Angioplasty, Balloon, Coronary ; Bradycardia ; etiology ; Cardiac Pacing, Artificial ; adverse effects ; Carotid Artery, Common ; abnormalities ; Heart Block ; etiology ; Humans ; Jugular Veins ; abnormalities ; Male ; Middle Aged ; Shock, Cardiogenic ; etiology ; Thromboembolism ; complications ; Torsades de Pointes ; etiology

Adenocarcinoma, Clear Cell ; diagnosis ; etiology ; therapy ; Cervix Uteri ; pathology ; Child ; Diethylstilbestrol ; Fatal Outcome ; Female ; Humans ; Magnetic Resonance Imaging ; Pregnancy ; Prenatal Exposure Delayed Effects ; Uterine Cervical Neoplasms ; diagnosis ; etiology ; therapy

INTRODUCTION: Early reperfusion of ST-segment elevation myocardial infarction (STEMI) results in better outcomes. Interventions that have resulted in shorter door-to-balloon (DTB) time include prehospital cardiovascular laboratory activation and prehospital electrocardiogram (ECG) transmission, which are only available for patients who arrive via emergency ambulances. We assessed the impact of mode of transport on DTB time in a single tertiary institution and evaluated the factors that affected various components of DTB time. METHODS: We conducted a retrospective cohort study using registry data of patients diagnosed with STEMI in the emergency department (ED) who underwent primary percutaneous coronary intervention. We compared patients who arrived by emergency ambulances with those who came via their own transport. The primary study end point was DTB, defined as the earliest time a patient arrived in the ED to balloon inflation. As deidentified data was used, ethics review was waived. RESULTS: A total of 321 patients were included for analysis after excluding 7 with missing data. The mean age was 61.4±11.4 years old with 49 (15.3%) females. Ninety-nine (30.8%) patients arrived by emergency ambulance. The median DTB time was shorter for patients arriving by ambulance versus own transport (52min, interquartile range [IQR] 45-61 vs 67min, IQR 59-74; CONCLUSION Arrival via emergency ambulance was associated with a decreased DTB for STEMI patients compared to arriving via own transport. There is a need for public education to increase the usage of emergency ambulances for suspected heart attacks to improve outcomes.
Aged ; Ambulances ; Angioplasty, Balloon, Coronary ; Female ; Humans ; Middle Aged ; Percutaneous Coronary Intervention ; Retrospective Studies ; Time Factors

Transvenous implantable cardioverter defibrillators are a type of implantable cardiac device. They are effective at reducing total and arrhythmic mortality in patients at risk of sudden cardiac death. Subcutaneous implantable cardioverter defibrillators (S-ICDs) are a new alternative that avoids the disadvantages of transvenous lead placement. In this case series, we report on the initial feasibility and safety of S-ICD implantation in Singapore.
Adult ; Death, Sudden, Cardiac ; prevention & control ; Defibrillators, Implantable ; statistics & numerical data ; Electrophysiology ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Patient Safety ; Prosthesis Implantation ; Singapore ; Tachycardia, Ventricular ; Ventricular Fibrillation

INTRODUCTIONRemote monitoring of cardiac implantable electronic devices (CIED) has been shown to improve patient safety and reduce in-office visits. We report our experience with remote monitoring via the Medtronic CareLink(®) network.

METHODSPatients were followed up for six months with scheduled monthly remote monitoring transmissions in addition to routine in-office checks. The efficacy of remote monitoring was evaluated by recording compliance to transmissions, number of device alerts requiring intervention and time from transmission to review. Questionnaires were administered to evaluate the experiences of patients, physicians and medical technicians.

RESULTSA total of 57 patients were enrolled; 16 (28.1%) had permanent pacemakers, 34 (59.6%) had implantable cardioverter defibrillators and 7 (12.3%) had cardiac resynchronisation therapy defibrillators. Overall, of 334 remote transmissions scheduled, 73.7% were on time, 14.5% were overdue and 11.8% were missed. 84.6% of wireless transmissions were on time, compared to 53.8% of non-wireless transmissions. Among all transmissions, 4.4% contained alerts for which physicians were informed and only 1.8% required intervention. 98.6% of remote transmissions were reviewed by the second working day. 73.2% of patients preferred remote monitoring. Physicians agreed that remote transmissions provided information equivalent to in-office checks 97.1% of the time. 77.8% of medical technicians felt that remote monitoring would help the hospital improve patient management. No adverse events were reported.

CONCLUSIONRemote monitoring of CIED is safe and feasible. It has possible benefits to patient safety through earlier detection of arrhythmias or device malfunction, permitting earlier intervention. Wireless remote monitoring, in particular, may improve compliance to device monitoring. Patients may prefer remote monitoring due to possible improvements in quality of life.

Aged ; Arrhythmias, Cardiac ; diagnosis ; Defibrillators, Implantable ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Monitoring, Physiologic ; methods ; Pacemaker, Artificial ; Patient Safety ; Pilot Projects ; Prospective Studies ; Quality of Life ; Remote Consultation ; methods ; Singapore ; Surveys and Questionnaires

INTRODUCTIONThe use of non-fluoroscopic systems (NFS) to guide radiofrequency catheter ablation (RFCA) for the treatment of supraventricular tachycardia (SVT) is associated with lower radiation exposure. This study aimed to determine if NFS reduces fluoroscopy time, radiation dose and procedure time.

METHODSWe prospectively enrolled patients undergoing RFCA for SVT. NFS included EnSiteTM NavXTM or CARTO® mapping. We compared procedure and fluoroscopy times, and radiation exposure between NFS and conventional fluoroscopy (CF) cohorts. Procedural success, complications and one-year success rates were reported.

RESULTSA total of 200 patients over 27 months were included and RFCA was guided by NFS for 79 patients; those with atrioventricular nodal reentrant tachycardia (AVNRT), left-sided atrioventricular reentrant tachycardia (AVRT) and right-sided AVRT were included (n = 101, 63 and 36, respectively). Fluoroscopy times were significantly lower with NFS than with CF (10.8 ± 11.1 minutes vs. 32.0 ± 27.5 minutes; p < 0.001). The mean fluoroscopic dose area product was also significantly reduced with NFS (NSF: 5,382 ± 5,768 mGy*cm2 vs. CF: 21,070 ± 23,311 mGy*cm2; p < 0.001); for all SVT subtypes. There was no significant reduction in procedure time, except for left-sided AVRT ablation (NFS: 79.2 minutes vs. CF: 116.4 minutes; p = 0.001). Procedural success rates were comparable (NFS: 97.5% vs. CF: 98.3%) and at one-year follow-up, there was no significant difference in the recurrence rates (NFS: 5.2% vs. CF: 4.2%). No clinically significant complications were observed in both groups.

CONCLUSIONThe use of NFS for RFCA for SVT is safe, with significantly reduced radiation dose and fluoroscopy time.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Catheter Ablation ; methods ; Child ; Female ; Fluoroscopy ; Humans ; Male ; Middle Aged ; Prospective Studies ; Radiation Dosage ; Radiation, Ionizing ; Tachycardia, Atrioventricular Nodal Reentry ; therapy ; Tachycardia, Supraventricular ; therapy ; Treatment Outcome ; Young Adult