P921Feasibility of multipoint, high-definition mapping with grid cathether of SVTs in patients with D-Transposition of the great arteries treated with atrial switch surgery

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
S I Llerena Butron ◽  
J Francisco Pascual ◽  
J Perez Rodon ◽  
A Santos Ortega ◽  
B Benito ◽  
...  
Keyword(s):  
Patient Characteristics ◽  
Vascular Complication ◽  
High Definition ◽  
Medium Term ◽  
Atrial Switch ◽  
History Of ◽  
A Minor ◽  
Transaortic Approach ◽  
Mapping Catheter

Abstract Introduction  Patients with D-transposition of the great arteries (TGA) treated with Senning or Mustard surgery develop supraventricular tachycardias (SVTs) that require treatment with ablation. The use of multipoint, high-density, wavefront-activation-orientation independent mapping catheters hasn’t been reported in literature. Purpose To describe the feasibility of using a specific mapping catheter in SVTs in this set of patients. Methods Prospective observational study in patients with history of SVT and atrial switch surgery, that underwent EP study and electroanatomic (EA) mapping with a new 8Fr deflectable, multipoint (16 equidistant electrodes along 4 splines), with magnetic sensor, wavefront-activation-orientation independent catheter, in a third level hospital since April 2018 until May 2019, with medium-term follow-up.  Results A total of 8 EPS (electrophysiologic studies) were performed in 7 patients (clinical data in Table 1). One patient had a tachycardia recurrence, accounting for a second EPS. The pulmonary venous atrium (PVA) was mapped in all procedures, whereas the systemic venous atrium (SVA) was mapped only in 75% of them, A total of 15 EA maps were obtained, with a ratio of 1.9 maps/patient, and an average of 20 375 ± 13 045 total points per patient. In all cases, PVA mapping was performed via retrograde transaortic approach, without transbaffle puncture. Tachycardia was induced in 5 out of 8 procedures, obtaining 6 different tachycardias (4 CTI dependent macro-reentry: 3 w/anticlockwise activation; 1 localized re-entry in SVA; 1 focal AT in SVA).  No arrhythmia was induced in the other 3 procedures, however, in a patient with a previous CTI ablation, evidence of a gap in the ablation line on the voltage map was found. Ablation was performed with an irrigated, contact force, 3.5 mm catheter in 6 of the 8 procedures (75%). A retrograde transaortic approach was used in 3 of CTI dependent macro-reentries (75%). In one patient (who underwent two procedures) ablation was performed through a baffle leak. We report an acute success rate of ablation of 100%, and a recurrence rate of 20% on medium-term follow up. There were no major complications; nonetheless, one patient with history of morbid obesity had a minor vascular complication on the femoral puncture site treated medically. Conclusions it’s feasible and safe to use this new mapping catheter in patients with history of atrial switch surgery, both via retrograde and anterograde approach on the PVA and SVA respectively. The most frequent tachycardia observed in this study was anticlockwise CTI-dependent atrial flutter. Abstract Figure. Patient characteristics

1326Identification of arrhythmic isthmus in patients with transposition of the great arteries treated with atrial switch surgery using a new high-definition wavefront-activation-orientation grid catheter

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
J Francisco Pascual ◽  
S Llerena Butron ◽  
J Perez Rodon ◽  
A Santos Ortega ◽  
B Benito ◽  
...  
Keyword(s):  
High Definition ◽  
Electrophysiologic Study ◽  
Atrial Switch ◽  
Voltage Mapping ◽  
History Of ◽  
Specific Mapping ◽  
Electrophysiological Characterization ◽  
Mapping Catheter

Abstract INTRODUCTION Patients with D- transposition of the great arteries (TGA) treated with Senning or Mustard surgeries have several atrial scars that predispose them to develop atrial tachycardias (AT). Identification of scar zones and possible arrhythmic isthmus in voltage mapping will help to guide the ablation. AIM To describe the feasibility of using a specific mapping catheter to identify possible arrhythmic isthmus in this set of patients. METHODS Prospective observational study in patients with history of SVT and atrial switch surgery, that underwent electrophysiologic study (EP) and electroanatomic (EA) mapping with a new 8Fr deflectable, multipoint wavefront-activation-orientation independent Grid catheter, in a third level hospital since April 2018 until May 2019, with medium-term follow-up. RESULTS A total of 8 EPs were performed in 7 patients (3 (57%) Female, median age 35 ± 6,3 y.o.). Figure 1A shows the localization and percentage of scar identified in both atria. A total of 6 AT were induced. In this, an arrhythmogenic isthmus was identified and, in all patients, at least one non-arrhytmogenic isthmus was documented. Figure 1B shows anatomical and electrophysiological characteristics of the isthmus. Arrhythmogenic isthmus had slower conduction velocity than non-arrhytmogenic ( mean 0,44m/s (IQI 0,17-0,62)  vs  1,05 m/s (IQI 0,86-1,39) p = 0.008) and fractionated potentials were detected more frequently (100% vs 50% p = 0.089) CONCLUSION EA mapping with a new a multipoint, high-definition, Grid Cather is feasible and allows the identification and electrophysiological characterization of arrhythmogenic and non-arrhytmogenic isthmus in patients with TGA treated with atrial switch surgery. Abstract Figure 1

scholarly journals Burden of comorbid conditions in children and young people with juvenile idiopathic arthritis: a collaborative analysis of 3 JIA registries

Rheumatology ◽  
2021 ◽  
Author(s):  
Lianne Kearsley-Fleet ◽  
Jens Klotsche ◽  
Joeri W van Straalen ◽  
Wendy Costello ◽  
Gianfranco D’Angelo ◽  
...  
Keyword(s):  
Patient Characteristics ◽  
Incidence Rates ◽  
Varicella Vaccination ◽  
Patient Registries ◽  
Biologic Treatment ◽  
Systemic Jia ◽  
History Of ◽  
First Time

Abstract Objectives Burden of comorbidities are largely unknown in JIA. From 2000, national and international patient registries were established to monitor biologic treatment, disease activity and adverse events in patients with JIA. The aim of this analysis was to investigate in parallel, for the first time, three of the largest JIA registries in Europe/internationally—UK JIA Biologic Registers (BCRD/BSPAR-ETN), German biologic registers (BiKeR/JuMBO), multinational Pharmachild—to quantify the occurrence of selected comorbidities in patients with JIA. Methods Information on which data the registers collect were compared. Patient characteristics and levels of comorbidity were presented, focussing on four key conditions: uveitis, MAS, varicella, and history of tuberculosis. Incidence rates of these on MTX/biologic therapy were determined. Results 8066 patients were registered into the three JIA registers with similar history of the four comorbidities across the studies; however, varicella vaccination coverage was higher in Germany (56%) vs UK/Pharmachild (16%/13%). At final follow-up, prevalence of varicella infection was lower in Germany (15%) vs UK/Pharmachild (37%/50%). Prevalence of TB (0.1–1.8%) and uveitis (15–19%) was similar across all registers. The proportion of systemic-JIA patients who ever had MAS was lower in Germany (6%) vs UK (15%) and Pharmachild (17%). Conclusion This analysis is the first and largest to investigate the occurrence of four important comorbidities in three JIA registries in Europe and the role of anti-rheumatic drugs. Combined, these three registries represent one of the biggest collection of cases of JIA worldwide and offer a unique setting for future JIA outcome studies.

Abstract WMP27: PAT Model Accurately Predicts Aneurysm Enlargement in 16 Growing Aneurysm Cases

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Aichi Chien ◽  
Michelle Hildebrandt ◽  
Geoffrey Colby ◽  
Victor Chang ◽  
Gary Duckwiler ◽  
...  
Keyword(s):  
Medical Records ◽  
Intracranial Aneurysms ◽  
Medical Center ◽  
Patient Characteristics ◽  
Percentage Error ◽  
Limited Information ◽  
Unruptured Intracranial Aneurysms ◽  
History Of ◽  
And Behavior

Objective: Imaging technology for unruptured intracranial aneurysms (UIA) has improved detection of such aneurysms. However, there is limited information on UIA change over time, and how to predict the rate of enlargement. The objective of this study was to quantify the accuracy of the Predicted Aneurysm Trajectory (PAT) model recently developed by Chien et al. (J Neurosurgery. 2019; Mar 1:1-11). Methods: Patients diagnosed with UIA were prospectively enrolled at the UCLA Medical Center, and followed through serial imaging. 16 UIA cases exhibiting growth across multiple follow-ups were included in this study. Prior images and medical records were collected. Characteristics relevant to the PAT model (mean ± stdev), including initial UIA size (7.26 ± 6.38), patient age (67.4 ± 9.48 yrs.), sex (4 male), history of smoking (n=5), hypothyroidism (n=4), and follow-up duration (36.5 ± 50.0 mos.) were used to predict UIA size at each follow-up. Predicted and actual UIA sizes at follow-up were compared using symmetric mean absolute percentage error (SMAPE) with percentage error ranging from 0-100%. Results: The 16 UIA cases were split by initial UIA size. For UIA smaller than 7 mm (10 cases, 23 follow-up), SMAPE = 11.13%. For UIA greater than 7 mm (6 cases, 15 follow-up), SMAPE = 8.07%. For all UIA cases (16 cases, 38 follow-up), SMAPE = 9.92%. Conclusions: The PAT model predicts the rate of enlargement for UIA, as opposed to whether or not UIA will grow. With this new sample of data, we found the predicted UIA size at follow-up to be quite accurate, deviating in the range of 10% from the actual, measured size. Patient characteristics such as the demographics and behavior included in the model influence the growth of UIA, which allows prediction of growth to optimize treatment and management in future cases.

scholarly journals 936. Body Fat Redistribution/Accumulation, Pancreatic Disorders, Musculoskeletal Disorders, IRIS, Severe Systemic Rash and Hypersensitivity Reactions Following Initiation of Commonly Prescribed Antiretrovirals

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S33-S34 ◽  
Author(s):  
Philip Lackey ◽  
Laurence Brunet ◽  
Jennifer Fusco ◽  
Vani Vannappagari ◽  
Leigh Ragone ◽  
...  
Keyword(s):  
Musculoskeletal Disorders ◽  
Body Fat ◽  
Patient Characteristics ◽  
Company Stock ◽  
Fat Redistribution ◽  
History Of ◽  
Pancreatic Disorders ◽  
Α Level ◽  
Inflammatory Syndrome

Abstract Background Dolutegravir (DTG), elvitegravir (EVG), raltegravir (RAL), and darunavir (DRV) are commonly used for the treatment of HIV. We assessed the frequency of 6 select disorders after prescription of DTG-, EVG-, RAL-, or DRV-based regimens. Methods HIV-positive patients in the OPERA® Observational Database initiating DTG-, EVG-, RAL-, or DRV-containing regimens were included. Disorders of interest were body fat redistribution/accumulation, pancreatic disorders, and musculoskeletal disorders, as defined in Figures 2–3, as well as immune reconstitution inflammatory syndrome (IRIS), severe systemic rash and hypersensitivity reaction (HSR). Baseline patient characteristics and disorder history were described. The proportion of patients with disorders of interest during follow-up were compared between core agents for each disorder. All events occurring during follow-up were considered prevalent, while incident disorders excluded patients with any history of disorder. To account for multiple comparisons, the Sidak Correction was applied (adjusted α level: 0.017). Results Out of 22,674 patients, 7,860 (35%) initiated DTG, 9,738 (43%) EVG, 1,600 (7%) RAL, and 3,477 (15%) DRV. Baseline demographic and clinical characteristics varied by core agent initiated (Figure 1). Compared with DTG, history of body fat redistribution/accumulation was less frequent in patients initiating EVG, and more frequent in patients initiating RAL (Figure 2). EVG users also had a lower prevalence during follow-up than DTG users (Figure 3). However, there was no difference in new onset of body fat redistribution/accumulation between groups (Figure 3). No difference in prevalent or incident pancreatic or musculoskeletal disorders was detected between core agents (Figure 3). IRIS, severe systemic rash, and HSR occurred in no more than 2 patients per core agent group, with no difference detected between groups. Conclusion Incident body fat redistribution/accumulation, pancreatic disorders, musculoskeletal disorders, IRIS, severe systemic rash, and HSR were rare in this large cohort of patients initiating DTG, EVG, RAL, or DRV. Despite some channeling of patients with a disorder history towards DTG and RAL use, the likelihood of new events did not differ by core agent. Disclosures L. Brunet, Epividian, Inc.: Employee, Salary. ViiV Healthcare: ViiV Healthcare has contracted research with my employer, Epividian, Inc., Employer received funding for research. Merck: Merck has contracted research with my employer, Epividian, Inc., Employer received funding for other research. J. Fusco, Epividian, Inc.: Employee, Salary. ViiV Healthcare: Viiv Healthcare contracted research with my employer, Epividian, Inc., Employer received funding for research. Merck & Co.: Merck contracted research with my employer, Epividian, Inc., Employer received funding for research. V. Vannappagari, ViiV HealthCare: Employee, GlaxoSmithKline Company Stock and Salary. L. Ragone, ViiV Healthcare: Employee and Shareholder, restricted shares and Salary. G. Fusco, Epividian, Inc.: Employee, Salary. ViiV Healthcare: Viiv Healthcare contracted research with my employer, Epividian, Inc., Employer received funding for research. Merck & Co.: Merck contracted research with my employer, Epividian, Inc., Employer received funding for research.

scholarly journals In-patient treatment of opiate dependence: medium-term follow-up outcomes

2005 ◽  
Vol 187 (4) ◽  
pp. 360-365 ◽  
Author(s):  
Bobby P. Smyth ◽  
Joe Barry ◽  
Alison Lane ◽  
Mary Cotter ◽  
Mary O'Neill ◽  
...  
Keyword(s):  
Methadone Maintenance ◽  
Patient Characteristics ◽  
Structured Interview ◽  
Opiate Dependence ◽  
Patient Treatment ◽  
Principal Influence ◽  
After Care ◽  
History Of ◽  
Pre Treatment

BackgroundThe outcome for opiate-dependent patients seeking abstinence is unclear in this era of improved access to methadone maintenance.AimsTo measure the outcome 2–3 years after in-patient treatment.MethodOpiate-dependent patients admitted with a goal of abstinence were followed-up. A structured interview examined drug use and treatment in the preceding month.ResultsFive patients had died and 109 (76%) of the remaining 144 were interviewed. Fifty per cent (54 patients) reported recent opiate misuse and 57% (62) were on methadone maintenance. Twenty-three per cent (25 patients) were abstinent (i.e. neither using opiates nor on methadone maintenance). Abstinence was significantly associated with completion of the 6-week in-patient treatment programme and attendance at out-patient after-care, and negatively associated with a family history of substance misuse.ConclusionsAbstinence remains an attainable goal. As the principal influence on outcome was treatment adherence, inpatient services should seek to enhance rates of programme completion. Aftercare should be provided to patients. We caution against use of pre-treatment patient characteristics as criteria for prioritising access to in-patient treatment.

scholarly journals Management of the patient with persistent symptoms after COVID-19 in primary care

2021 ◽  
Vol 16 (1) ◽  
pp. 42-45
Author(s):  
Mihaela Adela IANCU ◽  
◽  
Laura Maria CONDUR ◽  
Irina EREMIA ◽  
Adriana TICĂRĂU ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Laboratory Tests ◽  
Medium Term ◽  
Acute Period ◽  
Persistent Symptoms ◽  
History Of ◽  
Severity Of The Disease ◽  
Comprehensive History

After the acute period of the infection with SARS-CoV-2, new symptoms may appear. Alternatively, those present might persist. Medium-term symptoms and complications of COVID-19 infection have been reported to persist in several organs such as the heart, lungs, liver, kidneys, and brain. Subsequent monitoring varies from one week to three months, depending on the symptoms and risk factors present. During the initial follow-up assessment, a comprehensive history of the patient's COVID-19 disease, including disease history, duration and severity of symptoms, types and severity of complications has to be obtained. The need for laboratory tests is determined by the severity of the disease, previous results during their illness and current symptoms.

scholarly journals Venous thromboembolism and bleeding in a community setting

2009 ◽  
Vol 101 (05) ◽  
pp. 878-885 ◽  
Author(s):  
Joel Gore ◽  
George Reed ◽  
Darleen Lessard ◽  
Luigi Pacifico ◽  
Cathy Emery ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Total Mortality ◽  
Community Setting ◽  
Patient Characteristics ◽  
Recurrence Rates ◽  
Increased Risk ◽  
History Of ◽  
Recurrent Vte ◽  
The Impact

SummaryBleeding is the most frequent complication of antithrombotic therapy for venous thromboembolism (VTE). However, little attention has been paid to the impact of bleeding after VTE in the community setting. The purpose of this investigation was to describe the incidence rate of bleeding after VTE, to characterize patients most at risk for bleeding, and to assess the impact of bleeding on rates of recurrent VTE and all-cause mortality. The medical records of residents of the Worcester (MA, USA) metropolitan area diagnosed with ICD-9 codes consistent with potential VTE during 1999, 2001, and 2003 were individually validated and reviewed by trained data abstracters. Clinical characteristics, acute treatment, and outcomes (including VTE recurrence rates, bleeding rates, and mortality) over follow-up (up to 3 years maximum) were evaluated. Bleeding occurred in 228 (12%) of 1,897 patients with VTE during our follow-up. Of these, 115 (58.8%) had evidence of early bleeding occurring within 30 days of VTE diagnosis. Patient characteristics associated with bleeding included impaired renal function and recent trauma. Other than a history of prior VTE, the occurrence of bleeding was the strongest predictor of recurrent VTE (hazard ratio [HR] 2.18; 95% confidence interval [CI] 1.54–3.09) and was also a predictor of total mortality (HR 1.97; 95%CI 1.57–2.47). The occur-rence of bleeding following VTE is associated with an increased risk of recurrent VTE and mortality. Future study of antithrombotic strategies for VTE should be informed by this finding. Advances that result in decreased bleeding rates may paradoxically decrease the risk of VTE recurrence.

scholarly journals The natural history of abnormal ultrasound findings in hips of infants under six months of age

2018 ◽  
Vol 12 (4) ◽  
pp. 302-307 ◽  
Author(s):  
R. Sakkers ◽  
V. Pollet
Keyword(s):  
Natural History ◽  
Developmental Dysplasia ◽  
Treatment Algorithms ◽  
Ultrasound Findings ◽  
History Of ◽  
Us Findings ◽  
A Minor ◽  
Dysplasia Of The Hip

Purpose To collect and describe data on the natural history of abnormal ultrasound (US) findings in hips of infants under six months of age to serve as a reference to the design of screening programmes and treatment algorithms in the care for children with hip dysplasia. Methods A search in PubMed of the terms “DDH” and “ultrasound” was done to find hips with abnormal US findings that were not treated. In cases of multiple periods of follow-up, the classification of every period was evaluated separately (individual hip follow-up periods). Results Data of 13 561 hips with 16 991 follow-up periods were collected and analyzed. Most quantifiable classifications and follow-up periods were according to Graf (14 876) and a minor number of the hips had follow-up periods with femoral head coverage (FHC) (2115). Normal development without treatment in the first six months was for Graf 2a between 89% and 98%, for Graf 2c between 80% and 100% and for clustered data Graf 2a to 2c between 80% and 97%. For Graf 3 hips more than 50% were reported to develop into normal hips without treatment. As for Graf 4 hips this percentage was reported below 50%. For children with an FHC less than 50%, normalization was reported between 78% and 100%. Conclusion The natural history of developmental dysplasia of the hip (DDH) shows a benign course, especially in the well-centered hips. This outcome probably contributes to the fact that all studies on US screening of hips for detection of relevant DDH in order to improve outcomes of treatment are rated as substantially underpowered.

The Impact of Early Recognition and Treatment of Systemic Hypertension on Reducing Blood Pressure: The Hypertension and Vascular Evaluation Program

2020 ◽  
Vol 59 (11) ◽  
pp. 970-977
Author(s):  
Jungwon Min ◽  
Heather M. Griffis ◽  
Melodee Mendoza ◽  
Vicky Tam ◽  
Michelle Kaplinski ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Condition ◽  
Early Recognition ◽  
Patient Characteristics ◽  
Mixed Effects ◽  
Systemic Hypertension ◽  
History Of ◽  
Family History Of Hypertension ◽  
The Impact

This study aimed to evaluate the effect of an outpatient systemic hypertension program and associated factors with attending recommended follow-up visit. All visits were tracked in the program, 2011 to 2018. We examined patient characteristics by follow-up status and changes in systolic blood pressure (SBP) and the risk of hypertension in follow-up patients using a mixed-effects regression model. Among 310 patients with first visits, 113 patients returned for a follow-up visit. Patients who did not attend a follow-up were older and less likely to have a severe chronic condition or a family history of hypertension than followed-up patients. The risk of hypertension was significantly reduced by the number of follow-up visits (odds ratio = 0.53, 95% confidence interval = 0.31-0.92). Adolescent SBP and body mass index percentiles decreased with more follow-up visits. As the risk of hypertension is significantly reduced with follow-up visits, additional effort should be made to improve the likelihood of follow-up attendance.

Unrecognized Intracerebral Glass Particle Mimicking Cavernoma: Case Report

Neurosurgery ◽  
2006 ◽  
Vol 58 (1) ◽  
pp. E203-E203 ◽  
Author(s):  
Servet Inci ◽  
Ebru Karakoc ◽  
Serap Saygi ◽  
Tuncalp Ozgen
Keyword(s):  
Foreign Body ◽  
Head Injury ◽  
Foreign Bodies ◽  
Glass Particle ◽  
Trauma Patients ◽  
Intracranial Foreign Body ◽  
History Of ◽  
A Minor ◽  
New Onset

Abstract OBJECTIVE AND IMPORTANCE: Although the presence of a foreign body in the cranium after a head injury is a well-known entity, cases of retained intracranial foreign bodies causing a delayed onset of neurological symptoms are rare. To our knowledge, an unrecognized intracerebral glass particle mimicking a cavernoma has not been previously reported in the literature. CLINICAL PRESENTATION: We report a unique case regarding an intracranial foreign body. A 39-year-old patient presented with new-onset epilepsy. The patient had no history of trauma. According to the magnetic resonance imaging findings and the patient's clinical course, the responsible lesion was considered to be a temporal cavernoma. INTERVENTION: During the operation, surprisingly, a glass particle was found within the temporal lobe. The glass had penetrated the cranium during a minor head injury and had remained undetected for 33 years. The patient was seizure-free without medication during 3 years of follow-up. CONCLUSION: Intracranial small foreign bodies can be difficult to diagnose, especially in patients with no history or a vague history of head trauma. Patients with long-standing retained foreign bodies may remain clinically well until complications arise. Intracranial foreign bodies may mimic other pathologies clinically and radiologically.

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