Monika Gawałko

Risk factors for adverse outcomes of patients with acute coronary syndrome: single-centre experience with long-term follow-up of treated patients

BACKGROUND For patients experiencing an acute coronary syndrome (ACS), a crucial time to assess their prognosis and to plan management is at discharge from hospital. AIM The aim of the study was to identify risk factors of mortality during post-discharge period following a hospitalisation for ACS. METHODS We studied 672 consecutive ACS patients hospitalised and discharged alive between 2002 and 2004. The analysis was done with respect to the type of ACS, i.e. unstable angina/non-ST-segment elevation myocardial infraction (UA/NSTEMI; n = 255) vs. ST-segment elevation myocardial infarction (STEMI; n = 417). All patients underwent coronary angiography and, if indicated, primary angioplasty (STEMI: 417 patients; UA/NSTEMI: 157 patients). The Cox proportional hazards regression model was used to evaluate the independent effect of the risk factors on the occurrence of primary endpoint, i.e. all-cause mortality during six-year follow-up. Survival status and date of death were obtained from the National Registry of Population (PESEL database). RESULTS A total of 123 patients (18.3%) died within the post-discharge period. The multivariate analysis identified 11 highly significant independent predictors of mortality (in order of predictive strength): diabetes mellitus (all types), higher creatinine level, older age, and more frequent occurrence of: supraventricular arrhythmias during hospitalisation, peripheral artery disease, recurrent angina pectoris with documented ischaemia on electrocardiogram, male sex, prior myocardial infarction, treatment with intra-aortic balloon pump counterpulsation, heart failure, and higher peak levels of creatine kinase-MB. CONCLUSIONS The risk factors obtained from the medical history and during the hospitalisation improve the risk stratification during the post-discharge period after hospitalisation for ACS.

Initial experience of catheter ablation for cardiac arrhythmias in children and adolescents at a newly built ablation centre

BACKGROUND Catheter ablation (CA) therapy is the first-choice treatment in adults with heart rhythm disturbances. Arrhythmias in adults are mainly conditioned by coronary artery disease. Aetiology of arrhythmias in children is mostly associated with inherited heart disorders. According to the current guidelines, CA is widely used in children, indicating the need to make it more achievable in the paediatric population. AIM To assess the efficacy and safety of CA in children with different types of arrhythmias on the initial learning curve at a newly built Ablation Centre in the Independent Paediatric Hospital of the Medical University of Warsaw, Poland. METHODS The study population comprised 32 children with supraventricular tachycardias, asymptomatic pre-excitation syndrome, or ventricular ectopic beats undergoing CA. The mean age of the study population was 14.1 ± 2.4 years. In all patients, electrophysiological study (EPS) and CA were performed. Analysis with respect to procedure duration, fluoroscopy exposure duration, location of accessory pathways (AP), success rate, recurrences, and complications was performed. RESULTS The mean procedure duration was 105.4 ± 41.4 min (range 40-175 min). The mean fluoroscopy duration was 8:34 ± 5:01 min (range 1:28-21:01). The mean exposure to ionising radiation was 4.7 ± 3.2 mcG/kg. EPS revealed signifi¬cantly more frequent presence of AP in the left side (57.1%). The radiofrequency ablation procedure was successful in 26 of 32 (81.3%) children, and cryoablation was successful in two of four patients. In two (6.3%) children minor complications occurred. CONCLUSIONS Catheter ablation may be effectively performed without major complications in the initial phase of the learning curve if a reasonable approach with a gradual increase of the procedural complexity is taken.

Endovascular extraction of entrapped long-term central feeding catheter: Case series

Long-term tunneled central venous catheters are widely used in several clinical indications, that is, hemodialysis, chemotherapy, and total parenteral nutrition. However, central venous catheters are associated with a number of complications, including catheter occlusion and sepsis, which may necessitate earlier catheter removal. In most cases manual traction is sufficient to remove the catheter. Nevertheless, in some cases severe adhesions, formed between the catheter and the vessel wall, complicate simple catheter removal. We present four cases of entrapped long-term central venous catheters and describe methods (e.g. endoluminal balloon dilatation and wire snare) performed by experienced cardiologists at high-volume center to remove them. We claim that permanent central venous catheters removal procedures may be unpredictable and hazardous. Therefore, entrapped central venous catheters should be extracted by experienced operators in specialized high-volume centers.

Transvenous lead removal with a fragment of a papillary muscle - a silent complication.

Tricuspid valve (TV) insufficiency is one of the more important complications in patients with cardiac implantable electronic devices due to the endocardial lead [1]. The frequency of this complication is growing with the increasing number of implanted and removed leads crossing the TV [2] and with trauma upon removal of the old lead that increasingly grows into the heart tissue. However, in some cases, even serious heart damage, tricuspid regurgitation and other symptoms are not observed [3].

Atrioventricular block registration with smart phone associated ECG device.

The prevalence of cardiac rhythm disturbances increases with age and requires active screening for early detection. However, time, resources and costs are the main limiting factors for wider adoption of cardiac screening in the community setting. The ubiquitous access to the Internet and the dynamic adoption of smartphones provide opportunities for new technologies that transmit biomedical data, such as ECG. An example of such technology is Kardia Heart Monitor (AliveCor, Inc) that connects wirelessly to the smartphone and allows 30-second rhythm strips to be recorded. Pocket-size, mobile health devices provide an unprecedented opportunity for physicians to detect abnormalities in a quick and hassle-free fashion [1].

Three-dimensional print facilitated ventricular tachycardia ablation in patient with corrected congenital heart disease

Congenital heart disease is the most common type of birth defect causing significant hemodynamic and functional consequences, requiring surgical repair. An understanding of the precise surgical anatomy in such cases is often challenging and modern high resolution imaging techniques coupled with 3-dimensional (3D) printing may allow better visualization of the complex anatomy and improve planning of operations through hands-on simulation of surgical and interventional procedures [1–6]. A 52-year-old woman with a history of surgical treatment for tetralogy of Fallot (ToF), was referred to this department for ventricular tachycardia (VT) ablation. She had been treated in infancy with a left sided modified Blalock-Taussig shunt for ToF

The long-term prognosis following acute coronary syndromes: a prospective observational study of unselected group treated in the 24/7 cardiac catheterization laboratory at university hospital

BACKGROUND Risk stratification in acute coronary syndrome (ACS) is usually based on clinical data obtained during hospi-talisation. To date, there is a limited number of prospective observational studies assessing long-term prognosis of patients discharged from hospital after ACS. AIM This study is to investigate long-term follow-up of unselected ACS patients treated at the 24-hour/7-day (24/7) cardiac catheterisation laboratory and discharged from referral university hospital. METHODS We studied 672 consecutive ACS patients (median age 61 years, 66.7% men) hospitalised and discharged be-tween 2002 and 2004. The analysis was done in respect of the type of ACS, i.e. non-ST-segment elevation: unstable angina non-ST-segment elevation myocardial infarction (UA/NSTEMI; n = 255) vs. ST-segment elevation myocardial infarction (STEMI; n = 417). All patients underwent coronarography and, if indicated, primary angioplasty (417 patients with STEMI and 157 pa-tients with UA/NSTEMI). The primary endpoint was defined as all-cause mortality during six years of follow-up. Survival status and date of death were obtained from the National Death Registry of Poland and presented as Kaplan-Meier survival curves. RESULTS Despite a significantly higher one-year mortality of patients with UA/NSTEMI compared to those with STEMI (7.1% vs. 3.1%, p = 0.018), the overall mortality assessed throughout follow-up until 2009 was comparable between UA/NSTEMI and STEMI patients (18.8% vs. 18%, p = 0.79). CONCLUSIONS The long-term (several years) survival did not depend on the type of ACS.

Initial experience with the subcutaneous implantable cardioverter-defibrillator with the real costs of hospitalization analysis in a single Polish center

BACKGROUND The recent introduction of an entirely subcutaneous implantable cardioverter-defibrillator (S-ICD) represents an important progress in the defibrillation technology towards a less invasive approach. This is a single-center observational study of S-ICD implantations in Poland. METHODS The S-ICD was implanted in 11 patients with standard indications for an ICD. Patients in whom the device was implanted were evaluated for adverse events and device function at hospital discharge. All hospitalization costs were calculated and summed up for all patients. Costs were divided into following categories: medical materials, pharmaceuticals, operating theatre staff, cardiology department staff, laboratory tests, non-laboratory tests and additional non-medical costs. RESULTS The mean age of patients was 51.6 ± 16.4 years, 9 were men and 2 were women. Four patients had atrial fibrillation as the basal rhythm, 1 patient had atrial flutter and 6 patients had sinus rhythm. All patients had at least one condition that precluded the use of a traditional ICD system or the S-ICD was preferred due to other conditions, i.e. a history complicated transvenous ICD therapy (18%), anticipated higher risk of infection (27%), lack or difficult vascular access (18%), young age and anticipated high cumulated risk of lifetime device therapy (36%). The mean duration of the implantation procedure was 2 h. One patient developed a postoperative pocket hematoma. Mean total time of hospitalization was 28 (6-92) days. Average cost of hospitalization per patient was 21,014.29 EUR (minimal = 19,332.71 EUR and maximal = 24,824.14 EUR). CONCLUSIONS S-ICD implantation appears to provide a viable alternative to transvenous ICD, especially for patients without pacing requirements.

Implantation of the Micra transcatheter pacing system: Single Polish center experience with the real costs of hospitalization analysis

BACKGROUND The Micra Transcatheter Pacing System (TPS) is a miniaturized, single-chamber pacemaker system. Reported herein is an initial experience with implantation of the Micra TPS. METHODS The leadless pacemaker was implanted in 10 patients with standard indications for a permanent pacemaker. All hospitalization costs were calculated for all patients. RESULTS The mean age of the patients was 75 ± 7.1 years, 6 were men and 4 were women. Four patients had permanent atrial fibrillation as the basal rhythm and 6 patients had sinus rhythm. All patients had at least one relative contraindication that precluded the use of a traditional pacing system. Mean intraoperative ventricular sensing amplitude was 10.6 ± 5.4 mV, impedance 843 ± 185 ohms, and pacing threshold at 0.24 ms was 0.56 ± 0.23 V. At discharge, those values were 13.9 ± 5.6 mV, 667 ± 119 ohms and 0.47 ± 0.17, respectively. The mean duration of implantation procedure was 82 min, while mean fluoroscopy time was 3.5 min. Two patients developed hematoma at the groin puncture site post-implantation. In one case there was a need for erythrocyte mass transfusion and surgical intervention. Mean total time of hospitalization was 26 days and time from procedure to discharge 12 days. Average cost of hospitalization per one patient was 11,260.15 EUR minimal cost was 9,052.68 EUR, while maximal cost was 16,533.18 EUR. CONCLUSIONS Implantation of leadless pacemakers is feasible, safe and provides advantages over the conventional system. Hospitalization costs vary for individual patients in wide range.