Today implantable cardiac devices (ICD) are advanced therapeutic and preventive tools ensuring the collection and transmission of statistical and diagnostic patient data. The information obtained from implanted devices allows analyzing patients’ condition, selecting optimal treatment strategy, predicting and preventing possible complications. The number of ICD recipients is rapidly growing. Over 1,000 devices per 1 million population are implanted in Europe and the US annually. In the Russian Federation this number reaches 300 devices per 1 million population. Routine medical checkups of patients with ICD should be performed 2–4 times a year, with an average length of about 20 minutes. It means that only in the Russian Federation physicians will have to work 20–40 thousand extra hours with a tendency towards its increase as this figure will grow simultaneously with growing patients’ number. Remote monitoring (RM) technologies may solve this problem. In 2000 Biotronik AG developed the world's first system for remote monitoring of anti-arrhythmic devices called the “Home Monitoring” system. It is based on the mobile RM of patients who received ICD. The information collected by the devices is transmitted to a special service center via mobile communication networks and after processing, the information is transferred to a physician’s website along with a text message and a fax. The information is instantly delivered from a patient to a physician. A closed information network "patient-service center-physician" was developed for the hospitals and their patients, providing a novel advanced monitoring and timely treatment of the patient.

The presented clinical case demonstrates an individual choice of a staged comprehensive approach to interventional treatment of a patient with coronary artery disease and ventricular tachyrhythmias, focused on myocardial revascularization and interventional abolition of ventricular tachyrhythmias.

To assess efficacy of cardiac contractility modulation (CCM) therapy in patients with chronic heart failure (CHF), 30 Optimizer devices (Impulse Dynamics, Germany) were implanted in 2016, including 27 Optimizer IV devices and 3 Optimizer Smart devices in patients with atrial fibrillation (AF). Most patients suffered from coronary heart disease (87%), 5 of them (17%) had a history of PCI with stenting, and 2 patients (7%) had a history of coronary bypass surgery. Dilated cardiomyopathy was documented in 3 patients (10%) and post-myocarditic cardiosclerosis, in 1 patient (3%). Implantable cardioverters-defibrillators were implanted in 10 patients (33%) and cardiac pacemakers, in 2 patients (6.7%). The indications to implantation of CCM devices were as follows: well-controlled CHF II III (NYHA), left ventricular (LV) ejection fraction (EF) 20 40% according to the echocardiography data, QRS width <130 msec, presence of the sinus rhythm if the Optimizer IV device was implanted, and atrial fibrillation if the Optimizer Smart device was implanted. The study subjects’ assessment included 12 lead ECG, transthoracic echocardiography, 6 minute walk test, N terminal pro-brain natriuretic peptide (NT proBNP) testing, 24 hour Holter monitoring, and the quality of life assessment using Minnesota Living with Heart Failure Questionnaire. The follow-up period was 4±1.4 months for the patients with the Optimizer IV devices and 2 months with the Optimizer Smart devices. In 17 cases (57%), decreased energetic parameters within the effective range in the early postoperation period were required. In 14 patients (46.7%), 3 months after the procedure, the amplitude of stimuli which were previously bothering increased. In 27 patients with CCM devices, LV EF raised on the average by 8%, the quality of life improved on the average by 11 points, NT proBNP decreased by 488 ng/l, and the percentage of paced complexes was 82±12.1%, i.e. more than the recommended %. An improvement (mild increase in LV EF and quality of life) was also found in the three patients with Optimizer Smart devices despite a short follow-up period. Thus, the CHF treatment using implantable CCM devices leads to a considerable improvement of the quality of life and physical working capacity, as well as has an effect on the cardiac contractility parameters in these subjects. At the same time, further detailed studies of the long-term outcomes and safety of the CCM therapy, as well as defining clear indications to reach the maximal effect of the CCM device implantation are needed. The clinical efficacy, the complication rate, and the health economics of CCM therapy should be compared with those for the available treatment techniques with the proven benefit on the quality of life, hemodynamic parameters, hospitalizations, and survival of patients with CHF. Of note, among the surgical methods of CHF management, CCM therapy is considered a minimally invasive intervention; the implantation technique is similar to that of other antiarrhythmic devices.

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.

To assess the ASTROCARD system application during the electrophysiological study and radiofrequency catheter ablation of ventricular arrhythmias, 5 female patients were assessed.

To assess effectiveness and safety of radiofrequency ablation of arrhythmias originating from the aortic sinuses in 1999 through 2014, 130patients aged 28±9.8 years were examined and operated.

To study electrophysiological mechanisms and assess early and late outcomes of interventional treatment in patients with atrial tachycardia (AT) originating from the pulmonary vein (PV) ostia and paroxysmal atrial fibrillation (AF), 100 patients were examined. The study group consisted of 60 patients aged 43.5±12.19 years (16 65 years), 33 men (55%) and 27 women (45%), including 2 pediatric patients under 18 years (3.3%), with ectopic AT from PV. The arrhythmic history was 5.7±4.3 years (0.5 20 years). In the study group, 64 procedures were performed (1.06±0.06 patients per 1 patient). The control group consisted of 40 patients with paroxysmal AF due to the chaotic activity of PV aged 48.1±11.9 years (16 72 years), 32 men (80%) and 8 women (20%), including 1 pediatric patient under 18 years (2.5%). The arrhythmic history was 6.2±6.5 years. In the control group, 50 procedures were made (1.25±0.07 procedures per 1 patient). The transseptal puncture was performed in all patients for access to the left atrium (LA). Electrophysiological properties of the PV muscular muffs as well as the LV arrhythmogenicity were studied. For this purpose, 20 polar Lasso catheter was positioned in the PV ostium, and the PV spikes were recorded. The duration of radiofrequency ablation (RFA) was 15.1±10.5 min (9- 30 min) for one PV. After RFA of ostia of all PVs, their electrophysiological properties were compared (effective and functional refractory periods, probability of AF induction in an isolated PV, fragmented activity, duration of impulse conduction in PV) and repetitive PV angiography was performed to reveal their stenosis. The outcomes of RFA were assessed in the early, intermediate, and late post-intervention periods. In the early post-intervention period, the effectiveness in both groups was 100%; at discharge, all patients had the sinus rhythm and received antiarrhythmic and anticoagulant therapy discontinued 3 months later. Six months after the intervention, the AT recurrence was documented in 4 patients (6.6%) which required an additional interventional procedure. In the control group, recurrence of arrhythmia was revealed in 10 patients (25%). In the late post-intervention period (39.1±9.5 months), the overall effectiveness in patients with AT, taking repetitive procedures into the account, was 100%, as compared with 87% in the AF group. Thus, computed tomography of LA and PV, 12 canal Holter monitoring, and non-invasive electrophysiological mapping in the pre-intervention period permit one to reveal peculiar features of the LA and PV structure with a high accuracy. The tachycardia recurrence in the control group (25%), with two or more PVs being source of automaticity, are revealed significantly more frequently than in the study group (6.6%), where a single ectopic focus was predominantly a source of automaticity. The radiofrequency PV ostia isolation is a highly effective method of treatment of patients with ectopic AT originating from PV ostia and paroxysmal AF.

To study effectiveness of management of ventricular tachyarrhythmias in patients after the open-heart surgery, 38 patients were examined including 22 subjects after correction of congenital heart diseases and 16 patients after surgical treatment of coronary artery disease (aorto-coronary bypass grafting and/or aneurysmoplasty by Dor).

To study effectiveness of the radiofrequency ablation of incision tachycardias developed in the late post-operation period following surgical correction of congenital heart diseases, 16 patients aged 23.7±4.6 years (including 6 males) were examined and treated.

The case report is given of elimination of ventricular tachycardias from areas around the post-operation scar in a 55 year old male patient with coronary artery disease and post-infarction cardiosclerosis after the aorto-coronary bypass grafting surgery and aneurysmoplasty by Dor followed by implantation of cardioverter-defibrillator.