Publications by authors named "Stepan Havranek"
Article Synopsis
- Ventricular arrhythmias (VAs) are uncommon but can occur after electrical cardioversion (ECV) for atrial fibrillation (AF), with an incidence of about 0.2% based on a study of nearly 12,000 ECV procedures.
- The study involved 23 patients who experienced VAs within 10 days of ECV, with most cases developing 28.5 hours after the procedure, and a significant number had underlying health issues like congestive heart failure.
- The findings suggest that while VAs post-ECV are rare, they can be life-threatening, especially in patients with certain risk factors, indicating that careful monitoring is essential for these individuals.
Background: The initial rhythm is a known predictor of survival in extracorporeal cardiopulmonary resuscitation (ECPR) patients. However, the effect of the rhythm at hospital admission on outcomes in these patients is less clear.
Methods: This observational, single-center study assessed the influence of the rhythm at hospital admission on 30-day survival and neurological outcomes at discharge in patients who underwent ECPR for out-of-hospital cardiac arrest (OHCA).
Background: It is unclear how invasive resuscitative protocols may impact the time-dependent prognosis of out-of-hospital cardiac arrest (OHCA) resuscitations, or the relationship between intra-arrest transport and outcomes.
Methods: We performed a secondary analysis of the Prague OHCA Study, which randomized refractory OHCAs to "invasive" (intra-arrest transport for possible ECPR initiation) vs. "standard" resuscitation strategies (predominantly performed on-scene).
Article Synopsis
- Supraventricular tachycardia (SVT), a common issue for patients with pulmonary hypertension (PH), includes conditions like atrial fibrillation and atrial flutter, which can worsen heart function.
- Restoring normal heart rhythm through methods like catheter ablation can lead to improvements, though long-term success is challenged by the potential for arrhythmia recurrence.
- Catheter ablation is generally effective for less complex SVTs, but its use for complex cases like atrial fibrillation needs to be more tailored due to higher risks and varying outcomes.
Article Synopsis
- There is limited understanding of how idiopathic ventricular fibrillation (IVF) starts, but previous research suggests that it usually doesn't depend on pauses in heart rhythm.
- The study aimed to investigate the initiation patterns of polymorphic ventricular tachycardia (PVT) in IVF patients, analyzing a total of 410 arrhythmia episodes among 180 patients.
- Results showed that about 27.2% of PVT episodes were pause-dependent, with the majority occurring during normal heart rhythms and initiating PVCs mostly having short coupling intervals (under 350 ms).
Article Synopsis
- The study aimed to evaluate the long-term outcomes of extracorporeal cardiopulmonary resuscitation (ECPR) compared to conventional CPR (CCPR) in patients with refractory out-of-hospital cardiac arrest (OHCA).
- A total of 256 patients were randomly assigned to either ECPR or CCPR during resuscitation, with a long-term follow-up conducted 5.3 years later.
- Results showed that 27.6% of the ECPR group survived compared to 19.7% in the CCPR group, indicating improved long-term survival with ECPR, although neurological outcomes and quality of life were similar for both groups.
Background: The severity of tissue hypoxia is routinely assessed by serum lactate. We aimed to determine whether early lactate levels predict outcomes in refractory out-of-hospital cardiac arrest (OHCA) treated by conventional and extracorporeal cardiopulmonary resuscitation (ECPR).
Methods: This study is a post-hoc analysis of a randomized Prague OHCA study (NCT01511666) assessing serum lactate levels in refractory OHCA treated by ECPR (the ECPR group) or conventional resuscitation with prehospital achieved return of spontaneous circulation (the ROSC group).
Article Synopsis
- The Prague-17 trial compared bleeding events in patients with atrial fibrillation (AF) treated with left atrial appendage closure (LAAC) versus nonvitamin K anticoagulants (NOAC).
- During the study, which involved 402 high-risk AF patients over an average of 3.5 years, bleeding events were lower in the LAAC group (24 events) compared to the NOAC group (40 events).
- The findings suggest that LAAC is associated with reduced nonprocedural major and clinically relevant nonmajor bleeding events, particularly noting gastrointestinal bleeding as the most common type in both treatment groups.
Aims: Atrial fibrillation (AF), typical atrial flutter (AFL), and other atrial tachycardias (ATs) are common in patients with pulmonary hypertension. Frequently, several supraventricular arrhythmias are successively observed in individual patients. We investigated the hypothesis of whether more extensive radiofrequency catheter ablation of the bi-atrial arrhythmogenic substrate instead of clinical arrhythmia ablation alone results in superior clinical outcomes in patients with pulmonary arterial hypertension (PH) and supraventricular arrhythmias.
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- The study investigates patients with right bundle branch block (RBBB)-ventricular tachycardia (VT) and arrhythmogenic cardiomyopathy (ACM) by examining ECG characteristics of sinus rhythm (SR) and VT.
- It included 70 patients, revealing that the most common sites of origin for the VTs were primarily in the inferior and lateral walls of the left ventricle (LV), with a good correlation to electro-anatomic mapping (EAM) data.
- The findings highlight frequent abnormalities in SR depolarization and repolarization, which are associated with clinical implications in patients with ACM and RBBB-VT.
Background: Anderson-Fabry disease (AFD) is an X-linked inherited lysosomal disease caused by a defect in the gene encoding lysosomal enzyme α-galactosidase A (GLA). Atrio-ventricular (AV) nodal conduction defects and sinus node dysfunction are common complications of the disease. It is not fully elucidated how frequently AFD is responsible for acquired AV block or sinus node dysfunction and if some AFD patients could manifest primarily with spontaneous bradycardia in general population.
View Article and Find Full Text PDFBackground: Survival rates in refractory out-of-hospital cardiac arrest (OHCA) remain low with conventional advanced cardiac life support (ACLS). Extracorporeal life support (ECLS) implantation during ongoing resuscitation, a method called extracorporeal cardiopulmonary resuscitation (ECPR), may increase survival. This study examined whether ECPR is associated with improved outcomes.
View Article and Find Full Text PDFBackground: The prognosis of refractory out-of-hospital cardiac arrest (OHCA) is generally poor. A recent Prague OHCA study has demonstrated that an invasive approach (including extracorporeal cardiopulmonary resuscitation, ECPR) is a feasible and effective treatment strategy in refractory OHCA. Here we present a post-hoc analysis of the role of initial rhythm on patient outcomes.
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- Sarcoidosis is a disease that causes inflammation in different parts of the body, and it can affect the heart even if people don't have heart symptoms.
- This study looked at 55 patients who were recently diagnosed with sarcoidosis but showed no heart issues, using a special heart scan called CMR to check for heart involvement.
- The results showed that only a small number of those patients (6%) had signs of heart issues, suggesting that heart problems are rare in these cases, but the CMR scan can be helpful to find them.
Introduction: Atrial fibrillation (AF), with a prevalence of 2%, is the most common cardiac arrhythmia. Catheter ablation (CA) has been documented to be superior to treatment by antiarrhythmic drugs (AADs) in terms of sinus rhythm maintenance. However, in obese patients, substantial weight loss was also associated with AF reduction.
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- The study analyzed the medical records of 697 patients who suffered out-of-hospital cardiac arrest (OHCA) between January 2012 and December 2020 to assess coronary angiography (CAG) findings and interventions.
- Among the patients, 23% did not have return of spontaneous circulation (ROSC) upon hospital admission, and those without ROSC were generally younger and experienced longer resuscitation times compared to those with ROSC.
- Although patients without ROSC had higher rates of acute coronary occlusions, PCI was still performed effectively, resulting in a notable but lower 30-day survival rate of 24%, compared to 70% in those with ROSC.
Article Synopsis
- Out-of-hospital cardiac arrest (OHCA) has a low survival rate, and the effectiveness of an early invasive treatment approach compared to standard care is unclear.
- A randomized clinical trial in Prague involved 256 adults with OHCA to assess whether an invasive strategy improves neurologically favorable survival at 180 days.
- The trial was halted early for futility, showing that 31.5% of the invasive group had a good neurologic outcome compared to 22.0% in the standard care group.
Background: The PRAGUE-17 (Left Atrial Appendage Closure vs Novel Anticoagulation Agents in Atrial Fibrillation) trial demonstrated that left atrial appendage closure (LAAC) was noninferior to nonwarfarin direct oral anticoagulants (DOACs) for preventing major neurological, cardiovascular, or bleeding events in patients with atrial fibrillation (AF) who were at high risk.
Objectives: This study sought to assess the prespecified long-term (4-year) outcomes in PRAGUE-17.
Methods: PRAGUE-17 was a randomized noninferiority trial comparing percutaneous LAAC (Watchman or Amulet) with DOACs (95% apixaban) in patients with nonvalvular AF and with a history of cardioembolism, clinically-relevant bleeding, or both CHADS-VASc ≥3 and HASBLED ≥2.
Article Synopsis
- A study investigated the rates and outcomes of cardiac implantable electronic device (CIED) procedures in patients with active COVID-19, using data from 53 medical centers across 13 countries.
- The CIED implantation rate among hospitalized COVID-19 patients ranged from 0 to 16.2 per 1000, with a notable 30-day complication rate of 13.9% and a 180-day mortality rate of 9.6%.
- Significant differences in patient outcomes were identified between Europe and North America, highlighting the need for careful consideration of risks when performing CIED procedures on patients with COVID-19.
Aims: In arrhythmogenic cardiomyopathy (ACM), sustained ventricular tachycardia (VT) typically displays a left bundle branch block (LBBB) morphology while a right bundle branch block (RBBB) morphology is rare. The present study assesses the VT morphology in ACM patients with sustained VT and their clinical and genetic characteristics.
Methods And Results: Twenty-six centres from 11 European countries provided information on 954 ACM patients who had ≥1 episode of sustained VT spontaneously documented during patients' clinical course.
GDF-15 (Growth differentiation factor 15) is a protein synthesised in some tissues including liver, kidney, heart, or lung. GDF-15 a stress-responsive cytokine. GDF-15 is emerging as a biomarker of cardiometabolic risk and disease burden.
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- * In a review of 755 patients, the study found a 25% prevalence of SVT in those with isolated pre-capillary PH (Ipc-PH) and significantly higher rates (51%) in those with combined post- and pre-capillary PH (Cpc-PH). Atrial fibrillation was the most common type of SVT.
- * The study concluded that SVT is quite common in PH patients, particularly in those with elevated post-capillary pressure, but having SVT did not correlate with
Atrial fibrillation (AF) and atrial tachycardia (AT) are frequently observed in patients with chronic thromboembolic pulmonary hypertension (CTEPH) who were treated with pulmonary endarterectomy (PEA). Their prevalence and impact on prognosis of patients are not known. We analysed the prevalence of AF/AT and the clinical outcome in 197 patients with CTEPH treated with PEA (median age 62; interquartile range 53-68 years; 62% males).
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- Giant cell myocarditis (GCM) is a serious autoimmune heart condition mainly affecting middle-aged adults, leading to high rates of illness and death.
- A case study described a 70-year-old man with chronic immunosuppression who experienced severe heart problems that didn't respond to usual treatments.
- An endomyocardial biopsy confirmed GCM, allowing for targeted immunosuppressive therapy that resulted in a positive outcome, emphasizing the importance of timely diagnosis in older patients with heart failure.