Object of the study: combination of thoracoscopic epicardial ablation with subsequent catheter procedures is a modern and effective approach for the treatment of long-standing atrial fibrillation (LSAF). Given the standard method of epicardial ablation, the design of which depends mainly on the tools and technologies used, subsequent catheter ablation should eliminate all typical weaknesses of the epicardial stage.

The aim of this study was to establish the main causes of recurrence of atrial arrhythmias in patients with LSAF after primary epicardial ablation using the Dallas lesion set technique.

Methods: thoracoscopic ablation was performed for 330 patients, standard bipolar pulmonary vein (PV) isolation and monopolar linear lesions were performed to isolate the posterior wall of the left atrium (LA) (AtriCure Inc.). 47 of them, because of the recurrence of various atrial arrhythmias, the second endocardial stage of electrophysiological examination and radiofrequency catheter ablation (RFCA) was performed, with the vast majority of repeat procedures in a period of 3-6 months. The protocol for endocardial RFCA, in addition to mapping and eliminating the main cause of recurrence (atrial tachycardia, atrial flutter, or AF), included PV and posterior wall isolation control.

Results: the study showed that after Dallas lesion set thoracoscopic ablation in patients with recurrence of atrial arrhythmias: 1) it is often necessary to re-isolate LA posterior wall (a typical area for restoration of the conduction is the roof, however, rare variants of conducting through the posterior connection of the right PV are also possible); 2) after epicardial ablation of the LA roof with a monopolar electrode, a wide non-homogeneous scar forms with numerous zones of slow conduction, low-amplitude, fragmented signals, not reaching the mitral valve, this scar is the main cause of incisional flutter; 3) as a cause of arrhythmia recurrence, additional AF drivers are also possible, that are not covered by the design of epicardial ablation - ectopic/micro-reentrant tachycardias, various arrhythmias from the right atrium.

Conclusions: catheter ablation after thoracoscopic MAZE procedure allows to eliminate the existing limitations of the epicardial lines and supplementing them with the effect on the mechanisms of maintaining AF that are unique to a particular patient.

Aim. Ventricular arrhythmias (VA) originating from anterobasal region - left ventricular (LV) (summit) is a challenge for mapping and radiofrequency catheter ablation (RFCA). The study presents the strategy for mapping and RFCA of VA origination from LV summit

Methods. Four consecutive patients (3 males, mean age of 66,25±8,75 years old) were underwent for mapping and RFCA of LV summit VA.

Results. Left ventricular summit arrhythmias were successfully mapped and eliminated in 4 pts using combined opposite approach from distal great cardiac vein and left coronary cusp or endocardium of anterobasal region opposite of left ventricular summit. In some clinical cases point of effective RFCA of VA didn’t show optimal activation and pace mapping parameters. In spite of different VA morphology in consecutive patients - left bundle branch block (BBB) or right BBB, pseudo delta waves >54 ms, intrinsicoid deflection time >74 ms and maximal deflection index >0,45 indicated left ventricular summit VA. During one-month follow-up patients did not experience VA recurrence.

Conclusion. VA arising from left ventricular summit can be effectively cured with RFCA using different approach by opposite ablation technique. Morphology of VA may have left or right BBB in depend on early activation region. Site of VA elimination may not have optimal activation or pace mapping data.

Aim. To study the clinical and echocardiographic parameters associated with thrombosis of the left atrial appendage (LAA) and identify independent predictors of LAA thrombosis in patients with nonvalvular atrial fibrillation (AF) before the planned catheter ablation (CA) or cardioversion.

Material and methods. A retrospective data analysis of 638 patients with nonvalvular AF directed to hospitalization from 2014 to 2017 for CA or cardioversion was performed. All patients underwent clinical and instrumental examination, including transthoracic and transesophageal echocardiography (TEE).

Results. According to TEE the patients were divided into 2 groups: group 1 - 44 patients (7%) with LAA thrombosis and group 2 - 594 patients (93%) without LAA thrombosis. Patients in group 1 had higher risk on CHA2DS2-VASc scale, they were more likely to have coronary artery disease, arterial hypertension, congestive heart failure (stage IIA), obesity >II class, persistent AF. Patients in both groups did not differ in anticoagulant therapy. Patients with LAA thrombosis had enlarged left atrium and right ventricle, increased right atrial volume, left ventricular (LV) end-systolic and end-diastolic diameter, higher LV myocardial mass index, lower LV ejection fraction and blood flow velocity in LAA. Using logistic regression, such independent predictors of LAA thrombosis were detected as severe obesity >II class (OR 2.75; 95% CI 1.33-5.68; p=0.006), persistent AF (OR 2.31; 95 % CI 1.07-4.99; p=0.033), increased diameter of the left atrium (OR 1.13; 95% CI 1.03-1.24; p=0.009), eccentric LV hypertrophy (OR 3.13; 95% CI 1.04-9.40; p=0.042).

Conclusion. Thus, in our study we determined independent predictors of LAA thrombosis in patients with nonvalvular AF including clinical factors (obesity and persistent AF) and echocardiographic parameters (diameter of the left atrium and eccentric hypertrophy).

The aim of this work was to study the changes in the quality of life (QoL) of patients with frequent premature ventricular complexes without structural heart disease before and after effective radiofrequency ablation (RFA) using the SF-36 questionnaire.

Methods. In total, 91 patients were included in the study after performing effective RFA of frequent premature ventricular complexes. The study included adult patients under the age of 70 years, without structural heart disease, without severe comorbidities. According to the Holter monitor, the median number of premature ventricular complexes before RFA was 21,000 per day [IQR 18000; 33000]. Six months after RFA, they performed repeated the Holter monitor and a questionnaire on the SF-36 form. The median number of premature ventricular complexes at the 6 months after surgery was 12 per day [IQR 0; 204].

Results. Elimination of premature ventricular complexes after RFA was accompanied by a significant improvement in the QoL on the scales of physical functioning (p=0,000), role functioning (p=0,000), pain intensity (p=0,000), general health (p=0,000), life activity (p=0,000), role functioning due to emotional state (p=0,000) and mental health (p=0,000). On the social functioning scale, the differences were unreliable (p=0,100). Statistically significant improvement of QoL of patients who do not have clinical manifestations initially premature ventricular complexes, observed at several scales describing physical health component: physical functioning (p=0,000), role functioning, due to physical condition (p=0,038) and pain intensity (p=0,008).

Conclusions. Patients demonstrate improved quality of life 6 months after surgery with frequent premature ventricular complexes on almost all quality of life scales. According to several scales that characterize the physical component of health, improvement is also demonstrated by patients who do not have clinical manifestations of premature ventricular complexes before surgery.

The method of non-invasive proton-beam ablation of an arrhythmogenic substrate of ventricular tachycardia in patients with structural heart disease is aimed at eliminating triggers and/or destroying re-entry mechanisms using a proton beam described.

There is description of clinical case of cryoballoon pulmonary vein isolation in patient with atrial septal defect closure devise - occluder “Amplatzer”.

The article discusses the issues of modern indications for permanent pacing in children, as well as related complications, the clinical case of the development of severe heart failure due to unjustified dual chamber pacemaker implantation in young child is given to illustrate the discussion topic.

The reasons for the low efficiency of algorithms for differential diagnostics of wide QRS tachycardia when applied in everyday clinical practice are examined, ways to increase their sensitivity and specificity are discussed.