Clinical features, etiology, and survival in patients with restrictive cardiomyopathy: A single-center experience.

BACKGROUND: Numerous prognostic factors have been proposed for cardiac amyloidosis (CA). The knowledge about other subtypes of restrictive cardiomyopathy (RCM) is scant. AIMS: This study aimed to elucidate the etiology and prognostic factors of RCM as well as assess cardiac biomarkers: high-sensitive troponin T (hs-TnT), growth differentiation factor-15 (GDF-15), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and soluble suppression of tumorigenicity 2, as mortality predictors in RCM. METHODS: We enrolled 36 RCM patients in our tertiary cardiac department. All patients were screened for CA. Genetic testing was performed in 17 patients without CA. RESULTS: Pathogenic or likely pathogenic gene variants were found in 86% of patients, including 5 novel variants. Twenty patients died, and 4 had a heart transplantation during the study. Median overall survival was 29 months (8-55). The univariate Cox models analysis indicated that systolic and diastolic blood pressure, GDF-15, hs-TnT, NT-proBNP, left ventricular stroke volume, the ratio of the transmitral early peak velocity (E) estimated by pulsed wave Doppler over the early mitral annulus velocity (e'), tricuspid annulus plane systolic excursion, early tricuspid valve annular systolic velocity, the presence of pulmonary hypertension, and pericardial effusion influenced survival (P <0.05). A worse prognosis was observed in patients with GDF-15 >1316 pg/ml, hs-TnT >42 ng/l, NT-proBNP >3383 pg/ml, and pericardial effusion >3.5 mm (Kaplan-Meier analysis, log-rank test, P <0.001). CONCLUSIONS: Genetic testing should be considered in every RCM patient where light-chain amyloidosis has been excluded. Survival remains poor regardless of etiology. Increased concentrations of GDF-15, hs-TNT, NT-proBNP, and pericardial effusion are associated with worse prognosis. Further studies are warranted.

Analysis of the Results of the Borowiec SLR Station (7811) for the Period 1993-2019 as an Example of the Quality Assessment of Satellite Laser Ranging Stations.

This paper presents the results of an orbital analysis of satellite laser ranging data performed by the Borowiec SLR station (7811) in the period from July 1993 to December 2019, including the determination of the station positions and velocity. The analysis was performed using the GEODYN-II orbital program for the independent monthly orbital arcs from the results of the LAGEOS-1 and LAGEOS-2 satellites. Each arc was created from the results of the laser observations of a dozen or so selected stations, which were characterized by a large number of normal points and a good quality of observations. The geocentric and topocentric coordinates of the station were analyzed. Factors influencing the uncertainty of the measurements were determined: the number of the normal points, the dispersion of the normal points in relation to the orbits, and the long-term stability of the systematic deviations. The position leap at the end of 2002 and its interpretation in ITRF2014 were analyzed. The 3D stability of the determined positions throughout the period of study was equal to 12.7 mm, with the uncertainty of determination being at the level of 4.3 mm. A very high compliance of the computed velocity of the Borowiec SLR station (24.9 mm/year) with ITRF2014 (25.0 mm/year) was found.

Spectrum of transthyretin gene mutations and clinical characteristics of Polish patients with cardiac transthyretin amyloidosis.

BACKGROUND: Transthyretin amyloidosis (ATTR) is a rare, life-threatening systemic disorder. We present first findings on the cardiac hereditary ATTR in Poland. METHODS: Sixty-eight consecutive patients with suspected or known cardiac amyloidosis were evaluated, including blood tests, standard 12-lead electrocardiography (ECG) and transthoracic echocardiography. ATTR was confirmed histologically or non-invasively using 99mTc-DPD scintigraphy. Transthyretin (TTR) gene sequencing was performed. RESULTS: In 2017-2019, 10 unrelated male patients were diagnosed with hereditary ATTR. All patients had very uncommon TTR gene mutations: 7 patients had p.Phe53Leu mutation, 2 patients had p.Glu109Lys mutation and 1 patient had p.Ala101Val mutation. The age of onset ranged from 49 to 67 years (mean [SD] age, 58.7 [6.4] years). On ECG, most patients (70%) had pseudoinfarct pattern and/or low QRS voltage. The maximal wall thickness (MWT) on echocardiography varied considerably among the patients from moderate (16 mm) to massively increased (30 mm). Most patients (90%) had decreased left ventricular ejection fraction (mean [SD], 43 [11] %). On follow-up, we observed progressive heart failure in almost all cases. The first patient with p.Phe53Leu mutation died of heart failure, the second died suddenly, the third successfully underwent combined heart and liver transplant with 15 months survival from the surgery. The patient with p.Ala101Val mutation died of stroke. CONCLUSIONS: According to available data, this is the first time that the types of TTR mutations and the clinical characteristics of Polish patients with cardiac hereditary ATTR have been described. Previous literature data about Polish background in families with p.Phe53Leu mutation and the present results, suggest that this TTR mutation might be endemic in the Polish population.

Analysis of the Quality of SLR Station Coordinates Determined from Laser Ranging to the LARES Satellite.

The LARES (LAser RElativity Satellite) was built by the Italian Space Agency (ASI) and launched on 13 February 2012 by the European Space Agency. It is intended for studying the Lense-Thirring effect resulting from general relativity as well as for geodynamic studies and satellite geodesy. The satellite is observed by most ground laser stations. The task of this work is to determine the station coordinates and to assess the quality of their determination by comparison with the results from the LAGEOS-1 and LAGEOS-2 satellites. Observation results in the form of normal points (396,105 normal points in total) were downloaded from the EUROLAS Data Center for the period from 29 February 2012 to 31 December 2015. Seven-day orbital arcs were computed by the NASA GSFC GEODYN-II software, determining the coordinates of seventeen selected measuring stations. The average Root Mean Square (RMS) (15.1 mm) of the determined orbits is nearly the same as for LAGEOS (15.2 mm). The stability of the coordinates of each station (3DRMS) is from 9 mm to 46 mm (for LAGEOS, from 5 mm to 15 mm) with the uncertainty of determining the coordinates of 3-11 mm (LAGEOS 2-7 mm). The combined positioning for the LARES + LAGEOS-1 + LAGEOS-2 satellites allows for the stability of 5-18 mm with an uncertainty of 2-6 mm. For most stations, this solution is slightly better than the LAGEOS-only one.

Clinical efficacy of potassium canreonate-canrenone in sinus rhythm restoration among patients with atrial fibrillation - a protocol of a pilot, randomized, double -blind, placebo-controlled study (CANREN-AF trial).

BACKGROUND: Atrial fibrillation (AF) is the most frequent cardiac arrhythmia which increases the risk of thromboembolic complications and impairs quality of life. An important part of a therapeutic approach for AF is sinus rhythm restoration. Antiarrhythmic agents used in pharmacological cardioversion have limited efficacy and potential risk of proarrhythmia. Simultaneously, underlying conditions of AF should be treated (e.g. electrolyte imbalance, increased blood pressure, neurohormonal disturbances, atrial volume overload). There is still the need for an effective and safe approach to increase AF cardioversion efficacy. This randomized, double-blind, placebo-controlled, superiority clinical study is performed in patients with AF in order to evaluate the clinical efficacy of intravenous canrenone in sinus rhythm restoration. METHODS: Eighty eligible patients with an episode of AF lasting less than 48 h are randomized in a 1:1 ratio to receive canrenone or placebo. Patients randomized to a treatment intervention are receiving canrenone intravenously at a dose of 200 mg within 2-3 min. Subjects assigned to a control group obtain the same volume of 0.9% saline within the same time. The primary endpoint includes return of sinus rhythm documented in the electrocardiogram within 2 h after drug or placebo administration. Other endpoints and safety outcomes analyses, due to expected lack of statistical power, are exploratory. DISCUSSION: Current evidence supports renin-angiotensin-aldosterone system (RAAS) inhibition as an upstream therapy in AF management. Excess aldosterone secretion results in proarrhythmic effects. Among the RAAS inhibitors, only canrenone is administered intravenously. Canrenone additionally increases the plasma level of potassium, lowers blood pressure and reduces preload. It has been already used in primary and secondary hyperaldosteronism in the course of chronic liver dysfunction and in heart failure. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03536806. Registered on 25 May 2018.

Impaired right ventricular function as a predictor of early mortality in patients with light­ chain cardiac amyloidosis assessed in a cardiology department.

INTRODUCTION    Light­chain (AL) amyloidosis is the most common cardiac amyloidosis. Despite progress in treatment, early mortality remains a substantial problem in these patients. OBJECTIVES    The aim of this study was to determine a clinical profile of patients diagnosed with AL amyloidosis in a cardiology department, as well as to define the cut­off point for early mortality and identify predictors of early mortality in this population. PATIENTS AND METHODS    The study included 30 patients (14 women; median age, 61.5 years) with AL amyloidosis confirmed by echocardiography and biopsy of 2 organs. RESULTS    Six patients were diagnosed with stage II amyloidosis according to the Mayo 2004 classification, and 24 patients-with stage III. Early mortality was defined as death during 102 days after diagnosis and was observed in 14 patients. Patients who died earlier were younger and more frequently reported a weight loss of more than 10 kg and orthostatic hypotension than patients who died later. Moreover, they had higher concentrations of high­sensitivity troponin T and N­terminal pro­B­type natriuretic peptide (NT­proBNP) and worse left and right ventricular (RV) contractility. In the Cox models, the age of less than 64 years, NT­proBNP levels exceeding 4968 pg/ml, RV end­diastolic diameter of less than 34 mm, and tricuspid annular plane systolic excursion lower than 13 mm were significant predictors of mortality within 102 days after diagnosis. CONCLUSIONS    We presented the results of the first Polish prospective noninterventional study on AL amyloidosis diagnosed in the cardiology department. We found that patients have advanced disease at the time of diagnosis. Younger age, impaired RV function, and higher concentrations of cardiac markers are predictors of worse prognosis.

Transcatheter aortic valve implantation in patients with bicuspid aortic valve: a series of cases.

BACKGROUND: Bicuspid aortic valve (BAV) has been considered a relative contraindication for transcatheter aortic valve implantation (TAVI). Due to more oval shape of the BAV annulus compared to tricuspid aortic valve, the procedure has been discouraged because of an increased risk of stent assembly displacement, uneven expansion, post-procedure paravalvular leakage, stent valve distortion, or other malfunction after implantation. For the same reasons patients with BAV have been excluded from the majority of clinical TAVI trials. AIM: To evaluate the efficacy and safety of TAVI in patients with BAV stenosis. METHODS: We analysed a group of 104 patients admitted to our institution for TAVI between January 2009 and May 2012. During pre-procedure evaluation, transthoracic and transoesophageal (TEE) echocardiography as well as angio-computed tomography (CT) scan were performed to assess aortic valve anatomy and morphology. Appropriate measurements and detailed analyses of imaging data have been accomplished to select optimal access site, prosthesis size as well as to plan the procedure. BAVs were recorded in seven patients (6.7%; mean age 77.7 years). These patients presented with severe symptomatic aortic valve stenosis with a mean aortic valve area of 0.55 cm² (0.46-0.7 cm²) as measured in TEE. All of the patients had been disqualified from surgical valve replacement due to high surgical risk with a mean logistic Euroscore of 19.9%. All of them successfully underwent TAVI using CoreValve (n = 5) or Sapien (n = 2) valves. Follow-up was completed at 30 days, and six and 12 months after the procedure. RESULTS: During follow-up one patient developed an elliptic distortion of the aortic prosthesis in CT, although it did not result in significant malfunctioning of the implant. One patient died of infective endocarditis 30 days after the procedure. Survivors at 30-day follow-up had mild to moderate aortic insufficiency, and it did not deteriorate after six months. At one year follow-up six out of seven patients remained alive. They achieved significant functional improvement by New York Heart Association class compared to baseline. CONCLUSIONS: TAVI may constitute an alternative treatment option for high-risk patients with BAV, resulting in a low periprocedural mortality rate, and good 30-day, six-month, and one-year outcomes.

The impact of transcatheter aortic valve implantation on left ventricular performance and wall thickness - single-centre experience.

INTRODUCTION: Transcatheter aortic valve implantation (TAVI) is a treatment alternative for the elderly population with severe symptomatic aortic stenosis (AS) at high risk for surgical aortic valve replacement (SAVR). AIM: To assess the impact of TAVI on echocardiographic parameters of left ventricular (LV) performance and wall thickness in patients subjected to the procedure in a single-centre between 2009 and 2013. MATERIAL AND METHODS: The initial group consisted of 170 consecutive patients with severe AS unsuitable for SAVR. Logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) was 21.73 ±12.42% and mean age was 79.9 ±7.5 years. RESULTS: The TAVI was performed in 167 (98.2%) patients. Mean aortic gradient decreased significantly more rapidly after the procedure (from 58.6 ±16.7 mm Hg to 11.9 ±4.9 mm Hg, p < 0.001). The LV ejection fraction (LVEF) significantly increased in both short-term and long-term follow-up (57 ±14% vs. 59 ±13%, p < 0.001 and 56 ±14% vs. 60 ±12%, p < 0.001, respectively). Significant regression of interventricular septum diameter at end-diastole (IVSDD) and end-diastolic posterior wall thickness (EDPWth) was noted in early (15.0 ±2.4 mm vs. 14.5 ±2.3 mm, p < 0.001 and 12.7 ±2.1 mm vs. 12.4 ±1.9 mm, p < 0.028, respectively) and late post-TAVI period (15.1 ±2.5 mm to 14.3 ±2.5 mm, p < 0.001 and 12.8 ±2.0 mm to 12.4 ±1.9 mm, p < 0.007, respectively). Significant paravalvular leak (PL) was noted in 21 (13.1%) patients immediately after TAVI and in 13 (9.6%) patients in follow-up (p < 0.001). Moderate or severe mitral regurgitation (msMR) was seen in 24 (14.9%) patients from the initial group and in 19 (11.8%) patients after TAVI (p < 0.001). CONCLUSIONS: The TAVI had an immediate beneficial effect on LVEF, LV walls thickness, and the incidence of msMR. The results of the procedure are comparable with those described in other centres.

The prevalence and characteristics of intra-atrial right coronary artery anomaly in 9,284 patients referred for coronary computed tomography angiography.

OBJECTIVE: To determine the prevalence, radiologic patterns and clinical characteristics of intra-atrial right coronary artery (IARCA) among adult coronary computed tomography angiography (CCTA) population. METHODS: We included 9,284 consecutive subjects who underwent CCTA at a single high-volume center. The presence of IARCA including the number, length and diameter of IARCA segments with accompanying atherosclerosis and coronary anomalies were evaluated. Additionally, clinical characteristics and midterm follow-up of IARCA patients were recorded. RESULTS: The IARCA prevalence was 0.15% (14/9,284) with 15 intra-atrial segments. The intra-atrial segment length ranged from 14 to 53 mm, and the mean diameter proximal to the entry site was 3.3 ± 0.7 mm. IARCA was more often associated with intramuscular course of the left anterior descending coronary artery (29% vs. 4%, p=0.001) and anomalous origin of the left circumflex artery from the right aortic sinus (14% vs. 0.3%, p=0.001) compared with non-IARCA cases. The majority of IARCA patients were women (86%) presenting with supraventricular arrhythmia (71%). Compared with computed tomographic population without IARCA, IARCA subjects were younger (60 ± 12 vs. 54 ± 14 years, p=0.037) and more often women (51% vs. 86%, p=0.013). At a mean of 20 months follow-up of IARCA patients there were no adverse cardiac events except for supraventricular tachycardia episodes occurring in 36% of subjects. CONCLUSIONS: IARCA occurs rarely and is often associated with additional coronary anomalies. The clinical profile of IARCA patients is most often represented by middle-aged women with supraventricular arrhythmia showing favorable midterm prognosis.

Prevalence and characteristics of coronary anomalies originating from the opposite sinus of Valsalva in 8,522 patients referred for coronary computed tomography angiography.

Although coronary computed tomographic angiography has the ability to depict potentially malignant features of anomalous coronary artery originating from the opposite sinus of Valsalva (ACAOS), there are limited data on the significance of ACAOS in the computed tomography population. The aims of this study were to assess the prevalence of ACAOS and to correlate its anatomic features with patients' symptoms among 8,522 consecutive subjects who underwent coronary computed tomographic angiography from February 2008 to May 2012. The ACAOS proximal course was classified into anterior, interarterial, septal, and retroaortic subtypes. Malignant ACAOS was recorded if a slitlike ostium, an acute angle of takeoff, an intramural course, and significant compression between the aorta and pulmonary trunk were present simultaneously. The prevalence of ACAOS was 0.84% (72 of 8,522), including right-sided origins of the left main coronary artery (n = 11), left anterior descending coronary artery (n = 9), and left circumflex coronary artery (n = 33) and left-sided origin of the right coronary artery (n = 20). Of the 24 ACAOS (0.28%) with an interarterial course, 12 (0.14%) showed significant vessel compression, of which 6 (0.07%) were classified as malignant. The presence of significant interarterial compression and malignant ACAOS type were observed in left-sided right coronary arteries only, and interarterial compression correlated with patients' symptoms at a median of 15-month follow-up. In conclusion, the computed tomographic prevalence of ACAOS seems to be comparable with that of previous angiographic studies. The malignant features of ACAOS in the adult computed tomography population might be exclusively associated with left-sided right coronary arteries.

[Early asymptomatic pacemaker lead thrombosis successfully treated with pharmacotherapy]. / Wczesna, bezobjawowa zakrzepicaelektrody ukladu stymulujacegoskutecznie leczona zachowawczo.

The case of a 85-year-old female with multiple prothrombotic risk factors, who developed asymptomatic lead thrombosis 36 h after pacemaker implantation is presented. The successful medical treatment with enoxaparin and oral anticoagulant was introduced.

Does contrast agent injection during trans-catheter aortic valve implantation negatively affect kidney function?

BACKGROUND: Trans-catheter aortic valve implantation (TAVI) has recently emerged as an alternative to conventional surgery in high-risk surgical patients with haemodynamically significant aortic valve stenosis. However, patients referred for TAVI are usually elderly individuals (> 80 years) who frequently also suffer from renal impairment. Trans-catheter valve therapies require extensive use of contrast injections with a risk of nephrotoxicity. AIM: To evaluate post-TAVI renal function and to determine whether the exposure to contrast injections might cause reduced kidney function and contrast-induced nephropathy. METHODS: From January 2009 to September 2010, TAVI was performed in 39 patients (26 women and 13 men). The mean age of the patients was 81.43 ± 7.39 years, and the mean volume of contrast material administered was 187.95 ± 91.34 mL. Serum creatinine and glomerular filtration rate (GFR, acc. to the MDRD formula) were estimated in all patients prior to and 1, 2, and 5-8 days after TAVI. RESULTS: Two female patients died on postoperative day 1. Other patients did not show clinically significant reduction in renal function following the procedure (mean creatinine concentration 104.46 vs 99.77 vs 94.56 vs 93.64 mmol/L, NS and mean GFR 52.37 vs 56.63 vs 60.18 vs 61.34 mL/min/1.73 m², NS). CONCLUSIONS: 1. The TAVI procedure, which includes contrast injection does not seem to cause a clinically significant decrease of renal function. 2. None of our elderly patients with severe aortic valve stenosis, multiple co-morbidities, and pre- TAVI renal compromise developed contrast-induced nephropathy.

Transcatheter aortic valve implantation using transfemoral/transsubclavian or transapical approach: 30-day follow-up of the initial 30 patients.

BACKGROUND: Transcatheter aortic valve implantation (TAVI) is a new method for the treatment of aortic stenosis (AS). AIM: To evaluate early results of TAVI using transfemoral/transsubclavian approach (TFA/TSA) or transapical approach (TAA) in patients with severe AS and high risk for surgical aortic valve replacement. METHODS: Between January 2009 and May 2010, 30 high-risk patients underwent TAVI. The primary treatment option was TFA, and TAA was used if contraindications to TFA were present; one patient underwent the procedure using TSA. Reasons for selecting TAA were as follows: small diameter (<7 mm) and/or severe calcification of the iliofemoral arteries, peripheral atherosclerosis, "porcelain" aorta and a horizontal course of the ascending aorta. Edwards-Sapien or CoreValve devices were used in all cases, and procedures were performed without the use of cardiopulmonary bypass in a cardiac catheterisation laboratory. RESULTS: Mean patient age was 82.46 ± 5.79 years, mean NYHA class was 3.23 ± 0.41, and predicted mean surgical mortality using logistic Euroscore was 29.18 ± 16.9% (22.72 ± 12.07% in the TFA/TSA group vs 34.6 ± 15.4% in the TAA group; p = 0.031). Eleven patients were treated using TAA. The valve was implanted successfully in 96% of patients. Inhospital mortality was 3.3%. Mean 30-day mortality was 6.6% in the entire cohort, 0% in the TFA/TSA group and 18% in the TAA group. There were no cases of periprocedural myocardial infarction (MI), cardiogenic shock, stroke/transient ischaemic attack, or need for cardiopulmonary resuscitation. One patient died suddenly three weeks after the procedure; except for this case, there were no major adverse cardiovascular events (MACCE: MI, cerebrovascular accident, re-do procedure) at 30-day follow-up. The TAVI was associated with a significant reduction in the mean maximal aortic gradient in both groups (from 99.6 ± 22.07 mm Hg to 21.83 ± 9.38 mm Hg post-procedure and to 23.25 ± 9.22 mm Hg at 30-day follow up), with no cases of severe aortic valve regurgitation. The NYHA class at 30 days improved from 3.23 ± 0.41 to 1.72 ± 0.52 (p = 0.03). CONCLUSIONS: Our results demonstrate lower 30-day complication rate and mortality in the TFA/TSA group. The availability of several techniques of valve implantation in the group of non-surgical patients with severe AS potentially broadens the patient population with indications for this treatment.

Transapical aortic valve implantation - a rescue procedure for patients with aortic stenosis and "porcelain aorta".

Surgical aortic valve replacement (AVR) still remains the treatment of choice in symptomatic significant aortic stenosis (AS). Due to technical problems, extensive calcification of the ascending aorta ("porcelain aorta") is an additional risk factor for surgery and transapical aortic valve implantation (TAAVI) is likely to be the only rescue procedure for this group of patients. We describe the case of an 81-year-old woman with severe AS and "porcelain aorta", in whom the only available life-saving intervention was TAAVI.

Application of classic heart failure definitions of asymptomatic and symptomatic ventricular dysfunction and heart failure symptoms with preserved ejection fraction to patients with systemic right ventricles.

Heart failure guidelines classify patients into subgroups with asymptomatic versus symptomatic ventricular dysfunction versus heart failure with a preserved ejection fraction. In this study, this approach was applied in a series of patients with complete transposition of the great arteries after atrial switch to assess to what extent this classification fits patients with systemic right ventricles. The study included stable adult patients after atrial switch, stratified according to preserved versus impaired systolic function (fractional area change > or =0.40 vs <0.40), absence versus presence of symptoms, absence versus presence of significant tricuspid regurgitation (TR), and normal versus elevated brain natriuretic peptide (BNP) levels. Twenty-two of 42 participants (52.4%; mean age 18.2 +/- 2.8 years) had preserved systolic function, and 20 (47.6%) had impaired systolic function; 10 patients (23.8%) had asymptomatic right ventricular (RV) dysfunction. The latter more frequently had significant TR (p = 0.04) and elevated BNP levels (p = 0.008), compared with asymptomatic patients with preserved systolic function. Normal BNP levels independently predicted preserved RV function in all patients (odds ratio 6.4, 95% confidence interval 1.03 to 39.1, p = 0.04) and in asymptomatic patients (odds ratio 14.4, 95% confidence interval 1.2 to 176.2, p = 0.03). Heart failure symptoms with preserved systolic function were present in 5 patients (11.9%), including 3 patients with significant TR. In conclusion, asymptomatic RV dysfunction and heart failure symptoms with preserved systolic function are common in patients with systemic right ventricles. BNP levels can be used to predict preserved systolic RV function, especially in asymptomatic patients. Heart failure symptoms with preserved RV systolic function can be frequently explained by the coexistence of significant TR.

[Pseudo atypical atrial flutter or atrial tachycardia dependent on complex substrate in a patient with univentricular heart after palliative operations - mapping and ablation]. / Rzekomo atypowe trzepotanie przedsionków czy czestoskurcz przedsionkowy zalezny od zlozonego podloza u chorej z sercem jednokomorowym po operacjach paliatywnych - opis ablacji.

We describe a case of persistent atrial tachycardia/flutter in a 19-year old female with corrected transposition of great arteries (ccTGA) and dual inlet left ventricle (DILV), treated with surgical palliative operations. The arrhythmia became persistent and symptomatic with dyspnea and severe cyanosis. During the EP study, the right atrial isthmus-dependent reentry was identified. In electroanatomical maps large areas of low voltage and electrical silence were localised. Due to these areas of slow conduction the isthmus dependent arrhythmia had long CL. Linear RF applications closed the isthmus, resulting in flutter termination. During 3 months of follow-up the patient remained free of arrhythmia.

[Radiofrequency ablation of long standing persistent atrial fibrillation and post-incisional macroreentrant right atrial tachycardia in patient with advanced biventricular heart failure--case raport]. / Ablacja dlugotrwale przetrwalego migotania przedsionków oraz prawoprzedsionkowego czestoskurczu pokardiotomijnego u chorego z zaawansowana niewydolnoscia serca jako propozycja terapeutyczna - opis przypadku.

We present a case of a 54 year old male with a long-standing atrial fibrillation (AF) who was scheduled for cardiac transplantation due to the progression of heart failure. Previous treatment included pacemaker implantation, mitral valvuloplasty, a-v node modification using RF ablation, and pharmacological therapy. This time the patient underwent complex AF ablation which consisted of pulmonary vein isolation, mitral and left atrial roof line creation, cavo-tricuspid isthmus ablation and ablation of complex fractionated atrial electrograms, which resulted in restoration of sinus rhythm. Because of the right atrial post-incisional tachycardia the patient underwent second ablation session. This complex invasive approach occurred successful. The patient remains in sinus rhythm with improved left ventricular function and better NYHA class over a 12-month follow-up.