AimTo evaluate predictors of asymptomatic atrial fibrillation in patients older than 70 years with complete atrioventricular (AV) block, normal left ventricular systolic function, and implanted dual chamber (DDD) pacemaker.MethodsHundred and eighty six patients with complete AV block were admitted over one year to the Sisters of Mercy University Hospital. The study recruited patients older than 70 years, with no history of atrial fibrillation, heart failure, or reduced left ventricular systolic function. All the patients were implanted with the same pacemaker. Out of 103 patients who were eligible for the study, 81 (78%) were evaluated. Follow-up time ranged from 12 to 33 months (average±standard deviation 23 ± 5 months). Primary end-point was asymptomatic atrial fibrillation occurrence recorded by the pacemaker. Atrial fibrillation occurrence was defined as atrial high rate episodes (AHRE) lasting >5 minutes. Binary logistic regression was used to identify the predictors of development of asymptomatic atrial fibrillation.ResultsThe 81 patients were stratified into two groups depending on the presence of AHRE lasting >5 minutes (group 1 had AHRE>5 minutes and group 2 AHRE<5 minutes). AHRE lasting >5 minutes were detected in 49 (60%) patients after 3 months and in 53 (65%) patients after 18 moths. After 3 months, only hypertension (odds ratio [OR], 17.63; P = 0.020) was identified as a predictor of asymptomatic atrial fibrillation. After 18 months, hypertension (OR, 14.0; P = 0.036), P wave duration >100 ms in 12 lead ECG (OR, 16.5; P = 0.001), and intracardial atrial electrogram signal amplitude >4 mV (OR, 4.27; P = 0.045) were identified as predictors of atrial fibrillation.ConclusionIn our study population, hypertension was the most robust and constant predictor of asymptomatic atrial fibrillation after 3 months, while P wave duration >100 ms in 12-lead ECG and intracardial atrial signal amplitude were predictors after 18 months.

Background: Persistent left superior vena cava (LSVC) is a rare congenital venous anomaly that may be found at the time of cardiac device lead insertion.

In patients with chronic BBB and syncope, a nonfunctional infrashisal AV block induced by incremental atrial pacing identified patients with particularly high risk of development of spontaneous infrahisal AV block. Therefore, permanent cardiac pacing is absolutely indicated in these patients.

In patients with second- or third-degree AV block and DDD pacemaker, the development of persistent AF is associated with an increased risk of cardiovascular death and heart failure.

AimTo assess the efficacy of propafenone in prevention of atrioventricular nodal reentrant tachycardia (AVNRT) and orthodromic atrioventricular tachycardia (AVRT) based on the clinical results of arrhythmia recurrence and find the electrophysiological predictor of propafenone effectiveness.MethodsThis retrospective study included 44 participants in a 12-month period, who were divided in two groups: group A – in which propafenone caused complete ventriculo-atrial block and group B – in which propafenone did not cause complete ventriculo-atrial block.ResultsGroup A had significantly lower incidence of tachycardia than group B (95% vs 70.8%, P = 0.038), and complete ventriculo-atrial block predicted the efficacy of propafenone oral therapy in the prevention of tachycardia (sensitivity 87.5%, specificity 52.8%, positive predictive value 95%, negative predictive value 29.2%). Patients with AVNRT in group B who did not experience the recurrences of tachycardia had significantly shorter echo zone before intravenous administration of propafenone than the patients who experienced episodes of sustained tachycardia (median 40 ms [range 15-60 ms] vs 79 ms [range 50-180 ms], P = 0.008).ConclusionIn patients with non-inducible tachycardia, complete ventriculo-atrial block can be used as an electrophysiological predictor of the efficacy of propafenone oral therapy in the prevention of tachycardia. In patients with non-inducible AVNRT, but without complete ventriculo-atrial block, propafenone was more effective in patients with shorter echo zone of tachycardia.

Fibrilacija atrija u bolesnika s resinkronizacijskom terapijom srca: terapijske mogućnosti Atrial Fibrillation in Patients with Cardiac Resynchronization Therapy: Therapeutic Options SAŽETAK: Fibrilacija atrija (FA) često je prisutna u bolesnika s resinkronizacijskom terapijom srca (CRT) i može imati znatan negativan utjecaj na prognozu i odgovor na CRT. Liječenje FA-a u bolesnika s CRT-om uključuje optimalnu medikamentu terapiju za zatajivanje srca, antikoagulantnu terapiju i terapiju za kontrolu frekvencije ili kontrolu ritma sa specifičnim ciljem da se osigura visoki postotak (≥98 %) biventrikularne (BiV) stimulacije. U bolesnika sa zatajivanjem srca i FA-om, kontrola ritma antiaritmičnim lijekovima nije uspjela pokazati nikakvu dobit u preživljenju u usporedbi s lijekovima za kontrolu frekvencije. U tom kontekstu kontrola frekvencije lijekovima preferira se kao prvi izbor liječenja u bolesnika s CRT-om i perzistentnom ili trajnom FA. Međutim, opservacijske prospektivne studije i metaanalize pokazuju da je ablacija AV spoja bolja od lijekova za kontrolu frekvencije u postizanju visokog postotka BiV stimulacije i smanjenju smrtnosti. Zbog toga ablacija AV spoja može biti prvi izbor liječenja u bolesnika s CRT-om i trajnom FA. Amiodaron i dofetilid jedini su antiaritmici pogodni za kontrolu ritma u bolesnika s CRT-om, ali uz umjerenu učinkovitost i znatne nuspojave. Kateterska ablacija FA-a drugi je mogući izbor za kontrolu ritma u bolesnika sa CRT-om, jer poboljšava odgovor na CRT pospješujući atrioventrikularnu i interventrikularnu sinkroniju. Prema rezultatima randomiziranih kontroliranih studija u bolesnika sa zatajivanjem srca, ablacija FA može se uzeti u obzir u bolesnika s CRT-om i paroksizmalnom FA, koji ne reagiraju na antiaritmične lijekove, kao i u odabranih bolesnika s perzistentnom FA prije nego što se prihvati terapija za kontrolu frekvencije. SUMMARY:Atrial fibrillation (AF) is often present in patients with cardiac resynchronization therapy (CRT), and may have a significant negative impact on the prognosis and CRT response. Management of AF in CRT patients includes the optimal pharmacological heart failure therapy, anticoagulation therapy, and rate or rhythm control therapy with specific goal to ensure a high percentage (≥98%) of biventricular (BiV) pacing. In heart failure patients with AF, a rhythm control with antiarrhythmic drugs has failed to show any survival benefit compared with a rate control drugs. In this context, a rate control with drugs is preferred as first-line therapy in CRT patients with persistent or permanent AF. However, the observational prospective studies and meta-analyses indicate that AV junction ablation is superior to rate control drugs in achieving adequate BiV pacing and reducing mortality. Therefore, an ablation of AV junction should be considered as the first therapeutic choice in CRT patients with permanent AF. Amiodarone and dofetilide are the lone antiarrhythmic drugs suitable for the rhythm control in CRT patients, but with a moderate efficacy and significant ...

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Bundle branch reentrant ventricular tachycardia (BBRVT) has a suitable anatomic substrate for radiofrequency catheter ablation. However, the experience with this treatment is still small. In the current study, we examined the safety and the long-term efficacy of radiofrequency ablation in the cure of patients with BBRVT. Four patients with BBRVT, identified during electrophysiological study, underwent temperature-controlled radiofrequency ablation of the right bundle branch (RBB). All of them had syncope and structural heart disease with reduced left ventricular ejection fraction. The baseline examination revealed an intraventricular block, prolonged HV interval and inducible sustained VT because of bundle branch reentry in all patients. RBB was successfully abolished in all patients after the delivery of 3 +/- 1 radiofrequency pulses. After ablation, a permanent pacemaker was implanted in one patient with significantly prolonged HV interval. All patients were free of BBRVT during a mean follow-up of 20 months. One patient received implantable cardioverter-defibrillator for myocardial VT five months after ablation. Two patients developed congestive heart failure. Radiofrequency catheter ablation of the RBB is a safe and highly effective therapeutic procedure for definitive cure of BBRVT. Long-term prognosis of these patients depends mainly on the underlying heart disease and the treatment of other VT.