This is a prospective multicenter registry of atrial fibrillation (AF) ablation with the Ablation Index (AI) technology, which has been introduced as a marker predicting ablation lesion depth. The index incorporates the main parameters of radiofrequency point-by-point ablation: power, contact force, and time of ablation. The AI is calculated for every operator depending on personal skills, and there are no strict indications on the range of the parameter considering its safety and efficacy during pulmonary vein isolation. The registry aims to evaluate AI values used in different centers by different operators and to evaluate the optimal limits associated with better acute and long-term AF ablation results.

<p><strong>Aim.</strong> Endoscopic surgery demonstrates promising results of treatment in patients with non-paroxysmal atrial fibrillation. Minimally invasive thoracoscopic ablation contributes to the growing interest in such operations all over the world. Nowadays totally thoracoscopic ablations are available for patients in Russian Federation. Emphasis in our study was placed on the collection and analysis of data on thoracoscopic ablation procedures used for treating patients with lone atrial fibrillation.</p><p><strong>Methods.</strong> The study covered the operations performed by Russian cardiac surgeons over a period up until January 1, 2018. Data collection was based on emailed registration forms containing information about the date of procedures, type of ablation pattern, previous catheter procedures, used devices, methods of left atrial appendage closure and safety profile information. 30-day mortality, conversion to sternotomy/thoracotomy, stroke/ transient ischemic attack, reexplorations, cardiac tamponade and phrenic nerve damage were considered as major complications.</p><p><strong>Results</strong>. The study encompassed 10 cardiosurgical centers in Russian Federation where totally thoracoscopic ablations had been carried out between 2011– 2018. Six hundred fifty-two procedures were registered. Most patients were ablated in Dallas and Box Lesion patterns. Left atrial appendage exclusion was performed in 90,4% patients. Major complications were observed in 27 (4%) patients, mostly during the “learning curve” period.</p><p><strong>Conclusion.</strong> The given study is the first attempt to collect and systematize the data on a new surgical procedure for treatment of patients with atrial fibrillation. The data obtained allow for making a conclusion that thoracoscopic ablation is becoming a wide-spread surgical technique to treat patients with lone atrial fibrillation in Russia. The quantity of procedure increases annually. Introducing thoracoscopic procedures in clinical practice may be accompanied by complications at any center. Nevertheless, according to our investigation the rate of complications is low, which enables us to recommend thoracoscopic ablation to treat a numerous cohort of atrial fibrillation patients in Russia.</p><p>Received 13 June 2018. Revised 22 July 2018. Accepted 23 July 2018.</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>

Purpose Our study aimed to assess the achievement of target ablation index (AI) values and their impact on first-pass pulmonary vein isolation (FPI) as well as to identify FPI predictors. Methods Atrial fibrillation (AF) ablation was performed according to the local practice, and target AIs were evaluated. The actual AI was calculated as the median value of all ablation points for the anterior and posterior left atrial (LA) walls. Results A total of 450 patients from nine centers were enrolled. Patients with first-time ablation ( n = 408) were divided into the FPI and non-FPI groups. In the FPI group, a higher median target AI was reported for both the anterior and posterior LA walls than those in the non-FPI group. A higher actual AI was observed for the anterior LA wall in the FPI group. The actual AI was equal to or higher than the target AI for the posterior, anterior, and both LA walls in 54%, 47%, and 35% ( n = 158) cases, respectively. Parameters such as hypertension, stroke, ablation power, actual AI value on the anterior wall, target AI values on both LA walls, AI achievement on the posterior wall, carina ablation, and operator experience were all associated with FPI in a univariate logistic regression model; only carina ablation was an independent predictor of FPI. Conclusions According to our multicenter study, FPI and a target AI were not achieved in a significant proportion of AF ablation procedures. Higher actual and target AI values were associated with FPI, but only carina ablation can independently predict FPI.

This article describes the patient selection procedure for subcutaneous cardioverter-defibrillator implantation, the implantation technique, and the features of postoperative follow-up of patients, the features of programming at all stages of patient treatment.

The choice of an optimal, most safe and physiological place in the heart for the electrode implantation is an issue to be solved by a specialist in surgery of heart arrhythmias. According to the literature, the techniques to stimulate both cardiac apex and other alternative areas are imperfect. At present, stimulation of the heart conduction system, namely, the His bundle is considered a promising area in arrhythmology. This type of stimulation is a physiological one, while it involves the His-Purkinje system. We present a successful clinical case of the electrode implantation with a two-chamber pacemaker to the heart conduction system in a 67-year-old patient with permanent atrial fibrillation. The surgical intervention made it possible to reduce the QRS length from 180 to 110 ms. This clinical case shows that the heart conduction system pacing allows for implementation of the principles of physiological stimulation in patients with impaired atrioventricular conduction. The technique with a two-chamber pacemaker is feasible in clinical practice.

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Objective of the research: to study the results of levosimendan use in young children with heart failure (HF) of functional class IV (FC). Materials and methods: the analysis of observation of patients who received levosimendan: 2 with cardiomyopathies (CMP), 12 with congenital heart defects (CHD). The drug was administered intravenously 0,2 μg/kg/min. Results: in patients with CMP, the ejection fraction doubled after administration of levosimendan, in children with CHD heart contractility increased by 18%, and pulmonary artery pressure decreased by 17 mm Hg. There were no undesirable effects. Conclusion: administration of levosimendan provides an increase in cardiac output and a decrease in pulmonary resistance in children with HF IV FC without undesirable effects.

The article provides a review of international clinical studies on the use of a subcutaneous implantable cardioverter-defibrillator (ICD) in comparison with classical intravenous defibrillation systems. Subcutaneous ICDs have shown themselves to be a worthy alternative to intravenous defibrillating systems for the primary prevention of sudden cardiac death, when the patient is not indicated for anti-tachy stimulation and anti-brady stimulation. World experience on the use of subcutaneous ICDs proves the safety and effectiveness of the functioning of the subcutaneous ICD system, excluding from the patient’s life the formidable risks associated with the implantation procedure and further functioning of the classical intravenous ICD system.