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J Kusniec

Publications and source records attributed to J Kusniec.

At least 19 recordsLinked to original sources
PubMed2006

Junctional rhythm quantity and duration during slow pathway radiofrequency ablation in patients with atrioventricular nodal re-entry supraventricular tachycardia.

AIM: The occurrence of accelerated junctional rhythm during radiofrequency energy delivery at the region of the slow pathway is a well-recognized marker of successful treatment of atrioventricular nodal re-entry tachycardia (AVNRT). Our aim was to evaluate if the quantity and duration of accelerated junctional rhythm during radiofrequency ablation of the slow pathway is correlated with residual slow pathway conduction. METHODS AND RESULTS: Forty consecutive patients with AVNRT undergoing radiofrequency ablation of slow pathway who developed accelerated junctional rhythm during ablation were included. We compared accelerated junctional rhythm quantity and duration between two groups: group A, without echo beats and group B, with echo beats on post-ablation electrophysiology study. The total amount of accelerated junctional rhythm was significantly greater in group A than in group B [75.0 (63.5-165.0) vs. 36.0 (24.0-65.0), P=0.006], as well as total duration of accelerated junctional rhythm [47.0(33.5-81.0) s vs. 23.0 (16.0-42.0) s, P=0.006]. The cycle length of accelerated junctional rhythm did not differ between the two groups [510.0 (445.0-545.0) ms vs. 500.0 (450.0-585.0) ms, P=0.5). CONCLUSIONS: The amount and duration of accelerated junctional rhythm is correlated with the total abolishment abolition of slow pathway conduction. A higher amount and duration of accelerated junctional rhythm during radiofrequency applications may be an additional marker of successful ablation.

Adult↗
PubMed2006

Are neutrons involved in the pathogenesis of life-threatening cardiac arrhythmias?

Geomagnetic fields protect the earth from the adverse effects of cosmic rays, whose activity can be indirectly measured by monitoring the level of neutrons in the environment. The number and days of discharges from automatic implantable cardioverter defibrillators (ICD) in patients with cardiac arrhythmias are inversely correlated with the daily level of geomagnetic activity (GMA). The aim of the present was to determine whether neutron levels on days of AICD discharges are higher than average. Days on which discharges occurred were recorded in 31 patients bearing ICDs for managing ischemic cardiomyopathy. Daily neutron levels obtained from the monitoring data of the Russian Academy of Sciences in Moscow were analyzed using Student's t test. The mean (+/-SD) daily neutron level for the 1096-day period was 8299.29 +/- 294.236 imp/min (median 8252), and for days of ACID discharge, 8423.93 +/- 274.187 imp/min (median 8443) (p = 0.0002). The mean neutron activity on days of AICD discharges in response to ventricular disturbances was significantly higher than the mean level over the 1096-day study period. Whether this relation is a direct result of low GMA or due to an independent role of neutrons in the pathogenesis and timing of cardiac arrhythmias is unknown.

Arrhythmias, Cardiac↗
PubMed1999

Relation between QT dispersion and slow intraventricular conduction in patients with acute anterior wall myocardial infarction.

BACKGROUND: QT dispersion has been proposed as a simple, noninvasive measure for identifying patients at risk of postinfarction arrhythmia. It is assumed to reflect nonuniform ventricular repolarization, which, in turn, may result from regional differences in repolarization time as well as from localized activation delay. The aim of this study was to examine the relation between QT dispersion and intraventricular conduction abnormalities in patients with acute anterior wall myocardial infarction. METHODS AND RESULTS: Standard 12-lead electrocardiographic and 12-lead signal-averaged electrocardiographic recordings were performed in 25 patients with a first Q-wave anterior wall myocardial infarction. Measures calculated by using the 6 precordial (V1 through V6) leads for QT dispersion were (1) difference between maximum and minimum QT and QTc intervals and (2) standard deviation of QT and QTc intervals. Measures calculated from the signal-averaged electrocardiogram were (1) maximum filtered QRS duration; (2) mean; and (3) standard deviation of filtered QRS duration. No relation was found between any measure of filtered QRS duration and that of QT dispersion by using linear correlation analysis. Similarly, no significant association was demonstrated between the filtered QRS duration and corresponding QT interval measurements (total 131 leads). CONCLUSIONS: The lack of correlation between signal-averaged electrocardiogram indexes of slow intraventricular conduction and electrocardiogram variables of QT dispersion suggests an independent predictive value for the 2 methods in identifying patients at risk of postinfarction arrhythmia. This suggestion is further supported by the finding that altered activation sequence is an unlikely mechanism of QT dispersion in patients with acute myocardial infarction, as indicated by the lack of association between the filtered QRS duration and corresponding QT interval measurements.

Arrhythmias, Cardiac↗
PubMed1999

Perforation of the right ventricular free wall by an active fixation transvenous cardioverter defibrillator lead.

A 58-year-old patient with dilated cardiomyopathy underwent implantable cardioverter defibrillator (ICD) implantation. The postoperative course was complicated by perforation of the right ventricular free wall by the active fixation transvenous ICD lead. The type of ICD lead and the type of organic heart disease are apparently important risk factors for perforation.

Cardiomyopathy, Dilated↗
PubMed1998

Early development of high-degree atrioventricular block in inferior acute myocardial infarction is predicted by a J-point/R-wave ratio above 0.5 on admission.

This study assessed the ability of simple clinical and electrocardiographic (ECG) variables routinely obtained on admission to identify patients with inferior myocardial infarction who are at high risk of developing high-degree atrioventricular (AV) block within the first 24 h of hospitalization in 205 patients. The admission ECGs were classified into two patterns based on the J-point to R-wave amplitude ratio: pattern 1: those with J-point/R-wave ratio <0.5; pattern 2: patients with J-point/R-wave ratio >/=0.5 in >/=2 inferior leads (II, III and aVF). High-degree AV block was found in 10.2% of the patients (21 of 205 patients; 5 and 16% of the patients with initial patterns 1 and 2, respectively, p = 0.014). Multivariate logistic regression analysis revealed that the only variables independently associated with high-degree AV block were the initial ECG pattern 2 versus 1 (odds ratio, OR, 4.47, 95% confidence interval, CI, 1.18-16.9; p = 0.0276), age (OR 1.06, 95% CI 1.01-1.12; p = 0.0254); Killip class >1 (OR 2.33, CI 0.83-6. 54; p = 0.1065) and thrombolytic therapy (OR 0.32, 95% CI 0.11-0.93; p = 0.037).

Adult↗
PubMed1997

The relationship between the electrocardiographic pattern with TIMI flow class and ejection fraction in patients with a first acute anterior wall myocardial infarction.

AIMS: The aim of this study was to assess the value of the electrocardiogram in predicting the patency of the left anterior descending artery and left ventricular ejection fraction in patients with a first acute anterior wall myocardial infarction at discharge from the coronary care unit. METHOD: We included 116 consecutive patients with an acute anterior myocardial infarction who had undergone coronary angiography and left ventriculography before discharge from the coronary care unit (7th to 10th day). The ST segment, either elevated or isoelectric (< 1 mm), and the T wave (positive or negative) in precordial leads V2-V4 were analysed and compared to the TIMI flow from each patient. RESULTS: Out of 69 patients with negative T waves, 38 (55%) had TIMI flow 3 compared with 20 (29%) and 11 (16%) with TIMI flow 2 and 0-1, respectively; and out of 47 patients with positive T waves seven (15%) had TIMI flow 3, 17 (36%) TIMI flow 2 and 23 (49%) TIMI flow 0-1 (P < 0.001). Out of 63 patients with an isoelectric ST segment, 35 (55%) had TIMI flow 3, 18 (29%) TIMI flow 2 and 10 (16%) TIMI flow 0-1, and out of 53 with ST segment elevation, 10 (19%) had TIMI flow 3, 19 (36%) TIMI flow 2 and 24 (45%) TIMI flow 0-1 (P < 0.001). When both parameters were analysed together, we found that in 46 patients with both isoelectric ST segments and negative T waves, 30 (65%) had TIMI flow 3 compared with two of 30 (7%) patients with ST segment elevation and positive T waves (P < 0.001). Patients with isoelectric ST segments had a better degree of left ventricular ejection fraction (57.8 +/- 14.1%) than patients with ST segment elevation (41.7 +/- 13%) (P < 0.001). Patients with positive and negative T waves had a similar left ventricular ejection fraction (49 +/- 18.1% vs 51 +/- 14%). CONCLUSION: We concluded that patients with a first acute anterior myocardial infarction and an electrocardiogram pattern of an isoelectric ST segment and a negative T wave have a higher incidence of a patent left anterior descending coronary artery than similar patients with ST segment elevation and a positive T wave. An isoelectric ST segment is also related to better left ventricular function.

Cardiac Catheterization↗
PubMed1997

Implantation of cardioverter defibrillator and pacemaker using the same pectoral quadrant.

We implanted a cardioverter defibrillator (ICD) together with a pacemaker system in three patients with ventricular tachycardia and bradyarrhythmias. Both systems (ICD and pacemaker) were implanted in the same left pectoral quadrant using a single skin incision and the subclavian and/or the cephalic vein. The ICD was implanted deep to the pectoralis major muscle, the pacemaker was placed subcutaneously in a more medial pocket. There were no technical difficulties during implantation or complications during follow-up.

Aged↗
PubMed1997

Radiofrequency catheter ablation of ectopic atrial tachycardia.

Ectopic atrial tachycardia (EAT) is an uncommon type of supraventricular tachycardia. It is usually chronic, incessant and resistant to pharmacologic therapy. Radiofrequency catheter ablation, which has become one of the treatments of choice for the more common types of supraventricular tachycardia, has recently also been shown to be effective in EAT. Radiofrequency catheter ablation was attempted in three patients with incessant EAT. Two of the patients, aged 7 and 13 years, had signs of left ventricular dysfunction, and the EAT originated in the left atrium. The remaining patient, aged 72 years, had a right EAT with normal left ventricular function. Radiofrequency ablation was guided by endocardial atrial mapping to locate the site of earliest atrial activation. Ablation was successful in all three patients, with complete cure of the tachycardia for a follow-up period of 12 to 19 months. Radiofrequency catheter ablation of EAT is highly successful and should be considered as one of the treatments of choice for this arrhythmia.

Adolescent↗
PubMed1996

Exercise-induced syncope and Holter-documented asystole in an endurance runner with moderate aortic stenosis.

The case of an endurance runner with moderate aortic stenosis, who had recurrent syncope, is reported. A Holter recording during syncope revealed asystole lasting 57 s. Head-up tilt table test with isoproterenol was abnormal. No important abnormality was found in sinus or atrioventricular nodal functions. It was postulated that the syncope was due to exaggerated left ventricular baroreflex response, probably aggravated by the increased vagal tone in an endurance runner. The patient was given a beta-adrenergic blocker, and a pacemaker was implanted because of the profound cardio-inhibitory response. The arguments for this approach are discussed.

Adrenergic beta-Antagonists↗
PubMed1996

Relationship between late potentials and the predischarge electrocardiographic pattern in patients with acute anterior wall myocardial infarction.

HYPOTHESIS: The presence of late potentials on the signal-averaged electrocardiogram (SAECG) identifies patients at high risk for development of ventricular tachyarrhythmias after myocardial infarction (MI). METHODS: The electrocardiogram and left ventricular function in 65 patients recovering from a first acute anterior wall MI were analyzed. We compared the pattern of the ST segment (isoelectric or elevated) and of the T wave (positive or negative) with the SAECG using an orthogonal bipolar lead configuration (X, Y, Z) with bidirectional Butterworth filtering (Simson's method). RESULTS: Abnormal SAECG was found in 17 (26%) patients; 11 of 18 patients with ST elevation had abnormal SAECG, and only 6 of 47 patients with isoelectric ST segment developed abnormal SAECG (p < 0.0001, odds ratio = 10.74). Of 19 patients with positive T waves, 10 had abnormal SAECG, and abnormal SAECG was found in 7 of 46 patients with negative T waves (p < 0.003, odds ratio = 5.27). When both parameters were considered together, 9 of 12 patients with ST elevation and positive T wave developed abnormal SAECG, and 35 of 40 patients with isoelectric ST and negative T wave had normal SAECG (p < 0.0002). Left ventricular ejection fraction was similar in patients with abnormal SAECG (43 +/- 14%) and normal SAECG (46 +/- 11%). CONCLUSION: These findings suggest that patients with anterior wall MI and a predischarge pattern of ST elevation and positive T wave have a higher incidence of abnormal SAECG and therefore may have a worse prognosis, especially related to the subsequent development of ventricular arrhythmias.

Action Potentials↗
PubMed1996

Contribution of cardiopulmonary indices in the assessment of patients with silent and symptomatic ischemia during exercise testing.

Cardiopulmonary and radionuclear indices were used to evaluate and compare cardiac function during exercise testing in patients with symptomatic and silent ischemia. The study comprised 58 patients aged 35-74 years, divided into three groups: Group I-20 patients (controls) with neither ST depression nor chest pain; Group II-22 patients with ST depression > 1 mm and no chest pain; Group III-16 patients with both ST depression and chest pain. All patients in Groups II and III demonstrated significant coronary artery disease. No antianginal medication was taken at least 24 h before testing. All patients underwent a cardiopulmonary exercise test and a multigated acquisition radionuclear study. The following variables were measured: oxygen consumption (VO2), CO2 output (VCO2), minute ventilation (VE), O2-pulse, ventilatory anaerobic threshold (VAT), left ventricular ejection fraction (LVEF) at rest (r) and at maximal effort (ex). Probability values were significant for all variables (P < 0.01-0.0001) except left ventricular ejection fraction-rest (P not significant between the three groups). No significant differences in extent of coronary artery disease were noted between Groups II and III. These findings suggest that during exercise testing patients with silent ischemia have better overall cardiac function than patients with symptomatic ischemia. Their value for both cardiopulmonary and radionuclear indices are closer to those of the control group than to the symptomatic group, regardless of the severity of the coronary artery disease Summary of results: (mean +/- 1 S.D.) Group VO2-max O2-Pulse max VAT (%) VAT (ml/min) LVEF-rest delta LVEF (ex-r) I 25.2 +/- 6.3 15.7 +/- 3.4 51.2 +/- 6.6 1075 +/- 289 54.7 +/- 7 5.4 +/- 4.85 II 22.4 +/- 2.8 14.5 +/- 2 47.0 +/- 5.3 854 +/- 136 52 +/- 10 1.2 +/- 6.7 III 16.0 +/- 2.5 11.4 +/- 2 41.6 +/- 7.7 683 +/- 105 51 +/- 8.5 -5.87 +/- 6.3

Adult↗
PubMed1995

QT prolongation and polymorphous ventricular tachycardia associated with trasodone-amiodarone combination.

Trasodone, a second generation antidepressant, has been shown to equal standard tricyclics in clinical efficacy while causing significantly fewer cardiac side effects. Although clinical trials have demonstrated a relatively safe arrhythmogenic profile, trasodone has been implicated in the pathogenesis of ventricular arrhythmias. This report describes a patient in whom the administration of trasodone in addition to previously well-tolerated long-term amiodarone therapy was associated with a marked prolongation of the QT interval and polymorphous ventricular tachycardia. Caution in the concurrent use of trasodone and other medications known to cause QT prolongation and polymorphous ventricular tachycardia is recommended.

Aged↗
PubMed1995

ST segment reelevation after acute myocardial infarction: marked differences in the electrocardiographic pattern between early and late episodes.

This study assesses the electrocardiographic (ECG) morphologic differences between early (< 24 h) and late (> 24 h) episodes of ST segment reelevation after acute myocardial infarction. We studied the records of 101 consecutive patients with acute myocardial infarction whose admission ECG demonstrated ST segment elevation with positive T waves, without pathological Q waves in the relevant leads, and without signs of bundle branch block or left ventricular hypertrophy. Thirty-five patients had 44 episodes of early ST segment reelevation, while 22 patients experienced 26 late episodes of ST segment reelevation. Seven patients experienced both early and late episodes. Early episodes of ST segment reelevation was seen more often after thrombolytic therapy: 43% (32 of 74 patients) versus 11% (3 of 27 patients) (P < 0.006). No differences were found in the incidence of late episodes between those who underwent (23%) or did not undergo (19%) thrombolytic therapy. Two patterns of ST segment elevation were distinguished. Pattern A with positive T waves, ST segment elevation (> or = 0.1 mV), but without distortion of the terminal portion of the QRS complex. Pattern B characterized by positive T waves, ST segment elevation (> or = 0.1 mV) with distortion of the terminal portion of the QRS complex. Each ECG was categorized according to these two patterns. The admission ECG pattern was A in 75 patients, and B in 26. No significant differences were found between patients with early, late, or no episodes of ST segment reelevation in the appearance of pattern A or B on admission.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Implications of inferior ST-segment depression in anterior acute myocardial infarction: electrocardiographic and angiographic correlation.

This study assesses the significance of inferior ST-segment depression during anterior acute myocardial infarction (AMI) by investigating the relationship between inferior ST-segment depression and (1) the site of the left anterior descending (LAD) coronary artery lesion and (2) ST-segment deviation in the various anterior and lateral leads. We studied 126 patients with anterior AMI who underwent coronary angiography within 21 days of hospitalization. The admission 12-lead electrocardiograms were evaluated for ST-segment amplitude in each lead at 0.08 second after the J-point. Coronary angiography was evaluated for the site and severity of luminal narrowing of the coronary arteries. The site of the culprit lesion in the LAD artery, relative to the origin of the first septal and diagonal branches, was determined. In four patients no lesion was identified in the LAD artery. Of the remaining 122 patients, 40 and 53 patients had a LAD artery lesion proximal to the first septal and first diagonal branches, respectively. Additional luminal narrowing (> or = 70% of diameter) was found in the circumflex and the right coronary arteries in 27 and 37 patients, respectively. ST-segment depression of > 1 mm in leads II, III, and aVF was noted in 24, 29, and 24 patients, respectively. The prevalence of a LAD artery preseptal and prediagonal lesion was higher in patients with inferior ST-segment depression.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

Bundle-branch reentry tachycardia.

A 21-year-old man with aborted sudden death developed bundle-branch reentry tachycardia at electrophysiologic study. Ablation of the right bundle branch was performed in an attempt to eliminate the recurrence of ventricular arrhythmia. The clinical arrhythmia was no longer inducible; however, a second type of ventricular tachycardia of a different mechanism and origin was induced. Following a new clinical episode of ventricular tachycardia with hemodynamic deterioration, an automatic implantable cardioverter and defibrillator was implanted.

Adult↗