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Percutaneous Transluminal Septal Myocardial Ablation in Hypertrophic Cardiomyopathy
Published in Srilakshmi M. Adhyapak, V. Rao Parachuri, Hypertrophic Cardiomyopathy, 2020
Anene C. Ukaigwe, Paul Sorajja
The data limitations posed by the lack of randomized controlled trials continues to fuel the debates regarding which SRT is superior. The residual LVOT gradient is consistently associated with worse outcomes, therefore elimination of this gradient is a more important consideration than the method, as long as the chosen SRT can be safely performed with the least complications [47]. Over the past three decades, with increasing experience, PTSMA has evolved to use more refined imaging guidance and infarct localization with echo contrast and reduced alcohol volume. The earlier concern about the arrhythmogenicity of myocardial scarring appears to be unfounded with contemporary PTSMA techniques [35, 36]. Therefore PTSMA has emerged as an invaluable, accessible technique for the management of symptoms attributable to drug-refractory HCM in appropriately selected patients. With accumulating long-term follow-up retrospective data, pacemaker requirement, and reintervention for symptomatic LVOT, gradients remain the only outcomes where myectomy performs better than PTSMA.
Atherosclerosis imaging and screening
Published in Clive Handler, Gerry Coghlan, Marie-Anne Essam, Preventing Cardiovascular Disease in Primary Care, 2018
Clive Handler, Gerry Coghlan, Marie-Anne Essam
Cardiac magnetic resonance imaging has potential for imaging and characterising atherosclerotic plaque and can differentiate different plaque components – fibrous cap, calcium and lipid core. This may provide prognostic information because patients with lipid-rich, unstable, inflamed plaques may be at particularly high risk from coronary events. Carotid arteries are easier to image than the aorta or coronary arteries. Cardiac magnetic resonance imaging can detect silent myocardial scarring and this might prove to be a useful predictor of cardiovascular mortality. Cardiac MR is not widely available and there are no large-scale studies concerning its prognostic value. It is comparatively reproducible and accurate.
Arrhythmias
Published in Clive Handler, Gerry Coghlan, Nick Brown, Management of Cardiac Problems in Primary Care, 2018
Clive Handler, Gerry Coghlan, Nick Brown
Radio-frequency ablation of ventricular arrhythmias originating from the right ventricular outflow tract and a focal point in the left ventricle may be treated with ablation. Patients with myocardial scarring who remain symptomatic despite having an implantable cardioverter defibrillator may benefit from ablation of foci of arrhythmias in the ventricle.
Atrial tachyarrhythmia as a presenting symptom leading to the diagnosis of pulmonary sarcoidosis treated with catheter-based ablation
Published in Baylor University Medical Center Proceedings, 2021
Ayman Haq, Talia G. Meidan, Gaurav Synghal, Hafiza Khan
A 55-year-old woman was referred for 5 months of progressive palpitations. Her father had cardiac sarcoidosis and psoriasis and her daughter had ankylosing spondylitis and psoriatic arthritis. Laboratory studies, electrocardiogram, and echocardiogram were unremarkable. Ambulatory cardiac monitoring revealed an atrial tachycardia (Figure 1). An electrophysiology study revealed left-sided pre-atrial contractions triggering atrial fibrillation and typical and atypical atrial flutter. Cardiac gated computed tomography disclosed no cardiac abnormality but revealed multiple pulmonary nodules (Figure 2). An endobronchial ultrasound-guided fine-needle aspiration was consistent with pulmonary sarcoidosis (Figure 3). Cardiac magnetic resonance imaging (MRI) revealed normal chamber sizes without evidence of myocardial scarring. She underwent radiofrequency ablation of the cavotricuspid isthmus and left common, right superior, and right inferior pulmonary vein isolation via cryoablation. Hydroxychloroquine was initiated 19 days later. She did not have atrial fibrillation or atrial flutter after ablation, and her loop recorder was explanted 3 years after implantation.
Letter to the Editor - New Pharmacotherapy for Heart Failure with Reduced Ejection Fraction
Published in Expert Review of Cardiovascular Therapy, 2020
Adam Ioannou, Sofia Metaxa, Steny Simon, Amit K. J. Mandal, Constantinos G. Missouris
Our findings may help shed some light on the underlying mechanisms of sacubitril/valsartan. Non-ischemic cardiomyopathy patients have shown greater improvements in ejection fraction following renin angiotensin system inhibition and beta blockade compared with those with ischemic cardiomyopathy. The ischemic myocardium exhibits a greater degree of beta adrenoreceptor uncoupling and is therefore less likely to respond to pharmacotherapy [6,7]. Furthermore, the increased level of fibrosis and reduced viability of an ischemic myocardium prohibits reverse remodeling and the extent of myocardial scarring has an inverse correlation with the degree of improvement in ejection fraction. The distinct underlying pathophysiology of these two different cardiomyopathies is likely to impact on the potential for reverse remodeling, with non-ischemic patients having a better overall response to pharmacotherapy [8,9].
Optimal site selection and image fusion guidance technology to facilitate cardiac resynchronization therapy
Published in Expert Review of Medical Devices, 2018
Benjamin J. Sieniewicz, Justin Gould, Bradley Porter, Baldeep S Sidhu, Jonathan M Behar, Simon Claridge, Steve Niederer, Christopher A. Rinaldi
Tissue characterization using cardiac CT has been used to identify areas of myocardial scarring. After an infarct, myocardial tissue replaced by fibrous scar and eventually, after several months, undergoes significant lipomatous metaplasia [64]. Using unenhanced CT, it is possible to identify the fat in infarcted myocardium. New-generation dual-source CT (DSCT) allows the integration of late-iodine enhancement imaging and has been shown to correlate reasonably well (52% sensitivity, 88% specificity) with LGE-derived CMR imaging [65].