Aim. The results presented, of subanalysis of the catheter ablation (CA) registry in atrial fibrillation (AF) with the patients properties, specifics of CA and treatment results, in Russia comparing to European countries.Material and methods. During 2012 to 2015, totally 3742 patients included to the registry, of those 477 in Russia. In 467 Russian patients (males 56,5%; mean age 58,5 y. o.) CA AF was done. During one year 392 patients were followed up. Minimum requirements to follow-up: routine ECG registration and non less than one contact after 12 months passed.Results. In Russian patients there were more common obesity (46,1% and 29,2%, p<0,001), hypertension heart disease (40,2% and 22,8%, p<0,0001), coronary heart disease (31,7% and 16,2%, p<0,0001), chronic heart failure (67,3% and 13,0%, p<0,0001). In Russia the patients more commonly underwent primary CA (83,5% in Russia and 77,6% in European countries, p<0,05), more rare in Russia the cryoballoon ablation was done (3% and 18%, p<0,05). Generally adverse events were reported more rare in Russia (10,5% and 16,6%, p=0,0007), including cardiovascular adverse events (2,6% and 5,2%, p<0,05). Tachiarrhythmias recurs were diagnosed more rare in Russia, including by the subsutaneous ECG monitors (17% and 1,6% in other countries, р<0,001). Within the year of follow-up, full absence of tachiarrhythmias recurs in Russia was found in 65,8% of patients, in other countries — in 74,7% (р=0,0003).Conclusion. In real clinical setting, high efficacy of CA AF was shown, resistant to antiarrhythmic therapy. In most of Russian patients there were cardiovascular comorbidities. There was lower rate of reported adverse events in Russian centers of interventional treatments.

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Background Galectin-3 (Gal-3) and transforming growth factor-beta1 (TGFbeta1) – biomarkers of fibrosis are increased in patients with atrial fibrillation (AFib) and metabolic syndrome (MetS). We propose that both can impact on progression of the arrhythmia. Purpose Objective of the study was to evaluate the role of Gal-3 and TGFbeta1 in predicting the effect of antiarrhythmic pharmacotherapy (APT) and radiofrequency ablation therapy (RAT) in patients with AFib and MetS. Methods 539 AFib patients hospitalized in cardiology department (2015–2016 years) were examined. 204 AFib patients with paroxysmal (n=156) and persistent (n=48) forms 35–60 years old were included in prospective study: 110 had ≥3 components of MetS (IDF, 2005) and 94 without MetS. Serum GAL-3, TGF-beta1 (Enzyme immunoassay) were performed. Antiarrhythmics were applied during 12 months. Antiarrhythmic effect of pharmacotherapy was established if no episodes of AFib were registered during follow-up. 73 patients without effect of APT were treated with RAT with pulmonary veins isolation. Ablation procedure was performed with the system of electroanatomical mapping CARTO3. In the “offline” mode we evaluated areas of low voltage in the amplitude spectrum of 0,2–1,0 mV and divided all patients into groups: I – minimal (<10% of LAarea, n=18), II – mild (10–19% of LAarea,n=26), III – moderate (20–29% of LAarea, n=17) and IV - severe low voltage area (≥30% of LAarea,n=12). After ablation, we analyzed the clinical data and the effectiveness of RAT during 12 months. Results Gal-3 in patients with recurrent paroxysms and without the effect of APT was higher than in patients without recurrent paroxysms (1312,1 [750,2; 2494,3] and 500,2 [410,3; 723,4] pg/ml, p<0,001). TGF-beta1 was also higher in patients without the effect of APT (11521,2 [2950,2; 17642,2] and 2999,5 [1767,4; 5490,2] pg/ml, p<0,001). Patients from IV group had greater low voltage area of LA, than in I group (33,4±2,1 and 6,6±2,4%, p<0,001), but also higher levels of Gal-3 (1201,1 [950,2; 2140,3] and 490,2 [310,3; 523,4] pg/ml, p=0,027) and TGF-beta1 (9497,2 [1257,2; 14672,2] and 3491,5 [1767,4; 8470,2] pg/ml, p=0,04). The multivariate regression analysis demonstrated that Gal-3 is an independent predictor of non-effective antiarrhythmic pharmacotherapy of AFib (OR=2,38, 95% CI: 1,12–5,04, p=0,024). In patients with AFib and MetS who had Gal-3 above 770,5 pg/ml (cut-off point on ROC-curve) the risk of non-effective APT was in 3,6-fold higher during follow-up (RR=3,6, 95% CI: 1,6–7,9, p=0,002). Binomial regression analysis was found that greater % of LA fibrosis corresponds to higher probability of recurrence of AFib after RAT (OR=1,1, 95% CI: 1,03–1,12, p=0,002). Conclusions Galectin-3 and TGF-beta1 in AFib and MetS patients with left atrium severe fibrosis are higher than in patients with minimal fibrosis. We suppose that profibrogenic substances can impact on progression of AFib and non-effectiveness antiarrhythmic pharmacotherapy. Acknowledgement/Funding Governmental grant 17-75-30052

This review examines the features of the structure, pathogenesis and treatment of atrial fibrillation in patients with severe chronic kidney disease.

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The recent data of sudden cardiac death prevention for patients with arrhythmogenic dysplasia/cardiomyopathy of right ventricle are presented. Appropriate algorithm of threatment in different groups is also discussed.

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