The aim: To study the predictive power of demographic, hemodynamic and electrocardiographic factors for atrial fibrillation recurrence after radiofrequency ablation (RFA) in patients with chronic heart failure. Materials and methods: Study included 120 patients, aged 59,80±10,08 years old with chronic heart failure with preserved left ventricular ejection fraction who were undergo RFA due to atrial fibrillation (AF). A standard 12-lead electrocardiogram (ECG) was registered. Before the procedure the standard echocardiographic parameters were obtained. After 12 months, patients were divided into 2 groups: non-recurrence group and recurrence group. Results: As a result of prospective follow-up within 12 months AF recurrences were observed in 32 patients (27%), 88 patients remained non-recurrent (73%). The left atrium (LA) diameter and aortic root diameter were lager in the recurrence group (4,59±0,45 vs. 4,08±0,61 cm, p<0,001; 3,37±0,60 vs. 2,80±0,67 cm, p<0,001). The AF recurrence group before RFA had a significantly longer QTc interval than the non-recurrence group (387,23±2,31 vs. 341,22±8,91 ms, p<0,010). ROC curve analysis revealed LA diameter the most sensitive factor for AF recurrence after RFA. Conclusions: QTc duration before radiofrequency ablation and its prolongation after intervention are independent predictors of atrial fibrillation recurrence; left atrium diameter before ablation is a highly sensitive predictor in patients with chronic heart failure with preserved left ventricular ejection fraction.

Background. General quality of life improvement was proven for all types of radiofrequency ablation: the same for atrial fibrillation and flutter [1,2]. However, in some cases we observe no changes or worsening of life quаlity after ablation, and it isn't always connected with effectiveness of procedure.Purpose. To evaluate predictors of no improvement or decrease of life quality two years after radiofrequency ablation of atrial fibrillation and flutter.Methods. We studied 186 patients (mean age 59±9,6 years, 83 female (44,6%)) before, 3, 12 and 24 months after radiofrequency pulmonary vein isolation for atrial fibrillation -(84 patients, 45,2%), radiofrequency ablation of cava-tricuspid isthmus for atrial flutter (34 patients, 18,3%) and combined pulmonary vein isolation and ablation of cava-tricuspid isthmus for combination of arrhythmias (68 patients, 36,5%). As a control group we randomized 122 patients (mean age 58,4±12,4 years, 90 female (51,7%)) with paroxysmal and persistent forms of atrial fibrillation and flutter, who got just pharmacological antiarrhythmic therapy. Quality of life was evaluated by Ukrainian-language modification of the Ferrans and Powers questionnaire (FPq) [3]. Significant decreasing of life quality -Class 1 by FPq two years after ablation was chosen as an endpoint. Form and duration of arrhythmia, relapses of arrhythmia, blood pressure, electrocardiogram and echocardiogram signs, using and doses of antiarrhythmic, antihypertensive and anticoagulant drugs were evaluated (standardized difference of all variables <0.05).Results. Quality of life improved in all study groups 3 months after ablation and don't changes during two years of observation, the most significant changes concerned isolated fibrillation or flutter and lessfor combined arrhythmias. In contrast, group of pharmacological antiarrhythmic therapy was shown a decrease of life quality in two years period. Class 1 FPq two years after ablation was associated with duration of arrhythmia for atrial fibrillation ablation and persistant form, duration of arrhythmia, systolic blood pressure, duration of QTc interval and ℬ-blockers doses. ROC analysis shown high sensivity of arrhythmia duration and systolic blood pressure to life quality prognosis after ablation.Conclusion. Duration of arrhythmia before procedure and systolic blood pressure were independent predictors of no improvement or decrease of life quality in patient two years after radiofrequency ablation of atrial fibrillation and flutter.

The benefit of radiofrequency ablation (RFA) in rhythm control in atrial fibrillation (AF) and flutter patients is uncertain, but risk of death, arrhythmia recurrence and other post ablation complications remains high. Existing data on the impact of pulmonary vein isolation and cava-tricuspid isthmus RFA on long-term prognosis of patients with AF and flutter and its advantage over pharmacological antiarrhythmic therapy (AAT) are insufficient and contradictory. The aim: we sought to evaluate two-year outcomes of pulmonary vein isolation and cava-tricuspid isthmus RFA vs pharmacological only AAT according to a single center experience. Material and methods: we enrolled 174 patients after pulmonary vein isolation RFA, cava-tricuspid isthmus RFA and their combination and 122 patient who did not undergo RFA and got pharmacological AAT only. Results: there was no significant difference in mortality between the RFA and AAT only groups (5.8 % and 9.0 % respectively) with the same structure of causes of death. The Caplan-Meyer curve analysis demonstrated better survivance (p=0.031) after RFA just during first year of observation. RFA effectiveness in arrhythmia relapse prevention was the highest for cava-tricuspid isthmus RFA procedure and worst – in group of combined pulmonary vein isolation and cava-tricuspid isthmus procedures. RFA showed an advantage over AAT in smaller quantities of non-fatal cardiovascular events (p<0.001) and cardiovascular hospitalizations (p=0.0026). Conclusions: RFA of pulmonary vein isolation and cava-tricuspid isthmus RFA decrease arrhythmia episodes frequency, risk of non-fatal cardiovascular events and cardiovascular hospitalizations. Timely combined PVI and CTI procedure is associated with worsening of all outcomes.

Introduction. Radiofrequency ablation (RFA) is today the method of choice for the ineffective medical treatment of atrial fibrillation (AF), but its course is often complicated by comorbid pathology. The predicted great impact of these nosologies on the effectiveness of radiofrequency ablation of the arrhythmia substrate requires additional study before RFA. Objectives – to analyze the clinical characteristics of patients with isolated atrial fibrillation and combination with of atrial fibrillation with atrial flutter (AF + AFib) that underwent radiofrequency ablation of the arrhythmia substrate. Materials and methods. 84 patients aged 65 ± 9 (82.3 % of men) were examined, who underwent RFA of the arrhythmia substrate: cavo-tricuspid isthmus (CTI) or combined with pulmonary veins isolation (CTI + PV) strategy for patients with AFib. Before radiofrequency ablation, the following clinical indicators were assessed: forms of AF + AFib, the presence of chronic heart failure (CHF) and functional classes (FC) according to NYHA classification, the forms of chronic coronary syndromes (CCS): postinfarction cardiosclerosis, syndrome-X, functional classes of stable angina (SA), stages of arterial hypertension (AH), the presence of type 2 diabetes or stroke in the anamnesis. Results. Radiofrequency ablation of isolated atrial fibrillation was more often performed for persistent arrhythmia in patients with stable angina III FC, arterial hypertension stage 2 and 3, radiofrequency ablation of combination of atrial fibrillation with atrial flutter – equally often for persistent or paroxysmal form in patients with SA I and II class, AH stage 2 and 3; in both cases patients with chronic heart failure II and III FC more often needed radiofrequency ablation of the arrhythmia substrate. Conclusions. Given the lack of correlation between clinical and demographic characteristics, it is advisable to continue studying their prognostic effect on the course of comorbid pathology and treatment of patients after radiofrequency ablation of the arrhythmia substrate of atrial fibrillation and combination of atrial fibrillation with atrial flutter.

In recent decades, there has been a rise of chronic heart failure mortality. Among the huge range of modern methods of this pathology treatment, the cardioresynchronizing therapy stands out, it allows the improvement of the patient's heart function, reduces clinical signs of the disease, improves well−being, as well as diminishes morbidity and mortality. The use of this method in the patients with a comorbid pathology, i.e. in those with chronic heart failure and type 2 diabetes, deserves a special attention. In order to determine the clinical characteristics of the patients who required a pacemaker implantation, we examined 203 patients who had reasonable indications for this in accordance with the ACC / ANA and ESC current recommendations. Another important criterion for inclusion into the group of implantation was considered to be the presence of comorbid Diabetes mellitus type 2. The gender and age characteristics of the surveyed population were dominated by elderly male patients. The presence of concomitant cardiovascular pathology depending on the age of patients was analyzed, which showed mostly hypertension of stage 2−3, a constant atrial fibrillation. In structure of comorbid pathology the somatic diseases, including type 2 Diabetes mellitus prevailed. Electrostimulators were implanted into the examined cohort of patients, among which 132 devices worked in DDD mode, 71 of the installed stimulators had the DDDR mode. The research results concluded that the implantation of a pacemaker became a necessary procedure for elderly patients, mostly men, with a high prevalence of cardiovascular (coronary heart disease, hypertension, persistent atrial fibrillation) and somatic pathology in the form of type 2 Diabetes mellitus. Key words: chronic heart failure, type 2 diabetes mellitus, pacemaker implantation, clinical features, gender and age characteristics.