ABSTRACT
Background Premature atrial contractions (PACs) are usually seen as a relatively benign condition. Data about PACs induced cardiomyopathy and requiring ablation are limited. Case After recovery of COVID-19 infection, an otherwise healthy 39 year old patient presented with palpitations lasting for several months. His blood lab-work was non-significant. Electrocardiogram showed frequent premature beats with both narrow and wide QRS complex. Medical treatment was ineffective. Holter monitoring showed 21% burden of premature beats over 2 days. Transthoracic echocardiogram (TTE) showed ejection fraction (EF) 45% with dilated LV dimension. MRI confirmed a structurally normal heart. Decision-making The patient was diagnosed with arrhythmia-induced cardiomyopathy, so he was referred for electrophysiological study. There was A-V activation pattern confirming atrial origin of all of the premature beats. Intermittent bundle branch block during conduction of the beats with the shortest A-V time caused wide QRS complex. With 3D CARTO mapping system, activation mapping of the right atrium and direct mapping of tricuspid annulus, we were able to reach the origin site of the PACs and apply ablation lesions there. After a month, TTE showed EF 56% with normal LV dimensions. Symptoms resolved and there was no evidence of PACs. Conclusion follow up of patients with frequent PACs is very important for early detection of induced cardiomyopathy. Catheter ablation in these cases leads to excellent results. [Formula presented]Copyright © 2023 American College of Cardiology Foundation
ABSTRACT
The proceedings contain 250 papers. The topics discussed include: applying machine learning to arsenic species and metallomics profiles of toenails to evaluate associations of environmental arsenic with incident cancer cases;user satisfaction with an AI system for chest X-ray analysis implemented in a hospital’s emergency setting;scaling AI projects for radiology – causes and consequences;ECG classification using combination of linear and non-linear features with neural network;dataset comparison tool: utility and privacy;when context matters for credible measurement of drug-drug interactions based on real-world data;a lightweight and interpretable model to classify bundle branch blocks from ECG signals;analysis of stroke assistance in Covid-19 pandemic by process mining techniques;automated diagnosis of autism spectrum disorder condition using shape based features extracted from brainstem;using explainable supervised machine learning to predict burnout in healthcare professionals;and an image based object recognition system for wound detection and classification of diabetic foot and venous leg ulcers.
ABSTRACT
Background: Transthyretin cardiac amyloidosis (ATTR-CM) is important comorbidity associated with severe aortic stenosis (AS). Multiple studies have shown that ATTR-CM was present in 10-15% of all cases with severe AS. The purpose of this quality improvement project is to raise awareness of ATTR-CM in patients who underwent transcatheter aortic valve replacement (TAVR) for severe AS amongst the healthcare providers and patients. Methods: We retrospectively reviewed all TAVR cases performed at our institution in 2019 (Total cases 87). We screened for the presence of predefined high-risk features for ATTR-CM based on prior literature (Presence of diastolic dysfunction, left ventricular hypertrophy on echocardiogram, low voltage-mass ratio, low limb lead voltage on EKG, arrhythmia/bundle branch block, or systemic symptoms of amyloidosis). We subsequently contacted the patients to discuss our clinical suspicion of ATTR-CM and offered clinical referral to a cardiac amyloid specialist. Results: Of the total of 87 patients who underwent TAVR in 2019, 12 patients were deceased at chart review. We have identified 50 patients (66.7%) who had high-risk features of ATTR-CM. A total of 17 patients (34% of 50 patients) agreed to be referred to cardiac amyloid specialist. Six patients (12%) were tested with 99m Technetium Pyrophosphate imaging, and all were negative for ATTR-CM. Eleven patients (22%) are still pending testing. Six patients did not wish for referral due to personal reasons. We were not able to reach 15 patients via phone (30%). In addition, we have found additional 12 patients who were deceased (Total mortality count of 24, 27.5%) in two years. Conclusion: Our project has increased awareness within structural cardiologists as we have implemented a prospective screening process within our institution. While we expected to diagnose ATTR-CM in 10% of severe AS who underwent TAVR, we had multiple difficulties contacting them, coordinating referrals due to the COVID-19 pandemic and higher 2-year mortality. We are hypothesizing whether the higher 2-year mortality is secondary to undetected ATTR-CM. We are planning for screening and timely referral for patients who underwent TAVR more recently.