Pulmonary Vein Isolation for Treatment of Paroxysmal Atrial Fibrillation on Patient with Situs Inversus Totalis.

A 56-year-old male with paroxysmal atrial fibrillation refractory to class IC and class III antiarrhythmic drugs was admitted to our hospital for radiofrequency catheter ablation of atrial fibrillation. During preoperative examination situs inversus totalis was revealed. Pulmonary vein (PV) isolation was successfully performed with atrial fibrillation termination and elimination of all PV potentials. The procedure was performed without any complications. Our report shows that PV isolation for treatment of drug-refractory atrial fibrillation can be safely performed in patients with dextrocardia and situs inversus totalis.

[Comparison of transthoracic, transesophageal, and intracardiac echocardiography sensitivity for guiding transseptal puncture during radiofrequency ablation in the left atrium].

The paper contains comparison of sensitivity and rates of false negative results of transthoracic (TT), transesophageal (TE), and intracardiac (IC) echocardiography (echoCG) during transseptal puncture in the run of the procedure of radiofrequency ablation of atrial fibrillation. In the work fulfilled we analyzed results of 208 echocardiographical intraprocedural investigations conducted with the aim of visualization of interatrial septum (IAS) during transseptal puncture. TT, TE and IC echoCG were carried out in 32, 26, and 150 cases, respectively. Phenomenon of IAS stretching was visualized by TT echoCG in 2 (6%) cases (sensitivity 6.7%). At TE tenting phenomenon was verified in 20 patients (20%) (sensitivity 86.9%). Puncture of IAS was carried out under IC echoCG control in 127 patients. Puncture was made in the center of thin portion of IAS (in the region of fossa ovalis), in its upper and lower portions in 65, 28, and 15.7% of cases, respectively. Sensitivity of IC echoCG was 98.4%. Rate of false positive results reached 92.8, 13.04 and 1.5% for TT, TE and IC echoCG, respectively. At present IC echoCG is most sensitive and safe ultrasound technique for verification of optimal positioning of the system for conduct of transseptal puncture in the region of IAS in comparison with TT and TE echoCG.

[Echocardiographic evaluation in patients with idiopathic ventricular arrhythmias originating from right ventricular outflow tract before and one year after radiofrequency catheter ablation].

PURPOSE: To estimate echocardiographic measurements in patients with idiopathic ventricular arrhythmias originating from right ventricular outflow tract (RVOT) before and one year after radiofrequency ablation (RFA) comparing with healthy volunteers. MATERIALS AND METHODS: The study consisted of 30 patients (7 women, 34.9+/-15.2 years of age) with predominantly repetitive monomorphic ventricular ectopy and nonsustained ventricular tachycardias. Arrhythmia history was 4.6+/-3.5 years. The control group consisted of 20 healthy unselected subjects (5 women, 41.9+/-5.3 years of age) without left ventricular (LV) dysfunction. All consecutive patients with idiopathic ventricular arrhythmias underwent electrophysiology study and RFA. Transthoracic echocardiography was performed before, 2, 6 and 12 months after RFA. RESULTS: Significantly higher LV end diastolic volume and lower LV ejection fraction were observed in study group patients to compare with control group patients. LV function significantly improved in postablative patients during 1 year follow up. There were no found complications associated with RFA. CONCLUSIONS: Idiopathic ventricular arrhythmias originating from right ventricular outflow tract (RVOT) could be a cause of arrhythmogenic LV remodeling. Successful ablation of the focal source of right ventricular ectopy resulted in normalization of LV function during follow up period.

[Radiofrequency ablation of chronic atrial fibrillation by combined isolation of pulmonary veins and anatomical modification of arrhythmia substrate].

Primary procedure of radiofrequency ablation (RFA) of chronic atrial fibrillation (AF) using nonfluoroscopic mapping system was carried out in 49 patients (mean age 52.2 +/- 11.3 years, 6 women). Etiology of AF was coronary artery disease, cardiosclerosis after myocarditis, dilated cardiomyopathy in 32, 11 and 2 patients, respectively. AF was idiopathic in 4 patients. History of chronic AF varied from 6 months to 17 years (mean 1.8 years). During follow-up for 14 +/- 5 months total efficacy of RFA was 86%. Redo procedures of endocardial electrophysiological study EPS and RFA were performed in 3 cases because of atypical atrial flutter in 2, 3, and 6 months after initial intervention, and in 1 case because of focal left atrial tachycardia (2 months after initial procedure of EPS and RFA for AF). After repetitive sessions because of atypical atrial flutter and focal left atrial tachycardia efficacy was 98%. There were no complications related to the operations.

[The experience of the use of intracardiac echocardiography during puncture of atrial septum].

We analyzed results of 175 intracardiac ultrasound studies (ICUS) in 113 men (mean age 54,6 +/- 11,0 years) and 62 women (mean age 49,7 +/- 8,9 years) with atrial fibrillation (n=146) and WPW syndrome (n=29). ICUS was used for guidance of catheters or electrodes from right to left atrium through atrial septum in 160 procedures of radiofrequency ablations for atrial fibrillation (n=146) or WPW syndrome (n=14). Complications of transseptal puncture developed in 4 patients (2,7%) with atrial fibrillation. There were no procedure related deaths. In all cases ICUS allowed to visualize interatrial septum and its thinnest part. Thus ICUS facilitates transseptal approach to the left atrium, provides lowering of risk of dangerous complications, and allows real time monitoring of possible intraprocedural complications.

[Effect of cardiac resynchronization therapy on quality of life of patients with chronic heart failure].

AIM: To study quality of life of heart failure patients who underwent cardiac resynchronization therapy. MATERIAL AND METHODS: Cardiac resynchronization devices were implanted to 27 consecutive patients (69.7+/-11.9 years of age) with severe heart failure (NYHA class III-IV). Follow up period was 11.6+/-4.9 months. Changes of parameters of quality of life (measured by questionnaire SF-36), ECHO-characteristics (left ventricular ejection fraction, end-diastolic diameter, end-systolic diameter, pulmonary artery blood pressure, mitral and tricuspid regurgitation), six-minute walk distance were assessed at baseline and in 2, 6, and 12 months after implantation of resynchronization device. RESULTS: Cardiac resynchronization therapy improved quality of life according to physical and emotional scales. Changes of the following hemodynamic characteristics were positive: ejection fraction (from 30.6+/-4,2% at baseline to 43.4+/-5.1, 46.8+/-0.3, 45.7+/-3.4% in 2, 6, 12 months after implantation, respectively), end-diastolic diameter (from 82+/-2 mm at baseline to 76+/-3, 73+/-2, 75+/-4 mm in 2, 6, 12 months after implantation, respectively), end-systolic diameter (from 56+/-2 mm at baseline to 53+/-2, 51+/-1, 52+/-3 mm in 2, 6, 12 months after implantation, respectively), pulmonary artery blood pressure (from 44+/-4 mm Hg at baseline to 35+/-3, 30+/-5, 34+/-4 mm Hg in 2, 6, 12 months after implantation, respectively), mitral regurgitation degree (from 2.8+/-0.2 at baseline to 2.4+/-0.2, 2.3+/-0.1, 2.5+/-0.3 in 2, 6, 12 months after implantation, respectively) and tricuspid regurgitation degree (from 2.5+/-0.1 at baseline to 2.1+/-0.2, 2.1+/-0.1, 2.2+/-0.2 in 2, 6, 12 months after implantation, respectively). Moreover, six minutes walk distance significantly improved (from 212+/-18 m at baseline to 270+/-14, 286+/-17 and 278+/-13 m in 2, 6, and 12 months after cardiac resynchronization device implantation, respectively). CONCLUSION: Cardiac resynchronization therapy improves quality of life of patients with terminal stage heart failure.

[Effect of respiratory infections on the clinical course of coronary artery disease].

The subjects of the study were 64 patients with coronary artery disease (CAD), and 38 healthy controls. The study included determination of Chlamydia pneumonia (CLPN), Toxoplasma gondii (TG), Herpes simplex virus (HSV) 1, 2, Epstein-Barr virus (EBV), and antibodies to these microorganisms. Diagnostically significant elevation of the serum levels of IgG antibodies to CLPN, HSV 1, 2, or TG was associated with CAD progression, and seropositivity to several of the agents strongly correlated with CAD progression. Moreover, the risk of future coronary events increased depending on the level of total pathogen burden. These results suggest that intracellular infectious agents are involved in the development of atherosclerosis and CAD.