EXAMINATION OF ELECTROPHYSIOLOGICAL PARAMETERS OF THE ATRIUMS IN PATIENTS WITH LONG-TERM PERSISTENT FORM OF ATRIAL FIBRILLATION AND VALVULAR HEART DISEASE

The study objective is to examine electrophysiological parameters of atrial myocardium, characteristics of atrioventricular conduction, and potential factors affecting recurrent atrial fibrillation (AF) in patients with persistent and long-term persistent forms of AF prior to the Labirynth IIIB surgery with single-step correction of valvular heart disease.Materials and methods. The study included 100 adults (48 men, 52 women) with persistent and long-term persistent forms of AF and different valvular heart diseases. Mean patient age was 59 years. Mean AF duration was 4 years. All patients were prescribed antiarrhythmic therapy but it proved ineffective. In 15 % of patients, restoration of the sinus rhythm was attempted through electrical cardioversion but long-term control of the sinus rhythm wasn’t achieved. All patients were diagnosed with organic pathology of the mitral valve. Also, in 80 % of patients, relative insufficiency of the tricuspid valve was detected. Chronic heart failure functional class per NYHA was III. Size of the left atrium was 5 cm, mean left ventricular ejection fraction was 61 %. All patients underwent electrical cardioversion. After successful restoration of the sinus rhythm, endocardial electrophysiology study (EES) of the heart was performed. Then, correction of valvular pathologies and the Labyrinth IIIB surgery were performed. Results. Examination of refractoriness of different parts of the atriums has shown that effective refractory period (ERP) of the atrioventricular node was minimal compared to other parts of the atriums. Maximal ERP duration was observed in the upper part of the right atrium. Therefore, in patients with long history of AF, heterogeneity of atrial myocardium ERP duration is observed. In 17 % of patients, atrial vulnerability was detected. The area of atrial vulnerability was always associated with ERP. Its duration in patients with atrial vulnerability was significantly higher.Conclusion. Long-term mitral valve incompetence and persistent AF lead to anatomical and electrophysiological remodeling of the atriums, which manifests through increased volume of the left atrium, as well as increased duration of intra-atrial conduction and heterogeneity  of refractory periods. EES allows to evaluate these functions of the atrioventricular conduction system and atrial electrophysiological parameters: detect aberrations in conduction through atrial myocardium, dispersion of its refractoriness, and the area of atrial vulnerability. These factors can serve as predictors of AF recurrence

THE FATHER AND THE SON KASSIRSKY - PRIDE OF NATIVE CARDIOLOGY (FOR THE 85TH ANNIVERSARY OF THE HONORARY SCIENTIST PROFESSOR G. I. KASSIRSKY)

The article is dedicated to the memory of professor G. I. Kassirsky, one of the  founders of the novel direction in fatherhood cardiology — cardiorehabilitation. The biography, data on scientific works and adherents provided

Stents in coronary heart disease patients: review of the studies available

The review presents the results of published randomized trials, registers, meta-analyses, and systematic reviews on the following clinical outcomes: mortality, incidence of repeat myocardial infarctions, repeat revascularizations and stent thromboses among patients with various forms of coronary heart disease, after implantation of noneluting, sirolimus-eluting and paclitaxel-eluting stents

Immunoprophylaxis of Respiratory Syncytial Virus Infection in Children

The article is dedicated is to the issue of respiratory syncytial virus (RSV) infection in children. Urgency of this issue is beyond any doubt. RSV prevalence in the children hospitalized due to infections of lower airways is 18–33% in the advanced countries; up to 30% of the population become infected in the seasonal period of morbidity rise; 70% of children undergo RSV infection in the first year of life; almost every child becomes infected within the first two years of life. Infants are characterized by severe course of RSV infection; the most commonly hospitalized age group is infants aged 2–5 months. Especially severe and life-threatening course is observed in premature infants and young children with immature and/or pathological cardiorespiratory system — in patients with congenital malformations and immunodeficiencies. Specialists of the professional association of pediatricians “Union of Pediatricians of Russia” formulated and briefly described the main peculiarities of RSV infection and characterized groups of severe course risk, as well as indications and patterns of passive immunization — the only reliably effective preventive technology available at the moment, which allows preventing incapacitating consequences of RSV infection — in accordance with principles of the evidence based medicine

Myocardial infarction: how accurate are official statistics?

Aim. To assess the dynamics of total myocardial infarction (MI) incidence by the data on medical assistance appealability (1992-2006), MI hospitalisations, in-hospital lethality and mean hospitalisation duration (2002-2006) in the Russian Federation (RF) as a whole and in Krasnodar Region.Material and methods. The official medical statistics forms were used for the analysis: Form 12 and Form 14, calculating absolute increase, increase rates, absolute value of 1 % increase and other parameters.Results. According to From 12 data, total MI incidence increased in 1992-2006, slightly decreasing during the last three years. Hospitalised MI incidence (Form 14) did not change. Both in the RF and in Krasnodar Region, hospitalised MI incidence was 1,5-1,6 times higher than that based on medical assistance appealability data, which points to inadequate MI incidence coverage. In-hospital lethality in 2002-2006 remained stable both in the RF and Krasnodar Region: 15,40 % and 15,30 % in 2002; 15,47 % and 15,10 % in 2006, respectively. Mean hospitalisation duration decreased by 20 % in Krasnodar Region and by 10 % in the RF.Conclusion: Existing principles of MI statistical coverage in the RF are inadequate and not reflecting healthcare effects on MI morbidity and mortality. These principles should be changed, with an introduction of standard methods for disease prevalence and treatment effectiveness assessment

Antioxidant protection system before and after coronary bypass surgery in coronary heart disease patients with left ventricular dysfunction

The study involved 74 patients with coronary heart disease (CHD) (mean age 52,4±4,5 years), with stable effort and exertion angina, Stage II arterial hypertension (in 56% of the participants), and multifocal atherosclerosis in 61% of cases. Among CHD patients without substantial decrease in left ventricular contractility (ejection fraction, EF >45%), activity of antioxidant enzymes increased: for superoxide dismutase (SOD), katalase, and glutathione peroxidase - by 87,5%, 25%, and 34%, respectively. In patients with EF ≥ 35%, SOD and glutathione peroxidase activity increase is also observed (by 198% and 33%, respectively), as well as reduced katalase activity. In participants with EF<35%, pseudo-normalization of SOD activity and reduction of katalase and glutathione peroxidase activity was observed: antioxidant protection system (AOP) potential was decreased (initial, reversible phase). Reduced alpha-tocopherol level was registered only in individuals with EF<35%. Severe IF dysfunction (EF<28%) was associated with AOP activity decrease: by 67% for SOD, by 90% for katalase, and by 74% for glutathione peroxidase. Authors suggest that reduced AOP system reserve in patients with severely impaired LV contractility is one of the most important factors for complication risk, reperfusion (oxidative) and surgery stress

Bone marrow stem cell treatment in heart failure patients

Chronic heart failure (CHF) treatment is an important problem of modern cardiology, with only one radical, but not universally possible solution – heart transplantation. Regenerative myocardial therapy, stem cell transplantation, raises increasing interest recently, due to many researchers’ doubts on genetic therapy for coronary heart disease and CHF management

Original method of external muscular counter-pulsation in coronary heart disease patients at cardiosurgery clinic

Aim. To assess the effects of external muscular counter-pulsation (MCP) in early post-operation period among coronary heart disease (CHD) patients, who underwent coronary aortic bypass graft (CABG) surgery. Мaterial and methods. 47 CHD patients (all males, functional class of angina 3.4±0.08), after on-pump CABG, were divided into two groups. In the main group (n=29), starting at Day 1-2 after CABG, standard therapy was combined with MCP course (CardioLa device, Switzerland). Control group (n=18) was observed according to standard protocol. The methods used included echocardiography (EchoCG) and tetrapolar thoracic impedancometry at rest. Results. MCP facilitated normalization of central and peripheral hemodynamics, disturbed due to on-pump intervention. In main group, stroke volume (р<0.002), stroke index (р<0.003), minute volume (р<0.0001), cardiac index (р<0.0001) and total ejection fraction (р<0.0001) increased, according to EchoCG at rest, and total peripheral resistance decreased, according to tetrapolar thoracic impedancometry results, comparing to control group. The number of post-operation days at the hospital was significantly lower in main group, comparing with controls (р<0.0001). Conclusion. MCP is highly effective for stabilization and improvement of central and peripheral hemodynamics in early post-CABG period