Quadripolar Left Ventricular Lead in a Patient with CRT-D Does Not Overcome Phrenic Nerve Stimulation

Effective cardiac resynchronization therapy (CRT) requires an accurate atrio-biventricular pacing system. The innovative Quartet lead is a quadripolar, over-the-wire left ventricular lead with four electrodes and has recently been designed to provide more options and greater control in pacing vector selection. A lead with multiple pacing electrodes is a potential alternative to physical adjustment of the lead and may help to overcome high thresholds and phrenic nerve stimulation (PNS)

Diagnostic Value of Dynamic Contrast-Enhanced Magnetic Resonance Imaging in the Evaluation of the Biliary Obstruction

Purpose. In this study, our purpose was to investigate the diagnostic efficacy of the dynamic contrast-enhanced magnetic resonance imaging (MRI) method in the patients with bile duct obstruction. Materials and Methods. 108 consecutive patients (53 men, 55 women, mean age; 55.77 ± 14.62, range 18–86 years) were included in this study. All the patients underwent conventional upper abdomen MRI using intravenous contrast material (Gd-DTPA) and MRCP in 1.5 Tesla MRI scanner. MRCP images were evaluated together with the T1 and T2w images, and both biliary ducts and surrounding tissues were examined for possible pathologies that may cause obstruction. Results. MRI/MRCP findings compared with final diagnoses, MRI/MRCP in the demonstration of bile duct obstruction sensitivity 96%, the specificity 100%, and accuracy 96.3%, in the detection of presence and level of obstruction, the sensitivity 96.7%, specificity 100%, and accuracy 97.2%, in the diagnosis of choledocholithiasis, the sensitivity 82.3%, specificity 96%, and accuracy 91.7%, and in the determination of the character of the stenosis, sensitivity 95.6%, specificity 91.3%, and accuracy 94.5% were found. Conclusion. The combination of dynamic contrast-enhanced MRI and MRCP techniques in patients with suspected biliary obstruction gives the detailed information about the presence of obstruction, location, and causes and is a highly specific and sensitive method

Transcatheter Aortic Valve Implantation: Our Experience and Review of the Literature

Transcatheter Aortic Valve Implantation [TAVI] is widespread worldwide as an alternative therapy procedure to the patients suffering from severe aortic valve stenosis. However, we shouldn’t forget that the conventional surgical aortic valve replacement is still the gold standard therapy for severe aortic valve stenosis. For the patients who cannot be treated conventionally because of high risk comorbid diseases and older age, TAVI is an effective alternative therapy method. The indications should be limited, concerning the high mortality rate, 10% within 30 days of intervention. Long term efficacy data are still inadequate. Although the indications are restricted to older patients with a STS score >10 or log-Euro Score >20, age is not a definite indication for this treatment. The patients should be assessed by a heart team including a non-interventional cardiologist, interventional cardiologist, cardiac anesthesiologist and cardiac surgeon according to their general status, frailty and STS- Euro score. In other words, assessment and treatment of the patient by a heart team is the main factor besides the limited power of the scoring systems. The treatment should be applied to the patients with an aortic annulus diameter between 18-27 mm and a life expectancy of at least over 1 year. The currently ongoing investigations are focused on parameters like safety, efficiency and long term reliability of TAVI. The scientific and technical developments lead to new definitions and parameters regarding the treatment indications of severe aortic valve stenosis. In this review, we present the actual data about TAVI and also our own experiences

Cardiac arrhythmias in patients with SARS-CoV‑2 infection and effects of the lockdown on invasive rhythmological therapy

Background!#!Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, various strategies have been taken worldwide to reduce the risk of infection. As part of the amendment to the Infection Protection Act, elective medical interventions were restricted, leading to a change in patient care. However, the consequences of the lockdown on the treatment of rhythmological patients in Germany remains unclear.!##!Objectives!#!The aim of this study was to analyze the reduction in rhythmological interventions and the patient care situation using a nationwide survey during the first lockdown period.!##!Methods!#!A survey was sent to all electrophysiological centers certified by the German Society of Cardiology. Here, the treatment volume of tachycardia and bradycardia and their invasive therapy were surveyed before and during the lockdown period. Furthermore, the number of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) treated at these centers and the incidence of cardiac arrhythmias was also recorded.!##!Results!#!Participating centers performed a total of 24,648 ablation procedures/year and represent approximately 34% (24,648/72,548) of the estimated German ablation treatments. The majority of these centers (33/40; 82.5%) were so-called primary COVID-19 hospitals (level-1). Overall, the number of ablations and pacemaker implantations were reduced by 41% and 18% respectively. Due to postponed ablation procedures and pacemaker implantations, 22/40 (55%) centers reported a worsening of clinical symptoms or early re-hospitalization of their patients.!##!Conclusion!#!These results demonstrate a significant decline in elective rhythmological procedures during the lockdown, as required by the German Federal Government. At the same time, however, more than half of the participating centers reported an increase in patient re-hospitalizations due to postponed procedures

MRI of Pancreas in Patients with Chronic Pancreatitis and Healthy Volunteers: Can Pancreatic Signal Intensity and Contrast Enhancement Patterns be Valuable Predictors of Early Chronic Pancreatitis?

WOS: 000415813000007Background: Chronic pancreatitis is a progressive inflammatory disease of the pancreatic parenchyma and ductal structures. Typical MR imaging features of chronic pancreatitis include dilatation of the main pancreatic duct and irregularities of branch pancreatic ducts that can be evaluated with MRCP, loss of the normal high signal intensity of the pancreatic parenchyma on T1-weighted images, and decreased enhancement on dynamic contrast-enhanced sequences. Objective: The aim was to evaluate the parenchymal MRI findings of the pancreas in conjunction with MRCP in patients with chronic pancreatitis and normal healthy subjects. Methods: MRI and MRCP findings of 90 consecutive patients with chronic pancreatitis and 26 healthy volunteers were evaluated in this study. Patients were divided into five groups according to Cambridge classification system considering ERCP, MRCP, CT, US and EUS findings. On MRI, signal intensity ratios of the pancreas and the spleen on unenhanced T1 weighted fat saturated spoiled gradient echo images (SIR P/S) along with the enhancement ratio between the arterial phase and the portal venous phase (SIR A/V) were calculated and their frequency in each Cambridge score were documented. MRI findings in normal subjects were compared to patients with chronic pancreatitis. Results: MRCP findings were normal and pancreatic signal intensity was higher than spleen (SIR P/S > 1) in 26 healthy control subjects. Mean pancreas signal in control group (SIR P/S; 1.48 +/- 0.13) was significantly higher (P < 0,001) than mean signal intensity in patients with chronic pancreatitis (SIR P/S; 1.18 +/- 0.24). In the control group, the highest contrast enhancement occurred in arterial phase (SIR A; 1.7 +/- 0.32) and this was significantly higher (P < 0,001) than portal venous phase (SIR V; 1.45 +/- 0.28). In chronic pancreatitis group, the highest contrast enhancement occurred in portal venous phase (SIR V; 1.56 +/- 0.18) but there was no statistically significant difference (P = 0.06) compared to arterial phase (SIR A; 1.51 +/- 0.21). Mean SIR A/V values of control group were 1.18 +/- 0.08, and SIR A/V values of patients with chronic pancreatitis were 0.97 +/- 0.12 respectively. Mean SIR A/V value in control group was statistically higher than patients with chronic pancreatitis (P < 0.05). Between the control group and patients with chronic pancreatitis in terms of SIR statistically significant differences were found SIR P/S (Spearman correlation coefficient (rs) = -0.76, P < 0.001), SIR A (rs = -0.28, P = 0.003), SIR V (rs = 0.43, P < 0.001), SIR LV (rs = 0.54, P < 0.001) and SIR A/V (rs = -0.68, P < 0.001). Conclusion: In our study, MRI findings were significantly different in subjects with chronic pancreatitis compared to the control group. MRI findings correlated well with the ductal changes according to Cambridge classification. However, MRI findings may occur prior to ductal changes