Objective of the study. To evaluate the safety profile and efficiency of thoracoscopic ablation in the treatment of patients with isolated atrial fibrillation.

Materials and methods. The study included the treatment data of 78 patients (61 men and 17 women) who underwent thoracoscopic ablation and left atrial auricle amputation for the treatment of AF. The mean age of the patients was 58.0±8.5 years. Long-existing form of AF was presented in 87,2%, expressed LV dysfunction in 21,8% of patients. The study evaluated the efficacy and incidence of complications that occurred during the operation and during 30 days postoperative period.

Results. No deaths, access conversions, cerebrovascular events, or bleeding were recorded in the study group of patients during the entire follow-up period. Freedom from all types of complications was 86% during the 30-day follow-up period. The most frequent complication of the postoperative period was respiratory tract infections, recorded in 10.3% of cases. By the time of discharge from the hospital, sinus rhythm was registered in 79.4% of patients.

Conclusion. The application of thoracoscopic ablation and isolation of the LA appendage in an experienced cardiosurgical centre is a safe and effective technique of treatment of patients with isolated AF.

Aim: The aim of this work is to analyze the clinical and echocardiographic results of Morrow myoseptectomy without correction of moderate and severe mitral insufficiency; to identify risk factors for ≥2+ degree of residual mitral insufficiency after myoseptectomy.

Material and Methods: From January 2019 to September 2023, 200 patients underwent Morrow resection of hypertrophied LVP at our center. Exclusion criteria for the study were:

1) age less than 18 years;

2) need for coronary bypass;

3) organic lesions of aortic and mitral valves requiring surgical correction.

Thus, 115 patients who underwent isolated intervention were included in the study. Two groups were formed: group 1 (n=36) - patients with no or mild MI; group 2 (n=79) - patients with moderate and severe MI.

Based on the analysis of immediate and long-term results of treatment of a randomized cohort of patients with idiopathic non-paroxysmal atrial fibrillation, the safety and effectiveness of minimally invasive biatrial epicardial bipolar radiofrequency ablation both in the format of hybrid treatment in combination with endocardial ablation of pulmonary veins and in a stand-alone variant have been shown. 

Aim: To evaluate the effectiveness of hybrid and staged treatment of idiopathic persistent atrial fibrillation (AF) by analyzing immediate and long-term (2 years) treatment results in a single-center randomized clinical controlled trial.

Methods: A single-center randomized trial included 33 patients with non-paroxysmal AF. All patients underwent minimally invasive video-assisted epicardial radiofrequency ablation (RFA) as the first procedure in accordance with Patent for invention of the Republic of Belarus № 22432 dated 12.06.2016. "A method of bipolar minimally invasive epicardial radiofrequency ablation in patients with isolated persistent atrial fibrillation". Depending on the distribution of the group, the patient received an endocardial ablation procedure either during the current hospitalization, or in the period 3-6 months after the epicardial stage in case of recurrence of atrial arrhythmia (Atrial Fibrillation/Atrial Flutter). The primary endpoints included the frequency of AF recurrence at the hospital stage, the frequency of sinus rhythm retention (SR) at the end of hospitalization, the need for pacemakers, the frequency of major adverse cardio- and cerebrovascular events (MACCE). Secondary endpoints included retention of SR at the end of observe, the need to take class I/III antiarrhytmic drugs (AAD) and anticoagulants outside the "blind" period, as well as the need for repeated procedures.

Results: There were no differences in the results between the groups for the primary endpoints. By the time of discharge from the hospital, sinus rhythm (SR) occurred in 100% of patients. We did not observe major adverse cardiovascular and cerebrovascular events at the hospital stage. AF paroxysms at the end of the study period in patients using class I/III AAD were observed in 2 (13.33%) cases in the "hybrid" group and 2 (11.1%) cases in the "staged" treatment group. The need for repeated procedures for atrial arrhythmias was 2 (13.3%) cases in the "hybrid" treatment group and 5 (27.78%) cases in the "staged" treatment group. The cumulative mid-term SR retention rate at 1 year was 94.5% in both groups; after 2 years, the rate was 86.7% in the "hybrid" treatment group and 88.9% in the "staged" group.

Conclusion: Epicardial bipolar biatrial ablation has shown high efficacy in the treatment of non-paroxysmal forms of AF, but often requires repeated procedures to eliminate typical atrial flutter. To perform more effective pulmonary veins isolation, it is reasonable to perform separate pulmonary vein ablation in addition to antral ablation. The staged treatment of persistent forms of AF is justified from the clinical and economic point of view.

Aim: to determine the possibility of performing and evaluate the safety of simultaneous surgical treatment of aortic valve disease through partial sternotomy and thoracoscopic treatment of atrial fibrillation.

Materials and Methods: From December 2022 to March 2023, four aortic valve replacement operations were performed at the FSBI Federal Center for High Medical Technologies of the Ministry of Health of the Russian Federation, Kaliningrad by upper median partial sternotomy to the 4th intercostal space in combination with left atrial thoracoscopic epicardial ablation and tourniquet left atrial appendage ligation. All patients were female, a mean age of 71.4 years, concomitant diagnosis of obesity and an average body mass index of 35.2. In three cases, a biological aortic valve prosthesis was implanted, in one mechanical one. For the treatment of atrial fibrillation, bilateral thoracoscopic ablation of the left atrium was performed. Double tourniquet ligation was performed to exclude the left atrial appendage from the blood flow.

Results: mean aortic cross-clamping time was 42 minutes, cardiopulmonary bypass time was 51 minutes. The duration of the stage of thoracoscopic ablation is 124 minutes, valve replacement is 154 minutes. All patients were transferred to the intensive care unit without AF. In two cases, temporary pacemaker support was required for 4 hours after surgery. The mean ventilatory time in the ICU was 154 minutes. All patients had a smooth postoperative period without atrial tachyarrhythmias. Hospitalization time was 10-14 days.

Conclusion: Our work has shown the possibility of performing two minimally invasive treatments at the same time. The immediate results have allowed us to expand the indications for various combinations of types of operations and treatments.

The present clinical case demonstrated the successful use of remote magnetic navigation (RMN) system with retrograde approach for pulmonary vein isolation in patient with paroxysmal atrial fibrillation (AF).

Transseptal puncture (TSP) is the routine and necessitate approach to the left atrium (LA) for cardiac electrophysiological procedures. However, in some cases the operator can face with difficulties during TSP and sometimes this procedure can’t be performed. Here we presented the successful clinical case for using retrograde approach to the LA with RMN in patient with paroxysmal AF.

The main approaches to non-drug therapy of persistent atrial fibrillation were considered. The role of different treatment strategies was assessed: surgical, endoscopic, catheter ablation and cryoballon ablation of target anatomical substrates. Catheter isolation of the pulmonary veins is the most effective strategy for treatment of patients with paroxysmal atrial fibrillation; however, the success of this technique for persistent atrial fibrillation treatment remains low despite the wide range of catheter techniques used. The posterior wall of the left atrium makes a significant contribution to the development of this process, which confirms the high efficiency of its surgical isolation, even in patients with long-term persistent atrial fibrillation. Today, there is growing evidence in favor of isolation of the pulmonary veins in combination with isolation of the posterior wall of the left atrium using a cryoballoon. The data of clinical studies comparing the safety and efficacy of this approach in comparison with other invasive methods in the long-term period are presented. The technical reproducibility of the technique, high immediate and long-term success of the procedure with respect to maintaining sinus rhythm were noted.