Arrhythmology

From the beginning of 1970s the method of cardiac rhythm treatment and conduction has been implemented – implantation of an artificial pacemaker (cardiac pacemaker implantation). Since the beginning of the 1980s was introduced the endovascular (minimally invasive) method of diagnosis, such as an endocardial electrophysiological study of heart and later - heart rhythm disturbance treatment – catheter destruction of arrhythmia focus. In our country these methods have been actively used in the mid-90s of the last century. In view of rapidly developing medical technology and medical equipment cardiac arrhythmias and conduction became more available, safe and effective methods in cardiology.

A heart-surgeon chooses the way of patient’s treatment according to the clinical picture of disease, instrumentally diagnostic treatment and recommendation. Taking medicine without doctor instructions and self-treatment are extremely unwanted, unhealthy. It may be dangerous for your life and health, if the treatment doesn’t take into an account the nature, mechanism and cause of arrhythmia.

From minimally invasive methods of cardiac arrhythmias treatment and conduction can be identified:

1) Artificial cardiac pacemaker implantation (single- and dual chamber pacemaker), cardioverter- defibrillator (single- and dual- and trilocular chamber), devices for cardiac resynchronization therapy.

2) Heart arrhythmia catheter ablation.

For a surgery (procedure) the patient requires hospital admission. There is no special preparation for an operation, but it’s obligatory to make medical and diagnostic examination. Usually a hospital stay takes an average 2-3 days. After implantation of antiarrythmetic devices all patients are followed up by a doctor in outpatient department of our Center.

Cases for an implantation of cardiac pacemaker:Показаниями для установки кардиостимулятора

  1. Atrioventricular block 3rd
  2. Atrioventricular block 2nd grade: with symptomatic bradycardia (including chronic heart failure), ventricular arrhythmia, with documented asystole more than 3 seconds (or heart rate less than 40 beats / min).
  3. Atrioventricular block 2nd grade, appearing during the physical exercise test in the absence of coronary artery disease.
  4. Atrioventricular block 2nd grade 2nd
  5. Atrioventricular block 2nd grade grow progressively worse or transient Atrioventricular block 3rd
  6. Trifascicular heart block.
  7. Sick sinus syndrome with documented symptomatic pauses and bradycardia .
  8. Clinically manifested chronotropic incompetence.
  9. Symptomatic sinus bradycardia with a heart rate less than 40 beats / min.
  10. Chronic atrial fibrillation with symptomatic bradycardia, documented bradycardia less than 37 beats / minute and pauses for more than 3 seconds.
  11. Syncope connected with carotid sinus hypersensitivity.

Implantation of cardioverter-defibrillators(ir synchronize devices) are used for patients:

  1. Who survived after sudden circulatory arrest, which appear as a result of ventricular tachycardia, ventricular fibrillation.
  2. Who has a structural heart disease and spontaneous sustained ventricular tachycardia.
  3. Who has left ventricular dysfunction (less than 35%) and II or III CHF by NYHA after myocardial infarction is not less than 40 days.
  4. Who has the non-ischemic dilated cardiomyopathy with left ventricular dysfunction (ejection fraction less than 35%) and CHF FC II and IIII by NYHA.
  5. Who has heart failure III-IV FC by NYHA, with ejection fraction of less than or equal to 35%, with more than 120 ms QRS to sinus rhythm amid optimal medical therapy.

It is important to note that the effectiveness of medication drugs for arrhythmia treatment must be taken continuously. When the pharmacological drugs are ineffective and patient reluctance to take them, it is possible to carry out the ablation arrhythmia focus.

Cases for catheter ablation of arrhythmia focus:

  1. Paroxysmal atrioventricular-node re-entry tachycardia.
  2. Paroxysmal antrioventicular reciprocating tachycardia involving an additional way of passage(WPW syndrome).
  3. Paroxysmal form of typical atrial flutter.
  4. Paroxysmal form of atrial fibrillation.
  5. Chronic tachysystolic atrial fibrillation with the ineffectiveness of drug therapy.
  6. Paroxysmal atrial tachycardia.
  7. Monomorphic ventricular tachycardia (One focus).
  8. Ventricular premature beats with clinical symptomatology.

Methods of cardiac pacemaker implantation, cardioverter-defibrillators and cardiac resynchronization therapy devices

Implantation of the devices is performed under local anesthesia with X-ray, duration - to 40-55 minutes. Generally a patient is conscious. In the area of the left subclavian is made a small incision - 4 cm. Puncture of the subclavian vein is made with the help of removable introducers (“tubes”), under radioexamination control endocardial electrodes are injected in the heart and set them in the right position (atria, ventricles). Stimulators divided into single- and dual- and trilocular chamber, depending on the amount of stimulated chambers of heart. During the triocular-chamber pacemaker implantation, first is made coronary sinus angiography, then the left ventricular electrode is implanted with a help of special delivery system under X-ray control. After the implantation, electrodes connected to the pacemaker and implanted it into prepared "pocket" under the skin. All tissue sutured in layers and applied a cosmetic seam to the skin. Next morning patients can walk.

The methodology of catheter ablation of arrhythmia foci

An effective treatment for tachyarrhythmias is catheter ablation (destruction) of arrhythmia focus. The operation is usually performed under conditions with X-ray under local anesthesia. A small puncture of the vessel is made and set introducers ("tube"), through which is injected the heart catheter electrodes under the control of X-rays. After the endocardial cardiac electrophysiological study, with help of which is detected a mechanism and localization of focus arrhythmias, ablation is performed ("burning") identified focus. The operation is made on the average for 45-55 minutes, and the next day the patient can be discharged from the hospital.