TACTICS OF PRENATAL CARE OF A YOUNG PATIENT WITH INHERITED LONG QT SYNDROME AND IMPLANTED CARDIOVERTER-DEFIBRILLATOR

Ase report. This clinical case illustrates the example of prenatal care of a young woman with verified long QT syndrome (LQTS) type 2 with implanted cardioverter-defibrillator (ICD). In the course of pregnancy she had physiological sinus tachycardia, though the life-threatening ventricular arrhythmias and ICD shocks were not registered. On the 38th week of pregnancy the woman underwent the planned caesarean delivery (due to obstetrics indications) with live child. In the post-partum period she continued to experience recurrent VF episodes terminated after the adequate ICD shocks. Life-threatening arrhythmias were triggered by group PVC registered in the settings of persistent bradycardia. At the moment the number of the adequate ICD shocks reduced supported by betablocker therapy, the patient remains on continued standard monitoring. Discussion. Numerous cases of favourable course and even benefits in clinical and functional status during pregnancy in patients with LQTS are reported. This fact can be conditioned by the positive influence of physiological hemodynamical changes and hypersympathicotonia during pregnancy especially on the bradydependent arrhytmias. Conclusion. Pregnancy in patients with inherited LQTS and implanted ICDs is not always contraindicated and treatment tactics depends on certain clinical situation. Algorithms of pharmacological and shock therapy during pregnancy in women with ICD are corrected individually

Markers of myocardial injury and inflammation after radiofrequency ablation in children and adolescents

Aim. To assess the severity of myocardial damage and inflammation after radiofrequency ablation in children and adolescents using biochemical markers.Material and methods. The study included 58 children with tachyarrhythmias (Wolff-Parkinson-White (WPW) syndrome, WPW phenomenon, atrial tachycardia, paroxysmal atrioventricular reciprocating tachycardia, ventricular tachycardia) who underwent catheter ablation from July to October 2019. Before and after surgical treatment (after 2 hours and 5 days), the blood concentrations of myocardial damage and inflammation biomarkers (myoglobin, creatine phosphokinase-MB, interleukin-8, C-reactive protein, tumor necrosis factor alpha, metalloproteinase (MMP)-2, MMP-9, heart-type fatty acid binding protein). During the operation, catheter ablation parameters (power, temperature, application duration), the localization of arrhythmogenic focus and the type of ablation catheter were recorded. Their relationship with changes in the concentration of biochemical markers before and after intervention was studied.Results. Two hours after the operation, the concentrations of myoglobin, creatine phosphokinase-MB, MMP-9, heart-type fatty acid binding protein were increased several times (p<0,05). Changes in concentrations of interleukin-8, tumor necrosis factor alpha after the operation was not revealed. On the 5th day, elevated levels of cardiac markers returned to baseline values. MMP-9 level also decreased, but was higher than the preoperative level. Using Spearman’s correlation analysis, a direct relationship was revealed between the application duration and heart-type fatty acid binding protein level.Conclusion. Radiofrequency ablation is a safe method of treating arrhythmias in children and adolescents, since there is low volume of damaged myocardium. There was a slight increase in the level of biochemical markers after ablation (myoglobin, creatine phosphokinase-MB, fatty acid binding protein, MMP-9), incomparable with their rise in acute coronary syndrome, as well as the rapid decrease in the early postoperative period

Re-envisioning Addiction Treatment: A Six-Point Plan

This article is focused on improving the quality of addiction treatment. Based on observations that patients are leaving treatment too early and/or are continuing to use substances during their care, the authors propose six actions that could help reorient and revitalize this kind of clinical work: (1) conceptualize and treat addictive disorders within a psychiatric/mental health framework; (2) make the creation of a strong therapeutic alliance a core part of the healing process; (3) understand patients’ addictions and other problems using models based on multiple internal parts, voices, or modes; (4) make contingency management and the use of positive reinforcement systems a standard and central practice in all treatment settings; (5) envision long-term change and healing through the lens of identity theory; and (6) integrate the growing developments in recovery culture with formal treatment

Preventing the Reintroduction of Malaria in Mauritius: A Programmatic and Financial Assessment

Sustaining elimination of malaria in areas with high receptivity and vulnerability will require effective strategies to prevent reestablishment of local transmission, yet there is a dearth of evidence about this phase. Mauritius offers a uniquely informative history, with elimination of local transmission in 1969, re-emergence in 1975, and second elimination in 1998. Towards this end, Mauritius's elimination and prevention of reintroduction (POR) programs were analyzed via a comprehensive review of literature and government documents, supplemented by program observation and interviews with policy makers and program personnel. The impact of the country's most costly intervention, a passenger screening program, was assessed quantitatively using simulation modeling

Ventricular arrhythmias. Ventricular tachycardias and sudden cardiac death. 2020 Clinical guidelines

Russian Society of Cardiology (RSC).With the participation of Russian Scientific Society of Clinical Electrophysiology, Arrhythmology and Cardiac Pacing, Russian Association of Pediatric Cardiologists, Society for Holter Monitoring and Noninvasive Electrocardiology.Approved by the Scientific and Practical Council of the Russian Ministry of Health

POSSIBILITY OF NOVEL ORAL ANTICOAGULANTS USAGE DURING ABLATION IN ATRIAL FIBRILLATION

The review provides the data on contemporary approaches to anticoagulant therapy during catheter radiofrequency ablation of atrial fibrillation. The opportunities are discussed for various types of periprocedural use of warfarin, and the results mentioned for the efficacy and safety of novel oral anticoagulants in catheter ablation

Cardiology Research Institute, Tomsk National Research Medical Center

Aim. To test the hypothesis that the combined use of ivabradine (If inhibitor) and ranolazine (late sodium channel blocker) can reduce the ventricular rate in patients with permanent atrial fibrillation (AF) resistant to standard heart rate-lowering therapy.Material and methods. The study included 25 patients with a permanent AF and an uncontrolled ventricular rate. All patients had NYHA class I-III heart failure with preserved ejection fraction. Patients took ivabradine 2,5 mg twice daily and ranolazine 250 mg twice daily. Twenty-four Holter monitoring was performed after 1, 2, 4 weeks and at the end of the study. The follow-up lasted 8 weeks.Results. In 68% and 16% of patients, strict and lenient rate control was achieved, respectively. There was no ventricular rate decrease in 12% of patients. Adverse effects developed in 4% of subjects.Conclusion. The combined use of ivabradine and ranolazine in patients with a permanent AF and uncontrolled ventricular rate reduces the rate without QT prolongation or reducing left ventricular contractile function. The findings support the hypothesis that the suppression of If current and dominant fibrillation frequency may be a new goal of permanent AF therapy. Prospective, randomized studies are needed to determine the role of drugs for ventricular rate control in patients with permanent AF and to study the effects on efficacy, safety, hospitalization frequency, and other clinical outcomes