Torsade de pointes (TdP) or "twisting of the points" represents polymorphic ventricular tachycardia in the setting of prolonged QT interval and is characterized by QRS complexes that change in ...morphology and amplitude. We report a rare case of TdP, associated with QT interval prolongation, caused by intravenous moxifloxacin given for pneumonia in a 71-year-old African American man. Electrocardiogram initially revealed QT interval prolongation that led to torsades de pointes. These changes reverted to normal when moxifloxacin was held. Although the risk for quinolone-associated TdP seems to be low, caution is still warranted when given someone with high risk of QT prolongation.
Abstract only Introduction: Some studies suggest an increased incidence of atrial fibrillation (AF) in patients receiving corticosteroids, whereas others suggest a preventive effect of steroids. Data ...on the impact of steroids on the incidence of new-onset AF in hospitalized COVID-19 patients is lacking. Methods: This retrospective, multicenter cohort study included patients ≥ 18 years admitted to one tertiary care and five community hospitals for treatment of COVID-19 infection between 3/1/2020 and 3/31/2021. Subjects were stratified based on steroid exposure during hospitalization: group 1 (full-dose) received cumulative dosage including dexamethasone ≥ 6 mg/day, methylprednisolone ≥ 80 mg/day or hydrocortisone ≥ 50 mg/day for ≥ 3 days, group 2 (low-dose) did not receive the aforementioned dosage, and group 3 had no steroid usage. Patients with a history of AF and length of stay < 3 days were excluded. Results: Among 4578 (1556 in group 1, 1046 in group 2, 2156 in group 3) patients (mean age 65.4 ± 61 years, 50.4 % females), 542 patients developed new-onset AF. 523 (24.3%) patients in group 1, 97 (9.3%) in group 2, and 125 (8%) in group 3 died during hospitalization. In multivariable logistic regression models adjusted for hypoxia and significant baseline demographics (age, sex, body mass index, hypertension, pulmonary disease, chronic kidney disease, liver disease, and cerebrovascular accident), we found that group 1 had a higher incidence of AF compared to group 3 (adjusted relative risk aRR 1.59; 95% CI 1.27 - 1.99; p < 0.001) and group 2 (aRR 1.39; 95% CI 1.09 - 1.77; p = 0.007). The group 2 vs group 3 (aRR 1.14; 95% CI 0.87 - 1.50; p = 0.347) comparison did not reach statistical significance (Figure). Conclusions: Corticosteroids, the mainstay of treatment of hypoxic COVID-19 patients, are associated with an increased risk of developing AF. This suggests that steroids have a potential direct arrhythmogenic effect in COVID-19 patients.
Abstract only Introduction: Transcatheter aortic valve implantation (TAVI) is rarely complicated by acute circulatory collapse. Mechanical circulatory support (MCS) acts as a bridge to definitive ...intervention in these patients, however, the outcomes of MCS devices in TAVI patients are not well studied. Methods: Using the Nationwide Inpatient Sample Database from 2016 to 2018, we identified patients who underwent TAVI and required MCS using ICD-10 codes. The MCS devices included intra-aortic balloon pump (IABP) (group 1), Impella (group 2), and extracorporeal membrane oxygenation (ECMO) (group 3). Patients <18 years and those requiring more than one device use were excluded. The primary outcome was in-hospital mortality and secondary outcomes were cardiac arrest, cerebrovascular accident, myocardial infarction, and renal failure. Results: Our analysis included 148,210 TAVI patients (based on weighted sample) with 1250 requiring MCS devices (IABP N=655, Impella N=360, ECMO N=235). Patients who required Impella were older than those who required ECMO and IABP (mean age group 1 75.8 ± 11.3, group 78.3 ± 10.1, group 3). The utilization of MCS devices was not different among the gender (females 46.2%; p = 0.2376) and races (Whites 86.8%, African Americans 4.26%, Hispanics 4.96%; p = 0.5038). Incidence of in-hospital mortality was highest in ECMO (group 1 27.5%, group 2 38.9%, group 3 42.6%, p < 0.001) (Figure). The multivariate logistic regression model adjusted for MCS devices, age, race, sex, hypertension, diabetes, cardiopulmonary disease, kidney disease (CKD), liver disease, peripheral arterial disease (PAD), and arrhythmias indicated that use of any MCS device, age, female sex, congestive heart failure, CKD, liver disease, PAD, and arrhythmias were independent predictors of in-hospital mortality. Conclusions: In TAVI, the use of ECMO was associated with higher in-hospital mortality, cardiac arrest, major bleeding, and renal failure when compared to Impella and IABP.
Abstract only
Introduction:
Data on echocardiographic findings in COVID-19 patients is limited. Atrial arrhythmias (AA) are common in COVID-19 but their impact on echocardiographic phenotypes is not ...well studied. We aimed to assess transthoracic echocardiographic (TTE) findings in adult hospitalized patients with COVID-19 undergoing TTE, and compare patients with new-onset or history of AA to patients with normal sinus rhythm (NSR).
Methods:
We studied TTE findings in adult patients who were admitted to one tertiary care and five community hospitals in Michigan with PCR-proven SARS-CoV-2 infection from 3/1/2021 to 12/1/2020, and stratified them into three groups: Group 1 (NSR), group 2 (new-onset AA including atrial fibrillation and atrial flutter), and group 3 (history of AA).
Results:
Among 6927 (5522 in group 1, 626 in group 2, 779 in group 3) hospitalized patients (mean age 65.4 ± 17.1 years, 50.7 % females) 115 patients underwent TTE (Table). Group 2 and 3 patients were significantly older, more commonly males, Whites, smokers, and more frequently had diabetes mellitus, hypertension, heart failure, history of coronary artery disease, and cerebrovascular accident compared to group 1 (p≤0.05 for all). The most common TTE abnormalities were valvular abnormalities (40.9%), RV dilation (29.6% of patients), elevated PASP (16.5%), reduced LV ejection fraction (13.9%), pericardial effusion (9.6%), and LV dilation (6.1%) with no significant difference in the prevalence of these echocardiographic abnormalities between the 3 groups.
Conclusions:
TTE abnormalities are common in hospitalized COVID-19 patients with valvular abnormalities, RV dilation, and PASP elevation being the most common. Current or prior history of atrial arrhythmias did not increase the prevalence of echocardiographic abnormalities. Clinicians should have a low threshold to obtain echocardiogram in hospitalized COVID-19 patients if clinically indicated even in the absence of AA.
Abstract only Introduction: MitraClip, an efficacious strategy for patients with heart failure and severe mitral regurgitation, can be complicated by acute circulatory collapse in rare instances. ...Data on the use of mechanical circulatory support (MCS) in these patients is scarce. Methods: Using the Nationwide Inpatient Sample Database from 2016 to 2018, we identified patients who underwent MitraClip insertion and required MCS using ICD-10 codes. The MCS devices included intra-aortic balloon pump (IABP) (group 1), Impella (group 2), and extracorporeal membrane oxygenation (ECMO) (group 3). Patients <18 years and those requiring more than one device use were excluded. The primary outcome was in-hospital mortality and secondary outcomes were myocardial infarction (MI), cerebrovascular accident, sepsis, and major bleeding. Results: Our analysis included 17,070 MitraClip patients (based on weighted sample) with 360 requiring MCS devices (IABP N=270, Impella N=75, ECMO N=15). Patients who required Impella were older than those who required ECMO and IABP (mean age group 1 75.8 ± 11.3, group 2 78.3 ± 10.1, group 3 77.1 ± 8.9; p < 0.0001). The utilization of MCS devices was different among races (Whites 80.8%, African Americans 7.6%, Hispanics 6.53%; p = 0.0078) but not among gender (males 52.3%; p = 0.8467). Incidence of in-hospital mortality was highest in Impella (group 1 31.5%, group 2 46.7%, none in group 3; p < 0.001) (Figure). The multivariate logistic regression model adjusted for MCS devices, age, race, sex, hypertension, diabetes, cardiopulmonary disease, kidney disease (CKD), liver disease, peripheral arterial disease, and arrhythmias indicated that the use of IABP, Impella, CKD, and liver disease were independent predictors of in-hospital mortality. Conclusions: In MitraClip, the use of ECMO was associated with a higher incidence of major bleeding and sepsis when compared to Impella and IABP, however, Impella use was associated with higher in-hospital mortality and MI.
Patterns of care for acute myocardial infarction (AMI) strongly depend on the availability of on-site cardiac catheterization facilities. Although the management found at hospitals without on-site ...catheterization does not lead to increased mortality, little it known about its impact on resource utilization and non-fatal outcomes.
We identified all patients (n = 35,289) admitted with a first AMI in the province of Quebec between January 1, 1996 and March 31, 1999 using population-based administrative databases. Medical resource utilization and non-fatal and fatal outcomes were compared among patients admitted to hospitals with and without on-site cardiac catheterization facilities.
Cardiac catheterization and PCI were more frequently performed among patients admitted to hospitals with catheterization facilities. However, non-invasive procedures were not used more frequently at hospitals without catheterization facilities. To the contrary, echocardiography odds ratio (OR), 2.04; 95% confidence interval (CI), 1.93-2.16 and multi-gated acquisition imaging (OR, 1.24; 95% CI, 1.17-1.32) were used more frequently at hospitals with catheterization, and exercise treadmill testing (OR, 1.02; 95% CI, 0.91-1.15) and Sestamibi/Thallium imaging (OR, 0.93; 95% CI, 0.88-0.98) were used similarly at hospitals with and without catheterization. Use of anti-ischemic medications and frequency of emergency room and physician visits, were similar at both types of institutions. Readmission rates for AMI-related cardiac complications and mortality were also similar adjusted hazard ratio, recurrent AMI: 1.02, 95% CI, 0.89-1.16; congestive heart failure: 1.02; 95% CI, 0.90-1.15; unstable angina: 0.93; 95% CI, 0.85-1.02; mortality: 0.99; 95% CI, 0.93-1.05).
Although on-site availability of cardiac catheterization facilities is associated with greater use of invasive cardiac procedures, non-availability of catheterization did not translate into a higher use of non-invasive tests or have an impact on the fatal and non-fatal outcomes available for study in our administrative database.
Percutaneous treatment of patent foramen ovale with a septal closure device has become a common procedure, but it is associated with various complications. Migration of the device is uncommon, and ...migration through the aortic valve into the aorta is rare. Managing the migration of a patent foramen ovale occluder can be challenging; it usually requires surgical retrieval of the foreign body. We report a rare case in which a patient experienced migration of a large patent foramen ovale closure device to the descending aorta. Rarer still was its successful percutaneous management.
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