The use of radiofrequency ablation (RFA) for the management of supraventricular tachycardia (SVT) in infants and small children remains controversial. The aim of this study was to evaluate the safety and efficacy of RFA in critically ill small children (<1 year of age) with drug-resistant tachycardia accompanied by arrhythmogenic cardiomyopathy and heart failure. The study included 15 patients age 5.3 ± 3.7 months. Wolff-Parkinson-White syndrome and atrial tachycardia were detected in eight (53.3 %) and seven (46.7 %) of patients, respectively. Patients with structural heart pathology, including congenital heart diseases and laboratory-confirmed myocarditis, were excluded from the study. Indications for RFA included drag-refractory SVT accompanied by arrhythmogenic cardiomyopathy and heart failure. Unsuccessful ablation was observed in two 1-month-old patients who underwent successful ablation 3 months later. The follow-up period ranged from 0.5 to 8 years (average 3.9). Only one patient (6.7 %) had tachycardia recurrence 1 month after RFA. The short- and long-term RFA success rates were 86.7 and 93.3 %, respectively. The study did not show any procedure-related complications. Heart failure disappeared within 5-7 days. Complete normalization of heart chamber sizes was documented within 1 month after effective RFA. A three-dimensional CARTO system (Biosense Webster, Inc., USA) was used in three patients with body weight >7 kg. The use of the CARTO system resulted in a remarkable decrease of the fluoroscopy time without vascular injury or other procedure-related complications in all cases. Our study suggests that RFA may be considered the method of choice for SVT treatment in small children when drug therapy is ineffective and arrhythmogenic cardiomyopathy progresses.

Цель. Оценить клинические и гемодинамические параллели у детей дошколь-ного возраста с аритмиями в различных возрастных группах. Материал и методы. Обследовано 195 детей с идиопатическими аритмиями в возрасте от 0 до 7 лет -82 пациента с синдромом WPW, 55 детей с пред-сердными тахикардиями, 7 детей с АВУРТ, 13 -с желудочковыми тахикарди-ями (ЖТ), 38 детей с желудочковыми и наджелудочковыми экстрасистолиями (изолированной, групповой и их сочетанием). Возрастные группы: 1 -дети до 1 года (n=72; 37%); 2 -дети от 1 до 3 лет (n=37; 19%); 3 -дети от 3 до 7 лет (n=87; 44%). Всем пациентам проводилось общеклиническое обследование, электрокардиография в 12 стандартных отведениях, Холтеровское монитори-рование, эхокардиография. Результаты. При анализе вариантов течения тахикардий выявлено прео-бладание пароксизмального течения тахикардии у детей от 3 до 7 лет (p=0,001) и постоянного течения тахикардии у детей до 1 года (p<0,001). Частота приступов при пароксизмальных тахикардиях у детей до 1 года была выше по сравнению с детьми от 1 до 3 лет (p=0,028) и детьми от 3 до 7 лет (p<0,001). При оценке показателей ЭхоКГ у детей с аритмиями в зави-симости от возраста выявлено значимое преобладание признаков АКМП у старших детей по отношению к младшим (p=0,002). Проявления сердеч-ной недостаточности (СН) в большей мере оказались свойственны детям до 1 года по сравнению с детьми от 1 до 3 лет и от 3 до 7 лет (F=44,117; p=<0,001). Заключение. Таким образом, аритмогенное ремоделирование сердца в большей степени свойственно детям в возрасте от 3 до 7 лет. У пациентов с аритмиями в возрасте до 1 года клинические проявления СН сопровожда-ются диастолическими нарушениями, предшествующими развитию АКМП, которую традиционно принято считать систолической дисфункцией. К факто-рам, влияющим на данные гемодинамические закономерности, относятся высокая среднесуточная ЧСС, склонность тахикардий к постоянному и непре-рывно-рецидивирующему течению, большая частота приступов при пароксиз-мальных тахикардиях у детей до 1 года. Aim. To study clinical and hemodynamic parallels in preschool children with arrhythmias in different age groups. (p=0,028) and 3-7 y. o. children (p<0,001). In assessment of echocardiography of arrhythmic children depended on age there was significant prevalence of ACMP in older children comparing to the younger (p=0,002). Signs of heart failure were more common in children of 1 y. o. comparing to those of 1-3 and 3-7 y. o. (F=44,117; p=<0,001). Conclusion.So the arrhythmogenic heart remodeling mostly common for the children of 3 to 7 y. o. In less 1 year infants with arrhythmias clinical signs of HF are followed by diastolic disorders that develop before ACMP development, that is traditionally regarded as systolic dysfunction. Into the factors that influence these hemodynamic relations we include high mean heartrate, tendency of tachicardias to recurrent and permanent course, high frequency of attacks in paroxysmal tachicardias in infants before 1 year old. Russ J Cardiol 2014, 12 (116): 31-37http://dx

Цель. Оптимизировать тактику лечения детей с аритмиями на основе оценки и прогнозирования эффективности терапии. Материал и методы. Проспективное когортное исследование проводилось с 2007 по 2017гг. Пролонгированную антиаритмическую терапию получали 100 пациентов в возрасте от 0 до 7 лет с различными электрофизиологическими вариантами клинически значимых аритмий. Протокол исследования включал данные анамнеза, электрокардиографию (ЭКГ) в 12 отведениях, Холтеровское мониторирование ЭКГ, эхокардиографию (ЭхоКГ). Для верификации электрофизиологического механизма тахикардии части пациентов выполнялось чреспищеводное электрофизиологическое исследование. Результаты. Вероятность эффективного результата антиаритмической терапии (ААТ) выше у детей первого года жизни с отсутствием признаков аритмогенной кардиомиопатии (АКМП). Более старший возраст детей, наличие выраженных проявлений АКМП по данным ЭхоКГ являются факторами, повышающим риск неэффективной ААТ. На основании полученных данных была разработана многофакторная модель прогноза эффективности пролонгированной антиаритмической терапии для определения индивидуальной тактики лечения у детей с аритмиями. Заключение. Исследование показало, что возраст и состояние внутрисердечной гемодинамики влияют на эффективность антиаритмической терапии. Предложенная модель позволит избежать длительной медикаментозной нагрузки и своевременно применить другие методы лечения в случае прогнозирования неэффективного результата ААТ.

Introduction. Persistent atrial standstill is a rare syndrome characterized by absence of mechanical and electrical atrial activity. The article presents a unique case of atrial standstill in the newborn patient with tachyarrhythmia.Brief description. The first manifestation of atrial standstill in the patient was heart failure (HF) manifestations and wide-complex tachycardia according to electrocardiography, which was identified as ventricular tachycardia. At the local outpatient clinic, the child was prescribed with antiarrhythmic therapy (AAT), which decreased heart rate. Three months later, a transesophageal electrophysiological study was carried out in our center in order to determine the arrhythmia origin. A multiform idioventricular rhythm with a heart rate of 46-119 beats per min was diagnosed, atrial pacing spike (A waves) was not recorded. Given bradyarrhythmia, hemodynamic abnormalities on echocardiography (significant atrial enlargement, decreased contractility), the patient, in order to prevent the risk of sudden cardiac death, underwent implantation of single chamber pacemaker in VVIR mode and bipolar ventricular lead. Anticoagulant therapy was prescribed. After 6-month follow-up, relief of HF symptoms and an increase in left ventricular contractile function was noted.Discussion. Timely diagnosis and implantation of pacemakers allowed avoiding AAT and minimizing the HF symptoms. Continuous ventricular pacing and anticoagulant therapy are important in HF prevention.

This review discusses the role of autoimmune mechanisms in the development of heart rhythm disturbances and conduction disorders of various origins. The search was performed using PubMed, Medline and Google Scholar. Specific cardiovascular diseases (dilated cardiomyopathy, myocarditis, conduction disorders) developing in childhood and adolescence are associated with an increase in titer to intracellular proteins specific to myocardiocytes and cells of the cardiac conduction system. Candidate autoantibodies markers for autoimmune response have been selected. The rationale for analyzing the immune status of heart rhythm disturbances in children and adolescents has been provided.

Background: Radiofrequency ablation (RFA) is the standard method of treatment for tachyarrhythmias in school children, and it leads to complete recovery in children without structural heart disease. However, RFA in young children is limited by the risk of complications and unstudied remote effects of radiofrequency lesions.Objective: To present the experience of RFA of arrhythmias and the results of followup of younger children. Materials andMethods: RFA procedures (n = 255) were performed in 209 children with arrhythmias from 0 to 7 years old. The arrhythmias were presented with atrioventricular reentry tachycardia with Wolff-Parkinson-White (WPW) syndrome (56%), atrial ectopic tachycardia (21.5%), atrioventricular nodal reentry tachycardia (4.8%), and ventricular arrhythmia (17.2%). Results:The overall effectiveness of RFA, considering the repeated procedures performed due to the primary ineffectiveness and recurrencies, was 94.7%. There was no mortality associated with RFA in patients, including young patients. All cases of "major" complications are associated with RFA of the left-sided accessory pathway and tachycardia foci and are represented by the mitral valve damage in three patients (1.4%). Tachycardia and preexcitation recurred in 44 (21%) patients. There was a correlation between recurrences and parameters of RFA (odds ratio 0.894; 95% confidence interval: 0.804-0.994; p = .039). Reducing the maximum power of effective applications in our study increased the risk of recurrence. Conclusion:The use of the minimum effective parameters of RFA in children reduces the risk of complications, but increases arrhythmia recurrence rate.

Rhythm and conduction disorders of the heart occupy one of the leading places in the structure of cardiovascular pathology in children. Supraventricular tachycardias means tachyarrhythmias, caused by abnormal myocardial excitation with the source of rhythm localization above the His bundle bifurcation-in the atria, atrioventricular junction (node), and also arrhythmias with circulation of the excitation wave between the atria and the ventricles with additional atrial compounds. The team of authors presents clinical recommendations developed on the principles of evidence-based medicine, including all stages of diagnosis and treatment of children with supraventricular tachycardias. The use of recommendations in clinical practice allows to selecte the best strategy for diagnosis and treatment of supraventricular tachycardia in a particular patient.

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