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1. Cavutilide (Refralon) for pharmacological cardioversion of early recurrence atrial fibrillation and flutter in blanking period after pulmonary veins isolation

Author

M. A. Zelberg, N. Yu. Mironov, Kh. M. Dzaurova, Yu. A. Yuricheva, E. B. Maykov, P. S. Novikov, D. A. Gagloeva, M. A. Krimukova, S. F. Sokolov, and S. P. Golitsyn

Subjects
atrial fibrillation, atrial flutter, cardioversion, catheter ablation, recurrence, cavutilide, refralon, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Objective. Evaluate efficacy and safety of cavutilide (Refralon) for pharmacological cardioversion in patients with recurrent atrial fibrillation and flutter (AF/AFL), in 90days blanking period of catheter ablation.Materials and methods. included 56 patients: 46 patients with recurrent paroxysmal AF/AFL and 10 patients with recurrent persistent AF/AFL. In 45 patients (80.3%), sinus rhythm (SR) restoration was performed within 7 days from the moment of catheter ablation. Intraoperative confirmation of pulmonary vein (PV) isolation was noted in 85.7% cases (n=48). After excluding contraindications, cavutilide was administrated in the intensive care unit according to a 4-stage protocol (5 µg/kg – 5 µg/kg-10 µg/ kg – 10 µg/kg). Effectiveness of pharmacological cardioversion was assessed as the fact of restoring SR and the fact of preservation of SR 24 hours after cavutilide administration. Safety points – QT prolongation, ventricular arrhythmogenic effects, pauses and bradyarrhythmias.Results. The overall effectiveness of cavutilide among all included patients reached 98.2% (n=55), and preservation of SR 24 hours after cavutilide administration was observed in 94.5% (n=53) patients. All the patients with recurrent persistent AF/AFL successfully restored and maintained SR 24 hours after cavutilide administration 100% (n=10). In patients with recurrent paroxysmal AF/AFL restoration of SR observed in 97.8% (n=45) and preservation of SR after 24 hours – in 93.4% (n=43), respectively. The effectiveness of cavutilide did not depend on the results of the catheter ablation. Recurrences of AF/AFL after SR restoration were more common in patients without successful PV isolation. QT prolongation >500ms observed in 8.9% (n=5) of cases, including 1 case of self-terminating torsade de pointes, managed by MgSO4 infusion. Bradyarrhythmias that did not require urgent therapy were noted in 10.7% (n=6) of cases.Conclusion. Pharmacological cardioversion with Cavutilide (Refralon) is highly effective and safe method of SR restoration in patients with recurrent AF/AFL in 90days blanking period after catheter ablation.

Published
2024
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2. Relationship between structural changes in the myocardium of the left atrium and the effectiveness of cryoablation in persistent atrial fibrillation

Author

V. S. Kirilova, O. V. Stukalova, O. P. Aparina, and E. B. Maykov

Subjects
fibrosis, atrial fibrillation, balloon cryoablation, magnetic resonance imaging, pulmonary veins, stroke, transient ischemic attack, Internal medicine, RC31-1245
Abstract

Introduction. High-resolution contrast-enhanced cardiac magnetic resonance imaging reveals left atrial fibrosis, the severity of which may be related to the effectiveness of catheter ablation.Aim. To study the structural changes of the left atrium myocardium according to magnetic resonance imaging with contrast in patients with persistent atrial fibrillation before balloon cryoablation and compare the results with the effectiveness of the intervention.Materials and methods. The study included 89 patients with persistent form of atrial fibrillation. The patients were randomized into two groups: in the 1st, the pulmonary veins cryoablation was performed (n = 39 (53.4%)); in the 2nd, the pulmonary veins and posterior wall of the left atrium cryoablation was performed (n = 34 (46.6%)). All patients before cryoablation underwent cardiac magnetic resonance imaging with delayed contrast using a high-resolution MR pulse sequence. The clinical efficacy of the intervention was evaluated after 12 months after the cryoablation.Results. The severity of fibrotic myocardial lesion of the left atrium before balloon cryoablation was 0.7% [0; 3,07]. Overall efficiency of the intervention rate was 57.1%. Cryoablation was most effective (59.5%) in patients severity of fibrosis less than 20% and least effective (50%) severity of fibrosis more than 20%. Risk factors for atrial fibrillation recurrence after cryoablation were: early atrial fibrillation recurrence, female sex, the maximum atrial fibrillation duration more than 3 months, stroke/TIA.Conclusion. The severity of left atrial fibrosis more than 20%, early recurrence of atrial fibrillation in the first 3 months after the cryoablation, female sex, the duration of the maximum atrial fibrillation episode more than 3 months, and a history of stroke/transient ischemic attack may be associated with recurrence of AF during the period observation 3–12 months.

Published
2023
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3. Assessment of structural changes in the left atrium myocardium according to cardiac magnetic resonance with contrast before and after balloon cryoablation in patients with persistent atrial fibrillation

Author

O. V. Stukalova, V. S. Kirilova, O. P. Aparina, and E. B. Maykov

Subjects
left atrium, fibrosis, atrial fibrillation, balloon cryoablation, magnetic resonance imaging, pulmonary veins, structural lesion, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Aim. To study the structural changes of the left atrium myocardium according to magnetic resonance imaging with contrast in patients with persistent atrial fibrillation before and after balloon cryoablation and compare the results with the effectiveness of the intervention.Material and methods of research. The study included 28 patients with persistent form of atrial fibrillation. All patients before and after magnetic resonance imaging underwent cardiac magnetic resonance imaging with delayed contrast using a high-resolution MR pulse sequence (voxel size 1,25x1,25x1,25 mm) before and after cryoablation.The severity of atrial fibrous lesion was calculated automatically using a specialized LGE HEART Analyzer program using algorithms based on the myocardial contrast index with a threshold value of 1.38. The clinical efficacy of the intervention was evaluated after 12 months and the relationship was determined structural changes in the myocardium of the left atrium according to contrast magnetic resonance imaging data before and after the cryoablation.Results. The severity of fibrotic myocardial lesion of the left atrium before balloon cryoablation was 1,5 [0,16; 9,3]%. In Utah patients, stage 1 fibrosis was detected in 71,4% (n=20), stage 2 in 14,3% (n=4), stage 3 in 3,6% (n=1), stage 4 in 10,7% (n=3). 3 months after cryoablation, there was an increase in the severity of fibrosis of 2,7 [1,02; 18,8]% (p

Published
2023
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4. Venous thrombosis in patients after intracardial catheter interventions: incidence, risk factors, special aspects of the diagnosis

Author

A. I. Loginova, E. S. Kropacheva, E. V. Titaeva, E. B. Maykov, T. V. Balakhonova, and S. P. Golitsyn

Subjects
catheter ablation, venous thrombosis, risk factors, d-dimer, Medicine
Abstract

Rationale: Thrombosis of the puncture site in the femoral veins is one of the potentially dangerous complications of intracardial catheter interventions associated with thromboembolic risk related to its proximal location. According to the literature, the incidence of symptomatic venous thrombosis (VT) is 1–3%. No special studies on the assessment of risk factors for this complication, its diagnosis and treatment have been conducted.Aim: To study the incidence, risk factors and special aspects of VT diagnosis in patients undergoing intracardial electrophysiological studies (EFI) and/or catheter ablation.Materials and methods: This prospective study included 408 patients (194 men and 214 women, with median age of 51±10.1 years), who were admitted to the hospital with various cardiac rhythm disorders for intracardial EFIs and/or catheter ablations from 2016 to 2018. Before the interventions, in addition to common laboratory and instrumental work-up, all the patients underwent ultrasound duplex scanning (USDS) of the iliac-femoral segment; in 269 patients the level of D-dimer was measured. Latest at 24 hours after the intervention, all patients underwent a control ultrasound scan of the femoral vein puncture site. In case of VT occurrence anticoagulant therapy was started in all patients and they were followed up till complete VT resolution and at least for 3 months (the study endpoint). The VT incidence and its risk factors including the prognostic value of D-dimer levels were evaluated.Results: The VT incidence after catheter interventions was 11.7% (n=48). There was a significant correlation between VT occurrence and such risk factors as diabetes mellitus (p=0.001) and obesity (p500 ng/mL) and subsequent VT development was found (p>0.05). The quartile analysis revealed an association between baseline D-dimer levels exceeding 434 ng/mL (which corresponds to the range of 75 to 100%) and the presence of the following risk factors: age over 65 years (p

Published
2019
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5. CRYOBALLOON ABLATION IN RUSSIAN SITES OF INTERVENTIONAL ATRIAL FIBRILLATION MANAGEMENT TREATMENT: RESULTS OF THE FIRST NATIONWIDE SURVEY

Author

E. N. Mikhailov, D. S. Lebedev, E. A. Pokushalov, K. V. Davtyan, E. A. Ivanitsky, A. A. Nechepurenko, A. Ya. Kosonogov, G. V. Kolunin, I. A. Morozov, S. A. Termosesov, E. B. Maykov, D. N. Khomutinin, S. A. Eremin, I. M. Mayorov, A. B. Romanov, V. V. Shabanov, V. S. Shatachtsyan, V. Yu. Tsivkovsky, A. V. Patsyuk, A. Sh. Revishvili, and E. V. Shlyakhto

Subjects
atrial fibrillation, catheter ablation, cryoablation, cryoballoon, results, complications., Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

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

Published
2015
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6. Takotsubo cardiomyopathy after cryoballoon pulmonary vein ablation in a patient with persistent atrial fibrillation: clinical case

Author

P. S. Novikov, I. A. Novikov, N. Yu. Mironov, M. A. Saidova, L. O. Dulaev, and E. B. Maykov

Subjects
cardiovascular system, Emergency Medicine, Pharmacology (medical), cardiovascular diseases, Cardiology and Cardiovascular Medicine
Abstract

We present a case of takotsubo cardiomyopathy characterized as acute transient left ventricular systolic dysfunction in a patient with persistent atrial fibrillation, that occurred after cryoballoon pulmonary vein ablation procedure.

Published
2022

7. Clinical experience of new antiarrhythmic drug refralon for pharmacological cardioversion in patients with atrial fibrillation after pulmonary vein cryoablation

Author

S. F. Sokolov, N. Yu. Mironov, Sergey P. Golitsyn, N. A. Mironova, P Novikov, Yu. A. Yurichev, M. A. Zelberg, and E. B. Maykov

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, Cryoablation, Atrial fibrillation, medicine.disease, Pulmonary vein, Electrical cardioversion, Internal medicine, Persistent atrial fibrillation, Emergency Medicine, medicine, Cardiology, Pharmacological cardioversion, Pharmacology (medical), In patient, Cardiology and Cardiovascular Medicine, business, Atrial flutter
Abstract

We present two cases of successful pharmacological cardioversion using antiarrhythmic drug refralon in patients with persistent atrial fibrillation after pulmonary vein cryoablation and ineffective electrical cardioversion. These clinical cases represent the first experience of successful use of refralon in patients who underwent cryoablation.

Published
2021

8. [Potential risk factors of atrial fibrillation recurrence after cryoballoon ablation]

Author

I. A. Novikov, P. S. Novikov, N. U. Mironov, L. Yu. Layovich, T. A. Malkina, M. A. Shariya, S. F. Sokolov, and E. B. Maykov

Subjects
Male, Treatment Outcome, Pulmonary Veins, Recurrence, Risk Factors, Atrial Fibrillation, Catheter Ablation, Humans, Female, Prospective Studies, Middle Aged, Cardiology and Cardiovascular Medicine, Cryosurgery
Abstract

Aim To identify risk factors for recurrence of atrial fibrillation (AF) following cryoballoon ablation (CBA).Material and methods This prospective study included patients with paroxysmal AF who had undergone CBA (141 patients, median age 60 years, 3% men). The evaluation prior to CBA included clinical instrumental parameters (electrocardiography (ECG), 24-h ECG monitoring, echocardiography, contrast-enhanced cardiac multispiral computed tomography). Also, possible intraoperative indexes that could affect the CBA effectivity, were evaluated. The postoperative follow-up duration was 12 months. Effectivity was assessed during in-person visits at 3, 6, and 12 months, when questioning of patients and 24-h ECG monitoring were performed. CBA was considered ineffective if the patient had recurrences of any atrial tachyarrhythmia longer than 30 sec after the end of the 3-month “blind” period.Results During the 12-month follow-up, recurrences of atrial tachyarrhythmia were observed in 46 (32.6 %) patients. Patients with ineffective CBA more frequently had AF during the first 3 months (71.7 % vs. 11.6 %; рvs. 20.0 %; р=0.008), and stroke/recurrent ischemic attacks (15.2 % vs. 5.2 %; р=0.047). Multifactorial regression analysis showed that the factors of AF recurrence included common PV collector (relative risk (RR) 2.35; 95 % confidence interval (CI) 1.29–4.25; р=0.005), multiple ineffective AADs (RR 1.42; 95 % CI 1.08–1.86; р=0.011), and early AF recurrence (RR 7.57; 95 % CI 3.84–14.90; рConclusion Common PV collector and multiple ineffective AADs are risk factors of ineffective CBA. Early recurrences during the first 3 postoperative months are a significant risk factor of long-term AF recurrences.

Published
2021

9. [Recent advances in diagnosis and management of atrial fibrillation]

Author

N. Yu. Mironov, E S Mironova, O. V. Stukalova, N. A. Mironova, S. F. Sokolov, E. B. Maykov, A V Pevzner, Yu. A. Yuricheva, Sergey P. Golitsyn, T V Sharf, O P Aparina, I. A. Novikov, and L. Yu Laiovich

Subjects
History, medicine.medical_specialty, business.industry, Endocrinology, Diabetes and Metabolism, medicine, Management of atrial fibrillation, General Medicine, Family Practice, Intensive care medicine, business
Abstract

Alterations of heart rhythm are a common clinical event. They can be caused by almost any kind of heart disorder. Atrial fibrillation (AF) is the most common type of abnormal heart rhythm. Prevalence of AF in the general population is 1-2%, and given that AF incidence rate continues to increase it can be predicted that the number of patients will be doubled within the next 50 years. This review provides the most recent diagnostic and treatment methods, including both unique domestic antiarrhythmic drugs and non - drug methods for AF treatment which were developed and implemented in clinical practice at NMRC of Cardiology of the Ministry of Health of the Russian Federation.Нарушения ритма сердца - широко распространенное клиническое явление. Их возникновение может быть обусловлено практически любым видом сердечной патологии. Фибрилляция предсердий (ФП) является наиболее распространенной формой нарушений ритма сердца. Распространенность ФП в общей популяции составляет 1-2%, и продолжающийся рост заболеваемости позволяет прогнозировать удвоение количества больных в течение ближайших 50 лет. В данном обзоре представлены новейшие диагностические методики и методы лечения, включающие как уникальные отечественные антиаритмические препараты, так и немедикаментозные методы лечения ФП, разработанные и внедренные в клиническую практику в НМИЦ кардиологии Минздрава России.

Published
2021

10. [Comparative efficacy and safety of enoxaparin followed by warfarin and rivaroxaban monotherapy in the treatment of venous thrombosis in patients after intracardiac catheter interventions]

Author

E. S. Kropacheva, T. V. Balakhonova, E. B. Maykov, A. I. Loginova, and S P Golitsyn

Subjects
History, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Femoral vein, lcsh:Medicine, Catheter ablation, Intracardiac injection, Cardiac Catheters, Rivaroxaban, catheter ablation, Medicine, Humans, In patient, Enoxaparin, Venous Thrombosis, anticoagulant therapy, business.industry, lcsh:R, Warfarin, Anticoagulants, General Medicine, medicine.disease, Catheter, Venous thrombosis, Treatment Outcome, Anesthesia, Family Practice, business, medicine.drug
Abstract

to compare two anticoagulant therapy (ACT) regimens in the treatment of venous thrombosis (VT) in patients after catheter interventions - electrophysiological studies (EFIs) and ablations: enoxaparin followed by warfarin, and rivaroxaban monotherapy.The study included patients from 18 years and older with heart rhythm disorders and planned catheter ablation. When parietal venous thrombosis (VT) were detected at the femoral vein puncture site, all patients were randomly assigned to two treatment groups. In group I enoxaparin 1 mg/kg was prescribed every 12 hours with switching to warfarin after 7 days with maintenance of the target INR values (2.0-3.0). In group II rivaroxaban therapy was started at a dose of 15 mg twise/day for 21 days with a further transition to a dose of 20 mg/day. The total period of observation and treatment of patients was at least 3 months.408 patients were observed, 42 (10.3%) patients with parietal VT were divided into two treatment groups. In group I (n=16) complete lysis of VT was noted by the 7th day of treatment in 7 (58.3%) patients, however this scheme was associated with a greater risk of complications (р=0.003) at the puncture site in the form of arteriovenous fistulae (n=1; 8.3%) and intermuscular hematomas (n=4; 25%). In group II (n=26), no complications were noted, the lysis time of VT was on average 21 days (n=18; 69.2%). Complete lysis of VT was noted in both groups at the time of the control observation point (3rd month).The efficiency of the two VT treatment regimens was comparable. Enoxaparin therapy is associated with a high risk of local complications, namely intermuscular hematomas (n=4; 25%) and arteriovenous fistulas (n=1; 8.3%). Rivaroxaban monotherapy is safer (p=0.003); in Group II none of the patients had any complications.Цель исследования: сравнить две схемы антикоагулянтной терапии (АКТ) в лечении венозных тромбозов (ВТ) у пациентов после внутрисердечных катетерных вмешательств - электрофизиологических исследований (ЭФИ) и абляций: эноксапарина с последующим назначением варфарина и монотерапии ривароксабаном. Материалы и методы. В исследование включали пациентов от 18 лет с нарушениями ритма сердца и планируемыми катетерными вмешательствами. При выявлении пристеночного ВТ в месте пункции бедренной вены пациентов рандомизировали на две группы лечения: в группе I проводилась АКТ эноксапарином 1 мг/кг каждые 12 ч с переходом на варфарин через 7 дней с поддержанием целевых значений международного нормализованного отношения (2,0-3,0), в группе II - АКТ ривароксабаном 15 мг 2 раза/сут в течение 21 дня с дальнейшим переходом на дозу 20 мг/сут. Срок наблюдения и лечения пациентов составил 3 мес. Результаты. Наблюдали 408 пациентов, из них 42 (10,3%) пациента с пристеночным ВТ распределили на две группы лечения. В группе I (n=16) у 7 (58,3 %) больных отмечен полный лизис ВТ к 7-му дню лечения, однако эта схема сопряжена с большим риском осложнений (р=0,003) со стороны места пункции в виде артериовенозных соустий (n=1; 6,25%), межмышечных гематом (n=4; 25%). В группе II (n=26) осложнений не отмечалось, время лизиса ВТ в среднем составило 21 день (n=18; 69,2%). В обеих группах на момент проведения контрольной точки наблюдения (3-й месяц) отмечен полный лизис ВТ. Заключение. Эффективность двух схем лечения ВТ оказалась сопоставимой. Терапия эноксапарином сопряжена с большим риском развития местных осложнений: межмышечных гематом (n=4; 25%), артериовенозных соустий (n=1; 8,3%). Монотерапия ривароксабаном была более безопасна (р=0,003), в группе II осложнений не отмечено.

Published
2020

11. [Electrophysiological Cardiac Parameters and Results of Antiarrhythmic Treatment in Patients with Paroxysmal Atrial Fibrillation (Lone and Associated with Arterial Hypertension)]

Author

I. A. Novikov, Peter Sergeevich Novikov, E S Mironova, Lada Yurievna Layovich, Sergey P. Golitsyn, E. B. Maykov, N. A. Mironova, and N. Yu. Mironov

Subjects
medicine.medical_specialty, medicine.medical_treatment, Asymptomatic, Refractory, Interquartile range, Internal medicine, Atrial Fibrillation, Medicine, Humans, Atrial Appendage, Heart Atria, business.industry, Atrial fibrillation, Cryoablation, medicine.disease, Atrioventricular node, Catheter, medicine.anatomical_structure, Concomitant, Hypertension, cardiovascular system, Cardiology, Catheter Ablation, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Anti-Arrhythmia Agents
Abstract

Purpose:to assess cardiac electrophysiological parameters in patients with paroxysmal atrial fibrillation (AF), lone or with concomitant arterial hypertension (AH), and their prognostic significance relative to treatment effectiveness.Materials and methods. We included in this study 184 patients with paroxysmal AF (84 with concomitant AH and 100 with presumed lone AF). Cardiac electrophysiological study was performed in accordance with standardized protocol that included assessment of sinus node recovery time, sinoatrial, intraatrial and interatrial conduction time, and effective refractory periods (ERP) of right and left atria and atrioventricular node. Patients with inducible supraventricular reentrant arrhythmias that could potentially trigger AF underwent catheter radiofrequency ablation of those arrhythmias. Other patients received either antiarrhythmic drug therapy (AAD; n=79) or catheter cryo-ablation (CBA; n=81). Treatment was considered ineffective in case of any symptomatic or asymptomatic AF episode documented by ECG or Holter ECG within 12 months of follow-up.Results.Patients with lone AF compared with those with AH had shorter ERP of the right atrium (219±21 ms vs. 253±44 ms, respectively, p

Published
2019

12. Refralon (niferidil) is a new class III antiarrhythmic agent for pharmacological cardioversion for persistent atrial fibrillation and atrial flutter

Author

E. I. Chazov, Sergey P. Golitsyn, E. B. Maykov, Yu. A. Yuricheva, S. F. Sokolov, L. V. Rozenshtraukh, and N. Yu. Mironov

Subjects
Male, History, medicine.medical_specialty, Potassium Channels, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, atrial flutter, Action Potentials, lcsh:Medicine, Antiarrhythmic agent, Ventricular tachycardia, niferidil, pharmacological cardioversion, Bolus (medicine), Piperidines, Internal medicine, medicine, Humans, Sinus rhythm, atrial fibrillation, iii class antiarrhythmic agents, refralon, medicine.diagnostic_test, Dose-Response Relationship, Drug, business.industry, lcsh:R, Atrial fibrillation, Heart, General Medicine, Middle Aged, medicine.disease, Treatment Outcome, Atrial Flutter, Echocardiography, Data Interpretation, Statistical, Ambulatory, Cardiology, Electrocardiography, Ambulatory, Female, Family Practice, business, Electrocardiography, Anti-Arrhythmia Agents, Atrial flutter
Abstract

To evaluate the efficacy and safety of refralon (niferidil), a new class III antiarrhythmic agent whose activity is related to the block of delayed rectifying potassium current and to the prolongation of atrial and ventricular action potential and refractory periods, when it is used as an agent for pharmacological cardioversion for atrial fibrillation (AF) and atrial flutter (AFL).The efficacy of the drug as 3 intravenous boluses of 10 μg/kg was evaluated in 134 patients (90 men; 57.8 ± 11 years) with a mean AF duration of 3 (1.5; 6) months. Its effect was controlled by 24-hour Holter ECG monitoring. The criterion for its antiarrhythmic effect was 24-hour sinus rhythm (SR) recovery.Niferidil restored SR in 47.7% of the patients with AF after administration of bolus 1, in 62% after bolus 2, and in 84.6% after bolus 3. SR was restored in all 100% patients with AFL. With the AF duration of less than 3 months, the efficacy of niferidil was 91.8%. There was nonsustained polymorphic ventricular tachycardia (VT) (torsade de pointes) in 1 (0.7%) patient and nonsustained monomorphic VT was stated in 5 (3.7%) patients. CONCLUSIONPharmacological cardioversion with niferidil for persistent AF and VT may be regarded as a possible alternative to electrical cardioversion.Цель исследования. Оценка эффективности и безопасности рефралона (ниферидила) - нового антиаритмического препарата III класса, действие которого связано с блокадой калиевых токов задержанного выпрямления, удлинением потенциала действия и рефрактерных периодов в предсердиях и желудочках, при его применении в качестве средства для медикаментозной кардиоверсии при фибрилляции предсердий (ФП) и трепетании предсердий (ТП). Материалы и методы. Эффективность препарата в виде 3 болюсов по 10 мкг/кг внутривенно оценена у 134 больных (57,8±11 лет, 90 мужчин) при средней длительности ФП 3 (1,5; 6) мес. Действие препарата контролировалось при 24-часовом холтеровском мониторировании электрокардиограммы. Критерием антиаритмического эффекта было восстановление синусового ритма (СР) в течение 24 ч. Результаты. Ниферидил восстановил СР у 47,7% больных с ФП после введения 1-го болюса, у 62% - после введения 2-го и у 84,6% - после введения 3-го болюса. СР восстановлен у всех 100% больных с ТП. При длительности ФП менее 3 мес эффективность ниферидила составила 91,8%. Неустойчивая полиморфная желудочковая тахикардия (ЖТ) типа torsades de pointes отмечена в 1 (0,7%) случае. Неустойчивая мономорфная желудочковая тахикардия (ЖТ) констатирована у 5 (3,7%) больных. Заключение. Медикаментозная кардиоверсия персистирующей ФП и ТП с использованием ниферидила может рассматриваться как возможная альтернатива электрической кардиоверсии.

Published
2015

16. P1445Occurence and determinants of new-onset atrial fibrillation after cavotricuspid isthmus ablation in patients with 'isolated' typical atrial flutter

Author

E B Maykov, P Novikov, A V Pevzner, Golitsyn Sp, N B Shlevkov, and Sokolov Sf

Subjects
medicine.medical_specialty, Cavotricuspid isthmus, business.industry, medicine.medical_treatment, Ablation, New onset atrial fibrillation, Physiology (medical), Typical atrial flutter, Internal medicine, Cardiology, Medicine, In patient, Cardiology and Cardiovascular Medicine, business
Published
2017

17. A CASE OF BRUGADA SYNDROME DIAGNOSED AFTER CONVERSION OF SEEMINGLY LONE ATRIAL FIBRILLATION

Author

S A Bakalov, Kirill Gruzdev, Vladislav Vlodzyanovsky, Sergey P. Golitsyn, N B Shlevkov, V. G. Kiktev, Nikolay Yu. Mironov, and E. B. Maykov

Subjects
medicine.medical_specialty, business.industry, Internal medicine, medicine, Cardiology, Lone atrial fibrillation, Cardiology and Cardiovascular Medicine, medicine.disease, business, Brugada syndrome
Published
2017

18. Efficacy of a new class III drug niferidil in cardioversion of persistent atrial fibrillation and flutter

Author

E. B. Maykov, Leonid V. Rosenshtraukh, Evgeny I. Chazov, Yulia A Yuricheva, S. F. Sokolov, Nikolay Yu. Mironov, and Sergey P. Golitsyn

Subjects
Drug, Male, medicine.medical_specialty, medicine.medical_treatment, media_common.quotation_subject, Antiarrhythmic agent, Cardioversion, Bolus (medicine), Piperidines, Internal medicine, Atrial Fibrillation, medicine, Humans, Sinus rhythm, media_common, Aged, Pharmacology, medicine.diagnostic_test, Dose-Response Relationship, Drug, business.industry, Middle Aged, medicine.disease, Treatment Outcome, Atrial Flutter, Ambulatory, Cardiology, Electrocardiography, Ambulatory, Female, Cardiology and Cardiovascular Medicine, business, Electrocardiography, Anti-Arrhythmia Agents, Atrial flutter
Abstract

Aims To study the efficacy and safety of the new class III antiarrhythmic agent niferidil for pharmacological cardioversion in patients with persistent atrial fibrillation (AF) and atrial flutter (AFl). Methods and results One hundred thirty-four adults (aged 57.8 ± 11 years, 90 males) were included with median AF duration of 3 (1.5-6) months. All patients received a total of 10-30 μg/kg, niferidil, intravenously, in 1-3 (if needed) consecutive boluses at 15-minute intervals. Holter electrocardiogram monitoring was started before infusion and was continued for 24 hours. The criterion for an antiarrhythmic effect was sinus rhythm restoration within 24 hours of the initial bolus. Niferidil converted AF to sinus rhythm in 47.7% of cases after bolus 1, in 62% of cases after bolus 2, and in 84.6% of cases bolus 3. Niferidil induced a 100% recovery rate in patients with AFl and a 91.8% recovery rate in patients with AF of duration from 8 days to 3 months. Nonsustained torsade de pointes occurred in 1 patient (0.7%), and nonsustained monomorphic ventricular tachycardia was observed in 5 patients (3.7%). Conclusions The new intravenous class III drug niferidil demonstrated high conversion rates of 84.6% in patients with persistent AF and 100% in patients with persistent AFl. Niferidil may be used as a possible alternative to electrical cardioversion for pharmacological cardioversion of persistent AF/AFl.

Published
2014

19. Atrial fibrillation translational session III

Author

V. V. Taranchuk, O. N. Plenova, D. Petrac, V. Radeljic, D. Delic-Brkljacic, S. Manola, N. Pavlovic, Y. U. A. Yuricheva, E. B. Maykov, S. F. Sokolov, S. P. Golitsyn, G. G. Beloshapko, A. V. Yushmanova, L. V. Rosenshtraukh, E. I. Chazov, L. Lickfett, R. Andrie, E. Mittmann-Braun, M. Linhart, F. Stockigt, G. Nickenig, J. Schrickel, S. Rolf, S. Kircher, T. Gaspar, A. Arya, N. Watanabe, K. Kiuchi, G. Hindricks, C. Piorkowski, K. C. K. Wong, N. Qureshi, M. Jones, A. Muthumala, K. Rajappan, Y. Bashir, and T. R. Betts

Subjects
Physiology (medical), Cardiology and Cardiovascular Medicine
Published
2011

20. Comparative efficacy and safety of enoxaparin followed by warfarin and rivaroxaban monotherapy in the treatment of venous thrombosis in patients after intracardiac catheter interventions

Author

A I Loginova, E S Kropacheva, E B Maykov, T V Balakhonova, and S P Golitsyn

Subjects
catheter ablation, venous thrombosis, anticoagulant therapy, Medicine
Abstract

Aim: to compare two anticoagulant therapy (ACT) regimens in the treatment of venous thrombosis (VT) in patients after catheter interventions - electrophysiological studies (EFIs) and ablations: enoxaparin followed by warfarin, and rivaroxaban monotherapy. Materials and methods. The study included patients from 18 years and older with heart rhythm disorders and planned catheter ablation. When parietal venous thrombosis (VT) were detected at the femoral vein puncture site, all patients were randomly assigned to two treatment groups. In group I enoxaparin 1 mg/kg was prescribed every 12 hours with switching to warfarin after 7 days with maintenance of the target INR values (2.0-3.0). In group II rivaroxaban therapy was started at a dose of 15 mg twise/day for 21 days with a further transition to a dose of 20 mg/day. The total period of observation and treatment of patients was at least 3 months. Results. 408 patients were observed, 42 (10.3%) patients with parietal VT were divided into two treatment groups. In group I (n=16) complete lysis of VT was noted by the 7th day of treatment in 7 (58.3%) patients, however this scheme was associated with a greater risk of complications (р=0.003) at the puncture site in the form of arteriovenous fistulae (n=1; 8.3%) and intermuscular hematomas (n=4; 25%). In group II (n=26), no complications were noted, the lysis time of VT was on average 21 days (n=18; 69.2%). Complete lysis of VT was noted in both groups at the time of the control observation point (3rd month). Conclusion. The efficiency of the two VT treatment regimens was comparable. Enoxaparin therapy is associated with a high risk of local complications, namely intermuscular hematomas (n=4; 25%) and arteriovenous fistulas (n=1; 8.3%). Rivaroxaban monotherapy is safer (p=0.003); in Group II none of the patients had any complications.

Published
2019
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