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Article ; Online: Shared Decision Making and Cardioneuroablation Allow Discontinuation of Permanent Pacing in Patients with Vagally Mediated Bradycardia.

Stec, Sebastian / Wileczek, Antoni / Reichert, Agnieszka / Śledź, Janusz / Kosior, Jarosław / Jagielski, Dariusz / Polewczyk, Anna / Zając, Magdalena / Kutarski, Andrzej / Karbarz, Dariusz / Zyśko, Dorota / Nowarski, Łukasz / Stodółkiewicz-Nowarska, Edyta

Journal of cardiovascular development and disease

2023 Volume 10, Issue 9

Abstract: Background: Safe discontinuation of pacemaker therapy for vagally mediated bradycardia is a dilemma. The aim of the study was to present the outcomes of a proposed diagnostic and therapeutic process aimed at discontinuing or not restoring pacemaker ... ...

Abstract	Background: Safe discontinuation of pacemaker therapy for vagally mediated bradycardia is a dilemma. The aim of the study was to present the outcomes of a proposed diagnostic and therapeutic process aimed at discontinuing or not restoring pacemaker therapy (PPM) in patients with vagally mediated bradycardia. Methods: The study group consisted of two subgroups of patients with suspected vagally mediated bradycardia who were considered to have PPM discontinued or not to restore their PPM if cardioneuroablation (CNA) would successfully treat their bradycardia. A group of 3 patients had just their pacemaker explanted but reimplantation was suggested, and 17 patients had preexisting pacemakers implanted. An invasive electrophysiology study was performed. If EPS was negative, extracardiac vagal nerve stimulation (ECVS) was performed. Then, patients with positive ECVS received CNA. Patients with an implanted pacemaker had it programmed to pace at the lowest possible rate. After the observational period and control EPS including ECVS, redo-CNA was performed if pauses were induced. The decision to explant the pacemaker was obtained based on shared decision making (SDM). Results: After initial clinical and electrophysiological evaluation, 17 patients were deemed eligible for CNA (which was then performed). During the observational period after the initial CNA, all 17 patients were clinically asymptomatic. The subsequent invasive evaluation with ECVS resulted in pause induction in seven (41%) patients, and these patients underwent redo-CNA. Then, SDM resulted in the discontinuation of pacemaker therapy or a decision to not perform pacemaker reimplantation in all the patients after CAN. The pacemaker was explanted in 12 patients post-CNA, while in 2 patients explantation was postponed. During a median follow-up of 18 (IQR: 8-22) months, recurrent syncope did not occur in the CNA recipients. Conclusions: Pacemaker therapy in patients with vagally mediated bradycardia could be discontinued safely after CNA.
Language	English
Publishing date	2023-09-11
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2777082-5
ISSN	2308-3425 ; 2308-3425
ISSN (online)	2308-3425
ISSN	2308-3425
DOI	10.3390/jcdd10090392
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Article ; Online: Safety and efficacy of His bundle pacing validated by extracardiac vagal nerve stimulation (HIS-STORY).

Josiak, Krystian / Stec, Sebastian / Zyśko, Dorota / Skonieczny, Bartosz / Kosior, Jaroslaw / Śledź, Janusz / Wilczek, Antoni / Stodółkiewicz-Nowarska, Edyta / Biel, Bartosz / Szymkiewicz, Paweł / Skoczyński, Przemysław / Karbarz, Dariusz / Ludwik, Bartosz / Banasiak, Waldemar / Jagielski, Dariusz

Cardiology journal

2022 Volume 29, Issue 4, Page(s) 698–701

MeSH term(s)	Bundle of His ; Bundle-Branch Block/therapy ; Cardiac Pacing, Artificial ; Electrocardiography ; Humans ; Vagus Nerve Stimulation/adverse effects
Language	English
Publishing date	2022-06-15
Publishing country	Poland
Document type	Journal Article
ZDB-ID	2488680-4
ISSN	1898-018X ; 1897-5593
ISSN (online)	1898-018X
ISSN	1897-5593
DOI	10.5603/CJ.a2022.0053
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Article ; Online: Efficacy and safety of zero-fluoroscopy approach for ablation of atrioventricular nodal reentry tachycardia: experience from more than 1000 cases.

Świętoniowska-Mścisz, Aleksandra / Stec, Piotr / Stec, Sebastian / Szydłowski, Lesław / Zagrodzka, Magdalena / Kusa, Jacek / Morka, Aleksandra / Kameczura, Tomasz / Mścisz, Adrian / Anna Stec-Gola / Karbarz, Dariusz / Śledź, Janusz

Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing

2022 Volume 66, Issue 5, Page(s) 1231–1242

Abstract: Background: Radiofrequency catheter ablation (RFCA) of the slow pathway in atrioventricular nodal reentry tachycardia (AVNRT) is associated with high efficacy and low risk of total perioperative or late atrioventricular block. This study aimed to ... ...

Abstract	Background: Radiofrequency catheter ablation (RFCA) of the slow pathway in atrioventricular nodal reentry tachycardia (AVNRT) is associated with high efficacy and low risk of total perioperative or late atrioventricular block. This study aimed to evaluate the efficacy, safety, and feasibility of slow-pathway RFCA for AVNRT using a zero-fluoroscopy approach. Methods: Data were obtained from a prospective multicenter registry of catheter ablation from January 2012 to February 2018. Consecutive unselected patients with the final diagnosis of AVNRT were recruited. Electrophysiological and 3-dimensional (3D) electroanatomical mapping systems were used to create 3D maps and to navigate only 2 catheters from the femoral access. Acute procedural efficacy was evaluated using the isoproterenol and/or atropine test, with 15-min observation after ablation. Each case of recurrence or complication was consulted at an outpatient clinic during long-term follow-up. Results: Of the 1032 procedures, 1007 (97.5%) were completed without fluoroscopy. Conversion to fluoroscopy was required in 25 patients (2.5%), mainly due to an atypical location of the coronary sinus (n = 7) and catheter instability (n = 7). The mean radiation exposure time was 1.95 ± 1.3 min for these cases. The mean fluoroscopy time for the entire study cohort was 0.05 ± 0.4 min. The mean total procedure time was 44.8 ± 18.6 min. There were no significant in-hospital complications. The total success rate was 96.1% (n = 992), and the recurrence rate was 3.9% (n = 40). Conclusion: Slow-pathway RFCA can be safely performed without fluoroscopy, with a minimal risk of complications and a high success rate.
MeSH term(s)	Humans ; Tachycardia, Atrioventricular Nodal Reentry/diagnosis ; Prospective Studies ; Atrioventricular Block/etiology ; Isoproterenol ; Fluoroscopy/methods ; Catheter Ablation/methods ; Treatment Outcome
Chemical Substances	Isoproterenol (L628TT009W)
Language	English
Publishing date	2022-12-10
Publishing country	Netherlands
Document type	Multicenter Study ; Journal Article
ZDB-ID	1329179-8
ISSN	1572-8595 ; 1383-875X
ISSN (online)	1572-8595
ISSN	1383-875X
DOI	10.1007/s10840-022-01419-2
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Article ; Online: Zero-fluoroscopy catheter ablation of symptomatic pre-excitation from non-coronary cusp during pregnancy.

Karbarz, Dariusz / Stec, Piotr J / Deutsch, Karol / Śledź, Janusz / Stec, Sebastian

Kardiologia polska

2017 Volume 75, Issue 12, Page(s) 1351

MeSH term(s)	Arrhythmias, Cardiac/diagnostic imaging ; Arrhythmias, Cardiac/etiology ; Arrhythmias, Cardiac/surgery ; Catheter Ablation ; Female ; Humans ; Pregnancy ; Pregnancy Complications, Cardiovascular/diagnostic imaging ; Pregnancy Complications, Cardiovascular/etiology ; Pregnancy Complications, Cardiovascular/surgery ; Wolff-Parkinson-White Syndrome/complications ; Young Adult
Language	English
Publishing date	2017-12-18
Publishing country	Poland
Document type	Case Reports ; Journal Article
ZDB-ID	411492-9
ISSN	1897-4279 ; 0022-9032
ISSN (online)	1897-4279
ISSN	0022-9032
DOI	10.5603/KP.2017.0231
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Article ; Online: Atypowa postać zespołu tako-tsubo związanego z migotaniem przedsionków w zespole Wolffa-Parkinsona-White’a powikłanego nagłym zatrzymaniem krążenia: trudności diagnostyczne.

Kukla, Piotr / Stec, Sebastian / Karbarz, Dariusz / Wrzosek, Bożena / Jastrzębski, Marek / Kluczewski, Maciej / Kurdzielewicz, Wojciech

Kardiologia polska

2013 Volume 71, Issue 8, Page(s) 864–868

Abstract: Atypical form of tako-tsubo cardiomyopathy (TTC) is associated with regional wall motion abnormalities in basal and/or middle segments or only middle segments with sparing of apical segments or apical and basal segments. We described a case of47-year-old ...

Title translation	Atypical form of tako-tsubo cardiomyopathy in a patient with atrial fibrillation in Wolff-Parkinson-White syndrome complicated with ventricular fibrillation: the diagnostic problems.
Abstract	Atypical form of tako-tsubo cardiomyopathy (TTC) is associated with regional wall motion abnormalities in basal and/or middle segments or only middle segments with sparing of apical segments or apical and basal segments. We described a case of47-year-old female with atypical form of TTC due to fast atrial fibrillation that converted into ventricular fibrillation in WPW syndrome. The echocardiogram made after direct current cardioversion revealed decreased left ventricular ejection fraction (LVEF 35%) with akinesis of inferior and posterior walls and anterior part of interventricular septum in the middle and the basal segments with hyperkinesis of apical segments. The biochemistry blood samples revealed elevated both troponin T- 0.35 ng/mL and NT-proBNP - 3550 pg/mL plasma level. The ECG showed sinus rhythm 62 bpm, shortened PQ interval 100 ms, widened QRS duration - 115 ms with delta wave, prolonged QT interval - 520 ms, QS in leads: II, III, aVF. NegativeT waves in leads: I, aVL and positive, symmetrical T waves in leads V1-V6. The coronarography revealed normal coronaryarteries. The control echocardiography after 10 days showed normal LVEF 70%, without any wall motion abnormalities. TTC was recognised based on: history of sudden stress situation before, ischaemic ECG changes, positive markers of myocardial injury, transient segmental wall motion abnormalities and normal coronary arteries. The ablation of right postero-septal accessory pathway was successfully performed.
MeSH term(s)	Atrial Fibrillation/diagnosis ; Atrial Fibrillation/etiology ; Echocardiography ; Electrocardiography ; Female ; Humans ; Middle Aged ; Takotsubo Cardiomyopathy/complications ; Takotsubo Cardiomyopathy/diagnosis ; Ventricular Fibrillation/diagnosis ; Ventricular Fibrillation/etiology ; Wolff-Parkinson-White Syndrome/complications ; Wolff-Parkinson-White Syndrome/diagnosis
Language	Polish
Publishing date	2013
Publishing country	Poland
Document type	Case Reports ; English Abstract ; Journal Article
ZDB-ID	411492-9
ISSN	1897-4279 ; 0022-9032
ISSN (online)	1897-4279
ISSN	0022-9032
DOI	10.5603/KP.2013.0203
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Zs.B 598: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
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Article ; Online: A simplified approach for evaluating sustained slow pathway conduction for diagnosis and treatment of atrioventricular nodal reentry tachycardia in children and adults.

Sledz, Janusz / Labus, Michal / Mazij, Mariusz / Klank-Szafran, Monika / Karbarz, Dariusz / Ludwik, Bartosz / Kusa, Jacek / Deutsch, Karol / Szydlowski, Leslaw / Mscisz, Adrian / Spikowski, Jerzy / Morka, Aleksandra / Kameczura, Tomasz / Swietoniowska-Mscisz, Aleksandra / Stec, Sebastian

Advances in medical sciences

2018 Volume 63, Issue 2, Page(s) 249–256

Abstract: Purpose: During incremental atrial pacing in patients with atrioventricular nodal reentrant tachycardia, the PR interval often exceeds the RR interval (PR > RR) during stable 1:1 AV conduction. However, the PR/RR ratio has never been evaluated in a ... ...

Abstract	Purpose: During incremental atrial pacing in patients with atrioventricular nodal reentrant tachycardia, the PR interval often exceeds the RR interval (PR > RR) during stable 1:1 AV conduction. However, the PR/RR ratio has never been evaluated in a large group of patients with pacing from the proximal coronary sinus and after isoproterenol challenge. Our study validates new site of pacing and easier method of identification of PR > RR. Material and methods: A prospective protocol of incremental atrial pacing from the proximal coronary sinus was carried out in 398 patients (AVNRT-228 and control-170). The maximum stimulus to the Q wave interval (S-Q = PR), SS interval (S-S), and Q-Q (RR) interval were measured at baseline and 10 min after successful slow pathway ablation and after isoproterenol challenge (obligatory). Results: The mean maximum PR/RR ratios at baseline were 1.17 ± 0.24 and 0.82 ± 0.13 (p < 0.00001) in the AVNRT and controls respectively. There were no PR/RR ratios ≥1 at baseline and after isoproterenol challenge in 12.3% of the AVNRT group and in 95.9% of the control group (p < 0.0001). PR/RR ratios ≥1 were absent in 98% of AVNRT cases after slow pathway ablation/modification in children and 99% of such cases in adults (P = NS). The diagnostic performance of PR/RR ratio evaluation before and after isoproterenol challenge had the highest diagnostic performance for AVNRT with PR/RR > = 1 (sensitivity: 88%, specificity: 96%, PPV-97%, NPV-85%). Conclusions: The PR/RR ratio is a simple tool for slow pathway substrate and AVNRT evaluation. Eliminating PR/RR ratios ≥1 may serve as a surrogate endpoint for slow pathway ablation in children and adults with AVNRT.
MeSH term(s)	Adult ; Case-Control Studies ; Child ; Coronary Sinus/pathology ; Electrocardiography ; Female ; Heart Conduction System/pathology ; Humans ; Male ; Tachycardia, Atrioventricular Nodal Reentry/diagnosis ; Tachycardia, Atrioventricular Nodal Reentry/therapy
Language	English
Publishing date	2018-02-10
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2273668-2
ISSN	1898-4002 ; 1896-1126
ISSN (online)	1898-4002
ISSN	1896-1126
DOI	10.1016/j.advms.2018.01.001
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Article ; Online: Maximum voltage gradient technique for optimization of ablation for typical atrial flutter with zero-fluoroscopy approach.

Deutsch, Karol / Śledź, Janusz / Mazij, Mariusz / Ludwik, Bartosz / Labus, Michał / Karbarz, Dariusz / Pasicka, Bernadetta / Chrabąszcz, Michał / Śledź, Arkadiusz / Klank-Szafran, Monika / Vitali-Sendoz, Laura / Kameczura, Tomasz / Śpikowski, Jerzy / Stec, Piotr / Ujda, Marek / Stec, Sebastian

Medicine

2017 Volume 96, Issue 25, Page(s) e6939

Abstract: Radiofrequency catheter ablation (RFCA) is an established effective method for the treatment of typical cavo-tricuspid isthmus (CTI)-dependent atrial flutter (AFL). The introduction of 3-dimensional electro-anatomic systems enables RFCA without ... ...

Abstract	Radiofrequency catheter ablation (RFCA) is an established effective method for the treatment of typical cavo-tricuspid isthmus (CTI)-dependent atrial flutter (AFL). The introduction of 3-dimensional electro-anatomic systems enables RFCA without fluoroscopy (No-X-Ray [NXR]). The aim of this study was to evaluate the feasibility and effectiveness of CTI RFCA during implementation of the NXR approach and the maximum voltage-guided (MVG) technique for ablation of AFL.Data were obtained from prospective standardized multicenter ablation registry. Consecutive patients with the first RFCA for CTI-dependent AFL were recruited. Two navigation approaches (NXR and fluoroscopy based as low as reasonable achievable [ALARA]) and 2 mapping and ablation techniques (MVG and pull-back technique [PBT]) were assessed. NXR + MVG (n = 164; age: 63.7 ± 9.5; 30% women), NXR + PBT (n = 55; age: 63.9 ± 10.7; 39% women); ALARA + MVG (n = 36; age: 64.2 ± 9.6; 39% women); and ALARA + PBT (n = 205; age: 64.7 ± 9.1; 30% women) were compared, respectively. All groups were simplified with a 2-catheter femoral approach using 8-mm gold tip catheters (Osypka AG, Germany or Biotronik, Germany) with 15 min of observation. The MVG technique was performed using step-by-step application by mapping the largest atrial signals within the CTI.Bidirectional block in CTI was achieved in 99% of all patients (P = NS, between groups). In NXR + MVG and NXR + PBT groups, the procedure time decreased (45.4 ± 17.6 and 47.2 ± 15.7 min vs. 52.6 ± 23.7 and 59.8 ± 24.0 min, P < .01) as compared to ALARA + MVG and ALARA + PBT subgroups. In NXR + MVG and NXR + PBT groups, 91% and 98% of the procedures were performed with complete elimination of fluoroscopy. The NXR approach was associated with a significant reduction in fluoroscopy exposure (from 0.2 ± 1.1 [NXR + PBT] and 0.3 ± 1.6 [NXR + MVG] to 7.7 ± 6.0 min [ALARA + MVG] and 9.1 ± 7.2 min [ALARA + PBT], P < .001). The total application time significantly decreased in the MVG technique subgroup both in NXR and ALARA (P < .01). No major complications were observed in either groups.Complete elimination of fluoroscopy is feasible, safe, and effective during RFCA of CTI in almost all AFL patients without cardiac implanted electronic devices. The most optimal method for RFCA of CTI-dependent AFL seems to be MVG; however, it required validation of optimal RFCA's parameters with clinical follow-up.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Atrial Flutter/surgery ; Catheter Ablation/methods ; Feasibility Studies ; Female ; Fluoroscopy ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Prospective Studies ; Quality Improvement ; Registries ; Treatment Outcome
Language	English
Publishing date	2017-06-22
Publishing country	United States
Document type	Evaluation Study ; Journal Article ; Multicenter Study
ZDB-ID	80184-7
ISSN	1536-5964 ; 0025-7974
ISSN (online)	1536-5964
ISSN	0025-7974
DOI	10.1097/MD.0000000000006939
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Article ; Online: Shared Decision Making and Cardioneuroablation Allow Discontinuation of Permanent Pacing in Patients with Vagally Mediated Bradycardia.

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Article ; Online: Safety and efficacy of His bundle pacing validated by extracardiac vagal nerve stimulation (HIS-STORY).

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Article ; Online: Efficacy and safety of zero-fluoroscopy approach for ablation of atrioventricular nodal reentry tachycardia: experience from more than 1000 cases.

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Article ; Online: Zero-fluoroscopy catheter ablation of symptomatic pre-excitation from non-coronary cusp during pregnancy.

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Article ; Online: Atypowa postać zespołu tako-tsubo związanego z migotaniem przedsionków w zespole Wolffa-Parkinsona-White’a powikłanego nagłym zatrzymaniem krążenia: trudności diagnostyczne.

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Article ; Online: A simplified approach for evaluating sustained slow pathway conduction for diagnosis and treatment of atrioventricular nodal reentry tachycardia in children and adults.

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Article ; Online: Maximum voltage gradient technique for optimization of ablation for typical atrial flutter with zero-fluoroscopy approach.

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