ЭФФЕКТИВНОСТЬ РЕТРОПЕРФУЗИОННОЙ ПОДДЕРЖКИ КОРОНАРНОГО КРОВОТОКА В ПРОЦЕССЕ ЭНДОВАСКУЛЯРНОЙ КОРРЕКЦИИ СЛОЖНЫХ ФОРМ ПОРАЖЕНИЙ ПЕРЕДНЕГО КОРОНАРНОГО БАССЕЙНА У ПАЦИЕНТОВ С ОСТРЫМ КОРОНАРНЫМ СИНДРОМОМ С ПОДЪЕМОМ СЕГМЕНТА ST

The most adverse outcomes of PCI in patients with ACS-STE occurs during prolonged endovascular correction of complex coronary impairment forms in the absence of coronary arterial flow support. The aim of this study was to assess the effectiveness of retroperfusion support of coronary blood flow during endovascular correction of complex anterior coronary bed impairment forms in patients with ACS-STE. The results of treatment of 12 patients who underwent endovascular image-guided intervention was analyzed from 26.04.2012 to 10.05.2014. 1st group consisted of 6 (50%) patients who underwent retroperfusion support of coronary circulation. 2nd group consisted of 6 (50%) patients in whom retroperfusion support have not been performed. In 1st group there there was a significant decrease in ST-segment elevation during retroperfusion after 60 seconds of the absence of antegrade blood flow in the anterior coronary bed compared with patients who underwent angioplasty without the coronary blood flow support (ST in V1-V3 with retroperfusion was 2,2±0,4 mm; ST in V1-V3 without retroperfusion was 2,9±0,4 mm; p=0,027). In 2nd group, in the absence of retroperfusion support in all patients after 60 seconds of antegrade flow overlap there was a significant increase in segment elevation ST (ST in V1-V3 was 2,7±0,3 mm; p = 0,027) compared to the initial ECG pattern. Similar dynamics was observed in blood pressure levels. Thus, selective retroperfusion of great cardiac vein can be used as an intraoperative support of cardiac hemodynamics in patients with ASC-STE.Наибольшее количество неблагоприятных исходов ЧКВ у больных с OKCotST возникает в процессе длительной эндоваскулярной коррекции сложных форм поражений переднего коронарного бассейна в отсутствие поддержки венечного артериального кровотока. Целью данного исследования являлось проведение оценки эффективности ретроперфузионной поддержки коронарного кровотока в процессе эндоваскулярной коррекции сложных форм поражений переднего коронарного бассейна у пациентов с OKCotST. В период с 26.04.2012 г. по 10.05.2014 г. проанализированы результаты лечения 12 пациентов, перенесших рентгеноэндоваскулярное вмешательство. 1-ю группу составили 6 (50%) больных, которым выполнялась ретроперфузионная поддержка коронарного кровоснабжения, 2-ю группу - 6 (50%) пациентов, которым ретроперфузионная поддержка не выполнялась. В 1-й группе в процессе ретроперфузии на 60-й секунде отсутствия антеградного кровотока по переднему коронарному бассейну наблюдалось достоверное уменьшение элевации сегмента ST по сравнению с ангиопластикой без поддержки коронарного кровотока (STв V1-V3 при ретроперфузии - 2,2±0,4 мм; ST в V1-V3 без ретроперфузии - 2,9±0,4 мм; p=0,027). Во 2-й группе, при отсутствии ретроперфузионной поддержки у всех пациентов на 60-й секунде перекрытия антеградного кровотока наблюдалось достоверное увеличение элевации сегмента ST (ST в V1-V3 - 2,7±0,3 мм; p=0,027) по сравнению с исходной ЭКГ-картиной. Подобная динамика прослеживалась и в отношении показателей артериального давления. Таким образом, селективная ретроперфузия большой кардиальной вены может быть использована как способ интраопе-рационной поддержки кардиогемодинамики у пациентов с OKCotST

CRYOBALLOON ABLATION IN RUSSIAN SITES OF INTERVENTIONAL ATRIAL FIBRILLATION MANAGEMENT TREATMENT: RESULTS OF THE FIRST NATIONWIDE SURVEY

Aim. The results of cryoballoon ablation (CBA) are known from the studies performed in the experienced centers of catheter treatment of atrial fibrillation (AF). The current study presents the results of CBA in real practice in centers with various experienceMaterial and methods. Among 62 Russian sites performing catheter treatment of AF, in 15 the CBA methods were in use to isolate pulmonary veins, in the years 2012-2014. Centers staff were surveyed for the detailed description of all performed CBA till 10.2014. The questionnaire included 74 lines about the centers experience, patients properties and ablation procedures, management of patients and complications. At the second step the questionnaire was used about complications.Results. Thirteen centers provided full data on all patients with CBA (457 procedures; 94% for paroxysmal AF; >95% CBAs in Russia). Six centers were marked as highly experienced for CBA for AF (mean 414,2±339,4 ablations for AF per year), and 7 — with lesser experience (33,2±34,3 ablations for AF per year). Ten centers provided the results of 6/12 month observation, and 11 centers — detalization of the complications data. there were no statistically significant differences in arrhythmia absence in patients from both types of centers (61,9±10,0 versus 61,3±30,4%). Serious complications developed in 1,5% of patients (4 tamponades, 2 strokes and 1 diaphragmal nerve palsy) and were similarly spread among more and less experienced centers (1,4% vs. 2%, p>0,05). Minor adverse events (vascular, transient diaphragm nerve palsy, transient hemoptysis) were found in 37 (8%) patients and were more common in more experienced (teaching) centers. Overall frequency of adverse events and of vascular events was higher in females than males (12% and 4,9% vs. 6% and 0%, resp.; p<0,05).Conclusion. In the real clinical practice CBA is performed with acceptable efficacy and moderate frequency of adverse events development. In less experienced centers of catheter treatment of AF the prevalence of serious adverse events does not differ from less experienced. Women develop vascular complications more often

ЭФФЕКТИВНОСТЬ РЕТРОПЕРФУЗИОННОЙ ПОДДЕРЖКИ КОРОНАРНОГО КРОВОТОКА В ПРОЦЕССЕ ЭНДОВАСКУЛЯРНОЙ КОРРЕКЦИИ СЛОЖНЫХ ФОРМ ПОРАЖЕНИЙ ПЕРЕДНЕГО КОРОНАРНОГО БАССЕЙНА У ПАЦИЕНТОВ С ОСТРЫМ КОРОНАРНЫМ СИНДРОМОМ С ПОДЪЕМОМ СЕГМЕНТА ST

The most adverse outcomes of PCI in patients with ACS-STE occurs during prolonged endovascular correction of complex coronary impairment forms in the absence of coronary arterial flow support. The aim of this study was to assess the effectiveness of retroperfusion support of coronary blood flow during endovascular correction of complex anterior coronary bed impairment forms in patients with ACS-STE. The results of treatment of 12 patients who underwent endovascular image-guided intervention was analyzed from 26.04.2012 to 10.05.2014. 1st group consisted of 6 (50%) patients who underwent retroperfusion support of coronary circulation. 2nd group consisted of 6 (50%) patients in whom retroperfusion support have not been performed. In 1st group there there was a significant decrease in ST-segment elevation during retroperfusion after 60 seconds of the absence of antegrade blood flow in the anterior coronary bed compared with patients who underwent angioplasty without the coronary blood flow support (ST in V1-V3 with retroperfusion was 2,2±0,4 mm; ST in V1-V3 without retroperfusion was 2,9±0,4 mm; p=0,027). In 2nd group, in the absence of retroperfusion support in all patients after 60 seconds of antegrade flow overlap there was a significant increase in segment elevation ST (ST in V1-V3 was 2,7±0,3 mm; p = 0,027) compared to the initial ECG pattern. Similar dynamics was observed in blood pressure levels. Thus, selective retroperfusion of great cardiac vein can be used as an intraoperative support of cardiac hemodynamics in patients with ASC-STE.Наибольшее количество неблагоприятных исходов ЧКВ у больных с OKCotST возникает в процессе длительной эндоваскулярной коррекции сложных форм поражений переднего коронарного бассейна в отсутствие поддержки венечного артериального кровотока. Целью данного исследования являлось проведение оценки эффективности ретроперфузионной поддержки коронарного кровотока в процессе эндоваскулярной коррекции сложных форм поражений переднего коронарного бассейна у пациентов с OKCotST. В период с 26.04.2012 г. по 10.05.2014 г. проанализированы результаты лечения 12 пациентов, перенесших рентгеноэндоваскулярное вмешательство. 1-ю группу составили 6 (50%) больных, которым выполнялась ретроперфузионная поддержка коронарного кровоснабжения, 2-ю группу - 6 (50%) пациентов, которым ретроперфузионная поддержка не выполнялась. В 1-й группе в процессе ретроперфузии на 60-й секунде отсутствия антеградного кровотока по переднему коронарному бассейну наблюдалось достоверное уменьшение элевации сегмента ST по сравнению с ангиопластикой без поддержки коронарного кровотока (STв V1-V3 при ретроперфузии - 2,2±0,4 мм; ST в V1-V3 без ретроперфузии - 2,9±0,4 мм; p=0,027). Во 2-й группе, при отсутствии ретроперфузионной поддержки у всех пациентов на 60-й секунде перекрытия антеградного кровотока наблюдалось достоверное увеличение элевации сегмента ST (ST в V1-V3 - 2,7±0,3 мм; p=0,027) по сравнению с исходной ЭКГ-картиной. Подобная динамика прослеживалась и в отношении показателей артериального давления. Таким образом, селективная ретроперфузия большой кардиальной вены может быть использована как способ интраопе-рационной поддержки кардиогемодинамики у пациентов с OKCotST

Outcomes of Cryoballoon Ablation in High-and Low-Volume Atrial Fibrillation Ablation Centres: A Russian Pilot Survey

properly cited. 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 procedurerelated 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

Outcomes of Cryoballoon Ablation in High- and Low-Volume Atrial Fibrillation Ablation Centres: A Russian Pilot Survey

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