Right atrium blood cyst in a patient with hypertrophic cardiomyopathy

Background: Intracardiac blood cysts are generally observed in infants and regress spontaneously with time. Blood cysts are mainly located on the left side of the heart and atrioventricular valves. These findings are extremely rare in older children and adults. We report a rare case of blood cyst in the right atrium of an adult patient with hypertrophic cardiomyopathy. Case presentation: We present a case of a 45-year-old female patient with a cardiac blood cyst in the right atrium and hypertrophic cardiomyopathy. Despite the successful percutaneous alcohol septal ablation for hypertrophic obstructive cardiomyopathy, the patient died before scheduled ICD implantation. Conclusion: We reported a rare case of a 45-year-old female patient with a cardiac blood cyst in the right atrium and hypertrophic obstructive cardiomyopathy. To the best of our knowledge, this is the first-ever case report in the literature of blood cyst and hypertrophic cardiomyopathy. Characterisation of an atrial blood cyst using multimodality imaging is recommended. There is no consensus on the optimal management of cardiac blood cysts. Cardiac blood cysts are rarely detected preoperatively and should be included in the differential diagnosis of cardiac masses

Quantitative evaluation of temporal episode patterns in paroxysmal atrial fibrillation

Flow velocity in left atrial appendage decreases when paroxysmal atrial fibrillation (PAF) progresses to longer episodes, suggesting that the temporal PAF episode pattern may be related to risk of thrombus formation. This study investigates the feasibility of discriminating episode patterns based on two descriptors: the aggregation characterizes the temporal distribution of PAF episodes, whereas the Gini coefficient characterizes differences in episode duration. The descriptors were studied on three PhysioNet databases with annotated PAF episodes, resulting in a total of 102 recordings. Three types of patterns were defined: congregation of several episodes in a single and multiple clusters, and episodes dispersed over the entire monitoring period. The results show that the aggregation descriptor achieves large values for patterns with a single and multiple clusters (0.76± 0.07 and 0.60± 0.08, respectively). In contrast, much lower values are obtained for dispersed episode patterns (0.10± 0.05). The Gini coefficient is better suited for discriminating among the patterns with high PAF burden and, therefore, represents a descriptor which is complementary to aggregation. Both descriptors may have relevance when studying the relationship between episode pattern and the risk of thrombus formation

Impact of single versus double transseptal puncture on outcome and complications in pulmonary vein isolation procedures

Background: The aim of the current study was to analyze the impact of single versus double transseptal puncture (TSP) for atrial fibrillation (AF) ablation. Methods: Consecutive patients undergoing AF ablation were prospectively included in the AF ablation registry and were analyzed according to single versus double TSP. Results: A total of 478 patients (female 35%, persistent AF 67%) undergoing AF ablation between 01/2014 and 09/2014 were included. Single TSP was performed in 202 (42%) patients, double TSP in 276 (58%) patients. Age, gender, body mass index, CHA2DS2-VASc score, left ventricular ejection fraction and operator experience (experienced operator defined as ≥ 5 years of experience in invasive electrophysiology) were equally distributed between the two groups. Repeat procedures (re-dos) were more frequently performed using single TSP access (p < 0.001). Left atrial (LA) diameter was larger in patients with double TSP (p = 0.001). Procedure duration in single TSP was identical to double TSP procedures (p = 0.823). Radiation duration was similar between the two groups (p = 0.217). There were 49 (10%) patients with complications after catheter ablation. There were no differences between complication rates and TSP type (p = 0.555). Similarly, recurrence rates were comparable between both TSP groups (p = 0.788). Conclusion: There was no clear benefit of single or double TSP in AF ablation

High prevalence of atrial fibrillation in a Lithuanian stroke patient cohort

Background and Objectives: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with a five-fold increased risk for acute ischemic stroke (AIS). We aimed to estimate the prevalence of AF in a Lithuanian cohort of stroke patients, and its impact on patients regarding case fatality, functional outcome, and health-related quality of life (HRQoL) at 90 days. Materials and Methods: A single-center prospective study was carried out for four non-consecutive months between December 2018 and July 2019 in one of the two comprehensive stroke centers in Eastern Lithuania. A telephone-based follow-up was conveyed at 90 days using the modified Rankin Scale (mRS) and EuroQoL five-dimensional three-level descriptive system (EQ-5D-3L) with a self-rated visual analog scale (EQ-VAS). One-year case fatality was investigated. Results: We included 238 AIS patients with a mean age of 71.4 ± 11.9 years of whom 45.0% were female. A striking 97 (40.8%) AIS patients had a concomitant AF, in 68 (70.1%) of whom the AF was pre-existing. The AIS patients with AF were at a significantly higher risk for a large vessel occlusion (LVO; odds ratio 2.72 [95% CI 1.38–5.49], p = 0.004), and had a more severe neurological impairment at presentation (median NIHSS score (interquartile range): 9 (6–16) vs. 6 (3–9), p < 0.001). The LVO status was only detected in those who had received computed tomography angiography. Fifty-five (80.9%) patients with pre-existing AF received insufficient anticoagulation at stroke onset. All patients received a 12-lead ECG, however, in-hospital 24-h Holter monitoring was only performed in 3.4% of AIS patients without pre-existing AF. Although multivariate analyses found no statistically significant difference in one-year stroke patient survival and favorable functional status (mRS 0–2) at 90 days, when adjusted for age, gender, reperfusion treatment, baseline functional status, and baseline NIHSS, stroke patients with AF had a significantly poorer self-perceived HRQoL, indicated by a lower EQ-VAS score (regression coefficient ± standard error: β = −11.776 ± 4.850, p = 0.017). Conclusions: In our single-center prospective observational study in Lithuania, we found that 40.8% of AIS patients had a concomitant AF, were at a higher risk for an LVO, and had a significantly poorer self-perceived HRQoL at 90 days. Despite the high AF prevalence, diagnostic tools for subclinical AF were greatly underutilized

Mitigating arrhythmia risk in Hydroxychloroquine and Azithromycin treated COVID-19 patients using arrhythmia risk management plan

Aims: To assess cardiac safety in COVID-19 patients treated with the combination of Hydroxychloroquine and Azithromycin using arrhythmia risk management plan. Methods and results: We retrospectively examined arrhythmia safety of treatment with Hydroxychloroquine and Azithromycin in the setting of pre-defined arrhythmia risk management plan. The data was analyzed using R statistical package version 4.0.0. A two-tailed p-value<0.05 was considered significant. 81 patients were included from March 23rd to May 10th 2020. The median age was 59 years, 58.0% were female. The majority of the study population (82.7%) had comorbidities, 98.8% had radiological signs of pneumonia. Fourteen patients (17.3%) experienced QTc ≥ 480 ms and 16 patients (19.8%) had an increase of QTc ≥ 60 ms. Seven patients (8.6%) had QTc prolongation of ≥ 500 ms. The treatment was discontinued in 4 patients (4.9%). None of the patients developed ventricular tachycardia. The risk factors significantly associated with QTc ≥ 500 ms were hypokalemia (p = 0.032) and use of diuretics during the treatment (p = 0.020). Three patients (3.7%) died, the cause of death was bacterial superinfection with septic shock in two patients, and disseminated intravascular coagulation with multiple organ failure in one patient. None of these deaths were associated with cardiac arrhythmias. Conclusion: We recorded a low incidence of QTc prolongation ≥ 500 ms and no ventricular tachycardia events in COVID-19 patients treated with Hydroxychloroquine and Azithromycin using cardiac arrhythmia risk management plan