Association between regional distributions of SARS-CoV-2 seroconversion and out-of-hospital sudden death during the first epidemic outbreak in New York.

Background Increased incidence of out-of-hospital sudden death (OHSD) has been reported during the coronavirus 2019 (COVID-19) pandemic. New York City (NYC) represents a unique opportunity to examine the epidemiologic association between the two given the variable regional distribution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in its highly diverse neighborhoods. Objective The purpose of this study was to examine the association between OHSD and SARS-CoV-2 epidemiologic burden during the first COVID-19 pandemic across the highly diverse neighborhoods of NYC. Methods The incidences of OHSD between March 20 and April 22, 2019, and between March 20 and April 22, 2020, as reported by the Fire Department of New York were obtained. As a surrogate for viral epidemiologic burden, we used percentage of positive SARS-CoV-2 antibody tests performed between March 3 and August 20, 2020. Data were reported separately for the 176 zip codes of NYC. Correlation analysis and regression analysis were performed between the 2 measures to examine association. Results Incidence of OHSD per 10,000 inhabitants and percentage of SARS-CoV-2 seroconversion were highly variable across NYC neighborhoods, varying from 0.0 to 22.9 and 12.4% to 50.9%, respectively. Correlation analysis showed a moderate positive correlation between neighborhood data on OHSD and percentage of positive antibody tests to SARS-CoV-2 (Spearman ρ 0.506; P2= 0.645). Conclusion The association in geographic distribution between OHSD and SARS-CoV-2 epidemiologic burden suggests either a causality between the 2 syndromes or the presence of local determinants affecting both measures in a similar fashion

Safety of magnetic resonance imaging scanning in patients with cardiac resynchronization therapy–defibrillators incorporating quadripolar left ventricular leads

© 2020 The Authors Background: Magnetic resonance imaging (MRI) scanning of magnetic resonance (MR)-conditional cardiac implantable cardioverter-defibrillators (ICDs) can be performed safely following specific protocols. MRI safety with cardiac resynchronization therapy–defibrillators (CRT-Ds) incorporating quadripolar left ventricular (LV) leads is less clear. Objective: The purpose of this study was to evaluate the safety and effectiveness of ICDs and CRT-D systems with quadripolar LV leads after an MRI scan. Methods: The ENABLE MRI Study included 230 subjects implanted with a Boston Scientific ImageReady ICD (n = 39) or CRT-D (n = 191) incorporating quadripolar LV leads undergoing nondiagnostic 1.5-T MRI scans (lumbar and thoracic spine imaging) a minimum of 6 weeks postimplant. Pacing capture thresholds (PCTs), sensing amplitudes (SAs), and impedances were measured before and 1 month post-MRI using the same programmed LV pacing vectors. The ability to sense/treat ventricular fibrillation (VF) was assessed in a subset of patients. Results: A total of 159 patients completed a protocol-required MRI scan (MRI Protection Mode turned on) with no scan-related complications. All right ventricular (RV) and left LV PCT and SA effectiveness endpoints were met: RV PCT 99% (145/146 patients), LV PCT 100% (120/120), RV SA 99% (145/146), and LV SA 98% (116/118). In no instances did MRI result in a change in pacing vector or lead revision. All episodes of VF were appropriately sensed and treated. Conclusion: This first evaluation of predominantly CRT-D systems with quadripolar LV leads undergoing 1.5-T MRI confirmed that scanning was safe with no significant changes in RV/LV PCT, SA, programmed vectors, and VF treatment, thus suggesting that MRI in patients having a device with quadripolar leads can be performed without negative impact on CRT delivery

Atrial fibrillation is an independent predictor for in-hospital mortality in patients admitted with SARS-CoV-2 infection.

Background Atrial fibrillation (AF) is the most encountered arrhythmia and has been associated with worse in-hospital outcomes. Objective This study was to determine the incidence of AF in patients hospitalized with coronavirus disease 2019 (COVID-19) as well as its impact on in-hospital mortality. Methods Patients hospitalized with a positive COVID-19 polymerase chain reaction test between March 1 and April 27, 2020, were identified from the common medical record system of 13 Northwell Health hospitals. Natural language processing search algorithms were used to identify and classify AF. Patients were classified as having AF or not. AF was further classified as new-onset AF vs history of AF. Results AF occurred in 1687 of 9564 patients (17.6%). Of those, 1109 patients (65.7%) had new-onset AF. Propensity score matching of 1238 pairs of patients with AF and without AF showed higher in-hospital mortality in the AF group (54.3% vs 37.2%; P \u3c .0001). Within the AF group, propensity score matching of 500 pairs showed higher in-hospital mortality in patients with new-onset AF as compared with those with a history of AF (55.2% vs 46.8%; P = .009). The risk ratio of in-hospital mortality for new-onset AF in patients with sinus rhythm was 1.56 (95% confidence interval 1.42-1.71; P \u3c .0001). The presence of cardiac disease was not associated with a higher risk of in-hospital mortality in patients with AF (P = .1). Conclusion In patients hospitalized with COVID-19, 17.6% experienced AF. AF, particularly new-onset, was an independent predictor of in-hospital mortality

The Effect of Chloroquine, Hydroxychloroquine and Azithromycin on the Corrected QT Interval in Patients with SARS-CoV-2 Infection

Background - The novel SARs-CoV-2 coronavirus is responsible for the global COVID-19 pandemic. Small studies have shown a potential benefit of chloroquine/hydroxychloroquine ± azithromycin for the treatment of COVID-19. Use of these medications alone, or in combination, can lead to a prolongation of the QT interval, possibly increasing the risk of Torsade de pointes (TdP) and sudden cardiac death. Methods - Hospitalized patients treated with chloroquine/hydroxychloroquine ± azithromycin from March 1st through the 23rd at three hospitals within the Northwell Health system were included in this prospective, observational study. Serial assessments of the QT interval were performed. The primary outcome was QT prolongation resulting in TdP. Secondary outcomes included QT prolongation, the need to prematurely discontinue any of the medications due to QT prolongation and arrhythmogenic death. Results - Two hundred one patients were treated for COVID-19 with chloroquine/hydroxychloroquine. Ten patients (5.0%) received chloroquine, 191 (95.0%) received hydroxychloroquine and 119 (59.2%) also received azithromycin. The primary outcome of TdP was not observed in the entire population. Baseline QTc intervals did not differ between patients treated with chloroquine/hydroxychloroquine (monotherapy group) vs. those treated with combination group (chloroquine/hydroxychloroquine and azithromycin) (440.6 ± 24.9 ms vs. 439.9 ± 24.7 ms, p =0.834). The maximum QTc during treatment was significantly longer in the combination group vs the monotherapy group (470.4 ± 45.0 ms vs. 453.3 ± 37.0 ms, p = 0.004). Seven patients (3.5%) required discontinuation of these medications due to QTc prolongation. No arrhythmogenic deaths were reported. Conclusions - In the largest reported cohort of COVID-19 patients to date treated with chloroquine/hydroxychloroquine {plus minus} azithromycin, no instances of TdP or arrhythmogenic death were reported. Although use of these medications resulted in QT prolongation, clinicians seldomly needed to discontinue therapy. Further study of the need for QT interval monitoring is needed before final recommendations can be made

Indications for implantable cardioverter-defibrillator placement in ischemic cardiomyopathy and after myocardial infarction

Dramatic reductions in the rate of sudden cardiac death due to use of implantable cardioverter-defibrillators (ICDs) have been well-established in several large randomized clinical trials including patients with left ventricular dysfunction after myocardial infarction. This article reviews the literature regarding ICD utilization in the postinfarction population, with a strong emphasis on recent clinical trials. The most current indications for, and timing of, ICD implantation postinfarction also are summarized. © 2011 Springer Science+Business Media, LLC

Folk remedies still in use: A case of soft palate and uvular oedema due to Ecbalium elaterium

A case of soft palate and uvular oedema due to nasal administration of juice produced from the fruit of the plant Ecbalium elaterium, widely known as squirting cucumber, is presented. The patient recovered after administration of subcutaneous adrenaline and methylprednisolone. Cucurbitacins have been implicated in the past as toxic constituents of plants from the Cucurbitaceae family Either an allergic reaction or a direct toxic effect of the constituents is responsible for the occurrence. A few similar cases have been reported, mostly in eastern Mediterranean countries