Miodrag Grujic

Recent Trends in Cardiovascular Disease and Risk Factors: Yugoslavia

This paper presents trends from demographic and health statistics data of the former Yugoslavia (fYU) and recently of the Federal Republic of Yugoslavia (RYU). The war and economic depression in the last 3 years have dramatically increased rates of diseases, injuries and deaths. Until recently, from 1950 to 1991, there had been a steady increase of life expectancy for fYU. According to the 1992 World Health Statistics Annual, fYU, compared to the Seven Countries and Hungary, has now reached high rates of cardiovascular disease (CVD) deaths on the same order as in the USA, Italy, Greece, and the Netherlands, but lower than in Finland and in Hungary. However, in Vojvodina, the northern province of Serbia, CVD deaths were as frequent as in Hungary. Trends in CVD deaths increased in fYU between the 1960s and 1980, and then stabilized with a slight decline until 1990. However, according to the 1991–1992 data for Central Serbia and Vojvodina, rates for all-cause and CVD deaths are dramatically increasing. In fYU, RYU, and particularly in Central Serbia and Vojvodina, the proportional contributions of CVD deaths to all-cause deaths is greater than 50% in men and 60% in women. In the Serbian part of the Seven Countries Study, after 25 years of follow-up of men aged 40–59 at entry, the best survival was found for Belgrade University professors, although they died proportionally more from CVD. The highest age-adjusted 25-year mortality (among the highest in the Seven Countries Study) was observed in Zrenjanin, a town representative of Vojvodina. The Zrenjanin cohort was characterized by major increases of risk factors over the first 10 years, especially of serum cholesterol and blood pressure; these were real changes and not only due to aging.

The Occurrence of New Arrhythmias after Catheter-Ablation of Accessory Pathway: Delayed Arrhythmic Side-Effect of Curative Radiofrequency Lesion?

INTRODUCTION New arrhythmias (NA) may appear late after accessory pathway (AP) ablation, but their relation to curative radiofrequency (RF) lesion is unknown. OBJECTIVE The aim of this study was to determine the prevalence and predictors for NA occurrence after AP ablation and to investigate pro-arrhythmic effect of RF. METHODS Total of 124 patients (88 males, mean age 43 +/- 14 years) with Wolff-Parkinson-White syndrome and single AP have been followed after successful RF ablation. Post-ablation finding of arrhythmia, not recorded before the procedure, was considered a NA. The origin of NA was assessed by analysis of P-wave and/or QRS-complex morphology, and, thereafter, it was compared with locations of previously ablated APs. RESULTS Over the follow-up of 4.3 +/- 3.9 years, NA was registered in 20 patients (16%). The prevalence of specific NAs was as follows: atrioventricular (AV) block 0.8%, atrial premature beats 1.6%, atrial fibrillation 5.4%, atrial flutter 0.8%, sinus tachycardia 4.8%, ventricular premature beats (VPBs) 7.3%. Multivariate Cox-regression analysis identified (1) pre-ablation history of pathway-mediated tachyarrhythmias >10 years (HR = 3.54, p = 0.016) and (2) septal AP location (HR = 4.25, p = 0.003), as the independent predictors for NA occurrence. In four NA cases (two cases of septal VPBs, one of typical AFL and one of AV-block) presumed NA origin was identified in the vicinity of previous ablation target. CONCLUSION NAs were found in 16% of patients after AP elimination. In few of these cases, late on-site arrhythmic effect of initially curative RF lesion might be possible. While earlier intervention could prevent NA occurrence, closer follow-up is advised after ablation of septal AP.

The appearance of ventricular preexcitation during exercise testing reproduced by dobutamine administration.

A 33‐year‐old woman presented with exercise‐related palpitations after an apparently successful catheter‐ablation of overt midseptal accessory pathway. Post procedure, the electrocardiogram at rest was normal, while the progressive appearance of delta‐wave during treadmill stress testing was recorded. In addition, the occurrence of ventricular preexcitation was reproduced by controlled administration of dobutamine. Detailed understanding of the unusual pathway electrophysiology resulted in specific planning of the second procedure. In the basal state, pacing maneuvers did not demonstrate any evidence of pathway conduction. However, during infusion of dobutamine bidirectional conduction in the right anterior pathway was restored, enabling definitive cure by radiofrequency. (PACE 2010; 33:766–769)