OR01 2. Pacemaker, Defibrillator and Electrophysiology Radiofrequency Catheter Ablation of Atrial Fibrillation Since 2001: Did We Improve? H
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Left Anterior Descending Coronary Artery Dissection During Ventricular Tachycardia Ablation – Case Report
CASE REPORTS Left anterior descending coronary artery dissection during ventricular tachycardia ablation – case report KRESIMIR KORDIC, SIME MANOLA, IVAN ZELJKOVIC, IVICA BENKO, NIKOLA PAVLOVIC University Hospital Center Sisters of Charity, Department of Cardiology, Zagreb, Croatia Fascicular left ventricular tachycardia (VT) is the second most frequent idiopathic left VT in the setting of a structurally normal heart. Catheter ablation is curative in most patients with low complication rates. We report a case of ostial left anterior descending coronary artery (LAD) occlusion during fascicular ventricular tachycardia ablation. Dissection was the most likely cause of LAD obstruction. To the authors’ best knowledge, this is the first case reporting selective LAD dissection during electrophysiology study with no left main coronary artery (LMCA) affection. Key words: ventricular tachycardia, electrophysiology, radiofrequency catheter ablation, ST elevation myocardial infarction, percutaneous coronary intervention. INTRODUCTION An electrocardiogram following cardioversion showed normal sinus rhythm, without preexcitation Fascicular left ventricular tachycardia (VT) is or conduction abnormalities. There was no structural the second most frequent idiopathic left VT, after heart disease found on transthoracic echocardio- left ventricular outflow tract VT, occurring in the graphy. setting of a structurally normal heart [1]. An electrophysiology study was performed According to current ESC guidelines [2], using right femoral approach. During the tachy- catheter ablation is curative in most patients with cardia, His was activated after the ventricular VT without overt structural heart disease, with low activation and tachycardia could be entrained from complication rates (around 3%) [3]. Complications atrium and the ventricle. Based on these findings, include access site vascular complications, thrombo- the diagnosis of fascicular ventricular tachycardia embolism, atrioventricular block, myocardial per- was established. -
Late Presentation of Constrictive Pericarditis After Limited Epicardial Ablation for Inappropriate Sinus Tachycardia
Late presentation of constrictive pericarditis after limited epicardial ablation for inappropriate sinus tachycardia Adam Oesterle, MD,* Amita Singh, MD,* Husam Balkhy, MD,* Aliya N. Husain, MD,† Deborah Moyer, APN,* Roderick Tung, MD, FHRS,* Hemal M. Nayak, MD, FHRS* From the *Center for Arrhythmia Care, Heart and Vascular Center, The University of Chicago Medicine, Chicago, Illinois, and †Department of Pathology, The University of Chicago Medicine, Chicago, Illinois. Introduction Biosense-Webster Thermocool SF catheter (Diamond Bar, CA) was delivered in the endocardium. The ablation catheter The number of radiofrequency catheter ablation (RFA) and the angioplasty balloon were both removed and the procedures performed in the epicardial space is increasing.1 ablation catheter was inserted into the epicardial space Major acute complications (primarily pericardial bleeding) through the deflectable sheath, and 5 focal lesions were and delayed complications have been reported in 5% and 2% – delivered in the epicardium overlying the sinus node. At the of cases, respectively.2 4 To the best of our knowledge, a end of the procedure his heart rate decreased from 140 to 70 single case of constrictive pericarditis after multiple epicar- beats per minute. Kenalog (1 mg/kg) was injected into the dial ablations for ventricular tachycardia has been reported.5 pericardial space and the epicardial sheath was removed We describe a late presentation of constrictive pericarditis immediately after the procedure. The fluid was serous, that occurred after a single percutaneous epicardial without any evidence of bleeding, throughout the case. procedure with limited ablation for inappropriate sinus Twelve hours after the procedure, the patient developed tachycardia. pleuritic chest pain, treated with indomethacin, colchicine, and his home dose of aspirin 81 mg daily. -
Arterial Switch Operation Surgery Surgical Solutions to Complex Problems
Pediatric Cardiovascular Arterial Switch Operation Surgery Surgical Solutions to Complex Problems Tom R. Karl, MS, MD The arterial switch operation is appropriate treatment for most forms of transposition of Andrew Cochrane, FRACS the great arteries. In this review we analyze indications, techniques, and outcome for Christian P.R. Brizard, MD various subsets of patients with transposition of the great arteries, including those with an intact septum beyond 21 days of age, intramural coronary arteries, aortic arch ob- struction, the Taussig-Bing anomaly, discordant (corrected) transposition, transposition of the great arteries with left ventricular outflow tract obstruction, and univentricular hearts with transposition of the great arteries and subaortic stenosis. (Tex Heart Inst J 1997;24:322-33) T ransposition of the great arteries (TGA) is a prototypical lesion for pediat- ric cardiac surgeons, a lethal malformation that can often be converted (with a single operation) to a nearly normal heart. The arterial switch operation (ASO) has evolved to become the treatment of choice for most forms of TGA, and success with this operation has become a standard by which pediatric cardiac surgical units are judged. This is appropriate, because without expertise in neonatal anesthetic management, perfusion, intensive care, cardiology, and surgery, consistently good results are impossible to achieve. Surgical Anatomy of TGA In the broad sense, the term "TGA" describes any heart with a discordant ven- triculoatrial (VA) connection (aorta from right ventricle, pulmonary artery from left ventricle). The anatomic diagnosis is further defined by the intracardiac fea- tures. Most frequently, TGA is used to describe the solitus/concordant/discordant heart. -
Electrophysiology with Artificial Intelligence Context and Challenge
Envisioning Cardiac Electrophysiology with Artificial Intelligence Context and Challenge An estimated 17 million people die of cardiovascular As technology advances, various industries are adopting diseases (CVDs) every year worldwide. CVD covers technologies such as digital transformation, internet of hypertension, sudden cardiac arrest, arrhythmia/rhythm things (IoT), artificial intelligence (AI), nanotechnology, disturbance, stroke, peripheral artery disease, and many and so on within their product/service portfolio and the more. Arrhythmias constitute a major problem, wherein the medical device industry is no exception. the heart beats either too quickly or too slowly or with an irregular pattern [1]. This indicates the malfunctioning of The focus of this paper is to discuss software-based the hearth’s electrical system. Clinical symptoms including solutions incorporating AI within EP systems that can shortness of breath, dizziness, sudden weakness, fluttering improve overall system performance, improve the in the chest, lightheadedness, and fainting, are indications therapeutic outcomes, reduce procedural time, and assist for malfunctioning of the heart. the electrophysiologist during the procedure. An electrophysiology (EP) study is a test to assess a person’s cardiac electrical activity. It helps the electrophysiologist to diagnose and determine the precise location and nature of arryhthmias. The test is performed by inserting catheters and wired electrodes to measure electrical activity through blood vessels that enter the heart. The two main goals of a cardiac EP study are (1) to accurately diagnosis the conduction-disturbance mechanism and (2) to determine the best line of treatment for the conduction-disturbances. Treatment following a cardiac EP study could range from ablation therapy to pharmacologic to device to surgical intervention based on the nature of the findings. -
About Electrophysiology Study of the Heart
About Electrophysiology Study of the Heart What is an Electrophysiology Study? An ElectroPhysiology (EP) Study is a test that looks at the electrical system of your heart. An EP Study will show if you have a heart rhythm problem and what is causing the problem. Heart rhythm problems are known as arrhythmias. Why is an EP Study done? An EP Study is done when you have problems such as fainting, dizziness, heart palpitations or an abnormal heart beat. How does the heart work? To understand this procedure, you need to know how the heart’s electrical system works. The sinoatrial node (SA node) is a natural pacemaker. It starts the electrical signal that travels across the upper 2 chambers or atria of the heart to the atrioventricular node (AV node). The AV node transfers the electrical signal from the upper part of the heart to the lower 2 pumping chambers or ventricles. The bundle branches are specialized tissues that help send electrical impulses through the ventricles. This makes a normal heart beat called normal sinus rhythm. 01-77-0623-0 (Rev 03/2016) Page 1 of 4 What causes heart rhythm problems? Problems happen when the heart beats too fast or too slow. Some people are born with heart rhythm problems. Problems may also be caused by aging or heart disease. There are many different kinds of arrhythmias. Problems occur when the heart beats too fast or too slow. When this happens you may feel: dizzy faint short of breath very tired palpitations (pounding in your chest) The treatment for heart rhythm problems may include one or more of the following: medication a pacemaker a defibrillator ablation Who will do the EP Study? A doctor who specializes in ElectroPhysiology (EP) will do the procedure. -
TGA Surgical Techniques: Tips & Tricks
TGA Surgical techniques: tips & tricks (Arterial switch operation) Seoul National University Children’s Hospital Woong-Han Kim Surgical History • 1951 Blalock and Hanlon, atrial septectomy • 1954 Mustard et al. arterial switch op • (monkey lung, 7 patients, 19 days old) • 1958 Senning, Atrial switch operation • 1963 Mustard, Mustard operation • 1966 Raskind and Miller, Balloon atrial septostomy • 1969 Rastelli, Rastelli operation • 1975 Jatene, first successulful ASO in patients with TGA and large VSD • 1977 Yacoub et al. two stage repair • 1983 Quaegebeur and Castaneda, primary repair in neonate • 1988 Boston group, rapid two-stage ASO The wide range of spatial relationships between the great arteries in TGA d-TGA Taussig-Bing (DORV) Posterior TGA Complete Transposition of the Great Arteries . Ventriculoarterial discordance . Also known as d-TGA (d = dextroposition of the bulboventricular loop) . Aorta on the right and anterior • Morphogenesis – Failure of the septum to spiral • Straight septum • Parallel arrangement of RVOT and LVOT – Abnormal growth and development of subaortic infundibulum – Absence of subpulmonic infundibulum growth Major coexisting anomalies * About 75% of neonates presenting TGA have no other cardiac anomalies, other than PFO or ASD and 20% have VSD and only 5% have LVOTO. 1 VSD Conoventricular(not necessarily juxtapulmonary) 55~60% Juxtaaortic 5% Juxtaarterial 5% Inlet septal 5% Juxtatricuspid Juxtacrucial : straddling muscular 25~30% 2 LVOTO It occurs 0.7% in TGA + IVS at birth and 20% in TGA+VSD, and may develop after birth in others and so reach an overall prevalence of 30%. Dynamic type - leftward bulging of septum Anatomic type - subvalvar fibrous ridge, fibrous tags, aneurysm, muscular (malalignment) or fibromuscular obstruction, valvar hypoplasia, combined. -
2018 EP Reimbursement and Coding Guide Physicians and Facilities Resources to Assist You with the Reimbursement Process!
2018 EP Reimbursement and Coding Guide Physicians and Facilities Resources to assist you with the Reimbursement Process! Reimbursement and Coding and Reimbursement Electrophysiology EP Procedure Documentation Coding Guide Frequently Asked Questions Coding Checklist Best Practices Online HCPCS C-Code Finder Coding & Reimbursement Webinars Email your Coding Questions www.biosensewebster.com/reimbursement Electrophysiology Diagnostic, Ablation, and Intracardiac Echocardiography Guided Transcatheter Procedures This guide has been developed to assist you in obtaining physician payment and hospital reimbursement for: • Electrophysiology (EP) diagnostic and ablation procedures • The acquisition of radiological images • EP and Cardiology procedures that may utilize intracardiac echocardiography (ICE) These procedures may be a covered service if they meet all of the requirements established by Medicare and private payers. It is essential that each claim be coded properly and supported with appropriate documentation in the medical record. TABLE OF CONTENTS PHYSICIAN SERVICES 4-6 CPT® Codes OUTPATIENT FACILITY SERVICES 7 Ambulatory Payment Classifications (APCs) INPATIENT FACILITY SERVICES 8 Medicare Severity Diagnosis Related Groups (MS-DRGs) PROCEDURE CODES 9-10 ICD-10-CM Procedure Codes DIAGNOSIS CODES 11-13 ICD-10-CM Diagnosis Codes HCPCS CODES FOR BIOSENSE WEBSTER, INC. PRODUCTS 14-15 NOTES 16 DISCLAIMER The information contained in this guide is provided to assist you in understanding the reimbursement process. It is intended to assist providers in accurately obtaining reimbursement for health care services. It is not intended to increase or maximize reimbursement by any payer. We strongly suggest that you consult your payer organization with regard to local reimbursement policies. The information contained in this document is provided for information purposes only and represents no statement, promise or guarantee by Biosense Webster, Inc. -
Appendix A: Surgical Procedure Terms and Definitions
Appendix A: Surgical Procedure Terms and Definitions Anomalous Systemic Venous Connection Anomalous Systemic Venous Connection Repair Repair includes a range of surgical approaches, including, among others: ligation of anomalous vessels, reimplantation of anomalous vessels (with or without use of a conduit), or redirection of anomalous systemic venous flow through directly to the pulmonary circulation (bidirectional Glenn to redirect LSVC or RSVC to left or right pulmonary artery, respectively). Aortic Aneurysm Aortic aneurysm repair Aortic aneurysm repair by any technique. Aortic Dissection Aortic Dissection repair Aortic dissection repair by any technique. Aortic Root Replacement Aortic Root Replacement, Bioprosthetic Replacement of the aortic root (that portion of the aorta attached to the heart; it gives rise to the coronary arteries) with a bioprosthesis (e.g., porcine) in a conduit, often composite. Aortic Root Replacement, Mechanical Replacement of the aortic root (that portion of the aorta attached to the heart; it gives rise to the coronary arteries) with a mechanical prosthesis in a composite conduit. Aortic Root Replacement, Homograft Replacement of the aortic root (that portion of the aorta attached to the heart; it gives rise to the coronary arteries) with a homograft Aortic Root Replacement, Valve sparing Replacement of the aortic root (that portion of the aorta attached to the heart; it gives rise to the coronary arteries) without replacing the aortic valve (using a tube graft). Aortic Valve Disease Ross Procedure Replacement of the aortic valve with a pulmonary autograft and replacement of the pulmonary valve with a homograft conduit. Konno Procedure (with and without aortic valve replacement) Relief of left ventricular outflow tract obstruction associated with aortic annular hypoplasia, aortic valvar stenosis and/or aortic valvar insufficiency via Konno aortoventriculoplasty. -
Electrophysiology Study
Electrophysiology (EP) Study Highly trained specialists perform EP studies in a specially designed EP lab outfitted with advanced technology and equipment. Why an EP study? The Value of an EP Study While electrocardiograms (ECGs An electrophysiology, or EP, study or EKGs) are important tests of the provides information that is key to heart’s electrical system, they diagnosing and treating arrhythmias. provide only a brief snapshot of Although it is more invasive than an the heart’s electrical activity. electrocardiogram (ECG) or echocar - Arrhythmias can be unpredictable diogram, and involves provoking and intermittent, which makes it arrhythmias, the test produces data unlikely that an electrocardiogram that makes it possible to : will capture the underlying electri - Normally, electricity flows through - cal pathway problem. Even tests • Diagnose the source of arrhythmia out the heart in a regular, meas - that stretch over longer time periods , symptoms such as Holter monitoring, may not ured pattern. This electrical system • Evaluate the effectiveness of capture an event. brings about coordinated heart certain medications in controlling muscle contractions. A problem During an EP study, a specially the heart rhythm disorder anywhere along the electrical trained cardiac specialist may pro - • Predict the risk of a future cardiac pathway causes an arrhythmia, voke arrhythmia events and collect event, such as Sudden Cardiac or heart rhythm disturbance. By data about the flow of electricity Death accurately diagnosing the precise during actual events. As a result, cause of an arrhythmia, it is possi - • Assess the need for an implantable EP studies can diagnose the ble to select the best possible device (a pacemaker or ICD) or cause and precise location of the treatment. -
Cardiac Ablation: Types and Outcomes
CARDIAC ABLATION: TYPES AND OUTCOMES CARDIOVERSION AND ABLATION JASSIN M. JOURIA Dr. Jassin M. Jouria is a practicing Emergency Medicine physician, professor of academic medicine, and medical author. He graduated from Ross University School of Medicine and has completed his clinical clerkship training in various teaching hospitals throughout New York, including King’s County Hospital Center and Brookdale Medical Center, among others. Dr. Jouria has passed all USMLE medical board exams, and has served as a test prep tutor and instructor for Kaplan. He has developed several medical courses and curricula for a variety of educational institutions. Dr. Jouria has also served on multiple levels in the academic field including faculty member and Department Chair. Dr. Jouria continues to serve as a Subject Matter Expert for several continuing education organizations covering multiple basic medical sciences. He has also developed several continuing medical education courses covering various topics in clinical medicine. Recently, Dr. Jouria has been contracted by the University of Miami/Jackson Memorial Hospital’s Department of Surgery to develop an e-module training series for trauma patient management. Dr. Jouria is currently authoring an academic textbook on Human Anatomy & Physiology. ABSTRACT Atrial arrhythmias are serious disorders that can cause an irregular and/or rapid heartbeat, which can lead to serious clinical sequelae. Atrial fibrillation is an example of an atrial arrhythmia that can lead to blood clots, stroke, or heart failure. Electrical cardioversion and ablation are two procedures that can minimize these risks and treat atrial arrhythmia. Each of these treatments have risks and neither offers a complete success rate, but they can be very effective in providing greater quality of life, and extending the life expectancy of patients. -
101St Annual Meeting Share Your Annual Meeting Experience on Twitter: Featuring Aortic Symposium @AATSHQ and Mitral Conclave #AATS2021 a Virtual Learning Experience
TABLE OF CONTENTS AATS Annual Meeting Committees ............................................................................. 2 Accreditation ......................................................................................................................... 5 Scientific Program ...............................................................................................................8 Abstracts ............................................................................................................................108 C. Walton Lillehei Abstracts ..................................................................................341 Case Video Abstracts ..............................................................................................350 PROGRAM BOOK 101st Annual Meeting Share your Annual Meeting experience on Twitter: Featuring Aortic Symposium @AATSHQ and Mitral Conclave #AATS2021 A Virtual Learning Experience April 30-May 2, 2021 This program book went to ePrint on April 29, 2021. Any program changes made after this date are available at aats.org/annualmeeting. President Marc R. Moon *AATS Member ◆AATS New Member 1 101st Annual Meeting AMERICAN ASSOCIATION April 30 – May 2, 2021 | A Virtual Learning Experience FOR THORACIC SURGERY AORTIC SYMPOSIUM AATS – PROMOTING SCHOLARSHIP IN Co-Chairs THORACIC AND CARDIOVASCULAR SURGERY *Joseph S. Coselli *Steven L. Lansman Since 1917, when it was founded as the first organization dedicated to thoracic surgery, the Committee Members American Association for Thoracic Surgery -
NATIONAL QUALITY FORUM National Voluntary Consensus Standards for Pediatric Cardiac Surgery Measures
NATIONAL QUALITY FORUM National Voluntary Consensus Standards for Pediatric Cardiac Surgery Measures Measure Number: PCS‐001‐09 Measure Title: Participation in a national database for pediatric and congenital heart surgery Description: Participation in at least one multi‐center, standardized data collection and feedback program that provides benchmarking of the physician’s data relative to national and regional programs and uses process and outcome measures. Participation is defined as submission of all congenital and pediatric operations performed to the database. Numerator Statement: Whether or not there is participation in at least one multi‐center data collection and feedback program. Denominator Statement: N/A Level of Analysis: Group of clinicians, Facility, Integrated delivery system, health plan, community/population Data Source: Electronic Health/Medical Record, Electronic Clinical Database (The Society of Thoracic Surgeons Congenital Heart Surgery Database), Electronic Clinical Registry (The Society of Thoracic Surgeons Congenital Heart Surgery Database), Electronic Claims, Paper Medical Record Measure Developer: Society of Thoracic Surgeons Type of Endorsement: Recommended for Time‐Limited Endorsement (Steering Committee Vote, Yes‐9, No‐0, Abstain‐0) Attachments: “STS Attachment: STS Procedure Code Definitions” Meas# / Title/ Steering Committee Evaluation and Recommendation (Owner) PCS-001-09 Recommendation: Time-Limited Endorsement Yes-9; No-0; Abstain-0 Participatio n in a Final Measure Evaluation Ratings: I: Y-9; N-0 S: H-4; M-4; L-1 U: H-9; M-0; L-0 national F: H-7; M-2; L-0 database for Discussion: pediatric I: The Steering Committee agreed that this measure is important to measure and report. and By reporting through a database, it is possible to identify potential quality issues and congenital provide benchmarks.