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Sághy L, Zsigmond EJ, Benák A, Makai A, Miklós M, Klausz G, Vámos M. [Transvenous lead extraction at the University of Szeged: 10-year experience]. Orv Hetil 2023; 164:1954-1964. [PMID: 38071649 DOI: 10.1556/650.2023.32893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/16/2023] [Indexed: 12/18/2023]
Abstract
Bevezetés: A cardialis implantálható elektromos eszközökhöz
kapcsolódó egyes komplikációk időnként részleges vagy teljes
rendszereltávolítást, azaz transzvénás elektróda extrakciót igényelnek. A
beavatkozások komplexitására és kimenetelére vonatkozó megfigyelések nemzetközi
regiszterekből származnak, a kezelt betegcsoportok jellemzői azonban jelentős
eltéréseket mutatnak. Célkitűzés: Az intézetünkben 2012 óta
szisztematikusan működő extrakciós program eredményeinek összefoglalása és
nemzetközi adatokkal való összehasonlítása. Módszerek:
Retrospektív módon elemeztük a 2012 és 2022 között extrakcióban részesült
betegek klinikai jellemzőit, a beavatkozások indikációit, technikáit és
kimenetelét, összevetve ezeket a legnagyobb átfogó európai regiszter (ELECTRa)
adataival. Vizsgáltuk továbbá a sikerarányt a „lépcsőzetes eszközbevetés”
különböző szintjein. Eredmények: A vizsgálatba 200 beteget (65
± 14,3 év, 74,5% férfi) vontunk be. Az extrakció indikációja dominálóan infekció
volt, melynek aránya jóval meghaladta az ELECTRa-ban közöltet (87,5%
vs. 52,8%, p<0,001). Az elektródák implantációs ideje
szintén magasabb tendenciát mutatott tanulmányunkban (7,8 ± 6,2
vs. 6,4 ± 5,4 év), továbbá a passzív fixációs elektródák
száma is szignifikánsan nagyobbnak bizonyult (62,2% vs. 46,6%,
p<0,001). Betegeink egyötöde előzőleg már átesett egy sikertelen extrakciós
kísérleten. A beavatkozások alatt nagyobb arányban volt szükség „locking
styletek” (81,9% vs. 71,1%, p<0,001) és aktív extrakciós
hüvelyek (71,8% vs. 27,1%, p<0,001) használatára. Major
komplikáció 4,5%-ban, beavatkozáshoz köthető halál 4 esetben (2%) fordult elő.
Procedurális sikert 88,2%-ban értünk el, mely alacsonyabbnak bizonyult az
ELECTRa-ban közölt 95,7%-hoz képest. A lépcsőzetes eszközbevetés vizsgálata
során a kumulatív klinikai sikerarány 24,8% volt „locki-ng stylettel” végzett
húzással, 74,2% a primer aktív hüvellyel, 91,3% magas szintű extrakciós
technikákkal (módozatváltás, femoralis extrakció), valamint 96,6%-ban nem
sürgősségi szívsebészeti extrakcióval. Megbeszélés és
következtetés: A Szegedi Tudományegyetem Elektrofiziológiai
Részlegén sikeres, korszerű technikákon alapuló elektróda extrakciós program
épült fel az elmúlt 10 évben. A kezelt betegek rizikóstatusa, valamint a
beavatkozások komplexitása jóval meghaladja a nemzetközi regiszterek ilyen
irányú jellemzőit. Az optimális sikerarány érdekében elengedhetetlen a különböző
extrakciós technikák elérhetősége és az azokban való jártasság, valamint az
implantálócentrumokkal folytatott szoros oktatási és referálási együttműködés.
Orv Hetil. 2023; 164(49): 1954–1964.
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Affiliation(s)
- László Sághy
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Belgyógyászati Klinika, Elektrofiziológiai Részleg Szeged, Semmelweis u. 8., 6725 Magyarország
| | - Előd János Zsigmond
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Belgyógyászati Klinika, Elektrofiziológiai Részleg Szeged, Semmelweis u. 8., 6725 Magyarország
| | - Attila Benák
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Belgyógyászati Klinika, Elektrofiziológiai Részleg Szeged, Semmelweis u. 8., 6725 Magyarország
| | - Attila Makai
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Belgyógyászati Klinika, Elektrofiziológiai Részleg Szeged, Semmelweis u. 8., 6725 Magyarország
| | - Marton Miklós
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Belgyógyászati Klinika, Elektrofiziológiai Részleg Szeged, Semmelweis u. 8., 6725 Magyarország
| | - Gergely Klausz
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Belgyógyászati Klinika, Elektrofiziológiai Részleg Szeged, Semmelweis u. 8., 6725 Magyarország
| | - Máté Vámos
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Belgyógyászati Klinika, Elektrofiziológiai Részleg Szeged, Semmelweis u. 8., 6725 Magyarország
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Schwertner WR, Tokodi M, Veres B, Behon A, Merkel ED, Masszi R, Kuthi L, Szijártó Á, Kovács A, Osztheimer I, Zima E, Gellér L, Vámos M, Sághy L, Merkely B, Kosztin A, Becker D. Phenogrouping and risk stratification of patients undergoing cardiac resynchronization therapy upgrade using topological data analysis. Sci Rep 2023; 13:20594. [PMID: 37996448 PMCID: PMC10667223 DOI: 10.1038/s41598-023-47092-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023] Open
Abstract
Choosing the optimal device during cardiac resynchronization therapy (CRT) upgrade can be challenging. Therefore, we sought to provide a solution for identifying patients in whom upgrading to a CRT-defibrillator (CRT-D) is associated with better long-term survival than upgrading to a CRT-pacemaker (CRT-P). To this end, we first applied topological data analysis to create a patient similarity network using 16 clinical features of 326 patients without prior ventricular arrhythmias who underwent CRT upgrade. Then, in the generated circular network, we delineated three phenogroups exhibiting significant differences in clinical characteristics and risk of all-cause mortality. Importantly, only in the high-risk phenogroup was upgrading to a CRT-D associated with better survival than upgrading to a CRT-P (hazard ratio: 0.454 (0.228-0.907), p = 0.025). Finally, we assigned each patient to one of the three phenogroups based on their location in the network and used this labeled data to train multi-class classifiers to enable the risk stratification of new patients. During internal validation, an ensemble of 5 multi-layer perceptrons exhibited the best performance with a balanced accuracy of 0.898 (0.854-0.942) and a micro-averaged area under the receiver operating characteristic curve of 0.983 (0.980-0.986). To allow further validation, we made the proposed model publicly available ( https://github.com/tokmarton/crt-upgrade-risk-stratification ).
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Affiliation(s)
| | - Márton Tokodi
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Boglárka Veres
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Anett Behon
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Eperke Dóra Merkel
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Richárd Masszi
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Luca Kuthi
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Ádám Szijártó
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - István Osztheimer
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Endre Zima
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - László Gellér
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Máté Vámos
- Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - László Sághy
- Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary.
| | - Annamária Kosztin
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Dávid Becker
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
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Merkely B, Gellér L, Zima E, Osztheimer I, Molnár L, Földesi C, Duray G, Wranicz JK, Németh M, Goscinska‐Bis K, Hatala R, Sághy L, Veres B, Schwertner WR, Fábián A, Fodor E, Goldenberg I, Kutyifa V, Kovács A, Kosztin A. Baseline clinical characteristics of heart failure patients with reduced ejection fraction enrolled in the BUDAPEST-CRT Upgrade trial. Eur J Heart Fail 2022; 24:1652-1661. [PMID: 35791276 PMCID: PMC9796950 DOI: 10.1002/ejhf.2609] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/23/2022] [Accepted: 07/02/2022] [Indexed: 01/07/2023] Open
Abstract
AIMS The BUDAPEST-CRT Upgrade study is the first prospective, randomized, multicentre clinical trial investigating the outcomes after cardiac resynchronization therapy (CRT) upgrade in heart failure (HF) patients with intermittent or permanent right ventricular (RV) pacing with wide paced QRS. This report describes the baseline clinical characteristics of the enrolled patients and compares them to cohorts from previous milestone CRT studies. METHODS AND RESULTS This international multicentre randomized controlled trial investigates 360 patients having a pacemaker (PM) or implantable cardioverter defibrillator (ICD) device for at least 6 months prior to enrolment, reduced left ventricular ejection fraction (LVEF ≤35%), HF symptoms (New York Heart Association [NYHA] functional class II-IVa), wide paced QRS (>150 ms), and ≥20% of RV pacing burden without having a native left bundle branch block. At enrolment, the mean age of the patients was 73 ± 8 years; 89% were male, 97% were in NYHA class II/III functional class, and 56% had atrial fibrillation. Enrolled patients predominantly had conventional PM devices, with a mean RV pacing burden of 86%. Thus, this is a patient cohort with advanced HF, low baseline LVEF (25 ± 7%), high N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels (2231 pg/ml [25th-75th percentile 1254-4309 pg/ml]), and frequent HF hospitalizations during the preceding 12 months (50%). CONCLUSION When compared with prior CRT trial cohorts, the BUDAPEST-CRT Upgrade study includes older patients with a strong male predominance and a high burden of atrial fibrillation and other comorbidities. Moreover, this cohort represents an advanced HF population with low LVEF, high NT-proBNP, and frequent previous HF events. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT02270840.
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Affiliation(s)
- Béla Merkely
- Semmelweis University, Heart and Vascular CenterBudapestHungary
| | - László Gellér
- Semmelweis University, Heart and Vascular CenterBudapestHungary
| | - Endre Zima
- Semmelweis University, Heart and Vascular CenterBudapestHungary
| | | | - Levente Molnár
- Semmelweis University, Heart and Vascular CenterBudapestHungary
| | - Csaba Földesi
- Gottsegen National Cardiovascular CenterBudapestHungary
| | - Gábor Duray
- Department of CardiologyHungarian Defence Forces Medical CentreBudapestHungary
| | - Jerzy K. Wranicz
- Department of ElectrocardiologyMedical University of LodzLodzPoland
| | - Marianna Németh
- Semmelweis University, Heart and Vascular CenterBudapestHungary
| | - Kinga Goscinska‐Bis
- Department of Electrocardiology and Heart FailureMedical University of SilesiaKatowicePoland
| | - Robert Hatala
- Department of Cardiology and AngiologyNational Institute of Cardiovascular Diseases and Slovak Medical UniversityBratislavaSlovakia
| | - László Sághy
- Cardiac Electrophysiology Division, Department of Internal MedicineUniversity of SzegedSzegedHungary
| | - Boglárka Veres
- Semmelweis University, Heart and Vascular CenterBudapestHungary
| | | | | | | | - Ilan Goldenberg
- Clinical Cardiovascular Research CenterUniversity of RochesterRochesterNYUSA
| | - Valentina Kutyifa
- Semmelweis University, Heart and Vascular CenterBudapestHungary,Clinical Cardiovascular Research CenterUniversity of RochesterRochesterNYUSA
| | - Attila Kovács
- Semmelweis University, Heart and Vascular CenterBudapestHungary
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Răileanu G, Sághy L, Kupó P, Pap R. Wide and narrow QRS complexes during flutter. What's the mechanism? HeartRhythm Case Rep 2021; 7:422-424. [PMID: 34194994 PMCID: PMC8226278 DOI: 10.1016/j.hrcr.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Gabriela Răileanu
- Second Department of Internal Medicine and Cardiology Center, Medical School, University of Szeged, Szeged, Hungary
| | - László Sághy
- Second Department of Internal Medicine and Cardiology Center, Medical School, University of Szeged, Szeged, Hungary
| | - Péter Kupó
- Second Department of Internal Medicine and Cardiology Center, Medical School, University of Szeged, Szeged, Hungary
| | - Róbert Pap
- Second Department of Internal Medicine and Cardiology Center, Medical School, University of Szeged, Szeged, Hungary
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Szilágyi J, Sághy L. Atrial Remodeling in Atrial Fibrillation. Comorbidities and Markers of Disease Progression Predict Catheter Ablation Outcome. Curr Cardiol Rev 2021; 17:217-229. [PMID: 32693769 PMCID: PMC8226201 DOI: 10.2174/1573403x16666200721153620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 01/19/2023] Open
Abstract
Atrial fibrillation is the most common supraventricular arrhythmia affecting an increasing proportion of the population in which mainstream therapy, i.e. catheter ablation, provides freedom from arrhythmia in only a limited number of patients. Understanding the mechanism is key in order to find more effective therapies and to improve patient selection. In this review, the structural and electrophysiological changes of the atrial musculature that constitute atrial remodeling in atrial fibrillaton and how risk factors and markers of disease progression can predict catheter ablation outcome will be discussed in detail.
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Affiliation(s)
- Judit Szilágyi
- 2nd Department of Internal Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - László Sághy
- 2nd Department of Internal Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
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6
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Blomström-Lundqvist C, Traykov V, Erba PA, Burri H, Nielsen JC, Bongiorni MG, Poole J, Boriani G, Costa R, Deharo JC, Epstein LM, Sághy L, Snygg-Martin U, Starck C, Tascini C, Strathmore N. European Heart Rhythm Association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections-endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), International Society for Cardiovascular Infectious Diseases (ISCVID), and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2021; 41:2012-2032. [PMID: 32101604 DOI: 10.1093/eurheartj/ehaa010] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/07/2019] [Accepted: 01/10/2020] [Indexed: 01/07/2023] Open
Abstract
Pacemakers, implantable cardiac defibrillators, and cardiac resynchronization therapy devices are potentially lifesaving treatments for a number of cardiac conditions but are not without risk. Most concerning is the risk of a cardiac implantable electronic device (CIED) infection, which is associated with significant morbidity, increased hospitalizations, reduced survival, and increased health care costs. Recommended preventive strategies such as administration of intravenous antibiotics before implantation are well-recognized. Uncertainties have remained about the role of various preventive, diagnostic, and treatment measures such as skin antiseptics, pocket antibiotic solutions, antibacterial envelopes, prolonged antibiotics post-implantation, and others. When compared with previous guidelines or consensus statements, the present consensus document gives guidance on the use of novel device alternatives, novel oral anticoagulants, antibacterial envelopes, prolonged antibiotics post-implantation, as well as definitions on minimum quality requirements for centres and operators and volumes. The recognition that an international consensus document focused on management of CIED infections is lacking, the dissemination of results from new important randomized trials focusing on prevention of CIED infections, and observed divergences in managing device-related infections as found in an European Heart Rhythm Association worldwide survey, provided a strong incentive for a Novel 2019 International State-of-the-art Consensus document on risk assessment, prevention, diagnosis, and treatment of CIED infections.
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Affiliation(s)
| | - Vassil Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Acibadem City Clinic Tokuda Hospital, Nikola Vaptsarov blvd 51 B, 1 407 Sofia, Bulgaria
| | - Paola Anna Erba
- Department of Translational Research and New Technology in Medicine, University of Pisa-AOUP, Lungarno Antonio Pacinotti, 43, 56126 Pisa PI, Italy.,Department of Nuclear Medicine & Molecular Imaging University Medical Center Groningen, University of Groningen, 9712 CP Groningen, Netherlands
| | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark
| | - Maria Grazia Bongiorni
- CardioThoracic and Vascular Department, University Hospital of Pisa, Via Paradisa 2, 56125 Pisa PI, Italy
| | - Jeanne Poole
- Department of Cardiology, University of Washington, Roosevelt Way NE, Seattle, WA 98115, USA
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Largo del Pozzo, 71, 41125 Modena, Italy
| | - Roberto Costa
- Department of Cardiovascular Surgery, Heart Institute (InCor) of the University of São Paulo, Butanta, São Paulo - State of São Paulo, Brazil
| | - Jean-Claude Deharo
- Department of Cardiology, Aix Marseille Université, CHU la Timone, 278 Rue Saint-Pierre, 13005 Marseille, France
| | - Laurence M Epstein
- Electrophysiology, Northwell Health, Hofstra/Northwell School of Medicine, 300 Community Drive, Manhasset, NY 11030, USA
| | - László Sághy
- Electrophysiology Division, 2nd Department of Medicine and Cardiology Centre, University of Szeged, Aradi vértanúk tere 1, 6720 Szeged, Hungary
| | - Ulrika Snygg-Martin
- Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Pl. 1, 13353 Berlin, Germany
| | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, Azienda ospedaliera dei Colli, Via Gaetano Quagliariello, 54, 80131 Napoli NA, Italy
| | - Neil Strathmore
- Department of Cardiology, Royal Melbourne Hospital, 300 Grattan St, Parkville VIC 3050, Melbourne, Australia
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Kupó P, Tutuianu CI, Kaninski G, Gingl Z, Sághy L, Pap R. Limitations of ventricular pacing maneuvers to differentiate orthodromic reciprocating tachycardia from atrioventricular nodal reentry tachycardia. J Interv Card Electrophysiol 2021; 63:323-331. [PMID: 33871788 DOI: 10.1007/s10840-021-00993-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Various ventricular pacing maneuvers have been developed to differentiate orthodromic reciprocating tachycardia (ORT) from atrioventricular nodal reentry tachycardia (AVNRT). We aimed to evaluate the diagnostic value of ventricular pacing maneuvers in patients undergoing catheter ablation for AVNRT/ORT. METHODS Sixty patients with supraventricular tachycardia (SVT) undergoing invasive EP study were included (ORT: 31, typical AVNRT: 18, atypical AVNRT: 11). Ventricular overdrive pacing (VOP) and resetting by premature ventricular stimulation (PVS) during SVT were analyzed by 3 independent observers blinded to the ultimate diagnosis. We determined intraclass correlation coefficient (ICC) for interobserver agreement and the diagnostic accuracy of consensual results. RESULTS Although specificity of all parameters was high (96-100%) for ORT, semi-quantitative parameters of VOP (requiring the recognition of specific ECG patterns) had lower interobserver reliability (ICC: 0.32-0.66) and sensitivity (16.1-77.4%). In contrast, most quantitative measurements of VOP and PVS showed good reproducibility (ICC: 0.93-0.95) and sensitivity (74.2-89.3%), but post-pacing interval after VOP needed correction with AV nodal conduction slowing. False negative results for diagnosing ORT were more common with left free wall vs. right free wall or septal, and slowly vs. fast-conducting septal APs. False positivity was only seen with a bystander, concealed nodo-fascicular/nodo-ventricular (NF/NV) AP in a case of AVNRT. CONCLUSIONS No single maneuver is 100% sensitive for ORT. Semi-quantitative features have limited reproducibility and all parameters can be misleading in the case of rate-dependent delay during VOP/PVS, ORT circuits remote from the pacing site, or a bystander, concealed NF/NV AP.
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Affiliation(s)
- Péter Kupó
- 2nd Department of Internal Medicine and Cardiology Centre, Medical School, University of Szeged, Semmelweis u. 8, Szeged, H-6725, Hungary.
| | - Cristina Ioana Tutuianu
- 2nd Department of Internal Medicine and Cardiology Centre, Medical School, University of Szeged, Semmelweis u. 8, Szeged, H-6725, Hungary
| | - Genadi Kaninski
- 2nd Department of Internal Medicine and Cardiology Centre, Medical School, University of Szeged, Semmelweis u. 8, Szeged, H-6725, Hungary
| | - Zoltán Gingl
- 2nd Department of Internal Medicine and Cardiology Centre, Medical School, University of Szeged, Semmelweis u. 8, Szeged, H-6725, Hungary
| | - László Sághy
- 2nd Department of Internal Medicine and Cardiology Centre, Medical School, University of Szeged, Semmelweis u. 8, Szeged, H-6725, Hungary
| | - Róbert Pap
- 2nd Department of Internal Medicine and Cardiology Centre, Medical School, University of Szeged, Semmelweis u. 8, Szeged, H-6725, Hungary
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Kupó P, Pap R, Sághy L, Tényi D, Bálint A, Debreceni D, Basu-Ray I, Komócsi A. Ultrasound guidance for femoral venous access in electrophysiology procedures-systematic review and meta-analysis. J Interv Card Electrophysiol 2020; 59:407-414. [PMID: 31823233 PMCID: PMC7591449 DOI: 10.1007/s10840-019-00683-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 12/02/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE The most common complications of electrophysiology (EP) procedures are related to vascular access. Our study aims to conduct a meta-analysis comparing ultrasound (US)-guided vs. palpation-based technique for femoral venous access in EP procedures. METHODS Electronic databases were searched and systematically reviewed for studies comparing femoral vein puncture with/without US in EP procedures. The primary outcome was the rate of major vascular complications; secondary outcomes were minor vascular complications, inadvertent artery puncture, postprocedural groin pain, and puncture time. Predefined subgroup analysis was conducted separately for patients undergoing pulmonary vein isolation procedure (PVI). A random-effects model was used to derive risk ratios (RR) with 95% confidence interval (CI). RESULTS Nine studies involving 8232 patients met our inclusion criteria. Compared with the standard technique, the use of US reduced major vascular complications (from 2.01 to 0.71%, p < 0.0001). The rate of minor vascular complications (RR = 0.30, 95% CI, 0.14-0.62, p = 0.001) and inadvertent artery puncture were lower with US-guided puncture (RR = 0.31, 95% CI, 0.17-0.58, p = 0.0003). Puncture time was shorter (mean difference = - 92.1 s, 95% CI, - 142.12 - - 42.07 s, p = 0.0003) and postprocedural groin pain was less frequent (RR = 0.57, 95% CI, 0.41-0.79, p = 0.0008) in the US group. Subgroup analysis of patients undergoing PVI also showed significant reduction of major vascular complications (RR = 0.27, 95% CI, 0.12-0.64, p = 0.003) and inadvertent artery puncture (RR = 0.35, 95% CI, 0.21-0.59, p < 0.0001). CONCLUSION Real-time US-guidance of femoral vein puncture in EP procedures is beneficial: it reduces major and minor vascular complications, inadvertent artery puncture, postprocedural groin pain, and puncture time.
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Affiliation(s)
- Péter Kupó
- Heart Institute, Medical School, University of Pécs, Ifjúság útja 13, Pécs, H-7624, Hungary.
- Second Department of Internal Medicine and Cardiology Centre, Medical School, University of Szeged, Szeged, Hungary.
| | - Róbert Pap
- Second Department of Internal Medicine and Cardiology Centre, Medical School, University of Szeged, Szeged, Hungary
| | - László Sághy
- Second Department of Internal Medicine and Cardiology Centre, Medical School, University of Szeged, Szeged, Hungary
| | - Dalma Tényi
- Department of Neurology, Medical School, University of Pécs, Pécs, Hungary
| | - Alexandra Bálint
- Heart Institute, Medical School, University of Pécs, Ifjúság útja 13, Pécs, H-7624, Hungary
| | - Dorottya Debreceni
- Heart Institute, Medical School, University of Pécs, Ifjúság útja 13, Pécs, H-7624, Hungary
| | - Indranill Basu-Ray
- St. Francis Hospital, Memphis, TN, USA
- All India Institute of Medical Sciences, Virbhadra Marg, Rishikesh, Uttarakhand, India
| | - András Komócsi
- Heart Institute, Medical School, University of Pécs, Ifjúság útja 13, Pécs, H-7624, Hungary
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Pap R, Tutuianu CI, Sághy L. Transition from narrow to wide QRS complex tachycardia: What is the mechanism? Pacing Clin Electrophysiol 2020; 43:258-260. [PMID: 31989668 DOI: 10.1111/pace.13877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 01/16/2020] [Accepted: 01/23/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Robert Pap
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | | | - László Sághy
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
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10
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Kupó P, Sághy L, Pap R. Intracardiac echocardiography from the right ventricular outflow tract confirms an accessory pathway in the aortomitral continuity. J Cardiovasc Electrophysiol 2019; 30:2117-2118. [PMID: 31393039 DOI: 10.1111/jce.14107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/04/2019] [Accepted: 08/05/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Péter Kupó
- Second Department of Internal Medicine and Cardiology Centre, Medical School, University of Szeged, Szeged, Hungary
| | - László Sághy
- Second Department of Internal Medicine and Cardiology Centre, Medical School, University of Szeged, Szeged, Hungary
| | - Róbert Pap
- Second Department of Internal Medicine and Cardiology Centre, Medical School, University of Szeged, Szeged, Hungary
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11
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Riesz TJ, Pap R, Sághy L. Converging “railroad track” appearance on the interval plot of ventricular arrhythmia episodes stored by an ICD. Pacing Clin Electrophysiol 2019; 42:1144-1145. [DOI: 10.1111/pace.13753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/12/2019] [Accepted: 06/19/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Tamás János Riesz
- Electrophysiology Division, Second Department of Internal Medicine and Cardiology CentreUniversity of Szeged Szeged Hungary
| | - Róbert Pap
- Electrophysiology Division, Second Department of Internal Medicine and Cardiology CentreUniversity of Szeged Szeged Hungary
| | - László Sághy
- Electrophysiology Division, Second Department of Internal Medicine and Cardiology CentreUniversity of Szeged Szeged Hungary
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12
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Besenyi Z, Nagy FT, Sághy L, Pávics L. 18F-fluoro-dezoxi-glükóz pozitronemissziós tomográfia/komputertomográfia ( 18F-FDG-PET/CT) képalkotás a kardiológiában. Orv Hetil 2019; 160:1015-1024. [DOI: 10.1556/650.2019.31414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract: Over the past decades, 18F-FDG-PET/CT imaging has been recognized as an indispensable tool in the diagnosis, staging and treatment monitoring of cancer. This modern imaging technique combining functional and morphologic information has approved indications not only in oncology but in clinical cardiology as well. In the current review we discuss the specific requirements of patient preparation and image acquisition protocol for cardiac 18F-FDG-PET/CT. We review the literature in some cases highlighted by our own examinations of well-known “gold standard” viability and onco-cardiology examinations while placing special emphasis on inflammatory disorders involving the heart. This relatively newer class of indications includes prosthetic valve endocarditis, cardiac implantable device infection, myocardial inflammation of varying origin such as sarcoidosis where 18F-FDG-PET/CT appears to be particularly useful in the differential diagnosis of cases where standard investigation is non-diagnostic or equivocal. Orv Hetil. 2019; 160(26): 1015–1024.
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Affiliation(s)
- Zsuzsanna Besenyi
- Nukleáris Medicina Intézet, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 6., 6720
| | - Ferenc Tamás Nagy
- II. Belgyógyászati Klinika és Kardiológiai Központ, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - László Sághy
- II. Belgyógyászati Klinika és Kardiológiai Központ, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - László Pávics
- Nukleáris Medicina Intézet, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 6., 6720
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Abstract
Abstract: In case of atrial fibrillation, there is a higher risk of thrombus formation, which could affect the right heart as well. Visualization of the right atrial appendage is difficult; the aim of the present review was to demonstrate the role of routine echocardiographic techniques and to show related clinical data. Orv Hetil. 2019; 160(12): 443–447.
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Affiliation(s)
- Attila Nemes
- Szent-Györgyi Albert Klinikai Központ, II. Belgyógyászati Klinika és Kardiológiai Központ, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Semmelweis u. 8., 6725
| | - Kálmán Havasi
- Szent-Györgyi Albert Klinikai Központ, II. Belgyógyászati Klinika és Kardiológiai Központ, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Semmelweis u. 8., 6725
| | - László Sághy
- Szent-Györgyi Albert Klinikai Központ, II. Belgyógyászati Klinika és Kardiológiai Központ, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Semmelweis u. 8., 6725
| | - Mária Kohári
- Szent-Györgyi Albert Klinikai Központ, II. Belgyógyászati Klinika és Kardiológiai Központ, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Semmelweis u. 8., 6725
| | - Tamás Forster
- Szent-Györgyi Albert Klinikai Központ, II. Belgyógyászati Klinika és Kardiológiai Központ, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Semmelweis u. 8., 6725
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14
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Pap R, Kohári M, Sághy L. Isolated left atrial posterior wall tachycardia. J Cardiovasc Electrophysiol 2018; 30:616-617. [PMID: 30516307 DOI: 10.1111/jce.13808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 12/03/2018] [Indexed: 11/30/2022]
Abstract
A case of macroreentry tachycardia of the isolated posterior left atrium is presented after surgical and subsequent catheter ablation.
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Affiliation(s)
- Robert Pap
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - Maria Kohári
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - László Sághy
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
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15
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Nemes A, Havasi K, Ambrus N, Kohári M, Sághy L, Forster T. A bal pitvari fülcse echokardiográfiás vizsgálata – transoesophagealis, transthoracalis és intracardialis lehetőségek. Orv Hetil 2018; 159:335-345. [DOI: 10.1556/650.2018.31001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract: Left atrial appendage is a cardiac chamber in variable shapes and sizes. Its condition is associated with atrial arrhytmias and the presence of a thrombus. Due to its difficult visualisation, the present review aimed to demonstrate the role of different echocardiographic methods in its assessment. Orv Hetil. 2018; 159(9): 335–345.
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Affiliation(s)
- Attila Nemes
- Szent-Györgyi Albert Klinikai Központ, II. Belgyógyászati Klinika és Kardiológiai Központ, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Semmelweis u. 8., 6725
| | - Kálmán Havasi
- Szent-Györgyi Albert Klinikai Központ, II. Belgyógyászati Klinika és Kardiológiai Központ, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Semmelweis u. 8., 6725
| | - Nóra Ambrus
- Szent-Györgyi Albert Klinikai Központ, II. Belgyógyászati Klinika és Kardiológiai Központ, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Semmelweis u. 8., 6725
| | - Mária Kohári
- Szent-Györgyi Albert Klinikai Központ, II. Belgyógyászati Klinika és Kardiológiai Központ, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Semmelweis u. 8., 6725
| | - László Sághy
- Szent-Györgyi Albert Klinikai Központ, II. Belgyógyászati Klinika és Kardiológiai Központ, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Semmelweis u. 8., 6725
| | - Tamás Forster
- Szent-Györgyi Albert Klinikai Központ, II. Belgyógyászati Klinika és Kardiológiai Központ, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Semmelweis u. 8., 6725
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16
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Kurtev S, Valduva C, Sághy L, Pap R. Different responses of supraventricular tachycardia with 2:1 AV block to consecutive premature ventricular contractions. Pacing Clin Electrophysiol 2018; 41:306-308. [DOI: 10.1111/pace.13283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 01/06/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Svetoslav Kurtev
- 2nd Department of Medicine and Cardiology Center; University of Szeged; Szeged Hungary
| | - Cristina Valduva
- 2nd Department of Medicine and Cardiology Center; University of Szeged; Szeged Hungary
| | - László Sághy
- 2nd Department of Medicine and Cardiology Center; University of Szeged; Szeged Hungary
| | - Robert Pap
- 2nd Department of Medicine and Cardiology Center; University of Szeged; Szeged Hungary
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17
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Ambrus N, Havasi K, Kalapos A, Sághy L, Makai A, Bogáts G, Hegedűs Z, Iványi B, Besenyi Z, Pápai Z, Nagy L, Forster T, Nemes A. Primary cardiac angiosarcoma: A case report. Echocardiography 2018; 35:267-271. [PMID: 29349900 DOI: 10.1111/echo.13808] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Cardiac angiosarcomas are the most common primary malignant cardiac tumors in adults. The diagnosis is often delayed due to nonspecific clinical symptoms at presentation. The cornerstones of diagnosis are echocardiography and the histological evaluation of the cardiac biopsy. The knowledge on the treatment is limited; the outcomes of chemotherapy, radiotherapy, complete surgical removal, and heart transplantation are controversial. We report a 38-year-old woman with a primary heart tumor which infiltrated the right atrial wall and the pericardium and caused pericardial effusion. Angiosarcoma was verified histologically. The surgical excision could not be radical, and the patient died 3 months from diagnosis.
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Affiliation(s)
- Nóra Ambrus
- Faculty of Medicine, Second Department of Medicine and Cardiology Center, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Kálmán Havasi
- Faculty of Medicine, Second Department of Medicine and Cardiology Center, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Anita Kalapos
- Faculty of Medicine, Second Department of Medicine and Cardiology Center, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - László Sághy
- Faculty of Medicine, Second Department of Medicine and Cardiology Center, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Attila Makai
- Faculty of Medicine, Second Department of Medicine and Cardiology Center, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Gábor Bogáts
- Faculty of Medicine, Second Department of Medicine and Cardiology Center, Division of Cardiac Surgery, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Zoltán Hegedűs
- Faculty of Medicine, Second Department of Medicine and Cardiology Center, Division of Cardiac Surgery, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Béla Iványi
- Faculty of Medicine, Department of Pathology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Zsuzsanna Besenyi
- Affidea Diagnostics and Faculty of Medicine, Department of Radiology and Nuclear Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Zsuzsanna Pápai
- Department of Oncology, Hungarian Defence Forces Military Hospital, Budapest, Hungary
| | - László Nagy
- Department of Internal Medicine, Dr. István Bugyi Hospital, Szentes, Hungary
| | - Tamás Forster
- Faculty of Medicine, Second Department of Medicine and Cardiology Center, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Attila Nemes
- Faculty of Medicine, Second Department of Medicine and Cardiology Center, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
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18
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Juhász V, Hornyik T, Benák A, Nagy N, Husti Z, Pap R, Sághy L, Virág L, Varró A, Baczkó I. Comparison of the effects of I K,ACh, I Kr, and I Na block in conscious dogs with atrial fibrillation and on action potentials in remodeled atrial trabeculae. Can J Physiol Pharmacol 2017; 96:18-25. [PMID: 28892643 DOI: 10.1139/cjpp-2017-0342] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a major cause of morbidity and mortality. Traditional antiarrhythmic agents used for restoration of sinus rhythm have limited efficacy in long-term AF and they may possess ventricular proarrhythmic adverse effects, especially in patients with structural heart disease. The acetylcholine receptor-activated potassium channel (IK,ACh) represents an atrial selective target for future AF management. We investigated the effects of the IK,ACh blocker tertiapin-Q (TQ), a derivative of the honeybee toxin tertiapin, on chronic atrial tachypacing-induced AF in conscious dogs, without the influence of anesthetics that modulate a number of cardiac ion channels. Action potentials (APs) were recorded from right atrial trabeculae isolated from dogs with AF. TQ significantly and dose-dependently reduced AF incidence and AF episode duration, prolonged atrial effective refractory period, and prolonged AP duration. The reference drugs propafenone and dofetilide, both used in the clinical management of AF, exerted similar effects against AF in vivo. Dofetilide prolonged atrial AP duration, whereas propafenone increased atrial conduction time. TQ and propafenone did not affect the QT interval, whereas dofetilide prolonged the QT interval. Our results show that inhibition of IK,ACh may represent a novel, atrial-specific target for the management of AF in chronic AF.
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Affiliation(s)
- Viktor Juhász
- a Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Tibor Hornyik
- a Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Attila Benák
- b 2nd Department of Internal Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - Norbert Nagy
- c MTA-SZTE Research Group of Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged, Hungary
| | - Zoltán Husti
- a Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Róbert Pap
- b 2nd Department of Internal Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - László Sághy
- b 2nd Department of Internal Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - László Virág
- a Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - András Varró
- a Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary.,c MTA-SZTE Research Group of Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged, Hungary
| | - István Baczkó
- a Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
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Hategan L, Csányi B, Ördög B, Kákonyi K, Tringer A, Kiss O, Orosz A, Sághy L, Nagy I, Hegedűs Z, Rudas L, Széll M, Varró A, Forster T, Sepp R. A novel ‘splice site’ HCN4 Gene mutation, c.1737 + 1 G > T, causes familial bradycardia, reduced heart rate response, impaired chronotropic competence and increased short-term heart rate variability. Int J Cardiol 2017; 241:364-372. [DOI: 10.1016/j.ijcard.2017.04.058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/22/2017] [Accepted: 04/19/2017] [Indexed: 11/26/2022]
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Pap R, Sepp R, Sághy L. Termination of Persistent Perimitral Atrial Flutter by Selective Contrast Injection Into the Vein of Marshall. JACC Clin Electrophysiol 2015; 1:596-597. [DOI: 10.1016/j.jacep.2015.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 09/10/2015] [Indexed: 10/22/2022]
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21
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Pap R, Makai A, Szilágyi J, Klausz G, Bencsik G, Forster T, Sághy L. Should the Aortic Root Be the Preferred Route for Ablation of Focal Atrial Tachycardia Around the AV Node?: Support From Intracardiac Echocardiography. JACC Clin Electrophysiol 2015; 2:193-199. [PMID: 29766869 DOI: 10.1016/j.jacep.2015.10.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 10/19/2015] [Accepted: 10/22/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The purpose of this study was to determine the optimal approach to focal atrial tachycardia originating from around the atrioventricular node. BACKGROUND Focal atrial tachycardia (FAT) demonstrating earliest activation around the atrioventricular (AV) node during right atrial (RA) mapping has been eliminated by ablation at the RA para-Hisian region, from the left atrium (LA) or the noncoronary aortic cusp (NCC). However the optimal approach has not been determined. METHODS We conducted a retrospective analysis of a consecutive series of 148 patients undergoing catheter ablation for FAT between 2006 and 2014 in our institution. RESULTS Earliest activation was recorded in the peri-AV nodal region during RA mapping in 34 patients (23%). Of these, 7 patients (20.5%) had successful ablation at the RA septum, using either radiofrequency (n = 4) or cryoenergy (n = 3). Seven FATs (20.5%) were ablated from the LA at the region of the aortomitral continuity, and 20 patients (59%) had successful ablation in the NCC, including 1 patient with a recurrence after a temporarily successful cryoablation from the RA. The proportion of the 3 approaches in this series showed a significant temporal evolution and overall frequency favoring ablation in the NCC (p = 0.011 for time trend and 0.013 for actual vs. expected frequencies). Intracardiac echocardiography proved superior catheter stability with the NCC approach. There were 2 cases of atrioventricular block and 1 recurrence after RA ablation versus no complications or recurrent FAT with NCC and LA approaches. CONCLUSIONS Most peri-AV nodal FATs can be safely and effectively ablated from the NCC. The strategy of preferential NCC approach avoids RA para-Hisian ablation with the accompanying risk of AV block.
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Affiliation(s)
- Robert Pap
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary.
| | - Attila Makai
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - Judit Szilágyi
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - Gergely Klausz
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - Gábor Bencsik
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - Tamás Forster
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - László Sághy
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
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Tutuianu C, Szilagy J, Pap R, Sághy L. Very Long-Term Results Of Atrial Fibrillation Ablation Confirm That This Therapy Is Really Effective. J Atr Fibrillation 2015; 8:1226. [PMID: 27957186 DOI: 10.4022/jafib.1226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 06/17/2015] [Accepted: 06/25/2015] [Indexed: 01/29/2023]
Abstract
Catheter ablation -in general- is a highly effective and "curative" intervention for a broad spectrum of supraventricular and ventricular arrhythmias. After a successful procedure eliminating a simple arrhythmia substrate, the recurrence rate is low and the short term success correlates well with the long term freedom from the arrhythmia.
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Affiliation(s)
- Cristina Tutuianu
- 2nd Department of Medicine and Cardiology Center, Electrophysiology Division, University of Szeged, Szeged Hungary
| | - Judit Szilagy
- 2nd Department of Medicine and Cardiology Center, Electrophysiology Division, University of Szeged, Szeged Hungary
| | - Robert Pap
- 2nd Department of Medicine and Cardiology Center, Electrophysiology Division, University of Szeged, Szeged Hungary
| | - László Sághy
- 2nd Department of Medicine and Cardiology Center, Electrophysiology Division, University of Szeged, Szeged Hungary
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Abstract
One of the most important proarrhythmic complications after left atrial (LA) ablation is regular atrial tachycardia (AT) or flutter. Those tachycardias that occur after atrial fibrillation (AF) ablation can cause even more severe symptoms than those from the original arrhythmia prior to the index ablation procedure since they are often incessant and associated with rapid ventricular response. Depending on the method and extent of LA ablation and on the electrophysiological properties of underlying LA substrate, the reported incidence of late ATs is variable. To establish the exact mechanism of these tachycardias can be difficult and controversial but correlates with the ablation technique and in the vast majority of cases the mechanism is reentry related to gaps in prior ablation lines. When tachycardias occur, conservative therapy usually is not effective, radiofrequency ablation procedure is mostly successful, but can be challenging, and requires a complex approach.
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Affiliation(s)
| | | | - Judith Szilágyi
- 2nd Department of Internal Medicine and Cardiology Centre, University of Szeged, Korányi fasor 6. 6724 Szeged, Hungary.
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Tutuianu C, Sághy L, Pap R. A Wide Complex Left Bundle Branch Block Tachycardia in a Patient with Complete Right Bundle Branch Block: What is the Mechanism? J Cardiovasc Electrophysiol 2015; 26:816-8. [PMID: 25777462 DOI: 10.1111/jce.12661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 03/10/2015] [Accepted: 03/13/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Cristina Tutuianu
- 2nd Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | - László Sághy
- 2nd Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | - Robert Pap
- 2nd Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
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Chadaide S, Domsik P, Kalapos A, Sághy L, Forster T, Nemes A. Three-dimensional speckle tracking echocardiography-derived left atrial strain parameters are reduced in patients with atrial fibrillation (results from the MAGYAR-path study). Echocardiography 2013; 30:1078-83. [PMID: 23659362 DOI: 10.1111/echo.12218] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Three-dimensional (3D) speckle tracking echocardiography (3DSTE) is a novel imaging modality for assessing cardiac function. We aimed to analyze left atrial (LA) function using 3DSTE in patients with atrial fibrillation (AF). METHODS 3DSTE was performed in 20 patients prior to their pulmonary vein isolation for AF. Every patient underwent a complete two-dimensional echocardiographic study at the same time. 3DSTE-derived circumferential (CS), longitudinal (LS), radial (RS), 3D (3DS), and area strain (AS) values were measured in the basal (b), mid (m), and superior (s) regions of the LA. 3DSTE-defined maximal (LAmax ) and minimal LA volumes (LAmin ) and LA total emptying fraction were calculated automatically. Eleven randomly selected age- and gender-matched healthy volunteers served as controls. RESULTS Patients with AF had significantly larger LAmax and LAmin and reduced LS, RS and CS.3DS and AS were significantly lower throughout the LA in cases with AF (3DS-b, -m, -s [AF patients vs. controls]: -18 ± 8% vs. -29 ± 8%, P = 0.001; -14 ± 6% vs. -22 ± 7%, P = 0.002; -10 ± 7% vs. -20 ± 9%, P = 0.002; AS-b, -m, -s [AF patients vs. controls]: 35 ± 15% vs. 52 ± 13%, P = 0.004; 50 ± 21% vs. 72 ± 19%, P = 0.009; 31 ± 21% vs. 65 ± 27%, P < 0.0001, respectively). CONCLUSIONS 3DSTE-derived "uni-dimensional" LS, RS, CS, as well as novel strain parameters (3DS, AS) are significantly reduced in patients with AF compared to matched controls. 3DS and AS might be new strain parameters providing further insights into the alterations of LA function in patients developing AF.
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Affiliation(s)
- Számi Chadaide
- 2nd Department of Medicine and Cardiology Center, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
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Traykov VB, Pap R, Gingl Z, Chadaide S, Haqqani HM, Klausz G, Gallardo R, Forster T, Callans DJ, Sághy L. Role of triggering pulmonary veins in the maintenance of sustained paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 2013; 36:845-54. [PMID: 23510088 DOI: 10.1111/pace.12121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 01/04/2013] [Accepted: 01/13/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND Triggers from thoracic veins have been implicated not only in the initiation, but also in the perpetuation of paroxysmal atrial fibrillation (PAF). To investigate their role we studied the distribution and stability of dominant frequencies (DFs) during PAF and the response to isolation of the triggering pulmonary vein (PV). METHODS AND RESULTS Triggering structures inducing PAF were identified during isoproterenol challenge in 26 patients (15 males, 55 ± 8.5 years). During sustained PAF, sequential recordings were made with a decapolar circular mapping catheter from each PV and the left atrial posterior wall (LAPW), together with coronary sinus (CS) and right atrium (RA) recordings. DF was determined using fast Fourier transformation. Recordings were repeated after ≥15 minutes of PAF. Radiofrequency ablation was directed first at the triggering PVs. PAF initiated from the PVs in 24 patients and from RA in two. There was a significant frequency gradient from the triggering structure to the PVs, CS, LAPW, and RA (P < 0.0001). During the second recording, DF decreased at all sites (P < 0.02), but the frequency gradient remained unchanged. Despite isolation of the triggering PV, PAF continued in 53% of patients, although DF measured in the CS was lower. AF termination occurred with contralateral PV isolation in half of the remaining patients and further AF slowing was noted in the rest. CONCLUSIONS Triggering structures harbor the fastest activity during sustained PAF pointing to their leading role in arrhythmia perpetuation. However, nontriggering PVs also seem to contribute to PAF maintenance.
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Affiliation(s)
- Vassil B Traykov
- Second Department of Internal Medicine and Cardiology Centre, University of Szeged, Kor´anyi Fasor 6, 6720 Szeged, Hungary.
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Pap R, Kohári M, Makai A, Bencsik G, Traykov VB, Gallardo R, Klausz G, Zsuzsanna K, Forster T, Sághy L. Surgical technique and the mechanism of atrial tachycardia late after open heart surgery. J Interv Card Electrophysiol 2012; 35:127-35. [PMID: 22836480 DOI: 10.1007/s10840-012-9705-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 02/28/2012] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Diverse atrial tachycardias (ATs) can develop after open heart surgery. The aim of our study was to examine the determinants of the mechanism of postoperative AT. METHODS AND RESULTS One hundred patients with AT occurring at least 3 months after open heart surgery were studied. Patients were grouped according to the atrial incision applied at the time of surgery. During 127 electrophysiology procedures, 151 ATs were studied. Eighty-eight patients had cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL), 49 patients had at least one non-CTI-dependent AFL and 11 patients had focal AT. While CTI-dependent AFL was equally prevalent across groups, the finding of a non-CTI-dependent AFL was progressively more common as more extensive atriotomy was applied (p < 0.001). Among patients who had right atrial (RA) operations, RA incisional tachycardia was the most common non-CTI-dependent circuit, while the finding of perimitral or left atrial (LA) roof-dependent AFL was associated with LA atriotomy (p = 0.002 and p = 0.041, respectively). After adjustment for possible confounders, surgical group remained independent predictor of non-CTI-dependent AFLs (p < 0.001). No predictor was identified for focal AT, which originated from typical predilection sites and in 36% from the vicinity of surgical scar. Radiofrequency ablation was highly effective for all ATs, but the recurrence rate of AFL and atrial fibrillation was high at 22% and 27%, respectively, during 19 ± 15 months of follow-up. CONCLUSION While CTI-dependent AFL is the most common AT late after open heart surgery, atypical AFL becomes progressively more common with more extensive atriotomy. Right atrial incisional tachycardia is the dominant non-CTI-dependent AFL after opening of the RA, while a perimitral or roof-dependent LA circuit can be expected after LA operations.
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Affiliation(s)
- Róbert Pap
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Korányi fasor 6, 6720, Szeged, Hungary
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28
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Affiliation(s)
- Róbert Pap
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary.
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Pap R, Makai A, Sághy L. Intracardiac echocardiography identifies the substrate of left ventricular papillary muscle ectopy. Europace 2010; 12:157. [DOI: 10.1093/europace/eup393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bencsik G, Pap R, Sághy L. Intracardiac echocardiography for visualization of the Eustachian valve during radiofrequency ablation of typical atrial flutter. Europace 2009; 11:901. [PMID: 19447806 DOI: 10.1093/europace/eup123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gábor Bencsik
- Second Department of Internal Medicine and Cardiology Centre, University of Szeged, 6726 Szeged, Korányi fasor 6, Hungary.
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Pap R, Klausz G, Gallardo R, Sághy L. Intracardiac echocardiography in a case with previous failed cavotricuspid isthmus ablation. J Interv Card Electrophysiol 2009; 26:119-20. [DOI: 10.1007/s10840-009-9399-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Accepted: 03/16/2009] [Indexed: 10/20/2022]
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Traykov VB, Pap R, Bencsik G, Makai A, Forster T, Sághy L. Ventricular location of a part of the right atrial isthmus after tricuspid valve replacement for Ebstein’s anomaly: a challenge for atrial flutter ablation. J Interv Card Electrophysiol 2009; 25:199-201. [DOI: 10.1007/s10840-008-9354-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Accepted: 11/24/2008] [Indexed: 11/29/2022]
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Sághy L, Makai A, Bencsik G, Pap R. Coexistent right- and left-sided slow pathways participating in distinct AV nodal reentrant tachycardias. Pacing Clin Electrophysiol 2008; 31:1348-50. [PMID: 18811819 DOI: 10.1111/j.1540-8159.2008.01189.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report a patient with two distinct atrioventricular (AV) nodal slow pathways, participating in two different AV nodal reentrant tachycardias--one eliminated from the right, the other only after ablation on the left side of the posterior septum. The case provides support for the concept of the posterior AV nodal extensions--a biatrial structure in most hearts--representing the anatomic basis of slow pathway conduction.
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Affiliation(s)
- László Sághy
- Second Department of Internal Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
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Tábori K, Baczkó I, Lengyel C, Orosz A, Pap R, Sághy L, Gy J. Species-dependent differences in the influence of heart rate variability on short-term variability of repolarization. J Mol Cell Cardiol 2008. [DOI: 10.1016/j.yjmcc.2008.02.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Pap R, Traykov VB, Makai A, Bencsik G, Forster T, Sághy L. Ablation of posteroseptal and left posterior accessory pathways guided by left atrium-coronary sinus musculature activation sequence. J Cardiovasc Electrophysiol 2008; 19:653-8. [PMID: 18284500 DOI: 10.1111/j.1540-8167.2008.01103.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION While some posteroseptal and left posterior accessory pathways (APs) can be ablated on the tricuspid annulus or within the coronary venous system, others require a left-sided approach. "Fragmented" or double potentials are frequently recorded in the coronary sinus (CS), with a smaller, blunt component from left atrial (LA) myocardium, and a larger, sharp signal from the CS musculature. METHODS AND RESULTS Forty patients with posteroseptal or left posterior AP were included. The LA-CS activation sequence was determined at the earliest site during retrograde AP conduction. Eleven APs (27.5%) were ablated on the tricuspid annulus (right endocardial), 9 (22.5%) inside the coronary venous system (epicardial), and 20 (50%) on the mitral annulus (left endocardial). A "fragmented" or double "atrial" potential was recorded in all patients inside the CS at the earliest site during retrograde AP conduction. Sharp potential from the CS preceded the LA blunt component (sharp/blunt sequence) in all patients with an epicardial AP, and in 10 of 11 (91%) patients with a right endocardial AP. Therefore, 18 of 19 (95%) APs ablated by a right-sided approach produced this pattern. The reverse sequence (blunt/sharp) was recorded in 19 of 20 (95%) patients with a left endocardial AP. CONCLUSION During retrograde AP conduction, the sequence of LA-CS musculature activation-as deduced from analysis of electrograms recorded at the earliest site inside the CS-can differentiate posteroseptal and left posterior APs that require left heart catheterization from those that can be eliminated by a totally venous approach.
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Affiliation(s)
- Róbert Pap
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary.
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Pap R, Makai A, Sághy L. Post-incisional right atrial tachycardia eliminated by a single radiofrequency lesion. J Interv Card Electrophysiol 2007; 19:73-6. [PMID: 17668306 DOI: 10.1007/s10840-007-9141-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Accepted: 06/04/2007] [Indexed: 11/26/2022]
Affiliation(s)
- Róbert Pap
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Korányi fasor 6., Szeged 6720, Hungary.
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Traykov VB, Pap R, Bencsik G, Makai A, Sághy L. Transition of Narrow into Wide Complex Tachycardia with Left Bundle Branch Block Morphology and Varying QRS Duration: What is the Mechanism? Pacing Clin Electrophysiol 2007; 30:547-50. [PMID: 17437581 DOI: 10.1111/j.1540-8159.2007.00707.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Makai A, Csillik A, Csanádi Z, Sághy L, Forster T, Rudas L. Unusual case of orthostatic tachycardia. Orv Hetil 2007; 148:77-80. [PMID: 17344123 DOI: 10.1556/oh.2007.27850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Bevezetés:
Az orthostasis intolerancia, az orthostaticus tachycardia gyakran jelez hypovolemiát, gyógyszermellékhatást vagy autonóm elégtelenséget. Az orthostasisszal provokálható tachyarrhythmia ritka jelenség, emelt fejvégű billenőasztal vizsgálatsorozatokban csak elvétve fordul elő.
Célkitűzés:
A szerzők egy olyan beteget mutatnak be, akinek AV-csomó reentry tachycardiás paroxysmusait függőleges testhelyzet provokálta.
Módszer:
Vagusmanőverekkel az anterográd lassú pálya vezetésének blokkolása révén sikeresen szüntették a tachycardiát.
Eredmények:
Figyelemre méltó, hogy a vagusmanőverek csak vízszintes testhelyzetben bizonyultak hatásosnak.
Következtetés:
Ez a megfigyelés felhívja a figyelmet a manőverek pontos kivitelezésének fontosságára.
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Affiliation(s)
- Attila Makai
- Szegedi Tudományegyetem, Altalános Orvostudományi Kar, Aneszteziológiai és Intenzív Terápiás Intézet, Altalános Intenzív Részleg, Szeged, Korányi fasor 7, 6720.
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Makai A, Sághy L, Rudas L, Szepes A, Vincze D, Fazekas T. [Wenckebach AV block, as part of vasovagal syncope]. Orv Hetil 2002; 143:2351-3. [PMID: 12434737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Vasovagal syncope or common faint is the most frequent form of syncopes. With regard to the different involvement of the efferent mechanisms, several forms of the neurally mediated syncope syndromes are recognized. The authors present a case of mixed type vasovagal syncope, diagnosed by tilt table testing. The efferent mechanisms of syncope included Wenckebach type atrioventricular block due to increased vagal tone, and sympathetic withdrawal, reflected by sudden drop in the blood pressure. The significance and interrelationship of these factors are discussed.
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Affiliation(s)
- Attila Makai
- Szegedi Tudományegyetem, Altalános Orvostudományi Kar, Szent Györgyi Albert Orvos és Gyógyszertudományi Centrum, II. Belgyógyászati Klinika és Kardiológiai Központ, Belgyógyászati Intenzív Osztály
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Abstract
The changes in red blood cell (RBC) lipid peroxidation [measured via the malonyl dialdehyde (MDA) concentration], reduced (GSH), and oxidized glutathione (GSSG) levels, hemoglobin (Hb) oxidation and antioxidant enzyme [catalase (Cat), glutathione peroxidase, and superoxide dismutase (SOD)] activities were studied in 45 pediatric patients with various glomerular diseases [minimal change nephrotic syndrome (MCNS) in relapse or in remission, lupus nephropathy (SLE), poststreptococcal glomerulonephritis (APSGN), IgA nephropathy (IGA gn)], and in 20 adult patients with IGA gn and also in 15 pediatric and 14 adult controls. The in vitro effects of hydrogen peroxide [acetyl phenylhydrazine (APH) test] on the GSH and Hb metabolisms were likewise investigated. There was an increased oxidative stress in MCNS with relapse, IGA gn, SLE gn, and APSGN, which could be detected in the GSH and Hb oxidation and in the lipid peroxidation on the peripheral RBC-s. The RBC SOD and Cat activities were significantly lower in all patients than in the controls. The RBC GSSG level was significantly elevated in all patients, with the exception of MCNS in remission. This stimulated a compensatory GSH production in MCNS with relapse and in IGA gn, but not in SLE or APSGN. The regeneration of GSH from GSSG was reduced in MCNS with relapse, SLE, and IGA gn, but not in APSGN. In remission, the GSH-GSSG redox system normalizes, but in vitro the APH test stimulates an intensive Hb oxidation. In conclusion, there is a correlation between the presence of active glomerular disease and the evidence of oxidative changes in the various parameters measured in peripheral RBCs.
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Affiliation(s)
- S Túri
- Department of Paediatrics, Albert Szent-Györgyi Medical University, Szeged, Hungary
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