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Biomedical subjects

M Pleskot

Publications and source records attributed to M Pleskot.

At least 19 recordsLinked to original sources
PubMed2004

[The activation of haemostasis during radiofrequency catheter ablation].

The aim of the study was to investigate chosen haemostasis activation markers during electrophysiologic study (EPS) with consequent radiofrequency catheter ablation (RFA). Sixty-three patients were studied prospectively. Indications for EPS and RFA were supraventricular tachycardias with the arrhythmogenic substrate located in the right atrium. Blood samples were drawn 24 hours before the procedure (T -1), at the beginning of the procedure (T0), at the end of EPS (T1), 30 minutes after completion of RFA (T2), and 24 hours after the procedure (T3). To study coagulation, fibrinolytic and platelet activation were measured concentrations of thrombin-antithrombin III (TAT), D-dimers (DD), platelet count and parameters, and circulating platelet aggregates (CPAi). During the EPS and RFA, TAT levels increased from the baseline 5.03 +/- 2.53 microg/l (T -1) to 12.90 +/- 12.83 microg/l at T0 (p < 0.001) to 36.07 +/- 15.59 microg/l at T1 (p < 0.001) and decreased to 28.85 +/- 13.14 microg/l at T2 (p < 0.001). Levels of DD increased from 0.30 +/- 0.20 mg/l at T0 to 0.44 +/- 0.25 mg/l at T1 (p < 0.001) and to 0.87 +/- 0.74 mg/l at T2 (p < 0.001). The number of platelets was significantly decreased (-13.7%) before and during the procedure (T -1 vs. T3; p < 0.001). Marked platelet activation (CPAi 0.62 +/- 0.32) was observed before the procedure opposite to the physiological values (CPAi 1.0 +/- 0.1), without changes during the procedure (CPAi at T2 0.69 +/- 0.23). Our results confirmed activation of several haemostasis parameters during EPS and RFA, and support eligibility of the antithrombotic prevention in patients indicated for EPS and RFA.

Adult↗
PubMed2002

[Dysfunction of a valve prosthesis].

The authors describe the case of a haemodynamically unstable patient with dysfunction of a valvular prosthesis which was resolved by emergency surgery. In the discussion they deal with two basic causes of these dysfunctions and their possible solutions.

Female↗
PubMed2002

[Sudden cardiac death (part 1].

Sudden cardiac death is a sudden unexpected non-violent death for cardiac reasons which according to the majority of authors occurs within one hour after the development of symptoms of acute impairment of health. This syndrome is a major problem of contemporary medicine with a very adverse prognosis. The authors analyze the epidemiology, causes, influence of the external environment, basic arrhythmogenic mechanisms and prognosis of sudden death. Examination methods of this clinical condition are evaluated from the aspect of their application in the risk stratification of patients.

Arrhythmias, Cardiac↗
PubMed2002

[Sudden cardiac death (part 2)].

In addition to acute treatment of sudden cardiac death the authors focus attention in particular on an analysis of long-term diagnostic and therapeutic provisions to cope with this serious clinical condition. The basic therapeutic procedures include influencing of the arrythmogenic substrate and modulating factors associated with the development of tachyarrhythmias by revascularization of the myocardium and radiofrequency ablation; as to drugs in particular by administration of angiotensin converting enzyme inhibitors and in rare instances by the application of other surgical methods. Haemodynamically important ventricular arrhythmias are treated by antiarrhythmics (beta-blockers, amiodarone, sotalol) and an implantable cardioverter-defibrillator. In the conclusion the authors propose a diagnostic therapeutic algorithm after circulatory arrest with successful cardiopulmonary resuscitation.

Arrhythmias, Cardiac↗
PubMed2001

Influence of amiodarone on urinary excretion of 6beta-hydroxycortisol in humans.

The present study was undertaken to evaluate the use of cortisol 6beta-hydroxylation in defining the effect of amiodarone on cytochrome CYP3A activity. To accomplish this goal, the in vivo activity of CYP3A was estimated by measuring the 24-hour urinary excretion of 6beta-hydroxycortisol (6beta-OHC) and by calculating 24-hour ratio of 6beta-hydroxycortisol to urinary free cortisol (6beta-OHC/UFC ratio). Nine cardiac patients scheduled for amiodarone treatment were recruited to participate in this study. Urine was collected over a 24-hour period from each subject before the first amiodarone administration and during the third day of oral administration of amiodarone (200 mg four times daily as a loading dose). Three days of amiodarone treatment caused a significant decrease (p<0.05) in both the 6beta-OHC/UFC ratio and the 24-hour urinary excretion of 6beta3-OHC. These results suggest that amiodarone is an inhibitor of CYP3A activity.

Administration, Oral↗
PubMed2001

[Primary PTCA in the treatment of acute myocardial infarct. Experience at the Faculty Hospital in Hradec Kralove].

INTRODUCTION: Primary coronary angioplasty is at present a fully accepted and worldwide method of treatment of acute myocardial infarction. As proved by a number of randomized studies, this treatment is associated with a higher rate of coronary patency, a smaller infarction focus an better clinical results as compared with thrombolytic treatment. METHOD: The authors analyzed a register of 233 consecutively treated patients with primary coronary angioplasty in the Faculty Hospital in Hradec Králové with elevation of the ST sections on electrocardiographic examination during the period from September 1997-January 2001. RESULTS: Acute success defined as a residual stenosis < 30%, normal flow through the vessel (TIMI III) and survival for the first 24 hours was 91.0% and without patients with cardiogenic shock even 96.0%. The total mortality on hospitalization was 9.1%. The mortality of patients without cardiogenic shock was only 1.9%. A high mortality was recorded in patients in cardiogenic shock (74.0%). A stent was implanted in 65.0% patients, subacute thrombosis of the stent occurred in 1.9%. During a 6-month follow up the total mortality was 10.3%. The percentage of patients without any cardiovascular even (event free survival, EFS) after discharge from hospital was 81.0%. CONCLUSIONS: The authors provided evidence that primary coronary angiolpasty is a safe and highly effective method in the treatment of acute myocardial infarction. It is associated with a total hospitalization mortality of ca 10% and a mortality of less than 2% in patients without cardiogenic shock. Cardiogenic shock, on the other hand, remains a problem despite intensive treatment such as inotropic support, mechanical reperfusion and intraortal balloon counterpulsation. In the presented work the mortality of patients with cardiogenic shock was 74.1%. Implantation of a stent does not involve a major risk for the patient, the incidence of subacute thrombosis of the stent is low and does not differ from elective procedures. The fate of patients during the follow up after primary angioplasty is favourable. In the presented work the total 6-month mortality was 10.3% and EFS was 81.0%.

Angioplasty, Balloon, Coronary↗
PubMed2000

[Myocardial revascularization in malignant ventricular tachyarrhythmia--prognostic significance].

BACKGROUND: The survival of patients with chronic ischaemic heart disease and malignant ventricular tachyarrhythmia is influenced positively in some instances by revascularization of the heart muscle and implantation of a cardioverter-defibrillator. The objective of the submitted work was to evaluate by perspective follow-up of subjects with chronic ischaemic heart disease and malignant ventricular tachyarrhythmia: a) the effect of revascularization of the heart muscle on the prognosis, making use of programmed stimulation of the ventricles and testing the effectiveness of antiarrhythmic treatment; b) the importance of implantation of a cardioverter-defibrillator in revascularized and non-revascularized subjects for the prevention of sudden "arrhythmic" deaths. METHODS AND RESULTS: The authors examined 37 patients (32 men and 5 women), age bracket 34 to 78 years (mean age 61 +/- 11) with IHD and spontaneous ventricular tachyarrhythmia after ruling out acute myocardial infarction. The group was divided into sub-groups without revascularization (21 subjects) and with revascularization (16 subjects). In both sub-groups programmed stimulation of the ventricles was implemented. During the diagnostic finding of programmed stimulation they tested antiarrhythmic drugs, most frequently amiodarone administered orally. A cardioverter-defibrillator was implanted to 10 patients. All patients were followed-up to death, the longest period being 24 months. They evaluated the frequency of cardiac deaths (death on cardiac grounds incl. sudden "arrhythmic" death) and sudden "arrhythmic" deaths (death within on hour after onset of symptoms or first recorded malignant ventricular tachyarrhythmia). In the sub-group without revascularization with diagnostic inducibility of the heart muscle in 85.7% of patients the authors described 9 cardiac deaths (42.9%) and 8 sden "arrhythmic" deaths (38.1%). Conversely in the sub-group with revascularization and with diagnostic programmed stimulation of the ventricles in half the subjects 5 clinical deaths were found (31.3%) and 3 sudden "arrhythmic" deaths (18.8%). Analysis of 11 sudden "arrhythmic" deaths revealed that no subjects with an implanted cardioverter-defibrillator (5) died (documented malignant ventricular tachyarrhythmia). Five of the six patients who died (all without a cardioverter-defibrillator) were not revascularized. CONCLUSIONS: Revascularization of the heart muscle in patients with ischaemic heart disease (after elimination of acute cardiac infarction) and malignant ventricular tachyarrhythmia reduces the risk of relapse of this arrhythmia. The benefit of implantation of a cardioverter-defibrillator was recorded in all subjects regardless of the revascularization of the heart muscle.

Adult↗
PubMed2000

[Ventricular fibrillation in chronic heart disease].

The objective of the work was to describe in subjects with spontaneous ventricular fibrillation, after elimination of acute cardiac disease, the strategy of antiarrhythmic treatment and to evaluate, based on prospective follow-up, the effectiveness of this treatment. The authors included in the group 36 patients (30 men and 6 women) within the range from 34 to 78 years (mean age 58 +/- 11 years) with spontaneous ventricular fibrillation. They divided the group into a subgroup (15 subjects) without revascularization of the heart muscle, into a subgroup (17 subjects) with revascularization of the myocardium (coronary angioplasty and bypasses) and a subgroup (4 subjects) where ischaemic heart disease was ruled out (mostly cardiomyopathies). In all subgroups they used programmed ventricular stimulation (apparatuses of Quinton Co. USA, Biotronik Co. GFR), in the subgroup with revascularization within 3 months. During the diagnostic procedure of ventricular stimulation they tested antiarrhythmic drugs most frequently amiodarone per os (for 4 weeks). An implantable cardioverter--defibrillator was implanted in 17 patients (8 subjects without revascularization, 6 subjects with revascularization, 3 subjects without ischaemic heart disease). All patients were followed up till death, maximum 24 months. The authors evaluated the rate of cardiac deaths (death on cardiac grounds, incl. sudden arrhythmic death) and sudden arrhythmic deaths (within one hour after the onset of symptoms or the first malignant ventricular tachyarrhythmia recorded after implantation of the defibrillator). In the subgroup without revascularization with electric instability of the ventricles according to programmed stimulation 66.7% they described seven cardiac deaths (46.7%) and 6 sudden "arrhythmic" deaths (40%) incl. 5 subjects with ineffective testing of antiarrhythmic drugs. Conversely in the subgroup with revascularization and with diagnostic programmed stimulation in 47.1% they found 3 cardiac deaths (17.7%), one sudden "arrhythmic" death (5.9%)--a subject with ineffective testing. In the subgroup without ischaemic heart disease they recorded cardiac and sudden "arrhythmic" deaths in half the subjects, in all instances in subjects without inducible ventricular tachyarrhythmia. The authors found in the course of a two-year investigation a relapse of cardiac arrest in 25% of subjects after spontaneous ventricular fibrillation. A third of these subjects (all without a cardioverter-defibrillator) died. They confirm the benefit of implantation of a defibrillator for all subjects regardless of the basic diagnosis and revascularization of the heart muscle.

Adult↗
PubMed2000

Influence of CYP3A metabolizer status on the pharmacokinetics and pharmacodynamics of amiodarone.

UNLABELLED: The present work was designed to determine whether the individual differences in pharmacokinetics and pharmacodynamics of amiodarone and its N-desethyl metabolite are related to cytochrome CYP3A metabolizer status. METHODS: 12 cardiac patients with inducible ventricular tachyarrhythmias during the baseline electrophysiologic study were enrolled in this study. Urinary 24-hour excretion of 6 beta-hydroxycortisol (6 beta-OHC and the ratio of 6 beta-hydroxycortisol to urinary free cortisol (6 beta-OHC/UFC) were measured before the first amiodarone administration. Trough plasma concentrations of amiodarone and N-desethylamiodarone (N-DEA) were measured after 79 +/- 11 days (2nd period) and after 182 +/- 25 days (3rd period). Electrophysiologic effects of amiodarone therapy were established with serial electrophysiologic studies in 9 of these patients at the baseline and after 79 +/- 11 days (during the second period). RESULTS: Both the 6 beta-OHC excretion and 6 beta-OHC/UFC ratio varied approximately 6-fold between the patients. We found significant inverse correlation between the 6 beta-OHC excretion and the trough plasma concentrations of amiodarone at the time of the 3rd period (rs = -0.58, p < 0.05). Similarly, there was correlation between the 24-hour urinary 6 beta-OHC excretion and trough plasma concentrations of amiodarone during the 3rd period (rs = -0.64, p < 0.025). We were unable to detect any association between CYP3A activity and amiodarone pharmacodynamics. CONCLUSION: This study points toward important information value of CYP3A metabolizer status in the context of therapeutic drug monitoring of amiodarone.

Adult↗
PubMed1999

[Revascularization of the myocardium and electrical instability of the ventricles].

The objective of the investigation was to evaluate in patients with chronic ischaemic heart disease (IHD) and malignant ventricular tachyarrhythmia the asset of myocardial revascularization for improvemet of the electric instability of the ventricular myocardium and a subsequent outline of the tactics of antiarrhythmic treatment. The authors included in the group a total of 35 patients (30 men and 5 women), age 34-78 years (mean 61 +/- 11) with IHD (according to selective coronarography) with spontaneous ventricular fibrillation (18 sebjects) or persistent (above 30s) marked symptomatic ventricular tachycardia (17 subjects), after ruling out acute cardiac infarction. The group was divided into a subgroups of 16 subjects with revascularization of the heart muscle (coronary angioplasty, coronary bypass) and a subgroup (19 subjects) without revascularization of the hearth muscle. In both groups programmed stimulation of the cardiac chambers was implemented (PSSK) (apparatuses of Qinton Co. USA, Biotronik, GFR), in the subgroup after revascularization within three months. In case of a PSSK finding the authors tested antiarrhythmic drugs, most frequently amiodarone by the oral route (within one month). Treatment not causing permanent ventricular arrhythmia was considered effective. In the subgroup with revascularization the authors described diagnostic PSSK in 8 subject where testing of antiarrhythmics was made in 6 patients (an effective antiarrhythymic agent was found in one instance, i.e. in 16.7%). In the subgroup without revascularization diagnostic PSSK was implemented in 17 subject. Antiarrythmic drugs were tested in 16 patients (effective treatment in 12.5%--always amiodaroe by the oral route). Diagnostic ventricular tachyarrhythmia was found in patients with spontaneous ventricular tachycardia in all instances with revascularization and in 92.3% without revascularization. In patients with spontaneous ventricular fibrillation they proved diagnostic PSSK in 33.3% of the patients with revascularization and in 66.7% without revascularization. The relative number of implantation of cardioverter-defibrillators in group with and without revascularization was similar (25%, 26.3%). Revascularization of the heart muscle in patients with chronic IHD reduces markedly the electric instability of the ventricular heart muscle, in particular in case of spontaneou ventricular fibrillation. Selective coronarography and possibly revascularization of the heart muscle is esential in those patients. The tactics of antiarrhythymic treatment of revascularization of the heart muscle were not affected.

Adult↗
PubMed1997

[Familial hypertrophic cardiomyopathy].

Investigating the family consisted of 8 members authors confirmed the diagnosis of hypertrophic cardiomyopathy in 5 cases. Secondly clinical features and echocardiographic data were compared. The clinical symptoms were not proportional to the pattern of hypertrophy revealed by echocardiography. The most significant pattern of hypertrophy was registered in youngest patients most likely due to increased expression and penetration of responsible genes. Considering cardiomyopathy as an inherited disease authors find family screening as a key in understanding and management of the disease.

Adolescent↗
PubMed1996

[Prognostic significance of impaired intra-and infra-bundle of His conduction in the heart].

BACKGROUND: So far no final solution was found as regards the relationship of impaired conduction in the His-Purkynĕ system and the incidence of cardiac and in particular sudden deaths. The objective of the present work was to assess by long-term prospective follow-up of subjects with a normal and pathological prolongation of the intra- and infrahisian conduction in the heart, based on the electrogram of the bundle of His, the importance of these findings for assessment of the patient's prognosis. METHODS AND RESULTS: After elimination of subjects with ventricular preexcitation the authors included in the group 340 patients (243 men, 97 women, aged 16-81 years, mean 49 +/- 16), where they recorded the electrogram of the bundle of His (without cardiac stimulation, during graded and programmed stimulation of the atria, after i.v. administration of ajmaline). In 206 cases they implemented at the same time programmed stimulation of the ventricles. The HV interval or the length of the H wave were in 286 patients normal and in 54 patients protracted. All patients were followed up by the authors for 6 to 144 months (mean follow up period 56.1 months). In the group of subjects with normal intra- and infrahisian conduction, as compared with the group with protracted conduction in the same area, the number of cardiac deaths was lower, i.e. 10.1 %, as compared with 22.2 %, sudden "cardiac" deaths (death within one hour after the onset of symptoms), i.e., 6.6 % as compared with 11.1 %, and sudden bradyarrhythmic" deaths (sudden "cardiac" death except subjects with diagnostic programmed ventricular stimulation), i.e. 2.8 % as compared with 11.1 %. CONCLUSIONS: The results support significantly the prognostic impact of pathological conduction in the His-Purkynĕ system as regards the occurrence of cardiac deaths and sudden "brady arrhythmic" deaths (p < 0.05). Conversely, the differences as regards the occurrence of sudden "cardiac" deaths were not significant.

Adolescent↗
PubMed1996

[Changes in platelet activity in invasive cardiologic procedures].

The authors revealed some changes in the platelet activity in patients with invasive cardiological procedures. Changes of the platelet function were manifested by an enhanced aggregation of platelets in vivo, an increased secretion from alpha granules and increased release of prostaglandin metabolites from platelets and from the vascular wall. Acetylsalicylic acid (ASA) suppressed the formation of circulating platelet aggregates in vivo, but the platelet activity was manifested by another mechanism, independent on ASA. The authors recorded therefore an increase of prostaglandin metabolites and PF4 even in patients who were treated with ASA before the invasive examination.

Angioplasty, Balloon, Coronary↗
PubMed1995

[Arrhythmogenic right ventricle].

A 26-year-old patient with an irrelevant personal and family-history was treated on account of attacks of relapsing ventricular tachycardia and cardiac failure, mostly dextrolateral. After ruling out other possible causes of the disease--such as embolism of the lungs, ischaemic heart disease, out other possible causes of the disease--such as embolism of the lungs, ischaemic heart disease, Ebstein's anomaly, the diagnosis of an arrhythmogenic right ventricle was established. This disease is suggested by negative T waves in the thoracic leads V1-V3 during sinus rhythm and by the shape of the QRS complex which was the type found in block of the Tawara branch with an axis of + 100 degrees during attacks of ventricular tachycardia. Moreover, ventricular tachycardia of the same type was produced during electrocardiographic examination. On angiographic examination ARVD is suggested by marked trabeculization and impaired kinetics of the outflow tract of the right ventricle. In the prevention of relapses of ventricular tachycardia beta-blockers and Cordarone were successful when used simultaneously with cardiac stimulation type AAI applied on account of a confirmed sinoatrial block.

Adult↗
PubMed1995

[Importance of programmed ventricular stimulation in the evaluation of proarrhythmic effects of orally administered anti-arrhythmia agents].

The objective of the submitted work was to assess, using programmed stimulation of the cardiac ventricles during antiarrhythmic treatment (amiodarone and propafenon administered orally), the presence of indicators suggesting imminent ventricular ectopic proarrhythmia. The authors included in the group, after elimination of subjects with ECG (Holter monitoring) signs of proarrhythmias 50 patients (43 men, 7 women, 23-78 years, mean age 54.0 +/- 14.2 years), where they used initial programmed stimulation of the ventricles, not sooner than three months after acute cardiac disease. On account of electric instability of the ventricles the authors administered to 39 patients amiodarone by the oral route (200 to 400 mg/day) and to 11 subjects propafenon also by the oral route (900 mg/day). A subsequent programmed stimulation of the ventricles was repeated after amiodarone treatment after an interval of 4-144 weeks and after propafenon treatment after 1-48 weeks. They included among indicators of proarrhythmic action of antiarrhythmics (as compared with the initial examination): induction of diagnostic tachycardia at a lower grade of stimulation or with a smaller number of extrastimuli, the change from non-persisting unimorphous ventricular tachycardia into permanent unimorphous ventricular tachycardia, an increase of the frequency of tachycardia, marked deterioration of the patient's symptoms during tachycardia and the necessity to eliminate tachycardia by an electric discharge (during the initial examination an electric discharge was not used). The authors described in the group on indicator of proarrhythmic effect conditioned by programmed stimulation of the ventricles in 24 patients (48%). In one subject they found simultaneously two indicators in 12 instances (24%) and three indicators in 5 instances (10%).(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1995

[Prognostic importance of invasive electrophysiologic findings in the heart].

The objective of the work was the long-term perspective follow-up of subjects with a normal and pathologically delayed intra-, infra-His conduction in the heart based on the electrogram of the bundle of His and subjects with a normal or pathological finding during programmed stimulation of the ventricles, to assess the impact of these findings for the patients' prognosis. The authors included in the group, after elimination of subjects with the syndrome of ventricular preexcitation, 340 patients (243 men, 97 women, 16-81 years, mean age 49 +/- 16) where they made an invasive electrophysiological examination of the heart (electrogram of the bundle of His without cardiac stimulation, during graded and programmed stimulation of the atria, in 206 subjects also programmed stimulation of the ventricles) not before three months after acute cardiac disease. The authors found normal HV intervals or a normal length of H waves in 286 patients and delayed values in 54 patients. They revealed a diagnostic conclusion of programmed ventricular stimulation in 71 subjects and a non-diagnostic conclusion in 135 subjects. All patients were followed up irrespective of implantation of a pacemaker and antiarrhythmic treatment for 6 to 144 months (mean follow-up period 56.1 months). During the mentioned period they described the occurrence of cardiac deaths (deaths from cardiac causes) in 29 subjects with a normal intra-, infra-His conduction (10.1%), in 12 subjects with delayed intra-, infra-His conduction (22.2%), in 7 subjects with undiagnosed programmed ventricular stimulation (5.2%) and in 13 subjects with diagnosed programmed ventricular stimulation (18.3%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

[Late ventricular potentials--relation to the results of programmed ventricular stimulation, the incidence of ventricular ectopic arrhythmias and left ventricular function].

The authors evaluated the incidence of late ventricular potentials (LVP) in 84 patients (63 men and 21 women) with programmed stimulation of the ventricles. At the same time they described the relationship of the mentioned potentials to the finding of ventricular ectopic arrhythmias during ECG monitoring and left ventricular function (ultrasonographic examination). Non-invasive recording of late ventricular potentials is due to the assessed sensitivity, i.e. 73%, and specificity i.e. 67% (in relation to the results of programmed ventricular stimulation) a useful method for evaluation of the arrhythmogenic substrate of the heart muscle. The authors detected LVP in 35% of 37 subjects without arrhythmias, in 58% of 31 subjects with premature ventricular contractions class 3 to 5 according to Lown and in 60% of 15 subjects with relapsing ventricular tachycardias. LVP are more frequent in patients with impaired left ventricular function. They were recorded during the ejection fraction of the left ventricle beneath 50% in 69% of 16 subjects and in the left ventricular ejection fraction above 50% in 44% of 68 subjects.

Action Potentials↗