Marcin Gułaj

Bio: Marcin Gułaj is an academic researcher from Ministry of Interior (Bahrain). The author has contributed to research in topics: Implantable cardioverter-defibrillator. The author has an hindex of 2, co-authored 2 publications receiving 13 citations.

Implantable cardioverter-defibrillators in patients with long QT syndrome: a multicentre study.

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.

Electrotherapy and electrophysiology procedures during the coronavirus disease 2019 pandemic: an opinion of the Heart Rhythm Section of the Polish Cardiac Society (with an update).

Abstract: 488 of performed ablations has decreased considerably (by 74%), especially in case of pulmonary vein isolation (by 80%). Restrictions in performing procedures that can be safely postponed by a few months without any harm to those awaiting are entirely justified by the need to limit the risk of potential infection of patients and medical personnel in healthcare centers by the undiagnosed carriers. However, the delay in emergency and urgent procedures may result in significant health deterioration or may even lead to immediate lifethreatening situations.2 On the one hand, the current epidemic situation in Poland indicates the rising number of infected individuals, which increases the potential risk of new infections in healthcare centers. On the other hand, the constantly rising number of tests excluding the infection enables to minimize this risk. The course of epidemic and the estimated time necessary for its reduction remain unknown.3,4 For that reason, the periodic reevaluation of the urgency of indications to perform invasive Update Due to the ongoing pandemic of coronavirus disease 2019 (COVID-19) and the dynamically changing epidemic situation, and taking into account the growing body of knowledge on the disease itself as well as predictions of its further spread, the Board of the Heart Rhythm Section supplements the previous opinion dated March 23, 20201 with the following information: The number of invasive electrotherapy and electrophysiology procedures has drastically fallen in the recent weeks. It applies both to urgent and elective procedures. According to the analysis of unpublished data collected from 10 main electrotherapy centers in Poland comparing the number of procedures in the previous and current year in the period from March 15 to April 14, the number of electrotherapy procedures has dropped by 41%, including implantation of pacemakers by 39%, placement of implantable cardioverter -defibrillators (ICD) by 52%, and resynchronization therapy devices by 35%. A remarkable reduction in the number of corrective surgeries of lead extraction (by 43%) was also observed. Moreover, the number Correspondence to: Maciej Kempa, MD, PhD, Department of Cardiology and Electrotherapy, Medical University of Gdańsk, ul. Dębinki 7, 80-952 Gdańsk, Poland, phone: +48 58 349 39 10, email: kempa@gumed.edu.pl Received: May 3, 2020. Accepted: May 4, 2020. Published online: May 5, 2020. Kardiol Pol. 2020; 78 (5): 488-492 doi:10.33963/KP.15338 Copyright by the Polish Cardiac Society, Warsaw 2020

Acc/aha/hrs 发布新版成人室上性心动过速指南

Abstract: 美国心脏病学院（ACC）、美国心脏协会（AHA）、美国心律学会（HRS）专家工作组历时1年，于近期联合发布了新版成人室上性心动过速（SVT）指南，全文于2015年9月23日全文刊登在Circulation、Journal of the American College of Cardiology和Heart Rhythm Journal三大重要杂志上。

[Subcutaneous implantable cardioverter-defibrillator in prevention of sudden cardiac death in Poland - opinion paper endorsed by the Polish Cardiac Society Working Group on Heart Rhythm].

Abstract: In the past years, cardiovascular mortality has decreased but despite these cardiovascular diseases are responsible for millions of deaths every year in the world and approximately 25% of which are sudden cardiac death (SCD). Implantable defibrillators (ICD) is proven therapy used in primary and secondary SCD prevention. Currently majority of devices use transvenous leads inserted predominantly into the right heart for both pacing and defibrillation. On the other hand, ICD may cause complica­tions, including inappropriate shocks, device-related infection and lead failure. Problems with transvenous leads prompted the development of a subcutaneous defibrillator (S-ICD) with an electrode system that is placed entirely subcutaneously, outside the thoracic cavity. The device may be useful when venous access is difficult, in young patients and in patients at particular risk of infection. S-ICD is not suitable for patients with indications for bradycardia pacing, cardiac resynchronisation therapy and in cases with tachyarrhythmia easily terminated by antitachycardia pacing.

Children and young adults treated with transvenous and subcutaneous implantable cardioverter-defibrillators: a 22-year single-center experience and new perspectives

Abstract: Background: Over the last several years the evolution of transvenous implantable cardioverter‑defibrillator (T‑ICD) system and the introduction of subcutaneous ICD (S‑ICD) have contributed to the development of the sudden cardiac death (SCD) prevention in clinical practice. Aims: To report our clinical experience with ICD therapy in children and young adults during the twenty‑ ‑two years of the follow‑up. Methods: We reviewed the database of ICD recipients choosing 80 consecutive patients (pts) implanted at the age of 6–21 in 1996–2018. We analyzed the rate of appropriate (AT) and inappropriate therapies (IT), mortality, complications and new treatment options. Results: A total of 21/80 patients (26.25%) received ≥1 AT for ventricular tachycardia/ventricular fibrillation (anti‑tachycardia pacing or shock) and 25/80 patients (31.25%) had one or multiple IT (P = 0.47). Nine patients (11%) had both AT and IT interventions. During follow‑up, 2 (2.5%) cardiac resynchronization therapy (CRT) systems, and 8 (10%) S‑ICDs were implanted, 3 heart transplantations were performed, and 1 severe tricuspid valve regurgitation occurred. A total of 6/80 patients (7.5%) died. All deaths occurred in the hypertrophic cardiomyopathy group. Conclusions: The mortality rate was 6/80 (7.5%) in the twenty‑two‑year follow‑up. The rate of AT vs. IT was almost equal and remained steady in the long observation period. Severe TR might be a serious clinical problem in some patients. Entirely S‑ICD for SCD prevention is a feasible and safe therapy in young recipients.

Review of different clinical scenarios in patients with cardiovascular disease in the era of the coronavirus pandemic.

Abstract: 818 respiratory syndrome coronavirus 2 binds to its target cells through angiotensin-converting enzyme 2 (ACE2)., which is expressed in the lungs, intestines, kidneys, blood vessels, and heart.6,7 In animal models, the upregulation of ACE2 expression in various organs resulted from ACEI and ARB treatment.8-10 Angiotensin-converting enzyme 2 turns angiotensin II to angiotensin 1-7, which has a protective role in the cardiovascular system and, potentially, a vasodilatory effect. Moreover, ACE2 prevents acute lung injury.11,12 Possible upregulation of ACE2 expression as a receptor for viral cell entry (with ACEIs or ARBs) may theoretically increase susceptibility to COVID-19. Interestingly, a contrasting hypothesis has also been postulated. Angiotensin receptor blockers have been suggested to act beneficially in patients with COVID-19 by ACE2 upregulation, thus increasing the concentration of vasodilating angiotensin 1-7 at the expense of angiotensin II causing vasoconstriction, which contributed to lung protection.13,14 Therefore, in the absence of firm evidence regarding beneficial or adverse outcomes of ACEI and ARB treatment in patients with COVID-19, the European Society of Cardiology (ESC) as well as the American College of Cardiology and American Heart Association do not recommend discontinuation or any modification of clinically indicated therapy. The risk of discontinuing drug use is well known: it may destabilize blood pressure control and consequently increase cardiovascular mortality in patients with COVID-19.15,16