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Nekić A, Prepolec I, Pašara V, Bogdanić JE, Posavec JP, Kardum D, Katić Z, Štajduhar A, Nikolić BP, Puljević D, Miličić D, Chierchia GB, de Asmundis C, Velagić V. Treatment of atrial fibrillation with second-generation cryoballoon followed by contact-sensing radiofrequency catheter ablation for arrhythmia recurrences-results of a 5-year follow-up. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01752-8. [PMID: 38261100 DOI: 10.1007/s10840-024-01752-8] [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: 11/26/2023] [Accepted: 01/14/2024] [Indexed: 01/24/2024]
Abstract
INTRODUCTION The aim of this study was to report the long-term follow-up results of cryoballoon (CB) ablation in patients with atrial fibrillation. METHODS All consecutive patients who underwent second-generation CB ablation from February 2015 to December 2017 were included in our study. In all procedures, we used a 28-mm CB placed via a single transseptal puncture guided by intracardiac ultrasound. A 20-mm octapolar intraluminal circular catheter was used for intracardiac recordings. A single 180-s freeze strategy was employed. Repeated procedures were performed with a 3D mapping system and radiofrequency catheters. RESULTS A total of 126 patients (69.8% male, mean age 57 ± 11 years), of which 77.0% had paroxysmal atrial fibrillation (PAF), were included in the study. After a 5-year period, 52.4% of patients were in sinus rhythm without AF recurrence, off antiarrhythmic drugs. A total of 61.9% of patients were free of AF recurrence when redo PVI procedures were performed. When accounting for redo pulmonary vein isolation and antiarrhythmic drugs, a total of 73.8% of the patients were without AF recurrence in long-term follow-up. The patients who underwent redo pulmonary vein isolation procedures had statistically significant lower rates of AF recurrence (p = 0.006). In patients with PAF, long-term success rates improved from 62.9 to 79.4% for patients who underwent the redo procedure (p = 0.020). In patients with persistent atrial fibrillation (PersAF), success rates went up from 41.4 to 55.1% for patients with single or repeated PVI procedure (p = 0.071). In the whole cohort, a total of 3 (2.4%) procedure-related major complications occurred which included persistent PNP, arterial pseudoaneurysm, and arteriovenous fistula. CONCLUSION Our data suggest a favorable long-term safety and efficacy profile of second-generation CB ablation. In the mixed paroxysmal and persistent population, up to 73.8% of patients remained free of AF recurrence in the 5-year follow-up, when accounting for redo procedures and AADs. Only 2.4% of patients experienced major complications of the ablation procedure, none with permanent sequelae.
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Affiliation(s)
- Andrija Nekić
- School of Medicine, University of Zagreb, Šalata 3, Zagreb, Croatia
| | - Ivan Prepolec
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Vedran Pašara
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | | | | | - Domagoj Kardum
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Zvonimir Katić
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | | | - Borka Pezo Nikolić
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Davor Puljević
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Davor Miličić
- School of Medicine, University of Zagreb, Šalata 3, Zagreb, Croatia
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - G B Chierchia
- Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium
| | | | - Vedran Velagić
- School of Medicine, University of Zagreb, Šalata 3, Zagreb, Croatia.
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia.
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Pavlović N, Đula K, Kuharić I, Brusich S, Velagić V, Jurišić Z, Bakotić Z, Anić A, Pezo Nikolić B, Radeljić V, Čubranić Z, Zeljković I, Zadravec D, Manola Š. MANAGEMENT OF PATIENTS WITH CARDIAC IMPLANTABLE ELECTRONIC DEVICES UNDERGOING MAGNETIC RESONANCE IMAGING - PROPOSAL FOR UNIFIED HOSPITAL PROTOCOL: CROATIAN WORKING GROUP ON ARRHYTHMIAS AND CARDIAC PACING. Acta Clin Croat 2020; 59:119-125. [PMID: 32724282 PMCID: PMC7382882 DOI: 10.20471/acc.2020.59.01.14] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
For many years, magnetic resonance imaging (MRI) was contraindicated in patients with cardiac implantable electronic devices (CIED). Today, there is a growing amount of evidence that MRI can be performed safely in the majority of patients with CIEDs. Firstly, there are devices considered MRI conditional by manufacturers that are available on the market and secondly, there is clear evidence that even patients with MRI non-conditional devices can also undergo MRI safely. Protocols have been developed and recommendations from different cardiac and radiologic societies have been published in recent years. However, the majority of physicians are still reluctant to refer these patients to MRI. Therefore, this document is published as a joint statement of the Croatian Working Group on Arrhythmias and Cardiac Pacing and Department of Radiology, Sestre milosrdnice University Hospital Centre to guide and ease the management of patients with CIED undergoing MRI. Also, we propose a unified protocol and checklist that could be used in Croatian hospitals.
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Affiliation(s)
- Nikola Pavlović
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Kristijan Đula
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Ivan Kuharić
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Sandro Brusich
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Vedran Velagić
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Zrinka Jurišić
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Zoran Bakotić
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Ante Anić
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Borka Pezo Nikolić
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Vjekoslav Radeljić
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Zlatko Čubranić
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Ivan Zeljković
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Dijana Zadravec
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Šime Manola
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
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Ströker E, Takarada K, de Asmundis C, Abugattas JP, Mugnai G, Velagić V, de Regibus V, Coutiño HE, Choudhury R, Iacopino S, De Greef Y, Tanaka K, Brugada P, Chierchia GB. Second-generation cryoballoon ablation in the setting of left common pulmonary veins: Procedural findings and clinical outcome. Heart Rhythm 2017. [DOI: 10.1016/j.hrthm.2017.06.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Velagić V, de Asmundis C, Mugnai G, Hünük B, Hacioğlu E, Ströker E, Moran D, Ruggiero D, Poelaert J, Verborgh C, Umbrain V, Paparella G, Beckers S, Brugada P, Chierchia GB. Learning curve using the second-generation cryoballoon ablation. J Cardiovasc Med (Hagerstown) 2017; 18:518-527. [DOI: 10.2459/jcm.0000000000000493] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Puljević M, Velagić V, Pezo-Nikolić B, Puljević D. [ATRIAL FIBRILLATION AND HEMODINAMICALY UNSTABLE WIDE QRS COMPLEX TACHYCARDIA – A case report]. Lijec Vjesn 2016; 138:255-259. [PMID: 30148551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Tachycardia is an arrhythmia characterized by heart rate > 100 / minute. According to the width of the QRS complex it can be divided into narrow QRS (< 120 ms) and wide QRS tachycardia (> 120 ms). Narrow QRS tachycardia is always supraventricular which means that its source is proximal to the bundle of His, while wide QRS tachycardia can be ventricular (source is in the ventricle, distal to the bundle of His) or supraventricular. The strategies for treating these two conditions are different so the correct diagnosis is prerequisite for optimal therapy. We present this case because the differential diagnosis of wide QRS tachycardia and therefore the treatment planning was particularly difficult due to concurrently present atrial fibrillation with hemodynamic compromise and an acute threat to the life of the patient.
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Ströker E, de Asmundis C, Saitoh Y, Velagić V, Mugnai G, Irfan G, Hünük B, Tanaka K, Belsack D, Buyl R, Brugada P, Chierchia GB. Anatomic predictors of phrenic nerve injury in the setting of pulmonary vein isolation using the 28-mm second-generation cryoballoon. Heart Rhythm 2016; 13:342-51. [DOI: 10.1016/j.hrthm.2015.10.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Indexed: 10/22/2022]
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Ciconte G, Velagić V, Mugnai G, Saitoh Y, Irfan G, Hunuk B, Ströker E, Conte G, Sieira J, Di Giovanni G, Baltogiannis G, Brugada P, de Asmundis C, Chierchia GB. Electrophysiological findings following pulmonary vein isolation using radiofrequency catheter guided by contact-force and second-generation cryoballoon: lessons from repeat ablation procedures. Europace 2016; 18:71-77. [DOI: 10.1093/europace/euv224] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Ciconte G, Mugnai G, Sieira J, Velagić V, Saitoh Y, Irfan G, Hunuk B, Ströker E, Conte G, Di Giovanni G, Baltogiannis G, Wauters K, Brugada P, de Asmundis C, Chierchia GB. On the Quest for the Best Freeze. Circ Arrhythm Electrophysiol 2015; 8:1359-65. [DOI: 10.1161/circep.115.002966] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [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: 03/13/2015] [Accepted: 10/27/2015] [Indexed: 11/16/2022]
Abstract
Background—
The second-generation cryoballoon is effective in achieving acute pulmonary vein isolation (PVI) and favorable clinical outcome. To date, no data are available on factors affecting late PV reconnection after second-generation cryoballoon ablation.
Methods and Results—
A total of 29 consecutive patients (25 male, 86.2%; mean age 57.8±13.8 years) underwent a repeat procedure, after a mean 11.6±4.5 months (range, 3.5–19.7 months), after index ablation using the 28-mm second-generation cryoballoon. All repeat ablations were performed using a 3-dimensional electroanatomical mapping system. Among all 115 PVs, including 1 left common ostiums (LCOs), 25 (21.7%) showed a PV reconnection in 20 patients (1.25 per patient). Persistent PVI could be documented in 90 of 115 PVs (78.2%). In 9 of 29 patients (31%), all PVs were electrically isolated. In the multivariable analysis, time to PVI (
P
=0.03) and failure to achieve −40°C within 60 s (
P
=0.05) independently predicted late PV reconnection. At receiver-operator curve analysis, time to PVI <60 s identified the absence of PV reconduction (sensitivity, 86.7%; specificity, 86.2%; positive predictive value, 59.1%; and negative predictive value, 96.4%; area under the curve, 0.85; confidence interval, 0.73–0.97;
P
<0.001).
Conclusions—
The rate of late PV reconnection after second-generation cryoballoon ablation is low (1.25 PVs/patient). Faster time to isolation and achievement of −40°C within 60 s independently predict durable PVI. In addition, 60-s cut-off for time to PVI indicates persistent isolation with 96.4% negative predictive value. These parameters might guide the operator whether to perform further applications to ensure a long-lasting PVI.
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Affiliation(s)
- Giuseppe Ciconte
- From the Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium
| | - Giacomo Mugnai
- From the Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium
| | - Juan Sieira
- From the Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium
| | - Vedran Velagić
- From the Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium
| | - Yukio Saitoh
- From the Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium
| | - Ghazala Irfan
- From the Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium
| | - Burak Hunuk
- From the Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium
| | - Erwin Ströker
- From the Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium
| | - Giulio Conte
- From the Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium
| | | | | | - Kristel Wauters
- From the Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium
| | - Pedro Brugada
- From the Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium
| | - Carlo de Asmundis
- From the Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium
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Saitoh Y, Ströker E, Irfan G, Mugnai G, Ciconte G, Hünük B, Velagić V, Overeinder I, Tanaka K, Brugada P, de Asmundis C, Chierchia GB. Fluoroscopic position of the second-generation cryoballoon during ablation in the right superior pulmonary vein as a predictor of phrenic nerve injury. Europace 2015; 18:1179-86. [DOI: 10.1093/europace/euv362] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 10/02/2015] [Indexed: 11/14/2022] Open
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Velagić V, Chierchia GB, La Meir M. Clipping to sinus rhythm: cardioversion of atrial fibrillation by a thoracoscopic left atrial appendage occlusion. Europace 2015; 17:1532. [PMID: 26333376 DOI: 10.1093/europace/euv199] [Citation(s) in RCA: 3] [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: 11/14/2022] Open
Affiliation(s)
- Vedran Velagić
- Centre for Cardiovascular Diseases, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Gian-Battista Chierchia
- Centre for Cardiovascular Diseases, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Mark La Meir
- Centre for Cardiovascular Diseases, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
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Affiliation(s)
- Vedran Velagić
- Department of Cardiovascular Medicine, University of Zagreb School of Medicine and University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb 10000, Croatia
| | - Richard Matasić
- Department of Cardiovascular Medicine, University of Zagreb School of Medicine and University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb 10000, Croatia
| | - Maja Čikeš
- Department of Cardiovascular Medicine, University of Zagreb School of Medicine and University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb 10000, Croatia
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Saitoh Y, Irfan G, Ciconte G, Mugnai G, Sieira J, Di Giovanni G, Baltogiannis G, Conte G, Hünük B, Ströker E, Velagić V, Overeinder I, De Asmundis C, Chierchia GB, Brugada P. Persistence of Phrenic Nerve Palsy Following 28-mm Cryoballoon Ablation: A Four-Year Single Center Experience. Pacing Clin Electrophysiol 2015; 38:807-14. [PMID: 25851416 DOI: 10.1111/pace.12636] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 03/24/2015] [Accepted: 03/29/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Phrenic nerve palsy (PNP) is the most frequently observed complication in the setting of cryoballoon (CB) ablation (Arctic Front, Medtronic Inc., Minneapolis, MN, USA). Although, usually transient, resolving before the end of the procedure, persistent PNP (not resolving before the end of procedure) can occur. Literature on persistent PNP after second generation CB ablation is relatively sparse. METHODS A total of 316 consecutive patients having undergone large 28-mm CB ablation as index procedure in the Heart Rhythm Management Center, UZ Brussels, Belgium, from January 2009 to December 2013 were retrospectively reviewed for the study. Of these 117 patients were treated with the first generation CB (CB1) and 199 patients with the second generation CB (CB2). RESULTS PNP occurred in 10% of the total population. Persistent PNP was only observed following CB2 ablation which occurred in 4.5% of the group. At a mean follow-up of 11 months, diaphragmatic contraction in persistent PNP patients resumed in 78% (7/9) of the patients. In a final follow-up at 5 and 20 months, PNP persisted in two patients, respectively. PNP during ablation in the right inferior pulmonary vein was only observed in the CB2 group. No predictors of persistency of PNP were observed. CONCLUSION Persistence of PNP only occurred in the CB2 group in 4.5% of patients. The majority of patients with persistent PNP were asymptomatic. In most of the patients having persistent PNP after ablation, complete phrenic nerve function resumed during follow-up (78%).
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Affiliation(s)
- Yukio Saitoh
- From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium
| | - Ghazala Irfan
- From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium
| | - Giuseppe Ciconte
- From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium
| | - Giacomo Mugnai
- From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium
| | - Juan Sieira
- From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium
| | | | | | - Giulio Conte
- From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium
| | - Burak Hünük
- From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium
| | - Erwin Ströker
- From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium
| | - Vedran Velagić
- From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium
| | - Ingrid Overeinder
- From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium
| | - Carlo De Asmundis
- From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium
| | | | - Pedro Brugada
- From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium
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Ciconte G, de Asmundis C, Sieira J, Conte G, Di Giovanni G, Mugnai G, Saitoh Y, Baltogiannis G, Irfan G, Coutiño-Moreno HE, Hunuk B, Velagić V, Brugada P, Chierchia GB. Single 3-minute freeze for second-generation cryoballoon ablation: One-year follow-up after pulmonary vein isolation. Heart Rhythm 2015; 12:673-80. [DOI: 10.1016/j.hrthm.2014.12.026] [Citation(s) in RCA: 161] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Indexed: 10/24/2022]
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Puljević M, Velagić V, Puljević D, Miličić D. Propranolol efficiency in prevention of sustained ventricular tachycardia in patients with implanted cardioverter-defibrillator: a case series. Croat Med J 2014; 55:75-6. [PMID: 24577831 PMCID: PMC3944421 DOI: 10.3325/cmj.2014.55.75] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Mislav Puljević
- Mislav Puljevic, University of Zagreb, School of Medicine, Department for Cardiovascular Diseases, Clinical Hospital Center Zagreb, Zagreb, Croatia,
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Puljević D, Velagić V, Puljević M, Pezo-Nikolić B. [The first case of radiofrequent ablation of ventricular tachycardia in a patient with ischemic cardiomyopathy in our country]. Lijec Vjesn 2013; 135:77-82. [PMID: 23671973] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Ablation of ventricular tachycardia in patients with ischemic cardiomyopathy is more complicated and more difficult than ablation of most supraventricular tachycardias. Arrhythmogenic substrate is complex and its localisation is often unclear. Because of the tachycardia characteristics, more precise mapping methods often can't be utilised. Also, patients are usually seriously ill with decreased systolic function, heart failure, ischemia and various comorbidities where tachycardia induction and ablation procedure may facilitate abrupt hemodynamic disturbance. Uninducibility of the clinical tachycardia can be achieved in 65-95% of patients, but tachycardia recurs in 20-44% of patients. Serious complications were noted in 8% of patients with lethal outcome in 2.7% of patients. Decision about therapeutic strategy should be made individually according to potential risk and procedure benefit. This paper presents the first case of the successful ablation of ventricular tachycardia in a patient with ischemic cardiomyopathy in our country.
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Affiliation(s)
- Davor Puljević
- Klinika za bolesti srca i krvnih zila, Medicinski fakultet Sveucililta u Zagrebu, KBC Zagreb.
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Jajić Z, Rajnpreht I, Kovačić N, Lukić IK, Velagić V, Grubišić F, Marušić A, Grčević D. Which clinical variables have the most significant correlation with quality of life evaluated by SF-36 survey in Croatian cohort of patient with ankylosing spondylitis and psoriatic arthritis? Rheumatol Int 2011; 32:3471-9. [DOI: 10.1007/s00296-011-2190-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 10/22/2011] [Indexed: 11/29/2022]
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Čikeš M, Bijnens B, Đurić Ž, Benčič ML, Gošev I, Velagić V, Gašparović H, Miličić D, Biočina B. Detecting Volume Responders prior to Implantation of a Cardiac Resynchronization Therapy Device via Minithoracotomy: The Septal Flash as a Predictor of Immediate Left Ventricular Reverse Remodeling. Heart Surg Forum 2009; 12:E362-7. [DOI: 10.1532/hsf98.20091129] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Polasek O, Marusić A, Rotim K, Hayward C, Vitart V, Huffman J, Campbell S, Janković S, Boban M, Biloglav Z, Kolcić I, Krzelj V, Terzić J, Matec L, Tometić G, Nonković D, Nincević J, Pehlić M, Zedelj J, Velagić V, Juricić D, Kirac I, Belak Kovacević S, Wright AF, Campbell H, Rudan I. Genome-wide association study of anthropometric traits in Korcula Island, Croatia. Croat Med J 2009; 50:7-16. [PMID: 19260139 DOI: 10.3325/cmj.2009.50.7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
AIM To identify genetic variants underlying six anthropometric traits: body height, body weight, body mass index, brachial circumference, waist circumference, and hip circumference, using a genome-wide association study. METHODS The study was carried out in the isolated population of the island of Korcula, Croatia, with 898 adult examinees who participated in the larger DNA-based genetic epidemiological study in 2007. Anthropometric measurements followed standard internationally accepted procedures. Examinees were genotyped using HumanHap 370CNV chip by Illumina, with a genome-wide scan containing 316730 single nucleotide polymorphisms (SNP). RESULTS A total of 11 SNPs were associated with the investigated traits at the level of P<10(-5), with one SNP (rs7792939 in gene zinc finger protein 498, ZNF498) associated with body weight, hip circumference, and brachial circumference (P=3.59-5.73 x 10(-6)), and another one (rs157350 in gene delta-sarcoglycan, SGCD) with both brachial and hip circumference (P=3.70-6.08 x 10(-6). Variants in CRIM1, a gene regulating delivery of bone morphogenetic proteins to the cell surface, and ITGA1, involved in the regulation of mesenchymal stem cell proliferation and cartilage production, were also associated with brachial circumference (P=7.82 and 9.68 x 10(-6), respectively) and represent interesting functional candidates. Other associations involved those between genes SEZ6L2 and MAX and waist circumference, XTP6 and brachial circumference, and AMPA1/GRIA1 and height. CONCLUSION Although the study was underpowered for the reported associations to reach formal threshold of genome-wide significance under the assumption of independent multiple testing, the consistency of association between the 2 variants and a set of anthropometric traits makes CRIM1 and ITGA1 highly interesting for further replication and functional follow-up. Increased linkage disequilibrium between the used markers in an isolated population makes the formal significance threshold overly stringent, and changed allele frequencies in isolate population may contribute to identifying variants that would not be easily identified in large outbred populations.
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Affiliation(s)
- Ozren Polasek
- Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Croatia
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Kolcić I, Biloglav Z, Zgaga L, Jović AV, Curić I, Curić S, Susac J, Velagić V, Matec L, Zobić I, Zedelj J, Strnad M. Prevalence of increased body weight and hypertension in the population of Croatian mainland and Adriatic Islands--are islanders really healthier? Coll Antropol 2009; 33 Suppl 1:135-140. [PMID: 19563159] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The aim of this study was to compare the prevalence of the hypertension and the increased body weight (BMI) between Croatian mainland and Adriatic island population. The data from the Croatian Adult Health Survey (N = 9,070) served as an estimate for the mainland Croatian population, while the data from "1001 Dalmatian study" (N = 1,001) were collected from four Adriatic islands; Rab, Vis, Lastovo and Mljet. The prevalence of increased body weight and hypertension was calculated for the four age groups and analyzed using chi-square test. The results indicate that men from the islands less frequently had normal body mass index (P < 0.001), and were more frequently overweight (P < 0.001). The prevalence of overweight and obesity were similar between the island and mainland women. The percent of normotensive respondents in men was significantly lower in islands (P < 0.001), while the prevalence of newly diagnosed hypertension was significantly higher among islanders in both genders (P < 0.001). Despite the traditionally prevalent Mediterranean diet and overall more favorable lifestyle islanders may not be as healthy as previously studies suggested, in terms of cardiovascular risk factors prevalence. This might be related to the poor access to health care and preventive measures or low interest for health care especially among men on the islands, reflected in the higher prevalence of newly diagnosed hypertension. These findings suggest that island populations represent good candidates for disease awareness programs and health promotion interventions.
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Affiliation(s)
- Ivana Kolcić
- Department of Medical Statistics, Epidemiology and Medical Informatics, "Andrija Stampar" School of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia.
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Abstract
Nonalcoholic fatty liver disease (NAFLD) has, although it is a very common disorder, only relatively recently gained broader interest among physicians and scientists. Fatty liver has been documented in up to 10 to 15 percent of normal individuals and 70 to 80 percent of obese individuals. Although the pathophysiology of NAFLD is still subject to intensive research, several players and mechanisms have been suggested based on the substantial evidence. Excessive hepatocyte triglyceride accumulation resulting from insulin resistance is the first step in the proposed ‘two hit’ model of the pathogenesis of NAFLD. Oxidative stress resulting from mitochondrial fatty acids oxidation, NF-κB-dependent inflammatory cytokine expression and adipocytokines are all considered to be the potential factors causing second hits which lead to hepatocyte injury, inflammation and fibrosis. Although it was initially believed that NAFLD is a completely benign disorder, histologic follow-up studies have showed that fibrosis progression occurs in about a third of patients. A small number of patients with NAFLD eventually ends up with end-stage liver disease and even hepatocellular carcinoma. Although liver biopsy is currently the only way to confirm the NAFLD diagnosis and distinguish between fatty liver alone and NASH, no guidelines or firm recommendations can still be made as for when and in whom it is necessary. Increased physical activity, gradual weight reduction and in selected cases bariatric surgery remain the mainstay of NAFLD therapy. Studies with pharmacologic agents are showing promising results, but available data are still insufficient to make specific recommendations; their use therefore remains highly individual.
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Affiliation(s)
- Marko Duvnjak
- Division of Gastroenterology and Hepatology, Department of Medicine, Sestre Milosrdnice University Hospital, Vinogradska 29, Zagreb, Croatia.
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