Atrioventricular synchronous leadless pacing: Micra AV

Since the arrival of leadless pacemakers (LPs), they have become a cornerstone in remedial treatment of bradycardia and atrioventricular (AV) conduction disorders, as an alternative to transvenous pacemakers. Even though clinical trials and case reports show indisputable benefits of LP therapy, they also bring some doubts. Together with the positive results of the MARVEL trials, AV synchronization has become widely available in LPs, presenting a significant development in leadless technology. This review presents the Micra AV (MAV), describes major clinical trials, and introduces the basics of AV synchronicity obtained with the MAV and its unique programming options

Dzieci i młodzież w kręgu oddziaływania mediów i grup rówieśniczych - "w" i "pomimo" czasów ponowoczesnych

Praca recenzowana / peer-reviewed pape

Prognostic importance of serum troponin concentration in patients with an implanted cardioverter‑defibrillator admitted to the emergency department due to electric shock

Background: High-energy implantable cardioverter-defibrillator (ICD) therapy may increase serum troponin (cTnI) concentration.   Aims: We aimed to assess an impact of cTnI concentration after ICD high-energy therapy on mortality. Methods: A total of 150 patients aged 64.2 +/- 12.8 years admitted to the Emergency Departments (EDs) due to at least one electrical shock during the last 24 hours with measured serum cTnI concentration at admission were included. Age, gender, comorbidities, shocks’ numbers, therapy appropriateness, serum creatinine concentration, and left ventricular ejection fraction were noted for the retrospective analysis. Survival was obtained using the personal identification numbers (PESEL), on November 2018 until death or a period of three years had elapsed (1057 days). Results: cTnI concentration was increased in 92 (61.3%) patients. The mortality rate was related to age – HR: 1.04, 95% CI: 1.01-1.08, p = 0.026; increased cTnI concentration – HR: 2.88, 95% CI: 1.30-6.37, p = 0.009; diabetes – HR: 2.19, 95% CI: 1.09-4.39, p = 0.027; ischemic heart disease – HR: 2.96, 95% CI: 1.11-7.87, p = 0.030, serum creatinine concentration – HR: 2.17, 95% CI: 1.18-4.00, p = 0.013; LVEF (HR 0.95, 95% CI: 0.91-0.99, p = 0.009), and previous or current CABG or PCI (HR: 0.38, 95% CI: 0.15-0.96, p = 0.040 and HR: 0.29, 95% CI: 0.13-0.65, p = 0.003, respectively). Conclusions: Increased mortality rate in patients with ICD shocks is multifactorial. Increased cTnI concentration at ED admission, but not the number of ICD shocks, is an independent marker of higher long-term mortality

Phrenic nerve stimulation in patients with central sleep apnea: a single‑center experience from pilot and pivotal trials evaluating the remedē System

Background: Patients with central sleep apnea (CSA) have recently been shown to have improved sleep metrics and quality of life (QoL) with phrenic nerve stimulation (PNS). Aims: The aim of this study was to report the results of a partnership between cardiology, sleep medicine, and electrophysiology in a single clinical center as well as the enrollment, implantation, and follow‑up experience demonstrating both the safety and efficacy of PNS. Methods: This analysis included data from the pilot and pivotal trials investigating the effect of PNS using an implantable transvenous system in patients with CSA. We present our experience and data on the enrollment processes, implantation feasibility and safety, sleep indices, and QoL at 6 and 12 months of follow‑up. Results: Between June 2010 and May 2015, cardiology patients were prescreened and 588 of them were sent for in‑home sleep test. Ninety‑six patients were referred for polysomnographic studies, and 33 were enrolled and had an implant attempt, with 31 successfully receiving an implant. The apnea–hypopnea index was reduced in the pilot trial (mean [SD] of 48.7 [15.5] events/h to 22.5 [13.2] events/h; P < 0.001) and in the pivotal trial (mean [SD] of 48.3 [18.8] events/h to 26.0 [21.9] events/h; P < 0.001). Improvement in QoL was also observed. Conclusions: We showed that PNS improved sleep metrics and QoL in patients with CSA, which is a result of multiple factors, including a comprehensive coordination between cardiology, sleep medicine, and electrophysiology. This ensures appropriate patient identification leading to safe implantation and full patient compliance during follow‑up visits