Prevalence and management of driveline infections in mechanical circulatory support - a single center analysis

Background: Driveline infections in continuous-flow left ventricular assist devices (cf-LVAD) remain the most common adverse event. This single-center retrospective study investigated the risk factors, prevalence and management of driveline infections. :Methods Patients treated after cf-LVAD implantation from December 2014 to January 2020 were enrolled. Baseline data were collected and potential risk factors were elaborated. The multi-modal treatment was based on antibiotic therapy, daily wound care, surgical driveline reposition, and heart transplantation. Time of infection development, freedom of reinfection, freedom of heart transplantation, and death in the follow-up time were investigated. Results: Of 75 observed patients, 26 (34.7%) developed a driveline infection. The mean time from implantation to infection diagnosis was 463 (+/- 399; range, 35-1400) days. The most common pathogen was Staphylococcus aureus (n = 15, 60%). First-line therapy was based on antibiotics, with a primary success rate of 27%. The majority of patients (n = 19; 73.1%) were treated with surgical reposition after initial antibiotic therapy. During the follow-up time of 569 (+/- 506; range 32-2093) days, the reinfection freedom after surgical transposition was 57.9%. Heart transplantation was performed in eight patients due to resistant infection. The overall mortality for driveline infection was 11.5%. Conclusions: Driveline infections are frequent in patients with implanted cf-LVAD, and treatment does not efficiently avoid reinfection, leading to moderate mortality rates. Only about a quarter of the infected patients were cured with antibiotics alone. Surgical driveline reposition is a reasonable treatment option and does not preclude subsequent heart transplantation due to limited reinfection freedom

Choroby przełyku a migotanie przedsionków - ich rola w powstawaniu przetoki przedsionkowo-przełykowej. Diagnostyka i postępowanie

Migotanie przedsionków (AF) jest często spotykane w praktyce lekarskiej - u młodych osób częściej występuje tak zwane pierwotne napadowe, ogniskowe AF lub wyzwalane częstoskurczem przedsionkowo-komorowym (atrio-ventricular reentrant tachycardia in Wolff-Parkinson-White syndrome [AVNRT-WPW], atrio-ventricular nodal reentrant tachycardia [AVNRT] - z rzekomymi włóknami Mahaima), typowym trzepotaniem prawoprzedsionkowym (atrial flutter [AFL]) lub nawrotnym częstoskurczem węzłowym (AVNRT). Można przypuszczać, że u niektórych pacjentów choroby układu pokarmowego mogą być czynnikiem usposabiającym do występowania AF; dotyczy to głównie chorób, w przebiegu których dochodzi do wzrostu wskaźników zapalnych. Zapalenie przełyku zwiększa prawdopodobieństwo wystąpienia AF. Dużą rolę w wystąpieniu poablacyjnej przetoki przedsionkowo-przełykowej może odgrywać współistniejąca choroba wrzodowa lub refluks żołądkowo-przełykowy. Pacjent z zapaleniem przełyku lub objawową chorobą wrzodową nie powinien być kwalifikowany do zabiegu ablacji (RF-AF) do czasu wyleczenia choroby podstawowej. Ze względu na złożoność zabiegu (u osób z przetrwałym AF, niejednokrotnie wymagane są dwie lub więcej sesji), trzeba się liczyć z powikłaniami związanymi z ablacją - do częstych należą ograniczone i przemijające zmiany w obrębie przełyku. Bardzo rzadko występującym, ale bardzo groźnym dla życia powikłaniem jest przetoka przedsionkowo-przełykowa. Pierwszymi objawami sugerującymi przetokę przedsionkowo-przełykową są: ból w klatce piersiowej/nadbrzuszu, leukocytoza, gorączka, narastające osłabienie, nudności, (krwiste) wymioty. Kolejne to objawy neurologiczne (drgawki, niedowłady, zaburzenia czucia, utraty przytomności), które zwykle pojawiają się po około 5-40 godzin od wystąpienia pierwszych symptomów. Po ablacji AF w przypadku dolegliwości z przewodu pokarmowego, bezwzględnie przeciwwskazane jest wykonywanie echa przezprzełykowego, gastroskopii i ezofagoskopii! Rozpoznanie umożliwia wykonanie tomografii komputerowej lub rezonansu magnetycznego. W przypadku objawów sugerujących przetokę przedsionkowo-przełykową należy pacjenta niezwłocznie skierować do ośrodka, który wykonał ablację migotania, lub ośrodka, w którym pilnie można utworzyć zespół chirurgów specjalizujących się zarówno w chirurgii klatki piersiowej, jak i układu pokarmowego. Właściwe przygotowanie chorego do zabiegu, rozważna i ograniczona ablacja oraz rozsądne postępowanie po zabiegu, pozwalają na ograniczenie ryzyka śmiertelnego powikłania. Po zabiegu przez kilka tygodni konieczna jest dieta przecierana, przeciwwskazane są ostre przyprawy oraz picie alkoholu. Forum Medycyny Rodzinnej 2010, tom 4, nr 5, 330-33

Risk factors of atrial fibrillation recurrence despite successful radiofrequency ablation of accessory pathway: At 11 years of follow-up

Background: Previous reports on patients with radiofrequency catheter ablation (RFCA) of accessorypathway (AP) and atrial fibrillation (AF) include only short follow-up periods. The aim of this studywas to analyze predictors of recurrence of AF in patients after successful RFCA of APs over long termfollow-up periods.Methods: Of the 1,007 patients who underwent non-pharmacological treatment of APs (between theyears 1993–2008), data of 100 consecutive patients were retrospectively analyzed (75 men, mean age43.6 ± 14.7), with the longest period of follow-up (mean 11.3 ± 3.5 years) after successful RFCA ofAP. In Group 1, there were 72 patients (54 men, mean age 40.66 ± 13.85 years) without documentedepisodes of AF after RFCA of AP. Group 2 consisted of 28 patients (21 men, mean age 50.79 ± 14.49years) with AF episodes despite successful elimination of AP.Results: In univariate analysis, patients from Group 1 were significantly younger at the time of ablationthan patients from Group 2 (40.66 ± 13.85 vs. 50.79 ± 14.49 years; p = 0.002), had shorter historyof AF episodes (4.11 ± 4.07 vs. 8.25 ± 7.50 years; p = 0.024) and had less frequently documentedatrial tachycardia (AT) prior to ablation (3.39 vs. 20.00%; p = 0.022). In multivariate analysis, thehistory of AF in years (p = 0.043), was an independent risk factor for AF recurrences.Conclusions: Older patient age, longer history of AF and AT prior to RFCA of APs identified a subgroupof patients who required additional treatment. In the multivariate analysis, the history of AF inyears (p = 0.043) was a risk factor for AF recurrence

Acute Hemodynamic Effects of Simultaneous and Sequential Multi-Point Pacing in Heart Failure Patients With an Expected Higher Rate of Sub-response to Cardiac Resynchronization Therapy: Results of Multicenter SYNSEQ Study

The aim of the SYNSEQ (Left Ventricular Synchronous vs. Sequential MultiSpot Pacing for CRT) study was to evaluate the acute hemodynamic response (AHR) of simultaneous (3P-MPP syn) or sequential (3P-MPP seq) multi-3-point-left-ventricular (LV) pacing vs. single point pacing (SPP) in a group of patients at risk of a suboptimal response to cardiac resynchronization therapy (CRT). Twenty five patients with myocardial scar or QRS ≤ 150 or the absence of LBBB (age: 66 ± 12 years, QRS: 159 ± 12 ms, NYHA class II/III, LVEF ≤ 35%) underwent acute hemodynamic assessment by LV + dP/dtmax with a variety of LV pacing configurations at an optimized AV delay. The change in LV + dP/dt max (%ΔLV + dP/dt max) with 3P-MPP syn (15.6%, 95% CI: 8.8%-22.5%) was neither statistically significantly different to 3P-MPP seq (11.8%, 95% CI: 7.6-16.0%) nor to SPP basal (11.5%, 95% CI:7.1-15.9%) or SPP mid (12.2%, 95% CI:7.9-16.5%), but higher than SPP apical (10.6%, 95% CI:5.3-15.9%, p = 0.03). AHR (defined as a %ΔLV + dP/dt max ≥ 10%) varied between pacing configurations: 36% (9/25) for SPP apical, 44% (11/25) for SPP basal, 54% (13/24) for SPP mid, 56% (14/25) for 3P-MPP syn and 48% (11/23) for 3P-MPP seq.Fifteen patients (15/25, 60%) had an AHR in at least one pacing configuration. AHR was observed in 10/13 (77%) patients with a LBBB but only in 5/12 (42%) patients with a non-LBBB (p = 0.11). To conclude, simultaneous or sequential multipoint pacing compared to single point pacing did not improve the acute hemodynamic effect in a suboptimal CRT response population. Clinical Trial Registration: ClinicalTrials.gov, identifier: NCT02914457

Pregnancy-related cardiac non-elective hospitalizations and pregnancy outcomes. A tertiary referral cardiac center experience

Background: Pregnant women with cardiovascular diseases (CVD) and their offspring are at higher risk of morbidity and mortality.Aims: To provide data on pregnancy outcomes among women with different types of CVD requiring non-elective cardiac hospitalization in a tertiary referral cardiac center.Methods: We identified all records of non-elective hospitalizations of pregnant women hospitalized between January 2009 through March 2018, at our institution — a tertiary referral cardiac center. The incidence and types of cardiac complications during pregnancy, as well as the pregnancy and offspring outcomes, were determined.Results: One hundred and sixty-one out of 328 pregnancy-related hospitalizations in 140 pregnancies were non-elective. Cardiac complications occurred in 62 (44%) pregnancies, with the most frequent being episodes of arrhythmia (22.1% pregnancies), followed by heart failure exacerbations (6.4% pregnancies). Maternal mortality reached 2.1% and affected only women with primary cardiomyopathies (CMP). Offspring mortality was 2.8%. Newborns of mothers with cardiac complications had significantly lower Apgar scores and gestational age at delivery, compared to mothers without cardiac complications.Conclusions: In our series mortality and morbidity among pregnant women with CVD hospitalizations were high. An unfavorable maternal outcome mainly affected women with CMP. Offspring of mothers with cardiovascular complications are prone to have a lower gestational age and Apgar score

Invasive electrophysiologySotalol prevents atrio-ventricular tachycardia but not atrial fibrillation with rapid ventricular response in a patient wiht WPW syndrome

We present a case of 23-year-old male with the Marfan syndrome multiple accessory pathways and atrio-ventricular reentry ant tachycardia (AVRT) as well as atrial fibrillation (AF). Sotalol was partially effective for AVRT, however, it did not prevent AF, RF ablation cured all arrythmias. This case shows that sotalol can attenuate AVRT recurrences, however, it does not prevent rapid conduction via accessory pathways during AF

12-letnia obserwacja pacjenta po skutecznej ablacji ustawicznego częstoskurczu wiązkowego przebiegającego z obukomorową niewydolnością serca i dysfunkcją ośrodków automatyzmu

We present a case of a 14 year-old boy with a incessant fascicular tachycardia with retrograde conduction and tachycardiomyopathy. Verapamil, adenosine, lignocaine and repeated cardioversions were unsuccessful in termination of tachycardia. Amiodarone however caused sinus node dysfunction and temporary electrode pacing had to be used. The patient underwent successful radiofrequency catheter ablation in the area of the left posterior fascicle. Because of ventricular extrasystoles (with QRS morphology resembling that of fascicular VT) the patient underwent second ablation which significantly reduced the number of ventricular beats. The course of subsequent 12-year follow-up was uneventful. Kardiol Pol 2010; 68, 12: 1408-141