Utajona ekstrasystolia z pęczka Hisa przyczyną bloku przedsionkowo-komorowego

We present electrocardiograms of a 37 year-old male with frequent extrasystoles and second-degree atrioventricular block.Electrophysiological study confirmed the initial diagnosis of manifest and concealed His bundle ectopy as the cause of hisbrady- and tachyarrhythmia

Echocardiographic assessment of right ventricular function in responders and non-responders to cardiac resynchronization therapy

Introduction: The aim of this study was to determine whether baseline right ventricular (RV) function assessed by standard echocardiography may indicate patients who will respond to cardiac resynchronization therapy (CRT). Material and methods: The data of 57 patients (54 men, 95%), aged 66.4 ±8.7 years with heart failure (HF) having a CRT device implanted were collected. All patients had left ventricular ejection fraction (LVEF) ≤ 35% and QRS complex duration ≥ 120 ms. Echocardiographic examination with tissue Doppler imaging techniques and complex RV evaluation were performed at baseline and three months after CRT onset. Results: Three months after CRT implantation, patients responding to CRT, defined as a reduction of left ventricle end-systolic volume (LVESV) of at least 10% (n = 34), compared to patients with a reduction of LVESV of less than 10% (n = 23), had at baseline a smaller right atrium diameter (47.85 ±11.33 mm vs. 52.65 ±8.69 mm; p = 0.028), higher TAPSE (14.56 ±2.57 mm vs. 13.04 ±2.93 mm; p = 0.030) and lower grade of tricuspid valve regurgitation (1.82 ±0.97 vs. 2.3 ±0.88; p = 0.033). Conclusions: This study showed that there are differences in baseline right ventricular function between responders and non-responders to CRT. Yet in our study, none of the baseline RV parameters provided any value in identifying patients who would respond to CRT

Baseline tissue Doppler imaging-derived echocardiographic parameters and left ventricle reverse remodelling following cardiac resynchronization therapy introduction

Introduction: The aim of the study was to assess the relation of baseline mechanical dyssynchrony with the left ventricular end-systolic volume (LVESV) decrease following cardiac resynchronization (CRT) therapy introduction. Material and methods: Sixty consecutive patients (aged 66.3 ±8.7 years; 57 men) with chronic heart failure (71.7% of ischaemic and 28.3% of non-ischaemic origin) and current indications for CRT were assessed before and 3 months after biventricular heart stimulator implantation. Longitudinal movements of twelve segments of the left ventricle (LV) (6 basal and 6 midlevel) and two segments of the right ventricle (RV) were analysed using tissue Doppler imaging (TDI) techniques with time from onset of Q wave in ECG to peak systolic velocity in colour-coded TDI (TTDI ), time to peak strain (Tstrain) and time to peak strain rate (Tstrain rate). Minimal and maximal time differences within LV and between LV and RV walls were calculated. Results: In the study group LVEF and 6-min walk test distance increased, while NYHA class, NT-proBNP level, left ventricular end-diastolic volume and LVESV decreased. Significant correlations between the magnitude of LVESV reduction with maximal time differences between Tstrain of 12 LV segments (r = 0.34, p = 0.017) and time differences between TTDI basal LV-RV segments (r = –0.29, p = 0.041) were found. Conclusions: Only a few TDI-derived parameters such as maximal time differences between Tstrain of 12 LV segments and TTDI difference of LV-RV basal segments can be useful to predict the magnitude of left ventricle reverse remodelling after CRT introduction

Clinical and classic echocardiographic features of patients with, and without, left ventricle reverse remodeling following the introduction of cardiac resynchronization therapy

Background: The aim of the study was to assess clinical and classic echocardiographic data in patients with different cardiac resynchronization therapy (CRT) outcomes. Methods: Sixty consecutive patients (aged 66.3 ± 8.7 years, 57 men) with chronic heart failure (CHF) in New York Heart Association (NYHA) classes III–IV despite optimized pharmacotherapy, with left ventricular end-diastolic diameter (LVEDD) > 55 mm, left ventricular ejection fraction £ 35% and wide QRS complex (≥ 120 ms), including individuals with permanent atrial fibrillation (AF) and single- and dual-chamber pacing, were assessed firstly before, and secondly three months after, biventricular heart stimulator implantation (excluding three patients who died during the follow-up). Patients developing ≥ 10% reduction of left ventricular end-systolic volume (LVESV) were classified as responders to CRT. Results: The group of responders (n = 34, 59.7%) and the group of non-responders (n = 23, 40.3%) did not differ regarding baseline echocardiographic parameters or in terms of clinical data of age, gender, concomitant diseases, smoking or pharmacological treatment. The differences involved higher rates of ischemic CHF background, prevalence of hypertension and permanent AF, and a higher concentration of N-terminal pro-B-type natriuretic peptide (NT-proBNP) among the non-responders. In the multivariate logistic regression analysis, NT-proBNP, body mass index (BMI) and the presence of permanent AF correlated negatively with the magnitude of LVESV reduction following CRT introduction. Conclusions: Classic echocardiographic data did not predict left ventricle reverse remodeling. Higher rates of ischemic CHF aetiology, hypertension, permanent AF and higher NT-proBNP concentration were found in the group without at least 10% LVESV reduction at the three month follow-up. NT-proBNP, BMI and the presence of permanent AF had negative effects on the magnitude of LVESV. (Cardiol J 2011; 18, 2: 157-164

Starszy pacjent z uporczywymi omdleniami — trzy oblicza problemu

Elderly patients may have several cardiological diseases simultaneously responsible for the appearance of one specific symptom. In article we described the case of an 84-year-old man who was diagnosed during one hospitalization with a number of cardiovascular diseases that could cause syncope: symptomatic bradycardia, atrioventricular-nodal reentrant tachycardia, and orthostatic hypotension. Periodically high blood pressure values also occurred. Effective treatment was given to all these diseases, with symptoms resolving. The article discusses the management of these clinical situations, paying particular attention to elderly patients.U pacjentów w starszym wieku może występować równolegle kilka schorzeń kardiologicznych odpowiedzialnych za pojawienie się jednego określonego objawu. W pracy opisano przypadek 84-letniego mężczyzny, u którego rozpoznano podczas jednej hospitalizacji szereg chorób układu sercowo-naczyniowego mogących być przyczyną omdleń: istotną bradykardię zatokową, napadowy częstoskurcz nawrotny w węźle przedsionkowo-komorowym oraz hipotonię ortostatyczną. Sporadycznie obserwowano również wysokie wartości ciśnienia tętniczego. Prowadzono wielokierunkowe leczenie zmierzające do kontrolowania objawów wszystkich tych schorzeń. W artykule omówiono postępowanie w wymienionych sytuacjach klinicznych, zwracając szczególną uwagę na starszych pacjentów