Browsing by Author "Mujović, Nataša (22941523800)"

Introduction Atrioventricular (AV) junction ablation coupled with pacemaker implantation is an effective therapeutic option for rate control in atrial fibrillation (AF) and heart failure (HF). However, there is controversy regarding the long-term outcome of the procedure, since right ventricular stimulation can lead to left ventricular remodelling and HF. Objective The aim of the study was to determine a 5-year outcome of the procedure on survival, HF control and myocardial function in patients with HF and uncontrolled AF. Methods All patients with AF and HF who underwent AV-junction ablation with pacemaker implantation in our institution ere followed after the procedure. HF diagnosis was established if ≥2 of the following criteria were present: 1) ejection fraction (EF) ≤45%; 2) previous episode of congestive HF (CHF); 3) NYHA-class ≥2; and 4) use of drug-therapy for HF. Results Study included 32 patients (25 males; 53.4±9.6 years). The mean heart rate was 121±25 bpm before and 75±10 bpm after ablation (p=0.001). Over the follow-up of 5.0±4.0 years nine patients (28.1%) died (five died suddenly, three of terminal CHF and one of stroke). After the procedure, CHF occurrence was reduced (p=0.001), as well as the annual number of hospitalizations (p=0.001) and the number of drugs for CHF (p=0.028). In addition, NYHA-class and EF were improved, from 3.3±0.7 to 1.6±0.8 (p<0.001) and from 39±11% to 51±10% (p<0.001), respectively. Conclusion In HF patients with uncontrolled AF, 5-year mortality after AV-junction ablation and pacemaker implantation was 28%. In the majority of these patients good rate of AF and HF control were achieved, as well as the improvement of functional status and myocardial contractility.

Modifiable risk factors, such as cardiometabolic and lifestyle risk factors, considerably contribute to (bi)atrial remodeling, finally resulting in clinical occurrence of atrial fibrillation (AF). Early identification and prompt intervention on these risk factors may delay further progression of atrial arrhythmia substrate and prevent the occurrence of new.onset AF. Moreover, in patients with previous history of recurrent AF, aggressive risk factor management may improve efficacy of other rhythm control strategies, including antiarrhythmic drugs and catheter ablation in sinus rhythm maintenance. Finally, modification of risk factors improves overall health and reduces cardiovascular mortality and morbidity. The first part of this review evaluates the association between AF and the following risk factors: hypertension, diabetes mellitus, physical activity, and cigarette smoking. We systematically discuss the impact of risk factor modification on primary and secondary prevention of AF. © 2020 by the Author(s).

Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with increased risk of death, stroke, and heart failure. Prevalence and incidence of AF are rising due to better overall medical treatment, longer survival, and increasing incidence of cardiometabolic and lifestyle risk factors. Treatment of AF and AF-related complications significantly increases healthcare costs. In addition, the use of conventional rhythm control strategies (including, antiarrhythmic drugs and catheter ablation) is associated with limited efficacy for sinus rhythm maintenance and serious adverse effects. Aggressive cardiometabolic risk factor management may prevent incident as well as recurrent AF, improve overall health, and reduce mortality. Therefore, modifiable risk factor management became one of the 3 treatment pillars in AF management along with anticoagulation as well as conventional rate and rhythm control strategies. The second part of this review systematically discusses the association between AF and potentially modifiable risk factors for AF, such as obesity, obstructive sleep apnea, alcohol consumption, and dyslipidemia. We also provide practical guidelines for the risk factor management with respect to primary and secondary prevention of AF. © 2020 by the Author(s).

Introduction. Inflammatory myofibroblastic tumor (IMT) is a rare neoplasm. This disease, of unknown etiology, runs an unpredictable course. Its definitive diagnosis calls for a detailed histopathological analysis including immunohistochemistry. Microscopically, IMT is composed of myofibroblastic spindle and inflammatory cells in different proportions. It presents infrequently in adults with nonspecific symptomatology. The presence of IMT is described in every anatomical region but the tracheal one is especially uncommon. Case report. A 41year-old female patient checked into our institution due to exacerbation of asthma-like symptoms such as shortness of breath, cough and exertion intolerance. She was originally treated as the asthmatic patient with the bronchodilator therapy with no success. Chest x-ray done during one of the outpatient follow-up appointments pointed to a suspected change in the tracheal distal part. After her admission to our institution, the following diagnostic procedures were performed: Spirometry, chest computed tomography (CT) scan, chest magnetic resonance imaging (MRI) and bronchoscopy and the change in tracheal distal third was confirmed. Right-sided thoracotomy with mobilization of lung, tracheal resection and termino-terminal (T-T) anastomosis was undertaken. Subsequent histopathological analysis of surgically removed afflicted tracheal part of them trachea including immunohistochemistry enabled us to definitively of diagnose IMT. Four years after surgical resection, the patient showed no recidivism of illness. Conclusion. Definitive IMT diagnosis requires the detailed diagnostic tests, most importantly, an adequate histopathological analysis including immunohistochemistry. Complete surgical resection is the treatment of choice in case of IMT. Further monitoring of patients is necessary due to a risk of recurrence. © 2019, Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.