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Background. Clinical search for modern, more hemodynamically efficient areas for placing endocardial electrodes with constant cardiostimulation. Our aim is to study electrophysiological parameters and clinical results of His bundle direct stimulation, analyze traits of compromised electrode removal from the given heat area.Materials and Methods. We examined 36 patients divided into two groups (18 patients in each group) according to the signs of transatrial (first) or transventricle (second) stimulation of His bundle. Up to 12 months from the implantation moment we analyzed electrocardiostimulation parameters, data of body-surface ECG, ultrasound dynamics of heart cavity sizes, life quality according to MOS SF-36 scale.Results. In the first group time for electrical systole of ventricle myocardium (width QRS) was authentically less – 111 ± 13 ms comparing to the second – 134 ± 19 which corresponded to physiological pattern for myocardial ventricle activation, excluded dyssinchrony, left ventricle diastolic dysfunction, development of arrhythmogenic chronic cardiac insufficiency. Life quality in the first group was authentically higher – 71 ± 8,5 vs 63 ± 9,9 points in patients from the second group. Four electrodes (2 electrodes in each group) were removed due to exit-block development.Conclusion. Implantation of transatrial electrode in the bundle of His area ensures stable fixation, lower risk of dislocation in the early postoperative period and eases its removal if coinciding indications occur. Clinical application of this medical approach is an impact for creating a peculiar endocardial electrode in native industry, supplying device and stimulator type DDD(R), with a spare ventricle canal which is rather timely regarding conditions for import substitution plan.

Modem development of invasive arrhythmology is favorable for removal of problematic endocardial electrode removal in a great majority of cases. However such factors as increased average life expectancy of population, annual increase in absolute number of implantations, emergence of more difficult heart-implanted electronic devices, and together with it and average quantity of the implanted electrodes, maintain the most specified interest to the mentioned subject. The statistics, indications, the main surgical techniques, complications of the procedure of endocardial electrode removal are covered in the review

Percutaneous coronary intervention (PCI) with stenting in patients with stable ischemic heart disease (IHD) is not always accompanied by a significant improvement of clinical symptoms and quality of life (QOL), because of the presence of affective disorders. The aim of this study was to investigate the dynamics of QOL in patients with stable IHD after PCI and conservative treatment, depending on the presence of symptoms of anxiety and depression. In the group of patients with comorbid symptoms of anxiety-depressive disorders, the initial values of GH, VT, SF, RE, MH according to the SF-36 scale were low during PCI. After PCI, QOL of patients in this group improved, and the studied parameters became comparable to those in the group without affective symptoms. In the group of conservative treatment with concomitant symptoms of anxiety and depression, RP, GH, VT, SF and MH values were initially low. A significant dynamics of QOL in patients of this group was not observed after the conservative treatment. In patients without affective symptoms, there was an improvement in SF and RE after the conservative treatment at the 3 months follow-up.

One of the factors negatively affecting the cardiac prognosis of coronary heart disease (CHD) is affective disorders of the depressive spectrum. Symptoms of depression may increase the level of systemic inflammation and promote disorders of carbohydrate metabolism by altering the synthesis and secretion of adipokines: leptin, resistin, adiponectin. The aim of this study was to assess the adipokin status in patients with stable coronary artery disease in the conditions of conservative therapy and during percutaneous coronary interventions (PCI) with stenting, including patients with depressive symptoms. The presence of depressive symptoms was accompanied by an increase in the level of resistin in the blood plasma in patients with stable ischemic heart disease. PCI with coronary artery stenting resulted in an increase in the concentration of all the adipokines: adiponectin, leptin, resistin. Stenting of coronary arteries in people with depressive symptoms led to an increase in the level of resistin, adiponectin with a decrease in the concentration of leptin in the blood plasma on the third day after the operative intervention.

Analysingthe example of unusual case of a successful direct constant His bundle pacing, we would like to draw specialist’s attention to details of procedure and some important electrophysiological particularities we have come across during operation. Long-term (7 years) results ( pacing options, ECG data, changes of left ventricle ejection fraction and patient’s quality of life) were considered too.

Objective: to study electrophysiological parameters and clinical results of direct constant His bundle pacing (HBP). Materials and methods: we examined 36 patients, divided into 2 equal groups (of 18 patients) according to the type of pacing. Group 1 included patients with atrial lead delivery and group 2with ventricle lead delivery. Within 12 months after implantation of the pacemaker were evaluated pacing options, ECG data, changes in heart cavities sizes, quality of life assessments with the MOS SF-36. Results: it turned out that in group 1 QRS duration was 111±13 ms, whereas QRS duration in group 2 was 134±19 ms. So QRS duration and morphology corresponded to physiological and excluded uprising of ventricle dyssynchrony, LV diastolic dysfunction and chronic heart insufficiency, quality of life were higher for group 1 paients : 71±8,5 whereas 63±9,9 in group 2. Conclusions: implantation atrial lead in His-bundle provides more reliable fixation, less early dislocation risk in early postoperative period and facilitates lead extraction. Clinical implementation of this method will contribute Russian industry, which is especially important in import substitution conditions, to the creation of special lead, delivery system and DDDR pacemaker with a backup ventricle channel.

The review of domestic and foreign literary sources and own experience of cryoballon ablation, the modern method of treatment of patients with AF is presented. The indications are detailed, the data on the effectiveness and safety of the technique are given. Particular attention is paid to comparing the cryoballoon and radiofrequency isolation of the pulmonary veins.