THE FIRST CASE OF RADIOFREQUENT ABLATION OF VENTRICULAR TACHYCARDIA IN A PATIENT WITH ISCHEMIC CARDIOMYOPATHY IN OUR COUNTRY

Ablacija ventrikularne tahikardije kod bolesnika s ishemijskom kardiomiopatijom kompliciranija je i mnogo teža od ablacije većine supraventrikularnih tahikardija. Aritmogeni supstrat je kompleksniji, a lokalizacija mu je često nejasna. Zbog karakteristika tahikardije preciznije metode mapiranja često se ne mogu rabiti. Uz to se obično radi o bolesnicima sa slabijom sistoličkom funkcijom, zatajivanjem srca, ishemijom i brojnim komorbiditetima gdje izazivanje tahikardije i postupak ablacije mogu dovesti do naglog hemodinamskog urušavanja. Neinducibilnost kliničke aritmije postiže se kod 65–95% bolesnika, ali se recidiv javlja kod 20–44% bolesnika. Teže komplikacije bilježe se kod 8% bolesnika uz smrtni ishod kod 2,7% bolesnika. Odluku o strategiji liječenja treba stoga donositi individualno procjenjujući potencijalnu korist i rizik od intervencije. Ovaj članak prikazuje prvi slučaj uspješne ablacije ventrikularne tahikardije kod bolesnika s ishemijskom kardiomiopatijom koja je učinjena u našoj zemljAblation of ventricular tachycardia in patients with ischemic cardiomyopathy is more complicated and more difficult than ablation of most supraventricular tachycardias. Arrhythmogenic substrate is complex and its localisation is often unclear. Because of the tachycardia characteristics, more precise mapping methods often can’t be utilised. Also, patients are usually seriously ill with decreased systolic function, heart failure, ischemia and various comorbidities where tachycardia induction and ablation procedure may facilitate abrupt hemodynamic disturbance. Uninducibility of the clinical tachycardia can be achieved in 65–95% of patients, but tachycardia recurs in 20–44% of patients. Serious complications were noted in 8% of patients with lethal outcome in 2.7% of patients. Decision about therapeutic strategy should be made individually according to potential risk and procedure benefit. This paper presents the first case of the successful ablation of ventricular tachycardia in a patient with ischemic cardiomyopathy in our country

Are Medical Students more Subjective to Illness Anxiety Disorder?

Studying medicine was assumed to be a risk factor to develop hypochondriacal tendencies. The main objective of this study was to determine if the medical students develop hypochondriacal worries more frequently than other, non – medical, students. We gathered a sample of 376 medical students and 367 non – medical students, total of 743 students. Whiteley Index, a fast screening test for hypochondriacal worries, along with three extra questions, was given to students to fill out. Significantly higher score on Whiteley Indeks was determined among medical students than in non – medical students. It was also shown that the medical students on third and fourth year of study were especially more subjective to develop hypochondriasis. The findings indicate that medical students are more subjective to develop hypochondriacal tendencies. Organization of medical and psychological help for students should be established

ATRIAL FIBRILLATION AND HEMODINAMICALY UNSTABLE WIDE QRS COMPLEX TACHYCARDIA – A case report

Tahikardija je aritmija karakterizirana srčanom frekvencijom > 100/minuti. Prema širini QRS-kompleksa može se podijeliti na tahikardije uskih ( 120 ms). Tahikardija uskih QRS-kompleksa uvijek je supraventrikularna, što znači da joj je izvorište proksimalno od Hisova snopa, dok tahikardija širokih QRS-kompleksa može biti ventrikularna (izvorište u ventrikulu distalno od Hisova snopa), ali i supraventrikularna. Strategija liječenja ovih dvaju poremećaja različita je pa je točna dijagnoza preduvjet optimalne terapije. Prikazujemo ovaj slučaj jer su diferencijalna dijagnoza tahikardije širokih QRS-kompleksa, a time i planiranje terapije bili posebno otežani zbog istodobno prisutne fibrilacije atrija te hemodinamske kompromitacije i akutnog ugrožavanja života bolesnice.Tachycardia is an arrhythmia characterized by heart rate > 100 / minute. According to the width of the QRS complex it can be divided into narrow QRS ( 120 ms). Narrow QRS tachycardia is always supraventricular which means that its source is proximal to the bundle of His, while wide QRS tachycardia can be ventricular (source is in the ventricle, distal to the bundle of His) or supraventricular. The strategies for treating these two conditions are different so the correct diagnosis is prerequisite for optimal therapy. We present this case because the differential diagnosis of wide QRS tachycardia and therefore the treatment planning was particularly difficult due to concurrently present atrial fibrillation with hemodynamic compromise and an acute threat to the life of the patient

The first case of epicardial ablation of ventricular tachycardia in a patient with non-ischemic cardiomyopathy in our country

Od 2012. u nas se uspješno provode procedure endokardijalne ablacije u bolesnika sa strukturnom bolesti srca i ventrikularnim aritmijama. Riječ je o kompleksnim elektrofiziološkim procedurama kojima se koristimo u liječenju električne oluje ili pri repetitivnim uključivanjima kardioverterskog defibrilatora. Međutim, kod dijela bolesnika endokardijalna ablacija nije uspješna budući da se ključni supstrat aritmije nalazi subepikardijalno. Prikazujemo 20-godišnjeg bolesnika koji je preživio izvanbolnički arest, uzrokovan ventrikularnom fibrilacijom (VF) u sklopu preboljenog miokarditisa. Širokom kardiološkom obradom isključen je drugi uzrok aritmije, a magnetskom rezonancijom utvrđen je supstrat u obliku subepikardijalnih ožiljnih zona u lijevom ventrikulu. Bolesniku je ugrađen kardioverterski defibrilator, no usprkos većem broju linija antiaritmičke terapije i dalje su bili učestali recidivi VF-a. Stoga je učinjena kombinirana perkutana endokardijalna/epikardijalna procedura, nakon koje bolesnik više nije imao recidiva aritmije. Zbog velike kompleksnosti epikardijalne ablacije dosad smo ovakve bolesnike morali referirati kolegama u inozemnim centrima, što odsad više nije nužno.Since 2012 we have successfully implemented endocardial ablation procedures in patients with structural heart disease and ventricular arrhythmias. These are complex electrophysiological procedures that are used to treat electric storms or repetitive discharges of cardioverter-defibrillators. However, in one part of the patients endocardial ablation is unsuccessful, since the key substrate of arrhythmia is subepicardial. We report a 20-year-old patient who has survived out-of-hospital arrest, caused by ventricular fibrillation (VF) in the setting of myocarditis. Extensive cardiac work-up did not show any pathology, however cardiac magnetic resonance found subepicardial scarring zones in the left ventricle as the primary cause of arrhythmia. The patient was implanted with a cardioverter-defibrillator, but in spite of several lines of antiarrhythmic therapy there were still frequent recurrent VFs. Therefore, a combined percutaneous endo/epi procedure was performed, after which the patient had no recurrence of arrhythmia. Due to the great complexity of epicardial ablation, so far these patients have been refered to colleagues in foreign centers, which is no longer the case

Quality of Life after Cardiac Surgery

The aim of this study was to determine a health-related quality of life two or more years after a cardiac surgery using the MOS-36 item short-form health survey questionnaire. 330 members of »Croatian society of patients who underwent cardiac surgery« were asked and 196 responders, 122 men and 74 women, were included in survey, all of them more than two years after surgery and older than fifty years of age. The answers were collected by phone. Women gained better results for Physical Functioning (p<0.003) and men estimated better scores for psychical health (p<0.001). Our patients gained some different results in respect to the Croatian sample of healthy people of the same age. They declared better General Health (p<0.001), less Bodily Pain (p<0.001), but inferior Role-Emotion (p<0.001) and Social Functioning (p<0.001). The estimations of QOL improving were comparable with the results of numerous shorter follow-ups