9 research outputs found
Ablation of ventricular arrhythmias above semilunar valves.
Aritmije iz izgonskog trakta desne ili lijeve klijetke mogu imati svoje ishodiÅ”te u supravalvularnim miokardnim ekstenzijama. Medikamentozna terapija je tradicionalno neuspjeÅ”na, pa se kod simpomatskih sluÄajeva ili onih kod kojih se razvije aritmijom inducirana kardiomiopatija treba odluÄiti za interventno rjeÅ”enje. Za njihovu uspjeÅ”nu eliminaciju ablacijom mapiranje i primjena radiofrekventne energije mora se uÄiniti iznad semilunarnih valvula, u regijama koje imaju specifiÄne anatomske osobitosti. U ovom preglednom radu donosimo kratak osvrt na anatomsku podlogu ovih aritmija i intraproceduralne korake koji vode uspjeÅ”noj i sigurnoj ablaciji, kao i pregled vlastitog iskustva.Arrhythmias from the right and left ventricular outflow tract may stem from supravalvular myocardial extensions. Medical therapy has traditionally been unsuccessful, so in symptomatic cases or those in which arrhythmia-induced cardiomyopathy develop we should opt for an intervention. Mapping and use of radiofrequency energy has to be performed above semilunar valves for their successful elimination by ablation, in the regions that have specific anatomical features. This review article provides a brief overview of the anatomical substrate of these arrhythmias and intraprocedural steps that lead to successful and safe ablation, as well as an overview of our own experience
āDouble fireā ā a rare and commonly unrecognized arrhythmia.
Dvojna fiziologija provoÄenja atrioventrikularnim (AV) Ävorom, odnosno prisutnost tzv. sporog puta, prema raznim studijama, elektrofizioloÅ”kim ispitivanjem se može dokazati u do Äak 35% ljudi. MeÄutim, kod samo manjeg broja on ima i kliniÄki znaÄaj.
Prikazujemo sluÄaj pacijentice s vrlo rijetkom elektrofizioloÅ”kom manifestacijom aktivnog sporog puta, dvostrukog odgovora ventrikula na jedan atrijski kompleks. Problem je uspjeÅ”no rjeÅ”en radiofrekventnom ablacijom.
Ovakav naÄin provoÄenja AV Ävorom vjerovatno je i znatno ÄeÅ”Äi nego Å”to se opisuje u literaturi, ali se na žalost rijetko prepoznaje te je uglavnom refraktoran na medikamentoznu terapiju.Dual atrioventricular node (AV) pathway physiology or the presence of so-called slow conduction pathway is according to various studies demonstrable in up to 35% of normal people during electrophysiology study (EPS). In only a small number of them, it has a clinical significance.
We present a case of a patient with a very rare electrophysiological manifestation of active slow pathway, double ventricular response to one atrial complex. The problem was successfully treated with radiofrequency ablation.
This form of conduction via AV node is probably much more common than it was previously described in the literature, but unfortunately it is rarely recognized and is generally refractory to medical therapy
KroniÄne nezarazne bolesti kod hrvatskih branitelja u odnosu na opÄu populaciju: 25 godina nakon rata
Many published reports have documented an increased prevalence of chronic
medical conditions among veterans, but there were only a few studies that compared these increases
with the general population. The aim of this study was to determine differences in chronic medical
conditions between Croatian war veterans and the general population. This study included two
groups of subjects, i.e. 1453 participants who are Croatian war veterans and 1429 participants from
the general population. Medical history, physical examination, laboratory tests and specific diagnostic
procedures were taken during systematic physical examination in both groups. The prevalence
of hypertension, diabetes, hyperlipidemia, hypothyroidism and hyperthyroidism, chronic obstructive
pulmonary disease, coronary heart disease, malignancy, psychiatric diseases, cholelithiasis, nephrolithiasis,
smoking and alcohol consumption was analyzed. Croatian war veterans were found to be more
likely to develop hypertension than individuals in the general population (29.5% vs. 24.3%), as well
as diabetes (7.3% vs. 3.8%), hyperlipidemia (56.4% vs. 27.3%), hyperthyroidism (3.1% vs. 0.8%), coronary
heart disease (4.3% vs. 1 %), malignancy (4.1% vs. 2.2%), psychiatric diseases (15.4% vs. 1.1%),
and alcohol consumption (53% vs. 29%). Significant difference was found in favor of the general
population for hypothyroidism (14.3% vs. 8%). There were no differences in the prevalence of chronic
obstructive pulmonary disease, cholelithiasis, nephrolithiasis, and smoking. Our findings confirmed
the hypothesis of a higher prevalence of cardiovascular diseases, malignancy and psychiatric diseases
among Croatian war veterans and emphasized the need of better control of their medical conditions.PoveÄana uÄestalost kroniÄnih bolesti meÄu veteranima dokumentirana je kroz brojna istraživanja, no samo ih je nekoliko
studija usporeÄivalo s opÄom populacijom. Cilj ovog istraživanja bio je utvrditi razlike u pojavnosti kroniÄnih bolesti izmeÄu
hrvatskih branitelja i opÄe populacije. Ovo istraživanje obuhvatilo je dvije skupine ispitanika, 1453 hrvatskih branitelja i
1429 sudionika iz opÄe populacije. Anamneza, fizikalni pregled, laboratorijske pretrage i specifiÄni dijagnostiÄki postupci
provedeni su tijekom sistematskog fizikalnog pregleda u obje skupine. Analizirana je uÄestalost hipertenzije, Å”eÄerne bolesti,
hiperlipidemije, hipotireoze i hipertireoze, kroniÄne opstruktivne pluÄne bolesti, koronarne bolesti, malignih bolesti, psihijatrijskih
bolesti, kolelitijaze, nefrolitijaze, puÅ”enja i konzumacije alkohola. UtvrÄeno je da hrvatski branitelji imaju veÄu
vjerojatnost za razvoj hipertenzije (29,5% prema 24,3%), dijabetesa (17,3% prema 3,8%), hiperlipidemije (56,4% prema
27,3%), hipertireoze (3,1% prema 0,8%), koronarne bolesti srca (4,3% naspram 1%), zloÄudne bolesti (4,1% naspram 2,2%),
psihijatrijske bolesti (15,4% naspram 1,1%) i ÄeÅ”Äu konzumaciju alkohola (53% naspram 29%) nego pojedinci u opÄoj populaciji.
UoÄena je znaÄajna razlika u korist opÄe populacije za hipotireozu (14,3% naspram 8%). Nije bilo razlika u uÄestalosti
kroniÄne opstruktivne pluÄne bolesti, kolelitijaze, nefrolitijaze i puÅ”enja. NaÅ”i nalazi potvrdili su hipotezu o viÅ”oj uÄestalosti
kardiovaskularnih bolesti, malignih i psihijatrijskih bolesti meÄu hrvatskim braniteljima te naglasili potrebu bolje kontrole
njihovog zdravstvenog stanja
Preporuke za postupanje kod bolesnika sa srÄanim implantabilnim elektroniÄkim ureÄajima koji su podvrgnuti magnetskoj rezonanci - Radna skupina za aritmije i elektrostimulaciju Hrvatskoga kardioloÅ”kog druÅ”tva
For many years, magnetic resonance imaging (MRI) was contraindicated in patients with cardiac implantable electronic devices (CIED). Today, there is a growing amount of evidence that MRI can be performed safely in the majority of patients with CIEDs. Firstly, there are devices considered MRI conditional by manufacturers that are available on the market and secondly, there is clear evidence that even patients with MRI non-conditional devices can also undergo MRI safely. Protocols have been developed and recommendations from different cardiac and radiologic societies have been published in recent years. However, the majority of physicians are still reluctant to refer these patients to MRI. Therefore, this document is published as a joint statement of the Croatian Working Group on Arrhythmias and Cardiac Pacing and Department of Radiology, Sestre milosrdnice University Hospital Centre to guide and ease the management of patients with CIED undergoing
MRI. Also, we propose a unified protocol and checklist that could be used in Croatian hospitals.Magnetska rezonanca (MR) dugo je bila kontraindicirana dijagnostiÄka metoda kod bolesnika sa srÄanim implantabilnim elektroniÄkim ureÄajima (CIED). Danas imamo dovoljno dokaza da se MR može sigurno uÄiniti kod veÄine bolesnika s CIED. Prvo, postoje ureÄaji koji mogu biti podvrgnuti MR prema preporukama proizvoÄaÄa, a drugo, postoje jasni dokazi da veÄina ureÄaja koji nisu oznaÄeni kao sigurni za MR od proizvoÄaÄa takoÄer mogu biti podvrgnuti MR. Tijekom godina
razvijeni su brojni protokoli kardioloÅ”kih i radioloÅ”kih druÅ”tava, meÄutim, dio lijeÄnika i dalje oklijeva kod postavljanja indikacije
za MR u ove skupine bolesnika. Stoga je Radna skupina za aritmije i elektrostimulaciju srca Hrvatskoga kardioloŔkog druŔtva u suradnji s radiolozima KBC Sestre milosrdnice pripremila preporuke za postupanje s bolesnicima s CIED koji su podvrgnuti MR
Chronic Medical Conditions in Croatian War Veterans Compared to the General Population: 25 Years after the War
Many published reports have documented an increased prevalence of chronic
medical conditions among veterans, but there were only a few studies that compared these increases
with the general population. The aim of this study was to determine differences in chronic medical
conditions between Croatian war veterans and the general population. This study included two
groups of subjects, i.e. 1453 participants who are Croatian war veterans and 1429 participants from
the general population. Medical history, physical examination, laboratory tests and specific diagnostic
procedures were taken during systematic physical examination in both groups. The prevalence
of hypertension, diabetes, hyperlipidemia, hypothyroidism and hyperthyroidism, chronic obstructive
pulmonary disease, coronary heart disease, malignancy, psychiatric diseases, cholelithiasis, nephrolithiasis,
smoking and alcohol consumption was analyzed. Croatian war veterans were found to be more
likely to develop hypertension than individuals in the general population (29.5% vs. 24.3%), as well
as diabetes (7.3% vs. 3.8%), hyperlipidemia (56.4% vs. 27.3%), hyperthyroidism (3.1% vs. 0.8%), coronary
heart disease (4.3% vs. 1 %), malignancy (4.1% vs. 2.2%), psychiatric diseases (15.4% vs. 1.1%),
and alcohol consumption (53% vs. 29%). Significant difference was found in favor of the general
population for hypothyroidism (14.3% vs. 8%). There were no differences in the prevalence of chronic
obstructive pulmonary disease, cholelithiasis, nephrolithiasis, and smoking. Our findings confirmed
the hypothesis of a higher prevalence of cardiovascular diseases, malignancy and psychiatric diseases
among Croatian war veterans and emphasized the need of better control of their medical conditions
Preporuke za postupanje kod bolesnika sa srÄanim implantabilnim elektroniÄkim ureÄajima koji su podvrgnuti magnetskoj rezonanci - Radna skupina za aritmije i elektrostimulaciju Hrvatskoga kardioloÅ”kog druÅ”tva
For many years, magnetic resonance imaging (MRI) was contraindicated in patients with cardiac implantable electronic devices (CIED). Today, there is a growing amount of evidence that MRI can be performed safely in the majority of patients with CIEDs. Firstly, there are devices considered MRI conditional by manufacturers that are available on the market and secondly, there is clear evidence that even patients with MRI non-conditional devices can also undergo MRI safely. Protocols have been developed and recommendations from different cardiac and radiologic societies have been published in recent years. However, the majority of physicians are still reluctant to refer these patients to MRI. Therefore, this document is published as a joint statement of the Croatian Working Group on Arrhythmias and Cardiac Pacing and Department of Radiology, Sestre milosrdnice University Hospital Centre to guide and ease the management of patients with CIED undergoing
MRI. Also, we propose a unified protocol and checklist that could be used in Croatian hospitals.Magnetska rezonanca (MR) dugo je bila kontraindicirana dijagnostiÄka metoda kod bolesnika sa srÄanim implantabilnim elektroniÄkim ureÄajima (CIED). Danas imamo dovoljno dokaza da se MR može sigurno uÄiniti kod veÄine bolesnika s CIED. Prvo, postoje ureÄaji koji mogu biti podvrgnuti MR prema preporukama proizvoÄaÄa, a drugo, postoje jasni dokazi da veÄina ureÄaja koji nisu oznaÄeni kao sigurni za MR od proizvoÄaÄa takoÄer mogu biti podvrgnuti MR. Tijekom godina
razvijeni su brojni protokoli kardioloÅ”kih i radioloÅ”kih druÅ”tava, meÄutim, dio lijeÄnika i dalje oklijeva kod postavljanja indikacije
za MR u ove skupine bolesnika. Stoga je Radna skupina za aritmije i elektrostimulaciju srca Hrvatskoga kardioloŔkog druŔtva u suradnji s radiolozima KBC Sestre milosrdnice pripremila preporuke za postupanje s bolesnicima s CIED koji su podvrgnuti MR
Differences in activated clotting time and total unfractionated heparin dose during pulmonary vein isolation in patients on different anticoagulation therapy
Background: Periprocedural pulmonary vein isolation (PVI) anticoagulation requires balancing between bleeding and thromboembolic risk. Intraprocedural anticoagulation is monitored by activated clotting time (ACT) with target value >300 s, and there are no guidelines specifying an initial unfractionated heparin (UFH) dose.
Methods: We aimed to assess differences in ACT values and UFH dosage during PVI in patients on different oral anticoagulants. We conducted an international, multi-center, registry-based study. Consecutive patients with atrial fibrillation (AF) undergoing PVI, on uninterrupted anticoagulation therapy, were analyzed. Before transseptal puncture, UFH bolus of 100 IU/kg was administered regardless of the anticoagulation drug.
Results: Total of 873 patients were included (median age 61 years, IQR 53-66; female 30%). There were 248, 248, 189, 188 patients on warfarin, dabigatran, rivaroxaban, and apixaban, respectively. Mean initial ACT was 257 Ā± 50 s, mean overall ACT 295 Ā± 45 s and total UFH dose 158 Ā± 60 IU/kg. Patients who were receiving warfarin and dabigatran compared to patients receiving rivaroxaban and apixaban had: (i) significantly higher initial ACT values (262 Ā± 57 and 270 Ā± 48 vs. 248 Ā± 42 and 241 Ā± 44 s, p < .001), (ii) significantly higher ACT throughout PVI (309 Ā± 46 and 306 Ā± 44 vs. 282 Ā± 37 and 272 Ā± 42 s, p < .001), and (iii) needed lower UFH dose during PVI (140 Ā± 39 and 157 Ā± 71 vs. 171 Ā± 52 and 172 Ā± 70 IU/kg).
Conclusion: There are significant differences in ACT values and UFH dose during PVI in patients receiving different anticoagulants. Patients on warfarin and dabigatran had higher initial and overall ACT values and needed lower UFH dose to achieve adequate anticoagulation during PVI than patients on rivaroxaban and apixaban