The transradial artery has been established as the default access site for most coronary catheterization procedures with fewer access-related and bleeding complications, rapid hemostasis, early ambulation of the patient, and reduction in all-cause mortality compared with transfemoral access. However, radial artery occlusion (RAO) remains the most frequent complication of coronary catheterization procedures performed via transradial artery access. The purpose of our review was to conduct detailed literature research and summarize all the available treatment strategies for RAO, given the lack of a standardized treatment protocol in the literature. Pharmacological treatment with low-molecular-weight heparin (LMWH) or other anticoagulants, invasive strategies, and pharmaco-invasive methods available in the literature were included in our review. Data were derived from case series, case reports, clinical trials, and observational studies. Eight studies regarding pharmacological treatment with LMWH or any other anticoagulant and seven studies of invasive treatment were included in our review. There were only two randomized studies: one with LMWH (tinzaparin) and one with apixaban. Furthermore, taking into consideration data derived from the above-mentioned studies, a treatment algorithm for RAO was proposed. RAO remains the most frequent complication of coronary procedures with transradial access. Application of preventive strategies and comprehensive knowledge of the risk factors remain the key factors for the reduction of the incidence of this clinical entity. Therapeutic options include anticoagulation regimens and interventional techniques through the distal radial artery. Large, randomized, multicenter studies should be conducted to evaluate the efficacy of the available treatment methods and define a standardized treatment protocol for RAO. (Hellenic Journal of Cardiology 2025;84:81-95) (c) 2025 Hellenic Society of Cardiology. Publishing services by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Cardiac myxomas typically demonstrate slow growth rates, with rapid enlargement raising suspicion for malignancy. We present a 77-year-old male with a history of non-Hodgkin lymphoma who developed symptomatic atrial fibrillation. Transthoracic echocardiography revealed a left atrial mass measuring 2.5 cm that was absent six months earlier, suggesting a growth rate of approximately 5 mm/month. Multimodality imaging including transesophageal echocardiography, cardiac CT, and MRI showed features suggestive of myxoma but could not definitively exclude lymphoma recurrence given the patient's oncological history and atypical growth pattern. Thoracoscopic resection was successfully performed. Histopathology confirmed a cardiac myxoma with central necrosis—a rare finding occurring in less than 3% of cases—which likely contributed to the unusually rapid growth. This case highlights the diagnostic value of multimodality imaging and the importance of multidisciplinary decision-making in managing complex cardiac masses.

BACKGROUND:Radial artery occlusion (RAO) is one of the most common complications associated with transradial access in cardiac catheterization procedures. To date there are no standardized protocols, and only a few studies have evaluated the use of anticoagulation for RAO treatment. The current meta-analysis aimed to assess the impact of various anticoagulation strategies on RAO treatment after cardiac catheterization via the transradial route. METHODS:Literature search was performed in PubMed, Web of Science, and CENTRAL databases, from inception until September 2024. The primary outcome of this study was the incidence of radial artery recanalization. The secondary outcomes were the incidence of any bleeding events and symptom resolution during patient follow-up. RESULTS:A total of six studies with 398 patients were included in the analysis. Patients with RAO under anticoagulation had a sevenfold increased chance of radial artery recanalization [pooled odds ratio (pOR) = 7.36 (3.82-14.17), P < 0.001]. Regarding the symptom persistence, there was no statistically significant difference between patients receiving and not receiving anticoagulation [pOR = 2.61 (0.26-25.86), P = 0.41]. Regarding bleeding events, no pooled data could be extracted; however, no major bleeding events were reported in any study. CONCLUSION:This meta-analysis provides compelling evidence that anticoagulation therapy significantly improves radial artery recanalization rates in patients with RAO without increasing the risk of major bleeding events; however, its effect on symptom resolution remains limited, suggesting the need for a comprehensive approach to RAO management.

Introduction: There are worldwide reports that hospital admissions for acute coronary syndrome (ACS) have declined during the COVID-19 pandemic. Chios is a Greek island with only one confirmed coronavirus case during the lockdown. This study aimed to compare admissions for ACS in Chios General Hospital, Greece, between the COVID-19 lockdown period and the same period in the previous year.Methods: Retrospective record analysis of an isolated insular population referring to the only district hospital on the island. ACS incidence, type, and complications were recorded and compared between 26/02/2020-04/05/2020 and between 26/02/2019-04/05/2019.Results: ACS hospital admissions in 2020 were 1.72/10,000 inhabitants vs. 1.03/10,000 inhabitants in 2019 (p=0.317). No differences in ACS type, duration from symptom onset to first medical contact, hemodynamic status, left ventricular function at discharge, or complications were recorded.Conclusion: The incidence of ACS did not decrease and the prognosis was not worse during the COVID-19 pandemic in a strictly isolated Greek insular population not overwhelmed by coronavirus cases.

INTRODUCTION Chios Mastiha essential oil (CMO) is a natural product extracted from the resin of Mastiha, possessing antioxidant, anti -microbial, anti -ulcer, anti-neoplastic, and cholesterol -lowering capabilities in vitro, and its hypolipidemic effect was con firmed in animal studies. Yet, there are no randomized, placebo -controlled clinical studies in the literature regarding CMO 's hypolipidemic effects in humans. A prospective, randomized, placebo -controlled study was designed to study the hypolipidemic effect of CMO capsules on healthy volunteers with elevated cholesterol. METHODS 192 healthy volunteers were screened and 160 of them with total cholesterol > 200 mg/dl participated in the study. They were randomized with a 2:1 ratio of receiving CMO capsules (200 mg mastiha-oil/capsule) and placebo for 8 weeks respectively. 113 patients received CMO and 47 were randomized in the control group, and all of them completed the follow-up period. RESULTS After 8 weeks of CMO administration, total and LDL cholesterol were signi ficantly lower in the CMO compared to the placebo group 215.2 +/- 27.5 vs 237.0 +/- 27.9 mg/dl (p < 0.001) and 135.0 +/- 26.1 vs 153.0 +/- 23.3 mg/dl (p < 0.001) respectively. No gastrointestinal adverse events or liver or renal toxicity were reported. Additionally, in the CMO group total cholesterol was signi ficantly decreased by 20.6 mg/dl (9%), LDL by 18.1 mg/dl (12%), triglycerides by 21.8 mg/dl (15%), and glucose by 4.6 mg/dl (5%) and HDL was increased by 2.4 mg/dl (5%), compared to their baseline values. CONCLUSION The MASTIHA-OIL study showed the ef ficacy and safety of CMO in reduction of total and LDL cholesterol after 8 weeks of administration in healthy volunteers with elevated cholesterol levels. (Hellenic Journal of Cardiology 2024;77:63 -69) (c) 2023 Hellenic Society of Cardiology. Publishing services by Elsevier B.V. This is an open access article under the CC BY -NC -ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Background: Intravenous (IV) flecainide is recommended for the pharmacological cardioversion of recent-onset atrial fibrillation (AF). The aim of this study was to study the efficacy and safety of IV flecainide, co-administered with oral b-blockers, for the cardioversion of paroxysmal AF. Methods: Single-center registry, initiated in the “Skylitseion” General Hospital of Chios in January 2020. The main inclusion criterion was IV flecainide administration plus oral b-blocker for recent-onset AF (≤48 h). The primary outcome was conversion to sinus rhythm at 2 h. Results: A total of 121 (73 males and 48 females, with mean age 61.4 years) consecutive, unselected patients who complied with the study protocol were included. A successful conversion to sinus rhythm at 2 h was achieved in 99 patients (success rate: 81.8%). The median conversion time was 11.7 min (varied from 3 to 23 min). Duration of hospitalization was significantly shorter in patients who were successfully cardioverted with IV flecainide (10.9 vs. 30.7 h, p < 0.001). No serious adverse events were recorded. Conclusion: This is one of the largest registries worldwide, evaluating the effectiveness and safety of IV flecainide co-administered with a b-blocker in the acute management of recent-onset AF. The successful conversion rate at 2 h is very high and quick with no serious adverse events.

https://e-kcj.org A 75-year-old man with history of chronic kidney disease under dialysis due to diabetes mellitus and coronary artery disease, was hospitalized in our cardiology clinic with complete heart block. Since no reversible causes were detected, implantation of a permanent pacemaker was decided. The patient had history of left-hand fistula obstruction, and superior vena cava syndrome due to obstruction from temporary central venous dialysis catheters which was corrected with vein diastoles by vascular surgeon. Thrombophilia was excluded and since the patient had history of temporary central dialysis catheter placement at both subclavian veins, and the clinical examination revealed marked varicose thoracic veins, a computed tomography angiography of upper limbs, head, and neck with iv contrast from the left arm was carried out (Figure 1A). The exam revealed the presence of varicose thoracic veins and obstruction of both subclavian veins, with the contrast remaining at the obstruction point of the left subclavian vein (Figure 1B and C). Since no vascular access was available the implantation of a leadless Micra-VVI pacemaker (single chamber pacemaker, atrial sensing mode was not available at that time) was decided by the Heart Team.1) The procedure was uncomplicated, and our patient remains asymptomatic until the present day with pacemaker rhythm electrocardiogram (iatrogenic atrioventricular dissociation with single chamber patient and native atrial rhythm) (Figures 1D and 2).

https://e-jcvi.org A 77-year-old female patient with history of mechanical mitral valve replacement seven months before her presentation and paroxysmal atrial fibrillation was admitted to the emergency department with low-grade fever of three months duration, without taking any antibiotics during this period. She lived in a village of north Chios, but she denied any contact with contaminated dairy products or infected farm animals. Laboratory findings showed leukocytosis, thrombocytosis and increased C-reactive protein, erythrocyte sedimentation rate and ferritin and her electrocardiogram showed sinus rhythm. All blood cultures were negative. Neither transoesophageal echocardiogram (Movie 1) nor thoracic and abdominal computed tomography revealed abnormal findings. As neither cause of fever was recognized nor the diagnosis of infective endocarditis was confirmed based on 2 minor Duke’s criteria, a broad-spectrum antibiotic combination with ceftriaxone and vancomycin was administered initially. Serological tests for intracellular bacterial pathogens were performed and showed mildly increased immunoglobin (Ig) G and IgM antibodies for Coxiella burnetii (1:512 and 1:24, respectively). Based on it, the diagnosis of Q fever was considered quite possible and therapy with doxycycline and hydroxychloroquine was initiated. Despite the targeted therapy, she still suffered from fever 3 months later and a new serological test was collected, which revealed further increase of IgG and IgM antibodies (1:960 and 1:100, respectively). Moreover, a new computed tomography showed splenic septic emboli (Figure 1). A second transoesophageal echocardiogram revealed a 6x6 mm mitral vegetation, nonexistent at the previous one (Figures 2 and 3, Movies 2 and 3). Based on both the serological and echocardiographic findings, the diagnosis of Q fever endocarditis could be established as definite. The patient remains on doxycyxline-hydroxychloroquine combination therapy, while we highlighted the importance of adherence to therapy. She will be reevaluated in three months with new antibodies test according to the management strategy of Q fever.1)

An 81-year-old woman was admitted to our cardiology clinic with episodes of atypical chest pain.She had a personal history of hypertension and had undergone implantation of a VVIR pacemaker (in a subcutaneous pocket at theright upper side of her thorax) fifteen years before at another institution, because of atrioventricular conduction disturbances (Figure 1DI).Seven years before, the pacemaker was re-implanted and substituted by a DDDR device because of skin erosion and inserted in a lower subcutaneous pocket, also in the right side of the thorax, without lead removal (Figure 1DII).

An 81-year-old woman was admitted to our cardiology clinic with episodes of atypical chest pain. She had a personal history of hypertension and had undergone implantation of a VVIR pacemaker (in a subcutaneous pocket at the right upper side of her thorax) fifteen years before at another institution, because of atrioventricular conduction disturbances (Figure 1DI). Seven years before, the pacemaker was re-implanted and substituted by a DDDR device be-