Pulmonary Vein Isolation Outcome Degree Is a New Score for Efficacy of Atrial Fibrillation Catheter Ablation.

This study introduces the pulmonary vein isolation outcome degree (PVIOD) as a new semiquantitative measure for the efficacy of atrial fibrillation (AF) catheter ablation and reports the determination of predictors associated with PVIOD. The median follow-up periods of 117 patients after the first and last ablation were, respectively, 82 (IQR 15) and 72 (IQR 30) months. PVIOD 1 included 32.

Severe pacemaker pocket infection during the COVID-19 pandemic, transvenous lead removal.

Introduction: The estimated infection rate after permanent endocardial lead implantation is between 1% and 2%. Pacemaker lead endocarditis is treated with total removal of the infected device and proper antibiotics. In this case report, we present a patient with delayed diagnosis and treatment due to the COVID-19 outbreak.

Predictors of Recurrence of AF in Patients After Radiofrequency Ablation.

Catheter ablation is a well-known treatment for patients with AF. Despite the growing knowledge in the field, the identification of predictors of recurrence of AF after catheter ablation is one of the primary goals and is of major importance to improve long-term results of the procedure. The aim of this article is to provide an overview of what has been published in recent years and to summarise the major predictors, helping cardiac electrophysiologists in the selection of the right candidates for catheter ablation.

Ablation index-guided 50 W ablation for pulmonary vein isolation in patients with atrial fibrillation: Procedural data, lesion analysis, and initial results from the FAFA AI High Power Study.

Background: Radiofrequency high-power ablation appears to be a novel concept for atrial fibrillation (AF). The ablation index (AI) value has been associated with durability of pulmonary vein isolation (PVI).

Objectives: This study aimed to report the procedural data and initial results of a combined ablation technique using AI-guided high-power (AI-HP; 50 W) ablation for PVI.

Low On-Treatment Platelet Reactivity Predicts Long-Term Risk of Bleeding After Elective PCI.

Background: Bleeding after percutaneous coronary interventions (PCI) is an important complication with impact on prognosis.

Aim: To evaluate the predictive value of enhanced platelet responsiveness to dual antiplatelet therapy with aspirin and clopidogrel, for bleeding, after elective PCI.

Methods And Results: We performed multiple electrode aggregometry (MAE) platelet functional tests induced by arachidonic acid (ASPI) and adenosine-diphosphate (ADP) before PCI, and 24 hours after PCI, in 481 elective PCI patients who were followed-up for an average of 15.

Radiofrequency ablation of anteroseptal accessory pathway--a challenge to the electrophysiologist.

Introduction: Anteroseptal accessory pathways (APs) are located in the apex of the triangle of Koch's connecting the atrial and ventricular septum in the region of the His bundle. Ablation of anteroseptal pathway locations remains a challenge to the electrophysiologist due to a very high risk of transiet or permanent atrioventricular (AV) block.

Case Report: A male, 18-year-old, patient was hospitalized due to radiofrequency (RF) ablation of APs.

Emotional stress as a cause of syncope and torsade de pointes in patients with long QT syndrome.

Introduction: Long QT syndrome (LQTS) is a disorder of myocardial repolarization characterized by the prolongation of QT interval and high risk propensity of torsade de pointes (TdP) that can lead to syncope, cardiac arrest and sudden death. Episodes may be provoked by various stimuli depending on the type of the condition.

Case Report: A 25-year-old famele patient was hospitalized due to syncope that occurred immediately after her solo concert, first time in her life.

Contractile reserve assessed by dobutamine test identifies super-responders to cardiac resynchronization therapy.

Introduction: In this study, we sought to determine whether myocardial contractile reserve (CR) assessed by dobutamine stress echocardiography (DSE) can identify patients who experience nearly complete normalization of left ventricular (LV) function after the implantation of a cardiac resynchronization therapy (CRT) pacemaker.

Material And Methods: The study group consisted of 55 consecutive patients with non-ischemic dilated cardiomyopathy, LV ejection fraction (LVEF) < 35%, and prolonged QRS complex duration, who were scheduled for CRT pacemaker implantation. The DSE (20 µg/kg/min) was performed in all patients.

Successful implantation of a biventricular pacing and defibrillator device via a persistent left superior vena cava.

Introduction: Persistent left superior vena cava is the most common thoracic venous abnormality which is usually asymptomatic, found incidentally during pacemaker implantation. The main problem is related to reaching the appropriate pacing site and ensuring stable lead placement.

Case Report: We reported a successful implantation of a biventricular pacing and defibrillator device (CRT-D) via a persistent left superior vena cava in a 55-year-old man with dilated cardiomyopathy and severe heart failure.

Feasibility of semi-quantitative assessment of left ventricular contractile reserve in dilated cardiomyopathy.

Background: We and others have shown previously that left ventricular (LV) contractile reserve assessed quantitatively by high-dose dobutamine stress-echocardiography (DSE) has prognostic implications in patients with dilated cardiomyopathy.

Purpose: To assess the feasibility of semi-quantitative assessment of LV contractile reserve by differently skilled operators in patients with dilated cardiomyopathy.

Methods: High-dose DSE was performed in 63 consecutive patients, mean age 50 ± 10 years and ejection fraction (EF) 19 ± 8%.

A misinterpretation of the left ventricular non-compaction-adult patient with primary pulmonary hypertension.

Non-compaction of the left ventricle is a rare cardiac malformation, defined as a primary cardiomyopathy caused by genetic malformations. Although the pathogenesis of this cardiomyopathy is unknown, there are two possible hypotheses (congenital and acquired) which lead to arrest in intrauterine endomyocardial morphogenesis. We are presenting a case of a 60-year-old woman, with a history of bradyarrhythmia, syncope and cyanosis.

Wireless monitoring of reconstructed 12-lead ECG in atrial fibrillation patients enables differential diagnosis of recurrent arrhythmias.

Unlabelled: Differential diagnosis of symptomatic events in post-ablation atrial fibrillation (AF) patients (pts) is important; in particular, accurate, reliable detection of AF or atrial flutter (AFL) is essential. However, existing remote monitoring devices usually require attached leads and are not suitable for prolonged monitoring; moreover, most do not provide sufficient information to assess atrial activity, since they generally monitor only 1-3 ECG leads and rely on RR interval variability for AF diagnosis. A new hand-held, wireless, symptom-activated event monitor (CardioBip; CB) does not require attached leads and hence can be conveniently used for extended periods.

Wireless remote monitoring of reconstructed 12-lead ECGs after ablation for atrial fibrillation using a hand-held device.

Objective: Atrial fibrillation (AF) surveillance using a wireless handheld monitor capable of 12-lead electrocardiogram reconstruction was performed, and arrhythmia detection rate was compared with serial Holter monitoring.

Methods: Twenty-five patients were monitored after an AF ablation procedure using the hand-held monitor for 2 months immediately after and then for 1 month approximately 6 months postablation. All patients underwent 12-lead 24-hour Holter monitoring at 1, 2, and 6 months postablation.

Impact of concomitant aortic regurgitation on long-term outcome after surgical aortic valve replacement in patients with severe aortic stenosis.

Background: Prognostic value of concomitant aprtic regurgitation (AR) in patients operated for severe aortic stenosis (AS) is not clarified. The aim of this study was to prospectively examine the impact of presence and severity of concomitant AR in patients operated for severe AS on long-term functional capacity, left ventricular (LV) function and mortality.

Methods: Study group consisted of 110 consecutive patients operated due to severe AS.

[Implantable cardioverter-defibrillator oversensing due to electric shock].

Introduction: We described the first case of oversensing due to electric shock in Serbia, in a 54-year-old man who had implantable cardioverter-defibrillator (ICD).

Case Outline: In July 2002, the patient had acute anteroseptal myocardial infarction and ventricular fibrillation (VF) which was terminated with six defibrillation shocks of 360 J. Coronary angiography revealed 30% stenosis of circumflex artery, the left anterior descending coronary artery was recanalized and the right coronary artery was without stenosis.

Stenting and surgery for coronary vasospasm : the wrong solution fails to solve the problem.

A 55-year-old man, with a history of medically uncontrolled coronary vasospasm, presented for evaluation of chest pain 6 months after implantation of left internal mammary artery. Due to recurrent episodes of vasospastic angina and serious complications of coronary spasm (ventricular fibrillation, myocardial infarction), a stent had previously been implanted in the proximal part of left anterior descending artery at the site of angiographically and ergonovine-proven coronary spasm, with subsequent in-stent restenosis.

[Brugada syndrome--a brand new case].

Background: Brugada syndrome (BS) is a disorder characterized by syncope or sudden death associated with one of several electrocardiographic (ECG) patterns characterized by incomplete right bundle branch block and ST elevation in the anterior precordial leads. Patients with BS are prone to develop ventricular tachyarrhythmias that may lead to syncope, cardiac arrest, or sudden cardiac death.

Case Report: A 58-year-old woman is the first described case of Brugada syndrome in Serbia with intermittent typical changes in basic electrocardiography (ECG): ST segment elevation in the precordial chest leads like dome or coved--major form or type I.

[Location of accessory pathways and its radiofrequency ablation in Wolf-Parkinson-White syndrome].

Introduction: Radiofrequency ablation (RFA) of accessory pathways (AP) is the first line therapy in symptomatic patients with preexcitation syndrome, resistant to medical therapy.

Objective: To evaluate the influence of AP location on RFA effectiveness.

Method: The study compared RFA results of AP located on the left side, right side, and in septal area of the heart in the first 101 consecutive patients treated at Dedinje Cardiovascular Institute in Belgrade.

[Management of refractory angina pectoris].

An increasing number of patients with coronary artery disease have ischemic symptoms that are unresponsive to both conventional medical therapy and revascularization techniques. The objective of this study was to define the population of patients with refractory angina pectoris and to present the therapeutic options currently available for this condition. Among many techniques, the enhanced external counterpulsation, transmyocardial laser revascularization and neurostimulation have been shown to reduce angina and to improve objective measures of myocardial ischemia in patients with refractory angina.

Spontaneous ventricular arrhythmias following partial left ventriculectomy for nonischemic dilated cardiomyopathy: relation to hemodynamics and survival.

The study assessed the value of ambulatory electrocardiogram (AECG) monitoring for identification of patients who are at increased risk for cardiac death or arrhythmic event following partial left ventriculectomy (PLV). Furthermore, the impact of PLV and its hemodynamics on the occurrence of spontaneous ventricular arrhythmias was assessed in long-term survivors. In 32 idiopathic dilated cardiomyopathy patients who underwent PLV, ambulatory ECG (AECG) was performed preoperatively, early postoperatively, and 6 months and 12 months after surgery.

[Echocardiographic evaluation of left ventricular diastolic function in patients with aortic valve stenosis].

Impairment of left ventricular diastolic function in aortic valve stenosis occurs very early and precedes the impairment of systolic function. Aim was to examine left ventricular diastolic function and its association with severity of myocardial hypertrophy and clinical picture. The paper comprised 78 patients with isolated aortic valve stenosis in whom were performed ultrasonography and catheterization.

[Postoperative changes in left ventricular systolic function in patients with aortic valve stenosis].

Left ventricular systolic function in aortic stenosis remains intact for long period due to myocardial hypertrophy. Aim of this study was postoperative follow-up of the left ventricular systolic function both in patients with preserved and with decreased systolic performance. The study comprised 78 patients with severe and moderate aortic valve stenosis, out of whom 42 patients underwent surgery.

Acute effects of DDD pacing in patients with pulmonary infundibular stenosis.

We evaluated acute effects of DDD pacing (right atrium sensed and left ventricle paced) in 3 patients with pulmonary infundibular stenosis and found a decrease in dynamic right ventricular outflow gradient in all of them. It appears that acute temporary DDD pacing may decrease the dynamic obstruction of the right ventricular outflow tract in these patients, probably because of asynchronous contraction of the right ventricle induced by pacing from the left ventricular apex, with contraction of infundibular portion being delayed.