Hybrid Convergent Procedure for the Treatment of Persistent and Long-Standing Persistent Atrial Fibrillation

Background: The limited effectiveness of endocardial catheter ablation (CA) for persistent and long-standing persistent atrial fibrillation (AF) treatment led to the development of a minimally invasive epicardial/endocardial ablation approach (Hybrid Convergent) to achieve a more comprehensive lesion set with durable transmural lesions. The multicenter randomized controlled CONVERGE trial (Convergence of Epicardial and Endocardial Ablation for the Treatment of Symptomatic Persistent AF) evaluated the safety of Hybrid Convergent and compared its effectiveness to CA for persistent and long-standing persistent AF treatment. Methods: One-hundred fifty-three patients were randomized 2:1 to Hybrid Convergent versus CA. Primary effectiveness was freedom from AF/atrial flutter/atrial tachycardia absent new/increased dosage of previously failed/intolerant class I/III antiarrhythmic drugs through 12 months. Primary safety was major adverse events through 30 days. CONVERGE permitted left atrium size up to 6 cm and imposed no limits on AF duration, making it the only ablation trial to substantially include long-standing persistent–AF, that is, 42% patients with long-standing persistent–AF. Results: Of 149 evaluable patients at 12 months, primary effectiveness was achieved in 67.7% (67/99) patients with Hybrid Convergent and 50.0% (25/50) with CA ( P =0.036) on/off previously failed antiarrhythmic drugs and in 53.5% (53/99) versus 32.0% (16/50; P =0.0128) respectively off antiarrhythmic drugs. At 18 months using 7-day Holter, 74.0% (53/72) Hybrid Convergent and 55% (23/42) CA patients experienced ≥90% AF burden reduction. A total of 2.9% (3/102) patients had primary safety events within 7 days, and 4.9% (5/102) between 8 and 30 days postprocedure. No deaths, cardiac perforations, or atrioesophageal fistulas occurred. All but one primary safety event resolved. Conclusions: The Hybrid Convergent procedure has superior effectiveness compared to the CA for the treatment of persistent and long-standing persistent atrial fibrillation. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01984346.

The Features of Systolic Function and Remodelation of the Left Ventricle in Patients with Rheumatoid Arthritis in Combination with Arterial Hypertension

Recent studies have shown that heart disease in patients with rheumatoid arthritis occurs according to various data in 20-100% of cases. Hypertension is often the first objectively detectable marker of cardiovascular pathology in patients with rheumatoid arthritis. Hypertension in patients with rheumatoid arthritis usually becomes an active initiator and accelerator of the progression of atherosclerosis and remodeling of the left ventricle. Cardiac remodeling in patients with hypertension and in patients with rheumatoid arthritis, combined with hypertension is a significant factor that affects to the quality of life and prognosis and requires careful study of this problem. The purpose of the work was to study the systolic function and morphological parameters of the left ventricle in patients with rheumatoid arthritis in combination with hypertension and to establish indicators associated with high cardiovascular risk. Material and methods. The main group of patients consisted of 93 patients with rheumatoid arthritis of moderate activity in combination with hypertension stage II. The second group included 45 patients with essential hypertension stage II. The control group had 31 almost healthy people. An ultrasound examination of the heart was performed with studying of systolic function and the main morphological parameters of the left ventricle. Results and discussion. We found a significant increase in the left ventricle myocardial mass index by 11.97% in patients with rheumatoid arthritis in combination with hypertension compared to the patients with essential hypertension and by 30.1% compared to the control group. We also detected the significant increase of the interventricular septum thickness by 9.02%, the posterior wall of left ventricle – by 5.51%, and the relative wall thickness of left ventricle – by 6.0% in patients with rheumatoid arthritis in combination with hypertension compared to the patient with essential hypertension. There was a significant increase in end-diastolic volume by 8.64%; end-systolic volume – by 12.95%; and a decrease of ejection fraction by 2.5% in patients with rheumatoid arthritis in combination with hypertension with m SCORE >4 points compared to the corresponding indicators of patients with m SCORE ≤4 points. The study showed that the most common type of left ventricle remodeling was concentric left ventricle hypertrophy (79% of patients) in patients with rheumatoid arthritis with hypertension. In addition, the subgroup of patients with m SCORE >4 points left ventricle myocardial mass and left ventricle myocardial mass index were by 15.01% and 14.86% significantly higher than the corresponding indicators in the subgroup of patients with m SCORE ≤4 points. Conclusion. The patients with rheumatoid arthritis in combination with hypertension showed an association between increasing of the left atrium size and the volume parameters of the left ventricle, and the presence of fluid in the pericardial cavity. This was manifested by the left atrium size increase by 10.65%, end-diastolic volume – by 8.62%, end-systolic volume – by 12.2% and the ejection fraction decrease by 2.23% in patients with fluid versus to a subgroup of patients without fluid in the pericardium

The dilatation factor of left atrium in remote period after the mitral valve prosthesis

Objective. Studying of the morphometry indices and contractility of the heart left compartments in the left atrium reduction after prosthesis of a mitral valve. Materials and methods. Into the investigation 634 consequently operated patients with isolated mitral failure were included, who were surgically treated in Amosov National Institute of Cardiovascular Surgery from the 1st of January to the 1st of January 2007 yr. In all the patients the mitral valve prosthesis was performed. In the left atrium dilatation in 49 (7.7%) patients additionally its reduction was done, using paraanular plication of posterior wall of left atrium with the aim to achieve its size lesser than 5,0 cm. Results. Of 49 patients, suffering constant form of atrial fibrillation, thromboembolic complications have occurred in 3 (6.1%) while performance of paraanular plasty of left atrium with simultaneous elimination of its auricle. All thromboembolic complications were nonsevere, and a left atrium size did not exceeded 5.5 sm. Conclusion. The left atrium reduction and elimination of its auricle in the left-sided atriomegaly constitutes a significant element of the result improvement in the mitral valve prosthesis in late period of follow-up.

P5359Pulmonary artery pressure is elevated three month after delivery in patients with preeclampsia and antiphospholipid syndrome

Introduction Preeclampsia (PE) is a multisystem disease affecting 2–8% of all pregnancies. Recently we found that the prevalence of antiphospholipid syndrome (APS) in PE patients at 13.9%. APS can be the cause of thromboembolic pulmonary hypertension. However, data on heart function and pulmonary pressure in PE and in PE with APS are sparse. Purpose We sought to investigate cardiac hemodynamics in this population. Method Between July 2016 and December 2018, we performed echocardiography in patients who had suffered from PE alone (n=102, age=32.6±4.8 y) or PE with APS (n=21, age=32.1±4.2 y) 3 months after delivery. APS was diagnosed according to the Sapporo criteria. Results The overall prevalence of APS was 17%. Right ventricular to right atrial pressure (RV/RA) gradient was significantly higher in PE + APS patients than in patients who had PE only (21.1±3.8 vs. 17.9±4.6mmHg, p=0.04, PE+APS vs. PE). The indexed volume of the left atrium (LA: 20.3±4.4 vs 23.5±5.5ml/m2, p=0.01, PE+APS vs. PE) and the birthweight of the newborn (1379.8±759.1 vs 1848.1±879.6.1g, p=0.02, PE+APS vs. PE) were lower in APS patients. Conclusion In patients with preeclampsia and APS, three month after delivery, pulmonary artery pressure was higher and the left atrium size smaller than in patients who had PE only. Conceivably this may reflects multiple subclinical clots in the pulmonary vessels in APS patients and may put these patients at an elevated risk of pulmonary hypertension later in life.