A. V. Kozlov

Radiofrequency ablation of the pulmonary veins using a single-catheter method is as effective as the traditional approach in the treatment of paroxysmal atrial fibrillation | Bazylev | Journal of Arrhythmology Радиочастотная аблация легочных вен с использованием однокатетерного метода не уступает по эффективности традиционному подходу при пароксизмальной форме фибрилляции предсердий | Базылев | Вестник аритмологии

Aim. To evaluate the prognostic value of local captures after pulmonary vein isolation in patients with nonparoxysmal atrial fibrillation (AF) for the long-term results of radiofrequency ablation (RFA).Methods. A single-center observational prospective study. The total number of patients 110. All patients underwent primary catheter ablation for nonparoxysmal AF. During the operation, the activity of pulmonary veins and the presence of local captures were assessed. Patients with local captures in at least one pulmonary vein were included in the first group. Patients who had no local captures were included in the second group. The number of patients in the first group is 54 patients, the number of patients in the second group is 56 patients. The groups had no statistically significant differences in the main indicators -gender, weight, age, duration of medical history, volume of the left atrium and left ventricular ejection fraction, as well as in concomitant pathology. The time of RFA and fluoroscopy, and the duration of operations between the groups also had no statistically significant differences.Results. The follow-up period was 800 [286.5;800] days. The overall effectiveness of the treatment was 68.2% (75 patients out of 110), considering repeated operations. In the group with local captures, sinus rhythm was maintained at the end of the follow-up period in 42 out of 54 patients (77,7%), in the group without local captures in 33 out of 56 patients (58,9%). The difference is statistically significant (odds ratio 2,439 (95% confidence interval 1,060 -5,615 p=0,034). The presence of local captures in the construction of a multifactorial logistic regression model is a predictor of the effectiveness of RFA (χ2=14,710; p=0,012).Conclusion. In this study, local captures in the pulmonary veins in patients with nonparoxysmal atrial fibrillation were a predictor of improved long-term results of radiofrequency ablation.

Aim. To study the change in the position of the esophagus during radiofrequency ablation of the pulmonary veins (RFA PV) using esophagographyMethods. The period of the study is from August 2022 to January 2023 inclusive. The study is a single-center observational non-randomized study. The study included 191 patients. RFA PV were performed under conscious sedation with dexmedetomidine and fentanyl. The patients were available for verbal contact throughout the operation. After performing a transeptal puncture, esophagography was performed in the LAO 30° projection using 10 ml of Omnipac water-soluble contrast agent (GE Healthcare Ireland). At the end of the operation, esophagography was performed repeatedly. The position of the esophagus was determined relative to the shadow of the spine. Measurements were carried out at three levels: the upper one at the intersection of the esophagus and the roof of the left atrium, the lower one at the intersection with the ring of the mitral valve; the middle level at the middle of the distance between the upper and lower measurements. The width of the contrasted lumen of the esophagus was measured at the same levels. Lateral displacement of the esophagus was defined as the difference in the values of measurements of the position of the lateral and medial boundaries of the esophageal shadow on esophagograms obtained at the beginning and end of the operation.Results. The average lateral displacement of the esophagus was 2.0 ±1.9 mm at the upper level, 3.4±1.6 mm at the middle level and 1.4±1.2 mm at the lower level of the left atrium. There was no significant statistically difference in the change in the position of the esophagus at the beginning and end of the operation (p=0.251, p=0.558, p=0.824, respectively, for the upper, middle and lower measurement levels). The most significant displacement of the esophageal shadow was 5.3 mm. The maximum change in the width of the contrasted lumen of the esophagus was 5.5 mm.Conclusions. According to esophagography with water-soluble contrast, the position of the esophagus during RFA PV does not experience clinically significant changes.

Aim. To study how the presence of local capture (LC) after pulmonary vein (PV) isolation affects the effectiveness of radiofrequency ablation (RFA) in patients with paroxysmal atrial fibrillation (AF)Methods. The study was a single-center, observational, prospective study. The total number of 186 patients. All patients underwent RFA PV for paroxysmal AF. During the operation, the activity of PV and the presence of LC were assessed. Patients in whom LC after PV isolation occurred in at least one PV were included in the first group; patients in whom LC were absent - in the second group. The first group - 98 patients, the second group - 88. Patients in the groups did not statistically differ in the main indicators - weight, gender, age, duration of anamnesis, left atrium volume and ejection fraction, as well as in the presence of concomitant pathology. The duration of the operation, the time of RFA and time fluoroscopy between the groups also did not differ statistically.Results. Mean observation time for patients was 374.4±25,.2 days. In the first group, sinus rhythm was maintained in 82 patients out of 98 (83,7%), in the second group 60 patients out of 88 (68.2%). The difference is statistically significant odds ratio 2.392 (95% confidence interval 1.189 - 4.816, p=0.031).Conclusion. The presence of local captures of the myocardium of the pulmonary veins after radiofrequency isolation is associated with an improvement in the results of treatment of patients with paroxysmal AF.

Aim. To study the role of left atrial posterior wall (LAPW) isolation in increasing the clinical efficacy of radiofrequency ablation (RFA) in patients with persistent atrial fibrillation (PeAF) during electrophysiological studies.Methods. A single-center randomized prospective study. From February 2020 to February 2021, 35 procedures were performed on patients with PeAF. Patients were randomized into two groups - pulmonary vein isolation (PVI) plus LAPW isolation according to the “box lesion” scheme (the first group) and the PVI-only group (the second group). If it was impossible to achieve LAPW isolation, “debulking” was performed. After 3 months, regardless of the clinical status, EPS and RFA of the reconnection zones were performed.Results. The full study protocol study was completed by 30 patients - 14 in the first group and 16 in the second group. The characteristics of the patients in the groups did not differ statistically. The duration of the primary and redo procedures, as well as the RFA time during the primary procedure in the first group is significantly longer than in the second group. Pulmonary veins were isolated in all patients participating in the study. In the first group, LAPW isolation was achieved only in 21.4% of cases (3 patients), in the remaining 78.6% of cases (11 patients) “debulking” was performed. PVI in the first group was maintained in 78.6% of cases (11 patients), and in the second group in 56.2% (9 patients), the difference was not statistically significant (p=0.209). In the first group, LAPW isolation was maintained in 28.6% of patients (4 patients). All patients with reconnection underwent RFA with the restoration of the conduction block. In the midterm (440±82.1 days) of follow-up, the sinus rhythm was preserved in the first group in 11 patients (78.5%), and in the second group in 13 (81.2%) patients. There was no statistically significant difference between the groups (OR 0.846 95% CI 0.141-5.070, p=0.641).Conclusions. In our study, LAPW isolation in addition to PVI in patients with PeAF did not improve the efficacy of treatment with a significantly longer duration of procedure and RFA time.

Фибрилляция предсердий (ФП) является наиболее часто встречающейся аритмией в клинической практике. В статье рассмотрены различные стратегии радиочастотной аблации (РЧА) при ФП: сегментарная остиальная аблация устьев легочных вен, антральная изоляция, линейные воздействия в левом предсердии, аблация комплексных фракционированных предсердных электрограмм (CFAEs), аблация ганглионарных сплетений, пошаговый метод аблации, аблация «роторов» и фокальных импульсов. В настоящее время антральная изоляция легочных вен (ЛВ) считается более выигрышной стратегией аблации ФП, так как позволяет воздействовать на большее число механизмов, вызывающих и поддерживающих аритмию. Эффективность всех остальных методов остается под вопросом. Имеются противоречивые данные литературы, и в настоящее время роль дополнительных аблаций в улучшении клинических исходов остается спорной и требует дальнейших исследований. Восстановление проведения в изолированных легочных венах является практически универсальной находкой у пациентов, подвергшихся повторной РЧА ФП, хотя связь электрической реконнекции с возвратом аритмии остается не совсем ясной. Расмотрены несколько методов, направленных на увеличение вероятности создания перманентной изоляции устьев ЛВ: увеличение времени ожидания после острой изоляции устьев ЛВ и повторная аблация возникающих «прорывов» проведения возбуждения, высокоамплитудная стимуляция с картирующего катетера вдоль созданной линии повреждения и реаблация мест с сохраненной возбудимостью, введение аденозина для выявления скрытого проведения, использование аблационных катетеров с технологией контроля силы контакта с тканью для создания более стойкого повреждения миокарда. Изоляция устьев ЛВ является единственным методом с доказанной эффективностью при интервенционном лечении ФП. На данный момент не существует методики, обеспечивающей 100% перманентную изоляцию легочных вен после единственной процедуры. Фибрилляция предсердий (ФП) является наиболее часто встречающейся аритмией в клинической практике. В статье рассмотрены различные стратегии радиочастотной аблации (РЧА) при ФП: сегментарная остиальная аблация устьев легочных вен, антральная изоляция, линейные воздействия в левом предсердии, аблация комплексных фракционированных предсердных электрограмм (CFAEs), аблация ганглионарных сплетений, пошаговый метод аблации, аблация «роторов» и фокальных импульсов. В настоящее время антральная изоляция легочных вен (ЛВ) считается более выигрышной стратегией аблации ФП, так как позволяет воздействовать на большее число механизмов, вызывающих и поддерживающих аритмию. Эффективность всех остальных методов остается под вопросом. Имеются противоречивые данные литературы, и в настоящее время роль дополнительных аблаций в улучшении клинических исходов остается спорной и требует дальнейших исследований. Восстановление проведения в изолированных легочных венах является практически универсальной находкой у пациентов, подвергшихся повторной РЧА ФП, хотя связь электрической реконнекции с возвратом аритмии остается не совсем ясной. Расмотрены несколько методов, направленных на увеличение вероятности создания перманентной изоляции устьев ЛВ: увеличение времени ожидания после острой изоляции устьев ЛВ и...