Исследовали эффекты антиаритмических препаратов амиодарона и его аналога дронедарона на зависимость интервал — сила папиллярных мышц сердца крыс. Оценивали первое сокращение после периодов покоя (4 – 60 с), экстрасистолические (0,2 – 1,5 с от начала базового сокращения) и постэкстрасистолические сокращения. Анализировали зависимость изменений амплитуды сокращения после тестов до и после перфузии изолированных мышц амиодароном (10–6 М) и дронедароном (1,5 × 10–6 М) в течение 10 мин. Оба препарата вызывали снижение амплитуды экстрасистолических сокращений на 3 – 8 % и 6 – 12 %, соответственно (p < 0,05). На фоне препаратов амплитуда постэкстрасистолических сокращений после коротких экстрасистолических интервалов значительно повышалась (13 – 12 % амиодарон и 6 – 8 % дронедарон) в сравнении с контролем (p < 0,05). Перфузия мышц амиодароном и дронедароном вызывала повышение амплитуды сокращений после периодов покоя (4 – 60 с) на 10 – 75 % и 11 – 46 %, соответственно, по сравнению с интактными папиллярными мышцами. Таким образом, дронедарон снижает возбудимость сарколеммы кардиомиоцитов в большей степени, чем амиодарон. Дронедарон и амиодарон способны повышать постэкстрасистолическую потенциацию и потенциацию, индуцированную периодами покоя, при этом эффект амиодарона более выражен.

The article is devoted to surgical treatment of the coronary artery disease in combination with atrial fibrillation. Despite the growing number of surgical atrial fibrillation ablation procedures during coronary artery bypass grafting surgery, only 27.5% of patients receive intervention for atrial fibrillation correction in addition to CABG. Article comprises long-term results of the prospective, singlecenter trial on clinical efficacy of combined stepwise approach in treatment of patients with atrial fibrillation and CABG in comparison with surgical ablation alone.

The article highlights the problem of treatment for atrial fibrillation (AF) in patients with ischemic heart disease requiring direct myocardial revascularization. Although there is a growing number of surgical interventions for AF correction during coronary artery bypass grafting, two thirds of patients do not receive treatment. The objective of this prospective single center study was to compare a conventional method with combined two-step approach in treatment of this group of patients. The study showed that adding catheter radiofrequency ablation increases the effectiveness and does not affect the perioperative mortality in patients with atrial fibrillation and ischemic heart disease requiring coronary artery bypass grafting.

Remote monitoring of patients with implanted cardiac pacemakers (ICP) and with implanted cardioverter defibrillators (ICD) is a reliable alternative to the ambulatory medical exams. It allows for early detection of changes in patient condition and cardiac stimulation system, saves patient time required for unnecessary ambulatory exams, and decreases physician workload. Reduction of time spent for planned visits to a doctor, on the one hand, and early diagnosis of life(threatening complications, on the other hand, provide significant economic effect and result in better quality of patient life. Aim: The aim of the study was to analyze the advantages of mobile telemonitoring for detection of abnormal work of stimulation system, complications, and undiagnosed disorders in heart rhythm in study patients. Materials and Methods. The study included 42 patients aged 65.71±11.30 years (Me)=67.00 years including 21 men (50%) with different diseases requiring implantation of two(chamber ICP. All patients were divided into 2 groups. Follow up period lasted for one year. Results: Follow up based on remote monitoring at early stage allowed for detection of the changes requiring medical intervention. Most patients from two groups did not have any changes in their condition and did not require regular ambulatory examination. Besides, the study found the intergroup differences between the numbers of hospitalizations and ambulatory visits during the year. Conclusions. Remote monitoring allows for detection of changes in patient condition and in ICP system work earlier than standard follow up examinations suggesting the advantages of remote telemonitoring.

The objective of the study was to assess the efficacy of various approaches for surgical treatment of atrial fibrillation (AF), depending on the electrophysiological mechanisms. A total of 423 patients with various forms of AF resistant to antiarrhythmic drug therapy were surveyed. All patients underwent intracardiac electrophysiological study. Depending on the electrophysiological forms of AF, the type of surgical treatment for each patient was selected. Electrophysiological detection of AF provides a way to differentiate the approaches for catheter treatment. Catheter treatment of focal AF is based on radiofrequency isolation of the arrhythmogenic region. In the case of detection of deceleration areas (arrhythmogenic zones) in the myocardium of the left atrium contributing to the development of the mechanism of reentry, performance of additional defragmentation of this section is necessary.

Aim. The aim of the study was to determine the effects of interventional treatment for atrial fibrillation (AF) on the dynamic changes in the system of extracellular matrix proteolysis. Material and methods. A total of 50 patients were included in the study: 27 patients (18 males) had persistent AF (mean age of 62.1±9.4 years); 23 patients (14 males) had long-lasting persistent AF (mean age of 64±11 years). All patients received radiofrequency antral pulmonary veins isolation and linear lesions on the back wall of the left atrium and the mitral isthmus with CARTO system (Biosense Webster, USA). Blood serum changes in the parameters of extracellular matrix proteolysis and concentrations of growth factors including matrix metalloproteinase (MMP)-1, MMP-3, MMP-9, tissue growth factor β1 (TGF-β1), tissue inhibitor of matrix metalloproteinases 1 (TIMP-1), and fibroblast growth factor (FGF) were determined before the Maze procedure, immediately after the procedure, after 1 day, 3 months, and 6 months. Results. The concentrations of all MMPs immediately after the Maze procedure dramatically decreased most likely due to significant thermal damage of the left atrium. On the next day after the procedure, the MMP-1 concentration restored to the initial level, the MMP-3 concentration remained at the same level, whereas the MMP-9 concentration drastically increased to the level exceeding the initial value. After 3 months, the concentrations of MMP-1 and MMP-3 were near the initial levels, whereas MMP-9 concentration dropped to the level recorded immediately after the procedure. After 6 months of observation, the MMP-1 concentration demonstrated downward trend and was lower than the initial value; the MMP-1 level also did not reach the initial level; and the MMP-9 concentration returned to the initial level. The TGF-β1 concentration also dramatically dropped right after the procedure and slowly recovered during 6 months of follow-up. The decrease in the TGF-β1 concentration immediately after the procedure can be explained by massive cell death in the atrial myocardium. One day after the procedure, the TGF-β1 concentration increased and reached the initial level, but it decreased after 3 and 6 months. Conclusion. The reductions in the concentrations of MMPs and growth factors in the absence of AF after the Maze procedure resulted from the arrest and perhaps the reversal of the structural remodeling.

The article is devoted to the modern aspects of the interventional arrhythmology. The first aim of this study was to test the accuracy of the noninvasively obtained ventricular activation (isolated epicardial vs combined endo-epicardial mapping) as compared with that of standard invasive mapping in patients with ventricular arrhythmias. It was 88.3%. The second aim was to evaluate the patients’ state of health by EQ-5D questionnaire and the appearance of cardiovascular events in the remote period after “MAZE” radiofrequency endocardial catheter ablation procedure, according to the efficacy of the interventional treatment. We also estimated the influence of the inflammation on the results of the atrial fibrillation catheter treatment. The results of the method for the selection and effectiveness of the treatment of severe heart failure are presented.

Individual peculiarities of the receptor apparatus of cardiomyocytes may determine pathological features of heart activity and susceptibility to pharmaceuticals. The possible role of beta-adrenoreceptor polymorphism in the development of cardiac rhythm disturbances is assessed by PCR. Special attention is given to A145G polymorphism of the ADRB1 gene in 127patients with primary cardiac rhythm disorders. It was shown that A145G polymorphism (Ser49Gly) at DNA sites encoding for the amino acid sequence of beta-1 adrenoreceptors can influence the development of sex-specific cardiac rhythm disorders.

To compare accuracy of non-invasive topical diagnosis of ventricular arrhythmias using the results of epicardial and combined epi-endocardial mapping and the data of intra-cardiac electrophysiological study, 94 patients (35 men and 59 women) aged 20 67 years (mean age: 43.5 years) with ventricular arrhythmias of different origin and location were examined. In all patients, the non-invasive electrophysiological study was carried out, which included surface ECG in 240 leads, spiral computed tomography with the data processing to locate an area of the earliest activation, corresponding to the arrhythmogenic focus projection. According to the data of intra-cardiac electrophysiological study and successful radiofrequency ablation, in 58 patients, the arrhythmogenic focus was located in the right ventricle outflow tract (RVOT): in 3 patients, in the anterolateral area of RVOT; in 8 patients, on the anterior wall of RVOT; in 20 subjects, in the antero-septal area of RVOT; in 23 patients, in the septal area of RVOT; and in 4 subjects, in the postero-septal area of RVOT. The combined epi-endocardial mapping in 56 cases showed the same arrhythmogenic focus location, in 2 patients, discrepancies were revealed. When using epicardial mapping, the arrhythmogenic focus was precisely located in 48 patients. In 8 patients, according to the data of the intra-cardiac electrophysiological study and successful radiofrequency ablation, the arrhythmogenic focus was located in the right ventricle inflow tract (RVIT): in 2 patients, in basal segments of the free wall; in 1 patient, in apical segments of the free wall; in 1 patient, in the antero-septal area on the border between apical and medial segments of the right ventricle; and in 4 patients, in parahisian area, under the tricuspid valve annulus. The epi-endocardial mapping in 6 cases showed the same arrhythmogenic focus location, in 2 patients, discrepancies were revealed. When using epicardial mapping, the arrhythmogenic focus was precisely located in 3 patients. In 12 patients, according to the data of intra-cardiac electrophysiological study and successful radiofrequency ablation, the arrhythmogenic focus was located in the left ventricle outflow tract (LVOT): in 3 patients, in the projection of non-coronary aortic sinus; in 2 patients, on the border between of the right and left aortic sinuses; in 2 patients, in the projection of the right aortic sinus; and in 5 patients, in the projection of the left aortic sinus. The epi-endocardial mapping showed the same arrhythmogenic focus location in 11 cases. During epicardial mapping, it was possible to locate the arrthythmogenic focus precisely in 7 patients only. In 16 patients, according to the data of intra-cardiac electrophysiological study and successful radiofrequency ablation, the arrhythmogenic focus was located in the left ventricle inflow tract (LVIT): in 2 patients, on the boundary between medial apical segments in the postero-septal position of the left ventricle; in 2 patients, in the apical part of intra-ventricular septum; in 1 patient, in basal parts of the anterior wall; in 1 patient, in basal parts of the lateral wall; in 4 patients, in basal parts of the posterior wall; in 3 patients, in basal parts of LV, in postero-septal location; and in 3 patients, ventricular extrasystoles originated from the left ventricle papillary muscle. The epi-endocardial mapping showed the same arrhythmogenic focus location in 10 cases, epicardial pacing showed the same results. Thus, the topical diagnostics of ventricular arrhythmias based on the epi-endocardial mapping data permits one to locate arrhythmogenic foci with a rather high accuracy.

Objective. To evaluate the efficacy and safety of transcatheter renal denervation (TRD) in drug-resistant hypertension in a single-institution study (NCT01499810). Design and methods. Subjects with essential hypertension aged 18-80 years with blood pressure (BP) > 160/100 mmHg despite three or more antihypertensive drugs who signed written informed consent were included in the study. Exclusion criteria were: mean 24-h systolic BP 2 , severe concomitant diseases. TRD was performed as 4-8 point radiofrequency (RF) ablations in each renal artery using standard EP catheter 5F. Efficacy endpoints: changes in office and ambulatory BP at 6 and 12 months after TRD. Safety endpoints: adverse events, changes in renal blood flow (ultrasound dopplerography) and renal function (proteinuria, serum creatinine, eGFR) at 1 st week, 6 and 12 months after TRD. Results. Interim analysis was done to monitor safety of TRD. The intervention was performed in 45 patients (aged 52,9 ± 12,2 years, 22 male), 29 patients were examined at 6 months and 16 patients — at 12 months after TRD. Intraoperative angiography showed no damage of renal arteries due to RF ablation. There were 5 minor periprocedural complications: small subcapsular kidney hematoma (80 ml by magnet-resonance tomography), contrast nephropathy, 2 access site pseudoaneurysms, allergy to dye. No additional events, significant changes in renal blood flow or renal function were found at 6 and 12 months of follow-up. Office BP fell by -34,8/-17,2 mmHg (p < 0,00001/0,00001) at 6 months and -41,0/-24,1 mmHg (p < 0,0001/0,0001) at 12 months after TRD (systolic/diastolic, respectively). Mean 24-h BP decreased by -11,1/-7,1 (p < 0,001/0,001) and 20,8/-13,1 mmHg (p < 0,0001/0,0001), respectively. Conclusions. TRD is safe in patients with resistant hypertension and causes significant long-term reduction of both office and ambulatory BP.

The principles of atrial fibrillation (AF) treatment are presented in the article. The modern methods of the medicated and drug-free sinus rhythm restoration and the thrombotic complications prevention are shown. Tactics and possibility of AF intervention treatment are defined.