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BackgroundComplication from the Watchman device (Boston Scientific Corp, Marlborough, Massachusetts) is operatordependent, with the latest EWOLUTION trial showing low complication rates (1.8%) thought to be due to maturing physician experience. ObjectivesThe objective of this study is to understand the yearly trend of utilization and complication rates of the Watchman device in hospitalized patients. MethodsThe national inpatient sample (NIS) was queried for all hospitalization with primary atrial fibrillation or flutter from 2016 to 2019 with percutaneous left atrial appendage occlusion (LAAO). The frequency of periprocedural complications, including death, stroke, major bleeding requiring blood transfusion, pericardial effusion, post-op hypotension, cardiac arrest, postprocedural CHF, implant displacement/leak, systemic embolism, and requiring repeat procedures, were assessed. ResultsFrom 2016 to 2019, an estimated 60,350 LAAO procedures were performed. The majority of the procedure was done in white (84.88%), males (58.40%), with a mean age of 76, at teaching hospitals (88.27%). Complication rates were around 5.72%, with no change from 2016 to 2019 (annual percentage change, APC: 6.23; p-value: 0.170) despite rapid increase in yearly utilization of Watchman from 1.12% in 2016 to 5.45% in 2019 (APC: 62.30; p-value of 0.013). Pericardial effusion (3.41%) was the most common complication, followed by bleeding requiring transfusion (1.40%) that had no significant change over time. ConclusionOur study demonstrates that trend of complications with the Watchman device implantation in the realworld practice didn't improve over time, possibly due to characteristics inherent to the device and patient population. Hence, we expect a further drop in nationwide complication rates with the improved design of Watchman-FLX and increased placement experience.

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With the growing rates of vaccination against coronavirus disease 2019 (COVID-19) across the globe, rare side effects have been increasingly noticed on a post-marketing basis. Cases of myocarditis and pericarditis have been reported in the literature following COVID messenger RNA (mRNA) vaccination. However, diffuse alveolar hemorrhage (DAH) following vaccination has not been reported. DAH is a life-threatening clinicopathological entity characterized by bleeding into the alveolar space from pulmonary microvasculature. It presents a diagnostic challenge in the setting of acute respiratory failure, requiring prompt suspicion and workup.We report a case of a 59-year-old male with a recent COVID-19 infection who presented with DAH within eight hours of the first dose of mRNA vaccination (Moderna, Cambridge, MA). Bronchial alveolar lavage was performed, along with imaging of the chest, to confirm the diagnosis. Immunological workup with rheumatoid factor, anti-citrullinated peptide, anti-neutrophil cytoplasmic antibodies (P-ANCA and C-ANCA), anti-glomerular basement antibodies, Anti-double-stranded DNA, C3 and C4 complement levels, and cryoglobulin were all negative. Infectious workup with cultures and PCR from bronchial lavage was also negative. In the absence of any other causes, the etiology was likely deemed to be vaccine-induced DAH. Herein, we also discuss the possible mechanism of vaccine-related DAH and emphasize the need for further studies on vaccine-related adverse events.

Background Unlike SARS-CoV and MERS-C0V, SARS-CoV-2 has the potential to become a recurrent seasonal infection; hence, it is essential to compare the clinical spectrum of COVID-19 to the existent endemic coronaviruses. We conducted a retrospective cohort study of hospitalized patients with seasonal coronavirus (sCoV) infection and COVID-19 to compare their clinical characteristics and outcomes. Methods A total of 190 patients hospitalized with any documented respiratory tract infection and a positive respiratory viral panel for sCoV from January 1, 2011, to March 31, 2020, were included. Those patients were compared with 190 hospitalized adult patients with molecularly confirmed symptomatic COVID-19 admitted from March 1, 2020, to May 25, 2020. Results Among 190 patients with sCoV infection, the Human Coronavirus-OC93 was the most common coronavirus with 47.4% of the cases. When comparing demographics and baseline characteristics, both groups were of similar age (sCoV: 74 years vs. COVID-19: 69 years) and presented similar proportions of two or more comorbidities (sCoV: 85.8% vs. COVID-19: 81.6%). More patients with COVID-19 presented with severe disease (78.4% vs. 67.9%), sepsis (36.3% vs. 20.5%), and developed ARDS (15.8% vs. 2.6%) compared to patients with sCoV infection. Patients with COVID-19 had an almost fourfold increased risk of in-hospital death than patients with sCoV infection (OR 3.86, CI 1.99–7.49; p < .001). Conclusion Hospitalized patients with COVID-19 had similar demographics and baseline characteristics to hospitalized patients with sCoV infection; however, patients with COVID-19 presented with higher disease severity, had a higher case-fatality rate, and increased risk of death than patients with sCoV. Clinical findings alone may not help confirm or exclude the diagnosis of COVID-19 during high acute respiratory illness seasons. The respiratory multiplex panel by PCR that includes SARS-CoV-2 in conjunction with local epidemiological data may be a valuable tool to assist clinicians with management decisions.

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Objective To describe the clinical characteristics and outcomes of two waves of the COVID-19 pandemic. Methods We retrospectively reviewed a de-identified dataset of patients with COVID-19 admitted to our community hospital in Evanston, Illinois, from March 1, 2020, to February 28, 2021. We then identified patients from the first wave as those admitted during the initial peak of admissions observed at our hospital between March 1, 2020, and September 3, 2020. The second wave was defined as those admitted during the second peak of admissions observed between October 1, 2020, and February 28, 2021. Results A total of 671 patients were included. Of those, 399 (59.46%) were identified as patients from the first wave, and 272 (40.54%) were identified as patients from the second wave. Significantly more patients received steroids (86.4% vs. 47.9%, p <.001), remdesivir (59.6% vs. 9.5%, p <.001), humidified high-flow nasal cannula (18% vs. 6.5%, p <.001) and noninvasive ventilation (11.8% vs. 3.3%, p <.001) during the second wave. Patients from the first wave had a greater hazard for death compared to patients from the second wave (Hazard Ratio [HR] 1.62, 95% CI 1.08 – 2.43; p =.019). Conclusion Among patients hospitalized with COVID-19 in our community hospital, we observed a decrease in case-fatality rate in the second surge of the COVID-19 pandemic compared with the first wave.

This case report presents a 60-year-old gentleman with a significant smoking history and possible asbestos exposure who was referred to the emergency department for atrial fibrillation with a rapid ventricular rate and symptoms of heart failure. Labs showed normal brain natriuretic peptide and troponin I. His echocardiography finding suggested constrictive pericarditis with an ejection fraction of 60%. A computed tomography scan was concerning for a pericardial mass. Left and right heart catheterization hinted more toward constrictive physiology; however, some findings were concerning for restrictive physiology. Hence, cardiac magnetic resonance imaging was done, which established the diagnosis of constrictive pericarditis. Pericardiectomy was planned with a maze procedure for atrial fibrillation. However, a malignant neoplasm was seen on a frozen biopsy. Hence, surgery was limited to partial pericardiectomy, as the patient had advanced infiltrative neoplasm that had resulted in constrictive pericarditis. The final pathology report confirmed the diagnosis of malignant pericardial mesothelioma mixed type. Malignancy is usually diagnosed in an advanced stage, like in our case, due to nonspecific initial presentation. A literature review suggests that there is a lack of established consensus on treatment. The response to therapy also seems to be poor and results only in palliation of symptoms, with a median survival of six months from diagnosis despite optimum medical management.