Contemporary Practices for Management of Subclinical Atrial Fibrillation.

Subclinical atrial fibrillation (SCAF) episodes are frequently detected in patients with cardiac implantable electronic devices (CIEDs). These asymptomatic arrhythmias are increasingly recognized as potential harbingers of clinical atrial fibrillation and thromboembolic events. However, the management of SCAF-particularly regarding the use of oral anticoagulation (OAC)-remains controversial.

Dual-morphology Bundle Branch Re-entrant Ventricular Tachycardia in Non-dilated Cardiomyopathy.

Bundle branch re-entrant (BBR) tachycardia is an uncommon form of ventricular tachycardia (VT). This arrhythmia typically occurs in patients with a structural heart disease, especially dilated cardiomyopathy, and significant conduction system impairment, although affected patients with a structurally normal heart or normal conduction system have been reported. The QRS morphology during tachycardia can vary; it typically has a left bundle branch block (LBBB) morphology in which the antegrade conduction is over the right bundle and the retrograde limb is over the left bundle.

Clinical parameters of death and heart failure hospitalization in biventricular systolic dysfunction assessed via cardiac magnetic resonance.

Aims: While factors associated with adverse events are well elucidated in setting of isolated left ventricular dysfunction, clinical and imaging-based prognosticators of adverse outcomes are lacking in context of biventricular dysfunction. The purpose of this study was to establish role of clinical variables in prognosis of biventricular heart failure (HF), as assessed by cardiac magnetic resonance imaging.

Methods: Study cohort consisted of 840 patients enrolled in DERIVATE registry with coexisting CMR-derived right ventricular (RV) and left ventricular (LV) dysfunction, as defined by RV and LV ejection fractions ≤45 % and ≤ 50 %, respectively.

Percutaneous pericardiocentesis using the apical approach: case series and review of the literature.

Background: Pericardiocentesis offers a definitive diagnostic and a life-saving therapeutic modality through removal of pericardial fluid and relief of high intrapericardial pressure. Percutaneous pericardiocentesis has been performed via different approaches depending on different institutional experiences. In this paper, we present our institutional experience and review the current literature of the different approaches for performing percutaneous pericardiocentesis.

Inappropriate Subcutaneous Implantable Cardioverter-defibrillator Shocks-A Rare Case of Triple Counting.

Sudden cardiac death (SCD) caused by ventricular tachyarrhythmias is a significant contributor to cardiovascular deaths worldwide. Implantable cardioverter-defibrillators (ICDs) have shown efficacy in preventing and reducing mortality from SCD, but traditional transvenous ICDs have inherent challenges and drawbacks, such as lead fractures, lead-associated endocarditis, and lead failure. To address these issues, subcutaneous ICDs (S-ICDs) have been developed.

Left Atrial Appendage Closure: An Alternative to Anticoagulation for Stroke Prevention in Patients with Kidney Disease.

Anticoagulation to reduce thromboembolic stroke risk due to nonvalvular atrial fibrillation in ESKD is associated with increased bleeding. There is an existing debate in ESKD centers around the pros and cons of anticoagulation. We propose percutaneous left atrial appendage occlusion as a third alternative to balance thrombosis and bleeding risks in this high-risk population.

Major adverse cardiac events in symptomatic women with non-obstructive CAD on coronary CTA: pooled analysis from PROMISE and SCOT-HEART.

The presence of non-obstructive coronary artery disease (CAD) on coronary computed tomography angiography (CTA) has been associated with the occurrence of major adverse cardiac events (MACE). However, factors associated with the development of MACE in symptomatic women with non-obstructive CAD on coronary CTA have not been fully elucidated. We sought to examine the influence of risk factors and coronary artery calcification on MACE in symptomatic women with non-obstructive CAD on coronary CTA.

Direct Oral Anticoagulants Versus Warfarin in Left Ventricular Thrombus: A Systematic Review and Meta-Analysis.

Background: There are conflicting results regarding the safety and efficacy of direct oral anticoagulants (DOACs) in the management of left ventricular thrombus (LVT) compared with the vitamin K antagonist warfarin.

Study Question: What is the safety and efficacy of DOACs in the management of LVT compared with warfarin?

Data Source: Randomized clinical trials and cohort studies in the MEDLINE and Cochrane databases from inception till April 4, 2021.

Study Design: The present analysis is a systematic review and meta-analysis.

Oral Anticoagulation Discontinuation Following Catheter Ablation of Typical Atrial Flutter.

Catheter ablation (CA) of typical atrial flutter (AFL) is the preferred treatment for typical AFL due to its excellent long-term success rate. However, current guidelines recommend pursuing oral anticoagulation (OAC) based on established indices of stroke regardless of the perceived success of ablation. We conducted a retrospective study of all patients who underwent typical AFL ablation at our institute from 2011 to 2017.

Left Bundle Branch Block-Induced Cardiomyopathy in a Transplanted Heart Treated With His Bundle Pacing.

A 70-year-old male with prior orthotopic heart transplant developed left bundle branch block followed by new-onset left ventricular systolic dysfunction. He underwent His bundle pacing for cardiac resynchronization therapy with complete normalization of his ejection fraction. This is the first reported case of left bundle branch block-induced cardiomyopathy in a transplanted heart.

The sensitivity of graphic trends in differentiating sinus and supraventricular tachycardia.

Background: The use of cardiac telemetry in the inpatient setting is widespread and has become integral in managing hospitalized patients. Telemetry is used to monitor patients with brady- and tachyarrhythmias. While most of the focus is on the rhythm strip data, a significant utility remains in analyzing the graphic heart rate trends.

Gender differences, outcomes and trends among nonagenarian with atrial fibrillation: insight from National Inpatient Sample database.

Background: Nonagenarians (NG), individuals aged ≥ 90 years, constitute an increasing proportion of hospitalizations presenting with atrial fibrillation (AF). However, not much is known about demographics, clinical outcomes, and trends of hospitalizations. Therefore, we analyzed data about hospitalizations and clinical outcomes among NGs with AF over ten years from 2005 to 2014 using a publically available database, the National Inpatient Sample.

Utility of Inferior Lead Q-waveforms in diagnosing Ventricular Tachycardia.

Background: Electrocardiogram (ECG) differentiation of wide complex tachycardia (WCT) into ventricular tachycardia (VT) and supraventricular tachycardia with aberration (SVT-A) is often challenging.

Objective: To determine if the presence of Q-waveforms (QS, Qr, QRs) in the inferior leads (II, III, aVF) can differentiate VT from SVT-A in a WCT compared to Brugada algorithm. We studied 2 inferior lead criteria namely QWC-A where all the inferior leads had a similar Q wave pattern and QWC-B where only lead aVF had a Q-waveform.

His-bundle pacing: A novel treatment for left bundle branch block-mediated cardiomyopathy.

Background: Chronic left bundle branch block (LBBB) can lead to LBBB-mediated cardiomyopathy from left ventricular dysynchrony. His-bundle pacing (HBP) results in direct electrical synchrony using the native His-Purkinje system, providing a novel treatment for this cardiomyopathy.

Objective: To assess the feasibility of HBP for cardiac resynchronization therapy (CRT) in LBBB-mediated cardiomyopathy patients.

Mapping and Ablation of Ventricle Arrhythmia in Patients with Left Ventricular Assist Devices.

Ventricular arrhythmias (VA) constitute well-known problems in patients with left ventricular assist devices (LVADs), with incidence ranging from 18% to as high as 52%. Catheter ablation has become a common therapeutic intervention to treat drug-refractory VA, particularly with the increase and more widespread use of durable LVADs to bridge patients to transplantation or as destination therapy. In this article, we focus on etiology, mechanisms, periprocedural management, and mapping and ablation techniques in patients with LVADs and VA.

His Bundle Pacing in Heart Failure-Concept and Current Data.

Purpose Of Review: His bundle pacing (HBP) has continued to emerge as a viable alternative to both right ventricular pacing (RVP) and cardiac resynchronization therapy. In recent years, a considerable amount of research has been published with regard to using HBP to treat congestive heart failure (CHF) and this article presents a concise yet comprehensive review of this literature.

Recent Findings: Studies have demonstrated that HBP is useful for CHF patients who are non-responders to biventricular pacing (BiVP) or have a history of previously failed coronary sinus lead placement, right/left bundle branch block cardiomyopathy, or pacing-induced cardiomyopathy.

How to Perform His Bundle Pacing: Tools and Techniques.

Recently, permanent His bundle pacing (HBP) has emerged as a viable pacing strategy for chronic ventricular pacing. It allows for recruitment of the native His Purkinje system thereby preventing pacing-induced ventricular dyssynchrony seen in traditional right ventricular pacing. Current tools allow for relatively good success rates for implantation.

Subvalvular aortic stenosis: a review of current literature.

Subvalvular aortic stenosis (SAS) is one of the common adult congenital heart diseases, with a prevalence of 6.5%. It is usually diagnosed in the first decade of life.

Significance of inferior wall ischemia in non-dominant right coronary artery anatomy.

Aim: To investigate the relationship of inferior wall ischemia on myocardial perfusion imaging in patients with non-dominant right coronary artery anatomy.

Methods: This was a retrospective observational analysis of consecutive patients who presented to the emergency department with primary complaint of chest pain. Only patients who underwent single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) were included.