Russian Journal of Cardiology 2020, 25 (7)
СтатьиCONTENTS
CLINICAL MEDICINE NEWS
Clinical medicine updates: a review of international news
Russian Journal of Cardiology. 2020;25( 7):8
Address to the readers
Russian Journal of Cardiology. 2020;25(7):9
ORIGINAL ARTICLES
CENTRAL DIRECTIONS FOR REDUCING CARDIOVASCULAR MORTALITY: WHAT CAN BE CHANGED TODAY?
Shlyakhto E. V.1,2, Baranova E. I.1,2
Abstract
The article provides modern data on the prevalence of cardiovascular diseases and mortality in Europe and Russia. Groups of high-risk patients requiring special attention when conducting measures to reduce cardiovascular mortality are discussed: patients with hypertension, including resistant, patients with severe dyslipidemia, heart failure, and atrial fibrillation. Particular attention is paid to the problem of effective and safe treatment and reducing cardiovascular mortality in patients with atrial fibrillation and a high risk of stroke. The treatment of these patients may be most successful due to the availability of effective medications that reduce cardiovascular mortality. The article outlines the major paradigms of modern healthcare: focus on results and patient, integration of inpatient and outpatient health care units and accelerating the innovation in the diagnosis and treatment of patients with cardiovascular diseases.
Key words: cardiovascular mortality, resistant hypertension, dyslipidemia, atrial fibrillation, anticoagulants.
Relationships and Activities: none.
1First Pavlov State Medical University of St. Petersburg, St. Petersburg; 2Almazov National Medical Research Center, St. Petersburg, Russia.
Shlyakhto E. V. ORCID: 0000-0003-2929-0980, Baranova E. I.* ORCID: 0000-0002-8788-0076.
*Corresponding author: baranova.grant2015@yandex.ru
Received: 25.06.2020
Revision Received: 30.06.2020
Accepted: 07.07.2020
For citation: Shlyakhto E. V., Baranova E. I. Central directions for reducing cardiovascular mortality: what can be changed today? Russian Journal of Cardiology . 2020;25(7):3983. (In Russ.) doi:10.15829/1560-4071-2020-3983
ORIGINAL ARTICLES
CLINICAL EFFICACY OF ATRIAL FIBRILLATION ABLATION DEPENDING ON HISTOLOGICAL CHANGES IN THE MYOCARDIUM
Shelemekhov A. E., Batalov R. E., Usenkov S. Yu., Archakov E. A., Gusakova A. M., Rogovskaya Yu. V., Rebenkova M. S.
Abstract
There is a group of patients with so-called idiopathic atrial fibrillation (AF) without the causes of arrhythmia established by a standard examination.
Aim. To study the effect of histological changes in the myocardium in patients with idiopathic AF on the effectiveness of ablation.
Material and methods. The study included 101 patients with idiopathic AF. All patients underwent ablation, during which a myocardial biopsy was performed. Depending on the results of intervention, 3 groups were formed: 1 — no AF within 12 months, 2 — recurrent arrhythmia within first 3 months of follow-up, 3 — recurrent arrhythmia after first 3 months of follow-up. To assess inflammatory changes and the severity of fibrosis, histological and immunohistochemical tests of myocardial biopsies were performed.
Results. Histological criteria for lymphocytic myocarditis in group 1 observed in 47,5% of patients, in groups 2 and 3 in 27,3% and 25%, respectively. Infiltration of less than 7 cells per 1 mm 2 by CD3+ lymphocytes prevailed in group 3. The activity of inflammation in the studied groups did not significantly differ. The minimum severity of fibrosis was significantly less frequently recorded in group 1 than in group 2 and 3. Nonexpression of viral antigens in the first group was significantly less common than in the second and third groups. Moreover, the combination of expression of enterovirus VP1 and human herpesvirus 6 antigens was significantly more often recorded in the first group. Positive correlation was found between the expression of viral antigens and markers of endo- and myocardial fibrosis.
Conclusion. The primary risk factor for recurrent arrhythmia was the initial stage of fibrosis, while inflammatory changes and viral infection were not risk factors. The presence of viral antigens in the myocardium had an indirect effect on the clinical outcome.
Key words: radiofrequency ablation, atrial fibrillation, myocarditis, endomyocardial biopsy, effectiveness.
Relationships and Activities: none.
Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk, Russia.
Shelemekhov A. E.* ORCID: 0000-0001-5671-7201, Batalov R. E. ORCID: 0000-0003-1415-3932, Usenkov S. Yu. ORCID: 0000-0001-9553-9647, Archakov E. A. ORCID: 0000-0002-2530-361X, Gusakova A. M. ORCID: 0000-0002-3147-3025, Rogovskaya Yu. V. ORCID: 0000-0001-5553-7831, Rebenkova M. S. ORCID: 0000-0002-3496-0224.
*Corresponding author: SmartSokol@mail.ru
Received: 08.07.2019
Revision Received: 24.08.2019
Accepted: 06.09.2019
For citation: Shelemekhov A. E., Batalov R. E., Usenkov S. Yu., Archakov E. A., Gusakova A. M., Rogovskaya Yu. V., Rebenkova M. S. Clinical efficacy of atrial fibrillation ablation depending on histological changes in the myocardium. Russian Journal of Cardiology. 2020;25(7):3418. (In Russ.) doi:10.15829/1560-4071-2020-3418
CATHETER ABLATION OF ATRIAL ARRHYTHMIAS IN PATIENTS AFTER THORACOSCOPIC ABLATION OF PERSISTENT ATRIAL FIBRILLATION
Artyukhina E. A., Taymasova I. A., Revishvili A. Sh.
Abstract
Aim. To determine the mechanisms of development and approaches to interventional treatment of postoperative atrial tachycardia in patients after thoracoscopic ablation (TA) of atrial fibrillation (AF).
Material and methods. The results of thoracoscopic ablation of AF in 46 patients were analyzed, of which 19,5% (n=9) had atrial tachycardia after the procedure. Radiofrequency ablation (RFA) was conducted in these patients after a 3-month blanking period. Regardless of tachycardia type, the threedimensional reconstruction including high-density right and left atrial (LA) voltage mapping was performed in order to visualize the lesions, pulmonary veins and LA posterior wall isolations. After RFA and sinus rhythm restoration, re-mapping was performed to assess conduction block and absence of electrical activity in the lesion zones.
Results. Complete pulmonary vein (PV) isolation was verified in 55,5% of patients (n=5). In 44,4% (n=4), there were residual PV fractionated potentials without conduction with LA. In 22,2% of subjects (n=2), we identified typical atrial flutter (AFL), which was terminated by RFA in cavotricuspid isthmus (CTI). There were 77,7% (n=7) of patients who were diagnosed with atypical LA flutter; 66,6% (n=6) of them had conduction reconnection at the thoracoscopic box-lesion line. Perimitral AFL with slow conduction zone which was located on the anterior wall of LA was verified in 11,1% of patients (n=1). The effective RFA was performed in these areas. Two main factors affecting failed ablation were LA volume and body mass index (BMI). In patients with arrhythmias after TA, LA volume was 180,2±35,6 ml vs 158,34±38,5 ml in patients with sinus rhythm. BMI was 30,8±3,1 kg/m 2 and 28,9±3,9 kg/m2, respectively. The mean follow-up was 9,8±2,7 months. All patients after catheter ablation maintained a stable sinus rhythm.
Conclusion. Atrial tachycardia after TA is caused by the gaps in box-lesion lines. The main predictors of gaps are high values of LA volume and BMI. The high-density mapping increases the effectiveness of RFA. Combination of epicardial and endocardial accesses is the most effective approach to treatment of patients with persistent AF.
Key words: atrial fibrillation, thoracoscopic ablation, atrial tachycardia, highdensity mapping, radiofrequency ablation.
Relationships and Activities: none.
Vishnevsky National Medical Research Center of Surgery, Moscow, Russia.
Artyukhina E. A. ORCID: 0000-0001-7065-0250, Taymasova I. A.* ORCID: 0000-0002-9280-9063, Revishvili A. Sh. ORCID: 0000-0003-1791-9163.
*Corresponding author: irina-tame@yandex.ru
Received: 08.12.2019
Revision Received: 26.12.2019
Accepted: 20.01.2020
For citation: Artyukhina E. A., Taymasova I. A., Revishvili A. Sh. Catheter ablation of atrial arrhythmias in patients after thoracoscopic ablation of persistent atrial fibrillation. Russian Journal of Cardiology. 2020;25(7):3655. (In Russ.) doi:10.15829/1560-4071-2020-3655
RESULTS OF CATHETER ABLATION IN PATIENTS WITH IDIOPATHIC PREMATURE VENTRICULAR CONTRACTIONS DEPENDING ON THE USE OF FLUOROSCOPY
Vyrva A. A.1, Shtegman O. A.2, Ivanitskiy E. A. 1, Vyrva P. V.2, Kropotkin E. B.1, Sakovich V. A. 1
Abstract
Premature ventricular contractions (PVC) is a very common type of arrhythmia. Some patients require surgical treatment. The search for the safest methods of surgical treatment is an important research task.
Aim. To evaluate the efficacy and safety of catheter ablation in patients with idiopathic ventricular arrhythmias depending on the implementation of X-ray control.
Material and methods. The study included 183 patients admitted to the Federal Center for Cardiovascular Surgery for elective surgery, with frequent idiopathic PVC and indications for surgical treatment of arrhythmia. In the majority of patients with idiopathic PVC, the central origin of ectopia is the right ventricular outflow tract (RVOT). The patients were divided into two groups: group 1 (n=90) — patients with idiopathic PVC after fluoroscopy-guided radiofrequency ablation (RFA); group 2 (n=93) — patients after RFA without fluoroscopy. All patients underwent electrocardiography, echocardiography, and electrophysiological testing. All patients before and after RFA underwent 24-hour Holter monitoring.
Results. Among patients of group 1, the initial success of RFA was 62,2%, and in group 2 — 71% (p=0,21). Surgery complications were registered in 3,3% and 4,3% of patients of groups 1 and 2. No deaths have been reported. The duration of surgery did not depend on the use of fluoroscopy. Among patients with failed initial RFA, the effectiveness of subsequent interventions was 88,6%. The greatest efficiency of initial RFA was observed when the ectopic ventricular focus was located in RVOT. The lowest efficiency of RFA was observed when the focus was located in the left ventricular papillary muscles.
Conclusion. RFA in patients with idiopathic PVC without fluoroscopy does not increase the complication rate and the duration of surgery and have a comparable efficacy compared to fluoroscopy-guided RFA.
Key words: ventricular arrhythmias, electrophysiological testing, radiofrequency catheter ablation, fluoroscopy, non-fluoroscopic catheter ablation.
Relationships and Activities: none.
1Federal Center for Cardiovascular Surgery, Krasnoyarsk; 2V.F. Voyno-Yasenetsky Krasnoyarsk State Medical University named after Professor, Krasnoyarsk, Russia.
Vyrva A. A.* ORCID: 0000-0002-6937-9544, Shtegman O. A. ORCID: 0000-0001-5913-7333, Ivanitskiy E. A. ORCID: 0000-0002-4946-8005, Vyrva P. V. ORCID: 0000-0001-5733-3277, Kropotkin E. B. ORCID: 0000-0001-9094-378X, Sakovich V. A. ORCID: 0000-0001-8470-0845.
*Corresponding author: Direktor131@yandex.ru
Received: 28.01.2020
Revision Received: 04.04.2020
Accepted: 15.04.2020
For citation: Vyrva A. A., Shtegman O. A., Ivanitskiy E. A., Vyrva P. V., Kropotkin E. B., Sakovich V. A. Results of catheter ablation in patients with idiopathic premature ventricular contractions depending on the use of fluoroscopy. Russian Journal of Cardiology. 2020;25(7):3719. (In Russ.) doi:10.15829/1560-4071-2020-3719
PREDICTORS OF SPONTANEOUS ECHO CONTRAST AND LEFT ATRIAL APPENDAGE THROMBOSIS IN NONVALVULAR ATRIAL FIBRILLATION
Khorkova N. Yu., Gizatulina T. P., Belokurova A. V., Gorbatenko E. A.
Abstract
Aim. To identify predictors of spontaneous echo contrast (SEC) and/or left atrial appendage (LAA) thrombosis in patients with nonvalvular atrial fibrillation (AF) who are referred for elective cardioversion or catheter ablation (CA).
Material and methods. A retrospective analysis of data from 638 patients with nonvalvular AF who were hospitalized from 2014 to 2017 for cardioversion or CA was performed. All patients underwent diagnostic tests, including transthoracic and transesophageal echocardiography (TEE).
Results. According to the TEE results, two groups of patients were formed: group 1 — 95 patients (14,9%) with signs of SEC and/or thrombosis in LAA; group 2 — 543 patients (85,1%) without SEC or thrombosis in LAA. Patients with the phenomenon of SEC and/or LAA thrombosis were older, had a higher risk on the CHA 2DS2-VASc score. These patients were more likely to have coronary heart disease (CAD), hypertension, stage IIA chronic heart failure, obese class ≥II, persistent or permanent AF. Patients in both groups did not differ in anticoagulant therapy. Patients in group 1 had a larger size of the left and right atria, right ventricle, left ventricular (LV) endsystolic and end-diastolic diameters, higher LV mass index, lower values of LV ejection fraction and blood flow velocity in LAA. Logistic regression revealed following independent predictors of SEC and/or LAA thrombosis: CAD (odds ratio (OR) 2,289; 95% confidence interval (CI) 1,313-3,990; p=0,003), persistent or permanent AF (OR 2,071; 95% CI 1,222-3,510; p=0,007), LA diameter >43 mm (OR 3,569; 95% CI 2,0822-6,117; p<0,001), concentric or eccentric LV hypertrophy (OR 2,230; 95% CI 1,302-3,819; p=0,003).
Conclusion. As the result, all patients referring for CA or cardioversion, regardless of the CHA2DS2-VASc score, should underwent LAA. According to this study, the presence of CAD, persistent or permanent AF, LA diameter >43 mm, concentric or eccentric LV hypertrophy are independent predictors of SEC and/or LAA thrombosis.
Key words: atrial fibrillation, transesophageal echocardiography, thrombosis, spontaneous echo contrast.
Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Tomsk, Russia.
Khorkova N. Yu.* ORCID: 0000-0002-7083-3214, ResearcherID: J-3195-2017, Gizatulina T. P. ORCID: 0000-0003-4472-8821, ResearcherID: H-1774-2019, Belokurova A. V. ORCID: 0000-0002-6049-8985, ResearcherID: J-3276-2017, Gorbatenko E. A. ORCID: 0000-0003-3675-1503, ResearcherID: M-8298-2019.
Relationships and Activities: none.
*Corresponding author: nhorkova@bk.ru
Received: 24.02.2020
Revision Received: 30.03.2020
Accepted: 01.04.2020
For citation: Khorkova N. Yu., Gizatulina T. P., Belokurova A. V., Gorbatenko E. A. Predictors of spontaneous echo contrast and left atrial appendage thrombosis in nonvalvular atrial fibrillation. Russian Journal of Cardiology . 2020;25(7):3765. (In Russ.) doi:10.15829/1560-4071-2020-3765
RADIONUCLIDE IMAGING FOR FEASIBILITY OF TARGET LEFT VENTRICULAR LEAD PLACEMENT IN PATIENTS WITH HEART FAILURE SCHEDULED FOR CARDIAC RESYNCHRONIZATION THERAPY
Romanov A. B., Minin S. N., Nikitin N. A., Losik D. V., Stenin I. G., Yelesin D. A., Zhizhov R. E., Filippenko A. G., Mikheenko I. L., Artemenko S. N., Fisher E. V., Baranova V. V., Shirokova N. V., Shabanov V. V.
Abstract
Aim. To assess the feasibility and effectiveness of target left ventricular (LV) lead placement using the radionuclide imaging and changes of myocardial perfusion (MP) and cardiac sympathetic neural activity (SNA) in patients with heart failure (HF) before and after cardiac resynchronization therapy (CRT).
Material and methods. This prospective, observational study included 15 patients (9 men, 61 [58; 72] years old) with HF who were referred for CRT. Patients underwent radionuclide imaging with assessment of MP and cardiac SNA with 123I-MIBG. All patients underwent implantation of CRT devices with target LV lead placement. Target LV lead placement was performed in accordance with preoperative data on 99mTc-MIBI myocardial perfusion scintigraphy and intraoperative data on coronary sinus (CS) anatomy. After successful implantation, patients were assigned to the group 1 (target LV lead placement). In case of targeted placement inability, the LV lead was implanted into the available CS branches — group 2. The patients were followed up within period of 3-6 months after surgery.
Results. Target LV lead placement was performed in 9 (60%) of 15 patients (group 1). In 6 (40%) of 15 patients, targeted implantation was not possible and LV lead was implanted anatomically (group 2). The follow-up period was 4 [3.5; 4.5] months. Patients from group 1 demonstrated a significant improvement of myocardial perfusion compared with preoperative data: summed stress score improved from 16,2±12,2 to 10,8±12,8 (p=0,007), summed rest score — from 15,2±12,5 to 9,8±12,9 (p=0,008), respectively. A significant change in the 123I-MIBG scintigraphy of cardiac SNA was also observed: an improvement in the delayed heart/mediastinum ratio from 1,4±0,2 to 1,63±0,1 (p=0,02) and an improvement in the washout rate from 13,2±5,6% to 7,8±4,7% (p=0,026), respectively. These parameters did not show any significant difference between the groups and within the anatomical positioning group.
Conclusion. In patients with HF scheduled for CRT, the target LV lead placement using radionuclide imaging results in an improvement of myocardial perfusion and cardiac SNA compared with baseline data and does not have differences compared to anatomical positioning. Further studies are needed to assess the role of radionuclide imaging in CRT.
Key words: cardiac resynchronization therapy, myocardial perfusion, sympathetic neural activity, scintigraphy.
Relationships and Activities. This study was supported by a grant from the Russian Science Foundation (project № 17-75-20118).
Meshalkin National Medical Research Center, Novosibirsk, Russia.
Romanov A. B.* ORCID: 0000-0002-6958-6690, ResearcherID: L-7898-2014, Minin S. N. ORCID: 0000-0001-6626-6408, ResearcherID: M-6858-2017, Nikitin N. A. ORCID: 0000-0001-5643-9109, ResearcherID: L-7087-2017, Losik D. V. ORCID: 0000-0003-4886-9648, ResearcherID: R-5648-2016, Stenin I. G. ORCID: 0000-0002-9664-3558, ResearcherID: AAL-4112-2020, Yelesin D. A. ORCID: 0000-0002-5343-5070, ResearcherID: K-4763-2017, Zhizhov R. E. ORCID: 0000-0002-7204-4294, ResearcherID: Q-1062-2017, Filippenko A. G. ORCID: 0000-0001-8068-7276, ResearcherID: AAH-5212-2019, Mikheenko I. L. ORCID: 0000-0002-3552-7158, ResearcherID: U-1209-2019, Artemenko S. N. ORCID: 0000-0002-8586-8938, ResearcherID: M-6504-2016, Fisher E. V. ORCID: 0000-0003-1518-0668, ResearcherID: AAL-3644-2020, Baranova V. V. ORCID: 0000-0003-1097-811X, ResearcherID: AAL-4113-2020, Shirokova N. V. ORCID: 0000-0002-8438-4085, ResearcherID: AAL-4122-2020, Shabanov V. V. ORCID: 0000-0001-9066-3227, ResearcherID: AAL-4220-2020.
*Corresponding author: abromanov@mail.ru
Received: 07.04.2020
Revision Received: 14.04.2020
Accepted: 16.04.2020
For citation: Romanov A. B., Minin S. N., Nikitin N. A., Losik D. V., Stenin I. G., Yelesin D. A., Zhizhov R. E., Filippenko A. G., Mikheenko I. L., Artemenko S. N., Fisher E. V., Baranova V. V., Shirokova N. V., Shabanov V. V. Radionuclide imaging for feasibility of target left ventricular lead placement in patients with heart failure scheduled for cardiac resynchronization therapy. Russian Journal of Cardiology. 2020;25(7):3834. (In Russ.) doi:10.15829/1560-4071-2020-3834
TWO-YEAR FOLLOW-UP OF PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION RECEIVING CARDIAC CONTRACTILITY MODULATION
Vander M. A.1, Lyasnikova E. A.1, Belyakova L. A. 2, Trukshina M. A.1, Galenko V. L.1, Kim I. M. 1, Lelyavina T. A.1, Sitnikova M. Yu.1, Abramov M. L. 1, Lebedev D. S.1, Mikhaylov E. N.1
Abstract
Aim. To assess the 2-year prognosis of patients with heart failure with reduced ejection fraction (HFrEF) receiving cardiac contractility modulation (CCM).
Material and methods. This single-center observational study included 55 patients (46 men, mean age 53±11 years) with NYHA class II–III HFrEF receiving optimal medical therapy, with sinus rhythm, QRS <130 ms or QRS<150 ms with nonspecific intraventricular conduction delay. NYHA class II and III were established in 76% and 24% of patients, respectively. All patients were implanted with CCM devices between October 2016 and September 2017. Follow-up visits were carried out every 3 months during the 1st year and every 6 months during the 2nd year of observation. The primary composite endpoint was mortality and heart transplantation. Secondary composite endpoints included death, heart transplantation, paroxysmal ventricular tachycardia/ ventricular fibrillation, hospitalizations due decompensated HF.
Results. The one-year and two-year survival rate was 95% and 80%, respectively. Primary endpoint was observed in 20% of patients. NYHA class III and higher levels of N-terminal pro-brain natriuretic peptide (NTproBNP) were associated with unfavorable prognosis (p=0,014 and p=0,026, respectively). NTproBNP was an independent predictor of survival (p=0,018). CCM contributed to a significant decrease in hospitalizations due to decompensated HF (p<0,0001). The secondary endpoint was observed in 18 (33%) of patients during the 1st year. The predictor for the secondary composite endpoint was NTproBNP (p=0,047).
Conclusion. CCM is associated with a significant decrease in hospitalization rate due to decompensated HF. The 2-year survival rate of patients with NYHA class II-III HF receiving CCM was 80%. The NTproBNP level was an independent predictor of survival in patients receiving CMM for 2 years. Further longer-term studies of the CCM efficacy are required.
Key words: cardiac contractility modulation, heart failure, reduced ejection fraction, long-term results, prognosis.
Relationships and Activities: none.
1Almazov National Medical Research Center, St. Petersburg; 2First Pavlov State Medical University, St. Petersburg, Russia.
Vander M. A.* ORCID: 0000-0001-9708-7541, Lyasnikova E. A. ORCID: 0000-0003-0613-829X, Belyakova L. A. ORCID: 0000-0003-2457-1169, Trukshina M. A. ORCID: 0000-0003-3597-6794, Galenko V. L. ORCID: 0000-0002-0503-167X, Kim I. M. ORCID: 0000-0002-0438-0499, Lelyavina T. A. ORCID: 0000-0001-6796-4064, Sitnikova M. Yu. ORCID: 0000-0002-0139-5177, Abramov M. L. ORCID: 0000-0001-5391-0006, Lebedev D. S. ORCID: 0000-0002-2334-1663, Mikhaylov E. N. ORCID: 0000-0002-6553-9141.
*Corresponding author: marianna.vander@gmail.com
Received: 21.04.2020
Revision Received: 04.05.2020
Accepted: 20.05.2020
For citation: Vander M. A., Lyasnikova E. A., Belyakova L. A., Trukshina M. A., Galenko V. L., Kim I. M., Lelyavina T. A., Sitnikova M. Yu., Abramov M. L., Lebedev D. S., Mikhaylov E. N. Two-year follow-up of patients with heart failure with reduced ejection fraction receiving cardiac contractility modulation. Russian Journal of Cardiology. 2020;25(7):3853. (In Russ.) doi:10.15829/1560-4071-2020-3853
DRUG-INDUCED BRADYCARDIA AS A MEDICAL AND SOCIAL PROBLEM: DATA FROM THE CARDIAC DRUG OVERDOSES HOSPITAL REGISTRY (STORM)
Nikulina N. N., Seleznev S. V., Chernysheva M. B., Yakushin S. S.
Abstract
Aim. To analyze hospitalizations due to drug-induced bradyarrhythmia (DIB) over a 5-year period (2014-2018), its clinical characteristics, causes and outcomes.
Material and methods. The analysis included all hospitalizations due to DIB at the Ryazan Regional Vascular Center in 2017 and 2018 and retrospectively in 2014.
Results. A total of 325 cases of DIB were included in the analysis (age 76,0 [68.0; 82.0] years; men — 26,1%). The proportion of DIB as a hospitalization cause in 2017 increased by 4,3 times compared to 2014 (p<0,001), in 2018 compared to 2014 — by 6,3 times (p<0,001) and compared to 2017 — by 46,2% (p=0,001). We recorded the following manifestations of DIB: bradycardia (<40 bpm — 51,4%), atrioventricular (31,7%) and sinoatrial (29,2%) block, syncope (36,0%), Frederick’s syndrome (8,6%), pauses >3 s (5,9%). Management in intensive care was required in 42,2% of patients, temporary cardiac pacing — in 7,7%, permanent pacemaker — in 6,2%. Mortality rate was 6,2%. Before hospitalization, patients took beta-blockers (65,1%), antiarrhythmic agents (39,6%), cardiac glycosides (23,0%), I 1-imidazoline receptor agonist moxonidine (13,5%, its prescription rate increased 8,9 times over 5 years, p=0,004), nondihydropyridine calcium channel blockers (7,9%), and other
drugs (15,4%). In 60,1% of patients, ≥2 drugs with bradycardic action were used, in 22,0% — ≥3, in 8,1% — ≥4, in 10,6% — with an excessive single/daily dose.
Conclusion. The medical and social significance of DIB have been demonstrated. DIB due to exceeding the recommended dose was associated with independent try of patients to manage the deterioration. In other cases, DIB was due to the summation/potentiation of several drugs’ action, the comorbidities contributing to the development of bradyarrhythmia and/or changes in pharmacokinetic properties of drugs.
Key words: drug-induced bradycardia, bradyarrhythmia, adverse drug reaction, overdose.
Relationships and Activities : none.
I. P. Pavlov Ryazan State Medical University, Ryazan, Russia.
Nikulina N. N.* ORCID: 0000-0001-8593-3173, Seleznev S. V. ORCID: 0000-0002-4069-8082, Chernysheva M. B. ORCID: 0000-0002-5460-5027, Yakushin S. S. ORCID: 0000-0002-1394-3791.
*Corresponding author: natalia.nikulina@mail.ru
Received: 19.05.2020
Revision Received: 01.06.2020
Accepted: 03.06.2020
For citation: Nikulina N. N., Seleznev S. V., Chernysheva M. B., Yakushin S. S. Drug-induced bradycardia as a medical and social problem: data from the Cardiac Drug Overdoses Hospital Registry (STORM). Russian Journal of Cardiology . 2020;25(7):3918. (In Russ.) doi:10.15829/1560-4071-2020-3918
CLINICAL, ECHOCARDIOGRAPHIC PARAMETERS AND MARKERS OF OXIDATIVE STRESS ASSOCIATED WITH ATRIAL FIBRILLATION IN PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFT SURGERY
Rubanenko O. A.1, Rubanenko A. O.1, Shchukin Yu. V. 1, Limareva L. V.1, Bogush V. V.1, Milyakova M. N. 2
Abstract
Aim. To estimate the association of clinical, echocardiographic parameters and markers of oxidative stress with postoperative atrial fibrillation (POAF) in patients with coronary artery disease (CAD) undergoing coronary artery bypass graft (CABG) surgery.
Material and methods. This case-control study included 158 patients with CAD who were scheduled for CABG surgery. Patients were divided into two groups: group 1 (n=111) — patients without POAF (men — 82%, median age — 62,0 [56,0;66,0] years); group 2 (n=47) — patients with POAF (men — 84,4%, median age — 65,0 [61,0;70,0] years). The median of POAF development was 5,2 [2,0;7,0] days after CABG. We studied plasma and erythrocyte superoxide dismutase (SOD) levels, plasma nitrogen oxide and myeloperoxidase levels, erythrocyte levels of catalase, malondialdehyde, reduced glutathione, glutathione reductase and gluta thione peroxidase, and advanced oxidation protein products. The determination was carried out before and on average 3-4 days after CABG. All the patients also underwent echocardiography.
Results. Multivariate regression revealed following parameters associated with POAF: left atrial diameter >41 mm (odds ratio (OR) 4,1, 95% confidence interval (CI) 1,7-8,9, р=0,001), postoperative plasma levels of SOD >1100,5 U/g (OR 3,0, 95% CI 1,3-9,7, р=0,04), postoperative levels of reduced glutathione ≤0,194 μmol/g Hb (OR 1,6, 95% CI 1,1-6,8, р=0,002), postoperative levels of glutathione peroxidase ≤17,36 mmol/g Hb (OR 1,9, 95% CI 1,1-7,8, р=0,0005), postoperative levels of glutathione reductase ≤2,99 mmol/g Hb (OR 2,1, 95% CI, 1,1-5,9, р=0,004), postoperative levels of malondialdehyde >1,25 μmol/g Hb (OR 1,9, 95% CI 1,1-7,2, р<0,0001), postoperative plasma levels of nitrogen oxide >36,4 μmol/l (OR 1,4, 95% CI 1,03-4,8, р=0,001).
Conclusion. Our study showed significant association of increased left atrial diameter, high activity of oxidative stress and low activity of antioxidant system with POAF in patients with CAD undergoing CABG surgery.
Key words: atrial fibrillation, coronary artery bypass graft surgery, oxidative stress, prognosis.
Relationships and Activities: none.
1Samara State Medical University, Samara; 2REAVIZ Medical University, Samara, Russia.
Rubanenko O. A.* ORCID: 0000-0001-9351-6177, ResearcherID: I-8490-2015, Rubanenko A. O. ORCID: 0000-0002-3996-4689, Shchukin Yu. V. ORCID: 0000-0003-0387-8356, Limareva L. V. ORCID: 0000-0003-4529-5896, Bogush V. V. ORCID: 0000-0001-7597-449Х, Milyakova M. N. ORCID: 0000-0001-9665-3388.
*Corresponding author: olesya.rubanenko@gmail.com
Received: 12.05.2020
Revision Received: 29.06.2020
Accepted: 07.07.2020
For citation: Rubanenko O. A., Rubanenko A. O., Shchukin Yu. V., Limareva L. V., Bogush V. V., Milyakova M. N. Clinical, echocardiographic parameters and markers of oxidative stress associated with atrial fibrillation in patients undergoing coronary artery bypass graft surgery. Russian Journal of Cardiology . 2020;25(7):3896. (In Russ.) doi:10.15829/1560-4071-2020-3896
STRUCTURAL AND FUNCTIONAL MYOCARDIAL ABNORMALITIES AND ARRHYTHMIAS IN PATIENTS WITH TYPE 1 DIABETES COMPLICATED WITH KETOACIDOSIS
Mukha N. V., Govorin A. V., Zaitsev D. N., Filev A. P.
Abstract
Aim. To study the structural and functional cardiac changes and arrhythmias in patients with type 1 diabetes (T1D) complicated with ketoacidosis.
Material and methods. We analyzed 24-hour Holter monitoring data in 112 patients with T1D complicated with diabetic ketoacidosis (DKA). To assess the left ventricular (LV) diastolic function, all patients underwent echocardiography.
Results. In patients with T1D complicated with DKA, the following cardiac arrhythmias were recorded: supraventricular arrhythmias — 60,7%, premature ventricular contractions — 26,2%, premature ventricular and supraventricular contractions — 13,1%. In 30% of patients with T1D complicated with DKA, premature ventricular contractions were classified as class 4A, in 10% — class 4B. With severe DKA, 5% of patients had short runs of unstable ventricular tachycardia. As the severity of ketosis increases, myocardial remodeling and LV diastolic dysfunction are recorded, as well as the spectral and temporal parameters of heart rate variability decrease.
Conclusion. In patients with T1D complicated with DKA, structural and functional LV abnormalities, the development of LV diastolic dysfunction and cardiac arrhythmias are more often recorded. The most pronounced changes were found in the group of patients with T1D with moderate and severe DKA.
Key words: type 1 diabetes, ketoacidosis, arrhythmia.
Relationships and Activities: none.
Chita State Medical Academy, Chita, Russia.
Mukha N. V.* ORCID: 0000-0001-8128-636Х, Govorin A. V. ORCID: 0000-0001-7586-6595, Zaitsev D. N. ORCID: 0000-0002-2741-3783, Filev A. P. ORCID: 0000-0002-3445-7119.
*Corresponding author: mushanatasha@inbox.ru
Received: 07.05.2020
Revision Received: 16.06.2020
Accepted: 01.07.2020
For citation: Mukha N. V., Govorin A. V., Zaitsev D. N., Filev A. P. Structural and functional myocardial abnormalities and arrhythmias in patients with type 1 diabetes complicated with ketoacidosis. Russian Journal of Cardiology . 2020;25(7):3891. (In Russ.) doi:10.15829/1560-4071-2020-3891
COMORBIDITY IN ACUTE HEART FAILURE COMPLICATING MYOCARDIAL INFARCTION
Zykov M. V.1,4, Kashtalap V. V.1,2, Bykova I. S. 1, Poltaranina V. A.5, Barbarash O. L.1,2, Raff S. A. 6,7, Kosmacheva E. D.6,7, Erlikh A. D.3,8 on behalf of all participants in the RECORD-3 registry
Abstract
Aim. To study the relationship between comorbidity and acute heart failure (AHF) complicating myocardial infarction (MI).
Material and methods. The analysis included 993 patients with MI from the registry of acute coronary syndrome RECORD-3. Killip class II-IV was recorded in every fifth patient (n=205). Hospital mortality was 6,3%. The mean age was 64,3 (63,5-65,0) years (men — 66,1%). All patients were divided into three groups depending on the number of comorbidities (type 2 diabetes, chronic kidney disease, atrial fibrillation, anemia, stroke, hypertension, obesity, peripheral atherosclerosis, thrombocytopenia). The first group included patients with no more than one disease (n=251), the second one — with 2 or 3 diseases (n=480), and the third one — with 4 or more diseases (n=262).
Results. AHF detection rate increased in groups with increasing comorbidity: 12,3%, 17,9% and 33,6%, respectively (p<0,0001). Regardless of the initial therapy, in patients of the first group without AHF, the hospital mortality rate did not exceed 1%. In patients of the third group with Killip class II-IV AHF, the hospital mortality was the highest and also did not depend on the choice of treatment strategy (24,6% with conservative management, 31,6% with percutaneous coronary intervention (PCI)). PCI made it possible to reliably (p<0,05) reduce the risk of hospital mortality in patients of the second and third groups without AHF: relative risk 4,3 (1,0-19,9) and 4,2 (1,1-18,3), respectively. Analysis of a 1-year follow-up revealed that AHF is a death predictor after hospital discharge independent of the comorbidity severity: 11,1%, 13,3%, and 14,3%, respectively. In patients without AHF, a 1-year mortality increased from the first to the third group: 1,1%, 5,8% and 7,0%, respectively (p=0,043).
Conclusion. Сomorbidity is an independent predictor of heart failure in MI, and their combination is associated with the most unfavorable in-hospital prognosis, regardless of the treatment strategy. The greatest advantage of PCI for reducing the hospital mortality rate was obtained in patients with comorbidity and without manifestations of AHF.
Key words: myocardial infarction, heart failure, prognosis, comorbidity.
Relationships and Activities: none.
1Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo; 2Kemerovo State Medical University, Kemerovo; 3N. E. Bauman City Clinical Hospital № 29, Moscow; 4City Hospital № 4, Sochi; 5Regional Clinical Hospital, Nizhnevartovsk; 6Kuban State Medical University, Krasnodar; 7Research Institute — S. V. Ochapovsky Regional Clinical Hospital №1, Krasnodar; 8Pirogov Russian National Research Medical University, Moscow, Russia.
Zykov M. V.* ORCID: 0000-0003-0954-9270, Kashtalap V. V. ORCID: 0000-0003-3729-616X, Bykova I. S. ORCID: 0000-0003-0912-7879, Poltaranina V. A. ORCID: 0000-0002-0010-8375, Barbarash O. L. ORCID: 0000-0002-4642-3610, Raff S. A. ORCID: 0000-0002-5791-4677, Kosmacheva E. D. ORCID: 0000-0001-8600-0199, Erlikh A. D. ORCID: 0000-0003-0607-2673.
*Corresponding author: mvz83@mail.ru
Received: 14.07.2019
Revision Received: 24.08.2019
Accepted: 29.08.2019
For citation: Zykov M. V., Kashtalap V. V., Bykova I. S., Poltaranina V. A., Barbarash O. L., Raff S. A., Kosmacheva E. D., Erlikh A. D. on behalf of all participants in the RECORD-3 registry. Comorbidity in acute heart failure complicating myocardial infarction. Russian Journal of Cardiology . 2020;25(7):3427. (In Russ.) doi:10.15829/1560-4071-2020-3427
GALECTIN-3: ROLE IN THE FORMATION OF VARIOUS HEMODYNAMIC PHENOTYPES OF HEART FAILURE AND INTERACTION WITH SOME NEUROHUMORAL FACTORS
Kurbonov A. K., Gadaev A. G., Nurillaeva N. M., Ernazarov M. M., Nasretdenova D. O.
Abstract
Aim. To study the interaction of serum galectin-3 (Gal-3) with fibrogenic factors, cardiac remodeling, as well as parameters of central hemodynamics in various hemodynamic phenotypes of heart failure (HF).
Material and methods. A total of 210 male and female patients with HF were examined (mean age 64,1±1,4 years). HF was established on the basis of patient complaints, medical history, physical examination and laboratory tests using the 2016 ESC Chronic Heart Failure Guidelines. In addition to standard diagnostic tests, enzyme immunoassays were performed: serum Gal-3, aldosterone, matrix metalloproteinase 1 (MMP1), tissue inhibitor of matrix metalloproteinase 1 (TIMP1).
Results. Patients were divided into two groups: group I (n=59) — patients with HF with reduced ejection fraction (LVEF <40%), group II (n=56) — patients with HF with midrange EF (LVEF 41-49%), group III (n=95) — patients with HF with preserved EF (LVEF >50%). Reference values of studied substances were as follows: Gal-3 — 8,6 [3,7; 11,7] ng/ml; aldosterone — 86,8 [47,8; 199,1] pg/ml; MMP1 — 14,5 [8,5; 18,7] ng/ml; TIMP1 — 87,4 [68,6; 115,2] ng/ml. In patients with HF, the levels of Gal-3, aldosterone and TIMP1 increased with the disease functional class (FC). In patients of group I, it significantly increased by 1,7-2,5 (p<0,01), 4,1-5,9 (p<0,05) and 4,1-5,7 (p<0,05); in group II, 1,8-2,8 (p<0,01), 5,6-6,8 (p<0,01) and 6,1-8,3 (p<0,01); in group III, by 2,1-3,1 (p<0,01), 6,1-6,9 (p<0,01) and 6,8-9,3 times (p<0,01), respectively. A positive correlation was established with FC: in groups I and II, Gal-3 had a significant negative relationship with LVEF (p<0,001; p<0,01, respectively); in group III, Gal-3 had a moderate positive relationship with LV posterior wall thickness (p<0,05), interventricular septum thickness (p<0,05), the left ventricle mass index (p<0,01) and LV relative wall thickness (p<0,01).
Conclusion. Levels of Gal-3 and aldosterone increased with HF FC and had a relevant relationship with the activation of some other neurohumoral factors. Gal-3 can be used as an early biomarker of myocardial fibrosis and cardiac remodeling, in predicting and evaluating risk factors, clinical course and outcome of the disease, as well as to assess the effectiveness of treatment in patients with these HF phenotypes.
Key words: heart failure, galectin-3, aldosterone, myocardial fibrosis, biological markers.
Relationships and Activities: none.
Tashkent Medical Academy, Tashkent, Uzbekistan.
Kurbonov A. K. ORCID: 0000-0002-4428-1700, Gadaev A. G. ORCID: 0000-0001-9103-3358, Nurillaeva N. M.* ORCID: 0000-0002-4417-0875, Ernazarov M. M. ORCID: 0000-0002-3703-4162, Nasretdenova D. O. ORCID: 0000-0003-1305-9389.
*Corresponding author: nargizanur@yandex.ru
Received: 30.08.2019
Revision Received: 06.01.2020
Accepted: 20.01.2020
For citation: Kurbonov A. K., Gadaev A. G., Nurillaeva N. M., Ernazarov M. M., Nasretdenova D. O. Galectin-3: role in the formation of various hemodynamic phenotypes of heart failure and interaction with some neurohumoral factors. Russian Journal of Cardiology. 2020;25(7):3476. (In Russ.) doi:10.15829/1560-4071-2020-3476
CLINIC AND PHARMACOTHERAPY
AZILSARTAN MEDOXOMIL FOR IMPROVING INSULIN RESISTANCE AND ADIPOKINE LEVELS IN HYPERTENSION IN COMPARISON WITH ANGIOTENSIN-CONVERTING ENZYME INHIBITORS
Nedogoda S. V., Chumachek E. V., Tsoma V. V., Sanina T. N., Salasyuk A. S., Smirnova V. O., Popova E. A.
Abstract
Aim. To assess azilsartan medoxomil (AZM) in achieving the target blood pressure (BP) (<140/90 mm Hg), its angioprotective action in patients with hypertension (HTN), as well as contribution in reducing levels of adipokines and inflammation markers in patients switching from lisinopril or enalapril.
Material and methods. This open-label observational study lasting 24 weeks included 60 patients who had previously received monotherapy with lisinopril 20 mg/day or enalapril 20 mg/day, and did not reach the target BP levels (<140/90 mm Hg). During the study, all patients underwent 24-hour BP monitoring, applanation tonometry (determination of the augmentation index and central BP), pulse wave velocity measurement, laboratory tests (lipid profile, uric acid, fasting glucose, HOMA index, homocysteine, leptin, adiponectin, highly sensitive C-reactive protein (hs-CRP), tumor necrosis factor alpha, interleukin-6 (IL-6).
Results. After switching from lisinopril and enalapril to AZM, a decrease in systolic BP was 24,3% and 31,3%, diastolic BP — 19,8% and 21,4% (p<0,05). In the groups of initial therapy with lisinopril and enalapril, there was a decrease in central (aortic) BP by 20,4% and 25,5%, central pulse pressure by 20,6% and 27,6%, augmentation index by 33,1% and 34,58%, pulse wave velocity by 19,4% and 20,7% (p<0,05), levels of leptin by 10,4%, and 16,8%, hs-CRP by 16,1% and 19,3%, IL-6 by 23,6% and 25,1%, respectively. We also revealed an increase in adiponectin levels by 7,2% and 9,2%, respectively (p<0,05).
Conclusion. Azilsartan medoxomil has advantages over angiotensin-converting enzyme inhibitors (enalapril, lisinopril) in achieving BP control, and improving vascular elasticity. It contributes to a decrease in insulin resistance and noninfectious inflammation.
Key words: hypertension, pulse wave velocity, central blood pressure, augmentation index, adipokines, azilsartan.
Relationships and Activities: none.
Volgograd State Medical University, Volgograd, Russia.
Nedogoda S. V.* ORCID: 0000-0001-5981-1754, Chumachek E. V. ORCID: 0000-0002-6740-8321, Tsoma V. V. ORCID: 0000-0002-0662-1217, Sanina T. N. ORCID: 0000-0003-4797-7479, Salasyuk A. S. ORCID: 0000-0002-6611-9165, Smirnova V. O. ORCID: 0000-0002-0646-5824, Popova E. A. ORCID: 0000-0002-3498-7718.
*Corresponding author: nedogodasv@rambler.ru
Received: 26.03.2020
Revision Received: 02.04.2020
Accepted: 27.04.2020
For citation: Nedogoda S. V., Chumachek E. V., Tsoma V. V., Sanina T. N., Salasyuk A. S., Smirnova V. O., Popova E. A. Azilsartan medoxomil for improving insulin resistance and adipokine levels in hypertension in comparison with angiotensinconverting enzyme inhibitors. Russian Journal of Cardiology . 2020;25(7):3767. (In Russ.) doi:10.15829/1560-4071-2020-3767
MODERN APPROACHES TO TRANSVENOUS LEAD EXTRACTION
Podolyak D. G., Kiprensky A. Yu., Mironovich S. A.
Abstract
Aim. To show the effectiveness and safety of modern transvenous lead extraction (TLE) techniques used in cardiac surgery.
Material and methods. The study included 102 patients (men — 66, women — 36; mean age 58,3±1,7 years). Fifteen (14,7%) patients had infectious indications for TLE, 87 (85,3%) patients — non-infectious. Among the infectious indications (14,7%) were: isolated pocket infection of implantable electronic device (IED) — 13 (12,9%); pocket infection with bacteremia — 1 (0,9%); infectious endocarditis without pocket infection — 1 (0,9%). Of the non-infectious indications, 87 patients (85,3%) had: venous occlusion — 4 (3,9%); chronic pain at IED area — 10 (9,8%); device upgrade — 16 (15,7%); non-functioning (dysfunction, fracture) leads — 57 (55,9%).
Results. Using simple traction, 75 (50,4%) leads were removed. TLE technique was used in 56 (37,5%) extractions. Of these, telescoping/rotational mechanical dilators were used in 23 (15,4%) and 33 (22,1%) lead extractions, respectively. In 15 (14,7%) patients with infectious indications, 33 (22,1% of total) leads were removed. In 87 (85,3%) patients with noninfectious indications, 98 (65,8% of total) leads were removed. It was not possible to completely remove 18 (12% of total) leads.
Conclusion. Currently, modern TLE techniques have shown their high efficiency and safety. It is confirmed by large international studies such as ELECTRa, LExiCon, PLEXES, where success rate reaches 97,7% and mortality does not exceed 0,5%. The successful application of modern techniques enlarged the list of indications and has been widely used in routine cardiac surgery.
Key words: transvenous lead extraction, implantable electronic device, endocardial lead, pocket infection.
Relationships and Activities: none.
B. V. Petrovsky Russian Surgery Research Center, Moscow, Russia.
Podolyak D. G.* ORCID: 0000-0002-6256-8772, Kiprensky A. Yu. ORCID: 0000-0001-6207-2091, Mironovich S. A. ORCID: 0000-0002-7499-7179.
*Corresponding author: dimap-cardio@mail.ru
Received: 26.06.2020
Revision Received: 13.07.2020
Accepted: 15.07.2020
For citation: Podolyak D. G., Kiprensky A. Yu., Mironovich S. A. Modern approaches to transvenous lead extraction. Russian Journal of Cardiology . 2020;25(7):4012. (In Russ.) doi:10.15829/1560-4071-2020-4012
CHOICE OF DUAL ANTIPLATELET THERAPY IN PATIENTS WITH ACUTE CORONARY SYNDROME AFTER PERCUTANEOUS CORONARY INTERVENTION
Golosova A. N., Gatsura S. V., Ulyanova E. A., Dvoryanchikova Zh. Yu.
Abstract
The article presents modern approaches to choosing a P2Y 12 inhibitor as part of combined antithrombotic therapy in patients with acute coronary syndrome, depending on the indications for interventional treatment and the presence of comorbidities such as atrial fibrillation and diabetes.
Key words: acute coronary syndrome, percutaneous coronary intervention, dual antiplatelet therapy, prasugrel, ticagrelor, clopidogrel.
Relationships and Activities. The paper was supported by the pharmaceutical company Servier (France).
A. I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.
Golosova A. N.* ORCID: 0000-0002-2562-9839, Gatsura S. V. ORCID: 0000-0002-1513-5149, Ulyanova E. A. ORCID: 0000-0002-6513-7222, Dvoryanchikova Zh. Yu. ORCID: 0000-0003-3816-3852.
*Corresponding author: golosovaalla@mail.ru
Received: 26.03.2020
Revision Received: 24.04.2020
Accepted: 05.06.2020
For citation: Golosova A. N., Gatsura S. V., Ulyanova E. A., Dvoryanchikova Zh. Yu. Choice of dual antiplatelet therapy in patients with acute coronary syndrome after percutaneous coronary intervention. Russian Journal of Cardiology . 2020;25(7):3809. (In Russ.) doi:10.15829/1560-4071-2020-3809
HEART RATE-LOWERING THERAPY IN GOUT PATIENTS WITH STABLE CORONARY ARTERY DISEASE: FOCUS ON IVABRADINE
Kushnarenko N. N., Medvedeva T. A., Mishko M. Yu., Karavaeva T. M.
Abstract
Aim. To study the effect of ivabradine and bisoprolol on cardiac hemodynamics and diastolic remodeling in gout patients with coronary artery disease and hypertension and without left ventricular systolic dysfunction.
Material and methods. The open randomized parallel clinical trial of 35 men with intercritical gout at the age of 41,4±3,3 years, with class II-III stable angina, hypertension and sinus rhythm without data suggestive of heart failure was performed. All patients included in the study were randomly divided into two groups: eighteen patients took bisoprolol at a dose of 2,5 to 10 mg/day, 17 subjects received bisoprolol 2,5 mg/day with ivabradine (Coraxan, SERVIER, France) 5 mg 2 times a day. Adjustment of the therapy was carried out every 2 weeks until the target heart rate (HR) was reached at 55-60 beats/min and then remained unchanged until 12 weeks of therapy. All patients underwent echocardiography, 24-hour Holter and central aortic blood pressure monitoring, and 3-minute cycle ergometer test with a power of 25, 50, 75 and 100 watts.
Results. There was a comparable decrease in the maximum and minimum 24-hour average heart rates in patients receiving only bisoprolol and those taking bisoprolol+ivabradine. Patients taking bisoprolol+ivabradine had a decrease of central systolic and diastolic blood pressure (BP). Pulse pressure in the bisoprolol group increased by 17,7% (p=0,02), and when ivabradine was added, on the contrary, it decreased by 7,0% (p=0,04). Twelve-week therapy with beta-blockers and ivabradine was accompanied by an effective decrease in the pulse wave velocity in both groups (p<0,05). All gout patients did not have a decrease of systolic function and there was an improvement in diastolic remodeling with beta-blockers and ivabradine therapy.
Conclusion. The results obtained indicate that the addition of ivabradine to bisoprolol leads to an effective decrease in heart rate, an improvement in arterial stiffness and exercise tolerance. Combination therapy with ivabradine is accompanied by an improvement in clinical outcomes using lower doses of betblockers, which requires further study and a double-blind controlled study.
Key words: gout, angina of effort, bisoprolol, diastolic function, ivabradine, heart rate.
Relationships and Activities. The paper was supported by the pharmaceutical company Servier (France).
Chita State Medical Academy, Chita, Russia.
Kushnarenko N. N. ORCID: 0000-0002-0350-0698, Medvedeva T. A.* ORCID: 0000-0001-8410-5827, Mishko M. Yu. ORCID: 0000-0003-3243-2951, Karavaeva T. M. ORCID: 0000-0002-0487-6275.
*Corresponding author: saidi-tma@mail.ru
Received: 24.06.2020
Revision Received: 06.07.2020
Accepted: 20.07.2020
For citation: Kushnarenko N. N., Medvedeva T. A., Mishko M. Yu., Karavaeva T. M. Heart rate-lowering therapy in gout patients with stable coronary artery disease: focus on ivabradine. Russian Journal of Cardiology. 2020;25(7):3980. (In Russ.) doi:10.15829/1560-4071-2020-3980
CHANGES IN PRESCRIBING ANTITHROMBOTIC THERAPY IN PATIENTS WITH ATRIAL FIBRILLATION AND MYOCARDIAL INFARCTION IN 2016-2019
Pereverzeva K. G., Yakushin S. S., Yakushina M. S., Ezhova A. V., Bogdanovich I. A., Simkova L. A.
Abstract
Aim. To study the changes in prescribing antithrombotic therapy (ATT) among patients with myocardial infarction (MI) and atrial fibrillation (AF), hospitalized in a cardiology hospital in 2016-2017 and 2018-2019.
Material and methods. The study included 362 patients with MI and AF: in 2016-2017 — 106 patients, of which 104 were included in the analysis, in 2018-2019 — 256 patients. The median age of patients hospitalized in 2016-2017 was 70,0 (61,0; 78,0) years, in 2018-2019 — 71 (65,0; 79,3) years (p=0,09). There were 60 men (55,6%) in 2016-2017 and 143 (55,8%) in 2018-2019 (p=0,90).
Results. In 2016-2017, 80 (76,9%) patients were prescribed dual antiplatelet therapy (DAPT), 17 (16,3%) — therapy with oral anticoagulants (OAC), while 7 (6,7%) of them were as part of triple ATT, 9 (8,7%) — as part of dual ATT (OAC+antiplatelet agent), and 1 (1,0%) — as monotherapy. In 2018-2019, 97 (37, 9%) patients were prescribed DAPT, 140 (54,7%) — OAC therapy, while 115 (44,9%) of them were as part of triple ATT, 25 (9,8%) — as a part of dual ATT (OAC+antiplatelet agent). Among all cases of OAC prescription in 2016-2017 and 2018-2019, warfarin was prescribed in 11 (64,7%) and 51 (36,4%) patients, respectively (p=0,02), while rivaroxaban — in 6 (35,3%) and 88 (62,9%) patients, respectively (p=0,03). In 2018-2019, one patient was prescribed dabigatran etexilate.
Conclusion. The study revealed that the prescription rate of triple ATT at discharge in 2018-2019 increased 6,7 times compared to 2016-2017 and amounted to 44,9% (n=115) (p<0,001). The prescription rate of OAC in 2018-2019 also increased 3,4 times compared to 2016-2017 and amounted to 54,7% (n=140) (p<0,001).
Key words: atrial fibrillation, myocardial infarction, antithrombotic therapy, oral anticoagulants, warfarin, rivaroxaban.
Relationships and Activities: none.
I. P. Pavlov Ryazan State Medical University, Ryazan, Russia.
Pereverzeva K. G.* ORCID: 0000-0001-6141-8994, Yakushin S. S. ORCID: 0000-0002-1394-3791, Yakushina M. S. ORCID: 0000-0001-7957-8064, Ezhova A. V. ORCID: 0000-0003-4440-4819, Bogdanovich I. A. ORCID: 0000-0003-1682-0225, Simkova L. A. ORCID: 0000-0003-4704-058X.
*Corresponding author: pereverzevakg@gmail.com
Received: 13.05.2020
Revision Received: 01.06.2020
Accepted: 03.06.2020
For citation: Pereverzeva K. G., Yakushin S. S., Yakushina M. S., Ezhova A. V., Bogdanovich I. A., Simkova L. A. Changes in prescribing antithrombotic therapy in patients with atrial fibrillation and myocardial infarction in 2016-2019. Russian Journal of Cardiology. 2020;25(7):3908. (In Russ.) doi:10.15829/1560-4071-2020-3908
A NEW APPROACH TO HEART RATE CONTROL IN PATIENTS WITH PERMANENT ATRIAL FIBRILLATION. PILOT STUDY
Tatarsky B. A.1, Kazennova N. V.1, Batalov R. E. 2, Popov S. V.2
Abstract
Aim. To test the hypothesis that the combined use of ivabradine (I f inhibitor) and ranolazine (late sodium channel blocker) can reduce the ventricular rate in patients with permanent atrial fibrillation (AF) resistant to standard heart rate-lowering therapy.
Material and methods. The study included 25 patients with a permanent AF and an uncontrolled ventricular rate. All patients had NYHA class I-III heart failure with preserved ejection fraction. Patients took ivabradine 2,5 mg twice daily and ranolazine 250 mg twice daily. Twenty-four Holter monitoring was performed after 1, 2, 4 weeks and at the end of the study. The follow-up lasted 8 weeks.
Results. In 68% and 16% of patients, strict and lenient rate control was achieved, respectively. There was no ventricular rate decrease in 12% of patients. Adverse effects developed in 4% of subjects.
Conclusion. The combined use of ivabradine and ranolazine in patients with a permanent AF and uncontrolled ventricular rate reduces the rate without QT prolongation or reducing left ventricular contractile function. The findings support the hypothesis that the suppression of If current and dominant fibrillation frequency may be a new goal of permanent AF therapy. Prospective, randomized studies are needed to determine the role of drugs for ventricular rate control in patients with permanent AF and to study the effects on efficacy, safety, hospitalization frequency, and other clinical outcomes.
Key words: permanent atrial fibrillation, ventricular rate control, ivabradine, ranolazine.
Relationships and Activities: none.
1Almazov National Medical Research Center, St. Petersburg; 2Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk, Russia.
Tatarsky B. A. ORCID: 0000-0001-7303-9756, Kazennova N. V. ORCID: 0000-0003-0523-9339, Batalov R. E.* ORCID: 0000-0003-1415-3932, Popov S. V. ORCID: 0000-0002-9050-4493.
*Corresponding author: romancer@cardio-tomsk.ru
Received: 25.06.2019
Revision Received: 31.07.2019
Accepted: 14.08.2019
For citation: Tatarsky B. A., Kazennova N. V., Batalov R. E., Popov S. V. A new approach to heart rate control in patients with permanent atrial fibrillation. Pilot study. Russian Journal of Cardiology . 2020;25(7):3388. (In Russ.) doi:10.15829/1560-4071-2020-3388
IDENTIFICATION OF POTENTIALLY EFFECTIVE ANTIARRHYTHMIC DRUGS TO INDIVIDUALIZE PREMATURE VENTRICULAR CONTRACTION THERAPY IN PATIENTS WITHOUT STRUCTURAL CARDIAC CHANGES
Olesin A. I.1, Konstantinova I. V.1, Zueva Yu. S. 2, Koziy A. V.3
Abstract
Aim. To individualize premature ventricular contraction (PVC) therapy in patients without structural cardiac changes by identifying potentially effective antiarrhythmic agents.
Material and methods. The study included 122 patients aged 20 to 43 years without structural cardiac changes with class IV-V PVC (Rayn B. classification (1984)) and subjective arrhythmia signs. After 24-hour Holter monitoring, the selection of potentially effective antiarrhythmic agents for terminating PVC was carried out on the basis of an increase in premature beat index after the third dose compared with the initial data of ≥2 relative units. The accuracy of drug choice was evaluated according to 24-hour ECG monitoring after a short course of therapy for each tested antiarrhythmic agent for at least 5 days. The follow-up duration ranged from 1 to 4-5 years. The endpoint was the duration of positive antiarrhythmic effect of the drugs used.
Results. In 55,74% of patients, a positive antiarrhythmic effect was detected in two agents, in 34,43% — in three, and in the rest — in four antiarrhythmic drugs. The accuracy of drug choice averaged over 90%. In 18,85% of patients, the antiarrhythmic effect of PVC therapy maintained for less than 1 year (on average 0,8±0,05 years), in other patients, from 1 year to 5 years (on average 3,7±0,09 years) (p<0,05). The duration of maintaining a positive clinical effect for 1 year or more correlated with true positive results (r=0,94), and less than 1 year — with false negative results of testing with antiarrhythmic drugs (r=0,92).
Conclusion. In all patients without structural cardiac changes with PVC, a potential positive antiarrhythmic effect was detected for two or more drugs. The accuracy of choosing potentially effective drugs for terminating PVC in these patients averaged over 90%.
Key words: premature ventricular contraction, differentiated therapy.
Relationships and Activities: none.
1I. I. Mechnikov North-Western State Medical University, St. Petersburg; 2Elizabeth Hospital, St. Petersburg; 3Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, St. Petersburg, Russia.
Olesin A. I.* ORCID: 0000-0001-7827-1052, Konstantinova I. V. ORCID: 0000-0003-3350-3088, Zueva Yu. S. ORCID: 0000-0002-1685-6300, Koziy A. V. ORCID: 0000-0002-1426-3579.
*Corresponding author: olesin58@mail.ru
Received: 27.12.2019
Revision Received: 27.01.2020
Accepted: 02.02.2020
For citation: Olesin A. I., Konstantinova I. V., Zueva Yu. S., Koziy A. V. Identification of potentially effective antiarrhythmic drugs to individualize premature ventricular contraction therapy in patients without structural cardiac changes. Russian Journal
of Cardiology . 2020;25(7):3697. (In Russ.) doi:10.15829/1560-4071-2020-3697
EXPERIENCE OF USING PROPAFENONE IN NEWBORNS AND YOUNG CHILDREN WITH ARRHYTHMIAS
Kruchina T. K.1,2, Kovalchuk T. S.1, Vasichkina E. S. 1, Tatarsky B. A.1
Abstract
Aim. To evaluate the efficacy and safety of propafenone therapy in newborns and young children, including children with congenital heart defects (CHD).
Material and methods. The study included 65 children with initiation of propafenone therapy at the age of 0-5 years. For diagnosis of arrhythmias and treatment control, electrocardiography (ECG), 24-hour Holter monitoring and echocardiography were performed. The initial dose of propafenone was 5-7 mg/kg/day; the maximum dose — 15 mg/kg/day. The dose was titrated to effective with clinical and ECG control. It was considered acceptable to increase the duration of PQ interval and QRS complex by no more than 25% of the baseline value. The adverse and arrhythmogenic effects of the drug were evaluated.
Results. Indications for propafenone administration were atrial tachycardia in 29 (44,61%) children, frequent premature ventricular contractions and ventricular tachycardia in 13 (20%) children, Wolff-Parkinson-White syndrome in 13 (20%) children, and other types of supraventricular tachycardia in 10 (15,39%) children. Sixteen (24,62%) children had CHD. In 20 (30,77%) children, propafenone was administrated in the neonatal period. The duration of propafenone therapy was 17,3±15,16 months. The drug was effective in 39 (60%) children (81,25% with CHD and 53,06% without CHD), not effective enough in 14 (21,54%) children, ineffective in 12 (18,46%) children. There was no association of the effectiveness/inefficiency of propafenone depending on the age, sex and the type of arrhythmia. Five (7,69%) children had prolongation of PQ interval and/or QRS by more than 25%. Arrhythmogenic effect of propafenone was observed in 1 (1,54%) child, noncardiac adverse effects — in 3 (4,62%) children. There were no cases of sudden cardiac death.
Conclusion. Propafenone is an effective antiarrhythmic drug in newborns and young children with supraventricular and ventricular arrhythmias, including children with CHD. Using propafenone may be accompanied with adverse and arrhythmogenic effects, which were observed in 6% of children and were not associated with CHD.
Key words: antiarrhythmic therapy, propafenone, newborns, children, cardiac arrhythmias, congenital heart defects.
Relationships and Activities: none.
1Almazov National Medical Research Center, St. Petersburg; 2Children’s City Hospital №1, St. Petersburg, Russia.
Kruchina T. K.* ORCID: 0000-0002-6865-0136, Kovalchuk T. S. ORCID: 0000-0002-0842-9560, Vasichkina E. S. ORCID: 0000-0001-7336-4102, Tatarsky B. A. ORCID: 0000-0001-7303-9756.
*Corresponding author: tkruchina@gmail.com
Received: 16.08.2019
Revision Received: 16.12.2019
Accepted: 11.01.2020
For citation: Kruchina T. K., Kovalchuk T. S., Vasichkina E. S., Tatarsky B. A. Experience of using propafenone in newborns and young children with arrhythmias. Russian Journal of Cardiology. 2020;25(7):3462. (In Russ.) doi:10.15829/1560-4071-2020-3462
CHOICE OF VENTRICULAR ARRHYTHMIA THERAPY IN CORONARY ARTERY DISEASE
Tatarinova A. A., Ryngach E. A., Treshkur T. V.
Abstract
Aim. To study trigger factors of ventricular arrhythmias (VA) in patients with stable coronary artery disease (CAD) and evaluate the effectiveness of individualized treatment.
Material and methods. The study included 155 patients with CAD aged 36 to 83 years (61,5±9,8 years); 73,5% were men with frequent single and coupled ventricular ectopic complexes (VEC) and the left ventricle ejection fraction (LVEF) of 56,4±8,5%. Exclusion criteria were class IV angina, acute coronary syndrome, LV aneurysm, LVEF ≤45%. Treatment and examination of patients was carried out according to the algorithm we proposed in 2017 for managing patients with CAD and high-grade VA.
Results. Depending on association between ventricular ectopy and transient myocardial ischemia (TMI) during an exercise tolerance test, patients were divided into 2 groups. Group I included 84 patients (54,2%) with ischemic VA. According to noninvasive topical diagnostics, the arrhythmogenic focus in all patients with ischemic VA was located in the left ventricle. Group II consisted of 71 (45,8%) patients with nonischemic VA, and two subgroups were distinguished depending on presence/absence of TMI: 2A and 2B. During the exercise test, several types of VA were identified. Myocardial revascularization (MR) was indicated in 84,5% of cases in both groups. Six months after MR in group I, the antiarrhythmic effect (AAE) was observed in 55 (77,5%) patients. In group IIA, AAE was significantly lower at 61,7% (p=0,048). We also revealed anxiety in 15 patients of group II. Anxiolytic therapy showed AAE in 75% of group IIA patients and in 63,6% of group IIB patients. Nine patients of group II were referred to radiofrequency ablation of VA with a positive effect of 55,5%. Antiarrhythmic drugs (amiodarone, sotalol) were taken by 5 people of group I.
Conclusion. The search for trigger factors and their elimination provides a high AAE for VA therapy in patients with CAD.
Key words: ventricular arrhythmias, ischemia, exercise tolerance test, antiarrhythmic effect, myocardial revascularization.
Almazov National Medical Research Center, St. Petersburg, Russia.
Tatarinova A. A.* ORCID: 0000-0001-5955-2529, Ryngach E. A. ORCID: 0000-0003-2795-5774, Treshkur T. V. ORCID: 0000-0001-6843-302X.
*Corresponding author: antsvet.18@mail.ru
Received: 10.01.2020
Revision Received: 10.02.2020
Accepted: 19.03.2020
For citation: Tatarinova A. A., Ryngach E. A., Treshkur T. V. Сhoice of ventricular arrhythmia therapy in coronary artery disease. Russian Journal of Cardiology . 2020;25(7):3707. (In Russ.) doi:10.15829/1560-4071-2020-3707
ARRHYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY IN RECIPIENTS ON HEART TRANSPLANT WAITING LIST
Simonenko M. A., Fedotov P. A., Kostareva A. A., Sazonova Yu. V., Malikov K. N., Bortsova M. A., Polyakova A. P., Berezina A. V., Zemskov I. A., Pervunina T. M., Mitrofanova L. B., Nikolaev G. V., Gordeev M. L., Sitnikova M. Yu., Karpenko M. A.
Abstract
Aim. To determine the clinical features of arrhythmogenic right ventricular dysplasia (ARVD) in recipients on heart transplant waiting list (WL) and after a heart transplantation (HTx).
Material and methods. From January 2010 to December 2018, we included 192 recipients in heart transplant waiting list (HTx WL) on behalf of Almazov National Medical Research Center. ARVD was diagnosed in 4 subjects (F. Marcus et al. criteria, 2010). All 4 patients (female, mean age 46,5 years-old (16-54-year-old)) underwent HTx. Prior to HTx, arrhythmias (atrial fibrillation, atrial flutter) were diagnosed in 3 recipients. In patient №2, pacemaker in VVI mode was implanted due to sick sinus syndrome (SSS) and tachycardia-bradycardia syndrome and others underwent ICD implantation.
Results. Survival after HTx was 30,9 (3,9-46,2) months. All recipients were treated with triple-drug immunosuppressive therapy (calcineurin inhibitors, mycophenolic acid, steroids) and induction with Basiliximab. All patients experienced high sensitivity to immunosuppressive therapy (agranulocytosis), and therefore a colonystimulating factor was administered to all of them. After immunosuppression reduction (Tacrolimus plus Methylprednisolone) agranulocytosis did not recur.
Conclusion. ARVD is a rare disease in the structure of end-stage heart failure in recipients in HTx WL. An examination of this pathology is necessary to manage patients on-time with surgical treatment (ICD, HTx). According to our results, causal variants in desmosome genes were determined in 1 from 4 patients and simultaneous presence of two unique genetic variants in the RKR2 gene were found in one. A special feature of post-HTx management was the development of agranulocytosis, which once again underlines the need for a personalized approach to the selection of the immunosuppressive therapy.
Key words: arrhythmogenic right ventricular cardiomyopathy, heart failure, heart transplantation
Relationships and Activities. This work was supported by a grant from Saint Petersburg State University 11934817 and a grant from the Russian Foundation for Basic Research 19-015-00313.
Almazov National Medical Research Center, St. Petersburg, Russia.
Simonenko M. A.* ORCID: 0000-0003-3228-1188, Fedotov P. A. ORCID: 0000-0002-7452-1971, Kostareva A. A. ORCID: 0000-0002-9349-6257, Sazonova Yu. V. ORCID: 0000-0002-7825-3513, Malikov K. N. ORCID: 0000-0003-4896-1516, Bortsova M. A. ORCID: 0000-0002-9694-7850, Polyakova A. P. ORCID: 0000-0001-8273-6254, Berezina A. V. ORCID: 0000-0002-5770-3845, Zemskov I. A. ORCID: 0000-0003-3020-7398, Pervunina T. M. ORCID: 0000-0001-9948-7303, Mitrofanova L. B. ORCID: 0000-0003-0735-7822, Nikolaev G. V. ORCID: 0000-0003-3235-4850, Gordeev M. L. ORCID: 0000-0002-8199-0813, Sitnikova M. Yu. ORCID: 0000-0002-0139-5177, Karpenko M. A. ORCID: 0000-0001-5398-5665.
*Corresponding author: dr.maria.simonenko@gmail.com
Received: 13.07.2019
Revision Received: 10.11.2019
Accepted: 11.11.2019
For citation: Simonenko M. A., Fedotov P. A., Kostareva A. A., Sazonova Yu. V., Malikov K. N., Bortsova M. A., Polyakova A. P., Berezina A. V., Zemskov I. A., Pervunina T. M., Mitrofanova L. B., Nikolaev G. V., Gordeev M. L., Sitnikova M. Yu., Karpenko M. A. Arrhythmogenic right ventricular cardiomyopathy in recipients on heart transplant waiting list. Russian Journal of Cardiology . 2020;25(7):3426. (In Russ.) doi:10.15829/1560-4071-2020-3426
LITERATURE REVIES
ROLE OF THE AUTONOMIC NERVOUS SYSTEM IN ATRIAL FIBRILLATION PATHOGENESIS
Popova E. P.1, Bogova O. T.2, Puzin S. N. 1,2,3, Fisenko V. P.1
Abstract
The aim of this review was to study the role of the autonomic nervous system in the pathogenesis of atrial fibrillation (AF), as well as to establish the relationship of autonomic regulation with other mechanisms underlying the AF. At present, the molecular and cellular mechanisms underlying the AF have not been precisely established. There is interest in evidence showing that both sympathetic outflow and an increased vagal tone can initiate and support AF. As modern studies have shown, autonomic cardiac regulation can be an important factor in the pathogenesis of AF.
Key words: pathogenesis of atrial fibrillation, trigger activity, reentry, autonomic nervous system.
Relationships and Activities: none.
1I.M. Sechenov First Moscow State Medical University, Moscow; 2Russian Medical Academy of Continuous Professional Education, Moscow; 3Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow Region, Russia.
Popova E. P.* ORCID: 0000-0002-1717-730X, Bogova O. T. ORCID: 0000-0001-5406-7225, Puzin S. N. ORCID: 0000-0003-1030-8319, Fisenko V. P. ORCID: 0000-0002-9080-5763.
*Corresponding author: kispo-pharm@mail.ru
Received: 18.12.2019
Revision Received: 27.12.2019
Accepted: 28.12.2019
For citation: Popova E. P., Bogova O. T., Puzin S. N., Fisenko V. P. Role of the autonomic nervous system in atrial fibrillation pathogenesis. Russian Journal of Cardiology. 2020;25(7):3663. (In Russ.) doi:10.15829/1560-4071-2020-3663
FEATURES OF ELECTROCARDIOGRAPHIC CHANGES IN NON-CORONAROGENIC SYNDROMES IN PATIENTS WITH COVID-19
Shlyakhto E. V., Parmon E. V., Berngardt E. R., Zhabina E. S.
Abstract
The ongoing pandemic caused by virus SARS-CoV-2 encourages the search for ways to save the population. Since people first encountered this disease, it is being actively studied, and updating medical information is extremely valuable. Since people first encountered this disease, it is being actively studied, and updating medical information is extremely valuable. The purpose of this review is to systematize the literature on the effect of SARS-CoV-2 on the cardiovascular system, focusing on changes in the surface electrocardiogram depending on the clinical course of the disease, the characteristics of the treatment and outcomes, and the possible identification of electrocardiographic predictors of complications, as well as sudden cardiac death in patients with non-coronarogenic syndromes with new virus infection (COVID-19).
Key words: COVID-19, SARS-CoV-2, electrocardiography, cardiovascular system, predictors of the adverse course.
Relationships and Activities: none.
Almazov National Medical Research Center, St. Petersburg, Russia.
Shlyakhto E. V. ORCID: 0000-0003-2929-0980, Parmon E. V. ORCID: 0000-0002-0852-631X, Berngardt E. R.* ORCID: 0000-0002-0734-0791, Zhabina E. S. ORCID: 0000-0002-9001-8743.
*Corresponding author: edbern@mail.ru
Received: 13.07.2020
Revision Received: 24.07.2020
Accepted: 27.07.2020
For citation: Shlyakhto E. V., Parmon E. V., Berngardt E. R., Zhabina E. S. Features of electrocardiographic changes in non-coronarogenic syndromes in patients with COVID-19. Russian Journal of Cardiology. 2020;25(7):4019. (In Russ.) doi:10.15829/1560-4071-2020-4019
2019 ESC Guidelines for the management of patients with supraventricular tachycardia
The Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC)
Developed in collaboration with the Association for European Paediatric and Congenital Cardiology (AEPC)
Russian Journal of Cardiology . 2020;25(7):3864. (In Russ.) doi:10.15829/1560-4071-2020-7-3864
Key words: guidelines, arrhythmia, tachycardia, supraventricular, flutter, atrioventricular, re-entrant, focal, macro-re-entrant, junctional, nodal, pre-excitation, ablation.
