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60 Figure 1Referring diagnosis[Figure omitted. See PDF]Abstract 60 Figure 2Procedures[Figure omitted. See PDF]Abstract 60 Figure 3Discharges[Figure omitted. See PDF]ConclusionsThe opening of a second cath lab in our tertiary centre helped to improve patient flow, reduce waiting times for procedures, reduce admission lengths and reduce cost to the hospital. These are all important factors as our health service struggles to come to terms with the economic and organisational impact of the COVID-19 pandemic.
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57 Figure 1(Left to Right): lA Fluroscopic Image Showing ICE Catheter (Circled) On Left. lB: ICE Catheter on Left, Amplatzer Delivery Sheath On Right Deploying Amulet LAAO Device. 1C Contrast Image Post Deployment of LAAO Device Showing No Opacification of Left Atrial Appendage with Contrast, Indicative of Satisfactory Occlusion of LAA[Figure omitted. See PDF]Abstract 57 Table 1Baseline patient characteristicsICE Guided (n=25) TOE Guided (n=24) Age 76 ± 6.07 78.58 ± 6.63 Sex M(%)/F(%) 18(72%)/7(28%) 19(79%)/5(21%) CHA2DS2-VASc 3.84 ± 1.08 3.75 ± 0.92 HASBLED 2.96 ± 0.72 2.875 ± 0.88 Baseline Haemoglobin 12.53 ± 1.69 13.175 ± 1.48 Baseline Creatinine 91.72 ± 22.21 100.5 ± 28.57 Indication for LAA occlusion: -Intracranial Haemorrhage (%) 9(36%) 3 (12.5%) -GI Bleeding (%) 13 (52%) 15 (62.5%) -Epistaxis (%) 1 (4%) 1 (4.2%) -Stroke on NOAC Therapy (%) 1 (4%) 0 (0%) -Haematuria (%) 1 (4%) 2 (8.4%) -Other (%) 0 (0%) 3 (12.5%) ± Values Refer to Standard Deviation from the Mean Value.Abstract 57 Table 2Primary and second endpoints ICE Guided (n=25) TOE Guided (n=24) P Value* Primary Endpoints: Successful Implantation (%) 24 (96%) 24 (100%) 0.312 Procedure Related Death (%) 0 (0%) 0 (0%) N/A Secondary Endpoints: Fluroscopy Time (Mins) 41.64 ± 13.39 63.08±14.93 <0.001 Procedure Time (Mins) 127.56 ± 49.32 184.92 ± 63.16 <0.001 Haematoma (%) 0 (0%) 2 (8.33%) 0.235 LOS 2.6 ± 1.55 2.9 ± 1.15 0.03 Cardiac Arrest (%) 0 (0%) 1 (4.16%) 1.00 Pericardial Effusion (%) 1 (4%) 1 (4.16%) 1.00 Tamponade (%) 1 (4%) 0 (0%) 1.00 Peri-Device Leak (%) 1 (4%) 1 (4.16%) 1.00 Device Embolisation (%) 0 (0%) 1 (4.16%) 0.490 ± Vaules Refer to Standard Deviation from the Mean.*P Value from Mann Whitney U Test/Fishers Exact/T-Test as detailed in methods.*P Value <0.05 was determined to be statistically significant.ConclusionICE guided LAA occlusion leads to shorter hospital length of stay, procedure time and reduces time spent under fluoroscopy compared with TOE guided LAA occlusion. There was no statistically significant variations in the procedural complications between the two groups. ICE guided LAA occlusion removes the need for GA, making procedures logistically less challenging and eliminating the need for an aerosol generating procedure (TOE). In the current climate of a global Covid-19 pandemic which has limited access to ICU beds and anaesthetic support, ICE guided LAAO is a safe and cost effective alternative for stroke prevention to TOE guided LAAO in patients with high CHA2DS2-VASc scores and contraindications to oral anticoagulation. We will continue to follow these patients with gated CT Aorta to ascertain the incidence of device leak.
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Background Delayed hospital presentation with STEMI during the SARS-CoV-2 pandemic can lead to increased incidence of typically rare mechanical sequelae. Intramyocardial dissecting hematoma (IDH) is one such complication of myocardial infarction. Case A 51 year-old male patient with a background of hypertension presented with a 7 hour history of typical chest pain. His initial ECG showed anterolateral ST segment elevation with reciprocal ST depression in the inferior leads, consistent with STEMI. Urgent angiography revealed a 100% acute occlusion in the mid-LAD. TIMI 3 flow was restored using a Xience 3.00 x 18mm stent, with resolution of pain and interval ECG improvement. Laboratory investigations revealed new significant anaemia. Decision-making Post-procedural transthoracic echocardiography revealed severely impaired systolic function and moderate concentric biventricular hypertrophy, and raised the suspicion of a mechanical complication (see image). This was further supported by his delayed presentation and extensive infarct area. His anaemia was suggestive of active haemorrhage. Endoscopic investigation failed to show a gastrointestinal source. Cardiac MRI (CMR) confirmed the presence of IDH. Conclusion This case highlights the need for a heightened index of suspicion for typically rare mechanical complications post-STEMI due to delayed hospital presentation during the current pandemic, as well as the growing utility of multimodality imaging such as CMR. [Formula presented]