Background: Obesity has been associated with increased incidence and severity of various cardiovascular risk factors and increased risk for stroke. However, the evidence of its effect on outcomes in stroke victims have been equivocal. We aimed to investigate the distribution of BMI in a nation-wide cohort of individuals, admitted for a stroke, and the relationship between BMI and in-hospital mortality. Methods: Data from the U.S. National Inpatient Sample (NIS) was collected, to identify hospitalizations for stroke, between October 2015 and December 2016. The patients were sub-divided into six groups based on their BMI: underweight, normal weight, overweight, obese I, obese II and extremely obese groups. Various sociodemographic and clinical parameters were gathered, and incidence of mortality and the length of hospital stay were analyzed. Multivariable analysis was performed to identify independent predictors of in-hospital mortality. Results: A weighted total of 84,185 hospitalizations for stroke were included in the analysis. The approximate mean patients aged was 65.5 ± 31 years, the majority being female (55.3%) and white (63.1%). The overall in-hospital mortality during the study period was 3.6%. A reverse J-shaped relationship between the body mass index and in-hospital mortality was documented, while patients with elevated BMI showed significantly lower in-hospital mortality compared to the underweight and normal weight study participants, 2.8% vs. 7.4%, respectively, p < 0.001. Age and several comorbidities, as well as the Deyo Comorbidity Index, were found to predict mortality in a multivariable analysis. Conclusion: A reverse J-shaped relationship between body mass index and in-hospital mortality was documented in patients admitted for a stroke in the U.S. during the study period. The above findings support the existence of an “obesity paradox” in patients hospitalized following a stroke, similar to that described in other cardiovascular conditions.

Sport activity compared to sedentary life is associated with improved wellbeing and risk reduction in many different health conditions including atrial fibrillation (AF). Vigorous physical activity is associated with increased AF risk. We describe four individuals, who regularly perform endurance sport activity and developed AF. We discuss the changes occurring in the heart of endurance athletes and the possible etiology for AF, as well as currently available treatment options in this seemingly healthy population. Although the etiology of AF in the general population differs from the one in the usually younger endurance sport activity population, the treatment options are similar. There are several factors unique to those involved in vigorous physical activity that can influence their management. Despite a lack of evidence, endurance athletes with AF have traditionally been advised to “de‐training,” to reduce both the amount and intensity of exercise. Some of the current offered treatment options (beta‐blockers, class III antiarrhythmic) have a varied range of adverse effect, hindering them unattractive for these individuals. Depending on risk stratification tools, anticoagulation may be indicated. Some suggest an intermittent dosing therapy, while others recommend following current guidelines. AF ablation is recommended in exercising individuals with recurrent, symptomatic AF and/or in those who do not want drug therapy, given its impact on athletic performance, AF treatment decisions should be individualized for those engaging vigorous physical activity, while considering the potential risks, the urgency of returning to training, and the will and expectations of the patient.

Background: Atrial fibrillation (AF) catheter ablation in cancer patients has been evaluated in very few studies. We aimed to investigate utilization trends and in-hospital outcomes of AF catheter ablation among cancer patients in a large US inpatient registry. Methods: Utilizing the National Inpatient Sample (NIS) database, patients who underwent AF catheter ablation between 2012 and 2019 were identified. Sociodemographic, clinical data, in-hospital procedures and outcomes were collected. Baseline characteristics and in-hospital outcomes were compared between patients with and without cancer. Results: An estimated total of 67,915 patients underwent AF catheter ablation between 2012 and 2019 in the US. Of them, 950 (1.4%) had a cancer diagnosis. Patients with a cancer diagnosis were older and had higher Charlson Comorbidity Index, CHA2DS2-VASc and ATRIA bleeding indices scores. A higher rate of total complications was observed in cancer patients (10.5% vs. 7.9, p < 0.001), driven mainly by more bleeding and infectious complications. However, no significant differences in cardiac or neurological complications as well as in-hospital mortality rates were observed and were relatively low in both groups. Conclusions: AF catheter ablation in cancer patients is associated with higher bleeding and infectious complication rates, but not with increased cardiac complications or in-hospital mortality in a US nationwide, all-comer registry.

Background: Atrial fibrillation (AF) is frequently observed in cancer patients, driven by mutual comorbidities and increasing the risk of thromboembolic events. Impediments can hinder the utilization of anticoagulants among patients with malignancy—drug interactions with chemotherapy, renal dysfunction, drug intolerance, and increased bleeding risk. Left atrial appendage occlusion (LAAO) is an effective and safe non-pharmacological approach to prevent thromboembolic complications when anticoagulants are not suitable. Cancer patients were generally excluded from the original LAAO trials, and current safety and efficacy in cancer patients remain uncertain. Methods: This retrospective study utilized the National Inpatient Sample (NIS) database to analyze in-hospital outcomes of LAAO in US patients with and without cancer between 2016 and 2019. Patient demographics, comorbidities, procedures, and in-hospital outcomes were extracted using ICD-10-CM codes. Results: Among 12,273 hospitalizations for LAAO across the US representing an estimated 61,365 LAAO procedures, 2.2% (1365 cases) were performed in cancer patients. Older age, male gender, chronic kidney disease, prior stroke, and anemia were more prevalent in the cancer group, with 785 (58%) having a solid malignancy and 580 (42%) having a hematologic malignancy. Compared to non-cancer patients, cancer patients exhibited a higher rate of in-hospital complications (8.8% vs. 5.7%; p < 0.001), primarily driven by acute kidney injury (4.4% vs. 2.4%; p = 0.002), acute heart failure (3.7% vs. 2.6%; p = 0.012), and cardiac tamponade (1.5% vs. 0.8%; p = 0.006). No significant differences were observed in vascular complications, periprocedural stroke, or in-hospital mortality. Average length of stay (LOS) was longer in cancer patients (1.4 ± 2.7 days vs. 1.8 ± 2.5 days; p < 0.001). Conclusions: This nationwide study found that cancer patients undergoing LAAO had an increased rate of in-hospital complications, particularly acute kidney injury, heart failure, and tamponade, but no increase in in-hospital mortality was observed. Further research is needed to evaluate the long-term safety and efficacy of LAAO for managing embolic prevention in this complex patient population.