Prospective evaluation of iatrogenic atrial septal defect after cryoballoon or radiofrequency catheter ablation of atrial fibrillation-"EVITA" study.

PURPOSE: Iatrogenic atrial septal defect (IASD) after catheter ablation (CA) for atrial fibrillation (AF) due to transseptal puncture (TSP) can occur. The aim of this prospective study was to describe the incidence of IASD and to detect any cerebrovascular accident (CVA) after radiofrequency (RF) and cryoballoon (CB) CA. METHODS: Between July 2014 and September 2016, 94 patients (pts) (RF; 48, CB; 46, 30 (31.9%) women, mean age = 60 ± 9.7 years) with paroxysmal AF were enrolled who underwent CA procedure for the first time. During RF ablation a single (n = 30, 62.5%) or double (n = 18, 37.5%) TSP was performed. Transoesophageal echocardiography before the procedure and at the 3-month and 12-month follow-up (FU) was accomplished. During the FU period, we evaluated the occurrence of any postprocedural CVA. RESULTS: At the 3-month FU, IASD was detected in 17/94 (18.1%) pts; in 9/48 (18.8%) pts in the RF while in 8/46 (17.4%) pts in the CB group (p = 0.866), all of them with left-to-right shunt. In the RF group, 6/30 (20%) pts with a single TSP while 3/18 (16.7%) pts in the double TSP group had IASD (p = 0.780). 14/17 (82.4%) IASDs showed high spontaneous closure rate at the 12-month FU. None of the pts died or suffered from CVA. CONCLUSION: Persistent IASD can occur rather frequently following AF CA. No significant difference was observed between the RF and CB techniques concerning the presence of IASD at 3-month. IASDs showed a high spontaneous closure rate. No cerebral thromboembolic event was observed in the 12-month FU period.

[Data on secondary prevention of coronary artery disease in Hungary and some changes in the last ten years (EUROASPIRE 1995-2005)]. / Magyarországi adatok a koszorúér-betegség másodlagos megelozésének helyzetérol és a változás fobb jellemzoi (EUROASPIRE 1995-2005).

In year 1995 the European Society of Cardiology started an epidemiological study EUROASPIRE to evaluate the results of secondary prevention in some European countries. The first study period was in 1995, the second in 1999-2000 and the third in 2007. From Hungary the same study centers participated in EUROASPIRE I-II-III investigation. Authors present the Hungarian data and changes occurring the last ten years. During the three studies, 1627 coronary patients- younger than 70 years - were evaluated, using standardized methods. In the two Hungarian study centers, the proportion of women and patients older than 60 years increased. The hospital documentation of risk factors improved, at the time of EUROASPIRE III necessary data were found in 89%-99% of patient's records. Mean systolic and diastolic blood pressure continuously decreased between the first and second study period, but at the time of the third study 44% of the patients had elevated blood pressure (>140/90 mmHg). Prevalence of smoking decreased by 8% between second and third study period, however, at the time of the last study, 18% of coronary patients were smokers. The mean of total cholesterol was lower in the last study period comparing to the first investigation (5.6 vs. 5.2 mmol/l). HDL cholesterol level was unchanged and increasing triglyceride values were observed. During the study period the prevalence of obesity continuously increased from 23% to 49%. Prevalence of patients with total cholesterol level 5.5 mmol/l or higher has decreased from 60% to 24%, however 57% of patients did not reach the target level (4.5 mmol/l) although 80% of patients were treated with lipid lowering drugs: 76% of them received statins. Authors say that some part of secondary prevention improved during the last ten years, but many patients did not reach the target blood pressure and cholesterol level and it is embarrassing the prevalence of obesity and diabetes. The published data are not representative for whole Hungary; most probably the general situation is worse. Authors emphasize the importance of secondary prevention in the graduate and postgraduate education. For improving the secondary prevention, better cooperation is needed between hospital staff and patients and general practitioners as well.

[Outpatient cardiac rehabilitation: initial experience in the first Hungarian multicenter study]. / Járóbetegformában végzett kardiológiai rehabilitácio: az elsô hazai kontrollált multicentrikus tanulmány néhány eredménye.

INTRODUCTION: This paper assesses the first controlled multicentric investigation of outpatient cardiac rehabilitation in Hungary. Framing and starting of the program was carried out beside the Hungarian experts by the United States Department of Health and Human Services. AIMS: To prove the extreme importance of cardiac rehabilitation, both inpatient and outpatient, after the hospital treatment of cardiac emergencies. METHODS: 531 patients were collected at the beginning of the study from three Hungarian cardiological centers having cardiac surgery and cardiac rehabilitation ward. 167 patients were ranked into the outpatients group (Group A), 311 were rehabilitated in hospital (Group B) and 53 served as control (group C). After physical, ergometric and echocardiographic examinations and psychometric evaluation (Beck and WHOBREF questionnaires) the patients of Group A and B performed a conducted training three times weekly for 3 months. All the patients were examined 3 and 12 months later. RESULTS: Significant improvement of ergometric data was observed in both groups of patients who underwent rehabilitation training, but this was not the case with control patients. This improvement could not be observed after one year. The number of anginal attacks and the need of hospital treatment also showed a significant reduction in Groups A and B. CONCLUSIONS: The data have proved that cardiac rehabilitation has an extremely important role in the stabilisation of heart functions and general health of patients after acute myocardial infarction or heart surgery. It was also proved, that 12-week rehabilitation training is not sufficient to achieve long-term stabilization. Sufficient data have accumulated during the study about the effectiveness and safety of outpatient cardiac rehabilitation as an alternative to inpatient service.

Preventing complicated transseptal puncture with intracardiac echocardiography: case report.

BACKGROUND: Recently, intracardiac echocardiography emerged as a useful tool in the electrophysiology laboratories for guiding transseptal left heart catheterizations, for avoiding thromboembolic and mechanical complications and assessing the ablation lesions characteristics. Although the value of ICE is well known, it is not a universal tool for achieving uncomplicated access to the left atrium. We present a case in which ICE led to interruption of a transseptal procedure because several risk factors for mechanical complications were revealed. CASE PRESENTATION: A case of a patient with paroxysmal atrial fibrillation and atrial flutter, and distorted intracardiac anatomy is presented. Intracardiac echocardiography showed a small oval fossa abouting to an enlarged aorta anteriorly. A very small distance from the interatrial septum to the left atrial free wall was seen. The latter two conditions were predisposing to a complicated transseptal puncture. According to fluoroscopy the transseptal needle had a correct position, but the intracardiac echo image showed that it was actually pointing towards the aortic root and most importantly, that it was virtually impossible to stabilize it in the fossa itself. Based on intracardiac echo findings a decision was made to limit the procedure only to ablation of the cavotricuspid isthmus and not to proceed further so as to avoid complications. CONCLUSION: This case report illustrates the usefulness of the intracardiac echocardiography in preventing serious or even fatal complications in transseptal procedures when the cardiac anatomy is unusual or distorted. It also helps to understand the possible mechanisms of mechanical complications in cases where fluoroscopic images are apparently normal.

Value of rilmenidine therapy and its combination with perindopril on blood pressure and left ventricular hypertrophy in patients with essential hypertension (VERITAS).

OBJECTIVES: The primary objective was to assess the effects of rilmenidine monotherapy and in combination with perindopril on blood pressure (BP) in patients assessed with grade 1 or 2 essential hypertension. The study also examined the effects of 2-year rilmenidine monotherapy on left ventricular hypertrophy (LVH) and on diastolic function of the left ventricle, along with the effects of rilmenidine on left ventricular mass index in hypertensive patients with no LVH, and the relationship between BP reduction and any change in LVH. RESEARCH DESIGN AND METHODS: Mild-to-moderate hypertensive patients (n = 500) were enrolled in a multicentre 2-year open study and treated with rilmenidine (1-2 mg per day) monotherapy or rilmenidine plus perindopril (2, 4 or 8 mg per day) if control of hypertension was not achieved with rilmenidine monotherapy within 12 weeks. Blood pressure was recorded at regular intervals by the investigators and LVH measured by centralised single-blind echocardiographic reading. RESULTS: Rilmenidine monotherapy (average dose 1.42 mg) produced a significant decrease in BP from the baseline of 163 +/- 10/100 +/- 5 mmHg to 134 +/- 10/86 +/- 7 mmHg at 1 year and to 136 +/- 10/84 +/- 7 mmHg at 2 years (p < 0.001 for both). In 188 patients with LVH, the left ventricular mass index was significantly reduced from 161.4 +/- 30.5 to 131.3 +/- 26.5 at 1 year and to 134.1 +/- 26.0 g/m(2) at 2 years (p < 0.001 for both). Addition of perindopril to those patients whose BP was not normalised by rilmenidine monotherapy after 12 weeks further decreased BP significantly from 150 +/- 13/93 +/- 8 mmHg to 142 +/- 14/89 +/- 7 mmHg at the end of the 2nd year. CONCLUSIONS: Long-term rilmenidine monotherapy was shown to be efficient in controlling BP and in reducing LVH. The addition of perindopril to rilmenidine monotherapy proved to be effective and well tolerated in those patients who did not respond to rilmenidine alone.

[Secondary prevention of coronary disease--at the turn of the millennium in light of the Hungarian data of the EUROASPIRE I-II. Studies]. / A koszorúér-betegség másodlagos prevenciója. Helyzetkép az ezredfordulón az EUROASPIRE I-II vizsgálat magyar adatainak tükrében.

UNLABELLED: Relevant national societies attribute special importance to the secondary prevention of coronary patients. This is well formulated in their recommendations (9, 11). Actual clinical practice was studied in 1995-1996 by the EUROASPIRE I study. Its Hungarian data were published in 1999 (8). The scope of EUROASPIRE II in 1999-2000 was to study changes occurred in these 5 years. In this paper the authors intend to answer the question whether the clinical practice of secondary prevention of coronary patients showed any changes at the turn of the millennium. Participating centres, the criteria of patient selection and the applied methods were identical in the two studies. Hospital data of 516 patients below the age of 70 were analysed. There was no difference between the two studies neither in the distribution according to gender and age, nor in the number of death. Documentation of the relevant data in the hospital records improved substantially: blood pressure was registered in every patient chart, lipid values in 91%. Information on smoking however is still missing in 1/3 of the patients, while on weight and height in half of them. The response rate at the follow up investigation on was 75%. The prevalence of obesity increased by 60%, that of smoking by 13% since the first investigation 5 years ago. This rate of increase is the largest among the 9 participating centres. The prevalence of hypertension decreased by 24.5% and the proportion of hypertensive patients receiving treatment increased by 7%. In spite of these blood pressure values over 140/90 mmHg were found in 37% of the patients. The mean triglyceride value increased by 53% and the prevalence of severe hypercholesterolaemia by 43%. Lipid lowering drugs are given to 51% of the patients in contrast to 22% 5 years earlier. In spite of this cholesterol values above 5.5 mmol/l were found in 42%. In respect of prophylactic drugs the proportion of patients receiving beta blockers increased from 58 to 84%. INTERPRETATION: The evaluation of complex risk of patients and their long-term care is still deficient. Drug treatment improved quantitatively but not qualitatively. This and the lack of lifestyle-improving medical efforts is reflected by the increase of the proportion of obese and smoking patients and the persistently high prevalence of hypercholesterolaemia and hypertension.