Aim. To evaluate endocrine profile, biomarkers of heart failure, 5-year survival of cardiac resynchronization therapy (CRT) male responders living in the Far North (FN) and the south of Tyumen region (sTr).

Methods. Fifty-six CRT male responders (with decrease of left ventricular end-systolic volume >15% in November 2020) under the age of 65 (55.0±7.8 years old) were divided into 2 groups: 1(n=23) - FN patients; 2 (n=33) - sTr. Echocardiography (Echo), thyroid-stimulating hormone (TSH), triiodothyronine (fT3), thyroxine (fT4), parathyroid hormone (PTH), cortisol (CORT), testosterone (TES), estradiol (E2), dihydroepiandrosterone sulfate (DHEAS), progesterone (PGN), adrenaline (Adr), norepinephrine (NAdr), interleukins (IL) 6, 10, tumor necrosis factor (TNF-α), C-reactive protein (CRP), NT-proBNP, myeloperoxidase (MPO), matrix metalloproteinase (MMP-9 ), tissue inhibitor of metalloproteinases (TIMP-1) were assessed. Relationship of hormones with Echo, biomarkers was evaluated by Spearman method, 5-year survival - by Kaplan-Meier method, and association of lastmentioned with studied factors - by Cox regression.

Results. Radiofrequency ablation of atrioventricular junction (RFA AVJ) were differed in groups (47.8 vs 21.2%; p=0.036). At the initial stage, in group 1, right ventricle, Adr, TNF-α, CRP, TIMP-1, CORT, TSH, fT4 were greater, fT3/fT4 was lower. In groups, reverse cardiac remodeling was revealed in dynamics; decrease of TIMP-1, PGN in Gr1; decrease of NT-proBNP, TIMP-1, MPO, PGN, increase of TES, E2, TNF-α in Gr2,. Positive associations of TSH, PTH and negative - DHEAS with Echo; positive connections between PGN, CORT and MMP-9; TES with NAdr; E2 with IL-10 were registered. Five-year survival rate was 80.7% vs 83.4% (Log Rank test=0.724), associated with IL-6 level in northerners.

Conclusion. Multihormonal imbalance, manifested by greater levels of CORT, TSH, fT4, lower values of fT3/fT4, accompanied by sympatho-adrenal, immune activation, fibroformation imbalance, higher power of RFA AVJ, indicates greater severity of heart failure, tension of adaptive mechanisms in CRT male responders of FN. CRT modulating effects in groups contributed to comparable 5-year survival associated with level of IL-6 in northerners.

Aim. To assess safety and effectiveness of zero fluoro catheter ablation (CA) of tachyarrhythmias in patients with antiarrhythmic device.

Methods. One hundred ninety-seven patients with implanted antiarrhythmic device and indication for catheter ablation of tachyarrhythmias were included in retrospective study. In control group of patients n=63 (mean age 65.5±11.9 years) all procedures were performed under fluoroscopic guidance. In a study group, n=134 (mean age 66.1±15.6 years) all procedures were performed without the use of fluoroscopy. To reconstruct 3D anatomy we used navigation systems: magnet and impedance. In some cases we used intracardiac ultrasound. In the first group there were 65% of patients with pacemakers, 4.8% patients with implantable cardioverters-defibrillators and 30.2% of patients had cardiac resynchronization systems. In second 70.1%, 12.7% and 17.2% respectively. In control group CA was performed within 24 hours after device implantation in 13 patients (20.6%), in study group - 23 (17.2%). In the rest cohort of patients mean period between device implantation and CA was 29.26±28 months - in control group, 38.8±39 months. Antiarrhythmic device programming was performed before and right after CA.

Results. Interventional catheter procedure was performed in 98.4% of patients in control group and in 98.5% of patients in study group. Radiation exposure in control group was 0.24 mZv, in study group 0 mZv. There were no conversions from zero fluoroscopy procedure to X -ray controlled due to different reasons. In control (fluoroscopy controlled) group 8 hours after CA ventricle lead dislodgement was diagnosed. Antiarrhythmic device in this patient was implanted 6 days before CA. There were no lead dislodgements or cardiac pacing disorders in study group.

Conclusion. Zero fluoroscopy CA of tachyarrhythmias in patients with antiarrhythmc device is as safe and effective as standard fluoroscopy controlled procedure.

The aim of the study was to analyze the factors influencing the mortality prognosis for atrial fibrillation (AF) among the adult population of the Kuzbass region.

Methods. 576 patients with AF were included in the study. During a three-year follow-up death was recorded in 54 (9.4%) patients. An analysis of factor s associated with mortality was carried out. Multiple logistic regression, Quasi-Newton measurement method, ROC analysis were used, the critical significance level was 0.05.

Results. According to the conducted study data, a statistically significant increase in the chance of a fatal outcome was revealed in individuals with a history stroke (odds ratio (OR) 2.47 [1.06-5.75]), with a body mass index (BMI) equal to or higher than 32.4±6.8 kg/m² (OR 1.07 [1.01-1.14]), with an increase in the ventricular rate (VR) of AF equal to or higher than 84.2±15.4 beats per minute (OR 1.02 [1.00-1.04]) and the risk of thromboembolic complications according to the CHA₂DS₂ VASc scale equal to or higher than 4.3±2.3 points (OR 1.12 [1.04-1.21]). A decrease in creatinine clearance (CC) according to Cockcroft-Gault was associated with a high risk of adverse outcome (OR 0.99 [0.98-1.00]). At the same time, the fact of irregular intake of anticoagulant therapy was associated with a high probability of death, but did not depend on which anticoagulant was prescribed.

Conclusions. According to the results of a complex analysis it was revealed that patients with AF who have a history of stroke, high values of BMI, ventricular rate AF, CHA₂DS₂ VASc were more often having an unfavorable outcome.

Aim. To present the experience of lead implantation in patients with cardiac implantable electronic devices (CIED) and access veins stenoses/occlusions, evaluate the effectiveness and safety of different methods and propose a decision-making algorithm for the method of new lead implantation in such patients.

Methods. The study includes 31 patients with CIED and access veins obstruction, which required implantation of new leads. Leads were implanted after recanalization of the veins with hydrophilic wires through long introducers, or after transvenous lead extraction (TLE) using TightRail sheath.

Results. Recanalization of veins using guidewires followed by lead implantation through a long introducer was performed in 24 patients, in 9 of them, after recanalization as the second step during the same procedure, TLE was performed. TLE without preliminary recanalization with guidewire was performed in 5 patients. In two patients, leads were implanted after vein puncture medial to the occlusion. Successful new leads implantation was performed in all patients. Decision making algorithm for the method of leads implantation through obstruction veins in various clinical situations is proposed.

Conclusions. Recanalization of occluded veins with guidewire and TLE in patients with CIED are effective methods for providing ipsilateral access for lead implantation through obstructed veins. The safety of TLE in patients with access vein obstruction requires further study.

Aim. Search for predictors of early recurrence of atrial tachyarrhythmias after radiofrequency ablation (RFA) of atrial fibrillation (AF).

Methods. The study included 57 subjects with persistent (n = 17; 30%) and paroxysmal (n = 40; 70%) forms of AF, admitted for the RFA. All patients underwent transthoracic echocardiography, assessment of deformation of both atria using 2D Strain, computed tomography (CT) with 3D reconstruction of the left atrium (LA). Intraoperatively, high-density voltage mapping of LA was performed before RF pulmonary vein isolation. All patients underwent follow-up after 3 months.

Results. Recurrence of atrial tachyarrhythmia after 3 months was recorded in 17.5% of patients. High prevalence of low-amplitude activity zones in the LA and persistent AF were the strongest predictors. The LA reservoir function below 21.7%, the conduction function below 15.7%, the LA stiffness index above 0.314 relative units, the LA volume with the appendage above 121.7 ml, and the LA vertical size according to CT data above 65.5 mm statistically significantly predicted early recurrences of atrial tachyarrhythmias with high sensitivity and specificity.

Conclusion. The decreased LA deformation in the reservoir and conductor phase, increased LA stiffness index, the prevalence of low-amplitude activity zones, vertical size and volume of the LA with an auricle according to CT data and persistent AF are significant predictors of early relapses after interventional treatment of AF.

Aim. The aim of this study was to develop additional selection criteria for implanted cardioverter-defibrillator (ICD) implantation in the primary prevention of sudden cardiac death (SCD) based on the risk stratification for the development of sustained ventricular tachycardia (VT).

Methods. The study included 451 patients with heart failure and reduced left ventricular ejection fraction (HFrEF) who were referred for ICD implantation for primary prevention of SCD. Participants underwent pre-implantation screening of clinical, instrumental, and laboratory parameters, followed by prospective observation for 24 months to record the first occurrence of sustained VT or justified ICD therapy. To achieve the study’s goal, training and test samples were formed.

Results. The arrhythmic endpoint was recorded in 84 patients (26%) in the training group and in 35 patients (27%) in the test group. Univariate analysis identified 11 factors with the highest predictive potential (p<0.1) associated with the occurrence of the studied endpoint. These included clinical data: coronary artery disease, arterial hypertension, resting heart rate >80 bpm; electrocardiographic parameters: complete left bundle branch block according to Strauss criteria, P-wave duration (lead II) >120 ms, or the presence of atrial fibrillation (in the case of persistent form), index of cardiac electrophysiological balance (ICEB) >3.1; echocardiographic parameters: presence of eccentric left ventricular hypertrophy, global longitudinal strain ≥ minus 6%; laboratory markers: galectin-3 >12 ng/ml, sST-2 >35 ng/ml, NT-proBNP >2000 pg/ml. Based on the regression coefficients, points were assigned to each factor, and the sum of these points determined the value of a new proposed index - the arrhythmic risk index (ARI). ARI values >5 points predicted the two-year likelihood of VT in HFrEF patients with a sensitivity of 78.6% and specificity of 64.3% (AUC=0.788±0.028 with 95% confidence interval (CI): 0.732-0.843; p=0.0001). The application of ARI in the test group demonstrated good model performance in predicting two-year VT risk (AUC=0.652±0.053 with 95% CI: 0.547-0.757; p=0.008).

Conclusion. Based on the obtained results, a predictive index was developed, allowing for personalized and timely risk assessment of VT in patients with HFrEF.

The aim is to assess the relationship between systolic, diastolic, and pulse blood pressure (SBP, DBP, PBP) during ventricular extrasystoles (VE) and the individual characteristics of ectopic beats.

Methods. The primary method of investigation was BP measurement for each heartbeat. Inclusion criteria were the presence of ≥10000 monomorphic VE per day. A total of 53 patients were included, either without structural heart changes or with minimal structural alterations. The mean of systolic, diastolic, and pulse BP (SBP, DBP, and PBP) during VE (SBP VE, DBP VE, PBP VE) and during post-extrasystolic sinus contraction (post VE SBP, post VE DBP, post VE PBP) were calculated for each patient as fractions of 1.0.

Results. The QRS complex width in VE originating from the right ventricular outflow tract is greater than from the left ventricular outflow tract; fragmentation of the QRS complex is more commonly observed in these VE. Significant correlations were observed between SBP VE and mean coupling interval (CI), PBP VE and CI, and SBP VE and PBP VE, though not between DBP VE and CI. DBP VE was significantly associated with VE count and daily VE percentage, while PBP VE was associated with left ventricular ejection fraction. It has been shown that post-VE SBP and post VE DBP are lower, while post VE PBP is higher compared to the corresponding parameters of sinus beats preceding the VE. Significant relationships were found between post VE SBP and post VE PBP, the duration of the post-extrasystolic pause, and the presence of paired VE; between post VE DBP and post VE PBP, DBP VE, CI VE, the presence of non-sustained ventricular tachycardia, and daily VE percentage; between post VE PBP and DBP VE, the presence of non-sustained ventricular tachycardia, daily VE percentage, and post-extrasystolic pause duration. Post VE PBP was equally determined by values of post VE SBP and DBP.

Conclusion. With the shortening of the VE coupling interval, its SBP decreases, while DBP increases slightly, which may determine its hemodynamic significance. In post-extrasystolic sinus beats, both SBP and DBP decrease.

A case of a child with the breath-holding spells (BHS), atrioventricular block and long pauses of heart rhythm till 12 sec is presented. The attacks began at 1 year and completely stopped at 3 years. A typical ECG pattern for BHS is identified. The issues of therapy and the need for implantation of pacemaker are discussed.

A clinical case of patient with implanted system subcutaneous cardioverter-defibrillator and cardiac contractility modulation device is described. No violations were identified in the joint operation of the devices.

Atrial fibrillation (AF) is the most common arrhythmia among the adult population, affecting up to 2% of the population. Among patients with chronic heart failure (CHF), the prevalence of AF reaches 12.3%. The presence of common risk factors and pathophysiological mechanisms of AF and CHF development lead to the frequent combination of these two pathologies, which has a negative impact on the course of the underlying disease and further prognosis, increasing the chances of adverse outcomes such as stroke, myocardial infarction, and cardiovascular mortality. The results of most randomized studies indicate that interventional treatment of AF in patients with CHF and intermediate to low left ventricular ejection fraction (LV) contributes to reducing the functional class of CHF and improving quality of life, but at the same time, there is currently no consensus on the effectiveness, safety, and extent of catheter intervention. In this review, we attempted to summarize the literature data regarding the outcomes of interventional treatment of AF in patients with systolic LV dysfunction.

The article presents the results of a transesophageal electrophysiological study of a 39-year-old patient with a combination of an accessory pathway and dissociation of the atrioventricular node into fast and slow conduction zones. The criteria for identifying slow anterograde conduction along the accessory pathway and a rare mechanism for inducing paroxysmal reciprocal atrioventricular nodal tachycardia are discussed.