Svetana Garkina - Academia.edu (original) (raw)
Papers by Svetana Garkina
Introduction. Radiofrequency ablation (RFA) is an established treatment of post-myocardial infarc... more 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. E...
Funding Acknowledgements Type of funding sources: None. Background Wearable monitors and external... more Funding Acknowledgements Type of funding sources: None. Background Wearable monitors and external smart-phone enabled devices represent the new era in remote patient management during covid-19 pandemy. There is growing evidence showing that arrhythmias are one of the major complications of SARS-CoV-2 infection especially in high risk group of patients. Methods We enrolled 34consecutive patients with confirmed diagnosis of SARS-CoV-2 (mean age62.45 ± 5.25years, 16male). Remote wireless rhythm monitoring was performed using portative ECG sensor.Average follow-up period was 21 days during in-hospital stage and 2 months after discharge. Results Among hospitalized patients with verified SARS-CoV-2 some presented different arrhytmias before admission (9 patients had atrial fibrillation and 11 patients had history of ventricular extrasystoles and non-sustained ventricular tachycardia). One patient underwent cardiac transplantation 1.5 years ago (female 38 years old with a history of dilate...
European Heart Journal
Background Atrial fibrillation (AF) is a global health care problem with evidence suggesting an i... more Background Atrial fibrillation (AF) is a global health care problem with evidence suggesting an increasing prevalence and incidence worldwide. Undiagnosed AF represents the most common cause of thromboembolic events. The aim of the study was to analyze the clinical profile and outcome in patients with cardioembolic stroke and newly detected AF. Methods We enrolled 139 consecutive patients with atrial fibrillation and confirmed diagnosis of ischemic stroke (mean age 72.25±6.33 years, 59 male). Follow-up period was 1 year since the episode of acute stroke. Results All patients with verified cardioembolic stroke were first diagnosed with AF on admission. Patients with AF were characterized by polymorbidity (hypertension was diagnosed in 96 patients, a concomitant chronic renal failure was observed in 60 cases while a complicated course of coronary heart disease – in 35 patients, 22 patients were diagnosed with diabetes mellitus, while 9 people had a long smoking history). Mean value of...
European Heart Journal
Background Although there is a tremendous improvement in mapping and ablation techniques over the... more Background Although there is a tremendous improvement in mapping and ablation techniques over the last decades, the recurrence rate of ventricular tachycardia (VT) in patients with structural heart diseases following endo-epicardial catheter ablation remains high. Purpose To determine predictors of VT recurrence in patients with structural heart disease after combined endo-epicardial radiofrequency (RF) VT ablation. Methods This prospective single-center study included 39 patients (34 men and 5 women, mean age 49.6±16.0 years), who underwent endo-epicardial mapping and ablation of the VT substrate. Etiology of structural heart diseases included: previous myocardial infarction (n=15); non-ischemic cardiomyopathy (n=24: 15 – arrhythmogenic right ventricular cardiomyopathy (ARVC), 6 – myocarditis, 3 – unspecified). First-line epicardial access was performed in 16 patients, as a second approach – in 23 subjects. We evaluated total ventricular myocardial areas, epi- and endocardial areas...
Science and Innovations in Medicine
Ase report. This clinical case illustrates the example of prenatal care of a young woman with ver... more Ase report. This clinical case illustrates the example of prenatal care of a young woman with verified long QT syndrome (LQTS) type 2 with implanted cardioverter-defibrillator (ICD). In the course of pregnancy she had physiological sinus tachycardia, though the life-threatening ventricular arrhythmias and ICD shocks were not registered. On the 38th week of pregnancy the woman underwent the planned caesarean delivery (due to obstetrics indications) with live child. In the post-partum period she continued to experience recurrent VF episodes terminated after the adequate ICD shocks. Life-threatening arrhythmias were triggered by group PVC registered in the settings of persistent bradycardia. At the moment the number of the adequate ICD shocks reduced supported by betablocker therapy, the patient remains on continued standard monitoring. Discussion. Numerous cases of favourable course and even benefits in clinical and functional status during pregnancy in patients with LQTS are reported...
Fundamental and Clinical Medicine
Aim. To evaluate basic clinicopathologicalcharacteristics of patients with atrial fibrillationand... more Aim. To evaluate basic clinicopathologicalcharacteristics of patients with atrial fibrillationand pharmacological anamnesis at the time of cardioembolicstroke.Material and Methods. Study included 99 patientswith atrial fibrillation admitted to SeredavinSamara Regional Clinical Hospital due to cardioembolicstroke. The follow-up duration was 1year.Results. The average age of the patients was69.1 ± 8.7 years. Patients with atrial fibrillationand acute cardioembolic stroke were characterizedby multimorbidity. Arterial hypertension, chronickidney disease, and diabetes mellitus were diagnosedin 96/99 (97.0%), 60/99 (60.6%), and 22/99(22.2%) patients, respectively. Average risk scoreaccording to the CHA2DS2-VASc scale before admissionwas 4.51 ± 1.2 points; therefore, 96 patientshad indications for anticoagulant therapy (≥2 points on the CHA2DS2-VASc scale). However,adequate prevention of thromboembolic complicationsbefore admission was carried out only in16/99 (16.2%) patients.Conclusion. ...
EP Europace
patients without clinical recurrence, 12 of 13 (92%) showed termination of AF during the procedur... more patients without clinical recurrence, 12 of 13 (92%) showed termination of AF during the procedure. In addition, repetitive triggers from pulmonary vein (PV) or superior vena cava (SVC) were observed in 8 of 13 (62%) patients. Repeat procedures were performed in 18 patients (35%) and sinus rhythm was maintained in 45 patients (87%) while 38 (84%) are taking antiarrhythmic drugs. Conclusions: The recurrence rate after CA of longstanding persistent AF with unsuccessful ECV was very high, especially in patients with failure of restoration of sinus rhythm. However, the patients with repetitive triggers from PV or SVC showed favorable outcome. A further study to investigate the non-invasive predictors of PV or SVC dependent AF is warranted.
European Heart Journal, Aug 1, 2017
When the engine fails-Challenging heart failure cases / Unique situations in the management of ve... more When the engine fails-Challenging heart failure cases / Unique situations in the management of ventricular arrhythmias daily whereas tripterygium and hydroxychloroquine were remained the primary dosage. The patient came to the cardiology department for return visit on May 20th, 2016. Her BP was 100/70mmHg, heart rate was 65/min. It was surprising that the QRS interval became normal and CLBBB disappeared (Figure 1B, upper panel). The echocardiography revealed the left ventricular contractility recovered to normal. The LVDd was decreased to 5.7cm and LVEF was increased to 50% (Figure 1B, lower panel). The cardiac remodeling was reversed to a certain degree. We suspected the patient suffered from IgG4 related heart disease and suggested her myocardial biopsy. She rejected our recommendation for fear of the procedural risk. During the following half a year, the patient maintained the medication. On December 15th, 2016, the blood test showed IgG4 level was 5.18g/L and another echocardiography demonstrated that LVDd 5.6cm and LVEF 53%. In December 2017, methylprednisolone was reduced to 6mg once daily while tripterygium and hydroxychloroquine were still kept the primary dosage. Perindopril was kept 8mg once daily and Metoprolol succinate was kept 47.5mg once daily. The patient had no symptoms of heart failure. In May 2017, the IgG4 was retested 4.78g/L. The echocardiography showed LVDd 5.65cm, LVEF 50% and mild regurgitation of mitral and tricuspid valves. The patient was required to maintain current medication.
Jounal of arrhythmology
Purpose: to compare epicardial and endocardial surface area of local abnormal ventricular activit... more Purpose: to compare epicardial and endocardial surface area of local abnormal ventricular activity (LAVA) and low voltage zone (LVZ) and effectiveness of endocardial versus combined endo-epicardial ablation of ventricular arrhythmias in ARVC patients.Methods: a prospective observational “case-control” study comprised 20 patients with ARVC and ventricular arrhythmias referred to catheter ablation. The study group with epicardial approach (EPI group) comprised 10 patients with sustained VT, who signed informed consent for the epicardial access. The control group (ENDO group) comprised 10 patients with sustained VT or frequent symptomatic premature ventricular contractions (PVC). Electroanatomical voltage mapping and LAVA ablation was performed.Results: the patient mean age was 41.4±13.8 years, 70% males; 90% patients in the EPI group had sustained VT, 50% - in the ENDO group. In the EPI group the endocardial unipolar low voltage zone area (LVZ) significantly prevailed over the bipolar...
Journal of Cardiovascular Diseases & Diagnosis, 2018
Introduction: The last decades demonstrated significant progress in catheter treatment techniques... more Introduction: The last decades demonstrated significant progress in catheter treatment techniques, with several theories and findings presenting the detailed knowledge of the substrates and patterns of ventricular tachyarrhythmias with structural heart diseases. It is still an actively developing method of treatment requiring detailed assessment including electrical storm. Study objectives: To estimate efficacy and survival in patients with ischaemic cardiomyopathy and ventricular tachyarrhythmias undergoing catheter ablation. Materials and Methods: Study enrolled patients with prior myocardial infarction and documented episodes of sustained ventricular tachyarrhythmia (within not less than 40 days after acute myocardial infarction) registered on ECG, 24 hours Holter monitor or during ICD programming and/or ICD telemetry. We evaluated 72 patients (mean age of 64 ± 13 years, 63 males) with postinfarction ventricular tachyarrhythmias. Among them there were 12 patients with emergent catheter ablation of electrical storm. Results: During 35 ± 16 months of follow-up period 63% of patients didn't present any sustained ventricular tachyarrhythmias. Perioperative fatal outcomes were not registered. The implemented strategy did not deteriorate left ventricle ejection fraction after catheter treatment according to control echocardiography data (30 ± 13% vs 29 ± 11% after RFA, p>0.05). In patients with catheter ablation of electrical storm during the first year of follow-up the recurrent ventricular tachycardias were registered in 33% of cases (4 patients). In single case the rare paroxysms were effectively stopped by ICD anti-tachycardia pacing without electrical storm. During follow-up period the recurrent electrical storms were not registered, general mortality rate from progressing heart failure was 25% (3 patients) in the first 18 months after catheter treatment. Acute and long-term efficacy of electrical storm elimination was equal to 100%, whereas complete reduction of arrhythmias during the long-term period was achieved in 75% of patients (including repeated RFA sessions). Most of patients (67%) presented clinically relevant heart failure with high functional class (NYHA III-IV) at the moment of electrical storm and 6 of 8 patients then had significant improvement after catheter ablation. Conclusion: During 5 years of follow up the overall efficacy of catheter elimination of ventricular tachyarrhythmias and patients' survival was 63% and 78% respectively. The was no statistically significant difference in mortality rate in patients with effective catheter treatment and those with recurrent ventricular tachyarrhythmia after RFA.
European Heart Journal, Aug 1, 2017
ated with higher rate of bleeding events when compared to the lowest quartile on univariate analy... more ated with higher rate of bleeding events when compared to the lowest quartile on univariate analysis. After adjustment for the HAS BLED score, monocyte counts were still independently related to bleeding (p=0.04 all) (Table). Use of OAC did not significantly increase bleeding events (5% vs 4% for patients taking OAC vs no OAC respectively) Conclusion: Higher monocyte count is strongly predictive of major bleeding events in patients with AF. This is consistent with the role of monocytes in inflammation and prognostication in AF, and further supports their involvement in thrombosis and fibrinolysis.
"Arterial’naya Gipertenziya" ("Arterial Hypertension")
Design and methods. We observed 64 geriatric patients (67,3 3,9 years old) with chronic heart f... more Design and methods. We observed 64 geriatric patients (67,3 3,9 years old) with chronic heart failure (CHF) and arterial hypertension (AH), which had been divided into 2 groups. The fi rst group included 32 patients who received classical group educational model, the second - 32 patients who were individually educated based on effective medical consulting. All patients received standard treatment of AH and CHF (angiotensin-converting enzyme inhibitors, -blockers, diuretics, aldosterone antagonists and digoxin). Results. Initially less than 14 % of patients had good compliance. After 12 months of intervention, medication adherence increased to 59,4 % in I group and 87,5 % in II group. In 6 months the dynamics of clinical symptoms and functional status was positive in all groups, particularly after individual education, the difference between groups was signifi cant in 12 months. Only in II group we observed signifi cant reduction of emergency calls and extra hospital admissions du...
Kardiologiia
Aim. To evaluate the effect of atrial fibrillation (AF) catheter ablation (CA) on long-term freed... more 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 foll...
Journal of Clinical Practice
The review discusses accumulated to date scientific data on dilated cardiomyopathy: causative fac... more The review discusses accumulated to date scientific data on dilated cardiomyopathy: causative factors, clinical manifestations, sudden cardiac death in patients with the disease and its risk-stratification in the light of National guidelines on the definition of risk and prevention of sudden cardiac death (2012). A case of a patient with dilated cardiomyopathy and high-risk of sudden cardiac death is presented.
European Heart Journal
Ventricular arrhythmias and sudden cardiac death-Diagnostic methods 1023 (28,0%) or ventricular (... more Ventricular arrhythmias and sudden cardiac death-Diagnostic methods 1023 (28,0%) or ventricular (23,9%) arrhythmias. Analyzing the follow ups, we found that older athletes had higher complexity and prevalence of arrhythmias, whereas younger people had higher frequency of arrhythmias in the 24h recordings. Arrhythmic peaks in each of the three age groups were found respectively at 14±2 years, 24±4,5 years and 58±11,1 yrs. These findings lead us to say that in sports population arrhythmias are a common event and they are often compatible with sports practice.
"Arterial’naya Gipertenziya" ("Arterial Hypertension")
European Heart Journal, 2013
Early diagnosis and institution of disease specific therapy results in improvement of LVEF in maj... more Early diagnosis and institution of disease specific therapy results in improvement of LVEF in majority of patients.
Background: Head-up tilt testing (HUT) plays a pivotal role in the management of vasovagal syncop... more Background: Head-up tilt testing (HUT) plays a pivotal role in the management of vasovagal syncope (VVS). Heart rate variability (HRV) is a well-known method used for noninvasive evaluation of autonomic nervous system activity. However, different results have been obtained in studies that have evaluated the HRV response to HUT in patients with VVS. Methods: One hundred fourteen patients with recurrent VVS were enrolled in the study. According to the results of HUT, patients were divided into five groups: positive (n = 30) and negative (n = 23) Westminster; positive (n = 44) and negative (n = 11) Italian. Fourteen healthy volunteers with no history of syncope comprised the control group. Spectral indices of HRV variability were analyzed for three short-term intervals. Results: Both protocols showed similar distribution of responses to tilt-testing. In the supine position, significant differences were observed between patients from groups 1, 2 and 3 in comparison with the control and Italian negative groups. They had significantly lower initial results of LF 1 [nu] and LF 1 /HF 1 ratio, and higher HF 1 [nu] values. The onset of HUT in patients with positive Westminster protocol was characterized by an almost twofold increase in LF [nu] and decrease in HF [nu] compared to all other patients. LF 2 /HF 2 ratio in the Westminster positive group had increased more than five times since the baseline level, while during the last period, LF 3 /HF 3 ratio had increased more than six times. Conclusions: Patients with VVS have disturbed sympathovagal balance at rest. Our data suggests that the results of HUT could be predicted by analyzing the spectral parameters of HRV during the first five minutes of the test. The reaction to orthostasis in patients with syncope during the Westminster protocol was more severe compared to the Italian protocol group and the control group. Vasovagal response during the Italian protocol may be triggered by drug-induced vasodilatation.
European Heart Journal
Background Ventricular arrhythmias contribute to significant escalation of mortality rate in pati... more Background Ventricular arrhythmias contribute to significant escalation of mortality rate in patients with ischemic cardiomyopathy (ICM). Risk of sudden cardiac death (SCD) could be reduced after implantation of a cardioverter-defibrillator (ICD), yet at the same time more frequent shock episodes are associated with poor life quality and higher hospitalization rate. Radiofrequency (RF) ablation of triggering ventricular premature beats or substrate-based catheter treatment are considered to be effective in patients with ICM but prognosis remains controversial. Objective To evaluate role of catheter treatment of ventricular tachyarrhythmias (VTA) and its effect on survival in patients with ischemic cardiomyopathy. Methods We enrolled 72 consecutive patients (mean age 64±13 years, 63 male) with prior myocardial infarction (more than 40 days ago) and documented ventricular tachycardia (VT) episodes, including 12 patients which underwent emergency electrical storm ablation. Considering ...
Introduction. Radiofrequency ablation (RFA) is an established treatment of post-myocardial infarc... more 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. E...
Funding Acknowledgements Type of funding sources: None. Background Wearable monitors and external... more Funding Acknowledgements Type of funding sources: None. Background Wearable monitors and external smart-phone enabled devices represent the new era in remote patient management during covid-19 pandemy. There is growing evidence showing that arrhythmias are one of the major complications of SARS-CoV-2 infection especially in high risk group of patients. Methods We enrolled 34consecutive patients with confirmed diagnosis of SARS-CoV-2 (mean age62.45 ± 5.25years, 16male). Remote wireless rhythm monitoring was performed using portative ECG sensor.Average follow-up period was 21 days during in-hospital stage and 2 months after discharge. Results Among hospitalized patients with verified SARS-CoV-2 some presented different arrhytmias before admission (9 patients had atrial fibrillation and 11 patients had history of ventricular extrasystoles and non-sustained ventricular tachycardia). One patient underwent cardiac transplantation 1.5 years ago (female 38 years old with a history of dilate...
European Heart Journal
Background Atrial fibrillation (AF) is a global health care problem with evidence suggesting an i... more Background Atrial fibrillation (AF) is a global health care problem with evidence suggesting an increasing prevalence and incidence worldwide. Undiagnosed AF represents the most common cause of thromboembolic events. The aim of the study was to analyze the clinical profile and outcome in patients with cardioembolic stroke and newly detected AF. Methods We enrolled 139 consecutive patients with atrial fibrillation and confirmed diagnosis of ischemic stroke (mean age 72.25±6.33 years, 59 male). Follow-up period was 1 year since the episode of acute stroke. Results All patients with verified cardioembolic stroke were first diagnosed with AF on admission. Patients with AF were characterized by polymorbidity (hypertension was diagnosed in 96 patients, a concomitant chronic renal failure was observed in 60 cases while a complicated course of coronary heart disease – in 35 patients, 22 patients were diagnosed with diabetes mellitus, while 9 people had a long smoking history). Mean value of...
European Heart Journal
Background Although there is a tremendous improvement in mapping and ablation techniques over the... more Background Although there is a tremendous improvement in mapping and ablation techniques over the last decades, the recurrence rate of ventricular tachycardia (VT) in patients with structural heart diseases following endo-epicardial catheter ablation remains high. Purpose To determine predictors of VT recurrence in patients with structural heart disease after combined endo-epicardial radiofrequency (RF) VT ablation. Methods This prospective single-center study included 39 patients (34 men and 5 women, mean age 49.6±16.0 years), who underwent endo-epicardial mapping and ablation of the VT substrate. Etiology of structural heart diseases included: previous myocardial infarction (n=15); non-ischemic cardiomyopathy (n=24: 15 – arrhythmogenic right ventricular cardiomyopathy (ARVC), 6 – myocarditis, 3 – unspecified). First-line epicardial access was performed in 16 patients, as a second approach – in 23 subjects. We evaluated total ventricular myocardial areas, epi- and endocardial areas...
Science and Innovations in Medicine
Ase report. This clinical case illustrates the example of prenatal care of a young woman with ver... more Ase report. This clinical case illustrates the example of prenatal care of a young woman with verified long QT syndrome (LQTS) type 2 with implanted cardioverter-defibrillator (ICD). In the course of pregnancy she had physiological sinus tachycardia, though the life-threatening ventricular arrhythmias and ICD shocks were not registered. On the 38th week of pregnancy the woman underwent the planned caesarean delivery (due to obstetrics indications) with live child. In the post-partum period she continued to experience recurrent VF episodes terminated after the adequate ICD shocks. Life-threatening arrhythmias were triggered by group PVC registered in the settings of persistent bradycardia. At the moment the number of the adequate ICD shocks reduced supported by betablocker therapy, the patient remains on continued standard monitoring. Discussion. Numerous cases of favourable course and even benefits in clinical and functional status during pregnancy in patients with LQTS are reported...
Fundamental and Clinical Medicine
Aim. To evaluate basic clinicopathologicalcharacteristics of patients with atrial fibrillationand... more Aim. To evaluate basic clinicopathologicalcharacteristics of patients with atrial fibrillationand pharmacological anamnesis at the time of cardioembolicstroke.Material and Methods. Study included 99 patientswith atrial fibrillation admitted to SeredavinSamara Regional Clinical Hospital due to cardioembolicstroke. The follow-up duration was 1year.Results. The average age of the patients was69.1 ± 8.7 years. Patients with atrial fibrillationand acute cardioembolic stroke were characterizedby multimorbidity. Arterial hypertension, chronickidney disease, and diabetes mellitus were diagnosedin 96/99 (97.0%), 60/99 (60.6%), and 22/99(22.2%) patients, respectively. Average risk scoreaccording to the CHA2DS2-VASc scale before admissionwas 4.51 ± 1.2 points; therefore, 96 patientshad indications for anticoagulant therapy (≥2 points on the CHA2DS2-VASc scale). However,adequate prevention of thromboembolic complicationsbefore admission was carried out only in16/99 (16.2%) patients.Conclusion. ...
EP Europace
patients without clinical recurrence, 12 of 13 (92%) showed termination of AF during the procedur... more patients without clinical recurrence, 12 of 13 (92%) showed termination of AF during the procedure. In addition, repetitive triggers from pulmonary vein (PV) or superior vena cava (SVC) were observed in 8 of 13 (62%) patients. Repeat procedures were performed in 18 patients (35%) and sinus rhythm was maintained in 45 patients (87%) while 38 (84%) are taking antiarrhythmic drugs. Conclusions: The recurrence rate after CA of longstanding persistent AF with unsuccessful ECV was very high, especially in patients with failure of restoration of sinus rhythm. However, the patients with repetitive triggers from PV or SVC showed favorable outcome. A further study to investigate the non-invasive predictors of PV or SVC dependent AF is warranted.
European Heart Journal, Aug 1, 2017
When the engine fails-Challenging heart failure cases / Unique situations in the management of ve... more When the engine fails-Challenging heart failure cases / Unique situations in the management of ventricular arrhythmias daily whereas tripterygium and hydroxychloroquine were remained the primary dosage. The patient came to the cardiology department for return visit on May 20th, 2016. Her BP was 100/70mmHg, heart rate was 65/min. It was surprising that the QRS interval became normal and CLBBB disappeared (Figure 1B, upper panel). The echocardiography revealed the left ventricular contractility recovered to normal. The LVDd was decreased to 5.7cm and LVEF was increased to 50% (Figure 1B, lower panel). The cardiac remodeling was reversed to a certain degree. We suspected the patient suffered from IgG4 related heart disease and suggested her myocardial biopsy. She rejected our recommendation for fear of the procedural risk. During the following half a year, the patient maintained the medication. On December 15th, 2016, the blood test showed IgG4 level was 5.18g/L and another echocardiography demonstrated that LVDd 5.6cm and LVEF 53%. In December 2017, methylprednisolone was reduced to 6mg once daily while tripterygium and hydroxychloroquine were still kept the primary dosage. Perindopril was kept 8mg once daily and Metoprolol succinate was kept 47.5mg once daily. The patient had no symptoms of heart failure. In May 2017, the IgG4 was retested 4.78g/L. The echocardiography showed LVDd 5.65cm, LVEF 50% and mild regurgitation of mitral and tricuspid valves. The patient was required to maintain current medication.
Jounal of arrhythmology
Purpose: to compare epicardial and endocardial surface area of local abnormal ventricular activit... more Purpose: to compare epicardial and endocardial surface area of local abnormal ventricular activity (LAVA) and low voltage zone (LVZ) and effectiveness of endocardial versus combined endo-epicardial ablation of ventricular arrhythmias in ARVC patients.Methods: a prospective observational “case-control” study comprised 20 patients with ARVC and ventricular arrhythmias referred to catheter ablation. The study group with epicardial approach (EPI group) comprised 10 patients with sustained VT, who signed informed consent for the epicardial access. The control group (ENDO group) comprised 10 patients with sustained VT or frequent symptomatic premature ventricular contractions (PVC). Electroanatomical voltage mapping and LAVA ablation was performed.Results: the patient mean age was 41.4±13.8 years, 70% males; 90% patients in the EPI group had sustained VT, 50% - in the ENDO group. In the EPI group the endocardial unipolar low voltage zone area (LVZ) significantly prevailed over the bipolar...
Journal of Cardiovascular Diseases & Diagnosis, 2018
Introduction: The last decades demonstrated significant progress in catheter treatment techniques... more Introduction: The last decades demonstrated significant progress in catheter treatment techniques, with several theories and findings presenting the detailed knowledge of the substrates and patterns of ventricular tachyarrhythmias with structural heart diseases. It is still an actively developing method of treatment requiring detailed assessment including electrical storm. Study objectives: To estimate efficacy and survival in patients with ischaemic cardiomyopathy and ventricular tachyarrhythmias undergoing catheter ablation. Materials and Methods: Study enrolled patients with prior myocardial infarction and documented episodes of sustained ventricular tachyarrhythmia (within not less than 40 days after acute myocardial infarction) registered on ECG, 24 hours Holter monitor or during ICD programming and/or ICD telemetry. We evaluated 72 patients (mean age of 64 ± 13 years, 63 males) with postinfarction ventricular tachyarrhythmias. Among them there were 12 patients with emergent catheter ablation of electrical storm. Results: During 35 ± 16 months of follow-up period 63% of patients didn't present any sustained ventricular tachyarrhythmias. Perioperative fatal outcomes were not registered. The implemented strategy did not deteriorate left ventricle ejection fraction after catheter treatment according to control echocardiography data (30 ± 13% vs 29 ± 11% after RFA, p>0.05). In patients with catheter ablation of electrical storm during the first year of follow-up the recurrent ventricular tachycardias were registered in 33% of cases (4 patients). In single case the rare paroxysms were effectively stopped by ICD anti-tachycardia pacing without electrical storm. During follow-up period the recurrent electrical storms were not registered, general mortality rate from progressing heart failure was 25% (3 patients) in the first 18 months after catheter treatment. Acute and long-term efficacy of electrical storm elimination was equal to 100%, whereas complete reduction of arrhythmias during the long-term period was achieved in 75% of patients (including repeated RFA sessions). Most of patients (67%) presented clinically relevant heart failure with high functional class (NYHA III-IV) at the moment of electrical storm and 6 of 8 patients then had significant improvement after catheter ablation. Conclusion: During 5 years of follow up the overall efficacy of catheter elimination of ventricular tachyarrhythmias and patients' survival was 63% and 78% respectively. The was no statistically significant difference in mortality rate in patients with effective catheter treatment and those with recurrent ventricular tachyarrhythmia after RFA.
European Heart Journal, Aug 1, 2017
ated with higher rate of bleeding events when compared to the lowest quartile on univariate analy... more ated with higher rate of bleeding events when compared to the lowest quartile on univariate analysis. After adjustment for the HAS BLED score, monocyte counts were still independently related to bleeding (p=0.04 all) (Table). Use of OAC did not significantly increase bleeding events (5% vs 4% for patients taking OAC vs no OAC respectively) Conclusion: Higher monocyte count is strongly predictive of major bleeding events in patients with AF. This is consistent with the role of monocytes in inflammation and prognostication in AF, and further supports their involvement in thrombosis and fibrinolysis.
"Arterial’naya Gipertenziya" ("Arterial Hypertension")
Design and methods. We observed 64 geriatric patients (67,3 3,9 years old) with chronic heart f... more Design and methods. We observed 64 geriatric patients (67,3 3,9 years old) with chronic heart failure (CHF) and arterial hypertension (AH), which had been divided into 2 groups. The fi rst group included 32 patients who received classical group educational model, the second - 32 patients who were individually educated based on effective medical consulting. All patients received standard treatment of AH and CHF (angiotensin-converting enzyme inhibitors, -blockers, diuretics, aldosterone antagonists and digoxin). Results. Initially less than 14 % of patients had good compliance. After 12 months of intervention, medication adherence increased to 59,4 % in I group and 87,5 % in II group. In 6 months the dynamics of clinical symptoms and functional status was positive in all groups, particularly after individual education, the difference between groups was signifi cant in 12 months. Only in II group we observed signifi cant reduction of emergency calls and extra hospital admissions du...
Kardiologiia
Aim. To evaluate the effect of atrial fibrillation (AF) catheter ablation (CA) on long-term freed... more 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 foll...
Journal of Clinical Practice
The review discusses accumulated to date scientific data on dilated cardiomyopathy: causative fac... more The review discusses accumulated to date scientific data on dilated cardiomyopathy: causative factors, clinical manifestations, sudden cardiac death in patients with the disease and its risk-stratification in the light of National guidelines on the definition of risk and prevention of sudden cardiac death (2012). A case of a patient with dilated cardiomyopathy and high-risk of sudden cardiac death is presented.
European Heart Journal
Ventricular arrhythmias and sudden cardiac death-Diagnostic methods 1023 (28,0%) or ventricular (... more Ventricular arrhythmias and sudden cardiac death-Diagnostic methods 1023 (28,0%) or ventricular (23,9%) arrhythmias. Analyzing the follow ups, we found that older athletes had higher complexity and prevalence of arrhythmias, whereas younger people had higher frequency of arrhythmias in the 24h recordings. Arrhythmic peaks in each of the three age groups were found respectively at 14±2 years, 24±4,5 years and 58±11,1 yrs. These findings lead us to say that in sports population arrhythmias are a common event and they are often compatible with sports practice.
"Arterial’naya Gipertenziya" ("Arterial Hypertension")
European Heart Journal, 2013
Early diagnosis and institution of disease specific therapy results in improvement of LVEF in maj... more Early diagnosis and institution of disease specific therapy results in improvement of LVEF in majority of patients.
Background: Head-up tilt testing (HUT) plays a pivotal role in the management of vasovagal syncop... more Background: Head-up tilt testing (HUT) plays a pivotal role in the management of vasovagal syncope (VVS). Heart rate variability (HRV) is a well-known method used for noninvasive evaluation of autonomic nervous system activity. However, different results have been obtained in studies that have evaluated the HRV response to HUT in patients with VVS. Methods: One hundred fourteen patients with recurrent VVS were enrolled in the study. According to the results of HUT, patients were divided into five groups: positive (n = 30) and negative (n = 23) Westminster; positive (n = 44) and negative (n = 11) Italian. Fourteen healthy volunteers with no history of syncope comprised the control group. Spectral indices of HRV variability were analyzed for three short-term intervals. Results: Both protocols showed similar distribution of responses to tilt-testing. In the supine position, significant differences were observed between patients from groups 1, 2 and 3 in comparison with the control and Italian negative groups. They had significantly lower initial results of LF 1 [nu] and LF 1 /HF 1 ratio, and higher HF 1 [nu] values. The onset of HUT in patients with positive Westminster protocol was characterized by an almost twofold increase in LF [nu] and decrease in HF [nu] compared to all other patients. LF 2 /HF 2 ratio in the Westminster positive group had increased more than five times since the baseline level, while during the last period, LF 3 /HF 3 ratio had increased more than six times. Conclusions: Patients with VVS have disturbed sympathovagal balance at rest. Our data suggests that the results of HUT could be predicted by analyzing the spectral parameters of HRV during the first five minutes of the test. The reaction to orthostasis in patients with syncope during the Westminster protocol was more severe compared to the Italian protocol group and the control group. Vasovagal response during the Italian protocol may be triggered by drug-induced vasodilatation.
European Heart Journal
Background Ventricular arrhythmias contribute to significant escalation of mortality rate in pati... more Background Ventricular arrhythmias contribute to significant escalation of mortality rate in patients with ischemic cardiomyopathy (ICM). Risk of sudden cardiac death (SCD) could be reduced after implantation of a cardioverter-defibrillator (ICD), yet at the same time more frequent shock episodes are associated with poor life quality and higher hospitalization rate. Radiofrequency (RF) ablation of triggering ventricular premature beats or substrate-based catheter treatment are considered to be effective in patients with ICM but prognosis remains controversial. Objective To evaluate role of catheter treatment of ventricular tachyarrhythmias (VTA) and its effect on survival in patients with ischemic cardiomyopathy. Methods We enrolled 72 consecutive patients (mean age 64±13 years, 63 male) with prior myocardial infarction (more than 40 days ago) and documented ventricular tachycardia (VT) episodes, including 12 patients which underwent emergency electrical storm ablation. Considering ...