Postoperative atrial fibrillation (POAF) is a common complication following coronary artery bypass grafting (CABG), associated with increased morbidity and health care costs. This study examines the incidence and impact of POAF on outcomes in CABG patients at a single institution. This retrospective observational study included patients undergoing isolated CABG between 2006 and 2022, excluding those with preoperative atrial fibrillation. Data include demographics, length of stay (LOS), mortality, and complications (Bleeding, stroke, and infection rates), comparing outcomes in patients with and without POAF. Among 2,671 patients, 238 (8.9%) developed POAF. POAF patients had higher rates of infection (7.56 vs. 5.75%), postoperative bleeding (5.04 vs. 2.84%), and stroke (5.46 vs. 2.01%). Thirty-day, 2-year, and 5-year mortality rates were 1.3, 7.8, and 24%, respectively. Intensive care unit (ICU) and hospital LOS were also prolonged in POAF patients as well. A total of 63.6 and 8.44% of POAF patients were discharged within 5 days from the hospital and ICU, respectively. Compared with 73.1 and 15.8% of non-POAF patients experienced no complications. POAF significantly impacts CABG patient outcomes, increasing morbidity, mortality, and resource utilization. Monitoring and early intervention are essential to mitigate these effects.

Superior vena cava (SVC) syndrome is commonly caused by malignancies from lung cancers, thrombus, and indwelling intravascular devices. Specifically, SVC syndrome is mostly associated with malignancies such as small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). Pulmonary sarcomatoid carcinoma (PSC), as a rare type of NSCLC, accounts for 0.1% to 0.4% of pulmonary tumors. PSC's rapid progression, aggressive growth, and complexity to diagnose help differentiate from other thoracic malignancies, yet due to its rarity, there is limited literature documenting an association between this entity and SVC syndrome. Here we present an atypical case of SVC syndrome with a history of tobacco use and chronic right upper extremity lymphedema who developed facial swelling, dyspnea, and worsening right upper extremity swelling. Imaging revealed a large mediastinal mass compressing both the SVC and pulmonary artery. Further workup and endobronchial ultrasound (EBUS) were performed, which led to a diagnosis of poorly differentiated sarcomatoid carcinoma. Additionally, pericardiocentesis revealed features consistent with adenocarcinoma. The case was further complicated with hypoxic respiratory failure and new-onset atrial fibrillation. With extensive intensive care unit (ICU) care, the patient was discharged with a medication regiment, and referred to oncology, cardiology, and palliative care. Patient declined chemotherapy and immunotherapy, opting for hospice care. Patient stay was complicated by hypoxia respiratory failure, pleural effusions, pericardial effusion, and atrial fibrillation with rapid ventricular response (RVR). This case emphasizes that SVC syndrome can be associated with poorly differentiated sarcomatoid carcinoma.

Multi-valvular involvement represents the most severe form of rheumatic heart disease (RHD), presenting complex clinical challenges requiring a comprehensive understanding for optimal patient management. In resource-limited settings, late presentation and inadequate secondary prophylaxis result in advanced disease with high complication burdens.

The safety and efficacy of pulsed field ablation (PFA) for cardiac ablation have been demonstrated in pulmonary vein (PV) isolation (PVI), but its relevance to target additional extra-PV substrate is still under investigation. We conducted a pilot, prospective, single-center, nonrandomized study in 25 patients with atrial fibrillation despite previous catheter ablation (52% men; 74 ± 9 years of age). Patients underwent catheter ablation using PFA with the goal of ablating artificial intelligence (AI)-guided spatiotemporal dispersion. Biatrial mapping of spatiotemporal dispersion was obtained using the Volta AF-Xplorer™ (Volta Medical, Providence, RI, USA). Re-conducting PVs and extra-PV regions of interest exhibiting dispersion were ablated using the Farawave™ catheter (Boston Scientific, Marlborough, MA, USA). This catheter was used either in the basket or flower configuration sequentially centered at an estimated geometric center of AI-detected dispersion regions. The mean procedure and biatrial mapping times were 75 ± 12 and 14 ± 7 min, respectively, and no fluoroscopy was used. No complications occurred, and sinus rhythm conversion by ablation was obtained in 23 patients (92%). The rate of freedom from any atrial arrhythmia at 6 months was 88%. In conclusion, we observed that PFA for personalized, AI-guided extra-PV dispersion repeat ablation appears safe and procedurally efficient.

This report describes a 57-year-old male patient with metastatic breast cancer who experienced atrial fibrillation during the infusion of utidelone as palliative chemotherapy. All cardiological examinations conducted before treatment were normal. There was no evidence of thyroid dysfunction, nor any objective data indicating acute or chronic cardiovascular disease. Other combination drugs have been used in clinical practice for decades and rarely have proarrhythmic activity. The innovative drug utidelone, independently developed in China, was approved by the National Medical Products Administration (NMPA) of China in 2021 for the treatment of patients with metastatic breast cancer. Cardiotoxicity has not been prominently reported in prior clinical trials of utidelone. Although a definite causal relationship cannot be confirmed, the close temporal association and clinical course suggest that utidelone may have contributed to the arrhythmias. This case highlights the need for careful cardiac monitoring during treatment.

The prediction of atrial fibrillation in high-risk populations is an important research area of modern atrial fibrillation care. One such population is the embolic stroke of undetermined source population, where appropriate anticoagulation might help reduce the annual stroke recurrence risk by 5%. In this study, individuals were categorized according to their tertile of left atrioventricular coupling index, a composite echocardiographic parameter that reflects both left atrial and ventricular size. Its association with the detection of an implantable loop recorder and subclinical atrial fibrillation was investigated. A retrospective single-centre cohort study was performed. A total of 296 embolic stroke of undetermined source patients, referred for an implantable loop recorder, who also underwent echocardiography, were screened. Of these, 230 cases had echocardiograms of sufficient quality to measure the left atrioventricular coupling index. Patients were categorized according to their left atrioventricular coupling index tertile, with tertile 1 being less than 16.97, tertile 2 being 16.97-23.9, and tertile 3 being greater than 23.9. Patients in the third left atrioventricular coupling tertile were more likely to develop atrial fibrillation of any duration, with a 1.9-fold increased univariable hazard ratio, although this association was not significant in longer duration of atrial fibrillation episode. This effect was no longer significant with stepwise multivariable analysis, suggesting that age was primarily mediating the effect seen in this study. Left atrioventricular coupling index was not an independent predictor of future implantable loop recorder-detected atrial fibrillation after adjustment for age in this cohort.

Current data indicate that low-dose colchicine (0.5 mg/day) may reduce the risk of major adverse cardiovascular (CV) events (MACE) in patients with coronary artery disease and thus can become a new standard, effective, cost-efficient, and well-tolerated therapy for cardiac patients. Various important randomised controlled studies have reported on colchicine's influence on CV outcomes, and meta-analyses of these trials show that colchicine mitigates the risk of recurrent MACE by 25%, resulting in its recent approval by the Food and Drug Administration for the management and prevention of CV disease (CVD). While colchicine reduces MACE risk, its survival benefit remains inconclusive, warranting further long-term investigations. The non-significant decrease in CV death of ~20% is surpassed by a more apparent, borderline non-significant rise in the risk of non-CV death by ~40%. Main populations comprising patients with heart failure, patients submitted to surgical revascularisation, females, elderly persons, and non-Caucasians are under-represented in current trials, limiting the generalisability of such treatment. Thus, colchicine shows promise in curtailing MACE, additional data from large-scale, long-term trials are needed to corroborate such findings before its widespread use in clinical practice to favourably influence the secondary prevention of atherosclerotic CVD. Colchicine may have important advantages in curtailing myocardial infarction in specific high-risk patient groups but uncertainty about the magnitude of the impact on survival remains, particularly in the general population. Unfortunately, this agent is plagued by gastrointestinal side effects, which may deter its use. More data from larger-scale randomised studies will be required.