Vol 2, No 2 (2022)


Epicardial Adipose Tissue and Cardiac Arrhythmias

Kanorskii S.G.


Obesity is associated with an increased risk of atrial and ventricular arrhythmias, including life-threatening ones. Epicardial adipose tissue (EAT) is located deep under the visceral pericardium (epicardium) and is therefore in direct contact with the underlying myocardium. In pathological conditions, EAT undergoes a phenotypic transition from a “neighbor” with protective properties to a substrate that secretes many substances that change the electrophysiology of cardiomyocytes by modulating ion currents that disrupt intercellular electrical connections and stimulate fibrosis. An excess of EAT can cause atrial and ventricular conduction disturbances, which are already evident with standard electrocardiography, predispose to the occurrence of the re-entry phenomenon and cardiac arrhythmias. Among the mechanisms of arrhythmogenesis under the influence of EAT, modulation of ion channels and gap junctions, fibrous remodeling and fatty infiltration are more often considered. However, most of these mechanisms have been studied in experimental studies and cannot easily be extrapolated to humans. There is convincing evidence of a direct relationship between EAT volume and the severity of atrial fibrillation, as well as the clinical benefit obtained from weight loss in patients with this arrhythmia. It is likely that the benefits of weight loss may extend to ventricular arrhythmias.

Cardiac Arrhythmias. 2022;2(2):5-18
pages 5-18 views

Endocardial Electrophysiological Study in Clinical Practice in Patients with Bradysystole and Conduction Rhythm Disorders: a review

Zhelyakov E.G., Ardashev A.V.


The article demonstrates modern diagnostic capabilities of endocardial electrophysiological examination in cardiological patients with bradysystole and conduction disturbances that allow adequate assessment of the clinical situation. We made an attempt to systematize current indications for an electrophysiological study in this category of patients based on the analysis of several current recommendations.

Cardiac Arrhythmias. 2022;2(2):19-30
pages 19-30 views

Original Research

Correction of Potentially Modifiable Components of Metabolic Syndrome for the Primary Prevention of Atrial Fibrillation in Comorbid Patients with Premature Atrial Complexes

Olesin A.I., Konstantinova I.V., Ivanov V.S.


AIM: The study aimed to evaluate the influence of the correction of potentially modifiable risk factors for the development of atrial fibrillation (AF) as primary prevention of AF in patients with metabolic syndrome (MS) and premature atrial complexes (PAC).

MATERIALS AND METHODS: We monitored 856 MS patients with PAC, aged 58–72 (mean age, 66.4 ± 0.7) years, in the north-western region of the Russian Federation. A 5-year risk of AF was calculated in all patients after the examination by determining the potential prognostic time range for Af development and its index of probable occurrence (RCHARGE-AF) using the CHARGE-AF model. The correction of potentially modifiable MS components and risk factors for AF development (smoking cessation, elimination of physical inactivity, etc.) until their target values were achieved was offered to all patients. The follow-up endpoint was the preservation of sinus rhythm or AF registration.

RESULTS: All patients with MS were distributed into three groups. Group I consisted of 557 (65.07%) patients with incomplete correction of risk factors, and group II included 93 (10.86%) who achieved the target values of all potentially modifiable factors for AF development. The control group included the remaining patients without quantitative and qualitative changes in the dynamics AF predictors. No significant differences were found between the groups in terms of sex, age, concomitant diseases, and risk factors for AF. The achievement of the target values of the main MS components, including body mass index and/or waist circumference, correlated with the performance of regular aerobic exercises (odds ratio [OR] = 8.9), adherence to a diet (OR = 7.5), duration of MS diagnosis < 20 years before the start of correction (OR = 12.8), and intake of a glucagon-like peptide-1 receptor agonist (Liraglutide) (OR = 5.4).

In the control group, group I, and group II, AF development did not differ significantly and was registered in 192 (93.20%), 491 (88.15%), and 79 (84.95%) patients (p > 0.05), respectively.

CONCLUSIONS: In MS patients with PAC and a high 5-year risk of AF, the correction of potentially modifiable risk factors for AF development, as its primary prevention, is ineffective. The determination of the RCHARGE-AF index in MS patients with PAC in dynamics indicates the efficiency of the correction of potentially modifiable risk factors for AF development, but it does not determine the degree of the risk of its occurrence.

The authors declare no conflict of interest.

Cardiac Arrhythmias. 2022;2(2):31-40
pages 31-40 views

Case reports

A Case of Mitral Annular Disjunction Combined with Ventricular Arrhythmias

Novikova T.N., Basova V.A., Evdokimova L.S., Gnevasheva N.A., Itskovich I.E., Novikov V.I., Saiganov S.A., Shcherbakova V.A.


The article presents a clinical case of a combination of mitral valve prolapse (MVP), mitral annular disjunction (MAD), and ventricular arrhythmia. The presence of MAD worsens the prognosis in MVP and predisposes to life-threatening ventricular arrhythmias. In a 42-year-old patient, MAD was detected during echocardiography to determine the indications for surgical correction of mitral insufficiency in MVP. Severe myxomatous degeneration of the mitral valve leaflets, polysegmental prolapse, and typical auscultatory pattern (systolic click followed by systolic murmur in the second half of systole) were the indications for the targeted search for MAD. Multi-day (ECG) monitoring recorded nonsustained ventricular tachycardias and premature ventricular complexes (PVCs). Cardiac magnetic resonance imaging was performed for confirmation the diagnosis and searched for left ventricular myocardial fibrosis accompanying MAD. Finally, MAD was confirmed, but myocardial fibrotic changes were not detected. Owing to the absence of myocardial fibrosis, the patient was treated conservatively with a beta-adrenoblocker (25 mg/day slow-release metoprolol succinate) in combination with 25 mg/day allaforte. Repeated 24-h ECG monitoring did not detect ventricular tachycardias and nonsustained registered a significant decrease of number of PVCs. The patient is followed up prospectively due to high risk factors for fibrosis and worsening prognosis, which may require surgical correction of the existing disturbances and/or implantation of a cardioverter-defibrillator.

Cardiac Arrhythmias. 2022;2(2):41-50
pages 41-50 views

Preoperative Prediction of Optimal Method and Site of Left Ventricular Electrode Implantation

Stepanova V.V., Marinin V.A., Zubarev S.V.


We present a clinical case of cardiac resynchronization device implantation in a patient with a zone of late left ventricular activation in the area of the anterior coronary sinus vein, which, however, was unsuitable for endovascular implantation and stable electrode placement in it. This anatomical feature was diagnosed at the outpatient stage using a noninvasive mapping technique. Using this approach, we were able to understand that an epicardial electrode implantation, instead of traditional endovascular implantation of the left ventricular electrode through the coronary sinus vein, is indicated for the patient. Targeted implantation of an epicardial electrode in the area of interest on the epicardial surface of the left ventricle in the basal part of the anterolateral wall allowed achieving a complete clinical response to resynchronization therapy.

Cardiac Arrhythmias. 2022;2(2):51-56
pages 51-56 views

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