Aim. The results presented, of subanalysis of the catheter ablation (CA) registry in atrial fibrillation (AF) with the patients properties, specifics of CA and treatment results, in Russia comparing to European countries.

Material and methods. During 2012 to 2015, totally 3742 patients included to the registry, of those 477 in Russia. In 467 Russian patients (males 56,5%; mean age 58,5 y. o.) CA AF was done. During one year 392 patients were followed up. Minimum requirements to follow-up: routine ECG registration and non less than one contact after 12 months passed.

Results. In Russian patients there were more common obesity (46,1% and 29,2%, p<0,001), hypertension heart disease (40,2% and 22,8%, p<0,0001), coronary heart disease (31,7% and 16,2%, p<0,0001), chronic heart failure (67,3% and 13,0%, p<0,0001). In Russia the patients more commonly underwent primary CA (83,5% in Russia and 77,6% in European countries, p<0,05), more rare in Russia the cryoballoon ablation was done (3% and 18%, p<0,05). Generally adverse events were reported more rare in Russia (10,5% and 16,6%, p=0,0007), including cardiovascular adverse events (2,6% and 5,2%, p<0,05). Tachiarrhythmias recurs were diagnosed more rare in Russia, including by the subsutaneous ECG monitors (17% and 1,6% in other countries, р<0,001). Within the year of follow-up, full absence of tachiarrhythmias recurs in Russia was found in 65,8% of patients, in other countries — in 74,7% (р=0,0003).

Conclusion. In real clinical setting, high efficacy of CA AF was shown, resistant to antiarrhythmic therapy. In most of Russian patients there were cardiovascular comorbidities. There was lower rate of reported adverse events in Russian centers of interventional treatments.

Aim. In the study we set an aim to evaluate the rate of thromboembolic complications in atrial fibrillation (AF) patients with implanted occluding device of the left atrium appendage (LAA).

Material and methods. Beginning at 2012, in the study center, 102 LAA occluders were implanted, of those 44 Watchman device (Boston Scientific), 55 Amplatzer Cardiac Plug (AGA Medical), and 3 Amulet (Abbott). Total follow-up 304,8 patientyears, mean follow-up duration 2,98±1,72 y.

Results. During the period, 1 (0,98%) case of acute stroke was registered and 1 case of transient cerebral ischemia. Control transesophageal assessment was done in 100 patients, in 4 (4%) cases there was transient thrombosis of atrial area of the device with no significant outcomes.

Conclusion. Implantation of the LAA occluder is an alternative for anticoagulation in AF patients with high thromboembolic and not possible drug prevention.

Aim. Current registry is the continued national study on cryoablation in atrial fibrillation (AF). The aim of the project is assessment of safety and efficacy of cryoballoon ablation of pulmonary veins from AF treatment in real clinical practice prospective observation.

Material and methods. The project has been developed for prospective inclusion of the data to guarded automatic informational system, on clinical data of patients, ablation parameters, repeat ablation and results of 12-month follow-up. To participate in the project in January of 2017, the representatives of 33 in-patient facilities were invited, that routinely perform the procedure.

Results. Twenty five institutions confirmed their participation, and by December of 2017, the database was completed by specialists from 13 clinics: information on the ablation procedure and outcomes is included for 451 patient. The enrollment is ongoing with estimated end by January 2019; prospective follow-up to be completed by January 2020.

Conclusion. Prospective registry of AF cryoablation is important for gathering of experience and common analysis of the procedures throughout the country. Detailed analysis will make it to reveal predictors of efficacy and methods for procedural risk decrease.

Aim. To assess the characteristics and prevalence of cardiac rhythm disorders in epilepsy patients during the iktal period, by long term ECG monitoring.

Material and methods. To the study, 79 patients included, age 18 to 51 y. o. with confirmed diagnosis of focal epilepsy with continuing attacks regardless the antiepilepsy treatment. For rhythm disorder screening, all patients underwent implanting of subcutaneous ECG monitors.

Results. Disorders of cardiac rhythm and conduction during the iktal period were found in 88,61% cases. Most prevalent were sinus tachycardia (59,5%, 47 cases), cardiac rhythm and conduction disorders (29%, 23 cases). In 9 cases (11,4%) there were no cardiac rhythm and conduction disorders registered. Also, the probable predictors found, of the disorders of cardiac rhythm in epilepsy patients. Patients gender, type of attacks, frequency, circadian specifics were the markers influencing the rate of iktal cardiac rhythm changes.

Conclusion. Sinus tachycardia, rhythm and conduction disorders are registered in most of patients during the iktal period and significantly more common in males, the patients with bilateral tonic and clonic seizures, serial course of the attacks and in the patients with sleep-related seizures. Evaluation of antiepilepsy treatment influence on the prevalence of iktal rhythm and conduction disorders did not reveal significant difference for none of the drug groups. Also, there was no significant differences in comparison of the studied parameters for polyand monotherapy by anticonvulsants.

Aim. To compare the results of non-invasive activational mapping in patients with “idiopathic” ventricular arrhythmias (IVA) with the data on myocardial structure obtained by late enhancement magnetic resonance tomography (MRI).

Material and methods. Twenty eight IVA patients, mean age 37 y. o. [26; 45], with ventricular arrhythmias of the heart (VA) of 2nd or higher grade by Lown, and 5 healthy volunteers (HV), mean age 29 [29; 30], underwent surface epiand endocardial non-invasive mapping (SEENIM) of the heart with the system for noninvasive electrophysiological investigation of the heart “Amicard 01C” with the analysis of duration of the activation-recovery interval (ARI) of the ventricles, and high resolution MRI (voxel 1,25x1,25x2,5mm) with delayed contrasting.

Results. The number of VA in IVA group was 20196 [11479; 29834] for 24 hours. In 11 patients there were episodes of non-sustained ventricular tachycardia (VT). By SEENIM, predominating morphological type of ventricular ectopic activity in 22 patients sourced from the right ventricle myocardium (RV), of those in 20 from outflow tract of the LV (OTLV). There was significantly prolonged ARI in OTLV patients with IVA comparing to HV (p<0,05). In IVA and non-sustained ventricular tachycardia patients, by contrast MRI of the heart, in LV myocardium there were small foci of contrast retention found. There was no correlation of the areas of contrast retention and topography of VA sources.

Conclusion. In most of IVA patients the source of VA was outflowing tract of the RV. The revealed prolongation of the ARI of this area in IVA patients can be an important factor of IVA onset. Small foci of LV fibrosis, found in late enhancement MRI of the heart and episodes of so called idiopathic VT, might be the earliest presentation of the “tachycardiopathy” at the step of pathology development when there are no signs of LV dilation.

Aim. Retrospective analysis of efficacy of the acute vasoreactive test (AVRT) as a criteria for operability of children with inborn left-to-right blood shunting complicated by pulmonary arterial hypertension (IRLBS-PAH), by an experience of one center.

Material and methods. Retrospective analysis of the data of right heart chambers catheterization and echocardiographic study from 29 case histories of BS-PAH patients during 2012-2016. Results of AVRT are interpreted by modified Barst criteria (decline of pulmonary vascular resistance index, PVRI, and relation of PVRI to the index of systemic vascular resistance, SVR more than 20%, and the and PVRI <6 Wood units/m2 in PVR/SVR <0,3). In accordance with the results of AVRT, patients were selected to two main groups: group 1 — children with positive response, group 2 — children with negative response. After correction of the inborn defect in bith groups, following assessment of cardiovascular system condition was done by echocardiographical study in one week and one month. Metrics of echocardiography data was indexed. For the defect of interventricular septum (DIVS), indexation of the size was done via the relation to aortic root diameter, that was measured in parasternal position, longitudinal axis. Systolic pressure in the right ventricle was measured by the velocity of tricuspid regurgitation, measured in apical four-chamber position. Mean values with the standard deviation and p-values were calculated in R studio 2017 software, v.1.0.153.

Results. Among 29 patients, girls to boys relation was 4,8:1. Mean age 6,0±4,9 y. o. For group 1: median of DIVS 1,4 with the value of additional shunting 9,93±9,39 mm, baseline systolic pressure in the right ventricle (SPRV) 57,96±20,16 mmHg, in one month after surgery 38,96±14,16 mmHg. No complications registered. In the second group, median DIVS 0,4 with additional shunting 3,3±0 mm. Baseline SPRV 66,05±17,27 mmHg, with the decline in one month after transcatheter closure to 57,4±17,35 mmHg. During the early post-surgery period, in 2 patients of group 2 there was pulmonary crisis, treated with inhalatory iloprost.

 Conclusion. Acute vasoreactive test is effective criteria of operability assessment of inborn left-to-right blood shunting, complicated by pulmonary arterial hypertension, in pediatrics.

Aim. Comparison of in-hospital results of two strategies on an aimed incomplete myocardial revascularization (AIMR) ONCAB and MIDCAB of left anterior descending artery (LAD) in multivessel coronary disease patients.

Material and methods. To the study, 63 patients included with achieved AIMR (LAD shunting) in multivessel disease. All patients, depending on the strategy of revascularization, were selected to 2 groups: 1. ONCAB (47,6%, n=30) and 2. MIDCAB (52,4%, n=33).

Results. In the early post-surgery period of follow-up, among the adverse cardiovascular events, in the general selection of patients, there was non-fatal Q-myocardial infarction in MIDCAB group, followed by a decline of the left ventricle ejection fraction from 65% to 38%. ONCAB group was characterized by higher volume intra-operational blood loss, rate of wound and hemorrhagic complications, that in one case led to remediastinotomy, and in every tenth patient — blood transfusion during the early period. In our study, the chosen surgical strategy was the only alternative to medication therapy.

Conclusion. In the study, at in-hospital stage of management there were comparable outcomes of AIMR with either ONCAB and MIDCAB. Nevertheless, coronary bypass with MIDCAB technology demonstrated a range of benefits related to decreased risk of hemorrhagic complications, wound infection and lower duration of hospitalization.

Aim. To evaluate the impact of genetics in development of thoracic aneurysm in patients with tricuspid valve (TAV) and bicuspid aortic valve (BAV) based on the analysis and search for mutations in NOTCH1.

Material and methods. In the study, 60 patients included with the dilation of thoracic aorta more than 40 mm and 200 patients with no aortic pathology, included in the comparison group. All patients underwent echocardiographic assessment on Vivid 7 (GE, USA) equipment, by standard protocol. For molecular genetics we utilized the strategy of targeted mutation screening, including the analysis of 10 of 34 exones of the gene NOTCH1, performed with the direct sequencing.

Results. Patients with BAV were younger than those with no inborn defect. Arterial hypertension was verified only in every second BAV patient. Also, maximal rates of blood pressure were significantly lower in patients with inborn defects (р<0,02). As a result of genetic analysis in the studied group, in 9 patients with inborn defect and 2 patients with TAV there were 10 variants found of aminoacid replacement in 6 among 10 analyzed exones, of those 5 replacements — synonimic, and the mutation S2449R was found first time. Mutations P1227S, E1305K, R1279H and D1267N were found at the site of Notch1 protein binding with DLL4, of those 3 are highly pathogenic, that could influence the protein-protein interactions Notch1 with DLL4 leading to formation on aneurysm.

Conclusion. Mutations P1227S D1267, E1305K in the gene NOTCH1, being highly pathogenic, may lead to the changes of protein functioning via Notch signalling disorder, that is more characteristic for BAV patients.

Aim. To reveal the molecular genetic predictors of adverse clinical course of coronary heart disease (CHD).

Material and methods. A clinical genetic investigation performed, of 567 CHD patients, of those 199 underwent dynamic follow-up. Genotypes Pro12Pro, Pro12Ala, Ala12Ala of the gene PPAR-γ2, genotypes L162L and L162V gene PPAR-α, genotypes A603A, A603G, G603G gene of tissue factor were assessed with polymerase chain reaction and further restrictional analysis.

Results. Carriage of the allele V162 gene PPAR-α and allele Ala12 gene PPAR-γ2 is associated with development of the following endpoints in CHD patients: recurrent angina, progression of heart failure, life-threatening arrhythmias, stroke and transient cerebral ischemia, myocardial infarction, fatal outcomes. Diabetes type 2 (DM2) in CHD patients was associated with the risk of adverse outcome 2,55 times. There was relation of DM2 in CHD patients and mortality. In CHD patients that undergone percutaneous coronary intervention and bypass grafting, the combination endpoint was registered rarer than in CHD patients with no interventions, with a decline of adverse CHD prognosis 2 times. The results can be explained by decreased inhibition of NF-kВ pathway in carriers of V162 and Ala12 genes PPAR-α and PPAR-γ2, that facilitates activation of the factors of immune inflammation and atherogenesis with further adverse outcomes of CHD. It is known that DM2 is a risk factor of CHD and its complications.

Aim. To analyze the results of 5-year follow-up of the paroxysmal atrial fibrillation patients (PAF) taking antiarrhythmic therapy (AAT)

Material and methods. Patients (n=500) were selected to 11 groups: I — healthy, II — controls, III-XI — PAF taking AAT. The baseline parameters of heart rate variability (HRV) were assessed during 5-year follow-up.

Results. Decrease of SDNN does 1,9 times increase the risk of AF development during the first 3 months from preventive AAT start. Decrease of RMSSD does 3,9 times increase the risk of AF during the first 2 weeks, and 1,9 times — 3 months; decrease of Delta X increases the risk of AF 3,9 times during 2 weeks, 2 times — during 3 months, 1,4 times — during 6 months, 1,3 times — during 12 months and 3 years. Increase of Amo does 1,8 times increase the risk of AF during first 3 months. If there was baseline decrease of Delta X and RMSSD, then within 2 weeks the AF paroxysm developed in 7,9% patients, and in 3 months — 15,9% patients. With the decrease of Delta X and RMSSD, in combination with low SDNN, the probability of sinus rhythm retention during 1 year is 51,2%.

Conclusion. PAF patients taking preventive AAT demand for ECG assessment of HRV parameters no less than once per 3 months.

Aim. To assess the expression of ММР-9 and TIMP-2 after intramyocardial injection of the allogenic biomaterial (AB) into ischemized myocardium in rodents.

Material and methods. One hundred Wistar rodents were used, who underwent ligation of coronary artery. The experiment group (n=50), together with coronary occlusion, received the suspension of AB 12 mg. General histology was applied: hematoxyline and eosine, by Mallori; immune histochemistry (ММP-9, TIMP-2, CD68); morphometry: index of the scar area (ISA), amount of ММP-9, TIMP-2, CD68-positive cells.

Results. It was shown that in the experimental group, after implantation of AB there were lesser than in controls values of ISA (2,74 times, p<0,05 . <0,0001), numbers of MMP9+ cells (p<0,001) and macrophages CD68+ (p<0,05), as the manifestation of proteolysis and area of lesion. On the contrary, amount of Timp-2+ cells in the experimental group was higher than in the control (p<0,0004).

Conclusion. Resorption of allogenic material (Alloplant) products does influence the balance of metalloproteinases and their inhibitors in the myocardium after ischemic lesion. This effect might influence the processes of myocardial remodelling and scar formation.

Clinical case demonstrates a cardiovascular phenotype of Fabry disease — rare inherited disorder, linked with female sex. Clinically manifest Fabry disease is described in female patient with paroxysmal atrial fibrillation. The specifics of differential diagnostics described, as of management, and indications for genetic diagnostics and prescription of genotype-specific enzyme replacement therapy.

Statistical analysis performed, of the informativity of biometric signs of electrocardiogram. It was found that amplitude and time parameters of PQST areas of electrocardiograms show enough dispersion and are not easily distinguished. For reliable biometric personality identification quite a range of such signs is needed. Based on the known signs, novel signs were formulated via the bootstrap method. The novel signs presented much lower dispersion. It was found, that reliable identification of personality is possible with combined usage of the amplitudes in Sand T-areas of cardiocycle.

In epilepsy patients during video-electroencephalographic monitoring there are various electrocardiographic (ECG) changes during the epileptic seizure, sometimes remaining at postictal period as well. In the literature, various cardiac rhythm and conduction disorders are described, ventricular and supraventricular disorders, ST segment shifts. Some among these might be life-threatening, probably leading to unexplained sudden death in epilepsy. In the review, we focus on the most common ECG changes in patients with ongoing epileptic seizures.