The problems of remote monitoring of patients with implanted devices are considered, the results of the ReHoming study are given, and potentialities of assessment of the heart rate variability in the long-term survey is discussed.

To assess long-term outcomes of extended pulmonary vein isolation for treatment of persistent atrial fibrillation, 210 patients aged 55.6±8.9 years with symptomatic persistent atrial fibrillation (EHRA class 3.4±0.2) resistant to antiarrhythmic therapy for 4.8±3.0 years were examined and treated. Aim: Assessment of long-term outcomes extended pulmonary vein (PV) isolation for treatment of persistent atrial fibrillation (AF). Methods: The study included 210 subjects with symptomatic persistent AF resistant to antiarrhythmic therapy. The subjects were randomized for treatment in three following groups: pulmonary vein antrum isolation (PVAI; n=68), extended pulmonary vein antrum isolation (EPVAI; n=75), or ganglionic plexus ablation (GPA; n=67). We assessed the parameters short-term outcomes of the procedures. The time course of the left atrium (LA) mechanical function and the level of N-terminal fragment of precursor brain-type natriuretic peptide (NT ProBNP) were also assessed. The assessment of clinical effect of the procedure was based on the subjects’ self-assessment and the results of 7 day Holter monitoring. The primary effectiveness endpoint was freedom from AF after ablation. The follow-up period of the study subjects was 5 years. Results: Both the procedure duration and the overall duration of all applications in the GPA group were shorter. An increased duration of all applications in the EPVAI group did not significantly affect the overall duration of the procedure. Three months following the procedure, the GPA group was characterized by the most favorable results of self-assessment; later on, no differences were detected. 12-36 months following the procedure, the number of patients with the optimal effect prevailed in the EPVAI group. The AF recurrence rate in the EPVAI group was significantly lower. Thus, by the fifth year after the procedure, freedom from atrial arrhythmias was 58% in the EPVAI group, 35% in the PVAI group, and 22% in the GPA group (p=0.0114). The positive correlation between the LA ablation area and the long-term clinical effectiveness was also revealed. The PVAI and EPVAI groups were characterized by a significant decrease in reservoir and contractile functions of LA, especially if the ablation area was more than 25%. No significant increase in the NT ProBNP level was found; it indicates that changes in the LA mechanical function did not have an impact on the central hemodynamics. Conclusions: The long-term clinical effectiveness of primary EPVAI in persistent AF is significantly better than of PVAI and GPA. The GPA group was characterized by the lowest number of post-ablation arrhythmias. The PVAI and EPVAI groups were characterized by a similar incidence of post-ablation arrhythmias.

To assess the QT/JT interval duration and blood pressure levels during short-term non-invasive positive airway pressure therapy, 25 patients with obesity, dyslipidemia, arterial hypertension, and obstructive sleep apnea-hypopnea syndrome were observed. To assess the QT/JT interval duration and dispersion, and the blood pressure level in the course of the short-term auto-titrating positive airway pressure therapy, 25 male subjects (mean age: 41 years) were assessed. All patients reported snore and had abdominal obesity, dyslipidemia, arterial hypertension, as well as moderate-to-severe sleep apnea-hypopnea syndrome. A 24 hour multifunctional study with cardiorespiratory monitoring was conducted in the study subjects before and in the course of therapy. The mean duration of auto-titrating treatment was 5 nights. During the treatment, decreased mean corrected QT interval for the wakefulness period (421 ms [412 436 ms] and 412 ms [404 431 ms]) and the sleep period (422 ms [407 437 ms] and 412 ms [402 427 ms]), as well as mean corrected JT interval for the wakefulness period (319 ms [306 330 ms] and 308 ms [296 320 ms]) and the sleep period (319 ms [303 335 ms] and 315 ms [299 329 ms]) were found (p<0.05 in all cases). There was no statistically significant difference in mean heart rate, non-corrected QT/JT intervals, and their dispersions. However, in 10 patients with an increased QT interval dispersion (>60 ms), it was found to be decreased on the average by 24.4% (p<0.05). A two-fold decrease in mean values of following sympathetic modulation markers: very low frequency (VLF) and low frequency (LF), was reported during sleep (p<0.05 in both cases). A threefold decrease in mean values of a parasympathetic tone indicator, the number of pairs of successive NNs that differ by more than 50 ms divided by the total number of all NN intervals (pNN50) was documented during sleep (p<0.05). The reduced duration of diastolic hypertension duration during the periods of sleep (by 22%) and wakefulness (by 10%), recovery of the diurnal pattern (n=8), and reduced mean values of systolic blood pressure (by 7 mm Hg) during sleep were registered in the course of treatment. Thus, a decreased sympathetic and parasympathetic effects on the heart rate, reduced duration of myocardial repolarization, decreased blood pressure, and recovery of its diurnal profile were observed during the short-term non-invasive positive airway pressure therapy during sleep.

To assess cognitive functions in patients with paroxysmal and permanent atrial fibrillation and the effect of permanent pacemaker implantation on them, 23 patients aged 62.8±5.5 years (men: 65.2%) were examined. To assess cognitive functions in patients with paroxysmal and permanent atrial fibrillation (AF) before and at different stages after implantation of permanent pacemaker, 23 patients with coronary heart disease aged 62.8±5.5 years (15 men [65.2%] and 8 women [34.8%]) were examined. The patients were distributed into two following groups: Group I (n=12; 52.2%) with permanent AF and Group II (n=11; 47.8%) with paroxysmal AF. The Status PF complex was used for assessment of cognitive functions. The parameters of visual and aural memory, attentional capacity, ideation using simple and complex analogies, simple hand-eye responses, as well as personal and state anxiety were assessed. The tests were performing before the pacemaker implantation as well as 5-7 days and 30-40 days following the pacemaker implantation. The comparative assessment of cognitive functions showed that both permanent and paroxysmal AF contributed to development of cognitive deficiency which was more pronounced in the patients with permanent AF. At the early stage after pacemaker implantation (Day 5 7), selected cognitive function parameters improved, primarily in the patients with paroxysmal AF. At the late stage after pacemaker implantation (Day 30 40), cognitive functions remained unchanged in the patients with paroxysmal AF and decreased in the patients with permanent AF. An insufficient improvement of cognitive functions in both groups could be caused by different reasons, including the negative impact of personal and state anxiety due to adaptation of a patient to pacemaker.

The prevalence, severity, and clinical significance of tricuspid regurgitation associated with endocardial right-ventricular electrodes of implanted devices were considered.

Peculiar features of excitation and contraction of the left ventricle in normal conditions, complete left bundle branch block, and apical pacing are considered; potentialities of assessment of parameters of twist in predicting the response to the cardiac resynchronization therapy are discussed.

A case report is given of implantation of a dual-chamber pacemaker in a female patient with the persistent superior vena cava with introduction of electrodes with the active fixation through both venae cavae.

The technique of puncture of the inter-atrial septum under visual guidance with the aid of intra-cardiac echocardiography is presented; potential complications of the procedure are discussed.