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BackgroundThe alert-based HeartInsight algorithm predicts risk of worsening heart failure hospitalisations (WHFHs) by evaluating temporal trends of seven physiologic parameters obtained through automatic daily remote monitoring of implantable cardioverter-defibrillators. The aim of the present study was to evaluate the predictive performance of HeartInsight in a larger and more heterogeneous meta-cohort of patients, incorporating newer device generations and including patients managed with the most recent guideline-directed medical therapy (GDMT).MethodsThe HeartInsight algorithm was retrospectively applied to data from four clinical trials in which WHFH events were adjudicated by independent external boards and remote monitoring was activated to provide relevant parameter trends. The analysis comprised 1352 patients with New York Heart Association (NYHA) class II/III, and no long-standing atrial fibrillation.ResultsDuring a median follow-up of 599 days, 110 patients (median age 68 years (IQR, 61–75), 75.7% male) had a total of 165 WHFHs. The estimated sensitivity of WHFH prediction, as determined by generalised estimating equations, was 51.5% (95% CI 43.0% to 59.9%). The false alert rate was 0.85 per patient-year, the median alerting time was 34 days (IQR, 16–78) and the specificity was 81.4% (95% CI 80.4 to 82.4%). The results were verified in the multivariable analysis with two adjusting covariates (newer/older device generation and quadruple/other GDMT) and in the univariable analysis of prespecified patient subgroups according to NYHA class, aetiology and sex, showing no significant differences.ConclusionsStudy results underscore the robustness of the predictive algorithm in a heterogeneous and contemporarily managed heart failure population.

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-ablation. Methods Patients with non-paroxysmal AF undergoing coronary artery bypass grafting and/or valve repair/replacement were included in the trial if concomitant cryo-ablation was part of the treatment plan according to current guidelines. The patients reported in this study were assigned to undergo staged percutaneous radiofrequency catheter ablation (PRFCA), i.e., hybrid treatment, as a part of the SURHYB trial protocol. Results We analyzed 103 patients who underwent PRFCA 105 ± 35 days after surgery. Left and right pulmonary veins (PVs) were found isolated in 65 (63.1%) and 63 (61.2%) patients, respectively. The LA posterior wall isolation and mitral isthmus conduction block were found in 38 (36.9%) and 18 (20.0%) patients, respectively. Electrical reconnections (gaps) in the left PVs were more often localized superiorly than inferiorly (57.9% vs. 26.3%, P  = 0.005) and anteriorly than posteriorly (65.8% vs. 31.6%, P  = 0.003). Gaps in the right PVs were more equally distributed anteroposteriorly but dominated in superior segments (72.5% vs. 40.0%, P  = 0.003). There was a higher number of gaps on the roof line compared to the inferior line (131 (67.2%) vs. 67 (42.2%), P  < 0.001). Compared to epicardial cryo-ablation, endocardial was more effective in creating PVs and LA posterior wall isolation ( P  < 0.05). Cryo-ablation using nitrous oxide (N 2 0) or argon (Ar) gas as cooling agents was similarly effective ( P  = NS). Conclusions The effectiveness of surgical cryo-ablation in achieving transmural and durable lesions in the left atrium is surprisingly low. Gaps are located predominantly in the superior and anterior portions of the PVs and on the roof line. Endocardial cryo-ablation is more effective than epicardial ablation, irrespective of the cooling agent used.

Left atrial (LA) enlargement is a predictor of worse outcome after catheter ablation for atrial fibrillation (AF). Widely used two-dimensional (2D)-echocardiography is inaccurate and underestimates real LA volume (LAV). We hypothesized that baseline clinical characteristics of patients can be used to adjust 2D-ECHO indices of LAV in order to minimize this disagreement. The study enrolled 535 patients (59 ± 9 years; 67% males; 43% paroxysmal AF) who underwent catheter ablation for AF in three specialized centers. We investigated multivariately the relationship between 2D-echocardiographic indices of LA size, specifically LA diameter in M-mode in the parasternal long-axis view (LAD), LAV assessed by the prolate-ellipsoid method (LAVEllipsoid), LAV by the planimetric method (LAVPlanimetry), and LAV derived from 3D-electroanatomic mapping (LAVCARTO). Cubed LAD of 106 ± 45 ml, LAVEllipsoid of 72 ± 24 ml and LAVPlanimetry of 88 ± 30 ml correlated only modestly (r = 0.60, 0.69, and 0.53, respectively) with LAVCARTO of 137 ± 46 ml, which was significantly underestimated with a bias (±1.96 standard deviation) of -31 (-111; +49) ml, -64 (-132; +2) ml, and -49 (-125; +27) ml, respectively; p < 0.0001 for their mutual difference. LA enlargement itself, age, gender, type of AF, and the presence of structural heart disease were independent confounders of measurement error of 2D-echocardiographic LAV. Accuracy and precision of all 2D-echocardiographic LAV indices are poor. Their agreement with true LAV can be significantly improved by multivariate adjustment to clinical characteristics of patients.

Cryoenergy is the most commonly used method of lesion formation in patients who have undergone surgical ablation of atrial fibrillation. Despite frequent use, the clinical effect of cryoenergy in endocardial and epicardial approaches is unknown. To compare the effect of various cryoenergy applications on the postoperative incidence of sinus rhythm and completeness of lesions performed. A total of 55 patients underwent concomitant atrial fibrillation surgical ablation using cryoenergy under various conditions: epicardially during cardiac arrest, epicardially on beating heart, and endocardially. In the postoperative period, patients were invited to attend an electrophysiological examination to assess the completeness of surgical ablation lesions and, if necessary, to complete catheter ablation. Twenty-four patients underwent epicardial ablation on the arrested heart (group 1), 12 patients underwent epicardial ablation on the beating heart (group 2), and 19 patients underwent endocardial ablation (group 3). In the electrophysiological examination, sinus rhythm was present in 71% vs. 83% vs. 89% of patients, respectively. The completeness of pulmonary vein isolation was confirmed in 31% vs. 25% vs. 95% of patients, complete box lesions in 15% vs. 0% vs. 79% of patients, respectively. Despite the similar clinical effect of surgical ablation in all three approaches, the morphologically most effective use of cryoenergy is endocardial ablation. This approach has a very good result. Our findings further support the endocardial use of cryoenergy during surgical ablation of atrial fibrillation.

The number of patients with implantable cardioverter-defibrillators (ICDs) has been continuously rising. Telemonitoring care (Home Monitoring™ – HM) has been increasingly used during the monitoring of these patients. 150 patients with ICDs who were monitored using the HM system (HM+), and 150 patients with ICDs who were monitored using standard outpatient check-ups (HM−) were included. A questionnaire, which focused on the quality of life (QoL) (EQ5D-3L), level of anxiety and depression (HADS), and a custom questionnaire examining the subjective approach of patients to the HM system and telecare workflow, was sent out to all patients. The method of ICD monitoring did not directly influence the QoL (p=NS). A non-significant trend towards better QoL in HM+ compared to HM− patients was recorded. It was based on total QoL scores (68.6±19 vs. 64.6±16.5, p=0.09). Regarding anxiety and depression, statistical testing also failed to find any difference between HM+ and HM− patients. The most striking difference between HM+ and HM− patients was recorded in the preference for the type of monitoring. 54.9% of HM− patients were interested in remote monitoring, 45.1% said they preferred outpatient check-ups, and only 6.7% (p<0.0001) of HM+ patients were interested in switching to outpatient check-ups from remote monitoring. HM+ patients were more inclined to use remote ICD monitoring (p=0.007) and had a positive approach towards the telecare system (p=0.034). The method of device monitoring does not significantly affect QoL in patients with ICDs, nor does it affect levels of anxiety and depression. Generally, patients with ICDs monitored using the HM system were very satisfied with telecare and would prefer not to lose remote ICD monitoring.

Introduction. The medicine management is considered an important area of health care, which is ensured by various healthcare professionals including nurses. Nurses gain the competence of medicines administration immediately after graduation. This competence can be applied to any area of healthcare. Even in specialized settings such as intensive care units, any additional qualification e.g. specialized education is not required. On the contrary, appropriate education is considered an important factor that could help to reduce the risk of adverse events related to medication management.Aim. The aim of this study was to analyse the students’ knowledge in this field at the end of nursing studies at bachelor level (n = 67) and specialized intensive care nursing studies at master level (n = 42).Methodology. Knowledge was assessed using a written test, which was related to the management of medicinal products administered commonly at intensive care units by qualified nurses as well as nurse specialists without distinction. From the point of view of the formal competencies of healthcare professionals, the questions were divided into three categories.Results. The mean success rate on the test was 53.4%. The highest range of knowledge was demonstrated by already qualified students at the end of specialised studies with prior work experience in ICU, the lowest by students just before graduation. The highest rating was achieved by all students in the activity-oriented category for which the responsibility lies primarily with the medical doctor, but nurses were expected to have this knowledge and participate at related activities on the basis of a physician’s order. This knowledge included also the area of clinical pharmacology. On the other hand, the lowest score was achieved by all groups of students in the category of activities that are not treated by the physician’s order, and the use of diverse knowledge from different areas was usually necessary.Conclusions. Clinical practice has an irreplaceable role for nurses in the process of qualifying education as well as lifelong learning. The extent of nursing education in medicine management, the manner of nursing training, as well as the proportion of nursing specialists in the nursing team at specialised workplaces, deserves much greater attention in terms of ensuring safe care in this area. Shifting some competencies and duties in medicine management, especially related to intravenous (IV) therapy, to less qualified healthcare professionals appears to be highly controversial and risky.

Introduction. Although the incidence of cardiac arrest in children is much lower than in adults, the condition is still considered a major health problem with a very low chance for survival. As in adults, the timely provision of cardiopulmonary resuscitation (CPR) in children is crucial. Current guidelines for CPR in children were published along with the guidelines for CPR in adults in 2015. As in previous years, they are based on consensus provided by International Liaison Committee on Resuscitation (ILCOR). Guidelines of particular ILCOR member councils may vary and reflect regional characteristic such as different access to health care, education methods or willingness of population to provide emergency assistance. Moreover, the conditions requiring CPR in children are characterized not only by different incidence, but also by aetiology or techniques used for different age groups. Therefore, emphasis is put on simplicity and feasibility as well as on consistency with adult guidelines to improve retention of the paediatric sequences. Nurses may be first rescuers not only in health care facilities. Better understanding of CPR guidelines might help them to improve their ability to detect conditions requiring CRP and also initiate and provide effective emergency care.Aim. The aim of this study is to compare different approaches to paediatric CPR, in particular to basic life support (BLS), used in current guidelines of different ILCOR member councils.Results and conclusions. General algorithm for adult CPR may be followed for victims of all age, but in case of children, slightly different approach might have much more favourable outcome.

Introduction: Quality of life must be perceived in two levels - objective and subjective. Heart arrhythmia is a disease of the cardiovascular system that, by its subjective and objective symptoms, can affect the individual's life physically, mentally, and also socially. It can limit a person in his or her everyday activities or in activities that make them happy or satisfied.Objectives: The aim of the research was to map the quality of life of patients with arrhythmia and to verify whether the duration of arrhythmia has an effect on the quality of life of patients with arrhythmia.Methods: A standardized ASTA (Arrhythmia - Specific Questionnaire in Tachycardia and Arrhythmias) questionnaire was used to collect quantitative data. The research group consisted of adult patients diagnosed with hearth arrhythmia, hospitalized at the Department of Cardiology of the Ceske Budejovice Hospital (Nemocnice České Budějovice a.s.). A total of 127 valid questionnaires were used for data processing.Results: The research revealed that the most common symptom of arrhythmia in 58% cases was rapid heartbeat, irregular heartbeat, and a sense of heart failure. Most respondents agreed with the claim that heart rhythm disorder makes it impossible for them to perform work, study, and perform daily life activities. No statistically significant differences were found in the evaluation of the influence of the arrhythmia duration on the patients' quality of life.Conclusions: Arrhythmia duration in the selected sample does not affect the overall health status and quality of life measured by the ASTA series questionnaires. Arrhythmia restricts the patient to perform work tasks, study, and perform daily life activities.

Atrial fibrillation (AF) is one of the most common supraventricular arrhythmias. Its prevalence in the general population over the last twenty years has increased significantly. The issue of the perception of nursing care has not yet been examined in detail. The aim of this research was to assess how nursing behavior was perceived by nurses and patients with radiofrequency catheter ablation (RFA) for AF. The research was conducted with quantitative methods using a standardized questionnaire CBI-24 (Caring Behaviors Inventory). The research sample consisted of two groups: patients with AF undergoing RFA (n=264) and cardiological nurses (n=92). The research was conducted between 2012 and 2014. On the basis of an overall evaluation of the perception of nursing behavior from the perspective of the patients and the nurses, there were no statistically significant differences (p=0.15). When evaluating the dimensions, i.e. “security”, “knowledge and skills”, “respectfulness” and “connectedness”, it was apparent that there was a statistically significant difference between the nurses and the patients perception of the dimensions of “knowledge and skills” (p=0.04) and “connectedness” (p=0.003), as the patients evaluated nursing care more positively than the nurses. The patients undergoing RFA AF evaluated the overall nursing behavior more positively than the nurses. The nurses perceived technical prowess more positively than the humanistic approach to patients. The patients evaluated the nurses’ performance more positively than the creation of a sense of security and safety. The areas of communication and education were identified as other problematic sections.