Aims: To perform the analysis of adverse events (AE) rate and trends of physiologically meaningful parameters in patients with cardiac implantable electronic devices (CIEDs) with the mobile remote monitoring option.

Methods: In 9 clinical centers of the Russian Federation and 2 clinical centers of the Republic of Kazakhstan, 126 patients with an implantable cardioverter-defibrillator (ICD) or a pacemaker (PM) equipped with the Home Monitoring (HM) technology (BIOTRONIK, Berlin, Germany) were enrolled. Based on the daily data transmission, all alarm alerts, all HM options changes and all AE were recorded with dated alert content and undertaken measures.

Results: The study patients, followed up at least for one year, experienced 42 adverse events (AE), of which 26 were serious AE (SAE) and 3 SAE were defined as device-related (SAED). ICD patients (N=90) with concomitant coronary artery disease (CAD) had a statistically significantly higher SAE prevalence (p=0.0249). Patients with CRT-D had a lower SAE rate than patients with dual- or single-chamber ICD (р=0.046). Downloads of Home Monitoring parameters for retrospective mathematical analysis were available for 60 ICD patients, of which 47 had episodes of ventricular tachycardia (VT), ventricular fibrillation (VF) and/or atrial tachyarrhythmia (AT). Machine learning analysis of the trends of the physiologically meaningful parameters revealed correlations between changes and arrhythmia episodes, with the random forest and gradient boosting methods demonstrating the random effect of the results.

Conclusion: Home Monitoring of CIED patients enables the evaluation of different devices applications and their clinical advantages. This might implement the prevention of adverse events and iatrogenic effects of pacing. Based on daily transmission of physiologically meaningful Home Monitoring parameters, the study results demonstrate the feasibility of developing a prediction algorithm for adverse events.

Noninvasive epi-endocardial ElectroCardioGraphic Imaging (ECGI) allows reconstruction of electrograms and high-resolution visualization of various isoparametric maps based on multichannel ECG recordings and tomography. We aimed to verify the ECGI accuracy during septal ventricular pacing in patients with pre-implanted pacemakers using the new ECGI algorithm.

Methods. Ten patients underwent epi-endocardial ECGI mapping (Amycard 01C EP Lab, Amycard LLC, Russia - EP Solutions SA, Switzerland). The iterative Equal Single Layer algorithm (ESL-iterative) and a new Fast Route algorithm in combination with the vector approach (FRA-V) were used to reconstruct isopotential and correlation similarity maps. Geodesic distance between noninvasively reconstructed early activation zone and RV reference pacing sites were measured to evaluate the ECGI accuracy.

Results. The mean (SD) geodesic distance between noninvasively identified sites and reference pacing sites was 22 (15) mm for the ESL-iterative and 12 (7) for FRA-V algorithms, median (25-75% IQR) - 23 (8-29) mm and 10 (8-14) mm, respectively. The accuracy of ECGI mapping based on the FRA-V algorithm was significantly better than ESL-iterative algorithm (p=0,01). A detailed visual analysis of correlation similarity and isopotential maps showed significantly more accurate localization of early activation zones using the new FRA-V algorithm.

Conclusions. Our study showed the feasibility and accuracy of a novel epi-endocardial ECGI mapping approach to identify early activation zones during septal ventricular pacing using the new FRA-V algorithm. The FRA-V algorithm is significantly better for epi-endocardial ECGI mapping and shows a significant advantage of this technique compared to other non-invasive methods of topical diagnostics. Moreover, simultaneous beat-to-beat mapping of entire ventricular septum allows using this technique for pre-ablation evaluation of unstable and polymorphic ventricular arrhythmia exit sites.

Objective: we aimed to assess the efficacy and safety of pulmonary vein (PV) cryoballoon ablation (CBA) in patients with a common trunk of the pulmonary veins (PVCT).

Materials and methods: We performed a retrospective analysis of 596 primary PV CBA procedures using the second-generation cryoballoon (CB) Arctic Front Advance (28 mm). PV anatomy was visualized using direct LA angiography during high-frequency right ventricular pacing. We included forty-nine patients in whom a PVCT was identified. The one-step and sequential ablation approaches with simultaneous recording of biophysical and electrophysiological parameters were used for PVCT isolation. During CBA in the right PVs, high-output (2000 ms, 25 mA) pacing of the right phrenic nerve was performed via a electrode placed in the superior vena cava, and amplitude of diaphragm movement was monitored. In the case of impairment/loss of the diaphragm contraction ablation was immediately stopped.

Results: 91.1% (543) patients had the normal drainage of PV. In 4 patients (0.67%), an additional right pulmonary vein was identified. The prevalence of PVCT was 8.2% (49 pts): a left common trunk (LCT) was observed in 43 patients (87.7%), a right common trunk (RCT) - in 6 patients (12.2%). Acute efficacy of PVCT isolation was 95.9% (47/79): in LCT - 95.3%, in RCT - 100%. The feasibility of the one-step antral isolation was 59.1% (n=29). During a median follow up of 12 (3-20) months, the clinical success rate of the procedure was 69.4%. A comparative analysis showed no significant difference between common trunk ablation approaches and clinical efficacy (p=0.346).

Conclusion: CBA has been shown effective and safe for symptomatic AF patients with PVCT. The simultaneous and sequential ablation approaches can be performed with comparable efficacy.

Introduction. Radiofrequency ablation (RFA) is an established treatment of post-myocardial infarction ventricular tachycardia (VT). Endocardial VT ablation can be insufficient 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 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-defibrillator and/or ECG monitoring.

Results. Epicardial access was successful in 12 patients. Epicardial access was performed at a first 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.

Aim: we aimed to assess the capabilities of “machine learning” methods in predicting remote outcomes in patients with non-valvular atrial fi brillation (AF).

Methods. From 2015 to 2016 234 patients with non-valvular AF were included in the study (median age 72 (65; 79) years; 50.0% men). During the median follow-up of 2.9 (2.7; 3.2) years 42 patients died, 9 patients had non-fatal acute cerebral circulatory disorders and 3 patients had non-fatal myocardial infarction (MI). These events in 52 subjects (22.2% from all patients included) were combined into a combined endpoint (death and a nonfatal cardiovascular accident at the stage of remote observation). The first 184 patients comprised a “training” group. The next 50 patients formed the “test” group. The following methods of «machine learning» were used in the analysis: classifi cation trees, linear discriminant analysis, the k-nearest neighbor method, support vectors method, neural network.

Results. Long-term outcomes were influenced by age, known traditional risk factors for cardiovascular diseases, the presence of these diseases, changes in intracardiac hemodynamics and heart chambers as evaluated by echocardiography, the presence of concomitant anemia, advanced stages of chronic kidney disease, and the administration of drugs associated with a more severe cardiovascular disease progression (amiodarone, digoxin). The best prognosis was created using the model of linear discriminant analysis, the complex neural network model, and the support vector machine.

Conclusion. Modern methods aimed at prognosis estimation seem to be of importance in cardiology. These methods include big data analysis and machine learning technologies. The methods require further evaluation and confirmation, and in the future they may allow correcting cardiovascular risks, using data from real clinical practice and evidence-based medicine at the same time.

Introduction: Coronary artery bypass grafting (CABG) might be associated with the development of heart rhythm disturbances. We aimed at evaluating an association of intraoperative hemolysis (IOH) with the development of cardiac rhythm disturbances in patients with coronary artery disease after on-pump CABG.

Methods. The assessment of the degree of IOH was performed according to the level of plasma free hemoglobin [Hb] at baseline, immediately after the patient was connected to the cardiopulmonary bypass (CPB) device and 15 minutes before cessation of CPB. We included 123 patients, and they were divided into 3 groups (gr.) according to free [Hb] level: gr.1 - ≤0.1 g/l; gr.2 - > 0.1 g/l and <0,5 g/l; gr.3 - ≥0.5 g/l. A variety of ECG screening methods were applied for the detection of cardiac arrhythmia in the postoperative period. The follow-up period was 1 months.

Results. Arrhythmias were observed in 2.3% of patients in the 1st group, in 11.9% in the 2nd group, and in 52.6% in the 3rd group. The level of plasma free [Hb] in samples taken at the end of CPB was strongly associated with the arrhythmia detection (rs=0,70, p <0.001). Life-threatening and hemodynamically unstable arrhythmias were more frequently detected in the group with a higher degree of IOH (p <0.001), and accounted for about half of all arrhythmias.

Conclusions. On-pump CABG is associated with the development of cardiac arrhythmias in the postoperative period in 22% of patients. A significant proportion of these arrhythmias are potentially life-threatening. The highest proportion of patients with cardiac rhythm disturbances after CABG was observed when the level of plasma free hemoglobin was >0.5 g.

The results of the examination and treatment of a patient with frequent ventricular ectopy are presented in the article. During ablation of an ectopic focus in the left coronary sinus of the aorta, as a result of dislocation of the ablation catheter, a spasm of the left coronary artery has been diagnosed and successfully managed.

A case report of atrial tachycardia ablation form the non-coronary Valsalva sinus is presented.

A case report describing thoracoscopic approach for implantation of a cardiac pacemaker in a 3.8 years old girl with complete atrioventricular block is presented.