Subject(s)
Coccidioidomycosis/microbiology , Pericarditis, Constrictive/microbiology , Antifungal Agents/therapeutic use , Cardiac Catheterization , Coccidioidomycosis/complications , Coccidioidomycosis/diagnosis , Coccidioidomycosis/physiopathology , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Pericardiectomy , Pericarditis, Constrictive/diagnosis , Pericarditis, Constrictive/physiopathology , Pericarditis, Constrictive/therapy , Treatment OutcomeABSTRACT
BACKGROUND: Transcatheter left atrial appendage occlusion (LAAO) has become a suitable alternative to anticoagulation in patients with atrial fibrillation (AF). However, volume-outcome relationships at the individual operator level have not been studied. METHODS: Study population included 425 consecutive patients with AF undergoing LAAO from August 2015 to November 2018 by seven operators at BUMC-Phoenix. Operator volume was divided in tertiles by those with <40 cases/year (2 operators), 41-80 cases/year (3 operators) and >80 cases/year (2 operators). Patient data including comorbidities, labs, medications, procedural characteristics and outcomes were collected. The primary composite outcome was major adverse cardiac events (MACE) including mortality, stroke, bleeding and vascular complications. RESULTS: Mean age was 75⯱â¯8â¯years and 251 (59%) were males. Mean CHA2DS2-VASc score was 4.5⯱â¯1.3 points and mean HASBLED score was 3.9⯱â¯1.0 points. MACE outcome was similar in the three operator groups in both unadjusted (pâ¯=â¯0.83) and adjusted (ORâ¯=â¯0.59: 95% Confidence Interval [CI]: 0.15-2.29, pâ¯=â¯0.45) analysis. The occurrence MACE was also similar between Interventional Cardiologist (IC) and Electrophysiologist (EP) operators in an unadjusted (pâ¯=â¯0.24) and adjusted (ORâ¯=â¯0.60: 95% CI: 0.21-1.68, pâ¯=â¯0.33) analysis. The secondary outcome of technical success did not differ among the three tertiles (pâ¯=â¯0.37) and among IC & EP operators respectively (pâ¯=â¯0.24) as well. CONCLUSION: Operator experience does not affect MACE and technical success even after adjusting for comorbidities. These results suggest a lower learning curve for LAAO with high technical success achievable even by low volume operators.
Subject(s)
Atrial Appendage/physiopathology , Atrial Fibrillation/therapy , Atrial Function, Left , Cardiac Catheterization/instrumentation , Heart Rate , Stroke/prevention & control , Aged , Aged, 80 and over , Atrial Fibrillation/diagnosis , Atrial Fibrillation/mortality , Atrial Fibrillation/physiopathology , Cardiac Catheterization/adverse effects , Cardiac Catheterization/mortality , Clinical Competence , Female , Humans , Learning Curve , Male , Prosthesis Design , Registries , Retrospective Studies , Risk Assessment , Risk Factors , Stroke/diagnosis , Stroke/mortality , Time Factors , Treatment OutcomeSubject(s)
Coronary Occlusion/therapy , Patient Discharge , Percutaneous Coronary Intervention , Aged , Arizona , Chronic Disease , Coronary Occlusion/diagnostic imaging , Coronary Occlusion/mortality , Feasibility Studies , Female , Humans , Length of Stay , Male , Middle Aged , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/mortality , Retrospective Studies , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
Rate-related left bundle branch block (LBBB) is a well-studied phenomenon. Cardiac memory is another physiologic phenomenon in which T-wave abnormalities occur in the absence of ischemia. The association between these 2 phenomena has been described in several case reports. A literature review was performed through Ovid and PubMed, where at total of 93 cases of rate-related LBBB were identified. Cases were reviewed, and data were collected on rates of appearance and disappearance as well as the presence or absence of cardiac memory. There is some overlap in the rate at which LBBB appears. Cardiac memory is associated with rate-related LBBB in several cases, but its true prevalence is unknown. Cardiac memory is a phenomenon that is well described in the literature but is often underrecognized in clinical practice. As a consequence of overlooking this phenomenon and not including cardiac memory in the differential when T-wave abnormalities are observed, patients may be subjected to unnecessary invasive diagnostic testing.
Subject(s)
Bradycardia/physiopathology , Bundle-Branch Block/physiopathology , Electrocardiography , Heart Conduction System/physiopathology , Heart Rate/physiology , Bradycardia/complications , Bundle-Branch Block/etiology , Female , Humans , Middle AgedABSTRACT
BACKGROUND: There are non-randomized data about the benefits of Impella use in the setting of cardiogenic shock. However, limited data exist to help guide clinicians about whether in the context of the intervention the device should be implanted early or late; how long the device should stay in; and how the mode of explant should be. METHODS: This is a retrospective, single center registry over 5 years comparing in-hospital outcomes and 1-year mortality in all-comers who had the Impella device placed early versus those who had the device placed late as a bailout. The primary endpoint was a composite of in-hospital all-cause mortality, major vascular, bleeding complications, and stroke. A secondary endpoint was 1-year mortality. RESULTS: Of 262 total patients, 181 (69.1%) had early and 81 (30.9%) had late Impella placement. Patients in the early group had a lower combined MACCE (17.1% vs 59.3%, P < 0.001) and in-hospital mortality (8.8% vs 48.1%, P < 0.001) compared to the late group. Major vascular (3.3% vs 2.5%, P = 1.0), bleeding complications (5.0% vs 7.4%, P = 0.57), and stroke (3.3% vs 7.4%, P = 0.20) were not significant between groups. Early Impella placement had lower 6 month (17.7% vs 53.1%, P < 0.001) and 1-year mortality rates (21.5% vs 53.1%, P < 0.001) compared to those in the late group. CONCLUSION: For patients with need for an Impella device, regardless of the indication, early implantation is associated with better in-hospital and 1-year outcomes as compared to when the device is implanted late as a bailout.
