Albino Jović - Academia.edu (original) (raw)
Papers by Albino Jović
PubMed, Mar 1, 1996
Syncope is a common clinical problem, and diagnostic evaluation and treatment of the patient with... more Syncope is a common clinical problem, and diagnostic evaluation and treatment of the patient with syncope is often a particularly complex task. As many episodes of unexplained syncope are neurocardiogenic or vasovagal, head-up tilt-table testing is a valuable method for identifying individuals with recurrent loss of consciousness. Although over the past several years much has been learned about pathophysiologic mechanism involved, much of the disorder remains incompletely understood. Optimal standardization of head-up titl-table testing protocols is very important for clinical experience exchanges and for comparison of different therapeutic modalities. Medical therapy is often the first choice and a number of pharmacological treatments have been developed. Exceptionally, has to be combined with dual-chamber cardiac pacing. Head-up tilt-table test is a basic diagnostic procedure in the evaluation of the patient with syncope and should be performed in all cardiac and neurophysiologic laboratories.
Cardiologia Croatica, Oct 29, 2014
Heart, 1997
Objective-To evaluate the time course of the recovery of atrial mechanical function after pharmac... more Objective-To evaluate the time course of the recovery of atrial mechanical function after pharmacological cardioversion of chronic atrial fibrillation to sinus rhythm. Patients and methods-21 patients (12 male, 9 female, aged 37-77 years) with chronic atrial fibrillation (< 6 months) were followed up by serial transmitral pulsed Doppler echocardiography. Echocardiographic studies were performed within the first 24 hours and on day 8, 15, and 30 after cardioversion. Results-There was a significant increase (mean (SD)) in the peak A-wave velocity (from 0 35 (0.10) on day 1 to 0 50 (1.73) on day 8, and thereafter a gradual increase to 0*61 (0.14) m/s on day 30). Similarly, integrated late atrial velocities increased from 4 50 (1.46) on day 1 to 5*61 (1.73) on day 8 and 5*97 (1.47) cm/s2 on day 30. The atrial contribution to total transmitral flow increased significantly from 26 (7)% immediately after conversion of atrial fibrillation to sinus rhythm to 34 (7)% on day 30, indicating the haemodynamic benefit of the restoration of sinus rhythm. Left atrial diameter decreased but not significantly, from 4-11 (0.37) to 3-98 (0.34) cm (P < 0.005). Conclusions-These results suggest that restoration of atrial mechanical function after pharmacological cardioversion in patients with chronic atrial fibrillation is slow and gradual, as it is after electrical DC restoration of sinus rhythm. This time course may have important implications for determining how long treatment with anticoagulants and antiarrhythmic agents needs to continue in individual patients. It will also influence the clinical assessment of the haemodynamic benefit of restoring sinus rhythm in patients with chronic atrial fibrillation.
PubMed, 1994
The aim of the present study was to determine clinical value and the feasibility of transesophage... more The aim of the present study was to determine clinical value and the feasibility of transesophageal atrial pacing (TAP) in diagnosing myocardial ischemia in patients with coronary artery disease (CAD). Forty patients with CAD and with significant ST-segment depression in a standard 12-lead ECG during bicycle-stress testing underwent TAP. Rapid atrial stimulation was performed by using a very flexible six-polar polyurethane pacing lead introduced through the nares into the esophagus and connected to the stimulator allowing selection of rate, output voltage and pulse duration. The satisfactory atrial pacing was obtained by 28 +/- 6 V output and 7 +/- 1 ms pulse duration. Of 40 patients who underwent TAP, ischemic ECG changes were induced in 35 (u = 2,24 p < 0,05) and were very similar to those that occurred during bicycle-stress testing according to their intensity and distribution and affected ECG leads with comparable peak rate-pressure products. This suggests comparable sensitivity of TAP and bicycle-stress testing in discovering myocardial ischemia in CAD patients. Four patients had negative test for myocardial ischemia and in one TAP was discontinued because of intolerable chest discomfort. In conclusion, TAP is a reliable alternative technique for the assessment of coronary artery disease. In combination with some other noninvasive methods (echocardiography, scintigraphy, i.v. digital angiography), it has become a routine diagnostic procedure in cardiac patients.
Lijec̆nic̆ki vjesnik
The case of a man 32 years of age with echinococcosis of the heart who died due to rupture of a p... more The case of a man 32 years of age with echinococcosis of the heart who died due to rupture of a pericardial echinococcal cyst into the right atrium with the range into the pulmonary circulation and fatal embolism of the branch of pulmonary artery is presented. Such localization of echinococcus is extremely unusual as well as the complication it caused, and promoted this report which is very instructive for a clinician, the more so that the patient was surgically treated, but irregularly followed up, and the disease had a poor outcome. Prophylaxis with albendazole over a period of one month and more frequent control examinations by means of adequate diagnostic methods in such cases is stressed.
Cardiologia Croatica, 2014
Cardiologia Croatica, 2014
Cardiologia Croatica, 2013
Background: The purpose is to give an overview of application of intracardiac echocardiography (I... more Background: The purpose is to give an overview of application of intracardiac echocardiography (ICE) in routine electrophysiology (EP) practice. Validation of ICE in improving the safety of transseptal puncture is shown separately. Methods and Results: During the observed period (11/2009-03/2013) ICE was used in 83 procedures. 75 were AF ablations in which ICE was used initially to facilitate transseptal puncture and later on to check catheter contact with tissue and to monitor for the complications (pericardial effusion, thrombus formation at materials used in the left atrium). There were 4 left atrial tachycardias ablations, 2 left ventricular tachycardias and 1 accessory pathway and AVNRT ablation assisted by ICE. Conclusion: ICE is essential tool in EP lab. Its use not only improves safety yet efficacy through helping catheter navigation and validating the catheter-tissue contact.
Cardiologia Croatica, 2014
Cardiologia Croatica, 2013
Background: This is a single center experience and validation of transseptal punctures (TSP) assi... more Background: This is a single center experience and validation of transseptal punctures (TSP) assisted by fluoroscopy and intracardiac echocardiography (ICE). Methods: 2 operators unexperienced in TSP performed initial 10 TSP each under supervision of experienced operator and with fluoroscopy and ICE guidance. Further 60 TSP were validated in a way that TSP assembly was positioned only under fluoroscopy guidance and after operator felt assembly is at eligible place for performing TSP, the position was checked and corrected if needed according to the ICE image. Results: 93% of all TSP were made during atrial fibrillation ablation procedure. After typical fluoro markers of good positioning of transseptal sheath had been observed, ICE guided reposition was needed in 7% of the TSP mostly due to the anterior position of TSP assembly. There were no cases in where solely fluoroscopy guided positioning would point the assembly toward aorta(too anteriorly), and there was one case in which where solely fluoro guided TSP would very likely result in cardiac tamponade due to posterior atrial puncture. No complication due to transseptal puncture happened. Conclusion: ICE guided TSP is safe and easy. ICE usage resulted in TSP assembly repositioning in 7% of the cases in which typical fluoro markers of ideal position were observed. Thus ICE usage helped avoid too anterior punctions that would make catheter navigation throughout AF ablation procedure more difficult and helped avoid too posterior punction that would likely result in cardiac tamponade. There were no cases were the danger to puncture aorta was caused.
Cardiologia Croatica, 2014
Cardiologia Croatica, 2014
Cardiologia Croatica, 2014
Cardiologia Croatica, 2013
Cardiologia CROATICA Background: Electrical pulmonary vein isolation (PVI) has become an effectiv... more Cardiologia CROATICA Background: Electrical pulmonary vein isolation (PVI) has become an effective tool to control atrial fibrillation (AF). Point by point ablation guided by electroanatomical mapping system is a preferable method of achieving it. Most electrophysiology (EP) labs routinely employ some kind of preprocedural imaging to gain insight into PV anatomical variants that could alter the strategy of ablation procedure. On the other hand there is scarce data on correlation of knowledge of pulmonary vein (PV) anatomy on success, duration and safety of the procedure. Methods: From November 2009 till March 2013 we performed 75 AF ablations in General Hospital Zadar, EP lab. All patients underwent preprocedural left atrial and pulmonary veins MSCT angiography using Siemens Somatom 16. 3D reconstructions were made with standard software and operators were aware of the anatomy. Patients were divided into 2 groups depending on anatomical variants of PVs: Group A-standard anatomy in whom all 4 PVs connect to LA with separated ostia and Group B-any other anatomical variant. We then correlated the anatomy with outcomes in terms of success, duration and safety of the ablation procedure. Results: The most common anatomical variant we met in our cohort was a common left trunk in 17% of patients (13/75). Accessory PVs were registered in 14% (11/75). We had a rare case of accessory right PV connecting to LA roof
Cardiologia Croatica, 2013
Collegium antropologicum, 2011
The aim of this investigation was to determine whether H. pylori infection is an independent risk... more The aim of this investigation was to determine whether H. pylori infection is an independent risk factor for acute myocardial infarction (AMI), determine is there a link between H. pylori infection and severity of disease. In this prospective, single centre study, were enrolled 100 patients with AMI and control group was consisted 93 healthy individuals. The results of this study showed no difference between H. pylori seropositivity distribution in the investigate and control group (29 vs. 26 %) and there was no significant difference on the severity of the disease. There was significant association in the patients with three and more risk factors, where the patients with lower blood pressure (124.4/77.4 vs. 145.9/87.7 mmHg) and better controlled diabetes (HbA1c 6.1% vs. 6.9%) had greater risk for AMI if they are H. pylori seropositive. The large multicentric trials would be needed to define a precise role of H. pylori infection on the developement of AMI.
Cardiologia Croatica, 2013
Background: The transradial approach (TRA) for percutaneous coronary diagnostic and interventiona... more Background: The transradial approach (TRA) for percutaneous coronary diagnostic and interventional procedures has been shown to decrease vascular complications and improve clinical outcomes compared with transfemoral approach (TFA). Despite its obvious advantages, TRA is still infrequently used in routine practice. Main disadvantages of TRA compared with TFA, beside the necessary learning curve is a variable rate of transradial failure due to specific problems related to this arterial access. Objective: To evaluate the incidence and causes of TRA failure in coronary angiographies and interventional procedures performed in a large cohort of unselected patients in single center observational study. Methods: All consecutive right TRA procedures performed at our institution between January 2011 and December 2012, by low-to-intermediate volume operators, were analyzed retrospectively. Results: In the observed period we performed 1341 coronary diagnostic and interventional procedures, 1243 (92,7%) were performed using right TRA as primary access. Mean age was 64.1 years, and 35% were female. TRA failure occurred in 75 procedures (6.0%). In that subgroup, mean age was 68.3 and 61% were female. Two main causes of failed TRA were puncture failure in 32 (42.6%) and unsuitable anatomy (i.e. tortuous subclavian and brachiocephalic arteries, radial loop, radial hypoplasia or abberant arteries) in 31 (41.3%) patients. The remaining causes occurred at a much
Cardiologia Croatica, 2013
PubMed, Mar 1, 1996
Syncope is a common clinical problem, and diagnostic evaluation and treatment of the patient with... more Syncope is a common clinical problem, and diagnostic evaluation and treatment of the patient with syncope is often a particularly complex task. As many episodes of unexplained syncope are neurocardiogenic or vasovagal, head-up tilt-table testing is a valuable method for identifying individuals with recurrent loss of consciousness. Although over the past several years much has been learned about pathophysiologic mechanism involved, much of the disorder remains incompletely understood. Optimal standardization of head-up titl-table testing protocols is very important for clinical experience exchanges and for comparison of different therapeutic modalities. Medical therapy is often the first choice and a number of pharmacological treatments have been developed. Exceptionally, has to be combined with dual-chamber cardiac pacing. Head-up tilt-table test is a basic diagnostic procedure in the evaluation of the patient with syncope and should be performed in all cardiac and neurophysiologic laboratories.
Cardiologia Croatica, Oct 29, 2014
Heart, 1997
Objective-To evaluate the time course of the recovery of atrial mechanical function after pharmac... more Objective-To evaluate the time course of the recovery of atrial mechanical function after pharmacological cardioversion of chronic atrial fibrillation to sinus rhythm. Patients and methods-21 patients (12 male, 9 female, aged 37-77 years) with chronic atrial fibrillation (< 6 months) were followed up by serial transmitral pulsed Doppler echocardiography. Echocardiographic studies were performed within the first 24 hours and on day 8, 15, and 30 after cardioversion. Results-There was a significant increase (mean (SD)) in the peak A-wave velocity (from 0 35 (0.10) on day 1 to 0 50 (1.73) on day 8, and thereafter a gradual increase to 0*61 (0.14) m/s on day 30). Similarly, integrated late atrial velocities increased from 4 50 (1.46) on day 1 to 5*61 (1.73) on day 8 and 5*97 (1.47) cm/s2 on day 30. The atrial contribution to total transmitral flow increased significantly from 26 (7)% immediately after conversion of atrial fibrillation to sinus rhythm to 34 (7)% on day 30, indicating the haemodynamic benefit of the restoration of sinus rhythm. Left atrial diameter decreased but not significantly, from 4-11 (0.37) to 3-98 (0.34) cm (P < 0.005). Conclusions-These results suggest that restoration of atrial mechanical function after pharmacological cardioversion in patients with chronic atrial fibrillation is slow and gradual, as it is after electrical DC restoration of sinus rhythm. This time course may have important implications for determining how long treatment with anticoagulants and antiarrhythmic agents needs to continue in individual patients. It will also influence the clinical assessment of the haemodynamic benefit of restoring sinus rhythm in patients with chronic atrial fibrillation.
PubMed, 1994
The aim of the present study was to determine clinical value and the feasibility of transesophage... more The aim of the present study was to determine clinical value and the feasibility of transesophageal atrial pacing (TAP) in diagnosing myocardial ischemia in patients with coronary artery disease (CAD). Forty patients with CAD and with significant ST-segment depression in a standard 12-lead ECG during bicycle-stress testing underwent TAP. Rapid atrial stimulation was performed by using a very flexible six-polar polyurethane pacing lead introduced through the nares into the esophagus and connected to the stimulator allowing selection of rate, output voltage and pulse duration. The satisfactory atrial pacing was obtained by 28 +/- 6 V output and 7 +/- 1 ms pulse duration. Of 40 patients who underwent TAP, ischemic ECG changes were induced in 35 (u = 2,24 p < 0,05) and were very similar to those that occurred during bicycle-stress testing according to their intensity and distribution and affected ECG leads with comparable peak rate-pressure products. This suggests comparable sensitivity of TAP and bicycle-stress testing in discovering myocardial ischemia in CAD patients. Four patients had negative test for myocardial ischemia and in one TAP was discontinued because of intolerable chest discomfort. In conclusion, TAP is a reliable alternative technique for the assessment of coronary artery disease. In combination with some other noninvasive methods (echocardiography, scintigraphy, i.v. digital angiography), it has become a routine diagnostic procedure in cardiac patients.
Lijec̆nic̆ki vjesnik
The case of a man 32 years of age with echinococcosis of the heart who died due to rupture of a p... more The case of a man 32 years of age with echinococcosis of the heart who died due to rupture of a pericardial echinococcal cyst into the right atrium with the range into the pulmonary circulation and fatal embolism of the branch of pulmonary artery is presented. Such localization of echinococcus is extremely unusual as well as the complication it caused, and promoted this report which is very instructive for a clinician, the more so that the patient was surgically treated, but irregularly followed up, and the disease had a poor outcome. Prophylaxis with albendazole over a period of one month and more frequent control examinations by means of adequate diagnostic methods in such cases is stressed.
Cardiologia Croatica, 2014
Cardiologia Croatica, 2014
Cardiologia Croatica, 2013
Background: The purpose is to give an overview of application of intracardiac echocardiography (I... more Background: The purpose is to give an overview of application of intracardiac echocardiography (ICE) in routine electrophysiology (EP) practice. Validation of ICE in improving the safety of transseptal puncture is shown separately. Methods and Results: During the observed period (11/2009-03/2013) ICE was used in 83 procedures. 75 were AF ablations in which ICE was used initially to facilitate transseptal puncture and later on to check catheter contact with tissue and to monitor for the complications (pericardial effusion, thrombus formation at materials used in the left atrium). There were 4 left atrial tachycardias ablations, 2 left ventricular tachycardias and 1 accessory pathway and AVNRT ablation assisted by ICE. Conclusion: ICE is essential tool in EP lab. Its use not only improves safety yet efficacy through helping catheter navigation and validating the catheter-tissue contact.
Cardiologia Croatica, 2014
Cardiologia Croatica, 2013
Background: This is a single center experience and validation of transseptal punctures (TSP) assi... more Background: This is a single center experience and validation of transseptal punctures (TSP) assisted by fluoroscopy and intracardiac echocardiography (ICE). Methods: 2 operators unexperienced in TSP performed initial 10 TSP each under supervision of experienced operator and with fluoroscopy and ICE guidance. Further 60 TSP were validated in a way that TSP assembly was positioned only under fluoroscopy guidance and after operator felt assembly is at eligible place for performing TSP, the position was checked and corrected if needed according to the ICE image. Results: 93% of all TSP were made during atrial fibrillation ablation procedure. After typical fluoro markers of good positioning of transseptal sheath had been observed, ICE guided reposition was needed in 7% of the TSP mostly due to the anterior position of TSP assembly. There were no cases in where solely fluoroscopy guided positioning would point the assembly toward aorta(too anteriorly), and there was one case in which where solely fluoro guided TSP would very likely result in cardiac tamponade due to posterior atrial puncture. No complication due to transseptal puncture happened. Conclusion: ICE guided TSP is safe and easy. ICE usage resulted in TSP assembly repositioning in 7% of the cases in which typical fluoro markers of ideal position were observed. Thus ICE usage helped avoid too anterior punctions that would make catheter navigation throughout AF ablation procedure more difficult and helped avoid too posterior punction that would likely result in cardiac tamponade. There were no cases were the danger to puncture aorta was caused.
Cardiologia Croatica, 2014
Cardiologia Croatica, 2014
Cardiologia Croatica, 2014
Cardiologia Croatica, 2013
Cardiologia CROATICA Background: Electrical pulmonary vein isolation (PVI) has become an effectiv... more Cardiologia CROATICA Background: Electrical pulmonary vein isolation (PVI) has become an effective tool to control atrial fibrillation (AF). Point by point ablation guided by electroanatomical mapping system is a preferable method of achieving it. Most electrophysiology (EP) labs routinely employ some kind of preprocedural imaging to gain insight into PV anatomical variants that could alter the strategy of ablation procedure. On the other hand there is scarce data on correlation of knowledge of pulmonary vein (PV) anatomy on success, duration and safety of the procedure. Methods: From November 2009 till March 2013 we performed 75 AF ablations in General Hospital Zadar, EP lab. All patients underwent preprocedural left atrial and pulmonary veins MSCT angiography using Siemens Somatom 16. 3D reconstructions were made with standard software and operators were aware of the anatomy. Patients were divided into 2 groups depending on anatomical variants of PVs: Group A-standard anatomy in whom all 4 PVs connect to LA with separated ostia and Group B-any other anatomical variant. We then correlated the anatomy with outcomes in terms of success, duration and safety of the ablation procedure. Results: The most common anatomical variant we met in our cohort was a common left trunk in 17% of patients (13/75). Accessory PVs were registered in 14% (11/75). We had a rare case of accessory right PV connecting to LA roof
Cardiologia Croatica, 2013
Collegium antropologicum, 2011
The aim of this investigation was to determine whether H. pylori infection is an independent risk... more The aim of this investigation was to determine whether H. pylori infection is an independent risk factor for acute myocardial infarction (AMI), determine is there a link between H. pylori infection and severity of disease. In this prospective, single centre study, were enrolled 100 patients with AMI and control group was consisted 93 healthy individuals. The results of this study showed no difference between H. pylori seropositivity distribution in the investigate and control group (29 vs. 26 %) and there was no significant difference on the severity of the disease. There was significant association in the patients with three and more risk factors, where the patients with lower blood pressure (124.4/77.4 vs. 145.9/87.7 mmHg) and better controlled diabetes (HbA1c 6.1% vs. 6.9%) had greater risk for AMI if they are H. pylori seropositive. The large multicentric trials would be needed to define a precise role of H. pylori infection on the developement of AMI.
Cardiologia Croatica, 2013
Background: The transradial approach (TRA) for percutaneous coronary diagnostic and interventiona... more Background: The transradial approach (TRA) for percutaneous coronary diagnostic and interventional procedures has been shown to decrease vascular complications and improve clinical outcomes compared with transfemoral approach (TFA). Despite its obvious advantages, TRA is still infrequently used in routine practice. Main disadvantages of TRA compared with TFA, beside the necessary learning curve is a variable rate of transradial failure due to specific problems related to this arterial access. Objective: To evaluate the incidence and causes of TRA failure in coronary angiographies and interventional procedures performed in a large cohort of unselected patients in single center observational study. Methods: All consecutive right TRA procedures performed at our institution between January 2011 and December 2012, by low-to-intermediate volume operators, were analyzed retrospectively. Results: In the observed period we performed 1341 coronary diagnostic and interventional procedures, 1243 (92,7%) were performed using right TRA as primary access. Mean age was 64.1 years, and 35% were female. TRA failure occurred in 75 procedures (6.0%). In that subgroup, mean age was 68.3 and 61% were female. Two main causes of failed TRA were puncture failure in 32 (42.6%) and unsuitable anatomy (i.e. tortuous subclavian and brachiocephalic arteries, radial loop, radial hypoplasia or abberant arteries) in 31 (41.3%) patients. The remaining causes occurred at a much
Cardiologia Croatica, 2013