Assessment of Cardiac Resynchronisation Therapy Efficacy Determining Factors for Patients with Moderate and Severe Heart Failure in the Population of Latvia in a 12 and 24 Month Study

Publisher Copyright: © 2018 Maija Vikmane et al.The aim of this study was to evaluate treatment of patients with moderate and severe heart failure (HF) who were resistant to pharmacotherapy in Latvia and to assess the cardiac resynchronisation therapy (CRT) by exploring the predisposing factors which provides CRT efficacy. We accomplished prospective analysis of left ventricle ejection fraction (LVEF) and other parameter changes 12 and 24 months after CRT device implantation, dividing the population into two groups: responders - to whom LVEF improvement was ≥10% and non-responders where ≥ 10% LVEF improvement was not achieved. The study included 50 chronic HF patients with preserved sinus rhythm, who underwent CRT device implantation in Latvia at the Pauls Stradiņš Clinical University Hospital from June 2009 to March 2012. In the group of patients where 12 and 24 months after CRT device implantation LVEF improvement ≥10% was achieved, there were statistically significantly more patients with left bundle branch block (LBBB) QRS morphology, wider QRS complex, nonischemic genesis of HF, and normal systolic blood pressure. Patients with LVEF improvement had more pronounced ventricular dyssynchrony measured by Echo before CRT device implantation and, accordingly, the CRT mode was programmed as left ventricle paced before right ventricle and close to 100% biventricular pacing was achieved and the patient was female.publishersversionPeer reviewe

Comparison of effectiveness and safety of antiarrhythmic drugs class IC and III in patients after electrical cardioversion

Publisher Copyright: © 2019 Aldis Strelnieks et al. published by Sciendo.Patients with atrial fibrillation are faced with an increased risk of thromboembolic events, myocardial infarction, chronic heart failure and death. For some patients with atrial fibrillation, direct current cardioversion (DCCV) is a strategy that can be used to reacquire sinus rhythm. Our aim was to analyse the most commonly used medications after an electrical cardioversion, the reasons for not using them, the effects of pharmacotherapy on recurrence rates, and compare results with data from studies in 2014. The prospective study includes patients with electrocardiographically confirmed atrial fibrillation who underwent direct current cardioversion, hospitalised at Pauls Stradiņš Clinical University Hospital (Riga, Latvia). The average age was 64.6 years. 50% of the patients were female. During the six-month study period, 14.3% patients were using amiodarone, 8.3% patients were on etacizine, 7.1% received propafenone, and 57.1% used beta blockers in monotherapy or in combination. Warfarin was used in 28.0% patients, direct oral anticoagulants (DOAC's) in 29.9%, 21,4% of patients received aspirin and 16.7% did not use any antithrombotic therapy. Comparing the recurrence rate in patients using different antiarrhythmic drugs, amiodarone showed a statistically significant superiority compared to etacizine and propafenone (p = 0.02). The obtained data showed that over four years, the use of anticoagulants increased by 11.6%.publishersversionPeer reviewe

Second European Cardiac Resynchronisation Therapy Survey (Crt Survey II): Latvian Data Compared to Europe

The cardiac resynchronisation therapy (CRT) survey II is a joint initiative between the European Heart Rhythm Association and the Heart Failure Association. It compiles real world data about cardiac resynchronisation therapy in European Society of Cardiology member states. 11 088 patients assigned to implantation of CRT with pacemaker function (CRT-P) or CRT with an incorporated defibrillator (CRT-D) were enrolled in the survey starting 1 October 2015 till 31 December 2016 and for each patient, an electronic case report form (eCRF) was completed. Each participating country had each eCRF data-point benchmarked against the total cohort. In total, 79 patients were included from Latvia. The mean age of patients was 68.1, similar to the total cohort of other ESC member states, and 21.8% of patients were female. Latvian patients compared to other countries more often had permanent atrial fibrillation, NYHA class III and IV, ejection fraction 35 %. CRT-Ds and multipolar lead implantation rates were higher. Peri-procedural complication rates were similarly low in both groups. At discharge, prescribed medication rates were similar but more frequently MRAs, ivabradine and calcium channel blockers were prescribed and slightly less frequently ACE inhibitors/ARBs were prescribed. The CRT survey II is a valuable resource that describes ongoing practice of cardiac resynchronisation therapy around Europe and benchmarking against the total cohort is nationally significant for each participating country.publishersversionPeer reviewe

Sirds resinhronizācijas iekārtu implantācijas efektivitātes kritēriju izvērtējums pacientiem ar sirds mazspēju Latvijas populācijā. Promocijas darba kopsavilkums

The Doctoral Thesis has been elaborated at the Latvian Centre of Cardiology, Pauls Stradiņš University Hospital, Rīga. Defence: at the public session of the Doctoral Council of Medicine on 27 January 2020 at 15.00 in Hippocrates Lecture Theatre, 16 Dzirciema Street, Rīga Stradiņš University.Introduction. Heart failure (HF) is one of the main causes of hospitalisation, disabilities and death worldwide and in Latvia as well. Pharmacological therapy often has proven to be ineffective since it fails to prevent uncoordinated ventricular contraction. Application of cardiac resynchronisation therapy (CRT) helps restore proper coordination between both ventricles, thus improving the HF prognosis. Nevertheless, it remains unclear what initial factors may affect the CRT efficiency. Aim. The aim of the study is to analyse progression of treatment and the factors affecting the efficiency in HF patients with moderate and severe clinical course with implanted cardiac resynchronisation devices. Methods. The prospective single-centre study analysed patients with HF who had undergone scheduled implantation of CRT. Efficiency of CRT was detected by echocardiography, studying the improvement in ejection fraction (EF) of the left ventricular after 12 and 24 months, respectively. ΔEF improvement ≥ 10% – CRT responders and ΔEF improvement 50 ms, SBP above 130 mm Hg.The doctoral thesis was carried out under financial support of the European Social Fund project “Support for doctoral study programmes and the acquisition of a scientific degree at Rīga Stradiņš University”

Assessment of Factors Determining Efficacy of Cardiac Resynchronisation Therapy for Patients with Heart Failure in the Population of Latvia. Summary of the Doctoral Thesis

Promocijas darbs izstrādāts Paula Stradiņa Klīniskās universitātes slimnīcas Latvijas Kardioloģijas centra Aritmoloģijas un kardiostimulācijas nodaļā. Aizstāvēšana: 2020. gada 27. janvārī plkst. 15.00 Rīgas Stradiņa universitātes Medicīnas promocijas padomes atklātā sēdē Rīgā, Dzirciema ielā 16, Hipokrāta auditorijā.Ievads. Sirds mazspēja (SM) ir viens no galvenajiem mirstības, hospitalizācijas un invaliditātes cēloņiem pasaulē un arī Latvijā. Farmakoloģiskā terapija nereti nav efektīva, jo tā nespēj novērst izveidojušos sirds kambaru nekoordinēto saraušanos. Pielietojot sirds resinhronizācijas terapiju (CRT), tiek nodrošināta saskaņota abu sirds kambaru saraušanās, tādējādi uzlabojot SM prognozi, taču līdz šim nav skaidrs, kādi sākotnējie faktori varētu ietekmēt CRT efektivitāti. Mērķis. Analizēt ārstēšanas norisi un tās efektivitāti ietekmējošos faktorus SM pacientiem ar vidēji smagu un smagu klīnisko gaitu, pielietojot implantējamās sirds resinhronizācijas iekārtas. Metodes. Prospektīvā viena centra pētījumā tika iekļauti 50 pacienti ar SM, kuriem veikta plānveida CRT iekārtas implantācija. CRT efektivitāte noteikta ehokardiogrāfiski (EhoKG), izvērtējot kreisā kambara izsviedes frakcijas (EF) uzlabošanos pēc 12 un 24 mēnešiem. Pacienti tika dalīti divās pamatgrupās, vadoties pēc EhoKG, prospektīvi izvērtētām kreisā kambara izsviedes frakcijas izmaiņām (ΔEF): • ΔEF uzlabošanās ≥ 10% – CRT “atbildētāji”, • ΔEF uzlabošanās 50 ms, SAS virs 130 mm Hg.Promocijas darbs veikts ar ESF projekta “Atbalsts doktorantiem studiju programmas apguvei un zinātniskā grāda ieguvei Rīgas Stradiņa universitātē” atbalstu

Assessment of Factors Determining Efficacy of Cardiac Resynchronisation Therapy for Patients with Heart Failure in the Population of Latvia. Doctoral Thesis

Promocijas darbs izstrādāts Paula Stradiņa Klīniskās universitātes slimnīcas Latvijas Kardioloģijas centra Aritmoloģijas un kardiostimulācijas nodaļā. Aizstāvēšana: 2020. gada 27. janvārī plkst. 15.00 Rīgas Stradiņa universitātes Medicīnas promocijas padomes atklātā sēdē Rīgā, Dzirciema ielā 16, Hipokrāta auditorijā.Ievads. Sirds mazspēja (SM) ir viens no galvenajiem mirstības, hospitalizācijas un invaliditātes cēloņiem pasaulē un arī Latvijā. Farmakoloģiskā terapija nereti nav efektīva, jo tā nespēj novērst izveidojušos sirds kambaru nekoordinēto saraušanos. Pielietojot sirds resinhronizācijas terapiju (CRT), tiek nodrošināta saskaņota abu sirds kambaru saraušanās, tādējādi uzlabojot SM prognozi, taču līdz šim nav skaidrs, kādi sākotnējie faktori varētu ietekmēt CRT efektivitāti. Mērķis. Analizēt ārstēšanas norisi un tās efektivitāti ietekmējošos faktorus SM pacientiem ar vidēji smagu un smagu klīnisko gaitu, pielietojot implantējamās sirds resinhronizācijas iekārtas. Metodes. Prospektīvā viena centra pētījumā tika iekļauti 50 pacienti ar SM, kuriem veikta plānveida CRT iekārtas implantācija. CRT efektivitāte noteikta ehokardiogrāfiski (EhoKG), izvērtējot kreisā kambara izsviedes frakcijas (EF) uzlabošanos pēc 12 un 24 mēnešiem. Pacienti tika dalīti divās pamatgrupās, vadoties pēc EhoKG, prospektīvi izvērtētām kreisā kambara izsviedes frakcijas izmaiņām (ΔEF): • ΔEF uzlabošanās ≥ 10% – CRT “atbildētāji”, • ΔEF uzlabošanās 50 ms, SAS virs 130 mm Hg.Promocijas darbs veikts ar ESF projekta “Atbalsts doktorantiem studiju programmas apguvei un zinātniskā grāda ieguvei Rīgas Stradiņa universitātē” atbalstu

Sinus Rhythm Maintenance After Electrical Cardioversion for Atrial Fibrillation in High-Risk Patients — Comparative Efficacy of Antiarrhythmic Medications

Publisher Copyright: © 2021 Sciendo. All rights reserved.Atrial fibrillation (AF) conversion to sinus rhythm by electrical cardioversion (ECV) is followed by the challenge of preventing arrhythmia recurrence, especially in high-risk patients. The properties of class IC, class III and also class II antiarrhythmic medications have been established, but not all effects have been studied. The aim of the study was to compare efficacy of class IC and class III antiarrhythmic medications, and additionally medication with a class II mechanism of action, or taken concomitantly with a beta-blocker, for post-cardioversion sinus rhythm maintenance in patients with high-risk AF. A total of 112 patients who underwent successful ECV in Latvian Centre of Cardiology were included. Data was acquired by a face-to-face interview and 1-, 3-, 6-month follow-up interviews. Comparing class IC (used by 34.8%) and class III (used by 65.2%) drugs, there was no statistically significant difference between six-month sinus rhythm maintenance rates (53.8% vs. 63.0%, p = 0.346) and arrhythmia-free survival (p = 0.313). Comparing amiodarone (used by 57.1%) and ethacizine, concurrently with a beta-blocker (used by 25.9%), no statistically significant difference was found between six-month sinus rhythm maintenance (64.1% vs. 58.6%, p = 0.616) and arrhythmia-free survival (p = 0.706). The results showed that specific antiarrhythmic drug choice was not associated with superior effectiveness, highlighting that, if not contraindicated, ethacizine, concomitantly with a beta-blocker, could be used as a similarly effective alternative for amiodarone, which has adverse health effects.publishersversionPeer reviewe

Sinus Rhythm Maintenance After Electrical Cardioversion for Atrial Fibrillation in High-Risk Patients — Comparative Efficacy of Antiarrhythmic Medications

Atrial fibrillation (AF) conversion to sinus rhythm by electrical cardioversion (ECV) is followed by the challenge of preventing arrhythmia recurrence, especially in high-risk patients. The properties of class IC, class III and also class II antiarrhythmic medications have been established, but not all effects have been studied. The aim of the study was to compare efficacy of class IC and class III antiarrhythmic medications, and additionally medication with a class II mechanism of action, or taken concomitantly with a beta-blocker, for post-cardioversion sinus rhythm maintenance in patients with high-risk AF. A total of 112 patients who underwent successful ECV in Latvian Centre of Cardiology were included. Data was acquired by a face-to-face interview and 1-, 3-, 6-month follow-up interviews. Comparing class IC (used by 34.8%) and class III (used by 65.2%) drugs, there was no statistically significant difference between six-month sinus rhythm maintenance rates (53.8% vs. 63.0%, p = 0.346) and arrhythmia-free survival (p = 0.313). Comparing amiodarone (used by 57.1%) and ethacizine, concurrently with a beta-blocker (used by 25.9%), no statistically significant difference was found between six-month sinus rhythm maintenance (64.1% vs. 58.6%, p = 0.616) and arrhythmia-free survival (p = 0.706). The results showed that specific antiarrhythmic drug choice was not associated with superior effectiveness, highlighting that, if not contraindicated, ethacizine, concomitantly with a beta-blocker, could be used as a similarly effective alternative for amiodarone, which has adverse health effects