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Issues - Journal of arrhythmology №79, 15/03/2015


Experience of Diagnosis and Fifteen-Year Outcomes of Catheter Treatment of Ventricular Arrhythmias Originating from the Aortic Sinuses

E.A. Artyukhina, A.Sh. Revishvili

To assess effectiveness and safety of radiofrequency ablation (RFA) of ventricular arrhythmias originating from the aortic sinuses (AS) in the department of arrhythmia surgery of Bakulev Scientific Center for Cardiovascular Surgery in 1999 through 2014, 130 patients aged 28±9.8 years (85 men and 45 women) were examined and operated. Antiarrhythmic treatment using 2‑3 medications was ineffective in all patients. All patients had stable ventricular allorhythmia; in 42% of patients, incessant tachycardia was documented. The tachycardia cycle duration was 544±81.8 ms. The echocardiographic assessment showed that the heart chambers' size was within the normal values for the corresponding age. The electrophysiological study performed according to the standard protocol showed presence of dual atrioventricular pathways in 2 subjects and left accessory atrioventricular junction in one patient. The right femoral artery puncture was performed; the controlled tetrapolar electrode RF Marinr MC‑XL, 7Fr. (Medtronic, USA) was positioned into the AS (left, right, or non-coronary one) where zones of the earliest activation were revealed. The stimulation mapping of this zone produced the shape of ECG complexes absolutely identical to that of tachycardia complexes on 12‑lead ECG. Selective coronary angiography was performed to locate precisely the electrode with regard to of coronary ostia. CARTO and CARTO XP systems (Biosense Webster, USA) were used in 11.5% of patients.

The arrhythmogenic focus was located in the left AS in 74 patients (57%). Pre-spike activity in the early activation zone was found in 57% of patients. The distance between the early activation zone and the left coronary ostium was 13.7±4 mm. In 23 patients (17.6%), the focus was located in the projection of the right AS and in 19 patients (14.6%), of the non-coronary AS. When positioning the electrode, the His bundle spike was recorded, as well; however, RFA was performed in the early zone without presence of the His bundle spike. The distance from the right coronary artery was 11±6.8 mm in the right AS and 24±4.2 mm in the non-coronary AS. For obvious reasons, radiofrequency applications in the projection of the left coronary ostium were not made. Sensitivity of the algorithm of ECG diagnosis of ventricular arrhythmias originating from the right and left ventricle outflow tract was 84%; its specificity was 98%. Effectiveness of the primary catheter ablation was 97.4%. The arrhythmia recurrence occurred in 2 cases; effectiveness of repetitive procedures was 100%. Thus, the current algorithms of ECG diagnosis, non-invasive topical diagnosis, and invasive mapping using navigation systems as well as the RFA technique in the aortic sinuses developed in detail can high efficiently eliminate ventricular arrhythmias during the 15‑year follow-up and with minor complications.

To assess effectiveness and safety of radiofrequency ablation of arrhythmias originating from the aortic sinuses in 1999 through 2014, 130 patients aged 28±9.8 years were examined and operated.

Key words: left ventricle outflow tract, aortic sinuses, ventricular arrhythmias, electrophysiological study, radiofrequency catheter ablation.


Prevalence and Distribution of Arrhythmias during the First Day of ST Elevation Myocardial Infarction after Reperfusion Therapy

M.M. Demidova, N.N. Burova, O.I. Kunina, V.V. Dorofeykov, V.M. Tikhonenko

To assess prevalence and distribution of arrhythmias in patients with ST elevation myocardial infarction (STEMI) after reperfusion therapy, the patients admitted to Almazov Federal Medical Scientific Center in 2007 through 2011 were examined. In 2007‑2009, the systemic thrombolytic therapy was performed using bolus injections of Purolase in a dose of 2,000,000 UI followed by intravenous infusion over 60 minutes in a dose of 4,000,000-6,000,000 UI. In 2010‑2011, coronary angiography and primary percutaneous coronary intervention (PCI) of infarct-related artery was performed. All subjects received the standard antiplatelet therapy, anticoagulation, as well as therapy with β‑blockers, angiotensin-converting enzyme inhibitors, and statins. 140 patients aged 55±13 years were included into the study (men: 80%); systemic thrombolytic therapy was performed in 70 patients and PCI in 70 subjects, as well. 12‑­lead ECG Holter monitoring started immediately upon admission and continued throughout the first day of STEMI using the Kardiotekhnika 04‑8m recorder (Inkart, St. Petersburg, Russia).

A considerable decrease in sinus rate was recorded during the blood flow recovery only in case of inferior STEMI; in 17 patients of 70 (24%), sinus bradycardia or pauses due to sinus arrest were recorded (in 5 patients receiving systemic thrombolysis and in 12 patients receiving PCI). During coronary reperfusion, heart rate (HR) decreased from 75±13 bpm to 38±9 bpm (p<0.001) by 37±15 bpm. Total occlusion of infarct-related artery with TIMI 0 (OR: 8.8; 95% CI: 1.06‑73.04; p=0.044) was the only predictor of bradycardia and pauses due to sinus arrest. Ventricular premature contractions (VPC) were documented in all study subjects. More than 30 single VPC per hour were observed in 31.5% of patients. Accelerated idioventicular rhythms during reperfusion and on the first day of STEMI were documented in 73.8% of patients receiving systemic thrombolysis and in 87.0% of patients receiving PCI (p=0.1). Episodes of non-sustained ventricular tachycardia (VT) were observed in 76.9% of patients receiving systemic thrombolysis and in 84.8% of patients receiving PCI (p=0.2). Ventricular fibrillation (VF) developed in 14 patients (8.8%): during reperfusion in 1 patient and on the second day of STEMI in 2 patients.

The ventricular arrhythmia (VA) distribution by the time of their development depended on the method of reperfusion therapy. In the patients receiving PCI, the VA peak was observed immediately after the procedure; subsequently, the number of arrhythmias decreased; after the systemic thrombolytic therapy the delayed VA peak was observed. Most episodes of non-sustained VT after PCI occurred with some delay; this fact confirms importance of telemetric control throughout no less than 16‑17 hours after reperfusion.

To assess prevalence and distribution of arrhythmias in patients with ST elevation myocardial infarction after reperfusion therapy, 140 patients aged 55±13 years (men: 80%) were examined.

Key words: myocardial infarction, percutaneous interventions, systemic thrombolysis, ventricular premature contractions, ventricular tachycardia, ventricular fibrillation, Holter monitoring.


Predictors of Response to Cardiac Resynchronization Therapy in Patients with Chronic Heart Failure

Yu.V. Stavtseva, S.V. Villevalde, A.S. Vorobyev, D.N. Frolov, T.A. Gusaim, A.V. Sveshnikov, Zh.D. Kobalava

To study eligibility criteria for cardiac resynchronization therapy (CRT), 45 patients with implanted devices for CRT were examined (median age: 61 years). The chronic heart failure (CHF) severity corresponded to CHF Class IV (NYHA) in 9 patients (20%), CHF Class II in 28 patients (62.2%), and CHF Class III in 8 subjects (17.8%). The median QRS width was 161.1 ms [120‑230 ms]. In a majority of patients (68.9%; n=31), ischemic cardiomyopathy was diagnosed. The complete left bundle branch block (LBBB) was recorded in 41 cases (91.1%) and the complete right bundle branch block (RBBB), in 4 subjects (8.9%). The median follow-up period was 29.3 months [10.3‑79.3 months].

The mortality and hospitalizations due to CHF, as well as the functional response (FR), echocardiographic response (ER), complete response (CR), and partial response (PR) were considered when assessing effectiveness of CRT. The response to CRT was observed in 72.1% of patients (n=31; PR: 44.2%, ER: 9.3%, FR: 18.5%). The following peculiar features of ER to CRT were revealed: a decrease in end-systolic volume (ESV) by 30% and more was found in 34.9% of patients (n=15; super-responders), a decrease by 15‑30% was found in 20.9% of subjects (n=9; responders), and a decrease by less than 15% was observed in 30.2% (n=13, non-responders). In 14.0% of patients (n=6), an increase in ESV by 15% or more was recorded (negative responders). Among the patients with FR to the procedure (n=27), a CHF improvement by 1 functional class was observed in 55.6% of cases (n=15), by 2 functional classes in 37.0% of cases (n=10), and by 3 functional classes in 7.4% of cases (n=2). According to the multifactor regression analysis, the QRS complex duration (β: -0.36; p=0.01; OR: 1.045; 95% CI: 1.006‑1.085) and TPS‑SD (β: -0.29; p=0.04; OR: 1.044; 95% CI: 1.010‑1.079) were independent predictors of ER to CRT. Statistically significant difference in the body mass, body surface area, body mass index, and hospitalization rate due to CHF was revealed between the patient groups with and without FR. When using tissue Doppler, TPS‑SD was the only predictor of response to CRT; this fact is of a practical interest and warrants validation of the above parameter in controlled clinical trials.

To study additional criteria which can be used when selecting subjects for cardiac resynchronization therapy, 45 patients with chronic heart failure were examined (median age: 61 years; mean QRS width: 161.1 ms [120‑230 ms], in the majority of patients (68.9%), ischemic cardiomyopathy was documented.

Key words: ischemic cardiomyopathy, chronic heart failure, mechanical dyssynchrony, cardiac resynchronization therapy, electrocardiography, echocardiography.


Late Outcome of Resynchronization Therapy in Patients with Chronic Heart Failure and Chronic Atrial Fibrillation

I.G. Stenin, A.G. Strelnikov, V.V. Shabanov, S.N. Artemenko, R.T. Kamiev, A.B. Romanov, E.A. Pokushalov

To assess effectiveness of cardiac resynchronization therapy (CRT) in combination with pharmacological ventricular rate control (VRC) versus CRT in combination with radiofrequency ablation (RFA) of atrioventricular junction (AVJ), 90 patients aged 62.2±8.1 years (men: 90%) with chronic heart failure (CHF) and chronic atrial fibrillation (AF) were examined. The left ventricular (LV) ejection fraction (EF) was 28.8±5.6%, and QRS width, 151.3±11.6 ms. The study subjects were randomized into two following groups: Group I (n=45) received CRT + VRC and Group II (n=45), CRT + RFA AVJ. The conventional therapy of CHF was given to all patients. Percentage of complexes with biventricular pacing complexes was 94.6±5.3% in Group I and 100% in Group II (p=0.07). Echocardiographic assessment of the study subjects was performed 3, 6, 12, 24, and 36 months after implantation of CRT devices. Patients were considered responders to the therapy in case of a LV EF increase by 10% or a decrease in end diastolic/systolic volume (EDV/ESV) by 15% 3 months following implantation as compared with baseline.

The long-term follow-up period lasted for 42.4±7.1 months. The 36‑month mortality was 26.6% (12 patients) in the group of CRT + VRC and 17.7% (8 patients) in the group of CRT + RFA AVJ (p=0.35). The total number of repetitive hospitalizations due to CHF progression during 36 months of follow-up was 24 (20 patients; 53.4% of the total number of hospitalizations). In Group II, the number of repetitive hospitalizations due to CHF progression during 36 months of follow-up was 18 (17 patients; 40% of the total number of hospitalizations; p=0.18 between the study groups). By the end of follow-up period, a considerable improvement of CHF (class by NYHA) was observed in both groups as compared with baseline (p<0.05). LV EF in 36 months increased from 28.2±7.1% to 43.7±4.2% in the group of CRT + VRC (p=0.008) and from 29.5±4.2% to 48.1±4.4% in the group of CRT + RFA AVJ (p=0.002). Thus, in patients with CHF Class II‑IV receiving optimal medical treatment and with ineffective pharmacological rate control, LV EF ≤35%, and LBBB with QRS width ≥120 ms, the CRT device implantation with subsequent RFA AVJ is recommended in the course of the same hospitalization after stabilization of electrical capture threshold of the right and left ventricles, even in case of a high percentage (more than 90%) of biventricular pacing.

To assess effectiveness of cardiac resynchronization therapy in chronic heart failure associated with permanent atrial fibrillation, 90 patients aged 62.2±8.1 years (men: 90%) with the left ventricle ejection fraction of 28.8±5.6% were examined and treated.

Key words: chronic heart failure, permanent atrial fibrillation, cardiac resynchronization therapy, ventricular rate, atrioventricular junction, radiofrequency catheter ablation.


Assessment of Effect of Levosimendan on Reverse Cardiac Remodeling in Patients with Dilated Cardiomyopathy after Implantation of Systems for Cardiac Resynchronization Therapy

R.V. Marchenko, S.S. Durmanov

To assess the effect of Levosimendan on reverse cardiac remodeling in patients with implanted devices for cardiac resynchronization therapy (CRT), 14 patients aged 55.4±7.6 years (4 men; 28.6%) with dilated cardiomyopathy and chronic heart failure (CHF) having indications to CRT were included into the study. The mean body mass index was 30.2 kg/m2 [29.2; 39.6 kg/m2]; class of CHF (NYHA): 3.0 [2.75; 3.0]. The concomitant arterial hypertension was found in 6 patients (42.9%). The mean MLHFQ score (Minnesota Living with Heart Failure Questionnaire) was 53.1±21.6. The mean QRS width was 160 ms [150; 185]. Echocardiographic parameters of the study subjects were as follows: end diastolic diameter of the left ventricle: 69.3±9.7 mm; left ventricular ejection fraction (LV EF): 26.5±6.0%, left atrium size: 47.3±6.6 mm; degree of mitral regurgitation: 2.5±1.5. The blood proBNP level was 1,357.5 ng/dl [328.7; 6,062.7]. Patients with persistent, long-standing persistent, and chronic atrial fibrillation/flutter were excluded from the study.

Implantation of devices for CRT‑P or CRT‑D was performed in all study subjects. In the early post-operation period, the study subjects were randomized into two treatment groups using a random number generator. The first group subjects received 24‑hour intravenous infusion of a long-acting inotropic agent Levosimendan on the first or second day after the CRT device implantation (Group Levosimendan). The patients of the other group were discharged after implantation of CRT device without administration of the medication (Control group). The study groups had similar gender, age, body mass index, prevalence of concomitant atrial hypertension, QRS width, and all analyzed parameters. The patients were examined 1, 3, and 6 months after implantation of CRT devices.

Six months following implantation of CRT devices, a significant improvement of CHF functional class (NYHA), improvement of quality of life, increased LF EF to 31.1±8.3% (p=0.038), less mitral regurgitation of 1.9±0.9 (p=0.002), and a decrease in blood proBNP were observed in both groups. No changes in the end diastolic diameter of the left ventricle and the left atrium size were seen. In the Levosimendan group 6 months after implantation, only a significant improvement of qualify of live occurred as compared with baseline: the quality of life (QoL) aggregate score decreased from 56.9±23.0 to 32.7±15.1 (p=0.020). In the control group 6 months after implantation, the following changes were revealed: CHF functional class improved, the quality of life improved, the degree of mitral regurgitation and the blood proBNP level decreased.

Thus, intravenous infusion of a long-acting inotropic agent Levosimendan has no effect on reverse cardiac remodeling in the patients with dilated cardiomyopathy, CHF Class II‑IV (NYHA), LBBB, wide QRS complex, and implanted devices for CRT. The Improvement of clinical and echocardiographic parameters in these patients is likely to be related only to the resynchronization effect of implanted devices.

To assess the effect of Levosimendan on reverse cardiac remodeling, 14 patients aged 55.4±7.6 years with dilated cardiomyopathy and chronic heart failure, and with implanted devices for cardiac resynchronization therapy were examined.

Key words: dilated cardiomyopathy, chronic heart failure, left bundle branch block, cardiac resynchronization therapy, Levosimendan, ejection fraction.


Outcomes of Surgical Treatment of Adult Patients with Congenital Heart Disease and Atrial Fibrillation

A.M. Karaskov, E.V. Lenko, A.V. Bogachev-Prokofyev, A.V. Afanasyev, A.N. Turov, Yu.L. Naberukhin, O.A. Lenko

To assess outcomes of surgical treatment of adult patients with congenital heart disease (CHD) and atrial fibrillation (AF), 21 patients aged 57.5±7.9 years (women: 57.1%) with mean body mass index (BMI) of 27 kg/m2 were examined and operated. Persistent AF was documented in 13 patients (61.9%); 31.8% of subjects had paroxysmal AF. Bi-atrial radiofrequency ablation and surgical correction of the underlying disease were performed under conditions of extracorporeal circulation. As the first step, the left atrium ablation was performed using the box-lesion scheme, i.e. epicardial isolation of collectors of the right and left pulmonary veins. Then, on an open heart, upper and lower ablation lines were made in the left atrium, as well as a line towards the mitral valve fibrous ring using a bipolar clamp which stopped 5-7 mm from the fibrous ring, with the subsequent last stage of the procedure made using a unipolar electrode. The left appendage of the study subjects was sutured by a double-row suture. After removal of aortic clamp and restoration of cardiac activity, ablation lines were made on the right atrium free wall towards the upper and lower cave veins using a bipolar electrode and a line to the tricuspid valve using a unipolar electrode; the atriotomy access was sutured as the last step of the procedure. The septal defect was closed using a subject's pericardial patch; the combined tricuspid valvuloplasty was performed in 10 cases (47.6%). No hospital mortality was observed.

The duration of hospitalization was 14.9±7.2 days. Tachyarrhythmia was detected during hospitalization in 23.8% of patients. Atrial flutter developed four times more frequently than AF; the sick sinus syndrome was documented in 4 patients (19.0%). The catheter ablation was effectively performed in all patients with recurrence of atrial flutter. Thus, tachyarrhythmia after the maze IV procedure can be successfully eliminated without delay even in an in-patient setting. Both medical therapy and, in case of its failure, invasive mapping with catheter ablation can be currently used. By discharge from hospital, 20 patients (95.2%) have had the sinus rhythm according to the Holter monitoring data; AF was observed in only 1 patient (4.8%). The sinus rhythm recovered in almost all subjects; no mortality and absence of specific adverse events favor the effectiveness and safety of the approach.

To assess the outcomes of surgical treatment of adult patients with congenital heart disease and atrial fibrillation, surgical correction of congenital heart disease with simultaneous surgical ablation was performed in 21 patients aged 57.5±7.9 years (women: 57.1%).

Key words: congenital heart disease, atrial septal defect, atrial fibrillation, atrial flutter, extracorporeal circulation, radiofrequency catheter ablation, surgical ablation, cardiac pacing, Amiodarone.


Late Outcomes of Catheter Ablation of Idiopathic Ventricular Tachyarrhythmia

E.A. Ivanitsky, V.A. Sakovich, E.B. Kropotkin, S.N. Artemenko, V.V. Shabanov, A.G. Strelnikov, R.T. Kamiev, A.B. Romanov, E.A. Pokushalov

To assess long-term effectiveness and safety of radiofrequency ablation (RFA) of ventricular tachyarrhythmia originating (VTA) from the right ventricle (RV) and left ventricle (LV), 452 patients aged 37.8±18.7 years (women: 54.4%, n=246) with symptomatic ventricular premature contractions (VPC) or ventricular tachycardia (VT) were examined and treated. Symptoms of chronic heart failure were detected in 392 patients (86.8%). The most prevalent complaints of patients before the procedure were as follows: palpitations (n=278; 61.5%) and dyspnea at exertion (n=129; 28.5%). The number of VPC according to the pre-procedural 24-hour Holter monitoring data was 19,137±12,209 per day. Due to a history of sustained VT and syncope, cardioverter-defibrillator was implanted to 100 patients (22.1%) before and after RFA. Antiarrhythmic drugs (AAD) were ineffective in all study subjects. Absence of VPC/VT in the late post-ablation period after primary of repetitive ablations was the primary study endpoint. Adverse events of the procedure were the most important secondary study endpoint.

The follow-up period lasted for 36 months. Post-procedure adverse events occurred in 1.54% of patients (1.56% of patients with VTA from RV and 1.52% of patients with VTA from LV). All adverse events successfully resolved. The late effectiveness of RFA of VTA of non-ischemic origin from RV after the primary and repetitive ablation was 87.9% and 95.6%, respectively. In its turn, the late effectiveness of RFA of VTA of non-ischemic origin from LV after the primary and repetitive ablation was also high; it was 90.2% and 95.5%, respectively. All patients did not take AAD. Thus, RFA of VTA of different types and locations in non-ischemic subjects is a safe and highly effective approach which can eliminate VTA in a majority of patients throughout the long-term follow-up period.

To assess effectiveness and safety of radiofrequency ablation of idiopathic ventricular tachyarrhythmia in 2007‑2012, 452 patients aged 37.8±18.7 years (women: 54.4%) were examined and surgically treated.

Key words: ventricular tachycardia, ventricular premature contractions, electrophysiological study, radiofrequency catheter ablation.


Optimization of Rate Response in Patients with Permanent Single‑Chamber Cardiac Pacing and Heart Failure

M.V. Kuznetsova, D.A. Andreev, M.Yu. Gilyarov, V.P. Sedov, I.V. Samoylenko, Yu.S. Sazonova, A.N. Aleksandrov, I.V. Drozdov

To develop an algorithm of optimization of rate response (RR) settings in patients with single-chamber permanent cardiac pacing and chronic heart failure (CHF), 58 patients aged up to 85 years reporting dyspnea at exertion were examined. Indications for cardiac pacing were as follows: atrial fibrillation (AF)/flutter with slow ventricular rate and atrioventricular (AV) block or radiofrequency ablation of AV junction due to chronic AF with fast ventricular rate. The patients were included into the study not earlier than one month after pacemaker implantation, if percentage of paced complexes was no less than 80%. The study subjects were examined with the aid of the stress test with gas analysis (ergospirometry), 6‑minute walk test, as well as DASI (Duke Activity Status Index) and MLHFQ (Minnesota Living with Heart Failure Questionnaire) quality of life questionnaires. The patients were randomized into two groups. In the study group, the rate response parameters were selected using the stress-echocardiography and ergospirometry data. In the control group, the rate response parameters were adjusted 2-3 weeks after the study inclusion by an experienced cardiologist from Cardiac Arrhythmia Department. The subject's complaints, heart rate histograms recorded in the pacemaker memory, and the heart rate increase curves during exercise tests (walking in corridor, stair climbing) were used to assess adequacy of rate response settings. In three months, ergospirometry, echocardiography, 6‑minute walk test, and quality of life assessment were performed in the subjects of both groups.

In the study group, stress-echocardiography showed transient local abnormalities of wall motion in 24 patients (77.4%). Coronary angiography was performed in 18 patients and showed intact coronary arteries in 15 subjects (83%) and hemodynamically significant lesions in 3 patients (17%). Ergospirometry showed an inadequate increase in heart rate in 28 patients (90%). In 3 months, an increase in peak oxygen consumption from 12.6±2.6 to 14.3±2.8 (p<0.0001), oxygen consumption at the anaerobic threshold level from 10.0±1.8 to 11.3±2.2 (p<0.0001), duration of the test from 381±153 s to 567±140 s (p<0.0001), 6‑minute walk test distance by 75±63 m (p<0.0001), as well as an improvement of diastolic left ventricular function were documented in the study group. The E/E' ratio decreased from 11.7±3.2 to 10.4±2.9 (p=0.03), systolic pressure in the pulmonary artery decreased from 44±14 mm Hg to 39±12 mm Hg (p=0.001), and the left atrial volume decreased from 108 ml [84; 132] to 96 ml [85; 131] (p=0.039). An improved quality of life was noted in accordance with the data of DASI questionnaire (increase in the score from 26.27±11.3 to 31,5±10.39; p=0.009) and MLHFQ questionnaire (decrease in the score from 36±19 to 27±15; p<0.0001). No statistically significant changes were revealed in the control group. Thus, optimization of the rate response settings of single-chamber pacemakers with accelerometer sensors in patients with CHF with the aid of stress-echocardiography and ergospirometry led to an improved physical working capacity, diastolic function of the left ventricle, and quality of life.

To develop an algorithm of optimization of rate response settings, 58 patients with chronic heart failure, permanent atrial fibrillation, and single-chamber cardiac pacing due to atrioventricular block were examined.

Key words: cardiac pacemaker, rate response, chronic heart failure, stress-echocardiography, ergospirometry.


Assessment of Need of Patients with Chronic Heart Failure in Implantable Electronic Devices

Yu.V. Stavtseva, S.V. Villevalde, A.S. Vorobyev, A.F. Safarova, A.V. Sveshnikov, Zh.D. Kobalava

To determine a need in implantable electronic devices in a cross-sectional epidemiological single-center study, analysis of clinical and demographical data was performed of consecutive patients with chronic heart failure (CHF) admitted due to various reasons to Municipal Hospital #64 in Moscow in January through December 2013. The National guidelines criteria were taken into the account when considering indications to the electronic device implantation. The study database contained the basic clinical and demographical data, as well as the results of electrocardiographic (ECG) and echocardiographic (EchoCG) assessments. Throughout the study period, the data were on 838 patients aged 70.4±12.0 years (men: 43.3%) were obtained. According to the NYHA classification, CHF Class I, II, III, and IV was revealed in 30 patients (3.6%), 338 patients (40.3%), 368 patients (43.9%), and 102 patients (12.7%), respectively. The coronary heart disease (65.5%), arterial hypertension (93.3%), and atrial fibrillation (41.1%) were the most widespread concomitant pathologies in the study population. Atrioventricular (AV) block, mostly of Grade I, was found in 70 patients (8.4%). Intraventricular block was documented in 180 patients (21.4%), including complete left bundle branch block (LBBB) in 11.1% of cases (n=93) and complete right bundle branch block (RBBB) in 4.1% of cases (n=34).

The need of the study population in implantable cardioverters-defibrillators (ICD) was 7.3% (n=61) and 2.5% (n=21), respectively. The results of the MADIT II study were extrapolated to the patients with episodes of non-sustained ventricular tachycardia (n=11). Taking the data revealed into the account, the overall need in ICD was 10.3%, with the ratio of patients with indications to primary and secondary prevention of sudden cardiac death being 2.9:1. The overall need in cardiac resynchronization therapy (CRT) was 7.0% (59 patients; men: 64.4%). The coronary heart disease was the most widespread underlying disease causing CHF in this subject group (n=53; 89.8%). Intra-ventricular block was predominantly represented by LBBB (n=57; 96.6%). The group of subjects with indications to CRT also included two patients with RBBB and QRS width of more than 150 ms. One-year survival in the study group calculated based on the CCI parameter was 72.7±11.1%.

Thus, implantation of electronic devices (ICD and CRT devices) is indicated in 17.3% of cases in an in-patient population. Despite an increasing number of applicable procedures currently performed in the Russian Federation, the need in implantation of electronic devices is realized in less than in 1% of cases, which is largely caused by financial and organizational factors. In case of limited resources, the optimization of patients' selection for implantation of electronic devices is of a great importance, a number of clinical and epidemiological factors which affect effectiveness and safety of procedures should be taken into the account in the course of the assessment of subjects' eligibility.

To determine a need in implantable electronic devices (cardioverters-defibrillators and devices for cardiac resynchronization therapy) in the Russian Federation, 838 patients aged 70.4±12.0 patients (men: 43.3%) with chronic heart failure were examined.

Key words: chronic heart failure, implantable electronic devices, cardioverters-defibrillators, cardiac resynchronization therapy, echocardiography.


Predictors of Ventricular Fibrillation in ST Elevation Myocardial Infarction

M.M. Demidova, D. Erlinge, P.G. Platonov

To reveal predictors of ventricular fibrillation (VF) in patients with ST elevation myocardial infarction (STEMI) who received primary percutaneous transluminal coronary angioplasty (PTCA), the analysis of the data of patients admitted to Lund University Hospital in 2007-2009 was made. The information was obtained from the RIKS‑HIA registry (Register of Information and Knowledge about Swedish Heart Intensive Care Admissions), hospital charts, ECG tracings, and telemetric records. The VF group included 121 patients with VF and ventricular tachycardia (VT) which required defibrillation, if VF/VT developed within 48 hours of the first STEMI symptoms. The study group consisted of 1,718 patients aged 66±12 years (men: 70%), including 61 patients (3.1%) after cardiopulmonary resuscitation on a pre-hospital stage; 54 ones of them were admitted to hospital while closed-chest cardiac massage was being performed.

Most frequently, VF developed before reperfusion (in 73 patients; 4.2%), VF during reperfusion was documented in 26 patients (1.5%). In 22 patients, VF developed after termination of the primary angioplasty: on the first day in 17 patients and on the second day in 5 patients. Totally, in 96% of VF survivors, the arrhythmia occurred on the first day of STEMI. The patients with VF were characterized by a higher number of subjects with a history of myocardial infarction (25.6% and 13.8%, respectively, p<0.001). The VF subjects significantly more frequently received therapy with β‑blockers (44.2% and 25.5%, respectively; p<0.001), Aspirin (39.1% and 24.0%, respectively; p<0.001), Digoxin (4.3% and 1.3%, respectively; p=0.011), and statins (28.1% and 18%, respectively; p=0.007) on admittance to hospital. The VF subjects had higher levels of blood creatinine and glucose on admittance. No difference in location of the myocardial infarction was found between the subjects with and without VF. The patients with VF had more severe coronary lesions: the left stem disease was revealed more frequently (14.8% and 6.5%, respectively, p<0.01) and the single-vessel disease was found less frequently (33.9% and 43.9%, respectively, p<0.05). Independent predictors of VF in STEMI subjects are as follows: smoking, intake of digoxin prior to STEMI, and left stem disease.

To reveal predictors of ventricular fibrillation in patients with ST elevation myocardial infarction who received primary angioplasty, the analysis of the data of 1,718 patients (men: 70%) aged 66±12 years admitted to Lund University Hospital in 2007-2009 was made.

Key words: myocardial infarction, life-threatening ventricular arrhythmias, ventricular fibrillation, coronary arteries, primary angioplasty, revascularization, cardiopulmonary resuscitation.


Guide to Practitioners

Revisited Properties of Accessory Pathways

A.E. Rivin, M.V. Gordeeva, N.S. Sokurenko, M.M. Medvedev

A possibility is considered of the correct assessment of properties of accessory pathways based on electrocardiographic signs of the WPW phenomenon; a clinical case report in given.

Key words: WPW phenomenon, WPW syndrome, accessory pathways, electrophysiological study, effective refractory period, Wenckebach point.



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