Recurrent chylothorax as a consequence of esophageal stent.

Incidence of chylothorax post-esophageal stenting has not been reported. We present a 40-year-old female with metastatic breast cancer who presented with dyspnea. She was recently hospitalized for dysphagia secondary to a mediastinal mass requiring an esophageal stent. CT chest now reported large bilateral pleural effusions. A benign chylothorax was drained from the right side. After persistent high-output drainage, a review of her CT chest revealed thoracic duct impingement by the esophageal stent. The stent was retracted proximally, and pleural fluid output subsequently decreased. Repeat fluid analysis revealed a transudative effusion. This is the first reported case of esophageal stenting causing reversible chylothorax.

Diagnostic Utility of Smartwatch Technology for Atrial Fibrillation Detection - A Systematic Analysis.

BACKGROUND: Smartphone technologies have been recently developed to assess heart rate and rhythm, but their role in accurately detecting atrial fibrillation (AF) remains unknown. OBJECTIVE: We sought to perform a meta-analysis using prospective studies comparing Smartwatch technology with current monitoring standards for AF detection (ECG, Holter, Patch Monitor, ILR). METHODS: We performed a comprehensive literature search for prospective studies comparing Smartwatch technology simultaneously with current monitoring standards (ECG, Holter, and Patch monitor) for AF detection since inception to November 25th, 2019. The outcome studied was the accuracy of AF detection. Accuracy was determined with concomitant usage of ECG monitoring, Holter monitoring, loop recorder, or patch monitoring. RESULTS: A total of 9 observational studies were included comparing smartwatch technology, 3 using single-lead ECG monitoring, and six studies using photoplethysmography with routine AF monitoring strategies. A total of 1559 patients were enrolled (mean age 63.5 years, 39.5% had an AF history). The mean monitoring time was 75.6 days. Smartwatch was non-inferior to composite ECG monitoring strategies (OR 1.06, 95% CI 0.93 - 1.21, p=0.37), composite 12 lead ECG/Holter monitoring (OR 0.90, 95% CI 0.62 - 1.30, p=0.57) and patch monitoring (OR 1.28, 95% CI 0.84 - 1.94, p=0.24) for AF detection. The sensitivity and specificity for AF detection using a smartwatch was 95% and 94%, respectively. CONCLUSIONS: Smartwatch based single-lead ECG and photoplethysmography appear to be reasonable alternatives for AF monitoring.

Cutaneous Conundrums in Cardiac Sarcoidosis: A Series on Skin Disease in Immunosuppression.

Sarcoidosis is a complex systemic condition resulting in formation of non-caseating granulomas. Infiltrative disease in cardiac sarcoidosis can have significant ramifications on mortality and is one of the few indications for systemic immunosuppressive therapy. In the patient on immunosuppressive medication, resultant sequelae such as skin and soft tissue infections are common and must be differentiated from cutaneous forms of sarcoidosis and other skin pathologies. Patients with humoral or cellular immunodeficiencies may have cutaneous lesions secondary to endemic fungi, mycobacterium, viral diseases, parasites, or encapsulated organisms. We report a rare case of cardiac sarcoidosis on immunosuppressive therapy, with a series of cutaneous sequelae due to opportunistic infection.

A Rare Case of Bronchopericardial Fistula Following Atrial Fibrillation Ablation.

Radiofrequency ablation (RFA) for atrial fibrillation (AF) has emerged as an effective and reliable treatment modality. Since its introduction in the 1990s, major and minor complications have been identified. Major complications include periprocedural death, atrioesophageal (AE) fistula, stroke, cardiac perforation and tamponade, pulmonary venous stenosis, phrenic nerve injury, retroperitoneal hematoma, and arrhythmias. Minor complications include pseudoaneurysms and arteriovenous fistulas . We report an extremely rare and life-threatening complication of bronchopericardial fistula following AF ablation resulting in respiratory complications.