Atrial Fibrillation Triggered by Theophylline: a Case Report Treated with "Pill in the Pocket"

Background and objectives: Acromegaly is endocrinal disorder which results in changes involving general appearance as well as upper airway abnormalities, cardiovascular and metabolic disorders which can aggravate the anesthesia and can lead to complications. We aim to discuss the challenges for anesthesiologist that occurs facing patient with acromegaly and are necessary to investigate before performing any kind of intervention. Case Presentation: 79 years old male patient presented the hospital with recently diagnosed acromegaly for rectal prolapse surgery. From anamnesis he had NYHAIII with cardiomyopathy, atrial fibrillation and arterial hypertension, also multiple old compressive fractures Th10 – L5. He was graded with Mallampati score IV and ASA class IV. The complementary examinations were made to assess the possible complications. In induction of general anesthesia the intubation was performed using fibro- bronchoscope and anesthesia went without complications except hypotension which was managed. After surgery the patient was leaded to the postoperative room for further monitoring. Discussion and Conclusion: Acromegalic patients have an increased risk of difficulty during anesthesia compared to general population due to difficult intubation, cardiovascular complications , OSA , alteration in intraoperative glucose intolerance and fluid regulation. Therefore profound investigation and assessment are necessary to predict and prepare for possible difficulties in the surgery room.

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Case Report: Rivaroxaban-associated Bullous Pemphigoid in A Patient with Atrial Fibrillation

CJC Open ◽

10.1016/j.cjco.2021.06.003 ◽

2021 ◽

Author(s):

Jiaming (Calvin) Liang ◽

Karanvir Raman ◽

Siu Him Chan ◽

A. Yashar Tashakkor

Keyword(s):

Atrial Fibrillation ◽

Case Report ◽

Bullous Pemphigoid

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Abolishment of high-risk left lateral accessory pathway by myocardial infarction: a blessing in disguise? A case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab050 ◽

2021 ◽

Vol 5 (2) ◽

Author(s):

Jim O’Brien ◽

Nikola Kozhuharov ◽

Shui Hao Chin ◽

Mark Hall

Keyword(s):

Atrial Fibrillation ◽

Acute Coronary Syndrome ◽

Case Report ◽

High Risk ◽

Coronary Sinus ◽

Refractory Period ◽

Accessory Pathway ◽

Coronary Syndrome ◽

Electrophysiology Study ◽

Anomalous Coronary

Abstract Background Antegradely conducting left lateral accessory pathways are a risk for supraventricular tachycardias and pre-excited atrial fibrillation. Rarely, an anomalous coronary sinus can cause difficulty in locating the pathway. The left circumflex coronary artery and obtuse marginal branches supply the posterolateral left ventricle. We describe a case report of a high-risk accessory pathway associated with an anomalous coronary sinus which, between successive electrophysiology studies, was obliterated by a felicitous acute coronary syndrome in the left circumflex territory. Case summary A 49-year-old male with palpitations and manifest pre-excitation was referred for electrophysiology study. Initial study revealed a high-risk left lateral accessory pathway with antegrade effective refractory period of 240 ms and rapidly conducting pre-excited atrial fibrillation. The coronary sinus could not be cannulated to localize the pathway. Coronary angiography and cardiac computed tomography showed an anomalous coronary sinus emptying into the right atrial free wall and patent coronaries. While awaiting repeat electrophysiology study, the patient suffered an acute coronary syndrome with immediate loss of previously visible pre-excitation on electrocardiogram, and underwent stenting of an occluded marginal branch of the circumflex. Repeat electrophysiology study demonstrated a now low-risk accessory pathway (effective refractory period 390 ms). Since infarction, the patient’s palpitations have fully settled with all subsequent electrocardiograms devoid of manifest pre-excitation. Discussion Left lateral accessory pathways, which can associate with an anomalous coronary sinus, derive from tissue similar to normal ventricular myocardium and are vulnerable to ischaemic insults in the area subtended by the circumflex artery.

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B-PO04-214 ATRIAL TRANS-SEPTOPLASTY DURING CONCOMITANT ATRIAL FIBRILLATION ABLATION AND LEFT ATRIAL APPENDAGE CLOSURE: A CASE REPORT

Heart Rhythm ◽

10.1016/j.hrthm.2021.06.906 ◽

2021 ◽

Vol 18 (8) ◽

pp. S366

Author(s):

Devi G. Nair ◽

Siji S. Thomas ◽

Brian Cheung

Keyword(s):

Atrial Fibrillation ◽

Case Report ◽

Left Atrial ◽

Left Atrial Appendage ◽

Atrial Fibrillation Ablation ◽

Atrial Appendage ◽

Left Atrial Appendage Closure

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Hardware challenges with an anticoagulation strategy guided by detection of atrial fibrillation by an implantable loop recorder

European Heart Journal ◽

10.1093/ehjci/ehaa946.0393 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Mittal ◽

D Brenner ◽

S Oliveros ◽

A Bhatt ◽

M Preminger ◽

...

Keyword(s):

Atrial Fibrillation ◽

Data Transmission ◽

Data Transfer ◽

Implantable Loop Recorder ◽

Loop Recorder ◽

Bedside Monitor ◽

Pill In The Pocket ◽

Fundamental Requirement ◽

Ecg Data ◽

Clinical Strategy

Abstract Background A “pill-in-the-pocket” anticoagulation strategy, guided by ECG data from an implantable loop recorder (ILR), has been advocated as a clinical strategy. However, a fundamental requirement is the ability to reliably obtain daily ECG data from patients. Objective To determine the reliability of daily ECG data transfer from ILRs. Methods We evaluated patients implanted with an ILR in whom we sought to withhold oral anticoagulation (OAC) unless atrial fibrillation (AF) was detected. The ILR transmits data nightly to a bedside monitor. Once received, the data are sent to a central server. Over the course of a month, we tracked for each patient whether ECG data were received by the server. Results The study included 170 AF patients with an ILR where we planned to withhold OAC unless AF was documented. Daily ECG data were automatically transmitted and retrievable in only 36 (21%) patients. Two (1%) pts had not a single day of connectivity, 6 (4%) pts were connected <7 days, and 16 (9%) pts were connected <14 days. Wireless connectivity was lost for >48 hours in 89 (52%) patients (Figure). Most patients experienced multiple reasons for data transmission failure within the month. Conclusions To determine whether an ILR guided OAC strategy is feasible, reliable daily transmission of ECG data is a fundamental prerequisite. Current technology facilitated daily ECG data transfer in only 1/5 of patients. In the remaining, there was either extended loss of connectivity or no connectivity at all. A “pill-in-the-pocket” anticoagulation approach is currently difficult given existing hardware limitations. Funding Acknowledgement Type of funding source: None

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