Cardiology Procedures Research Articles

Complications Associated with Transradial Access in Coronary Angiography and Intervention

Objectives: The study's goal is to compare distal and traditional methods in order to investigate the complications related to transradial access in coronary angiography and intervention. Materials and Methods: This study was conducted at the Department of Cardiology, AFIC, Rawalpindi, Pakistan in the period from January 2022 to December 2023 in patients with the age of 18 years and more who underwent coronary angiography or percutaneous coronary intervention via radial artery. Inclusion required the participant to sign an informed consent form and for data capture a complete record review. Results: The study conducted among 300 patients showed that the complication rate of the procedure was 10%. In particular, there was a significant and highly statistically significant difference to complications where distal transradial intervention had a rate of 5% and conventional approach had 15%. The most frequent complication documented was radial artery spasm which was managed using appropriate medications. Conclusion: Transradial access for coronary procedures are safe particularly with the distal located access which can potentially add more value to the improvement of the patient. These studies underscore the importance of technical improvement involving general and procedural aspects of care to prevent complications during cardiology procedures.

Bridging the Gap: The Importance of Non-technical Skills in Cardiology for Enhanced Patient Care and Team Performance.

Cardiology, a high-acuity medical specialty, has traditionally emphasised technical expertise, often overshadowing the critical role of non-technical skills (NTS). This imbalance stems from the historical focus on procedural competence and clinical knowledge in cardiology training and practice, leaving a significant gap in the development of crucial interpersonal and cognitive abilities. However, emerging evidence highlights the significant impact of NTS on patient outcomes, team dynamics, and overall healthcare efficiency. This review explores the importance of NTS in cardiology whilst drawing parallels with other high-stakes fields, such as aviation, surgery, and emergency medicine, which have successfully integrated NTS frameworks. These fields are particularly relevant due to their similar requirements for rapid decision-making under pressure, team-based approaches, and the potential for severe consequences in case of errors. Key NTS domains relevant to cardiology include leadership, such as in guiding cardiac teams effectively during procedures and emergencies; cooperation and resource management, such as focusing on optimising team performance and resource allocation in cardiac care units; communication and interaction, such as clear and concise information exchange during complex cardiac interventions; assessment and decision-making such as making critical choices in time-sensitive situations; situational awareness (SA) that maintains a comprehensive understanding of the patient's condition and surrounding environment; and coping with stress, which involves managing personal and team stress during and after high-pressure situations. The integration of NTS into cardiology practice is essential for improving patient care, reducing healthcare costs, and preventing clinician burnout. Despite the recognition of NTS' importance, there is a notable lack of structured training and validated assessment tools in cardiology. This absence poses a significant challenge to the implementation of NTS, as it hinders the systematic development and evaluation of these crucial skills amongst cardiologists. For instance, whilst technical skills in procedures like angiography are rigorously assessed, there is limited formal evaluation of NTS, for instance, a cardiologist's ability to lead a team effectively during a cardiac emergency. This review advocates for the development and implementation of NTS training and evaluation methods suitable for cardiology, emphasising the need for a balanced skill set that complements technical proficiency with social and cognitive abilities. Future research should focus on adapting existing tools or developing new ones to address the unique challenges of cardiology teams and foster safer, more effective patient care. Specific areas for investigation include developing cardiology-specific NTS assessment tools, creating structured NTS training programmes for cardiology fellows, evaluating the impact of NTS training on patient outcomes in cardiac care, and exploring the relationship between NTS proficiency and technical skill performance in cardiology procedures. By addressing these research gaps and developing targeted NTS interventions, cardiology can foster a more comprehensive approach to professional development, ultimately leading to improved patient care and healthcare efficiency in this critical field.

Patent Foramen Ovale (PFO): History, Diagnosis, and Management.

Current guidelines recommend closing a patent foramen ovale (PFO) in patients who have experienced a cryptogenic or cardioembolic stroke, have a high-risk PFO, and are aged between 16 and 60 years (class A recommendation, level I evidence). In terms of efficacy, in the CLOSE and RESPECT trials, the number needed-to-treat (NNT) to prevent one stroke recurrence in a five-year term was between 20 and 44. Other trials, such as the REDUCE trial, presented much better data with a NNT of 28 at two years and as low as 18 over a follow-up period of 10 years. Interventional PFO closure is relatively straightforward to learn compared to other cardiology procedures; however, it must be performed meticulously to minimize the risk of post-procedural complications. Usually, a double-disk occlusion device is used, followed by antiplatelet therapy. While the potential benefits of PFO closure for conditions such as migraines are currently being studied, robust trials are still required. Therefore, deciding to close a PFO for reasons other than stroke should be considered on a case-by-case basis.

“Kissing-Balloon” Angioplasty Associated Coronary Artery Perforation in Anterior STEMI: A Cautionary Tale

Introduction: Bifurcation technique angioplasty remains one of the most challenging procedures in interventional cardiology, up to 10% of patient with STEMI present with a bifurcation as the culprit lesion. Coronary artery perforation is a known complication of percutaneous coronary intervention and complex coronary anatomy is often posed as a risk factor. Interventional and surgical management of coronary artery perforation is indicated as soon as possible. Case presentation: A 55-year-old male was admitted to the emergency room with severe chest pain 12-hour prior to his admission. An anterior STEMI was diagnosed, and the patient underwent emergency coronary angiography with a bifurcation lesion of the mid LAD and D1, after transient loss of anterograde flow a secondary vessel a “kissing-balloon” technique was performed and type III coronary artery perforation in the Ellis classification of the side-branch was identified. Patient developed cardiogenic shock and urgent thoracotomy was performed. The patient was discharged in good conditions. Conclusion: Coronary artery perforation is a feared complication of percutaneous coronary intervention. Chest pain and hemodynamic deterioration can quickly lead to patient’s death. Identification as soon as possible and interventional or surgical management must be performed.

Ultrasonographic and functional evaluation of forearm circulation with occluded radial artery

Abstract Introduction The transradial approach (TRA) has gained popularity in cardiology procedures. This study aims to evaluate forearm and hand arterial circulation in radial artery (RA) occlusion (RAO) patients after coronary angiography (CAG) and percutaneous coronary interventions (PCI). The ulnar (UA) and anterior interosseous artery (AIA) can compensate for RAO. Methods A prospective, observational study was conducted on 40 RAO patients after CAG/PCI. Ultrasonographic and functional evaluation (Barbeau test) of collateral circulation through AIA or UA were performed. Statistical analyses were applied to evaluate various Doppler ultrasound parameters and the anatomical characteristics of the RAO. Results The RAO group mean age was 71.22 ± 9.99 years, and 45% were male. RA, UA, and AIA showed significant differences in peak systolic velocity, end-diastolic velocity, arterial diameter, total flow volume, and stroke volume (p < 0.01). Pulse quality over RA and UA also differed significantly (p < 0.0001). Blood flow direction in the distal RA segment divided patients into an antegrade flow group (50%) from AIA and a retrograde flow group (50%) from UA. The Barbeau test results varied among RAO patients, with type D being the most common. Anatomical locations of RAO included the anatomical snuffbox (10%), wrist (60%), and forearm (30%). The logistic regression model revealed that the Barbeau test results on Finger 2 (p=0.0006, OR=0.1398) and Finger 4 (p=0.004, OR 0.2843) were significant predictors for the occurrence of antegrade or retrograde blood flow in the distal RA when RAO occurred. Furthermore, when the RA was occluded, the study revealed that a palpable pulse over the RA was still possible in 15% of cases. Conclusion Ultrasonographic evaluation and the Barbeau test can assess collateral circulation and predict blood flow patterns in RAO patients. Further research is needed to validate these findings, explore additional factors influencing collateral circulation and access route selection, and investigate the clinical implications of different RAO anatomical locations in cardiology procedures.Radial Artery OcclusionThe pulse quality over RA/UA with RAO

Leveraging mixed reality in mitraclip implantation: A preliminary case series toward a pilot study

Abstract Introduction The advent of mixed reality (MR) technology, particularly when combined with Hololens 2.0 and specialized software for three-dimensional DICOM image visualization, offers a promising avenue for enhancing the precision and spatial awareness in interventional cardiology procedures. This case series aims to preliminarily evaluate the impact of MR on MitraClip implantation processes, setting a foundation for an ensuing comprehensive pilot study. Methods We conducted a comparative analysis within a case series of four MitraClip implantations, categorizing them into two groups based on the utilization of MR support. We examined procedural efficiency, radiation metrics (SKIA and DAP), and operator stress indicators, including cortisol levels, heart rate variability, QTc interval, and subjective assessments through NASA TLX, STAI Y, and SSQ questionnaires. Results Initial findings from the MR-assisted procedures suggest a notable improvement in procedural efficiency and a reduction in operator stress. Specifically, MR use was associated with shorter procedural times (ranging from 60 to 130 minutes) and lower radiation exposure, with SKIA durations between 15.5 and 40.5 minutes. Moreover, operators in the MR group showed reduced cortisol levels (8.2-9.2 mmol/L), indicating decreased physiological stress. Heart rate variability analysis further supported superior stress management among MR-supported operators. Subjective evaluations reinforced these physiological findings. NASA TLX scores in the MR group (13-20) markedly contrasted with those in the control group (30-45), signifying a significant reduction in perceived workload. SSQ scores remained minimal, implying good MR tolerability, and STAI Y scores (30-35) were lower than those in the control group (40-50), highlighting reduced anxiety levels during MR-assisted procedures. Conclusion This explorative case series lays the groundwork for a forthcoming pilot study, revealing MR's potential to not only streamline MitraClip implantation but also to alleviate operator stress. Both objective and subjective data advocate for expanded research to definitively ascertain MR's benefits in cardiac interventions, promising to refine procedural workflows and enhance patient outcomes. This series acts as a stepping stone towards a larger-scale evaluation that could solidify MR's role in the future of interventional cardiology.Operator's View and Technology PreviewFunction diagram

TCT-742 Radiation Hazards and Safety Among Physicians and Allied Health Practitioners (AHP) in Invasive Cardiology Procedures

TCT-742 Radiation Hazards and Safety Among Physicians and Allied Health Practitioners (AHP) in Invasive Cardiology Procedures

Extracorporeal Membrane Oxygenation Assisted Cardiac Interventions

The use of extracorporeal membrane oxygenation (ECMO) for management of critically ill patients has significantly increased in the recent past due to technological progress and increased experience with safe ECMO runs. The use of venoarterial (VA) ECMO during high risk interventional cardiology procedures ensure adequate cardiac output and other organ perfusion as well. The use of elective VA ECMO support during procedure allow interventionists to perform procedure safely and comfortably, moreover the support may be extended during post-procedural period in case of cardiogenic shock or arrhythmia. VA ECMO may also be instituted in emergent situations when conventional cardiopulmonary resuscitation (CPR) is ineffective to achieve return of spontaneous circulation. The various procedures with high risk potential due to anatomical complexity, haemodynamic decompensation or preexisting clinical condition may require mechanical circulatory support. These include percutaneous coronary interventions, Transcatheter aortic valve implantation (TAVI), complex congenital anamoly or electrophysiological procedures. However an integrated team approach with appropriate communication is vital among interventional cardiologist, ECMO specialist, cardiac surgeon, cardiac anaesthesiologist and perfusionist for a successful outcome.

SP8.10 - Systematic Review and Meta-Analysis of Interactive multimedia Interventions used in the Informed Consent Process

Abstract Aim The use of digital technology to improve the informed consent process has increased over the past decade. A wide range of multimedia modalities are now available. This review aimed to assess the impact of interactive multimedia interventions on the informed consent process. Methods This was a subgroup analysis of a larger systematic review and meta-analysis conducted in accordance with a predefined protocol registered on PROSPERO (CRD42023380406). Five databases were searched using pre-defined search criterion in December 2022 for randomised trials of interactive multimedia interventions designed to improve the informed consent process. Adults >18 years undergoing invasive interventions with the capacity to consent were included. The Cochrane Risk of Bias (RoB) tool was used to assess study quality. Standardised mean difference for continuous variables and risk ratios for dichotomous variables were used to assess effect. Meta-analyses were performed in RevMan5. Results 21 studies (22 interventions arms) with 2090 participants were included. All studies involved patients undergoing informed consent in an elective hospital setting for various surgical, cardiological and radiological procedures. Statistically significant improvement in immediate (SMD 0.40, 95% CI 0.18 to 0.62, I2=55%) and short-term knowledge (SMD 0.47, 95% CI 0.16 to 0.79, I2=45%) were demonstrated. No statistically significant differences were found for long term knowledge, generalised anxiety, satisfaction with the consent process or length of consultation. Conclusions Interactive multimedia interventions improve immediate and short-term knowledge in patients undergoing invasive interventions and could be considered as an adjunct to enhance patient knowledge during the informed consent process.

Risk factors of cardiac arrest during a percutaneous coronary intervention performed with rotational atherectomy - analysis based on a Large National Registry.

Rotational atherectomy (RA) is traditionally administered for patients with heavily calcified lesions and is thereby characterized by a high risk of the performed intervention. However, the prevalence characteristics of cardiac arrest are poorly studied in this group of patients. We aimed to evaluate the frequency and risk factors of cardiac arrest during percutaneous coronary interventions (PCI) performed with RA and preceding coronary angiography (CA). Based on the data collected in the Polish Registry of Invasive Cardiology Procedures (ORPKI) from 2014 to 2021, we included 6522 patients who were treated with RA-assisted PCI. We scrutinized patient and procedural characteristics, as well as periprocedural complications, subsequently comparing groups in terms of cardiac arrest incidence with the use of univariable and multivariable analyses. Thirty-five (0.5%) patients suffered from cardiac arrest during RA-PCI or preceding CA. They were characterized by significantly higher rates of prior stroke, acute coronary syndromes (ACS) as indications and higher Killip class (P < 0.001) at the admission time. Among the confirmed independent predictors of in-procedure cardiac arrest, the following can be noted: factors related to patients' clinical characteristics (e.g., older age, female sex, and disease burden), periprocedural characteristics (e.g., PCI within left main coronary artery [LMCA]), and periprocedural complications (e.g., coronary artery perforation and no-reflow phenomenon). Severe clinical condition at baseline, expressed by ACS presence and Killip class IV, as well as RA-PCI performed within LMCA and other periprocedural complications, were the strongest predictors of cardiac arrest during RA-assisted PCI and CA.

Cardiac arrest in adult cardiology patients receiving anaesthetic care: analysis from the 7th National Audit Project (NAP7) of the Royal College of Anaesthetists.

The 7th National Audit Project of the Royal College of Anaesthetists studied peri-operative cardiac arrest because of existing knowledge gaps in this important topic. This applies in particular to cardiology patients receiving anaesthetic care, because numbers, types and complexity of minimally invasive interventional procedures requiring planned and unplanned anaesthesia in the cardiac intervention suite is increasing. We analysed collected data to determine the epidemiology, clinical features, management and outcomes of peri-operative cardiac arrest in adult patients receiving anaesthetic care for cardiology procedures. There were 54 reports of peri-operative cardiac arrest in adult patients receiving anaesthetic care for cardiology procedures, accounting for 54/881 (6.1%) of all reports to NAP7. The estimated incidence (95%CI) of cardiac arrests in this group was 1/450 or 0.22 (0.17-0.29)%. These patients were older than other adult patients in the NAP7 population, with a notably high proportion of patients of Asian ethnicity when compared with the remaining NAP7 cohort (9/54, 17% vs. 35/709, 5%). Rates of extracorporeal membrane oxygenation cardiopulmonary resuscitation were low (3/53, 6%). A common theme was that of logistical issues and teamworking, with reporters commenting on the difficulties of remote and/or unfamiliar locations and communication issues between specialties, on occasion resulting in poor teamworking and a lack of focus. The NAP7 panel review identified several other common themes which included: cardiogenic shock; late involvement of anaesthesia in the case; and transcatheter aortic valve implantation. Cardiology procedures requiring anaesthesia care account for < 1% of anaesthesia activity but generate 6% of all peri-operative cardiac arrests. The incidence of cardiac arrest was disproportionately high in cardiological procedures requiring anaesthetic care. The nature of the cardiac arrest reports to NAP7 indicate that logistical and human factors in multidisciplinary teams in the cardiac intervention suite merit addressing to improve care.

Analysis of interventional cardiological risk in emergency aid: Indications and procedures

Introduction: Interventional cardiology procedures require special preparation recommended in the form of a protocol for each service. It is understood that the need for this is an advance for the ICHS, mainly because anxiety and fear accompany patients. Objetives: The aim of this study is to carry out an up-to-date literature review on information about hemodynamics and interventional cardiology services. Material and Methods: The methodology used was a literature review. The health terminologies consulted in the Health Sciences descriptors (DeCS/BIREME) were used; information on Hemodynamics and Interventional Cardiology services. Results and Discussions: Hemodynamics and interventional cardiology is an area of cardiology that diagnoses and treats diseases of the heart and blood vessels using catheters. The Hemodynamics service is responsible for performing cardiac catheterization for the diagnosis and treatment of heart disease. The department performs the procedure on adults and children. Many patients are referred to the interventional cardiologist after an assessment with the clinical cardiologist. However, some go to the emergency department first because they have symptoms that could be considered serious, such as chest pain or even because they are already having a heart attack. Conclusions: Through procedures such as catheterization, angioplasty, intracoronary ultrasound, among others, interventional cardiology is a procedure without cuts, which allows patients to recover quickly. In this case, it can be used both to treat coronary artery disease, such as angina and heart attacks, as well as structural heart disease, such as problems with heart valves like severe aortic stenosis.

Stickiness of 7 types of iodinated contrast media used during interventional radiology and interventional cardiology procedures

IntroductionDuring Interventional Cardiology (IC) and Interventional Radiology (IR) procedures operators’ gloves, guide wires and catheters may stick together due to the inherent stickiness of Iodine Containing Contrast Media (ICCM). This may result in displacement of materials, compromising technical success. In this study we compare the stickiness of seven frequently used types of ICCM. Material and methodsXenetix 300, Hexabrix 320 (Guerbet, Villepinte, France), Ultravist 300 (Bayer, Leverkusen, Germany), Visipaque 270, Omnipaque 300, Visipaque 320 (GE, Wauwatosa, WI) and Iomeron300 (Bracco, Milano, Italy) are compared using a probe-tack test. Pieces of surgical gloves are put together with 0.1 ml of of ICCM in between, and subsequently pulled apart under computer control. Stickiness is measured as the work needed to separate the probes. ResultsFrom least to most sticky results were: Hexabrix 320 (mean Work (mJ); range: 0.70; 0.16–1.23), Visipaque 270 (1.18; 0.47–1.89), Visipaque 320 (1.70; 0.59–2.81), Iomeron 300 (3.01; 1.82–4.20), Xenetix 300 (5.83; 3.96–7.69), Ultravist 300 (5.83; 2.83–8.84), Omnipaque 300 (8.14; 6.95–9.33). The four least sticky ICCM differ statistically significantly (p = 0.000–0.004) from the remaining. In this research Omnipaque 300, Ultravist 300 and Xenetix 300 are the stickiest and may hence pose the greatest practical problems during procedures; in contrast, Hexabrix 320, Visipaque 270 and Visipaque 320 are the least sticky in this research and may therefore aid in constraining complications caused by stickiness. ConclusionA significant and reproducible difference in stickiness exists between commercially available ICCM, Hexabrix 320, Visipaque 270, Visipaque 320 and Iomeron 300, being least sticky.

Current Antithrombotic Treatments for Cardiovascular Diseases: A Comprehensive Review.

Antithrombotic therapies (ATT) play a pivotal role in the management of cardiovascular diseases, aiming to prevent ischemic events while maintaining a delicate balance with the patient's bleeding risk. Typically, ATT can be classified into antiplatelet and anticoagulant therapies. Their application spans a broad spectrum of cardiovascular conditions, ranging from ischemic heart disease to atrial fibrillation, encompassing venous thromboembolisms and innovative structural interventional cardiology procedures. The global burden of cardiovascular diseases is steadily increasing, often giving rise to overlapping clinical presentations. Accordingly, the adoption of combined pharmacological approaches becomes imperative, potentially disrupting the delicate equilibrium between ischemic and bleeding risk, thus leading to nuanced pharmacotherapeutic pathways. In this context, contemporary investigations strive to identify a convergence point that optimizes the duration of medical therapy while addressing the need for antithrombotic effects, especially in the context of ischemic heart disease. This review aims to comprehensively revisit the main antithrombotic strategies in cardiovascular diseases, with the intention of enhancing a systematic approach which is key for the effective clinical management of these patients. Also, the review will examine the most impactful studies that have established the groundwork for current scientific evidence, with acknowledgement of special populations. Finally, we will cast a gaze into the future of this dynamic and evolving research field, exploring forthcoming perspectives and advancements.

Place of high-flow nasal oxygen in nonoperating room anesthesia.

This article aims to assess the utility of high-flow nasal oxygen (HFNO) therapy in nonoperating room anesthesia (NORA) settings. The number of procedural interventions under deep sedation in NORA is still increasing. Administration of oxygen is recommended to prevent hypoxemia and is usually delivered with standard oxygen through nasal cannula or a face mask. HFNO is a simple alternative with a high warmed humidified flow (ranging from 30 to 70 l/min) with a precise fraction inspired of oxygen (ranging from 21 to 100%). Compared to standard oxygen, HFNO has demonstrated efficacy in reducing the incidence of hypoxemia and the need for airway maneuvers. Research on HFNO has primarily focused on its application in gastrointestinal endoscopy procedures. Yet, it has also shown promising results in various other procedural interventions including bronchoscopy, cardiology, and endovascular procedures. However, the adoption of HFNO prompted considerations regarding cost-effectiveness and environmental impact. HFNO emerges as a compelling alternative to conventional oxygen delivery methods for preventing hypoxemia during procedural interventions in NORA. However, its utilization should be reserved for patients at moderate-to-high risk to mitigate the impact of cost and environmental factors.

Role of 3D transoesophageal echocardiography in the study of infective endocarditis. Demonstration in a case collection.

Infective endocarditis (IE) is a condition that predominantly affects native or prosthetic heart valves, which is currently on the rise due to the increase in invasive cardiology procedures, such as the utilization of cardiac implantable electronic devices and transcatheter interventions. The recommended imaging tests for diagnosis are 2D transthoracic echocardiography (2D TTE) and 2D transoesophageal echocardiography (2D TOE). However, these modalities present limitations in detecting vegetations and estimating their dimensions. These disadvantages can be overcome by 3D transoesophageal echocardiography (3D TOE), particularly with the multiplanar reconstruction tool, which allows for the visualization of infinite valve planes, thus optimizing the detection of lesions and precise measurements. Furthermore, the volume rendering provides insight into the anatomical relationships between lesions, which is particularly useful for surgical planning. In this review, we aim to discuss the role of this recent imaging modality in the diagnosis, prognosis, and therapeutic of IE. Finally, we present a collection of images that illustrate the use of 3D TOE tools.

Revolutionizing Cardiology through Artificial Intelligence-Big Data from Proactive Prevention to Precise Diagnostics and Cutting-Edge Treatment-A Comprehensive Review of the Past 5 Years.

Artificial intelligence (AI) can radically change almost every aspect of the human experience. In the medical field, there are numerous applications of AI and subsequently, in a relatively short time, significant progress has been made. Cardiology is not immune to this trend, this fact being supported by the exponential increase in the number of publications in which the algorithms play an important role in data analysis, pattern discovery, identification of anomalies, and therapeutic decision making. Furthermore, with technological development, there have appeared new models of machine learning (ML) and deep learning (DP) that are capable of exploring various applications of AI in cardiology, including areas such as prevention, cardiovascular imaging, electrophysiology, interventional cardiology, and many others. In this sense, the present article aims to provide a general vision of the current state of AI use in cardiology. We identified and included a subset of 200 papers directly relevant to the current research covering a wide range of applications. Thus, this paper presents AI applications in cardiovascular imaging, arithmology, clinical or emergency cardiology, cardiovascular prevention, and interventional procedures in a summarized manner. Recent studies from the highly scientific literature demonstrate the feasibility and advantages of using AI in different branches of cardiology. The integration of AI in cardiology offers promising perspectives for increasing accuracy by decreasing the error rate and increasing efficiency in cardiovascular practice. From predicting the risk of sudden death or the ability to respond to cardiac resynchronization therapy to the diagnosis of pulmonary embolism or the early detection of valvular diseases, AI algorithms have shown their potential to mitigate human error and provide feasible solutions. At the same time, limits imposed by the small samples studied are highlighted alongside the challenges presented by ethical implementation; these relate to legal implications regarding responsibility and decision making processes, ensuring patient confidentiality and data security. All these constitute future research directions that will allow the integration of AI in the progress of cardiology.

Same-day discharge strategy in a heart rhythm management clinic - what about patients' reported experience?

Abstract Background and aims Same-day discharge (SDD) has been adopted for many interventional cardiology procedures, however data on patients’ experience are scarce. The aim of this study was to investigate patient-reported experience of a SDD strategy following electrophysiology procedures (EP) in a Heart Rhythm Management Department. Methods Consecutive patients undergoing EP procedures in our centre, who fulfilled pre-defined eligibility criteria for SDD, were asked to complete the study questionnaire, right before hospital discharge. Procedures suitable for SDD ranged from non-invasive (electric cardioversion, tilt test) to invasive ones (EP studies, device replacement, rhythm recorders implantation, ablation of supraventricular tachycardias including atrial fibrillation). The questionnaire aimed to assess patients’ experience before and during the procedure, their satisfaction with the quality of the provided information and their comprehension of the given instructions regarding the post-discharge period and their medication. Results The study questionnaire was completed by 501 patients. The majority of participants described SDD as a good or a quite good experience (n=440, 87,8%), while 94,6% of them (n=474) would not hesitate to undergo a second SDD procedure, if necessary. A direct interview with a healthcare team member was viewed as the preferred method of obtaining information on the procedure. At discharge, 1 out of 10 patients were still unsure of the instructions given by the healthcare team, including their anticoagulation treatment. Patient reported satisfaction rates did not differ between invasive and non-invasive procedures. However, after an invasive procedure, patients seemed to significantly have a better understanding of post-discharge instructions. Conclusion Patients reported a high level of satisfaction with SDD EP procedures. However, significant efforts need to be made in order to ensure their understanding of post-discharge instructions.Figure : Patients' reported experience

Rare Case of Right Ventricular Perforation during Pericardiocentesis: A Case Report

Iatrogenic cardiac injuries are potential complications arising from diagnostic and therapeutic procedures in cardiology, including interventions like cardiac catheterization, coronary angioplasty, and pacemaker implantation ­­[1,2]. Pericardial tamponade can occur, with a prevalence of 0.12%, often requiring urgent intervention such as pericardiocentesis. Patients with chronic pericardial effusion and signs of tamponade may adapt to gradual fluid accumulation, but vigilance for iatrogenic injuries remains crucial. Transthoracic echocardiography aids in rapid diagnosis and guides timely interventions [3]. Therefore, the right ventricular perforation seems to be one of these complications, and it may occur during pericardiocentesis. Surgical approaches for acute tamponades vary, with median sternotomy enabling comprehensive exploration [4]. Echocardiographic monitoring can signal clinical deterioration, necessitating prompt fluid management and early intervention to optimize outcomes. Although, the therapies in right ventricular perforation are variable. In our case, we emphasize about the conservative approach.

Analysis of ionizing radiation doses received by patients during electrocardiological procedures

Medical procedures in the field of electrocardiology belong to a large group of cardiological procedures. Performing them involves exposure to ionizing radiation. In this study, five medical procedures in the field of electrocardiology performed in three medical facilities were analyzed in terms of patients’ exposure to ionizing radiation. A total of 178 patients were analyzed. Depending on the type of procedure, the recorded doses ranged from 7.4 to 614.62 mGy. The majority of electrocardiological procedures are pacemaker implantations 38% and RF ablation 33%. The results obtained show a significant dispersion of the recorded dose values in the same type of treatment. This is reflected, for example, in the high coefficient of variation for doses in RF ablation. The type of X-ray machine used during the procedure also influences the dose values. Although the exposure of patients undergoing electrocardiological procedures to ionizing radiation is much lower than in the case of cardiac vascular procedures, it may reach a similar level, especially in the case of implantation of devices regulating the correct functioning of the heart.