R. Lenarczyk

Effect of Cardiac Resynchronization on Gradient Reduction in Patients with Obstructive Hypertrophic Cardiomyopathy: Preliminary Study

Background: The purpose of this study was to assess the effectiveness of cardiac resynchronization therapy (CRT) in terms of outflow tract gradient reduction and functional improvement in symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM) requiring implantable cardioverter‐defibrillator (ICD) implantation.

Electrophysiological features of orthodromic atrioventricular reentry tachycardia in patients with Wolff-Parkinson-White syndrome and atrial fibrillation

The aim of this study was to compare the electrophysiological features of tachycardia between WPW patients with and without AF. The study population consisted of 114 patients with WPW syndrome and reciprocating tachycardia during electrophysiological study. Two groups were selected: group I with AF during the procedure (n = 42) and the control group n = 72 without AF (group II). Cycle length (V‐V interval), antero A‐V, retrograde V‐A conduction time during tachycardia and indexes V‐A/V‐V were analyzed. In addition, the relation between antero‐, retrograde conduction time, and V‐V was evaluated. Selection of the most predictive factor for AF presence was performed using regression analysis. Significant differences between the two groups were observed. These included a higher rate of tachycardia, shorter anterograde conduction time, A‐V/V‐V‐indexes, longer retrograde conduction time, and V‐A/V‐V‐indexes in group I compared with group II. Significant, positive correlations between anterograde conduction time and V‐V were present in both groups, but retrograde conduction correlated significantly with the V‐V‐interval only in group II and group I (r = 0.37 vs r =−0.01, respectively). Significant, negative correlations between A‐V and V‐A conduction time in all analyzed points has been found to exist in group I (r =−0.45 for the point of maximal preexcitation [PMP]), whereas there were no significant correlations between these parameters in group II (r = 0.04). The most powerful AF predictor has been identified as the V‐A/V‐V index. The presence of AF in WPW syndrome may be associated with discrete patient characteristics. Ventricular activation occurs earlier, and atrial later, in the tachycardia cycle in AF than in patients free of AF. The different ability of the accessory pathway for adaptation to tachycardia rate changes in group I causes prolonged retrograde conduction over the pathway while the tachycardia rate increases. (PACE 2003; 26[Pt. I]:1479–1488)

Quality of Life in Cardiac Resynchronization Recipients: Association with Response and Impact on Outcome

The prognostic impact of improvement in health‐related quality of life (QoL) and its relation to response in cardiac resynchronization therapy (CRT) recipients remains unknown.

Influence of Reciprocating Tachycardia on the Development of Atrial Fibrillation in Patients with Preexcitation Syndrome

Background: We sought to evaluate the influence of atrio‐ventricular reentrant tachycardia (AVRT) on atrial pressures during tachycardia and the presence of atrial fibrillation (AF) in patients with preexcitation syndrome.

CRT34: HEART RATE VARIABILITY BEHAVIOUR DURING CARDIAC RESYNCHRONIZATION THERAPY

The influence of cardiac resynchronization therapy (CRT) on heart rate variability (HRV) and therefore on autonomic nervous system in the heart has been discussed recently. Purpose of the study to assess the behaviour of HRV parameters in patients (pts) with chronic heart failure (CHF) treated with CRT therapy in three months follow-up. Methods The study group consisted of 17 pts (3F,14M, aged 53±9 years) with CHF at NYHA class III, EF<35% and significant systolic dyssynchrony of the left ventricle in whom BIV pacemakers InSyncIII (Medtronic) were implanted. HRV “time domain” parameters were calculated based on 24-hour digital Holter monitoring which was performed: before the procedure (I), 3-4(II) days after, 1(III), and 3(IV) months after BIV implantation. View this table: Conclusions The decrease of HRV immediately after BIV implantation and the tendency of HRV improvement during CRT therapy in three months follow-up are observed. CRT therapy may improve the autonomic tone in the heart.

CRT14: SLEEP APNEA IN PATIENTS TREATED WITH CARDIAC RESYNCHRONIZATION THERAPY

Purpose of the study to assess the SDB in pts with advanced chronic heart failure (CHF) treated with CRT in 3 months follow-up. Methods: The study group consisted of 17 pts (3F, 14M, aged 53±9 years) with CHF at NYHA class III, EF 5 and≤15) or Apneic (Est.AHI >15). The Est.AHI as well as the percentage of pts qualified for Normal, Borderline or Apneic class from baseline recordings and after 3 months follow-up were calculated. Results Mean value of the Est.AHI before BIV implantation was 7,5±4,6 (range: 23,3-0) and decreased significantly in 3 months follow-up having then the value of 4,6±5,5 (range: 13,0-0); p=0,003. After 3 months follow-up the total and significant reduction of Apneic class and the tendency to increase of Borderline class were observed. View this table: Conclusions In pts treated with CRT therapy in three months follow-up the improvement of sleep apnea parameters is observed. CRT therapy may have beneficial influence on sleep disordered breathing.