Ultrasound detection of non-atherosclerotic intima-medial abnormalities of lower limbs arteries in amateur endurance runners.

BACKGROUND: Structural changes in the lower limb's arterial wall in amateur endurance runners are a rare incidental finding, represented just by several case reports. AIM: Study the incidence of non-atherosclerotic lower limb artery wall changes in defined group of amateur endurance runners and identify relationship with the training parameters and the relevant biochemical markers. METHODS: Amateur male athletes engaged in endurance running for more than 5 years were enrolled. Tibial and anterior popliteal arteries on each side were examined by ultrasound with focus on non-atherosclerotic structural wall changes: intima-medial border blurring, presence and character of non-atherosclerotic noduli. Subsequently the descriptive and correlation analysis were performed. RESULTS: The study enrolled 20 amateur male endurance runners from Black Swan Triathlon Club Slovakia. The low atherosclerotic risk was represented by normal lipid levels, BMI under 30 kg/m2 and non-smokers in all participants. At least one type of structural artery wall abnormality (noduli or intima-medial border blurring) was present in 19 of 20 participants (95%). The most present was the intima-medial blurring. (80% of participants). The noduli were present in 65% of study group, in almost 40% of these, they were considered as hyperechogenic. All these affections were predominantly in popliteal artery area (65%). The vast majority has bilateral affection. We find a mild correlation between these ultrasound findings and training load represented by annual kilometers and run hours. There was no association between these changes and lipid spectrum or CRP level. CONCLUSION: The subclinical lower limb artery changes, represented by intima-medial border blurring and non-atherosclerotic noduli were present in almost every amateur endurance runner. Despite the underlying mechanism is not understood, the increased training load seems to be one of the responsible factors.

[Outcomes of catheter ablation of atrial fibrillation in patients over 65 years of age]. / Výsledky katetrové ablace fibrilace síní u pacientu nad 65 let.

PURPOSE: This study assessed ablation techniques, recurrent arrhythmias, long-term outcomes, and complications of catheter ablation for atrial fibrillation (AF) in patients 65 years of age. METHODS: Consecutive patients aged < 65 years (n = 653) vs 65 years (n = 213), who underwent catheter ablation of AF in the course of eight years, were compared. Ablation strategy and procedure endpoints were left at the operators discretion. RESULTS: The group of patients 65 years comprised more females (p < 0.001), and more frequently presented with persistent AF (p = 0.010). These patients less frequently underwent simple pulmonary vein isolation (p = 0.017); on the contrary, extensive ablation including coronary sinus intervention was more common (p = 0.020). There was no difference in repeat ablation procedures (25 % vs 26 % patients; p = 0.823, or 1.4 vs 1.5 ablation procedures/1 patients; p = 0.479, respectively). Spectrum of recurrent arrhythmias did not differ between the groups except for more frequent paroxysmal AF before the first repeat ablation in patients < 65 years (p = 0.050). At the end of 49 ± 26 month total follow-up, stable sinus rhythm (SR) was achieved in 85 % patients < 65 years vs 76 % patients 65 years (p = 0.318). To maintain stable SR, older patients more often continued to take antiarrhythmic medication (p = 0.054). More serious complication occurred in 3.8 % of the patients 65 years vs 2.1 % of the patients < 65 years of age (p = 0.207). CONCLUSION: Patients 65 years of age achieved insignificantly worse long-term outcome after insignificantly fewer repeat ablation procedures, and with more frequent use of antiarrhythmic drugs. SR maintenance and risk of complications were, however, favorable.

[A comparison of two methods of long-term external ECG telemonitoring in patients after ablation for atrial fibrillation]. / Srovnání dvou metod dlouhodobého externího telemonitorování EKG po ablaci fibrilace síní

AIM: The aim of the study was to compare two methods of long-term ECG monitoring after atrial fibrillation (AF) ablation. METHODS: The study included 279 patients with paroxysmal (n = 163) or persistent (n = 116) AF, who were followed up for 1 year after the first catheter ablation for AF. All patients were provided with episodic ECG recorder for 1 year and instructed to send at least 2 random ECG recordings per day and whenever they sensed symptoms. They were also provided with external loop recorder for 2-3 weeks at 6 and 12 months to enable more continuous ECG monitoring. RESULTS: At the end of 39 ± 12 (12-60) month follow-up, 143 (88%) patients with paroxysmal AF, and 105 (91%) patients with persistent AF, respectively, remained in stable sinus rhythm. The efficacy of episodic recorder expressed as a ratio of patients with identified AF/atrial tachycardia (AT) out of all patients with a documented episode of AF/AT was superior to the efficacy of loop recorder. No AF/AT episode was recorded with the loop recorder that was not also documented by the episodic recorder. Of the patients with the AF/AT recurrence detected by the episodic recorder, the arrhythmia was also revealed by the loop recorder in 70% of the patients after paroxysmal AF ablation (p < 0.001), and in 52% of the patients after persistent AF ablation (p = 0.006). Asymptomatic AF/AT was present in 42 (26%) of patients with paroxysmal AF, and in 28 (24%) patients with persistent AF (p = 0.810). From conventional follow-up unexpected and clinically significant episode of AF/AT that required change in therapy was detected in 9 (5.5%) patients after ablation for paroxysmal AF, and in 4 (3.4%) patients after ablation for persistent FS. CONCLUSION: More episodes of AF/AT after ablation were detected by 1-year daily ECG monitoring using episodic recorder as compared to periodic ECG monitoring with loop recorder. Identification of clinically significant episodes of AF/AT unrecognized from conventional follow-up was low.

[Catheter ablation of atrio-ventricular accessory pathways in the era of ablation therapy of complex arrhythmias: a changing perspective for oncoming generation of electrophysiologists]. / Katetrová ablace atrioventrikulárních prídatných drah v ére ablacní lécby komplexních arytmií: menící se perspektiva pro nastupující generaci elektrofyziologu

INTRODUCTION: Catheter ablation of atrio-ventricular accessory pathways has become a routine treatment method. However, its perspective has been changing in the era of ablation of complex arrhythmias. This study was aimed at evaluating accessory pathways ablation efficacy within the last nine years at one center. METHODS: From February 2002 to June 2011, catheter ablation of accessory pathways was performed in 247 patients (100 females, 42 ± 16 years). Elimination of accessory pathways conduction in both directions was the procedure endpoint. RESULTS: Immediate accessory pathways conduction elimination at the first ablation was achieved in 228 (92%) patients. Ablation failed to eliminate accessory pathways conduction in 19 (8%) patients, or accessory pathways conduction subsequently recurred in another 7 (3%) patients. Repeat ablation was completed in 20 (8%) patients, 2 patients underwent a third ablation procedure. In total, accessory pathway was permanently eliminated in 238 (96%) patients. Ablation failure was connected with a risky position in the vicinity of atrio-ventricular conduction system in 6 (67 %) out of 9 patients. By the individual A, B, C, D operators experience, efficacy of the first procedure/total efficacy, was 97%/99%, 90%/96%, 87%/87%, and 91%/91%, respectively (comparison of inter-operator efficacy of the first and repeat ablation by Kruskal-Wallis ANOVA test: p = 0,19 and 0,05, respectively). CONCLUSION: Accessory pathways ablation efficacy exceeds 95%, and ablation failure is dominantly related to the accessory pathways location close to the atrio-ventricular conduction system. Individual operator's experience was associated with a certain disparity between high and nearly absolute accessory pathways ablation efficacy.

[Catheter ablation of chronic atrial fibrillation using circumferential and complex linear lesions in the left atrium: modes of arrhythmia termination and long-term clinical outcome]. / Katetrová ablace pro chronickou fibrilaci síní metodou obkruzujících a komplexních lineárních lézí v levé srdecní síni. Ukoncení arytmie pri ablaci a dlouhodobé klinické výsledky.

OBJECTIVE: The aim of the article is to present the method and results of catheter ablation for chronic atrial fibrillation. METHOD: Catheter ablation for chronic atrial fibrillation was performed in 82 patients (18 females, aged 54 +/- 10 years), in 112 ablation procedures. Mean duration of the chronic phase of atrial fibrillation was 28 +/- 28 months. Before ablation, amiodarone was administered without effect to 74 (90%) patients, and was counter-indicated in 8 (10%) patients. Ablation strategy consisted of circumferential lesions around the pulmonary veins and of complex linear lesions in the left atrium. Full pulmonary vein antra isolation, and sinus rhythm restoration, or at least converting atrial fibrillation into the left atrial tachycardia, were the procedure end points. RESULTS: Sinus rhythm was restored by ablation at least in one of the ablation procedures in 43 (52%) patients. During the follow-up period spanning 17.3 +/- 11.6 months after the last ablation, stable sinus rhythm was achieved in 63 (77%) patients, of whom 38 (60%) had their sinus rhythm restored by ablation and another 14 (22%) their atrial fibrillation converted into the left atrial tachycardia. Of the 63 patients with stable sinus rhythm, class I or III antiarrhythmic medication has been maintained in 21 (33%) patients, and amiodarone has been taken by 13 (21%) patients. CONCLUSION: Catheter ablation of chronic atrial fibrillation is potentially highly effective in long-term restoration of sinus rhythm.

[Long term effectiveness of surgical cryoablation for chronic atrial fibrillation in patients undergoing surgery for severe mitral valve regurgitation]. / Dlouhodobá úcinnost chirurgické kryoablace chronické fibrilace síní provedené pri operaci pro závaznou mitrální regurgitaci.

OBJECTIVE: The objective of the study was to evaluate effectiveness of surgical cryoMAZE ablation for chronic atrial fibrillation (AF) in patients undergoing mitral valve surgical intervention. METHODOLOGY: Forty-seven patients (31 females), aged 67.3 +/- 7.3 years who underwent surgical intervention for severe mitral regurgitation were studied. Mitral valvuloplasty was performed in 21 patients, and mitral valve replacement in 26 patients. Combined procedure was employed in 35 patients; simultaneous aortocoronary bypass was performed in 16 patients, tricuspid valvuloplasty (TVP) in 5 patients, and aortic valve replacement (AVR) in 5 patients. RESULTS: The mean follow-up time was 19 +/- 10 months. After 6 or 12 months 36 or 32 patients were seen and 23 (64%) or 22 (69%) of them were in stable sinus rhythm (SR), respectively. In the subset of 24 patients with simultaneous intervention on a different valve (TVP or AVR), after 6 or 12 months, 14 (74 %) or 15 (83 %) patients had stable SR, respectively. In the follow-up period, 2 patients underwent successful catheter ablation for type I atrial flutter or for a residual left atrial atypical flutter. CONCLUSION: In the study using the method of cryoMAZE ablation for chronic AF performed during the mitral valve surgical intervention, a long-term stable SR was achieved in a high proportion of patients, particularly in patients with simultaneous intervention on two or three different valves.

[Recurrent arrhythmias after catheter ablation of originally paroxysmal atrial fibrillation and results of repeat ablation]. / Recidivující arytmie po katetrové ablaci puvodne paroxyzmální fibrilace síní a výsledky opakované ablace.

AIMS: The aim is a description of the recurrent arrhythmias after previous ablation of paroxysmal atrial fibrillation (AF), and the results of a repeat catheter ablation. METHODS: A repeat ablation was performed in 76 patients (18 females, 54 +/- 11 years) in 96 procedures, which was 21% out of 362 patients, who had undergone the first ablation for a paroxysmal AF. The endpoints of the repeat ablation were re-isolation of the pulmonary veins (PV) and termination of a spontaneous or induced arrhythmia and restoration of a stable sinus rhythm (SR), and possibly achievement of noninducibility of any arrhythmia. RESULTS: Clinical left atrial tachycardia (LAT) was present in 10 (13%) patients before the first, and in 5 (25%) patients before the second repeat ablation. Arrhythmia arising from an arrhythmogenic PV due to the conduction recovery into the left atrium (LA) was found in 50 (66%) patients during the first, and in 7 (35%) patients during the second repeat ablation. Arrhythmias, predominantly of the reentry mechanism and originating in the LA free wall, were found in 26 (34%), respectively 13 (65%) during the first or the second repeat ablation. All arrhythmias from PVs were terminated by a PV encircling ablation. Substrate-related arrhythmias were terminated by ablation except for 2 (3%) patients during the first and 3 (15%) patients during the second repeat ablation. Persistent AF was mainly terminated via conversion into a LAT. In these cases, the ablation sites leading to the SR restoration were, similarly to the primary LATs, located predominantly in the LA anterior wall. During the 22 +/- 13 months follow-up, 68 (89%) patients were free of AF, 54 (71%) patients off the antiarrhythmic drugs and 14 (18%) patients with the class I or III antiarrhythmic drugs. CONCLUSION: AF associated with PV-LA re-connection dominated prior to the first repeat ablation, then the proportion of the substrate-related arrhythmias from the LA free wall increased. Clinical efficacy of the repeat ablation is high.

[Sustained monomorphic ventricular tachycardia in patients with structural heart disease. Different arrhythmogenic substrates, different options of palliative and curative treatment in the era of three-dimensional mapping]. / Setrvalá monomorfní komorová tachykardie u patientu se strukturalnim postizenim srdce. Ruzné arytmogenní substráty, ruzné moznosti paliativní nebo kurativní lécby katetrovou ablací v ere trojrozmerného mapování.

UNLABELLED: Results of catheter ablation of sustained monomorphic ventricular tachycardia (SMVT) in patients with structural heart disease are presented. METHODS: Catheter ablation was performed in 34 patients (5 females), aged 63 +/- 11 years. One (3%) patient had a permanent SMVT resistant to electric cardioversion, 13 (38%) patients had incessant SMVT, 4 (12%) patients had SMVT at least once a day, 9 (26%) patients at least once a week, and 7 (21%) patients at least once a month. Twenty-nine (85%) patients were treated with amiodarone. Twenty-seven (79%) patients had a history of remote myocardial infarction, 2 (6%) patients presented with dilated cardimyopathy, 4 (12%) patients had arrhythmogenic right ventricular cardimyopathy, and 1 (3%) patient was after surgery for tetralogy of Fallot. Left ventricular ejection fraction was 35 +/- 13%. Ablation was mostly performed as a palliative approach with the purpose to eliminate clinically significant forms of SMVT leading to frequent ICD discharges, respectively to the worsening of heart failure. Less frequently, ablation was accomplished as a curative therapy. For the SMVT ablation, electroanatomic mapping was used, and, target or substrate mapping and ablation or their combinations were employed. RESULTS: Clinical form of SMVT was successfully eliminated in 33 (97%) patients, all inducible ventricular tachyarrhythmias were eliminated in 14 (41%) patients. Any ventricular tachycardia did not recur in 29 (85%) patients during 22 +/- 17 months follow-up. Twenty-three (68 %) patients had eventually implanted ICD. Ablation was performed as a curative procedure in 11 (32 %) patients. Average procedure duration was 213 +/- 56 minutes, fluoroscopy time was 18 +/- 9 minutes, and number of radiofrequency applications was 23 +/- 13. CONCLUSION: Catheter ablation in patients with structural heart disease offers a highly effective method in elimination of clinical forms of SMVT. In long-term perspective, it is associated with low recurrence of any ventricular tachyarrhythmia. Efficacy of the ablation in elimination of all inducible forms of ventricular tachyarrhythmia is lower and therefore it should be mostly viewed as a palliative method, particularly in patients with left ventricular dysfunction and incomplete revascularization.