Surgical treatment of incisional tachycardia and atrial fibrillation in patients with mitral valve prosthesis: should we be scared?

Mitral valve disease, including dysfunction of the mitral valve, is often accompanied by atrial fibrillation. Among the patients with prosthetic mitral valves, atrial fibrillation occurs in 30–50% cases. Development of atrial arrhythmias and incisional tachycardia in the early and late postoperative periods can significantly influence patients’ rehabilitation and prognosis. Our clinical case describes a patient with a mechanical mitral valve and incisional tachycardia, which led to progression of heart failure and reduced left ventricular systolic function. The patient underwent catheter ablation with non-invasive myocardium mapping. The case reveals the potentials of treatment of incisional tachycardia and atrial fibrillation, which do not respond to drug therapy. Modern methods of visualization enable the cardiac surgeons to reduce possible intraoperative risks and development of complications in this group of patients

Nonfluoroscopic catheter ablation in patients with atrial fibrillation

The article demonstrates available literature data on the nonfluoroscopic catheter ablation of atrial fibrillation (AF). The main disadvantages of standard fluoroscopic catheter ablation are shown. The research results on the use of intracardiac echocardiography are presented. The first experience of using the fluoroscopy-free procedure in Russia as a pilot study is also presented. During the period from December 2017 to December 2019, 28 radiofrequency ablations and 40 pulmonary vein cryoballoon ablations were performed without fluoroscopy using threedimensional imaging and intracardiac echocardiography. Despite the small number of large studies in this area, clinical cases described in the literature, as well as their own results, demonstrate the safety of using three-dimensional imaging in combination with intracardiac echocardiography as an alternative to fluoroscopy. Application of the approach is of undoubted practical interest and requires further study in large studies