Session Introduction

Oleksii Vynogradov

Heartin Inc, United States

Title: Using smart ECG t-shirt with AI based arrhythmia detection

Biography:

I'm a serial entrepreneur and investor with twenty-five years’ experience. I have created nine companies and have done couple exits so far. My professional background is business and team development, software/hardware engineering, sales, and finance.

For last eight years I have been focusing on healthcare area with a company called HeartIn. My company is creating a unique smart Garment with built-in sensors that brings wellness solutions and cardio-diagnostic to the mass market. The product has user-friendly comfortable design.

Abstract:

Our team used smart ECG t-shirt with real customers while workout to understand mass market screening case. We have 1789 records from 96 users. Quantity of records:

• Up to 10 seconds length - 97

• 10-60 seconds length - 187

• 60-300 seconds length - 167

• more than 300 seconds length – 224

Customers has no real arrhythmia detection. Algorithm has false positive detection:

• Up to 10 seconds length: None

• 10-60 seconds length - 2 Sinus bradycardia

• 60-300 seconds length 37 Sinus tachycardia and 13 Sinus bradycardias

• more than 300 seconds length 1975 Ventricular tachycardia 1356

Sinus tachycardia 496 Supraventricular ectopy or tachycardia 85 Sinus bradycardia 37 Ventricular trigeminy 15 Asystole 4 Ventricular bigeminy.

Chair

Sumit Verma

Soochow university, USA

Session Introduction

Eric Edward Vinck

El Bosque University, Colombia

Title: Video-assisted thoracoscopic cardiac denervation of refractory ventricular arrhythmias and electrical storms: A single-center series

Biography:

Eric Edward Vinck has completed his Medical School Training in 2015, is currently a third year General Surgery Resident at El Bosque University in Bogota. He has been part of the General Thoracic Surgery Research Division of Fundacion Cardioinfantil since 2014, has published nine papers both nationally and internationally.

Abstract:

Background: The combined treatment of beta-blockers with ablation and implanted cardioverter defibrillation therapy continues to be the mainstay treatment for ventricular arrhythmias (VAs). Despite treatment, some patients remain refractory. Recent studies have shown success rates using video-assisted thoracoscopic (VATS) cardiac denervation as an effective therapeutic option for these patients.

Case Series Presentation:During a period of three years, from 2015 through 2017, 20 patients (N=20) failed traditional medical and interventional treatment for the management of ventricular arrhythmias and electrical storms. After remaining refractory, the patients were referred to our thoracic surgery department for a VATS based treatment. The patients all had ventricular arrhythmias and electrical storms secondary to different cardiomyopathies. The patients were refractory to combined medical (betablockers), implanted cardioverter defibrillation (ICD) and ablation therapy.

All 20 patients agreed to surgery and were taken to cardiac denervation using a bilateral VATS approach by two thoracic surgeons at a single Cardiothoracic Center. During the month prior to bilateral VATS denervation a combined total of 29 (N=29) ICD shocks were registered in addition to six (N=6) cases of electrical storms averaging three (N=3) shocks per day. Mean shocks per patient was 2.3. During the first three months following VATS, the patients had a 90% (N=18/20) total resolution of ICD registered shocks, a 100% (N=6/6) resolution of electrical storms, and a 92% (N=11/12) resolution of shocks in patients having previous ablation therapy. No complications were documented following surgery except for one case of pneumothorax as a result of the procedure, and there were no peri-operative mortalities.

Conclusions: Bilateral thoracoscopic cardiac denervation can be a safe and seemingly effective therapeutic option for patients presenting with lifethreatening refractory ventricular arrhythmias and electrical storms in a variety of cardiomyopathies including Chagas disease.

 

Abdalazeem Ibrahem

National Health Research Institutes, United Kingdom

Title: Refractory VF cardiac arrest due to multiple pulmonary embolism

Biography:

Abdalazeem Ibrahem has done his Graduation from Kassala University, Sudan in 2009. He also did his Co-medical training in UK 2015, MRCP UK Diploma 2015. Currently he is working as Cardiology Registrar in University Hospital of North Durham, UK.

Abstract:

Introduction: Pulmonary embolism (PE) can be associated with arrhythmias. Ventricular fibrillation is reported to be associated with PE, but rare with high mortality and poor outcomes. We report a case of 67-year-old gentleman who presented with syncopal episode. On day three of admission, he was found to be in ventricular fibrillation, ALS algorithm was followed. When reversible conditions were explored, thromboembolism was falsely ruled out because of ECHO results on admission. Bed side ECHO performed to rule out cardiac tamponade, which showed multiple large echogenic mobile mass consistent with PE.

Conclusion: ALS (advanced life support) algorithm remains vital in exploring reversible conditions during cardiac arrest. Never be reassured by the previous normal results. Simple bed side ECHO gives a lot of information in emergency situation.

Case description: 7-year-old gentleman presented to emergency department  with syncopal episode. He doesn’t have any significant past medical history. He has significant alcohol intake and lives alone. On admission he was hemodynamically stable, no significant abnormality on systemic examination.

Initial investigations: CRP 120mg/L, WCC 12.2 x 109, HB 113 mg/dl, Urea and electrolytes normal, serial Troponin I 1560, 1189.

ECG: Atrial fibrillation with LBBB.

CXR: Right mid zone consolidation/mass (further imaging advised).

Bed side ECHO: Dilated cardiomyopathy, EF 20-25%.

Initial diagnosis: Community acquired pneumonia, newly diagnosed arrhythmia (AF) and Dilated cardiomyopathy.

Discussion: Pulmonary embolism common condition resulting in cardiac arrest in many patients. Thrombolysis performed at appropriate time results in improvement of overall mortality rate. Literature shows pulmonary embolism is mostly associated with pulseless electrical activity, right ventricular strain pattern but it can be associated with any kind of arrhythmias, some common than the other. In our case the embolic event is associated with ventricular fibrillation, which is rare but reported. Always have a high suspicion of pulmonary embolism in any arrhythmia, vague symptoms resulting in haemodynamic compromise situation. A bed side ECHO showed evidence of PE, which was thrombolysis appropriately. This massively improved the clinical outcome. This case again reemphasis about the ALS algorithm, exploring reversible conditions to improve the overall mortality. It’s safe to have high suspicion of thromboembolic event in any patient with cardiac arrest (even when the investigations show normal results). Re-think all the reversible conditions and rule out individually in the current situation rather than relying on the investigations on admission. Bedside simple ECHO can give lot of information in establishing a cause of cardiac arrest, when performed by qualified individual without interrupting CPR, if in progress.

Rhea Verma

Heart Rhythm Center, USA

Title: Relationship of transeptal puncture (TSP) site to the non-coronary cusp of aortic valve

Biography:

Abstract:

Background: Methods for performing TSP have evolved over time. Intracardiac echo (ICE) is standard in most practices for TSP during atrial fibrillation (AF) ablation. However, this has added significant cost to the procedure. We studied the feasibility of using aortic root angiography, specifically the relationship of TSP site to non-coronary cusp (NCC) of aortic valve to help facilitate needle localization prior to TSP.

Methods: One hundred and eleven (111) consecutive patients undergoing AF ablation were enrolled. Aortic root angiography was performed by placing an angled pigtail catheter in the NCC. Images were taken in the RAO 45° and LAO 30°. The Brockenbrough needle was introduced in the SL1 sheath and retracted until it fell in the fossa ovalis (FO). Relationship of TSP site to NCC was recorded. ICE was required for various reasons in some patients (IVP dye allergy, severe vascular disease, severe atrial enlargement, and other anatomical variants). The degree of tenting of FO was also recorded in relationship to aortic margins in LAO 30°.

Results: There is a strong relationship between the TSP site and margins of the NCC in 97/107 (90.1%) patients, TSP were completed successfully by positioning the needle posterior to but within the inferior and superior margins of NCC in RAO. In a few patients, the needle was above (2/107-1.8%) or below NCC (8/107-7.4%). Variable degrees of tenting were visualized (mild 16/107, mod 53/107, severe 38/107). ICE was required in 11/111 (10%) of patients where this method was unsuccessful. Angiographic data was available in 107 patients. No cases of extra cardiac puncture were recorded i.e. no tamponade or dye extravasation.

Conclusions: TSP can be completed safely in the majority of patients using aortic root angiography and relationship to NCC as guidance. This can allow significant cost savings by using ICE in AF ablation only in selected cases.

Chih-Ying Changchien

Republic of China Air Force, Taiwan

Title: Indoxyl sulfate(IS) suppressed myocardial connexin43(Cx43) translation and phosphorylation via JNK activation

Biography:

Chin- Ying Changchien has completed her PhD degree in National Taiwan University in 2009 and promoted as professor in department of biology and anatomy, National Defense Medical Center in 2018. Her reaech focuses encompass uremic myopathy on skeletal muscle and myocardium; molecular therapy investigation on glioma and bladder cancer. She has been principle investigator of ministery of science and technology (MOST) since 2010 and  published more than 25 papers in reputed journals.

Abstract:

Heart rhythm disturbances has been widely recognized as major trigger of cardiovascular (CV) mortality in chronic kidney disease (CKD) patients. Connexin43 (Cx43)-composed gap junctions are essential in cardiomyocytes synchronization and may involve in pathological response to uremic toxins. In primary culture of rat neonatal cardiomyocytes, we demonstrated that indoxyl sulfate (IS) treatment decreased spontaneous contractions without viability impairment. Meanwhile, there was disruption of gap junction intercellular communication (GJIC) between cardiomyocytes since 30 minutes of IS stimulation. This phenomenon implicated close association between ISinduced bradycardia and gap junction alterations. Effect of IS caused time- and dose- dependent Cx43 redistribution. The patterns of Cx43 immunostaining returned to baseline when IS stimulation diminished. Furthermore, showterm IS exposure downregulated Cx43 total protein, phosphorylated form and mRNA level. The above changes as well as GIJC and Cx43 suppression were reversed by pretreatment with JNK inhibitor (SP600125). Elevated JNK1 and JNK2 phosphorylation were further identified post IS exposure 15 minutes. The inhibition of p-JNK could attenuate IS-mediated downward trends in Cx43 transcription and translation. Our findings disclose that IS might remodel myocardial gap junction and Cx43 expression through JNK regulation. 

Sahil Verma

Heart Rhythm Center, USA

Title: In a preliminary simulation data, stent with thinnest strut beta crystalline titanium gold alloy (β-ti-au) outperforms typical implants

Biography:

Abstract:

Background: Large volume of data support the overall safety of coronary stents for cardiovascular disease. Yet, one cannot lose sight of their shortcomings such as restenosis; hence stents continue to evolve in lattices, materials, and drugs. Studies outlining the successful use of titanium gold alloy stents to counter these issues are lacking.

Methods: In this analysis we obtained available historical manufacturing records on routinely used stents to compare to two revolutionary titaniumgold alloy stents. By using a 3D CAD finite element analysis space, each stent type was tested for flexibility, rigidity and radial forces. Except for lengths and diameter, each type was held to their own strut geometry and thickness. Our analysis focused on using Von Mises Stress and resulting deformation or expansion. Our assessments were performed by using discrete changes and Pearson’s chi-squared statistics to obtain significance of our findings. Three lengths: 15mm, 27.5mm and 40mm were tested for each type. Comparisons were obtained from the mean percentage length or diameter (3.5mm) changes.

Results: β-Ti-Au alloy in our hexagonal mesh was significantly more expansive (78.29 percent gain in diameter under 7 atm than Orsiro Hybrid (the baseline) p < 0.001. The best performance in vertical crush testing was obtained from our second original structure, titanium – gold alloy stent 1 (0.8 percent vs control). Nobori was the most longitudinally flexible in that testing category but was closely matched by beta titanium – gold alloy (1.97 percent vs 2.19 percent) with promus PREMIER’s performance serving as the zero-reference point. In radial strength testing, our opened and closed titanium-gold structures first and second designs respectively came second and third to Orsiro (10.03 percent >9.09 percent >7.80 percent). Maximum changes in displacements 0.19 and 0.25. Both values were significant. (95% CI 0.11-0.27, 0.17-2.33).

Conclusion: Routine use of Titanium in coronary stents has been hindered by its low density, elastic modulus and strength; contrary these results suggest that by mixing titanium with gold and on the right structure the alloy can be constructed with a thin strut for percutaneous coronary intervention.

Jacob Jamesraj

Madras Medical Mission Hospital, India

Title: Diastolic dysfunction as cardiac feature of rheumatoid arthritis

Biography:

Jacob Jamesraj is a cardiothoracic and vascular surgeon at the Madras Medical Mission Hospital in Chennai, India. His interests are off pump coronary surgery, valve repairs, homograft banking, minimally invasive surgery and teaching. He has designed many training kits which are useful in registrar training in coronary and valve surgeries. Minimal access surgery and Videoscopic techniques can be practiced on the simulator. He conducts a Cardiac Morphology course every year which is popular with students from all over India and the neighboring countries. He has designed database software.

Abstract:

Valve repairs skills in cardiac surgical practice are an important part of a surgeon’s armamentarium. A graded wet lab training program goes a long way in safely equipping a surgeon. We have designed a simulator (training device) to enable this. A five-step graded wet lab training program is proposed.

Step 1- Understanding Anatomical perspectives

Anatomy of the valves and its structural components are taught by dissection.

Step 2 - Implanting a ring

The bovine heart is mounted on the work table of the simulator. Surgical orientation and exposure of the valves, identification of the annulus and suture placement and implantation of the ring to achieve the ring annuloplasty are taught.

Step 3 - Complex repairs

Chordal shortening and lengthening techniques, chordal transfers and placement of artificial chordate are taught.

Step 4 - Minimally Invasive Surgery

The Minimal access attachment is placed, and MICS surgical techniques are taught.

Step 5 - Videoscope surgery

Adding a webcam connected to a laptop transforms the device into a videoscopic MICS technique learning arena. Thus, a registrar in training is equipped to be a safe valve repair surgeon with minimal access and videoscope skills.

Lidija Jevdijic

General Hospital Aurora, Serbia

Title: Significance of BMI ratio in pregnant women in the development of preeclampsia and the way of terminating pregnancy and birth weight

Biography:

Lidija Jevdjic graduated from the Faculty of Medicine of the University of Belgrade, Serbia, 1996. Specialist is internal medicine with sub specialization in cardiology. From 1997 to 2017 she was employed at the Clinic for Gynecology and Obstetrics Cassone 2018, she is the Head of the polyclinic department at the General Hospital "Aurora"Belgrade She is the author of many papers published in the country and abroad, as well as a lecturer at many national and international congresses. She is the author of the chapter "Cardiovascular Disease in Pregnancy" in the textbook "Anesthesia in Obstetrics. Dr. Jevdjić is the co-founder of the Center for Women's Heart in Serbia. Mother of three children.

Abstract:

Obesity is a global health problem that is increasing in prevalence. Thus, many pregnant patients are seen with high body mass index (BMI). Obesity during pregnancy is considered a high-risk state because it is associated with many complications. The test is to show not only the importance of the relationship of BMI among pregnant women in developing preeclampsia but also expressed the importance of BMI with severe preeclampsia in the third trimester, the way of terminating the pregnancy and birth weight. Among 2100 pregnant women who got cardinal l examination in the period Jun 2013 to June 2014, were 37 of them diagnosed with a severe form of preeclampsia. All of them had blood pressure over 160/110 mmHg and Sy Helpful the evaluation of gestational weight gain on pregnancy outcomes and newborn weight in different BMI, we categorized the pregnant women into three groups based on their BMI: Normal: BMI of 20-24.9 kg/m, Over weight: BMI of 25-30 kg/m and Obese: BMI > 30 kg/m. This research demonstrates that an increased maternal BMI with preeclampsia increases the incidence of induction of labor, caesarean section, pre term labor and low birth weight. Prevention is the best way to prevent this problem. As pregnancy is the worst time to lose weight, women with a high BMI should be encouraged to lose weight prior to conceiving. During the second half of pregnancy, one needs to closely watch for signs and symptoms of pre-eclampsia.