European Heart Journal: Case Reports最新文献

Background: Pulsed field ablation (PFA) is increasingly adopted for catheter atrial fibrillation (AF) ablation due to its safety and efficacy as compared to thermal energies. Left ventricular assist device (LVAD) is also an established treatment in patients with advanced heart failure. Radiofrequency catheter ablation of AF in LVAD carriers has only been case-reported. Pulsed field energy using a pentaspline catheter has never been reported for combined AF and typical atrial flutter in a continuous-flow LVAD patient.

Case summary: We report the case of a 57-year-old male with advanced heart failure due to a non-ischaemic dilated cardiomyopathy. A LVAD was successfully implanted. Despite amiodarone and beta-blockers, the patient experienced symptomatic recurrent AF and atrial flutter with multiple episodes per day of low flow alarm by the LVAD. The patient was scheduled for catheter ablation and pulsed field energy was selected to shorten the time of the general anaesthesia. Under fluoroscopy guidance pulmonary vein isolation (PVI), posterior wall isolation (PWI) and cavotricuspid isthmus (CTI) ablation were successfully performed, leading to sinus rhythm restoration and symptom relief without any interference with the LVAD. At 8 months of follow-up, the patient was in sinus rhythm and did not experience any heart failure decompensation or atrial arrhythmia recurrence.

Discussion: This case highlights the feasibility and the safety of PFA-assisted PVI, PWI, and CTI ablation in LVAD patients. No complications related to the transseptal approach or interference of pulsed field energy with the LVAD have been detected.

Background: A 55-year-old woman was admitted with recurrent early-morning chest tightness approximately twice per month. Coronary computed tomography showed no significant stenosis.

Case summary: During acetylcholine provocation testing, the patient developed extensive left main coronary artery (LMCA) dissection extending into the left anterior descending artery and left circumflex artery, resulting in thrombolysis in myocardial infarction (TIMI) Grade 1 flow and cardiogenic shock. A microaxial flow pump (Impella CP) was immediately inserted via the femoral artery, leading to rapid haemodynamic stabilization and improvement of ST-segment depression. Intravascular ultrasound demonstrated dynamic reduction of the false lumen and expansion of the true lumen after initiation of Impella support. Percutaneous coronary intervention was subsequently performed under the Impella support, with stent deployment from the LMCA to the left anterior descending artery (LAD), followed by kissing-balloon inflation into the left circumflex artery (LCx). Final angiography confirmed restoration of TIMI Grade 3 flow.

Discussion: The patient experienced a favourable clinical course and was discharged after completing cardiac rehabilitation. This case highlights the potential role of early Impella support in stabilizing haemodynamics and preserving true lumen integrity during bailout percutaneous coronary intervention for iatrogenic LMCA dissection. Intravascular ultrasound provided valuable insights into haemodynamic improvements following Impella support.

Background: Primary cardiac fibroma is a rare benign tumour, accounting for ∼1% of all primary cardiac tumours in adults. Although histologically benign, it can cause severe complications including arrhythmias, heart failure, and even sudden death.

Case summary: We report a 51-year-old female presenting with chest pain and exertional dyspnoea. Transthoracic echocardiography and cardiac magnetic resonance imaging revealed a large intramyocardial mass at the left ventricular apex. The patient underwent complete surgical resection under cardiopulmonary bypass. Histopathology confirmed a primary cardiac fibroma. The postoperative course was uneventful, and the patient remained well at 6-month follow-up without recurrence.

Discussion: Surgical resection is the treatment of choice for primary cardiac fibroma, preventing life-threatening arrhythmias and haemodynamic compromise. This case highlights the importance of multimodality imaging and the role of surgical management.

Background: Isolated left ventricular apical hypoplasia is a rare and lesser-known form of cardiomyopathy characterized by specific findings on cardiac imaging. It is thought to be congenital in origin, with clinical features that can range from being asymptomatic to presenting with heart failure and arrhythmias.

Case summary: A 43-year-old woman presented with chest pain and had previously undergone evaluation at another facility, including a 2D echocardiogram and computed tomography (CT) coronary angiography. These tests revealed a dilated left atrium and ventricle and reduced left ventricular function alongside a Type I left anterior descending artery. A cardiac magnetic resonance image (MRI) and review of the CT scan confirmed a diagnosis of isolated left ventricular apical hypoplasia. Guideline-directed medical therapy was initiated due to the initial presentation of left ventricular dysfunction.

Conclusion: Left ventricular apical hypoplasia is characterized by (i) a truncated, spherical, and impaired left ventricle (LV) with bulging of the interventricular septum towards the right ventricle (RV), (ii) fatty material in the apical region of the LV, (iii) abnormalities in the papillary muscles and trabecular structures, and (iv) elongation of the RV wrapping around the underdeveloped LV. Limited data is available on this condition, with only a few reported cases. Currently, no definitive guidelines exist, and management is tailored to the patient's specific presentation, including treating heart failure and any arrhythmias that may arise. While the aetiology of this condition remains poorly understood, it is crucial to recognize it to prevent misdiagnosis and to encourage further research into its management.

Background: Isolated atrial myocarditis is rarely diagnosed in non-open-heart surgical cases. We report a case of isolated lymphocytic atrial myocarditis presenting with atrial arrhythmias, syncope, and atrial wall thickening, confirmed histologically by transcatheter atrial biopsy and multimodality imaging.

Case summary: A 69-year-old woman presented to the emergency department with general fatigue and a syncopal episode. Electrocardiogram revealed sick sinus syndrome (SSS) with a heart rate of 40 beats/min. Laboratory tests indicated a mild inflammatory response without cardiac enzyme level elevation. Transthoracic echocardiography demonstrated left atrial wall thickening and mild pericardial effusion. Contrast-enhanced computed tomography revealed a thrombus in the left atrial appendage, ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) showed diffuse uptake in both atria without ventricular involvement. Three weeks later, the patient presented with atrial fibrillation. An endomyocardial atrial biopsy was performed to histologically investigate the cause of atrial wall thickening, which revealed lymphocytic myocarditis, thereby ruling out malignant lymphoma and amyloidosis. No causative virus was identified, and immunosuppressive therapy was not initiated because the patient showed spontaneous improvement in atrial arrhythmia and atria wall thickening. Anticoagulation therapy resulted in complete resolution of the thrombus within 3 months. Follow-up FDG-PET/CT at 5 months confirmed the resolution of atrial uptake, and the patient remained symptom-free without SSS or AF recurrence at the 1-year follow-up.

Discussion: In cases of isolated atrial myocarditis presenting with atrial arrhythmias and atrial wall thickening, a combination of imaging modalities and histological evaluation by atrial biopsy may be helpful in establishing a definitive diagnosis.