Percutaneous carillon mitral contour system deployment followed by crt-d implantation: first case report from oman

Mitral valve regurgitation [MR] is a common problem in patients with cardiac issues especially those with dilated cardiomyopathy [DCM] due to mitral annular dilatation and malcoaptation of the mitral valve leaflets. Although DCM is associated with high mortality rates, there has been no global agreement about the best method of treatment. Treatment of MR in such cases can be done by surgery, which has many limitations due to high-risk concerns. MR may also be managed by other alternatives such as mitral-clip and transcoronary venous mitral annuloplasty using the Carillon Mitral Contour System . Combined therapy with a cardiac resynchronization therapy defibrillator [CRT-D] and mitral contour can be used in such cases with valuable improvement in general condition in many patients. In our case, we used the Carillon Mitral Contour System for treatment of severe MR in a 64-year-old patient with severely impaired systolic function after implantation of a CRT-D

Gulf implantable cardioverter-defibrillator registry: rationale, methodology, and implementation

Background: The implantable cardioverter-defibrillator [ICD] is effective in the prevention of sudden cardiac death in high-risk patients. Little is known about ICD use in the Arabian Gulf. We designed a study to describe the characteristics and outcomes of patients receiving ICDs in the Arab Gulf region

Methods: Gulf ICD is a prospective, multi-center, multinational, and observational study. All adult patients 18 years or older, receiving a de novo ICD implant and willing to sign a consent form will be eligible. Data on baseline characteristics, ICD indication, procedure and programing, in-hospital, and 1-year outcomes will be collected. Target enrollment is 1500 patients, which will provide adequate precision across a wide range of expected event rates

Results: Fifteen centers in six countries are enrolling patients [Saudi Arabia, United Arab Emirates, Kuwait, Oman, Bahrain, and Qatar]. Two-thirds of the centers have dedicated electrophysiology laboratories, and in almost all centers ICDs are implanted exclusively by electrophysiologists. Nearly three-quarters of the centers reported annual ICD implant volumes of

Conclusions: Gulf ICD is the first prospective, observational, multi-center, and multinational study of the characteristics and, the outcomes of patients receiving ICDs in the Arab Gulf region. The study will provide valuable insights into the utilization of and outcomes related to ICD therapy in the Gulf region

Dual-site right ventricular and left ventricular pacing in a patient with left ventricular systolic dysfunction and atrial fibrillation using a standard CRT-D device

In patients undergoing cardiac resynchronization therapy with defibrillator [CRT-D] implantation for left ventricular systolic dysfunction [LVSD] accompanied by permanent atrial fibrillation [AF], generally, the unused atrial port is plugged at device implantation. We describe an alternative use for the atrial-port in this case report. A 43 year old gentleman with LVSD due to left ventricular non-compaction [LVNC] and AF of unknown duration underwent a CRT-D implantation after optimization of cardiac failure treatment. The atrial-port which would otherwise have been plugged was connected to a high right ventricular septal [RVS] pacing-lead and the shock-lead was positioned at the right ventricular apex [RVA]. This approach permitted modified cardiac resynchronization in a high RVS to left ventricular [LV] and RVA pacing sequence using the high RVS and LV pacing combined with a shock vector including the RV apex. A standard CRT-D device with a minimum programmable A-V delay of 30 ms [technically RVS to LV delay in the 'DDD' pacing mode] was used. The device was programmed to a 'DDD' pacing mode [sequential multi-site ventricular pacing with some programmability]. The mode switch operation was programmed 'OFF' since atrial sensing is unavailable. Device-delivered shocks did not cardiovert the patient back to sinus rhythm suggesting that the AF was permanent [no prior cardioversion attempts were made on the presumption that the chances of maintaining sinus rhythm, given the underlying cardiac condition, were low]. Subsequently, the patient required radio-frequency ablation of the atrio-ventricular node for conducted AF. Symptomatic, echocardiographic and radiological improvement preceded atrio-ventricular node ablation. Amongst AF patients with permanent AF undergoing CRT-D implantation, those patients who are likely to have the CRT-D device atrial-ports plugged could benefit from having both the options of [i] a RVA shock vector as well as [ii] a high RVS-pacing feasible, by utilizing the atrial-port of a conventional CRTD device for a RVS pacing lead, should a RVA shock-lead position be preferred. New device programming algorithms will be necessary to make patient-customized programming in this lead configuration flexible, more useful clinically and easy