[Recurrent ventricular tachycardia as a cause of circulatory decompensation in the case of various comorbid diseases]. / Nawracajace czestoskurcze komorowe jako przyczyna dekompensacji ukladu krazenia w przypadku róznych chorób wspóltowarzyszacych.

Ventricular arrhythmias, including tachycardia and ventricular fibrillation are often a dangerous consequence other co-existing conditions in the phase of their destabilization. Causal and symptomatic treatment diseases such as: ischemic heart disease, cardiac insufficiency, hyperthyroidism, or cancer, can be effectively stabilized without necessity for the implantation of cardioverter-defibrillator (ICD). CASE REPORT: The 62-year-old patient was admitted to the cardiology department after a second episode of unconsciousness last week due to recurrent VT. Despite many diagnostic difficulties, the possibility of effective conservative treatment has been demonstrated.

[Factors predisposing to the reprogramming of implantable cardioverter-defibrillators and the causes of changes in pharmacotherapy in patients with dilated cardiomyopathy for primary prevention of sudden cardiac death]. / Czynniki wplywajace na przeprogramowanie implantowanych kardiowerterów-defibrylatorów oraz powody zmian farmakoterapii u chorych z kardiomiopatia rozstrzeniowa w prewencji pierwotnej naglego zgonu sercowego.

UNLABELLED: Ambulatory care of patients with implantable cardioverter-defibrillator (ICD) involves regular follow-up visit, where a decision on reprogramming of the device and modification of pharmacotherapy is made. AIM: The aim of the study was the assessment of frequency and reasons of reprogramming and pharmacotherapy changes in patients with dilated cardiomyopathy with an ICD implanted due to primary prevention of sudden cardiac death (SCD). MATERIALS AND METHODS: The study included 143 consecutive patients with an ICD implanted in 2010-2011. The inclusion criteria were: left ventricle ejection fraction (LVEF)≤35%, New York Heart Association (NYHA) Class≥II, implantation due to primary prevention of SCD. All ambulatory visits in outpatient department were investigated retrospectively. The following variables were analyzed: age, gender, presence of coronary artery disease (CAD) and atrial fibrillation (AF), LVEF, NYHA class, presence of interventions, reprogramming and pharmacotherapy changes. RESULTS: The most common changes in ICD parameters were modification of detection and therapy of ventricular arrhythmias. Modification of pharmacotherapy were most often referred to B-blocker and cardiac glycosides. Patients with AF had more often parameters of bradycardia pacing changed (p=0,016). There was a significant correlation between number of interventions and total number of reprogramming (r=0,3 p<0,05). A negative correlation was found between LVEF and number of reprogramming of detection of ventricular tachyarrhythmia (r=-0,18 p<0,05) and between LVEF and number of interventions (r=-0,2, p<0,05). Patients with interventions and patients AF had more pharmacotherapy changes (82 vs 29, p<0,001 and 59 vs 52, p<0,01 respectively). A significant correlation was found between number of interventions and total number of pharmacotherapy changes (r=0,5 p<0,05) and between number of interventions and modification of pharmacotherapy with B-blocker, cardiac glycosides and introduction of amiodarone therapy (r=0,47; r=0,30; r=0,32 respectively, p<0,05). CONCLUSIONS: Patients with AF had more changes in ICD parameters, pacing parameters and pharmacotherapy. Patients with lower LVEF had more interventions and more changes in detection of ventricular tachyarrhythmia.

[The rapid progress of heart failure due to systemic amyloidosis with cardiac involvement--case report]. / Gwaltownie postepujaca niewydolnosc krazenia w przebiegu amyloidozy z zajeciem serca-opis przypadku.

UNLABELLED: Amyloidosis is a disease having many different faces. Different symptoms may appear, depending on which organ is involved. That's why correct diagnosis can be difficult. Cardiac involvement must always be considered because of poor prognosis (30 to 68 % patients survive one year). Also in case of rapid progress of cardiac wall thickening, amyloidosis should be taken into account. MATERIAL AND METHODS: we present a case of a female patient with rapid progress of heart failure due to systemic amyloidosis with cardiac involvement. CASE REPORT: 48-old female, with no prior medical history, admitted to cardiology ward because of dyspnea on exertion and leg edema. Couple days before admission hypertrophic cardiomyopathy was diagnosed. Laboratory test revealed elevated troponin I, d-dimers and BNP (natriuretic peptide type B). Electrocardiogram showed low QRS voltage in limb leads. Echocardiography confirmed concentric thickening of left ventricular walls and reduced ejection fraction (40%). We performed cardiac magnetic resonance. Morphology of the delayed enhancement and an increased signal in T2 dependent sequences suggested overlap of general inflammatory process and hypertrophic cardiomyopathy. Because of amyloidosis suspicion, gingival and subcutaneous adipose tissue biopsies were performed. Sirius red stain identified amyloid only in the walls of gingival blood vessels. Diagnosis of amyloidosis was established and further diagnostics planned. Soon after patients condition worsened. Finally, in intensive care unit, after cardiac arrest patient died. CONCLUSION: Amyloidosis with cardiac involvement has a very poor prognosis. Multiple tissue biopsy and histopathological assessment should lead to correct diagnosis and proper treatment.

[Pathogenesis of tricuspid valve regurgitation in patients with implanted of right-ventricular electrode]. / Patogeneza niedomykalnosci zastawki trójdzielnej u pacjentów po implantacji elektrody prawokomorowej.

Permanent pacemakers could provoke or enhance preexisting tricuspid valve regurgitation. Pacemaker electrode implantation provokes local inflammatory process and subsequent permanent tissue remodeling, particularly in area of neighboring valve apparatus. As a consequence valve regurgitation may occur. It is supposed that valve perforation and right ventricle contraction asynchrony caused by right ventricle apex stimulation may lead to tricuspid valve regurgitation. Presented work shows current literature review according this topic.

[Assessment of time to stimulate the function of the type of AAI in the distant observation in patients with sick sinus syndrome]. / Ocena czasu funkcjonowania ukladu stymulujacego typu AAI w odleglej obserwacji u chorych na zespól chorego wezla zatokowego.

UNLABELLED: For the first time in 1966 vestibular stimulation has been applied. This idea is implemented in a patient with sinus node dysfunction and normal AV conduction. The aim of the study was to evaluate the time of AAI stimulation until the first reimplantation of stimulating system and to determine the cause of it. MATERIAL AND METHODS: Work is retrospective in nature. The analysis included 251 patients who were subjected to AAI pacemaker implantation in the period from December 1988 to January 2009. The group consisted of 150 women and 101 men. The average age of patients at the time of implantation of 62.0 +/- 13.3 years (17.3 -90.2). The median follow-up was 7.6 +/- 4.8 years (maximum 20.1 years). For each patient, Wenckebach point was above 130/min. Of the 251 patients, 98 were undergoing treatment reimplantation of stimulating system. RESULTS: The median time to stimulate the function of the type of AAI was 8.69 +/- 2.4 years. The main cause was the exhaustion of the battery replacement--91.8% of cases, but sometimes less damage to the electrodes--7.1% of cases. Duration does not depend on the gender of the patient, or to his age at the time of implantation. CONCLUSIONS: The most common cause of reimplantation is battery exhausted. AAI stimulation is very effective treatment in the test group of patients.