Introduction: Atrial fibrillation (AF) after cardiac surgery occurs in 20%–40% of cases and is associated with significant morbidity. Studies have shown an association with immediate postoperative AF (POAF) and recurrent AF; however, to our knowledge, no trials have used continuous electrogram monitoring data from cardiac devices (pacemakers or defibrillators) to assess the rate of long-term AF recurrence.Methods: Using institutional databases, we identified patients with a cardiac device who underwent coronary artery bypass grafting (CABG) and/or a procedure on their aortic valve (AV) or mitral valve (MV) between January 2011 and March 2020. POAF and comorbidities were assessed using the electronic patient record, and recurrent device-detected AF was defined as any episode of AF lasting >6 min on device check between 6 weeks and 18 months postoperatively.Results: POAF was associated with recurrent device-detected AF (n = 85, odds ratio 3.26, 95% confidence interval 1.19–8.97, p = 0.02). Age was an independent risk factor for developing POAF (n = 302, p = 0.033), and MV surgery had a higher rate of POAF than CABG alone (54% vs. 32%, p = 0.047) and AV surgery (54% vs. 34%, p = 0.048). Forty-four per cent of patients developing POAF were discharged on oral anticoagulation (OAC).Discussion: Postoperative is associated with a threefold greater odds of developing recurrent device-detected AF: it is not a simple transient phenomenon. Larger prospective studies are required to identify which patients would benefit from heart rhythm surveillance and whether OAC is an effective treatment in this patient group.

Introduction: Plerixafor, a novel CXCR4 pathway antagonist, is used to mobilise CD34-positive stem cells for autologous stem cell transplantation to treat haematological malignancy. Data regarding the rates of failure to mobilise and frequency of use of Plerixafor vary widely. Methods: This retrospective study reviewed 203 consecutive patients with myeloma (n = 122) or lymphoma (n = 81) undergoing peripheral blood stem cell mobilisation between 1/1/2016 and 5/8/2019 at a New Zealand hospital using data from an institution transplant database and the electronic medical record. Patients with myeloma were mobilised using cyclophosphamide and G-CSF after induction chemotherapy with cyclophosphamide, bortezomib and dexamethasone. Patients with lymphoma were mobilised with G-CSF after induction or salvage chemotherapy according to disease type. Patients failing to mobilise sufficient stem cells either received “pre-emptive” Plerixafor added to G-CSF +/- chemotherapy during the 1st attempt or were re-mobilised after a 4-week break with Plerixafor and G-CSF alone. Results: The success rate of mobilisation for lymphoma and myeloma patients at first attempt was 79% and 87% respectively. Plerixafor allowed successful harvest for 5 of 7 lymphoma patients and 8 of 9 myeloma patients who failed to harvest at first attempt, resulting in 88% and 94% of all patients having a successful harvest on either first or second attempt, respectively. Age greater than 60 years was a risk factor for failed mobilisation in lymphoma patients. Conclusion: This study shows that an approach using pre-emptive and rescue Plerixafor is effective and allows haematopoietic stem cell mobilisation for ≥88% of patients. Further research is required to establish the optimal strategy for its use.

Cardiovascular computed tomography (CT) enables a non-invasive assessment of a multitude of cardiac ailments notably coronary, structural and congenital heart diseases, as well as valvular disorders and cardiomyopathies. Technological advancement, including machine learning and generative artificial intelligence (AI), has revolutionized the application of cardiac CT not only as a diagnostic tool but also to guide interventions. CT-derived fractional flow reserve (FFRCT) enhanced the diagnostic accuracy of CT coronary angiography (CTCA) to detect obstructive coronary artery disease (CAD), determine plaque extension, volume and composition, quantify risk of Major Adverse Cardiovascular Events (MACE) and plan percutaneous coronary interventions (PCI) or Coronary Artery Bypass Grafting (CABG). Additionally, CTCA can provide scoring tools to improve procedural success, and minimize complications of complex coronary interventions, such as chronic total occlusion (CTO) interventions. Moreover, cardiac CT aids in pre-procedural planning and assessment of interventions like transcatheter aortic valve implantation (TAVI) and left atrial appendage occlusion (LAAO). Its ability to provide comprehensive anatomical and functional information makes it indispensable in guiding complex structural interventions and ensuring optimal patient outcomes. This review explores the evolving role of cardiac CT in coronary and structural heart disease interventions, highlighting its technological advancements, clinical applications, and future directions in cardiovascular care.