Short- versus long-term ECG recordings for the assessment of non-linear heart rate variability parameters after beating heart myocardial revascularization.

Non-linear analyses of heart rate dynamics reveal subtle changes not evident from conventional heart rate variability measures. Traditionally, the information was inferred from 24-hour ECG recordings, making it less suitable for clinical application. Moreover, only few studies have attempted to evaluate the reliability of non-linear analyses in relation to varying proportion of artifacts in tracings. In 67 patients revascularized with beating-heart technique, fractal dimension and detrended fluctuation analyses were obtained from 24-hour Holter and 15-minute high-resolution ECG recordings pre and postoperatively. We found strong correlations of non-linear indices between 24-hour and 15-minute recordings (0.54-0.77, p<0.001), unaffected by proportion of artifacts.

How does successful off-pump pulmonary vein isolation for paroxysmal atrial fibrillation influence heart rate variability and autonomic activity?

OBJECTIVE: : Surgical pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) blocks trigger stimulation from PVs and partially disconnects the atria from sympathetic and parasympathetic neural stimulation. This study describes long-term changes in heart rate variability (HRV) and autonomic activity (AA) after successful bipolar radiofrequency PVI. METHODS: : Twenty-seven patients who underwent coronary artery bypass grafting and successful (defined as stable sinus rhythm for 1 year) off-pump bipolar radiofrequency PVI for PAF were prospectively followed 3, 6, and 12 months after surgery including 24 hours Holter electrocardiogram. The following HRV and AA parameters were calculated: mean NN-interval, SD of NN-intervals, SD of averaged NN-intervals, root mean square of successive differences, low frequency (LF) power (0.04-0.15 Hz; a parameter specific for sympathetic activity), high frequency (HF) power (0.15-0.4 Hz; a parameter specific for parasympathetic activity), and the LF:HF ratio. RESULTS: : Preoperatively, high HRV and AA parameters were recorded. In 3-, 6-, and 12-month time, a progressive reduction of HRV and AA was observed, reaching significance after 12 months. Respective rates before surgery and 12 months after it were: for SD of averaged NN-intervals (122.4 ± 113; 80.5 ± 42 milliseconds; P = 0.046), for root mean square of successive differences (79.2 ± 93; 45 ± 20 milliseconds; P = 0.04). The LF:HF ratios were 1.22 and 0.73 before and 12 months after surgery, respectively. The statistically significant continuous reduction in LF:HF ratio (P = 0.02) is suggestive of a progressive parasympathetic dominance 12 months after surgery. CONCLUSIONS: : Successful PVI for PAF results in HRV and sympathetic activity reduction with preoperative sympathetic dominance and oncoming vagal dominance after 1 year from surgery. Despite preoperative sympathetic dominance, successful PVI for PAF results in HRV and a reduction in sympathetic activity with emerging parasympathetic dominance 12 months after surgery.

Minimally invasive off-pump video-assisted endoscopic surgical pulmonary vein isolation using bipolar radiofrequency ablation - preliminary report.

BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia, having a strong impact on long-term stroke and heart failure prevalence and mortality. Nowadays, rapid development in the field of minimising the invasiveness of surgical ablation of AF can be observed. AIM: To report on the feasibility and early results of the first Polish experience with a novel technique of minimally invasive video-assisted beating heart bilateral surgical ablation for lone paroxysmal AF using irrigated bipolar radiofrequency technique. METHODS: Between February and December 2006, 6 patients with highly symptomatic paroxysmal AF, resistant to pharmacological treatment, underwent video-assisted beating heart bilateral pulmonary vein isolation using irrigated bipolar radiofrequency combined with vein of Marshall dissection and left atrial appendage closure. In 2 patients at least 2 unsuccessful percutaenous ablations had previously been performed. RESULTS: There were no complications. Ablation time was on average 88+/-12.1 seconds. At least one recurrence of AF was observed in 4 patients in the early postoperative period; in 3 of them an electrical cardioversion was performed. All patients were discharged home in stable sinus rhythm. Three patients have exceeded 3 months' observation; one has reached 6 months of observation. All are in stable sinus rhythm and the follow-up course is uneventful. CONCLUSIONS: Minimally invasive video-assisted beating heart bilateral surgical ablation for lone paroxysmal AF using irrigated bipolar radiofrequency is effective and safe. These promising results have to be confirmed by larger studies.

Use of new liquid nitrogen cryocatheter in the surgical treatment of atrial fibrillation: clinical experience, mid- and long-term results.

Surgical treatment of atrial fibrillation (AF) evolves to less invasive, safer and technically easier procedures mostly due to the electrophysiological studies, technological progress and creativeness in ablation systems construction. We present first clinical experience, mid- and long-term results of AF treatment with new liquid nitrogen cryothermy device for endocardial application. In 26 patients we have proved the feasibility and clinical effectiveness of liquid nitrogen cryocatheter ablation reaching more than 70% of sinus rhythm rate in long follow-up from 3 up to 24 months.

Epicardial beating heart "off-pump" ablation of atrial fibrillation in non-mitral valve patients using new irrigated bipolar radiofrequency technology.

PURPOSE: We evaluated the use of a novel irrigated bipolar radiofrequency system for the treatment of nonmitral paroxysmal atrial fibrillation. DESCRIPTION: Between December 2003 and July 2005, 24 patients with paroxysmal atrial fibrillation underwent nonmitral cardiac procedures (coronary artery bypass grafting, n = 14; aortic valve replacement, n = 6; aortic valve replacement and coronary artery bypass grafting, n = 3; Bentall procedure, n = 1). In 12 of 14 of the coronary artery bypass graft patients, the procedure was performed off pump. All patients additionally underwent pulmonary vein isolation using the Medtronic Cardioblate BP system (Medtronic, Minneapolis, MN). Acute conduction block was evaluated in 16 patients. EVALUATION: Patients were followed-up for 6 months. Major adverse events include 1 patient death and 1 patient requiring implantation of a pacemaker. At discharge 19 of 22 patients (86.3%) were in stable sinus rhythm. After 3 months, stable sinus rhythm was found in 15 of 21 patients (71%). After 6 months, 15 of 15 patients (100%) were in stable sinus rhythm. Complete conduction block was accomplished in 29 of 32 pulmonary vein pairs (91%) after a single radiofrequency ablation and in 31 of 32 pairs (97%) after a second application. CONCLUSIONS: Pulmonary vein isolation with the use of this irrigated bipolar radiofrequency device is feasible, safe, and gains high experimental and clinical efficacy, including use during off-pump surgery.

Value of transesophageal dobutamine stress echocardiography for selection of the type of cardiac surgery in significant ischaemic mitral insufficiency.

BACKGROUND: Ischaemic mitral regurgitation (IMR) may be surgically treated by isolated myocardial revascularisation or in combination with valve repair. Dobutamine stress echocardiography (DSE) may be helpful in selecting an optimal surgical strategy. AIM: To develop the optimal surgical approach to patients (pts) with significant (ERO lO2 cm(2)) IMR on the basis of TEE-DSE. An attempt was undertaken to select patients in whom coronary revascularisation should be performed alone or in combination with reconstruction of mitral apparatus. METHODS: The study group comprised 212 pts (M/F--134/78; mean age 65+/-10 years) with a history of Q-wave myocardial infarction qualified to elective surgical revascularisation on the basis of coronary angiography. In 25 pts with significant IMR (ejection fraction <40%, wall motion score index 1.8+/-0.3) TEE-DSE was performed. Based on TEE-DSE results pts were divided into the following groups: Group I--7 pts with significant reduction of MR and improvement of left ventricular contractility following dobutamine infusion and qualified to CABG; and Group II (n=18) without significant changes of IMR (9 pts) or with significant reduction of IMR without significant influence on WMSI (9 pts) who were qualified to CABG with mitral valve surgery. RESULTS: In 4 pts from Group II valve replacement was performed and the remaining 14 pts had mitral annuloplasty. Echocardiographic assessments performed 2-7 days, 6 months and 12 months following the surgical procedure revealed IMR intensity as follows (number of patients is given): Group I--small 5/4/4, moderate 2/2/2, severe 0/0/0, Group II--small 15/14/13, moderate 2/3/3, severe 0/0/0. CONCLUSIONS: TEE-DSE seems to be a useful tool for optimal selection of surgical treatment in patients with significant IMR and qualification for CABG.

[Renal carcinoma extending to the inferior vena cava and the right atrium. A case report]. / Przerzutowy guz raka nerki imitujacy sluzaka prawego przedsionka. Opis przypadku.

A case of a 66-year-old male hospitalised due to heart failure is presented. Echocardiography showed an abnormal structure in the right atrium resembling myxoma or thrombus. Abdominal ultrasonography revealed a right renal tumor. Finally, magnetic resonance imaging showed that the abnormal structure in the right atrium was a neoplasmatic plug continuously extending from renal carcinoma. The renal tumor and it's metastatic plug were successfully removed during surgery.