Ewa Szufladowicz

Ablation of severe drug-resistant tachyarrhythmia during pregnancy

Ablation of Tachyarrhythmia During Pregnancy. Aims: The goal of this study was to describe mapping and ablation of severe arrhythmias during pregnancy, with minimum or no X‐ray exposure. Treatment of tachyarrhythmia in pregnancy is a clinical problem. Pharmacotherapy entails a risk of adverse effects and is unsuccessful in some patients. Radiofrequency ablation has been performed rarely, because of fetal X‐ray exposure and potential maternal and fetus complications.

Clinical Validation and Comparison of Alternative Methods for Evaluation of Entrainment Mapping

Introduction: Measuring the postpacing interval (PPI) and correcting for the tachycardia cycle length (TCL) is an important entrainment response (ER). However, it may be impossible to measure PPI due to electrical noise on the mapping catheter. To overcome this problem, 2 alternative methods for the assessment of ER have been proposed: N+1 difference (N+1 DIFF) and PPIR method. PPI‐TCL difference (PPI − TCL) correlates very well with ER assessed by new methods, but the agreement with PPI − TCL was established only in relation to PPIR method. Moreover, it is not known which of these methods is superior in the assessment of ER.

Ventricular fibrillation risk factors in over one thousand patients with accessory pathways

BACKGROUND Published data concerning risk factors of VF in WPW patients are inconsistent or contradictory. METHODS AND RESULTS We included 1007 patient (pts) (mean age 35 years; 45% female) with an accessory pathway (AP) referred for non pharmacological treatment. Group 1 consisted of 56 pts (42M, aged 34 ± 15 yrs) with an AP and documented VF and Group 2-951 pts (513M, aged 35 ± 15 yrs) with an AP and without VF. Univariate predictors of VF were: overt pre-excitation, male gender, multiple AP, large AP. Multivariate predictors were: overt pre-excitation, male gender and MAP. The mean shortest pre-excited RR interval during AF was significantly shorter in Group 1: 205 ± 27 vs. 243 ± 64, P=0.019. VF as an end point of the first arrhythmia episode (AVRT or AF) was observed in 20 pts (15M, 5F). Primary VF (no documented arrhythmia prior to aborted SCD) occurred in 16 pts (13M, 3F). The mean age of primary VF pts was significantly lower than of pts with history of AVRT or AVRT and/or AF (24.5 vs. 36.5 vs. 38 yrs., P<0.005 and P=0.002, respectively). Age at VF occurrence shows a bi-modal distribution with peak occurrences in the 2-nd/3-rd and 5-th decades. CONCLUSION In patients with an accessory pathway, overt pre-excitation, male gender and multiple AP constitute independent risk factors of VF episodes. Young patients in the 2-nd/3-rd and older patients in the 5-th decade might be at higher risk of VF occurrence.

Relationship between Cycle Length of Typical Atrial Flutter and Double Potential Interval after Achievement of Complete Isthmus Block

Background:  There is some disagreement concerning the minimal value of the interval between components of double potentials (DPs interval) that allows distinguishing complete and incomplete block in the cavotricuspid isthmus (CTI).

Unsuccessful left ventricular lead implantation in two first-degree relatives. Is the coronary venous anatomy similar in both cases?

We reported on two unsuccessful implantations of the left ventricular lead in two first-degree relatives due to inability to cannulate the coronary sinus (CS). The anatomy of the coronary venous system investigated by means of dual source computed tomography showed several similarities in both patients: narrowing of the proximal part of CS and a small number of CS tributaries.

P1-63 FIRST EPISODE OF ATRIAL FIBRILLATION IN OVERT AND CONCEALED WOLF-PARKINSON-WHITE SYNDROME

Background: Long refractory period of the A-V node is a natural barrier, which protects the ventricles from too fast heart rhythm. In WPW syndrome, AF is particularly dangerous when accessory pathway (AP) has short refractory period. The aim of our study was to analyze the occurrence of AF in dependence on sex, age, property of AP and other factors (CHD, HT) Methods: 747 pts, mean age 35.5, underwent non-pharmacological treatment of WPW (years 1988-2005). 221 (39.5%) of them (68 F, 153 M) had documented atrial fibrillation. The results of 12 lead ECG Holter, ECG monitoring, and an echocardiography study were analyzed. Results: 140 pts (63.3%) have had episode of AF and AVRT, 79 (25,5%) only AF. 20 pts (9%) have documented VF. 18% had HT, 7,3% CHD, 13,7% changes in coronary arteries, 8,7% valvular heart disease. 20% underwent cardioversion. Women had the first episode of AF most frequently at 4 decade (25.5%), men at 3rd (27.6%). The mean age of the first AF episode in men was significantly lower than women (32.4 vs 39.6). More frequently AF occured in pts with left sided AP (61%) than right-sided (30%). Midseptal occurs seldom (9%). AF occurred most frequently in overt APs – 81.3% (intermittent – 11%, and concealed – 7.7%). Conclusions: Men have had AF episodes 2,2 times more often than woman. Pts with avrt have had AF earlier than pts without avrt (36 vs 46). Men have had first episode of AF earlier than women (32.4 vs 39.6).