The use of digital technologies for processing and diagnosing electrocardiogram signals using wavelet-analysis can significantly improve the efficiency and quality of parameter estimations of the pacemaker configuration during implantation. It is also efficient in the process of correction of functional modes of cardiac pacemaker and diagnostics to eliminate postoperative complications, etc. A special processing of complex cardio signals at a qualitatively new level is an indispensable condition for the decisive improvement of the processing of current values of diagnosed parameters, widespread use of digital instruments for sound and informed decision-making on the provision of medical care and the treatment of people with diseases of the cardiovascular system. The article discusses the approximation method. Digital technologies are implemented using MATLAB computing environment.

In patients with ischemic stroke more than 17 % have atrial fibrillation. Oral anticoagulant therapy is the main strategy for embolism prevention in patients with atrial fibrillation. In the presence of contraindications, an alternative to anticoagulant therapy is isolation of the left atrial appendage. The use of the left atrial appendage occluder is comparable in effectiveness to the prevention of ischemic stroke using anticoagulant therapy. However, possible complications arising from device implantation remain a limitation to the spread of this method. The article presents a clinical observation of a 55-year-old patient who was admitted to the hospital for a planned intervention — endovascular implantation of the Watchman device (Boston Scientific, USA). The development of atrial fibrillation was induced by acute myocardial infarction in 2016. In 2019, the patient underwent ischemic stroke in the territory of the right middle cerebral artery. The indication for implantation was recurrent gastroduodenal bleeding while taking oral anticoagulants. During the implantation stage, the delivery system was dislocated into the pericardial cavity. In connection with the frolicking complication, a decision was made to drain the pericardium with repositioning and subsequent implantation of the Watchman to close the left atrial appendage defect. Despite the frolic complication, left atrial appendage isolation was achieved. This prevented the development of massive hemopericardium and cardiac tamponade. The patient fully returned to normal life and self-care, the modified Rankin score was 190 days after the surgery. During the 10-month follow-up, the patient did not experience cardiovascular events and major bleeding, which indirectly indicates the effectiveness of left atrial appendage occlusion, despite the developed complication.

Катетерная радиочастотная аблация субстрата фибрилляции предсердий может быть затруднена у пациентов после открытой операции на сердце. Трудности могут возникнуть при наличии протеза митрального клапана, предсердных аритмий нескольких морфологий (преобладает левопредсердное атипичное трепетание), в том числе и инцизионных. Данные случаи требуют тщательного и скрупулёзного подхода для достижения полноценной аблации всех субстратов аритмий. Отличительной особенностью данного наблюдения является успешное одномоментное устранение субстрата фибрилляции предсердий (изоляция легочных вен) и двух предсердных re-entry аритмий у пациента с механическим митральным протезом. Ключевые слова: радиочастотная аблация; фибрилляция предсердий; митральный протез; навигационное картирование; инцизионная аритмия Конфликт интересов: отсутствует. Финансирование: отсутствует.

Background. Endovascular occlusion of the left atrial appendage (LAA) using the Watchman device may be considered an adequate alternative to oral anticoagulant (OAC) administration in high-risk patients.Objective. To describe our experience with Watchman endovascular occlusion of the left atrial appendage in a city hospital setting in terms of feasibility and safety, as well as assess the short-term efficacy of this procedure.Design and methods. The study included patients who underwent implantation of the Watchman occlusion device from January 2016 to November 2020. The effectiveness of the procedure was defined as the ability to implant the Watchman without maintaining residual current, safety was defined as the occurrence of nosocomial and 45-day events including stroke, pericardial effusion, major bleeding, and device migration.Results. The study included 22 patients: 10 men and 12 women, who underwent implantation of the Watchman occluding device in the LAA. The indication for implantation was a history of gastrointestinal bleeding in 15 patients, cerebral hemorrhage in 3 patients and low compliance to therapy in 4 patients. The success rate of the procedure was 95.7 %. According to control transesophageal echocardiography, after 45 days LAA was excluded from the bloodstream in 21 of 22 patients.Conclusion. Despite the higher complication rate of occlusion of the LAA compared to drug treatment, the overall mortality from any cause in patients with the implanted Watchman was lower.