Atrial Fibrillation Complicating Acute Myocardial Infarction: Prevalence, Impact, and Management Considerations.

PURPOSE OF REVIEW: Atrial fibrillation (AF) and myocardial infarction (MI) often coexist, and this overlapping nature leads to heightened morbidity and increases the need for comprehensive risk management strategies. The precise trajectory and implications of atrial fibrillation complicating myocardial infarction remain subjects of debate, with divergent reports presenting varying accounts. This review seeks to provide an in-depth exploration of the existing literature to cover the predictors, implication, and available management of new onset atrial fibrillation (NOAF) complicating acute myocardial infarction (AMI). RECENT FINDINGS: Clinical risk factors, laboratory markers, echocardiographic findings, and angiographic data can be used to assess patients at risk of developing NOAF post-AMI. The diagnosis of NOAF post MI has been associated with overall worse short- and long-term prognosis with increased risk for mortality, cardiogenic shock, stroke, and bleeding, along with reduced rates of coronary angiography and percutaneous coronary intervention, and higher risk of future recurrence of AF and ischemic stroke. Despite the paucity of preventative treatment, the optimal management of acute coronary syndrome and the use of guideline directed therapy do decrease the risk of development of atrial fibrillation post myocardial infarction.

Cardiac Contractility Modulation in Patients with Advanced Heart Failure: A Comprehensive Review of Literature.

Heart failure is a significant cause of morbidity and mortality worldwide. Despite advancements in guideline-directed medical therapy and improvements in device-based therapies, patients with advanced heart failure have high rates of mortality regardless of ejection fraction. For patients with reduced ejection fraction who meet criteria, cardiac resynchronization therapy or implantable cardiac defibrillators are options available to improve outcomes. However, not all heart failure patients meet those criteria. Cardiac contractility modulation is an innovative therapy that serves to improve functional outcomes and quality of life, while also modifying pathologic gene expression and preventing further remodeling. In this article, we aim to discuss the major clinical trials investigating cardiac contractility modulation as a suitable therapy for patients with advanced heart failure.

Syncope With Sinus Arrest Following a Single Dose of a COVID-19 Vaccine.

Vaccines against the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) are of paramount importance in combating the current coronavirus disease 2019 (COVID-19) pandemic. Syncopal episodes following routine vaccinations are well-reported; however, only a few cases of syncope following SARS-CoV-2 vaccines exist in the literature. This is a case report of a 21-year-old female patient who developed recurrent syncopal attacks over three months that started one day after receiving the first dose of the Pfizer-BioNTech COVID-19 vaccine (Pfizer, New York City; BioNTech, Mainz, Germany). Holter monitoring during successive episodes showed progressive bradycardia followed by a prolonged sinus arrest. The patient eventually required pacemaker placement that resulted in the total resolution of her symptoms. Further studies are required to investigate a possible correlation and the mechanisms involved.

Stellate ganglion blockade for treating refractory electrical storm: a historical cohort study.

BACKGROUND: Stellate ganglion blockade (SGB) has been used to treat electrical storm (ES) refractory to antiarrhythmic therapy or to stabilize patients before more definitive intervention. Nevertheless, its efficacy is not well understood, with only a few case reports and retrospective case series in the literature. METHODS: We conducted a historical cohort study on patients with drug-refractory ES who underwent ultrasound-guided unilateral SGB from 1 January 2010 until 19 July 2019 at two hospital sites. Stellate ganglion blockade was performed with variable combinations of bupivacaine, lidocaine, ropivacaine, and dexamethasone. We collected data on demographic and procedural characteristics, the number of arrhythmias and defibrillation episodes, antiarrhythmic and anticoagulant medication, left ventricular ejection fraction (EF), and respiratory support requirement. RESULTS: We identified N = 13 patients; their mean (standard deviation [SD]) age was 64 (13) yr, and 10 (77%) were male. The baseline mean (SD) number of overall arrhythmia and defibrillation episodes per day were 9 (6) and 4 (3), respectively; the mean (SD) pre-SGB EF was 23 (7)%. Seven patients (54%) received dexamethasone in addition to local anesthetic for SGB. One patient experienced hypotension after SGB. Arrhythmias and defibrillation episodes significantly decreased at 24, 48, 72, and 96 hr after SGB; at 96 hr, 62% and 92% of patients had no VA and defibrillation episodes, respectively (P < 0.001 for all time points). Ejection fraction and the number of patients receiving antiarrhythmic medications or requiring respiratory support were unchanged. CONCLUSIONS: Unilateral SGB was associated with a reduction in arrhythmias and defibrillation episodes, but did not affect antiarrhythmic medication, respiratory support, or EF. Randomized controlled trials on larger cohorts are needed to confirm these findings.

RéSUMé: CONTEXTE: Le bloc du ganglion stellaire (BGS) a été employé pour traiter les tempêtes électriques réfractaires à la thérapie antiarythmique ou pour stabiliser les patients avant une intervention plus définitive. Néanmoins, son efficacité n'est pas bien comprise, et il n'existe que quelques présentations de cas et séries de cas rétrospectives dans la littérature. MéTHODE: Nous avons mené une étude de cohorte historique auprès de patients souffrant de tempêtes électriques réfractaires aux médicaments qui ont subi un BGS unilatéral échoguidé entre le 1er janvier 2010 et le 19 juillet 2019 dans deux sites hospitaliers. Le bloc du ganglion stellaire a été réalisé à l'aide de combinaisons variables de bupivacaïne, de lidocaïne, de ropivacaïne et de dexaméthasone. Nous avons colligé les données touchant aux caractéristiques démographiques et procédurales, au nombre d'arythmies et d'épisodes de défibrillation, aux traitements antiarythmique et anticoagulant, à la fraction d'éjection (FE) ventriculaire gauche, et au besoin d'assistance respiratoire. RéSULTATS: Nous avons identifié N = 13 patients; leur âge moyen (écart type [ÉT]) était de 64 (13) ans, et 10 (77 %) patients étaient des hommes. Globalement, le nombre moyen (ÉT) d'épisodes d'arythmie et de défibrillation de base par jour était de 9 (6) et 4 (3), respectivement; la FE moyenne (ÉT) pré-BGS était de 23 (7) %. Sept patients (54 %) ont reçu de la dexaméthasone en plus de l'anesthésique local pour le BGS. Un patient a souffert d'hypotension après le BGS. Les arythmies et les épisodes de défibrillation ont diminué de manière significative à 24, 48, 72, et 96 heures après le BGS; à 96 heures, 62 % et 92 % des patients ne subissaient plus aucun épisode d'arythmie ventriculaire et de défibrillation, respectivement (P < 0,001 pour tous les temps). La fraction d'éjection et le nombre de patients recevant des médicaments antiarythmiques ou nécessitant une assistance respiratoire sont demeurés inchangés. CONCLUSION: Un BGS unilatéral a été associé à une réduction des épisodes d'arythmies et de défibrillation, mais n'a pas eu d'impact sur le traitement antiarythmique, l'assistance respiratoire, ou la FE. Des études randomisées contrôlées réalisées avec des cohortes plus importantes sont nécessaires pour confirmer ces résultats.