A. V. Prokopenko

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.

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.

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.