Second-generation cryoballoons are associated with a shorter procedure time and fluoroscopy time, along with lower arrhythmia recurrence rates, reflecting higher procedure efficacy when compared to first-generation cryoballoons. However, they are also associated with a higher incidence of transient and persistent phrenic nerve palsies with a non-significant difference in rates of access site complications and pericardial effusion.

The short-term safety and efficacy of DOACs and warfarin are not different in patients with nonvalvular atrial fibrillation periprocedurally. Under an uninterrupted anticoagulation strategy, DOACs are associated with a 38% lower risk of major bleeding compared with warfarin.

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BD-DES, when compared to second generation PP-DES, showed no significant advantage and the outcomes were comparable between both the groups.

A male patient in his early 90s with a past medical history of hypertension and dyslipidemia and a surgical history of prosthetic (mechanical) aortic valve replacement (AVR) performed 27 years ago (1988) for aortic stenosis presented to our hospital with a chief medical complaint of fatigue, weakness, and chills for a duration of one day. His medications at home included clopidogrel, chlorthalidone, valsartan, and metoprolol. He had discontinued taking warfarin a few weeks after being discharged from his valve replacement surgery because of excessive bruising. His primary care doctor later started him on clopidogrel in 2001.His initial vitals in the emergency department were stable, except for a low-grade temperature of 100.4 °F. The physical examination revealed dry mucous membranes and a grade 3/6 systolic murmur, and metallic aortic valve opening and closing clicks at the aortic area along with a grade 2/6 systolic murmur at the apex. His electrocardiography revealed a normal sinus rhythm with signs of chamber enlargements. Chest X-ray revealed enlarged cardiac silhouette and the presence of heart valve prosthesis. Initial blood tests included total biochemistry, complete blood count, prothrombin time, partial thromboplastin time, fibrinogen, and thyroid function tests. All were unremarkable, except for creatinine of 2.30 and BUN of 51. A functional aortic prosthetic (metallic) valve with a maximum/mean gradient of 72/39 mmHg was verified with transthoracic echocardiography. In addition, a mildly elevated pulmonary artery pressure of 40 mmHg and a left ventricular ejection fraction of 55-65% were estimated; there was no evidence of thrombus or pannus formation.The patient was admitted with a diagnosis of acute kidney injury secondary to dehydration, and he was successfully treated with intravenous (IV) hydration. After educating the patient about the consequences of thrombosis and thromboembolism (TE) in patients with metallic heart valves, he was immediately bridged with IV heparin onto oral warfarin, with which he was discharged on. His international normalized ratio (INR) at discharge was in the therapeutic range at 2.6. Case 2The second case is a male patient in his 60s with a past medical history of chronic hepatitis C and rheumatic aortic valve disease and a surgical history of prosthetic AVR performed 37 years ago for aortic valve incompetence. He underwent AVR with Braunwald-Cutter prosthesis at 22 years of age. The aortic valve was replaced again five years later with a Björk-Shiley (B-S) valve due to fractures of the valve's outlet AbstrACt: Sixty percent of the patients going for valve replacement opt for mechanical valves and the remaining 40% choose bioprosthetics. Mechanical valves are known to have a higher risk of thrombosis; this risk further varies depending on the type of valve, its position, and certain individual factors. According to current guidelines, long-term anticoagulation is indicated in patients with metallic prosthetic valve disease. We report two unique cases of patients who s...

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Venous thromboembolism (VTE) is a leading cause of morbidity with potentially detrimental career consequences in elite athletes. Their unique predisposing factors entail a higher-than-expected VTE incidence. Anticoagulation treatment is challenging, especially among those athletes wishing to resume their competitive activities. The authors review the current VTE treatment guidelines from the perspective of treating elite athletes. They then provide an expert opinion individualized treatment approach based on the pharmacokinetic properties of direct oral anticoagulants that permits tailoring the drug's timing to the athlete's competitive endeavors. They also present low-molecular-weight heparin as an alternative. The proposed risk management approach allows mitigation against VTE recurrence, reducing the chance of major bleeding, and honoring the athlete's self-determination to resume their career while accepting the risks involved. A shared decision making with the athlete and his/her team along with the presence of adequate resources are key components. Ultimately, the authors hope this work will serve as a stepping stone to validated VTE treatment regimens that consider the particularities of elite athletes.

IntroductionAnti-arrhythmic medications (AAMs) are known to increase cardiac mortality significantly due to their pro-arrhythmic effects. However, the effect of AAMs on non-cardiac mortality has not been evaluated.MethodsTrials published in English language journals from 1990 to 2015 were thoroughly retrieved by searching websites such as PubMed, Medline, Cochrane Library, and Google Scholar. Randomized controlled trials reporting non-cardiac deaths as primary or secondary outcomes were used to compare AAMs to non-arrhythmic therapy (AV nodal blocking agents, implantable cardiovascular defibrillation (ICD), or placebo). Information regarding the sample size, treatment type, baseline characteristics, and outcomes was obtained by using a standardized protocol. The fixed effect model was used to perform meta-analysis, and results were expressed in terms of odds ratio (OR) with confidence interval (CI) of 95%, inter study heterogeneity was assessed using I2. Intention to treat principle was applied to extract data.ResultsTotal of 18,728 patients were enrolled in 15 trials; 9359 patients received AAMs and 9369 received non-arrhythmic therapy. AAMs were associated with an increased risk of non-cardiac mortality (OR=1.30, [95% CI: 1.12, 1.50], p=0.0005, I2 index=24%) and all-cause mortality (OR=1.09, [95% CI: 1.01, 1.18], p=0.04, I2=54%) as compared to non-arrhythmic therapy. There was no difference in the cardiac mortality (OR=1.01, [95% CI: 0.92, 1.11], p=0.82, I2=53%) or arrhythmic mortality (OR=1.00, [95% CI: 0.89, 1.13], p=0.94, I2=64%) between the two groups.ConclusionAAMs are associated with an increased risk of non-cardiac and all-cause mortality. The effect of AAMs, especially amiodarone, on non-cardiac mortality requires further evaluation.