With progress in Electrotherapy of the heart, used nowadays also in heart failure (HF) patients, the problem of physiological character of therapy and prevention of iatrogenic effects become even more challenging. Clinical research is aimed on physiological rate adaptation and myocardium excitation pattern at pacing, and thus on minimizing the disturbances of the cardiovascular system (CVS) regulation loops. Criteria for physiological therapy could be the haemodynamic improvement avoiding the stress characteristic non-specific amplification of neurohumoral regulation (NHR). Rate adaptive pacing accounting for Inotropic myocardium function, regulated by the Autonomous nervous system directly via the β-adrenergic network, could decrease the myocardium adrenergic modulation for patients’ benefit, also in HF. Along with the neurohumoral factors, being the main cause of HF syndrome, different inflammation cytokines play their key role by modulating the CVS functions. Inflammation in one or another form manifests itself practically in all cardiac pathologies and heart arrhythmias independent of their localization. It has rather common pathogenic and morphological pattern, mediated by different system markers, including Endotoxin as well. Appropriately, the biological markers, participating in the NHR processes, of specific and non-specific adaptation of the body to metabolic demand, are significant to determine the physiological character of the therapy, also in the heart pacing. Further research is based on the knowledge of both the CVS regulation loops and the mechanisms of specific and non-specific adaptation of the body to different factors, i.e. the physical load and the psycho emotional stress.

This article reviews pathogenic mechanisms that underlie idiopathic cardiac rhythm and conduction disturbances. It focuses on the role of the various components of the inflammatory response of the myocardium, particularly on the autoimmune factors and fibrosis. Identification of potentially reversible autoimmune or inflammatory factors in the pathogenesis of cardiac conduction disturbances may be useful in predicting the development of the disease, serve as a rationale for more careful monitoring of these patients, and may become a target for new therapeutic approaches.

Catheter ablation of ventricular tachycardia (VT) has become a standard therapeutic method both in patients with idiopathic VT and VT associated with structural heart disease. With the advent of novel technologies such as electroanatomical mapping, image integration, intracardiac echocardiography, and/or irrigated tip ablation catheter with or without contact force assessment, VT ablation procedure can be performed safely and efficiently. This paper reviews state-of-the-art techniques and strategies used in catheter ablation of ventricular arrhythmias.

The study of primary electrical diseases of the heart in children and young people is of high demand because these diseases are the main cause of malignant ventricular tachycardias and sudden cardiac death (SCD). This group of diseases includes long QT syndrome with estimated prevalence rate of 1 in 2500 to 3000 in new-borns according to recent data. Clinical manifestation of the disease and efficacy of treatment depend on particular molecular-genetic variant of the syndrome. Sudden cardiac death risk stratification in patients with long QT syndrome is based on clinical, electrocardiography, and molecular-genetic factors and markers. Common approach to treatment of long QT syndrome consists in administration of beta-adrenoblockers. Efficacious method of SCD prevention in patients with long QT syndrome is implantation of cardioverter-defibrillator.

The aim of the study was to evaluate sympathetic innervation of the heart in patients with hypertension and persistent atrial fibrillation (AF) before and after radiofrequency catheter ablation (RFA). A total of 27 patients with stage I-II hypertension (degree 1 -3) were included in the study. Patients with persistent AF (n=17) received intracardiac procedure and RFA (isolation of pulmonary vein antrum, posterior wall of the left atrium, and left isthmus of the heart). Ten patients did not have AF. Efficacy of RFA was assessed after 12 months. All patients were divided into subgroups according to the presence of the arrhythmia recurrence. Radionuclide scintigraphy with¹²³I-metaiodbenzylguanidine (¹²³I-MIBG) was performed to evaluate sympathetic activity of the myocardium. We estimated general sympathetic activity by the heart/ mediastinum (H/M) ratio and the indicator washout rate. Regional sympathetic activity was assessed by measuring the filling defect of¹²³I-MIBG. The analysis of data showed that the H/M ratio was significantly lower in patients with AF compared with the corresponding value in patients without AF (1.70±0.14 vs. 1.96+0.08 on early scintigrams, р=0.005; 1.68+0.12 vs. 2.0±0.14 on delayed scintigrams, р=0.001). These results indicate that AF contributes to the worsening of the heart sympathetic activity in the presence of hypertension. Subjective improvement of the health and improvement in the general sympathetic cardiac function were observed in all patients after RFA: the early and delayed H/M ratios significantly increased from 1.70+0.14 to 1.97±0.21 (р=0.001) and from 1.68+0.12 to 1.96±0.12 (р=0.003), respectivley. The significant improvement in both general and regional sympathetic cardiac function was shown in patients with the efficient RFA compared with the subgroup of recurrent AF (early H/M ratio of 2.0+0.17 in patients with effective RFA vs. 1.77±0.01 in patients with ineffective RFA, p=0.021; indicator washout rate of 9.5±1.24% vs. 17.9±1.05%, p=0.004;¹²³I-MIBG filling defect of 6.8+0.43% vs. 13.5±0.75%, p=0.001, correspondingly).

The objective of the study was to estimate the levels of C-reactive protein, serum interleukin 1β, and tumor necrosis factor-α in patients with coronary heart disease (CHD) and different forms of atrial fibrillation (AF). The study surveyed a total of 113 patients aged 49.6+2.8 years with a primary diagnosis of coronary artery disease. Data demonstrated a link between the levels of proinflammatory cytokines in patients with coronary artery disease and the number of seizures and arrhythmias. The study reliably showed that the higher levels of TNF-α and IL-1β in the serum are associated with the higher frequency of AF episodes.

Purpose: To determine the clinical and electrophysiological predictors influencing the course of the disease and the results of interventional treatment of patients (pts) with persistent atrial fibrillation (PsAf). Material and Methods: The clinical evaluation of the immediate and long-term results of radiofrequency ablation (RFA) of pulmonary veins (PV) and left atrium (LA) in pts with PsAf was made. From March 2008 to June 2009 74 catheter based procedures of RFA of PsAf were performed (mean age of the patients was 54.9+8.7 years, 50 males and 24 females). Mean duration of arrhythmia was 7.2±5.3 years, body mass index was 29.5±5.4. The vast majority of pts (83.7%) had hypertension and 19% of pts had coronary artery disease. The LV and heart valves function were assessed as well as the effect of structural heart disease on natural development of AF. Pts were divided into 3 groups according to the volume of LA (group I: LA volume up to 90 mL; group II: 90-130 mL; group III: 130 mL and more). Efficacy was assessed after one RFA procedure and after several RF procedures. Repeated RFA procedure was performed in 33.8% of pts, among them 73% of the recurrences were associated with the return of conduction from PV to LA. Results: Follow-up period was 12-50 months (mean 28±16 months). Sinus rhythm at discharge was recorded in 97.2% of pts. According to the first year of observation, after a single RFA procedure sinus rhythm was maintained in 66% of pts, among them 54% of pts underwent just circular isolation of PV in the antral site; in 37.8% of cases, circular antral isolation of PV was combined with linear lesions in the left inferior isthmuses of the heart. Redo procedure was necessary in 32.4% cases (7 pts from group I, 14 pts from group II, and 5 pts from group III). Thus, the effectiveness of radiofrequency pulmonary vein isolation after a single RFA of PsAf in the first 15 months of observation in all 3 groups was similar. During long-term follow-up (50 months), efficacy after a single RFA of PsAf declined to about 50% in group I; effectiveness in group II remained constant within 60% which was due to the emergence of incisional atrial tachyarrhythmias in group with LA volume < 90 mL. After a few redo procedures, the effectiveness of RFA increased to 80 % in the group with moderate increase in LA and in group III (with a volume of more than 130 mL of the LA) efficiency increased from 40 to 60%. Four pts (5.4%) required radiofrequency modification AVN and pacemaker implantation due to the failed multiple procedure attempts, age, and clinical significance. Conclusions: Based on the factors influencing efficiency of RFA of PAF (LA volume of 90-130 mL, volume index of LA of 50.4 mL/m², decreased myocardial contractility, mitral valve insufficiency and duration of arrhythmia more than 6 years), 80% of effectiveness can be reached by aggressive approach in the early stages of disease. Obviously redo procedures are mandatory to maintain sinus rhythm in long term follow-up. Pts with a long history of AF need additional linear lesions.

The objective of the study was to assess the efficacy of various approaches for surgical treatment of atrial fibrillation (AF), depending on the electrophysiological mechanisms. A total of 423 patients with various forms of AF resistant to antiarrhythmic drug therapy were surveyed. All patients underwent intracardiac electrophysiological study. Depending on the electrophysiological forms of AF, the type of surgical treatment for each patient was selected. Electrophysiological detection of AF provides a way to differentiate the approaches for catheter treatment. Catheter treatment of focal AF is based on radiofrequency isolation of the arrhythmogenic region. In the case of detection of deceleration areas (arrhythmogenic zones) in the myocardium of the left atrium contributing to the development of the mechanism of reentry, performance of additional defragmentation of this section is necessary.

The aim of the study was to estimate the relationship between quality of life (QoL) and left atrial (LA) mechanical function after successful pulmonary vein (PV) isolation. A total of 120 patients after the ablation for atrial fibrillation were enrolled in the study. Patients of group I had the LA mechanical function disorder; group II did not have this disorder. Intraatrial hemodynamics was studied by invasive manometry and echocardiography; QoL was evaluated by using the SF-36 questionnaire at 3, 6, and 12 months. In 3 months, QoL decrease was demonstrated in group I in comparison with group II. In 6 months, QoL in group I improved whereas it did not significantly change in group II. After 12 months, QoL did not differ between groups. A similar trend was observed for the characteristics of the LA mechanical function. Conclusion: The QoL deterioration in patients who underwent successful PV isolation was associated with the disorder of the LA mechanical function due to the massive radiofrequency exposure in the antral area.

The aim of this study was to evaluate the occurrence of cardiovascular events in the long-term period after “MAZE” radiofrequency endocardial catheter ablation procedure, according to the efficacy of the interventional treatment. A total of 391 patients (247 male) aged 18 to 77 years (mean age 54.9±10.1 years) with atrial fibrillation (AF) were examined. All patients underwent catheter ablation, including pulmonary veins isolation and ablation of the lines in the back wall, roof of the left atrium, and the mitral isthmus. According to the results of our study, the long-term efficacy was 83.3% in patients with paroxysmal AF and about 72.4% in patients with persistent AF. Maintaining the sinus rhythm significantly reduced the risk of stroke (including fatal stroke) as compared with single anticoagulation therapy during the heart rate control strategy.

The article discusses strategies of management of patients with atrial fibrillation (AF): control of cardiac rhythm or heart rate (HR). Based on own data from over 10-year-old experience with cardioversion performed in Novosibirsk Regional Clinical Cardiology Dispensary, the algorithm of management of a patient is presented; the preparation and method for electronic cardioversion are described. The article analyses the results of external shock therapy (EST) and complications from the use of various anticoagulants for the safe restoration of sinus rhythm. Authors make conclusions on the preferability of cardiac rhythm control strategy in patients with atrial fibrillation and on the safety and efficacy of electrical cardioversion in the presence of adequate antithrombotic support.

We examined 23 patients with paroxysmal form of atrial fibrillation in the presence of coronary heart disease and hypertension to study в-adrenergic receptor reactivity and tone of the autonomic nervous system (ANS). The evaluation of β-adrenergic reactivity of the cell membranes was performed; sinus rhythm variability was determined; and sympatheticotonic and vagotonic disorders in patients with paroxysmal form of atrial fibrillation were studied before and during treatment with sotalol. Using a quantitative biochemical method of adrenergic reactivity of the organism, individual sensitivity to β-adrenergic blocking agent (sotalol) was determined based on measuring the β-APM values of red blood cells. Effect of sotalol on ANS manifested through greater augmentation of the high-frequency spectral component of heart rate variability compared with the low frequency component. Long-term sotalol administration significantly reduced β-APM and increased the sensitivity of adrenergic receptors while maintaining the achieved target heart rate.

First-time paroxysmal atrial fibrillation occurs in 5-15% of patients after implantation of dual chamber pacemaker which is of particular importance for patients of older age categories and it significantly increases the risk of thrombogenic events. The aim of the study was to develop a pharmacological approach to prevention of postimplantation atrial fibrillation of nonischemic origin in elderly and senile patients. The study results demonstrated that, in elderly patients implanted with dual chamber pacemaker, symptomatic atrial fibrillation paroxysms were predominant and lasted longer than asymptomatic paroxysms by 5.0 min on average. The use of amiodarone and propafenone as basic antiarrhythmic therapy in patients of group 1 contributed to a decrease in the frequency of asymptomatic arrhythmias. Comprehensive prevention program with administration of phosphatidylcholine and quercetin in liposomal form in patients of group 2 contributed to more pronounced reduction in the frequency and duration of both symptomatic and asymptomatic arrhythmia paroxysms suggesting the ability of liposomal preparations to potentiate the anti-arrhythmic effects of basic therapy.

Electrocardiography (ECG) is one of the main methods of cardiovascular diagnosis, its principle consists of graphically reflected electrical signals from the myocardium. The currently used standard electrocardiogram leads reflect changes in the excitation processes of myocardium in both time and space - in the frontal and horizontal axes. Direction of the excitation wave can be conventionally represented as a total vector which reflects the running of electrical impulses in the heart. Cardiac resynchronization therapy (CRT) with biventricular pacing is aimed to synchronize the timing of right and left ventricle. Response to CRT depends on the site of ventricular leads implantation and their relative position, which can be determined by using ECG vector analysis. The aim of this study: to give a descriptive assessment of the ECG patterns in isolated left/right ventricular stimulation at various electrode positions using the standard X-ray projections in CRT patients.

The aim of the study was to provide comparative analysis of the zones with maximum intraventricular myocardial dyssynchrony (IVD) and the localizations of ventricular electrodes in patients with differential responses to cardiac resynchronization therapy (CRT). Materials and Methods: Retrospective study comprised patients (n=40) who had sinus rhythm, complete left bundle branch block (LBBB), left ventricular (LV) ejection fraction (EF) <35%, and NYHA functional class III and IV chronic heart failure (CHF). Patients received optimal drug therapy and were implanted with a system for CRT. Mean age was 60.9±11.4 years, 65% men (n=26), 35% women (n=14); cardiomyopathy of ischemic genesis was found in 52.5% of cases. Under X-ray control, right atrial (RA) lead was implanted in the Ra appendage, right ventricular (RV) lead was implanted in the interventricular septum (iVs) or the RV apex, and LV lead was implanted in one of coronary sinus veins. Period of follow up after CRT device implantation was 12.0+1.7 months. Patients were divided into groups: group 1 (n=20) with strong response to CRT (decrease in LV end-systolic volume (ESV) >15%, relative increase of LV eF ≥10%), and group 2 (n=20) with insufficient response to CRT (the absence of dynamics in the sizes, volumes, and LV EF). For topical evaluation of the zone of stimulation with ventricular electrode, a vector analysis of ECG was performed in the beginning and the end of the follow up period (VL was divided in 12 segments, RV was divided in 3 segments). Intraventricular and interventricular dyssynchrony of the myocardium was detected by echocardiography with tissue Doppler sonography. Results: initially, the groups did not differ in regard to gender, age, and parameters of echocardiography with tissue Doppler sonography. The absence of initial IVD was observed in 7 patients of group 1 and in 8 patients of group 2, p = 0.503, cardiomyopathy of ischemic genesis significantly prevailed in group 2 (75%, n=15, р=0.014). Dislocation of the leads was not documented for the entire period of the study, displacement of LV electrodes within the vein of the coronary sinus occurred in three cases. The final sizes, volumes, and LV EF values differed between the groups (р < 0.001), mean LV EF was 44.9±5.9% in group 1 and 26.9±6.4% in group 2. Overlapping of maximum IVD zone with the site of LV electrode implantation was more significant in group 1, р = 0.028. Final values of IVD were within normal ranges in both groups, the absence of IVD was observed in 95% and 80% of patients in group 1 and group 2, respectively, р = 0.493. Conclusions: correspondence of the myocardial zone with maximum dyssynchrony to the site of the Lv lead implantation was associated with a high response to CRT in the long term. Insufficient response can be caused by a non-optimal positioning of the LV electrode, lack of agreement between implantation site and IVD zone, and by positions of the ventricular electrodes close to each other.

To study long-term efficacy of cardiac resynchronization therapy (CRT) in patients with chronic heart failure, CRT was performed in 151 patients aged 55.4±10.3 years (21-76 years) and mean functional class by NYHA of 3.2±0.4. The predominating etiology of chronic heart failure was nonischemic cardiomyopathy (n=98, 65%). The QRS complex width was 183±32 ms (146-240 ms). The clinical examination of study subjects was performed after one, three, six, 12, 24, and 36 months following implantation of CRT device. The follow-up period lasted for 35.7±4.3 months. According to data, recorded by the implanted CRT devices, pacing rates in patients with AF without AV nodal ablation and patients with AF after AV nodal ablation were 66.7±2.6% and 95.3±11.7%, respectively. Majority of nonresponders did not have AV nodal ablation. Finally, CRT had beneficial effects on LVEF, NYHA Class, and quality of life in AF patients with AV nodal ablation. CRT efficacy depended on amount of ventricular capture beats in this category of patients.

The aim of the study was to evaluate impact of atrial fibrillation on efficacy of cardiac resynchronization therapy (CRT) in patients with severe heart failure. The study comprised 110 patients (56 women) aged 47.7±10.9 years with NYHA functional class III chronic heart failure (CHF), main diagnosis of dilated cardiomyopathy (DCM), and registered permanent form of atrial fibrillation (AF). The QRS width varied from 146 ms to 240 ms (average 183±32 ms); left ventricular ejection fraction (EF) was 30.1±3.8%; end diastolic volume (EDV) was 272.4±49.8 mL; and 6-minute walk distance was 247.8±57.3 m. Optimal drug therapy for CHF was inefficacious in these patients during three to six months. All patients were implanted with CRT device. Follow up examination in the presence of biventricular stimulation was conducted after 36 months of therapy. The analysis of the results of 36-month-long CRT demonstrated that sinus rhythm spontaneously restored in 84 patients (76.4%) who had AF and inefficacious antiarrhythmic therapy before the beginning of CRT. During three years of the study, EF increased in this patients’ group by 18% from 29.0±3.8% to 42.5±4.2% (р<0.0001); EDV decreased by 48 mL from 215.9±58.1 mL to 177.1±26.6 mL (p<0.0005). Atrial fibrillation did not resolve in 26 patients (23.6%) during 36 months. In these patients, LV EF increased by 9% from 29.0±3.8% to 38.7±2.1%; EDV decreased by 15% from 215.9±58.1 mL to 200.7±39.1 mL (p<0.0005). In conclusion, restoration of sinus rhythm is an important task in patients with DCM and severe heart failure because, according to our study, it enables to achieve stable EF increase and EDV decrease for the entire period of CRT.

The aim of the study was to assess efficacy and safety of cardiac resynchronization therapy, where the left ventricle lead was implanted endocardially. Data of 10 consecutive patients were analyzed.

Ventricular arrhythmias (VA) are still the leading cause of sudden cardiac death. Therefore the identification of the predictors of high-grade VA and risk stratification of fatal events is important for clinical cardiology. We analyzed the clinical and Holter monitoring data of 993 patients with and without high-grade VA, referred for the coronary angiography. Patients with VA were older (57.2±8.4 years vs. 54.9±8.3 years, р=0.001), had lower left ventricular (LV) ejection fraction (51.6±11.2% vs. 58.4±7.6%, p<0.001), and the larger extent of LV wall motion abnormalities (10.8±15.7% vs. 5.5±10.9, р=0.001). In patients with VA, LV end diastolic diameter was significantly greater (54.3±7.4 mm vs. 49.9±4.7 mm, p<0.001), and severe functional class of chronic heart failure (NYHA) was more common (28.1% vs. 15.5%, p<0.001). For VA prediction, we used mathematical model, artificial neuronal network (ANN), and multilayer perceptron (3 neurons in input layer; 11 neurons in hidden layer, and 2 neurons in output layer). Sensitivity and specificity rates of this model were 83.58% and 53.8%, respectively. Model of ANN demonstrated high diagnostic accuracy in prediction of high-grade VA development in all three samples: learning, testing, and control. For prediction of high-grade VA, computer software “The Diagnostic Calculator” was proposed.

Objective: To evaluate cardiac function before and after radiofrequency ablation in patients with ventricular arrhythmias. Material and methods: The study included patients (n=22, mean age of 43 5±11.7 years) with ventricular arrhythmias (VA): premature ventricular beats (n=17) and paroxysmal ventricular tachycardia (n=5). Procedure of radiofrequency ablation (RFA) of ventricular arrhythmia was performed in 22 patients according to appropriate indications. Comparison group comprised 15 patients (mean age of 56.3±8.3 years) without cardiac arrhythmias. All patients underwent a complete clinical examination including gated blood pool SPECT (GBP-SPECT). Results. Compared with control group, patients with ventricular arrhythmia had moderate dilatation and reduced contractile function of both ventricles. The value of RV EF in patients with VA were significantly lower than in the control group (43.25±8.08% and 54.35±12.48%, p<0.05, respectively). The intra- and interventricular dyssynchrony was significantly higher in patients with VA and was most pronounced in the right ventricle. Interventricular dyssynchrony value was normal (<50 ms). After RFA procedure, the value of intraventricular dyssynchrony of right ventricle significantly decreased. In addition, left ventricular EDV and EF, as well as right ventricular EsV and ESI significantly decreased. The values of contractility indices of the right ventricle significantly increased. Conclusion. Ventricular arrhythmia had a negative impact on myocardial contractility, which normalized after the removal of the pathological ectopic focus. The degree of hemodynamic disturbances was determined not only by the fact of ectopia, but also by its localization.

The article presents experimental and clinical results of the study aimed at evaluation of the risk for damage of blood supply to the sinus node in patients after surgical interventions on the mitral valve depending on the type of atriotomy. The experiment was performed on the isolated hearts where coronary circulation was filled with the thick contrast medium according to the originally designed method. The study was carried out by using the isolated cadaveric hearts whose coronaries were filled with the thick contrast medium according to the originally designed method. Following the initial X-ray studies of the coronary circulation, the atriotomy incisions were done and subsequently closed; after that, X-ray studies were repeated again to evaluate the involvement of the arteries supplying the cardiac conduction system into the incisions. Clinical part of the study consisted in the intraoperative analysis of the sinus node function before and after intervention on the mitral valve. The results of the study showed that the transseptal approach via the upper edge of the oval fossa should be avoided whereas the left atrial approach along the posterior interatrial cushion and the upper atrioseptotomy according to Guiraudon were preferable.

The article presents a clinical case of treatment of atrial tachyarrhythmias in an infant. During the hospitalization, catheter ablation of atrial tachycardia and atrial flutter was performed and antiarrhythmic therapy was selected.

The article presents clinical cases of successful implantation of cardiac resynchronization device (CRT-P). Young children received surgical correction of congenital ventricular septal defect (VSD). Due to the intraoperative development of complete atrioventricular heart block, the electric cardiac pacemaker (ECP) was implanted. The following progression of dilatation of the cardiac cavities, decrease in the left ventricular ejection fraction (LV EF), inefficacy of drug therapy, and the worsening of heart failure required CRT-P implantation.

The prognosis following acute myocardial infarction (MI) has improved considerably in recent decades, essentially due to the development of percutaneous coronary intervention and improved medical therapy, including administration of thrombolytic agents. However, despite these major advances, ventricular fibrillation (VF) or rapid ventricular tachycardia (VT) still occur during the acute phase of MI in 2-8% of cases. Post-MI VA is traditionally divided into two types: early VA occurs within 48 h of MI symptom onset, whereas late VA occurs over 48 h after MI. Early VA is often attributed to the transient ischaemic settings. Several studies have shown that patients who develop VF during the acute phase of MI have a higher risk of death in the short-term. In contrast, data on mid-to-long-term survival are limited and controversial. Late VA, particularly sustained monomorphic ventricular tachycardia (VT), is more frequently due to a reentrant mechanism resulting from the presence of scar tissue, and the arrhythmogenic substrate is thought to be irreversible in these patients. While consensus guidelines agree that survivors of late VA after MI should be given an implantable cardioverter-defibrillator (ICD) prior to hospital discharge, the utility of ICDs for patients experiencing early VA after MI is less deanite.

The article presents the biography of the famous Russian heart surgeon Vikenty V. Pekarsky and his contribution to the development of Russian cardiac surgery. The author gives a brief review of his scientific, educational, medical, and social activities.