Endre Zima

Introduction: Population aging in Europe is ongoing and linked to poorer outcomes after out-of-hospital cardiac arrest (OHCA), yet age alone should not guide treatment. We aimed to describe age-related survival, identify independent predictors, and develop a predictive model using EMS data. Methods: We analyzed 147,962 adult OHCA cases from the Hungarian National EMS registry. Variables included initial rhythm, witness status, location, and sex. The primary outcome was survival to hospital admission. Multivariable logistic regression assessed independent predictors and age × treatment interactions; performance was evaluated with AUC, Brier score, and cross-validation. Results: Overall survival was 8.8%; elderly patients had lower survival (7.3%) than non-elderly (11.7%, p < 0.001). VF/VT (adjusted OR 5.34), medical personnel witness (OR 4.52), and AED shock (OR 3.52) were the strongest predictors. Age attenuated the survival benefit of VF/VT (interaction OR 0.914) and the protective effect of female sex (interaction OR 0.882; both p < 0.001). Model performance was good (AUC 0.784; Brier 0.0705). Conclusions: Age independently predicts survival after OHCA, but substantial treatment benefits persist in the elderly. Age–treatment interactions support geriatric-tailored resuscitation strategies and potential integration of this high-performing model into clinical decision support systems.

Aims: Landiolol is an ultrashort-acting, highly cardio-selective beta1-adrenergic receptor blocker used for short-term control of tachyarrhythmias. While its real-world use has been described in Japan, data from European clinical practice are lacking. This study aimed to collect real-world data on landiolol use, effectiveness, and safety across diverse clinical settings in Europe. Methods and results: This multicentre, observational study included adult patients with supraventricular arrhythmias treated with landiolol. Patient characteristics, drug utilization patterns, efficacy, and safety were assessed. In total, 450 patients were enrolled and 449 were analysed (median age: 72 years, IQR 63–78) from 17 sites across 8 European countries. Most patients (73.1%) received landiolol for atrial fibrillation. The median (IQR) duration of infusion was 8.9 (2.3–34.0) h, with starting, minimum, and maximum doses of 5.3 (2.5–10.0), 4.0 (1.7–10), and 10.0 (6.0–30.0) µg/kg/min, respectively. Heart rate (HR) control, defined as HR ≤110 b.p.m. or a reduction of >20% from baseline, was achieved in 74.2% of patients within 4 h after treatment discontinuation, with 36.9% of arrhythmia patients restoring sinus rhythm. Blood pressure (BP) remained stable throughout treatment. A total of 123 adverse events and 113 major adverse cardiac events were reported, none of which were related to landiolol. Conclusion: In European clinical practice, landiolol dosing adhered to product information recommendations. Landiolol was effective in controlling HR, with minimal impact on BP. The treatment was well tolerated, and no new safety signals were identified. These findings support the efficacy and safety of landiolol across diverse clinical settings in Europe.

Background/Objectives: Patients with normal sinus rhythms undergoing cardiac resynchronization therapy defibrillator (CRT-D) implantation may benefit from a novel two-lead CRT-D system (CRT-DX), which features an atrial sensing dipole integrated into the right ventricular lead. This single-arm, international, non-controlled investigation focused on the safety and clinical efficacy of CRT-DX devices in CRT-D candidates who do not require atrial pacing. Methods: Patients indicated for CRT-D implantation (resting heart rates > 40 bpm and ≥100 bpm during exercise, no second or higher-degree AV block, and no history of persistent or permanent atrial fibrillation) were enrolled across 21 sites in four European countries. The primary endpoint was the need for an additional RA lead implantation within 12 months. Secondary endpoints comprised any invasive re-intervention to the CRT-DX system or infection. Results: Among the 110 patients (mean age 62 years, 70% male), 60% had an underlying non-ischemic cardiac disease. During 12 months of follow-up, RA lead implantation was required in two patients for atrial undersensing or chronotropic incompetence (RA lead implantation-free rate: 98.2% (95% CI: 92.7–99.5%)). Atrial sensing amplitudes were stable (mean: 4.7 ± 1.7 mV), AV-synchrony was maintained at >99%, and the median percentage of biventricular pacing exceeded 98%. The left ventricular ejection fraction improved by an absolute 14.7%. Conclusions: Using simple, clinically applicable inclusion criteria, the two-lead CRT-DX system demonstrated a low rate of subsequent RA lead implantations (1.8%) and maintained adequate RA sensing amplitudes throughout the observation period. The two-lead CRT-DX concept appears to be a feasible alternative for patients with preserved chronotropic competence.

Background/Objectives: Remote telemedical management (RTM) in heart failure (HF) patients with cardiac implantable electronic devices (CIED) is a reliable approach to follow device-specific and heart failure-related parameters. However, while some positive outcome data is available, results are inconclusive. We aimed to assess the benefits of continuous remote telemonitoring (RTM) compared to the in-person visit (IPV) in reducing all-cause mortality, heart failure hospitalizations (HFH), cardiovascular (CV) deaths, and the occurrence of inappropriate therapy. Methods: The study comprised a systematic review and meta-analysis of randomized controlled trials (RCTs) testing RTM (device-related or other non-invasive telemonitoring systems) vs. IPV for the management of HF patients. The main endpoints were all-cause and CV mortality. Risk of bias and level of evidence were assessed. Hazard ratios (HRs), odds ratios (ORs) and 95% confidence intervals (CI) were calculated. CENTRAL, EMBASE and MEDLINE were searched, and only randomized controlled studies were included. Results: Sixteen RCTs were identified, comprising a total of 11,232 enrolled patients. Seven studies evaluated all-cause mortality, resulting in an OR 0.83 (95% CI 0.72 to 0.96). When CV mortality was assessed, the RTM group showed a significant benefit compared to the IPV group (OR 0.81, 95% CI 0.67 to 0.97). The risk of bias ranged from “low” to “some concerns” for most outcomes, and the certainty was low to moderate depending on the specific outcomes. Conclusions: RTM proved to be superior in reducing all-cause and CV mortality compared to IPV; however, there is a clear need to have standardized alert actions to achieve the mortality benefit.

Background: Early defibrillation improves outcomes in cardiac arrest, but the optimal defibrillation strategy and energy requirements remain debated. This study investigated whether arterial blood gas (ABG) parameters could predict optimal defibrillation energy requirements for achieving the highest first-shock success rates in an animal model. Our study focused on clinical scenarios where ABG measurements are readily available, such as ventricular tachycardia and ventricular fibrillation storms requiring multiple shock deliveries. Materials and Methods: In the experimental setting, ventricular fibrillation was induced by 50 Hz direct current (DC), and the defibrillation threshold (DFT) was determined using a stepwise defibrillation protocol. ABG parameters were measured before each defibrillation attempt, recording partial arterial pressure of carbon dioxide (PaCO₂) and oxygen (PaO₂), pH, hematocrit (Hct), sodium (Na⁺), potassium (K⁺), and bicarbonate (HCO₃⁻) levels. The relationships between ABG parameters and the DFT were analyzed for 15 subjects using classical data analysis techniques and machine learning (ML) algorithms. Multiple ML models were trained and tested to predict the higher energy needed for successful defibrillation based on the ABG parameters. Results: Statistically significant differences were found in Hct and Na⁺ levels between the two DFT categories, above 130 Joules (J) and below 40 J (p < 0.01). The DFT negatively correlated with PaO₂ and positively correlated with Hct and Na⁺. However, other ABG parameters did not show significant correlations with DFT. Using ML, we predicted cases requiring higher defibrillation E. Our best-performing model, the Extra Trees Classifier, achieved 83% overall accuracy, with 100% and 67% precision rates for higher and lower DFT categories, respectively. We validated the model using bootstrap resampling and 10-fold cross-validation, confirming consistent performance. We identified Hct, PaCO₂, and PaO₂ as significant contributors to model prediction based on the feature importance value. Conclusions: Modern data analysis techniques applied to ABG parameters may guide personalized defibrillation energy selection, particularly in controlled clinical environments such as catheterization laboratories and intensive care units where ABG measurements are readily available.

A kórházon kívüli hirtelen szívhalál, másnéven a keringésmegállás továbbra is vezető szív- érrendszeri haláloknak számít. A keringésmegállást elszenvedő egyén azonnali ellátást igényel, a keringését újraélesztéssel mesterségesen kell fenntartani, mindaddig, amíg egészségügyi személyzet speciális beavatkozásokkal vissza tudja állítani a beteg keringését. Ideális esetben a kórházon kívüli hirtelen szívhalál ellátása már a helyszínen, azonnal megkezdődik, újraélesztésben jártas személyek és akár az eseményt észlelő laikusok által. Mindez azért fontos, mert még azonnali riasztás esetén is a mentőegység vagy elsődleges ellátó egészségügyi személyzet kiérkezése akár 5-8 perc is lehet. Az agy visszafordíthatatlan károsodása 3-5 perces keringésmegállás és következményes oxigénhiányos állapotnál már elkezdődik, ezért kulcsfontosságú a hirtelen szívhalált észlelő részéről az azonnali újraélesztés megkezdése, aki sokszor nem egészségügyben jártas, ún. laikus személy. Ilyen módon, a hirtelen szívhalál kedvező kimenetelének javításában, illetve a mortalitás csökkentésében kiemelt szerepe van a laikusok képzésének, az alapszintű újraélesztés (basic life support , BLS) oktatásának. Célunk volt egy teljes, 10-12. évfolyamos középiskolás – mintegy 360 fős - tanulócsoport BLS oktatási projektjének megszervezése, meghatározott oktatási módszertannal, fél év leforgása alatt. A tanulmány a projekt menedzsmentje kapcsán azonosított problémákat és kulcspontokat mutatja be: az oktatás órarendbe és tanrendbe illesztése, engedélyeztetése az iskolavezetéssel, a diákokkal és törvényes képviselőik tájékozott beleegyezése, gyakorlatok beosztása, valamint a minőségbiztosítást alátámasztó adatok rögzítése, anonimizálása, elemzése, és kiértékelése. Eredményeink egyrészt a sikeres, 296 tanuló számára megvalósított, gimnáziumi BLS oktatás, az félautomata defibrillátor kihelyezése, közösségi hozzáférés lehetőségének megalapozása, egy lehetséges jógyakorlat megteremtése. Jelen kéziratban bemutatjuk a serdülők szervezett újraélesztés-oktatásának egészségügyi és oktatásügyi módszertanának homogenizálását segítő stratégiai módszereinket, a szervezési kulcsproblémák azonosítását és azok gyakorlati megoldásait.