[Improvement of the technique of positioning the endocardial electrodes of the cardiac contractility modulation device in patients with CHF with reduced ejection fraction and atrial fibrillation].

AIM: To evaluate the efficacy and safety of the advanced technique for positioning the endocardial electrodes of a cardiac contractility modulation (CCM) device. MATERIALS AND METHODS: The CCM system was implanted in 100 patients, of which 60 CCM electrodes were positioned in the most optimal zones of myocardial perfusion, in particular, in the zone of the minor focal-scar/fibrotic lesion (the Summed Rest Score of 0 to 1-2, the intensity of the radiopharmaceutical at least 30%), and in 40 patients according to the standard procedure. Before the implantation of the CCM system, 60 patients underwent tomography (S-SPECT) of the myocardium with 99mTc-methoxy-isobutyl-isonitrile at rest to determine the most optimal electrode positioning zones and 100 patients underwent transthoracic echocardiography at baseline and after 12 months to assess the effectiveness of surgical treatment. RESULTS: Improved ventricular electrode positioning technique is associated with the best reverse remodeling of the left ventricular myocardium, especially in patients with ischemic chronic heart failure, with less radiation exposure to the surgeon and the patient, and without electrode-related complications. CONCLUSION: At the preoperative stage, it is recommended to perform a synchronized single-photon emission computed tomography of the myocardium with 99mTc-methoxy-isobutyl-isonitrile at rest before implantation of the CCM device to assess the presence of scar zones/myocardial fibrosis in the anterior and inferior septal regions of the interventricular septum of the left ventricle, followed by implantation of ventricular electrodes in the zone of the minor scar/fibrous lesion, which will allow to achieve optimal stimulation parameters, increase the effectiveness of CCM therapy, reduce the radiation exposure on medical personnel and the patient during surgery.

[Efficacy and Safety of Nonfluoroscopic Approach During Catheter Ablation of Ventricular Tachycardias].

Aim      To evaluate a possibility of using radiofrequency catheter ablation guided by intracardiac echocardiography (ICE), its efficacy and safety for treatment of ventricular tachycardia (VT) of various etiology.Material and methods  Catheter intervention was performed for 20 enrolled patients with symptomatic VT. Ablation procedures were guided by a 3D electroanatomical mapping system and ICE.Results Mean duration of the procedure was 201.2±62.5 min. The procedure was successful (non-inducibility of VT) in 100% of cases. None of the patients had postoperative complications.Conclusion      Ablation of VT arrhythmogenic substrate guided by 3D electroanatomical navigational mapping and ICE without X-ray is feasible and safe.

[The effectiveness of cardiac contractility modulation in patients with chronic heart failure and atrial fibrillation: results of the 12-month follow-up].

AIM: To evaluate the efficacy, safety and effect on the prognosis of cardiac contractility modulation (CCM) in patients with chronic heart failure (CHF) with reduced left ventricular ejection fraction and atrial fibrillation compared with the group of only optimal drug therapy (ODT) of the 12-month follow-up. MATERIALS AND METHODS: Patients (n=200) were sequentially included in two groups: group 1 patients with CHF who are on ODT in combination with implanted CCM devices (n=100), group 2 comparison patients with CHF who receive only ODT (n=100). Initially and after 12 months, 12-channel electrocardiography (ECG), transthoracic echocardiography, daily ECG-monitoring, determination of the level of NT-proBNP, a six-minute walk test and an assessment of the quality of life according to the Minnesota Questionnaire were performed. RESULTS: In the CCM therapy group, a significant clinical improvement was revealed, which was expressed in the form of a decrease in functional class CHF by NYHA (New York Heart Association), an increase in the distance of a six-minute walk test and an improvement in the quality of life according to Minnesota Questionnaire, as well as an improvement in left ventricle contractile function compared to the ODT group. The absence of a proarrhythmogenic effect of the CCM was shown. There was a significant decrease in the frequency of the readmission due to CHF and the probability of achieving the combined endpoint in the CCM therapy group compared with only ODT. CONCLUSION: The use of CCM in patients with CHF and atrial fibrillation is an effective and safe method of therapy that leads to the development of reverse remodeling of the myocardium, improves the clinical status of patients and reduces the frequency of readmission due to decompensation of CHF.

[Experience of complex application of cardiac contractility modulation by Optimizer Smart System and endovascular mitral valve repair by the MitraClip System in the treatment of heart failure].

A 58-year-old female patient with severe chronic heart failure and mitral regurgitation receiving an optimal drug therapy was implanted with an Optimizer Smart device for modulation of cardiac contractility and underwent transcatheter mitral plasty using a MitraClip system. The complex therapy resulted in a significant clinical improvement and beneficial dynamics of echocardiographic parameters.

The Use of Transvenous Lead Extraction of Non-Infected Leads to Prevent Long-Term Lead-Related Complications.

The aim of the investigation was to study the issue of making challenging decisions concerning abandonment or removal of non-infected superfluous leads during lead revisions or cardiac implantable electronic device upgrades. Materials and Methods: From 2010 to 2019, a total of 482 patients who had undergone cardiac implantable electronic device implantation in the past were admitted to hospital for generator replacement or lead revision. In 126 patients, 155 malfunctioning leads were found. Mean age of the patients was 59.2±16.7. Total venous occlusion was found in 10 cases of these patients. All patients were divided into two groups: extracted leads group (n=83) and abandoned leads group (n=43). The main factor which influenced our strategy was the mean age of the lead. In group 1 the mean age of the lead was 6.9±5.6 years. In group 2 it was about 12 years. Results: Lead extraction was performed by manual traction in 69 (61.7%) leads, by lead locking device in 32 (28.5%) leads, and 11 (9.8%) leads were removed using TightRail rotating dilator sheath. In 1 case of total occlusion of the superior vena cava, we performed a video-assisted thoracoscopic lead extraction at the time of vein occlusion recanalisation and electronic device reimplantation. In abandoned leads group 3 patients had lead-related complications. Conclusion: Transvenous lead extraction with the mean age of the lead less than 10 years is an effective and safe strategy. Preventive transvenous lead extraction of non-infected leads allows avoiding lead-related complications in the long-term period.

[Dynamics of Holter electrocardiogram monitoring in patients with chronic heart failure and atrial fibrillation on the background of cardiac contractility modulation].

AIM: To evaluate the dynamics of cardiac arrhythmias on the background of cardiac contractility modulation (MCC) in patients with chronic heart failure (CHF) and various forms of atrial fibrillation (AF) on the basis of daily electrocardiogram (ECG) monitoring. MATERIALS AND METHODS: In 100 patients with CHF and AF, the following studies were performed before implantation of the MCC device and after 12 months of follow-up: 12-channel ECG with an estimate of the width of the QRS complex, transthoracic echocardiography (EchoCG), and Holter ECG monitoring. All patients received long-term optimal drug therapy for CHF before surgery. RESULTS: The results obtained indicate that there is no effect of MCC on the development and progression of ventricular arrhythmias in patients with CHF and AF during the year of follow-up, both extrasystole and tachyarrhythmias, regardless of the etiology and LVEF (less than 35% or more than 35%), and a decrease in the frequency of AF paroxysms in patients with CHF during treatment. These results are due to the reverse remodeling of the LV myocardium under the influence of the MCC device. CONCLUSION: The use of MСС in patients with CHF and AF is a safe method of therapy that does not induce cardiac arrhythmias, including ventricular extrasystole. Large-scale comparative studies are required to evaluate these results.

[Implantable loop recorders for prolonged heart-rhythm monitoring in patients with cryptogenic stroke]. / Dlitel'noe monitorirovanie EKG u patsientov s kriptogennym insul'tom po dannym petlevogo implantiruemogo registratora.

OBJECTIVE: The timely diagnosis of atrial fibrillation (AF) in patients with cardiac embolism with implantable loop recorders (ILR). MATERIAL AND METHODS: Twenty-nine patients, hospitalized within 6 months after stroke (n=19) or transient ischemic attack (n=10), were included in the study. ILR were implanted in all cases. The mean time of follow-up was one year. RESULTS: Five hundred and thirteen transmissions were detected during the whole follow-up period. Symptomatic episodes were recorded in 165 cases. Such episodes as bradycardia, asystole, AF, atrial tachycardia and ventricular tachycardia were recorded in 98 cases out of 348 planned transmissions. All transmissions were analyzed by an operator. However, 70 cases were false-positive because of ILR over-sensing. In total, arrhythmias were detected in 5 patients, including sick sinus syndrome (1), supraventricular tachycardia (1), ventricular tachycardia (1) and atrial fibrillation (3). Anticoagulant therapy was started immediately after the diagnosis of AF. CONCLUSION: Loop recording monitoring is an effective strategy in patients with cardiac embolism for timely diagnosis and further treatment of arrhythmia.

[Complications of the Catheter Treatment of Atrial Fibrillation: Stenosis of All Pulmonary Veins after Radiofrequency Ablation].

Radiofrequency ablation is the "gold standard" in atrial fibrillation treatment. The frequency of complications is about 3.5-3.9 %. The symptomatic pulmonary vein stenosis is one of the most severe complications. In this report we present a clinical case of stenosis of all four pulmonary veins after redo catheter ablation of atrial fibrillation in 61year-old patient, and discussion of possible causes, specific features of diagnosis, and possible approaches to treatment of this complication.

Possibilities and perspectives of using cardiac contractility modulation in patients with chronic heart failure and atrial fibrillation.

Heart failure is one of the main health care problems all over the world. Although, there are many drugs with proven effectiveness and hi-tech devices, there is a continuous process of searching new possibilities in heart failure prophylaxis going on because of huge economic burden and impact on life quality. Developing of atrial fibrillation in heart failure patients increases the risks of hospitalization and all-cause mortality. Appearance of new Optimizer Smart® system of cardiac contractility modulation is a perspective way of treatment in patients with heart failure and atrial fibrillation, who are not a candidate or have not got a good result from cardiac resynchronization therapy (CRT).

Diagnostic utility of long-term remote ECG monitoring in compare with 24 hour Holter monitoring in patients with atrial fibrillation after catheter radiofrequency ablation in the early postoperative period.

AIM: To evaluate the diagnostic utility of long-term remote monitoring of ECG compared with 24 hour Holter monitoring for the detection of cardiac arrhythmias and conduction disturbance in patients with atrial fibrillation (AF) after catheter radiofrequency ablation (RFA; isolation) of the pulmonary veins. MATERIALS AND METHODS: The study included 62 patients aged 58.5±11.1 years, with paroxysmal or persistent AF, after catheter RFA (pulmonary veins isolation). Patients underwent long-term remote ECG monitoring, 24 hour Holter monitoring and transthoracic echocardiogram. RESULTS: After 24 hour Holter monitoring of 62 patients with AF after RFA in 21 of them (33.9%) was detected early recurrence of AF. Remote ECG monitoring of 18 patients, detected AF in 7 patients (39%), 2 of them were asymptomatic AF recurrence. 24 hour Holter monitoring of the same 18 patients AF recurrence was not detected at all (0%). CONCLUSION: Both of devices, long-term remote monitoring of ECG and 24 hour Holter monitoring detected 45.2% of recurrence of AF. Over the wearing of both devises 24 hour Holter and long-term remote monitor the last detected more events among 18 patients (33% vs 0%). Two evens of AF recurrence were asymptomatic.

[Catheter Isolation of Pulmonary Veins in a Patient With Paroxysmal Atrial Fibrillation After Repair of Interventricular Septum With a Xeno-Pericardial Patch].

Catheter radiofrequency ablation of focal atrial fibrillation was successfully performed in a patient after closure of interventricular septal defect with a xeno-pericardial patch and plastic of tricuspid valve. The case demonstrates feasibility of carrying out such interventions under intracardiac echocardiographic guidance in patients with disturbed anatomy and complicated access to the left atrium.

[Catheter Isolation of Pulmonary Veins in a Patient With Paroxysmal Atrial Fibrillation After Repair of Interventricular Septum With a Xeno-Pericardial Patch].

Catheter radiofrequency ablation of focal atrial fibrillation was successfully performed in a patient after closure of interventricular septal defect with a xeno-pericardial patch and plastic of tricuspid valve. The case demonstrates feasibility of carrying out such interventions under intracardiac echocardiographic guidance in patients with disturbed anatomy and complicated access to the left atrium.

[The Role of Intracardiac Echocardiography in Clinical Practice].

The article contains review of possibilities of the method of intracardiac echocardiography (ICE) in clinical electrophysiology, delineation of indications to its use, and perspectives of development of this technology. Characteristics of technical variants of the method and special features of their application are also given. Technique of performance of interventions under ICE control is described in detail. Foreign experience of ICE use is summarized, and own experience is presented.