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Warsaw, Poland

Stec S.,Postgraduate Medical School | Tarnowski W.,Orlowskis Hospital | Kalin K.,Postgraduate Medical School | Sikora K.,Grochowski Hospital | Kulakowski P.,Postgraduate Medical School
Dysphagia | Year: 2010

We report a novel technique for diagnosing a new cause of esophageal dysphagia in a patient without organic heart and esophageal disease. A coincidence between intermittent esophageal dysphagia and cardiac arrhythmia, frequent premature ventricular complexes (PVC) were confirmed by clinical observation, simultaneous ECG monitoring, and motility study. High-resolution esophageal manometry (HRM) revealed abnormal peristaltic waves only during frequent PVC. Abnormal peristaltic waves and PVC disappeared simultaneously and completely within 15 min after intravenous infusion of antiarrhythmic agent (140 mg propafenone). Oral treatment with antiarrhythmic drugs was not tolerated or ineffective. Complete remission of PVC and dysphagia was achieved immediately after radiofrequency catheter ablation of arrhythmogenic focus located in the right ventricular outflow tract. This case demonstrates a new technique for the management of a syndrome called "PVC-associated dysphagia" that can be mediated by cardioesophageal reflex. Interdisciplinary cooperation and simultaneous HRM with ECG monitoring may confirm the diagnosis and guide effective treatment. © Springer Science+Business Media, LLC 2009. Source

Kokowicz P.,Postgraduate Medical School | Stec S.,Postgraduate Medical School | Flasinska K.,Grochowski Hospital | Budaj A.,Postgraduate Medical School
Kardiologia Polska | Year: 2010

Background: Increase of troponin (cTn) is a marker of myocardial injury caused by different mechanisms. Exercise testing (ExT) is a useful clinical tool in predicting the risk of myocardial ischemia, especially in patients with multivessel coronary artery disease (CAD), who are more often endangered by medical complications. The test is however limited by its low sensitivity and specificity. Aim: To evaluate the reasons for troponin I (cTnI) release after ExT, and to determine its clinical and prognostic implications in patients with stable CAD, referred for elective coronary angiography (ANG). Methods: 118 patients without signs of systolic heart failure, referred for planned coronary ANG were included in the analysis. After baseline measurements of NT-proBNP, hsCRP, cTnI, CK-MB levels, maximal ExT was performed, followed by the consecutive measurements of cTnI and CK-MB 12 and 24 hours after examination. All patients underwent coronary ANG and ECHO within 7 days of taking blood samples. All patients were followed up on average for 35.5 months. Results: The cTnI elevation ≥ 0.14 ng/mL (≥ 99th percentile value of the reference group) after 24 hours of the ExT was observed in 11 (9%) patients. Predictors of cTnI release in patients after ExT were as follows: ejection fraction ≤ 50%, lack or insufficient physical activity, max systolic blood pressure > 160 mm Hg at peak of ExT (OR 6.6, 95% CI 1.2-35.4, p = 0.027; OR 5.5, 95% CI 1.1-28.8, p = 0.04; OR 6.3, 95% CI 1.3-31.6, p = 0.025, respectively). Increase of cTnI after ExT did not correlate with multivessel CAD nor with future adverse clinical events. Conclusions: The cTnI release post ExT is more frequently observed in patients with stable CAD with ejection fraction ≤ 50%, low physical activity, and max systolic blood pressure > 160 mm Hg at peak ExT. Post ExT cTnI increase in patients with stable CAD did not correlate with the number of atherosclerotic coronary vessels, and had no prognostic implications. Increase of cTnI after ExT did not have any predictive value in respect to acute coronary syndrome and/or death during long-term follow up. Copyright © Via Medica. Source

Steg P.G.,University Paris Diderot | Jolly S.S.,Hamilton Health Sciences | Mehta S.R.,Hamilton Health Sciences | Afzal R.,Hamilton Health Sciences | And 13 more authors.
JAMA - Journal of the American Medical Association | Year: 2010

Context: The optimal unfractionated heparin regimen for percutaneous coronary intervention (PCI) in patients with non-ST-segment elevation acute coronary syndromes treated with fondaparinux is uncertain. Objective: To compare the safety of 2 unfractionated heparin regimens during PCI in high-risk patients with non-ST-segment elevation acute coronary syndromes initially treated with fondaparinux. Design, Setting, and Participants: Double-blind randomized parallel-group trial in 179 hospitals in 18 countries involving 2026 patients undergoing PCI within 72 hours, nested within a cohort of 3235 high-risk patients with non-ST-segment elevation acute coronary syndromes initially treated with fondaparinux enrolled from February 2009 to March 2010. Interventions: Patients received intravenously either low-dose unfractionated heparin, 50 U/kg , regardless of use of glycoprotein IIb/IIIa (GpIIb-IIIa) inhibitors or standarddose unfractionated heparin, 85 U/kg (60 U/kg with GpIIb-IIIa inhibitors), adjusted by blinded activated clotting time (ACT). Main Outcome Measures: Composite of major bleeding, minor bleeding, or major vascular access-site complications up to 48 hours after PCI. Key secondary outcomes include composite of major bleeding at 48 hours with death, myocardial infarction, or target vessel revascularization within day 30. Results: The primary outcome occurred in 4.7% of those in the low-dose group vs 5.8% in the standard-dose group (odds ratio [OR], 0.80; 95% confidence interval [CI], 0.54-1.19; P=.27). The rates of major bleeding were not different but the rates of minor bleeding were lower with 0.7% in the low-dose group vs 1.7% in the standard-dose group (OR, 0.40; 95% CI, 0.16-0.97; P=.04). For the key secondary outcome, the rates for low-dose group were 5.8% vs 3.9% in the standard-dose group (OR, 1.51; 95% CI, 1.00-2.28; P=.05) and for death, myocardial infarction, or target vessel revascularization it was 4.5% for the low-dose group vs 2.9% for the standard-dose group (OR, 1.58; 95% CI, 0.98-2.53; P=.06). Catheter thrombus rates were very low (0.5% in the low-dose group and 0.1% in the standard-dose group, P=.15). Conclusion: Low-dose compared with standard-dose unfractionated heparin did not reduce major peri-PCI bleeding and vascular access-site complications. Trial Registration: clinicaltrials.gov Identifier: NCT00790907. ©2010 American Medical Association. All rights reserved. Source

Alfonso F.,University of San Carlos | Timmis A.,London Chest Hospital | Pinto F.J.,University of Lisbon | Ambrosio G.,University of Perugia | And 3 more authors.
Heart | Year: 2012

Disclosure of potential conflicts of interest (COI) is used by biomedical journals to guarantee credibility and transparency of the scientific process. COI disclosure, however, is not systematically nor consistently dealt with by journals. Recent joint editorial efforts paved the way towards the implementation of uniform vehicles for COI disclosure. This paper provides a comprehensive editorial perspective on classical COI-related issues. New insights into current COI policies and practices among European Society of Cardiology national cardiovascular journals, as derived from a cross-sectional survey using a standardised questionnaire, are discussed. Source

Piotrowski R.,Grochowski Hospital | Krynski T.,Grochowski Hospital | Baran J.,Grochowski Hospital | Futyma P.,St Josephs Center | And 2 more authors.
Cardiology Journal | Year: 2014

Background and aim: To assess safety and efficacy of antazoline for termination of atrial fibrillation (AF) occurring during ablation of accessory pathways (AP). Methods: We analyzed electrophysiological mechanism of antazoline (changes in A-A interval) and the percentage of pre-excited QRS complexes before and after antazoline administration. The total dose administered and the time from the start of injection to sinus rhythm restoration were also measured. Results: Out of consecutive 290 patients with Wolff-Parkinson-White syndrome undergoing radiofrequency (RF) ablation, 12 (4.1%) (4 females, mean age 36 ± 20 years) developed sustained AF which did not stop spontaneously within 10 min, and antazoline in 100 mg repe-ated boluses was administered. In all 12 patients the drug restored sinus rhythm after a mean of 425 ± 365 s (range 43-1245 s) using a mean cumulative dose of 176 ± 114 mg (range 25-400 mg). The drug slightly prolonged R-R intervals during AF (from 383 ± 106 to 410 ± ± 70 ms) and reduced the percentage of fully pre-excited QRS complexes (from 35% to 26%). Intracardiac recordings showed gradual increase in A-A intervals, as well as regularization and decreasing fractionation of atrial activity following drug injection (mean A-A interval of 162 ± 30 ms at baseline vs. 226 ± 26 ms shortly before sinus rhythm restoration, p < 0.001). AP was not completely blocked in any patient which enabled continuation of ablation. Conclusions: Antazoline safely and rapidly converts AF into sinus rhythm during ablation of A P. The drug does not block AP completely, enabling continuation of ablation. The drug converting AF into more organized atrial activity (atrial futter/tachycardia) before sinus rhythm resumption. © 2014 Via Medica. Source

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