Predictors of Higher Frequency of Atrial Fibrillation in Patients with Cardiac Resynchronization Therapy.

: Cardiac resynchronization therapy (CRT) is one of the effective therapeutic options in the treatment of systolic heart failure (HF) with persistent symptoms. This prospective study was designed to determine whether CRT with biventricular pacing would reduce the risk of development of atrial fibrillation (AF) and to identify predictors for AF occurrence. : The study population consisted of 126 patients, with a mean age of 63.

Information-Theoretic Analysis of Cardio-Respiratory Interactions in Heart Failure Patients: Effects of Arrhythmias and Cardiac Resynchronization Therapy.

The properties of cardio-respiratory coupling (CRC) are affected by various pathological conditions related to the cardiovascular and/or respiratory systems. In heart failure, one of the most common cardiac pathological conditions, the degree of CRC changes primarily depend on the type of heart-rhythm alterations. In this work, we investigated CRC in heart-failure patients, applying measures from information theory, i.

Effects of Cardiac Resynchronization Therapy on Cardio-Respiratory Coupling.

In this study, the effect of cardiac resynchronization therapy (CRT) on the relationship between the cardiovascular and respiratory systems in heart failure subjects was examined for the first time. We hypothesized that alterations in cardio-respiratory interactions, after CRT implantation, quantified by signal complexity, could be a marker of a favorable CRT response. Sample entropy and scaling exponents were calculated from synchronously recorded cardiac and respiratory signals 20 min in duration, collected in 47 heart failure patients at rest, before and 9 months after CRT implantation.

Primary hyperparathyroidism associated with acquired long QT interval and ventricular tachycardia.

Summary: We present a 54-year-old patient admitted to the emergency department due to loss of consciousness. The initial ECG registered monomorphic ventricular extrasystoles and prolonged QT interval (QT corrected (QTc) >500 ms). Sustained ventricular tachycardia (VT) was registered on 24-h Holter ECG monitoring, which clinically was presented as a crisis of consciousness.

Diagnostic value of implantable loop recorders in patients with unexplained syncope or palpitations.

Background: The implantable loop recorder (ILR) is a small cardiac rhythm-monitoring device. Our aim was to determine ILR diagnostic value in patients with unexplained syncope, presyncope, or palpitations suggesting cardiac arrhythmias.

Methods: This has been a retrospective, observational, single-center study.

Multiscale Entropy Analysis: Application to Cardio-Respiratory Coupling.

It is known that in pathological conditions, physiological systems develop changes in the multiscale properties of physiological signals. However, in real life, little is known about how changes in the function of one of the two coupled physiological systems induce changes in function of the other one, especially on their multiscale behavior. Hence, in this work we aimed to examine the complexity of cardio-respiratory coupled systems control using multiscale entropy (MSE) analysis of cardiac intervals MSE (RR), respiratory time series MSE (Resp), and synchrony of these rhythms by cross multiscale entropy (CMSE) analysis, in the heart failure (HF) patients and healthy subjects.

Differentiation of Heart Failure Patients by the Ratio of the Scaling Exponents of Cardiac Interbeat Intervals.

Heart failure (HF) is one of the most frequent heart diseases. It is usually characterized with structural and functional cardiac abnormalities followed by dysfunction of autonomic cardiac control. Current methods of heartbeat interval analysis are not capable to differentiate HF patients and some new differentiation of HF patients could be useful in the determination of the direction of their treatment.

Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology.

Cardiomyopathies are a heterogeneous group of heart muscle diseases and an important cause of heart failure (HF). Current knowledge on incidence, pathophysiology and natural history of HF in cardiomyopathies is limited, and distinct features of their therapeutic responses have not been systematically addressed. Therefore, this position paper focuses on epidemiology, pathophysiology, natural history and latest developments in treatment of HF in patients with dilated (DCM), hypertrophic (HCM) and restrictive (RCM) cardiomyopathies.

Bidirectional Cardio-Respiratory Interactions in Heart Failure.

We investigated cardio-respiratory coupling in patients with heart failure by quantification of bidirectional interactions between cardiac (RR intervals) and respiratory signals with complementary measures of time series analysis. Heart failure patients were divided into three groups of twenty, age and gender matched, subjects: with sinus rhythm (HF-Sin), with sinus rhythm and ventricular extrasystoles (HF-VES), and with permanent atrial fibrillation (HF-AF). We included patients with indication for implantation of implantable cardioverter defibrillator or cardiac resynchronization therapy device.

Left atrial phasic function and heart rate variability in patients with systemic sclerosis: A new part of the old puzzle.

Objective: We aimed to research left atrial (LA) phasic function and heart rate variability (HRV), as well as their relationship, in subjects with uncomplicated systemic sclerosis (SSc).

Methods: The investigation involved 44 SSc patients and 33 age-matched healthy controls. All participants underwent clinical examination, serological tests, 24-hours Holter monitoring, and echocardiographic examination including strain analysis.

The Relationship of Myocardial Collagen Metabolism and Reverse Remodeling after Cardiac Resynchronization Therapy.

Background: In the majority of patients with a wide QRS complex and heart failure resistant to optimal medical therapy, cardiac resynchronization therapy (CRT) leads to reverse ventricular remodeling and possibly to changes in cardiac collagen synthesis and degradation. We investigated the relationship of biomarkers of myocardial collagen metabolism and volumetric response to CRT.

Methods: We prospectively studied 46 heart failure patients (mean age 61±9 years, 87% male) who underwent CRT implantation.

Uncoupling of cardiac and respiratory rhythm in atrial fibrillation.

Rearranged origin of heart rhythm in patients with atrial fibrillation (AF) influences the regulation of the heart and consequently the respiratory rhythm, and the bidirectional interaction of these rhythms not documented. Hence, we examined coupling of the RR interval and the respiration (Resp) signal by coherence, Granger causality and the cross-sample entropy method of time series analysis in patients with AF and a healthy control group. In healthy subjects, the influence of respiration on cardiac rhythm was found as increased coherence at the breathing frequency (BF) range, significantly stronger interaction and synchrony from Resp to RR than from RR to Resp.

Is pacemaker therapy the right key to patients with vasovagal syncope?

Introduction: Vasovagal syncope is the most common type of reflex syncope. Efficacy of cardiac pacing in this indication has not been the subject of many studies and pacemaker therapy in patients with vasovagal syncope is still controversial.

Objective: This study aimed to assess the efficacy and safety of pacing therapy in treatment of patients with vasovagal syncope, to determine contribution of new therapeutic models in increasing its success, and to identify risk factors associated with a higher rate of symptoms after pacemaker implantation.

Treatment strategies for carotid artery aneurysms.

Background: The aim of this paper was to present single centre experience in the treatment of extra cranial carotid artery aneurysms (ECCA) and to analyze results discussing different treatment modalities.

Methods: The study analyzed 60 patients with 62 ECCA treated surgically at the Clinic for vascular and endovascular surgery, Serbian Clinical Center (Belgrade) in the period between 1985 and 2013. Treatment strategy was individually selected and demographic, morphologic, intraoperative and postoperative data were collected.

Generalized Poincaré Plots-A New Method for Evaluation of Regimes in Cardiac Neural Control in Atrial Fibrillation and Healthy Subjects.

Classical Poincaré plot is a standard way to measure nonlinear regulation of cardiovascular control. In our work we propose a generalized form of Poincaré plot where we track correlation between the duration of j preceding and k next RR intervals. The investigation was done in healthy subjects and patients with atrial fibrillation, by varying j,k ≤ 100.

The interaction between blood pressure variability, obesity, and left ventricular mechanics: findings from the hypertensive population.

Objective: The aim of this study was to determine the relationship between blood pressure (BP) variability and left ventricular (LV) mechanical function in untreated normal-weight, overweight, and obese hypertensive patients.

Methods: This cross-sectional study included 144 untreated hypertensive study participants who underwent 24-h ambulatory BP monitoring and complete two (2DE) and three-dimensional echocardiography (3DE). All the patients were divided into three groups according to their BMI: normal-weight patients (BMI < 25 kg/m), overweight patients (25 ≤ BMI < 30 kg/m), and obese patients (BMI ≥ 30 kg/m).

EYE LENS EXPOSURE TO MEDICAL STAFF PERFORMING ELECTROPHYSIOLOGY PROCEDURES: DOSE ASSESSMENT AND CORRELATION TO PATIENT DOSE.

The purpose of this study was to assess the patient exposure and staff eye dose levels during implantation procedures for all types of pacemaker therapy devices performed under fluoroscopic guidance and to investigate potential correlation between patients and staff dose levels. The mean eye dose during pacemaker/defibrillator implementation was 12 µSv for the first operator, 8.7 µSv for the second operator/nurse and 0.

[Approach to the Treatment of Atrial Fibrillation in Patients with Cardiovascular Risk Profile: Multicentric International Study].

Introduction: Atrial fibrillation (AF), the most common arrhythmia that requires treatment, does not come out of the focus of researchers. Monitoring its prevalence and effects of therapy is a good guideline approach to the growing population of patients in which this arrhythmia occurs.

Objective: The aim of the study was to evaluate the efficacy of treatment of AF and cardiovascular profiles in the observed population.

Influence of Different β-Blockers on Platelet Aggregation in Patients With Coronary Artery Disease on Dual Antiplatelet Therapy.

Introduction: The use of β-blockers in the treatment of patients with coronary heart disease is associated with a decrease in the frequency of angina pectoris and mortality of patients. Due to the severity of the disease and previous cardiovascular interventions, many patients with coronary artery disease (CAD) use dual antiplatelet therapy to achieve greater inhibition of platelet aggregation. The influence of β-blockers on platelet aggregation in patients using antiplatelet therapy is not well understood.

Myocardial mechanical and QTc dispersion for the detection of significant coronary artery disease.

Aims: Ischaemic but viable myocardium may exhibit prolongation of contraction and QT interval duration, but it is largely unknown whether non-invasive assessment of regional heterogeneities of myocardial deformation and QT interval duration could identify patients with significant coronary artery disease (CAD).

Methods And Results: We retrospectively studied 205 patients with suspected CAD who underwent coronary angiography. QTc dispersion was assessed from a 12-lead electrocardiogram (ECG) as the difference between the longest and shortest QTc intervals.

Association between left ventricular mechanics and heart rate variability in untreated hypertensive patients.

The authors sought to investigate left ventricular (LV) mechanics and heart rate variability (HRV), and their relationship, in untreated hypertensive patients. A total of 63 untreated hypertensive patients and 45 healthy patients were included. All patients underwent 24-hour Holter monitoring and echocardiographic examination (two- and three-dimensional).

[Long-term follow-up after catheter-ablation of atrioventricular junction and pacemaker implantation in patients with uncontrolled atrial fibrillation and heart failure].

Introduction: Atrioventricular (AV) junction ablation coupled with pacemaker implantation is an effective therapeutic option for rate control in atrial fibrillation (AF) and heart failure (HF). However, there is controversy regarding the long-term outcome of the procedure, since right ventricular stimulation can lead to left ventricular remodelling and HF.

Objective: The aim of the study was to determine a 5-year outcome of the procedure on survival, HF control and myocardial function in patients with HF and uncontrolled AF.

Approach to patients with implanted pacemaker and scheduled surgical or diagnostic procedure.

Application of cardiac electrostimulation in strictly defined indications has been on the increase over the last few decades. Frequent use of this therapy as well as the fact that it is applied predominantly in patients in the seventh decade of life, implies possible signifficant comorbidities and need for various diagnostic and surgical procedures. These are the reasons we decided to point out certain specific features in approaching this patient group in preparation and implementation of these procedures.

[The degree of coronary atherosclerosis as a marker of insulin resistance in non-diabetics].

Introduction: The metabolic syndrome and its influence on coronary artery disease development and progression remains in focus of international research debates, while insulin resistance, which represents its core, is the key component of hypertension, dyslipidaemias, glucose intolerance and obesity.

Objective: The aim of this study was to establish relationship between basal glucose and insulin levels, insulin sensitivity and lipid panel and the degree of coronary atherosclerosis in nondiabetic patients.

Methods: The coronary angiograms were evaluated for the presence of significant stenosis, insulin sensitivity was assessed using the intravenous glucose tolerance test with a minimal model according to Bergman, while baseline glucose (GO), insulin (10) and lipid panel measurements (TC, HDL, LDL, TG) were taken after a 12-hour fasting.

[Brain natriuretic peptide as a predictor of heart failure in patients with permanent pacemaker].

Introduction: Brain natriuretic peptide (BNP) has a role in control of cardiovascular and renal functions.

Objective: The objective was to assess the predictive value of BNP levels for development of heart failure in patients with permanent pacemakers.

Method: In patients with implanted DDD pacemakers, BNP levels were measured at rest and after exercise testing, on DDD and VVI modes.