Gabriel Cismaru

By Cismaru Gabriel, Lucian Muresan, Puiu Mihai, Radu Rosu, Gabriel Gusetu, Dana Pop and Dumitru Zdrenghea

Tachycardia-induced cardiomyopathy is a systolic cardiac dysfunction given by prolonged elevated heart rates in patients with incessant or frequent tachyarrhythmias. Arrhythmias associated with tachycardiomyopathy can be either supraventricular (atrial tachycardia, atrial flutter, atrial fibrillation, AVNRT, permanent junctional reciprocating tachycardia, high rates of atrial pacing) or ventricular (frequent premature ventricular complexes, right ventricular outflow tract tachycardia, LVOT, left ventricular fascicular tachycardia, bundle-branch reentry or high rate of ventricular pacing). Electrophysiological study confirms the clinical diagnosis of tachycardia-induced cardiomyopathy, reveals the arrhythmia mechanism and facilitates catheter ablation that results in complete recovery of ventricular function. This chapter has two parts: 1. Theoretical insight into the pathogenesis of tachycardia-induced cardiomyopathy, clinical manifestations and therapy. 2. Practical issues: we describe our EP lab’s experience on electrophysiological study and ablation in patients with tachycardia-induced cardiomyopathy. We will present five cases of ablation: PVCs >30,000/24 h, antidromic tachycardia, 2:1 atrial flutter, persistent atrial fibrillation and RVOT PVCs with nonsustained VT.

Part of the book: The Role of the Clinical Cardiac Electrophysiologist in the Management of Congestive Heart Failure

By Gabriel Cismaru, Lucian Muresan, Puiu Mihai, Radu Rosu, Gabriel Gusetu, Andrei Cismaru, Dana Pop and Dumitru Zdrenghea

This chapter aims to provide basic anatomical knowledge for the interventional electrophysiologists to understand catheter placement and ablation targets. We begin with the location of the heart inside the mediastinum, position of cardiac chambers, pericardial space and neighboring structures of the heart. We continue with the right atrium and important structures inside it: sinus node, cavotricuspid isthmus, Koch’s triangle and interatrial septum with fossa ovalis. A special part of this chapter is dedicated to the left atrium and pulmonary veins with the venoatrial junction, important structures for catheter ablation of atrial fibrillation. We finish our description with both ventricles with outflow tracts and the coronary venous system.

Part of the book: Human Anatomy

By Andrei Cismaru and Gabriel Cismaru

Stem cell therapy is a new strategy for patients with ischemic heart disease. However, no consensus exists on the most optimal delivery strategy, but an important factor that determines the success of stem cell therapy is the choice of cell delivery route to the heart. Delivery strategy affects the fate of cells and subsequently influences outcome of procedure. Our review summarizes current approaches for administration of stem cells to the heart. Three most used approaches are intracoronary, intramyocardial, and epicardial injection. They have been widely used for delivery of different types of cells. There are several advantages of these stem cell administration approaches, but stem cell retention and stem cell survival rates are quite low using these methods, which might limit their therapeutic effects. Alternative attempts to improve current stem cell therapy methods are reviewed along with emerging new stem cell delivery approaches. The present chapter displays the current status on stem cell delivery techniques, their efficacy, and clinical success in different trials.

Part of the book: Stem Cells in Clinical Practice and Tissue Engineering

By Andrei Cismaru, Iulia Coroian, Gabriel Cismaru and Adrian Udrea

Medullary thyroid carcinoma is a hormone-producing malignant tumor that synthesizes calcitonin. MTC can be sporadic or familial. It has a malignant behavior. Our chapter has 3 parts: 1.Updates on the diagnosis of MTC -in this part we review the clinical findings in MTC: isolated thyroid nodule, palpable cervical lymph nodes and systemic manifestations. Fine needle aspiration, serum calcitonin, computed tomography (CT) and fludeoxyglucose - positron emission tomograpyh (FDG-PET) are summarized. Biomarkers with prognostic value are be described in detail: plasma calcitonin, carcino-embryonic antigen, germ-line RET mutation and matrix metalloproteinase. 2. Updates on the management and treatment of MTC -we discuss the surgical treatment, radiation therapy, systemic therapy with angiogenesis inhibitors and transcatheter arterial embolization to prevent extension of the tumor. Based on the characteristics of MTC a new approach using gene therapy has been developed to obtain complete remission of the carcinoma. 3. We describe a typical case of MTC from the oncology department, with cervical lymph nodes and a thyroid nodule. Immunohistochemistry staining showed calcitonin in the tumor cells. Thyroid ultrasound with fine needle aspiration biopsy confirmed the MTC. CT images of the cervical lymph nodes and thyroid nodule as well as microscopy images are presented. Chemotherapy with Dacarbazine was initiated with favorable outcome.

Part of the book: Head and Neck Cancer

By Cismaru Gabriel, Serban Schiau, Gabriel Gusetu, Lucian Muresan, Mihai Puiu, Radu Rosu, Dana Pop and Dumitru Zdrenghea

In patients with Brugada syndrome, implantable cardioverter‐defibrillator (ICD) is the only demonstrated treatment that prevents sudden cardiac death. The progress in ICD technology improved the diagnosis and efficacy of implantable devices in the management and treatment of ventricular tachycardia (VT) and ventricular fibrillation (VF). Recording of electrical events just before and after a delivered or aborted ICD therapy permits a more accurate characterization of the rhythm but also provides information on the electrical events preceding the arrhythmia. This chapter aims to gain insight into the mechanism of initiation and termination of spontaneous VF by analyzing intracardiac electrograms (IEGM) in Brugada patients implanted with ICDs. It has two parts: (1) update on ICD electrograms in Brugada syndrome patients, where we review the medical literature on ICD electrograms and their use for detecting electrical manifestations of Brugada syndrome, and (2) examples of ICD electrograms, from our own database of patients affected by Brugada syndrome.

Part of the book: Interpreting Cardiac Electrograms

By Cismaru Gabriel

Part of the book: Bedside Procedures

By Mart Min and Gabriel Cismaru

Part of the book: Cardiac Rhythm Management