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Objective: To assess the influence of body-mass index (BMI) on the association of ankle-brachial index (ABI) with mortality. Patients and Methods: We conducted a prospective study of National Health and Nutrition Examination Survey participants enrolled from January 1, 1999 to December 31, 2002 with BMI and ABI data available. ABI categories were 1.3 (high). BMI categories were

Sudden cardiac death (SCD) is a leading cause of death in the United States. Despite improvements in therapy, the incidence of SCD as a proportion of overall cardiovascular death remains relatively unchanged. This article aims to answer the question, "Who is at risk for SCD?" In the process, it reviews the definition, pathophysiology, epidemiology, and risk factors of SCD. Patients at risk for SCD and appropriate treatment strategies are discussed.

James L. Januzzi Jr, MD, FACC, Chair Tariq Ahmad, MD, MPH, FACC Brendan Everett, MD, FACC William Hucker, MD, PhD Dharam J. Kumbhani, MD, SM, FACC Joseph E. Marine, MD, FACC Pamela B. Morris, MD, FACC Robert N. Piana, MD, FACC Sunil V. Rao, MD, FACC Marielle Scherrer-Crosbie, MD, PhD

Objectives The present study describes the use of octreotide (OCT) in patients with atrial fibrillation (AF) receiving oral anticoagulation (OAC) who have gastrointestinal (GI) bleeding related to arteriovenous malformations (AVMs), as well as its effect on OAC tolerance and subsequent rebleeding. Background AVMs cause significant GI bleeding, especially in patients with AF who are receiving OAC for stroke prevention. OCT has been shown to minimize recurrent GI bleeds related to AVMs. Methods In a multicenter, observational study, 38 AF patients with contraindications to OAC because of AVM-related GI bleeding were started on 100 μg of subcutaneous OCT twice daily. OAC was resumed in all patients within 48 h. Incidence of recurrent GI bleeds was calculated, and hemoglobin levels were recorded at enrollment and at 3 and 6 months’ follow-up. Results After a median follow-up of 8 months, 36 patients (mean age 69 ± 8.0 years; mean CHA2DS2-VASc score 3 ± 1 and mean HAS-BLED score 3 ± 1) were available for analysis. All were able to successfully resume OAC, and 28 of 36 (78%) remained on OAC at the conclusion of the study, whereas 8 underwent left atrial appendage closure with subsequent OAC discontinuation. No systemic thromboembolic events occurred in follow-up. Of the 28 patients who continued receiving OAC, 19 (68%) were free of recurrent GI bleed, 4 had minor GI bleeds, 4 required transfusion, and 1 required colectomy for GI bleeding. Mean hemoglobin levels in all patients receiving OAC were significantly higher at 3- and 6-month follow-up than at baseline (p Conclusions Subcutaneous OCT therapy is an attractive option in AF patients receiving OAC who have AVM-related GI bleeds. It allows successful reinitiation of OAC as a bridge to left atrial appendage exclusion or short-term relief from bleeding.

Academic medical centers are commonly referred challenging cases from the community. Fragmented and ultra-specialized care may introduce biases in medical decision-making. A 64-year-old white male with a history of heart failure with preserved ejection fraction, severe diastolic dysfunction

Studies assessing direct oral anticoagulants (DOAC) in patients with atrial fibrillation (AF) have excluded those with bioprosthetic heart valves (BPHV). Data on the safety and efficacy of DOACs is limited in this population We queried the electronic medical records (EMR) of our institution for

Cryoballoon pulmonary vein (PV) isolation/ablation is an efficacious treatment of paroxysmal and early persistent atrial fibrillation (AF), including in patients with left common (LC) PV anatomy. The efficacy of cryoballoon ablation is unknown in patients with right middle or accessory (RMA) PVs.

Significant uncertainty exists surrounding adverse outcomes in patients receiving testosterone replacement therapy (TRT). We examined the incidence of recurrent myocardial infarction (MI) and all-cause mortality in patients with low total testosterone (TT) levels and a prior history of MI. We

Readmissions after syncope are common and contribute to increased healthcare utilization and costs. Data on its thirty-day readmissions are limited. Hospitalizations with primary diagnosis of syncope (ICD 9 CM code: 780.2], between January and November 2014, who survived index hospitalization were

Symptomatic renal fibromuscular dysplasia (RFMD) occurs in 0.4% of the general population and presents most frequently as renovascular hypertension. Revascularization is generally considered in patients with medically refractory hypertension. A 51-year-old woman with multifocal FMD of bilateral

Recent increase in the torch flame use for cannabis inhalation is concerning because of its higher butane content and risk of myocarditis. A 36-year-old healthy male presented with myalgias, and suffered an in-hospital asystolic arrest. Coronary angiogram and 2D-Echocardiogram were normal. He

Patients with cardiac implantable electronic devices (CIEDs) frequently have arrhythmias warranting catheter ablation (CA). The risk of lead dislodgement with CA in patients with CIED implant within 1 year is uncertain. We retrospectively evaluated patients undergoing CA of arrhythmias at an

Background: Rapid and significant rise in esophageal temperature (ET) during radiofrequency ablation (RFA) for atrial fibrillation (AF) can be an indicator of an esophageal injury and limits our ability to achieve pulmonary vein isolation(PVI) by incomplete left atrial posterior wall (PW)ablation.

Background: The survival benefit of Implantable cardioverter defibrillator (ICD) in ischemic cardiomyopathy with an ejection fraction (EF) of ≤35% is well established. However, there remains controversy regarding its benefit in non-ischemic cardiomyopathy (NICM). We performed a meta-analysis

Background: Very recently St Jude Medical (SJM) released an advisory regarding premature battery depletion in a family of implantable cardioverter-defibrillators (ICDs) including biventricular cardiac defibrillators (CRTDs). There have been reported cases of loss of pacing and inability to

Background: The LARIAT device is a percutaneous endo-epicardial left atrial appendage (LAA) exclusion system that is currently performed in high risk atrial fibrillation (AF) patients intolerant to oral anticoagulation for stroke prevention and maybe reduction of AF burden. Methods: A comprehensive

Background: Novel oral anticoagulants (NOACs) have been found to be safe and effective for the prevention of systemic thromboembolim (STE) in non-valvular atrial fibrillation (AF) but their experience in patients undergoing cardioversion (CV) is limited. Methods: A comprehensive literature search

Background: Percutaneous left atrial appendage closure (LAAC) is effective for stroke prevention in atrial fibrillation (AF) patients unable to tolerate long-term oral anticoagulation. We analyzed the safety of two commonly used LAAC methods using surveillance data from the FDA MAUDE database.

Background: Uninterrupted use of anticoagulation is currently preferred over bridging therapy during cardiac implantable electronic device (CIED) implantation. However, there is limited experience with uninterrupted non-vitamin K antagonist oral anticoagulants (NOAC) in this setting. We performed a