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To evaluate the dynamics of cardiac arrhythmias on the background of cardiac contractility modulation (MCC) in patients with chronic heart failure (CHF) and various forms of atrial fibrillation (AF) on the basis of daily electrocardiogram (ECG) monitoring.In 100 patients with CHF and AF, the following studies were performed before implantation of the MCC device and after 12 months of follow-up: 12-channel ECG with an estimate of the width of the QRS complex, transthoracic echocardiography (EchoCG), and Holter ECG monitoring. All patients received long-term optimal drug therapy for CHF before surgery.The results obtained indicate that there is no effect of MCC on the development and progression of ventricular arrhythmias in patients with CHF and AF during the year of follow-up, both extrasystole and tachyarrhythmias, regardless of the etiology and LVEF (less than 35% or more than 35%), and a decrease in the frequency of AF paroxysms in patients with CHF during treatment. These results are due to the reverse remodeling of the LV myocardium under the influence of the MCC device.The use of MСС in patients with CHF and AF is a safe method of therapy that does not induce cardiac arrhythmias, including ventricular extrasystole. Large-scale comparative studies are required to evaluate these results.Цель. Оценить динамику нарушений ритма сердца на фоне модуляции сердечной сократимости (МСС) у пациентов с хронической сердечной недостаточностью (ХСН) и различными формами фибрилляции предсердий (ФП) по данным суточного мониторирования электрокардиограммы (ЭКГ). Материалы и методы. У 100 пациентов с ХСН и ФП до имплантации устройства МСС и через 12 мес наблюдения проводились следующие исследования: 12-канальная ЭКГ с оценкой ширины комплекса QRS, трансторакальная эхокардиография, холтеровское мониторирование ЭКГ. Все пациенты до операции получали длительную оптимальную медикаментозную терапию ХСН. Результаты. Полученные результаты свидетельствуют об отсутствии влияния МСС на развитие и прогрессирование желудочковых нарушений ритма сердца у пациентов с ХСН и ФП в течение года наблюдения, как экстрасистол, так и тахиаритмий независимо от этиологии и фракции выброса левого желудочка (менее 35 или более 35%), снижение частоты возникновения пароксизмов ФП у пациентов с ХСН на фоне лечения. Данные результаты обусловлены обратным ремоделированием миокарда левого желудочка под воздействием МСС-устройства. Заключение. Применение МСС у пациентов с ХСН и ФП является безопасным методом терапии, не индуцирующим нарушения ритма сердца, в том числе желудочковую экстрасистолию. Для оценки данных результатов требуется проведение крупномасштабных сравнительных исследований.

Aim. Endoscopic surgery demonstrates promising results of treatment in patients with non-paroxysmal atrial fibrillation. Minimally invasive thoracoscopic ablation contributes to the growing interest in such operations all over the world. Nowadays totally thoracoscopic ablations are available for patients in Russian Federation. Emphasis in our study was placed on the collection and analysis of data on thoracoscopic ablation procedures used for treating patients with lone atrial fibrillation.Methods. The study covered the operations performed by Russian cardiac surgeons over a period up until January 1, 2018. Data collection was based on emailed registration forms containing information about the date of procedures, type of ablation pattern, previous catheter procedures, used devices, methods of left atrial appendage closure and safety profile information. 30-day mortality, conversion to sternotomy/thoracotomy, stroke/ transient ischemic attack, reexplorations, cardiac tamponade and phrenic nerve damage were considered as major complications.Results. The study encompassed 10 cardiosurgical centers in Russian Federation where totally thoracoscopic ablations had been carried out between 2011– 2018. Six hundred fifty-two procedures were registered. Most patients were ablated in Dallas and Box Lesion patterns. Left atrial appendage exclusion was performed in 90,4% patients. Major complications were observed in 27 (4%) patients, mostly during the “learning curve” period.Conclusion. The given study is the first attempt to collect and systematize the data on a new surgical procedure for treatment of patients with atrial fibrillation. The data obtained allow for making a conclusion that thoracoscopic ablation is becoming a wide-spread surgical technique to treat patients with lone atrial fibrillation in Russia. The quantity of procedure increases annually. Introducing thoracoscopic procedures in clinical practice may be accompanied by complications at any center. Nevertheless, according to our investigation the rate of complications is low, which enables us to recommend thoracoscopic ablation to treat a numerous cohort of atrial fibrillation patients in Russia.Received 13 June 2018. Revised 22 July 2018. Accepted 23 July 2018.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.