Ojas Bansal

Left Atrial Appendage Closure -The WATCHMAN Device.

Atrial fibrillation (AF) is one of the most common arrhythmias seen in clinical cardiology practice. Patients with non-valvular AF have an approximately 5-fold increase in the risk of stroke, with an exponential increase with advancing age. Cardioembolic strokes carry a high mortality risk. Although the potential of warfarin to reduce systemic embolization in AF patients is well established, its use is difficult due to narrow therapeutic windows and additional complications (e.g. increased risk of bleeding), especially for aging patients. Therefore, alternative means of treatment to reduce stroke risk in these patients are needed. The left atrial appendage is the major source of thrombus formation in patients with non-valvular AF. The WATCHMAN device (Boston Scientific, MA) is a percutaneous left atrial appendage closure device which has been tested prospectively in multiple randomized trials. It offers a new stroke risk reduction option for high-risk patients with non-valvular atrial fibrillation who are seeking an alternative to long-term warfarin therapy. Based on the robust WATCHMAN clinical program which consists of numerous studies, with more than 2,400 patients and nearly 6,000 patient-years of follow-up, the WATCHMAN LAAC Device is approved by FDA. In this article we reviewed the preclinical studies and clinical trials, as well as the next generation of the device.

Premature Ventricular Contraction–Induced Cardiomyopathy

Premature ventricular contractions are of common occurrence in routine clinical practice. Though generally perceived as of benign consequence in healthy people in the absence of heart disease, their presence can be a harbinger of fatal ventricular tachyarrhythmia in individuals with structural heart disease. With some of the latest insights into the treatment of ventricular tachyarrhythmia, especially with the advent of catheter ablation, there has been renewed interest in premature ventricular contractions, not only as a predictor of arrhythmia, but also for their potential etiological association with cardiomyopathy.

A rare nidus for pulmonary thromboembolism after vertebroplasty.

Percutaneous vertebroplasty is used to treat osteoporotic compression fractures and bone loss due to malignancy. The cement used can serve as a potential nidus for pulmonary thromboembolism (PTE). An 87-year-old woman with recent L2 vertebroplasty presented with abdominal pain and shortness of breath. Thoracoabdominal CT scan revealed extensive bilateral pulmonary emboli associated with a 9 cm cement fragment in the inferior vena cava (IVC) extending proximally from the level of the right superior renal vein, likely secondary to cement leak from the vertebral plexus into the IVC. She refused catheter extraction was managed conservatively. There are 51 reported cases of cement pulmonary embolism. IVC foreign bodies serving as a nidus for PTE have been reported with IVC filters with an incidence of 6.2%. This is the second reported case of vertebroplasty cement serving as a nidus for PTE. Treatment depends on time interval between the procedure and the symptom onset.

Number of shocks during elective cardioversion predicts long term recurrence of atrial fibrillation

atrial fibrillation☆ Venkata M. Alla ⁎, Swapna Kanuri , Ojas Bansal , Yeruva M. Reddy , Manu Kaushik , Dennis Esterbrooks , Aryan Mooss a a Division of Cardiology, Creighton University Medical Center, Omaha, NE, United States b Department of Internal Medicine, Creighton University Medical Center, Omaha, NE, United States c Department of Cardiology, University of Kansas Medical Center, Kansas City, United States

Efficacy of Ezetimibe and Statin Versus Statin: A Meta-Analysis of Randomized Controlled Trials

Current ACC/AHA guidelines do not make recommendation to use Ezetimibe to reduce Atherosclerotic cardiovascular disease. Most recently, the IMPROVE-IT trial demonstrated improved cardiovascular outcomes with addition of Ezetimibe to statin (ES) compared to statin alone (S). We performed a Meta-

Bronchomediastinal fistula presenting as purulent pericarditis in a healthy 32-year-old man

Acute purulent pericarditis is rarely caused by anaerobic bacteria and it is almost always a complication of another disease process. Esophagomediastinal fistula, odontogenic, or pleuropulmonary infections have been reported to be the primary source of purulent pericarditis. If not diagnosed and treated promptly, purulent pericarditis is usually a fatal disease. We describe a case of bronchomediastinal fistula as sequels from a necrotizing parenchymal infection, leading on to secondary mediastinitis and pleuropericardial involvement in an immunocompetent patient. <Learning objective: Eikenella corrodens is an important pathogen associated with a spectrum of intrathoracic suppurative infections. Purulent pericarditis can be fatal if not recognized early enough. Physicians should be aware of such a presentation.>.