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Jurin I, Jurišić A, Rudež I, Kurtić E, Skorić I, Čikara T, Šipić T, Rudan D, Manola Š, Hadžibegović I. Outcomes of Patients with Normal LDL-Cholesterol at Admission for Acute Coronary Syndromes: Lower Is Not Always Better. J Cardiovasc Dev Dis 2024; 11:120. [PMID: 38667738 PMCID: PMC11050419 DOI: 10.3390/jcdd11040120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/02/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND AND AIM There are few prospective data on the prognostic value of normal admission low-density lipoprotein cholesterol (LDL-C) in statin-naïve patients with acute coronary syndromes (ACS) who are treated with a preemptive invasive strategy. We aimed to analyze the proportion of patients with normal LDL-C at admission for ACS in our practice, and their characteristics and clinical outcomes in comparison to patients with high admission LDL-C. PATIENTS AND METHODS Two institutions' prospective registries of patients with confirmed ACS from Jan 2017 to Jan 2023 were used to identify 1579 statin-naïve patients with no history of prior coronary artery disease (CAD), and with available LDL-C admission results, relevant clinical and procedural data, and short- and long-term follow-up data. Normal LDL-C at admission was defined as lower than 2.6 mmol/L. All demographic, clinical, procedural, and follow-up data were compared between patients with normal LDL-C and patients with a high LDL-C level (≥2.6 mmol/L) at admission. RESULTS There were 242 (15%) patients with normal LDL-C at admission. In comparison to patients with high LDL-cholesterol at admission, they were significantly older (median 67 vs. 62 years) with worse renal function, had significantly more cases of diabetes mellitus (DM) (26% vs. 17%), peripheral artery disease (PAD) (14% vs. 9%), chronic obstructive pulmonary disease (COPD) (8% vs. 2%), and psychological disorders requiring medical attention (19% vs. 10%). There were no significant differences in clinical type of ACS. Complexity of CAD estimated by coronary angiography was similar between the two groups (median Syntax score 12 for both groups). There were no significant differences in rates of complete revascularization (67% vs. 72%). Patients with normal LDL-C had significantly lower left ventricular ejection fraction (LVEF) at discharge (median LVEF 52% vs. 55%). Patients with normal LDL-C at admission had both significantly higher in-hospital mortality (5% vs. 2%, RR 2.07, 95% CI 1.08-3.96) and overall mortality during a median follow-up of 43 months (27% vs. 14%, RR 1.86, 95% CI 1.45-2.37). After adjusting for age, renal function, presence of diabetes mellitus, PAD, COPD, psychological disorders, BMI, and LVEF at discharge in a multivariate Cox regression analysis, normal LDL-C at admission remained significantly and independently associated with higher long-term mortality during follow-up (RR 1.48, 95% CI 1.05-2.09). CONCLUSIONS A spontaneously normal LDL-C level at admission for ACS in statin-naïve patients was not rare and it was an independent risk factor for both substantially higher in-hospital mortality and mortality during long-term follow-up. Patients with normal LDL-C and otherwise high total cardiovascular risk scores should be detected early and treated with optimal medical therapy. However, additional research is needed to reveal all the missing pieces in their survival puzzle after ACS-beyond coronary anatomy, PCI optimization, numerical LDL-C levels, and statin therapy.
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Affiliation(s)
- Ivana Jurin
- Department for Cardiovascular Diseases, Dubrava University Hospital, 10000 Zagreb, Croatia; (I.J.); (A.J.); (T.Š.); (D.R.); (Š.M.)
| | - Anđela Jurišić
- Department for Cardiovascular Diseases, Dubrava University Hospital, 10000 Zagreb, Croatia; (I.J.); (A.J.); (T.Š.); (D.R.); (Š.M.)
| | - Igor Rudež
- Department of Cardiac and Transplant Surgery, Dubrava University Hospital, 10000 Zagreb, Croatia;
| | - Ena Kurtić
- Division of Cardiology, Department of Medicine, University Hospital Merkur, 10000 Zagreb, Croatia;
| | - Ivan Skorić
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
| | - Tomislav Čikara
- Department for Cardiovascular Diseases, Dubrava University Hospital, 10000 Zagreb, Croatia; (I.J.); (A.J.); (T.Š.); (D.R.); (Š.M.)
| | - Tomislav Šipić
- Department for Cardiovascular Diseases, Dubrava University Hospital, 10000 Zagreb, Croatia; (I.J.); (A.J.); (T.Š.); (D.R.); (Š.M.)
| | - Diana Rudan
- Department for Cardiovascular Diseases, Dubrava University Hospital, 10000 Zagreb, Croatia; (I.J.); (A.J.); (T.Š.); (D.R.); (Š.M.)
- University North, Trg dr. Zarka Dolinara 1, 48000 Koprivnica, Croatia
| | - Šime Manola
- Department for Cardiovascular Diseases, Dubrava University Hospital, 10000 Zagreb, Croatia; (I.J.); (A.J.); (T.Š.); (D.R.); (Š.M.)
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
| | - Irzal Hadžibegović
- Department for Cardiovascular Diseases, Dubrava University Hospital, 10000 Zagreb, Croatia; (I.J.); (A.J.); (T.Š.); (D.R.); (Š.M.)
- Faculty of Dental Medicine and Health Care, Josip Juraj Strossmayer University, 31000 Osijek, Croatia
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Pavlov M, Barić D, Novak A, Manola Š, Jurin I. From statistical inference to machine learning: A paradigm shift in contemporary cardiovascular pharmacotherapy. Br J Clin Pharmacol 2024; 90:691-699. [PMID: 37845041 DOI: 10.1111/bcp.15927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/02/2023] [Indexed: 10/18/2023] Open
Abstract
AIMS Heart failure with reduced ejection fraction (HFrEF) poses significant challenges for clinicians and researchers, owing to its multifaceted aetiology and complex treatment regimens. In light of this, artificial intelligence methods offer an innovative approach to identifying relationships within complex clinical datasets. Our study aims to explore the potential for machine learning algorithms to provide deeper insights into datasets of HFrEF patients. METHODS To this end, we analysed a cohort of 386 HFrEF patients who had been initiated on sodium-glucose co-transporter-2 inhibitor treatment and had completed a minimum of a 6-month follow-up. RESULTS In traditional frequentist statistical analyses, patients receiving the highest doses of beta-blockers (BBs) (chi-square test, P = .036) and those newly initiated on sacubitril-valsartan (chi-square test, P = .023) showed better outcomes. However, none of these pharmacological features stood out as independent predictors of improved outcomes in the Cox proportional hazards model. In contrast, when employing eXtreme Gradient Boosting (XGBoost) algorithms in conjunction with the data using Shapley additive explanations (SHAP), we identified several models with significant predictive power. The XGBoost algorithm inherently accommodates non-linear distribution, multicollinearity and confounding. Within this framework, pharmacological categories like 'newly initiated treatment with sacubitril/valsartan' and 'BB dose escalation' emerged as strong predictors of long-term outcomes. CONCLUSIONS In this manuscript, we not only emphasize the strengths of this machine learning approach but also discuss its potential limitations and the risk of identifying statistically significant yet clinically irrelevant predictors.
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Affiliation(s)
- Marin Pavlov
- Department of Cardiology, Dubrava University Hospital, Zagreb, Croatia
| | - Domjan Barić
- Department of Physics, Faculty of Science, University of Zagreb, Zagreb, Croatia
| | - Andrej Novak
- Department of Cardiology, Dubrava University Hospital, Zagreb, Croatia
- Department of Physics, Faculty of Science, University of Zagreb, Zagreb, Croatia
| | - Šime Manola
- Department of Cardiology, Dubrava University Hospital, Zagreb, Croatia
| | - Ivana Jurin
- Department of Cardiology, Dubrava University Hospital, Zagreb, Croatia
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Pavlov M, Hadžibegović I, Pavlović N, Manola Š. Septal branch in percutaneous coronary intervention: A strange and rare brew. Author's reply. Kardiol Pol 2023; 82:121-122. [PMID: 37768100 DOI: 10.33963/v.kp.97650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 09/28/2023] [Indexed: 09/29/2023]
Affiliation(s)
- Marin Pavlov
- Department of Cardiology, Dubrava University Hospital, Zagreb, Croatia.
- University North, Trg dr. Zarka Dolinara 1, Koprivnica, Croatia.
| | | | - Nikola Pavlović
- Department of Cardiology, Dubrava University Hospital, Zagreb, Croatia
| | - Šime Manola
- Department of Cardiology, Dubrava University Hospital, Zagreb, Croatia
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Brlek P, Pavelić ES, Mešić J, Vrdoljak K, Skelin A, Manola Š, Pavlović N, Ćatić J, Matijević G, Brugada J, Primorac D. Case report: State-of-the-art risk-modifying treatment of sudden cardiac death in an asymptomatic patient with a mutation in the SCN5A gene and a review of the literature. Front Cardiovasc Med 2023; 10:1193878. [PMID: 37745129 PMCID: PMC10512029 DOI: 10.3389/fcvm.2023.1193878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Brugada syndrome is a rare hereditary disorder characterized by distinct ECG findings, complex genetics, and a high risk of sudden cardiac death. Recognition of the syndrome is crucial as it represents a paradigm of sudden death tragedy in individuals at the peak of their lives. Notably, Brugada syndrome accounts for more than 20% of sudden cardiac deaths in individuals with structurally normal hearts. Although this syndrome follows an autosomal dominant inheritance pattern, it is more prevalent and severe in males. Diagnosis is primarily based on the characteristic ECG pattern observed in the right precordial leads. Mutations in the SCN5A gene, resulting in loss of function, are the most common genetic cause. We presented a 36-year-old proband with a family history of sudden cardiac death. Although the patient was asymptomatic for Brugada syndrome, his father had experienced sudden death at the age of 36. The proband was admitted to St. Catherine's Specialty Hospital where blood was taken and subjected to next-generation sequencing (NGS) using a "Sudden cardiac death" panel. The analysis identified a pathogenic variant in the SCN5A gene [c.4222G > A(p.Gly1408Arg)], which is associated with autosomal dominant Brugada syndrome. Based on the positive genetic test result, the patient was referred for further examination. ECG with modified precordial lead positioning confirmed the presence of the Brugada phenotype, displaying the type-2 and type-1 ECG patterns. Therefore, we made the diagnosis and decided to implant an implantable cardioverter-defibrillator (ICD) based on the results of broad genetic NGS testing, diagnostic criteria (ECG), and considering the high burden of sudden cardiac death in the patient's family, as well as his concerns that limited his everyday activities. This case shows that genetics and personalized medicine hold immense potential in the primary prevention, diagnosis, and treatment of Brugada syndrome and sudden cardiac death.
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Affiliation(s)
- Petar Brlek
- St. Catherine Specialty Hospital, Zagreb, Croatia
- School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | | | - Jana Mešić
- St. Catherine Specialty Hospital, Zagreb, Croatia
| | | | | | - Šime Manola
- Department for Cardiovascular Diseases, University Hospital Dubrava, Zagreb, Croatia
| | - Nikola Pavlović
- Department for Cardiovascular Diseases, University Hospital Dubrava, Zagreb, Croatia
| | - Jasmina Ćatić
- St. Catherine Specialty Hospital, Zagreb, Croatia
- Department for Cardiovascular Diseases, University Hospital Dubrava, Zagreb, Croatia
| | | | - Josep Brugada
- Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Dragan Primorac
- St. Catherine Specialty Hospital, Zagreb, Croatia
- School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Medical School, University of Rijeka, Rijeka, Croatia
- Medical School, University of Mostar, Mostar, Bosnia and Herzegovina
- Medical School, University of Split, Split, Croatia
- Department of Biochemistry & Molecular Biology, The Pennsylvania State University, State College, PA, United States
- The Henry C. Lee College of Criminal Justice and Forensic Sciences, University of New Haven, West Haven, CT, United States
- Medical School REGIOMED, Coburg, Germany
- National Forensic Sciences University, Gujarat, India
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Pavlov M, Hadžibegović I, Pavlović N, Manola Š. Septal branch in heart failure: Significant implications of an insignificant branch. Kardiol Pol 2023; 81:1302-1303. [PMID: 37537916 DOI: 10.33963/kp.a2023.0169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 07/31/2023] [Indexed: 08/05/2023]
Affiliation(s)
- Marin Pavlov
- Department of Cardiology, Dubrava University Hospital, Zagreb, Croatia.
- University North, Koprivnica, Croatia.
| | | | - Nikola Pavlović
- Department of Cardiology, Dubrava University Hospital, Zagreb, Croatia
| | - Šime Manola
- Department of Cardiology, Dubrava University Hospital, Zagreb, Croatia
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Manukyan H, Szegedi N, Pavlović N, Blessberger H, Fiedler L, Krieger K, Manola Š, Nagy VK, Roithinger FX, Salló Z, Steinwender C, Gellér L, Matschuck GA, Kosiuk J. Novel protocol for optimal utilization of HPSD approach for pulmonary vein isolation. J Arrhythm 2023; 39:539-545. [PMID: 37560278 PMCID: PMC10407163 DOI: 10.1002/joa3.12868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/19/2023] [Accepted: 04/28/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND The efficiency of pulmonary vein isolation (PVI) depends on the durability of RF lesions. Recent studies documented sustained continuity of ablation lines, improvements in durability, and expected clinical outcomes through altered settings in duration and power. However, the ablation strategy has not been adapted to this new approach and different biophysics of lesion formation. PURPOSE The aim of this study was to demonstrate that by adjusting the ablation approach to the broader geometry of lesions by increasing the minimal spacing between adjacent RF, a further significant reduction of procedural time while maintaining sufficient long-term outcomes is achievable. METHODS The presented study was a prospective, observational multi-center trial. The periprocedural data were compared with data from a consecutively collected historical cohort. RESULTS In total, 196 patients were included (mean age 62 ± 11 years, male 64.3%). Procedural duration, RF time, and LA dwelling time were significantly shorter in the HPSD group compared with the standard group (73 ± 26 min vs. 98 ± 36 min, p < .001; 14 ± 7 min vs. 33 ± 12 min, p < .001; and 59 ± 21 min vs. 77 ± 32 min, p < .001, respectively). Mean AF-free survival in the first year of follow-up was 304 ± 14 days in the HPSD group versus 340 ± 10 days in the standard group (log-rank p = .403). There were no statistically significant differences in the complication rates between the groups. CONCLUSION Increasing the minimal distance between individual application points simplifies AF ablation and further reduces procedure time without negative effects on efficacy and safety. Larger studies are needed to optimally utilize this approach.
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Affiliation(s)
| | - Nandor Szegedi
- Heart and Vascular CenterSemmelweis UniversityBudapestHungary
| | - Nikola Pavlović
- Department of CardiologyUniversity Hospital DubravaZagrebCroatia
| | | | | | - Konstantin Krieger
- Department of Internal Medicine and CardiologyUnfallkrankenhaus BerlinBerlinGermany
- Department of ElectrophysiologyAsklepios Klinikum HarburgHamburgGermany
| | - Šime Manola
- Department of CardiologyUniversity Hospital DubravaZagrebCroatia
| | - Vivien K. Nagy
- Heart and Vascular CenterSemmelweis UniversityBudapestHungary
| | | | - Zoltán Salló
- Heart and Vascular CenterSemmelweis UniversityBudapestHungary
| | - Clemens Steinwender
- Department of CardiologyKepler University HospitalLinzAustria
- Clinic of Internal Medicine II, Department of CardiologyParacelsus Medical University of SalzburgSalzburgAustria
| | - László Gellér
- Heart and Vascular CenterSemmelweis UniversityBudapestHungary
| | | | - Jedrzej Kosiuk
- Department of RhythmologyHelios Clinic KoethenKoethenGermany
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Tzeis S, Brusich S, Manola Š, Kojić D, Pernat A, Asvestas D, Xenos T, Bastiančić AL, Tomović M, Rauber M, Vardas P, Pavlović N. Ablation of residual potentials along the circumferential line reduces acute pulmonary vein reconnection. Hellenic J Cardiol 2023; 72:1-8. [PMID: 36907510 DOI: 10.1016/j.hjc.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/18/2023] [Accepted: 03/08/2023] [Indexed: 03/13/2023] Open
Abstract
INTRODUCTION Acute pulmonary vein (PV) reconnection is frequently encountered in patients undergoing PV isolation (PVI) procedure for the treatment of atrial fibrillation. In this study, we investigated whether the identification and ablation of residual potentials (RPs), after the initial achievement of PVI, reduces acute PV reconnection rate. METHODS Following PVI in 160 patients, mapping along the ablation line was performed to identify RPs, defined as bipolar amplitude ≥0.2 mV or 0.1-0.19 mV combined with a negative component of the unipolar electrogram. Ipsilateral PV sets with RPs were randomized to either no further ablation (Group B) or to additional ablation of the identified RPs (Group C). The primary study endpoint was spontaneous or adenosine-mediated acute PV reconnection after a 30-min waiting period and was also evaluated in ipsilateral PV sets without RPs (Group A). RESULTS After isolation of 287 PV pairs, 135 had no RPs (Group A), whereas the remaining PV pairs were randomized to either Group B (n = 75) or Group C (n = 77). Ablation of RPs resulted in a reduction of spontaneous or adenosine-mediated PV reconnection rate (16.9% in Group C vs 48.0% in Group B; p < 0.001). Group A was associated with a significantly lower percentage of acute PV reconnection as compared to Group B (5.9% vs 48.0%; p < 0.001) and Group C (5.9% vs 16.9%; p = 0.016). CONCLUSION After PVI achievement, the absence of RPs along the circumferential line is associated with a low likelihood of acute PV reconnection rate. Ablation of RPs significantly reduces spontaneous or adenosine-mediated acute PV reconnection rate.
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Affiliation(s)
- Stylianos Tzeis
- Cardiology Department, Mitera Hospital, Hygeia Group, Athens, Greece.
| | - Sandro Brusich
- Clinic for Cardiovascular Diseases, University Hospital Centre Rijeka, Rijeka, Croatia
| | - Šime Manola
- Department of Cardiovascular Medicine, University Hospital Dubrava, Zagreb, Croatia
| | - Dejan Kojić
- Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Andrej Pernat
- Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Theodoros Xenos
- Biosense Webster, Johnson & Johnson MedTech Greece, Athens, Greece
| | - Ana Lanča Bastiančić
- Clinic for Cardiovascular Diseases, University Hospital Centre Rijeka, Rijeka, Croatia
| | | | - Martin Rauber
- Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Panos Vardas
- Cardiology Department, Mitera Hospital, Hygeia Group, Athens, Greece
| | - Nikola Pavlović
- Department of Cardiovascular Medicine, University Hospital Dubrava, Zagreb, Croatia
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Jurin I, Trkulja V, Lucijanić M, Pejić J, Letilović T, Radonić V, Manola Š, Rudan D, Hadžibegović I. Red Cell Distribution Width in Acute Pulmonary Embolism Patients Improves 30-Day Mortality Risk Stratification Based on the Pulmonary Embolism Severity Index. Heart Lung Circ 2022; 31:859-866. [PMID: 35074262 DOI: 10.1016/j.hlc.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 11/24/2021] [Accepted: 12/05/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To validate red cell distribution width (RDW) as an improvement in 30-day mortality risk stratification based on the Pulmonary Embolism Severity Index (PESI) in acute pulmonary embolism (PE). PATIENTS AND METHODS Prospective observational analysis of consecutive adult acute PE patients. RESULTS Among 731 patients, 30-day mortality was 11.9%. With adjustment for the PESI score and number of covariates, higher RDW was associated with higher mortality (RDW continuous: OR 1.21, 95% CI 1.06-1.38; Bayesian OR 1.22, 1.07-1.40; RDW 'high' [>14.5% in men >16.1% in women] vs normal: OR 3.83, 1.98-7.46; Bayesian OR 3.98, 2.04-7.68]. Crude mortality was 3.6% if PESI 86-105 (intermediate risk), but 1.2% if RDW normal and 7.1% if RDW high; 11.8% if PESI 106-125 (high risk), but 3.6% if RDW normal and 18.8% if RDW high. Adjusted probabilities showed higher mortality (ORs between 3.5-5.8) if RDW was high in any PESI risk subgroup. Crude mortality rates in two random-split subsets (n=365 and n=366) again showed the same patterns. CONCLUSIONS On-admission RDW above the normal range improves 30-day mortality risk stratification based on PESI score in acute PE. Particularly, it corrects PESI-based intermediate-risk or high-risk allocation by reclassification into very low-risk (<3.5%) or very high-risk (>11.0%).
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Affiliation(s)
- Ivana Jurin
- Department for Cardiovascular Diseases, University Hospital Dubrava, Zagreb, Croatia
| | | | - Marko Lucijanić
- Hematology Department, University Hospital Dubrava, Zagreb, Croatia
| | - Josip Pejić
- Department for Thoracic Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Tomislav Letilović
- Zagreb University School of Medicine, Zagreb, Croatia; Cardiology Department, University Hospital Merkur, Zagreb, Croatia
| | - Vedran Radonić
- Cardiology Department, University Hospital Merkur, Zagreb, Croatia
| | - Šime Manola
- Department for Cardiovascular Diseases, University Hospital Dubrava, Zagreb, Croatia
| | - Diana Rudan
- Department for Cardiovascular Diseases, University Hospital Dubrava, Zagreb, Croatia
| | - Irzal Hadžibegović
- Department for Cardiovascular Diseases, University Hospital Dubrava, Zagreb, Croatia; Faculty of Dental Medicine and Health Care, Josip Juraj Strossmayer University, Osijek, Croatia.
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Primorac D, Odak L, Perić V, Ćatić J, Šikić J, Radeljić V, Manola Š, Nussbaum R, Vatta M, Aradhya S, Sofrenović T, Matišić V, Molnar V, Skelin A, Mirat J, Brachmann J. Sudden Cardiac Death-A New Insight Into Potentially Fatal Genetic Markers. Front Med (Lausanne) 2021; 8:647412. [PMID: 33829027 PMCID: PMC8019733 DOI: 10.3389/fmed.2021.647412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/01/2021] [Indexed: 01/13/2023] Open
Abstract
Sudden cardiac death (SCD) is an unexpected and dramatic event. It draws special attention especially in young, seemingly healthy athletes. Our scientific paper is based on the death of a young, 23-year-old professional footballer, who died on the football field after a two-year history of cardiac symptoms. In this study we analyzed clinical, ECG and laboratory data, as well as results of genetic testing analysis in family members. To elucidate potential genetic etiology of SCD in this family, our analysis included 294 genes related to various cardiac conditions.
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Affiliation(s)
- Dragan Primorac
- St. Catherine Specialty Hospital, Zagreb, Croatia.,Eberly College of Science, The Pennsylvania State University, University Park, State College, Philadelphia, PA, United States.,The Henry C. Lee College of Criminal Justice and Forensic Sciences, University of New Haven, West Haven, CT, United States.,Medical School, University of Split, Split, Croatia.,Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.,Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.,Medical School, University of Rijeka, Rijeka, Croatia.,Medical School REGIOMED, Coburg, Germany.,Medical School, University of Mostar, Mostar, Bosnia and Herzegovina
| | - Ljubica Odak
- St. Catherine Specialty Hospital, Zagreb, Croatia.,Children's Hospital Zagreb, Zagreb, Croatia
| | | | - Jasmina Ćatić
- St. Catherine Specialty Hospital, Zagreb, Croatia.,Department of Cardiology, Clinical Hospital Dubrava, Zagreb, Croatia
| | - Jozica Šikić
- Department of Cardiology, Clinical Hospital Sveti Duh, Zagreb, Croatia
| | - Vjekoslav Radeljić
- Department of Cardiology, Clinical Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Šime Manola
- Department of Cardiology, Clinical Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | | | | | | | | | - Vid Matišić
- St. Catherine Specialty Hospital, Zagreb, Croatia
| | - Vilim Molnar
- St. Catherine Specialty Hospital, Zagreb, Croatia
| | | | - Jure Mirat
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Johannes Brachmann
- Medical School, University of Split, Split, Croatia.,Medical School REGIOMED, Coburg, Germany
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Zeljković I, Pavlović N, Radeljić V, Manola Š. Delayed radiofrequency ablation efficacy in slow pathway ablation: a case report. Eur Heart J Case Rep 2021; 5:ytaa489. [PMID: 33569524 PMCID: PMC7859601 DOI: 10.1093/ehjcr/ytaa489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/15/2020] [Accepted: 11/03/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND The delayed effect of radiofrequency (RF) ablation was described in cases of accessory pathway and premature ventricular contraction ablation, as well as delayed atrioventricular (AV) block after slow pathway ablation. CASE SUMMARY We report a case of a female patient with AV nodal re-entry tachycardia (AVNRT), in whom the first electrophysiology study ended with acute failure of slow pathway ablation, despite using long steerable sheath, both right and left-sided ablation with >15 min of RF energy application and repeatedly achieving junctional rhythm. Six weeks afterwards, during scheduled three-dimensional electroanatomical mapping procedure, there was no proof of dual AV nodal conduction nor could the tachycardia be induced. Also, the patient did not have palpitations between the two procedures nor during the 12-month follow-up period. DISCUSSION This case illustrates that watchful waiting for delayed RF ablation efficacy in some cases of AVNRT ablation could be reasonable, in order to reduce the risk of complications associated with slow pathway ablation.
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Affiliation(s)
- Ivan Zeljković
- Department of Cardiology, Sestre Milosrdnice University Hospital, Vinogradska cesta 29, 10 000 Zagreb, Croatia
| | - Nikola Pavlović
- Department of Cardiology, Sestre Milosrdnice University Hospital, Vinogradska cesta 29, 10 000 Zagreb, Croatia
| | - Vjekoslav Radeljić
- Department of Cardiology, Sestre Milosrdnice University Hospital, Vinogradska cesta 29, 10 000 Zagreb, Croatia
| | - Šime Manola
- Department of Cardiology, Sestre Milosrdnice University Hospital, Vinogradska cesta 29, 10 000 Zagreb, Croatia
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Zeljković I, Bulj N, Kordić K, Pavlović N, Radeljić V, Benko I, Zadro Kordić I, Đula K, Kos N, Delić Brkljačić D, Manola Š. Atrial appendages’ mechanics assessed by 3D transoesophageal echocardiography as predictors of atrial fibrillation recurrence after pulmonary vein isolation. IJC Heart & Vasculature 2020; 31:100642. [PMID: 33015318 PMCID: PMC7522341 DOI: 10.1016/j.ijcha.2020.100642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 08/05/2020] [Accepted: 09/10/2020] [Indexed: 11/30/2022]
Abstract
Data on atrial appendages' mechanics as predictors of AF recurrence after PVI is scarce. 3D and 2D-TEE have potential to provide additional data on LAA function. Patients with AFR had significantly lower LAA tissue velocity and ostium surface area. RAA tissue velocity and SVC ostium surface area were not correlated to AF recurrence.
Background Although there are numerous studies reflecting predictors of atrial fibrillation (AF) recurrence (AFR) after pulmonary vein isolation (PVI), data on atrial appendages' mechanics is scarce. This study aimed to assess atrial appendages' mechanics by 2-dimensional (2D) and 3-dimenssional (3D) transoesphageal echocardiography (TEE) and to explore its value to predict AFR after PVI. Methods Consecutive patients with paroxysmal AF undergoing first PVIwere analysed. 3D and 2D-TEE with tissue Doppler imaging (TDI) and strain analysis was obtained prior to the PVI, including: left atrial appendage (LAA) TDI and strain analysis, LAA ostium surface area, right atrial appendage’s TDI velocity and superior vena cava (SVC) ostium surface area. The primary end-point was freedom from any documented recurrence of atrial arrhythmia lasting > 30 s. Results This single-centre, prospective study included 74 patients with paroxysmal AF (median age 59 years; 36% female; BMI 27.4 ± 4.1 kg/m2, LA volume index 32 ± 11 mL/m2). After a median follow-up of 14 (IQR 10–22) months, 21 (28%) patients had AFR. In a univariate and multivariate Cox-regression analysis LAA TDI velocity (HR 1.48, 95%CI 1.28–1.62, p < 0.001) and LAA ostium surface area(HR 1.58, 95%CI 1.06–1.81, p = 0.033) both independently predicted AFR after single PVI. RAA TDI velocity and SVC ostium surface area were not correlated to AFR. Conclusion Paroxysmal AF patients with lower LAA TDI tissue velocity and LAA ostium surface area have higher risk of developing AFR after PVI. To our knowledge, this is the first study assessing atrial appendages’ mechanics in predicting AFR after PVI. Clinical trial registration: www.drks.de(Identifier: DRKS00010495)
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Affiliation(s)
- Ivan Zeljković
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
- Corresponding author at: Department of Cardiology, Sestre milosrdnice University Hospital Centre, Vinogradska cesta 29, 10 000 Zagreb, Croatia.
| | - Nikola Bulj
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Krešimir Kordić
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Nikola Pavlović
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Vjekoslav Radeljić
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ivica Benko
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Ines Zadro Kordić
- Department of Internal Medicine, County Hospital “dr. Ivo Pedišić”, Sisak, Croatia
| | - Kristijan Đula
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Nikola Kos
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Diana Delić Brkljačić
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Šime Manola
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
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Hoteit S, Babacanli A, Babacanli MR, Šikić A, Olujić V, Radovanić S, Radeljić V, Zeljković MK, Manola Š, Zeljković I. Impact of mobility on degree of hydration in octogenarian population examined in the emergency department. Am J Emerg Med 2020; 46:681-683. [PMID: 32933809 DOI: 10.1016/j.ajem.2020.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/13/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sara Hoteit
- Duga Resa Long-term Care Hospital, Ulica Jozefa Jeruzalema 7, Duga Resa 47250, Croatia
| | - Alen Babacanli
- Department of Emergency Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | | | - Aljoša Šikić
- Department of Emergency Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Vida Olujić
- Department of Internal Emergency Medicine, Split University Hospital Centre, Split, Croatia
| | - Sandra Radovanić
- Department of Internal Emergency Medicine, Split University Hospital Centre, Split, Croatia
| | - Vjekoslav Radeljić
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Matea Kolačević Zeljković
- Unit of Clinical Pharmacology and Toxicology, Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Šime Manola
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Ivan Zeljković
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia.
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Pavlović N, Đula K, Kuharić I, Brusich S, Velagić V, Jurišić Z, Bakotić Z, Anić A, Pezo Nikolić B, Radeljić V, Čubranić Z, Zeljković I, Zadravec D, Manola Š. MANAGEMENT OF PATIENTS WITH CARDIAC IMPLANTABLE ELECTRONIC DEVICES UNDERGOING MAGNETIC RESONANCE IMAGING - PROPOSAL FOR UNIFIED HOSPITAL PROTOCOL: CROATIAN WORKING GROUP ON ARRHYTHMIAS AND CARDIAC PACING. Acta Clin Croat 2020; 59:119-125. [PMID: 32724282 PMCID: PMC7382882 DOI: 10.20471/acc.2020.59.01.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
For many years, magnetic resonance imaging (MRI) was contraindicated in patients with cardiac implantable electronic devices (CIED). Today, there is a growing amount of evidence that MRI can be performed safely in the majority of patients with CIEDs. Firstly, there are devices considered MRI conditional by manufacturers that are available on the market and secondly, there is clear evidence that even patients with MRI non-conditional devices can also undergo MRI safely. Protocols have been developed and recommendations from different cardiac and radiologic societies have been published in recent years. However, the majority of physicians are still reluctant to refer these patients to MRI. Therefore, this document is published as a joint statement of the Croatian Working Group on Arrhythmias and Cardiac Pacing and Department of Radiology, Sestre milosrdnice University Hospital Centre to guide and ease the management of patients with CIED undergoing MRI. Also, we propose a unified protocol and checklist that could be used in Croatian hospitals.
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Affiliation(s)
- Nikola Pavlović
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Kristijan Đula
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Ivan Kuharić
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Sandro Brusich
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Vedran Velagić
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Zrinka Jurišić
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Zoran Bakotić
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Ante Anić
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Borka Pezo Nikolić
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Vjekoslav Radeljić
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Zlatko Čubranić
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Ivan Zeljković
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Dijana Zadravec
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
| | - Šime Manola
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Cardiology, Rijeka University Hospital Centre, Rijeka, Croatia; 4Department of Cardiology, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Cardiology, Split University Hospital Centre, Split, Croatia; 6Department of Cardiology, Zadar General Hospital, Zadar, Croatia
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Taleski J, Manola Š, Radeljić V, Bulj N, Delić Brkljačić D, Pavlović N. LEFT VENTRICULAR LEAD PLACEMENT FOR PACING AND SENSING IN A PATIENT WITH ARRHYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY UNDERGOING ICD IMPLANTATION. Acta Clin Croat 2019; 58:391-393. [PMID: 31819339 PMCID: PMC6884391 DOI: 10.20471/acc.2019.58.02.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We present a case of a 64-year-old female patient scheduled for implantable cardioverter defibrillator (ICD) implantation due to arrhythmogenic right ventricular cardiomyopathy (ARVC). Dual coil, active fixation ICD lead was introduced through the axillary vein. More than 20 positions were changed in the right ventricle (RV) (outflow tract, high, mid and apical septum, infero-basal, apical and lateral wall). Maximum R wave amplitude was 2 mV with pacing threshold of 0.5 V. Since the sensing was inappropriate, we decided to place the pace/sense lead of the ICD in the coronary sinus. The lead was placed in the basal part of the lateral vein. The pacing threshold was 1.0 V/0.40 ms and R wave was 9 mV. The lead was connected to the ICD sense-pace port and high voltage coils were connected in the usual way. The RV sense-pace lead was capped off. The device sensed an R wave of 7.0 mV 48 hours later. The purpose of this report is to show a possible solution of sensing problems during an ICD implantation in a patient with ARVC.
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Affiliation(s)
| | - Šime Manola
- 1Department of Cardiology, Division of Cardiac Electrophysiology and Electrostimulation, Skopje, Republic of Macedonia; 2Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Vjekoslav Radeljić
- 1Department of Cardiology, Division of Cardiac Electrophysiology and Electrostimulation, Skopje, Republic of Macedonia; 2Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Nikola Bulj
- 1Department of Cardiology, Division of Cardiac Electrophysiology and Electrostimulation, Skopje, Republic of Macedonia; 2Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Diana Delić Brkljačić
- 1Department of Cardiology, Division of Cardiac Electrophysiology and Electrostimulation, Skopje, Republic of Macedonia; 2Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Nikola Pavlović
- 1Department of Cardiology, Division of Cardiac Electrophysiology and Electrostimulation, Skopje, Republic of Macedonia; 2Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
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Zeljković I, Manola Š, Radeljić V, Delić Brkljačić D, Babacanli A, Pavlović N. ROUTINELY AVAILABLE BIOMARKERS AS LONG-TERM PREDICTORS OF DEVELOPING SYSTOLIC DYSFUNCTION IN COMPLETELY REVASCULARIZED PATIENTS WITH ACUTE ST ELEVATION MYOCARDIAL INFARCTION. Acta Clin Croat 2019; 58:95-102. [PMID: 31363330 PMCID: PMC6629206 DOI: 10.20471/acc.2019.58.01.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The aim of this study was to assess the efficacy of high-sensitivity C-reactive protein (hsCRP), cardiac troponin T (cTnT) and creatine kinase (CK) as long-term predictors of reduced systolic function in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) with complete revascularization. This prospective study evaluated consecutive patients with acute STEMI who had normal left ventricular ejection fraction (LVEF ≥50%) at admission with single-vessel disease and underwent complete revascularization. Blood samples were collected from admission to day 7. The primary endpoint was reduction of LVEF <50% after 12 months. The study included 47 patients, median age 59±10 years, 74.5% of them men. Patients who developed systolic dysfunction (LVEF <50%) had significantly higher mean values of cTnT after 24 hours (5.11 vs. 2.82 µg/L, p=0.010) and peak values of CK (3375.5 vs. 1865 U/L, p=0.008). There was no significant relation between hsCRP and development of reduced LVEF (p=0.541). In conclusion, cTnT and CK could serve as long-term predictors of reduced left ventricular systolic function (<50%) in acute STEMI patients with normal systolic function at admission, single-vessel coronary disease and complete revascularization during primary PCI.
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Affiliation(s)
| | - Šime Manola
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Emergency Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Vjekoslav Radeljić
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Emergency Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Diana Delić Brkljačić
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Emergency Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Alen Babacanli
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Emergency Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Nikola Pavlović
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Emergency Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
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Pavlović N, Manola Š, Vražić H, Vučić M, Brusich S, Radeljić V, Zeljković I, Matasić R, Anić A, Benko I, Gavranović Ž, Zlatić Glogoški M. Recommendations for Perioperative Management of Patients with Cardiac Implantable Electronic Devices. Acta Clin Croat 2018; 57:383-390. [PMID: 30431735 PMCID: PMC6532011 DOI: 10.20471/acc.2018.57.02.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
SUMMARY – Four thousand cardiac implantable electronic devices (CIED) are implanted yearly in Croatia with constant increase. General anesthesia and surgery carry some specific risk for the patients with implanted CIEDs. Since most of the surgical procedures are performed in institutions without reprogramming devices available, or in the periods when they are unavailable, these guidelines aim to standardize the protocol for perioperative management of these patients. With this protocol, most of the procedures can be performed easily and, more importantly, safely in the majority of surgical patients.
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Affiliation(s)
| | - Šime Manola
- Institute of Postcoronary Care and Arrhythmias, Department of Cardiovascular Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Hrvoje Vražić
- Institute of Cardiology, Department of Internal Diseases, Dubrava University Hospital, Zagreb, Croatia
| | - Marinko Vučić
- Institute of Anesthesiology and Intensive Care, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Sandro Brusich
- Institute of Cardiovascular Diseases, Department of Internal Medicine, Rijeka University Hospital Centre, Rijeka, Croatia
| | - Vjekoslav Radeljić
- Institute of Postcoronary Care and Arrhythmias, Department of Cardiovascular Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Ivan Zeljković
- Institute of Postcoronary Care and Arrhythmias, Department of Cardiovascular Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Richard Matasić
- Department of Cardiovascular Diseases, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Ante Anić
- Division of Cardiology, Institute of Internal Medicine, Zadar General Hospital, Zadar, Croatia
| | - Ivica Benko
- Institute of Postcoronary Care and Arrhythmias, Department of Cardiovascular Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Željka Gavranović
- Institute of Anesthesiology and Intensive Care, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Milana Zlatić Glogoški
- Institute of Anesthesiology and Intensive Care, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
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Zeljković I, Bulj N, Kolačević M, Čabrilo V, Brkljačić DD, Manola Š. Failure of Intracardiac Pacing After Fatal Propafenone Overdose: A Case Report. J Emerg Med 2018; 54:e65-e68. [PMID: 29336990 DOI: 10.1016/j.jemermed.2017.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 11/04/2017] [Accepted: 12/01/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Propafenone is a sodium-channel blocker, class IC antiarrhythmic drug, frequently used to manage supraventricular dysrhythmias, especially atrial fibrillation. We report a self mono-intoxication with propafenone. CASE REPORT A 68-year-old woman presented with a decreased level of consciousness, hypotension, and electrocardiogram showing QRS widening with atrial asystole and extreme bradycardia < 20 beats/min. After initial stabilization with transcutaneous pacing, laboratory findings detected normal electrolyte ranges and metabolic acidosis, and her medical history revealed availability of propafenone due to paroxysmal atrial fibrillation and depressive syndrome, which led to the suspicion of intoxication. Despite intravenous sodium bicarbonate, calcium, norepinephrine, and aggressive fluid replacement (10% glucose with insulin), hemodynamic stability was not achieved. Temporary intracardiac pacing was implanted. However, even with multiple electrode positions, effective capture could not be achieved. At that time, transcutaneous pacing was also ineffective. Consequently, the patient died in refractory asystole due to complete myocardial nonexcitability. The concentration of 5270 ng/mL of propafenone was found in the blood at autopsy, using gas spectrometry-mass chromatography. It is the third highest reported propafenone lethal concentration and the first case in which the myocardial nonexcitability refractory to intracardiac pacing was seen despite normal electrode position in the right ventricle, with failure to achieve the patient's hemodynamic stability. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should be aware of possible propafenone ingestion causing toxicity, which is probably more frequent than previously described, especially because propafenone is widely available due to its use in managing atrial fibrillation, the most common arrhythmia nowadays.
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Affiliation(s)
- Ivan Zeljković
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Nikola Bulj
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Matea Kolačević
- Unit of Clinical Pharmacology and Toxicology, Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Vedran Čabrilo
- Department of Emergency Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Diana Delić Brkljačić
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Šime Manola
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
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Zeljković I, Benko I, Manola Š, Radeljić V, Pavlović N. An uncommon case of spontaneous conversion from AV re-entry tachycardia to AV nodal re-entry tachycardia in a patient with dual tachycardia. Indian Pacing Electrophysiol J 2016; 15:245-8. [PMID: 27134441 PMCID: PMC4834425 DOI: 10.1016/j.ipej.2016.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We report the case of a 46-year old patient in whom an electrophysiology study (EP) was performed due to paroxysmal supraventricular tachycardia documented in 12-lead ECG. During the EP study, supraventricular tachycardia was induced easily and it corresponded to orthodromic AV reentry tachycardia (AVRT) using a concealed left free wall accessory pathway. However, during the study AVRT spontaneously and repeatedly converted to the typical slow-fast AV node reentry tachycardia (AVNRT). Both accessory and AV nodal slow pathways were ablated, due to the finding that both AVRT and AVNRT were independently inducible during the EP study.
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Affiliation(s)
- Ivan Zeljković
- Department of Cardiology and Electrophysiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Ivica Benko
- Department of Cardiology and Electrophysiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Šime Manola
- Department of Cardiology and Electrophysiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Vjekoslav Radeljić
- Department of Cardiology and Electrophysiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Nikola Pavlović
- Department of Cardiology and Electrophysiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
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Manola Š, Bernat R, Pavlović N, Radeljić V, Bulj N, Trbušić M. Transcatheter patent foramen ovale closure and radiofrequency ablation of right atrial tachycardia. Acta Clin Croat 2014; 53:490-493. [PMID: 25868319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
Patent foramen ovale (PFO) can be found in approximately 25% of adult population. Transcatheter closure of PFO is a potential option in selected patients with PFO. We report a case of a female patient that underwent mapping and catheter ablation of atrial tachycardia and PFO closure in the same procedure.
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Petrač D, Radeljić V, Delić-Brkljačić D, Manola Š, Cindrić-Bogdan G, Pavlović N. Persistent atrial fibrillation is associated with a poor prognosis in patients with atrioventricular block and dual-chamber pacemaker. Pacing Clin Electrophysiol 2012; 35:695-702. [PMID: 22452373 DOI: 10.1111/j.1540-8159.2012.03376.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The prognostic significance of development of persistent atrial fibrillation (AF) in patients with atrioventricular (AV) block and dual chamber (DDD) pacemakers has not been separately investigated. We sought to determine whether persistent AF influences clinical outcome in these patients. METHODS Three hundred-eight consecutive patients with second- or third-degree AV block and implanted a DDD pacemaker were followed for 36 ± 20 months and retrospectively divided into two groups. Thirty-four patients who developed persistent AF formed persistent AF group, and 278 patients who remained free of this arrhythmia control group. Clinical and outcome data of the two groups were compared. The primary outcome was cardiovascular death. RESULTS The primary outcome occurred more often among the patients in the persistent AF group (6.8% per year) than among those in the control group (2.9% per year; P = 0.028). This difference was primarily because of higher rate of heart failure-related deaths in the persistent AF group (P = 0.009). Secondary outcomes, hospitalization for heart failure and paroxysmal AF episode ≥5 minutes, occurred also more often among the patients in the persistent AF group (P = 0.008 and P < 0.001, respectively), although the risk of nonfatal stroke was similar in both groups (P = 0.628). CONCLUSION In patients with second- or third-degree AV block and DDD pacemaker, the development of persistent AF is associated with an increased risk of cardiovascular death and heart failure.
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Affiliation(s)
- Dubravko Petrač
- Bogdan Cardiology Polyclinic, Zagreb, Croatia. d.petrac@inet-hr
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Radeljić V, Pavlović N, Manola Š, Delić-Brkljačić D, Pintarić H, Petrač D. Incidence and predictors of asymptomatic atrial fibrillation in patients older than 70 years with complete atrioventricular block and dual chamber pacemaker implantation. Croat Med J 2011; 52:61-7. [PMID: 21328722 PMCID: PMC3046490 DOI: 10.3325/cmj.2011.52.61] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
AIM To evaluate predictors of asymptomatic atrial fibrillation in patients older than 70 years with complete atrioventricular (AV) block, normal left ventricular systolic function, and implanted dual chamber (DDD) pacemaker. METHODS Hundred and eighty six patients with complete AV block were admitted over one year to the Sisters of Mercy University Hospital. The study recruited patients older than 70 years, with no history of atrial fibrillation, heart failure, or reduced left ventricular systolic function. All the patients were implanted with the same pacemaker. Out of 103 patients who were eligible for the study, 81 (78%) were evaluated. Among those 81 (78%) were evaluated. Eighty one (78%) patients were evaluated. Follow-up time ranged from 12 to 33 months (average ±standard deviation 23 ± 5 months). Primary end-point was asymptomatic atrial fibrillation occurrence recorded by the pacemaker. Atrial fibrillation occurrence was defined as atrial high rate episodes (AHRE) lasting >5 minutes. Binary logistic regression was used to identify the predictors of development of asymptomatic atrial fibrillation. Results. The 81 patients were stratified into two groups depending on the presence of AHRE lasting >5 minutes (group 1 had AHRE>5 minutes and group 2 AHRE<5 minutes). AHRE lasting >5 minutes were detected in 49 (60%) patients after 3 months and in 53 (65%) patients after 18 moths. After 3 months, only hypertension (odds ratio [OR], 17.63; P = 0.020) was identified as a predictor of asymptomatic atrial fibrillation. After 18 months, hypertension (OR, 14.0; P = 0.036), P wave duration >100 ms in 12 lead ECG (OR, 16.5; P = 0.001), and intracardial atrial electrogram signal amplitude >4 mV (OR, 4.27; P = 0.045) were identified as predictors of atrial fibrillation. CONCLUSION In our study population, hypertension was the most robust and constant predictor of asymptomatic atrial fibrillation after 3 months, while P wave duration >100 ms in 12-lead ECG and intracardial atrial signal amplitude were predictors after 18 months.
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Affiliation(s)
- Vjekoslav Radeljić
- Department of Cardiology, Sisters of Mercy University Hospital Center, Vinogradska cesta 29, 10000 Zagreb, Croatia
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Manola Š, Pintarić H, Pavlović N, Štambuk K. Coronary artery stent fracture with aneurysm formation and in-stent restenosis. Int J Cardiol 2010; 140:e36-9. [DOI: 10.1016/j.ijcard.2008.11.100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Accepted: 11/16/2008] [Indexed: 11/24/2022]
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