Percutaneous closure of the left atrial appendage for prevention of thromboembolism in atrial fibrillation for patients with contraindication to or failure of oral anticoagulation: a single-center experience.

Introduction: In non-valvular atrial fibrillation 90% of thrombi originate in the left atrial appendage (LAA). Percutaneous LAA closure has been shown to be non-inferior to warfarin for prevention of thromboembolism.

Objective: To evaluate the initial experience of a single center in percutaneous LAA closure in patients with high thromboembolic risk and in whom oral anticoagulation was impractical or contraindicated or had failed.

Cardiovascular disease: thinking beyond atherosclerosis.

A 56-year-old female patient was referred to our institution for atypical chest pain and palpitations. Physical examination, resting ECG and transthoracic echocardiogram were unremarkable. Stress perfusion scintigraphy was positive for anterior and apical myocardial ischaemia.

Percutaneous closure of the left atrial appendage for thromboembolic prevention in atrial fibrillation.

Atrial fibrillation is a common arrhythmia in clinical practice. It is associated with high morbidity and mortality due to its thromboembolic potential, which makes thromboembolic prevention particularly important. Warfarin has been the first-line therapy for this purpose, but it has various limitations and is often contraindicated or underutilized.

Nesidioblastosis: an undescribed cause of transient loss of conscience in young adults.

A young woman with recurrent episodes of traumatic transient loss of consciousness was found to have severe hypoglycaemia during episodes after negative investigation for common causes. She was diagnosed nesidioblastosis and total pancreatectomy was performed leading to symptom resolution.

Atrial fibrillation in acute pulmonary embolism: prognostic considerations.

Aims: Although it is accepted that atrial fibrillation (AF) may be both the contributing factor and the consequence of pulmonary embolism (PE), data on the prognostic role of AF in patients with acute venous thromboembolism are scarce. Our aim was to study whether AF had a prognostic role in patients with acute PE.

Methods: Retrospective cohort study involving 270 patients admitted for acute PE.

Early repolarization patterns and the role of additional proarrhythmic triggers.

The majority of individuals with early repolarization (ER) patterns have a benign prognosis. However, recent case-control series and population studies have established a significant association between ER and an increased risk of arrhythmic death. There is a common agreement that J-waves, particularly of large amplitude, dynamic, and present in multiple leads, are more prevalent in patients with idiopathic ventricular fibrillation, but the distinction between benign and malignant electrocardiographic variants of ER is still a controversial subject.

Decreased glomerular filtration rate and markers of left atrial stasis in patients with nonvalvular atrial fibrillation.

Background: It is currently unknown if the increased risk of stroke in subjects with chronic kidney disease and atrial fibrillation (AF) is due to the presence of left atrial stasis or to any other vascular or systemic conditions.

Methods: This was a retrospective study of 372 subjects undergoing evaluation during an AF episode. The following markers of left atrial stasis were sought on transesophageal echocardiogram: left atrial or left atrial appendage thrombus (LAAT), dense spontaneous echocardiographic contrast (DSEC), and low flow velocities (LFV) in the left atrial appendage.

Cardiovascular risk assessment of pulmonary embolism with the GRACE risk score.

Despite the existence of several risk scores, the accurate prediction of the prognosis in pulmonary embolism (PE) remains a challenge. The Global Registry of Acute Coronary Events (GRACE) risk score has a high diagnostic performance for adverse outcomes in acute coronary syndrome. We aimed to assess the applicability and extend the use of the GRACE risk score to PE.