State Research Institute of Circulation Pathology

Novosibirsk, Russia

State Research Institute of Circulation Pathology

Novosibirsk, Russia

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Hindricks G.,University of Leipzig | Pokushalov E.,State Research Institute of Circulation Pathology | Urban L.,National Institute of Cardiovascular Diseases | Taborsky M.,Na Homolce Hospital | And 2 more authors.
Circulation: Arrhythmia and Electrophysiology | Year: 2010

Background-Current methods for detecting atrial fibrillation (AF) have limited diagnostic yield. Continuous monitoring with automatic arrhythmia detection and classification may improve detection of symptomatic and asymptomatic AF and subsequent patient treatment. The study purpose was to quantify the performance of the first implantable leadless cardiac monitor (ICM) with dedicated AF detection capabilities. Methods and Results-Patients (n=247) with an implanted ICM (Reveal XT, Medtronic Inc, Minneapolis, Minn) who were likely to present with paroxysmal AF were selected. A special Holter device stored 46 hours of subcutaneously recorded ECG, ICM markers, and 2 surface ECG leads. The ICM automatic arrhythmia classification was compared with the core laboratory classification of the surface ECG. Of the 206 analyzable Holter recordings collected, 76 (37%) contained at least 1 episode of core laboratory classified AF. The sensitivity, specificity, positive predictive value, and negative predictive value for identifying patients with any AF were 96.1%, 85.4%, 79.3%, and 97.4%, respectively. The AF burden measured with the ICM was very well correlated with the reference value derived from the Holter (Pearson coefficient=0.97). The overall accuracy of the ICM for detecting AF was 98.5%. Conclusions-In this ICM validation study, the dedicated AF detection algorithm reliably detected the presence or absence of AF and the AF burden was accurately quantified. The ICM is a promising new diagnostic and monitoring tool for the clinician to treat AF patients independently of symptoms. Long-term studies are needed to evaluate the clinical benefits of the technology. Clinical Trial Registration-clinicaltrials.gov Identifier NCT00680927. © 2010 American Heart Association, Inc.


Purerfellner H.,Public Hospital Elisabethinen | Pokushalov E.,State Research Institute of Circulation Pathology | Sarkar S.,Medtronic | Koehler J.,Medtronic | And 3 more authors.
Heart Rhythm | Year: 2014

Background Frequent premature atrial contractions and sick sinus syndrome are primary causes of inappropriate atrial fibrillation (AF) detection in insertable cardiac monitors (ICMs). Objective The study aimed to validate an algorithm designed to reduce inappropriate AF detection on the basis of the identification of a single P wave during the cardiac cycle. Methods The original detection algorithm looks for evidence of AF based on differences in the pattern of R-R intervals over a 2-minute period. The improved algorithm reduces evidence for AF detection if P waves are detected. The algorithm was validated by using Holter data, which collected 2 leads of surface electrocardiogram and continuously uplinked ICM electrocardiogram over a 46-hour period. ICM detections were compared with Holter annotations to compute episode and duration detection performance. Results Valid Holter recordings (8442 hours) were analyzed from 206 patients. True AF was observed in 76 patients, yielding 482 true AF episodes ≥2 minutes in duration and 1191 hours of AF. The algorithm correctly identified 97.8% of the total AF duration and 99.3% of the total sinus or non-AF rhythm duration. The algorithm detected 85% (90% per-patient average) of all AF episodes ≥2 minutes in duration, and 55% (78% per-patient average) of the detected episodes had AF. AF was found in 95% of the detected episodes >1 hour. The improved algorithm reduced inappropriate episodes and duration by 46% and 55%, respectively, while also reducing appropriate episodes and duration by 2% and 0.1%, respectively. Conclusion An improvement in the ICM algorithm for AF detection incorporating P-wave information substantially reduced inappropriately detected episodes and duration, with minimal reduction in sensitivity for detecting AF. © 2014 Heart Rhythm Society.


Pokushalov E.,State Research Institute of Circulation Pathology | Romanov A.,State Research Institute of Circulation Pathology | Corbucci G.,Medtronic | Artyomenko S.,State Research Institute of Circulation Pathology | And 6 more authors.
Journal of the American College of Cardiology | Year: 2012

Objectives: The aim of this prospective randomized study was to assess the impact of renal artery denervation in patients with a history of refractory atrial fibrillation (AF) and drug-resistant hypertension who were referred for pulmonary vein isolation (PVI). Background: Hypertension is the most common cardiovascular condition responsible for the development and maintenance of AF. Treating drug-resistant hypertension with renal denervation has been reported to control blood pressure, but any effect on AF is unknown. Methods: Patients with a history of symptomatic paroxysmal or persistent AF refractory to <2 antiarrhythmic drugs and drug-resistant hypertension (systolic blood pressure >160 mm Hg despite triple drug therapy) were eligible for enrolment. Consenting patients were randomized to PVI only or PVI with renal artery denervation. All patients were followed <1 year to assess maintenance of sinus rhythm and to monitor changes in blood pressure. Results: Twenty-seven patients were enrolled, and 14 were randomized to PVI only, and 13 were randomized to PVI with renal artery denervation. At the end of the follow-up, significant reductions in systolic (from 181 ± 7 to 156 ± 5, p < 0.001) and diastolic blood pressure (from 97 ± 6 to 87 ± 4, p < 0.001) were observed in patients treated with PVI with renal denervation without significant change in the PVI only group. Nine of the 13 patients (69%) treated with PVI with renal denervation were AF-free at the 12-month post-ablation follow-up examination versus 4 (29%) of the 14 patients in the PVI-only group (p = 0.033). Conclusions: Renal artery denervation reduces systolic and diastolic blood pressure in patients with drug-resistant hypertension and reduces AF recurrences when combined with PVI. (Combined Treatment of Resistant Hypertension and Atrial Fibrillation; NCT01117025) © 2012 American College of Cardiology Foundation.


Pokushalov E.,State Research Institute of Circulation Pathology | Romanov A.,State Research Institute of Circulation Pathology | Corbucci G.,Medtronic | Artyomenko S.,State Research Institute of Circulation Pathology | And 3 more authors.
Circulation: Arrhythmia and Electrophysiology | Year: 2011

Background-Catheter ablation of atrial fibrillation (AF) has proved effective in curing highly symptomatic patients with paroxysmal AF. The aim of this prospective, randomized study was to identify the optimal treatment of patients with AF recurrences after the first ablation. Methods and Results-Two hundred eighty-six patients with paroxysmal AF underwent ablation (circumferential pulmonary vein isolation with linear lesions) and were monitored with an implantable cardiac monitor (Reveal XT, Medtronic). Patients without AF recurrences during the 3-month postablation period were assigned to group 1; those with AF recurrences to group 2. Patients in group 2 were randomly assigned to group 3 or group 4. Group 3 patients were treated only with antiarrhythmic drugs for 6 weeks, with no early reablation during the 3-month postablation period. In the case of AF recurrence after the 3-month postablation period, patients underwent reablation. Group 4 patients were treated according to the onset mechanism of AF recurrences, as detected and stored by the implantable cardiac monitor: antiarrhythmic drug therapy, but no reablation if AF was not preceded by triggers; early reablation if premature atrial beats or atrial tachycardias or flutter triggered AF. All patients were followed up for 1 year to assess maintenance of sinus rhythm in each group. On 12-month follow-up examination, of the 119 (42%) patients in group 1, 112 (94%) had no AF recurrences. Among the 83 patients in group 3, only 27 (33%) had no recurrences. Of the 84 group 4 patients, 67 (80%) had no AF recurrences (P<0.0001 versus group 3). Conclusions-Patients with recurrences after the first AF ablation are likely to respond to a second early ablation when AF is triggered by supraventricular arrhythmias or premature contractions. © 2011 American Heart Association, Inc.


Katritsis D.G.,Athens Euroclinic | Pokushalov E.,State Research Institute of Circulation Pathology | Romanov A.,State Research Institute of Circulation Pathology | Giazitzoglou E.,Athens Euroclinic | And 4 more authors.
Journal of the American College of Cardiology | Year: 2013

Objectives The aim of this study was to investigate whether the combination of conventional pulmonary vein isolation (PVI) by circumferential antral ablation with ganglionated plexi (GP) modification in a single ablation procedure, yields higher success rates than PVI or GP ablation alone, in patients with paroxysmal atrial fibrillation (PAF). Background Conventional PVI transects the major left atrial GP, and it is possible that autonomic denervation by inadvertent GP ablation plays a central role in the efficacy of PVI. Methods A total of 242 patients with symptomatic PAF were recruited and randomized as follows: 1) circumferential PVI (n = 78); 2) anatomic ablation of the main left atrial GP (n = 82); or 3) circumferential PVI followed by anatomic ablation of the main left atrial GP (n = 82). The primary endpoint was freedom from atrial fibrillation (AF) or other sustained atrial tachycardia (AT), verified by monthly visits, ambulatory electrocardiographic monitoring, and implantable loop recorders, during a 2-year follow-up period. Results Freedom from AF or AT was achieved in 44 (56%), 39 (48%), and 61 (74%) patients in the PVI, GP, and PVI+GP groups, respectively (p = 0.004 by log-rank test). PVI+GP ablation strategy compared with PVI alone yielded a hazard ratio of 0.53 (95% confidence interval: 0.31 to 0.91; p = 0.022) for recurrence of AF or AT. Fluoroscopy duration was 16 ± 3 min, 20 ± 5 min, and 23 ± 5 min for PVI, GP, and PVI+GP groups, respectively (p < 0.001). Post-ablation atrial flutter did not differ between groups: 5.1% in PVI, 4.9% in GP, and 6.1% in PVI+GP. No serious adverse procedure-related events were encountered. Conclusions Addition of GP ablation to PVI confers a significantly higher success rate compared with either PVI or GP alone in patients with PAF. (Circumferential Versus Ganglionated Plexi Ablation for Atrial Fibrillation [AF]; NCT00671905) © 2013 by the American College of Cardiology Foundation.


Katritsis D.G.,Athens Euroclinic | Giazitzoglou E.,Athens Euroclinic | Zografos T.,Athens Euroclinic | Pokushalov E.,State Research Institute of Circulation Pathology | And 2 more authors.
Heart Rhythm | Year: 2011

Background: Evidence indicates that the combination of left atrial ganglionated plexi (GP) ablation and pulmonary vein (PV) isolation is beneficial for treatment of paroxysmal atrial fibrillation (AF). Objective: The purpose of this study was to compare GP and PV ablation with PV isolation alone for treatment of paroxysmal AF. Methods: Sixty-seven patients with paroxysmal AF were randomized to either PV isolation using a circular catheter suitable for both mapping and ablation (PV group) or anatomic GP modification followed by PV isolation (GP+PV group). Patients were seen at monthly visits, and 48-hour ambulatory ECG recordings were obtained every 3 months for a predefined follow-up period of 12 months. Primary endpoint was freedom from AF or other sustained atrial arrhythmia recurrence 3 to 12 months postablation after one or two procedures, without antiarrhythmic medications. Results: Recurrence of arrhythmia was documented in 18 (54.5%) patients in the PV group 4.7 ± 1.0 months after ablation, and repeat PV isolation was performed in 7 (21.2%) of these patients 5.1 ± 1.1 months after the first procedure. Recurrence of arrhythmia was documented in 9 (26.5%) patients in the GP+PV group 5.0 ± 1.3 months after ablation, and repeat ablation was performed in 6 (17.6%) of these patients 4.3 ± 0.5 months after the first procedure. At the end of follow-up, 20 (60.6%) patients in the PV group and 29 (85.3%) patients in the GP+PV group remained arrhythmia-free (log rank test, P = .019). Conclusion: Addition of anatomic GP modification to PV isolation confers significantly better outcomes than PV isolation alone during a follow-up period of 12 months. © 2011 Heart Rhythm Society.


Pokushalov E.,State Research Institute of Circulation Pathology | Romanov A.,State Research Institute of Circulation Pathology | Katritsis D.G.,Athens Euroclinic | Artyomenko S.,State Research Institute of Circulation Pathology | And 5 more authors.
Heart Rhythm | Year: 2014

Background The potential role of renal denervation (RD) in patients with AF and less severe hypertension is unknown. Objective The purpose of this study was to assess the potential role of RD as an adjunct to pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF) and moderate resistant or severe resistant hypertension. Methods The data for this study were obtained from 2 different prospective randomized studies, analyzed by meta-analysis. Patients with paroxysmal AF or persistent AF and moderate resistant hypertension (office blood pressure BP 140/90 mm Hg and <160/100 mm Hg; first study; n = 48) or severe resistant hypertension ( 160/100 mm Hg; second study; n = 38) were randomized to PVI or PVI with RD. Results At 12 months, 26 of the 41 PVI with RD patients (63%) were AF-free vs 16 of the 39 patients (41%) in the PVI-only group (P =.014). In patients with severe hypertension, 11 of the 18 PVI with RD patients (61%) vs 5 of the 18 PVI-only patients (28%) were AF-free (P =.03). For moderate hypertension, the differences were less dramatic: 11 of 21 (52%) vs 15 of 23 (65%) when RD added (P =.19). The superior efficacy of adding RD was most apparent in persistent AF and severe hypertension (hazard ratio 0.25, confidence interval 0.09-0.72, P =.01). Duration of the procedure and fluoroscopy were nonsignificantly longer in the RD group. Conclusion RD may improve the results of PVI in patients with persistent AF and/or severe resistant hypertension. © 2014 Heart Rhythm Society.


Pokushalov E.,State Research Institute of Circulation Pathology | Romanov A.,State Research Institute of Circulation Pathology | Katritsis D.G.,Athens Euroclinic | Artyomenko S.,State Research Institute of Circulation Pathology | And 4 more authors.
Heart Rhythm | Year: 2013

Background The optimal ablation technique for persistent and long-standing persistent atrial fibrillation (AF) is unclear. Both linear lesion (LL) and ganglionated plexus (GP) ablation have been used in addition to pulmonary vein isolation (PVI), but no direct comparison of the 2 methods exists. Objective The aim of this study is to assess the comparative safety and efficacy of 2 different ablation strategies - PVI+LL vs PVI+GP ablation - in patients with persistent or long-standing persistent AF. Methods Two hundred sixty-four consecutive patients with persistent/long-standing persistent AF were randomly assigned to 2 different ablation schemes: PVI+LL (n = 132) and PVI+GP (n = 132) ablation. Consistent sinus rhythm (SR) off antiarrhythmic drug was assessed after follow-up of at least 3 years with the use of an implanted monitoring device. Results All procedural end points were acutely achieved. At 12 months after a single procedure, 47% of the patients treated with PVI+LL were in SR compared to 54% of the patients treated with PVI+GP (P =.29). At 3 years, 34% of the patients with PVI+LL and 49% of the patients with PVI+GP maintained SR (P =.035). Atrial flutter was more frequent in the PVI+LL group than in PVI+GP group (18% vs 6%; P =.002). After a second procedure in 78 patients of the PVI+LL group and 55 patients of the PVI+GP group, the long-term overall success rate was 52% and 68%, respectively (P =.006). Conclusions PVI+GP ablation confers superior clinical results with less ablation-related left atrial flutter and reduced AF recurrence compared to PVI+LL ablation at 3 years of follow-up. © 2013 Heart Rhythm Society.


Pokushalov E.,State Research Institute of Circulation Pathology
Current cardiology reports | Year: 2013

Cardiovascular diseases are a leading cause of mortality worldwide. Terminally differentiated adult cardiomyocytes lack the innate ability to regenerate. Cell- and gene-based therapies are emerging as exciting new experimental strategies for myocardial repair and treatment of a variety of cardiovascular diseases. The potential advantages and shortcomings of each strategy for electrophysiological disorders are discussed. Since the first description of human induced pluripotent stem cell-derived cardiomyocytes, these cells have garnered tremendous interest for their potential use in patient-specific analysis and therapy. However, a full understanding of their electrophysiological and contractile function is necessary before this potential can be realized. This review focuses on the mechanisms by which stem cell therapy may function as an antiarrhythmic treatment and early clinical results.


Steinberg J.S.,Columbia University | Pokushalov E.,State Research Institute of Circulation Pathology | Mittal S.,Columbia University
Current Cardiology Reports | Year: 2013

Renal artery denervation (RDN) has been introduced as an ablation procedure that can effectively treat drug-resistant forms of hypertension. The ablative lesions reduce the afferent and efferent sympathetic nerve traffic to and from the kidneys, thus improving blood pressure control. Because of better control of blood pressure, and because the procedure reduces central sympathetic output to sensitive structures within the cardiovascular system, it has been hypothesized that RDN may be a valuable antiarrhythmic intervention. Preliminary results using RDN for atrial fibrillation control are promising. This review focuses on the mechanisms by which RDN may function as an antiarrhythmic treatment and early clinical results. © 2013 Springer Science+Business Media New York.

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