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The utility of cardiac computer tomography in a case of a pacemaker and dextrocardia
Abstract
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331 The utility of cardiac computer tomography in a case of a pacemaker and dextrocardia B. Pang 1,2,∗ , H. Mond 1,2 1 Royal
Melbourne Hospital, Melbourne, VIC, Australia 2 University of Melbourne, Melbourne, VIC, Australia A 70-year-old male presented with chest pain following pacemaker implantation for syncope with complete heart block. Right atrial (RA) and right ventricular (RV) pacing leads were implanted into a left sided subclavian vein and superior vena cava (SVC). Fluoroscopic images suggested dextrocardia (Figure 1A). A cardiac CT was ordered to define the cardiac anatomy and to exclude coronary artery disease. CT (Figure 1B) confirmed that the pacing wires travelled via the left SVC rather than a persistent left SVC and coronary sinus. Axial CT images demonstrated the aorta was on the right side and inferior vena cava (IVC) and liver on the left side. The morphological LV was orientated to the right. Atrioventricular and ventricular-arterial connections were intact. There was no perforation and only moderate coronary artery disease. Conclusion: Congenital cardiovascular abnormalities often result in unusual locations of pacing leads and require an understanding of the particular anatomy and technical challenges. In dextrocardia situs invertus there is a “mirror image” of the normal heart with the apex directed towards the right, the superior vena cava and liver are on the left side. Cardiac CT was also able to exclude significant coronary artery disease and perforation. Figure 1.(A) Anterior-posterior fluoroscopic view of the right ventricular (RV) and right atrial (RA) pacing leads. (B) Three-dimensional CT image with the RV and RA removed. The proximity of the tip of the RV lead to the left anterior descending (LAD) coronary artery can be appreciated.
http://dx.doi.org/10.1016/j.hlc.2015.06.332
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332 Thoracoscopic surgical ablation versus catheter ablation for atrial fibrillation: systematic review and meta-analysis K. Phan 1,∗ , C. Medi 2 , T. Yan 1 1 The
Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia 2 Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia Background: For patients with atrial fibrillation (AF) who are refractory to anti-arrhythmic drugs (AAD), minimally invasive video-assisted thoracoscopic surgical ablation (SA) and catheter ablation (CA) are potential treatment options. The recent FAST randomised study suggested that thoracoscopic SA was superior to CA in achieving freedom of AF in patients who have failed at least one prior AAD. In order to assess SA versus CA, a systematic review and meta-analysis was conducted. Methods: Electronic searches were performed using six databases from their inception to December 2014. Relevant studies comparing thoracoscopic SA and CA were identified, data were extracted and analysed according to predefined clinical endpoints. Relative risk (RR) and weighted mean difference (WMD) were used as summary statistics. Results: Freedom from AF/arrhythmias was significantly higher in SA versus CA at 12-months off-AAD (78.4% vs 53%; RR, 1.54; P<0.0001) and on-AAD (84.1% vs 47.8%; RR, 1.79; P<0.00001). This difference was maintained in paroxysmal and persistent AF subgroups. The SA cohort had a significantly lower requirement for repeat ablations compared to the CA cohort (4.2% vs 21.7%; RR, 0.21; P<0.0001). However, major complications were significantly higher in the SA group (28.2% vs 7.8%; RR, 3.30; P=0.0003), driven by pleural effusion and pneumothorax. Conclusion: SA may be more efficacious than CA treatment in a selected patient population with refractory AF and prior failed catheter intervention. Improved freedom from arrhythmias at up to 12-month follow-up is counterbalanced by higher procedural complication rates. http://dx.doi.org/10.1016/j.hlc.2015.06.333 333 Three-dimensional (3D) wavemapping of human persistent atrial fibrillation B. Pathik 1,2,∗ , T. Walters 1,2 , G. Morris 1 , J. Morton 1,2 , J. Kalman 1,2 , G. Lee 1,2 1 Department
of Cardiology, Royal Melbourne Hospital, Melbourne, VIC, Australia 2 Department of Medicine, University of Melbourne, Melbourne, VIC, Australia Background: The mechanism of persistent atrial fibrillation (AF) remains uncertain. We sought to determine the prevalence of focal drivers and rotors in persistent AF using a novel 3D Wavemapping technique that utilises local activation timings during AF.
S252
331 The utility of cardiac computer tomography in a case of a pacemaker and dextrocardia B. Pang 1,2,∗ , H. Mond 1,2 1 Royal
Melbourne Hospital, Melbourne, VIC, Australia 2 University of Melbourne, Melbourne, VIC, Australia A 70-year-old male presented with chest pain following pacemaker implantation for syncope with complete heart block. Right atrial (RA) and right ventricular (RV) pacing leads were implanted into a left sided subclavian vein and superior vena cava (SVC). Fluoroscopic images suggested dextrocardia (Figure 1A). A cardiac CT was ordered to define the cardiac anatomy and to exclude coronary artery disease. CT (Figure 1B) confirmed that the pacing wires travelled via the left SVC rather than a persistent left SVC and coronary sinus. Axial CT images demonstrated the aorta was on the right side and inferior vena cava (IVC) and liver on the left side. The morphological LV was orientated to the right. Atrioventricular and ventricular-arterial connections were intact. There was no perforation and only moderate coronary artery disease. Conclusion: Congenital cardiovascular abnormalities often result in unusual locations of pacing leads and require an understanding of the particular anatomy and technical challenges. In dextrocardia situs invertus there is a “mirror image” of the normal heart with the apex directed towards the right, the superior vena cava and liver are on the left side. Cardiac CT was also able to exclude significant coronary artery disease and perforation. Figure 1.(A) Anterior-posterior fluoroscopic view of the right ventricular (RV) and right atrial (RA) pacing leads. (B) Three-dimensional CT image with the RV and RA removed. The proximity of the tip of the RV lead to the left anterior descending (LAD) coronary artery can be appreciated.
http://dx.doi.org/10.1016/j.hlc.2015.06.332
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332 Thoracoscopic surgical ablation versus catheter ablation for atrial fibrillation: systematic review and meta-analysis K. Phan 1,∗ , C. Medi 2 , T. Yan 1 1 The
Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia 2 Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia Background: For patients with atrial fibrillation (AF) who are refractory to anti-arrhythmic drugs (AAD), minimally invasive video-assisted thoracoscopic surgical ablation (SA) and catheter ablation (CA) are potential treatment options. The recent FAST randomised study suggested that thoracoscopic SA was superior to CA in achieving freedom of AF in patients who have failed at least one prior AAD. In order to assess SA versus CA, a systematic review and meta-analysis was conducted. Methods: Electronic searches were performed using six databases from their inception to December 2014. Relevant studies comparing thoracoscopic SA and CA were identified, data were extracted and analysed according to predefined clinical endpoints. Relative risk (RR) and weighted mean difference (WMD) were used as summary statistics. Results: Freedom from AF/arrhythmias was significantly higher in SA versus CA at 12-months off-AAD (78.4% vs 53%; RR, 1.54; P<0.0001) and on-AAD (84.1% vs 47.8%; RR, 1.79; P<0.00001). This difference was maintained in paroxysmal and persistent AF subgroups. The SA cohort had a significantly lower requirement for repeat ablations compared to the CA cohort (4.2% vs 21.7%; RR, 0.21; P<0.0001). However, major complications were significantly higher in the SA group (28.2% vs 7.8%; RR, 3.30; P=0.0003), driven by pleural effusion and pneumothorax. Conclusion: SA may be more efficacious than CA treatment in a selected patient population with refractory AF and prior failed catheter intervention. Improved freedom from arrhythmias at up to 12-month follow-up is counterbalanced by higher procedural complication rates. http://dx.doi.org/10.1016/j.hlc.2015.06.333 333 Three-dimensional (3D) wavemapping of human persistent atrial fibrillation B. Pathik 1,2,∗ , T. Walters 1,2 , G. Morris 1 , J. Morton 1,2 , J. Kalman 1,2 , G. Lee 1,2 1 Department
of Cardiology, Royal Melbourne Hospital, Melbourne, VIC, Australia 2 Department of Medicine, University of Melbourne, Melbourne, VIC, Australia Background: The mechanism of persistent atrial fibrillation (AF) remains uncertain. We sought to determine the prevalence of focal drivers and rotors in persistent AF using a novel 3D Wavemapping technique that utilises local activation timings during AF.