Clinical effectiveness of catheter treatment for atrial fibrillation depending on the dynamics of histological changes in the myocardium

Background. Atrial fibrillation (AF) is combined with an inflammatory process that occurs in the myocardium. Diagnosis of histological changes, including inflammatory changes, in the myocardium is a complex task in the field of modern medicine. The only reliable way of determining the inflammatory changes in the myocardium is endomyocardial biopsy (EMB). As per our literature review, there are no data on the effect of histological changes in the myocardium on the efficacy of interventional treatment for AF. Moreover, assessing the dynamics of EMB results allows us to approach the treatment of patients in greater detail, thereby lowering the risk of the development and progression of serious cardiac pathologies, particularly AF. Aim. To study the effectiveness of catheter treatment for 'idiopathic' AF, depending on the dynamics of histological changes in the myocardium. Methods. We enrolled 48 patients with an 'idiopathic' form of AF; the median patient age was 39.0 y (33.5-48.0 y). Of these, 42 (87.5 %) were men and 6 (12.5 %) were women. The median duration of arrhythmic history was 4.0 y (2.0-7.0 y). All the patients underwent radiofrequency isolation of the pulmonary veins (Rcil) and EMB from the right ventricle. Histological tests, using the criteria of Cristina Basso, and immunohistochemical (IHC) tests were performed to determine the antigens of the following viruses: herpes simplex virus (HSV) types 1, 2 and 6, enterovirus (EV), Epstein-Barr, adenovirus and parvovirus (PV). After 6 mon, EMB, histological and IHC studies were repeated. Depending on the clinical form of AF, the patients are divided into the following three groups: group 1-paroxysmal form [21 (43.7 %) patients], group 2-persistent [13 (27.1 %) patients], group 3-long-term persistent [14 (29.2 %) patients]. Based on the results of the observation and evaluation of effectiveness, all the groups were divided into the following three subgroups: a-absence of AF during 12 mon of observation, b-early arrhythmia recurrences were registered during the first 3 mon of observation, c-presence of late arrhythmia recurrence after 3 mon of observation. Results. According to the histological criteria for active lymphocytic myocarditis identified in the subgroups, there were 5 patients (35.7 %) in 1a, 2 (50 %) in 1b, 6 (75 %) in 2a, 2 (66,7 %) in 2b, 7 (70 %) in 3a, 2 (66.7 %) in 3b, and 1 (100 %) in 3c. The rest of the patients showed signs of lymphocytic infiltration. After 6 mon, only in group 2a, there was a significant reduction in the number of patients with active lymphocytic myocarditis (p function show_eabstract() { $('#eabstract1').hide(); $('#eabstract2').show(); $('#eabstract_expand').hide(); }