Agnieszka Sławuta

Permanent His bundle pacing — An optimal treatment method in heart failure patients with AF and narrow QRS

Article history: Received 28 March 2016 Accepted 3 April 2016 Available online 8 April 2016 complexes the cardiac resynchronisation contributes to hemodynamic, echocardiographic and clinical improvement [3]. There are very scarce data dealing with the problem of an outcome of resynchronisation in narrow and broad QRS patients. Only one small study by Lustgarten et al. has addressed this problem and only in a subset of studied patients. The smart idea of their study was to implant CHF and LBBB

Cardiac resynchronization therapy with His bundle pacing as a method of treatment of chronic heart failure in patients with permanent atrial fibrillation and left bundle branch block

CRT is a therapeutic option for patients with heart failure, sinus rhythm, prolonged QRS complex duration and reduced ejection fraction. We present a case of 71-year-old woman with dilated cardiomyopathy, NYHA functional class III and AF. We implanted CRT combined with direct His-bundle pacing. The indication for such a therapy was a left bundle branch block with a QRS complex of 178ms and a left ventricular EF of 15%, left ventricular end-diastolic diameter (LVEDD) of 75mm. After 8months of follow-up the LVEDD was 60mm with EF 35-40%.

The optimal management of patient with permanent atrial fibrillation and heart failure with reduced ejection fraction – The permanent His-bundle pacing is a solution. A case report

Atrial fibrillation (AF) coexists frequently with heart failure (HF). Permanent His-bundle pacing (pHBP) seems to be an optimal approach to the management of patients with HF and concomitant AF, which are the indication for single chamber ICD implantation. This management allows to up-titrate the beta-blocker dose in order to prevent tachyarrhythmia with no risk of bradyarrhythmia or triggering deleterious right ventricular pacing. We present a case of 69-years-old male with AF, worsening HF and high burden of RV pacing. The upgrade from single chamber ICD to dual chamber ICD with pHBP alleviated the symptoms and contributed to substantial echocardiographic improvement.

Prąd uszkodzenia pęczka Hisa i czynny rytm węzłowy — rozważania kliniczne i techniczne

We present a case of dual chamber cardioverter-defibrillator placement with atrial lead implanted in His-bundle area, resulting in current of injury and accelerated nodal rhythm recorded in pacing system analyzer, rarely seen in clinical practice. Such presentation resulted in excellent pacing and sensing conditions, despite primarily doubtful setting.

Ocena sztywności tętnic u chorych z przewlekłą chorobą nerek

Cardiovascular diseases are the main cause of death among patients with chronic kidney disease. Classic and disease-specific cardiovascular risk factors are observed in this group of patients. Recently, arterial stiffness has been paid more attention to as a cardiovascular risk factor. High-resolution echo-tracking is a direct and non-invasive ultrasound method of local arterial stiffness evaluation. New publications show that indices of local arterial stiffness, such as stiffness parameter beta, are predictors of cardiovascular mortality. Evaluation of local arterial stiffness can take a prominent place in cardiovascular risk assessment due to limitations of standard diagnostic methods present in chronic kidney disease. Further studies on high-resolution echo-tracking are essential to establish the role of this method in evaluation of chronic kidney disease patients.

The P wave duration in patients with atrial fibrillation undergoing cryoballoon pulmonary vein isolation. Preliminary results.

The pulmonary vein isolation remains the major target of atrial fibrillation ablation. The cryoablation lesions in the left atrium are supposed to disconnect the pulmonary vein from the atrium on the atrial side of the orifices. We hypothesized that the cryoballoon pulmonary vein isolation could result in the prolongation of the P wave duration. The aim of the study was to assess the duration of the P wave in 12-lead electrocardiogram and the influence of pulmonary vein isolation on this parameter. The study group included 21 patients (11 women and 10 men) 66.2+/-7.4 years of age undergoing cryoballoon ablation. In order to measure the P wave duration, we used the constant acquisition of electrogram and the electrocardiographic channels provided by LABSYSTEMTM Pro EP Recording System (Boston Scientific), magnifying the leads 64x. We calculated the duration in the simultaneously recorded 12-lead ECG, from the beginning of the earliest recorded P wave deflection, until the end of the latest P-wave deflection recorded in any lead. The P wave duration in the entire study group was 141.7+/12.5 ms before the ablation and increased significantly to 151.1+/-11.5 ms (p<0.05) after the procedure. The respective values in women were 144.1+/-4.3 vs. 156.0+/-4.7 ms (p<0.01) and 139.1+/-4.6 vs. 145.6+/-4.5 ms in men (p<0.05). The mean standard deviation of every single measurement considered separately was 4.4+/2.1 ms before the cryoablation and 4.6+/-1.8 ms after the procedure (p= not significant (n.s).), indicating very good reproducibility of the measurements. We concluded, that cryoballoon pulmonary vein isolation leads to the prolongation of the measured P wave duration. It seemed to result from conduction disturbances created by cryoablation. The clinical significance of the observed changes remains unknown.

Optymalna rozbudowa dwujamowego układu stymulującego u pacjentki z utrwalonym migotaniem przedsionków

In patients with sick sinus syndrome, and previously implanted dual-chamber pacemaker, the occurrence of atrial fibrillation finally assessed as permanent is most commonly regarded as a natural course of the disease. The inappropriate heart rate control and right ventricular pacing can both negatively influence left ventricle mechanical performance leading to cardiomyopathy and heart failure. It was presented the case of a 72-year-old woman with permanent atrial fibrillation with narrow QRS complex, after dual-chamber pacemaker implantation, admitted to our department with signs and symptoms of acute decompensated congestive heart failure. The modification of pharmacotherapy allowed to compensate heart failure, however with only small influence on structural remodelling and patient’s symptoms. The successful upgrade of the pacing system to the direct His-bundle pacing enabled the restoration of proper function of the heart and full symptoms relief. The direct His-bundle pacing is an approach of choice in such a group of patients.

Ustąpienie całkowitego bloku przedsionkowo-komorowego po ablacji typowego trzepotania przedsionków

A 58-year-old man was admitted with third-degree atrioventricular block and concomitant typical atrial flutter. In such situation the procedure consist of dual-chamber pacemaker implantation followed by cavotricuspid isthmus ablation. In presented case a decision has been made to reverse the order of standard procedures. The radiofrequency ablation of atrial flutter resulted in resolution of complete atrioventricular block and restoration of atrioventricular conduction 1:1, thus the implantation of the dual-chamber pacemaker was not necessary.

Antiarrhythmic properties of atrial pacing

Bradycardia, atrial stretch and dilatation, autonomic nervous system disorders, and the presence of triggers such as atrial premature contractions, are factors which predispose a person to paroxysmal AF. Atrial pacing not only eliminates bradycardia but also prevents atrial premature contractions and dispersion of refractoriness, which are a substrate for atrial fibrillation. As the prolonged duration of atrial activation during pacing, especially from locations changing the physiological pattern of this activation (right atrium lateral wall, right atrium appendage), negatively influences both a mechanical and an electrical function of the atria, the atrial pacing site affects an atrial arrhythmogenesis. A conventional atrial lead location in the right atrium appendage causes non-physiological activation propagation, resulting in a prolongation of the activation time of both atria. This location is optimal according to a passive fixation of the atrial lead but the available contemporary active fixation leads could potentially be located in any area of the atrium. There is growing evidence of the benefit of pacing, imitating the physiological propagation of impulses within the atria. It seems that the Bachmanns bundle pacing is the best pacing site within the atria, not only positively influencing the atrial mechanical function but also best fulfilling the so-called atrial resynchronization function, in particular in patients with interatrial conduction delay. It can be effectively achieved using only one atrial electrode, and the slight shortening of atrioventricular conduction provides an additional benefit of this atrial pacing site.

His-bundle pacing using dual-chamber cardioverter–defibrillator in patients with chronic atrial fibrillation: different pacing and sensing features

A direct His-bundle pacing wins popularity as more implantation centres use this technique. Maintaining physiologic ventricular activation (in patients with narrow QRS complex) or even correcting t...