Background. Clinical search for modern, more hemodynamically efficient areas for placing endocardial electrodes with constant cardiostimulation. Our aim is to study electrophysiological parameters and clinical results of His bundle direct stimulation, analyze traits of compromised electrode removal from the given heat area.

Materials and Methods. We examined 36 patients divided into two groups (18 patients in each group) according to the signs of transatrial (first) or transventricle (second) stimulation of His bundle. Up to 12 months from the implantation moment we analyzed electrocardiostimulation parameters, data of body-surface ECG, ultrasound dynamics of heart cavity sizes, life quality according to MOS SF-36 scale.

Results. In the first group time for electrical systole of ventricle myocardium (width QRS) was authentically less – 111 ± 13 ms comparing to the second – 134 ± 19 which corresponded to physiological pattern for myocardial ventricle activation, excluded dyssinchrony, left ventricle diastolic dysfunction, development of arrhythmogenic chronic cardiac insufficiency. Life quality in the first group was authentically higher – 71 ± 8,5 vs 63 ± 9,9 points in patients from the second group. Four electrodes (2 electrodes in each group) were removed due to exit-block development.

Conclusion. Implantation of transatrial electrode in the bundle of His area ensures stable fixation, lower risk of dislocation in the early postoperative period and eases its removal if coinciding indications occur. Clinical application of this medical approach is an impact for creating a peculiar endocardial electrode in native industry, supplying device and stimulator type DDD(R), with a spare ventricle canal which is rather timely regarding conditions for import substitution plan.

We analyzed influence of sinus rhythm restoration in patients with severe heart insufficiency and permanent atrial fibrillation on efficiency of cardiac resynchronization therapy. In the study we included 150 patients (76 female patients), mean age was 47,7±10,9 years, with chronic cardiac insufficiency III functional class (FC) according to NYHA with main diagnosis dilated cardiomyopathy (DCMP) and registered stable form of atrial fibrillation (AF). Complex QRS width varied from 146 ms to 240 ms (mean 183±32 ms), ejection fraction (EF) of left ventricle was 30,1±3,8%, EDV was 272,4±49,8 ml. six-minute distance was 247,8±57,3 m. Optimal medical therapy for CCI was ineffective from three to six months. All patients had CRT devices. Control assessment was performed in 36 months. Analysis of CRT results, for 36 months, demonstrated improved HR in 115 (76,7%). In this group for 3-year follow up period EF changed from 29,0±3,8% to 42,5±4,2% (р<0,0001), and increase rate was 18%, EDV decreased from 215,9±58,1 ml to 177,1±26,6 ml (p<0,0005), to 48 ml in general. In 35 (23,3%) patients during 36 months AF preserved, and in this group for 3 years, LV EF increased from 29,0±3,8% to 38,7±2,1%, and increase rate was 9%, EDV decreased from 215,9±58,1 ml to 200,7±39,1 ml.(p<0,0005), to 15ml in general. Thus, in patients with DCMP and severe cardiac insufficiency SR is a serious task, as it enables to achieve stable increase of EF and reduce EDV during all period of CRT.

Present study is based on diagnosis results of 61 patients with focal lesions in thyroid gland. In our paper we applied ultrasonic scanner Toshiba Aplio 500 with strain elastography function. All patients were indicated fine-needle aspiration biopsy and cytological examination of biopsy specimen. All patients were divided into two groups. The first group contained 19 patients with thyroid gland cancer, in the second group there were 42 patients with colloid cellular goiter. To assess results of strain elastography we applied scale Ueno with modification С. Asteria. After processing received results we had following data: focal lesions, valued in 3 and 4 points, were qualified properly in 15 patients, foci with 1 and 2 points were correct in 37 patients. Diagnostic efficiency for thyroid gland cancer diagnosis was: sensitivity – 78.9%, specificity – 88.1%, accuracy – 85.2%.

In the present article we describe a clinical case demonstrating our first application of thoracoscopic radiofrequency ablation with vacuum technology Estech Cobra Fusion in a patient, 46, with prolonged persistent atrial fibrillation. We discussed actual questions, performance and showed efficiency of thoracoscopic technologies for atrial fibrillation on a beating heart.

We demonstrated findings regarding left ventricle electrode implantation with CRT, and suggested alternative implantation version, and performed analysis of therapy efficiency in cases with transseptal implantation technique.

We present a clinical case with continuous recurrent ventricle tachycardia. Patient, 60, admitted with complaints on heart disorders, periods of unexpected total weakness, repeated episodes of pre-syncopal condition, frequent dizziness, which he has been experiencing for about a year. In the anamnesis patient had diagnosis of intermittent syndrome WPW with paroxysmal antidromic tachycardia, and we performed ablation for additional conducting atrioventricular connection. By results of examination we recommended ablation of arrhythmia substrate with the subsequent solution whether implantation of a cardioverter defibrillator was required. Stimulation and activation mapping was performed. The area of ventricular tachycardia substrate was defined in the septal part of the right ventricle outflow tract, and frequent ventricular ectopic activity – in the area of the anterio-lateral wall of LV outflow tract under the aortal valve. On the basis of radiofrequency impact series we observed ventricular disturbances discontinuation. After the performed operation the patient demonstrated clinical improvement. According to Holter ECG monitoring for jogging of group ventricular activity, and also ventricular tachycardia was not registered.

Secondary dilation (arrhythmogenic) cardiomyopathy in children after artificial pacemaker implantation occurs rather rare. Criteria for implantation are typical: expressed disorders of systemic ventricle function (lowering EF < 35% in dynamics) and prolongation of QRS interval more 120 ms. Heart transplantation is the only alternative. We present 2 cases with successful application of cardioresynchronizer for critical lowering EF at a time of AP implantation. We consider this method will assist in overcoming critical decompensated heart insufficiency and it is a good alternative to the only reliable approach in these children-heart transplantation. The age of patients is not a constraint factor.

At present heart transplantation is the most effective method for treating patients with terminal stage of heart insufficiency. And now the number of possible recipients exceeds the number of performing transplantations several times in the world [1]. Due to the limited number of donors there is a necessity to rational employment for donor organs [2]. Deficit of donor hearts urged on surgeons to extend selection criteria and demands for heart harvesting in so called suboptimal donors which leads to increased number and timeliness performance of transplantations [3, 4, 5]. In the present article we demonstrated two clinical cases with successful orthotopic heart transplantation (OHT) with donor organs usage, which differed rather significantly regarding aortic dimensions, and this fact necessitated performance of reduction aortoplasty in recipients. Besides, we presented a case with aт OHT patient with ascending aorta aneurism, complicated dissection type II DeBakey, who was indicated supracoronary grafting of the ascending aorta and a part of aortic arch before the transplantation.

This review is devoted to a method of sudden cardiac death (SCD) prevention by means of the implanted cardioverter defibrillators (ICD). In our study we present definition, epidemiology, mechanism and the nosological reasons of SCD. Further is the historical review of defibrillation development, cardioversion, creation and improvement of the implanted antiarrhytmic devices. Thus we present the analysis of the main clinical trials on ICD efficiency studying in primary and secondary prevention of SCD. The main advantages of these devices in patients with high risk of SCD development are shown.

In the present article we demonstrate data on epidemic nature of atrial fibrillation spread (AF) today, and describe economic and social consequences of abrupt increase in patient numbers. The strategy of AF treatment and significant restriction in opportunities of drug treatment is discussed. Intervention treatment was developed after discovery of pulmonary vein electric activity and its connection with induction and persisting arrhythmia. We described in details technique of catheter ablation in patients with paroxysmal and persisting atrial fibrillation. It is shown that despite a row of additional acceptances and approaches in catheter ablation, pulmonary vein isolation remains a cornerstone for AF successful treatment. Today there are two main approaches for catheter treatment: radio-frequency and cryoballoon isolation of pulmonary veins. Introduction of new modifications with a cryocylinder allows to reduce operation time and shorten complication development probability. Necessity for integrated approach to treat patients with persisting arrhythmia, further complications and possibility to develop new technologies is discussed. We consider team approach in treatment this category of patients to be extremely important.

Modem development of invasive arrhythmology is favorable for removal of problematic endocardial electrode removal in a great majority of cases. However such factors as increased average life expectancy of population, annual increase in absolute number of implantations, emergence of more difficult heart-implanted electronic devices, and together with it and average quantity of the implanted electrodes, maintain the most specified interest to the mentioned subject. The statistics, indications, the main surgical techniques, complications of the procedure of endocardial electrode removal are covered in the review