Aktivační sekvence při poruchách komorového vedení a různých typech komorové stimulace

Disertační práce se skládá ze souboru publikací, které se zabývají studiem aktivační sekvence srdečních komor u pacientů se srdečním selháním a poruchami nitrokomorového vedení. Ačkoliv není možné využít elektroanatomický mapovací systém k výběru kandidátů resynchronizační terapie v každodenní praxi, jeho použití umožnilo mnohem přesnější analýzu elektrické aktivace než dovoluje standardní EKG. Charakter aktivační sekvence se významně liší podle etiologie srdečního selhání. U pacientů s DKMP je přítomno homogenní šíření elektrické aktivace s dominantním mezikomorovým zpožděním, což na EKG odpovídá obrazu blokády levého raménka Tawarova , a nejpozději aktivovaným segmentem bývá posterolaterální stěna levé komory. Naproti tomu pacienti s ICHS mívají poruchu vedení variabilní podle množství a polohy jizev po infarktu myokardu. Nejpozději aktivovaný segment je obvykle na laterální straně jizvy a tomu na EKG odpovídá nespecifická porucha nitrokomorového vedení. Tato variabilita aktivačních sekvencí přítomná především u pacientů s ICHS podporuje koncept resynchronizační terapie individuálně "šité na míru", kdy poloha stimulační elektrody má být cílena do místa s nejpozdější aktivací a tedy s největší dyssychronií. Z různých stimulačních režimů používaných v rámci resynchronizační terapie umožňuje pouze...Academic dissertation: Ventricular activation patterns in conduction abnormalities and during different pacing modes Petr Peichl, MD, Department of Cardiology, IKEM, Vídeňská 1958/9, Prague, Czech Republic 5 Congestive heart failure (CHF) is a progressive disease caused by left ventricular dysfunction with high morbidity and mortality rates. Ventricular dysfunction is often linked to ventricular dilatation, which in turn may cause ventricular conduction delays and further worsening of the cardiac function. Recent decade gave rise to cardiac resynchronization therapy (CRT), a therapeutic modality based on premise that preexcitation of late activating10 regions by cardiac pacing may restore the left ventricular synchronous contraction. The goals of the publications included in the dissertation were: (1) to analyze the ventricular activation patterns in patients eligible for CRT with respect to the underlying heart disease and/or QRS morphology on the surface electrocardiogram(ECG), (2) to quantify changes in ventricular activation patterns during different pacing modes and (3) to compare15 the hemodynamic performance of different pacing modes during exercise. 1. Patients with CHF and wide QRS complex represent a broad spectrum of underlying conduction disturbances with variable inter- and intraventricular...Institute for Clinical and Experimental MedicineInstitut klinické a experimentální medicínyFirst Faculty of Medicine1. lékařská fakult

Heating system of the student hotel

Bakalářská práce popisuje návrh otopné soustavy pro objekt studentských kolejí, s využitím CZT jako zdroje tepla. Teoretická část obsahuje základní pojmy o centralizovaném zásobování teplem a jeho problematice. Ve výpočtové části jsem navrhl otopnou soustavou s tímto zdrojem tepla.The bachelor´s thesis presents a central heating system project intended for student dormitories. Theoretical part outlines fundamentals of central heating, its specifics and challenges. Practical part describes the heating system project itself in detail.

The role of imaging to support catheter ablation of atrial fibrillation

AbstractAtrial fibrillation (AF) ablation is a complex procedure that requires transseptal puncture and extensive manipulation with catheter(s) in the left atrium and pulmonary veins. Individual anatomy of these structures contributes to a challenge of AF ablation. The proximity of surrounding structures, such as esophagus, further increases risk of complications of this procedure. Increased risk of intracardiac thrombosis associated with AF is another factor that may complicate management of these patients. For all these reasons, imaging techniques play increasingly important role. Preprocedural imaging becomes important not only to rule out thrombus but also for assessment of anatomy of the PVs and left atrium, left atrial size and the extent of a substrate. Various forms of imaging help significantly during the procedure both with identification of anatomy and with catheter navigation. Many studies have shown increased efficacy, safety and decreased fluoroscopy times. After the procedure, imaging techniques such as echocardiography, CT or MR imaging are useful to diagnose potential complications. This paper briefly reviews clinical utility of different imaging tools for ablation of AF

Catheter Ablation of Ventricular Tachycardia

Catheter ablation is highly successful and may be considered as the first line treatment in all symptomatic idiopathic forms of ventricular tachycardia (VT). Also ablation plays an important role in recurrent VTs associated with structural heart disease and relatively preserved left ventricular ejection fraction (>35%) and/or bundle branch reentry VT. It also constitutes the preferable treatment modality in incessant VTs of any origin and in patients with implantable defibrillator (ICD) devices who present with recurrent VTs and/or an electrical storm leading to multiple ICD shocks Catheter ablation appears to improve arrhythmia control in about two thirds of patients with structural heart disease and mappable VTs. Novel substrate and/or noncontact mapping techniques suggest that even hemodynamically unstable VTs and/or VTs of multiple morphologies can be successfully ablated. As the ablation method is not curative and there remains the risk of dying suddenly in patients with depressed left ventricular ejection fraction, the majority of patients with VT associated with structural heart disease also receive an ICD

2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias

Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias

Multi-national survey on the methods, efficacy, and safety on the post-approval clinical use of pulsed field ablation (MANIFEST-PF).

AIMS Pulsed field ablation (PFA) is a novel atrial fibrillation (AF) ablation modality that has demonstrated preferential tissue ablation, including no oesophageal damage, in first-in-human clinical trials. In the MANIFEST-PF survey, we investigated the 'real world' performance of the only approved PFA catheter, including acute effectiveness and safety-in particular, rare oesophageal effects and other unforeseen PFA-related complications. METHODS AND RESULTS This retrospective survey included all 24 clinical centres using the pentaspline PFA catheter after regulatory approval. Institution-level data were obtained on patient characteristics, procedure parameters, acute efficacy, and adverse events. With an average of 73 patients treated per centre (range 7-291), full cohort included 1758 patients: mean age 61.6 years (range 19-92), female 34%, first-time ablation 94%, paroxysmal/persistent AF 58/35%. Most procedures employed deep sedation without intubation (82.1%), and 15.1% were discharged same day. Pulmonary vein isolation (PVI) was successful in 99.9% (range 98.9-100%). Procedure time was 65 min (38-215). There were no oesophageal complications or phrenic nerve injuries persisting past hospital discharge. Major complications (1.6%) were pericardial tamponade (0.97%) and stroke (0.4%); one stroke resulted in death (0.06%). Minor complications (3.9%) were primarily vascular (3.3%), but also included transient phrenic nerve paresis (0.46%), and TIA (0.11%). Rare complications included coronary artery spasm, haemoptysis, and dry cough persistent for 6 weeks (0.06% each). CONCLUSION In a large cohort of unselected patients, PFA was efficacious for PVI, and expressed a safety profile consistent with preferential tissue ablation. However, the frequency of 'generic' catheter complications (tamponade, stroke) underscores the need for improvement

Electrocardiographic findings in patients with arrhythmogenic cardiomyopathy and right bundle branch block ventricular tachycardia

AIMS: Little is known about patients with right bundle branch block (RBBB)-ventricular tachycardia (VT) and arrhythmogenic cardiomyopathy (ACM). Our aims were: (i) to describe electrocardiogram (ECG) characteristics of sinus rhythm (SR) and VT; (ii) to correlate SR with RBBB-VT ECGs; and (iii) to compare VT ECGs with electro-anatomic mapping (EAM) data. METHODS AND RESULTS: From the European Survey on ACM, 70 patients with spontaneous RBBB-VT were included. Putative left ventricular (LV) sites of origin (SOOs) were estimated with a VT-axis-derived methodology and confirmed by EAM data when available.  Overall, 49 (70%) patients met definite Task Force Criteria. Low QRS voltage predominated in lateral leads (n = 37, 55%), but QRS fragmentation was more frequent in inferior leads (n = 15, 23%). T-wave inversion (TWI) was equally frequent in inferior (n = 28, 42%) and lateral (n = 27, 40%) leads. TWI in inferior leads was associated with reduced LV ejection fraction (LVEF; 46 ± 10 vs. 53 ± 8, P = 0.02). Regarding SOOs, the inferior wall harboured 31 (46%) SOOs, followed by the lateral wall (n = 17, 25%), the anterior wall (n = 15, 22%), and the septum (n = 4, 6%). EAM data were available for 16 patients and showed good concordance with the putative SOOs. In all patients with superior-axis RBBB-VT who underwent endo-epicardial VT activation mapping, VT originated from the LV. CONCLUSIONS: In patients with ACM and RBBB-VT, RBBB-VTs originated mainly from the inferior and lateral LV walls. SR depolarization and repolarization abnormalities were frequent and associated with underlying variants

2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias: Executive summary

Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias