Atrial fibrillation (AF) is a triggered rhythm, and ablation of the trigger is a common strategy for rhythm control. We describe a patient with symptomatic AF who was found to have episodes of AF triggered by premature ventricular complexes, likely by retrograde atrioventricular nodal conduction. ( Level of Difficulty: Beginner. )

Purpose Non‐white patients are underrepresented in left atrial appendage occlusion (LAAO) trials, and racial disparities in LAAO periprocedural management are unknown. Methods We assessed sociodemographics and comorbidities of consecutive patients at our institution undergoing LAAO between 2015 and 2020, then in adjusted analyses, compared procedural wait time, procedural complications, and post‐procedure oral anticoagulation (OAC) use in whites versus non‐whites. Results Among 109 patients undergoing LAAO (45% white), whites had lower CHA2DS2VASc scores, on average, than non‐whites (4.0 vs. 4.8, p = .006). There was no difference in median time from index event (IE) or initial outpatient cardiology encounter to LAAO procedure (whites 10.5 vs. non‐whites 13.7 months, p = .9; 1.9 vs. 1.8 months, p = .6, respectively), and there was no difference in procedural complications (whites 4% vs. non‐whites 5%, p = .33). After adjusting for CHA2DS2VASc score, OAC use at discharge tended to be higher in whites (OR 2.4, 95% CI [0.9‐6.0], p = .07). When restricting the analysis to those with prior gastrointestinal (GI) bleed, adjusting for CHA2DS2VASc score and GI bleed severity, whites had a nearly five‐fold odds of being discharged on OAC (OR 4.6, 95% CI [1‐21.8], p = 0.05). The association between race and discharge OAC was not mediated through income category (total mediation effect 19% 95% CI [‐.04‐0.11], p = .38). Conclusion Despite an increased prevalence of comorbidities amongst non‐whites, wait time for LAAO and procedural complications were similar in whites versus non‐whites. Among those with prior GI bleed, whites were nearly five‐fold more likely to be discharged on OAC than non‐whites, independent of income.

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Approximately one quarter of sarcoidosis patients have cardiac involvement which is the second most common cause of mortality in sarcoidosis patients. Among pulmonary sarcoidosis patients, symptoms and access to care have been shown to vary by race. These metrics have not been in examined in a cardiac sarcoidosis (CS) population. Leveraging a racially diverse, urban CS registry at Temple University Hospital, we assessed socioeconomics and potential disparities in disease management and resource allocation. METHODS: Using our electronic medical record, we performed a retrospective review of consecutive CS patients receiving care at our hospital between January 2014 and September 2019. Patient demographics, socioeconomics characteristics, CS related interventions and outcomes were collected. Comparisons were made among race (white vs non-white), gender (male vs female), and household income (low vs medium/high income). Patient's home ZIP codes were collected as a surrogate for socioeconomic status. Using US census data in 2019, ZIP codes were used to categorize patients based on median annual household income into either low income (<$45,000) or medium/high income group (>$45,000). Outcomes were defined as arrhythmia burden (defined by any atrial tachycardia, non-sustained ventricular tachycardia, or sustained ventricular tachycardia found in intra-cardiac device interrogation), intra-cardiac device placement, and use of steroids and immunomodulators. RESULTS: We identified 49 CS patients, of which 49% were non-white (23 black, 1 Hispanic), 57% were male (n¼28), with a mean age of 56AE13 years. Whites were more likely to live in a higher income ZIP codes (82% white vs 33% non-white patients, p<0.0001). When comparing among race (white vs non-white), gender (male vs female), or income by ZIP code (low vs medium/ high income), there is no statistical significant difference in medical comorbidities (hypertension, hyperlipidemia, diabetes, coronary artery disease, obstructive sleep apnea). Arrhythmia burden and intra-cardiac device placements were similar among comparison groups. There was no difference in steroid use among race (84% white vs 83% non-white, p¼0.95), gender (71% female vs 78% male, p¼0.57), and income (79% low income vs 70% medium/high income, p¼0.45). Similarly, there was no difference in immunomodulator use among race (36% white vs 50% black, p¼0.32), gender (52% female vs 56% male, p¼0.74), and income (48% low income vs 35% medium/high income, p¼0.36). CONCLUSIONS: When comparing CS patients by race, gender, or income by ZIP code, there was no difference in medical comorbidities, prevalence of arrhythmic events, presence of intra-cardiac devices, or steroid or immunomodulator use. CLINICAL IMPLICATIONS: This revelation is promising but needs further examination by collaboration between CS registries and large prospective studies.