Influence of ablation therapy on the quality of life in children with supraventricular tachycardia.

OBJECTIVE: Numerous restrictions, which are imposed on children with arrhythmia, influence their quality of life (QoL) and may have a negative impact on their further development. Ablation is a highly successful treatment leaving patients free from arrhythmia and other related limitations. There are very few studies evaluating the influence of ablation on the QoL in children with arrhythmia, based on small groups of patients. The aim of this study was to evaluate the impact of ablation on the QoL in children with supraventricular tachycardia (SVT). PATIENTS AND METHODS: We included 122 children with SVT who underwent a successful ablation. The Qol was assessed before and after the ablation, using the WHOQOL-BREF and the Pediatric Arrhythmia Related Score (PARS) - a specific questionnaire developed by the authors. RESULTS: Six months after the ablation, WHOQOL-BREF showed a significant improvement in the QoL in the physical (Phd) (p < 0.0001), psychological (Psd) (p = 0.0014) and social relationships (SRD) (p = 0.0165) domains. PARS showed a significant improvement in the QoL in the Phd (p < 0.0001), Psd (p = 0.0307) and medical satisfaction domains (Msd) (p < 0.0001). No improvement in Psd was revealed in children who had been off medications before the ablation. In the youngest children, a significant improvement was observed in all the measured domains in both questionnaires (p < 0.05), while in older children the greatest improvement after the ablation was noted in the area of physical functioning. CONCLUSIONS: Ablation in children with SVT significantly improved general satisfaction with health and with the QoL and had a positive impact on QoL scores. The youngest patients and those on antiarrhythmic medication before the ablation, benefit most from the procedure.

[Takotsubo cardiomyopathy in a young woman after a traffic accident with blunt chest trauma]. / Kardiomiopatia takotsubo u mlodej kobiety po wypadku komunikacyjnym z tepym urazem klatki piersiowej.

Takotsubo cardiomyopathy (TC) is characterized as an acute, reversible left ventricular dysfunction which may be triggered by mental or physical stress. In the case of a 32-year-old woman severe heart failure was observed after a traffic accident with blunt chest trauma. ECG showed ST changes mimicking acute myocardial infarction; although, echocardiography revealed a profile of left ventricular contractile disturbances typical of TC, with ejection fraction reduced to 20%. Additionally, repeated echocardiography showed transient left ventricular wall thickness, suggestive of myocardial edema. Recovery to normal heart function and morphology was confirmed in cardiovascular magnetic resonance. Coronary arteries potency was verified in multi-slice computed tomography. Summing up, it seems that TC should be included in differential diagnosis of heart failure in posttraumatic patients; however, it is impossible to say conclusively which factor was dominant in TC pathogenesis in the case presented: emotional stress or chest trauma.

Atrial fibrillation current and future treatments: radiofrequency ablation and novel pacing techniques.

Atrial fibrillation (AF) is a common clinical arrhythmia with significant symptomatology and is associated with an increased risk of systemic embolic events. Until recently, the treatment options for AF were essentially pharmacological. Recent developments in the understanding of the mechanisms of AF have resulted in a series of non-pharmacological treatments becoming available. Such treatments include surgical 'maze' procedures and, more recently, the introduction of radiofrequency ablation techniques within the atria to prevent fibrillation. Complex pacing procedures, including multisite and biatrial pacing, have been used to treat AF. Tailoring treatment for individual patients is a complex task and this review will attempt to rationalise the non-pharmacological treatment paths for individual patients with AF.

Correlation of ST-segment depression during ambulatory electrocardiographic monitoring with myocardial perfusion and left ventricular function.

To assess the relation between silent ischemia and objective markers of ischemia we compared ambulatory electrocardiographic (AECG) monitoring, exercise stress testing, and technetium-99m methoxyisobutyl isonitrile single-photon emission computed tomography (SPECT) in 68 patients with coronary artery disease. ST-segment depression at AECG monitoring occurred in 40%, exercise testing was positive in 88%, and SPECT was abnormal in 98% of patients. Patients with ST-segment depression had a higher incidence of 3-vessel disease (70% vs 45%, p = 0.04), shorter duration of exercise (267 +/- 109 vs 416 +/- 167 seconds, p < 0.01), lower workload achieved (5.1 +/- 1.9 vs 7.6 +/- 2.8 METs, p < 0.0002), and a greater extent of ischemia at scintigraphy (p = 0.01). Patients with a total ischemic time of >30 minutes in a 24-hour period had a lower ejection fraction (48 +/- 21% vs 70 +/- 9%, p = 0.001), a higher perfusion index at rest (2.4 +/- 0.6 vs 1.6 +/- 0.6, p = 0.001), and a greater number of segments with fixed perfusion defects (4.1 +/- 3.7 vs 1.3 +/- 1.8, p = 0.02) in comparison with those who had a shorter ischemic time. We conclude that AECG monitoring fails to identify a substantial proportion of patients with objective markers of ischemia; however, ST-segment depression reflects more significant disease. Longer total ischemic time correlates with the area of myocardial damage but not with other markers of ischemia.

Use of 99Tcm-MIBI scintigraphy in the evaluation of perfusion improvement after myocardial revascularization with the use of the left internal thoracic artery.

In spite of successful revascularization, in a significant group of patients myocardial ischaemia is present after surgery. The final effect of surgery depends on preoperative left ventricular function, initial coronary artery status, completeness of revascularization, the use of arterial or venous grafts, and many other factors. The aim of our 99Tcm-MIBI scintigraphy study was to examine the improvement of perfusion in the left anterior descending artery (LAD) vascular territory after revascularization with the use of the left internal thoracic artery (LITA), with respect to the LAD diameter and use of additional venous graft to diagonal artery. The study group consisted of 45 subjects (42 male, three female) aged 34-68 years (mean age 50.9+/-8.3 years) recruited from patients in whom LITA was grafted into LAD. The operation and postoperative period was uneventful in all patients. Two weeks before, and 3-4 months after surgery, dipyridamole-rest sestamibi SPECT were performed. The revascularization significantly improved both stress (deltaPI = 0.77+/-0.66; P < 0.001) and rest (deltaPI = 0.32+/-0.60; P < 0.001) perfusion of the LAD territory. The improvement was slightly better in patients who received two grafts (deltaPI = 1.42+/-0.91) for the LAD territory in comparison to the group revascularized only with LITA (deltaPI = 0.80+/-0.69; P = patients who received an arterial bypass to the LAD artery the perfusion was abnormal in all eight patients after anterior myocardial infarction and in 39% of patients without a history of infarction. The perfusion improvement was the best when the diameter of LAD was > or = 1.5 mm (deltaPI = 0.88+/-0.95). The independent predictors of perfusion improvement were the number of segments with reversible perfusion defect within the revascularized area (beta = 0.84, P < 0.001), the diameter of revascularized artery (beta = 0.17, P = 0.03) and the presence of pathological Q wave at preoperative ECG (beta = -0.20, P = 0.02). We conclude that the degree of perfusion improvement in the LAD territory after revascularization with the use of LITA depends on the diameter of bypassed coronary artery, completeness of revascularization and the reversibility of preoperative perfusion defect.

99Tcm-sestamibi tomoscintigraphy at rest and after nitrate administration in predicting wall motion recovery after revascularization.

To evaluate whether nitroglycerin administered before the injection of sestamibi improves the detection of viable but hypoperfused myocardium, 41 post-infarction patients with left ventricular dysfunction underwent echocardiography and SPET at rest and after nitrate administration. In 25 revascularized patients, perfusion at rest and contractility were assessed 3-4 months after coronary artery bypass grafting. Perfusion (PI) and wall motion indices (WMI) were calculated for each revascularized area. There was a strong correlation between contractility and perfusion defect (r = 0.58, P < 0.0001). Nitrates significantly reduced the number of perfusion defects in hypokinetic (delta PI = 0.25 +/- 0.66) and akinetic (delta PI = 0.32 +/- 0.62), but not in dyskinetic (delta PI = 0.08 +/- 0.62), segments. Twenty-five revascularized patients had 110 asynergic segments and 136 segments with a resting perfusion defect. Function improved in 42% and perfusion in 64% of segments after surgery. Viable segments had a lower PI at rest (2.78 +/- 1.38 vs 3.86 +/- 1.29, P < 0.001) and a lower WMI (2.46 +/- 0.50 vs 2.79 +/- 0.59, P = 0.002). Nitrates reduced the number of perfusion defects slightly more in viable than non-viable segments (delta PI = 0.58 +/- 0.89 vs 0.30 +/- 0.46, P = 0.06). Contractility and perfusion at rest were the most important predictors of functional recovery. The sensitivity and specificity in predicting contractile improvement were 74% and 64% for resting SPET respectively, and 80% and 50% for nitrate SPET respectively. Nitrate administration significantly reduces perfusion defects in asynergic regions; however, its usefulness in predicting contractile recovery may be limited owing to its low specificity. Contractility and sestamibi uptake at rest were the strongest predictors of post-operative wall motion improvement.

Dynamics of the QT interval in patients with exercise-induced ventricular tachycardia in normal and abnormal hearts.

Inhomogeneity of ventricular repolarization reflected in prolongation of the QT interval of the surface electrocardiogram can predispose patients to ventricular arrhythmia. This study examines whether an abnormality of QT adaptation to changes in heart rate is likely to be of importance in the pathogenesis of ventricular tachycardia (VT) in patients with and without underlying structural heart disease. The QT-R-R relationship during exercise was studied in 52 patients. Forty-two patients had VT associated with a "clinically normal" heart (idiopathic VT), of which 23 had no VT on exercise and 19 had exercise-induced VT. These patients were compared to 10 subjects with exercise-induced VT related to ischemic heart disease. The QT interval was measured manually from computer-averaged QRS complexes recorded at 1- to 3-minute intervals during treadmill exercise tests. An approximately linear association existed between the QT and R-R intervals within the range of heart rates observed. The slope of the QT-R-R relation was lower in patients with structural heart disease (0.23 +/- 0.06) than in patients with normal hearts with (0.29 +/- 0.12) and without (0.29 +/- 0.12) exercise-induced VT (p < 0.05). The intercept of the regression line was higher in patients with structurally abnormal hearts (209.2 +/- 55.3 msec) than in patients with idiopathic VT with (155.6 +/- 49.7 msec) and without (157.7 +/- 69.0 msec) exercise-induced VT (p < 0.02). The corrected QT (Bazett's formula) was similar all three groups at rest, but was higher in patients with structurally abnormal hearts at peak exercise, 449.6 +/- 28.0 versus 425.8 +/- 27.4 msec (idiopathic VT, exercise induced) versus 427.3 +/- 26.6 msec (idiopathic VT, not exercise induced) (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

RR variability and baroreflex sensitivity in patients with ventricular tachycardia associated with normal heart and patients with ischemic heart disease.

Recent studies have suggested that disordered autonomic function, particularly the loss of protective vagal reflexes are associated with an increased incidence of arrhythmic deaths following myocardial infarction (MI). Heart rate variability (HRV) and baroreflex sensitivity (BRS) are measures of myocardial autonomic function and predict arrhythmic deaths post-MI. Patients with ventricular tachycardia associated with a "normal heart" frequently have exercise-induced arrhythmia suggesting that the autonomic nervous system is important in the genesis of this form of ventricular tachycardia (VT). This study examines HRV and BRS in patients with VT associated with a "normal heart" and compares these values to patients post-MI with and without evidence of arrhythmia. Twenty patients with VT associated with a "normal heart," 16 patients with MI but without arrhythmia on follow-up, and 11 patients with MI and VT on follow-up were studied. HRV was measured from 24-hour Holter recordings and BRS was measured from plots of change in systolic blood pressure versus change in heart rate following an intravenous injection of 0.4-0.6 mg phenylephrine. HRV was significantly higher in the patients with VT associated with a normal heart (34.2 +/- 10.8 msec) compared to the patients post-MI, without (23.7 +/- 6.7 msec) and with (14.8 +/- 3.8 msec) arrhythmia (F = 9.2, P less than 0.001) and these differences were unaffected by adjustment for age.(ABSTRACT TRUNCATED AT 250 WORDS)

[ECG Holter monitoring during endoscopic examination]. / Monitorowanie zapisu EKG systemem Holtera w czasie badan endoskopowych.

The aim of the study was an evaluation of ECG changes during endoscopy. In 57 hospitalized patients (34 female, 18 male, mean age 54) who had gastroscopy (n = 23), endoscopic retro-cholangiopancreatography (ERCP) (n = 17) or colonoscopy (n = 17) two hours before and two hours after the examination, an ECG monitoring by Holter method was done. The patients also filled a questionnaire to measure their level of anxiety. Arrhythmias and ST depression/elevation were seen in 37 (65%) patients during endoscopy. In 12% complex arrhythmias (III, IV A and IV B type Lown) were recorded. Complex arrhythmias and/or horizontal ST depression greater than 1 mm were observed more frequently (p less than 0.01) in the group of patients with clinically evident diseases of the cardiovascular system; this group was older than the group without cardiac symptoms. There was no correlation between ECG changes and the level of anxiety before the examination. During ERCP ECG changes were more complex than during colonoscopy (p less than 0.01) or gastroscopy (p less than 0.05).