Early Ventricular Arrhythmias After Left Ventricular Assist Device Implantation.

BACKGROUND: Although sustained ventricular arrhythmias (VAs) are a common complication after durable left ventricular assist device (LVAD) implantation, the incidence, risk factors, and prognostic implications of postoperative early VAs (EVAs) in contemporary patients with LVAD are poorly understood. METHODS AND RESULTS: A single-center retrospective analysis was performed of patients who underwent LVAD implantation from October 1, 2006, to October 1, 2022. EVA was defined as an episode of sustained VA identified ≤30 days after LVAD implantation. A total of 789 patients underwent LVAD implantation (mean age 62.9 ± 0. years 5, HeartMate 3 41.4%, destination therapy 43.3%). EVAs occurred in 100 patients (12.7%). A history of end-stage renal disease (odds ratio [OR] 5.6, 95% confidence interval [CI] 1.45-21.70), preoperative electrical storm (OR 2.82, 95% CI 1.11-7.16), and appropriate implantable cardiac defibrillator therapy before implantation (OR 2.8, 95% CI 1.26-6.19) are independently associated with EVAs. EVA was associated with decreased 30-day survival (hazard ratio 3.02, 95% CI 1.1-8.3, P = .032). There was no difference in transplant-free survival time between patients with and without EVAs (hazard ratio 0.82, 95% CI 0.5-1.4, P = .454). CONCLUSIONS: EVAs are common after durable LVAD implantation and are associated with an increased risk of 30-day mortality.

Adult Tourniquet for Use in School-Age Emergencies.

BACKGROUND: Gunshot injuries are a leading cause of morbidity and mortality in the pediatric population. The Pediatric Trauma Society supports the use of tourniquets for exsanguinating hemorrhage in severe extremity trauma. The Combat Application Tourniquet (CAT) used with success in adults has not been prospectively tested in children. Our objective with this study was to determine if the CAT is successful in arresting extremity arterial blood flow in school-aged children. METHODS: Sixty school-aged volunteers (ages 6-16 years) recruited by age cohort had the CAT applied to an upper arm and thigh while peripheral pulse was monitored by Doppler. The number of windlass turns (maximum allowed: 3 [1080°]) required to arrest arterial pulse was recorded. Success was analyzed by BMI percentile for age and extremity circumference. RESULTS: The CAT was successful in occluding arterial blood flow as detected by Doppler pulse in all 60 (100%) of the upper extremities tested. In the lower extremity, 56 (93%) had successful occlusion. The 3-turn maximum allowed by the protocol was not adequate in some obese, older subjects (BMI >30). In both the upper and lower extremity, the number of turns required to occlude blood flow gradually increased with an increase in arm and thigh circumference. CONCLUSIONS: Prospective testing of a cohort of school-aged children 6 to 16 years revealed the CAT tourniquet to be suitable for use in both the upper and lower extremity.

Advanced Strategies in the Diagnosis and Treatment of Patients with Coronary Artery Disease and Heart Failure: When Heart Failure Causes Ischemia and Angiotensin Converting Enzyme Inhibitor and Betablockers Helps in Diuresis.

In the diagnosis and management of patients with Coronary Artery Disease (CAD) and chronic Left Ventricular (LV) dysfunction or Heart Failure (HF), there are many uncertainties because of the non-specificity of the symptoms and signs of HF. Usually, severe CAD causes LV dysfunction. However, not rarely, LV dysfunction is the cause or aggravation of ischemia to many subsets of patients with or without CAD. In this article, the care of patients with CAD with LV dysfunction, along with the challenges of diagnosing asymptomatic HF and the criteria for monitoring success are presented. Then the evidence of LV dysfunction triggering or aggravating ischemia is discussed. The newest methodology of assessing the venous blood volume which causes the main presentations of HF when its filling capacity is exceeded will also be presented in details. In summary, the effects of fluid mobilization by conventional medications for CAD (e.g Angiotensin Converting Enzyme Inhibitors (ACEI) or Beta-blockers (BB) and their therapeutic mechanisms are discussed. The goal of this review is to present the cardiologist consultants strong scientific evidence of detrimental interaction between CAD and LV dysfunction and the therapeutic action of ACEI and BB in the mobilization of venous fluid. As a result, the management of patients with CAD and HF could be exercised on an advanced level of expertise.