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Related Concept Videos

Cardiomyopathy V: Interprofessional Care01:29

Cardiomyopathy V: Interprofessional Care

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Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
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Cardiopulmonary Resuscitation IV: Pharmacological Management01:25

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Pharmacologic intervention is crucial in treating cardiac arrest patients during ACLS or Advanced Cardiovascular Life Support. The ACLS algorithms guide the administration of specific drugs based on the patient's cardiac arrest rhythm, which includes pulseless ventricular tachycardia (VT), ventricular fibrillation (VF), asystole, and pulseless electrical activity (PEA).EpinephrineIndication: Epinephrine is the first-line drug for all cardiac arrest rhythms.Mechanism of Action: Epinephrine...
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Cardiopulmonary Resuscitation III: AED Use01:23

Cardiopulmonary Resuscitation III: AED Use

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Introduction to AEDAn Automated External Defibrillator (AED) is a portable medical device that analyzes the heart's rhythm and, if necessary, delivers an electrical shock to help the heart re-establish an effective rhythm during sudden cardiac arrest (SCA). SCA occurs when the heart suddenly and unexpectedly stops beating, leading to a loss of blood flow to the brain and other vital organs. In such emergencies, time is of the essence, and using an AED, combined with Cardiopulmonary...
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Cardiac Catheterization III: Left Heart Catheterization01:24

Cardiac Catheterization III: Left Heart Catheterization

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Left heart catheterization is an invasive diagnostic procedure used to evaluate the function and structure of the left side of the heart. It is generally performed to diagnose and treat cardiovascular conditions such as valve abnormalities, coronary artery disease, and congenital heart defects.Diagnostic and therapeutic purposesLeft heart catheterization serves various diagnostic and therapeutic purposes, including:Assessing coronary artery bypass grafts.Evaluating coronary artery disease in...
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Cardiac Catheterization IV: Nursing Management01:26

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Nursing responsibilities before cardiac catheterization include:Assess for allergies and establish baseline health status.Before cardiac catheterization, assess the patient for allergies to contrast dye. Perform a comprehensive baseline assessment, including vital signs, heart and breath sounds, and a neurovascular assessment of the extremities, noting distal pulses, skin color, and temperature. Instruct the patient to fast for 8-12 hours before the procedure. Evaluate baseline laboratory...
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Cardiomyopathy II: Dilated Cardiomyopathy01:30

Cardiomyopathy II: Dilated Cardiomyopathy

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Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
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Related Experiment Video

Updated: Jul 21, 2025

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Direct current cardioversion practices following percutaneous left atrial appendage closure.

Sapan Bhuta1, Adnan Shaaban1, Nkongho C Binda1

  • 1Section of Electrophysiology, Division of Cardiovascular Medicine, Ross Heart Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.

Journal of Cardiovascular Electrophysiology
|July 26, 2023
PubMed
Summary

Direct current cardioversion (DCCV) after left atrial appendage closure (LAAC) shows varied use of imaging and anticoagulation. Left atrial appendage imaging before DCCV is recommended to assess for thrombus and device issues.

Keywords:
anticoagulationatrial fibrillationcardioversionclosureleft atrial appendageocclusionpercutaneoustransesophageal echocardiography

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Electrophysiology

Background:

  • Percutaneous left atrial appendage closure (LAAC) is an alternative to oral anticoagulation for stroke risk reduction in non-valvular atrial fibrillation (AF).
  • Direct current cardioversion (DCCV) is sometimes performed after LAAC to restore sinus rhythm.
  • Optimal protocols for imaging and anticoagulation before and after DCCV in LAAC patients are not well-defined.

Purpose of the Study:

  • To evaluate real-world utilization of transesophageal echocardiography (TEE) or cardiac computed tomography angiography (CCTA) prior to DCCV.
  • To assess the patterns of oral anticoagulation (OAC) use before and after DCCV in patients with AF post-LAAC.
  • To determine the incidence of left atrial thrombus (LAT), device-related thrombus (DRT), and peri-device leak (PDL) in this patient cohort.

Main Methods:

  • Retrospective single-center study of patients undergoing DCCV after percutaneous LAAC (2016-2022).
  • Key data collected included pre-DCCV imaging (TEE/CCTA), pre- and post-DCCV OAC use, and incidence of adverse events.
  • Adverse events included LAT/DRT, PDL, stroke, systemic embolism, device embolization, major bleeding, or death within 30 days.

Main Results:

  • 122 DCCV procedures were performed in 76 patients post-LAAC. Watchman devices were most common.
  • 25% of DCCV cases were considered non-guideline based due to inadequate OAC duration or lack of pre-DCCV imaging.
  • Of 70 cases with pre-DCCV imaging, 23% showed PDL and 6% had LAT/DRT, leading to procedure cancellation in some instances. No DCCV-related complications occurred within 30 days.

Conclusions:

  • Significant variability exists in the application of TEE/CCTA and OAC around DCCV post-LAAC.
  • Pre-DCCV LAA imaging is crucial, particularly within the first year after LAAC, to evaluate device placement, PDL, and detect LAT/DRT.
  • Standardized protocols may improve the safety and efficacy of DCCV in patients with prior LAAC.