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Funding Acknowledgements Type of funding sources: None. Background There is a limited knowledge of immediate and long-term efficacy of pulsed field ablation for residual atrial tachycardia (AT) following (longstanding) persistent atrial fibrillation (AF) ablation and resistant to prior radiofrequency ablation (RFA). Purpose To present immediate effects of PFA (Farapulse) in a series of patients with repeat ablation for residual atrial tachycardia (AT) resistant to prior RFA. Methods and results In 5-11/2022, of 23 patients scheduled for PFA, 19 patients (64±7 years, 3 females) underwent PFA for left atrial (LA) AT resistant to RFA in first (n=4), second (n=11), third (n=3), and fourth (n=1) repeat ablation, respectively, after primary persistent AF ablation (4 patients were redirected to RFA for septal/right atrial AT source found by 3D mapping). At the procedure onset, persistent AT was ongoing (n=15) or was induced (n=4; AF induced and subsequently converted into AT in 3 patients). Mapping/ablation strategy was directed according to CS activation/entrainment to: 1) no 3D mapping and direct PFA (n=11); 2) PFA directly after 3D LA mapping (n=5); 3) PFA following RFA after 3D LA mapping (n=3). Total of 29 ATs was found (1,2, and 3 ATs in 12, 4, and 3 patients, respectively). Localized AT sources (n=16) dominated over macroreentry (MR) ATs (8 perimitral, 4 roof-dependent, 1 typical flutter). Only MR ATs, only localized ATs, and both MR+localized ATs were present in 7, 4, and 8 patients, respectively. All ATs were stopped with 5±9 PFA applications at the site of AT source and remained non-inducible. In 3 patients with initial ineffective RFA (6, 11, 6 minutes) within the same procedure, subsequent PFA terminated the AT with 1, 4, and 1 application respectively. Procedure and fluoroscopy times were 104±29 and 12±4 minutes, no complication occurred. Conclusion PFA with catheter Farapulse can affect complex/epicardial AT sources resistant to RFA in prior or present ablation procedure.

Funding Acknowledgements Type of funding sources: None. Background Benefits of pulsed field ablation (PFA) compared to radiofrequency ablation (RFA) are not known in patients with longstanding persistent atrial fibrillation (LSPAF). Purpose To present interim procedural and short-term clinical results of an ongoing prospective randomized comparison of PFA vs. RFA in patients with LSPAF. Methods In 9/2021-10/2022, 125 patients underwent catheter ablation for LSPAF using PFA (n=64, 69±8 years, 11 F, continuous AF 32±20 months) vs. RFA (n=61, 68±8 years, 17 F, continuous AF 29±23 months). PFA included pulmonary vein isolation (PVI) and extra-PV left atrial (LA) ablation. RFA included stepwise PVI, electrogram-guided LA ablation, CS isolation, and electrogram-guided right atrial ablation. Intermediate endpoints were PVI, mitral isthmus, LA roof and CTI blocks); sinus rhythm (SR) restoration by ablation was the desired procedural endpoint. Follow-up included 7-day ECG monitoring every 3 months during the first year, and every 6 months afterwards. Results In groups PFA vs. RFA, procedure and fluoroscopy times were 116±32 vs. 204±44 minutes, and 17±5 vs. 8±2 minutes, respectively (both p30 s) was achieved in 38 (79%) vs. 23 (46%) patients. Conclusion Interim results of ongoing comparison suggest procedure time reduction and improved AF/AT free survival after PFA as compared to RFA in patients with LSPAF.

Funding Acknowledgements Type of funding sources: None. Background In patients with longstanding persistent atrial fibrillation (LSPAF), mapping with multipolar catheter can enhance identification of arrhythmogenic sources during ongoing AF/converted atrial tachycardia (AT), reduce procedure time, and improve outcome of catheter ablation. Purpose To compare procedural characteristics and long-term outcome of radiofrequency catheter ablation (RFA) for LSPAF between two mapping approaches in a prospective randomized bi-centric study. Methods Between 1/2019-9/2021, RFA was performed in in 172 patients with LSPAF. Mapping with multipolar catheter Pentaray (group 1, n=85) vs. mapping with ablation catheter Navistar STSF (group 2, n=87) were compared. Stepwise ablation to the desired AF termination included pulmonary vein isolation (PVI), electrogram guided left atrial (LA) ablation, CS isolation, and right atrial electrogram guided ablation. PVI, mitral isthmus, LA roof, and CTI block were Intermediate endpoints proved at the procedure end. Sinus rhythm (SR) restoration by ablation was the desired procedure endpoint. Follow-up included 7-day ECG monitoring every 3 months during the first year, and every 6 months afterwards. Results In groups 1 vs. 2, AF was terminated (into SR or AT) in 70 (82%) vs. 68 (78%) patients (p=0.81); and SR was restored by ablation in 54 (64%) vs. 46 (53%) patients(p=0.46), respectively. Procedure, fluoroscopy, and RF delivery times (min) were 251±46 vs. 257±45 (p=0.35); 10,4±2,8 vs. 11,0±3,1 (p=0.17), and 70±21 vs. 70±24 (p=0.98), respectively. At the end of 13-45 months follow-up, stable SR was present in 72 (85%) vs. 69 (79%), patients following repeat ablation in 42 (49%) vs. 42 (48%) patients. Only 29 (34%) vs. 26 (30%) patients remained free from any AF/AT recurrence (>30 s) after single ablation (all p=NS). Conclusion Mapping with multipolar catheter vs. standard ablation catheter was associated with nonsignificant differences in procedural characteristics and clinical results of RF catheter ablation for LSPAF.

Funding Acknowledgements Type of funding sources: None. Background Pulsed field ablation (PFA) is a promising method to reduce procedure time and improve ablation safety and efficacy in all types of atrial fibrillation (AF). Purpose To present ablation approach and medium-term outcomes of PFA in all AF types. Methods Between 9/2021-10/2022, PFA using Farawave catheter was performed in 250 patients (63±11 years, 65 females). Patients with paroxysmal AF were basically scheduled for simple pulmonary vein isolation (PVI) (Farawave, ICE), patients with longstanding AF (LSPAF) underwent complex left atrial (LA) PFA (Farawave, CS 10-pole catheter, ICE); ablation extent varied in persistent AF. Results Paroxysmal AF (n=131; 115 ablated in SR), persistent AF (n=39; 11 ablated in SR), and LSPAF (n=64) were ablated with procedure times 58±20, 105±28, and 116±32 minutes, respectively, and fluoroscopy times 9±5, 14±7, and 17±7 minutes, respectively. Additional 16 patients underwent PFA for atrial tachycardia (AT). Ongoing AF was terminated by PFA in 13/16 (81%), 16/28 (57%), and 23/64 (36%) patients with paroxysmal AF, persistent AF, and LSPAF, respectively. In groups of paroxysmal AF ablated in SR, paroxysmal AF ablated in AF, persistent AF ablated in SR, persistent AF, and LSPAF, simple PVI was performed in 100%, 50%, 73%, 11%, and 0 patients respectively; and freedom from AF/AT was present in 86/99 (87%), 11/14 (79%), 7/10 (70%), 11/12 (92%), and 40/52 (77%) patients, respectively, of total 187 patients with follow-up ≥3 months (≥6 months in 139 patients). In 8 patients with repeat ablation post-PFA for paroxysmal AF (n=4), persistent AF (n=2), LSPAF (n=2), extra-PV AF/AT sources dominated in all groups. Complications included one tamponade with pericardiocentesis, and prolonged ST elevation with negative coronary angiography. Conclusion PFA using Farawave catheter was associated with reduced procedure times and favourable medium-term outcome for all AF types. Early experience specifically suggests improved outcome after extensive LA ablation for persistent AF/LSPAF.

The causes of nonischemic dilated cardiomyopathy are classified as genetic or nongenetic, but environmental factors such as metal pollutants may interact with genetic susceptibility. The presence of metal particles has been detected in the myocardium, including in those patients with dilated cardiomyopathy. It is also known that hypersensitivity reactions can induce inflammation in tissue. The present study aimed to verify if metal-induced delayed-type hypersensitivity is present in patients with nonischemic dilated cardiomyopathy. The patient group consisted of 30 patients with newly diagnosed dilated cardiomyopathy; the control group comprised 41 healthy subjects. All patients and control subjects provided blood samples for lymphocyte transformation testing (MELISA®) to assess possible hypersensitivity to seven common metals. Specific exposure to metals was based on interview data. Results showed that exposure to cadmium and lead (p = 0.0002), aluminum (p = 0.0006), nickel (p = 0.0012), and chromium (p = 0.0065) was more often reported by patients than controls. The patients also had significantly more frequent hypersensitivity reactions to mercury (26.7% vs. 7.3%, p = 0.014624), nickel (40% vs. 12.2%, p = 0.02341), and silver (20% vs. 4.8%, p = 0.025468) than the control group. Patients with dilated cardiomyopathy had greater exposure to certain metals compared with healthy controls. Hypersensitivity to metals was more frequent in patients with dilated cardiomyopathy, suggesting a possible association that warrants further investigation.

The influence of polymorphisms in the large group of MMP and TIMP genes on clinical outcomes in patients after ST elevation myocardial infarction (STEMI) treated with primary PCI was analysed. In total, 550 consecutive Caucasian patients with STEMI were included in the present study, with a median of 32 months. We analysed 19 polymorphisms in the genes coding MMP and TIMP genes. The MMP-1 -519A/G and -422A/T polymorphisms are associated with combined endpoint after myocardial infarction. The hazard ratio for AT variant of MMP-1 -422A/T was 1.75 (p

Objective Takotsubo syndrome (TS) is a heart condition characterised by a sudden transient left ventricular dysfunction; its pathophysiology is probably associated with elevated levels of catecholamines but the exact mechanism is not known as yet. Literature and clinical experience suggest that TS affects persons with various comorbidities. This pilot work aims to evaluate the frequency of comorbidities with potential pathological immune reactivity, and to evaluate the potential association between TS and hypersensitivity to metals assessed by LTT-MELISA (R). Methodology, Results A total of 24 patients (23 women, 1 man) with a history of TS attack and 27 healthy controls were evaluated. Hypersensitivity was evaluated by a lymphocyte transformation test (LTT-MELISA (R)); a questionnaire of environmental burden was used to select evaluated metals. A total of 19 patients (79%) had at least one condition that might potentially be associated with pathological immune reactivity (autoimmune thyroid disease, drug allergy, bronchial asthma, cancer, contact dermatitis, rheumatoid arthritis). Hypersensitivity to metals was identified significantly more frequently in TS patients than in healthy controls (positive reaction to at least one metal was identified in 95.8% of TS patients and in 59.3% of controls; p = 0.003); the difference was statistically significant for mercury (45.8% and 14.8%, respectively; p = 0.029). Conclusion Our work shows that conditions with pathological immune reactivity occur frequently in TS patients, and our data suggest a possible association between TS and hypersensitivity tometals (mercury in particular) evaluated by LTT-MELISA (R). We also suggest that apart from the triggering stress factor, potential existence of other serious conditions should be considered when taking medical history of TS patients.

Aims: Tissue inhibitors of metalloproteinase (TIMPs) bind to active matrix metalloproteinase (MMPs), and thereby inhibit their proteolytic activity. We investigated the role of polymorphisms in the gene for TIMP-1 and serum levels of TIMP-1 in association with postmyocardial infarction (MI), left ventricular (LV) dysfunction, and symptoms of acute heart failure (AHF) in patients treated with primary percutaneous coronary intervention. Methods: In total, 556 patients with STEMI were evaluated. Levels of TIMP-1 were measured at admission and 24 h after MI onset. The TIMP-1 exon 5 SNP rs4898 (F124F with T>C) located at X chromosome was assayed. Results: TIMP-1 levels were higher for men with AHF as well as for men with LV dysfunction (ejection fraction [EF]

We compared the prognostic capacity of conventional and novel invasive parameters derived from the slope of the preload recruitable stroke work relationship (PRSW) in STEMI patients and assessed their contribution to the TIMI risk score.Left ventricular end-diastolic pressure (EDP), ejection fraction (EF), pressure adjusted maximum rate of pressure change in the left ventricle (dP/dt/P), aortic systolic pressure to EDP ratio (SBP/EDP) and end-diastolic volume adjusted stroke work (EW), derived from the slope of the PRSW relationship, were obtained during the emergency cardiac catheterization in 523 STEMI patients. The predictive power of the analyzed parameters for 30-day and 1-year mortality was evaluated using C-statistics and reclassification analysis was adopted to assess the improvement in TIMI score.The highest area under the curve (AUC) values for 30-day mortality were observed for EW (0.872(95% confidence interval 0.801-0.943)), SBP/EDP (0.843(0.758-0.928)) and EF (0.833(0.735-0.931)); p0.001 for all values. For 1-year mortality the best predictive value was found for EW (0.806(0.724-0.887) and EF (0.793(0.703-0.883)); p0.001 for both. The addition of EDP, SBP/EDP ratio and EW to TIMI score significantly increased the AUC according to De Long's test. For 30-day mortality, increased discriminative power following addition to the TIMI score was observed for EW and SBP/EDP (Integrated Discrimination Improvement was 0.086(0.033-0.140), p=0.002 and 0.078(0.028-0.128), p=0.002, respectively).EW and SBP/EDP are prognostic markers with high predictive value for 30-day and 1-year mortality. Both parameters, easily obtained during emergency catheterization, improve the discriminatory capacity of the TIMI score for 30-day mortality.

Background: Pre-infarction unstable angina pectoris (UAP) can be considered ischemic preconditioning. The aim of this study was to compare short and long term outcomes in patients with or without pre-infarction UAP and ST elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). Methods: 593 patients with STEMI (388 without and 205 with UAP) were evaluated. Levels of biomarkers (troponin I, BNP, NT-ProBNP, neopterin, endoglin and pentraxin-3) at hospital admission and 24 h after STEMI onset were assessed. Echocardiography was undertaken on the fourth day after MI and after 12 months. The median follow-up was 37 months. Results: We found no significant differences in sex, age or risk factors for atherosclerosis between the UAP and non-UAP group. As the median time from the onset of chest pain to admission was significantly longer in the UAP group (228 min vs 258 min; P=0.009), we used a propensity score to obtain comparable matched groups for use in further analyses. The levels of NT-proBNP were significantly higher on admission and after 24 hours in the UAP group. Left ventricular functions according to invasive and echocardiographic parameters were entirely comparable at hospitalization and after 12 months. No differences were found in severity index of acute heart failure during hospitalization. The incidence of major acute coronary events during follow-up was comparable for the groups. Conclusions: In patients with STEMI treated with primary PCI, pre-infarction UAP has no beneficial clinical effect during hospitalization or during long-term follow-up.

Acute heart failure during ST elevation myocardial infarction (STEMI) makes worse prognosis. The aim of the work was to find independent factors with relationship to acute heart failure (AHF) and the early development of left ventricular dysfunction within the prospective followed patients with STEMI.A total of 593 patients with STEMI treated by primary PCI (164 patients with AHF) were the study population. The activity of BNP and NT-ProBNP were measured at hospital admission and 24 h after MI onset. Left ventricular angiography was done before PCI; echocardiography was undertaken between the third and fifth day after MI.The patients with AHF had higher level of glycaemia, creatinine, uric acid, HDL-cholesterol, leukocytosis and natriuretic peptid. The total hospital mortality was 3.7%. 0.2% within the patients without AHF, 3.2%, 14.3%, resp. 63.6% within the patients with mild AHF, with pulmonary oedema, resp. with cardiogenic shock. The patients with AHF had lower ejection fraction (45.4 +/- 11.9% vs 53.0 +/- 10.3%). According to the multiple logistic regression we found higher glycaemia, age, heart rate, anterior wall MI, lower aortic pulse pressure and collaterals of infarct related artery as factors with independent relationship to AHF. Higher glycaemia, age, heart rate, anterior wall MI and lower aortic pulse pressure were found as independent factors with relationship to left ventricular dysfunction. According to ROC analysis possible cut off corresponding with AHF we suggested 29.5 mm Hg for LVEDP, 28.5 for dP/dt/P, 9.5 mmol/l for glycaemia, 50 mm Hg for aortic pulse pressure.Our results found the development of AHF in one third of patients with STEMI. AHF increases the risk of in-hospital mortality and the risk depends upon severity of failure. As the independent factors with relationship to development of AHF or left ventricular dysfunction we detected higher glycaemia, heart rate, anterior wall MI, age. Lower risk had patients with higher aortic pulse pressure.

Background We evaluated the associations among angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism, ACE activity and post-myocardial infarction (MI) left ventricular dysfunction and acute heart failure (AHF) early after presentation with MI with ST-segment elevation (STEMI). Methods A total of 556 patients with STEMI treated by primary PCI (421 patients without AHF and 135 patients with AHF) were the study population. The activity of BNP, NT-ProBNP and ACE were measured at hospital admission and 24 h after MI onset. Left ventricular angiography was done before PCI; echocardiography was undertaken between the third and fifth day after MI. Results In comparison with the II genotypes group, the DD/ID group had a higher level of ACE activity upon hospital admission (p < 0.001). We found a significantly higher level of ACE activity in patients with moderate LV dysfunction (EF 40-54%) in comparison both with patients with preserved LV function (EF ≥55%) and with patients with severe LV dysfunction (p = 0.028). A non-significant trend towards a higher incidence of mild AHF (22.1% vs. 16.02%, p = 0,093), a significantly higher value of end-systolic volume (ESV/BSA) (30.0 ± 12.3 vs. 28.5 ± 13.0; p < 0.05) and lower EF (50.2 ± 11.1 vs. 52.7 ± 11.7; p < 0.05) in the DD/ID genotypes group was noted. Even after multiple adjustments according to multivariate models, the EF for the DD/ID group remained significantly lower (p = 0,033). The DD/ID genotypes were associated with a significantly higher risk of EF Conclusions These results suggest that the I/D polymorphism of ACE is associated with the development of LV dysfunction in the acute phase after STEMI. We demonstrated for the first time an association of the low ACE activity with the severe LV dysfunction, although patients with moderate LV dysfunction had higher level ACE activity than patients with preserved LV function.

Acute mesentery artery embolization is a rare diagnosis. In case of late recognition the mortality may reach up to 93%. Acute abdominal pain, vomitus, rapid and sudden bowel evacuation with or without blood are the typical symptoms of the disease. Unfortunately, the symptoms do not often correlate with clinical findings. Plain X-ray of abdomen or CT tomography may show no signs of intestinal ischaemia. The diagnostic method to choose is either spiral CT angiography or contrast angiography, respectively. The most common therapeutical approach is surgical revascularization but in selected cases it is feasible to perform local thrombolysis with a microcatheter placed directly into the occluded artery. Papaverin vasodilatation and intravenous anticoagulation are also justifiable, catheter aspiration and stent implantation have also been challenged. Our review is to provide a detailed up-to-date information about the issue and is an extensive follow-up of our recently published case report [Superior mesentery artery embolization as a complication of the primary angioplasty solved by local thrombolysis. Vnitr Lék 2008; 54(9): 871-875].

Acute mesentery artery embolization is a rare complication of invasive catheterizations. The incidence is unknown. In case of late diagnosis the mortality may reach up to 93%. Acute abdominal pain, vomitus, rapid and sudden bowel evacuation with or without blood are the typical symptoms of the disease. Plain X-Rays of abdomen or CT tomography may show no signs of intestinal ischaemia. The diagnostic method to choose is either spiral CT angiography or contrast angiography, respectively. The most common therapeutical approach is surgical revascularization but in selected cases it is feasible to perform local thrombolysis with a microcatheter placed directly into the artery with embolus. We report a case of a man who was admitted with an acute myocardial infarction who underwent primary angioplasty with implantation ofa bare-metal stent. After the procedure he developed severe and progressive abdominal pain as a result of acute superior mesentery artery embolization. In this patient we performed a local thrombolysis with rt-PA (alteplase) with a great technical success and immediate pain relief, with no need of surgical revision. Our approach was concordant to recommendations cited in this article.

Define the profile of NT-proBNP values in asymptomatic adult patients after radical correction of Tetralogy of Fallot (TOF) and identify links between possible increase in NT-proBNP and residual echocardiographic findings.NT-proBNP samples were taken from and a detailed echocardiographic examination was performed in 21 adult stabilised patients after radical correction of TOF in childhood. The results were submitted for statistical analysis.The incidence of low values of the S wave11.5 cm/s of tricuspid anulus evaluated by tissue Doppler echocardiography (TDI) (P0.05) was significantly higher in patients with NT-proBNP125 pg/ml. All patients with impaired right ventricular diastolic filling evaluated by tissue Doppler echocardiography (E' / A'1 ) had higher values of NT-proBNP (NS). Other echocardiographic parametres did not show any dependence on NT-proNBP values, including the morphology or atrial defects in the right heart sections which are most conspicuous in an echocardiographic examination.Asymptomatic patients after radical correction of TOF have higher values of NT-proBNP (167.95 +/- 91.75 pg/ml). At the same time, the increase closely correlates with the detection of a global right ventricle systolic dysfunction evaluated by S (TDI). On the other hand, there is often no correlation between highly conspicuous changes in the morphology of the right heart compartments or residual or postincision defects of the pulmonary valve on the one hand and increased NT-proBNP on the other. The S measurement has the potential to become routine examination in patients after radical correction of TOF for timely detection of right ventricular systolic dysfunction. Precise prognostic and primarily therapeutic impact of the pathologic finding still needs to be determined.

Primary amyloidosis is a rare disease, cardiac involvement occurs in up to 40% of patients. Diffuse amyloid deposits cause an impairment of myocardial systolic and diastolic function. In this paper we are presenting a case of a 54-year-old woman. The woman was admitted because of progressive fatigue, dyspnoea, chest pain, later she experienced hypotension, dyspepsia, and enterorrhagia. ECG showed decrease in QRS amplitude. We have found an echocardiographic evidence of wall hypertrophy. Right cardiac catheterization showed a restrictive situation. Immunobinding of serum and urine revealed monoclonal kappa light chains. The diagnosis was determined by rectal biopsy. Unfortunately, amyloid deposits caused progressive heart failure, hemorrhage, and death just before the diagnosis of primary amyloidosis could be determined on the basis of results of the immunofixations of serum and urine proteins (detection of the monoclonal light chains kappa) and from biopsy specimens taken from rectum (amyloid deposits).

A group of 63 patients with infectious endocarditis (IE) (1991-1998) was subjected to a detailed retrospective analysis. The authors investigated the age of the patients, site of IE, type of infectious agent, incidence of coinciding diseases or interventions in the close premorbid period of IE, size of vegetation, incidence of embilizations, heart failure, indications for vital early cardiosurgery, number of deaths. From the clinical analysis it may be concluded: 1. There is a new group of patients with IE, who before development of the disease have no manifest cardiac disease who however frequently suffer from another coinciding disease; 2. There is a significant increase of dextrolateral IE (frequently "pacemaker" IE); 3. The ratio of staphylococcal strains in the etiopathogenesis of IE is rising; 4. The mean age of the affected patients is rising (as well as the age scatter); 5. IE is unfortunately frequently diagnosed only after embolization of the vegetation (mostly cerebrovascular attacks) in obscure febrile conditions.

The authors assessed in 24 men with stable angina pectoris, using means of ergometry, the antiischaemic and antianginose effects of a combination of the nitrate Iso-Mack retard and the diuretic Moduretic. The effects were compared with the effects of Iso-Mack retard administered alone and with the effects of placebo. The examination was made after a single dose of the drugs and after three-week administration. The authors revealed that a single dose of the diuretic significantly enhanced the effects of nitrate. During long-term administration the diuretic did not prevent a significant diminution of the nitrate effects. Finally the authors discuss possible mechanisms of development of tolerance for nitrates and possibilities how to influence this tolerance by a diuretic.

In 24 men with angina after exertion the authors assessed, using ergometry, the action of molsidomine retard and isosorbide dinitrate retard after a single dose and after tree-week administration of the drug. The authors found that 8 mg of molsidomine retard in a single dose had a somewhat more potent effect than 40 mg isosorbide dinitrate retard. After prolonged administration the effect of both drugs on haemodynamics diminished and in molsidomine a significant decline of action was observed before development of a reduced S-T segment on the ECG. After three weeks' administration the effects of both drugs were comparable. After neither drug clinically significant tolerance developed when the drug was administered every 8 hours. In the conclusion the authors discuss possible mechanisms involved in development of tolerance.