Topical diagnosis of focal arrhythmias using different invasive electroanatomic mapping systems is based on the registration of electrical potentials on the endo- or epicardial surface. At the same time, simultaneous registration of early activation zones on both epi- and endocardium remains a challenging task, especially in complex and unstable atrial and ventricular arrhythmias. Noninvasive ElectroCardioGraphic Imaging (ECGI) is a method that allows to electrically map endocardial and epicardial surfaces. The aim of this single-center cross-sectional single-blind study was to evaluate the accuracy of noninvasive ECGI epi-endocardial mapping based on the left ventricular (LV) epicardial pacings in patients with implanted CRT devices.
Methods. 30 patients with previously implanted pacemakers underwent epi-endocardial ECGI mapping using “Amycard 01C EP Lab” system (Amycard LLC, Russia - EP Solutions SA, Switzerland). Multichannel ECG were recorded during left epicardial ventricular pacings followed by torso and ECG-gated cardiac computed tomography. The data obtained from CT was imported into “Amycard 01C EP lab” software in DICOM-format to reconstruct 3D polygonal models of the torso and heart. In this study we consider both epicardial and epi-endocardial 3D models of the heart. Early activation zone was determined from the isopotential maps with 1 ms step followed by geodesic distance measurement between noninvasively reconstructed and the reference pacing site.
Results. The mean (SD) geodesic distance between noninvasively reconstructed and the reference pacing sites was 9 (6) mm for the LV epicardial and 12 (5) for the LV epi-endocardial models, median (25-75% IQR) - 7 (5-11) mm и 11 (9-16) mm respectively. There was a signifi cant difference in accuracy for LV epicardial and epi-endocardial models (p=0,007). At the same time, there were no signifi cant interrelations between cardiac CT, pacing, clinical characteristics and accuracy values.
Conclusions. This is the fi rst clinical study that specifi cally demonstrates noninvasive epi-endocardial ECGI accuracy considering also the quality of polygon models as well as possible infl uence of different factors on the utilized inverse ECG problem algorithm. The main fi nding of this study was that the median accuracy of noninvasive ECGI mapping was 12 mm for the epicardial LV pacing on epi- and endocardial surfaces. Therefore, this study showed suffi cient accuracy to use this technology in routine clinical practice for identifi cation of focal arrhythmia sources. 

Implantable cardioverters-defi brillators (ICD) are up-to-date sophisticated devices designed to decrease a risk of sudden cardiovascular death. Several studies have revealed that ICD implantation is associated with an improved quality of life in most subjects. The remote monitoring plays an important role in functioning of current ICDs. The contribution of remote monitoring of ICD activities to trends in quality of life is underestimated and has been inadequately investigated. 

Aim: To assess the quality of life of patients with ICD depending on availability of the remote monitoring system with the aid of the SF-36 questionnaire (Medical Outcomes Study - Short Form).
Material and methods: One hundred and thirty-six patients with single-chamber and dual-chamber ICDs completed the questionnaire. Based on a availability of telemetric control of the implantable device, the patients were distributed into two groups. The remote monitoring group consisted in 71 subjects. In 65 patients, the control over the ICD function was performed without the system of remote monitoring only during visits to physicians. The subjects of both groups had similar clinical and demographic characteristics excluding the follow-up period duration. The quality of life was analyzed
using scores on 8 scales of the state of health of the SF-36 questionnaire.
Results: Availability of the remote monitoring system was associated with a signifi cant improvement of quality of life on the scales of physical functioning (p=0.013) and physical role functioning due to physical condition (p=0.008), bodily pain (p=0.018), general health perception (p=0.031), vitality (p=0.006), social functioning (p=0.035), and mental health (p=0.015). In whole, both physical and psychological components of health in the patients with remote monitoring were higher than those assessed in the offi ce (p=0.007 and p=0.019, respectively).
Conclusions: The quality of life of patients with ICDs with the function of telemetric control (remote monitoring) was signifi cantly higher according to almost all scales of the SF-36 questionnaire.

Introduction: Сardioversion (CV) in patients with persistent atrial fi brillation (AF) and restoration of sinus rhythm (SR) are associated with mechanical dysfunction of the left atrium (LA) and left atrial appendage (LAA), which is named “atrial stunning” (AS). Mechanism of AS is not yet clear. AS further leads to decrease in left atrial appendage average velocity (LAAAV) and to increase in spontaneous echo contrast (SEC) degree and increases in the risk of thromboembolism after successful cardioversion. The duration and the degree of AS seem to depend on the duration of AF. Hypothesis: CV in patients with a persistent AF is associated with a high risk of thromboembolic events, which is associated not only with thrombus formation in conditions of prolonged AF, but also with thrombus formation «de novo» after the restoration of SR. The negative factor of the electrical trauma of the heart is always present in electrical CV (ECV), while it is absent in pharmacological CV (PhCV). So, it is possible to suggest that in cases of PhCV the degree of AS may be less pronounced.
Methods: 40 patients (Pts) with persistent AF were included in the study. Pts were randomly divided to receive either ECV (n=20) or PhCV (n=20). In the ECV group under the general anesthesia Pts were given direct-current synchronized electrical shock (150-170J). In the PhCV group Pts were given an infusion of a new class III drug refralon. All 40 Pts were anticoagulated by enoxaparin. Transesophageal echocardiography was performed in all patients before and one day after recovery of SR. LAAPV, SEC were measured in all cases before and after cardioversion.
Results: Baseline characteristics (male/female, age, duration of AF, left ventricular ejection fraction and left atrial volume, hypertension, diabetes mellitus, CHA2DS2 VASc score) were similar in both groups . The conversion rate was 90% in the PhCV group and 95 % in the ECV group (p<0,54). PhCV group demonstrated the decrease of LAAAV from 42,2±3,4 to 31,0±3,4 cm/s (p=0,02) and LAA EF from 39,8±14,7 to 31,5±15,6%(p=0,02) and the increase of SEC by 50% (p=0,02). ECV group showed the same changes: the decrease of LAAAV from 36,8 ±8,6 to 22,9± 4,8 cm/s (p=0,02) and LAA EF from 45,8±16,2 to 29,4±8,8% (p=0,0035) and the increase of SEC by 100% (p=0,053). Thrombus in LAA was revealed one day after successful CV in one patient from PhCV group.
Conclusions: Development of AS doesn’t depend on the mode of conversion of AF. AS is a function of persistent AF becoming apparent at the restoration of SR. AS is responsible for the postcardioversion thrombus formation in LA/LAA and possible cardioembolism despite the restoration of SR. One case of thrombus detection after PhCV confi rms this statement. The decrease of LA pump function was less pronounced in PhCV group.

Aim: To explore conduction abnormalities in the left atrium (LA) under programmed pacing in patients with atrial fi brillation (AF) and to investigate the relationship between the conduction delay sites and the localization of fi brosis area and electrical rotors.
Materials and methods: Activation and voltage mapping was performed in 10 patients (5 females, age 56,6±9,0 y.o) with paroxysmal (n=2) and persistent (n=8) AF before pulmonary vein isolation procedure using CARTO 3 System (Biosense Webster, Inc, USA) (n=9) and Rhythmia HDx System (Boston Scientifi c, Inc, USA) (n=1). In those patients who had AF rhythm (n=9), sinus rhythm was recovered by electrical cardioversion in 15 minutes before the catheter procedure. Cardiac mapping was conducted under programmed pacing (5 basic stimulus with 600 ms coupling interval and the 6th stimulus with 320 ms coupling interval) from the coronary sinus. Before the procedure some patients with AF rhythm (n=5) underwent non-invasive cardiac mapping (Amycard 01 C System, Amycard, LLC, Russia). AF was induced during programmed pacing in one patient; in the remaining 9 patients, the mapping procedure was completed. Slow conduction sites were detected in the LA in all patients with persistent AF while no one patient with paroxysmal AF have signifi cant conduction delay.
The slow conduction sites were found in the posterior region (n=2), in the posterior-superior region and in the roof (n=2), in the anterior-medial region (n=2) and in the posterior-lateral region (n=1) of the LA. Their diameter was 8.6±0.6 mm under the basic and 9.7±0.6 under the short coupling interval. Conduction delay was 46 ± 4 ms under the basic and 54±5 ms under the short coupling interval. Low voltage zones (magnitude < 0.5 mV) were detected in 3 patients with persistent AF. Only in one case the low voltage zone coincided with the conduction delay site. Electrical rotors were detected in all 5 examined patients. Localization of the stable rotors did not well match with the slow conduction sites.
Conclusions: The study confi rmed the presence of local conduction delay sites in patients with persistent AF. The conduction abnormalities can play a signifi cant role in genesis of AF. 

Introduction: radiofrequency ablation (RFA) is an established treatment of post-myocardial infarction ventricular tachycardia (VT). Endocardial VT ablation can be insuffi cient for VT termination when the scar is intramural/epicardial.
Purpose: to assess the extent of epicardial electrophysiological VT substrate in patients with remote myocardial infarction.
Materials and methods: thirteen patients with sustained postinfarction VT, who signed an informed consent, were included into the study. All patients underwent full clinical evaluation. Electroanatomical voltage bi- and unipolar mapping (EAVM) of endocardial and epicardial surfaces was performed. Maps were evaluated for the presence of low-voltage areas and local abnormal ventricular activity (LAVA). RFA was performed at LAVA sites. The end-point of the procedure was scar LAVA abolition and VT noninducibility (procedure success). VT recurrence was detected using an implantable cardioverter-defi brillator and/or ECG monitoring.

Results: epicardial access was successful in 12 patients. Epicardial access was performed at a fi rst procedure in 7 patients, 4 patients had a history of previous endocardial ablation. Epicardial LAVA sites were detected in 9 patients. Endocardial and epicardial arrhythmogenic substrate localization coincided in 8 patients. One patient had only epicardial scar, 1 patient had only septal endocardial scar. In one patient LAVA sites had different localizations on epicardial and endocardial maps. Acute ablation success was noted in 12 patients.
Conclusion: in our patient group transmural scar and epicardial electrophysiological arrhythmogenic substrate was detected in 82% of cases. Isolated endocardial ablation may be unsuccessful, in such cases epicardial mapping and ablation might be useful.

Objective: To assess the effi cacy and safety of pulmonary vein (PV) cryoballoon ablation (CBA) in patients with the common trunk of the pulmonary veins (PVCT).
Materials and methods: A retrospective analysis was performed on procedural data of the 596 primary PV CBA using the second-generation cryoballoon (CB) Arctic Front Advance (28мм, Medtronic). A direct LA angiography on high-frequency right ventricular pacing was performed for PV anatomy visualization. 49 patients with evaluated PVCTs were enrolled in the study. One-step and sequential ablation approaches with simultaneous recording of biophysical and electrophysiological parameters were used for PVCT isolation. During cryoablation in right PVs, a high-output (2000ms, 25mA) pacing of right phrenic nerve was performed by the electrode placed in superior vena cava and the amplitude of the diaphragm movement was monitored. In the case of impairment/loss of the diaphragm’s contraction ablation was immediately stopped.
Results: The typical drainage of PV was evaluated in 91,1% (543) patients. In 4 patients (0,67%) an additional right pulmonary vein was identifi ed. The prevalence of PVCT was 8,2% (49pts): left common trunk (LCT) was observed in 43 patients (87,7%), right common trunk (RCT) - in 6 patients (12,2%). Acute effi cacy of PVCT isolation was 95,9% (47/79): in LCT – 95,3%, in RCT - 100%. Thefeasibilityofone-stepantralisolationwas59,1% (n=29). With a median follow up of 12:(3-20) months the clinical success rate of the procedure was 69.4%. Comparative analysis showed no signifi cant difference between common trunk ablation approaches and clinical effi cacy(p=0,346).
Conclusion: Cryoballoon ablation is effi cient and safe for symptomatic AF patients’ treatment with PVCT. Simultaneous and sequential ablation tactics can be performed with comparable effi cacy.

A clinical case report is given of a 69-year-old male patient with fi rst-degree and second-degree (Type I) atrioventricular block complaining of tiredness, increasing fatigue, weakness, and intermissions, in whom implantation of dual-chamber pacemaker led to their almost complete relief.

The results are given of assessment and treatment of four elderly subjects with paroxysmal, persistent, and longstanding persistent atrial fi brillation and implanted spinal cord pacemaker due to neurological manifestations of diabetic neuropathy that let to maintain the sinus rhythm within 15 months (12-18 months) of the follow-up.

Electrocardiographic criteria of early recognition of early repolarization are considered; approaches to its differential diagnosis with intra-ventricular blocks are discussed

Clinical case reports including medical malpractice in prescription of antithrombotic therapy are given leading in a number of cases to major and fatal adverse events.