Implantable Cardioverter-Defibrillators in Poland Compared with other European Countries from the Patient's Perspective: Insights from the EHRA Patient Survey.

BACKGROUND: The aim of this study was to compare differences between Polish ICD recipients and ICD recipients from other European countries in terms of quality of life, information provision before ICD implantation, and end-of-life issues. METHODS: This is a sub-analysis of the "Living with an ICD" patient survey (25-item questionnaire) organized by the European Heart Rhythm Association between 12 April 2021 and 5 July 2021 in ten European countries. RESULTS: There were 410 (22.7%) patients from Poland and 1399 (77.3%) from other European countries. A total of 51.0% of Polish patients reported improvement in their quality of life compared with 44.3% in other countries (p = 0.041). Remote monitoring was three times more often utilized in other countries than in Poland (66.8% vs. 21.0%, p < 0.001). While 78.1% of Poles felt well informed before ICD implantation compared with 69.6% of subjects from other countries (p = 0.001), they were less familiar with the ICD deactivation process than others (38.9% vs. 52.5%, p < 0.001). CONCLUSIONS: Despite the less frequent use of remote monitoring and gaps in end-of-life issues, Polish ICD recipients reported more favorable quality of life and a higher level of information received before device placement than patients in other European countries.

Right ventricular lead induced ventricular arrhythmia-A rare complication of cardiac resynchronization therapy.

BACKGROUND: A 53-year-old male with heart failure secondary to anterior wall myocardial infarction treated with cardiac resynchronization-defibrillator (CRT-D) device presented with ventricular arrhythmia: repetitive incessant slow ventricular tachycardias (VT) below the CRT-D detection zone, accelerated ventricular rhythm, and numerous premature ventricular ectopic beats (ExV), resulting in loss of biventricular pacing. METHODS AND RESULTS: Nonsustained monomorphic VT (nsVT) and ExV were observed in an electrocardiogram under biventricular stimulation. During noninvasive CRT-D programming, ventricular bigeminy reproducibly recurred only at right ventricular (RV) pacing and its morphology was almost identical to the stimulated beats. The left ventricular (LV) pacing failed to induce ventricular ectopy or tachycardia. CONCLUSIONS: This unusual case shows a rare phenomenon of late proarrhythmic effect due to the RV lead pacing-a new finding reported only in a few publications. Here we present our approach to CRT programming that suppressed the clinical arrhythmia without the need of catheter ablation and achieving the high biventricular pacing capture rate along with optimal hemodynamic CRT-D performance.

Conscious sedation during cryoballoon ablation of atrial fibrillation: a feasibility and safety study.

BACKGROUND: Cryoballoon ablation for atrial fibrillation (cryoAF) is relatively simple, cost-effective and easy procedure. However, general anesthesia during this procedure may have negative impact on patients' mortality and morbidity, as well as procedure costs. We sought to assess the feasibility and safety of conscious sedation during cryoAF. METHODS: Patients with paroxysmal or persistent, drug-refractory AF who underwent a first procedure of cryoAF were included in our single-center, retrospective study. The loading dose of midazolam was 2 mg and loading fentanyl dose was 25 µg intravenously. Additional doses of midazolam and fentanyl were administered, if necessary. Midazolam and fentanyl were administered to maintain amnesia and analgesia, and patients' responsiveness in Ramsay Sedation Score was assessed every 10 minutes with sedation kept at the Ramsey Sedation Scale not exceeding Ramsey 3 Grade. RESULTS: A total of 71 patients with mean age 59.5±11.1 years were enrolled (48 males, 68%). The TEE and the TEE-guided transseptal puncture was feasible in all patients. The mean duration of cryoAF procedure was 136.3±36.0 minutes. The overall mean midazolam and fentanyl used doses were: 5.1±3.1 mg (55.7±35.1 µg/kg) and 98.9±51.1 µg (1.13±0.60 µg/kg). In 3 patients (4.2%), vascular complications occurred (femoral vein bleeding with hematoma formation without communication with femoral artery). In 1 case (1.4%) transient right phrenic palsy was observed; symptoms disappeared completely within 12 hours after procedure. The overall acute procedural success rate of cryoAF (defined as electrical isolation of all pulmonary veins) was 68/71 (95.8%). CONCLUSIONS: Conscious sedation is a safe, efficacious and feasible during cryoablation of pulmonary veins for AF.

Outcomes of percutaneous coronary intervention in patients after previous coronary artery bypass surgery.

BACKGROUND: Patients after previous coronary artery bypass grafting (CABG) often require repeat percutaneous revascularisation due to poor patency rates of saphenous vein grafts (SVG) and higher risk of re-CABG. Few data are available to evaluate different percutaneous revascularisation strategies in patients after previous CABG. AIM: To evaluate outcomes of percutaneous coronary intervention (PCI) in patients after previous CABG, including the effect of treatment on the quality of life and symptoms, and secondly to assess the relation between angiographic factors and treatment outcomes METHODS: This was a prospective observational study which included 78 patients after previous CABG. Following coronary angiography, the patients were assigned to one of three groups: group A (n = 20), PCI of a SVG (PCI SVG); group B (n = 29), PCI of a native coronary artery (PCI NA); group C (n = 29), control group that received medical treatment (MT) only. Duration of follow-up was 12 months. RESULTS: Compared to MT patients, patients treated with PCI had significantly higher Canadian Cardiovascular Society (CCS) class (2.75 vs. 2.41, p = 0.03) and more frequently had coronary angiography performed due to unstable angina (57% vs. 31%, p = 0.04). Patients in the PCI SVG group had significantly older SVG conduits compared to the PCI NA group (13.4 years vs. 8.2 years, p = 0.005). At 12 months of follow-up, we found a significant improvement in the EQ-5D index of the quality of life, and a significant reduction in CCS class in the PCI SVG group (0.66 vs. 0.7, p = 0.0003, and 2.75 vs. 1.9, p < 0.001, respectively) and in the PCI NA group (0.65 vs. 0.72, p < 0.001, and 2.75 vs. 2.17, p < 0.001, respectively), but no improvement in the MT group. Treatment outcomes did not differ significantly between the three groups (combined endpoint rate 20% vs. 13% vs. 27.5%, p = 0.37). In multivariate analysis, SVG age > 11 years was identified as a significant predictor of poor outcomes in patients treated with PCI after previous CABG. CONCLUSIONS: PCI in patients after previous CABG does not improve prognosis but significantly improves the quality of life and reduces symptom severity.

Laser biostimulation in end-stage multivessel coronary artery disease--a preliminary observational study.

BACKGROUND: Low-energy laser radiation through its direct influence on tissue repair processes without heating effect may have vital importance in the therapy of patients with advanced coronary artery disease (CAD). AIM: The introductory assessment of the effects of laser biostimulation applied to patients with advanced multivessel CAD. METHODS: 39 patients with advanced CAD were assigned (mean age 64.8+/-9.6, male gender 64%, CCS class 2.5+/-0.5, EF=46+/-11%, 69% with a history of acute myocardial infarction), to undergo two sessions of irradiation of low-energy laser light on skin in the chest area from helium-neon B1 lasers. The time of irradiation was 15 minutes while operations were performed 6 days a week for one month. Before including the patients in the experimental group a full clinical evaluation, basic biochemical tests, ECG, 24h Holter recordings, 6-minute walk test, treadmill test using Bruce protocol and full echocardiographic examination were performed. After the first and second period of laser therapy with a one-month break between them analogical parameters with the initial examination were measured. RESULTS: No side effects associated with the laser biostimulation or performed clinical tests were noted. Lower CCS class (2.5+/-0.5 --> 2.2+/-0.4 --> 2.0+/-0.4, p<0.001), higher exercise capacity (5.1+/-2.2 --> 5.8+/-2.2 --> 6.6+/-2.5 [METS], p=0.023), longer exercise time (257+/-126 --> 286+/-127 --> 325+/-156 [s], p=0.06), less frequent angina symptoms during the treadmill test (65% --> 44% --> 38%, p=0.02), longer distance of 6-minute walk test (341+/-93 --> 405+/-113 --> 450+/-109 [m], p <0.001), lower systolic blood pressure values (SP 130+/-14 --> 125+/-12 --> 124+/-14 [mmHg], p=0.05) and trend towards less frequent 1 mm ST depression lasting 1 min during Holter recordings were noted. CONCLUSIONS: An improvement of functional capacity and less frequent angina symptoms during exercise tests without a significant change in the left ventricular function were observed. Laser biostimulation in short-term observation was a very safe method. These encouraging results should be confirmed in a larger, placebo-controlled study.