Alcohol — heart out of harmony

Patomechanizmy migotania przedsionków (AF) zwykle są złożone. W młodości, u osób bezorganicznej choroby serca, najczęściej występuje tak zwane ogniskowe, odosobnione napadowemigotanie przedsionków. Migotanie jest jednym z powikłań chorób poligenowych,wczesnym — reumatycznej wady zastawki mitralnej, późnym — wady aortalnej. W wiekudojrzałym i starszym towarzyszy nadciśnieniu, chorobie niedokrwiennej, cukrzycy. Nierzadkopojawia się w u osób z chorobami monogenowymi, w tym w zespole Wolffa, Parkinsonai White’a, różnych postaciach kardiomiopatii. Groźnymi czynnika mi usposabiającymi domigotania są między innymi: otyłość, zespół obturacyjnego bezdechu sennego. Udziałw rozwoju migotania pr zedsionków mogą mieć substancje działające kardiotoksycznie,miedzy innymi: niekorzystnie modyfikując przewodzenie elektryczne w sercu i wpływającna powstawanie czynników wyzwalających. Jedną z nich jest alkohol etylowy, zarówno kiedywypity jest w dużej dawce, jak i kiedy nadużywany jest w sposób przewlekły.Przedstawiamy zarys wiedzy uwzględniający działanie alkoholu na występowanie migotaniaprzedsionków oraz towarzyszących chorobie trudności terapeutycznych.Complex mechanisms that cause atrial fibrillation (AF) are not complete understood. Thisarrhythmia is strongly epidemiologically connected with mono- and poligenic cardiovasculardiseases. There is a possibility that some substances which are cardiotoxic and modifyautonomic nervous system, electrical activity and conduction in heart may induce AF. Suchsubstance, commonly used, although chronic and in huge doses is ethanol. In this articleauthors would like to present recent knowledge and to recapitulate the relationship betweenAF and alcohol, and its diagnostic and treatment problems

New hope for patients and challenges for the multidisciplinary arrhythmia team: a hybrid convergent approach for atrial fibrillation treatment

Background: Available data suggest the important role of ablation of the left atrial posterior wall and epicardial myocardial layers in rhythm control therapy in patients with persistent drug‑refractory atrial fibrillation (AF). However, endocardial ablation is not always effective in transmural substrate modification. The alternative treatment option is minimally invasive hybrid approach (HABL) combining the strengths of surgical and catheter ablation. Aims: This study aimed to assess the periprocedural safety as well as acute and long‑term outcomes of HABL for AF. Methods: This is a retrospective single‑center study of patients who underwent HABL using the minimally invasive transabdominal approach between July 2009 and January 2020. Demographic in‑hospital data and 12‑month follow‑up results were obtained. The number of hospitalizations, cardioversions, re‑ablations, and severe adverse events in a 3‑year period before and after HABL were compared using data from the national healthcare provider. Results: In total, 158 patients (mean [SD] age, 51.02 [10.67] years) who underwent HABL were included; 61.4% had persistent AF. There was a 4.4% incidence of periprocedural complications without any fatalities. In 66% of patients, additional endocardial substrate modification was needed, in 52.6% on the posterior wall. In the 12‑month follow‑up, most patients (78.3%) remained free of arrhythmias. There was a significant reduction in the number of hospitalizations (for AF, 1.65 vs 0.54; or any other cause, 2.56 vs 1.31 per patient), cardioversions, and re‑ablations after HABL (all P < 0.05). Conclusions: The hybrid multidisciplinary approach for treatment of AF is a safe and very effective treatment method in long‑term follow‑up, which reduces healthcare burden. It could be considered as an alternative therapeutic option especially in patients with persistent AF

The potential benefits of the influenza vaccination on COVID-19 mortality rate - a retrospective analysis of patients in Poland

In this study, we used publicly available data from the Centrum e-Zdrowia (CeZ) Polish Databank proposing a possible correlation between influenza vaccination and mortality due to COVID-19. We limited our search to the patients with positive COVID-19 laboratory tests from 1 January 2020 to 31 March 2021 and who filled a prescription for any influenza vaccine during the 2019–2020 influenza season. In total, we included 116,277 patients and used a generalized linear model to analyze the data. We found out that patients aged 60+ who received an influenza vaccination have a lower probability of death caused by COVID-19 in comparison to unvaccinated, and the magnitude of this difference grows with age. For people below 60 years old, we did not observe an influence of the vaccination. Our results suggest a potential protective effect of the influenza vaccine on COVID-19 mortality of the elderly. Administration of the influenza vaccine before the influenza season would reduce the burden of increased influenza incidence, the risk of influenza and COVID-19 coinfection and render the essential medical resources accessible to cope with another wave of COVID-19. To our knowledge, this is the first study showing a correlation between influenza vaccination and the COVID-19 mortality rate in Poland

Radiofrequency catheter ablation of accessory pathways in patients with Ebstein’s anomaly: At 8 years of follow-up

Background: Data regarding long-term follow-up of radiofrequency catheter ablation (RFCA) of accessory pathways (APs) in patients with Ebstein’s anomaly (EA) are limited. The procedures are challenging due to multiple or wide APs. Methods: Analysis was performed on clinical and periprocedural data of patients with EA referred to the centre in order to perform catheter ablation of AP. The group consisted of 22 patients (female 40.9%, mean age 33.6 ± 19.1 years). The follow-up utilized electrocardiogram and Holter monitoring. Results: Twenty-two patients had 33 accessory pathways (8 patients had multiple APs, 11 patients broad AP). Twenty-nine different arrhythmias were ablated: 20 orthodromic atrioventricular reciprocating tachycardia (O-AVRT), 5 antidromic atrioventricular reciprocating tachycardia (A-AVRT), 3 slow/ fast atrioventricular nodal reentry tachycardia (s/f AVNRT) and 1 cavotricuspid-isthmus-dependent atrial flutter (CTI-AFL). In 3 (13.6%) patients multiple ablation targets for RFCA ablation were observed. The acute procedural success rate after the first RFCA performed was: 100% for AVNRT, 77.3% for APs and 50.0% for CTI-AFL ablation. Follow-up (mean 95.7 ± 49.8 months) was completed in 86.4% of patients. One patient had paroxysmal atrial fibrillation not targeted during ablation. One patient died due to heart failure 12 years after RFCA. Three patients who underwent RFCA of accessory pathways in the mid-1990s were lost in follow-up. Conclusions: Radiofrequency ablation in patients with EA is challenging but safe and have a high short-term as well as long-term success rate

Statins in covid-19 therapy

Inhibitors of 3-hydroxy-3methylgultaryl-coenzyme A reductase (statins) are one of the main groups of drugs used in preventing and treating cardiovascular diseases worldwide. They are widely available, cheap, and well-tolerated. Based on statins’ pleiotropic properties, including improvement of endothelial dysfunction, antioxidant properties, atherosclerotic plaque stabilization, and inhibition of inflammatory responses, it can be hypothesized that the use of statins, at least as an adjuvant in antiviral therapy, may be justified. All these effects might be especially beneficial in patients with COVID-19, suffering from endothelial dysfunction, microvascular and macrovascular thrombosis, and cytokine storm. Here, we review the recent data regarding the pathophysiology of SARS-CoV-2 activity in host cells, proposed COVID-19 therapy, the pleiotropic activity of statins, and statins in clinical trials in respiratory infections. According to the guidelines of the European and American Cardiac Societies, in patients with cardiovascular disease or high cardiovascular risk with concomitant COVID-19 it is recommended to continue statin treatment. However, the initiation of statin therapy de novo in COVID-19 treatment should only be done as part of a clinical trial