Alexey A. Vyrva

We present a case of asymptomatic coronary-atrial fistula formation after zero fluoro catheter ablation for incessant right atrial tachycardia using ABLATION INDEX module.

The choice of an optimal, most safe and physiological place in the heart for the electrode implantation is an issue to be solved by a specialist in surgery of heart arrhythmias. According to the literature, the techniques to stimulate both cardiac apex and other alternative areas are imperfect. At present, stimulation of the heart conduction system, namely, the His bundle is considered a promising area in arrhythmology. This type of stimulation is a physiological one, while it involves the His-Purkinje system. We present a successful clinical case of the electrode implantation with a two-chamber pacemaker to the heart conduction system in a 67-year-old patient with permanent atrial fibrillation. The surgical intervention made it possible to reduce the QRS length from 180 to 110 ms. This clinical case shows that the heart conduction system pacing allows for implementation of the principles of physiological stimulation in patients with impaired atrioventricular conduction. The technique with a two-chamber pacemaker is feasible in clinical practice.

Premature ventricular contractions (PVC) is a very common type of arrhythmia. Some patients require surgical treatment. The search for the safest methods of surgical treatment is an important research task.Aim. To evaluate the efficacy and safety of catheter ablation in patients with idiopathic ventricular arrhythmias depending on the implementation of X-ray control.Material and methods. The study included 183 patients admitted to the Federal Center for Cardiovascular Surgery for elective surgery, with frequent idiopathic PVC and indications for surgical treatment of arrhythmia. In the majority of patients with idiopathic PVC, the central origin of ectopia is the right ventricular outflow tract (RVOT). The patients were divided into two groups: group 1 (n=90) — patients with idiopathic PVC after fluoroscopy-guided radiofrequency ablation (RFA); group 2 (n=93) — patients after RFA without fluoroscopy. All patients underwent electrocardiography, echocardiography, and electrophysiological testing. All patients before and after RFA underwent 24-hour Holter monitoring.Results. Among patients of group 1, the initial success of RFA was 62,2%, and in group 2 — 71% (p=0,21). Surgery complications were registered in 3,3% and 4,3% of patients of groups 1 and 2. No deaths have been reported. The duration of surgery did not depend on the use of fluoroscopy. Among patients with failed initial RFA, the effectiveness of subsequent interventions was 88,6%. The greatest efficiency of initial RFA was observed when the ectopic ventricular focus was located in RVOT The lowest efficiency of RFA was observed when the focus was located in the left ventricular papillary muscles.Conclusion. RFA in patients with idiopathic PVC without fluoroscopy does not increase the complication rate and the duration of surgery and have a comparable efficacy compared to fluoroscopy-guided RFA.