Patient management in clinical practice generally complies with the current guidelines; however, much importance is attached to the severity of arrhythmia (the number of VPBs per day, the presence of UVT) in addition to the presence of symptoms. In the opinion of most physicians, the initiation of treatment is justified when there are 10,000-15,000 and more per day. QOL assessment may be promising in choosing the optimal management tactics for these patients. Treatment should not be initiated immediately in patients with a high level of QOL, especially in those with arrhythmia lasting less than 12 months, by taking into account that there can be a spontaneous improvement in 38% of cases within the next month. The immediate results of ADT and RFA are comparable in patients with VA in the absence of structural heart disease. The Class IC antiarrhythmic drug ethacyzin is the most effective agent that ensures positive changes in arrhythmic syndrome in 66.7% of cases with the rate of side effects being in 17.8%.
In spite of significant increasing of number of patients with disorders of diastolic function of heart and fibrillation of atria, understanding of mechanisms of their development and modes of treatment is still to be reached. The present review presents Actual view of the role of diastolic dysfunction of heart in development and progression of fibrillation of atria, including possibilities of its adjustment after interventional treatment.
Background One of the most arrhythmias associated with atrial fibrillation (AF) is typical atrial flutter (AFL). The main methods of surgical treatment of these arrhythmias is catheter ablation. The problem of catheter ablation strategy for these coexistentarrhythmias is not solved. Purpose: To assess the effectiveness of long-term maintenance of sinus rhythm in a two-stage approach to the interventional treatment of atrial fibrillation associated with typical atrial flutter. Methods: The study included 34 patients aged 41-82 years with AF and coexistent typical AFL. Female 11 (32,35%), male 23 (67,35%). Randomization 1:1. Group 1 (n=17) has been performed radiofrequency ablation (RFA) of the cavotricuspid isthmus (CTI) with radiofrequency catheter isolation of the PV. Group 2 (n=17) has been performed only RFA of CTI. AF and AFL recurrences rate has been evaluated in both groups. Follow-up period 12 months. Results: Procedure duration and fluoroscopy time were less in group 2 that those in group 1. Extended intervention in group 1 was accompanied with complications in two cases. There were no significant differences in AF recurrence rate in both groups (p=0,43183). AFL recurrences has not been found in both groups. Conclusion: One stage ablation approach in AF patients with coexistent AFLassociated with increaseprocedure duration and fluoroscopy time. The frequency of AF recurrence in patients who underwent extended intervention (catheter isolation of the PV and RFA CTI) and in patients who underwent only the elimination of typical atrial flutter, was not statistically significantly different (p = 0.43183). In the presence of AF and typical atrial flutter, a two-stage approach to interventional treatment should be regarded as appropriate.
атетерная изоляция легочных вен (КИЛВ) является операцией выбора у пациентов с пароксизмальной формой фибрилляции предсердий (ФП). Предоперационная оценка вариантов впадения легочных вен (ЛВ) в левое предсердие (ЛП) является важным этапом планирования вмешательства. Существующие анатомические классификации вариантов впадения ЛВ в ЛП, как правило, трудно применимы в клинической практике. Цель исследования. Классифицировать варианты дистальной анатомии лѐгочных вен у больных с фибрилляцией предсердий по данным мультиспиральной компьютерной томографии (МСКТ). Материалы и методы. В исследование включено 167 пациентов (80-женского пола) в возрасте 18-79 лет, которым выполнена МСКТ ЛП и ЛВ для оценки их анатомических особенностей перед выполнением КИЛВ. Пароксизмальная форма ФП-107 больных (64,1%), персистирующая форма ФП-39 пациентов (23,3%). В 21 случае (12,6%) форма ФП не уточнена. Результаты. Выявлены следующие варианты впадения легочных вен (ЛВ) в левое предсердие (ЛП). Вариант 1-типичная анатомия: наличие четырех раздельных устьев ЛВ (n=88; 52,7%). Вариант 2-рассыпной тип: наличие трех или более раздельных ипсилатеральных устьев ЛВ (n=36; 21,5%). Вариант 3-коллектор левых ЛВ: левая верхняя и левая нижняя ЛВ сливаются в один ствол до впадения в ЛП (n=31; 18,6%). Вариант 4-смешанный тип: сочетание коллектора ЛВ с рассыпным типом строения (n=10; 6%). Вариант 5-общий ствол контрлатеральных ЛВ: слияние контрлатеральных ЛВ в один ствол до впадения в ЛП (n=1; 0,6%). Вариант 6-коллектор правых ЛВ (n=1; 0,6%). Заключение. Дистальная анатомия ЛВ характеризуется выраженной вариабельностью. У больных с ФП типичный анатомический паттерн впадения ЛВ в ЛП встречается в 52,7% случаев. Реже встречаются рассыпной тип строения ЛВ, наличие коллектора ЛВ, а также их сочетание. Коллекторы правых ЛВ и контрлатеральных ЛВ являются крайне редкими анатомическими вариантами. Выделение шести вариантов впадения ЛВ в ЛП (Вариант 1-типичная анатомия; Вариант 2-рассыпной тип; Вариант 3коллектор левых ЛВ; Вариант 4-смешанный тип; Вариант 5-коллектор контрлатеральных ЛВ; Вариант 6-коллектор правых ЛВ) позволяет описать особенности дистальной анатомии легочных вен по данным МСКТ. Ключевые слова: фибрилляция предсердий, легочные вены, компьютерная томография.
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.
Background: Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and is associated with an increased risk of death, progression of heart failure, and the development of cardiogenic thromboemboli. Despite the significant success in the management of AF in the paroxysmal form, the results of the treatment for patients with persistent forms of AF remain unsatisfactory. Though the surgical approach provides higher rates of efficiency regarding the restoration of a sinus rhythm, transmural lesions are not always attainable, as a result, the rate of AF recurrence in the long-term period remains fairly high. It is also impossible to create ablative patterns to the mitral and tricuspid valves during thoracoscopic epicardial ablation, which can cause the development of recurrent AF, perimitral and typical atrial flutter. Therefore, the development of hybrid approaches combining the advantages of catheter and thoracoscopic techniques is an urgent task of contemporary surgical and interventional arrhythmology. Aims: to estimate the immediate results of a hybrid approach in the management of patients with persistent AF. Methods: We report the first experience of a hybrid treatment of patients with persistent AF. 6 patients aged 53-64 years (1 female, 5 males) were included in the study. At the first stage, thoracoscopic epicardial bipolar ablation was performed (modified GALAXY protocol); the second stage (in 3 to 6 months after the thoracoscopic stage) included an intracardiac electrophysiological study with three-dimensional endocardial mapping followed by endocardial ablation. Results: The thoracoscopic stage of the hybrid treatment included ablation according to the box lesion scheme using a bipolar irrigation equipment. No lethal outcomes and severe, life-threatening complications were registered. The duration of the inpatient period was 510 hospital-days. The 2nd stage of the hybrid treatment was limited to intracardiac electrophysiological examination only in 2 patients. In 4 patients, epicardial radiofrequency ablation was complemented by endocardial radiofrequency exposure. In 3 of the 4 patients who underwent endocardial radiofrequency ablation, catheter ablation of the mitral and cavotricuspid isthmus was required because of the induction of perimitral and typical flutter, respectively. After the 2nd stage of the hybrid treatment, at the time of discharge all the patients maintained a stable sinus rhythm. There were no severe complications or lethal outcomes. Conclusion: a hybrid approach in the AF management is a safe and effective method of treatment, which combines the advantages of minimally invasive surgery and endocardial intervention in patients with persistent AF. The technique is safe and has acceptable short-term results.
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