Indonesian Journal of Cardiology

Timeframe Factors of Door-to-Device Time During Pandemic Situation in a Tertiary Cardiovascular Centre in Indonesia

Isman Firdaus — 2024-09-20

Background: The coronavirus disease 2019 (COVID-19) pandemic has greatly affected every aspect of life, especially in the field of cardiovascular services. This creates many challenges in the treatment of highly time-sensitive and potentially lethal conditions such as ST-elevation acute myocardial infarction (STEMI). STEMI patients at high risk for COVID-19 are recommended to be evaluated with additional testing for COVID-19 and possibly require respiratory support, all of which can delay Door-to-device time (DTDT).

Objective: In this study, we sought to determine the DTDT for primary percutaneous coronary intervention (PCI) in acute STEMI, the various timeframes influencing the DTDT, and which time factor has the most significant correlation to DTDT in the COVID-19 pandemic era.

Methods: A longitudinal retrospective study was conducted at the largest tertiary referral hospital in Indonesia from March 2020 to February 2021. The following timeframes were measured during the study: Door-to-Diagnosis Time [Δt1], Diagnosis-to-Activation Time [Δt2], Informed Consent Time [Δt3], Preparation at Emergency Room (ER) Time [Δt4], Preparation at Catheterization Laboratory Time [Δt6], and PCI Initiation-to-Balloon Time [Δt7]. Spearman’s correlation (ρ) was used to ascertain the correlation among time factors.

Results: 238 patients met the inclusion criteria of this study. The observed DTDT was 110 [47 – 437] minutes. Of the variables, DTDT had a strong positive correlation with preparation at the ER time (median 28,0 (1 – 344) minutes; r = 0.702; p-value < 0.0001).

Conclusion: This study sheds light on preparation at the ER time as a significant influencing factor for Door-to-device time in the COVID-19 pandemic era.

Anteroposterior Diameter of the Left Atrium Determines the Occurrence of Left Atrial Tachycardia in Non-paroxysmal Atrial Fibrillation Patients after Catheter Ablation

Dicky Armein Hanafy — 2024-09-20

Objectives:

The relationship between left atrial (LA) size and atrial fibrillation (AF) is well-established. However, the specifics of LA regional remodeling and its connection to left atrial tachycardia (LA-AT) post-ablation in patients with non-paroxysmal AF are less understood. This study aims to explore how LA dimensions are related to the development of LA-AT following AF ablation procedures in these patients.

Methods:

This study focused on 73 patients with non-paroxysmal atrial fibrillation (average age 52, predominantly male, with a nearly even split between persistent and long-lasting persistent AF), all undergoing their first catheter ablation for AF. Prior to the ablation, left atrial dimensions were determined through computed tomography, measuring the maximal transverse, anteroposterior, and superoinferior diameters.

Results:

Over an average follow-up period of 23 months, 31.5% of the patients (Group 1) experienced left atrial tachycardia (LA-AT) that required a second linear ablation procedure. This group had significantly larger left atrial (LA) dimensions in terms of transverse, anteroposterior, and superoinferior measurements compared to the other group (Group 2). However, the recurrence of atrial fibrillation (AF) was not linked to any specific LA diameter. The anteroposterior diameter was identified as a significant predictor (p=0.002, HR 2.3, 95% CI 1.3-3.8) for LA-AT occurrence through multivariate analysis.

Conclusions:

Eccentric dilatation involving the anteroposterior diameter is a significant predictor for the occurrence of LA-AT in patients with non-paroxysmal AF after catheter ablation.

Keywords

Atrial fibrillation; Atrial flutter; Atrial tachycardia; Left atrial diameter; Catheter ablation; Computed tomography

The IndONEsia ICCU Registry

Dafsah Arifa Juzar — 2024-09-20

Introduction: Patients in the Intensive Cardiovascular Care Unit (ICCU) often present with cardiovascular disease (CVD) issues accompanied by various non-cardiovascular conditions. However, a widely applicable scoring system to predict patient outcomes in the ICCU is lacking. Therefore, developing and validating scores for predicting ICCU patient outcomes are warranted. The aims of the IndONEsia ICCU (One ICCU) registry include developing an epidemiological registry of ICCU patients and establishing a multicentre research network to analyse patient outcomes.

Methods and results: This nationwide multicenter cohort protocol will capture data from patients receiving cardiovascular critical care treatment in 10 Indonesian hospitals with ICCU facilities. Recorded data will encompass demographic characteristics, physical examination findings at hospital and ICCU admission, diagnoses at ICCU admission, therapy, intervention, complications on days 3 and 5 of in-ICCU care, in-hospital outcomes, and 30-day outcomes.

Conclusion: The One ICCU is a large, prospective registry describing the care process and advancing clinical knowledge in ICCU patients. It will serve as an investigational platform for predicting the mortality of ICCU patients.

The Use of Artificial Intelligence (AI) to Predict Heart Failure in Type II Diabetes Mellitus Patients: A Systematic Review

Lies Dina Liastuti — 2024-09-20

Heart failure (HF) is a critical concern for individuals with Type II Diabetes Mellitus (T2DM), significantly increasing morbidity and mortality rates. Artificial Intelligence (AI) and machine learning hold promise in enhancing predictive capabilities and guiding personalised interventions. This systematic review evaluates existing AI models' effectiveness in predicting HF complications in T2DM patients. A comprehensive literature search identified 8 relevant studies, predominantly from European, North American, and Southeastern populations. These studies utilised multi-centered registries and electronic medical records to develop AI models predominantly focused on supervised learning algorithms. While the AI models had promising performance, these models lack external validation with diverse populations and reproducibility, hindering their clinical applicability. Moreover, variations in outcome definitions and input features underscore the need for standardised approaches. Despite these limitations, AI models offer valuable insights into HF risk assessment in T2DM, highlighting the importance of further validation and reproducibility for clinical integration.

Successful Electrical Cardioversion in Late Pregnancy Woman With Supraventricular Tachycardia

Dimas Setiaji — 2024-09-20

Background: Pregnancy, precipitate cardiac arrhythmia, and supraventricular tachycardia (SVT) are some most frequent and sustained arrhythmias in pregnancy. In general, the pharmacological approach in pregnant patient is similar to that in the non-pregnant patient. However, fetal safety becomes a special consideration before administering the therapy.

Case Presentation: We reported a 34-year-old female G3P2A0 with 35 weeks of gestation who came to the emergency department with sudden onset palpitations within 2 hours before admission. She had no prior history of any major medical illness. The clinical examination revealed that the patient had a regular pulse rate of 198/minute, and the blood pressure was 80/50 mmHg. The electrocardiogram showed the presence of SVT. Synchronized cardioversion with 50 joules was performed. The patient’s rhythm was converted to sinus tachycardia with a pulse rate of 120/minute and blood pressure was 90/60 mmHg. The patient was admitted to ICCU immediately after cardioversion and discharged from the hospital without any adverse effects after two days of monitoring.

Conclusion: SVT is arrhythmia condition that is often found in pregnant women. In an unstable SVT condition, cardioversion is the first general action that is safe to be performed on the mother and the fetus. It must have strict observation before and after cardioversion to monitor whether there was a problem with the fetus or not.