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Cardiac troponins have a crucial role in diagnosing acute myocardial infarction, but have been considered by some authors to have a high false positive rate. Such opinions may decrease the confidence in troponin with important clinical consequences. The aim of the paper is to analyze three different meanings of the phrase »false positive troponin«: A) analytic (technical) false positive, with no real myocardial damage; B) false positive considering AMI: cardiac injury is present, but there is no AMI; C) false positive considering CAD: there is myocardial damage, but no CAD. The most frequent and the most important source of misunderstanding is the confusion between aspects A) and B). Namely, there has been a relatively small percentage of false positive troponin elevations due to analytic reasons. On the contrary, there has been a relatively large percentage of »false positive« results in patients with myocardial necrosis due to causes other than AMI; for them - instead of »FP troponin elevation« - another phrase ought to be used, e.g., »non-AMI troponin elevation« until the etiopathogenesis in an individual patient is recognized. The phrase »false positive troponin« should be restricted to the artificial increase in troponin due to preanalytic and analytic reasons. By doing so, we may decrease the degree of confusion about troponin and increase the confidence in this highly specific marker of myocardial injury. The possibility of an analytic false positive result should always be kept in mind when one interprets elevated troponin.

Medical significance of heart failure (HF) is obvious; it results from high prevalence, morbidity and mortality rate. Acute cardiogenic pulmonary edema (ACPE) is an emergency, the most severe retrograde left ventricular (LV) insufficiency. PubMed search revealed not a single paper with the objective to evaluate atrial fibrillation (AF) prevalence and prognostic significance in ACPE patients. Given the lack of information on the clinically very relevant topic, the aim of the study was to analyze prevalence, pathophysiologic consequences and possible prognostic significance of AF in ACPE. We studied homogenous group of 1397 ACPE patients, including those in cardiogenic shock, but without concomitant acute myocardial infarction (AMI). Prevalence of AF in ACPE was 29.74%. Intra-hospital mortality of ACPE patients with AF was 20.05% vs. 12.85% in patients without AF (p=0.00078). In conclusion, prevalence of AF is very high in the largest published homogenous acute cardiogenic pulmonary edema series (without AMI). Pathophysiologic mechanisms of AF-induced clinical course detrimental effects include impairment of left ventricle function (even critically), as well as induction / worsening of ischemia, etc. AF is associated with (almost) doubled mortality in acute cardiogenic pulmonary edema. AF was a better predictor of in-hospital mortality then LV ejection fraction, diabetes mellitus, and many others.

Region atrioventrikularnog (AV)čvora povezan sa nastankom supraventrikularnih tahikardija (SVT). Mogu se javiti u svakom životnom dobu ali veoma često su u pitanju mladi ljudi bez strukturne bolesti srca. Najčešća forma SVT je atrioventrikularna nodalna reentry tahikardija (AVNRT) koja se javlja kod 60-70% pacijenata. AVNRT nastaje zbog postojanja dva funkcionalno različita puta unutar AV čvora što podrazumeva dvojni sprovodni sistem ili dvojnu elektrofiziologiju. Ovakve elektrofiziološke karakteristike pogoduju nastanku kružnog kretanja impulsa (reentry) i nastanka supraventrikularne tahikardije. U sve tri forme AVNRT učestvuje spori put kao jedan krak tahikardije zbog čega je kateter-ablacija ili modifikacija sporog puta uspostavljena kao zlatni standard lečenja ovih pacijenata. Cilj intervencije je neinducibilnost tahikardije na kraju procedure i ovaj rezultat postiže se kod gotovo 99% pacijenata. U periodu dugoročnog praćenja kod 1-3% pacijenata dolazi do ponovne pojave AVNRT odnosno do parcijanog oporavka sprovodljivosti tkiva, što je indikacija za reintervenciju. Kod oko 1% pacijenata periproceduralno se javlja pojava AV bloka većeg stepena i zahteva implantaciju trajnog pejsmejkera. Period praćenja ovih pacijenata podrazumeva anketu o tegobama pre i posle ablacije, praćenje kvaliteta života, pojavu recidiva AVNRT, pojavu novih aritmija nakon ablacije i elektrokardiografsko praćenje PQ intervala odnosno kasne identifikacije AV bloka. Cilj: Cilj rada bio je prikazati dugoročnu uspešnost kateter-ablacije u lečenju najčešće kliničke forme supraventrikularne tahikardije- AVNRT,ustanoviti stopu kasne pojave AV bloka nakon višegodišnjeg praćenja,ustanoviti potrebu za prekidanjem ili redukcijom uzimanja antiaritmijske terapije i ispitati pojavu novih aritmija u periodu praćenja. Materijal i metod: Studija je kohortna. Studija je uključila sve ispitanike oba pola starije od 18 godina kojima je rađena kateter-ablacija sporog puta AV čvora u periodu od januara 2007. do decembra 2009. godine u Klinici za Kardiologiju Kliničkog Centra Srbije, a koji su ispunili uslove za uključenje u studiju. Intervencija je urađena kod 92 ispitanika. Pacijenti su biti klinički praćeni na kontrolnim pregledima nakon 12 meseci i nakon 10 godina posle urađene intervencije , do januara 2018. godine, radi analize ranih i kasnih ishoda intervencije... Region of atrioventricular (AV) node is associated with the development of supraventricular tachycardia (SVT). It can occur at any age, but very often it is the matter are young people without structural heart disease. The most common form of SVT is atrioventricular nodal reentry tachycardia (AVNRT) that occurs in 60-70% of patients. The AVNRT is created due to the existence of two functionally different paths within the AV node, which implies a dual conductive system or dual electrophysiology. Such electrophysiological characteristics favor the occurrence of circular motion of the pulse (reentry) and the formation of supraventricular tachycardia. In all three forms of AVNRT participates slow pathway as one arm of tachycardia, which is why catheter-ablation or modification is slow pathway as the gold standard of treatment for these patients. The goal of intervention is the noninducibility of tachycardia at the end of the procedure, and this result is achieved in almost 99% of patients. In the long-term follow-up period, 1-3% of patients experience AVNRT re-occurrence, or partial recovery of tissue conduction, which is an indication for reintervention. In approximately 1% of patients periprocedural occurrence of AV block of higher degree occurs and requires the implantation of a permanent pacemaker. The follow-up period for these patients involves a preand post-ablation questionnaire, monitoring the quality of life, the occurrence of AVNRT recurrence, the emergence of new arrhythmias after ablation, and electrocardiographic monitoring of the PQ interval or late AV block diagnosis. Objective: The aim of the paper was to demonstrate the long-term effectiveness of catheter ablation in the treatment of the most common clinical form of supraventricular tachycardia- AVNRT, to establish the rate of late AV block appearance after many years of follow-up, to determine the need to interrupt or reduce the use of antiarrhythmic therapy and to investigate the emergence of new arrhythmias during the monitoring period. Material and Method: The study is cohort. The study included all respondents of both sexes older than 18 years old who performed a catheter ablation of the slow AV pathway in the period from January 2007 to December 2009 at the Clinic for Cardiology of the Clinical Center of Serbia, who met the conditions for inclusion in the study...

Uvod: Pretkomorsko treperenje (atrijalna fibrilacija [AF] ) i pretkomorsko lepršanje (atrijalni flater [AFL] ) su srodne aritmije, koje dele isti elektrofiziološki supstrat. Godišnja incidenca AFL u opštoj populaciji iznosi 88 novih slučajeva na 100.000 odraslih osoba. Veći rizik od pojave AFL imaju muškarci, starije osobe, bolesnici sa srčanom insuficijencijom i hroničnom opstruktivnom bolešću pluća (HOBP). AFL ima veliki klinički značaj, jer može dovesti do tahikardiomiopatije, sistemskog tromboembolizma sa šlogom i redukcije kvaliteta života. Radiofrekventna kateterablacija (RFKA) kavotrikuspidnog istmusa (KTI), kao kritičnog supstrata aritmije, je efikasnija od antiaritmijske (AA) terapije u kliničkoj kontroli tipičnog AFL i stoga predstavlja prvu terapijsku opciju. Usled složene anatomije KTI procedura može biti pravi izazov. Hlađenjem vrha katetera tokom RFKA, tehnologija spoljne irigacije obezbeđuje stabilniju emisiju energije u tkivo uz kreiranje nekrotične lezije većeg volumena u poređenju sa konvencionalnom RFKA, te je omogućena efikasnija ablacija KTI. S druge strane, hlađenjem vrha katetera gubi se povratna informacija o realnoj temperaturi kontaktne površine katetera i tkiva te može doći do pregrevanja tkiva i proceduralnih komplikacija. Cilj: analiza (1) primarnog uspeha RFKA KTI upotrebom katetera sa spoljnom irigacijom vrha, (2) periproceduralnih komplikacija, i (3) dugoročnog kliničkog efekta procedure na pojavu AFL, AF, kontrolu srčane insuficijencije (SI), upotrebu AA lekova i simptomatski status. Metode: Analizirana je populacija od 248 konsekutivnih bolesnika (≥18 god., >40 kg), koji su podvrgnuti RFKA tipičnog AFL u Kliničkom centru Srbije u periodu od januara 2007.god do decembra 2013.god. uz upotrebu katetera sa spoljnom irigacijom. Svi bolesnici su imali tipičan AFL dokumentovan na EKG-u pre procedure. RFKA je vršena linearnim pristupom najpre centralnog a zatim (ako je neophodno) septalnog i/ili lateralnog KTI. Primarni cilj procedure bio je bidirekcioni blok u istmusu koji je definisan kao prisustvo minimalno 2 od 3 kriterijuma: (1) descendentna aktivaciona sekvenca na lateralnom zidu desne pretkomore pri stimulaciji iz koronarnog sinusa, (2) vremenski interval preko KTI >140 ms, (3) dvostruki signali na KTI >90 ms... Introduction: atrial fibrillation (AF) and atrial flutter (AFL) are related arrhythmias, sharing the same electrophysiological substrate. Annual AFL incidence rate is 88 new cases in 100.000 of adult persons in the general population. Males, older persons, patients with heart failure and chronic obstructive pulmonary disease (COPD) carry a higher risk of AFL occurrence. Occurrence of AFL can have significant clinical implications because it can lead to development of tachycardiomyopathy, systemic thrombo-embolism with ischemic stroke and quality of life reduction. Radiofrequency catheter ablation (RFCA) of cavotricuspid isthmus (CTI), which is the critical arrhythmia substrate, is more efficient than antiarrhythmic drugs (AAD) to clinically control AFL and therefore presents the first therapeutic option. Due to complex anatomy, CTI ablation can be real challenge. Cooling of ablation electrode during RFCA with external irrigation technology, provides more stable energy emission to the tissue with creation of necrotic lesion of larger volume, comparing to conventional RFCA. However, the cooling of the catheter tip loses a feedback on the real temperature of the contact surface and can lead to tissue overheating and procedural complications. Objectives: to determine (1) primary success rate of CTI RFCA using the externally irrigated-tip catheters, (2) periprocedural compliaction rate, (3) clinical effects of the procedure on long-term AFL and AF occurrence, heart failure (HF) control, AAD use and symptomatic status of the patients. Methods: Study population consisted of 248 consecutive patients (≥18 god., >40 kg) who underwent RFCA of typical AFL in Clinical Center of Serbia between January 2007 and December 2013, using externally irrigated-tip catheters. All patients had ECG confirmed typical AFL before the procedure. RFCA was performed by linear approach, initially at central, and thereafter, if necessary, at septal and/or lateral CTI segments. Primary end-point of the procedure was bidirectional isthmus block, defined as the presence of at least 2 of the following 3 criteria: (1) descendent activation sequence at the lateral right atrial wall during pacing from coronary sinus, (2) CTI time interval >140 ms, and (3) double potential at CTI >90 ms...

Background: Ishemic heart disease is mostly a consequence of atherosclerosis. Atherosclerosis, a chronic inflammatory disease, underlies the pathogenesis of coronary artery disease. The present study assessed the diagnostic and prognostic validity of inflammatory biomarkers, including high sensitive C-reactive protein (hsCRP),fibrinogen, ESR, leukocytes, serum neopterin, nitrite/nitrate (NO2 –/NO3–), inducible nitricoxide synthase (iNOS), tumor necrosis factor-α (TNF-α) and asymmetric dimethylarginine (ADMA) and their correlation with risk factors in patients with acute coronary syndrome and stable angina pectoris. Methods: We studied 74 patients with chronic stable angina pectoris, 73 with unstable angina, 94 with acute myocardial infarction and 66 age-matched healthy volunteers (control group). Serum neopterin, ADMA, iNOS and TNF-α were determined by the commercially available enzyme linked immunosorbent assay methods and NO2 – /NO3– by the modified cadmium-reduction method. The diagnostic accuracy of markers was evaluated by the ROC curve analysis. Results: Mean serum neopterin levels were significantly higher in patients with unstable and stable angina pectoris in comparison to control subjects (p