The prospective, multi-center, randomized CEASE-AF trial previously reported that hybrid ablation with left atrial appendage exclusion (LAAE) improved freedom from atrial arrhythmias by 32% and 33% through 12- and 24-months compared to endocardial catheter ablation in patients with non-paroxysmal atrial fibrillation (AF). In this analysis, we report 3-year outcomes of CEASE-AF. To evaluate long-term safety and effectiveness of de novo hybrid ablation with LAAE compared to endocardial catheter ablation for non-paroxysmal AF Patients 18-75 years of age with no prior ablation who had symptomatic, drug-refractory persistent AF and enlarged left atrium (>4 cm) or longstanding persistent AF (LSPAF) were eligible. Patients were randomized 2:1 to a) staged epicardial-endocardial (hybrid) ablation to achieve left atrial posterior wall (LAPW) and pulmonary vein isolation (PVI) as well as LAAE or b) endocardial catheter ablation, including repeat ablation with 180 days of the index procedure, to achieve PVI. Effectiveness was freedom from AF, atrial flutter (AFL), or atrial tachycardia (AT) off anti-arrhythmic drugs (AADs) except previously failed AADs at same or lower dose. Rhythm was assessed by 48-hr Holter and adjudicated by an independent core laboratory. The safety endpoint was major complication rate adjudicated by an independent clinical events committee. Reinterventions could include repeat ablations (including epicardial crossover), electrical or pharmaceutical cardioversion, implantation of a permanent pacemaker or implantable cardioverter defibrillator, or other interventions. 102 patients were in the Hybrid Arm and 52 in the Catheter Arm, with similar baseline characteristics. Mean age was 60.7±7.9 years, mean LAD was 4.7±0.4 cm, 74% were male, and 19% had LSPAF. Through 36-months, effectiveness was 61.1% (58/95) in the Hybrid Arm and 27.5% (14/51) in the Catheter Arm (p<0.001), an absolute difference of 33.6% (95% CI: 15.9%-48.5%). In patients with persistent AF, effectiveness was 61.0% (47/77) in the Hybrid Arm and 32.6% (14/43) in the Catheter Arm (p=0.003). In patients with LSPAF, effectiveness was 61.1% (11/18) in the Hybrid Arm and 0% (0/8) in the Catheter Arm (p=0.007). Through 36-mo, safety rates were 12.7% (13/102) and 9.6% (5/52) in the Hybrid and Catheter Arms, respectively (p=0.79). Safety and effectiveness across the trial duration are shown in the Figures. In the Hybrid Arm, 28.4% (27/95) of patients had a reintervention through 36-mo, compared to 56.9% (29/51) in the Catheter Arm (p<0.001). In CEASE-AF, the rhythm control benefit of a hybrid ablation approach exceeded that of an endocardial-only approach for non-paroxysmal AF, and this effect was durable through 36-months without significantly increasing complications.Efficacy Complications
Common Position of Scientific Societies: Polish Society of Dermatology (PTD), Polish Society for Fundamental and Clinical Immunology (PTiDiK), Polish Society of Paediatric Oncology and Haematology (PTOHD) Background and Objectives This paper aims to analyse, assess and appraise appropriate use of Normal Polyvalent Immunoglobulins (IgGs) across multiple indications, wherever these therapies are known to be used and have been proven to be an effective therapeutic modality. This assessment is based on a framework proposed by a group of international experts in the recent Green Paper „Appropriate Use of Immunoglobulins in Europe”.1 Based on a systematic application of the framework’s criteria to all IgG conditions and diseases, this paper presents a short-list of indications, where IgG use is appropriate, together with a guidance on optimal therapeutic paradigms. As such, this paper is aimed to assist the clinical community and policy makers in navigating the extremely complex clinical landscape of rare and ultra-rare diseases and conditions, which are either immune-mediated or stem from deficient, dysregulated or dysfunctional immune system. Some of the indications considered in this study are currently not registered for IgG use in Poland or, if registered, not fully covered with reimbursement. In cases where IgG use in such conditions or diseases is found to be appropriate, this study may be also considered by the relevant regulatory and/or HTA bodies as a contribution towards reassessment or reappraisal.
Cardiac sympathetic denervation (CSD) reduces risk of ventricular tachyarrhythmias (VTA in long-QT syndrome, catecholaminergic polymorphic ventricular tachycardia and cardiomyopathies. CSD has also a theoretical potential to be alleviate symptoms in other disorders dependent on adrenergic input. The aim of this study was to assess efficacy and safety of bilateral CSD (BCSD) procedure performed for wide range of cardiovascular disorders. Apart form efficacy of CSD also physical and psychological consequences and patient satisfaction were studied. Between 2018 - 2024 51 patients were qualified for BCSD in 2 centers in Poland. The median age of patients was 46,8 (range 17-78) years, 26 were males, 22 had prior ICD implants. In 4 cardioneuroablation was also performed. In 49 patients video- and in 2 robot-assisted BCSD ob T1-T4(5) chain was performed for recurrent VTA or electric storm in 41, coronary spam (5), Takotsubo cardiomyopathy (1), inappropriate sinus tachycardia (1) and Raynaud syndrome (9) . Several patients had multiple indications. In two patients with DCM VTA recurred within a week after CSD and also thereafter. There were 5 deaths on follow-up in the course of underlying disease, none was linked directly to BCSD. One death occurred in a patient in whom CSD was a last resort for refractory VT storm. Persistent neuropathic pain was the main adverse effect reported by patients. In the group of patients in whom both CSD and CNA wee performed no serious AE were observed. BiCSD is an effective when performed for various cardiovascular indications such as recurrent ventricular tachyarrytmias, coronary spasm and Raynaud syndrome. BCSD is also well tolerated by majority of patients. The failure of antiarrhythmic effect shortly after the procedure in 2 patients with dilated cardiomyopathy and low EF needs to be elucidated in further studies.
Purpose: The purpose of this paper is to present the physiological changes occurring in the human body with increasing altitude and decreasing barometric pressure, and to summarize current knowledge on high-altitude diseases, with particular emphasis on Acute Mountain Sickness (AMS). The article outlines the pathophysiological basis of its clinical manifestations, risk factors, diagnostic criteria, differentiation from other conditions, and methods of prevention and treatment. It also aims to raise awareness of high-altitude risks and promote safe practices during mountain travel. This work is intended as educational material for medical students, health professionals, travellers, and those beginning their high-altitude journeys. Materials and methods: This review paper is based on data obtained from peer-reviewed scientific articles and reports published in reputable databases and journals, including PubMed, Taylor & Francis, CDC, SAGE Journals, ScienceDirect, and Practical Medicine, as well as Modern Management Review, The American Journal of Medicine, PLOS One, and High Altitude Medicine & Biology. The analysis also draws on the official position of the UIAA Medical Commission. Clinical studies, reviews, guidelines, and reports on high-altitude diseases published between 2010 and 2025 in English or Polish were included. Conclusions: Acute mountain sickness arises from inadequate acclimatization to high-altitude hypoxia. Key risk factors include rapid ascent and prior AMS episodes. Gradual acclimatization is the most effective preventive measure, while pharmacological support may aid high-risk individuals. Early symptom recognition and prompt intervention are essential to prevent severe, potentially life-threatening complications, underscoring the importance of understanding human physiological limits and adaptation in extreme environments.
The article presents the results of a comparative analysis of representation and transformation of mythological and folkloric characters and motifs in Tatar and Chuvash children’s drama of the late 20 th and early 21 st centuries. The object of the study is fairy tale plays by T. Minnullin, F. Yarullin, G. Gilmanov, R. Sagdi (the Tatar tradition), I. Trer, O. Turgay, and E. Narbi (the Chuvash tradition). We apply the historical-literary, comparative-typological, and structural-semiotic methods to identify the specifics of the archetypal images’ adaptation (Shurale/ Arçuri, Diyu/Aslă Tură, Ubyrly/Ukh, Buka/Ama) in a new sociocultural context. The scientific novelty is the introduction of a number of little-studied texts into the scientific circulation (for example, the plays “Savtepi” by O. Turgay and E. Narb’s play “Ukh Starik”), as well as a systemic comparison of two national traditions, which allows us to identify common mechanisms of mythopoetic modelling and ethno-specific features (individualism/collectivism, the extent of sacredness). As a result, we have established that the authors use archaic plots and characters as a tool for actualizing ecological and ethical discourse, forming cultural identity and retransmitting moral values. Despite the general trend towards humanisation and demythologisation of images, Tatar drama emphasizes a socially adaptive function of myth, while Chuvash drama preserves its connection with cosmogonic ideas and ritual practices.
