Faculty of Medicine

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Author: search.filters.author.Boskov, Vladimir

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    P1495ECG parameters as predictors of response to cardiac resynchronization therapy
    (Oxford University Press (OUP), 2017-06)
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    Taleski, Jane
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    Boskov, Vladimir
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    Risteski, D.
    Aim: Cardiac resynchronization has proven benefit as treatment modality in patients with heart failure. Unfortunately, the use of current selection criteria is associated with a failure to respond of approximately 30% cases. The aim of our study is to define more ECG criteria which can predict response to cardiac resynchronization. Methods and results: A total of 82 patients were enrolled in our study, and were followed for a mean of 25.6 months. Mean QRS duration in our group was 174ms, and 75% were LBBB, no patients with RBBB, 25% with wide QRS but undetermined BB morphology. To define if the patient is responder we used scoring system defined as: increase in LVEF more than 10% (1 point), lowering of NYHA class (1 point), QRS narrowing (1 point), hospitalization for heart failure in the follow-up period (-1 point). As non –responders were defined all patient with a score 0 or -1 (8 patients), and responders were all patients with the score 1-3 (74 patients). In the responder group we found significantly wider QRS (p=0,04), higher R6/S6 ratio (p=0,02), higher (S1+R6)-(S6+R1) (p=0,02), and higher R amplitude in V6 (p<0,01). When we divided the group of patients according to BB morphology the significance in LBBB patients was kept in R6/S6 ratio (p=0,03), (S1+R6)-(S6+R1) (p=0,02) and R amplitude in V6 (p<0,01). In undetermined BB morphology – group of patients we found significantly higher R amplitude in V6 (p=0,01) and significantly higher S amplitude in V6 (p<0,01). Conclusion: We conclude that we could engage more ECG criteria to predict response to cardiac resynchronization therapy, even in the LBBB patients, but also in patients with wide QRS and undetermined BB morphology.
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    Scoring System Assessment of Cephalic Vein Access for Device Implantation
    (MediaSphere Medical, LLC, 2018-08)
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    Janusevsi, Filip
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    Pocesta, Bekim
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    Boskov, Vladimir
    The purpose of this study was to explore the usability of the cephalic vein (CV) for cardiac implantable electronic device (CIED) lead access by applying a scoring system to assess the venous anatomy. This prospective, single-center study included 100 consecutive patients who underwent CIED implantation within a period of one year. Contrast-enhanced venography images were obtained for every patient, focused on the CV, “T-junction,” and the subclavian/ axillary veins (SV/AVs). Though careful examination of the images, an angle, valves, diameter, noncollateral (AVDnC) score was constructed and used to aid in choosing a CV or SV/AV access approach; in all cases, however, the preferred approach was CV independent of the AVDnC score result obtained. Upon use of the scoring system, the majority of patients (54%) had type A score result ( 3), indicating a favorable anatomy for CV access. In 48 of these patients, the CV was used for the implantation of at least one lead. The remaining 46 (46%) patients had type B score result ( 2). In 41 patients from this group, SV/AV access was used for lead implantation and, in five patients, CV access was used. The number of leads introduced through the CV was associated with larger score and the operator’s experience. In conclusion, in more than 50% of patients, at least one lead could be introduced through the CV. The scoring system used herein can simplify the choice between CV and SV/AV access and could eventually increase the efficiency and safety of the procedure, especially when less experienced implanters are involved.
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    Induction of atrioventricular node reentry by simultaneous anterograde conduction over the fast and slow pathways
    (2006-07)
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    Kovacevic, Dejan
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    Boskov, Vladimir
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    Gjorgov, Nicola
    Atrio-ventricular node reentry (AVNRT) is typically induced with an anterograde block over the fast pathway (FP) and conduction over the slow pathway (SP), with subsequent retrograde conduction over the FP. Rarely, a premature atrial complex (PAC) conducts simultaneously over the FP and SP to induce AVNRT. Previous publications have reported that conduction over the fast and slow pathway of the atrioventricular node can occur successively one after the other, thus leading to dual ventricular depolarization from what initially was a single atrial impulse. We report a case of an 18-year-old male patient referred for repeated bursts of ectopic activity. Evaluation of the patient's electrocardiographic recordings suggested the presence of dual ventricular activations for each atrial beat. The electrophysiological study revealed that the patient had simultaneous conduction over the fast and slow pathways of the atrioventricular node giving rise to a non-reentrant tachycardia, along with an absence of retrograde (ventriculoatrial) conduction, and a significant atrio-His bundle jump (A-H jump) through the slow pathway from the fast pathway during programmed electrical stimulation from the right atrium. Ablation of the slow pathway at the base of the Koch triangle yielded a cessation of the dual ventricular response, absence of the nonreentrant tachycardia and no A-H jump.
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    Anticoagulation Management in Patients with Pacemaker-Detected Atrial Fibrillation
    (ID Design 2012/DOOEL Skopje, 2016-06-15)
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    Boskov, Vladimir
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    Risteski, Dejan
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    In patients with an implanted pacemaker, asymptomatic atrial fibrillation (AF) is associated with an increased risk of thrombo-embolic complications. There is still no consensus which duration of episodes of atrial fibrillation should be taken as an indicator for inclusion of oral anticoagulation therapy (OAC).
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    Electrocardiographic Parameters as Predictors of Response to Cardiac Resynchronization Therapy
    (ID Design 2012/DOOEL Skopje, 2018-02-15)
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    Boskov, Vladimir
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    Risteski, Dejan
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    Janusevski, Filip
    INTRODUCTION: Although strict selection criteria are used to select patients for cardiac resynchronisation therapy, up to 30% of patients do not have a positive clinical response. PATIENTS: A total of 102 consecutive patients who had biventricular pacemaker/defibrillator (CRT-P or CRT-D) implanted were enrolled in this prospective observational study. RESULTS: During the average follow-up period of 24.3 months 5 patients died and 17 (16.7%) patients were hospitalised with the symptoms of heart failure; 75 (73.5%) patients were responders based on the previously defined criteria. Responders in the group of LBBB patients kept the significant difference in a computed variable (S1 + R6) - (S6 + R1) and R6/S6 ratio. Responders in non-LBBB patients kept the significant difference only in the height of R waves in V6. The R6/S6 ratio tended to be higher, but it did not reach a statistical significance. CONCLUSION: None of the tested ECG parameters stands out as an independent predictor of response to cardiac resynchronisation therapy, but some of them were different in responder-compared to the non-responder group. The amplitude of R wave in V6, higher R/S ratio in V6 and higher computed variable (S1 + R6) - (S6 + R1) may predict the likelihood of response to CRT therapy in both LBBB-patients and non-LBBB patients.