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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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    Vascular anomaly – persistent left superior vena cava
    (Hrvatsko kardiološko društvo, 2013-09-23)
    Boshkov, Vladimir
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    Danilovska, Ilina
    Persistent left superior vena cava (PLSVC) is a very rare congenital vascular anomaly, 0,3% in general population. In 90% of cases PLSVC flows into the right atrium via the coronary sinus, but it can also be associated with other cardiovascular abnormalities including ASD, VSD, bicuspid aortic valve, coarctation of aorta and cor triatriatum, resulting in a right to left sided shunt. Our case, a 72-old male, was admitted to the hospital for a third replacement of the pacemaker. We didn't have any information for any vascular anomaly. The first indication for implantation of a pacemaker — AAI, was dysfunction of sinoatrial node. Few years later, there was progression of the block and the patient was implanted a new system on the other side, a dual-chamber pacemaker (DDDR). During the second re-implantation, the patient was implanted a singlechamber pacemaker (VVIR). Now we noticed malfunction of the system and high impedance of electrode. X-ray before procedure found lead fracture, hence it was decided to implant a new system on the left side and the left subclavia vein was used as a vascular access. Due to contrast application, an aberrant flow was noticed, i.e. the left subclavia vein drained into the right atrium via the coronary sinus, and active fixation was used. Before each intervention we shall review the complete patient documentation in detail and in case we suspect any anomaly we shall carry out an echocardiography. The dilatation of the coronary sinus would indicate PLSVC.