russjcardiolРоссийский кардиологический журналRussian Journal of Cardiology1560-40712618-7620«SILICEA-POLIGRAF» LLC10.15829/1560-4071-2025-6651XCROEBrussjcardiol-6651Research ArticleФИБРИЛЛЯЦИЯ ПРЕДСЕРДИЙATRIAL FIBRILLATIONЭлектрическая изоляция ушка левого предсердия в лечении пациентов с фибрилляцией предсердий (обзор)Left atrial appendage electrical isolation in the treatment of patients with atrial fibrillation: a literature reviewhttps://orcid.org/0000-0003-4408-3592БрутянА. А.BrutyanA. A.

Брутян Акоп Альбертович — к.м.н., врач по РЭВДЛ, отделение рентгенхирургических методов диагностики и лечения

Петроверигский пер., д. 10, стр. 3, Москва, 101990

Petroverigsky Lane, 10, bld. 3, Moscow, 101990

bruthakob@gmail.comhttps://orcid.org/0000-0003-3788-3997ДавтянК. В.DavtyanK. V.

Давтян Карапет Воваевич — д.м.н., профессор, врач — сердечно-сосудистый хирург, руководитель отдела нарушений сердечного ритма и проводимости

Петроверигский пер., д. 10, стр. 3, Москва, 101990

Petroverigsky Lane, 10, bld. 3, Moscow, 101990

doctordavtyan@mail.ruhttps://orcid.org/0000-0001-7077-9644ЧугуновИ. А.ChugunovI. A.

Чугунов Иван Александрович — к.м.н., врач по РЭВДЛ, отделение рентгенхирургических методов диагностики и лечения

Петроверигский пер., д. 10, стр. 3, Москва, 101990

Petroverigsky Lane, 10, bld. 3, Moscow, 101990

vvizevvolf@gmail.comhttps://orcid.org/0000-0002-1118-5376СимонянГ. Ю.SimonyanG. Yu.

Симонян Георгий Юрьевич — к.м.н., врач — сердечно-сосудистый хирург, с.н.с. отдела нарушений сердечного ритма и проводимости

Петроверигский пер., д. 10, стр. 3, Москва, 101990

Petroverigsky Lane, 10, bld. 3, Moscow, 101990

mtsystem@rambler.ruФГБУ Национальный медицинский исследовательский центр терапии и профилактической медицины Минздрава РоссииРоссияNational Medical Research Center for Therapy and Preventive MedicineRussian Federation202522032026304SОбразование66516651Copyright © Брутян А.А., Давтян К.В., Чугунов И.А., Симонян Г.Ю., 20262026Брутян А.А., Давтян К.В., Чугунов И.А., Симонян Г.Ю.Brutyan A.A., Davtyan K.V., Chugunov I.A., Simonyan G.Y.This work is licensed under a Creative Commons Attribution 4.0 License.https://russjcardiol.elpub.ru/jour/article/view/6651

Катетерная изоляция легочных вен является методом выбора для лечения пациентов с симптомной фибрилляцией предсердий (ФП). Несмотря на технологический прогресс, появление все более совершенных методов изоляции — эффективность лечения по данным различных источников не превышает 60-80%. В преобладающем большинстве случаев это связано с наличием внелёгочных источников для аритмии. Одной из наиболее недооценённых структур для запуска и поддержания ФП является ушко левого предсердия (УЛП). В данном литературном обзоре дано современное представление о методах изоляции УЛП, эффективности и возможных осложнениях. Также отражен вопрос возможных тромбоэмболических событий после изоляции УЛП, который является наиболее частым и весомым ограничением для распространения данной процедуры.

Catheter-based pulmonary vein isolation is the treatment of choice for patients with symptomatic atrial fibrillation (AF). Despite technological advances, the treatment efficacy, according to various sources, does not exceed 60-80%. In the vast majority of cases, this is due to nonpulmonary sources of arrhythmia. One of the most underestimated structures for the initiation and maintenance of AF is the left atrial appendage (LAA). This literature review provides a current understanding of LAA isolation methods, their effectiveness, and potential complications. It also addresses the issue of potential thromboembolic events after LAA isolation, which is the most common and significant limitation to the widespread use of procedure.

фибрилляция предсердийушко левого предсердиякриобаллонная аблация ушка левого предсердияэлектрическая изоляция ушка левого предсердияatrial fibrillationleft atrial appendageleft atrial appendage cryoballoon ablationleft atrial appendage electrical isolationReferencesVan Gelder IC, Kotecha D, Rienstra M, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for CardioThoracic Surgery (EACTS). Eur Heart J. 2024;45(36):3314-414.Van Gelder IC, Kotecha D, Rienstra M, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for CardioThoracic Surgery (EACTS). Eur Heart J. 2024;45(36):3314-414.Parameswaran R, Al-Kaisey AM, Kalman JM. Catheter ablation for atrial fibrillation: current indications and evolving technologies. Nat Rev Cardiol. 2021;18(3):210-25. doi:10.1038/s41569-020-00451-x.Parameswaran R, Al-Kaisey AM, Kalman JM. Catheter ablation for atrial fibrillation: current indications and evolving technologies. Nat Rev Cardiol. 2021;18(3):210-25. doi:10.1038/s41569-020-00451-x.Haïssaguerre M, Jaïs P, Shah DC, et al. Spontaneous Initiation of Atrial Fibrillation by Ectopic Beats Originating in the Pulmonary Veins. New England Journal of Medicine. 1998;339(10):659-66.Haïssaguerre M, Jaïs P, Shah DC, et al. Spontaneous Initiation of Atrial Fibrillation by Ectopic Beats Originating in the Pulmonary Veins. New England Journal of Medicine. 1998;339(10):659-66.Theis C, Kaiser B, Kaesemann P, et al. Pulmonary vein isolation using cryoballoon ablation versus RF ablation using ablation index following the CLOSE protocol: A prospective randomized trial. J Cardiovasc Electrophysiol. 2022;33(5):866-73.Theis C, Kaiser B, Kaesemann P, et al. Pulmonary vein isolation using cryoballoon ablation versus RF ablation using ablation index following the CLOSE protocol: A prospective randomized trial. J Cardiovasc Electrophysiol. 2022;33(5):866-73.Di Biase L, Lakkireddy DJ, Marazzato J, et al. ACC Electrophysiology and Interventional Councils. Antithrombotic Therapy for Patients Undergoing Cardiac Electrophysiological and Interventional Procedures: JACC State-of-the-Art Review. J Am Coll Cardiol. 2024;83(1):82-108. doi:10.1016/j.jacc.2023.09.831.Di Biase L, Lakkireddy DJ, Marazzato J, et al. ACC Electrophysiology and Interventional Councils. Antithrombotic Therapy for Patients Undergoing Cardiac Electrophysiological and Interventional Procedures: JACC State-of-the-Art Review. J Am Coll Cardiol. 2024;83(1):82-108. doi:10.1016/j.jacc.2023.09.831.Kuck KH, Brugada J, Schlüter M, et al.; FIRE AND ICE Trial Investigators. The FIRE AND ICE Trial: What We Know, What We Can Still Learn, and What We Need to Address in the Future. J Am Heart Assoc. 2018;7(24):e010777. doi:10.1161/JAHA.118.010777.Kuck KH, Brugada J, Schlüter M, et al.; FIRE AND ICE Trial Investigators. The FIRE AND ICE Trial: What We Know, What We Can Still Learn, and What We Need to Address in the Future. J Am Heart Assoc. 2018;7(24):e010777. doi:10.1161/JAHA.118.010777.Heeger CH, Wissner E, Knöll M, et al. Three-Year Clinical Outcome After 2ndGeneration Cryoballoon-Based Pulmonary Vein Isolation for the Treatment of Paroxysmal and Persistent Atrial Fibrillation — A 2 — Center Experience. Circulation Journal. 2017;81(7):974-80.Heeger CH, Wissner E, Knöll M, et al. Three-Year Clinical Outcome After 2ndGeneration Cryoballoon-Based Pulmonary Vein Isolation for the Treatment of Paroxysmal and Persistent Atrial Fibrillation — A 2 — Center Experience. Circulation Journal. 2017;81(7):974-80.Wazni OM, Dandamudi G, Sood N, et al. Cryoballoon Ablation as Initial Therapy for Atrial Fibrillation. New England Journal of Medicine. 2021;384(4):316-24.Wazni OM, Dandamudi G, Sood N, et al. Cryoballoon Ablation as Initial Therapy for Atrial Fibrillation. New England Journal of Medicine. 2021;384(4):316-24.Di Biase L, Burkhardt JD, Mohanty P, et al. Left atrial appendage: An underrecognized trigger site of atrial fibrillation. Circulation. 2010;122(2):109-18.Di Biase L, Burkhardt JD, Mohanty P, et al. Left atrial appendage: An underrecognized trigger site of atrial fibrillation. Circulation. 2010;122(2):109-18.Aryana A, Baker JH, Espinosa Ginic MA, et al. Posterior wall isolation using the cryoballoon in conjunction with pulmonary vein ablation is superior to pulmonary vein isolation alone in patients with persistent atrial fibrillation: A multicenter experience. Heart Rhythm. 2018;15(8):1121-9.Aryana A, Baker JH, Espinosa Ginic MA, et al. Posterior wall isolation using the cryoballoon in conjunction with pulmonary vein ablation is superior to pulmonary vein isolation alone in patients with persistent atrial fibrillation: A multicenter experience. Heart Rhythm. 2018;15(8):1121-9.Aryana A, Lafortune P, Di Biase L, Natale A. Cryoballoon Ablation of the Pulmonary Veins, the Posterior Wall, the Left Atrial Appendage, and the Mitral Isthmus Guided by Intracardiac Echocardiography-integrated and Three-dimensional Mapping. Journal of Innovations in Cardiac Rhythm Management. 2022;13(1):4863-8.Aryana A, Lafortune P, Di Biase L, Natale A. Cryoballoon Ablation of the Pulmonary Veins, the Posterior Wall, the Left Atrial Appendage, and the Mitral Isthmus Guided by Intracardiac Echocardiography-integrated and Three-dimensional Mapping. Journal of Innovations in Cardiac Rhythm Management. 2022;13(1):4863-8.Tohoku S, Chen S, Bordignon S, et al. Hot or cold? Feasibility, safety, and outcome after radiofrequency-guided versus cryoballoon-guided left atrial appendage isolation. J Arrhythm. 2022;38(3):316-26.Tohoku S, Chen S, Bordignon S, et al. Hot or cold? Feasibility, safety, and outcome after radiofrequency-guided versus cryoballoon-guided left atrial appendage isolation. J Arrhythm. 2022;38(3):316-26.Chen S, Schmidt B, Bordignon S, et al. Durable cryoballoon-based left atrial appendage isolation: Catheter maneuver, occlusion grade, contact force, and time to isolation. J Cardiovasc Electrophysiol. 2019;30(8):1278-9. doi:10.1111/jce.13895.Chen S, Schmidt B, Bordignon S, et al. Durable cryoballoon-based left atrial appendage isolation: Catheter maneuver, occlusion grade, contact force, and time to isolation. J Cardiovasc Electrophysiol. 2019;30(8):1278-9. doi:10.1111/jce.13895.Yorgun H, Sener YZ, Tanese N, et al. Long-term outcomes of left atrial appendage isolation using cryoballoon in persistent atrial fibrillation. Europace. 2023;25(2):366-73.Yorgun H, Sener YZ, Tanese N, et al. Long-term outcomes of left atrial appendage isolation using cryoballoon in persistent atrial fibrillation. Europace. 2023;25(2):366-73.Romero J, Gabr M, Patel K, et al. Efficacy and safety of left atrial appendage electrical isolation during catheter ablation of atrial fibrillation: An updated meta-analysis. Europace. 2021;23(2):226-37. doi:10.1093/europace/euaa266.Romero J, Gabr M, Patel K, et al. Efficacy and safety of left atrial appendage electrical isolation during catheter ablation of atrial fibrillation: An updated meta-analysis. Europace. 2021;23(2):226-37. doi:10.1093/europace/euaa266.Canpolat U, Yorgun H, Aytemir K. Tips and tricks of durable cryoballoon based left atrial appendage isolation. J Cardiovasc Electrophysiol. 2019;30(8):1280. doi:10.1111/jce.13897.Canpolat U, Yorgun H, Aytemir K. Tips and tricks of durable cryoballoon based left atrial appendage isolation. J Cardiovasc Electrophysiol. 2019;30(8):1280. doi:10.1111/jce.13897.Romero J, Di Biase L. Left atrial appendage electrical isolation for persistent atrial fibrillation: Radiofrequency vs cryoballoon ablation. Pacing Clin Electrophysiol. 2019;42(6):655- 7. doi:10.1111/pace.13689.Romero J, Di Biase L. Left atrial appendage electrical isolation for persistent atrial fibrillation: Radiofrequency vs cryoballoon ablation. Pacing Clin Electrophysiol. 2019;42(6):655- 7. doi:10.1111/pace.13689.Fink T, Ouyang F, Heeger CH, et al. Management of thrombus formation after electrical isolation of the left atrial appendage in patients with atrial fibrillation. Europace. 2020;22(9):1358-66.Fink T, Ouyang F, Heeger CH, et al. Management of thrombus formation after electrical isolation of the left atrial appendage in patients with atrial fibrillation. Europace. 2020;22(9):1358-66.Di Biase L, Mohanty S, Trivedi C, et al. Stroke Risk in Patients With Atrial Fibrillation Undergoing Electrical Isolation of the Left Atrial Appendage. J Am Coll Cardiol. 2019;74(8): 1019-28.Di Biase L, Mohanty S, Trivedi C, et al. Stroke Risk in Patients With Atrial Fibrillation Undergoing Electrical Isolation of the Left Atrial Appendage. J Am Coll Cardiol. 2019;74(8): 1019-28.Kim YG, Shim J, Oh SK, et al. Electrical isolation of the left atrial appendage increases the risk of ischemic stroke and transient ischemic attack regardless of post isolation flow velocity. Heart Rhythm. 2018;15(12):1746-53.Kim YG, Shim J, Oh SK, et al. Electrical isolation of the left atrial appendage increases the risk of ischemic stroke and transient ischemic attack regardless of post isolation flow velocity. Heart Rhythm. 2018;15(12):1746-53.Panikker S, Jarman JWE, Virmani R, et al. Left atrial appendage electrical isolation and concomitant device occlusion to treat persistent atrial fibrillation. Circ Arrhythm Electrophysiol. 2016;9(7):e003710. doi:10.1161/CIRCEP.115.003710.Panikker S, Jarman JWE, Virmani R, et al. Left atrial appendage electrical isolation and concomitant device occlusion to treat persistent atrial fibrillation. Circ Arrhythm Electrophysiol. 2016;9(7):e003710. doi:10.1161/CIRCEP.115.003710.Zender N, Weise FK, Bordignon S, et al. Thromboembolism after electrical isolation of the left atrial appendage: A new indication for interventional closure? Europace. 2019;21(10):1502-8.Zender N, Weise FK, Bordignon S, et al. Thromboembolism after electrical isolation of the left atrial appendage: A new indication for interventional closure? Europace. 2019;21(10):1502-8.

The authors declare that there are no conflicts of interest present.