Volume 9 • Issue 2 • June 2023 – JCE – Journal of Cardiovascular Emergencies

Left Atrial Volume to Predict the Recurrence of Atrial Fibrillation in Patients Treated with Catheter Ablation

Dev Desai, Nilay Suthar — Mon, 05 Jun 2023 16:08:52 +0000

Left Atrial Volume Quantified by MSCT Predicts Emergency Hospitalizations for AF and Arrhythmia Recurrence after Catheter Ablation

Sun, 04 Jun 2023 17:24:44 +0000

ABSTRACT
Introduction: This study aimed to investigate the correlation between multislice computed tomography (MSCT)-derived parameters characterizing atrial enlargement and the frequency of emergency hospitalizations after catheter ablation for atrial fibrillation (AF). Methods: The study included 52 patients with paroxysmal or persistent AF, who presented criteria for interventional rhythm control strategies and underwent MSCT evaluation prior to ablation. Results: The majority of emergency hospital admissions were due to heart failure caused by high-frequency arrhythmia (90.33%), or by cardioembolic complications, causing acute stroke (9.67%). The number of emergency referrals was significantly increased in cases of moderately enlarged left atrial volume (69.23%), and re-admission was necessary for over three quarters of the patients with highly enlarged left atrial volume (76.92%, p = 0.02). The average recurrence rate of AF following ablation therapy was 28.84% during the one-year follow-up, being 0% for volumes <71.33 mL, 32% for volumes between 71.33 mL and 109.5 mL, and 53.84% for volumes >109.5 mL (p = 0.01). Conclusion: A large volume of the left atrium, determined by MSCT, is associated with a higher risk of emergency rehospitalizations following catheter ablation of AF.

The Use of Simulation and Deep Learning Models in the Endovascular Treatment of Ruptured Intracranial Aneurysms: A Case Report

Sat, 03 Jun 2023 16:00:20 +0000

ABSTRACT
Introduction: The current paper presents an examination of the emerging role of deep learning- based simulation software in enhancing preprocedural planning for intracranial aneurysm treatment using flow diverters. Intracranial aneurysms pose significant risk due to their potential rupture leading to life-threatening subarachnoid hemorrhage. Innovative endovascular treatment options like flow diverters, which redirect blood flow and promote healing, are gaining attention. The role of simulation software in optimizing these procedures is becoming increasingly crucial. Case presentation: This study involves a 47-year-old female patient diagnosed with an intracranial aneurysm. Through diagnostic angiography and 3D rotational angiography imaging, the complex aneurysm anatomy was determined and the need for flow diverter placement ascertained. The Sim&Size software was used to simulate the size and placement of the flow diverter, based on the patient’s specific vascular anatomy. The procedure, including the placement of the flow diverter as per the simulation, was successful. Conclusion: The Sim&Size simulation software significantly contributes to the enhancement of intracranial aneurysm treatment planning. By providing patient-specific simulations, it improves procedural precision and reduces the risk of complications, thus potentially optimizing patient outcomes. However, the quality of the simulation is contingent on the accuracy of the input data, and it does not account for physiological dynamics. Despite these limitations, this tool represents a promising development in neurointerventional practice.

Cardiac Resynchronization in the Acute Phase of Decompensated Heart Failure in a Young Patient with Systemic Sclerosis

Zsolt Parajkó, István Kovács, Monica Chițu, Imre Benedek — Fri, 02 Jun 2023 15:56:45 +0000

Cardiac resynchronization therapy is an essential tool for treating patients with heart failure in different types of dilatative cardiomyopathy with bundle branch block. This technique is wildly used with significant benefits in terms of quality of life and effort tolerability along with optimized medical therapy. In spite of its benefits, several factors may influence its efficacy such as etiology, lead position, or device settings. In some cases, the anatomical variance of the coronary sinus could create technical difficulties for advancing the left ventricular lead. This case report describes a female patient presenting with decompensated heart failure, known with complicated sclerosis multiplex and a fibrous tissue in the coronary sinus, which created a critical obstruction leading to impossibility to advance the left ventricular lead. This case underlines the importance of appropriate imaging investigation for optimal interventional approach in these difficult cases.

Multimodality imaging-based therapeutic decision in ischemic cardiomyopathy and ventricular tachycardia – a Case Report

Report Radu Andy Sascău, Alexandra Clement, Cristian Stătescu — Wed, 31 May 2023 08:23:46 +0000

ABSTRACT
Introduction: In patients with ischemic heart disease and coronary chronic total occlusion, it is extremely important to assess the presence of myocardial viability via different cardiac imaging techniques in order to predict a potential functional recovery following revascularization. Multimodality cardiac imaging techniques estimate the risk of sudden cardiac death and personalize patient selection for primary prevention implantable cardioverterdefibrillator therapy. Case presentation: A 61-year-old patient with a history of an extensive anterior myocardial infarction with conservative management (8 years before the current presentation, when the coronary angiography revealed two-vessel chronic total occlusion) presented to our outpatient service for fast-paced palpitations at home and fatigue. At the time of the index hospitalization, the patient refused coronary artery bypass grafting. During this period, he did not undergo any cardiovascular evaluation, but he did follow the pharmacological recommendations from the initial hospital discharge. Given the detection of multiple premature ventricular contractions and numerous episodes of nonsustained ventricular tachycardia during this medical visit, a multimodal imaging evaluation was conducted, which further guided the implementation of a personalized therapy. Conclusions: In patients with ischemic heart failure and coronary chronic total occlusion, presenting with ventricular tachycardia, the therapeutic decision should be based on the results of a multimodality cardiac imaging evaluation.