Arrhythmiarizikó és cardialis szövődmények áramütéses balesetet követően : Szakirodalmi áttekintés és sürgősségi ellátási protokoll

Az áramütés súlyos esetben hirtelen halállal vagy több szervrendszer kiterjedt károsodásával járhat. A magasfeszültségű áramütés (>1000 V) általában súlyosabb égési sérülésekkel és magasabb kórházi mortalitással jár, mint az alacsony-feszültségű, de a sérülések súlyosságát a feszültségen kívül a test ellenállása, az áramexpozíció ideje, az áram fajtája, erőssége és útja is befolyásolja. A kritikus állapotú vagy súlyos égési sérüléseket szenvedett betegek sürgősségi ellátása komplex és multidiszciplináris szemléletet igényel. A súlyos szövődményekkel járó áramütéses balesetek ugyanakkor a fejlett országokban ritkák: az áramütés következtében sürgősségi osztályon jelentkező betegek döntő többsége panaszmentesen vagy minor panaszokkal kerül felvételre. A ritmuszavarok az áramütéses balesetek messze leggyakoribb cardialis szövődményei, és rendszerint közvetlenül az áramütés után jelentkeznek. Az elektromos áram kamrafibrillációt vagy asystoliát is kiválthat, mely a baleset helyszínén ellátás nélkül halálhoz vezethet. Bár sok helyen elterjedt gyakorlat az áramütést szenvedett betegek rutinszerű monitorozása, a klinikailag releváns arrhythmiák összességében ritkák, és a felvételi EKG alapján diagnosztizálhatók, ezért EKG-monitorozás csak meghatározott rizikófaktorok esetén szükséges. Jelen munkánk célja összefoglalni az áramütést szenvedett betegek optimális sürgősségi ellátásával kapcsolatos legfontosabb szempontokat, különös tekintettel az áramütéses balesetet követően fellépő cardialis szövődményekre és arrhythmiákra, valamint az EKG-monitorozás indikációira

A mechanikus keringéstámogatás életet ment - a műszívprogram első három évének tapasztalata a Semmelweis Egyetemen

INTRODUCTION: Since the celebration of the 20th anniversary of the first heart transplantation in Hungary in 2012 the emerging need for modern heart failure management via mechanical circulatory support has evolved. In May 2012 the opening of a new heart failure and transplant unit with 9 beds together with the procurement of necessary devices at Semmelweis University accomplished this need. AIM: The aim of the authors was to report their initial experience obtained in this new cardiac assist device program. METHOD: Since May, 2012, mechanical circulatory support system was applied in 89 cases in 72 patients. Indication for support were end stage heart failure refractory to medical treatment and acute left or right heart failure. RESULTS: Treatment was initiated for acute graft failure after heart transplantation in 27 cases, for end stage heart failure in 24 cases, for acute myocardial infarction in 21 cases, for acute postcardiotomy heart failure in 14 cases, for severe respiratory insufficiency in 2 cases and for drug intoxication in one case. Among the 30 survivor of the whole program 13 patients were successfully transplanted. CONCLUSIONS: The available devices can cover all modalities of current bridge therapy from short term support through medium support to heart transplantation or long term support and destination therapy. These conditions made possible the successful start of a new cardiac assist device program. Orv. Hetil., 2015, 156(13), 521-527

Direct comparison of steroid and non-steroid eluting small surface pacing leads: Randomized, multicenter clinical trial

BACKGROUND: The aim of the study was to evaluate the effi cacy and safety of small surface steroid-eluting atrial and ventricular pacing leads in comparison to non-steroid leads using remote monitoring system (Biotronik Home Monitoring(R)). METHODS: In this randomized multicenter prospective trial, SIELLO T steroid-eluting ventricular leads (n = 42) were compared to BPPU T non-steroid leads (n = 46) and SIELLO JT steroid-eluting atrial leads (n = 24) to BPPU JT non-steroid leads (n = 27) (Biotronik, Berlin, Germany) in pacemaker devices with remote monitoring capabilities. Lead parameters were evaluated during implantation, at 1-week and 1, 3, 6-month outpatient follow-up. Remote monitoring data were collected weekly. RESULTS: Atrial and ventricular steroid-eluting leads had stable sensing and impedance as compared to non-steroid leads at implantation and during follow-up. Patients with non-steroid atrial leads had signifi cantly higher threshold compared to steroid leads at 1-week and at 1, 3, 6-month follow-up with a peak at 1-month (1-month 1.4 +/- 0.6 vs. 0.7 +/- 0.3 V at 0.4 ms, p < 0.001; 6-month 0.3 +/- 0.5 vs. 0.2 +/- 0.3 V at 0.4 ms, p = 0.002). Patients with non-steroid ventricular leads had signifi cantly higher threshold compared to steroid leads at 1, 3, 6-month (6-month 1.0 +/- 0.3 vs. 0.6 +/- 0.2 V at 0.4 ms, p < 0.001). Remote monitoring confi rmed consistent results. During the study, 3 patients died of non-lead-related death. Lead repositioning was necessary in 2 atrial, 2 ventricular steroid leads and in 1 ventricular non-steroid lead. CONCLUSIONS: Atrial and ventricular pacemaker leads with steroid showed signifi cantly lower pacing threshold compared to non-steroid leads, confi rmed by remote monitoring

Comparison of the effects of epicardial and endocardial cardiac resynchronization therapy on transmural dispersion of repolarization.

BACKGROUND: Despite significant improvements in cardiac output and functional capacity with cardiac resynchronization therapy (CRT), incidence of sudden cardiac death still remains high. Reversal of physiological myocardial activation sequence during epicardial pacing increases the transmural dispersion of repolarization (TDR). The aim of this study was to compare the effects of endocardial and epicardial biventricular pacing on repolarization parameters in the same patient group. METHODS: Seven patients who had transseptal endocardial left ventricle (LV) lead placement, in whom epicardial CRT had failed due to coronary sinus (CS) lead dislodgement after successful implantation, were admitted to the study. LV endocardial leads were implanted through the inter-atrial septum in a lateral position. ECGs were scanned before and after successful epicardial and endocardial biventricular pacing and analyzed using digital callipers. ECG markers of TDR (TpTe and TpTe/QT ratio) were measured and compared. RESULTS: Baseline QRS durations (161.7+/-15.9 vs 162.2+/-17.8 ms, p = 0.95), TpTe values (107.1+/-20.5 vs 108.5+/-17.6 ms, p = 0.89) and TpTe/QT ratios (0.24+/-0.05 vs 0.24+/-0.03, p = 0.88) were similar before epicardial and endocardial CRT. QRS interval reduction was similar (-28.3+/-11.6 vs -29.1+/-11.4 ms, p = 0.89) in both groups. Compared to transseptal endocardial CRT, epicardial CRT was associated with a significant increase in TpTe (17.1+/-19.5 vs -12.6+/-18.9 ms, p = 0.01) and TpTe/QT ratio (0.03+/-0.04 vs -0.02+/-0.03, p = 0.04). CONCLUSION: Transseptal LV endocardial pacing is associated with significant reduction in TDR characteristics compared to epicardial pacing in CRT. Further studies are warranted to determine whether these effects may contribute to reduction of arrhythmias in patients with CRT. This article is protected by copyright. All rights reserved

Ritmus- és frekvenciakontroll újraélesztés kapcsán és keringésmegingással fenyegető szívritmuszavarok esetén

A szív- és érrendszeri megbetegedések mortalitása jelentősen csökkent az elmúlt években, a hirtelen szívmegállás azonban továbbra is vezető halálok a különböző mortalitási mutatókban, aminek hátterében igen gyakran szívritmuszavar áll. A hirtelen szívhalál elektrofiziológiai okai a kamrai tachycardia, a kamrafibrilláció, az asystolia és a pulzus nélküli elektromos aktivitás. Ezenfelül egyéb szívritmuszavarok is hirtelen szívmegállással fenyegethetnek, ezeket összefoglalóan malignus ritmuszavaroknak hívjuk. A különféle arrhythmiák gyors és pontos felismerése, azok megfelelő ellátása komoly kihívásokat jelent mind a prehospitális, mind pedig a kórházi ellátás szintjén. Ezekben az állapotokban kritikus jelentőségű az életveszélyes állapot azonnali észlelése, valamint a gyors reakció és kezelés. Jelen közleményünk a különböző eszközös és gyógyszeres kezelési lehetőségeket veszi sorra a keringésmegingással fenyegető állapotokban, az Európai Újraélesztési Tanács 2021. évi ajánlásának tükrében. Cikkünkben taglaljuk ezen állapotok epidemiológiáját, etiológiáját, bemutatjuk továbbá a különböző tachy- és bradyarrhythmiák korszerű ellátási lehetőségeit, ami segítséget nyújt e kórképek ellátásában mind kórházi körülmények között, mind pedig kórházon kívüli ellátóhelyeken

Radiofrequency Ablation at Low Irrigation Flow Rates Using a Novel 12-Hole Gold Open-Irrigation Catheter

BACKGROUND: High irrigation rates during radiofrequency (RF) ablation may cause fluid overload and limit lesion size. This in vivo animal study assessed the safety and efficacy of RF ablation at low irrigation rates using a novel 12-hole gold catheter. METHODS: A total of 103 lesions, created on the thigh of five mongrel dogs, were analyzed. Lesions were created using a 12-hole irrigated gold-tip (Au) and a six-hole irrigated platinum-iridium (PtIr) catheter (both 7F/3.5-mm electrode; BIOTRONIK SE & CO, KG, Berlin, Germany) in parallel and perpendicular orientation. RF current was delivered for 60 seconds at 30 W using 8 mL/min and 15 mL/min irrigation. Electrode temperature, steam pops, lesion dimensions, and coagulum formation were recorded. RESULTS: Electrode temperatures were lower for Au compared to PtIr in parallel (8 mL/min: 38.1 +/- 1.7 degrees C vs 48.0 +/- 4.8 degrees C, P < 0.0001; 15 mL/min: 36.0 +/- 1.5 degrees C vs 46.9 +/- 5.4 degrees C, P < 0.0001) and perpendicular position (15 mL/min: 35.5 +/- 1.2 degrees C vs 38.4 +/- 2.5 degrees C, P = 0.003). The number of steam pops between Au and PtIr was comparable for parallel (8 mL/min: 14% vs 27%, P = 0.65; 15 mL/min: 14% vs 43%, P = 0.21) and perpendicular orientation (8 mL/min: 25% vs 17%, P = 1.00; 15 mL/min: 18% vs 0%, P = 0.48). Au created larger volumes than PtIr at 8 mL/min irrigation (861 +/- 251 mm3 vs 504 +/- 212 mm3 , P = 0.004); however, for 15 mL/min, volumes were comparable (624 +/- 269 mm3 vs 768 +/- 466 mm3 , P = 0.46). No coagulum formation was observed for any of the catheters on the surface and catheter tip. CONCLUSION: RF ablation at low flow rate using a novel 12-hole irrigation Au catheter is safe and results in larger lesions than with a PtIr electrode

Hasüregbe vándorolt epicardialis pacemaker

Migration of a permanent pacemaker generator from their intramuscular pocket to the abdominal cavity is a less frequent, but potentially life-threatening complication. The authors present the case of a 69-year-old woman, who visited the emergency department of the clinic, with complains of non-specific abdominal symptoms. Her past medical history included a complete atrioventricular block diagnosed in 2009 during the mitral valve replacement and since then she had an epicardial permanent pacemaker; the pulse generator was placed into an intramuscular pouch created in the left subcostal region. Surprisingly, radiologic examinations showed that the generator migrated into the pouch of Douglas. Considering patient safety, first a new intracardiac pacemaker was implanted and then the migrated device was removed surgically. The patient was discharged on the seventh postoperative day

Longer right to left ventricular activation delay at cardiac resynchronization therapy implantation is associated with improved clinical outcome in left bundle branch block patients.

AIMS: Data on longer right to left ventricular activation delay (RV-LV AD) predicting clinical outcome after cardiac resynchronization therapy (CRT) by left bundle branch block (LBBB) are limited. We aimed to evaluate the impact of RV-LV AD on N-terminal pro-B-type natriuretic peptide (NT-proBNP), ejection fraction (EF), and clinical outcome in patients implanted with CRT, stratified by LBBB at baseline. METHODS AND RESULTS: Heart failure (HF) patients undergoing CRT implantation with EF /= 120 ms were evaluated based on their RV-LV AD at implantation. Baseline and 6-month clinical parameters, EF, and NT-proBNP values were assessed. The primary endpoint was HF or death, the secondary endpoint was all-cause mortality. A total of 125 patients with CRT were studied, 62% had LBBB. During the median follow-up of 2.2 years, 44 (35%) patients had HF/death, 36 (29%) patients died. Patients with RV-LV AD >/= 86 ms (lower quartile) had significantly lower risk of HF/death [hazard ratio (HR): 0.44; 95% confidence interval (95% CI): 0.23-0.82; P = 0.001] and all-cause mortality (HR: 0.48; 95% CI: 0.23-1.00; P = 0.05), compared with those with RV-LV AD /= 86 ms and LBBB showed the greatest improvement in EF (28-36%; P<0.001), NT-proBNP (2771-1216 ng/mL; P < 0.001), and they had better HF-free survival (HR: 0.23, 95% CI: 0.11-0.49, P < 0.001) and overall survival (HR: 0.35, 95% CI: 0.16-0.75; P = 0.007). There was no difference in outcome by RV-LV AD in non-LBBB patients. CONCLUSION: Left bundle branch block patients with longer RV-LV activation delay at CRT implantation had greater improvement in NT-proBNP, EF, and significantly better clinical outcome