A prospectiveanalysisoftheresultsofcathetertreatmentof 130 patientswith AF resistanttomedicaltherapy, operatedduringtheperiod 2015–2017 wasconducted. Thebasisfordiagnosisof AF andthedetectionofconcomitantdiseaseswas a comprehensivelaboratoryandclinicalexamination. Atthetimeofinclusioninthestudy, antiarrhythmicdrugsweretakenbymostpatients - 132 (83%). Accordingtotheclassificationof ACC/AHA/ESC/2015, allweredividedinto 4 subgroups: Iasubgroup - patientswithparoxysmal AF (n=30), Ibsubgroup - patientswithpersistent AF (n=32) , Icsubgroup - patientswithlong-sustainedformof AF (n=35), Idsubgroup - patientswithchronicformof AF (n =33).
Thelevelofserummarkersoffibrosisandinflammationwasminimalinthecontrolgroupandwasmaximalinpatientswithchronicformof AF: MMP-9 - 75.8±14.7, 252.3±24.9 ng/ml (p<0.03). TIMP-1 is 103.61±14.96, 155.90±45.86 ng/ml (p<0.03). ЦТПК-І - 67.3±11.05, 183.31±29.18 ng/ml (p <0.03). PSA - 1.3±0.5, 3.1±1.1 ng/ml (p <0.03).
Operativeinterventionwascarriedoutattheelectrophysiologicalcomplex EP Workmate (St.JudeMedic, USA). ElectroanatomicalmappingwascarriedoutundertheNavigatornavigationsystem (St.JudeMedic, USA). Thus, theminimumtimeoftheprocedure, theradiofrequencyinfluenceandthefluoroscopywasinsubgroupIa (121.4± 15.8, 56.7±9.6 and 4.2±1.9 min.) Wheretheprocedurewasperformedexclusivelybythemethodof C. Pappone. Accordingly, themaximumtimeofthestudiedindiceswasinthesubgroupId – 192.8±23.7; 97.9±15.3 and 13.8±4.9 min. (p<0.005), wheretheprocedurewasperformed EMES, supplementedbytreatmentof CFA areas. As a result, intraoperativerecoveryofthesinusrhythmwas: 80% insubgroupIa; 75% insubgroupIb; 72.7% inthesubgroupIcand 71.4% inthesubgroupId. Relapse AF intheearlypostoperativeperiod (7 days) forsubgroupsIa, Ib, Ic, Idwere - 6.7; 9.4; 12.1 and 14.3% ofpatients. Theattackswereeliminatedbyintravenousadministrationofprocaineamide (1000 mg) oramiodarone (300 mg) for (35.0 ± 21.1) min. Intheremotepostoperativeperiod (1 year), therelapseof AF wasobservedat -10; 15.6; 21.2 and 25.7% ofpatientsrespectively. Thetotalnumberofrepeatproceduresis 53 (40.8%) patients.
Thepostoperativelevelofmarkerfibrosis (MMP-9, TIMP-1 and ЦТПК-І) andinflammation (PSA, FNP-a, IL-6) forgroupswithandwithoutrecurrenceof AF was 241 ± 23.4 and 152.7 ± 44.9; 164.4 ± 28.8 and 186 ± 26.9; 152.7 ± 44.9 and 92.5 ± 24.4 ng / ml and 2.91 ± 1.3 and 1.9 ± 0.9 mg / l, 6.84 ± 1.3 and 4.5 ± 1.1 pg/ml and 7.4 ± 1.5 and 4.6 ± 1.4 pg/ml.
Patients’ qualityoflifewasassessedusingthe SF-36 questionnaire. Themainincreasewasshownbythescaleofphysicalfunctioningandoverallmorbidity: from 38.9±10.4 to 77.87±1.10 points (p <0,01) and 48.7±0.9 to 66.4±9.2 (p <0.01) respectively. A similardynamicsischaracteristicforindicatorsofthepsychologicalcomponentofhealth.
