Peter T. Moore

Cardiac Amyloid Imaging with 18F-Florbetaben PET: A Pilot Study

Our aim was to determine the feasibility of 18F-florbetaben PET in diagnosing cardiac amyloidosis. Methods: 18F-florbetaben PET was performed on 14 patients: 5 amyloid light chain, 5 amyloid transthyretin, and 4 control with hypertensive heart disease. Qualitative and quantitative assessments of 18F-florbetaben activity were performed using the SUVmean of the left ventricular myocardium and blood pool and calculation of target-to-background SUV ratio. Myocardial 18F-forbetaben retention was also calculated as the percentage mean myocardial SUV change between 0 and 5 min and 15 and 20 min after radiotracer injection. Global left ventricular longitudinal and right ventricular free wall longitudinal strain were calculated using 2-dimensional speckle-tracking echocardiography. Results: Target-to-background SUV ratio and percentage myocardial 18F-forbetaben retention were higher in amyloid patients than in hypertensive controls. A cutoff of 40% was able to differentiate between cardiac amyloid patients and hypertensive controls. Percentage myocardial 18F-forbetaben retention was an independent determinant of both global left ventricular longitudinal and right ventricular free wall longitudinal strain via an inverse curve relationship. Conclusion: 18F-florbetaben PET imaging can accurately identify and differentiate between cardiac amyloidosis and hypertensive heart disease. Percentage myocardial 18F-florbetaben retention was an independent determinant of myocardial dysfunction in cardiac amyloidosis.

Seven years experience of a nurse-led elective cardioversion service in a tertiary referral centre: an observational study

BACKGROUND Traditionally the provision of elective external direct current cardioversion (EDCCV) for patients with atrial arrhythmias has been doctor-led. Increasing demands on hospital beds and time pressures for doctors has driven the desire for an alternative approach. We established a nurse-led cardioversion service in 2006 and present our experience. METHODS A prospective database of patients undergoing elective EDCCV between July 2006 and July 2013 was collected. Demographic data, arrhythmia, success and immediate complications of cardioversion were recorded. RESULTS A total of 974 EDCCV were performed on 772 patients. The mean patient age was 62.7 years, 564 (73.1%) were male. In 530 patients (69.0%) AF was the primary arrhythmia, in 242 (31.0%) atrial flutter. All EDCCVs were performed in a high dependency unit. Sinus rhythm was obtained in 692 patients (89.6%). Of 640 outpatients, 629 (98.3%) were discharged on the same day of their procedure. Eleven patients (1.7%) required admission to hospital. No patients required urgent temporary transvenous or permanent pacing, and there were no deaths in association with this procedure. CONCLUSIONS Nurse-led elective EDCCV is a safe and effective way of restoring sinus rhythm in patients with AF or atrial flutter, with additional benefits to resource provision.

Imaging and Right Ventricular Pacing Lead Position: A Comparison of CT, MRI, and Echocardiography.

Right ventricular nonapical (RVNA) pacing may reduce the risk of heart failure. Fluoroscopy is the standard approach to determine lead tip position, but is inaccurate. We compared cardiac computed tomography (CT), magnetic resonance imaging (MRI), two‐dimensional and three‐dimensional transthoracic echocardiography (TTE), and chest x‐ray (CXR) to assess which provides the optimal assessment of right ventricular (RV) lead tip position.

Possible late diagnosis of the Brugada syndrome in a patient presenting with a primary cardiac arrest

A 38-year-old male was cardioverted from a primary ventricular fibrillation (VF) arrest. Following a history, examination, and investigations, including an electrophysiology study and flecainide challenge, no cause was established. An implantable cardioverter-defibrillator (ICD) with an active fixation dual-coil Riata lead …

Surface ECG and Fluoroscopy are Not Predictive of Right Ventricular Septal Lead Position Compared to Cardiac CT.

Controversy exists regarding the optimal lead position for chronic right ventricular (RV) pacing. Placing a lead at the RV septum relies upon fluoroscopy assisted by a surface 12‐lead electrocardiogram (ECG). We compared the postimplant lead position determined by ECG‐gated multidetector contrast‐enhanced computed tomography (MDCT) with the position derived from the surface 12‐lead ECG.

Cardiac amyloid imaging with 18F-florbetaben positron emission tomography: a pilot study

Materials and methods F-florbetaben PET was performed in 14 subjects: 5 AL amyloid, 5 ATTR amyloid, and 4 control subjects with hypertensive heart disease. Qualitative and quantitative assessments of F-florbetaben activity were performed using mean standardized uptake value (SUV) of the left ventricular (LV) myocardium and blood pool, and calculation of target-to-background SUV ratio. Percentage myocardial F-forbetaben retention was also calculated as the percentage mean myocardial SUV change between 0–5 min and 15–20 min after radiotracer injection. Global LV longitudinal and right ventricular (RV) free wall longitudinal strain were calculated using 2D speckle tracking echocardiography.

An Unusual Cause of Out-of-Hospital Cardiac Arrest Recorded on a Heartrate Monitor

Coronary vasospasm is an uncommon, but perhaps under-recognised, cause of cardiac arrest. We present a novel case of an exercise-induced out-of-hospital cardiac arrest due to coronary vasospasm, captured on a heartrate monitor, and discuss the management options for this condition.