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Purpose of the study. To analyze the long-term results from various strategies of endovascular treatment for coronary artery disease (CAD) in patients concomitant with cancer.Patients and methods. 74 patients with both CAD disease and cancer were treated in A. V. Vishnevskiy National Medical Research Center of Surgery from 01/01/2018 to 12/31/2022. By a multidisciplinary council, patients were divided into three groups: group 1 (n = 39) – staged treatment: percutaneous coronary intervention (PCI) is the first stage, the second is surgical treatment of cancer; group 2 (n = 14) – staged treatment: the first stage was surgical treatment of cancer, and the second stage was PCI; group 3 (n = 21) – PCI and open surgery were performed on the same day.Results. In the immediate period, 3 (4.0 %) deaths were observed: 2 (5.1 %) in group 1, 1 (4.8 %) in group 3, the cause of which was complications arising after oncological surgical interventions. One (2.6 %) patient from group 1 had acute myocardial infarction (AMI) due to acute stent thrombosis in the left anterior descending artery (LAD). The patient underwent successful emergency PCI. In the long-term period, 15 (25.4 %) patients died, out of which 11 (18.7 %) from progression of cancer, and 4 (6.7 %) from other causes. Among the major cardiovascular complications, the following were observed: 1 (3.2 %) AMI in group 1 and 1 (7.1 %) in group 2.Conclusion. In the long-term follow-up period, the leading cause of death (73,3 %) was progression of cancer. There were no detected from deaths AMI, which confirms the importance and feasibility of myocardial revascularization in this severe group of patients. PCI in patients with coronary artery disease in combination with cancer allows for effective and safe surgical treatment of malignant pathology without cardiac mortality both in the immediate and long-term follow-up periods.

The purpose of this study was to explore the psychological mechanism of self-regulated learning in a technology–enhanced learning environment and to develop a comprehensive model of its function. As a theoretical approach, we used Pintrich’s model of Self-regulated learning. The mixed research methods were used in this study. First, we conducted focus-group discussions with students from higher education. Based on the results of the focus group, a questionnaire has been developed. A total of 307 BA students participated in the study, out of whom 213 (69.4%) were female students and 94 (30.6%) were male students. To explore the underlying factor structure of the questionnaire, items were subjected to principal component analysis (PCA). The principal component analysis revealed the presence of 14 components exploring the 61,77% variance respectively. After checking the factors similarity, the following scales were identified: Motivational scale, Cognitive strategies scale, and Deficit of SRL scale. Each scale reflects the area of positive and negative factors of technology use on the students’ self-regulated learning. To examine the factorial properties of the questionnaire, all scales were tested using structural equation modeling (SEM). Results show that the model fit of the empirical and theoretical models is satisfactory for all three scales. The reliability of the questionnaire was measured using Cronbach’s alpha. Coefficients ranged from .637 to .894. As for gender differences, male and female respondents showed statistically significant differences in the following factors: Self-efficacy in the task domain; Note-taking; Nonacceptance beliefs toward technology; and Blockages to technology integration.

Актуальность. С увеличением выраженности коморбидного фона значимо возрастает риск осложнений искусственного кровообращения. Комплекс повреждающих факторов процедуры запускает системный воспалительный ответ, что в ряде случаев сопровождается поражением органов-мишеней, переводя хронические органные дисфункции в острые. В некоторых исследованиях применения систем минимально инвазивного экстракорпорального кровообращения (англ. Minimal invasive Extra-Corporeal Circulation, MiECC) показано преимущество в сравнении с традиционными экстракорпоральными контурами, но разнообразие минимально инвазивных систем, разнородность пациентов и исходов не позволяют с уверенностью экстраполировать эти данные на возрастных коморбидных пациентов. Цель. Сравнить выраженность системного воспаления и результаты лечения у коморбидных кардиохирургических пациентов, оперированных в условиях искусственного кровообращения с классическим и минимально инвазивным экстракорпоральным контуром. Методы. Ретроспективное когортное исследование 760 пациентов, последовательно получивших в 2019–2022 гг. плановые кардиохирургические вмешательства. Критерии включения: коморбидный статус (индекс коморбидности Чарлсон с поправкой на возраст не менее 6); искусственное кровообращение длительностью не менее 90 мин. Критерии исключения: экстренное оперативное вмешательство, отказ от участия в исследовании. Критериям включения соответствовали 68 пациентов. По методу экстракорпорального кровообращения сформировали две исследуемые группы — с классическим экстракорпоральным контуром (n = 51) и с минимально инвазивным (n = 17). Кон­трольные точки — до начала искусственного кровообращения и через 24 ч после операции (лактат; креатинин; индекс оксигенации, уровень гемолиза). Для маркеров системного воспалительного ответа — через 1 ч после начала искусственного кровообращения и 24 ч после его окончания (интерлейкин-6; интерлейкин-10; прокальцитонин; С-реактивный белок; растворимая форма триггерного рецептора, экспрессируемого на миелоидных клетках (англ. soluble Triggering Receptor Expressed on Myeloid cells-1, sTREM-1)). Оценивали респираторные, почечные осложнения, дренажную кровопотерю, нарушения системы гемостаза, потребность в симпатомиметиках, длительность пребывания в отделении реанимации и интенсивной терапии и стационаре. Результаты. Группы статистически значимо не различались по гендерно-антропометрическим характеристикам, характеру оперативных вмешательств и основным параметрам перфузии. В группе с классическим экстракорпоральным кровообращением наблюдались значимо более высокие дозы вазоконстрикторной поддержки (норадреналин), а также снижение темпа диуреза, частоты легочного повреждения, повышение уровня лактата и гемолиза. Маркеры системного воспалительного ответа также достоверно выше. Заключение. Применение систем минимально инвазивного экстракорпорального кровообращения по сравнению с классическим искусственным кровообращением существенно не влияет на частоту органных дисфункций, однако уменьшает выраженность системного воспалительного ответа и иммунной супрессии, которые являются триггерными механизмами развития полиорганной недостаточности. Это может быть особенно актуально для пациентов с хроническими органными дисфункциями. Для систем минимально инвазивного экстракорпорального кровообращения, с учетом высокой стоимости и нецелевого воздействия на плейотропные факторы развития системной воспалительной реакции, необходимо определить спектр показаний. Поступила в редакцию 6 апреля 2023 г. Исправлена 17 августа 2023 г. Принята к печати 18 августа 2023 г. Финансирование Исследование проведено в рамках научно-исследовательской работы «Разработка минимально инвазивных и гибридных технологий хирургического лечения заболеваний сердца». Конфликт интересов Авторы заявляют об отсутствии конфликта интересов. Вклад авторов Концепция и дизайн работы: А.Ш. Ревишвили, Г.П. Плотников, В.А. Попов Сбор и анализ данных: Р.А. Корнелюк, Л.Б. Берикашвили, И.П. Комков, Е.С. Малышенко, В.М. Земсков Статистическая обработка данных: Л.Б. Берикашвили Написание статьи: Р.А. Корнелюк, Г.П. Плотников, Л.Б. Берикашвили Исправление статьи: Г.П. Плотников Утверждение окончательного варианта статьи: все авторы

Актуальность. Результаты аблации желудочковой тахикардии у больных со структурной патологией сердца не являются оптимальными. Радиочастотная аблация с использованием высокой мощности воздействия может иметь долгосрочный положительный эффект. Цель. Оценить безопасность, раннюю и отдаленную эффективность радиочастотной аблации высокой мощности для лечения желудочковой тахикардии у пациентов со структурной патологией сердца в многоцентровом проспективном регистре. Методы. В исследование включили 63 пациента (66,7 % — мужчины, медиана возраста 61 [51,0–66,5] год) с ишемической болезнью сердца и медикаментозно-резистентной желудочковой тахикардией, которых направили на радиочастотную аблацию. Проводили аблацию воздействием радиочастотной энергии 50 Вт. Для биполярного и активационного картирования со стандартными настройками использовали системы нефлюороскопической 3D-навигации. Конечная точка безопасности включала периоперационные осложнения, такие как смерть, гемоперикард, инсульт, инфаркт миокарда, электрический шторм, сосудистые осложнения. Конечная точка эффективности — неиндуцируемость желудочковой тахикардии в конце аблации и отсутствие желудочковой тахикардии через 12 мес. наблюдения. Вторичные конечные точки — изменение терапии имплантированного кардиовертера-дефибриллятора, эхографические показатели и количество госпитализаций. Результаты. Всем пациентам провели аблацию желудочковой тахикардии под общей седацией. Индуцировали 1 клиническую желудочковую тахикардию у 96,8 % больных на диагностическом этапе аблации. После аблации не индуцировали клинические желудочковые тахикардии (p < 0,0001 по сравнению с данными до аблации). Ни у одного пациента периоперационных осложнений не наблюдали. Желудочковая тахикардия без антиаритмических препаратов отсутствовала у 52 (82,6 %) больных через 12 мес. наблюдения. В отдаленном периоде наблюдения количество терапий имплантированного кардиовертера-дефибриллятора значительно уменьшилось по сравнению с исходным уровнем (3,2 против 31,7 % соответственно, p = 0,0001). Фракция выброса левого желудочка увеличилась с 48,7 ± 14,7 до 50,3 ± 11,9 % через 12 мес. наблюдения (р = 0,038). Частота госпитализаций снизилась с 2 [диапазон: 0–12] до 0 [диапазон: 0–3] (p < 0,0001) до и после радиочастотной аблации соответственно. Заключение. Радиочастотная аблация с применением высокой мощности для лечения желудочковой тахикардии у ишемических пациентов продемонстрировала безопасность и высокую периоперационную и отдаленную эффективность, что связано с клиническим улучшением. Необходимы дальнейшие рандомизированные исследования для внедрения аблации желудочковой тахикардии в рутинную клиническую практику для аблации. Поступила в редакцию 5 сентября 2022 г. Исправлена 16 февраля 2023 г. Принята к печати 31 мая 2023 г. Финансирование Исследование не имело спонсорской поддержки. Конфликт интересов Авторы заявляют об отсутствии конфликта интересов. Вклад авторов Концепция и дизайн работы: С.В. Королев, А.Ш. Ревишвили, А.Б. Романов Сбор и анализ данных: все авторы Статистическая обработка данных: С.В. Королев Написание статьи: С.В. Королев Исправление статьи: А.Б. Романов, А.Ш. Ревишвили Утверждение окончательного варианта статьи: все авторы

A clinical case of treatment for ventricular arrhythmia from the right ventricular outflow tract using non-invasive real-time electrophysiological mapping and the “Astrocard” navigation system (“Meditek”, Russia) is presented. This clinical case demonstrates the accuracy of non-invasive real-time mapping for the diagnosis and treatment of ventricular arrhythmias.

Brugada syndrome (BrS) is an inherited cardiac arrhythmia characterized by ST-elevation, negative T-wave, and a high risk of sudden cardiac death (SCD) due to ventricular tachycardia. It is associated with mutations in over 20 genes but only SCN5A is recommended for routine genetic screening. This study was performed to estimate diagnostic yield and pathogenicity assessment of rare genetic variants in the genes encoding Nav1.5 channel in Russian patients with Brugada syndrome (BrS). Targeted genes panel sequencing of the five genes were screened using IonTorrent PGM with following Sanger confirmation. Detailed clinical evaluation of 75 unrelated BrS probands with a deep phenotyping of SCN5A (+) probands was performed. Twelve rare genetic variants (six missense, six truncating) were initially identified and classified as disease-causing. Reassessment of the clinical significance in the light of the current guidelines revealed: 2 Pathogenic (P) variants; 8 Likely Pathogenic (LP); two missense variants (p.G274S and p. S1778H) were re-classified later as a variant of uncertain significance (VUS). Unique VUS (p.Arg100Ser) was detected in the SCN4B gene. Lone Brugada-pattern was observed in 46% probands; 54% patients had concomitant arrhythmias. PR interval, the only electrocardiography parameter correlating with SCN5A-mutation, was longer (207 ± 24 ms) than normal in SCN5A (+) probands. SCD cases were registered in 31 families. Depression was the only recurring extra-cardiac complaint in SCN5A (+) probands; it was self-reported in five SCN5A (+) probands, and co-segregated with Brugada pattern in 2 families. After variants reassessment, the ratio of SCN5A (+) probands with Brugada syndrome accounts for 13% in Russian cohort.

A case report of ventricular tachycardia (VT) treatment in a patient after myocardial infarction using non-invasive real-time electrophysiological mapping is presented. This clinical observation demonstrates the diagnostic possibilities of non-invasive mapping in the treatment of VT with hemodynamic instability. Non-invasive mapping can be used as a method for visualizing the early activation and slow conduction zones in hemodynamically instable VT, when effective endocardial mapping is not possible.

Russian Society of Cardiology (RSC).With the participation of Russian Scientific Society of Clinical Electrophysiology, Arrhythmology and Cardiac Pacing, Russian Association of Pediatric Cardiologists, Society for Holter Monitoring and Noninvasive Electrocardiology.Approved by the Scientific and Practical Council of the Russian Ministry of Health.

Russian Society of Cardiology (RSC).With the participation of Russian Scientific Society of Clinical Electrophysiology, Arrhythmology and Cardiac Pacing, Russian Association of Cardiovascular Surgeons.Approved by the Scientific and Practical Council of the Russian Ministry of Health.

With the participation: All-Russian Scientific Society of Specialists in Clinical Electrophysiology, Arrhythmology and Pacing, Russian Association of Cardiovascular SurgeonsEndorsed by: Research and Practical Council of the Ministry of Health of the Russian Federation

The treatment of coronary artery disease (CAD) in patients with combined pathology of peripheral arteries who are to perform endovascular or surgical interventions is a difficult task. The most important issues are the adequate diagnostics of artery systems’ lesions, determining the most optimal strategy and stages of treatment. This makes a multidisciplinary approach with the involvement of various specialists the most optimal.Aim. Based on multidisciplinary approach, to determine the prevalence of CAD and treatment strategy in patients with lesions of the aorta and peripheral arteries.8Material and methods. The study included 693 patients with pathology of the aorta and peripheral arteries: 171 (32,5%) were female, and 522 (75,3%) were male. The age of patients ranged from 29 to 93 years, an average — 67,2+8,8 years. Also 32,5% of patients (n=223) were older than 71 years. Cardiac complaints were present only in 203 (29,3%) patients, while 490 (70,7%) were asymptomatic. The majority of 693 patients had an isolated lesion of the internal carotid artery (ICA) (n=196, 28,3%), a combined lesion of the ICA and lower limb arteries (n=93, 13,4%), a combined lesion of the iliac and superficial femoral arteries (n=70, 10,1%) and femoral arteries lesions (n=60, 8,6%).Results. Finally, 554 (79,9%) of 693 patients had lesions of at least one coronary artery more than 50%, while 368 (66,4%) of them were clinically asymptomatic. By the decision of the multidisciplinary heart team, 316 (57,0%) patients underwent myocardial revascularization operations: 21 (6,7%) — coronary artery bypass grafting and 295 (50,3%) — percutaneous coronary intervention. Surgical and endovascular operations for pathology of the aorta and peripheral arteries were performed in 486 (70,1%) of 693 patients. Unlike with 260 (53,5%) patients, in 226 (46,5%) patients, in addition to vascular surgery, myocardial revascularization was performed. As a result of 923 (564 endovascular and 359 surgical) operations performed in 580 patients at the hospital stage, 3 (0,51%) of them had a fatal outcome. In other 2 (0,56%) cases, there was stroke: in one case after ICA prosthetics, in the other case — thrombosis of the ICA after the carotid endarterectomy. Acute myocardial infarction at the hospital stage was not detected in any of the patients.Conclusion. In 79,9% of patients with atherosclerosis of the aorta and peripheral arteries, at least one coronary artery lesion of more than 50% is detected. In 66,4% of patients with pathology of the aorta and peripheral arteries and with lesions of the coronary arteries of more than 50%, there are no cardiac complaints. In 45,6% of patients hospitalized with a diagnosis of atherosclerotic lesions of the aorta and peripheral arteries, myocardial revascularization is required. A multidisciplinary approach is an effective and safe treatment strategy for patients with pathology of the aorta and peripheral arteries of atherosclerotic origin and concomitant CAD.

The presented clinical case demonstrates an individual choice of a staged comprehensive approach to interventional treatment of a patient with coronary artery disease and ventricular tachyrhythmias, focused on myocardial revascularization and interventional abolition of ventricular tachyrhythmias.

This review is devoted to a method of sudden cardiac death (SCD) prevention by means of the implanted cardioverter defibrillators (ICD). In our study we present definition, epidemiology, mechanism and the nosological reasons of SCD. Further is the historical review of defibrillation development, cardioversion, creation and improvement of the implanted antiarrhytmic devices. Thus we present the analysis of the main clinical trials on ICD efficiency studying in primary and secondary prevention of SCD. The main advantages of these devices in patients with high risk of SCD development are shown.

In the present article we describe a clinical case demonstrating our first application of thoracoscopic radiofrequency ablation with vacuum technology Estech Cobra Fusion in a patient, 46, with prolonged persistent atrial fibrillation. We discussed actual questions, performance and showed efficiency of thoracoscopic technologies for atrial fibrillation on a beating heart.

Endorsed by: Research and Practical Council of the Ministry of Health of the Russian Federation.

Aim. To determine the mechanisms of development and approaches to interventional treatment of postoperative atrial tachycardia in patients after thoracoscopic ablation (TA) of atrial fibrillation (AF).Material and methods. The results of thoracoscopic ablation of AF in 46 patients were analyzed, of which 19,5% (n=9) had atrial tachycardia after the procedure. Radiofrequency ablation (RFA) was conducted in these patients after a 3-month blanking period. Regardless of tachycardia type, the threedimensional reconstruction including high-density right and left atrial (LA) voltage mapping was performed in order to visualize the lesions, pulmonary veins and LA posterior wall isolations. After RFA and sinus rhythm restoration, re-mapping was performed to assess conduction block and absence of electrical activity in the lesion zones.Results. Complete pulmonary vein (PV) isolation was verified in 55,5% of patients (n=5). In 44,4% (n=4), there were residual PV fractionated potentials without conduction with LA. In 22,2% of subjects (n=2), we identified typical atrial flutter (AFL), which was terminated by RFA in cavotricuspid isthmus (CTI). There were 77,7% (n=7) of patients who were diagnosed with atypical LA flutter; 66,6% (n=6) of them had conduction reconnection at the thoracoscopic box-lesion line. Perimitral AFL with slow conduction zone which was located on the anterior wall of LA was verified in 11,1% of patients (n=1). The effective RFA was performed in these areas.Two main factors affecting failed ablation were LA volume and body mass index (BMI). In patients with arrhythmias after TA, LA volume was 180,2±35,6 ml vs 158,34±38,5 ml in patients with sinus rhythm. BMI was 30,8±3,1 kg/m2 and 28,9±3,9 kg/m2, respectively. The mean follow-up was 9,8±2,7 months. All patients after catheter ablation maintained a stable sinus rhythm.Conclusion. Atrial tachycardia after TA is caused by the gaps in box-lesion lines. The main predictors of gaps are high values of LA volume and BMI. The high-density mapping increases the effectiveness of RFA. Combination of epicardial and endocardial accesses is the most effective approach to treatment of patients with persistent AF.

Aim. Current registry is the continued national study on cryoablation in atrial fibrillation (AF). The aim of the project is assessment of safety and efficacy of cryoballoon ablation of pulmonary veins from AF treatment in real clinical practice prospective observation.Material and methods. The project has been developed for prospective inclusion of the data to guarded automatic informational system, on clinical data of patients, ablation parameters, repeat ablation and results of 12-month follow-up. To participate in the project in January of 2017, the representatives of 33 in-patient facilities were invited, that routinely perform the procedure.Results. Twenty five institutions confirmed their participation, and by December of 2017, the database was completed by specialists from 13 clinics: information on the ablation procedure and outcomes is included for 451 patient. The enrollment is ongoing with estimated end by January 2019; prospective follow-up to be completed by January 2020.Conclusion. Prospective registry of AF cryoablation is important for gathering of experience and common analysis of the procedures throughout the country. Detailed analysis will make it to reveal predictors of efficacy and methods for procedural risk decrease.