Aim. The study of interatrial septum (IAS) and coronary sinus (CS) syntopia in patients with atrial fibrillation (AF), who subsequently underwent pulmonary vein isolation with a cryoballoon and the determination of anatomical landmarks for puncture of the IAS.

Methods. The data of preoperative computed tomography of the heart of 25 consecutive patients with AF, who subsequently underwent pulmonary vein isolation with a cryoballoon, were analyzed. Angulations describing IAS orientation and CS direction were measured. The relationships between IAS orientation, CS direction and size of left atrium were subsequently analyzed.

Results. The mean angulations for IAS orientation and CS direction were 47.2±7.8° (range 27.6 - 57.3) and 47.2±7.8° (range 26.7 - 59.3) respectively. On the conventional clock face (direction of the flag of the puncture needle), these values corresponded to the following time: 4 h 34 min±15 min (from 3 h 55 min to 4 h 55 min) for the IAS orientation and 4 h 31 min±16 min (from 3 h 53 min to 4 h 54 min) for the CS direction. Statistically significant correlation was revealed between the IAS orientation and the CS direction (r = 0.77; p <0.001). Linear regression analysis by the least squares method showed that the CS direction explains 60% of the observed variability in IAS orientation. The final regression equation for the relationship between the IAS orientation and the CS direction is presented as: IAS orientation = 12.76 + 0.75 × CS direction. Analysis of the relationship between the IAS orientation and the size of the left atrium did not reveal any significant correlation and dependence (p=0.84). All 25 patients who took part in the study underwent pulmonary vein isolation with a cryoballoon. Puncture of the IAS from the first time was successful in 100% of patients. In 24 patients (96%), it was possible to achieve grade 4 occlusion of the pulmonary veins, and a bidirectional block was confirmed when checking the electrical activity of PV. All cryoballoon ablation procedures were completed without complications.

Conclusion. In patients with AF, the CS direction can be a reliable predictor of the IAS orientation, which can be used in clinical practice. However, to verify the data and determine technical recommendations for transseptal puncture, additional clinical studies are needed.

Aim. To conduct a comparative assessment of the long-term results of thoracoscopic and catheter ablation using the ablation index in patients with non-paroxysmal atrial fibrillation (AF).

Methods. A comparative analysis of the long-term results of catheter ablation using the ablation index - group № 1 (36 patients) and thoracoscopic ablation with the left atrial appendage exclusion - group № 2 (42 patients) was performed.

Results. The effectiveness of catheter ablation was 57.14%, thoracoscopic ablation - 67.5% at 12-month followup (р=0,128). There were also no statistically significant differences in safety (p=0.55). Analyzing the structure of postprocedural atrial tachycardias in group №1 was demonstrated that AF recurrence was in 93.3%, in group №2 - in 50%. Atypical atrial flutter was documented in 6.6% of cases in group №1 and in 31.5% - in group №2. Typical atrial flutter was documented only in group №2 (18.75% (3)). However, AF recurrence was more common in the catheter ablation group after 6 months of follow-up (p=0.04).

Conclusion. Catheter and thoracoscopic ablation are comparable in terms of overall efficacy and safety, however, thoracoscopic ablation provides greater freedom from AF in a 6 month.

Aim. The aim of the study was to evaluate the long-term results of implantation of domestic endocardial leads (EL) with active fixation ELBI 233C-53 and ELBI 233C-58, implanted in the atrial and ventricular positions, respectively.

Methods. A total of 165 patients were included in the retrospective, single-center study. 239 EL were implanted from 2016 to 2018 (55 ELBI 233C-53 and 184 ELBI 233C-58). The median age was 78 years (43 to 92 years). 846 programming protocols were analyzed, which were carried out on the 1st day after implantation, and then every 6 months. Complications are divided into early (1-7 days) and late (8 days or more).

Results. In the EL ELBI 233C-53 group, there were no statistically significant changes in the pacing parameters during the observation period. There were 6 complications (10.9%): exit block (n=1, 1.8%), dislocation of the EL (n=3, 5.4%), damage to the EL structure (n=2, 3.7%). The number of reoperations was 3 (5.4%). In the ELBI 233C-58 group, a statistically significant increase in the pacing threshold was found (p=0.026). 13 (7.0%) complications were registered, including an increase in the pacing threshold (n=11.6%), exit block (n=1, 0.5%), damage to the EL structure (n=1, 0.5%). The number of reoperations in this group was 2 (1%).

Conclusion. EL ELBI 233C-53 and ELBI 233C-58 demonstrated acceptable pacing parameters and safety during observation. Complications occurred mainly in the first year after implantation. The number of repeated operations was low. There were no deaths caused by complications after lead implantation.

Aim. Cryoballoon ablation (CBA) is one of the methods for catheter pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (AF). Left atrial additional lesion (LAAL) to PVI were proposed to eliminate extrapulmonary AF triggers. Nonetheless whether the additional lesions improve CBA effectiveness is not clear.

Methods. Primary CBA procedures performed for paroxysmal AF during 2017-2021 were analyzed. The study group (Algorithm group, n=82) was recruited prospectively in 2019-2021. As the first step CBA PVI were performed in all pts. In those who were on sinus rhythm (SR) after the PVI, AF induction attempts with burst atrial pacing were performed. Pts with induced AF and those who stayed on AF after PVI underwent LAAL at the left ganglionated plexus area. In case of stable SR (non-inducible AF) the procedure finished. If AF was inducible or did not terminate during CBA, the second LAAL set were performed - LA posterior wall lesions. If AF was still inducible or did not terminate, the SR was restored by electrical cardioversion. The control group (Control group, n=94) was formed retrospectively from patients with routinely performed only CBA PVI with achievement of isolation criteria in 2017-2019. If AF continued, sinus rhythm was restored by cardioversion. There were no attempts of induction AF during the procedure.

Results. The Algorithm and Control groups were comparable in terms of clinical, demographic and electrophysiological characteristics. At 12 months postoperatively, the effectiveness was higher in the Algorithm group than in the Control group (78.0% vs. 62.8%, p = 0.044). No adverse effects were found.

Conclusion. Thus, the stepwise approach with LAAL increases the effectiveness of CBA in the long-term period and does not affect the risk of complications.

Aim. To assess the diagnostic significance of clinical indicators and left ventricle ejection fraction (LV EF) for predicting the probability of death from acute decompensated heart failure (ADHF) in patients with chronic heart failure with a reduced LV EF (HFrEF) within one year after implantation of cardioverter defibrillator (ICD).

Methods. The study included 384 patients with heart failure NYHA 3-4 functional class with LV EF ≤ 35%, undergoing ICD implantation for the purpose of primary prevention of sudden cardiac death. After ICD implantation the patients included in the study were prospectively observed during one year (visits to the clinic after 3, 6, 12 months). The primary end point - a case of ADHF was registered.

Results. In a one-year observation, the primary endpoint was recorded in 38 patients (10 per cent). Single factor logistic regression analysis showed 5 factors with the greatest predictive potential (p<0.1), related to the occurrence of the investigated endpoint. These included: history of arterial hypertension (AH) and obesity, LV EF based on the biplane Simpson’s method, LV EF ≤ 28% and systolic blood pressure. Based on the results of the multi-factor regression analysis, a predictive model was developed, which included three factors with the highest levels of statistical significance: the presence of AH, obesity and LV EF ≤ 28%. The diagnostic efficiency of the model was 69.5% (sensitivity 78.9%; specificity 68.5%).

Conclusion. The results of the research indicate that the main predictor of one-year mortality due to ADHF in the studied cohort of HFrEF patients with NYHA class 3-4 is LV EF ≤ 28%. The presence in the history of AH and obesity was associated with the best prognosis for life.

Aim. To study the intraprocedural changes in baroreflex activity after catheter pulmonary vein isolation in paroxysmal atrial fibrillation patients.

Methods. From October 2021 to June 2022, sinus rhythm was registered at the start of procedure in 21 patients with paroxysmal atrial fibrillation admitted for catheter pulmonary vein isolation. Patients before and after procedure were tested with phenylephrine. Pre- and postoperative baroreflex activity and sinus rhythm rate were analyzed.

Results. After catheter pulmonary vein isolation, the baroreflex activity decreased from 5.8 [3.5; 11.3] ms/mmHg to 0.3 [-0.1; 1.8] ms/mmHg, р<0.001, based on systolic arterial pressure, and from 9.5 [5.1; 15.5] ms/mmHg to 0.6 [0; 7.6] ms/mmHg, p=0.033, based on diastolic arterial pressure.

Conclusion. Intraprocedural phenylephrine test allows to study the baroreflex activity changes and to assess the modification of cardiac autonomic innervation.

Aim. To study the incidence, predictors, and clinical outcome of device-related thrombus (DRT) after left atrial appendage occlusion (LAAO) in patients with atrial fibrillation (AF).

Methods. A prospective observational study included 120 patients with non-valvular AF who underwent LAAO with Watchman (n=92) and Amplatzer Amulet (n=28). The presence of device-related thrombus (DRT) was assessed at visits 45 days, 6 months, 1 year, 2 years, 3 years after implantation by transesophageal echocardiography.

Results. A total of 11 (9.2%) patients had DRT during the follow-up period. The greatest number of thrombosis was observed after 45 days (n=4) and after 6 months (n=4). There was no significant difference in the incidence of DRT between device types. Independent predictors of thrombosis were: history of myocardial infarction (hazard ratio (HR) 12.88 [95% confidence interval (CI) 3.21-51.62]; p<0.001), chronic heart failure (HR 8.83 [95% CI 1.91-40.77]; p=0.005), residual leak size >5 mm in the early postoperative period (HR 6.13 [95% CI 2.53-14.86]; p<0.001) and the degree of spontaneous echo contrast during the initial examination (HR 9.09 [95% CI 1.36-60.58], p=0.023). There were no cases of thromboembolic complications associated with DRT. One patient developed a non-fatal stroke at 35 weeks of follow-up, while DRT was detected at the visit at the end of the 3rd year of follow-up.

Conclusion. DRT after LAAO was observed in the early and long-term follow-up periods. This event was associated with the baseline patients’ characteristics and post-procedural aspects with no dependence on type of antithrombotic therapy.

The aim of this work is to analyze the effectiveness of thoracoscopic ablation (TSA) of atrial fibrillation (AF) and to define the risk factors for the return of atrial tachyarrhythmias after TSA in the long-term follow-up period.

Methods. From January 2019 to December 2021, 150 patients with symptomatic atrial fibrillation (persistent 29.3% monitoring at the control points of the study, the results of which evaluated the effectiveness of the procedure.

Results. The overall efficiency of TSA in the long-term follow-up period was 72.5%. After off-antiarrhythmic drugs, freedom from any atrial tachyarrhythmias was 79.2%, 70.5% and 68.9% after 6, 12 and 24 months, respectively. Additional catheter ablations after 3 months increase the effectiveness of the procedure to 82.9%. Important risk factors for the return of arrhythmia after TSA should be considered the patient’s age, duration of AF, previous catheter ablations and the left atria diameter of more 40 mm.

Conclusion. The hybrid approach significantly improves the effectiveness of TSA for patients with non-paroxysmal forms of AF. The results obtained require further study of this problem in order to improve the quality of TSA and determine the optimal set of ablation lines, considering the risk factors for the return of arrhythmia.

Current clinical case demonstrates the catheter treatment of longstanding persistent atrial fibrillation and atrial flutter without the use of fluoroscopy in patient with chronic heart failure. The effect on the parameters of heart remodeling, as well as the dynamics of NT-proBNP after 6 months of follow-up is demonstrated.

Neonatal lupus is a rare disease associated with the circulation in the mother’s blood of one or more autoantibodies to soluble intracellular ribonucleoproteins Ro/SS-A and La/SS-B. This disease is extremely often manifested by congenital heart block, which can progress even after the birth of a child. We have described a case of fibrosis, calcification and cartilaginous metaplasia of the atrioventricular node zone, which caused complete atrioventricular block in a child who died from neonatal lupus.

This article describes a rare clinical manifestation of arrhythmogenic cardiomyopathy in a 13-year-old boy - the “hot phase”, characterized by severe chest pain and a significant increase on a level of troponin I. The clinical case demonstrates the difficulties of the differential diagnosis of this disease and an importance of an integrated approach to examination of the patient, including cardiac magnetic resonance imaging and genetic testing.

Focal activity is one of the dominant triggers of atrial fibrillation. Its activity is revealed in paroxysmal as well as in persistent patterns of arrhythmia. Starting as a trigger of atrial fibrillation in pulmonary veins, over time with increasing of burden of atrial fibrillation, focal activity is more and more revealed out of pulmonary veins: anterior and posterior left atrial walls, interatrial septum, coronary sinus, ligament of Marshal and right atrium. Diagnostics of focal activity is a challenging clinical task despite implementation of mathematical algorithms of electrogram analysis because of its spatial instability and activation direction of the mapping electrode. All these items are discussed in the article.

Approaches to the differential diagnosis of ventricular premature beats and aberrant QRS complexes with a picture of complete right bundle branch block are considered, based on the assessment of the rates of myocardial coverage by excitation, the similarity, and differences in the initial parts of “narrow” and “wide” QRS complexes, the presence of a low-amplitude onset of the QRS complex in several leads.

Clinical data of a 39-year-old patient with corrected transposition of the great arteries, combined with complete atrioventricular block and conduction along an accessory pathway, are presented. The features of changes in the structure of the conduction system, rhythm and conduction characteristic of this rare congenital heart disease are discussed.