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The Proximity of Implanted Pacemaker and Implantable Cardioverter-Defibrillator Leads to Coronary Arteries as Assessed by Cardiac Computer Tomography
CSANZ 2013 Abstracts
475
476
The Proximity of Implanted Pacemaker and Implantable Cardioverter-Defibrillator Leads to Coronary Arteries as Assessed by Cardiac Computer Tomography
The Rocking Right Ventricle Paradigm
B. Pang 1,2,∗ , S. Joshi 1,2 , E. Lui 2,3 , M. Tacey 4 , J. Alison 5,6 , S. Seneviratne 5,6 , J. Cameron 5,6 , H. Mond 1,2 1 The
Department of Cardiology, Royal Melbourne Hospital, Parkville, Australia 2 The Department of Medicine, University of Melbourne, Australia 3 The Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Australia 4 Melbourne EpiCentre, University of Melbourne, Australia 5 Monash Cardiovascular Research Centre, MonashHEART, Australia 6 Southern Clinical School, Monash University, Melbourne, Australia Introduction: Case reports describe implanted screwin pacemaker leads damaging coronary arteries. Our aim was to investigate the proximity of right atrial (RA) and right ventricular (RV) pacemaker and implantable cardioverter-defibrillator (ICD) leads to the major coronary anatomy using cardiac computer tomography (CT). Methods: CT Images from patients undergoing clinically indicated were retrospectively analysed to assess the spatial relationship of lead tips to the major coronary anatomy. Results: Fifty RV leads and 35 RA leads were assessed. Leads in the short axis RV antero-septal junction (20 of 52) were in close proximity (median 4.7 mm) to the overlying left anterior descending (LAD) coronary artery. RA leads in the anterior (26 of 35) and lateral (7 of 35) walls of the RA appendage were spatially distant (16.9 ± 7.7 mm and 18.9 ± 12.4 mm, respectively) and directed away from the right coronary artery. However, there were particular lead locations where lead tips were directed towards and were in close proximity to the major coronary anatomy A RA lead adjacent to superior border of the tricuspid valve was 4.3 mm from the right coronary artery and a RA lead on the medial wall of the RA appendage was 1.6 mm away from the aorta. A RV pacemaker lead in the lateral wall of the RV adjacent to the tricuspid valve was 3.4 mm away from the right coronary artery. Conclusions: At particular pacing sites, leads are in close proximity and pose a potential threat to the aorta, LAD and right coronary artery. http://dx.doi.org/10.1016/j.hlc.2013.05.477
S201
D. Seaton 1,∗ , B. Shearer 1 , K. Aldridge 1 , F. Kermeen 2 1 The
Prince Charles Hospital, Australia Lung Transplant Service, Australia
2 Queensland
Introduction: Identifying accurate and reliable echocardiographic parameters for the functional assessment of the right ventricle (RV) in pulmonary hypertension (PHT) remains a challenge. Aim: We report the concerning anomaly of normalisation of quantitative parameters of annular motion in the setting of severe RV dysfunction (RVD) characterised by the “rocking right ventricle”. Method: Eighty-two patients (68%F) from tertiary PAH centre, 21 IPAH, 3 FPAH, 20 PAH-CHD, 17 PAH-CTD, 7 CTEPH, 4 porto-pulmonary & 10 out of proportion PHT underwent echocardiography over 3/12. Results: Mean age 54.3 ± 17.7 years, mWHO-FC 2.7 ± 0.6 with m6MWT 404 ± 150.3 m with 45% prescribed one, 29% two & 17% triple PAH therapies. Echocardiography confirmed severe PHT with mRVSP 90.6 mmHg ±24, mRA size 25.4 cm2 ±7.6, 26% pericardial effusion and RVD in 84%. However, the mean TAPSE 18 mm ±4.7& S velocity 10.8 cm/s ±1.6, were preserved within normal limits. Sub-group analysis 14 patients with cardiac MRI (mRVEDV 141.7 ± 35 mls (BSA corrected) & RVEF 32.8% ±7.3 were compared with mRVSP 98.2 mmHg ±18.4, mRA size 27.4 cm2 ±5.5, RV FAC 18.9% (±6.6)and again mean TAPSE and S were preserved 19.9 mm ±3.7, 11.8 cm/s ±1.8. Conclusion: Our data supports RVSP, RA size, FAC, presence of pericardial effusion and the visual assessment of the RV as important predictors and TAPSE and S have poor correlation and are frequently normal in patients with advanced PHT with associated RVD. Further analysis of RV strain patterns within this group is warranted as prognostic markers in PHT. http://dx.doi.org/10.1016/j.hlc.2013.05.478 477 The Role of Modern-Era Transthoracic Echocardiography for Detection of Cardiac Device-Related Infective Endocarditis J. Sedgwick ∗ , A. Secomb, J. Sherman, A. Benjamin, R. Denman, D. Burstow, D. Roper The Prince Charles Hospital, Brisbane, Australia Background: Cardiac device-related infective endocarditis (CDRIE) is increasingly encountered and associated with high morbidity and mortality. Few trials have assessed the diagnostic accuracy of modern-era transthoracic with transoesophageal echocardiography in patients undergoing lead explantation. Aim: To determine the diagnostic accuracy of TTE using modern era imaging for detection of CDRIE.
ABSTRACTS
Heart, Lung and Circulation 2013;22:S126–S266
475
476
The Proximity of Implanted Pacemaker and Implantable Cardioverter-Defibrillator Leads to Coronary Arteries as Assessed by Cardiac Computer Tomography
The Rocking Right Ventricle Paradigm
B. Pang 1,2,∗ , S. Joshi 1,2 , E. Lui 2,3 , M. Tacey 4 , J. Alison 5,6 , S. Seneviratne 5,6 , J. Cameron 5,6 , H. Mond 1,2 1 The
Department of Cardiology, Royal Melbourne Hospital, Parkville, Australia 2 The Department of Medicine, University of Melbourne, Australia 3 The Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Australia 4 Melbourne EpiCentre, University of Melbourne, Australia 5 Monash Cardiovascular Research Centre, MonashHEART, Australia 6 Southern Clinical School, Monash University, Melbourne, Australia Introduction: Case reports describe implanted screwin pacemaker leads damaging coronary arteries. Our aim was to investigate the proximity of right atrial (RA) and right ventricular (RV) pacemaker and implantable cardioverter-defibrillator (ICD) leads to the major coronary anatomy using cardiac computer tomography (CT). Methods: CT Images from patients undergoing clinically indicated were retrospectively analysed to assess the spatial relationship of lead tips to the major coronary anatomy. Results: Fifty RV leads and 35 RA leads were assessed. Leads in the short axis RV antero-septal junction (20 of 52) were in close proximity (median 4.7 mm) to the overlying left anterior descending (LAD) coronary artery. RA leads in the anterior (26 of 35) and lateral (7 of 35) walls of the RA appendage were spatially distant (16.9 ± 7.7 mm and 18.9 ± 12.4 mm, respectively) and directed away from the right coronary artery. However, there were particular lead locations where lead tips were directed towards and were in close proximity to the major coronary anatomy A RA lead adjacent to superior border of the tricuspid valve was 4.3 mm from the right coronary artery and a RA lead on the medial wall of the RA appendage was 1.6 mm away from the aorta. A RV pacemaker lead in the lateral wall of the RV adjacent to the tricuspid valve was 3.4 mm away from the right coronary artery. Conclusions: At particular pacing sites, leads are in close proximity and pose a potential threat to the aorta, LAD and right coronary artery. http://dx.doi.org/10.1016/j.hlc.2013.05.477
S201
D. Seaton 1,∗ , B. Shearer 1 , K. Aldridge 1 , F. Kermeen 2 1 The
Prince Charles Hospital, Australia Lung Transplant Service, Australia
2 Queensland
Introduction: Identifying accurate and reliable echocardiographic parameters for the functional assessment of the right ventricle (RV) in pulmonary hypertension (PHT) remains a challenge. Aim: We report the concerning anomaly of normalisation of quantitative parameters of annular motion in the setting of severe RV dysfunction (RVD) characterised by the “rocking right ventricle”. Method: Eighty-two patients (68%F) from tertiary PAH centre, 21 IPAH, 3 FPAH, 20 PAH-CHD, 17 PAH-CTD, 7 CTEPH, 4 porto-pulmonary & 10 out of proportion PHT underwent echocardiography over 3/12. Results: Mean age 54.3 ± 17.7 years, mWHO-FC 2.7 ± 0.6 with m6MWT 404 ± 150.3 m with 45% prescribed one, 29% two & 17% triple PAH therapies. Echocardiography confirmed severe PHT with mRVSP 90.6 mmHg ±24, mRA size 25.4 cm2 ±7.6, 26% pericardial effusion and RVD in 84%. However, the mean TAPSE 18 mm ±4.7& S velocity 10.8 cm/s ±1.6, were preserved within normal limits. Sub-group analysis 14 patients with cardiac MRI (mRVEDV 141.7 ± 35 mls (BSA corrected) & RVEF 32.8% ±7.3 were compared with mRVSP 98.2 mmHg ±18.4, mRA size 27.4 cm2 ±5.5, RV FAC 18.9% (±6.6)and again mean TAPSE and S were preserved 19.9 mm ±3.7, 11.8 cm/s ±1.8. Conclusion: Our data supports RVSP, RA size, FAC, presence of pericardial effusion and the visual assessment of the RV as important predictors and TAPSE and S have poor correlation and are frequently normal in patients with advanced PHT with associated RVD. Further analysis of RV strain patterns within this group is warranted as prognostic markers in PHT. http://dx.doi.org/10.1016/j.hlc.2013.05.478 477 The Role of Modern-Era Transthoracic Echocardiography for Detection of Cardiac Device-Related Infective Endocarditis J. Sedgwick ∗ , A. Secomb, J. Sherman, A. Benjamin, R. Denman, D. Burstow, D. Roper The Prince Charles Hospital, Brisbane, Australia Background: Cardiac device-related infective endocarditis (CDRIE) is increasingly encountered and associated with high morbidity and mortality. Few trials have assessed the diagnostic accuracy of modern-era transthoracic with transoesophageal echocardiography in patients undergoing lead explantation. Aim: To determine the diagnostic accuracy of TTE using modern era imaging for detection of CDRIE.
ABSTRACTS
Heart, Lung and Circulation 2013;22:S126–S266