Modern non-pharmacological methods of treating atrial fibrillation

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Abstract

Treatment of atrial fibrillation remains one of the most important and discussed problems of modern cardiology. Since relapses of arrhythmia and adverse reactions often occur when using antiarrhythmic drugs, catheter technologies have been widely used over the past 30 years. The most widespread among them in clinical practice are radiofrequency ablation and cryoballoon ablation. Modern non-fluoroscopic mapping and navigation systems, irrigated catheters with pressure sensors and cryoballoon ablation make it possible to achieve transmural effects on pathological pathways of the left atrium wall while minimizing the risk of complications. The article outlines the rationale, indications and contraindications for catheter ablation, as well as potential complications.

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About the authors

V. I. Steklov

The P.V. Mandryka Central Military Clinical Hospital, Ministry of Defense of the Russian Federation

Author for correspondence.
Email: cvkg_man@mil.ru

заслуженный врач РФ, доктор медицинских наук, полковник медицинской службы запаса

Russian Federation, Moscow

A. A. Sergoventsev

Main Military Medical Directorate of the Russian Defense Ministry

Email: cvkg_man@mil.ru

заслуженный врач РФ, кандидат медицинских наук, генерал-майор медицинской службы

Russian Federation, Moscow

M. B. Patsenko

Main Military Medical Directorate of the Russian Defense Ministry

Email: cvkg_man@mil.ru

заслуженный врач РФ, доктор медицинских наук, доцент, полковник медицинской службы

Russian Federation, Moscow

A. V. Demyanenko

The P.V. Mandryka Central Military Clinical Hospital, Ministry of Defense of the Russian Federation

Email: cvkg_man@mil.ru

заслуженный врач РФ, кандидат медицинских наук, полковник медицинской службы

Russian Federation, Moscow

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Supplementary files

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2. Fig. 1. Scheme of the RFA procedure. The ablation electrode is placed in the area of ​​the arrhythmia source (circle) under fluoroscopic or intracardiac echocardiographic control. Radiofrequency energy generated by the generator is supplied to the electrode and leads to heating of the tissue around its tip. An indifferent electrode in the form of a plate, placed under the patient's back, serves as a return line for the radiofrequency current (figure from the article by D. Panescu et al. [17], with changes)

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3. Fig. 2. Pathogenetic mechanisms of atrial fibrillation. A – localization of arrhythmogenic triggers located inside and outside the pulmonary veins. B – relationship between the anatomy of the atria and arrhythmogenic mechanisms of AF. LAA – left atrial appendage; RAA – right atrial appendage; SVC – superior vena cava; LSPV – left superior pulmonary vein; RSPV – right superior pulmonary vein; LIPV – left inferior pulmonary vein; RIPV – right inferior pulmonary vein; WS – coronary sinus; IVC – inferior vena cava. Figure from the book [10] with changes

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Copyright (c) 2024 Steklov V.I., Sergoventsev A.A., Patsenko M.B., Demyanenko A.V.



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