[Cardiac resynchronization therapy in patients with permanent atrial fibrillation].

UNLABELLED: In our study we compared effect of cardiac resynchronization therapy (CRT) in chronic heart failure (CHF) patients with permanent atrial fibrillation (AF) and patients with sinus rhythm. Special feature of our work was that patients with permanent atrial fibrillation didnt have obligatory ablation of atrio-ventricular node but underwent aggressive rate control to achieve more than 90% of biventricular (BV) complexes. We used 24 hours Holter monitoring because there are data that this method is more accurate than CRT counters. METHODS: We included 30 patients: 21 patients with sinus rhythm and 9 patients with permanent AF with ejection fraction <35%, II-IV NYHA class and wide QRS (>120 ms). We examined patients before implantation of CRT and after 6 months. RESULTS: mean NYHA class decreased from III to II. Distance at 6-min walk test increased by 107 m in AF group and by 105 in sinus rhythm group. EF increased by 7% in AF group and by 6% in sinus rhythm group. Mean time of further observation was 2 years (from 10 months to 5 years). There was 1 death (11.1%) in AF group and 3 deaths (15%) in sinus rhythm group (p>0,05). CONCLUSION: CRT is effective in CHF patients with permanent AF and pharmacological rate control if percent of BV pacing is more than 90% on Holter monitoring.

[Cardiac resynchronizing therapy. Selection of patients and their management after implantation of biventricular heart pacemaker].

Chronic heart failure (CHF) - a widely spread manifestation of various forms of heart diseases - is characterized by high mortality. Prognosis is especially unfavorable in patients with wide QRS complex. Method of resynchronizing therapy was elaborated for the treatment of this group of patients in addition of medical therapy. Its efficacy for improvement of clinical course and prognosis of CHF was demonstrated in a number of randomized controlled trials. However according to some data in 30-45% of cases application of the method is associated with no clinical improvement or reversal of cardiac remodeling when standard criteria (left ventricular ejection fraction less or equal 35%, QRS 120-150 ms, functional class II-IV) are used for patients selection. In this review we consider possibilities of various methods of selection of patients providing maximal probability of efficacy. We also present analysis of techniques of detection of implantation site of left ventricular lead and various tactics of management of patients after implantation of biventricular pacemaker.

[Electrophysiological effects and antiarrhythmic activity of novel domestic class III antiarrhythmogenic drug niferidil administered in patients with paroxismal supraventricular tachycardia].

Intracardiac electrophysiological effects and antiarrhythmic activity of novel domestic class III antiarrhythmogenic drug niferidil has been studied in a group of 25 patients with paroxismal supraventricular tachycardia (PSVT) diagnosis. The drug was administered in a dose of 20 mg/kg (i.v.). Niferidil injections increased the refractory periods in both right and left atrium (by 22 and 20%, respectively, p < 0.001), right ventricle (12%, p < 0.01), and the His-Purkinje system (34%, p < 0.001) and improved additional anterograde and retrograde conduction (by 22 and 31%, respectively, p < 0.001), while not influencing the conduction via excitable cardiac tissues. Elongation of the QTc interval (22%, p <0.05) in one case was accompanied by an arrythmogenic effect (induction of short-term polymorphous ventricular tachycardia of the "torsade de pointes" type. Niferidil arrested PSVT in 78% cases and prevented PSVT development in response to endocardial stimulation in 86% of patients.

[Antitachycardia and resynchronization devices in the treatment of heart failure and prevention of sudden death].

According to the modern ideas of the heart failure pathogenesis the noticeable contribution introduces ventricular dissynchrony which essence consists of the electrical and mechanical dissociation of different segments of the myocardium. In recent years the new method of cardiac resynchronization therapy has been worked out and achived good results. Its main purpose is the resynchronization of the heart by three-chamber or biventricular stimulation, which leads to an improvement of the effectiveness of heart activity. At the same time implanted cardioverter-defibrillator systems are actively used in the complex treatment of heart failure as a mean of sudden cardiac death prevention. In this article we present results of main international studies, which reveal clinical effectiveness of both methods for decreasing total mortality and frequency of hospitalizations, prolonging life span, and improving quality of life.