Prognostic value of coronary atherosclerosis and CAC score for the risk of chemotherapy-related cardiac dysfunction (CTRCD): The protocol of ANTEC study.

BACKGROUND: Cardiological complications of oncological treatment, including the most serious one, heart failure, constitute a significant and still unsolved clinical problem. A history of dyslipidemia and complications of atherosclerosis, including coronary artery disease, are established risk factors for cardiotoxicity in cancer patients. In recent years, a protective effect of statin treatment on the development of heart failure in cancer patients has been observed. This protocol describes a study aiming to assess the prognostic value of coronary atherosclerosis burden and the CAC score on the onset of cardiac dysfunction associated with cancer therapy. METHODS: ANTEC (Atherosclerosis iN chemoTherapy-rElated Cardiotoxicity) is a single-site, prospective, observational study to evaluate the influence of the coronary atherosclerosis and CAC score assessed by computed tomography on the development of left ventricular systolic dysfunction in cancer patients with at least moderate cardiotoxicity risk. A group of 80 patients diagnosed with cancer prior to high-dose anthracycline chemotherapy (doxorubicin ≥ 240 mg / m2 body weight or epirubicin ≥ 600 mg / m2 body weight), without a history of heart failure and coronary artery disease, will be included in the study. Patient follow-up is planned for 12 months. In all patients, coronary computed tomographic angiography (CCTA) will be performed once at the beginning of the study. The primary endpoint is the onset of cancer therapy-related cardiovascular toxicity, defined as mild, moderate, severe and very severe according to ESC 2022 Cardio-oncology guidelines. During follow up, echocardiography with GLS assessment will be performed every three months. Additionally, new biomarkers of atherosclerosis (IL-6, MPO, TNF-alpha) will be measured every 6 months. The study registration identifier on clinicaltrials.gov is NCT05118178. CLINICAL TRIALS REGISTRY: This study is listed on cinicaltrials.gov with identifier NCT05118178.

Patient perspective and safety of remote monitoring of implantable cardioverter-defibrillators in the Polish Nationwide Multicenter Registry: the Medtronic CareLink network evaluation.

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.

Cardiotoxicity danger in immunotherapy.

Immunotherapy based on immune checkpoint inhibitors (ICIs) is currently broadly used in the treatment of different types of cancer. The treatment targeting programmed cell death protein 1/programmed death-ligand 1 axis is already approved by Food and Drug Administration for numerous cancers. These kinds of therapy brought spectacular results in the treatment of non-small cell lung cancer where systemic therapy was ineffective. However, a wide range of applied therapies based on ICIs in the clinic have led to unexpected side effects, such as severe cardiotoxicity. It needs to be underlined that the molecular mechanism of myocarditis in response to ICIs is still not fully understood. Lack of sufficient knowledge, especially concerning the kind of risk factors increasing probability of myocarditis, poses currently a large clinical problem. Continuous cardiac monitoring of patients who undergo ICI treatment presents another problem as it is cost-ineffective for the healthcare system. Herein, we highlight the risks of use of anticancer therapy based on ICIs. We also stress that detailed monitoring of any event of cardiotoxicity following ICIs treatment should be carefully investigated and registered to give a global overview of the frequency of myocarditis occurrence. Moreover, we propose that the extension of molecular and systemic knowledge of etiology of myocarditis as a side effect, including the role of protein kinases, will be highly beneficial for the medical field. Last but not least, better understanding of mechanisms of cardiotoxicity induction will improve the safety of cancer patients and will help clinicians in prediction of unexpected side effect occurrence.

Patients with cardiac implantable electronic devices undergoing radiotherapy in Poland. Expert opinion of the Heart Rhythm Section of the Polish Cardiac Society and the Polish Society of Radiation Oncology.

Older age and high morbidity of the society contribute to a growing number of patients with cardiac implantable electronic devices (CIEDs) requiring effective cancer treatment, including radiotherapy (RT). The effect of RT on a CIED may vary depending on the type and physical parameters of radiation, location of the treated lesion, indications for electrotherapy, and the type of CIED. In the most dramatic scenarios, it may cause an irreversible damage to the CIED, with serious clinical consequences. The lack of precise guidelines may limit the access to RT for many patients with CIEDs who would otherwise benefit from the therapy or may lead to a therapy without taking the necessary precautions, which may worsen the prognosis. Therefore, clear and unequivocal recommendations for assessing patient eligibility for RT are aimed at ensuring that adequate precautions are taken as well as at providing patients with concomitant cardiovascular and oncologic diseases with access to safe and effective RT.

Clinical factors affecting long term survival in patients with systolic heart failure and cardiac resynchronization therapy in advanced age.

Identification of demographic and clinical factors which influence prognosis is crucial in patients with heart failure and cardiac resynchronization therapy (CRT). MATERIALS AND METHODS: 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. RESULTS: Total mortality was 30.9%. Mortality rate was similar in subjects aged ≤70 and >70 (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 patients >70 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 patients >70 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. CONCLUSIONS: In patients with cardiac resynchronization therapy female gender was not associated with mortality and was the factor of better prognosis. For subjects aged >70 a worse prognosis was related to renal insufficiency.

Hospital-based and telemonitoring guided home-based training programs: effects on exercise tolerance and quality of life in patients with heart failure (NYHA class III) and cardiac resynchronization therapy. A randomized, prospective observation.

UNLABELLED: Cardiac resynchronization therapy with defibrillator function (CRT-D) along with an optimal medical therapy improves symptoms, cardiac efficiency, quality of life (QoL) and prognosis in patients with heart failure (CHF). The aim of the study was to assess effects of hospital-based and home-based/telemonitoring exercise training. METHODS: The prospective, randomized study was conducted in 52 patients (pts), aged 45-75years (mean 62±9.3), with CHF of ischemic or another etiology, NYHA class III and implanted CRT-D. Group CRT-Ex (n=26) underwent initial exercise training in the hospital setting and continued training program at home with telemonitoring 5 times a week for 8weeks. The CRT-control group (n=26) consisted of patients who had hospital rehabilitation, but no training program after discharge. RESULTS: No differences between the groups in CHF etiology, comorbidities, medical therapy and in any of spiroergometry (CPX) parameters at baseline were observed. After 3-4months the CRT-Ex group achieved better results in VO2 peak, VCO2 peak and treadmill test duration. But after 12months the measurements returned to the baseline values. No significant differences were observed directly between two groups in distances of 6-MWT at baseline, at 3-4months and at 12months. Echocardiographic evaluation showed significant reduction of left ventricular dimensions and improvement in the left ventricular ejection fraction (EF), in both groups (25.3±7.4% to 28.9±9.1%, CRT-Ex group, p=0.0213 and 24.9±7.2% to 31.7±10.6%, CRT-Control group, p=0.0001). Significant improvement in all domains of QoL was observed in the CRT-Ex group, while the CRT-Control pts declared only higher energy levels and less pain. Intensity of telemonitoring guided home-based exercise training was low. In the 12- and 18-months follow-up there were no differences in the ICD-interventions, mortality or hospitalization rates between the groups. CONCLUSIONS: A structured exercise training program in the hospital and home-based with telemonitoring was safe option of additional treatment and improved directly physical fitness and, quality of life in patients with NYHA III CHF and CRT-D. However these effects haven't been sustained in longer period of time and had no impact on prognosis.

Effectiveness of antitachycardia pacing therapy after primary prophylaxis implantation of implantable defibrillators in coronary artery disease patients.

PURPOSE: Effectiveness of implantable defibrillators (ICD) has been proven with large randomized trials. Unfortunately, ICD discharge is painful and potentially threatening for the patient despite its life saving effects. We analyzed influence of the clinical parameters present before implantation on the effectiveness of antitachycardia pacing therapy (ATP) in terminating ventricular tachycardia (VT) slower than 200 bpm in the coronary artery disease patients with prophylactic implanted ICD in a single centre retrospective trial. PATIENTS/METHODS: We analyzed 121 consecutive coronary disease patients with ICD implanted in primary prophylaxis between 2001 and 2007, with the mean age of 62 ± 10 years. The mean follow-up was 876 ± 538 days. RESULTS: 32 of them had VT. In 27 persons (84.4%) at least one ATP attempt terminate VT. ATP was always successful in 21 patients. We analyzed age, sex, LVEF, NYHA class, widening of QRS complex, atrial fibrillation, type of myocardial infarction or diabetes. There were no significant differences in clinical features between patients with successful and unsuccessful ATP therapy. CONCLUSIONS: High effectiveness of ATP was shown in this group. There were no clinical factors indicating success of this type of therapy. That could justify programming ATP as the first line therapy in the VT zone in primary prophylaxis coronary artery disease patients to reduce application of shock therapy. It should be possible to apply a single mode of programming when discharging patients after the implantation procedure regardless of the patient's clinical condition. This could help to control and programme the devices, thus reducing the risk of errors.

Beneficial triple-site cardiac resynchronization in a patient supported with an intra-aortic balloon pump for end-stage heart failure.

The authors present the case of a 62-year-old male patient with an implantable cardioverter-defibrillator and end-stage heart failure supported with an intra-aortic balloon pump. Implantation of a triple-site cardiac resynchronization system and complex heart failure treatment brought a significant improvement, return to home activity and 17-month survival. The patient died due to heart failure aggravation. Within this time he was rehospitalized and successfully treated twice for an electrical storm.

QRS complex widening as a predictor of appropriate implantable cardioverter-defibrillator (ICD) therapy and higher mortality risk in primary prevention ICD patients.

BACKGROUND AND AIM: Effectiveness of implantable cardioverter-defibrillators (ICD) in patients with reduced left ventricular ejection fraction after myocardial infarction has been documented in large randomised trials. We analysed the predictive value of clinical factors at the time of implantation for adequate ICD interventions and mortality risk. METHODS: We analysed 121 consecutive patients (15 women, 106 [88%] men; mean age 62 ± 10 years) with coronary artery disease in whom ICD was implanted for primary prevention between 2001 and 2007. Mean duration of follow-up was 876 ± 538 days. RESULTS: Forty-four (36.4%) patients had adequate ICD interventions. In the Cox analysis, wider QRS complexes (hazard ration [HR] per each 10 ms increment: 1.13, confidence interval [CI] 1.039-1.229, p = 0.0045) and younger age at the time of ICD implantation (HR per each 10 year increment: 0.7, CI 0.5-0.9, p = 0.0081) were associated with a higher probability of adequate intervention. Wider QRS complexes were associated with a higher probability of electrical storm (HR 1.059, CI 1.014-1.045, p = 0.0002). During follow-up, 21 (17.4%) patients died. In the Cox analysis, wider QRS complexes (HR per each 10 ms increment: 1.123, CI 1.011-1.248, p = 0.0306 [in univariate analysis only]), older age at the time of implantation (HR per each 10 year increment: 1.7, CI 1.1-2.8, p = 0.0396) and higher NYHA class (HR 4.4, CI 1.7-11.5, p = 0.0022) were associated with increased mortality. Mortality was reduced by previous revascularisation (HR 0.3, CI 0.1-0.7, p = 0.006). CONCLUSIONS: Patients with wider QRS complexes at the time of ICD implantation had a higher probability of adequate device intervention and mortality risk. QRS complex widening was also associated with a higher incidence of electrical storm.

Magnetic resonance imaging assessment of intraventricular dyssynchrony and delayed enhancement as predictors of response to cardiac resynchronization therapy in patients with heart failure of ischaemic and non-ischaemic etiologies.

PURPOSE: To assess the value of dyssynchrony and myocardial viability assessment by cardiac magnetic resonance (CMR) in prediction of response to cardiac resynchronization therapy (CRT) in patients with heart failure (HF) of both ischaemic and non-ischaemic etiologies. MATERIALS AND METHODS: Patients scheduled for CRT in NYHA class II-IV, left ventricular ejection fraction <35%, QRS ≥ 120 ms were included. Tagged cine and late gadolinium enhancement (LGE) images were performed. Dyssynchrony was assessed with inTag toolbox and LGE was quantified using cutoff value at half of maximal signal in the scar. Cardiopulmonary exercise test, echocardiography and blood testing for NT-proBNP levels were done at baseline and 6 months after CRT. RESULTS: 52 patients (age 60.3 ± 13 years) were included. 26 patients (50%) met response criteria. The ischaemic etiology of HF was more frequent (69% vs. 31%, p=0.002), the percent of LGE was higher (7.7% [0-13.5%] vs. 19.0% (0-31.9%], p=0.013), regional vector of circumferential strain variance (RVV) was lower (0.27 ± 0.08 vs. 0.34 ± 0.09, p=0.009) and uniformity of radial strain was higher (0.72 ± 0.25 vs. 0.56 ± 0.29, p=0.046) in non-responders vs. responders. Multivariate logistic regression showed that RVV predicted response to CRT (HR 2.3, 95% CI 1.02-5.02, p=0.0430) independently of LGE and the etiology of heart failure. In the subgroup of patients with ischaemic HF the extend of transmural scar within myocardium was higher in non-responders vs. responders (26.3% vs. 15.0% respectively, p=0.01) and was a predictor of response to CRT in univariable analysis (HR 0.87, 95% CI 0.77-0.98, p=0.025) providing the sensitivity of 76% and specificity of 75% at the cutoff point of 18% in the prediction of poor response to CRT. In patients with non-ischaemic HF QRS was wider (162 ms vs. 140 ms, p=0.04), regional vector of strain variance (RVV) was higher (0.39 vs. 0.25, p=0.002) and uniformity of radial strain was lower (0.52 vs. 0.80, p=0.049) in non-responders vs. responders. Univariable logistic regression showed that RVV was a predictor of response to CRT (HR 1.50, 95% CI 1.06-2.13, p=0.022), providing the sensitivity of 94% and specificity of 85% at the cutoff point of 0.31. CONCLUSIONS: CMR derived parameters of dyssynchrony such as RVV may provide an additive value in prediction of response to CRT, especially in patients with non-ischaemic etiology of heart failure. In patients with ischaemic HF the transmurality of LGE is an important predictor of lack of response to CRT.

Over 10 years with an implantable cardioverter-defibrillator - a long term follow-up of 60 patients.

BACKGROUND: Transvenous implantable cardioverter-defibrillators (ICD) have been implanted in Poland since 1995. As the method spreads it is important to consider its long-term benefits and disadvantages. AIM: To assess survival, efficacy and complication rate in ICD patients, who received the device more than ten years earlier. METHODS: Retrospective analysis of 60 ICD patients implanted between 1995-1999. RESULTS: There were 42 (70%) males, mean age 50.6 ± 16.4 years. In 59 patients ICD was implanted for sudden cardiac death (SCD) secondary prevention. Thirty eight patients (34 M, 63.3%) had coronary artery disease (CAD). The CAD was diagnosed in 89.5% of males and 10.5% of females (p〈 0.0001). Mean follow-up time was 75.4 ± 34.7 months. During this time 22 patients died (37%, 19 M, 3 F). Three deaths were SCD. Mean one-year mortality was 6.7%. Deaths were more frequent among males: 45.2% vs 16.7%, p〈 0.005. In CAD mortality was higher than in non-CAD patients (50% vs 13.6%, p〈 0.005). Appropriate ICD discharges in the ventricular fibrillation (VF) zone occurred in 35 (58%) patients, and in ventricular tachycardia (VT) zone - in 26 (43%) patients. Mean intervention rate per year was 3.7 for VF and 0.6 for VT. Complications occurred in 27 (45%) patients and 5 (8%) of them had no ICD intervention during follow-up. In 5 patients more than one complication was diagnosed. There were inappropriate discharges in 15 (25%) patients, 11 (18%) had electrical storm, and ICD-related infections were noted in 3 (5%) patients. During the perioperative period, lead revisions were done in 4 patients; in 3 with discharges induced by T-wave oversensing and in one with lead dislocation. Four cases of lead failure occurred during follow-up, requiring new lead implantation. In 4 patients, electrical storm (3 patients) and supraventricular tachycardia with ICD discharges (1 patient) were treated with radiofrequency ablation. Only 10 (17%) patients did not demonstrate any ICD interventions or ICD-related complications. CONCLUSIONS: 1. ICD interventions caused by malignant ventricular arrhythmias occurred in 75% patients with the device implanted more than 10 years earlier. 2. Almost a half of the analysed population suffered from complications and side effects related to implanted ICD and they were present in 8% of subjects without ICD intervention. Neither ICD interventions nor device-related adverse events were recorded in 17% of patients.

Implantable cardioverter-defibrillator in patients with hypertrophic cardiomyopathy: efficacy and complications of the therapy in long-term follow-up.

INTRODUCTION: Although implantable cardioverter-defibrillators (ICDs) are used in sudden cardiac death (SCD) prevention in high-risk patients with hypertrophic cardiomyopathy (HCM), long-term results as well as precise risk stratification are discussed in a limited number of reports. The aim of the study was to assess the incidence of ICD intervention in HCM patients with relation to clinical risk profile. METHODS AND RESULTS: We studied 104 consecutive patients with HCM implanted in a single center. The mean age of study population was 35.6 (SD, 16.2) years with the average follow-up of 4.6 (SD, 2.6) years. ICD was implanted for secondary (n = 26) and primary (n = 78) prevention of SCD. In the secondary prevention group, 14 patients (53.8%) experienced at least 1 appropriate device intervention (7.9%/year). In the primary prevention (PP) group appropriate ICD discharges occurred in 13 patients (16.7%) and intervention rate was 4.0%/year. Nonsustained VT was the only predictive risk factor (RF) for an appropriate ICD intervention in the PP (positive predictive value 22%, negative predictive value 96%). No significant difference was observed in the incidence of appropriate ICD discharges between PP patients with 1, 2, or more RF. Complications of the treatment included: inappropriate shocks (33.7%), lead dysfunction (12.5%), and infections: 4.8% of patients. Four patients died during follow-up. CONCLUSION: ICD therapy is effective in SCD prevention in patients with HCM, although the complication rate is significant. Nonsustained ventricular tachycardia seems to be the most predictive RF for appropriate device discharges. Number of RF did not impact the incidence of appropriate ICD interventions.

Flow disturbances in carotid and vertebral arteries in symptomatic patients referred for pacemaker implantation.

BACKGROUND: Electrocardiographic abnormalities and clinical symptoms are used as indications for cardiac pacing. Syncope, faints and other neurological symptoms are of multi-factorial origin and are due to reduced brain perfusion. AIM: To examine the carotid and vertebral artery blood flow and to assess whether stenosis of these arteries is associated with symptoms of cerebral hypoperfusion in patients undergoing pacemaker implantation. METHODS: In 152 consecutive patients (84 men, age 70.6+/-10 years), admitted for pacemaker implantation from January 2003 to June 2004, ultrasonographic and colour Doppler examinations of the carotid and vertebral arteries were performed. The patient's medical history and symptoms, conduction disturbances, and modes of pacing were evaluated using a uniform questionnaire. Clinical manifestations of atherosclerosis were present in 21% (remote myocardial infarction) and 8% (stroke) of patients. Patients were divided into 2 groups: asymptomatic subjects (25%) and those with symptoms of cerebral hypoperfusion (75%). RESULTS: There were no significant differences in indications and modes of pacing between the groups; only second degree atrioventricular block was significantly more frequent in patients without symptoms (p=0.0163). Prevalence of either common or internal carotid artery stenosis>50% was higher in symptomatic than asymptomatic patients (32 vs. 16, p<0.05). Multivariate analysis revealed a 3.5 times higher probability of Stokes-Adams attacks and syncope in patients with confirmed atherosclerotic lesions (OR 3.5, 95% CI 1.2-13.4; p=0.0351). Blood flow disturbances in vertebral arteries were more frequent in symptomatic patients: 26 vs. 11%, p=0.0438. The lowest risk of loss of consciousness was observed in patients with second degree atrioventricular block, with no atherosclerotic lesions: (OR 0.2; 95% CI 0.03-0.06; p=0.0102). CONCLUSIONS: Prevalence of atherosclerotic lesions in carotid and vertebral arteries is higher in symptomatic patients referred for pacemaker implantation. The lowest risk of symptoms was found in patients with a second degree atrioventricular block and no atherosclerotic lesions. Ultrasonographic examination of carotid and vertebral arteries should be considered in all symptomatic patients with indications for pacemaker implantation.

Causes of redo procedures in patients with an implantable cardioverter-defibrillator--long-term follow-up results.

BACKGROUND: Implantation of a cardioverter-defibrillator (ICD) is a well-established method to prevent sudden cardiac death (SCD). Due to the expanding indications for this type of treatment and increasing survival of these patients, the ICD population is growing rapidly. AIM: To assess the rate and causes of reoperations in patients with ICD over a long-term (at least 4 years) follow-up period. METHODS: Between 1995 and 2006, an ICD was implanted in 598 patients. This study included all patients with a follow-up duration of at least 4 years and only those who underwent a repeat procedure later than 6 weeks after the index ICD implantation. RESULTS: The study group consisted of 174 patients with a mean age of 51+/-18 years who were followed for a mean of 6+/-1.7 years. Coronary artery disease (CAD) was diagnosed in 92 (53%) patients, and non-ischaemic cardiomyopathy in 82 (47%) patients. Prophylactic ICD therapy was instituted in 11 (6%) patients, whereas 163 (94%) patients received ICD for secondary prophylactics. During the follow-up period, 10 deaths occurred: 6 of all deaths (60%) in patients with CAD and 4 of all deaths (40%) in the non--ischaemic group. A total of 211 redo procedures in 139 patients were performed. Indications for repeat procedures included battery depletion in 136 patients, ICD malfunction in 37 cases, infection related to the implanted system in 5 patients, problems with leads in 19 cases, an upgrade to the dual-chamber system in 5 or to the biventricular system in 3 patients, and the revision of an ICD pocket in 6 patients. CONCLUSIONS: Repeat procedures in ICD recipients are frequent. The most common cause is battery depletion and ICD replacement indicated by a manufacturer. Improvement in ICD technology is essential to increase ICD longevity and decrease the redo-procedure rates. Patients with ICD should be regularly followed in experienced centres in order to detect ICD system failure early.

[From implantable cardioverter-defibrillator to cardiac resynchronization therapy with the use of epicardial left ventricular lead. The evolution of the treatment of post inflammatory heart failure--a case report]. / Od wszczepialnego kardiowertera-defibrylatora do nasierdziowo-przezzylnej stymulacji resynchronizujacej. Ewolucja metod leczenia u chorego z pozapalna niewydolnoscia serca.

The authors present a case of a 77-year-old man with heart failure in the course of dilated cardiomyopathy (DCM) and atrial fibrillation (AF), after implantation of an automatic cardioverter-defibrillator (ICD) due to recurrent symptomatic ventricular tachycardia (VT). Addition of cardiac resynchronization therapy (CRT) was decided due to the heart-failure dependent intensification of the arrhythmia and poststimulation enlargement of QRS. CRT was led to withdraw patient's arrhythmia and to improvement of the general condition of the patient for approximately one year. After the arrhythmia reoccurred due to dislocation of the electrode in the coronary sinus with loss of left ventricle stimulation. Multiple attempts at restoration of resynchronization function via a transvenous approach failed. The patient was qualified for implantation of an epicardial left ventricle electrode. The surgery was combined with a planned exchange of ICD-CRT. Basing on a 6-month observation period an improvement heart performance and general state of health have been observed. No arrhythmic event has been noted in device memory. Performed procedures are picturing the evolution of in pacing techniques and automatic defibrillation in Poland over recent years.

[Acute inferolateral myocardial infarction as the first manifestation of left atrial myxoma -- a case report]. / Sluzak lewego przedsionka powiklany zawalem serca sciany dolno-bocznej.

A case of a young patient admitted to our hospital due to acute myocardial infarction is presented. Coronary angiography revealed normal coronary arteries. Echocardiography performed immediately after coronary angiography showed the presence of the left atrial myxoma. Three days later the patient underwent urgent surgery with a favourable outcome. The role of echocardiography in detecting atrial myxoma and mechanisms of myocardial infarction caused by this anomaly are discussed.