BACKGROUND: The effect of left ventricular septal myocardial pacing (LVSP) and left bundle branch pacing (LBBP) on ventricular synchrony and left ventricular (LV) hemodynamic status is poorly understood. OBJECTIVES: The aim of this study was to investigate the impact of LVSP and LBBP vs biventricular pacing (BVP) on ventricular electrical synchrony and hemodynamic status in cardiac resynchronization therapy patients. METHODS: In cardiac resynchronization therapy candidates with LV conduction disease, ventricular synchrony was assessed by measuring QRS duration (QRSd) and using ultra-high-frequency electrocardiography. LV electrical dyssynchrony was assessed as the difference between the first activation in leads V1 to V8 to the last from leads V4 to V8. LV hemodynamic status was estimated using invasive systolic blood pressure measurement during multiple transitions between LBBP, LVSP, and BVP. RESULTS: A total of 35 patients with a mean LV ejection fraction of 29% and a mean QRSd of 168 ± 24 ms were included. Thirteen had ischemic cardiomyopathy. QRSd during BVP, LVSP, and LBBP was the same, but LBBP provided shorter LV electrical dyssynchrony than BVP (-10 ms; 95% CI: -16 to -4 ms; P = 0.001); the difference between LVSP and BVP was not significant (-5 ms; 95% CI: -12 to 1 ms; P = 0.10). LBBP was associated with higher systolic blood pressure than BVP (4%; 95% CI: 2%-5%; P < 0.001), whereas LVSP was not (1%; 95% CI: 0%-2%; P = 0.10). Hemodynamic differences during LBBP and LVSP vs BVP were more pronounced in nonischemic than ischemic patients. CONCLUSIONS: Ultra-high-frequency electrocardiography allowed the documentation of differences in LV synchrony between LBBP, LVSP, and BVP, which were not observed by measuring QRSd. LVSP provided the same LV synchrony and hemodynamic status as BVP, while LBBP was better than BVP in both.

• MeSH
• dysfunkce levé srdeční komory patofyziologie   terapie   MeSH
• elektrokardiografie * MeSH
• funkce levé komory srdeční fyziologie   MeSH
• hemodynamika * fyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mezikomorová přepážka patofyziologie   MeSH
• senioři MeSH
• srdeční resynchronizační terapie * metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

• MeSH
• kožní nemoci MeSH
• nemoci cév MeSH
• vény MeSH
• Publikační typ
• periodika MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• angiologie

• MeSH
• bovinní papilomavirus 1 MeSH
• Papillomaviridae MeSH
• vakcinace MeSH
• virové nemoci terapie   MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• dermatovenerologie
• mikrobiologie, lékařská mikrobiologie
• dermatovenerologie

Five European bison (Bison bonasus) from three European zoos were shipped to the Bukovské Vrchy Hills (Slovakia) in June 2004 and kept together in an acclimatization enclosure. The European bison were released into the wild in December 2004. At that time, papillomas were found at the medial canthus of the left eye of a 12-yr-old female bison. Cutaneous papillomatosis was confirmed histologically. Negative stain transmission electron microscopic examination revealed papillomavirus in the papillomas, and papillomavirus DNA also was detected using the polymerase chain reaction with FAP59 and FAP64 primers. The amplified 413 bp DNA sequence was identical to that of BAPV2 bovine papillomavirus. This paper is the first report of papillomatosis in European bison.

• MeSH
• amplifikace genu MeSH
• bizon virologie   MeSH
• bovinní papilomavirus 1 izolace a purifikace   klasifikace   MeSH
• DNA virů analýza   MeSH
• financování organizované MeSH
• infekce papilomavirem epidemiologie   patologie   veterinární   MeSH
• molekulární sekvence - údaje MeSH
• polymerázová řetězová reakce veterinární   MeSH
• sekvence nukleotidů MeSH
• transmisní elektronová mikroskopie veterinární   MeSH
• zvířata v ZOO virologie   MeSH
• zvířata MeSH
• Check Tag
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• kazuistiky MeSH

Úvod: První klinické studie naznačily, že levokomorová stimulace (LVP) vede ke srovnatelnému zlepšení jako stimulace biventrikulární (BVP). Dlouhodobý efekt LVP a její vliv na komorovou dyssynchronii však nejsou dostatečně známy. Metodika: Pro vyloučení možného vlivu jizev po infarktu myokardu na aktivační sekvenci komor byla dlouhodobá účinnost LVP studována u souboru pacientů s idiopatickou dilatační kardiomyopatií. Do studie bylo zahrnuto 33 pacientů, kteří splňovali konvenční indikační kriteria k resynchronizační terapii a měli sinusový rytmus. Nemocní byli randomizováni k BVP nebo LVP. Hodnotili jsme dlouhodobé klinické a echokardiografické zlepšení v obou skupinách a ovlivnění stupně komorové dyssynchronie pod vlivem BVP a LVP v prvních 12 měsících terapie, a to v pravidelných 3 měsíčních intervalech. Výsledky: Vstupní klinické charakteristiky byly u obou skupin srovnatelné, kromě většího interventrikulárního zpoždění ve skupině BVP. Přestože došlo u obou studovaných skupin ke zlepšení třídy NYHA, LVP byla spojena s lepšími výsledky již od 3. měsíce terapie. U BVP byl patrný trend k postupnému zlepšování tolerance zátěže v čase. BVP i LVP vedly ke zmenšení end-diastolického rozměru LK, ale stupeň redukce byl větší u BVP. Naproti tomu LVEF vzrostla u obou skupin srovnatelně. Jak LVP, tak BVP prodloužily významně preejekční periodu pravé komory bez korespondující změny tohoto intervalu u komory levé. Výsledkem byla redukce interventrikulárního zpoždění. Na druhou stranu nevedl ani jeden stimulační režim k výraznějšímu ovlivnění intraventrikulární dyssynchronie hodnocené tkáňovými rychlostmi nebo k zásadnějšímu prodloužení diastolického plnícího času. Závěry: BVP i LVP vedou u nemocných se sinusovým rytmem ke srovnatelnému dlouhodobému klinickému zlepšení, trend k trvalému zvyšování tolerance zátěže a redukci end-diastolického rozměru LK je však více vyjádřen u BVP. Oba typy stimulace vedou k významné interventrikulární resynchronizaci.

Introduction: First studies suggested that single-site left-ventricular pacing (LVP) results in acute hemodynamic benefit that is comparable to biventricular pacing (BVP). However, the long-term effects of LVP and its influence on ventricular dyssynchrony are still not well known. Methods: In order to avoid the influence of post-infarction scar on ventricular activation, this issue was studied in patients with idiopathic dilated cardiomyopathy only. Total of 27 patients with DCM and conventional indication for CRT were included in the study. They were randomized to either BV or LVP, and their clinical and echocardiographic outcomes were studied every 3 months during the first year of CRT. Results: The baseline characteristics were comparable between groups except larger interventricular delay in BVP group. Although both BVP and LVP were associated with improvement in NYHA class, LVP was superior to BVP since the third months of therapy. There was a trend towards sustained improvement in exercise capacity during the time in BVP. Both BVP and LVP led to a significant reduction of LV end-diastolic diameter, but the improvement was greater in BVP group. However, ejection fraction increased similarly in both groups. Both, BVP and LVP cause significant prolongation of the right-ventricular preejection period without corresponding change of the same interval in the left ventricle, thus reducing interventricular dyssynchrony. On the other hand, neither of the pacing modes changed significantly the degree of intraventricular dyssynchrony as assessed by tissue velocities or the ventricular filling time. Conclusions: Both BVP and LVP lead to comparable clinical improvement. However, trend towards a progressive improvement of exercise capacity and reduction of left-ventricular size is visible during BVP. Both pacing modes reduce interventricular dyssynchrony in patients with idiopathic dilated cardiomyopathy.

• MeSH
• finanční podpora výzkumu jako téma MeSH
• kardiostimulace umělá metody   MeSH
• klinické zkoušky jako téma statistika a číselné údaje   MeSH
• lidé MeSH
• srdeční komory patologie   radiografie   MeSH
• srdeční selhání MeSH
• výsledek terapie MeSH
• výsledky a postupy - zhodnocení (zdravotní péče) MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH
• srovnávací studie MeSH

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

BACKGROUND: Left bundle branch pacing (LBBP) is a novel physiological pacing technique which may serve as an alternative to cardiac resynchronization therapy (CRT) by biventricular pacing (BVP). This study assessed ventricular activation patterns and echocardiographic and clinical outcomes of LBBP and compared this to BVP. METHODS: Fifty consecutive patients underwent LBBP or BVP for CRT. Ventricular activation mapping was obtained by ultra-high-frequency ECG (UHF-ECG). Functional and echocardiographic outcomes and hospitalization for heart failure and all-cause mortality after one year from implantation were evaluated. RESULTS: LBBP resulted in greater resynchronization vs BVP (QRS width: 170 ± 16 ms to 128 ± 20 ms vs 174 ± 15 to 144 ± 17 ms, p = 0.002 (LBBP vs BVP); e-DYS 81 ± 17 ms to 0 ± 32 ms vs 77 ± 18 to 16 ± 29 ms, p = 0.016 (LBBP vs BVP)). Improvement in LVEF (from 28 ± 8 to 42 ± 10 percent vs 28 ± 9 to 36 ± 12 percent, LBBP vs BVP, p = 0.078) was similar. Improvement in NYHA function class (from 2.4 to 1.5 and from 2.3 to 1.5 (LBBP vs BVP)), hospitalization for heart failure and all-cause mortality were comparable in both groups. CONCLUSIONS: Ventricular dyssynchrony imaging is an appropriate way to gain a better insight into activation patterns of LBBP and BVP. LBBP resulted in greater resynchronization (e-DYS and QRS duration) with comparable improvement in LVEF, NYHA functional class, hospitalization for heart failure and all-cause mortality at one year of follow up.

• Publikační typ
• časopisecké články MeSH

BACKGROUND: Cardiac resynchronization therapy (CRT) with biventricular pacing (BVP) is a well established therapy in patients with reduced left ventricular ejection fraction (LVEF), heart failure, and wide QRS or expected frequent ventricular pacing. Left bundle branch area pacing (LBBAP) has recently been shown to be a safe alternative to BVP. OBJECTIVES: The aim of this study was to compare the clinical outcomes between BVP and LBBAP among patients undergoing CRT. METHODS: This observational study included patients with LVEF ≤35% who underwent BVP or LBBAP for the first time for Class I or II indications for CRT from January 2018 to June 2022 at 15 international centers. The primary outcome was the composite endpoint of time to death or heart failure hospitalization (HFH). Secondary outcomes included endpoints of death, HFH, and echocardiographic changes. RESULTS: A total of 1,778 patients met inclusion criteria: 981 BVP, 797 LBBAP. The mean age was 69 ± 12 years, 32% were female, 48% had coronary artery disease, and mean LVEF was 27% ± 6%. Paced QRS duration in LBBAP was significantly narrower than baseline (128 ± 19 ms vs 161 ± 28 ms; P < 0.001) and significantly narrower compared to BVP (144 ± 23 ms; P < 0.001). Following CRT, LVEF improved from 27% ± 6% to 41% ± 13% (P < 0.001) with LBBAP compared with an increase from 27% ± 7% to 37% ± 12% (P < 0.001) with BVP, with significantly greater change from baseline with LBBAP (13% ± 12% vs 10% ± 12%; P < 0.001). On multivariable regression analysis, the primary outcome was significantly reduced with LBBAP compared with BVP (20.8% vs 28%; HR: 1.495; 95% CI: 1.213-1.842; P < 0.001). CONCLUSIONS: LBBAP improved clinical outcomes compared with BVP in patients with CRT indications and may be a reasonable alternative to BVP.

• MeSH
• elektrokardiografie MeSH
• funkce levé komory srdeční MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• srdeční resynchronizační terapie * MeSH
• srdeční selhání * terapie   MeSH
• tepový objem MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH

Background: Bifocal pacing (BFP) has been proposed as a more feasible alternative of cardiac resynchronization therapy (CRT). AIM: To evaluate BFP in patients with severe congestive heart failure and significant intraventricular conduction delay and to compare it with biventricular pacing (BVP). METHODS: Both echocardiographic examination including tissue Doppler imaging and invasive measurements of cardiac hemodynamics was performed under basal conditions and during BFP and BVP. RESULTS: 50 patients were included: 29 patients with ischemic heart disease (IHD), 21 patients with idiopathic dilated cardiomyopathy (IDCM). Left ventricular (LV) pressure gradient (dp/dt max) increased during BFP compared to the baseline (13.4 %, 95 % CI 9.2-17.6 %, p < 0.0001) and a further increase was achieved during BVP (29.5 %, 95 % CI 23.7-35.4 %, p < 0.0001). A significant correlation was found between the distance of the right ventricular apical and outflow tract leads and percentage of dp/dt max increase in IDCM patients (r = 0.72, p < 0.001), but not in IHD patients. Interventricular mechanical delay (IVMD) decreased in BFP compared to baseline (43 +/- 22 ms vs. 53 +/- 31 ms, p = 0.006). BVP produced even shorter IVMD (22 +/- 19 ms, p < 0.0001). In all patients, the regional systolic contraction times were significantly shortened, corresponding with prolongation of the respective regional diastolic filling times during both BFP (p < 0.05 for all segments) and BVP (p < 0.001 for all segments). The effect of BVP on regional systole shortening was more pronounced. CONCLUSIONS: BFP improves LV hemodynamics by decreasing the inter- and intraventricular conduction delays. The leads in the right ventricle should be placed at the longest achievable distance. BVP is superior to BFP.

• MeSH
• elektrokardiografie MeSH
• funkce levé komory srdeční MeSH
• hemodynamika MeSH
• kardiostimulace umělá metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• srdeční arytmie etiologie   terapie   MeSH
• srdeční selhání komplikace   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

BACKGROUND: Bifocal pacing (BFP) has been proposed as a feasible alternative to cardiac resynchronization therapy. AIM: To evaluate BFP in patients with severe heart failure and significant intraventricular conduction delay and to compare it with biventricular pacing (BVP). METHODS: Echocardiographic examination including TDI and invasive measurement of haemodynamics was performed under basal conditions, during BFP and during BVP. RESULTS: Fifty patients were included: 29 with ischaemic heart disease (IHD), 21 with idiopathic dilated cardiomyopathy (IDCM). LV dp/dt(max) increased during BFP compared to the basal state (13.4%, 95% CI 9.2-17.6%, p<0.0001) and a further increase was achieved during BVP (29.5%, 95% CI 23.7-35.4%, p<0.0001). A significant correlation was found between the distance of the right ventricular apical and outflow tract leads and percentage of dp/dt(max) increase in IDCM patients (r=0.72), but not in IHD patients. Interventricular mechanical delay (IVMD) decreased in BFP (43+/-22 ms vs. 53+/-31 ms, p=0.006), but BVP produced even shorter IVMD (22+/-19 ms, p<0.0001). In all patients, regional systolic contraction times were significantly shortened, corresponding with prolongation of the respective regional diastolic filling times during both BFP (p<0.05 for all segments) and BVP (p<0.001 for all segments). CONCLUSIONS: BFP improves LV haemodynamics by decreasing the inter- and intraventricular conduction delays. The leads in the right ventricle should be placed at the longest achievable distance. BVP is superior to BFP.

• MeSH
• časové faktory MeSH
• dilatační kardiomyopatie patofyziologie   terapie   MeSH
• dopplerovská echokardiografie metody   MeSH
• hodnocení léčiv MeSH
• ischemická choroba srdeční patofyziologie   terapie   MeSH
• kardiostimulace umělá metody   škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• reprodukovatelnost výsledků MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• srovnávací studie MeSH