Atrial fibrillation (AF) is the most common arrhythmia. It is diagnosed in more than 33 million people worldwide and is the leading cause of hospitalization for arrhythmias. AF is characterized by fast and irregular atrial activation without discrete P-waves at a surface electrocardiography. AF pathophysiological mechanisms are very complex and include the dynamic interaction between arrhythmia substrate and triggers. Consequently, the clinical search for effective therapeutic targets should include the entire process of the onset and progression of the disease: from the first paroxysms to the development of a stable permanent form of AF.

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

Преимущества применения операционных микро-скопов, микрохирургических инструментов и тонкого «микрохирургического» шовного материала для сшива-ния артерий малого калибра давно доказаны в рекон-структивной хирургии [16]. В начале 70-х гг. микрохирур-гическая техника была внедрена для манипуляции на ко-ронарных артериях (КА), однако эта методика не получи-ла распространения, так как требовала переквалифика-ции хирургов. Кроме того, ошибочно принятое в качестве операции выбора, на протяжении 20 лет, только аутове-нозное коронарное шунтирование (КШ) чаще всего не требовало значительного оптического увеличения и ис-пользования микрохирургических методов [10,20]. Более широкое внедрение множественного аутоартериального КШ, использование бимаммарных, Y-образных кон-струкций, желудочно-сальниковых артерий требует по-вышения прецизионности вмешательства, что обусловли-вает перспективность применения методов микрохирур-гии [15]. С 1985 г. в нашей клинике микрохирургическая техника рутинно применяется в коронарной хирургии [1][2][3]. Однако остается открытым вопрос об эффектив-ности применения операционного микроскопа по срав-нению со стандартной техникой выполнения дистальных анастомозов (ДА). Aim. To compare long-term outcomes of coronary artery bypass surgery using microsurgical and standard technique for distal anastomoses. Material and methods. It was analyzed 10-year results of 193 patients who underwent elective coronary artery bypass grafting (CABG) in 1999-2001. Analysis included survival, angina recurrence, incidence of non-fatal myocardial infarction and reoperation rate. Initially patients were randomized into two groups: microsurgical technique (n=89) and conventional technique (n=104). Survival analysis was performed using Kaplan-Meier method. Results. 10-year survival in case of microsurgical method compared with conventional technique was 84,3 and 70,2% (p=0,03); non-fatal myocardial infarction incidence -9,6 and 21,2% (p=0,03); angina recurrence -14,4 and 25,5% (p=ns); reoperation rate -10,8 and 22,3% (p=0,04), respectively. Conclusion. The use of surgical microscope and microsurgical technique decreases mortality, non-fatal myocardial infarction incidence and reoperation rate. Thus, the use of large optical magnification has a positive effect on survival and efficacy of coronary surgery during follow-up. ИШЕМИЧЕСКАЯ БОЛЕЗНЬ СЕРДЦА 10-year results of coronary artery bypass grafting with microsurgical technique

<p>The increase in indications for cardiac implantable devices had led to an increase in the number of device implantations worldwide, with a corresponding increase in the incidence of complications. Finally, in 1980, the development of methods for removing problematic leads and devices were first attempted. Currently, an average of 10,000–15,000 extractions/year are performed worldwide. Improving the design and technical performance of device leads has been the goal of several scientific and engineering efforts; however, they occasionally continue to fail, potentially leading to adverse clinical outcomes. The preferred technique is transvenous lead extraction, and over the past few decades, its effectiveness has substantially improved. Nevertheless, the extraction procedure is associated with high risks, and these risks should be considered when deciding on the procedure. The present review discusses the issues associated with determining appropriate strategies to reduce the risks associated with lead extraction and identifying accurate indicators for the removal of cardiac implantable device leads.</p><p>Received 17 May 2019. Revised 12 December 2019. Accepted 13 December 2019.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p>

<p>Management of patients with terminal heart failure is one of the most serious ongoing problems in cardiac surgery. In addition, the clinical progression of heart failure is often characterized by cardiac rhythm disturbances, with atrial fibrillation and atrial flutter being the most common types of these disorders. The prognosis may be extremely unfavorable if inappropriate tactics of treatment is used. Development of interventional and minimally invasive surgery expanded the possibilities of treatment of such patients. The article looks at some application features of a hybrid approach to treatment of a patient with atrial flutter and a terminal stage of chronic heart failure.</p><p>Received 3 May 2017. Accepted 24 June 2017.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> The authors declare no conflict of interest.</p>

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