Wnuk-Wojnar A

Predictors of Ventricular Tachvcardia Inducibility in Programmed Electrical Stimulation and the Effectiveness of Serial Drug Testing: Polish Multicenter Study

WNUK‐WOJNAR, A.M., ET AL.: Predictors of Ventricular Tachycardia Inducibility in Programmed Electrical Stimulation and Effectiveness of Serial Drug Testing: Polish Multicenter Study. In 100 patients with IHD and complex ventricular arrhythmias, programmed electrical stimulation was performed using up to three extrastimuli at sinus rhythm, and paced 100, 120, and 140 beats/min delivered from the RV apex, outflow tract or the LV with ventricular mapping to evaluate late potentials (LP) in 41 patients. Sustained monomorphic VT (SMVT) was provoked in 91% of 42 patients with a history of VT/VF, p < 0.001, all five patients had SMVT in 24‐hour ECG, p < 0.005, and 91% of 21 patients with LV dyskinesis, p < 0.01. After depolarizations were found in 62% of 21 patients with a history of VT, in 58% of 31 patients with inducible VT, p < 0.01 and in five of six patients with LV dyskinesis. In patients with inducible VT, LP had a higher amplitude (105 ± 35 vs 60 ± 47 µV) and were more delayed (202 ± 96 vs 133 ± 75 msec) than in noninducible patients. In 17 patients, serial drug testing was performed after oral administration using mexilitene, disopyramide, chinidine, propafenone, sotalol, and amiodarone. If one drug was tested, the therapy efficacy was 25% if two drugs‐60%, and if three drugs‐75%. In eight patients, VT was inducible in all tests, but in only one of these patients chronic antiarrhythmic therapy was not effective. We conclude that the most important predictors of VT inducibility are a history of VT or 24‐hour ECG, and LV dyskinesis. Serial drug testing is efficient only when many drugs are tested, but even if VT is inducible, it does not exclude the possibility of a good clinical outcome in chronic therapy.

247 Doppler-echo evaluation of left atrial and ventricular function after circumferential RF catheter ablation of pulmonary veins due to paroxysmal and persistens atrial fibrillation. A prospective 5 m

Background: Hemodynamics of isolated atrial fibrillation (AF) has not been widely investigated, but it is belived to be associated with slight enlargement of left atrial (LA) size and minor degree of left ventricular (LV) diastolic dysfunction, that is presumed rather to be a result than a cause of so called „lone AF”. Positive impact of sinus rhythm restoration by catheter ablation on LA size and LV function remains unclear. Aims: To evaluate the possible reverse remodeling of LV and LA after successful ablation procedure of AF and its relationship with arrhythmia recurrence in prospective 5 months follow-up study with transthoracal and transesophageal echocardiographic examination (TTE and TEE). Methods and results: Sixty two patients, with refractory to antiarrhyhtmic agents and highly symptomatic episodes of paroxysmal and persistent AF underwent circumferential pulmonary vein RF catheter ablation according to Pappone technique. 3-dimensional electroanatomic CARTO system was used. In all patients TTE and TEE was performed before and 5±3 months after procedure, in order to assess LA area and left atrial appendage (LAA) area and flow as well as certain systolic/diastolic LV function parameters (mitral flow A/E ratio, E-wave deceleration time, Tei index, ejection fraction). The influence of LA and LV function parameters change on maintenance of sinus rhythm was studied and conversely, the impact of sinus rhythm restoration on LA and LV function. Seventeen patients reported symptoms of arrhythmia, whereas 45 remained AF free. There were nether clinical nor echocardiographic baseline data determining ablation success rate. We found significant difference as far as LVEF was concerned before and after ablation procedure (62±3%, 64±4%; p<0.01), with no significance but still a positive trend (p=0.06) in a subgroup presenting with no arrhythmia recurrence at follow-up. We found evident correlation between certain, but not all LV systolic/diastolic parameters at the time of follow-up and the recurrence of arrhythmia. The most significant parameter for arrhythmia recurrence in our study was Tei index, that deteriorated significantly in patients with unsuccessful ablation. Conclusions: Five months follow-up after CPVI, with echo performance shows good clinical results, with significant improvement of some but not all LV systolic/diastolic function parameters.

A Clinical Study on Platelet Preservation in Coronary Artery Bypass Surgery During Cardiopulmonary Bypass Without Oxygenator

The direct blood gas interface in bubble oxygenators is thought to be the main causative factor in the production of platelet (Plt) damage and bleeding unrelated to technical problems. To diminish the unphysiological surface area, the elimination of membrane or bubble oxygenator by the technique of extracorporeal circulation (ECC) with patient’s lungs used for oxygenation (autooxygenation technique [2]) was introduced.

Predictive Value of Various Types of Ventricular Response to Programmed Ventricular Stimulation: Relation to Holter Monitoring

The study was performed to determine the predictive value of programmed stimulation for identification of pts with ventricular arrhythmias: 75 patients were studied by means of 24‐hour ambulatory ECG (24 ECG) and programmed right (in some patients also left) ventricle stimulation at sinus and two or three pacing rates using two (standard) and three extrastimuli or burst stimulation (extensive protocol). Lown classes 0.1–3 and 4a–4h were observed in 24 ECG in 35, 14, and 26 patients, respectively. In programmed stimulation 1–6 repetitive ventricular responses (RVR) were found in 56 pts, nonsustained ventricular tachycardia in 11 and sustained ventricular tachycardia in 21 pts. High incidence of induced VT was found in pts with complex ventricular arrhythmia in 24 ECG, 81% of this group, in all but six pts only standard protocol was used. The 1–6 RVR were observed in almost 40% of pts without any arrhythmia. Conclusion; Only VT induction is a useful index for high risk patients.