BACKGROUND: Left bundle branch area pacing (LBBAP) may be associated with greater improvement in left ventricular ejection fraction and reduction in death or heart failure hospitalization compared with biventricular pacing (BVP) in patients requiring cardiac resynchronization therapy. We sought to compare the occurrence of sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) and new-onset atrial fibrillation (AF) in patients undergoing BVP and LBBAP. METHODS: The I-CLAS study (International Collaborative LBBAP Study) included patients with left ventricular ejection fraction ≤35% who underwent BVP or LBBAP for cardiac resynchronization therapy between January 2018 and June 2022 at 15 centers. We performed propensity score-matched analysis of LBBAP and BVP in a 1:1 ratio. We assessed the incidence of VT/VF and new-onset AF among patients with no history of AF. Time to sustained VT/VF and time to new-onset AF was analyzed using the Cox proportional hazards survival model. RESULTS: Among 1778 patients undergoing cardiac resynchronization therapy (BVP, 981; LBBAP, 797), there were 1414 propensity score-matched patients (propensity score-matched BVP, 707; propensity score-matched LBBAP, 707). The occurrence of VT/VF was significantly lower with LBBAP compared with BVP (4.2% versus 9.3%; hazard ratio, 0.46 [95% CI, 0.29-0.74]; P<0.001). The incidence of VT storm (>3 episodes in 24 hours) was also significantly lower with LBBAP compared with BVP (0.8% versus 2.5%; P=0.013). Among 299 patients with cardiac resynchronization therapy pacemakers (BVP, 111; LBBAP, 188), VT/VF occurred in 8 patients in the BVP group versus none in the LBBAP group (7.2% versus 0%; P<0.001). In 1194 patients with no history of VT/VF or antiarrhythmic therapy (BVP, 591; LBBAP, 603), the occurrence of VT/VF was significantly lower with LBBAP than with BVP (3.2% versus 7.3%; hazard ratio, 0.46 [95% CI, 0.26-0.81]; P=0.007). Among patients with no history of AF (n=890), the occurrence of new-onset AF >30 s was significantly lower with LBBAP than with BVP (2.8% versus 6.6%; hazard ratio, 0.34 [95% CI, 0.16-0.73]; P=0.008). The incidence of AF lasting >24 hours was also significantly lower with LBBAP than with BVP (0.7% versus 2.9%; P=0.015). CONCLUSIONS: LBBAP was associated with a lower incidence of sustained VT/VF and new-onset AF compared with BVP. This difference remained significant after adjustment for differences in baseline characteristics between patients with BVP and LBBAP. Physiological resynchronization by LBBAP may be associated with lower risk of arrhythmias compared with BVP.

• MeSH
• elektrokardiografie MeSH
• fibrilace komor epidemiologie   etiologie   terapie   MeSH
• funkce levé komory srdeční MeSH
• komorová tachykardie * epidemiologie   etiologie   terapie   MeSH
• lidé MeSH
• srdeční resynchronizační terapie * škodlivé účinky   MeSH
• srdeční selhání * epidemiologie   terapie   MeSH
• tepový objem MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

AIMS: To predict worsening heart failure hospitalizations (WHFHs) in patients with implantable defibrillators and remote monitoring, the HeartInsight algorithm (Biotronik, Berlin, Germany) calculates a heart failure (HF) score combining seven physiologic parameters: 24 h heart rate (HR), nocturnal HR, HR variability, atrial tachyarrhythmia, ventricular extrasystoles, patient activity, and thoracic impedance. We compared temporal trends of the HF score and its components 12 weeks before a WHFH with 12-week trends in patients without WHFH, to assess whether trends indicate deteriorating HF regardless of alert status. METHODS AND RESULTS: Data from nine clinical trials were pooled, including 2050 patients with a defibrillator capable of atrial sensing, ejection fraction ≤ 35%, NYHA class II/III, no long-standing atrial fibrillation, and 369 WHFH from 259 patients. The mean HF score was higher in the WHFH group than in the no WHFH group (42.3 ± 26.1 vs. 30.7 ± 20.6, P < 0.001) already at the beginning of 12 weeks. The mean HF score further increased to 51.6 ± 26.8 until WHFH (+22% vs. no WHFH group, P = 0.003). As compared to the no WHFH group, the algorithm components either were already higher 12 weeks before WHFH (24 h HR, HR variability, thoracic impedance) or significantly increased until WHFH (nocturnal HR, atrial tachyarrhythmia, ventricular extrasystoles, patient activity). CONCLUSION: The HF score was significantly higher at, and further increased during 12 weeks before WHFH, as compared to the no WHFH group, with seven components showing different behaviour and contribution. Temporal trends of HF score may serve as a quantitative estimate of HF condition and evolution prior to WHFH.

• MeSH
• defibrilátory implantabilní * MeSH
• extrasystoly MeSH
• hospitalizace MeSH
• komorová tachykardie * diagnóza   terapie   MeSH
• lidé MeSH
• srdeční selhání * diagnóza   terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH

• MeSH
• defibrilátory implantabilní MeSH
• hypertenze farmakoterapie   komplikace   MeSH
• komorová tachykardie terapie   MeSH
• lidé MeSH
• senioři MeSH
• zástava srdce mimo nemocnici * terapie   MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

BACKGROUND: Primary preventive implantation of implantable defibrillator (ICD) is according to current guidelines indicated in patients with heart failure NYHA (New York Heart Association) class II/III and LVEF <35%. Thanks to advances in heart failure pharmacotherapy, a decrease in mortality could render a benefit of ICD insufficient to justify its implantation in some patients. METHODS: Study design: multicenter, prospective, randomized, controlled trial evaluating the benefit of implantation of Cardiac Resynchronization and Defibrillator Therapy (CRT-D) or CRT Alone (CRT-P) in non-ischemic patients with reduced left ventricle ejection fraction (LVEF) and optimal pharmacotherapy without significant mid-wall myocardial fibrosis detected by cardiac magnetic resonance (CMR). The primary end-point: Re-hospitalization for heart failure, ventricular tachycardia, major adverse cardiac events (MACE). The secondary end-points: Sudden cardiac death, cardiovascular death, resuscitated cardiac arrest or sustained ventricular tachycardia, device-related complications, and change in quality of life. Course of the study: After a pharmacotherapy is optimized and significant mid-wall myocardial fibrosis excluded, patients will be randomized 1:1 to CRT-P or CRT-D implantation. DISCUSSION: If our hypothesis is confirmed, this could provide evidence for the management of these patients with a significant impact on common daily praxis and health care expenditures. TRIAL REGISTRATION: CLINICALTRIALS: gov, NCT04139460.

• MeSH
• defibrilátory implantabilní * MeSH
• dilatační kardiomyopatie * komplikace   diagnostické zobrazování   terapie   MeSH
• fibróza MeSH
• gadolinium MeSH
• kardiomyopatie * terapie   MeSH
• komorová tachykardie * terapie   MeSH
• kontrastní látky MeSH
• kvalita života MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• prospektivní studie MeSH
• srdeční resynchronizační terapie * MeSH
• srdeční selhání * MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH

• MeSH
• defibrilátory implantabilní * škodlivé účinky   MeSH
• elektrická defibrilace * škodlivé účinky   MeSH
• fibrilace komor terapie   MeSH
• komorová tachykardie terapie   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH

BACKGROUND: Children with catecholaminergic polymorphic ventricular tachycardia (CPVT) are at risk for sudden death, and a risk stratification tool does not exist. OBJECTIVE: The purpose of this study was to determine whether proband status, age at symptom onset, and/or sex are independent predictors of cardiac events. METHODS: A multicenter, ambispective, cohort of pediatric CPVT patients was categorized by sex, proband status, and age at symptom onset (D1: first decade of life [symptom onset <10 years] or D2: second decade of life [symptom onset 10-18 years, inclusive]). Demographics, therapy, genetics, and outcomes were compared between groups. RESULTS: A total of 133 patients were included and stratified into 58 D1 and 75 D2 patients (68 female and 65 male; 106 probands and 27 relatives). Localization of RYR2 variants to hotspots differed based on proband status and age at symptom onset. The cardiac event rate was 33% (n = 44/133), inclusive of a 3% (n = 4/133) mortality rate, over a median of 6 years (interquartile range 3-11) after time of symptom onset. Proband status, rather than age at of symptom onset or sex, was an independent predictor of time to first cardiac event (P = .008; hazard ratio = 4.4). The 5-, 10- and 15-year event-free survival rates for probands were 77%, 56%, and 46%, respectively, and for relatives were 96%, 91%, and 86%, respectively. Event risk after diagnosis was 48% (32/67) in patients on β-blocker or flecainide alone vs 10% (5/48) in patients on β-blocker plus flecainide and/or left cardiac sympathetic denervation (P <.001). CONCLUSION: Proband status, but not age at symptom onset or male sex, independently predicted an earlier onset of cardiac events. A larger sample size would enable a comprehensive investigation of other risk factors.

• MeSH
• dítě MeSH
• komorová tachykardie epidemiologie   terapie   MeSH
• lidé MeSH
• mladiství MeSH
• rizikové faktory MeSH
• sexuální faktory MeSH
• stupeň závažnosti nemoci MeSH
• věk při počátku nemoci MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Kanada MeSH
• Spojené státy americké MeSH

Arytmie představují nejčastější komplikaci infarktu myokardu. Přehled stručně shrnuje z pohledu aktuálních poznatků problematiku arytmií, které se obvykle vyskytují v souvislosti s infarktem myokardu.

Arrhythmias are the most frequent complication of myocardial infarction. This review summarizes the up-to-date management of the most common arrhythmias in acute and post-myocardial infarction patients.

• MeSH
• akutní nemoc terapie   MeSH
• antikoagulancia terapeutické užití   MeSH
• bradykardie terapie   MeSH
• defibrilátory implantabilní MeSH
• fibrilace komor terapie   MeSH
• fibrilace síní terapie   MeSH
• infarkt myokardu * komplikace   MeSH
• komorová tachykardie terapie   MeSH
• lidé MeSH
• rizikové faktory kardiovaskulárních chorob MeSH
• trombóza prevence a kontrola   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Česká republika je na předních světových místech v počtu implantací kardiostimulátorů i defibrilátorů v Evropě. Stále častěji mohou mít některý z implantátů lidé v mladší generaci. Kardiologové jsou pak konfrontováni s dotazy a doporučeními, zda a za jakých podmínek se může pacient s implantovaným kardiostimulátorem či defibrilátorem věnovat sportovní aktivitě. Tato péče vyžaduje specifické kardiologické vzdělání souběžně s porozuměním mysli a tužeb sportovce. Nově vznikající subspecializace sportovní kardiologie jde výše zmíněným požadavkům naproti a stává se mostem mezi světem sportu a světem pacientů s kardiovaskulárním onemocněním. V této přehledové práci jsou shrnuta ve zkrácené formě aktuálně publikovaná data o jednotlivých aspektech sportu s implantovaným kardiostimulátorem a defibrilátorem. Jsou diskutovány otázky indikace implantací, návratu ke sportovní činnosti po implantaci, péče o oblast generátoru po implantaci, zatížení elektrod u sportovců, specifikace programování systémů u sportovců, zátěžového testování. V neposlední řadě jsou shrnuta fakta o způsobilosti sportovce s implantovaným systémem ke sportu.

The Czech Republic is one of the leaders in the number of implantations of pacemakers and defibrillators in Europe. Increasingly, people in the younger generation may have one of the implants. Cardiologists are then confronted with questions and asked for recommendations about conditions a patient with an implanted pacemaker or defibrillator can engage in the sports activity. This care requires specific cardiological educa- tion along with an understanding of the athlete's mind and desires. The emerging sub-specialization of sports cardiology answers the above-mentioned requirements and becomes a bridge between the world of sports and the world of patients with cardiovascular disease. In this review, the currently published data on individual aspects of the sport with an implanted pacemaker and defibrillator are summarized in an abbreviated form. Issues of indication of implants, return to sports activities after implantation, care of the generator area, issues of electrode durability in athletes, specifica- tions of system programming in athletes, stress testing are discussed. Finally, the facts about the eligibility of an athlete with an implanted system for sport are summarized.

• MeSH
• defibrilátory implantabilní normy   statistika a číselné údaje   MeSH
• kardiostimulátor mikrobiologie   statistika a číselné údaje   MeSH
• komorová tachykardie klasifikace   terapie   MeSH
• lidé MeSH
• osobní ochranné prostředky normy   MeSH
• prostředky srdeční resynchronizační terapie statistika a číselné údaje   trendy   MeSH
• sportovci MeSH
• sporty klasifikace   MeSH
• srdeční arytmie * chirurgie   epidemiologie   klasifikace   MeSH
• určení vhodnosti pacienta normy   MeSH
• zátěžový test metody   normy   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH
• směrnice pro lékařskou praxi MeSH

BACKGROUND: Venous ethanol infusion via an occlusive balloon has been used as a bailout approach to treat ablation-refractory ventricular arrhythmias (VAs). Unfavorable venous anatomy (lack of intramural veins at the targeted site or collateral vein-ethanol shunting) limits its efficacy. Blocking collateral flow with a second balloon may optimize myocardial ethanol delivery. OBJECTIVE: The purpose of this study was to validate the "double-balloon" approach to enhance ethanol delivery in cases of unfavorable venous anatomy. METHODS: Eight patients referred after failed ablations (3 left ventricular [LV] summit, 5 scar-related ventricular tachycardia) underwent endocardial mapping and additional radiofrequency ablation without VA resolution. Coronary veins were mapped using a multipolar catheter or wire, and selective venograms were obtained. The double balloon was used when (1) distal collateral branches shunted flow away from the targeted region; (2) the target vein had optimal signals only proximally; or (3) a large vein was targeted that had multiple branches for a large area of interest. RESULTS: Acute successful ethanol infusion myocardial delivery and resolution of VA was accomplished using the posterolateral LV veins (n = 2 patients, 3 procedures), lateral LV vein (n = 1), apical anterior interventricular vein (AIV; n = 1), middle cardiac vein (n = 1), and septal branches of the AIV (n = 3). At median follow-up of 313.5 days, 2 patients experienced recurrence. CONCLUSION: The double-balloon technique can enhance ethanol delivery to target isolated vein segments, block collateral flow, or target extensive areas, and can expand the utility of venous ethanol for treatment of VAs.

• MeSH
• ablace metody   MeSH
• dospělí MeSH
• elektrokardiografie MeSH
• ethanol aplikace a dávkování   MeSH
• flebografie MeSH
• komorová tachykardie diagnóza   patofyziologie   terapie   MeSH
• koronární cévy diagnostické zobrazování   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• následné studie MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• srdeční komory patofyziologie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural MeSH

BACKGROUND: Andersen-Tawil Syndrome type 1 (ATS1) is a rare arrhythmogenic disorder, caused by loss-of-function mutations in the KCNJ2 gene. We present here the largest cohort of patients with ATS1 with outcome data reported. OBJECTIVES: This study sought to define the risk of life-threatening arrhythmic events (LAE), identify predictors of such events, and define the efficacy of antiarrhythmic therapy in patients with ATS1. METHODS: Clinical and genetic data from consecutive patients with ATS1 from 23 centers were entered in a database implemented at ICS Maugeri in Pavia, Italy, and pooled for analysis. RESULTS: We enrolled 118 patients with ATS1 from 57 families (age 23 ± 17 years at enrollment). Over a median follow-up of 6.2 years (interquartile range: 2.7 to 16.5 years), 17 patients experienced a first LAE, with a cumulative probability of 7.9% at 5 years. An increased risk of LAE was associated with a history of syncope (hazard ratio [HR]: 4.54; p = 0.02), with the documentation of sustained ventricular tachycardia (HR 9.34; p = 0.001) and with the administration of amiodarone (HR: 268; p < 0.001). The rate of LAE without therapy (1.24 per 100 person-years [py]) was not reduced by beta-blockers alone (1.37 per 100 py; p = 1.00), or in combination with Class Ic antiarrhythmic drugs (1.46 per 100 py, p = 1.00). CONCLUSIONS: Our data demonstrate that the clinical course of patients with ATS1 is characterized by a high rate of LAE. A history of unexplained syncope or of documented sustained ventricular tachycardia is associated with a higher risk of LAE. Amiodarone is proarrhythmic and should be avoided in patients with ATS1.

• MeSH
• amiodaron aplikace a dávkování   škodlivé účinky   MeSH
• Andersenův syndrom komplikace   genetika   terapie   MeSH
• antiarytmika aplikace a dávkování   škodlivé účinky   MeSH
• beta blokátory terapeutické užití   MeSH
• databáze faktografické MeSH
• defibrilátory implantabilní MeSH
• dítě MeSH
• dospělí MeSH
• draslíkové kanály dovnitř usměrňující genetika   MeSH
• elektrokardiografie MeSH
• genetické testování MeSH
• hodnocení rizik * MeSH
• kojenec MeSH
• komorová tachykardie etiologie   terapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mutace MeSH
• náhlá srdeční smrt epidemiologie   MeSH
• předškolní dítě MeSH
• srdeční arytmie etiologie   terapie   MeSH
• svalová slabost etiologie   MeSH
• synkopa etiologie   terapie   MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• kojenec MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH