Sandra Kutkiene˙, Lina Gumbiene, Juratę Aganauskiene, Rima Steponenienea, Germanas Marinskisa and Audrius Aidietis
Implantable cardioverters-defibrillators have decreasedmorbidity and mortality as well as improved quality of life in patients with life-threatening cardiac arrhythmias and allowed an increasing number of young women to reach their reproductive years. New questions and tasks arise for medical professionals as to organize appropriate management of these patients, because little is known regarding the risk and outcomes of such pregnancies. The aim of this report is to describe our centre’s first experience of pregnancy and delivery management in patient with an implantable cardioverter-defibrillator as primary prevention of ventricular arrhythmias in congenital long QT syndrome.
Gytis Grigaliūnas, Lina Gumbienė, Nomeda Valevičienė, Mindaugas Matačiūnas, Virgilijus Tarutis, Germanas Marinskis and Audrius Aidietis
Tetralogy of Fallot (TOF) is the most common cause of cyanotic congenital heart defect. Over the last century, the life expectancy of TOF patients has significantly improved. This, however, has brought new challenges both to patients and their health-care providers, the main of them being late arrhythmia. Ironically, late arrhythmia is predominantly generated due to the fibrotic scars caused by the life-saving surgical repair. Once the first two mainly arrhythmia-free decades after the repair pass, the risk of developing late arrhythmia and, therefore, SCD becomes substantial. Consequently, young adults with repaired Tetralogy of Fallot (rTOF) require careful outpatient monitoring.
There have been many attempts to predict the risk of life-threatening arrhythmia in rTOF patients. This has led to the defining of various risk factors, ranging from the widely used QRS prolongation to novel predictors, derived from cardiac magnetic resonance (CMR) based anatomical findings (left ventricular dyssynchrony indexes, right ventricular output tract akinetic length, right ventricular mass-to-volume ratio). The latter predictors have recently established CMR as a tool of high significance in evaluation of rTOF patients.
Although the role of Holter monitoring findings in rTOF patient-assessment remains unclear, it may be useful in those who are 25 years and older. Implantable cardioverter–defibrillator (ICD) implantation is the first-line treatment for secondary prevention of sudden cardiac death (SCD). rTOF patients suffer from the highest rate of inappropriate and the lowest rate of appropriate ICD shocks, when compared to other congenital heart diseases. As a consequence, ICD implantation for primary SCD prevention should be carefully weighed. Catheter-based ablation therapy leads to high rate of initial success when abolishing monomorphic ventricular tachycardia and intra-atrial reentrant tachycardia, however recurrence rates remain high.
Vilius Janušauskas, Lina Puodžiukaitė, Greta Radauskaitė, Aleksejus Zorinas, Sigita Aidietienė, Paulius Jurkuvėnas, Gediminas Račkauskas, Kęstutis Ručinskas and Audrius Aidietis
Objectives: Termination of atrial fibrillation (AF) during transcatheter ablation has been associated with improved outcomes in some studies. Our aim was to determine if termination of AF during beating-heart surgical ablation affects long-term results.
Design and methods: This observational, retrospective study included 69 patients who underwent minimally invasive stand-alone surgical epicardial ablation for non-valvular, persistent AF using a bipolar ablation device. Patients with confirmed pulmonary vein isolation were included in the evaluation. Absence of arrhythmia was confirmed at 3, 6, and 12 months and annually thereafter with 24-h Holter monitoring.
Results: Altogether, 39 (57%) patients were in AF at the beginning of surgical procedure. Among them, 21 (54%) recovered their sinus rhythm (SR) during the ablation: 7 (18%) had AF termination during left atrial ablation, 14 (36%) had AF termination during right atrial (RA) ablation. The remaining 18 (46%) patients required cardioversion to achieve SR. The mean follow-up was 55 ± 24 months. There were no significant differences in the patients’ preoperative and intraoperative data. The percentages of patients without AF termination during ablation who experienced freedom from AF and antiarrhythmic medications at 1, 2, 3, 4, and 5 years postoperatively were 78%, 63%, 50%, 33%, and 43%, respectively. The corresponding percentages in patients with AF termination were 83%, 74%, 67%, 71%, and 75%, respectively.
Conclusions: There is a trend towards better long-term results if arrhythmia was terminated during surgical epicardial ablation on beating heart. Termination of AF during RA ablation (observed in 36% of patients), suggests that AF is a biatrial disease in patients with persistent AF.