Aim. To compare the effectiveness and safety of endovascular occlusion and thoracoscopic amputation of the left atrial appendage (LAA) in patients with atrial fibrillation (AF).Methods. We present a retrospective single-center study with a prospective component including 25 patients with AF who underwent thoracoscopic amputation of the LAA and 31 patients on prospective part who underwent endovascular occlusion of the LAA. All patients signed voluntary informed consent for medical intervention and participation in the study. The criteria for selecting patients for thoracoscopic amputation of the LAA were the impossibility of performing an endovascular technique, features of its anatomy and increased trabecularity.Results. In the group of patients with thoracoscopic amputation of the LAA, 2 cases of embologenic stump of the LAA with a depth of 1.6 cm (8%) were identified; these patients were recommended to continue taking anticoagulant therapy. Among patients who underwent thoracoscopic amputation, no complications were identified in the first 30 days after surgery, including mortality, bleeding, phrenic nerve paresis, acute cerebrovascular accident, pleurisy, pneumothorax, hemothorax. In 3 patients who underwent endovascular occlusion of the LAA, hematomas were detected at the site of puncture of the great vessels (9.7%), in 2 patients thrombus were detected on the occlusion device according to the results of transesophageal echocardiography (6.5%), which required the prescription of warfarin in these patients. Also, in 2 patients (6.5%) during implantation of the occluder into the LAA, as a result of the incorrect diameter of the disk of the occluding device, a residual cavity with a depth of 0.7 cm was formed between the ridge and the occluder. No significant differences in the frequency of non-severe complications were found in the groups, p =0.139. During the year of postoperative observation, thromboembolic complications were absent in the operated patients of both groups.Conclusion. When comparing two methods of LAA isolation, no severe complications were identified, either in the perioperative or in the early or late postoperative period. There were no significant differences in the incidence of non-severe complications in the early postoperative period. Thus, the effectiveness and safety of thoracoscopic amputation and endovascular occlusion of the left atrial appendage are comparable.

We present a case of asymptomatic coronary-atrial fistula formation after zero fluoro catheter ablation for incessant right atrial tachycardia using ABLATION INDEX module.

Aim. To identify factors associated with the effectiveness of radiofrequency catheter ablation (RFA) of focal atrial tachycardia (AT) in school-aged patients in the long-term period.Methods. The study group consisted of 57 children aged 11 to 17 years 11 months (Me 15.83, IQR 14.63-17.0), who underwent catheter ablation, including repeated, for focal AT in the Almazov National Medical Research Centre from December 2009 until April 2023. We analyzed clinical and demographic data, laboratory data, parameters of tachyarrhythmia, electrophysiological study and RFA. Structural heart diseases were present in 13 children, and idiopathic arrhythmia was present in 44 patients. The criterion for intraoperative effectiveness were the absence of arrhythmia at the end of the waiting period in the X-ray operating room, delayed - within 12 months after the procedure.Results. Intraoperative effectiveness of RFA was achieved in 51 patients (89.5%), long-term - in 32 patients (56.1%). Based on the data obtained, a prognostic model of the delayed effectiveness of RFA of focal AT in school-age children was developed (p<0.001). Predictors included in the model: percentage of arrhythmia during the day (odds ratio (OR): 0.981; 95% confidence interval (CI) 0.962-0.999; p=0.043), presyncope (OR: 0.177; 95% CI 0.035-0.903; p=0.037), number of ectopic foci (OR: 0.289; 95% CI 0.128-0.649; p=0.003), right atrium localization (OR: 0.097; 95% 0.013-0.699; p=0.021). The area under the ROC curve corresponding to the association of the absence of arrhythmia after ablation and the values of the logistic regression function was 0.843±0.54 with 95% CI: 0.738-0.938. The sensitivity was 81.3%, specificity - 76.0%. No significant association with effectiveness of RFA was found between the method of arrhythmia induction and the use of drug sedation.Conclusion. It was established that factors such as percentage of arrhythmia during the day, the presence of presyncope, the number of ectopic foci and the presence of an ectopic foci in the right atrium had an inverse relationship with the effective outcome of RFA.

A clinical case of cryoballon ablation of pulmonary veins in a patient with atrial fibrillation with congenital heart disease: persistent left superior vena cava, atresia of the superior vena cava. The methods of investigation at the preoperative stage are described, which allow to plan the operation in advance, taking into account the peculiarities of the confluence of the main veins into the heart, and also some technical features of cryoballon ablation surgery are emphasized.

Arrhythmogenic right ventricular dysplasia is a hereditary cardiomyopathy - a common cause of sudden cardiac death in children and young adults. Loeys-Dietz syndrome is an ultra-rare connective tissue disorder characterized by aneurysms of the aorta and other large arteries, arterial tortuosity, and joint hypermobility and is associated with pathogenic variants in genes encoding protein components TGF-β pathway. We present a rare case of a two-abovementioned genetic disorders combination in a proband with a complex and rapidly progressive cardiovascular syndrome.

Aim. To identify the features of activation of the right and left ventricles during cardiac conductive system pacing.Methods. There are 2 groups of the study. The cardiac conductive pacing carried in patients of first group. The cardiac conductive pacing not carried in patients of second group. Before and after implantation of the pacemaker, all patients underwent ECG, noninvasive activation mapping using the Amycard software and hardware complex, the width of the QRS, the activation time of the left (LVAT) and right (RVAT) ventricles were determined initially and against the background of pacing. The parameter values are presented in the format: median and interquartile range (Me [25; 75]).Results. The study protocol was performed in 30 patients: first group - 20 patients, second group - 10. The age of the patients was 73 [57; 81] and 71 [63; 75] years, respectively. The value of native QRS complexes in first group was 106 [100; 132] msec, in second group - 144 [109; 155] msec; LVAT 70 [60; 93] msec and 88 [75; 115] msec, respectively; RVAT 62 [50; 74] msec and 85 [67; 117] msec, respectively. There were no statistically significant differences between the groups (p > 0.05) in age, values of native QRS, LVAT, RVAT. The implantable electrode model is identical in both groups. The value of the QRS complex during pacing in first group was 117 [109; 125] msec and 160 [145; 173] msec in second group; LVATp 76 [65; 89] msec and 129 [119; 148] msec, respectively; RVAT 67 [60; 80] msec and 108 [90; 128] msec, respectively. The study revealed statistically significant differences between the two groups of all evaluated parameters against the background of pacing: QRS (p = 0.01), LVAT (p = < 0.01), RVAT (p < 0.01). It should be noted that the initial values and values against the background of pacing of the QRS, LVAT, RVAT complex in patients of group No. 1 did not differ (p > 0.05); in patients of the second group, the values of the QRS, LVAT, RVAT complex initially and against the background of stimulation had significant differences (p = 0.11, p < 0.01 and p = 0.038 respectively).Conclusion. Cardiac conductive system paving is a promising method of cardiac pacing, which allows to achieve activation of the myocardium of the left and right ventricles, which does not differ significantly from activation with a sinus rhythm.

This article brings together the opinions of leading experts in the field of cardiac arrhythmia interventional treatment using multipolar mapping. The advantages and applicability of the PENTARAY® NAV eco mapping catheter are discussed in detail.

Aim. To compare the long-term outcomes of the catheter ablation (CA) using remote magnetic-guided navigation (RMN) and manual radiofrequency CA (MAN) in patients with congenital heart defect (CHD) and incisional atrial tach-yarrhythmias (AT).Methods. In this retrospective study cohort, 67 patients were included with CHD and AT. CHD were classified based on complexity (simple, moderate, and complex) according to ACC/AHA guidelines 2008. Fifty-seven (85%) patients underwent at least one surgical procedure for CHD correction before CA. The patients were divided into the two groups regarding CA approach: the MAN group (n=42) and the RMN group (n=25). The primary endpoitnts was long-term freedom from any AT, including atrial fibrillation. Key secondary endpoints included perioperative and late complications. To compare freedom from any AT between the groups, 1:3 propensity score matching was applied, and 63 patients were matched. The matching was exact on CHD complexity. The weighted matched observations were assessed with univariate Cox regression with any AT as the outcome.Results. The median follow-up period was 20 months. In the matched MAN and RMN groups, 92.3% and 83.3% patients, respectively, had incisional АТ (p=0.27), the other patients having additionally AF. The mean fluoroscopy time was statistically significant lower in the RMN group compared with MAN (р=0.009) with longer procedural duration in the RMN group (p<0.001). There was no statistically significant difference in perioperative and late complications. The freedom from any AT 36 months after CA was 78.9% in the matched RMN group and 47.2% in the matched MAN group. The comparison of freedom from any AT between the groups yielded p=0.040, hazard ration 0.32 [95% confidence interval 0.11; 0.95].Conclusion. RMN CA was superior over manual CA with respect to long-term freedom from AT in patients with CHD with similar safety profile.

Aim. To evaluate the effectiveness and identify predictors of recurrence after pulmonary veins (PV) cryoballoon isolation patients with atrial fibrillation (AF).Methods. In total, the study included 100 patients who met the selection criteria. Depending on the form and duration of AF paroxysms documented by ECG and Holter monitoring, patients were divided into two groups. The first group included 57 patients with paroxysmal AF (57%), and the second group included 43 patients with persistent AF (43%).Results. As a result of our study, important achievements of the greatest efficiency during cryoballon ablation were identified: isolation of all PV; achievement of the “input-output” block (elimination of spike activity according to the diagnostic electrode in the PV during appplication), which was recorded at a temperature of -30 and more °C; the minimum appplication time is 180 sec after reaching the entry-exit block. An electroanatomical diagram of the left atrium with a high frequency of left atrium and PV activity in patients with paroxysmal and persistent forms of AF was developed. Nine zones with pronounced activity were identified, more pronounced zones with low-amplitude activity in patients with persistent AF. The multivariate Cox analysis showed predictors, an exceptional effect on the risk of AF recurrence after cryoballoon ablation: the presence of diabetes mellitus led to the risk of AF recurrence by 2.39, incomplete isolation of the PV by 3.98 times, the value of left atrial volume index ≥ 61.9 ml/m2 in 2.91 times, peak atrial longitudinal strain value of left atrium ≤29.3.Conclusion. The results of the study allow us to determine the criteria for high efficiency during cryoballoon ablation, as well as a high-risk group for relapse. When selecting patients for cryoballoon control of PV coronavirus, with the achievement of a greater one, possible factors should be considered: indexed volume of left atrium according to multispiral computed tomography, peak atrial longitudinal strain value of left atrium, absence of diabetes mellitus.

Aim. This study aims to compare the results of the distal femoral access with the classic approach in patients undergoing pulmonary vein cryoballoon ablation and left atrial appendage occluder implantation.Methods. The primary results of the 1:1 randomized single-center study are presented. The study group recruited 47 patients who underwent the catheter-based procedure using ultrasound-assisted distal femoral access. 38 patients with traditional ultrasound-guided proximal femoral access were involved in the control group.Results. Total 85 patients were included: 47 in the study group and 38 in the control group. The median age was 61 years, and pulmonary vein cryo-ablation was performed in 84%. 95% of patients were taking direct oral anticoagulants. In the study group, the most frequent topographic and anatomical variant was the location of the superficial femoral vein on the lateral side from the artery (81%), whereas in the control group it was on the medial side (81%). The median access time was 30 s in the study group for the right leg and 35 s for the left leg. In the control group, access time was 33 s and 39 s for the right and left leg respectively. Unintentional arterial puncture occurred more frequently in both groups when the vein was fully overlapped by the artery for both right and left legs, but the differences were statistical unsignificant (p>0.05 and p=0.09 in the main group, p=0.24 and p=0.72 in the control group). In a correlation analysis, neither body mass index (p=0.19) nor femoral circumference (p=0.19 for right and p=0.06 for left legs) influenced the access time and did not increase the number of unintended arterial punctures. Two patients in the control group required additional manual hemostasis. There was no postprocedural venous thrombosis in both groups. Back pain was observed only in patients in the control group.Conclusion. The efficacy and safety of the distal femoral access approach are comparable to the traditional proximal approach. Earlier postprocedural activation of patients can help improve quality of life.