicked non-ST-elevation myocardial infarction. A 36-year-old male with a past medical history of resistant hypertension, previous severe acute respiratory syndrome coronavirus 2 infection, and alcohol abuse presented to the hospital after cardiac arrest. He was taken to the catheterization lab upon arrival and was found to have an unremarkable coronary angiogram. After angiography, computerized tomography (CT) head was performed revealing an acute, large-volume, subarachnoid hemorrhage. Subsequent CT angiogram of the head confirmed this with source noted to be a ruptured aneurysm of the anterior communicating artery. ST depression on ECG has been reported in patients who have suffered a subarachnoid hemorrhage. Although the most common etiology of cardiac arrest is an acute coronary syndrome, other etiologies based on a patient’s past medical history need to remain in the differential. Recognition of ECG changes may lead to earlier diagnosis and decreased mortality in subarachnoid patients.

Background Left atrial appendage occlusion (LAAO) devices have become a favorable alternative option among nonvalvular atrial fibrillation (AF) patients with long-term contraindication to anticoagulation. Real-world experience with postprocedural readmission rates and predictors of readmission in LAAO patients is limited. Objective To assess all-cause 30-day readmission rate and predictors of readmission after LAAO procedure in the United States. Method This retrospective observational study included all AF patients undergoing percutaneous LAAO procedures in the United States from January 1, 2016, and December 31, 2017, in the National Readmission Database. The primary outcome measure was all-cause 30-day readmission. A propensity score-matched analysis compared outcomes with a non-LAAO AF cohort. Result Among 14 024 LAAO procedures (age: 76 ± 8 years; 60.5% males), 9.4% were readmitted within 30-days and, 0.2% died during their index hospitalization. The most frequent primary diagnosis during readmission among LAAO was gastrointestinal bleeding (12%). The incidence of LAAO procedures increased by 102%. In the multivariate model, gender and CHA2 DS2 -VASc failed to predict readmission. Age 55-64 years had lower odds (adjusted odds ratios [aOR]: 0.41; 95% confidence interval [CI]: 0.18-0.94), while drug abuse (aOR: 4.1; 95% CI: 1.34-12.54), and deficiency anemia (aOR: 1.88; 95% CI: 1.12-3.18) had higher odds of readmission. In propensity-matched cohort, compared to non-LAAO AF, LAAO patients had lower 30-day readmission (9.4% vs. 10.98%, p = .002) and all-cause in-hospital mortality (0.19% vs. 0.57%, p Conclusion The readmission rate following the LAAO procedure is substantial (approximately 10%), and largely attributable to gastrointestinal bleeding. Factors such as drug abuse and anemia must be explored further to minimize readmission risk.

Obesity continues to climb in prevalence throughout the world thus leading to an increasing number of patients undergoing bariatric surgery. There are several adverse consequences for this surgery including sinus bradycardia of which little is known in terms of outcome. A 22-year-old woman

Rate-dependent infra-hisian conduction delay (IHCD) has overlapping features with ventricular tachycardia on electrocardiogram. In order to distinguish and properly diagnose, one must use a multimodality approach to reach the proper diagnosis and treatment. 57-year-old male with hypertension and

SHIFT trial showed reduced hospital admission rates and mortality with ivabradine, in patients with refractory sustained sinus tachycardia and heart failure with reduced ejection fraction (HFrEF). We present a case of a patient with normal QTc on maximum beta blocker therapy and aggressive diuretics

Objective: Atrio-esophageal fistula is an infrequent but devastating complication of catheter-based ablation of atrial fibrillation (AF). Thermal esophageal injury may be the precursor of atrio-esophageal fistula. Here, we evaluated the role of esophageal temperature monitoring in preventing thermal esophageal injury during pulmonary vein isolation for AF with radiofrequency energy. Methods: In this meta-analysis, we searched the PubMed, Cochrane, Scopus, Embase, and Refworks databases for all published studies from January 2004 to June 2016 to evaluate the role of esophageal temperature monitoring. We searched for terms esophageal temperature monitoring, AF, radiofrequency ablation, atrio-esophageal fistula, and thermal esophageal injury. We included studies comparing luminal esophageal temperature (LET) monitoring with no LET monitoring during radiofrequency ablation of AF. We excluded studies in which post-ablation esophagogastroduodenoscopy (EGD) was not performed to identify esophageal thermal injuries. To perform the meta-analysis, we used Review Manager statistical software and a fixed-effects modeling to derive the outcomes. Given significant heterogeneity between the studies, we used meta-regression analysis to adjust for age and sex. Results: We identified 4 non-randomized controlled trials that met our search criteria and included a total of 411 patients (n=235 in the LET monitoring group; n=176 in the no LET monitoring group) in the analysis. There were 21 (8.9%) patients with thermal esophageal injury in the LET monitoring group and 12 (6.8%) in the no LET monitoring group. The pooled odds ratio was 0.66 (0.23-1.89), indicating no statistically significant differences between the 2 groups with regard to esophageal injury. Because of the small sample size and the non-randomized nature of the trials, we observed significant heterogeneity in outcomes among the trials. Conclusion: The role of esophageal temperature monitoring in reducing the risk of esophageal thermal lesions during pulmonary vein isolation for AF has not been established, and more studies including randomized controlled trials are needed to assess its true impact.