80 results on '"Koźluk E"'
Search Results
2. Morphology of the tendon of Todaro within the human heart in ontogenesis
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Kozłowski D, Marek Grzybiak, Koźluk E, and Owerczuk A
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Adult ,Aged, 80 and over ,Tendons ,Adolescent ,Child, Preschool ,Infant, Newborn ,Humans ,Infant ,Heart ,Heart Atria ,Middle Aged ,Child ,Aged - Abstract
The tendon of Todaro, found in the right atrium of the heart, has considerable clinical importance in the fields of both cardiac surgery and invasive cardiology. The goal of this study was to examine the occurrence and degree of development of the tendon of Todaro in humans. Research was conducted on material consisting of 160 human hearts of both sexes from the age of 14 Hbd to 87 years of age. Classical anatomical methods were used and histological sections were prepared from 100 hearts of various age groups stained with Masson's method in Goldner's modification. The tendon of Todaro occurred in all examined hearts. In foetal hearts, in the area typical of the course of the tendon of Todaro, a very well-developed, white structure was observed, convexed into the lumen of the atrium. Histologically, this was young fibrous tissue with a characteristically large number of fibroblasts. Evenly in infants and newborns, a visible convex structure was also observed extending into the lumen of the right atrium, however, to a lesser degree than in foetuses. In the group of hearts of young adults, it was also possible to follow the course of the tendon of Todaro macroscopically. However, the older the heart was, the less the convex was visible, and in older adults it was completely invisible. In histological sections, it was observed that with ageing the number of connective tissue cells decreased, and fibres forming the lining increased. In the hearts of older adults the tendon of Todaro formed very small ribbons of connective tissue. Histologically, only small numbers of cellular elements were noticed. In the adult heart the examined tendon was located the deepest and did not connect to the endocardium. We can conclude that the tendon of Todaro is a stable structure, occurring in all examined hearts even when it is not macroscopically visible. Due to the morphological changes that affect the tendon of Todaro in human ontogenesis, for the cardiac surgeon, its relevance as an important topographical structure in the hearts of older adults is minimal.
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- 2000
3. Morphology of the atrioventricular node in relation to the mechanism of atrioventricular nodal reentry tachycardia--a preliminary report
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Kozłowski D, Koźluk E, Kołodziej P, Grochowski P, Marek Grzybiak, and Walczak F
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Aged, 80 and over ,Male ,Atrioventricular Node ,Humans ,Tachycardia, Atrioventricular Nodal Reentry ,Female ,Middle Aged ,Aged - Published
- 1996
4. Multifactorial analysis of indicators of correct catheter localization for slow pathway radiofrequency ablation in patients with atrioventricular nodal reentrant tachycardia
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Koźluk, E., primary, Walczak, F., additional, Szufladowicz, E., additional, Jedynak, Z., additional, Masiak, H., additional, and Kępski, R., additional
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- 2001
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5. Results of head-up tilt test in relation to the protocol used. The pilot results of the Polish multicenter study
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Koźluk, E., Kozłowski, D., Szufladowicz, E., Jacek Gajek, Krupa, W., Pia̧tkowska, A., Zyśko, D., Zastawna, I., Walczak, F., and Świa̧tecka, G.
6. Histologic evaluation of the atrioventricular nodal artery in healthy humans and in patients with conduction disturbances
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Kozłowski D, Owerczuk A, Koźluk E, Marek Grzybiak, Adamowicz-Kornacka M, Walczak E, and Walczak F
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Adult ,Aged, 80 and over ,Male ,Pacemaker, Artificial ,Adolescent ,Middle Aged ,Coronary Vessels ,Heart Block ,Atrial Fibrillation ,Atrioventricular Node ,Catheter Ablation ,Humans ,Female ,Aged - Abstract
The anatomy of the conduction system of the heart so relevant in the contemporary invasive cardiology is not fully understood. It has turned out that ablation procedures bring new information as to its structure and function, but in some cases can result in complete a-v block. Atrioventricular nodal artery located within the nodal-perinodal tissue can probably be damaged during the ablation procedures. Therefore, we decided to explore in detail the morphology and the topography of the atrioventricular nodal artery in healthy humans and in patients with clinical traits of a-v conduction disturbances requiring permanent pacing. The microscopic study was carried out on 30 normal human hearts specimens (17 F, 3 M) from 17 to 86 years of age, and on 20 hearts with conduction disturbances (11 F, 9 M) from 39 to 85 years of age. We found that the number of the atrioventricular node arteries is different and independent of the extent that induces block causing conduction disturbances. The topography of the artery in perinodal zone was consistent in normal hearts, yet in hearts with conduction disturbances we observed about 2% of deviations in its location. It might be the reason for generation of iatrogenic complications after invasive cardiological procedures. The morphology revealed changes in 50% of the examined hearts and their vessel walls, which was declared to be connected with ageing. This correlated with certain stages of atherosclerosis as well as hypertension characteristic of elderly patients. We observed that in 33% of hearts from control group small parietal thrombi were detected and in 60% of paced group respectively. Hence, it seems that the procedures in perinodal zone should be performed in its proximal part because of a minor probability of direct and indirect (through nodal artery) damage of the atrioventricular structure of the junction.
7. The middle cardiac vein as a key for 'posteroseptal' space - A morphological point of view
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Kozłowski D, Koźluk E, Piatkowska A, Maruszak H, Gawrysiak M, Marek Grzybiak, and Walczak F
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Adult ,Male ,Catheter Ablation ,Humans ,Arrhythmias, Cardiac ,Female ,Heart ,Middle Aged ,Coronary Vessels ,Aged ,Veins - Abstract
About 25% of accessory pathways (AP) run via "posteroseptal" space (PSS). There are three approaches for ablation of these pathways: from the right atrium, from the left atrium or from the ventricle and coronary sinus (CS). However in some cases AP is too far from all of them. Catheterisation of the middle cardiac vein (MCV) seems to be the only chance for successful ablation. Our aim was to evaluate the topography of the MCV in PSS. Classical anatomical investigation was carried out on the autopsy material of 98 consecutive human hearts (42 F, 56 M; age 57 +/- 21 yrs). It was supported by transverse section performed under coronary sinus. Regions just behind the atrioventricular septum and behind the cavities were respectively classified as "septal", right (RP) and left posterior (LP). Between them right (RPS) and left posteroseptal areas (LPS) were present. At the posterior view of the heart the angle between CS and MCV ranged from 75 to 90 degrees in 62% of hearts, 60-75 degrees in 18%, 30-60 degrees in 10% and 90-130 degrees in 10%. In 16% MCV ran via the "septal" region, 59%--LPS, 10%--RPS, 10%--RP and 5%--LP. At the ostium of 58% MCV a valve was observed, however there was no trouble with insertion of the 6F catheter into it. We concluded that it is possible to insert the 6F catheter into MCV, which makes it possible to perform ablation of epicardial postero-inferior accessory pathways. The origin of MCV is usually located in the left "posteroseptal" region and runs towards the left side of the posterior wall.
8. Efficacy of catheter ablation in patients with an electrical storm
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Koźluk, E., Gaj, S., Kiliszek, M., Piotr Lodziński, Pia̧tkowska, A., and Opolski, G.
9. Application of the Wavelet transform for the detection of the QRS complex,Zastosowanie przekształeenia falkowego do detekcji zespołu QRS
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Agnieszka Duraj, Krawczyk, A., Koźluk, E., and Kumor, M.
10. Holter-type impedance cardiography device. A system for continuous and non-invasive monitoring of cardiac haemodynamics,Holter Reograficzny-reomonitor. System do cia̧głej, nieinwazyjnej oceny objȩtości wyrzutowej i podokresów skurczu serca
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Cybulski, G., Koźluk, E., Michalak, E., Wiktor Niewiadomski, and Pia̧tkowska, A.
11. Genetic background of common arrhythmias,Genetyczne uwarunkowania najczestszych arytmii
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Kiliszek, M., Łukasz Małek, Koźluk, E., Lodziński, P., and Opolski, G.
12. Lead dislocations in atrial resynchronization pacing - Analysis of risk factors,Dyslokacje elektrod do przedsionkowej stymulacji resynchronizujacej - Ocena czynnikow ryzyka
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Koźluk, E., Piotr Lodziński, Kotliński, Z., Piatkowska, A., Szumowski, Ł., Lodzińska, M., and Walczak, F.
13. Negative delta wave mimicking old inferior myocardial infarction - A case report,Patologiczny załomek Q - Przestroga przed rutyna̧ lekarska̧
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Koźluk, E., Kiliszek, M., Piotr Lodziński, Zastawna, I., Kochanowski, J., Opolski, G., and Wrabec, K.
14. The LocaLisa system as the key to shortening the procedure duration and fluoroscopy time during ablation of atrial fibrillation
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Koźluk, E., Gawrysiak, M., Piotr Lodziński, Kiliszek, M., Winkler, A., Kochanowski, J., Pia̧tkowska, A., Kasprzak, J. D., Kozłowski, D., and Opolski, G.
15. Clinical and anatomical models of atrial fibrillation ablation in patients with common pulmonary vein trunk - Preliminary report,Modele kliniczno-anatomiczne ablacji podłoza migotania przedsionków u pacjentów ze wspólnym pniem zył płucnych - doniesienie wstȩpne
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Koźluk, E., Zyśko, D., Pia̧tkowska, A., Piotr Lodziński, Kiliszek, M., Małkowska, S., Balsam, P., Rodkiewicz, D., Zukowska, M., and Opolski, G.
16. Histologic and coronarographic evaluation of the atrioventricular nodal artery in patients with various type of cardiac rhythm disorders,Ocena histologiczna i koronarograficzna tȩtnicy wȩzła przedsionkowo-komorowego u chorych z różnymi zaburzeniami rytmu serca
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Kozłowski, D., Koźluk, E., Walczak, F., Grzybiak, M., Owerczuk, A., Adamowicz, M., Adam Kosiński, Walczak, E., Stanke, A., Szumowski, Ł., Witkowski, A., and Ruzyłło, W.
17. Preliminary evaluation of the topography of the His bundle with regards to ablation procedures
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Kołodziej P, Kozłowski D, Koźluk E, Grochowski P, Adamowicz M, Marek Grzybiak, Walczak E, Walczak F, and Kruś S
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Adult ,Aged, 80 and over ,Male ,Bundle of His ,Reference Values ,Catheter Ablation ,Tachycardia, Supraventricular ,Humans ,Female ,Middle Aged ,Aged
18. The role of the control head-up tilt test in the evaluation of treatment efficiency in vasovagal patients.
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Kozlowski, D., Krupa, W., Radomski, M., Królak, T., Świątecka, G., Koźluk, E., and Szufladowicz, E.
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- 2000
19. Multifactorial analysis of indicators of correct catheter localization for slow pathway radiofrequency ablation in patients with atrioventricular nodal reentrant tachycardia.
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Koźluk, E., Walczak, F., Szufladowicz, E., Jedynak, Z., Masiak, H., and Kępski, R.
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- 2000
20. Zero-fluoroscopy catheter ablation of premature ventricular contractions: comparative outcomes from the right ventricular outflow tract and other ventricular sites.
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Rodkiewicz D, Momot K, Koźluk E, Piątkowska A, Rogala K, Puchalska L, and Mamcarz A
- Abstract
Background: The three-dimensional electroanatomic mapping (EAM) system allows performing catheter ablation (CA) without fluoroscopy in patients with premature ventricular contractions (PVCs). The right ventricle outflow tract (RVOT) location is favorable for performing zero-fluoroscopy CA. Non-RVOT zero-fluoroscopy CA is a challenging procedure. The study aimed to evaluate the efficacy and safety of zero-fluoroscopy CA using the EAM in patients with PVCs from RVOT and non-RVOT., Methods: Completely zero-fluoroscopy CA of PVCs guided by EAM was performed in 107 patients with PVCs. 54 patients underwent zero-fluoroscopy RVOT CA. The remaining 53 patients underwent zero-fluoroscopy non-RVOT CA. Demographic and clinical baseline characteristics, procedure parameters, and follow-up were obtained from medical records. Primary outcomes were the acute and the permanent success rate (12-month follow-up), complications, and procedure time., Results: There were no significant differences between groups regarding baseline characteristics. Acute procedural success was achieved in 52 patients (94,44%) in the RVOT zero-fluoroscopy CA group and in 45 patients (86,54%) in the non-RVOT zero-fluoroscopy CA group (ns). A long-term success rate was achieved in 50 patients (90,74%) in the RVOT zero-fluoroscopy CA group and in 44 patients (84,62%) in the non-RVOT zero-fluoroscopy CA group (ns). The median procedure time was 80.5 minutes in the RVOT group and 90 minutes in the non-RVOT group (ns). There were two complications in the non-RVOT group (ns)., Conclusions: There were no differences in procedure time efficacy and safety zero-fluoroscopy ablation between RVOT and non-RVOT locations. Non-fluoroscopy CA of PVCs is a feasible, safe, and efficient procedure.
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- 2024
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21. Efficacy of Catheter Ablation Using the Electroanatomical System without the Use of Fluoroscopy in Patients with Ventricular Extrasystolic Beats.
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Rodkiewicz D, Koźluk E, Momot K, Rogala K, Piątkowska A, Buksińska-Lisik M, Kwasiborski P, and Mamcarz A
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Background: Catheter ablation (CA) has become safe and efficient for the treatment of patients with ventricular extrasystolic beats (VEBs). The three-dimensional electroanatomic mapping (EAM) system allows the elimination of fluoroscopy time during CA procedures. Non-fluoroscopy CA is a challenging procedure requiring intimate knowledge of cardiac anatomy in patients with VEBs. The study aimed to evaluate the efficacy and safety of the non-fluoroscopy CA using the EAM system in patients with VEBs., Methods: Completely fluoroless CA of VEBs guided by EAM was performed in 86% (94 out of 109) of consecutive patients with VEBs. The remaining 15 patients underwent conventional fluoroscopy-guided CA. Demographic and clinical baseline characteristics, procedure parameters, and following complications were obtained from the medical records. Primary outcomes were the acute procedural success rate, the permanent success rate (6-month follow-up), complications, and procedure time., Results: There were no significant differences between groups regarding baseline characteristics. Acute procedural success was achieved in 85 patients (90%) in the non-fluoroscopy group and in 14 patients (93%) in the fluoroscopy group (ns). A long-term success rate was achieved in 82 patients (87%) in the non-fluoroscopy group and in 14 (82%) patients in the fluoroscopy group (ns). The median procedure time was 85 min in the non-fluoroscopy group and 120 min in the fluoroscopy group ( p = 0.029). There was only one major complication in the non-fluoroscopy group (ns)., Conclusions: Completely fluoroless CA of VEBs guided by EAM is a feasible, safe, and efficient procedure.
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- 2023
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22. An assessment of heart rate and blood pressure asymmetry in the diagnosis of vasovagal syncope in females.
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Pawłowski R, Zalewski P, Newton J, Piątkowska A, Koźluk E, Opolski G, and Buszko K
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Introduction: Heart Rate Asymmetry (HRA) describes a phenomenon of differences between accelerations and decelerations in human heart rate. Methods used for HRA assessment can be further implemented in the evaluation of asymmetry in blood pressure variations (Blood Pressure Asymmetry-BPA). Methods: We have analyzed retrospectively the series of heartbeat intervals extracted from ECG and beat-to-beat blood pressure signals from 16 vasovagal patients (age: 32.1 ± 13.3; BMI: 21.6 ± 3.8; all female) and 19 healthy subjects (age: 34.6 ± 7.6; BMI: 22.1 ± 3.4; all female) who have undergone tilt test (70°). Asymmetry was evaluated with Poincaré plot-based methods for 5 min recordings from supine and tilt stages of the test. The analyzed biosignals were heart rate (RR), diastolic (dBP) and systolic Blood Pressure (sBP) and Pulse Pressure (PP). In the paper we explored the differences between healthy and vasovagal women. Results: The changes of HRA indicators between supine and tilt were observed only in the control group (Porta Index p = 0.026 and Guzik Index p = 0.005). No significant differences in beat-to-beat variability (i.e. spread of points across the line of identity in Poincaré plot-SD1) of dBP was noted between supine and tilt in the vasovagal group ( p = 0.433 in comparison to p = 0.014 in healthy females). Moreover, in vasovagal patients the PP was significantly different (supine: 41.47; tilt: 39.27 mmHg) comparing to healthy subjects (supine: 35.87; tilt: 33.50 mmHg) in supine ( p = 0.019) and in tilt ( p = 0.014). Discussion: Analysis of HRA and BPA represents a promising method for the evaluation of cardiovascular response to orthostatic stressors, however currently it is difficult to determine a subject's underlying health condition based only on these parameters., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Pawłowski, Zalewski, Newton, Piątkowska, Koźluk, Opolski and Buszko.)
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- 2023
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23. Is Increased Resting Heart Rate after Radiofrequency Pulmonary Vein Isolation a Predictor of Favorable Long-Term Outcome of the Procedure?
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Maciejewski C, Peller M, Lodziński P, Koźluk E, Piątkowska A, Rodkiewicz D, Sierakowska I, Roman N, Wiśniewska D, Żółcińska D, Rymaszewska D, Opolski G, Grabowski M, and Balsam P
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Background: Increased resting heart rate (RHR) after pulmonary vein isolation (PVI) for treatment of atrial fibrillation (AF) is a common observation, possibly resulting from ganglionated plexus modification during ablation. Previous trials have suggested that an increase in RHR after ablation might be related to higher efficacy of the procedure. The aim of this study was to determine whether or not higher increase in RHR after radiofrequency (RF) PVI might predict better long-term outcome of the procedure in a real-life cohort of patients in whom index ablation for paroxysmal AF was performed. Material and methods: The health records of patients who underwent index point-by-point or drag lesion RF PVI for paroxysmal AF in our department between January 2014 and November 2018 were analyzed. Resting heart rate (RHR) was determined from 12-lead ECG recorded prior to the ablation and before discharge to evaluate changes in RHR after PVI. Only patients in sinus rhythm before the procedure and at discharge were included in the analysis. Telephone follow-up was collected for evaluation of arrhythmia recurrence status. Results: A total of 146 patients who underwent PVI for paroxysmal AF were included. Mean follow-up time was 3.5 years. RHR increased from 64 [58.5−70], prior to procedure, to 72 [64.25−80] bpm at discharge (p < 0.001). Higher increase in RHR was not protective from arrhythmia recurrence in long-term observation in both univariable HR = 1.001 (CI 0.99−1.017, p = 0.857) and multivariable analyses HR = 1.001 (CI 0.99−1.02, p = 0.84). Conclusions: RHR after PVI increased in comparison to baseline in our cohort. However, we did not observe higher increase in RHR to be associated with more favorable long-term effectiveness of the procedure.
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- 2022
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24. Efficacy and Safety of Zero-Fluoroscopy Approach during Catheter Ablation of Accessory Pathway.
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Rodkiewicz D, Koźluk E, Piątkowska A, Gąsecka A, Krzemiński K, and Opolski G
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Background: Catheter ablation (CA) is a safe and efficient treatment in patients with an atrioventricular accessory pathway (AP). Electroanatomical mapping (EAM) systems are useful during CA of AP, especially for reducing fluoroscopy. There are limited data about the feasibility of CA procedures performed with the use of the EAM system entirely without fluoroscopy in adults with AP. The aim of the study is to assess the feasibility, efficacy and safety of CA with the use of EAM without fluoroscopy, compared to CA with EAM and fluoroscopy in patients with AP., Methods: The study included 83 consecutive patients (age 38.25 ± 15.8 years), who were subjected to CA for AP. In 40 patients CA was performed with the use of EAM without fluoroscopy (EAM group), and in 43 patients CA was performed with EAM and fluoroscopy (control group). Baseline characteristics, procedure parameters and complications were obtained from the medical records. Data on permanent success rate was obtained after the mean follow-up time of 1 year. Primary outcomes were acute procedural success rate, long term success rate at 1-year follow-up and complications. Secondary outcomes were the procedure time and number of applications., Results: There were no statistically significant differences in baseline characteristics between the groups, except for the AP locations. Right-sided AP was more common in the EAM group, while left-sided AP was more common in the control group ( p = 0.007 and p = 0.004, respectively). Acute procedural success was achieved in 38 patients (95.0%) in the EAM group and in 39 patients (90.7%) in the control group ( p = 0.449). Long term success rate was achieved in 36 patients (90.0%) in the EAM group and in 36 (83.7%) patients in the control group ( p = 0.399). There was one minor complication in the form of RBBB in the EAM group ( p = 0.138). The mean procedure time was shorter in the EAM group compared to the control group (93.0 ± 58.3 min vs. 127.6 ± 57.5 min; p = 0.009)., Conclusions: CA of both right-sided and left-sided AP completely guided by EAM without the use of fluoroscopy is feasible, safe and effective.
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- 2022
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25. Contact Force-Sensing versus Standard Catheters in Non-Fluoroscopic Radiofrequency Catheter Ablation of Idiopathic Outflow Tract Ventricular Arrhythmias.
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Karkowski G, Kuniewicz M, Ząbek A, Koźluk E, Dębski M, Matusik PT, and Lelakowski J
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Background: Adequate contact between the catheter tip and tissue is important for optimal lesion formation and, in some procedures, it has been associated with improved effectiveness and safety. We evaluated the potential benefits of contact force-sensing (CFS) catheters during non-fluoroscopic radiofrequency catheter ablation (NF-RFCA) of idiopathic ventricular arrhythmias (VAs) originating from outflow tracts (OTs)., Methods: A group of 102 patients who underwent NF-RFCA (CARTO, Biosense Webster Inc., Irvine, CA, USA) of VAs from OTs between 2014 to 2018 was retrospectively analyzed., Results: We included 52 (50.9%) patients in whom NF-RFCA was performed using CFS catheters and 50 (49.1%) who were ablated using standard catheters. Arrhythmias were localized in the right and left OT in 70 (68.6%) and 32 (31.4%) patients, respectively. The RFCA acute success rate was 96.1% (n = 98) and long-term success during a minimum 12-month follow-up (mean 51.3 ± 21.6 months) was 85.3% ( n = 87), with no difference between CFS and standard catheters. There was no difference in complications rate between CFS ( n = 1) and standard catheter ( n = 2) ablations., Conclusions: There is no additional advantage of CFS catheters use over standard catheters during NF-RFCA of OT-VAs in terms of procedural effectiveness and safety.
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- 2022
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26. Non-fluoroscopic radiofrequency catheter ablation of right- and left-sided ventricular arrhythmias.
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Karkowski G, Kuniewicz M, Koźluk E, Chyży T, Ząbek A, Dusza M, and Lelakowski J
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Introduction: Radiofrequency catheter ablation (RFCA) is an important method of treatment of ventricular arrhythmias (VAs). In the majority of RFCA, fluoroscopy is used, exposing patients and medical staff to all related side effects. Current experience of non-fluoroscopic (NF)-RFCA in VAs from the left side is limited., Aim: Analysis of safety and effectiveness of NF-RFCA of VAs from left- and right-sided cardiac chambers., Material and Methods: From 2014 to 2018, a group of 128 patients who underwent RFCA of VAs were retrospectively divided into two groups: NF-RFCA and fluoroscopic (F)-RFCA. Patients in each group were then subsequently subdivided into two groups based on VAs localization - left- (LS-Va) and right-sided (RS-Va) VAs. In all patients the CARTO Biosense Webster mapping system was used., Results: In group 1 (NF-RFCA n = 88) 66 (75%) patients underwent RFCA of RS-Va and 22 (25%) of LS-Va. Early success was achieved in 89.8% ( n = 79) and long term success in 81.8% ( n = 72). In group 2 (F-RFCA n = 40) 19 patients (47.5%) had RFCA of RS-Va and 21 (52.5%) patients of LS-Va. Acute procedural success rate was 80% ( n = 32) and long-term success 72.5% ( n = 29). There were 4 (4.6%) perioperative complications in NF-RFCA and 2 (5%) in F-RFCA. Success rate, procedure time and complications were not significantly different between groups and subgroups in follow-up., Conclusions: NF-RFCA in VAs from the right and left cardiac chamber is safe and equally effective as F-RFCA, and it should be implemented as often as possible for protection of patients and electrophysiology staff., Competing Interests: The authors declare no conflict of interest., (Copyright © 2020 Termedia Sp. z o. o.)
- Published
- 2020
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27. Diagnostic value of implantable loop recorder in patients undergoing cryoballoon ablation of atrial fibrillation.
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Kusiak A, Jastrzębski M, Bednarski A, Kułakowski P, Piotrowski R, Koźluk E, Baszko A, and Czarnecka D
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- Adult, Aged, Female, Humans, Male, Middle Aged, Postoperative Complications physiopathology, Prostheses and Implants, Reproducibility of Results, Sensitivity and Specificity, Atrial Fibrillation physiopathology, Atrial Fibrillation surgery, Catheter Ablation methods, Electrocardiography, Ambulatory instrumentation, Electrocardiography, Ambulatory methods, Postoperative Complications diagnosis
- Abstract
Background: Due to limited data, implantable loop recorders (ILR) are not currently recommended by the guidelines to routinely monitor patients after atrial fibrillation (AF) ablation., Aims: To validate the diagnostic value of ILR after AF ablation, modern generation ILRs (LINQ) were implanted in patients scheduled for cryoballoon ablation of AF (CBA)., Methods: We included 29 patients with frequent and symptomatic episodes of paroxysmal AF. ILR was implanted 3 months prior to CBA, and data were collected before and for 6 months after the procedure. The device was programmed to maximize sensitivity of AF/ atrial tachycardia (AT) detection. All EGM recordings were "manually" assessed and annotated as true AF, pseudo AF, unrecognized AF, and episodes with no EGM available. Duration and episode-based standard performance metrics were evaluated., Results: A total number of 5,842 episodes were recorded. A total of 4,403 episodes were true AF, 453 episodes were pseudo AF, and 986 episodes had no EGM available. The device did not recognize 144 episodes of AF. Duration-based sensitivity was 95.2%, duration-based specificity 99.9%, duration-based PPV 99.2%, duration-based NPV 99.9%, episode-based sensitivity 98.0%, and episode-based PPV 91.0%. Misdiagnosis happened in 1 in 10 episodes. Total data review time was 166 hr., Conclusions: Implantable loop recorders is a valuable tool in evaluation of AF episodes in patients undergoing CBA. However, for high precision all recorded episodes need to be evaluated "manually." The memory storage space is too low for frequent AF episodes, resulting in overwriting of stored EGMs and data loss., (© 2019 The Authors. Annals of Noninvasive Electrocardiology published by Wiley Periodicals, Inc.)
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- 2020
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28. Paroxysmal and persistent atrial fibrillation ablation outcomes with the pulmonary vein ablation catheter GOLD duty-cycled phased radiofrequency ablation catheter: quality of life and 12-month efficacy results from the GOLD Atrial Fibrillation Registry.
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Boersma L, Koźluk E, Maglia G, de Sousa J, Grebe O, Eckardt L, Hokanson RB, Hemingway LA, Ostern E, Park HS, Rovaris G, Arribas F, Scharf C, Csanádi Z, Arenal Á, Laurenzi F, Klaver M, and Goette A
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- Catheters, Female, Humans, Male, Middle Aged, Prospective Studies, Quality of Life, Recurrence, Registries, Treatment Outcome, Atrial Fibrillation diagnosis, Atrial Fibrillation surgery, Catheter Ablation adverse effects, Pulmonary Veins surgery
- Abstract
Aims: The GOLD AF Registry has been designed to prospectively assess the population, indications, and outcomes using second-generation phased radiofrequency (RF) ablation (pulmonary vein ablation catheter GOLD) in a global examination of standard-of-care use for the treatment of paroxysmal and persistent atrial fibrillation (AF)., Methods and Results: GOLD AF (NCT02433613) is a prospective, observational, multi-centre registry designed to characterize efficacy and safety of phased RF ablation in patients with AF. The primary endpoint was freedom from AF recurrence at 12-month follow-up after a 90-day blanking period. Ancillary objectives include safety, procedural efficiency, and quality of life (QoL). The QoL assessment using the Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) and the European Heart Rhythm Association (EHRA) Score of AF-related symptoms was collected at baseline and 12 months. In total, 1054 patients were included in this analysis (age 60.6, 67.6% male, 26.5% PersAF). Kaplan-Meier estimate of freedom from AF recurrence was 77.7% at 12 months. Peri-procedural device or procedure-related complications were observed in 26 (2.5%) patients, with a low stroke rate of 0.3%. One-year post-ablation, the EHRA AF Symptom score decreased in 68% of patients. The AFEQT score improvement was observed in 88.4% and 90.4% of patients who completed the questionnaire in-person or interviewed by phone at 12 month follow-up, respectively., Conclusion: Phased RF ablation for the treatment of paroxysmal and persistent AF demonstrated a 77.7% freedom from AF recurrence at 12 months in addition to a significant reduction in arrhythmia symptoms and clinically meaningful improved QoL. Low peri-procedural complication rate of <3% was reported., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2020
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29. Effectiveness comparison of various atrial fibrillation ablation methods in patients with common venous trunk.
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Koźluk E, Zyśko D, Piątkowska A, Kiliszek M, Lodziński P, Małkowska S, Balsam P, Rodkiewicz D, Żukowska M, and Opolski G
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- Electrocardiography, Ambulatory, Humans, Pulmonary Veins physiopathology, Recurrence, Treatment Outcome, Atrial Fibrillation surgery, Catheter Ablation methods, Pulmonary Veins surgery
- Abstract
Background: Atrial fibrillation (AF) is a common clinical problem. The left atrium anatomy makes up a factor that may significantly affect the effectiveness of the AF ablation., Objectives: The aim of the study was to evaluate a long-term effectiveness ablation in patients with common pulmonary vein trunk (CPVT) and AF., Material and Methods: The outcomes of 129 procedures in 95 patients with CPVT out of 1,475 procedures carried out in 1,150 patients with AF treated with ablation, were analyzed. Ablation with CARTO 3 system (Johnson & Johnson, New Brunswick, USA), cryoballoon, and the circular multipolar duty-cycled radiofrequency-based pulmonary vein ablation producer with catheter (PVAC) were considered as advanced methods. The following data was recorded for every patient: age, gender, AF duration and type, previous antiarrhythmic drugs, weight, height, any prior cardioversion, and comorbidities, including hypertension, diabetes, hypothyreosis, thyrotoxicosis, heart failure, and stroke/transient ischemic attack. The following anatomical factors were assessed: the presence of patent foramen ovale (PFO) and localization of the CPVT on the basis of venography or computed tomography (CT). In the 1st year after ablation, 24-h Holter monitoring was performed 3-5 times, and the patients were encouraged to visit their doctor or an emergency department if a cardiac arrhythmia occurred. Long-term ablation effectiveness was assessed based on a telephone interview and patients' answers to the questionnaires including 12-lead electrocardiography (ECG)., Results: Sinus rhythm was maintained in 44 patients (43.6 %) after a median of 42 months (range 12-120). A lower number of clinical factors (odds ratio [OR] range 0.09; 95% confidence interval [CI] 0.02-0.56; p < 0.01), and advanced ablation methods (OR 3.1; 95% CI 1.4-7.1; p < 0.01) were related to a better longterm effectiveness., Conclusions: The long-term effectiveness of pulmonary vein (PV) isolation in patients with AF and CPVT is higher when advanced ablation techniques are used. Accumulation of clinical factors was found to be the most tremendous predictor of AF recurrence.
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- 2019
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30. Transfer Information Assessment in Diagnosis of Vasovagal Syncope Using Transfer Entropy.
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Buszko K, Piątkowska A, Koźluk E, Fabiszak T, and Opolski G
- Abstract
The paper presents an application of Transfer Entropy (TE) to the analysis of information transfer between biosignals (heart rate expressed as R-R intervals (RRI), blood pressure (sBP, dBP) and stroke volume (SV)) measured during head up tilt testing (HUTT) in patients with suspected vasovagal syndrome. The study group comprised of 80 patients who were divided into two groups: the HUTT(+) group consisting of 57 patients who developed syncope during the passive phase of the test and HUTT(-) group consisting of 23 patients who had a negative result of the passive phase and experienced syncope after provocation with nitroglycerin. In both groups the information transfer depends on the phase of the tilt test. In supine position the highest transfer occurred between driver RRI and other components. In upright position it is the driver sBP that plays the crucial role. The pre-syncope phase features the highest information transfer from driver SV to blood pressure components. In each group the comparisons of TE between different phases of HUT test showed significant differences for RRI and SV as drivers.
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- 2019
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31. Direct results of a prospective randomized study comparing ablation with the nMARQ catheter and the PVAC catheter used with and without a 3D system (MAPER 3D Study).
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Koźluk E, Piątkowska A, Rodkiewicz D, Peller M, Kochanowski J, and Opolski G
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Introduction: Our aim was to compare in a prospective randomized study the safety, direct results and periprocedural data of ablation using an nMARQ catheter, a PVAC catheter used with the EnSite system, or a PVAC catheter only under fluoroscopy control., Material and Methods: One hundred two patients (70 male, 57 ±11 years) with atrial fibrillation (AF) were prospectively randomized to: group 1 - ablation performed with an nMARQ catheter and the CARTO 3 system; group 2 - a PVAC catheter used with the EnSite system; group 3 - ablation with a PVAC catheter without a 3D system., Results: Complete isolation of 400/402 pulmonary veins (PV) (99.5%). Linear ablation was performed in 23 patients in group 1 (small distance between lines isolating PV), in 3 patients in group 2, in 1 patient in group 3. The superior vena cava was isolated in 1 patient, 9 patients, and 9 patients respectively. Duration of fluoroscopy and dose area product were significantly smaller in group 1 (6.5 ±2.9 min/808.8 ±393.9 cGy/cm
2 vs. 13.6 ±5.6 min/1662.6 ±677.8 cGy/cm2 and 18.8 ±7.6 min/2327.9 ±975.5 cGy/cm2 ; p < 0.001). Procedure duration was shorter in group 1 (82.9 ±18.8 min vs. 101.2 ±19.6 min, p < 0.001 and 99.8 ±20.8 min, NS). Contrast injection was necessary in 2 patients in group 1, in 8 patients in group 2 and in all patients in group 3. Because nMARQ is a thermocool catheter, the volume of fluid injection was significantly greater (2348.5 ±543.5 ml vs. 1077.9 ±280.5 ml and 1076.5 ±375.6 ml, p < 0.001). There were no periprocedural deaths. We observed no cardiac tamponade, neurological complications and no atrioesophageal fistula during follow-up., Conclusions: The lowest radiological exposure was observed during ablation performed with an nMARQ catheter. 3D systems reduced fluoroscopy duration and the necessity of contrast injection. The nMARQ catheter requires injection of a large volume of fluid., Competing Interests: Edward Koźluk – Medtronic and Johnson and Johnson proctor for ablation procedures. Others authors declare no conflict of interest.- Published
- 2019
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32. Entropy Measures in Analysis of Head up Tilt Test Outcome for Diagnosing Vasovagal Syncope.
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Buszko K, Piątkowska A, Koźluk E, Fabiszak T, and Opolski G
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The paper presents possible applications of entropy measures in analysis of biosignals recorded during head up tilt testing (HUTT) in patients with suspected vasovagal syndrome. The study group comprised 80 patients who developed syncope during HUTT (57 in the passive phase of the test (HUTT(+) group) and 23 who had negative result of passive phase and developed syncope after provocation with nitroglycerine (HUTT(-) group)). The paper focuses on assessment of monitored signals' complexity (heart rate expressed as R-R intervals (RRI), blood pressure (sBP, dBP) and stroke volume (SV)) using various types of entropy measures (Sample Entropy (SE), Fuzzy Entropy (FE), Shannon Entropy (Sh), Conditional Entropy (CE), Permutation Entropy (PE)). Assessment of the complexity of signals in supine position indicated presence of significant differences between HUTT(+) versus HUTT(-) patients only for Conditional Entropy (CE(RRI)). Values of CE(RRI) higher than 0.7 indicate likelihood of a positive result of HUTT already at the passive phase. During tilting, in the pre-syncope phase, significant differences were found for: (SE(sBP), SE(dBP), FE(RRI), FE(sBP), FE(dBP), FE(SV), Sh(sBP), Sh(SV), CE(sBP), CE(dBP)). HUTT(+) patients demonstrated significant changes in signals' complexity more frequently than HUTT(-) patients. When comparing entropy measurements done in the supine position with those during tilting, SV assessed in HUTT(+) patients was the only parameter for which all tested measures of entropy (SE(SV), FE(SV), Sh(SV), CE(SV), PE(SV)) showed significant differences.
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- 2018
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33. The complexity of hemodynamic response to the tilt test with and without nitroglycerine provocation in patients with vasovagal syncope.
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Buszko K, Piątkowska A, Koźluk E, Fabiszak T, and Opolski G
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- Adult, Female, Hemodynamics drug effects, Humans, Male, Middle Aged, Nitroglycerin pharmacology, Retrospective Studies, Syncope, Vasovagal physiopathology, Tilt-Table Test, Vasodilator Agents pharmacology, Young Adult, Syncope, Vasovagal diagnosis
- Abstract
The paper presents a comparison of vasovagal syndrome occurrence in a head up tilt table test between patients with a positive result of passive tilt test and those with a positive result after pharmacological provocation. The study group consisted of 80 patients: 57 patients who experienced syncope in the passive phase of the test (43 women (aged: 35.6 ± 16.2) and 14 men (aged: 41.7 ± 15.6) and 23 patients who experienced syncope after pharmacological provocation (17 women (age: 32.3 ± 12) and 6 men (age: 43 ± 15). The main investigation was based on the assessment of monitored signals complexity: heart rate, blood pressure and stroke volume. The analysis of complexity in chosen measurement phases was performed with Sample Entropy. The investigation showed that the reactions of autonomic nervous system during tilt test and before syncope are similar for positive result of passive tilt test and positive result of tilt test with provocation. The differences in supine position occurred only in analysis based on impedance measurement (SV: p = 0.01). Significant differences were denoted for all signals just before the syncope (RRI, sBP, dBP: p = 0,00001 and SV: p = 0.01). In analysis of signals complexity the significant differences occurred just before the syncope for Sample Entropy of blood pressure (SampEn (sBP): p = 0.0008, SampEn (dBP): p = 0,0001).
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- 2018
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34. Ventricular fibrillation induced by radiofrequency energy delivery for premature ventricular contractions arising from the right ventricular outflow tract: is implantablecardioverterdefibrillator indicated?
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Orczykowski M, Derejko P, Urbanek P, Bodalski R, Lenarczyk R, Kozłowski D, Koźluk E, Łasocha D, Sterliński M, Kalarus Z, Bilińska M, and Szumowski Ł
- Subjects
- Adult, Aged, Female, Heart Ventricles radiation effects, Humans, Male, Prognosis, Radiofrequency Therapy, Ventricular Fibrillation diagnosis, Young Adult, Defibrillators, Implantable, Radio Waves adverse effects, Ventricular Fibrillation etiology, Ventricular Premature Complexes radiotherapy
- Abstract
INTRODUCTION Inadvertently induced ventricular fibrillation (VF) by radiofrequency (RF) energy delivery for premature ventricular complexes (PVCs) is a rare phenomenon; nevertheless, it is crucial to assess long‑term risk of sudden cardiac death in these patients. OBJECTIVES The aim of our study was to define the long‑term prognosis in patients with normal ejection fraction (EF), in whom VF was inadvertently induced by RF energy application during ablation of symptomatic idiopathic PVCs originating from the right ventricular outflow tract (RVOT). PATIENTS AND METHODS Among over 20 000 RF catheter ablations performed at 5 tertiary centers (2008-2016), 6 patients (5 men) had VF induced by RF application to the RVOT. The mean (SD) age of patients was 35.2 (16.8) years. All patients had normal EF (≥60%). We analyzed the risk of malignant ventricular arrhythmias and assessed heart function during follow‑up. RESULTS After ablation, baseline contrast‑enhanced magnetic resonance imaging was performed in 4 of the 6 patients; no area of late gadolinium enhancement was observed. One patient received an implantable cardioverter‑defibrillator (ICD). Exercise tests revealed only rare PVCs. All patients completedthe follow‑up (mean [SD] duration of follow‑up, 64.0 [34.9] months). All patients were alive, with no cases of syncope, documented ventricular tachycardia, or VF. The patient with an ICD received 2 inappropriate high‑voltage therapies. CONCLUSIONS Patients with inadvertently induced VF via RF energy application during ablation of PVCs from the RVOT, who have normal left ventricular function and no electrocardiography abnormalities have good prognosis and low VF risk during long‑term follow‑up. Therefore, ICD placement seems to be not indicated for these patients.
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- 2018
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35. Takotsubo syndrome after pericardial tamponade following cryoballoon ablation of pulmonary veins for paroxysmal atrial fibrillation and complicated by right coronary artery thrombosis.
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Hiczkiewicz J, Koźluk E, Łojewska K, Budzianowski J, Zimoląg R, Grydz Ł, and Sabiniewicz R
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- Atrial Fibrillation diagnosis, Atrial Fibrillation physiopathology, Cardiac Tamponade diagnostic imaging, Coronary Thrombosis diagnostic imaging, Echocardiography, Electrocardiography, Female, Humans, Middle Aged, Pulmonary Veins physiopathology, Takotsubo Cardiomyopathy diagnostic imaging, Takotsubo Cardiomyopathy physiopathology, Ventricular Function, Left, Atrial Fibrillation surgery, Cardiac Tamponade etiology, Coronary Thrombosis etiology, Cryosurgery adverse effects, Pulmonary Veins surgery, Takotsubo Cardiomyopathy etiology
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- 2017
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36. Pulmonary vein isolation in a patient with atrial fibrillation and a filter in the inferior vena cava.
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Rodkiewicz D, Kiliszek M, Koźluk E, Piątkowska A, and Opolski G
- Abstract
Competing Interests: The authors declare no conflict of interest.
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- 2017
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37. The influence of the atrial fibrillation episode duration on the endothelial function in patients treated with pulmonary veins isolation.
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Peller M, Lodziński P, Ozierański K, Tymińska A, Balsam P, Kajurek K, Kiliszek M, Koźluk E, and Opolski G
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- Catheter Ablation, Endothelin-1 blood, Female, Humans, Male, Middle Aged, Pulmonary Veins, Thrombomodulin blood, Atrial Fibrillation physiopathology, Endothelium, Vascular physiopathology, Vascular Endothelial Growth Factor A blood
- Abstract
Background: Atrial fibrillation (AF) is associated with endothelial dysfunctions., Objectives: The aim of the study was to assess the influence of the duration of an AF episode on the endothelial function., Material and Methods: The study included 65 patients with persistent AF qualified for the percutaneous pulmonary veins isolation. Patients were divided into three subgroups with increasing time of the duration of AF episode, as follow: ≤ 7 months (n = 24 patients), from 7 to 14 months (n = 18 patients) and ≥ 14 months (n = 23 patients). Concentrations of endothelin-1 (ET-1), thrombomodulin (TM) and VEGF in serum were measured., Results: Median age in the whole study group was 56 years with 84.6% of males. Patients with longer lasting AF episode had a higher body mass index and less incidence of heart failure. Median values of ET1, TM and VEGF were 3.1 (2.5-3.5) pg/mL, 3126.0 (2827.2-3594.1) pg/mL and 464.6 (323.6-630.1), respectively. Among increasing tertiles of AF episode duration, median ET-1 serum concentrations were as follows: 3.3 (2.8-3.7) pg/mL, 3.06 (2.6-3.4) pg/mL, 2.7 (2.3-3.2) pg/mL, p = 0.019, respectively. There was also a trend towards negative association of serum VEGF level with AF episode duration. Serum biomarkers' levels were not associated with total AF duration., Conclusions: AF episode duration may be associated with the endothelial function, assessed by serum biomarkers. ET-1 serum concentrations are significantly lower in patients with longer AF. ET-1, TM and VEGF have no correlation with total AF duration.
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- 2017
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38. Catheter ablation of cardiac arrhythmias in pregnancy without fluoroscopy: A case control retrospective study.
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Koźluk E, Piątkowska A, Kiliszek M, Lodziński P, Małkowska S, Balsam P, Rodkiewicz D, Piątkowski R, Zyśko D, and Opolski G
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- Adult, Case-Control Studies, Female, Fluoroscopy, Humans, Pregnancy, Retrospective Studies, Arrhythmias, Cardiac therapy, Catheter Ablation methods, Pregnancy Complications therapy
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Background: Cardiac arrhythmias are common in pregnant women. In most cases, they do not require treatment other than rest, electrolyte supplementation and avoidance of strong coffee and tea. Persistent arrhythmia or the ventricular rate running at a high frequency may cause hemodynamic deterioration in the fetus or in both the fetus and the mother., Objectives: The aim of this study was to assess the prevalence and characteristics of arrhythmias in pregnant women who qualified for ablation as well as the feasibility and specific features of these interventions., Material and Methods: The study group consisted of 11 pregnant women (16-32 Hbd) aged 31 + 6. The control group consisted of 111 women aged 15-50 years (34 + 10), scheduled for ablation in 2012. The medical records of the selected study and control groups were analyzed and the following data was retrieved: age, the reason the ablation procedure was performed, the ablation duration, the number of radiofrequency applications, the total duration of radiofrequency applications, gravity, and comorbidities., Results: In the study group, accessory pathway related arrhythmias or atrial tachycardia (AT) accounted for 62% of cases, whereas in the control group for 32% (p = 0.042). All the procedures in the study group were performed with an electroanatomical system without fluoroscopy. All of the patients, but one, had no recurrence of arrhythmia. There were no complications and no overt effects were noted in the fetus., Conclusions: Ablation of arrhythmias during pregnancy is rare. An experienced surgeon using electroanatomical system is usually able to ablate arrhythmic substrate without the use of X-ray fluoroscopy. The most prevalent causes of arrhythmias in pregnant women requiring ablation are accessory pathway and AT focus.
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- 2017
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39. Antazoline for termination of atrial fibrillation during the procedure of pulmonary veins isolation.
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Balsam P, Koźluk E, Peller M, Piątkowska A, Lodziński P, Kiliszek M, Kołtowski Ł, Grabowski M, and Opolski G
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- Aged, Female, Humans, Male, Middle Aged, Pulmonary Veins pathology, Retrospective Studies, Treatment Outcome, Antazoline therapeutic use, Atrial Fibrillation drug therapy, Atrial Fibrillation surgery, Catheter Ablation methods, Pulmonary Veins surgery
- Abstract
Purpose: Pulmonary vein isolation is a well established method of definite treatment of atrial fibrillation (AF). Periprocedural onset of AF usually terminates spontaneously within minutes, but not in all cases. Antazoline is an antihistaminic agent with antiarrhythmic properties. The aim of our retrospective study was to evaluate the efficacy of antazoline in termination of AF in patients undergoing pulmonary vein isolation., Materials and Methods: Consecutive 141 patients who received antazoline to terminate AF during pulmonary vein isolation were analyzed. The antazoline was administered at the rate of 30-50mg/min (max. 500mg) after the circumferential ablation in the ostia of pulmonary veins and before confirmation of isolation. Success was defined as restoration of sinus rhythm within 20min after antazoline infusion., Results: The efficacy of antazoline was 83.6% in paroxysmal and 31.1% in persistent AF patients. Clinical variables that were independently predictive of antazoline ineffectiveness were female (odds ratio [OR]: 4.35; 95% confidence interval [CI]: 1.26-14.3; p=0.018) and AF at the beginning of procedure (OR 28.4; 95% CI 3.89-208.0; p=0.001). Due to antazoline related side effects infusion was discontinued in 7 patients (5%)., Conclusions: Antazoline seems to be safe agent in termination of AF in patients undergoing pulmonary vein isolation. We also observed satisfying efficacy, which needs to be proved in a randomized clinical trial., (Copyright © 2015 Medical University of Bialystok. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.)
- Published
- 2015
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40. Members of the emergency medical team may have difficulty diagnosing rapid atrial fibrillation in Wolff-Parkinson-White syndrome.
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Koźluk E, Timler D, Zyśko D, Piątkowska A, Grzebieniak T, Gajek J, Gałązkowski R, and Fedorowski A
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- Adult, Atrial Fibrillation physiopathology, Atrial Fibrillation therapy, Female, Humans, Male, Predictive Value of Tests, Prognosis, Surveys and Questionnaires, Wolff-Parkinson-White Syndrome physiopathology, Wolff-Parkinson-White Syndrome therapy, Atrial Fibrillation diagnosis, Clinical Competence, Diagnostic Errors, Electrocardiography, Emergency Service, Hospital, Heart Conduction System physiopathology, Heart Rate, Patient Care Team, Wolff-Parkinson-White Syndrome diagnosis
- Abstract
Background: Atrial fibrillation (AF) in patients with Wolff-Parkinson-White (WPW) syndrome is potentially life-threatening as it may deteriorate into ventricular fibrillation. The aim of this study was to assess whether the emergency medical team members are able to diagnose AF with a rapid ventricular response due to the presence of atrioventricular bypass tract in WPW syndrome., Methods: The study group consisted of 316 participants attending a national congress of emergency medicine. A total of 196 questionnaires regarding recognition and management of cardiac arrhythmias were distributed. The assessed part presented a clinical scenario with a young hemodynamically stable man who had a 12-lead electrocardiogram performed in the past with signs of pre-excitation, and who presented to the emergency team with an irregular broad QRS-complex tachycardia., Results: A total of 71 questionnaires were filled in. Only one responder recognized AF due to WPW syndrome, while 5 other responders recognized WPW syndrome and paroxysmal supraventricular tachycardia or broad QRS-complex tachycardia. About 20% of participants did not select any diagnosis, pointing out a method of treatment only. The most common diagnosis found in the survey was ventricular tachycardia/broad QRS-complex tachycardia marked by approximately a half of the participants. Nearly 18% of participants recognized WPW syndrome, whereas AF was recognized by less than 10% of participants., Conclusions: Members of emergency medical teams have limited skills for recognizing WPW syndrome with rapid AF, and ventricular tachycardia is the most frequent incorrect diagnosis.
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- 2015
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41. Early hemodynamic response to the tilt test in patients with syncope.
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Koźluk E, Cybulski G, Piątkowska A, Zastawna I, Niewiadomski W, Strasz A, Gąsiorowska A, Kempa M, Kozłowski D, and Opolski G
- Abstract
Introduction: Our aim was to evaluate the differences in the early hemodynamic response to the tilt test (HUTT) in patients with and without syncope using impedance cardiography (ICG)., Material and Methods: One hundred twenty-six patients (72 female/48 male; 37 ±17 years) were divided into a group with syncope (HUTT(+), n = 45 patients) and a group without syncope (HUTT(-), n = 81 patients). ECG and ICG signals were continuously recorded during the whole examination, allowing the calculation of heart rate (HR), stroke volume (SV), and cardiac output (CO) for every beat. The hemodynamic parameters (averaged over 1 min) were analyzed at the following points of the HUTT: the last minute of resting, the period immediately after the tilt (0 min), 1 min and 5 min after the maneuver. The absolute changes of HR, SV and CO were calculated for 0, 1, and 5 min after the maneuver in relation to the values at rest (ΔHR, ΔSV, ΔCO). Also, the percentage changes were calculated (HRi, SVi, COi)., Results: There were no differences between the groups in absolute and percentage changes of hemodynamic parameters immediately after and 1 min after tilting. Significant differences between the HUTT(+) and HUTT(-) groups were observed in the 5(th) min of tilting: for ΔSV (-27.2 ±21.2 ml vs. -9.7 ±27.2 ml; p = 0.03), ΔCO (-1.78 ±1.62 l/min vs. -0.34 ±2.48 l/min; p = 0.032), COi (-30 ±28% vs. -0.2 ±58%; p = 0.034)., Conclusions: In the 5(th) min the decrease of hemodynamic parameters (ΔSV, ΔCO, COi) was significantly more pronounced in HUTT(+) patients in comparison to the HUTT(-) group.
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- 2014
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42. The presence of pacing artifacts may impede diagnosis of ventricular fibrillation during cardiac arrest.
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Timler D, Zyśko D, Koźluk E, Piątkowska A, Grzebieniak T, Gajek J, Melander O, and Fedorowski A
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- Diagnostic Errors, Humans, Artifacts, Electrocardiography, Heart Arrest complications, Pacemaker, Artificial, Ventricular Fibrillation diagnosis, Ventricular Fibrillation etiology
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- 2014
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43. Obstructive sleep apnoea in patients with atrial fibrillation: prevalence, determinants and clinical characteristics of patients in Polish population.
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Szymański FM, Płatek AE, Karpiński G, Koźluk E, Puchalski B, and Filipiak KJ
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- Aged, Blood Pressure, Comorbidity, Female, Humans, Male, Middle Aged, Poland, Polysomnography, Prevalence, Risk Factors, Atrial Fibrillation epidemiology, Health Status, Sleep Apnea, Obstructive epidemiology
- Abstract
Background: Obstructive sleep apnoea (OSA) and atrial fibrillation (AF) are two conditions highly prevalent in the general population. OSA is known to cause haemodynamic changes, oxidative stress, and endothelial damage, and therefore promote vascular and heart remodelling which results in AF triggering and exacerbation. Coexistence of OSA and AF influences the course of both diseases, and therefore should be taken into consideration in patient management strategy planning., Aim: To assess the prevalence of OSA in Polish AF patients, and to describe the clinical characteristics of patients with concomitant OSA and AF., Methods: We enrolled into the study 289 consecutive patients hospitalised in a tertiary, high-volume Cardiology Department with a primary diagnosis of AF. In addition to standard examination, all patients underwent an overnight sleep study to diagnose OSA, which was defined as apnoea-hypopnoea index (AHI) ≥ 5 per hour., Results: After applying exclusion criteria, the final analysis covered 266 patients (65.0% male, mean age 57.6 ± 10.1 years). OSA was present in 121 (45.49%) patients. Patients with OSA were older (59.6 ± 8.0 vs. 56.0 ± 11.4 years; p = 0.02), had higher body mass index (BMI; 30.9 ± 5.4 vs. 28.7 ± 4.4 kg/m²; p < 0.01) larger neck size (41.2 ± 3.8 vs. 39.3 ± 3.3 cm; p = 0.0001) and waist circumference (108.5 ± 13.1 vs. 107.7 ± 85.4 cm; p < 0.0001) than patients without OSA. There were no significant differences between the groups in terms of systolic and diastolic blood pressure or history of comorbidities (p > 0.05). OSA patients were less likely than non-OSA patients to have paroxysmal AF (62.0% vs. 75.9%; p = 0.02). Dividing newly diagnosed OSA patients according to the disease severity showed that mild OSA (AHI ≥ 5/h and < 15/h) was present in 27.82% of the study population, moderate OSA (AHI ≤ 15/h and ≥ 30/h) in 13.16% of patients, and severe OSA (> 30/h) in 4.51% of patients. No significant differences in terms of comorbidities and anthropometric features were seen between mild and moderate, between moderate and severe, and between mild and severe OSA., Conclusions: OSA is highly prevalent in patients with AF in the Polish population, and affects approximately half of the patients. OSA patients are more likely to be older, have higher BMI, and greater waist and neck circumference. Persistent AF is the most common form of the arrhythmia in patients with OSA, while patients without OSA are more likely to have paroxysmal AF.
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- 2014
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44. Does a blanking period after pulmonary vein isolation impact long-term results? Results after 55 months of follow-up.
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Lodziński P, Kiliszek M, Koźluk E, Piątkowska A, Balsam P, Kochanowski J, Scisło P, Piątkowski R, and Opolski G
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- Adult, Amiodarone adverse effects, Anti-Arrhythmia Agents adverse effects, Atrial Fibrillation diagnosis, Atrial Fibrillation etiology, Atrial Fibrillation physiopathology, Catheter Ablation adverse effects, Chi-Square Distribution, Drug Administration Schedule, Electrocardiography, Ambulatory, Female, Humans, Hypertension complications, Linear Models, Male, Middle Aged, Multivariate Analysis, Poland, Prospective Studies, Pulmonary Veins physiopathology, Recurrence, Risk Factors, Sotalol adverse effects, Time Factors, Treatment Outcome, Amiodarone administration & dosage, Anti-Arrhythmia Agents administration & dosage, Atrial Fibrillation surgery, Catheter Ablation methods, Heart Rate drug effects, Pulmonary Veins surgery, Sotalol administration & dosage
- Abstract
Background: The aims of the study are 1) to assess antiarrhythmic prophylaxis efficacy during the first 2 months after radiofrequency ablation (ARF) due to AF; 2) to define risk factors for early AF recurrence (EAFR) after ARF; 3) to determine the long-term follow-up results and risk factors for late AF recurrence (LAFR)., Methods: A total number of 210 consecutive patients who had undergone ARF due to AF were analyzed. Patients were randomized into three groups: Group 1 (G1), without any anti-arrhythmic drug (AAD); Group 2 (G2), with amiodarone or sotalol; Group 3 (G3), with last ineffective AAD. The study was designed to analyze two periods: short-term observation, the first 2 months after ARF; and at least 2 years of long-term follow-up., Results: After 2 months, clinical data were collected from 171 patients (123 males, mean age of 50.3 years; persistent AF in 19.8%; lone AF in 36.6%). Sinus rhythm (SR) was maintained in 84 (49.1%) patients; 35 (20.4%) patients presented with a single episode of AF, 39 (23%) patients experienced a reduction in number of AF episodes, and 13 (7.5%) patients showed no improvement. No predisposing factor for early recurrence was found. After a mean follow-up of 55 months, clinical data were collected in 137 patients, of which 47 (34%) maintained SR. Those more likely to sustain SR were: males (82.9% vs. 62.2%; p = 0.018), younger patients (44.8 ± 12.7 vs. 52.5 ± 9.9; p = 0.0001), patients with smaller left atrium diameter (4.05 ± ± 0.49 cm vs. 4.25 ± 0.51 cm; p = 0.04), and those without any AF recurrence during the first 2 months after ARF (78.7% vs. 35.6%; p < 0.0001). In the multivariable analysis, the independent risk factors for LAFR were hypertension (p < 0.001) and persistent AF (p = 0.014)., Conclusions: Antiarrhythmic prophylaxis does not affect the number of AF recurrences during the first 2 months after ablation. SR maintenance during a blanking period after AF ablation is a positive prognostic factor in long-term follow-up. Persistent AF and hypertension are independent risk factors for late AF recurrence after pulmonary vein isolation.
- Published
- 2014
- Full Text
- View/download PDF
45. Successful catheter ablation of Mahaim potential in a patient with wide QRS complex tachycardia.
- Author
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Kiliszek M, Rodkiewicz D, Koźluk E, and Opolski G
- Subjects
- Aged, Catheter Ablation, Electrocardiography, Humans, Male, Pre-Excitation, Mahaim-Type etiology, Tachycardia, Ventricular complications, Pre-Excitation, Mahaim-Type surgery, Tachycardia, Ventricular surgery
- Published
- 2014
- Full Text
- View/download PDF
46. Authors' response.
- Author
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Balsam P and Koźluk E
- Subjects
- Female, Humans, Male, Atrial Fibrillation surgery, Catheter Ablation instrumentation, Pulmonary Veins surgery
- Published
- 2014
- Full Text
- View/download PDF
47. Influence of left atrial size on the outcome of pulmonary vein isolation in patients with atrial fibrillation.
- Author
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Kiliszek M, Miązek N, Peller M, Gajda S, Koźluk E, Lodziński P, Kapłon-Cieślicka A, Piątkowski R, Budaj-Fidecka A, Balsam P, and Opolski G
- Subjects
- Aged, Aged, 80 and over, Female, Humans, Male, Organ Size, Treatment Outcome, Atrial Fibrillation surgery, Catheter Ablation methods, Heart Atria anatomy & histology, Heart Atria diagnostic imaging, Pulmonary Veins anatomy & histology, Pulmonary Veins surgery
- Abstract
Background: Atrial fibrillation (AF) is the most frequent sustained supraventricular tachyarrhythmia. Radiofrequency (RF) ablation is one of the options used to prevent the recurrence of AF. Despite thorough studies, the relation between left atrial (LA) size and the results of RF ablation remains controversial., Aim: To estimate the relation between LA size assessed by echocardiography and the AF recurrence rate after pulmonary vein isolation (PVI)., Methods: Our analysis comprised 175 AF patients subjected to PVI between June 2011 and March 2012. Inclusion criteria comprised: symptomatic AF with no reversible cause, and age < 70, LA < 5.5 cm (anteroposterior). PVI was performed with a 4-mm non-irrigated catheter or irrigated catheter and circular mapping catheter (electroanatomic mapping with LocaLisa or CARTO systems). Recurrence was defined as any atrial tachyarrhythmia episode that lasted more than 30 s after three months of blanking period. Standard echocardiographic post-ablation anteroposterior LA measurements were performed with additional parameters such as systolic and diastolic LA area and volume (on sinus rhythm)., Results: The analysis included 198 procedures performed in 175 patients. Median follow-up time was 17 months. Median age was 56 years. After the first procedure, AF recurred in 88 (52.4%) patients. Efficacy after the last procedure was 55.2% (43.5% for persistent AF and 59.7% for paroxysmal AF). No significant relation between any of the LA parameters and the recurrence rate was found. Cox univariate and multivariate analysis revealed only very early AF recurrence as a prognostic factor for AF recurrence in the long term., Conclusions: In patients with AF, no relation could be observed between the recurrence rate after PVI and the echocardiographic LA measurement parameters.
- Published
- 2014
- Full Text
- View/download PDF
48. Radiofrequency ablation without the use of fluoroscopy - in what kind of patients is it feasible?
- Author
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Koźluk E, Gawrysiak M, Piątkowska A, Lodziński P, Kiliszek M, Małkowska S, Zaczek R, Piątkowski R, Opolski G, and Kozłowski D
- Abstract
Introduction: The aim of the study was to describe the experience in performing ablation without fluoroscopy., Material and Methods: From 575 ablation procedures with CARTO performed in the period 2003-2008, 108 (42 M; age 40 ±16 years) were done without fluoroscopy. One patient had ablation using the Localisa system. There was one man with thrombocytopenia and two pregnant women., Results: Right ventricular (RV) outflow tract arrhythmias and other RV arrhythmias were noted in 38 patients (35%) and 17 patients (15%), respectively. There were 5 (4.6%) left ventricular (LV) outflow tract arrhythmias and 19 (17.5%) other LV tachycardias; right accessory pathways in 17 patients (20%), in the middle cardiac vein in 1, Mahaim fibres in 1, and 3 cases of permanent junctional reciprocating tachycardias. One patient with CRT had AV node ablation (Localisa). In 3 patients there were also other arrhythmias treated: slow AV nodal pathway, typical flutter isthmus and right atrial tachycardia. In 2004, 1/96 CARTO procedures was done without fluoroscopy, in 2006 2/97, in 2007 19 (2 in LV) of 93, in 2008 87 (22 in LV) of 204. The percentage of ablations without fluoroscopy in every hundred CARTO procedures was: 1%, 1%, 8%, 23%, 46%, 28% (mean 18%). There were no procedure-related complications., Conclusions: It is feasible to perform ablations within both right and left sides of the heart without fluoroscopy. The number and type of non-fluoroscopic procedures depends on the operator's experience. Pregnant patients, with malignant history or with hematologic diseases should be ablated without fluoroscopy in centres that specialise in these kinds of procedures.
- Published
- 2013
- Full Text
- View/download PDF
49. The knowledge of public access to defibrillation in selected cities in Poland.
- Author
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Kozłowski D, Kłosiewicz T, Kowalczyk A, Kowalczyk AK, Koźluk E, Dudziak M, Homenda W, and Raczak G
- Abstract
Introduction: The Public Access to Defibrillation (PAD) program was designed to raise the awareness of sudden cardiac death (SCA) pre-hospital management among the community. The goal of the following research was to confirm the final impact of the Polish PAD program on various resident groups that differ by age, training and education level., Material and Methods: The trial total number of participants reached 404 people from three cities divided into two groups. In group one (n = 295) were randomly selected people inside the trial area and in group two (n = 109) we had individuals who were theoretically trained in basic life support (BLS) algorithms, including the use of an automatic external defibrillator (AED). The research method was based on two different questionnaires completed by participants from each group., Results: The greatest knowledge of SCA, as well as the use of AED, and the best practical skills, were possessed by the residents of cities with a population over 100 000, aged between 18 and 30 years, who completed secondary or higher education (31.7%). The group with the smallest knowledge about SCA lived in the country (10.7%). The second group with little knowledge of the subject consisted mostly of individuals with primary education (4.19%) or professional abilities and over 50 years old (2.16%)., Conclusions: There must be some actions taken in order to increase the community awareness concerning automatic defibrillation. Training on AED and the possibility of practical exercise needs to be organized and should be conducted especially among residents of the countryside and people under 30 or over 50 years old.
- Published
- 2013
- Full Text
- View/download PDF
50. Lack of movement of the cardiac silhouette in fluoroscopy is an early sign of pericardial fluid during catheter ablation: a three-case report.
- Author
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Kiliszek M, Lodziński P, Koźluk E, and Opolski G
- Subjects
- Aged, Atrial Fibrillation complications, Cardiac Tamponade etiology, Catheter Ablation, Echocardiography, Female, Fluoroscopy, Humans, Male, Middle Aged, Pericardial Effusion complications, Atrial Fibrillation diagnosis, Atrial Fibrillation therapy, Cardiac Tamponade diagnostic imaging, Pericardial Effusion diagnosis
- Published
- 2013
- Full Text
- View/download PDF
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