Analysis of the endocardial stage of treatment of tachyarhythmias after open interventions for atrial fibrillation. Experience of one center

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Abstract

AIM: To study EFI parameters and features of recurrent atrial tachyarrhythmias in patients who underwent surgical correction of AF.

MATERIALS AND METHODS: from January 2013 to December 2021, 447 combined interventions were performed to eliminate AF using the labyrinth-3 and left atrial labyrinth techniques with correction of CHD (congenital heart disease) and/or coronary artery disease.

Rhythm disturbances were detected in 57 (12.7%) patients at various follow-up periods. Endovascular interventions were performed in 39 patients. The average follow-up period after the endocardial stage was 34.37 (standard deviation 24.32) months. The median age of patients was 64 (58–67) years, 21 (54%) were men. The patients were divided into 2 groups: group 1 — after the classic biatrial (BA) labyrinth-3 — 23 (59%) patients, group 2 — after the left-atrial variant (LA) labyrinth-3 — 16 (41%) patients.

At the endocardial stage, electrophysiological studies (EFI) were performed to clarify the mechanism of arrhythmia, and ablation eliminated tachyarrhythmia. EFI protocol: revision of the pulmonary veins, determination of the isolation of the posterior wall of the LA assessment of atrial arrhythmia, elimination of arrhythmia, control induction of arrhythmia after ablation. After repeated intervention, patients were observed in the operating clinic every 3 months.

RESULTS: After the endocardial stage, a regular rhythm was determined in 19 (82.6%) patients of the BA group, 13 (92.9%) patients of the LA group (p = 0.914). Relapses in the form of AF were noted in 5 patients (4 — group 1 and 1 — group 2) group (p = 0.306) All relapses of tachyarrhythmia with an irregular cycle (AF) were detected in patients with AF before the endovascular stage In both groups, there were cases of restoration of conduction in the pulmonary veins — 10 (43.5%) patients after BA ablation and 1 (5.3%) patient after LA ablation. There are no recurrences of atrial arrhythmia after ablation of atrial flutter (arrhythmia with a stable cycle).

CONCLUSION: The endocardial stage is highly effective and demonstrates subsequent freedom from atrial arrhythmia in patients who have tachycardia with a regular cycle after both methods of surgical ablation of AF. Recurrent tachyarrhythmia in the form of AF (irregular cycle) is associated with a low probability of maintaining a regular atrial rhythm after a repeated endocardial procedure, due to the presence of structural and electrophysiological changes in the atrial myocardium.

About the authors

Anzhelika S. Postol

Federal Center for High Medical Technologies Kaliningrad; Baltic Federal University named after I. Kant

Author for correspondence.
Email: postol-75@mail.ru
ORCID iD: 0000-0003-0983-3773
SPIN-code: 1322-5069

Cand. Sci. (Med.), doctor of arrhythmology department of the Federal Center for High Medical Technologies of Healthcare Ministry of Russia, Kaliningrad; Senior Lecturer of Therapy of Immanuel Kant Baltic Federal University

Russian Federation, Kaliningrad; Kaliningrad

Georgy N. Antipov

Federal Center for High Medical Technologies Kaliningrad; Baltic Federal University named after I. Kant

Email: postol-75@mail.ru
ORCID iD: 0000-0002-7704-2669
SPIN-code: 5399-9578

Cand. Sci. (Med.), Head of the Cardiosurgical Department No. 2 of the Federal Center for High Medical Technologies, Kaliningrad

Russian Federation, Kaliningrad; Kaliningrad

Andrey V. Ivanchenko

Federal Center for High Medical Technologies Kaliningrad

Email: ivancha74@gmail.com
ORCID iD: 0000-0001-5501-4926

Head of the Department of Surgical Treatment of Complex Cardiac Arrhythmias and Electrocardiostimulation of the Federal Center for High Medical Technologies

Russian Federation, Kaliningrad

Vitaliy V. Lyashenko

Federal Center for High Medical Technologies Kaliningrad

Email: vitalylyashenko5@gmail.com
ORCID iD: 0000-0002-8501-4801
SPIN-code: 3023-3477

surgeon of Cardiovascular Surgeon Arrhythmology Department of the Federal Center for High Medical Technologies

Russian Federation, Kaliningrad

Dmitry A. Kalinin

Federal Center for High Medical Technologies Kaliningrad

Email: dk.oniks@mail.ru
ORCID iD: 0000-0003-0942-3264

surgeon of Cardiovascular Surgeon Arrhythmology Department of the Federal Center for High Medical Technologies

Russian Federation, Kaliningrad

Sergey N. Kotov

Federal Center for High Medical Technologies Kaliningrad

Email: ksn82@rambler.ru
ORCID iD: 0000-0002-4027-4159
SPIN-code: 2554-3369

Head of Functional Diagnostics Department of the Federal Center for High Medical Technologies

Russian Federation, Kaliningrad

Alexander B. Vygovsky

Federal Center for High Medical Technologies Kaliningrad

Email: vygovsky@list.ru
ORCID iD: 0000-0003-4832-2028
SPIN-code: 2094-9955

Deputy Chief Physician for Medical Affairs of the Federal Center for High Medical Technologies

Russian Federation, Kaliningrad

Yuriy A. Shneider

Federal Center for High Medical Technologies Kaliningrad

Email: schneider2000@mail.ru
ORCID iD: 0000-0002-5572-3076
SPIN-code: 5027-6453

MD, Dr. Sci. (Med.), Professor, Head of the Federal Center for High Medical Technologies

Russian Federation, Kaliningrad

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2. Fig. 1. Design diagram of the completed study

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3. Fig. 2. Typical amplitude map of a patient after labyrinth-3 surgery. The arrows indicate zones of absence of electrical activity in all pulmonary veins and the posterior wall of the left atrium

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4. Fig. 3. Amplitude map and recording of the electrocardiogram and endograms of the patient after the labyrinth-3 operation. Top–down: amplitude map of the patient, standard electrocardiogram leads, and signals from the multipole circular electrode (yellow) on the posterior wall of the left atrium, where the arrows indicate the activity from the anastomosis on the left, signals from the ablation electrode (white), and signals from the multipole electrode in the coronary sinus (green). Isolation of the posterior wall was achieved, the dissociation of arrhythmic activity corresponded to data from the Lasso catheter, and flutter persists, and sinus rhythm exists along the electrode from the coronary sinus (also the arrowhead is the lower horizontal arrow on the recording from the coronary sinus). The EPT system “Claris” (Abbott, USA) was used. The recording speed was 200 mm/s

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5. Fig. 4. Relief of tachycardia in the posterior anastomosis on the right. Top–down: amplitude map of the patient, standard leads of the electrocardiogram, and signals from the multipole circular electrode (yellow) on the posterior wall of the left atrium. The arrows indicate the absence of activity from the anastomosis on the right, where the treatment electrode is located. White, signals from the ablation electrode; green, signals from the multipole electrode in the coronary sinus. The Claris EPT system (Abbott, USA) was used. The recording speed was 200 mm/s

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6. Fig. 5. Fragment of the operation of radiofrequency ablation of septal atrial flutter after the labyrinth-3 operation, arrest of arrhythmia and restoration of sinus rhythm during ablation. Top–down: standard electrocardiogram leads, signals from a multipole circular electrode (yellow) on the left atrial posterior wall, signals from an ablation electrode (white), and signals from a multipole electrode in the coronary sinus (green). The EPT system “Claris” (Abbott, USA) was used. The recording speed was 200 mm/s

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7. Fig. 6. Re-induction of atrial fibrillation after cardioversion. The arrows indicate the onset of atrial fibrillation through several sinus complexes immediately after cardioversion. Top–down: standard electrocardiogram leads, signals from a multipole circular catheter “Lasso” located in the superior vena cava (yellow endograms) which starts from a single ectopy (the earliest signal during the start of an arrhythmia) and transforms into arrhythmic fibrillatory activity (also indicated by an arrow), signals from the ablation electrode (white), and signals from the multipole electrode in the coronary sinus (green). The EPT system “Claris” (Abbott) was used. The recording speed was 200 mm/s

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8. Fig. 7. Atrial flutter in a patient after labyrinth-3 surgery. Top–down: standard electrocardiogram leads, signals from a multipole circular electrode on the left atrial posterior wall (yellow), signals from the ablation electrode (white), ablation electrode located on a partially isolated site of the atrial myocardium, and signals from the multipole electrode in the coronary sinus (green). The EPT system “Claris” (Abbott, USA) was used. The recording speed was 200 mm/s

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