Введение. Фибрилляция предсердий (ФП) – прогностически неблагоприятная аритмия, ассоциирующаяся с пятикратным увеличением риска тромбоэмболических осложнений, источником которых является тромб ушка левого предсердия (УЛП). Цель исследования: изучить роль полиморфизма генов тромбофилии у пациентов с неклапанной ФП и тромбозом УЛП. Материалы и методы. В проспективное исследование включены 86 пациентов с неклапанной ФП (53 мужчины и 33 женщины, средний возраст 58,35 ± 9,34 лет): 60 пациентов с тромбозом УЛП (основная группа), 26 пациентов – без тромбоза УЛП (контрольная группа). Всем пациентам выполнялись лабораторные методы исследования с определением параметров коагуляционного и тромбоцитарного звеньев гемостаза и молекулярно-генетическое тестирование: FII 20210 G > A, FV 1691 G > A, FVII 10976 G > A, F13 G > T, FGB 455 G > A, ITGA2 807 C > T, ITGB3 1565 Т > С, PAI‑1–675 5G > 4G. Результаты. У пациентов с наличием тромбоза УЛП в сравнении с контрольной группой отмечена более частая встречаемость генов тромбоцитарного звена гемостаза – полиморфизма 807 T гена ITGA2 (51,7% и 23,1%; р = 0,014) и 1565 С гена ITGB3 (23,3% и 3,8%; р = 0,032). Не выявлено значимых различий по показателям агрегометрии между группами в зависимости от наличия мутантных аллелей ITGA2 и ITGB3. Сочетание мутантных аллелей обоих генов интегринов является прогностически неблагоприятной комбинацией для развития тромбоза и ассоциируется с увеличенным индексом объема левого предсердия (47,5 ± 13,3 мл/м2) в отличие от изолированного присутствия мутаций одного из интегринов — ITGA2 или ITGB3 (37,3 ± 9,5 мл/м2), либо полного отсутствия данных мутаций (36,1 ± 10,7 мл/м2). Заключение. У пациентов с ФП и тромбозом УЛП значимо чаще встречается неблагоприятная комбинация носительства мутантных аллелей генов ITGA2 и ITGВ3, ассоциирующаяся с выраженностью структурного ремоделирования левого предсердия и не связанная с агрегационной активностью тромбоцитов. troduction. Atrial fibrillation (AF) is cardiac arrhythmia with an unfavorable prognosis. AF is associated with a 5-fold increase in the risk of thromboembolic complications due to a thrombus in the left atrial appendage (LAA). Aim: to study the role of thrombophilia gene polymorphisms in patients with non-valvular AF and LAA thrombosis. Materials and Methods. The prospective study included 86 patients with non-valvular AF (53 men and 33 women with a mean age of 58.35 ± 9.34 years). Among them, 60 patients had LAA thrombosis (main group), while the remaining 26 patients had no such thrombosis (control group). All patients underwent laboratory testing to evaluate coagulation and platelet hemostasis parameters, as well as molecular genetic testing: FII 20210 G > A, FV 1691 G > A, FVII 10976 G > A, F13 G > T, FGB 455 G > A, ITGA2 807 C > T, ITGB3 1565 T > C, PAI‑1–675 5G > 4G. Results. Platelet hemostasis genes were observed more frequently in patients with LAA thrombosis compared with the control group. Specifically, 807T polymorphism of the ITGA2 gene (51.7% and 23.1%; p = 0.014) and 1565 C of the ITGB3 gene (23.3% and 3.8%; p = 0.032) were noted. There were no significant differences in aggregometry between the groups depending on the presence of mutant alleles of ITGA2 and ITGB3. The combination of mutant alleles of both integrin genes is prognostically unfavorable for thrombosis development and is associated with an increased left atrial volume index (47.5 ± 13.3 mL/m2) in contrast to the presence of mutations in only one of the integrins – ITGA2 or ITGB3 (37.3 ± 9.5 mL/m2), or the absence of these mutations (36.1 ± 10.7 mL/m2). Conclusion. In patients with AF and LAA thrombosis, a statistically significant increase in frequency was found in carriers of mutant alleles of the ITGA2 and ITGВ3 genes. This unfavorable combination was associated with the severity of left atrium structural remodeling but not associated with platelet aggregation activity.

Aim. To identify predictors of spontaneous echo contrast (SEC) and/or left atrial appendage (LAA) thrombosis in patients with nonvalvular atrial fibrillation (AF) who are referred for elective cardioversion or catheter ablation (CA). Material and methods . A retrospective analysis of data from 638 patients with nonvalvular AF who were hospitalized from 2014 to 2017 for cardioversion or CA was performed. All patients underwent diagnostic tests, including transthoracic and transesophageal echocardiography (TEE). Results. According to the TEE results, two groups of patients were formed: group 1 — 95 patients (14,9%) with signs of SEC and/or thrombosis in LAA; group 2 — 543 patients (85,1%) without SEC or thrombosis in LAA. Patients with the phenomenon of SEC and/or LAA thrombosis were older, had a higher risk on the CHA2DS2-VASc score. These patients were more likely to have coronary heart disease (CAD), hypertension, stage IIA chronic heart failure, obese class >II, persistent or permanent AF Patients in both groups did not differ in anticoagulant therapy. Patients in group 1 had a larger size of the left and right atria, right ventricle, left ventricular (LV) end-systolic and end-diastolic diameters, higher LV mass index, lower values of LV ejection fraction and blood flow velocity in LAA. Logistic regression revealed following independent predictors of SEC and/or LAA thrombosis: CAD (odds ratio (OR) 2,289; 95% confidence interval (CI) 1,313-3,990; p=0,003), persistent or permanent AF (OR 2,071; 95% CI 1,222-3,510; p=0,007), LA diameter >43 mm (OR 3,569; 95% CI 2,0822-6,117; p 43 mm, concentric or eccentric LV hypertrophy are independent predictors of SEC and/or LAA thrombosis.

To study frequency of appropriate activations of implanted cardioverters-defibrillators for primary and secondary prevention of sudden cardiac death in patients with chronic heart failure in real clinical practice, 199 patients aged 56±11 years were examined.

Фибрилляция и трепетание предсердий представляют важные проблемы современной кардиологии. Частота этих патологий существенно возрастает с возрастом. Фибрилляция предсердий является фактором, приводящим к возрастанию риска тромбоэмболических осложнений, в частности тромба в ушке левого предсердия — одного из независимых предикторов инсульта. В последнее время все большее распространение при профилактике тромбоэмболических осложнений у пациентов получают новые пероральные антикоагулянты. В настоящей публикации мы приводим описание клинического случая применения нового перорального антикоагулянта ривароксабана при тромбозе левого предсердия у пациента с фибрилляцией предсердий при проведении катетерной абляции.

Two clinical case reports are given of application of cryoablation for treatment of frequent symptomatic ventricular premature beats originating from the right ventriclular inflow tract after unsuccessful repetitive radiofrequency ablations.

Clinical impact of 209 radiofrequency ablations, performed in 199 patients with ventricular arrhythmias from 2004 to 2011, was studied. The study showed that radiofrequency ablation was effective in patients with ventricular tachycardia and premature ventricular complexes. Treatment effectiveness increased with experience in performing ablation procedures.

The potentialities of the intrathoracic impedance monitoring using implanted devices for management of patients with chronic heart failure are discussed; clinical examples are given.

To assess effectiveness of radiofrequency ablation and dynamics of the atrio-ventricular junction and sinus node function in patients with orthodromic tachycardia at the background of the concealed WPW-syndrome, 23 patients aged 40.4±14.5 years (18 64 years, 13 men and 10 women) were examined and treated.

To assess the risk of thromboembolic events and adequacy ofprescription of Warfarin in patients with atrial fibrillation of a non-valvular origin available upon admission to specialized hospital, an analysis of hospital charts of1007 subjects (559 men and 448 women) aged 63±12 years was carried out.

Transesophageal electrophysiological study was carried out in 15 patients with atrioventricular nodal reentrant tachycardia before the antiarrhythmic therapy at the peak of 150 mg of propafenon and 80 mg of sotalol. These drugs had the similar antiarrythmic efficacy. Sotalol prolonged refractoriness in the atrioventricular node, mean P-P interval and sinus node recovery time greatly in comparison with propafenon.