This editorial refers to the article by Lukin IB. Algorithms for the prevention and treatment of supraventricular tachycardia in patients with implanted pacemakers: case series. Journal of Arrhythmology. 2022;29(4): е9-е14.

Aim. To estimate the 10-year survival, clinical and biochemical status of responders and nonprogressors to cardiac resynchronization therapy (CRT) using biomarkers of fibrogenesis, neuro-humoral, immune, sympatho-adrenal activation.

Methods. Eighty CRT patients (mean age 58.9±10.1 years; 90% men; 72.5% with coronary artery disease) with the best CRT response timing («best» timing), assessed by maximum decrease in left ventricle end-systolic volume (LVESV), were divided into groups: Gr.1 (n=42): non-progressors (decrease in LVESV by >0<15%), Gr.2 (n=38): responders (decrease in LVESV by >15<30%). At baseline, in the «best» timing and in the «end» timing (November 2020), parameters of echocardiography, NT-proBNP, epinephrine, norepinephrine (NAdr), IL 1β, 6, TNF-α, C-reactive protein, matrix metalloproteinase 9, tissue inhibitor of matrix metalloproteinases 1 in plasma were studied. Survival was estimated by Kaplan-Meier method. Logistic regression was used to assess relationship of studied factors with CRT efficacy, and Cox regression with survival.

Results. In Gr.1, greater heart failure functional class was revealed (p=0.042). In Gr.1, there was less reverse cardiac remodeling in the «best» timing and greater pulmonary artery systolic pressure (p=0.029), NT-proBNP (p=0.020) in the «end» timing. Immune activation and imbalance of fibrogenesis were found across all time points of the study. In Gr.1, increase in NAdr level was revealed only in the «end» timing (p=0.017), but in Gr.2 it already was in the «best» timing (p=0.003). Correlations of NAdr «best» with ΔLVESV (r=-0.245; p=0.038), Δ left ventricle end-diastolic volume (LVEDV) (r=-0.293; p=0.013) in general group; and with IL-1β «best» (r=0.363; p=0.032), TNF-α «best» (r=0.360; p=0.034) in responders group were registered. Responder’s survival was the best only at 2 and 3 years after CRT implantation, with comparable survival between groups in subsequent years. In Gr.1, significant factors associated with 2-3-year survival were LVEDV «best» (RR 0.831 (0.713-0.967), p=0.017), LVESV «best» (RR 1.245 (1.040-1.492), p=0.017); in Gr.2, NT-proBNP «end» (RR 1.001 (1.000-1.001), p=0.024) related to 10-year survival in the absence of significant factors.

Conclusion. Comparable 10-year survival rate of non-progressors and responders is probably due to immune, sympathetic-adrenal activation, fibrogenesis imbalance. In non-progressors group CRT response can be assessed as positive due to significant reverse cardiac remodeling and survival comparable to responders and associated with NT-proBNP level.

Aim. To analyze the experience of a multidisciplinary hospital in the implantation of pacemaker (PM) in patients with COVID-19, to evaluate predictors and the incidence of complications and adverse outcomes.

Methods. One-hundred twenty five patients with active COVID-19 underwent PM implantation/replacement during the period from 04/01/2020 to 11/30/2021 at the Department of Cardiovascular Surgery of the City Multidisciplinary Hospital, reprofiling to provide medical care to patients with COVID-19. The presence of SARS-CoV-2 virus was confirmed by a positive result of the polymerase chain reaction performed the day before the procedure.

Results. Median age of patients was 81 [73-86] years. Indications for PM in most cases were atrioventricular block of II-III degrees (n=71, 56.8%), sick sinus syndrome (n=30, 24%). The PM was replaced in 20 (16%) patients. Of the 125 patients in the study survey, the 30-day complication rate was 12%, and the 180-day mortality rate was 16.8%.

Conclusion. Patients with active COVID-19 had an increased level of complications and mortality rates after PM implantation/replacement. It is necessary to take these risks into consideration to better select patients with active COVID-19 infection.

The aim of the study was to identify predictors of early and delayed pacemaker (PM) implantation in patients with myocardial infarction (MI) and heart block, allowing the development of models for predicting the feasibility of its implantation.

Methods. A randomized selection method was used to form a cohort of patients with MI complicated by cardiac conduction disorders. The first (control) group included 72 patients who did not have a PM implanted, the second (n=46) and third (n=68) groups consisted of patients with MI, having, respectively, indications for early (in the acute period of MI) and delayed (average after 3 years) PM implantation. All patients underwent endovascular revascularization of the infarct-dependent artery during hospitalization. Demographic, clinical, and morphological predictors of PM implantation in patients of the second and third groups were evaluated in comparison with the control group. Multiple logistic regression was used to identify factors associated with the need for PM implantation in the short term (hospital period) and in the long-term period.

Results. Factors that determine the expediency of a permanent PM in the acute period of MI at the hospital stage, delayed pacemaker implantation 3.2±1.9 years after myocardial infarction, as well as predictors that do not require a permanent PM throughout the entire observation period, were identified. The main factors that require permanent PM implantation in the acute period were identified: 3rd degree atrioventricular (AV) block in NSTEMI, GRACE score 96 or higher, development of 3rd degree AV block in MI of any localization except postero-inferior. Predictors for the need for PM implantation after 3.2±1.9 years (delayed period) were STEMI of anterior localization; at the same time, age had an inversely proportional relationship in predicting the fact of permanent pacing. The factors that determine the need for PM implantation are the presence of anterior MI, the multiple coronary artery lesions.

Conclusion. In the acute (hospital) period of NSTEMI, PM implantation is indicated at a high risk of adverse cardiovascular complications (GRACE scale of 96 points and above), in the presence of the 3rd degree AV block in any MI localization, except for the inferior one. Indications for permanent pacing 3.2±1.9 years after an acute coronary event are STEMI of anterior localization and multiple coronary artery lesions.

Aim. To study the role of fibroblast growth factor 23 (FGF-23) as a predictor of left atrial appendage (LAA) thrombosis

in patients (pts) with non-valvular atrial fibrillation (AF) and different risk levels of thromboembolic complications (TEC) according to the CHA₂DS₂-VASc score.

Methods. The study included 250 pts with non-valvular AF hospitalized for radiofrequency ablation, divided into 2 groups: group (gr.) 1 - with 0-1 points (n=79) and gr.2 - with ≥2 points on the CHA2DS2-VASc scale (n=171). According to the results of transesophageal echocardiography, pts of each group were divided into subgroups depending on the presence of LAA thrombosis, which was found in 19 pts of gr.1 and 72 of gr.2. Patients underwent transthoracic echocardiography, determination of blood biomarkers: NT-proBNP (pg/ml), GDF-15 (pg/ml), FGF-23 (pmol/l), highly sensitive C-reactive protein (mg/l), cystatin C (mg/l).

Results. Pts with LAA thrombosis in both groups had in common: a longer history of arterial hypertension, a greater proportion of coronary artery disease and persistent AF, lower GFR, higher values of atrial volume indices, left ventricle myocardial mass, systolic pressure in the pulmonary artery, median NT-proBNP, FGF-23 and GDF-15. Logistic regression analysis performed separately in the groups revealed the same independent predictors of LAA thrombosis in both groups: LA volume index (LAVI) and the level of FGF-23 in the blood. At the same time, the threshold value of FGF-23, separating pts by the presence of LAA thrombosis, was higher in gr.1 (≥0.85 and ≥0.5 pmol/l, respectively), and the area under the AUC curve for FGF-23 in gr.1 was greater: 0.964 vs 0.865 in gr.2 (p=0.026).

Conclusion. The serum level of FGF-23, along with the LAVI, is an independent predictor of LAA thrombosis in pts with AF and various risk of TEC according to CHA₂DS₂-VASc; the threshold level of FGF-23 for pts at low risk of TEC is significantly higher than for high risk pts, and allows more accurate prediction of the presence of LAA thrombosis.

The article provides a review of international clinical studies on the use of a subcutaneous implantable cardioverter-defibrillator (ICD) in comparison with classical intravenous defibrillation systems. Subcutaneous ICDs have shown themselves to be a worthy alternative to intravenous defibrillating systems for the primary prevention of sudden cardiac death, when the patient is not indicated for anti-tachy stimulation and anti-brady stimulation. World experience on the use of subcutaneous ICDs proves the safety and effectiveness of the functioning of the subcutaneous ICD system, excluding from the patient’s life the formidable risks associated with the implantation procedure and further functioning of the classical intravenous ICD system.

There is the first clinical use of POLARx cryoballoon catheter for pulmonary vein isolation in patients with atrial fibrillation in Russian Federation.

The article highlights current issue of the etiology of cardiomyopathy resulting from persistent tachycardia. Clinical studies devoted to the diagnosis and treatment of tachycardia-induced cardiomyopathy and the criteria for its diagnosis are presented. The article presents a clinical case report of a 48-year-old patient who developed cardiomyopathy against the background of long-term persistent tachysystolic atrial fibrillation. After the restoration of the sinus rhythm against the background of optimal drug therapy, the clinical signs of cardiomyopathy regressed, the size of the heart chambers and the contractile function of the myocardium of the left ventricle of the heart returned to normal.

The description of the clinical case presents a rare observation of a multi-stage approach to the treatment of right-sided accessory pathway. There are presented the results and features of successful epicardial ablation using a minimally invasive thoracoscopic approach, which made it possible to eliminate accessory pathways for right-sided epicardial localization after failed recurring cataract ablations.

The aim of the study is the demonstration of the 1^st clinical experience of stereotactic arrhythmia radioablation (STAR) of the patient with antiarrhythmic drug (AAD) refractory ventricular tachycardia (VT) in Russia. The results of STAR of 57 years old patient with AAD and multiple radiofrequency ablation refractory VT are described. This clinical study demonstrates efficacy and safety of STAR of VT.

We describe a clinical case of 37 y.o. woman with anteroseptal accessory pathway associated with left ventricular dyssynchrony and ejection fraction reduction. Wolff-Parkinson-White syndrome and phenomenon diagnostic criteria are discussed.

Two clinical cases of prevention and relief of supraventricular tachycardia using modern algorithms in pacemakers of the latest generation in patients with bradyarrhythmia and paroxysmal atrial fibrillation (AF) are presented. In the first clinical case, the patient did not have an episode of AF for six months. In the second clinical case, the patient for 2 years did not have an episode of AF lasting more than 1 minute. Episodes sinus rhythm restoration by antitachypacing algorithms were recorded. These clinical cases demonstrate the effectiveness of modern algorithms in pacemakers of the latest generation for the AF prevention and sinus rhythm restoration.

This article refers to the editorial by Medvedev MM. Is it possible to terminate atrial fibrillation with the pacing? Journal of Arrhythmology. 2022;29(4): 5-6. https://doi.org/10.35336/VA-2022-4-01.