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

ABLATION FOR UNINTERRUPTEDLY RECURRENT VENTRICLE TACHYCARDIA

We present a clinical case with continuous recurrent ventricle tachycardia. Patient, 60, admitted with complaints on heart disorders, periods of unexpected total weakness, repeated episodes of pre-syncopal condition, frequent dizziness, which he has been experiencing for about a year. In the anamnesis patient had diagnosis of intermittent syndrome WPW with paroxysmal antidromic tachycardia, and we performed ablation for additional conducting atrioventricular connection. By results of examination we recommended ablation of arrhythmia substrate with the subsequent solution whether implantation of a cardioverter defibrillator was required. Stimulation and activation mapping was performed. The area of ventricular tachycardia substrate was defined in the septal part of the right ventricle outflow tract, and frequent ventricular ectopic activity – in the area of the anterio-lateral wall of LV outflow tract under the aortal valve. On the basis of radiofrequency impact series we observed ventricular disturbances discontinuation. After the performed operation the patient demonstrated clinical improvement. According to Holter ECG monitoring for jogging of group ventricular activity, and also ventricular tachycardia was not registered

GENDER DIFFERENCES OF CORONARY HEART DISEASE PATIENTS WITH POSTINFARCTION CARDIOSCLEROSIS AND CHRONIC MITRAL REGURGITATION BY THE DATA OF CORONARY ANGIOGRAPHY REGISTRY

Aim. To reveal gender differences of clinical and functional parameters in postmyocardial infarction patients with chronic mitral regurgitation by data of coronary angiography Registry.Material and methods. Among 15283 patients of Coronary angiography Registry© evaluated from 1991 to 2012 we selected end assessed clinical and functional parameters of 350 men and 53 women with Q-wave myocardial infarction and moderate or severe mitral regurgitation and signs of scars detected by echocardiography.Results. Comparing to the men, women had lower hemoglobin level (135,5±11,3 vs 148,3±14,2 g/l, р<0,001) and rate of smokers (9,8 vs 62,6%, р<0,001). The prevalence of hypothyroidism (29,7 vs 9,6%, р=0,001) and severe MR (17,0 vs 9,1%, р=0,038) were higher in women. They had higher indexes of left atrium size (25,1±2,9 vs 23,7±3,2 mm/m2, р=0,008), left ventricular (LV) posterior wall thickness (6.0±0.7 vs 5,2±0,8 mm/m2, р<0,001), lower extent of LV wall motion abnormalities (28,7±14,7 vs 33,5±14,9%, р=0,036) and higher LV ejection fraction (47,3±8,2 vs 43,9±9,2%, р=0,013). The localization of myocardial scars and coronary stenosis did not differ between men and women. According to the results of multivariate analysis, female gender was independently associated with greater index of LV posterior wall thickness (OR 3,215; CI 1,781–5,804; р<0,001), hypothyroidism (OR 3,070; CI 0,994–9,483; р=0,050), greater body mass index (OR 1,17; CI 1,042–1,317; р=0,008), smoking (ОR 0,056; CI 0,013–0,244; р<0,001) and lower hemoglobin level (OR 0,927; CI 0,890–0,966; р<0,001).Conclusion. There are gender differences in clinical and functional parameters of postmyocardial infarction patients with chronic mitral regurgitation: more severe LV remodeling in women

LONG TERM RESULTS OF PERCUTANEOUS CORONARY INTERVENTIONS COMPARING WITH CONSERVATIVE MANAGEMENT IN TREATMENT OF STABLE ISCHEMIC HEART DISEASE PATIENTS UNDER REAL CIRCUMSTANCES

Aim. To evaluate long term results of percutaneous coronary interventions (PCI) in stable ischemic heart disease patients (IHD) under real clinical circumstances.Material and methods. The PCI group consisted of 150 patients with stable IHD after PCI, randomly selected from the Registry of Coronary Angiography. Comparison group consisted of randomly selected from the Registry 150 patients with stable IHD receiving only drug therapy (DT).Results. In long term perion it was found that total mortality (4,0% vs. 11,3%, p=0,017) and cardiovascular mortality (3,3% vs. 10,7%, p=0,013) were lower in PCI group. After PCI there was rarer coronary bypass operation need (2,0% vs. 10,0%, p=0,004). By the prevalence of myocardial infarction in compared groups there were no statistically significant differences (6,7% vs. 5,3%, p=0,627). Kaplan-Meier curve analysis showed that positive effect of PCI was fulfilled in 15 months and progressively increased until the end of follow-up. In stepped regression of Cox proportional risks it was revealed that in long term period PCI performing associated with the increase of survival rate 2,8 times (RR=2,81, 95% CI 1,03-7,69, p=0,044). Long term survival showed independent relation with the grade of coronary lesion. In PCI group, as in DT group, there were no positive dynamics of angina functional classes. In MT group during the follow-up functional class of heart failure became harder than in PCI group, and in PCI groupthere were no significant dynamics of heart failure functional class.Conclusion. Real clinical practice proved the effectiveness of PCI with DT in treatment of stable IHD. In long term results evaluation, PCI for stable IHD associated with the increase of survival 2,8 times comparing with the group with only DT. Positive PCI effect realized after 15 months and progressively increased to the end of follow-up

CLINICAL CHRACTERISTICS OF PATIENTS AND RESULTS OF CATHETER ABLATION IN ATRIAL FIBRILLATION IN RUSSIA: SUBANALYSIS OF THE EUROPEAN REGISTRY 2012-2016

Aim. The results presented, of subanalysis of the catheter ablation (CA) registry in atrial fibrillation (AF) with the patients properties, specifics of CA and treatment results, in Russia comparing to European countries.Material and methods. During 2012 to 2015, totally 3742 patients included to the registry, of those 477 in Russia. In 467 Russian patients (males 56,5%; mean age 58,5 y. o.) CA AF was done. During one year 392 patients were followed up. Minimum requirements to follow-up: routine ECG registration and non less than one contact after 12 months passed.Results. In Russian patients there were more common obesity (46,1% and 29,2%, p<0,001), hypertension heart disease (40,2% and 22,8%, p<0,0001), coronary heart disease (31,7% and 16,2%, p<0,0001), chronic heart failure (67,3% and 13,0%, p<0,0001). In Russia the patients more commonly underwent primary CA (83,5% in Russia and 77,6% in European countries, p<0,05), more rare in Russia the cryoballoon ablation was done (3% and 18%, p<0,05). Generally adverse events were reported more rare in Russia (10,5% and 16,6%, p=0,0007), including cardiovascular adverse events (2,6% and 5,2%, p<0,05). Tachiarrhythmias recurs were diagnosed more rare in Russia, including by the subsutaneous ECG monitors (17% and 1,6% in other countries, р<0,001). Within the year of follow-up, full absence of tachiarrhythmias recurs in Russia was found in 65,8% of patients, in other countries — in 74,7% (р=0,0003).Conclusion. In real clinical setting, high efficacy of CA AF was shown, resistant to antiarrhythmic therapy. In most of Russian patients there were cardiovascular comorbidities. There was lower rate of reported adverse events in Russian centers of interventional treatments

Antiarrhythmic drug therapy after atrial fibrillation ablation: data of the ESC-EHRA registry

Aim. Catheter ablation (CA) is an effective approach for rhythm control in atrial fibrillation (AF), however antiarrhythmic therapy (AAT) remains important. There is a lack of data about long-term AAT use after CA. This study evaluates AAT after CA for AF.Material and methods. In 2012-2016, EURObservational Research Programme of Atrial Fibrillation Ablation Long-Term (EORP AFA L-T) registry was conducted, which included 476 Russian patients (57,1% — men; mean age — 57,1±8,7 years). The follow-up after CA was 12 months (available in 81,9% of patients). The use of AAT was evaluated prior to hospitalization, during hospitalization for CA, as well as at 3, 6 and 12 months of follow-up.Results. Prior to CA, 439 (92,2%) patients received AAT During CA, 459 (96,4%) patients were treated with AAT. After CA, AAT was used by 463 (97,3%), 370 (94,8%), and 307 (78,7%) patients at 3, 6 and 12 months of follow-up, respectively. There was no arrhythmia recurrence in 187 (47,9%) subjects. Among these patients, 40 (21,4%) received class IC or III AAT. The peak of AAT use was found for class IC agents within 3 months after CA (P<0,05), while for other drugs this trend was not observed. There were no factors associated with AAT usage in patients without arrhythmia recurrence after CA. A positive correlation of arrhythmia non-recurrence with a minimum number of previously used antiarrhythmic agents was revealed (RR=0,85; 95% CI 0,73-0,98; P=0,03).Conclusion. The frequency of AAT use after AF ablation is significantly reduced. However, there is a cohort of patients without documented arrhythmia recurrence still receiving AAT, which requires special attention of physicians. There were no clinical predictors of continued AAT in subjects without arrhythmia recurrence