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Aims: QRS narrowing with initiation of biventricular pacing might be an acute electrocardiographic indicator of correction of left bundle branch block (LBBB)-induced depolarization delay and asynchrony. However, its impact on prognosis remains controversial, especially in non-LBBB patients. Our goal was to evaluate the impact of QRS narrowing on long-term mortality and morbidity in a large cohort of patients undergoing cardiac resynchronization therapy (CRT) with different pre-implantation QRS types: LBBB, non-LBBB, and permanent right ventricular pacing.Methods and Results: This study included consecutive patients who underwent CRT device implantation. Study endpoints: death from any cause or urgent heart transplantation and death from any cause/urgent heart transplantation or hospital admission for heart failure. All pre- and post-implantation electrocardiograms were analysed using digital callipers, high-amplitude augmentation, 100 mm/s paper speed, and global QRS duration measurement method. A total of 552 CRT patients entered the survival analysis. During the 9 years observation period, 232 (42.0%) and 292 (52.9%) patients met primary and secondary endpoints, respectively. QRS narrowing predicted survival in the Kaplan-Meier analysis only in patients with LBBB. Multivariate Cox regression model showed that QRS narrowing was the major determinant of both study endpoints, with hazard ratios of 0.46 and 0.43, respectively. There was a strong relationship between mortality risk and shortening/widening of the QRS, albeit only in the LBBB group. Patients with non-LBBB morphologies had unfavourable prognosis similar to that in LBBB patients without QRS narrowing.Conclusion: Acute QRS narrowing in patients with LBBB might be a desirable endpoint of CRT device implantation. [ABSTRACT FROM AUTHOR]

Introduction: Single-shot techniques such as cryoballoon and multipolar phased pulmonary vein ablation catheter (PVAC) are an alternative to the point-by-point radiofrequency method for atrial fibrillation (AF) ablation. However, there is a lack of data concerning sequential use of single-shot techniques, that is, for both the index and redo ablation., Aim: To assess long-term outcomes of the 'single-shot techniques only' AF ablation strategy., Material and Methods: We analyzed all consecutive AF ablations performed over a 10-year period (2009-2019) in a center where a 'single-shot technique only' principle was followed from the start of the AF ablation program. Kaplan-Meier AF-free survival curves were calculated and complications were assessed on the basis of our prospectively maintained database., Results: A total of 597 patients (62.4 ±12.5 years) with paroxysmal (78.1%) or persistent (21.9%) AF entered the study and 655 AF ablation procedures were performed. In 96.5% of redos ( n = 58) a different technique (mostly PVAC) was used than for the index ablation (mostly cryoballoon). The Kaplan-Meier estimates of 1, 2 and 5 years freedom from AF were 78.2%, 69.2%, and 56.0%, for the index ablation, and 80.3%, 76.1% and 68.3%, for the redo, respectively. The minor and major complication rates were 8.1%, and 4.0%, respectively., Conclusions: An AF ablation program based solely on sequential use of two different single-shot techniques for both index and redo procedures is safe and effective. These observations might have important practical implications for new operators/centers starting AF ablation programs and for use of single-shot techniques for redo procedures., Competing Interests: The authors declare no conflict of interest., (Copyright © 2020 Termedia Sp. z o. o.)

Aims: QRS narrowing with initiation of biventricular pacing might be an acute electrocardiographic indicator of correction of left bundle branch block (LBBB)-induced depolarization delay and asynchrony. However, its impact on prognosis remains controversial, especially in non-LBBB patients. Our goal was to evaluate the impact of QRS narrowing on long-term mortality and morbidity in a large cohort of patients undergoing cardiac resynchronization therapy (CRT) with different pre-implantation QRS types: LBBB, non-LBBB, and permanent right ventricular pacing., Methods and Results: This study included consecutive patients who underwent CRT device implantation. Study endpoints: death from any cause or urgent heart transplantation and death from any cause/urgent heart transplantation or hospital admission for heart failure. All pre- and post-implantation electrocardiograms were analysed using digital callipers, high-amplitude augmentation, 100 mm/s paper speed, and global QRS duration measurement method. A total of 552 CRT patients entered the survival analysis. During the 9 years observation period, 232 (42.0%) and 292 (52.9%) patients met primary and secondary endpoints, respectively. QRS narrowing predicted survival in the Kaplan-Meier analysis only in patients with LBBB. Multivariate Cox regression model showed that QRS narrowing was the major determinant of both study endpoints, with hazard ratios of 0.46 and 0.43, respectively. There was a strong relationship between mortality risk and shortening/widening of the QRS, albeit only in the LBBB group. Patients with non-LBBB morphologies had unfavourable prognosis similar to that in LBBB patients without QRS narrowing., Conclusion: Acute QRS narrowing in patients with LBBB might be a desirable endpoint of CRT device implantation.

Introduction: The aim of this study was to determine whether baseline right ventricular (RV) function assessed by standard echocardiography may indicate patients who will respond to cardiac resynchronization therapy (CRT)., Material and Methods: The data of 57 patients (54 men, 95%), aged 66.4 ±8.7 years with heart failure (HF) having a CRT device implanted were collected. All patients had left ventricular ejection fraction (LVEF) ≤ 35% and QRS complex duration ≥ 120 ms. Echocardiographic examination with tissue Doppler imaging techniques and complex RV evaluation were performed at baseline and three months after CRT onset., Results: Three months after CRT implantation, patients responding to CRT, defined as a reduction of left ventricle end-systolic volume (LVESV) of at least 10% (n = 34), compared to patients with a reduction of LVESV of less than 10% (n = 23), had at baseline a smaller right atrium diameter (47.85 ±11.33 mm vs. 52.65 ±8.69 mm; p = 0.028), higher TAPSE (14.56 ±2.57 mm vs. 13.04 ±2.93 mm; p = 0.030) and lower grade of tricuspid valve regurgitation (1.82 ±0.97 vs. 2.3 ±0.88; p = 0.033)., Conclusions: This study showed that there are differences in baseline right ventricular function between responders and non-responders to CRT. Yet in our study, none of the baseline RV parameters provided any value in identifying patients who would respond to CRT.

Background: The aim of the study was to appraise time domain heart rate variability (HRV) parameters in patients with ST-segment elevation myocardial infarction (STEMI) in different age groups., Material and Methods: Retrospective analysis included 357 consecutive patients in sinus rhythm without diabetes, aged 27-87 years (mean age--63.0 +/- 11.8 years, 243 men) treated with primary percutaneous transluminal coronary angioplasty (PTCA) due to first in their life STEMI. Each patient had an echocardiographic examination and 24-hour ECG monitoring results interpreted. Participants were divided in the analysis applying the WHO old age criterion into two groups: group A < 65 years old (n = 188) and B aged > or = 65 years (n = 169)., Results: In the whole study group age negatively correlated with SDNN, SDANNI, SDNNI and EF, whereas positive correlation between EF and SDANN, and EF and SDNNI was observed. Elderly patients as compared to the younger individuals had significantly diminished SDNN, SDANN, SDNNI and more often SDNN < 70 ms (33.7% vs 20.7%, p < 0.0001). When the circumflex artery lesion was the cause of myocardial infarction SDNN and SDANN were significantly lower in the group B, whereas in case of PTCA of RCA, apart from decreased SDNN and SDANN, EF was also compromised in this group., Conclusions: Elderly patients with myocardial infarction with ST-segment elevation treated with primary PTCA, compared to the younger age group, are characterized by increased sympathetic activation assessed by heart rate variability and heart rate in 24-hour ECG monitoring.

Background and Aim: The aim of this study was to evaluate the short term effect of cardiac resynchronisation therapy (CRT) on right ventricular (RV) function assessed by standard echocardiography., Methods: Data from 57 patients (54 men, 95%; three women, 5%), aged 66.4 ± 8.7 years with heart failure (HF) was analysed. All patients were in NYHA III-IV functional classes, despite optimal pharmacological treatment according to the current guidelines, had left ventricular ejection fraction ≤ 35% and QRS complex ≥ 120 ms in a standard electrocardiogram. At baseline and three months after CRT implantation the patients' histories were taken, an anthropometrical examination was made, laboratory tests including the level of NT-proBNP and electrocardiogram were performed, and echocardiographic examination was extended by tissue Doppler imaging techniques and complex RV evaluation., Results: Three months after CRT implantation in the whole study group, the average NYHA functional class had decreased from 3.11 ± 0.28 to 2.25 ± 0.68 (p < 0.001), and the six-minute walk test distance had increased from 298.04 ± 107.42 m to 373.12 ± 127.15 m (p < 0.001). CRT improved RV systolic function in the whole study group. Tricuspid annular plane systolic excursion had increased from 13.95 ± 2.80 to 15.79 ± 2.33 mm (p < 0.001), and so likewise had systolic excursion velocity (S'), which rose from 8.84 ± 3.45 to 11.00 ± 3.43 cm/s (p < 0.001). Tricuspid regurgitation grade decreased from 2.02 ± 0.95 to 1.86 ± 0.91 (p = 0.013). RV systolic pressure decreased from 31.07 ± 20.43 to 27.75 ± 17.35 mm Hg (p < 0.001). RV fractional area change rose from 31.35 ± 10.30% to 35.40 ± 10.51% (p < 0.001)., Conclusions: This study showed that CRT improved RV systolic function evaluated with parameters assessed in standard echocardiographic examination three months after therapy initiation. The observed improvement was consistent among all applied echocardiographic parameters reflecting RV systolic function.

The aim of the study was to assess the influence of cardiac resynchronization therapy(CRT) on a series of humoral parameters crucial for the pathophysiology of chronic heart failure such as aldosterone or the inflammatory markers. Thirty eight consecutive patients (aged 66.3 +/- 9.6 years, 31 men - 82% ) with chronic heart failure (57.9% with ischaemic background and 42.1% of non-ischaemic etiology) in stable for at least 3 months, NYHA class III - IV despite optimized pharmacotherapy, with left ventricular ejection fraction (LVEF) < or = 35% and wide QRS complex (> or = 120 ms) had the blood serum tested for the concentrations of interleukin-6 (IL-6), interleukin-18 (IL-18), C-reactive protein (CRP) and aldosterone before and 12-16 weeks after CRT introduction. In the study group aldosterone concentrations were significantly reduced. Among the inflammatory markers the level of IL-6 decreased, IL-18 concentrations showed a falling trend (445.1 +/- 225.7 pg/ml vs 418.4 +/- 229.6 pg/ml, p = 0.052), whereas no change of CRP serum contain was noted. It was showed that cardiac resynchronization therapy had an impact on systemic inflammation and hormonal status in patients with chronic heart failure during short-term observation.

Background: Sleep-related breathing disorders are common in patients with chronic heart failure (CHF) and contribute to exacerbation of CHF. The effects of biventricular stimulation (CRT) seem to exceed the improvement of mechanical heart performance and are likely to affect other aspects of CHF pathophysiology. The aim of the study was to assess the influence of CRT on subjective and objective sleep features., Material and Methods: Twenty seven consecutive patients (aged 67.7 +/- 8.7 years, 23 men - 85%) with chronic heart failure (62.9% with ischaemic background and 37.1% of non-ischaemic etiology) in stable for at least 3 months NYHA class III - IV despite optimized pharmacotherapy, with left ventricular end-diastolic diameter (LVEDd) > 55 mm, left ventricular ejection fraction (LVEF) < or = 35% and wide QRS complex (> or = 120 ms) were appraised before and 12-16 weeks after CRT introduction clinically (including 6-minute walk test--6-MWT), echocardiographically and in polisomnography. The apnea-hypopnea index (AHI) and apnea indexes (AI) of central, obstructive and mixed types were calculated. The sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI), daytime sleepiness with the Epworth Sleepiness Scale (ESS)., Results: LVEF increased, 6-MWT distance rose. Left ventricular diameters and left ventricular end-systolic volume decreased. PQSI and ESS fell (9.3 +/- 4.2 vs 6.2 +/- 3.2, p < 0.001 and 8.4 +/- 4.1 vs 7.0 +/- 3.4, p < 0.001, respectively). AHI, obstructive AL and mixed AL did not alter but significant reduction of central AL was noted (9.6 +/- 13.0 vs 3.7 +/- 6.2, p = 0.023)., Conclusions: CRT decreases central sleep apnea and improves quality of sleep and daytime sleepiness in patients with CHF.