LAA closure with the LARIAT device can be performed effectively with acceptably low access complications and periprocedural adverse events in this observational study.

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IntroductionHeart perforation is a rare complication of pacemaker (PM)/implantable cardioverter-defibrillator (ICD) implantation.Material and methodsIn our clinic in 2005–2010, 6 patients with heart perforation were hospitalized (3 women, 3 men), mean age 58.6 ±20.8 years (17 to 73 years). The indication to PM/ICD implantation was tachy-brady syndrome in 3 cases, second-degree atrioventricular block, advanced with losses of consciousness, vaso-vagal syndrome type II B with asystole lasting 12 s and recurrent non-sustained ventricular tachycardia in 1 patient. We analyzed patient's medical records, X-rays, echocardiography, computed tomography (CT) and procedure protocols.ResultsThe incidence of heart perforation was 0.09%. Symptoms developed 4 to 990 days (mean 186.3 ±394.3) after PM/ICD implantation. The perforation site was found in the right atrial wall in 1 cases and the right ventricular wall in 6 cases. The TTE revealed an accumulation of fluid in the pericardium over 10 mm behind the posterior wall of the left ventricle in all patients. The CT scan confirmed perforation of the heart chambers (atrium and in 6 cases ventricle). In 5 cases the whole device was removed by direct traction or percutaneous lead extraction with pericardiocentesis when necessary (pericardium drainage in 3 cases) while in 1 case cardiac surgery was needed.ConclusionsThe perforating lead may be removed by direct traction in the operating room with cardiosurgical, anesthesiological and echocardiographical backup. In case of the lead perforation outside the pericardial sac or its atypical location, cardiac surgery is a safer method. The most important diagnostic method remains computed tomography.

Background and AimsHigher levels of stress impact the prevalence of metabolic syndrome (MetS) and coronary heart disease. The association between MetS, impaired pulmonary function and low level of physical activity is still pending assessment in the subjects exposed to stress. The study aimed to examine whether higher levels of stress might be related to MetS and the plaque presence, as well as whether MetS might affect pulmonary function.Design and MethodsThe study embraced 235 police officers (mean age 40.97 years) from the south of Poland. The anthropometrics and biochemical variables were measured; MetS was diagnosed using the International Diabetes Federation criteria. Computed tomography coronary angiography of coronary arteries, exercise ECG, measurements of brachial flow-mediated dilation, and carotid artery intima-media thickness were completed. In order to measure the self-perception of stress, 10-item Perceived Stress Scale (PSS-10) was applied. Pulmonary function and physical activity levels were also addressed. Multivariate logistic regression analyses were applied to determine the relationships between: 1/ incidence of coronary plaque and MetS per se, MetS components and the number of classical cardiovascular risk factors, 2/ perceived stress and MetS, 3/ MetS and pulmonary function parameters.ResultsCoronary artery atherosclerosis was less associated with MetS (OR = 2.62, 95%CI 1.24–5.52; p = 0.011) than with a co-existence of classical cardiovascular risk factors (OR = 5.67, 95% CI 1.07–29.85, p = 0.03; for 3 risk factors and OR = 9.05; 95% CI 1.24–66.23, p = 0.02; for 6 risk factors, respectively). Perceived stress increased MetS prevalence (OR = 1.07, 95% CI 1.03–1.13; p = 0.03), and impacted coronary plaque prevalence (OR = 1.05, 95% CI 1.001–1.10; p = 0.04). Leisure-time physical activity reduced the chances of developing MetS (OR = 0.98 95% CI 0.96–0.99; p = 0.02). MetS subjects had significantly lower values of certain pulmonary function parameters.ConclusionsExposure to job-specific stress among police officers increased the prevalence of MetS and impacted coronary plaque presence. MetS subjects had worse pulmonary function parameters. Early-stage, comprehensive therapeutic intervention may reduce overall risk of cardiovascular events and prevent pulmonary function impairment in this specific occupational population.

Aims:A novel therapy offering cardiac resynchronization therapy (CRT) with an additional lead placed in His bundle has been reported in a few case reports and case series as improving the hemodynamical and clinical condition of patients with permanent atrial fibrillation (AF) in whom other therapeutic methods have not been successful. Methods:Fourteen consecutive patients with permanent AF, heart failure (HF), bundle branch block (BBB) with QRS complex width >130 ms, and impaired left ventricular ejection fraction (LVEF) underwent implantation of implantable cardioverter defibrillator (ICD)/CRT systems with His bundle pacing (HBP). During the follow-up, we assessed the efficacy of ICD/CRT systems with HBP in HF treatment. Results:The study cohort consisted of 14 patients with the mean age of 67.35 ± 10 years. The mean duration of QRS was 159.2 ± 28.6 ms, mean LVEF was 24.36 ± 10.7%, and mean follow-up duration was 14.4 months. One patient died due to HF aggravation during the follow-up. In the remaining 13 patients, the mean LVEF significantly improved from 24% to 38%, P = 0.0015. The left ventricular end-diastolic dimension decreased from 72 mm to 59 mm, P < 0.001; left ventricular end-systolic dimension decreased from 59 mm to 47 mm, P = 0.0026. The mean QRS duration shortened from 159 ms to 128 ms, P = 0.016. The mean percentage of HBP reached 97%. As a result, 92.3% of patients demonstrated significant improvement in the New York Heart Association functional class, P < 0.001. Conclusion:The use of atrial channel for HBP, choice of optimal ICD/CRT pacing configuration, and optimization of pharmacological therapy resulted in a substantial narrowing of QRS width and clinical improvement in left ventricular mechanical function during the follow-up. K E Y W O R D Satrial fibrillation, bundle branch block, cardiac resynchronization therapy, His bundle pacing, pacemaker 1 BACKGROUND Cardiac resynchronization therapy (CRT) is an acknowledged therapeutic choice for patients with sinus rhythm, congestive heart failure (HF) in the New York Heart Association (NYHA) class II-IV, wide QRS > 130 ms, and reduced left ventricular ejection fraction (LVEF) ≤35%, who remain symptomatic despite optimal medical therapy. 1,2 CRT in patients with permanent atrial fibrillation (AF) is usually less effective compared to patients in sinus rhythm. 1-3 The reasons for a less favorable response to CRT in that population are complex. 4 The greatest magnitude of benefit from CRT tends to be observed in those who are paced at >98% of the time.The findings from the RAFT-AF study showed that it was challenging to achieve the appropriate target of biventricular pacing in patients with permanent AF to the extent that only one-third of the study population reached nearly 100% pacing. 5 Irregular and fast ventricular response in AF induces changes in the myocardium referred to as a tachycardiomyopathy 6 and is increasing the risk of inappropriate therapies from implantable cardioverter defibrillator (ICD). 7 Additionally, patients with CRT derive ...

These preliminary data demonstrate that substernal defibrillation is feasible and successful defibrillation can be achieved with the shock energy available in current transvenous ICDs. This may open new alternatives to extravascular ICD therapy.

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Objective The aim of this study was to evaluate the incidence of venous stenosis and occlusion (VSO) in patients referred for transvenous lead extraction (TLE) with regard to the indications for this treatment and to analyse the influence of VSO on efficacy, complications and technical challenges of TLE procedures. Methods The material consists of 133 consecutive TLE procedure records. The contrast venography examination of the ipsilateral access vein was performed prior to the operation. The whole study population was divided into two subgroups, based on the presence (subgroup I) or absence (subgroup II) of VSO. Results Phlebography was performed in 133 patients with age ranging from 25.7 to 86.1 years, 44 female (33.1%). The VSO was confirmed in 48 (36.1%) patients - subgroup I. Most of the patients were referred to TLE due to non-infectious reasons (100 pts-75.2%). The absence of VSO was observed substantially more frequently in patients with diabetes (P = 0.02). Procedural success rate reached 93.3% in subgroup I and 98.8% in subgroup II (P = 0.1). There was no significant difference in the use of advanced tools and alternative access sites. Conclusion The presence of VSO can be expected in one third of patients referred for lead extraction. There is no association between indication for TLE (infected or noninfected lead extraction) and the incidence of VSO. Diabetes proved to have a protective effect on venous patency in the previously mentioned group. VSO does not influence the effectiveness, safety, and the use of additional tools during TLE procedures.