Fluoroscopy-free ablation in congenital heart disease of moderate or great complexity

2021 ◽  
Author(s):  
Arjun K. Mahendran ◽  
Sara Bussey ◽  
Philip M. Chang
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Great Complexity

scholarly journals Outcomes of women with congenital heart disease admitted to acute-care hospitals for delivery in Japan: a retrospective cohort study using nationwide Japanese diagnosis procedure combination database

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Manabu Nitta ◽  
Sayuri Shimizu ◽  
Makoto Kaneko ◽  
Kiyohide Fushimi ◽  
Shinichiro Ueda
Keyword(s):  
Congenital Heart Disease ◽  
Cohort Study ◽  
Heart Disease ◽  
Acute Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Congenital Heart ◽  
Acute Care Hospitals ◽  
Diagnosis Procedure Combination ◽  
Great Complexity

Abstract Background The number of women with congenital heart disease (CHD) who are of childbearing age is increasing due to advancements in medical management. Nonetheless, data on the outcomes of delivery in women with CHD remain limited. Therefore, we conducted a retrospective cohort study using a nationwide database of deliveries by women with CHD. Methods Deliveries by women with CHD discharged from acute-care hospitals between April 2017 and March 2018 were identified based on the Diagnosis Procedure Combination database which covers almost all acute-care hospitals in Japan. By using this database, we tried to include relatively high-risk deliveries by women with CHD. Subjects were divided into three groups according to the underlying disease complexity: simple, moderate, and great complexity. The clinical characteristics and incidence of peripartum cardiovascular events were compared among the three groups. Results A total of 249 deliveries from 107 hospitals were included. The largest facility had 29 deliveries per year. Given the uncertainty of underlying cardiac anomalies, 48 women were excluded, and the remaining 201 women (median age, 32 years) were analyzed. In-hospital maternal death, use of extracorporeal membrane oxygenation, intra-aortic balloon pump, pacemaker, and direct current cardioversion were not observed. Nine patients (4.5%) required intravenous diuretic administration. However, the difference in the frequency of diuretic use was not significant among the three groups (simple, 1.9%; moderate, 7.2%; great, 6.9%; P = 0.204). One participant required valve replacement surgery at 22 days after a successful cesarean section. As the disease complexity increased, deliveries occurred more frequently at university hospitals (simple, 41.7%; moderate, 52.2%; great, 72.4%; P = 0.013) and the length of hospitalization was significantly longer, with median durations of 9.0 (interquartile range [IQR] 7.0–11.0) days, 10.0 (IQR 8.0–24.0) days, and 11.0 (IQR 8.0–36.0) days in the simple, moderate, and great complexity groups, respectively (P = 0.002). Conclusions Appropriate patient selection and management by specialized tertiary institutions may contribute to positive outcomes in pregnancies in women with CHD.

Abstract 191: Identification of Adults With Congenital Heart Disease From Administrative Data

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Jill M Steiner ◽  
James N Kirkpatrick ◽  
Susan R Heckbert ◽  
J R Curtis
Keyword(s):  
Myocardial Infarction ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Positive Predictive Value ◽  
End Of Life ◽  
Administrative Data ◽  
Predictive Value ◽  
Congenital Heart ◽  
Eisenmenger Syndrome ◽  
Great Complexity

Introduction: With improved management, there are now more adults with congenital heart disease (ACHD) than children. However, long-term survival with moderate or severe ACHD remains limited, and there is relatively sparse literature on the intensity or quality of end-of-life care for these patients. The goal of this analysis is to examine the accuracy of administrative data for identifying patients who died with ACHD to facilitate study of care provided near the end of life. Methods: We created a list of ICD-9 and ICD-10 codes representing ACHD of moderate or great complexity. We performed a search for these codes in the electronic health record (EHR) of adults who received care 2010-2016 within our healthcare system. We used state death records to identify which of these patients died during the same timeframe. Manual EHR review was completed to evaluate performance of this search strategy. Identified patients were also compared to a list of patients seen in our ACHD clinic and known to have died during 2010-2016. Results: Using ICD data, 121 patients were identified, of which 66 actually had the moderate or greater complexity ACHD conditions by EHR review (positive predictive value, 0.55; 95% confidence interval 0.45, 0.63). EHR review confirmed 12 patients with Eisenmenger Syndrome, for which there is no specific ICD code. “Cyanosis+other” did not identify any of these, “VSD+other” (ventricular septal defect) identified 6, and there were 6 whose only ACHD code was VSD. Of the remaining 55 patients, 24 had ACHD not on the targeted list, largely due to coding error. In addition, despite being coded as having ACHD, 31 patients had no identified ACHD on EHR review. These misidentifications were attributed to coding error for 15 patients. Another 11 patients (35%) had acquired VSD due to myocardial infarction or endocarditis, for which there is no separate ICD code. Codes with the highest degree of error, incorrect more than 50% of the time, were those for congenitally corrected transposition, endocardial cushion defect, and hypoplastic left heart syndrome. The list of known deceased clinic patients included 21 with ACHD of interest. Only 1 of these was not identified by the ICD search, yielding a sensitivity for our list of ICD codes in this small sample of 0.95 (0.77,0.99). Conclusion: Use of administrative data to identify patients with ACHD of moderate or great complexity who have died had good sensitivity but suboptimal positive predictive value. Strategies to improve accuracy can be employed. Excluding patients who have codes for myocardial infarction or endocarditis in addition to VSD and using “VSD+other” as an additional proxy for Eisenmenger Syndrome are two examples. Administrative data is not ideal for identification of patients with ACHD of moderate or great complexity who have died, and manual EHR review is necessary to confirm these diagnoses.

scholarly journals Identification of adults with congenital heart disease of moderate or great complexity from administrative data

2017 ◽  
Vol 13 (1) ◽  
pp. 65-71 ◽  
Author(s):  
Jill M. Steiner ◽  
James N. Kirkpatrick ◽  
Susan R. Heckbert ◽  
Asma Habib ◽  
James Sibley ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Administrative Data ◽  
Congenital Heart ◽  
Great Complexity

Abstract 14549: Outcome of Radiofrequency Catheter Ablation of Cavo-tricuspid Isthmus Dependent Flutter in Patients With Adult Congenital Heart Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Stephanie Jou ◽  
Isaac L Goldenthal ◽  
Angelo B Biviano ◽  
Elaine Wan ◽  
Amardeep S Saluja ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Catheter Ablation ◽  
Radiofrequency Catheter Ablation ◽  
Congenital Heart ◽  
Ventricular Ejection Fraction ◽  
The Mean ◽  
Great Complexity

Introduction: Both typical cavo-tricuspid isthmus (CTI) dependent (or its equivalent) and atypical atrial flutter (AFL) are common in adults with congenital heart disease (CHD) either due to its inherent cardiac anatomy or as a result of prior surgical procedures. Radiofrequency catheter ablation is routinely used as a therapeutic option. Hypothesis: Patients with CHD will have an improvement in systemic ventricular ejection fraction and a decreased incidence of atrial arrhythmias after ablation. Methods: A retrospective study was conducted on 99 patients with CHD who underwent ablation for clinical AFL at a single institution between 2010 and 2019. Of these patients, 62 had CTI-AFL. The 2 patients with unspecified CHD were excluded. CHD was divided into 3 categories according to the American College of Cardiology Task Force 1 of the 32nd Bethesda Conference - simple, moderate severity, and great complexity lesions. Outcomes of ablation at 1 year follow up were assessed. Results: Typical counterclockwise CTI-AFL was seen in 50 patients. The mean age was 49.1±13.6 years old with 29 (48.3%) females. Of the 60 patients, 35% (n=21) had simple lesions, 51.7% (n=31) had moderate lesions, and 13.3% (n=8) had great complexity lesions. The mean left or systemic ventricular ejection fraction (EF) significantly improved on follow-up echo among patients with simple CHD (49.1±13.1 to 56.5±4.7%, p=0.018) and moderate CHD (49.5±14.9 to 54±8.5%, p=0.02), but did not change among patients with great complexity CHD (52.5±6 to 52.5±9.25%, p=0.9). There was a significantly increased incidence of atrial fibrillation (9.5% vs. 16.1% vs. 50%, p=0.04) post ablation among simple, moderate, and great complexity lesions, respectively, but no significant difference in the recurrence rate of atrial flutter (p=0.3). Conclusions: Patients who underwent CTI-AFL ablation showed an improvement in EF in patients with simple and moderate CHD. There was also a significantly increased incidence in the development of atrial fibrillation post ablation in CHD with great complexity compared to simple or moderate CHD.

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