Attila Kardos

Publications (25)62.57 Total impact

• Article: [Percutaneous left atrial appendage closure after resolution of left atrial appendage thrombi with dabigatran].

  Zsuzsanna Kis, Csaba Földesi, Mátyás Pál, Zoltán Som, Andrea Csillik, Pál Abrahám, András Temesvári, Géza Fontos, András Szatmári, Péter Andréka, Attila Kardos
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  ABSTRACT: The "gold standard" of the prevention of atrial fibrillation related thromboembolic events is anticoagulation therapy with oral vitamin K antagonists. A certain proportion of high-risk patients with atrial fibrillation are not receiving effective antithrombotic therapy because of problems associated with its use. Resolution of subsequent left atrial appendage thrombi is quite a great challenge in patients who are not tolerating "standard" antithrombotic drugs. According to the knowledge of the authors, this is the first report of a patient with non-valvular persistent atrial fibrillation and high stroke risk, who was intolerant to "standard" anticoagulant therapy and had persistent left atrial appendage thrombi following the use of a wide variety of "standard" anticoagulants. Successful resolution of left atrial appendage thrombi with dabigatran and successful percutaneous left atrial appendage closure were performed in this case. Orv. Hetil., 2013, 154, 262-265.
  Orvosi Hetilap 02/2013; 154(7):262-5.
• Source

  Available from: Attila Mihalcz

  Article: Could successful cryoballoon ablation of paroxysmal atrial fibrillation prevent progressive left atrial remodeling?

  Tamás Erdei, Mónika Dénes, Attila Kardos, Attila Mihálcz, Csaba Földesi, András Temesvári, Mária Lengyel
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  ABSTRACT: Radiofrequency catheter ablation of atrial fibrillation (AF) has been proved to be effective and to prevent progressive left atrial (LA) remodeling. Cryoballoon catheter ablation (CCA), using a different energy source, was developed to simplify the ablation procedure. Our hypothesis was that successful CCA can also prevent progressive LA remodeling. 36 patients selected for their first CCA because of nonvalvular paroxysmal AF had echocardiography before and 3, 6 and 12 months after CCA. LA diameters, volumes (LAV) and LA volume index (LAVI) were evaluated. LA function was assessed by: early diastolic velocities of the mitral annulus (Aa(sept), Aa(lat)), LA filling fraction (LAFF), LA emptying fraction (LAEF) and the systolic fraction of pulmonary venous flow (PVSF). Detailed left ventricular diastolic function assessment was also performed. Excluding recurrences in the first 3-month blanking period, the clinical success rate was 64%. During one-year of follow-up, recurrent atrial arrhythmia was found in 21 patients (58%). In the recurrent group at 12 months after ablation, minimal LAV (38 ± 19 to 44 ± 20 ml; p < 0.05), maximal LAV (73 ± 23 to 81 ± 24 ml; p < 0.05), LAVI (35 ± 10 to 39 ± 11 ml/m2; p = 0.01) and the maximal LA longitudinal diameter (55 ± 5 to 59 ± 6 mm; p < 0.01) had all increased. PVSF (58 ± 9 to 50 ± 10%; p = 0.01) and LAFF (36 ± 7 to 33 ± 8%; p = 0.03) had decreased. In contrast, after successful cryoballoon ablation LA size had not increased and LA function had not declined. In the recurrent group LAEF was significantly lower at baseline and at follow-up visits. In patients whose paroxysmal atrial fibrillation recurred within one year after cryoballoon catheter ablation left atrial size had increased and left atrial function had declined. In contrast, successful cryoballoon catheter ablation prevented progressive left atrial remodeling.
  Cardiovascular Ultrasound 03/2012; 10:11. · 1.26 Impact Factor
• Article: Comparison of the efficacy of two surgical alternatives for cardiac resynchronization therapy: trans-apical versus epicardial left ventricular pacing.

  Attila Mihalcz, Imre Kassai, Attila Kardos, Csaba Foldesi, Dominic Theuns, Tamas Szili-Torok
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  ABSTRACT: Epicardial pacing lead implantation is the currently preferred surgical alternative for left ventricular (LV) lead placement. For endocardial LV pacing, we developed a fundamentally new surgical method. The trans-apical lead implantation is a minimally invasive technique that provides access to any LV segments. The aim of this prospective randomized study was to compare the outcome of patients undergoing either trans-apical endocardial or epicardial LV pacing. In group I, 11 end-stage heart failure (HF) patients (mean age 59.7 ± 7.9 years) underwent trans-apical LV lead implantation. Epicardial LV leads were implanted in 12 end-stage HF patients (group II; mean age 62.8 ± 7.3 years). Medical therapy was optimized in all patients. The following parameters were compared during an 18-month follow-up period: LV ejection fraction (LVEF), LV end-diastolic diameter (LVEDD), LV end-systolic diameter, and New York Heart Association (NYHA) functional class. Nine out of 11 patients responded favorably to the treatment in group I (LVEF 39.7 ± 12.5 vs 26.0 ± 7.8%, P < 0.01; LVEDD 70.4 ± 13.6 mm vs 73.7 ± 10.5 mm, P = 0.002; NYHA class 2.2 ± 0.4 vs 3.5 ± 0.4, P < 0.01) and eight out of 12 in group II (LVEF 31.5 ± 11.5 vs 26.4 ± 8.9%, P = < 0.001; NYHA class 2.7 ± 0.4 vs 3.6 ± 0.4, P < 0.05). During the follow-up period, one patient died in group I and three in group II. There was one intraoperative LV lead dislocation in group I and one early postoperative dislocation in each group. None of the patients developed thromboembolic complications. Our data suggest that trans-apical endocardial LV lead implantation is an alternative to epicardial LV pacing.
  Pacing and Clinical Electrophysiology 02/2012; 35(2):124-30. · 1.35 Impact Factor
• Article: The diagnostic performance of non-contrast T1-mapping in patients with acute myocarditis on cardiovascular magnetic resonance imaging.

  Vanessa Ferreira, Stefan K Piechnik, Erica Dall'armellina, Theodoros Karamitsos, Jane M Francis, Robin P Choudhury, Attila Kardos, Matthias G Friedrich, Matthew D Robson, Stefan Neubauer
  Journal of Cardiovascular Magnetic Resonance 02/2012; 14 Suppl 1:P179. · 3.72 Impact Factor
• Article: [Cardiac resynchronization therapy for patients with atrial fibrillation].

  Attila Mihálcz, Pál Abrahám, Attila Kardos, Csaba Földesi, Tamás Szili-Török
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  ABSTRACT: Atrial fibrillation and chronic heart failure are two major and even growing cardiovascular conditions that often coexist. Cardiac resynchronization therapy is an important, device-based, non-pharmacological approach in a selected group of chronic heart failure patients that has been shown to improve left ventricular function and to reduce both morbidity and mortality in large randomized trials. The latest European and American guidelines have considered atrial fibrillation patients with heart failure eligible for cardiac resynchronization therapy. This review summarizes current literature concerning the following topics: prognostic relevance of atrial fibrillation in heart failure, effects of cardiac resynchronization therapy in atrial fibrillation, relevance and strategies of rhythm and rate control in this group of patients. Authors explain how atrial fibrillation may interfere with the delivery of adequate cardiac resynchronization therapy, how to reduce the burden of atrial tachyarrhythmias, and finally present a brief overview.
  Orvosi Hetilap 10/2011; 152(44):1757-63.
• Article: Coupled pacing controls rapid heart rates better than paired pacing during atrial fibrillation.

  Attila Kardos, Pal Abraham, Attila Mihalcz, Csaba Foldesi, Tamas Szili-Torok
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  ABSTRACT: Delivery of a ventricular extrastimulus shortly after the effective refractory period (ERP) of a sensed (coupled pacing; CP) or a paced (paired pacing; PP) ventricular event can instantly decrease the mechanical pulse rate (MPR) during rapidly conducting atrial fibrillation (AF). We compared the short-term rate-controlling effects of CP and PP during AF with rapid ventricular rates. Sixteen patients with ongoing, spontaneous AF were examined. Mechanical pulse rate was registered via arterial pressure tracings. During CP a coupling interval (CI) of ERP+20 ms was used to reach an optimal haemodynamic effect. Paired pacing was started at a basic cycle length (CL) of 500 ms followed by an extrastimulus with an CI of ERP+20 ms. Drive train was changed at 50 ms increments until the lowest MPR was reached. Proarrhythmic effects were characterized by the number of premature ventricular complexes (PVCs). Mechanical pulse rate significantly decreased in all patients during CP (113 ± 9 vs. 58 ± 4/min). Using CP the controlled rhythm remained irregular (CL range: 896 ± 24-1452 ± 67 ms) while no PVCs were observed. With different drive trains PP resulted in different regular MPRs (range 62 ± 6-80 ± 4/min), but the lowest MPR achieved was significantly higher in the PP group than in the CP. Paired pacing caused premature beats in nine patients (56%) resulting in loss of continuous MPR control. Both CP and PP can reduce the MPR during rapidly conducting AF. Coupled pacing is more applicable, but PP has the advantage to achieve different target heart rates. Paired pacing has more proarrhythmic effects as compared with CP.
  Europace 09/2011; 14(4):481-5. · 1.98 Impact Factor
• Article: Extrasystolic stimulation with bi-ventricular pacing: an acute haemodynamic evaluation.

  Berthold Stegemann, Attila Mihalcz, Csaba Földesi, Radu Vatasescu, Attila Kardos, Zsolt Török, Vince Splett, Richard Cornelussen, Laszlo Rudas, Tamas Szili-Török
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  ABSTRACT: Cardiac resynchronization therapy (CRT) by means of biventricular pacing (BiVP) is well established as a treatment for patients with heart failure (HF). Post-extrasystolic potentiation, (PESP) which involves a transient increase in myocardial contractility following a ventricular extrasystole, can be achieved using extrasystolic stimulation (ESS). On this basis, ESS has been proposed as a therapeutic. We assessed acute haemodynamic effects of ESS in the context of BiVP. Patients (n = 15, left ventricular ejection fraction < 40%, QRS ≥ 125 ms) with HF, received BiVP in combination with right ventricular (RV) ESS (single stimulus or pulse train). Left ventricular (LV) and peripheral arterial pressures were recorded and dP/dt was monitored. Addition of RV ESS to BiVP pacing led to a 21% increase in maximum (max) dP/dt (P < 0.001) and an 8.5 mm Hg increase in a systolic arterial pressure (P < 0.001). The modest fall in end-diastolic pressure (3.3 mmHg, P < 0.001) observed during ESS and BiVP was prevented by maintaining baseline sinus rate. Varying ESS modes or pacing outputs was not associated with differences in haemodynamic parameters. Biventricular pacing in combination with ESS, with maintenance of sinus rate, improves myocardial contractility in patients undergoing CRT.
  Europace 06/2011; 13(11):1591-6. · 1.98 Impact Factor
• Article: Indications and outcome of implantable cardioverter-defibrillators for primary and secondary prophylaxis in patients with noncompaction cardiomyopathy.

  Kadir Caliskan, Tamas Szili-Torok, Dominic A M J Theuns, Attila Kardos, Marcel L Geleijnse, Aggie H M M Balk, Ron T van Domburg, Luc Jordaens, Maarten L Simoons
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  ABSTRACT: Noncompaction cardiomyopathy (NCCM) is a rare, primary cardiomyopathy, with initial presentation of heart failure, emboli, or arrhythmias, including sudden cardiac death. Implantable cardioverter-defibrillators (ICDs) are frequently used for primary and secondary prevention in different cardiomyopathy patients, but data about ICD in NCCM are scarce. The aim of this study was, therefore, to investigate ICD indications and outcomes in NCCM patients. We collected prospective data from our NCCM cohort (n = 77 pts, mean age: 40 ± 14 years). ICD was implanted in 44 (57%) patients with NCCM according to the current ICD guidelines for nonischemic cardiomyopathies: in 12 for secondary prevention (7 × ventricular fibrillation, 5 × sustained ventricular tachycardia [VT]) and in 32 patients for primary prevention (heart failure/severe LV dysfunction). During a mean follow-up of 33 ± 24 months, 8 patients presented with appropriate ICD shocks due to sustained VT after median 6.1 [1-16] months. This included 4 of 32 (13%) patients in the primary prevention group and 4 of 12 (33%) in the secondary prevention group (P = 0.04). 9 patients presented with inappropriate ICD therapy: 6 (19%) in the primary and 3 (25%) in the secondary prevention group, at a median follow-up of 4 (2-23) months. In our cohort of NCCM patients, an ICD was frequently implanted for primary or secondary prevention of sudden cardiac death. At follow-up, frequent appropriate ICD therapy was observed in both groups, supporting the application of current ICD guidelines for primary and secondary prevention of sudden cardiac death in NCCM.
  Journal of Cardiovascular Electrophysiology 02/2011; 22(8):898-904. · 3.06 Impact Factor
• Article: Double intra-atrial connections in a patient late after orthotopic heart transplantation.

  Tamas Bauernfeind, Kadir Caliskan, Attila Kardos, Aggie H M M Balk, Luc Jordaens, Tamas Szili-Torok
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  ABSTRACT: Atrial tachycardias occurring late after orthotopic heart transplantation are frequently caused by an ongoing atrial tachycardia in the recipient remnant atrium that is associated with intra-atrial muscle band connections between the 2 atrial compartments. The standard approach for most centers that treat these patients is to identify and disconnect these intra-atrial connections. We present a patient where double intra-atrial connections were capable of different degrees of stimulus propagation from the recipient remnant atrium to the donor atrial compartment. After the ablation of both intra-atrial connections, we also ablated the index arrhythmia in the recipient remnant atrium. This case presentation draws attention to the possibility of the presence of multiple intra-atrial connections.
  The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 03/2010; 29(6):700-3. · 3.54 Impact Factor
• Article: Empty handed: a call for an international registry of risk stratification to reduce the 'sudden-ness' of death in patients with non-compaction cardiomyopathy.

  Kadir Caliskan, Attila Kardos, Tamas Szili-Torok
  Europace 10/2009; 11(9):1138-9. · 1.98 Impact Factor
• Article: [Effectiveness of D,L-sotalol in post-ablative atrial arrhythmias in patients with atrial fibrillation treated with radiofrequency ablation].

  Attila Mihálcz, Csaba Földesi, Attila Kardos, Károly Ladunga, Tamás Szili-Török
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  ABSTRACT: Left atrial tachycardia is the most common arrhythmia developing after pulmonary vein (PV) isolation in patients with atrial fibrillation. Aim: To compare the clinical effectiveness of class Ic propafenone and class III D,L sotalol in antiarrhythmic treatment of post-ablation left atrial tachycardias. METHODS AND RESULTS: A total of 75 consecutive patients with an age of 55.4 +/- 7.14 (mean +/- SD) years underwent real electrical isolation of the pulmonary veins. Beside electroanatomical guidance, a circular mapping catheter was used to achieve total electrical disconnection of the pulmonary veins from left atrium at the antrum level. After procedure, the antiarrhythmic drug therapy was continued with the tendency to taper down during follow up visits. These were scheduled 1 and later 3 monthly after PV isolation. After the first 3 months follow-up period, left atrial tachycardia occurred in 21 patients (31.3 %). 11 of them were on propafenone therapy, 6 were on sotalol therapy and 4 patients with left atrial tachycardia received amiodarone. In the first and third group, after developing left atrial tachycardia, the 1C class drug or amiodarone was changed to III D,L sotalol. In the second group, after developing left atrial tachycardia, the III D,L sotalol was changed to 1C class drug. 9 months later, in III D,L sotalol treated group of left atrial tachycardia patients (15), the drug was considered effective in 12 patients. CONCLUSION: In prevention of left atrial tachycardia occurred after PV isolation, sotalol is not more effective than 1C class propafenone. Otherwise, III D,L sotalol seems to be effective in anti-arrhythmic treatment of developed post-ablation in late left atrial tachycardias.
  Orvosi Hetilap 10/2009; 150(36):1694-700.
• Article: A novel approach for endocardial resynchronization therapy: initial experience with transapical implantation of the left ventricular lead.

  Imre Kassai, Attila Mihalcz, Csaba Foldesi, Attila Kardos, Tamas Szili-Torok
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  ABSTRACT: Coronary sinus lead placement for transvenous left ventricular (LV) pacing in cardiac resynchronization therapy (CRT) has a significant failure rate at implant and a considerable dislocation rate during follow-up. For these patients epicardial pacing lead implantation is the most frequently used alternative. Recent data support endocardial lead implantation through the atrial septum and the mitral valve, because this method provides further hemodynamic advantages. On the other hand transseptal CRT carries a significant risk for device related infective endocarditis of the mitral valve. The aim of this prospective, nonrandomized study was to demonstrate the feasibility of a fundamentally new approach for endocardial LV lead implantation. We performed 12 transapical LV lead implantations in 10 end-stage heart failure patients. In each operation an active fixation lead was placed into the LV cavity using standard Seldinger technique through the LV apex. By use of a J-shaped guide wire, the tip of the lead was positioned and fixed into the basal-lateral segment of the LV under fluoroscopy guidance. Pacing parameters were assessed and found to be optimal in all patients. The lead was conducted through the chest wall near the apex into a subcutaneous tunnel up to the pocket of the previously implanted device. After surgery the patients are anticoagulated with target anticoagulation level identical to mechanical valve prostheses. In 8 patients there were no major or minor complications related to this new technique. During the follow-up period (mean 7.2 +/- 4.1 months) all patients responded favorably to the treatment. One lead dislocation and 1 pocket infection were detected; the lead repositioning and replacing could be performed without reopening of the pleural cavity. The potential advantages of this new technique are that it is minimally invasive, endocardial, and does not involve the mitral valve. LV lead repositioning can also be performed minimally invasively.
  Heart Surgery Forum 07/2009; 12(3):E137-40. · 0.63 Impact Factor
• Article: Cavotricuspid isthmus ablation with large-tip gold alloy versus platinum-iridium-tip electrode catheters.

  Attila Kardos, Csaba Foldesi, Attila Mihalcz, Tamas Szili-Torok
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  ABSTRACT: Gold has excellent electrical conductive properties and creates deeper and wider lesions than platinum-iridium during radiofrequency (RF) ablation in vitro. We tested the maximum voltage-guided technique (MVGT) of cavotricuspid isthmus (CTI) ablation using two 8-mm tip catheters containing gold (group G) or platinum-iridium (group PI). We enrolled 31 patients who underwent CTI ablation. In group G (n = 15) CTI ablation was performed with a gold-tip ablation catheter, while in group PI (n = 16) a platinum-iridium tip was used. Ablation was guided by CTI potentials with the highest amplitude until achievement of bidirectional block (BIB). If BIB was not achieved after 10 RF applications, RF was delivered via a 3.5-mm irrigated-tip catheter. Success rate, procedure duration, duration of fluoroscopic exposure, and number of RF applications were measured. BIB was achieved in all patients in group G, while in group PI an irrigated tip was used in four patients (0% vs 25%, P < 0.001). These four patients required a total of 21 additional RF applications (5.25 +/- 2.22). Procedure time (56.4 +/- 12 vs 73.1 +/- 15 minutes P < 0.05) and fluoroscopic explosure (4.9 +/- 2.3 vs 7.1 +/- 3.8 minutes, P < 0.01) were shorter in group G than in group PI. Mean number of RF applications was lower (4.6 +/- 1.9 vs 6.6 +/- 3.1 P < 0.001) and total RF duration shorter (280 +/- 117 vs 480 +/- 310 seconds) in group G than in group PI. No difference was observed in the number of recurrences at a 6 month-follow up (1 in group G vs 1 in group PI). Using the MVGT of CTI ablation, gold-tip catheters were associated with shorter procedural and fluoroscopic times, and fewer RF applications.
  Pacing and Clinical Electrophysiology 04/2009; 32 Suppl 1:S138-40. · 1.35 Impact Factor
• Article: [New method for the treatment of atrial fibrillation: circumferential cryoballoon ablation of the pulmonary vein].

  Csaba Földesi, Attila Kardos, Attila Mihálcz, Zoltán Som, Gabriella Hódi, Péter Andréka, Tamás Szili-Török
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  ABSTRACT: Atrial fibrillation is the most frequent arrhythmia with increasing prevalence. Given a limited success rate of drug therapy for atrial fibrillation, interventional treatment options have been developed during the last years. Catheter ablation of atrial fibrillation (until recently the mostly used energy source was radiofrequency energy) has been established as an important therapeutic alternative. Depending on interpersonal (both on patient and operator side) and technical variabilities using radiofrequency energy potentially life-threatening complications such as pulmonary vein stenosis or atrio-esophageal fistulas may occur. Cryoenergy is a novel energy source for transcatheter ablation eliminating the arrhythmia substrate by freezing. The cornerstone of catheter ablation for atrial fibrillation is electrical isolation of the pulmonary veins. During cryoballoon ablation the targeted pulmonary vein transiently occluded by the inflated balloon catheter and using this method a circumferential lesion is created. The success rate of cryoballoon ablation is comparable with the radiofrequency ablation with increased safety. We performed the first cryoballoon ablations for patients with paroxysmal atrial fibrillation in Hungary. On this occasion we review the potential advantages of this technique which may serve as basis for its widespread use in the future.
  Orvosi Hetilap 10/2008; 149(38):1779-84.
• Article: [Treatment of arrhythmias associated with congenital heart disease using transcatheter ablation].

  Tamás Szili-Török, Szabolcs Szeghy, Attila Kardos, László Környei, Dóra Paprika, András Szatmári, András Temesvári
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  ABSTRACT: Rhythm disturbances are common long after surgical repair of congenital heart disease. These arrhythmias caused by the progression of the disease itself, however, a significant proportion is a result of the presence of surgical scar. Although interventional electrophysiology procedures are complex and encounter difficulties, pharmacological therapy is often very disappointing. In the present study we aimed to describe our experience obtained between 2004 and 2006 in patients undergoing transcatheter ablation long after surgery for congenital heart disease. During this period 26 patients underwent catheter ablation. The procedure was successful in 24 out of the 26 patients (92%). Three patients required redo ablations due to arrhythmia recurrences (11%). There were no major complications related to the intervention. In four patients minor complications occurred (small hematomas). Our descriptive data indicate that transcatheter ablation for arrhythmias after surgery for congenital heart disease is a effective safe and more importantly curative procedure. It is associated with reasonable success rate, low complication rate, but slightly higher recurrence rate as compared to the classical electrophysiological interventions.
  Orvosi Hetilap 02/2008; 149(3):115-9.
• Source

  Available from: Tchavdar N Shalganov

  Article: Ice mapping during tachycardia in close proximity to the AV node is safe and offers advantages for transcatheter ablation procedures.

  Attila Kardos, Dora Paprika, Tchavdar Shalganov, Radu Vatasescu, Csaba Foldesi, Laszlo Kornyei, Tamas Szili-Torok
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  ABSTRACT: Ablation during ongoing orthodromic reentry tachycardia (AVRT) and atrioventricular nodal reentry tachycardia (AVNRT) is not recommended using radiofrequency energy when the arrhythmia substrate is located in close proximity to the atrioventricular (AV) node due to a significant risk for inadvertent AV block. The aim of the study is to test the feasibility of ice mapping during tachycardias involving arrhythmia substrate located in close proximity to the AV node. This was a single-centre, prospective, randomized study. A total of 65 patients was screened and 30 patients with supraventricular arrhythmias were assigned either to a cryo or RF energy group after diagnosis of AVNRT (17 pts) or AVRT (13 pts) with an anteroseptal accessory pathway. RF ablation was performed using standard ablation techniques. In the cryo group, ice mapping was performed during tachycardia with cooling of the catheter tip temperature to a maximum of -40 degrees C. Ablation was performed only if ice mapping terminated the tachycardia without prolongation of the AV conduction. The overall acute success rate was 84%, and was not different in the cryo and RF groups (85% vs. 82.4%, P = 0.43). Both fluoroscopy and the procedure times were comparable. There was a marked reduction in the mean number of applications in the cryo group [2 (1-6) vs. 7 (1-41), P = 0.002]. In one patient ablation was not attempted in the cryo group because of AV prolongation, and in two patients temporary second-degree AV block was observed in the RF group. After 12 months follow-up the long-term success rate was similar between the two groups. (I) Ice mapping is a feasible method to determine the exact location of accessory pathways and of the slow pathway during tachycardia. (2) Ice mapping performed during tachycardia causes less ablation lesions without increasing the procedure and fluoroscopy times.
  Acta cardiologica 01/2008; 62(6):587-91. · 0.61 Impact Factor
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  Available from: Tchavdar N Shalganov

  Article: Mid-term echocardiographic follow up of left ventricular function with permanent right ventricular pacing in pediatric patients with and without structural heart disease.

  Tchavdar Nikolov Shalganov, Dora Paprika, Radu Vatasescu, Attila Kardos, Attila Mihalcz, Laszlo Kornyei, Andras Szatmari, Tamas Szili-Torok
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  ABSTRACT: Chronic right ventricular apical pacing may have detrimental effect on left ventricular function and may promote to heart failure in adult patients with left ventricular dysfunction. A group of 99 pediatric patients with previously implanted pacemaker was studied retrospectively. Forty-three patients (21 males) had isolated congenital complete or advanced atrioventricular block. The remaining 56 patients (34 males) had pacing indication in the presence of structural heart disease. Thirty-two of them (21 males) had isolated structural heart disease and the remaining 24 (13 males) had complex congenital heart disease. Patients were followed up for an average of 53 +/- 41.4 months with 12-lead electrocardiogram and transthoracic echocardiography. Left ventricular shortening fraction was used as a marker of ventricular function. QRS duration was assessed using leads V5 or II on standard 12-lead electrocardiogram. Left ventricular shortening fraction did not change significantly after pacemaker implantation compared to preimplant values overall and in subgroups. In patients with complex congenital heart malformations shortening fraction decreased significantly during the follow up period. (0.45 +/- 0.07 vs 0.35 +/- 0.06, p = 0.015). The correlation between the change in left ventricular shortening fraction and the mean increase of paced QRS duration was not significant. Six patients developed dilated cardiomyopathy, which was diagnosed 2 months to 9 years after pacemaker implantation. Chronic right ventricular pacing in pediatric patients with or without structural heart disease does not necessarily result in decline of left ventricular function. In patients with complex congenital heart malformations left ventricular shortening fraction shows significant decrease.
  Cardiovascular Ultrasound 02/2007; 5:13. · 1.26 Impact Factor
• Source

  Available from: PubMed Central

  Article: Pulmonary vein isolation without left atrial mapping.

  Attila Kardos, Csaba Foldesi, Karoly Ladunga, Attila Toth, Tamas Szili-Torok
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  ABSTRACT: One of the crucial points during in most approaches developed for ablation of atrial fibrillation (AF) is the ability to identify the pulmonary vein (PVs) and to accurately locate their ostia. Objectives: The purpose of this case series was to investigate a simplified method for fusion of the multislice computer tomography (CT) derived 3D dataset with the electroanatomical map in order to facilitate the mapping procedure. In 5 consecutive patients (4 male) referred for catheter ablation of symptomatic drug-refractory paroxysmal atrial fibrillation contrast enhanced computer tomography was performed before the procedure and imported into an electroanatomical mapping system (Carto XP) using CartoMerge Image Integration Module. During the procedure a multipolar mapping catheter (Quick Star DS, Biosense Webster, Diamond Bar, CA, USA) was introduced to the coronary sinus (CS) to align the CSCT shell to the proper position. The CS potentials provided information to identify the ostium of the CS to achieve a more accurate fusion of the images. No mapping points were taken in the left atrium. The feasibility of the method was characterized by the distance of mapping points. Mapping, registration and outcome data were compared with a cohort of patients undergoing MRI image integration. The mean distance between the mapping points taken in the CS by the Quick Star catheter and the CS CT surface was suitable (mean+/-SD, 1.4+/-0.3 mm). Full electrical isolation of the pulmonary veins could be achieved in all patients. The mean procedure and fluoroscopy time were 39 +/- 22 and 134 +/-38 min respectively, significantly decreased as compared to the MRI cohort. Highly accurate CT image and the electroanatomical map (EAM) fusion can be obtained by the Carto 3D electromanatomical mapping system using CS as the key anatomical structure for registration. Using this technique the mapping time of the left atrium can be reduced.
  Indian pacing and electrophysiology journal 02/2007; 7(3):142-7.
• Source

  Available from: Tchavdar N Shalganov

  Article: Mid-term echocardiographic follow up of left ventricular function with permanent right ventricular pacing in pediatric patients with and without structural heart disease

  Tchavdar Shalganov, Dora Paprika, Radu Vatasescu, Attila Kardos, Attila Mihalcz, Laszlo Kornyei, Andras Szatmari, Tamas Szili-Torok
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  ABSTRACT: Abstract Background Chronic right ventricular apical pacing may have detrimental effect on left ventricular function and may promote to heart failure in adult patients with left ventricular dysfunction. Methods A group of 99 pediatric patients with previously implanted pacemaker was studied retrospectively. Forty-three patients (21 males) had isolated congenital complete or advanced atrioventricular block. The remaining 56 patients (34 males) had pacing indication in the presence of structural heart disease. Thirty-two of them (21 males) had isolated structural heart disease and the remaining 24 (13 males) had complex congenital heart disease. Patients were followed up for an average of 53 ± 41.4 months with 12-lead electrocardiogram and transthoracic echocardiography. Left ventricular shortening fraction was used as a marker of ventricular function. QRS duration was assessed using leads V₅or II on standard 12-lead electrocardiogram. Results Left ventricular shortening fraction did not change significantly after pacemaker implantation compared to preimplant values overall and in subgroups. In patients with complex congenital heart malformations shortening fraction decreased significantly during the follow up period. (0.45 ± 0.07 vs 0.35 ± 0.06, p = 0.015). The correlation between the change in left ventricular shortening fraction and the mean increase of paced QRS duration was not significant. Six patients developed dilated cardiomyopathy, which was diagnosed 2 months to 9 years after pacemaker implantation. Conclusion Chronic right ventricular pacing in pediatric patients with or without structural heart disease does not necessarily result in decline of left ventricular function. In patients with complex congenital heart malformations left ventricular shortening fraction shows significant decrease.
  Cardiovascular Ultrasound. 01/2007;
• Article: Right diaphragmatic paralysis following endocardial cryothermal ablation of inappropriate sinus tachycardia.

  Radu Vatasescu, Tchavdar Shalganov, Attila Kardos, Khatuna Jalabadze, Dora Paprika, Margit Gyorgy, Tamas Szili-Torok
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  ABSTRACT: Inappropriate sinus tachycardia (IST) is a rare disorder amenable to catheter ablation when refractory to medical therapy. Radiofrequency (RF) catheter modification/ablation of the sinus node (SN) is the usual approach, although it can be complicated by right phrenic nerve paralysis. We describe a patient with IST, who had symptomatic recurrences despite previous acutely successful RF SN modifications, including the use of electroanatomical mapping/navigation system. We decided to try transvenous cryothermal modification of the SN. We used 2 min applications at -85 degrees C at sites of the earliest atrial activation guided by activation mapping during isoprenaline infusion. Every application was preceded by high output stimulation to reveal phrenic nerve proximity. During the last application, heart rate slowly and persistently fell below 85 bpm despite isoprenaline infusion, but right diaphragmatic paralysis developed. At 6 months follow-up, the patient was asymptomatic and the diaphragmatic paralysis had partially resolved. This is the first report, we believe, of successful SN modification for IST by endocardial cryoablation, although this case also demonstrates the considerable risk of right phrenic nerve paralysis even with this ablation energy.
  Europace 11/2006; 8(10):904-6. · 1.98 Impact Factor