Aim. To assess the relationship between structural and functional parameters of the heart and the presence and prevalence of low-amplitude activity (LAA) zones according to high-density voltage mapping of the left atrium (LA) in patients with atrial fibrillation (AF).

Methods. The study included 57 patients (23 women and 34 men) 55.4±9.8 years with paroxysmal (n=40, 70%) and persistent AF (n=17, 30%). Transthoracic echocardiography, assessment of deformation of both atria - 2D Strain STE were performed in all patients. High-density voltage mapping of the LA was performed intraoperatively before the catheter ablation procedure.

Results. LAA zones were registered in 33% of patients. Persistent form of AF, LA stiffness index, reservoir and contractile functions of the LA, E/A and E/e’ ratios became the strongest predictors of identifying LAA zones in the LA. A prognostic model was constructed using the LA stiffness index and E/A ratio, which determines a high probability of identifying LAA zones in the LA with a sensitivity and specificity of 74 and 74%, respectively.

Conclusion. Preoperative assessment of the stiffness index, reservoir and contractile function of the LA, E/A and E/e’ ratios has predictive value in assessing the prevalence of fibrosis using high-density voltage mapping of the LA. Studying of noninvasive ultrasound parameters in combination with known predictors of effectiveness will allow us to create algorithms for selecting patient selection for catheter ablation and avoid predictably ineffective interventions.

Aim. To evaluate the impact of Marshall ligament cutting off on the incidence of atrial fibrillation (AF) within 1 month after coronary artery bypass grafting (CABG).

Methods. A double-blind, randomized, single-center clinical trial included 60 patients; 30 patients were allocated to the Marshall ligament cutting off group (main group), and 30 patients to the group without Marshall ligament cutting off (control group). The groups did not differ in baseline clinical and demographic parameters. The primary endpoint was the occurrence of AF within 28 days after CABG. Logistic regression was performed to identify efficacy factors.

Results. Postoperative AF developed in 9 patients: 7 patients in the control group and 2 patients in the main group. The statistical model revealed two independent factors that significantly reduced the risk of postoperative AF: performing the surgery without cardiopulmonary bypass (off-pump) and Marshall ligament cutting off (p=0.030 and p=0.048, respectively). The logistic regression model demonstrated excellent predictive ability and high patient classification accuracy; sensitivity was 93.8%, specificity was 62.5% at a cutoff of 0.5. The area under the ROC curve (AUC=0.898) indicates the model’s excellent ability to distinguish between patients with and without postoperative atrial fibrillation.

Conclusion. Marshall ligament transection during off-pump CABG prevents the development of postoperative atrial fibrillation.

Aim. To evaluate survival outcomes, the frequency of adverse events and repeat interventions, and to identify predictors of adverse outcomes in patients with chronic heart failure (CHF) with improved left ventricular ejection fraction (LVEF) receiving implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D) for primary prevention of sudden cardiac death (SCD).

Methods. A single-center retrospective study was conducted including 87 patients with CHF and improved LVEF (baseline LVEF ≤35%, LVEF ≥40% at enrollment with absolute increase ≥10%), who underwent ICD (n=34; 39.1%) or CRT-D (n=53; 60.9%) implantation at the Almazov National Medical Research Centre, Ministry of Health of Russia between 2016 and 2022. The primary endpoint was all-cause mortality; secondary endpoints included episodes of inappropriate electrical therapy and complications related to implanted devices. The median follow-up period after enrollment was 5.2±2.8 years. Statistical analysis was performed using StatTech v. 4.8.5 software.

Results. During the follow-up period, 10 deaths (11.9%) were registered: 4 cases among ICD patients (11.8%) and 6 cases among CRT-D patients (12.0%) with no statistically significant differences between groups. The overall rate of device-related complications was 16.1%, with the highest incidence of lead dislodgement (6.9%) and lead damage (4.6%). Inappropriate electrical therapy was registered in 13.8% of patients. Risk factors associated with unfavorable prognosis were identified: ischemic etiology of CHF, valvular heart disease, incomplete recovery of left ventricular systolic function, and atrial fibrillation.

Conclusion. The presence of ICD/CRT-D in patients with CHF and improved LVEF is associated with substantial risks of complications and inappropriate therapy, indicating the need for improvement of personalized approaches to primary SCD prevention in this patient category.

Despite effective prevention of sudden cardiac death in patients with structural heart disease, reducing the burden of ventricular arrhythmias remains a significant clinical challenge. The limited efficacy and potential side effects of antiarrhythmic therapy increase interest in interventional treatment for ventricular tachycardia (VT), which has evolved considerably from open-heart surgery to modern catheter-based techniques. The optimal place for catheter ablation of substrate-related VT and the most effective approaches for these procedures have yet to be established. A thorough understanding of the gaps in evidence, as well as the possibilities and limitations of catheter ablation, is essential for the effective management of patients with structural heart disease-related VT.