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

Predictors of atrial fibrillation in patients with dualchamber pacemakers

During prospective study the predictors of primary AF incidence were studied in 87 patients (mean age 64,3±10.5 years) with chronic ischemic heart disease after dual chamber pacemakers (DCP) implantation: 39 - with sick sinus syndrome (SSS), 43 - with the atrioventricular block II-III degree (AVB), 5 - with binodal disease. The end point was the primary incidence of sustained paroxysmal AF (>30 seconds). The primary AF development is noted at 16 (18,4%) patients later 10 months after DCP implantation. At comparison of groups with and without AF by means of Stjudents criterion and Fisher's nonparametric criterion the factors associating with AF have been revealed: presence AVB (p=0,004), a male (p=0,01), left atrium dilation (p=0,04), right ventricular stimulation percent >60% (p=0,009), atrial stimulation percent 30 сек. Первичное развитие ФП отмечено у 16 (18,4%) пациентов спустя 10 месяцев после имплантации ЭКС. При сравнении групп с ФП и без ФП с помощью критерия Стъюдента и непараметрического критерия Фишера были выявлены факторы, ассоциирующиеся с ФП: наличие АВБ (р=0,004), мужской пол (р=0,01), дилатация левого предсердия (р=0,04), доля правожелудочковой стимуляции >60% (р=0,009), доля предсердной стимуляции <35% (р=0,04), длительность детектируемой АВ-задержки <180мсек (р=0,03). Методом бинарной логистической регрессии выявлено 2 независимых предиктора ФП: длительность детектируемой АВ-задержки <180 мс и принадлежность к мужскому полу. Наличие в ЭКС алгоритма, способствующего спонтанному АВ проведению, достоверно снижало развитие ФП только при СССУ (р=0,02)