Introduction: Extracorporeal membrane oxygenation (ECMO) is increasingly used in cardiac arrest (CA). Adequacy of carotid and coronary blood flows (CaBF, CoBF) and coronary perfusion pressure (CoPP) in ECMO treated CA is not well established. This study compares femoro-femoral (FF) to femoro-subclavian (FS) ECMO and intraaortic balloon counterpulsation (IABP) contribution based on CaBF, CoBF, CoPP, myocardial and brain oxygenation in experimental CA managed by ECMO. Methods: In 11 female pigs (50.3 ± 3.4 kg), CA was randomly treated by FF versus FS ECMO ± IABP. Animals under general anesthesia had undergone 15 minutes of ventricular fibrillation (VF) with ECMO flow of 5 to 10 mL/kg/min simulating low-flow CA followed by continued VF with ECMO flow of 100 mL/kg/min. CaBF and CoBF were measured by a Doppler flow wire, cerebral and peripheral oxygenation by near infrared spectroscopy. CoPP, myocardial oxygen metabolism and resuscitability were determined. Results: CaBF reached values > 80% of baseline in all regimens. CoBF > 80% was reached only by the FF ECMO, 90.0% (66.1, 98.6). Addition of IABP to FF ECMO decreased CoBF to 60.7% (55.1, 86.2) of baseline, P = 0.004. FS ECMO produced 70.0% (49.1, 113.2) of baseline CoBF, significantly lower than FF, P = 0.039. Addition of IABP to FS did not change the CoBF; however, it provided significantly higher flow, 76.7% (71.9, 111.2) of baseline, compared to FF + IABP, P = 0.026. Both brain and peripheral regional oxygen saturations decreased after induction of CA to 23% (15.0, 32.3) and 34% (23.5, 34.0), respectively, and normalized after ECMO institution. For brain saturations, all regimens reached values exceeding 80% of baseline, none of the comparisons between respective treatment approaches differed significantly. After a decline to 15 mmHg (9.5, 20.8) during CA, CoPP gradually rose with time to 68 mmHg (43.3, 84.0), P = 0 .003, with best recovery on FF ECMO. Resuscitability of the animals was high, both 5 and 60 minutes return of spontaneous circulation occured in eight animals (73%). Conclusions: In a pig model of CA, both FF and FS ECMO assure adequate brain perfusion and oxygenation. FF ECMO offers better CoBF than FS ECMO. Addition of IABP to FF ECMO worsens CoBF. FF ECMO, more than FS ECMO, increases CoPP over time.

The aim of the study was to detect changes of both the QT dispersion and T-loop morphology resulting from the changed spatial position of the heart during pregnancy. Electrocardiographic and vectorcardiographic recordings were obtained from 37 healthy women 19-36 years old in the 36th to 40th week of physiological pregnancy and 2 to 6 days after delivery. The same recordings were obtained from 18 healthy women of the same age. The average QT dispersion (±S.D.) in normal subjects was significantly lower (34±12 ms) than in those in late pregnancy (73±18 ms) (P<0.001). The average amplitude of T-loop (Ta) in women in late pregnancy was significantly (P<0.001) smaller (532±98 mV) and the width of T-loop (Tw) was wider (21.24±11.48 deg) than in the control group (793±114 mV and 7.17±3.02 deg, respectively). The partial post-partum restoration of all parameters was not significant. In all groups, the QT dispersion was significantly correlated with Tw but not with Ta. According to these results we can conclude that the QT dispersion is an indirect reflection of the complete process of ventricular repolarization, reflected in the morphology of the T-loop..

Purpose: Patients with pulmonary hypertension (PH) frequently suffer from supraventricular tachycardias (SVT). The main purpose of our study was to identify the cumulative incidence of SVT in patients with different etiologies of PH. The secondary objective was to analyse the clinical impact of SVT.Methods: We retrospectively studied the prevalence of SVT and the clinical outcome in 755 patients (41% males; 60 ± 15 years; mean follow-up 3.8 ± 2.8 years) with PH of different etiologies. The prevalence of SVT was analysed separately in isolated pre-capillary PH (Ipc-PH) and in patients with combined post- and pre-capillary PH (Cpc-PH).Results: The prevalence of SVT in the Ipc-PH group (n = 641) was 25% (n = 162). The most prevalent arrhythmias were atrial fibrillation followed by a typical atrial flutter (17% and 4.4% of all Icp-PH patients). An excessive prevalence of SVT was found in patients with pulmonary arterial hypertension associated with congenital heart disease (35%, p = 0.01). Out of the overall study population, Cpc-PH was present in 114 (15%) patients. Patients with Cpc-PH manifested a higher prevalence of SVT than subjects with Ipc-PH (58; 51% vs. 162; 25%; p <0.0001) and were more likely to have persistent or permanent atrial fibrillation (38; 29% vs. 61; 10%; p <0.0001). Parameters significantly associated with mortality in a multivariate analysis included age, male gender, functional exercise capacity and right atrial diameter (p < 0.05). Neither diagnosis of SVT nor type of arrhythmia predicted mortality.Conclusions: The study detected a significant prevalence of SVT in the population of PH of different origins. Different spectrum and prevalence of arrhythmia might be expected in different etiologies of PH. Patients with an elevated post-capillary pressure showed a higher arrhythmia prevalence, predominantly due to an excessive number of atrial fibrillations. The diagnosis of SVT was not associated with mortality.

Background: Changes in quality of life (QoL) after catheter ablation for long‐standing persistent atrial fibrillation ( LSPAF ) are not well described. We sought to compare QoL improvement after catheter ablation of paroxysmal atrial fibrillation ( PAF ) versus that after LSPAF . Methods and Results: A total of 261 PAF and 126 LSPAF ablation recipients were prospectively followed for arrhythmia recurrence, QoL, hospital stay, and sick leave. In PAF versus LSPAF groups, 1.3±0.6 versus 1.6±0.7 procedures were performed per patient ( P <0.00001) during a 3‐year follow‐up. Good arrhythmia control was achieved in 86% versus 87% of patients ( P =0.69) and in 69% versus 69% of patients not receiving antiarrhythmic drugs ( P =0.99). The baseline QoL was better in the PAF than in the LSPAF group (European Quality of Life Group instrument self‐report questionnaire visual analog scale: 66.4±14.2 versus 61.0±14.2, P =0.0005; European Quality of Life Group 3‐level, 5‐dimensional descriptive system: 71.4±9.2 versus 67.7±13.8, P =0.002). Postablation 3‐year increase in QoL was significant in both groups (all P <0.00001) and significantly lower in PAF versus LSPAF patients (visual analog scale: +5.0±14.5 versus +10.2±12.8, P =0.001; descriptive system: +5.9±14.3 versus +9.3±13.9, P =0.03). In multivariate analysis, LSPAF , less advanced age, shorter history of AF and good arrhythmia control were consistently associated with postablation 3‐year improvement in QoL. Days of hospital stay for cardiovascular reasons and days on sick leave per patient/year were significantly reduced in both groups. Conclusions: Patients with LSPAF had worse baseline QoL. The magnitude of QoL improvement after ablation of LSPAF was significantly greater compared with after ablation of PAF , particularly when good arrhythmia control was achieved without the use of antiarrhythmic drugs.

Obesity is an important risk factor for atrial fibrillation (AF). Nonrandomized studies have shown that weight loss and increased physical activity are associated with AF reduction. The goal of this study was to assess whether treatment based on lifestyle modification (LFM; directed weight loss and physical exercise) in combination with antiarrhythmic drugs (AADs) is noninferior to catheter ablation (CA) in patients with AF and obesity. In a randomized multicenter noninferiority trial, we enrolled patients with paroxysmal or persistent AF and a body mass index (BMI) of 30-40 kg/m². Patients were randomized to the CA vs LFM+AAD groups in a 1:1 ratio. Seven-day electrocardiographic Holter recordings were performed every 3 months. The primary endpoint was AF freedom during the 12 months after randomization (ie, absence of any AF episode lasting >30 s; the blanking period was 3 months). Secondary endpoints included AF burden, peak oxygen uptake during cardiopulmonary exercise testing, changes in metabolic parameters, and quality of life as assessed with the Atrial Fibrillation Effect on Quality of Life (AFEQT) questionnaire, all compared between randomization and 12 months. A total of 212 patients were enrolled and randomized. Nine patients withdrew consent, leaving 203 patients for the final analysis; 100 patients were allocated to the CA group and 103 to the LFM+AAD group (overall age 60 ± 9 years, 31.5% female, BMI 34.9 ± 3.0 kg/m², 55.7% with paroxysmal AF); the mean follow-up time was 23.5 months. The percentage of patients with AF freedom at 12 months was 73.0% (95% CI: 64.3%-81.7%) in the CA group and 34.6% (95% CI: 25.3%-43.9%) in the LFM+AAD group (P_{noninferiority} = 0.99, P_superiority <0.001). Weight change (-6.4 ± 7.9 kg vs -0.35 ± 4.8 kg; P < 0.001) and decreased HbA_1c, were more significant in the LFM+AAD group than in the CA group. Despite important metabolic improvements associated with LFM, CA was superior to LFM combined with AADs in improving freedom from AF at 1 year in patients with AF and obesity.