Long-term use of the wearable cardioverter defibrillator in patients with explanted ICD.

Objectives: To evaluate the effectiveness of wearable cardioverter defibrillator (WCD) use in protecting patients from sudden cardiac arrest (SCA) while they were treated in nonhospital settings until re-implantation of an Implantable cardioverter-defibrillator (ICD) was feasible. We sought to determine whether the WCD could be successfully utilized long term (≥1 year) after ICD extraction in patients at continued risk of SCD in which ICD re-implantation was not practical.

Background: ICDs have proven to improve mortality in patients for both secondary and primary prevention of SCA.

Successful fluoroless radiofrequency catheter ablation of supraventricular tachycardia during pregnancy.

Even in the absence of underlying heart disease, pregnancy is known to increase susceptibility supraventricular tachycardia (SVT). This brings a management challenge, mainly due to concerns about pharmacotherapy and radiation to the fetus. This case highlights the capability of using fluoroless mapping technologies to treat refractory arrhythmia cases safely and successful.

Is there still a role for renal artery stenting in the management of renovascular hypertension - A single-center experience and where do we stand?

Background: Renal artery (RA) stenosis has been implicated in the pathophysiological mechanism for resistant hypertension. Despite the increasingly diagnosed frequency of hemodynamically significant lesions, the value of RA revascularization remains controversial. Our group had previously demonstrated significant blood pressure (BP) reduction in a retrospective cohort of appropriately selected patients undergoing RA stenting up to 18-months of follow-up.

Renin-Angiotensin System Inhibition and Lower 30-Day All-Cause Readmission in Medicare Beneficiaries with Heart Failure.

Background: Heart failure is the leading cause for 30-day all-cause readmission, the reduction of which is a goal of the Affordable Care Act. There is a growing interest in understanding the impact of evidence-based heart failure therapy on 30-day all-cause readmission. In the current study, we examined the impact of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEI-ARBs) on 30-day all-cause readmission in heart failure.

Pericardial salmonella with cardiac tamponade and ventricular wall rupture: A case report.

Introduction: Non-typhoidal Salmonella (NTS) is mostly restricted to gastroenteritis; however, we report a case of Salmonella pericarditis complicated by tamponade and spontaneous ventricular wall rupture.

Case Presentation: A 67-year-old male presents to the Emergency Department with complaints of fevers, chills and body aches. A chest radiograph displayed an infiltrate and an electrocardiogram suggested acute pericarditis.

Infections, Arrhythmias, and Hospitalizations on Home Intravenous Inotropic Therapy.

Inotropes improve symptoms in advanced heart failure (HF) but were associated with higher mortality in clinical trials. Recurrent hospitalizations, arrhythmias, and infections contribute to morbidity and mortality, but the risks of these complications with modern HF therapies are not well known. We collected arrhythmia, infection, and hospitalization data on 197 patients discharged from our institution from January 2007 to March 2013 on intravenous inotropes.

Clinical Characteristics and Outcomes of Intravenous Inotropic Therapy in Advanced Heart Failure.

Background: Inotrope use in heart failure treatment was associated with improved symptoms, but worse survival in clinical trials. However, these studies predated use of modern heart failure therapies. This study evaluates contemporary outcomes on long-term inotropes.

Beta-blocker Use and 30-day All-cause Readmission in Medicare Beneficiaries with Systolic Heart Failure.

Background: Beta-blockers improve outcomes in patients with systolic heart failure. However, it is unknown whether their initial negative inotropic effect may increase 30-day all-cause readmission, a target outcome for Medicare cost reduction and financial penalty for hospitals under the Affordable Care Act.

Methods: Of the 3067 Medicare beneficiaries discharged alive from 106 Alabama hospitals (1998-2001) with a primary discharge diagnosis of heart failure and ejection fraction <45%, 2202 were not previously on beta-blocker therapy, of which 383 received new discharge prescriptions for beta-blockers.

Impact of atrial fibrillation and heart failure, independent of each other and in combination, on mortality in community-dwelling older adults.

Atrial fibrillation (AF) and heart failure (HF), common in older adults, are associated with poor outcomes. However, little is known about their impact, independent of each other. We studied 5,673 community-dwelling adults aged ≥ 65 years in the Cardiovascular Health Study.

Reclassification of cardiovascular risk in patients with normal myocardial perfusion imaging using heart rate response to vasodilator stress.

Previous studies have shown that patients with normal vasodilator myocardial perfusion imaging (MPI) findings remain at a greater risk of future cardiac events than patients with normal exercise MPI findings. The aim was to assess improvement in risk classification provided by the heart rate response (HRR) in patients with normal vasodilator MPI findings when added to traditional risk stratification. We retrospectively studied 2,000 patients with normal regadenoson or adenosine MPI findings.

Live/Real time three-dimensional transthoracic echocardiographic assessment of pericardial disease.

We studied 19 patients with pericardial disease using two-dimensional and three-dimensional transthorathic echocardiography (2DTTE and 3DTTE, respectively) in order to determine whether 3DTTE provides incremental value on top of 2DTTE in the evaluation of these patients. With 3DTTE a more comprehensive assessment of pericardial effusion can be made and both the parietal and visceral layers of the pericardium can be visualized en face and examined for pathologies and fibrin deposits. In our series of patients, 3DTTE was superior to 2DTTE in uncovering mass lesions involving the pericardium such as tuberculous granulomas and metastatic disease.