A case of complete heart block with a therapeutic dilemma

Third-degree atrioventricular (AV) block, also referred to as complete heart block (CHB), is caused by a cardiac conduction system disease or damage resulting in no conduction through the atrioventricular node (AVN), leading to complete dissociation of the atrial and ventricular beats. We present a case of a patient with acquired CHB who has been treated without a permanent pacemaker

A myocardial infarction caused by an epicardial radiofrequency ablation

A myocardial infarction (MI) occurs when blood flow in the coronary blood vessel decreases or stops causing damage to the heart muscle. Cardiac radiofrequency ablation (RFA) is a procedure using catheters inserted through a vein or artery which reach heart and deliver RF energy in the form of heat to modify the heart tissue that triggers or sustains tachycardia or tachyarrhythmia

Left main stenosis: how do we treat it?

Aim: To evaluate clinical, interventional and outcome data of patients treated for left main (LM) stenosis. Patients and Methods: Study was conducted in University Hospital Centre „Sestre milosrdnice“, Zagreb. We retrospectively analyzed all coronary angiographies from June 20, 2017 until February 12, 2020. Cases were identified by a nation-wide database (Stenos). Patients with percutaneous coronary intervention (PCI) involving LM were analyzed, regardless of Medina stenosis class. Results: Out of 5537 procedures (3255 interventions, 1775 non elective), 400 procedures involved LM stenosis. PCI was performed in 235 patients. In 25 cases LM interventions were protected (excluded from further analysis). Centre yearly LM volume was 79.7, average operator LM volume was 9.9/year. Male sex was predominant (72.4%), average age was 68.6±10.3. Total of 63.8% patients presented with acute coronary syndrome (elevation 16.7%, non-elevation 33.3%, unstable angina 13.8%). Ad-hoc PCI was performed in 70.0% of cases. Stenoses involved LM in 92.4%, ostial left anterior descending artery in 59.5%, ostial circumflex artery in 44.3% patients. Bifurcation was stented in 80.5%, while 2 or more stents were used in 20.5% of all cases. Dominant bifurcation technique was provisional stenting (74.6%), followed by T and protrusion (15.4%). Proximal optimization (POT) was performed in 96.4%, which was followed by kissing in 34.7%, or strut dilatation in 10.3%, and re-POT in 57.8% of eligible patients. Intravascular ultrasound (IVUS) was used in 16.7%, coronary flow physiology in 1.4% patients. Radial access was most commonly used (83.1%; 58.6% right-sided), followed by femoral (14.9%, rightsided in 84.6%). Shock was present in 7.3% on admission, while 9.6% of the patients were resuscitated. Mechanical circulatory support (MCS) was used in 1.4%. Two patients (0.9%) required emergent surgery. In-hospital mortality was 6.2%. Follow-up was available for 75.7% patients (294 [100-474] days). Major adverse cardiovascular event was observed in 7.0% patients. Conclusion: Patient preferences, operator and centre experience, and availability of cardiac surgery impacts the decision to interventional treat LM stenosis.1 Acute presentation, radial access, ad-hoc procedures, and simple stenting technics predominate. IVUS and MCS are still underutilized

Rutinski dostupni biomarkeri kao prediktori razvoja sistoličke disfunkcije tijekom dugoročnog praćenja bolesnika s potpuno revaskulariziranim akutnim infarktom miokarda sa ST elevacijom

The aim of this study was to assess the efficacy of high-sensitivity C-reactive protein (hsCRP), cardiac troponin T (cTnT) and creatine kinase (CK) as long-term predictors of reduced systolic function in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) with complete revascularization. This prospective study evaluated consecutive patients with acute STEMI who had normal left ventricular ejection fraction (LVEF ≥50%) at admission with single-vessel disease and underwent complete revascularization. Blood samples were collected from admission to day 7. The primary endpoint was reduction of LVEF <50% after 12 months. The study included 47 patients, median age 59±10 years, 74.5% of them men. Patients who developed systolic dysfunction (LVEF <50%) had significantly higher mean values of cTnT after 24 hours (5.11 vs. 2.82 μg/L, p=0.010) and peak values of CK (3375.5 vs. 1865 U/L, p=0.008). There was no significant relation between hsCRP and development of reduced LVEF (p=0.541). In conclusion, cTnT and CK could serve as long-term predictors of reduced left ventricular systolic function (<50%) in acute STEMI patients with normal systolic function at admission, single-vessel coronary disease and complete revascularization during primary PCI.Cilj istraživanja bio je utvrditi učinkovitost visokoosjetljivog C-reaktivnog proteina (hsCRP), kardijalnog troponina T (cTnT) i kreatin kinaze (CK) kao dugoročnih prediktora razvoja sistoličke disfunkcije u bolesnika sa STEMI-infarktom kojima je učinjena potpuna revaskularizacija tijekom primarne perkutane koronarne intervencije (PCI). Provedena je prospektivna studija kojom su evaluirani uzastopni bolesnici s akutnim STEMI-infarktom koji su imali urednu sistoličku funkciju kod prijma uz jednožilnu koronarnu bolest i koji su potpuno revaskularizirani tijekom primarne PCI. Uzorci krvi su prikupljani od prijma do 7. dana hospitalizacije. Primarni ishod bio je razvoj sistoličke disfunkcije lijevog ventrikla (LVEF <50%) nakon godinu dana. U istraživanje je bilo uključeno 47 bolesnika s medijanom dobi 59±10 godina i 74,5% su bili muškarci. Bolesnici koji su razvili sistoličku disfunkciju (LVEF <50%) su imali značajno više vrijednosti cTnT nakon 24 sata (5,11 prema 2,82 μg/L, p=0,010) i više maksimalne vrijednosti CK (3375,5 prema 1865 U/L, p=0,008). Nije utvrđena povezanost između hsCRP-a i razvoja sistoličke disfunkcije (p=0,541). Zaključak je da cTnT i CK mogu poslužiti kao dugoročni prediktori snižene sistoličke funkcije lijevog ventrikla (<50%) u bolesnika s akutnim STEMI-infarktom koji su imali urednu sistoličku funkciju kod prijma uz jednožilnu koronarnu bolest i koji su potpuno revaskularizirani tijekom primarne PCI