Search

Purpose To compare effectiveness of different treatments for atrial fibrillation (AF) patients who were scheduled for cardioversion (CV) or ablation (CA) presenting with left atrium appendage (LAA) thrombus despite chronic oral anticoagulation therapy (OAC). Methods This was a retrospective cohort study. We analyzed 2014–2019 medical records of patients scheduled for CV or CA of AF who were diagnosed with LAA thrombus despite optimal OAC and had a follow-up transesophageal echocardiogram (TOE). Changes in treatment were divided into the following groups: switch to a drug with different mechanism of action, switch to a drug with similar mechanism of action, initiation of combination therapy, or deliberate no change in treatment. Patients with contraindications to non-vitamin K antagonists were excluded from the analysis. Results We analyzed data of 129 patients comprising 181 cycles of treatment. The overall effectiveness of LAA thrombus dissolution was 51.9% regardless of the number of cycles and 42.6% for the first cycle of treatment. Any change of treatment was more effective than deliberate no change—OR 2.97 [95% CI: 1.07–8.25], P = 0.031, but no particular strategy seemed to be more effective than the other. Left atrium area (OR 0.908 [95% CI: 0.842–0.979]) and number of treatment cycles (OR 0.457 [95% CI: 0.239–0.872]) were both adversely related to thrombus resolution. There was one ischemic and three bleeding adverse events during the treatment. Conclusion LAA thrombus resolution in patients already on OAC may require a change of previous OAC treatment but the overall effectiveness of dissolution seems to be about 50%.

Objective Impaired cardiac adrenergic activity has been demonstrated in heart failure (HF) and in diabetes mellitus (DM). [123I]I-metaiodobenzylguanidine (MIBG) enables assessment of the cardiac adrenergic nervous system. Tomographic imaging of the heart is expected to be superior to planar imaging. This study aimed to determine the quality and utility of MIBG SPECT in the assessment of cardiac innervation in postinfarction HF patients without DM, qualified for implantable cardioverter defibrillator (ICD) in primary prevention of sudden cardiac death. Methods Consecutive patients receiving an ICD on the basis of contemporary guidelines were prospectively included. Planar MIBG studies were followed by SPECT. The essential analysis was based on visual assessment of the quality of SPECT images (“high”, “low” or “unacceptable”). The variables used in the further analysis were late summed defect score for SPECT images and heart-to-mediastinum rate for planar images. MIBG images were assessed independently by two experienced readers. Results Fifty postinfarction nondiabetic HF subjects were enrolled. In 13 patients (26%), the assessment of SPECT studies was impossible. In addition, in 13 of 37 patients who underwent semiquantitative SPECT evaluation, the assessment was equivocal. Altogether, in 26/50 patients (52%, 95% confidence interval 38–65%), the quality of SPECT images was unacceptable or low and was limited by low MIBG cardiac uptake and by comparatively high, interfering MIBG uptake in the neighboring structures (primarily, in the lungs). Conclusions The utility of MIBG SPECT imaging, at least with conventional imaging protocols, in the qualification of postinfarction HF patients for ICD, is limited. In approximately half of the postinfarction HF patients, SPECT assessment of cardiac innervation can be impossible or equivocal, even without additional damage from diabetic cardiac neuropathy. The criteria predisposing the patient to good-quality MIBG SPECT are: high values of LVEF from the range characterizing the patients qualified to ICD (i.e., close to 35%) and left lung uptake intensity in planar images comparable to or lower than heart uptake.

Pharmacological cardioversion (PCV) is commonly a primary option for termination of recent-onset atrial fibrillation (AF) in emergency departments (ED). This is a subanalysis of the CANT II study, evaluating the effectiveness and safety of antazoline in patients (n = 777) at three stages of chronic kidney disease (CKD): Group I > 60 mL/min (n = 531), Group II 45–59 mL/min (n = 149), and Group III < 45 mL/min (n = 97). Patients in Group III were older and with a higher prevalence of co-morbidities; however, we did not find statistically significant differences in the overall effectiveness of PCV in comparison with the other groups. In patients receiving amiodarone, the PCV success rate was similar in all the studied groups, but along with a renal function decline, it decreased in patients receiving antazoline (79.1 vs. 35%; p < 0.001), and it increased almost significantly in patients receiving propafenone (69.9 vs. 100%; p = 0.067). In patients in Group I, antazoline restored a sinus rhythm as effectively as propafenone and amiodarone; however, in patients in Group III, both antazoline and amiodarone became less effective in restoring a sinus rhythm than propafenone (p = 0.002 and p = 0.034, respectively). The rate of safety endpoint was the highest in patients in Group III (eGFR < 45 mL/min), and it was significantly higher than in patients in Groups I and II (p = 0.008 and p = 0.036, respectively). We did not observe antazoline-related adverse events in any of the studied groups of patients. This real-world registry analysis revealed a different influence of CKD on the effectiveness of individual drugs, and while propafenone and amiodarone maintained their AF termination efficacy, antazoline became significantly less effective in restoring sinus rhythm.

Due to safety concerns about available antiarrhythmic drugs (AADs), reliable agents for termination of atrial fibrillation (AF) are requisite.The aim of the study was to evaluate the efficacy and safety of antazoline, a first‑generation antihistamine, for cardioversion of recent‑onset AF in the setting of an emergency department.This multicenter, retrospective registry covered 1365 patients (median [interquartile range] age, 69.0 [61.0-76.0] years, 53.1% men) with new‑onset AF submitted to urgent pharmacological cardioversion. AAD allocation was performed by the attending physician: antazoline alone was utilized in 600 patients (44%), amiodarone in 287 (21%), propafenone in 150 (11%), and ≥2 AADs in 328 patients (24%). Antazoline in monotherapy or combination was administered to 897 patients (65.7%). Matched antazoline and nonantazoline groups were identified using propensity score matching (PSM, n = 330). The primary end point was return to sinus rhythm within 12 hours after initiation of the treatment.Before PSM, antazoline alone was superior to amiodarone (78.3% vs 66.9%; relative risk [RR], 1.17; 95% CI, 1.07-1.28; P0.001) and comparable to propafenone (78.3% vs 72.7%; RR, 1.08; 95% CI, 0.97-1.20; P = 0.14) in terms of rhythm conversion rate. In the post‑PSM population, the rhythm conversion rate was higher among patients receiving antazoline alone than in the nonantazoline group (84.2% vs 66.7%; RR, 1.26; 95% CI, 1.11-1.43; P0.001), and the risk of adverse events was comparable (P = 0.2).Antazoline appears to be an efficacious agent for termination of AF in real‑world setting. Randomized controlled trials are required to evaluate its safety in specific patient populations.

Arrhythmia-mediated cardiomyopathy (AMC) is an essential clinical situation which is commonly underdiagnosed. Successful arrhythmia control leads to improvement in health-related quality of life (HRQoL) and heart failure (HF) symptoms in patients with structural heart disease (SHD).The aim of the study was to evaluate the impact of catheter ablation (CA) of persistent arrhythmia on HRQoL, biochemical and clinical parameters HF in patients with SHD and AMC.Patients with SHD, on optimal medical treatment, with persistent arrhythmia and strong suspicion of AMC, scheduled for CA were prospectively enrolled. Study procedures included: HRQoL measurement (Minnesota Living With Heart Failure Questionnaire [MLHFQ] and EuroQol Research Foundation [EQ-5D-3L] questionnaire), biomarkers (N-terminal pro-B-type natriuretic peptide [NT-proBNP], troponin T [TnT], matrix metaloproteinase-9 [MMP-9], soluble suppression of tumorigenesis-2 [sST2], tissue inhibitor of matrix metalloproteinase-1 [TIMP-1]), transthoracic echocardiography and clinical assessment.At 6 months, 30/35 (86%) patients were free of persistent arrhythmia. Patients who underwent successful CA had a significant improvement in HRQoL: MLHFQ (median [interquartile range, IQR], -22 [-28;-11]; P0.001), EQ5D-3L Score (mean [standard deviation], 21.8 (16.8); P0.001); EQ5D-3L index (median [IQR], 0.09 (0.05;0.18); p0.001). A significant decrease in injury biomarkers: NT-proBNP (median [IQR], -414 [-1397;-318] pg/ml; P0.001), TnT (median [IQR], -2.27 (-8.52;0.55) ng/ml; P0.01) but not fibrosis biomarkers (median [IQR], sST2: 2.20 [-5.4;4.3] ng/ml; P = 0.741, MMP-9: 34 [-376;283] ng/ml; P = 0.881, TIMP-1: 11.1 [-17.1;31.9] ng/ml; P = 0.215) was observed. There was a significant increase of left ventricular ejection fraction (LVEF) (mean [SD], 9.8 [5.9]; P0.01).Successful CA significantly improved clinical status, LVEF and HRQoL of patients with SHD and AMC.

INTRODUCTION Little is known about the safety and effectiveness of pharmacological cardioversion of recent-onset atrial fibrillation (AF) in the elderly. Antazoline has already been shown to be effective and safe in a wide variety of patients. OBJECTIVES To compare clinical effectiveness and safety of iv antazoline administered for pharmacological cardioversion of recent-onset AF in patients aged ≥75 years and younger. PATIENTS AND METHODS This retrospective analysis was conducted using data derived from emergency room medical records of patients qualified for pharmacological cardioversion due to symptomatic AF lasting less than 48 hours. For the purpose of the analysis the threshold for old age was set at 75 years. Conversion to sinus was considered a primary effectiveness outcome. The primary safety outcome was defined as any adverse event (AE) leading to hospitalization. RESULTS Out of 334 patients, 110 patients ≥75 years old comprised the study group. Successful CV was achieved using smaller doses of antazoline in the study group than in the control group: 151 (59) mg vs. 168 (58) mg (P = 0.039). The effectiveness and safety of antazoline was similar in patients aged ≥75 and

Purpose The aim of this study was to assess exercise capacity and echocardiographic parameters in patients with heart failure with reduced ejection fraction (HFrEF) in NYHA III functional class, after cardiac resynchronization therapy (CRT) or implantable cardioverter-defibrillator (ICD) implantation followed by 6 months of supervised rehabilitation in ICD patients. Materials and methods The study included patients with HFrEF and impaired left ventricle systolic function (LVEF ≤ 35%), divided into two groups: CRT group - patients after CRT-D implantation > six weeks, and ICD-rehab group - patients after ICD implantation > six weeks, followed by 6 months of supervised aerobic interval training and the conditioning exercises. At baseline and after 6 months in all the patients cardiopulmonary exercise tests (CPX) and standard echocardiographic examinations were performed. Results The study included 61 patients (49–77 years) with HFrEF. At baseline, the values of CPX parameters were similar in both groups. After completing training almost all CPX parameters in the ICD-rehab group significantly improved, except for anaerobic threshold (AT). In the CRT group significant improvements were found in 2 parameters: peak oxygen uptake (VO2) and exercise tolerance (metabolic equivalents, METs). Significant reductions in left and right ventricle diameters and an increase in LVEF were observed in both groups after 6 months. Conclusions Significant improvement in exercise tolerance capacity and increase of LVEF were observed in similar extent both in heart failure patients with CRT and with ICD undergoing the rehabilitation program. Regular, controlled exercise trainings provided additional, safe and easy to conduct therapeutic option for heart failure patients with no indications for CRT.

Objective Impaired cardiac adrenergic activity has been demonstrated in heart failure (HF) and in diabetes mellitus (DM). [123I]I-metaiodobenzylguanidine (MIBG) enables assessment of the cardiac adrenergic nervous system. Tomographic imaging of the heart is expected to be superior to planar imaging. This study aimed to determine the quality and utility of MIBG SPECT in the assessment of cardiac innervation in postinfarction HF patients without DM, qualified for implantable cardioverter defibrillator (ICD) in primary prevention of sudden cardiac death. Methods Consecutive patients receiving an ICD on the basis of contemporary guidelines were prospectively included. Planar MIBG studies were followed by SPECT. The essential analysis was based on visual assessment of the quality of SPECT images (“high”, “low” or “unacceptable”). The variables used in the further analysis were late summed defect score for SPECT images and heart-to-mediastinum rate for planar images. MIBG images were assessed independently by two experienced readers. Results Fifty postinfarction nondiabetic HF subjects were enrolled. In 13 patients (26%), the assessment of SPECT studies was impossible. In addition, in 13 of 37 patients who underwent semiquantitative SPECT evaluation, the assessment was equivocal. Altogether, in 26/50 patients (52%, 95% confidence interval 38–65%), the quality of SPECT images was unacceptable or low and was limited by low MIBG cardiac uptake and by comparatively high, interfering MIBG uptake in the neighboring structures (primarily, in the lungs). Conclusions The utility of MIBG SPECT imaging, at least with conventional imaging protocols, in the qualification of postinfarction HF patients for ICD, is limited. In approximately half of the postinfarction HF patients, SPECT assessment of cardiac innervation can be impossible or equivocal, even without additional damage from diabetic cardiac neuropathy. The criteria predisposing the patient to good-quality MIBG SPECT are: high values of LVEF from the range characterizing the patients qualified to ICD (i.e., close to 35%) and left lung uptake intensity in planar images comparable to or lower than heart uptake.

Background: Remote monitoring of cardiovascular implantable electronic devices allows the assessment of system effectiveness, arrhythmia occurrence, and indirectly, clinical changes. Medical interventions can be performed earlier because of a faster transfer of information to the monitoring site, even in the case of asymptomatic arrhythmias or abnormalities in the operation of the system. Aims: The aim of the study was to assess the effectiveness of remote monitoring of implantable cardioverter-defibrillators and evaluation in an outpatient setting during 12-month follow-up. Methods: We analyzed 176 patients at 10 sites (men, 84.1%). The mean (SD) age of the patients was 60.7 (12.5) years (range, 20–86 years), and mean (SD) follow-up period was 405 (70) days (range, 131–723 days). Results: A total of 354 outpatient and 514 remote follow-up visits were conducted. Episodes of arrhythmias and device malfunctions were detected with similar frequency in outpatient visits and in remote visits. During the study period, patient sense of safety increased. More patients preferred joined remote and outpatient visits as the optimal healthcare model. As the patient survey showed, the greatest benefit of the CareLink network was fast intervention and an increased sense of safety. Conclusions: The strategy of remote monitoring appeared to be feasible, safe, and patient friendly, demonstrating that the majority of patients do not require an additional in -person visit within 1 year from the device implantation just to confirm the proper functioning of the implantable cardioverter--defibrillators.

Leadless cardiac pacing is the therapeutic option, which may be the only, not just most optimal treatment method in some clinical conditions. The authors present the case report of permanent transvenous cardiac pacing lasting for more than 25 years, with numerous complications and evolving electrocardiotherapy intervention strategies.

Identification of demographic and clinical factors which influence prognosis is crucial in patients with heart failure and cardiac resynchronization therapy (CRT).The study included 223 patients with CRT (177 males), mean age 64.6±9.7 years, including 98 patients (43.9%) with defibrillation function (CRT-D) and 58 (26.0%) with permanent atrial fibrillation (AF). Of 223, n=72 patients (32.3%) had CRT implanted after the age of 70. The mean follow-up was 37±19 months. Mortality rates and other clinical factors according to age were assessed in multivariable analysis of CRT patients follow-up.Total mortality was 30.9%. Mortality rate was similar in subjects aged ≤70 and70 (HR:1.41, 95%CI:0.70-2.82). The female gender was the strongest clinical factor of best prognosis (HR:0.12,95%CI:0.03-0.59, p=0.0088). Lower mortality was also associated with higher left ventricular ejection fraction (HR:0.94,95%CI:0.90-0.98, p=0.0031). Coronary disease (HR:2.09,95%CI:1.10-3.99, p=0.0245), chronic kidney disease (HR:3.00, 95%CI:1.47-6.12, p=0.0024)and higher NYHA class (HR:2.28, 95%CI:1.18-4.40, p=0.0137) were factors of increased mortality. For patients70 years old, gender was not a survival determining factor and mortality was lower in regard to hypertension or permanent AF. Only chronic kidney disease was significantly associated with higher mortality in patients70 years old (HR:6.74, 95%CI:1.90-23.9). The use of defibrillation function had no influence on survival rate at any age.In patients with cardiac resynchronization therapy female gender was not associated with mortality and was the factor of better prognosis. For subjects aged70 a worse prognosis was related to renal insufficiency.

INTRODUCTION Numerous studies described the effectiveness and safety of antazoline in pharmacological cardioversion of short‑duration atrial fibrillation (AF). However, there are no data on the comparison of antazoline and antiarrhythmic drugs listed in clinical guidelines. OBJECTIVES The aim of the study was to assess the comparative effectiveness and safety of antazoline‑based and propafenone‑based strategies in pharmacological cardioversion of short‑duration AF performed in our emergency department. PATIENTS AND METHODS We conducted a retrospective case‑control study based on the analysis of medical records of patients undergoing pharmacological cardioversion of short‑duration AF with intravenous antazoline or propafenone at our department in the years 2008-2012. The primary endpoint was the successful cardioversion of AF. The primary safety endpoint was hospitalization due to the adverse effects of the treatment. RESULTS We analyzed 432 cases of cardioversion. The mean age of patients was 68.9 ±9.8 years; 65% of the patients were male; 90% of the patients had a history of AF. Antazoline was administered 334 times and propafenone-98 times. The mean dose of antazoline was 172 ±65 mg, while all patients in the propafenone group received the drug at a fixed dose of 70 mg (1 vial). Cardioversion with antazoline was successful in 239 cases (71.6%) and with propafenone-in 54 patients (55.1%) (relative risk [RR], 1.30; 95% confidence interval [CI], 1.07-1.57). The rate of hospitalization due to the adverse effects of the treatment were low and similar between the study groups: 10 (3.0%) for antazoline and 4 (4.1%) for propafenone (RR, 0.73; 95% CI, 0.23-2.27). CONCLUSIONS The antazoline‑based strategy was more effective and safer in comparison with propafenone‑based strategy in the pharmacological cardioversion of short‑duration AF in our emergency department.

Background: Cardiovascular implantable electronic device (CIED) infection is a complication of increasing incidence. We present a protocol of an observational case control clinical trial “Positron Emission Tomography Combined With Computed Tomography (PET CT) in Suspected Cardiac Implantable Electronic Device Infection, a Pilot Study — PET Guidance I” (NCT02196753). Aim: The aim of this observational clinical trial is to assess and standardise diagnostic algorithms for CIED infections (lead-dependent infective endocarditis, generator pocket infection, fever of unknown origin) with PET CT in Poland. Methods and results: Study group will consist of 20 patients with initial diagnosis of CIED-related infection paired with a control group of 20 patients with implanted CIEDs, who underwent PET CT due to other non-infectious indications and have no data for infectious process in follow-up. All patients included in the study will undergo standard diagnostic pro­cess. Conventional/standard diagnostic and therapeutic process will consist of: medical interview, physical examination, laboratory tests, blood cultures; imaging studies: echocardiography: transthoracic (TTE), and, if there are no contraindications transoesophageal, computed tomography scan for pulmonary embolism if indicated; if there are abnormalities in other systems, decisions concerning further diagnostics will be made at the physician’s discretion. As well as standard diagnostic procedures, patients will undergo whole body PET CT scan to localise infection or inflammation. Diagnosis and therapeutic decision will be obtained from the Study Committee. Follow-up will be held within six months with control visits at three and six months. During each follow-up visit, all patients will undergo laboratory tests, two blood cultures collected 1 h apart, and TTE. In case of actual clinical suspicion of infective endocarditis or local generator pocket infection, patients will be referred for further diagnostics. Endpoints for the results assessment — primary endpoints are to standardise PET CT in the diagnostic process: sensitivity, specificity, positive predictive value, and negative predictive value of the diagnosis made by PET CT; secondary endpoints are: assessment of usefulness of PET CT for detection of remote infective complications (metastatic abscesses, infected pulmonary emboli), incidence of particular localisations of infection, influence of PET CT on therapeutic decision: confirmation or change of decision based on PET CT, safety and complications of diagnostic process of CIED-related infections with PET CT. Conclusions: Evaluation of PET CT use for device-related infections in a case control study may be conclusive and improve diagnostic pathway.

Publication of the European Lead Extraction ConTRolled (ELECTRa) study conducted in 2012-2014 demonstrated a very large 96.7% clinical efficacy of TLE (Transvenous Lead Extraction). The risk of severe TLE complications of 1.7% with periprocedural mortality of only 0.5% indicates high TLE safety. Significant differences in the results of centers with small and large experience indicate the possibility of successive improvement of the results.

The author describes the case of the superior vena cava occlusion detected during the new implantation of the pacemaker after lead extraction due to pocket infection. New electrode was implanted via the right subclavian vein. The occlusion in the superior vena cava was overcome with a guidewire (0.32 F) and a diagnostic catheter (JR2).

Background Young implantable cardioverter defibrillator (ICD) recipients have a high rate of complications, some of which seem to be underestimated. We report our clinical experience with ICD therapy in children and young adults during a 15 year follow up. Methods We reviewed the database of ICD recipients at the present institution and chose 73 consecutive patients who underwent implantation at age 6-21 years. We analyzed intervention rate, mortality, rate and characteristics of complications and treatment options. Results A total of 20/73 patients (27.4%) received ≥1 episode of appropriate therapy (AT) for ventricular tachycardia/ventricular fibrillation (anti-tachycardia pacing or shock) and 24/73 patients (32.8%) had one or multiple episodes of inappropriate therapy (IT). Eight patients (11%) had both interventions: AT + IT. A total of 15/73 patients (20.5%) had ventricular lead dysfunction, with 13 re-implantations (17.8%) of a new system. Four of 73 patients (5.5%) had infection: endocarditis or device pocket infection. A total of 2/73 patients (2.7%) died due to ventricular lead dysfunction, while 22/73 patients (30.1%) needed elective device replacement, five of them twice (6.8%). Conclusion Endocardial ICD implantation in children and young adults is a feasible and life-saving procedure, according to the present 15 year follow up. The rate of complications including IT was high: 72.8% in the young ICD recipients. Re-implantation of a new system was often required due to ventricular lead dysfunction or infection in 25% of the patients.

Background: Antiarrhythmic treatment of patients with recurrent ventricular tachyarrhythmia, in whom catheter ablation and amiodarone treatment were ineffective or contraindicated, is an unsolved clinical problem. Aim: The study aims to evaluate the efficacy and tolerability of mexiletine in patients with recurrent ventricular tachyarrhythmias and/or electrical storm events, in whom standard treatment strategies failed to prevent ventricular tachyarrhythmia. Methods: We performed a retrospective cohort analysis of all patients treated with mexiletine for recurrent ventricular tachycardia and/or ventricular fibrillation in our institution between January 2011 and September 2015. The primary endpoints were total number of electrical storm events and ventricular tachycardia/ventricular fibrillation (VT/VF) episodes after the beginning of mexiletine therapy. Secondary endpoints were total number of implantable cardioverter-defibrillator (ICD) therapies and discontinuation of the therapy. Events were compared with a matched duration period before initiating mexiletine. Patients served as self-controls. Results: Seventeen patients were included in the study; 11 patients were males. Mean age was 64.2 ± 15.4 years. The median time of mexiletine treatment was eight months (interquartile range [IR]: 1–22 months). The mexiletine dose was 600 mg/day in 13 patients and 400 mg/day in four patients. In four patients the dose was modified during treatment in a range from 400 to 600 mg/day depending on clinical decision. Treatment with mexiletine significantly reduced the number of electrical storm events (14 episodes vs. two episodes; median and IR for 17 patients: 1 [0–1] vs. 0 [0–0], p = 0.0010), VT/VF episodes (285 vs. 74 episodes; median and IR for 17 patients: 7 [5–27] vs. 0 [0–5], p = 0.0115), and ICD interventions (317 interven­tions vs. nine interventions; median and IR for 17 patients: 10 [5–25] vs. 0 [0–2], p = 0.0006), in comparison with a matched period before initiation of treatment. In 14 out of 17 patients (82%) sufficient tolerability of mexiletine was observed. Only in three (18%) patients severe side effects of mexiletine treatment occurred requiring discontinuation of therapy. Conclusions: Mexiletine was a sufficiently tolerated antiarrhythmic drug in short-term treatment of ventricular tachyarrhyth­mias in the studied population. Mexiletine may be effective in the treatment of recurring ventricular tachyarrhythmias or electrical storm events.

Streszczenie Wstęp: Celem pracy była ocena poziomu aktywności fizycznej, jakości życia oraz lęku, stresu i depresji u pacjentów po wszczepieniu kardiowertera-defibrylatora (ICD), u których wystąpił bądź nie incydent burzy elektrycznej związany z wielokrotnymi interwencjami ICD. Materiał i metody: Przebadano 36 pacjentów z ICD w wieku od 39 do 83 lat. Pacjentów podzielono na dwie grupy: osoby u których wystąpił (Burza +) lub nie (Burza -) incydent burzy elektrycznej. Badano: poziom aktywności fizycznej, jakości życia oraz depresji, stresu i lęku. Wyniki: W grupie Burza (+) znamiennie częściej występowały utraty przytomności przed wszczepieniem ICD i wyładowania po implantacji, niż w grupie Burza (-). Stwierdzono, iż w grupie Burza (+) u znamiennie większej ilości osob występowała obawa przed wyładowaniami, w porównaniu z grupą Burza (-). Istotnie większy był też u niej poziom lęku. W grupie Burza (+) występowały łagodne objawy depresyjne, poziom stresu był natomiast zbliżony w obu grupach. Badani nie różnili się pomiędzy sobą w większości parametrów jakości życia oraz całotygodniowej aktywności fizycznej. Wnioski: 1.Występowanie incydentów burzy elektrycznej u pacjentów z ICD istotnie zwiększa poziomu lęku przed detekcją urządzenia, wpływa na występowanie łagodnych objawów depresyjnych. 2.Burza elektryczna nie rzutuje na wzrost poziomu odczuwanego stresu, ani też na całotygodniową aktywność fizyczną. 3. Burze elektryczne ograniczają wykonywanie pracy zawodowej i prac domowych.4.Częstsze utraty przytomności u pacjentów przed wszczepieniem ICD mogą wskazywać na zwiększenie częstotliwości burz elektrycznych pojawiających się po implantacji urządzenia.

Background: Ensuring a haemodynamically effective cardiac rhythm is a challenge in patients waiting for pacemaker reimplantation after transcutaneous lead extraction due to an infection of the implanted system. Aim: The authors report a retrospective analysis of temporary pacing with an active fixation lead (AFTP) connected to an externalised pacemaker in patients after transvenous lead extraction (TLE) due to an infection. Methods: AFTP was used in 34 patients (12 women) aged from 38 to 88 years (mean 67.5 years). This represented 24.5% of the population of patients undergoing TLE due to infective indications. In 32 cases, the indication for temporary pacing was atrioventricular block, and in 2 patients sick sinus syndrome. The lead was implanted via the internal jugular vein puncture into the right ventricle in 33 cases and into the right atrium in 1 case. Leads were secured to the skin and attached to externalized pacemakers. Results: AFTP was used for 4 to 26 days (average 14.5 days). Re-implantation was performed in 29 patients (85.3% of the study group). There was no early infection recurrence. Three patients died during AFTP (8.8% of the study group), including two due to septic shock, and a cardiac arrest due to pulseless electrical activity in another patient. Conclusions: Temporary pacing with an active fixation lead is an effective and safe method to ensure a hemodynamically stable heart rhythm for a period ranging from a few to several days after the surgery in patients after transcutaneous lead extraction due to infective indications.