Introduction. In patients with drug-refractory symptomatic atrial fibrillation (AF), radiofrequency catheter ablation has become the main treatment option. Despite advances in technology and experience, the incidence of complications for this procedure reported by researchers still varies. In the USA, irrigated catheters are used nearly always, mostly with contact force sensing. We used conventional catheters. The aim. To analyze the complications in 1000 consecutive radiofrequency catheter ablations of atrial fibrillation. Results and discussion. Non-irrigated 4 mm tip ablation catheters and two venous punctures were used. In total, 32 (3.2%) complications were observed. Pericardial tamponade was observed in 6 cases (0.6%), pericardial effusion in 7 (0.7%), pericardial puncture without effusion in 1 (0.1%), pericarditis in 1 (0.1%), complete atrioventricular (AV) block in 2 (0.2%), transient AV block in 1 (0.1%), stroke in 2 (0.2%), diaphragm paresis with pneumonia in 1 (0.1%), femoral artery aneurysm in 6 (0.6%), femoral hematoma requiring blood transfusion in 2 (0.2%), arteriovenous fistula in 2 (0.2%), hematuria in 1 (0.1%). Similar frequency of iatrogenic AV block was reported in the literature. There were 26 (3.4%) complications during 794 primary procedures. After 206 repeated procedures, we observed 2 femoral hematomas, 2 femoral artery aneurysms, 1 arteriovenous fistula and 1 complete AV block – a total of 6 (2.9%) complications. In several reports the incidence of life-threatening complications was lower than that in our study. However, the total number of complications in our group is at the level of the best results, despite the fact that we do not use irrigated catheters, esophageal temperature probes and endovascular ultrasound probes. Conclusions. The technique that we use is as safe as other methods of AF radiofrequency catheter ablation.

Atrial fibrillation (AF) is a worldwide epidemic that has hit about 33 million people. In clinical studies, the efficacy of antiarrhythmic therapy and catheter ablation in the treatment of AF was compared, and controversial results were obtained. Objective. To analyze three advanced publications in recent years, which, according to the authors, are of fundamental importance for the choice of radiofrequency catheter ablation as a treatment option for AF. Results and discussion. In the CABANA study catheter ablation was compared with antiarrhythmic therapy and showed significant improvement in the quality of life. Within 3 years, AF recurrence rate was 69% in the group of antiarrhythmic treatment and 50% in the catheter ablation group. The proportion of patients with non-paroxysmal AF decreased from 57% to 26% with antiarrhythmic treatment and up to 16% with catheter ablation. Among the serious complications in the catheter ablation group were tamponades (0.8%), minor hematomas (2.3%) and pseudoaneurysms (1.1%). Thyroid dysfunction (1.6%) and proarrhythmogenic effect (0.8%) were observed in the group of antiarrhythmic therapy. In the CASTLE-AF (HF) study, 179 patients were randomly selected for catheter ablation, and 184 for antiarrhythmic therapy. All of them were in NYHA class II, III or IV, had left ventricular ejection fraction 35% or less, and used implantable defibrillator. In the mean follow-up of 37.8 months, significantly less patients died after catheter ablation (24 [13.4%] versus 46 [25.0%]), and less were hospitalized due to worsening heart failure (37 [20.7%] versus 66 [35.9%]). ATTEST is the first randomized controlled trial that has demonstrated slowing down of the progression of AF after catheter ablation. Radiofrequency ablation was performed in 128 patients, antiarrhythmic therapy was applied in 127 patients. Within 3 years, the incidence of persistent AF or atrial tachycardia was lower in patients treated with ablation compared with patients on antiarrhythmic therapy (2.4% vs. 17.5%; P = 0.0009). Conclusions. The expected benefit of catheter ablation of AF in comparison with drug therapy is as follows: increase in the probability of maintaining sinus rhythm, improvement of the quality of life, decrease in the number of hospitalizations and all-cause mortality in patients with heart failure, decrease in fatigue.

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Introduction. Puncture of the atrial septum for access to the left atrium is often used for cardiac interventions in adults. In children, transseptal puncture is a less common, technically more difficult procedure, and the frequency of its complications is not well described in the literature. Objective. Our aim was to study the feasibility and safety of transseptal puncture in children through retrospective analysis of 208 consecutive radiofrequency catheter ablations (RFCA) for left-sided atrioventricular accessory pathways (AP). Results and discussion. Successful transseptal puncture was possible in 100% of cases, ablation in 97%. The mean time, including mapping and radiofrequency ablation, was 40 ± 22 minutes, and the mean fluoroscopy time was 3.8 ± 1.9 minutes. There were no complications associated with transseptal puncture. Recurrence of AP was reported in 6 (2.9%) children. Residual atrial septal defects 1 year after the procedure were detected by echocardiography in 5 (2.4%) children. The transseptal access ensures successful and effective ablation of the left-sided accessory pathways in the vast majority of children. RCA with transseptal access has a total operative time and fluoroscopy time comparable to those described in the literature for RCA with retrograde access. The reduced duration of the procedure and the fluoroscopy time are of great importance in the pediatric age group, which is most vulnerable to drug and radiation exposure. However, transseptal puncture in children remains a technically complex intervention with the possibility of corresponding complications. It should be performed by an experienced electrophysiologist who has experience in pediatric catheter ablation. Conclusions. Transseptal puncture is a feasible and reasonably safe procedure for children. It can be considered as the first choice approach in children with left-sided accessory pathways.

Результаты катетерного лечения непароксизмальных форм фибрилляции предсердий (ФП) хуже, чем пароксизмальных. В статье представлены результаты радиочастотной катетерной деструкции длительно персистирующей формы ФП у 47 последовательных пациентов, которым было выполнено 57 процедур, что составило 1,2 процедуры на пациента. Большинство процедур выполнено без применения навигационных систем с использованием электродов без функции охлаждения с дистальным электродом 4 мм. После первой процедуры в течение 1 года синусовый ритм удерживался у 27 (57,4%) пациентов. С учетом повторных процедур синусовый ритм в течение 1 года был у 35 (74,5%) пациентов, из них антиаритмические препараты принимали 8 (22,9%) больных. После последней процедуры удалось проследить судьбу 42 (89,4%) пациентов. Средний период наблюдения составил 2,6±1,9 года. Синусовый ритм сохранился у 19 (45,2%) пациентов, из них антиаритмическую терапию получали 11 (57,9%). Таким образом, представленная методика является достаточно эффективной при длительно персистирующей форме ФП.