Idiopathic Form of Atrial Fibrillation,  Inflammation  and Clinical Results of Radiofrequency Ablation

Баталов, Р. Е.; Роговская, Ю. В.; Рябов, В. В.; Татарский, Р. Б.; Сазонова, С. И.; Хлынин, М. С.; Попов, С. В.; Карпов, Р. С.

doi:10.15829/1560-4071-2014-12-7-12

Cited by 9 publications

(7 citation statements)

References 11 publications

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“…Миокардит клинически можно было подозревать лишь у отдельных пациентов, однако частота его обнаружения при биопсии многократно превзошла ожидания. Это совпадает с работой Баталова Р. Е. и др., которые также столкнулись с высокой частотой миокардита там, где ожидали увидеть скорее фиброз [9], в т.ч. у пациентов с артериальной гипертонией, ишемической болезнью сердца и пр.…”

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Myocardial morphological changes and pulmonary vein catheter ablation efficacy in patients with atrial fibrillation

Kalemberg¹,

Davtyan²,

Благова

et al. 2021

Russ J Cardiol

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Aim. To study the association between morphological changes and comorbidities and atrial fibrillation (AF) catheter ablation efficacy, and to evaluate morphological predictors of AF recurrence in patients with durable pulmonary vein isolation (PVI) after catheter intervention.Material and methods. Fifty-four patients with paroxysmal/persistent AF without severe structural heart disease were enrolled in this study who underwent primary pulmonary vein cryoballoon ablation (CBA) with simultaneous implantation of an electrocardiogram loop recorder (Medtronic Reveal XT) and interatrial/interventricular septum biopsy. The follow-up duration was 12 months with scheduled 3, 6 and 12 month visits. Patients with recurrent AF were referred for redo procedure, where the PVI durability was assessed. The follow-up duration after the second procedure was also 12 months. The patients were divided into two groups: patients without recurrent AF and patients with recurrent AF after two catheter interventions.Results. In interventricular septum biopsy samples we found the morphological criteria of myocarditis in 70% of the patients (n=34). Individual morphological changes were detected in all patients. The most common types were cardiomyocyte hypertrophy — 98,1% (n= 52), overcrossing of cardiomyocytes — 77,4% (n=41) and lymphohistiocytic infiltration of the interstitium by more than 14 cells — 75,5% (n=40). Patients with persistent AF were significantly more likely to have endothelial cell swelling (55% vs 45%, p=0,022). Interstitial tissue edema was the only morphological parameter significantly associated with AF recurrence (p=0,03).Conclusion. In patients with AF and no structural heart disease who underwent drug-resistant AF cryoballoon ablation, morphological changes in the myocardium of the atria and ventricles are detected in 100% of cases. The predominant biopsy diagnosis is myocarditis. Morphological signs of the inflammatory process activity, as interstitial tissue edema are associated with the high incidence of non-venous AF. Further preoperative evaluation is needed to identify patients with non-venous atrial fibrillation, which will increase the effectiveness of interventional approach.

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Section: Discussionunclassified

Myocardial morphological changes and pulmonary vein catheter ablation efficacy in patients with atrial fibrillation

Kalemberg¹,

Davtyan²,

Благова

et al. 2021

Russ J Cardiol

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“…Как известно, фиброзные изменения миокарда являются фактором риска рецидива ФП и прогрессирования заболевания [25], при этом достоверно неизвестно, что было причиной фиброза. Данные изменения возникают в ответ на повреждение ткани (длительная ишемия, перегрузка миокарда, воздействие иных факторов), в том числе и воспалительного характера.…”

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Clinical effectiveness of catheter treatment for atrial fibrillation depending on the dynamics of histological changes in the myocardium

Шелемехов¹,

Баталов²,

Роговская³

et al. 2020

PKiK

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Background. Atrial fibrillation (AF) is combined with an inflammatory process that occurs in the myocardium. Diagnosis of histological changes, including inflammatory changes, in the myocardium is a complex task in the field of modern medicine. The only reliable way of determining the inflammatory changes in the myocardium is endomyocardial biopsy (EMB). As per our literature review, there are no data on the effect of histological changes in the myocardium on the efficacy of interventional treatment for AF. Moreover, assessing the dynamics of EMB results allows us to approach the treatment of patients in greater detail, thereby lowering the risk of the development and progression of serious cardiac pathologies, particularly AF.Aim. To study the effectiveness of catheter treatment for ‘idiopathic’ AF, depending on the dynamics of histological changes in the myocardium.Methods. We enrolled 48 patients with an ‘idiopathic’ form of AF; the median patient age was 39.0 y (33.5–48.0 y). Of these, 42 (87.5 %) were men and 6 (12.5 %) were women. The median duration of arrhythmic history was 4.0 y (2.0–7.0 y). All the patients underwent radiofrequency isolation of the pulmonary veins (Rcil) and EMB from the right ventricle. Histological tests, using the criteria of Cristina Basso, and immunohistochemical (IHC) tests were performed to determine the antigens of the following viruses: herpes simplex virus (HSV) types 1, 2 and 6, enterovirus (EV), Epstein-Barr, adenovirus and parvovirus (PV). After 6 mon, EMB, histological and IHC studies were repeated. Depending on the clinical form of AF, the patients are divided into the following three groups: group 1—paroxysmal form [21 (43.7 %) patients], group 2—persistent [13 (27.1 %) patients], group 3—long-term persistent [14 (29.2 %) patients]. Based on the results of the observation and evaluation of effectiveness, all the groups were divided into the following three subgroups: a—absence of AF during 12 mon of observation, b—early arrhythmia recurrences were registered during the first 3 mon of observation, c—presence of late arrhythmia recurrence after 3 mon of observation.Results. According to the histological criteria for active lymphocytic myocarditis identified in the subgroups, there were 5 patients (35.7 %) in 1a, 2 (50 %) in 1b, 6 (75 %) in 2a, 2 (66,7 %) in 2b, 7 (70 %) in 3a, 2 (66.7 %) in 3b, and 1 (100 %) in 3c. The rest of the patients showed signs of lymphocytic infiltration. After 6 mon, only in group 2a, there was a significant reduction in the number of patients with active lymphocytic myocarditis (p < 0.05). All the patients showed fibrotic changes and expression of HSV 6 and EV antigens of varying severity; this persisted till after 6 mon. The overall effectiveness of the surgical treatment was 66.7 % for paroxysmal, 61.5 % for persistent and 71.4 % for long-term persistent forms of AF during 12 mon of follow-up.Conclusion. Patients with ‘idiopathic’ AF show inflammatory changes in the myocardium, and 48.7 % met the criteria for myocarditis. All the patients showed the expression of viral antigens and the development of fibrosis that met the criteria for post-inflammatory changes. A repeat study that was conducted after 6 mon showed no significant dynamics of inflammatory and fibrotic changes. Despite the presence of inflammatory changes in the myocardium, the effectiveness of catheter treatment was 66.7 % for paroxysmal, 61.5 % for persistent and 71.4 % for long-term persistent forms of AF.Received 29 April 2020. Revised 1 June 2020. Accepted 3 June 2020.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Author contributions Conception and design: A.E. Shelemekhov, R.E. Batalov Data collection and analysis: A.E. Shelemekhov, Yu.V. Rogovskaya, S.Yu. Usenkov, E.A. Archakov, M.S. Rebenkova Drafting the article: A.E. Shelemekhov Statistical analysis: A.E. Shelemekhov, A.M. Gusakova Critical revision of the article: R.E. Batalov, Yu.V. Rogovskaya, A.M. Gusakova Final approval of the version to be published: A.E. Shelemehov, R.E. Batalov, Yu.V. Rogovskaya, S.Yu. Usenkov, E.A. Archakov, A.M. Gusakova, M.S. Rebenkova

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“…Діагностику та лікування клінічних форм ІХС здійснювали згідно з наказом МОЗ України № 152 від 02.03.2016 року [9]. Діагностику та лікування ФП здійснювали згідно з наказом МОЗ України № 597 від 15.06.2016 року та інших джерел [1,9,13].…”

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The Role of Vasodilation Factors in the Pathogenesis of Chronic Heart Failure of Ischemic Origin in Atrial Fibrillation

Denesiuk¹,

Afanasiuk²,

Denesiuk³

et al. 2021

RS Global - Science Review

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The purpose of the study is to study the possible role of vasodilation factors in the pathogenesis of chronic heart failure (CHF) in persistent atrial fibrillation (AF) in patients with stable coronary heart disease. Materials and methods. A survey of 86 patients with stable coronary heart disease complicated by CHF II-III FC according to the NYHA classification. There was 1 group - 22 patients with CHF with reduced LV EF ≤ 40.0% and AF; I (comparative group) - 20 patients with CHF with reduced LV EF without AF; 2-nd group - 24 patients with preserved LV EF ≥ 40.1% and AF and II (comparative group) - 20 patients with CHF with preserved LV EF without AF. The content of endothelial nitric oxide synthase (eNOS), nitrites (NO2-) and nitrates (NO3-) was determined. All patients underwent electrocardiographic examination (ECG) for the initial screening of arrhythmias and conduction, diagnosis of focal changes in the ventricular myocardium. Structural and hemodynamic characteristics of the heart muscle were determined by echocardiography.Results. In the examined patients of the 1st group with CHF of ischemic origin and reduced LV EF ≤ 40.0% and AF in comparison with the 2nd group of patients with CHF with preserved LV EF and AF, a significant increase in the values of ICO, ICD, IMML, the size of LA and a decrease in LV EF (p <0.01), indicating the development of LVH (remodeling) and a decrease in isotropic heart function. When comparing the levels of vasodilation factors in patients with CHF with low LV EF and AF and data from the CHF comparison group without AF, a significant decrease in eNOS by 96.8% (almost twice) and a significant decrease in serum nitrite and nitrate levels (p < 0.01), indicating the development of endothelial dysfunction. Conclusions. In patients with CHF of ischemic origin in the development of persistent forms of AF pathogenetic role is played by a significant decrease in vasodilating factors (content of eNOS, nitrites and nitrates). At decrease in EF of LV ≤ 40,0% there is a significant decrease in vasodilating factors, as a result of disturbance of endothelial function that testifies to need of correction of the revealed changes directed on slowing down of disease progression.

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Idiopathic Form of Atrial Fibrillation, Inflammation and Clinical Results of Radiofrequency Ablation

Cited by 9 publications

References 11 publications

Myocardial morphological changes and pulmonary vein catheter ablation efficacy in patients with atrial fibrillation

Myocardial morphological changes and pulmonary vein catheter ablation efficacy in patients with atrial fibrillation

Clinical effectiveness of catheter treatment for atrial fibrillation depending on the dynamics of histological changes in the myocardium

The Role of Vasodilation Factors in the Pathogenesis of Chronic Heart Failure of Ischemic Origin in Atrial Fibrillation

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