METHOD FOR DETERMINING INDICATIONS FOR INTERVENTIONAL TREATMENT OF PATIENTS WITH NON-PAROXYSMAL FORMS OF ATRIAL FIBRILLATION TAKING INTO ACCOUNT CLINICAL, FUNCTIONAL AND ELECTROPHYSIOLOGICAL DATA Russian patent published in 2025 - IPC A61B5/318 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to cardiology and cardiovascular surgery, and can be used in personalized determination of indications for interventional treatment of patients with atrial fibrillation (AF). Method is carried out in blocks. Block 1 includes assessment of systolic cardiac function according to transthoracic echocardiography. If the systolic function of the heart is impaired, then atrial fibrillation is considered to be clinically significant and the interventional treatment of the patient is indicated. If the systolic function of the heart is not disturbed, then the diastolic function of the heart is assessed by transthoracic echocardiography. If the diastolic function of the heart is not disturbed, then atrial fibrillation is assessed as clinically insignificant and it is considered that the interventional treatment is not indicated for the patient. If the diastolic function of the heart is impaired, then block 3 of the algorithm is used. If the diastolic cardiac function cannot be assessed by transthoracic echocardiography, a nomogram of the risk of diastolic dysfunction is used taking into account the patient's age in years and the length of the arrhythmic history in months, as shown in Fig. 1. If a high and a very high risk of diastolic dysfunction is determined, then the diastolic function of the heart is considered to be impaired and block 2 is passed. If the average risk of diastolic dysfunction is determined, the diastolic function of the heart is considered to be intact and interventional treatment is not indicated. Block 2 involves non-invasive electrophysiological mapping of the heart with localization of rotary activity in the atria, which consists of successive stages. Multichannel surface electrocardiogram (ECHO CG) is recorded. Performing multispiral computed tomography of heart with contrast (MSCT); ECHO CG and MSCT are synchronized to produce voxel and polygonal atrial models. Then, an electrocardiogram fragment is selected for analysis. Performing global band-pass filtering from 3 to 9 Hz of selected area of electrocardiogram. Activation maps are calculated with restoration of an unfiltered signal in a standard lead. Section with a maximum pause between the adjacent QRS complexes is selected – the interval T-q. Phase isopotential map is selected. Left and right boundaries of the "window of interest" are selected, where only atrial electrical activity is visualized. Rotary activity is analysed on an isopotential phase map. Rotary activity is analysed on a density map of phase singularities. When determining the localization of rotary activity in the atria, block 3 is performed. If rotary activity in atria is not localized, then it is considered that performance of interventional treatment is not indicated. Block 3 includes performing MSCT of the heart with contrast, wherein the type of inflow of pulmonary veins into the left atrium is assessed: type 1 – typical anatomy: presence of four separate orifices of pulmonary veins; type 2 – loose type: presence of three or more ipsilateral orifices of pulmonary veins; type 3 – left pulmonary vein trunk: left upper and lower pulmonary veins merge into one trunk before confluence into left atrium, right pulmonary veins flow into left atrium by two separate orifices; type 4 – mixed type: combination of pulmonary vein trunk on one side and loose type on the other; type 5 – contralateral pulmonary vein trunk: fusion of contralateral pulmonary veins into one trunk before confluence into the left atrium; type 6 – trunk of right pulmonary veins: right pulmonary veins merge into common trunk before confluence with left atrium. If type 1, type 2 or type 4 is determined, atrial fibrillation is assessed as clinically significant and it is considered that the interventional treatment is indicated for the patient. If type 3, type 5 or type 6 is determined, atrial fibrillation is assessed as clinically insignificant and it is considered that interventional treatment is not indicated for the patient.

EFFECT: method enables the personalized assessment of the clinical significance of AF, specifying the indications for the interventional treatment of the patients with AF, based on the staged analysis of the morpho-functional features of the cardiovascular system, if it is impossible to determine diastolic function of heart according to transthoracic echocardiography.

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