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1.
Revista Española de Cardiología ; 2022.
Article in Spanish | ScienceDirect | ID: covidwho-2031648

ABSTRACT

Resumen Introducción y objetivos Se presentan los datos correspondientes a los implantes de desfibrilador automático implantable (DAI) en España en el año 2021. Métodos Los datos provienen de los centros implantadores, que cumplimentaron voluntariamente una hoja de recogida de datos durante el implante. Resultados En 2021 se recibieron 7.496 formularios de implante, frente a los 7.743 comunicadas por Eucomed (European Confederation of Medical Suppliers Associations), lo que implica que se han recogido datos del 96,8% de los dispositivos implantados en España. El cumplimiento osciló entre el 99,9% en el campo «nombre del hospital implantador» y el 8,9% en la variable «hospital de referencia». En 2021, 199 hospitales han participado en el registro, lo cual supera las cifras de los años previos en que el número de participantes osciló alrededor de 170 hospitales. La tasa total de implantes registrados fue 158/millón de habitantes (163 según Eucomed), lo que la sitúa como el año con mayor actividad. Sin embargo, el registro sigue mostrando diferencias importantes entre las comunidades autónomas y la tasa de implante más baja de todos los países europeos participantes en Eucomed. Conclusiones El Registro español de desfibrilador automático implantable del año 2021 recoge un incremento en el número de implantes de DAI y refleja la recuperación de la actividad hospitalaria tras el impacto inicial de la pandemia por COVID-19 durante 2020. A pesar del incremento en el número total de implantes en España, este sigue siendo muy inferior a la media de la Unión Europea y persisten las diferencias entre las comunidades autónomas españolas. Introduction and objectives This article presents the data corresponding to implantable cardioverter-defibrillator (ICD) implantations in Spain in 2021. Methods The data were drawn from implanting centers, which voluntarily completed a data collection sheet during the procedure. Results In 2021, 7496 implant data sheets were received, compared with 7743 reported by Eucomed (European Confederation of Medical Suppliers Associations), indicating that data were collected from 96.8% of the devices implanted in Spain. Data completion ranged from 99.9% for “name of implanting hospital” to 8.9% for “implanting hospital”. In 2021, 199 hospitals participated in the registry, exceeding the figures of previous years, with around 170 participating hospitals. The total rate of registered implants was 158/million inhabitants (163 according to Eucomed), making 2021 the year with the highest activity. However, the registry continues to show significant differences among the various autonomous communities and the lowest implantation rate of all the European countries participating in Eucomed. Conclusions The Spanish implantable cardioverter-defibrillator registry for 2021 recorded an increase in the number of ICD implantations, reflecting the recovery of hospital activity after the initial impact of the COVID-19 pandemic in 2020. Although the total number of implants has increased in Spain, figures are still much lower than the European Union average, with differences persisting among Spanish autonomous communities.

2.
Open Access Macedonian Journal of Medical Sciences ; 10:1252-1256, 2022.
Article in English | EMBASE | ID: covidwho-2010395

ABSTRACT

BACKGROUND: In 2015, approximately 350,000 adults in the United States experienced nontraumatic out-of-hospital cardiac arrest and were treated by the emergency medical services (EMS) personnel. Despite recent increases, <40% of adults receive layman-initiated cardiopulmonary resuscitation (CPR), and <12% apply an automated external defibrillator before EMS personnel. AIM: To know the ability of the Medan city community in handling cardiac arrest for the first time and implementing the 2020 AHA basic life support (BLS). METHODS: This study used a descriptive method with a cross-sectional approach and was conducted in the city of Medan in the period July–October 2021. Sampling used cluster sampling and purposive sampling with inclusion and exclusion criteria. RESULTS: In this study, it was found that the majority of the people of Medan City had less knowledge about CPR in BLS. In this study, only respondents from Medan Marelan District were dominated by good knowledge by 80%. It was found that the people of Medan City have a good level of knowledge about these cardiac events, and the people of Medan City have a low level of knowledge about BLS and CPR. CONCLUSION: The ability of the people of Medan City in implementing BLS and CPR in BLS for cardiac events outside the hospital is still lacking.

3.
Scientific reports ; 12(1):14575, 2022.
Article in English | MEDLINE | ID: covidwho-2008311

ABSTRACT

Public access automated external defibrillators (AEDs) represent emergency medical devices that may be used by untrained lay-persons in a life-critical event. As such their usability must be confirmed through simulation testing. In 2020 the novel coronavirus caused a global pandemic. In order to reduce the spread of the virus, many restrictions such as social distancing and travel bans were enforced. Usability testing of AEDs is typically conducted in-person, but due to these restrictions, other usability solutions must be investigated. Two studies were conducted, each with 18 participants: (1) an in-person usability study of an AED conducted in an office space, and (2) a synchronous remote usability study of the same AED conducted using video conferencing software. Key metrics associated with AED use, such as time to turn on, time to place pads and time to deliver a shock, were assessed in both studies. There was no difference in time taken to turn the AED on in the in-person study compared to the remote study, but the time to place electrode pads and to deliver a shock were significantly lower in the in-person study than in the remote study. Overall, the results of this study indicate that remote user testing of public access defibrillators may be appropriate in formative usability studies for determining understanding of the user interface.

4.
Medicina (Brazil) ; 55(2), 2022.
Article in English | EMBASE | ID: covidwho-1979696

ABSTRACT

Intensive Care Medicine gained prominence in 2020 and 2021 due to the COVID-19 pandemic. It is a recent medical specialty, which many physicians and the public know little about. This article makes a historical perspective, from the emergence of the first areas for observation of critically ill patients in the nineteenth century to the present, to the impact of the pandemic and its consequences.

5.
Hong Kong Journal of Emergency Medicine ; 29(1):23S-24S, 2022.
Article in English | EMBASE | ID: covidwho-1978657

ABSTRACT

Background: Regional variations in the impact of the coronavirus disease-2019 (COVID-19) pandemic on out-of-hospital cardiac arrest (OHCA) have been reported. We aimed to examine differences in the community response, emergency medical services (EMS) interventions, and outcomes of OHCA, in Singapore (population 5.7 million) and Atlanta (population 4.16 million), before and during the pandemic. Methods: Using prospectively collected Singapore Pan-Asian Resuscitation Outcomes Study (PAROS) and Atlanta Cardiac Arrest Registry to Enhance Survival (CARES) data, we compared EMS-treated adult OHCAs (≥18 years) during the pandemic period (17weeks from the date of first confirmed COVID-19 case) and pre-pandemic period (corresponding weeks in 2019). The primary outcome was pre-hospital return of spontaneous circulation (ROSC). We reported adjusted odds ratios (aOR) for OHCA characteristics, pre-hospital interventions, and outcomes using binary logistic regression. Results: Of the 3987 EMS-treated OHCAs (overall median age 69 years, 60.1% males) in Singapore and Atlanta, 2084 occurred during the pandemic and 1903 during the pre-pandemic period. Compared with Atlanta, OHCA cases in Singapore were older (median age 72 vs 66 years), received more bystander interventions (65.1% vs 41.4% received cardiopulmonary resuscitation (CPR) and 28.4% vs 10.1% had automated external defibrillator application), yet observed less pre-hospital ROSC (11.3% vs 27.1%). When compared with the pre-pandemic period, the likelihood of residential OHCAs doubled in both cities during the pandemic;in Singapore, OHCAs were more likely to be witnessed (aOR 1.95, 95% confidence interval (CI), 1.59-2.39) yet less likely to receive CPR (aOR 0.81, 95% CI, 0.65-0.99) during the pandemic. OHCAs occurring during the pandemic, compared with pre-pandemic, were less likely to be transported in Singapore and Atlanta (aOR 0.50, 95% CI, 0.42%-0.85%, and 0.36, 95% CI, 0.26-0.50, respectively), without significant differences in overall pre-hospital ROSC. Conclusion: Changes in OHCA characteristics and pre-hospital interventions during the pandemic were likely collateral consequences, with regional variations partly reflecting differences in systems of care and other sociocultural factors. These highlight opportunities for public education and the need for further study into lower transport rates during the pandemic.

6.
J Cardiol Cases ; 26(2): 85-87, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1977431

ABSTRACT

Pregnancy in left ventricular hypertrabeculation/noncompaction (LVHT) is a matter of concern due to the risk for arrhythmia or heart failure (HF). This risk seems higher if arrhythmias have been already diagnosed before pregnancy. Pregnancies in LVHT cases with implanted cardioverter-defibrillators (ICD) are rarely reported.We report pregnancy of and delivery to a 28-year old patient with hypertrophic phenotype of LVHT with ICD, implanted 11 years previously for secondary prevention of sudden cardiac death, in whom genetic analysis disclosed a variant in the TPM1 Gen (c.425A > T). Until the 28th gestational week (GW), the pregnancy was without problems, then increasing HF due to diastolic dysfunction developed. In GW34, she was treated with atosiban for tocolysis because of premature labor. Due to aggravation of HF, preterm delivery by cesarean section in spinal anesthesia in GW35 was carried out. Delivery and maternal postpartal course were without problems, HF regressed. ICD interrogation did not show any arrhythmia.Pregnancy and delivery can be managed safely in hypertrophic phenotype of LVHT with ICD under interdisciplinary surveillance. Diastolic dysfunction may occur in the third trimester and lead to HF. Tocolytic drugs should be used with caution, even though the drugs are assumed to be safe regarding cardiovascular complications. Learning objective: Pregnancy and delivery can be managed safely in hypertrophic phenotype of left ventricular hypertrabeculation/noncompaction with implanted cardioverter-defibrillators under interdisciplinary surveillance. Diastolic dysfunction may occur in the third trimester and lead to heart failure. Tocolytic drugs should be used with caution, even though the drugs are assumed to be safe regarding cardiovascular complications.

7.
Europace ; 2022 Jul 29.
Article in English | MEDLINE | ID: covidwho-1973143

ABSTRACT

Remote monitoring (RM) of cardiac implantable electrical devices (CIEDs) is currently proposed as a standard of care for CIEDs follow-up, as recommended by major cardiology societies worldwide. By detecting a series of relevant device and patient-related parameters, RM is a valuable option for early detection of CIEDs' technical issues, as well as changes in parameters related to cardio-respiratory functions. Moreover, RM may allow longer spacing between in-office follow-ups and better organization of in-hospital resources. Despite these potential advantages, resulting in improved patient safety, we are still far from a widespread diffusion of RM across Europe. Reimbursement policies across Europe still show an important heterogeneity and have been considered as an important barrier to full implementation of RM as a standard for the follow-up of all the patients with pacemakers, defibrillators, devices for cardiac resynchronization, or implantable loop recorders. Indeed, in many countries, there are still inertia and unresponsiveness to the request for widespread implementation of RM for CIEDs, although an improvement was found in some countries as compared to years ago, related to the provision of some form of reimbursement. As a matter of fact, the COVID-19 pandemic has promoted an increased use of digital health for connecting physicians to patients, even if digital literacy may be a limit for the widespread implementation of telemedicine. CIEDs have the advantage of making possible RM with an already defined organization and reliable systems for data transmissions that can be easily implemented as a standard of care for present and future cardiology practice.

8.
Int J Environ Res Public Health ; 19(15)2022 Jul 25.
Article in English | MEDLINE | ID: covidwho-1957327

ABSTRACT

INTRODUCTION: Sudden cardiac arrest (SCA), which causes more than half of all cardiovascular related deaths, can be regarded as a common massive global public health problem. Analyzing out-of-hospital cardiac arrest (OHCA) cases, one of the key components is automatic external defibrillators (AEDs). AIM: The aim of this study was to analyze the use and distribution of AEDs in Polish public places. MATERIALS AND METHODS: The data were analyzed by using the Excel and R calculation programs. RESULTS: The data represents 120 uses of automatic external defibrillators used in Polish public space in the period 2008-2018. The analysis describes 1165 locations of AEDs in Poland. It was noted that the number of uses in the period 2010-2016 fluctuated at a constant value, with a significant rise in 2017. When analyzing the time of interventions in detail the following was noted: the highest percentage of interventions was observed in April, and the lowest in November; the highest number of interventions was observed on a Friday, while the least number of interventions was observed on a Sunday; most occurred between 12:00 to 16:00, and least between 20:00 to 8:00. CONCLUSIONS: The observed growth in the number of cases of AED use in public places is associated with the approach to training, the emphasis on public access to defibrillation, and, therefore, the growth of social awareness. This study will be continued. The next analysis would include 2020-2022 and would be a comparative analysis with the current research.


Subject(s)
COVID-19 , Emergency Medical Services , Out-of-Hospital Cardiac Arrest , COVID-19/epidemiology , Defibrillators , Humans , Out-of-Hospital Cardiac Arrest/epidemiology , Out-of-Hospital Cardiac Arrest/therapy , Pandemics , Poland/epidemiology , SARS-CoV-2
9.
Europace ; 24(SUPPL 1):i851-i852, 2022.
Article in English | EMBASE | ID: covidwho-1915622

ABSTRACT

Background: Remote monitoring (RM) for implantable cardioverter defibrillators (ICDs) is recommended as the standard of care in clinical guidelines. Presumably, the restrictions on face-to-face visits that were imposed during the coronavirus (COVID-19) pandemic have further accelerated the adoption of RM. However, quantitative real-world data on the uptake of RM during the COVID-19 pandemic is lacking. Purpose: To assess the uptake of RM during the COVID-19 pandemic to a pre-COVID-19 period, and compare the arrhythmic burden between the two groups. Methods: This is a substudy of the retrospective, observational single-center DISTANT-study. For this substudy, data from patients who were enrolled in the RM program after de novo ICD implantation (single- and dual chamber, biventricular or subcutaneous ICDs) were analysed. The time until RM was initiated per patient was calculated for patient implanted during the COVID-19 pandemic (March 2020-January 2021) and compared to a similar 10-month period pre-COVID-19 (May 2019-March 2020). ICD therapy (shock and/or anti-tachycardia pacing), non-sustained ventricular tachycardia (NSVT), supraventricular tachycardia (SVT) and mortality were registered for each patient. Patients <18 years old at implantation and patients with a follow-up of <6 months were excluded from this analysis. Results: A total of 134 patients (72.4 %male, mean age 57.3 ±14.9 years) were eligible for this substudy, of which 61 patients in the COVID-19 group and 73 patients in the pre-COVID-19 group. In both groups there was a similar percentage of primary prevention ICD implantations (COVID-19: 43%, pre-COVID: 44%;p=0.888). During COVID-19, RM was initiated more promptly following ICD implantation compared to pre-COVID-19 (respectively 63 days vs. 131 days;p=0.007). Second, in the COVID-19 group 60.7% patients were enrolled in RM within 30 days following implantation compared to 39.7% in the pre-COVID-19 group (p=0.016). In terms of arrhythmic burden, no differences in the occurrence of ICD therapy (p=0.759), NSVT (p=0.267) and SVT (p=0.454) were observed. Conclusion: During the COVID-19 pandemic RM was initiated more promptly following ICD implantation compared to before the pandemic, however, no differences in arrhythmic burden between groups were observed. (Figure Presented).

10.
Europace ; 24(SUPPL 1):i752, 2022.
Article in English | EMBASE | ID: covidwho-1915620

ABSTRACT

Background: Both COVID-19 and the measures taken to control the pandemic may significantly affect cardiovascular health. The effects of a lockdown on physical activity and its potential consequences for arrhythmia burden remain largely unknown. Purpose: In this study, we investigated the effect of the lockdown during the first COVID-19 wave on patients' physical activity and arrhythmia burden. Methods: All patients with an ICD connected to a Carelink home-monitoring system from two Dutch hospitals were included. Anonymized data on physical activity, heart rate, and occurrence of ventricular tachycardia/fibrillation (VT/VF), and atrial fibrillation/tachycardia (AF/AT) were obtained and were compared between March-April 2020 (lockdown) and March-April 2019 (reference) within each patient. The study was approved by the local ethics committee. Results: The ICDs of 531 patients registered significantly less activity during de lockdown period compared to the reference period (21,895 ±12,394min vs 25,173±12,532min, p<0.0001, panel a). Daytime and nighttime heart rates were significantly lower during lockdown compared to the reference period (71.3±9bpm vs 72.6±9bpm, p<0.0001 and 63.4±9 vs 63.8±9, p=0.02, respectively). 94 patients with VT/VF during the reference period did not show any VT/VF during lockdown, while only 4 patients without VT/VF during the reference period showed VT/VF during lockdown (p<0.0001, panel B). There was no significant difference in the occurrence of NSVT or AF/AT. Conclusion: During the lockdown in the first COVID-19 wave, the Carelink system revealed significantly less activity and lower heart rates. Moreover, there was a significant reduction in the occurrence of VT/VF. (Figure Presented).

11.
European Journal of Preventive Cardiology ; 29(SUPPL 1):i391, 2022.
Article in English | EMBASE | ID: covidwho-1915603

ABSTRACT

Background: Underlying mechanisms for sport-related acute myocardial infarction (SR-AMI) are only poorly understood. Moreover, their coronary artery disease (CAD) characteristics and lesion complexity are poorly described. Purpose: To characterize coronary angiographic feature of patients with SR-AMI Methods: From the RICO database, a large regional acute MI survey, all consecutive patients hospitalized in our University Hospital from 2010 to 2021 who underwent coronary angiography for SR-MI were retrospectively analysed. SR-MI was defined as MI occurring during sport activity or within the first hour of recovery. Results: Among the 174 patients included, most were male (n=157(91%)). Median (IQR) age was 59 y (48-66), and had ST segment elevation MI (STEMI) (n= 112 (64%)). The SR-MI often occurred while cycling (41%), jogging (23%), hiking (9%) or playing soccer (9%). Patients commonly experienced pre-hospital (PH) sudden cardiac arrest (SCA) (17%). Atherothrombotic risk factors were dyslipidaemia (32%), current smoking (31%) or hypertension (28%). A history of CAD was documented in 31 (18%) patients. Most (n=156(91%)) had significant lesions, of whom 140 (81%) were considered as culprit. Culprit lesions were located on left anterior descending (39%), circumflex (14%) and right coronary artery (33%). Median (IQR) Syntax score was 10.5 (6-15). The vast majority of patients (n=152 (87%)) had at least one complex lesion;114 of them had several characteristics of complex lesion. Lesions were eccentric in 68 (39%) patients;an intraluminal thrombus was documented in 85 patients (49%), in 55% of STEMI and 37% of non-STEMI (p =0.027). However, 18 subjects (10%) had optically normal coronary angiogram or non-significant lesions, suggesting alternative mechanism such as type 2 MI. Treatment of the lesions was mainly achieved by PCI and/or stenting (n=132(77%)) or coronary artery bypass grafting (n=11(6%)). In-hospital death occurred in 11 patients (6%), of whom 10 experienced a PH-SCA and one was admitted with a cardiogenic shock during the Covid-19 pandemics lockdown. Among the 5 patients treated with extracorporeal membrane oxygenator, only one survived. Conclusion: In our large retrospective study, SR-MI was commonly associated with complex coronary lesions, often characterized by intraluminal thrombus. Our findings suggest that the mechanisms of these events could be mainly related to type 1 MI patterns Moreover, PH-SCA was frequent, thus justifying mass-education to basic life support and deployment of automated external defibrillators, especially in the sport settings.

12.
Italian Journal of Medicine ; 16(SUPPL 1):79, 2022.
Article in English | EMBASE | ID: covidwho-1912978

ABSTRACT

A 46-years old Egyptian man was admitted to our department because of the onset of worsening dyspnea. In his clinical history were present: hypothyroidism, obesity, hyperuricemia, hypertension and recent Sars-Cov2 infection. Bilateral pleuric effusion was suspected during physical examination and confirmed by chest CT. Blood data showed mild macrocytic anemia, increased levels of creatinine, transaminases, pro-BNP (3574 pg/ml cut-off 0-125) and D-dimer. Multiple molecular swabs for research of Sars-Cov2 were negative. ECG showed sinus rhythm and non specific atypia of repolarization. An eco-fast was performed at bedside and revelead left ventricular dilatation and severe systolic disfunction due to diffuse hypokinesia (EF 30%). Diuretic therapy was set up with improvement of the clinical status. In order to exclude ischaemic genesis of the cardiopathy a coronary angiography was performed without evidence of obstructive lesions. An echocardiogram was repeated and it showed a parietal ipertrabeculation of the left ventricle. This aspect was suggestive of non-compact myocardium, a rare disease due to the arrest of the myocardial maturation process during fetal development, leading to the persistence of embryonic structures in the heart muscle. Genetic inheritance arises in 30-50% of patients and are involved genes that generally seem to encode sarcomeric or cytoskeletal proteins.Cardiac MRI is planned in order to have further confirmation of our diagnostic hypothesis. In the meantime wearable defibrillator was prescribed for the prevention of sudden death.

14.
Acta Clinica Belgica: International Journal of Clinical and Laboratory Medicine ; 77(sup1):1-33, 2022.
Article in English | EMBASE | ID: covidwho-1886341
15.
Indian Pediatrics ; 59(4):342-343, 2022.
Article in English | EMBASE | ID: covidwho-1881539
16.
Journal of Tehran University Heart Center ; 17(1):22-25, 2022.
Article in English | EMBASE | ID: covidwho-1863462

ABSTRACT

Severe Coronavirus disease 2019 (COVID-19) infection presents with acute respiratory distress syndrome and multiorgan dysfunction. Cardiac involvement is seen in about a quarter of patients, and it can present as acute coronary syndromes, arrhythmias, myocarditis, and thromboembolic events. Ventricular arrhythmias in the setting of COVID-19 infection are usually multifactorial in etiology. There are only a few reports of ventricular tachycardia (VT) storms in patients with COVID-19 infection. We hereby report a case of an elderly man with severe left ventricular systolic dysfunction and a stable cardiac status for the last few years who, following coronary artery bypass graft surgery and implantable cardioverter-defibrillator (ICD) implantation, experienced a VT storm after a COVID-19 infection. The VT storm was controlled using multiple ICD shocks, along with antiarrhythmic drugs. Following his recovery from COVID-19 infection, the patient was asymptomatic at a 3-month follow-up.

17.
Byulleten Sibirskoy Meditsiny ; 21(1):109-120, 2022.
Article in English | Web of Science | ID: covidwho-1856480

ABSTRACT

Aim. To review the current progress in the use of remote health monitoring (RHM) technologies for chronic noncommunicable diseases (CNCD). To search for data, we used Web of Science, Scopus, Russian Science Citation Index, Academic Search Complete (EBSCO), Cochrain, and PubMed databases. The date range was 5-10 years. The importance of development of RHM technologies and their further study was shown to confirm the evidence of effect of certain RHM systems. New approaches to the integration of the medical community into the international telemedicine strategy are considered. It was established that RHM can potentially decrease treatment costs and reduce the burden on medical organizations. The review analyzes the experience in using RHM in patients with cardiovascular diseases, as well as respiratory and endocrine disorders. The review also summarizes and systematizes the findings of studies on assessing the effectiveness of RHM technologies in clinical practice, including their use in the COVID-19 pandemic. It is noted that despite high interest of the scientific community in the study of RHM technologies, unambiguous results demonstrating the effectiveness of such developments in clinical practice have not been presented.

18.
Pacing Clin Electrophysiol ; 45(6): 807-810, 2022 06.
Article in English | MEDLINE | ID: covidwho-1832218

ABSTRACT

In the era of coronavirus disease 2019 (COVID-19), the management of cardiac implantable electronic devices infections with concomitant viral infection has not been completely defined yet. In this explorable context, we report the first experience of a Cardiac resynchronization therapy with defibrillator (CRT-D) implantation after transvenous lead extraction for endocarditis in a COVID-19 patient. We describe both the measures and procedures implemented to reduce the cross-infection in the operating room and our clinical practice to improving procedure effectiveness on patient care.


Subject(s)
COVID-19 , Cardiac Resynchronization Therapy , Defibrillators, Implantable , Endocarditis , Heart Diseases , Cardiac Resynchronization Therapy Devices , Device Removal/methods , Humans , Retrospective Studies , SARS-CoV-2 , Treatment Outcome
19.
J Arrhythm ; 38(3): 271-274, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1820894

ABSTRACT

The Japanese Heart Rhythm Society established a nationwide, mandatory, multi-center, prospective, observational registry of transvenous lead extraction (TLE) named the Japanese lead extraction registry (J-LEX) in 2018. We have published the first annual report of J-LEX with 661 cases from 42 hospitals. The second annual report of J-LEX in 2020 enrolled increased numbers of 785 cases from 75 hospitals. TLE procedure was attempted on patients with an average age of 71.7 years old, male in 72.5% in the hybrid operating room in 57.9%, and in standard OR with a C-arm fluoroscope in 18.7%. The indication of TLE was an infection in 62.8% and the guideline classification was class-I in 67.4% and class-IIa in 23.8%. The average implantation duration of target leads was 7.9 years. Complete removal was achieved in 96.6% of the target leads and clinical success in 98.1% of the patients. Perioperative complications were observed in 7.1% of the patients. One patient died during a TLE operation and the other three patients died in-hospital (cardiac death in one patient and non-cardiac in two patients). Although the annual J-LEX report in 2020 demonstrated an increased number of TLE procedures despite the first pandemic year of coronavirus disease-2019 (COVID-19), perioperative complications increased a little in comparison with J-LEX 2019.

20.
Journal of Heart and Lung Transplantation ; 41(4):S343, 2022.
Article in English | EMBASE | ID: covidwho-1796803

ABSTRACT

Introduction: Inflammatory cardiomyopathies can be a diagnostic dilemma. Early management can lead to reduced morbidity and mortality for patients. We describe a rare presentation of an unusual cardiomyopathy. Case Report: A 58-year-old female presented with a 10-day prodrome of cough, NYHA class III dyspnea, and fatigue with minimal symptoms of orthopnea, paroxysmal nocturnal dyspnea or peripheral edema. She was previously healthy with no cardiac medications. Family history was significant for granulomatosis with polyangiitis. COVID-19 swab was negative. She was symptomatic with transient complete heart block and junctional escape of 20bpm. A temporary transvenous pacemaker was placed. Echocardiogram showed biventricular dysfunction with left ventricular ejection fraction < 30%. Troponin and brain-natriuretic peptide were elevated. Coronary angiogram showed no significant occlusions. CT excluded pulmonary embolism, pneumonia, or adenopathy. She was initiated on heart failure medications but beta blocker was not started given heart block. Six days into admission, her heart failure improved but she developed transient complete heart block without junctional escape. There was no ventricular ectopy. Evaluation for rheumatologic, infectious, and inflammatory causes showed elevated C-reactive protein and antineutrophil cytoplasmic antibodies. The remainder of the workup was negative. Leading diagnoses were idiopathic giant cell myocarditis or cardiac sarcoidosis. An endomyocardial biopsy revealed multinucleated giant cells and myocyte necrosis. She was diagnosed with giant cell myocarditis. Prior to discharge, she had defibrillator insertion and was initiated on prednisone and tacrolimus. Shortly after this time, she returned with critical cardiogenic shock despite intensification of immunosuppressive therapies and was listed for cardiac transplant. Giant cell myocarditis (GCM) is a rare and often fatal autoimmune cause of heart failure. Patients frequently present with congestive heart failure, ventricular arrhythmia and a rapid progression of symptoms. In GCM, it is rare to present with atrioventricular conduction delays. Given the crossover in symptoms with sarcoidosis and GCM, diagnosis may be challenging. In this case of an acute presentation of heart failure and complete heart block, endomyocardial biopsy was central to the diagnosis and management of GCM.

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