INFLUENCE OF PERMANENT PACING OF THE ATRIA FROM UPPER ANTERIOR AREA OF INTERCARDIAC SEPTA (AREA OF BAKHMAN'S FASCICLES) ON THE PART OF AMOTIVATIONAL VENTRICLE STIMULATION.

This research includes 74 patients with syndrome of the sinus node asthenia. The application of permanent bilocular pacing was indicated for these patients. An atrial electrode was located in the right atrial auricle in 37 patients and it was in the area of Bakhman's fascicles in other 37 patients. All the patients had a stimulated atrio-ventricular delay on 250 ms, but sensing delay was shorter on 20 ms. Given data were analyzed after operation in the periods of 6 and 12 months. Cumulative percent of ventricular stimulation was significantly less in the group with electrode in the area of Bakhman's fascicles (6%) as compared with the group where electrode installed in the right atrial auricle (41%) after 6 months. There were 4% in comparison with 43% after 12 months. The localization of atrial electrode in the area of Bakhman's fascicles led to reduction of cumulative percent of ventricular stimulation on 35% after 6 months and on 39% after 12 months. Permanent pacing in the area of Bakhman's fascicles could be an effective mode to decrease the part of amotivational stimulation of the right ventricle.

[ASSESSMENT OF EFFICACY OF TEMPORARY EPICARDIAL BIVENTRICULAR RESYNCHRONIZATION PACING AFTER CARDIAC SURGERY].

The temporary pacing is provided as a key principle of maintenance and correction of hemodynamics after weaning the patient from cardiopulmonary bypass. There are conventional algorithms of temporary pacing, but the substantiation of electrode fixation areas is variable. The authors experimentally investigated the efficacy of temporary epicardial pacing in DDD and DDDBV using 18 laboratory animals after cardiac surgery with application of cardiopulmonary bypass. The hemodynamic parameters were compared in given groups. It was noted that in case of temporary epicardial pacing in DDDBV conditions was the best hemodynamic effect. The authors recommended more optimal areas for electrode fixation in temporary pacing: bachmans bunble (closest to the artrial septum), proximal part of the crista terminalis for the right atrium electrodes; the front-side free wall of the right ventricle at the distance of 3-4 cm from the apex of the heart, diaphragmatic surface of the right ventricle proximal to artioventricular groove for the right ventricle electrodes; obtuse margin (side wall of the left ventricle), diaphragmatic surface of the left ventricle proximal to artioventricular groove for the left ventricle electrodes.

[Characteristics of coronary artery involvement and probability of appropriate discharges of cardioverter-defibrillator implanted for primary prevention of sudden cardiac death].

PURPOSE: To assess characteristics of involvement of coronary vascular bed in patients with ischemic heart disease and cardioverter defibrillator (CD) implanted for primary prevention of sudden cardiac death (SCD) with and without history of appropriate implantable (I) CD therapies. MATERIAL AND METHODS: We examined 64 survivors of myocardial infarction (MI) (60 men, 4 women) with CD implanted for primary prevention of SCD. Mean duration of follow up after CD implantation was 19.0 +/- 2.0 months. Patients were divided into 2 groups: with (n = 26, group 1) and without (n = 38, group 2) appropriate ICD therapies during follow-up. Coronary angiography data (on presence of hemodynamically significant lesions in main stem [MS], anterior interventricular, circumflex branches [CB] of left coronary artery [LCA], and in right coronary artery [RCA]) and data of transthoracic echocardiography (on localization of akinesia and dyskinesia zones) obtained in these groups were compared. RESULTS: Lesions in anterior interventricular branch were found in 25 (96%) and 28 (74%) patients in groups 1 and 2, respectively. Frequencies of involvement of other coronary arteries were not significantly different: MS LCA--7 (27%) vs 5 (13%), p = 0.14; CB--17(65%) vs. 18 (47%), p = 0.24; RCA--16 (62%) vs. 17 (45%), p = 0.29) in groups 1 and 2, respectively. There were no significant differences between groups in frequencies of various localizations of MI as detected by echocardiography. CONCLUSION: Hemodynamically significant involvement of anterior intraventricular branch of LCA is a predictor of any appropriate ICD therapy.

[Prognosis of probability of the development of atrial fibrillation after successful surgical correction of mitral valvular disease].

The estimation of frequency of occurence of atrial fibrillation in patients with mitral valvular diseases was made before operation and at the early postoperative period. A logistic regressive analysis has shown that the appearance of atrial fibrillation in long-term periods is influenced by 4 independent preoperative factors: preoperative atrial fibrillation, age, anterior-posterior size of the left atrium, diagnosis of rheumatism. The dependence of the appearance of atrial fibrillation on the preoperative status of the patient was detected. A statistical model having the prognostic value 89.6% has been constructed. The model is good in use, reliable and can be effectively used in everyday clinical practice in order to determine the probability of the appearance of atrial fibrillation at the postoperative period of the concrete patient and decision on necessity of surgical ablation.

[Experience of left ventricular assist device "Incor" as "bridge to recovery" implantation in patients with end stage congestive heart failure].

Left ventricular assist device "Incor" ("Berlinhear", Germany) implantation experience in patient with ischemic cardiomiopathy and severe congestive heart failure is presented. Left ventricular assist device implantation was followed by coronary artery bypass grafting simultaneously. Total assist time was 211 days. Complications developed during assisting time are shown. After Left ventricular assist device explantation three chamber pacemaker was implanted as cardiac resynchronization therapy. Left ventricular end diastolic size decreased (from 78 to 70 mm), ejection fraction increased (from 19 to 35%) during assist time.

[Interrelation between typical atrial flutter and atrial fibrillation: two sides of the same coin].

A range of clinical studies have shown that typical atrial flutter (AFI) is often accompanied by attacks of atrial fibrillation (AFib), and vice versa. Probably, these two forms of cardiac arrhythmia have common electrophysiological mechanisms. The combination of both forms is highly resistible to pharmacotherapy. Hybrid therapy including conservative treatment with antiarrhythmic drugs, catheter radiofrequency ablation and electrocardiostimulation is used widely and more effective in treatment of AFI accompanied by AFib. Up-to-date knowledge of heart electrophysiology has allowed substantial advancement in understanding interrelations between these two frequent arrhythmias, and made it possible to improve the results of treatment. However, it is not quite clear yet if there is an interconnection between the etiology of AFib and that of AFI, and what therapeutic strategy should be applied to patients with the combination of AFI and AFib.

[Electrocardiographic changes during coronarography]. / Elektrokardiograficheskie izmeneniia vo vremia koronarografii.

The endocardial manipulations and bolus intracoronary administration of contrast substances, of the first generation in particular, can induce disturbances of the myocardium repolarization and different disturbances of the cardiac rhythm, life-threatening included. The aim of the investigation is to assess transitory electrophysiological alterations in the myocardium during coronarography and during the first day after it. Under examination there were 39 patients with ischemic heart disease and stenocardia of the II-III functional classes in whom the coronarography was performed according to clinical indications. The Holtner dynamic observation of ECG was made in all the patients. All the ECG changes were detected and estimated during coronarography: arrhythmias, disturbances of conduction and transitory ischemic alterations of the myocardium. It gives a possibility to decide between the methods of pharmacological correction of possible disturbances.