Showing papers by "Andrzej Lubiński published in 2018"
TL;DR: It is demonstrated that fewer women than men undergo ICD implantation for primary prevention after multivariate adjustment, women have a significantly lower mortality and receive fewer appropriate ICD shocks.
Abstract: Aims Therapy with an implantable cardioverter defibrillator (ICD) is established for the prevention of sudden cardiac death (SCD) in high risk patients. We aimed to determine the effectiveness of primary prevention ICD therapy by analysing registry data from 14 centres in 11 European countries compiled between 2002 and 2014, with emphasis on outcomes in women who have been underrepresented in all trials. Methods and results Retrospective data of 14 local registries of primary prevention ICD implantations between 2002 and 2014 were compiled in a central database. Predefined primary outcome measures were overall mortality and first appropriate and first inappropriate shocks. A multivariable model enforcing a common hazard ratio for sex category across the centres, but allowing for centre-specific baseline hazards and centre specific effects of other covariates, was adjusted for age, the presence of ischaemic cardiomyopathy or a CRT-D, and left ventricular ejection fraction ≤25%. Of the 5033 patients, 957 (19%) were women. During a median follow-up of 33 months (IQR 16-55 months) 129 women (13%) and 807 men (20%) died (HR 0.65; 95% CI: [0.53, 0.79], P-value < 0.0001). An appropriate ICD shock occurred in 66 women (8%) and 514 men (14%; HR 0.61; 95% CI: 0.47-0.79; P = 0.0002). Conclusion Our retrospective analysis of 14 local registries in 11 European countries demonstrates that fewer women than men undergo ICD implantation for primary prevention. After multivariate adjustment, women have a significantly lower mortality and receive fewer appropriate ICD shocks.
55 citations
TL;DR: ICD therapy is effective in nearly half the patient population; however, the rates of early and late complica-tions are high and the number of unnecessary ICD shocks and reimplantation procedures may be lowered by modern programming and increased longevity of newer ICD generators.
Abstract: Background: Implantable cardioverter-defibrillator (ICD) therapy has been proven effective in the prevention of sudden cardiac death, but data on outcomes of ICD therapy in the young and otherwise healthy patients with long QT syndrome (LQTS) are limited. Aim: We sought to collect data on appropriate and inappropriate ICD discharges, risk factors, and ICD-related complications. Methods: All LQTS patients implanted with an ICD in 14 centres were investigated. Demographic, clinical, and ICD therapy data were collected. Results: The study included 67 patients (88% female). Median age at ICD implantation was 31 years (12–77 years). ICD indication was based on resuscitated cardiac arrest in 46 patients, syncope in 18 patients, and malignant family history in three patients. During a median follow-up of 48 months, 39 (58%) patients received one or more ICD therapies. Time to first appropriate discharge was up to 55 months. Inappropriate therapies were triggered by fast sinus rhythm, atrial fibrillation, and T-wave oversensing. No predictors of inappropriate shocks were identified. Risk factors for appropriate ICD therapy were: (1) recurrent syncope despite b-blocker treatment before ICD implantation, (2) pacemaker therapy before ICD implantation, (3) single-chamber ICD, and (4) noncompliance to b-blockers. In 38 (57%) patients, at least one complication occurred. Conclusions: ICD therapy is effective in nearly half the patient population; however, the rates of early and late complications are high. Although the number of unnecessary ICD shocks and reimplantation procedures may be lowered by modern programming and increased longevity of newer ICD generators, other adverse events are less likely to be reduced.
10 citations
TL;DR: Antazoline has an effect on electrophysiological parameters of the atrial muscle and has rapid onset of action and no negative effect on sinus node function and atrioventricular conduction in a unique property among antiarrhythmic drugs.
Abstract: Antazoline is a first-generation antihistaminic agent with additional anticholinergic properties and antiarrhythmic potential. Recent data shows its high effectiveness in sinus rhythm restoration among patients with paroxysmal atrial fibrillation. The effect of antazoline on electrophysiological parameters of the heart in vivo has not yet been examined. The aim of this study was to evaluate changes in electrophysiological parameters of the heart muscle and conduction system as a response to increasing doses of antazoline. After successful ablation of supraventricular arrhythmias, the electrophysiological parameters: sinus rhythm cycle length (SRCL), AH, HV, QRS, QT, QTc intervals, Wenckebach point (WP), sinus node recovery period (SNRT), intra- (hRA-CSos) and interatrial conduction time (hRA-CSd), right and left atrium refractory period (RA-; LA-ERP), and atrioventricular node refractory period (AVN-ERP) were assessed initially and after 100, 200, and 300 mg of antazoline given intravenously. Fifteen patients (8 males, 19–72 years old) undergoing EPS and RF ablation were enrolled. After 100 mg bolus, a significant reduction in SRCL was noticed. After antazoline administration, significant prolongation of HV, QRS, QTc, hRA-CSos, hRA-CSd intervals, RA– and LA-ERP and reduction of SRCL were observed. After a total dose of 300 mg, QT interval prolonged significantly. Increasing the dose of antazoline had no impact on AH, Wenckebach point, AVN-ERP, and SNRT. Antazoline has an effect on electrophysiological parameters of the atrial muscle and has rapid onset of action. No negative effect on sinus node function and atrioventricular conduction in a unique property among antiarrhythmic drugs.
8 citations
TL;DR: MRI showed subendocardial ischaemic necrosis with organ viability preservation in the heart muscle in a 58-year-old woman with suspected myocardial infarction with non obstructive coronary arteries (MINOCA).
Abstract: We present the case of a 58-year-old woman with suspected myocardial infarction. Coronarography did not reveal changes
in coronary arteries. Laboratory tests revealed increases in troponin and inflammation parameters, and therefore
MRI was performed. This showed subendocardial ischaemic necrosis with organ viability preservation in the heart
muscle. As a result, myocardial infarction with non obstructive coronary arteries (MINOCA) was diagnosed.
1 citations
TL;DR: It was concluded that 18F-FDG uptake in the heart may have been an artefact associated with previous treatment for coronary artery disease or locally hypertrophied myocardium and was considered to be cured of neoplastic disease.
Abstract: A 76-year-old woman diagnosed with left lung tumour of uncertain origin was admitted to our department to explain the correlation between focal heart and lung co-uptake of 18F-fludeoxyglucose (18F-FDG) visualised in positron emission tomography/computed tomography (PET/CT) image reconstructions. In the past the patient underwent several percutaneous coronary interventions and developed heart failure with left ventricular ejection fraction (LVEF) of ~30%, requiring a subsequent implantation of a cardiac resynchronisation therapy cardioverter-defibrillator (CRT-D). The first PET/CT revealed solitary heart uptake of tracer in the basal segments of the interventricular septum (IVS), in no relationship with any of the electrodes for CRT-D (Fig. 1). There was no evidence of a device-related infective endocarditis: there were no clinical symptoms, markers of inflammation (white blood cells, C-reactive protein, and procalcitonin) were within reference ranges, and blood cultures were negative. There were no symptoms of cardiac metastases such as significant progression of LVEF impairment, dyspnoea or chest pain, or metabolic activity of mediastinal lymph nodes. Transthoracic echocardiography (TTE) performed on admission showed IVS thickness of 8 to 11 mm in the basal segments with thinning in the mid-cavity and apical segments, enlarged left ventricle and both atria, LVEF of 30%, and no pericardial effusion. After one month a comparative PET/CT was performed, revealing a few dispersed foci of increased activity localised in the left ventricular myocardium, which were suspected to be artefacts (Fig. 2). Meanwhile, the patient was referred for surgical biopsy of the lung tumour diagnosed in histopathology as a non-small cell lung carcinoma (NSCLC). According to the histopathologic diagnosis, the heart uptake of 18F-FDG should be considered as a potential metastatic lesion [1] rather than an artefact [2, 3]. Late gadolinium-enhanced cardiac magnetic resonance (MR) was contraindicated due to the presence of a non-MR conditional device and expected artefacts related to electrodes for CRT-D placed in the magnetic field, therefore the patient finally underwent contrast-enhanced cardiac computed tomography angiography as a first-line diagnostic approach to discover the nature of the lesion. The examination revealed homogeneous IVS, mildly hypertrophied (up to 11 mm) in the basal segments, with no evidence of low-attenuation infiltrating mass typical for cardiac metastases [4] in the regions of tracer uptake (Fig. 3). Based on the literature it was concluded that 18F-FDG uptake in the heart may have been an artefact associated with previous treatment for coronary artery disease or locally hypertrophied myocardium. TTE performed on a follow-up visit six months after NSCLC excision showed stable IVS thickness in all segments, enlarged left ventricle and both atria, LVEF of 28%, and no pericardial effusion. Based on complete excision of the lung tumour and the heart without evident metastases, the patient was considered to be cured of neoplastic disease and has not been referred for complementary treatment.