Influence of Intrinsic Myocardial Conduction on Paced QRS Morphology During Cardiac Resynchronization Therapy Follow up

We report two cases of patients of cardiac resynchronization therapy (CRT) whose ECGs, during follow up, showed different paced QRS morphology as compared to those of immediate post-device implantation. Parameters of leads, including sensitivity and capture thresholds, were unchanged. There was no lead dislodgement confirmed on fluoroscopy. The ECGs obtained in device off mode showed different intrinsic QRS morphology as compared to those of pre-implant morphology. These changes were attributable to electrolyte imbalance in one patient and progressive intraventricular conduction defect in the other. These cases demonstrate that intrinsic myocardial conduction pattern influences paced QRS morphology. Irreversible change in paced QRS morphology may indicate poor prognosis

Permanent pacing across a tricuspid bioprosthesis

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The Impact of Hypothyroidism on Clinical Outcomes in Patients Undergoing Percutaneous Coronary Intervention

Introduction: Hypothyroidism either subclinical (SCH) or overt is independently associated with an increased risk of coronary artery disease (CAD). The combined effects of SCH and overt hypothyroidism on clinical outcomes after percutaneous coronary intervention (PCI) are largely unknown. Aim: The aim of the study is to assess the impact of subclinical and overt hypothyroidism among patients presenting with CAD undergoing PCI. Materials and Methods: A total of 102 patients who were referred to the Madras Medical Mission Hospital for PCI from September 2020 to March 2021 were enrolled in the study. These patients were categorized into three groups. Each group has 34 patients and was followed for one year. Group 1: Patients with normal TSH levels (TSH-0.45 -5mlU/Liter) and euthyroid at T3, T4 levels. Group 2: Patients with subclinical hypothyroidism with elevated TSH levels (TSH=5-15mlU/liter) and normal thyroid with T3, T4 levels. Group 3: Patients with a family history of overt hypothyroidism or high TSH levels(<15mlU/liter) and low T3 and T4 levels [16]. Results: We applied ANOVA to find the PCI outcomes. A p-value of <0.05 was accepted as significant. Age (p-0.03), recent myocardial infarction (p-0.04), diabetes mellitus (p<0.001), HbA1C (p-0.012), and systolic blood pressure (p-0.04) were found to be significant. Post-PCI bleeding complications (p<0.001) during one month, six months, and one-year follow-up were the main observation of the study. Conclusion: The prior history of DM and elevated HbA1c levels observed in the overt hypothyroid group indicate that DM was one of the key factors associated with overt hypothyroidism. Despite the fact that PCI was safe for patients with hypothyroidism, the risk of early post-PCI bleeding was of concern

Consensus document for invasive coronary physiologic assessment in Asia-Pacific countries

Background: Currently, invasive physiologic assessment such as fractional flow reserve is widely used worldwide with different adoption rates around the globe. Patient characteristics and physician preferences often differ in the Asia-Pacific (APAC) region with respect to treatment strategy, techniques, lesion complexity, access to coronary physiology and imaging devices, as well as patient management. Thus, there is a need to construct a consensus document on recommendations for use of physiology-guided percutaneous coronary intervention (PCI) in APAC populations. This document serves as an overview of recommendations describing the best practices for APAC populations to achieve more consistent and optimal clinical outcomes.  Methods and Results: A comprehensive multiple-choice questionnaire was provided to 20 interven- tional cardiologists from 10 countries in the APAC region. Clinical evidence, tips and techniques, and clinical situations for the use of physiology-guided PCI in APAC were reviewed and used to propose key recommendations. There are suggestions to continue to develop evidence for lesion and patient types that will benefit from physiology, develop directions for future research in health economics and local data, develop appropriate use criteria in different countries, and emphasize the importance of education of all stakeholders. A consensus recommendation to enhance the penetration of invasive physiology-based therapy was to adopt the 5E approach: Evidence, Education, Expand hardware, Economics and Expert consensus.  Conclusions: This consensus document and recommendations support interventional fellows and cardiologists, hospital administrators, patients, and medical device companies to build confidence and encourage wider implementation of invasive coronary physiology-guided therapy in the APAC region.

Zero contrast optical coherence tomography–guided percutaneous coronary intervention for in-stent restenosis of the saphenous vein graft using a non-contrast flush medium

Percutaneous coronary intervention (PCI) is often denied for individuals with coronary artery disease who are prone to develop contrast-induced acute kidney injury. We report a 73-year-old, stage 3 chronic kidney disease patient (CKD), who underwent coronary artery bypass surgery and saphenous vein graft (SVG) stenting in the past, presented with in-stent restenosis (ISR) of SVG stent. Zero contrast optical coherence tomography (OCT) guided–PCI was successfully performed using low molecular weight dextran-40 (LMWD-40) as the flush medium. Our report suggests the safety and feasibility of LMWD-40–based OCT-guided zero contrast PCI in ISR of SVG in a CKD patient, although further prospective studies are needed to evaluate this technique. Keywords: Zero contrast, Optical coherence tomography, Dextran-40, Chronic kidney disease, Percutaneous coronary intervention, Contrast induced-Acute kidney injur

Catheter ablation of atrial arrhythmias in a patient with surgically corrected congenital heart disease and inferior vena cava interruption

AbstractA 15year old girl who underwent surgical correction of ventricular septal defect and patent ductus arteriosus ligation in childhood presented with atrial tachycardia of crista terminalis origin and counterclockwise atrial flutter. She also had associated interruption of inferior vena cava which continued as azygous vein and left superior vena cava which drained via coronary sinus into the right atrium. She underwent radiofrequency ablation of both the tachycardias via internal jugular vein and azygous vein approach using 3D electroanatomical mapping system