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There is very limited data on long-term safety and efficacy of ablation procedures for Junctional ectopic tachycardia (JET) in adults. A retrospective chart analysis of all patients who underwent catheter ablation for JET between 2007 and 2016 were included in the study. A total of 12 patients are

Esophageal injury related lesions post atrial fibrillation (AF) ablation range from superficial erythema to a full blown atrio-esophageal fistula (AEF). Very little is known about the natural progression of these lesions. We performed a systematic review of the literature to identify temporal

Atrial fibrillation ablation has emerged as an effective tool in the management of symptomatic atrial fibrillation. Currently, the electrophysiologists are striving to maximize the success while minimizing complications. Phrenic nerve injury (PNI) is one of the concerning complications, especially in cases of cryoballoon ablation. Due to anatomical proximity to atrial tissue, phrenic nerve is particularly susceptible to injury. With evolving monitoring techniques it is now possible to minimize the likelihood of a permanent PNI. However, the challenge remains to detect PNI at the earliest and to avoid further damage to the nerve. In this review, we discuss pertinent anatomical principles, techniques to avoid PNI and management in cases where PNI is encountered.

Prior studies have highlighted disparities in cardiac lifesaving procedure utilization, particularly among women and in minorities. Although there has been a significant increase in implantable cardioverter‐defibrillator (ICD) insertion, socioeconomic disparities still exist in the trend of ICD utilization. With the use of the Nationwide Inpatient Sample from 2003 through 2011, we identified subjects with ICD insertion (procedure code 37.94) and cardiac resynchronization defibrillator (procedure code 00.50, 00.51) as codified by the International Classification of Diseases, Ninth Revision, Clinical Modification. Overall, 1 020 076 ICDs were implanted in the United States from 2003 to 2011. We observed an initial increase in ICD utilization by 51%, from 95 062 in 2003 to 143 262 in 2006, followed by a more recent decline. The majority of ICDs were implanted in men age ≥65 years. Implantation of ICDs was 2.5× more common in men than in women (402 per million vs 163 per million). Approximately 95% of the ICDs were implanted in insured patients, and 5% were used in the uninsured population. There has been a significant increase in ICD implantation in blacks, from 162 per million in 2003 to 291 per million in 2011. We found a significant difference in the volume of ICD implants between the insured and the uninsured patient populations. Racial disparities have narrowed significantly in comparison with those noted in earlier studies and are now more reflective of the population demographics at large. On the other hand, significant gender disparities continue to exist.

Background and Purpose: Thirty-day readmission rate is an indicator of quality and efficiency of care. Patients admitted within 30 days after index hospitalization are at high risk for recurrent 30-day readmissions. Therefore, we aimed to study the incidence and predictors of recurrent 30-day readmission after hospitalization for heart failure (HF), myocardial infarction (MI) and pneumonia. Methods: California State Inpatient Database (SID), a discharge database of all acute care admissions in the state of California was analyzed for adults discharged alive during 2003 to 2011 with primary diagnosis of HF, MI, or pneumonia using ICD-9 codes as defined by CMS for public reporting. Index cases were followed up for all-cause recurrent 30-day readmission using revisit variables included in SID. Inter-hospital transfers were counted as one common admission. Each patient could provide more than one index admissions if admitted multiple times with diagnosis of HF, MI or pneumonia during the study period. Multiple logistic regression models were constructed to identify independent factors associated with recurrent 30-day readmissions. Results: Of the 741,318 cases of HF, 374,860 cases of MI, and 676,412 cases of pneumonia included in the analysis, 70,629 (9.5%), 18,314 (4.9%) and 36,254 (5.4%) resulted in recurrent 30-day readmissions respectively. Rates of recurrent 30-day readmission after initial 30-day readmissions were 36.4%, 25.5%, and 29.4% for HF, MI and pneumonia respectively. Among 30-day readmissions, 66.6%, 69.0% and 66.5% were readmitted again within first 15 days of discharge from the initial 30-day readmission respectively. The most common etiology for recurrent 30-day readmission after HF and MI was HF (37.5% and 17.6% respectively), and after pneumonia was pneumonia (14.1%). In multivariate analysis, recurrent 30-day readmission rate was higher among younger, non-white race, Medicaid and Medicare (vs. private insurance), higher comorbidity index, hospitals with lowest case volume, and discharge against medical advice, discharge to facility or home health care (vs. home/self-care). Conclusion: Patients admitted within 30 days from discharge remains at high risk for recurrent 30-day readmission. Two-thirds of readmissions occurred within 15 days of discharge from the previous admission thus, interventions implemented before the discharge and during early post-discharge follow up are keys to successfully reducing recurrent 30-day readmissions.

We want to thank Dr. Maekawa for their interest in our recent study on β-blocker use in patients with stable angina undergoing elective percutaneous coronary intervention [(1)][1]. Our paper demonstrated that use of β-blockers at the time of discharge in patients with stable angina without a

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: 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

Objectives: To assess the utility of CHADS2 score to predict the outcomes of pulmonary vein antral isolation (PVAI) in patients with atrial fibrillation (AF). Background: The CHADS2 score is a clinical classification scheme used for predicting stroke in patients (pts) with AF. In the current study

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: Safety of peri-procedural use of novel oral anticoagulation agents (NOACs) during cardiac device implantation has been suggested in small observational studies. Larger data affirming its safety is lacking. Methods: We performed a multicenter evaluation of safety of uninterrupted

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

Atrial fibrillation (AF) is the most prevalent arrhythmia in United States. Patients with AF are at increased risk of thromboembolic events. This risk is even higher with cardioversion and ablation, especially during periprocedural period. Conventional approaches using heparin and warfarin have been successfully studied to mitigate thromboembolic risk. However, these approaches are with certain inherent limitations. The advent of new target specific oral anticoagulants (TSOAs) may overcome some of the impediments of conventional therapies and provide an alternative for anticoagulation for cardioversion and AF ablation. We will review the role of the new TSOAs in the current anticoagulation strategies to reduce the risk of thromboembolic events associated with cardioversion and AF ablation.

Proton pump inhibitors (PPI), commonly used medications for peptic ulcer prophylaxis, have been recently described to cause hypomagnesemia through both urinary and gastrointestinal losses. Very few reports have linked hypomagnesemia with life-threatening ventricular arrhythmias. However, these reports included patients with other complex medical problems that may have also contributed to these arrhythmias. To our knowledge, ventricular arrhythmias associated with hypomagnesemia induced by proton pump inhibitors have never been reported. We present a case of a 53-year-old chronic alcoholic male patient, who was started on a proton pump inhibitor for peptic ulcer prophylaxis, which resulted in resistant hypomagnesemia associated with a storm of life-threatening arrhythmias, namely Torsades de Pointes (TdP). A 53-year-old man with no previous cardiac history was brought by Emergency Medical Services with a chief complaint of palpitations and dizziness for 1 day. His only significant medical history was chronic alcohol abuse and was not taking any medications before his admission. His physical examination was normal, except for an irregularly irregular rapid pulse and a blood pressure of 157/104 mm Hg. The ECG on admission showed atrial fibrillation with rapid ventricular response at an average of 190 beats per minute. Admitting routine labs showed normal complete blood counts. Electrolyte laboratory values revealed 136 mEq/L of sodium, 4.6 mmol/L of potassium, 100 mEq/L of chloride, 16 mEq/L of bicarbonate, 11 mg/dL of blood urea nitrogen, 0.68 mg/dL of creatinine, 9 mg/dL of calcium, and 1.5 mg/dL of magnesium. He was started on intravenous diltiazem for rate control and intravenous heparin for anticoagulation. Routine oral pantoprazole 40 mg once daily was also prescribed for peptic ulcer prophylaxis. Seven hours later, while on telemetry, the patient became unresponsive. The telemetry rhythm …

Objective: Congenitally corrected transposition of great arteries (CCTGA) is characterized by atrioventricular and ventriculoarterial discordance. Characterizations of these anomalies are important because they may influence surgical approach and management. Methods: We present a case of newly diagnosed CCTGA at the age of 50. He presented with sudden onset of shortness of breath for the first time and was diagnosed with CCTGA. Echocardiogram, magnetic resonance imaging, and cardiac catheterization were utilized to elucidate the pathology. Results: Intraoperatively, patient's CCTGA and ventricularization of the right ventricle were confirmed. The severe systemic atrioventricular valve regurgitation was replaced with a bioprosthetic valve (Medtronic Mosaic No. 29) with placement of epicardial ventricular leads for possible future placement of automatic implantable cardioverter defibrillators. Pathology report confirmed a degeneration of the systemic atrioventricular valve. Conclusions: Significant coronary artery anomalies have also been described in literature with CCTGA. The variances encountered in this case are excellent examples of the intricacies associated in diagnosis and surgical care in patients with CCTGA.

Warfarin's monopoly as an anticoagulation therapy for atrial fibrillation has been challenged recently. RE-LY trial has shown superiority of dabigatran over warfarin in prevention of stroke with significantly lower risk of intracranial hemorrhage in patients with non-valvular atrial

Case Report A 75-yr-old gentleman, with a past medical history of diabetes mellitus and Acute Myeloid Leukemia presented to our emergency department with a chief complaint of exertional dyspnea and chest pain. A week prior to this visit, he had recieved a cycle of decitabine chemotherapy at 20 mg/metered square for ten days. This was his second cycle of decitabine. His out patient medications included megesterol, omeprazole, morphine sulfate and insulin glargine. The patient was admitted to the Coronary Care Unit for Acute Coronary Syndrome. His cardiac enzymes were elevated (peak troponin 30 ng/mL, CKMB 67.4 ng/mL). His 12 lead EKG revealed sinus tachycardia with a ventricular rate of 113, but without acute ST–T wave changes. The BNP was 259 pg/mL. A 2D echo revealed moderate diffuse hypokinesis with an EF of 35%. He subsequently underwent a left heart catheterization, which showed non-obstructive CAD. In our patient, the elevated troponins (peak troponin 30 ng/mL) and BNP were seen concomitant with the onset of cardiogenic shock. Two months ago, his 2 D echocardiogram revealed an ejection fraction of about 55%–65% with slightly increased left ventricular (LV) wall thickness. Discussion The most common adverse effects of decitabine include cytopenia, nausea, pain and erythema/nodules at the injection site. To date, there has been only one reported case of a hypomethylating agent inducing acute myocarditis. We a present a case of reversible, non-ischemic cardiomyopathy secondary to decitabine chemotherapy, which resolved after the drug was discontinued. Trials involving decitabine for the treatment of MDS reported no myocarditis. In our case, the diagnosis of transient cardiomyopathy was highly probable since the patient's troponins and echocardiogram returned to baseline after discontinuation of treatment. Also, the patient never had any further chest pain at his 6 month follow up. In this case, we believe that the elevated Troponin I levels, along with a cardiac catheterization revealing patent coronary vessels, favor our hypothesis that our patient suffered from acute myocarditis as a result of direct toxicity from decitabine chemotherapy. We doubt that there was an underlying infectious etiology, since the patient had three negative blood cultures, two negative urine cultures and a negative viral serology. Our case demonstrates that chest pains in a patient treated with hypomethylating agents should be further explored in order to rule out acute myocarditis.

Role of neutrophil lymphocyte ratio (NLR) in predicting cardiovascular events has not been studied in general population. To see if NLR adds to Framingham risk score (FRS) for prediction of coronary heart disease (CHD) mortality in a nationally representative cohort. We included 6,413 subjects of

We present a rare case of Twiddler’s syndrome diagnosed in an asymptomatic patient on a routine follow up. This case reiterates the need for frequent monitoring of the implanted device. In addition, it was detected 4 years after implantation of an automatic implantable cardioverter defibrillator. This late representation is extremely uncommon.

The exact relationship between blood pressure (BP) and mortality is unclear in a population of patients with atrial fibrillation (AF). We performed a post hoc analysis of 3,947 participants from the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Trial. Systolic (SBP) and