We report a case of two patients with frequent idiopathic premature ventricular contractions. One of them had more than 25% of ventricular contractions per day leading to fast development of cardiomyopathy and its complete regression upon ventricular arrhythmia elimination. The second one had from 40% to 73% of ventricular contractions per day including non-sustained and sustained ventricular tachycardia without any structural changes of the heart during 28 years of follow-up.
{"title":"Number of ventricular premature beats and other causes of cardiomyopathy associated with arrhythmia: case series","authors":"Yu. V. Shubik, A. B. Korneev, A. N. Morozov","doi":"10.35336/va-1237","DOIUrl":"https://doi.org/10.35336/va-1237","url":null,"abstract":"We report a case of two patients with frequent idiopathic premature ventricular contractions. One of them had more than 25% of ventricular contractions per day leading to fast development of cardiomyopathy and its complete regression upon ventricular arrhythmia elimination. The second one had from 40% to 73% of ventricular contractions per day including non-sustained and sustained ventricular tachycardia without any structural changes of the heart during 28 years of follow-up.","PeriodicalId":52704,"journal":{"name":"Vestnik aritmologii","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135113726","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. I. Bashta, L. I. Vilenskiy, Yu. S. Krivosheev, K. V. Modnikov, M. A. Modnikova, A. B. Romanov
Aim. To study the efficacy and safety of laparoscopic mechanical renal denervation. Methods. Thirty sheep with mean weight 92.3±2.1 kg were divided in 2 groups: control group (group I, n=15) and mechanical laparoscopic renal denervation group (group II, n=15). The follow-up period was 6 months. The following parameters were assessed: blood pressure in response to high-frequency electrical intraluminal stimulation, creatinine, blood urea nitrogen test (BUN), damage to the renal arteries according to the result of angiography, the degree of destruction of nerve fibers according to histological examination. Results. All animals were alive during the entire observation period. The creatinine and BUN were within the normal ranges during the observation period. Angiography of the renal arteries did not reveal iatrogenic stenotic lesions. After 6 months in group 2 there was hypertensive response of blood pressure to high-frequency electrical stimulation (increased systolic blood pressure ∆70.27±5.31 (p>0.005), diastolic blood pressure ∆49.87±6.05 (p>0.005)). After 6 months, the animals were euthonised, further histological examination was completed. Histological examination: in the group II, there was swelling and vacuolization of the nerve fiber without signs of demyelination. Conclusions. Laparoscopic mechanical renal denervation is a safe technique. However, the hypotensive effect is short-term.
{"title":"Laparoscopic approach for renal denervation: an experimental study on animals","authors":"D. I. Bashta, L. I. Vilenskiy, Yu. S. Krivosheev, K. V. Modnikov, M. A. Modnikova, A. B. Romanov","doi":"10.35336/va-1167","DOIUrl":"https://doi.org/10.35336/va-1167","url":null,"abstract":"Aim. To study the efficacy and safety of laparoscopic mechanical renal denervation. Methods. Thirty sheep with mean weight 92.3±2.1 kg were divided in 2 groups: control group (group I, n=15) and mechanical laparoscopic renal denervation group (group II, n=15). The follow-up period was 6 months. The following parameters were assessed: blood pressure in response to high-frequency electrical intraluminal stimulation, creatinine, blood urea nitrogen test (BUN), damage to the renal arteries according to the result of angiography, the degree of destruction of nerve fibers according to histological examination. Results. All animals were alive during the entire observation period. The creatinine and BUN were within the normal ranges during the observation period. Angiography of the renal arteries did not reveal iatrogenic stenotic lesions. After 6 months in group 2 there was hypertensive response of blood pressure to high-frequency electrical stimulation (increased systolic blood pressure ∆70.27±5.31 (p>0.005), diastolic blood pressure ∆49.87±6.05 (p>0.005)). After 6 months, the animals were euthonised, further histological examination was completed. Histological examination: in the group II, there was swelling and vacuolization of the nerve fiber without signs of demyelination. Conclusions. Laparoscopic mechanical renal denervation is a safe technique. However, the hypotensive effect is short-term.","PeriodicalId":52704,"journal":{"name":"Vestnik aritmologii","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135779100","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}
E. V. Guseva, N. B. Shlevkov, G. S. Tarasovskiy, V. N. Shitov, H. F. Salami, V. G. Kiktev, M. A. Saidova
Aim. To evaluate the possibility to use parameters of global, segmental longitudinal left ventricle (LV) strain and LV mechanical dispersion (MD) as new possible markers of malignant ventricular tachyarrhythmias (MVT) in patients with structural heart disease and reduced and intermediate LV ejection fraction (EF). Methods. The study included 113 patients (105 male, age 66 [59;73] year) with ischemic (n=89) or non-ischemic (n=24) dilated cardiomyopathy and LVEF<50%, implanted cardioverter-defibrillators, cardiac resynchronization therapy devices-defibrillators, pacemakers or documented MVT. All patients underwent transthoracic echocardiography with an assessment of speckle-tracking echocardiography parameters (global and segmental longitudinal LV strain, LV MD). Comparative univariate and ROC-analyses were performed between patients with and without MVT separately for patients with LVEF <35% (n=60) and LVEF 36-50% (n=53) LVEF. Results. The group of patients with LVEF ≤35% with MVT (n=30) was characterized by lower values of longitudinal strain of the basal segment of the LV septum wall (-5[-6,5;-0,5] vs -6,8[-11;-4.4], р=0,01, respectively) and the middle segment of the LV inferior wall (-3[-6;2] vs -6[-9;-1,5], р=0,04, respectively). The group of patients with LVEF 36-50% with MVT (n=33) was distinguished by a large value of LV end-diastolic volume (166,5[146,3;193] vs 156[133,8;165,5], р=0,04, respectively). The greater values of LV MD were noted in both groups of patients with MVT. The optimal cutoff value of LV MD was 120 ms (area under the ROC curve 0.817, sensitivity-73,3%, specificity-80%) for patients with LVEF≤35%, and 90 ms (area under the ROC curve 0.761, sensitivity-72.7%, specificity-75%) for patients with LVEF 36-50%. Conclusion. Speckle-tracking echocardiography parameters may serve as additional markers of increased risk of MVT in patients with structural heart disease and impaired LVEF. Only LV MD is useful for risk stratification of MVT in patients with either reduced or intermediate LVEF.
的目标。评价在结构性心脏病左室射血分数(EF)降低和中度的患者中，将左室整体、节段性纵向张力和左室机械离散度(MD)参数作为恶性室性心动过速(MVT)新的可能标志的可能性。方法。该研究纳入113例患者(105例男性，年龄66[59;73]岁)，分别为缺血性(n=89)或非缺血性(n=24)扩张型心肌病和LVEF<50%，植入心律转复除颤器、心脏再同步化治疗装置-除颤器、起搏器或记录的MVT。所有患者均行经胸超声心动图，评估斑点跟踪超声心动图参数(整体和节段性左室纵向应变，左室MD)。分别对LVEF为35% (n=60)和LVEF为36-50% (n=53)的LVEF患者进行了MVT患者和非MVT患者的比较单因素和roc分析。结果。LVEF≤35%合并MVT组(n=30)的特点是左室隔壁基段纵向应变值较低(-5[-6,5;-0,5]vs -6,8[-11;-4.4]，分别为0.01)和左室下壁中段(-3[-6;2]vs -6[-9;-1,5]，分别为0.04)。LVEF 36-50%合并MVT的患者组(n=33)以较大的左室舒张末期容积为特征(166,5[146,3;193]vs 156[133,8;165,5]，分别=0,04)。两组MVT患者的左室MD值均较高。LVEF≤35%的患者LV MD的最佳截断值为120 ms (ROC曲线下面积0.817，敏感性73.3%，特异性80%)，LVEF 36-50%的患者LV MD的最佳截断值为90 ms (ROC曲线下面积0.761，敏感性72.7%，特异性75%)。结论。斑点跟踪超声心动图参数可作为结构性心脏病和LVEF受损患者MVT风险增加的附加标记。只有LV MD对低或中度LVEF患者的MVT风险分层有用。
{"title":"Left ventricle mechanical dispersion is a new universal marker of malignant ventricular tachyarrhythmias in patients with structural heart disease","authors":"E. V. Guseva, N. B. Shlevkov, G. S. Tarasovskiy, V. N. Shitov, H. F. Salami, V. G. Kiktev, M. A. Saidova","doi":"10.35336/va-1210","DOIUrl":"https://doi.org/10.35336/va-1210","url":null,"abstract":"Aim. To evaluate the possibility to use parameters of global, segmental longitudinal left ventricle (LV) strain and LV mechanical dispersion (MD) as new possible markers of malignant ventricular tachyarrhythmias (MVT) in patients with structural heart disease and reduced and intermediate LV ejection fraction (EF). Methods. The study included 113 patients (105 male, age 66 [59;73] year) with ischemic (n=89) or non-ischemic (n=24) dilated cardiomyopathy and LVEF<50%, implanted cardioverter-defibrillators, cardiac resynchronization therapy devices-defibrillators, pacemakers or documented MVT. All patients underwent transthoracic echocardiography with an assessment of speckle-tracking echocardiography parameters (global and segmental longitudinal LV strain, LV MD). Comparative univariate and ROC-analyses were performed between patients with and without MVT separately for patients with LVEF <35% (n=60) and LVEF 36-50% (n=53) LVEF. Results. The group of patients with LVEF ≤35% with MVT (n=30) was characterized by lower values of longitudinal strain of the basal segment of the LV septum wall (-5[-6,5;-0,5] vs -6,8[-11;-4.4], р=0,01, respectively) and the middle segment of the LV inferior wall (-3[-6;2] vs -6[-9;-1,5], р=0,04, respectively). The group of patients with LVEF 36-50% with MVT (n=33) was distinguished by a large value of LV end-diastolic volume (166,5[146,3;193] vs 156[133,8;165,5], р=0,04, respectively). The greater values of LV MD were noted in both groups of patients with MVT. The optimal cutoff value of LV MD was 120 ms (area under the ROC curve 0.817, sensitivity-73,3%, specificity-80%) for patients with LVEF≤35%, and 90 ms (area under the ROC curve 0.761, sensitivity-72.7%, specificity-75%) for patients with LVEF 36-50%. Conclusion. Speckle-tracking echocardiography parameters may serve as additional markers of increased risk of MVT in patients with structural heart disease and impaired LVEF. Only LV MD is useful for risk stratification of MVT in patients with either reduced or intermediate LVEF.","PeriodicalId":52704,"journal":{"name":"Vestnik aritmologii","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135729838","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. B. Romanov, A. G. Filippenko, V. V. Shabanov, V. V. Beloborodov, V. A. Boboshko, S. E. Khrushchev, P. S. Ruzankin
Aim. To compare the long-term outcomes of the catheter ablation (CA) using remote magnetic-guided navigation (RMN) and manual radiofrequency CA (MAN) in patients with congenital heart defect (CHD) and incisional atrial tachyarrhythmias (AT). Methods. In this retrospective study cohort, 67 patients were included with CHD and AT. CHD were classified based on complexity (simple, moderate, and complex) according to ACC/AHA guidelines 2008. Fifty-seven (85%) patients underwent at least one surgical procedure for CHD correction before CA. The patients were divided into the two groups regarding CA approach: the MAN group (n=42) and the RMN group (n=25). The primary endpoitnts was long-term freedom from any AT, including atrial fibrillation. Key secondary endpoints included perioperative and late complications. To compare freedom from any AT between the groups, 1:3 propensity score matching was applied, and 63 patients were matched. The matching was exact on CHD complexity. The weighted matched observations were assessed with univariate Cox regression with any AT as the outcome. Results. The median follow-up period was 20 months. In the matched MAN and RMN groups, 92.3% and 83.3% patients, respectively, had incisional АТ (p=0.27), the other patients having additionally AF. The mean fluoroscopy time was statistically significant lower in the RMN group compared with MAN (р=0.009) with longer procedural duration in the RMN group (p<0.001). There was no statistically significant difference in perioperative and late complications. The freedom from any AT 36 months after CA was 78.9% in the matched RMN group and 47.2% in the matched MAN group. The comparison of freedom from any AT between the groups yielded p=0.040, hazard ration 0.32 [95% confidence interval 0.11; 0.95]. Conclusion. RMN CA was superior over manual CA with respect to long-term freedom from AT in patients with CHD with similar safety profile.
{"title":"Remote magnetic-guided catheter ablation versus manual ablation in patients with repaired congenital heart disease and atrial tachyarrhythmias: propensity-matched observational study of long-term results","authors":"A. B. Romanov, A. G. Filippenko, V. V. Shabanov, V. V. Beloborodov, V. A. Boboshko, S. E. Khrushchev, P. S. Ruzankin","doi":"10.35336/va-1214","DOIUrl":"https://doi.org/10.35336/va-1214","url":null,"abstract":"Aim. To compare the long-term outcomes of the catheter ablation (CA) using remote magnetic-guided navigation (RMN) and manual radiofrequency CA (MAN) in patients with congenital heart defect (CHD) and incisional atrial tachyarrhythmias (AT). Methods. In this retrospective study cohort, 67 patients were included with CHD and AT. CHD were classified based on complexity (simple, moderate, and complex) according to ACC/AHA guidelines 2008. Fifty-seven (85%) patients underwent at least one surgical procedure for CHD correction before CA. The patients were divided into the two groups regarding CA approach: the MAN group (n=42) and the RMN group (n=25). The primary endpoitnts was long-term freedom from any AT, including atrial fibrillation. Key secondary endpoints included perioperative and late complications. To compare freedom from any AT between the groups, 1:3 propensity score matching was applied, and 63 patients were matched. The matching was exact on CHD complexity. The weighted matched observations were assessed with univariate Cox regression with any AT as the outcome. Results. The median follow-up period was 20 months. In the matched MAN and RMN groups, 92.3% and 83.3% patients, respectively, had incisional АТ (p=0.27), the other patients having additionally AF. The mean fluoroscopy time was statistically significant lower in the RMN group compared with MAN (р=0.009) with longer procedural duration in the RMN group (p<0.001). There was no statistically significant difference in perioperative and late complications. The freedom from any AT 36 months after CA was 78.9% in the matched RMN group and 47.2% in the matched MAN group. The comparison of freedom from any AT between the groups yielded p=0.040, hazard ration 0.32 [95% confidence interval 0.11; 0.95]. Conclusion. RMN CA was superior over manual CA with respect to long-term freedom from AT in patients with CHD with similar safety profile.","PeriodicalId":52704,"journal":{"name":"Vestnik aritmologii","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135779423","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}
L. E. Korobchenko, H. I. Condori Leandro, A. D. Vakhrushev, E. M. Andreeva, D. S. Lebedev, E. N. Mikhaylov
The aim. The results of ventricular tachyarrhythmia catheter ablation in patients with structural heart diseases remains to be improved. Both evolution of the arrhythmia substrate and its deep location are the main reasons for standard endocardial ablation limitations. Theoretically, the reduction of myocardial perfusion rate may improve convective heating of the myocardium during radiofrequency (RF) ablation, expanding the volume of damage. The purpose of this study was to assess the effect of coronary sinus (CS) occlusion in order to reduce myocardial perfusion during RF ablation on the volume of myocardial damage. Methods. The study was performed on 13 pigs. Following vascular access accomplishment, a balloon catheter was inserted into the lumen of the CS. A 3.5-mm open-irrigated RF ablation catheter was inserted into the cavity of the left ventricle. RF applications were applied in an alternate order, with and without CS occlusion (power 30 and 40W, application time 40 and 30 s, respectively). Each ablation point was marked on a three-dimensional electroanatomic map. After euthanasia, myocardial lesions were analyzed. Results. The analysis of 50 RF applications was performed (22 with CS occlusion and 28 without CS occlusion). At the same time, 28 applications (13 with occlusion and 15 without occlusion) were performed at a power of 40W, and 22 applications (9 with occlusion and 13 without occlusion) at a power of 30 watts. There was a trend toward the increase in lesion sizes created during CS occlusion. Significantly larger lesions were detected with 40W applications during CS occlusion when compared with open CS applications: depth 11.6±3.9 vs. 8.8±3.8 mm (p=0.04), diameter 11.7±4.6 vs. 8.5±3.9 mm (p=0.03), volume 504.2±499.5 vs. 183.0±157.5 mm 3 (p=0.01). Transmural myocardial lesions were more often encountered during applications with CS occlusion with both power settings, 30 and 40W: 68.2% of transmural lesions versus 39.3%; p=0.046. Conclusion. RF applications with a power of 40W and CS occlusion are characterized by greater depth, diameter, and volume of damage, as well as a greater frequency of transmural necrosis. Temporary transcatheter occlusion of CS can be proposed for ablation of ventricular arrhythmia with extended and deep substrate.
的目标。结构性心脏病患者室性心动过速导管消融的效果有待改进。心律失常底物的演变及其深位是标准心内膜消融限制的主要原因。理论上，心肌灌注率的降低可以改善射频消融过程中心肌的对流加热，扩大损伤体积。本研究的目的是评估射频消融过程中冠脉窦(CS)闭塞以减少心肌灌注对心肌损伤体积的影响。方法。该研究在13头猪身上进行。血管通路完成后，将球囊导管插入CS管腔。将3.5 mm开放冲洗射频消融导管插入左心室腔内。射频应用以交替顺序应用，有和没有CS遮挡(功率分别为30和40W，应用时间分别为40和30秒)。在三维电解剖图上标记每个消融点。安乐死后，分析心肌病变。结果。分析了50例射频应用(22例CS闭塞，28例CS不闭塞)。同时，在40W功率下进行28次应用(有遮挡13次，无遮挡15次)，在30瓦功率下进行22次应用(有遮挡9次，无遮挡13次)。CS闭塞时病变大小有增加的趋势。在CS闭塞时，40W应用与开放CS应用相比，病变明显更大:深度11.6±3.9 vs 8.8±3.8 mm (p=0.04)，直径11.7±4.6 vs 8.5±3.9 mm (p=0.03)，体积504.2±499.5 vs 183.0±157.5 mm 3 (p=0.01)。在功率设置为30和40W的CS闭塞应用期间，更常遇到跨壁心肌病变:68.2%的跨壁病变对39.3%;p = 0.046。结论。功率为40W的射频应用和CS闭塞的特点是更大的深度、直径和损伤体积，以及更频繁的跨壁坏死。暂时经导管阻断CS可用于基底延伸和深的室性心律失常的消融。
{"title":"Transcatheter occlusion of the coronary sinus increases radiofrequency ablation lesion size in the left ventricular myocardium: a new approach to improve the efficiency of ventricular tachyarrhythmia substrate destruction","authors":"L. E. Korobchenko, H. I. Condori Leandro, A. D. Vakhrushev, E. M. Andreeva, D. S. Lebedev, E. N. Mikhaylov","doi":"10.35336/va-1207","DOIUrl":"https://doi.org/10.35336/va-1207","url":null,"abstract":"The aim. The results of ventricular tachyarrhythmia catheter ablation in patients with structural heart diseases remains to be improved. Both evolution of the arrhythmia substrate and its deep location are the main reasons for standard endocardial ablation limitations. Theoretically, the reduction of myocardial perfusion rate may improve convective heating of the myocardium during radiofrequency (RF) ablation, expanding the volume of damage. The purpose of this study was to assess the effect of coronary sinus (CS) occlusion in order to reduce myocardial perfusion during RF ablation on the volume of myocardial damage. Methods. The study was performed on 13 pigs. Following vascular access accomplishment, a balloon catheter was inserted into the lumen of the CS. A 3.5-mm open-irrigated RF ablation catheter was inserted into the cavity of the left ventricle. RF applications were applied in an alternate order, with and without CS occlusion (power 30 and 40W, application time 40 and 30 s, respectively). Each ablation point was marked on a three-dimensional electroanatomic map. After euthanasia, myocardial lesions were analyzed. Results. The analysis of 50 RF applications was performed (22 with CS occlusion and 28 without CS occlusion). At the same time, 28 applications (13 with occlusion and 15 without occlusion) were performed at a power of 40W, and 22 applications (9 with occlusion and 13 without occlusion) at a power of 30 watts. There was a trend toward the increase in lesion sizes created during CS occlusion. Significantly larger lesions were detected with 40W applications during CS occlusion when compared with open CS applications: depth 11.6±3.9 vs. 8.8±3.8 mm (p=0.04), diameter 11.7±4.6 vs. 8.5±3.9 mm (p=0.03), volume 504.2±499.5 vs. 183.0±157.5 mm 3 (p=0.01). Transmural myocardial lesions were more often encountered during applications with CS occlusion with both power settings, 30 and 40W: 68.2% of transmural lesions versus 39.3%; p=0.046. Conclusion. RF applications with a power of 40W and CS occlusion are characterized by greater depth, diameter, and volume of damage, as well as a greater frequency of transmural necrosis. Temporary transcatheter occlusion of CS can be proposed for ablation of ventricular arrhythmia with extended and deep substrate.","PeriodicalId":52704,"journal":{"name":"Vestnik aritmologii","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135992655","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}
P. O. Savina, O. V. Blagova, D. Kh. Ainetdinova, A. V. Sedov, I. V. Novikova, E. V. Pavlenko, Yu. A. Lutokhina, S. A. Alexandrova
Aim. To study the spectrum of rhythm and conduction disorders in patients with arrhythmic variant of postcovid myocarditis and determine the treatment approaches. Methods. The study included 23 patients with post-COVID-19 по абстракту разное написание. Post-COVID arrhythmias who had at least two of the three Lake-Louise criteria for myocarditis on magnetic resonance imaging of the heart and/or elevated anticardiac antibody (ACA) titers. The period of occurrence of post-COVID arrhythmias was 4.0 [2.0; 8.0] months, from 2 to 34 months. Echocardiography, Holter monitoring, and ACA study were performed. Cardiac magnetic resonance imaging was performed in 70% of patients (n=16). Coronary artery disease was excluded in 9 patients with risk factors. Results. In all patients’ arrhythmias were associated with COVID-19. Rhythm and conduction disturbances occurred within 2 to 34 months after infection. Echocardiography revealed no left ventricle systolic dysfunction. In all patients, an increase in ACA by 3 or more times was noted, in 65.2% (n=15) a specific antinuclear factor (ANF) was detected, reflecting the high immunological activity of myocarditis. Ventricular arrhythmias in most cases were represented by frequent ventricular extrasystole. Among supraventricular arrhythmias, frequent extrasystoles, non-sustained tachycardia, paroxysmal form of atrial fibrillation were detected. In one case, a transient atrioventricular block II-III degree developed. Treatment approaches included antiarrhythmic and immunosuppressive therapy. All patients underwent Holter monitoring, which showed regression of arrhythmias. Patients with high immunological activity of myocarditis underwent immunosuppressive therapy with methylprednisolone 8-16 mg/day (n=13), with moderate - mild immunosuppressive therapy with hydroxychloroquine 200 mg/day (n=10). When controlling the ACA titers, their decrease was noted. The decrease in the specific ANF titer was close to statistically significant (p=0.057). Interventional treatment of arrhythmias was performed in three patients. Conclusions. Arrhythmias that first developed after COVID-19 require the exclusion of subacute/chronic myocarditis that develops 2-8 months after COVID-19. The spectrum of arrhythmias in patients with post-COVID myocarditis is mostly represented by frequent symptomatic extrasystoles. Basic therapy of the arrhythmic variant of post-COVID myocarditis with methylprednisolone and/or hydroxychloroquine makes it possible to increase the effectiveness of antiarrhythmic drugs with the opportunity of their complete withdrawal in some patients.
{"title":"Arrhythmic variant of post-covid myocarditis: spectrum of rhythm and conduction disorders, treatment approaches","authors":"P. O. Savina, O. V. Blagova, D. Kh. Ainetdinova, A. V. Sedov, I. V. Novikova, E. V. Pavlenko, Yu. A. Lutokhina, S. A. Alexandrova","doi":"10.35336/va-1248","DOIUrl":"https://doi.org/10.35336/va-1248","url":null,"abstract":"Aim. To study the spectrum of rhythm and conduction disorders in patients with arrhythmic variant of postcovid myocarditis and determine the treatment approaches. Methods. The study included 23 patients with post-COVID-19 по абстракту разное написание. Post-COVID arrhythmias who had at least two of the three Lake-Louise criteria for myocarditis on magnetic resonance imaging of the heart and/or elevated anticardiac antibody (ACA) titers. The period of occurrence of post-COVID arrhythmias was 4.0 [2.0; 8.0] months, from 2 to 34 months. Echocardiography, Holter monitoring, and ACA study were performed. Cardiac magnetic resonance imaging was performed in 70% of patients (n=16). Coronary artery disease was excluded in 9 patients with risk factors. Results. In all patients’ arrhythmias were associated with COVID-19. Rhythm and conduction disturbances occurred within 2 to 34 months after infection. Echocardiography revealed no left ventricle systolic dysfunction. In all patients, an increase in ACA by 3 or more times was noted, in 65.2% (n=15) a specific antinuclear factor (ANF) was detected, reflecting the high immunological activity of myocarditis. Ventricular arrhythmias in most cases were represented by frequent ventricular extrasystole. Among supraventricular arrhythmias, frequent extrasystoles, non-sustained tachycardia, paroxysmal form of atrial fibrillation were detected. In one case, a transient atrioventricular block II-III degree developed. Treatment approaches included antiarrhythmic and immunosuppressive therapy. All patients underwent Holter monitoring, which showed regression of arrhythmias. Patients with high immunological activity of myocarditis underwent immunosuppressive therapy with methylprednisolone 8-16 mg/day (n=13), with moderate - mild immunosuppressive therapy with hydroxychloroquine 200 mg/day (n=10). When controlling the ACA titers, their decrease was noted. The decrease in the specific ANF titer was close to statistically significant (p=0.057). Interventional treatment of arrhythmias was performed in three patients. Conclusions. Arrhythmias that first developed after COVID-19 require the exclusion of subacute/chronic myocarditis that develops 2-8 months after COVID-19. The spectrum of arrhythmias in patients with post-COVID myocarditis is mostly represented by frequent symptomatic extrasystoles. Basic therapy of the arrhythmic variant of post-COVID myocarditis with methylprednisolone and/or hydroxychloroquine makes it possible to increase the effectiveness of antiarrhythmic drugs with the opportunity of their complete withdrawal in some patients.","PeriodicalId":52704,"journal":{"name":"Vestnik aritmologii","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135992727","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}
Z. Z. Khalimov, N. S. Bokhan, K. A. Kozyrin, I. N. Mamchur, S. E. Mamchur
A clinical case of successful radiofrequency thoracoscopic ablation of persistent atrial fibrillation after implantation of an occluder in the left atrium appendage is presented.
本文报道一例成功的射频胸腔镜消融在左心房附件植入封堵器后的持续性房颤的临床病例。
{"title":"Thoracoscopic ablation of persistent atrial fibrillation after left atrial appendage occluder implantation: a case report","authors":"Z. Z. Khalimov, N. S. Bokhan, K. A. Kozyrin, I. N. Mamchur, S. E. Mamchur","doi":"10.35336/va-1203","DOIUrl":"https://doi.org/10.35336/va-1203","url":null,"abstract":"A clinical case of successful radiofrequency thoracoscopic ablation of persistent atrial fibrillation after implantation of an occluder in the left atrium appendage is presented.","PeriodicalId":52704,"journal":{"name":"Vestnik aritmologii","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136032619","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}
Aim. To study how the presence of local capture (LC) after pulmonary vein (PV) isolation affects the effectiveness of radiofrequency ablation (RFA) in patients with paroxysmal atrial fibrillation (AF). Methods. The study was a single-center, observational, prospective study. The total number of 186 patients. All patients underwent RFA PV for paroxysmal AF. During the operation, the activity of PV and the presence of LC were assessed. Patients in whom LC after PV isolation occurred in at least one PV were included in the first group; patients in whom LC were absent - in the second group. The first group - 98 patients, the second group - 88. Patients in the groups did not statistically differ in the main indicators - weight, gender, age, duration of anamnesis, left atrium volume and ejection fraction, as well as in the presence of concomitant pathology. The duration of the operation, the time of RFA and time fluoroscopy between the groups also did not differ statistically. Results. Mean observation time for patients was 374.4±25.2 days. In the first group, sinus rhythm was maintained in 82 patients out of 98 (83,7%), in the second group 60 patients out of 88 (68.2%). The difference is statistically significant odds ratio 2.392 (95% confidence interval 1.189 - 4.816, p=0.031). Conclusion. The presence of local captures of the myocardium of the pulmonary veins after radiofrequency isolation is associated with an improvement in the results of treatment of patients with paroxysmal AF.
{"title":"The presence of local captures of the myocardium of the pulmonary veins after radiofrequency isolation improves the outcome of treatment in patients with paroxysmal atrial fibrillation","authors":"V. V. Bazylev, A. V. Kozlov, S. S. Durmanov","doi":"10.35336/va-1186","DOIUrl":"https://doi.org/10.35336/va-1186","url":null,"abstract":"Aim. To study how the presence of local capture (LC) after pulmonary vein (PV) isolation affects the effectiveness of radiofrequency ablation (RFA) in patients with paroxysmal atrial fibrillation (AF). Methods. The study was a single-center, observational, prospective study. The total number of 186 patients. All patients underwent RFA PV for paroxysmal AF. During the operation, the activity of PV and the presence of LC were assessed. Patients in whom LC after PV isolation occurred in at least one PV were included in the first group; patients in whom LC were absent - in the second group. The first group - 98 patients, the second group - 88. Patients in the groups did not statistically differ in the main indicators - weight, gender, age, duration of anamnesis, left atrium volume and ejection fraction, as well as in the presence of concomitant pathology. The duration of the operation, the time of RFA and time fluoroscopy between the groups also did not differ statistically. Results. Mean observation time for patients was 374.4±25.2 days. In the first group, sinus rhythm was maintained in 82 patients out of 98 (83,7%), in the second group 60 patients out of 88 (68.2%). The difference is statistically significant odds ratio 2.392 (95% confidence interval 1.189 - 4.816, p=0.031). Conclusion. The presence of local captures of the myocardium of the pulmonary veins after radiofrequency isolation is associated with an improvement in the results of treatment of patients with paroxysmal AF.","PeriodicalId":52704,"journal":{"name":"Vestnik aritmologii","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135347884","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}
Aim. To evaluate the effectiveness and identify predictors of recurrence after pulmonary veins (PV) cryoballoon isolation patients with atrial fibrillation (AF). Methods. In total, the study included 100 patients who met the selection criteria. Depending on the form and duration of AF paroxysms documented by ECG and Holter monitoring, patients were divided into two groups. The first group included 57 patients with paroxysmal AF (57%), and the second group included 43 patients with persistent AF (43%). Results. As a result of our study, important achievements of the greatest efficiency during cryoballon ablation were identified: isolation of all PV; achievement of the “input-output” block (elimination of spike activity according to the diagnostic electrode in the PV during appplication), which was recorded at a temperature of -30 and more °C; the minimum appplication time is 180 sec after reaching the entry-exit block. An electroanatomical diagram of the left atrium with a high frequency of left atrium and PV activity in patients with paroxysmal and persistent forms of AF was developed. Nine zones with pronounced activity were identified, more pronounced zones with low-amplitude activity in patients with persistent AF. The multivariate Cox analysis showed predictors, an exceptional effect on the risk of AF recurrence after cryoballoon ablation: the presence of diabetes mellitus led to the risk of AF recurrence by 2.39, incomplete isolation of the PV by 3.98 times, the value of left atrial volume index ≥ 61.9 ml/m 2 in 2.91 times, peak atrial longitudinal strain value of left atrium ≤29.3. Conclusion. The results of the study allow us to determine the criteria for high efficiency during cryoballoon ablation, as well as a high-risk group for relapse. When selecting patients for cryoballoon control of PV coronavirus, with the achievement of a greater one, possible factors should be considered: indexed volume of left atrium according to multispiral computed tomography, peak atrial longitudinal strain value of left atrium, absence of diabetes mellitus.
{"title":"Evaluation of efficacy and identification of predictors of recurrence in patients after pulmonary vein cryoballoon ablation","authors":"G. A. Avanesyan, A. G. Filatov","doi":"10.35336/va-1195","DOIUrl":"https://doi.org/10.35336/va-1195","url":null,"abstract":"Aim. To evaluate the effectiveness and identify predictors of recurrence after pulmonary veins (PV) cryoballoon isolation patients with atrial fibrillation (AF). Methods. In total, the study included 100 patients who met the selection criteria. Depending on the form and duration of AF paroxysms documented by ECG and Holter monitoring, patients were divided into two groups. The first group included 57 patients with paroxysmal AF (57%), and the second group included 43 patients with persistent AF (43%). Results. As a result of our study, important achievements of the greatest efficiency during cryoballon ablation were identified: isolation of all PV; achievement of the “input-output” block (elimination of spike activity according to the diagnostic electrode in the PV during appplication), which was recorded at a temperature of -30 and more °C; the minimum appplication time is 180 sec after reaching the entry-exit block. An electroanatomical diagram of the left atrium with a high frequency of left atrium and PV activity in patients with paroxysmal and persistent forms of AF was developed. Nine zones with pronounced activity were identified, more pronounced zones with low-amplitude activity in patients with persistent AF. The multivariate Cox analysis showed predictors, an exceptional effect on the risk of AF recurrence after cryoballoon ablation: the presence of diabetes mellitus led to the risk of AF recurrence by 2.39, incomplete isolation of the PV by 3.98 times, the value of left atrial volume index ≥ 61.9 ml/m 2 in 2.91 times, peak atrial longitudinal strain value of left atrium ≤29.3. Conclusion. The results of the study allow us to determine the criteria for high efficiency during cryoballoon ablation, as well as a high-risk group for relapse. When selecting patients for cryoballoon control of PV coronavirus, with the achievement of a greater one, possible factors should be considered: indexed volume of left atrium according to multispiral computed tomography, peak atrial longitudinal strain value of left atrium, absence of diabetes mellitus.","PeriodicalId":52704,"journal":{"name":"Vestnik aritmologii","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135352294","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. V. Moskovskikh, A. V. Smorgon, S. Yu. Usenkov, E. A. Archakov, E. S. Sitkova, R. E. Batalov, S. V. Popov
Aim. To assess the dynamics of left (LA) and right atrium (RA) strain after antral pulmonary vein isolation in patients with paroxysmal and persistent atrial fibrillation. Methods. The study included 57 subjects (31 men and 26 women) aged of 55.4±9.8 years. Patients were divided into 2 groups: group 1 with paroxysmal atrial fibrillation (n=40; 70%) and group 2 with persistent atrial fibrillation (n=17; 30%). All patients were treated (were undergone) with antral isolation of the pulmonary veins. Speckle-tracking echocardiography at sinus rhythm was performed before interventional treatment, after 3 days, 3 months and one year. The reservoir, conduit and contractile LA function and peak longitudinal RA strain were analyzed. Results. In both groups, reservoir (p<0.001), conductive (p<0.001) and contractile LA functions (p<0.001 and p=0.001) decreased significantly in the early postoperative period. LA mechanics recovered after 3 months in all patients and were comparable to the level before and one year after radiofrequency ablation. RA strain was significantly increased in the early postoperative period. RA strain was significantly higher at one year follow-up period compared with baseline. Conclusion. Catheter ablation has a damaging effect on the LA - inhibition of reservoir, conductive and contractile functions in the early postoperative period, while the RA strain is intensified. LA strain is recovered in 3 months after radiofrequency ablation and remains comparable with the baseline level at one year follow-up. Reservoir and conduction function of LA and longitudinal deformation of RA are better in the patients with a stable sinus rhythm for a year after ablation compared with patiens who had a tachyarrhythmia recurrence.
{"title":"Dynamics of left and right atrial strain after radiofrequency ablation in patients with paroxysmal and persistent atrial fibrillation","authors":"T. V. Moskovskikh, A. V. Smorgon, S. Yu. Usenkov, E. A. Archakov, E. S. Sitkova, R. E. Batalov, S. V. Popov","doi":"10.35336/va-1197","DOIUrl":"https://doi.org/10.35336/va-1197","url":null,"abstract":"Aim. To assess the dynamics of left (LA) and right atrium (RA) strain after antral pulmonary vein isolation in patients with paroxysmal and persistent atrial fibrillation. Methods. The study included 57 subjects (31 men and 26 women) aged of 55.4±9.8 years. Patients were divided into 2 groups: group 1 with paroxysmal atrial fibrillation (n=40; 70%) and group 2 with persistent atrial fibrillation (n=17; 30%). All patients were treated (were undergone) with antral isolation of the pulmonary veins. Speckle-tracking echocardiography at sinus rhythm was performed before interventional treatment, after 3 days, 3 months and one year. The reservoir, conduit and contractile LA function and peak longitudinal RA strain were analyzed. Results. In both groups, reservoir (p<0.001), conductive (p<0.001) and contractile LA functions (p<0.001 and p=0.001) decreased significantly in the early postoperative period. LA mechanics recovered after 3 months in all patients and were comparable to the level before and one year after radiofrequency ablation. RA strain was significantly increased in the early postoperative period. RA strain was significantly higher at one year follow-up period compared with baseline. Conclusion. Catheter ablation has a damaging effect on the LA - inhibition of reservoir, conductive and contractile functions in the early postoperative period, while the RA strain is intensified. LA strain is recovered in 3 months after radiofrequency ablation and remains comparable with the baseline level at one year follow-up. Reservoir and conduction function of LA and longitudinal deformation of RA are better in the patients with a stable sinus rhythm for a year after ablation compared with patiens who had a tachyarrhythmia recurrence.","PeriodicalId":52704,"journal":{"name":"Vestnik aritmologii","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135352468","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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