Sławomir Sielski

Atrioventricular Conduction Disturbances in Patients with Sinoatrial Node Disease and Atrial Pacing

In sinoatrial node disease (SND) atrial pacing may be limited by progression of AV block. The incidence of AV block after All systems implantation range, according to various authors, from 0% to 12%. The aim of this study was to examine the AV conduction disturbances that forced a change in the mode of pacing in patients with AAI pacemakers. The information was collected retrospectively from a cohort of 122 patients. The follow‐up period ranged from 5 to 83 months (mean = 35J. Among these patients there were 37 with sinus bradycardia and 85 with bradycardia‐tachycardia syndrome. Their mean age was 63 years. Before AAI pacemaker insertion, all patients had normal AV conduction on 12‐lead EGG, and all but five had a Wenckebach cycle length shorter than 500 msec. Seven out of these 122 patients (5.7%) developed symptomatic conduction disturbances (second‐degree type I AV block in five, second degree type II AV block in one, and third‐degree AV block in one], necessitating a change from AAI to another mode of pacing. We conclude that progression of AV block after atrial pacemaker implantation in patients with SND is infrequent and mild in the majority of cases. Intraventricular disturbances such as left anterior hemiblock represent contraindication to AAI pacing particularly in patients who may be in need of antiarrhythmic drugs.

Influence of cardiac resynchronization therapy on oxidative stress markers in patients with chronic heart failure

BACKGROUND The aim of the study was to assess changes of substances of oxidative stress in patients treated with cardiac resynchronization therapy (CRT). METHODS The study comprised 51 patients with median age of 66 years. The presence, severity, and changes of oxidative stress during CRT were assessed and expressed as malondialdehyde (MDA) concentration in plasma or in red blood cells. Antioxidant activity was assessed by the activity of catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GPx) in red blood cells. The concentration and activities were analyzed directly prior to implantation, 2-5 days after the procedure and after 6 months. Follow-up (6 months) included clinical, echocardiographic and implanted device assessments. RESULTS During the follow-up, 14% patients died. The median percentage of biventricular pacing was 99.29%. After 6 months 88% of patients improved NYHA, 12% remained as non-responders. Left ventricular ejection fraction increased from median 21.5% to 29% (p < 0.05). Left ventricular end-diastolic diameter decreased significantly from a median of 69.5 mm to 63 mm (p < 0.05). After a 6-month study, MDA plasma concentration and the activity levels of each antioxidant enzymes (CAT, SOD, GPx) showed a statistically significant reduction (p < 0.05). Changes concerning MDA concentrations in red blood cells remained statistically insignificant. CONCLUSIONS Resynchronization effect oxidative stress by reducing plasma concentration of MDA, CAT, SOD and GPX.

Successful reduction of severe mitral regurgitation after implantation of four MitraClip devices

Mitral regurgitation (MR) is one of the most common valvular heart diseases. According to the current guidelines, surgical treatment may be considered in symptomatic patients with severe functional MR. A therapy using the MitralClip (MC) system may be an alternative approach for patients who are at high surgical risk. The presented case report illustrates, as the first one in Poland, a very rare need for the implantation of 4 MC devices in a symptomatic patient with severe functional MR and indicates feasibility and safety of such management.

Percutaneous left atrial appendage closure for thromboembolic prophylaxis in patients with atrial fibrillation. The impact of operator's experience on the procedure course

Background. Left atrial appendage (LAA) closure represents an alternative strategy to oral anticoagulants in thromboembolic prophylaxis in patients with atrial fibrillation (AF). The LAA closure with the WATCHMAN™ device has been proved to be non-inferior to warfarin therapy. Nevertheless, this strategy is associated with numerous periprocedural complications. This study was conducted to determine whether the experience of the operating team affects the duration of the procedure and its complication rate. Methods. This retrospective single-centre study examined LAA percutaneous closure procedures in 43 consecutive AF patients with contraindications to oral anticoagulation (13 female, 30 male; mean age 70.98 ± 10.69 years). All device implantations were performed by two operators using the WATCHMAN™ device and the result was assessed by two echocardiographers. We compared the first 22 (group A) with the subsequent 21 procedures (group B). Results. For group B, a decrease in the overall procedure time (PT) by 28% (from 83.41 min ± 36.49 to 59.76 min ± 21.70; p = 0.006) was found, with a subsequent reduction in fluoroscopy time (FT) by 33% (from 16.59 min ± 7.25 to 11.2 min ± 7.21; p = 0.019) and the volume of contrast medium (CV) by 40% (from 129.14 mL ± 79.81 to 78.05 mL ± 33.82; p = 0.004). The incidence of periprocedural adverse events and complications was 55% (12 patients) in group A and 33% (7 patients) in group B. Conclusions. The increasing operators’ and echocardiographers’ experience in LAA closure is associated with reduction in procedure time, fluoroscopy time and contrast volume.