rST represents an important cause of long-term morbidity and mortality after an initial ST. Bifurcation ST and a larger proximal reference vessel diameter are independently associated with an increased risk of rST.

Stroke is the most feared complication of atrial fibrillation (AF). Although oral anticoagulation with non-vitamin K antagonist and non-vitamin K antagonist oral anticoagulants (NOACs) have been established to significantly reduce risk of stroke, real-world use of these agents are often suboptimal due to concerns for adverse events including bleeding from both patients and clinicians. Particularly in patients with previous serious bleeding, oral anticoagulation may be contraindicated. Left atrial appendage occlusion (LAAO), mechanically targeting the source of most of the thrombi in AF, holds an immense potential as an alternative to OAC in management of stroke prophylaxis. In this focused review, we describe the available evidence of various LAAO devices, detailing data regarding their use in patients with a contraindication for oral anticoagulation. Although some questions of safety and appropriate use of these new devices in patients who cannot tolerate anticoagulation remain, LAAO devices offer a significant step forward in the management of patients with AF, including those patients who may not be able to be prescribed OAC at all. Future studies involving patients fully contraindicated to OAC are warranted in the era of LAAO devices for stroke risk reduction.

The majority of ST patients present with late/very late ST with high thrombus burden and STEMI. Presence of collateral vessels and low thrombus burden is cardioprotective, while reduced initial TIMI flow is associated with larger infarct size and recurrent ST. Aspiration thrombectomy and repeat stenting are associated with improved epicardial coronary artery flow and myocardial perfusion among patients treated for ST. © 2014 Wiley Periodicals, Inc.

Among first-time ICD recipients, specific clinical characteristics predicted acute hospitalization ICD implantation. After adjustment for potential confounders, acute hospitalization ICD implantation was not associated with increased risk of morbidity or mortality.

Introduction: Free-floating thrombi (FFT) in the right heart are a rare occurrence with an unknown true prevalence. Mortality of 27.1% among treated patients to 100% if left untreated has been documented. FFT represent a medical therapeutic emergency as they can transform into pulmonary emboli leading to catastrophic consequences. Uniform consensus is lacking on the most appropriate management. Here we describe a case of this fatal disease which was successfully treated with interventional embolectomy and thrombolysis. Case Presentation: A 70 year old gentleman with a history of chronic kidney disease presented to the hospital with worsening shortness of breath, chest pain and two syncopal episodes. On exam, patient was afebrile with a blood pressure of 114/78 mm Hg, heart rate of 96/minute, respiratory rate of 22/ minute, signs of right heart failure and hypoxemia. Of note, the patient was recently admitted to the hospital with similar complaints and was found to have two vessel coronary artery disease on angiogram. He was discharged with a plan for a staged percutaneous coronary intervention (PCI) to avoid contrast induced nephropathy. On this admission, patient was diagnosed with a Non-ST elevation myocardial infarction and successfully underwent PCI as planned. A follow up transthoracic echocardiogram revealed a very large size, free-floating serpiginous echo-density in the dilated right atrium prolapsing into the enlarged hypokinetic right ventricle. There was no evidence of extension into the pulmonary vasculature .This finding, which was absent on the previous study was confirmed with a transesophageal echocardiogram (TEE). Due to the severity of the disease, a collective decision was taken by the cardiologists, surgeons and interventional radiologists to proceed with suction thrombectomy using AngioVac procedure. A large 22 cm intact clot, which had now travelled to the pulmonary vasculature, was aspirated under fluoroscopic and TEE guidance followed by catheter directed thrombolysis for remaining filling defects. Patient tolerated the procedure well and had an uneventful post operative course. He continues to remain stable on follow up visits. Conclusion: This case underlines the importance of considering pulmonary embolism as one of the potential etiologies of acute decompensated heart failure. The key to favorable outcome lies in prompt diagnosis and urgent intervention using a multidisciplinary team approach. This practice proved to be life-saving in our case of FFT with exceptionally high mortality.