Неинвазивная диагностика и результаты интервенционного лечения аритмий сердца с использованием новой системы неинвазивного поверхностного картирования «Амикард 01к»

Non-invasive methods of arrhythmias diagnosis become more relevant that can complement the information about the certain mechanisms of cardiac arrhythmias in the preoperative period and reduce the time of ablation and fluoroscopy. The basis for non-invasive diagnosis is currently the principle of electric field potential reconstruction of the epicardial surface of the heart and the endocardial surface of the atria and ventricles. This principle is implemented in software and hardware complex "Amycard" intended for non-invasive cardiac EP study based on the inverse ECG study. Objective. The study purpose is to test the topical diagnosis of some cardiac arrhythmias by the synchronized reconstruction of epi-endocardial potentials compared with an epicardial mapping, an assessment of opportunities and results of the system application in invasive EP study. Material and methods. 79 patients with the different cardiac arrhythmias were examined during the study (42 men and 37 women), average age – 33.4 y. o. All patients underwent ECG in 12 standard leads, echocardiography, ambulatory electrocardiographic Halter monitoring, lab oratory tests, including clinical and biochemical blood tests, immunological research for myocardial blood antibody, blood test for thyroid hor mones (indicated). MRI of myocardium was undertaken to patients with the right ventricular arrhythmias and coronary angiography to deter mine the ischemic genesis of cardiac arrhythmias. Non-invasive mapping of surface activation, cardiac computer tomography with contrast for the further construction of surface and reconstructed epicardial isopotential and isochronous maps were undertaken after preliminary survey. Next step was an endocardial electrophysiological study. Results. During the data processing and comparing the localization of arrhythmogenic focus by the results of noninvasive surface mapping and cardiac EP study, the study showed the following results: 33 patients (89.2%) had the localization of ectopic focus coincided with the data of intracardiac EP study with the stable accuracy. Daily monitoring of Halter ECG in the early postoperative period in these patients showed a complete disappearance of ventricular arrhythmias (n=14), or a significant reduction in their number (n=3). 4 cases had the localization of arrhythmogenic focus, defined by the noninvasive activation mapping for isochronous and reconstructed epicardial isopotential maps mis matched with the data of EPS. Of these three patients had an unsuccessful RFA. All the patients were undergone the RFA of arrhythmogenic focuses. Only two cases of ventricular arrhythmia, when the area of early activa tion was located in the projection of the epicardial coronary arteries, were limited by the EPS only. Conclusion. Using results of the surface activation mapping in patients with various cardiac arrhythmias shows its high diagnostic value and the necessity for a preoperative examination. Previously held topical diagnosis of arrhythmogenic substrate will reduce the time of the arrhythmia origin finding, to avoid possible adverse intraoperative complications such as a damage of coronary vessels, as well as reduce the time of intra operative fluoroscopy.