Paweł Zagożdżon

Hemodynamic effects of alternative atrial pacing sites in patients with paroxysmal atrial fibrillation.

DABROWSKA‐KUGACKA, A., et al.: Hemodynamic Effects of Alternative Atrial Pacing Sites in Patients with Paroxysmal Atrial Fibrillation. Recently, multisite atrial pacing has been suggested as an alternative therapy to prevent recurrences of paroxysmal atrial fibrillation (PAF). A study was conducted to compare the acute effects of biatrial (BiA), left atrial (LA), and right atrial appendage (RAA) pacing on cardiac hemodynamics. In 14 patients with PAF and a BiA pacemaker (with leads in the RAA and coronary sinus), cardiac output (CO), right (RV) and left ventricular (LV) filling, RA‐LA contraction delay [PA(m‐t)] and the difference in A wave duration [Adif(m‐p)] at the level of the mitral valve (Adurm) and pulmonary veins (Adurp) during RAA, BiA, and LA pacing were examined by echo‐Doppler measurements. The atrial pacing site did not affect the CO. LA, but not BiA, pacing resulted in delayed RA contraction in comparison with RAA pacing with significant diminution of the RA contribution to RV filling. With LA pacing, the usual right‐to‐left atrial contraction sequence was reversed (PA(m‐t): 8 ± 7 ms control; 5 ± 30 ms RAA; −10 ± 21 ms BiA; −72 ± 36 ms LA; LA versus control versus RAA and versus BiA, P < 0.001. LA and BiA pacing prolonged Adurp (LA 186 ± 52 ms, BiA 180 ± 45 ms, RAA 153 ± 49 ms; LA and BiA vs RAA, P < 0.01) . Thus Adurp exceeded Adurm[Adif (m‐p): control 38 ± 40 ms, RAA 7 ± 42 ms, BiA −12 ± 43 ms, LA −20 ± 44 ms; control vs RAA, BiA, and LA; and RAA vs LA, P < 0.05]. The study showed that (1) the atrial pacing site has no influence on global cardiac performance; (2) the hemodynamic effect of BiA pacing is not superior to that of RAA pacing, and LA pacing can even be deleterious; (3) LA pacing reverses the usual right‐to‐left atrial contraction sequence and reduces the RA contribution to RV filling; (4) BiA and LA pacing prolong Adurp due to an altered activation pattern, decreased pulmonary venous return, or increased LA pressure. (PACE 2003; 26[Pt. II]:278–283)

Incidence of spinal muscular atrophy in Poland--more frequent than predicted?

Background: The application of molecular methods has enhanced and enlarged the diagnostics of spinal muscular atrophy (SMA) and its carriership. It allows for reliable epidemiological studies which are of importance to demography and genetic counseling. Methods: This study sought to evaluate the incidence of SMA in Poland, on the basis of the prevalence of the SMN1 gene deletion carrier state in the general population, as well as an analysis of all cases of SMA diagnosed in the years 1998–2005. Results: The prevalence of the SMN1 gene deletion carrier state was estimated at 1 per 35 persons (17/600), yielding an incidence of SMA equal to 1 per 4,900. By contrast, the incidence of SMA based on the results of the meta-analysis was an estimated 1 per 7,127 in Warsaw and 1 per 9,320 persons across Poland, suggesting that some cases of SMA remain undiagnosed. SMA1 predominated among the diagnoses, accounting for 69% of all cases. Conclusion: A high prevalence of the SMN1 deletion carrier state in the general population indicates that SMA could be a more frequent disease than is predicted by the epidemiological data regarding diagnosed cases.

Survival and cause-specific mortality among unemployed individuals in Poland during economic transition

BACKGROUND There were few reports about the relationship between unemployment and mortality in Central Eastern European countries experiencing economic transition. METHODS This study measures overall and cause-specific mortality rates in 47,247 subjects registered as unemployed in Danzig City and Danzig County for the period of 1999 and 2004 and compares them with the age-matched general population. RESULTS In unemployed male subjects, the age-standardized all-cause mortality rate was significantly higher than in men from the general population: 8.36 per 1000, 95% confidence interval (95% CI) 7.71-9.0 compared with 5.1 per 1000, 95% CI 4.94-5.21. The age-standardized mortality in unemployed women was also higher than in the reference population data: 5.55 per 1000, 95% CI 4.77-6.34 and 1.89 per 1000, 95% CI 1.81-1.97, respectively. External causes, suicides, alcohol and smoking-related causes explain the excess mortality among both men and women. Unemployment status was associated with a greater risk of death in men than in women: hazard ratio (HR) 2.02, 95% CI 1.33-3.08 and HR 0.74, 95% CI 0.37-1.5, respectively. CONCLUSIONS Possible explanations for this disparity may be the current regulations and sociocultural context in Poland. More research is needed to understand the differences in mortality risk associated with unemployment observed between men and women in Poland.

Atrial lead location at the Bachmann's bundle region results in a low incidence of far field R-wave sensing

AIMS The aim of the study was to investigate far field R-wave sensing (FFRS) rate and characteristics at different right atrial (RA) positions in patients treated with multisite atrial pacing, with the RA lead implanted at the Bachmanns bundle (BB) area in 69 patients, in comparison to RA appendage (RAA) in 70 patients. METHODS AND RESULTS All measurements were done during sinus rhythm in supine patients, with unipolar (UP) and bipolar (BP) sensing configuration. The presence, amplitude threshold (FFRS trsh) and FFRS timing were determined. Sensing safety margin was defined as the ratio of sensed P-wave vs. FFRS trsh, for both the minimal (Pmin) and the mean (Pmean) P-wave amplitude. At both atrial locations BP sensing was superior to UP in FFRS rejection (P < 0.0001). At 0.5 mV sensitivity level (BP) FFRS occurred in 1% of patients at the BB site vs. 11% at the RAA (P = 0.01). FFRS trsh (BP) was 0.2 +/- 0.1 mV at the BB vs. 0.4 +/- 0.3 mV in the RAA position (P < 0.0001). Sensing safety margin, when determined for the Pmin amplitude was > or =5 in 99% of patients from the BB group, in comparison to 66% of RAA patients (P < 0.0001), in whom it was <2 in 13%. Even with the use of BP leads equipped with a 10 mm tip-to-ring spacing FFRS incidence was lower at the BB site (P < 0.01), FFRS trsh was lower (P < 0.001), and sensing safety margin was higher vs. RAA (P = 0.002). CONCLUSION Bachmanns bundle area features optimal conditions for signal sensing, and such atrial lead positioning may offer advantages to prevent oversensing of R-wave, thus improving functioning of standard dual chamber pacemakers, ICDs and CRT-Ds.

Neopterin and interleukin-6 as predictors of recurrent atrial fibrillation

Objective: Available evidence suggests that inflammation may be associated with atrial fibrillation (AF). This prospective and observational study aimed to assess whether plasma neopterin (NPT) and interleukin-6 (IL-6) levels before and after electrical cardioversion (CV) predict AF recurrence. Methods: The study was designed as a prospective observational trial. Blood samples were collected (24 hours before, 24 h after CV, and 7 days after CV) in 60 patients with a dual-chamber pacemakar and preserved left ventricular systolic function who underwent successful CV of persistent AF. All significant parameters associated with AF recurrence lasting ≥30 min and detected by pacemaker data logs were evaluated in multivariate logistic regression analysis. Echocardiography was performed 7 days after CV in patients with sinus rhythm. The control group included 17 subjects without AF. Results: The analysis included 51 patients who remained in sinus rhythm 7 days after CV. During 12 months of follow-up, AF recurred in 46 patients. Baseline IL-6 levels did not differ between the two groups, but baseline NPT levels were higher in the study group than in the control group (19±7 vs. 11±5 nmol/mL, p<0.001). NPT levels of ≥14.6 nmol/L at baseline and ≥13.3 nmol/L 7 days after CV separated the patients with AF recurrence from those without arrhythmia after CV. Only left atrial emptying fraction <38% was an independent predictor of AF recurrence (p=0.03), whereas NPT levels of ≥13.3 nmol/L 7 days after CV showed borderline statistical significance (p=0.07). Conclusion: Increased NPT level was observed in patients with persistent AF. Neither baseline IL-6 and NPT levels nor their changes within 7 days after CV were predictive of AF recurrence. Further studies are needed to establish the prognostic significance of NPT in patients with AF. (Anatol J Cardiol 2016; 16: 563-71) 0000; 00: 000–000

Characterization of estrogenic and androgenic activity of phthalates by the XenoScreen YES/YAS in vitro assay

The presented study investigates and compares the estrogenic and androgenic activities of commonly used diesters of phthalic acid (phthalates) using the XenoScreen YES/YAS assay. Phthalates are commonly used plasticizers in polymers dedicated for i.e. food and drug containers. Since phthalates are not chemically bonded to the polymer, they can leach or migrate from the polymer. Therefore, phthalates are identified as contaminants in a variety of consumer products. Investigation of estrogenic and androgenic activities of phthalates (DEP, DBP, BBP, DEHP and DINP) showed no significant effect of tested substances either on hERα or hAR receptors. Phthalates exhibited strong anti-estrogenic (IC50 for BBP=8.66μM, IC50 for DEHP=3.61μM and IC50 for DINP=0.065μM) and anti-androgenic (IC50 for BBP=5.30μM, IC50 for DEHP=2.87μM and IC50 for DINP=0.068μM) activities.

Low-density lipoprotein cholesterol and survival in pulmonary arterial hypertension

Low-density lipoprotein cholesterol(LDL-C) is a well established metabolic marker of cardiovascular risk, however, its role in pulmonary arterial hypertension (PAH) has not been determined. Therefore we assessed whether LDL-C levels are altered in PAH patients, if they are associated with survival in this group and whether pulmonary hypertension (PH) reversal can influence LDL-C levels. Consecutive 46 PAH males and 94 females were age matched with a representative sample of 1168 males and 1245 females, respectively. Cox regression models were used to assess the association between LDL-C and mortality. The effect of PH reversal on LDL-C levels was assessed in 34 patients with chronic thromboembolic pulmonary hypertension (CTEPH) undergoing invasive treatment. LDL-C was lower in both PAH (2.6 ± 0.8 mmol/l) and CTEPH (2.7 ± 0.7 mmol/l) patients when compared to controls (3.2 ± 1.1 mmol/l, p < 0.001). In PAH patients lower LDL-C significantly predicted death (HR:0.44/1 mmol/l, 95%CI:0.26–0.74, p = 0.002) after a median follow-up time of 33(21–36) months. In the CTEPH group, LDL-C increased (from 2.6[2.1–3.2] to 4.0[2.8–4.9]mmol/l, p = 0.01) in patients with PH reversal but remained unchanged in other patients (2.4[2.2–2.7] vs 2.3[2.1–2.5]mmol/l, p = 0.51). We concluded that LDL-C level is low in patients with PAH and is associated with an increased risk of death. Reversal of PH increases LDL-C levels.

Complications of PEG are not related to age – The result of 10-year multicenter survey

PURPOSE The aim of this study was to analyze whether the insertion of Percutaneous Endoscopic Gastrostomy (PEG) during infancy is related to higher morbidity. Moreover, we analyzed the structure of indications to PEG placement in various age groups of pediatric patients. MATERIAL/METHODS The study involved medical data of children after PEG insertion from six Polish endoscopic centers: infants (<12 months of age), toddlers (12-36 months), and preadolescents (>36 months). RESULTS The overall prevalence of early complications associated with PEG insertion was 5.14%; while they were noted in infants and preadolescents, none were recorded in toddlers. The analyzed age groups did not differ significantly in terms of the prevalence of late complications. Cerebral palsy (34.86%) and other chronic neurological conditions (34.29%) were the most frequent indications to PEG insertion in the whole group. Patients with congenital heart defects and multiple defect syndrome were inserted PEG at the youngest age; in contrast, the age at insertion was the highest in cystic fibrosis patients. CONCLUSIONS The early qualification to nutritional intervention via endoscopically formed gastrostomy can have important clinical implications with regards to improved therapeutic outcomes and reduced morbidity rates.

Predictors of poor outcome in patients with pulmonary arterial hypertension: A single center study

Objectives Pulmonary arterial hypertension (PAH) is a rare disorder with unfavorable prognosis despite implementation of specific PAH-oriented therapy. The aim of the study was to define predictors of poor prognosis in patients from one center treated according to the Polish National Health Fund program. Patients and methods Forty-seven consecutive patients (30 women; aged 39±17 years) with PAH diagnosis were enrolled to the study. Clinical assessment, laboratory measurements, electrocardiogram, echocardiography, 6-minute walk test, 24-hour Holter monitoring, cardiopulmonary exercise test and microvolt T-wave alternans test were performed during routine visits. Eight patients died during 2.6±1.7 years follow-up. Results Parametrs which differentiated patients who died were brain natriuretic peptide (BNP) concentration ≥330 pg/mL (sensitivity 88%, specificity 92%, area under the ROC curve [AUC] 0.92); bilirubin concentration ≥1.2 mg/dL (sensitivity 88%, specificity 81%, AUC 0.85); right atrial area ≥21 cm2 (sensitivity 86%, specificity 69%, AUC 0.84), right ventricular (RV) dimension in the apical 4-chamber view ≥47 mm (sensitivity 86%, specificity 86%, AUC 0.85) and RV to left ventricular diastolic diameter ratio ≥1.5 (sensitivity 83%, specificity 84%; AUC 0.85). In multivariate analysis, independent predictors of mortality were higher BNP (p = 0.04) and bilirubin level (p = 0.03), higher right atrial area (p = 0.02) and lower tricuspid annular plane systolic excursion (p = 0.03). Conclusions In PAH patients treated with specific PAH-oriented therapy right atrial enlargement, impaired right ventricular systolic function, as well as increased BNP and bilirubin concentration was associated with an increased mortality risk.

The association of proton pump inhibitor therapy and small bowel bacterial overgrowth in children

We read with interest the article by Cares et al. [1] in which they report the evidence of small bowel bacterial overgrowth (SIBO) in patients younger than 18 years of age taking a proton pump inhibitor (PPI) for longer than 6 months. The authors concluded that, to date, only one study, published in Jornal de Pediatria, evaluated the risk of SIBO in children taking PPIs [2]. We would like to respectfully add to the authors’ knowledge by making them aware of two other previous publications in the English literature on the same topic. The first was by Rosen et al. [3], a 5-year prospective cohort study in children of 1–8 years of age undergoing bronchoscopy and endoscopy for the evaluation of chronic cough. The concentration and prevalence of gastric and lung bacteria of patients who were receiving PPIs were compared with those not receiving PPIs. It was found that 46% of patients taking PPIs had gastric bacterial growth compared with 18% of untreated patients (P=0.003). In our own study [4], the method used was similar to that by Cares et al. [1]. SIBO was diagnosed in 22.5% of 40 children treated for 3 months with a PPI. In comparison to those without SIBO, children with SIBO had higher frequency of abdominal pain, bloating, eructation, and flatulence. We pointed that patients with gastrointestinal symptoms after PPI treatment should be evaluated for SIBO rather than empirically prolonging PPI therapy.