Ultrasound-guided imaging for vagus nerve stimulation to facilitate cardioneuroablation for the treatment of functional advanced atrioventricular block.

We present a case study article demonstrating successful implementation of ultrasound guided extra cardiac vagus nerve stimulation during cardioneuroablation. To our knowledge it is first published description of this technique, as most ECVS are done in the internal jugular vein bulb area. This method allows for reduction of fluoroscopy time, and most importantly reproducible vagus nerve capture especially after full bi-nodal (sinus and atrioventricular) cardioneuroablation when stimulation of vagus nerve may not give any effect in the heart. This article includes a case study with "dual component" atrioventricular block, where functional component is cured with cardioneuroablation, but structural (PR elongation) remains after procedure.

Variability of circadian blood pressure profile during 24-hour ambulatory blood pressure monitoring in hypertensive patients.

BACKGROUND: Evaluation of circadian blood pressure (BP) profile is an important element of ambulatory BP monitoring (ABPM). Abnormal nocturnal fall in BP is more common in patients with secondary causes of hypertension and in the elderly. Cardiovascular risk is substantially increased in these patients. AIM: Analysis of circadian BP profile in a population of treated hypertensives and identification of factors affecting variability of nocturnal fall in BP. METHODS: 24-h ABPM was performed in hypertensive patients. Based on nocturnal fall pattern, four subgroups were identified:dippers, non-dippers, extreme dippers, and risers. Comorbidities were assessed, and data obtained in all groups were compared with the dipper profile group. RESULTS: We analysed 161 patients (86 men, 53.4%). A dipper profile was noted in 44.7% of patients. Abnormal circadian BP profile was observed in 55.3% of patients, including a non-dipper profile in 21.1% of patients, an extreme dipper profilein 32.3% of patients, and a riser profile in 1.9% of patients. No significant differences in the rates of dyslipidaemia, previous myocardial infarction, previous stroke, and coronary artery disease were seen between the groups. The whole study population was also characterised by similar rates of excessive body weight and abdominal obesity. CONCLUSIONS: An abnormal circadian BP profile was found in over 50% of hypertensive patients. A negative correlation was found between nocturnal BP fall and the patient age. No differences were found between groups with different circadian BP pattern regarding duration of hypertension and the presence of dyslipidaemia, obesity, diabetes, or coronary artery disease.

Blood pressure load in adults with treated hypertension.

BACKGROUND AND AIM: To assess blood pressure (BP) load in a population of treated hypertensive patients. METHODS: The study group consisted of 137 hypertensive adults, including 75 (54.75%) men and 62 (45.25%) women, with either formerly or newly diagnosed hypertension based on office BP measurements. The median age in the whole study group was 52 years (47 and 56 years among men and women, respectively). The mean body mass index (BMI) was 27 ± 4 kg/m², and median duration of hypertension was 3 years. We divided the study group into subgroups depending on age, gender, BMI, and duration of hypertension. All patients underwent single 24-h ambulatory BP monitoring. We calculated 24-h, daytime and nighttime BP loads separately for systolic and diastolic BP. Statistical analysis was carried out using the SPSS 15.0 environment. RESULTS: Men were significantly younger than women (48.17 vs. 55.48 years, p < 0.02). Mean BMI was higher in men than women (28 vs. 26 kg/m², p < 0.044). There were no differences in the mean values of BP load depending on gender, BMI and, duration of hypertension (p = NS). Twenty-four hour and daytime diastolic BP load was higher in patients aged 41-65 years than in patients above 65 years (32.4 vs. 20.8%, p < 0.04; and 29.6 vs. 17.5%, p < 0.03). A negative correlation was found between daytime diastolic BP load and age (r = -0.19, p < 0.026) and a positive correlation was found between night time systolic BP load and age (r = 0.24, p < 0.005). CONCLUSIONS: There was no relationship between BP load and gender, BMI, and duration of hypertension. Diastolic BP load was age-related. Middle-aged patients were characterised by significantly higher values of 24-h and daytime diastolic BP load than the elderly patients.