"Fire or Ice" in the Treatment of Patients with Complex Heart Rhythm Disorders

Introduction. When a pathological process emerges in a part of the cardiac conduction system, it results in various cardiac arrhythmias causing cardiac activity disorders affecting the entire body and posing a threat to the patient’s life.

Today, the endovascular treatment of arrhythmias has replaced many open heart surgeries becoming a widely accepted alternative to drug therapy. The key techniques of x-ray-guided endovascular treatment of arrhythmias includes the implantation of various devices, transcatheter radiofrequency ablation of arrhythmogenic zones and cryoablation. An excellent comparison of ablation techniques has been presented in the most extensive international randomized clinical trial FIRE AND ICE.

The implantation of single-and two-chamber pacemakers, electrophysiological research, radio frequency ablation are all performed at the Bashkir State Medical University Clinic.

Material and methods. The electrophysiological research and transcatheter radiofrequency endocardial ablation using the Carto 3 system for complex rhythm disorders have been carried out at the Bashkir State Medical University Clinic since 2013.

Results and discussion. 159 EPIs and RFAs have been performed at the Bashkir State Medical University Clinic.

Conclusions. X-ray guided endovascular surgery is the method of choice in the treatment of various forms of arrhythmias.

1. Revishvili A.Sh., Fetisova E.A., Kalinin V.V., Kalinin A.V., Chaikovs-kaya M.K., Mironovich S.A., et al. Electrophysiological mechanisms underlying termination of atrial fibrillation: insights gained from non-invasive phase mapping. Journal of arrhythmology. 2017;(88):5-12 (In Russ.).

2. Hansen B.J., Zhao J., Csepe T.A., Moore B.T., Li N., Jayne L.A., et al. Atrial fibrillation driven by micro-anatomic intramural re-entry revealed by simultaneous sub-epicardial and sub-endocardial optical mapping in explanted human hearts. Eur Heart J. 2015;36(35):2390-401. DOI: 10.1093/eurheartj/ehv233

3. Kanorskii S.G. Treatment of patients with atrial fibrillation: the search for optimal solutions. Kardiologiia. 2016;56(8):46-53 (in Russ.). DOI: 10.18565/cardio.2016.8.46-53

4. Baimbetov A.K., Rzaev F.G., Nardaya Sh.G., Bizhanov K.A., Ergeshov K.A., Medeubekov U.Sh. New trends in interventional arrhythmology: experience of two centers in cryoablation of atrial fibrillation. Journal of arrhythmology. 2018;(92):5-10 (In Russ.). DOI: 10.25760/VA-2018-92-5-10

5. van den Ham H.A., Klungel O.H., Singer D.E., Leufkens H.G., van Staa T.P. Comparative Performance of ATRIA, CHADS2, and CHA2DS2-VASc Risk Scores Predicting Stroke in patients with atrial fibrillation: results from a national primary care database. J Am Coll Cardiol. 2015;66(17):1851-9. DOI: 10.1016/j.jacc.2015.08.033

6. Novikova N.A., Volovchenko A.N. Direct oral anticoagulants during preparation to electric cardioversion. Journal of arrhythmology. 2017;(88):18-24 (In Russ.).

7. Mamchur S.E., Ardashev A.V. Sudden cardiac death and wolff-parkinson-white syndrome. Journal of arrhythmology. 2014;(76):30-7 (In Russ.).

8. Nyns E.C.A., Kip A., Bart C.I., Plomp J.J., Zeppenfeld K., Schalij M.J., et al. Optogenetic termination of ventricular arrhythmias in the whole heart: towards biological cardiac rhythm management. Eur Heart J. 2017;38(27):2132-36. DOI: 10.1093/eurheartj/ehw574

9. Lim H.S., Zellerhoff S., Derval N., Denis A., Yamashita S., Berte B., et al. Noninvasive mapping to guide atrial fibrillation ablation. Card Electrophysiol Clin. 2015;7(1):89-98. DOI: 10.1016/j.ccp.2014.11.004.

10. Berenfeld O., Yamazaki M., Filgueiras-Rama D., Kalifa J. Surface and intramural reentrant patterns during atrial fibrillation in the sheep. Methods Inf Med. 2014;53(4):314-9. DOI: 10.3414/ME13-02-0047

11. Kuck K.H., Furnkranz A., Chun K.R., Metzner A., Ouyang F., Schluter M., et al. Cryoballoon or radiofrequency ablation for symptomatic paroxysmal atrial fibrillation: reintervention, rehospitalization, and quality-of-life outcomes in the FIRE AND ICE trial. Eur Heart J. 2016;37(38):2858-65. DOI: 10.1093/eurheartj/ehw285

12. Schnabel R.B., Yin X., Gona P., Larson M.G., Beiser A.S., McManus D.D., et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet. 2015;386(9989):154-62. DOI: 10.1016/S0140-6736(14)61774-8

13. Mikhailov E.N., Gasymova N.Z., Bayramova S.A., Kharats V.E., Kacha-lkova O.N., Dmitriev A.Yu., et al. Clinical characteristics of patients and results of catheter ablation in atrial fibrillation in Russia: subanalysis of the European registry 2012-2016. Russian Journal of Cardiology. 2018;(7):7-15 (In Russ.). DOI: 10.15829/1560-4071-2018-7-7-15

14. Tondo C., Iacopino S., Pieragnoli P., Molon G., Verlato R., Curnis A., et al. Pulmonary vein isolation cryoablation for patients with persistent and long-standing persistent atrial fibrillation: Clinical outcomes from the real-world multicenter observational project. Heart Rhythm. 2018;15(3):363-8. DOI: 10.1016/j.hrthm.2017.10.038

15. Sergeev A.V., Bockeria O.L., Melikulov A.Kh., Klimchuk I.Ya., Turdubaev A.K., Bockeria L.A. Electrophysiological characteristics of left the atrial tachycardias after surgical ablation for atrial fibrillation. Bulletin of Bakoulev Scientific Center for Cardiovascular Surgery RAMS. 2017;18(5):472-8 (In Russ.). DOI: 10.24022/1810-0694-2017-18-5-472-478

16. Fasano A., Anfuso L., Arena G., Pandozi C. Thermal field in cryoabla-tion procedures for pulmonary veins isolation: importance of esophageal temperature monitoring. J Atr Fibrillation. 2017;9(6):1533. DOI: 10.4022/jafib.1533

17. Plechev V., Galimov O., Ishmetov V., Kashaev M., Abdrakhmanov R., Zyazetdinov R., et al. The experience of using direct oral anticoagulant Rivaroxaban in acute venous thrombosis treatment. Surgeon. 2016;(2):12-7 (In Russ.).