Regarding the editorial by Sau and Ng. 'Hypertrophic cardiomyopathy risk stratification based on clinical or dynamic electrophysiological features: two sides of the same coin'

This Letter to the Editor refers to article ‘Hypertrophic cardiomyopathy risk stratification based on clinical or dynamic electrophysiological features: two sides of the same coin’ by Sau A, Ng, FS https://doi.org/10.1093/europace/euad072. ‘Response to the letter to the editor EUPC-D-23-00362 of Richard Saumarez’, by Arunashis Sau and Fu Siong Ng, https://doi.org/10.1093/europace/euad174

Decyzja o wstrzymaniu użytkowania dużego obiektu energetycznego spalania – ważenie interesu publicznego i prywatnego

Celem artykułu jest analiza, w jakim stopniu i czyim interesem powinien się kierować organ inspekcji ochrony środowiska, podejmując decyzję o wstrzymaniu użytkowania instalacji dużego obiektu energetycznego spalania. Badaniu poddano jedynie postępowanie w oparciu o art. 367 ustawy z dnia 27 kwietnia 2001 r. – Prawo ochrony środowiska z tego względu, że fakultatywny charakter tego postępowania w połączeniu z możliwością wyznaczenia dodatkowego terminu na usunięcie naruszeń jedynie na wniosek strony budzi wątpliwości autorów niniejszego artykułu w zakresie ważenia interesów publicznego i prywatnego. W analizowanym postępowaniu interes publiczny przejawiający się w obowiązku ochrony środowiska ujęty w art. 5 i 74 Konstytucji RP jest przeciwstawiany interesowi prywatnemu, w głównej mierze wyrażonemu w art. 20–22 oraz 31 Konstytucji RP, tj. zasadom własności prywatnej i swobody działalności gospodarczej. Organ inspekcji ochrony środowiska każdorazowo musi dokonać wnikliwej analizy, przykładając stan faktyczny danej sprawy do wytycznych zawartych w powyżej wskazanych artykułach Konstytucji RP, kierujących rozstrzygnięcie w przeciwnych kierunkach. Autorzy niniejszego artykułu wskazują, że w szczególności w przypadku dużych obiektów energetycznego spalania, interes użytkowników tych instalacji doznaje nieuzasadnionego uszczerbku przejawiającego się specyfiką procedury postępowania o wstrzymanie użytkowania instalacji w oparciu o art. 367 prawa ochrony środowiska

Percutaneous removal of endocardial implantable cardioverter-defibrillator lead displaced to the right pulmonary artery

We describe a case of percutaneous removal of endocardial implantable cardioverter-defibrillator lead displaced to the right pulmonary artery. The procedure was performed from two accesses; from the lower one (femoral) and then, due to technical problems, from the upper one (subclavian). In the last stage the flattened Dotter’s basket was introduced to the heart inside the Byrd dilator and then fastened to the described lead as the external ‘splint’. This solution is an alternative to the recommended use of the internal metal leader with anchoring function in case of significant malformation of the internal lumen of the lead. The procedure we describe is an example of the sort of individual, original solution indispensable for the efficient and safe removal of untypically displaced leads. (Cardiol J 2010; 17, 3: 293-298

Percutaneous removal of endocardial implantable cardioverter-defibrillator lead displaced to the right pulmonary artery

We describe a case of percutaneous removal of endocardial implantable cardioverter-defibrillator lead displaced to the right pulmonary artery. The procedure was performed from two accesses; from the lower one (femoral) and then, due to technical problems, from the upper one (subclavian). In the last stage the flattened Dotter’s basket was introduced to the heart inside the Byrd dilator and then fastened to the described lead as the external ‘splint’. This solution is an alternative to the recommended use of the internal metal leader with anchoring function in case of significant malformation of the internal lumen of the lead. The procedure we describe is an example of the sort of individual, original solution indispensable for the efficient and safe removal of untypically displaced leads

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 &plusmn; 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 &#8805; 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&#8211;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

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