1st Live Case

Potential conflicts of interest

▪ I have the following potential conflicts of interest to report:

Devdas Inderbitzin

Received educational grant from St. Jude Medical

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)

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

ECG

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

TTE

TTE

CT Scan

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

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

Question

What would be the best treatment?

Lets connect to our colleagues treating the patient …

&

… discuss the options.

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