Cardiology Commons^™

Is There A Role Of Adding Defibrillation To Cardiac Resynchronization Therapy For Primary Prevention In Patients With Heart Failure And Reduced Ejection Fraction?, Hong Yee Lim, Yew Chung Chan, Wee Lee Chin, Soot Keng Ma

Journal of the Hong Kong College of Cardiology

Heart failure with reduced ejection fraction (HFrEF) is a major global health concern, and the mortality rate remains high despite advances in medical and device therapies. Cardiac resynchronization therapy with a pacemaker (CRT-P) and implantable cardioverter-defibrillator (ICD) therapies have demonstrated efficacy in improving outcomes for patients with heart failure, but their roles in combination for primary prevention remain under ongoing investigation. This review explores the current literature on the role of adding defibrillation to CRT for primary prevention in HFrEF patients. We examine key studies, mechanisms of action, and clinical outcomes to evaluate the benefits, risks, and future directions of …

Future Perspective Of Pulse Field Ablation For Atrial Fibrillation, Ka-Ying Li, Ho-Ting Ngan, Chu-Pak Lau, Hung-Fat Tse

Journal of the Hong Kong College of Cardiology

Pulse field ablation (PFA) represents cutting edge technique in cardiac electrophysiology designed to treat arrhythmias. Unlike traditional catheter ablation methods that rely on thermal energy to create heart lesions, PFA employs pulsed electric fields to trigger irreversible electroporation, resulting in precise tissue ablation. This comprehensive review explores the mechanisms and clinical uses of PFA, emphasizing its potential benefits over conventional ablation techniques and exploring its limitations. It also examines clinical data on current PFA devices, which offer consistent procedural outcome and lower risk of thermal related complications. These developments have driven rapid advancements of modern PFA catheters, with future innovations …

Micra Leadless Pacemaker Implantation Via Transjugular Approach, Yuen-Fung Yiu, Ngai-Yin Chan

Journal of the Hong Kong College of Cardiology

Leadless pacemaker implantation offers a safe and effective option for patients with limited venous access or high bleeding risk. The procedure usually necessitates insertion of a large-bore sheath over the femoral vein. We report a case of successful Micra^TM implantation via transjugular approach in a patient with inferior vena cava obstruction.

Atrial Fibrillation Burden And Clinical Outcomes In Dual-Chamber Pacemaker Recipients, Ka Ho Oscar Chiu, Shou Yan Kam, Ka Chun Kevin Lee, To Shing Wong, Jacky Kit Chan, Yuk-Kong Lau, Kwok-Lun Lee, Wai-Ling Jessica Poon

Journal of the Hong Kong College of Cardiology

Background

Pacemaker-detected atrial fibrillation (PDAF) and its burden are associated with adverse clinical outcomes, but consensus is lacking on its definition and local clinical outcomes are unclear. We evaluated PDAF, its burden and relationship with major adverse cardiovascular and cerebrovascular events (MACCE).

Methods

This retrospective study recruited adult patients receiving dual-chamber pacemakers from 2014 to 2022. The presence of PDAF of 5 minutes, PDAF burden (defined by the longest episode) and time to new-onset PDAF were measured and analysed. High PDAF burden was defined as PDAF lasting 24 hours.

Results

A total of 275 patients were analysed and followed for …

Will Conduction System Pacing Replace Biventricular Pacing For Treating Heart Failure In Patients With Wide Qrs Duration?, Chan Yat Sun Joseph

Journal of the Hong Kong College of Cardiology

Conduction system pacing CSP) is an emerging therapy for resynchronization of patients with heart failure and wide QRS duration. It has been proposed to replace cardiac resynchronization therapy with biventricular pacing (CRT with BVP) mainly because of shortcoming of CRT with BVP including failure to implant coronary sinus leads and unsatisfactory response in certain subset of heart failure patients. The current evidence for CSP in heart failure patients with wide QRS duration is reviewed and the gap in evidence in supporting CSP to replace CRT with BVP is discussed.

Comparison Of Clinical Outcomes Between Provisional Stenting And Two-Stent Approach For True Left Main Bifurcation Lesions In The Era Of Imaging Guided Percutaneous Coronary Intervention, Ming Leo Lau, Ho Fai Daniel Fong, Nim Pong Kwong

Journal of the Hong Kong College of Cardiology

Background

Currently there are two strategies in Percutaneous Coronary Intervention (PCI) of the true left main (LM) bifurcation lesions: provisional stenting and two-stent technique. The optimal treatment strategy for true LM bifurcation lesions is undetermined. In addition, the percentage of use of imaging-guiding in these studies was low. We would like to undertake a retrospective cohort study to compare the clinical outcomes of provisional stenting versus two-stent technique in treating the true LM bifurcation lesions with the help of intravascular imaging.

Methods

Data of consecutive patients undergoing PCI of true LM bifurcation lesions in Yan Chai Hospital from January, 2018 …

Challenges Faced In Managing The Hemodynamic Status Due To Recurrent Gastrointestinal Bleeding In Typhoid Fever With Uncorrected Double Outlet Right Ventricle Patient: A Case Report, Kellyn Trycia Zenjaya, Lindawati Wijoyo, Jovan Amadeo Muliyanto, Rizqi Rokhmadhoni Pikir, Dwi Putri Lestari, Esthy Poespitaningtyas

Journal of the Hong Kong College of Cardiology

Double Outlet Right Ventricle (DORV) is a rare cyanotic congenital heart defect often associated with polycythemia and bleeding risk. A 7-year-old boy with uncorrected DORV presented with fever, melena, and shock. He was cyanotic, tachypneic, and tachycardic, with SpO₂ of 68% and a harsh ejection systolic murmur. Labs showed anemia, thrombocytopenia, leukocytosis, and prolonged APTT. Tubex TF IgM was strongly positive. A diagnosis of typhoid fever with gastrointestinal bleeding and uncorrected DORV was made. Management included oxygen, inotropes, and fluid resuscitation. Propranolol was withheld. Severe infection with underlying cyanotic heart disease and coagulopathy presents a critical management dilemma.

Characteristics And Clinical Outcomes Of Young Patients With St-Segment Elevation Myocardial Infarction A Retrospective Study, Cheung Pak Nung Rocco, Chi Yan Raymond Fung

Journal of the Hong Kong College of Cardiology

Background ST-segment elevation myocardial infarction (STEMI) carries high mortality and poor outcomes without timely treatment. Its occurrence in young patients is especially concerning due to social impact. Objectives This study examined the characteristics and outcomes of young STEMI patients in Hong Kong to identify areas for public health improvement. Methods We retrospectively reviewed STEMI patients admitted to Princess Margaret Hospital from January 2019 to January 2023 who underwent coronary angiography and reperfusion therapy. Patients were grouped as young (years) or older (≥50 years). Results Out of 818 patients treated with PCI, 102 (12.5%) were under 50 years old. Compared to …

An Unusual Cause Of Acute Constrictive Pericarditis, Yue Hin Tang, Raymond Chi Yan Fung

Journal of the Hong Kong College of Cardiology

Constrictive pericarditis, a condition where the pericardium thickens and constricts, has long been considered as a chronic sequela of prior insults to the pericardium such as heart surgery, repeated pericarditis, tuberculosis infection, radiation exposure, etc. Susceptible populations are thus expected to be middle-aged.

We present a case in which a young gentleman was diagnosed with acute constrictive pericarditis due to Adult-onset Still’s disease with macrophage activation syndrome. This case illustrated that constrictive pericarditis could happen in acute settings and thus the importance of cardiologists to maintain open-minded in search of a diagnosis

Bridging Awareness, Risk, And Innovation In Peripheral Arterial Disease, Guang-Ming Tan, Bryan P. Yan

Journal of the Hong Kong College of Cardiology

No abstract for this article type.

Machine Learning-Based Risk Stratification For Limb-Related Outcomes In Peripheral Artery Disease Patients Undergoing Percutaneous Transluminal Angioplasty, Yujia Zhang, Zhoudong Jing, Zhiqiang Liu, Angel Lai, Guangming Tan, Bryan P Yan

Journal of the Hong Kong College of Cardiology

Background: Patients with peripheral artery disease (PAD) remain at high risk of mortality and major adverse limb events (MALE) after endovascular revascularization, yet outcome prediction tools are limited. We apply machine learning (ML) to improve prognostic stratification in this population. Methods: PAD patients undergoing percutaneous transluminal angioplasty (PTA) between 2007 and 2024 were included. The primary endpoint was 1-year major adverse limb events (MALE) or all-cause death. Data were divided into training (70%) and testing (30%) sets. Six ML models were developed, and performance was evaluated using the area under the receiver operating characteristic curve (AUC). Feature importance and risk …

A Cross-Sectional Survey And Latent Class Analysis Of Knowledge On Peripheral Arterial Disease In Hong Kong, Angel Lai, Guang-Ming Tan, Bryan P. Yan

Journal of the Hong Kong College of Cardiology

BACKGROUND: Peripheral arterial disease (PAD) is prevalent and associated with significant cardiovascular (CV) mortality. However, it remains under-recognized, particularly in Asian countries. This study aims to assess awareness of PAD, its risk factors, and perceived consequences in relation to other CV diseases to inform strategies for improving clinical care.

METHODS: A total of 1,008 adults attending outpatient clinics at a university-affiliated tertiary hospital were recruited between January-August 2020 for a phone questionnaire. Differences between awareness groups were analysed by Pearson’s Chi-square test, predictors of PAD awareness were determined using multivariate logistic regression, and latent class analysis (LCA) was performed to …

Iatrogenic Femoral Arteriovenous Fistula After Leadless Pacemaker Implantation Treated With Balloon-Expandable Stent: A Report Of Three Cases, Cheuk Yin Lai, Timothy Ho Him, Mark Tk Tam, Guang-Ming Tan, Bryan P Yan

Journal of the Hong Kong College of Cardiology

Endovascular covered stenting is a minimally invasive option for treating iatrogenic femoral access site complications, including arteriovenous femoral fistula (AVF). Reports on AVF repair mainly concern small bore devices, but large bore devices such as leadless pacemakers post unique challenges. We present 3 cases of iatrogenic femoral AVF after large-bore, 27Fr access sheath insertion for leadless pacemaker implantation. Both underwent endovascular balloon-expandable covered stenting, with resolution of AVF and durable long-term results. As patients referred for leadless pacemaker implantations are often frail with co-morbidities, endovascular stenting is an appealing alternative to open surgical repair for AVF.

Right Heart Failure After Tricvalve Implantation For Symptomatic Torrential Tricuspid Regurgitation: A Case Report, King Sum Luk, Chun Kit Wong

Journal of the Hong Kong College of Cardiology

Patients with symptomatic torrential tricuspid regurgitation (TR) presenting with right heart failure are associated with significant morbidity and mortality. While medical therapy is often ineffective, the perioperitive risks of surgical correction are high. Transcatheter TricValve implantation is one of the evolving therapeutic options for this condition with many unanswered questions. We reported a case of life-threatening right heart failure after transcatheter TricValve implantation despite initial improvement. Important considerations of TricValve implantation are discussed. In particular, careful patient selection and evaluation with perioperative echocardiogram are of paramount importance.

Traumatic Tricuspid Regurgitation And Right Coronary Artery Dissection, Kan Chung Yan Joyce, Wong Chun Kit Martin

Journal of the Hong Kong College of Cardiology

Traumatic tricuspid valve regurgitation and coronary artery dissection are rare complications of blunt chest trauma. We report a case of acute severe traumatic tricuspid valve regurgitation and right coronary artery dissection in a young male patient with unremarkable medical history after a road traffic accident.

Comparison Of Primary Percutaneous Coronary Intervention (Ppci) Vs. Pharmacoinvasive Strategy As Reperfusion Strategies In Patients With St-Elevation Myocardial Infarction (Stemi), Siu Wai For

Journal of the Hong Kong College of Cardiology

Background – Guidelines recommended primary percutaneous coronary intervention (PPCI) as the preferred reperfusion strategy in the treatment of patients with ST-elevation myocardial infarction (STEMI). However, PPCI might not be readily available in the real-world situations due to the limitation of resources. A pharmacoinvasive strategy consisting of early thrombolytic therapy followed by PCI was suggested as an alternative reperfusion approach. Prior studies had shown that clinical outcomes of pharmacoinvasive strategy were comparable to PPCI. The purpose of this retrospective study was to assess the outcomes of reperfusion strategies in patients with STEMI in the North Territories East of Hong Kong, comparing …

Atorvastatin In Preventing Anthracycline-Induced Cardiotoxicity In Low-Risk Breast Cancer Patients: A Randomized Controlled Trial (Atopact-Low), Chonthicha Tanking, Chanwit Wuttichaipradit, Chayanee Samdaengpan, Jomtana Siripaibun, Siriwan Manahwan,R.N, Bundhitwong Trikesornnopamas, Phakawan Budchala, Viroj Muangsillapasart

Journal of the Hong Kong College of Cardiology

Background: According to the current guideline, statins should be provided to prevent anthracycline cardiotoxicity in high-risk cancer patients. This study aims to investigate the role of atorvastatin in preventing anthracycline-induced cardiac dysfunction among low-risk breast cancer patients. Methods: In this randomized, double-blinded, placebo-controlled trial, newly diagnosed breast cancer patients with low risk of cancer therapy-related cardiac dysfunction (CTRCD) were assigned to receive atorvastatin 40 mg or placebo. Echocardiography was performed before, at 3 and 6 months after the anthracycline treatment to determine changes in LVEF as a primary outcome. The secondary outcome included changes in global longitudinal strain (GLS), LV …

Diagnosing Hypertrophic Cardiomyopathy In Athletes, Chalisa Srisukajorn, Tamonwan Megan Jirakulaporn, Helen C Huang, Erik Fung, Polakit Teekakirikul

Journal of the Hong Kong College of Cardiology

Sudden cardiac death (SCD) in a young asymptomatic individual is a devastating, unpredictable event, with a widespread impact on the public health system. Hypertrophic cardiomyopathy (HCM) is the most common form of genetic heart disease, and considered one of the leading causes of SCD affecting young and frequently asymptomatic patients. A diagnosis of HCM is challenging particularly in young athletes due to overlapping clinical phenotypesbetween pathological left ventricular hypertrophy (LVH) and exercise-induced physiological LVH. Severalinvestigational tools have been used to differentiate these two distinct entities. This review article focuses upon the diagnosis of HCM in young athletes, SCD risk assessment, …

Procedural And Clinical Outcomes Of Dedicated Venous Stents In Acute And Chronic Venous Obstruction: A Retrospective Single Center Study, Guangming Tan, Madeleine G Yan, Bryan Py Yan

Journal of the Hong Kong College of Cardiology

Background Endovenous angioplasty with stenting is an accepted treatment for patient with venous obstruction. Dedicated venous stents have been developed to improve the efficacy and safety of the venoplasty procedure. We report the procedural as well as clinical outcomes of these new generation stents in the treatment of acute and chronic venous obstruction. Method This is a single centre retrospective cohort study of patients who received venous stenting for either acute or chronic venous obstruction. Baseline demographics, procedural details, clinical outcomes including 30 day all-cause mortality, 90 day primary patency rate, and change in Villalta score were reported. Result 41 …

Institute Of Cardiovascular Science And Medicine Faculty Of Medicine The University Of Hong Kong

Journal of the Hong Kong College of Cardiology

No abstract provided.

Abstracts For Lectures

Journal of the Hong Kong College of Cardiology

No abstract provided.

9th Asian Preventive Cardiology And Cardiac Rehabilitation Conference Symposia

Journal of the Hong Kong College of Cardiology

No abstract provided.

9th Asian Preventive Cardiology And Cardiac Rehabilitation Conference

Journal of the Hong Kong College of Cardiology

No abstract provided.

Old But Not Vain : Two Cases Of Refractory Polymorphic Ventricular Tachycardia Associated With Coronary Artery Disease Successfully Treated With Quinidine, Tit-Kei Ng, Tommy King-Him Ma, Chi-Chun Au, Janice Woon-Yan Wong, Jenny Nga-Lai Chow, Andrew Vincent Li, Adrian Yin-Cheung Luk, Sze-Wah Lai, Candy Ming-Yan Cheuk, Jaclyn Chi-Lin Chan, Li-Wah Tam

Journal of the Hong Kong College of Cardiology

Post myocardial infarct polymorphic Ventricular Tachycardia (VT) triggered by injured Purkinje fibres can cause VT storms that are refractory to various treatment even after successful reperfusion or revascularization. We reported such recurrent polymorphic VT in two post myocardial infarct patients after Percutaneous Coronary Intervention. Both of them responded readily to Quinidine. We also discussed the pathophysiology of this arrhythmia and the treatment option of it, namely catheter ablation and antiarrhythmics

Recurrent Cyanotic Spells In An Octogenarian, Chin Tong Kwok, Chun Kit Wong

Journal of the Hong Kong College of Cardiology

We report rare case of an octogenarian who, after years of diagnostic delay, was found to have a patent foramen ovale, and due to an ascending aortic aneurysm that anatomically facilitated right-to-left shunt, presenting with life-threatening cyanotic attacks. The characteristic orthodeoxia-platypnea syndrome and high alveolar arterial gradient hint to the diagnosis. She was eventually treated successfully with urgent percutaneous PFO closure. Routine ordering of a transthoracic echocardiogram, without agitated saline injection under provocation maneuvers, may not be sufficient to rule out shunts.

Roles Of Exercise Treadmill Test In The Diagnosis & Risk Stratification Of Cardiac Channelopathies, Kit Chan

Journal of the Hong Kong College of Cardiology

Channelopathies are the leading causes of SCD in patients without structural heart disease. Missing the diagnosis of high-risk but concealed channelopathies could have lethal clinical consequences. However, the diagnosis of channelopathies is often challenging due to the dynamic clinical presentations and elusive ECG manifestations of these diseases. An integrated approach including clinical assessment, repeated electrocardiography, drug provocation tests, exercise stress test and genetic studies is often required for establishing the diagnosis. Pharmacological provocation tests may have limited sensitivity and may be associated with false positive results. Wide-spread use of genetic studies are limited by low yield, cost-effectiveness and availability issue. …

The Impact Of Renal Insufficiency Upon Admission On The Clinical Outcome Of Patients With Acute St-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention, Wai Lun Kwong, Kwok Ho Yau, Eugene Sin, Kwok Keung Chan

Journal of the Hong Kong College of Cardiology

Background: Coronary artery disease is common in patients with renal insufficiency. In acute coronary syndrome, impaired renal function is present in approximately 30-40% of patients and is associated with worse prognosis. Local data regarding the risks and benefits for those patients suffering from acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) is scarce. We evaluated the clinical outcomes of patients suffering from STEMI with and without renal insufficiency upon admission who underwent PPCI.

Methods: From 1^st January 2009 to 30^th September 2017, all patients with STEMI treated with PPCI were identified. The primary …

Medical Professionals’ Perspective On Safety And Efficacy Of Early Mobilization In Acute Heart Failure Patients, Kevin Triangto, Febrian M. Santausa, Basuni Radi, Bambang Budi Siswanto

Journal of the Hong Kong College of Cardiology

Acute heart failure (HF) patients most of the time presents with hemodynamic instability, which often leads to prolonged bedrest. Newer studies had shown that early mobilization for HF patients would lead to better outcomes. However, the early mobilization practice has not always been done due to several barriers in the medical professionals’ perspective, especially regarding safety and efficacy. Prior studies had shown that medical professionals’ views would greatly affect patients’ perspectives, especially in HF rehabilitation. This study is aimed to describe medical professionals’ views on the safety of early mobilization for HF. It was then revealed that General Practitioners’ (GP) …

Prediction Of Clinical Atrial Fibrillation By Cardiac Implantable Electronic Device Detected Atrial High Rate Episodes, Shek Joyce, Fung Chi Yan Raymond, Yuen Ho Chuen, Chan Ngai Yin, Yu Lok Man Ellen

Journal of the Hong Kong College of Cardiology

Background Current guidelines mainly address clinical atrial fibrillation and long Atrial Heart Rate Episodes (AHRE). This study focused on the clinical significance of incidental short AHRE detected by Cardiac Implantable Electronic Device (CIED).

Methods A single-centre retrospective observational study recruited patients from CIED clinic of Princess Margaret Hospital from 2015 to 2022, excluding patients with known clinical AF. The primary outcome was clinical AF and/or long AHRE more than 24 hours. Secondary outcomes included non-fatal stroke, admission for heart failure, myocardial infarction and death. AHRE+ vs AHRE- were compared using multivariate analysis, introducing AHRE duration as a time-dependent covariates. A …

Review On Molecular Genetic Basis Of Hypertrophic Cardiomyopathy, Derek Pok Him Lee

Journal of the Hong Kong College of Cardiology

Hypertrophic cardiomyopathy (HCM) is one of the most common types of inherited cardiomyopathy with a wide range of clinical manifestations ranging from subtle myocardial hypertrophy to debilitating heart failure, cardiac arrhythmias, and sudden cardiac death. We reviewed the literature on the latest knowledge regarding the pathophysiology and molecular genetic basis of HCM. This will include laboratory studies on animal models and human pluripotent stem-cell derived cardiomyocytes and the theory of proximal mechanisms involving calcium handling and energy expenditure underlying HCM. The current review will also illustrate the pathogenicity of various associated genetic variants, genotype-phenotype correlation and the optimal approach to …