Publications by authors named "Milos Taborsky"

103 Publications

Effects of Epoxyeicosatrienoic Acid-Enhancing Therapy on the Course of Congestive Heart Failure in Angiotensin II-Dependent Rat Hypertension: From mRNA Analysis towards Functional In Vivo Evaluation.

Biomedicines 2021 Aug 20;9(8). Epub 2021 Aug 20.

Department of Internal Medicine I, Cardiology, University Hospital Olomouc and Palacký University, I.P. Pavlova 185/6, Nová Ulice, 779 00 Olomouc, Czech Republic.

This study evaluates the effects of chronic treatment with EET-A, an orally active epoxyeicosatrienoic acid (EETs) analog, on the course of aorto-caval fistula (ACF)-induced heart failure (HF) in Ren-2 transgenic rats (TGR), a model characterized by hypertension and augmented activity of the renin-angiotensin system (RAS). The results were compared with standard pharmacological blockade of the RAS using angiotensin-converting enzyme inhibitor (ACEi). The rationale for employing EET-A as a new treatment approach is based on our findings that apart from increased RAS activity, untreated ACF TGR also shows kidney and left ventricle (LV) tissue deficiency of EETs. Untreated ACF TGR began to die 17 days after creating ACF and were all dead by day 84. The treatment with EET-A alone or ACEi alone improved the survival rate: in 156 days after ACF creation, it was 45.5% and 59.4%, respectively. The combined treatment with EET-A and ACEi appeared to improve the final survival to 71%; however, the difference from either single treatment regimen did not reach significance. Nevertheless, our findings support the notion that targeting the cytochrome P-450-dependent epoxygenase pathway of arachidonic acid metabolism should be considered for the treatment of HF.
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http://dx.doi.org/10.3390/biomedicines9081053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8393645PMC
August 2021

Trends in the treatment and survival of heart failure patients: a nationwide population-based study in the Czech Republic.

ESC Heart Fail 2021 Aug 19. Epub 2021 Aug 19.

Department of Medicine II - Cardiology and Angiology, The General Teaching Hospital in Prague, Praha 2, Czech Republic.

Aims: A retrospective nationwide observational analysis of diagnoses, procedures, and treatment reported to the Czech National Registry of Reimbursed Health Services between 2012 and 2018.

Methods And Results: Prevalence of heart failure (HF) patients increased from 176 496 (1679.4 per 100 000 population) in 2012 to 285 745 (2689.0 per 100 000 population) patients in 2018 (mean age 74.4 ± 12.8 years). In the last years, a stable incidence of HF patients was observed (544 per 100 000 population in 2016 vs. 551 per 100 000 population in 2018; P = 0.310). Mortality rate decreased from 20.55% in 2012 to 15.89% in 2018. The number of hospitalized patients remained similar (318.2 per 100 000 population in 2012 vs. 311.8 per 100 000 population in 2018; P = 0.479). The most used drugs were diuretics (173 295; 60.6%) and beta-blockers (178 823; 62.6%), followed by angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (angiotensin-converting enzyme inhibitors 120.581; 42.2%; angiotensin II receptor blockers 47 216; 16.5%). Even though the whole number of implanted devices in HF patients increased steadily (from 25 205 in 2012 to 45 363 in 2018), the prevalence of all devices (pacemakers and defibrillators) in the HF patients remained about the same (14.3% in 2012; 15.9% in 2018).

Conclusions: The study included all patients with HF in the Czech Republic. These are the first nationwide data of HF epidemiology in the Eastern bloc. The incidence of HF remains stable in the last years. Due to aging of the population, the prevalence of HF significantly increased in the last 6 years. Despite a continuous increase in the prevalence of HF and a suboptimal utilization of its pharmacological therapy, mortality decreased, and the number of hospitalized patients remained the same.
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http://dx.doi.org/10.1002/ehf2.13559DOI Listing
August 2021

Interventional prevention of paradoxical embolism as the gold standard: End of discussion?

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021 Jun 14. Epub 2021 Jun 14.

Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic.

Paradoxical embolism is one of the predominant causes of cryptogenic stroke and interventional secondary prevention, i.e., closure of the patent foramen ovale (PFO), is a much discussed issue. This review aims to provide a complex perspective on this topic, aggregates and comments on the available data and current guidelines. Several large trials were performed, some of which proved the superiority of PFO closure over pharmacotherapy while others have not. Studies detecting significant superiority of intervention worked with disproportionately high representation of large shunts compared to the general population. Other controversies also remain, such as the lack of comparison of the effect of modern anticoagulant/antiplatelet treatment to PFO closure or the risk of developing unwanted side effects after intervention, and these are discussed in detail. PFO closure is a suitable method for secondary prevention of paradoxical embolism and, therefore, cryptogenic stroke. However, this is only true for carefully selected patient populations and such selection is of the utmost importance in deciding on interventional or conservative treatment.
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http://dx.doi.org/10.5507/bp.2021.036DOI Listing
June 2021

Angiotensin-converting enzyme inhibitors, angiotensin-II-receptor antagonists and angiotensin-receptor blocker/neprilysin inhibitor utilization in heart failure patients: Sub-analysis of a nation-wide population-based study in the Czech Republic.

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021 Jun 4. Epub 2021 Jun 4.

Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Olomouc, Czech Republic.

Aims: Sub-analysis of a retrospective nation-wide observational analysis of heart failure (HF) epidemiology reported to the Czech National Registry of Reimbursed Health Services between 2012 and 2018 aimed at angiotensin-converting enzyme inhibitors (ACEI), angiotensin-II-receptor antagonists (ARB) and angiotensin receptor blocker/neprilysin inhibitor (ARNI) use.

Methods And Results: ACEi and ARBs were generally used in 87.6% of all HF patients in 2012 (n=154 627); 84.5% in 2013 (n=170 861); 83.5% in 2014 (n=186 963); 81.6% in 2015 (n=198 844); 80.1% in 2016 (n=205 793); 78.0% in 2017 (n=212 152) and in 76.7% in 2018 (n=219 235). In a sub-analysis of patients with a medical procedure and/or examination using an I50.x ICD code accounted for in the given year, ACEi and ARBs were generally used in 99.3% in 2012 (n=63 250); 96% in 2013 (n=62 241); 95.2% in 2014 (n=64 414); 93.3% in 2015 (n=65 217); 91.8% in 2016 (n=65 236); 90.1% in 2017 (n=65 761) and in 88.6% in 2018 (n=66 332). In 2018, the majority of patients with HF were prescribed ramipril (n=49 909; 17.5%) and perindopril (n=44 332; 15.5%). The mostly prescribed ARBs in 2018 were telmisartan (n=18 669; 6.5%); losartan (n=13 935; 4.9%) and valsartan (n=4 849; 1.7%). In 24.5% of cases, ACEIs and ARBs were prescribed in a fixed combination with another drug. ARNI became gradually more prescribed from 2018 (n=9 659 in November 2020).

Conclusion: In an analysis of ACEIs, ARBs and ARNIs utilization in all patients treated for heart failure in the given year in the whole country, we found a comparable rate of drug prescription in comparison with specific heart failure registries. This indicates a good translation of current standard of care into common clinical practice. Ramipril and perindopril remained the mostly prescribed ACEIs and telmisartan became the mostly prescribed ARB. Since 2018, ARNIs began to be widely prescribed.
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http://dx.doi.org/10.5507/bp.2021.035DOI Listing
June 2021

Directly Measured Adherence to Treatment in Chronic Heart Failure: LEVEL-CHF Registry.

Am J Med Sci 2021 04 7;361(4):491-498. Epub 2020 Dec 7.

1st Department of Internal Medicine - Cardiology, Faculty of Medicine and Dentistry, Olomouc University Hospital, Palacky University, Olomouc, Czech Republic.

Background: Currently, most available data on the medication adherence of patients with chronic heart failure are based on indirect methods. We examined the level of adherence to medical therapy using a direct method - serum drug level testing.

Methods: We carried out a prospective single-centre registry of patients with chronic heart failure (LEVEL-CHF registry), in whom we analysed serum levels of the medications prescribed for the treatment of heart failure: angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers and mineralocorticoid receptor antagonists. We labelled a patient as non-adherent if at least one serum level of a prescribed drug was unmeasurable (below the detection limit). Patients with all tested drugs identifiable in serum were labelled as adherent. We enrolled 274 patients (208 men and 66 women) mean age 62 years.

Results: 82.5% of patients were adherent and 17.5% non-adherent to prescribed medications. 3.6% were completely non-adherent without any detectable drugs in serum. Patients aged <60 years were more likely to be non-adherent than older patients (OR 2.15). No other clinical or laboratory parameters predicted non-adherence.

Conclusions: A significant proportion of outpatients with chronic heart failure were non-adherent to treatment when assessed by a direct method of serum drug level testing. Non-adherence was more likely in younger patients.
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http://dx.doi.org/10.1016/j.amjms.2020.12.004DOI Listing
April 2021

Cardiac Resynchronization and Defibrillator Therapy (CRT-D) or CRT Alone (CRT-P) in patients with dilated cardiomyopathy and heart failure without late gadolinium enhancement (LGE) cardiac magnetic resonance imaging (CMRI) high-risk markers - CRT-REALITY study - Study design and rationale.

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021 Mar 12. Epub 2021 Mar 12.

Institute for Biostatistics and Analyses of Faculty of Medicine Brno, Czech Republic.

Background: Primary preventive implantation of implantable defibrillator (ICD) is according to current guidelines indicated in patients with heart failure NYHA (New York Heart Association) class II/III and LVEF <35%. Thanks to advances in heart failure pharmacotherapy, a decrease in mortality could render a benefit of ICD insufficient to justify its implantation in some patients.

Methods: Study design: multicenter, prospective, randomized, controlled trial evaluating the benefit of implantation of Cardiac Resynchronization and Defibrillator Therapy (CRT-D) or CRT Alone (CRT-P) in non-ischemic patients with reduced left ventricle ejection fraction (LVEF) and optimal pharmacotherapy without significant mid-wall myocardial fibrosis detected by cardiac magnetic resonance (CMR). The primary end-point: Re-hospitalization for heart failure, ventricular tachycardia, major adverse cardiac events (MACE). The secondary end-points: Sudden cardiac death, cardiovascular death, resuscitated cardiac arrest or sustained ventricular tachycardia, device-related complications, and change in quality of life. Course of the study: After a pharmacotherapy is optimized and significant mid-wall myocardial fibrosis excluded, patients will be randomized 1:1 to CRT-P or CRT-D implantation.

Discussion: If our hypothesis is confirmed, this could provide evidence for the management of these patients with a significant impact on common daily praxis and health care expenditures.

Trial Registration: ClinicalTrials.gov, NCT04139460.
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http://dx.doi.org/10.5507/bp.2021.015DOI Listing
March 2021

Beta-blockers utilization in heart failure patients: Sub-analysis of a nation-wide population-based study in the Czech Republic.

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020 Dec 15. Epub 2020 Dec 15.

Department of Internal Medicine I - Cardiology, University Hospital Olomouc, 775 20 Olomouc, Czech Republic.

Aims: Sub-analysis of a retrospective nation-wide observational analysis of heart failure (HF) epidemiology reported to the Czech National Registry of Reimbursed Health Services between 2012 and 2018 aimed at beta-blockers (BBs) utilization.

Methods And Results: The beta-blockers were generally used in 81.8% of all patients treated for HF in 2012 (n=52 140); 81.8% in 2013 (n=53 058); 83.1% in 2014 (n=56 221); 82.1% in 2015 (n=57 421); 83.3% in 2016 (n=59 187); 82.2% in 2017 (60 058) and in 81.4% in 2018 (n=60 966). In 2018, the majority of patients treated for HF were prescribed metoprolol (22 974; 30.7%) and bisoprolol (21 001; 28%). Carvedilol was prescribed in 7 331 patients treated for HF (9.8%), nebivolol in 5 392 HF patients. Despite its primary indication, betaxolol was used in 2 341 patients treated for HF (3.1%). All other beta-blockers were used in less than 1% of HF patients. In some of the mostly used BBs, their prescription in patients treated for HF changed in the last years (metoprolol 32.4% in 2012, 30.7% in 2018; bisoprolol 20.3% in 2012, 28% in 2018; carvedilol 18.3% in 2012, 9.8% in 2018; nebivolol 2.5% in 2012, 7.2% in 2018; betaxolol 4.2% in 2012, 3.1% in 2018).

Conclusion: In an analysis of beta-blockers utilization in all patients treated for heart failure in the given year in the whole country, we have found only slightly lower amount of drug prescription in comparison with specific heart failure registries. This indicates a good translation of current standard of care into common clinical practice. Metoprolol remained the mostly prescribed drug. The prescription of bisoprolol and nebivolol has increased at the expense of carvedilol.
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http://dx.doi.org/10.5507/bp.2020.057DOI Listing
December 2020

SETAP: epidemiology and prevention of stroke and transient ischaemic attack in Czech patients with atrial fibrillation.

Europace 2021 04;23(4):539-547

Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Olomouc 775 20, Czech Republic.

Aims: The aim of this study is to analyse the prevalence, epidemiology, and anticoagulation prevention of stroke or transient ischaemic attack (TIA) in Czech patients with atrial fibrillation (AF).

Methods And Results: Retrospective observational analysis of diagnoses, procedures, and treatment reported to the Czech National Registry of Reimbursed Healthcare Services between 2015 and 2018. Prevalence of AF in 2018 was 4.3% of Czech population and the prevalence of stroke/TIA in AF patients was 22.3% with annual incidence of 181.62 cases per 100 000 inhabitants. In 2018, CHA2DS2-ASc score ≥4 was present in 98% AF patients in secondary and 59% in primary prevention, respectively, while the anticoagulation treatment was used by 71-81% of them. Between 2015 and 2018, the percentage of AF patients treated with warfarin monotherapy in primary prevention decreased from 35% to 31%, with acetylsalicylic acid (ASA) monotherapy from 18% to 16% and non-vitamin K antagonist oral anticoagulants (NOACs) monotherapy increased from 7% to 11%. In secondary prevention, the percentage of warfarin monotherapy treatment decreased from 35% to 32%, with ASA monotherapy from 20% to 18% and with NOACs monotherapy increased from 9% to 15%.

Conclusion: This study followed all Czech patients with AF. The unadjusted prevalence and incidence of AF was higher compared with other countries and 2019 European Society of Cardiology Statistics. The study identified several gaps in standard of reimbursed care. 20-30% of AF patients with other risk factors were without any prevention medication and the share of ASA monotherapy in treated patients was 16-18%.
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http://dx.doi.org/10.1093/europace/euaa261DOI Listing
April 2021

Arterial Hypertension and Risk of Recurrent Event in Young Ischemic Stroke Patients.

Can J Neurol Sci 2021 05 11;48(3):358-364. Epub 2020 Sep 11.

Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, Olomouc, Czech Republic.

Introduction: In young patients, the cause of ischemic stroke (IS) remains often cryptogenic despite presence of traditional vascular risk factors (VRFs). Since arterial hypertension (AH) is considered the most important one, we aimed to evaluate the impact of AH and blood pressure (BP) levels after discharge on risk of recurrent IS (RIS) in young patients.

Methods: The study set consisted of acute IS patients < 50 years of age enrolled in the prospective Heart and Ischemic STrOke Relationship studY registered on ClinicalTrials.gov (NCT01541163). Cause of IS was assessed according to the ASCOD classification.

Results: Out of 319 enrolled patients <50 years of age (179 males, mean age 41.1 ± 7.8 years), AH was present in 120 (37.6%) of them. No difference was found in the rates of etiological subtypes of IS between patients with and without AH. Patients with AH were older, had more VRF, used more frequently antiplatelets prior IS, and had more RIS (10 vs. 1%, p = 0.002) during a follow-up (FUP) with median of 25 months. Multivariate logistic regression stepwise model showed the prior use of antiplatelets as only predictor of RIS (p = 0.011, OR: 6.125; 95% CI: 1.510-24.837). Patients with elevated BP levels on BP Holter 1 month after discharge did not have increased rate of RIS during FUP (3.8 vs. 1.7%, p = 1.000).

Conclusion: AH occurred in 37.6% of young IS patients. Patients with AH had more frequently RIS. Prior use of antiplatelets was found only predictor of RIS in young IS patients with AH.
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http://dx.doi.org/10.1017/cjn.2020.200DOI Listing
May 2021

Pseudoaneurysm as a rare very late complication of transradial cardiac catheterization.

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020 Jun 26. Epub 2020 Jun 26.

Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic.

Aims: Here, we report a case of very late (70+ days) development of pseudoaneurysm on the site of sheath insertion in a 60- year old woman.

Methods: The patient underwent cardiac catheterization using transradial approach.

Results: Despite the transradial approach, which is generally considered as a suitable prevention of this problem, and despite absence of any periprocedural complications, the patient developed a pseudoaneurysm after more than 70 days from the procedure.

Conclusions: In some cases, a pseudoaneurysm may develop extremely late after cardiac catheterization. Such an extremely late development of pseudoaneurysm has not been described in literature so far.
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http://dx.doi.org/10.5507/bp.2020.027DOI Listing
June 2020

Left Atrial Appendage Closure Versus Direct Oral Anticoagulants in High-Risk Patients With Atrial Fibrillation.

J Am Coll Cardiol 2020 06;75(25):3122-3135

Cardiocenter, Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic; Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address:

Background: Percutaneous left atrial appendage closure (LAAC) is noninferior to vitamin K antagonists (VKAs) for preventing atrial fibrillation (AF)-related stroke. However, direct oral anticoagulants (DOACs) have an improved safety profile over VKAs, and their effect on cardiovascular and neurological outcomes relative to LAAC is unknown.

Objectives: This study sought to compare DOACs with LAAC in high-risk patients with AF.

Methods: Left Atrial Appendage Closure vs. Novel Anticoagulation Agents in Atrial Fibrillation (PRAGUE-17) was a multicenter, randomized, noninferiority trial comparing LAAC with DOACs. Patients were eligible to be enrolled if they had nonvalvular AF; were indicated for oral anticoagulation (OAC); and had a history of bleeding requiring intervention or hospitalization, a history of a cardioembolic event while taking an OAC, and/or a CHADS-VASc of ≥3 and HAS-BLED of >2. Patients were randomized to receive LAAC or DOAC. The primary composite outcome was stroke, transient ischemic attack, systemic embolism, cardiovascular death, major or nonmajor clinically relevant bleeding, or procedure-/device-related complications. The primary analysis was by modified intention to treat.

Results: A high-risk patient cohort (CHADS-VASc: 4.7 ± 1.5) was randomized to receive LAAC (n = 201) or DOAC (n = 201). LAAC was successful in 181 of 201 (90.0%) patients. In the DOAC group, apixaban was most frequently used (192 of 201; 95.5%). At a median 19.9 months of follow-up, the annual rates of the primary outcome were 10.99% with LAAC and 13.42% with DOAC (subdistribution hazard ratio [sHR]: 0.84; 95% confidence interval [CI]: 0.53 to 1.31; p = 0.44; p = 0.004 for noninferiority). There were no differences between groups for the components of the composite endpoint: all-stroke/TIA (sHR: 1.00; 95% CI: 0.40 to 2.51), clinically significant bleeding (sHR: 0.81; 95% CI: 0.44 to 1.52), and cardiovascular death (sHR: 0.75; 95% CI: 0.34 to 1.62). Major LAAC-related complications occurred in 9 (4.5%) patients.

Conclusions: Among patients at high risk for stroke and increased risk of bleeding, LAAC was noninferior to DOAC in preventing major AF-related cardiovascular, neurological, and bleeding events. (Left Atrial Appendage Closure vs. Novel Anticoagulation Agents in Atrial Fibrillation [PRAGUE-17]; NCT02426944).
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http://dx.doi.org/10.1016/j.jacc.2020.04.067DOI Listing
June 2020

General anesthesia or conscious sedation in paroxysmal atrial fibrillation catheter ablation.

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021 Jun 6;165(2):162-168. Epub 2020 Apr 6.

Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic.

Background: Catheter ablation of paroxysmal atrial fibrillation (AF) can be performed under general anesthesia or conscious sedation. The influence of type of anesthesiology care on procedural characteristics and ablation outcome in patients in whom intracardiac echocardiography (ICE) and elimination of adenosine-mediated dormant conduction (DC) is used is not entirely known.

Methods: 150 patients with paroxysmal AF were randomized to point-by-point radiofrequency catheter isolation of pulmonary veins (PVI) under general anesthesia (n=77) or conscious sedation (n=73). Adenosine-mediated dormant conduction was eliminated in all patients. Antiarrhythmic medication was discontinued after PVI. During twelve months of follow-up, all patients underwent four times 7-day ECG monitorings.

Results: There was no difference between groups in AF recurrence (28.6% vs. 31.5%, P=0.695). Patients in conscious sedation had longer procedure times (160 ± 32.1 vs. 132 ± 31.5 min, P<0.001), longer RF energy application times (40 ± 15 vs. 29 ± 11 min, P<0.001) and longer fluoroscopy times (6.2 min ± 5.3 vs. 4.3 min ± 2.2, P<0.001) with similar complication rates.

Conclusion: Conscious sedation is not inferior to general anesthesia in regard to arrhythmia recurrence or complication rates of catheter ablation of paroxysmal atrial fibrillation. However, it is associated with longer procedure times, longer time of radiofrequency energy application and longer fluoroscopy times.
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http://dx.doi.org/10.5507/bp.2020.012DOI Listing
June 2021

Acute myocardial infarction, intraventricular thrombus and risk of systemic embolism.

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020 Mar 31;164(1):34-42. Epub 2020 Jan 31.

Department of Internal Medicine I - Cardiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic.

The development of left ventricular thrombus (LVT) is a well-known and serious complication of acute myocardial infarction (AMI) due to the risk of systemic arterial embolism (SE), which is variable in its clinical picture and has potentially serious consequences depending on the extent of target organ damage. SE results in an increase in mortality and morbidity in these patients. LVT is one of the main causes of the development of ischaemic cardio-embolic cardiovascular events (CVE) after MI and the determination of the source of cardiac embolus is crucial for the initiation of adequate anticoagulant therapy in secondary prevention. Echocardiography holds an irreplaceable place in the diagnosis of LVT, contrast enhancement provides higher sensitivity. The gold standard for LVT diagnosis is cardiac magnetic resonance imaging, but it is not suitable as a basic screening test. In patients with already diagnosed LVT, it is necessary to adjust antithrombotic therapy by starting warfarin anticoagulation for at least 6 months with the need for echocardiographic follow-up to detect thrombotic residues. The effect of prophylactic administration of warfarin in high-risk patients after anterior AMI does not outweigh the risk of severe bleeding complications and does not result in a decrease in mortality and morbidity. At the present time, there is not enough evidence to use direct oral anticoagulants in this indication.
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http://dx.doi.org/10.5507/bp.2020.001DOI Listing
March 2020

Alcohol Use in the Czech Republic – Joint Statement of the Society for Addiction Medicine of the J. E. Purkyně Czech Medical Association and the Czech Society of Cardiology

Cent Eur J Public Health 2019 12;27(Suppl):S3-S5

Institute of Medical Biochemistry and Laboratory Diagnostic, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic

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http://dx.doi.org/10.21101/cejph.a5972DOI Listing
December 2019

Increased Expression of miR-146a in Valvular Tissue From Patients With Aortic Valve Stenosis.

Front Cardiovasc Med 2019 26;6:86. Epub 2019 Jun 26.

Department of Pathological Physiology, Faculty of Medicine Dentistry, Palacky University, Olomouc, Czechia.

miR-146a has been implicated in the regulation of the immune response as well as in inflammatory process of atherosclerosis. In the present study, we have investigated the expression of miR-146a and its targets, TLR4 a IRAK1, in aortic valve stenosis. A total of 58 patients with aortic stenosis (non- and atherosclerotic; tissue obtained during standard aortic valve replacement) were enrolled. The relative expression of mir-146a was higher in valvular tissue from patients with atherosclerosis compared to those without atherosclerosis ( = 0.01). Number of the IRAK1 and TLR4 transcripts did not differ between the investigated groups. There was a trend toward elevation of miR-146a expression in context of inflammatory infiltrate observed in the valvular tissue from patients with atherosclerosis ( = 0.06). In conclusion, in line with the acknowledged role of miR-146a in atherosclerotic inflammation, our data suggest it may be extended to the specific location of aortic valves in aortic stenosis.
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http://dx.doi.org/10.3389/fcvm.2019.00086DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6606704PMC
June 2019

Transmission and loss of ECG snapshots: Remote monitoring in implantable cardiac monitors.

J Electrocardiol 2019 Sep - Oct;56:24-28. Epub 2019 Jun 14.

Rigshospitalet Copenhagen, Cardiology, Blegdamsvej 9, 2100 Copenhagen, Denmark.

Introduction: Remote monitoring including transmission of electrocardiogram (ECG) strips has been implemented in implantable cardiac monitors (ICM). We appraise whether the physician can rely on remote monitoring to be informed of all possibly significant arrhythmias.

Methods: We analyzed remote monitoring transmissions of patients in the ongoing BIO|GUARD-MI study, in which Biotronik devices are used. Once per day, the devices automatically transmit messages with up to six ECG snapshots to the Home Monitoring Service Center. If more than one type of arrhythmia is recorded during a day, at least one ECG of each arrhythmia type is transmitted.

Results: 212 study patients were registered at the service center. The mean age of the patients was 70 ± 8 years, and 74% were male. Patients were followed for an average of 13 months. The median time from device implantation until the first message receipt in the service center was 2 days. The median patient-individual transmission success was 98.0% (IQR 93.6-99.8) and remained stable in the second and third year. The most frequent arrhythmias were atrial fibrillation, bradycardia and high ventricular rate. 17.3% of the messages with ECG snapshots contained more than one arrhythmia type.

Discussion: Our analysis confirms that the physician can rely on Home Monitoring to be informed of all possibly significant arrhythmias during long-term follow-up. We have found hints that the transmission of only one episode per day may lead to the loss of clinically relevant information if patients with ICMs are followed by remote monitoring only.
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http://dx.doi.org/10.1016/j.jelectrocard.2019.06.005DOI Listing
June 2021

Clinical evaluation of a small implantable cardiac monitor with a long sensing vector.

Pacing Clin Electrophysiol 2019 07 5;42(7):1038-1046. Epub 2019 Jun 5.

Clinic for Cardiology and Angiology, St. Elisabeth Hospital Essen, Essen, Germany.

Introduction: We conducted this study to show the safety and efficacy of a new implantable cardiac monitor (ICM), the BioMonitor 2 (Biotronik SE & Co. KG; Berlin, Germany), and to describe the arrhythmia detection performance.

Methods: The BioMonitor 2 has an extended sensing vector and is implanted close to the heart. It can transmit up to six subcutaneous electrocardiogram strips by Home Monitoring each day. We enrolled 92 patients with a standard device indication for an ICM in a single-arm, multicenter prospective trial. Patients were followed for 3 months, and 48-h Holter recordings were used to evaluate the arrhythmia detection performance.

Results: One patient withdrew consent and in one patient, the implantation failed. Two study device-related serious adverse events were reported, satisfying the primary safety hypothesis. Implantations took 7.4 ± 4.4 min from skin cut to suture. At 1 week, the R-wave amplitude was 0.75 ± 0.53 mV. In the 82 patients with completed Holter recordings, all patients with arrhythmias were correctly identified. False positive detections of arrhythmia were mostly irregular rhythms wrongly detected as atrial fibrillation (episode-based positive predictive value 72.5%). Daily Home Monitoring transmission was 94.9% successful.

Conclusion: Safety and efficacy of the new device has been demonstrated. The detected R-wave amplitudes are large, leading to a low level of inappropriate detections due to over- or undersensing.
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http://dx.doi.org/10.1111/pace.13728DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6851891PMC
July 2019

Ventricular tachycardia: a presentation of Fabry disease case report.

Eur Heart J Case Rep 2019 Mar 22;3(1):yty154. Epub 2018 Dec 22.

Department of Internal Medicine-Cardiology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc, Czech Republic.

Background: Fabry disease is an inherited rare metabolic disease caused by mutation in the gene, encoding lysosomal enzyme alpha-galactosidase A. The disorder is a systemic disease that manifests as cerebrovascular and cardiac disease, chronic renal failure, skin lesion, peripheral neuropathy, and other abnormalities. Ventricular tachycardia as a Fabry disease presentation is very rare.

Case Summary: A 36-year-old man self-presented to a general practitioner complaining of episodes of shortness of breath together with a 6-month history of malaise. The 12-lead electrocardiogram (ECG) prompted a decision to transfer him immediately to a percutaneous coronary intervention (PCI) capable hospital under the suspicion of acute coronary syndrome. Whilst awaiting transport, he experienced acute onset of dyspnoea together with non-specific chest heaviness. A repeat ECG monitor strip showed ventricular tachycardia transforming to ventricular fibrillation. The patient was successfully defibrillated. Coronary angiography was performed upon arrival at hospital and demonstrated unobstructed coronary arteries. Transthoracic echocardiography revealed concentric left ventricular hypertrophy (LVH) and normal systolic function, with severe diastolic dysfunction. Magnetic resonance imaging (MRI) confirmed the LVH, and did not demonstrate any late gadolinium enhancement.

Discussion: Our case illustrates the pivotal role of critical clinical thinking in the diagnosis of rare but treatable hereditary cardiomyopathy. The uncommon cardiac presentation of Fabry disease promotes further research linking different phenotypes of Fabry disease with different pathogenic mutations.
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http://dx.doi.org/10.1093/ehjcr/yty154DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6439386PMC
March 2019

Implant-based multi-parameter telemonitoring of patients with heart failure and a defibrillator with vs. without cardiac resynchronization therapy option: a subanalysis of the IN-TIME trial.

Clin Res Cardiol 2019 Oct 14;108(10):1117-1127. Epub 2019 Mar 14.

Department of Electrophysiology, University of Leipzig, Heart Center, Leipzig, Germany.

Aims: In the IN-TIME trial, automatic daily implant-based multiparameter telemonitoring significantly improved clinical outcomes in patients with chronic systolic heart failure and implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D). We compared IN-TIME results for ICD and CRT-D subgroups.

Methods: Patients with LVEF ≤ 35%, NYHA class II/III, optimized drug treatment, no permanent atrial fibrillation, and a dual-chamber ICD (n = 274) or CRT-D (n = 390) were randomized 1:1 to telemonitoring or no telemonitoring for 12 months. Primary outcome measure was a composite clinical score, classified as worsened if the patient died or had heart failure-related hospitalization, worse NYHA class, or a worse self-reported overall condition.

Results: The prevalence of worsened score at study end was higher in CRT-D than ICD patients (26.4% vs. 18.2%; P = 0.014), as was mortality (7.4% vs. 4.1%; P = 0.069). With telemonitoring, odds ratios (OR) for worsened score and hazard ratios (HR) for mortality were similar in the ICD [OR = 0.55 (P = 0.058), HR = 0.39 (P = 0.17)] and CRT-D [OR = 0.68 (P = 0.10), HR = 0.35 (P = 0.018)] subgroups (insignificant interaction, P = 0.58-0.91).

Conclusion: Daily multiparameter telemonitoring has a potential to reduce clinical endpoints in patients with chronic systolic heart failure both in ICD and CRT-D subgroups. The absolute benefit seems to be higher in higher-risk populations with worse prognosis.
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http://dx.doi.org/10.1007/s00392-019-01447-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6753058PMC
October 2019

Atrial fibrillation inducibility after pulmonary vein isolation under general anaesthesia.

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020 Sep 4;164(3):261-266. Epub 2019 Mar 4.

Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic.

Aims: Atrial fibrillation (AF) inducibility with rapid atrial pacing following AF ablation is associated with higher risk of AF recurrence. The predictive value of AF inducibility in paroxysmal AF patients after pulmonary vein isolation (PVI), done under general anaesthesia (GA), remains questionable since GA might alter AF inducibility and/or sustainability.

Methods: Consecutive patients (n = 120) with paroxysmal AF without prior catheter ablation (CA) were enlisted in the study. All patients were ablated under GA. We have used a point-by-point CA and elimination of dormant conduction after adenosine in all patients. A predefined stimulation protocol was used to induce arrhythmias after PVI. Regular supraventricular tachycardias were mapped and ablated. Patients were divided into 3 subgroups - noninducible, inducible AF with spontaneous termination in five minutes, inducible AF without spontaneous termination. During 12 months of follow-up, all patients were examined four-times with 7-day ECG recordings.

Results: There was no statistical difference between the three subgroups in a rate of arrhythmia recurrence (11.1 vs. 27.5 vs. 27.3%, P=0.387), despite a clear trend to a better success rate in the non-inducible group. The subgroups did not differ in left atrial (LA) diameter (41.0±6, 43.0±7, 42.0±5 mm, P=0.962) or in any other baseline parameter.

Conclusion: AF inducibility as well as presence or absence of its early spontaneous termination after PVI done under general anaesthesia in paroxysmal AF patients were not useful as predictors of procedural failure.
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http://dx.doi.org/10.5507/bp.2019.004DOI Listing
September 2020

Long-term outcome of paroxysmal atrial fibrillation catheter ablation with and without pulmonary vein dormant conduction after adenosine challenge.

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020 Jun 4;164(2):147-153. Epub 2019 Mar 4.

Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic.

Objectives: The prognostic significance of adenosine-mediated pulmonary vein (PV) dormant conduction is unclear. We prospectively followed patients with adenosine-mediated PV reconduction with a subsequent repeated ablation until there was no reconduction inducible with patients without reconduction after PV isolation.

Method And Results: Consecutive patients (n=179) with paroxysmal atrial fibrillation (AF) without prior catheter ablation (CA) were enlisted in the study. We used a point-by-point CA and general anesthesia in all patients. Twenty minutes after PV isolation we administered adenosine in a dose sufficient to produce an atrioventricular block. If a dormant conduction was present (n=54) we performed additional ablation until there was no adenosine mediated reconduction inducible. During 36 months of follow-up, all patients were examined for eight 7-day ECG recordings. There was no difference in arrhythmia recurrence rate between patients with and without dormant conduction (29.6 vs. 24.8% at 12 months, P=0.500; 31.5 vs. 30.4% at 36 months, P=1.000), for any echocardiographic parameter or any parameter of the ablation procedure.

Conclusion: The patients with dormant conduction after adenosine during catheter ablation of paroxysmal atrial fibrillation with complete elimination of the dormant conduction by additional extensive ablation have the same outcome in the long term as patients without a dormant conduction.
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http://dx.doi.org/10.5507/bp.2019.005DOI Listing
June 2020

Pharmacological Blockade of Soluble Epoxide Hydrolase Attenuates the Progression of Congestive Heart Failure Combined With Chronic Kidney Disease: Insights From Studies With Fawn-Hooded Hypertensive Rats.

Front Pharmacol 2019 23;10:18. Epub 2019 Jan 23.

Center for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czechia.

An association between congestive heart failure (CHF) and chronic kidney disease (CKD) results in extremely poor patient survival rates. Previous studies have shown that increasing kidney epoxyeicosatrienoic acids (EETs) by blocking soluble epoxide hydrolase (sEH), an enzyme responsible for EETs degradation, improves the survival rate in CHF induced by aorto-caval fistula (ACF) and attenuates CKD progression. This prompted us to examine if sEH inhibitor treatment would improve the outcome if both experimental conditions are combined. Fawn-hooded hypertensive (FHH) rats, a genetic model showing early CKD development was employed, and CHF was induced by ACF. Treatment with an sEH inhibitor was initiated 4 weeks after ACF creation, in FHH and in fawn-hooded low-pressure (FHL) rats, a control strain without renal damage. The follow-up period was 20 weeks. We found that ACF FHH rats exhibited substantially lower survival rates (all the animals died by week 14) as compared with the 64% survival rate observed in ACF FHL rats. The former group showed pronounced albuminuria (almost 30-fold higher than in FHL) and reduced intrarenal EET concentrations. The sEH inhibitor treatment improved survival rate and distinctly reduced increases in albuminuria in ACF FHH and in ACF FHL rats, however, all the beneficial actions were more pronounced in the hypertensive strain. These data indicate that pharmacological blockade of sEH could be a novel therapeutic approach for the treatment of CHF, particularly under conditions when it is associated with CKD.
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http://dx.doi.org/10.3389/fphar.2019.00018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6351500PMC
January 2019

Consensus statement of professional associations on prescribing of PCSK9-inhibitors.

Vnitr Lek Winter 2019;64(12):1131-1136

A new class of drugs known as PCSK9 inhibitors (PCSK9i) provide biological treatment for hypercholesterolemia. These drugs are administered using a subcutaneous injection once in two or four weeks. PCSK9i are not a replacement of the existing hypolipidemics, they just expand the therapeutic spectrum for the critically ill and those who cannot use the standard therapy and do not reach satisfactory target values. There are essentially two indications: (1) hypercholesterolemie and mixed dyslipidemia and (2) secondary prevention of cardiovascular diseases (CVD). Statin intolerance is not the only indication for treatment. However as its presence sometimes plays an essential role as to choosing the treatment, it will be also discussed in the paragraph on reimbursement conditions. Reimbursement conditions (very simplified): the treatment will be provided at selected centres. A list of the centres is included in an annexe to this article. You will find it also on www.interna-cz.eu, on www.kardio-cz.cz and www.athero.cz. The indicative concentration of LDL-cholesterol (LDL-C) from which on PCSK9i can be prescribed as covered from the public health insurance, is the following: (1) familial hypercholesterolemia 4.0 mmol/l, (2) for secondary prevention CVD 3.0 mmol/l - Please note: the presented LDL-C level is one reached under maximum (tolerated) high intensity hypo-lipidemic therapy. High intensity hypolipidemic therapy is defined as atorvastatin 40-80 mg or rosuvastatin 20-40 mg + ezetimibe. In the case of demonstrated intolerance of both the mentioned statins the patient has to be treated with a maximum tolerated dose of statins, in combination with another hypolipidemic drug (ezetimibe). Statin intolerance is defined as intolerance of at least two successive statins, which results in their discontinuation. Statin intolerance alone is not the indication for PCSK9i treatment! The payment criteria must always be complied with. A medical officer can of course be asked to approve such treatment in exceptional cases. Key words: alirocumab - PCSK9 inhibitors centers - center therapy - evolocumab - familial hypercholesterolemia - proprotein konvertase subtilisin kexin 9 inhibitors (PCSK9i) - secondary prevention - statins intolerance.
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July 2019

Subclinical atrial fibrillation - what is the risk of stroke?

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2019 Jun 10;163(2):107-113. Epub 2019 Jan 10.

Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic Corresponding author: Jiri Plasek, e-mail.

Atrial fibrillation is the most common arrhythmia and as such, it has become a significant public health issue due to its impact on patient morbidity and mortality. The prevalence of atrial fibrillation (AF) almost doubled in the last decade, being currently 2% in unselected patient populations. Its occurrence varies with age (present in almost 20% of octogenarians) and concomitant diseases. The most prevalent concomitant diseases are hypertension, diabetes, heart failure, renal failure, and cognitive decline. Cognitive decline or stroke may be actually the first manifestation of undiagnosed atrial fibrillation. In the majority of cases, atrial fibrillation is more of a syndrome than a disease in itself, with a multitude of etiologic factors and mechanisms. The risk of cardioembolic stroke increases with the number of comorbidities and age. The overall age-adjusted risk of stroke in patients with atrial fibrillation is 5 times higher than in the general population. Nowadays, the detection of asymptomatic episodes of atrial fibrillation by cardiac electronic implantable devices (CIED), referred to as device detected or subclinical atrial fibrillation, has opened new frontiers in AF management. The risk of stroke and subsequent need for anticoagulation treatment in this group of patients with device detected AF is however not clear. Here, we will review the literature to determine the association of subclinical atrial fibrillation with the risk of stroke.
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http://dx.doi.org/10.5507/bp.2018.083DOI Listing
June 2019

The Role of Renal Vascular Reactivity in the Development of Renal Dysfunction in Compensated and Decompensated Congestive Heart Failure.

Kidney Blood Press Res 2018 23;43(6):1730-1741. Epub 2018 Nov 23.

Center for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.

Background/aims: Reduction of renal blood flow (RBF) is commonly thought to be a causative factor of renal dysfunction in congestive heart failure (CHF), but the exact mechanism of the renal hypoperfusion is not clear. Apart from the activation of neurohormonal systems controlling intrarenal vascular tone, the cause might be altered reactivity of the renal vasculature to endogenous vasoactive agents.

Methods: To evaluate the role of this mechanism, we assessed by an ultrasonic transient-time flow probe maximum RBF responses to renal artery infusion of angiotensin II (ANG II), norepinephrine (NE) and acetylcholine (Ach) in healthy male rats and animals with compensated and decompensated CHF. CHF was induced by volume overload achieved by the creation of the aorto-caval fistula (ACF) in Hannover Sprague-Dawley rats.

Results: Maximum responses in RBF to ANG II were similar in rats studied five weeks (compensated phase) and 20 weeks (decompensated phase) after ACF creation when compared to sham-operated rats. On the other hand, NE elicited larger maximum decreases in RBF in rats with CHF (five and 20 weeks post-ACF) than in sham-operated controls. We observed greater maximum vasodilatory responses to Ach only in rats with a compensated stage of CHF (five weeks post-ACF).

Conclusion: Greater renal vasoconstrictor responsiveness to ANG II or reduced renal vasodilatation in response to Ach do not play a decisive role in the development of renal dysfunction in ACF rats with compensated and decompensated CHF. On the other hand, exaggerated renal vascular responsiveness to NE may be here a contributing causative factor, active in either CHF phase.
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http://dx.doi.org/10.1159/000495391DOI Listing
February 2019

Selective coronary angiography, percutaneous coronary intervention and asymptomatic peri-procedural myocardial injury.

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2019 Dec 6;163(4):324-330. Epub 2018 Nov 6.

Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic.

Background: While there have been a number of studies reporting the incidence and implications of elevated troponin levels after percutaneous coronary intervention (PCI), the body of information about the incidence, associations, and implications of elevated troponin levels following coronary angiography (CAG) is limited.

Materials And Methods: A total of 220 consecutive patients with stable coronary artery disease or intermediate or low-risk acute coronary syndrome without persistent ST-segment elevation (NSTE-ACS) were included in our study. High-sensitivity cardiac troponin I (hs-cTnI) levels were measured before and after coronary angiography (CAG) in patients with or without PCI and correlated with a number of clinical variables.

Results: Hs-cTnI elevations above the 99 percentile upper reference limit (URL), or above 20% of the initially positive, yet already declining values, were found in 60 (37.2%) patients after CAG and in 45 (76.2%) patients undergoing PCI. Significant correlations of hs-cTnI elevation were found with the following variables: volume of contrast, fluoroscopy time, dose-area product, amount of contrast agent injected directly into the coronary arteries, total time of balloon dilation and the number and total length of implanted stents (P<0.001 for all).

Conclusion: While an asymptomatic elevation of hs-cTnI is a common finding after PCI, it does occur, quite surprisingly, also after CAG. Despite contradictory views regarding the clinical relevance of asymptomatic post-procedural elevated hs-cTnI levels, it is generally believed that a mild elevation is not associated with an increased risk. Still, it may pose a diagnostic quandary following a successful interventional procedure and even more so after an uncomplicated CAG.

Trial Registration: Clinicaltrials.gov - NCT02960321.
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http://dx.doi.org/10.5507/bp.2018.066DOI Listing
December 2019

Heart failure disease management program, its contribution to established pharmacotherapy and long-term prognosis in real clinical practice - retrospective data analysis.

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2019 Dec 5;163(4):318-323. Epub 2018 Oct 5.

Department of Cardiology, Heart Function Clinics, St. Paul´s Hospital, Vancouver, Canada.

Background And Aims: The prognosis of patients with heart failure (HF) is still generally unfavorable. HF with reduced ejection fraction (HFrEF) patients reach target medication doses in very low percentages in daily clinical practice. HF disease management programs (DMP), including nurse and telemedicine support that facilitate achieving target medication doses, may improve the unfavorable prognosis.

Methods: We retrospectively analyzed the data of 738 patients with HFrEF who were followed in a single HF center during the years 1975-2011, for 6.4 (median) years. DMP, nurse and telemedicine support is established at this center.

Results: The group achieved left ventricle (LV) recovery after the HF treatment. The median LV ejection fraction improved from 25.0% at baseline to 50.0% at the time of the latest data collection. The proportion of NYHA II, III and IV classes decreased from 27.6%, 30.2% and 29.7% to 26.6%, 7.2% and 0.1%, respectively while the proportion of NYHA class I increased from 12.5% to 66.1%. Median NT-proBNP decreased from 975.0 to 324.0 pg/mL. The survival of the patient group was favorable; 79.7% survived 18.1 years after diagnosis of HF. A high percentage of the patients received recommended target or higher than target doses of angiotensin-converting enzyme inhibitors (82.0%) and beta-blockers (78.1%).

Conclusion: The established pharmacotherapy resulted from an effective DMP and this contributed to the favorable prognosis.
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http://dx.doi.org/10.5507/bp.2018.059DOI Listing
December 2019

Rationale and design of the EU-CERT-ICD prospective study: comparative effectiveness of prophylactic ICD implantation.

ESC Heart Fail 2019 02 9;6(1):182-193. Epub 2018 Oct 9.

Department of Cardiology, Magdalena Klinika, Krapinske Toplice, Croatia.

Aims: The clinical effectiveness of primary prevention implantable cardioverter defibrillator (ICD) therapy is under debate. The EUropean Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter Defibrillators (EU-CERT-ICD) aims to assess its current clinical value.

Methods And Results: The EU-CERT-ICD is a prospective investigator-initiated non-randomized, controlled, multicentre observational cohort study performed in 44 centres across 15 European Union countries. We will recruit 2250 patients with ischaemic or dilated cardiomyopathy and a guideline indication for primary prophylactic ICD implantation. This sample will include 1500 patients at their first ICD implantation and 750 patients who did not receive a primary prevention ICD despite having an indication for it (non-randomized control group). The primary endpoint is all-cause mortality; the co-primary endpoint in ICD patients is time to first appropriate shock. Secondary endpoints include sudden cardiac death, first inappropriate shock, any ICD shock, arrhythmogenic syncope, revision procedures, quality of life, and cost-effectiveness. At baseline (and prior to ICD implantation if applicable), all patients undergo 12-lead electrocardiogram (ECG) and Holter ECG analysis using multiple advanced methods for risk stratification as well as detailed documentation of clinical characteristics and laboratory values. Genetic biobanking is also organized. As of August 2018, baseline data of 2265 patients are complete. All subjects will be followed for up to 4.5 years.

Conclusions: The EU-CERT-ICD study will provide a necessary update about clinical effectiveness of primary prophylactic ICD implantation. This study also aims for improved risk stratification and patient selection using clinical and ECG risk markers.
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http://dx.doi.org/10.1002/ehf2.12367DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6351896PMC
February 2019

Apparent foreign-body-like structure detected in the left atrium after catheter ablation for persistent atrial fibrillation.

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2019 Jun 11;163(2):184-186. Epub 2018 Sep 11.

Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic.

Background: A foreign body left in left atrium after catheter ablation of atrial fibrillation is a very rare complication. Nevertheless, there are no reports so far about a large newly emerged structure only giving the impression of being a foreign body left in the heart after catheter ablation.

Case Report: This report presents a case of a patient after catheter ablation for persistent atrial fibrillation. Because of atrial tachycardia during follow-up, patient was indicated for reablation. Imaging methods including intracardiac echocardiography showed a straw-like foreign body with the character of a transseptal sheath in left atrium. A cardiac surgery was performed with extraction of the foreign body. We found a fibrous chord-like material in the left atrium, microscopy showed myocardial tissue with continuous transition to fibrinous elastic vessel. No signs of foreign material were found.

Conclusion: We have found a newly emerged body giving the impression of being of foreign origin in left atrium after catheter ablation of atrial fibrillation. Microscopy of the extracted material showed myocardial tissue with continuous transition to fibrinous elastic vessel and a fibrinous tissue with focal dystrophic calcification. Its origin remains unknown.
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http://dx.doi.org/10.5507/bp.2018.052DOI Listing
June 2019

ECG non-gated multi-detector computed tomography protocol prior to catheter ablation of atrial fibrillation provides sufficient data quality with lower radiation exposure compared to ECG-gated protocol - results of a prospective, randomized and blinded study.

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2018 Aug 28. Epub 2018 Aug 28.

Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic.

Background: The role of ECG-gating in left atrium (LA) computed tomography (MDCT) imaging is not precisely defined.

Methods And Results: 62 patients were randomized according to ECG gating with prospective evaluation of image quality, Volume CT Dose Index, Dose Length Product, Effective Dose and registration error between anatomical map and MDCT. We found significant difference in all radiation variables, but not in visual quality, registration error, CA duration, CA fluoroscopy time and CA fluoroscopy dose.

Conclusion: Helical non-gated MDCT achieved a radiation dose more than four times lower with comparable image quality and course of ablation compared to ECG-gated protocol.
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http://dx.doi.org/10.5507/bp.2018.045DOI Listing
August 2018
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