T ranscatheter aortic valve implantation (TAVI) has become the treatment of choice for patients with aortic stenosis who are considered to be nonoperable and a good alternative for those at high surgical risk.1 However, the occurrence of some periprocedural complications remains a concern. The need for permanent pacemaker implantation (PPI) after the procedure is one of the most frequent complications associated with TAVI, with an overall incidence of ≈15% (≈25% and 7% after TAVI with self-expandable valves [SEVs] and balloon-expandable valves [BEVs], respectively). 1 Clinical Perspective on p 1243Strong evidence supports the potential negative impact of right ventricular apical pacing, which has been associated with an increased rate of the combined end point of mortality and rehospitalization for heart failure in patients with left ventricular dysfunction, 2-4 ventricular tachyarrhythmias, 5,6 and pacing-induced cardiomyopathy in patients without overt structural heart disease. 7 However, evidence for the clinical impact of PPI after TAVI remains scarce and based on small Background-Very few data exist on the clinical impact of permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation. The objective of this study was to assess the impact of PPI after transcatheter aortic valve implantation on late outcomes in a large cohort of patients. =0.121). Conclusions-The need for PPI was a frequent complication of transcatheter aortic valve implantation, but it was not associated with any increase in overall or cardiovascular death or rehospitalization for heart failure after a mean follow-up of ≈2 years. Indeed, 30-day PPI was a protective factor for the occurrence of unexpected (sudden or unknown) death.

NOP-LBBB occurred in ∼1 of 10 patients who had undergone TAVI with a balloon-expandable valve. NOP-LBBB was associated with a higher rate of PPI, a lack of improvement in left ventricular ejection fraction, and a poorer functional status, but did not increase the risk of global or cardiovascular mortality or rehospitalizations at 1-year follow-up.

Advanced CKD was associated with a higher rate of early and late mortality and bleeding events following TAVI, with AF and dialysis therapy determining a higher risk in these patients. The mortality rate of patients with both factors was unacceptably high and this should be taken into account in the clinical decision-making process in this challenging group of patients.

Background-Despite valuable supplemental training resources for surgical skill acquisition, utility of virtual reality simulators to improve skills relevant to performing cardiac catheterization has not been evaluated. Methods and Results-Post baseline cardiac catheterization performance assessment, 27 cardiology trainees were randomized to either mentored training on a virtual reality simulator (n=12) or no simulator training (control; n=15). Cardiac catheterization performance was reassessed 1 week post baseline assessment. Performance scores at 1 week were compared with baseline within each group, and change in score from baseline to 1 week was compared between groups. Linear regression modeling was performed to assess the effect of simulator training as a function of baseline performance.

AR occurred very frequently after TAVR, but an increased risk of mortality at ∼2-year follow-up was observed only in patients with acute moderate to severe AR.

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Patient: Male, 43-year-old Final Diagnosis: Heart failure • HIV infection • thrombosis Symptoms: Heart failure Medication: — Clinical Procedure: Echocardiography Specialty: General and Internal Medicine Objective: Unusual clinical course Background: Left ventricular thrombus (LVT) is a complication of left ventricular dysfunction and myocardial infarction (MI) and is associated with systemic thromboembolism. Two-dimensional transthoracic echocardiography (TTE) is considered the first-line diagnostic tool for detection of LVT. Vitamin K antagonists (VKA) targeting an international normalized ratio (INR) from 2 to 3 are the only approved treatments by the Food and Drug Administration (FDA). New emerging observational data support the use of direct oral anticoagulants (DOACs) as an alternative therapeutic option; however, their safety and efficacy have not been assessed in a good-quality randomized controlled trial. Case Report: Here, we present a case of a 43-year-old man diagnosed with human immunodeficiency virus (HIV)-associated dilated cardiomyopathy complicated with an LVT. He was treated with rivaroxaban for 9 consecutive months with no interruption of therapy at any point in time; however, he presented to the emergency department with symptoms of decompensated heart failure. A follow-up TTE demonstrated a significant increase in the size of his LVT. This case questions the efficacy of using factor Xa inhibitor (rivaroxaban) as an alternative option for LVT treatment. Conclusions: This case demonstrates a failure of rivaroxaban in treating LVT in a patient with HIV-associated dilated cardiomyopathy. Good-quality randomized clinical trials or prospective studies are required to establish the efficacy and safety of DOACs for LVT treatment as an alternative to VKA.

A 29-year-old woman (gravida 3, para 2) presented at 28 weeks+2 days of gestation with a two-months history of dyspnea associated with orthopnea and occasional palpitations. On transthoracic echocardiography, she was diagnosed with a 3.2 × 2.7 cm left atrial myxoma. The patient underwent open surgical resection at 30 weeks of gestation. She had an uneventful postoperative recovery and was discharged on the ninth day. At 41 weeks of gestation, she gave birth by cesarean to a healthy baby of normal weight. Both the mother and the baby were discharged in stable condition.