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All Journal Indonesian Journal of Cardiology
Hermanto, Dony Yugo
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Health Professions Medicine & Pharmacology

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Exploring Clinical and Echocardiographic Factors in EHRA Type 2 Atrial Fibrillation for Predicting Ischaemic Stroke: A Search for Unrevealed Insights Simbolon, Jessica Putri Natalia; Raharjo, Sunu Budhi; Santoso, Anwar; Liastuti, Lies Dina; Hermanto, Dony Yugo; Rossimaria, Vienna; Pritazahra, Armalya; Hanafy, Dicky Armein; Yuniadi, Yoga
Jurnal Kardiologi Indonesia Vol 44 No 3 (2023): Indonesian Journal of Cardiology: July - September 2023
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1562

Abstract

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia in adults. Valvular heart diseases (VHD), regardless of the arrhythmic problems, increase the risk of thromboembolism, which are even higher in those with associated atrial fibrillation. The EHRA (Evaluated Heartvalves, Rheumatic or Artificial) classification categorised AF patients with significant VHD into type 1 and type 2. Unfortunately, there are currently very limited data on risk prediction in stroke-related valvular AF, particularly in the Asian population. Aims: To investigate the clinical and echocardiographic risk factors for ischaemic stroke prediction in patients with EHRA type 2 VHD. Methods: This retrospective study enrolled 695 AF patients with EHRA type 2 VHD. The data were collected from patients' medical records who met the inclusion and exclusion criteria from 2015 until 2020. The primary outcome was ischaemic strokes within observation period. Results: There were 67 ischaemic stroke events (9,6%) of the total sample. Our analysis found that none of the analysed variables proved to be statistically significant risk factors in predicting the occurrence of ischaemic stroke. The median CHA2DS2-VASc risk prediction in the sample was 3, with an accuracy of AUC 0.502 (CI 95%; 0.429 – 0.576), sensitivity 56.7% and specificity 44.7%. Conclusion: Based on the parameters analysed in this study, no factor was statistically well-predictive to predict the ischaemic stroke incidence in EHRA type 2 VHD AF. In addition, the CHA2DS2-VAS accuracy was low in this population. Further exploration is needed to build an accurate ischaemic stroke risk prediction for EHRA type 2 VHD.This article has a related Erratum.
From Benign Origins to Final Moments: Right Ventricular Outflow Tract Premature Ventricular Complexes Culminating in Asystole on Holter Monitoring Raharjo, Sunu Budhi; Raj, Sai Vhimal; Pritazahra, Armalya; Hanafy, Dicky Armein; Hermanto, Dony Yugo; Yuniadi, Yoga
Jurnal Kardiologi Indonesia Vol 46 No 4 (2025): October - December, 2025
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1586

Abstract

Background: Premature Ventricular Complexes (PVCs) are a common cardiac arrhythmia typically of benign nature. Their origin, the right ventricular outflow tract (RVOT), is often a point of interest due to its implications in treatment strategies. While the vast majority of PVC RVOT cases remain uneventful, there are isolated incidents that challenge this common perception. Continuous monitoring methods, such as the Holter monitor, have provided invaluable insights into the real-world dynamics of arrhythmias, capturing rare events that can be of paramount clinical significance. Case Illustration: A 60-year-old female, presented to Harapan Kita Hospital Jakarta in May with palpitations. Over several visits, physical examinations consistently indicated a heart within normal parameters, absent of murmurs or gallop. Successive ECGs revealed persistent PVCs of RVOT origin. Despite medical intervention, her arrhythmic pattern persisted. By September, her symptoms had diversified, including occasional chest pain, nausea, and dyspnea. An ECG, yet again, confirmed PVCs with RVOT origin. During a Holter monitoring session on September, a distressing sequence of events was captured. The monitor initially registered a non-sustained Ventricular Tachycardia (VT). which escalated to sustained VT, ventricular fibrillation, and culminating in asystole, marking the patient's final moments. Conclusions: The pathophysiological journey from benign PVCs of RVOT origin to a fatal arrhythmic event underscores the unpredictability and inherent dangers of cardiac arrhythmias. This case is a reminder of the critical importance of persistent monitoring, timely interventions, and the nuanced understanding of conditions conventionally deemed 'benign'.
Exploring Clinical and Echocardiographic Factors in EHRA Type 2 Atrial Fibrillation for Predicting Ischaemic Stroke: A Search for Unrevealed Insights Simbolon, Jessica Putri Natalia; Raharjo, Sunu Budhi; Santoso, Anwar; Liastuti, Lies Dina; Hermanto, Dony Yugo; Rossimarina, Vienna; Pritazahra, Armalya; Hanafy, Dicky Armein; Yuniadi, Yoga
Jurnal Kardiologi Indonesia Vol 46 No 4 (2025): October - December, 2025
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.2022

Abstract

In “Exploring Clinical and Echocardiographic Factors in EHRA Type 2 Atrial Fibrillation for Predicting Ischaemic Stroke: A Search for Unrevealed Insights” (Indonesian Journal of Cardiology, 44(3), 87-94. https://doi.org/10.30701/ijc.1562), there is an error noted. An error has been found in the PDF version of this article. The DOI printed in the PDF is incorrect. The correct DOI is https://doi.org/10.30701/ijc.1562. The error occurs only in the PDF; the DOI listed in the article metadata is already correct.The publisher apologizes for any inconvenience caused by this error.DOI of original article: https://doi.org/10.30701/ijc.1562
Cardiac Resynchronization Therapy (CRT) Optimization: A Way Out for Non-Responders - A Case Report Damaiati, Nabila Edhiningtyas; Hermanto, Dony Yugo
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1469

Abstract

Background Non-responders account for 30% of patients receiving Cardiac Resynchronization Therapy (CRT). Optimization of CRT using Electrocardiographic (ECG) and Transthoracic Echocardiographic (TTE) guidance has been proposed as a strategy to enhance therapeutic efficacy in this subset. This case report presents a young female patient with advanced heart failure secondary to ischemic cardiomyopathy, highlighting the role of ECG- and TTE-guided CRT optimization in improving clinical and hemodynamic outcomes. Case Illustration A 37-year-old female presented with advanced heart failure. Her medical history was notable for recurrent episodes of acute coronary syndrome, multiple Percutaneous Coronary Interventions (PCIs), and Cardiac Resynchronization Therapy with Pacemaker (CRT-P) implantation, despite adherence to Guideline-Directed Medical Therapy (GDMT). On admission, the ECG demonstrated atrial sensing with consistent biventricular pacing. Laboratory evaluation revealed an elevated N-terminal pro–B-type natriuretic peptide (NT-proBNP) level of 5.462 pg/mL. TTE showed a severely reduced Left Ventricular Ejection Fraction (LVEF) of 20% and an absent A wave on mitral inflow Doppler, indicating impaired diastolic filling. Additionally, the Left Ventricular Outflow Tract (LVOT) Velocity Time Integral (VTI) was reduced to 7.4 cm, consistent with low forward stroke volume.Six months after the implantation, CRT optimization was performed using ECG and TTE guidance. Optimization resulted in a reduction of QRS duration to 129 ms, distinct separation of the mitral inflow E and A waves, an increase in LVOT VTI to 10.9 cm, and an improvement in functional capacity to New York Heart Association (NYHA) class III. Conclusion CRT optimization, guided by ECG or TTE, is critical in managing non-responders. In this case, it led to improved QRS duration, hemodynamics, and NYHA functional class. Routine reassessment should be considered in patients with persistent symptoms despite optimal GDMT to enhance clinical response.
Co-Authors Anwar Santoso Damaiati, Nabila Edhiningtyas Dicky Armein Hanafy Liastuti, Lies Dina Pritazahra, Armalya Raj, Sai Vhimal Rossimaria, Vienna Rossimarina, Vienna Simbolon, Jessica Putri Natalia Sunu Budhi Raharjo Yoga Yuniadi