[Long-term outcome of catheter ablation therapy of supraventricular tachyarrhythmias]. / Dlouhodobé výsledky katetrizacní ablacní lécby u supraventrikulárních tachyarytmií.

AIM: The aim of the article is presentation of our results and experiences with radiofrequency catheter ablation (CA) in the therapy of supraventricular tachyarrhythmias. PATIENTS AND METHODS: From 1996 to 2009, 1 485 patients underwent CA (total procedure number - 1 627). The group consist of 772 patients with paroxysmal atrioventricular nodal reentry tachycardia (AVNRT): 484 women, mean age 50.3 +/- 16.4 years; 312 patients with atrioventricular reentry tachycardia (AVRT): 145 women, mean age 40.1 +/- 14.9 years; 391 patients with typical atrial flutter (AF): 96 women, mean age 61.6 +/- 11 years; and 64 patients with atrial tachycardia (AT): 35 women, mean age 53.6 +/- 14.2 years, focal AT 33, macroreentrant AT 31. CA was performed for more than one type of arrhythmia in 54 patients. RESULTS: Acute ablation success was achieved in 98.7% of patients with AVNRT, 94.6% of patients with AVRT, 97.7% of patients with AF, and 81.3% of patients with AT. Serious procedure complications occurred in 22 patients (1.4%). The recurrence rate was 1.8-12.5%. 88 patients underwent successful reablation procedure. Long-term ablation success was achieved in 89-99% of patients depending on the different type of arrhythmia. During the long-term follow-up (mean 73 +/- 38 months) died 23 patients, the most common cause of death was malignancy (9 patients). CONCLUSION: Our long-term experience and good results documented high success rate and safety of radiofrequency catheter ablation in the therapy of patients with supraventricular tachyarrhythmias.

[Improvement of quality of life after ablation of longstanding persistent versus paroxysmal atrial fibrillation: results of 2-year follow-up]. / Zlepsení kvality zivota po ablaci dlouhodobe perzistentní versus paroxysmální fibrilace síní: výsledky dvouletého sledování.

AIMS: The purpose of the study was to assess quality of life and socio-economic parameters in patients after ablation of paroxysmal versus longstanding persistent atrial fibrillation (AF). METHODS: The study included 89 patients with paroxysmal AF and 56 patients with longstanding persistent AF who underwent ablation within 1 year, and were afterwards prospectively followed up for 2 years. Quality of life was evaluated by the EQ-5D questionnaire before and every 6 months after ablation. RESULTS: Objective, respectively subjective quality of life at baseline was lower in patients with longstanding persistent AF (67 +/- 16 vs 71 +/- 10; p = 0.01, resp. 64 +/- 12 vs 67 +/- 16; p = 0.07); however, after 2 years, it exceeded that of the patients with paroxysmal AF (80 +/- 17 vs 75 +/- 18; p = 0.03; resp. 73 +/- 13 vs 70 +/- 17; p = 0.18). The baseline-2 year difference in improvement was higher in patients with longstanding persistent AF in both objective (p = 0.001) and subjective component (p = 0.05). Both groups displayed significant decrease in the days of hospitalization, and the days of working incapacity. CONCLUSION: Patients with longstanding persistent AF exhibit worse baseline quality of life than the patients with paroxysmal AF, and higher quality of life improvement after ablation.

High-sensitivity troponin T as a marker of myocardial injury after radiofrequency catheter ablation.

BACKGROUND: The aim of our study was to monitor radiofrequency catheter ablation-induced myocardial damage by measuring high-sensitivity cardiac troponin T (hs-cTnT). METHODS: Serum concentrations of hs-cTnT (Elecsys 2010 system, Roche) were measured in 73 healthy blood donors and serially in 27 patients who had samples taken both before and 24 h after radiofrequency ablation (RFA) for atrioventricular nodal re-entry tachycardia (AVNRT), atrial fibrillation (AF) or right atrial flutter (AFL). RESULTS: Significant increases of hs-cTnT were seen in patients after RFA (AVNRT: P = 0.0115, AF: P = 0.0011, AFL: P = 0.0009). Postprocedural serum hs-cTnT correlated with the number of radiofrequency applications and with the duration of RFA procedure. Spearman's coefficient of rank correlation (r) were as follows: hs-cTnT versus RFA duration: r = 0.771 (P < 0.001); hs-cTnT versus number of pulses: r = 0.708 (P < 0.001). Patients with the diagnosis of AVNRT had lower serum hs-cTnT concentration after RFA compared with AFL (P < 0.0001) and AF (P < 0.0001) patients. CONCLUSIONS: Our data indicate that RFA causes a significant increase of serum hs-cTnT concentration that could be used to monitor myocardial injury.

Diurnal variation of 6beta-hydroxycortisol in cardiac patients.

The 24-hour urinary excretion of 6-beta-hydroxycortisol (6beta-OHC) and the urinary ratio of 6beta- hydroxycortisol/cortisol (6beta-OHC/UFC) have been proposed as noninvasive probes for human cytochrome P450 3A4 isoform (CYP3A4). In this study, we evaluated within- and between-day variability of 6beta-OHC excretion and 6beta-OHC/UFC ratio in nine Caucasian men with cardiac disease. Each study participant was asked to collect 24-hour urine specimens during four consecutive days in five standardized time intervals. Concentrations of UFC and 6beta-OHC were determined by immunoassay and the high-performance liquid chromatographic (HPLC) method, respectively. The HPLC method was accurate and precise, as indicated by the recovery rate of 96.5-103.3 % and less than 5.2 % and 6.3 % of the coefficient of variation for within-run and between-run assay, respectively. In patients, diurnal variations in UFC and 6beta-OHC excretion were parallel. Consequently, 6beta-OHC/UFC ratio remained stable during the day. Both, 6beta-OHC excretion and 6beta-OHC/UFC ratio showed significant relationship between 24-hour value and values measured in corresponding collection periods with best correlations obtained from night interval (22.00-06.00, r = 0.86-0.91). These results indicated that urinary 6beta-OHC excretion and 6beta-OHC/UFC ratio measured in overnight/morning urine could precisely reflect 24-hour values even in severely ill patients. In addition, a simple and sensitive HPLC method was described for determination of 6beta-OHC in urine.

[Syncope in ventricular tachycardia as a first clinical sign of patent ductus arteriosus in an adulthood]. / Synkopa pri komorové tachykardii jako první klinický projev perzistující otevrené tepenné duceje v dospelosti.

The case-report describes a 48-year-old-female patient with the patent ductus arteriosus with the following structural changes leading to the malignant arrhythmias manifested as a syncope. The patient was treated by Amplatzer occluder and the implantation of the cardioverter-defibrillator. The authors discuss the patent ductus arteriosus, arrhythmias and sudden cardiac death in the patients with the congenital heart disease in an adulthood.

[The activation of haemostasis during radiofrequency catheter ablation]. / Aktivace hemostázy behem katetrizacní radiofrekvencní ablace.

The aim of the study was to investigate chosen haemostasis activation markers during electrophysiologic study (EPS) with consequent radiofrequency catheter ablation (RFA). Sixty-three patients were studied prospectively. Indications for EPS and RFA were supraventricular tachycardias with the arrhythmogenic substrate located in the right atrium. Blood samples were drawn 24 hours before the procedure (T -1), at the beginning of the procedure (T0), at the end of EPS (T1), 30 minutes after completion of RFA (T2), and 24 hours after the procedure (T3). To study coagulation, fibrinolytic and platelet activation were measured concentrations of thrombin-antithrombin III (TAT), D-dimers (DD), platelet count and parameters, and circulating platelet aggregates (CPAi). During the EPS and RFA, TAT levels increased from the baseline 5.03 +/- 2.53 microg/l (T -1) to 12.90 +/- 12.83 microg/l at T0 (p < 0.001) to 36.07 +/- 15.59 microg/l at T1 (p < 0.001) and decreased to 28.85 +/- 13.14 microg/l at T2 (p < 0.001). Levels of DD increased from 0.30 +/- 0.20 mg/l at T0 to 0.44 +/- 0.25 mg/l at T1 (p < 0.001) and to 0.87 +/- 0.74 mg/l at T2 (p < 0.001). The number of platelets was significantly decreased (-13.7%) before and during the procedure (T -1 vs. T3; p < 0.001). Marked platelet activation (CPAi 0.62 +/- 0.32) was observed before the procedure opposite to the physiological values (CPAi 1.0 +/- 0.1), without changes during the procedure (CPAi at T2 0.69 +/- 0.23). Our results confirmed activation of several haemostasis parameters during EPS and RFA, and support eligibility of the antithrombotic prevention in patients indicated for EPS and RFA.

[Sudden cardiac death (part 2)]. / Náhlá srdecní smrt (cást 2).

In addition to acute treatment of sudden cardiac death the authors focus attention in particular on an analysis of long-term diagnostic and therapeutic provisions to cope with this serious clinical condition. The basic therapeutic procedures include influencing of the arrythmogenic substrate and modulating factors associated with the development of tachyarrhythmias by revascularization of the myocardium and radiofrequency ablation; as to drugs in particular by administration of angiotensin converting enzyme inhibitors and in rare instances by the application of other surgical methods. Haemodynamically important ventricular arrhythmias are treated by antiarrhythmics (beta-blockers, amiodarone, sotalol) and an implantable cardioverter-defibrillator. In the conclusion the authors propose a diagnostic therapeutic algorithm after circulatory arrest with successful cardiopulmonary resuscitation.

[Sudden cardiac death (part 1]. / Náhlá srdecní smrt (1. cást).

Sudden cardiac death is a sudden unexpected non-violent death for cardiac reasons which according to the majority of authors occurs within one hour after the development of symptoms of acute impairment of health. This syndrome is a major problem of contemporary medicine with a very adverse prognosis. The authors analyze the epidemiology, causes, influence of the external environment, basic arrhythmogenic mechanisms and prognosis of sudden death. Examination methods of this clinical condition are evaluated from the aspect of their application in the risk stratification of patients.

Similar turnover and shedding of the cellular prion protein in primary lymphoid and neuronal cells.

The cellular prion protein (PrP(C)) is essential for pathogenesis and transmission of prion diseases. Although prion replication in the brain is accompanied by neurodegeneration, prions multiply efficiently in the lymphoreticular system without any detectable pathology. We have used pulse-chase metabolic radiolabeling experiments to investigate the turnover and processing of PrP(C) in primary cell cultures derived from lymphoid and nervous tissues. Similar kinetics of PrP(C) degradation were observed in these tissues. This indicates that the differences between these two organs with respect to their capacity to replicate prions is not due to differences in the turnover of PrP(C). Substantial amounts of a soluble form of PrP that lacks the glycolipid anchor appeared in the medium of splenocytes and cerebellar granule cells. Soluble PrP was detected in murine and human serum, suggesting that it might be of physiological relevance.

Influence of amiodarone on urinary excretion of 6beta-hydroxycortisol in humans.

The present study was undertaken to evaluate the use of cortisol 6beta-hydroxylation in defining the effect of amiodarone on cytochrome CYP3A activity. To accomplish this goal, the in vivo activity of CYP3A was estimated by measuring the 24-hour urinary excretion of 6beta-hydroxycortisol (6beta-OHC) and by calculating 24-hour ratio of 6beta-hydroxycortisol to urinary free cortisol (6beta-OHC/UFC ratio). Nine cardiac patients scheduled for amiodarone treatment were recruited to participate in this study. Urine was collected over a 24-hour period from each subject before the first amiodarone administration and during the third day of oral administration of amiodarone (200 mg four times daily as a loading dose). Three days of amiodarone treatment caused a significant decrease (p<0.05) in both the 6beta-OHC/UFC ratio and the 24-hour urinary excretion of 6beta3-OHC. These results suggest that amiodarone is an inhibitor of CYP3A activity.

Wet effluent diffusion denuder technique and determination of volatile organic compounds in air. I. Oxo compounds (alcohols and ketones).

The wet effluent diffusion denuder (WEDD) preconcentration technique for the determination of methanol, ethanol, 1-propanol, 2-propanol, 1-butanol, 1-pentanol, acetone, methyl ethyl ketone, diethyl ketone and methyl n-propyl ketone in air is discussed. The compounds are continuously collected into a thin film of deionized water flowing down the inner wall of the cylindrical wet effluent diffusion denuder. The concentrate is analysed by gas chromatography. Detection limits of alcohols and ketones are as low as 1 microg/l (GC-flame ionization detection) and/or 1 ng/l (GC-MS). This technique could be applicable for the continuous monitoring of ppb (v/v) levels of both alcohols and ketones in the air.

Binding of disease-associated prion protein to plasminogen.

Transmissible spongiform encephalopathies are associated with accumulation of PrP(Sc), a conformer of a cellular protein called PrP(C). PrP(Sc) is thought to replicate by imparting its conformation onto PrP(C) (ref. 1), yet conformational discrimination between PrP(C) and PrP(Sc) has remained elusive. Because deposition of PrP(Sc) alone is not enough to cause neuropathology, PrP(Sc) probably damages the brain by interacting with other cellular constituents. Here we find activities in human and mouse blood which bind PrP(Sc) and prion infectivity, but not PrP(C). We identify plasminogen, a pro-protease implicated in neuronal excitotoxicity, as a PrP(Sc)-binding protein. Binding is abolished if the conformation of PrP(Sc) is disrupted by 6M urea or guanidine. The isolated lysine binding site 1 of plasminogen (kringles I-III) retains this binding activity, and binding can be competed for with lysine. Therefore, plasminogen represents the first endogenous factor discriminating between normal and pathological prion protein. This unexpected property may be exploited for diagnostic purposes.

Influence of CYP3A metabolizer status on the pharmacokinetics and pharmacodynamics of amiodarone.

UNLABELLED: The present work was designed to determine whether the individual differences in pharmacokinetics and pharmacodynamics of amiodarone and its N-desethyl metabolite are related to cytochrome CYP3A metabolizer status. METHODS: 12 cardiac patients with inducible ventricular tachyarrhythmias during the baseline electrophysiologic study were enrolled in this study. Urinary 24-hour excretion of 6 beta-hydroxycortisol (6 beta-OHC and the ratio of 6 beta-hydroxycortisol to urinary free cortisol (6 beta-OHC/UFC) were measured before the first amiodarone administration. Trough plasma concentrations of amiodarone and N-desethylamiodarone (N-DEA) were measured after 79 +/- 11 days (2nd period) and after 182 +/- 25 days (3rd period). Electrophysiologic effects of amiodarone therapy were established with serial electrophysiologic studies in 9 of these patients at the baseline and after 79 +/- 11 days (during the second period). RESULTS: Both the 6 beta-OHC excretion and 6 beta-OHC/UFC ratio varied approximately 6-fold between the patients. We found significant inverse correlation between the 6 beta-OHC excretion and the trough plasma concentrations of amiodarone at the time of the 3rd period (rs = -0.58, p < 0.05). Similarly, there was correlation between the 24-hour urinary 6 beta-OHC excretion and trough plasma concentrations of amiodarone during the 3rd period (rs = -0.64, p < 0.025). We were unable to detect any association between CYP3A activity and amiodarone pharmacodynamics. CONCLUSION: This study points toward important information value of CYP3A metabolizer status in the context of therapeutic drug monitoring of amiodarone.

[Ventricular fibrillation in chronic heart disease]. / Komorová fibrilace u chronických onemocnení srdce.

The objective of the work was to describe in subjects with spontaneous ventricular fibrillation, after elimination of acute cardiac disease, the strategy of antiarrhythmic treatment and to evaluate, based on prospective follow-up, the effectiveness of this treatment. The authors included in the group 36 patients (30 men and 6 women) within the range from 34 to 78 years (mean age 58 +/- 11 years) with spontaneous ventricular fibrillation. They divided the group into a subgroup (15 subjects) without revascularization of the heart muscle, into a subgroup (17 subjects) with revascularization of the myocardium (coronary angioplasty and bypasses) and a subgroup (4 subjects) where ischaemic heart disease was ruled out (mostly cardiomyopathies). In all subgroups they used programmed ventricular stimulation (apparatuses of Quinton Co. USA, Biotronik Co. GFR), in the subgroup with revascularization within 3 months. During the diagnostic procedure of ventricular stimulation they tested antiarrhythmic drugs most frequently amiodarone per os (for 4 weeks). An implantable cardioverter--defibrillator was implanted in 17 patients (8 subjects without revascularization, 6 subjects with revascularization, 3 subjects without ischaemic heart disease). All patients were followed up till death, maximum 24 months. The authors evaluated the rate of cardiac deaths (death on cardiac grounds, incl. sudden arrhythmic death) and sudden arrhythmic deaths (within one hour after the onset of symptoms or the first malignant ventricular tachyarrhythmia recorded after implantation of the defibrillator). In the subgroup without revascularization with electric instability of the ventricles according to programmed stimulation 66.7% they described seven cardiac deaths (46.7%) and 6 sudden "arrhythmic" deaths (40%) incl. 5 subjects with ineffective testing of antiarrhythmic drugs. Conversely in the subgroup with revascularization and with diagnostic programmed stimulation in 47.1% they found 3 cardiac deaths (17.7%), one sudden "arrhythmic" death (5.9%)--a subject with ineffective testing. In the subgroup without ischaemic heart disease they recorded cardiac and sudden "arrhythmic" deaths in half the subjects, in all instances in subjects without inducible ventricular tachyarrhythmia. The authors found in the course of a two-year investigation a relapse of cardiac arrest in 25% of subjects after spontaneous ventricular fibrillation. A third of these subjects (all without a cardioverter-defibrillator) died. They confirm the benefit of implantation of a defibrillator for all subjects regardless of the basic diagnosis and revascularization of the heart muscle.

[Inhalation of high-doses of ipratropium bromide (Atrovent) does not cause any changes in systemic or pulmonary hemodynamics]. / Inhalovaný ipratropium bromid (Atrovent) ve vysokých dávkách nepusobí zmeny ani systémové ani plicní hemodynamiky.

BACKGROUND: Parasympatolytics are recommended as the first choice remedy in patients with the chronic obstructive lung disease. Though their side effects are rare, some physicians are afraid of they can in high doses influence the cardiovascular system. The aim of the work was to ascertain whether the inhalation of 0.12 mg of ipratropium bromide might affect the systemic and pulmonary circulation. METHODS AND RESULTS: 15 patients (10 males, 5 females, average age 61.8 +/- 10.3 years) with chronic obstructive lung disease (13) and idiopathic pulmonary fibrosis (2) were examined during the period of disease stabilisation. Results of the right-side catheterization were not statistically changed (p < 0.91) 30 or 60 minutes after the inhaling of 0.12 of ipratropium. Also the value of the pick expiratory forced rate (PEFR) was not statistically increased (p < 0.25). CONCLUSIONS: Inhaling of 0.12 mg of ipratropium in patients with serious chronic pneumopathies did not affect systemic or pulmonary hemodynamics. Such dose appears to be safe even for patients with the chronic ischaemic hart disease.

[Myocardial revascularization in malignant ventricular tachyarrhythmia--prognostic significance]. / Revaskularizace myokardu u zhoubné komorové tachyarytmie--prognostický význam.

BACKGROUND: The survival of patients with chronic ischaemic heart disease and malignant ventricular tachyarrhythmia is influenced positively in some instances by revascularization of the heart muscle and implantation of a cardioverter-defibrillator. The objective of the submitted work was to evaluate by perspective follow-up of subjects with chronic ischaemic heart disease and malignant ventricular tachyarrhythmia: a) the effect of revascularization of the heart muscle on the prognosis, making use of programmed stimulation of the ventricles and testing the effectiveness of antiarrhythmic treatment; b) the importance of implantation of a cardioverter-defibrillator in revascularized and non-revascularized subjects for the prevention of sudden "arrhythmic" deaths. METHODS AND RESULTS: The authors examined 37 patients (32 men and 5 women), age bracket 34 to 78 years (mean age 61 +/- 11) with IHD and spontaneous ventricular tachyarrhythmia after ruling out acute myocardial infarction. The group was divided into sub-groups without revascularization (21 subjects) and with revascularization (16 subjects). In both sub-groups programmed stimulation of the ventricles was implemented. During the diagnostic finding of programmed stimulation they tested antiarrhythmic drugs, most frequently amiodarone administered orally. A cardioverter-defibrillator was implanted to 10 patients. All patients were followed-up to death, the longest period being 24 months. They evaluated the frequency of cardiac deaths (death on cardiac grounds incl. sudden "arrhythmic" death) and sudden "arrhythmic" deaths (death within on hour after onset of symptoms or first recorded malignant ventricular tachyarrhythmia). In the sub-group without revascularization with diagnostic inducibility of the heart muscle in 85.7% of patients the authors described 9 cardiac deaths (42.9%) and 8 sden "arrhythmic" deaths (38.1%). Conversely in the sub-group with revascularization and with diagnostic programmed stimulation of the ventricles in half the subjects 5 clinical deaths were found (31.3%) and 3 sudden "arrhythmic" deaths (18.8%). Analysis of 11 sudden "arrhythmic" deaths revealed that no subjects with an implanted cardioverter-defibrillator (5) died (documented malignant ventricular tachyarrhythmia). Five of the six patients who died (all without a cardioverter-defibrillator) were not revascularized. CONCLUSIONS: Revascularization of the heart muscle in patients with ischaemic heart disease (after elimination of acute cardiac infarction) and malignant ventricular tachyarrhythmia reduces the risk of relapse of this arrhythmia. The benefit of implantation of a cardioverter-defibrillator was recorded in all subjects regardless of the revascularization of the heart muscle.

Neuroinvasion of prions: insights from mouse models.

The prion was defined by Stanley B. Prusiner as the infectious agent that causes transmissible spongiform encephalopathies. A pathological protein accumulating in the brain of scrapie-infected hamsters was isolated in 1982 and termed prion protein (PrPSc). Its cognate gene Prnp was identified more than a decade ago by Charles Weissmann, and shown to encode the host protein PrP(C). Since the latter discovery, transgenic mice have contributed many important insights into the field of prion biology, including the understanding of the molecular basis of the species barrier for prions. By disrupting the Prnp gene, it was shown that an organism that lacks PrP(C) is resistant to infection by prions. Introduction of mutant PrP genes into PrP-deficient mice was used to investigate the structure-activity relationship of the PrP gene with regard to scrapie susceptibility. Ectopic expression of PrP in PrP knockout mice proved a useful tool for the identification of host cells competent for prion replication. Finally, the availability of PrP knockout mice and transgenic mice overexpressing PrP allows selective reconstitution experiments aimed at expressing PrP in neurografts or in specific populations of haemato- and lymphopoietic cells. The latter studies have allowed us to clarify some of the mechanisms of prion spread and disease pathogenesis.

[Revascularization of the myocardium and electrical instability of the ventricles]. / Revaskularizace myokardu a elektrická nestabilita komor.

The objective of the investigation was to evaluate in patients with chronic ischaemic heart disease (IHD) and malignant ventricular tachyarrhythmia the asset of myocardial revascularization for improvemet of the electric instability of the ventricular myocardium and a subsequent outline of the tactics of antiarrhythmic treatment. The authors included in the group a total of 35 patients (30 men and 5 women), age 34-78 years (mean 61 +/- 11) with IHD (according to selective coronarography) with spontaneous ventricular fibrillation (18 sebjects) or persistent (above 30s) marked symptomatic ventricular tachycardia (17 subjects), after ruling out acute cardiac infarction. The group was divided into a subgroups of 16 subjects with revascularization of the heart muscle (coronary angioplasty, coronary bypass) and a subgroup (19 subjects) without revascularization of the hearth muscle. In both groups programmed stimulation of the cardiac chambers was implemented (PSSK) (apparatuses of Qinton Co. USA, Biotronik, GFR), in the subgroup after revascularization within three months. In case of a PSSK finding the authors tested antiarrhythmic drugs, most frequently amiodarone by the oral route (within one month). Treatment not causing permanent ventricular arrhythmia was considered effective. In the subgroup with revascularization the authors described diagnostic PSSK in 8 subject where testing of antiarrhythmics was made in 6 patients (an effective antiarrhythymic agent was found in one instance, i.e. in 16.7%). In the subgroup without revascularization diagnostic PSSK was implemented in 17 subject. Antiarrythmic drugs were tested in 16 patients (effective treatment in 12.5%--always amiodaroe by the oral route). Diagnostic ventricular tachyarrhythmia was found in patients with spontaneous ventricular tachycardia in all instances with revascularization and in 92.3% without revascularization. In patients with spontaneous ventricular fibrillation they proved diagnostic PSSK in 33.3% of the patients with revascularization and in 66.7% without revascularization. The relative number of implantation of cardioverter-defibrillators in group with and without revascularization was similar (25%, 26.3%). Revascularization of the heart muscle in patients with chronic IHD reduces markedly the electric instability of the ventricular heart muscle, in particular in case of spontaneou ventricular fibrillation. Selective coronarography and possibly revascularization of the heart muscle is esential in those patients. The tactics of antiarrhythymic treatment of revascularization of the heart muscle were not affected.

[Prognostic significance of impaired intra-and infra-bundle of His conduction in the heart]. / Prognostický význam poruseného intra-a infrahisálního vedení v srdci.

BACKGROUND: So far no final solution was found as regards the relationship of impaired conduction in the His-Purkyne system and the incidence of cardiac and in particular sudden deaths. The objective of the present work was to assess by long-term prospective follow-up of subjects with a normal and pathological prolongation of the intra- and infrahisian conduction in the heart, based on the electrogram of the bundle of His, the importance of these findings for assessment of the patient's prognosis. METHODS AND RESULTS: After elimination of subjects with ventricular preexcitation the authors included in the group 340 patients (243 men, 97 women, aged 16-81 years, mean 49 +/- 16), where they recorded the electrogram of the bundle of His (without cardiac stimulation, during graded and programmed stimulation of the atria, after i.v. administration of ajmaline). In 206 cases they implemented at the same time programmed stimulation of the ventricles. The HV interval or the length of the H wave were in 286 patients normal and in 54 patients protracted. All patients were followed up by the authors for 6 to 144 months (mean follow up period 56.1 months). In the group of subjects with normal intra- and infrahisian conduction, as compared with the group with protracted conduction in the same area, the number of cardiac deaths was lower, i.e. 10.1 %, as compared with 22.2 %, sudden "cardiac" deaths (death within one hour after the onset of symptoms), i.e., 6.6 % as compared with 11.1 %, and sudden bradyarrhythmic" deaths (sudden "cardiac" death except subjects with diagnostic programmed ventricular stimulation), i.e. 2.8 % as compared with 11.1 %. CONCLUSIONS: The results support significantly the prognostic impact of pathological conduction in the His-Purkyne system as regards the occurrence of cardiac deaths and sudden "brady arrhythmic" deaths (p < 0.05). Conversely, the differences as regards the occurrence of sudden "cardiac" deaths were not significant.