Eduard A. Ivanitskiy

Cryoballoon ablation (CBA), along with radiofrequency ablation and pulsedfield ablation, has proven to be a safe and equally effective method with a short learning curve and minimal time investment. The CBA technique for atrial fibrillation (AF) involves cryoballoon pulmonary vein occlusion, which is confirmed by the absence of contrast leakage from the target vein on fluoroscopy, followed by cryotherapy. Numerous studies have demonstrated the negative impact of fluoroscopy on the human body. This is especially relevant in centers performing a high volume of surgical procedures. This paper presents the immediate and long-term results of non-fluoroscopy CBA of AF and describes the methodology. This technique involves intravascular ultrasound-guided (IVUS) manipulations, eliminating the need for contrast agent or ionizing radiation. It also simultaneously monitors the position of tools within the heart cavities and the echo-free space. The technique is described step by step and illustrated with IVUS screenshots and explanations. Over eight years of clinical experience using non-fluoroscopy CBA of AF has demonstrated that its effectiveness and safety are comparable to the classical technique using fluoroscopy and venography. It eliminates the negative effects of ionizing radiation and radiocontrast agents, maintains the "one shot" principle, does not increase surgical time, and is reproducible.

Left bundle branch pacing is a new type of physiological cardiac pacing. It has advantages in patients with bradycardia and heart failure. However, this type of treatment raises a number of questions among specialists. There is a misunderstanding of implantation technical aspects, and evidence base for this method remains unclear due to the small number of large-scale studies in the world literature, as well as the absence of this type of treatment in Russian clinical guidelines. In this article, a group of authors reflects the solution of the above problems in clinical practice by describing the technical aspects of left bundle branch pacing and showing its advantages as an alternative to resynchronization therapy and conventional electrical pacing.

Aim. To assess safety and effectiveness of zero fluoro catheter ablation (CA) of tachyarrhythmias in patients with antiarrhythmic device.Methods. One hundred ninety-seven patients with implanted antiarrhythmic device and indication for catheter ablation of tachyarrhythmias were included in retrospective study. In control group of patients n=63 (mean age 65.5±11.9 years) all procedures were performed under fluoroscopic guidance. In a study group, n=134 (mean age 66.1±15.6 years) all procedures were performed without the use of fluoroscopy. To reconstruct 3D anatomy we used navigation systems: magnet and impedance. In some cases we used intracardiac ultrasound. In the first group there were 65% of patients with pacemakers, 4.8% patients with implantable cardioverters-defibrillators and 30.2% of patients had cardiac resynchronization systems. In second 70.1%, 12.7% and 17.2% respectively. In control group CA was performed within 24 hours after device implantation in 13 patients (20.6%), in study group - 23 (17.2%). In the rest cohort of patients mean period between device implantation and CA was 29.26±28 months - in control group, 38.8±39 months. Antiarrhythmic device programming was performed before and right after CA.Results. Interventional catheter procedure was performed in 98.4% of patients in control group and in 98.5% of patients in study group. Radiation exposure in control group was 0.24 mZv, in study group 0 mZv. There were no conversions from zero fluoroscopy procedure to X -ray controlled due to different reasons. In control (fluoroscopy controlled) group 8 hours after CA ventricle lead dislodgement was diagnosed. Antiarrhythmic device in this patient was implanted 6 days before CA. There were no lead dislodgements or cardiac pacing disorders in study group.Conclusion. Zero fluoroscopy CA of tachyarrhythmias in patients with antiarrhythmc device is as safe and effective as standard fluoroscopy controlled procedure.

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

Clinical data of a 39-year-old patient with corrected transposition of the great arteries, combined with complete atrioventricular block and conduction along an accessory pathway, are presented. The features of changes in the structure of the conduction system, rhythm and conduction characteristic of this rare congenital heart disease are discussed.

The article reflects information for cardiologists, cardiac surgeons, doctors pro­gramming implanted antiarrhythmic devices, employees and residents of the depart­ments of cardiology and cardiac surgery. Most often, we choose a model of an implantable cardioverter-defibrillator (ICD) strictly individually for each patient, based on the anamnesis characteristics, safety and highest efficiency of ICD systems offered on the market. With each new ICD model, manufacturing companies strive to minimize the number of implantable components and develop better algorithms to discriminate between atrial tachyarrhythmias and true ventricular tachyarrhythmias. However, the risk of inappropriate ICD therapy still remains high. Thus, attending physicians and cardiologists programming implantable antiarrhythmic devices often face difficulties in correcting ICD settings and planning further treatment of a patient with shocks caused by atrial tachyarrhythmias. The authors sought to form an idea about the features of a single-chamber ICD recording atrial potentials using a floating dipole, as well as the advantages of the DX system over classical single-chamber ICD systems, and to define a type of a patient for whom this implantable system would be the best choice preventing sudden cardiac death.

The article provides a review of international clinical studies on the use of a subcutaneous implantable cardioverter-defibrillator (ICD) in comparison with classical intravenous defibrillation systems. Subcutaneous ICDs have shown themselves to be a worthy alternative to intravenous defibrillating systems for the primary prevention of sudden cardiac death, when the patient is not indicated for anti-tachy stimulation and anti-brady stimulation. World experience on the use of subcutaneous ICDs proves the safety and effectiveness of the functioning of the subcutaneous ICD system, excluding from the patient’s life the formidable risks associated with the implantation procedure and further functioning of the classical intravenous ICD system.

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.

This article describes the patient selection procedure for subcutaneous cardioverter-defibrillator implantation, the implantation technique, and the features of postoperative follow-up of patients, the features of programming at all stages of patient treatment.

Purpose Our study aimed to assess the achievement of target ablation index (AI) values and their impact on first-pass pulmonary vein isolation (FPI) as well as to identify FPI predictors. Methods Atrial fibrillation (AF) ablation was performed according to the local practice, and target AIs were evaluated. The actual AI was calculated as the median value of all ablation points for the anterior and posterior left atrial (LA) walls. Results A total of 450 patients from nine centers were enrolled. Patients with first-time ablation (n = 408) were divided into the FPI and non-FPI groups. In the FPI group, a higher median target AI was reported for both the anterior and posterior LA walls than those in the non-FPI group. A higher actual AI was observed for the anterior LA wall in the FPI group. The actual AI was equal to or higher than the target AI for the posterior, anterior, and both LA walls in 54%, 47%, and 35% (n = 158) cases, respectively. Parameters such as hypertension, stroke, ablation power, actual AI value on the anterior wall, target AI values on both LA walls, AI achievement on the posterior wall, carina ablation, and operator experience were all associated with FPI in a univariate logistic regression model; only carina ablation was an independent predictor of FPI. Conclusions According to our multicenter study, FPI and a target AI were not achieved in a significant proportion of AF ablation procedures. Higher actual and target AI values were associated with FPI, but only carina ablation can independently predict FPI.