Sławomir Sielski

Bio: Sławomir Sielski is an academic researcher from Nicolaus Copernicus University in Toruń. The author has contributed to research in topics: Implantable cardioverter-defibrillator & Atrial fibrillation. The author has an hindex of 5, co-authored 19 publications receiving 76 citations.

Case report Percutaneous closure of mitral perivalvular leak

Abstract: Paravalvular leak (PVL) is a complication observed in patients after prosthetic valve replacement. The incidence of PVL is estimated as 2-3%. The cause of PVL may be paravalvular infection, suture continuity disruption, damage of tissues around the annulus or limitation of disc mobility by thrombus or vegetation. The preferable method of treatment of PVL is surgery. Recently, percutaneous closure of PVL became an alternative method. We present a case of successfully completed percutaneous closure of PVL with the use of Amplatzer occluder device in a patient with mitral PVL.

Resveratrol and cardiovascular system-the unfulfilled hopes

Abstract: Resveratrol is a natural polyphenolic compound with a stilbene structure endowed with multiple health-promoting effects. Among phenolic compounds, resveratrol is assigned a leading role in the health-promoting effects of red wine. The aim of the study was to assess the effect of resveratrol on the cardiovascular system in the experimental and clinical studies conducted so far. Moreover, the paper discusses the results of the most recent meta-analyses assessing resveratrol’s therapeutic effect on the cardiovascular system in humans. In animal and preclinical studies, resveratrol has demonstrated a wide physiological and biochemical spectrum of activity, including antioxidant, anti-inflammatory, antiplatelet, and anticoagulant activities, which translated into its health-promoting effects on the cardiovascular system. The performed meta-analyses allow to confirm such an impact, however, after the assessment with the use of the SYRCLE’s tool, these studies are burdened with a high risk of bias, and the results are not clearly presented. Despite numerous articles and clinical studies, the convincing beneficial mechanisms of resveratrol as well as its health-promoting effects in cardiovascular diseases have not been clearly confirmed in humans. Therefore, there is a need for further clinical studies, especially randomized, double-blind, placebo-controlled trials to objectively confirm the possible health-promoting effects of this substance and to determine both the efficacy and safety, and possible therapeutic potential.

Atrioventricular conduction disturbances in patients with sinoatrial node disease and atrial pacing.

Abstract: In sinoatrial node disease (SND) atrial pacing may be limited by progression of AV block. The incidence of AV block after AAI systems implantation range, according to various authors, from 0% to 12%. The aim of this study was to examine the AV conduction disturbances that forced a change in the mode of pacing in patients with AAI pacemakers. The information was collected retrospectively from a cohort of 122 patients. The follow-up period ranged from 5 to 83 months (mean = 35). Among these patients there were 37 with sinus bradycardia and 85 with bradycardia-tachycardia syndrome. Their mean age was 63 years. Before AAI pacemaker insertion, all patients had normal AV conduction on 12-lead ECG, and all but five had a Wenckebach cycle length shorter than 500 msec. Seven out of these 122 patients (5.7%) developed symptomatic conduction disturbances (second-degree type I AV block in five, second degree type II AV block in one, and third-degree AV block in one), necessitating a change from AAI to another mode of pacing. We conclude that progression of AV block after atrial pacemaker implantation in patients with SND is infrequent and mild in the majority of cases. Intraventricular disturbances such as left anterior hemiblock represent contraindication to AAI pacing particularly in patients who may be in need of antiarrhythmic drugs.

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.

Jak oceniać remodeling tętnic wieńcowych? Kryteria wyboru przekrojów referencyjnych

Abstract: Wstep: Rozwoj miazdzycy w tetnicach wiencowych powoduje przebudowe ich ściany (remodeling). Najlepszą przyzyciową metodą badania remodelingu tetnic wiencowych jest ultrasonografia wewnątrznaczyniowa (IVUS, intravascular ultrasound). Ocena remodelingu za pomocą IVUS polega na porownaniu wielkości przekroju poprzecznego przez tetnice w miejscu rozwoju blaszki miazdzycowej oraz w przekroju referencyjnym. Uogolniony charakter miazdzycy czesto uniemozliwia znalezienie przekrojow referencyjnych calkowicie wolnych od zmian miazdzycowych. Cel pracy: Ustalenie maksymalnej dopuszczalnej wielkości blaszki miazdzycowej w przekrojach odniesienia do badania remodelingu. Material i metody: Przeanalizowano zapisy IVUS wykonane u 38 pacjentow zakwalifikowanych do przezskornej rewaskularyzacji serca przed przystąpieniem do interwencji. W obrebie kazdego z wyodrebnionych 137 segmentow tetnic wiencowych porownywano przekroj w miejscu maksymalnego zwezenia i przekroj refererencyjny z najmniejszą blaszką miazdzycową. Aby wyznaczyc dopuszczalną wielkośc blaszki w przekroju referencyjnym, przeprowadzono analize parametrow określających remodeling w zalezności od wielkości blaszki miazdzycowej w przekroju odniesienia. Wyniki: Przekroje referencyjne calkowicie wolne od zmian miazdzycowych znaleziono zaledwie w 16% badanych segmentow tetnic. Wyniki oceny remodelingu wzgledem przekrojow odniesienia z blaszką miazdzycową nie zmienialy sie w porownaniu z wynikami oceny wzgledem przekrojow calkowicie wolnych od zmian miazdzycowych az do osiągniecia przez blaszke wielkości 35% pola powierzchni przekroju tetnicy. Średnia wielkośc blaszki w przedziale 0–35% wynosila 18% ± 12%. Wnioski: Aby zachowac wiarygodnośc oceny remodelingu, wzgledna wielkośc blaszki miazdzycowej w przekrojach referencyjnych nie powinna przekraczac 35%. Wykorzystanie do analizy remodelingu przekrojow odniesienia z wiekszą blaszką moze byc przyczyną powaznych bledow. (Folia Cardiol. 2001; 8: 181–195)

Collapsible prosthetic heart valves

Abstract: Prosthetic heart valves, which are collapsible to a relatively small circumferential size for less invasive delivery into a patient and which then re-expand to operating size at an implant site in the patient, include a collapsible/expandable stent-like supporting structure and various components of flexible, sheet-like material that are attached to the supporting structure. For example, these sheet-like other components may include prosthetic valve leaflets, layers of buffering material, cuff material, etc. Improved structures and techniques are provided for securing such other components to the stent-like supporting structure of the valve.

Collapsible and re-expandable prosthetic heart valve cuff designs and complementary technological applications

Abstract: A prosthetic heart valve is provided with a cuff having features which promote sealing with the native tissues even where the native tissues are irregular. The cuff may include a portion adapted to bear on the LVOT when the valve is implanted in a native aortic valve. The valve may include elements for biasing the cuff outwardly with respect to the stent body when the stent body is in an expanded condition. The cuff may have portions of different thickness distributed around the circumference of the valve in a pattern matching the shape of the opening defined by the native tissue. All or part of the cuff may be movable relative to the stent during implantation.

Complications related to permanent pacemaker therapy.

Abstract: This study evaluates complications related to permanent endocardial pacing in the era of modern pacemaker therapy. There is only limited information available about the complications related to modern cardiac pacing. Most of the existing data are based on the 1970s and are no longer valid for current practice. The recent reports on pacemaker complications are focused on some specific complication or are restricted to early complications. Thus, there are no reports available providing a comprehensive view of complications related to modern cardiac pacing. Four hundred forty-six patients, who received permanent endocardial pacemakers between January 1990 and December 1995 at Kuopio University Hospital, were reviewed retrospectively using patient records. Attention was paid to the occurrence of any complication during the implantation or follow-up. An early complication was detected in 6.7%, and 4.9% of patients were treated invasively due to the early complication. Late complication developed in 7.2% and reoperation was required in 6.3% of the patients. Complications related to the implantation procedure occurred in 3.1%. Inadequate capture or sensing was observed in 7.4% of the patients. Pacemaker infection was detected in 1.8% and erosion in 0.9% of the patients. An AV block developed in 3.6% (1.6%/year) patients who received an AAI(R)-pacemaker due to sick sinus syndrome. There was no mortality attributable to pacemaker therapy. A great majority (68%) of the complications occurred within the first 3 months after the implantation. Complications associated to modern permanent endocardial pacemaker therapy are not in-frequent.Elevan percent of patients needed an invasive procedure due to an early or late complication.

Stent features for collapsible prosthetic heart valves

Abstract: A prosthetic heart valve includes a stent having an expanded condition and a collapsed condition The stent includes a plurality of distal cells, a plurality of proximal cells, a plurality of support struts coupling the proximal cells to the distal cells, and at least one support post connected to a plurality of proximal cells The proximal cells are longitudinally spaced apart from the distal cells Various strut configurations and connections of the struts to the proximal cells and of the proximal cells to the support post improve stent flexibility and reduce stress in the valve leaflets

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。