Agata Musialik-Łydka

Mid-term outcomes of triple-site vs. conventional cardiac resynchronization therapy: a preliminary study.

BACKGROUND The primary objectives of this study were to compare the implantation course of triple-site (double left-single right) and conventional cardiac resynchronization devices. The secondary target was to assess mid-term outcomes of both types of cardiac resynchronization therapy (CRT). METHODS Fifty-four patients with NYHA classes III-IV, left ventricular EF<or=35% and QRS>or=120 ms were included; 27 received triple-site pacemakers (TRIV group), 27 conventional CRT devices (BIV group). Procedural course, clinical data, QRS duration, echocardiographic parameters, peak oxygen consumption (VO2max) and 6-minute walking distance (6MWD) were screened for inter-group differences. RESULTS Procedure duration was higher in TRIV than in BIV group (197.6 vs. 137.6 min, P<0.001), fluoroscopy exposure and complication-rates were similar. After 3 months of CRT, triple-site pacing was associated with a more significant (P<0.05) NYHA class reduction (by 1.4 vs. 1.0 class, respectively), increase in VO(2) max (2.9 vs. 1.1 mL/kg/min) and 6MWD (98.7 vs. 51.6 m) than conventional CRT. A higher EF and more improved intraventricular synchrony were observed in the TRIV than in the BIV group. The response rate in the TRIV group was 96.3% vs. 62.9% in the conventional group (P=0.002). Triple-site stimulation was an independent predictor of response to CRT (adjusted odds ratio 26.4, P=0.01). CONCLUSIONS Triple-site resynchronization appears to be more beneficial than conventional CRT. Upgrade to triple-site CRT may be considered in non-responders to standard resynchronization.

[Atrial fibrillation in patient with concealed Wolff-Parkinson-White syndrome].

We present a case of 33-year-old woman suffered from palpitations and syncope. ECG was normal at the rest and showed irregular tachycardia with wide QRS complex (HR > 300/min) during the effort. The patient was admitted to our department in order to perform detailed diagnostics and therapy. Based on electrophysiological study we found and ablated numerous concealed accessory pathways. During 1 year observation patient stay assymptomatic.

Electrical storm in patients with implantable cardioverter-defibrillator

76 years old patient after the ICD implantation as a primary prevention of sudden cardiac death was admitted to the hospital because of the electrical storm which presented in ECG as a variety ventricular arrhythmia. Because of patients’ resistance for pharmacological treatment and antiarrhythmic therapies delivered from ICD, we performed an ablation and implemented the resynchronization therapy of the heart.