4 research outputs found
ΠΠ·Π°ΠΈΠΌΠΎΡΠ²ΡΠ·Ρ ΡΡΡΡΠΊΡΡΡΠ½ΡΡ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΠΉ ΠΌΠΈΠΎΠΊΠ°ΡΠ΄Π° Π»Π΅Π²ΠΎΠ³ΠΎ ΠΏΡΠ΅Π΄ΡΠ΅ΡΠ΄ΠΈΡ ΠΈ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ ΠΊΡΠΈΠΎΠ°Π±Π»Π°ΡΠΈΠΈ ΠΏΡΠΈ ΠΏΠ΅ΡΡΠΈΡΡΠΈΡΡΡΡΠ΅ΠΉ ΡΠΈΠ±ΡΠΈΠ»Π»ΡΡΠΈΠΈ ΠΏΡΠ΅Π΄ΡΠ΅ΡΠ΄ΠΈΠΉ
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 3β12 months.ΠΠ²Π΅Π΄Π΅Π½ΠΈΠ΅. ΠΠ°Π³Π½ΠΈΡΠ½ΠΎ-ΡΠ΅Π·ΠΎΠ½Π°Π½ΡΠ½Π°Ρ ΡΠΎΠΌΠΎΠ³ΡΠ°ΡΠΈΡ (ΠΠ Π’) ΡΠ΅ΡΠ΄ΡΠ° Ρ ΠΎΡΡΡΠΎΡΠ΅Π½Π½ΡΠΌ ΠΊΠΎΠ½ΡΡΠ°ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΡΠ°Π·ΡΠ΅ΡΠ΅Π½ΠΈΡ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ Π²ΡΡΠ²ΠΈΡΡ ΡΠΈΠ±ΡΠΎΠ· Π»Π΅Π²ΠΎΠ³ΠΎ ΠΏΡΠ΅Π΄ΡΠ΅ΡΠ΄ΠΈΡ, Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΠΎΡΡΡ ΠΊΠΎΡΠΎΡΠΎΠ³ΠΎ ΠΌΠΎΠΆΠ΅Ρ Π±ΡΡΡ ΡΠ²ΡΠ·Π°Π½Π° Ρ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡΡ ΠΊΠ°ΡΠ΅ΡΠ΅ΡΠ½ΠΎΠΉ Π°Π±Π»Π°ΡΠΈΠΈ.Π¦Π΅Π»Ρ. ΠΠ·ΡΡΠΈΡΡ ΡΡΡΡΠΊΡΡΡΠ½ΡΠ΅ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡ ΠΌΠΈΠΎΠΊΠ°ΡΠ΄Π° Π»Π΅Π²ΠΎΠ³ΠΎ ΠΏΡΠ΅Π΄ΡΠ΅ΡΠ΄ΠΈΡ ΠΏΠΎ Π΄Π°Π½Π½ΡΠΌ ΠΠ Π’ Ρ ΠΊΠΎΠ½ΡΡΠ°ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΏΠ΅ΡΡΠΈΡΡΠΈΡΡΡΡΠ΅ΠΉ ΡΠΎΡΠΌΠΎΠΉ ΡΠΈΠ±ΡΠΈΠ»Π»ΡΡΠΈΠΈ ΠΏΡΠ΅Π΄ΡΠ΅ΡΠ΄ΠΈΠΉ ΠΈ ΡΠΎΠΏΠΎΡΡΠ°Π²ΠΈΡΡ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ Ρ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡΡ Π±Π°Π»Π»ΠΎΠ½Π½ΠΎΠΉ ΠΊΡΠΈΠΎΠ°Π±Π»Π°ΡΠΈΠΈ.ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π²ΠΊΠ»ΡΡΠ΅Π½Ρ 73 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° Ρ ΠΏΠ΅ΡΡΠΈΡΡΠΈΡΡΡΡΠ΅ΠΉ ΡΠΎΡΠΌΠΎΠΉ ΡΠΈΠ±ΡΠΈΠ»Π»ΡΡΠΈΠΈ ΠΏΡΠ΅Π΄ΡΠ΅ΡΠ΄ΠΈΠΉ. ΠΠ°ΡΠΈΠ΅Π½ΡΡ Π±ΡΠ»ΠΈ ΡΠ°Π·Π΄Π΅Π»Π΅Π½Ρ Π½Π° Π΄Π²Π΅ Π³ΡΡΠΏΠΏΡ: Π² 1-ΠΉ Π²ΡΠΏΠΎΠ»Π½ΡΠ»Π°ΡΡ ΠΊΡΠΈΠΎΠ°Π±Π»Π°ΡΠΈΡ Π»Π΅Π³ΠΎΡΠ½ΡΡ
Π²Π΅Π½ (n = 39 (53,4%)); Π²ΠΎ 2-ΠΉ β ΠΊΡΠΈΠΎΠ°Π±Π»Π°ΡΠΈΡ Π»Π΅Π³ΠΎΡΠ½ΡΡ
Π²Π΅Π½ ΠΈ Π·Π°Π΄Π½Π΅ΠΉ ΡΡΠ΅Π½ΠΊΠΈ Π»Π΅Π²ΠΎΠ³ΠΎ ΠΏΡΠ΅Π΄ΡΠ΅ΡΠ΄ΠΈΡ (n = 34 (46,6%)). ΠΡΠ΅ΠΌ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌ Π΄ΠΎ ΠΊΡΠΈΠΎΠ°Π±Π»Π°ΡΠΈΠΈ ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠ»Π°ΡΡ ΠΠ Π’ ΡΠ΅ΡΠ΄ΡΠ° Ρ ΠΎΡΡΡΠΎΡΠ΅Π½Π½ΡΠΌ ΠΊΠΎΠ½ΡΡΠ°ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΡΠ°Π·ΡΠ΅ΡΠ΅Π½ΠΈΡ. ΠΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠ°Ρ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²Π° ΠΎΡΠ΅Π½ΠΈΠ²Π°Π»Π°ΡΡ ΡΠ΅ΡΠ΅Π· 12 ΠΌΠ΅Ρ. ΠΏΠΎΡΠ»Π΅ ΠΊΡΠΈΠΎΠ°Π±Π»Π°ΡΠΈΠΈ.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΡΡΠ°ΠΆΠ΅Π½Π½ΠΎΡΡΡ ΡΠΈΠ±ΡΠΎΠ·Π° Π»Π΅Π²ΠΎΠ³ΠΎ ΠΏΡΠ΅Π΄ΡΠ΅ΡΠ΄ΠΈΡ Π΄ΠΎ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²Π° ΡΠΎΡΡΠ°Π²Π»ΡΠ»Π° 0,7% [0; 3,07]. ΠΠ±ΡΠ°Ρ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²Π° ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° 57,1%. ΠΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²ΠΎ Π±ΡΠ»ΠΎ Π½Π°ΠΈΠ±ΠΎΠ»Π΅Π΅ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΡΠΌ (59,5%) Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΠΎΡΡΡΡ ΡΠΈΠ±ΡΠΎΠ·Π° Π΄ΠΎ Π°Π±Π»Π°ΡΠΈΠΈ ΠΌΠ΅Π½Π΅Π΅ 20% ΠΈ Π½Π°ΠΈΠΌΠ΅Π½Π΅Π΅ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΡΠΌ (50%) β ΠΏΡΠΈ ΡΠΈΠ±ΡΠΎΠ·Π½ΠΎΠΌ ΠΏΠΎΡΠ°ΠΆΠ΅Π½ΠΈΠΈ Π±ΠΎΠ»Π΅Π΅ 20%. Π€Π°ΠΊΡΠΎΡΠ°ΠΌΠΈ ΡΠΈΡΠΊΠ° ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π° ΡΠΈΠ±ΡΠΈΠ»Π»ΡΡΠΈΠΈ ΠΏΡΠ΅Π΄ΡΠ΅ΡΠ΄ΠΈΠΉ ΠΏΠΎΡΠ»Π΅ ΠΊΡΠΈΠΎΠ°Π±Π»Π°ΡΠΈΠΈ ΡΠ²ΠΈΠ»ΠΈΡΡ: ΡΠ΅ΡΠΈΠ΄ΠΈΠ² ΡΠΈΠ±ΡΠΈΠ»Π»ΡΡΠΈΠΈ ΠΏΡΠ΅Π΄ΡΠ΅ΡΠ΄ΠΈΠΉ Π² ΠΏΠ΅ΡΠ²ΡΠ΅ 3 ΠΌΠ΅Ρ. ΠΏΠΎΡΠ»Π΅ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²Π°, ΠΆΠ΅Π½ΡΠΊΠΈΠΉ ΠΏΠΎΠ», Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ ΠΌΠ°ΠΊΡΠΈΠΌΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΠΏΠΈΠ·ΠΎΠ΄Π° ΡΠΈΠ±ΡΠΈΠ»Π»ΡΡΠΈΠΈ ΠΏΡΠ΅Π΄ΡΠ΅ΡΠ΄ΠΈΠΉ Π±ΠΎΠ»Π΅Π΅ 3 ΠΌΠ΅Ρ. ΠΈ ΠΈΠ½ΡΡΠ»ΡΡ / ΡΡΠ°Π½Π·ΠΈΡΠΎΡΠ½Π°Ρ ΠΈΡΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠ°Ρ Π°ΡΠ°ΠΊΠ° Π² Π°Π½Π°ΠΌΠ½Π΅Π·Π΅.ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. ΠΡΡΠ°ΠΆΠ΅Π½Π½ΠΎΡΡΡ ΡΠΈΠ±ΡΠΎΠ·Π° Π»Π΅Π²ΠΎΠ³ΠΎ ΠΏΡΠ΅Π΄ΡΠ΅ΡΠ΄ΠΈΡ Π±ΠΎΠ»Π΅Π΅ 20%, ΡΠ°Π½Π½ΠΈΠΉ ΡΠ΅ΡΠΈΠ΄ΠΈΠ² ΡΠΈΠ±ΡΠΈΠ»Π»ΡΡΠΈΠΈ ΠΏΡΠ΅Π΄ΡΠ΅ΡΠ΄ΠΈΠΉ Π² ΠΏΠ΅ΡΠ²ΡΠ΅ 3 ΠΌΠ΅Ρ. ΠΏΠΎΡΠ»Π΅ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²Π°, ΠΆΠ΅Π½ΡΠΊΠΈΠΉ ΠΏΠΎΠ», Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ ΠΌΠ°ΠΊΡΠΈΠΌΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΠΏΠΈΠ·ΠΎΠ΄Π° ΡΠΈΠ±ΡΠΈΠ»Π»ΡΡΠΈΠΈ ΠΏΡΠ΅Π΄ΡΠ΅ΡΠ΄ΠΈΠΉ Π±ΠΎΠ»Π΅Π΅ 3 ΠΌΠ΅Ρ. ΠΈ ΠΈΠ½ΡΡΠ»ΡΡ / ΡΡΠ°Π½Π·ΠΈΡΠΎΡΠ½Π°Ρ ΠΈΡΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠ°Ρ Π°ΡΠ°ΠΊΠ° ΠΌΠΎΠ³ΡΡ Π±ΡΡΡ ΡΠ²ΡΠ·Π°Π½Ρ Ρ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²ΠΎΠΌ ΡΠΈΠ±ΡΠΈΠ»Π»ΡΡΠΈΠΈ ΠΏΡΠ΅Π΄ΡΠ΅ΡΠ΄ΠΈΠΉ Π² ΠΏΠ΅ΡΠΈΠΎΠ΄ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ 3β12 ΠΌΠ΅Ρ
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 414,2Β±339,4 ablations for AF per year), and 7 β with lesser experience (33,2Β±34,3 ablations for AF per year). Ten centers provided the results of 6/12 month observation, and 11 centers β detalization of the complications data. there were no statistically significant differences in arrhythmia absence in patients from both types of centers (61,9Β±10,0 versus 61,3Β±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 1β3%. 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 (194Β men and 214Β women, with median age of 51Β±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 269Β 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 3Β 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 434Β ng/mL (which corresponds to the range of 75 to 100%) and the presence of the following risk factors: age over 65Β 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