ABSTRACT
Introduction: There is a distinct unmet need in structured, curriculum based, unbiased education in neuromodulation. Current teaching is through sporadic industry workshops, cadaver courses and peer proctorship. The COVID pandemic has created a unique opportunity where online platforms have enabled education to be delivered remotely in both synchronous and asynchronously. The William Harvey Research Institute, Queen Mary University, London, UK have initiated University based accreditation- Post Graduate Certificate in neuromodulation (PGCert) that provides candidate a qualification in one academic year through part-time study. Method(s): The program underwent rigorous staged university approval process (figure 1). To ensure market feasibility, two short proof of concept CPD programs "Executive Education in Neuromodulation (EEPIN)" were delivered in 2021. These courses attracted 87 candidates across Australia, Singapore, India, Germany, Poland, Czech Republic, Ireland, and UK. The faculty includes key opinion leaders that will deliver the program ensuring the candidates gain academic background and specialist skills to understand safe practice of neuromodulation. The PGCert advisory board has been established to ensure strict governance in terms of content and unbiased delivery confirming ACCME guidance. In order to obtain PGCert, candidates are required to complete 4 x 15 credit modules (60 credits). The four modules include Anatomy & Neurophysiology;Patient care and Procedurals skills;Devices and available technology;Intrathecal drug delivery for cancer and non-cancer pain. The modular nature of the program is designed to provide cumulative knowledge, from basic science to clinical application in line with the best available evidence. The modules comprise nine lectures, spreading over three consecutive days, followed by a written assignment with 40 direct contact hours in each module. The webpage can be accessed at Results: The anonymous data from EEPIN reported on Likert scale 1-5: Objectives defined 30.6% - 4 and 69.4% -5;Relevance of topics 10.2%- 4 and 89.8% -5;Content of presentations 22.4%- 4 and 77.6% -5;Organization 24.5% -4 and 69.4% -5;Candidate faculty interaction 14.3% -4 and 81.6% -5. 97% of the EEPIN candidates recommended the program to others whilst 81.8% expressed their strong interest to enroll for university-based post graduate qualification if offered. Conclusion(s): This PGcert Neuromodulation is a unique, university accredited program that provides qualification in neuromodulation with access to a flexible online e-learning platform to discuss and exchange ideas, share knowledge in candidate's own time. This will support the ongoing need for formal curriculum-based education in neuromodulation. Disclosure: Kavita Poply, PHD: None, Phillippe Rigoard: None, Jan Kallewaard, MD/PhD: None, FRANK J.P.M. HUYGEN, MD PhD: ABBOTT: Speakers Bureau:, Saluda: Consulting Fee:, Boston Scientific: Consulting Fee:, Grunenthal: Speakers Bureau:, Pfizer: Speakers Bureau:, Ashish Gulve, FRCA, FFPMRCA, FFPMCAI, DPMed, FCARCSI, MD, MBBS: None, Ganesan Baranidharan, FRCA: None, Sam ELDABE, MD, FRCA, FFPMRCA: Medtronic: Consulting Fee:, Medtronic: Contracted Research:, Mainstay Medical: Consulting Fee:, Saluda Medical: Consulting Fee:, Boston Scientific: Contracted Research:, Saluda Medical: Contracted Research:, James Fitzgerald, MA,PhD: St Jude Medical: Consultant: Self, Medtronic: Consulting Fee:, UCB: Contracted Research:, Merck: Contracted Research:, Serge Nikolic, MD: None, Stana Bojanic, BSc MBBS FRCS (SN): Abbott: Contracted Research:, Habib Ellamushi: None, Paresh Doshi, MS MCh: None, Preeti Doshi, MBBS, MD, FRCA: None, Babita Ghai, MBBS, MD, DNB: None, Marc Russo, MD: Presidio Medical: Ownership Interest:, Saluda Medical: Ownership Interest:, Boston Scientific: Contracted Research: Self, Mainstay Medical: Contracted Research: Self, Medtronic: Contracted Research: Self, Nevro: Contracted Research: Self, Saluda Medical: Contracted Research: Self, Presidio Medical: Contracted Research: Self, Freedom Ne ro: Ownership Interest - Own Stocks: Self, Lungpacer: Ownership Interest - Own Stocks: Self, SPR Therapeutics: Ownership Interest - Own Stocks: Self, Lawrence Poree, MD,MPH,PHD: Medtronic: Consulting Fee: Self, Saluda Medical: Contracted Research: Family, Nalu Medical: Contracted Research: Family, Gimer Medical: Consulting Fee: Self, Nalu Medical: Consulting Fee: Self, Saluda Medical: Consulting Fee: Self, Nalu: Ownership Interest:, Saluda Inc: Ownership Interest:, Alia Ahmad: None, Alaa Abd Sayed, MD: Medtronic, Abbott, SPR and StimWave: Consulting Fee:, Salim Hayek, MD,PhD: None, CHRISTOPHER GILLIGAN, MD MBA: Persica: Consulting Fee: Self, Saluda: Consulting Fee: Self, Mainstay Medical: Contracted Research: Self, Sollis Therapeutics: Contracted Research: Self, Iliad Lifesciences, LLC: Owner: individuals with legal ownership in a company:, Vivek Mehta: NoneCopyright © 2023
ABSTRACT
Introduction: Bart's Neuromodulation Centre is a center of excellence for research and innovation. In the UK, the NICE 159 guidelines have highlighted the importance of psychological and multidisciplinary assessment to ascertain the suitability of patients for Neuromodulation. The global pandemic of Covid-19 has had far-reaching physical, psychological, and socioeconomic implications. Despite the various limitations of running services during a pandemic, Barts Neuromodulation Centre maintained the importance of multidisciplinary assessment in the selection of patients suitable for this form of therapy. This paper presents psychological wellbeing outcomes of neuromodulation patients during this unprecedented period. Method(s): Data collection was gathered remotely between January 2021 to December 2021.N=178 completed questionnaires. The mean age was 55 years and 63% were female. Data was collected at baseline and in addition, post-implant data was obtained at 1,3,6 and 12 month follow up. As per NHS England outpatient guidance (2020), all data was completed remotely. All collected data was anonymized and data was stored on an encrypted database. Result(s): Results showed a 78% decrease in depression scores from baseline to 2 years+ and a 76% decrease in anxiety scores from baseline to 2 years+. Conclusion(s): The data demonstrates significant improvements in psychological wellbeing as shown in depression and anxiety scores after SCS therapy. Despite the global pandemic, there remains a strong demand for SCS and encouragingly showed significant improvements in psychological wellbeing. It would be useful to explore ways to improve patient compliance and explore broader parameters of outcomes. Disclosure: Angie Alamgir, PHD: None, Serge Nikolic, MD: None, Habib Ellamushi: None, Amin Elyas, FRCS: None, Joanne Lascelles, Clinical nurse specialist: None, Kavita Poply, PHD: None, Sanskriti Sharma: None, Alia Ahmad, MSc: None, Vivek Mehta: NoneCopyright © 2023
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Introduction: Covid-19 was classed as a global pandemic by the World Health Organization (WHO) in March 2020. This had an overwhelming effect on the National Health Services (NHS) in the United Kingdom resulting in the disruption and subsequent prioritization of the elective recovery services. Despite the various limitations of delivering services during a pandemic, Barts Neuromodulation Centre maintained the importance of multidisciplinary assessment in the selection of patients suitable for this form of therapy. We present the data on our continued activity through pandemic, dependent on the performance feasibility. The aim of this effectiveness project was to evaluate the post SCS outcome data during covid-19 pandemic. Method(s): This was a telephone and in person data collection of patient responses to standardized and validated pain outcome questionnaires following SCS implant performed at St Bartholomew's Hospital, London during January-December 2021. Data was collated from a tertiary Neuromodulation center at Barts Health NHS Trust, UK. Patients completed the questionnaires prior to SCS implant and post implant 1, 3, 6, and 12 month follow- up appointments with our neuromodulation specialists Results: Two hundred and fifteen patients underwent face to face or telephonic consultation during January to December 2021 for the follow ups. Total 178 patients registered their responses with F:M being 63%:37% and the average age 55 years. At each time point, the following number of patients completed: baseline n= 52;1 month n= 27;3 months n=28;6-month n= 21 and 12 months, n= 26. We demonstrate that NRS pain scores reduced by 43%, ODI disability improved by 35%, HADS anxiety reduced by 45%, depression reduced by 46%, PSQ sleep improved by 77% and EQ5D quality of life improved by 66% at 12 months when compared to baseline. There were no serious adverse events reported through this time. Conclusion(s): To our knowledge, this is one of the first reported real-world post SCS outcome data of prospective follow ups. We demonstrate safe delivery of services and data collection feasibility through pandemic. Moreover, our patient cohort showed improvement in the all dimensions of chronic refractory pain following SCS therapy despite clinical burden of COVID-19. Disclosure: Alia Ahmad: None, Angie Alamgir, PHD: None, Sanskriti Sharma: None, Joanne Lascelles, Clinical nurse specialist: None, Amin Elyas, FRCS: None, Helen Bonar: None, Serge Nikolic, MD: None, Habib Ellamushi: None, Vivek Mehta: None, Kavita Poply, PHD: NoneCopyright © 2023
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Background: Among patients with COVID-19 infection, the risk of adverse cardiovascular outcome, particularly myocarditis and dysrhythmias remain elevated at least up to one year after infection. We present a case of atrial tachycardia and atrial Torsades de Pointes from COVID myocarditis, persisted 6 months after infection, which was successfully managed by ablation. Objective(s): A 25-year-old female presented with mild COVID-19 infection, Omicron variant, in May 2022. One month after, her Covid infection resolved;she presented with symptomatic atrial tachycardia, paroxysmal atrial fibrillation and flutter. ECG showed multiple blocked premature atrial contractions (PAC) (Figure 1A). Holter monitor showed PAC triggered atrial tachycardia degenerating to paroxysmal atrial fibrillation, atrial Torsades de Pointes. She has mild persistent troponin elevation. Echocardiography was normal. Cardiac MRI showed evidence of mild myocarditis with subepicardial late Gadolinium enhancement (LEG) along the lateral mid-apical left ventricular wall and edema. (Figure 1B). She was treated with Colchicine for 2 months. Repeat cardiac MRI 4 months after COVID infection showed resolution of edema and LGE. However, her symptomatic PAC and atrial tachycardia did not respond to betablocker and amiodarone. She underwent electrophysiology study. Activation mapping of PAC using CARTO revealed earliest activation at the right anterior atrial wall, with close proximity to tricuspid valve;unipolar signal showed QS pattern, bipolar signal showed 16 msec pre-PAC (Figure 1C and 1D). Mechanical pressure from ThermoCool SmartTouch ablation catheter (Biosense Webster Inc.) at this site suppressed the PAC. Radiofrequency ablation resulted with an initial acceleration and then disappearance of the PAC. We did not isolate pulmonary veins or ablate cavotricuspid isthmus. Post ablation, PAC and atrial fibrillation were not inducible on Isoproterenol. Method(s): N/A Results: Covid myocarditis can result in dysrhythmia that lingers long after Covid myocarditis has resolved. Covid myocarditis can be caused by direct viral invasion of myocytes or more commonly is inflammatory related to cytokine release and edema. Our case demonstrates that dysrhythmias can persist despite resolution of myocarditis. Catheter ablation can successfully to treat these arrhythmias. Conclusion(s): This case highlights the importance of recognizing cardiac dysrhythmia as possible the long-term cardiac complications of COVID-19, requiring specific treatment such as catheter ablation. [Formula presented]Copyright © 2023
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Introduction: Smokers are at increased risk of developing viral infections and more severe outcomes than are nonsmokers. Objectif: To evaluate the effect of current smoking on the prognostic of COVID19 infection. Method(s): This is a retrospective observational study including all patients admitted for COVID-19 pneumonia between February and August 2021 in the pulmonary department at Habib Bourguiba Hospital. We compared the demographic, clinical, biological, radiological characteristics and outcomes of 2 groups: G1: current smokers;G2: non-smokers. Result(s): Three hundred patients were included in this study (G1: n =95;G2: n =205). All the smokers were male. The mean number of daily cigarettes consumption was 17.0 cigarettes. No differences were found between the two groups regarding the age, biological inflammatory markers (D-dimer, Creactive protein, neutrophil-to-lymphocyte ratio) and extend of radiological damage. Hypertension was more prevalent in G2 (46,1% versus 27,3%, p= 0,01), however, chronic obstructive pulmonary disease was more frequent in G1(8,4 % versus 3,9 %, p= 0,034). Troponin level was significantly higher in G1 (p=0,004). The average length of hospital stay was 10 [7-16] days in G1 versus 9 [5-14] days in G2 (p=0,293). No Significant difference were found between the two groups regarding in-hospital mortality (p=0, 75) and need for mechanical ventilation (p=0, 79). Conclusion(s): Our study shows that the severity of the COVID 19 infection among smoker and non-smoker patients is similar, and smokers are not more prone than others to develop severe outcomes.
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Introduction: To date, there is no specific therapy for coronavirus disease 2019 (COVID-19). Among antiinflammatory agents, colchicine has been proposed as a treatment. Objectif: To evaluate the effect of treatment with colchicine on clinical outcomes in patients hospitalized with COVID19. Method(s): In the pulmonary department at Habib Bourguiba Hospital, southern Tunisia, 162 consecutive inpatients (Group1, G1) with virologically and radiographically confirmed COVID-19 admitted between January and March 2021, were treated with institutional treatment for COVID-19. They were compared with 86 consecutive inpatients (Group2, G2)admitted between 01 April and 20 June, treated with colchicine 0.5mg twice daily in addition to standard of care for as long as 3 weeks. Result(s): No differences were found between the two groups regarding the sex, age, biological inflammatory markers and extend of radiological damage. Obesity was more prevalent in G1 (27, 9% versus 26%, p= 0,94), however, diabetes mellitus was more frequent in G2 (44, 2% versus 37, 8 %, p= 0,29). D-dimer level was significantly higher in G1 (1349 mug/l versus 943 mug/l;p=0,008). Using univariate analysis, colchicine reduced in-hospital mortality (13, 7% versus 27, 6%;p=0,014). No significant difference were found between the two groups regarding length of hospitalisation (p= 0, 68) and need for mechanical ventilation (p= 0, 43). Following multivariate analysis including, no significant difference was found between the two groups regarding inhospital mortality (OR= 1, 29 (95% CI: 0,496 to 3,040);p=0, 65). Conclusion(s): Our study shows that colchicine did not improve outcomes in patients with severe COVID-19 infection.
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Background: Junctional ectopic tachycardia (JET) is a rare tachyarrhythmia in adults. The precise site of origin within the AV junction is unknown. Objective: N/A Methods: N/A Results: A 71-year-old male presented with dyspnea on exertion and recently diagnosed tachycardia in March 2021. He had a history of diabetes mellitus, obesity, hypertension, obstructive sleep apnea, and COVID-19 in 2020. A 14-day monitor demonstrated 43% supraventricular ectopy SVE burden and short runs of SVT. He presented for an electrophysiology (EP) study. He presented to the EP lab in sinus rhythm with frequent SVE. Multipolar catheters were placed in the His bundle region, right atrium, coronary sinus, and right ventricle. The SVE beats had the same QRS morphology, and an identical HV interval and His-right bundle activation sequence as in sinus rhythm and no retrograde conduction, consistent with premature junctional complexes (PJCs). Occasional short bursts of junctional tachycardia were noted. Isoproterenol was titrated to a maximum dose of 8 mcg/min. No other SVT was inducible with atrial overdrive pacing or programmed stimulation or with isoproterenol infusion. A 6 mm tip cryoablation catheter was advanced to the right atrium to the anatomical location of the slow pathway in the inferior triangle of Koch using an electroanatomic mapping system (EnSite NavX). Signals immediately prior to ablation (Figure 1) were notable for a pre-potential 26 ms prior to the His with PJCs. Cryoablation was performed at this site (Figure 2) with resolution of the PJCs at the onset of the freeze. After thawing, a second freeze was administered. No further PJCs were noted at baseline or with isoproterenol infusion. Conclusion: JET could originate from anywhere within the AV node or proximal His bundle. The application of cryoablation at a typical AV nodal slow pathway location with a preceding pre- potential and immediate obliteration of PJCs suggests that the origin in this case was from this region rather than a true His bundle extrasystole. Identification of pre-potentials to the junctional ectopy can guide safe ablation of this dysrhythmia. [Formula presented] [Formula presented]