Aim. This study aimed to evaluate the efficacy and safety of cardiac contractility modulation (CCM) therapy in elderly patients with heart failure with reduced ejection fraction (HFrEF).

Methods. Sixteen patients older than 65 years old (median age 70 years) undergoing CCM Optimizer (Impulse Dynamics) device implantation due to HFrEF (NYHA class II - 9 (56%), III - 4 (25%), IV - 3 (19%)) were enrolled in this two-center observational study. Before implantation 6-minute walk test (6MWT), transthoracic echocardiography (TTE) was performed on all patients, and NTproBNP levels were assessed. The follow-up duration was 12 months with 2, 6, 12-month follow-up visits. Control 6MWT, TTE and NTproBNP tests were performed at 6-month and 12-month follow-up visits.

Results. Two patients died during follow-up due to HF decompensation. The remaining patients showed a significant improvement in 6MWT (350 m vs 402.5 m, p=0,01). We also noted a tendency towards the left ventricular EF improvement (33% vs 40%, p=0,2) and lower values of NTproBNP levels (1112 pg/ml vs 527 pg/ml, p=0,19).

Conclusion. CCM therapy is a safe and efficient additional treatment option to manage elderly patients with HFrEF for reducing signs and symptoms of HF.

Purpose. The aim of this study was to reveal the effect of the duration and characteristics of anticoagulant therapy on the clot dissolution in the left atrial appendage (LAA) in patients with persistent atrial fibrillation (AF).

Material and methods. The repeat transesophageal echocardiography was performed in 68 patients with persistent AF, because the thrombus was detected in the LAA during the first examination. Of these, 37 (54.4%) patients started or continued to receive warfarin and 31 (45.6%) patients continued to receive the direct oral anticoagulants. Transesophageal echocardiography was repeated after 3-5 weeks. One follow-up examination was for 53 patients, two follow-up examination was for 11 patients and three follow-up examination was for 4 patients. Cox regression analysis was performed to identify factors affecting the likelihood of clot dissolution and Kaplan-Meier survival analyses with log-rank tests were used to compare the clot dissolution time.

Results. The chance of the LAA thrombus lysis is 50% after 35.0 ± 3.7 days of receiving anticoagulants. This time is reduced to 30.0 ± 1.4 days for small thrombus (no more than 18 mm), and it increases to 45.0 ± 7.4 days (p = 0.038) for large thrombus. The dissolution time of small thrombus depends on the characteristics of the treatment: the median of the dissolution curve is 24.0 ± 3.7 days when the patients received the direct oral anticoagulants, and the median of the dissolution curve is 40.0 ± 7.2 days (p = 0.009), if the patients received warfarin. The dependence of the dissolution time of large thrombus on the characteristics of treatment did not found.

Conclusion. The LAA thrombus dissolution time in patients with atrial fibrillation depends on their size, and the dissolution time of small thrombi depends on the characteristics of anticoagulant therapy.

Methods. 82 SR (80.5% men; mean age 60.4±9.3; 45 (54.9%) with CAD) were divided according to period of LVESV maximum decrease: Gr.1 (n=19)- <24months (14.0 [8.0; 21.0]), Gr.2 (n=63)->24 months (59[43.0; 84.0]). Dynamics of echocardiography, adrenaline (ADR) plasma levels, norepinephrine (NE), interleukins (IL) 1β, 6, 10, TNF-α, NT-proBNP, MMP-9, TIMP-1, 4, were examined. Five-year survival was estimated by Kaplan-Meier method. ROC analysis and logistic regression were applied to identify late CRT response factors.

Results. Initially, groups didn’t differ by clinical and echocardiographic findings. At baseline, Gr.2 had larger ADR (p=0.049) and NE (p=0.061). Rate of change in NE was opposite in groups during CRT: ΔNE increased in Gr.1 and decreased in Gr.2. (p=0.015), which was associated with better reverse cardiac remodeling (lower LV end systolic diameter, LV end diastolic diameter, LVESV, LV end diastolic volume), decrease in activity of immune inflammation (decrease in levels of IL-1β, 6, 10, TNF-α) and fibrosis formation (decrease in TIMP- 1, enhancement of MMP-9/TIMP-1). Cut-off value of 2.55 ng/ml for NE complied with the highest sensitivity (80%), specificity (60%), AUC=0.693 (p=0.011) for predicting late CRT response. Proportion of patients with NE<2.55 ng/ml was 21.1% in Gr.1 and 59.7% in Gr.2, (p=0.003), mean follow-up period was 45.8±0.3 and 94.9±35.9 months (p<0.001), respectively All SR of Gr.2 were alive within 5 years, survival rate was 50% in Gr.1 (Log-Rank test<0.001). NE was associated with late CRT response (OR 8.0 (95%CI 1.5-42.8), p=0.015).

Conclusion. Late CRT response was accompanied by increased life expectancy, better 5-year survival, associated with greater reverse cardiac remodeling, decreased fibrosis activity, immune, neurohumoral, sympathoadrenal activation. When NE level was less than 2.55 ng/ml, probability of late response increased 8-fold.

Ventricular arrhythmias (in particular, episodes of ventricular fibrillation and paroxysmal ventricular tachycardia) are associated with a significant increase in the risk of sudden cardiac death (SCD) in patients with chronic heart failure (CHF). The most widely used strategy for stratification of SCD risk in patients with CHF uses low left ventricular ejection fraction as the main criterion, but modern epidemiological studies confirm the need to search for new SCD markers, in particular, electrocardiographic and imaging ones. The most reasonable and promising is an integrated approach that implies a combination of sequential use of non-invasive and invasive techniques, which makes it possible to improve the identification of high-risk individuals who need an invasive strategy to prevent SCD, but who do not always meet the “classical” criteria for ICD implantation.

A case report of unusual QT interval prolongation after ventricular premature beat is presented.

The article presents two clinical cases of patients with a fatal outcome after a coronavirus infection. The first patient had sepsis and purulonecrotic phlegmon complication after radiofrequency ablation of the cavatricuspid isthmus. The second one had a complication in the form of the esophageal rupture in the middle third after transesophageal echocardiography.

A case of asymptomatic migration of the proximal end of the ventricular electrode cut off along the length of the ventricular lead into the pulmonary artery in the late postoperative period is described.

Results of the survey which conducted with specialists who involved in the treatment of patients with atrial fibrillation regarding treatment strategy, choice of antiarrhythmic drugs and anticoagulants and a comparison data from real clinical practice with current clinical guidelines are presented.