Objective. Direct-current electrical cardioversion is the main method for the conversion of atrial fibrillation. Its success depends on many factors. In several studies, biphasic shock waveforms have been demonstrated to be superior to monophasic shocks for termination of atrial fibrillation; however, information about impact of paddle position is controversial. Initial energy level is an object of discussions. The aim of the study was to compare a truncated exponential biphasic waveform with monophasic damped sine waveform and antero-lateral with antero-posterior paddle positions for cardioversion of atrial fibrillation, to determine its impact on early reinitiation of atrial fibrillation. Material and methods. A total of 224 consecutive patients with atrial fibrillation underwent electrical cardioversion with biphasic (Bi, n=112) or monophasic (Mo, n=112) shock waveform in a randomized fashion. The position of hand-held paddle electrodes was randomly selected in both groups to be anterior-lateral and anterior-posterior. Energies used were 100–150–200–300–360 J (Bi) or 100–200–300–360 J (Mo). If monophasic shock of 360 J was ineffective, we used biphasic shock of 360 J. Early recurrent atrial fibrillation (ERAF) was defined as a relapse of atrial fibrillation within 2 min after a successful cardioversion, acute recurrent – within 24 h. Results. Two study groups (Bi vs Mo) did not differ with regard to age, body mass index, duration of AF episode (mean 98±147 days for the Bi group and 80±93 days for the Mo group, P=0.26), underlying heart disease, left atrial diameter, left ventricular ejection fraction. In the Mo group, more patients used amiodarone (59.82% vs 41.97%, P=0.002), in the Bi group more patients used propafenone (16.07% vs 8.93%, P=0.033). Cardioversion success rate was 97.32% in the Bi group and 79.46% in the Mo group (P<0.001). After biphasic shock of 360 J in Mo group, the cumulative success rate was 99.11%. Mean delivered energy and mean number of shocks were significantly lower in the Bi group (198.5±204.4 J, 1.5±0.9 shocks vs 489.1±464.2 J, 2.4±1.5 shocks). The efficacy of first shock was 66.96% in the Bi group and 37.5% in the Mo group (P<0.0001). Incidence of ERAF was 4.46% in both groups. Paddle position had no impact on efficacy of cardioversion and ERAF. Conclusions. For the cardioversion of atrial fibrillation, biphasic shock waveform has a higher success rate than monophasic shock waveform. We did not observe the influence of paddle positions on efficacy of cardioversion. Shock waveform and paddle position had no impact on ERAF. We recommend starting with biphasic energy of 150 J and monophasic of not less than 200 J for cardioversion of atrial fibrillation.

Ventricular septal defect after myocardial infarction is a rare but often life-threatening mechanical complication. The keys of management are a prompt diagnosis of ventricular septal defect and an aggressive approach to stabilize patient’s hemodynamics. Invasive monitoring, judicious use of inotropes and vasodilators, and an intra-aortic balloon pump are recommended for the optimal support of patient’s hemodynamics. The best results are achieved if optimally medically managed patients survive at least 4 weeks before elective surgery necessary for scar formation in a friable infarcted tissue. We report a case of acute myocardial infarction complicated by the rupture of ventricular septum. Instead of attempting an immediate surgical closure of ventricular septal defect, the postponed surgery was successfully performed 3 weeks after the occurrence of ventricular septal defect. Preoperatively, clinical and hemodynamic conditions of the patient were maintained stable with the support of an intra-aortic balloon pump and inotropes.

Atrial fibrillation (AF) despite the absence of heart failure is related to increased levels of natriuretic peptides (NPs). NPs have not been widely investigated in relation to left atrium (LA) function after sinus rhythm (SR) restoration and duration of AF. The aim of the study was to determine the changes of NPs levels and to define their relation with LA phasic function after electrical cardioversion (ECV). Methods. The study included 48 persistent AF patients with restored SR after ECV. NT-proANP and NT-proBNP were measured for all patients before the ECV. LA phasic function (reservoir, conduit, and pump phases) was assessed using echocardiographic volumetric analysis within the first 24 hours after ECV. Patients were repeatedly tested after 1 month in case of SR maintenance. Results. After 1 month, SR was maintained in 26 (54%) patients. For those patients, NT-proBNP decreased significantly (p=0.0001), whereas NT-proANP tended to decrease (p=0.13). Following 1 month after SR restoration, LA indexed volume decreased (p=0.0001) and all phases of LA function improved (p=<0.01). Patients with AF duration < 3 months had lower NT-proANP compared to patients with AF duration from 6 to 12 months (p = 0.005). Higher NT-proANP concentration before ECV was associated with lower LA reservoir function during the first day after SR restoration (R=-0.456, p=0.005), whereas higher NT-proBNP concentration after 1 month in SR was significantly related to lower LA reservoir function (R=-0.429, p=0.047). Conclusions. LA indexed volume, all phases of LA function, and NT-proBNP levels improved significantly following 1 month of SR restoration. Preliminary results suggest that higher baseline NT-proANP levels and higher NT-proBNP for patients with maintained SR for 1 month are related to lower LA reservoir function. The longer duration of persistent AF is associated with higher NT-proANP concentration.

Darbo tikslas. Nustatyti Kardiologijos intensyvios terapijos skyriaus (KITS) pacientų šlapimo organų infekcijos (ŠOI) rizikos veiksnius, sukėlėjus, antimikrobinį gydymą, ŠOI gydymo bei hospitalizacijos KITS trukmę, mirštamumą ir jo rizikos veiksnius. Metodai. Į retrospektyvaus tyrimo imtį įtraukti 57 pacientai, 2007-2011 m. gydyti Kauno klinikų KITS, kuriems buvo nustatyta bakteriurija. Rezultatai. Vyrų ir moterų bakteriurijos dažnis nesiskyrė (47,4 proc. ir 52,5 proc.). Tiriamųjų vidutinis amžius 73,01±12,3 m., bakteriurija dažniau nustatyta pacientams >65 m., lyginant su jaunesniais, p&lt;0,05. ŠOI sirgo 52 iš 57 tiriamųjų. Visiems 11 cukriniu diabetu (CD) sirgusių pacientų išsivystė ŠOI. Šlapimo pūslės kateterizacija taikyta 49 pacientams, iš jų 45 sirgo ŠOI. Vidutinė tirtų KITS pacientų kateterizacijos trukmė 10±2 d. Dažniausiai ŠOI sukėlė gramneigiama lazdelė - 44 atvejai iš 64, iš jų E. coli – 43,2 proc. (p&lt;0,05), grybai išauginti kritinių būklių, ilgiau gydytiems pacientams. Dažniausiai skirtas antibiotikas (AB) - cefuroksimas (77 proc.). Pacientams, kuriems empirinis antibakterinis gydymas buvo adekvatus (n = 24, 46 proc.), ŠOI trukmė 9,9±4,7d., kai neadekvatus (dažniausiai dėl atsparumo skirtam AB), 15,7±3,3d., p&lt;0,05. Vidutinė hospitalizacijos KITS trukmė kolonizacijos atveju 3,6±1,8d., ŠOI atveju 10,67±3,9 d., o vidutinė tirto laikotarpio hospitalizacijos KITS trukmė 1,08±0,4 d., p&lt;0,05. Grybo sukeltos ŠOI atveju hospitalizacijos KITS trukmė 27,75±12,3 d., o bakterijų 10,68±5,3 d., p&lt;0,05. Kai empiriškai paskirtas antibakterinis gydymas buvo adekvatus, gydymo KITS trukmė buvo 3,3±2,1 d., o kai neadekvatus - 14,7±5,3 d., p&lt;0,05. Vyresnis nei 50 m. amžius, CD (95 proc., ŠS 1,3, PI 0,33 – 4,99), šlapimo pūslės kateterizacija ir jos trukmė (visi mirę pacientai buvo kateterizuoti, ir mirė 76 proc., kuriems taikyta ilgalaikė kateterizacija) susieta su mirštamumu, p&lt;0,05. Išvados. Bakteriurija būdinga >65 m. amžiaus pacientams. Beveik visuomet ji susijusi su šlapimo organų infekcija, jos reikšmingi rizikos veiksniai – cukrinis diabetas ir šlapimo pūslės kateterizacija. Du trečdaliai šlapimo organų infekcijos sukėlėjų - gramneigiamos lazdelės, iš jų pusė - E. coli. Dažniausiai empiriškai šlapimo organų infekcija gydyta intraveniniu cefuroksimu. Empirinis antibakterinis gydymas adekvatus buvo mažiau nei pusei atvejų, dažniausia gydymo neadekvatumo priežastis – sukėlėjo atsparumas skirtam antibiotikui. Tiek šlapimo organų infekcija, tiek ir šlapimo kolonizacija mikrobais didino hospitalizacijos KITS trukmę. Hospitalizacijos KITS trukmė mažesnė, kai šlapimo organų infekcijos sukėlėjas E. coli, didžiausia, kai grybas. Adekvataus antibakterinio gydymo atveju tiek šlapimo organų infekcijos gydymo trukmė, tiek ir hospitalizacijos KITS trukmė ženkliai mažesnė. KITS pacientų, sergančių šlapimo organų infekcija, mirštamumas 40 procentų. Jį didino vyresnis nei 50 m. amžius, cukrinis diabetas bei šlapimo pūslės kateterizacija, ypač – ilgalaikė.