The aim of this study was to investigate the association between implantable cardioverter-defibri... more The aim of this study was to investigate the association between implantable cardioverter-defibrillator (ICD) status at the time of hospitalization for worsening heart failure (HF) with postdischarge events in patients with reduced left ventricular ejection fraction. We conducted an analysis of 4133 patients hospitalized for HF with left ventricular ejection fraction 40% or less in EVEREST. The final analysis included patients without an electrophysiological device (n = 3102) and those with an ICD (n = 600) at the time of enrollment. During a median follow-up of 300 days, all-cause mortality was 22.9% in the no device group and 35.2% in the ICD group (hazard ratio [HR], 1.62; 95% confidence interval [CI], 1.39-1.89). Rehospitalization for HF was 27.0% in the no device group and 46.8% in the ICD group (HR, 2.20; 95% CI, 1.92-2.52). After adjustment for multiple variables, the rates for all-cause mortality were similar (HR, 1.01; 95% CI, 0.83-1.22), but the ICD group had elevated rates of HF hospitalizations compared with the no device group (HR, 1.35; 95% CI, 1.14-1.60). In patients with reduced left ventricular ejection fraction, an ICD at presentation for hospitalization for worsening HF was associated with similar rates of death but higher rates of rehospitalization for HF. Given our findings, further studies should investigate optimization of care in patients already implanted with an ICD as well as the role of ICD implantation during or soon after hospitalization for HF in patients not yet implanted.
Background: Acquired long QT syndrome (a-LQTS) is associated with life-threatening ventricular ar... more Background: Acquired long QT syndrome (a-LQTS) is associated with life-threatening ventricular arrhythmias, mainly torsades de pointes (TdP). ECG parameters predicting evolving into ventricular fibrillation (VF) are ill defined. Aims: To determine ECG parameters preceding and during TdP associated with higher risk of developing VF. Methods: We analyzed 151 episodes of TdP, recorded in 28 patients with a-LQTS (mean QTc 638 ms ± 57). Results: All 28 patients had prolonged QT interval, (mean QTc 638 ms ± 57) ranging from 502 ms to 858 ms correcting by Bazett's formula. The mean TdP heart rate was 218 bpm ± 38 (mean cycle length of TdP 274 ± 47 ms). We classified TdPs episodes into "slower"-TdP (s-TdP) < 220 bpm (range from 145-220 bpm) observed in 81 (53.6%) episodes and "faster"-TdP (f-TdP) ࣙ 220 bpm (ranged from 221-281 bpm) observed in 70 (46.4%) episodes. Among 151 episodes of TdP, 21 (13.9%) were unstable (converted into VF). Out of 81 episodes of "slower"-TdP only 2 (2.5%) episodes converted into VF. The mean coupling interval (CI) of the PVC initiating TdP was 510 ms ± 118, the pause-RR interval was 1147 ms ± 335, the prematurity index (PI) of PVC that initiated TdP was 0.45 ± 0.13. The mean cycle length variability of TdP (VRV-TdP) was 30.79 ms ± 19.7. U wave was observed in 86 episodes (56.9%), among that in 69 episodes, the U/T wave ratio was > 1. Macro T wave alternans was observed in 4 patients. The QT interval was not different in patients with VF(+) and VF(−) episodes, 633 ± 60 and 639 ± 57, respectively. Conclusions: Some electrocardiographic parameters can be helpful in determining the risk of TdP evolving into VF. The slower ventricular rate (< 220 bpm), the higher rate instability (VRV > 30 ms) and the short episodes < 20 beats could predict benign evolution. torsades de pointes; acquired long QT syndrome; ventricular fibrillation; ventricular rate variability
Atypical form of tako-tsubo cardiomyopathy (TTC) is associated with regional wall motion abnormal... more Atypical form of tako-tsubo cardiomyopathy (TTC) is associated with regional wall motion abnormalities in basal and/or middle segments or only middle segments with sparing of apical segments or apical and basal segments. We described a case of 47-year-old female with atypical form of TTC due to fast atrial fibrillation that converted into ventricular fibrillation in WPW syndrome. The echocardiogram made after direct current cardioversion revealed decreased left ventricular ejection fraction (LVEF 35%) with akinesis of inferior and posterior walls and anterior part of interventricular septum in the middle and the basal segments with hyperkinesis of apical segments. The biochemistry blood samples revealed elevated both troponin T-0.35 ng/mL and NT-proBNP-3550 pg/mL plasma level. The ECG showed sinus rhythm 62 bpm, shortened PQ interval 100 ms, widened QRS duration-115 ms with delta wave, prolonged QT interval-520 ms, QS in leads: II, III, aVF. Negative T waves in leads: I, aVL and positive, symmetrical T waves in leads V 1-V 6. The coronarography revealed normal coronary arteries. The control echocardiography after 10 days showed normal LVEF 70%, without any wall motion abnormalities. TTC was recognised based on: history of sudden stress situation before, ischaemic ECG changes, positive markers of myocardial injury, transient segmental wall motion abnormalities and normal coronary arteries. The ablation of right postero-septal accessory pathway was successfully performed.
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego, 2008
Double tachycardia (DT) is a coincidence of two arrhythmias. We described the coincidence of freq... more Double tachycardia (DT) is a coincidence of two arrhythmias. We described the coincidence of frequent and symptomatic premature ventricular contractions (PVCs) from the right ventricular outflow tract (RVOT) and atrioventricular nodal reentrant tachycardia (AVNRT). 54-years-old woman had no organic heart disease and 24 hours ECG Holter monitoring showed paroxysm of tachycardia and more than five thousands of PVCs. The patient was selected to invasive electrophysiology study (EPS) and radiofrequency (RF) ablation. The EPS confirmed induction of AVNRT and the presence of PVCs originating from RVOT The modification of slow pathway of AVNRT using RF ablation was performed. The ablation of PVCs was unsuccessful. After the ablation, ventricular arrhythmia remained symptomatic and patient underwent second session of RF ablation. With applications of RF current in RVOT only the reduction of PVCs was obtained but after 24 hours PVCs disappeared. During 12-month follow-up the patient remained...
The aim of this study was to investigate the association between implantable cardioverter-defibri... more The aim of this study was to investigate the association between implantable cardioverter-defibrillator (ICD) status at the time of hospitalization for worsening heart failure (HF) with postdischarge events in patients with reduced left ventricular ejection fraction. We conducted an analysis of 4133 patients hospitalized for HF with left ventricular ejection fraction 40% or less in EVEREST. The final analysis included patients without an electrophysiological device (n = 3102) and those with an ICD (n = 600) at the time of enrollment. During a median follow-up of 300 days, all-cause mortality was 22.9% in the no device group and 35.2% in the ICD group (hazard ratio [HR], 1.62; 95% confidence interval [CI], 1.39-1.89). Rehospitalization for HF was 27.0% in the no device group and 46.8% in the ICD group (HR, 2.20; 95% CI, 1.92-2.52). After adjustment for multiple variables, the rates for all-cause mortality were similar (HR, 1.01; 95% CI, 0.83-1.22), but the ICD group had elevated rates of HF hospitalizations compared with the no device group (HR, 1.35; 95% CI, 1.14-1.60). In patients with reduced left ventricular ejection fraction, an ICD at presentation for hospitalization for worsening HF was associated with similar rates of death but higher rates of rehospitalization for HF. Given our findings, further studies should investigate optimization of care in patients already implanted with an ICD as well as the role of ICD implantation during or soon after hospitalization for HF in patients not yet implanted.
Background: Acquired long QT syndrome (a-LQTS) is associated with life-threatening ventricular ar... more Background: Acquired long QT syndrome (a-LQTS) is associated with life-threatening ventricular arrhythmias, mainly torsades de pointes (TdP). ECG parameters predicting evolving into ventricular fibrillation (VF) are ill defined. Aims: To determine ECG parameters preceding and during TdP associated with higher risk of developing VF. Methods: We analyzed 151 episodes of TdP, recorded in 28 patients with a-LQTS (mean QTc 638 ms ± 57). Results: All 28 patients had prolonged QT interval, (mean QTc 638 ms ± 57) ranging from 502 ms to 858 ms correcting by Bazett's formula. The mean TdP heart rate was 218 bpm ± 38 (mean cycle length of TdP 274 ± 47 ms). We classified TdPs episodes into "slower"-TdP (s-TdP) < 220 bpm (range from 145-220 bpm) observed in 81 (53.6%) episodes and "faster"-TdP (f-TdP) ࣙ 220 bpm (ranged from 221-281 bpm) observed in 70 (46.4%) episodes. Among 151 episodes of TdP, 21 (13.9%) were unstable (converted into VF). Out of 81 episodes of "slower"-TdP only 2 (2.5%) episodes converted into VF. The mean coupling interval (CI) of the PVC initiating TdP was 510 ms ± 118, the pause-RR interval was 1147 ms ± 335, the prematurity index (PI) of PVC that initiated TdP was 0.45 ± 0.13. The mean cycle length variability of TdP (VRV-TdP) was 30.79 ms ± 19.7. U wave was observed in 86 episodes (56.9%), among that in 69 episodes, the U/T wave ratio was > 1. Macro T wave alternans was observed in 4 patients. The QT interval was not different in patients with VF(+) and VF(−) episodes, 633 ± 60 and 639 ± 57, respectively. Conclusions: Some electrocardiographic parameters can be helpful in determining the risk of TdP evolving into VF. The slower ventricular rate (< 220 bpm), the higher rate instability (VRV > 30 ms) and the short episodes < 20 beats could predict benign evolution. torsades de pointes; acquired long QT syndrome; ventricular fibrillation; ventricular rate variability
Atypical form of tako-tsubo cardiomyopathy (TTC) is associated with regional wall motion abnormal... more Atypical form of tako-tsubo cardiomyopathy (TTC) is associated with regional wall motion abnormalities in basal and/or middle segments or only middle segments with sparing of apical segments or apical and basal segments. We described a case of 47-year-old female with atypical form of TTC due to fast atrial fibrillation that converted into ventricular fibrillation in WPW syndrome. The echocardiogram made after direct current cardioversion revealed decreased left ventricular ejection fraction (LVEF 35%) with akinesis of inferior and posterior walls and anterior part of interventricular septum in the middle and the basal segments with hyperkinesis of apical segments. The biochemistry blood samples revealed elevated both troponin T-0.35 ng/mL and NT-proBNP-3550 pg/mL plasma level. The ECG showed sinus rhythm 62 bpm, shortened PQ interval 100 ms, widened QRS duration-115 ms with delta wave, prolonged QT interval-520 ms, QS in leads: II, III, aVF. Negative T waves in leads: I, aVL and positive, symmetrical T waves in leads V 1-V 6. The coronarography revealed normal coronary arteries. The control echocardiography after 10 days showed normal LVEF 70%, without any wall motion abnormalities. TTC was recognised based on: history of sudden stress situation before, ischaemic ECG changes, positive markers of myocardial injury, transient segmental wall motion abnormalities and normal coronary arteries. The ablation of right postero-septal accessory pathway was successfully performed.
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego, 2008
Double tachycardia (DT) is a coincidence of two arrhythmias. We described the coincidence of freq... more Double tachycardia (DT) is a coincidence of two arrhythmias. We described the coincidence of frequent and symptomatic premature ventricular contractions (PVCs) from the right ventricular outflow tract (RVOT) and atrioventricular nodal reentrant tachycardia (AVNRT). 54-years-old woman had no organic heart disease and 24 hours ECG Holter monitoring showed paroxysm of tachycardia and more than five thousands of PVCs. The patient was selected to invasive electrophysiology study (EPS) and radiofrequency (RF) ablation. The EPS confirmed induction of AVNRT and the presence of PVCs originating from RVOT The modification of slow pathway of AVNRT using RF ablation was performed. The ablation of PVCs was unsuccessful. After the ablation, ventricular arrhythmia remained symptomatic and patient underwent second session of RF ablation. With applications of RF current in RVOT only the reduction of PVCs was obtained but after 24 hours PVCs disappeared. During 12-month follow-up the patient remained...
Uploads
Papers by Sebastian Stec