If “Hold to Test” pressed and released prior to first voltage decrement, the programmer may continue the Decrement Test instead of terminating the test.
Device: Abbott: Merlin™ Patient Care System (PCS) Software Model 3330 v25.0.X–v25.3.X
GTIN 05414734509725
When used with: Abbott Gallant™, Neutrino™ NxT, Entrant™ devices
TGA Reference:
Australian Register of Therapeutic Goods (ARTG): 124262
The status of cardio-oncology services in Australia through an online multi-disciplinary survey.
Read the article published in the Internal Medicine Journal, by Prof Kazuaki Negishi, senior author, that assesses the status of cardio-oncology services in Australia through an online multi-disciplinary survey.
Read summary in full and link to article on WileyOnline from the Internal Medicine Journal (IMJ).
The interaction between physical activity, our genome and cardiac structure is complex. Emerging evidence suggests functional capacity and cardiac size play a critical role in the development of heart failure and atrial fibrillation – both key causes of illness and health expenditure. Extremes of activity, from a sedentary lifestyle to endurance athletes, can impact heart structure and function and risk of arrhythmias. The sedentary end of the spectrum is associated with smaller stiffer hearts, poor exercise capacity and cardiovascular risk factors including type 2 diabetes and obesity. Through in-depth assessment of clinical, imaging and genetic factors that influence low exercise capacity and atrial fibrillation, this research project aims to identify novel and simple ways to detect people in this high risk population. Using the largest and most comprehensive cohort of cardiac, exercise and genetic metrics world-wide, we will also develop an understanding of the interaction between physical activity, cardiac structure and genetics by assessing how a person’s genetic signature impacts the heart’s ability to remodel in response to exercise.
Our aim is to identify and better understand clinical and genetic predictors of low exercise capacity and atrial fibrillation. Our hypothesis is that small cardiac size can be used to identify people with poor exercise capacity due to reduced cardiac reserve and that polygenic risk scores can predict those who are genetically primed to have low exercise capacity and atrial fibrillation.
Aim 1: Determine clinical and imaging markers which predict poor exercise capacity and atrial fibrillation.
Aim 2: Identify genetic traits associated with small hearts, poor exercise capacity and cardiac atrophy.
Aim 3: Assess the relationship between genes, physical activity, and heart structure and how they impact one another.
This project will generate highly clinically relevant knowledge with clear benefits to Australian clinical practice. Current health interventions are directed at those diagnosed with disease, but there is a crucial window of opportunity in preventing disease. By identifying markers predictive of exercise capacity, we will be able to identify individuals at greatest risk of heart failure and arrhythmias – both key causes of illness and health expenditure. By evaluating the relationship between our genome and exercise capacity we will identify to what extent the sedentary population may be genetically primed to be non-responders to exercise. The use of a cheap genetic test to anticipate response to therapy would be a considerable advance in individualized care. This research will lead to improvement in individualized risk assessments and early interventions to reduce population cardiac morbidity and mortality.
PREDICT-STROKE is a randomised, multicentre trial to evaluate the potential benefits of aggressive risk factor modification versus standard of care to prevent major adverse cardiovascular events in patients with an embolic stroke or transient ischaemic attack.
Stroke is a major contributor to cardiovascular morbidity and mortality, resulting in lost quality of life, economic productivity, and health expense. Approximately one third of all strokes are attributable to atrial fibrillation, and a further third are cryptogenic (without known cause). Most cryptogenic strokes are subclassified as embolic stroke of undetermined source (ESUS). Approximately 3/10 patients with ESUS will be diagnosed with AF with prolonged monitoring.
Atrial cardiomyopathy is a relatively novel concept which encompasses pathological changes in the left atrium leading to the development of AF, or atrial thrombus and cardioembolism (potentially in the absence of AF). Multiple known factors influence atrial cardiomyopathy, and these include hypertension, obesity, diabetes, sleep apnoea and systemic inflammation.
We aim to test the hypothesis that aggressive management of these factors in a patient- specific fashion will prevent recurrent clinical and radiological embolic stroke.
The primary aim of the study is to investigate for patients with embolic stroke or transient ischaemic attack, whether the risk of major adverse cardiovascular events (including recurrent embolic stroke) can be modified by aggressive risk factor prevention.
For the diagnosis of atrial cardiomyopathy, invasive electroanatomical atrial mapping is known to demonstrate electrical atrial scar and regions of low voltage – the characteristic electrical changes of atrial cardiomyopathy. We aim to show that a multielectrode vest used to perform electrocardiographic imaging (ECGi) will correlate with invasive electroanatomical atrial mapping, predicting its extent and assist in stratifying risk of future atrial fibrillation.
We hypothesise that aggressive risk factor modification will reverse atrial cardiomyopathy, and that serial ECGi mapping will be able to demonstrate concordant longitudinal changes.
Systemic inflammation is closely related to the risk of developing AF, as shown by its relationship to multiple biomarkers of inflammation. We aim to investigate the relationship between these biomarkers and the extent of atrial cardiomyopathy as diagnosed by ECGi.
The primary potential benefit of this study is the identification of directed therapy for secondary prevention of embolic stroke of undetermined source. More generally, we expect a reduction in cardiovascular disease, which will provide individual patient benefit. With risk factor modification, we anticipate a group-level effect in weight reduction, blood pressure management and lifestyle improvement, which each have public health benefits for reduced incidence of atherosclerotic cardiovascular disease and improved mental health.
A clinically significant reduction in the primary endpoint of the study would translate to reduced hospitalisations, preserved quality of life, preserved cognitive function, freedom from physical disability and overall reduced healthcare expenditure.
The current picture of young peoples’ health in Australia is alarming with escalating health risks such as poor diet, physical inactivity, increased screen time and poor mental health becoming widely prevalent. These health risks can lead to chronic health problems such as heart disease in adulthood. Australia’s 3.3 million teenagers have little support to manage these health risks and accessible, engaging programs that support a healthy lifestyle are urgently needed. My innovative Health4Me program will strive to solve this problem. We know that text message healthy lifestyle programs in adults have improved health outcomes and resulted in positive behaviour change. Over the next 3 years, I will lead a research project that will develop and test an engaging healthy lifestyle program for teenagers using text messages, a method through which they communicate every day. I will work with teenagers to co-create the Health4Me program using an established process. I will test how effective Health4Me is in a randomised clinical trial (330 teenagers) and evaluate if the program improves physical and mental health outcomes, whether it is acceptable and engaging and if the program can be embedded into the Australian healthcare system. If it helps, it can be scaled up to deliver to teenagers throughout Australia to improve health outcomes.
Aortic stenosis is the most common heart valve disease. It is characterised by a complex interplay between the aortic valve and the heart muscle (ventricular) function, making diagnosis and treatment timing challenging. Although replacement of the aortic valve has improved the prognosis of this condition, the current recommendations for the timing of replacement are associated with a highly advanced disease state and oftentimes sub-clinical heart muscle dysfunction, which is not only likely irreversible, but also portends a worse prognosis. It is possible that there may be a significant advantage to aortic valve intervention prior to the end-stage disease state which currently forms the basis for guideline recommendations. In the proposed doctoral research, we aim to better predict the response to therapy in aortic stenosis and identify factors associated with a favourable response to aortic valve intervention, such that we can help individualise treatment for patients and improve survival.
In celebration of International Women’s Day last month, we are delighted to showcase women with diverse backgrounds and varied experiences spanning the professional cardiology spectrum in Australia and New Zealand.
Four Cardiac Society women share their career journeys, challenges and thoughts on diversity and inclusion…we hope you find their stories inspiring.
The new temporary Medicare Benefits Schedule (MBS) item for use during thallium-201 (Tl-201) supply disruptions was implemented on 1 April 2022.
Item 61644 is a direct substitute of item 61325 and enables the use of FDG PET in place of Tl-201 for cardiac viability testing when Tl-201 is unavailable.
The item will be available from 1 April 2022 until 30 September 2022. (See Factsheet Summary below):
Factsheet – substitute PET item for use during thallium-201 supply shortage.
Summary by Alex Voskoboinik
Syncope is a common presentation encountered by physicians in both the acute and ambulatory setting, and is a frequent presentation in the elderly population. While syncope is frequently encountered by cardiologists, the diagnostic approach to identify cardiogenic syncope can be varied, challenging and resource intensive, and may involve a multitude of investigations including tilt table testing and use of implantable loop recorder. While clinical and electrophysiologic features suggestive of cardiogenic syncope have been well-demonstrated in contemporary literature, there is an absence of a simple syncope risk score readily accessible to clinicians to assist in identifying cardiogenic syncope and subsequent requirement for permanent pacing. Current syncope risk scores, such as the San Francisco Syncope Rule and EGSYS score have not been validated for use outside the Emergency Department.
In this study of 100 consecutive patients receiving implantable loop recorder, 50 of whom underwent pacemaker insertion due to bradyarrhythmias detected on implantable loop recorder and 50 of whom did not have any arrhythmias detected for >3 years, four significant predictors of bradycardic syncope were identified. These were incorporated into the DROP score: Distal conduction disease, Related historical predisposing or precipitating factors absent, Older age >65 years and PR interval prolongation >200ms. Of significance, higher DROP scores strongly predicted requirement of permanent pacing in time-to-event analysis. The DROP score may be of benefit in identifying patients that are likely to benefit from upfront pacemaker insertion following unexplained syncope.
Xiaoman Xiao, MBBS; Jeremy William, MBBS; Peter M. Kistler, MBBS, PhD; Stephen Joseph, MBBS, PhD; Hitesh C. Patel, MBBS, PhD; Gautam Vaddadi, MBBS, PhD; Jonathan M. Kalman, MBBS, PhD; Justin A. Mariani, MBBS, PhD; Aleksandr Voskoboinik, MBBS, PhD.
Published: March 31, 2022 DOI:https://doi.org/10.1016/j.hlc.2022.03.002
New and amended MBS items will be introduced in July and November, 2022 including:
See summary details here MBS changes July and November 2022.pdf
Factsheets and a Quick Reference Guides will be made available shortly at: www.mbsonline.gov.au and under the Fact Sheets tab.
A 25 year-old male with no past history presents with palpitations.
What is the most likely diagnosis? Why are there two QRS morphologies?
This is a ‘regularly irregular’ narrow complex tachycardia (hence not AF). There are clear p-waves marching through (with more A’s than V’s) with an isoelectric interval between them suggestive of a focal atrial tachycardia (blue arrow), particularly in the absence of structural heart disease. The p waves are inferiorly directed, suggesting they are coming from the top of the atria. In this case, there is Wenckebach conduction down the AV node (3:2 ratio) with progressive PR prolongation before a dropped beat. The change in QRS morphology is due to Ashman phenomenon – this is aberrant ventricular conduction affecting the distal conduction system due to a change in QRS cycle length, and it can be seen in any supraventricular arrhythmia. It is usually described as a wide QRS complex that follows a short R-R interval preceded by a long R-R interval (L – long, S – short in Figure). I occurs because the action potential duration (and hence refractory period) changes with the preceding R–R interval. A longer cycle lengthens the ensuing refractory period, and if a shorter cycle follows, the beat terminating the cycle tends to be conducted with aberrancy. The patient underwent catheter ablation of a focal tachycardia arising near the crista terminalis / SVC region.
Summary by Paul Bridgman
Louise Cullen et al; Heart, Lung and Circulation
Cullen and colleagues have previously reported that the IMPACT (The Improved Assessment of Chest Pain Trial) protocol can safely and efficiently allow a large proportion of general patients presenting to EDs with chest pain to undergo accelerated assessment for low, intermediate or high risk of an acute coronary syndrome (ACS).1 After risk assessment, and 2-hour serial troponin results, those deemed at low-risk could be safely discharged without further objective assessment.
Now, working with support from local Aboriginal and Torres Strait Islander Health Community-Controlled Health Organisations (ATSICCHOs), Cullen and colleagues have confirmed that the IMPACT pathway can also be safely implemented for patients of Aboriginal and Torres Strait Islander origin.2
In this trial, high and intermediate risk was managed according to the IMPACT pathway, but low-risk patients had additional cardiac testing in line with the National Heart Foundation/Cardiac Society of Australia and New Zealand 2016 guidelines for the management of ACS.3
Conducted in the Emergency Department of Cairns Hospital, Queensland between November 2017 and December 2019, the trial recruited 155 patients, classified as 11.6% low-risk, 56.1% intermediate-risk and 32.3% high risk for ACS. All patients with ACS were identified on their index admission. None of the patients assessed as low risk of ACS had any evidence of coronary artery disease from objective testing, and none had adverse cardiac events within 30 days of presentation. However, a high burden of cardiovascular risk factors was noted in this cohort.
The research found higher rates of ACS and at a younger age compared with the first IMPACT trial. It also found a high proportion of females with ACS (male, 38.1%). The authors state these findings should not only inform clinicians but also direct public health campaigns to better target those at risk.
1. Med J Aust 2017; 207 (5): 195-200.
2. Heart Lung Circ 2022; DOI: https://doi.org/10.1016/j.hlc.2022.02.010
3. Heart Lung Circ 2016; 25:895-951.
By Paul Bridgman 23 March 2022
It has been long debated whether the cause for stress cardiomyopathy is in the brain, the heart, or even perhaps in the connection between the two. A cardinal feature of the cardiomyopathy is QT prolongation, onset shortly after the precipitating event and then worsening over an average of three days before resolving. Published this week in PLOS One, a randomised control trial seeks to establish whether women who have recovered from stress cardiomyopathy show any increased susceptibility to QT prolongation with repeated exposure to emotional stress.
The trial included 12 women with a history of the condition and 12 controls without major cardiovascular disease. On two separate occasions, these women had 24-hour ECGs recorded with a holter monitor and were either subjected to a stress-inducing hyperventilation exercise or a calming diaphragmatic breathing exercise.
The trial showed that heart rate increases, and that QTc prolongs in response to the stress. The QT prolongation persisted for 20 minutes. As a secondary purely emotional stressor unheralded phone calls were made to the participants during the trial with similar results, there was no difference in response between cases and controls. While the trial showed that the QT interval is labile and strongly affected by emotion, there is nothing intrinsically different in response between the patients and the controls. Reassuringly, there was no evidence that the cases carried a background alteration in QT sensitivity.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0265607
Authors: Watson GM, Sutherland J, Lacey C, Bridgman PG (2022)
