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Magnetic resonance imaging (MRI) in patients with MRI-conditional cardiovascular implantable electronic devices (CIED) remain a logistical issue for device programming during the scan. In current practice, a trained person needs to be present on-site to program CIED for MRI scan. This can cause delay in patient care, rescheduling of tests and increase healthcare costs. A novel remote programming (RP) strategy can be utilized to reprogram the CIED remotely. We sought to explore the feasibility and safety of RP of CIEDs in patients undergoing MRI scan.We implemented the Medtronic CIED RP software at our institution after ensuring HIPAA compliance. The MRI technician started the session by contacting an off-site remote operator and placing a programmer wand from the 2090 Medtronic programmer over the CIED. The remote operator logged into a remote access software and provided a unique access code to the MRI technician. After entering the access code into the programmer, the remote operator was able to program the device as needed. We conducted a periodic audit of the first 209 patients who underwent RP of CIEDs for MRI. Outcomes analyzed were successful completion of RP sessions and time saved per scan.Of the 209 MRI scans, 51 scans were performed urgently. There were no connectivity and programming problems or need for MRI rescheduling. In-person reprogramming was not required for any patient. All scans were completed safely in a timely manner, and there were no reports of CIED malfunction. Time saved per scan was estimated to be 28 ± 10 min.Remote programming of CIEDs for MRI scans is a safe and effective strategy.

Background Role of statins in prevention of contrast-induced acute kidney injury (CI-AKI) in patients undergoing coronary angiography remains controversial. We studied the use of statins in decreasing CI-AKI following coronary angiography. Methods We reviewed all patients who underwent coronary angiography with or without PCI and had a follow-up creatinine from January 2012 to December 2016 at a single tertiary care center in the United States. CI-AKI was defined as 0.3 mg/dL absolute rise in creatinine. Patients who were on moderate to high-intensity statins or received moderate to high-intensity statins prior to coronary angiography were included in the statin group. Crude and adjusted odds ratios (AOR) were calculated using univariate multiple logistic regression analysis. Results Out of 2055 patients (females = 30.7%, mean age 58.0 ± 12.5 years, statin group = 886, non-statin group = 1169), 293 (14.3%) developed CI-AKI. Mean estimated glomerular filtration rate (eGFR) was not significantly different between the statin and the non-statin group (86.5 mL/min/1.73 m 2 vs 87.1 mL/min/1.73 m 2 , p = 0.65). There was no significant difference in the incidence of CI-AKI between statin and non-statin group (14.4% vs 14.1%, p = 0.83). When adjusted for other risk factors, statin use was not significantly associated with decreased risk of CI-AKI (AOR) = 0.8, [95% confidence interval (CI) = 0.6–1.1, p = 0.19]. Results remained statistically non-significant on subgroup analysis of patients with acute coronary syndrome (ACS) (OR = 0.8, 95% CI = 0.6–1.2, p = 0.27), patients who had percutaneous coronary intervention (PCI) (OR = 1.1, 95% CI = 0.6–1.7, p = 0.81) and patients with eGFR 2 (OR = 0.9, 95% CI = 0.6–1.5, p = 0.9). Conclusion Statin use prior to coronary angiography is not associated with decreased incidence of CI-AKI.

Introduction: Cardiac amyloidosis is associated with high risk for sudden cardiac death. However, the potential benefit of implantable cardioverter defibrillator (ICD) implantation in CA is unknown due to limited available data regarding outcomes following ICD implantation in this patient population. We sought to perform a meta-analysis of trials that evaluated the outcomes of ICD implantation in CA. Methods: We performed a systematic literature review in PubMed, SCOPUS, and Cochrane to identify all studies that evaluated ICD therapy in CA until May 2020. Outcomes analyzed were all-cause mortality and appropriate ICD therapy rates. A random effects model was used to calculate percentages and 95% confidence intervals (CI) of outcomes. Results: Of the screened articles, 5 observational studies were included for analysis. A total of 151 patients were analyzed. Mean age of population was 61.6 +/- 0.7 years and 79.2% were male. The all-cause mortality rate was 33% (95% CI:16 to 51%) and the incidence of appropriate ICD therapy was 23% (95% CI:16 to 30%) over a mean follow up period of 16 months (Figure). In trials that evaluated ICD therapy in non-ischemic cardiomyopathy such as DANISH, DEFINITE and SCD-HeFT trials mortality rates in the ICD arm were 21.6 % over 67.6 months, 9.4% over 29 months and 16.7% over 45.5 months, respectively. The incidence of appropriate therapy in DANISH, DEFINITE and SCD-HeFT trials were 28.9%, 19.8 % and 21% respectively. Conclusions: CA patients with ICD have equivalent appropriate therapy with disproportionately higher mortality over a shorter follow up compared to randomized trials of primary prevention ICD placement in NICMP. The benefit of ICD placement for mortality reduction in CA remains unclear and further large-scale studies are required to address this issue.

Intracardiac masses are diagnostically challenging with differential including tumor, thrombus and vegetation. Malignancies involving the heart are predominantly metastatic arising from lung, breast, kidney and melanoma. We report a case of squamous cell carcinoma (SCC) of the pharynx metastasizing

Background: Infectious endocarditis (IE) is a known complication after transcatheter aortic valve implantation (TAVI). Available data suggest that IE was infrequent after TAVI but was associated with substantial mortality. We sought to determine the 6-month incident rates and outcomes of this complication after TAVI in the United States representative patient population. Methods: A weighted sample of adult patients who underwent TAVI and survived to discharge were identified in the Nationwide Readmissions Database January to June 2014 using appropriate ICD-9 codes. Among these patients, readmissions within 180-days in which IE was diagnosed were identified. Microbiology, complications, valvular procedural utilization, and mortality with IE were the outcomes studied. Results: Of 7,834 patients (mean age 81 years, 52% men) who underwent TAVI during the study period, 61 patients (0.8%; mean age 79 years, 58% men) had IE within 180 days form discharge. Median day to developing IE was 79 days [interquartile range 49-124 days]. Septicemia was present in 43 patients (71%) of which 15 (24%) developed septic shock. Gram positive bacteremia was frequent with 13 patients (21%) having Streptococcal bacteremia, and 12 (19%) with Staphylococcal bacteremia. Gram negative organisms were identified in 4%. Heart failure developed in 46 patients (75%), respiratory failure in 12 (20%), and acute kidney injury in 18 (29%). Concomitant pneumonia was present in 8 patients (13%). A valvular intervention was not performed in any of the 61 patients and 13 patients (22%) died in-hospital after IE diagnosis. Conclusions: Nearly 8 out of every 1000 patients undergoing TAVI developed IE within 6 months post-procedure. IE post TAVI was most commonly caused by gram positive bacteria and was associated with very high rates of multi-system complication. A valvular intervention was not performed in these sick patients with IE, and 1 out of 5 patient who developed IE died.

Introduction: Spontaneous Coronary Artery Dissection (SCAD) is reported to occur predominantly in young women. Gender differences in the clinical presentation and outcomes of patients with SCAD have not been studied on a population level. We sought to compare the in-hospital outcomes of men and women presenting with acute myocardial infarction (AMI) and SCAD. Methods: We identified patients from the National Inpatient Sample (NIS) between 2005 and 2015 who presented with primary diagnoses of AMI and SCAD. We identified SCAD with ICD-9 code 414.12. A 1:1 propensity-matched cohort was created to examine the outcomes between men and women. Primary endpoint was in-hospital mortality. Secondary endpoints included in-hospital cardiac and non-cardiac complications. Results: Of the 6617 (32017 weighted national estimates) patients with SCAD over the study period, majority were males 3667 (55.4%). Males were younger than females (60.32 yr vs. 61.59 yr) and presented more often with ST-elevation myocardial infarction (STEMI) (53.0% vs. 45.9% P= Conclusion: In our large population-based analysis, compared to females, males were more likely to present with STEMI as compared to females. With the except of V-Tach, which was higher in males, there were no significant gender differences in hospital outcomes namely inpatient mortality, cardiogenic, Vfib or acute heart failure.

Introduction: There has been steady increase in the number of catheter ablations for the definitive management of atrial fibrillation and it is associated with its own complications with vascular complications being the most common. There are many studies comparing Ultrasound (US) guided versus Conventional Method (CM) of venipuncture for complications as these patients are on therapeutic anticoagulation. We conducted a meta-analysis to look for any difference between the two approaches. Methods: PubMed, Medline, EMBASE and Cochrane databases were analyzed from inception to January 2018 for all studies comparing US vs CM for venipuncture in patients undergoing catheter ablation. Four observational studies and one Randomized Controlled Trial (RCT) with 5158 patients were studied for major and minor vascular complications. Major vascular complications included hematoma/major bleeding (more than or equal to BARC2), AV fistula and pseudo aneurysm. Random effect model was used to estimate the odds ratio of dichotomous outcomes Results: Major and minor vascular complications were significantly less with US guided approach as compared to conventional approach {Odds Ratio (OR): 0.36, 95% CI 0.21-0.61, P=0.0002} and {Odds Ratio (OR): 0.30, 95% CI 0.15-0.64, P=0.002} respectively. Conclusion: Real time ultrasound use for venipuncture access is safer approach with significantly lesser vascular complications in patients with atrial fibrillation on anticoagulation undergoing catheter ablation.

Introduction: Ventricular ectopy after exercise, due to parasympathetic activity, predicts an increased risk of death in population-based cohorts. We sought to examine the composite risk of all cause mortality in patients with premature ventricular contractions (PVCs) in the early recovery phase of stress testing. Methods: PubMed, Medline & EMBASE were queried for all English language articles from 1993 to 2017. The primary outcome was incidence of all cause mortality in patients with frequent PVCs during recovery phase (RPV) of stress testing. Frequent PVCs were defined as the presence of seven or more ventricular premature beats/min, frequent ventricular couplets, ventricular bigeminy or trigeminy, or any other form of ventricular tachycardia or ventricular fibrillation. Meta-analysis of the main outcome was performed using a weighted random effects model. Results: A total of four observational studies including 38765 patients were retrieved. Data for 2065 patients with RPV was pooled. A comparative analysis of PVC vs Infrequent/Non-PVC group showed a calculated risk ratio for all cause mortality of 1.8 (95% CI 1.36-2.38; p=0.001). I 2 statistic for heterogeneity testing was 82.8% (Fig.1). Conclusion: Frequent premature ventricular contractions during early recovery phase of stress testing are associated with increased all cause mortality as compared to patients with infrequent or no PVCs.

Background: Studies have shown that transradial approach (TR) is associated with increased radiation exposure compared to transfemoral (TF) approach. However, it is believed that the difference in radiation exposure may not be significant between the two approaches when performed by experienced operators, as TR approach has a challenging learning curve. Newer studies have shown conflicting results in radiation exposure between the two treatment strategies. Hence, we sought to perform a meta-analysis comparing the radiation exposure between TR and TF approach during coronary angiography (CA) and percutaneous coronary intervention (PCI). Methods: We searched PubMed, EMBASE and SCOPUS for eligible studies. 27 randomized controlled trials (RCTs) were included in our analysis. Outcomes analyzed were Fluoroscopy time (FT) in minutes and dose-area product (DAP) in Gy/cm2. We used Inverse variance random effects model to calculate the mean difference (MD) and 95% confidence interval (CI). We performed a subgroup analysis of trials that compared the two approaches for CA and PCI separately. We also performed a subgroup analysis of trials that only included self-identified experienced operators. Results: FT was reported by 26 trials and was significantly higher with TR approach for both CA (MD=1.28, 95% CI 0.78 to 1.77, P Conclusions: TR approach is associated with higher radiation exposure than TF approach even with experienced operators. However, the clinical significance of this finding has to be evaluated in larger RCTs.

Background: CABG is the preferred revascularization strategy for unprotected left main disease. Multiple small scale trials and registry data showed that PCI with Drug Eluting Stents is a non-inferior strategy and is a Class IIa ACC/AHA recommendation in a high surgical risk patient with favorable anatomy. However, two recent large scale randomized trials have shown conflicting evidence. We conducted a meta-analysis of the existing data to compare the long term outcomes of PCI with DES vs CABG for left main stenosis. Methods: 4 randomized and 8 non-randomized studies involving 10,284 patients were included. The primary endpoint was a composite of death, stroke or MI at three years or longer. Secondary end points were MACCE (death, stroke, MI or repeat revascularization) and it's individual components. Heterogeneity of the studies was analyzed by Cochran’s Q statistics. The Mantel-Haenszel random effects model was used to calculate the combined odds ratio for outcomes. An independent analysis was performed for the randomized data only. Results: There was no significant difference in the primary composite outcome between PCI and CABG at long term follow up. However the MACCE was significantly higher in PCI, primarily driven by significantly high repeat revascularization. The stroke rate was lower in PCI, although not significant. Analysis of randomized data also yielded similar results. A subgroup analysis stratified by SYNTAX score showed that MACCE and repeat revascularization were not significantly different between PCI and CABG in low to intermediate SYNTAX score ( Conclusion: There was no significant difference in the primary composite outcome between PCI with DES and CABG at long term follow up. Repeat Revascularization in PCI was also not different from CABG in left main stenosis with low SYNTAX score. PCI with DES can be considered as a reasonable alternate strategy in isolated left main stenosis.