Fungal Leadless Pacemaker Endocarditis Managed by Percutaneous Vacuum-Assisted Evacuation of Vegetation, Pacemaker Extraction, and Replacement.

Leadless cardiac pacemakers (LCPs) mitigate the risks of traditional transvenous devices such as lead fracture and infection. Two LCPs are clinically available, using either a helix or tined active fixation approach. There are rare reports of LCP infection-all involving the tined device.

Methods and techniques to optimize energy delivery using the circular array pulsed field ablation catheter.

Pulsed field ablation (PFA) is a novel method of cardiac ablation in which electrical fields are used to create microscopic pores in the cardiomyocyte cell membrane, resulting in cell death. Unlike traditional thermal radiofrequency and cryoablation technologies, PFA is cardiomyocyte preferential, reducing the risk of collateral damage to the esophagus and phrenic nerve. However, achieving durable lesions with PFA is dependent on the proximity to the tissue and presently approved systems do not provide contact force sensing.

Beta-blocker use in patients with chronic obstructive pulmonary disease: A systematic review: A systematic review of βB in COPD.

Beta-blockers (βB) are a frequently used class of medications. Although βB have many indications, those related to cardiovascular disease are among the most common and important. However, in patients with chronic obstructive pulmonary disease (COPD), βB are used less often due to concerns about an unfavorable impact on respiratory morbidity and mortality.

Incorporation of a patient navigator into a secondary fracture prevention program identifies barriers to patient care.

Introduction: Patient navigation improves outcomes in various clinical contexts, but has not been evaluated in secondary fracture prevention.

Methods: We retrospectively reviewed charts of patients, age 50 + from April to October, 2016 hospitalized with fragility fracture contacted by a patient navigator. Patients were identified using an electronic tool extracting data from electronic medical records which alerted the patient navigator to contact patients by phone post-discharge to schedule appointments to "High-Risk Osteoporosis Clinic" (HiROC) and Dual-energy X-ray Absorptiometry (DXA) scan.

Distal Radial and Ulnar Arteries: the Alternative Forearm Access.

Purpose Of Review: Radial artery access for catheter-based procedures has demonstrated improved margins of safety and patient comfort without a loss of efficacy compared with femoral access. Unfortunately, radial access is not always available, so a review of the alternatives such as the ulnar artery and distal radial artery has been completed to understand alternative access sites that may preserve the benefits of distal forearm access without losing the efficacy of traditional transradial access.

Recent Findings: Several different trials have demonstrated the utility of ulnar access as a possible workhorse access point.

Cancer immune checkpoint blockade therapy and its associated autoimmune cardiotoxicity.

The immune checkpoint molecules are emerged in the evolution to protect the host from self-attacks by activated T cells. However, cancer cells, as a strategy to survive and expand, can hijack these molecules and mechanisms to suppress T cell-mediated immune responses. Therefore, an idea of blocking the checkpoint molecules to enhance the anti-tumor activities of the host immune system has been developed and applied to the cancer therapy after discovery of the inhibitory T cell co-receptor, cytotoxic T-lymphocyte associated protein 4 (CTLA-4), and further enhanced on the identification of PD-1 and its ligands.

Feasibility of concomitant vacuum-assisted removal of lead-related vegetations and cardiac implantable electronic device extraction.

Background: Cardiac implantable electronic device (CIED) infections associated with large, mobile vegetation adds to the complexity of lead extraction and is associated with significant patient morbidity and mortality.

Objective: To show the feasibility of concomitant cardiovascular implantable electronic device extraction and vacuum-assisted removal of lead-related vegetations.

Methods: This is a single-center retrospective case series of consecutive patients with persistent bacteremia, sepsis, or endocarditis despite medical therapy who have vegetations >2 cm and subsequently underwent immediate CIED lead extraction after debulking with vacuum-assisted suction.

Bleeding Complications Related to Right Heart Catheterization in the Setting of Elevated INR.

Objectives: Right heart catheterization (RHC) provides cardiovascular hemodynamic information in a variety of clinical settings. RHC performed in the setting of coagulopathy may have the potential to increase bleeding complications; however, data currently are limited. This study was undertaken to determine bleeding complications during RHC with an elevated international normalized ratio (INR) value.

The effect of establishing pre-angiography thresholds on contrast utilization.

Introduction: Contrast induced nephropathy is linked to contrast utilization and strategies for minimizing renal injury are incorporated into many laboratories that perform coronary angiography. Contrast limits have been described, below which there is minimal incremental increase in the risk of renal injury. Whether a priori acknowledgement of these limits as part of a contrast "Time-Out" reduces contrast utilization has not been established.