Transfabric Leaks After Percutaneous Left Atrial Appendage Occlusion Procedures with the WATCHMAN FLX Device.

Background: Cardiac computed tomography imaging with contrast is being used increasingly to image left atrial appendage occlusion (LAAO) devices. Contrast flow across a device, also known as a transfabric leak (TFL), may indicate a lack of complete LAAO-device endothelialization. The data on the rate, predictors, and clinical events associated with TFL are limited.

Failure of Ventricular Fibrillation Sensing During Subcutaneous Implantable Defibrillator Testing: A Twitchy Situation.

Oversensing of extra-cardiac noise may inhibit delivery of subcutaneous cardiac implantable defibrillator (S-ICD) therapy. We report a case of diaphragmatic tetany resulting in the inhibition of S-ICD therapy at the time of defibrillator testing without the use of muscle relaxants. Clinicians should be aware of this phenomenon.

"Spasms in Silence": A case of coronary vasospasm-induced ventricular fibrillation.

A 56-year-old man presented following an aborted cardiac arrest. His initial ECGs showed episodes of transient repolarization abnormalities. Coronary vasospasm can be a precipitant for ventricular arrhythmia in these patients, underpinning the importance of continuous ECG for accurate diagnosis and management.

Ablation of ventricular tachycardia after septal myectomy for hypertrophic cardiomyopathy.

Electrocardiography and 3D mapping images of the case.

MRI Accurately Visualizes RF Ablation Delivery Targeted to MRI-Defined Arrhythmia Substrates in the Left Ventricle.

Objective: Investigate the capacity of MRI to evaluate efficacy of radiofrequency (RF) ablations delivered to MRI-defined arrhythmogenic substrates.

Methods: Baseline MRI was performed at 3 T including 3D LGE in a swine model of chronic myocardial infarct (N = 8). MRI-derived maps of scar and heterogeneous tissue channels (HTCs) were generated using ADAS 3D.

Same-Day Discharge After Percutaneous Left Atrial Appendage Occlusion Procedures.

Information is evolving on the safety of same-day discharge (SDD) after left atrial appendage occlusion (LAAO) procedures. This single-centre retrospective study evaluated the feasibility of SDD and reported on the 30-day rehospitalization rate in patients discharged same-day compared with those admitted overnight after LAAO. Key findings of this study included more than 85% of patients with LAAO were safely discharged same-day; the rate of postdischarge rehospitalization was similar in SDD patients and those admitted overnight; and approximately 1 in 10 patients who had LAAO procedures were rehospitalized within 30 days postprocedure.

Long-term Clinical Outcomes in Contemporary Patients Undergoing Left Atrial Appendage Occlusion Procedures in Ontario, Canada.

Background: Percutaneous left atrial appendage occlusion (LAAO) is an alternative for stroke prevention in patients with atrial fibrillation with contraindications to oral anticoagulation. Population-level real-world data describing the use and outcomes of LAAO procedures are evolving, with a paucity of longer-term follow-up data. We report on the patient characteristics, procedure complications, and longer-term clinical outcomes in all patients undergoing LAAO procedures in Ontario, Canada.

Stroke risk in women with atrial fibrillation.

Background And Aims: Female sex is associated with higher rates of stroke in atrial fibrillation (AF) after adjustment for other CHA2DS2-VASc factors. This study aimed to describe sex differences in age and cardiovascular care to examine their relationship with stroke hazard in AF.

Methods: Population-based cohort study using administrative datasets of people aged ≥66 years diagnosed with AF in Ontario between 2007 and 2019.

Prognostic Value of Different Thresholds for Myocardial Scar Quantification on Cardiac MRI Late Gadolinium Enhancement Images in Patients Receiving Implantable Cardioverter Defibrillators.

Purpose: To compare the predictive value of different myocardial scar quantification thresholds using cardiac MRI for appropriate implantable cardioverter defibrillator (ICD) shock and mortality.

Materials And Methods: In this retrospective, two-center observational cohort study, patients with ischemic or nonischemic cardiomyopathy underwent cardiac MRI prior to ICD implantation. Late gadolinium enhancement (LGE) was first determined visually and then quantified by blinded cardiac MRI readers using different SDs above the mean signal of normal myocardium, full-width half-maximum, and manual thresholding.

Statin Use and Stroke Rate in Older Adults With Atrial Fibrillation: A Population-Based Cohort Study.

Background Atherosclerotic disease is an important contributor to adverse outcomes in patients with atrial fibrillation (AF). There is limited recognition of the association between statin use and stroke rates in AF. We aimed to quantify the association between statin use and stroke rate in AF.

P-Wave Duration/Amplitude Ratio Quantifies Atrial Low-Voltage Area and Predicts Atrial Arrhythmia Recurrence After Pulmonary Vein Isolation.

Background: Atrial low-voltage areas (LVAs) in patients with atrial fibrillation increase the risk of atrial arrhythmia (AA) recurrence after pulmonary vein isolation (PVI). Contemporary LVA prediction scores (DR-FLASH, APPLE) do not include P-wave metrics. We aimed to evaluate the utility of P-wave duration/amplitude ratio (PWR) in quantifying LVA and predicting AA recurrence after PVI.

Standard vs Augmented Ablation of Paroxysmal Atrial Fibrillation for Reduction of Atrial Fibrillation Recurrence: The AWARE Randomized Clinical Trial.

Importance: Recurrent atrial fibrillation (AF) commonly occurs after catheter ablation and is associated with patient morbidity and health care costs.

Objective: To evaluate the superiority of an augmented double wide-area circumferential ablation (WACA) compared with a standard single WACA in preventing recurrent atrial arrhythmias (AA) (atrial tachycardia, atrial flutter, or atrial fibrillation [AF]) in patients with paroxysmal AF.

Design, Setting, And Participants: This was a pragmatic, multicenter, prospective, randomized, open, blinded end point superiority clinical trial conducted at 10 university-affiliated centers in Canada.

Variation and clinical consequences of wait-times for atrial fibrillation ablation: population level study in Ontario, Canada.

Aims: Atrial fibrillation (AF) is the most common cardiac rhythm disorder. Emerging evidence supporting the efficacy of catheter ablation in managing AF has led to increased demand for this therapy, potentially outpacing the capacity to perform this procedure. Mismatch between demand and capacity for AF ablation results in wait-times which have not been comprehensively evaluated at a population level.

Use of Sacubitril/Valsartan Prior to Primary Prevention Implantable Cardioverter Defibrillator Implantation.

Background: Implantable cardioverter defibrillators (ICDs) are an adjunct to guideline-directed medical therapy for heart failure with reduced ejection fraction. The uptake of sacubitril/valsartan in this population is not well described. We report the uptake and factors associated with sacubitril/valsartan use in patients with left ventricular dysfunction undergoing ICD implantation.

Association Between Concurrent Use of Amiodarone and DOACs and Risk of Bleeding in Patients With Atrial Fibrillation.

Amiodarone is a commonly used pharmacotherapy in patients with atrial fibrillation (AF), with a potential for drug-drug interactions with direct oral anticoagulants (DOACs). We aimed to assess the bleeding risk after co-prescription of amiodarone and DOACs among adults with AF. We conducted a population-based, nested case-control study in Ontario, Canada.

Impact of Peridevice Leak on 5-Year Outcomes After Left Atrial Appendage Closure.

Background: In the U.S. Food and Drug Administration (FDA) clinical trials of left atrial appendage (LAA) closure, a postimplantation peridevice leak (PDL) of ≤5 mm (PDL≤5) was accepted as sufficient LAA "closure.

Occult arterial bleeding associated with cardiac device implantation.

The appearance of hematomas or hemorrhages after the implantation of a cardiac implantable electronic device (CIEDs) is a well-known early complication, which can be associated with reinterventions, infections, readmissions, and longer hospital stays. Occasionally, these bleedings may correspond to arterial hemorrhages, which require early identification and specific treatment. We reviewed two clinical cases of inadvertent arterial bleeding after Pacemaker implantation that required a high clinical suspicion together with a multidisciplinary evaluation of cardiologists, radiologists and interventional medicine that allowed a fast and effective endovascular approach.