M. S. Medved, S. Zubarev, T. Chumarnaya, A. E. Bazhutina, O. Solovyova, D. S. Lebedev
Aim. To identify the features of activation of the right and left ventricles during cardiac conductive system pacing.Methods. There are 2 groups of the study. The cardiac conductive pacing carried in patients of first group. The cardiac conductive pacing not carried in patients of second group. Before and after implantation of the pacemaker, all patients underwent ECG, noninvasive activation mapping using the Amycard software and hardware complex, the width of the QRS, the activation time of the left (LVAT) and right (RVAT) ventricles were determined initially and against the background of pacing. The parameter values are presented in the format: median and interquartile range (Me [25; 75]).Results. The study protocol was performed in 30 patients: first group - 20 patients, second group - 10. The age of the patients was 73 [57; 81] and 71 [63; 75] years, respectively. The value of native QRS complexes in first group was 106 [100; 132] msec, in second group - 144 [109; 155] msec; LVAT 70 [60; 93] msec and 88 [75; 115] msec, respectively; RVAT 62 [50; 74] msec and 85 [67; 117] msec, respectively. There were no statistically significant differences between the groups (p > 0.05) in age, values of native QRS, LVAT, RVAT. The implantable electrode model is identical in both groups. The value of the QRS complex during pacing in first group was 117 [109; 125] msec and 160 [145; 173] msec in second group; LVATp 76 [65; 89] msec and 129 [119; 148] msec, respectively; RVAT 67 [60; 80] msec and 108 [90; 128] msec, respectively. The study revealed statistically significant differences between the two groups of all evaluated parameters against the background of pacing: QRS (p = 0.01), LVAT (p = < 0.01), RVAT (p < 0.01). It should be noted that the initial values and values against the background of pacing of the QRS, LVAT, RVAT complex in patients of group No. 1 did not differ (p > 0.05); in patients of the second group, the values of the QRS, LVAT, RVAT complex initially and against the background of stimulation had significant differences (p = 0.11, p < 0.01 and p = 0.038 respectively).Conclusion. Cardiac conductive system paving is a promising method of cardiac pacing, which allows to achieve activation of the myocardium of the left and right ventricles, which does not differ significantly from activation with a sinus rhythm.
{"title":"Noninvasive activation mapping during the cardiac conductive system pacing","authors":"M. S. Medved, S. Zubarev, T. Chumarnaya, A. E. Bazhutina, O. Solovyova, D. S. Lebedev","doi":"10.35336/va-1251","DOIUrl":"https://doi.org/10.35336/va-1251","url":null,"abstract":"Aim. To identify the features of activation of the right and left ventricles during cardiac conductive system pacing.Methods. There are 2 groups of the study. The cardiac conductive pacing carried in patients of first group. The cardiac conductive pacing not carried in patients of second group. Before and after implantation of the pacemaker, all patients underwent ECG, noninvasive activation mapping using the Amycard software and hardware complex, the width of the QRS, the activation time of the left (LVAT) and right (RVAT) ventricles were determined initially and against the background of pacing. The parameter values are presented in the format: median and interquartile range (Me [25; 75]).Results. The study protocol was performed in 30 patients: first group - 20 patients, second group - 10. The age of the patients was 73 [57; 81] and 71 [63; 75] years, respectively. The value of native QRS complexes in first group was 106 [100; 132] msec, in second group - 144 [109; 155] msec; LVAT 70 [60; 93] msec and 88 [75; 115] msec, respectively; RVAT 62 [50; 74] msec and 85 [67; 117] msec, respectively. There were no statistically significant differences between the groups (p > 0.05) in age, values of native QRS, LVAT, RVAT. The implantable electrode model is identical in both groups. The value of the QRS complex during pacing in first group was 117 [109; 125] msec and 160 [145; 173] msec in second group; LVATp 76 [65; 89] msec and 129 [119; 148] msec, respectively; RVAT 67 [60; 80] msec and 108 [90; 128] msec, respectively. The study revealed statistically significant differences between the two groups of all evaluated parameters against the background of pacing: QRS (p = 0.01), LVAT (p = < 0.01), RVAT (p < 0.01). It should be noted that the initial values and values against the background of pacing of the QRS, LVAT, RVAT complex in patients of group No. 1 did not differ (p > 0.05); in patients of the second group, the values of the QRS, LVAT, RVAT complex initially and against the background of stimulation had significant differences (p = 0.11, p < 0.01 and p = 0.038 respectively).Conclusion. Cardiac conductive system paving is a promising method of cardiac pacing, which allows to achieve activation of the myocardium of the left and right ventricles, which does not differ significantly from activation with a sinus rhythm.","PeriodicalId":504293,"journal":{"name":"Journal of Arrhythmology","volume":"36 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139603704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Revishvili, V. Popov, E. Malyshenko, M. M. Anishchenko, N. V. Popova, M. W. Kadyrova, V. V. Aminov, M. Svetkin
Aim. To identify the predictors of atrial fibrillation (AF) recurrence after simultaneous Maze V procedure in combination with coronary artery bypass grafting.Methods. Medical records of 102 patients with coronary artery disease and concomitant AF were retrospectively reviewed. All patients underwent coronary artery bypass grafting and the combined Maze V procedure. The patients were divided into 2 groups: 51 patients with paroxysmal AF (group I), and 51 patients with non-paroxysmal AF (group II). In group I, 6 cases of AF recurrence were detected (subgroup IA), while 45 patients (subgroup IB) maintained sinus rhythm for the entire follow-up period. Accordingly, in group II, the return of AF was noted in 9 patients (subgroup IIA), sinus rhythm - in 42 patients (subgroup IIB). The follow-up period was 36 months. Clinical and echocardiographic parameters were studied as predictors of AF recurrence.Results. A significant predictor in patients with paroxysmal AF was a recurrence of AF at the hospital stage (odd ratio (OR) 10,25; 95% confidence interval (CI) 1,53-68,20; р=0.032). The duration of the AF history was the main predictor in patients with non-paroxysmal AF (OR 8,8; 95% CI 1,01-76,1; р=0.04). ROC analysis revealed a significant effect on the AF recurrence of left atrium (LA) dimension >48.5 mm, LA volume index >44.4 ml/m2 for patients with paroxysmal AF, and left ventriclular end-diastolic volume > 150 ml for patients with non-paroxysmal AFConclusion. A recurrence of AF at the hospital stage, LA dimension, LA volume index were significant predictors of AF recurrence after coronary artery bypass grafting + Maze V procedure in patients with paroxysmal AF. А long AF history and left ventriclular end-diastolic volume played the role of predictors for patients with non-paroxysmal AF.
目的确定同时进行 Maze V 手术和冠状动脉旁路移植术后心房颤动（房颤）复发的预测因素。方法：回顾性分析 102 例冠心病合并房颤患者的病历。所有患者均接受了冠状动脉搭桥术和 Maze V 联合术。患者被分为两组：51 例阵发性房颤患者（I 组）和 51 例非阵发性房颤患者（II 组）。在 I 组中，发现 6 例房颤复发（IA 亚组），而 45 例患者（IB 亚组）在整个随访期间保持窦性心律。因此，在第二组中，9 名患者（IIA 亚组）发现房颤复发，42 名患者（IIB 亚组）发现窦性心律。随访期为 36 个月。研究将临床和超声心动图参数作为房颤复发的预测因素。阵发性房颤患者在住院阶段房颤复发是一个重要的预测因素（奇数比（OR）10.25；95% 置信区间（CI）1.53-68.20；р=0.032）。房颤病史持续时间是非阵发性房颤患者的主要预测因素（OR 8,8；95% CI 1,01-76,1；р=0.04）。ROC分析显示，左心房（LA）尺寸大于48.5毫米、左心房容积指数大于44.4毫升/平方米（阵发性房颤患者）和左心室舒张末期容积大于150毫升（非阵发性房颤患者）对房颤复发有明显影响。阵发性房颤患者在住院阶段房颤复发、LA尺寸、LA容积指数是冠状动脉旁路移植术+Maze V术后房颤复发的重要预测因素。长期房颤病史和左心室舒张末期容积对非阵发性房颤患者具有预测作用。
{"title":"Predictors of atrial fibrillation recurrence after simultaneous Maze-V procedure and coronary artery bypass grafting","authors":"A. Revishvili, V. Popov, E. Malyshenko, M. M. Anishchenko, N. V. Popova, M. W. Kadyrova, V. V. Aminov, M. Svetkin","doi":"10.35336/va-1246","DOIUrl":"https://doi.org/10.35336/va-1246","url":null,"abstract":"Aim. To identify the predictors of atrial fibrillation (AF) recurrence after simultaneous Maze V procedure in combination with coronary artery bypass grafting.Methods. Medical records of 102 patients with coronary artery disease and concomitant AF were retrospectively reviewed. All patients underwent coronary artery bypass grafting and the combined Maze V procedure. The patients were divided into 2 groups: 51 patients with paroxysmal AF (group I), and 51 patients with non-paroxysmal AF (group II). In group I, 6 cases of AF recurrence were detected (subgroup IA), while 45 patients (subgroup IB) maintained sinus rhythm for the entire follow-up period. Accordingly, in group II, the return of AF was noted in 9 patients (subgroup IIA), sinus rhythm - in 42 patients (subgroup IIB). The follow-up period was 36 months. Clinical and echocardiographic parameters were studied as predictors of AF recurrence.Results. A significant predictor in patients with paroxysmal AF was a recurrence of AF at the hospital stage (odd ratio (OR) 10,25; 95% confidence interval (CI) 1,53-68,20; р=0.032). The duration of the AF history was the main predictor in patients with non-paroxysmal AF (OR 8,8; 95% CI 1,01-76,1; р=0.04). ROC analysis revealed a significant effect on the AF recurrence of left atrium (LA) dimension >48.5 mm, LA volume index >44.4 ml/m2 for patients with paroxysmal AF, and left ventriclular end-diastolic volume > 150 ml for patients with non-paroxysmal AFConclusion. A recurrence of AF at the hospital stage, LA dimension, LA volume index were significant predictors of AF recurrence after coronary artery bypass grafting + Maze V procedure in patients with paroxysmal AF. А long AF history and left ventriclular end-diastolic volume played the role of predictors for patients with non-paroxysmal AF.","PeriodicalId":504293,"journal":{"name":"Journal of Arrhythmology","volume":"8 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139603119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Komissarova, N. Rineiska, A. Efimova, N. Chakova, T. Dolmatovich, S. Niyazova
Aim. To analyze the correlation between genotype and phenotype in patients with biventricular arrhythmogenic right ventricular cardiomyopathy (ARVC).Methods. The clinical phenotype of 9 unrelated probands (89 % men, median age 35 [34; 37]) with biventricular ARVC were observed. The clinical and instrumental examination included a 12-lead ECG, 24-hour Holter ECG monitoring, transthoracic echocardiography and cardiac magnetic resonance imaging with late gadolinium enhancement. Biventricular variant of ARVC was diagnosed according to the 2020 Padua criteria for both right and left ventricles involvement. High-throughput sequencing was utilized to search for mutations in genes linked to the onset of cardiomyopathies and other inherited rhythm disorders. Statistical analysis procedures were performed using the STATISTICA-12 program.Results. In all patients with biventricular ARVC, according to late gadolinium enchansment magnetic resonance imaging, left ventricular involvement of varying degrees was detected, characterized by fibrous or fibrofatty infiltration of the myocardium, as well as regional or global systolic dysfunction. Genotyping in 9 patients with biventricular ARVC revealed 10 variants of the nucleotide sequence of III-V classes of pathogenicity according to the criteria of ACMG (2015) in 4 genes associated with ARVC (PKP2, DSP, DSC2, DSG2). Of these, 7 variants belonged to classes IV and V (PKP2 - 4 mutations, DSP - 2 mutations, DSG2 - 1 mutation); 3 nucleotide substitutions were variants with uncertain significance (VUS, class III) - 2 in DSC2 gene and 1 in DSP gene. A combination of nucleotide variants in two genes (DSP and DSC2) was detected in 1 patient. The findings highlight that mutations in DSP gene were associated with more severe systolic dysfunction and left ventricle dilation compared to carriers of mutations in PKP2 gene. In patients with variants of class III pathogenicity in DSC2 gene the most adverse clinical course of the disease was observed with the early onset of the first sustained ventricular tachycardia and the development of severe dysfunction and dilation of both ventricles requiring heart transplantation in comparison with carriers of mutations in other genes.Conclusion. The results obtained in a cohort of patients with biventricular ARVC demonstrate a specific correlation between genotype and clinical course and disease severity as well.
{"title":"Impact of genotype on clinical course in biventricular arrhythmogenic cardiomyopathy","authors":"S. Komissarova, N. Rineiska, A. Efimova, N. Chakova, T. Dolmatovich, S. Niyazova","doi":"10.35336/va-1269","DOIUrl":"https://doi.org/10.35336/va-1269","url":null,"abstract":"Aim. To analyze the correlation between genotype and phenotype in patients with biventricular arrhythmogenic right ventricular cardiomyopathy (ARVC).Methods. The clinical phenotype of 9 unrelated probands (89 % men, median age 35 [34; 37]) with biventricular ARVC were observed. The clinical and instrumental examination included a 12-lead ECG, 24-hour Holter ECG monitoring, transthoracic echocardiography and cardiac magnetic resonance imaging with late gadolinium enhancement. Biventricular variant of ARVC was diagnosed according to the 2020 Padua criteria for both right and left ventricles involvement. High-throughput sequencing was utilized to search for mutations in genes linked to the onset of cardiomyopathies and other inherited rhythm disorders. Statistical analysis procedures were performed using the STATISTICA-12 program.Results. In all patients with biventricular ARVC, according to late gadolinium enchansment magnetic resonance imaging, left ventricular involvement of varying degrees was detected, characterized by fibrous or fibrofatty infiltration of the myocardium, as well as regional or global systolic dysfunction. Genotyping in 9 patients with biventricular ARVC revealed 10 variants of the nucleotide sequence of III-V classes of pathogenicity according to the criteria of ACMG (2015) in 4 genes associated with ARVC (PKP2, DSP, DSC2, DSG2). Of these, 7 variants belonged to classes IV and V (PKP2 - 4 mutations, DSP - 2 mutations, DSG2 - 1 mutation); 3 nucleotide substitutions were variants with uncertain significance (VUS, class III) - 2 in DSC2 gene and 1 in DSP gene. A combination of nucleotide variants in two genes (DSP and DSC2) was detected in 1 patient. The findings highlight that mutations in DSP gene were associated with more severe systolic dysfunction and left ventricle dilation compared to carriers of mutations in PKP2 gene. In patients with variants of class III pathogenicity in DSC2 gene the most adverse clinical course of the disease was observed with the early onset of the first sustained ventricular tachycardia and the development of severe dysfunction and dilation of both ventricles requiring heart transplantation in comparison with carriers of mutations in other genes.Conclusion. The results obtained in a cohort of patients with biventricular ARVC demonstrate a specific correlation between genotype and clinical course and disease severity as well.","PeriodicalId":504293,"journal":{"name":"Journal of Arrhythmology","volume":"83 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139603931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. I. Mamedova, N. A. Prihod’ko, T. A. Lubimceva, A. V. Kozlenok, D. S. Lebedev
Aim. To compare endocardial and epicardial left ventricular (LV) pacing using real-time electrocardiography (ECG)-synchronized three-dimensional echocardiography (3DE).Methods. Experimental intraoperative study included 88 points obtained from 12 patients with compensated heart failure of II-IV functional class NYHA (LV ejection fraction < 35%) and cardiac resynchronization therapy indications - ECG pattern of complete left bundle branch block (LBBB) and QRS complex duration > 150 ms. During isolated LV pacing as part of cardiac resynchronization therapy implantation procedure endocardial and epicardial stimulation points matched under fluoroscopic control using quadripolar coronary sinus leads and endocardial electrodes for temporary pacing were obtained. The overall number of corresponding pacing sites included 44 endocardial and 44 epicardial stimulation positions. The mean age of patients was 68.5 [63; 73.5] years, 83% males (n=10). Before study enrollment, 12-channel ECG, echocardiography, and a six-minute walk test were performed for all participants along with cardiac magnetic resonance imaging and control coronary angiography if indicated. The prevalence of coronary heart disease was 50% (n=6) while dilated cardiomyopathy was the most common etiology of chronic heart failure in other cases. Intraoperative ECG with estimation of paced QRS complex morphology at each point was registered via LabSystem Pro Electrophysiological Recording System (Bard Electrophysiology, USA). 3DE was performed using TomTec and Philips Qlab 3DQ Advanced software (Philips Medical Systems, USA).Results. Three-dimensional parametric imaging of LV regional segmental excursion and myocardial contractility using 3DE revealed statistically significant difference in semi-quantative parameters such as ExcAvg (p<0.001), ExcMax (p=0.001), ExcMin (p<0.001) and LV ejection fraction based on 3D modelling (p=0.003) while endocardial pacing was more beneficial. During the course of endocardial stimulation, the 3DE dyssynchrony index estimated at the 2nd stimulation site was also significantly lower (p=0.03). Identical dyssynchrony parameters valid for the 16 and 12-segment 3D models (SDI-16, Tmsv-12SD) (at p=0.06) demonstrated only a tendency for significant difference. The duration of QRS complex at the time of endocardial pacing was significantly shorter (<190 [179;215] ms) (p=0.0008). Semi-quantitative and quantitative 3DE parameters showed the benefit of endocardial pacing resulting in cardiac contractility improvement with less dyssynchrony and LV volume reducing during intraoperative period.Conclusion. Endocardial pacing has potential benefit over the epicardial pacing represented by intraoperative dynamics of LV global and local contractility, intraventricular dyssynchrony estimated by 3DE and also ECG criteria. 3DE is helpful in more precise and reproducibile determing of late activation zone for target LV lead placement that is more manoeuvrable in case of endocardial
{"title":"Real-time three-dimensional transthoracic echocardiography in quantification of left ventricular dyssynchrony","authors":"A. I. Mamedova, N. A. Prihod’ko, T. A. Lubimceva, A. V. Kozlenok, D. S. Lebedev","doi":"10.35336/va-1193","DOIUrl":"https://doi.org/10.35336/va-1193","url":null,"abstract":"Aim. To compare endocardial and epicardial left ventricular (LV) pacing using real-time electrocardiography (ECG)-synchronized three-dimensional echocardiography (3DE).Methods. Experimental intraoperative study included 88 points obtained from 12 patients with compensated heart failure of II-IV functional class NYHA (LV ejection fraction < 35%) and cardiac resynchronization therapy indications - ECG pattern of complete left bundle branch block (LBBB) and QRS complex duration > 150 ms. During isolated LV pacing as part of cardiac resynchronization therapy implantation procedure endocardial and epicardial stimulation points matched under fluoroscopic control using quadripolar coronary sinus leads and endocardial electrodes for temporary pacing were obtained. The overall number of corresponding pacing sites included 44 endocardial and 44 epicardial stimulation positions. The mean age of patients was 68.5 [63; 73.5] years, 83% males (n=10). Before study enrollment, 12-channel ECG, echocardiography, and a six-minute walk test were performed for all participants along with cardiac magnetic resonance imaging and control coronary angiography if indicated. The prevalence of coronary heart disease was 50% (n=6) while dilated cardiomyopathy was the most common etiology of chronic heart failure in other cases. Intraoperative ECG with estimation of paced QRS complex morphology at each point was registered via LabSystem Pro Electrophysiological Recording System (Bard Electrophysiology, USA). 3DE was performed using TomTec and Philips Qlab 3DQ Advanced software (Philips Medical Systems, USA).Results. Three-dimensional parametric imaging of LV regional segmental excursion and myocardial contractility using 3DE revealed statistically significant difference in semi-quantative parameters such as ExcAvg (p<0.001), ExcMax (p=0.001), ExcMin (p<0.001) and LV ejection fraction based on 3D modelling (p=0.003) while endocardial pacing was more beneficial. During the course of endocardial stimulation, the 3DE dyssynchrony index estimated at the 2nd stimulation site was also significantly lower (p=0.03). Identical dyssynchrony parameters valid for the 16 and 12-segment 3D models (SDI-16, Tmsv-12SD) (at p=0.06) demonstrated only a tendency for significant difference. The duration of QRS complex at the time of endocardial pacing was significantly shorter (<190 [179;215] ms) (p=0.0008). Semi-quantitative and quantitative 3DE parameters showed the benefit of endocardial pacing resulting in cardiac contractility improvement with less dyssynchrony and LV volume reducing during intraoperative period.Conclusion. Endocardial pacing has potential benefit over the epicardial pacing represented by intraoperative dynamics of LV global and local contractility, intraventricular dyssynchrony estimated by 3DE and also ECG criteria. 3DE is helpful in more precise and reproducibile determing of late activation zone for target LV lead placement that is more manoeuvrable in case of endocardial ","PeriodicalId":504293,"journal":{"name":"Journal of Arrhythmology","volume":"121 24","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139605494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Ilov, D. Stompel, S. A. Boytsov, D. A. Zorin, E. I. Romantcov, A. Nechepurenko
Aim. To study the impact of left ventricle (LV) deformation parameters by the two-dimensional strain method to assess the intended use of cardioverter defibrillator implantation for primary prevention of sudden cardiac death.Methods. The study included 133 patients with congestive heart failure NYHA 3-4 functional class with a LV ejection fraction ≤35%, taking optimal drug therapy. The speckle-tracking echocardiography with the estimation of LV deformation indicators (segmental strains, global longitudinal and circular strain [GLS and GCS, respectively]) was carried out, after which the implantation of defibrillator for the purpose of primary prevention of sudden death was performed. The patients enrolled in the study were observed prospectively for two years after the operation (visits to the clinic after 3, 6, 12, 18, 24 months) for the registration of first-time ventricular tachyarrhythmias (VT) paroxysms and assessment of one-year cardiovascular mortality.Results. The arrhythmic endpoint appeared in 27 patients (20%), 19 patients (14%) died due to acute decompensation of heart failure. Comparative analysis of the studied parameters of LV deformation did not reveal statistically significant differences in the groups of survivors and deceased patients. Patients with VT had the worst deformation characteristics. It was found that at absolute values of GLS<6% the risk of the first VT manifestation during the observation period increased almost threefold (odds ratio (OR)=2.59; 95% confidence interval (CI): 1.07-6.26; p=0.031). The second independent predictor of the arrhythmic point was the longitudinal strain of the anterior wall (OR=1.28; 95%CI: 1.14-1.45; p=0.0001 for univariate analysis and OR=1.55; 95%CI: 1.18-2.04; p=0.002 for multivariate analysis). Based on the multifactor analysis, which included indicators of myocardial deformation, age, sex, and ischemic heart disease, predictive model was obtained to predict VT with 71% sensitivity and 97% specificity. The area under the curve was 0.916 (95%CI: 0.850-0.981; p=0.0001).Conclusion. LV deformation parameters do not help to predict cardiovascular mortality, but may be useful in stratification of VT risk. To achieve this GLS value as well as the segmental map of regional strains can be used.
{"title":"Associations of the left ventricle myocardial deformation parametrs with cardiovascular risk in patients with an implanted cardioverter-defibrillator","authors":"N. Ilov, D. Stompel, S. A. Boytsov, D. A. Zorin, E. I. Romantcov, A. Nechepurenko","doi":"10.35336/va-1249","DOIUrl":"https://doi.org/10.35336/va-1249","url":null,"abstract":"Aim. To study the impact of left ventricle (LV) deformation parameters by the two-dimensional strain method to assess the intended use of cardioverter defibrillator implantation for primary prevention of sudden cardiac death.Methods. The study included 133 patients with congestive heart failure NYHA 3-4 functional class with a LV ejection fraction ≤35%, taking optimal drug therapy. The speckle-tracking echocardiography with the estimation of LV deformation indicators (segmental strains, global longitudinal and circular strain [GLS and GCS, respectively]) was carried out, after which the implantation of defibrillator for the purpose of primary prevention of sudden death was performed. The patients enrolled in the study were observed prospectively for two years after the operation (visits to the clinic after 3, 6, 12, 18, 24 months) for the registration of first-time ventricular tachyarrhythmias (VT) paroxysms and assessment of one-year cardiovascular mortality.Results. The arrhythmic endpoint appeared in 27 patients (20%), 19 patients (14%) died due to acute decompensation of heart failure. Comparative analysis of the studied parameters of LV deformation did not reveal statistically significant differences in the groups of survivors and deceased patients. Patients with VT had the worst deformation characteristics. It was found that at absolute values of GLS<6% the risk of the first VT manifestation during the observation period increased almost threefold (odds ratio (OR)=2.59; 95% confidence interval (CI): 1.07-6.26; p=0.031). The second independent predictor of the arrhythmic point was the longitudinal strain of the anterior wall (OR=1.28; 95%CI: 1.14-1.45; p=0.0001 for univariate analysis and OR=1.55; 95%CI: 1.18-2.04; p=0.002 for multivariate analysis). Based on the multifactor analysis, which included indicators of myocardial deformation, age, sex, and ischemic heart disease, predictive model was obtained to predict VT with 71% sensitivity and 97% specificity. The area under the curve was 0.916 (95%CI: 0.850-0.981; p=0.0001).Conclusion. LV deformation parameters do not help to predict cardiovascular mortality, but may be useful in stratification of VT risk. To achieve this GLS value as well as the segmental map of regional strains can be used.","PeriodicalId":504293,"journal":{"name":"Journal of Arrhythmology","volume":"122 38","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139605481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Enina, T. I. Petelina, N. Е. Shirokov, E. Gorbatenko, A. E. Rodionova, L. I. Gapon
Aim. To investigate the association of testosterone levels (TES) and oxidative stress activity with 10-year survival in men with cardiac resynchronization therapy (CRT).Methods. 86 men with CRT (59.0±9.8 years; 66.3% ischemic cardiomyopathy) were divided into 4 groups: Gr.1 (n=19) TESmedian level; Gr.3 (n=23) TES> medians + MPO < median level; Gr.4 (n=26) TES > median level + MPO > median level. Echocardiography parameters, incidence of ventricular extrasystole, TES in plasma, estradiol, progesterone, dehydroepiandrosterone sulfate, norepinephrine, MPO, NT-proBNP, matrix metalloproteinase, tissue inhibitor of metalloproteinase were assessed. Prognostic level of NT-proBNP was assessed by ROC analysis; 10-year survival was measured by Kaplan-Meier method, factors associated with it were evaluated using Cox regression.Results. The majority of patients were NYHA II and NYHA III for Gr. 3 and Gr.4 respectively (р3-4=0,010). At baseline: there was no difference in echocardiography parameters, levels of NT-proBNP, MPO, steroids, matrix metalloproteinase between groups; tissue inhibitor of metalloproteinase was higher in Gr.2 and Gr.4; the highest norepinephrine levels was in Gr.4. Follow-up: reverse cardiac remodeling was associated with NT-proBNP decreasing and was registered in Gr.4 and Gr. 3. The level of MPO was decreased in Gr.3, Gr.4., and was the highest in Gr.4. The level of estradiol was increased in Gr.1; There were no difference in hormone levels in Gr.2. TES, dehydroepiandrosterone sulfate was increased, but progesterone was decreased in Gr.3 and in Gr.4. The norepinephrine`s levels were increased in all groups. The number of ventricular extrastimuli was increased in Gr.4. Predictive level of NT-proBNP was 756.0 pg/ml (AUC=0.685; p=0.003; sensitivity: 64%, specificity: 68%). The 10-year survival rate was 15.4%; 33.5%; 76.3%; 24.4% for Gr. 1-4 respectively (Log Rank test: Gr.1-2=0.378; Gr.1-3<0.001; Gr.1-4=0.070; Gr.2-3=0.009; Gr.2-4=0.772; Gr.3-4=0.010). The survivance was higher in patients with the best CRT response time (p=0.004), the level of NT-proBNP>756.0 pg/ml (p=0.001) in Gr.1, Gr.2; the best CRT response time (p=0.001), left ventricular ejection fraction (p=0.046), MPO>median (p=0.041), amiodarone administration (0.008) in Gr. 3, Gr. 4.Conclusion. CRT modulates steroidogenesis. Increase of TES and dehydroepiandrosterone sulfate with lower oxidative stress activity is associated with greater reverse cardiac remodeling and better 10-year survival rate. The higher level of TES and simultaneously MPO more than 32.5 pg/ml were related to less reverse cardiac remodeling, higher rate of amiodarone administration by 5.2 times, increasment of ventricular arrhythmias rate and higher relative risk of death by 4.2 times. Relationship between 10-year survival rate and period of best CRT response indicates less physiological nature of forceful modulating effects of CRT.
{"title":"Assotiation of testosterone levels and oxidative stress activity with 10-year survival in men with cardiac resynchronization therapy","authors":"T. Enina, T. I. Petelina, N. Е. Shirokov, E. Gorbatenko, A. E. Rodionova, L. I. Gapon","doi":"10.35336/va-1215","DOIUrl":"https://doi.org/10.35336/va-1215","url":null,"abstract":"Aim. To investigate the association of testosterone levels (TES) and oxidative stress activity with 10-year survival in men with cardiac resynchronization therapy (CRT).Methods. 86 men with CRT (59.0±9.8 years; 66.3% ischemic cardiomyopathy) were divided into 4 groups: Gr.1 (n=19) TESmedian level; Gr.3 (n=23) TES> medians + MPO < median level; Gr.4 (n=26) TES > median level + MPO > median level. Echocardiography parameters, incidence of ventricular extrasystole, TES in plasma, estradiol, progesterone, dehydroepiandrosterone sulfate, norepinephrine, MPO, NT-proBNP, matrix metalloproteinase, tissue inhibitor of metalloproteinase were assessed. Prognostic level of NT-proBNP was assessed by ROC analysis; 10-year survival was measured by Kaplan-Meier method, factors associated with it were evaluated using Cox regression.Results. The majority of patients were NYHA II and NYHA III for Gr. 3 and Gr.4 respectively (р3-4=0,010). At baseline: there was no difference in echocardiography parameters, levels of NT-proBNP, MPO, steroids, matrix metalloproteinase between groups; tissue inhibitor of metalloproteinase was higher in Gr.2 and Gr.4; the highest norepinephrine levels was in Gr.4. Follow-up: reverse cardiac remodeling was associated with NT-proBNP decreasing and was registered in Gr.4 and Gr. 3. The level of MPO was decreased in Gr.3, Gr.4., and was the highest in Gr.4. The level of estradiol was increased in Gr.1; There were no difference in hormone levels in Gr.2. TES, dehydroepiandrosterone sulfate was increased, but progesterone was decreased in Gr.3 and in Gr.4. The norepinephrine`s levels were increased in all groups. The number of ventricular extrastimuli was increased in Gr.4. Predictive level of NT-proBNP was 756.0 pg/ml (AUC=0.685; p=0.003; sensitivity: 64%, specificity: 68%). The 10-year survival rate was 15.4%; 33.5%; 76.3%; 24.4% for Gr. 1-4 respectively (Log Rank test: Gr.1-2=0.378; Gr.1-3<0.001; Gr.1-4=0.070; Gr.2-3=0.009; Gr.2-4=0.772; Gr.3-4=0.010). The survivance was higher in patients with the best CRT response time (p=0.004), the level of NT-proBNP>756.0 pg/ml (p=0.001) in Gr.1, Gr.2; the best CRT response time (p=0.001), left ventricular ejection fraction (p=0.046), MPO>median (p=0.041), amiodarone administration (0.008) in Gr. 3, Gr. 4.Conclusion. CRT modulates steroidogenesis. Increase of TES and dehydroepiandrosterone sulfate with lower oxidative stress activity is associated with greater reverse cardiac remodeling and better 10-year survival rate. The higher level of TES and simultaneously MPO more than 32.5 pg/ml were related to less reverse cardiac remodeling, higher rate of amiodarone administration by 5.2 times, increasment of ventricular arrhythmias rate and higher relative risk of death by 4.2 times. Relationship between 10-year survival rate and period of best CRT response indicates less physiological nature of forceful modulating effects of CRT.","PeriodicalId":504293,"journal":{"name":"Journal of Arrhythmology","volume":"32 38","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139607533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Gasimova, V. V. Shabanov, N. V. Safonov, F. G. Rzayev, A. G. Filatov, P. V. Rogalev, E. Kropotkin, E. N. Mikhaylov
This article brings together the opinions of leading experts in the field of cardiac arrhythmia interventional treatment using multipolar mapping. The advantages and applicability of the PENTARAY® NAV eco mapping catheter are discussed in detail.
本文汇集了使用多极映射技术进行心律失常介入治疗领域的权威专家的观点。其中详细讨论了 PENTARAY® NAV eco 映像导管的优势和适用性。
{"title":"Multipolar mapping in the management of different arrhythmias","authors":"N. Gasimova, V. V. Shabanov, N. V. Safonov, F. G. Rzayev, A. G. Filatov, P. V. Rogalev, E. Kropotkin, E. N. Mikhaylov","doi":"10.35336/va-1297","DOIUrl":"https://doi.org/10.35336/va-1297","url":null,"abstract":"This article brings together the opinions of leading experts in the field of cardiac arrhythmia interventional treatment using multipolar mapping. The advantages and applicability of the PENTARAY® NAV eco mapping catheter are discussed in detail.","PeriodicalId":504293,"journal":{"name":"Journal of Arrhythmology","volume":"34 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139609146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. A. Afanasiev, V. A. Korepanov, N. P. Babushkina, T. Rebrova, E. Muslimova, M. Golubenko, A. A. Garganeeva, T. Atabekov
Aim. To investigate functional state of mitochondria and mitochondrial DNA (mtDNA) polymorphism in coronary artery disease (CAD) patients with life-threatening cardiac rhythm disorders (CRD).Methods. We investigated venous blood samples of 45 patients with uncomplicated CAD and 120 CAD patients with CRD. Oxygen consumption rate of mitochondrias of leukocytes in V3 and V4 states were determined in pyruvate-malate and succinate buffers, as well as in the presence of palmitic acid (PA). In patients with complicated CAD, mtDNA haplogroup and substitutions in gene encoding proteins of the respiratory chain complexes and mitochondrial rRNA were determined. Statistical analysis was performed using Mann-Whitney, Wilcoxon tests and Chi-square test with Yates’ correction.Results. In CAD and CAD with CRD, oxygen consumption rate of intact mitochondria did not different in either pyruvate-malate or succinate buffers. In uncomplicated CAD, PA supplementation increases oxygen consumption rate by mitochondria in both succinate and pyruvate-malate buffers. The majority of patients (41%) with CAD and CRD were carriers of the haplogroup «H» and, in this indicator, the sample did not differ from patients with uncomplicated CAD. However, mtDNA of patients with complicated CAD was characterized by a more frequent combined carriage of two and more missense substitutions in genes of respiratory chain and rRNA.Conclusion. Mitochondria of patients with coronary artery disease and life-threatening cardiac rhythm disorders have reduced functional reserve. The distribution of frequencies of main mtDNA haplogroups of patients with coronary artery disease with life threatening cardiac rhythm disorders corresponds to the population. The mtDNA of such patients is characterized by a high frequency of carriage of combined polymorphisms in gene of electron transport chain proteins and rRNA.
{"title":"Functional ability of mitochondria and mitochondrial genome polymorphism as factors affecting arrhythmogenesis in chronic coronary artery disease","authors":"S. A. Afanasiev, V. A. Korepanov, N. P. Babushkina, T. Rebrova, E. Muslimova, M. Golubenko, A. A. Garganeeva, T. Atabekov","doi":"10.35336/va-1294","DOIUrl":"https://doi.org/10.35336/va-1294","url":null,"abstract":"Aim. To investigate functional state of mitochondria and mitochondrial DNA (mtDNA) polymorphism in coronary artery disease (CAD) patients with life-threatening cardiac rhythm disorders (CRD).Methods. We investigated venous blood samples of 45 patients with uncomplicated CAD and 120 CAD patients with CRD. Oxygen consumption rate of mitochondrias of leukocytes in V3 and V4 states were determined in pyruvate-malate and succinate buffers, as well as in the presence of palmitic acid (PA). In patients with complicated CAD, mtDNA haplogroup and substitutions in gene encoding proteins of the respiratory chain complexes and mitochondrial rRNA were determined. Statistical analysis was performed using Mann-Whitney, Wilcoxon tests and Chi-square test with Yates’ correction.Results. In CAD and CAD with CRD, oxygen consumption rate of intact mitochondria did not different in either pyruvate-malate or succinate buffers. In uncomplicated CAD, PA supplementation increases oxygen consumption rate by mitochondria in both succinate and pyruvate-malate buffers. The majority of patients (41%) with CAD and CRD were carriers of the haplogroup «H» and, in this indicator, the sample did not differ from patients with uncomplicated CAD. However, mtDNA of patients with complicated CAD was characterized by a more frequent combined carriage of two and more missense substitutions in genes of respiratory chain and rRNA.Conclusion. Mitochondria of patients with coronary artery disease and life-threatening cardiac rhythm disorders have reduced functional reserve. The distribution of frequencies of main mtDNA haplogroups of patients with coronary artery disease with life threatening cardiac rhythm disorders corresponds to the population. The mtDNA of such patients is characterized by a high frequency of carriage of combined polymorphisms in gene of electron transport chain proteins and rRNA.","PeriodicalId":504293,"journal":{"name":"Journal of Arrhythmology","volume":"13 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139609293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. A. Aivazian, A. N. Shamatolskiy, A. V. Zakrevskiy, E. A. Mironov, M. V. Ryzanov, A. L. Maximov
Case series of four lead extraction procedures is described in this article. In all cases, indications for transvenous leads extraction were lead disfunction. There were no complications of procedure.
{"title":"Transvenous leads extraction in children: a case series","authors":"S. A. Aivazian, A. N. Shamatolskiy, A. V. Zakrevskiy, E. A. Mironov, M. V. Ryzanov, A. L. Maximov","doi":"10.35336/va-1220","DOIUrl":"https://doi.org/10.35336/va-1220","url":null,"abstract":"Case series of four lead extraction procedures is described in this article. In all cases, indications for transvenous leads extraction were lead disfunction. There were no complications of procedure.","PeriodicalId":504293,"journal":{"name":"Journal of Arrhythmology","volume":"28 43","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139608220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Gagloeva, N. Y. Mironov, K. Dzaurova, M. A. Zelberg, Y. Yuricheva, S. Sokolov, S. Golitsyn
Aim. To compare efficacy and safety of refralon and amiodarone for cardioversion in patients with paroxysmal atrial fibrillation and flutter (AF/AFL). Methods. The study included 60 patients (32 men and 28 women) with symptomatic paroxysmal AF/AFL. All patients underwent a preliminary examination to exclude contraindications to cardioversion. The procedure of pharmacological cardioversion was carried out in the intensive care unit. By the method of envelope randomization, patients were divided into equal groups of refralon and amiodarone, 30 participants each. Both groups did not differ significantly in terms of main clinical characteristics. Cardioversion with refralon consisted of four subsequent iv injections: 5-5 - 10-10 µg/kg of body weight at intervals of 15 minutes. Patients of the second group were intravenously administered amiodarone at a dose of 5 mg/kg of body weight for 20-60 minutes, depending on the tolerability of the drug. In case of AF/AFL maintaining after 60 minutes from the start of administration, the infusion of amiodarone 100 mg/h continued until restoration of sinus rhythm (SR) or until the maximal total dose of 1200 mg/day was reached. Patients were observed for 24 hours.Results. SR restored in 96.7% (29 of 30) of patients in the refralon group, of which 56.7% (17 of 30) - after a dose of 5 μg / kg. In the amiodarone group SR restored in 53.3% (16 of 30) patients (p<0.001). Median time to arrhythmia conversion in refralon group was 14 [7;23] min, while in amiodarone group it was 150 [82;240] min (p<0.001). Within 60 minutes SR was restored in 26 patients in group of refralon and only in 4 patients in group of amiodarone (p<0.001). There were no statistically significant differences in the incidence of major adverse cardiac events, bradyarrhythmias, lowering of blood pressure, and QT prolongation between the groups.Conclusion. In randomized trial Refralon demonstrated higher rate of successful AF/AFL conversion and shorter time to SR restoration than amiodarone. The most of patients restored SR after administration of the lowest dose of refralon, that ensures the safety of cardioversion.
{"title":"Results of a prospective randomized study comparing efficacy and safety of refralon and amiodarone for cardioversion in patients with paroxysmal atrial fibrillation and flutter","authors":"D. Gagloeva, N. Y. Mironov, K. Dzaurova, M. A. Zelberg, Y. Yuricheva, S. Sokolov, S. Golitsyn","doi":"10.35336/va-1289","DOIUrl":"https://doi.org/10.35336/va-1289","url":null,"abstract":"Aim. To compare efficacy and safety of refralon and amiodarone for cardioversion in patients with paroxysmal atrial fibrillation and flutter (AF/AFL). Methods. The study included 60 patients (32 men and 28 women) with symptomatic paroxysmal AF/AFL. All patients underwent a preliminary examination to exclude contraindications to cardioversion. The procedure of pharmacological cardioversion was carried out in the intensive care unit. By the method of envelope randomization, patients were divided into equal groups of refralon and amiodarone, 30 participants each. Both groups did not differ significantly in terms of main clinical characteristics. Cardioversion with refralon consisted of four subsequent iv injections: 5-5 - 10-10 µg/kg of body weight at intervals of 15 minutes. Patients of the second group were intravenously administered amiodarone at a dose of 5 mg/kg of body weight for 20-60 minutes, depending on the tolerability of the drug. In case of AF/AFL maintaining after 60 minutes from the start of administration, the infusion of amiodarone 100 mg/h continued until restoration of sinus rhythm (SR) or until the maximal total dose of 1200 mg/day was reached. Patients were observed for 24 hours.Results. SR restored in 96.7% (29 of 30) of patients in the refralon group, of which 56.7% (17 of 30) - after a dose of 5 μg / kg. In the amiodarone group SR restored in 53.3% (16 of 30) patients (p<0.001). Median time to arrhythmia conversion in refralon group was 14 [7;23] min, while in amiodarone group it was 150 [82;240] min (p<0.001). Within 60 minutes SR was restored in 26 patients in group of refralon and only in 4 patients in group of amiodarone (p<0.001). There were no statistically significant differences in the incidence of major adverse cardiac events, bradyarrhythmias, lowering of blood pressure, and QT prolongation between the groups.Conclusion. In randomized trial Refralon demonstrated higher rate of successful AF/AFL conversion and shorter time to SR restoration than amiodarone. The most of patients restored SR after administration of the lowest dose of refralon, that ensures the safety of cardioversion.","PeriodicalId":504293,"journal":{"name":"Journal of Arrhythmology","volume":"9 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139608512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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