IMPORTANCE: In treating atrial fibrillation, pulsed field ablation (PFA) is a novel energy modality with comparable efficacy to conventional thermal ablation, such as radiofrequency ablation (RFA), but with the benefit of some preferentiality to myocardial tissue ablation. Studies have demonstrated important safety advantages, including the absence of esophageal injury or pulmonary vein stenosis and only rare phrenic nerve injury. However, there is emerging evidence of coronary artery vasospasm provoked by PFA. OBJECTIVE: To compare the incidence and severity of left circumflex arterial vasospasm between PFA and RFA during adjacent ablation along the mitral isthmus. DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study enrolled consecutive adult patients receiving first-ever PFA or RFA of the mitral isthmus during catheter ablation of atrial fibrillation in 2022 with acute follow-up at a single referral European center. EXPOSURE: A posterolateral mitral isthmus line was created using either a multielectrode pentaspline PFA catheter (endocardial ablation) or a saline-irrigated RFA catheter. Simultaneous diagnostic coronary angiography was performed before, during, and after catheter ablation. Nitroglycerin was planned for spasm persisting beyond 20 minutes or for significant electrocardiographic changes. MAIN OUTCOMES AND MEASURES: The frequency and severity of left circumflex arterial vasospasm was assessed and monitored, as were time to remission and any need for nitroglycerin administration. RESULTS: Of 26 included patients, 19 (73%) were male, and the mean (SD) age was 65.5 (9.3) years. Patients underwent either PFA (n = 17) or RFA (n = 9) along the mitral isthmus. Coronary spasm was observed in 7 of 17 patients (41.2%) undergoing PFA: in 7 of 9 (77.8%) when the mitral isthmus ablation line was situated superiorly and in 0 of 8 when situated inferiorly. Conversely, coronary spasm did not occur in any of the 9 patients undergoing RFA. Of 5 patients in whom crossover PFA was performed after RFA failed to achieve conduction block, coronary spasm occurred in 3 (60%). Most instances of spasm (9 of 10 [90%]) were subclinical, with 2 (20%) requiring nitroglycerin administration. The median (range) time to resolution of spasm was 5 (5-25) minutes. CONCLUSION AND RELEVANCE: When creating a mitral isthmus ablation line during catheter ablation of atrial fibrillation, adjacent left circumflex arterial vasospasm frequently occurred with PFA and not RFA but was typically subclinical.

• MeSH
• dospělí MeSH
• fibrilace síní * chirurgie   patofyziologie   MeSH
• katetrizační ablace * škodlivé účinky   MeSH
• koronární vazospasmus * etiologie   MeSH
• lidé MeSH
• nitroglycerin MeSH
• prospektivní studie MeSH
• senioři MeSH
• srdeční síně patofyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• komentáře MeSH

• MeSH
• arteriovenózní píštěl chirurgie   MeSH
• cévní přístupy MeSH
• dialýza ledvin MeSH
• lidé středního věku MeSH
• lidé MeSH
• mitrální insuficience diagnostické zobrazování   etiologie   MeSH
• regionální krevní průtok MeSH
• rychlost toku krve MeSH
• srdeční selhání diagnostické zobrazování   etiologie   terapie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

V kazuistike prezentujeme prípad 29-ročnej ženy so systémovým lupusom erythematosus a antifosfolipidovým syndrómom s náhodným nálezom vegetácií mitrálnej chlopne v 25. týždni gravidity. Kazuistika dokumentuje úskalia diferenciálnej diagnostiky endokarditídy u pacientov so systémovým lupusom. Zápalové postihnutie srdcových chlopní pri systémovom lupuse erythematosus sa vyskytuje vo forme špecifickej Libmanovej-Sacksovej (L-S) endokarditídy, nešpecifickej infekčnej endokarditídy alebo ich kombinácie. Diagnózu L-S endokarditídy podporuje leukopénia, zvýšený titer antifosfolipidových protilátok a normálna hladina CRP. Ďalšími kritériami sú negatívne hemokultúry, neúspech antibiotickej liečby a lokalizácia vegetácií na mitrálnej chlopni zo strany ľavej komory a na aortálnej chlopni zo strany aorty. Pri L-S endokarditíde sa môžu vyskytovať vegetácie na rozdiel od infekčnej endokarditídy na oboch plochách chlopní. Pri infekčnej endokarditíde sa vegetácie vyskytujú preferenčne v línii koaptácie. Naproti tomu pri systémovom lupuse erythematosus sa nachádzajú kdekoľvek na chlopni. Odlíšenie infekčnej endokarditídy a neinfekčnej L-S endokarditídy má principiálny význam, pretože ich terapia je zásadne odlišná.

We describe a case of a 29-year-old woman with systemic lupus erythematosus and antiphospholipid syndrome with an accidental finding of a mitral vegetation in 25th week of pregnancy. This case report documents the difficulty in differential diagnostics of endocarditis in patients with systemic lupus. Inflammation of the heart valves in systemic lupus erythematosus occurs either as a specific Libman-Sacks (L-S) endocarditis, nonspecific infective endocarditis or as a combination of both. Leukopenia, normal CRP level and positive antiphospholipid antibodies support the diagnosis of L-S endocarditis. Negative hemocultures, antibiotic treament failure, localisation of mitral vegetations on the ventricular surface and aortic vegetations on the vascular surface are additional supportive criteria. Possible localization of the vegetations on both sides of the leaflets in L-S endocarditis is distinct from strictly one-sided localization in infective endocarditis. Infective endocarditis lesions are more likely to be located at the leaflet’s line of closure. In contrast, Libman-Sacks vegetations can be located anywhere on the leaflets. Distinguishing infective endocarditis from L-S endocarditis is of principal importance because of radically different treatment of them.

• MeSH
• angiotensin konvertující enzym MeSH
• fyziologická kalcifikace MeSH
• hypertrofie levé komory srdeční patofyziologie   MeSH
• katetrizace MeSH
• magnetická rezonanční spektroskopie MeSH
• mitrální chlopeň chirurgie   MeSH
• mitrální insuficience MeSH
• nemoci koronárních tepen MeSH
• prasklé aneurysma MeSH
• statiny MeSH
• stenóza arteria carotis etiologie   farmakoterapie   MeSH
• tomografie emisní počítačová MeSH
• Publikační typ
• sborníky MeSH

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

Small colony variants (SCVs) are subpopulations of a bacterial strain that differ in morphology, growth rate, metabolism, and antibiotic sensitivity from the parent line. They are associated with chronic and difficult-to-treat infections. SCV endocarditis is very rare and usually associated with intracardiac devices. Herein, we report a case of endocarditis caused by SCV-forming Enterococcus faecalis that affected the native heart without any known predisposition.

• MeSH
• bakteriální endokarditida diagnóza   mikrobiologie   MeSH
• bakteriologické techniky metody   MeSH
• Enterococcus faecalis růst a vývoj   izolace a purifikace   MeSH
• grampozitivní bakteriální infekce diagnóza   mikrobiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mitrální chlopeň patologie   ultrasonografie   MeSH
• recidiva MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• práce podpořená grantem MeSH

Background We investigated whether post-systolic contraction has an impact on the diastolic function in patients with dilated cardiomyopathy (DCM). Methods Forty-eight DCM patients and 14 healthy volunteers underwent standard echocardiography, tissue Doppler imaging and strain focusing on diastolic function. The loops were recorded and post-systolic strain index (PSI) derived from speckle tracking strain analysis was assessed off-line. Results The post-systolic contraction was observed in 86% of the DCM patients. In correlations of post-systolic strain index and individual diastolic parameters, mitral anulus velocity in early diastole (Ea) showed statistically significant relation (r=−0.48, p=0.001) as well as the ratio of peak velocity of transmitral filling in early diastole and mitral anulus velocity in early diastole (E/Ea) (r=0.39, p=0.012). Other assessed diastolic parameters did not reveal any significant correlations with PSI; peak velocity of transmitral filling in early (E) and late diastole (A), decelerating time of early diastolic filling (DT), mitral anulus velocity in late diastole (Aa). Conclusion There is a significant association between post-systolic shortening and a worsening of left ventricle (LV) diastolic filling in DCM patients.

• Klíčová slova
• diastolic function,
• MeSH
• diastola MeSH
• dilatační kardiomyopatie komplikace   patofyziologie   MeSH
• echokardiografie metody   MeSH
• elektrokardiografie metody   MeSH
• experimenty na lidech MeSH
• financování organizované MeSH
• funkce levé komory srdeční fyziologie   MeSH
• klinické laboratorní techniky MeSH
• kontrakce myokardu fyziologie   MeSH
• lidé MeSH
• rentgendiagnostika hrudníku MeSH
• retrospektivní studie MeSH
• srdeční selhání etiologie   patofyziologie   MeSH
• statistika jako téma MeSH
• systola MeSH
• Check Tag
• lidé MeSH

• MeSH
• vrozené srdeční vady MeSH
• Publikační typ
• atlasy MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• kardiologie
• genetika, lékařská genetika

OBJECTIVES: This study sought to evaluate the safety and acute performance of the lattice tip for the treatment of atrial flutter and fibrillation (AF). BACKGROUND: A novel catheter using an expandable lattice structure with a wide thermal footprint incorporating multiple surface thermocouples/mini-electrodes has been designed for high-resolution mapping and high-current, temperature-controlled radiofrequency ablation (RFA). METHODS: Patients with typical right atrial flutter or AF were prospectively enrolled in a single-arm study at 3 centers. Patients with atrial flutter underwent cavotricuspid isthmus (CTI) ablation. Patients with paroxysmal AF underwent pulmonary vein isolation (PVI) and CTI if desired, and for patients with persistent AF, mitral isthmus and left atrial roof lines were also permitted. Mapping was performed with the lattice (Sphere-9) catheter and a novel compatible electroanatomic mapping system (Prism-1). RFA was performed in a point-by-point fashion (Tmax, 73°C to 80°C; range 2 to 7 s). Patients were followed for 3 months. RESULTS: A total of 71 patients underwent ablation: 65 PVI (38% with persistent AF) and 22 mitral isthmus, 24 roof, and 48 CTI lines. PVI was achieved in 64 of 65 (98.5%) by using the lattice alone and required a mean of 2.7 ± 0.70 RFA min. Mitral block was achieved in 100% by using 11.5 ± 10.7 applications and 1.0 ± 0.92 RFA min; only 1 patient required adjunctive epicardial coronary sinus ablation. Roof line and CTI block were achieved in 95.8% and 100% of patients, using 4.9 ± 1.9 and 5.9 ± 3.1 applications for 0.4 ± 0.16 and 0.5 ± 0.24 RFA min, respectively. At 3 months, there were no deaths, strokes, tamponade, or atrioesophageal fistula. CONCLUSIONS: This first-in-human study demonstrated clinical feasibility and safety for rapid high-current, temperature-controlled point-by-point PVI and linear ablation.

• MeSH
• fibrilace síní * chirurgie   MeSH
• katetrizační ablace * MeSH
• katétry MeSH
• lidé MeSH
• teplota MeSH
• venae pulmonales * chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: The purpose of this study was to provide detailed topography of the left atrial medial isthmus (situated between the right inferior pulmonary vein ostium and the medial part of the mitral annulus). METHODS: Two hundred human hearts (Caucasian, 22.5% females, 48.7 ± 4.9 years old) were investigated. RESULTS: The mean length of the medial isthmus was 42.4 ± 8.6 mm. Additionally, the medial isthmus line was divided by the oval fossa into three sections with equal mean lengths (upper: 14.2 ± 7.2 vs middle: 14.1 ± 6.1 vs lower: 14.9 ± 4.6 mm; P > .05). The left upper section of the atrial wall was thinner than the lower section (2.5 ± 1.1 vs 3.4 ± 1.6 mm; P < .0001). This study noted three separate spatial arrangements of the isthmus line. Type I (54.5%) had an oval fossa located outside the isthmus line; type II (32.5%) had an oval fossa crossed by the isthmus line, and type III (13.0%) had an oval fossa rim located tangentially to the isthmus line. In 68.5% of the examined specimens, the isthmus area had a smooth surface. Conversely, the remaining 31.5% had additional structures within its borders such as diverticula, recesses, and tissue bridges. CONCLUSION: This study is the first to describe the morphometric and topographical features of the left atrial medial isthmus. Interventions within the medial isthmus line should be performed cautiously, especially when they are transected by the oval fossa (32.5%). Careful navigation of the area is also recommended due to the possibility of existent additional structures. The latter could lead to catheter entrapment during ablation procedures.

• MeSH
• lidé středního věku MeSH
• lidé MeSH
• mrtvola MeSH
• srdeční síně anatomie a histologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Při užití ergotových agonistů dopaminu (EAD: např. pergolid, bromokriptin, dihydroergokriptin) v léčbě Parkinsonovy nemoci mohou vznikat orgánové fibrotické změny pleuropulmonální, perikardiální, retroperitoneální a chlopenní. Případ 1: 56letá nemocná s Parkinsonovou nemocí, léčena od července 2002 pergolidem v dávce 3x1 mg/24 hod. V červnu 2003 byly shledány otoky dolní končetin, echokardiografie prokázala nevelkou mitrální regurgitaci při morfologicky prakticky intaktním nálezu na chlopni. V lednu 2004 se vyvinula rychle progredující levostranná srdeční insuficience. Byla zjištěna významná mnohotná chlopení vada s dominující mitrální regurgitací a provedena náhrada mitrální chlopně a pergolid vyměněn za ropinirol. Kardiální funkce ani hybný stav nejsou zatím zcela kompensovány. Případ 2: 66letý nemocný s Parkinsonovou nemocí od roku 1996, od roku 1999 léčen pergolidem v konečné dávce 3 mg/24 hod. Počátkem roku 2004 se objevily lividní otoky dolních končetin. Zjištěna oboustranná hydronefróza se strikturou ureterů, počínající renální insuficience. Byla provedena plastika obou ureterů, histologicky prokázána periureterální fibróza, nasazeny kortikoidy a pergolid vyměněn za pramipexol. Přesto nastala progrese nálezu, nemocný byl indikován k provedení ureterálních stentů. Z literatury a z našich vlastních zkušeností vyplývají následující doporučení k omezení rizika komplikací: Nenasazovat EAD jako agonisty dopaminu první volby. Pravidelně klinicky monitorovat všechny nemocné léčené EAD. Významné projevy: dušnost, kašel, subakutně vznikající únavový syndrom, přibývání či ubývání na váze, otoky dolních končetin (i asymetrické), mikční obtíže, rozvoj srdeční insuficience, bolesti na hrudi, srdeční šelest. Záchyt zvýšené sedimentace, bílkovin akutní fáze či anémie má podpůrný význam. U všech symptomatických nemocných provést pomocná vyšetření (podle charakteru komplikací): RTG snímek plic či CT hrudníku, spirometrie, echokardiografie, vyšetření renálních funkcí, sonografie ledvin a močových cest, CT retroperitonea. Před zahájením terapie EAD provést vyšetření renálních funkcí, RTG plic a echokardiografii. Kontrolní echokardiografii provést po 3–6 měsících a následně vždy po 6–12 měsících.

Ergot derivative dopamine agonists, e.g. pergolide, bromocriptine, dihydroergocriptine used in treatment of Parkinson's disease can cause pleural, pericardial, retroperitoneal and valvular fibrotic changes. Case No 1: A 56-year-old woman with PD was treated with pergolide 3mg/24h since July 2002. In June 2003, edema of lower extremities was first noticed and echocardiography found a minor mitral regurgitation without any morphological changes of the valve. In January 2004, left- sided cardiac failure rapidly developed and echocardiography revealed multivalvular insufficiency with predominating severe mitral regurgitation. Mitral valve replacement was performed and pergolide was changed to ropinirole. Until now, neither cardiac functions nor motor status are sufficiently compensated. Case No 2: A 66-year-old-man with PD since 1996 was treated with pergolide 3mg/day since 1999. In the beginning of 2004, leg edema appeared. On examination, bilateral hydronephrosis with ureteric strictures and incipient renal insufficiency was found. Bilateral ureteroplasty was performed and the histology showed periureteric fibrosis. Treatment with steroids was initiated and pergolide was changed to pramipexole. Despite the treatment, the fibrosis progressed, requiring ureteral stenting. Based on the literature review and on our own experience, we propose following guidelines to minimize the risk of complications: A. Not to use EAD as the first-line dopamine agonists. B. Regularly follow all patients treated with EAD, especially monitor the majorsymptoms: dyspnea, cough, fatigue, leg edema (also asymmetric), symptoms of urinary outflow obstruction, cardiac insufficiency, chest pain, heart murmur. An elevated ESR, C-reactive protein or anemia support the diagnosis. C. All symptomatic patients should undergo workup for serosal fibrosis (according to type of complication): chest X-ray or CT scan, spirometry, renal functions, renal ultrasound, CT of retroperitoneum. D. Before the introduction of EAD therapy, examine the renal functions, perform chest X-ray and echocardiography. Screening echocardiography should be performed in 3–6 months and subsequently in every 6–12 months.

• MeSH
• agonisté dopaminu škodlivé účinky   terapeutické užití   MeSH
• dospělí MeSH
• lidé MeSH
• nemoci ledvin diagnóza   patologie   terapie   MeSH
• nemoci srdečních chlopní etiologie   patologie   MeSH
• nežádoucí účinky léčiv MeSH
• Parkinsonova nemoc farmakoterapie   patologie   MeSH
• pergolid škodlivé účinky   terapeutické užití   MeSH
• retroperitoneální fibróza etiologie   patologie   terapie   MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH