Joanna Bartkowiak, Vratika Agarwal, Mark Lebehn, Tamim Nazif, Isaac George, S. Kodali, T. Vahl, R. Hahn
Limited data exists on strain changes post-TAVI in aortic regurgitation (AR) patients. Three AR patients undergoing TAVI showed initial GLS reduction followed by sustained GLS improvement within the first year. Findings align with surgically treated AR patients. There is a possible superiority of GLS-to-LVEDD ratio's in assessing patients with severe volume overload.
{"title":"Strain Assessment in Patients with Aortic Regurgitation undergoing Transcatheter Aortic Valve Implantation: Case Series","authors":"Joanna Bartkowiak, Vratika Agarwal, Mark Lebehn, Tamim Nazif, Isaac George, S. Kodali, T. Vahl, R. Hahn","doi":"10.1093/ehjcr/ytae261","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae261","url":null,"abstract":"\u0000 \u0000 \u0000 Limited data exists on strain changes post-TAVI in aortic regurgitation (AR) patients.\u0000 \u0000 \u0000 \u0000 Three AR patients undergoing TAVI showed initial GLS reduction followed by sustained GLS improvement within the first year.\u0000 \u0000 \u0000 \u0000 Findings align with surgically treated AR patients. There is a possible superiority of GLS-to-LVEDD ratio's in assessing patients with severe volume overload.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141676962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kenta Yoshida, Mitsuru Yoshino, Tokuma Kawabata, H. Tasaka, K. Kadota
There are few reports of establishing cardiac resynchronization therapy-defibrillator with placing a shock lead directly into the LBBA. A 76-year-old woman with heart failure due to dilated cardiomyopathy presented to our cardiovascular medicine department. Despite receiving optimal medical therapy, she had New York Heart Association class III heart failure. While her electrocardiogram showed a sinus rhythm with a left bundle branch block pattern (QRS duration, 160 ms) and left ventricular ejection fraction of 21.0%, holter monitoring revealed frequent multifocal ventricular premature beats and non-sustained ventricular tachycardia. Owing to worsening heart failure symptoms, cardiac resynchronization therapy (CRT)-D implantation was performed. As the Agilis HisPro catheter has two 90° deflections, we reshaped its proximal part to the second deflection and added a septal curve, allowing us to screw the shock lead deep into ventricular septum and achieve QRS narrowing of right ventricular pace (114 ms). The time from stimulus to left ventricular activation was 84 ms. Coronary sinus and right atrial leads were placed in conventional manner. Finally, a defibrillation threshold test confirmed a successful treatment with no postoperative adverse events. Combining left bundle branch area pacing (LBBAP) with coronary sinus (CS) pacing improved prognosis by achieving superior electrical resynchronisation (left bundle branch–optimized CRT: LOT-CRT). However, in the absence of suitable tool for directly placing the shock lead in left bundle branch area (LBBA), it was difficult to establish LOT-CRTD. Herein, we established LOT-CRTD by reshaping Agilis HisPro catheter, which enabled shock lead placement in LBBA.
{"title":"Cardiac Resynchronization Therapy–Defibrillator Implantation with Shock Lead Placement in the Left Bundle Branch Area by Reshaping Steerable Delivery Sheath: A Case Report","authors":"Kenta Yoshida, Mitsuru Yoshino, Tokuma Kawabata, H. Tasaka, K. Kadota","doi":"10.1093/ehjcr/ytae323","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae323","url":null,"abstract":"\u0000 \u0000 \u0000 There are few reports of establishing cardiac resynchronization therapy-defibrillator with placing a shock lead directly into the LBBA.\u0000 \u0000 \u0000 \u0000 A 76-year-old woman with heart failure due to dilated cardiomyopathy presented to our cardiovascular medicine department. Despite receiving optimal medical therapy, she had New York Heart Association class III heart failure. While her electrocardiogram showed a sinus rhythm with a left bundle branch block pattern (QRS duration, 160 ms) and left ventricular ejection fraction of 21.0%, holter monitoring revealed frequent multifocal ventricular premature beats and non-sustained ventricular tachycardia. Owing to worsening heart failure symptoms, cardiac resynchronization therapy (CRT)-D implantation was performed. As the Agilis HisPro catheter has two 90° deflections, we reshaped its proximal part to the second deflection and added a septal curve, allowing us to screw the shock lead deep into ventricular septum and achieve QRS narrowing of right ventricular pace (114 ms). The time from stimulus to left ventricular activation was 84 ms. Coronary sinus and right atrial leads were placed in conventional manner. Finally, a defibrillation threshold test confirmed a successful treatment with no postoperative adverse events.\u0000 \u0000 \u0000 \u0000 Combining left bundle branch area pacing (LBBAP) with coronary sinus (CS) pacing improved prognosis by achieving superior electrical resynchronisation (left bundle branch–optimized CRT: LOT-CRT). However, in the absence of suitable tool for directly placing the shock lead in left bundle branch area (LBBA), it was difficult to establish LOT-CRTD. Herein, we established LOT-CRTD by reshaping Agilis HisPro catheter, which enabled shock lead placement in LBBA.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141677777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
James Mannion, Faizan Rathore, Nicola Hutchison, J. Lyne
Mapping of ventricular tachycardia (VT) can prove challenging secondary to scar complexity and potential multiple arrhythmia channels, including epicardial. Some mapping strategies include entrainment, local activation time, voltage and pacing maps. We describe an interesting case of an epicardial pace map utilising a coronary sinus (CS) lead inserted for cardiac resynchronisation therapy (CRT). A 69 year old male with ischaemic cardiomyopathy presented for CRT device upgrade. He also had recurrent shocks for ventricular tachycardia (VT) despite endocardial VT ablation and sympathectomy. During coronary sinus lead implantation, a paced complex morphology similar to the clinical VT was observed. Correspondingly, an epicardial ablation was undertaken to an area of very late activation on the basal infero-lateral wall, resulting in lack of inducibility.
{"title":"Identifying ventricular tachycardia exit site utilising a coronary sinus lead pace map; a case report","authors":"James Mannion, Faizan Rathore, Nicola Hutchison, J. Lyne","doi":"10.1093/ehjcr/ytae320","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae320","url":null,"abstract":"\u0000 Mapping of ventricular tachycardia (VT) can prove challenging secondary to scar complexity and potential multiple arrhythmia channels, including epicardial. Some mapping strategies include entrainment, local activation time, voltage and pacing maps. We describe an interesting case of an epicardial pace map utilising a coronary sinus (CS) lead inserted for cardiac resynchronisation therapy (CRT). A 69 year old male with ischaemic cardiomyopathy presented for CRT device upgrade. He also had recurrent shocks for ventricular tachycardia (VT) despite endocardial VT ablation and sympathectomy. During coronary sinus lead implantation, a paced complex morphology similar to the clinical VT was observed. Correspondingly, an epicardial ablation was undertaken to an area of very late activation on the basal infero-lateral wall, resulting in lack of inducibility.","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141687788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Exercise-induced complete atrioventricular block (EIAVB) is a rare cardiac conduction abnormality presenting challenges in diagnosis due to non-specific symptoms such as exertional dyspnea, dizziness, and syncope. We present a case of a 76-year-old female with recurrent exercise-associated syncope. Non-invasive exercise testing played a crucial role in diagnosing her condition, revealing EIAVB and underscoring its importance in patients with cardiovascular risk factors. This case provides insight into the pathophysiology of EIAVB, including altered atrioventricular nodal refractoriness and exercise-induced ischemic imbalances. It highlights the need for heightened clinical vigilance in diagnosing exercise-related syncope, especially in pre-existing cardiovascular conditions. This case underscores the critical importance of non-invasive testing for diagnosing EIAVB, highlighting the necessity of thorough evaluation in patients presenting with ambiguous symptoms and cardiovascular risks. Consequently, it advocates for adherence to guidelines to enhance outcomes and reduce the need for unnecessary invasive procedures.
{"title":"Exercise-Induced Complete Atrioventricular Block Resulting in Cardiac Arrest: A Case Report and Review of Diagnostic Strategies","authors":"Fabrício Braga, Tácito Bessa, Matheus Cunha, Roberto Bueno Paiva, Ricardo Stein","doi":"10.1093/ehjcr/ytae316","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae316","url":null,"abstract":"\u0000 \u0000 \u0000 Exercise-induced complete atrioventricular block (EIAVB) is a rare cardiac conduction abnormality presenting challenges in diagnosis due to non-specific symptoms such as exertional dyspnea, dizziness, and syncope.\u0000 \u0000 \u0000 \u0000 We present a case of a 76-year-old female with recurrent exercise-associated syncope. Non-invasive exercise testing played a crucial role in diagnosing her condition, revealing EIAVB and underscoring its importance in patients with cardiovascular risk factors.\u0000 \u0000 \u0000 \u0000 This case provides insight into the pathophysiology of EIAVB, including altered atrioventricular nodal refractoriness and exercise-induced ischemic imbalances. It highlights the need for heightened clinical vigilance in diagnosing exercise-related syncope, especially in pre-existing cardiovascular conditions.\u0000 \u0000 \u0000 \u0000 This case underscores the critical importance of non-invasive testing for diagnosing EIAVB, highlighting the necessity of thorough evaluation in patients presenting with ambiguous symptoms and cardiovascular risks. Consequently, it advocates for adherence to guidelines to enhance outcomes and reduce the need for unnecessary invasive procedures.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141686759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
There is limited evidence for the use of an intra-aortic balloon pump (IABP) in adult patients with a total cavopulmonary, or Fontan circulation. A patient in his twenties with a Fontan circulation presented with sepsis, pneumonia, and pulmonary edema. He was born with a hypoplastic left ventricle, atrioventricular septal defect, and hypoplastic aortic arch, and a total cavopulmonary circulation had been established within his first years of life. Standard of care treatment with antibiotics, non-invasive ventilatory support, loop diuretics and vasopressors was initiated. Due to persistent pulmonary congestion and increasing general fatigue, an IABP was placed via a femoral artery to offload the failing systemic ventricle. Secondary to IABP treatment, mean arterial pressure rose, and vasodilatory nitroprusside could be introduced. Over four days of IABP treatment, the patient´s general condition and ventricular systolic function improved significantly. This case suggests that IABP treatment was important in the recovery of our patient with a Fontan circulation, pneumonia and heart failure. We propose that during IABP treatment, an increase in stroke volume and a reduction in ventricular filling pressure is achieved, thereby increasing the transpulmonary pressure gradient that is central to pulmonary blood flow in Fontan patients. More definitive evidence is necessary to confirm our hypotheses.
{"title":"Intra-aortic balloon pump treatment in an adult patient with a Fontan circulation and acute heart failure: a case report","authors":"M. S. Langseth, N. Nordstrand, Gunnar Erikssen","doi":"10.1093/ehjcr/ytae289","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae289","url":null,"abstract":"\u0000 \u0000 \u0000 There is limited evidence for the use of an intra-aortic balloon pump (IABP) in adult patients with a total cavopulmonary, or Fontan circulation.\u0000 \u0000 \u0000 \u0000 A patient in his twenties with a Fontan circulation presented with sepsis, pneumonia, and pulmonary edema. He was born with a hypoplastic left ventricle, atrioventricular septal defect, and hypoplastic aortic arch, and a total cavopulmonary circulation had been established within his first years of life. Standard of care treatment with antibiotics, non-invasive ventilatory support, loop diuretics and vasopressors was initiated. Due to persistent pulmonary congestion and increasing general fatigue, an IABP was placed via a femoral artery to offload the failing systemic ventricle. Secondary to IABP treatment, mean arterial pressure rose, and vasodilatory nitroprusside could be introduced. Over four days of IABP treatment, the patient´s general condition and ventricular systolic function improved significantly.\u0000 \u0000 \u0000 \u0000 This case suggests that IABP treatment was important in the recovery of our patient with a Fontan circulation, pneumonia and heart failure. We propose that during IABP treatment, an increase in stroke volume and a reduction in ventricular filling pressure is achieved, thereby increasing the transpulmonary pressure gradient that is central to pulmonary blood flow in Fontan patients. More definitive evidence is necessary to confirm our hypotheses.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141337690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ashish Mittal, M. Navaratnarajah, S. Harden, Theodore Velissaris, Paul R Roberts
LAAA is a rare cardiac anomaly which can be congenital or acquired in origin. Because most cases are asymptomatic, it is typically diagnosed incidentally in 2nd to 3rd decades of life. We present a case of 28-year-old male with refractory atrial tachyarrhythmias and significantly reduced exercise tolerance. The informed consent was given by patient for this manuscript. We present a case of 28-year-old male with refractory atrial tachyarrhythmias, and significantly reduced exercise tolerance after an episode of COVID respiratory infection. He was referred by primary care physician for management of AF with CHA2DS2Vasc score zero. He had documented AF and AFL resistant to both chemical and electrical cardioversion. Initial portable focused TTE documented borderline reduced LVEF in context of AFL. Electrophysiological study confirmed diagnosis of typical atrial flutter. Successful radiofrequency ablation of cavo-tricuspid isthmus resulted in bidirectional isthmus conduction block. However, patient developed AF which was electrically cardioverted at the end of procedure. Patient was discharged on Bisoprolol, Ramipril and Apixaban and outpatient cardiac MRI was organised to look for post COVID myocardial scarring. Patient had recurrence of symptoms, this time it was due to AF. Multimodal imaging led to discovery of LAAA, which after discussion in MDT he was accepted for and managed with surgical resection of LAAA with concomitant Cox Maze IV procedure. On 9 months post operative follow up patient is maintaining sinus rhythm and has completely returned to baseline activities. A young patient with refractory atrial arrhythmia should be referred for multimodal cardiovascular imaging to rule out any structural heart disease. LAAA is rare and can be managed conservatively, but surgical excision is most reported and appears to favour arrythmia free survival.
{"title":"Staged hybrid ablation in left atrial appendage aneurysm a rare cause of refractory atrial tachyarrhythmia - a case report","authors":"Ashish Mittal, M. Navaratnarajah, S. Harden, Theodore Velissaris, Paul R Roberts","doi":"10.1093/ehjcr/ytae298","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae298","url":null,"abstract":"\u0000 \u0000 \u0000 LAAA is a rare cardiac anomaly which can be congenital or acquired in origin. Because most cases are asymptomatic, it is typically diagnosed incidentally in 2nd to 3rd decades of life. We present a case of 28-year-old male with refractory atrial tachyarrhythmias and significantly reduced exercise tolerance. The informed consent was given by patient for this manuscript.\u0000 \u0000 \u0000 \u0000 We present a case of 28-year-old male with refractory atrial tachyarrhythmias, and significantly reduced exercise tolerance after an episode of COVID respiratory infection. He was referred by primary care physician for management of AF with CHA2DS2Vasc score zero. He had documented AF and AFL resistant to both chemical and electrical cardioversion. Initial portable focused TTE documented borderline reduced LVEF in context of AFL. Electrophysiological study confirmed diagnosis of typical atrial flutter. Successful radiofrequency ablation of cavo-tricuspid isthmus resulted in bidirectional isthmus conduction block. However, patient developed AF which was electrically cardioverted at the end of procedure. Patient was discharged on Bisoprolol, Ramipril and Apixaban and outpatient cardiac MRI was organised to look for post COVID myocardial scarring. Patient had recurrence of symptoms, this time it was due to AF. Multimodal imaging led to discovery of LAAA, which after discussion in MDT he was accepted for and managed with surgical resection of LAAA with concomitant Cox Maze IV procedure. On 9 months post operative follow up patient is maintaining sinus rhythm and has completely returned to baseline activities.\u0000 \u0000 \u0000 \u0000 A young patient with refractory atrial arrhythmia should be referred for multimodal cardiovascular imaging to rule out any structural heart disease. LAAA is rare and can be managed conservatively, but surgical excision is most reported and appears to favour arrythmia free survival.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141342428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shaohui Wu, Guangchen Zou, Yuzhang Sun, Weifeng Jiang, Xu Liu
Oesophageal fistula is a rare complication of catheter ablation of atrial fibrillation with most fistulas being atrio-oesophageal fistulas, but oesophageal-pericardial fistula can also happen in the absence of atrial perforation. A 68-year-old male patient presented with chest pain 10 days after catheter ablation of paroxysmal atrial fibrillation. He was discharged after an initial negative workup which included a CT chest without contrast. He later presented again with severe chest pain and fever and was found to have a oesophageal-pericardial fistula. He underwent surgical and endoscopic treatment with good recovery. Patients with oesophago-pericardial fistulas often have delayed presentation 1-4 weeks after the ablation procedure. Early diagnosis can be challenging. CT with oral and intravenous contrast is often used for diagnosis. Treatment often includes antibiotics, surgical or interventional drainage of infected spaces with oesophageal repair, clipping or stenting. In contrast to atrio-oesophageal fistulas which carry a high mortality rate, mortality for oesophago-pericardial fistulas appears to be much lower.
{"title":"Oesophago-pericardial fistula after catheter ablation of atrial fibrillation: a case report","authors":"Shaohui Wu, Guangchen Zou, Yuzhang Sun, Weifeng Jiang, Xu Liu","doi":"10.1093/ehjcr/ytae287","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae287","url":null,"abstract":"\u0000 \u0000 \u0000 Oesophageal fistula is a rare complication of catheter ablation of atrial fibrillation with most fistulas being atrio-oesophageal fistulas, but oesophageal-pericardial fistula can also happen in the absence of atrial perforation.\u0000 \u0000 \u0000 \u0000 A 68-year-old male patient presented with chest pain 10 days after catheter ablation of paroxysmal atrial fibrillation. He was discharged after an initial negative workup which included a CT chest without contrast. He later presented again with severe chest pain and fever and was found to have a oesophageal-pericardial fistula. He underwent surgical and endoscopic treatment with good recovery.\u0000 \u0000 \u0000 \u0000 Patients with oesophago-pericardial fistulas often have delayed presentation 1-4 weeks after the ablation procedure. Early diagnosis can be challenging. CT with oral and intravenous contrast is often used for diagnosis. Treatment often includes antibiotics, surgical or interventional drainage of infected spaces with oesophageal repair, clipping or stenting. In contrast to atrio-oesophageal fistulas which carry a high mortality rate, mortality for oesophago-pericardial fistulas appears to be much lower.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141345431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Philipp Breitbart, Hannah Billig, Florian André, Norbert Frey, G. Korosoglou
Delayed coronary obstruction (DCO) is a rare but potentially life-threatening complication after transcatheter aortic valve implantation (TAVI) mostly affecting the left main coronary artery (LMCA) and often caused by prosthesis endothelialization or thrombus formations. Herein, we report an unusual case of a delayed LMCA-obstruction caused by a calcium nodule, which was diagnosed 4 months after TAVI due to recurrent ventricular tachycardia (VT) episodes. A 73-year-old patient was readmitted to an external hospital with syncope three months after TAVI. Fast VT could be induced in electrophysiological examination, why the patient received a 2-chamber implantable cardioverter defibrillator (ICD). However, after one month the patient was readmitted to our department with another syncope. ICD records revealed multiple fast VT episodes (200-220bpm). In addition, the patient reported new-onset exertional dyspnea (NYHA stage III) and elevated high-sensitive cardiac troponin of 115ng/L. Due to symptoms and laboratory markers indicating potential myocardial ischemia, a cardiac computed tomography angiography (CCTA) was performed. CCTA revealed obstruction of the left main coronary artery likely caused by calcium shift during TAVI. After CCTA-guided percutaneous coronary intervention, patient´s course remained uneventful. The present case report highlights the role of CCTA as a powerful non-invasive diagnostic tool in complex settings after TAVI. DCO as a procedural complication can occur after TAVI and manifest with various symptoms, including new-onset or recurrent VTs, like in the present case. CCTA provided accurate assessment of the implanted prosthesis and detection of DCO, thus guiding the subsequent PCI.
{"title":"Syncope due to Recurrent Ventricular Tachycardias after TAVI with Unexpected Diagnosis in Cardiac Computed Tomography: a case report","authors":"Philipp Breitbart, Hannah Billig, Florian André, Norbert Frey, G. Korosoglou","doi":"10.1093/ehjcr/ytae300","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae300","url":null,"abstract":"\u0000 \u0000 \u0000 Delayed coronary obstruction (DCO) is a rare but potentially life-threatening complication after transcatheter aortic valve implantation (TAVI) mostly affecting the left main coronary artery (LMCA) and often caused by prosthesis endothelialization or thrombus formations. Herein, we report an unusual case of a delayed LMCA-obstruction caused by a calcium nodule, which was diagnosed 4 months after TAVI due to recurrent ventricular tachycardia (VT) episodes.\u0000 \u0000 \u0000 \u0000 A 73-year-old patient was readmitted to an external hospital with syncope three months after TAVI. Fast VT could be induced in electrophysiological examination, why the patient received a 2-chamber implantable cardioverter defibrillator (ICD). However, after one month the patient was readmitted to our department with another syncope. ICD records revealed multiple fast VT episodes (200-220bpm). In addition, the patient reported new-onset exertional dyspnea (NYHA stage III) and elevated high-sensitive cardiac troponin of 115ng/L. Due to symptoms and laboratory markers indicating potential myocardial ischemia, a cardiac computed tomography angiography (CCTA) was performed. CCTA revealed obstruction of the left main coronary artery likely caused by calcium shift during TAVI. After CCTA-guided percutaneous coronary intervention, patient´s course remained uneventful.\u0000 \u0000 \u0000 \u0000 The present case report highlights the role of CCTA as a powerful non-invasive diagnostic tool in complex settings after TAVI. DCO as a procedural complication can occur after TAVI and manifest with various symptoms, including new-onset or recurrent VTs, like in the present case. CCTA provided accurate assessment of the implanted prosthesis and detection of DCO, thus guiding the subsequent PCI.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141350419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alejandro Velasco, Chirag Buch, Dawn Hui, C. Joseph, David Onsager, W. Zagrodzky, E. Kulstad, Hemal M Nayak
The hybrid Convergent procedure is approved to treat symptomatic patients with long-standing persistent atrial fibrillation (AF). Despite direct visualization during surgical ablation as well as the use of luminal oesophageal temperature (LET) monitoring, oesophageal injury is still possible. A dedicated device for proactive oesophageal cooling has recently been cleared by the Food and Drug Administration (FDA) to reduce the likelihood of ablation-related oesophageal injury resulting from radiofrequency cardiac ablation procedures. This report describes the first uses of proactive oesophageal cooling for oesophageal protection during the epicardial ablation portion of hybrid convergent procedures. Five patients with long-standing persistent AF underwent hybrid Convergent ablations with the use of proactive oesophageal cooling as means of oesophageal protection. All cases were completed successfully with no adverse effects. Most notably, cases were shorter when compared to cases using LET monitoring, likely due to lack of pauses for overheating of the oesophagus that would otherwise be required to prevent damage to the oesophagus. This report describes the first uses of proactive oesophageal cooling for oesophageal protection during the epicardial ablation portion of five hybrid Convergent procedures. Use of cooling enabled uninhibited deployment of lesions without the need to pause energy delivery due to elevated temperatures in the oesophagus, providing a feasible alternative to LET monitoring.
混合型 Convergent 手术已被批准用于治疗长期持续性心房颤动（房颤）的无症状患者。尽管在手术消融过程中采用了直接可视技术和管腔食管温度（LET）监测技术，但食管仍有可能受到损伤。最近，美国食品和药物管理局（FDA）批准了一种用于主动食道冷却的专用设备，以降低射频心脏消融术导致的消融相关食道损伤的可能性。本报告介绍了在混合融合手术的心外膜消融部分首次使用主动食道冷却来保护食道的情况。 五名长期持续性房颤患者接受了混合会聚消融术，并使用主动食道冷却作为食道保护手段。所有病例均顺利完成，无不良反应。最值得注意的是，与使用 LET 监测的病例相比，病例时间更短，这可能是由于食道过热时无需暂停，否则就需要暂停以防止食道受损。 本报告介绍了在五例混合型 Convergent 手术的心外膜消融部分首次使用主动食道冷却来保护食道的情况。使用冷却技术可以不受限制地部署病灶，而无需因食道温度升高而暂停能量输送，为 LET 监测提供了一种可行的替代方法。
{"title":"Hybrid Convergent Procedure with Proactive Oesophageal Cooling for the Treatment of Long-Standing Persistent Atrial Fibrillation: a Case Series","authors":"Alejandro Velasco, Chirag Buch, Dawn Hui, C. Joseph, David Onsager, W. Zagrodzky, E. Kulstad, Hemal M Nayak","doi":"10.1093/ehjcr/ytae301","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae301","url":null,"abstract":"\u0000 \u0000 \u0000 The hybrid Convergent procedure is approved to treat symptomatic patients with long-standing persistent atrial fibrillation (AF). Despite direct visualization during surgical ablation as well as the use of luminal oesophageal temperature (LET) monitoring, oesophageal injury is still possible. A dedicated device for proactive oesophageal cooling has recently been cleared by the Food and Drug Administration (FDA) to reduce the likelihood of ablation-related oesophageal injury resulting from radiofrequency cardiac ablation procedures. This report describes the first uses of proactive oesophageal cooling for oesophageal protection during the epicardial ablation portion of hybrid convergent procedures.\u0000 \u0000 \u0000 \u0000 Five patients with long-standing persistent AF underwent hybrid Convergent ablations with the use of proactive oesophageal cooling as means of oesophageal protection. All cases were completed successfully with no adverse effects. Most notably, cases were shorter when compared to cases using LET monitoring, likely due to lack of pauses for overheating of the oesophagus that would otherwise be required to prevent damage to the oesophagus.\u0000 \u0000 \u0000 \u0000 This report describes the first uses of proactive oesophageal cooling for oesophageal protection during the epicardial ablation portion of five hybrid Convergent procedures. Use of cooling enabled uninhibited deployment of lesions without the need to pause energy delivery due to elevated temperatures in the oesophagus, providing a feasible alternative to LET monitoring.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141352035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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