Left ventricular assist devices (LVADs) are an increasingly used strategy for the management of patients with advanced heart failure. Although these devices effectively improve survival, atrial and ventricular arrhythmias are common with a prevalence of 20-50% at one year after LVAD implantation. Arrhythmias predispose these patients to additional risk and are associated with considerable morbidity from recurrent implantable cardioverter-defibrillator shocks, progressive failure of the unsupported right ventricle, and herald an increased risk of mortality. Management of patients with arrhythmias and LVAD differs in many aspects from the general population heart failure patients. These include ruling out the reversible causes of arrhythmias that in LVAD patients may include mechanical irritation from the inflow cannula and suction events. For patients with symptomatic arrhythmias refractory to medical treatment, catheter ablation might be relevant. There are specific technical and procedural challenges perceived to be unique to LVAD-related ventricular tachycardia (VT) ablation such as vascular and LV access, signal filtering, catheter manoeuvrability within decompressed chambers, and electroanatomic mapping system interference. In some patients, the arrhythmogenic substrate might not be readily accessible by catheter ablation after LVAD implantation. In this regard, the peri-implantation period offers a unique opportunity to surgically address arrhythmogenic substrate and suppress future VT recurrences. This document aims to address specific aspects of the management of arrhythmias in LVAD patients focusing on anti-arrhythmic drug therapy and ablations.
- MeSH
- antiarytmika * terapeutické užití MeSH
- funkce levé komory srdeční MeSH
- katetrizační ablace * metody MeSH
- komorová tachykardie terapie chirurgie patofyziologie MeSH
- konsensus MeSH
- lidé MeSH
- podpůrné srdeční systémy * MeSH
- rizikové faktory MeSH
- srdeční arytmie * terapie patofyziologie diagnóza MeSH
- srdeční selhání * terapie patofyziologie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- směrnice pro lékařskou praxi MeSH
- Geografické názvy
- Evropa MeSH
- MeSH
- antiarytmika terapeutické užití MeSH
- antikoagulancia terapeutické užití MeSH
- fibrilace síní * diagnóza patofyziologie terapie MeSH
- katetrizační ablace metody MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Fibrilace síní je nejčastější setrvalou arytmií u pacientů s hypertrofickou kardiomyopatií. Souhrnný článek se zabývá komplexními mechanismy vedoucími k rozvoji fibrilace síní u této skupiny pacientů a specifickými aspekty její terapie (zejména antikoagulační terapie a přístupy k udržení sinusového rytmu). Závěrečná část je věnována vlivu arytmie na klinickou symptomatologii a prognózu pacientů s hypertrofickou kardiomyopatií.
Atrial fibrillation is the most common sustained arrhythmia in patients with hypertrophic cardiomyopathy. The review article focuses on the complex mechanisms of development of atrial fibrillation in this subgroup of patients and on specific aspects of treatment (anticoagulation therapy and rhythm control). The final part focuses on the arrhythmia's effect on clinical symptomatology and prognosis of patients with hypertrophic cardiomyopathy.
- MeSH
- antiarytmika farmakologie terapeutické užití MeSH
- antikoagulancia farmakologie terapeutické užití MeSH
- dilatace patologická etiologie komplikace MeSH
- elektrokardiografie metody MeSH
- fibrilace síní * diagnóza etiologie farmakoterapie MeSH
- hodnocení rizik metody MeSH
- hypertrofická kardiomyopatie * komplikace MeSH
- lidé MeSH
- tromboembolie prevence a kontrola MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
While 3-N-butylphthalide (NBP) has demonstrated notable cardioprotective effects, its precise role in mitigating myocardial arrhythmia following ischemia/reperfusion (IR) injury in diabetes remains unclear. This study aimed to explore the potential mechanisms through which NBP mitigates reperfusion-induced myocardial arrhythmia in diabetic rats, with a particular focus on mitochondrial function and biogenesis, endoplasmic reticulum (ER) stress, and oxidative/inflammatory responses. Sixty Sprague-Dawley rats were divided into non-diabetic and diabetic groups, subjected to in-vivo myocardial IR injury, and treated with NBP (100 mg/kg, intraperitoneally) through different modalities: preconditioning, postconditioning, or a combination of both. Electrocardiography (ECG) was employed to assess the incidence and severity of arrhythmia. Fluorometric, Western blotting and ELISA analyses were utilized to measure the mitochondrial, ER stress, and cellular outcomes. Treatment of non-diabetic rats with NBP in preconditioned, postconditioned, and combined approaches significantly reduced cardiotroponin-I and the frequency and severity of arrhythmias induced by IR injury. However, only the combined preconditioning plus postconditioning approach of NBP had protective and antiarrhythmic effects in diabetic rats, in an additive manner. Moreover, the NBP combined approach improved mitochondrial function and upregulated the expression of PGC-1?, Sirt1, and glutathione while concurrently downregulating ER stress and oxidative and pro-inflammatory-related proteins in diabetic rats. In conclusion, the combined approach of NBP treatment was effective in mitigating myocardial arrhythmia in diabetic rats. This approach coordinates interactions within the mitochondria-endoplasmic reticulum network and inhibits oxidative and inflammatory mediators, offering a promising strategy for managing myocardial arrhythmia in diabetic patients. Key words: Myocardial Infarction, Mitochondria, Arrhythmia, Reperfusion, Diabetes, Ischemia.
- MeSH
- antiarytmika farmakologie terapeutické užití MeSH
- benzofurany * farmakologie terapeutické užití MeSH
- experimentální diabetes mellitus * metabolismus farmakoterapie komplikace MeSH
- krysa rodu rattus MeSH
- oxidační stres * účinky léků MeSH
- potkani Sprague-Dawley * MeSH
- reperfuzní poškození myokardu * metabolismus farmakoterapie prevence a kontrola MeSH
- srdeční arytmie * etiologie prevence a kontrola metabolismus farmakoterapie MeSH
- srdeční mitochondrie metabolismus účinky léků MeSH
- stres endoplazmatického retikula * účinky léků MeSH
- zánět metabolismus farmakoterapie MeSH
- zvířata MeSH
- Check Tag
- krysa rodu rattus MeSH
- mužské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
Fibrilace síní (FS) je nejčastější setrvalou arytmií v dospělé populaci a významným způsobem zatěžuje pacienty i systém zdravotní péče. Management FS se dá zjednodušeně rozdělit na dvě strategie – kontrola frekvence a kontrola rytmu. Optimální léčebná strategie je již několik dekád opakovaně studována. Současně platný doporučený postup Evropské kardiologické společnosti pro léčbu FS na podkladě výsledků mnoha randomizovaných studií doporučuje pro většinu pacientů s FS kontrolu frekvence. Modernější antiarytmika a větší dostupnost a technologický pokrok katetrizačních ablací FS vedly k uskutečnění nových studií. Z nich nejzásadnější byla EAST‐AFNET 4, jejíž výsledky a výsledky dalších následujících studií ve prospěch kontroly rytmu podnítily aktuální změnu paradigmatu léčby FS. Tento článek přináší přehled obou léčebných strategií, evidenci pro časnou kontrolu rytmu, rozbor studie EAST‐AFNET 4, která se stala v této oblasti zásadním milníkem, a shrnutí současných doporučených postupů.
Atrial fibrillation (AF) is the most common sustained arrhythmia in the adult population, having a significant impact on both the patients and healthcare system. AF management may be easily divided in two strategies – frequency control and rhythm control. The optimal treatment strategy has been repeatedly studied in the past decades. Based on many randomized studies, the current guidelines of the European Society of Cardiology recommend frequency control for most patients with AF. More modern antiarrhythmics and easier access to catheter ablations together with technological progress have led to the completion of new trials. The most important of those, EAST‐AFNET 4, the results of which (along with other trials) favored rhythm control, inspired a recent paradigm change in the treatment of AF. This article summarizes both treatment strategies, evidence supporting early rhythm control, the pivotal EAST‐AFNET 4 analysis, and current guidelines as well.
- Klíčová slova
- studie EAST-AFNET 4,
- MeSH
- antiarytmika farmakologie terapeutické užití MeSH
- fibrilace síní * diagnóza prevence a kontrola MeSH
- katetrizační ablace metody MeSH
- lidé MeSH
- management nemoci MeSH
- randomizované kontrolované studie jako téma MeSH
- srdeční frekvence * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- antiarytmika terapeutické užití MeSH
- fibrilace síní * komplikace mortalita terapie MeSH
- hypertenze komplikace MeSH
- katetrizační ablace metody MeSH
- lidé MeSH
- mozková hypoxie a ischemie etiologie MeSH
- rizikové faktory kardiovaskulárních chorob MeSH
- srdeční selhání etiologie komplikace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- novinové články MeSH
AIMS: A recently published trial has shown no differences in outcomes between patients with new-onset supraventricular arrhythmia (SVA) in septic shock treated with either propafenone or amiodarone. However, these outcome data have not been evaluated in relation to the presence or absence of a dilated left atrium (LA). METHODS AND RESULTS: Patients with SVA and a left ventricular ejection fraction ≥ 35% were randomized to receive intravenous propafenone (70 mg bolus followed by 400-840 mg/24 h) or amiodarone (300 mg bolus followed by 600-1800 mg/24 h). They were divided into groups based on whether their end-systolic left atrial volume (LAVI) was ≥40 mL/m2. The subgroup outcomes assessed were survival at ICU discharge, 1 month, 3 months, 6 months, and 12 months. Propafenone cardioverted earlier (P = 0.009) and with fewer recurrences (P = 0.001) in the patients without LA enlargement (n = 133). Patients with LAVI < 40 mL/m2 demonstrated a mortality benefit of propafenone over the follow-up of 1 year [Cox regression, hazard ratio (HR) 0.6 (95% CI 0.4; 0.9), P = 0.014]. Patients with dilated LA (n = 37) achieved rhythm control earlier in amiodarone (P = 0.05) with similar rates of recurrences (P = 0.5) compared to propafenone. The outcomes for patients with LAVI ≥ 40 mL/m2 were less favourable with propafenone compared to amiodarone at 1 month [HR 3.6 (95% CI 1.03; 12.5), P = 0.045]; however, it did not reach statistical significance at 1 year [HR 1.9 (95% CI 0.8; 4.4), P = 0.138]. CONCLUSION: Patients with non-dilated LA who achieved rhythm control with propafenone in the setting of septic shock had better short-term and long-term outcomes than those treated with amiodarone, which seemed to be more effective in patients with LAVI ≥ 40 mL/m2. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03029169, registered on 24 January 2017.
- MeSH
- amiodaron * terapeutické užití aplikace a dávkování MeSH
- antiarytmika * terapeutické užití aplikace a dávkování MeSH
- lidé středního věku MeSH
- lidé MeSH
- propafenon * terapeutické užití aplikace a dávkování MeSH
- senioři MeSH
- septický šok * farmakoterapie patofyziologie MeSH
- srdeční síně * patofyziologie diagnostické zobrazování účinky léků MeSH
- supraventrikulární tachykardie * farmakoterapie patofyziologie MeSH
- tepový objem fyziologie účinky léků MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- randomizované kontrolované studie MeSH
- srovnávací studie MeSH
PURPOSE: The echocardiography parameters may predict the maintenance of sinus rhythm after cardioversion of a supraventricular arrhythmia (SVA). MATERIALS AND METHODS: Patients in septic shock with onset of an SVA, normal to moderately reduced LV systolic function (EF_LV˃̳35%) and on a continuous noradrenaline of <1.0 μg/kg.min were included. Echocardiography was performed at the arrhythmia onset, 1 h and 4 h post cardioversion on an infusion of propafenone or amiodarone. RESULTS: Cardioversion was achieved in 96% of the 209 patients within a median time of 6(1.8-15.6)h, 134(64.1%) patients experienced at least one SVA recurrence after cardioversion. At 4 h the left atrial emptying fraction (LA_EF, cut-off 38.4%, AUC 0.69,p˂0.001), and transmitral A wave velocity-time-integral (Avti, cut-off 6.8 cm, AUC 0.65,p = 0.001) showed as limited predictors of a single arrhythmia recurrence. The LA_EF 44(36,49)%, (p = 0.005) and the Avti 8.65(7.13,9.50)cm, (p < 0.001) were associated with sustained sinus rhythm and decreased proportionally to increasing numbers of arrhythmia recurrences (p < 0.001 and p = 0.007, respectively). The enlarged left atrial end-systolic diameter at the arrhythmia onset (p = 0.04) and elevated systolic pulmonary artery pressure at 4 h (p = 0.007) were weak predictors of multiple(˃3) recurrences. CONCLUSION: The LA_EF and Avti are related to arrhythmia recurrences post-cardioversion suggesting potential guidance to the choice between rhythm and rate control strategies. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03029169, registered on 24th of January 2017.
- MeSH
- amiodaron terapeutické užití aplikace a dávkování MeSH
- antiarytmika terapeutické užití MeSH
- echokardiografie * MeSH
- elektrická defibrilace * MeSH
- lidé středního věku MeSH
- lidé MeSH
- propafenon terapeutické užití aplikace a dávkování MeSH
- prospektivní studie MeSH
- recidiva MeSH
- senioři MeSH
- septický šok * terapie patofyziologie komplikace MeSH
- supraventrikulární tachykardie terapie patofyziologie diagnostické zobrazování MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
AIMS: Pulmonary vein isolation (PVI) is a well-established strategy for the treatment of paroxysmal atrial fibrillation (PAF). Despite randomized controlled trials and real-world data showing the promise of pulsed-field ablation (PFA) for this treatment, long-term efficacy and safety data demonstrating single-procedure outcomes off antiarrhythmic drugs remain limited. The aim of the FARA-Freedom Study was to evaluate the long-term efficacy and safety of PFA using the pentaspline catheter for PAF. METHODS AND RESULTS: FARA-Freedom, a prospective, non-randomized, multicentre study, enrolled patients with PAF undergoing de novo PVI with PFA, who were followed for 12 months with weekly transtelephonic monitoring and a 72-h Holter ECG at 6 and 12 months. The primary safety endpoint was a composite of device- or procedure-related serious adverse events out to 7 days post-ablation and PV stenosis or atrioesophageal (AE) fistula out to 12 months. Treatment success is a composite of acute PVI and chronic success, which includes freedom from any documented atrial tachyarrhythmia longer than 30 s, use of antiarrhythmic drugs or cardioversion after a 3-month blanking period, or use of amiodarone or repeat ablation at any time. The study enrolled 179 PAF patients (62 ± 10 years, 39% female) at 13 centres. At the index procedure, all PVs were successfully isolated with the pentaspline PFA catheter. Procedure and left atrial dwell times, with a 20-min waiting period, were 71.9 ± 17.6 and 41.0 ± 13.3 min, respectively. Fluoroscopy time was 11.5 ± 7.4 min. Notably, monitoring compliance was high, with 88.4 and 90.3% with weekly events and 72-h Holter monitors, respectively. Freedom from the composite primary effectiveness endpoint was 66.6%, and 41 patients had atrial tachyarrhythmia recurrence, mostly recurrent atrial fibrillation (31 patients). The composite safety endpoint occurred in two patients (1.1%), one tamponade and one transient ischaemic attack. There was no coronary spasm, PV stenosis, or AE fistula. There were four cases of transient phrenic nerve palsy, but all resolved during the index procedure. CONCLUSION: In this prospective, non-randomized, multicentre study, PVI using a pentaspline PFA catheter was effective in treating PAF patients despite rigourous endpoint definitions and high monitoring compliance and demonstrated favourable safety. REGISTRATION: Clinical Trials.gov Identifier: NCT05072964 (sponsor: Boston Scientific Corporation).
- MeSH
- antiarytmika MeSH
- fibrilace síní * chirurgie MeSH
- katetrizační ablace * metody MeSH
- lidé MeSH
- píštěle * chirurgie MeSH
- prospektivní studie MeSH
- recidiva MeSH
- stenóza chirurgie MeSH
- tachykardie chirurgie MeSH
- venae pulmonales * chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
