ResearchPad - case-study https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Service user and staff acceptance of fetal ultrasound telemedicine]]> https://www.researchpad.co/article/elastic_article_14047 We present qualitative findings from interviews with frontline clinicians and service users of a fetal telemedicine service.MethodsSemi-structured interviews with clinical stakeholders and service users were conducted, undertaken as part of a service evaluation. Data collection was undertaken by different teams, using interview schedules aligned to independent evaluation aims. Data were subjected to thematic analysis.ResultsSonographers reported four main challenges: delivering a shared consultation; the requirement to resist scanning intuitively; communications during the scan; and restricted room space. Notwithstanding, all clinicians reported that participating women were accepting of the technology. Service users reported few concerns. The main benefits of fetal telemedicine were identified as upskilled staff, increased access to specialist support and improved management of complex pregnancies. Convenience was identified as the main benefit by service users, including savings in time and money from not having to travel, take time off work, and arrange childcare.ConclusionsService users and clinical stakeholders were accepting of the service. Service users reported satisfaction with communications during the consultation and awareness that telemedicine had facilitated local access to clinical expertise. Whilst clinical stakeholders reported challenges, the iterative nature of the evaluation meant that concerns were discussed, responded to, and overcome as the pilot developed. Clinical stakeholders’ perception of benefits for service users encouraged their acceptance. Moreover, the evaluation established that fetal ultrasound telemedicine is a viable method to access expertise safely and remotely. It provided demonstrable evidence of a potential solution to some of the healthcare challenges facing rural hospitals. ]]> <![CDATA[Utility of a Leadless Pacemaker as a Backup to Left Ventricle–only Pacing in a Patient with Prior Device-related Severe Tricuspid Regurgitation]]> https://www.researchpad.co/article/elastic_article_13313 The contribution of endocardial cardiac device leads to severe tricuspid regurgitation (TR) has become increasingly recognized. Current strategies for treating cardiac device lead–related TR have limitations. We present a case of a pacemaker-dependent patient with severe TR as a complication of multiple cardiac device leads who underwent laser lead extraction, which was followed by implantation of a dual-chamber pacemaker with a coronary sinus lead for left ventricular pacing and a leadless transcatheter pacemaker for backup right ventricular (RV) pacing. This report represents one of the first cases of a leadless pacemaker implanted for RV backup pacing, highlighting the possibility of future biventricular pacing therapy (with a leadless pacemaker in VVT mode) without endocardial leads crossing the tricuspid valve.

]]>
<![CDATA[Patent Foramen Ovale as a Rare Focus of Origination of Atrial Tachycardia]]> https://www.researchpad.co/article/elastic_article_13305 Supraventricular tachycardia refers to a group of arrhythmias whose mechanism involves tissues from the His bundle or above. Repetitive focal atrial tachycardia (AT) (FAT) accounts for less than 10% of supraventricular tachycardia cases. FAT originating from the patent foramen ovale (PFO) has not been well-described and is a rarely reported phenomenon to date. Here, we report a rare case of FAT arising from the PFO. To the best of our knowledge, this is the first detailed report of AT arising from the PFO. We have included the description of the ablation procedure and postulated the possible electrophysiological mechanisms of a regularly irregular FAT noted in our patient during the electrophysiology study. Our case shows catheter ablation to be a successful treatment strategy in AT arising from the PFO, with the possibility of providing a long-term cure and freedom from antiarrhythmic drugs.

]]>
<![CDATA[An “UninTENSional” Subcutaneous Implantable Cardioverter-defibrillator Shock]]> https://www.researchpad.co/article/elastic_article_13304 Subcutaneous implantable cardioverter-defibrillators (ICDs) (S-ICDs) are advantageous because they eliminate the need for transvenous leads. However, just like in the case of traditional ICDs, inappropriate shocks are an unwanted complication that may result following their placement. In this case, we discuss the mechanism of an inappropriate shock in a patient with an S-ICD.

]]>
<![CDATA[Acute Water Ingestion as a Treatment for Postural Orthostatic Tachycardia Syndrome]]> https://www.researchpad.co/article/elastic_article_13302 A 24-year-old female presented to our clinic with symptomatic tachycardia. In the clinic, she was able to replicate her symptoms, which were due to tachycardia in a standing position that resolved upon sitting. The patient was then offered eight ounces (236.6 mL) of water and, after consumption of such, the standing tachycardia was no longer observed. A diagnosis of postural orthostatic tachycardia syndrome (POTS) was made. This case report discusses a novel approach to acute treatment for POTS.

]]>
<![CDATA[Surgical Mapping and Ablation in the Left Ventricular Summit Guided by Presurgery Pericardial Mapping]]> https://www.researchpad.co/article/elastic_article_13301 Successful catheter ablation of ventricular arrhythmias arising from the left ventricular (LV) summit is challenging. The use of a catheter-based epicardial approach may be limited due to the proximity of the major coronary arteries and the presence of epicardial fat. Surgical cryoablation in the LV summit is a viable option for drug-refractory ventricular arrhythmias. Presurgical epicardial mapping can facilitate the surgical procedure by localizing the area of interest to allow for a more limited surgical dissection of the epicardial fat.

]]>
<![CDATA[Selective His-bundle Pacing May Preserve Intrinsic Repolarization as Well as Depolarization]]> https://www.researchpad.co/article/elastic_article_13298 A 79-year-old man with chronic atrial fibrillation underwent single-chamber His-bundle pacemaker implantation. The post-implant electrocardiogram (ECG) demonstrated selective His-bundle capture, with a narrow paced QRS and repolarization pattern similar to that of the baseline ECG. Furthermore, repolarization changes prototypic of ventricular pacing did not occur with selective His-bundle capture. While His-bundle pacing, with or without selective His-bundle capture, can preserve physiologic patterns of depolarization, only His-bundle selective pacing can preserve intrinsic ST- and T-wave patterns. Thus, the maintenance of physiologic repolarization may have various advantages, including accurate interpretation of ECG changes that are not generally interpretable in the setting of ventricular pacing.

]]>
<![CDATA[The Mysterious Case of an Athletic Woman with Recurrent Syncope and a “Normal” Heart]]> https://www.researchpad.co/article/elastic_article_13293 A 53-year-old female with a history of sports participation presented to a community hospital emergency department for collapse. She was given a LifeVest® wearable cardioverter-defibrillator (WCD) (Zoll Medical Corp., Chelmsford, MA, USA) and scheduled to undergo cardiac magnetic resonance imaging (MRI) with gadolinium enhancement at a tertiary center. However, before the scheduled MRI scan could be performed, she developed tachycardia, for which the WCD alarmed. A dual-chamber implantable cardioverter-defibrillator was subsequently implanted. Assessment of a patient with syncope requires consideration of the idea that a life-threatening and recurrent arrhythmia may be a cause for the problem. However, current guidelines do not cover the routine use of WCDs in syncope. Additionally, the patient described here did not clearly meet United States Food and Drug Administration indications for the provision of an external defibrillator. We present this case to provoke discussion among colleagues regarding this patient’s treatment plan.

]]>
<![CDATA[Advances and Limitations in Electroanatomic Mapping for Infant Catheter Ablation]]> https://www.researchpad.co/article/elastic_article_13285 Advances in electroanatomic mapping (EAM) technology have facilitated improved success and safety profiles in the field of catheter ablation. However, these advances in their current iteration may be of limited value in ablation performed in very small children. The present case report highlights the application of current EAM technologies in an infant with incessant arrhythmias and includes a discussion regarding the application and limitations of newer mapping and ablation technologies in this unique and fragile patient group.

]]>
<![CDATA[Atrial Antitachycardia Pacing in Complex Congenital Heart Disease: A Case Series]]> https://www.researchpad.co/article/elastic_article_13282 Among the congenital heart disease (CHD) population, intra-atrial reentrant tachycardia (IART) is a common sequela resulting from anatomical anomalies and surgical scars that significantly increases morbidity and mortality. Atrial antitachycardia pacing (ATP) delivered by atrial antitachycardia devices (ATDs) has been used to treat IART in the CHD population. However, there remains limited data on the safety and efficacy of ATP, as well as on comparisons of its effects amongst different CHD subtypes. The purpose of the current study is to describe the clinical history and ATP efficacy in three patients with unique forms of complex CHD. During this study, a single-center review of three patients with ATDs was performed. One patient with each of the following CHD anomalies was selected for inclusion: systemic left ventricle, systemic right ventricle, and single ventricle. Data collected included ATP success rates, medications in use, direct current (DC) cardioversions, and any complications related to the ATDs. Study findings revealed the patient with a systemic left ventricle had an ATD implanted for approximately 9.5 years, with 695 of 956 (73%) episodes successfully converted. Unsuccessfully treated episodes were generally asymptomatic and self-terminating in this patient. The patient with a systemic right ventricle had an ATD implanted for approximately 16 years, with 333 of 348 (96%) episodes being successfully converted. The patient with a single ventricle had an ATD implanted for approximately 12.5 years, with 404 of 416 (97%) episodes successfully converted. The patients with biventricular physiology were able to forgo DC cardioversion after receiving their ATDs. However, due to medical noncompliance as well as multiple episodes of IART, which presented with 1:1 conduction or low rates, the single-ventricle patient still required DC cardioversions post-ATD implantation. In conclusion, this study’s findings demonstrate that, while ATP can be effective in a wide variety of CHDs, experiences can vary based on individual arrhythmia substrates, cardiac anatomy, and medical compliance. Additionally, challenges remain in IART detection in patients with especially complex CHD anatomies.

]]>
<![CDATA[Amiodarone-induced Hyponatremia: A Case Report and a Review of the Literature]]> https://www.researchpad.co/article/elastic_article_13281 Amiodarone is a widely used medication for controlling various types of cardiac arrhythmias. Nonetheless, it carries several known adverse effects that may preclude its use or necessitate discontinuation. Hyponatremia resulting from amiodarone is rarely reported, and its incidence is unknown. We present a case of severe hyponatremia secondary to amiodarone therapy and a review of the literature.

]]>
<![CDATA[A Rare Evidence of a Dual Atrioventricular Nodal Physiology in a Patient with Narrow Complex Tachycardia]]> https://www.researchpad.co/article/elastic_article_13275 The present case details an interesting intracardiac electrogram in a patient who demonstrated recurrent episodes of narrow complex tachycardia and who was subsequently found to have a typical atrioventricular nodal reentrant tachycardia during an electrophysiology study. The patient subsequently underwent slow pathway ablation and was found to be noninducible for any tachycardia after ablation.

]]>
<![CDATA[Confirm RX™ Cardiac Monitor Placement in a Pediatric Patient]]> https://www.researchpad.co/article/elastic_article_13271 We present the first known report of a pediatric implantation of the Bluetooth™-enabled Confirm RX™ insertable cardiac monitor (Abbott Laboratories, Chicago, IL, USA) in a 17-year-old patient with unexplained syncopal episodes. This case illustrates the ability to obtain immediate rhythm information from a patient using a Bluetooth™-enabled device following a minimally invasive procedure.

]]>
<![CDATA[Ventricular Tachycardia Ablation in Patients with Left Ventricular Assist Devices]]> https://www.researchpad.co/article/elastic_article_13269 In this complex case study, we discuss a patient who underwent successful catheter ablation for ventricular tachycardia following left ventricular assist device placement. We discuss the technique and review existing literature in an effort to explore the feasibility and safety of this procedure in this clinical setting.

]]>
<![CDATA[Cardiac Resynchronization Therapy Upgrade in a Patient with Dextrocardia and Situs Inversus Totalis, Facilitated by Coronary Sinus Cannulation with Electrophysiology Catheters from Both Femoral and Axillary Venous Approaches]]> https://www.researchpad.co/article/elastic_article_13264 Cardiac resynchronization therapy in patients with dextrocardia with situs inversus totalis can be technically challenging. There are few case reports of cardiac resynchronization therapy implantation in these individuals. Here, we describe a procedure of cardiac resynchronization therapy upgrade in a patient with dextrocardia and situs inversus totalis facilitated by coronary sinus cannulation from both the femoral and axillary venous approaches.

]]>
<![CDATA[Right Ventricular and Chest Wall Perforation with Implantable Cardioverter-Defibrillator Lead with Lodgment into the Cutaneous Tissue of the Chest Wall]]> https://www.researchpad.co/article/elastic_article_13260 Implantable cardioverter-defibrillator (ICD) lead perforation is a rare but serious complication of cardiac device implantation. Subacute (24 h to one month) and delayed (>1 month) presentations of rupture are also rare. Here we report a case of right ventricular perforation by a ventricular ICD lead in a 61-year-old man that was detected four months’ postimplantation. The lead was present out from his chest wall and was palpable beneath the skin.

]]>
<![CDATA[Direct His-bundle Pacing in a Patient with a Persistent Left Superior Vena Cava]]> https://www.researchpad.co/article/elastic_article_13257 We report a case of direct His-bundle lead placement at the time of implantable cardioverter-defibrillator insertion and atrioventricular node ablation. The patient was found to have an isolated persistent left superior vena cava, and selective His-bundle pacing was successfully achieved through the use of a steerable sheath and dedicated mapping catheter.

]]>
<![CDATA[A Cautionary Tale on Atrial Capture Management, Biventricular Pacing, and Recurrent Asystole]]> https://www.researchpad.co/article/elastic_article_13254 Capture management algorithms in current cardiac implantable electronic devices (CIEDs) can enhance device performance and battery longevity. Although generally safe, these algorithms have on rare occasions been implicated in the onset of significant complications, especially in pacemaker-dependent patients. CIEDs implanted in patients with postoperative congenital heart disease (CHD) often require epicardial pacing leads rather than transvenous leads; unfortunately, epicardial leads can experience higher rates of malfunction. We herein report on a young adult with a status of postoperative CHD and complete atrioventricular block following implantation of a epicardial dual-chamber cardiac resynchronization therapy pacemaker (CRT-P; Consulta®; Medtronic, Minneapolis, MN, USA) who developed frequent periods of asystole after malfunction of one of the ventricular leads. The underlying cause of asystole was found to be due to the atrial capture management (ACM) algorithm of the CRT-P device, temporarily converting biventricular to right ventricular–only pacing as part of the algorithm. This case highlights implications of the ACM algorithm in devices with a similar platform for pacemaker-dependent patients.

]]>
<![CDATA[Moving Air in the Esophagus During Cryoballoon Ablation]]> https://www.researchpad.co/article/elastic_article_13250 A 56-year-old male patient underwent cryoballoon ablation for symptomatic paroxysmal atrial fibrillation. Massive air movement reminiscent of an air esophagram was detected during cryoballoon application in the right superior pulmonary vein. In this case report, we sought to consider all possible explanations of this finding.

]]>
<![CDATA[Nonfluoroscopic Ablation in the Setting of Congenital Heart Disease]]> https://www.researchpad.co/article/elastic_article_13246 In this case series, we demonstrate the performance of nonfluoroscopic ablation in the congenital heart disease population. Techniques for procedural safety and the benefits of three-dimensional mapping in the setting of structural heart disease are reviewed.

]]>