Цель. Оценить вклад воспаления в клинические результаты радиочастотной аблации (РЧА) фибрилляции предсердий (ФП). Материал и методы. Обследовано 274 пациента, поступивших в клинику с диагнозом идиопатическая форма ФП, из которых только у 67 (24,5%) этот диагноз был подтвержден на первом этапе обследования. Всем пациентам проведены внутрисердечное исследование и РЧА ФП, эндомиокардиальная биопсия (ЭМБ) с гистологическим и иммуногистохимическим исследовани-ями для определения иммунофенотипа клеток инфильтрата в эндомиокарде и выявления экспрессии антигенов кардиотропных вирусов: к парвовирусу В19, энтеровирусу, вирусу герпеса человека 1 и 2-го типа, аденовирусу, цито-мегаловирусу, вирусу Эпштейна-Барра. Оценивалась эффективность катетер-ного лечения, возникновение ранних и поздних рецидивов предсердных тахиаритмий. Результаты. Гистологических изменений в миокарде правого желудочка, по данным эндомиокардиальной биопсии, не обнаружено у 9 (13,4%) пациен-тов. У 26 (38,8%) выявлены фиброзные изменения миокарда: у 11 (42,3%) -преимущественно периваскулярный фиброз, у 8 (30,8%) -мелкоочаговый, у 7 -(26,9%) -перимускулярный. Воспалительные изменения (согласно Далласским критериям) отмечены у 32 (47,8%) пациентов, из которых у 9 (28,1%) обнаружена лимфоцитарная инфильтрация (менее 14 лимфоцитов в мм 2 ). У одного из этих пациентов (3,1%) было выявлено сочетание экспрес-сии вируса простого герпеса человека 2-го типа и вируса Эпштейна-Барра. У 23 пациентов (34,3%), найден миокардит, из них у 18 (78,3%) обнаружена экспрессия вируса. У одного (5,6%) пациента выявлена экспрессия трех виру-сов, у шести (33,3%) пациентов -двух вирусов, у 11 пациентов (61,1%) -одного вирусного антигена. Срок наблюдения за пациентами в среднем соста-вил 19,3±3,7 месяцев. Эффективность первичной РЧА у пациентов с интакт-ным миокардом составила 88,9%, с фиброзными изменениями различной степени выраженности -46,2%, при наличии критериев миокардита -34,4%. Ранние рецидивы аритмии отсутствовали при неизмененном миокарде. При наличии фиброзных изменений чаще регистрировались ранние рецидивы (53,8%) и реже -поздние (34,6%). При наличии воспалительных изменений выявлена обратная зависимость, чаще выявлялись поздние рецидивы (53,1%) и реже -ранние (37,5%). Заключение. По нашим данным, только 24,5% пациентов не имеют заболева-ний, способствующих развитию аритмии. Проведение гистологического исследования показало, что только около 10% пациентов имеют идиопатиче-скую форму аритмии, у половины пациентов отмечаются субклинические воспалительные изменения миокарда, у остальных выявлены фиброзные изменения. Наличие воспалительных и фиброзных изменений в миокарде увеличивает количество ранних и поздних рецидивов аритмии и, соответ-ственно, вдвое уменьшает эффективность РЧА ФП.Российский кардиологический журнал 2014, 12 (116): 7-12 http://dx

Background The aim of the study was to evaluate the impact of idiopathic ventricular tachycardia and premature ventricular beats on cardiac function and dyssynchrony and to elucidate relationships between data of scintigraphic and intracardiac electrophysiology studies (EPSs). Methods The study comprised 64 patients with idiopathic ventricular arrhythmias (VAs; median age of 14 years ranging from 8 to 18 years). The control group comprised 20 patients (median age of 12 ranging from 7 to 16 years) without cardiac arrhythmias. EPS and radiofrequency ablation (RFA) procedure for VA were performed in 21 children according to indications. The functional state of both ventricles was assessed by gated blood pool single photon emission computer tomography (GBP‐SPECT) before and after RFA in all patients. Results Patients with VA had local areas of asynchronous myocardial contraction (AMC). Compared with the control group, VA patients had significantly higher values of end‐diastolic volume, end‐systolic volume, and lower contractility indices. Negative association was found between total numbers of AMC areas and cardiac contractility indices. Ectopic foci localization, determined based on EPS data, was associated with AMC areas topography based on GBP‐SPECT. RFA procedure significantly improved cardiac contractility indices; AMC areas completely disappeared or decreased compared with the preoperative conditions. Conclusion In VA patients, AMC areas were localized mostly in the right ventricle. Comparison of the results of GBP‐SPECT and EPS studies showed a relationship between AMC localizations and ectopic foci topography. The fact that AMC areas disappeared after RFA supports the hypothesis stating that the presence of AMC areas is a scintigraphic symptom of ectopic focus.

The aim of the study was to evaluate the inflammatory changes in the myocardium, based on endomyocardial biopsy (EMB) data in patients undergoing radiofrequency ablation (RFA) for idiopathic atrial fibrillation (AF). A total of 67 patients with idiopathic AF were enrolled in the study. Patients underwent the intracardiac examination, RFA of AF, and EMB with histological and immunohistochemical studies. The catheter-treatment effectiveness, and occurrence of early and late recurrences of atrial tachyarrhythmias, were assessed depending on the identified histological changes. Nine patients (13.4%) did not have any histological changes in the myocardium according to EMB. Fibrotic changes were detected in 26 cases (38.8%). Inflammatory changes according to the Dallas criteria were observed in 32 patients (47.8%). The follow-up period for patients averaged 19.3 ± 3.7 months. The effectiveness rates of primary RFA were 88.9% in patients with the intact myocardium, 46.2% in patients with fibrotic changes of varying severity, and 34.4% in patients with the presence of criteria for myocarditis. No early recurrence of arrhythmias was observed in patients with unchanged myocardia. The presence of inflammatory and fibrotic changes in the myocardium increased the rates of early and late arrhythmia recurrences and accordingly halved the effectiveness RFA of AF.

Aim. To evaluate the effect of catheter ablation on left (LA) and right atria (RA) function in patients with atrial fibrillation.Material and methods. The study included 28 patients (14 men and 14 women) aged 33 to 72 years (mean age, 57,7±9,9 years) with paroxysmal (n=23) and persistent AF (n=5). All patients underwent radiofrequency ablation (RFA) with pulmonary vein antrum isolation. Before ablation and 3 days after, transthoracic twodimensional echocardiography was performed in sinus rhythm with an assessment of LA reservoir, conduit and booster pump function and RA peak longitudinal strain.Results. In the studied patients, a significant decrease in the reservoir, conduit and booster pump function of the LA was revealed after RFA, while there was no significant change in RA peak longitudinal strain after catheter ablation. LA reservoir, conduit and booster pump function decreased by 6,45% (p<0,001), 3,59% (p<0,001), 2,85% (p<0,001), respectively, while RA peak longitudinal strain increased by 0,73% (p=0,43).Conclusion. Catheter ablation has a significant damaging effect on the LA tissue, inhibiting the reservoir, pumping and pipeline functions. At the same time, the contractility of the PP in the early postoperative period improves, but not significantly.

Background: Cardiac resynchronization therapy (CRT) improves the outcome in patients with heart failure (HF). However, approximately 30% of patients are nonresponsive to CRT. The aim of this study was to determine the role of the left ventricular (LV) mechanical dyssynchrony (MD) and scar burden as predictors of CRT response. Methods: In this study, we included 56 patients with HF and the left bundle-branch block with QRS duration ≥ 150 ms who underwent CRT-D implantation. In addition to a full examination, myocardial perfusion imaging and gated blood-pool single-photon emission computed tomography were performed. Patients were grouped based on the response to CRT assessed via echocardiography (decrease in LV end-systolic volume ≥15% or/and improvement in the LV ejection fraction ≥5%). Results: In total, 45 patients (80.3%) were responders and 11 (19.7%) were nonresponders to CRT. In multivariate logistic regression, LV anterior-wall standard deviation (adjusted odds ratio (OR) 1.5275; 95% confidence interval (CI) 1.1472–2.0340; p = 0.0037), summed rest score (OR 0.7299; 95% CI 0.5627–0.9469; p = 0.0178), and HF nonischemic etiology (OR 20.1425; 95% CI 1.2719–318.9961; p = 0.0331) were the independent predictors of CRT response. Conclusion: Scar burden and MD assessed using cardiac scintigraphy are associated with response to CRT.

Aim. To study the efficacy and safety of antithrombotic therapy in patients with paroxysmal atrial fibrillation (AF) after catheter treatment during 36 months of follow-up.Material and methods. The retrospective observational study included 592 patients (283 men) who underwent catheter treatment of AF, aged 26 to 86 years (median age was 61.0 [55; 67]) with paroxysmal AF, treated in cardiac arrhythmias department of the Institute of Cardiology of Tomsk National Research Medical Center from 01.01.2017 to 31.12.2019. All patients were retrospectively divided into 2 groups: the first group consisted of patients with effective AF ablation, the second - with ineffective AF ablation. During follow-up after 12, 24 and 36 months, patients' complaints, documented arrhythmia recurrences, adherence to the prescribed treatment, and adverse clinical events were taken into account.Results. In patients with paroxysmal AF, the effectiveness of catheter treatment was 73.1% after 12 months of follow-up, 69.3% – after 24 months, 71.6% – after 36 months. The analysis of our data showed that during the follow-up period of 36 months, the incidence of ischemic stroke against the background of anticoagulant therapy and effective catheter treatment of paroxysmal AF was significantly lower than in patients with unsuccessful ablation (0.3% (n=1) and 3.7% (n=4), respectively), even despite the fact that not all patients from the first group received prescribed medication.Conclusion. The use of anticoagulant therapy in patients with paroxysmal AF after interventional treatment is safe, since the invasive strategy in combination with anticoagulant therapy does not increase the risk of major and minor bleeding, and in the case of effective intervention allows statistically significantly reduce the risk of ischemic stroke and almost completely eliminate the likelihood of other thromboemolic complications.

The aim of this study was to measure the accuracy of noninvasively obtained ventricular activation (isolated epicardial vs combined endo-epicardial mapping) as compared with that of standard invasive mapping in patients with ventricular arrhythmias. 94 patients (35 males and 59 females) aged 20 to 67 years (mean age 42.6 years) with ventricular arrhythmias of different localization and etiology and 8 patients (4 males and 4 females) aged 21 to 65 years (mean age 48.8 years) with atrial arrhythmias were examined. All patients underwent noninvasive electrophysiological examination, which was performed with Amycard System, subsequent intracardiac mapping and radiofrequency catheter ablation. The arrythmogenic focus localizations coincided in 83 cases, in 11 patients with ventricular arrhythmias some variances were observed and in patients with atrial arrhythmias no such variances were found. Thus, the accuracy of noninvasive mapping turned out to be 89.2%.Key words: heart arrhythmias; noninvasive topical diagnostics; intracardial electrophysiological study. Circulation Pathology and Cardiac Surgery (2014) 4: 96-103Хлынин Михаил Сергеевич -кандидат медицинских наук, младший научный сотрудник отделения хирургического лечения сложных нарушений ритма сердца и электрокардиостимуляции НИИ кардиологии (Томск).Попов Сергей Валентинович -доктор медицинских наук, профессор, руководитель отделения хирургического лечения сложных нарушений ритма сердца и электрокардиостимуляции НИИ кардиологии (Томск).Криволапов Сергей Николаевич -врач анестезиолог-реаниматолог отделения хирургического лечения сложных нарушений ритма сердца и электрокар-диостимуляции НИИ кардиологии (Томск).Баталов Роман Ефимович -кандидат медицинских наук, старший научный сотрудник отделения хирургического лечения сложных нарушений ритма сердца и электрокардиостимуляции НИИ кардиологии (Томск).Неинвазивная топическая диагностика нарушений ритма сердца

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