Safety and efficacy of cryoablation without the use of fluoroscopy

Background: Development of electroanatomical systems make it possible to perform ablations without the use of fluoroscopy. The aim of this study was to evaluate the efficacy and safety of cryoablation pro­cedures without the use of fluoroscopy. Methods: The study group consisted of 45 patients (14 female; age 36 ± 15 years) treated with cry­oablation using the EnSite electroanatomical system: 10 with ventricular extrasystoly from the right ventricle, 6 with the arrhythmogenic site near the left coronary artery, 17 patients with Wolff-Parkinson- -White syndrome (WPW), 2 patients with atrioventricular nodal reentrant tachycardia (AVNRT) type 2, 7 patients with AVNRT type 1, 3 patients with atrial tachycardia. Results: In 38 of the 45 patients (84%) cryoablation procedure was performed without the use of fluoroscopy. Cryoablation efficacy was 78.9%. In 5 patients unsuccessful cryoablation was fallowed by radiofrequency applications. Finally, efficacy reached 92.1%. There were no deaths. In 1 patient a small adverse event — right bundle branch block was observed after ablation of para-Hisian accessory path­way. No other adverse events were observed. In the long term follow-up efficacy was 89.5%. Conclusions: Cryoablation using electroanatomical system without the use of fluoroscopy is a safe and efficient procedure and it is a possible alternative in most patients qualified for cryoablation

Czy głównym winowajcą omdleń jest mózg czy układ naczyniowy?

W artykule przybliżono problematykę omdleń. Zwrócono uwagę na rokowniczą rolę podziału omdleń na kardiogenne, niekardiogenne i o nieznanej etiologii. Do omdleń niekardiogennych zalicza się najczęściej występujące w praktyce omdlenia wazowagalne. Przedstawiono nowoczesne metody zgłębiania patomechanizmu tych omdleń, które koncentrują się na dwóch ich podstawowych aspektach: zachowania się ukrwienia i czynności elektrycznej mózgu (w odniesieniu do teorii ośrodkowych tych omdleń) lub zachowania się centralnego i obwodowego układu naczyniowego (teorie obwodowe). Pełniejsze zrozumienie tych elementów może w najbliższej przyszłości pomóc w celowanym leczeniu różnych postaci omdleń odruchowych. Forum Medycyny Rodzinnej 2008, tom 2, nr 1, 33-4

Acute myeloid leukemia – treatment of relapsed and refractory form

Relapsed and refractory acute myeloid leukemia (AML) is defined by clinical and biologic features that predict their poor response to therapy. Despite even the most aggressive and well-developed strategies for treatment, most patients succumb to the disease. No currently available treatment has demonstrated consistent efficacy in terms of salvage therapy or long-term survival in this group of patients. This review will discuss some of the emerging strategies: targeted molecular therapies, novel cytotoxics, and immune-based therapies to treat relapsed and refractory AML patients

GWAS links variants in neuronal development and actin remodeling related loci with pseudoexfoliation syndrome without glaucoma

Pseudoexfoliation syndrome (PEXS) is an age-related elastosis, strongly associated with the development of secondary glaucoma. It is clearly suggested that PEXS has a genetic component, but this has not been extensively studied. Here, a genome-wide association study (GWAS) using a DNA-pooling approach was conducted to explore the potential association of genetic variants with PEXS in a Polish population, including 103 PEXS patients without glaucoma and 106 perfectly (age- and gender-) matched controls. Individual sample TaqMan genotyping was used to validate GWAS-selected single-nucleotide polymorphism (SNP) associations. Multivariate binary logistic regression analysis was applied to develop a prediction model for PEXS. In total, 15 SNPs representing independent PEXS susceptibility loci were selected for further validation in individual samples. For 14 of these variants, significant differences in the allele and genotype frequencies between cases and controls were identified, of which 12 remained significant after Benjamini-Hochberg adjustment. The minor allele of five SNPs was associated with an increased risk of PEXS development, while for nine SNPs, it showed a protective effect. Beyond the known LOXL1 variant rs2165241, nine other SNPs were located within gene regions, including in OR11L1, CD80, TNIK, CADM2, SORBS2, RNF180, FGF14, FMN1, and RBFOX1 genes. None of these associations with PEXS has previously been reported. Selected SNPs were found to explain nearly 69% of the total risk of PEXS development. The overall risk prediction accuracy for PEXS, expressed by the area under the ROC curve (AUC) value, increased by 0.218, from 0.672 for LOXL1 rs2165241 alone to 0.89 when seven additional SNPs were included in the proposed 8-SNP prediction model. In conclusion, several new susceptibility loci for PEXS without glaucoma suggested that neuronal development and actin remodeling are potentially involved in either PEXS onset or inhibition or delay of its conversion to glaucoma

Members of the emergency medical team may have difficulty diagnosing rapid atrial fibrillation in Wolff-Parkinson-White syndrome

Background: Atrial fibrillation (AF) in patients with Wolff-Parkinson-White (WPW) syn­drome is potentially life-threatening as it may deteriorate into ventricular fibrillation. The aim of this study was to assess whether the emergency medical team members are able to diagnose AF with a rapid ventricular response due to the presence of atrioventricular bypass tract in WPW syndrome. Methods: The study group consisted of 316 participants attending a national congress of emergency medicine. A total of 196 questionnaires regarding recognition and management of cardiac arrhythmias were distributed. The assessed part presented a clinical scenario with a young hemodynamically stable man who had a 12-lead electrocardiogram performed in the past with signs of pre-excitation, and who presented to the emergency team with an irregular broad QRS-complex tachycardia. Results: A total of 71 questionnaires were filled in. Only one responder recognized AF due to WPW syndrome, while 5 other responders recognized WPW syndrome and paroxysmal su­praventricular tachycardia or broad QRS-complex tachycardia. About 20% of participants did not select any diagnosis, pointing out a method of treatment only. The most common diagnosis found in the survey was ventricular tachycardia/broad QRS-complex tachycardia marked by approximately a half of the participants. Nearly 18% of participants recognized WPW syn­drome, whereas AF was recognized by less than 10% of participants. Conclusions: Members of emergency medical teams have limited skills for recognizing WPW syndrome with rapid AF, and ventricular tachycardia is the most frequent incorrect diagnosis.

Kardioneuroablacja w omdleniach odruchowych — nowa nadzieja dla trudnych pacjentów

We are presenting a new method of treatment of vasovagal syncope, which is the ablation of parasympathetic ganglia in the atria. This method, shifting the balance of the autonomic nervous system in the sympathetic direction, is directed to the immediate cause of syncope which is excessive activation of the vagus nerve. Its effectiveness in the annual observation is within 80-100%. This method offers a great chance to improve the quality of life in patients with reflex syncope what have not been prevented by conventional treatment.Autorzy niniejszej pracy przybliżają nową metodę leczenia omdleń wazowagalnych, jakąjest ablacja zwojów przywspółczulnych w przedsionkach. Metoda ta, przesuwając równowagęautonomicznego układu nerwowego w kierunku współczulnym, jest ukierunkowanana bezpośrednią pr zyczynę omdlenia, czyli nadmierne pobudzenie ner wu błędnego. Jejskuteczność w obserwacji rocznej mieści się w granicach 80–100%. Metoda ta daje dużeszanse poprawy jakości życia u pacjentów z omdleniami odruchowy mi, które nie uległywyciszeniu pod wpływem typowego leczenia