A bi-AT can develop when an AnL is created for PMF termination. Biatrial entrainment mapping facilitates diagnosis. Termination of the bi-AT is feasible when ablated from either RA or LA.

Aim. To evaluate the effect of atrial fibrillation (AF) catheter ablation (CA) on long-term freedom from AF and left heart reverse remodeling in patients with heart failure with reduced ejection fraction (HFrEF).Methods. There were 47 patients (mean age 53.3 ± 10 years, 39 males) enrolled into single-center observational study, with left ventricular ejection fraction (LVEF) <40 %. Patients underwent CA for AF refractory to antiarrhythmic drugs. Baseline clinical data and diagnostic tests results were obtained during personal visits and / or via secure telemedical services. Personal contact with evaluation of recurrence of AF and echocardiographic values was performed with 30 (64 %) patients.Results. Paroxysmal AF was present in 12 (40 %) patients, persistent – in 18 (60 %). During mean follow-up of 3 years (0.5–6 years) redo ablation was performed in 9 patients (30 %) with average number of 1.3 procedures per patient. At 6 months 24 (80 %) patients were free from AF, at last follow-up – 16 (53 %). The mean time to first recurrence following CA was 15.6±13.3 months. Follow-up echocardiography revealed significant LVEF improvement (р<0,0001), reduction of left atrium size (р<0,0001), left ventricle end-diastolic volume (р<0,002) and left ventricle endsystolic volume (p<0,0001) and mitral regurgitation (р=0,001).Conclusion. AF CA in patients with HFrEF is associated with improvement in systolic function and left heart reverse remodeling. Durable long-term antiarrhythmic effect often requires repeated procedures.

Значимая положительная динамика клинического течения и обратного ремоделирования миокарда у молодых пациентов с хронической сердечной недостаточностью на фоне модуляции сердечной сократимостиВандер М. А., Лясникова Е. А., Ким И. М., Лелявина Т. А., Ситникова М. Ю., Лебедев Д. С., Михайлов Е. Н.Представлены три клинических случая 2-летнего наблюдения за молодыми пациентами с хронической сердечной недостаточностью с низкой фракцией выброса левого желудочка некоронарогенного генеза после имплантации системы модуляции сердечной сократимости. Показана выраженная положительная динамика клинического течения и обратного ремоделирования миокарда по данным двухмерной эхокардиографии и 2D speckle tracking эхокардиографии (STE). Методика 2D STE позволила наглядно продемонстрировать улучшение локальной сократимости межжелудочковой перегородки в зоне имплантированных электродов и отдаленный эффект улучшения глобальной сократимости в течение 1 года наблюдения на фоне модуляции сердечной сократимости.Российский кардиологический журнал. 2019;24(7):99-102 http://dx.Ключевые слова: модуляция сердечной сократимости, хроническая сердечная недостаточность, 2D-speckle tracking эхокардиография.Конфликт интересов: не заявлен.ФГБУ Национальный медицинский исследовательский центр им. В. А. Алмазова Минздрава России, Санкт-Петербург, Россия.

Introduction. Radiofrequency ablation (RFA) is an established treatment of post-myocardial infarction ventricular tachycardia (VT). Endocardial VT ablation can be insufficient for VT termination when the scar is intramural/epicardial.Purpose: to assess the extent of epicardial electrophysiological VT substrate in patients with remote myocardial infarction.Materials and methods. Thirteen patients with sustained postinfarction VT, who signed an informed consent, were included into the study. All patients underwent full clinical evaluation. Electroanatomical voltage bi- and unipolar mapping of endocardial and epicardial surfaces was performed. Maps were evaluated for the presence of low-voltage areas and local abnormal ventricular activity (LAVA). RFA was performed at LAVA sites. The end-point of the procedure was scar LAVA abolition and VT noninducibility (procedure success). VT recurrence was detected using an implantable cardioverter-defibrillator and/or ECG monitoring.Results. Epicardial access was successful in 12 patients. Epicardial access was performed at a first procedure in 7 patients, 4 patients had a history of previous endocardial ablation. Epicardial LAVA sites were detected in 9 patients. Endocardial and epicardial arrhythmogenic substrate localization coincided in 8 patients. One patient had only epicardial scar, 1 patient had only septal endocardial scar. In one patient LAVA sites had different localizations on epicardial and endocardial maps. Acute ablation success was noted in 12 patients.Conclusion. In our patient group transmural scar and epicardial electrophysiological arrhythmogenic substrate was detected in 82% of cases. Isolated endocardial ablation may be unsuccessful, in such cases epicardial mapping and ablation might be useful.

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