Yu.V. Zinchenko Efficacy of transesophageal electric cardiac stimulation in patients with non-valvular atrial flutter type I depending on heart failure stage

We performed transesophageal electric cardiac stimulation (TEECS) procedures in order to restore sinus rhythm in isolated atrial flutter (AF) type I in 637 patients with various cardiac pathology: coronary arteries
disease (CAD) in 459 (72.1 %) and myocardial fibrosis in 178 (27.9 %) patients. Concomitant arterial hypertension (AH) was present in 383 (60.1 %) patients. Depending on stage of congestive heart failure (CHF), all
patients were divided into three groups: group 1 (n=99) – stage 0, group 2 (n=393) – stage I, and group 3 (n=145) – stage IIА. According to the results of our study TEECS is a highly effective method of cardioversion in
AF type I, allowing to restore sinus rhythm in 79.3 to 97 % patients with CHF not more than stage IIA. Severity of CHF depended on patients’ age, arrhythmia duration, gender, CAD, AH, combination of atrial flutter and atrial fibrillation, as well as such concomitant pathology as diabetes mellitus, obesity, chronic pulmonary disease, chronic thyroid pathology and history of stroke. In patients with CHF stage IIA we observed significant decrease in TEECS efficacy. Electric impulse therapy was often used and permanent arrhythmia was more prevalent. According to the echocardiography data in these patients significant increase of left chambers, left ventricular mass and decrease of its contractility were revealed. After evaluation of the electrophysiological characteristics of right atrium and atrioventricular conduction no differences between groups was found. At the same time, we found decrease in wave A amplitude at transesophageal electrogram depicting processes of electrophysiological remodelling of left atrium during its dilation.

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