<p>Heart failure and left bundle branch block is a common disease in the modern world. Cardiac resynchronization therapy is used to correct this condition, but some patients have no positive clinical effect from its use. One of the reasons for the lack of response to therapy is not the optimal position of the left ventricular electrode. In this clinical case we presented the experience of using myocardial perfusion scintigraphy to determine the optimal position of the left ventricular electrode.<br />A 60-year-old patient, who was admitted to the center with symptoms of heart failure and signs of complete left bundle branch block, underwent an implantation of the cardiac resynchronization system. Both intraoperative data and the data of preliminary myocardial scintigraphy were used to select the site of implantation of the left ventricular electrode. A significant improvement in the patient’s condition, evaluated after 6 months after the implantation of the device, allowed us to conclude that the use of myocardial perfusion scintigraphy with standard methods of ultrasound diagnosis can increase the efficiency of implantation of cardiac resynchronization devices and a response to the therapy.</p><p>Received 2 October 2019. Revised 20 December 2019. Accepted 23 December 2019.</p><p><strong>Funding:</strong> The work is supported by a grant of the President of the Russian Federation for young scientists No. МД-2893.2018.7.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p>

<p>The prevalence of congenital heart diseases is nine persons per 1000. Sometimes, congenital heart disease needs surgical correction. The long-term postoperative period is often associated with complex heart rhythm disturbances like ectopic or re-entry tachycardia. These cases, in combination with difficult anatomy, results in challenges during interventional treatment. Catheter ablation has been demonstrated as safe and effective in different types of arrhythmia treatments in such patients, including paediatric cohorts. Despite these facts, several important problems regarding using current technologies are still unresolved. Remote magnetic navigation showed good results regarding localisation of arrhythmogenic zones during treatment of complex heart rhythm disturbances. The objective of the present article is to review recently published data in this area and experience of Meshalkin National Medical Research Center in heart rhythm disturbances treatment using remote magnetic navigation in patients after surgical correction of congenital heart disease.</p><p>Received 28 September 2020. Revised 25 December 2020 г. Accepted 30 December 2020.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and study design: A.B. Romanov, A.M. Chernyavskiy<br />Drafting the article: V.V. Beloborodov, А.V. Ponomarenko, E.А. Morzhanaev<br />Critical revision of the article: A.B. Romanov, А.V. Ponomarenko, I.L. Mikheenko, E.А. Morzhanaev, A.G. Filippenko, <br />A.M. Chernyavskiy<br />Final approval of the version to be published: V.V. Beloborodov, N.А. Yelemessov, А.V. Ponomarenko, E.А. Morzhanaev, <br />A.G. Filippenko, I.L. Mikheenko, A.M. Chernyavskiy, A.B. Romanov</p>

<p>Despite the development of modern diagnostic technology and intraoperative navigation, catheter ablation of ventricular tachycardia in patients with coronary heart disease remains difficult. This procedure is challenging because of the electrical heterogeneity of the damaged myocardium, which leads to the emergence of reentry cycles. The clinical case that is presented is part of a study aimed at finding a personalized approach to VT ablation.<br />A 53 year old man with coronary heart disease, post-infarction cardiosclerosis, stenting of the right coronary artery and paroxysmal ventricular tachycardia was admitted to the cardiac surgery department with arrhythmias. Recently, this patient had experienced paroxysms of arrhythmias more frequently, up to several times a month, despite receiving antiarrhythmic therapy. Upon admission, the patient complained of a rapid heartbeat, weakness and discomfort in the chest area. The patient’s current drug therapy included betalok, cardiomagnyl and rosuvastatin. Due to his condition, the patient was asked to participate in a study with the aim of developing a personalized approach to the ablation of ventricular cardiac arrhythmias.<br />After the patient agreed to be included in the study, he underwent a series of tests including single-photon emission computed tomography of the myocardium with perfusion and non-neutropic radiopharmaceuticals and magnetic resonance imaging of the heart with contrast. Based on these tests a targeted ablation was performed which relieved the tachycardia, the impossibility of subsequent induction and the homogenization of the substrate until the disappearance of pathological symptoms.<br />The presented clinical case demonstrates the possibility of using non-invasive imaging methods to develop a personalized approach to VT ablation in patients with coronary artery disease. However, the diagnostic accuracy, prognostic ability and feasibility of using these methods require further study.</p><p>Received 8 April 2020. Revised 22 April 2020. Accepted 24 April 2020.</p><p><strong>Funding:</strong> The work is supported by a financial grant of the Russian Science Foundation (project No. 17-75-20118).</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Drafting the article: A.B. Romanov, S.M. Minin, N.A. Nikitin <br />Literature review: A.G. Filippenko, E.A. Morzhanaev, I.S. Peregudov <br />Illustrations: A.B. Romanov, S.V. Shayakhmetova, S.M. Minin, N.A. Nikitin, V.V. Shabanov <br />Critical revision of the article: A.B. Romanov, С.В. Шаяхметова, S.M. Minin, N.A. Nikitin, I.L. Mikheenko, V.V. Shabanov, D.V. Losik <br />Surgical treatment: A.B. Romanov <br />Final approval of the version to be published: A.B. Romanov, S.M. Minin, S.V. Shayakhmetova, N.A. Nikitin, A.G. Filippenko, I.L. Mikheenko, E.A. Morzhanaev, I.S. Peregudov, D.V. Losik, V.V. Shabanov</p>

Introduction. The case report describes radiofrequency ablation of ventricular tachycardia (VT) using robotic magnetic navigation (RMN) in a teenager after surgery of congenital heart disease (CHD) and transcatheter closure of ventricular septal defect (VSD) using an occluder.Short description. The 16-year-old female patient was operated on in 2005 for CHD. In 2018, the patient underwent resection of ascending aortic sub-valvular membrane, followed by transcatheter closure of VSD with an occluder. After surgery, VT of 294 bpm was documented, which required an emergency hospitalization. Decision was taken to perform a radiofrequency ablation (RFA) using RMN. RFA was performed from the pulmonary artery valve through the scar to upper occluder edge spreading to tricuspid valve. After procedure, VT paroxysms were not induced with all pacing types. According to ECG series and 24-hour Holter monitoring on the 2nd day after surgery, VT episodes were not recorded. During the 6-month follow-up period, VT episodes were not registered without taking antiarrhythmic drugs.Discussion. This case report demonstrates the effectiveness of using RMN system for VT ablation in a teenager with CHD, who underwent open surgical interventions and transcatheter VSD closure using an occluder.