BackgroundCryoballoon‐based pulmonary vein isolation (CB‐PVI) has been widely used for the treatment of atrial fibrillation. Although generally safe and effective, the procedure may be associated with pulmonary vein (PV) stenosis and bronchial or esophageal injury. The mechanisms leading to these complications have not been studied in detail. Our aim was to examine acute effects of cryoballoon on the pulmonary vessel and right heart pressures as well as PV wall morphology.Methods and ResultsIn 8 patients (5 men, mean age 55±14 years) undergoing CB‐PVI, pressure in each PV was measured by catheter located inside the PV directly before and after CB‐PVI. The right atrial, right ventricular, and pulmonary artery pressures as well as pulmonary arterial wedge capillary pressure in the pulmonary artery branch corresponding to target PV were also measured. Morphological changes in PVs were assessed using intravascular ultrasonography.There were no significant differences in PV pressures before and after ablation. The pulmonary arterial wedge capillary pressure significantly increased during cryoapplication (left superior: 20±10 versus 29±8.5 mm Hg, P=0.004; left inferior: 24±10 versus 32±6 mm Hg, P=0.012; right superior: 25±9 versus 35±10 mm Hg, P=0.002; right inferior: 24±10 versus 37±12 mm Hg, P=0.0036). The right atrial and pulmonary artery pressures increased significantly after CB‐PVI (9±6 versus 13±8 mm Hg, P=0.004, and 20±9 versus 24±10 mm Hg, P=0.048, respectively). Intravascular ultrasonography showed acute edema and dissection‐like changes causing relative lumen narrowing in 90% of PVs.Conclusions CB‐PVI causes significant rise in pulmonary artery and right atrial pressures as well as PV wall damage. The clinical significance of these findings warrants further investigations.
Study design: A cross-sectional study with comparison group. Objectives: To examine the effect of rugby training on the blood antioxidant capacity in able-bodied and wheelchair rugby players with tetraplegia. Setting: Poland. Methods: Four groups of subjects participated in the study: sedentary able-bodied males (group SA, n¼19), sedentary males with tetraplegia (group ST, n¼10), able-bodied rugby players (group RA, n¼22) and wheelchair rugby players with tetraplegia (group RT, n¼14). The activities of superoxide dismutase (SOD), glutathione reductase (GR) and catalase (CAT) were determined in erythrocyte hemolysates, whereas glutathione peroxidase (GPX) activity was determined in whole-blood hemolysates. Concentrations of total antioxidant status (TAS) was determined in plasma. Results: SOD activity was significantly higher in the group SA compared with group ST and group RA. No significant differences occurred within the tetraplegic groups: RT and ST. Resting CAT and GPX activities were significantly higher in both the groups of rugby players than in the respective group of sedentary males. There were no differences in GR activity among all the studied groups. Plasma TAS concentration was higher in both the groups of able-bodied males compared with the respective groups of tetraplegics. The present study is the first to conduct an evaluation of wheelchair rugby training-induced adaptations to oxidative stress in individuals with tetraplegia. Conclusion: Adaptive response to training was similar in both able-bodied and wheelchair rugby players, and it was characterized by increased erythrocyte CAT and GPX activities in resting conditions improving resistance to oxidative stress.
A case of a 55-year-old woman with psoriasis and long-lasting history of typical intermittent claudication associated with frequent premature ventricular complexes is reported. Atherosclerotic and nonarterial pathologic conditions were taken into consideration and were excluded. Applying 6-minute walk test and resting and peak-exercise pulsed Doppler ultrasonography, it was possible to prove a decrease in perfusion during exercise-persistent ventricular bigeminy. Rapid improvement in symptoms was observed after a single dose of propafenone; however, it led to a worsening of psoriasis. The patient was referred for radiofrequency ablation. Radiofrequency ablation in the right ventricular outflow tract resulted in complete abolition of premature ventricular complexes and intermittent claudication. The patient remained free of claudication and symptoms related to arrhythmia with an ability to walk more than 5 km, without stopping. Relief of symptoms may be achieved by antiarrhythmic treatment; however, side effects of antiarrhythmic drugs or their ineffectiveness should encourage the use of radiofrequency ablation.
IntroductIon Atherosclerosis related to cardiovascular disease (CVD) is the most common cause of death worldwide. Moreover, hypercholesterolemia is considered as one of the main cardiovascular risk factors related to atherosclerosis.1 It is known that lowering cholesterol levels significantly reduces total mortality and deaths from CVD in primary and secondary prevention. ABstrActIntroductIon Endothelial dysfunction is one of the markers of atherosclerosis. oBjectIves The aim of the study was to evaluate endothelial function by assessing flow-mediated dilation (FMD) and to measure the parameters of brachial arterial stiffness in patients with familial hypercholesterolemia (FH) and those with high low-density lipoprotein (LDL) cholesterol levels without FH mutations (nonfamilial hypercholesterolemia -non-FH). PAtIents And methodsThe study involved 60 patients (mean age, 41.9 ±7.7 y) without documented cardiovascular events and clinical symptoms of cardiovascular diseases: 21 patients with elevated plasma LDL cholesterol levels and genetically confirmed FH, 19 patients with elevated LDL cholesterol levels and without FH mutations, and 20 healthy controls. In each patient, ultrasound imaging was used to assess endothelium-dependent FMD and nitroglycerin-induced endothelium-independent dilation (EID) in the brachial artery. In addition, echo-tracking and photoplethysmography were used to assess the parameters of arterial stiffness.results FMD was significantly lower in patients with FH (11.0% ±9.9% vs. 21.0% ±14.3%, P <0.01) and non-FH (14.2% ±10.1% vs. 21.0% ±14.3%, P <0.05) compared with controls. EID and arterial stiffness parameters were similar between the groups.conclusIons Reduced FMD may suggest endothelial dysfunction. A lack of significant differences in arterial stiffness parameters may indicate that vascular remodeling is not advanced in patients with elevated LDL cholesterol levels. A lack of significant differences in FMD and arterial stiffness between patients with and without FH may indicate that FH mutation itself is not the main determinant of endothelial dysfunction and vascular remodeling in younger patients with hypercholesterolemia.
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