Myocarditis: A Rare Complication of Immune Checkpoint Inhibitor Therapy.

Immune checkpoint inhibitors (ICIs) are a class of immunotherapy agents that are often used in cancer treatment. A rare but life-threatening complication that can be seen is ICI-induced myocarditis. We discuss a case of pembrolizumab-induced myocarditis and the nuances involved in timely diagnosis and treatment. A 64-year-old female with a past medical history significant for metastatic right-sided colorectal adenocarcinoma undergoing immunotherapy with pembrolizumab presented with worsening shortness of breath and was found to be hypoxic. Initial laboratory analysis was remarkable for troponin of 0.35 ng/mL, which later peaked at 6.01 ng/mL. The electrocardiogram showed non-specific ST segment changes in the anteroseptal leads, and a subsequent echocardiogram revealed severely reduced left ventricular systolic function with an ejection fraction of 25%. Coronary angiography showed non-obstructive coronary arteries. As the patient was on pembrolizumab immunotherapy for cancer, there was high suspicion of ICI-induced myocarditis, and the patient was started empirically on steroids. Subsequently, cardiac magnetic resonance imaging was done, which confirmed the diagnosis of myocarditis. Pembrolizumab therapy was discontinued, and she was started on guideline-directed medical therapy for heart failure. While ICIs have transformed cancer therapy, healthcare providers must be vigilant for immune-related adverse events such as myocarditis. Early recognition, prompt management, and close monitoring are crucial for optimizing patient outcomes.

Thirty-Day Readmissions After Percutaneous Left Atrial Appendage Occlusion: Insights from the Nationwide Readmissions Database.

Percutaneous left atrial appendage occlusion (LAAO) provides a nonpharmacological alternative of preventing stroke in patients with non-valvular atrial fibrillation who are poor candidates for oral anticoagulation. Data on 30 day readmission measures following LAAO is limited. Index LAAO procedures and 30 day readmissions were identified using the Nationwide Readmissions Database (NRD) from 2016 to 2018. The rates and causes of 30 day readmissions were studied. Complex samples multivariable logistic regression models were used to identify predictors of 30 day readmission. Among 29,367 patients undergoing LAAO, the rates of 30 day readmissions were 9.2%. The most common overall cause of 30 day readmission was gastrointestinal bleeding (18.5%), followed by heart failure (13.1%), and infection (7.3%). Female gender (OR1.22; 95% CI 1.08-1.38), HF (OR 1.30; 95% CI 1.15-1.47), anemia (OR 1.37; 95% CI 1.11-1.68), chronic lung disease (OR 1.42; 95% CI 1.25-1.62), End stage renal disease (OR 2.75; 95% CI 2.13-3.55), Acute kidney injury (OR 1.66; 95% CI 1.25-2.20), bleeding/transfusion (OR 1.63; 95% CI 1.28-2.09) were found to be independent predictors of 30 days Readmission. The overall rate of 30 day readmission after LAAO was 9.2% with non-cardiac causes (gastrointestinal bleeding) being the most common. Reducing in-hospital complications and identifying optimal post procedural anticoagulation/antithrombotic regimen may help decrease readmissions following LAAO.