Background: There are limited data on the impact of right heart failure (RHF) on patients undergoing transcatheter aortic valve implantation (TAVI). We investigated the mortality, in-hospital complications, length of stay, and total hospitalization charges for TAVI admissions, with and without RHF. Methods: We analyzed the National Inpatient Sample data from 2018 to 2022. The International Classification of Diseases–Tenth Revision (ICD-10) codes were used to define the patient cohorts. Propensity score weighting was used to balance patient demographic, hospital-level, and comorbidity data. Results: From 2018 to 2022, there were 383,860 TAVI admissions, among which 1915 (0.50%) had the presence of RHF. Compared to patients without RHF, mortality was higher in patients with RHF (7.57% vs. 1.11%, p < 0.01). Similarly, acute kidney injury (37.10% vs. 8.56%, p < 0.01), respiratory failure (12.79% vs. 1.91%, p < 0.01), and use of mechanical circulatory support (11.48% vs. 0.83%, p < 0.01) was higher in the cohort with RHF. Median length of stay (7 days vs. 2 days, p < 0.01) and hospitalization charges ($257,239 vs. $180,501, p < 0.01) were higher in patients with RHF. Conclusions: In conclusion, we report that RHF is associated with increased mortality risk, complications, and resource utilization in patients undergoing TAVI. Right ventricular function should be a part of the evaluation for TAVI, given significantly elevated risks associated with its presence.

Background: Myocarditis has been rarely reported following COVID‐19 vaccination, most commonly in younger males. Although a temporal association has been observed, establishing causality in individual cases remains challenging. Myocardial inflammation may involve the cardiac conduction system, rarely resulting in high‐grade atrioventricular (AV) block. Importantly, these conduction abnormalities may be transient and resolve as the underlying inflammation improves. Case Summary: We report a rare case of myocarditis following a COVID‐19 vaccination in an elderly woman who experienced complete heart block and worsening exertional dyspnea subsequent to receiving a COVID‐19 booster. Coronary angiography revealed patent coronary arteries, and magnetic resonance imaging confirmed the presence of myocarditis. Her conduction abnormality progressively resolved without the need for permanent pacing, and she was subsequently discharged in stable condition. Discussion: Myocarditis should be considered as a potentially reversible cause of high‐grade AV block. A thorough clinical history and multimodal imaging are essential for diagnosis, as early recognition and appropriate monitoring may allow recovery of AV conduction and avoid unnecessary permanent pacemaker implantation.

Although atrial fibrillation (AF) and atrial flutter (AFL) are different arrhythmias, they are assumed to confer the same risk of stroke and systemic thromboembolism (STE) despite a lack of available evidence. In this study, we investigated the difference in the risk of stroke or STE after AF and AFL hospitalizations. The National Readmission Database (NRD) 2018 was used to identify AF and AFL patients using appropriate International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes and were followed until the end of the calendar year to identify stroke or STE readmissions. Survival estimates were calculated, and a Cox proportional hazards model was used to calculate the adjusted hazards ratio (aHR) and compare the risk of stroke or STE readmissions between AF and AFL groups. A total of 215,810 AF and 15,292 AFL patients were identified. AFL patients were more likely to be younger (66 vs. 70 years), male (68% vs. 47%), and had higher prevalence of obesity (25% vs. 22%), obstructive sleep apnea (14% vs. 12%), diabetes mellitus (31% vs. 26%), and alcohol use (6.9% vs. 5.5%) (all p < 0.01). After adjusting for potential patient and hospital-level characteristics, there was a statistically significant decrease in one-year stroke or STE readmission risk in AFL patients compared to AF patients (aHR 0.79 (0.66-0.95); p = 0.01). AFL patients are commonly younger males with a higher burden of medical comorbidity. There is a decrease in the one-year risk of stroke or STE events in AFL patients compared to AF. The predictors of stroke and STE are similar in both AFL and AF groups. Further studies with longer follow-up and anticoagulation data are needed to verify the results.

Background: Leadless pacemakers offer a safe and effective alternative pacing strategy. However, limited data are available for patients with end stage renal disease (ESRD), a population of significant relevance. Methods: Using the Nationwide Readmission Database, we extracted data from all adult patients with ESRD who underwent traditional transvenous or leadless pacemaker implantation between 2016 and 2021. We compared in-hospital mortality, 30-day readmission rates, complication rates, and healthcare resource utilization between the two cohorts. Results: A total of 6384 (81.2%) patients were included in the transvenous pacemaker cohort, and 1481(18.8%) patients were included in the leadless pacemaker cohort. In patients with ESRD, leadless pacemaker implantation was linked to higher in-hospital complications when compared to transvenous pacemakers. These included the need for blood transfusion (aOR 1.85, 95% CI 1.32–2.60, p < 0.01), vascular complications (aOR 3.6, CI 1.40–9.26, p = 0.01), and cardiac complications (aOR 4.12, CI 1.70–9.98, p < 0.01). However, there were no differences between the two groups in terms of in-hospital mortality and 30-day readmission rates. The median length of stay was longer for leadless pacemaker implantation than transvenous pacemaker implantation (5 days vs. 4 days, p < 0.01). The total hospitalization charges were also higher ($139,826 vs. $93,919, p < 0.01). Conclusions: Although previous studies have demonstrated lower long-term complication rates with leadless pacemakers than transvenous pacemakers, our analysis shows a higher risk of short-term in-hospital complications in ESRD patients, though no differences in in-hospital mortality and 30-day readmissions.

Cardiac pacing has undergone a significant transformation in the last decade. Leadless pacing (LP), once only a conceptual idea stemming from the early interest in eliminating lead-related complications of transvenous pacemakers, has now become a reality in clinical practice. Since the introduction of the first human single-chamber asynchronous leadless ventricular pacing in 2012, atrioventricular-synchronized single- or dual-chamber leadless pacing systems have been approved for clinical use since 2020. Leadless cardiac resynchronization therapy (CRT) has shown optimistic results in case series and awaits its full utility in real-world clinical practice. With the successful feasibility study of leadless conduction system pacing, we are eagerly awaiting long-term safety and efficacy data on a large scale. Another important frontier is the development of self-rechargeable LP, which may be an ideal pacemaker for the future and may reduce the burden of multiple device replacements as batteries near the end-of-service. Totally extravascular percutaneous leadless pericardial micro-pacemaker system implantation is under development. In this state-of-the-art review, we examine the evolution of cardiac pacing, emphasizing the development and utility of LP to meet maximum physiological pacing needs, optimize atrioventricular synchrony and cardiac resynchronization, and broaden its indications.

Background: Pulmonary embolism (PE) is a major global health concern and the third leading cause of cardiovascular mortality in the U.S. There are various treatment options available for the treatment of intermediate-to-high risk acute PE, including catheter-based treatments, surgical embolectomy, and systemic thrombolysis. Objective: To perform a systematic review and Bayesian network meta-analysis (NMA) comparing the safety and efficacy of advanced therapies in patients with intermediate-to-high risk acute PE. Methods: We searched PubMed/Medline, Embase, and Scopus for relevant studies published until August 30, 2024, and performed a Bayesian NMA to synthesize direct and indirect evidence using the Bayesian inference Using Gibbs Sampling to conduct a Network meta-analysis package in R. Results: Of 1,586 studies, 47 met the inclusion criteria, of which 45 were non-randomized. A total of 267,695 acute intermediate-to-high risk PE patients were included in the analysis, receiving one of five advanced interventions: ultrasound-assisted thrombolysis (USAT), standard catheter-directed thrombolysis (sCDT), catheter-based embolectomy, surgical pulmonary embolectomy (SE), or systemic thrombolysis. USAT had the lowest risk of short-term (94.11), long-term mortality (94.67), major bleeding (90.38), and risk of blood transfusions (91); sCDT had the lowest risk of intracranial hemorrhage (86.2), and SE had the lowest risk of any bleeding (99.37) and gastrointestinal bleeding (87.46) based on Surface Under the Cumulative Ranking values. Conclusion: In our study, USAT offers significant short- and long-term mortality benefits with the lowest risk of major bleeding and transfusion requirements, while sCDT is ideal for patients at high-risk for intracranial hemorrhage. Relevance for patients: Among catheter-based therapies for acute intermediate-to-high-risk PE, USAT offered the best clinical and safety outcomes.