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1
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P wave duration and morphology in patients with atrial fibrillation

100%
Mercik J. S., Unkell M., Marinov M., Wolff P. S., Radziejewska J., Gajek J.
European Journal of Translational and Clinical Medicine
|
2020
|
vol. 3
|
issue 2
22-28
EN
Background: Functional and structural atrial changes contribute to AF. It decreases conduction velocity and forms intra atrial blocks. In the ECG those changes are manifested by the duration and morphology of the P wave. Material and method: The study group consisted of 50 patients with atrial fibrillation. There were 27 women and 23 men, aged 65.3 +/- 9.8 years. 22 patients had paroxysmal AF and 28 had persistent AF, in the latter direct current cardio version was performed. Results: In patients with a prolonged episodes of atrial fi- brillation the P wave duration was longer in comparison to patients with sinus rhythm (187.1 +/- 31.5 vs 161.1 +/- 18.8 ms; p = 0.006). There were significant differences in P wave duration among the patients with normal and abnormal interatrial conduction, with the longest duration in complete Bachmann's bundle block group (152.7 +/- 17.5 vs 165.3 +/- 15.3 vs 207.9 +/- 27.5 ms; p < 0.001). Conclusions: In patients with persistent atrial fibrillation the duration of the P wave is prolonged in comparison to paroxysmal. In the majority of patients prolongation of the P wave duration is dependent on different forms of conduction block. The morphological changes of P waves are caused by the arrhythmia rather than left atrial hypertrophy.
2
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Radiofrequency pulmonary veins isolation of atrial fibrillation in patients undergoing mitral valve replacement

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Grabowski M., Hryniewiecki T., Gawałkiewicz T., Stępińska J., Biederman A.
Open Medicine
|
2006
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vol. 1
|
issue 1
58-68
EN
Introduction: Pulmonary veins isolation (PVI) is useful method in patients (pts) with mitral valve disease (MVD) and chronic atrial fibrillation (AF) during prosthetic valve implantation. The aim of the study: To evaluate e.ectiveness of PVI in the treatment of AF in pt with MVD during valve implantation. Material and methods: 45 pts (mean age 55 yrs) with AF were operated on for MVD.RF ablation around the pulmonary veins, a lesion between them and to the mitral annulus were performed. There were 44 prostheses implanted, 1 case of mitral valve annuloplasty, associated with tricuspid valve repair (5 pts), aorto-coronary bypass procedure (2 pts), ASD II closure (1 pt). Results: SR was achieved in 2 (44,5%) pts, 21 (46,5%)pts were in AF, 4 (9%) pts needed pacing. No correlation between SR restoration and preoperative echocardiographic parameters, age, gender, NYHA functional class were found. In long-term follow-up 1 pt have reversed AF to SR spontaneously. There were 6 cases of paroxysmal AF,1 pt needed pacemaker implantation. 20 (44,5%) pts are in SR, 20 (44,5%) in AF, 5 (11%) in permanent pacing. Conclusion: PVI with RF use is effective in restoring sinus rhythm in patients with chronic AF secondary to mitral valve disease.
3
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Usefulness of CartoMerge image integration module in catheter ablation of atrial fibrillation

100%
Drelich Ł., Królak T., Liżewska-Springer A., Kempa M., Kozłowski D., Raczak G.
European Journal of Translational and Clinical Medicine
|
2019
|
vol. 2
|
issue 1
48-52
EN
Background: Anatomy assessment using Computer Tomography (CT) and Magnetic Resonance (MRI) is performed in patients undergoing pulmonary vein isolation (PVI). The aim of this analysis was to investigate whether electroanatomical 3D map and CT/MRI image integration using the CartoMerge system improves efficacy, reduces procedure time or fluoroscopy usage. Materials and methods: 57 patients undergoing PVI were divided in two groups: “Merge” (n=45 pts) and “non-Merge” (n=14 pts) depending on usage of image integration. PV isolation during procedure (acute PVI), procedure time, fluoroscopy time, number of radio frequency (RF) applications and AF recurrence during follow-up (Merge group: 12-24 months, non-Merge group: 9-18 months) were analyzed. Results: Intra-procedural PVI was equal in both groups (93%). Long-term efficacy, defined as absence of AF recurrence, was insignificantly higher in the Merge group (69,8% vs 50%, p=0,11793). Procedure time was significantly longer in the Merge group – 239,1 (±55,5) min. vs 192,4 (±44,5). Fluoroscopy time was similar in both groups 29,9 (±12,23) vs 24,6 (±26,5) min, (p=0,579). Number of RF applications was significantly higher in the Merge group 48,5 (±25,2) vs 27,2 (±14,9). Conclusions: CartoMerge did not improve the rate of acute PVI, long-term effectivity or fluoroscopy time. In the non-Merge group the procedure time was shorter and the number of applications was significantly smaller.
4
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Periprocedural decrease in tumor necrosis factor alpha is a risk factor for atrial fibrillation recurrence after ablation

100%
Szczerba E., Koźluk E., Januszkiewicz Ł., Lisicka M., Nowak J., Kondracka A., Majstrak J., Rodkiewicz D., Piątkowska A., Kiliszek M., Opolski G.
European Journal of Translational and Clinical Medicine
|
2022
|
vol. 5
|
issue 2
16-23
EN
Background Concentration of tumor necrosis factor alpha (TNF-alpha) might be useful in selecting patients with paroxysmal atrial fibrillation (PAF) who will benefit the most from pulmonary vein isolation. Material and methods We performed prospective cohort study among patients with PAF who had sinus rhythm prior to undergoing either radiofrequency ablation or cryoablation procedure. Blood samples were collected at the start of the procedure and 16-24 h after. TNF-alpha concentrations were measured. Follow-up data was obtained during a structured telephone interview and 24-hour ECG Holter monitoring 12 months after the ablation procedure. Results Thirty seven patients were enrolled. After 12-month follow-up 27 patients maintained sinus rhythm, 8 had recurrence of AF and 2 were lost to follow-up. There was no significant correlation between TNF-alpha concentrations in any of the samples and the recurrence of arrhythmia (for pre-procedural samples: 1.75 pg/ml vs 1.74 pg/ml; p=0.72; for post-procedural samples: 1.49 pg/ml vs 1.79 pg/ml; p=0.16). In patients who had a recurrence of AF, we observed a decrease in the periprocedural TNF-alpha concentration (-0.12 pg/ml vs 0.05 pg/ml; p=0.05). Conclusions Neither pre- nor post-procedural TNF-alpha concentrations are predictive of ablation outcome in patients with PAF. We observed a decrease in the periprocedural TNF-alpha concentration in patients who had AF recurrence.
5
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Clinical and laboratory assessment of patients with new-onset atrial fibrillation in acute myocardial infarction

100%
Raczkowska-Golanko M., Daniłowicz-Szymanowicz L., Nowak R., Puchalski W., Gruchała M., Kozłowski D., Raczak G.
|
|
issue 1
39-43
EN
Background New-onset atrial fibrillation (NOAF) is one of the complications of acute myocardial infarction (AMI), and is associated with poor outcome. The aim of the study was clinical and laboratory assessment of patients with NOAF in AMI. Material and methods This is a retrospective, single-centre study of AMI patients with NOAF, who were admitted to Clinical Centre of Cardiology of the University Clinical Centre in Gdansk, from January 2016 to June 2018. The medical history, echocardiography parameters, AMI localization and infarcted-related artery as well as laboratory parameters at the admission and at the moment of NOAF onset were taken into further analyses. Results From 1155 consecutive AMI patients 103 (8.9%) with NOAF were enrolled into the study. A significant increase in C-reactive protein (CRP) and high-sensitive Troponine I (hsTnI) level, whereas significant decrease in potassium and hemoglobin level was observed at the moment of NOAF in comparison to admission. Conclusions Our study suggests that markers of inflammation (CRP), myocardial necrosis (hsTnI), hemoglobin and serum potassium may be associated with NOAF in the setting on AMI. The aforementioned parameters are generally available and may be used as an inexpensive and rapid way to select patients who are at high risk of developing NOAF.
6
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ANTAZOLINE RENAISSANCE IN THE TREATMENT OF CARDIAC ARRHYTHMIA: A REVIEW

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PALIMONKA K., PAŚKO P., SZUTA M., SOWIZDRANIUK J.
Acta Poloniae Pharmaceutica - Drug Research
|
2020
|
vol. 77
|
issue 2
209-219
EN
Antazoline is an antihistaminic, immunosuppressive, antiarrhythmic agent. Antazoline can be administered orally, intravenously, intramuscularly or via the ophthalmic route. Antazoline has a limited application as an antiarrhythmic drug. This review was undertaken with the aim to combine the old and the new results of different types of studies (clinical, retrospective, or pharmacokinetic) and sum up the positive and negative effects of antazoline in cardiology and emergency medicine. A literature queries were performed in the following databases: PubMed, Embase, Google scholar, and Web of Science (all from their inception date till June 2019). The queries covered antazoline in combinations with such terms as antiarrhythmic activity, arrhythmia, electrocardiography, emergency medicine, and cardiology. Additional publications were found by checking all the reference lists. The newest research shows that antazoline may have the highest success rate of pharmacological cardioversion among all drugs used in the contemporary treatment of cardiac arrhythmia (up to 85.3%). The rate of cardioversion with antazoline alone was higher than combined amiodarone and/or propafenone. Most of the studies which were reviewed indicated that paroxysmal atrial fibrillation, compared to chronic atrial fibrillation, responded more satisfactorily to antazoline treatment. Most patients tolerated antazoline well and conversion was safe, effective, and smooth. Some research proves that the antazoline use may also reduce the rate of hospitalization due to the adverse effects. Antazoline has a definite place in the therapeutic repertoire for several cardiac arrhythmias. It should not be neglected as an old drug, and ought to be reconsidered in emergency medicine treatment recommendations
7
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Usefulness of CartoMerge image integration module in catheter ablation of atrial fibrillation

100%
Drelich Ł., Królak T., Liżewska-Springer A., Kempa M., Kozłowski D., Raczak G.
|
EN
Background Anatomy assessment using Computer Tomography (CT) and Magnetic Resonance (MRI) is performed in patients undergoing pulmonary vein isolation (PVI). The aim of this analysis was to investigate whether electroanatomical 3D map and CT/MRI image integration using the CartoMerge system improves efficacy, reduces procedure time or fluoroscopy usage. Materials and methods 57 patients undergoing PVI were divided in two groups: “Merge” (n=45 pts) and “non-Merge” (n=14 pts) depending on usage of image integration. PV isolation during procedure (acute PVI), procedure time, fluoroscopy time, number of radio frequency (RF) applications and AF recurrence during follow-up (Merge group: 12-24 months, non-Merge group: 9-18 months) were analyzed. Results Intra-procedural PVI was equal in both groups (93%). Long-term efficacy, defined as absence of AF recurrence, was insignificantly higher in the Merge group (69,8% vs 50%, p=0,11793). Procedure time was significantly longer in the Merge group – 239,1 (±55,5) min. vs 192,4 (±44,5). Fluoroscopy time was similar in both groups 29,9 (±12,23) vs 24,6 (±26,5) min, (p=0,579). Number of RF applications was significantly higher in the Merge group 48,5 (±25,2) vs 27,2 (±14,9). Conclusions CartoMerge did not improve the rate of acute PVI, long-term effectivity or fluoroscopy time. In the non-Merge group the procedure time was shorter and the number of applications was significantly smaller.
8
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Cardioneuroablation in neurocardiogenic syncope – hype or hope?

100%
Koźluk E., Piątkowska A., Rodkiewicz D., Opolski G.
European Journal of Translational and Clinical Medicine
|
2022
|
vol. 5
|
issue 1
47-52
EN
We are presenting the ablation of parasympathetic ganglia in the atria as a new method of treatment of vasovagal and other neurocardiogenic syncope. This method, shifting the balance of the autonomic nervous system in the sympathetic direction, is directed to the immediate cause of syncope which is excessive activation of the vagus nerve. Its effectiveness in the annual observation is within 80-100%. This method offers a great chance to improve the quality of life in patients with reflex syncope what have not been prevented by conventional treatment.
9
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Clinical and laboratory assessment of patients with new-onset atrial fibrillation in acute myocardial infarction

100%
Raczkowska-Golanko M., Daniłowicz-Szymanowicz L., Nowak R., Puchalski W., Gruchała M., Kozłowski D., Raczak G.
European Journal of Translational and Clinical Medicine
|
2018
|
vol. 1
|
issue 1
39-43
EN
Background: New-onset atrial fibrillation (NOAF) is one of the complications of acute myocardial infarction (AMI), and is associated with poor outcome. The aim of the study was clinical and laboratory assessment of patients with NOAF in AMI. Material and methods: This is a retrospective, single-centre study of AMI patients with NOAF, who were admitted to Clinical Centre of Cardiology of the University Clinical Centre in Gdansk, from January 2016 to June 2018. The medical history, echocardiography parameters, AMI localization and infarcted-related artery as well as laboratory parameters at the admission and at the moment of NOAF onset were taken into further analyses. Results: From 1155 consecutive AMI patients 103 (8.9%) with NOAF were enrolled into the study. A significant increase in C-reactive protein (CRP) and high-sensitive Troponine I (hsTnI) level, whereas significant decrease in potassium and hemoglobin level was observed at the moment of NOAF in comparison to admission. Conclusions: Our study suggests that markers of inflammation (CRP), myocardial necrosis (hsTnI), hemoglobin and serum potassium may be associated with NOAF in the setting on AMI. The aforementioned parameters are generally available and may be used as an inexpensive and rapid way to select patients who are at high risk of developing NOAF.
10
Content available remote

The international normalized ratio (INR) as seen in a population of patients with atrial fibrillation and cerebral infarction undergoing long-term treatment with vitamin K antagonists

100%
Szczepańska-Szerej A., Wojtan M., Szajnoga B.
Current Issues in Pharmacy and Medical Sciences
|
2015
|
vol. 28
|
issue 4
269-272
EN
It is estimated that nearly 20% of all cerebral infarctions in the total population are the result of a complication of atrial fibrillation (AF). While oral anticoagulation with vitamin K antagonists (AVKs) substantially reduces this risk, this requires regular monitoring of the international normalized ratio (INR) in order to achieve therapeutic levels (2,0-3,0). The aim of this study was to evaluate a group at high risk of cerebral infarction, among patients with AF undergoing long-term treatment with VKAs, taking into account the significance of therapeutic INR values. The analysed group consisted of 90 acute ischaemic stroke patients with paroxysmal or chronic “non-valvular” AF, receiving treatment with VKAs. As a result of the study, therapeutic INR values (≥ 2) were seen in thirty-five of these individuals (38,8%), while 55 (61,2%) showed non-therapeutic INR values. Moreover, there were no differences in demographics, vascular risk factors, biochemical and morphological blood parameters, mean CHA2DS2-VASc score and TOAST classification between either of the two groups. Furthermore, no additional factor that would increase their risk of cerebral infarction during the adequate treatment with VKAs was found. However, patients with non-therapeutic INR values had a statistically significantly higher frequency of concomitant moderate pathology of the bicuspid valve, p<0.05. Hence, a lack of proper control of INR can proved to be particularly dangerous for this subgroup of patients. Hence, this is a group with an elevated risk of cerebral infarction and therefore requires special oversight of VKA treatment or NOA treatment.
11
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Difference in demand for analgesic and sedative medication according to the type of catheter ablation for atrial fibrillation

88%
Koźluk E., Rzechorzek W., Piątkowska A., Rodkiewicz D., Opolski G.
European Journal of Translational and Clinical Medicine
|
2021
|
vol. 4
|
issue 1
35-42
EN
Background: Our aim was to determine if there is a difference in demand for analgesic and sedative medication according to the type of catheter ablation for atrial fibrillation (AF). Material and methods: We collected data from protocols of 1144pts, who underwent ablation of AF. We excluded 275pts, at most due to electrocardioversion during the procedure. We divided them into 4 groups: cryoballoon ablation group (CB, n = 101), single-point radiofrequency ablation group (RFth-, n = 541), single-point radiofrequency ablation group with thermocool catheter (RFth+, n = 156) and Multielectrode Pulmonary Vein Ablation Catheter group (PVAC, n = 71). We used fentanyl and midazolam for pain control. The dose was adjusted by the operator, accord-ing to patients’ request. Results: The median dose of fentanyl 0.04 mg (0.00-0.08) and midazolam 1.00 mg (0.00-2.00) in CB group was lower than in other groups (p < 0.001). The median dose of fentanyl 0.12 mg (0.08-0.17) was lower in RFth- than in in RFth+ group: 0.15 mg (0.1-0.2) (p < 0.001). The demand for analgesia was higher when PVAC was used, with median dose of fentanyl 0.15 mg (0.1-0.2) (p < 0.0024). Conclusions: The demand for analgesic/sedative medication was lower among patients who underwent CB. Among those who underwent RF ablation it was higher in groups with thermocool and multielectrode catheters.
12
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Comparison of Acoustocerebrography Measurement and Magnetic Resonance Imaging Methods in the Assessment of White Matter Lesions in Patients with Atrial Fibrillation

88%
Dobkowska-Chudon W., Wrobel M., Frankowska E., Zegadlo A., Krupienicz A., Nowicki A., Olszewski R., Dobkowska-Chudon W., Wrobel M., Frankowska E., Zegadlo A., Krupienicz A., Nowicki A., Olszewski R.
Archives of Acoustics
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2020
|
vol. 45
|
issue 3
13
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The P wave duration in patients with atrial fibrillation undergoing cryoballoon pulmonary vein isolation. Preliminary results

88%
Zawadzki J. M., Adamowicz J., Sławuta A., Gajek A., Zyśko D., Gajek J.
European Journal of Translational and Clinical Medicine
|
2018
|
vol. 1
|
issue 1
44-47
EN
The pulmonary vein isolation remains the major target of atrial fibrillation ablation. The cryoablation lesions in the left atrium are supposed to disconnect the pulmonary vein from the atrium on the atrial side of the orifices. We hypothesized that the cryoballoon pulmonary vein isolation could result in the prolongation of the P wave duration. The aim of the study was to assess the duration of the P wave in 12-lead electrocardiogram and the influence of pulmonary vein isolation on this parameter. The study group included 21 patients (11 women and 10 men) 66.2+/-7.4 years of age undergoing cryoballoon ablation. In order to measure the P wave duration, we used the constant acquisition of electrogram and the electrocardiographic channels provided by LABSYSTEM™ Pro EP Recording System (Boston Scientific), magnifying the leads 64x. We calculated the duration in the simultaneously recorded 12-lead ECG, from the beginning of the earliest recorded P wave deflection, until the end of the latest P-wave deflection recorded in any lead. The P wave duration in the entire study group was 141.7+/-12.5 ms before the ablation and increased significantly to 151.1+/-11.5 ms (p<0.05) after the procedure. The respective values in women were 144.1+/-4.3 vs. 156.0+/-4.7 ms (p<0.01) and 139.1+/-4.6 vs. 145.6+/-4.5 ms in men (p<0.05). The mean standard deviation of every single measurement considered separately was 4.4+/-2.1 ms before the cryoablation and 4.6+/-1.8 ms after the procedure (p= not significant (n.s).), indicating very good reproducibility of the measurements. We concluded, that cryoballoon pulmonary vein isolation leads to the prolongation of the measured P wave duration. It seemed to result from conduction disturbances created by cryoablation. The clinical significance of the observed changes remains unknown.
14
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How to deal with patients with atrial fibrillation during the COVID-19 epidemic?

88%
Tomaszuk-Kazberuk A.
European Journal of Translational and Clinical Medicine
|
2020
|
vol. 3
|
issue 1
53-59
EN
Patients with atrial fibrillation (AF) due to old age and comorbidities are at a higher risk of SARS-CoV-2 infection. These patients should protect themselves by limiting contact with other people to an absolute minimum and they should be educated about hygiene, including careful hand washing. In general, the principles of antiarrhythmic drug treatment of quarantined, infected and asymptomatic individuals remain unchanged. In the hospital setting it is important to remember about possible interactions between antibiotics, anticoagulants, antiarrhythmic, antiviral and antimalarial drugs. The current pandemic also led to limitations regarding the implantation and control of implantable devices to an absolute minimum.
15
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Irrigated DiamondTemp catheter and return to ablation under temperature control. First Polish experience with DiamondTemp catheter in pulmonary vein isolation

88%
Koźluk E., Piątkowska A., Rodkiewicz D., Opolski G.
European Journal of Translational and Clinical Medicine
|
2021
|
vol. 4
|
issue 2
44-51
EN
We present the first Polish experience with ablation performed using DiamondTemp catheter. The study was conducted with 3 male patients diagnosed with atrial fibrillation (AF). In the first 2 patients typical transseptal punctures were performed, followed by mapping with the Advisor catheter and EnSite-Precision system. One patient had a residual atrial septal leak, therefore ablation without fluoroscopy was attempted. High-power, short-duration ablation under temperature control was performed around pulmonary vein (PV) ostia. The power was 49-53 W, the temperature was 45-48 ͦC. Duration of procedures/fluoroscopy were: 146/8.9, 177/5.9, 132/0.0 min. In the reference group, 10 recent AF identical ablation procedures performed with traditional equipment resulted in 143.0±27.0/6.0±4.4 min. Duration of DiamondTemp applications were 14.7, 32.7, 30.8 min (reference group 37.3 ± 11.4 min). Procedural endpoints were achieved in all but one patient with incomplete isolation of the low segment of the right inferior PV. There were no procedural complications noted. In conclusion, the DiamondTemp saline-irrigated catheter is safe and effective for high-power short-duration ablation in patients with AF. Furthermore, this technology makes it possible to complete the procedure without fluoroscopy. However these findings must be confirmed in larger group of patients.
16
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Content available

The P wave duration in patients with atrial fibrillation undergoing cryoballoon pulmonary vein isolation. Preliminary results

88%
Zawadzki J. M., Adamowicz J., Sławuta A., Gajek A., Zyśko D., Gajek J.
|
|
issue 1
44-47
EN
The pulmonary vein isolation remains the major target of atrial fibrillation ablation. The cryoablation lesions in the left atrium are supposed to disconnect the pulmonary vein from the atrium on the atrial side of the orifices. We hypothesized that the cryoballoon pulmonary vein isolation could result in the prolongation of the P wave duration. The aim of the study was to assess the duration of the P wave in 12-lead electrocardiogram and the influence of pulmonary vein isolation on this parameter. The study group included 21 patients (11 women and 10 men) 66.2+/-7.4 years of age undergoing cryoballoon ablation. In order to measure the P wave duration, we used the constant acquisition of electrogram and the electrocardiographic channels provided by LABSYSTEM™ Pro EP Recording System (Boston Scientific), magnifying the leads 64x. We calculated the duration in the simultaneously recorded 12-lead ECG, from the beginning of the earliest recorded P wave deflection, until the end of the latest P-wave deflection recorded in any lead. The P wave duration in the entire study group was 141.7+/-12.5 ms before the ablation and increased significantly to 151.1+/-11.5 ms (p<0.05) after the procedure. The respective values in women were 144.1+/-4.3 vs. 156.0+/-4.7 ms (p<0.01) and 139.1+/-4.6 vs. 145.6+/-4.5 ms in men (p<0.05). The mean standard deviation of every single measurement considered separately was 4.4+/-2.1 ms before the cryoablation and 4.6+/-1.8 ms after the procedure (p= not significant (n.s).), indicating very good reproducibility of the measurements. We concluded, that cryoballoon pulmonary vein isolation leads to the prolongation of the measured P wave duration. It seemed to result from conduction disturbances created by cryoablation. The clinical significance of the observed changes remains unknown.
17
Publication available in full text mode
Content available

How to deal with patients with atrial fibrillation during the COVID-19 epidemic?

88%
Tomaszuk-Kazberuk A.
European Journal of Translational and Clinical Medicine
|
2020
|
vol. 3
|
issue 1
53-59
EN
Patients with atrial fibrillation (AF) due to old age and comorbidities are at a higher risk of SARS-CoV-2 infection. These patients should protect themselves by limiting contact with other people to an absolute minimum and they should be educated about hygiene, including careful hand washing. In general, the principles of antiarrhythmic drug treatment of quarantined, infected and asymptomatic individuals remain unchanged. In the hospital setting it is important to remember about possible interactions between antibiotics, anticoagulants, antiarrhythmic, antiviral and antimalarial drugs. The current pandemic also led to limitations regarding the implantation and control of implantable devices to an absolute minimum.
18
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The involvement of Na+/K+-ATPase in the development of platelet procoagulant response

75%
Tomasiak M., Stelmach H., Rusak T., Ciborowski M., Radziwon P.
Acta Biochimica Polonica
|
2007
|
vol. 54
|
issue 3
625-639
EN
In circulation, platelets may come into contact with both exogenous (cardiac glycoside treatment) and endogenously produced inhibitors of Na+/K+-ATPase. We examined whether blocking of platelet Na+/K+-ATPase by ouabain results in generation of procoagulant activity. It was shown that an in vitro treatment of platelets with ouabain (20-200 µM for 20 to 60 min) is associated with an intracellular accumulation of sodium ([Na+]i), generation of a weak calcium signal, and expression of procoagulant activity. The ouabain-induced procoagulant response was dose- and time-related, less pronounced than that evoked by collagen and similar to that produced by gramicidin, not affected by EDTA or aspirin, and strongly reduced in the absence of extracellular Na+ or by hyperosmolality. Flow cytometry studies revealed that ouabain treatment results in a unimodal left shift in the forward and side scatter of the entire platelet population indicating morphological changes of the plasma membrane. The shift was dose related, weaker than that evoked by collagen and similar to that produced by gramicidin. Ouabain-treated platelets express phosphatidylserine (PS). The ouabain-evoked PS expression was dose- and time-dependent, weaker than that produced by collagen and similar to that evoked by gramicidin. Electronic cell sizing measurements showed a dose-dependent increase in mean platelet volume upon treatment with ouabain. Hypoosmotically-evoked platelet swelling resulted in the appearance of procoagulant activity. Thromboelastography measurements indicate that, in whole blood, nanomolar (50-1000 nM, 15 min) concentrations of ouabain significantly accelerate the rate of clot formation initiated by contact and high extracellular concentration of calcium. We conclude that inefficiently operating platelet Na+/K+-ATPase results in a rise in [Na+]i. An increase in [Na+]i and the swelling associated with it may produce PS exposure and a rise in membrane curvature leading to the generation of a procoagulant activity.
19
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High-power and short-duration ablation with the Qdot+ algorithm for pulmonary vein isolation and the right superior ganglion plexus ablation without fluoroscopy

75%
Koźluk E., Piątkowska A., Rodkiewicz D., Opolski G.
European Journal of Translational and Clinical Medicine
|
2021
|
vol. 4
|
issue 2
10-17
EN
In this report we present pulmonary vein and posterior box isolation together with the right superior ganglion plexus ablation using the Qdot Micro catheter without fluoroscopy. We describe different possibilities of this new technology for catheter ablation. The main advantages of this catheter to potentially increase ablation safety and effectiveness are discussed. Specifically, the possibility to perform high-density mapping with the lowest available distance between points. Furthermore, the possibility to decrease the risk of collateral tissue damage and to improve atrial linear lesions contiguity, transmurality and durability due to the dominance of resistive heating supported by the feedback temperature control. Finally, the possibility to shorten the procedure and fluoroscopy duration due to the high shortening of application duration to 4 seconds only.
20
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Profilaktyka powikłań zakrzepowo-zatorowych u pacjentów z migotaniem przedsionków i otyłością

63%
Kolasa I., Średniawa B.
Annales Academiae Medicae Silesiensis
|
2023
|
issue 77
60-66
EN
Atrial fibrillation (AF) is an arrhythmia that occurs in 1–2% of the population. Chronic oral anticoagulation is recommended in the group of patients with AF to prevent thromboembolic complications. Obesity is a factor contributing to the development and progression of AF, and the use of oral anticoagulants in patients with excess body fat may be difficult. Vitamin K antagonist (VKA) and non-vitamin K antagonist oral anticoagulants (NOAC) are commonly used. For VKA in obese patients, a longer time and a higher dose of drugs should be expected to achieve the target international normalized ratio (INR) values. It is not known whether the therapeutic range of INR should change with the body mass index (BMI) or body weight. NOACs include factor Xa inhibitors and direct thrombin inhibitors. The use of NOAC in obese patients has been proven to be effective and safe. In the group of patients with AF and morbid obesity or with a body weight > 120 kg, the use of VKA or determination of the plasma concentration should be considered in the prevention of thromboembolic complications due to the limited amount of data.
PL
Migotanie przedsionków (atrial fibrillation – AF) jest arytmią występującą u 1–2% populacji. Aby zapobiec po-wikłaniom zakrzepowo-zatorowym w grupie chorych z AF, zaleca się stosowanie przewlekłego, doustnego leczenia przeciwkrzepliwego. Otyłość jest czynnikiem przyczyniającym się do rozwoju i progresji AF, a stosowanie doustnych antykoagulantów u chorych z nadmiernym poziomem tkanki tłuszczowej może sprawiać trudności. Powszechnie stosowane są antagonisty witaminy K (vitamin K antagonist – VKA) oraz doustne antykoagulanty niebędące antagonistami witaminy K (non-vitamin K antagonist oral anticoagulants – NOAC). W przypadku VKA u pacjentów otyłych należy spodziewać się dłuższego czasu oczekiwania oraz zastosowania wyższej dawki leków do osiągnięcia docelowych wartości międzynarodowego współczynnika znormalizowanego (international normalized ratio – INR). Nie zostało poznane, czy zakres terapeutyczny INR powinien zmieniać się w zależności od wskaźnika masy ciała (body mass index – BMI) lub masy ciała. Do NOAC należą inhibitory czynnika Xa oraz bezpośrednie inhibitory trombiny. Dowiedziono, że stosowanie NOAC u otyłych pacjentów jest skuteczne i bezpieczne. W grupie chorych z AF i otyłością olbrzymią lub z ma-są ciała > 120 kg w prewencji powikłań zakrzepowo-zatorowych należy rozważyć stosowanie VKA lub ozna-czanie stężenia substancji w osoczu ze względu na ograniczoną ilość danych.
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