Objective. To study possibilities of non-invasive electrophysiological mapping (NEM) in assessment of dependence of cardiac resynchronization effect from the position of the left ventricular electrode (LVE). Design and methods. NEM was performed on 24 patients, utilizing the «Amycard 01C EP LAB». Position of the stimulation LVE pole was estimated on the segmental epicardial ventricular model; and the epicenter of the late activation area of the left ventricular (LV) with complete left bundle branch block (LBBB) was determined. Also the interventricular electrode distance was measured. Results. The epicenter of the late zone on LBBB most frequently was determined in the basal area on the border of the posterior and lateral walls of the LV - 42 % (n = 10). In patients with response to cardiac resynchronization therapy (CRT) the distance (LVE pole - the epicenter of the epicardial late activation area of the LV on LBBB) was not significantly greater than the width of the LV segment. The smallest interventricular electrode distance of 49 mm was found in patient without response to CRT. Conclusion. Using NEM, one may accurately measure the distance between the stimulating poles of ventricular electrodes and the distance from the stimulating LVE pole to the epicenter of the epicardial late activation area of the LV on LBBB. The CRT effect is clearer if the distance between LVE and late zone is not significantly greater than the width of one LV segment.

Objective. To evaluate serum galectin 3, aldosterone in patients with metabolic syndrome (MS) and atrial fibrillation (AF) and to reveal the correlation of these markers of fibrosis with risk factors of AF. Design and methods. We examined 100 patients with MS (50 with paroxysmal or persistent AF and 50 without arrhythmia) and 50 healthy persons. Serum galectin 3 and aldosterone were measured by ELISA method, ECHO cardiography was performed. Results. Serum aldosterone concentration in MS and AF group was higher than in healthy controls (202,2 ± 82,5 and 98,4 ± 51,8 pg/ml; р < 0,001) and higher than in the MS group without AF (202,2 ± 82,5 and 150,3 ± 72,2 pg/ml; р < 0,001). Serum galectin 3 in patients with MS and AF was higher, than in patients with MS without arrhythmia and much more higher than galectin 3 in healthy persons (0,72 [0,44; 1,36], 0,44 [0,42; 1,22] and 0,32 [0,28; 0,42] ng/ml; р < 0,01). Positive correlation between serum aldosterone and serum galectin 3 was reveal (r = 0,509, p < 0,001). Conclusion. Markers of fibrosis serum galectin 3 and serum aldosterone in patients with atrial fibrillation and metabolic syndrome was higher than in patients with the metabolic syndrome, without this arrhythmia and higher than in healthy persons. The correlation between serum aldosterone, serum galectin 3 and remodeling of left atrium was reveal. The markers of fibrosis (aldosteron, galectin 3) were associated with risk of AF in patients with MS.

Due to increasing cardiovascular implantable devices implantation rate, including CRT, the growing need in implantation of new leads requires extraction of redundant leads. Despite the fact that infection is the most common indication for lead removal, the non-infection indications are still of current interest. Objective. To evaluate effectiveness and safety of lead extraction in non-infection patients, basing on surgeries carried out in our department. Materials and methods. 115 lead extraction procedures were performed in our department from Apr 2011 till Dec 2015, 22 (19,13 %) were with non-infection indications, 13 (59,09 %) were women, mean age 66,86 ± 13,50 years. Effectiveness and safety of a procedure were evaluated. Non-infection patients included venous stenosis and thrombosis, extraction of non-functional or redundant functional leads. Mechanical extraction tools were used, patients with simple traction removal were excluded from this study. Results. Clinical procedural success rate was 100 % (22 cases), and complete procedural success rate was 95,45 % (21 case). 30 leads were removed with clinical success. No complications observed. Conclusion. Transvenous lead extraction in patients with non-infection indications for lead removal is effective and safe.

Background. Atrial fibrillation (AF) is the most common type of cardiac arrhythmia. There is paucity of information regarding gender differences in outcomes of patients undergoing AF catheter ablation. The aim of this prospective study was to determine gender differences in clinical characteristics, quality of life (QoL) and outcomes of the patients referred for AF catheter ablation. Methods. The study comprised of 55 patients (25 men) with symptomatic AF, who were referred for pulmonary vein isolation. A variety of clinical characteristics, echocardiography parameters, QoL before and after catheter ablation, safety and efficacy of the procedure over 12-months follow-up period were compared between men and women. Results. At the baseline, women had lower values of psychological parameters of QoL comparing to men (15,9 vs 19,9, p < 0.05), and more severe symptoms. Within 12 months after the procedure arrhythmia recurred in 28 % men and in 40 % women. Women had more complications during the procedure and in early postablation period (12 % women and 5 % men, p < 0.05). All patients with no arrhythmia recurrence had a significant improvement in all QoL domains and a decrease in AF EHRA score. Conclusions. The psychological status of women with AF associated with high degree of clinical manifestations. QOL can be an indicator of the efficacy of catheter ablation.

Relevance. Multifactorial diseases in comparison with monogenic and chromosomal diseases are less studied group of diseases of the person. At the same time these diseases are widespread and have hereditary predisposition that determines the high level of lifelong risk (lifetime risk). Diseases of the carrying-out system of heart also belong to this group of diseases. It should be noted that such primary disease of the carrying-out system of heart as the sick sinus syndrome, remain the least studied among a cohort of cardiovascular diseases. Purpose. To study influence of polymorphisms of genes (ADRA2B, NOS3, GJA5, MYH6, SCN5A, SCN10A) on emergence of an idiopathic sick sinus syndrome. Material and methods. Group I - 75 patients with an idiopathic sick sinus syndrome: 14 proband (mean age 65,5 ± 10,9 years) and 61 relatives of the I-III degree of relationship (mean age 43,0 ± 17,3 years); group II - 49 healthy relatives of proband of the I-III degree of relationship (mean age 24,2 ± 14,0 years); group III - group of control, 197 patients without cardiovascular pathology (mean age 45,0 ± 20,0 years). Surveyed people have been carried out by: clinical examination, an electrocardiography, atropinic test, an EchoCG, bicycle ergometry, intra-esophageal electrophysiology study, Holter monitoring, scintigraphy, coronary angiography according to indications. Besides, everything surveyed conducted molecular and genetic research of polymorphisms of genes ADRA2B, NOS3, SCN5A, SCN10A, GJA5, MYH6. Results. The scientific hypothesis of a role of polymorphisms of genes of ADRA2B, NOS3, SCN5A, SCN10A, GJA5, MYH6 is given in development of idiopathic sick sinus syndrome. Influence of polymorphisms of the specified genes on emergence and a current of hereditary sick sinus syndrome is established. Associations of polymorphisms of genes ADRA2B, NOS3, SCN5A and SCN10A, GJA5, MYH6 at patients with idiopathic sick sinus syndrome and persons of control group are studied. As a result of research it is revealed that definition genetic a determinant of sick sinus syndrome will be directed to definition of the gene “ensembles” allowing to develop genetic riskier developments of this pathology in families that answers the principles of the personified medicine.

A retrospective study involving 40 patients, based on the initial division of the patients into 2 groups: group I (N = 20) - high response to cardiac resynchronization therapy (CRT) and group II (N = 20) - lack of response to CRT. Criteria of CRT efficacy were: decrease in end-systolic left ventricular volume equal to or more than 15 %, relative increase in left ventricular ejection fraction equal to or greater than 10 %, decrease in functional class of chronic heart failure (NYHA) equal to 1 or greater. Low response of CRT was determined as the absence of criteria said above (the lack of positive dynamics in left ventricle diameters and volumes, ejection fraction, or it had a negative value in the form of further enlargement of the heart chambers and the reduction of its contractile capacity). The initial patient separation by the degree of response to cardiac resynchronization therapy suggests verification the hypothesis that a different response to CRT may be associated with the relative position of the ventricle electrodes and the parameters of ventricular myocardial dyssynchrony.

The first experience of various LAA occluders implantation in the North-West region for prevention of systemic thromboembolic events is reported. The implantation procedure is considered to be rather safety and effective and provides an opportunity for subsequent oral anticoagulants withdrawal. Therefore LAA occluder implantation can be an alternative in patients with high risk of bleeding and contraindications for permanent anticoagulation.

The level of IL-6 more than 1.77 mmol / L before the radiofrequency ablation of pulmonary veins increases the risk of recurrence after six months in patients with paroxysmal atrial fibrillation.

Catheter ablation of atrial fibrillation (AF) is a physically demanding procedure for the operator, involving radiation exposure, and has limited success rates. Remote robotic navigation (RRN) may offer benefit to the procedure. This prospective randomized study evaluated the hypothesis that the single-procedure persistent AF ablation success rate is greater with RRN than with manual navigation.

Atrial fibrillation (AF) often goes along with mitral valve (MV) pathology. At that the implementation of surgical ablation of AF in addition to valvular disease correction does not always guarantee freedom from arrhythmia. The risk of repeated interventions is extremely high, and the possibilities of catheter ablation methods are determined by the type of the valve prosthesis. The purpose of this research is to present a clinical case of successful radiofrequency catheter pulmonary veins reisolation after unsuccessful maze procedure in patient with biological prosthesis of MV. Conclusions. Catheter ablation methods can be successfully applied in subjects with biological prostheses of heart valves, and possible cancellation of anticoagulant therapy if the sinus rhythm is maintained contributes to realizing the benefits of this type of prostheses.

At the article data are considered about the diagnosis of the myocardial electrical instability and it’s correction under the noninvasive positive airway pressure therapy during sleep.

The article concerns the description of clinical case of arrhythmic variant flow of latent myocarditis, simulating coronary heart disease. The development of syncope conditions is a result of combined arrhythmias in patient (ventricular tachycardia, AV nodal reciprocal tachycardia). After further investigation it was conducted the radiofrequency ablation of ventricular tachycardia and slowly part of AV connection with positive effect during the next year of observation.

Life-threatening arrhythmia in most percent of cases are the direct causes of sudden cardiac death. Self-recovery heart rate occurs due to spontaneous thrombolysis to them and due to reperfusion or as a result of imitation precordial shock caused by falling from height of own growth. This case represents a rare authentically-documented clinical fact that sudden death due to life-threatening arrhythmias occurred during exercise. Apparently, when restoring sinus rhythm were involved in both of the above-described mechanism. Judging by the development of acute transient conduction disorders and multiple episodes of accelerated idioventricular rhythm, we can assume either spontaneous thrombolysis on the background of acute coronary insufficiency, either alone allowed long koronaroangiospazm.

Material was based on the example of clinical case. A man of 36 years old was diagnosed Brugada syndrome. The clinical case attracted attention. In young patient was presented difficult arrhythmia such as polymorphic ventricular tachycardia which was refractory to medical correction, with the presence of changes like Brugada syndrome on the electrocardiogram after cardioversion and complex diagnostic search.

The article describes a clinical case of peripartum cardiomiopathy in a 21-year-old woman.

The overall frequency of pre-excitation syndrome is 0.3% in general population and comes towards 0.5 % in patients with congenital heart disease. Kent fibers, defined as direct accessory pathways outside the AV junction , are the morphological substrate for the Wolff-Parkinson-White (WPW) syndrome. We present case study of the two left-hand Kent fibers ablation in patient with orthodromic tachycardia. Partial elimination of the accessory pathways may lead to recurrence of tachycardia in the early postoperative period. It is important that different pacing maneuvers and pharmacological tests contribute to the identification of multiple accessory pathways.