Occurrence of symptoms after catheter ablation of atrial fibrillation.

OBJECTIVES: The aim of our study was to verify the efficiency of catheter ablation of atrial fibrillation (CA AF) according to the "atrial fibrillation (AF) burden"(time spent in AF) and symptoms related to AF. METHODS: We retrospectively analysed a selected set of 133 patients with atrial fibrillation (81% men, 19% women) who underwent an invasive therapy in the form of CA AF and at the same time had an implanted long-term ECG loop recorder (Reveal XT) in a period of eight years. We investigated AF burden and objective symptoms of AF by data obtained from a long-term implantable ECG loop recorder. Subjective symptoms related to AF were identified during outpatient controls. RESULTS: Firstly, our results demonstrate for the first time a clinically relevant increase in the occurrence of asymptomatic episodes of AF after CA AF. Secondly, when analysing AF symptoms and AF burden at the same time, CA AF in terms of reduction of symptoms and shortening the time in AF had a better effect in patients undergoing 1 procedure (CA AF) compared to patients undergoing repeated procedures (re CA AF). CONCLUSION: The increase in the occurrence of asymptomatic episodes of AF is of considerable importance both for the clinical evaluation of ablation efficacy and for individualized clinical management of patients, especially with respect to antithrombotic therapy (Fig. 10, Ref. 19).

[Diagnosis and therapy of acute rejection in patients after orthotopic heart transplantation]. / Diagnostika a liecba akútnej rejekcie u pacientov po ortotopickej transplantácii srdca.

OBJECTIVE: In organ allotransplantation represents a serious problem acute rejection, which is the reaction of recipient organism aimed to reject the transplanted organ. AIM: To obtain experience in the field of routine long term are of patients after heart transplantation living in Slovakia. METHOD: 33 patients after orthotopic heart transplantation (HTx) were included in our long term care by the 1. June 1996. According to the accepted protocol we make the whole set of examinations is performed. This includes endomyocardial biopsy which is the only reliable method for the detection of rejection and also the criterion of sufficiency of immunosuppressive therapy. RESULTS: Acute rejection was revealed in 14 (43%) patients. CONCLUSIONS: Tactics of therapy and the length of the interval to subsequent biopsy were determined according to the histological findings of preceding biopsy, the clinical status and the combination of immunosuppression therapy. (Tab. 2, Ref. 13.)

[Dilated cardiomyopathy and heart transplantation]. / Dilatacná kardiomyopatia a transplantácia srdca.

Authors compare selected demographic, clinical, methodological and laboratory parameters in 20 patients who underwent heart transplantation (HTx) because of dilated cardiomyopathy (DKMP) with those, who have had HTx because of progressive and otherwise unresolved coronary artery disease (KCH). Patients operated because of DKMP were younger than those who underwent HTx for KCH. Women were only in the group of DKMP. Otherwise there were no differences between these two groups. The global analysis showed, that the majority of patients after HTx were asymptomatic. However, high incidence of obesity, hyperlipoproteinemia, cytopoenia, renal and hepatal dysfunction were found. Finally the authors presented an overview of standard chronic therapy after HTx and proposed some approaches to undesirable habits and disorders which aggravated the prognosis of the patients after HTx.

[Diagnostic and therapeutic potential of transesophageal cardiac pacing in the management of patients with arrhythmias]. / Diagnostický a terapeutický potenciál transezofágovej kardiostimulácie pre management pacientov s arytmiami.

BACKGROUND: Transoesophageal cardiostimulation is a semiinvasive method of stimulation of atrii enabling the performance of the programmed atrial stimulation without the inevitability of an invasive vascular approach. This method was used in 124 patients with the following indication spectrum. Diagnostic indications: total 82%, paroxysmal supraventricular tachycardia (SVT), and WPW sy-22%, tachycardia with wide QRS-complex-8%. SSS syndrome and bradycardia-20%, sycopes and collapses with unclear etiology-13%, palpitations-11%, control of antiarrhythmic therapy-4%, and other states-6%. Therapeutic indications: total-18%, versions of paroxysmal SVT and flutter of atrii. RESULTS: The patients with SVT were assumed to develop the arrhythmogenic mechanism--AV nodal re-entry tachycardia in 80%, orthodrome AV-re-entry tachycardia in 30%, and flutter of atrii in 20%. All patients with WPW-syndrome were stratified by the use of this method. The origin of this state from ventricular arrhythmia was verified in 40% of patients with tachycardia with a wide QRS complex. In coincidence with other indications, the diagnostic benefit of transoesophageal cardiostimulation was evaluated as follows: syncopes-68%, palpitations-64%, syndrome SSS and bradycardia-48%. The therapeutic indication of SVT version and flutter of atrii, was totally successful in 40%, partly successful in 45% and unsuccessful in 15% of patients. CONCLUSION: Transoesophageal cardiostimulation has contributed to the assessment of the diagnosis in 69% of patients and has acutely managed arrhythmia in 85% of cases. According to our experience, this method is effective in the initial management of patients with arrhythmia. Its low technical and economic demands make its wider utilisation appropriate in clinical practice of internal medicine. (Tab. 4, Fig. 9, Ref. 22).

[Arrhythmogenic right ventricular dysplasia]. / Arytmogénna dysplázia pravej komory.

Arrhythmogenic dysplasia of the right ventricle as a nosological entity was described relatively recently. However, at present, it is gradually being diagnosed more frequently. The authors describe the typical clinical picture of this disease in one of several patients with this disease, who were hospitalised at SUSCH. The authors describe the diagnostical value of individual findings. They indicate the importance of knowledge of individual diagnostical criteria in order to be able to recognize this disease and distinguish it from idiopathic ventricular tachycardia, the prognosis of which is generally better and also the therapeutical approach less aggressive. (Fig. 6, Ref. 29).

[Coenzyme Q10 and alpha-tocopherol in patients after heart transplantation]. / Koenzým Q10 a alfatokoferol u pacientov po transplantácii srdca.

Pathobiochemical mechanisms which participate in the rejection of transplanted heart are not fully clarified. A significant role in this process can be played by endogenous antioxidants, especially coenzyme Q10 which aside from its antioxidative properties is inevitable for cellular bioenergy. The authors investigated the concentration of Q10 alpha-tocopherol in endomyocardial biopsies in the blood in 11 patients from 1 to 9 years of age after transplantation of the heart (HTx-pat) examined in UKVCH in Bratislava who were compared with the group of 13 patients with cardiopathies of unclear origin (KPNP-pat) as possible candidates for transplantation. They detected a decreased concentration of coenzyme Q10 in the myocardium and blood of HTx-patients. Levels of alpha-to-copherol in the myocardium were identical in both groups, in plasma they were higher in patients after HTx. The authors suppose that the levels of coenzyme Q10 in patients after HTx can be influenced by an increased production of free oxygen radicals during rejection episodes, as well as immunosuppressive therapy, and indicate to the possible consequences of this decrease. The presented results provide the first information on the levels of coenzyme Q14 and alpha-tocopherol in patients after transplantation of the heart, registered and controlled in the Slovak Republic. They can contribute to the clarification of some pathobiochemical mechanisms of rejection, respectively to their therapeutic effect. (Fig. 2, Ref. 16.).

[Mitochondrial bioenergetics in patients before and after heart transplantation]. / Bioenergetika mitochondrií u pacientov pred transplantáciou a po transplantácii srdca.

BACKGROUND: The results of the study of biochemical and genetic characteristics of mitochondria in human medicine become widely used in practice. This is confirmed also by the Nobel Symposium which took place in 1994, and was dedicated to the problem of mitochondrial diseases and the effect of their therapy. Relatively rare is the information on the pathobiochemistry of heart muscle mitochondria in patients with cardiomyopathies. No information, so far, is available on oxidative phosphorylation in cases of myocardium transplantation in patients. MAIN PURPOSE AND OBJECTIVES: To bring early metabolic changes in mitochondria within EMB (endomyocardial biopsy) under control in patients after transplantation of the heart (Htx). These detected metabolic changes can contribute to the clarification of the mechanisms participating in the rejection of the transplanted myocardium. PATIENTS AND METHODS: The investigated group of patients included: a) patients with cardiopathies of unclear origin (NYHA II, NYHAIII) b) patients after transplantation of the heart (NYHAI-II) The authors assessed the properties of the respiratory chain and ATP production in mitochondria of EMB. CONCLUSIONS: The new methodical approach to the study of bioenergy of mitochondria of the myocardium in patients allows an early recognition of pathobiochemical changes in myocardium. Supplementing studies are going to reveal wether the presented methodical approach bear diagnostic value. (Fig. 3, Ref. 25.).

[Cardiopathies of unknown origin--a cooperative interdisciplinary study]. / Kardiopatie nejasného pôvodu--kooperatívna interdisciplinárna stúdia.

The authors described aim. objectives, design and criteria of the study which is oriented to the clinical and research problems of heart diseases of uncertain origin. The paper presents the preliminary experience with invasive cardiological techniques in this field. At the same time the authors discuss the potential impact of the basic research on the prevention and effective treatment of cardiopathy which is until now of unknown origin.

[Clinical aspects of cardiopathy of unknown origin]. / Klinický obraz kardiopatií nejasného pôvodu.

Frequently even physical and noninvasive examinations with laboratory analysis do not determine the final aetiology of cardiac symptoms, and it is necessary to complete them with an invasive examination with the aim of ascertaining the primary cause. Our article gives information about the results of clinical, laboratory and noninvasive examinations in the group of patients suspected of cardiopathy of unknown origin.

[Echocardiography of cardiopathies]. / Echokardiografia kardiopatií.

The authors deal with the relation of echocardiography and diseases of the cardiac muscle, draftly classified as cardiopathies. The author's starting point is issued from the presumption that heart diseases which lack the characteristic diagnostic signs in echocardiographic picture affect the heart's systolic and diastolic functions. Echocardiography enables to quantify the extent of affliction of both functions. On the basis of analysis of a set of 22 prospectively examined patients the authors judge as to wether the results of individual volume measurements by means of echocardiographic imaging (one dimensional, two dimensional, Doppler) are correct. In the frame of systolic and diastolic functions examination they highlight the Doppler evaluation due to its technical simplicity and good correlations with literal documents dealing with invasive examinations.

[Analysis of risk factors for perioperative myocardial infarct in aortocoronary bypass]. / Analýza niektorých perioperacného infarktu myokardu pri aortokoronárnom bypasse.

BACKGROUND: Perioperative myocardial infarction (PMI) belongs to the main complications of revascularization surgery of the heart. Perioperative analysis of PIM risk factors can aid the cardiosurgeons, anestesiologists and cardiologists to stratify the group exposed to the risk of PIM origin and to prepare the most appropriate complex peroperative procedure for this group of patients. AIM: The particular aim is to evaluate and analyze some PIM risk factors prior to and during surgery. METHODS: The paper represents a retrospective study which analyzes two period (1984-1986 and 1992). The total number of patients in the investigated group is 277. The group afflicted with PIM is constituted of 29 patients. The following clinical, hemodynamic, angiographic risk factors are analyzed prior to surgery: age, sex, precedence of infarction of myocardium, arterial hypertension, instabile angina pectoris, end-diastolic pressure and left ventricular ejection fraction, affliction of the main trunk of the left coronary artery and some peroperattive factors (number of grafts, sequence bypass, endarterectomy, completion of revascularization, a. mammaria interna graft, duration of the artificial vascular circuit and clamping of the aorta). RESULTS: Significant relation for the pIM origin was found in arterial hypertension (p<0.05), affliction of the main trunk (p<0.05), prolonged period of clamping of the aorta (p<0.05 in 1984-86, p<0.01 in 1992) and artificial vascular circuit (p<0.001). CONCLUSION: The basic PIM risk factors include the following: arterial hypertension prior to surgery, affliction of the main trunk of the left coronary artery, prolonged duration of the artificial vascular circuit and clamping of the aorta. MEANING FOR PRACTICE: 1. The analyzed problem represents a positive feedback for cardiosurgeons, anestesiologists and cardiologists. 2. The analysis of the risk factors can be utilized also by future surgical workplaces in the Slovak Republic.

[Personal experience with determination of endogenous, digoxin-like substances in patients with myocardial infarct and other cardiopathies]. / Nase skúsenosti s vysetrením endogénnych, digoxínu podobných látok u chorých s infarktom myokardu a inými kardiopatiami.

A group of 65 patients with acute infarction of myocardium (IM) who were not treated with digitalis preparations were subdued to examination to the presence of digitalis-like substances in their urine by means of radioimmuno-analytic method with use of anti-digoxin antibodies. The control group was constituted of 69 healthy subjects. Patients afflicted with IM had significantly increased concentrations of DLS in serum in comparison with health subjects. No significant relations of DLS to the activity of creatinkinase, IM localisation, occurrence of dysrhythmias, heart insufficiency and IM mortality were discovered. An increase in DLS in the blood of patients with acute IM probably coincides with a decreased cardiac output, with the activation of the stress axis and retention of sodium and fluids. The second examined group of patients was constituted of 20 subjects with other severe cardiopathies (inborn and acquired heart defects, chronic ischemic heart disease, inflammatory and degenerative diseases of the heart, and hypertension), who were subdued to catheter examinations. The authors discovered no significant differences of DLS concentrations in the blood during catheterization of individual compartments of inferior vena cava, superior vena cava, and the right ventricle. They were not successful in defining the particular site of DLS secretion on the basis of this examination. The authors pay attention to interaction of DLS during the radioimmuno-analytic examination of the digoxin serum concentration.