Hepatic manifestations of COVID-19 and effect of remdesivir on liver function in patients with COVID-19 illness.

COVID-19 has emerged as a major global health crisis since the first cases were reported in China in December 2019. Remdesivir is the only broad-spectrum antiviral approved by the US Food and Drug Administration to treat hospitalized patients with COVID-19 infection. Although the adverse effects of remdesivir are largely unknown, data from randomized controlled trials have demonstrated its deleterious effect on the liver.

ST Elevation in a Patient With COVID-19 Infection-Associated Fever: A Case of Brugada Pattern.

Coronavirus disease 2019 (COVID-19) is a global pandemic presenting with various cardiovascular manifestations. Although Brugada pattern ST-segment elevation (STE) is well described in patients admitted with febrile illness, the implication of recognizing this abnormality in patients with COVID-19 is critical in providing appropriate care for the patient and also reducing the exposure of healthcare professionals to the risk of infection. We report a patient with COVID-19 infection presenting with STE due to fever-related unmasking of Brugada pattern, who was managed conservatively.

Rate and predictors of electrical failure in non-recalled defibrillator leads.

Background: Implantable cardioverter defibrillator (ICD) leads are considered as the 'weakest link' in defibrillator systems due to FDA recalls and advisories involving popular lead models from major manufacturers. The rate of electrical failure of ICD leads not implicated in a recall is however not well determined.

Methods: Medical records of patients implanted with ICDs at hospitals of the University of Pittsburgh Medical Center between 2002 and 2014 were analyzed.

Usefulness of the CHADS-VASc Score to Predict Mortality in Defibrillator Recipients.

The CHADS-VAS score is a well-validated stratification tool that predicts the risk of thromboembolism and stroke in patients with nonvalvular atrial fibrillation. Several studies have examined its application as a predictor of mortality in clinical applications other than atrial fibrillation. However, there are current no studies examining its use as an outcome prediction tool in a population of patients with implantable cardiac defibrillators (ICDs).

Cardiovascular Implantable Electronic Device Infections: Risk Scoring and Role of Antibiotic Envelope in Prevention.

Cardiac implantable electronic device (CIED) has been increasingly used with expanding indications in patients with cardiac diseases. There is substantial evidence to suggest of their role in improving outcomes in patients with and without heart failure. Complications of the device implantation including infections are associated with increased morbidity and mortality and also substantial financial burden to the society.

Health and Economic Outcomes Associated with Use of an Antimicrobial Envelope as a Standard of Care for Cardiac Implantable Electronic Device Implantation.

Introduction: Infection of cardiac implanted electrical devices (CIED) is a problem. In selected patients, use of an "antibacterial envelope" (AIGISRx®) is associated with low CIED infection rates. The value of this device when used as a standard of care is unclear.

Failure rates of single- versus dual-coil nonrecalled sprint quattro defibrillator leads.

Electrical failure is more common in single-coil compared with dual-coil implantable cardioverter defibrillator (ICD) leads in the case of the recalled Riata lead. Single-coil leads are however favored in most patients given their lower risk of extraction. We therefore evaluated the failure-free survival of single- versus dual-coil ICD leads not included in Food and Drug Administration recalls.

Long-term outcome of defibrillator recipients included in the federal audit conducted by the Department of Justice.

Institutions across the United States have been subjected to a federal audit for defibrillator implantable cardioverter defibrillator [ICD] implantations that violated the Centers for Medicare and Medicaid payment policy. We examined the long-term outcome of ICD recipients whose implantation procedures were audited by the Department of Justice (DOJ). Patients (n = 225) included in the DOJ audit at the University of Pittsburgh Medical Center between the years 2003 and 2010 were followed to the end point of all-cause mortality.

Acute disseminated intravascular coagulation following ICD lead extraction.

We present an unusual case of disseminated intravascular coagulopathy (DIC) complicating percutaneous laser-assisted lead extraction. DIC has not been previously reported in association with lead extraction. It is possible to have occurred following the denudement of venous endothelium and exposure of underlying fibrous tissue.

Rate-control versus rhythm-control strategies and outcomes in septuagenarians with atrial fibrillation.

Background: The prevalence of atrial fibrillation substantially increases after 70 years of age. However, the effect of rate-control versus rhythm-control strategies on outcomes in these patients remains unclear.

Methods: In the randomized Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial, 4060 patients (mean age 70 years, range 49-80 years) with paroxysmal and persistent atrial fibrillation were randomized to rate-control versus rhythm-control strategies.

Cerebral Embolization During AF Ablation -Pathophysiology, Prevention and Management.

Catheter based ablation therapy has evolved as an invaluable tool in the management of symptomatic patients with atrial fibrillation (AF). The procedure of AF ablation requires instrumentation in the systemic circulation predisposing to various concerns that can result in systemic embolization. We will describe the reported incidence of these events and refer to the various pathophysiologic explanations for their occurrence.

AF and Venous Thromboembolism - Pathophysiology, Risk Assessment and CHADS-VASc score.

Atrial fibrillation (AF) and venous thromboembolism (VTE) are the two most common medical conditions managed with anti-coagulation therapy. Not all the patients with decreased mobility or AF have a similar risk for thromboembolism. The risk factors for venous thromboembolism and thromboembolism associated with AF are described in various studies.

Venous thromboembolism in patients with heart failure: in-hospital and chronic use of anti-coagulants for prevention.

Heart failure (HF) is a common clinical syndrome characterized by high morbidity and frequent hospitalizations. HF is an independent and major risk factor for venous thromboembolism (VTE) and VTE occurring in patients with HF carries a worse prognosis. The present review will focus on short and long term role of anti-coagulants in prevention of venous thrombosis in HF patients.

Atrial fibrillation in patients with heart failure: Role of catheter ablation therapies.

Atrial fibrillation (AF) represents the most common sustained cardiac arrhythmia in patients with heart failure (HF). AF in HF patients is associated with worsening of symptoms and also results in a substantial increase in mortality. Although HF patients in sinus rhythm have a better outcome than patients with AF, several randomized studies investigating pharmacological rhythm control versus rate control have shown no advantage of one strategy over the other in terms of patient outcomes.

Atrial fibrillation following cardiac surgery: established and emerging strategies of prevention.

More than 250,000 patients undergo cardiac surgery every year. Although advances in surgical techniques have reduced the peri-operative morbidity and mortality in these patients, atrial fibrillation persists to commonly occur following these surgeries. Traditional therapies have reduced their occurrence; however there are still a significant number of patients who develop this complication.

Relation of pre-event use of inhibitors of the renin-angiotensin system with myocardial infarct size in patients presenting with a first ST-segment elevation myocardial infarction.

Agents that block the renin-angiotensin system (RAS), including angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, are of proven benefit in patients after ST-segment elevation myocardial infarction (STEMI). However, no studies have evaluated the benefit of pre-event use of RAS inhibitors before STEMI. A retrospective review was performed of patients admitted to a single hospital with the diagnosis of STEMI and without a history of coronary disease or the equivalent, including diabetes mellitus, peripheral vascular disease, or stroke.

Demographic determinants and effect of pre-operative angiotensin converting enzyme inhibitors and angiotensin receptor blockers on the occurrence of atrial fibrillation after CABG surgery.

Background: Atrial fibrillation (AF) occurs in about 27% to 40% of post cardiac surgery patients. AF following coronary artery bypass graft surgery (CABG) is associated with a two-fold increase in morbidity and mortality. Various demographic risk factors and medications have been studied to predict the occurrence of this arrhythmia.

Large mycotic pseudoaneurysm of the left circumflex treated with antibiotics and covered stent.

Coronary artery mycotic aneurysms are rare complications of infective endocarditis. They are usually managed surgically with excision of the aneurysm. This surgical procedure has high morbidity and mortality.