To perform the comparative analysis of the double-patch correction of partial anomalous pulmonary vein drainage (PAPVD) in the superior vena cava (SVC) with the Warden procedure, 80 patients (40 patients in each group) were assessed and surgically treated in September 2013 through May 2016. In both study groups, two subgroups were identified. In one of them, the operation was performed using sternotomy and cardioplegia; in the other one, under the conditions of minimally invasive thoracotomy and ventricular fibrillation. The sinus node dysfunction (SND) was the primary endpoint. No early mortality was reported. The average stay on the premises of intensive care unit (ICU) was 1 day in both groups. The duration of mechanical ventilation in the double-patch group (DP) and in the Warden procedure group (WP) was similar, as follows: 4 7 hours (mean: 6 hours) and 3 6 hours (mean: 5 hours), respectively (p=0.13). The SND signs, such as sinus bradycardia, low atrial or nodal rhythm were statistically significantly more prevalent in Group I (27.5%) than in Group II (5%) (p=0.01). Temporary pacing was indicated in the DP group more frequently than in the WP group (17.5% and 2.5% of patients, respectively; p=0.02). In 2 cases (5%), an increased blood flow on the level of SVC with a peak gradient of 6 mm Hg and 7 mm Hg during follow-up echocardiography was revealed. No clinical signs of the superior vena cava syndrome were noted in these patients. No cases of the SVC or pulmonary vein stenosis were revealed after DP procedure. The DP correction of PAPVD in SVC was an independent predictor of SND (OR: 7.37; 95% CI: 1.33 40.6; p=0.02). By the discharge from hospital, SND signs had persisted in 7 patients from the DP group (10%) and in 1 patient (2.5%) from the WP group. The pacemaker implantation was indicated in none of them. All patients were discharged in a good condition; the duration of hospitalization was similar (p=0.81): 9 13 days (mean: 10 days) and 9 12 days (mean: 11 days) in Group I and Group II, respectively. The duration of hospitalization was not associated with the type of access during the procedure (p=0.38). Thus, the surgical treatment of PAPVD in SVC using any technique is beneficial with regard to survival, and is accompanied by few complications irrespective of the type of surgical access. SND occurs more frequently in the case of DP access; however, it is benign and terminates spontaneously. The significant stenosis of pulmonary vein and SVC in the early post-operation period after correction of PAPVD in SVC does not seem a medical problem.

To assess efficacy of cardiac contractility modulation (CCM) therapy in patients with chronic heart failure (CHF), 30 Optimizer devices (Impulse Dynamics, Germany) were implanted in 2016, including 27 Optimizer IV devices and 3 Optimizer Smart devices in patients with atrial fibrillation (AF). Most patients suffered from coronary heart disease (87%), 5 of them (17%) had a history of PCI with stenting, and 2 patients (7%) had a history of coronary bypass surgery. Dilated cardiomyopathy was documented in 3 patients (10%) and post-myocarditic cardiosclerosis, in 1 patient (3%). Implantable cardioverters-defibrillators were implanted in 10 patients (33%) and cardiac pacemakers, in 2 patients (6.7%). The indications to implantation of CCM devices were as follows: well-controlled CHF II III (NYHA), left ventricular (LV) ejection fraction (EF) 20 40% according to the echocardiography data, QRS width <130 msec, presence of the sinus rhythm if the Optimizer IV device was implanted, and atrial fibrillation if the Optimizer Smart device was implanted. The study subjects’ assessment included 12 lead ECG, transthoracic echocardiography, 6 minute walk test, N terminal pro-brain natriuretic peptide (NT proBNP) testing, 24 hour Holter monitoring, and the quality of life assessment using Minnesota Living with Heart Failure Questionnaire. The follow-up period was 4±1.4 months for the patients with the Optimizer IV devices and 2 months with the Optimizer Smart devices. In 17 cases (57%), decreased energetic parameters within the effective range in the early postoperation period were required. In 14 patients (46.7%), 3 months after the procedure, the amplitude of stimuli which were previously bothering increased. In 27 patients with CCM devices, LV EF raised on the average by 8%, the quality of life improved on the average by 11 points, NT proBNP decreased by 488 ng/l, and the percentage of paced complexes was 82±12.1%, i.e. more than the recommended %. An improvement (mild increase in LV EF and quality of life) was also found in the three patients with Optimizer Smart devices despite a short follow-up period. Thus, the CHF treatment using implantable CCM devices leads to a considerable improvement of the quality of life and physical working capacity, as well as has an effect on the cardiac contractility parameters in these subjects. At the same time, further detailed studies of the long-term outcomes and safety of the CCM therapy, as well as defining clear indications to reach the maximal effect of the CCM device implantation are needed. The clinical efficacy, the complication rate, and the health economics of CCM therapy should be compared with those for the available treatment techniques with the proven benefit on the quality of life, hemodynamic parameters, hospitalizations, and survival of patients with CHF. Of note, among the surgical methods of CHF management, CCM therapy is considered a minimally invasive intervention; the implantation technique is similar to that of other antiarrhythmic devices.

To study potentialities of improvement of efficacy of radiofrequency ablation (RFA) of recurrent atrial flutter with the aid of intra-procedural imaging of the cavo-tricuspid isthmus (CTI) structures using intracardiac echocardiography, 50 patients aged 63.1±6.9 years (men: 64.5%) were assessed and surgically treated. The radiofrequency ablation was performed in 21 patients (Group I) under control of intracardiac echocardiography and in 29 patients (Group II) under fluoroscopic control. After the procedure, 24 hour ECG Holter monitoring was performed in 6, 12, and 18 months; ECG was recorded during episodes of arrhythmia. The procedure duration was longer in Group I by 7.4±1.9 min. In group I, the fluoroscopy time was significantly shorter (4.0±1.0 min and 6.4±2.5 min, respectively; p=0.003). The bidirectional block in cavo-tricuspid isthmus was reached in 90.1% patients of Group I and 86.2% patients of Group II. Within 18 months of follow-up, the atrial flutter recurrence occurred in 1 patient of Group I (4.8%) and in 5 patients of Group II (17.2%). The cavo-tricuspid isthmus size in Group I was 28±6.4 mm (18 50 mm). In 19 patients (90.4%), the myocardial thickening of more than 7 mm was found in the proximal part of the cavo-tricuspid isthmus; the valve was of conic form, with the length of >14 mm. In two patients (14.3%), a “fossa” in the distal part of cavo-tricuspid isthmus (depth: 7 mm) close to the Eustachian channel was found. Thus, intracardiac echocardiography is a highly effective and safe method of the tachycardia substrate imaging and assessment of the ablative catheter location during the procedure; it permits one to improve the outcomes of isthmus-dependent atrial flutter, as well as to decrease the fluoroscopy exposure of the patient and the medical personnel.

To assess safety and efficacy of preventive ablation of the left atrium (LA) during correction of mitral valve disease with atriomegaly, 40 patients were included in a pilot prospective randomized study. The inclusion criteria were as follows: hemodynamically significant mitral valve disease when its surgical correction was indicated, dilated LA (LA size >60 mm according to the echocardiographic data), sinus rhythm, and no documented evidence of the history of atrial fibrillation (AF). The exclusion criteria were as follows: hemodynamically significant aortic valve disease, coronary lesions when interventions were indicated, and the subject’s refusal to take part in the study. The study subjects were distributed into two following groups: Study Group (n=20) consisted of patients who underwent the surgical prevention of AF; Control Group (n=20) consisted of patients in whom isolated interventions on the mitral valve were carried out. All baseline parameters were similar in both groups. The ablation was performed according to the earlier described technique using non-irrigated bipolar radiofrequency clamp electrode or cryoprobe. The radiofrequency ablation was performed according to the following technique: the right and left pulmonary vein isolation by separate collectors; the LA posterior wall isolation, with a line applied towards the LA appendage. In case of cryoablation, the LA posterior wall isolation, with a line applied towards the LA appendage was performed. The LA appendage was removed from circulation by double-layer continuous suture. The cardiac rhythm was assessed in the early postoperation period using 24-hour Holter monitoring and in 3 months and thereafter using 72-hour Holter monitoring. No hospital mortality was revealed. No significant difference between the groups was found in the pattern and the number of perioperative events. The early postoperative period was characterized by a higher occurrence of paroxysmal AF in Control Group than in the Study Group subjects: 9 patients (45%) and 3 patients (15%), respectively (p=0.009). The analysis of cumulative parameters of occurrence of AF, atrial flutter, or atrial tachycardias showed their predominance in Control Group (log-rank test; p<0.001). It was shown that the predictors of AF occurrence within 12 months of follow-up were as follows: baseline LA size, age, no preventive ablation, male sex, left ventricular ejection fraction, and mitral regurgitation at baseline. Thus, the procedure of surgical AF prevention in the patients with mitral valve defects is safe. The preventive ablation showed a significant benefit of freedom from AF, atrial flutter, or atrial tachycardias in 12 months. The preventive ablation explains a lower annual incidence of AF-associated hospitalizations after mitral valve interventions. Further randomized studies tailored to assess efficacy of the AF surgical prevention are needed.

To assess efficacy and safety of robot-assisted catheter pulmonary vein isolation during interventional treatment of atrial fibrillation, 55 patients with paroxysmal, persistent, and long-term persistent atrial fibrillation were assessed and surgically treated. To assess efficacy and safety of robot-assisted catheter pulmonary vein (PV) isolation during interventional treatment of atrial fibrillation (AF), 55 patients aged 35 72 years (median: 59 years) were surgically treated. The disease history was 6 216 months (median: 48 months; IQR: 24 72 months). The study group included 22 women (40%) and 33 men (60%) with paroxysmal AF (n=43; 78.2%), persistent AF (n=10; 18.2%), or long-term persistent AF (n=2; 3.6%). In 5 patients (9.1%) with paroxysmal AF, the concomitant typical isthmus-dependent atrial flutter was revealed. Prior to the procedure, trans-thoracic echocardiography and multi-spiral computed tomography was performed in all subjects. The procedures were performed under endotracheal anesthesia. The central veins were punctured and catheterized; transseptal catheterization of the left atrium (LA) was performed according to the Ross procedure with subsequent systemic administration of heparin. The anatomic reconstruction of LA and PV was performed using the Carto 3 system. The Artisan telescopic introducer with the Thermocool SF NAV DF irrigated ablative electrode-catheter was placed into LA through the 14F hemostatic introducer. During the antral RFA, the control of catheter pressure on the cardiac wall was performed using the IntelliSense technology. Upon termination of the applications by the circular multipole diagnostic Lasso catheter, the bidirectional conduction block in the area of PV was verified. According to the data of multi-spiral computed tomography of LA and PV, the following anatomic structures were revealed: the common PV collector in 23 patients (41.8%), accessory PV in 7 patients (12.7%), their combination in 7 patients (12.7%), and the standard location of PV in 18 patients (32.8%). The procedure efficacy within the first 6 months assessed in 49 patients was 71.4%. The procedure duration was 90 300 min (median: 180 min). The medical fluoroscopy time was 32 min. The following complications were revealed (n=4; 7.26%): intra-pericardial bleeding (n=3; 5.45%) which required intra-procedural pericardiocentesis and stroke (n=1; 1.81%). The results obtained by the authors were similar to the outcomes of previously conducted studies. The total complication rate revealed by the authors is slightly higher than that documented in an international register: 7.26% and 4.7%, respectively; however, it is similar to that obtained in centers which performed <100 procedures. All complication occurred when the technique was being adopted (the first 25 procedures). Thus, the first experience of application of the robot-assisted navigation system Sensei X was in line with the data of international studies which showed that the technique was effective and safe. The control of pressure on the endocardium, as well as flexibility and stability of the catheter permit one to perform the procedure effectively and rather safely. In case of the complex anatomic structure of LA and PV, application of the technique mentioned above can improve the efficacy and safety of the procedure.

The data are given on the relationship between the sleep breathing disorders (predominantly, obstructive sleep apnea) with atrial fibrillation and their effect on the outcomes in subjects with the arrhythmia.

The role of echocardiography in the risk stratification of sudden death on the basis of the left ventricle ejection fraction and myocardial deformation is discussed.

A case report is given of a 71 year old male patient with chronic heart failure and persistent atrial fibrillation managed with involvement of the cardiac contractility modulation therapy.

Peculiar features of the technique of ostial radiofrequency pulmonary vein isolation in a 58 year-old male patient with persistent atrial fibrillation and triatrial heart (cor triatriatum) are considered.

A case report of Brugada syndrome diagnosed after intravenous administration of Procainamide is given, when, due to recurrent atrial fibrillation, balloon ostial cryoablation of pulmonary veins was performed, and induction of ventricular fibrillation during the electrophysiological study required implantation of a cardioverter-defibrillator.

A possibility of temporary discontinuation of oral anticoagulant therapy is considered in the post-operative period of catheter pulmonary vein ostial isolation in patients with atrial fibrillation if the procedure is performed in clinical centers without possibility of emergency cardiac surgery support.

The results of randomized trials and meta-analyses pertinent to assessment of efficacy and safety of antithrombotic treatment during radiofrequency catheter ablation in patients with atrial fibrillation are considered.