Takotsubo syndrome in a patient with atrial fibrillation after electrical cardioversion: a case report

The paper presents a description of the diagnosis and treatment of takotsubo syndrome in a patient with paroxysmal atrial fibrillation after electrical cardioversion. A case report clearly reflects the need for an integrated diagnostic approach to verify the diagnosis using dynamic echocardiography, electrocardiography, angiographic and tomographic investigations. The complexity of differential diagnosis in this case was an atypical variant of myocardial dysfunction. Follow-up made it possible to track the clinical improvement of the patient and the almost complete normalization of myocardial contractility in terms characteristic of takotsubo syndrome

Role of humoral markers in the pathogenesis of heart failure with preserved ejection fraction in patients with non-obstructive coronary artery disease

Aim. To study the role of molecular biomarkers potentially influencing the formation and progression of heart failure (HF) with preserved ejection fraction (HFpEF) in non-obstructive coronary artery disease (CAD).Material and methods. We examined 48 patients with newly diagnosed HFpEF against the background of non-obstructive CAD. Group 1 (n=31) included patients with class I-II HF and group 2 (n=17) included patients with class III HF; the control group consisted of patients without heart failure (n=17). The content of NT-proBNP and sST2, diastolic dysfunction and coronary flow reserve parameters were assessed.Results. The content of NT-proBNP in patients of group 1 was 45% higher than in group 2 (p<0,001). The mean levels of sST2 did not exceed the reference values and significantly exceeded the control group (p<0,001). Coronary flow reserve (CFR) decreased (p<0,001) depending on the severity of HF. Negative associations of sST2 levels with LVEF, septal e’ and CFR were revealed, as well as NT-proBNP with CFR.Conclusion. HFpEF in non-obstructive CAD is triggered due to progressive impairment of endothelial function, which affects the decrease in coronary and myocardial flow reserves, diastolic function, hyperproduction of humoral factors that initiate perivascular fibrosis and apoptosis of cardiomyocytes

Effect of catheter ablation for atrial fibrillation on left and right atrial function

Aim. To evaluate the effect of catheter ablation on left (LA) and right atria (RA) function in patients with atrial fibrillation.Material and methods. The study included 28 patients (14 men and 14 women) aged 33 to 72 years (mean age, 57,7±9,9 years) with paroxysmal (n=23) and persistent AF (n=5). All patients underwent radiofrequency ablation (RFA) with pulmonary vein antrum isolation. Before ablation and 3 days after, transthoracic twodimensional echocardiography was performed in sinus rhythm with an assessment of LA reservoir, conduit and booster pump function and RA peak longitudinal strain.Results. In the studied patients, a significant decrease in the reservoir, conduit and booster pump function of the LA was revealed after RFA, while there was no significant change in RA peak longitudinal strain after catheter ablation. LA reservoir, conduit and booster pump function decreased by 6,45% (p<0,001), 3,59% (p<0,001), 2,85% (p<0,001), respectively, while RA peak longitudinal strain increased by 0,73% (p=0,43).Conclusion. Catheter ablation has a significant damaging effect on the LA tissue, inhibiting the reservoir, pumping and pipeline functions. At the same time, the contractility of the PP in the early postoperative period improves, but not significantly

ЭФФЕКТИВНОСТЬ АБЛАЦИИ ПЕРСИСТИРУЮЩЕЙ ФОРМЫ ФИБРИЛЛЯЦИИ ПРЕДСЕРДИЙ У ПАЦИЕНТОВ С СИНДРОМОМ ТАХИБРАДИ И САХАРНЫМ ДИАБЕТОМ 2-ГО ТИПА

Aim. To estimate the efficacy of catheter ablation in patients with type 2 diabetes mellitus (T2D) present with atrial fibrillation and sick sinus syndrome (SSS) undergoing permanent pacemaker implantation.Methods. 56 patients (34 females) with persistent AF and SSS were enrolled in the study. The mean age of patients was 67.7±10.7 years. Dual chamber cardiac pacemaker with remote monitoring function were implanted in all patients. All the patients were assigned to two groups: Group 1 comprised 31 patients aged 67.3±9.6 years, and Group 2 comprised 25 patients aged 72.6±9.9 years, including 22 (39.2%) diabetic patients. 2-3 days after pacemaker implantation, group 1 patients underwent intracardiac electrophysiology study and RFA of the pulmonary vein ostia, mitral isthmus and the left atrial posterior wall. Group 2 patients received antiarrhythmic drug therapy. Results. 3 patients (9%) in Group 1 had recurrent AF within the 6-month follow-up. The efficacy of the RFA for AF was 55% (n = 17) 1 year after the indexed hospitalization. 8 patients had short paroxysmal attacks which gradually lessened and stopped after. 5 patients (21%) in Group 2 did not have any AF paroxysms within the 1-year follow-up (Х2 = 5.52, р = 0.02). All these patients received amiodarone as antiarrhythmic drug therapy, whereas the others had paroxysmal attacks. Frequent attacks in 10 patients (40%) led to a change in antiarrhythmic drug use. Hospital readmission rates for AF were 16% and 52%, respectively (Х2 = 4.15, р = 0.04). The impact of atrial and ventricular stimulation on the development of recurrent AF was statistically insignificant (atrial stimulation – X2 = 0.01, cc = 1, p = 0.90; ventricular stimulation – X2 = 0.15, cc = 1, p = 0.69). None paroxysmal attacks were recorded in 10 diabetic patients (45%) after the RFA within the 1-year follow-up.Conclusion. Catheter ablation for persistent AF and SSS treated with permanent pacemakers is highly effective and safe method. In addition, it is superior to pharmacological approach. The presence of T2D likely did not significantly affect the efficacy of RFA for persistent form of AF. Цель. Изучение эффективности катетерного лечения у пациентов с фибрилляцией предсердий (ФП), сахарным диабетом 2-го типа (СД) и синдромом слабости синусового узла (СССУ), корригированного электрокардиостимулятором (ЭКС).Материалы и методы. В исследование включено 56 пациентов с персистирующей формой ФП и СССУ, средний возраст 67,7±10,7 лет, из них 34 (60%) женщины. Всем пациентам был имплантирован двухкамерный ЭКС с функцией удаленного мониторинга. Пациенты разделены на две группы. В первую вошел 31 больной, средний возраст – 67,3±9,6 года, во вторую – 25, средний возраст – 72,6±9,9 года, 22 (39,2%) пациента – с СД 2-го типа. Пациентам первой группы через 2-3 дня после имплантации ЭКС проведено внутрисердечное электрофизиологическое исследование и РЧА устьев легочных вен, задней стенки, митрального истмуса. Во второй группе пациенты получали антиаритмическую терапию.Результаты. Рецидив ФП до 6 месяцев наблюдения у пациентов первой группы зарегистрирован в трех случаях (9%), а эффективность РЧА ФП после года составила 55% (n = 17). У четверти больных (n = 8) наблюдались короткие пароксизмы ФП, которые купировались самостоятельно и не ощущались пациентами. Во второй группе пароксизмы ФП отсутствовали в течение года у 5 пациентов (21%) (Х2 = 5,52, р = 0,02). В качестве антиаритмической терапии у них использовался амиодарон. У остальных зарегистрированы пароксизмы ФП и у 10 (40%) в связи с частыми приступами потребовалась смена препарата. Количество госпитализаций у пациентов обеих групп по поводу пароксизмов аритмии составило 16% и 52% соответственно (Х2 = 4,15, р = 0,04). Анализ влияния доли стимуляции предсердий и желудочков на развитие рецидива ФП не показал статистической достоверности (для стимуляции предсердий – Х2 = 0,01, сс = 1, p = 0,90, для желудочков – Х2 = 0,15, сс = 1, p = 0,69). У 10 пациентов (45%) с СД после РЧА в течение года наблюдения не зарегистрировано ни одного пароксизма ФП.Заключение. Полученные результаты катетерного лечения пациентов с персистирующей формой ФП в сочетании с СССУ, корригированного имплантацией ЭКС, и СД свидетельствуют о его высокой эффективности и безопасности, а также подтверждают его преимущество перед фармакологическим подходом

Myocardial electroporation — an alternative to thermal methods of atrial fibrillation treatment

Atrial fibrillation is one of the most common cardiac arrhythmias. By all estimates, the number of patients with this arrhythmia will only increase. Currently, the main and most used methods for the treatment of atrial fibrillation are radiofrequency and cryo-balloon ablation. However, the accumulated experience of their use has revealed a number of shortcomings — the lack of long-term pulmonary vein isolation, as well as life-threatening procedure complications. Relatively recent foreign studies showed data on the use of an alternative method of influencing arrhythmogenic foci. The method is based on the use of non-thermal pulsed field ablation, which leads to the appearance of pores in cardiomyocytes and their necrosis, which causes a more stable electrical left atrial pulmonary vein isolation. The margins of the lesions in this exposure are usually very sharp with a narrow transition from normal tissue to tissue with the complete necrosis, while not damaging neighboring structures such as blood vessels, nerves and esophagus. At present, information published in the literature on the use of pulsed field ablation in various fields of medicine, including oncology and cardiology, is clearly not enough. The implementation of this method for the interventional treatment of cardiac arrhythmias is considered a promising direction and is the subject of research by many leading scientific groups around the world. The purpose of this review is to structure the most significant information on the use of pulsed field ablation, presented in the literature, to analyze its possibilities, effectiveness, and disadvantages

A case of non-invasive topical diagnostics with successful ablation during persistent atrial fibrillation

Treatment of persistent and long-persistent forms of atrial fibrillation remains a pressing issue. Using a personalized approach can help to more successfully eliminate arrhythmias and reduce the return probability. One of these approaches is the use of radiofrequency ablation in conjunction with modern high-tech research methods. The article describes a clinical case of successful catheter ablation of persistent atrial fibrillation in a patient with a mechanical mitral valve prosthesis, due to the use of non-invasive topical diagnostics prior to surgery

HUMIDITY AND MOISTURE MEASUREMENTS IN FOOD PROCESSING APPLICATIONS

In the framework of the EMPIR Project 14IND11 HIT (Metrology for humidity at high temperatures and transient conditions), a method for estimating in real time the water loss in a hazelnuts roasting process, through humidity measurements, and its correlation with food quality parameters was demonstrated in an industrial application. At the industrial plant of a manufacturer of food processing systems, two separate measurement setups were designed and implemented on laboratory-scale roasting ovens, based on infrared and hot-air heating, in order to estimate both the water loss and the volume temperature distribution in real time during roasting tuning processes. In such a roasting process, air temperature and dew point temperature were associated with the detailed roasting protocol which in turns produces different quality of the final processed product. To perform such in-process measurements, the above quantities were measured by several PRTs and by a chilled-mirror hygrometer at temperatures between 120 °C to 180 °C and dew-point temperatures up to 35 °C, respectively. This work reports on the measurement set-up, the details about preventing volatile organic contamination of the chilled-mirror hygrometer and the validation of real-time humidity measurements by comparison against a gravimetric (water-loss) method. Suitable data processing methods of humidity measurements were implemented in order to the estimate water loss from dew-point measurements and correlate it with selected food-quality parameters. The overall results of the study are presented

SPECKLE-TRACKING INTRACARDIAC ECHOCARDIOGRAPHY IN ATRIAL FIBRILLATION PATIENTS DURING RADIOFREQUENCY ISOLATION OF PULMONARY VEINS

Aim. To evaluate the speckle-tracking echocardiography (STE) application in atrial fibrillation (AF) patients during catheter treatment, by the data from intracardiac echocardiography (ICE).Material and methods. Totally, 30 patients included, with persistent and paroxysmal AF. In 25 (84%) the main disease was arterial hypertension, of those 14 (46%) had hypertension together with coronary heart disease. In 16% cases (4 patients) AF was idiopathic. All patients had indications for catheter treatment of the arrhythmia.Results. Before the start of radiofrequency intervention (RFI), superior pulmonary vein (PV) deformation was 24,5±1,5%, after the intervention 17,5±1,1%, tissue deformation decreased by 7% (р<0,001); of the left inferior PV before RFI — 21,5±0,9%, after — 14,4±0,9%, tissue deformation decreased by 7,1% (р<0,001); right inferior PV before RFI — 21,2±1,3%, after — 14,9±1,1%, tissue deformation decreased by 6,2% (р<0,001); right inferior before RFI — 20,5±1,1%, after — 14,4±1,1%, deformation change 6,1% (р<0,001). Under the influence of RFI, velocity of upper PV deformation decreased by 8,1% (р<0,001),  to -5,36±0,5%, after — 4,93±0,35%; in lower inferior PV decrease of velocity by 8,3% (р<0,001), before RFI -5,38±0,6%, after — 4,93±0,55%; right superior PV — decrease of PV deformation by 8,5% (р<0,001),  before RFI -5,5±0,15%, after -5,0±0,33%; in right inferior 8,2% (р<0,001) before RFI -5,9±0,4%, after -5,4±0,4%.Conclusion. Decrease of deformation by more than 6% and velocity of deformation by 8% after radiofrequency intervention are relevant signs of pulmonary veins ostia isolation