[Ablation of supraventricular tachydysrhythmias with direct and radiofrequency current]. / Skúsenosti s abláciou supraventrikulárnych tachydysrytmií jednosmerným a rádiofrekvencným prúdom.

Ablation therapy of tachycardias refractory to pharmaceutical preparations is considered in recent years the method of choice. In the submitted paper the authors give an account of 12 years experience with ablation treatment of supraventricular tachycardias. The group comprises 23 patients, who were subjected to ablation therapy by radiofrequency current (RF) on account of relapsing supraventricular dysrhythmias, resistant to medicamentous treatment (between May 1994 and February 1996). The mean age of the patients was 60.4 +/- 9.2 years. The historical control group is formed by 13 patients who were subjected to ablation of the AV junction by direct current (DC) between March 1984 and April 1994, their mean age being 68.4 +/- 10.4 years. After DC ablation the operation was successful in 8 cases (62%) where complete AV block was achieved, while it was partially successful in two cases where modification of the conductivity was achieved (15%) and it failed in three cases (23%). The levels of AST and CK enzymes at the investigated time intervals are significantly higher than in the RF method. During RF ablation the mean duration of successful ablation sequence was 36 s, the mean energy 1 042 +/- 726 J, the median number of sequences was 10.5. In ablation of the AV junction the success was 95%. In one of two patients who were subjected to ablation of arterial flutter a relapse of tachycardia was recorded after an interval of 24 hours. Subsequently complete ablation of the AV junction was performed. In a female patient with atrioventricular reciprocal tachycardia due to a latent accessory pathway in the area of the free left ventricular wall temporarily tachycardia could not be induced, however, after discharge from hospital the paroxysms of supraventricular tachycardia with a substantially lower frequency reappeared. Comparison of the two methods does not suggest a significant difference of their effectiveness, the RF method causes, however, less extensive myocardial damage.

[Trends in indications for permanent cardiac pacing therapy at the Cardiac Pacing Center in Eastern Slovakia 1978-1994]. / Vývoj indikácií trvalej kardiostimulacnej liecby v kardiostimulacnom centre východného Slovenska v rokoch 1978 az 1994.

At the Third Medical Clinic, which acts as a cardiostimulation centre for the eastern Slovak area, in 1978 to 1994 1 581 primary implantations and 996 reimplantations of pacemakers were made. In the group of primary implantations the mean age of patients was 70.7 +/- 10.9 years, the male/female ratio was 850/731. In the group of reimplantations the mean age was 71.3 +/- 11.6 years, incl. 483 men and 513 women. There is an almost linear rise of primoimplantations. In the group of reimplantations we can observe a two-peak shape of the curve with a maximum in 1986 and in 1990. While in 1978 atrioventricular block grade III accounted for almost 90% indications for primary implantations, during subsequent years its ratio declined gradually and at present it has reached a steady level of 30-40%. The second most frequent dysrhythmia in the group is dysfunction of the sinoatrial node which in 1978 accounted for 6% of the indications, while in 1994 it accounts for 28% of the primary implantations. In 1978 only non-programmable pacemakers VVI/V00 were implanted. In 1989 on a wider scale multiprogrammable ventricular single electrode systems VVIM were introduced which in 1994 accounted for 58% of the implanted pacemakers. Stimulation with adaptable frequency (VVIR, AAIR) and physiological stimulation of two cavities incl. VDD stimulation accounted for 42% in 1994. It can be summarized that during the last five years marked extension of physiological stimulation occurred with an opportunity to select the optimal mode of stimulation, to increase reliability and keeping qualities of the implanted pacemakers and to improve the perspectives of patients needing cardiostimulation therapy.

[Surgery in patients with organ transplants]. / Operácie chorých s transplantovanými orgánmi.

Patients after successful transplantation with immunosuppressive therapy form a "new circle of surgical patients" who can develop various surgical diseases, or injuries which bring about an inevitable urgent or planned surgical treatment. The authors present the results in three patients with transplanted organs (1993-1995) who were subdued to various surgical treatments. The first patient underwent a classical cholecystectomy, choledochotomy, and extraction of concrement from the choledochus after orthotopic transplantation of the heart. The second patient underwent transplantation of the kidneys precedingly to bilateral subtotal resection of both lobes of the thyroid gland due to marked bilateral nodal goitre intervening deeply retrosternally with a severe pressure syndrome on trachea and oesophagus. The immediate and long-term results were excellent. Orthotopic transplantation of the heart in the third patient preceded to intercostal drainage of the thorax and evacuation of pus due to an extensive empyema of the thorax and septic state, and later thoracotomy and decortication with extirpation of the substantial part of the empyema sack was performed with an excellent immediate and long-term effect. The authors present the principles which must be inevitably fulfilled in coincidence with successive surgical treatment in patients with transplanted organs in a permanent immunocomplex regime. (Fig 2, Ref. 11.)

[Occurrence of Leptospira serovars in old foci of leptospirosis]. / Súcasný stav výskytu leptospírových sérovarov v starých ohniskách leptospiróz.

In two old natural foci of leptospiroses in an Eastern Slovakian area an epidemiological investigation was made to detect persisting carriership in basis reservoirs-small mammals and the contact with leptospirae in population groups with an occupational risk. Using the microagglutination reaction (MAR), the authors examined 1,106 small mammals and detected in 50 cases, i.e. 4.5%, the presence of specific antibodies against leptospirae, most frequently in species Apodemus agrarius and Ap. flavicollis. Only in one instance a positive reaction was found in the main reservoir--Microtus arvalis. As to serovars, Leptospira grippotyphosa and the group L. sejroe dominated. Of 1,740 examined human sera (832 men, 908 women) 56 samples (3.2%) reacted in MAR (4.1% men, 2.4% women). The spectrum of serovars in positive subjects was the same as in the above mentioned reservoirs with a predominance of L. grippotyphosa and group L. sejroe. As compared with previous examinations made 18 years ago in small mammals, a decline of positivity to almost half was recorded (from 7.8% to 4.5%), a reduction of the number of serovars from 7 to 4 was observed, however, the positivity of dominating serovars did not decline. In humans a higher percentage of positivity to specific antibodies was found, as compared with the past, i.e. 3.0% as compared with 2.0%. The authors found differences in the frequency of different serovars. In the past serovar L. bratislava dominated in the above area, followed by L. grippotyphosa. At present the first place was held by L. grippotyphosa and the group of L. sejroe.(ABSTRACT TRUNCATED AT 250 WORDS)

[Non-invasive tests in the diagnosis of sinoatrial node dysfunction]. / Moznosti vybraných neinvazívnych testov v diagnostike dysfunkcie sinoatriálneho uzla.

The authors present a group of 67 patients, mean age 63 +/- 15 years, where they applied on account of suspected dysfunction of the sinoatrial node (SA) the atropine test (AT), 24-hour Holter monitoring and transoesophageal stimulation of the atria (TESP). The objective of the investigation was to test the reliability and yield of the mentioned methods and to investigate more closely the relations of their final indicators. Correlation analysis revealed a positive relationship between the maximal frequency during AT and the mean daily (r = 0.553, p < 0.001) and minimal frequency during Holter monitoring (r = 0.349, p < 0.0025). The recovery periods of the SA node were negatively related to the mean, minimal and maximal frequency during Holter monitoring. The relative rise of SF during the atropine test did not correlate with any Holter parameter nor with the recovery periods of the SA node. The length of the pause (Holter) did not correlate with any of the evaluated parameters. Based on the mentioned findings, the authors conclude that the diagnostic value of the mentioned non-invasive tests, when used separately, is limited but increases when the tests are combined.

[Rapid continuous stimulation of the atrium (overdrive) in the treatment of refractory supraventricular tachycardia]. / Rýchla kontinuálna stimulácia predsiení (overdrive) v liecbe refraktérnych supraventrikulárnych tachykardií.

In 71 patients, divided into four groups by the type of supraventricular tachycardia (SVT) during electrophysiological examination, 918 stimulations were implemented by the method of rapid continuous stimulation of the atria (overdrive) in order to interfere with a SVT paroxysm. In addition to characteristics of tachycardia the authors evaluated parameters of overdrive stimulation, i.e. the duration of the stimulation cycle (CL STIM), the ratio CL STIM/CL SVT, the number of stimuli required to terminate tachycardia (N STIM) and their mutual relations. In the group of atrioventricular reciprocal tachycardias (WPW, n = 17) the effectiveness was 50.4%, CL SVT 334 +/- 43 ms, the ratio CL STIM/CL SVT 78.3 +/- 12%, the median of N STIM 14 +/- 6. In the group of AV nodal tachycardias (AVNR, n = 26) the effectiveness is 53.1%, CL SVT 356 +/- 70 ms, CL STIM/CL SVT 77 +/- 8.6%. In the group of atrial tachycardias (AT, n = 5) the effectiveness was 62.3%, CL SVT 348 +/- 24 ms, CL STIM/CL SVT 73.7 +/- 7.5%, N STIM 6 +/- 4. In the group of atrial flutter (AFL, n = 23) the effectiveness was 9.2%, CL SVT 226 +/- 29 ms, CL STIM/CL SVT 84.5 +/- 8.2%, N STIM 22.5 +/- 9. The effectiveness of overdrive stimulation in AFL is significantly lower than in other groups of SVT. The regression correlation in the entire group of tachycardias for calculation of a suitable duration of CL STIM--0.855 x CL SVT--28 (ms), the median number of stimuli N STIM 14 +/- 7.(ABSTRACT TRUNCATED AT 250 WORDS)

[The intra-atrial-reentry type of supraventricular paroxysmal tachycardia]. / Supraventrikulárna paroxyzmálna tachykardia typu intraatriálnej reentry.

The authors describe a 10-year-old girl with supraventricular paroxysmal tachycardia of the intraatrial reentry type. The diagnosis was confirmed by Holter and electrophysiological examination. Therapeutic possibilities are discussed.

[Experience with permanent cardiac pacemakers in the East Slovakian Region 1978-1987]. / Skúsenosti s trvalou kardiostimuláciou vo Východoslovenskom kraji v rokoch 1978 az 1987.

The authors present a group of patients where in the course of the 10-year period of 1978-1987 a permanent pacemaker was implanted. 587 primary implantations were made and 327 exchanges of cardiac pacemakers. The mean age in the group of primary implantations was 70.4 +/- 10.3 years, in the group of exchanges 70.4 +/- 10.6 years. n 98.8% pacemakers VVI and VOO made in Czechoslovakia were implanted. Indications for primary implantation were in 64% atrioventricular block (AV) grade III, in 11% AV block grade II, in 22% disease of the sinoatrial node and in 4% other dysrhytmias. The age category above 60 years accounts for 85.5% in the group of primary implantations. A positive feature is the low incidence of complications of surgical and technical nature. An unfavourable feature is that almost all implanted devices were the simplest single electrode systems where the frequency cannot be adapted and where other parameters cannot be changed.

[Does the left atrial dimension predict the short-term effect of electric cardioversion?]. / Predpovedá rozmer l'avej predsiene krátkodobý efekt elektrickej kardioverzie?

The authors evaluate in their retrospective investigation the influence of the left atrium, assessed by echocardiography, on the short-term effect of electric cardioversion in auricular fibrillation. The group comprises 44 patients divided into four groups: ischaemic heart disease, cardiomyopathy and specific myocardial affection, mitral stenosis and idiopathic fibrillation. The authors did not find a significant difference between the left atrial diameter in patients with successful electric cardioversion (ECV) (44.4 +/- 8.2 mm) and patients with not successful ECV (43.4 +/- 6.7 mm). The authors did not prove the influence of age and aetiology of fibrillation on the effect of ECV. The size of the left atrium alone does not possess a significant predictive value when estimating the short-term effect of ECV.