Purpose. The results of cryoballoon ablation (CBA) procedure have been mainly derived from studies conducted in experienced atrial fibrillation (AF) ablation centres. Here, we report on CBA efficacy and complications resulting from real practice of this procedure at both high- and low-volume centres. Methods. Among 62 Russian centres performing AF ablation, 15 (24%) used CBA technology for pulmonary vein isolation. The centres were asked to provide a detailed description of all CBA procedures performed and complications, if encountered. Results. Thirteen sites completed interviews on all CBAs in their centres (>95% of CBAs in Russia). Six sites were high-volume AF ablation (>100 AF cases/year) centres, and 7 were low-volume AF ablation. There was no statistical difference in arrhythmia-free rates between high- and low-volume centres (64.6 versus 60.8% at 6 months). Major complications developed in 1.5% of patients and were equally distributed between high- and low-volume centres. Minor procedure-related events were encountered in 8% of patients and were more prevalent in high-volume centres. Total event and vascular access site event rates were higher in women than in men. Conclusions. CBA has an acceptable efficacy profile in real practice. In less experienced AF ablation centres, the major complication rate is equal to that in high-volume centres.
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.
Objective. To evaluate the efficiency of radiofrequency denervation of the renal arteries in patients with resi-stant arterial hypertension during a three-year follow-up. Materials and methods. The study involved 40 patients with resistant arterial hypertension aged 27 to 70 years (mean age 54.91±9.77 years) while receiving three or more antihypertensive drugs (including diuretic) in optimal doses. The conditions for inclusion in the study were considered resistant arterial hypertension with blood pressure (BP)>160/100 mm Hg, intact kidney function - glomerular filtration rate (MDRD)>45 ml/min - and the absence of secondary hypertension. All patients had sympatic radiofrequency denervation of renal arteries; its efficiency later was estimated according to the clinical measurement and ambulatory blood pressure monitoring (ABPM). Results. The level of office BP reliably differed initially and after 3 years: DSBP -34.48±6.44 mm Hg (p=0.001), DDBP - 22.29 mm Hg (p=0.001). According to ABPM results, reliable dynamics of systolic blood pressure was not observed. The data of DBP at night were significantly lower after 36 months; DDBP was -5.37±9.77 mm Hg. Conclusions. A marked decrease in the data of office SBP and DBP was observed, which proves the long-term efficiency of radiofrequency denervation of the renal arteries in patients with resistant hypertension. Accor-ding to ABPM results after 36 months, a significant decrease was registered among the DBP indicators at night and daytime.
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.
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 document provides an overview of current problems and trends in the catheter ablation of atrial fibrillation, summarizes the opinions of specialists, obtained during a web-based electronic survey, on aspects and parameters of radiofrequency ablation. The approaches on improving the efficacy and safety of radiofrequency catheter ablation of atrial fibrillation are provided.
Aim.To investigate the relationships between left atrial (LA) fibrosis extent and left ventricular (LV) structural and functional status in patients (pts) with nonvalvular atrial fibrillation (AF).Material and Methods.The study enrolled 56 pts (mean age 57.1±8.4 years, 25 females), admitted to hospital for primary catheter ablation (CA), including 47 pts with paroxysmal AF and 9 pts with persistent AF. All pts had scheduled transthoracic echocardiography to measure size and volume of cardiac chambers and systolic and diastolic functions of the left ventricle. Based on the calculation of the LV mass index (LVMI) and relative wall thickness (RWT), we categorized all pts into 4 groups: (1) normal geometry (n=27); (2) concentric remodeling (normal LVMI and high RWT, n=13); (3) concentric hypertrophy (high LVMI and high RWT, n=6); and (4) eccentric remodeling (high LVMI and normal RWT, n=10). The assessment of LA fibrosis sizes was based on the allocation of low voltage zones (<0.5 mV) in the process of voltage electroanatomic mapping (VEM) as the first stage of CA. Following indicators were calculated: total square of fibrosis (Sf), % of fibrosis from the total LA square (Sf%), the degree of LA fibrosis (an analog of the UTAH score), and number of LA fibrosis zones. Level of NT-proBNP in blood was determined among other laboratory tests. All pts had preserved LV ejection fraction (LVEF).Results.Results of the study confirmed positive relationships between Sf, Sf% and LA diameter, LVMI, and NT-proBNP level. Negative relationship was noted between Sf, Sf%, the UTAH degree and LVEF. Such LV geometry type as eccentric hypertrophy was associated with a higher number of LA fibrosis zones compared to the normal LV geometry, while significant differences in other types of geometry were not found.Conclusion. Thus, LA fibrosis extent was associated with LA size, LV function, and LV geometric remodeling pattern.
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