V České republice je indikace k profylaktické implantaci ICD u pacientů po infarktu myokardu založena na přítomnosti systolické dysfunkce LK, na nálezu NSVT a indukovatelnosti VT/VF při programované stimulaci komor. Nekonvenční holterovské ukazatele rizika u pacientů po IM mají silnější prediktivní charakteristiky než všechny doposud známé klinické a elektrofyziologické rizikové faktory. Cílem projektu je prospektivně ověřit, zda stratifikace rizika u poinfarktových pacientů, která využívá tyto nové holterovské prediktory, je efektivnější než současné klinické postupy. Do studie bude zařazeno 600 pacientů po dokumentovaném infarktu myokardu, s ejekční frakcí LK <= 35%. Bude sledován kombinovaný endpoint (kardiální úmrtí + nefatální srdeční zástava + první adekvátní ICD terapie).; Non-conventional Holter-based risk predictors - Heart Rate Turbulence (HRT) and Prevalent Low-Frequency Oscillation (PLF) - were established as powerful risk stratifiers in patients after myocardial infarction (MI). The aim of the project is to validateprospectively whether risk stratification of postinfarction patients with left ventricular (LV) dysfunction based on specific combination of PLF and HRT is more effective than current strategy in Czech Republic. The study will enroll 600 patients after documented MI, with LV dysfunction (LV ejection fraction <= 40%). PES will be performed in patients with NSVT and/or abnormal composite Holter-based risk predictor. ICD will be implanted in patients with inducible VT/VF during PES. During mean follow up of 24 months, the occurrence of combined endpoint (cardiac death + nonfatal cardiac arrest + appropriate ICD therapy) will be investigated.

• MeSH
• elektrokardiografie ambulantní MeSH
• infarkt myokardu MeSH
• mortalita MeSH
• srdeční arytmie MeSH
• srdeční elektrofyziologie MeSH
• systolické srdeční selhání MeSH
• zohlednění rizika MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• angiologie
• kardiologie
• NLK Publikační typ
• závěrečné zprávy o řešení grantu IGA MZ ČR

Neinvazívní diagnostika restenóz u pacientů po koronární angioplastice (PTCA) přístrojem Cardiag 128.1. XXX XXX XXX

• MeSH
• balónková koronární angioplastika MeSH
• elektrokardiografie přístrojové vybavení   MeSH
• subvalvulární aortální stenóza diagnóza   MeSH

• Konspekt
• Ortopedie. Chirurgie. Oftalmologie
• NLK Obory
• chirurgie
• NLK Publikační typ
• závěrečné zprávy o řešení grantu IGA MZ ČR

Although cycle length (CL) constitutes a fundamental descriptor of any arrhythmia, there is not larger study describing mean CL in electrophysiologically confirmed cavo-tricuspid isthmus (CTI)- dependent atrial flutter (AFL). We analyzed retrospectively digital recordings of 121 patients (98 men; age 64±11 years) referred for radiofrequency ablation of persistent CTI-dependent AFL. Median of mean AFL CL was 240 ms (interquartile range (IQR) of 222-258 ms, overall range of 178-399 ms). The distribution of CL was not normal (Shapiro Wilk test, p<0.001). Both counterclockwise and clockwise (14.9 % of all cases) AFLs were comparable in their CL; 240 (IQR 222-258) ms vs. 234 (217-253) ms, respectively. AFL CL<200 ms and AFL CL<190 ms was noticed in 5 (4.1 %) and 3 cases (2.5 %), respectively. In multivariate regression analysis, age (increase by 6±3 ms per decade of age, p=0.036), treatment with specific antiarrhythmic drugs (increase by 11±6 ms, p=0.052) and the history of cardiac surgery (increase by 26±9 ms, p=0.004) were independently associated with AFL CL. In conclusions, the distribution of AFL CL is not normal. The prevalence of AFL with short CL is low. Short CL<200 ms does not rule out the CTI-dependent AFL, especially in young and otherwise healthy patients.

• MeSH
• flutter síní patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• regresní analýza MeSH
• retrospektivní studie MeSH
• senioři MeSH
• trikuspidální chlopeň patofyziologie   MeSH
• vena cava inferior patofyziologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH

• Publikační typ
• abstrakt z konference MeSH

• Publikační typ
• abstrakt z konference MeSH

• MeSH
• nemocniční poplatky MeSH
• poplatky a výdaje MeSH
• zdravotní péče - kvalita, dosažitelnost a hodnocení MeSH

• Publikační typ
• abstrakt z konference MeSH

BACKGROUND: This study tested the hypothesis that heart rate turbulence (HRT) following ventricular pacing trains depends on train cycle length, presence of retrograde ventriculoatrial (VA) conduction, and left ventricular (LV) function. METHODS: We analyzed digital recordings of programmed ventricular stimulation (PVS) performed in 82 patients (57 men) referred for electrophysiologic studies of ventricular arrhythmias, whose mean age was 64 +/- 12 years and LV ejection fraction (EF) was 47 +/- 15%. Profiles of sinus RR intervals after all available 8-beat ventricular pacing trains (600-and 400-ms) were averaged. Heart rate turbulence slope (HRTS) was analyzed as the maximum positive slope of a regression line through a sequence of 2-5 (HRTS2 - HRTS5) consecutive RR intervals within the first 5 RR intervals after the pacing train. RESULTS: Dynamics of RR intervals had biphasic and monophasic patterns, in patients with and without VA conduction, respectively. Sinus nodal response was less prominent after 600-ms than 400-ms pacing trains. After 400-ms pacing trains, HRTS was significantly shallower in patients with LVEF 40%. HRTS4 was the best discriminator between the two groups (6.8 +/- 8.6 ms/RR vs 19.6 +/- 26.0 ms/RR, P = 0.017). CONCLUSION: In patients with VA conduction, HRT after ventricular pacing trains reflects a combination of vagal withdrawal due to transient hypotension and suppression of sinus node automaticity. Attenuation of vagal modulation was detected in patients with LV dysfunction during standard PVS.

• MeSH
• autonomní nervový systém patofyziologie   MeSH
• funkce levé komory srdeční MeSH
• kardiostimulace umělá * MeSH
• komorové extrasystoly * patofyziologie   terapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• retrospektivní studie MeSH
• senioři MeSH
• srdeční arytmie MeSH
• srdeční frekvence * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH

BACKGROUND: Positive Turbulence onset (TO) after atrial premature complexes (APCs) was found temporally related to spontaneous episodes of atrial fibrillation. This study tested the hypothesis that heart rate turbulence (HRT) after APCs is influenced by APC prematurity independently of the prematurity of conducted ventricular complexes. METHODS: We studied 33 patients (mean age = 58 +/- 16 years, 19 men), 11 of whom had structural heart disease, who were referred for electrophysiological studies of supraventricular or ventricular arrhythmias. Sequences of single right atrial extrastimuli were delivered with coupling intervals adjusted to reach 60% prematurity of conducted ventricular complexes. Descriptors of HRT were compared between patients with slow versus fast atrioventricular (AV) conduction of APCs. RESULTS: The early RR interval dynamics after APCs was prominently modulated by the suppression of sinus node automaticity by the direct effect of APCs. This effect was significantly greater after earlier APCs with longer AV conduction times than after later coupled APCs with shorter AV conduction times. CONCLUSIONS: The early phase of HRT is strongly influenced by the coupling interval of APCs, independently of the prematurity of conducted ventricular complexes. Consequently, the more positive TO preceding spontaneous atrial fibrillation episodes might be an epiphenomenon of incidental short-coupled APCs with delayed AV conduction, likely to trigger atrial fibrillation.

• MeSH
• dospělí MeSH
• fibrilace síní * patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nodus atrioventricularis patofyziologie   MeSH
• senioři MeSH
• síňové extrasystoly * patofyziologie   MeSH
• srdeční frekvence * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH
• srovnávací studie MeSH

INTRODUCTION: Conduction recurrence during radiofrequency (RF) ablation of cavotricuspid isthmus for typical atrial flutter is common. Understanding the temporal pattern of recurrences could help to predict a durable bidirectional block (BDB) and optimize the procedure. METHODS AND RESULTS: We analyzed atrial flutter ablations in 108 consecutive patients (85 males, age 63 +/- 11 years). RF energy was delivered through 8-mm tip or 4-mm cooled-tip catheter. On average, 18 +/- 11 pulses were necessary to achieve BDB. The time to recurrence of conduction after RF cessation was recorded. Early and late conduction recurrences were defined as < or =10 minutes and >10 minutes, respectively. Patients were observed for > or =30 minutes after bidirectional cavotricuspid isthmus (CTI) block was achieved. Conduction did not recur in 46 patients. In 8 cases, no block was achieved. A total of 167 conduction recurrences were recorded in the remaining 54 cases (1-10 per case). Of these, in 53 patients, recurrences were classified as early (98%) and 14 patients had late recurrences (8%). Thirteen patients had both early and late recurrences (24%). All but one late recurrence were preceded by at least one early recurrence. Absence of early recurrence had negative predictive value of 98%, while any early recurrence had positive predictive value of 26% for subsequent late conduction recovery. CONCLUSION: Incidence of isthmus conduction recurrence rapidly decayed during the waiting period. Absence of conduction recurrence within 10 minutes after first successful RF delivery was highly predictive of persistent BDB.

• MeSH
• časové faktory MeSH
• financování organizované MeSH
• flutter síní chirurgie   patofyziologie   MeSH
• katetrizační ablace metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• převodní systém srdeční patofyziologie   MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH