Clinical Outcomes of Early Rhythm or Rate Control for New Onset Atrial Fibrillation Following Transcatheter Aortic Valve Replacement.

BACKGROUND: New onset atrial fibrillation (NOAF) is a common occurrence after transcatheter aortic valve replacement (TAVR) and portends a poorer prognosis. The optimal strategy for managing NOAF in this population is uncertain. METHODS: This retrospective cohort study utilized deidentified patient data from the TriNetX Research Network. Patients with TAVR and NOAF were stratified into a rhythm control cohort if they were treated with antiarrhythmics, received AF ablation, or underwent cardioversion within 1 year of AF diagnosis. A rate control cohort was similarly defined by the absence of rhythm control strategies and treatment with a beta blocker, calcium channel blocker, or digoxin. After 1:1 propensity score matching, the Kaplan-Meier survival analysis and Cox proportional hazard ratios (HRs) were used to compare outcomes at 7 years of follow-up. RESULTS: We identified 569 patients in each cohort following propensity matching. At 7 years, the primary composite outcome of all-cause death, myocardial infarction, cerebrovascular accident, and heart failure hospitalization was not significantly different between the rhythm and rate control cohorts (HR 0.99, 95% CI 0.83-1.18). The individual components of the primary outcome in addition to all-cause hospitalization were also similar between the groups. CONCLUSIONS: Similar outcomes were seen among patients receiving an early rhythm or rate control strategy to manage NOAF after TAVR. The attenuated benefits of an early rhythm control strategy observed in this setting may be due to the overall high burden of comorbidities and advanced age of these patients.

Triple-Vessel Disease in a High-Risk Surgical Patient Treated With Nine Drug-Eluting Stents.

Coronary artery disease (CAD) is a major cause of morbidity and mortality in the United States, and as strides have been made in its management, outcomes have continued to improve. Management has evolved from expectant management to coronary artery bypass graft surgery and thrombolysis, to more recently percutaneous intervention with stenting and medical management in select cases. Here, we describe a case of a complex patient with severe triple-vessel disease who was deemed a poor surgical candidate for coronary artery bypass graft surgery and would instead undergo high-risk percutaneous intervention with the placement of nine drug-eluting stents.

Extramedullary Acute Myeloid Leukemia Presenting With Pericardial Effusion and Arrhythmias.

Acute myeloid leukemia (AML) is a hematologic malignancy that, through clonal transformation, results in abnormal proliferation and accumulation of immature myeloid cells in the bone marrow and blood. It is the most common type of acute leukemia in adults; however, extramedullary relapse is rare, and clinically significant metastasis to the heart with multiple presentations is even more infrequent. We present a case of a patient with AML, who, after successful treatment and remission, was found to have extramedullary metastasis in the form of one pericardial and two intracardiac masses, as well as a large pericardial effusion and conduction abnormalities.

HIV-Positive Patient With Non-Percutaneous Coronary Intervention (PCI)-Amenable Left Coronary Artery Aneurysms Presenting With ST-Elevation Myocardial Infarction (STEMI).

Human immunodeficiency virus (HIV) was first reported in the early 1980s and a once untreatable and fatal disease has since allowed individuals to live healthy lives with the advent of novel antiviral medications. While the life expectancy of an HIV-positive individual has dramatically increased, a myriad of HIV-related complications such as pneumocystis pneumonia, candidiasis, renal disease, anxiety/depression, and cardiovascular disease have dramatically decreased. However, these patients are still prone to complex medical problems. In this case report, we aim to highlight a rare, complicated case of an HIV-positive patient with coronary artery aneurysms complicated by an ST-elevation myocardial infarction (STEMI).

An Atypical Case of Lyme Disease Presenting With Lyme Carditis.

Lyme carditis is a rare but serious manifestation of Lyme disease presenting in the early disseminated stage of the disease often after a diagnosis has already been discovered. The classic case of Lyme disease presents a patient who had been participating in outdoor activities in a Lyme-endemic region and was found to have a tick bite. These patients often present in the early localized stage, within the first 1-2 weeks with the well-recognized erythema-migrans rash or with generalized flu-like symptoms. Here we describe a case of a 70-year-old male who presented to the hospital without any typical Lyme disease prodrome but instead with generalized symptoms of progressive orthopnea and dyspnea on exertion. His original diagnoses were not of infectious origin however after incidentally being found to have a second degree, Mobitz type 1 atrioventricular (AV) block; Lyme tests were ordered, and a diagnosis was confirmed. This incidence shows the importance of having a Lyme disease diagnosis when regionally appropriate for patients who may present with no other signs or symptoms other than an AV block. As in this case, after a diagnosis has been made the management becomes the treatment of the infection rather than the treatment of the symptoms themselves.