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Background: Substance use continues to be on the rise in the United States and has been linked to new onset cardiovascular (CVDs) and cerebrovascular disorders (CeVDs) leading to hospitalizations. We aimed to study the association of different subtypes of substance use disorders (SUDs) among hospitalized patients, with the different subtypes of CVDs and CeVDs, using the National Inpatient Sample (NIS) Database. Additionally, we aimed to assess the odds of hospitalizations with new onset CVDs and CeVDs among patients with different types of SUDs. Methods: A retrospective study of the NIS database (2016-2017) using the ICD-10-CM codes was performed. The hospitalizations with a secondary diagnosis of SUDs were identified. Weighted univariate analysis using the chi-square test and multivariate survey logistic regression analysis was performed to evaluate for the incidence, prevalence, and odds of association between vascular events and SUDs. Results: There were a total of 58,259,589 hospitalizations, out of which 21.42% had SUDs. Out of all the hospitalized patients between the age 18-50, more patients had SUDs than not (31.83%, p< 0.0001). This difference existed for all the different subtypes of SUDs including alcohol related disorder (42.61%), amphetamine dependence (76.17% vs 31.83%), cannabis related disorder (75.17%), cocaine related disorders (57.87%), hallucinogen related disorder (82.91%), inhalant related disorders (67.25%), opioid related disorders (52.86%), and nicotine dependence (35.72%). We found a significant association of acute ischemic stroke with amphetamine dependence (OR 1.23, 95%CI 1.14-1.33), cocaine related disorders (1.17, 1.12-1.23) and nicotine dependence (1.42, 1.40-1.43). Similarly, the association of intracerebral hemorrhage was higher with amphetamine dependence (2.58, 2.26-2.93), and cocaine related disorders (1.62, 1.46-1.79). The association of subarachnoid hemorrhage was noted to be higher with amphetamine dependence (1.82, 1.48-2.24) and nicotine dependence (1.47, 1.39-1.55). In terms of association of cardiovascular disorders with SUDs,the patients with myocardial infarction had higher odds of nicotine dependence (1.85, 1.83-1.87) than not, Similarly, the patients with angina pectoris were noted to have a higher association with cocaine related disorders (2.21, 1.86-2.62), and those with atrial fibrillation had a higher association alcohol related disorders (1.14, 1.11-1.17). Conclusion: Our study demonstrates the variability of CVD and CeVD in patients hospitalized for SUD. Findings from our study may help promote increased awareness and early management of these events. Further studies are needed to evaluate specific effects of frequency and dose on the incidence and prevalence of CVD and CeVD in patients with SUD.

Introduction Prospective studies on rivaroxaban and apixaban have shown the safety and efficacy of direct anticoagulation agents (DOAC)s used peri-procedurally during radiofrequency ablation (RFA) of atrial fibrillation (AF). Studies comparing the two agents have not been performed. Methods Consecutive patients from a prospective registry who underwent RFA of AF between April 2012 and March 2015 and were on apixaban or rivaroxaban were studied. Clinical variables and outcomes were noted. Results There were a total of 358 patients (n = 56 on apixaban and n = 302 on rivaroxaban). There were no differences in baseline characteristics between both groups. The last dose of rivaroxaban was administered the night before the procedure in 96% of patients. In patients on apixaban, 48% of patients whose procedure was in the afternoon took the medication on the morning of the procedure. TIA/CVA occurred in 2 patients (0.6%) in rivaroxaban group with none in apixaban group (p = 0.4). There was no difference in the rate of pericardial effusion between apixaban and rivaroxaban groups [1.7% vs 0.6% (p = 0.4)]. Five percent of patients in both groups had groin complications (p = 0.9). In apixaban group, all groin complications were small hematomas except one patient who had a pseudoaneurysm (1.6%). One pseudo-aneurysm, 1 fistula and 3 large hematomas were noted in patients on rivaroxaban (1.7%) with the rest being small hematomas. DOACs were restarted post procedure typically 4 h post hemostasis. Conclusions Peri-procedural uninterrupted use of apixaban and rivaroxaban during AF RFA is safe and there are no major differences between both groups.

Introduction: Ventricular arrhythmias (VA) arising from the left ventricular (LV summit) are often inaccessible especially in the region superior to the coronary sinus (CS) and ablation at multiple sites may be required. We sought to define the procedural characteristics and outcomes in this group of patients. Methods: Consecutive patients who underwent ventricular premature beat (VPB) ablation at our academic center were obtained. Patients with VPBs arising from the LV summit were noted and their charts were reviewed for clinical and procedural characteristics. Results: There were a total of 110 patients who underwent VPB ablation between January 2012 to March 2015. Of these there were 13 patients whose VA site of origin was determined to be from the LV summit intra-procedurally. Mean age of the patients was 53±16 years with 85% whites and 54% males. Mean QRS duration was 117±33ms. 11 patients were on a beta-blocker, 1 on a class Ia agent and 2 on no medications. Mean EF pre and post procedure was 41±14% and 47±10%. Mean PVC burden was 26%. EKG morphology showed LBBB pattern pattern in V1 with transition in V3 (in 6 patients), RBBB pattern (7 patients) with inferior axis and negative lateral leads. Mean procedure and fluoroscopic times were 266±82 and 45±20 minutes respectively. Acute success was obtained in 69% (n=9) and partial success in 15% (n=2). Acute success was obtained by ablating in the CS alone in 3 patients, epicardially alone in 3 patients and endocardially in 1 patient. In the other 2 patients, epi and endocardial ablation was performed in 1 patient and endo, epi and CS ablation in the other patient to obtain acute success. In the 2 patients with partial success, epicardial and CS ablation in 1 patient and endocardial and CS ablation in the other was performed. In one patient no ablation was performed and in another patient ablation was performed in all 3 sites without any success. Long term recurrence > 3 months occurred in 1 patient with acute success. A power of 30 to 50 watts was used in the CS, 30 to 45 watts in the epicardium and 30 to 50 watts in the endocardium. Conclusion: Epicardial or CS ablation alone was successful in terminating VPBS arising from the LV summit in about half of the patients with epicardial and/or endocardial and/or CS ablation required in few others.

Incidental findings (IF) are commonly seen in pre-procedural cardiac CT scan obtained prior to Atrial Fibrillation (AF) ablation. We intended to evaluate the prevalence and significance of these IF in otherwise healthy patient undergoing AF ablation. We performed a retrospective observational study

There is limited and conflicting data on the temporal relationship between atrial fibrillation (AF) episodes and occurrence of stroke/TIA. We sought to evaluate this relationship in patients with implantable cardiac devices (CIED) presenting with stroke. We performed a retrospective, single center