The myocardium of the right and left atrial appendages (auricles) in patients with paroxysmal, persistent, and permanent forms of atrial fibrillation was examined by histological methods and electron microscopy. Isolated atrial amyloidosis was detected in the left (50.0-56.3% patients) and in the right (45.0-55.6% patients) atrial appendages. In all cases, immunohistochemistry revealed atrial natriuretic peptide in fibrillary amyloid deposits. Ultrastructurally, amyloid masses formed clusters of myofibrils 8-10 nm in diameter. They were chaotically located in the extracellular space along the sarcolemma as well as in membrane invaginations, dilated tubules of cardiomyocyte T-tubular system, and vascular walls. Amyloidosis was predominantly observed in women; its degree positively correlated with age of patients and duration of atrial fibrillation but negatively correlated with atrial fibrosis. The study revealed positive (in permanent atrial fibrillation) and negative (in paroxysmal atrial fibrillation) correlation of amyloidosis with myofibril content in atrial cardiomyocytes.

Aim. Evaluate the overall effectiveness of cardiac contractility modulation (CCM) therapy in patients with chronic heart failure of various etiology.Methods. The study included 61 patients with chronic heart failure (NYHA class II-III), ejection fraction 20-40% and narrow QRS <130 ms, who were implanted the CCM devices. Depending on the etiology of heart failure, ischemic cardiomyopathy prevailed (41 patients). All patients were performed echocardiography, 6-min walk test and Minnesota Living with Heart Failure questionnaire (MHFLQ). Results. The observation period was 25 months. All 54 patients significantly improved left ventricular ejection fraction from 32.2% to 37.6% (р=0.026) and volume parameters (left ventricle end systolic volume from 150 to 137 ml (р=0.034), left ventricle end diastolic volume from 220 to 201 ml (р=0.044), reduced the heart failure NYHA class >1 in 29 (53.7%) patients (р=0.015), increased 6-min walk test from 265 to 343 m (р=0.029), and the MHFLQ improved from 46.1 to 35.8 (р=0.042). Non-ischemic cardiomyopathy was associated with significant improvement in MHFLQ (from 42.7 to 30.3, р=0.029) and lowering the heart failure NYHA class>1 (83.3%, vs 47.2%, p=0.012) compared to ischemic group. Conclusion. CCM is safe and effective in patients with chronic heart failure NYHA class II-III, ejection fraction 20- 40% and narrow QRS˂130 ms, who were implanted the CCM devices. Depending on the etiology of heart failure, ischemic cardiomyopathy prevailed (41 patients). All patients were performed echocardiography, 6-min walk test and Minnesota Living with Heart Failure questionnaire (MHFLQ).Results. The observation period was 25 months. All 54 patients significantly improved left ventricular ejection fraction from 32.2% to 37.6% (р=0.026) and volume parameters (left ventricle end systolic volume from 150 to 137 ml (р=0.034), left ventricle end diastolic volume from 220 to 201 ml (р=0.044), reduced the heart failure NYHA class >1 in 29 (53.7%) patients (р=0.015), increased 6-min walk test from 265 to 343 m (р=0.029), and the MHFLQ improved from 46.1 to 35.8 (р=0.042). Non-ischemic cardiomyopathy was associated with significant improvement in MHFLQ (from 42.7 to 30.3, р=0.029) and lowering the heart failure NYHA class>1 (83.3%, vs 47.2%, p=0.012) compared to ischemic group.Conclusion. CCM is safe and effective in patients with chronic heart failure NYHA class II-III, ejection fraction 20- 40% and narrow QRS˂130 ms. Non-ischemic etiology of cardiomyopathy was associated with significant improvement in MHFLQ and lowering the heart failure class.

Because of the high prevalence of different types of arrhythmias in population, new strategies and treatment methods are being developed by medical communities. The most perspective strategy for treating refractory arrhythmias is stereotactic radioablation. This article presents the review of experimental and clinical researches of radioablation of different heart zones and describes the first experimental study of stereotactic heart radioablation in Russian Federation.

Currently catheter radiofrequency ablation (RFA) has become the standard treatment for patients with atrial fibrillation (AF). During RFA, additional linear lesions are performed along the posterior wall of the left atrium, which can cause damage to the esophagus. The manuscript considers the methods introduced into practice to prevent damage to the esophagus during RFA, the pros and cons of the techniques.

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