Comparison of the safety and efficacy of Nanostim and Micra transcatheter leadless pacemaker (LP) extractions: a multicenter experience.

Purpose: Leadless pacemaker (LP) extraction is a relatively new field with limited operator experience. We sought to report a comparison of retrieval process for Nanostim vs Micra transcatheter LPs.

Methods: The list of retrievals for the Micra transcatheter pacemaker system (TPS) was obtained from Medtronic whereas Nanostim data was obtained from centers that participated in the Leadless II study.

Exclusion of electrical and mechanical function of the left atrial appendage in patients with persistent atrial fibrillation: differences in efficacy and safety between endocardial ablation vs epicardial LARIAT ligation (the EXCLUDE LAA study).

Background: Electrical isolation of the left atrial appendage (LAA) may provide incremental benefits for arrhythmia management in patients undergoing radiofrequency ablation (RFA) for persistent atrial fibrillation (AF).

Objective: The aim of this study was to compare efficacy and safety of endocardial ablation and LAA exclusion with LARIAT device for electrical and mechanical exclusion of LAA.

Methods: We compared patients who underwent endocardial LAA isolation during index RFA for persistent AF and underwent a repeat RFA to patients who underwent LAA exclusion with LARIAT device followed by RFA for AF in this multicenter registry.

Myocarditis Causing Premature Ventricular Contractions: Insights From the MAVERIC Registry.

Background: Premature ventricular contractions are a common clinical presentation that drives further diagnostic workup. We hypothesize the presence of underlying inflammation is often unrecognized in these patients with a potential for continued disease progression if not diagnosed and treated early in the disease course.

Methods: This is a single-center, prospective study including 107 patients with frequent symptomatic premature ventricular contractions (>5000/24 h) and no known ischemic heart disease.

WATCHMAN implantation in patients with a history of atrial fibrillation and intracranial hemorrhage.

Purpose: Use of oral anticoagulation (OAC) in patients with a history of intracranial hemorrhage (ICH) is often considered high risk as OAC-related ICH is associated with high mortality rates. Left atrial appendage closure with a WATCHMAN device is an alternative management strategy to OAC to decrease thrombotic risk in atrial fibrillation patients; however use of OAC followed by dual antiplatelet therapy (DAPT) or DAPT therapy alone is required for 6 months post-procedurally. In this study, we examined the safety of WATCHMAN implantation followed by 6 months of anti-thrombotic therapy in patients with a history of ICH.

Premature ventricular complexes: diagnostic and therapeutic considerations in clinical practice : A state-of-the-art review by the American College of Cardiology Electrophysiology Council.

Premature ventricular complexes (PVCs) are common arrhythmias in the clinical setting. PVCs in the structurally normal heart are usually benign, but in the presence of structural heart disease (SHD), they may indicate increased risk of sudden death. High PVC burden may induce cardiomyopathy and left ventricular (LV) dysfunction or worsen underlying cardiomyopathy.

Impact of left atrial appendage occlusion on left atrial function-The LAFIT Watchman study.

Background: Left atrial (LA) strain and strain rate (SR) analysis by two-dimensional speckle tracking echocardiography is a novel way of LA function assessment. From prior study, we know that LA appendage closure with LARIAT appears to improve LA function.

Objective: The purpose of this study was to assess the impact of LAA closure via Watchman device on LA function via strain and volumetric analyses using two-dimensional speckle tracking echocardiography (2D-STE).

Coagulation factors and fibrinolytic activity in the left atrial appendage and other heart chambers in patients with atrial fibrillation: is there a local intracardiac prothrombotic state? (HEART-CLOT study).

Introduction: Atrial fibrillation (AF), a risk factor for stroke and systemic thromboembolism, is associated with unfavorable fibrin clot properties and increased thrombus formation in peripheral blood. The left atrial appendage (LAA) is known to be the primary site of thrombus formation.

Aim: We investigated the relative differences in plasma fibrin clot features including plasma fibrin clot permeability (K) and clot lysis time (CLT) between the right atrium (RA), right ventricle (RV), left atrium (LA), left ventricle (LV), LAA, and peripheral blood.

Differences in Transient Thermal Response of Commercial Esophageal Temperature Probes: Insights From an Experimental Study.

Objectives: The purpose of this study was to evaluate the differences in transient thermal response (TTR) among various types of commercial esophageal temperature probes (ETPs) in the United States in an experimental model.

Background: There is little information regarding the variation in TTR among various commercial ETPs that are approved for atrial fibrillation ablation.

Methods: We compared various thermodynamic characteristics including, mean thermal time constant (τ), time to rise 1°C (T), time to peak temperature (T), and decay time among 22 different ETPs.

Peri-procedural use of direct anticoagulation agents during cardiac device implantation: vitamin K antagonists vs direct oral anticoagulants.

Background: Warfarin is deemed safe compared to bridging with heparin in the peri-procedure setting while implanting cardiac devices. The timing of discontinuation and re-initiation of direct anticoagulant agents (DOACs) such as dabigatran, apixaban, and rivaroxaban in the peri-procedural setting in comparison to warfarin is not well studied.

Objective: We wanted to compare three DOAC agents with warfarin during cardiac device implantation.

Is paroxysmal supraventricular tachycardia truly benign? Insightful association between PSVT and stroke from a National Inpatient Database Study.

Background: Atrial fibrillation and flutter are well-known causes of stroke. Whether other atrial arrhythmias categorized as paroxysmal supraventricular tachycardia (PSVT) are associated with stroke is less clear. We aimed to evaluate the association of PSVT with ischemic and embolic stroke and its impact on short-term outcomes in hospitalized stroke patients.

A Rare Case of Bronchopericardial Fistula Following Atrial Fibrillation Ablation.

Radiofrequency ablation (RFA) for atrial fibrillation (AF) has emerged as an effective and reliable treatment modality. Since its introduction in the 1990s, major and minor complications have been identified. Major complications include periprocedural death, atrioesophageal (AE) fistula, stroke, cardiac perforation and tamponade, pulmonary venous stenosis, phrenic nerve injury, retroperitoneal hematoma, and arrhythmias.

Role of Prophylactic Magnesium Supplementation in Prevention of Postoperative Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Grafting: a Systematic Review and Meta-Analysis of 20 Randomized Controlled Trials.

Background: Several randomized trials have evaluated the efficacy of prophylactic magnesium (Mg) supplementation in prevention of post-operative atrial fibrillation (POAF) in patients undergoing cardiac artery bypass grafting (CABG). We aimed to determine the role of prophylactic Mg in 3 different settings (intraoperative, postoperative, intraoperative plus postoperative) in prevention of POAF.

Methods: A systemic literature search was performed (until January 19, 2019) using PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials to identify trials evaluating Mg supplementation post CABG.

Direct Current Cardioversion of Atrial Fibrillation in Patients With Left Atrial Appendage Occlusion Devices.

Background: Direct current cardioversion (DCCV) is a common rhythm control strategy in patients with symptomatic atrial fibrillation or flutter. There is no long-term data regarding the safety of DCCV in patients with endocardial left atrial appendage occlusion (LAAO) devices.

Objectives: The purpose of this study was to assess the feasibility and safety of DCCV in patients with an LAAO device.

Mapping and localization of the left phrenic nerve during left atrial appendage electrical isolation to avoid inadvertent injury in patients undergoing catheter ablation of atrial fibrillation.

Background: A significant role of the left atrial appendage (LAA) in the genesis of atrial fibrillation (AF) has been described. Left atrial appendage electrical isolation (LAAEI) confers substantial long-term clinical benefits. Nevertheless, the left phrenic nerve (LPN) is in the vicinity of the LAA and can be injured during radiofrequency ablation at the ostial level.

Long-term clinical outcomes from real-world experience of left atrial appendage exclusion with LARIAT device.

Background: Left atrial appendage closure (LAAC) with LARIAT has emerged as one of the alternatives to oral anticoagulation (OAC) in patients with nonvalvular atrial fibrillation (AF). Our aim was to study long-term outcomes in patients undergoing LARIAT procedure.

Methods: We analyzed patients screened for LARIAT device in four centers between December 2009 and June 2012.

Incidence and causes of in-hospital outcomes and 30-day readmissions after percutaneous left atrial appendage closure: A US nationwide retrospective cohort study using claims data.

Background: Percutaneous left atrial appendage closure (pLAAC) emerged as an option for stroke prevention in patients with atrial fibrillation ineligible for long-term anticoagulation. Real-world data on pLAAC's in-hospital and 30-day readmission measures are limited.

Objective: We sought to report the nationwide incidence of the above outcomes using 2016 claims data.

Impact of New Guidelines of Unscheduled and Scheduled Sedation for Cardiologists: JACC Council Perspectives.

Until 2019, guidelines for procedural sedation emphasized a detailed process most applicable for elective procedures scheduled well in advance. These guidelines provided by the American Society of Anesthesiologists were adopted by many specialties and institutions, and they have historically served the medical field well. However, cardiologists and other specialists often encounter urgent situations that demand unscheduled sedation.

Direct oral anticoagulants: a review on the current role and scope of reversal agents.

New guideline recommendations prefer direct oral anticoagulants (DOACs) over warfarin in DOAC-eligible patients with atrial fibrillation and patients with venous thromboembolism. As expected with all antithrombotic agents, there is an associated increased risk of bleeding complications in patients receiving DOACs that can be attributed to the DOAC itself, or other issues such as acute trauma, invasive procedures, or underlying comorbidities. For the majority of severe bleeding events, the widespread approach is to withdraw the DOAC, then provide supportive measures and "watchful waiting" with the expectation that the bleeding event will resolve with time.

Efficacy and safety of single vs dual antiplatelet therapy in patients on anticoagulation undergoing percutaneous coronary intervention: A systematic review and meta-analysis.

Background: Selection of an appropriate antithrombotic regimen in patients requiring oral anticoagulation (OAC) undergoing percutaneous coronary intervention (PCI) still remains a challenge. An ideal 9-2regimen should balance the risk of bleeding against ischemic benefit.

Methods: A comprehensive literature search for studies comparing triple antithrombotic therapy (TAT) vs double antithrombotic therapy (DAT) in patients requiring OAC undergoing PCI was performed in clinicalTrials.

Risk of thromboembolic events after percutaneous left atrial appendage ligation in patients with atrial fibrillation: Long-term results of a multicenter study.

Background: Percutaneous left atrial appendage (LAA) occlusion with Lariat has emerged as a viable alternative to oral anticoagulation (OAC) to prevent thromboembolic (TE) events in patients with atrial fibrillation.

Objective: We evaluated the long-term TE risk in post-Lariat patients.

Methods: Consecutive patients undergoing LAA ligation with the Lariat device at multiple centers with at least 1-year follow-up were included in the analysis.

Incomplete endothelialization of WatchmanTM Device: Predictors and Implications from Two Cases.

Left atrial appendage occlusion (LAAO) is a promising alternative for stroke risk reduction in patients with non-valvular atrial fibrillation who are not suitable for long-term oral anticoagulation (OAC). Current practice mandates use of post-procedural OAC for 45 days after WatchmanTM placement during which complete device endothelialization is expected to occur. However, most of the evidence supporting this strategy stem from animal studies.

Anticoagulation After Catheter Ablation of Atrial Fibrillation: Is it time to Discontinue in Select Patient Population?

Background: Catheter ablation is an effective strategy for treatment of drug-refractory atrial fibrillation (AF). Continuation of oral anticoagulation (OAC) beyond 3 months after an apparently successful ablation of AF remains controversial.

Methods: A systematic electronic search of the scientific literature was performed in PubMed, EMBASE, SCOPUS and Google Scholar.