Described in this article is a clinical case of a 14-year girl with Ebstein's anomaly and a complex preexitation syndrome (two atrioventricular pathways and a true atriofascicular Mahaim's tract). The atriofascicular tract was involved in antidromic and orthodromic tachycardias. The Л-wave was absent initially, because the spontaneous right bundle block and the comparable AV conduction velocity imitated a normal sinus rhythm. All accessory pathways were eliminated successfully during catheter ablation.

To assess the functional recovery and remodeling of postinfarction myocardium, a combined technology of single-photon emission computed tomography (SPECT) and endocardial electrophysiological 3D reconstruction of the heart in patients with left ventricular dysfunction after myocardial infarction was used.

Проведен анализ основных публикаций по методам лечения предсердных и желудочковых тахиаритмий, основанных на фундаментальных теоретических и экспериментальных исследованиях. Была дана оценка глубины исследований и перспективы дальнейшего клинического применения метода низковольтажной дефибрилляции сердца для купирования предсердных и желудочковых тахиаритмий.

Ventricular arrhythmia therapy by using high-energy shock is associated with adverse events. In this study we estimated combined therapy of antitachycardia pacing and low-energy shock in patients with various types of ventricular tachycardia.

Российский кардиологический журнал № 2 (

To assess the effect of simultaneous renal artery denervation (RAD) and circulatory pulmonary vein isolation (CPVI) on the clinical course of atrial fibrillation (AF) and arterial hypertension (AH), 35 patients were examined (18 patients with CPVI and 17 patients with CPVI+RAD). In all patients, the complete electric CPVI without additional linear applications was performed. In all patients randomized to the CPVI+RAD group, bilateral RAD was performed immediately after the CPVI procedure. 3D reconstruction of aorta and renal arteries was performed using the navigational system and catheter for pulmonary vein isolation. The access was performed through the femoral artery. Mapping and RAD were carried out at the background of sedation with Propofol. Radiofrequency spiral application (8 10 W) was made from the distal part of the renal artery (from its bifurcation) towards its ostium. The duration of each application was 2 minutes. The number of applications did not exceed 6, and they were made more than 5 mm from the previous in longitudinal-rotary direction. The applications were made in both renal arteries. The complete CPVI was successfully achieved in 35 patients (100%). RAD was successfully performed in all 17 subjects of Group II which led to termination of the blood pressure increase in response to the overdrive suppression after ablation. The number of application per renal artery was 4.4±0.8 (4 6 applications, median: 4). The duration of procedure made up 152±29 min for the CPVI Group and 194±39 min for the CPVI+RAD Group (including 32±18 minutes for RAD; p=0.17). The X ray exposure was 22±17 min for the CPVI group and 29±12 min for the CPVI+RAD Group (including 9±2 min for RAD; p=0.22). No case of renal artery stenosis in patients with RAD was revealed during magnetic resonance tomography 6 months after the surgery. In the patients with RAD, the glomerular filtration rate did not significantly change as compared with the pre-operation data and made up 77.0±6.2 ml/min/1.72 m2 and 82±4.7 ml/min/1.72 m2, respectively, (p=0.42). Twelve months after the surgery, 12 patients of 17 in Group II (70.6%) were free of arrhythmia. In the pulmonary vein isolation group, only 6 patients of 18 (33.4%) were free of AF paroxysms (p=0.01). All 17 patients of Group II showed a decrease in the systolic blood pressure of more than 10 mm Hg after the RAD procedure. Thus, the additional RAD had a positive effect on the sinus rhythm maintenance in patients with AF and resistant AH, in whom CPVI was performed. RAD led to a considerable and stable decrease in the systolic and diastolic blood pressure within 12 months following the surgery.

To assess the atrial fibrillation (AF) burden using insertable cardiac monitors within first months of post-operation period and reveal its correlation with the late recurrence of arrhythmia, 642 patients (478 men) aged 56±7.6 years with symptomatic AF resistant to antiarrhythmic therapy were included into the retrospective study. Radiofrequency isolation of the right and left pulmonary veins (IPV) was performed by separate collectors using irrigated electrodes. The entrance and exit block was confirmed during pacing or with the aid of Lasso catheter. The Reveal XT device (Medtronic) was implanted between ribs III and IV parallel to the sternum, 1 cm from its edge. Patients with the AF burden of 0.5% were considered non-responders. After the first ablation procedure, by the end of 12 month follow-up, 417 patients of 642 (65%) were responders. In accordance with the ROC curve data, the patients with absence and presence of AF recurrence were separated based on the AF burden recorded by implantable recorders (devices) within 2 months following ablation. The curse showed 85% of specificity and 90% of sensitivity. The corresponding AF burden threshold according to the implantable recorder data obtained within 2 months following ablation which permitted one to identify patients with a risk of late recurrence of AF was 4.5%. It corresponded to the overall duration of AF of 65.9 hours (2.75 days). The positive and negative diagnostic value was 78.7% and 93.9%, respectively. The majority of patients with the AF burden >4.5% had also prolonged episodes of arrhythmia exceeding 20 hours/day within two consecutive days during two first months of post-operation period. In the group of patients with persistent AF, the AF burden equal to 4.5% showed 91% of specificity corresponding to the 100% sensitivity. All patients with persistent AF and the AF burden 4.5% within the first two months after the operation can be used for selecting appropriate candidates for repetitive operation and medical treatment.

To assess safety and effectiveness of ablation of ganglion plexuses and areas of complex fractionated atrial electrograms revealed during overdrive pacing in patients with paroxysmal atrial fibrillation (AF), 84 patients aged 59±7 years were included into the study. The ablation sites were defined as areas where vagus reflexes developed in response to overdrive pacing conducted with the frequency of 20 Hz, amplitude of 15 V, and impulse duration of 10 ms. Areas of complex fractionated atrial electrograms were defined as fractionated atrial electrograms which consisted of two or more deviations from baseline, with the persistent deviation from the prolonged activation complex. Radiofrequency ablation was performed in all areas with the positive vagus response during overdrive pacing and additionally continued in the area of complex fractionated atrial electrograms. In all study subjects, by the end of ablative procedure, the recorders Reveal XT (Medtronic Inc.) have been implanted according to the commonly accepted technique for persistent cardiac rhythm analysis. During the follow-up period, the patients were free of therapy with antiarrhythmics and β-blockers. Sustained AF was inducible by overdrive pacing in all study subjects. The number of overdrive suppressions made was 41±7 per patient. The number of radiofrequency applications sufficient to eliminate completely the vagus response was 5.4±2.5 ones per area revealed. In addition, 8.7±5.2 radiofrequency applications were performed in each area of complex fractionated atrial electrograms. In total, 68.2±9.4 radiofrequency applications were made. During the follow-up period, AF recurrence (i.e., AF burden >0.5%) was observed in 24 patients of 84 (28.6%). Thus, the expanded ablation of ganglion plexuses can be performed safely and provides the sinus node maintenance in a majority of patients with paroxysmal AF during a 12 month of follow-up. Effectiveness of the procedure can be caused by more pronounced autonomic denervation.

To develop management strategy for patients with recurrence of atrial fibrillation (AF) in the early post-operation period based on the loop recorder data, 314 patients were included into the study. Group 1 included patients with no recurrence of arrhythmia in the early post-operation period; Group 2 consisted of 182 patients (58%) with recurrence of the arrhythmia. The subjects of Group 2 were randomized into Group 3 (n=88) or Group 4 (n=89); 5 patients were excluded from the study. The Group 3 subjects received only medical antiarrhythmic therapy. In Group 4, management of early post-operation period depended on the AF mechanism recorded by the loop recorder. In the case of the first occurrence of AF, only antiarrhythmic therapy was prescribed; if AF was induced by any trigger activity, the early re-ablation was carried out. The pulmonary vein ostia antral isolation by the common collectors was performed in all study subjects with creation of ablation lines on the roof of the left atrium and mitral isthmus. The loop recorder implantation was carried out as a final stage of the operation. After 12 months of follow-up, 120 of 129 patients of Group 1 (95%) were responders. Only 29 of 88 patients of Group 3 (33%) were responders (p<0.001, as compared with Group 1). In Group 4, 71 patients of 89 (80%) were responders (p=0.001, as compared with Group 1; p<0.0001, as compared with Group 3). In Group 3, 24 patients of 35 (69%) with the sudden AF onset were responders, as compared with only 6 patients of 52 (8 %) with the trigger AF onset (p<0.0001 as compared with the subjects with sudden AF onset). In Group 4, 22 patients of 32 (63%) with the sudden AF onset were responders (p=0.38, as compared with the patients with sudden AF onset in Group 3). Among 57 patients with the trigger AF induction, 49 ones (89 %) were responders (p=0.003 as compared with the sudden AF onset and p<0.001 as compared with the trigger onset in the patients of Group 3).

To compare the effectiveness of aorto-coronary bypass grafting surgery in combination with epicardial cardiac resynchronization therapy and isolated endocardial cardiac resynchronization therapy in patients with severe heart failure of ischemic origin, 102 patients aged 62.7±5.8 years (men: 90%) were examined and underwent the surgery.

To optimize functioning of resynchronization devices in patients with chronic heart failure (CHF) of ischemic origin based on the data of tissue Doppler assessment, 106 patients aged 62.1±9.5 years (32-80 years) were examined.

To compare the outcomes of aorto-coronary bypass grafting and its combination with implantation of cardiac resynchronization devices, 164 patients with severe heart failure and left ventricular dyssynchrony were examined and surgically treated.

The treatment history of medically resistant focal tachycardia originating from the left auricle is described in a 9 year old male patient, when after unsuccessful endocardial ablation, resection of the left auricle was performed.

To assess the outcome ofepicardial radiofrequency catheter ablation of ventricular tachycardia in pediatric patients with arrhythmogenic cardiomyopathy of the right ventricle, 17 pediatric patients aged 14.1±1.7 years (male: 65%) were examined.

Considered are mechanisms of atrial tachycardia when the activation electroanatomic mapping showed a consecutive centrifugal activation of the right atrium from the single focus.

To assess effectiveness of the technique of the anatomic radiofrequency ablation of the ganglionar plexuses in the left atrium, 674 patients aged 52.3±6.3 years (42 72 years) with paroxysmal atrial fibrillation resistant to at least two antiarrhythmics of classes I and III were examined.

Aims:The aim of this study is to compare the concentration of brain natriuretic peptide (BNP), inflammatory markers , tumour necrosis factor-a (TNF-a), and C-reactive protein], echocardiographic parameters of left ventricular function, and physical capacity and to investigate how they change after carvedilol in patients with various aetiologies of heart failure (HF).Material and methods: A total of 86 patients with symptomatic HF in NYHA classes II and III [22 patients with non-ischaemic (NIC) and 64 patients with ischaemic aetiology-IC].Diagnostic work-up consisted of NYHA class assessment, echocardiographic parameters of left ventricular systolic [left ventricular diastolic dimension, left ventricular end-diastolic volumes, and ejection fraction (EF)], and diastolic function (E/A, isovolumic relaxation time, and deceleration time), measurements of BNP, TNF-a, C-reactive protein, and cardiopulmonary exercise stress test (VO2peak and VE/VCO2) at baseline and at 12 months after carvedilol therapy (at a mean dose of 28.5+ 5.8 mg/day) added to enalapril and a diuretic.Results: At baseline patients with NIC were characterized by higher heart rate at rest HRs (P ¼ 0.001), restrictive filling pattern (P ¼ 0.045), and lower C-reactive protein concentration (P ¼ 0.05).The remaining parameters did not differ significantly.After 12 months, carvedilol therapy patients with NIC were characterized by higher HRs (P ¼ 0.04), lower EF (P ¼ 0.04), higher IL-6 concentration (P ¼ 0.01), and by lower VO 2 peak%N (P ¼ 0.04) as compared with IC ones. Conclusion:In patients with HF irrespective of its aetiology chronic treatment with carvedilol reduces HR and improves left ventricular ejection fraction, whereas patients with ischaemic HF additionally the concentrations of IL-6 and C-reactive protein are decreased and VO2peak%N is increased.

The effectiveness of combined therapy for tachycardia/ bradycardia caused by a sick sinus dysfunction is analyzed. 123 patients with a sick sinus syndrome and atrial fibrillation seizures have been examined, with a two-chamber pacemaker implanted and subsequent drug therapy and catheter ablation of the His bundle or pulmonary vein ostia applied. Making use of anti-tachycardial and atrioprotective functions of atrial pacing enhances the antiarrythmic effect of pacing constant. The factors reducing the effectiveness of electrotherapy as a measure preventing atrial fibrillation have also been established.