[Modulation of cardiac contractility in patients with chronic heart failure and atrial fibrillation].

AIM: to evaluate the effectiveness of cardiac contractility modulation (MSS) in patients with chronic heart failure (CHF) and atrial fibrillation (AF). MATERIALS AND METHODS: The following studies were performed in 40 patients with CHF and AF before implantation of the MSS device and after 2 and 6 months of follow-up: 12-channel ECG, transthoracic EchoCG, 6-minute walk test, determination of the level of Pro-natriuretic N-terminal peptide (NT-proBNP), daily ECG monitoring, and a questionnaire based on the Minnesota quality of life questionnaire for patients with CHF (MHFLQ). All patients received long-term optimal drug therapy for CHF before surgery. RESULTS: The results obtained indicate a statistically significant positive effect of the use of MSS in patients with CHF and AF on LV FV, the functional class of CHF, and levels of NT-proBNP regardless of the etiology of CHF. CONCLUSION: The use of MSS may be promising for the treatment of heart failure in patients with CHF and AF.

[The role of intracardiac echocardiography in clinical practice].

The article contains review of possibilities of the method of intracardiac echocardiography (ICE) in clinical electrophysiology, delineation of indications to its use, and perspectives of development of this technology. Characteristics of technical variants of the method and special features of their application are also given. Technique of performance of interventions under ICE control is described in detail. Foreign experience of ICE use is summarized, and own experience is presented.

[Cardiac resynchronization therapy in patients with permanent atrial fibrillation].

UNLABELLED: In our study we compared effect of cardiac resynchronization therapy (CRT) in chronic heart failure (CHF) patients with permanent atrial fibrillation (AF) and patients with sinus rhythm. Special feature of our work was that patients with permanent atrial fibrillation didnt have obligatory ablation of atrio-ventricular node but underwent aggressive rate control to achieve more than 90% of biventricular (BV) complexes. We used 24 hours Holter monitoring because there are data that this method is more accurate than CRT counters. METHODS: We included 30 patients: 21 patients with sinus rhythm and 9 patients with permanent AF with ejection fraction <35%, II-IV NYHA class and wide QRS (>120 ms). We examined patients before implantation of CRT and after 6 months. RESULTS: mean NYHA class decreased from III to II. Distance at 6-min walk test increased by 107 m in AF group and by 105 in sinus rhythm group. EF increased by 7% in AF group and by 6% in sinus rhythm group. Mean time of further observation was 2 years (from 10 months to 5 years). There was 1 death (11.1%) in AF group and 3 deaths (15%) in sinus rhythm group (p>0,05). CONCLUSION: CRT is effective in CHF patients with permanent AF and pharmacological rate control if percent of BV pacing is more than 90% on Holter monitoring.

[Antitachycardia and resynchronization devices in the treatment of heart failure and prevention of sudden death].

According to the modern ideas of the heart failure pathogenesis the noticeable contribution introduces ventricular dissynchrony which essence consists of the electrical and mechanical dissociation of different segments of the myocardium. In recent years the new method of cardiac resynchronization therapy has been worked out and achived good results. Its main purpose is the resynchronization of the heart by three-chamber or biventricular stimulation, which leads to an improvement of the effectiveness of heart activity. At the same time implanted cardioverter-defibrillator systems are actively used in the complex treatment of heart failure as a mean of sudden cardiac death prevention. In this article we present results of main international studies, which reveal clinical effectiveness of both methods for decreasing total mortality and frequency of hospitalizations, prolonging life span, and improving quality of life.