Combined atrial fibrillation ablation and left atrial appendage occlusion procedure in the United States: a propensity score matched analysis from 2016-2019 national readmission database.

AIMS: The safety and feasibility of combining percutaneous catheter ablation (CA) for atrial fibrillation with left atrial appendage occlusion (LAAO) as a single procedure in the USA have not been investigated. We analyzed the US National Readmission Database (NRD) to investigate the incidence of combined LAAO + CA and compare major adverse cardiovascular events (MACEs) with matched LAAO-only and CA-only patients. METHODS AND RESULTS: In this retrospective study from NRD data, we identified patients undergoing combined LAAO and CA procedures on the same day in the USA from 2016 to 2019. A 1:1 propensity score match was performed to identify patients undergoing LAAO-only and CA-only procedures. The number of LAAO + CA procedures increased from 28 (2016) to 119 (2019). LAAO + CA patients (n = 375, mean age 74 ± 9.2 years, 53.4% were males) had non-significant higher MACE (8.1%) when compared with LAAO-only (n = 407, 5.3%) or CA-only patients (n = 406, 7.4%), which was primarily driven by higher rate of pericardial effusion (4.3%). All-cause 30-day readmission rates among LAAO + CA patients (10.7%) were similar when compared with LAAO-only (12.7%) or CA-only (17.5%) patients. The most frequent primary reason for readmissions among LAAO + CA and LAAO-only cohorts was heart failure (24.6 and 31.5%, respectively), while among the CA-only cohort, it was paroxysmal atrial fibrillation (25.7%). CONCLUSION: We report an 63% annual growth (from 28 procedures) in combined LAAO and CA procedures in the USA. There were no significant difference in MACE and all-cause 30-day readmission rates among LAAO + CA patients compared with matched LAAO-only or CA-only patients.

Hepatic Cyst: An Unusual Suspect of Syncope.

The patient is a 75-year-old man with history of diabetes and hypertension who presented with syncope after experiencing sharp, 10/10 right flank and abdominal pain worsening over three weeks associated with decreased appetite. Physical examination revealed hepatomegaly and right lower quadrant (RUQ) tenderness, negative for peritoneal signs. Bloodwork showed leukocytosis (13 K/mcl), alkaline phosphatase (141 U/L), total bilirubin (2.0 mg/dL), and gamma-glutamyl transferase (172 U/L). Computed Tomography (CT) revealed multiple hepatic cysts with the largest measuring 17 × 14 × 18 cm (Figure 1). Parenteral opiates provided minimal relief. Cardiac and neurologic etiologies of syncope were ruled out. The patient's course was complicated by opioid-induced delirium as his abdominal pain progressively worsened despite escalating doses of parenteral and oral analgesics. Gastroenterology and interventional radiology consulted to evaluate for Glisson's capsular stretch. Therapeutic aspiration yielded 2.5 L of serous fluid, which alleviated the patient's pain. Cytology was negative for malignancy. Opiates were titrated down. Repeat CT (Figure 2) showed cysts that were significantly reduced in size. The patient showed complete resolution of symptoms and was subsequently discharged. We present a rare case of a large hepatic cyst causing syncope. In the appropriate clinical setting, syncope with RUQ tenderness and hepatomegaly should raise the index of suspicion for hepatic cysts.

Association of Selected Adipocytokines and Inflammatory Markers on Body Mass Index in Type 2 Diabetes Patients in Saudi Arabia and as Risk Factors to Cardiovascular Disease.

INTRODUCTION: In this prospective study, we establishing the association of obesity in type 2 diabetes patients with various inflammatory markers and adipocytokines, as risk factors for cardiovascular disease (CVD). MATERIALS AND METHODS: In this work, a total of 85 individuals gave concern and were divided into 4 groups based on their body mass indices (BMI). Anthropometrics details were obtained from each individual and different laboratory tests were performed to measure levels of adipocytokines such as adiponectin, leptin and resistin and inflammatory markers such as TNF-α, IL-6 and hsCRP. All the 82 patients with T2D were studied in four groups, A includes obese with BMI >30 kg/m2, B includes overweight with BMI ranging 25 to 30 kg/m2), C includes non-obese with BMI < 25 kg/m2. Group D was control, included non-obese (BMI < 25 kg/m2) and non-diabetic individuals. Result & Discussion: There was an increase in plasma insulin levels in T2D patients, especially with exhibiting high BMI and diabetic conditions in Group A. Adiponectin was higher in the control group which is significant with the value of p<0.05 compared to other three groups. There was negative correlation observed found to be significant, between obesity and adiponectin. Positive correlation was seen among leptin, resistin and inflammatory markers among T2D and control individuals which were significant. T2D groups had an increase in plasma insulin and adiponectin, but decreased leptin, resistin and inflammatory markers compared to control. Overall, T2D patients showed a significant correlation between plasma insulin, adipocytokines and other inflammatory markers clearly designate the impact of metabolic conditions such as obesity on these factors and vice versa. Increased levels of the parameters restrained in the study correlate T2D and obesity to cardiovascular diseases.