Authors:E. Németh, K. Bretz, P. Sótonyi, Károly Bretz, T. Horváth, J. Tihanyi, E. Zima, and T. Barna
The aim of our study was to investigate changes in psycho-physiological parameters evoked by short duration, intensive physical stress on university students practicing judo at different intensities and timely manner. Stability of posture, muscle strength (hand force exertions), attention concentration (choice reaction time), cardiac parameters, (ECG, heart rate, heart rate variability), and oxygen saturation were measured, cardiac state and stress index were computed before and after the physical stress. The actual psychic state of the subjects was evaluated using the Spielberger’s STPI-H Y-1 test which determined anxiety, curiosity, anger and depression level. Analysis of psychometric and physiologic parameters indicated significant correlations, among others, between force and cardiac stress (−), force and depression (−), anxiety and errors in actions (+), cardiac state and errors in action (−), cardiac state and depression (−). Paired samples tests showed the influence of intensive physical stress within groups of students, and independent samples tests made it possible to evaluate the power of medical and sport students, performing physical training at a significantly higher level than it is usual among the medical students. Our results proved that higher level physical training influences the psychic state advantageously, limits increases in cardiac stress level, and decreases susceptibility to anxiety and depression.
Authors:Sz. Szilágyi, Béla Merkely, L. Molnár, E. Zima, I. Osztheimer, E. M. Végh, and L. Gellér
We describe a method to stabilize CS lead position using stent implantation in a CS side branch to anchor the electrode to the wall of the vein, in cases of intraoperative or postoperative lead dislocation, unstable lead position and phrenic nerve stimulation (PNS).
403 patients were treated with stenting. After finding the desired lead position bare metal coronary stent was introduced via another guide wire, but in the same CS sheath. The stent was deposited 5–35 mm proximal to the tip of the electrode with a pressure of 6 to 14 atmospheres.
Mechanical damage of the CS side branch or pericardial effusion was not observed. During follow-up (median 39, 23–48, max. 82 months) re-operation was necessary in only two patients because of high pacing threshold, while repositioning with ablation catheter was performed in 7 cases because of PNS. Impedance measurements did not suggest lead insulation failure. Transvenous extraction of stented CS leads was successful after 3, 18 and 49 months, while 4 leads were extracted easily during heart transplantation.
Stent implantation to stabilize CS lead position seems to be effective and safe for the prevention and treatment of CS lead dislocation in special cases.
Authors:E. Kovács, D. Pilecky, Z. Szakál-Tóth, A. Fekete-Győr, V.A. Gyarmathy, L. Gellér, B. Hauser, J. Gál, B. Merkely, and E. Zima
We investigated the effect of age on post-cardiac arrest treatment outcomes in an elderly population, based on a local database and a systemic review of the literature.
Data were collected retrospectively from medical charts and reports. Sixty-one comatose patients, cooled to 32–34 °C for 24 h, were categorized into three groups: younger group (≤65 years), older group (66–75 years), and very old group (>75 years). Circumstances of cardiopulmonary resuscitation (CPR), patients' characteristics, post-resuscitation treatment, hemodynamic monitoring, neurologic outcome and survival were compared across age groups. Kruskal-Wallis test, Chi-square test and binary logistic regression (BLR) were applied. In addition, a literature search of PubMed/Medline database was performed to provide a background.
Age was significantly associated with having a cardiac arrest on a monitor and a history of hypertension. No association was found between age and survival or neurologic outcome. Age did not affect hemodynamic parameter changes during target temperature management (TTM), except mean arterial pressure (MAP). Need of catecholamine administration was the highest among very old patients. During the literature review, seven papers were identified. Most studies had a retrospective design and investigated interventions and outcome, but lacked unified age categorization. All studies reported worse survival in the elderly, although old survivors showed a favorable neurologic outcome in most of the cases.
There is no evidence to support the limitation of post-cardiac arrest therapy in the aging population. Furthermore, additional prospective studies are needed to investigate the characteristics and outcome of post-cardiac arrest therapy in this patient group.
Authors:Valentina Kutyifa, B. Merkely, V. K. Nagy, A. Apor, E. Zima, and L. Gellér
Real-time three-dimensional transesophageal echocardiography (RT 3D TEE) is a novel method providing high spatial and temporal resolution imaging of the heart. During pulmonary vein isolation procedures visualization of the atria, interatrial septum and the ablation catheter is of high importance to increase safety. RT 3D TEE might be a useful tool to guide left atrial ablations.
A 53-year-old man was referred to our hospital to undergo pulmonary vein isolation procedure for the treatment of symptomatic drug-refractory paroxysmal atrial fibrillation. The transseptal puncture was performed under RT 3D TEE-guidance with direct visualization of the interatrial septum and fossa ovalis. RT 3D TEE provided a three-dimensional view of the puncture with “tenting”-sign and the transseptal needle-fossa ovalis angle enhancing the manipulation of the ablation catheter within the left atrium. The ablation catheter was visualized and tracked during the procedure. No adverse events occurred during the procedure.
Our case report demonstrates the feasibility of RT 3D TEE-guided atrial fibrillation ablation procedures. Safety profile might be improved by the real-time direct view of fossa ovalis. Decrease in fluoroscopy time can be achieved by visualizing the ablation catheter during the procedure.
Authors:István Hartyánszky, A. Tóth, G. Veres, B. Berta, E. Zima, Z. Szabolcs, G. Y. Acsády, B. Merkely, and F. Horkay
Background: Although circular ventricle resection techniques are the gold standard of left ventricle restoration, these techniques can lead to suboptimal results. Postoperative systolic resection line can be inadequate, as it must be planned on a heart stopped in diastole. The impaired geometry and contractility may lead to increased short- and long-term mortality. Moreover, postoperative low cardiac output due to insufficient left ventricular volume results in a potentially unstable condition, and cannot be corrected. Our aim was to find a preoperative method to minimize risk and maximize outcome with left ventricle restoration. Methods: We have created a novel method combining surgery with modern imaging techniques to construct a preoperative 3D systolic heart model. The model was utilized to determine resection could be intraoperatively used to create the new left ventricle. Results: The computer assisted ventricle engineering technique is described step by step through a successful aneurysmectomy of a 61-year-old female patient with a complicated giant left ventricle aneurysm. Conclusions: Using this model we are able to find the optimal resection line providing excellent postoperative result, thus minimizing the risk of low cardiac output syndrome. This is the first report of our new combined approach to left ventricle restoration.
Authors:N Szegedi, E Zima, M Clemens, A Szekely, RG Kiss, G Szeplaki, L Geller, B Merkely, Z Csanadi, and G Duray
Catheter ablation is a proven therapy of focal atrial tachycardia. However limited information is available about the additional value of electroanatomical over conventional mapping methods for this specific arrhythmia.
Consecutive catheter ablation procedures of FAT were analyzed in two cardiology centres. Only conventional mapping was used in 30 of the 60 procedures whereas additionally CARTO mapping was performed in another 30 procedures. Acute, six-month success rate, and procedural data were analyzed.
Localization of ectopic foci is congruent with previously published data. There was no statistically significant difference between procedure time and fluoroscopy time using additionally CARTO mapping, compared to conventional mapping only. Acute success rate was higher in procedures guided by CARTO mapping than in procedures based on conventional mapping (27/30 vs. 18/30, p = 0.0081). During the 6-month follow-up period there was a better outcome (p = 0.045) in case of CARTO guided procedures (success: 11 cases, partial success: 12 cases, failure: 4 cases) compared to conventional mapping (success: 4 cases, partial success: 18 cases, failure: 7 cases).
Catheter ablation of focal atrial tachycardias using the CARTO electroanatomical mapping system seems to provide higher acute and 6-month success rate compared to ablation using conventional mapping methods only.
Authors:Cs Csobay-Novák, P. Sótonyi, M. Krepuska, E. Zima, N. Szilágyi, Sz Tóth, Z. Szeberin, Gy Acsády, B. Merkely, and Kornélia Tekes
Foregoing researches made on the N/OFQ system brought up a possible role for this system in cardiovascular regulation. In this study we examined how N/OFQ levels of the blood plasma changed in acute cardiovascular diseases. Three cardiac patient groups were created: enzyme positive acute coronary syndrome (EPACS, n = 10), enzyme negative ACS (ENACS, n = 7) and ischemic heart disease (IHD, n = 11). We compared the patients to healthy control subjects (n = 31). We found significantly lower N/OFQ levels in the EPACS [6.86 (6.21–7.38) pg/ml], ENACS [6.97 (6.87–7.01) pg/ml and IHD groups [7.58 (7.23–8.20) pg/ml] compared to the control group [8.86 (7.27–9.83) pg/ml]. A significant correlation was detected between N/OFQ and white blood cell count (WBC), platelet count (PLT), creatine kinase (CK), glutamate oxaloacetate transaminase (GOT) and cholesterol levels in the EPACS group.Decreased plasma N/OFQ is closely associated with the presence of acute cardiovascular disease, and the severity of symptoms has a significant negative correlation with the N/OFQ levels. We believe that the rate of N/OFQ depression is in association with the level of ischemic stress and the following inflammatory response. Further investigations are needed to clarify the relevance and elucidate the exact effects of the ischemic stress on the N/OFQ system.