Tomas Skala

• Doctor of Medicine
• Medical Doctor at University Hospital Olomouc

Background Safety of protamine administration after catheter ablation of atrial fibrillation (AF) using pulse-field system has not been previously described in a prospective randomized trial. Methods Consecutive patients with paroxysmal, persistent or long-standing persistent AF undergoing catheter ablation of AF using Farapulse system were random...

Background Simple, cheap wearables for long-term ECG monitoring with automatic analysis of all measurements using a bespoke artificial intelligence (AI) are scarce. Annotated single-lead ECG data from a chest-belt are missing. Methods We have developed a complex software environment to acquire raw ECG data from the Polar H10 chest-belt, and a besp...

Pulsed field ablation (PFA) is an emerging technology for the treatment of atrial fibrillation (AF), for which pre-clinical and early-stage clinical data are suggestive of some degree of preferentiality to myocardial tissue ablation without damage to adjacent structures. Here in the MANIFEST-17K study we assessed the safety of PFA by studying the p...

Objectives Current recommendations support surgical treatment of atrial fibrillation (AF) in patients indicated for cardiac surgery. These procedures are referred to as concomitant and may be carried out using radiofrequency energy or cryo-ablation. This study aimed to assess the electrophysiological findings in patients undergoing concomitant cryo...

Objectives Current recommendations support surgical treatment of atrial fibrillation (AF) in patients indicated for cardiac surgery. These procedures are referred to as concomitant and may be carried out using radiofrequency energy or cryo-ablation. This study aimed to assess the electrophysiological findings in patients undergoing concomitant cryo...

Background and Aims Data on the hybrid atrial fibrillation (AF) treatment are lacking in patients with structural heart disease undergoing concomitant CryoMaze procedures. The aim was to assess whether the timely pre-emptive catheter ablation would achieve higher freedom from AF or atrial tachycardia (AT) and be associated with better clinical outc...

Background and aims Analysis of mortality from the national health registries and data from a specific central registry dealing with the implantation of pacemakers (REPACE) in Czech patients. Methods and results Retrospective observational analysis of pacemakers’ implantation in all Czech patients [ n = 82,791; 47,070 (56.9%) men, 75.9 ± 10.4 year...

Aim The aim is the long-term continuous monitoring of patients with an implanted pacemaker (PM) regarding real mortality and morbidity in relation to the standard population without PM, to predict the development of procedures and costs of care in the next ten years. Methodology The analysis is based on data , which are collected within the framew...

Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The study was supported by the Ministry of Health of the Czech Republic. Background Atrial fibrillation (AF) and other atrial tachycardias (ATs), including typical atrial flutter (AFL), are common in patients with pulmonary hypertensio...

Aims Atrial fibrillation (AF), typical atrial flutter (AFL), and other atrial tachycardias (ATs) are common in patients with pulmonary hypertension. Frequently, several supraventricular arrhythmias are successively observed in individual patients. We investigated the hypothesis of whether more extensive radiofrequency catheter ablation of the bi-at...

Background: Atrial fibrillation is common in patients with structural heart disease who are undergoing cardiac surgery. Surgical CryoMaze has been shown to be an effective treatment in several trials, but success rates have varied considerably, between 47-95%. The sequential hybrid approach, combining surgical CryoMaze followed by radiofrequency c...

Background Anderson-Fabry disease (AFD) is an X-linked inherited lysosomal disease caused by a defect in the gene encoding lysosomal enzyme α-galactosidase A (GLA). Atrio-ventricular (AV) nodal conduction defects and sinus node dysfunction are common complications of the disease. It is not fully elucidated how frequently AFD is responsible for acqu...

Background Atrial fibrillation (AF) and related atrial tachycardias (ATs) are common arrhythmias in patients with pulmonary hypertension (PH). They are currently assessed in a multicentre randomized trial investigating extensive radiofrequency catheter ablation of the arrhythmogenic substrate on top of selective ablation of clinical arrhythmia alon...

Background: Clinical parameters linked to a low benefit of ICD implantation and increased mortality risks are needed for an individualized assessment of potential benefits and risks of ICD implantation. Methods: Analysis of a prospective registry of all patients hospitalized from 2009 to 2019 in a single centre for a first implantation of any ty...

Aim: Retrospective national sub-analysis of antidiabetic pharmacotherapy in patients with diabetes mellitus (DM) and heart failure (HF) based on data reported to the National Register of Paid Health Services in the Czech Republic between 2012-2018. Methodology and results: In 2012, there were 75,022 patients with HF and DM (i.e. 42.5% of patient...

Aims A retrospective nationwide observational analysis of diagnoses, procedures, and treatment reported to the Czech National Registry of Reimbursed Health Services between 2012 and 2018. Methods and results Prevalence of heart failure (HF) patients increased from 176 496 (1679.4 per 100 000 population) in 2012 to 285 745 (2689.0 per 100 000 popul...

With the global increase in device implantations, there is a growing need to train physicians to implant pacemakers and implantable cardioverter-defibrillators. Although there are international recommendations for device indications and programming, there is no consensus to date regarding implantation technique. This document is founded on a system...

Aims: Sub-analysis of a retrospective nation-wide observational analysis of heart failure (HF) epidemiology reported to the Czech National Registry of Reimbursed Health Services between 2012 and 2018 aimed at angiotensin-converting enzyme inhibitors (ACEI), angiotensin-II-receptor antagonists (ARB) and angiotensin receptor blocker/neprilysin inhib...

Background: Primary preventive implantation of implantable defibrillator (ICD) is according to current guidelines indicated in patients with heart failure NYHA (New York Heart Association) class II/III and LVEF <35%. Thanks to advances in heart failure pharmacotherapy, a decrease in mortality could render a benefit of ICD insufficient to justify i...

Aims: Sub-analysis of a retrospective nation-wide observational analysis of heart failure (HF) epidemiology reported to the Czech National Registry of Reimbursed Health Services between 2012 and 2018 aimed at beta-blockers (BBs) utilization. Methods and results: The beta-blockers were generally used in 81.8% of all patients treated for HF in 201...

Aims The aim of this study is to analyse the prevalence, epidemiology, and anticoagulation prevention of stroke or transient ischaemic attack (TIA) in Czech patients with atrial fibrillation (AF). Methods and results Retrospective observational analysis of diagnoses, procedures, and treatment reported to the Czech National Registry of Reimbursed H...

Background With the increasing number of implanted cardiac pacemakers, ICDs and CRTs, the number of serious infectious complications of these procedures increases significantly, especially in the longer term from the primary implantation. The systematic solution is in most cases endovasal extraction of these systems. Methods In a multicenter, pros...

Background Thoracoscopic atrial fibrillation (AF) ablation (TARAFS) using irrigated bipolar radiofrequency energy should result in posterior left atrial (LA) wall isolation. Purpose To assess the long-term durability of this “box” lesion and the extent of additional ablation needed to achieve AF non-inducibility. Methods 22 patients with AF recur...

Background: Catheter ablation of paroxysmal atrial fibrillation (AF) can be performed under general anesthesia or conscious sedation. The influence of type of anesthesiology care on procedural characteristics and ablation outcome in patients in whom intracardiac echocardiography (ICE) and elimination of adenosine-mediated dormant conduction (DC) i...

Aim: Non-invasive imaging of the left atrium is a routine part of management before catheter radiofrequency ablation in patients suffering from atrial fibrillation. The aim of the study was to verify the degree of agreement in the left atrial volume (LAV) calculated from echocardiography and computed tomography (CT) images. Further, we tried to ver...

Background The prediction of outcome in comatose patients after out of hospital cardiac arrest (OHCA) has major ethical and socioeconomic implications. At present, there is a lack of data comparing the predictive value from cardiac arrest localization to hospital distance in OHCA survivors treated with endovascular therapeutic hypothermia. Methods...

Aims: Atrial fibrillation (AF) inducibility with rapid atrial pacing following AF ablation is associated with higher risk of AF recurrence. The predictive value of AF inducibility in paroxysmal AF patients after pulmonary vein isolation (PVI), done under general anaesthesia (GA), remains questionable since GA might alter AF inducibility and/or sus...

Objectives: The prognostic significance of adenosine-mediated pulmonary vein (PV) dormant conduction is unclear. We prospectively followed patients with adenosine-mediated PV reconduction with a subsequent repeated ablation until there was no reconduction inducible with patients without reconduction after PV isolation. Method and results: Consec...

Background: The impact of ECG gating during computed tomography (CT) acquisition of left atrium (LA) model on radiation dose, image quality and ablation event-free survival rate after catheter ablation (CA) of atrial fibrillation (AF) is not well defined. Methods: Sixty-two patients with paroxysmal atrial fibrillation were randomized for two typ...

Background: A foreign body left in left atrium after catheter ablation of atrial fibrillation is a very rare complication. Nevertheless, there are no reports so far about a large newly emerged structure only giving the impression of being a foreign body left in the heart after catheter ablation. Case report: This report presents a case of a pati...

Background: The role of ECG-gating in left atrium (LA) computed tomography (MDCT) imaging is not precisely defined. Methods and results: 62 patients were randomized according to ECG gating with prospective evaluation of image quality, Volume CT Dose Index, Dose Length Product, Effective Dose and registration error between anatomical map and MDCT...

Background: Leadless pacemakers (PMs) were recently introduced to address the complication rate of standard PMs with transvenous leads. Methods and results: A 34-year old male with a history of intravenous substance abuse and a chronic type C hepatitis developed a complete atrioventricular block after cardiac surgery for infective endocarditis....

Introduction: Frequent ventricular premature complexes (VPCs) may cause symptoms and/or lead to deterioration of LV systolic function. Although frequent VPCs may be abolished by catheter ablation, it may be challenging in case of their origin from the LV papillary muscles (PMs). Our collaborative study aimed to analyze in detail the site of origin...

Background We report the feasibility and outcomes of box-lesion ablation technique to treat stand-alone atrial fibrillation (AF). Methods There were 31 patients with a mean age of 63.3 ± 8.4 years who underwent bilateral totally thoracoscopic ablation of symptomatic paroxysmal AF (n = 8; 25.8%) and long-standing persistent AF (n = 23; 75.2%). The...

Aims: Consumption of wine has a protective effect on cardiovascular diseases. Data from prospective, long-term, head-to-head comparisons of effects of different drinks on markers of atherosclerosis have been insufficient. Methods and results: In Vino Veritas (IVV) study is long-term, prospective, multi-centre, randomized trial comparing effects...

Catheter ablation is an established method of heart rhythm disturbances treatment. With an increasing number of ablations, it is imperative to further minimise the risks and maximise efficacy of this treatment. Intracardiac echocardiography is a cardiac imaging method made possible thanks to a steerable catheter inserted from the groin into the hea...

Aims: Wine consumption is associated with a positive effect on blood cholesterol level. Data from prospective, long-term, head-to-head comparisons of different types of wine on blood cholesterol level are not sufficient. Methods and results: In Vino Veritas (IVV) study is a long-term, prospective, multi-centre, randomized trial comparing effects of...

Therapy of acute phase of ischemic central vascular accident is focused on immediate actions to suppress the severity of damage with the earliest possible initiation of reperfusion strategy together with initiation and maintenance of adequate therapy to prevent further cerebral reinfarctions. The key factor for adequate and effective secondary prev...

In this review, we outline contemporary and upcoming electroanatomic technologies focusing on new mapping tools especially in catheter ablation for atrial fibrillation. The number of catheter ablations has been increasing exponentially in the last few years due to technological advancements enabling complex ablation strategies. The quality of the c...

Atrial fibrillation is known very frequent cause of ischemic stroke. Undetected paroxysmal atrial fibrillation (PAF) is thus often considered a possible cause of cryptogenic ischemic stroke (CIS). The aim of this prospective study was to detect PAF using ECG Holter monitoring and determinate whether prolongation of the Holter monitoring to 3 weeks...

Background: Undetected atrial fibrillation (AF) is often suspected as the possible cause in patients with cryptogenic ischemic stroke (IS), especially in elderly population. In young IS patients, the prevalence of AF, particularly paroxysmal form, remains still not enough established. Our aim was to assess the presence of AF in young patients usin...

Background and aim: The cause of ischemic stroke (IS) in young patients remains often cryptogenic. In elderly population, undetected heart arrhythmias with a risk of embolization are considered the cause of cryptogenic IS (CIS). The aim of this prospective study was to assess the presence of heart arrhythmias in young CIS patients using a long-term...

Background and aim: The cause of ischemic stroke (IS) in young patients remains often cryptogenic. In elderly population, undetected heart arrhythmias with a risk of embolization are considered the cause of cryptogenic IS (CIS). The aim of this prospective study was to assess the presence of heart arrhythmias in young CIS patients using a long-term...

Right ventricular (RV) myocardial infarction (MI) is a frequent concomitant of an acute inferior MI. We set out to determine the diagnostic value of speckle tracking echocardiography in comparison with cardiac magnetic resonance (CMR) for RV stunning and scar prediction. 55 patients (66 ± 11 years) with an acute inferior ST elevation MI who underwe...

Ventricular extrasystoles are premature ventricular contractions resulting from electrical depolarization from an ectopic centre in the myocardium below the level of the bundle of His. They are the most frequent ventricular arrhythmias in the population. They occur both in patients with no organic heart disease and in those with various heart disea...

Aims: To assess the acute side-effects of right ventricular (RV) stimulation applied in apex and mid-septum, in order to establish the optimal lead location in clinical practice. Methods: During pacemaker implantation, the ventricular lead was temporarily fixed in the apex and then moved to mid-septum. In both positions, surface and endocardial...

ECG monitoring after catheter ablation is a necessary part of care of patients with atrial fibrillation. A significant number of patients after catheter ablation of atrial fibrillation have sooner or later arrhythmia recurrence. The riskier the patient the bigger the impact of a potential arrhythmia and the more intensive effort to monitor ECG afte...

Background: The aim was to compare the speckle tracking echocardiography (STE) derived systolic longitudinal strain (SL(Smax)) with rest single photon emission computed tomography (SPECT) perfusion imaging (Q(REST)), and to define the optimal cut-offs for SL(Smax) to discriminate transmural scar on contrast-enhanced magnetic resonance imaging (ceC...

In the absence of a rapid diagnosis and aggressive treatment, acute embolization to the pulmonary artery is often fatal. Due to its high mortality rates reported to be around 40%, surgical embolectomy was virtually used in the long term only in patients in extremely poor condition in whom medication therapy had failed. As experience increases, surg...

We report two cases of patients with a complete left bundle branch block (LBBB) with similar cardiac symptoms but different outcomes due to myocardial perfusion and function imaging, using single photon emission computed tomography (SPECT).

Patent foramen ovale (PFO) is a physiological variety characterized by the presence of a minimal shunt flow through the interatrial septum, with the incidence of 17-27% in a non-selected population. Acute pulmonary embolism is a relatively frequent heterogenic clinical entity with a variable clinical manifestation. Paradoxical embolization through...

J wave syndrome is a complex of clinical features characterized by early repolarization, ST segment elevation and J wave - mediated by transient accentuation of the potassium outward current Ito. The risks of sudden cardiac death of these syndromes differ with respect to the magnitude and location of abnormal J wave manifestation and ST segment ele...

Patients with ischemic heart disease and depressed left ventricular (LV) ejection fraction (LVEF) develop varying degrees of LV remodeling after cardiac surgical revascularization. Fifty-three patients with stable ischemic heart disease and impaired LV function (LVEF 34.9 ± 4%) were prospectively followed up for 24 months. Thirty-seven patients und...

Atrial fibrillation is the most worldwide-sustained arrhythmia and in about 20-30 % of patients in atrial fibrillation valvular heart disease is present. Minimalization of symptoms and prevention of complications (heart failure) is fundamental treatment of both issues. Strategy of rhythm control and rate control wth respect of valvular heart diseas...

Oral anticoagulant therapy has become a cornestone in many internal cases. As the population as a whole is aging, the number of patients who need warfarin is likewise increasing. The main problem of this therapy is due to the difficulty in determining the correct dosage of the drug to obtain effective anticoagulation. Altough there are miscellaneou...

The article deals with the indications and counterindications of individual accessible antiarythmia in the treatment of atrial fibrillation. It discusses the options for pharmacotherapy in the acute and long-term management of patients, options for a control strategy for an adequate ventricular response and efforts to maintain sinus rhythm.

Ischaemic stroke, especially in the younger population, is an important cause of morbidity and mortality. When compared with the older population, the underlying aetiology of stroke in the young includes higher rates of cardioembolic disease and congenital heart anomalies. Paradoxical embolism may be an important cause of ischaemic cerebral events,...

The presence of a velocity in isovolumic contraction phase (Vivc) evaluated using tissue Pulse wave Doppler myocardial imaging (PWDMI) correlates with a transmural extent of scar after myocardial infarction. The possible clinical usefulness of Vivc evaluated using color Doppler myocardial imaging (CDMI) in detection of a scar after myocardial infar...

Arrhythmogenic right ventricular dysplasia is a rare cause of collapse, most frequently due to ventricular tachycardia. In patients with documented ventricular tachycardia, cardioverter-defibrillator (ICD) implantation to prevent sudden cardiac death is indicated. In the presented case, ICD implantation was complicated with a ventricular defibrilla...

The aim of this study was to assess accuracy of echocardiography in the measurement of left ventricular ejection fraction (LVEF), enddiastolic volume (EDV) and endsystolic volume (ESV) compared with gated SPECT. A total of 70 patients with left ventricular systolic dysfunction were enrolled to study. Median of the time interval between gated SPECT...

We present the case of a 62-year-old woman admitted for a syncope. During hospitalization, the syncope recurred with new ECG-documented signs of subendocardial ischemia and increased troponin levels, with the episode classified as suspected acute non-ST elevation myocardial infarction. Surprisingly, coronary angiography did not find any significant...

The extent of scar or viable hypocontractile myocardial tissue determines postinfarction left ventricle remodeling. The aim of this pilot study was to evaluate the revascularization effect in a group of patients with ischemic cardiomyopathy and LV systolic dysfunction indicated for surgical revascularization, based on evidence for multivessel disea...

Chronic heart failure is a worldwide clinical syndrome with substantial socio-economical impact. The aim of this overview is the summary of contemporary knowledge in epidemiology, elementary pathophysiological implications and some possibilities of treatment of ischemic cardiomyopathy, which represents the most frequent cause of heart failure in de...

A 42-year old patient with suspected Marfan syndrome was admitted for examination of resting chest pain occurring intermittently for 1 week. Physical examination was completely normal with a normal blood pressure and present symmetrical upper extremities pulsation. ECG showed 2 mm ST-elevation in II, III, aVF, V4–6 leads. Selective coronarography w...

Tissue Doppler echocardiography (TDE) is an ultrasound modality enabling relatively accurate visualization and quantification of regional myocardial motion and deformation. The aim of this review is to discuss the possibilities of individual TDE modalities in the diagnosis of myocardial ischemia and viability. The paper systematically reviews the i...

Malignant arrhythmia is a frequent complication of myocardial ischemia due to the occurrence of coronary artery spasm. The paper describes a patient with variant angina pectoris with an ICD implant who was repeatedly resuscitated for circulatory arrest in malignant arrhythmia. During myocardial ischemia the ECG showed elevations in the ST segments...

Rupture of a papillary muscle is an infrequent but often fatal mechanical complication of acute myocardial infarction. The aim of this paper is to present a case report of a 65-year old women with acute severe mitral regurgitation with cardiogenic shock caused by two-step complete anterior papillary muscle rupture during acute myocardial infarction...

Background: Based on published results of meta-analyses of large studies, hemodynamic monitoring using pulmonary artery catheters is not associated with improved prognosis of critically ill patients treated this way at resuscitation departments and intensive care units (ICU). Moreover, this examination is invasive and may be associated with some sp...