Background-Left ventricular (LV) and right ventricular pacing site characteristics have been shown to influence response to cardiac resynchronization therapy (CRT). This study aimed to determine the clinical feasibility of image-guided lead delivery using a 3-dimensional navigational model displaying both LV and right ventricular (RV) pacing targets. Serial echocardiographic measures of clinical response and procedural metrics were evaluated. Methods and Results-Thirty-one consecutive patients underwent preimplant cardiac MRI with the generation of a 3-dimensional navigational model depicting optimal segmental targets for LV and RV leads. Lead delivery was guided by the model in matched views to intraprocedural fluoroscopy. Blinded assessment of final lead tip location was performed from postprocedural cardiac computed tomography. Clinical and LV remodeling response criteria were assessed at baseline, 3 months, and 6 months using a 6-minute hall walk, quality of life questionnaire, and echocardiography. Mean age and LV ejection fraction was 66±8 years and 26±8%, respectively. LV leads were successfully delivered to a target or adjacent segment in 30 of 31 patients (97%), 68% being nonposterolateral. RV leads were delivered to a target or adjacent segment in 30 of 31 patients (97%), 26% being nonapical. Twenty-three patients (74%) met standard criteria for response (LV end-systolic volume reduction ≥15%), 18 patients (58%) for super-response (LV end-systolic volume reduction ≥30%). LV ejection fraction improved at 6 months (31±8 versus 26±8%, P=0.04). Conclusions-This study demonstrates clinical feasibility of dual cardiac resynchronization therapy lead delivery to optimal targets using a 3-dimensional navigational model. High procedural success, acceptable procedural times, and a low rate of early procedural complications were observed. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01640769.
The most common type of infective endocarditis is bacterial endocarditis. However, fungal infections have been seen more frequently, mostly in the immunocompromised population. We report a case of invasive Aspergillus fumigatus native mitral valve endocarditis. The patient received appropriate empiric antifungal treatment with a combination of liposomal amphotericin B and flucytosine, associated with surgical debridement, valve replacement and chordae tendineae repair. Despite receiving the standard treatment of Aspergillus endocarditis, and susceptibility of the microorganism to the antifungal regimen, the patient, unexpectedly, developed early-onset septic emboli. It is surprising to see that the patient had developed such complications early, despite attempts to eliminate the source of infection with surgical intervention.
Background The prevalence of both chronic coronary syndrome (CCS) and its risk factors is alarming in Saudi Arabia and only a minority of patients achieve optimal medical management. Context-specific CCS guidelines outlining best clinical practices are therefore needed to address local gaps and challenges. Consensus panel A panel of experts representing the Saudi Heart Association (SHA) reviewed existing evidence and formulated guidance relevant to local clinical practice considering the characteristics of the Saudi population, the Saudi healthcare system, its resources and medical expertise. They were reviewed by external experts to ensure scientific and medical accuracy. Consensus findings Recommendations are provided on the clinical assessment and management of CCS, along with supporting evidence. Risk reduction through non-pharmacological therapy (lifestyle modifications) remains at the core of CCS management. Great emphasis should be placed on the use of available pharmacological options (anti-anginal therapy and event prevention) only as appropriate and necessary. Lifestyle counseling and pharmacological strategy must be optimized before considering revascularization, unless otherwise indicated. Revascularization strategies should be carefully considered by the Heart Team to ensure the appropriate choice is made in accordance to current guidelines and patient preference. Conclusion Conscientious, multidisciplinary, and personalized clinical management is necessary to navigate the complex landscape of CCS in Saudi Arabia considering its population and resource differences. The reconciliation of international evidence and local characteristics is critical for the improvement of healthcare outcomes among CCS patients in Saudi Arabia.
Background: Performance of Hajj is physically very demanding, especially if performed during the summer season. The aim of this study is to evaluate the importance of ambient temperature and dehydration, indicated by plasma osmolarity on the clinical outcomes of cardiac patients during Hajj season in 2017. Methods: We included all patients referred to tertiary center with acute coronary syndrome during Hajj period of 2017. Plasma osmolarity was calculated using concentrations of sodium, plasma glucose, and blood urea nitrogen at admission. Patients were stratified by groups (G) of admission osmolarity, clinical outcome was compared. The primary endpoints were in-hospital mortality, length of stay, Cardiac complications (heart failure, re-infarction, arrhythmia, shock and thrombus formation), left ventricular function and readmission rate. Result: Total of 300 patients were identified with mean age 56.2 ±12.1, 84% males and 97(32%) were pilgrims. They were exposed to average heat index 61.9 ±10.6° C. Significantly longer admissions were found in the group of higher osmolarity (G2) (≥295 mos/L) as compared to patients with normal osmolarity in G1 [6.7 ±14.9 VS 4.0 ±4.5, P=0.045]. Total in-hospital death rate was 4.3% (13). Using Binary regression analysis; osmolarity Group [p=0.009], Pilrgrim [P=0.005], Heat index [ P=0.005], were independent predictor of inhospital mortality, while Heat index is the only independent predictor for MACE [P=0.001]. Conclusion: Plasma osmolarity and heat index significantly affect cardiac patient’s outcome. These finding underscore the importance of health awareness of protection from dehydration for pilgrims during summer season.
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