1st live case - ecc-conference.comecc-conference.com/1/mam2017/mam2017-d2-s3-1-live-case1.pdf ·...
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![Page 1: 1st Live Case - ecc-conference.comecc-conference.com/1/mam2017/mam2017-d2-s3-1-live-case1.pdf · Transthoracic Echocardiography (01.11.2017) Normal EF (LVEF 61%) LA dilated: ESD 4.6cm](https://reader035.vdocument.in/reader035/viewer/2022063007/5fb9294d63b26c58c97ab219/html5/thumbnails/1.jpg)
1st Live Case
![Page 2: 1st Live Case - ecc-conference.comecc-conference.com/1/mam2017/mam2017-d2-s3-1-live-case1.pdf · Transthoracic Echocardiography (01.11.2017) Normal EF (LVEF 61%) LA dilated: ESD 4.6cm](https://reader035.vdocument.in/reader035/viewer/2022063007/5fb9294d63b26c58c97ab219/html5/thumbnails/2.jpg)
Potential conflicts of interest
▪ I have the following potential conflicts of interest to report:
Devdas Inderbitzin
Received educational grant from St. Jude Medical
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Case
• 70-year-old male
• Functional status: NYHA III and EHRA II
• CHA2DS2-VASc: 3, HAS-BLED: 4
• Chronic Obstructive Pulmonary Disease under C-PAP
• Alcohol and nicotine consumption
• No coronary artery disease
Weight 116 kg, BMI 35.6 kg/m2 (preop weight reduction of 6 kg)
![Page 4: 1st Live Case - ecc-conference.comecc-conference.com/1/mam2017/mam2017-d2-s3-1-live-case1.pdf · Transthoracic Echocardiography (01.11.2017) Normal EF (LVEF 61%) LA dilated: ESD 4.6cm](https://reader035.vdocument.in/reader035/viewer/2022063007/5fb9294d63b26c58c97ab219/html5/thumbnails/4.jpg)
Case
Arrhythmic History
• First onset of AF in 1998 (>19 years), uptake Amiodarone
• Intermittent right atrial flutter in 2008
• 2 Electro-conversions
• Tachyarrhythmias despite rate control with Bisoprolol
• Amiodarone (interrupted 2015 due to intolerance)
• On Rivaroxaban
![Page 5: 1st Live Case - ecc-conference.comecc-conference.com/1/mam2017/mam2017-d2-s3-1-live-case1.pdf · Transthoracic Echocardiography (01.11.2017) Normal EF (LVEF 61%) LA dilated: ESD 4.6cm](https://reader035.vdocument.in/reader035/viewer/2022063007/5fb9294d63b26c58c97ab219/html5/thumbnails/5.jpg)
ECG
![Page 6: 1st Live Case - ecc-conference.comecc-conference.com/1/mam2017/mam2017-d2-s3-1-live-case1.pdf · Transthoracic Echocardiography (01.11.2017) Normal EF (LVEF 61%) LA dilated: ESD 4.6cm](https://reader035.vdocument.in/reader035/viewer/2022063007/5fb9294d63b26c58c97ab219/html5/thumbnails/6.jpg)
Case
Transthoracic Echocardiography (01.11.2017)
Normal EF (LVEF 61%)
LA dilated: ESD 4.6cm (M-Mode), 2 cm/m2
No LAA thrombus
RA dilated: ES long axis 5.7cm
Valves: all valves with trace of regurgitation
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TTE
![Page 8: 1st Live Case - ecc-conference.comecc-conference.com/1/mam2017/mam2017-d2-s3-1-live-case1.pdf · Transthoracic Echocardiography (01.11.2017) Normal EF (LVEF 61%) LA dilated: ESD 4.6cm](https://reader035.vdocument.in/reader035/viewer/2022063007/5fb9294d63b26c58c97ab219/html5/thumbnails/8.jpg)
TTE
![Page 9: 1st Live Case - ecc-conference.comecc-conference.com/1/mam2017/mam2017-d2-s3-1-live-case1.pdf · Transthoracic Echocardiography (01.11.2017) Normal EF (LVEF 61%) LA dilated: ESD 4.6cm](https://reader035.vdocument.in/reader035/viewer/2022063007/5fb9294d63b26c58c97ab219/html5/thumbnails/9.jpg)
CT Scan
![Page 10: 1st Live Case - ecc-conference.comecc-conference.com/1/mam2017/mam2017-d2-s3-1-live-case1.pdf · Transthoracic Echocardiography (01.11.2017) Normal EF (LVEF 61%) LA dilated: ESD 4.6cm](https://reader035.vdocument.in/reader035/viewer/2022063007/5fb9294d63b26c58c97ab219/html5/thumbnails/10.jpg)
Question
What would be the best treatment?
A Catheter ablation of the pulmonary veins
B Thoracoscopic left atrium ablation
C Thoracoscopic ablation + epicardial LAA exclusion
D Stand alone epicardial LAA exclusion
E Percutaneous LAA closure
![Page 11: 1st Live Case - ecc-conference.comecc-conference.com/1/mam2017/mam2017-d2-s3-1-live-case1.pdf · Transthoracic Echocardiography (01.11.2017) Normal EF (LVEF 61%) LA dilated: ESD 4.6cm](https://reader035.vdocument.in/reader035/viewer/2022063007/5fb9294d63b26c58c97ab219/html5/thumbnails/11.jpg)
Question
Now please VOTE !
A Catheter ablation of the pulmonary veins
B Thoracoscopic left atrium ablation
C Thoracoscopic ablation + epicardial LAA exclusion
D Stand alone epicardial LAA exclusion
E Percutaneous LAA closure
votyng.com
![Page 12: 1st Live Case - ecc-conference.comecc-conference.com/1/mam2017/mam2017-d2-s3-1-live-case1.pdf · Transthoracic Echocardiography (01.11.2017) Normal EF (LVEF 61%) LA dilated: ESD 4.6cm](https://reader035.vdocument.in/reader035/viewer/2022063007/5fb9294d63b26c58c97ab219/html5/thumbnails/12.jpg)
Question
What would be the best treatment?
Lets connect to our colleagues treating the patient …
&
… discuss the options.
![Page 13: 1st Live Case - ecc-conference.comecc-conference.com/1/mam2017/mam2017-d2-s3-1-live-case1.pdf · Transthoracic Echocardiography (01.11.2017) Normal EF (LVEF 61%) LA dilated: ESD 4.6cm](https://reader035.vdocument.in/reader035/viewer/2022063007/5fb9294d63b26c58c97ab219/html5/thumbnails/13.jpg)
Question
What would be the best treatment?
A Catheter ablation of the pulmonary veins
B Thoracoscopic left atrium ablation
C Thoracoscopic ablation + epicardial LAA exclusion
D Stand alone epicardial LAA exclusion
E Percutaneous LAA closure