In this case report we present electrophysiological features of supraventricular tachycardia in a 64-year-old patient after previous slow pathway catheter ablation; ECG features of the tachycardia and results of electrophysiological testing are discussed.

Aim. To assess association of different dynamics of sex hormones with 10-year survival in men with congestive heart failure (CHF) and implanted cardiac resynchronization therapy (CRT) devices.

Methods. Based on tercile of testosterone at the end of the study (TESend), 157 men with CRT (mean age 58.7±9.7 years old; 95 men (60.5%) w/ ischemic CHF) were divided into 3 groups: gr. I (n=52) - TESend<13.3 nmol/l; gr. II (n=53) - TESend>13.3<19.2 nmol/l; gr. III (n=52) - TESend>19.2 nmol/l. Parameters of echocardiography (Echo) were investigated in dynamics, N-terminal fragment of probrain natriuretic peptide (NT-proBNP), interleukin-6 (IL-6), total and free testosterone (TES), estradiol (E2), sex hormone-binding globulin (SHBG), progesterone (PGN), dehydroepiandrosterone sulfate (DHEAS), E2/TES ratio were tested in plasma. Survival in groups was assessed using Kaplan-Meier method.

Results. Groups were comparable in age, presence of ischemic CHF, arterial hypertension and surgeries on myocardial revascularization. Higher incidence of atrial fibrillation, obesity, complete left bundle branch block, tendency to higher incidence of diabetes mellitus and higher body mass index was revealed in gr. I compared to gr. III. At baseline, groups didn’t differ in Echo parameters; the highest TES levels were found in gr. III. After CRT, there was less reverse cardiac remodeling, decrease of TES level (p<0.001) in gr. I vs increase of TES level in gr. II (p=0.041) and gr. III (<0.001); E2 level increased (p=0.008), levels of NT-proBNP and IL-6 decreased only in gr. III. In absence of dynamics of E2/TES index and DHEAS level in groups, E2/TES index was the highest and DHEAS level was the lowest in gr. I after CRT. 10-year survival of groups was 17.6%, 42.8%, 46.2% (Log Rank test I-II=0.016; Log Rank test I-III=0.004; Log Rank test II-III=0.528).

Conclusion. Obtained results indicated different dynamics of sex steroids after CRT. Sex hormones variation pattern, interrelated with increase in levels of testosterone, estradiol, dehydroepiandrosterone sulfate and decrease in testosterone to estradiol ratio, was associated with better 10-year survival in men with implantable CRT devices with greater reverse cardiac remodeling and reduction in activity of systemic immune inflammation.

Purpose. To identify predictors of ventricular tachycardia (VT) recurrence after endo-epicardial ablation in patients with structural heart disease.

Methods. A prospective observational study included 39 patients with structural heart disease and indications for catheter ablation of ventricular tachyarrhythmia. Endo- and epicardial electroanatomical mapping of the ventricular myocardium and ablation of abnormal electrical activity areas were performed. Clinical, ECG characteristics, and voltage maps of bipolar potentials (limits of scar detection <0.5 mV, normal activity >1.5 mV) and unipolar signals (limits <5.0 and >9.0 mV, respectively) on endo- and epicardial surfaces were evaluated. Intraprocedurally, the procedure was considered effective when no VT was inducible; partially effective - when only clinical VT(s) was/were non-inducible. Scheduled patient visits or remote monitoring were performed at 6, 12 and 24 months, and then annually.

Results. The mean age of the patients was 49.5±15.7 years (34 men and 5 women). VT recurrences at 6 months were more often detected in non-ischemic cardiomyopathy patients, in subjects with non-paroxysmal atrial fibrillation (42.9% vs. 7.4%), with a lower VT-QRS amplitude in lead III (0.6 [0.4;1.07] versus 1.28 [0.99; 1.53] mV), and when epicardial “scar” area prevailed over endocardial, P<0.05 for all listed parameters. At 12-months, VT recurrence was more common in patients with partially effective ablation (33.3% vs. 5.0% in patients with effective ablation, P=0.02). The presence of electrical storm at the time of ablation was independently associated with recurrences (HR 4.32; 95% CI: 1.06-17.48; P=0.04).

Conclusion. In a heterogeneous group of patients, clinical and electrophysiological factors associated with VT recurrence have been identified at various follow-up periods after endo-epicardial ablation. Electrical storm ablation is an independent predictor of VT recurrence in the long-term, up to 5 years of follow-up.

Aim. To identify electrocardiographic (ECG) predictors of drug-induced non-sustained polymorphic ventricular tachycardia (PVT).

Material and methods. The study included 110 patients with ischemic heart disease and /or arterial hypertension and cardiac arrhythmias who were taking class III antiarrhythmic drugs (amiodarone or sotalol). According to the presence or absence of the drug-induced QT interval prolongation (Bazett) (greater than 450 ms in men and greater than 470 ms in women), the patients were divided into 2 groups: «LQTS» (n=64) and «Non LQTS» (n=46). According to the presence or absence of non-sustained PVT, patients with drug-induced LQTS were additionally divided into the «PVT» (n=17) and «Non PVT» (n=47) groups. All patients underwent clinical, laboratory and instrumental examinations, which included taking anamnesis, physical examination, echocardiography, Holter monitoring, general clinical laboratory examinations, 12-lead ECG recording before and while taking antiarrhythmic drugs.

Results. In the «LQTS» group of patients, PVT was significantly more common than in the «non LQTS» group (p=0.017). When analyzing the baseline ECG parameters recorded before the initiation of antiarrhythmic therapy, no significant differences were found between the groups except for a greater QT interval dispersion in the group of patients with LQTS and non-sustained PVT compared with patients without LQTS (p=0.03). While receiving antiarrhythmic therapy, patients with LQTS and non-sustained PVT had a longer duration of the QT interval (p<0.05), as well as the duration of the corrected QT and JT intervals (p<0.001) compared with group of patients without LQTS and subgroup without non-sustained PVT. The values of the parameters of the balance of depolarization and repolarization of the ventricular myocardium (iCEB and iCEBc) were significantly higher in patients with LQTS and non-sustained PVT (p<0.001). Based on the results of the analysis of contingency tables, the most effective predictor of non-sustained PVT was an iCEBc value ≥5.81 (OR=7.294, 95% CI [4,245-11,532]). According to the results of one-way ROC-analysis, the iCEBc value ≥5.81 demonstrated high sensitivity (94.1%) and specificity (84.9%), as well as a fairly high area under the ROC-curve (0.901).

Conclusions. Our results indicate that the value of the corrected index of the cardioelectrophysiological balance ≥5.81 can be used in the prediction of non-sustained PVT in patients with QT interval prolongation induced by amiodarone and sotalol in addition to the existing ECG parameters.

Purpose. To assess the disorders of the cardiac conduction system (CCS) that occurred in the early postoperative period after aortic valve (AV) replacement by the Ozaki method.

Methods. The study included 256 patients after a successfully performed Ozaki procedure. Patients with a history of open cardiac surgery, with an implanted pacemaker, with permanent atrial fibrillation, with simultaneous Ozaki surgery with correction of another pathology, in case of repeated surgery on AV in the next six months, with lethal outcome, under the age of 18 years, when it is impossible to analyze the CCS dynamics were excluded. The mean age was 57.9±11.1 years, the male sex was 119 people (46.5%), the body mass index was 29.7±5.5 kg/m2 , diabetes was observed in 40 patients (15.6%), anamnesis of CCS disorders in 10 (3.9%), CCS disorders on the baseline electrocardiogram (ECG) in 32 (12.5%). Conduction abnormalities were assessed according to the anamnesis and the results of daily ECG recording.

Results. In the early postoperative period, CCS disorders were registered in 35 patients (13.7%), of whom 27 (10.6%) had their first occurrence, and 8 (3.1%) had previously existed. By the time of discharge, persistent CCS disorders (which occurred for the first time and in the case of progression of pre-existing blocks) remained in 11 (4.3%): 8 (3.1%) had bundle branch blocks, 3 (1.2%) had atrioventricular blocks that required implantation of a permanent pacemaker. Patients with pacemaker had initial conduction abnormalities. The most frequent dysfunction of the CСS was the left bundle branch block (LBBB) (45.5%). We analyzed 14 variables as predictors of the onset or progression of persistent CCS disorders. Two independent predictors were identified - the presence of conduction abnormalities on the baseline ECG and the time of cardiopulmonary bypass. In patients with persistent conduction disturbances in the postoperative period, CCS disorders on the baseline ECG were more common - 36.4% compared with patients without CCS disorders after surgery - 11.4% (p=0.035) and there was a longer duration of cardiopulmonary bypass 140.6±41.1 min. and 122.4±26.1 min. respectively (p=0.03).

Conclusion. The most frequent disorder of the conduction was the LBBB. None of the first dysfunctions of CCS led to the implantation of the pacemaker. The presence of initial ECG conduction disturbances and the time of cardiopulmonary

The number of implantations of cardiac electronic devices is increasing. Along with this, there is an increase in complications requiring lead extraction. As we know, lead extraction is associated with the risk of complications, including fatal ones. This review considers seven risk stratification scores for transvenous lead extraction. Their advantages and disadvantages and importance of their use in practice are discussed in this article.

The current single-factor prognostic scale for the risk of ventricular tachyarrhythmia in patients with chronic heart failure and reduced left ventricle ejection fraction is considered by most experts to be inconsistent with modern medicine and should be modified. This position directs the efforts of researchers to search for additional prognostic factors, such as serum biomarkers. The last may reflect the state of cardiomyocytes and extracellular cardiac matrix, as well as endogenous and exogenous impacts to these structures. Such information may be important in determining the probability of the presence of myocardial pro-arrhythmic substrate and the electrophysiological conditions necessary to realize its potential. The data presented in this review suggest that concentrations of serum biomarkers may provide additional information for the estimation of personalized arrhythmic risk, which should help to avoid the clinical underestimation of the risk of sudden cardiac death and be a determining factor in the decision to implant a cardioverter-defibrillator.