Introduction: Cardiac screening is mandated by most sporting organisations. A resting 12-lead ECG... more Introduction: Cardiac screening is mandated by most sporting organisations. A resting 12-lead ECG may identify individuals who harbour cardiac disorders who may be at risk of sudden cardiac death (SCD). Lateral wave inversion (TWI) may identify subjects with cardiac phenotypes that are linked to SCD. Aim: The aim of this study was to ascertain the prevalence of lateral TWI in adolescent individuals as part of a systematic nationwide cardiac screening. The yield of family screening in these probands was also evaluated. Methodology: A national cardiac screening program (BEAT-IT) was set up in the 2017/2018 scholastic year for students attending year 11 classes. 2672 students (14-17 years) and their legal guardians gave consent. Screening protocol consisted of a questionnaire/ECG at school. ECGs were reported as per the ‘International Recommendations for ECG interpretation’ (2017). Those with contiguous TWI in ≥2 lateral leads were evaluated. An athlete was defined as an individual who...
Ever since the introduction of Low Molecular Weight Heparin in the catheterisation suite at Mater... more Ever since the introduction of Low Molecular Weight Heparin in the catheterisation suite at Mater Dei Hospital, numerous cases of in-stent thrombosis prompted the set up of this audit to look at the local use of LMWH (available locally as Enoxaparin) in patients presenting with STEMI-ACS, NSTEMI-ACS and Unstable Angina, needing Percutaneous Coronary Interventions (PCIs) during admission so as to determine if the administration regimens used are in accordance with the European Society of Cardiology recommendations.
Funding Acknowledgements Type of funding sources: None. Introduction Risk stratification in Bruga... more Funding Acknowledgements Type of funding sources: None. Introduction Risk stratification in Brugada syndrome (BrS) is challenging. Cardiogenic syncope, family history of sudden cardiac death and ECG markers are useful variables in determining patient risk. Invasive risk stratification is sometimes needed in those with an intermediate risk phenotype. Implantable loop recorders (ILR) may be considered in those patients with no inducible ventricular arrythmias during programmed ventricular stimulation (PVS). Objective The aim of this study was to retrospectively evaluate the outcome of BrS patients referred for PVS and ILR implantation. Methodology Demographic, clinical and follow-up data of BrS patients seen in clinic were retrospectively analysed from hospital databases. A p vale of <0.05 was considered significant. Results 129 patients have been diagnosed with BrS since launching the inherited arrhythmia clinic service (53.5% males). 15 (high risk patients) had an ICD (n=13, 10.1...
Background Athletes presenting with 1st-degree atrioventricular block (AVB) on 12-lead electrocar... more Background Athletes presenting with 1st-degree atrioventricular block (AVB) on 12-lead electrocardiogram (ECG) may present a diagnostic conundrum, especially when significantly prolonged and associated with higher degrees of block. A pragmatic stepwise approach to the evaluation of these patients is, therefore, crucial. Case summary A 19-year-old waterpolo player was referred for assessment of a 1st-degree heart block and one isolated episode of syncope. All other cardiac investigations were within normal limits except for a 24-h ambulatory ECG which showed Mobitz 1 AVB and episodes of 2:1 block occurring in the context of Wenchebach. An electrophysiological study (EPS) was performed which effectively excluded infranodal conductive tissue disease, confirming physiological intranodal block. Discussion The increase in vagal tone is one of the physiological adaptations to an increased demand in cardiac output in athletes, which explains the presence of 1st-degree AVB in up to 7.5% of a...
BackgroundCardiac Magnetic Resonance (CMR) is increasingly being used for diagnosing various card... more BackgroundCardiac Magnetic Resonance (CMR) is increasingly being used for diagnosing various cardiac conditions. Parametric mapping enables quantitative myocardial characterization by directly measuring myocardial T1 and T2 values. However, reference values of parametric mapping are not standardized across different vendors and scanners, causing drawbacks for clinical implementation of this technique across different sites. We assessed the reference ranges of native T1 and T2 values in a healthy Maltese cohort to establish a local parametric mapping service. Methods and ResultsHealthy subjects (n=51; mean age 36.0 [range 19-59] years) with normal cardiac function on CMR were recruited. Subjects underwent uniform parametric mapping pulse sequences (MOLLI 5(3)3 for native T1 mapping, and gradient echo single shot FLASH readout for T2 mapping) on a 3T Siemens MAGNETOM Vida scanner. Native T1 and T2 values were measured by placing a region of interest within the interventricular septum ...
Introduction: Cascade family screening in inherited heart disease is often reserved for probands ... more Introduction: Cascade family screening in inherited heart disease is often reserved for probands with a clinical diagnosis. This study assessed the yield of family screening in a national cardiac screening program, comparing a clinical and a clinical/genetic screening algorithm. Methods: 2708 teens (14-16 years) participated in a national cardiac screening program. Probands with suspected or confirmed inherited cardiac disease were evaluated clinically and genetically (216 cardiac gene panel). Relatives were subjected to a standard clinical screening protocol. Segregation analysis (Sanger sequencing) was performed in families with gene positive (G+) probands (VUS, likely or definite pathogenic mutations as per ACMJ criteria). Cascade screening was limited to a) first degree relatives and/or b) G+ individuals in the presence or absence (not exceeding two generations) of a clinical phenotype. A standard clinical algorithm (family screening in probands with a pre-clinical or clinical diagnosis) was compared with a genetic lead algorithm. Results: 2(0.1%) probands were diagnosed with a cardiac phenotype (n=1 HCM, n=1 LQTS). Another 17(0.6%) probands had evidence of pre-clinical disease. 81 relatives (60.5% female) underwent evaluation, mean age 41.1±16.7 at first evaluation. 11 families (57.9%) were G+. 54(66.7%) were first degree relatives. 12(14.2%) were screened because of a phenotype in the proband, 57(70.4%) because of a pre-clinical ECG. Another 12(14.8%) were screened because of the family genotype, translating into a 7.4% higher referral rate. The diagnostic yield was higher in the presence of a proband phenotype (41.7% vs 4.3%, p=0.001). Using a standard clinical algorithm, the diagnostic yield of family screening was 10.1% (n=2 HCM, n=5 LQTS). Adding genetics to the algorithm identified another individual (n=1 DCM), equating to a mildly decreased overall yield of 9.9%. The yield between both algorithms was not significantly different (p=0.956). Conclusion: The yield of family screening in probands with a pre-clinical phenotype or clinical diagnosis was 10.1%. This was similar (9.9%) when incorporating genetic testing in the algorithm. The added benefit of systematic genetic testing in a family screening program is limited.
Introduction: Ivabridine (Procorlan) is a newly approved anti-ischaemic drug, recently included i... more Introduction: Ivabridine (Procorlan) is a newly approved anti-ischaemic drug, recently included in new European Society of Cardiology (ESC) Heart Failure after evidence showed it decreased the risk of Heart Failure Hospitalisation, left ventricular systolic function and quality of life. Audit Objection: One can assume that local Heart Failure Clinic patients are the worst in terms of symptom persistence and cardiac function. These are often followed up at closer intervals by specialist nurses and cardiologists, managed optimally according to international guidelines. Taking into consideration the aforementioned points, CHF Clinic attendees were used as the patient cohort for a retrospective audit, so as to identify those who would benefit from the addition of Ivabridine, as recommended by ESC guidelines. Methodology and Inclusion/Exclusion Criteria: The patient cohort consisted of 267 patients, 98 [36.70%] fulfilling the inclusion criterion of Ejection Fraction ≤ 35%, as recommended...
Introduction: Cardiac screening is mandated by most sporting organisations. A resting 12-lead ECG... more Introduction: Cardiac screening is mandated by most sporting organisations. A resting 12-lead ECG may identify individuals who harbour cardiac disorders who may be at risk of sudden cardiac death (SCD). Lateral wave inversion (TWI) may identify subjects with cardiac phenotypes that are linked to SCD. Aim: The aim of this study was to ascertain the prevalence of lateral TWI in adolescent individuals as part of a systematic nationwide cardiac screening. The yield of family screening in these probands was also evaluated. Methodology: A national cardiac screening program (BEAT-IT) was set up in the 2017/2018 scholastic year for students attending year 11 classes. 2672 students (14-17 years) and their legal guardians gave consent. Screening protocol consisted of a questionnaire/ECG at school. ECGs were reported as per the ‘International Recommendations for ECG interpretation’ (2017). Those with contiguous TWI in ≥2 lateral leads were evaluated. An athlete was defined as an individual who...
Ever since the introduction of Low Molecular Weight Heparin in the catheterisation suite at Mater... more Ever since the introduction of Low Molecular Weight Heparin in the catheterisation suite at Mater Dei Hospital, numerous cases of in-stent thrombosis prompted the set up of this audit to look at the local use of LMWH (available locally as Enoxaparin) in patients presenting with STEMI-ACS, NSTEMI-ACS and Unstable Angina, needing Percutaneous Coronary Interventions (PCIs) during admission so as to determine if the administration regimens used are in accordance with the European Society of Cardiology recommendations.
Funding Acknowledgements Type of funding sources: None. Introduction Risk stratification in Bruga... more Funding Acknowledgements Type of funding sources: None. Introduction Risk stratification in Brugada syndrome (BrS) is challenging. Cardiogenic syncope, family history of sudden cardiac death and ECG markers are useful variables in determining patient risk. Invasive risk stratification is sometimes needed in those with an intermediate risk phenotype. Implantable loop recorders (ILR) may be considered in those patients with no inducible ventricular arrythmias during programmed ventricular stimulation (PVS). Objective The aim of this study was to retrospectively evaluate the outcome of BrS patients referred for PVS and ILR implantation. Methodology Demographic, clinical and follow-up data of BrS patients seen in clinic were retrospectively analysed from hospital databases. A p vale of <0.05 was considered significant. Results 129 patients have been diagnosed with BrS since launching the inherited arrhythmia clinic service (53.5% males). 15 (high risk patients) had an ICD (n=13, 10.1...
Background Athletes presenting with 1st-degree atrioventricular block (AVB) on 12-lead electrocar... more Background Athletes presenting with 1st-degree atrioventricular block (AVB) on 12-lead electrocardiogram (ECG) may present a diagnostic conundrum, especially when significantly prolonged and associated with higher degrees of block. A pragmatic stepwise approach to the evaluation of these patients is, therefore, crucial. Case summary A 19-year-old waterpolo player was referred for assessment of a 1st-degree heart block and one isolated episode of syncope. All other cardiac investigations were within normal limits except for a 24-h ambulatory ECG which showed Mobitz 1 AVB and episodes of 2:1 block occurring in the context of Wenchebach. An electrophysiological study (EPS) was performed which effectively excluded infranodal conductive tissue disease, confirming physiological intranodal block. Discussion The increase in vagal tone is one of the physiological adaptations to an increased demand in cardiac output in athletes, which explains the presence of 1st-degree AVB in up to 7.5% of a...
BackgroundCardiac Magnetic Resonance (CMR) is increasingly being used for diagnosing various card... more BackgroundCardiac Magnetic Resonance (CMR) is increasingly being used for diagnosing various cardiac conditions. Parametric mapping enables quantitative myocardial characterization by directly measuring myocardial T1 and T2 values. However, reference values of parametric mapping are not standardized across different vendors and scanners, causing drawbacks for clinical implementation of this technique across different sites. We assessed the reference ranges of native T1 and T2 values in a healthy Maltese cohort to establish a local parametric mapping service. Methods and ResultsHealthy subjects (n=51; mean age 36.0 [range 19-59] years) with normal cardiac function on CMR were recruited. Subjects underwent uniform parametric mapping pulse sequences (MOLLI 5(3)3 for native T1 mapping, and gradient echo single shot FLASH readout for T2 mapping) on a 3T Siemens MAGNETOM Vida scanner. Native T1 and T2 values were measured by placing a region of interest within the interventricular septum ...
Introduction: Cascade family screening in inherited heart disease is often reserved for probands ... more Introduction: Cascade family screening in inherited heart disease is often reserved for probands with a clinical diagnosis. This study assessed the yield of family screening in a national cardiac screening program, comparing a clinical and a clinical/genetic screening algorithm. Methods: 2708 teens (14-16 years) participated in a national cardiac screening program. Probands with suspected or confirmed inherited cardiac disease were evaluated clinically and genetically (216 cardiac gene panel). Relatives were subjected to a standard clinical screening protocol. Segregation analysis (Sanger sequencing) was performed in families with gene positive (G+) probands (VUS, likely or definite pathogenic mutations as per ACMJ criteria). Cascade screening was limited to a) first degree relatives and/or b) G+ individuals in the presence or absence (not exceeding two generations) of a clinical phenotype. A standard clinical algorithm (family screening in probands with a pre-clinical or clinical diagnosis) was compared with a genetic lead algorithm. Results: 2(0.1%) probands were diagnosed with a cardiac phenotype (n=1 HCM, n=1 LQTS). Another 17(0.6%) probands had evidence of pre-clinical disease. 81 relatives (60.5% female) underwent evaluation, mean age 41.1±16.7 at first evaluation. 11 families (57.9%) were G+. 54(66.7%) were first degree relatives. 12(14.2%) were screened because of a phenotype in the proband, 57(70.4%) because of a pre-clinical ECG. Another 12(14.8%) were screened because of the family genotype, translating into a 7.4% higher referral rate. The diagnostic yield was higher in the presence of a proband phenotype (41.7% vs 4.3%, p=0.001). Using a standard clinical algorithm, the diagnostic yield of family screening was 10.1% (n=2 HCM, n=5 LQTS). Adding genetics to the algorithm identified another individual (n=1 DCM), equating to a mildly decreased overall yield of 9.9%. The yield between both algorithms was not significantly different (p=0.956). Conclusion: The yield of family screening in probands with a pre-clinical phenotype or clinical diagnosis was 10.1%. This was similar (9.9%) when incorporating genetic testing in the algorithm. The added benefit of systematic genetic testing in a family screening program is limited.
Introduction: Ivabridine (Procorlan) is a newly approved anti-ischaemic drug, recently included i... more Introduction: Ivabridine (Procorlan) is a newly approved anti-ischaemic drug, recently included in new European Society of Cardiology (ESC) Heart Failure after evidence showed it decreased the risk of Heart Failure Hospitalisation, left ventricular systolic function and quality of life. Audit Objection: One can assume that local Heart Failure Clinic patients are the worst in terms of symptom persistence and cardiac function. These are often followed up at closer intervals by specialist nurses and cardiologists, managed optimally according to international guidelines. Taking into consideration the aforementioned points, CHF Clinic attendees were used as the patient cohort for a retrospective audit, so as to identify those who would benefit from the addition of Ivabridine, as recommended by ESC guidelines. Methodology and Inclusion/Exclusion Criteria: The patient cohort consisted of 267 patients, 98 [36.70%] fulfilling the inclusion criterion of Ejection Fraction ≤ 35%, as recommended...
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