Biomedical subjects

O Jurkovicova

Publications and source records attributed to O Jurkovicova.

8 recordsLinked to original sources

PubMed2002

Thrombolytic therapy for patients with acute myocardial infarction. Causes increasing the probability of not receiving thrombolytic therapy.

Intravenous thrombolysis is the most accessible and the most common form of reperfusion therapy. The aim of this study was to identify demographic, clinical and electrocardiographic factors, which based on published data and in patients included in the project Audit of diagnostic and therapeutic procedures in patients with acute myocardial infarction (AUDIT), increased the probability of not receiving thrombolytic therapy. In order to maximize the impact of thrombolytic therapy to reduce the case fatality rate associated with an acute myocardial infarction, we review, which a number of studies provide evidence on the usage of thrombolytic therapy in elder, women, patients with diabetes mellitus, bundle-branch block and after stroke. (Fig. 10, Ref. 52.).

Health Services Accessibility↗

PubMed2001

Special character of atrial paroxysmal fibrillation in coincidence with WPW syndrome.

The paper summarizes the knowledge on paroxysmal atrial fibrillation in WPW syndrome. The peculiarities, ECG features, risk markers of sudden cardiac death, pharmacologic and non farmacologic therapy and prevention of this arrhythmia are presented. Potentially dangerous effects of drugs such as digoxin, verapamil, adenosine and betablockers are emphasized.

Atrial Fibrillation↗

PubMed2000

Electrophysiologic characteristics and radiofrequency ablation of concealed nodofascicular and left anterograde atriofascicular pathways.

INTRODUCTION: True nodoventricular or nodofascicular pathways and left-sided anterograde decremental accessory pathways (APs) are considered rare findings. METHODS AND RESULTS: Two unusual patients with paroxysmal supraventricular tachycardia were referred for radiofrequency (RF) ablation. Both patients had evidence of dual AV nodal conduction. In case 1, programmed atrial and ventricular stimulation induced regular tachycardia with a narrow QRS complex or episodes of right and left bundle branch block not altering the tachycardia cycle length and long concentric ventriculoatrial (VA) conduction. Ventricular extrastimuli elicited during His-bundle refractoriness resulted in tachycardia termination. During the tachycardia, both the ventricles and the distal right bundle were not part of the reentrant circuit. These findings were consistent with a concealed nodofascicular pathway. RF ablation in the right atrial mid-septal region with the earliest atrial activation preceded by a possible AP potential resulted in tachycardia termination and elimination of VA conduction. In case 2, antidromic reciprocating tachycardia of a right bundle branch block pattern was considered to involve an anterograde left posteroseptal atriofascicular pathway. For this pathway, decremental conduction properties as typically observed for right atriofascicular pathways could be demonstrated. During atrial stimulation and tachycardia, a discrete AP potential was recorded at the atrial and ventricular insertion sites and along the AP. Mechanical conduction block of the AP was reproducibly induced at the annular level and at the distal insertion site. Successful RF ablation was performed at the mitral annulus. CONCLUSION: This report describes two unusual cases consistent with concealed nodofascicular and left anterograde atriofascicular pathways, which were ablated successfully without impairing normal AV conduction system.

Adult↗

PubMed1999

Radiofrequency ablation of a concealed nodoventricular Mahaim fiber guided by a discrete potential.

INTRODUCTION: We present the case of a 17-year-old woman who underwent an electrophysiological study and radiofrequency (RF) ablation of supraventricular tachycardia refractory to medical treatment. Two right-sided, concealed, nondecremental atrioventricular accessory pathways (AV-APs) involved in orthodromic circus movement tachycardias were identified. After RF ablation of both AV-APs, evidence of bidirectional dual AV nodal conduction was demonstrated and regular narrow complex tachycardia was induced. METHODS AND RESULTS: During the tachycardia, retrograde slow and fast AV nodal pathway conduction with second-degree ventriculoatrial (VA) block and VA dissociation were observed. During the tachycardia with second-degree VA block, ventricular extrastimuli elicited during His-bundle refractoriness advanced the next His potential or terminated the tachycardia. Mapping the right atrial mid-septal region, a distinct high-frequency activation P potential was recorded in a discrete area, two thirds of the way from the His bundle toward the os of the coronary sinus. Detailed electrophysiologic testing with the recordable P potential demonstrated that the tachycardia utilized a concealed nodoventricular AP arising from the proximal slow AV nodal pathway. CONCLUSION: The tachycardia with slow 1:1 VA conduction could be reset by ventricular extrastimuli elicited during His-bundle refractoriness advancing the subsequent activation P potential and atrial activation. RF ablation guided by recording of the activation P potential resulted in elimination of both the slow AV nodal pathway and the nodoventricular connection with preservation of the normal AV conduction system.

Adolescent↗

PubMed1999

[Pharmacotherapeutic profile of patients with acute myocardial infarct in the early hospitalization period].

BACKGROUND: The early treatment efficacy of patients with acute myocardial infarction (AMI) with thrombolysis, antiplatelet drugs, betablockers and ACE inhibitors has been well documented in randomized mega trials. However, little is known about the fact to what extend the results of these mega trials have influenced the treatment practices. Moreover, in the view of a complete lack of data on management of patients with AMI in Slovak Republic a project of the Ministry of Health "Audit of diagnostic and therapeutic management in patients with acute coronary syndromes" (AUDIT) has been conducted. OBJECTIVES: To obtain preliminary information on the present state of pharmacotherapy of patients with AMI in Slovak Republic during the early hospitalization phase (EHP) from the Pilot Study (PS) of the project AUDIT. METHODS: Pharmacotherapy of AMI during EHP was analysed in 336 patients (232 males and 104 females, mean age 65 12 years, age range 30-93 years). Patients admitted with diagnosis of the first or repeated AMI or with suspect AMI were included. PS was done in prospective multicentric study between November 1, 1996 and December 31, 1996. 23 hospitals from various parts of Slovakia participated in this study. Data were compiled by means of questionaires and were processed by ACCES 97 and EXCEL 97. RESULTS: Antiplatelet therapy with acetylosalicylic acid (almost exclusively Anopyrin) received as much as 87.8% of patients with AMI during EHP. Thrombolytic therapy (TLT), almost exclusively with streptokinase, was performed in 105, i.e. in 31.8% of patients with AMI. TLT was performed in a statistically significantly smaller proportion of patients older than 65 years compared to patients 65 years of age and younger (20.9% vs 41.2%, p < or = 0.01). Females were treated with TLT statistically significantly less frequently than males (24.5% vs 35.1%, p < or = 0.05). The major cause for not performing the TLT was late arrival to hospital (in 32.1% patients). Betablockers were administered to a total of 42.9% of patients during EHP. Betablockers received only 3.6% of patients intravenously (!) and only 39.3% of patients orally. Treatment with oral betablockers was performed in a statistically significantly smaller proportion of patients older than 65 years compared to patients 65 years of age and younger (27.4% vs 49.7%, p < or = 0.01). Up to 49.1% of patients in EHP were treated with ACE inhibitors, however, left ventricular ejection fraction < 40% warranting feasibility of this treatment was achieved only in 26.7% of patients. Nitrates were administered to 62% of patients in EHP, of this number intravenously to 37.4% of patients. Calcium channel blockers were given only to 7.3% of patients. Treatment with heparin was performed in 90.9% of patients. 14.3% of patients received during EHP antiarrhythmics of class I and 2.7% of patients of class III. MgSO4 was used in 26.4% of patients in EHP. CONCLUSIONS: The reported PS of AUDIT Project gives for the first time information on the state of the pharmacotherapy of patients with AMI in Slovak Republic. Some results are relatively encouraging, however, others can not be a reason for satisfaction. The fact, that in Slovakia, adequate number of patients with AMI receive acetylosalicylic acid (Anopyrin) and that Slovakia belongs to countries with the smallest proportion of patients with AMI treated with calcium channel blockers and antiarrhythmics during EHP is encouraging. On the other hand, the use of TLT and betablockers is dissatisfactory. Requirement to increase the proportion of thrombolysed patients with AMI and the necessity for substantially more frequent use of betablockers, especially intravenous, in EHP in these patients result from these findings. In Slovakia, inadequately large proportion of patients with AMI is treated with ACE inhibitors, heparin, and partially also nitrates administered per os during EHP. (ABSTRACT TRUNCATED)

Adrenergic beta-Antagonists↗

PubMed1998

[In Process Citation]

Reperfusion arrhythmias originate as a consequence of the complex of cellular and humoral reactions accompanying the opening of coronary artery. As the primary cause of their generation are considered the chemically defined substances that are produced and accumulated in myocardium during reperfusion. The key role id ascribed to free oxygen radicals but of importance are also other substances such as calcium, thrombin, platelet activating factor, inositol triphosphate, angiotensin II and others. These chemical mediators of reperfusion arrhythmias operate as modulators of cellular electrophysiology causing the complex changes at the level of ion channels. It is supposed that in the genesis of reperfusion arrhythmias unlike ischemic arrhythmias operate nonreentrant mechanisms such as abnormal or enhanced automacy and triggered activity due to afterdepolarizations. As a typical reperfusion arrhythmia is considered an early (within 6 hours after start of thrombolysis), frequent (> 30 episodes/hour) and repetitive (occurring during > 3 consecutive hours) accelerated idioventricular rhythm (AIVR). AIVR with such characteristics has a high specificity and positive predictive accuracy but relative low sensitivity as a predictor of reperfusion. Thus, in occurrence of AIVR, recanalization of infarction-related coronary artery is very probable, but in absence of AIVR, reperfusion is still not excluded. The following arrhythmias are regarded also as markers of reperfusion: frequent premature ventricular complexes (> twofold increase in frequency within 90 minutes after the start of thrombolysis), a significant increase of episodes in nonsustained ventricular tachycardia, sinus bradycardia and probably also high degree atrioventricular blocks. At present, there is no definite evidence, as to whether sustained ventricular tachycardia and especially ventricular fibrillation can be caused by reperfusion. Reperfusion arrhythmias are an important noninvasive marker of successful recanalization of infarction-related coronary artery. However, they are also a sign of reperfusion injury and a finding which may limit the favourable effect of reperfusion. In account of that, there is a very intensive search for pharmacologic interventions which could protect or attenuate the reperfusion injury and thereby also the genesis of reperfusion arrhythmias. Although promising results were obtained with many substances antagonizing the effects of mediators of reperfusion injury, there is no definite recomendation for their use under clinical conditions. However, the results from the latest clinical trials with ACE inhibitors are very promising. These trials render relative conclusive evidence, that ACE inhibitors could have a protective effect against reperfusion arrhythmias. (Ref. 89, Tab. 1.)

Journal Article↗

PubMed1998

[In Process Citation]

In addition to ventricular arrhythmias, various forms of supraventricular arrhythmias (SVA) and atrioventricular (AV) and intraventricular (IV) conduction disturbances occur also in acute myocardial infarction (AMI). In the setting of AMI, SVA may be caused by relevant atrial ischemia or infarction. SVA complicate the course especially that of inferior, posterior and lateral AMI, SVA occur frequently also in the right ventricular myocardial infarction and in pericarditis. SVA appearing in the late phase of AMI are caused particularly by hemodynamic factors especially those of both left and right ventricular dysfunctions. Atrial dilatation and the increase of intraatrial pressure are also important factors in the genesis of SVA. The autonomous nervous system, electrolyte disturbances, acidosis and global hypoxia may operate as modulating factors in the development of SVA. AV conduction disturbances are significantly more frequent in patients with inferior than with anterior AMI. In inferior AMI, they are frequently caused by reflex parasympathetic activation. In the genesis of AV conduction disturbances, a significant role may be played also by the following mechanisms: Ischemia or necrosis of AV node or AV junction and the negative dromotropic effect of adenosine and potassium which are released to a great extent during myocardial ischemia and reperfusion. A high-degree AV block complicating the course of inferior AMI has a significantly better prognosis than that occurring in the setting of anterior AMI. In inferior AMI, AV block is frequently reversible, whereas in anterior AMI, it is persistent and irreversible. Early AV conduction disturbances, appearing within 24 hours of AMI have a better prognosis than those occurring in the late phase of AMI. Bundle branch blocks (BBB) complicating the course of AMI are caused by occlusion of bundle-related coronary artery or by serious ischemia in its bed. BBB is frequently a marker of a multivessel disease. New BBB appearing in AMI especially the right bundle branch block is considered as an predictor for the development of a complete AV block. Frequent and repetitive SVA as well as serious AV and IV conduction disturbances are frequently associated with a significantly worse clinically course of AMI and with increased mortality, with that of especially hospital mortality. However, this is usually not caused by SVA or AV and IV conduction disturbances per se. The major cause of death in these patients are heart failure cardiogenic shock and malignant ventricular arrthythmias due to larger AMI, significant reduction of left ventricular function and advanced coronary heart disease. Complex SVA as well as serious AV and IV conduction disturbances are usually considered as markers, but not as independent predictors for both increased hospital mortality and in some cases also for that of posthospital mortality. Their occurrence in AMI may help to identify the patients at great risk who require a very intensive treatment including aggressive management of extensive coronary heart disease. (Ref. 62.).

Journal Article↗

PubMed1996

Radiofrequency catheter ablation of a right atriofascicular (Mahaim) and two atrioventricular (Kent) accessory pathways in a single session.

This report describes the case of a 19-year-old patient with Ebstein's anomaly, who had an unusual combination of a right atriofascicular (Mahaim) and two ipsilateral right atrioventricular (Kent) accessory pathways participating in three types of antidromic and orthodromic reciprocating tachycardias in the absence of retrograde conduction over the bundle of His-atrioventricular node axis. All three pathways were ablated in a single session using temperature-guided radiofrequency current.

Adult↗