Notes

Stereotactic Radiosurgery and also Hypofractionated Stereotactic Radiotherapy for Nonfunctioning Pituitary Adenoma.
ularly effective against Staphylococcus species, the predominant cause of pocket infections. (Worldwide Randomized Antibiotic Envelope Infection Prevention Trial [WRAP-IT]; NCT02277990).
This study aimed to determine the long-term outcomes and predictors of left ventricular (LV) ejection fraction (LVEF) improvement in patients with severe cardiomyopathies undergoing cardiac resynchronization therapy (CRT).

Whether patients with severe LV dysfunction benefit from CRT or have reached a point in disease severity past the point at which CRT is beneficial is unknown.

We collected clinical and echocardiographic data on 420 patients with an LVEF of≤15% and a QRS duration of≥120ms undergoing CRT at the Cleveland Clinic and 2 hospitals in the Johns Hopkins Health System between April 2003 and May 2014. Multivariate models were created to determine factors associated with response to CRT, defined as an absolute improvement in LVEF of >5% and survival free of LVAD and heart transplant. Procedure-related deaths were also collected.

A total of 298 patients had pre- and appropriately timed post-CRT echocardiograms, of whom 145 (48.7%) met the criteria for response. MSA2 In multivariate analysis, LV sd patients, 30.4% realized a meaningful improvement in LVEF with CRT. The CRT implant procedure itself appears well tolerated.
This study assessed the management approach and outcome of subacute (1 to 30days post-implantation) and delayed (>30days) cardiac perforation by pacemaker or implantable cardioverter-defibrillator (ICD) leads.

Implantation of pacemaker and ICD leads is associated with a small but serious risk of cardiac perforation. Appropriate management remains uncertain.

The study population included all patients referred to a single institution for subacute or delayed lead perforation after pacemaker or ICD implantation (identified after hospital discharge) during the period from 2007 to 2020. The approach and outcome of lead management were retrospectively assessed.

Fifty-four cases of cardiac perforation were identified (35 females; mean age 75.5 ± 9.7 years). Cardiac perforation was related to a pacemaker lead in 36 patients, and the perforating leads were originally placed in the right ventricular apex in 41 patients. The average time from lead implantation to first presentation of symptoms of perforation was 60.8 ± 89.1days (range 2 to 412days). Symptoms suggestive of cardiac perforation were reported by 31 patients (57.4%). Twenty three patients were asymptomatic, in whom lead perforation was discovered incidentally on radiographic imaging, suggesting lead migration or anomalous electrical data on device interrogation. In all patients, the leads were removed or repositioned by the percutaneous approach, with no major periprocedural complications and without surgical intervention.

In this largest series to date of subacute or delayed cardiac device lead perforation, percutaneous repositioning or replacement of the perforating lead was found to be a safe and effective management approach.
In this largest series to date of subacute or delayed cardiac device lead perforation, percutaneous repositioning or replacement of the perforating lead was found to be a safe and effective management approach.
This study aimed to characterize corrected QT (QTc) prolongation in a cohort of hospitalized patients with coronavirus disease-2019 (COVID-19) who were treated with hydroxychloroquine and azithromycin (HCQ/AZM).

HCQ/AZM is being widely used to treat COVID-19 despite the known risk of QT interval prolongation and the unknown risk of arrhythmogenesis in this population.

A retrospective cohort of COVID-19 hospitalized patients treated with HCQ/AZM was reviewed. The QTc interval was calculated before drug administration and for the first 5days following initiation. The primary endpoint was the magnitude of QTc prolongation, and factors associated with QTc prolongation. Secondary endpoints were incidences of sustained ventricular tachycardia or ventricular fibrillation and all-cause mortality.

Among 415 patients who received concomitant HCQ/AZM, the mean QTc increased from 443 ± 25ms to a maximum of 473 ± 40ms (87 [21%] patients had a QTc≥500ms). Factors associated with QTc prolongation≥500ms were age (p<0.001), body mass index<30kg/m
(p=0.005), heart failure (p<0.001), elevated creatinine (p=0.005), and peak troponin (p<0.001). The change in QTc was not associated with death over the short period of the study in a population in which mortality was already high (hazard ratio 0.998; p=0.607). No primary high-grade ventricular arrhythmias were observed.

An increase in QTc was seen in hospitalized patients with COVID-19 treated with HCQ/AZM. Several clinical factors were associated with greater QTc prolongation. Changes in QTc were not associated with increased risk of death.
An increase in QTc was seen in hospitalized patients with COVID-19 treated with HCQ/AZM. Several clinical factors were associated with greater QTc prolongation. Changes in QTc were not associated with increased risk of death.
This study sought to determine the impact of adjunctive renal sympathetic denervation to catheter ablation in patients with atrial fibrillation (AF) and history of hypertension.

There are limited data regarding the impact of upstream adjunctive renal sympathetic denervation (RSDN) to pulmonary vein isolation (PVI) in patients with symptomatic atrial fibrillation (AF) and hypertension.

The data for this study were obtained from 2 prospective randomized pilot studies, the HFIB (Adjunctive Renal Denervation to Modify Hypertension and Sympathetic tone as Upstream Therapy in the Treatment of Atrial Fibrillation)-1 (n=30) and HFIB (Adjunctive Renal Denervation to Modify Hypertension and Sympathetic tone as Upstream Therapy in the Treatment of Atrial Fibrillation)-2 (n=50) studies, and we performed a meta-analysis including all published studies comparing RSDN+PVI versus PVI alone up to January 25, 2020, in patients with AF and hypertension.

At 24months, AF recurrence occurred in 53% and 38% in the PVI and PVI+RSDN groups (p=0.
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