Symptomatic tachy- and bradyarrhythmias after transcatheter closure of interatrial communications with Amplatzer devices

Background: The aim of this paper is to present our own experience related to frequency of symptomatic tachy- and bradyarrhythmias in patients after transcatheter closure of interatrial defects (ASD) and patent foramen ovale (PFO) using Amplatzer plugs. Methods: Transcatheter closure of interatrial communications with Amplatzer devices was carried out on 739 patients in our center. Only patients with new symptomatic arrhythmias (who required pharmacotherapy, cardioversion or pacemaker implantation) were included in to the study. All patients who had had arrhythmias prior to ASD closure, such as supraventricular tachycardias (SVT) or atrial flutter/fibrillation (AF), were excluded. Results: New tachy- and bradyarrhythmias after implantation of Amplatzer devices were observed in 11 patients (1.5%). There were 9 patients (mean age 36.7 years) with atrial tachyarrhythmias (AF in 8 and SVT in 1 patients), which occurred between the first day and 3 months after implantation. Seven patients were treated initially by pharmacotherapy; in 2 of them sinus rhythm returned just after cardioversion. In other 2 patients cardioversion was performed as an initial therapy. In none of these patients, but one recurrence of tachycardia was observed; however, 7 of them had pharmacotherapy prolonged up to 1 year. In 2 patients, aged 15 and 16, complete atrioventricular (AV) block was observed 4.3 and 1.5 years after Amplatzer implantation, respectively. In the first patient intermittent second-degree AV block (Mobitz II) was observed before ASD closure. In both patients, a DDDR pacemaker was implanted. Conclusions: Transcatheter closure of ASD using Amplatzer devices is associated with a risk of new atrial tachyarrhythmias (usually early after the procedure and in older patients). The risk of conduction disturbances such as complete heart block, which can occur in late followup, is low. Thence, close long-term follow-up of these patients is obligatory

A comparison of the clinical course of preexcitation syndrome in children and adolescents and in adults

Background: Atrioventricular reentrant tachycardia (AVRT) in patients with preexcitation syndrome (PS) is the main cause of paroxysmal regular arrhythmias in children and adolescents. While the previously published data most commonly concern clinical consequences of PS in adults, few researchers have evaluated the problem in children and adolescents. The aim of the study was to compare the clinical course of PS between the population of children and adolescents below 19 years of age and the population of adult patients. Method: The study population consisted of 302 consecutive PS patients managed between January 2001 and June 2005 with radiofrequency catheter ablation (RFCA). The study population was divided into two groups: Group 1 consisting of 52 patients aged 15.38 years on average (7-18 &#177; 2.53) and Group 2 consisting of 250 adult patients aged 38.67 years on average (19-72 &#177; 13.1). Results: Patients from Groups 1 and 2 experienced their first episode of AVRT at the mean age of 13.3 years and 29.1 years, respectively (p < 0.05). The mean annual numbers of AVRT episodes in Groups 1 and 2 were 12.97 (range, 2-96; median, 8) and 8.86 (range, 2-25; median, 6), respectively (p = non-significant). Two patients from Group 1 (3.85%) and 42 patients from Group 2 (16.8%) experienced episodes of atrial fibrillation (AF) (p < 0.05). Location of the accessory pathways (AP): In Group 1, the right free wall and anteroseptal AP locations were significantly more common [11 (21.15%) and 9 (17.31%) patients, respectively, vs.q 19 (7.6%) and 13 (5.2%) patients in Group 2; p < 0.01]. In Group 2, the left anterolateral AP location was more common [81 (32.4%) vs. 4 (7.69%) in Group 1; p < 0.01]. Conclusions: In children and adolescents with PS, a significantly lower incidence of AF was found. In Group 1, RFCA was performed significantly more frequently due to the development of AVRT caused by right free wall and right anteroseptal AP, while in the group of adults, the left anterolateral AP location was found more commonly. (Cardiol J 2007; 14: 384-390

Porównanie przebiegu klinicznego zespołu preekscytacji u dzieci i młodzieży z pacjentami dorosłymi

Wstęp: Nawrotny częstoskurcz przedsionkowo-komorowy (AVRT) u chorych z zespołem preekscytacji (PS) stanowi główną przyczynę napadowych miarowych arytmii u dzieci i młodzieży. Publikowane dane najczęściej dotyczą następstw klinicznych PS u dorosłych, w niewielu natomiast ocenia się ten problem u dzieci i młodzieży. Celem pracy była analiza porównawcza przebiegu klinicznego PS między populacją dzieci i młodzieży w wieku poniżej 19 lat a chorymi dorosłymi. Metoda: Badaniem objęto 302 kolejnych chorych z PS leczonych w okresie od stycznia 2001 do czerwca 2005 roku za pomocą ablacji prądem o wysokiej częstotliwości (RFCA). Z badanej populacji wyodrębniono dwie grupy: grupę I (52 chorych w wieku średnio 15,38 roku; 7-18 &#177; 2,53) i grupę II (250 chorych dorosłych w wieku średnio 38,67 roku; 19-72 &#177; 13,1). Wyniki: W grupie I wiek, w którym pierwszy raz wystąpił AVRT, wynosił średnio 13,3 roku, w grupie II - 29,1 roku (p < 0,05). Częstość występowania epizodów AVRT w skali rocznej wynosiła w grupie I średnio 12,97 (zakres 2-96, mediana 8), w grupie II - średnio 8,86 (zakres 2-25, mediana 6), p = NS. Epizody migotań przedsionków przebyło 2 chorych (3,85%) z grupy I i 42 pacjentów (16,8%) z grupy II (p < 0,05). W grupie I istotnie częściej stwierdzono lokalizację dróg dodatkowych (AP) prawostronną boczną (11 chorych; 21,15%) oraz przednioprzegrodową (9 chorych; 17,31%), natomiast w grupie II odpowiednio - u 19 (7,6%) i 13 pacjentów (5,2%; p < 0,01). W grupie II częściej występowała lokalizacja lewostronna przednio-boczna (81 chorych; 32,4%), w grupie I - u 4 pacjentów (7,69%; p < 0,01). Wnioski: U dzieci i młodzieży z PS istotnie rzadziej stwierdzano migotanie przedsionków. Częściej w grupie I wykonywano RFCA z powodu ujawnienia się AVRT zależnych od prawostronnych bocznych i prawostronnych przednio-przegrodowych AP, w grupie dorosłych natomiast częściej obserwowano lewostronną przednio-boczną lokalizację AP. (Folia Cardiologica Excerpta 2007; 2: 537-543

Browsers, grazers or mix-feeders? Study of the diet of extinct Pleistocene Eurasian forest rhinoceros Stephanorhinus kirchbergensis (J¨ager, 1839) and woolly rhinoceros Coelodonta antiquitatis (Blumenbach, 1799)

The wooly rhinoceros (Coelodonta antiquitatis) and forest rhinoceros (Stephanorhinus kirchbergensis) were prominent representatives of the Middle and Late Pleistocene glacial and interglacial faunas of Eurasia. Their diet has traditionally been inferred on functional morphology of the dentition and skull. In rare cases, food remains are preserved in the fossas of the teeth or as gut content. New approaches to infer diet include the study of isotopes and mesowear. Here we apply all four methods to infer the diet of these emblematic rhinoceros’ species and compare the food actually taken with the food available, as indicated by independent botanical data from the localities where the rhinoceros’ fossils were found: Gorz´ow Wielkopolski (Eemian) and Starunia (Middle Vistulian) as well as analysis of literature data. We also made inferences on the season of death of these individuals. Our results indicate that the woolly rhino in both Europe and Asia (Siberia) was mainly a grazer, although at different times of the year and depending on the region its diet was also supplemented by leaves of shrubs and trees. According to the results of isotope studies, there were important individual variations. The data show a clear seasonal variation in the isotope composition of this rhino’s diet. In contrast, Stephanorhinus kirchbergensis was a browser, though its diet included low-growing vegetation. Its habitat consisted of various types of forests, from riparian to deciduous and mixed forests, and open areas. The diet of this species consisted of selected items of vegetation, also including plants growing near both flowing and standing waters. The food remains from the fossae of the teeth indicated flexible browsing, confirming the previous interpretations based on functional morphology and stable isotopes. Long-term data from mesowear and microwear across a wider range of S. kirchbergensis fossils indicate a more mixed diet with a browsing component. The different diets of both of rhinoceros reflect not only the different habitats, but also climate changes that occurred during the Late Pleistocene

Anticoagulant selection in relation to the SAMe-TT2R2 score in patients with atrial fibrillation. the GLORIA-AF registry

Aim: The SAMe-TT2R2 score helps identify patients with atrial fibrillation (AF) likely to have poor anticoagulation control during anticoagulation with vitamin K antagonists (VKA) and those with scores &gt;2 might be better managed with a target-specific oral anticoagulant (NOAC). We hypothesized that in clinical practice, VKAs may be prescribed less frequently to patients with AF and SAMe-TT2R2 scores &gt;2 than to patients with lower scores. Methods and results: We analyzed the Phase III dataset of the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF), a large, global, prospective global registry of patients with newly diagnosed AF and ≥1 stroke risk factor. We compared baseline clinical characteristics and antithrombotic prescriptions to determine the probability of the VKA prescription among anticoagulated patients with the baseline SAMe-TT2R2 score &gt;2 and ≤ 2. Among 17,465 anticoagulated patients with AF, 4,828 (27.6%) patients were prescribed VKA and 12,637 (72.4%) patients an NOAC: 11,884 (68.0%) patients had SAMe-TT2R2 scores 0-2 and 5,581 (32.0%) patients had scores &gt;2. The proportion of patients prescribed VKA was 28.0% among patients with SAMe-TT2R2 scores &gt;2 and 27.5% in those with scores ≤2. Conclusions: The lack of a clear association between the SAMe-TT2R2 score and anticoagulant selection may be attributed to the relative efficacy and safety profiles between NOACs and VKAs as well as to the absence of trial evidence that an SAMe-TT2R2-guided strategy for the selection of the type of anticoagulation in NVAF patients has an impact on clinical outcomes of efficacy and safety. The latter hypothesis is currently being tested in a randomized controlled trial. Clinical trial registration: URL: https://www.clinicaltrials.gov//Unique identifier: NCT01937377, NCT01468701, and NCT01671007

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase&nbsp;1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation&nbsp;disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age&nbsp; 6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score&nbsp; 652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc&nbsp;= 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N&nbsp;= 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in&nbsp;Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in&nbsp;Asia&nbsp;and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Original articleRadiofrequency catheter ablation in children and adolescents with preexcitation syndrome

Background: Atrioventricular reentrant tachycardia (AVRT) is the most common tachycardia, accounting for 70% of regular narrow-QRS arrhythmias in children. Because of the potential disadvantages of a life-long drug therapy and relatively favourable results from radiofrequency catheter ablation (RFCA) therapy in adults, the indications for ablation therapy in children with preexcitation syndrome (PS) need to be considered. Aim: To assess efficacy and safety of RFCA in children and adolescents with PS. Methods: The study population consisted of 302 consecutive, symptomatic, drug-refractory patients with PS undergoing RFCA. Two age groups were selected: 52 patients younger than 19 years (24 females, age 15.38&#177;2.53 years); and 250 adults (115 females, age 38.67&#177;13.1 years). In all study patients electrophysiological study and radiofrequency catheter ablation were performed. Comparative analysis between groups was performed with respect to procedure duration, fluoroscopy exposure time, location of accessory pathways (AP), success rate, recurrences and complications. Results: No significant differences between the groups were noted with respect to procedure duration and exposure time. Success and recurrence rates did not differ between the two-age groups. The mean procedure time for children was 124.12&#177;43.48 min (range 45-285) and for adults &#8211; 126.3&#177;61.49 min (range 25-330) (NS). The mean fluoroscopy time for children was 27.95&#177;16.86 min (range 4-75) and for adults &#8211; 31.27&#177;25.51 min (range 1-131) (NS). The initial RF ablation procedure was successful in 48 (92.31%) children and in 233 (93.2%) adults (NS). Recurrence rate was 12.5% (6 patients) in children vs. 8.58% (20 patients) in adults (NS). In one child (1.92%) and in two adult patients (0.8%) serious complication occurred (NS). Electrophysiological study revealed significantly more frequent presence of the right free wall and right antero-septal AP in children than in adults (21.15 vs. 7.6%, and 17.31 vs. 5.2%, respectively, pWstęp: Nawrotny częstoskurcz przedsionkowo-komorowy w przebiegu zespołu preekscytacji (PS) to główna przyczyna tachyarytmii u dzieci i młodzieży. Słuszne więc jest postawienie pytania, kiedy podjąć decyzję o leczeniu inwazyjnym i czy ablacja prądem o częstotliwości radiowej (RFCA) jest w tej grupie wiekowej równie bezpieczna i skuteczna jak u dorosłych. Cel: Ocena skuteczności wczesnej i odległej oraz bezpieczeństwa leczenia dzieci i młodzieży z PS za pomocą RFCA. Metodyka: Badaną populację stanowiło 302 kolejnych, objawowych chorych z PS, leczonych za pomocą RFCA. Wyodrębniono dwie grupy: I &#8211; 52 chorych w wieku do 18 lat, II (kontrolną) &#8211; 250 chorych dorosłych w wieku średnio 38,6&#177;13,1 lat. Analizie poddano dane demograficzne, wyniki i przebieg RFCA &#8211; czas zabiegu, czas ekspozycji radiologicznej, lokalizację dróg dodatkowych (AP), obecność mnogich AP, skuteczność RFCA wczesną i odległą, wystąpienie poważnych powikłań oraz nawrotów. Zastosowano podział lokalizacji AP na szlaki prawostronne boczne (RFW), prawostronne przegrodowe przednie (RAS), prawostronne przegrodowe pośrednie (RMS), prawostronne przegrodowe tylne (RPS), lewostronne przegrodowe tylne (LPS), lewostronne tylno-boczne (LPL), lewostronne przednio-boczne (LAL) oraz zależne od zatoki wieńcowej (CS). Do celów analizy statystycznej wewnątrz grupy I przyjęto podział AP na prawostronne boczne (RFW), przegrodowe &#8211; SEPTAL (RAS, RMS, RPS, LPS oraz CS), lewostronne &#8211; LFW (LPL i LAL). Wyniki: W grupie I istotnie częściej stwierdzono lokalizację AP RFW &#8211; u 11 (21,1%) chorych oraz RAS &#8211; u 9 (17,3%) chorych; w grupie II RFW AP stwierdzono u 19 (7,6%) chorych, RAS &#8211; u 13 (5,2%),

Case reportIsolated non-compaction of the left ventricular myocardium in a neonate &#8211; a case report

We describe a case of a neonate who developed cardiogenic shock 24 days after birth. Echocardiography revealed congenital anomaly &#8211; isolated non-compaction of the left ventricular myocardium. Medical treatment was effective. The whole clinical presentation suggests the Barth syndrome. The diagnosis and treatment of this condition are discussed

Długoterminowe monitorowanie holterowskie &#8212; rodzaje i znaczenie kliniczne

Monitorowanie EKG metodą Holtera jest uznaną metodą służącą do diagnostyki zaburzeń rytmu serca i rozpoznawania arytmogennych przyczyn niewyjaśnionych utrat przytomności. Obecnie w praktyce klinicznej są dostępne nie tylko krótkoterminowe (24&#8211;48-godzinne) rejestratory holterowskie, ale także coraz częściej można wykorzystać rejestratory zdarzeń, wszczepialne rejestratory pętlowe czy system Mobile Holter. W wielu badaniach klinicznych dowiedziono bowiem, że wydłużenie czasu rejestracji EKG zwiększa prawdopodobieństwo wykrycia arytmii jako przyczyny zgłaszanych przez chorego dolegliwości. Ważnym wskazaniem do długoterminowego badania EKG metodą Holtera są kołatania serca, które mogą być zapowiedzią migotania przedsionków. Rozpoznanie migotania przedsionków, zwłaszcza u chorych z wysokim ryzykiem niedokrwiennego udaru mózgu, jest natomiast podstawą wdrożenia odpowiedniego leczenia przeciwkrzepliwego, które zmniejsza ryzyko hospitalizacji, inwalidztwa, a nawet śmierci. Każda z nowych metod ma ściśle określone wskazania do stosowania, posiada zalety, ale też i pewne ograniczenia. Niemniej, mimo że są to metody nowe, to jednak odgrywają coraz ważniejszą rolę w ambulatoryjnej praktyce internistycznej i kardiologicznej. (Folia Cardiologica Excerpta 2010; 5, 6: 353&#8211;360