114 research outputs found
Extraction of a translocated piece of an implantable cardioverter-defibrillator lead from the hepatic vein
The use of 1.5T magnetic resonance imaging for therapeutic decisions in patients with cardiac implantable electronic devices and significant neurological, neurosurgical and neuro-oncology diagnostic indications
Between September 2009 and May 2014 the classification of 36 patients with cardiac implantable electronic devices (CIEDs) in terms of the feasibility of MRI scanning due to strong clinical indications was carried out. Finally MRI examinations were performed in 20 patients, of whom 27 studies were conducted and a total number of 35 anatomical regions were scanned. Neurological, neurosurgical and neuro-oncology indications for MRI were reported in 19 patients (95%) in whom 26 MRI studies (96.3%) were performed, and 34 anatomical regions (97.1%) were scanned. One patient had indications for MRI in the field of cardiology.
Medical information obtained from 27 MRI studies allowed decisions to be made regarding the treatment in all patients. After 8 studies (29.6%), patients were classified into 9 different neurosurgical procedures. In the case of the remaining 19 studies (70.4%), there were no indications for surgical treatment and the decisions to implement conservative treatment were made.
There were no complications related to the implanted CIEDs observed: neither immediate nor in the follow-up.
Conclusions
(1)Magnetic resonance imaging studies in patients with non-MRI-conditional CIEDs in the vast majority are performed because of significant neurological, neurosurgical and neuro-oncology clinical indications.(2)Careful determination of the indications for MRI in each case allows the data necessary to be obtained to make definitive treatment decisions.(3)The adherence to examination protocol and device controlling procedures after MRI allows a very high safety profile of the method to be achieved
Arrhythmogenic focus localization in patients with right outflow tract ventricular arrhythmias
Background: Vast majority of ventricular arrhythmias in patients (pts) without structural
heart disease (NHVA) originate from the right ventricular outflow tract (RVOT). Premature
ventricular contractions (PVC) and ventricular tachycardia (VT) ECG morphology are proposed
to localize the site of radiofrequency ablation (RFA). An ECG algorithm to localize the
arrhythmogenic focus in RVOT was designed and verified in a prospective study.
Methods: Analysis of ECG morphology of spontaneous PVC and VT was performed in
30 pts (25 women), mean age 42 ± 10, after successful RFA of arrhythmogenic focus (AFo) in
RVOT (PVC in 11 pts, VT in 5 pts, PVC + VT in 14 pts). In the first step ECG data and
fluoroscopic RVOT sites of successful RFA were combined to gain the characteristic QRS
morphology patterns for exact sites of successful ablation (first 16 pts). This own algorithm
was used to recognize AFo in the following 14 pts.
Results: First step: RVOT in RAO 30° view was divided into 9 zones: 3 vertical (1, 2, 3) and
3 horizontal (superior, intermediate and inferior). Q, R and S waves < 0.5 mV in 12-lead
ECG were coded as q, r, s and waves ≥ 0.5 mV as Q, R, S. Vertical zones: zone 1 (RVOT
postero-lateral part): r in lead I; zone 3 (RVOT anterior wall): QS/qs in lead I. Other QRS
morphologies in lead I: zone 2. Horizontal zones: superior - transition from QS wave or r < S
in V1 into R > s in lead V4, intermediate - R = S or r = s in V4, inferior - transition from
qs/QS or r < S in V1–V4 into r, R in V6. Second step. Concordant ECG locations were
predicted by two independent cardiologists in 14 pts. Concordant AFo locations (ECG and
fluoroscopic) were achieved: in all 14 pts in horizontal zones and in 13 pts in vertical zones.
Overall (30 pts) no AFo discordances were noted in horizontal zones. In vertical zones AFo
location was concordant in 28 pts (93.3%).
Conclusions: Our data show that simple ECG algorithm based on spontaneous arrhythmia
morphology precisely localizes the arrhythmogenic focus in RVOT. This analysis applied before
RFA may shorten and simplify ablation procedure in patients with RVOT arrhythmia
Augmented-reality computed tomography-guided transcatheter pacemaker implantation in dextrocardia and congenitally corrected transposition of great arteries
Chirurgiczna i przeznaczyniowa ablacja dodatkowej drogi przewodzenia u pacjenta z wrodzonym skorygowanym przełożeniem wielkich pni tętniczych oraz anomalią Ebsteina
Skorygowane przełożenie wielkich pni tętniczych należy do rzadkich wrodzonych patologii
układu sercowo-naczyniowego, polegającej na inwersji komór przy zachowanej ciągłości przedsionków
i pni tętniczych. Izolowana wada bez patologii współistniejących zazwyczaj nie powoduje
rozwoju niewydolności serca. W opisywanym przypadku pacjenta z wrodzonym skorygowanym
przełożeniem wielkich pni tętniczych (CTGA), anomalią Ebsteina dotyczącą lewostronnej
zastawki trójdzielnej oraz zespołem Wolffa-Parkinsona-White´a i częstymi napadami
tachyarytmii nadkomorowych poddano najpierw chirurgicznej, później przezżylnej ablacji dodatkowej
drogi przewodzenia. Zniszczenie drogi dodatkowej pozwoliło na stałe wyeliminować
napady częstoskurczu nadkomorowego, a tym samym zapobiec rozwojowi tachykardiomiopatii.
(Folia Cardiol. 2003; 10: 219–224
Czy zawsze unikać stymulacji komorowej? Skuteczność sekwencyjnej stymulacji dwujamowej w redukcji istotnego gradientu w drodze odpływu lewej komory i objawów klinicznych u chorego z kardiomiopatią przerostową zawężającą
Additional data from clinical examination on site significantly but marginally improve predictive accuracy of the Revised Trauma Score for major complications during Helicopter Emergency Medical Service missions
Introduction: The Revised Trauma Score (RTS) accurately identifies trauma
patients at high risk of adverse events or death. Less is known about its usefulness in the general population and non-trauma recipients of Helicopter
Emergency Medical Service (HEMS). The RTS is a simple tool and omits a lot
of other data obtained during clinical evaluation. The aim was to assess the
role of the RTS to identify patients at risk of major complications (death,
cardiopulmonary resuscitation, defibrillation, intubation) in the general population of HEMS patients. Clinical factors beyond the RTS were analyzed
to identify additional prognostic factors for predicting major complications.
Material and methods: A retrospective analysis of medical records of adult
patients routinely collected during HEMS missions in the years 2011-2014
was performed.
Results: The analysis included 19 554 HEMS missions. Patients were 55 ±20
years old and 68% were male. The most common indication for HEMS was
diseases of the circulatory system - 41%. Major complications occurred in
2072 (10.6%) cases. In the general population of HEMS patients, the RTS
accurately identified individuals at risk of major complications at a cut-off
value of 10.5 and area under the curve (AUC) of 93.5%. In multivariate analysis, additional clinical data derived from clinical examination (ECG; skin,
pupil and breathing examination) significantly but marginally improved the
accuracy of RTS assessment: AUC 95.6% (p < 0.001 for the difference).
Conclusions: The Revised Trauma Score accurately identifies individuals at
risk of major complications during HEMS missions regardless of the indication. Additional clinical data significantly but marginally improved the accuracy of RTS in the general population of HEMS patient
The effect of anti-tachycardia atrial pacing in patients with recurrent paroxysmal atrial fibrillation
Background: Atrial fibrillation (AF) is an arrhythmia with complex pathophysiological characteristics.
The efficiency of various anti-tachyarrhythmic stimulation algorithms in patients
with recurrent AF has become a subject of research and the aim of this analysis is to evaluate
the success of treatment by continuous DDD(R) stimulation with an anti-tachyarrhythmic
pacing algorithm in patients with paroxymal AF.
Methods: In the period 2002-2004 19 patients (10 females and 9 males), aged 45-74 (with
a mean age of 64.2 ± 7.6), qualified for DDD(R) system implantation. The indication for
implantation was tachy-brady syndrome with recurrent AF resistant to pharmacological treatment.
All the patients had had at least three recurrences of symptomatic AF within the previous
year. The follow-up period was 12 months. AF recurrences, outpatient visits and hospitalisation
frequency were evaluated every 6 months and there were routine pacemaker controls.
Baseline and final visit echocardiograms and a quality of life (QoL) questionnaire (SF-36)
were obtained.
Results: One patient was excluded from the analysis owing to permanent AF with a final VVI
pacing mode. In comparison with the pre-inclusion 12 months AF-related hospitalisation
frequency within the 12-month follow-up period was 3.9 vs. 0.4 (p < 0.005) and outpatient
visits 2.1 vs. 0.8 (p < 0.05). The mean atrial pacing percentage in all patients was 95.7% ± 2.9%, and the mode switch percentage during the first and second 6 month periods was
6.4% (1-50%, median 2) and 2.5% (0-7, median 2, NS) respectively. There were 483/month
(0.44-5761, median 31) events defined as AF episodes during first 6 months and 84/month
(0-480, median 17, NS) during the second 6 months. The AF burden was 1.92 days/month
(7 h - 15 days, median 14 h), decreasing to 0.74 day/month (0-2.1 days, median 14 h, NS) in
the second 6-month period. A significant 12-month improvement was achieved in QoL parameters.
Conclusions: An overdrive atrial algorithm can be a beneficial, safe and comfortable method
in patients with paroxysmal drug-resistant AF and accepted indications for physiological
pacing
Lead extraction: The road to successful cardiac resynchronization therapy
Background: Still increasing life expectancy in patients with implanted devices and large number of leads more and more often induce the need to cure the treatment complications or to change especially to cardiac resynchronization therapy (CRT). In order to prevent further complications, the possibility of damaged or redundant leads extraction should be taken into consideration. The aim of the paper was to assess the effectiveness and safety of transvenous lead extraction (TLE) with co-implantation of resynchronization systems.
Methods and results: Between 2008 and March 2013, the system removal with TLE was conducted in 246 patients. In 38 patients (11 women, 28.9%), aged 43–79 (mean 65 years), it was combined with co-implantation of CRT-pacemaker or defibrillator (CRT-P/D). Indications for TLE covered: lead failure in 21 (55.3%) patients, redundant leads in 6 (15.8%), and the occluded venous system in 7 (18.4%). The up-grade of the pacemaker or defibrillator system to CRT-D was performed in 19 cases, CRT-P/D revision in next 19. Together 32 defibrillation leads and 42 pacing leads (27 left ventricular leads, and 1 epicardial lead) were implanted. The intended clinical target — an effective resynchronization therapy — was obtained in all patients. There was no case of death or severe complications. In 2 cases of venous occlusion, the implantation on the contralateral side was required.
Conclusions: TLE enables effective resynchronization therapy also in the case of the presence of too many leads, occlusion of the venous system or lead failure. Significant technical problems can occur especially in patients with venous system occlusion
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