The presence of mitral valve prolapse (MVP) varies from asymptomatic to life-threatening arrhythmias. Catheter ablation (CA) is widely used to treat ventricular arrhythmias (VAs) associated with MVP. Despite having high procedural success, outcome data after CA is limited, especially in a long-term setting. Therefore, this systematic review and meta-analysis were performed. Literature searching was conducted in Pubmed, EuropePMC, Proquest, and Ebsco from inception to December 2020 using keywords: ventricular arrhythmia, premature ventricular complex, ventricular tachycardia, ventricular fibrillation, mitral valve prolapse, and catheter ablation. A total of 407 potential articles were retrieved for further review. The final review resulted in six articles for systematic review and meta-analysis. The study was registered in PROSPERO (CRD42020219144). The most common origin of VAs was papillary muscle. The acute success rate of CA in the MVP group varies between 66% and 94%. Follow-up studies reported a higher percentage of VAs recurrence after CA in the MVP group (22.22%) compared with the non-MVP group (11.38%). However, the difference is not significant (P-value = 0.16). Other studies reported a 12.5%-36% rate and 40% of repeat ablation in the medium term and the long term, respectively. Episodes of sudden cardiac death during exertion could still occur following CA in patients with MVP. Distinct origin of VAs was observed during repeated ablation procedures, which may explain arrhythmic substrate progression. Diffuse left ventricular fibrosis around papillary muscle rather than local fibrosis was observed among older patients. Furthermore, the presence of mitral annular disjunction (MAD) and Filamin C mutation might increase the risk of recurrent VAs. CAn has been done as the treatment of VAs associated with MVP. The acute success rate of CA varies between studies and the number of patients requiring repeat CA varied from 12.5% to 40%. Sudden cardiac death could still occur after CA. Older age during CA, genetic predisposition, deep arrhythmic foci, multifocal VAs origin, diffuse fibrosis, and the presence of MAD may contribute to the recurrence of VAs. Further studies, stratification, and evaluation are needed to prevent fatal outcomes in VA associated with MVP, even after CA.

Euglycemic diabetic ketoacidosis (Eu-DKA) is a rare but life-threatening complication in diabetic patient treated with sodium-glucose cotransporter 2 inhibitors (SglT2i). A 71-year-old diabetic female treated with empagliflozin presented to the ED with shortness of breath. Diagnosis of acute pulmonary embolism was confirmed initially. She was treated conservatively with subcutaneous enoxaparin 60 mg bidaily. and oxygen therapy. respiratory distress associated with anion gap -metabolic acidosis and ketosis developed on the following days however her blood glucose levels were always within normal limit. Clinical recovery was gained after stopping the drug, administering rehydration, and insulin drip. Complication of DKA without hyperglycaemia should be considered while evaluating ketoacidosis in diabetic patients treated with SglT2i, particularly in critical illness cases.

Cardiac arrhythmia is one of the common complications among hospitalized COVID-19 patients. The incidence of arrhythmia in COVID-19 varies from 5.9% to 16.7%. This literature review to explore the epidemiology, risk factors, clinical manifestation, pathophysiology, outcomes, and management of hospitalized COVID -19 patients with cardiac arrhythmia. The literature search and review of the literature was performed on PubMed and Google Scholar from January 2020 to July 2021. Age, comorbidities, and COVID-19 disease severity may increase the risk to develop arrhythmia. Hypertension, coronary artery disease, heart failure, diabetes mellitus, and renal disease are more frequently observed patients with arrhythmia. The proposed pathophysiology of arrhythmia in COVID-19 are myocardial injury, hypoxia, cytokine storm, and drugs side effects. In addition, comorbidity, pre-existing scar or conduction defect, history of previous arrhythmia, electrolyte abnormalities may play a role in the pathophysiology of tachyarrhythmia and bradyarrhythmia. The in-hospital mortality, need of intensive care unit, need of mechanical ventilation or non-invasive ventilation, hypotension, and thromboembolic event were higher in hospitalized COVID-19 patients with arrhythmia. The general managements were to treat the underlying COVID-19 infection and to tackle the hemodynamic disturbances due to tachyarrhythmia or bradyarrhythmia. Cardiac arrhythmia is a common complication among hospitalized COVID-19 patients. Hospitalized COVID-19 patients with tachyarrhythmia or bradyarrhythmia had worse in-hospital outcomes compared with patients without arrhythmia.

Background: This study aimed to assess the factors contributing to the outcomes of recently hospitalized patients with heart failure (HF).Methods: A prospective data of 76 adults who were admitted due to acute HF between October 1, 2019 and June 30, 2020 at our center were analyzed. Endpoints included survival and rehospitalization within six months after discharge.Results: The mean age was 64.9 ± 13.8 years, with a male preponderance (68.4%). Approximately 60.5% of patients had the left ventricular ejection fraction (LVEF) <40%, whereas 26.3% of patients had LVEF ≥50%. Coronary artery disease (75%), arterial hypertension (72.4%), chronic kidney disease (46.1%), and diabetes mellitus (46.1%) were the most frequent comorbidities. Poor compliance (40.8%) and non-cardiac infection (21.1%) were the common precipitating factors for hospitalization. The majority of subjects had severe symptoms, indicated by the frequent need of intensive care unit (43%), high N-terminal prohormone brain natriuretic peptide levels [NT-proBNP; median, 4765 (1539.7-11782.2) pg/mL], and presence of either atrial fibrillation, severe mitral regurgitation, or significant pulmonary hypertension in approximately one-third of cases. Even though in-hospital mortality was relatively low (2.6%), the all-cause mortality and rehospitalization rates in the next six months after discharge were still high, reaching 22.54% and 19.72%, respectively. Further survival analysis showed that tachycardia on admission and pre-existing chronic kidney disease (CKD) resulted in low six-month survival rates among these patients. Conclusion:After hospital discharge, patients with HF were still exposed to higher risks of death and readmission albeit with the medication addressed. Tachycardia on admission and pre-existing CKD might predict worse outcomes.

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