Efficacy of cryoablation in idiopathic and non-idiopathic atrial fibrillation patients.

OBJECTIVES AND BACKGROUND: Studies assessing the unicentric and prospective comparison of efficacy of cryoballoon pulmonary vein isolation in idiopathic and non-idiopathic atrial fibrillation (AF) patients are missing. The aim of this study was to compare a single procedural outcome in these subgroups of AF patients. METHODS: A total of 208 patients with drug resistant AF were included in this study. Among them, 36 patients had idiopathic AF and 172 patients had non-idiopathic AF. The efficacy endpoint was freedom from any atrial arrhythmia lasting >30 s after a 3-months blanking period. RESULTS: The freedom from atrial arrhythmias without antiarrhythmic drugs after 1 and 3 years of follow-up, respectively, was 85.2 % and 70.4 % in patients with idiopathic AF; and 64.6 % and 39.9 % in patients with non-idiopathic AF (p=0.021). Moreover, the success rate when analysing only paroxysmal AF patients after 1 and 3 years of follow-up, respectively, was 95.7 % and 82 % in patients with idiopathic AF; and 72.6 % and 47 % in patients with non-idiopathic AF (p=0.022). CONCLUSIONS: A single cryoballoon pulmonary vein isolation was more effective in preventing atrial arrhythmias relapses in idiopathic AF patients compared to non-idiopathic AF patients. The best efficacy outcomes were observed in patients with paroxysmal idiopathic AF (Tab. 5, Fig. 2, Ref. 25).

Retrospective study assessing efficacy and safety of left atrial appendage occlusion.

OBJECTIVE: To describe the initial experience with Amplatzer Amulet in left atrial appendage occlusion in Slovakia. To evaluate procedural efficacy and safety. BACKGROUND: Atrial fibrillation increases the risk of stroke. While anticoagulation therapy can reduce the risk of stroke, it is associated with bleeding risk and often unsatisfactory prescribed. Most thrombi form in the left atrium appendage, hence left atrium appendage occlusion may be a suitable therapeutic alternative for these patients. METHODS: This is an observational, retrospective, single-centre, case-series study including 30 patients with atrial fibrillation at a high risk of stroke, undergoing left atrial appendage occlusion from June 2015 to December 2018. RESULTS: The left atrial appendage was successfully closed in 29 (96.7 %) patients. Three months after the procedure, 4 patients had small leaks (< 2 mm). No complications were reported so far. Prior to the procedure, patients mostly received low molecular weight heparin (53.3 %). Three months after the procedure, patients mostly received acetylsalicylic acid (60.7 %) and clopidogrel (32.1 %). CONCLUSION: Left atrial appendage occlusion was shown to be an effective and safe alternative to anticoagulation therapy in patients with atrial fibrillation, at a high risk of stroke and bleeding. The procedure is safe, when performed carefully even by less experienced cardiologists (Tab. 6, Fig. 4, Ref. 29). Text in PDF www.elis.sk Keywords: atrial fibrillation, stroke, haemorrhage, left atrial appendage occlusion, Amplatzer Amulet.

Catheter ablations of supraventricular tachycardias.

BACKGROUND: Supraventricular tachycardias (SVT) occur at all ages. Their spectrum as well as tolerance change with increasing age. OBJECTIVES: The aim of our study was to assess the course of SVT catheter ablations in elderly patients when compared to younger population. METHODS: The course of the SVT radiofrequency catheter ablation (RFCA) in the group of 288 patients, who underwent catheter ablation at our department during 24 months was retrospectively evaluated. Patients were divided into two subgroups according to age. In the first group 142 patients younger than 65 years were included and 146 patients aged 65 years or more in the second group. In both groups, the occurrence of heart rhythm disorders, fluoroscopy time and the incidence of complications with varying severity were observed. RESULTS: Life-threatening complications were observed only in three patients from the first group (one pulmonary embolism and two unintended complete atrioventricular blocks). Serious complications included a haemopericardium requiring a pericardial drainage in two cases and an arterial-venous fistula in one patient in the first group, and one retroperitoneal heamatoma in the second group. Minor complications represented by one heamatoma larger than 5x5cm occurred in one patient from each group. The occurrence of complications as well as average fluoroscopy time were not correlated between the groups. CONCLUSION: Based on our experience, radiofrequency catheter ablation of SVT in elderly patients is a safe procedure when indicated correctly. Taking into account the physical status of patients in this age group it is advisable to simplify and thus shorten the procedure (Tab. 1, Ref. 13). Full Text in PDF www.elis.sk.

Cryothermal ablation of typical atrial flutter.

OBJECTIVES: To evaluate the efficacy and safety of cryoablation compared with the radiofrequency (RF) method in the treatment of typical atrial flutter (AFL). METHODS: 12 patients with typical counterclockwise AFL underwent cryoablation of the cavotricuspid isthmus. Cryoablation was performed with a 9F catheter with an 8 mm tip electrode. Applications were delivered by point-by-point technique to create the ablation line. The end point of the procedure was achievement of bidirectional isthmus conduction block. Control group consisted of 12 consecutive patients who underwent the ablation by means of RF method. RESULTS: We found no differences in the duration of transisthmic conduction after ablation in both groups and in the fluoroscopy time. We found significant differences in the procedural time (187 +/- 81 vs 110 +/- 35 minutes, p<0.01) and in the analgesic use (0/12 vs 12/12, p<0.01). After a 3 month follow-up all patients in both groups were free from the recurrence of AFL, 1 pacient in cryoablation group had paroxysm of atrial fibrillation. CONCLUSIONS: Efficacy and safety profile of cryoablation are similiar with RF ablation. Procedural time in the cryoablation group is significantly longer but the use of analgesics can be completely avoided (Tab. 2, Ref. 20). Full Text (Free, PDF) www.bmj.sk.

The effect of myocardial revascularization on malignant ventricular arrhythmias in coronary artery disease.

BACKGROUND: Malignant ventricular arrhythmia in coronary artery disease (CAD) is a severe life-threatening disease and a risk factor for sudden cardiac death. Myocardial revascularization influences the arrhythmogenic substrate of the malignant ventricular arrhythmia in the secondary prevention of sudden cardiac death. Its effectivity remains controversial. OBJECTIVES: The aim of this study is to assess the inducibility of sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) in patients after myocardial revascularization and to compare the effectivity of complete and incomplete revascularization. PATIENTS: Fifty patients with documented sustained VT or VF and CAD were examined in our department. RESULTS: Conservatively treated patients were significantly older than revascularized patients (68 +/- 8 versus 62 +/- 9 years, p<0.05). We registered a trend towards a lower inducibility of malignant ventricular arrhythmias in the revascularized group and completely revascularized subgroup, but without statistical significance. Incompletely revascularized patients comprised only of men (100% versus 66.6%, p<0.05). Fewer ICDs were implanted in the completely revascularized group (55.6% versus 92.3%, p<0.05). CONCLUSION: Myocardial revascularization has little effect on the inducibility of malignant ventricular arrhythmias after myocardial revascularization. Complete revascularization significantly decreases the need of ICD implantation when compared to incomplete one (Tab. 3, Fig. 4, Ref. 24). Full Text (Free, PDF) www.bmj.sk.

[Early haemodynamic changes after radiofrequency ablation of the atrioventricular junction]. / Vcasné hemodynamické zmeny po rádiofrekvencnej ablácii predsienovokomorového spojenia.

INTRODUCTION: The effect of radiofrequency ablation of the atrioventricular junction may be accompanied by undesired effect of right ventricular stimulation. The objective of the study was to evaluate early haemodynamic effects of catheter ablation in patients with permanent atrial fibrillation resistant to pharmacotherapy. METHOD: The study included 19 patients aged 66.9 +/- 12.4 years on an average. Depending on the basal ejection fraction (EF), we divided the patients in to two groups (the 1 st group patients had EF less than 50 %, the 2nd group patients had EF equal to 50 % or higher). The patients were underwent radiofrequency ablation of the atrioventricularjunction and a pacemaker implantation. Haemodynamic changes were evaluated by measuring the ejection volume (EV) and the minute volume (MV) using echocardiography basally prior to and after the intervention, at different stimulation frequencies. For a more precise evaluation of the patients' condition, we defined the EVi am MVi indices as the ratio between the above values at different stimulation frequencies and the basal value. OUTCOME: EV in patients with a low EF increases at all stimulation frequencies with the maximum effect observed in the frequency band from 60-100/min. At stimulation frequency of 60/min, the volume increased from 26.4 ml before ablation to 39.5 ml after ablation. MV grows or remains unchanged at all frequencies except for 60/min, at which the growth in EV cannot compensate the drop in MV due to a fall in frequency. Patients in the 2nd group had a high EV value (52.3 ml) before ablation. After the intervention, their EV increased only at stimulation frequency of 60 and 80/min (64.0 and 55.1 ml, respectively). Also these patients' MV was high before ablation (6,097 ml). After the intervention, their MV decreased for all stimulation frequencies, but showed a growing tendency. Statistical evaluation showed negative correlation between EVi and MVi on the one hand, and between EF and the average of the left ventricle in systole on the other. CONCLUSION: Our results have shown that radiofrequency transcatheter ablation of the atrioventricular node (RFCA AVN) is beneficial for certain patients in both the groups, even though the mechanisms of improving their clinical condition are different.

[Trends in indications for permanent cardiac pacing therapy at the Cardiac Pacing Center in Eastern Slovakia 1978-1994]. / Vývoj indikácií trvalej kardiostimulacnej liecby v kardiostimulacnom centre východného Slovenska v rokoch 1978 az 1994.

At the Third Medical Clinic, which acts as a cardiostimulation centre for the eastern Slovak area, in 1978 to 1994 1 581 primary implantations and 996 reimplantations of pacemakers were made. In the group of primary implantations the mean age of patients was 70.7 +/- 10.9 years, the male/female ratio was 850/731. In the group of reimplantations the mean age was 71.3 +/- 11.6 years, incl. 483 men and 513 women. There is an almost linear rise of primoimplantations. In the group of reimplantations we can observe a two-peak shape of the curve with a maximum in 1986 and in 1990. While in 1978 atrioventricular block grade III accounted for almost 90% indications for primary implantations, during subsequent years its ratio declined gradually and at present it has reached a steady level of 30-40%. The second most frequent dysrhythmia in the group is dysfunction of the sinoatrial node which in 1978 accounted for 6% of the indications, while in 1994 it accounts for 28% of the primary implantations. In 1978 only non-programmable pacemakers VVI/V00 were implanted. In 1989 on a wider scale multiprogrammable ventricular single electrode systems VVIM were introduced which in 1994 accounted for 58% of the implanted pacemakers. Stimulation with adaptable frequency (VVIR, AAIR) and physiological stimulation of two cavities incl. VDD stimulation accounted for 42% in 1994. It can be summarized that during the last five years marked extension of physiological stimulation occurred with an opportunity to select the optimal mode of stimulation, to increase reliability and keeping qualities of the implanted pacemakers and to improve the perspectives of patients needing cardiostimulation therapy.

[Ultrasonic indicators of left ventricular function and elasticity of large vessels in newly diagnosed hypertensive patients]. / Ultrazvukové ukazovatele funkcie l'avej komory a poddajnosti vel'kých ciev u novozistených hypertonikov.

The authors investigate the degree of alteration of large vessels in newly detected not treated hypertension, using a series of non-invasive indicators of vascular function and their association with selected parameters of systolic and diastolic left ventricular function in a group of 23 hypertonic patients and 23 subjects with normal blood pressure. The mean age of the examined subjects was 51.1 +/- 16.6 years. In the echocardiographic indicators a significant difference was found between the groups as regards the weight of the LV and in the ratios of amplitudes and time integrals of waves E and A of the Doppler record of transmitral flow. Comparison of functional and morphological indicators of large vessels revealed significant differences between groups as regards tension in the aortic arch, value of the elastic module (EMp), rate of pulse wave (RPVcf) and relative systolic rate of the arteriovelocitogram. Correlation analysis revealed positive relations between age, blood pressure and weight of the LV on the one hand and EMp, diameter of the femoral artery and RPVc on the other hand. The ratio of E/A waves and their time integrals displayed the same correlation with the pulse change and the tension of the aortic arch, with the peak and relative systolic rate of the arteriovelocitogram and a negative correlation with the EMp values. These results provide evidence of a reduced elasticity of the large vessels in the group of newly detected hypertonics, associated with left ventricular hypertrophy and a reduction of its diastolic function. This finding implies the necessity to focus treatment not only on normalization of blood pressure readings but to consider also other components of the hypertensive syndrome.

[Factors affecting the vulnerability of the left atrium during rapid transesophageal atrial stimulation]. / Faktory ovplyvnujúce vulnerabilitu l'avej predsiene pri rýchlej transezofageálnej stimulácii predsiení.

Atrial fibrillation (AF) is associated with a higher morbidity and mortality because of the risk of systemic or pulmonary embolism as well as the negative impact on cardiac function. The authors investigate in the submitted paper factors influencing the vulnerability of atria during transoesophageal atrial stimulation (TESP). The group comprised 68 patients with a sinus rhythm, mean age 56.9 +/- 17.9 years. Depending on the response to rapid atrial stimulation, the patients were divided into three groups. In group I (small disposition to AF) they revealed a significantly lower age, the relative thickness of the left ventricular wall assessed by echocardiography and the dimension of the left atrium, as compared with groups with a medium increased (II) and high disposition (III) for AF. In group III hypertonic changes on the fundus were found more frequently, as well as anamnestic data on hypertension, diabetes and pathological values of the recovery period of the sinoatrial node. At the same time significantly lower values of the rate of the E wave were observed and of the ratio of amplitudes and E/A integrals from the Doppler record of the mitral valve. The weight of the left ventricle and its index by groups increased, however the changes did not attain statistical significance. Indicators of left ventricular systolic function did not differ. The authors conclude that the main independent factors which determine the response to provoked AF by the TESP method are the diastolic left ventricular function documented by the Doppler method, the diameter of the left atrium, the automation of the SA node. Less important factors are left ventricular hypertrophy and age.(ABSTRACT TRUNCATED AT 250 WORDS)

[Non-invasive tests in the diagnosis of sinoatrial node dysfunction]. / Moznosti vybraných neinvazívnych testov v diagnostike dysfunkcie sinoatriálneho uzla.

The authors present a group of 67 patients, mean age 63 +/- 15 years, where they applied on account of suspected dysfunction of the sinoatrial node (SA) the atropine test (AT), 24-hour Holter monitoring and transoesophageal stimulation of the atria (TESP). The objective of the investigation was to test the reliability and yield of the mentioned methods and to investigate more closely the relations of their final indicators. Correlation analysis revealed a positive relationship between the maximal frequency during AT and the mean daily (r = 0.553, p < 0.001) and minimal frequency during Holter monitoring (r = 0.349, p < 0.0025). The recovery periods of the SA node were negatively related to the mean, minimal and maximal frequency during Holter monitoring. The relative rise of SF during the atropine test did not correlate with any Holter parameter nor with the recovery periods of the SA node. The length of the pause (Holter) did not correlate with any of the evaluated parameters. Based on the mentioned findings, the authors conclude that the diagnostic value of the mentioned non-invasive tests, when used separately, is limited but increases when the tests are combined.