2020 Clinical guidelines for Atrial fibrillation and atrial flutter

Russian Society of Cardiology (RSC).With the participation of Russian Scientific Society of Clinical Electrophysiology, Arrhythmology and Cardiac Pacing, Russian Association of Cardiovascular Surgeons.Approved by the Scientific and Practical Council of the Russian Ministry of Health

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

COMPARISON RESULTS OF THE INTRACARDIAC ELECTROPHYSIOLOGICAL STUDY IN PATIENTS WITH TYPICAL ATRIAL FLUTTER AND FIBRILLATION

Aim. Comparison study of the parameters of intracardiac electrophysiological study (EPS) in patients with the typical atrial flutter (TAF) and atrial fibrillation (AF), of the courses as isolated types of arrhythmia.Material and methods. Totally, 82 patients included (59 (72%) males, mean age 55±10 y.o.), directed for catheter ablation procedure for TAF or AF. Depending on the anamnesis of arrhythmia, patients were selected to 4 groups: 1 — isolated TAF (n=26, 32%), 2 — AF with “spontaneous” TAF (n=27, 33%), 3 — AF and TAF, when the latter had been registered only under treatment by antiarrhythmics of IC and III classes (n=14, 17%), 4 — isolated AF (n=15, 18%). All patients underwent EPS within sinus rhythm and no antiarrhythmic therapy. During EPS the following parameters were defined: P-wave duration, time of interand intra-atrial conduction, effective refractory periods (ERP) in various areas of the atria. By the results of EPS, comparative statistical study performed of the listed parameters in the groups.Results. Patients with TAF (groups 1, 2, 3), in difference with isolated AF (group 4) had significantly longer P-wave and inter-atrial conduction time. Analysis of ERP showed similar heterogeneity of the parameters in different areas of the atria in all studied groups: the lowest ERP is found in the lateral area of the right atrium, the highest — in the distal area of coronary sinus. Intergroup differences by these parameters were non-significant.Conclusion. For TAF patients, as an isolated disorder or with AF, the characteristical is significant prolongation of the inter-atrial conduction time, that might expain tendency to tachiarrhythmias of re-entry genesis

Paroxysmal supraventricular tachycardia in patient with dilated cardiomyopathy and concomitant cardiac conduction defects: a case report and discussion

Patients with dilated cardiomyopathy (DCM) often have intraventricular conduction disorders, which contribute to aggravation of heart failure, are progressive in most cases and can specify the prognosis of the disease. Paroxysmal supraventricular arrhythmias in such patients proceed with severe clinical manifestations, often accompanied by hemodynamic instability and syncope. A case report of patient (59 years old) with DCM, reduced left ventricular ejection fraction (35-37%), left bundle branch block, and paroxysmal orthodromic reciprocating tachycardia is presented. When an electrode was inserted on the right ventricular (RV) apex during the radiofrequency ablation, a third-degree atrioventricular (AV) block was recorded. This was maintained during the operation and was recurrent when trying to remove the electrode from the RV apex, and therefore there was a need for temporary and then permanent cardiac pacing therapy. Given DCM, reduced left ventricular ejection fraction, left bundle branch block, and the expected high percentage of RV pacing, a decision was made to implant a cardiac resynchronization therapy defibrillator. The literature review considers risk factors for formation of third-degree AV block during cardiac catheterization, methods of its prevention, as well as discusses the prognostic significance of catheter-induced conduction disorders, and indications for temporary and permanent cardiac pacing therapy

Changes of NT-proBNP and sST2 levels for predicting isolated episodes of ventricular tachyarrhythmias and electrical storm in patients with systolic heart failure and various implanted devices

Aim. To study the changes in N-terminal pro-brain natriuretic peptide (NT-proBNP) and growth stimulation gene-2 (sST2) to predict isolated episodes of ventricular tachyarrhythmias (VTA) and electrical storm (ES) in patients with systolic heart failure and implanted cardioverter-defibrillators, cardiac resynchronization therapy (CRT) defibrillators, as well as cardiac contractility modulation (CCM) devices.Material and methods. The study included 69 patients (mean, 59; women, 10; mean age, 59±13 years) with class I-III systolic HF and ischemic (n=36) or nonischemic (n=33) cardiomyopathy. The survey was carried out at baseline, as well as 1, 3, 6 and 12 months after device implantation. This included data collection, physical examination, determination of NT-proBNP and sST2, 6-minute walk test, electrocardiography (ECG), 24-hour Holter monitoring, echocardiography, assessment of device performance. Predictors of isolated VTA and ES were identified using ROC and multivariate analyzes.Results. According to the follow-up (median, 28 months) results, 3 groups of patients were formed: group 1 — without VTA (n=45); group 2 — isolated VTA (n=15); group 3 — ES (n=9). According to multivariate analysis, predictors of isolated VTA were as follows: 1) baseline NT-proBNP >3200 pg/ml; 2) minimum NTproBNP >1100 pg/ml during 12-month follow-up; 3) sST2 >26 ng/ml 3 months after device implantation; 4) presence of old myocardial infarction; 5) no echocardiographic signs of response to CRT or CCM therapy. There were following predictors of ES: 1) left ventricular end-systolic dimension >7,0 cm; 2) presence of VTA runs according to 24-hour Holter monitoring; 3) no echocardiographic signs of response to CRT or CCM therapy.Conclusion. The results obtained indicate that NT-proBNP and sST2 assessment in patients with systolic heart failure is promising for predicting isolated VTA, but not ES. Cardiac reverse remodeling as a result of effective CRT or CCM therapy is associated with a significant risk reduction for isolated VTA and ES