Venous stenosis and occlusion in the presence of endocardial leads in patients referred for transvenous lead extraction.

Objective The aim of this study was to evaluate the incidence of venous stenosis and occlusion (VSO) in patients referred for transvenous lead extraction (TLE) with regard to the indications for this treatment and to analyse the influence of VSO on efficacy, complications and technical challenges of TLE procedures. Methods The material consists of 133 consecutive TLE procedure records. The contrast venography examination of the ipsilateral access vein was performed prior to the operation. The whole study population was divided into two subgroups, based on the presence (subgroup I) or absence (subgroup II) of VSO. Results Phlebography was performed in 133 patients with age ranging from 25.7 to 86.1 years, 44 female (33.1%). The VSO was confirmed in 48 (36.1%) patients - subgroup I. Most of the patients were referred to TLE due to non-infectious reasons (100 pts-75.2%). The absence of VSO was observed substantially more frequently in patients with diabetes (P = 0.02). Procedural success rate reached 93.3% in subgroup I and 98.8% in subgroup II (P = 0.1). There was no significant difference in the use of advanced tools and alternative access sites. Conclusion The presence of VSO can be expected in one third of patients referred for lead extraction. There is no association between indication for TLE (infected or noninfected lead extraction) and the incidence of VSO. Diabetes proved to have a protective effect on venous patency in the previously mentioned group. VSO does not influence the effectiveness, safety, and the use of additional tools during TLE procedures.

[Predictive parameters of occurrence of adequate interventions in patients with implanted cardioverter-defibrillators with or without resynchronisation therapy in primary prevention of sudden cardiac death in dilated cardiomyopathy]. / Parametry predykcyjne wystepowania adekwatnych interwencji u pacjentów z implantowanymi kardiowerterterami-defibrylatorami z lub bez funkcji resynchronizacji w prewencji pierwotnej naglego zgonu sercowego w kardiomiopatii rozstrzeniowej.

The task of the ICD is to detect ventricular arrhythmias and treatment of its adequate intervention. The task of the CRTD in addition to the above tasks is the treatment of heart failure. AIM: The aim of the study was to assess the predictive parameters of adequate interventions in patients with an ICD and CRTD. MATERIALS AND METHODS: The study consisted of 273 patients (230 M, mean age 65±11 years) with ICD and/or CRTD. The inclusion criteria were: left ventricle ejection fraction (LVEF) ≤ 35%, NYHA class ≥ II, implantation in primary SCD prevention and in case of CRTD additionally LBBB with wide QRS ≥ 120ms. The following data were assessed: age, gender, presence of dilated cardiomyopathy, diabetes, chronic kidney failure, atrial fibrillation (AF), LVEF, NYHA class, device interventions, number of arrhythmias, changes in pharmacotherapy, device parameters and mortality. RESULTS: During observation, which lasted the mean of 770±490 days, 102 patients had adequate device interventions. In the ICD group, adequate interventions appear mainly in the initial observation period (HR 2,01), in patients with left ventricular hypertrophy (HR 2,98) and ventricular arrhythmias (HR 6,78) and not treated with amiodarone (HR 4,31). In the CRTD group, adequate interventions appear mainly in younger patients (HR 1,06), in diabetes (HR 1,68), in NYHA class II, in paroxysmal atrial fibrillation (HR 1,09) and ventricular arrhythmias (HR 2,54) and not treated with amiodarone (HR 1,09). CONCLUSIONS: In the ICD group, left ventricular hypertrophy, ventricular arrhythmias is not treated with amiodarone in a significant influence on the risk of adequate intervention. In the Group of CRTD younger age, diabetes, NYHA class II, paroxysmal atrial fibrillation, ventricular arrhythmias is not treated with amiodarone in a significant influence on the risk of adequate intervention. In the ICD group, adequate interventions particularly often in the first year of follow-up. Patients with CRTD require special medical care.

[The evaluation of the ventricular arrhythmias and interventions of cardiac implantable electronic devices in patients with dilated cardiomyopathy for primary prevention of sudden cardiac death in ambulatory and telemetric follow-up]. / Ocena wystapienia arytmii komorowych i interwencji wszczepialnych urzadzen do elektroterapii serca u chorych na kardiomiopatie rozstrzeniowa w zapobieganiu pierwotnej naglego zgonu sercowego w obserwacji ambulatoryjnej i w kontroli metoda telemonitoringu.

Telemetric follow-up (RM) after cardiac devices implantation is not inferior to classic follow-up and enables earlier clinical complications detection. AIM: The aim of the study was to evaluation of the ventricular arrhythmias and interventions of ICD/CRTD in ambulatory and telemetric follow-up in patients with dilated cardiomyopathy. MATERIALS AND METHODS: Group A (CRT-D+ICD) - retrospective, patients followed-up in outpatient clinic - was consisted with 273 patients (mean age 65±11 years, 230M). In group A 128 patients after CRT-D implantation and 145 patients with ICD were selected. Group B (RM group) - prospective, RM Medtronic Carelink followup - was consisted with 177 patients (mean age 61±13 years, 141M). 35 patients had CRT-D and 142 had ICD implanted. Follow-up of patients from group A was performed in outpatient clinic. Follow-up of patients from group B was monitored daily follow-up using RM system (Medtronic Carelink). Frequency/type of ventricular arrhythmias, device interventions, patient's clinical status, medications, were assessed in both groups. To assess presence of ventricular arrhythmias, device interventions, ICD and CRT-D programming changes, pharmacotherapy changes, patients were randomly chosen from group A, according to age, gender, LVEF value, NYHA class, comorbidities, time of follow-up as a control group to group B (RM group). RESULTS: In multivariate analysis, it was found that a low ejection fraction <25% (HR 0,929; p<0,001), and diabetes mellitus (HR 7,038; p<0,009) predispose to ventricular arrhythmias. In the RM group, compared to control group, there were significantly less programming changes (5,9 vs 47,1%, p<0,001), time to first events (ventricular arrhythmias - 258 vs 487 d, p<0,001; interventions - 295 vs 775 d, p<0,01) was shorter, while time to first necessary programming (364 vs 304 d, p<0,001) or pharmacotherapy (330 vs 244 days, p<0,001) change was longer. General mortality did not differ significantly between the groups (p=0,130). CONCLUSIONS: Low ejection fraction <25%, and diabetes mellitus predispose to ventricular arrhythmias. Telemetric follow-up of cardiac implantable devices enables quick information transmission in cases of clinical complications (arrhythmias, interventions) and reduces number of ambulatory visits to only necessary ones. Telemetric followup of cardiac implantable devices is a safe. Key words: ventricular arrhythmias, interventions.

[The assessment of factors influencing occurrence of adequate interventions of cardiac resynchronization therapy with cardioverter-defibrillator implanted in primary prevention of sudden cardiac death in dilative cardiomyopathy and percentage of biventricular pacing].

The assessment of factors influencing occurrence of adequate interventions of cardiac resynchronization therapy with cardioverter-defibrillator implanted in primary prevention of sudden cardiac death in dilative cardiomyopathy and percentage of biventricular pacing. Introduction: The function of cardiac resynchronization therapy with cardioverter-defibrillator (CRT-D) is to treat heart failure (HF) and to treat ventricular arrhythmia, if it occurs, with adequate intervention. Aim: The aim of the study was to find predictors of adequate interventions and in how many patients biventricular pacing percentage decreases during the follow-up. Material and methods: The study comprised of 228 patients (178 M, mean age 66±10, 31-89 years) with implanted CRTD. The following data were analyzed: age, sex, presence of dilative cardiomyopathy, diabetes mellitus, lowered creatinine clearance, atrial fibrillation (AF), LVEF, NYHA class, adequate interventions, number of arrhythmias, pharmacotherapy modifications, device parameters and mortality. Results: Mean ejection fraction of the left ventricle was 20.9±6.4, (10.0- 35%). During the mean follow up of 770±490 days in 84 (37%) patients adequate interventions of the device occurred. The adequate interventions concerned mainly patients with diabetes mellitus (HR 2.95), in NYHA class II, with paroxysmal atrial fibrillation (HR 2.15). In 39 patients (17%) the mean percentage of biventricular pacing was below 90%, and in 18 (8%) below 85%. Conclusions: Diabetes mellitus, NYHA class II, paroxysmal atrial fibrillation have significantly increased the risk of adequate intervention. The most common causes of loss of biventricular pacing were: inappropriate AV delay, supraventricular arrhythmias and premature ventricular complexes. A significant correlation between low biventricular pacing percentage and the occurrence of supraventricular arrhythmias and adequate interventions was observed.

[Arrhythmia, device interventions and mortality analysis in patients with implanted cardioverter-defibrillator with/without resynchronisation therapy in dilative cardiomyopathy in primary prevention of sudden cardiac death]. / Analiza arytmii, interwencji urzadzenia oraz umieralnosci w populacji chorych z implantowanym kardiowerterem-defibrylatorem i/lub z funkcja resynchronizacji z powodu kardiomiopatii rozstrzeniowej w prewencji pierwotnej naglego zgonu sercowego.

UNLABELLED: Ambulatory follow-up of patients with implanted cardioverter-defibrillator (ICD) with/without resynchronisation therapy (CRTD) requires regular visits to assess arrhythmias, device interventions and mortality. AIM: The aim of the study was to examine arrhythmia prevalence, device interventions and mortality in patients with dilative cardiomyopathy with ICD/CRTD implanted in primary sudden cardiac death (SCD) prevention. MATERIALS AND METHODS: The study consisted of patients with ICD and/or CRTD implanted between 2010-2011. The inclusion criteria were: left ventricle ejection fraction (LVEF) ≤ 35%, NYHA class ≥ II, implantation in primary SCD prevention and in case of CRTD additionally LBBB with wide QRS ≥ 120ms. All of patients' visits in outpatient clinic were analysed. The following data were assessed: age, gender, presence of coronary artery disease (CAD), diabetes, thyroid gland diseases, chronic kidney failure, atrial fibrillation (AF), LVEF, NYHA class, device interventions, number of arrhythmias, changes in pharmacotherapy, device parameters and mortality. RESULTS: The study analysed 360 patients (302 M, mean age 64±12 years) with cardiac implantable devices (127 with CRTD, 233 with ICD). During observation, which lasted the mean of 768±491 days, 258 patients had ventricular arrhythmias and 118 patients had adequate device interventions. 10 patients died because of the progression of heart failure. Ventricular arrhythmia was more frequent in patients with CRTD, who died, with low cholesterol level, high NYHA class, low LVEF, diabetes and kidney failure. Device interventions occurred in the above described groups and additionally in patients with AF. After step exclusion of characteristics with highest p value in Wald test, it was confirmed that the factors influencing ventricular arrhythmia and death were low LVEF (HR=0,944, p<0,002 and HR=0,813, p<0,013) and diabetes (HR=7,043, p<0,009 and HR=29,931, p<0,002). CONCLUSIONS: Ventricular arrhythmia is more often in patients with CRTD, who died, with low cholesterol level, high NYHA class, low LVEF, diabetes and kidney failure. Adequate interventions are more often in patients who died, with low cholesterol level, high NYHA class, low LVEF, diabetes, kidney failure and AF. Patients who died, compared to those who survived, had significantly more often lipid level anomalies, high NYHA class, low LVEF, advanced age, diabetes, kidney failure, atrial fibrillation, arterial hypertension, device interventions and pharmacotherapy changes. Diabetes and low LVEF are predictors of ventricular arrhythmias and death.

[Safety and efficacy of classic ambulatory implantable cardioverter-defibrillator and resynchronisation systems follow-up compared to telemetric follow-up]. / Porównanie bezpieczenstwa i skutecznosci tradycyjnej kontroli ambulatoryjnej z kontrola metoda telemonitoringu wszczepialnych kardiowerterów-defibrylatorów oraz urzadzen resynchronizujacych serca.

UNLABELLED: Telemetric follow-up (RM) after cardiac devices implantation is not only not inferior to classic follow-up, but also enables earlier clinical complications detection and stricter patient monitoring. THE AIM: of the study was to confirm safety and efficacy of RM in patients with implantable cardioverter-defibrillator (ICD) or cardioverterdefibrillator with resynchronisation therapy (CRT-D), compared to traditional follow-up in outpatient clinic. MATERIALS AND METHODS: Group A (CRT-D+ICD) (retrospective, patients followed-up in outpatient clinic) was consisted with 273 patients (mean age 65±11 years, 230M). Group A included 128 patients after CRT-D implantation and 145 patients with ICD. Group B (RM group) (prospective, RM Medtronic CareLink follow-up) involved 89 patients (mean age 61±14 years, 73M). 11 patients had CRT-D and 78 had ICD implanted. Only patients with Medtronic equipment were included to group B. Follow-up of patients from group A - ambulatory visit in outpatient clinic: 1-3 months after implantation, then every 6 months. Follow-up of patients from group B - daily follow-up using RM system (Medtronic CareLink). Patient's clinical status, medications, frequency/ type of arrhythmias, device interventions were assessed in both groups. RESULTS: To assess presence of ventricular arrhythmia, device interventions, ICD and CRT-D programming changes, pharmacotherapy changes, a number of patients were randomly chosen from group A. They were similar in age, gender, LVEF value, NYHA class, comorbidities, time of follow-up (control group) to Group B (RM group). In the RM group, compared to control group, there were significantly less programming changes (3,4 vs 28,6%, p<0,001), time to first event was shorter (ventricular arrhythmia - 39 days, p<0,001; intervention - 102 days, p<0,001), time to first necessary programming change was longer (201 days, p<0,001). RM system proved to be save, more accurate (22% visits were performed personally by the physician operating Medtronic CareLink system, 71,4% consultations were performed via internet, phone), and general mortality did not differ significantly between the groups (p=0,147). CONCLUSIONS: Telemetric follow-up of cardiac implantable devices is a safe and more accurate method in comparison to classic ambulatory follow-up. Telemetric follow-up of cardiac implantable devices enables quick information transmission in case of clinical complications (arrhythmia, intervention). Telemetric follow-up allows to reduce number of ambulatory visits to only necessary ones.

[Ventricular arrhythmia and device intervention analysis in patients with implanted cardioverter-defibrillator with/without resynchronisation therapy in dilative cardiomyopathy in primary prevention of sudden cardiac death in telemetric follow-up].

Introduction: Remote monitoring of ICD/CRTD is safe, during which evaluates the type of arrhythmia, intervention. Aim: The aim of the study was the assessment of ventricular arrhythmia and ICD/CRTD intervention. Material and methods: The study included 177 patients (mean age 61,1±13; 23-88 y; Men 141) with an ICD/CRTD implanted. Patients were controlled telemonitoring system, Medtronic Carelink. The following variables were analyzed: age, gender, comorbidities, LVEF value, NYHA class, type of ventricular arrhythmias, device interventions, reprogramming and pharmacotherapy changes. Results: In multivariate analysis, it was found that, diabetes mellitus (HR 3,49), a low ejection fraction <25% (HR 2,51) predispose to ventricular arrhythmias; and a low ejection fraction <25% (HR 1,88), ischemic DCM (HR 1,92), II NYHA class, the lack of Amiodarone (HR 5,01) predispose to device intervention. Conclusions: 1. A low ejection fraction, ischemic dilative cardiomyopathy, II NYHA class, the lack treatment of Amiodarone predispose to ventricular arrhythmias. 2. A low ejection fraction, diabetes mellitus predispose to device intervention. 3. A significant correlation between interventions and ventricular arrhythmias, renal failure, diabetes mellitus, abnormal lipidogram were observed. 4. Telemetric follow-up of cardiac implantable devices is a safe and enables quick information transmission in cases of clinical complications (arrhythmias, interventions).

[Reasons of recurrence and subjective arrhythmia feelings after successful RF AVNRT ablation].

Aim of the study was analysis of electrophysiological and clinical parameters related to increasement of recurrence risk of AVNRT and subjective heart feelings after successful RF ablation. Materials and methods: Retrospective analysis was made among patients after successful RF AVNRT ablation. Study group was 93 patients (F=63), mean age 46.7+15.9 (from 18 to 80y). Electrophysiological and physical parameters achieved during electrophysiological study was analysed. Using telephone monitoring and question survey patients were divided into 3 subgroups A ­ without symptoms, B ­ with subjective arrhythmia feelings and C with documented arrhythmia recurrence. Results: 6.4% patients (n=6) had documented arrhythmia recurrence AVNRT (subgroup C); women 100% (n=6), mean age 43.5±14 years. 43% of patients (n=40) after successful RF ablation had subjective feelings of heart palpitations of a different kind (subgroup B); women 68% (n=32), mean age 42.8±14 years. 51% (n=47) of patients didn't feel any arrhythmia (subgroup A); women 64% (n=36), mean age 50.7±17 years. Conclusions: Factors related to increased risk of arrhythmia recurrence was: atypical forms of tachycardia, shorter tachycardia cycle, slow pathway modification, low mean power during RF ablation. Among patients without documented arrhythmia recurrence: lower age, higher time from the beginning arrhythmia until ablation procedure and Wenckebach Point cycle length shorter predispose to inadequate subjective arrhythmia feelings after successful RF ablation.

[Parameters of cardiac pacing and effectiveness of defibrillation during implantable cardioverter-defibrillator lead implantation to right ventricle outflow tract]. / Parametry stymulacji elektrycznej oraz skutecznosc defibrylacji podczas implantacji elektrody kardiowertera-defibrylatora w drodze odplywu prawej komory serca.

UNLABELLED: Traditional implantation site for implantable cardioverter-defibrillator (ICD) is right ventricular apex (RVA). According to many data, this location ensures low enough defibrillation threshold. ICDs are more often implanted in patients with impaired left ventricle function, in whom, along with disease progression, the need for permanent stimulation develops. Right ventricle outflow tract (RVOT) is considered to be a better site for permanent stimulation. The aim of the study was to assess acute parameters of an ICD lead implantation to RVOT. These are: electrical parameters measured during implantation, defibrillation safety margin (DSM) and some acute complications requiring reoperation. MATERIAL AND METHODS: The study was retrospective. 113 consecutive patients were included in the study (including 19 women, mean age was 60,08 years), who had a single coil ICD lead implanted in the clinic from 2008 to 2012. The implantation site was left to the physicians' discretion, which resulted in majority of RVOT implantations. Among indications to implantation in both groups ischaemic cardiomiopathy with low ejection fraction was a main indication. Excluding criteria were: using dual coil lead, lack of DSM, device of resynchronization implantation. During implantation procedure the following parameters were assessed: R wave amplitude, lead impedance, ventricular pacing threshold. DSM was performed according to the attached scheme. Analysis included: implantation criteria (primary or secondary prevention), demographic and clinical factors, administered anti-arrhythmic medications. RESULTS: In 91 patients (80.53% of the population) the lead was primarily positioned in RVOT while in 22 patients (19.47%) in RVA. In the primarily RVOT group, 50% of ICDs were dual chamber, while in RVA group it was 36%. There were no statistically significant differences between the groups in relation to pacing threshold, lead impedance or R wave amplitude. In 20 patients the lead was repositioned from RVOT to RVA and in 3 from RVA to RVOT due to inappropriate pacing parameters. DSM was satisfying in all of the patients. However, in patients implanted in primary prevention 20% of leads needed repositioning. In patients implanted in secondary prevention 25% of leads needed repositioning. Due to small patient groups, statistical calculations were not feasible in this matter. Complications demanding reoperation were the following: 1 case of right ventricle perforation, 2 cases of atrial lead dislodgement, 3 pocket haematomas, 1 ventricular exit block and 1 infection. CONCLUSIONS: Acute ventricular pacing parameters of single coil defibrillator leads do not differ significantly between RVA and RVOT. Surgical complications in both groups are similar, while permanent RVOT stimulation seems to be clinically better. Further observation in order to determine long term consequences of implantation in different sites seems reasonable.

[Quality of life in patients after anti-arrhythmic devices implantation]. / Jakosc zycia chorych po implantacji wszczepialnych urzadzén antyarytmicznych.

THE AIM OF STUDY: To assess changes in quality of life in patients with advanced heart failure before ICD or CRTD implantation and after 6 months follow-up period. MATERIAL AND METHODS: The quality of life study was performed in group consisting of 98 patients (69 male, mean age 70.4 +/- 8.60 years), who underwent CRTD implantation (48 patients, 33 male, mean age 70.6 +/- 9.12 years) or ICD implantation (50 patients, 36 male, mean age 70.3 +/- 8.16 years) before the procedure and after 6 months of follow-up. Inclusion criteria were as follows: patients with indications to ICD or CRTD implantation, complete quality of life questionnaires before the procedure and after 6 months follow-up, lack of diagnosed dementia. The quality of life assessment was performed using patient's self-assessment with SF-36 and DASI questionnaires. Patients' self-assessment, NYHA class and ejection fraction was compared before the implantation and after 6 months. Additionally, co-morbidities and experiencing of high voltage therapy were analyzed. RESULTS: In the whole group after 6 months NYHA class improved from mean 2.9 +/- 0.5 to 2.3 +/- 0.84, p < 0.001; in CRTD group from mean 3.0 +/- 0.62 to 2.3 +/- 0.95, p < 0.001; in ICD group from mean 2.9 +/- 0.35 to 2.2 +/- 0.74, p < 0.001. In the whole group after 6 months ejection fraction improved from mean 27.7 +/- 6.92 to 31.0 +/- 7.23%, p < 0.001; in CRTD group from mean 25.3 +/- 7.85 to 32.4 +/- 8.98%, p < 0.001; in ICD group there was no significant improvement of ejection fraction. After CRTD implantation improvement of quality of life was achieved in SF36 and DASI questionnaires. There was no significant improvement in ICD group. DASI index is deteriorated by device's interventions (cardioversions) (regression index=3.45, odds ratio OR = 31.5, 95% confidence interval OR = 8.2-121, p < 0.001) and presence of permanent atrial fibrillation (regression index = 1,243, odds ratio OR = 3.45, 95% confidence interval OR = 1.03-11.7, p < 0.042). SF36 index is deteriorated by presence of kidney failure (regression index = 1.91, odds ratio OR = 6.74, 95% confidence interval OR = 1.75-26, p < 0.005) and permanent atrial fibrillation (regression index = 2.27, odds ratio OR = 9.7, 95% confidence interval OR = 3.1-29.6, p < 0.001). CONCLUSIONS: Cardiac resynchronization therapy (CRTD) improves quality of life, NYHA class and left ventricle ejection fraction. Implantable cardioverter-defibrillator (ICD) does not significantly improve quality of life, NYHA class or left ventricle ejection fraction. Only in the CRTD group a significant positive correlation between changes in DASI and SF36 indexes and left ventricle ejection fraction was achieved. Experiencing cardioversion/defibrillation from implantable device and co morbidities (diabetes mellitus, arterial hypertension, kidney failure, permanent atrial fibrillation) significantly deteriorate patients' self assessment of quality of life.

[Antitachyarrhythmic interventions of implantable cardioverter-defibrillator in primary and secondary sudden cardiac death prevention patients]. / Interwencje antyarytmiczne u chorych po wszczepieniu kardiowertera-defibrylatora w prewencji pierwotnej i wtórnej naglego zgonu sercowego.

UNLABELLED: Antitachycardia pacing (ATP) and high voltage interventions (CV) are methods of interrupting dangerous ventricular arrhythmias. The aim of the study was to determine the frequency of ventricular tachyarrhythmias and form of ICD interventions in patients in the primary and secondary sudden cardiac death (SCD) prevention groups. MATERIAL AND METHODS: The study involved 399 patients (334 male, 65 female), mean age was 65.2 +/- 12.1 years (21-89 years), who had an ICD implanted in years 2008-2010. The analysis comprised age, gender, indications for ICD implantation, intracardiac electrograms derived from ICD during the follow-up. RESULTS: The patients were divided in 2 groups depending on the SCD prevention type: group A - primary prevention, group B - secondary prevention. In the A group, the peak death rate was in the 7th decade of life, while in the B group it was 10 years later. In the A group the main condition was coronary arteries disease (CAD) (76%) and dilating non-ischemic cardiomiopathy (18%), whilst in the B group, only CAD (100%). In the A group different forms of ventricular tachyarrhythmias were registered more often in the dead (57%), than living patients (38%). The difference was statistically significant (p < 0.025) and considered mainly ventricular fibrillation observed in 21% of dead patients and only in 4,2% living. Despite the fact, that in the B group the percentage of dangerous ventricular tachyarrhythmias (VT and especially VF) was higher, there were fewer deaths than in A group (7.8 vs 12.8%). In living patients in the B group, there were registered twice as many ICD interventions as in the A group. In the A group, in patients over 70 years old, in contrary to the younger, more frequently ventricular tachyarrhythmias and antiarrhythmic interventions (ATP, CV) were observed. In the B group, the relation was reversed. Inadequate and ineffective interventions occurred mainly in the A group. CONCLUSIONS: There were twice as many ICD interventions in patients implanted in secondary SCD prevention than in patients implanted in primary prevention. In secondary prevention, in contrary to the primary, the frequency of ventricular tachyarrhythmias and ICD interventions in patients younger than 70 years old is higher than in older patients. The most frequent reason for inadequate ICD interventions are sinus tachycardia and atrial fibrillation.

[Influence of increased mean heart rate at rest on mortality and ventricular tachycardia resulting in adequate intervention in patients after implantable cardioverter-defibrillator implantation]. / Wplyw zwiekszonej spoczynkowej sredniej czestosci serca na smiertelnosc i wystqpienie tachyarytmii komorowej wyzwalajacej adekwatna interwencje u chorych po zabiegu wszczepienia kardiowertera-defibrylatora.

INTRODUCTION: Increased heart rate at rest (HR) is a risk factor of sudden cardiac death (SCD) and cardiovascular mortality. AIM: Retrospective assessment of increased HR influence on mortality and ventricular tachycardia followed by adequate ICD intervention. MATERIAL AND METHODS: 350 patients (52 female, 298 male), mean age 65.1+/-10.1 years (22-89 years) with ICD without resynchronization function implanted between 2008 and 2010 were examined. ECGs at rest were used to determine HR. In case of atrial fibrillation, mean value of 2 shortest and longest RR intervals was calculated to determine HR. RESULTS: During the mean observation period of 387+/-300 days, 73 patients (66 male, 7 female), mean age 63.7+/-12.2 years (22-89) had an arrhythmial/intervention, and 46 patients (9 male, 37 feamle), mean age 68.8+/-10.3 years (43-86) died. To optimize sensitivity and specificity of HR, cut off point was established using ROC curve (79/min). Number of patients with HR>79/min was significantly higher (64.7% vs 19,1%, p<0.022) in the group of patients with arrhyth-mialintervention vs no arrhythmial/intervention, and in dead vs alive patients (73.9% vs 19.5%, p<0,001). Kaplan-Meier univariate analysis proved, that HR79/ min particularly predisposed to fast ventricular arrhythmias and interventions - CV (p<0.092). In Cox multivariate analysis, HR< or =79/min was a protective factor only in death risk (HR=0.2362, 95%CI=0.1094-0.5099, p<0.0002). CONCLUSIONS: An important factor increasing probability of survival without ventricular arrhythmia or death was a mean heart rate below 79/min. The cycle length of the baseline rhythm determine the arrhythmia cycle length.

[Venous thrombosis as a complication of pacemaker implantation--own observations]. / Zakrzepica zylna jako powiklanie po wszczepieniu rozrusznika serca--wlasne obserwacje.

UNLABELLED: Thrombosis is a fairly rare, yet dangerous complication of pacemaker implantation. It may occur in various time intervals after the actual implantation procedure. The risk factors are as follows: inflammation or injury, vein anomalies, arrhythmia, venous stenosis. The aim of the study was to assess the risk factors for venous thrombosis, determine the interrelationship between venous thrombosis and the level of select inflammatory and pro-thrombotic factors, as well as to evaluate the actual impact of pacemaker implantation procedure within a group of patients with permanent heart stimulation system. MATERIAL AND METHODS: The study involved 48 patients with permanent heart stimulation system, divided into 2 groups. Group A (18 F, 20 M; mean age 71.7 +/- 13.6 years) consisted of patients who had up to 3 thrombotic risk factors, whereas group B (2 F, 8 M; mean age 71.6 +/- 7.5 years) comprised the patients with more than 5 thrombotic risk factors. All patients were subsequently followed up for 18 months. Prior to pacemaker implantation the following factors were assessed in each patient: specific indications for pacemaker implantation, overall clinical condition, coexisting diseases, history of tobacco smoking, medications used prior to the procedure (anti-platelet, anti-coagulation), history of thrombotic or infectious complications, previous temporary heart stimulation. A transthoracic echocardiogram (TTE) and an ultrasound examination of the veins in both upper extremities were carried out. The levels of: D-dimers, fibrinogen, interleukin-6 (IL-6), hsCRP, TF and PAI-1 were determined in the venous blood. During the pacemaker implantation procedure the actual access to the veins and possible venous anomalies were assessed. After the pacemaker implantation, the TTE and venous ultrasound examination were carried out after 6 and 12 months, blood analyses for up to 7 days after the implantation, and subsequently after 6 and 12 months. RESULTS: Patients in group B had significantly lower left ventricle ejection fraction and larger left ventricle end diastolic diameter than group A patients. In 3 patients in group B (which made up 6.25% of the study population), symptomatic venous thrombosis occurred after a 12-month observation period (mean 13.06 months). Initially, the levels of IL-6, hsCRP, TF, PAI-1, fibrinogen and D-dimers were considerably higher in group B, in comparison to group A. In all patients the levels of the above referenced factors kept on increasing for up to 7 days after the procedure. In group A they subsequently decreased, whereas in group B they kept on growing. In group B a significant negative correlation was observed between the left ventricle ejection fraction and the inflammatory and thrombotic factors under study. The lower the ejection fraction, the higher actually were their values. CONCLUSIONS: In patients with more than 5 thrombosis risk factors, the increased levels of IL-6, hsCRP, fibrinogen, D-dimers, TF and PAI-1 were observed. A pacemaker implantation procedure is believed to increase both thrombotic and inflammatory state in a patient for up to 7 days after the procedure. In patients prone to thrombosis, a negative correlation between the ejection fraction and the levels of hsCRP, D-dimers, TF and PAI-1 were observed.

Utilization of Subcutaneous Cardioverter-Defibrillator in Poland and Europe-Comparison of the Results of Multi-Center Registries.

The implantation of a subcutaneous cardioverter-defibrillator (S-ICD) may be used instead of a traditional transvenous system to prevent sudden cardiac death. Our aim was to compare the characteristics of S-ICD patients from the multi-center registry of S-ICD implantations in Poland with the published results of the European Snapshot Survey on S-ICD Implantation (ESSS-SICDI). We compared data of 137 Polish S-ICD patients with 68 patients from the ESSS-SICDI registry. The groups did not differ significantly in terms of sex, prevalence of ischemic cardiomyopathy, concomitant diseases, and the rate of primary prevention indication. Polish patients had more advanced heart failure (New York Heart Association (NYHA) class III: 11.7% vs. 2.9%, NYHA II: 48.9% vs. 29.4%, NYHA I: 39.4% vs. 67.7%, p < 0.05 each). Young age (75.9% vs. 50%, p < 0.05) and no vascular access (7.3% vs. 0%, p < 0.05) were more often indications for S-ICD. The percentage of patients after transvenous system removal due to infections was significantly higher in the Polish group (11% vs. 1.5%, p < 0.05). In the European population, S-ICD was more frequently chosen because of patients' active lifestyle and patients' preference (both 10.3% vs. 0%, p < 0.05). Our analysis shows that in Poland, compared to other European countries, subcutaneous cardioverters-defibrillators are being implanted in patients at a more advanced stage of chronic heart failure. The most frequent reason for choosing a subcutaneous system instead of a transvenous ICD is the young age of a patient.

Delayed perforation of the right ventricle as a complication of permanent cardiac pacing - is following the guidelines always the right choice? Non-standard treatment - a case report and literature review.

A case of a delayed perforation of the right ventricle by the pacemaker lead in a 67-year-old woman is presented. Perforation, mimicking stenocardial symptoms, was incidentally diagnosed on a computed tomography chest scan. Percutaneous lead extraction was successfully performed, with simultaneous implantation of a new pacemaker lead.

[Atrioventricular nodal reentrant tachycardia--arrhythmias mechanism, clinical feature and electrocardiographic recordings]. / Nawrotny czestoskurcz wezlowy przedsionkowo-komorowy--mechanizm arytmil, obraz kliniczny oraz przykldy elektrokardiograficznych zapisów.

Atrioventricular nodal reentrant tachycardia (AVNRT) is probably the most common form of paroxysmal supraventricular tachycardia. It has two usual types of surface ECG patterns. In the so-called "common, usual, or typical" form of AVNRT the retrograde P wave is seen in close proximity to the QRS complex. In the "uncommon, unusual, or atypical" form of AVNRT the retrograde P wave occurs late, within or following the T wave. In the common type of AVNRT the reentrant circuit consists of the slow pathway in the anterograde direction and the fast pathway retrogradely. In the uncommon type of AVNRT the slow pathway is utilized retrograde and a relatively fast pathway is utilized in the anterograde direction. Common symptoms include palpitations, nervousness, anxiety, lightheadedness, neck and chest discomfort, and dyspnea. AVNRT may cause or worsen heart failure in patients with poor left ventricular function. It may cause angina or myocardial infarction in patients with coronary artery disease. Syncope may occur in patients with a rapid ventricular rate or prolonged tachycardia due to poor ventricular filling, decreased cardiac output, hypotension, and reduced cerebral circulation.

[Quality of life after RF ablation of reentrant supraventricular tachycardias and ventricular ectopic beats in own observation]. / Jakosc zycia po ablacji pradem o wysokleJ czestotliwosci nawrotnych czestoskurczów nadkomorowych i ekstrasystolii komorowej w obserwacji wlasnej.

THE AIM OF THIS STUDY: To assess the quality of life (QoL) in patients who underwent RF reentrant supraventricular tachycardias and ventricular ectopic beats ablation. MATERIAL AND METHODS: The study group consisted of 70 patients, 21 male, mean age 39.5 +/- 8.3 y. with supraventricular tachycardias (AVNRT, AVRT) and ventricular ectopic beats (VEB) treated with RF catheter ablation. The indications for the procedure were: nodal reentry tachycardia (group A n=24), WPW syndrome (group B n=24) and ventricular ectopic beats (group C n=22). Quality of life was prospectively evaluated. All the patients completed self-administered questionnaire (SF-36), disease--specific symptoms scale (Manolisa) and exercise capacity (DASI) before and 6 months after ablation. Scores were compared with t-Student test. RESULTS: In all study population significant improvement in QOL was found after ablation. The improvement was significant in all eight subscales of SF-36 scale. The patients reported significant improvement as assessed by disease-specific symptoms scale and exercise capacity. Before ablation, role limitations (subscales 2 of SF-36) and exercise capacity were lower in WPW patients as compared to remaining patientss (63.5 vs. 31.3, p < 0.005 and 52.9 vs. 46.1, p < 0.05; group B vs. group A) and (52.9 vs. 39.9, p < 0.01; group B vs. group C). CONCLUSIONS: The treatment of reentrant supraventricular arrhythmias and ventricular ectopic beats with RF catheter ablation significantly improves quality of life. The improvement was higher in VEB patients and negative correlation between QoL and an amount of VEB was observed. Pathomechanism of supraventricular tachycardia influences parameters of QoL. Role limitations were higher in AVNRT group than AVRT group. SF-36, disease--specific symptoms (Manolisa) and DASI questionnaire are useful in the assessment of efficacy of treatment for supraventricular arrhythmias and ventricular ectopic beats.

[Return of sinus rhythm in permanent atrial fibrillation patients at the time of the testing defibrillation during cardioverter-defibrillator implantation]. / Powrót rytmu zatokowego u chorych z utrwalonym migotaniem przedsionków podczas testowania progu defibrylacji przy wszczeplenlu kardiowertera-defibrylatora serca.

UNLABELLED: Among patients, who underwent implantable cardioverter-defibrillator (ICD) implantation procedure, there are some, who have permanent atrial fibrillation (AF). There is a theoretical possibility of return of sinus rhythm at these patients during ventricular defibrillation testing at the time of the ICD implantation procedure. The aim of the study was to attempt to find agents which can promote return of sinus rhythm at the time of the defibrillation testing during ICD implantation. MATERIAL AND METHODS: Seventy-two (mean age 65.8 years, 60 men) of the 611 patients (mean age 63.3 years, 501 men) who underwent ICD induction over this period had permanent AF before and at the time of the procedure. RESULTS: The return of sinus rhythm was observed in 17 patients (Group A, mean age 64.2 years, 14 men) during ICD implantation, at the time of the defibrillation testing. The return of sinus rhythm after ICD intervention could be associated with presence of 2-coil electrode (p < 0.001), with lower left atrial diameter (p < 0.001), with lower NYHA class (p < 0.05) and greater use of antiarrhythmic drugs (p < 0.025). CONCLUSIONS: Atrial fibrillation was present in 11.7% of 611 ICD patients. We observed the return of sinus rhythm after ICD intervention in 2.7% persons. The return of sinus rhythm could be associated with presence of 2-coil electrode, lower left atrial diameter, lower NYHA class and greater use of antiarrhythmic drugs. To prevent embolic complication oral anticoagulation should be standard treatment in this group of patients.

[Comparison of treatment effectiveness of implantable cardioverter defibrillator in patients undergoing defibrillation threshold testing at the time of implantation versus no defibrillation threshold testing]. / Porównanie skutecznosci leczenia za pomoca kardiowertera-defibrylatora chorych z przeprowadzona lub nie ocena progu defibrylacji podczas wszczepiania urzadzenia.

UNLABELLED: Inability to perform defibrillation threshold (DFT) testing during implantable cardioverter defibrillator (ICD) implantation due to comorbidities may influence long-term survival. MATERIAL AND METHODS: Retrospective review (2005-2007) identified 142 patients undergoing ICD implantation without DFT testing (No-DFT group). A control group consisting of 290 patients undergoing standard DFT testing (DFT group) was compared to the first group in terms of appropriate shocks, clinical shock efficacy and all-cause mortality. The primary and secondary prophylactic therapy were performed to the estimation. RESULTS: DFT testing was withheld due to atrial fibrillation with inability to exclude left atrial thrombus, left ventricular thrombus, congestive heart disease and(or) ischemia, hypotension and absent of anesthesiologist. The No-DFTgroup had a similar appropriate shock rate, but lower total survival (79.1% vs. 91.2%, p = 0.01) than the DFT group. In secondary prophylactic therapy, the No-DFT group had a higher incidence of sudden death (7.6% vs. 4.3%, p = 0.03) compared to the DFT group. CONCLUSIONS: The overall mortality was higher in the No-DFT group and number of sudden death in secondary prophylactic therapy. DFT testing should therefore remain the standard of care. Nevertheless, ICD therapy should not be withheld in patients who meet appropriate implant criteria simply on the basis of clinical scenarios that preclude routine DFT testing.

The utility of a CHA2DS2-VASc score in predicting the presence of significant stenosis and occlusion of veins with indwelling endocardial leads.

BACKGROUND: Currently, there are no studies in which a CHA2DS2-VASc score has been used to predict the risk of venous stenosis and occlusion (VSO) in patients after the implantation of a cardiac implantable electronic device (CIED). METHODS: The material consists of the records of 223 consecutive patients qualified for transvenous lead extraction, generator change and system revisions or upgrades in whom we assessed the utility of a CHA2DS2-VASc score in the prediction of VSO. The CHA2DS2-VASc score was calculated retrospectively based on the clinical data. The whole study population was divided into two groups, based on the presence (group I) or absence (group II) of VSO. Using the receiver operating characteristic (ROC) curve, we identified the optimal cut-off point for the CHA2DS2-VASc score that allowed the prediction of the absence of VSO. RESULTS: The venography was performed in 223 consecutive patients aged on average 68.2years (25.7-95.3), 77 females (34.5%). The presence of VSO was detected in 79 (35.4%) patients aged 68.3±14.1years, 30 female (40%) patients-group I. The level of the cut-off point for the CHA2DS2-VASc score that allowed the prediction of the absence of VSO was 3.0. CONCLUSION: In the whole population the incidence of VSO amounted to 35.4%. The result of the CHA2DS2-VASc score was a destimulant of VSO occurrence and was characterized by moderate sensitivity (73.4%) and specificity (42.4%) in predicting the absence of VSO. The most significant factor, which prevented VSO development was diabetes.