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104. Implantable cardioverter-defibrillator with biventricular resynchronization therapy in patients with severe congestive heart failure and malignant ventricular arrhythmias,Zastosowanie kardiowerterów-defibrylatorów z funkcja resynchronizujacej stymulacji dwukomorowej u chorych z ciezka niewydolnościa serca i złośliwymi komorowymi zaburzeniami rytmu

Author

Sterliński, M., Lewicka-Nowak, E., Andrzej Przybylski, Lubiński, A., Dabrowska-Kugacka, A., Kowalik, I., Jankowska, A., Faran, A., Kempa, M., Maciag, A., Pytkowski, M., Szwed, H., and Światecka, G.

107. Hemodynamic effects of alternative atrial pacing sites in patients with paroxysmal atrial fibrillation

Author

Ewa Lewicka-Nowak, G. Swiatecka, Andrzej Kutarski, Paweł Zagożdżon, and Alicja Dabrowska-Kugacka

Subjects
medicine.medical_specialty, Cardiac output, Contraction (grammar), Hemodynamics, Ventricular Function, Left, Electrocardiography, Internal medicine, Mitral valve, Atrial Fibrillation, Humans, Medicine, Atrial Appendage, Heart Atria, Cardiac Output, Coronary sinus, Aged, Diminution, business.industry, Cardiac Pacing, Artificial, Atrial fibrillation, General Medicine, Atrial Function, medicine.disease, Myocardial Contraction, Echocardiography, Doppler, medicine.anatomical_structure, Anesthesia, Cardiology, Cardiology and Cardiovascular Medicine, business, Venous return curve
Abstract

DABROWSKA-KUGACKA, A., et al.: Hemodynamic Effects of Alternative Atrial Pacing Sites in Patients with Paroxysmal Atrial Fibrillation.Recently, multisite atrial pacing has been suggested as an alternative therapy to prevent recurrences of paroxysmal atrial fibrillation (PAF). A study was conducted to compare the acute effects of biatrial (BiA), left atrial (LA), and right atrial appendage (RAA) pacing on cardiac hemodynamics. In 14 patients with PAF and a BiA pacemaker (with leads in the RAA and coronary sinus), cardiac output (CO), right (RV) and left ventricular (LV) filling, RA-LA contraction delay [PA(m-t)] and the difference in A wave duration [Adif(m-p)] at the level of the mitral valve (Adurm) and pulmonary veins (Adurp) during RAA, BiA, and LA pacing were examined by echo-Doppler measurements. The atrial pacing site did not affect the CO. LA, but not BiA, pacing resulted in delayed RA contraction in comparison with RAA pacing with significant diminution of the RA contribution to RV filling. With LA pacing, the usual right-to-left atrial contraction sequence was reversed (PA(m-t):8 ± 7ms control;5 ± 30ms RAA;−10 ± 21ms BiA;−72 ± 36 msLA; LA versus control versus RAA and versus BiA, P < 0.001. LA and BiA pacing prolonged Adurp(LA 186 ± 52 ms, BiA 180 ± 45 ms, RAA 153 ± 49 ms; LA and BiA vs RAA, P < 0.01). Thus Adurp exceeded Adurm[Adif (m-p): control 38 ± 40 ms, RAA 7 ± 42 ms, BiA −12 ± 43 ms, LA −20 ± 44 ms; control vs RAA, BiA, and LA; and RAA vs LA, P < 0.05]. The study showed that (1) the atrial pacing site has no influence on global cardiac performance; (2) the hemodynamic effect of BiA pacing is not superior to that of RAA pacing, and LA pacing can even be deleterious; (3) LA pacing reverses the usual right-to-left atrial contraction sequence and reduces the RA contribution to RV filling; (4) BiA and LA pacing prolong Adurp due to an altered activation pattern, decreased pulmonary venous return, or increased LA pressure. (PACE 2003; 26[Pt. II]:278–283)

110. Poster session 5

Author

Colunga Blanco, S, Garcia Campos, A, Capin Sampedro, E, Corros Vicente, C, Martin Fernandez, M, Leon Arguero, V, Fidalgo Arguelles, A, Velasco Alonso, E, Lopez Iglesias, F, De La Hera Galarza, JM, Gonzalez Matos, C, Chaparro-Munoz, M, Recio-Mayoral, A, Angelis, A, Vlachopoulos, C, Ioakeimidis, N, Felekos, I, Abdelrasoul, M, Aznaouridis, K, Chrysohoou, C, Rousakis, G, Aggeli, K, Tousoulis, D, Dinis, P G, Faustino, AC, Paiva, L, Fernandes, A, Costa, M, Cachulo, MC, Goncalves, L, Chinali, M, Emma, F, Rinelli, G, Esposito, C, Franceschini, A, Doyon, A, Raimondi, F, Schaefer, F, Pongiglione, G, Mateucci, MC, Toth, A, Vago, H, Juhasz, C, Janosa, C, Oprea, V, Balint, OH, Temesvari, A, Simor, T, Kadar, K, Merkely, B, Andreassi, M G, Bruno, R M, Borghini, A, Stea, F, Gargani, L, Mercuri, A, Sicari, R, Picano, E, Rodriguez Munoz, D, Lozano Granero, C, Carbonell San Roman, A, Moya Mur, JL, Fernandez-Golfin, C, Moreno Planas, J, Fernandez Santos, S, Casas Rojo, E, Hernandez-Madrid, A, Zamorano Gomez, JL, Reid, A B, Pearce, K, Gamlin, W, Miller, C, Schmitt, M, Park, JH, Seong, IW, Kim, KH, Kim, MJ, Jung, HO, Sohn, IS, Park, SM, Cho, GY, Choi, JO, Park, SW, study, NORMAL, Shetye, A, Nazir, SA, Khan, JN, Singh, A, Kanagala, P, Squire, I, Mccann, GP, Novo, G, Di Lisi, D, Meschisi, MC, Brunco, V, Badalamenti, G, Bronte, E, Russo, A, Novo, S, De Marchi, S F, Von Tscharner, M, Urheim, S, Aakhus, S, Seiler, C, Schmalholz, S, Cikes, M, Biering-Sorensen, T, Cheng, S, Oparil, S, Izzo, J, Pitt, B, Solomon, SD, Smarz, K, Zaborska, B, Jaxa-Chamiec, T, Tysarowski, M, Budaj, A, Illatopa, V, Cordova, F, Aguirre, O, Sanabria, S, Ortega, J, Peluso, D, Romeo, G, Perazzolo Marra, M, Tona, F, Famoso, G, Pigatto, E, Cozzi, F, Iliceto, S, Badano, LP, Wellnhofer, E, Kriatselis, C, Gerds-Li, JH, Kropf, M, Pieske, B, Graefe, M, De La Rosa Riestra, A, Martinez Santos, P, Batlle Lopez, E, Vilacosta, I, Sanchez Sauce, B, Espana Barrio, E, Jimenez Valtierra, J, Campuzano Ruiz, R, Alonso Bello, J, Martin Rios, MD, Sattarzadeh Badkoubeh, R, Farrashi, M, Abtahi, H, Sadeghi, H, Sadeghipour, P, Tavoosi, A, Mandour Ali, M, Abdel Rahman, TA, Mohamed, LA, Maghraby, HM, Kora, IM, Abdel Hameed, FR, Ali, MN, Azoz, A, Al Shehri, A, Youssef, A, Gad, A, Alsharqi, M, Alsaikhan, L, Pontone, G, Andreini, D, Rota, C, Guglielmo, M, Mushtaq, S, Baggiano, A, Beltrama, V, Solbiati, A, Guaricci, AI, Pepi, M, Krljanac, G, Trifunovic, D, Sobic Saranovic, D, Savic, L, Grozdic Milojevic, I, Asanin, M, Srdic, M, Petrovic, M, Zlaic, N, Mrdovic, I, Acar, R, Dogan, C, Izci, S, Gecmen, C, Unkun, T, Cap, M, Erdogan, E, Onal, C, Yilmaz, F, Ozdemir, N, Nucifora, G, Muser, D, Tioni, C, Zanuttini, D, Morocutti, G, Spedicato, L, Bernardi, G, Proclemer, A, Sirtautas, A, Pranevicius, R, Zapustas, N, Briedis, K, Valuckiene, Z, Jurkevicius, R, Roos, S T, Juffermans, LJM, Enait, V, Van Royen, N, Van Rossum, AC, Kamp, O, Qasem, M S, Khalaf, HASSEN, Hitham, SAKER, Osama, AS, Abazid, RAMI, Guall, RAHIM, Durdan, SHAFAT, Mohammed, ZYAD, Marini, C, Stella, S, Rosa, I, Ancona, F, Spartera, M, Italia, L, Latib, A, Colombo, A, Margonato, A, Agricola, E, Fabiani, I, Scatena, C, Mazzanti, C, Conte, L, Pugliese, N, Barletta, V, Bortolotti, U, Naccarato, AG, Di Bello, V, Gillis, K, Bala, G, Roosens, B, Hernot, S, Remory, I, Droogmans, S, Cosyns, B, Bandera, F, Generati, G, Labate, V, Donghi, V, Pellegrino, M, Carbone, F, Alfonzetti, E, Guazzi, M, Borowiec, A, Dabrowski, R, Kowalik, I, Firek, B, Chwyczko, T, Szwed, H, Lim, YJ, Kawamura, A, Kawano, S, Chalbia, T E, Zaroui, A, Ben Said, R, Ben Halima, M, Kheder, N, Farhati, A, Mourali, S, Mechmech, R, Santos, M, Leite, L, Martins, R, Baptista, R, Barbosa, A, Ribeiro, N, Oliveira, A, Castro, G, Pego, M, Gao, S A, Polte, C L, Lagerstrand, K, Johnsson, A A, Janulewicz, M, Bech-Hanssen, O, Zilberszac, R, Gabriel, H, Wisser, W, Maurer, G, Rosenhek, R, Farrag, AAM, El Aroussy, W, Abdel Ghany, M, Al Adeeb, K, Palmiero, G, Ascione, L, Carlomagno, G, Sordelli, C, Ferro, A, Ascione, R, Severino, S, Caso, P, Aruta, P, Muraru, D, Janei, C, Haertel Miglioranza, M, Cavalli, G, Romeo, G, Peluso, D, Cucchini, U, Iliceto, S, Badano, L, De Diego Soler, O, Armario Bel, X, Garcia-Garcia, C, Ferrer Sistach, E, Rueda Sobella, F, Oliveras Vila, T, Labata Salvador, C, Serra Flores, J, Lopez-Ayerbe, J, Bayes-Genis, A, Fasano, D, Conte, E, Gonella, A, Morena, L, Civelli, D, Losardo, L, Margaria, F, Riva, L, Tanga, M, Tamborini, G, Carminati, C, Muratori, M, Gripari, P, Ghulam Ali, S, Fusini, L, Vignati, C, Bartorelli, AL, Alamanni, F, Pepi, M, Ancona, F, Rosa, I, Stella, S, Marini, C, Spartera, M, Latib, A, Montorfano, M, Colombo, A, Margonato, A, Agricola, E, Raafat, D M, Ismaiel, A, Ali, N, Amry, S, Medicine, Faculty of, University, Assiut, Assiut, Egypt, Department, Pediatric, Marchel, M, Serafin, A, Kochanowski, J, Filipiak, KJ, Opolski, G, De Gregorio, C, Speranza, G, Ando', G, Magaudda, L, Gommans, D H F, Cramer, GE, Bakker, J, Michels, M, Dieker, HJ, Fouraux, MA, Marcelis, CLM, Timmermans, J, Brouwer, MA, Kofflard, MJM, Godinho, A R, Vasconcelos, M, Araujo, V, Almeida, P, Sousa, C, Macedo, F, Cardoso, JS, Maciel, MJ, Mielczarek, M, Voilliot, D, Huttin, O, Venner, C, Olivier, A, Villemin, T, Deballon, R, Manenti, V, Juilliere, Y, Selton-Suty, C, Bandera, F, Generati, G, Pellegrino, M, Labate, V, Carbone, F, Alfonzetti, E, Guazzi, M, Kubik, M, Dabrowska-Kugacka, A, Dorniak, K, Lewicka, E, Szalewska, D, Kutniewska-Kubik, M, Raczak, G, Cho, J Y, Kim, K H, Yoon, H J, Park, H J, Ahn, Y, Jeong, M H, Cho, J G, Park, J C, Kim, J H, Tarando, F, Galli, E, Habib, G, Schnell, F, Lederlin, M, Daubert, JC, Mabo, P, Donal, E, Lourenco Marmelo, B F, Faria, R, Magalhaes, P, Marques, N, Domingues, K, Lourenco, C, Almeida, AR, Teles, L, Picarra, B, Azevedo, O, SUNSHINE, Grupo, Reis, L, Lourenco, C, Oliveira, M, Magalhaes, P, Domingues, K, Marmelo, B, Almeida, A, Picarra, B, Faria, R, Marques, N, Sunshine, Domingues, K, Bento, D, Lourenco, C, Magalhaes, P, Cruz, I, Marmelo, B, Reis, L, Picarra, B, Faria, R, Azevedo, O, group, Sunshine, Krestjyaninov, MV, Gimaev, RH, Melnikova, MA, Olezov, NV, Ruzov, VI, Mesquita, J, Goncalves, P, Almeida, M S, Branco, P, Carvalho, M S, Dores, H, Gaspar, M A, Sousa, H, Andrade, M J, Mendes, M, Ikonomidis, I, Makavos, G, Varoudi, M, Papadavid, E, Andreadou, I, Gravanis, K, Liarakos, N, Pavlidis, G, Rigopoulos, D, Lekakis, J, Ferferieva, V, Deluyker, D, Bito, V, Peluso, D, Pigatto, E, Romeo, G, Muraru, D, Cozzi, F, Punzi, L, Iliceto, S, Badano, LP, Peluso, D, Pigatto, E, Romeo, G, Muraru, D, Cozzi, F, Iliceto, S, Badano, LP, King, GJ, Neilan, T, Coen, K, Gannon, S, Bennet, K, Clarke, JG, D'ascenzi, F, Solari, M, Cameli, M, Focardi, M, Corrado, D, Bonifazi, M, Henein, M, Mondillo, S, Ferrera Duran, C, Gomez-Escalonilla, C, De Agustin, A, Egido, J, Islas, F, Simal, P, Gomez De Diego, JJ, Luaces, M, Macaya, C, Perez De Isla, L, Sormani, P, Zancanella, M, Rusconi, C, Musca, F, Santambrogio, G, De Chiara, B, Vallerio, P, Cairoli, R, Giannattasio, G, Moreo, A, Gonzalez Fernandez, O, Alvarez Ortega, C, Mori Junco, R, Caro Codon, J, Meras Colunga, P, Ponz De Antonio, I, Lopez Fernandez, T, Valbuena Lopez, S, Moreno Yanguela, M, Lopez-Sendon, JL, Tereshina, O, Surkova, E, Cambronero Cortinas, E, Bonanad-Lozano, C, Lopez-Lereu, MP, Monmeneu-Menadas, JV, Gavara, J, De Dios, E, Paya-Chaume, A, Escribano-Alarcon, D, Chorro-Gasco, FJ, Bodi-Peris, V, Kupczynska, K, Michalski, BW, Miskowiec, D, Kasprzak, JD, Lipiec, P, Carvalho, J F, Morgado, G, Caldeira, D, Cruz, I, Joao, I, Almeida, A R, Lopes, L, Fazendas, P, Cotrim, C, Pereira, H, Shivalkar, B, De Block, C, Buys, D, Salgado, R, Vrints, C, Van Gaal, L, Aghamohammadzadeh, R, Mctear, C, Irwin, RB, Cifra, B, Dragulescu, A, Friedberg, M, Mertens, L, Cifra, B, Dragulescu, A, Friedberg, M, Mertens, L, Bandera, F, Carbone, F, Generati, G, Pellegrino, M, Labate, V, Alfonzetti, E, Guazzi, M, Kuznetsov, VA, Krinochkin, DV, Yaroslavskaya, EI, Zaharova, EH, Pushkarev, GS, Van Zalen, JJ, Sugihara, C, Patel, NR, Sulke, AN, Lloyd, GW, Kochanowski, J, Piatkowski, R, Scislo, P, Grabowski, M, Marchel, M, Opolski, G, Goebel, B, Roland, H, Hamadanchi, A, Otto, S, Jung, C, Lauten, A, Figulla, HC, Poerner, TC, Ladeiras-Lopes, R, Sampaio, F, Fonseca, P, Fontes-Carvalho, R, Pinho, M, Campos, AS, Castro, P, Fonseca, C, Ribeiro, J, Gama, V, Goebel, B, Heck, R, Hamdanchi, A, Otto, S, Jung, C, Lauten, A, Figulla, HR, Poerner, TC, Karvandi, M, Ranjbar, S, Ghaffaripour Jahromi, M, Karvandi, M, Ranjbar, S, Alonso Salinas, G, Hinojar, R, Fernandez Golfin, C, Esteban, A, Pascual-Izco, M, Garcia-Martin, A, Casas Rojo, E, Jimenez-Nacher, JJ, Zamorano, JL, Unkun, T, Gecmen, C, Cap, M, Izci, S, Erdogan, E, Onal, C, Acar, R, Bakal, RB, Kaymaz, C, Ozdemir, N, Ranjbar, S, Karvandi, M, Ghaffaripour Jahromi, M, Hubert, A, Galand, V, Schnell, F, Matelot, D, Martins, R, Leclercq, C, Carre, F, Enescu, OA, Suran, BC, Margulescu, AD, Rimbas, RC, Siliste, C, Vinereanu, D, Liccardo, M, Nocerino, P, Urso, AC, Borrino, A, Carbone, C, Follero, P, Ciardiello, C, Prato, L, Salzano, G, Cameli, M, Marino, F, Ruspetti, A, Sparla, S, Di Tommaso, C, Loiacono, F, Focardi, M, D'ascenzi, F, Henein, M, Mondillo, S, Ako, E, Porter, J, Walker, M, Lembo, M, Lo Iudice, F, Esposito, R, Santoro, C, Cocozza, S, Izzo, R, De Luca, N, De Simone, G, Trimarco, B, Galderisi, M, Goffredo, C, Gervasi, F, Patti, G, Mega, S, Bono, M, Di Sciascio, G, Enache, R, Buture, A, Badea, R, Platon, P, Ghiorghiu, I, Jurcut, R, Coman, IM, Popescu, BA, Ginghina, C, Novo, G, Lunetta, M, Spoto, MS, Lo Vi, AM, Pensabene, G, Meschisi, MC, Carita, P, Coppola, G, Novo, S, Assennato, P, Wdowiak-Okrojek, K, Shim, A, Wejner-Mik, P, Kasprzak, JD, Lipiec, P, Nemes, A, Havasi, K, Domsik, P, Kalapos, A, Forster, T, Nemes, A, Piros, GA, Domsik, P, Kalapos, A, Lengyel, C, Orosz, A, Forster, T, Di Salvo, G, Bulbul, Z, Issa, Z, Al Sehly, A, Pergola, V, Oufi, S, Capotosto, L, Conde, Y, Cimino, E, Rinaldi, E, Ashurov, R, Ricci, S, Pergolini, M, Vitarelli, A, Caravaca, P, Lujan Valencia, JE, Chaparro, M, Garcia-Guerrero, A, Cristo Ropero, MJ, Izquierdo Bajo, A, Madrona, L, Recio-Mayoral, A, Maceira Gonzalez, A M, Monmeneu, JV, Igual, B, Lopez Lereu, P, Garcia, MP, Iriart, X, Selmi, W, Jalal, Z, Thambo, JB, Jug, B, Kosuta, D, and Fras, Z

Abstract

Background: Handheld ultrasound devices allow for a bedside screening although quantitative parameters are not easily obtained. We aim to assess the reliability of visual qualitative evaluation of left ventricle (LV) compared with standard quantitative evaluation with 2D transthoracic echocardiography (TTE). Methods: Two cardiologists have reviewed 135 consecutive standard TTE examinations. Both observers visually assessed LV size, hypertrophy (LVH) and ejection fraction (EF). LV diameter, volume, wall thickness and EF (Teichholz and Simpson) were also measured by both observers. Visual and quantitative agreement and inter and intraobserver variability were calculated. Results: Image quality allowed for evaluation of 130 examinations. Visually assessed EF compared with Simpson had better consistency (Intraclass correlation coefficient [ICC] 0,91 IC95% 0,88-0,94) than with Teichholz (ICC 0,75 IC95% 0,66-0,82). We have also observed good interobserver agreement regarding visually assessed EF (ICC 0,81 IC95% 0,71-0,87) and Simpson EF (ICC 0,80 IC95% 0,70-0,89) as well as good intraobserver agreement (visual EF: ICC 0,81 IC95% 0,74-0,86; Simpson: ICC 0,89 IC95% 0,84-0,93). Regarding LVH we found moderate agreement between visual and quantitative assessment (weighted Kappa [wK] 0,44 (IC95% 0,32-0,56)), moderate interobserver agreement for quantitative assessment (ICC 0,59 IC95% 0,44-0,71) and poor interobserver agreement for visual assessment (wK 0,19 IC95% 0,08-0,30). Intraobserver variability regarding LVH visual estimation was moderate (wK 0,40 IC95% 0,29-0,52) and regarding LVH quantification was good (ICC 0,78 IC95% 0,70-0,84). LVH was visually overestimated in 25% of examinations. Regarding LV size, we found poor agreement between visual assessment and its quantification with end-diastolic diameter (wK 0,22 IC95% 0,06-0,39) and moderate agreement between visual assessment and end-systolic LV volume (wK 0,62 IC95% 0,47-0,77). Interobserver agreement regarding quantitative volume assessment was good (ICC 0,90 IC95% 0,85-0,94) and regarding visual assessment was moderate (wK 0,43 IC95% 0,26-0,70). We found good intraobserver variability of volume measurement (wK 0,64 IC95% 0,50-0,78) and of visual size assessment (ICC 0,96 IC95% 0,94-0,97). Conclusions: Visual LVEF assessment is consistent with quantitative assessment and should be regarded as a reliable parameter that can be obtained from bedside examination with a handheld device. Visual assessment of LV size and wall thickness is less reliable than its quantification and should be confirmed with standard measurements.

Published
2015
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111. Oral Abstract session: Advanced echo techniques - New eyes on congenital heart disease: Thursday 4 December 2014, 08:30-10:00 * Location: Agora

Author

Timoteo, A T, Moura Branco, L, Ramos, R, Aguiar Rosa, S, Agapito, A, Sousa, L, Oliveira, JA, Leal, A, Cruz Ferreira, R, Kutty, S, Li, L, Danford, D, Houle, H, Xiao, Y, Pedrizzetti, G, Porter, T, Leren, I S, Hasselberg, NE, Saberniak, J, Haland, TF, Kongsgard, E, Smiseth, OA, Edvardsen, T, Haugaa, KH, Ben Moussa, N, Cinteza, E, Giugno, L, Butera, G, Piazza, L, Micheletti, A, Saracino, A, Negura, D G, Carminati, M, Chessa, M, Kubik, M, Dabrowska-Kugacka, A, Lewicka, E, Danilowicz-Szymanowicz, L, Szalewska, D, Kutniewska-Kubik, M, Raczak, G, Enache, R, Mateescu, AD, Nastase, OA, Popescu, BA, Ginghina, C, Karsenty, C, Hadeed, K, Hascoet, S, Amadieu, R, Dulac, Y, Acar, P, Ammirati, A, Palmieri, R, Silvetti, MS, and Drago, F

Abstract

Background: Adults with repaired tetralogy of Fallot (rTOF) are at increased risk for arrhythmic events. Objectives: To evaluate whether right ventricle (RV) and right atrial (RA) two-dimensional speckle tracking (2D strain) are associated with arrhythmic events in patients with rTOF. Methods: We studied 65 consecutive patients with rTOF (34 ± 10 years, 71% males) referred for routine echocardiographic evaluation. We obtained standard echocardiographic measurements that included right heart assessment: RV end-diastolic and systolic area (RVESA), RV fractional area change (RVFAC), tricuspide annular plane systolic excursion (TAPSE), Tei Index, tissue Doppler of the tricuspid ring, tricuspide and pulmonary valve evaluation, residual defects. RV and RA 2D strain was assessed in a 4-chamber view. Patients were divided into two groups: Group 1 (with previous documentation of arrhythmias) and Group 2 (without arrhythmias). Logistic regression analysis was used to assess the statistical association between the studied parameters and arrhythmic events. Results: There were 14 patients with arrhythmic events (8 supraventricular, 4 ventricular and 2 with both). Patients in Group 1 were older (44 ± 11 vs. 32 ± 9 years, p<0.001), had surgical repair at an older age (16 ± 13 vs. 9 ± 11 years, p=0.019) and had the echo examination later after repair (28 ± 11 vs. 23 ± 6 years, p=0.025). All the other measurements were similar between groups. RV strain correlated with all RV function parameters (RVFAC: r= - 0.35; RVESV: r=0.36; TAPSE: r= - 0.36; tricuspide S': r= - 0.30) and with RA strain (r= - 0.51). RA strain correlated also with tricuspide A' (r=0.31) and TAPSE (r=0.27). Patients in Group 1 had significantly reduced RV strain (-13.0 ± 6.3 vs. -16.9 ± 3.6%, p=0.043) and RA strain (33.0 ± 7.2 vs. 28.5 ± 9.2%, p=0.027). RV strain is an independent predictor for the presence of arrhythmic events (OR 1.26, 95% CI 1.04-1.52,p=0.018), adjusted for patient's age and time from repair. RA strain did not remain as an independent predictor after adjustment (OR 0.95, 95% CI 0.88-1.01, p=0.124). By ROC curve analysis, only RV strain predicted the presence of arrhythmias (AUC 0.765, 95% CI 0.594-0.936) with a cut-off value of < -11.2% (sensitivity 57% and specificity 94%). Conclusions: Compared with conventional echocardiographic parameters, 2D strain measurements of the right heart (particularly RV) are associated with the occurrence of arrhythmic events and RV 2D strain may be useful in risk stratification of patients with rTOF.

Published
2014
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115. Microvolt T-wave alternans profiles in patients with pulmonary arterial hypertension compared to patients with left ventricular systolic dysfunction and a group of healthy volunteers.

Author

Danilowicz-Szymanowicz L, Lewicka E, Dabrowska-Kugacka A, Niemirycz-Makurat A, Kwiatkowska J, Lewicka-Potocka Z, Rozwadowska K, Stepnowska E, and Raczak G

Subjects
Adult, Electrocardiography, Healthy Volunteers, Humans, Middle Aged, Pilot Projects, Risk Assessment, Young Adult, Arrhythmias, Cardiac, Death, Sudden, Cardiac, Hypertension, Pulmonary complications, Ventricular Dysfunction, Left complications
Abstract

Objective: Microvolt T-wave alternans (MTWA) is a well-examined parameter for the risk stratification of sudden cardiac death (SCD) in patients with left ventricular dysfunction (LVD). However, the role of MTWA in pulmonary arterial hypertension (PAH) remains obscure. Consequently, the present study aimed to analyze the profile of MTWA among PAH patients in comparison with LVD patients and healthy volunteers., Methods: The prospectively study included 22 patients with PAH (mean pulmonary artery pressure ≥ 25 mm Hg and pulmonary capillary wedge pressure ≤15 mm Hg during right heart catheterization; mean age, 40±17 years); 24 with LVD [left ventricular ejection fraction (LVEF) ≤35%; mean age, 40±11 years]; and 28 healthy volunteers (mean age, 41±8 years). Patients with persistent atrial arrhythmia were excluded. The MTWA (spectral method) categories were positive, negative, or indeterminate (MTWA&#95;pos, MTWA&#95;neg, or MTWA&#95;ind, respectively). MTWA&#95;pos and MTWA&#95;ind were qualified as abnormal (MTWA&#95;abn). Statistical analyses (Mann-Whitney U, chi-square with Yates's correction, Fisher's exact test) were performed., Results: PAH patients had higher LVEF than LVD patients (61±7% vs. 27±7%; p<0.05). MTWA&#95;abn was observed more frequently in the PAH and LVD groups than in the healthy volunteers. Patients with PAH were characterized by a considerable percentage of MTWA&#95;pos and MTWA&#95;abn (59% and 73%, respectively), but this did not differ from LVD patients., Conclusion: Patients with PAH are characterized by a high rate of MTWA abnormalities similar to LVD patients, despite the relevant differences in LVEF. Further research is required to elucidate the clinical significance and prognostic value of this data, particularly in the context of SCDunderlying mechanisms in PAH patients.

Published
2016
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116. Neopterin and interleukin-6 as predictors of recurrent atrial fibrillation.

Author

Lewicka E, Dudzinska-Gehrmann J, Dabrowska-Kugacka A, Zagozdzon P, Lizewska A, Danilowicz-Szymanowicz L, and Raczak G

Abstract

Objective: Available evidence suggests that inflammation may be associated with atrial fibrillation (AF). This prospective and observational study aimed to assess whether plasma neopterin (NPT) and interleukin-6 (IL-6) levels before and after electrical cardioversion (CV) predict AF recurrence., Methods: The study was designed as a prospective observational trial. Blood samples were collected (24 hours before, 24 h after CV, and 7 days after CV) in 60 patients with a dual-chamber pacemakar and preserved left ventricular systolic function who underwent successful CV of persistent AF. All significant parameters associated with AF recurrence lasting ≥30 min and detected by pacemaker data logs were evaluated in multivariate logistic regression analysis. Echocardiography was performed 7 days after CV in patients with sinus rhythm. The control group included 17 subjects without AF., Results: The analysis included 51 patients who remained in sinus rhythm 7 days after CV. During 12 months of follow-up, AF recurred in 46 patients. Baseline IL-6 levels did not differ between the two groups, but baseline NPT levels were higher in the study group than in the control group (19±7 vs. 11±5 nmol/mL, p<0.001). NPT levels of ≥14.6 nmol/L at baseline and ≥13.3 nmol/L 7 days after CV separated the patients with AF recurrence from those without arrhythmia after CV. Only left atrial emptying fraction <38% was an independent predictor of AF recurrence (p=0.03), whereas NPT levels of ≥13.3 nmol/L 7 days after CV showed borderline statistical significance (p=0.07)., Conclusion: Increased NPT level was observed in patients with persistent AF. Neither baseline IL-6 and NPT levels nor their changes within 7 days after CV were predictive of AF recurrence. Further studies are needed to establish the prognostic significance of NPT in patients with AF.

Published
2016
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118. Atrial electromechanical sequence and contraction synchrony during single- and multisite atrial pacing in patients with brady-tachycardia syndrome.

Author

Dabrowska-Kugacka A, Lewicka-Nowak E, Ruciński P, Zagozdzon P, Raczak G, and Kutarski A

Subjects
Aged, Bradycardia diagnosis, Female, Humans, Male, Myocardial Contraction, Syndrome, Tachycardia, Ectopic Atrial diagnosis, Treatment Outcome, Bradycardia physiopathology, Bradycardia prevention & control, Cardiac Pacing, Artificial methods, Heart Atria physiopathology, Heart Conduction System physiopathology, Tachycardia, Ectopic Atrial physiopathology, Tachycardia, Ectopic Atrial prevention & control
Abstract

Objectives: Investigation of which atrial pacing modality provides atrial synchrony and the most physiological atrial contraction pattern in patients with brady-tachycardia syndrome., Methods: Fifteen healthy subjects and 57 patients with sinus node dysfunction, atrial fibrillation recurrences, and prolonged P-wave on the electrocardiogram treated with multisite atrial (MSA) pacing were studied. One atrial lead was implanted in the coronary sinus (CS) ostium area, the other at the right atrial appendage (RAA): RAA+CS group (28 patients), or Bachmann's bundle (BB) region: BB+CS group (29). Sinus rhythm (SR) and CS, RAA, BB, RAA+CS, and BB+CS pacing modalities were evaluated. Electromechanical delay (EMD) in atrial walls was assessed by tissue Doppler echocardiography. Interatrial (DeltainterA), intra-right (DeltaRA), and intra-left (DeltaLA) atrial dyssynchrony were calculated., Results: During SR, in the study group versus controls, important DeltainterA: 55 +/- 23 versus 22 +/- 11 ms (P < 0.01) and DeltaLA: 47 +/- 21 versus 21 +/- 6 ms (P < 0.001) were present. Single-site BB and both MSA pacing modes restored DeltainterA and DeltaLA (DeltainterA: 24 +/- 16, 20 +/- 13 and 14 +/- 9 ms, DeltaLA: 28 +/- 18, 28 +/- 13 and 20 +/- 10 ms during BB, RAA+CS and BB+CS pacing, respectively). CS pacing prolonged lateral RA EMD, while RAA pacing LA walls EMD, which resulted in DeltainterA persistence. CS pacing induced DeltaRA (50 +/- 23 vs 16 +/- 8 ms, P < 0.0001 vs controls). Atrial contraction sequence during BB pacing resembled that observed in controls., Conclusions: (1) Single-site BB and both MSA pacing modes restored atrial synchrony. (2) Single-site RAA and CS ostium pacing retained interatrial dyssynchrony; moreover, CS pacing created RA dyssynchrony. (3) Single-site BB pacing provided physiological atrial contraction sequence.

Published
2009
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120. Echocardiographic evaluation of patients with severe heart failure and impairment of intraventricular conduction following cardiac resynchronisation therapy.

Author

Faran A, Dabrowska-Kugacka A, Lewicka-Nowak E, Tybura S, Zieba B, Daniłowicz-Szymanowicz L, Krzymińska-Stasiuk E, Kempa M, Kogut K, and Raczak G

Subjects
Adult, Aged, Female, Heart Conduction System, Humans, Male, Middle Aged, Pacemaker, Artificial, Severity of Illness Index, Ultrasonography, Cardiac Pacing, Artificial, Heart Failure diagnostic imaging, Ventricular Remodeling
Abstract

Background: Echocardiographic examination is essential for clinical assessment of patients after cardiac resynchronisation therapy (CRT)., Aim: To assess the benefit of CRT in patients with end-stage heart failure at long-term follow-up., Methods: 28 patients with end-stage heart failure, NYHA class >or= III (>or= II in patients with indications for implantable cardioverter defibrillator and echocardiographic signs of ventricular mechanical systolic dyssynchrony), left ventricular ejection fraction (LVEF) <35%, QRS duration >120 ms and left bundle branch block morphology received a biventricular device. Standard colour Doppler echocardiography examination was performed at baseline, and then every 6 months, up to 2 years. Parameters of systolic and diastolic LV function, mitral insufficiency and right ventricular (RV) pressure were evaluated., Results: Following CRT, a statistically significant improvement of LV dimensions (p<0.05), and LVEF (p<0.001) was recorded. CRT also resulted in a mitral regurgitation decrement (p<0.01). Interventricular mechanical delay was shortened (p=0.0005). After 2 years, non-significant worsening of LV dimensions was observed. At long-term follow-up CRT did not result in LV volume, left atrium, RV dimension or RV pressure reduction., Conclusions: CRT is associated with reverse remodelling of the LV at mid-term follow-up.

Published
2008

121. Cardiac resynchronisation therapy in patients with end-stage heart failure--long-term follow-up.

Author

Faran A, Lewicka-Nowak E, Dabrowska-Kugacka A, Kempa M, Tybura S, Szwoch M, Królak T, and Raczak G

Subjects
Aged, Case-Control Studies, Echocardiography, Female, Follow-Up Studies, Humans, Male, Middle Aged, Pacemaker, Artificial, Severity of Illness Index, Stroke Volume, Time Factors, Treatment Outcome, Cardiac Pacing, Artificial, Heart Failure therapy
Abstract

Background: Cardiac resynchronisation therapy (CRT) has been shown to be effective in the treatment of patients with end-stage heart failure (HF). However, long-term results of CRT have not yet been validated., Aim: To assess the sustained benefit of CRT in patients with end-stage HF at long-term follow-up. In addition, predictors of response to CRT were analysed., Methods: Twenty-eight patients with end-stage HF, NYHA class >or=III (>or=II in patients with indications for ICD and echocardiographic signs of ventricular mechanical systolic dyssynchrony), left ventricular ejection fraction <35%, QRS duration >120 ms and left bundle branch block morphology received a biventricular device (BiV). In 27 patients LV pacing was achieved via the coronary sinus tributaries and in 1 patient an endocardial LV lead was introduced transseptally. Ten patients received an ICD-CRT device. The control group consisted of 29 patients fulfilling the criteria for ICD-CRT implantation in whom the CRT system was not implanted for various reasons. At baseline, 3 months after implantation, and then every 6 months the following parameters were evaluated: NYHA class, quality of life (QoL) score, QRS duration on surface ECG, and 6-minute walking distance. The need for hospitalisation assessed one year before and one year after implantation was compared. Follow-up was obtained up to 2 years., Results: The NYHA class and 6-minute walking test were significantly improved in the CRT group after 3 months and continued to improve gradually until 24 months of follow-up. The QoL improvement at 6 months was sustained over 2 years. Hospitalisation rate due to worsening of HF decreased. One-year and two-year survival were significantly better in the CRT group than in the control group (94 and 87 vs. 80 and 73% respectively). The only predictor of clinical improvement after CRT implantation was baseline NYHA class., Conclusion: Clinical improvements with CRT are progressive and sustained over 2 years of follow-up.

Published
2008

122. Right ventricular apex versus right ventricular outflow tract pacing: prospective, randomised, long-term clinical and echocardiographic evaluation.

Author

Lewicka-Nowak E, Dabrowska-Kugacka A, Tybura S, Krzymińska-Stasiuk E, Wilczek R, Staniewicz J, Swiatecka G, and Raczek G

Subjects
Aged, Aged, 80 and over, Atrial Fibrillation etiology, Echocardiography, Electrocardiography, Feasibility Studies, Female, Follow-Up Studies, Heart Failure complications, Heart Ventricles innervation, Heart Ventricles pathology, Humans, Longitudinal Studies, Male, Middle Aged, Prospective Studies, Stroke Volume, Ventricular Dysfunction, Left etiology, Cardiac Pacing, Artificial methods, Heart Failure diagnosis, Heart Failure therapy, Pacemaker, Artificial, Ventricular Dysfunction, Left diagnostic imaging
Abstract

Introduction: In patients treated with permanent pacing, the electrode is typically placed in the right ventricular apex (RVA). Published data indicate that such electrode placement leads to an unfavourable ventricular depolarization pattern, while right ventricular outflow tract (RVOT) pacing seems to be more physiological., Aim: To compare long-term effects of RVOT versus RVA pacing on clinical status, left ventricular (LV) function, and the degree of atrioventricular valve regurgitation., Methods: Patients with indications for permanent pacing, admitted to hospital between 1996 and 1997, were randomised to receive RVA or RVOT pacing. In 2004 during a final control visit in 27 patients clinical status, echocardiographic parameters and QRS complex duration as well as NT-proBNP level were measured. Analysed parameters were compared between groups and in the case of data available during the perioperative period also their evolution in time was assessed., Results: Out of 27 patients 14 were randomised to the RVA group and 13 to the RVOT group. No significant differences between groups were observed before the procedure with respect to age, gender, comorbidities or echocardiographic parameters. Mean duration of pacing did not differ significantly between the groups (89+/-9 months in RVA group vs 93+/-6 months in RVOT group, NS). In the RVA group significant LV ejection fraction decrease was observed (from 56+/-11% to 47+/-8%, p <0.05); in the RVOT group LV ejection fraction did not change (54+/-7% and 53+/-9%; NS). Progression of tricuspid valve regurgitation was also observed in the RVA group but not in the RVOT group. During the final visit NT-proBNP level was significantly higher in the RVA group: 1034+/-852 pg/ml vs 429+/-430 pg/ml (p <0.05)., Conclusions: In patients with normal LV function permanent RVA pacing leads to LV systolic and diastolic function deterioration. RVOT pacing can reduce the unfavourable effect and can slow down cardiac remodelling caused by permanent RV pacing. Clinical and echocardiographic benefits observed in the RVOT group after 7 years of pacing are reflected by lower NT-proBNP levels in this group of patients.

Published
2006

123. Biventricular pacing demonstrates similar effects in elderly and younger patients with advanced heart failure in the mid-term follow-up.

Author

Lewicka-Nowak E, Dabrowska-Kugacka A, Faran A, Kutarski A, Wilczek R, Swiatecka G, and Raczak G

Subjects
Adult, Aged, Defibrillators, Implantable, Electrocardiography, Female, Follow-Up Studies, Heart Failure physiopathology, Heart Ventricles physiopathology, Humans, Length of Stay, Male, Middle Aged, Prospective Studies, Treatment Outcome, Cardiac Pacing, Artificial methods, Heart Failure therapy
Abstract

Background: Biventricular (BIV) pacing has been shown to improve haemodynamics and functional status of patients (pts) with advanced chronic heart failure (CHF). No study has determined the effects of BIV in relation to the age of pts., Aim: To compare the clinical outcome in two groups of pts: > or =65 years (yrs) and <65 yrs referred for BIV pacing in our centre with at least 6 months of follow-up., Methods: Among 15 pts > or =65 yrs and 16 pts <65 yrs successfully implanted with a BIV pacemaker, 12 and 15 pts, respectively, completed 6-month follow-up. Evaluation included change of NYHA class, 6-minute walking distance (6-minWD), drug therapy, QRS duration and echocardiographic parameters. The need for hospitalisation due to the worsening of CHF symptoms, assessed 6 months before and 6 months after BIV pacing, was compared. During long-term follow-up survival and complications related to this therapy were analysed., Results: In both groups after 6 months of BIV pacing clinical improvement was observed, as demonstrated by the reduction in NYHA class (p <0.005), average duration of hospitalisation due to CHF (p <0.05) and diuretics doses (p <0.05). The comparison of changes in these parameters between the two groups, as well as of changes in 6-minWD and echocardiographic parameters, did not show significant difference. BIV pacing enabled an increase in the dosage of beta-blockers (in 50% pts > or =65 yrs and 60% pts <65 yrs), as well as of ACEI or ARB (25% and 40% pts, respectively). Survival was 80% in 15 pts > or =65 yrs during 16+/-15 months of follow-up and 81% in 16 pts v65 yrs during 22+/-14 months. All complications occurred in the 30-day post-operative period with similar frequency in both groups, also when LV lead-related complications were compared., Conclusions: In the mid-term follow-up BIV pacing demonstrates similar improvement in clinical status and exercise tolerance in elderly pts > or =65 yrs, as compared with pts <65 yrs. In both groups BIV pacing reduced the need for hospitalisation due to worsening of CHF symptoms, and enabled beneficial changes in the pharmacological treatment. Elderly patients are not at risk of more frequent complications associated with BIV pacing.

Published
2006

124. [Electrical remodeling in a patient with biventricular pacemaker].

Author

Lewicka-Nowak E, Faran A, Dabrowska-Kugacka A, Lubiński A, Wilczek R, and Swiatecka G

Subjects
Aged, Cardiomyopathy, Dilated physiopathology, Humans, Male, Treatment Outcome, Ventricular Dysfunction, Left physiopathology, Cardiomyopathy, Dilated therapy, Heart Conduction System physiopathology, Pacemaker, Artificial, Ventricular Dysfunction, Left therapy
Abstract

Electrical remodelling in a patient with biventricular pacemaker - a case report. A case of a 70-year-old patient with dilated cardiomyopathy is presented. The patient underwent biventricular pacemaker implantation and improved markedly. Indications for resynchronisation therapy are discussed.

Published
2004

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