Pulmonary vein capture is a predictor for long-term success of stand-alone pulmonary vein isolation with cryoballoon ablation in patients with persistent atrial fibrillation.

Background: The mechanisms of AF development and progression are still not completely understood. Despite the relative efficacy of ablation, the risk of AF recurrence is substantial, particularly in patients with persistent AF (perAF). At present we do not have any reliable intra-procedural electrophysiologic predictors of long-term success of AF ablation other than pulmonary vein isolation. We evaluated selected intraprocedural pulmonary vein characteristics that may be helpful in future guidance of persistent AF ablation. Methods: 390 consecutive procedures using cryoballoon for initial AF ablation were divided by clinical presentation (paroxysmal or persistent AF), and by pulmonary vein (PV) response to pacing after completion of ablation (discrete electrogram elicited with pacing-"PV capture" or not-"Control"). Patients were followed (median 20 months) for recurrent atrial arrhythmias as the primary end point of the study. Results: PV capture was identified in 20.3% and 17.1% and patients with paroxysmal and persistent AF respectively (ns). In patients with persistent AF presence of PV capture was associated with significantly better outcomes compared to patients without PV capture (p < 0.001). In the group "persistent AF and PV capture", an initial strategy of PV isolation and reisolation of the PVs (without additional lesions) for patients with recurrent atrial arrhythmias resulted in 20/23 (87%) patients in sinus rhythm off antiarrhythmic medications at study completion. In patients with paroxysmal AF, PV capture was not associated with outcome benefits. Specific electrophysiologic characteristics of PV (PV capture cycle length: PVCCL) did not have an impact on AF recurrence, although 25% shortening of PVCCL was observed after 60 s periods of pacing at short cycle lengths. No background demographic patient characteristic differences were identified between patients with vs. without PV capture. Conclusion: The presence of PV capture was associated with better outcomes in patients with persistent AF. PV capture may identify those patients with persistent AF in whom cryoballoon PV isolation alone is sufficient as an initial ablation procedure and as the primary ablation strategy for recurrent AF.

Overview of the current electrophysiology (EP) state of affairs in Russia.

Russia is the largest country in the world based on the landmass, covering more than one-eighth of the earth's inhabited area. Russia faces challenges in electrophysiology (EP) care including insufficient and uneven financing, complicated system for identifying optimal treatment for individual patients, relative paucity of reasonable educational and certification scope for electrophysiologists, suboptimal national statistical data gathering regarding heart rhythm disorders and EP devices in use, and weak networking of medical information. In comparison with the average level of EP utilization in ESC countries, Russia utilizes around 50% in pacemaker; 10% in ICD; 8% in cardiac resynchronization therapy; 55% in ablations; and 45% in AF ablations. As projected, Russia has the biggest unmet demand in EP procedures, so-called developmental potential in the European region. Nearly 37% of implanted single-chamber and 63% dual-chamber devices are manufactured outside of Russia. The price of the Russian devices is slightly (by 10-20%) lower than the one imported and they are readily provided for patients by the Russian Ministry of Health. Based on the analysis of the data available, we suggest some strategies for the improvement of the EP care in Russia. Solutions include the institution of formal EP education and standardization of it, development of international educational, and scientific collaboration; implementation quality-assessment tools for professional knowledge and skills; wide application of national medical databases and collection of heart rhythm disorders' statistics; growth of financial support of electrophysiology and transparent distribution of financing between state/municipal and private medical centers; enhancement of medical care accessibility countrywide; development of technologies for local EP devices production; and collection of data regarding usage and effectiveness of it.