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Unlabelled: It can be suggested that development of atrial fibrillation (AF) in patients with chronic obstructive pulmonary disease (COPD) is directly related to the system of inflammation. Genetic polymorphism of factors of this system can be one of components of mechanism of AF in COPD. Aim: to elucidate polymorphic markers of genes of factors of the system of inflammation associated with AF in patients with COPD. Material and methods. We examined 208 patients with COPD (52 with and 156 without AF). Examination included spirometry, echocardiography, and study of frequencies of polymorphic markers G(-238)A, G(-308)A of tumor necrosis factor (TNF) gene, C(-819)T of interleukin (IL) 10 gene, G(-174)C of IL-6 gene, rs2228145(AC) of IL-6R gene, and rs2069762(A/C) of IL-2 gene. RESULTS. Factors associated with AF were left atrial volume (odds ratio [OR] 1.021, 95% confidence interval [ClI] 1.004-1.043, p = 0,027), right atrial volume (OR 1.02, 95% CI 1.001-1.040, p=0.021), and carriage of C allele of polymorphic marker G(-174)C of IL-6 gene (OR 6.02, 95% Cl 1.87-19.38, p = 0.003)., Conclusion: C allele of polymorphic marker G(-174)C of IL-6 gene can be considered to be independently associated with development of AF in patients with COPD.

Thomboembolism is the most threatening complication in patients with atrial fibrillation. Main source of embolism is the left atrial thrombosis. Mechanisms of development of thromboembolic complications in patients with arrhythmias are far from being deciphered. In this review we discuss possible mechanisms of formation of intracardiac thrombus - abnormalities of functioning of the hemostasis system, endothelial dysfunction, inflammatory reactions, fibrosis of the left atrial wall, genetic traits.

Thromboembolism is the main cause of death and disability of patients with atrial fibrillation. Indirect anticoagulants are effective means of primary and secondary prevention of thromboembolic complications. However in a number of patients risk associated with therapy with indirect anticoagulants might exceed potential benefit. The principle problem requiring solution in a patient with atrial fibrillation is individual comparative assessment of risk of development of thromboembolic and hemorrhagic complications. Modern stratification scales which allow solving this problem are considered in this review.

Thrombosis of the left atrial appendage (LAA) is considered to be main cause of thromboembolic complications of atrial fibrillation (AF). Aim of this work was to study parameters of the hemostasis system in patients with AF in dependence on the presence of thrombus in the LAA. We examined 92 patients (58 men and 34 women) who at hospital admission had AF attack which lasted more than 48 hours. In patients with thrombus in the LAA according to data of transesophageal echocardiography differed magnitude of mean pulmonary artery pressure (odds ratio [OR] 1.053 95% confidence interval [CI] 1.007 to 1.102, p=0.024), diameter of left ventricular (LV) outflow tract (OR 7.711 95% CI 1.291 to 46.029, p=0.025), LV ejection fraction less than 40% (OR 0.286 95% CI 0.081 to 1.008, p=0.051), levels of type 1 plasminogen activator inhibitor-PAI-1 (OR 0.641 95% CI 0.422 to 0.974, p=0.037), and D-dimer (OR 1.003, 95% CI 1.000 to 1.006, p=0.046). Factors independently related to the presence of thrombus in LAA turned out only levels of PAI-1 (OR 0.51, 95% CI 0.276 to 0.936, p=0.03) and D-dimer (OR 1.01, 95% CI 1.001 to 1.014, p=0.026). Thus depletion of the system of fibrinolysis can lead to thrombus formation in the LAA and increase risk of development of thromboembolic complications.

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Many patients with nonvalvular AF have substantial rates of stroke and thromboembolism. The left atrial appendage (LAA) is a common source of cardiac thrombus formation associated with systemic embolism. Recent findings have suggested a link between inflammatory and haemostatic disturbance and genesis of the LAA thrombus. In this review, we describe the genetic variations probably involved in the pathogenesis of LAA thrombosis, their functional implications, and their association with thromboembolic risk. We consider polymorphisms in coagulation factors and the inflammatory markers.

Transesophageal echocardiography (TEE) is routinely used for visualization of left auricular thrombi in patients with atrial fibrillation (AF). Multispiral computed tomography (MSCT) with the use of contrast preparations is a novel method of visualization of intracardiac structures. Forty three patients (27 men, 16 women aged 46-81 years) with duration of atrial fibrillation > 48 hours and scheduled for sinus rhythm restoration were included in this study. TEE and MSCT were carried out in all patients during first 3 days of hospitalization. If according to both methods there were no thrombi in the left auricle cardioversion was performed. If data of one of the methods were suspicious of left auricular thrombus cardioversion was not performed. In these patients both investigations were repeated after 8 weeks of therapy with warfarin. If initially detected mass decreased or disappeared at the background of indirect anticoagulants, it was considered to be a thrombus. In 1/3 of patients repeat examination allowed to reject initial diagnosis of left auricular thrombosis. Simultaneous application of TEE and MSCT detected more thrombi than the use of either of these methods. Rate of detection of thrombi in left atrial auricle with the use of both methods was 32%.

Atrial fibrillation significantly worsens quality and duration of patient's life because of frequent development of thromboembolic complications. The main cause of these complications is formation of intracardiac thrombosis. Prevalence of left atrial thrombosis in patients with atrial fibrillation varies from 8 to 24%. About 90% of thromboses are localized in left auricle. This paper contains review of different methods of detection of left auricular thrombosis. Main structural and functional predictors of thrombosis and possibilities of modern techniques of their visualization are also described. Different methods of echocardiography first of all transesophageal echocardiography are at present foremost in assessment of structural and functional predictors of thrombosis development. With the help of transesophageal echocardiography it is possible to accomplish functional monitoring of the state of left auricle during treatment with different drugs and/or after cardioversion. Detection of risk factors of left auricular thrombosis is an important clinical task because it allows to select a group of high risk patients in which long-term therapy with anticoagulants is indicated.