[Possible complications of catheter ablation of atrial fibrillation].

Atrial fibrillation (AF) is the commonest form of disturbed cardiac rhythm. Hundreds of thousands of AF ablations are annually performed worldwide using different energy sources. One of the most popular methods is radiofrequency catheter ablation (RFA). This treatment is fraught with various risks being a highly complicated technical procedure. This review paper presents data on the most frequent complication of RFA, their frequency, causes, diagnosis, treatment and prevention. Much attention is given to the recognition and prevention of possible complications.

[Changes in myocardial damage markers after radiofrequency ablation in patients with arrhythmias]. / Kharakter izmeneniia markerov povrezhdeniia miokarda pri protsedure radiochastotnoi abliatsii u bol'nykh s aritmiiami.

The aim of this study was to evaluate myocardial cell damage after radiofrequency ablation (RFA), one of the most effective methods for the treatment of arrhythmias. Thirty patients aged 30.4 +/- 8.6 years were examined. Biochemical parameters were evaluated repeatedly 6-18 h after RFA. Positive troponin T (Tn-T) test and increased CK-Mb activity (p < 0.22) were observed in 8 patients (group 1), while in group II Tn-T test was negative. Biochemical findings in group I correlated with the results of ECG body surface mapping (STT) (negative area), duration and number of RFA lesions. Myocardial damage was detected using 3 cardiac markers: myo/CK-Mb and Tn-T. These testing should be carried out in due time repeatedly, in order to catch the STT maps and biochemical parameters were in high correlation after RFA. Presumably, T-wave abnormalities in Tn-T-negative group after RFA were due to the cardiac memory phenomenon. Myo/CK-Mb after RFA in Tn-T-positive group coincided with that in acute myocardial infarction. Hence, myocardial damage after RFA can be confirmed by the Tn-T test, which is helpful in the differential diagnosis of minor myocardial damage and cardiac memory phenomenon.

[The electrophysiological diagnosis and surgical treatment of atrial flutter]. / Elektrofiziologicheskaia diagnostika i khirurgicheskoe lechenie trepetaniia predserdii.

From 1982 to the late 1990 thirty-three patients with tachysystolic atrial fibrillation refractory to preventive antiarrhythmic therapy were examined and operated on. Invasive electrophysiological investigation was a must in the preoperative examination. The "entrainment" and "adaptation" effects of the refractory periods of different parts of the atria were estimated depending on the duration of the basic cycle of pacing. After provoking atrial flutter paroxysm the place of the early appearance of A spike was determined and endocardial mapping was performed. During intraoperative mapping, the data of low-amplitude and fragmented activity were processed by a computer; the sequence of electric activation of the atria was determined on flutter. 20 transthoracic operations with extracorporeal circulation were made. Of these, there were 7 operations of laser or cryogenic isolation of the AB node, 30 of laser photo ablation, and 9 of cryodestruction of the arrhythmogenic areas. In a female patient, resection of the terminal crest and sinoatrial node followed by implantation of a pacemaker was performed in the AAI mode. Closed operations involved both transvenous electrodestruction of the arrhythmogenic areas (5 patients) and destruction of the His bundle with the development of complete transverse block and implantation of the pacemaker in the VVI mode. The best results were attained in young persons with Type I idiopathic atrial flutter where areas of fragmented and low-amplitude activity could be accurately specified.