Clinical success rates of PV isolation are similar when using multipolar circular PV ablation catheter and point-by-point ablation with a three-dimensional (3D) navigation system in patients with PAF, and results in shorter procedural and fluoroscopic times with a comparable safety profile.

The effect of three-day fasting on cardiac ischemic tolerance was investigated in adult male Wistar rats. Anesthetized open-chest animals (pentobarbitone 60 mg/kg, i.p.) were subjected to 20-min left anterior descending coronary artery occlusion and 3-h reperfusion for infarct size determination. Ventricular arrhythmias were monitored during ischemia and at the beginning (3 min) of reperfusion. Myocardial concentrations of beta-hydroxybutyrate and acetoacetate were measured to assess mitochondrial redox state. Short-term fasting limited the infarct size (48.5±3.3 % of the area at risk) compared to controls (74.3±2.2 %) and reduced the total number of premature ventricular complexes (12.5±5.8) compared to controls (194.9±21.9) as well as the duration of ventricular tachycardia (0.6±0.4 s vs. 18.8±2.5 s) occurring at early reperfusion. Additionally, fasting increased the concentration of beta-hydroxybutyrate and beta-hydroxybutyrate/acetoacetate ratio (87.8±27.0) compared to controls (7.9±1.7), reflecting altered mitochondrial redox state. It is concluded that three-day fasting effectively protected rat hearts against major endpoints of acute I/R injury. Further studies are needed to find out whether these beneficial effects can be linked to altered mitochondrial redox state resulting from increased ketogenesis.

Hypoxic pulmonary vasoconstriction (HPV), an important physiological mechanism, is regulated by changes in the production of and interactions among reactive oxygen species (ROS).There is controversy, however, over whether HPV is mediated by an increase or a decrease in ROS production. Also, the role of NO in HPV remains unclear. The aim of this study was to investigate whether the inhibition of HPV by the antioxidant tempol was dependent on the concentration of NO, and how its effect was influenced by increased basal pulmonary vascular tone. In isolated rat lungs, we measured vasoconstrictor responses to acute ventilatory hypoxia before and after administration of tempol during perfusion with or without L-NAME. We found that tempol abolished HPV independently of NO production. When we increased basal vascular tone by K + -induced depolarization, we also found that tempol completely inhibited HPV. Our results indicate that inhibition of HPV by the superoxide dismutase mimetic tempol does not depend on either NO production or a decrease in basal vascular tone. Hypoxic pulmonary vasoconstriction (HPV) reduces blood flow to poorly ventilated areas of the lung in favour of perfusion of better ventilated regions. It optimizes lung ventilation/perfusion ratio and consequently also the oxygenation of arterial blood. As a local regulatory mechanism, HPV is fast in onset and readily reversible upon reoxygenation.The presence and intensity of HPV depends on interactions between reactive oxygen species (ROS) and NO produced in pulmonary arteries. It has been demonstrated that acute ventilatory hypoxia causes changes in production of superoxide via mitochondrial electron transport chain or NADPH oxidase activity (Marshall et al. 1996;Liu et al. 2006). Administration of superoxide dismutase (SOD) or of a non-selective NADPH oxidase inhibitor, diphenyleneiodonium, significantly attenuated HPV (Thompson et al. 1998;Liu et al. 2003). Lung hypoxia stimulates NO production, and inhibitors of NO synthesis potentiate HPV (for review see Hampl & Herget, 2000). In the presence of NO, superoxide anion rapidly forms peroxynitrite, which also causes pulmonary vasoconstriction (Belik et al. 2004). This reaction is almost 10 times faster than the removal of superoxide anion by SOD. As a result of this, superoxide has a direct effect on NO concentration. Therefore, scavenging superoxide may enhance NO activity and prevent peroxynitrite formation, leading to inhibition of HPV. In contrast, superoxide scavenging might have a direct effect on HPV by reducing the concentration of a mediator reactive oxygen species.Thus, the purpose of this study was to test, in isolated, physiological saline-perfused lungs, whether HPV is modulated mainly by superoxide production, independently of NO synthesis, or by a product of superoxide-NO interaction. For this purpose, we used the intracellularly acting ROS scavenger tempol (4-hydroxyl-2,2,6,6-tetramethylpiperidine-N -oxyl) and the NO synthesis inhibitor l-NAME.The vasoconstrictor response to acute ventila...

Úvod: Telemedicínské sledování pacientů s implantabilními kardiovertery-defi brilátory (ICD) je dnes obecně považováno za bezpečnější, účinnější a ekonomicky výhodnější. Cílem práce bylo posoudit dlouhodobý ekonomický přínos dálkového sledování pacientů s nově implantovaným ICD za pomocí systému Home Monitoring ™ (HM) ve srovnání se standardní ambulantní péčí v podmínkách ČR. Metody: Pacienti byli randomizováni k dálkovému sledování systémem HM s denními automatickými přenosy dat a ambulantní kontrolou v intervalu 12 měsíců (HM+) nebo ke standardním ambulantním kontrolám (HM-). Stanovení nákladů bylo provedeno na základě účtů zdravotních pojišťoven, přímých nákladů pacientů a provozních nákladů systému HM jako průměrně vynaložené na jednoho pacienta a měsíc sledování. Výsledky: Sledováno bylo celkem 198 pacientů po dobu v průměru 37,4 ± 15,2 měsíce. Ve skupině HM+ byl za dobu sledování redukován počet plánovaných kontrol o 48 % (p < 0,001). Ve skupině HM+ byla zaznamenána významně kratší délka hospitalizace. Nákladová data byla získána celkem u 75 % pacientů. Ve skupině HM-byly zaznamenány vyšší náklady za ambulantní péči (223 ± 99 Kč vs. 189 ± 93 Kč, p = 0,039) i transport zdravotní dopravní službou (640 ± 314 Kč vs. 367 ± 187 Kč, p = 0,003). Při započtení nákladů na provoz systému HM k ambulantní péči a přepravě nebyl rozdíl mezi skupinami signifi kantní, ale pokud byla do nákladů promítnuta také úhrada výkonu dálkové monitorace a pořízení domácí pacientské jednotky, byl již průměrný náklad vyšší pro skupinu HM+ (541 ± 188 Kč vs. 401 ± 332 Kč, p = 0,002). Nákladově neutrální by v takovém případě zůstal za předpokladu hrazené přepravy všech pacientů k ambulantním kontrolám. Závěr: Systém HM byl dosud v ČR u pacientů s jedno-nebo dvoudutinovými ICD z hlediska vynaložených výdajů nákladově výhodný pro zdravotní pojišťovny. Při kalkulaci této úhrady na vrub plátců zdravotní péče by systém HM zachoval nákladovou neutralitu pouze v případě hrazené přepravy většiny pacientů. Klinický prospěch dálkové monitorace bezprostředně plyne z kontinuity sledování, možnosti velmi časné detekce událostí a patřičné lékařské intervence, proto se domníváme, že systém HM by měl být hrazen automaticky u všech pacientů s implantovaným ICD, byť za cenu v kontextu celého zdravotnického rozpočtu nevýznamného navýšení nákladů.

BackgroundWe are presenting a case report on an unreported and unusual cutaneous manifestation of chronic lymphocytic leukemia in a patient with an implantable cardioverter-defibrillator (ICD).Case presentationA 65-year-old man with a history of chronic lymphocytic leukemia (CLL), previously treated with chlorambucil, was referred in October 2013 for extraction of a single chamber ICD due to a suspected device-related infection in the pulse generator area (left-hand side of Fig. 1). The ICD system (Current VR, St. Jude Medical, USA) had been implanted in November 2009. The patient complained of painless erythema with pruritus in the pocket area. Inflammatory blood parameters were C-reactive protein 17.3 mg/L and leucocytes 29.0 × 109/L. Due to the atypical appearance of the pocket area we did not extract the device. Instead, we created an exploratory excision in the skin induration, which had been present for approximately 6 weeks, and conducted a microbiological and histological examination. All cultivation examinations were negative. However, we did histologically show skin infiltration by CD-5 positive low-grade B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma (B-CLL/SLL). Re-initiation of chemotherapy was not necessary and the skin induration completely disappeared within 2 months (right-hand side of Fig. 1).ConclusionsComplete removal of an ICD system carries considerable risk. In patients with a history of hematological disease, it is crucial to exclude cutaneous manifestations of the disease prior to device removal.