Cryoablation vs Radiofrequency Ablation in Atrial Fibrillation: Results of the latest trials

In the recent years the importance of atrial fibrillation escalated rapidly. Despite having only 2% occurrence of total population in EU, becomes serious both medical and socioeconomical problem. According to the latest data one percent growth in the next ten years may be observed. There are many complications resulting from this disease such as: all cause deaths, brain strokes, heart failure and burden of health care caused by hospitalisations and lack of life quality. Pharmacological treatment of such disease is based on two strategies: antiarrhythmic drugs and cardioversions or ventricular rhythm control for permanent atrial fibrillation. Aiming at the specific group of patients with paroxysmal or persistent AF (atrial fibrillation) in both groups further invasive treatment should be considered. There are two main invasive treatments of AF – Radio frequency ablation (RF) and cryoballoon ablation (CRYO) as for the left atrium veins isolation. According to the The Cryo Vs RFA trial 208 patients underwent randomised clinical trial comparing CRYO, RF and COMBINED strategy. At 5 years of follow up, 57% of COMBINED patients remained free of AF after a single procedure compared to 47% CRYO and 19% RF patients. CRYO turned out to be superior to RF. Both of techniques combined had a significantly higher ratio of success in a single procedure efficacy. Aim of this study is to review newest trials comparing both of these techniques

Suicidal digoxin intoxication in 61 year old patient

Digoxin is one of the oldest drugs used in cardiology. It belongs to subgroup of cardiac glycosides. Currently, due to limited indications for use, cases of poisoning with this group of drugs are becoming less common. Ease of poisoning results from the low therapeutic index and symptoms of intoxication may include many different systems. The most serious symptoms of overdose are cardiac arrhythmias. We present a case of a patient with suicide poisoning due to ingestion of 30 tablets of 0.1mg digoxin

Long QT syndrome - causes and risk factors

Sudden cardiac death is a major public health challenge, which can be caused by genetic or acquired structural or electrophysiological abnormalities. These abnormalities include channelopathies such as long QT, short QT and Brugada syndromes. Long QT syndrome is a cardiac repolarization disorder and is associated with an increased risk of torsades de pointes (TdP). Main causes of acquired syndrome are specific medications and/or electrolytes imbalance. On the other hand common congenital causes are Jervell and Lange-Nielsen or Romano- Ward syndromes. Patients with risk factors, treated with specified QT prolongating drugs always require slow dose titration and electrocardiography monitoring. Aim of this study is to comprehensively and critically review the pathomechanisms of QT prolongation, risk factors and prevention methods

The new way of Dabigatran reversal – Idarucizumab

Since last few years a popularity of new oral anticoagulants significantly raised. There are following main direct oral anticoagulants (DOAC) used in therapy: Dabigatran, Rywaroxaban, Apixaban, Endoxaban. Dabigatran (Pradaxa) is the first oral direct thrombin inhibitor approved by FDA in stroke prevention in atrial fibrillation (AF). Anticoagulant effect occurs through direct thrombin binding. Unlike the vitamin K antagonists such as warfarin or acenokumarol, therapy with dabigatran has faster onset and offset action, doesn’t require routine monitoring has much less interactions. The main problem of treatment with dabigatran was difficulty in reversal of anticoagulant effect and overdose. Since three years the new antidote for dabigatran is available – Idarucizumab (Praxbind). Main indications for such use are dabigatran overdose, need of fast effect reversal before any interventions and life threatening bleeding. Despite other ways of anticoagulant effect reversal such as transfusion of plasma coagulation factors Idarucizumab is still highly recommended for direct use. Aim of this study is to review the new way of dabigatran reversal - Idarucizumab

Left atrial myxoma with concomitant coronary artery stenosis: comprehensive diagnosis and treatment

  A 69-year-old patient was admitted to the Department of Cardiology due to an accidental finding on a chest X-ray, enlarged heart outline, accompanied by worsening of heart failure to NYHA II with LVEF, about 30%. In the X-ray description, an enlargement of the left atrium silhouette with local calcifications. The patient underwent TTE, confirming the presence of a pedunculated tumor of the left atrium attached to the ceiling measuring 3.5x3.5x2.2 cm. Due to the ischemic heart disease manifestation patient uderwent coronarography confirming the presence of single-vessel coronary artery disease with changes in the middle segment of the LAD. Patient was treated with CABG LIMA-LAD surgery and removeal the left atrial tumor. Post operation tissue material prooved the preseance of left atrium myxoma. The postoperative course was uneventful, the patient was discharged home. &nbsp

Treatement methodes for Long QT syndrome

Long QT syndrome (LQTS) is a potentially fatal cardiac disorder caused by channelopathies. Such arrhythmia is often life threatening and might cause sudden cardiac death. There are many reasons of LQTS especially: specific medications and/or electrolytes imbalance or congenital causes like Jervell and Lange-Nielsen or Romano- Ward syndromes. In recent years many ways of treatment have been developed. Except conservative treatment with B-blockers also two surgical methods improved, implantable cardioverter defibrillator (ICD) and left cardiac sympathetic denervation (LCSD). Techniques of LCSD evolved causing side effects more tolerable and lowering the risk of Horner's syndrome. Aim of this study is to review the role of sympathectomy in LQTS