Left ventricular CRT-D lead implantation using the retrograde approach following lateral vein balloon angioplasty.

A 60-year-old female with heart failure with reduced left ventricle ejection fraction, implantable cardiac defibrillator and left bundle branch block was admitted to Department of Cardiology for cardiac resynchronization therapy defibrillator upgrade. Due to difficulties with advancement of left ventricular lead to lateral coronary vein, balloon angioplasty with use of retrograde approach via collateral branches and two CS sheaths positioning was performed. Final position of lead in lateral vein was achieved resulting with pacing threshold of 0.7 V/0.5 ms, impedance of 720 Ω and QRS of 130 ms.

Nutritional Status Predicts the Length of Stay and Mortality in Patients Undergoing Electrotherapy Procedures.

(1) Background: Nutritional status is a factor that impacts the patients' outcomes in various medical conditions including cardiovascular patients or surgical procedures. However, there is limited available information about its impact on the short-term outcomes of cardiac implantable electronic device (CIED) implantations. This study aimed to assess the relationship between nutritional status, complications, mortality risk, and length of stay at the hospital in patients undergoing CIED implantations. (2) Material and Methods: 588 patients who underwent CIED implantation in 2022 and 2023 were included in the retrospective analysis. The nutritional status assessment was performed using NRS 2002 and BMI. The implanted devices were single-chamber pacemakers (n = 82), dual-chamber pacemakers (n = 329), one-chamber ICDs (n = 83), dual-chamber ICDs (n = 19), CRT-P (n = 19), and CRT-D (n = 56). (3) Results: The regression analysis showed that the NRS 2002 score predicted the length of stay (age-adjusted: ß = 1.02, p = 0.001) among the CIED-implanted patients. The CRT-D subgroup was particularly responsible for this relationship (ß = 4.05, p = 0.003 after age adjustment). The analysis also revealed significant differences between the NRS 2002 score in the in-hospital death subgroups (1.75 ± 1.00 points for deaths vs. 1.00 ± 1.00 points for survivors; p = 0.04). There were no significant differences in nutritional status parameters regarding early complications subgroups. (4) Conclusions: This study showed that nutritional risk assessed with NRS 2002 is a predictor of length of stay (particularly for CRT-D) and mortality among patients undergoing CIED implantations. The results of the analysis point out the impact of patients' nutritional status on short-term outcomes of CIED implantations, particularly in CRT-D implants where 1 NRS 2002 point was a predictor of a mean 4.05 days (77.2%) longer hospitalization.

Hiatal hernia as a rare cause of cardiac complications - case based review of the literature.

INTRODUCTION: Hiatal hernia (HH) is a condition which refers to the protrusion of an intraabdominal organ in the thorax cavity throughan oesophageal hiatus of the diaphragm. Sliding HH is usually associated with non-specific symptoms, including heartburn, regurgitation or epigastric pain. Importantly, true paraesophageal hernia may lead to cardiac compression. Knowledge of cardiac manifestations of HH is limited. OBJECTIVE: The main aim of the study is to present the rare case of a patient with gastrothorax due to hiatal hernia which caused cardiac arrest, and to provide a literature-based review of the cardiac aspects of hiatal hernia. BRIEF DESCRIPTION OF THE STATE OF KNOWLEDGE: Patients with paraesophageal hernia may experience arrhythmia, including sinus tachycardia, atrial flutter, atrial fibrillation, supraventricular extrasystole and ventricular tachycardia, as well as left bundle branch block, atrioventricular conduction block and electrocardiographic changes in the ST-segment and T-wave. In echocardiograph, HH may appear as an extracardiac posterior mass encroaching on the left atrial cavity, mimicking the left atrial mass. Rarel, HH may be manifested as tension gastrothorax leading cardiac arrest. In such a case, timely diagnosis and instant adequate treatment of the underlying condition are crucial. CONCLUSIONS: Hiatal hernia should be considered as a possible cause of arrhythmia and changes in ST-T pattern, particularly if symptoms occurred after a meal. Differential diagnosis of the posterior mediastinal mass or intracardiac mass should include hiatal hernia. Gastrothorax is a rare condition associated with hiatal hernia which may lead to cardiac arrest. However, even timely recognition and therapy of gastrothorax does not ensure a positive clinical outcome.

Impact of pulmonary vein ovality index on cooling kinetics and acute success of atrial fibrillation ablation with the third-generation cryoballoon catheter.

INTRODUCTION: Atrial fibrillation (AF) is the most common arrhythmia, increasing the risk of stroke and all-cause mortality. Pulmonary vein isolation (PVI) with cryoballoon ablation (CBA) is a widely accepted approach for invasive treatment of patients with AF. CBA effectiveness is considered to be strongly dependent upon the anatomy of pulmonary veins, mainly the ovality of pulmonary veins' ostia. However, most published results refer to the second-generation cryoballoon. AIM: To investigate the impact of the ovality index (OI) of pulmonary veins (PVs) on cryokinetic parameters and acute effectiveness of PVI with the third-generation cryoballoon catheter. MATERIAL AND METHODS: We enrolled 54 patients with documented drug-refractory, symptomatic paroxysmal and persistent AF, who underwent CBA with the third-generation cryoballoon between March 2019 and July 2020. Prior to the procedure all patients underwent computed tomography (CT) scans to evaluate anatomy of PVs and calculate the ovality indices for each vein. Analyzed patients were divided into two equal groups depending on the mean OI for all veins. RESULTS: No differences were observed in acute effectiveness, total procedure time, freeze time, need for additional applications and complications in the group with lower (OI < 1.27) and higher (OI > 1.27) OI values. Remarkably, fluoroscopy time was even slightly shorter (p = 0.046) in patients with high OI. CONCLUSIONS: In the analyzed population, increased pulmonary vein OI had no negative effect on the CBA procedure performed with the third-generation cryoballoon catheter; therefore it can be considered as a more comprehensive single-shot PVI tool.