Aim. To evaluate the efficacy and safety of thoracoscopic and hybrid techniques in patients with various forms of atrial fibrillation (AF).

Methods. The results of thoracoscopic ablation of 87 patients with AF were analyzed: 27 (31%) with paroxysmal form, 15 (17%) - with persistent, 45 (52%) - with long-term persistent form at follow-up 18.6±6.7 months. “Box-Lesion” treatments and amputation of left atrial appendage (LAA) were performed in 69 (79.3%) patients, “Box Lesion” without LAA amputation in 12 (13.7%). When atrial tachycardia was recorded for more than 30 seconds after a 3-month “blind” period, patients underwent hybrid catheter intervention.

Results. Freedom from atrial arrhythmias in the group of paroxysmal AF was achieved in 84% of patients (21 of 25), in the group of persistent form - in 60% of patients (9 of 15), in the group of long-term persistent form - in 78% (32 of 41) at a given observation period. In the structure of postoperative atrial tachycardia, AF recurrence was 5 (6.25%), typical atrial flutter (AFL) - 3 (3.75%), atypical AFL - 10 (12.5%). The mean LA volume index in patients with stable sinus rhythm was 64.6±11.3 ml/m2 versus 74.65±15.4 ml/m2 in the atrial tachycardia group (Student’s t-test 0.53, p = 0.6). These patients underwent a hybrid intervention. At a follow-up period of 15.9±10.9 months, a stable sinus rhythm was maintained in 15 (83.3%) patients. The overall rate of intra- and postoperative complications of thoracoscopic ablation was 5.7%.

Conclusion. Thoracoscopic and hybrid approaches are effective methods for various forms of AF treatment.

Aim. To assess the effectiveness and safety of refralon based cardioversion on the experience of the cardiology department of Orenburg Regional Clinical Hospital.

Methods. The archival medical histories of 14 patients with persistent atrial fibrillation (AF) and 2 patients with persistent atrial flutter (AFL) (overall 16 patients), who underwent an attempt to restore sinus rhythm with refralon, were analyzed. The mean age of the patients was 51.7±10.4 years. The mean duration of AF/AFL since its last detection was 8.0±6.5 weeks (from 8 days to 8 months). Fifteen patients had hypertension, 3 of them had coronary artery disease (CAD), and 1 patient had CAD with type 2 diabetes mellitus. One of the patients had lone AF. Before cardioversion, all patients underwent the following examination: clinical and biochemical blood tests, clinical urine tests, electrocardiography (ECG), echocardiography (Echo), transesophageal Echo, Holter ECG, the determination of the level of thyroid-stimulating hormone, thyroxine, electrolytes, including potassium and magnesium.

Results. According to Echo, initially, the transverse size of the left atrium in patients was 4.3±0.3 cm. Its increase was noted in 68.7% of patients (from 4.3 to 5.0 cm). Restoration of sinus rhythm after the first step of refralon administration at a dose of 10 μg/kg was achieved in 8 patients, after the second step of administration (total dose 20 μg/kg) - in 5 patients and after the third step (total dose 30 μg/kg) - in 2 patients. In 1 patient, restoration of sinus rhythm was not achieved after the administration of the third bolus. Out of 15 patients with restored sinus rhythm, AF recurrence occurred in three. In one of the patients with successful cardioversion, the sinus rhythm was restored the next day. The duration of the last episode of AF and the size of the left atrium did not significantly affect the effectiveness of cardioversion and amounted to 62±54 days and 4.3±0.35 cm, respectively, in patients with successful cardioversion, and with a recurrence of AF - 34.3±28 days and 4.2±0.35 cm (p=0.2; р=0.6). The efficacy of cardioversion with refralon was 71.4% in patients with AF, and 100% in patients with AFL. No adverse events of refralon were found in patients.

Conclusion. At the time of discharge, sinus rhythm was recorded in 12 out of 16 patients (75%). The ineffectiveness of cardioversion with refralon was noted only in patients with AF; in all patients with AFL the sinus rhythm was restored.

Aim. To study the efficacy and safety of anticoagulant therapy in patients with persistent atrial fibrillation (AF) after interventional treatment during 36 months of follow-up.

Material and methods. The study included 135 patients (78 men and 58 women) in the age from 31 to 80 years (mean age 61.0 [55; 66]) with persistent AF who underwent catheter treatment. All patients were treated in the arrhythmia department of the Research Institute of Cardiology (Tomsk National Research Medical Center from 01.01.2017 to 31.12.2017.

Results. In patients with persistent AF, the effectiveness of catheter treatment was 60% after 12 months of follow-up (81 patients had no documented AF during this period) and 63.7 % (n=86) - after 24 and 36 months. No fatal outcomes, myocardial infarction, or ischemic stroke were observed within 12 months after catheter treatment in patients with an effective procedure. During 36 months of follow-up, the incidence of ischemic stroke on the background of receiving anticoagulant therapy and effective catheter treatment of persistent AF was significantly lower than in patients with unsuccessful ablation (1.16% and 10%, respectively), even though not all patients from the first group received prescribed medication.

Conclusion. Successful radiofrequency procedure/cryo-ablation of AF persistent form significantly reduced the risk of ischemic stroke from 10% to 1.16% and almost eliminated the likelihood of other thromboembolic complications, while the invasive strategy did not increase the risk of large and small bleeding in this group of patients.

Purpose. Determination the proportion and burden of new-onset atrial fibrillation (AF) in patients with cardiac implantable electronic devices (CIED) and without prior AF and assessing the incidence of risk factors for stroke in patients with AF.

Methods. The medical history of 111 patients with CIED with remote monitoring function were analyzed. AF diagnosed by the device was interpreted by an arrhythmologist and cases of significant AF were selected. The group of patients with and without AF was compared for several factors. To clarify the influence of risk factors on the duration of AF, all AF cases were divided into 3 categories depending on the AF burden per day. The first group included patients with an AF burden per day of 0.1% or less (n=10, (45.5%)), the second - from 0.3% to 12.2% (n=7, (31.8%)), and the third group - with 100% (n=5, (22.7%)). Patients with a burden of 0.2%, 12.3-99.9% were absent.

Results. Newly diagnosed AF was registered in 19.8% of cases. The risk of stroke among these patients was high - 2 [1; 3] points on the CHA2 DS2 -VASc for men, and 3 [2,75; 3,75] points for women. Hypertension of 2 and 3 degrees was recorded in all patients in the group with an AF burden of 100% per day. That significantly differed from the other 2 groups (p=0.043). In the group with an AF burden of 100%, the levels of NT-proBNP, D-dimer, and creatinine were significantly higher than in the other groups (p=0.037, p=0.031 and p=0.036, respectively). When analyzing the dependence of creatinine level on the presence of AF, the area under the ROC-curve was 0.653 with 95% confidence interval 0.528-0.779 (p=0.017). The proportion of right ventricular pacing in patients with ICD was higher in the group of patients with AF.

Conclusion. AF occurs in 1/5 of patients with CIED. All patients with AF were potential candidates for anticoagulation due to their high risk of stroke. The daily burden of AF is positively correlated with the presence and degree of hypertension, as well as with markers of renal dysfunction, chronic heart failure, and thrombosis. Elevated creatinine levels are a predictor of AF.

We aimed to analyze the management of children with Jervell-Lange-Nielsen syndrome based on their clinical and genetic characteristics and to assess the effectiveness of their therapy.

Methods. We analyzed medical data from 12 Jervell and Lange-Nielsen syndrome patients. Mean follow-up was 8.3±5.1 years. Comprehensive cardiological examination include the standard 12-lead electrocardiography (ECG), echocardiography, stress-test, 24-hour Holter recordings, blood tests, thyroid ultrasound, and assessment of thyroid hormone levels, and if necessary, consultation with a neurologist.

Results. At the first visit, the mean age was 3.0±2 years old, girls prevailed (67%). All patients are alive now. The mean QTc was 578.9±57.3 ms. Cardiac events had 10 patients (83%), mean age at the first event was 1.9±1.6 years. In 67% of children, syncope was initially regarded as epileptic. All patients received beta-blockers, which were prescribed at mean age 3.0±2.3 years (from 1 month to 7 years). In 8 patients cardiac events recurred despite regular and adequate beta-blocker therapy, all of them were implanted with implanted cardioverter-defibrillator. It was found that patients with the first syncope under the age of 1.5 and delayed initiation of therapy (at the mean age 4.3±1.7 years) had multiple recurrences of syncope despite therapy. Non-cardiac symptoms include sensorineural hearing loss in 100% of cases and hypochromic anemia in 75% of cases.

Conclusion. In Jervell-Lange-Nielsen patients who are characterized by resistant ventricular tachyarrhythmia aggressive antiarrhythmic therapy at a very early age is essential for increasing the risk of life-threatening cardiac events. Consequently, diagnosis of the disease in the first days of life is extremely relevant. ECG screening is crucial in solving the problem of early diagnosis of the disease. Extracardiac pathology in patients with Jervell-Lange-Nielsen syndrome necessitates the interaction of doctors of different specialties together when managing a patient.

The aim of our study was to evaluate implantation efficacy and safety across various occluder types and to identify factors determining device selection.

Methods. This single-site prospective observational study included patients above the age of 40 years with non-valvular atrial fibrillation (AF) and high thromboembolic risk, undergoing endovascular isolation of the left atrium appendage (LAA) with Watchman or Amplatzer Cardiac Plug/Amulet devices. Occluders were implanted to patients without either had contraindications to anticoagulant therapy (ACT) or refused ACT. We evaluated technical aspects of device implantation, short- and long-term outcomes of the intervention over 3 years of follow-up.

Results. 90 patients were enrolled in the study (62 into the Watchman arm and 28 into the Amplatzer arm). Interventions were technically successful in 89 cases. In 1 patient (1/90, 1.1%) technical success was not achieved due to device migration (Amplatzer Amulet). The incidence of early (occurring within˂ 24 hours) implantation complications was 0% in the Watchman arm, and 3.6% in the Amplatzer arm (1/28) (р=0.135) (device migration). The cumulative incidence of all in-hospital complications was 11.3% and 14.3%, respectively (р=0.734). No significant differences between arms were found in the incidence of device thrombosis within 90 days post-implantation (3.3% in the Watchman’s arm and 8.3% in the Amplatzer arm, р=0.316). During the observation period, there were no significant differences in comparison groups in the incidence of net clinical efficacy endpoint events (р=0.58). The bleeding rate was 17.7% and 14.3%, respectively, р=0.769. No factors influencing the choice of the device could be identified reliably; however, there was a trend towards Watchman preference for appendage anatomic variants such as broccoli and cactus. Amplatzer was preferred in patients with contraindications to ACT.

Conclusion. Implantation of Watchman and Amplatzer Amulet occluders is equally effective and safe in preventing thromboembolism in patients with AF not receiving ACT for various reasons. The individual choice of a device may be influenced by appendage anatomy and indications to occluder implantation.

We present two cases of successful pharmacological cardioversion using antiarrhythmic drug refralon in patients with persistent atrial fibrillation after pulmonary vein cryoablation and ineffective electrical cardioversion. These clinical cases represent the first experience of successful use of refralon in patients who underwent cryoablation.

Clinical case report of zero fluoroscopy radiofrequency catheter isolation of supraventricular ectopic foci in patient after orthotopic heart transplantation is presented.

Persistent left superior vena cava (PLSVC) is the most common anomaly of the thoracic veins (occurs in 0.2-0.6% of cases in the general population), in the vast majority of cases, PLSVC drains into the right atrium through the dilated coronary sinus and usually does not lead to significant hemodynamic disorders. The presence of PLSVC is often associated with cardiac arrhythmias; in this clinical case, we present the results of catheter ablation of arrhythmogenic foci in a 72-year-old patient with continuous-recurring ectopic tachycardia originating from the PLSVC.

The article discusses the results of a survey of doctors in the Russian Federation with the aim of studying approaches to the treatment of atrial fibrillation in real clinical practice and comparing the results obtained with the current clinical guidelines. Some new data are presented that could change the recommendations in the future; possible causes of medical errors and ways to correct them are discussed.