Previous studies have suggested that patients admitted on the weekend may experience worse outcomes compared to weekday admissions, a phenomenon known as the “weekend effect.” Atrial fibrillation (AF) management has evolved substantially in recent years, prompting a re-evaluation of whether the weekend effect persists in this population using more recently updated national data. We conducted a retrospective review using the 2022 National Inpatient Sample (NIS), analyzing adult hospitalizations with a primary diagnosis of atrial fibrillation. Weekday admissions were compared to weekend admissions. The primary outcome was receipt of cardioversion. Secondary outcomes included mortality, length of stay (LOS), and total hospital charges. Multivariate linear and logistic regression models were used to adjust for demographic, clinical, and hospital-level confounders. Among 277,440 hospitalizations for atrial fibrillation, 61,305 (22.1

Limited data exists pertaining to the impact of pulmonary hypertension (PH) and elevated pulmonary vascular resistance (PVR) on clinical outcomes in patients undergoing transcatheter mitral valve edge to edge repair (mTEER). Identify PH patients at risk for readmission and mortality following mTEER. We included patients who underwent mTEER between January 2021 and August 2024. The primary endpoint was a composite of all-cause mortality and heart failure (HF) hospitalizations. We evaluated the impact of baseline and post-procedure PH. PH was defined as right ventricular systolic pressure (RSVP) ≥50 mmHg as measured by echocardiogram. Elevated PVR was defined as PVR >2 on right heart catheterization (RHC). A total of 158 patients with mean age of 76 and STS median score of 5.1 (IQR 1.44-9.34) were included in the analysis. Over a follow up period of 330 days (IQR 140-655), 39 patients died and 40 patients had HF hospitalizations. Mean RAP and RVSP was 8 and 50 mmHg at baseline, and 7 and 43 mmHg at discharge, respectively. Out of 77 patients with PH at baseline, 37 (48.1%) had reduction in post-procedure RVSP to <50 mmHg. Baseline PH was not significantly associated with the primary endpoint (p=0.64). However, among patients who had baseline PH, those who had residual post-procedure PH were at significantly higher risk of primary endpoint compared to those with reduced RVSP (hazard ratio: 2.55, 95% CI 1.06-6.170; log rank p=0.031). Among 27 patients with pre-procedure PH who underwent RHC, 20 patients (74.1%) had elevated PVR. There was no significant difference in the primary endpoint between patients with and without elevated PVR (log rank p=0.574). Patients with baseline PH via echocardiography who underwent mTEER had significantly higher incidence of all-cause death and heart failure hospitalizations if their PH did not improve after the procedure. However, elevated PVR was not associated with increased mortality and heart failure hospitalizations.

INTRODUCTION:Despite the growing adoption of transcatheter aortic valve replacement (TAVR), there remains a lack of clinical data evaluating procedural safety and discharge practices. AIMS:This study aims to investigate if there have been improvements in postoperative clinical outcomes following TAVR. METHODS:In this large-scale, retrospective cohort study, patients who underwent TAVR as an inpatient were identified from 2016 to 2020 using the National Readmissions Database. The primary outcome was temporal trends in the rates of discharge to home. Secondary endpoints assessed annual discharge survival rates, 30-day readmissions, length of stay, and periprocedural cardiac arrest rates. RESULTS:Over the 5-year study period, a total of 31,621 inpatient TAVR procedures were identified. Of these, 79.2 % of patients were successfully discharged home with home disposition increasing year-over-year from 74.5 % in 2016 to 85.9 % in 2020 (Odds ratio: 2.01; 95 % CI 1.62-2.48, p < 0.001). The mean annual discharge survival rate was 97.7 % which did not change significantly over the 5-year study period (p = 0.551). From 2016 to 2020, 30-day readmissions decreased from 14.0 % to 10.3 %, respectively (p = 0.028). Perioperative cardiac arrest occurred in 1.8 % (n = 579) of cases with rates remaining unchanged during the study (p = 0.674). CONCLUSION:Most TAVR patients are successfully discharged alive and home, with decreasing 30-day readmissions observed over recent years. This data suggests potential improvements in preoperative planning, procedural safety, and postoperative care. Despite perioperative cardiac arrest being associated with high mortality, it remains a relatively rare complication of TAVR.

A large proportion of patients referred for transcatheter tricuspid valve intervention (TTVI) will have the presence of a cardiac implantable electronic device (CIED). In such patients, surgical correction of tricuspid regurgitation (TR) is associated with high rates of morbidity and mortality. Transvenous lead extraction (TLE) could potentially ameliorate CIED-induced TR; however, it carries inherent risks and frequently does not result in TR improvement. As multiple TTVI devices are in trial to gain regulatory approval, understanding which therapy is most appropriate among patients with a CIED is essential. This review centers on the nonsurgical treatment, including TLE and transcatheter tricuspid valve repair and replacement options, aimed at enhancing outcomes in patients with TR who also have concurrent CIEDs.

Advancements in technology have provided a greater ability to treat cardiac conditions. Accordingly, as healthcare providers consider these options for their patients, there remains a potential risk for cross-device interactions in the event a patient requires multiple devices.

Introduction: Post-Acute Sequela of COVID-19 (PASC) occurs after recovery from the initial illness. Autonomic dysfunction (AD) may explain these findings. We have previously shown orthostatic intolerance (OI) on standard Italian protocol head-up tilt table in 23 of 24 prospectively studied subjects with PASC and no prior OI. Postural orthostatic tachycardia syndrome (POTS) was noted in 4 of the 23. POTS is associated with elevated levels of autoantibodies. There is a paucity of data evaluating autoantibody presence in subjects with PASC related POTS. Hypothesis: We hypothesized that individuals with PASC related POTS would demonstrate higher levels of certain autoantibodies than controls. Methods: We recruited healthy, COVID-19 PCR negative controls, all previously vaccinated for COVID, who were age and gender matched with the 4 previously identified PASC related POTS patients. Serum was tested for autoantibodies in both groups. Results: Mean ages for the PASC related POTS and control groups were 29 and 31 years, respectively. The PASC related POTS patients had higher levels of functional autoantibodies to several G-protein coupled receptors than controls. The median values for adrenergic A1, adrenergic B2, muscarinic M4, angiotensin 2 and endothelin receptors, comparing controls to PASC related POTS patients, were 10.4 vs 27.5, 14.9 vs 38.5, 7.8 vs 29.0, 12.2 vs 29.5 and 12.6 vs 31.7 Units/ml, respectively. The small size of the 2 groups precludes meaningful statistical testing, but the box plots in Figure 1 show consistent differences in the concentration of antibody receptors seen between the 2 groups. Conclusions: Functional autoantibodies to several G-protein coupled receptors were seen in higher amount in subjects with PASC related POTS compared to healthy controls. While this is a small, case-control study, it suggests a potential autoantibody mediated mechanism that may explain some of the AD seen in PASC patients with POTS.

Introduction: Patients with serious COVID infections frequently develop shock. Their right-sided hemodynamic profiles have not been well characterized. Methods: In a prospectively collected database including 1997 patients hospitalized for COVID pneumonia from March 2020 to March 2021, 368 had shock requiring vasopressors. 327 had echocardiography to assess ventricular function and stroke volume based on clinical indications. LVEF (LV ejection fraction) and RVFAC (RV fractional area change) were measured using Simpson’s rule, stroke volume (SV) by aortic Doppler, and RVSP (RV systolic pressure) from tricuspid regurgitation velocity; 187 had evaluable data on all parameters. Patients were divided into groups with low or preserved RVFAC ( RVFAC L or RVFAC P , cutoff CI L or CI N , cutoff 2 ). Results: Mean age: 65±12, LVEF 59.5±12.8, RVFAC 35.3±10.6, CI 2.41±0.89. Overall hospital mortality in this cohort with shock was 80%. Mean RVSP was 38.8±12.2, PEEP 11.0±3.7. 43% of patients had low RVFAC (<35%), and RVFAC correlated with other measures of RV function such as tricuspid annular peak systolic excursion (TAPSE) and lateral tricuspid annulus peak systolic velocity (S’). Higher RVSP correlated with lower CI (r=0.134, p= 0.016) but not with PEEP (r=0.03, p=0.70). Mortality did not differ significantly among groups, (p=0.19 by ANOVA) but was highest in the group with low RVFAC and low CI. ( Figure ) Conclusion: RV dysfunction is common in patients with severe COVID-19 and shock. Although RV dysfunction is probably associated with a worse prognosis, outcome in COVID may be tied to pulmonary recovery. Whether treatment targeted at RV dysfunction will improve outcome remains uncertain.

Background: Our group has characterized hemodynamic profiles of patients with COVID-19 and shock using echocardiography in the first wave of the pandemic (W1), from 3/20-8/20. A substantial proportion of patients (43%) had preserved ejection fraction (EF) but low cardiac index (CI). This report compares the distribution of patients in these hemodynamic profiles in the second wave (W2), from 9/20-3/21. Methods: In 327 patients with COVID-19 and shock requiring vasopressors who had an echocardiogram, EF was measured using Simpson’s rule and SV by Doppler. Patients were characterized by EF and CI (SV×HR/BSA) and divided into groups with normal or low values using the cutoffs: EF 45%, CI 2.2 L/min/m 2 . Results: There were 155 patients in W1 and 172 in W2. Mean age: 66.9±12.6 vs 63.9±12.9, EF 59.9±12.8 vs 56.4±9.3; CI 2.4±0.9 vs 2.7±0.9, all p=NS. Hospital mortality was 77% and 83% in W1 and W2 respectively (p=0.07).

The right ventricle is highly sensitive to afterload, and pulmonary compromise can increase pulmonary vascular resistance and lead to right ventricular dysfunction. Pulmonary hypertension can also be exacerbated by mechanical ventilation. Patients with COVID-19 pneumonia and respiratory failure, especially those ventilated with positive end-expiratory pressure, are prone to pulmonary hypertension. Understanding their right ventricular hemodynamics can have therapeutic and prognostic implications.