Nikhilkumar Patel

Aster Medcity, India

Title: Challenges in pacing in right ventricular endomyocardial fibrosis: A case study

Abstract

Endomyocardial fibrosis is estimated to be the most common and progressive form of restrictive cardiomyopathy worldwide. Apical filling with fibrotic tissue of one or both ventricles especially of right ventricle is the hallmark of EMF. Ventricular stiffness and atrioventricular valvular regurgitation results in atrial enlargement, resulting in atrial arrhythmias such as atrial fibrillation, which is the predominant arrhythmia in EMF, accounting for 30% of all cases, followed by junctional rhythm, heart blocks, and intraventricular conduction delay. Although EMF can result in sinus node dysfunction and tachyarrhythmias, complete heart block necessitating a pacemaker is rare. However, among patients with EMF who experienced sudden cardiac death, 15%–20% had documented advanced atrioventricular block or asystole.

Fibrosis in the targeted ventricle and tricuspid regurgitations often poses a challenge for transvenous pacing. Large right atrium and likely septal involvement on the endocardial aspect of the right ventricular side could be a concern for conduction system pacing.

In our report, we attempted to insert the pacemaker lead into the right ventricular apex and tried conduction system pacing in a case of sick sinus syndrome, but unfortunately, both were unsuccessful. We also encountered difficulties in placing the lead in the posterolateral vein owing to its small size. Eventually, the lead was placed in the superior branch of the middle cardiac vein, which led to diaphragmatic stimulation. Despite adjusting the electrical parameters, the patient continued to experience diaphragmatic stimulation. Hence, sensed atrioventricular delay was set at 350 milliseconds, which reduced the need for ventricular pacing. It is worth noting that her current electrocardiogram shows a first-degree heart block, which may require ventricular pacing in the future.

In situations like these, alternative pacing strategies, such as epicardial pacing is an option, but this comes with challenges owing to right ventricular failure and calcification in the epicardium or myocardium.

Biography

Dr. Nikhilkumar Patel, a distinguished medical professional, embarked on his journey in the realm of healthcare at BJ Government Medical College, Pune, (India) where he completed his MBBS in 2014. He completed MD in Internal Medicine from Dr. Vasantrao Pawar Medical College, Nashik, (India) in 2018. Equipped with a profound understanding of internal medicine, Dr. Nikhilkumar Patel honed his expertise as a Senior Resident at Nair Hospital, Mumbai, (India) contributing significantly to patient care and medical research. Eager to delve deeper into cardiovascular health, he pursued a DM in Cardiology at Amala Institute of Medical Sciences, Thrissur, (India) in 2022. He assumed the role of

Assistant Professor at Amala Institute of Medical Sciences, where he shared his knowledge with aspiring medical professionals. Alongside his clinical commitments, he has also made contributions to medical literature, with three publications in indexed journals, including one in the prestigious Heart Rhythm Society journal.Currently, he is further expanding his horizons through a Fellowship in Electrophysiology at Aster Medcity, Kochi, (India) solidifying his status as a leader in the field.

Dr. Nikhilkumar Patel's illustrious career is characterized by a relentless pursuit of excellence, unwavering dedication to patient care, and a commitment to advancing medical science.

4th International Conference on Cardiology

Nikhilkumar Patel

Title: Challenges in pacing in right ventricular endomyocardial fibrosis: A case study

Abstract

Biography

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