Cardiac arrhythmia is a known manifestation of novel coronavirus 2019 (COVID-19) infection. Herein, we describe the clinical course of an otherwise healthy patient who experienced persistent ventricular tachycardia and fibrillation which is believed to be directly related to inflammation, as opposed to acute myocardial injury or medications that can prolong the QT interval.

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There is strong relationship exist between obesity and cardiovascular disease including coronary artery disease (CAD). However, better outcomes noted in obese patients undergoing percutaneous cardiovascular interventions for CAD, a phenomenon known as the obesity paradox. In this review, we performed extensive search for obesity paradox in obese patients undergoing percutaneous coronary intervention and discussed possible mechanism and disparities in different race and sex.

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TLC showed significant correlation with known predictors of difficulty during TLE using the laser sheath. TLC is an objective method to report the difficulty of TLE and could usefully be reported in future series of laser lead extractions.

Aortic regurgitation is a frequently encountered condition, in which traditional measurements of severity have proven to be of limited value in identifying those who would be best served by aortic valve replacement. Novel methods of assessing severity are vital, particularly as an entirely new paradigm of aortic regurgitation has surfaced, with the advent of transcatheter aortic valve replacement (TAVR), and the adverse events that are being observed with varying degrees of aortic regurgitation. With that in mind, a comprehensive assessment of aortic regurgitation should now include indexed left ventricular systolic volumes and a comprehensive assessment of right ventricular function, in addition to the quantitative measures that are currently recommended. Cardiac MRI also provides valuable information and should be strongly considered, particularly in challenging cases. The incremental value of additional echocardiographic parameters such as strain imaging, speckle tracking imaging, and tissue Doppler imaging remains unclear, and evidence for their utility is not, as yet, compelling. However, the field of aortic regurgitation assessment has been reinvigorated by the prevalence of paravalvular regurgitation post-TAVR, and many of the abovementioned parameters may need to be re-visited so that we can more accurately determine prognosis and risk stratify patients in a more reliable and evidence-based manner.

The superiority of drug-eluting stents (DES) compared with bare-metal stents (BMS) is well-established, but data regarding DES use in ST-elevation myocardial infarction (STEMI) as a function of race is limited. Our goal was to examine stent utilization patterns and disparities based on race, sex, and insurance status in patients with STEMI undergoing percutaneous coronary intervention. The National Inpatient Sample database was used to retrospectively compare DES vs BMS use in patients admitted with STEMI from 2009 to 2018. Multivariable logistic regression was performed to assess the independent predictors of DES use. DES utilization increased significantly from 62.8% in 2009 to 94.0% in 2018. However, African Americans were less likely to receive a DES (odds ratio [OR] .82, 95% confidence interval [CI] .77–.87) compared with Caucasians. Women were more likely to undergo DES implantation (OR 1.07, 95% CI 1.05–1.10). Patients insured by Medicaid (OR .84, 95% CI .80–.89) and those classified as Self-pay (OR .63, 95% CI .61–.66) were less likely to undergo DES implantation compared to those with private insurance (OR 1.33, 95% CI 1.29–1.38). Disparities based on race and insurance status continue to persist despite a significant increase in DES utilization in STEMI patients across the identified subgroups.

Background: Several variables have been identified as predictors for difficult or complicated transvenous lead extraction (TLE), including age and number of implanted leads, as well as patient’s age; however, a standard measure of TLE difficulty has not been described. Objective: Total laser cycles (TLC) delivered during laser-assisted TLE is an objective variable that could reflect the difficulty of TLE. This study investigated whether TLC is correlated with known predictors of difficult TLE. Methods: In a retrospective study of TLE procedures using the laser sheath, we analyzed TLC delivered and compared it to established predictors of procedural failure and complications. Results: Of 166 patients undergoing TLE, the laser sheath (SLS II or Glidelight, Spectranetics Inc,) was used as the primary extraction sheath in 130 patients, and 100 patients had complete TLC data available. The mean age of the oldest lead (AOL) was 7.1 ± 3.2 years, and 1.6 ± 0.7 leads (range, 1-4) were extracted per procedure. Two-thirds of procedures involved ICD leads. Clinical success was 97.5%, with one patient (0.6%) experiencing a major complication. Median TLC delivered was 1165 (IQR, 567-2062; range, 49 - 9522) Hz. TLC was positively correlated with AOL (ρ=0.203, p=0.042), and the combined age of leads extracted (ρ=0.287, p=0.004) Fig 1. TLC was also positively correlated with number of leads extracted per procedure (ρ=0.240, p=0.016). There was negative and non-significant correlation between TLC and patient’s age (ρ=-0.114, p=0.257). Conclusion: TLC showed significant correlation with known predictors of difficulty during TLE using the laser sheath. TLC can hence be used as an objective method to report the difficulty of TLE. Figures: Figure1: Panel A showing the correlation between age of oldest lead (AOL) and total laser cycles (TLC); Panel B showing the correlation between combined age of leads (CAL) and total laser cycles (TLC)