Search

We studied the presence of interstitial edema of the interatrial septum in patients with chronic heart failure (CHF) with atrial fibrillation (n=23) or without rhythm disturbances (n=9). The intensity of the MRI signal of the interatrial septum, interventricular septum, and skeletal muscle by T2-weighted MRI and the enhancement index of interatrial septum (the ratio of the signal intensity of the interatrial septum to the signal intensity of the skeletal muscle) were evaluated. The enhancement index of interatrial septum ⩾2 was regarded as an MRI sign of myocardial edema. The enhancement index of interatrial septum in patients with persistent atrial fibrillation was 2.4 (2.21; 2.69) and was higher than in CHF patients with paroxysmal atrial fibrillation and in CHF patients without arrhythmias and surpassed the control values (p<0.05), which indicates the presence of MRI signs of edema of the myocardium of the interatrial septum. The obtained data confirm the presence of myocardial edema of the interatrial septum in CHF patients and persistent form of atrial fibrillation, which expands the understanding of the pathogenesis of this condition., (© 2023. Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Previous studies show inconsistent results on the role of innervation imaging (with 123 I-mIBG) in predicting late atrial fibrillation (AF) recurrence after catheter ablation (CA). These studies included patients with paroxysmal AF and studied prognostic value of post-CA I-123-mIBG parameters. Current study investigated the ability of pre CA 123-I-mIBG imaging to predict late AF recurrence in patients with persistent AF., Methods: 123 I-mIBG cardiac imaging was performed before CA in 82 patients with persistent AF. Patient was followed for 12 months., Results: Multivariable analysis demonstrated that late heart-to-mediastinum ratio (H/M late ) and washout rate (WR) were independent predictors of AF recurrence. ROC-curve analysis data showed that H/M late <1.6 (sensitivity 73.53%, specificity 81.3%, AUC 0.792, P < .001) and WR > 25.11 (sensitivity 70.6%, specificity 70.8.3%, AUC 0.712, P < .001) indicate high probability of AF relapses during 12 months after CA., Conclusion: Pre-CA parameters of global cardiac sympathetic activity estimated by 123 I-mIBG scintigraphy are associated with late AF relapses in persistent AF patients with normal LVEF and absence of significant CAD., (© 2021. American Society of Nuclear Cardiology.)

Aim      To evaluate efficacy and safety of the anticoagulant therapy in patients with atrial fibrillation (AF) during a 36-month follow-up after an interventional treatment.Material and methods  This study included 302 patients aged 29 to 81 years with various forms of AF. Catheter ablation (CA) of AF foci was performed for all patients. The patients were divided into 3 groups: group 1 with paroxysmal AF, group 2 with persistent AF, and group 3 with longstanding persistent AF. Two subgroups were isolated in each group, with effective and ineffective CA. Results of the follow-up were analyzed at 12, 24, and 36 months after discharge from the hospital. The follow-up interview recorded complaints of palpitation attacks, effectiveness of administered CA, compliance with the treatment, adverse clinical outcomes, including thromboembolic complications (TEC), bleeding, and hospitalizations.Results Efficacy of the interventional treatment for 36 months was 65.3 % in patients with paroxysmal AF, 59.7 % in patients with persistent AF, and 57.1 % in patients with longstanding persistent AF. Patients with paroxysmal AF and effective CA had no adverse events throughout the same period during the antithrombotic treatment (ATT). In contrast, the group with ineffective ablation had both TEC and hemorrhagic complications during the ATT. In the group with persistent AF and effective CA throughout the follow-up period, TECs were less frequent than in the group of ineffective ablations during the ATT treatment. Patients with longstanding persistent AF and effective CA throughout the follow-up period, had no TECs in contrast to patients with ineffective ablation during the ATT treatment. There were no fatal outcomes in patients with effective procedure.Conclusion      A successful CA procedure for AF provides a significant decrease in the risk of ischemic stroke. Furthermore, the invasive strategy does not increase the risk of major and minor bleedings.

The review presents current data on atrial fibrillation, therapeutic approaches, and possibilities of interventional treatment and addresses inflammatory heart damage and its interrelation with arrhythmia.The review presents current data on atrial fibrillation, therapeutic approaches, and possibilities of interventional treatment and addresses inflammatory heart damage and its interrelation with arrhythmia.

Objective: Aim was to study the performance of single-photon emission computed tomography (SPECT) with 99m Tc-pyrophosphate ( 99m Tc-PYP) in diagnostics of chronic latent inflammation in myocardium of patients with atrial fibrillation (AF)., Methods: The research included 70 patients (the average age of 49.3 ± 10.2 years) with persistent form of idiopathic AF. All patients underwent myocardium SPECT with 99m Tc-PYP and cardiac magnetic resonance imaging (CMR) before the ablation. During the ablation endomyocardium sampling for histological and immunohistochemical verification of myocarditis was performed., Results: Sensitivity of SPECT with 99m Tc-PYP in diagnoses of chronic latent myocarditis in patients with AF in relation to endomyocardial biopsy was 80 %, specificity-83 % and diagnostic accuracy-82 %. Sensitivity, specificity and diagnostic accuracy of myocardium perfusion scintigraphy for diagnostics of latent myocarditis in relation to endomyocardial biopsy was 30, 50 and 50 % correspondingly. Also the close correlation between the size of the perfusion defect and the severity of myocardial fibrosis in patients with AF was revealed. Specificity of the Lake Louise criteria for diagnostics of latent myocarditis in relation to endomyocardial biopsy was 77.6 %, sensitivity-60 % and diagnostic accuracy-74.5 %. For only LGE specificity was 16 %, sensitivity-90 % and diagnostic accuracy-28 %., Conclusions: The study showed the possibility of successful application of radionuclide methods for diagnoses of chronic latent myocarditis at AF. Taking into account high informative values the results of scintigraphy can be also considered as a promising additional criteria for selecting patients with AF of unexplained etiology for non-invasive endomyocardial biopsy procedure.

Aim: To evaluate the efficacy of sotalol depending on the magnitude of changes in adrenal responsiveness and autonomic nervous system tone in patients with paroxysmal atrial fibrillation (AF)., Subjects and Methods: Twenty-six patients with paroxysmal AF in the presence of coronary heart disease (CHD) and hypertension were examined. Sinus rhythm variability and sympathicotonic and vagotonic disorders were studied in patients with paroxysmal AF before and during sotalol treatment. A commercial Beta-ARM-Agat kit was used to estimate the adrenal responsiveness of erythrocyte membranes (β-APM), which can judge the body's individual sensitivity to β-adrenoblockers., Results: Sotalol used in the average therapeutic doses of 160-240 mg did not reduce ejection fraction or increase atrioventricular conduction up to abnormal values. In patients with borderline and mild hypertension, the drug lowered blood pressure statistically significantly (p=0.01) and was well tolerated. The drug increased the sensitivity of β-adrenoblockers in patients with adrenergic AF., Conclusion: The effect of sotalol on the autonomic nervous system manifested in the higher power of a high-frequency spectral component of heart rate variability than in that of a low-frequency one. Long-term sotalol administration significantly reduced β-APM, increasing the sensitivity of adrenoceptors.

Aim: To estimate the capabilities of 99mTc-pyrphotech single-photon emission computed tomography (SPECT) in the diagnosis of myocardial inflammatory changes in patients with persistent atrial fibrillation (AF)., Subjects and Methods: Nineteen patients (11 males and 8 females, mean age 47.46 ± 9.92 years) with persistent idiopathic AF underwent preoperative complete clinical and instrumental examination. 99mTc-pyrphotech SPECT was performed to identify foci of myocardial inflammatory changes. After completing 99mTC-pyrphotech scanning, resting myocardial perfusion scintigraphy with 99mTC-methoxyisobutylisonitrile (99mTc-MIBI) was performed in accordance with the standard protocol. The scintigrams obtained in both studies were then combined using the applied programs Jet Stream Workspace Release 2.5 (Philips) and the application Fusion. During invasive intervention, endomyocardial samples were intraoperatively taken from all the patients for histological and immunohistochemical examinations., Results: Abnormal 99mTc-pyrphotech myocardial accumulation was found in 7 (36.8%) of the examinees, multiple foci in 3 cases and single foci in 4. Analysis of perfusion scintigrams indicated that the mean abnormal accumulation of 99mTc-MIBI in the left ventricle was 3.75 ± 0.88% (maximum 9%). Histological examination of endomyocardial samples from 19 patients with persistent AF verified myocarditis in 4 (21%) patients and myocardial sclerosis concurrent with other abnormalities in 15 (78.9%) patients., Conclusion: Latent lymphocytic or polymorphic cellular myocarditis of viral etiology is a cause of idiopathic AF in 20% of the cases. 99mTc-pyrphotech scintigraphy may be one of the primary noninvasive diagnostic techniques for the detection of myocardial inflammation in this form of arrhythmia.

The subjects of the study were 64 patients with coronary heart disease, atherosclerotic cardiosclerosis, constant atrial fibrillation, and total artificial atrioventricular blockade corrected by means of electrocardiostimulation, complicated by non-massive pulmonary arterial thromboembolism. Twenty-one patients had lowered arterial oxygen partial pressure, (paO2 whereas in 15 patients this variable was increased; both conditions were associated with vestibuloatactic and asthenic syndromes, as well as cognitive function decrease. The presence of sympathicotonia in 93% of the patients with increased paO2 made it possible to describe hyperventilation syndrome, which had not been described before and which takes place in cases of constantly relapsing non-massive embolization of pulmonary artery's small branches, associated with endocardial electrocardiostimulation.

Experimental atrial fibrillation in intact rats significantly decreased the content of catecholamines in atrial adrenergic fibers and phosphorylase activity, which attests to enhanced glycogen consumption in the heart. These changes were specific of the fibrillating myocardium and atria, but were absent in the ventricles. Induced atrial fibrillation did not modify activities of SDH and monoamine oxidase in cardiac subdivisions. It was hypothesized that increased energy requirements in the atria during myocardial fibrillation led to activation of anaerobic metabolism.

Aim: To assess effect of calcium antagonists amlodipine and verapamil on the risk of development of atrial fibrillation after coronary artery bypass surgery., Material: Of 74 patients subjected to mammary artery and venous coronary bypass grafting with the use of cardiopulmonary bypass 19 received amlodipine and 21 - verapamil., Results and Conclusion: Attacks of atrial fibrillation during 24 hour ECG monitoring were registered in 22.9% of patients mostly on days 2 and 3 after surgery. In verapamil treated patients atrial fibrillation occurred 1.5-2 times more often than in amlodipine treated patients or in patients receiving no calcium antagonists. This could possibly be explained by pronounced slowing of atrio-ventricular conduction by verapamil at the background of postoperative general "irritation" of the atrial myocardium.

The paper presents an account of and the technical data of a new external pacemaker to be used to prevent atrial fibrillations. It shows it expedient to design such devices and presents their characteristics.

Antiarrhythmic therapy was chosen for 3-7 days by modified chronic electrophysiological study at three stages: (1) the efficacy of a drug, its action onset and termination were defined; (2) a dosage was chosen on an individual basis and the duration of drug potency was specified; (3) the dosage regimen of a drug given as a course therapy was confirmed by the results of trials. Its choice was made on the basis of the oral administration of a tested drug and multiple programmed electric cardiostimulation. In late periods (3-37 months), the therapy was effective and safe in 51 (86%) of 59 patients. The drug regimens and doses were in poor agreement with conventional ones in 49% of the patients. The method proposed makes it possible to choose antiarrhythmic therapy on an individual basis and reduce the number of complications.