Practising the works of love and mercy in parishes

The parish is an ecclesial community, and as such it makes present the Church as a reflection of the Triune God, God who is love. The author of this article is attempting to translate these dogmatic truths of faith into practice at the level of the parish and thus to approach them on a plane that is practical rather than theoretical. Particular attention is given to the internal and external ways of practicing mercy. Preaching and practicing mercy starts with various human relationships in the parish, and bears fruit in a concrete, common and organized outward action. These are the two wings of practicing mercy in the parish: through the inner interpersonal relationships as well as through concreto initiatives and actions undertaken by the parish. lf any of the two wings is missing, the evangelical character of practicing mercy in the parish is distorted.Akademia im. Jana Długosza w Częstochowie61-7

Potrzeba badań komparatystycznych w edukacji religijnej

Besoin d’études comparatives dans l’éducation religieuseLes changements de la societé comtemporaine entraînent des changements dans l’éducation. Des nouveaux phénomènes culturels, et surtout les pluralisme des opinions et des conceptions d’éducation engendrent un grand besoin d’études comparatives. Dans le domaine de l’éducation religieuse se développe également une nécessité croissante de telles recherches. On peut parler actuellement d’un besoin de création d’une pédagogie comparative de la religion. Certains phénomènes actuels le corroborent, ainsi: le pluralisme religieux, l’accroissement de la mobilité religieuse du fait des migrations de populations, une societé sans repères quant au fait religieux, ou enfin l’activité oecuménique de l’Eglise. On peut baser ces recherches comparatives dans l’éducation religieuse sur trois concepts fondamentaux de la pédagogie comparative: l’universalisme (recherche de ce qui est commun), la confrontation (connaissance des différences), la coopération (collaboration dans le domaine de l’éducation religieuse). Tout ce que renferme l’éducation religieuse peut devenir objet d’examens comparatifs. Ces recherches peuvent concerner la comparaison des systèmes d’éducation religieuse, que ce soit dans une perspective interconfessionnelle ou sur le terrain de notre propre religion. La comparaison de la pédagogie de la religion peut constituer un facteur important dans la construction d’une collaboration entre religions, et une prévention à l’égard des phénomènes de fanatisme religieux dans le monde contemporain

High defibrillation threshold in patients with implantable cardioverter-defibrillator. How to solve the problem, single-center experience

Standard implantable cardioverter-defibrillator with transvenous leads systems have proven to be effective in terminating ventricular tachyarrhythmias in most patients (more then 90%) with sufficient safety margin, i.e. difference between maximal output energy of the ICD and defibrillation threshold. However in some clinical situation it is not possible, energy requirement is higher than normal, it is called high defibrillation threshold. We report clinical data of 3 patients with high defibrillation threshold among 415 ICD’s implanted in our institution (cases of ischaemic cardiomyopathy, dilated cardiomyopathy and hypertrophic cardiomyopathy are presented). We summarize our experience, therapeutic options and literature review investigating factors which influence defibrillation threshold: related to underlying cardiac disease, therapy (drugs interactions) and ICD system( lead and pulse generator type)

Endocardial lead extraction in the Polish registry : clinical practice versus current Heart Rhythm Society consensus

Introduction: Over the last 10 years, there has been an increasing number of patients with pacemaker (PM) and cardioverter-defibrillator (ICD). This study is a retrospective analysis of indications for endocardial pacemaker and ICD lead extractions between 2003 and 2009 based on the experience of three Polish Referral Lead Extraction Centers. Material and methods: Since 2003, the authors have consecutively retrospectively collected all cases and entered the information in the database. All patients which had indication for lead extraction according to Heart Rhythm Society Guidelines were included to final analyze. Between 2003 and 2005, the data were analyzed together. Since 2006, data have been collected and analyzed annually. Results: In each year, a significant increase in lead extraction was observed. The main indications for LE were infections in 52.4% of patients. Nonfunctioning lead extraction constituted the second group of indications for LE in 29.7% of patients. During the registry period, the percentage of class I indications decreased from 80% in 2006 to only 47% in 2009. On the other hand, increasingly more leads were removed because of class 2, especially class 2b. In 2009, 40% of leads were extracted due to class 2b. Conclusions: Polish Registry of Endocardial Lead Extraction 2003-2009, shows an increasing frequency of lead extraction. The main indication for LE is infection: systemic and pocket. An increase in class 2, especially 2b, LE indication in every center during the study period was found

Tricuspid regurgitation after implantable cardioverter-defibrillator implantation in patients with arrhythmogenic right ventricular cardiomyopathy

Introduction. The problem of lead-induced tricuspid regurgitation (LITR) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) is poorly investigated. Patients with high risk of adverse outcome usually receive implantable cardioverter-defibrillator (ICD) as a prevention of sudden cardiac death (SCD). nfortunately, the insertion of ICD into the right ventricle is supposed to exacerbate tricuspid regurgitation.As ICD (or cardiac resynchronization therapy defibrillator) seems to be necessity in prevention of SCD in quite large group of patients, we aimed to evaluate frequency of LITR and further outcome in these persons.Material and methods. In a database of 55 patients with ARVC and ICD implanted in prevention of SCD, we selected 35 patients (mean age 48.78 ± 13.56 years) with data suitable for analysis. Based on the results of echocardiography, study population was divided into 2 groups: TR+ group with worsening of tricuspid regurgitation (TR) defined as its deterioration to higher grade and TR– group (without worsening of TR).Results. In 65.71% of patients TR worsened after ICD implantation. Mean time of observation was 91.06 ± 55.32 months. In TR+ group, 2 patients (8.7%) died because of heart failure and 1 patient died in a traffic accident. In TR– group 1 patient (8.33%) died because of heart failure and 1 patient had heart transplantation (results were statistically insignificant).Conclusions. We couldn’t prove that the worsening of TR was associated with worsening of clinical outcome. Furtherstudies are needed to assess an influence of LITR on prognosis in patients with ARVC and ICD implanted.Introduction. The problem of lead-induced tricuspid regurgitation (LITR) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) is poorly investigated. Patients with high risk of adverse outcome usually receive implantable cardioverter-defibrillator (ICD) as a prevention of sudden cardiac death (SCD). nfortunately, the insertion of ICD into the right ventricle is supposed to exacerbate tricuspid regurgitation.As ICD (or cardiac resynchronization therapy defibrillator) seems to be necessity in prevention of SCD in quite large group of patients, we aimed to evaluate frequency of LITR and further outcome in these persons.Material and methods. In a database of 55 patients with ARVC and ICD implanted in prevention of SCD, we selected 35 patients (mean age 48.78 ± 13.56 years) with data suitable for analysis. Based on the results of echocardiography, study population was divided into 2 groups: TR+ group with worsening of tricuspid regurgitation (TR) defined as its deterioration to higher grade and TR– group (without worsening of TR).Results. In 65.71% of patients TR worsened after ICD implantation. Mean time of observation was 91.06 ± 55.32 months. In TR+ group, 2 patients (8.7%) died because of heart failure and 1 patient died in a traffic accident. In TR– group 1 patient (8.33%) died because of heart failure and 1 patient had heart transplantation (results were statistically insignificant).Conclusions. We couldn’t prove that the worsening of TR was associated with worsening of clinical outcome. Furtherstudies are needed to assess an influence of LITR on prognosis in patients with ARVC and ICD implanted

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 &plusmn; 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% &plusmn; 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

Wysoki próg defibrylacji u chorych z wszczepialnym kardiowerterem-defibrylatorem. Sposoby rozwiązania tego problemu na podstawie doświadczeń własnych

Współczesne standardowe wszczepialne kardiowertery-defibrylatory (ICD) z systemem elektrod przezżylnych umożliwiają skuteczne przerwanie tachyarytmii komorowych u większości chorych (> 90%) z zachowaniem wymaganego marginesu bezpieczeństwa, tj. różnicy między maksymalną energią dostarczaną przez ICD określonego typu a tzw. progiem defibrylacji. Jednak w szczególnych sytuacjach spełnienie tego warunku jest niemożliwe. Określa się je jako wysoki próg defibrylacji. W niniejszej pracy przedstawiono przypadki 3 chorych spośród 415 pacjentów z defibrylatorami wszczepionymi w okresie obserwacji, wymagających niestandardowego postępowania z powodu wysokiego progu defibrylacji u osób z kardiomiopatią niedokrwienną, rozstrzeniową oraz przerostową. Podsumowano w tym zakresie doświadczenia ośrodka, w którym pracują autorzy niniejszego opracowania, omówiono możliwe sposoby postępowania oraz dokonano przeglądu piśmiennictwa na temat czynników wpływających na próg defibrylacji wiążących się z pacjentem (choroba podstawowa), leczeniem (wpływ farmakoterapii) oraz z zastosowanym układem ICD (elektroda i sam generator impulsów)

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

The effectiveness of transvenous leads extractions implanted more than 10 years before

Background: The increasing number of patients with cardiac implantable electronic devices (CIEDs) causes a rise in the absolute percentage of individuals qualifying for a transvenous lead extraction (TLE) due to infectious, vascular or lead failure related indications. As the survival time prolongs, TLE procedures more and more often concern the electrodes of long- -term functioning. Authors provide a retrospective analysis of the effectiveness and safety of TLE performed on leads implanted at least 10 years before the extraction. Methods: Between 2008 and 2012 we performed TLE of 364 electrodes in 217 patients. Out of these, 66 (18.1%) leads in 43 (19.8%) patients had been implanted for at least 10 years. The mean dwelling time for electrodes was 161 months (120 to 330). In 62% of cases CIED-related infection was an indication for TLE. The following extracting techniques were used: manual direct traction, device traction, mechanical telescopic sheaths, autorotational cutting sheaths and femoral approach. Results: Fifty-eight pacemakers and 8 defibrillating leads were extracted. Sixty-three (95%) completely, in the remaining 3 cases the clinical success was achieved with the small portion of the lead left into the vascular space. No major procedure complications were observed; minor complications were found in 3 (6%) patients. Conclusions: TLE with the use of various endovascular techniques is an effective and safe method for treating infectious, vascular and mechanical complications of long-lasting CIEDs therapy.