Extracorporeal membrane oxygenation (ECMO) is a form of circulatory support used in patients with refractory cardiac and/or respiratory failure. The main role of such support is to allow the lungs and heart to rest and heal while providing adequate oxygenation to vital organs. During extracorporeal support, the venous blood removed is decarboxylated, oxygenated, warmed, and infused back into the circulation. Physicians and nursing staff should be familiar with ECMO in order to provide the best care for critically ill patients. The aim of this paper is to review the technical aspects, indications, contraindications, complications, and management of both veno-venous (VV) and veno-arterial (VA) ECMO.

Background: The impact of body mass index (BMI) on clinical outcomes after cardiac surgery remains controversial. The objective of this study was to evaluate the association between BMI and the duration of hospital stay in patients after cardiac surgery. Method: A retrospective, cross-sectional study was conducted with 1120 patients admitted to Beirut Cardiac Institute for cardiac surgery between July 2020 and July 2022. Patients were divided based on the BMI groups as follows: normal weight, overweight, obesity class I, obesity class II, and obesity class III. The length of hospital stay after cardiac surgery was compared among BMI groups after cardiac surgery, and also among each type of surgery. Results: Of the 1120 patients who underwent cardiac surgery, 270 (24.1%) patients had normal BMI, 459 (41.0%) patients were overweight, and 391 (34.9%) patients were obese. The average length of hospital stay was 8.97 ± 5.88 days, with no correlation between BMI and length of hospital stay (r = 0.058; P = 0.052). Obesity class III patients experienced the longest stay (11.37 ± 7.09 days) with a significant difference compared to the length of hospital stay of normal weight patients (P = 0.007). Patients who underwent coronary artery bypass graft (CABG) surgery experienced the shortest duration of stay (8.50 ± 4.81 days) compared to the isolated valve surgery (9.46 ± 8.12 days) and combined CABG and valve surgery (10.52 ± 4.56 days; P ≤ 0.001). Within the CABG group, obesity class III patients had experienced the longest length of hospital stay (13.05 ± 8.85 days) with a significant difference compared to the length of hospital stay in normal weight patients (7.93 ± 3.11 days; P = 0.004). Conclusion: Our results demonstrated no correlation between BMI and length of hospital stay after cardiac surgery. However, the obesity class III patients within the CABG group had the longest length of hospital stay. These findings highlight the importance of shifting the focus of healthcare planning to obesity class III, particularly in the context of specific surgical procedures.

Arrhythmogenic right ventricular dysplasia (ARVD) and Brugada syndrome( BS) are associated with an increased risk of sudden cardiac death. Although they are described as two different entities, research suggests that they are not entirely separate. This paper presents a 55 years old male who presented for syncope. Interestingly, his electrocardiogram met the diagnostic criteria for both ARVD and BS. Subsequently, an implantable cardioverter-defibrillator (ICD) was implanted before discharge due to his high risk of sudden cardiac death. This case revealed that ARVD and BS clinical features can coexist in a single patient, and therefore supports the existence of a common pathophysiological basis of both diseases.

Accessory pathways (APs) are muscular bundles capable of rapid conduction between atria and ventricles. They can be located anywhere along the atrioventricular groove or septum. The etiology of such pathways is generally unknown. This study aims to evaluate the correlation between gender, AP location, and clinical presentation. This is a retrospective study of 139 patients who underwent radiofrequency ablations for newly diagnosed accessory pathways between years 2010 and 2016. Information extracted from the medical records included: age at the time of diagnosis, gender, characteristics, and anatomical location of the accessory pathways. A total of 139 patients with AP were enrolled in the study. The mean age of diagnosis was 32.2 ± 13.5 years. With regards to gender, APs were more common among men (p-value 0.04). Males were predominant in both the right and left AP groups (p-value 0.025), although, overall, most of the AP were left located. Also, males were more commonly diagnosed with right posteroseptal (RPS) accessory pathways while females with left lateral (LL) pathways. Concerning the clinical presentation, the manifest form was more frequent than concealed. Males were prevalent in both groups (p-value 0.38). Gender components might have a role in the pathogenesis of AP formation.

Objective: This study examined the clinical characteristics, management strategies, and outcomes of heart failure (HF) patients in the Lebanese population to address knowledge gaps regarding comorbidities, adherence to guideline-directed medical therapy, and mortality. Methods: The study included 835 patients aged 18 years or older who were hospitalized for HF at a tertiary center between January 2020 and December 2023. Data encompassed demographics, medical history, treatments, and all-cause mortality. Results: The median age was 70.0 years (IQR: 62.0–79.0), with males comprising 60.8%. The most common comorbidities were hypertension (84.2%), coronary artery disease (74.6%), diabetes mellitus (55.2%), and atrial fibrillation (33.4%). Males had more ICD (17.1% vs. 8.6%, p < 0.001) and CRT-D implants (8.9% vs. 3.7%, p = 0.004), and higher coronary artery disease frequency (78.3% vs. 68.8%; p = 0.002), whereas females had higher rates of atrial fibrillation (39.4% vs. 29.5%; p = 0.003). HF patients with reduced ejection fraction were the most common (56.4%), followed by HF with preserved ejection fraction (30.1%). HF with preserved ejection fraction had the highest rates of hypertension (89.6%) and atrial fibrillation (39.4%). Utilization of ARNI (β = −0.423, HR = 0.655, p = 0.041, 95% CI: 0.437–0.983) and SGLT2i (β = −0.432, HR = 0.649, p = 0.035, 95% CI: 0.435–0.969) were linked to 34.5% and 35.1% reductions in mortality risk, respectively. Conclusions: These results highlight the substantial burden of HF in Lebanon. Distinct demographic and clinical patterns were identified by gender and left ventricular ejection fraction groups. The findings underscore the need for population-specific screening, management strategies, and targeted interventions to improve HF outcomes.

EnSite Precision technology (Abbott, Chicago, Illinois) is a novel mapping and navigation system facilitating the visualization and manipulation of intracardiac catheters during arrhythmia ablation procedures. When using Sensor Enabled (SE) catheters (Abbott, Chicago, Illinois), the mapping system uses both electrical impedance and magnetic data to facilitate more accurate mapping and navigation. Whether this translates into better clinical outcomes is unknown. This retrospective study will examine whether SE catheters improve the success rate or decrease the risks compared to Biosense Thermocool catheters (Biosense Webster Inc., Irvine, California) not employing sensor-enabled technology utilizing NavX EnSite Precision algorithms. Charts of 146 patients who underwent radiofrequency ablations for supraventricular and ventricular arrhythmias between 2016 and 2019 in the Beirut Cardiac Institute were reviewed and analyzed. It was concluded that SE catheters have the same success rate as electrical impedance catheters. A total of 70% of the ablations carried using the impedance-based catheter were successful compared to 74% using the SE catheter. However, the difference was statistically non-significant (p-value: 0.7). As for complications, the ventricular fibrillation rate was increased in the SE catheter group. Three procedures were complicated by pericardial effusion, three patients had reversible heart block, and one death was recorded, all reported while using the standard catheter (p-value: 0.01). SE catheters have the same success rates compared to standard catheters using the EnSite Precision mapping system.