Search

Atrial fibrillation (AF) is the most common cardiac arrhythmia encountered in clinical practice projected to affect 12.1 million individuals by the year 2030. Patients who are diagnosed with AF have an increased risk of morbidity and mortality. Although catheter ablation is a class I treatment recommendation in patients with symptomatic paroxysmal AF, antiarrhythmic medications (AAM) continue to be the mainstay of treatment in limited resource settings not offering ablation procedures. Currently, the most used AAMs are those which block either the sodium or potassium channels. We hypothesized that the use of selective dual AAM (sodium and potassium channel blockers) (DAAM) improves the chance of maintaining sinus rhythm and decreases the need for catheter ablation when compared with single AAM (SAAM). This retrospective observational study was conducted in 150 patients with paroxysmal AF over 5 years at Richmond University Medical Center in Staten Island, New York. The following data were collected: age, sex, comorbidities, electrocardiogram findings, ejection fraction by echocardiography, classes of AAM, duration, and response to treatments. The primary endpoint included the absence of symptoms and maintenance of sinus rhythm. The secondary endpoint included the requirement of electrical cardioversion or catheter ablation. A total of 86 patients met the inclusion criteria in our analysis. The average age of the patients was 71.06 years (SD = 7.66). About 45 patients were given DAAM of either amiodarone + flecainide or dronedarone + flecainide and were treated for an average of 15.4 months, followed by catheter ablation, if needed. Also, 41 patients received a SAAM followed by catheter ablation, if needed. A Mann-Whitney test indicated that electrical cardioversion and catheter ablation were greater for the SAAM group (Md = 1) than for the DAAM group (Md = 0) (U = 294.00, P value <0.001; U = 507.00, P value <0.001, respectively). No pro-arrhythmic side effects or death were encountered in either group. Treatment of paroxysmal AF with DAAM is effective compared with SAAM and is less likely to need catheter ablation or electrical cardioversion. Well-designed prospective studies are needed to further explore the use of DAAM in the management of paroxysmal AF and its clinical impact in limited resource settings., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Leadless pacemaker systems (LPs) were developed as an alternative to traditional transvenous permanent pacemakers (TV-PPM) due to increasing rates of device and procedural related complications, leading to a high-cost burden to our health-care system. LPs were initially indicated for single-chamber ventricular pacing; however, recent developments have allowed for dual-chamber pacing too. These systems have demonstrated highly successful implant rates with stable pacing performance. This article describes the retrieval techniques of the Micra LPs and ways to mitigate challenges encountered during the retrieval process., Competing Interests: Disclosure Kirollos Gabrah, DO: The author has nothing to disclose. Arun Umesh Mahtani, MD, MS: The author has nothing to disclose. Devi Nair, MD: The author has received grants, research support, consulting fees, or honoraria from Boston Scientific Corp, Medtronic Inc, Abbott Medical, Biosense Webster, Adagio, and Affera., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Competing Interests: Arun Umesh Mahtani, MD, MS: The author has no conflict of interest. Kirollos Gabrah, DO: The author has no conflict of interest. Devi Nair, MD, FHRS: The author has received grants, research support, consulting fees, or honoraria from Boston Scientific Corp, Medtronic Inc, Abbott Medical, Biosense Webster, Adagio, and Siemens.

As per the Centers for Disease Control and Prevention (CDC), the incidence of myocardial infarction (MI) is reported to be 805,000 cases annually in the United States (US). Although commonly occurring in elderly individuals with underlying cardiovascular comorbidities or younger generations with familial predispositions serving as risk factors, it is extremely rare for an isolated event to occur in teenagers with a history of marijuana use. In this article, we report a rare case of ST-elevation myocardial infarction (STEMI) in a 19-year-old male with no past medical history that was attributed to marijuana use. This case report and review of literature depict a potential association between marijuana use and STEMI. We also highlight potential clinical implications to aid healthcare professionals in making an early diagnosis and achieving a timely management strategy., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Problem: Reviewing residency application narrative components is time intensive and has contributed to nearly half of applications not receiving holistic review. The authors developed a natural language processing (NLP)-based tool to automate review of applicants' narrative experience entries and predict interview invitation., Approach: Experience entries (n = 188,500) were extracted from 6,403 residency applications across 3 application cycles (2017-2019) at 1 internal medicine program, combined at the applicant level, and paired with the interview invitation decision (n = 1,224 invitations). NLP identified important words (or word pairs) with term frequency-inverse document frequency, which were used to predict interview invitation using logistic regression with L1 regularization. Terms remaining in the model were analyzed thematically. Logistic regression models were also built using structured application data and a combination of NLP and structured data. Model performance was evaluated on never-before-seen data using area under the receiver operating characteristic and precision-recall curves (AUROC, AUPRC)., Outcomes: The NLP model had an AUROC of 0.80 (vs chance decision of 0.50) and AUPRC of 0.49 (vs chance decision of 0.19), showing moderate predictive strength. Phrases indicating active leadership, research, or work in social justice and health disparities were associated with interview invitation. The model's detection of these key selection factors demonstrated face validity. Adding structured data to the model significantly improved prediction (AUROC 0.92, AUPRC 0.73), as expected given reliance on such metrics for interview invitation., Next Steps: This model represents a first step in using NLP-based artificial intelligence tools to promote holistic residency application review. The authors are assessing the practical utility of using this model to identify applicants screened out using traditional metrics. Generalizability must be determined through model retraining and evaluation at other programs. Work is ongoing to thwart model "gaming," improve prediction, and remove unwanted biases introduced during model training., (Copyright © 2023 by the Association of American Medical Colleges.)

Background: Bystander cardiopulmonary resuscitation (CPR) is the cornerstone in managing out-of-hospital cardiac arrest (OHCA). However, India lacks a formal sudden cardiac arrest (SCA) registry and the infrastructure for a robust emergency medical services (EMS) response system. Also, there exists an opportunity to improve widespread health literacy and awareness regarding SCA. Other confounding variables, including religious, societal, and cultural sentiments hindering timely intervention, need to be considered for better SCA outcomes., Objectives: We highlight the current trends and practices of managing OHCA in India and lay the groundwork for improving the awareness, education, and infrastructure regarding the management of SCA., Conclusion: Effective management of OHCA in India needs collaborative grassroots reformation. Establishing a large-scale SCA registry and creating official and societal guidelines will be pivotal for transforming OHCA patient outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Cardiological Society of India. Published by Elsevier, a division of RELX India, Pvt. Ltd. All rights reserved.)

Cardiac Amyloidosis (CA) is a manifestation of a systemic disorder resulting from the deposition of transthyretin (TTR) in the myocardium. This leads to a myriad of manifestations ranging from conduction defects to heart failure. Previously CA was considered a rare disease, but recent advances in diagnostics and therapeutics have revealed the prevalence to be higher than estimated. There are two major classes of treatments for TTR cardiac amyloidosis (ATTR-CA): TTR stabilizers, such as tafamidis and AG10, and RNA interference (siRNA), such as patisiran and vutrisiran. Clustered regularly interspaced short palindromic repeats of genetic information-Cas9 endonuclease (CRISPR-Cas9) utilizes an RNA-guided endonuclease to target specific locations in the genome. Until recently, CRISPR-Cas9 was studied in small animal models for its ability to decrease extracellular deposition and accumulation of amyloid in tissues. Gene editing has demonstrated some early clinical promise as an emerging therapeutic modality in the treatment of CA. In an introductory human trial involving 12 subjects with TTR amyloidosis and amyloid cardiomyopathy (ATTR-CM), CRISPR-Cas9 therapy has demonstrated a reduction in approximately 90% of serum TTR proteins after 28 days. In this article, the authors review the current literature on therapeutic gene editing as a prospective curative treatment modality for CA., (Copyright © 2023 Elsevier Inc. All rights reserved.)

We highlight a case of a 38-year-old immunocompromised man with untreated human immunodeficiency virus and Hepatitis C who presented with progressive soft tissue infection of the right foot despite appropriate antibiotic therapy. While he was admitted, the patient disclosed a recent diagnosis of mpox treated with oral tecovirimat. He subsequently developed worsening lesions over his entire body. In addition, a polymerase chain reaction of the wound on the right foot was positive for mpox virus, and the patient improved on treatment with intravenous tecovirimat and vaccinia immunoglobulin., (© 2023 Wiley Periodicals LLC.)

We discuss a case report of a 66-year-old male with no prior cardiac history who presented to the hospital with persistent hiccups and shortness of breath. Following a positive nuclear stress test and cardiac catheterization, a rare anatomical variant of a sinoatrial nodal artery originating from the right posterolateral artery was revealed., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2022 The Author(s).)

The term paroxysmal supraventricular tachycardia encompasses a heterogeneous group of arrhythmias with different electrophysiologic characteristics. Knowledge of the mechanism of each supraventricular tachycardia is important in determining management in the office, at the bedside, and in the electrophysiology laboratory. Paroxysmal supraventricular tachycardias have an abrupt onset and offset, typically initiating and terminating with premature atrial ectopic beats. In the acute setting, both vagal maneuvers and pharmacologic therapy can be effective in arrhythmia termination. Catheter ablation has revolutionized therapy for many supraventricular tachycardias, and newer techniques have significantly improved ablation efficacy and decreased periprocedural complications and procedure times., (Copyright © 2019 Elsevier Inc. All rights reserved.)