|
| |
|
|
Studium of the clinical impact of different forms of cardiac resynchronisation therapy by patients with chronic heart failure
Burianová, Lucie ; Kautzner, Josef (advisor) ; Janoušek, Jan (referee) ; Táborský, Miloš (referee)
Studium of the clinical impact of different forms of cardiac resynchronization therapy by patients with chronic heart failure MUDr. Lucie Burianová ABSTRACT: Introduction: Biventricular (BiV) pacing decreases mortality and improves quality of life of patients with severe heart failure. Haemodynamic and short time clinical studies suggest that isolated leftventricular pacing could have the same effect. Aims: Compare the effect of BiV and leftventricular pacing by subjects with dilated cardiomyopathy and severe heart failure with the attention to signs of dyssynchrony and remodelation of the left chamber. In methodical substudy compare the results of left chamber volumes and ejection fraction (EF LK) measured by CT angiography and 2-dimensional echocardiography with use of contrast agent (K-ECHO). Methods: Patients indicated for cardiac resynchronization therapy were randomized for either BiV or leftventricular pacing. After implantation of the device they were examinated clinically and by echocardiography every 3 months in the period of one year. Four years from the onset of the study the major adverse events in both groups were evaluated. The results of left chamber volumes and EF LK measured by K-ECHO and CT angiography were compared. Results: We enrolled 33 patients. We found clinical improvement in both...
|
|
|
Resynchronization and prosynchronization in permanent cardiac pacing in children.
Kubuš, Peter ; Janoušek, Jan (advisor) ; Kautzner, Josef (referee) ; Novák, Miroslav (referee)
1 Abstract Objectives: To evaluate the results of permanent epicardial pacing and clinical impact of electromechanical dyssynchrony in permanent cardiac pacing in children; to identify the pacing sites with the greatest potential to prevent pacing-induced cardiomyopathy. Methods: Retrospective observational study of long-term results of permanent epicardial pacing in children in the Czech Republic. Multi-centre cross-sectional study on long-term effects of the site of ventricular pacing on left ventricular (LV) synchrony and function in children with structurally normal heart, requiring permanent pacing. Results: Overall probability of continued epicardial pacing (absence of change to a partial or total transvenous system) was 92.8 and 76.1% at 5 and 10 years after implantation, respectively. None of those patients who were paced from the systemic ventricle developed dyssynchronous systemic ventricular failure. Pacing site was the only significant predictor of LV ejection fraction (EF) and LV shortening fraction (P < 0.0001 for both). Pacing from the LV apex/LV midlateral wall was associated with preserved LV function (LV ejection fraction ≥ 55%; odds ratio (OR) = 8.26; P = 0.018). Pacing from the RV outflow tract/lateral RV predicted significantly decreased LV function (LV ejection fraction < 45%; OR =...
|
|
|
Studium of the clinical impact of different forms of cardiac resynchronisation therapy by patients with chronic heart failure
Burianová, Lucie ; Kautzner, Josef (advisor) ; Janoušek, Jan (referee) ; Táborský, Miloš (referee)
Studium of the clinical impact of different forms of cardiac resynchronization therapy by patients with chronic heart failure MUDr. Lucie Burianová ABSTRACT: Introduction: Biventricular (BiV) pacing decreases mortality and improves quality of life of patients with severe heart failure. Haemodynamic and short time clinical studies suggest that isolated leftventricular pacing could have the same effect. Aims: Compare the effect of BiV and leftventricular pacing by subjects with dilated cardiomyopathy and severe heart failure with the attention to signs of dyssynchrony and remodelation of the left chamber. In methodical substudy compare the results of left chamber volumes and ejection fraction (EF LK) measured by CT angiography and 2-dimensional echocardiography with use of contrast agent (K-ECHO). Methods: Patients indicated for cardiac resynchronization therapy were randomized for either BiV or leftventricular pacing. After implantation of the device they were examinated clinically and by echocardiography every 3 months in the period of one year. Four years from the onset of the study the major adverse events in both groups were evaluated. The results of left chamber volumes and EF LK measured by K-ECHO and CT angiography were compared. Results: We enrolled 33 patients. We found clinical improvement in both...
|
|
|
Physiological Mechanisms of Heart Rate Turbulence
Wichterle, Dan ; Kautzner, Josef (advisor) ; Kvasnička, Jiří (referee) ; Táborský, Miloš (referee)
Our papers on HRT physiology covered several electrophysiological phenomena associated with turbulent behaviour of sinus nodal discharge after isolated premature beat. Some observations were fairly novel (AV nodal turbulence, QT-turbulence, and HRT after atrial premature complexes), others were confirmative or complementary to the findings of other authors (impact of left ventricular ejection fraction and coupling interval). All of them were helpful for even deeper understanding the fundamental principles involved in HRT that, consequently, may offer an explanation of why HRT is such a potent postinfarction risk stratifier. From the very beginning we tried to suggest that late deceleration phase of HRT does not simply reflect the vagal function but originates from a complex interplay of both sympathetic and parasympathetic systems. Our paper on HRT hemodynamics (Wichterle et al. 2006) together with the article by Segersen et al. (2007) added perhaps "the last piece to the heart turbulence puzzle", as appreciated in Heart Rhythm editorial by Munich working group (Bauer et al. 2007).
|
|
|
The effect of biventricular pacing as compared to single - side left - ventricular pacing and bifocal pacing of the right ventricle in patients with chronic heart failure
Riedlbauchová, Lucie ; Kautzner, Josef (advisor) ; Horký, Karel (referee) ; Táborský, Miloš (referee)
Cardiac resynchronization therapy (CRT) represents an accepted treatment modality in patients with advance chronic heart failure, acute and long-term benefit of which was confirmed in several clinical trials. Recently, reduced mortality and rate of hospitalization for heart failure were also demonstrated. However, response to CRT is interindividually highly variable with a substantial proportion of CRT recipients who do not respond to this therapy. Although the identification of suitable candidates is probably the most important factor in the reduction of the rate of non-responders, some other determinants, peri- and post-implant, may substantially affect the final effect of CRT. The present PhD focused on some of these variables: 1/ First of them is a selection of the appropriate pacing mode. This PhD evaluated effect of 3 pacing modalities that have been proposed as alternatives of CRT - biventricular pacing (BiV), single-site left-ventricular pacing (LVP) and rightventricular bifocal pacing (Bif). It was clearly shown that the first two pacing strategies, BiV (it is simultaneous pacing of both ventricles) and LVP, cause comparable acute hemodynamic improvement at rest. Study No.2 of this PhD confirms that the comparable effect of BiV and LVP is preserved also during the exercise. In addition, study No.1...
|
|
| |
|
|
Venticular activation patterns in conduction abnormalities and during different pacing modes (aktivační sekvence při poruchách komorového vedení a různých typech komorové stimulace)
Peichl, Petr ; Kautzner, Josef (advisor) ; Lukl, Jan (referee) ; Kittnar, Otomar (referee)
Academic dissertation: Ventricular activation patterns in conduction abnormalities and during different pacing modes Petr Peichl, MD, Department of Cardiology, IKEM, Vídeňská 1958/9, Prague, Czech Republic 5 Congestive heart failure (CHF) is a progressive disease caused by left ventricular dysfunction with high morbidity and mortality rates. Ventricular dysfunction is often linked to ventricular dilatation, which in turn may cause ventricular conduction delays and further worsening of the cardiac function. Recent decade gave rise to cardiac resynchronization therapy (CRT), a therapeutic modality based on premise that preexcitation of late activating10 regions by cardiac pacing may restore the left ventricular synchronous contraction. The goals of the publications included in the dissertation were: (1) to analyze the ventricular activation patterns in patients eligible for CRT with respect to the underlying heart disease and/or QRS morphology on the surface electrocardiogram(ECG), (2) to quantify changes in ventricular activation patterns during different pacing modes and (3) to compare15 the hemodynamic performance of different pacing modes during exercise. 1. Patients with CHF and wide QRS complex represent a broad spectrum of underlying conduction disturbances with variable inter- and intraventricular...
|
|
| |
|
| |
guest ::
