Cost-Effectiveness of Canakinumab From a Canadian Perspective for Recurrent Cardiovascular Events
SUMMARY
Use of canakinumab, a novel monoclonal antibody (biologic) therapy, has been shown to reduce cardiovascular events but is associated with side effects and high costs. A decision model was developed to estimate the direct costs and outcomes among patients who have suffered a myocardial infarction and are treated with canakinumab. The current analysis did not demonstrate cost-effectiveness of canakinumab use in the Canadian public healthcare context, owing largely to the high medication cost.
The Physical Activity Levels and Sitting Time of Adults Living With Atrial Fibrillation: The CHAMPLAIN-AF Study
SUMMARY
This observational study (N = 619) found that 56% of adults living with atrial fibrillation (AF) were not physically active (< 150 minutes of moderate-to-vigorous physical activity [MVPA] per week); 54% patients did not know the MVPA recommendations, and ~60% reported that they had had no conversation with a healthcare professional regarding physical activity. Low MVPA levels may be due to lack of knowledge regarding physical activity. Exercise professionals can help educate patients and prescribe MVPA.
Which Recommendations Are You Using? A Survey of Emergency Physician Management of Paroxysmal Atrial Fibrillation
SUMMARY
Clinical guidance for atrial fibrillation produced by the Canadian Association of Emergency Physicians (CAEP) in 2018 and the Canadian Cardiovascular Society in 2018/2020 differed in key management areas. Our study surveyed emergency physicians across Canada and found varying levels of awareness and adherence, with divided decision-making in clinical vignettes. In 2021, CAEP published a more congruent checklist; however, our study’s findings emphasize the need for better alignment between organizations and improved knowledge translation.
Staphylococcus lugdunensis Endocarditis: Lower Mortality in the Contemporary Era?
SUMMARY
Staphylococcus lugdunensis is a rare cause of infective endocarditis associated with high mortality. We report on cases of Staphylococcus lugdunensis endocarditis in patients admitted at 2 tertiary care hospitals in Saskatoon, Saskatchewan, over a 6-year period, and we analyzed their baseline characteristics, antimicrobial susceptibility data, management and outcome data, as available, for each of them.
Sparing the Prod: Providing an Alternative to Endomyocardial Biopsies With Noninvasive Surveillance After Heart Transplantation During COVID-19
SUMMARY
This study is the first in Canada to assess the role for noninvasive rejection surveillance in personalizing titration of immunosuppression, avoiding endomyocardial biopsy during the COVID-19 pandemic, and improving patient satisfaction post–heart transplant. Noninvasive rejection surveillance was associated with the ability to lower immunosuppression without adverse safety concerns, increased patient satisfaction, and reduced anxiety in heart transplant recipients.
Rhythm-Monitoring Strategy and Arrhythmia Recurrence in Atrial Fibrillation Ablation Trials: A Systematic Review
SUMMARY
The monitoring strategy used after catheter ablation for atrial fibrillation affects atrial arrhythmia recurrence detection rates. In a systematic review of 56 randomized controlled trials of catheter ablation, a higher level of atrial arrhythmia recurrence was detected with continuous compared to intermittent monitoring (46.9% vs 31.2%). In trials using intermittent rhythm monitoring, duration of monitoring did not increase detection rates. Continuous-monitoring strategies are necessary if the true incidence of arrhythmia recurrence is to be determined.
COVID-19 Vaccination-Induced Myopericarditis: An Imager’s Perspective
SUMMARY
We describe a case series of 10 individuals with COVID-19 vaccine-related myocarditis confirmed by cardiac magnetic resonance imaging. Affected individuals were young men, who presented with chest pain and positive cardiac biomarkers after the second mRNA vaccine dose. Cardiac magnetic resonance imaging demonstrated relatively preserved systolic function and subepicardial or midmyocardial delayed enhancement affecting the inferior, inferolateral, and lateral walls, confirming myocarditis.
Biopsy-Proven Fulminant Myocarditis Requiring Mechanical Circulatory Support Following COVID-19 mRNA Vaccination
SUMMARY
A 48-year-old woman suffered from cardiogenic shock with fulminant myocarditis after receiving the second dose of COVID-19 vaccine (mRNA-1273). Endomyocardial biopsy revealed lymphocytic infiltration with predominant immunostaining for cluster of differentiation (CD)8- and CD68-positive cells. She was successfully treated using venoarterial extracorporeal membrane oxygenation and Impella support. Cytotoxic T cells may be involved in the fulminant mechanisms of COVID-19 vaccine–related myocarditis.
Dissimilar Atrial Rhythms Seen by Transesophageal Echocardiography During an Electrophysiology Study
SUMMARY
We describe a case of an 88-year-old woman with prior paroxysmal atrial fibrillation and new-onset, symptomatic atrial flutter who underwent electrophysiology study, ablation, transesophageal echocardiography, and cardioversion. Electrograms revealed dissociated atrial rhythms with supportive evidence via comparison of differential function of the left and right atrial appendages on transesophageal echocardiography, a finding not previously described.
Early Transcatheter Heart Valve Pannus Leading to Coronary Obstruction Managed With Orthotopic Chimney Stenting
SUMMARY
A 78-year-old woman was admitted with acute coronary syndrome 6 months after undergoing transcatheter aortic valve replacement related to extensive pannus, with challenging coronary access shown on computed tomography imaging. She underwent successful left main orthotopic chimney stenting, allowing immediate symptom and coronary flow improvement. Computed tomography imaging was the key to understanding the acute coronary syndrome mechanism and planning percutaneous coronary intervention.
