Search

Purpose. To identify predictors of ventricular tachycardia (VT) recurrence after endo-epicardial ablation in patients with structural heart disease.Methods. A prospective observational study included 39 patients with structural heart disease and indications for catheter ablation of ventricular tachyarrhythmia. Endo- and epicardial electroanatomical mapping of the ventricular myocardium and ablation of abnormal electrical activity areas were performed. Clinical, ECG characteristics, and voltage maps of bipolar potentials (limits of scar detection 1.5 mV) and unipolar signals (limits 9.0 mV, respectively) on endo- and epicardial surfaces were evaluated. Intraprocedurally, the procedure was considered effective when no VT was inducible; partially effective - when only clinical VT(s) was/were non-inducible. Scheduled patient visits or remote monitoring were performed at 6, 12 and 24 months, and then annually.Results. The mean age of the patients was 49.5±15.7 years (34 men and 5 women). VT recurrences at 6 months were more often detected in non-ischemic cardiomyopathy patients, in subjects with non-paroxysmal atrial fibrillation (42.9% vs. 7.4%), with a lower VT-QRS amplitude in lead III (0.6 [0.4;1.07] versus 1.28 [0.99; 1.53] mV), and when epicardial “scar” area prevailed over endocardial, PConclusion. In a heterogeneous group of patients, clinical and electrophysiological factors associated with VT recurrence have been identified at various follow-up periods after endo-epicardial ablation. Electrical storm ablation is an independent predictor of VT recurrence in the long-term, up to 5 years of follow-up.

Aim. To assess the antithrombotic therapy after left atrial appendage occlusion (LAAO) with the Watchman device (WD) and Amplarzer Cardiac Plug (ACP) for stroke prevention in patients with nonvalvular atrial fibrillation (AF) with contraindications for long anticoagulation therapy.Methods. 200 consecutive patients with nonvalvular AF and contraindications to oral anticoagulation therapy with contraindications for long anticoagulation who undergone LAAO implantation using WD (n=108; WD group) and ACP (n=92; ACP group) were enrolled into this study. Antithrombotic therapies were prescribed after successful LAAO implantation according to indications. Patients were followed at 45 days, 3, 6 and 12 months after enrollment. At each follow-up visit the data regarding clinical events and healthcare utilization were collected. Transesophageal echo (TEE) was perfomed at 45 days and 6 months after successful LAAO implantation. The efficacy end point was the composite of transit ischemic attack (TIA)/stroke, device thrombosis and procedure-related death.Results. During the follow-up TIA/stroke has occurred in 4.8% of patients in the WD group with no such events in ACP group (4.8% vs 0%, p=0.062). These patients had 4 or more points on the CHA2 DS2 -VASc, and they were prescribed various combinations of antithrombotic therapy, except warfarin, while patients from the WD group with 4 or more points on the CHA2 DS2 -VASc score taking warfarin had no thromboembolic events. Device thrombosis during TEE at 45 days after successful LAAO implantation was confirmed in 3 patients (2,9%) with WD with no such events in ACP group (2.9% vs 0%, p=0.251). The efficacy end point events in all groups were 4.6%: 8 events in WD group (7.6%) and 1 case in ACP group (1.1%). One patient in the ACP group died in 6 weeks after LAAO implantation. No autopsy was performed; therefore, the exact cause of death was not determined (p=0.038). Survival rate showed significantly higher rate events in WD group versus ACP group (p=0.027).Conclusion. Any combinations of antithrombotic therapy could be prescribed to patients with contraindications for anticoagulant therapy and high risk of stroke who undergone successful (LAAO) implantation with Amplatzer Cardiac Plug. It’s possible to cancel oral anticoagulants in this patient. Patients aged 70 and older with a CHA2 DS2 -VASc >4 and a history of stroke are recommended to take warfarin after successful Watchman Device implantation.

Purpose. To study the clinical course of multifocal atrial tachycardia (MAT) and to evaluate the effectiveness of antiarrhythmic therapy (AAT) in patients with onset of arrhythmia before the age of 1 year.Methods. The study included 15 children with primary registration of MAT at the age of 2.04±2.27 months, 4 of them - in utero. The follow-up period was 35.9±26.9 months (Me 29 months). All patients underwent laboratory monitoring, 12-lead ECG recording, 24-hour ECG monitoring, echocardiography at baseline and during time of observation.Results. Tachycardia was persistent in 80% of patients. Tachycardia-induced cardiomyopathy (TIC) was present in 7 (46%) patients. Structural heart disease was detected in 6 patients. The average heart rate at the onset of the disease was 157.9±23.78 bpm, the maximum - 256.7±35.84 bpm. Fourteen (93.3%) children received AAT. Seven patients were prescribed propranolol first, 6 - amiodarone, 1 - digoxin. Monotherapy was effective in 2 patients. Combined AAT was used in 12 patients, including three children with three drugs combination. No benefits were found for any of the drugs combinations. Stable sinus rhythm at the time of discharge was observed in 4 (28,6%) patients, sinus rhythm with atrial ectopic activity was registered in 2 of them; criteria for normosystole were achieved in 7 patients; in one child with TIC daytime tachysystole persisted despite three-component AAT, but echocardiography parameters improved. Arrhythmia was disappeared in 13 (86.6%) patients; the duration of arrhythmia in them from 1 to 15 months, duration of AAT - 1 ±7.5 months (Me 9.5 months). MAT persists in two patients with structural heart disease. One patient underwent radiofrequency ablation at the age of 5, with no effect. One patient had side effects from therapy that required correction. There were no lethal outcomes.Conclusion. MAT with a debut at the age of 1 year with timely prescribed treatment has a favorable course and a good prognosis, but the probability of AAT resistance is high. These cases require a long-term selection of therapy using various combinations of antiarrhythmic drugs. Heart rate control strategy can be sufficient to prevent the development of TIC.

The study aims to assess the role of magnetic resonance tomography (MRI) in identifying the substrate of “idiopathic” ventricular arrhythmias in pediatric patients.Methods. One hundred and seven children with “idiopathic” ventricular arrhythmias were enrolled. All patients underwent MRI on a high-field Magnetom Trio A Tim (Siemens) tomograph with a magnetic field induction of 3.0 T.Results. According to MRI data, dilated ventricles and/or a decreased ejection fraction were found in 55 (51%) patients. Based on structural abnormalities of the myocardium patients were divided into 2 groups: group 1 “normal”, without abnormalities, (69 (64.5%) children); group 2 - “fibrosis”, fibrotic changes were detected on late gadolinium enhancement (38 (35.5%) patients). Significant differences of indexed MR-indicators in these two groups were not found. However, in the “fibrosis” group, biventricular dysfunction occurred significantly more often than in the “normal” group, respectively (14 (37%) and 9 (13%) (p = 0.006)).Conclusion. MRI is important in assessing structural changes in pediatric patients with ventricular arrhythmias, and the combination of MRI results with clinical and electrophysiological data can significantly affect the change in management and treatment strategy in pediatric patients.

This document provides an overview of current problems and trends in the catheter ablation of atrial fibrillation, summarizes the opinions of specialists, obtained during a web-based electronic survey, on aspects and parameters of radiofrequency ablation. The approaches on improving the efficacy and safety of radiofrequency catheter ablation of atrial fibrillation are provided.

Aim. To study and compare the lesions characteristics of laser energy in heart ex vivo and in experimental large animals.Materials and methods. For the ex vivo experiment a pig heart was obtained from a local slaughterhouse. Laser applications were applied using power 15-30 W in the left and right ventricles 5-50 seconds in duration. Immediately after ablation, examination was performed to determine myocardial damage characteristics at each point. In the experimental study, 7 sheep were included, laser applications were performed under fluoroscopic control in the right atrium with power 10, 15 and 20 W, 10-25 s; in the right ventricle 20, 25 and 30 W for 10-40 s; and in the left ventricle 20, 25 and 30 W for 20-40 s. The animals were euthanized and macroscopic examination of laser lesions was performed.Results. A total of 27 laser applications were performed on the heart ex vivo, all lesions were visualized as white spots on the endocardial surface. The maximum lesion depth was 9 mm achieved when using 20 W /50 s, the maximum lesion diameter was 6 mm, when using 25 W /40 s. The minimum lesion diameter and depth were observed when using 30 W /5 s, 2x1 mm. A total of 48 laser applications were performed in experimental animals, in one experimental animal was observed a transmural lesion in the right atrium when using 15 W /20 s. In 3 out of 7 experimental animals, transmural lesions were observed in the right ventricle when using 20 W /30 s; 20 W /40 s and 30 W /10 s. In the left ventricle, transmural lesions were observed in 2 animals, using 15 W /20 s and 20 W /40 s. In the ex vivo study, there was a strong positive correlation between ablation energy and lesion depth (R=0.91, Pin vivo.Conclusions. Laser ablation 15-20 W for 15-40 s seems to be optimal for achieving the deepest lesions in the atrium and ventricular myocardium. In our small pilot study with fiberoptic catheter ablation on a beating heart there was no correlation between energy delivered and the depth and volume of necrotic myocardium.

This study presents literature data over the past few years on markers of acute myocardial damage after radiofrequency ablation. Information on markers such as troponin I and T, creatine phosphokinase and its fractions, CRP and interleukins and myoglobin is presented in detail. For each potential myocardial damage indicator, data related to their expression site, chemical basis of each marker and correlation between the degree of damage caused by radiofrequency exposure and the levels of various biomarkers of myocardial damage are provided.Received 12 November 2019. Revised 26 February 2020. Accepted 27 February 2020.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Author contributionsConception and study design: O.L. Zajfrid, R.B. Tatarsky, E.S. VasichkinaDrafting the article: O.L. Zajfrid, K.A. Chueva, A.V. Mikhailov Critical revision of the article: O.L. Zajfrid, R.B. Tatarsky, E.S. Vasichkina, I.L. Nikitina, D.S. LebedevFinal approval of the version to be published: O.L. Zajfrid, K.A. Chueva, E.S. Vasichkina, A.V. Mikhailov, D.S. Lebedev, I.L. Nikitina, R.B. Tatarsky

Aim. To analyze the prognostic value of 18 electrocardiographic (ECG) markers of left bundle branch block (LBBB) in predicting left ventricular (LV) reverse remodeling in patients receiving cardiac resynchronization therapy (CRT).Material and methods. The study included 98 patients. Depending on the presence of reverse remodeling during CRT, defined as a decrease in LV endsystolic volume ≥15%, the patients were divided into two groups: non-responders (n=33) and responders (n=65). We selected and analyzed 18 ECG markers included in 9 LBBB criteria.Results. Among the ECG markers significantly associated with reverse remodeling during CRT, the absence of q wave in leads V5-V6 demonstrated the highest sensitivity (92,31%), a negative predictive value (70,59%) and overall accuracy (73,47%). Normal internal deviation interval of the R wave in leads V1-V3 was also associated with the best sensitivity (92.31%), while QS with a positive T in lead aVR — the best specificity (69,7%). Discordant T wave demonstrated the highest positive predictive value (80,33%). Multivariate analysis revealed following ECG signs independently associated with reverse remodeling during CRT: QRS complex duration (odds ratio (OR)=1,022; 95% confidence interval (CI): 1,001-1,043; p=0,040); absence of q wave in leads V5-V6 (OR=4,076; 95% CI: 1,071-15,51; p=0,039); discordant T wave (OR=4,565; 95% CI: 1,708-12,202; p=0,002). These ECG findings were combined into a mathematical model that demonstrated high predictive power (AUC=0,81 [0,722-0,898], pConclusion. For the first time, the diagnostic value of ECG markers of LBBB were analyzed and a mathematical model with ECG signs was proposed to predict reverse remodeling in patients receiving CRT.

Noninvasive epi-endocardial ElectroCardioGraphic Imaging (ECGI) allows reconstruction of electrograms and high-resolution visualization of various isoparametric maps based on multichannel ECG recordings and tomography. This study shows results of ECGI accuracy verification based on septal ventricular pacing in patients with pre-implanted pacemakers using new algorithm for solving the inverse problem of electrocardiography.Methods. 10 patients in this study underwent epi-endocardial ECGI mapping (Amycard 01C EP Lab, Amycard LLC, Russia - EP Solutions SA, Switzerland). An iterative Equal Single Layer algorithm (ESL-iterative) and new Fast Route algorithm in combination with vector approach (FRA-V) were used to reconstruct isopotential and correlation similarity maps. Geodesic distance between noninvasively reconstructed early activate zone and RV reference pacing site were measured to evaluate ECGI accuracy.Results. The mean (SD) geodesic distance between noninvasively reconstructed and reference pacing site was 22 (15) mm for ESL-iterative and 12 (7) for FRA-V algorithm, median (25-75% IQR) - 23 (8-29) mm and 10 (8-14) mm respectively. Accuracy of ECGI mapping based on FRA-V algorithm was significantly better than ESL-iterative algorithm (p=0,01). Detailed visual analysis of correlation similarity and isopotential maps showed significantly more accurate localization of early activation zones using new FRA-V algorithm.Conclusions. These results showed a possibility of novel epi-endocardial ECGI mapping to detect early activation zone during septal ventricular pacing with sufficient accuracy (median 10 mm) using new FRA-V algorithm. Therefore, FRA-V algorithm is significantly better for epi-endocardial ECGI mapping and shows a significant advantage of this technique compared to other non-invasive methods of topical diagnostics. Moreover, simultaneous beat-to-beat mapping of entire ventricular septum allows using of this technique for preoperative topical diagnosis of complex unstable and polymorphic ventricular arrhythmias.

Mutations in the LMNA gene cause developing of several phenotypes, both with isolated involvement of cardiac, muscle, adipose and bone tissues, and with their combination. The dominance of cardiovascular signs in the clinical performance and false clarity in nosology definition can cause underestimation of subclinical markers of other systems partaking. It leads to an incorrect interpretation of the true disease etiology, failure in genetic diagnostics, and untimely determination of the correct management and prognosis. The article presents clinical cases that demonstrate both the most typical manifestations of laminopathy and rare combinations of symptoms, which represent a certain diagnostic difficulty.

Three clinical cases of 2-year follow-up of young patients with chronic heart failure with a low left ventricular ejection fraction of non-coronarogenic genesis after implantation of the cardiac contractility modulation system are presented. Significant positive dynamics of clinical course and reverse myocardial remodeling according to two-dimensional echocardiography and 2D speckle tracking echocardiography (STE) is shown. The 2D STE technique allowed us to demonstrate the improvement in local contractility of the interventricular septum in the area of implanted electrodes and the remote effect of global contractility improving during 1 year of observation with cardiac contractility modulation.

Aim. To assess various types of electrotherapy and the reasons for its use in patients with implanted cardioverter defibrillators (ICD) for primary prevention of sudden cardiac death (SCD).Material and methods. A retrospective single-site study of 308 patients with implanted cardioverter defibrillators was conducted. Patients were divided into 2 groups: 1 — patients with persistent paroxysmal ventricular tachycardia (VT)/ ventricular fibrillation (VF); 2 — patients without persistent paroxysms of VT/VF. The standard ICD programming protocol was carried out intraoperatively, at 3-4 days after the implantation, then 1 time in 12 months, as well as unscheduled on request. Primary data was collected about paroxysms of ventricular and supraventricular rhythm disturbances, episodes of unmotivated detection of tachyarrhythmias, adequacy of use and types of ICD electrotherapy. The period of dynamic observation was 7 years.Results. The group with an increased risk of persistent paroxysmal VT/VF is patients with ischemic genesis of chronic heart failure (CHF), repeated myocardial infarction, persistent atrial fibrillation (AF), as well as with recorde episodes of unstable VT and ventricular extrasystoles at programming visits. In 54,1% of cases with persistent paroxysms of VT/VF, unjustified detection of ventricular arrhythmias was established. Its causes were: 1) AF with a high heart rate; 2) T-wave detection; 3) sinus tachycardia in the area of detection of VT; 4) atrial flutter with a high heart rate.Conclusion. In patients with primary prophylaxis of SCD, the use of ICD electrotherapy takes place not only due to paroxysms of VT/VF, but also because of both paroxysms of supraventricular rhythm disturbances and other features of rhythm perception by the device. To reduce the number of unjustified triggers during the installation of ICD electrotherapy program in patients with AF/atrial flutter, it is advisable to use a dedicated area of monitor VT and programmed long-term tachycardia detection for adequate rhythm discrimination.

Aim. To determine the features of left atrial electroanatomic structure and the arrhythmia substrate in patients with atrial fibrillation (AF) after coronavirus disease 2019 (COVID-19).Material and methods. The pilot study included 20 patients with AF who underwent catheter radiofrequency ablation. Ten patients had COVID-19 and 10 patients were included as a control group. AF substrate was identified using anatomic and bipolar mapping. Zones with following amplitudes were analyzed: 0,75 mV. Left atrial volume was determined based on anatomic map.Results. The groups were homogeneous in AF type, number of patients after prior pulmonary vein isolation, and heart rate during mapping. In the COVID-19 group, there was a higher area of fibrous zones with an amplitude of 0,75 mV (11,6±8,0% vs 45,0±25,0% in the control group, p=0,001). In 7 COVID-19 patients, the posterior wall was isolated due to low-amplitude zones. Of these, three patients underwent surgery for the first time. According to ROC analysis, in patients after COVID-19, fibrous tissue (0,75 mV) — ~30% or less.Conclusion. This study shows that SARS-CoV-2 infection may cause left atrial remodeling in the form of diffuse fibrosis. The arrhythmia substrate in patients after COVID-19 can be localized not only in pulmonary vein mouths, but also in other left atrial areas. This must be taken into account before ablation, even if the procedure is being performed for the first time. It is recommended to perform amplitude mapping for all patients who have had SARS-CoV-2 infection in order to identify fibrous zones and plan the operation extent.

Russian Society of Cardiology (RSC).With the participation of Russian Scientific Society of Clinical Electrophysiology, Arrhythmology and Cardiac Pacing, Russian Association of Cardiovascular Surgeons.Approved by the Scientific and Practical Council of the Russian Ministry of Health.

Endorsed by: Research and Practical Council of the Ministry of Health of the Russian Federation.

Aim. To analyze 20 electrocardiographic (ECG) signs of left bundle branch block (LBBB) before and after septal myectomy in patients with hypertrophic cardio myopathy (HCM) and develop a criterion for proximal LBBB based on the selected signs.Material and methods. This retrospective non-randomized study included 50 patients with obstructive HCM who underwent septal myectomy. There were following inclusion criteria: QRS width Results. Exsection of a small myocardial area of the basal interventricular septal parts, weighing an average of 4,9±2 grams, led to a significant increase in the QRS width (by 61±14,6 ms) and the prevalence of almost all ECG signs of LBBB. In 100% of cases (n=50), the following signs demonstrated significant dynamics after surgery: (1) midQRS notching or slurring in ≥2 contiguous leads (I, aVL, V1-V2, V5-V6); (2) absence of q wave in V5-V6 and (3) discordant T wave in at least two leads (I, aVL, V5, V6). Based on the design of the study, (4) QRS width ≥120 ms was additionally included. These ECG characteristics were combined into a new criterion for proximal LBBBConclusion. A new criterion for proximal LBBB was developed using the pathophysiological model of iatrogenic conduction block of left bundle branch. Further estimation of this criterion on a set of candidates for CRT with heterogeneous level of LBBB is necessary.

Aim. To determine quantitative criteria for assessing the therapeutic benefits and the most informative time frames after cardiac resynchronization therapy (CRT) to assess its long-term effectiveness (1, 2, 3 years of follow-up) based on retrospective analysis. To assess the CRT effectiveness, parameters of left ventricular (LV) reverse remodeling and signs characterizing the clinical CRT response were considered.Material and methods. This single-center, retrospective, non-randomized study included data from 278 patients with implanted CRT devices. Quantitative criteria for assessing CRT effectiveness were determined using a two-step cluster analysis of patients 1, 2, and 3 years after CRT by LV reverse remodeling parameters.Results. In the dataset with satisfactory division accuracy, after the first year, two clusters were identified, which are conventionally named as “non-responders” and “responders”. Two and three years after therapy, patients were classified into three clusters: “non-responders”, “responders” and “super-responders”. For the obtained clusters, we found cutoff values for LV reverse remodeling parameters, which can be used as criteria for response to therapy.The study identified the most informative time frames for assessing the postoperative CRT effectiveness 1, 2, 3 years after the surgery. At the same time, the clinical response to therapy is manifested earlier in comparison with the reverse LV remodeling.Despite the high divisibility of patients into responders and non-responders, predictive models of CRT effectiveness created using the available data from standard diagnostic protocols for heart failure patients have insufficient accuracy to be used for making decisions on therapy appropriateness. This circumstance indicates the need to receive additional data to improve the forecasting quality.Conclusion. The study revealed a period for assessing the clinical response and changes in LV reverse remodeling after CRT surgery, which is important for the optimal choice of postoperative therapy. It has been shown that in most cases, one year after surgery is sufficient to assess the clinical response, and the process of LV reverse remodeling can last up to two years on average.When assessing the CRT effectiveness by reverse remodeling, along with a change in LV end-systolic volume (ESV), it is necessary to take into account LV end-diastolic volume (EDV) changes. The change in LV ejection fraction showed a significantly lower value among the analyzed parameters in assessing the CRT effectiveness. Based on the cluster classification of patients, a dividing rule was established for responders and non-responders in the first and second years after surgery with an accuracy of 97%: a decrease in LV ESV and EDV by 9% or more compared to preoperative values.

His bundle pacing (HBP) implements physiological impulse propagation along the cardiac conduction system and can serve as an analogue of both right ventricular and biventricular pacing. This review highlights clinical anatomy issues related to HBP; the technique of lead implantation in the His position is considered. We also describe the electrophysiological basis of HBP, possibilities of lead extraction, indications for implantation, and prospects for further development of the technique. HBP is a promising direction in cardiology, which in the future may fundamentally change the algorithms for managing patients with heart failure and conduction disorders.

Aim. To investigate the baseline characteristics of patients with resistant hypertension (HTN) undergoing radiofrequency renal sympathetic denervation (RD) and to determine immediate procedural effects.Material and methods. During 2018-2019, two series of radiofrequency RD procedures were performed in patients with true resistant HTN using balloon-type (bipolar ablation) or spiral-type (unipolar ablation) multielectorde catheters. The basic demographic, clinical and laboratory characteristics of included patients were assessed. A comparative analysis of two groups was carried out depending on the type of catheter used. Dynamics of office systolic blood pressure (SBP) were assessed as ∆ between the two following timepoints: at screening and at hospital discharge. The safety of radiofrequency RD was assessed. Multiple linear regression was used to determine the factors associated with the ∆ of office SBP after radiofrequency RD.Results. A total of 48 patients taking 4 (4;6) antihypertensive drugs were sequentially included. Radiofrequency RD was performed with a balloon-type catheter in 27 patients (mean age, 56±12 years old; 12 males) and with a spiral-type catheter in 21 patients (50±14 years old; 8 males). Radiofrequency RD was significantly longer in the spiral catheter group than in balloon one (110 versus 60 minutes, pConclusion. Radiofrequency RD using multielectode catheters is characterized by favorable short-term hemodynamic effects. We have found novel potential predictors of these effects. Further research will focus on testing initial hypotheses in the long term.

Aim. The results presented, of subanalysis of the catheter ablation (CA) registry in atrial fibrillation (AF) with the patients properties, specifics of CA and treatment results, in Russia comparing to European countries.Material and methods. During 2012 to 2015, totally 3742 patients included to the registry, of those 477 in Russia. In 467 Russian patients (males 56,5%; mean age 58,5 y. o.) CA AF was done. During one year 392 patients were followed up. Minimum requirements to follow-up: routine ECG registration and non less than one contact after 12 months passed.Results. In Russian patients there were more common obesity (46,1% and 29,2%, pConclusion. In real clinical setting, high efficacy of CA AF was shown, resistant to antiarrhythmic therapy. In most of Russian patients there were cardiovascular comorbidities. There was lower rate of reported adverse events in Russian centers of interventional treatments.

Aim. To evaluate diagnostic significance of non-invasive methods of myocarditis diagnostics. Material and methods. To the study, 141 patient included with suspected myocarditis (104 males, 37 females; age 11-69, mean age 42,7±13,7 y. o.). All patients, together with clinical assessment, underwent standard echocardiography, magnete resonance tomography (MRI) of the heart with contrast enhancement and endomyocardial biopsy with histological and immunohistochemical analysis. Also, the levels of circulating cardiotropic autoantibodies, troponin I and C-reactive protein were measured. Results. There were no significant differences between patients with myocarditis and dilation cardiomyopathy (DCM) in analysis of clinical, anamnestical and standard laboratory data. The differences found, in levels of circulating cardiospecific autoantibodies in myocarditis patients and DCM comparing to almost healthy donors. However the profile of autoantibodies in myocarditis and DCM patients differed only by the level of autoantibodies to cardiac myosin (χ 2 =6,0; р=0,014), cytoplasmic antigen of cardiomyocytes CoS-05-40 (χ 2 =10,2; р=0,001) and the adenine nucleotide translocator protein ANT (epitope EGS) (χ 2 =10,7; р=0,001). Sensitivity of MRI for myocarditis diagnosis is 67%. In acute myocarditis MRI sensitivity is significantly higher than in chronic inflammation: 85% and 63%, respectively. In chronic borderline myocarditis the sensitivity is no more than 55%. Conclusion. Low diagnostic significance of clinical and anamnestic data confirmed, and the data of standard laboratory and instrumental investigation, in diagnostics of myocarditis. In patients with myocarditis and DCM there was a specific autoantibodies profile found, different from that of almost healthy donors. MRI shows the highest sensitivity for acute myocarditis. In chronic one, sensitivity depends on inflammation activeness, making necessary the biopsy.

A case report of local infection along the pacemaker leads diagnosed as a cause of sepsis in an elderly pacemaker-dependent patient is described. Standard clinical and laboratory observation yielded no local infection responsible for sepsis. Additional evaluation using [18F]-fluorodesoxyglucose positron emission tomography was used for localization of occult infection. Complete pacemaker system deimplantation allowed successful treating of the patient.

Aim. To assess the severity of myocardial damage and inflammation after radiofrequency ablation in children and adolescents using biochemical markers.Material and methods. The study included 58 children with tachyarrhythmias (Wolff-Parkinson-White (WPW) syndrome, WPW phenomenon, atrial tachycardia, paroxysmal atrioventricular reciprocating tachycardia, ventricular tachycardia) who underwent catheter ablation from July to October 2019. Before and after surgical treatment (after 2 hours and 5 days), the blood concentrations of myocardial damage and inflammation biomarkers (myoglobin, creatine phosphokinase-MB, interleukin-8, C-reactive protein, tumor necrosis factor alpha, metalloproteinase (MMP)-2, MMP-9, heart-type fatty acid binding protein). During the operation, catheter ablation parameters (power, temperature, application duration), the localization of arrhythmogenic focus and the type of ablation catheter were recorded. Their relationship with changes in the concentration of biochemical markers before and after intervention was studied.Results. Two hours after the operation, the concentrations of myoglobin, creatine phosphokinase-MB, MMP-9, heart-type fatty acid binding protein were increased several times (pConclusion. Radiofrequency ablation is a safe method of treating arrhythmias in children and adolescents, since there is low volume of damaged myocardium. There was a slight increase in the level of biochemical markers after ablation (myoglobin, creatine phosphokinase-MB, fatty acid binding protein, MMP-9), incomparable with their rise in acute coronary syndrome, as well as the rapid decrease in the early postoperative period.

Endomyocardial biopsy (EMB) is the method of choice for diagnosing a wide range of myocardial diseases.Aim. To assess the rationale for diagnostic EMB in children and adults.Material and methods. Morphological and statistical analysis of 2803 diagnostic EMBs in adults (n=811) and children (n=83), including those in heart transplantation (n=1909), was carried out.Results. In 231 (28%) cases, adults were diagnosed with myocarditis, of which in 6 patients — granulomatous, in 5 — eosinophilic and in 6 — lymphocytic-macrophage myocarditis after coronavirus infection. In children, myocarditis was found in 22 cases (27%). Arrhythmogenic right ventricular dysplasia took the second place in detection rate in children and adults. Immunohistochemical study revealed viral envelope protein 1 (VP1) antigen of enteroviruses in one third of myocarditis cases, and in half — other cardiotropic viruses. Dotted dystrophin expression was observed in myocarditis. A correlation was established between the perforin expression and myocarditis presence (Pearson χ2=27,8; Fisher's exact test=27,3; p=0,01).Conclusion. Analysis of diagnostic EMB results confirmed its rationale in adults and children not only for heart transplantation, but also for identifying cardiac pathology, including for myocarditis diagnosis. It has been shown that immunohistochemical study with antiviral antibodies can be considered as an alternative method for detecting viral infection. An immunohistochemical analysis for perforin and dystrophin can be recommended as additional morphological markers of myocarditis.

Aim. To find out the clinical and electrophysiological predictors of recurrent ventricular tachyarrhythmias (VTA) after catheter homogenization of post-infarction scar areas. Material and methods . Patients included, with myocardial infarction (MI) in anamnesis and documented sustained VTA, regardless effective treatment by implantable cardioverter-defibrillator. Totally, 72 patients included (mean age 64±13 y.o.), of those 63 males with postinfarction VTA. In 12 cases there were“electrical storms” demanded urgent catheter management. In such patients, the extended catheter homogenization of the scar was performed, that is ablation of all conduction channels, anomalous potentials and surrounding ablation of infarction zone. Patients were selected to 2 groups according to recurrent VT in post-surgery period. First group included 27 (37%) VTA recurrent patients, mean age 62±10 y.o. Second group included 45 patients (63%) with non tachyarrhythmias recurrence, mean age 63±12 y.o. The evaluation was done, of the selected parameters with the aim to define predictors of rhythm disorders recurrence. Results. Main clinical predictors of VTA recurrence after catheter ablation were the duration of post MI period and its anterior localization. Full area of the scar surface (bipolar voltage lower 1,5 mV) was comparable in patients with recurrent VT and with none (66±51 cm 2 vs 82±49 cm 2 ). However the area of the dense scar (bipolar amplitude ≤0,5 mV) and percent of the dense scar in relation to entire scar was significantly smaller in the recurrence group (group 1 — 23±22 cm 2 and 24±18%, in group 2 — 41±22 cm 2 and 45±21%; p

Aim. Comparison of efficacy and safety of the robotic catheter and manual catheter ablation in management of patients with persistent atrial fibrillation (PsAF). Material and methods . In the study, 80 patients included, with PsAF. They were randomized to groups of manual ablation (MA) and robotic ablation (RA). After ablation, patients were followed up during 1 year every 3 months. Sinus rhythm retention was evaluated with Holter 24-hour ECG monitoring and 12-channel ECG. As efficacy criteria, the absence was taken of registered paroxysms of atrial fibrillation and other tachiarrhythmias lasted 30 sec and more. As primary endpoint, the absence was taken of any atrial tachiarrhythmias (AFib/AFlut) after the ablation procedure during 12 months, with every 3 months ECG monitoring. As secondary endpoints the following were taken: complications rate, duration of procedure and x-ray exposition, rate of recovery of conduction through the ablation line in acute phase (in 30 min post ablation) with intravenous ATP. Results. Mean procedure time and x-rays exposition in MA group was 164±28 min and 45±14 min, respectively. Mean duration of procedure in RA was 200±35 min (p

Russian Society of Cardiology (RSC).With the participation of Russian Scientific Society of Clinical Electrophysiology, Arrhythmology and Cardiac Pacing, Russian Association of Pediatric Cardiologists, Society for Holter Monitoring and Noninvasive Electrocardiology.Approved by the Scientific and Practical Council of the Russian Ministry of Health.

With the participation: All-Russian Scientific Society of Specialists in Clinical Electrophysiology, Arrhythmology and Pacing, Russian Association of Cardiovascular SurgeonsEndorsed by: Research and Practical Council of the Ministry of Health of the Russian Federation

Aim. By non-invasive methods, to assess relations of the zone of late electrical activation with changes in the left ventricle (LV) myocardium structure in patients — candidates for cardiac resynchronizing therapy. Material and methods. Totally, 37 patients included, with III functional class of chronic heart failure (CHF). In all patients, there was complete His left bundle branch block (LBBB) with QRS width 205 (190; 215) ms. Non-invasive electrophysiological mapping (NEM) was done with the “Amycard01C EP LAB” (EP Solutions SA,Switzerland), and magnetic-resonance imaging (MRI). At the first step, multichannel electrocardiography (ECG) was done. At the second step, MRI was done (MAGNETOM Trio A Tim 3 T, Siemens AG,Germany) with intravenous contrast “Gadovist” load. Changes inLV myocardium structure (post-inflammatory fibrosis or scar tissue) were evaluated by segments, within the delayed MRI contrasting. At the third stage, individual models of ventricles were built up. Activation ofLV epicardium in LBBB was evaluated by NEM. Results. Most oftenly the zone of late activation by NEM was found in the basal region on the border of posterior and lateral LV segments — 17 patients (46%) and in basal lateral LV segment — 8 (21%). By MRI, only post inflammatory fibrosis was found in 21 patient, among them in 5 the area of fibrosis was located on LV epicardium and overlapped the zone of late activation by NEM. Among 12 patients with ischemic heart disease 2 had scar onLV epicardium overlapping with the late activation zone. No one of 4 patients with combination of post-inflammatory fibrosis and ischemic scar did not show overlap of structural changes on the epicardium with the late activation zone. Conclusion. Combination of NEM and MRI in pre-operational period of patients investigation make it to relate structural changes inLV myocardium with the zone of its late electrical activation.

Aim. To perform the comparative analysis of atria morphometry and histological composition of myocardium in men and women with structural pathology of the heart. Material and methods . As the materials, case histories were used and autopsy records of 41 patient, age 43 to 88 y.o., 23 males and 18 females; of those 28 had coronary heart disease, 10 — other cardiovascular disorders, 3 — non-cardiac pathology. Organometry was done of the atria in 23 zones. Paraffin slices of all 23 localizations, as of the sinus and atrio-ventricular nodes were colored with hematoxiline and eosine, and by van Hison. Morphometry was done, with assessment of ganglia and nervous fibers localization density, relative square of fibrosis and lipomatosis areas, mean relative square or antigens expression areas in ganglia and nervous fibers. Comparison was done, of morphometric and clinical parameters in men and women. Results. In men, there was statistically significantly higher mean cardiac mass, distance between inferior pulmonary veins, thickness of the left atrial wall, the cuff height of inferior right pulmonary vein (p

Aim . To evaluate an extent of left arrial (LA) electroanatomical substrate (EAS) by the method of high density contact mapping in patients with atrial fibrillation (AF) and estimate its impact on recurrence rate following circular radiofrequency pulmonary veins (PV) isolation in prospective observational study. Material and methods. Totally 181 high symptomatic subjects with paroxysmal (142 pts) and persistent (39 pts) AF, who underwent circular RF PVI were enrolled. We created and prospectively analyzed LA electroanatomical high density bipolar maps. Bipolar signals ≤0.75mV, associated with local conduction velocity delay

Endomyocardial biopsy (EMB) is one of diagnostical tools for arrhythmogenic dysplasia of the right ventricle (ADRB). However sensitivity and specificity of EMB relay on the methodics of its performing. Aim. To compare “focus-guided” and “voluntary” EMB in diagnostics of ADRB in patients, scheduled for catheter ablation of ventricular rhythm disorders. Material and methods. To retrospective study 122 patients included, among those scheduled for catheter ablation of ventricular tachicardia and\or sympthomatic ventricular extrasystoly, underwent EMB (64 males, mean age 39±14 y.). Patients were selected to 2 groups: 1) 44 patients (36%) with “focus-guided” biopsy (minimum 1 fragment of endomyocardium from the area(s) of ectopy); 2) 78 patients (64%) with “voluntary” EMB (specimens taken from any area except the focus). Results. Sixteen (13,1%) patients took the definite dignosis of ADRB according to 2010 Criteria. Short-term effect of ablation reached 69,7% of patients, much less efficacy had ADRB group (43,8%). Sensitivity and specificity of EMB in the big criteria of ADRB revealing, by histology, was higher in the group with “focus-guided” EMB, comparing to the “voluntary” group (100% and 91,7% vs. 80% and 81,4%, respectively). Conclusion. To improve sensitivity and specificity of EMB in ADRB diagnostics it is aimful to take myocardium specimens from the area of researched ventricular ectopy.

Aim to assess clinical and prognostic value of circulating cardiospecific autoantibodies (AAB) and CD4+ T-regulatory cells in patients with myocarditis. Material and methods We included into this study 47 patients with lymphocytic myocarditis verified by analysis of histological and immunohistochemical data. Comparison group consisted of 30 practically healthy persons. Content of marker cardiotropic AAT were measured with the help of standardized immune enzyme test-systems. Number of circulating CD4+CD25+ and CD4+CD25+FoxP3+ T-lymphocytes were evaluated by flow cytometry. Results Among factors determining prognosis of patients with lymphocytic myocarditis factors of key significance were the presence of clinically overt heart failure at the disease debut, and degree of reduction of left ventricular ejection fraction. Distinctive feature of active myocarditis was elevation of titer of AABs to sarcomeric, cytoskeleton, and cytoplasmic proteins of cardiomyocytes, as well as elevated level of AABs to various epitopes of adenine nucleotide translocator. Elevated level of AAB to 1-adrenoreceptors was an independent predictor of unfavorable outcome in patients with lymphocytic myocarditis. Increased population of circulating CD4+CD25+ T-regulatory cells was as sociated with elevated concentration of of natriuretic peptide. Conclusion Abnormalities in the system of autoimmunity play key role not only in pathogenesis but also in prognosis of inflammatory myocardial diseases. Changes of profile of circulating cardiospecific AABs and T-regulatory cells can bear a protective function.

Aim. To assess the clinical course and cardiac reverse remodeling in patients with heart failure (HF) with reduced ejection fraction (HFrEF) receiving cardiac contractility modulation (CCM) therapy.Material and methods. Fifty-five patients (mean age, 53±11 years, 46 males) with NYHA class II-III HFrEF (ischemic etiology in 73% of patients), sinus rhythm, QRS25% and

The use of implantable cardioverter defibrillators has become a common standard method of primary and secondary prevention of sudden cardiac death, prolonging the life of patients with cardiomyopathy. At the same time, with the disease and comorbidity progression, at the final stages of life, a difficult decision arises to turn off the device due to a shift in priorities from extending life to maintaining its quality. Heart failure patients eventually die due to the progression of the underlying disease, despite currently available advanced technologies. Whether certain lifesustaining treatment methods are still appropriate in the final stages of life is an important topic of discussion in this article. Palliation for patients with implantable cardioverter-defibrillators is a challenging issue for both patients and medical professionals. This article describes the different ways to turn off defibrillation devices based on patient status.

Aim. To assess the 2-year prognosis of patients with heart failure with reduced ejection fraction (HFrEF) receiving cardiac contractility modulation (CCM).Material and methods. This single-center observational study included 55 patients (46 men, mean age 53±11 years) with NYHA class II-III HFrEF receiving optimal medical therapy, with sinus rhythm, QRS styear and every 6 months during the 2ndyear of observation. The primary composite endpoint was mortality and heart transplantation. Secondary composite endpoints included death, heart transplantation, paroxysmal ventricular tachycardia/ ventricular fibrillation, hospitalizations due decompensated HFResults.The one-year and two-year survival rate was 95% and 80%, respectively. Primary endpoint was observed in 20% of patients. NYHA class III and higher levels of N-terminal pro-brain natriuretic peptide (NTproBNP) were associated with unfavorable prognosis (p=0,014 and p=0,026, respectively). NTproBNP was an independent predictor of survival (p=0,018). CCM contributed to a significant decrease in hospitalizations due to decompensated HF (pstyear. The predictor for the secondary composite endpoint was NTproBNP (p=0,047).Conclusion. CCM is associated with a significant decrease in hospitalization rate due to decompensated HF. The 2-year survival rate of patients with NYHA class II-III HF receiving CCM was 80%. The NTproBNP level was an independent predictor of survival in patients receiving CMM for 2 years. Further longer-term studies of the CCM efficacy are required.

Aim. Catheter ablation (CA) is an effective approach for rhythm control in atrial fibrillation (AF), however antiarrhythmic therapy (AAT) remains important. There is a lack of data about long-term AAT use after CA. This study evaluates AAT after CA for AF.Material and methods. In 2012-2016, EURObservational Research Programme of Atrial Fibrillation Ablation Long-Term (EORP AFA L-T) registry was conducted, which included 476 Russian patients (57,1% — men; mean age — 57,1±8,7 years). The follow-up after CA was 12 months (available in 81,9% of patients). The use of AAT was evaluated prior to hospitalization, during hospitalization for CA, as well as at 3, 6 and 12 months of follow-up.Results. Prior to CA, 439 (92,2%) patients received AAT During CA, 459 (96,4%) patients were treated with AAT. After CA, AAT was used by 463 (97,3%), 370 (94,8%), and 307 (78,7%) patients at 3, 6 and 12 months of follow-up, respectively. There was no arrhythmia recurrence in 187 (47,9%) subjects. Among these patients, 40 (21,4%) received class IC or III AAT. The peak of AAT use was found for class IC agents within 3 months after CA (PConclusion. The frequency of AAT use after AF ablation is significantly reduced. However, there is a cohort of patients without documented arrhythmia recurrence still receiving AAT, which requires special attention of physicians. There were no clinical predictors of continued AAT in subjects without arrhythmia recurrence.

Guidelines for the diagnosis and treatment of circulatory diseases in the context of the COVID-19 pandemic

Aim . To study the specifics of clinical course and outcomes of higher degree AVB, developed due to inflammatory changes of myocardium in infants, during three years follow-up. Material and methods . For the assessment of AVB specifics in current myocarditis we have summarized the investigation data of 6 patients younger than 1,5 y. o.; mean age 10,0±4,5 months (3 to 16 months). In all clinical cases we performed the analysis of medical source documents with outcopying of pregnancy data, analysis of cardiotocography (CTG) data and ultrasound examination (USE) of the fetus (to rule out inborn cause for AVB), stages of the growth and development of a child, diseases anamnesis. The complex laboratory and instrumental investigation was done, including evaluation of biochemical markers of inflammation and serum markers of myocardial damage, electrocardiographic (ECG) and echocardiographic (EchoCG) studies. Results. Mean follow-up was 23,3±10,4 months (from 9 to 35 months). On treatment, all patients had tendency for the decrease of cardiac specific enzymes, the decrease of heart failure functional class and positive EchoCG dynamics by the end of the first year. However, AV-conduction disorders of the heart in all patients had irreversible course. Permanent pacemaker (PPM) was set up in two cases, in 6 and 14 months after diagnosis. Conclusion. In infants the AV conduction disorders that develop in myocarditis, show irreversible pattern of clinical course.