Zastosowanie automatycznych defibrylatorów zewnętrznych w przypadku nagłego zatrzymania krążenia

Konstrukcja automatycznego defibrylatora zewnętrznego (AED) i prosta instrukcja obsługi umożliwia rozpowszechnienie zastosowania wczesnej defibrylacji w społeczeństwie. W wypadku nagłego zatrzymania krążenia w przebiegu częstoskurczu komorowego lub migotania komór wczesna defibrylacja jest najlepszą opcją terapeutyczną poprawiającą rokowanie. Wprowadzenie szkolenia wykorzystującego AED w programie wczesnej defibrylacji wydaje się najlepszym rozwiązaniem poprawiającym rokowanie chorych z nagłym zatrzymaniem krążenia. Należy jednak pamiętać, że obok prawidłowo przeprowadzonych manualnych zabiegów resuscytacji krążeniowo-oddechowej wykonanie defibrylacji jest jednym z elementów postępowania pozwalającego przeżyć ofiarom nagłego zatrzymania krążenia

Zastosowanie automatycznych defibrylatorów zewnętrznych w przypadku nagłego zatrzymania krążenia

Konstrukcja automatycznego defibrylatora zewnętrznego (AED) i prosta instrukcja obsługi umożliwia rozpowszechnienie zastosowania wczesnej defibrylacji w społeczeństwie. W wypadku nagłego zatrzymania krążenia w przebiegu częstoskurczu komorowego lub migotania komór wczesna defibrylacja jest najlepszą opcją terapeutyczną poprawiającą rokowanie. Wprowadzenie szkolenia wykorzystującego AED w programie wczesnej defibrylacji wydaje się najlepszym rozwiązaniem poprawiającym rokowanie chorych z nagłym zatrzymaniem krążenia. Należy jednak pamiętać, że obok prawidłowo przeprowadzonych manualnych zabiegów resuscytacji krążeniowo-oddechowej wykonanie defibrylacji jest jednym z elementów postępowania pozwalającego przeżyć ofiarom nagłego zatrzymania krążenia

Arrhythmogenic focus localization in patients with right outflow tract ventricular arrhythmias

Background: Vast majority of ventricular arrhythmias in patients (pts) without structural heart disease (NHVA) originate from the right ventricular outflow tract (RVOT). Premature ventricular contractions (PVC) and ventricular tachycardia (VT) ECG morphology are proposed to localize the site of radiofrequency ablation (RFA). An ECG algorithm to localize the arrhythmogenic focus in RVOT was designed and verified in a prospective study. Methods: Analysis of ECG morphology of spontaneous PVC and VT was performed in 30 pts (25 women), mean age 42 &plusmn; 10, after successful RFA of arrhythmogenic focus (AFo) in RVOT (PVC in 11 pts, VT in 5 pts, PVC + VT in 14 pts). In the first step ECG data and fluoroscopic RVOT sites of successful RFA were combined to gain the characteristic QRS morphology patterns for exact sites of successful ablation (first 16 pts). This own algorithm was used to recognize AFo in the following 14 pts. Results: First step: RVOT in RAO 30° view was divided into 9 zones: 3 vertical (1, 2, 3) and 3 horizontal (superior, intermediate and inferior). Q, R and S waves < 0.5 mV in 12-lead ECG were coded as q, r, s and waves &#8805; 0.5 mV as Q, R, S. Vertical zones: zone 1 (RVOT postero-lateral part): r in lead I; zone 3 (RVOT anterior wall): QS/qs in lead I. Other QRS morphologies in lead I: zone 2. Horizontal zones: superior - transition from QS wave or r < S in V1 into R > s in lead V4, intermediate - R = S or r = s in V4, inferior - transition from qs/QS or r < S in V1&#8211;V4 into r, R in V6. Second step. Concordant ECG locations were predicted by two independent cardiologists in 14 pts. Concordant AFo locations (ECG and fluoroscopic) were achieved: in all 14 pts in horizontal zones and in 13 pts in vertical zones. Overall (30 pts) no AFo discordances were noted in horizontal zones. In vertical zones AFo location was concordant in 28 pts (93.3%). Conclusions: Our data show that simple ECG algorithm based on spontaneous arrhythmia morphology precisely localizes the arrhythmogenic focus in RVOT. This analysis applied before RFA may shorten and simplify ablation procedure in patients with RVOT arrhythmia

Chirurgiczna i przeznaczyniowa ablacja dodatkowej drogi przewodzenia u pacjenta z wrodzonym skorygowanym przełożeniem wielkich pni tętniczych oraz anomalią Ebsteina

Skorygowane przełożenie wielkich pni tętniczych należy do rzadkich wrodzonych patologii układu sercowo-naczyniowego, polegającej na inwersji komór przy zachowanej ciągłości przedsionków i pni tętniczych. Izolowana wada bez patologii współistniejących zazwyczaj nie powoduje rozwoju niewydolności serca. W opisywanym przypadku pacjenta z wrodzonym skorygowanym przełożeniem wielkich pni tętniczych (CTGA), anomalią Ebsteina dotyczącą lewostronnej zastawki trójdzielnej oraz zespołem Wolffa-Parkinsona-White´a i częstymi napadami tachyarytmii nadkomorowych poddano najpierw chirurgicznej, później przezżylnej ablacji dodatkowej drogi przewodzenia. Zniszczenie drogi dodatkowej pozwoliło na stałe wyeliminować napady częstoskurczu nadkomorowego, a tym samym zapobiec rozwojowi tachykardiomiopatii. (Folia Cardiol. 2003; 10: 219&#8211;224

The effect of anti-tachycardia atrial pacing in patients with recurrent paroxysmal atrial fibrillation

Background: Atrial fibrillation (AF) is an arrhythmia with complex pathophysiological characteristics. The efficiency of various anti-tachyarrhythmic stimulation algorithms in patients with recurrent AF has become a subject of research and the aim of this analysis is to evaluate the success of treatment by continuous DDD(R) stimulation with an anti-tachyarrhythmic pacing algorithm in patients with paroxymal AF. Methods: In the period 2002-2004 19 patients (10 females and 9 males), aged 45-74 (with a mean age of 64.2 &plusmn; 7.6), qualified for DDD(R) system implantation. The indication for implantation was tachy-brady syndrome with recurrent AF resistant to pharmacological treatment. All the patients had had at least three recurrences of symptomatic AF within the previous year. The follow-up period was 12 months. AF recurrences, outpatient visits and hospitalisation frequency were evaluated every 6 months and there were routine pacemaker controls. Baseline and final visit echocardiograms and a quality of life (QoL) questionnaire (SF-36) were obtained. Results: One patient was excluded from the analysis owing to permanent AF with a final VVI pacing mode. In comparison with the pre-inclusion 12 months AF-related hospitalisation frequency within the 12-month follow-up period was 3.9 vs. 0.4 (p < 0.005) and outpatient visits 2.1 vs. 0.8 (p < 0.05). The mean atrial pacing percentage in all patients was 95.7% &plusmn; 2.9%, and the mode switch percentage during the first and second 6 month periods was 6.4% (1-50%, median 2) and 2.5% (0-7, median 2, NS) respectively. There were 483/month (0.44-5761, median 31) events defined as AF episodes during first 6 months and 84/month (0-480, median 17, NS) during the second 6 months. The AF burden was 1.92 days/month (7 h - 15 days, median 14 h), decreasing to 0.74 day/month (0-2.1 days, median 14 h, NS) in the second 6-month period. A significant 12-month improvement was achieved in QoL parameters. Conclusions: An overdrive atrial algorithm can be a beneficial, safe and comfortable method in patients with paroxysmal drug-resistant AF and accepted indications for physiological pacing

Lead extraction: The road to successful cardiac resynchronization therapy

Background: Still increasing life expectancy in patients with implanted devices and large number of leads more and more often induce the need to cure the treatment complications or to change especially to cardiac resynchronization therapy (CRT). In order to prevent further complications, the possibility of damaged or redundant leads extraction should be taken into consideration. The aim of the paper was to assess the effectiveness and safety of transvenous lead extraction (TLE) with co-implantation of resynchronization systems. Methods and results: Between 2008 and March 2013, the system removal with TLE was conducted in 246 patients. In 38 patients (11 women, 28.9%), aged 43–79 (mean 65 years), it was combined with co-implantation of CRT-pacemaker or defibrillator (CRT-P/D). Indica­tions for TLE covered: lead failure in 21 (55.3%) patients, redundant leads in 6 (15.8%), and the occluded venous system in 7 (18.4%). The up-grade of the pacemaker or defibrillator system to CRT-D was performed in 19 cases, CRT-P/D revision in next 19. Together 32 defibrillation leads and 42 pacing leads (27 left ventricular leads, and 1 epicardial lead) were implanted. The intended clinical target — an effective resynchronization therapy — was obtained in all patients. There was no case of death or severe complications. In 2 cases of venous occlusion, the implantation on the contralateral side was required. Conclusions: TLE enables effective resynchronization therapy also in the case of the presence of too many leads, occlusion of the venous system or lead failure. Significant technical problems can occur especially in patients with venous system occlusion

The effectiveness of transvenous leads extractions implanted more than 10 years before

Background: The increasing number of patients with cardiac implantable electronic devices (CIEDs) causes a rise in the absolute percentage of individuals qualifying for a transvenous lead extraction (TLE) due to infectious, vascular or lead failure related indications. As the survival time prolongs, TLE procedures more and more often concern the electrodes of long- -term functioning. Authors provide a retrospective analysis of the effectiveness and safety of TLE performed on leads implanted at least 10 years before the extraction. Methods: Between 2008 and 2012 we performed TLE of 364 electrodes in 217 patients. Out of these, 66 (18.1%) leads in 43 (19.8%) patients had been implanted for at least 10 years. The mean dwelling time for electrodes was 161 months (120 to 330). In 62% of cases CIED-related infection was an indication for TLE. The following extracting techniques were used: manual direct traction, device traction, mechanical telescopic sheaths, autorotational cutting sheaths and femoral approach. Results: Fifty-eight pacemakers and 8 defibrillating leads were extracted. Sixty-three (95%) completely, in the remaining 3 cases the clinical success was achieved with the small portion of the lead left into the vascular space. No major procedure complications were observed; minor complications were found in 3 (6%) patients. Conclusions: TLE with the use of various endovascular techniques is an effective and safe method for treating infectious, vascular and mechanical complications of long-lasting CIEDs therapy.

Endocardial lead extraction in the Polish registry : clinical practice versus current Heart Rhythm Society consensus

Introduction: Over the last 10 years, there has been an increasing number of patients with pacemaker (PM) and cardioverter-defibrillator (ICD). This study is a retrospective analysis of indications for endocardial pacemaker and ICD lead extractions between 2003 and 2009 based on the experience of three Polish Referral Lead Extraction Centers. Material and methods: Since 2003, the authors have consecutively retrospectively collected all cases and entered the information in the database. All patients which had indication for lead extraction according to Heart Rhythm Society Guidelines were included to final analyze. Between 2003 and 2005, the data were analyzed together. Since 2006, data have been collected and analyzed annually. Results: In each year, a significant increase in lead extraction was observed. The main indications for LE were infections in 52.4% of patients. Nonfunctioning lead extraction constituted the second group of indications for LE in 29.7% of patients. During the registry period, the percentage of class I indications decreased from 80% in 2006 to only 47% in 2009. On the other hand, increasingly more leads were removed because of class 2, especially class 2b. In 2009, 40% of leads were extracted due to class 2b. Conclusions: Polish Registry of Endocardial Lead Extraction 2003-2009, shows an increasing frequency of lead extraction. The main indication for LE is infection: systemic and pocket. An increase in class 2, especially 2b, LE indication in every center during the study period was found

Occurrence and extraction of implantable cardioverter-defibrillator leads with conductor externalization

   Background: The increasing number of patients with implantable cardioverter-defibrillators (ICD) contributes to the rising number of patients qualifying for a transvenous lead extraction (TLE) due to infection, vascular or lead failure related indications. The purpose of this study was to perform a retrospective analysis of the occurrence of conductor externalization in TLE patients and to assess the success rate in the extraction of these leads. Methods: TLE procedure was performed between 2012 and 2014 of 428 electrodes in 259 patients. Out of these, 143 (33.4%) leads in 138 (52.9%) patients were ICD leads. The indications for the TLE in ICD patients were: infection in 37 patients, lead failure in 84 patients, and others in 17 patients. Conductor externalization was observed in 8 ICD leads (5.6%) in 8 (5.8%) patients. The mean dwell­ing time for externalized leads was 87.9 (55 to 132) months compared to 60.1 (3 to 246) months of the remaining 135 ICD leads (p = 0.0329). All externalized leads were successfully and completely extracted using device traction, mechanical telescopic sheaths and/or autorotational cutting sheaths. No complica­tions of lead extraction procedures were observed in 8 patients with externalization. Results: Patients with lead externalization were often in a better New York Heart Association func­tional class (I or II) compared to those in the rest of the study group (p = 0.0212). Conclusions: Conductor externalization is a rare finding in patients undergoing TLE. This occurs with different manufacturers and lead types. In this complication transvenous lead extraction with the mechanical extraction tools can be safely performed.