Rafal Mlynarski

A User‐Friendly Method of Cardiac Venous System Visualization in 64‐Slice Computed Tomography

Background: Previsualization of the cardiac venous system is very important for some techniques, for example, cardiac resynchronization therapy (CRT). The aim of this study was to propose a new, user‐friendly method of cardiac venous system visualization in 64‐slice computed tomography (CT).

Rough set techniques for medical diagnosis systems

The process of discovering natural phenomena or complex system was until recently limited to finding formulas that fit empirical data. This process used with success in science and engineering has its limits when the complexity of the natural processes increases. Therefore, to analyze data in the medical domain an alternative approach was needed. Several mathematical methods including neural nets, inductive learning fuzzy sets and rough sets were proposed to model data in the form of decision tables or rules. Pawlaks rough sets theory for handling imprecision and uncertainty in data has a main advantage over the other techniques which is the possibility to analyze data without any preliminary information what favor its usage in medical decision systems. In this paper we present the results of rule generation from our implementation of the LEM2 algorithm on reduced sets of attributes calculated using the Wrapper method with different learning algorithms

Lead Interaction: Rare Cause of Oversensing During Implantation Procedure of Implantable Cardioverter‐Defibrillator System

A variety of etiologies can cause erroneous detection in patients with implantable cardioverter defibrillator (ICDs). Interaction between two endocardial leads is rare and uncommon in causing electrical noise. During a reimplantation procedure of an ICD system in a 68‐year‐old man, additional electrical signals could be detected. The interaction between two endocardial defibrillation leads was identified as the cause of sensing problems. When it is not possible to extract the nonfunctional endocardial lead during implantation of the new electrode, it should be implanted away and not in parallel from the old one to avoid interaction between them. A variety of etiologies can cause erroneous detection in patiens with ICD. Interaction between two endocardial leads is rare and uncommon to cause electrical noise.

Automated decision support and guideline verification in clinical practice

Applying international guidelines in medical, including cardiological, therapies is a guarantee of safe and modern treatment. Unfortunately, standards are often not obeyed. In this paper we present an experimental software program based on rough sets methods. The main aim of this application is to improve patient care and help the decision process using guidelines verification. We concentrate on the practical aspects using these methods. Examples and clinical tests, which were based on real-life data of our patients, show that the accuracy of results reached on a large group of patients could be acceptable in clinical practice

Frailty Syndrome in Heart Failure Patients who are Receiving Cardiac Resynchronization.

We hypothesized that patients with de novo cardiac resynchronization therapy (CRT) implantation had a more intense frailty syndrome when compared to the patients who qualified for a system upgrade.

The presence of endocardial leads may limit applicability of coronary CT angiography.

Abstract Objectives. Some indications that MSCT is necessary may be visible in patients with implanted pacemakers, CRTs and ICDs devices. Purpose. To evaluate whether the presence of endocardial leads influences the quality of visualization of the coronary arteries in MSCT. Design. In 37 patients a 64-slice MSCT (Aquilion 64, Toshiba) was performed due to a suspicion of ischemic heart disease (33 patients) or suspicion of lead perforation (four patients). The control group consists of 35 patients. Influence of the leads was evaluated independently by two cardiologists. Results. The total number of leads that were evaluated was 63. In 26 cases (41%) significant problems with the evaluation of coronary arteries occurred: LM–1 (2%) case, LAD–3 (5%) cases, LCx–4 (6%) cases, RCA–18 (28%) cases. The presence of a right ventricular lead did not influence the quality of the imaging of the left main coronary artery (LM) and its main branches (LAD and LCx). The main concerns were related to the RCA visualization–interpretable images in 18/63 (29%) of the analyzed leads. Conclusions. The presence of implanted endocardial leads may limit the applicability of coronary CT angiography in patients with implanted anti-arrhythmic devices.

Influence of DDD rate response pacing with integrated double sensors on physical efficiency and quality of life

AIMS The aim of this study was to evaluate whether the use of a double sensor gives additional benefits for patients in improving physical efficiency as well as quality of life (QoL) as compared to the accelerometer sensor alone. METHODS AND RESULTS The presented research is a prospective, randomized, single-blind clinical trial. Double-sensor (accelerometer and minute-ventilation) pacemakers (Guidant, Pulsar Max DR) were implanted in 20 patients with sinus node dysfunction (SND) and chronotropic incompetence. After randomization, patients were placed in one of two groups: 1, only the accelerometer sensor was activated; 2, both sensors were activated. After a 3-month follow-up, an initial cardio-pulmonary exercise test was performed, after which the patients were placed in the opposite group for a further 3 months. Finally, the second tests were performed. In 75% of the patients an improvement in QoL was observed in the double-sensor group (P = 0.0242) when compared with the single-sensor group. The addition of a ventilating sensor had no influence on the duration of exercise test (A: 11 +/- 3.19 vs. B: 11 +/- 2.92 P = 1.0000). The parameters of cardio-pulmonary exercise tests recorded in situations A and B before exertion, and 6 minutes after exertion were not statistically different. CONCLUSION The use of double-sensor pacemakers does not improve physical efficiency; however, it does improve QoL.

Older age and a higher EHRA score allow higher levels of frailty syndrome to be predicted in patients with atrial fibrillation

Abstract Background: There is no research that evaluates the relationship between the severity of the symptoms of atrial fibrillation (AF), the presence of frailty syndrome and acceptance of the illness. Methods: The study included 132 patients aged 72.7 ± 6.73 with diagnosed AF. The severity of the symptoms of AF was determined according to European Heart Rhythm Association (EHRA) guidelines, frailty syndrome was assessed using the Tilburg frailty indicator (TFI) and the acceptance of the illness was assessed using the acceptance of illness scale (AIS). A standard statistical comparison and multiple regression analysis using the stepwise method were performed. Results: In patients with AF, frailty was 5.31 ± 2.69 (TFI). Frailty syndrome was diagnosed in 59.8% of the AF patients who had a score of 7.17 ± 1.72. A higher level of EHRA score was connected with a smaller degree of the acceptance of the illness p = 0.0000. The multiple regression model indicated that age (p = 0.0009) and the severity of the symptoms (p = 0.0001) are important predictors of frailty syndrome. Conclusions: There is a relationship between the presence of frailty syndrome and the intensity of the symptoms and the acceptance of AF. Age and the EHRA score permitted higher levels of frailty syndrome to be predicted.

Coronary venous system in cardiac computer tomography: Visualization, classification and role

The role of the coronary venous system was underestimated for many years. In the last 20 years, a few percutaneous cardiology techniques in which the anatomy of the coronary venous system was significant were developed and are in use. The most important seems to be cardiac resynchronization therapy, which is an invasive method for the treatment of heart failure. Unfortunately, one of the major problems is the significant anatomical variability of the coronary venous system. The description of the selected anatomical structures is only useful in selected cases such as, for example, the obstruction of selected vessels, a huge Thebesian valve, etc. The 3D images can add significant value; however, their usefulness is limited due to the different points of view that are obtained during intra-operational fluoroscopy. After summarizing all of the articles and guidelines, it can be recommended that the visualization of the coronary venous system be performed in certain patients before cardiac resynchronization. The best option is to use tomography with retrospective gating with the optimal reconstruction of cardiac veins that occurs during the diastolic phases.

Coronary Venous Retention—A Feature in Heart Failure as Evidenced by Mean of Cardiac Computed Tomography

Background:  Whether the functional status of the heart can influence the coronary venous system itself has not yet been examined. In order to answer this question, we used multislice computed tomography (CT) imaging.