The Necessity of an ICD-Therapy in Patients with Indications for Primary Prevention of Sudden Cardiac Death. One Center Experience.

Aim      Analysis of responses of cardioverter-defibrillators implanted in patients with cardiomyopathies (CMPs) of various origins and a high risk of sudden cardiac death (SCD) to assess the effectiveness of a modern strategy for primary prevention of SCD.Material and methods  In the Federal Center for High Medical Technologies in Kaliningrad from 2014 through 2018, implantable cardioverter-defibrillators (ICD) and cardiac resynchronization therapy defibrillators (CRT-D) were installed in 165 patients. Major indications for device implantation in these patients included left ventricular (LV) systolic dysfunction with ejection fraction (EF) ≤35 %; chronic heart failure (CHF) consistent with the New York Heart Association (NYHA) functional class (FC) II-III (IV for CRT-D) without previous episodes of life-threatening ventricular arrhythmias, circulatory arrest and resuscitation, which was consistent with the current international strategy for primary prevention of SCD. The study patients were divided into two groups based on the CMP origin; group 1 included 101 (61.2 %) patients with CMP of ischemic origin (ICMP) and group 2 consisted of 64 (38.8 %) patients with CMP of non-ischemic origin (NCMP). Information about arrhythmic episodes and device activation was retrieved from the device electronic memory during visits of patients to the clinic and was also transmitted to the clinic by a remote monitoring system. This information was studied and evaluated for the validity and effectiveness of the device triggering. If necessary, the parameters of detection and treatment were adjusted taking into account the obtained information. Information was analyzed and statistically processed with the SPSS Statistics 20.0 software.Results The patients were followed up for 28.3 ± 15.6 months, during which the devices delivered therapy to 55 (33.3%) patients of the entire group. In the ICMP group, the devices were activated in 44 (26.7 %) patients and in the NCMP group, the devices were activated in 11 (6.7 %) patients. In group 1 (ICMP), appropriate triggering was observed in 33 (20.0%) patients and inappropriate triggering was observed in 11 (6.7%) patients. In group 2 (NCMP), appropriate triggering was observed in 2 (1.2 %) patients and inappropriate triggering was observed in 9 (5.5 %) patients. The main cause of inappropriate triggering was atrial fibrillation (AF). 17 (10.3 %) patients with ICMP had sustained ventricular tachycardia (VT), which did not reach the detection frequency for ICD therapy; these VTs were only detected by devices and terminated spontaneously. Intragroup differences in the number of patients who received an appropriate treatment were statistically significant: 33 (32.6 %) in the ICMP group vs. 2 (3.1 %) in the NCMP group (р<0.006). Differences in the number of patients who received an inappropriate treatment were not statistically significant although their number was greater in the NCMP group than in the ICMP group (9 (14.1 %) vs. 11 (10.9 %), р>0.05).Conclusion      A higher requirement for the ICD treatment was revealed in patients with ICMP compared to patients with NCMP. The low demand for the ICD treatment in patients with NCMP and the more frequent inappropriate actuation of the devices in this patient group due to AF allow a conclusion that the criteria for primary prevention of SCD with ICD (LV EF ≤35% and clinically significant CHF) are not equally effective indications for ICD implantation in patients with ICMP and NCMP. It can be assumed that life-threatening ventricular arrhythmias are evident in patients with NCMP before the development of hemodynamically significant LV dysfunction and CHF, which warrants further research in this direction.

[Angiographic Results After Coronary Artery Bypass Grafting].

The main place among cardiovascular diseases takes coronary heart disease. The number of coronary artery bypass surgery increases every year. The large number of coronary artery bypass grafting (CABG) performed worldwide. The need for assessment of grafts patency is enormous. OBJECTIVE: We are performed analyze of graft patency results, after CABG surgery in our clinic. MATERIALS AND METHODS: This paper presents the results of a retrospective analysis of angiographic graft patency data depends of TIMI flow, Syntax score, diameter and degree of vascular lesions, as well as the surgery type. RESULTS: According angiographic data of 142 patients, we found that 74 (52.1 %) had no graft dysfunction. In the 68 (47.9 %) patients had various types graft dysfunction which is 3.0 % of the total number of operated patients in our center for coronary heart disease. 31 (46 %) patients were operated under Off pump, 19 (28 %) - On pump and 18 (26 %) - in a parallel bypass technic. According to our data parameters such as Syntax score, the diameter of the vessel and the percentage of lesion, its did not significantly affect the grafts patency in terms of up to 12,7±6,5 months. Preoperative coronary blood flow (assessed by TIMI scale) the significantly affects the grafts patency. CONCLUSIONS: In the graft patency for perioperative period and follow-up, significantly affected preoperative coronary blood flow assessed by TIMI. The results of beating heart (off pump and using a parallel IR) and On pump surgery similar in the immediate postoperative period. But there is tend to increase graft dysfunction in up to 30 months in patients after off pump surgery. We don't found relation between Syntax score, the diameter of the coronary arteries, the percentage of stenosis and graft patency after 12 months follow-up.

[Experience of Treatment of Spontaneous Rupture of Left Ventricular Posterior Wall After Mitral Valve Replacement].

Spontaneous rupture of the left ventricular posterior wall after mitral valve replacement is a severe complication and is associated with high mortality rate. This complication was first described in 1967 by Roberts and Morrow, which describe the results of autopsy of two patients. In leading clinics around the world left ventricular wall ruptures after mitral valve replacement account for up to 20% of causes of hospital mortality. Currently there is no clear-cut strategy of treatment of this complication. In this article we present analysis of both traditional and non-traditional methods of treatment of this complication as well as own small positive and negative experience.