BACKGROUND:Left atrial appendage occlusion (LAAO) is an established therapy for stroke prevention in non-valvular atrial fibrillation (NVAF), but outcomes in Hispanic populations remain underexplored. OBJECTIVE:The objective of our study was to evaluate the inpatient outcomes of Hispanic patients undergoing LAAO as compared to non-Hispanic white patients. METHODS:We conducted a retrospective cohort study using the National Inpatient Sample (NIS). From 157 434 LAAO hospitalizations identified, 133 517 were non-Hispanic white and 6814 were Hispanic/Latino. The primary outcome was in-hospital mortality. RESULTS:Unadjusted odds in the Hispanic/Latino group were higher for mortality (OR 1.78, 95% CI 1.18-2.68, p 0.006), stroke (OR 1.64, 95% CI 1.26-2.14, p < 0.001), infectious complications (OR 3.89, 95% CI 3.03-4.99, p < 0.001), major bleeding (OR 1.22, 95% CI 1.11-1.33, p < 0.001), DVT/PE (OR 2.15, 95% CI 1.58-2.93, p < 0.001), and vascular complications (OR 1.81, 95% CI 0.53-0.93, p < 0.001). After adjusting for covariates and comorbidities, Hispanic/Latino patients had still greater odds of mortality (aOR 1.20, 95% CI 0.75-1.92, p 0.445), infectious complications (aOR 3.54, 95% CI 2.62-4.55, p < 0.001), and vascular complications (aOR 1.57, 95% CI 1.22-2.03, p < 0.001). Non-Hispanic white patients had higher adjusted odds of pericardial effusion/tamponade (aOR 0.64, 95% CI 0.52-0.95, p 0.03), while Hispanic/Latino patients also had higher adjusted odds of cardiac arrest (aOR 1.99, 95% CI 1.15-3.42, p 0.46). CONCLUSION:Hispanic/Latino patients undergoing LAAO experience higher odds of infectious and vascular complications compared to non-Hispanic white patients. These findings highlight the need to further investigate disparities in procedural outcomes.

Background: Acute coronary syndrome (ACS) hospital admissions decreased during the start of the COVID-19 outbreak. Information is limited on how Google searches were related to patients ' behaviour during this time. Methods: We examined de-identi fi ed data from 2019 through 2020 regarding the following monthly items: (i) admissions for ACS from the Veterans Affairs Healthcare System; (ii) out-of-hospital cardiac arrest (OHCA) from the National Emergency Medical Services Information System (NEMSIS) public dataset; and (iii) Google searches for " chest pain, " " coronavirus, " " chest pressure, " and " hospital safe " from Google Trends. We analyzed the trends for ACS admissions, OHCA, and Google searches. Results: During the early months of the fi rst COVID-19 outbreak, the following occurred: (i) Veterans Affairs data showed a signi fi cant reduction in ACS admissions at a national and regional (Florida) level; (ii) the NEMSIS database showed a marked increase in OHCA at a national level; and (iii) Google Trends showed a signi fi cant increase in the before-mentioned Google searches at a national and regional level. Conclusions: ACS hospital admissions decreased during the beginning of the pandemic, likely owing to delayed healthcare utilization secondary to patients fear of acquiring a COVID-19 infection. Concordantly, the volume of Google searches for hospital safety and ACS symptoms increased, along with OHCA events, during the same time. Our results suggest that Google Trends may be a useful tool to predict patients ' behaviour and increase preparedness for future events, but statistical strategies to establish association are needed.

In hypertrophic cardiomyopathy ( HCM ), left ventricular outflow tract ( LVOT ) obstruction is the hallmark of the disease and the main cause of the associated symptoms. The systolic anterior motion ( SAM ) of an abnormally elongated and positioned anterior mitral leaflet contributes to dynamic LVOT obstruction and secondary mitral regurgitation ( MR ). Increasing interest in the interaction of the mitral valve in the disease has resulted in important therapeutic alternatives, especially for patients with persistent symptoms despite medical therapy who are at high risk for surgical myomectomy or with non-favorable anatomy for alcohol septal ablation. In this chapter, we review the reasoning behind the use of transcatheter edge-to-edge repair for HCM and describe future venues for the percutaneous repair of the mitral valve in HCM.

Transfemoral access is the preferred approach for TAVR. High-risk vascular anatomy predicts a greater risk of complications and, in many instances, requires the use of an alternative access. Using an alternative access has a significantly higher risk of complications and mortality and should be avoided if possible. Today, TAVR technology and procedure techniques have evolved, and just a small percentage of cases need an alternative approach. In this chapter, we describe the latest advancements in TAVR platforms and sophisticated techniques to facilitate a successful transfemoral approach in TAVR.

Pericardiocentesis (PC) in patients with pulmonary hypertension (PH) and pericardial effusions has unclear benefits because it has been associated with acute hemodynamic collapse and increased mortality. Data on in-hospital outcomes in this population are limited. The National Inpatient Sample database was used to identify adult patients who underwent PC during hospitalizations between 2016 and 2020. Data were stratified by the presence or absence of PH. A multivariate regression model and case-control matching was used to estimate the association of PH with PC in-hospital outcomes. A total of 95,665 adults with a procedure diagnosis of PC were included, of whom 7,770 had PH. Patients with PH tended to be older (aged 67 ± 15.7 years) and female (56%) and less frequently presented with tamponade (44.9% vs 52.4%). Patients with PH had significantly higher rates of chronic kidney disease, coronary artery disease, heart failure, and chronic lung disease, among other co-morbidities. In the multivariate analysis, PC in PH was associated with higher all-cause mortality (adjusted odds ratio [aOR] 1.40, confidence interval [CI] 1.30 to 1.51) and higher rates of postprocedure shock (aOR 1.53, CI 1.30 to 1.81) than patients without PH. Mortality was higher in those with pulmonary arterial hypertension than other nonpulmonary arterial hypertension PH groups (aOR 2.35, 95% CI 1.46 to 3.80, p <0.001). The rates of cardiogenic shock (aOR 1.49, 95% CI 1.38 to 1.61), acute respiratory failure (aOR 1.56, 95% CI 1.48 to 1.64), and mechanical circulatory support use (aOR 1.86, 95% CI 1.63 to 2.12) were also higher in patients with PH. There was no significant volume-outcome relation between hospitals with a high per-annum pericardiocentesis volume compared with low-volume hospitals in these patients. In conclusion, PC is associated with increased in-hospital mortality and higher rates of cardiovascular complications in patients with PH, regardless of the World Health Organization PH group.

A 67-year-old male presenting with an anterior ST-segment elevation myocardial infarction (STEMI) underwent stent placement in the left anterior descending coronary. The patient was discharged on an appropriate medical regimen containing dual antiplatelet therapy (DAPT). Four days later, the patient presented with repeat acute coronary syndrome symptomatology. Electrocardiogram demonstrated ongoing STEMI in the previously treated artery distribution. Emergency angiography revealed restenosis and total thrombotic occlusion. Post-intervention stenosis was 0% after aspiration thrombectomy and balloon angioplasty. Stent thrombosis is a high-mortality and therapeutically challenging condition requiring prepared clinicians who recognize predisposing risk factors and initiate early management.

Background: Pericardiocentesis in patients with Pulmonary Hypertension (PH) and pericardial effusions has unclear benefits, as it has been associated with acute hemodynamic collapse and increased mortality. Data on in-hospital outcomes in this population is limited. Aims. Describe pericardiocentesis-related patient characteristics and in-hospital outcomes in patients with PH versus without. Methods: The National Inpatient Sample database was used to identify adult patients undergoing pericardiocentesis during hospitalizations between 2016 and 2020. Data were stratified between patients with and without PH. A multivariate regression model was used to estimate the association of PH with pericardiocentesis in-hospital outcomes, adjusting for statistically significant comorbidities. Results: A total of 95,665 hospitalizations with a procedure diagnosis of pericardiocentesis were included, of which 7,770 had PH. Patients with PH tended to be older (67 ± 15.7) and female (56%), had significantly higher rates of hypertension (79% vs 66%, P<0.01), diabetes (26% vs 17%, P<0.01), chronic lung disease (32% vs 23%, P<0.01), chronic liver disease ( 15% vs 12%, P<0.01), CKD ( 44% vs 25%, P<0.01), and chronic heart failure (19% vs 10%, P<0.01). Pericardiocentesis in PH was associated with higher in-hospital all-cause mortality, post-procedure shock, cardiogenic shock, cardiac arrest, and mechanical circulatory support compared to patients without PH. Those presenting with cardiac tamponade had higher odds of mortality, post-procedural shock, and mechanical circulatory support (Figure 1) compared to patients without PH. All P values were < 0.001. Conclusion: PH was associated with higher mortality and a higher rate of cardiovascular complications in patients undergoing pericardiocentesis. Those presenting with tamponade had particularly worse outcomes. Further research on the outcomes of pericardiocentesis in these patients is needed.

Introduction: Transcatheter aortic valve replacement (TAVR) is a well-recognized treatment for severe aortic stenosis. One potentially life-threatening complication of TAVR is infective endocarditis (IE). There is limited contemporary data on the clinical characteristics and outcomes of patients undergoing TAVR who develop in-hospital IE. Aim: Describe the clinical characteristics and outcomes of patients undergoing TAVR who develop in-hospital IE. Methods: The National Inpatient Sample Database was queried from 2016 to 2020 for relevant ICD-10 procedural and diagnostic codes. Baseline characteristics and in-hospital outcomes of adult (≥18 years) patients undergoing TAVR who developed in-hospital IE were compared to that of patients who did not develop IE. Multivariate logistic-regression analyses adjusting for age, race, gender, and statistically significant comorbidities between cohort's were performed. A p-value <0.05 was considered significant. Results: A total of 314,250 hospitalizations for patients undergoing TAVR were identified. Of them, 1065 (0.3%) developed in-hospital IE. Overall, mean age of IE patients was 70.3 ± 15.0. Patients were predominantly (62%) males and white (79.5%) ( Table 1) . IE patients had a higher risk of in-hospital all-cause mortality (adjusted odds ratio [95% CI]: 2.07 [1.50-2.86]), septic shock (3.73 [2.71-5.13]), acute respiratory failure (2.59 [2.19-3.06]), ischemic stroke (4.4 [3.48-5.51]), acute kidney injury (3.05 [2.61-3.57]), cardiac arrest (2.82 [1.83-4.37] and cardiogenic shock 3.70 [2.98-4.57]). All p values were <0.01. Conclusion: Patients undergoing TAVR who develop in-hospital IE had higher in-hospital complications when compared to those of patients who did not develop IE. Although the rate of in-hospital IE was low, the number of patients identified in the NIS database was sizable and the syndrome deserves investigation due to its associated complications.

Aortic valve stenosis ( AS ) is the most common acquired valve disease in developed countries. Surgical aortic valve replacement ( SAVR ) was the only effective treatment option for patients with AS until the introduction of transcatheter aortic valve replacement ( TAVR ). TAVR has become a cornerstone in the management of patients with AS, and in the last few years, the total number of annual TAVR procedures has exceeded the number of SAVR procedures in the United States. TAVR valves have undergone substantial modifications to improve their performance. As TAVR technologies continue to evolve, new devices differing in their design will become available to fit more clinical needs of patients. Although the majority of patients can be successfully treated with any one of a number of devices, currently there is no one ideal valve that can fit all patients. Therefore, a multitude of factors should be considered when selecting a TAVR device for your patient, to obtain the best results. This chapter will summarize different types of TAVR devices available or under investigation and what patient, anatomic, or device-specific factors should be considered when selecting among TAVR devices.

Background Sequential synchronized atrioventricular (AV) pacing provides enhanced electrophysiologic parameters which contribute to improved hemodynamic parameters and increased cardiac performance to subsequently confer a clinical advantage over traditional ventricular pacing. Current temporary transvenous pacemaker catheters are limited to only one electrode which paces solely the right ventricle, thus lacking the capability to provide the optimal pacing mode. A new multilead pacemaker device was developed in response to the need for improved temporary pacing through the utilization of sequential synchronized atrioventricular pacing (TAVSP). It consists of seven preformed, preshaped nitinol wires electrodes, of which four are for intra-atrial and three for intraventricular positioning and endocardial contact, respectively. Each wire carries a ball tip designed to minimize tissue trauma and provide a high current density for adequate myocardial capture. The device is not yet Food and Drug Administration approved. Objective To present the unique structural components and mechanical properties of a novel sequential synchronized AV pacing device for temporary insertion and to report its first-in-human application with an analysis of the early clinical experience. Methods Following a process of development and proof of concept of the novel pacing modality in an animal model which demonstrated feasibility and safety, a series of patients who were candidates for the device application was identified. During left and right heart catheterization, the novel temporary pacing catheter was inserted transvenously and delivered in most patients under fluoroscopy or echocardiography. The catheter was deployed to its target right heart anatomic sites and then activated in an AV sequential mode. The technical aspects, the corresponding clinical utilization, and device performance were documented and analyzed. Results The series included 10 enrolled subjects. During planned left and right heart catheterization, the novel TAVSP device was inserted transvenously and then delivered and deployed successfully in a timely fashion in all patients. The pacing catheter achieved proper threshold and impedance in all (100%) patients. The performance of all ventricular leads was adequate; however, in 1 (10%) patient poor performance of the atrial leads was detected. The device was successfully retrieved in all patients. No adverse arrhythmia, impaired hemodynamics, or clinical adverse events occurred. No technical difficulties, component failure, or wires thrombosis were detected. All patients sustained the device application without sequala and were discharged home. Conclusion Initial clinical experience with the utilization of a novel TAVSP demonstrates feasibility and safety in humans. The TAVSP modality potentially offers improved pacing capability and subsequent hemodynamic benefits over the current temporary pacing catheters. Further experience with the clinical application of this pacing catheter is warranted.

Background. Current temporary transvenous pacemaker catheters lack sequential atrioventricular (AV) pacing in synchrony. Therefore, a catheter that could provide sequential AV pacing and maintain synchrony may be useful for patients in sinus rhythm who need temporary pacing. Objective. The purpose of this study was to describe the first in human experience with a novel temporary AV sequential pacing catheter (TAVSP). Methods. We prospectively identified eligible patients undergoing elective cardiac catheterization in whom the TAVSP catheter was delivered and used for temporary AV sequential pacing. Safety endpoints and device performance data were obtained. Results. Ten subjects were screened and enrolled in the study. TAVSP was delivered in all ten subjects, and AV sequential synchronous pacing was successfully obtained. The pacing catheter achieved an excellent pacing threshold and impedance in all ten patients except for one. There were no adverse events during the pacing procedure. Conclusion. Temporary AV sequential pacing using TAVSP catheter is safe and feasible and may be an alternative to conventional temporary pacing catheters to maintain AV synchrony during temporary pacing.

Introduction: There is emerging new evidence of an association of atrial septal defects (ASD) with hypoxic conditions such as obstructive sleep apnea (OSA). In this study, we determined in-hospital outcomes of patients with OSA undergoing percutaneous ASD repair (ASDR). Methods: The National Inpatient Sample Database was queried from 2011-2019 for relevant ICD-9 and -10 procedural and diagnostic codes. Baseline characteristics and in-hospital outcomes were compared in patients with and without a history of OSA with a primary diagnosis of ASD who underwent ASDR (Surgical or percutaneous) on the index admission. Logistic-regression was performed to adjust for pre-specified co-variable for different outcomes. p-value was considered significant when <0.001. Results: We identified a weighted sample of 132,221 patients (≥18 years old) with a primary diagnosis of ASD, out of whom 10.9% (14,457) had ASDR. Of patients who underwent ASDR, 11.2% (1,615) carried a diagnosis of OSA. Baseline characteristics are shown in Table 1. There was no statistically significant difference in all-cause mortality between patients who underwent ASDR, with and without OSA (2.7% vs 2.7%). After adjusting for potential confounders, there was no statistical difference between both groups’ in-hospital outcomes such as total cost, length of stay, acute renal failure, stroke rate, vascular or pericardial complications. Conclusions: Although patients with OSA who underwent ASD repair have higher co-morbidities, they were not at higher risk for inpatient complications post-procedure and there was no difference in mortality noted. Prospective studies are needed to further investigate the effect of ASDR in OSA patients.