Since the introduction of catheter ablation of atrial fibrillation (AF), it developed from a specialized experimental procedure into a common treatment option to prevent recurrent AF. In recent years substantial improvement has been made in the equipment and techniques used in catheter ablation of AF. The volume of procedures expanded year after year. Naturally, this has been reflected on indications for catheter ablation. The aim. To study the changes in indications for catheter ablations of AF which has occurred during the last decade, according to European and American literature. Materials and methods. We reviewed four documents related to the management of AF: 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation ofatrial fibrillation; 2017 HRS/EHRA/ECAS/APHRS/SOLEACE expert consensus statement on catheter and surgical ablation of atrial fibrillation; 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS; 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Results. During the analyzed period there have been a lot of changes inindications for catheter ablation of AF. Recent years guidelines pointed out that a decision on AF catheter ablation should be based on the patient’s preferences. It is recommended to take into consideration the procedural risks andmajor risk factors of arrhythmia recurrence. All this should be discussed with patient. Today antiarrhythmic drugs still remain a first-line rhythm control therapy. Catheter ablation is recommended after drug therapy failure in patients with all clinical forms of AF. In AF patients with heart failure, when tachycardia-induced cardiomyopathy is highly probable, catheter ablation is recommended as a first-line therapy. Conclusion. Catheter ablation is effective in maintaining sinus rhythm in patients with paroxysmal and persistent AF. Its role as a method of rhythm control has increased during thelast decade.

Дефект межпредсердной перегородки (ДМП) является одним из наиболее распространенных врожденных пороков сердца (ВПС). Для этого порока характерно развитие предсердных тахиаритмий, таких как предсердные макрориэнтри и фибрилляция предсердий (ФП). Целью данного исследования является анализ нашего первого опыта катетерного лечения ФП у пациентов после пластики ДМП. Материалы и методы. В работе представлены данные катетерных процедур по устранению ФП у трех пациентов в возрасте 40, 42 и 50 лет, которым ранее была произведена пластика ДМП. Время, прошедшее с момента хирургической коррекции порока, – 23, 16 и 40 лет соответственно; длительность существования аритмии – 3, 5 и 5 лет. Для сравнения представлены результаты 26 первичных катетерных процедур по лечению ФП у пациентов без сопутствующей структурной патологии сердца. Особенностью методики устранения аритмии в первой группе являлось применение чреспищеводной и внутрисердечной эхокардиографии (ЭхоКГ) при проведении транссептальной пункции. Результаты. В сроки от 14 до 16 месяцев у всех пациентов сохраняется синусовый ритм. У одного из пациентов через 6 месяцев после процедуры возник пароксизм ФП. В дальнейшем на фоне проводимой антиаритмической терапии рецидивов аритмии не было. В группе пациентов без сопутствующей структурной патологии в сроки от 14 до 18 месяцев рецидивы аритмии отсутствовали у 20 (76,9 %) из 26 пациентов. У 2 из 6 пациентов с рецидивами ФП после назначения антиаритмической терапии синусовый ритм сохраняется в течение более 6 месяцев.

The paper analyzes the experience of catheter treatment of various types of supraventricular arrhythmias in patients with Ebstein’s abnormality (EA) – 19 consecutive cases of the elimination of additional atrioventricular connections (AAVC) and 5 cases of atrial macro-reentry. The elimination of AAVC, just like atrial macroreentry, was preceded by a stage of electrophysiological diagnosis. In a series of observations in 19 patients with EA, 25 AAVC were detected. The article reflects the main electrophysiological differences between “wide” AAVC from multiple ones. In the first procedure, the conduction in all AAVC was eliminated in 16 (84.2%) of 19 patients. 6 of 25 AAVC were qualified by us as “wide”; to eliminate them, a larger number of applications was required – 6 ± 2 (in typical cases – 3 ± 1). In 2 of 3 patients with an unsatisfactory result of the first procedure, AAVC were eliminated during the second procedure. In the long-term period(5.6 ± 3.6 years), recurrences of propagation through AAVC occurred in 2 (10.5%) of 19 patients. All AAVC were permanently eliminated during second procedure. In the group of patients with atrial tachycardia, 3 had a graph characteristic of a typical isthmus-dependent atrial flutter. In one patient with atypical graphics, macro-reentry with excitation circulation around the scar on the anterolateral wall of the right atrium was found. In 3 of 4 patients with isthmus-dependent atrial flutter after radiofrequency exposure, the sinus rhythm was restored and a block of passage through the cavotricuspid isthmus was created. In one case there were changes in the cycle of tachycardia and the morphology of wave P, applying applications between the scar and the tricuspid valve ring led to the creation of a block of passage through this area and to the cessation of arrhythmia. In a patient who initially had reentry with a circulation of excitement around the postoperative scar, arrhythmia was eliminated in a similar way (an additional block was created through the cavotricuspid isthmus). In the observation period of 5.2 ± 2.5 years, there were no recurrences of arrhythmia.

Thanks to the successes of modern cardiac surgery, more and more patients with congenital heart disease (CHD) reach adulthood, with approximately one in four having various heart rhythm disturbances. Their causes are both the CHD themselves and the consequences of surgical or interventional intervention. Arrhythmias in this category of patients worsen the quality of life, lead to serious complications, and can cause sudden cardiac death. The paper summarizes and analyzes current trends and recommendations of the world’s leading specialized communities for the management of patients with congenital heart disease with cardiac arrhythmias. The article reflects approaches to the management and monitoring of this category of patients, including asymptomatic ones. The necessity of early detection of arrhythmia and the involvement of a team of specialists in specialized centers for the development of tactics and treatment after surgical correction is justified. Also discussed are the issues of indications for electrophysiological research and its feasibility, the possibility and effectiveness of catheter destruction, the need for continuous drug therapy, indications for implantation of artificial pacemakers and cardioverter-defibrillators. The paper also reflects the question of various mechanisms of the development of arrhythmia in patients after surgical correction of congenital heart defects, as well as highlighted the possible ways of preventing arrhythmogenesis in patients after surgical correction.