Search

Background: In contrast to adults, in whom cardiac rhythm disorders are mainly conditioned by coronary artery disease, in children, arrhythmias are most often associated with inherited heart disorders. Catheter ablation (CA) has an important role in the management of cardiac arrhythmias, in adults and children. The aim of the study was to assess and compare the efficacy and safety of CA in children and adults with preexcitation syndrome. Methods: The study population comprised 43 adults and 43 children diagnosed with a Wolff-Parkinson-White syndrome (WPW). The mean age of the study population was 41 ± 15 years for adults and 14 ± 2.5 years for children. In all patients, an electrophysiological study and CA were performed. Analysis with respect to the procedure duration, fluoroscopy exposure time, location of accessory pathways (AP), immediate success rate and complications were performed. Results: Electrophysiological study revealed the most frequent presence of left-sided AP (56% in children and 70% in adults). The mean procedure duration was 96 ± 36 min and 106 ± 51 min in children and adults, respectively (p = NS). The mean fluoroscopy duration was 8.5 ± 4.3 min and 5.9 ± 5.8 min in children and adults, respectively p < 0.05. The CA procedure was successful in 40 out of 43 (93%) adults and in 36 out of 43 (83.7%) children (p = NS). In 2 (4%) children minor complications occurred. Conclusions: Ablation in children and adults are equally effective with respect to short-term clinical observation.

Funding Acknowledgements Type of funding sources: None. Background Pulmonary vein isolation (PVI) is at the forefront of rhythm control strategies in patients with atrial fibrillation (AF). A very-high-power, short-duration (vHPSD) catheter was designed to improve the effectiveness of AF ablation within a shorter procedure time. We aimed to compare the effectiveness and safety of PVI ablation between this vHPSD ablation mode (90W/4s) and conventional index-guided ablation (up to 40W/indexed). Methods This single-center, retrospective, observational study enrolled 148 patients with AF, referred for catheter ablation between December 16, 2019 and July 29, 2022. In 77 procedures (mean age: 59.7±12.0 years; 61.0% male; 74.0% paroxysmal), a vHPSD catheter was used (vHPSD-group), and 71 patients (mean age: 58.1±11.6 years; 70.4% male; 67.6% paroxysmal) were treated with a ablation index catheter (AI-group). The study assessed the recurrence of AF at 3- and 6-months after ablation. The outcomes also included the amount of opioids administered during the procedure and the incidence of treatment-emergent adverse events. Additionally, procedural factors, such as total procedure time, fluoroscopy time and radiofrequency application time were compared between the groups. Results At 3 months, AF was found to recur in 14.29% (11/77) of patients in the vHPSD-group and in 30.99% (22/71) of patients in the AI-group (p=0.02). At 6 months, 18.31% (13/71) patients reported AF recurrence in the vHPSD-group and 32.73 % (18/55) in the AI-group (p=0.09). There was no difference in treatment-emergent adverse events between the two groups (3.9% vs. 2.8%; p=1.00). One severe adverse event (a cerebral vascular accident) was observed in the vHPSD-group. The mean dose of remifentanil was reported to be lower during vHPSD-based PVI (p Conclusions This study suggests that the vHPSD-quided PVI is equally effective and safe with reference to short-term clinical observation as conventional ablation. Also, the vHPSD ablation may allow to reduce the dosage of analgesics during significantly shorter procedures.

Background: Mobile devices are gaining a rising number of users in all countries around the globe. Novel solutions to diagnose patients with out-of-hospital onset of arrhythmic symptoms can be easily used to record such events, but the effectiveness of these devices remain unknown. Methods: In a group of 100 consecutive patients of an academic cardiology care center (mean age 68 ± 14.2 years, males: 66%) a standard 12-lead electrocardiogram (ECG) and a Kardia Mobile (KM) record were registered. Both versions were assessed by three independant groups of physicians. Results: The analysis of comparisons for standard ECG and KM records showed that the latter is of lower quality (p < 0.001). It was non-inferior for detection of atrial fibrillation and atrial flutter, showed weaker rhythm detection in pacemaker stimulation (p = 0.008), and was superior in sinus rhythm detection (p = 0.02), though. The sensitivity of KM to detect pathological Q-wave was low compared to specificity (20.6% vs. 93.7%, respectively, p < 0.001). Basic intervals measured by the KM device, namely PQ, RR, and QT were significantly different (shorter) than those observed in the standard ECG method (160 ms vs. 180 ms [p < 0.001], 853 ms vs. 880 ms [p = 0.03] and 393 ms vs. 400 ms [p < 0.001], respectively). Conclusions: Initial and indicative value of atrial fibrillation and atrial flutter detection in KM is comparable to results achieved in standard ECG. KM was superior in detection of sinus rhythm than eye-ball evaluation of 12-lead ECG. Though, the PQ and QT intervals were shorter in KM as compared to 12-lead ECG. Clinical value needs to be verified in large studies, though.

Background: The recent introduction of an entirely subcutaneous implantable cardioverter-defibril­lator (S-ICD) represents an important progress in the defibrillation technology towards a less invasive approach. This is a single-center observational study of S-ICD implantations in Poland. Methods: The S-ICD was implanted in 11 patients with standard indications for an ICD. Patients in whom the device was implanted were evaluated for adverse events and device function at hospital discharge. All hospitalization costs were calculated and summed up for all patients. Costs were divided into following categories: medical materials, pharmaceuticals, operating theatre staff, cardiology depart­ment staff, laboratory tests, non-laboratory tests and additional non-medical costs. Results: The mean age of patients was 51.6 ± 16.4 years, 9 were men and 2 were women. Four pa­tients had atrial fibrillation as the basal rhythm, 1 patient had atrial flutter and 6 patients had sinus rhythm. All patients had at least one condition that precluded the use of a traditional ICD system or the S-ICD was preferred due to other conditions, i.e. a history complicated transvenous ICD therapy (18%), anticipated higher risk of infection (27%), lack or difficult vascular access (18%), young age and anticipated high cumulated risk of lifetime device therapy (36%). The mean duration of the im­plantation procedure was 2 h. One patient developed a postoperative pocket hematoma. Mean total time of hospitalization was 28 (6–92) days. Average cost of hospitalization per patient was 21,014.29 EUR (minimal = 19,332.71 EUR and maximal = 24,824.14 EUR). Conclusions: S-ICD implantation appears to provide a viable alternative to transvenous ICD, espe­cially for patients without pacing requirements.

According to European Society of Cardiology guidelines, the goal of heart failure (HF) management is to provide an effective system of care through the whole patient’s journey including hospital and ambulatory pathway. Strategies based on patients’ education, psychosocial support and monitoring should be considered as a fundamental part of multidisciplinary disease management programs and may lead to a reduction in mortality and morbidity and improvement in the quality of life. In this article, we focus on patient’s education strategies by describing different models: “one-to-one” strategies, multidisciplinary care management programs, activation of the family members, pharmaceutical care, and end-stage HF advance care planning. Furthermore, we explain the problem of health literacy among HF patients and describe actionable advice on how medical professionals can effectively improve patients’ comprehension and knowledge on disease management and the ability for self-care. Lastly, we review the latest evidence on outcomes obtained by HF education.

Despite significant diagnostic and therapeutic advances, heart failure (HF) is linked with high mortality and morbidity. Hospitalization for decompensated HF is still the most common cause of hospitalization in adults. What is more, a particularly high risk of hospitalization (even up to 50% of patients) is observed within a few months after a previous HF hospitalization. Sacubitril/valsartan, a first-in-class drug, contains a neprilysin inhibitor (sacubitril) and an angiotensin II receptor blocker (valsartan). In PARADIGM-HF trial investigators showed, that sacubitril/valsartan significantly reduced primary endpoint combined with cardiovascular death or HF hospitalization in patients with chronic, symptomatic HF (New York Heart Association class II-IV) with reduced ejection fraction (left ventricular ejection fraction [LVEF] ≤ 35-40%). Recently, results of the PIONEER-HF trial, which included HF patients with LVEF ≤ 40% who were hospitalized for acute decompensated HF were also published. The study proved that early, in-hospital, implementation of sacubitril/valsartan in these patients resulted in a substantially greater reduction of N-terminal prohormone B-type natriuretic peptide concentration and a lower rate of HF rehospitalizations with similar safety profile for enalapril.

Background: The number of patients with implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy and defibrillator (CRT-D) is growing. This results in high workloads for centers performing standard controls (SC) of these systems. Medtronic CareLink Express® (MCLE) is a solution enabling remote controls (RC) of implantable devices. In cases of detecting arrhythmias or device malfunctioning, it automatically generates alarms transmitted to the controlling physician. The objective of the study was to evaluate the effectiveness of alarms generated by MCLE in identification of patients that require clinically significant intervention during SC. Methods: A total of 119 patients (age 64 ± 14, 17 women) implanted with ICD/CRT-D were included in the trial. Device reprogramming or pharmacological treatment modifications during SC were as­sessed as significant if they were required for optimal clinical management of the patient (effectiveness of antiarrhythmic and resynchronization therapy, also patient safety). Analysis of generated alarms was then performed to assess the effectiveness (sensitivity and specificity) of MCLE in identifying patients that require changes in therapy. Results: Data from 129 transmissions and 129 subsequent SCs were analyzed. 179 alarms were recorded during 96 (74%) transmissions. A total of 333 program changes of implanted devices took place during 107 (83%) SCs. Device reprogramming was considered clinically significant in 27 cases Additionaly, 13 pharmacological treatment modifications were performed. Sensitivity and specificity of alarms generated by MCLE with regards to identification of patients requiring clinically significant intervention was 87% and 31%, respectively. Finally, a statistically significant difference was observed in the number of clinically significant interventions among patients with and without MCLE alarms (33 [86.8%] vs. 5 [13.2%], p = 0.037). Conclusions: Medtronic CareLink Express® is an RC system enabling high-sensitivity supervision of patients with cardiac

Background: Dual antiplatelet therapy (DAPT) is recommended after elective percutaneous coronary intervention (PCI) in stable coronary artery disease (SCAD) patients; however, still one-third of patients do not obtain adequate platelet inhibition that may result in increased cardiovascular risk. The aim of the ONSIDE TEST study is to evaluate the clinical impact of point-of-care genotyping- and platelet function-based personalized dual antiplatelet strategies in SCAD individuals undergoing PCI. Methods: Fifty patients were randomized to one of the three study arms: 1) genotyping, 2) platelet function testing (PFT) and 3) control. Patients were tested with point-of-care Spartan RX CYP2C19 System (group 1) and VerifyNow P2Y12 assay (group 2). In cases of inadequate response to clopidogrel, a loading dose of prasugrel was administered before PCI. The main clinical endpoint is the incidence of periprocedural myocardial injury (PMI). Results: Five (32%) patients in the genotyping arm and two (13%) in the in the PFT arm were identi-fied as poor clopidogrel metabolizers. The periprocedural platelet reactivity was significantly lower in the genotyping (80 ± 49.0 PRU) and PFT (36.5 ± 47 PRU) arms as compared to the control arm (176 ± 67.8 PRU), p = 0.01 and p = 0.03, respectively. PMI appeared in 17 (37%) patients of the entire study population. Conclusions: Personalized DAPT results in an improved platelet inhibition. Apart from genotyping and aggregometry, it is feasible to integrate into everyday clinical practice PMI rates which are relevant when comparing different strategies

The use of dabigatran, a non-vitamin K antagonist (VKA) oral anticoagulant, is still increasing. Dabigatran has a good efficacy and safety ratio, as well as a more predictable anticoagulation effect compared with VKA. On the other hand, there is acenocoumarol/warfarin, a VKA which was evaluated in numerous clinical trials and is a drug of choice in a valve-related atrial fibrillation (AF). Based on the real clinical cases, we attempted to summarize current recommendations on how to manage periprocedural complications on oral anticoagulant treatment. In the first case we presented a patient on dabigatran, undergoing pulmonary vein isolation (PVI) of AF, who developed a right groin hematoma after the procedure and hence required several blood transfusions. In the second case we showed a patient on acenocoumarol, with high bleeding risk, who developed a pocket hematoma after an implantable cardioverter-defibrillator (ICD) implantation. We also reported a patient on dabigatran, who developed a femoral artery pseudoaneurysm (FAP) following PVI of AF. Periprocedural oral anticoagulation depends on the anticoagulant type and requires individual assessment of the patient’s thromboembolic and bleeding risk factors. Our case reports showed that in case of a bleeding, dabigatran may be quickly stopped and then restarted recently after reaching hemostasis, in contrast to acenocoumarol. They also confirm a possibility of successful pseudoaneurysm closure without dabigatran suspension.

Background: Endothelial dysfunction (ED) frequently precedes cardiovascular diseases (CVD) and is a well-established risk factor of major adverse cardiac events. Beta-blockers are the fundamental drugs used in CVD treatment. Methods: A systematic literature search for randomized controlled trials investigating influence of beta-blockers on endothelial function assessed by flow-mediated dilation (FMD) was performed in the PubMed and Cochrane Databases. Results: Sixteen full-text studies involving a total of 1,273 patients were included in the final analysis. The mean age of participating patients ranged from 44.9 to 63.2 years, the follow-up duration from 1 to 12 months. The comparison of FMD change between the beta-blockers and placebo groups showed a statistically significant effect of beta-blockers on endothelial function (mean difference [MD] 0.83; 95% confidence interval [CI] 0.11–1.55; p = 0.02). Third generation beta-blockers improved FMD in a statistically significant manner compared with second generation beta-blockers (MD 1.65; 95% CI 0.17–3.11; p = 0.03). Beta-blockers gave an FMD change similar to that obtained with angiotensin receptor blockers (ARB), calcium channel blockers (CCB) or hydrochlorothiazide. The FMD value in the beta-blocker group was significantly lower compared with the group treated with angiotensin converting enzyme inhibitors (ACEI) (MD –0.79; 95% CI –1.37–(–0.21); p = 0.008) and higher than in the ivabradine group (1.6 ± 3.61 vs –0.3 ± 1.66; p = 0.02). Conclusions: Beta-blockers improve the endothelial function compared with placebo. More­over, third generation beta-blockers improve FMD values significantly better than the second generation ones. Beta-blockers had similar effect on endothelial function as did ARB, CCB or diuretics. However, the beneficial effect of beta-blockers was lower when confronted with ACEI.

Background: Resting heart rate (HR) has been proven to influence long-term prognosis in patients with chronic heart failure (HF). The aim of this study was to assess the relationship between resting HR at hospital admission and hospital outcome in patients with HF. Methods: The study included Polish patients admitted to hospital due to HF who agreed to participate in Heart Failure Pilot Survey of the European Society of Cardiology. Results: The final analysis included 598 patients. Median HR at hospital admission was 80 bpm. In univariate analyses, higher HR at admission was associated with more frequent use of inotropic support (p = 0.0462) and diuretics (p = 0.0426), worse clinical (New York Heart Association — NYHA) status at discharge (p = 0.0483), longer hospital stay (p = 0.0303) and higher in-hospital mortality (p = 0.003). Compared to patients who survived, patients who died during hospitalization (n = 21; 3.5%) were older, more often had a history of stroke or tran­sient ischemic attack and were characterized by higher NYHA class, higher HR at admission, lower systolic and diastolic blood pressure at admission, lower ejection fraction, lower glomeru­lar filtration rate, and lower natrium and hemoglobin concentrations at hospital admission. In multivariate analysis, higher HR at admission (OR 1.594 [per 10 bpm]; 95% CI 1.061–2.395; p = 0.0248) and lower natrium concentration at admission (OR 0.767 [per 1 mmol/L]; 95% CI 0.618–0.952; p = 0.0162) were the only independent predictors of in-hospital mortality. Conclusions: In patients with HF, higher resting HR at hospital admission is associated with increased in-hospital mortality.

Background: Radiofrequency (RF) catheter ablation is a first-line therapy for patients with drug-refractory atrial fibrillation (AF). Complete isolation of electrical potentials at the ostium of pulmonary vein (PV) is a challenging procedure. There are different techniques and devices used for PV isolation (PVI). The objective of this study was to evaluate the efficacy and safety of PV ablation catheter (PVAC). Methods: A total of 67 consecutive patients with paroxysmal and persistent AF were treated with the PVAC. The patients’ information were obtained from clinical charts. Follow-up was obtained by one day Holter monitoring at 2, 4, 6, 8, 10 and 12 months after ablation and ECG registration if any symptoms or arrhythmia occurred. Results: The median follow-up duration was 16 months (IQR: 12–20 months). In the population which was available at follow-up (n = 60), 22 (36.7%) patients were in sustained sinus rhythm (SR) without anti-arrhythmic drugs (AAD). Overall 26 (43.3%) patients were in sustained SR with and without AAD. In the paroxysmal AF group, after a single PVAC ablation procedure (n = 39), 19 (48.7%) patients had sustained SR without AAD. In the persistent AF group (n = 15), after the single PVAC ablation, 2 (13.3%) patients had sustained SR without AAD. Conclusions: PVI with PVAC is a safe procedure with 48.7% efficacy in patients with paroxy smal AF. The efficacy of PVAC in patients with persistent or long-standing persistent AF is not acceptable. (Cardiol J 2013; 20, 6: 618–625)

Background: The aim of the study was to compare clinical characteristics of real-life atrial fibrillation (AF) patients with populations included in randomized clinical trials (ROCKET AF and RE-LY). Methods: The analysis included 3528 patients who are participants of the ongoing, multicentre, retrospective CRAFT study. The study is registered in ClinicalTrials.gov: NCT02987062. The study is based on a retrospective analysis of hospital records of AF patients treated with vitamin K antagonists (VKAs) (acenocoumarol, warfarin) and non-vitamin K oral anticoagulants (NOACs) (dabigatran, rivaroxaban). CHADS2 score was used for risk of stroke stratification. Results: VKA was prescribed in 1973 (56.0%), while NOAC in 1549 (44.0%), including dabigatran — 504 (14.3%) and rivaroxaban — 1051 (29.8%), of the 3528 patients. VKA patients in the CRAFT study were at significantly lower risk of stroke (CHADS2 1.9 ± 1.3), compared with the VKA population from the RE-LY (2.1 ± 1.1) and the ROCKET-AF (3.5 ± 1.0). Patients in the CRAFT study treated with NOAC (CHADS2 for patients on dabigatran 150 mg — 1.3 ± 1.2 and on rivaroxaban — 2.2 ± 1.4) had lower risk than patients from the RE-LY (2.2 ± 1.2) and the ROCKET AF (3.5 ± 0.9). Conclusions: Real-world patients had a lower risk of stroke than patients included in the RE-LY and ROCKET AF trials.