Thromboprophylaxis in hospitalized COVID-19 patients: the efficacy and safety of the approved hospital protocol.

Introduction: Prothrombotic coagulopathy in COVID-19 has led to a strong recommendation for thromboprophylaxis in all hospitalized patients, although there are large differences in the dosage regimens among hospitals and their outcomes remain uncertain. Objectives: We aimed to determine the incidence of thrombotic events and bleeding in patients with COVID-19 using the approved local thromboprophylaxis protocol. Patients and methods: We adapted a self-developed pharmacological thromboprophylaxis protocol based on clinical and laboratory risk assessment of thrombosis in 350 consecutive patients (median age, 67 years) with confirmed COVID-19, treated in designated wards at a single center in Kraków, Poland from October 10, 2020, to April 30, 2021. We recorded in-hospital venous and arterial thromboembolic events, major or clinically relevant bleeding, and deaths along with other complications related to heparin administration. Results: Thromboprophylaxis with low-molecular-weight heparin was administered in 99.7% of patients, 57 (16%) were treated in the intensive care unit. As many as 92% of patients followed the protocol for more than 85% of hospitalization time. Thromboembolic events occurred in 16 patients (4.4%): venous thromboembolism (n = 4; 1.1%), ischemic stroke (n = 4; 1.1%), and myocardial infarction (n = 8; 2.2%). Hemorrhagic complications were observed in 31 patients (9%), including fatal bleeds (n = 3; 0.9%). The overall mortality was 13.4%. The prophylactic, intermediate, and therapeutic anticoagulation preventive strategies with heparin were not related to any of the outcomes. Conclusions: The thromboprophylaxis protocol approved in our institution was associated with a relatively low risk of thromboembolism and bleeding, which provides additional evidence supporting the adoption of institutional strategies to improve outcomes in hospitalized patients with COVID-19.

Coronaviruses fusion with the membrane and entry to the host cell.

Coronaviruses (CoVs) are positive-strand RNA viruses with the largest genome among all RNA viruses. They are able to infect many host, such as mammals or birds. Whereas CoVs were identified 1930s, they became known again in 2003 as the agents of the Severe Acute Respiratory Syndrome (SARS). The spike protein is thought to be essential in the process of CoVs entry, because it is associated with the binding to the receptor on the host cell. It is also involved in cell tropism and pathogenesis. Receptor recognition is the crucial step in the infection. CoVs are able to bind a variety of receptors, although the selection of receptor remains unclear. Coronaviruses were initially believed to enter cells by fusion with the plasma membrane. Further studies demonstrated that many of them involve endocytosis through clathrin-dependent, caveolae-dependent, clathrin-independent, as well as caveolae-independent mechanisms. The aim of this review is to summarise current knowledge about coronaviruses, focussing especially on CoVs entry into the host cell. Advances in understanding coronaviruses replication strategy and the functioning of the replicative structures are also highlighted. The development of host-directed antiviral therapy seems to be a promising way to treat infections with SARS-CoV or other pathogenic coronaviruses. There is still much to be discovered in the inventory of pro- and anti-viral host factors relevant for CoVs replication. The latest pandemic danger, originating from China, has given our previously prepared work even more of topicality.

Increased levels of interleukin 27 in patients with early clinical stages of non-small cell lung cancer.

INTRODUCTION    Interleukin 27 (IL­27) is a cytokine secreted mostly by antigen­presenting cells. It is important for the immune polarization of T helper­1 (Th1) cells, and its role in interstitial lung diseases (ILDs) and lung cancer has been investigated. OBJECTIVES    We assessed IL­27 expression in the lower airways of patients with selected ILDs and early­stage non-small cell lung cancer (NSCLC). PATIENTS AND METHODS    IL­27 concentrations were examined by an enzyme­linked immunosorbent assay in bronchoalveolar lavage (BAL) fluid supernatants collected from patients with pulmonary sarcoidosis (PS; n = 30), extrinsic allergic alveolitis (EAA; n = 14), idiopathic pulmonary fibrosis (IPF; n = 12), nonspecific interstitial pneumonia (NSIP; n = 14), and NSCLC stages I to IIa (n = 16) with peripheral localization, and in controls (n = 14). The major lymphocyte subsets in BAL fluid were phenotyped, and intracellular IL­27 expression was evaluated by flow cytometry.  RESULTS    IL­27 concentrations in BAL fluid supernatants were significantly increased in Th1­mediated conditions such as EAA and PS, but not in IPF or NSIP. The highest IL­27 levels (median [SEM], 16.9 [17.5] pg/ml) were reported for NCSLC, and the lowest-for controls (median [SEM], 0.4 [0.2] pg/ml). IL­27 was undetectable in corticosteroid­treated patients with PS. Both CD4+ and CD8+ lymphocytes were positive for IL­27; they were a possible local source of IL­27 because the cytokine levels were positivelysignificantly correlated with the total number of lymphocytes, including CD4+ cells. CONCLUSIONS    Our results support the Th1­linked activity of IL­27in ILDs. Early­stageNSCLC is characterizedby high IL­27expression in the lower airways. IL­27 is produced by a high percentage of CD4+ and CD8+ cells in BAL fluid, both in patients and controls.

Fulminant heart failure due to giant cell myocarditis affecting the left ventricle.

A 56-year-old woman, previously healthy, was hospitalized after an episode of ventricular tachycardia in the course of infection. In view of the fulminant course of heart failure the patient was connected to an extracorporeal membrane oxygenation (ECMO) system. After 3 weeks of treatment with ECMO the patient received a heart transplant. A histopathological examination of the tissues of the explanted heart revealed giant cell myocarditis. The patient was treated with immunosuppression based on induction therapy followed by a standard regimen with steroids. Currently, the patient remains in good general condition with an left ventricular ejection fraction of 60%.

[The effectiveness of RF ablation of ventricular ectopic beats made using selected mapping techniques]. / Skutecznosc ablacji RF ekstrasystolii komorowej wykonanej z uzyciem wybranych technik mapowania.

UNLABELLED: Only several world-leading centers have summarized outcomes of invasive therapy of ventricular arrhythmia. AIM: The aim of the work is to compare the effectiveness of RF ablation of ventricular arrhythmia. MATERIALS AND METHODS: 183 patients (111 males, mean age 50 ± 17) underwent RF ablation of ventricular ecopic beats (VEB). Retrospective analysis of procedural protocols, in- and outpatient medical records was performed. RF ablation was done using electroanatomical CARTO system, Pacemapping or both methods (CARTO + Pacemapping). RESULTS: Long-term ablation effectiveness was as follows: CARTO - success rate assessed during the ablation procedure was 84,4%; during post operation period follow-up 70,3%, and in long term followup 71,1%; Pacemaping-success rate assessed during the ablation procedure was 91,7%; during post operation period follow-up 83,3%, and in long term follow-up 75,0%; CARTO + Pacemaping - success rate assessed during the ablation procedure was 85,4%; during post operation period follow-up 70,8%, and in long term follow-up 77,1%. Mean amount of VEBs per day before ablation was 18750 ± 12560 (2435 to 50000) and after ablation 575 ± 428 (0 to 1550), p<0.001. Best results were achieved in cases where both mapping techniques were used in combination. Among clinical parameters affecting long-term ablation effectiveness, only hypertension was found to significantly decrease long-term effectiveness of VEB ablation. Only ablation temperature and energy affected long-term therapy effect significantly (p<0,0014; HR=0,84). After the ablation, there was improvement of the left-ventricular end-diastolic diameter and ejection fraction. CONCLUSIONS: Long-term success of ventricular extrasystoly ablation in combined method (CARTO+Pacemapping) was slightly higher compared in CARTO technique and in Pacemapping technique. Classic RF ablation is effective and safe, therefore it can be considered as first-line therapy. In ablation, precise localization of arrhythmic focus is the most important factor. Ablation temperature and energy were significantly correlated to long-term ablation effectiveness. After ventricular extrasystoly ablation, left ventricle ejection fraction increased and left ventricle end-diastolic diameter decreased. Hypertension significantly decreased long-term effectiveness of ventricular extrasystoly ablation.

[Factors predisposing to the reprogramming of implantable cardioverter-defibrillators and the causes of changes in pharmacotherapy in patients with dilated cardiomyopathy for primary prevention of sudden cardiac death]. / Czynniki wplywajace na przeprogramowanie implantowanych kardiowerterów-defibrylatorów oraz powody zmian farmakoterapii u chorych z kardiomiopatia rozstrzeniowa w prewencji pierwotnej naglego zgonu sercowego.

UNLABELLED: Ambulatory care of patients with implantable cardioverter-defibrillator (ICD) involves regular follow-up visit, where a decision on reprogramming of the device and modification of pharmacotherapy is made. AIM: The aim of the study was the assessment of frequency and reasons of reprogramming and pharmacotherapy changes in patients with dilated cardiomyopathy with an ICD implanted due to primary prevention of sudden cardiac death (SCD). MATERIALS AND METHODS: The study included 143 consecutive patients with an ICD implanted in 2010-2011. The inclusion criteria were: left ventricle ejection fraction (LVEF)≤35%, New York Heart Association (NYHA) Class≥II, implantation due to primary prevention of SCD. All ambulatory visits in outpatient department were investigated retrospectively. The following variables were analyzed: age, gender, presence of coronary artery disease (CAD) and atrial fibrillation (AF), LVEF, NYHA class, presence of interventions, reprogramming and pharmacotherapy changes. RESULTS: The most common changes in ICD parameters were modification of detection and therapy of ventricular arrhythmias. Modification of pharmacotherapy were most often referred to B-blocker and cardiac glycosides. Patients with AF had more often parameters of bradycardia pacing changed (p=0,016). There was a significant correlation between number of interventions and total number of reprogramming (r=0,3 p<0,05). A negative correlation was found between LVEF and number of reprogramming of detection of ventricular tachyarrhythmia (r=-0,18 p<0,05) and between LVEF and number of interventions (r=-0,2, p<0,05). Patients with interventions and patients AF had more pharmacotherapy changes (82 vs 29, p<0,001 and 59 vs 52, p<0,01 respectively). A significant correlation was found between number of interventions and total number of pharmacotherapy changes (r=0,5 p<0,05) and between number of interventions and modification of pharmacotherapy with B-blocker, cardiac glycosides and introduction of amiodarone therapy (r=0,47; r=0,30; r=0,32 respectively, p<0,05). CONCLUSIONS: Patients with AF had more changes in ICD parameters, pacing parameters and pharmacotherapy. Patients with lower LVEF had more interventions and more changes in detection of ventricular tachyarrhythmia.

[Electrocardiologic opportunities for the treatment of recurrent ventricular tachycardia on the example of a patient with arrhythmogenic right ventricular dysplasia]. / Elektrokardiologiczne mozliwosci leczenia nawracajacych czestoskurczów komorowych na przykladzie pacjenta z arytmogenna dysplazja prawej komory.

Arrhythmogenic right ventricular dysplasia is a genetic disease, in which pathologic fibrofatty tissue occurs mainly in the right ventricle of the heart. Changes in heart muscle predispose to arrhythmias such as ventricular tachycardia or ventricular fibrillation, so these patients are candidates for implantation of implantable cardioverter-defibrillator. Furthermore, depending on the indication, RF-ablation is performed, which, due to changes in morphology of the heart muscle, are often difficult and of uncertain efficacy. In this paper we present a case of a patient with implanted cardioverter-defibrillator for primary prevention of sudden cardiac death. Initially, the patient experienced only complications related to the possession of the device, but due to the significant progression of the disease and symptoms, the device turned out to be necessary. In addition, the patient underwent complex electrophysiology procedures to control recurrent episodes of ventricular tachycardia. Treatment of cardiac arrhythmias in arrhythmogenic right ventricular dysplasia is problematic both because of the inability to predict the course of disease in asymptomatic patients, as well as due to the difficulty of carrying out effective ablation of arrhythmia foci in morphologically altered myocardium.

[Quality of life in patients after anti-arrhythmic devices implantation]. / Jakosc zycia chorych po implantacji wszczepialnych urzadzén antyarytmicznych.

THE AIM OF STUDY: To assess changes in quality of life in patients with advanced heart failure before ICD or CRTD implantation and after 6 months follow-up period. MATERIAL AND METHODS: The quality of life study was performed in group consisting of 98 patients (69 male, mean age 70.4 +/- 8.60 years), who underwent CRTD implantation (48 patients, 33 male, mean age 70.6 +/- 9.12 years) or ICD implantation (50 patients, 36 male, mean age 70.3 +/- 8.16 years) before the procedure and after 6 months of follow-up. Inclusion criteria were as follows: patients with indications to ICD or CRTD implantation, complete quality of life questionnaires before the procedure and after 6 months follow-up, lack of diagnosed dementia. The quality of life assessment was performed using patient's self-assessment with SF-36 and DASI questionnaires. Patients' self-assessment, NYHA class and ejection fraction was compared before the implantation and after 6 months. Additionally, co-morbidities and experiencing of high voltage therapy were analyzed. RESULTS: In the whole group after 6 months NYHA class improved from mean 2.9 +/- 0.5 to 2.3 +/- 0.84, p < 0.001; in CRTD group from mean 3.0 +/- 0.62 to 2.3 +/- 0.95, p < 0.001; in ICD group from mean 2.9 +/- 0.35 to 2.2 +/- 0.74, p < 0.001. In the whole group after 6 months ejection fraction improved from mean 27.7 +/- 6.92 to 31.0 +/- 7.23%, p < 0.001; in CRTD group from mean 25.3 +/- 7.85 to 32.4 +/- 8.98%, p < 0.001; in ICD group there was no significant improvement of ejection fraction. After CRTD implantation improvement of quality of life was achieved in SF36 and DASI questionnaires. There was no significant improvement in ICD group. DASI index is deteriorated by device's interventions (cardioversions) (regression index=3.45, odds ratio OR = 31.5, 95% confidence interval OR = 8.2-121, p < 0.001) and presence of permanent atrial fibrillation (regression index = 1,243, odds ratio OR = 3.45, 95% confidence interval OR = 1.03-11.7, p < 0.042). SF36 index is deteriorated by presence of kidney failure (regression index = 1.91, odds ratio OR = 6.74, 95% confidence interval OR = 1.75-26, p < 0.005) and permanent atrial fibrillation (regression index = 2.27, odds ratio OR = 9.7, 95% confidence interval OR = 3.1-29.6, p < 0.001). CONCLUSIONS: Cardiac resynchronization therapy (CRTD) improves quality of life, NYHA class and left ventricle ejection fraction. Implantable cardioverter-defibrillator (ICD) does not significantly improve quality of life, NYHA class or left ventricle ejection fraction. Only in the CRTD group a significant positive correlation between changes in DASI and SF36 indexes and left ventricle ejection fraction was achieved. Experiencing cardioversion/defibrillation from implantable device and co morbidities (diabetes mellitus, arterial hypertension, kidney failure, permanent atrial fibrillation) significantly deteriorate patients' self assessment of quality of life.

Factors predisposing to ventricular tachyarrhythmia leading to appropriate ICD intervention in patients with coronary artery disease or non-ischaemic dilated cardiomyopathy.

BACKGROUND: In order to achieve optimal outcomes when treating ventricular tachyarrhythmias with implantable devices, it is extremely important to identify parameters predisposing to arrhythmia. In view of current restrictions in healthcare funding, there is a growing demand for additional predictors of arrhythmia that would allow better patient selection for implantable cardioverter-defibrillator (ICD) use for primary prevention of sudden cardiac death (SCD). AIM: To identify parameters predisposing to ventricular tachyarrhythmia/appropriate ICD intervention in ICD recipients. METHODS: We analysed 376 patients (56 women, 320 men, mean age 66.1 ± 11.2 [range 22-89] years) who underwent ICD implantation between January 2008 and December 2010. Of these, 275 patients underwent ICD implantation for primary prevention of SCD and 101 for secondary prevention. Operative protocols and in-hospital and outpatient records were analysed retrospectively. Mean QRS width and heart rate (HR) were calculated in resting surface electrocardiograms (25 mm/s, 10 mm/1 mV). Intracardiac electrograms stored in ICD memory were used to evaluate appropriateness of anti-arrhythmic interventions and analyse the number of ventricular tachyarrhythmia events, ICD interventions and their type. We analysed the following clinical and procedural variables: age, gender, left ventricular ejection fraction (LVEF), type of SCD prevention (primary or secondary), ICD type (single chamber--VR, dual chamber--DR), performing defibrillation threshold testing to establish defibrillation safety margin at ICD implantation, ventricular lead location (right ventricular outflow tract region, right ventricular apex), mean HR, QRS width, New York Heart Association (NYHA) functional class, occurrence of ventricular tachyarrhythmia/appropriate ICD intervention after implantation, ICD interventions, history of cardiovascular disease and arrhythmia (myocardial infarction, ischaemic and non-ischaemic dilated cardiomyopathy, arterial hypertension, ventricular fibrillation, ventricular tachycardia, permanent atrial fibrillation, percutaneous coronary intervention, and/or coronary artery bypass grafting), and medications (amiodarone, sotalol, beta-blockers, angiotensin-converting enzyme inhibitors [ACEI]/angiotensin receptor blockers [ARB], statins, loop diuretics, aldosterone antagonists). RESULTS: During the mean follow-up period of 387 ± 300 (range 5-1400) days, appropriate ICD intervention due to ventricular tachyarrhythmia occurred in 68 of 376 ICD patients (61 men, 7 women, mean age 64.7 ± 12.3 [range 22-89] years). Mean time interval from ICD implantation to the occurrence of arrhythmia was 281 ± 229 (range 5-972) days (p 〈 0.001). To optimize sensitivity and specificity when analysing ventricular tachyarrhythmia/appropriate ICD intervention vs. no ventricular tachyarrhythmia/appropriate ICD intervention, cutoff values were established using ROC curves (cutoff for LVEF = 31%, HR = 79 bpm). Using these cutoff values, patients with ventricular tachyarrhythmia/appropriate ICD intervention were compared to those without ventricular tachyarrhythmia/appropriate ICD intervention. Significant differences were observed in LVEF (p< 0.001), HR (p< 0.022), ACEI/ARB use (p< 0.034), and NYHA class (p< 0.001). By Kaplan-Meier univariate analysis, patients with LVEF> 31% (log-rank test p< 0.001), HR ≤ 79 bpm (log-rank test p< 0.022), QRS width ≤ 114 ms (log-rank test p < 0.045), and NYHA class II (log-rank test p< 0.001) were more likely to be free from ventricular tachyarrhythmia/appropriate ICD intervention. Cox multivariate analysis showed that reduced LVEF (≤ 31%) was the only independent predictor of arrhythmia/intervention. LVEF values below 31% are associated with a significant 20-fold increase (p< 0.02) in the risk of arrhythmia during the first 3 years after ICD implantation. Among 68 patients with ventricular tachyarrhythmia/appropriate ICD intervention, mean 4.1 interventions per person occurred during the follow-up period. In the overall study population, the number of interventions was 0.28 per person per year. Overall, 92 inappropriate ICD interventions were observed, all resulting from atrial fibrillation with rapid ventricular rate. Interventions had no effect on total mortality. Higher numbers of appropriate interventions were observed in patients who died due to heart failure. CONCLUSIONS: Factors associated with a significantly increased risk of ventricular tachyarrhythmia/appropriate ICD intervention included reduced LVEF, increased resting HR, NYHA class II or higher heart failure, and wide QRS. Patients with low LVEF (< 31%) are at particular risk of SCD due to ventricular arrhythmia and this parameter alone can influence the decision regarding ICD implantation. No effect of ICD interventions on total mortality was observed, although more ICD interventions were observed in patients who died due to heart failure.

Determinants of patient survival rate after implantation of a cardioverter-defibrillator without resynchronisation capability.

BACKGROUND: Proper selection of patients at high risk for sudden cardiac death (SCD) and increasing use of implantable cardioverter-defibrillators (ICD) may contribute to improved survival among patients at the highest SCD risk. AIM: To assess patient survival rate after implantation of an ICD without resynchronisation capability in our own patient population. Using uni- and multivariate analysis, we attempted to identify factors associated with significant worsening of patient survival rate. METHODS: From the population of patients who underwent ICD implantation for primary or secondary prevention of SCD in 2008-2010, we selected 376 patients with coronary artery disease or dilated cardiomyopathy (56 females, 320 males). Mean age was 66.1 ± 11.2 (range 22-89) years. ICD implantation protocols and in-hospital and outpatient records were reviewed retrospectively. We analysed the following clinical and procedural variables: age, gender, left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) functional class, mean heart rate (HR), QRS width, number of antiarrhythmic ICD interventions, type of SCD prevention, ICD type, performing defibrillation threshold testing (DFT) to establish defibrillation safety margin at ICD implantation, ventricular lead location, history of cardiovascular disease and arrhythmia, medications used (amiodarone, sotalol, beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, statins, loop diuretics, aldosterone antagonists). Date and cause of death were established by contacting patient family and/or the hospital to which the patient was admitted shortly before death or the general practitioner caring for the patient (verification of death certificates). RESULTS: During the mean follow-up period of 447 ± 313 days, 46 patients died of known causes. Causes of death included sudden death in 16 patients, heart failure in 20 patients, and other causes in 10 patients (respiratory failure - 1, bleeding diathesis - 2, lung cancer - 3, colorectal cancer - 1, traffic accident - 1, and stroke - 2 patients). A comparison between primary and secondary prevention patients was performed. Mean QRS width <118 ms, resting HR < 78 bpm and LVEF >30% were significant cutoff values for improved survival as determined using the ROC curves. HR >78 bpm was observed in all SCD patients. In Kaplan-Meier univariate analysis including 27 parameters potentially influencing survival, 10 significant parameters were identified (type of prevention, presence of cardiomyopathy, ventricular tachycardia, HR, QRS width, LVEF, NYHA class, performing DFT, and statin and diuretic treatment). In Cox multivariate analysis, risk of death was increased with mean LVEV <30% (3-fold increase in risk), no DFT (2-fold increase in risk), NYHA class III or IV (3-fold increase in risk), and no statin use (2-fold increase in risk). Mean HR <78 bpm and QRS width <118 ms were independently related to an increased survival. CONCLUSIONS: Death rate was higher in patients with LVEF <30%, NYHA class III or IV, no DFT performed and no statin treatment. In these patients, indications for cardiac resynchronisation therapy should be considered. HR <78 bpm and QRS width <118 ms are independent protective factors. HR >78 bpm was observed in all SCD patients. Sicker ICD patients live for a shorter time. The presence of atrial fibrillation, number of antiarrhythmic ICD interventions, ICD type and revascularisation approach did not affect survival/mortality.

[Effectiveness of RF ablation of ventricular ectopic beats from the right and (or) left ventricle]. / Ocena skutecznosci ablacji RF ekstrasystolii komorowej pochodzacej z prawej i (lub) lewej komory serca.

UNLABELLED: There are few studies on the immediate and long term efficacy of ablation of ventricular ectopic beat (VEB) using different mapping systems arrhythmia. The aim of the study was to evaluate the efficacy of intraoperative, immediate and late outcome of RF ablation ventricular arrhythmias and a comparison of methods for identification and ablation of arrhythmia substrate. MATERIAL AND METHODS: In 88 patients, average age 50,8+/-17,8 years old (16 to 90) with performed RF ablation of VEB from the left ventricular and (or) right ventricular. We retrospectively evaluated surgical reports and clinical records. The number of applications, energy, temperature, duration of application, impedance, radiation exposure to X-ray and the presence of obesity, myocardial infarction were evaluated. RF ablation was performed using the method of Carto or Carto and Pace mapping stimulation or Pace mapping stimulation alone. Patients were divided into 3 groups: group A - long result was positive after ablation, group B - treatment was ineffective, group C - ad hoc and postoperative result were positive but long result was negative. RESULTS: The observation time was 30+/-11 months (3-48). An ad hoc positive end point of VEB ablation was 86%, postoperative 74%, and a distant 60%, respectively. There was 13% ineffective treatments. Carto system was used in 53 patients. In 6 (11%, group B) treatment was ineffective, the remaining 47 patients achieved complete success in 31 (58%, group A) cases, while temporary success in 16 (30%, group C) cases. The relationship between the average temperature of 57 Celcius degree during ablation (HR = 1.148, regression = 0.138, p < 0.039) and the effectiveness of treatment was found. No statistical significance between the assessment of the effectiveness of ablation of arrhythmias and the location of the substrate were found but there was no statistical difference between the analyzed parameters and the technical and clinical effectiveness of ablation in the method of localization of arrythmia. The highest percentage of ablation failures in follow-up concerned the technique Carto alone (34%), the most effective was combined techniques adding Pace mapping plus Carto (76% succes rate long after ablation). CONCLUSIONS: To find substrate of arrhythmia to ablate operator should be guided by stimulation mapping and electroanatomical map in order to achieve distant effect of operation. The only significant parameter correlating with the distant ablation efficacy was the mean temperature of the ablation. While using Carto to ablate arrythmia most important role is played by the precise location of the arrhythmia substrate rather than increasing the temperature during ablation.

[Evaluation of the early effectiveness and late arrhythmia recurrences subjectively experienced by the patient after RF ablation of accessory pathway in Wolf-Parkinson-White syndrome depending on it's localization and the electrical parameters of ablation--own observation]. / Ocena skutecznosci wczesnej oraz póznych nawrotów arytmii subiektywnie odczuwanych przez pacjenta po ablacji RF drogi dodatkowej w zespole Wolfa-Parkinsona-White'a w zaleznosci od lokalizacji oraz parametrów elektrycznych ablacji--obserwacje wlasne.

UNLABELLED: Nowadays, radiofrequency ablation (RF) is recommended treatment method of atrioventricular reentrant tachycardia associated with accessory pathway. This procedure is characterised by high early and late efficacy and low risk of complication. The aim of this study was to evaluate early effectiveness and late arrhythmia recurrences subjectively experienced by the patient after RF ablation of accessory pathway in Wolf-Parkinson-White Syndrome, depending on it's localization and the electrical parameters of ablation. MATERIAL AND METHODS: Seventy two patient in age 13-79 (35 +/- 15,3) who had RF ablation of accessory pathway preformed were included in this study. Localization of the pathway, electrical parameters of ablation and early effectiveness of the procedure was assessed retrospectively. Group of patients who had successful ablation (n = 57) were asked about recurrence of heart palpitation after minimum 6 months from the procedure and further. Additionally, information about comorbidities and medication used by patients was collected. RESULTS: Septal localization of accessory pathway was most frequent (59,7%) in study group (n = 72). Early effectiveness was achieved in 80% of patient. Electrical ablation parameters were similar in a group with successful (n = 57) and unsuccessful procedure (n = 15) with exception of numbers of RF application (14 vs 30). In a late observation, 59,09% of the patients did not experienced recurrence of heart palpitation. CONCLUSIONS: In accessory pathway with difficult anatomy access, increased number of RF application do not increase procedure effectiveness. Subjective late effect of the ablation reported by the patient is lower than after electrophysiological study verification. Lack of correlation between pathway localization and early effectiveness of the ablation or late recurrence of heart palpitation reported by the patient.