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Cardiac contractility modulation (CCM) is based on electrical stimulation of the heart without alteration of action potential and mechanical activation, the data on its fundamental molecular mechanisms are limited. Here we demonstrate clinical and physiological effect of 12 months CCM in 29 patients along with transcriptomic molecular data. Based on the CCM effect the patients were divided into two groups: responders (n = 13) and non-responders (n = 16). RNA-seq data were collected for 6 patients before and after CCM including 3 responders and 3 non-responders. The overall effect of CCM on gene expression was mainly provided by samples from the responder group and included the upregulation of the genes involved in the maintenance of proteostasis and mitochondrial structure and function. Using pathway enrichment analysis, we found that baseline myocardial tissue samples from responder group were characterized by upregulation of mitochondrial matrix-related genes, Z disc-protein encoding genes and muscle contraction-related genes. In summary, twelve months of ССM led to changes in signaling pathways associated with cellular respiration, apoptosis, and autophagy. The pattern of myocardial remodeling after CCM is associated with initial expression level of myocardial contractile proteins, adaptation reserves associated with mitochondria and low expression level of inflammatory molecules.

Arrhythmias occur both in the acute coronavirus disease 2019 (COVID-19) and in the post-acute period, which may be associated with the long-term SARS-CoV-2 persistence. In a case report, patient with primary dilated cardiomyopathy, an implanted cardioverter-defibrillator, recurrent ventricular arrhythmias, and an electrical storm are presented. The patient was repeatedly hospitalized in a city hospital, where electrical cardioversion, antiarrhythmic therapy, radiofrequency ablation of recurrent ventricular tachycardia regions, including emergency ("lifesaving") combined catheter radiofrequency destruction of the electrical storm substrate, was performed. Subsequently, against the background of ongoing postoperative therapy, massive pulmonary embolism (PE) suddenly developed, which led to the death. Autopsy established that the cause of the patient’s death was massive pulmonary embolism; SARS-CoV-2 and enterovirus was detected in the myocardium. Based on an autopsy study, the patient was diagnosed with primary dilated cardiomyopathy with secondary active chronic lymphocytic myocarditis.

Aim. To assess the association between changes in interventricular delay (IVD) and response to cardiac resynchronization therapy (CRT) during 24-month postoperative period in patients with quadripolar left ventricular leads.Material and methods. This retrospective non-randomized study included data from 48 patients with implanted CRT devices with quadripolar left ventricular (LV) leads, examined 3, 6, 12, 24 months after operation. CRT responders were considered patients with a decrease in end-systolic volume (ESV) by more than 10% compared with preoperative. To test the hypothesis about the rationale for choosing the maximum IVD when installing the LV lead, the group of patients was divided into two subgroups as follows: one with the maximum IVD (IVDmax, n=24), the other — without this condition (n=24).Results. A correlation was found between changes in IVD and ESV, as well as ejection fraction (EF) in the period of 6, 12 and 24 months after implantation compared to baseline. In the subgroup with IVDmax, the shortening of IVD in the postoperative period is higher at each considered period compared to the second subgroup, and in general, there is a more pronounced decrease in IVD over 24 months. At the same time, 3, 6, 12 months after surgery, patients with IVDmax show a significantly greater decrease in ESV and, accordingly, a greater increase in EF. Prognostic models of CRT response in the long term after implantation were created. Significant predictors were the initial IVD, changes in IVD in the early postoperative period and IVDmax selection. At the same time, not a single factor, taken separately, made it possible to separate responders and non-responders.Conclusion. A greater shortening of the IVD corresponds to a greater decrease in LV ESV and EDV, as well as a greater increase in EF in the long-term postoperative period. The choice of quadripolar LV lead in accordance with the maximum IVD is accompanied by a decrease in the proportion of non-responders, a more pronounced decrease in electrical ventricular dyssynchrony and an improvement in systolic function.

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

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, p

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 (p

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 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], p

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.

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 Pediatric Cardiologists, Society for Holter Monitoring and Noninvasive Electrocardiology.Approved by the Scientific and Practical Council of the Russian Ministry of Health.

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.

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

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.

In the present article we demonstrate data on epidemic nature of atrial fibrillation spread (AF) today, and describe economic and social consequences of abrupt increase in patient numbers. The strategy of AF treatment and significant restriction in opportunities of drug treatment is discussed. Intervention treatment was developed after discovery of pulmonary vein electric activity and its connection with induction and persisting arrhythmia. We described in details technique of catheter ablation in patients with paroxysmal and persisting atrial fibrillation. It is shown that despite a row of additional acceptances and approaches in catheter ablation, pulmonary vein isolation remains a cornerstone for AF successful treatment. Today there are two main approaches for catheter treatment: radio-frequency and cryoballoon isolation of pulmonary veins. Introduction of new modifications with a cryocylinder allows to reduce operation time and shorten complication development probability. Necessity for integrated approach to treat patients with persisting arrhythmia, further complications and possibility to develop new technologies is discussed. We consider team approach in treatment this category of patients to be extremely important.

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

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.

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 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

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 (P

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

Aim. Current registry is the continued national study on cryoablation in atrial fibrillation (AF). The aim of the project is assessment of safety and efficacy of cryoballoon ablation of pulmonary veins from AF treatment in real clinical practice prospective observation.Material and methods. The project has been developed for prospective inclusion of the data to guarded automatic informational system, on clinical data of patients, ablation parameters, repeat ablation and results of 12-month follow-up. To participate in the project in January of 2017, the representatives of 33 in-patient facilities were invited, that routinely perform the procedure.Results. Twenty five institutions confirmed their participation, and by December of 2017, the database was completed by specialists from 13 clinics: information on the ablation procedure and outcomes is included for 451 patient. The enrollment is ongoing with estimated end by January 2019; prospective follow-up to be completed by January 2020.Conclusion. Prospective registry of AF cryoablation is important for gathering of experience and common analysis of the procedures throughout the country. Detailed analysis will make it to reveal predictors of efficacy and methods for procedural risk decrease.

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%, p

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 (χ2=6,0; р=0,014), cytoplasmic antigen of cardiomyocytes CoS-05-40 (χ2=10,2; р=0,001) and the adenine nucleotide translocator protein ANT (epitope EGS) (χ2=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.

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. 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

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 cm2 vs 82±49 cm2). 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 cm2 and 24±18%, in group 2 — 41±22 cm2 and 45±21%; 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

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.

Endomyocardial biopsy (EMB) is one of diagnostical tools for arrhythmogenicdysplasia of the right ventricle (ADRB). However sensitivity and specificity of EMBrelay on the methodics of its performing.Aim. To compare “focus-guided” and “voluntary” EMB in diagnostics of ADRB inpatients, 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 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.

Aim. To reveal the factors determining prognosis in patients with morphologically documented myocarditis presented with rhythm disorders.Material and methods. Totally, 75 patients studied with lymphocyte infiltration myocarditis, 22 patients with dilated cardiomyopathy (DCMP). All patients underwent standard echocardiographic investigation, enhanced magnetic-resonance tomography, endomyocardial biopsy, viral genome molecular test, standard laboratory panel and autoantibodies profile in blood serum. Control group included 30 almost healthy individuals.Results. There were no established differences between the groups with or without rhythm disorders by the activity of inflammatory process and prevalence of viral genome finding in myocarditis patients. The similarity was found for autoantibodies profile in DCMP and myocarditis with rhythm disorders that probably related to fibrous changes in myocardium.Conclusion. The course of arrhythmia development in inflammatory myocardium diseases has complicated multifactorial nature related to a direct harm by infection, to development of autoimmune reactions and structural remodeling of myocardium. Not the arrhythmias influence prognosis, but structural changes in myocardium associated with the decrease of its global contractility.

Aim. The main goal of this study was to assess the early and delayed efficacies of urgent catheter ablation (CA) in patients with coronarogenic ventricular tachyarrhythmia (VTA) and electrical storms (ES).Material and methods. Procedures EFI and CA with the use of navigation charting system were done for 12 patients with ES. Mean time from implantation of ICD to ES was 3,4±3,2 y., quantity of adequate shocks of ICD per day in ES was 12,2±14,1. In most patients (67%) underwent CA, CHF of higher grade was diagnosed, LV EF was 32±12%.Results. Within primary approach of RFA the acute effect of clinical VTs was 58% (7 patients). During the first year of observation four patients developed VT returns (33%). During the whole observation time ES returns were not registered. Total mortality reached 25%Conclusion. Application of CA is able to suppress ES by 100% not only in acute period but in long-term too. Nevertheless, the additional CA application is necessary due to paroxysms of VT and interventions of ICD in 33% cases.

Aim. The results of cryoballoon ablation (CBA) are known from the studies performed in the experienced centers of catheter treatment of atrial fibrillation (AF). The current study presents the results of CBA in real practice in centers with various experienceMaterial and methods. Among 62 Russian sites performing catheter treatment of AF, in 15 the CBA methods were in use to isolate pulmonary veins, in the years 2012-2014. Centers staff were surveyed for the detailed description of all performed CBA till 10.2014. The questionnaire included 74 lines about the centers experience, patients properties and ablation procedures, management of patients and complications. At the second step the questionnaire was used about complications.Results. Thirteen centers provided full data on all patients with CBA (457 procedures; 94% for paroxysmal AF; >95% CBAs in Russia). Six centers were marked as highly experienced for CBA for AF (mean 414,2±339,4 ablations for AF per year), and 7 — with lesser experience (33,2±34,3 ablations for AF per year). Ten centers provided the results of 6/12 month observation, and 11 centers — detalization of the complications data. there were no statistically significant differences in arrhythmia absence in patients from both types of centers (61,9±10,0 versus 61,3±30,4%). Serious complications developed in 1,5% of patients (4 tamponades, 2 strokes and 1 diaphragmal nerve palsy) and were similarly spread among more and less experienced centers (1,4% vs. 2%, p>0,05). Minor adverse events (vascular, transient diaphragm nerve palsy, transient hemoptysis) were found in 37 (8%) patients and were more common in more experienced (teaching) centers. Overall frequency of adverse events and of vascular events was higher in females than males (12% and 4,9% vs. 6% and 0%, resp.; p

Aim. To reveal the specifics, and to evaluate the efficacy of implantation of epicardial (myocardial) electrodes under the conditions of artificial circulation and to define their influence on electromechanical parameters of the heart including pumping function.Material and methods. The results were analyzed of intraoperation and short-term (up to 24 months) results of implantation of epicardial electrodes under the conditions of AC in 32 patients, operated in 2007-2014 yy. For 32 patients the electrode was implanted (fixated) epicardially under the conditions of AC for conduction disorder correction after the main stage of cardiosurgical intervention. Including the fixation of epicardial electrode to both ventricles (group A, n=23) was done as biventricular ECS, and to one ventricle (group B, n=9) — monoventricular ECS. The following investigations were done: clinical examination, ECG, 6-minute walking test (6-WT), Echocardiography with dyssynchrony evaluation in M-, B-, doppler and tissue regimens, programming of ECS.Results. Mean follow-up period in both groups was 17±1,9 months. In 23 patients fixation of “-”-pole of epicardial electrode was done on the lateral surface of the left ventricle, and “+”-pole on posterior surface of the right ventricle, and in 8 patients epicardial electrode “+” and “-” was fixated in the area of lateral surface of the left ventricle and in one — area of the right ventricle if possible to the basal part. In 7 patients the atrial epicardial electrode was fixed to the base of the right atrium. So, we reached in 11 cases the 3-chamber ECS (CPT-ECS), in 12 — “biventricular” ECS (patients with permanent AF) and in 9 — monoventricular cardiostimulation.Conclusion. Epicardial (myocardial) biventricular stimulation of the heart is efficient method of rhythm disorder correction and the method of choice in those who need the replacement of endocardial ECS system, in heart defects patients, and if with CHF. While implanting epicardial systems there is a possibility to visually define the points and place of electrodes fixation. In biventricular ECS in dynamics there are significantly better results in the heart synchronicity parameters, that also was confirmed by the improvement of the LV systolic function and its remodeling in 12 months.

Aim. To investigate sudden cardiac death (SCD) predictors in patients after myocardial infarction (MI), to develop the strategy of risk stratification and SCD prevention.Material and methods. In total, 420 patients were examined at Day 10-14 after MI; follow-up period lasted for 1-4 years. General clinical examination, echocardiography, 24-hour electrocardiography (ECG) monitoring, late ventricular potentials (LVP) detection, active orthostatic test (AOT), heart rate variability (HRV) assessment at baseline and during functional tests, as well as psychological testing, were performed. Some participants underwent coronarography and endocardial electrophysiological examination. SCD risk was assessed by Cox multi-factor analysis and Kaplan-Meier survival curve method.Results. According to Cox multivariate regression analysis, the most important predictors included the following six parameters: LVP, HRV reduction, left ventricular ejection fraction