Aims The EURO-ENDO registry aimed to study the management and outcomes of patients with infective endocarditis (IE). Methods and results Prospective cohort of 3116 adult patients (2470 from Europe, 646 from non-ESC countries), admitted to 156 hospitals in 40 countries between January 2016 and March 2018 with a diagnosis of IE based on ESC 2015 diagnostic criteria. Clinical, biological, microbiological, and imaging [echocardiography, computed tomography (CT) scan, 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT)] data were collected. Infective endocarditis was native (NVE) in 1764 (56.6%) patients, prosthetic (PVIE) in 939 (30.1%), and device-related (CDRIE) in 308 (9.9%). Infective endocarditis was community-acquired in 2046 (65.66%) patients. Microorganisms involved were staphylococci in 1085 (44.1%) patients, oral streptococci in 304 (12.3%), enterococci in 390 (15.8%), and Streptococcus gallolyticus in 162 (6.6%). 18F-fluorodeoxyglucose positron emission tomography/computed tomography was performed in 518 (16.6%) patients and presented with cardiac uptake (major criterion) in 222 (42.9%) patients, with a better sensitivity in PVIE (66.8%) than in NVE (28.0%) and CDRIE (16.3%). Embolic events occurred in 20.6% of patients, and were significantly associated with tricuspid or pulmonary IE, presence of a vegetation and Staphylococcus aureus IE. According to ESC guidelines, cardiac surgery was indicated in 2160 (69.3%) patients, but finally performed in only 1596 (73.9%) of them. In-hospital death occurred in 532 (17.1%) patients and was more frequent in PVIE. Independent predictors of mortality were Charlson index, creatinine > 2 mg/dL, congestive heart failure, vegetation length > 10 mm, cerebral complications, abscess, and failure to undertake surgery when indicated. Conclusion Infective endocarditis is still a life-threatening disease with frequent lethal outcome despite profound changes in its clinical, microbiological, imaging, and therapeutic profiles.

Background Transesophageal echocardiography (TEE) has been used recently to detect atrial thrombi before cardioversion of atrial arrhythmias. It has been assumed that embolic events after cardioversion result from embolism of preexisting atrial thrombi that are accurately detected by TEE. This study examined the clinical and echocardiographic findings in patients with embolism after cardioversion of atrial fibrillation despite exclusion of atrial thrombi by TEE.Methods and Results Clinical and echocardiographic data in 17 patients with embolic events after TEE-guided electrical (n=16) or pharmacological (n=1) cardioversion were analyzed. All 17 patients had nonvalvular atrial fibrillation, including four patients with lone atrial fibrillation. TEE before cardioversion showed left atrial spontaneous echo contrast in five patients and did not show atrial thrombus in any patient. Cardioversion resulted in return to sinus rhythm without immediate complication in all patients. Thirteen patients had cerebral embolic events and four patients had peripheral embolism occurring 2 hours to 7 days after cardioversion.

Background: Radiofrequency ablation for atrial fibrillation (RAF) is an increasingly performed procedure. It is performed during cardiac surgery or percutaneously by catheter. A dangerous complication of RAF is atrioesophageal fistula (AEF), which predominantly manifests neurologically owing to food embolism. Because neurologists may not be familiar with AEF and the prognosis is dependent on a prompt diagnosis, awareness of AEF by the neurologist may play a crucial role. Objective: To summarize for the neurologist the knowledge about fistula between the left atrium and esophagus occurring after RAF. Design, Setting, and Patients: Using a MEDLINE search, we collected reports about AEF after RAF in 28 patients. Main Outcome Measures: From the collected reports, the description of symptoms, diagnostic investigations, therapy, and outcome of the 28 patients were summarized. Results: In 28 cases, AEF developed 3 to 38 days after RAF. Confusion, grand mal seizures, meningitis, focal cortical signs, and postprandial transient ischemic attacks associated with fever were the leading manifestations in 21 of 28 patients. Blood tests showed leukocytosis, elevated serum C-reactive protein levels, and thrombocytopenia. Blood cultures were frequently positive for bacteria. Lumbar puncture revealed pleocytosis, elevated protein levels, increased lactate levels, and bacteria. Diagnosis was established by thoracic contrast computed tomography. Endoscopy, insertion of nasogastric tubes, and transesophageal echocardiography were detrimental, leading to an increase in fistula size and food or air embolism. Therapy comprised surgery (n=11) or temporary esophageal stenting (n = 1). The remaining patients died before attempted surgery or confirmation of the diagnosis. A neurological deficit persisted in 3 of the 9 surviving patients.

Purpose: Aim was to assess the frequencies of electrocardiographic (ECG) abnormalities, including QT prolongation, in acute stroke patients and their association with stroke severity, stroke subtype and location, and cardiovascular risk factors. Methods: Prospectively, admission 12-lead ECG findings, stroke characteristics, cardiovascular risk factors, and potential QT-prolonging factors were collected in 122 consecutive patients with acute stroke. Results: Eighty-four patients (69%) had ECG abnormalities, most frequently ST changes in 34%, QT prolongation in 31%, and atrial fibrillation in 27% of them. Insular involvement and prior stroke independently predicted QT prolongation in small infarcts (insular involvement OR 0.12, 95% CI 0.02–0.74, p = 0.022; prior stroke OR 0.20, 95% CI 0.06–0.70, p = 0.012). Conclusion: Continuous ECG monitoring and assessment of the QT interval should be mandatory in patients with acute stroke.

Diabetic patients with atrial fibrillation frequently have additional risk factors for stroke or embolism, and thus should be treated with oral anticoagulation. Whether in the rare cases of atrial fibrillation, in whom diabetes is the only clinical risk factor, oral anticoagulation is indicated cannot be answered by the present study.

Insufficient water intake, impaired thermoregulation, and resulting death may be directly linked to the use of certain drugs, implying an immediate need for public awareness during heatwaves and for long-term strategies to mitigate the expected increase in future heatwave-related fatalities.

Non-compaction alone does not seem to be a risk factor for malignant ventricular arrhythmias.

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