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J Lelakowski

Publications and source records attributed to J Lelakowski.

12 recordsLinked to original sources
PubMed2001

[The effect of changes in stroke volume on QT dispersion during long-term DDD and VVI pacing].

UNLABELLED: The aim of this study was to evaluate the alterations of stroke volume (SV) on the QT dispersion (QTD) as a result of different pacing modes (DDD, VVI) and programmed AV delays (AVD). MATERIAL AND METHODS: We studied 60 patients (pts) (22 F, 38 M) in mean age 67.5 +/- 7.5 yrs in whom DDD pacemakers were implanted due to complete atrioventricular block (AVB III degree). 10 pts had coronary artery disease (CAD)--"CAD" subgroup, 14 pts arterial hypertension (AH)--"AH" subgroup, 27 pts CAD and AH--"AH + CAD" subgroup. The control group consisted of 9 pts without structural heart disease, but with AVB III degree, paced in DDD mode. Previous myocardial infarction was recognised in 7 patients in "CAD" subgroup and in 7 patients in "AH + CAD" subgroup. Left ventricular hypertrophy was detected in 4 men in "AH" subgroup and in 8 patients in "AH + CAD" subgroup. In all cases basic rate of the pacemaker was programmed at 70/min. Resting ECG showed all atrial and ventricular complexes captured. AVD optimization was based on the measurements of SV by Doppler echocardiography. QT intervals (QT) were measured from 12-lead ECG at 50 mm/sec. speed. QTD was calculated as the difference between maximal and minimal QT. It was measured at optimal AVD (with highest SV--opt. DDD) and "unoptimal" AVD (unopt. DDD) programmed AV intervals and then in VVI mode (with lowest SV) after 24 hrs following reprogramming of the pacemaker. RESULTS: In the whole population, in DDD mode, we found a strong correlation between SV and QTD (r = -0.655; p < 0.01). In VVI mode SV was significantly lower than in unopt. DDD (78.7 ml vs 90.0 ml, p < 0.001) and QTD was significantly greater (74.3 ms vs 69.2 ms, p < 0.05). The modifications in AVD and conversion of pacing mode (VVI to DDD) leading to maximal SV resulted in decreased QT dispersion. The highest SV (128.9 ml at opt. DDD) and the lowest QTD (48.3 ms at opt. DDD) were seen in the controls, but changes in dispersion were the least and insignificant during different pacing modes. In CAD; AH + CAD pts, we observed the lowest SV (61.7 ml; 74.9 ml at VVI respectively) and the highest QTD (77.8 ms; 80.9 ms at VVI respectively). In these pts, the modifications of AVD and conversion of pacing mode (VVI to opt. DDD) leading to maximal SV (106.8 ml; 115.9 ml in CAD and AH + CAD pts, respectively) resulted in decreased QTD (53.9 ms; 56.6 ms, respectively). During DDD pacing there was significant correlation of QTD to SV (r = -0.680; r = -0.656, respectively). In CAD pts with myocardial infarction or in AH pts with LV hypertrophy the correlation of SV to QTD was stronger (r = -0.937, r = -0.886, p < 0.025, respectively). We didn't find the correlation in the control group (r = -0.318). CONCLUSIONS: Programming of different AVD and pacing modes significantly influences QTD in CAD and/or AH pts. QTD reflects hemodynamic status of these paced pts.

Adult↗
PubMed2001

[QT dispersion in DDD and VVI paced patients after myocardial infarction or with left ventricular hypertrophy].

The aim of this study was to assess the alterations of stroke volume (SV) on the QT dispersion (QTD) as a result of different pacing modes and programmed AV delays in patients (pts) after myocardial infarction (MI) or with left ventricular hypertrophy (LVH). We studied 14 MI pts (9 M, 5 F) in mean age 72.3 +/- 3.7 yrs (Group I) and 12 pts with LVH (7 M, 5 F) in mean age 67.3 +/- 5.9 yrs (Group II), in whom DDD pacemakers were implanted due to complete atrioventricular block. The control group (Group III) consisted of 9 pts without MI or LVH. In all cases basic rate of the pacemaker was programmed at 70/min. Resting ECG showed all atrial and ventricular complexes captured. AV delay optimization was based on the measurements of SV by Doppler echocardiography. QT intervals (QTi) were measured from 12-lead ECG at 50 mm/s speed. QTD was calculated as the difference between maximal and minimal QTi. It was measured at optimal (opt. DDD, with highest SV) and "unoptimal" (unopt. DDD) programmed AV intervals and then in VVI mode (with lowest SV) after following reprogramming of the pacemaker. In Group I and II, a strong correlation between SV and QTD was found (R = 0.816 and -0.897, respectively). In control group, it was insignificant (R = -0.339). In VVI mode SV was significantly lower than in unopt. DDD (in Mi pts: 56.1 ml vs 71.1 ml, respectively, p < 0.01; in LVH pts: 64.1 ml vs 96.7 ml, respectively, p < 0.005) and QTD was significantly greater (74.8 ms vs 66.8 ms, respectively, p < 0.005 and 70.0 ms vs 53.5 ms, respectively, p < 0.005). In LVH pts or MI pts programming of different AV intervals and pacing modes significantly influences QTD.

Aged↗
PubMed2001

[Long term outcome in patients with and without restenosis after coronary angioplasty].

Restenosis at dilatation site still constitutes a significant limitation of percutaneous coronary revascularisation. Majority of patients with restenosis are treated with repeat angioplasty, although its impact on long-term outcome is still little known > Very few studies focused on this issue bring rather discrepant results. The present study is aimed at assessing the impact of restenosis on long-term outcome in patients treated with coronary angioplasty. A group of 567 patients, who in the years 1987-1996 had successfully undergone percutaneous balloon coronary angio-plasty (PTCA) at our Clinic, was retrospectively divided into two groups: a group comprising 188 patients (33.2%) suffering from recurrent angina in whom restenosis had been established through control angiography, and a group comprising 379 patients (66.8%) who during the observation period exhibited no angina symptoms, or in whom the control angiography did not reveal restenosis. The restenotic patients were older (p = 0.007), more frequently exhibited symptoms of unstable angina upon PTCA (p < 0.0001), and there were also fewer smokers among them (p = 0.02). Furthermore, restenotic patients more frequently had multivessel and multilesion angioplasty (p = 0.025; p = 0.004, respectively). Restenosis after the first PTCA was treated by repeated angioplasty in 149 (79.3%) patients, 26 (13.8%) underwent CABG operation and 13 (6.9%) patients were treated pharmacologically without repeated revascularization. Within the 5-year observation period the mortality rate in both groups did not differ significantly (5.9% vs. 4.0%). Restenotic patients sustained myocardial infarctions more frequently (8.0% vs. 3.2%, p = 0.01), had significant atherosclerosis progression (37.2% vs. 15.0%, p < 0.0001), and were more frequently subjected to repeated interventions (37.2% vs. 15.0%, p < 0.0001), both PTCA (79.3% vs. 11.6% p < 0.0001) and CABG surgery (32.5% vs. 4.2%, p < 0.0001), as well as to multiple re-interventions (31.9% vs. 4.8%, p < 0.0001), in comparison with the non-restenotic ones. Analysis of functional status of patients assessed in compliance with the CCS criteria at the end of the observation period proved that significantly more non-restenotic patients did not experience angina, or experienced it rather sporadically (CCS Class 0 and 1). Logistic regression uni- and multivariate analysis proved that restenosis is an independent risk factor of myocardial infarction, reinterventions--also multiple ones--and cardiac events, although not mortality.

Adult↗
PubMed2001

[Successful RF ablation in a patient with paroxysmal atrial fibrillation induces by atrioventricular nodal reentrant tachycardia].

We describe a case of 47-year old patient with frequent episodes of paroxysmal atrial fibrillation (PAF) with fast ventricular rate. During electrophysiological study an atrioventricular nodal reentrant tachycardia (AVNRT) was diagnosed with rapid degeneration into atrial fibrillation. Successful RF ablation of slow pathway was performed. There were no PAF recurrences during six months follow-up.

Atrial Fibrillation↗
PubMed2000

[Multi-site pace making for dilated cardiomyopathy].

Dual chamber pacing (DDD) has been reported to be effective in patients with dilated cardiomyopathy (DCM). Other works, however, show contradictory results. Deleterious effects resulting from desynchronization of the right and left ventricular contraction have been suggested. In patients with end-stage DCM and severe congestive heart failure multisite pacing may be associated with fast and sustained hemodynamic improvement.

Cardiac Pacing, Artificial↗
PubMed2000

[Quality of life in patients after implantation of pacemaker type DDD].

The aim of this study was to evaluate quality of life in pts with DDD pacemakers. The study group consisted of 343 pts (181 F, 162 M), mean age 66.7 +/- 2.5 y (19-92) in whom DDD pacemakers were implanted in the years 1992-1998 due to sick sinus syndrome (213 pts) or AV block (130 pts). Follow-up period was 111-2574 days, mean 924.58 +/- 550 days. The QOL assessment was based on the questionnaire prepared at our Center. The questionnaires were mailed to the pts. The significant improvement in overall well-being (p < 0.001), physical capacity (p < 0.005) and concentration (p < 0.025) was found as compared to the time before implantation. The incidence of syncopy decreased after implantation (p < 0.001). The pts complained of: limitation of arm moving (50.1%), anxiety for disturbances of PM function (41.4%), resignation from job (17.2%), restriction of sport activity (15.7%), necessity for follow-up visits (15.7%) and limitation of sex activity (10.2%). There were not significant differences in QOL between pts paced due to SSS or AV block. We found significant improvement in QOL after implantation of DDD pacemakers. The questionnaire-based assessment of QOL may be useful in management of DDD-paced pts.

Adult↗
PubMed2000

[Incidence of atrial fibrillation in paced patients with complete atrioventricular block].

The aim of the study was to evaluate the incidence of chronic AF in patients paced due to complete AV block. The study group consisted of 130 pts (70 F, 60 M), mean age 68.6 +/- 14.3 y in whom pacemakers were implanted in the years 1990-1998 due to III degree AV block. There were 76 pts with VVI, 24 DDD and 30 VDD modes of pacing. Follow-up period was mean. 47.6 +/- 25.9 m (7-110). Chronic AF developed in 25 pts (19.2%). In the VVI group the incidence of AF was significantly higher than in DDD and VDD groups--30.3% vs. 4.17% and 3.33% respectively, p < 0.01. Ventriculo-atrial conduction (VAC) was found in 19 pts (14.6%), but did not correlate with the development of AF. Stroke occurred in 2 pts with VVI pacing and chronic AF. In conclusion, in pts with complete AV block VDD and DDD pacing significantly reduce the incidence of chronic AF as compared to VVI.

Adolescent↗
PubMed2000

[Quality of life and working status in patients with coronary artery disease treated by percutaneous coronary angioplasty during long-term observation].

UNLABELLED: Improvement in the quality of life is nowadays widely acknowledged as an important factor in assessment of the long-term outcome of the actually pursued treatment. Percutaneous transluminal coronary angioplasty (PTCA) has been used in the treatment of coronary disease in ca. 1/3 of patients. The present study aimed to assess the quality of life in 567 patients successfully treated by PTCA in the period 1987-1996. In the observation period spanning 2.5-12 years (5.5 years on average) 26 patients (4.6%) died. A specially designed questionnaire was sent out to the remaining 541 patients, in which they were asked to attempt a subjective assessment of their general health condition and physical fitness, as well as to comment on the quality of their family and social life following angioplasty. The filled-in questionnaire was returned by 447 patients (82.6%). Their functional status, assessed in compliance with the CCS criteria, was perceptibly improved after the procedure and at the end of the observation period 70.5% of patients had no significant coronary complaints. A durable improvement after PTCA was claimed by 85.7% of patients, for 38.2% the result of PTCA turned out to be much better than originally expected, while 47.9% admitted that the procedure actually complied with their expectations. No improvement whatsoever was reported by 11.8%, while 2.3% of patients claimed their condition to have deteriorated since. In their own assessment, normal sexual life after PTCA was still pursued by 63.1% of patients, though men appeared to be more active in that domain than women (68.0% vs. 44.7%, p = 0.0001). Notable improvement was reported by 15.2%, while deterioration was claimed by 17.2%; in both cases it was significantly more frequent in men (improvement 17.0% vs 8.5%, p = 0.042, deterioration 19.5% vs 8.5%, p = 0.012). Angioplasty had no impact on their social relations in 78.8% of patients, while 21.2% of them are commonly perceived as the disabled persons. The need for psychotherapy (counselling) was expressed by 15.9%. The analysis of the key factors determining the actual quality of life in patients, carried out in the sub-groups, did not yield significant differences between the patients with stable and unstable angina, patients below and over 50 years of age, patients with complete and incomplete revascularisation, nor in patients who experienced or not, cardiac events during the follow-up. The significant differences between men and women were encountered only with respect to their sexual life. Diabetics in comparison with non-diabetics significantly more frequently reported improvement in their sexual life, full resumption of their non-occupational activities, generally showed more appreciation for the overall outcome of the PTCA procedure. Diabetics much less frequently experienced improvement in their general physical fitness, generally regarded the need for regular medical check-ups as a hindrance, as well as were more frequently perceived as the disabled persons. The working status of the patients after angioplasty failed to improve, however, as nearly half of them, despite the successfully completed procedure, was granted disability pensions or took advantage of the voluntary retirement schemes. Only 7.2% of the non-working patients well within their statutory employment age successfully returned to their employment, although not on a full-time basis. Patients who had completed their primary or secondary education were found to leave their employment twice more frequently than the ones with academic education. Similarly, patients living in the rural areas or in small towns (less than 40.000 inhabitants) left their employment twice more frequently than the ones living in major cities. CONCLUSIONS: Both the functional status of patients and the majority of the analysed factors determining the quality of life--in the subjective assessment of those patients--improved significantly after a successful PTCA. This improvement is irrespective of the patients' age, symptoms of unstable angina during the procedure, extensiveness of revascularisation as well as cardiac events during the follow-up. Nearly half of the working patients tend to leave their employment after a successful percutaneous revascularisation, while the non-working patients are seldom prompted to resume their employment by the successful procedure. Patients with academic education, living in major cities, are usually found to resume their original employment most frequently.

Adult↗
PubMed1999

[Hereditary long QT syndrome: our own experience].

We report the case of 16-year old girl who was admitted to our Department after the episode of ventricular fibrillation. We diagnosed the hereditary long QT syndrome. The patient's family was investigated and complex therapy was started in affected individuals including cardioselective beta-blocker (atenolol) and permanent cardiac pacing (VVIR and DDDR). This therapy is effective in prevention of life-threatening cardiac arrhythmias in our patients.

Adolescent↗
PubMed1999

[Possible therapeutic applications for contemporary pacemakers].

Pacemaker therapy has undergone widespread application in the clinical practice since the sixties. Nowadays the dynamic development of pacemaker technology has become clearly visible. Recommendations for their implantation became more common over last years. The aim of this paper was to describe few models of modern cardiostimulators present at our medical market as well as their role in antiarrhythmic therapy.

Arrhythmias, Cardiac↗
PubMed1996

[The role of prolonged cardiac pacing in management of secondary bradyarrhythmias based on personal experiences].

Three patients with bradyarrhythmia who were admitted to the Department for urgent pacemaker implantations are presented. The careful clinical evaluation revealed that these arrhythmias were remarkably secondary to underlying diseases (e.g. severe coronary heart disease, valvular defects). Surgical treatment applied in these cases (coronary bypass grafts, valve replacement) has resulted in successful outcome. We concluded that in some patients the pacemaker implantation alone, without heart surgery, would not be beneficial enough.

Aged↗