Background Coronavirus disease 2019 (COVID-19) is a global pandemic that had affected more than eight million people worldwide by June 2020. Given the importance of the presence of diabetes mellitus (DM) for host immunity, we retrospectively evaluated the clinical characteristics and outcomes of moderate-to-severe COVID-19 in patients with diabetes. Methods We conducted a multi-center observational study of 1,082 adult inpatients (aged ≥18 years) who were admitted to one of five university hospitals in Daegu because of the severity of their COVID-19-related disease. The demographic, laboratory, and radiologic findings, and the mortality, prevalence of severe disease, and duration of quarantine were compared between patients with and without DM. In addition, 1:1 propensity score (PS)-matching was conducted with the DM group. Results Compared with the non-DM group ( n =847), patients with DM ( n =235) were older, exhibited higher mortality, and required more intensive care. Even after PS-matching, patients with DM exhibited more severe disease, and DM remained a prognostic factor for higher mortality (hazard ratio, 2.40; 95% confidence interval, 1.38 to 4.15). Subgroup analysis revealed that the presence of DM was associated with higher mortality, especially in older people (≥70 years old). Prior use of a dipeptidyl peptidase-4 inhibitor or a renin-angiotensin system inhibitor did not affect mortality or the clinical severity of the disease. Conclusion DM is a significant risk factor for COVID-19 severity and mortality. Our findings imply that COVID-19 patients with DM, especially if elderly, require special attention and prompt intensive care.

A higher PVC burden (>26%/day) and the presence of retrograde P-waves were independently associated with PVC-mediated LV dysfunction.

BackgroundRespiratory syncytial virus (RSV) infection constitutes a substantial disease burden in the general population. However, the risk of death for RSV infection has been rarely evaluated with confounders or comorbidities adjusted. We aimed to evaluate whether RSV infection is associated with higher mortality than seasonal influenza after adjusting for confounders and comorbidities and the effect of oseltamivir on the mortality in patients with influenza infection.MethodsA retrospective cohort study was conducted on adult (≥18 years) patients admitted to the emergency department and ward of a university teaching hospital for suspected viral infection during 2013–2015 (N = 3743). RSV infection was diagnosed by multiplex PCR (N = 87). Adults hospitalized for seasonal influenza during the study period were enrolled as a comparison group (n = 312). The main outcome was 20-day all-cause mortality.We used Cox proportional hazard regression analyses to calculate the relative risk of death.ResultsAdult patients were less likely to be diagnosed with RSV than with influenza (2.3 vs 8.3%, respectively), were older and more likely to be diagnosed with pneumonia, chronic obstructive pulmonary disease, hypoxemia, and bacterial co-infection. In patients with RSV infection, the 20-day all-cause mortality was higher than that for influenza, (18.4 vs 6.7%, respectively). RSV infection showed significantly higher risk of death compared to the seasonal influenza group, with hazard ratio, 2.32 (95% CI, 1.17–4.58). Oseltamivir had no significant effect on mortality in patients with influenza.ConclusionsRSV infection was significantly associated with a higher risk of death than seasonal influenza, adjusted for potential confounders and comorbidities.

Background and ObjectivesThe electrophysiological properties associated with favorable outcome of radiofrequency catheter ablation (RFCA) for idiopathic ventricular arrhythmia (VA) originating from the papillary muscle (PM) remain unclear. The purpose of this study was to investigate the relationships of electrophysiological characteristics and predictors with the outcome of RFCA in patients with VAs originating from PM in the left ventricle (LV).Subjects and MethodsTwelve (4.2%) of 284 consecutive patients with idiopathic VAs originating from LV PM were assessed. The electrophysiological data were compared between the patients in the successful group and patients in the recurrence group after RFCA.ResultsIn 12 patients with PM VAs, non-sustained ventricular tachycardias (VTs, n=6), sustained VTs (n=4) and premature ventricular complexes (n=2) were identified as the presenting arrhythmias. Seven of eight patients showing high-amplitude discrete potentials at the ablation site had a successful outcome (85.7%), while the remaining four patients who showed low-amplitude fractionated potentials at the ablation site experienced VA recurrence. The mean duration from onset to peak downstroke (Δt) on the unipolar electrogram was significantly longer in the successful group than in the recurrence group (58±8 ms vs. 37±9 ms, p=0.04). A slow downstroke >50 ms of the initial Q wave on the unipolar electrogram at ablation sites was also significantly associated with successful outcome (85.7% vs. 25.0%, p=0.03).ConclusionIn PM VAs, the high-amplitude discrete potentials before QRS and slow downstroke of the initial Q wave on the unipolar electrogram at ablation sites were related to favorable outcome after RFCA.

Highlights Among 694 inpatients with COVID-19, 137 patients were classified as severe. No severe case was observed among patients aged ≤ 19 years. Asymptomatic patients accounted for 14.4% of cases. The first outbreak was primarily associated with younger age groups. The number of severe patients and the mortality rate were high in the second outbreak.

the late recurrence rate is higher in the patients with ERAT compared with those without ERAT following AF ablation, and is more often noted in the patients who underwent CTI ablation and had a prolonged procedure time. Furthermore, inducibility of AF or AT immediately after ablation independently predicts late recurrence in patients with ERAT.

Background-Chronic lung disease (CLD) is one of the important underlying diseases of atrial fibrillation (AF). The outcomes after radiofrequency catheter ablation of AF in patients with CLD have not yet been reported. We investigated the electroanatomic alterations in pulmonary veins (PVs) in CLD patients with AF and assessed their effect on the outcomes of radiofrequency catheter ablation of AF. Method and Results-We assessed 15 patients who had CLD and underwent radiofrequency catheter ablation of AF. CLD included chronic obstructive pulmonary disease, a tuberculosis-destroyed lung, and interstitial lung disease. For controls, we selected 60 sex-, age-, and procedure era-matched non-CLD patients who received radiofrequency catheter ablation for AF (4 controls for each CLD patient). Eight patients had chronic obstructive pulmonary disease, 6 had a tuberculosis-destroyed lung, and 1 had interstitial lung disease. PV morphology in the affected lung was altered significantly, ie, obliteration, pulling of the PVs toward the destroyed lung, or compensatory bulging of the PV antrum. These alterations were related to arrhythmogenicity in 6 (40%) of 15 patients with CLD. Non-PV foci were more common in the CLD group (4/15, 26.7%) than in the control group (3/60, 5.0%; Pϭ0.025). All non-PV foci were located in the right atrium. The AF recurrence rate in the CLD group (26.7%, 4/15) was similar to that in the control group (18.3%, 11/60; Pϭ0.45). Conclusions-Significant alteration of PV anatomy was related to arrhythmogenicity, and non-PV foci from the right atrium were commonly observed in the CLD group. Radiofrequency catheter ablation can be performed safely for AF in CLD patients with a comparable success rate to that in patients with normal lungs. (Circ Arrhythm Electrophysiol. 2011;4:815-822.)

trial fibrillation (AF) occurs in 0.4% of the general population, increasing to 5% in those over 65 years of age, and it is the most common arrhythmia, increasing cardiac morbidity and mortality. 1 AF is related to the structural and functional remodeling of the left atrium (LA) and ventricle (LV) because of persistent arrhythmia. 2,3 To restore sinus rhythm (SR), both electrical cardioversion (ECV) and radiofrequency (RF) catheter ablation (ABL) have proven to be effective treatment modalities for patients with AF. 4 Reverse morphological remodeling of the LA and improvement in LV diastolic and systolic functions after restoration of SR by either treatment modality have been demonstrated. 5 However, differences in the degree and the time course of functional reverse remodeling of the LA according to the each treatment modality have not been investigated. The objective of this study was to investigate the morphological and functional changes of the LA and LV in patients with sustained SR either after ABL or ECV. Circulation Journal Vol.72, December 2008 Methods Study PopulationSixty-three AF patients who had maintained SR for 3 months after either ECV (n=30, M:F 24:6, mean age 58.6± 9.3 years) or ABL (n=33, M:F 27:6, mean age 55.9±10.2 years) were included. Patients who underwent re-do ablation were excluded. Paroxysmal AF (PAF) was defined as the occurrence of 2 or more episodes of AF during the previous 12 months, typically lasting fewer than 7 days and terminating spontaneously. Persistent AF (PeAF) was defined as AF episodes lasting more than 7 days typically requiring cardioversion for restoration of SR. 6 The 29 of 30 patients had PeAF in the ECV group and 21 of 33 patients had PAF in the ABL group. All clinical information was obtained from medical records, and all patients completed a written informed consent form to participate in the study. ECVECV was performed if LA thrombi were not seen on transesophageal echocardiography. Direct current (DC) shock was delivered during sedation induced with intravenous midazolam (0.04 mg/kg) and pentothal sodium (1.5 mg/kg). One defibrillator pad with a 10-cm diameter was placed in the second intercostal space on the right side parasternally, the other was placed in a left-sided lateral position along the midaxillary line. The cardioversion procedure started with 70 J or 100 J of stored energy followed by 125 J and 150 J until the restoration of SR or failure to convert. Continuous electrocardiographic (ECG) monitoring was performed for several hours after the procedure to assess the maintenance of SR. Background The aim of this study was to assess whether the morphological and functional changes of the left atrium (LA) differ after catheter ablation (ABL) from those after electrical cardioversion (ECV) in atrial fibrillation (AF). Methods and Results AF patients who had maintained sinus rhythm for 3 months after either ECV (n=30) or ABL (n=33) were studied. Both 2-dimensional and Doppler echocardiography were performed at baseline, 1 week, 1 month, and 3 months aft...