Mihaela Grecu - Academia.edu (original) (raw)
Papers by Mihaela Grecu
PubMed, Feb 26, 2008
This study aimed to prove that angiotensin-converting enzyme inhibitors (ACEI) could improve sinu... more This study aimed to prove that angiotensin-converting enzyme inhibitors (ACEI) could improve sinus rhythm maintenance after electrical or chemical conversion of atrial fibrillation (AF). Methods: A prospective study of 36 patients with lone AF which undertook chemical or electrical conversion was conducted. Group 1 included 20 patients treated exclusively with a class I C antiarrhythmic (Propafenone, 450 mg daily) and group 2 included 16 patients treated with antiarrhythmic plus ACEI pre- and after cardioversion. Results: These two groups were comparable, with mean age 56.2 +/- 11.8 vs. 57.7 +/- 6.1 years (P 0.709), onset of AF 2.47 +/- 3.72 vs. 5.5 +/- 7.37 months (P 0.205) and echocardiographic parameters: left atrium diameter 45.1 +/- 5.8 vs. 45.0 +/- 6.1 mm (P 0.995); LVTDV 48.5 +/- 5.0 vs. 48.6 +/- 6.4 mm (P 0.998); LVTSV 35.1 +/- 5.0 vs. 36.0 +/- 7.0 mm (P 0.737) and EF 59.0 +/- 6.9% vs. 54.8 +/- 6.1% (P 0.135). The patients were followed up clinically and electrocardiographically 12 months after conversion. Kaplan-Meier analysis showed a higher probability of remaining in sinus rhythm one year after cardioversion for group 2 compared to group 1 (37.5% vs. 20%). The mean time interval for the appearance of recurrences was significantly higher in patients treated with ACEI and antiarrhythmics compared to the patients treated only with antiarrhythmics (7.06 +/- 1.02 vs. 4.50 +/- 0.93 months; Breslow test (generalized Wilcoxon)--4.473, P 0.034). Conclusion: The addition of ACEI to an antiarrhythmic decreases the rate of AF recurrences and facilitates the maintenance of sinus rhythm after cardioversion.
European Heart Journal, Aug 1, 2018
Conclusion: This large multicentric and prospective registry confirmed the heterogeneity of CS in... more Conclusion: This large multicentric and prospective registry confirmed the heterogeneity of CS in terms of etiology, presentation and prognosis with a predominance of non-ischemic CS in practice. Funding Acknowledgements: Supported by a grant of the Fédération Francaise de cardiologie and unrestricted grants from Daiichi-Sankyo, Maquet SAS, Abiomed and Orion Pharma 2999 Twenty-year trends in the characteristic, management and outcome of patients with STEMI and out-of-hospital reanimation
Archive of Clinical Cases, Jun 1, 2017
Sick sinus syndrome encompasses a variety of EKG manifestations consisting of atrial bradyarrhyth... more Sick sinus syndrome encompasses a variety of EKG manifestations consisting of atrial bradyarrhythmias and tachyarrhythmias, alternating bradyarrhythmias and tachyarrhythmias as in tachycardia-bradycardia syndrome. Supraventricular tachyarrhythmias that can occur include atrial flutter, atrial fibrillation, atrial tachycardia and paroxysmal supraventricular tachycardia, although there is no direct causal relation between paroxysmal supraventricular tachycardia and sinus node disease. Atrioventricular node re-entry is a common cause of paroxysmal supraventricular tachycardia episodes. We present the case of a 70 year old female, hospitalized for atypical chest pain and dizziness when walking. The EKG on admission showed sinus bradyarrhythmia, anterior fascicular block, atrial and ventricular extrasystoles. During the hospitalization the patient presented an episode of palpitations, narrow complex tachycardia being registered on the EKG, with no response to the Valsalva maneuver or intravenous beta blocker. The tachyarrhythmia ceased spontaneously after one hour. 24 hour Holter EKG was performed and confirmed sinus node dysfunction. The electrophysiological study identified paroxysmal supraventricular tachycardia due to atrioventricular nodal reentrant tachycardia, which was successfully treated by ablating the slow intranodal pathway. Therefore, in a case of sick sinus syndrome when the patient's symptoms cannot be attributed to the bradycardia, but to the tachyarrythmic episodes, it is often most efficient to treat the patient's paroxysmal supraventricular tachycardia by radiofrequency ablation, rather than using cardiac pacing.
PubMed, Apr 19, 2005
An 11 year-old boy was admitted with incessant sinus node reentrant tachycardia and secondary dil... more An 11 year-old boy was admitted with incessant sinus node reentrant tachycardia and secondary dilated arrhythmic cardiomyopathy, treated by radiofrequency ablation. Two years later he was admitted with incessant automatic atrial tachycardia and arrhythmic cardiomyopathy; a second catheter ablation procedure failed, but the third one, performed four month later, was successfully and resulted in a restoration of a normal sinus rhythm and a complete regression of arrhythmic cardiomyopathy.
This study aimed to prove that angiotensin-converting enzyme inhibitor (ACEI) could improve sinus... more This study aimed to prove that angiotensin-converting enzyme inhibitor (ACEI) could improve sinus rhythm maintenance after conversion of atrial fibrillation (AF). A study of 36 patients with lone AF who undertook electrical conversion was conducted. Group 1 included 20 patients treated exclusively with a class I C antiarrhythmic (Propafenona, 450 mg daily) and group 2 included 16 patients treated with antiarrhythmic plus ACEI after cardioversion. These two groups were comparable, with mean age 56.2+/-11.8 vs. 57.7+/-6.1 years (P 0.709), onset of AF 2.47+/-3.72 vs. 5.5+/-7.37 months (P 0.205) and echocardiografic parameters: left atrium diameter 45.1+/-5.8 vs. 45.0+/-6.1 mm (P 0.995); LVTDV 48.5+/-5.0 vs. 48.6+/-6.4 mm (P 0.998); LVTSV 35.1+/-5.0 vs. 36.0+/-7.0 mm (P 0.737) and EF 59.0+/-6.9% vs. 54.8+/-6.1% (P 0.135). The patients were followed up clinically and electrocardiographically 12 months after conversion. Kaplan-Meier analysis showed a higher probability of remaining in sinus rhythm one year after cardioversion for group 2 compared to group 1 (37.5% vs. 20%). The mean time interval for the appearance of recurrences was significantly higher in patients treated with ACEI and antiarrhythmics compared to the patients treated only with antiarrhythmics (7.06+/-1.02 vs. 4.50+/-0.93 months; Breslow test (generalized Wilcoxon) - 4.473, P 0.034). The addition of ACEI to an antiarrhythmic decreases the rate of AF recurrences and facilitates the maintenance of sinus rhythm after cardioversion.
PubMed, Apr 19, 2005
It is well known that the radiofrequency catheter ablation (RFCA) treatment of cardiac arrhythmia... more It is well known that the radiofrequency catheter ablation (RFCA) treatment of cardiac arrhythmias is effective and devoid of significant complications. However, in our country, the experience of this technique is not so large and requires more clinical studies to validate it. Objectives: The aim of this was to present our experience in the RFCA of cardiac tachycardias. Methods: Between July 2002 and February 2003, in Iaşi Cardiology Center, we performed a total of 79 diagnosis procedures. Of these 57 (72%) were radiofrequency ablation procedures at 51 patients, mean age 48 +/- 16 years (12-81), men majority 32 (63%). The electrophysiology diagnosis was: 22 (39%) common atrial flutter, 3 (5%) atrial tachycardias, 13 (23%) atrioventricular nodal reentrant tachycardia, 12 (21%) Wolff-Parkinson-White syndrome, 4 (7%) orthodromic tachycardia using concealed accessory pathway, 2 (3%) ventricular tachycardias and 1 (2%) ablation of the atrioventricular junction. Results: The initial ablation procedure was effective in 44/ 51 patients (86%), with a total duration of 130 +/- 42 min, using 24 +/- 10 min of radioscopy. During follow-up 13 +/- 1.3 (11-16 months), recurrence occurred in 7 patients 14%. In 7 of them a second effective procedure was performed in 4 patients. Finally, radiofrequency ablation was effective in 48/51 of patients (94%), improving the procedural success rate at 95% (54/57 patients). No complications occurred during follow-up. Conclusion: The treatment of cardiac arrhythmias by radiofrequency catheter ablation is effective and safe and is the only way to cure the supraventricular and ventricular tachyarrhythmias.
Pacing and Clinical Electrophysiology, Mar 1, 2009
We examined the possible role of atrioventricular node (AVN) conduction abnormalities as a cause ... more We examined the possible role of atrioventricular node (AVN) conduction abnormalities as a cause of AVN reentrant tachycardia (RT) in patients >65 years of age. Study Population: Slow pathway radiofrequency catheter ablation (RFCA) was performed in 104 patients. Patients in group 1 (n = 14) were >65 years of age and had AV conduction abnormalities associated with structural heart disease. Patients in group 2 (n = 90) were <65 years of age and had lone AVNRT. Results: Patients in group 1 versus group 2 (66% vs. 46% men) had a first episode of tachycardia at an older age than in
Romanian Journal of Cardiology, 2021
A 45-year-old male, hypertensive and obese presented with a 3-months history of short episodes of... more A 45-year-old male, hypertensive and obese presented with a 3-months history of short episodes of intermittent palpitations. Clinical examination was unremarkable; however, the electrocardiogram documented major right bundle branch block and the presence of fragmented QRS in all precordial leads. His echocardiography documented a dilated left ventricle, with mild systolic dysfunction and moderate biventricular reduction of the global longitudinal strain. On angiography, the epicardial coronary arteries were normal. A cardiac MRI revealed diffuse transmural fi brotic lesions with non ischemic pattern of the ventricles, suggestive of chronic myocarditis. The electrophysiological study induced two ventricular tachycardia morphologies which were ablated and an ICD for sudden cardiac death primary prevention was implanted. Fortunately, at 6 months follow-up our patient had no ICD therapies and reported an alleviation of symptoms.
Romanian Journal of Pediatrics, 2015
Primary cardiac arrhythmias are much less common in infants and children than in adults, their sy... more Primary cardiac arrhythmias are much less common in infants and children than in adults, their symptoms can be vague and nonspecific. Although real emergencies because of unstable arrhythmias in children are rare, it is important to identify and properly manage these cases. The study presents the case of a child who was admitted for respiratory symptoms, clinical examination discovering the heart rate of 214 bpm. The child became progressively anxious, showing a respiratory effort. The study of electrocardiogram established the diagnosis of anterior fascicular ventricular tachycardia with a tendency to become permanent. The evolution was favorable after the electrical cardioversion and preventive treatment with Verapamil had been performed.
We aimed to assess reverse left atrial (LA) remodeling at 6 months after ablation of paroxysmal a... more We aimed to assess reverse left atrial (LA) remodeling at 6 months after ablation of paroxysmal atrial fibrillation (AF), and to identify the most relevant parameter of reverse LA remodeling. Ma-terial and methods: Left atrial size was assessed by echocardiography: antero-posterior (AP) diameter, LA area in apical 4 and 2 chambers (A4c, A2c), LA volume by biplane for-mula (LAV1), and by computed-tomography (LAV2). Results: Seventy-eight consecutive patients with mean age of 57.41 ± 8.05 years were prospectively included; 60 (76.9%) were with paroxysmal AF less than 24 hours and 18 (23.1%) less than 7 days duration. All echo-cardiographic and computed-tomographic evaluations were made within 4 weeks before ab-lation and at 6 months after ablation procedure by the same operator. Circumferential or segmental pulmonary vein isolation was performed by radiofrequency in 58 (74.4%) pa-tients, and by cryotherapy in 18 (23.1%) patients. At 6 months 53 (67.9%) patients were in stable sinus rh...
Anatolian journal of cardiology, 2018
Postoperative atrial fibrillation (POAF) is the most common complication following cardiac surger... more Postoperative atrial fibrillation (POAF) is the most common complication following cardiac surgery, with increased risk of stroke and high mortality. Our aim was to identify patients at risk and to design a model that could predict POAF. In this single center study, we evaluated 1191 patients requiring isolated surgical aortic valve replacement between January 2000 and June 2014. The patients were followed during the early postoperative period until discharge. AF occurred in 342 patients (28.71%). Six variables associated with high arrhythmic risk [advanced age, body mass index, tricuspid regurgitation, prolonged ventilation, longer intensive care unit stay, and dilated left atrium (LA; volume ≥35 ml/m2)] were selected to create a multivariate prediction model. This model predicted POAF in 64.7% of cases, with a moderate discriminative power (AUC=0.65; p=0.001; 95% CI, 0.571-0.771). We also developed the CHAID (Chi-square automatic interaction detection) model showing multilevel int...
Archive of Clinical Cases, 2017
Archive of Clinical Cases, 2017
Dilated cardiomyopathy is associated with ventricular arrhythmias and with an increased risk of s... more Dilated cardiomyopathy is associated with ventricular arrhythmias and with an increased risk of sudden cardiac death. In these cases, wide complex tachyarrhythmias are frequently a diagnostic challenge. The efficiency of antiarrhythmic drug therapy is limited and often the implantation of a cardiac defibrillator is required. We hereby present the case of a 68 year old male patient known with dilated cardiomyopathy, who experienced a syncopal episode as the clinical expression of a wide complex tachycardia. The recorded electrocardiogram identified ventricular tachycardia originated in the right ventricle or in the interventricular septum. The electrocardiograms recorded before and after the syncopal episode showed a major left bundlebranch block and a first degree atrioventricular block. 24-hour Holter ECG monitoring detected ventricular tachycardia originating in the left ventricle. The etiology of the dilated cardiomyopathy, arrhythmias and conduction abnormalities could not be identified. During the electrophysiological study, no sustained supraventricular or ventricular tachyarrhythmias were triggered. The pharmacological treatment has been optimized and a cardiac defibrillator was implanted. The particularity of this case consists in the presence of multiple rhythm disturbances originating both in the left and right ventricle, in a patient with idiopathic dilated cardiomyopathy and conduction disturbances at several levels.
Archive of Clinical Cases, 2017
Sick sinus syndrome encompasses a variety of EKG manifestations consisting of atrial bradyarrhyth... more Sick sinus syndrome encompasses a variety of EKG manifestations consisting of atrial bradyarrhythmias and tachyarrhythmias, alternating bradyarrhythmias and tachyarrhythmias as in tachycardia-bradycardia syndrome. Supraventricular tachyarrhythmias that can occur include atrial flutter, atrial fibrillation, atrial tachycardia and paroxysmal supraventricular tachycardia, although there is no direct causal relation between paroxysmal supraventricular tachycardia and sinus node disease. Atrioventricular node re-entry is a common cause of paroxysmal supraventricular tachycardia episodes. We present the case of a 70 year old female, hospitalized for atypical chest pain and dizziness when walking. The EKG on admission showed sinus bradyarrhythmia, anterior fascicular block, atrial and ventricular extrasystoles. During the hospitalization the patient presented an episode of palpitations, narrow complex tachycardia being registered on the EKG, with no response to the Valsalva maneuver or intravenous beta blocker. The tachyarrhythmia ceased spontaneously after one hour. 24 hour Holter EKG was performed and confirmed sinus node dysfunction. The electrophysiological study identified paroxysmal supraventricular tachycardia due to atrioventricular nodal reentrant tachycardia, which was successfully treated by ablating the slow intranodal pathway. Therefore, in a case of sick sinus syndrome when the patient's symptoms cannot be attributed to the bradycardia, but to the tachyarrythmic episodes, it is often most efficient to treat the patient's paroxysmal supraventricular tachycardia by radiofrequency ablation, rather than using cardiac pacing.
Archive of Clinical Cases, 2017
Electrical storm represents a major clinical emergency characterized by electrical heart instabil... more Electrical storm represents a major clinical emergency characterized by electrical heart instability with several recurrent episodes of ventricular arrhythmias over a short period of time. We present the case of a 67year old male, hypertensive, diabetic who was referred to the cardiology department after a resuscitated cardiac arrest through sustained ventricular tachycardia. The echocardiography revealed a severe aspect of dilated cardiomyopathy and fibrotic aspect of inferior-posterior wall of the left ventricle. The ischemic coronary cause has been ruled out by coronary computed tomography. An implantable cardioverter defibrillator (ICD) was implanted. One day after, the electrical storm and hemodynamically stability worsened requiring high dosage of amiodarone, putting therapies of ICD on "off" and the intubation of the patient. Taking all into account, an urgent electrophysiological study was performed and led to complex radiofrequency catheter ablation of the substrate of the lateral, medium-ventricular wall. Afterwards, the electrical storm did not reappear, the ICD therapies were put on "on" and the patient was rapidly extubated, being discharged with pharmacological recommendations, the milestone being the anti-arrhythmic treatment. Though the treatment of electrical storm is complex but still unclearly defined, we emphasize the need of applying all the therapeutical measures and having a prompt response to this life-threatening condition.
Archive of Clinical Cases, 2017
In spite of the available clinical and electrocardiographic criteria for the differential diagnos... more In spite of the available clinical and electrocardiographic criteria for the differential diagnosis of wide QRS complex tachycardias, distinguishing orthodromic supraventricular tachycardias is still a challenge. We present a case of a 63-year old patient admitted in our clinic after experiencing two episodes of syncope. Echocardiography showed left ventricular hypertrophy, grade 1 diastolic dysfunction and left atrial enlargement. A Holter monitoring revealed episodes of atrial fibrillation and paroxysmal narrow QRS tachycardia alternating with wide QRS tachycardia (170-180 bpm). During an electrophysiology study we induced self-limiting orthodromic supraventricular tachycardias with narrow and left bundle branch block patterns. Retrograde mapping near the mitral annulus identified a concealed accessory posteroseptal bypass tract which was successfully ablated. After the procedure the patient developed atrial flutter and atrial fibrillation with rapid ventricular response (196 beats per minute) with a 3.9 s post-tachycardia pause. The patient underwent implantation of a cardiac pacemaker which allowed us to start antiarrhythmic treatment with amiodarone. This case shows that occult accessory posteroseptal bypass tracts can have a late-onset presentation in a 63-year old male and explains why latent rhythm disturbances require a step-by-step medical approach.
Romanian journal of internal medicine = Revue roumaine de médecine interne, 2007
This study aimed to prove that angiotensin-converting enzyme inhibitor (ACEI) could improve sinus... more This study aimed to prove that angiotensin-converting enzyme inhibitor (ACEI) could improve sinus rhythm maintenance after conversion of atrial fibrillation (AF). A study of 36 patients with lone AF who undertook electrical conversion was conducted. Group 1 included 20 patients treated exclusively with a class I C antiarrhythmic (Propafenona, 450 mg daily) and group 2 included 16 patients treated with antiarrhythmic plus ACEI after cardioversion. These two groups were comparable, with mean age 56.2+/-11.8 vs. 57.7+/-6.1 years (P 0.709), onset of AF 2.47+/-3.72 vs. 5.5+/-7.37 months (P 0.205) and echocardiografic parameters: left atrium diameter 45.1+/-5.8 vs. 45.0+/-6.1 mm (P 0.995); LVTDV 48.5+/-5.0 vs. 48.6+/-6.4 mm (P 0.998); LVTSV 35.1+/-5.0 vs. 36.0+/-7.0 mm (P 0.737) and EF 59.0+/-6.9% vs. 54.8+/-6.1% (P 0.135). The patients were followed up clinically and electrocardiographically 12 months after conversion. Kaplan-Meier analysis showed a higher probability of remaining in sin...
Revista medico-chirurgicală̆ a Societă̆ţ̜ii de Medici ş̧i Naturaliş̧ti din Iaş̧i
Calcium channel blockers are the only vasodilators that proved their efficiency in idiopathic pul... more Calcium channel blockers are the only vasodilators that proved their efficiency in idiopathic pulmonary hypertension (IPH). However, not every patient is responsive to this therapy. Only in isolated cases of IPH was proved the good effect of prostaglandins in lowering the pulmonary pressure by inhibiting the proliferation of smooth muscle cells. The follow up of a patient, male, 66 years, with IPH, NYHA IV class global cardiac decompensation, mostly the right heart, cyanotic, with 85% SaO2 at rest, massive edema, with "hair cut" aspect of pulmonary circulation, cardiomegaly assessed radiologically (CTI 0.55) and echocardiographically (important dilation of right heart chambers, RV 50/44 mm, compressing the left heart chambers, IVth grade tricuspid insufficiency and 160/90 mmHg pulmonary pressure) is presented. It was excluded a secondary cause of pulmonary hypertension, both by echocardiography and by cardiac catheterization, which eventually confirms the angiographic diag...
Revista medico-chirurgicală̆ a Societă̆ţ̜ii de Medici ş̧i Naturaliş̧ti din Iaş̧i
An 11 year-old boy was admitted with incessant sinus node reentrant tachycardia and secondary dil... more An 11 year-old boy was admitted with incessant sinus node reentrant tachycardia and secondary dilated arrhythmic cardiomyopathy, treated by radiofrequency ablation. Two years later he was admitted with incessant automatic atrial tachycardia and arrhythmic cardiomyopathy; a second catheter ablation procedure failed, but the third one, performed four month later, was successfully and resulted in a restoration of a normal sinus rhythm and a complete regression of arrhythmic cardiomyopathy.
Revista medico-chirurgicală̆ a Societă̆ţ̜ii de Medici ş̧i Naturaliş̧ti din Iaş̧i
It is well known that the radiofrequency catheter ablation (RFCA) treatment of cardiac arrhythmia... more It is well known that the radiofrequency catheter ablation (RFCA) treatment of cardiac arrhythmias is effective and devoid of significant complications. However, in our country, the experience of this technique is not so large and requires more clinical studies to validate it. The aim of this was to present our experience in the RFCA of cardiac tachycardias. Between July 2002 and February 2003, in Iaşi Cardiology Center, we performed a total of 79 diagnosis procedures. Of these 57 (72%) were radiofrequency ablation procedures at 51 patients, mean age 48 +/- 16 years (12-81), men majority 32 (63%). The electrophysiology diagnosis was: 22 (39%) common atrial flutter, 3 (5%) atrial tachycardias, 13 (23%) atrioventricular nodal reentrant tachycardia, 12 (21%) Wolff-Parkinson-White syndrome, 4 (7%) orthodromic tachycardia using concealed accessory pathway, 2 (3%) ventricular tachycardias and 1 (2%) ablation of the atrioventricular junction. The initial ablation procedure was effective in...
PubMed, Feb 26, 2008
This study aimed to prove that angiotensin-converting enzyme inhibitors (ACEI) could improve sinu... more This study aimed to prove that angiotensin-converting enzyme inhibitors (ACEI) could improve sinus rhythm maintenance after electrical or chemical conversion of atrial fibrillation (AF). Methods: A prospective study of 36 patients with lone AF which undertook chemical or electrical conversion was conducted. Group 1 included 20 patients treated exclusively with a class I C antiarrhythmic (Propafenone, 450 mg daily) and group 2 included 16 patients treated with antiarrhythmic plus ACEI pre- and after cardioversion. Results: These two groups were comparable, with mean age 56.2 +/- 11.8 vs. 57.7 +/- 6.1 years (P 0.709), onset of AF 2.47 +/- 3.72 vs. 5.5 +/- 7.37 months (P 0.205) and echocardiographic parameters: left atrium diameter 45.1 +/- 5.8 vs. 45.0 +/- 6.1 mm (P 0.995); LVTDV 48.5 +/- 5.0 vs. 48.6 +/- 6.4 mm (P 0.998); LVTSV 35.1 +/- 5.0 vs. 36.0 +/- 7.0 mm (P 0.737) and EF 59.0 +/- 6.9% vs. 54.8 +/- 6.1% (P 0.135). The patients were followed up clinically and electrocardiographically 12 months after conversion. Kaplan-Meier analysis showed a higher probability of remaining in sinus rhythm one year after cardioversion for group 2 compared to group 1 (37.5% vs. 20%). The mean time interval for the appearance of recurrences was significantly higher in patients treated with ACEI and antiarrhythmics compared to the patients treated only with antiarrhythmics (7.06 +/- 1.02 vs. 4.50 +/- 0.93 months; Breslow test (generalized Wilcoxon)--4.473, P 0.034). Conclusion: The addition of ACEI to an antiarrhythmic decreases the rate of AF recurrences and facilitates the maintenance of sinus rhythm after cardioversion.
European Heart Journal, Aug 1, 2018
Conclusion: This large multicentric and prospective registry confirmed the heterogeneity of CS in... more Conclusion: This large multicentric and prospective registry confirmed the heterogeneity of CS in terms of etiology, presentation and prognosis with a predominance of non-ischemic CS in practice. Funding Acknowledgements: Supported by a grant of the Fédération Francaise de cardiologie and unrestricted grants from Daiichi-Sankyo, Maquet SAS, Abiomed and Orion Pharma 2999 Twenty-year trends in the characteristic, management and outcome of patients with STEMI and out-of-hospital reanimation
Archive of Clinical Cases, Jun 1, 2017
Sick sinus syndrome encompasses a variety of EKG manifestations consisting of atrial bradyarrhyth... more Sick sinus syndrome encompasses a variety of EKG manifestations consisting of atrial bradyarrhythmias and tachyarrhythmias, alternating bradyarrhythmias and tachyarrhythmias as in tachycardia-bradycardia syndrome. Supraventricular tachyarrhythmias that can occur include atrial flutter, atrial fibrillation, atrial tachycardia and paroxysmal supraventricular tachycardia, although there is no direct causal relation between paroxysmal supraventricular tachycardia and sinus node disease. Atrioventricular node re-entry is a common cause of paroxysmal supraventricular tachycardia episodes. We present the case of a 70 year old female, hospitalized for atypical chest pain and dizziness when walking. The EKG on admission showed sinus bradyarrhythmia, anterior fascicular block, atrial and ventricular extrasystoles. During the hospitalization the patient presented an episode of palpitations, narrow complex tachycardia being registered on the EKG, with no response to the Valsalva maneuver or intravenous beta blocker. The tachyarrhythmia ceased spontaneously after one hour. 24 hour Holter EKG was performed and confirmed sinus node dysfunction. The electrophysiological study identified paroxysmal supraventricular tachycardia due to atrioventricular nodal reentrant tachycardia, which was successfully treated by ablating the slow intranodal pathway. Therefore, in a case of sick sinus syndrome when the patient's symptoms cannot be attributed to the bradycardia, but to the tachyarrythmic episodes, it is often most efficient to treat the patient's paroxysmal supraventricular tachycardia by radiofrequency ablation, rather than using cardiac pacing.
PubMed, Apr 19, 2005
An 11 year-old boy was admitted with incessant sinus node reentrant tachycardia and secondary dil... more An 11 year-old boy was admitted with incessant sinus node reentrant tachycardia and secondary dilated arrhythmic cardiomyopathy, treated by radiofrequency ablation. Two years later he was admitted with incessant automatic atrial tachycardia and arrhythmic cardiomyopathy; a second catheter ablation procedure failed, but the third one, performed four month later, was successfully and resulted in a restoration of a normal sinus rhythm and a complete regression of arrhythmic cardiomyopathy.
This study aimed to prove that angiotensin-converting enzyme inhibitor (ACEI) could improve sinus... more This study aimed to prove that angiotensin-converting enzyme inhibitor (ACEI) could improve sinus rhythm maintenance after conversion of atrial fibrillation (AF). A study of 36 patients with lone AF who undertook electrical conversion was conducted. Group 1 included 20 patients treated exclusively with a class I C antiarrhythmic (Propafenona, 450 mg daily) and group 2 included 16 patients treated with antiarrhythmic plus ACEI after cardioversion. These two groups were comparable, with mean age 56.2+/-11.8 vs. 57.7+/-6.1 years (P 0.709), onset of AF 2.47+/-3.72 vs. 5.5+/-7.37 months (P 0.205) and echocardiografic parameters: left atrium diameter 45.1+/-5.8 vs. 45.0+/-6.1 mm (P 0.995); LVTDV 48.5+/-5.0 vs. 48.6+/-6.4 mm (P 0.998); LVTSV 35.1+/-5.0 vs. 36.0+/-7.0 mm (P 0.737) and EF 59.0+/-6.9% vs. 54.8+/-6.1% (P 0.135). The patients were followed up clinically and electrocardiographically 12 months after conversion. Kaplan-Meier analysis showed a higher probability of remaining in sinus rhythm one year after cardioversion for group 2 compared to group 1 (37.5% vs. 20%). The mean time interval for the appearance of recurrences was significantly higher in patients treated with ACEI and antiarrhythmics compared to the patients treated only with antiarrhythmics (7.06+/-1.02 vs. 4.50+/-0.93 months; Breslow test (generalized Wilcoxon) - 4.473, P 0.034). The addition of ACEI to an antiarrhythmic decreases the rate of AF recurrences and facilitates the maintenance of sinus rhythm after cardioversion.
PubMed, Apr 19, 2005
It is well known that the radiofrequency catheter ablation (RFCA) treatment of cardiac arrhythmia... more It is well known that the radiofrequency catheter ablation (RFCA) treatment of cardiac arrhythmias is effective and devoid of significant complications. However, in our country, the experience of this technique is not so large and requires more clinical studies to validate it. Objectives: The aim of this was to present our experience in the RFCA of cardiac tachycardias. Methods: Between July 2002 and February 2003, in Iaşi Cardiology Center, we performed a total of 79 diagnosis procedures. Of these 57 (72%) were radiofrequency ablation procedures at 51 patients, mean age 48 +/- 16 years (12-81), men majority 32 (63%). The electrophysiology diagnosis was: 22 (39%) common atrial flutter, 3 (5%) atrial tachycardias, 13 (23%) atrioventricular nodal reentrant tachycardia, 12 (21%) Wolff-Parkinson-White syndrome, 4 (7%) orthodromic tachycardia using concealed accessory pathway, 2 (3%) ventricular tachycardias and 1 (2%) ablation of the atrioventricular junction. Results: The initial ablation procedure was effective in 44/ 51 patients (86%), with a total duration of 130 +/- 42 min, using 24 +/- 10 min of radioscopy. During follow-up 13 +/- 1.3 (11-16 months), recurrence occurred in 7 patients 14%. In 7 of them a second effective procedure was performed in 4 patients. Finally, radiofrequency ablation was effective in 48/51 of patients (94%), improving the procedural success rate at 95% (54/57 patients). No complications occurred during follow-up. Conclusion: The treatment of cardiac arrhythmias by radiofrequency catheter ablation is effective and safe and is the only way to cure the supraventricular and ventricular tachyarrhythmias.
Pacing and Clinical Electrophysiology, Mar 1, 2009
We examined the possible role of atrioventricular node (AVN) conduction abnormalities as a cause ... more We examined the possible role of atrioventricular node (AVN) conduction abnormalities as a cause of AVN reentrant tachycardia (RT) in patients >65 years of age. Study Population: Slow pathway radiofrequency catheter ablation (RFCA) was performed in 104 patients. Patients in group 1 (n = 14) were >65 years of age and had AV conduction abnormalities associated with structural heart disease. Patients in group 2 (n = 90) were <65 years of age and had lone AVNRT. Results: Patients in group 1 versus group 2 (66% vs. 46% men) had a first episode of tachycardia at an older age than in
Romanian Journal of Cardiology, 2021
A 45-year-old male, hypertensive and obese presented with a 3-months history of short episodes of... more A 45-year-old male, hypertensive and obese presented with a 3-months history of short episodes of intermittent palpitations. Clinical examination was unremarkable; however, the electrocardiogram documented major right bundle branch block and the presence of fragmented QRS in all precordial leads. His echocardiography documented a dilated left ventricle, with mild systolic dysfunction and moderate biventricular reduction of the global longitudinal strain. On angiography, the epicardial coronary arteries were normal. A cardiac MRI revealed diffuse transmural fi brotic lesions with non ischemic pattern of the ventricles, suggestive of chronic myocarditis. The electrophysiological study induced two ventricular tachycardia morphologies which were ablated and an ICD for sudden cardiac death primary prevention was implanted. Fortunately, at 6 months follow-up our patient had no ICD therapies and reported an alleviation of symptoms.
Romanian Journal of Pediatrics, 2015
Primary cardiac arrhythmias are much less common in infants and children than in adults, their sy... more Primary cardiac arrhythmias are much less common in infants and children than in adults, their symptoms can be vague and nonspecific. Although real emergencies because of unstable arrhythmias in children are rare, it is important to identify and properly manage these cases. The study presents the case of a child who was admitted for respiratory symptoms, clinical examination discovering the heart rate of 214 bpm. The child became progressively anxious, showing a respiratory effort. The study of electrocardiogram established the diagnosis of anterior fascicular ventricular tachycardia with a tendency to become permanent. The evolution was favorable after the electrical cardioversion and preventive treatment with Verapamil had been performed.
We aimed to assess reverse left atrial (LA) remodeling at 6 months after ablation of paroxysmal a... more We aimed to assess reverse left atrial (LA) remodeling at 6 months after ablation of paroxysmal atrial fibrillation (AF), and to identify the most relevant parameter of reverse LA remodeling. Ma-terial and methods: Left atrial size was assessed by echocardiography: antero-posterior (AP) diameter, LA area in apical 4 and 2 chambers (A4c, A2c), LA volume by biplane for-mula (LAV1), and by computed-tomography (LAV2). Results: Seventy-eight consecutive patients with mean age of 57.41 ± 8.05 years were prospectively included; 60 (76.9%) were with paroxysmal AF less than 24 hours and 18 (23.1%) less than 7 days duration. All echo-cardiographic and computed-tomographic evaluations were made within 4 weeks before ab-lation and at 6 months after ablation procedure by the same operator. Circumferential or segmental pulmonary vein isolation was performed by radiofrequency in 58 (74.4%) pa-tients, and by cryotherapy in 18 (23.1%) patients. At 6 months 53 (67.9%) patients were in stable sinus rh...
Anatolian journal of cardiology, 2018
Postoperative atrial fibrillation (POAF) is the most common complication following cardiac surger... more Postoperative atrial fibrillation (POAF) is the most common complication following cardiac surgery, with increased risk of stroke and high mortality. Our aim was to identify patients at risk and to design a model that could predict POAF. In this single center study, we evaluated 1191 patients requiring isolated surgical aortic valve replacement between January 2000 and June 2014. The patients were followed during the early postoperative period until discharge. AF occurred in 342 patients (28.71%). Six variables associated with high arrhythmic risk [advanced age, body mass index, tricuspid regurgitation, prolonged ventilation, longer intensive care unit stay, and dilated left atrium (LA; volume ≥35 ml/m2)] were selected to create a multivariate prediction model. This model predicted POAF in 64.7% of cases, with a moderate discriminative power (AUC=0.65; p=0.001; 95% CI, 0.571-0.771). We also developed the CHAID (Chi-square automatic interaction detection) model showing multilevel int...
Archive of Clinical Cases, 2017
Archive of Clinical Cases, 2017
Dilated cardiomyopathy is associated with ventricular arrhythmias and with an increased risk of s... more Dilated cardiomyopathy is associated with ventricular arrhythmias and with an increased risk of sudden cardiac death. In these cases, wide complex tachyarrhythmias are frequently a diagnostic challenge. The efficiency of antiarrhythmic drug therapy is limited and often the implantation of a cardiac defibrillator is required. We hereby present the case of a 68 year old male patient known with dilated cardiomyopathy, who experienced a syncopal episode as the clinical expression of a wide complex tachycardia. The recorded electrocardiogram identified ventricular tachycardia originated in the right ventricle or in the interventricular septum. The electrocardiograms recorded before and after the syncopal episode showed a major left bundlebranch block and a first degree atrioventricular block. 24-hour Holter ECG monitoring detected ventricular tachycardia originating in the left ventricle. The etiology of the dilated cardiomyopathy, arrhythmias and conduction abnormalities could not be identified. During the electrophysiological study, no sustained supraventricular or ventricular tachyarrhythmias were triggered. The pharmacological treatment has been optimized and a cardiac defibrillator was implanted. The particularity of this case consists in the presence of multiple rhythm disturbances originating both in the left and right ventricle, in a patient with idiopathic dilated cardiomyopathy and conduction disturbances at several levels.
Archive of Clinical Cases, 2017
Sick sinus syndrome encompasses a variety of EKG manifestations consisting of atrial bradyarrhyth... more Sick sinus syndrome encompasses a variety of EKG manifestations consisting of atrial bradyarrhythmias and tachyarrhythmias, alternating bradyarrhythmias and tachyarrhythmias as in tachycardia-bradycardia syndrome. Supraventricular tachyarrhythmias that can occur include atrial flutter, atrial fibrillation, atrial tachycardia and paroxysmal supraventricular tachycardia, although there is no direct causal relation between paroxysmal supraventricular tachycardia and sinus node disease. Atrioventricular node re-entry is a common cause of paroxysmal supraventricular tachycardia episodes. We present the case of a 70 year old female, hospitalized for atypical chest pain and dizziness when walking. The EKG on admission showed sinus bradyarrhythmia, anterior fascicular block, atrial and ventricular extrasystoles. During the hospitalization the patient presented an episode of palpitations, narrow complex tachycardia being registered on the EKG, with no response to the Valsalva maneuver or intravenous beta blocker. The tachyarrhythmia ceased spontaneously after one hour. 24 hour Holter EKG was performed and confirmed sinus node dysfunction. The electrophysiological study identified paroxysmal supraventricular tachycardia due to atrioventricular nodal reentrant tachycardia, which was successfully treated by ablating the slow intranodal pathway. Therefore, in a case of sick sinus syndrome when the patient's symptoms cannot be attributed to the bradycardia, but to the tachyarrythmic episodes, it is often most efficient to treat the patient's paroxysmal supraventricular tachycardia by radiofrequency ablation, rather than using cardiac pacing.
Archive of Clinical Cases, 2017
Electrical storm represents a major clinical emergency characterized by electrical heart instabil... more Electrical storm represents a major clinical emergency characterized by electrical heart instability with several recurrent episodes of ventricular arrhythmias over a short period of time. We present the case of a 67year old male, hypertensive, diabetic who was referred to the cardiology department after a resuscitated cardiac arrest through sustained ventricular tachycardia. The echocardiography revealed a severe aspect of dilated cardiomyopathy and fibrotic aspect of inferior-posterior wall of the left ventricle. The ischemic coronary cause has been ruled out by coronary computed tomography. An implantable cardioverter defibrillator (ICD) was implanted. One day after, the electrical storm and hemodynamically stability worsened requiring high dosage of amiodarone, putting therapies of ICD on "off" and the intubation of the patient. Taking all into account, an urgent electrophysiological study was performed and led to complex radiofrequency catheter ablation of the substrate of the lateral, medium-ventricular wall. Afterwards, the electrical storm did not reappear, the ICD therapies were put on "on" and the patient was rapidly extubated, being discharged with pharmacological recommendations, the milestone being the anti-arrhythmic treatment. Though the treatment of electrical storm is complex but still unclearly defined, we emphasize the need of applying all the therapeutical measures and having a prompt response to this life-threatening condition.
Archive of Clinical Cases, 2017
In spite of the available clinical and electrocardiographic criteria for the differential diagnos... more In spite of the available clinical and electrocardiographic criteria for the differential diagnosis of wide QRS complex tachycardias, distinguishing orthodromic supraventricular tachycardias is still a challenge. We present a case of a 63-year old patient admitted in our clinic after experiencing two episodes of syncope. Echocardiography showed left ventricular hypertrophy, grade 1 diastolic dysfunction and left atrial enlargement. A Holter monitoring revealed episodes of atrial fibrillation and paroxysmal narrow QRS tachycardia alternating with wide QRS tachycardia (170-180 bpm). During an electrophysiology study we induced self-limiting orthodromic supraventricular tachycardias with narrow and left bundle branch block patterns. Retrograde mapping near the mitral annulus identified a concealed accessory posteroseptal bypass tract which was successfully ablated. After the procedure the patient developed atrial flutter and atrial fibrillation with rapid ventricular response (196 beats per minute) with a 3.9 s post-tachycardia pause. The patient underwent implantation of a cardiac pacemaker which allowed us to start antiarrhythmic treatment with amiodarone. This case shows that occult accessory posteroseptal bypass tracts can have a late-onset presentation in a 63-year old male and explains why latent rhythm disturbances require a step-by-step medical approach.
Romanian journal of internal medicine = Revue roumaine de médecine interne, 2007
This study aimed to prove that angiotensin-converting enzyme inhibitor (ACEI) could improve sinus... more This study aimed to prove that angiotensin-converting enzyme inhibitor (ACEI) could improve sinus rhythm maintenance after conversion of atrial fibrillation (AF). A study of 36 patients with lone AF who undertook electrical conversion was conducted. Group 1 included 20 patients treated exclusively with a class I C antiarrhythmic (Propafenona, 450 mg daily) and group 2 included 16 patients treated with antiarrhythmic plus ACEI after cardioversion. These two groups were comparable, with mean age 56.2+/-11.8 vs. 57.7+/-6.1 years (P 0.709), onset of AF 2.47+/-3.72 vs. 5.5+/-7.37 months (P 0.205) and echocardiografic parameters: left atrium diameter 45.1+/-5.8 vs. 45.0+/-6.1 mm (P 0.995); LVTDV 48.5+/-5.0 vs. 48.6+/-6.4 mm (P 0.998); LVTSV 35.1+/-5.0 vs. 36.0+/-7.0 mm (P 0.737) and EF 59.0+/-6.9% vs. 54.8+/-6.1% (P 0.135). The patients were followed up clinically and electrocardiographically 12 months after conversion. Kaplan-Meier analysis showed a higher probability of remaining in sin...
Revista medico-chirurgicală̆ a Societă̆ţ̜ii de Medici ş̧i Naturaliş̧ti din Iaş̧i
Calcium channel blockers are the only vasodilators that proved their efficiency in idiopathic pul... more Calcium channel blockers are the only vasodilators that proved their efficiency in idiopathic pulmonary hypertension (IPH). However, not every patient is responsive to this therapy. Only in isolated cases of IPH was proved the good effect of prostaglandins in lowering the pulmonary pressure by inhibiting the proliferation of smooth muscle cells. The follow up of a patient, male, 66 years, with IPH, NYHA IV class global cardiac decompensation, mostly the right heart, cyanotic, with 85% SaO2 at rest, massive edema, with "hair cut" aspect of pulmonary circulation, cardiomegaly assessed radiologically (CTI 0.55) and echocardiographically (important dilation of right heart chambers, RV 50/44 mm, compressing the left heart chambers, IVth grade tricuspid insufficiency and 160/90 mmHg pulmonary pressure) is presented. It was excluded a secondary cause of pulmonary hypertension, both by echocardiography and by cardiac catheterization, which eventually confirms the angiographic diag...
Revista medico-chirurgicală̆ a Societă̆ţ̜ii de Medici ş̧i Naturaliş̧ti din Iaş̧i
An 11 year-old boy was admitted with incessant sinus node reentrant tachycardia and secondary dil... more An 11 year-old boy was admitted with incessant sinus node reentrant tachycardia and secondary dilated arrhythmic cardiomyopathy, treated by radiofrequency ablation. Two years later he was admitted with incessant automatic atrial tachycardia and arrhythmic cardiomyopathy; a second catheter ablation procedure failed, but the third one, performed four month later, was successfully and resulted in a restoration of a normal sinus rhythm and a complete regression of arrhythmic cardiomyopathy.
Revista medico-chirurgicală̆ a Societă̆ţ̜ii de Medici ş̧i Naturaliş̧ti din Iaş̧i
It is well known that the radiofrequency catheter ablation (RFCA) treatment of cardiac arrhythmia... more It is well known that the radiofrequency catheter ablation (RFCA) treatment of cardiac arrhythmias is effective and devoid of significant complications. However, in our country, the experience of this technique is not so large and requires more clinical studies to validate it. The aim of this was to present our experience in the RFCA of cardiac tachycardias. Between July 2002 and February 2003, in Iaşi Cardiology Center, we performed a total of 79 diagnosis procedures. Of these 57 (72%) were radiofrequency ablation procedures at 51 patients, mean age 48 +/- 16 years (12-81), men majority 32 (63%). The electrophysiology diagnosis was: 22 (39%) common atrial flutter, 3 (5%) atrial tachycardias, 13 (23%) atrioventricular nodal reentrant tachycardia, 12 (21%) Wolff-Parkinson-White syndrome, 4 (7%) orthodromic tachycardia using concealed accessory pathway, 2 (3%) ventricular tachycardias and 1 (2%) ablation of the atrioventricular junction. The initial ablation procedure was effective in...