Russian Society of Cardiology (RSC).With the participation of Russian Scientific Society of Clinical Electrophysiology, Arrhythmology and Cardiac Pacing, Russian Association of Pediatric Cardiologists, Society for Holter Monitoring and Noninvasive Electrocardiology.Approved by the Scientific and Practical Council of the Russian Ministry of Health.

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.

With the participation: All-Russian Scientific Society of Specialists in Clinical Electrophysiology, Arrhythmology and Pacing, Russian Association of Cardiovascular SurgeonsEndorsed by: Research and Practical Council of the Ministry of Health of the Russian Federation

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 estimate the efficacy of invasive and non-invasive long-term ECG monitoring in comparison with conventional follow-up for the detection of silent atrial fibrillation (AF)/atrial flutter (AFL)/atrial tachycardia (AT) in patients with a cryptogenic stroke.Methods. The randomized, prospective, two-center study enrolled 36 patients who suffered cryptogenic stroke (CS) or transient ischemic attack (TIA) without past history of AF/AFL/AT. Patients were randomized in a 1:1:1 ratio to one of the three ECG monitoring strategies: standard arrhythmia monitoring (group I, n=12), ECG-monitoring with implantable loop recorder (group II, n=12), and ambulatory noninvasive ECG monitoring (group III, n=12). The primary endpoint was the time to the first detection of AF/AFL/AT. Patients, assigned to the group I, underwent an assessment at scheduled and unscheduled visits and received ambulatory ECG monitoring 28 days and 1 year after randomization. Patients in the group II underwent implantation of Reveal XT (Medtronic, USA) with the daily remote data transmission to CareLink Network. In the group III, for long-term external monitoring, Spyder system (WEB Biotechnology, Singapore) was used for up to 28 days.Results. During the first 28 days of observation, there were no significant differences in AF detection rates between groups I, II, and III: 0 (0%), 1 (8%), and 2 (17%) cases, respectively, р=0.537. During the year of observation, AF/AFL/AT episodes were detected in 1 case (8%) in the group I, 6 cases (50%) in the group II, and 2 cases (17%) in the group III, p=0.0486. The mean time from enrollment into the study to detection of the first AF/AFL/AT episode was 67 days (15; 97) in all groups. In the groups II and III, the first arrhythmia episodes were detected by monitoring devices on days 24 and 6, respectively. In most cases, arrhythmia episodes detected by long-term monitoring were asymptomatic. Recurrent stroke or TIA events occurred in group I and III (1 case in each group), but not in the group with implantable cardiac monitors. Subgroup analysis showed that significantly higher AF/AFL/AT detection rate was associated with stroke, CHA2DS2VASc score ≥2, and the presence of hypertension. For the 12 months of follow-up, the mean AF burden in the group II was 0.4 (0.2; 0.5) hours per day (1.6%). In the patients with recurrent stroke, AF burden was 3.2% compared to 0.9% in the rest of patients.Conclusion. Detection of silent AF with implantable cardiac monitors is superior to standard and long-term external monitoring in cryptogenic stroke patients.

Premature ventricular contractions (PVC) is a very common type of arrhythmia. Some patients require surgical treatment. The search for the safest methods of surgical treatment is an important research task.Aim. To evaluate the efficacy and safety of catheter ablation in patients with idiopathic ventricular arrhythmias depending on the implementation of X-ray control.Material and methods. The study included 183 patients admitted to the Federal Center for Cardiovascular Surgery for elective surgery, with frequent idiopathic PVC and indications for surgical treatment of arrhythmia. In the majority of patients with idiopathic PVC, the central origin of ectopia is the right ventricular outflow tract (RVOT). The patients were divided into two groups: group 1 (n=90) — patients with idiopathic PVC after fluoroscopy-guided radiofrequency ablation (RFA); group 2 (n=93) — patients after RFA without fluoroscopy. All patients underwent electrocardiography, echocardiography, and electrophysiological testing. All patients before and after RFA underwent 24-hour Holter monitoring.Results. Among patients of group 1, the initial success of RFA was 62,2%, and in group 2 — 71% (p=0,21). Surgery complications were registered in 3,3% and 4,3% of patients of groups 1 and 2. No deaths have been reported. The duration of surgery did not depend on the use of fluoroscopy. Among patients with failed initial RFA, the effectiveness of subsequent interventions was 88,6%. The greatest efficiency of initial RFA was observed when the ectopic ventricular focus was located in RVOT The lowest efficiency of RFA was observed when the focus was located in the left ventricular papillary muscles.Conclusion. RFA in patients with idiopathic PVC without fluoroscopy does not increase the complication rate and the duration of surgery and have a comparable efficacy compared to fluoroscopy-guided RFA.

To assess safety and efficacy of nonfluoroscopic cryoballoon ablation, 32 patients with symptomatic drug resistant paroxysmal atrial fibrillation were treated.

Aim To assess the diagnostic accuracy of long QT syndrome in children and to estimate the results of the follow-up.Methods High-risk groups of children with bradycardia less than the second percentile and/or a family history of sudden death syndrome, and children with syncope diagnosed with the ECG testing were included in the study. All patients underwent routine medical examination, molecular genetic testing and were followed-up for 3,5–10 years.Results The majority of children haves transient corrected QT prolongation secondary to therapy, requiring ECG monitoring. High-risk group screening reports higher rates of idiopathic LQTS. ECG testing shows its efficiency among asymptomatic children with a normal heart rate. Patients present with syncope at the outpatient settings require the exclusion of a wide range of diseases, both congenital and acquired heart disease. The clinical status of the examined patients does not always correspond to the known LQTS variants. Molecular genetic analysis provides relevant information on the genetic heterogeneity of the disease, including new mutations, both pathological and beneficial ones.Conclusion Regardless of the presence or absence of molecular genetic confirmation of LQTS, beta blocker therapy in some cases combined with implanted cardioverterdefibrillator prevents the development of the adverse events in the long-term period and ensures normal emotional, intellectual and physical development.