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Arrhythmias in Pulmonary Hypertension
Dusík, Milan ; Havránek, Štěpán (advisor) ; Petrák, Ondřej (referee) ; Honěk, Jakub (referee)
Pulmonary hypertension (PH) is defined by the elevation of the mean pulmonary artery pressure above 20 mmHg. PH affects about 1% of population. Based on the similar pathophysiological mechanisms, clinical and hemodynamic characteristics, and therapeutic possibilities, PH is classified into 5 groups. Right heart catheterization is a crucial assessment to establish the diagnosis. Supraventricular tachycardias (SVTs), including atrial fibrillation (AF) and other atrial tachycardias (AT), are frequently found in patients with PH with a reported cumulative incidence of 10-36 %. The presence of an SVT in a PH patient leads to further deterioration and worsens the prognosis. This thesis is based on four distinct analyses focused on the SVTs in PH. The first analysis described the arrhythmias in patients with chronic thromboembolic pulmonary hypertension. The prevalence of AF/AT reached 29% and their presence was associated with reduced functional capacity. Despite the improved hemodynamics, the incidence of arrhythmias rose significantly after the pulmonary endarterectomy. The second analysis retrospectively studied the SVT prevalence and its association with PAWP values in patients with pre-capillary PH. Patients with PAWP above 11mmHg had higher arrhythmia prevalence, possibly because of the involvement...
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Using of non-invasive cardiac imaging for precise evaluation of atrium size and prediction of atrial wall fibrosis in patients with atrial fibrillation
Fingrová, Zdeňka ; Havránek, Štěpán (advisor) ; Kittnar, Otomar (referee) ; Skála, Tomáš (referee)
Atrial fibrillation is the most prevalent arrhythmia worldwide and remains one of the major causes of morbidity and mortality. Atrial fibrillation is an arrhythmia that has a various etiology and takes number of clinical forms. Due to the heterogenity of atrial fibrillation, it is necessary to individualize the optimal treatment strategy, ie conservative pharmacological therapy or interventional therapy as catheter ablation. Inncorrect indication of catheter ablation of atrial fibrillation leads to low success rate of the procedure and increases the risk of the procedure. The success rate of catheter ablation of atrial fibrillation depends on many clinical parameters, including the size and volume of the left atrium and the presence of pathological tissue in the atrial myocardium. In everyday practice, echocardiography (2D-echocardiography) is the most dominant method in estimation of the left atrial parameters, for it's simplicity, non- invasiveness, financial costs and the absence of ionizing radiation. Different methods for assesment of left atrial parameters are cardiac CT, cardiac magnetic resonance imaging and methods of 3-D echocardiography or 3-D angiography. The results of the present studies show that in patients with non-valvular atrial fibrillation who are indicated for catheter...
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