Взаимосвязь структурных изменений миокарда левого предсердия и эффективности криоаблации при персистирующей фибрилляции предсердий

Introduction. High-resolution contrast-enhanced cardiac magnetic resonance imaging reveals left atrial fibrosis, the severity of which may be related to the effectiveness of catheter ablation.Aim. To study the structural changes of the left atrium myocardium according to magnetic resonance imaging with contrast in patients with persistent atrial fibrillation before balloon cryoablation and compare the results with the effectiveness of the intervention.Materials and methods. The study included 89 patients with persistent form of atrial fibrillation. The patients were randomized into two groups: in the 1st, the pulmonary veins cryoablation was performed (n = 39 (53.4%)); in the 2nd, the pulmonary veins and posterior wall of the left atrium cryoablation was performed (n = 34 (46.6%)). All patients before cryoablation underwent cardiac magnetic resonance imaging with delayed contrast using a high-resolution MR pulse sequence. The clinical efficacy of the intervention was evaluated after 12 months after the cryoablation.Results. The severity of fibrotic myocardial lesion of the left atrium before balloon cryoablation was 0.7% [0; 3,07]. Overall efficiency of the intervention rate was 57.1%. Cryoablation was most effective (59.5%) in patients severity of fibrosis less than 20% and least effective (50%) severity of fibrosis more than 20%. Risk factors for atrial fibrillation recurrence after cryoablation were: early atrial fibrillation recurrence, female sex, the maximum atrial fibrillation duration more than 3 months, stroke/TIA.Conclusion. The severity of left atrial fibrosis more than 20%, early recurrence of atrial fibrillation in the first 3 months after the cryoablation, female sex, the duration of the maximum atrial fibrillation episode more than 3 months, and a history of stroke/transient ischemic attack may be associated with recurrence of AF during the period observation 3–12 months.Введение. Магнитно-резонансная томография (МРТ) сердца с отсроченным контрастированием высокого разрешения позволяет выявить фиброз левого предсердия, выраженность которого может быть связана с эффективностью катетерной аблации.Цель. Изучить структурные изменения миокарда левого предсердия по данным МРТ с контрастированием у пациентов с персистирующей формой фибрилляции предсердий и сопоставить результаты с эффективностью баллонной криоаблации.Материалы и методы. В исследование включены 73 пациента с персистирующей формой фибрилляции предсердий. Пациенты были разделены на две группы: в 1-й выполнялась криоаблация легочных вен (n = 39 (53,4%)); во 2-й – криоаблация легочных вен и задней стенки левого предсердия (n = 34 (46,6%)). Всем пациентам до криоаблации проводилась МРТ сердца с отсроченным контрастированием высокого разрешения. Клиническая эффективность вмешательства оценивалась через 12 мес. после криоаблации.Результаты. Выраженность фиброза левого предсердия до вмешательства составляла 0,7% [0; 3,07]. Общая эффективность вмешательства составила 57,1%. Вмешательство было наиболее эффективным (59,5%) у пациентов с выраженностью фиброза до аблации менее 20% и наименее эффективным (50%) – при фиброзном поражении более 20%. Факторами риска рецидива фибрилляции предсердий после криоаблации явились: рецидив фибрилляции предсердий в первые 3 мес. после вмешательства, женский пол, длительность максимального эпизода фибрилляции предсердий более 3 мес. и инсульт / транзиторная ишемическая атака в анамнезе.Заключение. Выраженность фиброза левого предсердия более 20%, ранний рецидив фибрилляции предсердий в первые 3 мес. после вмешательства, женский пол, длительность максимального эпизода фибрилляции предсердий более 3 мес. и инсульт / транзиторная ишемическая атака могут быть связаны с рецидивом фибрилляции предсердий в период наблюдения 3–12 мес

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

Venous thrombosis in patients after intracardial catheter interventions: incidence, risk factors, special aspects of the diagnosis

Rationale: Thrombosis of the puncture site in the femoral veins is one of the potentially dangerous complications of intracardial catheter interventions associated with thromboembolic risk related to its proximal location. According to the literature, the incidence of symptomatic venous thrombosis (VT) is 1–3%. No special studies on the assessment of risk factors for this complication, its diagnosis and treatment have been conducted.Aim: To study the incidence, risk factors and special aspects of VT diagnosis in patients undergoing intracardial electrophysiological studies (EFI) and/or catheter ablation.Materials and methods: This prospective study included 408 patients (194  men and 214  women, with median age of 51±10.1 years), who were admitted to the hospital with various cardiac rhythm disorders for intracardial EFIs and/or catheter ablations from 2016 to 2018. Before the interventions, in addition to common laboratory and instrumental work-up, all the patients underwent ultrasound duplex scanning (USDS) of the iliac-femoral segment; in 269  patients the level of D-dimer was measured. Latest at 24 hours after the intervention, all patients underwent a control ultrasound scan of the femoral vein puncture site. In case of VT occurrence anticoagulant therapy was started in all patients and they were followed up till complete VT resolution and at least for 3  months (the study endpoint). The VT incidence and its risk factors including the prognostic value of D-dimer levels were evaluated.Results: The VT incidence after catheter interventions was 11.7% (n=48). There was a significant correlation between VT occurrence and such risk factors as diabetes mellitus (p=0.001) and obesity (p<0.001). No association between elevated baseline D-dimer values (>500 ng/mL) and subsequent VT development was found (p>0.05). The quartile analysis revealed an association between baseline D-dimer levels exceeding 434  ng/mL (which corresponds to the range of 75 to 100%) and the presence of the following risk factors: age over 65  years (p<0.001), female gender (p=0.001), arterial hypertension (p=0.003), chronic coronary heart disease (p=0.044).Conclusion: In this study, all VTs (11.7%) detected after catheter transvenous interventions by USDS were asymptomatic. VTs were most frequent in patients with diabetes mellitus and obesity. D-dimer had no predictive value in the development of VT; however, its increased baseline values were more common in women, patients over 65 years, and in patients with arterial hypertension and chronic coronary heart disease