Cryoballoon ablation of atrial fibrillation in Republic of Moldova. Three years of experience

Medpark International Hospital, Chisinau, Republic of Moldova, TOBB University of Economics and Technology Hospital, Ankara, TurkeyIntroduction. Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in adults with currently estimated prevalence between 2% and 4%. AF is associated with significant morbidity and mortality having important impact to both patient’s quality of life and health economy. In the last years a lot of research efforts and resources are being directed towards gaining detailed information about the mechanisms underlying AF, its natural course and effective treatments. New evidence is continuously generated and published. The complexity of AF requires a multidisciplinary approach to the management of AF patients with their active involvement in partnership with clinicians. In recent years, substantial progress has been made in the detection of AF and its management. The procedure of pulmonary vein isolation is an established therapy for symptomatic atrial fibrillation. The second generation cryoballoon is one of the effective methods in achieving pulmonary vein isolation. In 2018 cryoballoon ablation (CBA) was implemented in Republic of Moldova and is regularly performed in Medpark International Hospital in the last three years. The aim of the study was to assess the freedom from AF recurrence after CBA. Material and methods. A retrospective study was performed in 13 consecutive patients who underwent CBA using Arctic Front Advance cryoballoon (Medtronic) for paroxysmal or persistent AF from June 2018 till December 2020 in Medpark International Hospital. We followed up the patients from June 2018 till April 2021. The information about the clinical symptoms and ECG data during follow-up was collected to identify the presence of recurrence. A recurrence after CBA was considered AF episode present after 3-month blanking period and that lasted at least 30 seconds. Continuous variables are presented as mean ± SD. Kaplan–Meier analysis was used to determine the probability of freedom from AF during follow-up. Results. A total number of 13 patients with a mean age of 62.85±6.58 years with paroxysmal (n=12; 92.3%) or persistent (n=1; 7.7%) AF were identified. There were 10 males (76.9%) and 3 females (23.1%). All patients had a successful pulmonary vein isolation procedure with 100% of veins isolated. No patient had complication during procedure as phrenic nerve palsy, stroke or pericardial effusion. After a 3-month blanking period during a mean follow-up of 369.5±289 days there were 4 (30.77%) AF recurrences. The average days before recurrence was 119.75±33.22 (150, 147, 91 and 91). Freedom from AF recurrence was 69.23% at 30.8±24.1 months follow-up). Conclusions. The second generation cryoballoon ablation is an effective method of treatment for atrial fibrillation. Our results are compatible with the success rate that is reported by majority of the studies

Prolonged sinus pauses after the paroxysms of atrial tachycardia in children, to pace or to ablate? Case report

Background. The presence of prolonged sinus pauses is quite rare in children and adolescents with structural normal heart. The decision of the optimal therapeutic tactics is always challenging. Case report. The 16-years-old girl addressed with complains of palpitations and dizziness after the palpitations end. A Holter ECG monitoring was performed with the detection of prolonged sinus pauses after the paroxysm of atrial tachycardia. We decided to perform an electrophysiological study to diagnose the tachycardia type. The presence of atrial tachycardia originating from the ostium of the coronary sinus was demonstrated. We decided to manage the tachyarrhythmia with catheter ablation. During the application of the radiofrequency currents, the tachycardia stopped, and the sinus rhythm was restored. The ablation was preferred over medication taking into consideration the potential risk of worsening of the bradycardia by antiarrhythmic therapy. Conclusions. The optimal therapeutic solution in similar pediatric cases should be directed towards the supraventricular tachycardia treatment and not to the bradyarrhythmia. The majority of supraventricular tachycardias could be cured by catheter ablation

First experience with cryoballoon ablation for atrial fibrillation in Republic of Moldova

Medpark International Hospital, Cardiology and Interventional Cardiology Department, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova, TOBB University of Economics and Technology Hospital, Cardiology Department, Ankara, Turkey, The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020Introduction. Pulmonary vein isolation is an established therapy for symptomatic atrial fibrillation (AF). The second generation cryoballoon is effective in achieving pulmonary vein isolation. In 2018 we implemented the cryoballoon ablation (CBA) in Republic of Moldova.Aim of the study. To assess the freedom from AF recurrence after CBA. Materials and methods. A retrospective study was performed in 8 consecutive patients who underwent CBA using Arctic Front Advance cryoballoon (Medtronic) for paroxysmal or persistent AF from June 2018 till December 2019 in Medpark International Hospital. We followed up the patients from June 2018 till March 2020. The information about the clinical symptoms and ECG data during follow-up was collected to identify the presence of recurrence. A recurrence after CBA was considered AF episode that lasted at least 30 seconds. Continuous variables are presented as mean ± SD. Kaplan–Meier analysis was used to determine the probability of freedom from AF during follow-up. Results. A total number of 8 patients with a mean age of 60.13 ± 6.88 years with paroxysmal (n=7; 87.5%) or persistent (n=1; 12.5%) AF were identified. There were 6 males (75%) and 2 females (25%). All patients had a successful pulmonary vein isolation procedure with 100% of veins isolated. No patient had complication during procedure as phrenic nerve palsy, stroke or pericardial effusion. After a 3-month blanking period during a mean follow-up of 337 ± 135 days there were 2 (25%) AF recurrences. One patient developed atrial flutter but not AF in the follow-up period with restoration of sinus rhythm with electrical cardioversion. The average days before recurrence was 120.5 ± 41.72 (150 and 90). Freedom from AF recurrence was 75% at 11,2 months follow-up. Conclusions. The second generation cryoballoon ablation is an effective method of treatment for atrial fibrillation. Our results are compatible with the success rate that is reported by majority of the studies

Vitamin D Düzeyinin İnvaziv Elektrofizyolojik Parametrelere ve Atriyal Fibrilasyon İndüklenebilirliği’ne Etkisi

Deficiencies of Vitamin D (VitD) has been associated with coronary heart disease, hypertension and left ventricular hypertropy. However its effects on cardiac conduction system and atrial fibrillation (AF) predisposition have not been studied yet. In this study we aim to evaluate the effects of VitD on invasive electrophysiologic parameters and AF inducibility. Materials and Methods: This retrospective crosssectional study included 135 patients. Study population was divided into three group as VitD sufficient, VitD insufficient and VitD deficient according to baseline vitD levels. Patients’ invasive electrophysiologic parameters and induced AF episodes were recorded. Results: Corrected sinus node recovery time, baseline cycle length, atrial-His interval, His-ventricular interval and Wenckebach cycle length were lengthened in vitD deficient group but they didn’t reach statistical significance. The rate of AF inducibility was twice as likely in VitD deficient group than sufficient group, however, it also didn’t reach statistical significance. Conclusion: Baseline VitD levels were not associated with cardiac electrophysiologic parameters and AF inducibility. To demonstrate the role of VitD in cardiac conduction system and AF inducibility thoroughly, further studies such as addressing VitD replacement are warranted.Amaç: Vitamin D (vit D) eksikliği, koroner kalp hastalığı, hipertansiyon ve sol ventrikül hipertrofisi ile ilişkili bulunmuştur. Ancak kardiyak iletim sistemi ve atriyal fibrilasyon (AF) yatkınlığına etkisi henüz araştırılmamıştır. Bu çalışmada, VitD'nin invaziv elektrofizyolojik parametreler ve AF indüklenebilirliği üzerindeki etkilerini değerlendirmeyi amaçladık. Gereç ve Yöntem: Bu retrospektif kesitsel çalışma 135 hastayı içermektedir. Çalışma popülasyonu, temel vitD düzeylerine göre VitD yeterli, VitD yetersiz ve VitD eksikliği olmak üzere üç gruba ayrıldı. Hastaların invaziv elektrofizyolojik parametreleri ve uyarılan AF epizodları kaydedildi. Bulgular: Düzeltilmiş sinüs nodu iyileşme zamanı, bazal döngü uzunluğu, atriyal-His aralığı, His-ventriküler aralık ve Wenckebach siklus uzunluğu, vitD eksikliği olan grupta uzamış, ancak istatistiksel olarak anlamlı bulunmamıştır. AF indüklenebilirlik oranı, VitD eksikliği olan grupta, yeterli gruba göre iki kat daha fazlaydı., ancak istatistiksel olarak anlamlı değildi. Sonuç: Bazal VitD seviyeleri kardiyak elektrofizyolojik parametreler ve AF indüklenebilirliği ile ilişkili değildi. VitD'nin kardiyak iletim sistemindeki rolünü ve AF'nin indüklenebilirliğini tam olarak göstermek için VitD replasmanını da içeren daha ileri çalışmalar gereklidir

Treatment for ventricular tachycardia in the absence of structural heart disease

Medpark International Hospital, Cardiology and Interventional Cardiology Department, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova, TOBB University of Economics and Technology Hospital, Cardiology Department, Ankara, TurkeyBackground. According to the recent data in up to 10% of the patients with ventricular tachycardia (VT) there is an absence of structural heart disease. Several types of VT could be present in such patients: right ventricular outflow tract (RVO T) VT, caticholaminergic polymorphic VT, idiopathic left VT, Brugada syndrome, long QT syndrome. According to the VT type the management can be pharmacological therapy, radio-frequency ablation, implantation of cardioverter defibrillator or a combination of them. The decision about the management is based on the type of VT, data obtained from echocardiography, magnetic resonance imaging (MRI) and electrophysiological study (EPS)

The Effects of The Duration of Mobile Phone Use on Heart Rate Variability Parameters in Healthy Subjects

Objective: This study aimed to estimate the influence of the duration of mobile phone use on heart rate variability (HRV) in healthy individuals. Methods: One hundred forty-eight individuals without any established systemic disease and who had undergone 24-h ambulatory ECG monitoring were included in the case-control study. All the individuals had been using mobile phones for more than 10 years. Three-channel 24-h Holter monitoring was performed to derive the mean heart rate, standard deviation of normal NN intervals (SDNN), standard deviation of 5-min (m) mean NN intervals (SDANN), the proportion of NN50 divided by the total number of NNs (pNN50), the root mean square differences of successive NN intervals (RMSSD), high (HF)-, low (LF)-, very low (VLF)-frequency power, total power components, and the LF/HF ratio. Individuals were divided into four groups according to their duration of mobile phone use [no mobile phone use (Control group), 60 min/day (Group 3)]. Results: All the groups had similar features with regard to demographic and clinical characteristics. No significant arrhythmias were observed in any of the groups. The LF/HF ratio was higher, whereas the SDNN, SDANN, RMSSD, and pNN50 values were lower in the study groups than in the control group (p0.05). Conclusion: In this study, it was shown that the duration of mobile phone use may affect the autonomic balance in healthy subjects. The electromagnetic field created by mobile phone use may induce HRV changes in the long term.PubMedWoSScopu

A Gray Zone Population: Prediabetes—It Is Not as Easy as Its Look

[No abstract available

Ocena budowy zatoki wieńcowej w wielodetektorowej tomografii komputerowej u chorych z nawrotnym częstoskurczem nadkomorowym

Background: In a number of previous studies it has been observed that coronary sinus (CS) ostium was larger and cannulation was easier in patients with atrioventricular nodal reentrant tachycardia (AVNRT).Aim: To investigate the size and morphology of CS in AVNRT patients and compare them to those of atrioventricular reentrant tachycardia (AVRT) patients and a control group using multidetector computed tomography (MDCT), which is a non-invasive technique.Methods: Eighteen consecutive patients with AVNRT who were scheduled for catheter ablation in our institution constituted the study population. Sixteen patients with AVRT and 16 patients without supraventricular arrhythmia who underwent MDCT for other indications comprised the control group. A conventional transthoracic echocardiography was performed to all patients. The diameter of the CS at ostium as well as at 5, 10, and 15 mm inside the CS were measured on MDCT images. The CS was also categorised according to its morphology, as to whether it had a windsock shape or a tubular shape.Results: The AVNRT, AVRT and control groups were similar with regard to age, gender, body surface area and echocardiographic parameters. The size of the CS ostium was 10.9 ± 3.0, 11.1 ± 3.9 and 12.5 ± 3.6 mm for the AVNRT, AVRT and control groups, respectively (p = 0.393). There was no significant difference in the size of the CS from the ostium until 15 mm into the CS between the AVNRT, AVRT and control groups. The number of patients with windsock or tubular CS morphology were also similar between the three groups.Conclusions: Contrary to previous reports, the CS size and morphology of patients with AVNRT did not differ from that of AVRT or control patients.Wstęp: W wielu wcześniejszych badaniach obserwowano, że ujście zatoki wieńcowej (CS) było większe (co wiązało się z łatwiejszą kaniulacją) u pacjentów z nawrotnym częstoskurczem węzłowym (AVNRT).Cel: Celem badania była ocena wymiarów i morfologii CS przy użyciu nieinwazyjnego badania metodą wielodetektorowej tomografii komputerowej (MDCT) u chorych z AVNRT oraz u pacjentów z nawrotnym częstoskurczem przedsionkowo-komorowym (AVRT) i u osób z grupy kontrolnej oraz porównanie uzyskanych wartości.Metody: Grupa badana liczyła 18 kolejnych chorych z AVNRT skierowanych na przezcewnikową ablację do ośrodka autorów. Do badania włączono ponadto 16 pacjentów z AVRT i 16 osób bez nadkomorowych zaburzeń rytmu, u których istniały inne wskazania do przeprowadzenia MDCT; stanowili oni grupę kontrolną. U wszystkich pacjentów wykonano konwencjonalną echokardiografię przezprzełykową. Na podstawie obrazów MDCT określono wymiary CS na wysokości ujścia oraz 5, 10 i 15 mm w głąb. Autorzy określili kategorie budowy CS w zależności od tego, czy miała kształt stożkowaty, czy cylindryczny.Wyniki: Grupy chorych z AVNRT i AVRT oraz grupa kontrolna były podobne pod względem wieku, płci, powierzchni ciała i parametrów echokardiograficznych. Wielkość ujścia CS wynosiła 10,9 ± 3,0; 11,1 ± 3,9 i 12,5 ± 3,6 mm, odpowiednio w grupach AVNRT, AVRT i w grupie kontrolnej (p = 0,393). Nie stwierdzono istotnej różnicy w wymiarach CS na odcinku od ujścia do 15 mm w głąb między poszczególnymi grupami. Liczba chorych, u których CS miała kształt stożkowaty lub cylindryczny, była również zbliżona we wszystkich grupach.Wnioski: W przeciwieństwie do wcześniejszych doniesień, w niniejszym badaniu nie zanotowano różnic w zakresie wymiarów i budowy CS między chorymi z AVNRT a pacjentami z AVRT oraz osobami z grupy kontrolnej

Nieadekwatna tachykardia zatokowa - skuteczna terapia iwabradyną

Inappropriate sinus tachycardia (IST) is characterised by an exaggerated increase of heart rate in response to normal physiologic demands. Therapeutic options including medical and radiofrequency ablation interventions are still under debate. Ivabradine inhibits spontaneous pacemaker activity of the sinus node by selectively blocking If channels of pacemaker cells. Here we present a case of a patient with IST, who was successfully treated with ivabradine after various ineffective therapeutic approaches. Kardiol Pol 2010; 68, 8: 935-93