Does a blanking period after pulmonary vein isolation impact long-term results? Results after 55 months of follow-up

Background: The aims of the study are 1) to assess antiarrhythmic prophylaxis efficacy dur­ing the first 2 months after radiofrequency ablation (ARF) due to AF; 2) to define risk factors for early AF recurrence (EAFR) after ARF; 3) to determine the long-term follow-up results and risk factors for late AF recurrence (LAFR). Methods: A total number of 210 consecutive patients who had undergone ARF due to AF were analyzed. Patients were randomized into three groups: Group 1 (G1), without any anti­arrhythmic drug (AAD); Group 2 (G2), with amiodarone or sotalol; Group 3 (G3), with last ineffective AAD. The study was designed to analyze two periods: short-term observation, the first 2 months after ARF; and at least 2 years of long-term follow-up. Results: After 2 months, clinical data were collected from 171 patients (123 males, mean age of 50.3 years; persistent AF in 19.8%; lone AF in 36.6%). Sinus rhythm (SR) was maintained in 84 (49.1%) patients; 35 (20.4%) patients presented with a single episode of AF, 39 (23%) patients experienced a reduction in number of AF episodes, and 13 (7.5%) patients showed no improvement. No predisposing factor for early recurrence was found. After a mean follow-up of 55 months, clinical data were collected in 137 patients, of which 47 (34%) maintained SR. Those more likely to sustain SR were: males (82.9% vs. 62.2%; p = 0.018), younger patients (44.8 ± 12.7 vs. 52.5 ± 9.9; p = 0.0001), patients with smaller left atrium diameter (4.05 ± ± 0.49 cm vs. 4.25 ± 0.51 cm; p = 0.04), and those without any AF recurrence during the first 2 months after ARF (78.7% vs. 35.6%; p < 0.0001). In the multivariable analysis, the inde­pendent risk factors for LAFR were hypertension (p < 0.001) and persistent AF (p = 0.014). Conclusions: Antiarrhythmic prophylaxis does not affect the number of AF recurrences during the first 2 months after ablation. SR maintenance during a blanking period after AF ablation is a positive prognostic factor in long-term follow-up. Persistent AF and hypertension are independent risk factors for late AF recurrence after pulmonary vein isolation.

Znaczenie przetrwałego otworu owalnego u pacjenta kwalifikowanego do zabiegu ortotopowego przeszczepienia wątroby

Persistent foramen ovale (PFO) is a congenital defect of interatrial septum, that in majority of patients stays asymptomatic. However, in conditions that lead to increased pressure in right atrium over left atrium, it may lead to blood shunt from the right to the left atrium. We are presenting a case report of 63-years-old male who was referred to the qualification for the orthotopic liver transplantation due to the decompensated liver cirrhosis. During transesophageal echocardiography with contrast PFO was detected. In the literature cases suggesting increased perioperative risk in patients with PFO are described. It is both related to air embolisms connected with the transplantation itself and possibility of crossed embolisms. For this reason, the patient was scheduled to the transcatheter PFO closure, after which he could have liver transplantation. The operation was performed a month later, uneventfully.Przetrwały otwór owalny (PFO) to wrodzona wada przegrody międzyprzedsionkowej, która w większości przypadków nie ujawnia się klinicznie. Jednak w warunkach doprowadzających do przewyższenia wartości ciśnienia w prawym przedsionku nad lewym przedsionkiem może stanowić przyczynę przecieku prawo-lewego. W artykule przedstawiono przypadek 63-letniego mężczyzny ze schyłkową niewydolnością wątroby marskiej, kwalifikowanego do zabiegu ortotopowego przeszczepienia wątroby. U pacjenta podczas przezprzełykowego badania echokardiograficznego z użyciem kontrastu stwierdzono PFO. W literaturze istnieją opisy przypadków sugerujące podwyższone ryzyko okołooperacyjne w grupie pacjentów z PFO, które ma wynikać z ryzyka powstawania zatorów powietrznych podczas transplantacji wątroby, jak i, dodatkowo, z możliwości powstania zatorów skrzyżowanych przez PFO. Z tego powodu podjęto decyzję o przezskórnym zamknięciu PFO przed planowanym przeszczepieniem. Po wykonanym zabiegu pacjenta zakwalifikowano do operacji transplantacji wątroby, która odbyła bez powikłań, miesiąc po zamknięciu ubytku

Outcome prediction following transcatheter aortic valve implantation: Multiple risk scores comparison

Background: The aim of the study was to compare 7 available risk models in the prediction of 30-day mortality following transcatheter aortic valve implantation (TAVI). Heart team decision supported by different risk score calculations is advisable to estimate the individual procedural risk before TAVI. Methods: One hundred and fifty-six consecutive patients (n = 156, 48% female, mean age 80.03 ± 8.18 years) who underwent TAVI between March 2010 and October 2014 were in­cluded in the study. Thirty-day follow-up was performed and available in each patient. Base­line risk was calculated according to EuroSCORE I, EuroSCORE II, STS, ACEF, Ambler’s, OBSERVANT and SURTAVI scores. Results: In receiver operating characteristics analysis, neither of the investigated scales was able to distinguish between patients with or without an endpoint with areas under the curve (AUC) not exceeding 0.6, as follows: EuroSCORE I, AUC 0.55; 95% confidence intervals (CI) 0.47–0.63, p = 0.59; EuroSCORE II, AUC 0.59; 95% CI 0.51–0.67, p = 0.23; STS, AUC 0.55; 95% CI 0.47–0.63, p = 0.52; ACEF, AUC 0.54; 95% CI 0.46–0.62, p = 0.69; Ambler’s, AUC 0.54; 95% CI 0.46–0.62, p = 0.70; OBSERVANT, AUC 0.597; 95% CI 0.52–0.67, p = 0.21; SURTAVI, AUC 0.535; 95% CI 0.45–0.62, p = 0.65. SURTAVI model was calibrated best in high-risk patients showing coherence between expected and observed mortality (10.8% vs. 9.4%, p = 0.982). ACEF demonstrated best classification accuracy (17.5% vs. 6.9%, p = 0.053, observed mortality in high vs. non-high-risk cohort, respectively). Conclusions: None of the investigated risk scales proved to be optimal in predicting 30-day mortality in unselected, real-life population with aortic stenosis referred to TAVI. This data supports primary role of heart team in decision process of selecting patients for TAVI

Wieloczynnikowe podłoże dolegliwości bólowych w klatce piersiowej

W niniejszej pracy przedstawiono przypadek 66-letniego mężczyzny z ostrym zespołem wieńcowym o złożonej patogenezie (spazm tętnicy wieńcowej, miażdżyca, czynnościowe zawężenie drogi odpływu lewej komory), jednocześnie wskazując nietypowość obrazu dysfunkcji tętnic wieńcowych w badaniach dodatkowych. Za dominującą przyczynę dolegliwości uznano postać naczynioskurczową dławicy piersiowej, uwzględniając trudności w sformułowaniu jednoznacznych wniosków