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Effectiveness of treatment of chronic forms of atrial fibrillation by radiofrequency catheter ablation, application of preventive stimulation modes and hybrid therapies
Šedivá, Lucie ; Aschermann, Michael (advisor) ; Heinc, Petr (referee) ; Horký, Karel (referee)
Výsledky naší studie nám umožňují odpovědět na hlavní cíl studie: Pomocí paměťových záznamů z kardiostimulátoru jsme prokázali největší efektivitu na potlačení FS kombinovanou terapií, tedy radiofrekvenční katetrizační ablací a aktivovanými preventivními funkcemi kardiostimulátoru. Hodnocení celkové zátěže FS, které jsme měli umožněné díky paměťovým funkcím KS prokázalo výrazně lepší výsledky u skupiny C, 63% vyléčených ( FS=0), proti skupině B, která měla úspěšnost léčby 45% ( FS=0) a skupina A pouze 30% ( FS=0). Ad 1 Do naší studie byli zařazeni nemocní s chronickými typy FS, ze 150 nemocných bylo 39 nemocných ( 26%) ve stadiu permanentní FS, 111 nemocných (74%) mělo persistující FS, vyžadující pro výrazné potíže a hemodynamický dopad opakované kardioverze. Ve všech skupinách jsme prokazovali významné zlepšení ( ve skupině A mělo v závěru studie devět nemocných permanentní FS. Ve skupině B to byl jeden nemocný a ve skupině v C měli čtyři nemocní permanentní. Ve skupině C bylo nejvíce nemocných s nulovou zátěží FS ( celkem 24 nemocných). Ad 2 Posouzení kvality života-srovnání dotazníků před randomizací a po dvanácti měsících ukazuje nejlepší výsledek u skupiny C, i když u celého souboru došlo vlivem léčby ke zlepšení kvality života. Ad 3 V celém průběhu studie od aktivace preventivních algoritmů po...
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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...
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Contribution of New Immunosuppressants after Heart Transplantation
Skalická, Blanka ; Málek, Ivan (advisor) ; Horký, Karel (referee) ; Lischke, Robert (referee)
Background: Acute cellular rejection and graft vascular disease are major factors limiting the survival after orthotopic heart transplantation (OHTx). Tacrolimus could be more potent than cyclosporin A in therapy of recurrent acute rejection episodes in OHTx patients. Dyslipidemia is one of the risk factors involved in the development of graft vascular disease. Statins are common part of standard drug regimen after OHTx. On the other hand, they are potentially dangerous as they could interact with cyclosporin A. Study in healthy volunteers showed that tacrolimus should have no interactions with statins. Aim: In the first study we retrospectively assessed the effect of switching patients after OHTx with recurrent cellular rejection episodes from cyclosporin A to tacrolimus. In the second (prospective) study we evaluated the efficacy and safety of combined therapy with tacrolimus and atorvastatin in patients after OHTx with dyslipidemia. (...) Conclusions: Tacrolimus has a beneficial effect not only on recurrent acute rejection episodes in heart transplant recipients but it also decreases the incidence of future rejection episodes. In patients after OHTx with dyslipidemia switching to tacrolimus and atorvastatin could be a suitable therapeutic option, because this combination is safe and effective in...
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Examination methods of skin microcirculation in diabetes foot syndrome
Krčma, Michal ; Rušavý, Zdeněk (advisor) ; Filipovský, Jan (referee) ; Horký, Karel (referee) ; Prázný, Martin (referee)
Introduction: Since the mid 1980s, a lot of attention has been dedicated to the importance of microcirculation; a part of arterial bed including arterioles, precapillary sphincters, capillaries, venules and arteriovenous shunts. It is a structure of decisive importance for an organism; in its domain an exchange of blood gases and metabolic products takes place and it contributes to thermoregulation. Mediation of vasomotor reaction and vasoarterial reflex maintaining a stable hydrostatic pressure is also an important function. Microcirculation is for its dimensions (capillary diameter approx. 5 x 10-5 mm2, blood flow velocity around 0.4 mm.s-1) relatively difficult to access for more detailed examination, yet its impairments are very severe and dominate in many metabolic disorders. Microcirculation impairment is crucial in diabetes mellitus, where arteriovenous shunts open at the expense of nutritive bed due to a loss of sympathetic tone in peripheral circulation in diabetic neuropathy (Netten, Houben). Blood flow is therefore seemingly sufficient, but the affected tissue undergoes ischemia (warm ischemia). To what extent hyperinsulinemia contributes to this effect is not yet clearly known, one of the possible explanations may be a stimulation of sympathetic activity. Not a few studies are dealing with...
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Wall shear stress and its role in progress of atherosclerosis
Chytilová, Eva ; Malík, Jan (advisor) ; Horký, Karel (referee) ; Piťha, Jan (referee)
Atherosclerosis is associated with systemic risk factors such as hypertension, hyperlipidemia, diabetes mellitus and smoking. Nonetheless, atherosclerosis is a focal disease, preferentially affecting predisposed areas. The main local hemodynamic factor is wall shear stress, the frictional force acting tangencially on the endothelial cell surface. The effect of wall shear stress depends on its magnitude and direction, as well as on the characteristic of vessel geometry and blood flow. Wall shear stress is an important determinant of endothelial function and phenotype. Previous research showed that arterial sites with chronically low WSS are more prone to the development of atherosclerotic plaques. Mostly, it is the case of outer wall of arterial bifurcations, where the stroma of vessel wall prevents arterio-constriction in response to low WSS. However, lower WSS was described also in straight arterial segments, such as carotid arteries, in the presence of atherosclerosis risk factors.
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Detection of Global and Local Ischemic Changes in Electrical Field of the Heart
Šťovíček, Petr ; Kittnar, Otomar (advisor) ; Kneppo, Peter (referee) ; Horký, Karel (referee)
In this thesis, detailed investigation into the electrical field of the heart is presented in patients with various manifestations of myocardial ischemia. Methods of standard scalar electrocardiography and body surface potential mapping were used through statistical and mathematical analysis in order to compare their diagnostic performance. Body surface mapping proved to be more powerful research and diagnostic tool than standard electrocardiography and also constituted a framework for data entering the computer electrical model of the human heart and torso. Global and local ischemic changes were the primary objectives of the individual studies of this thesis. Different patient populations were studied including post myocardial infarction population, patients with variant angina and patients referred for percutaneous coronary angioplasty, and the population of patients suffering from ventricular arrhythmias related mostly to their postinfarction status. Traditional depolarization and repolarization changes were studied together with novel diagnostic parameters such as minimal potential loss within the QRS complex, single-beat cardiac micropotentials and distribution of the QT interval on the human thorax. Critical appraisal and error performance of so called QT interval dispersion was another important...
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