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Heart rhythm disorders are one of the most urgent problems in cardiology. The first reports on the possibility of using drugs in the treatment of cardiac arrhythmias began to appear in the scientific literature from the middle of the 18th century. This pharmacotherapeutic direction has been developed since the second half of the 20th century, when new antiarrhythmic drugs began to be used in clinical practice. The introduction of new drugs and modern methods of treating arrhythmias into clinical practice has significantly improved the prognosis and quality of life of patients. Combination antiarrhythmic therapy, including antiarrhythmic drugs and radiofrequency ablation, seems to be the most promising and successful tactic for treating patients in the future. A historical review of the literature on the clinical use of antiarrhythmic drugs both in past years and at present is presented in the article.

Aim. To study changes in myocardial contractile function when prescribing mineralocorticoid receptor antagonists of spironolactone in patients after coronavirus infection SARS-CoV-2 with symptoms of chronic heart failure (CHF).Materials and methods. The study included 90 hospitalized patients with a diagnosis of SARS-CoV-2 coronavirus infection. The inclusion criteria were: age from 18 to 85 years; the presence of CHF with a preserved or mildly reduced left ventricular ejection fraction (LVEF). The patients were randomized into two groups: group I (n=60) included patients who, for 6 months after discharge from the hospital, in addition to standard drug therapy for CHF, took spironolactone at a dose of 25 mg per day; group II (comparison group; n=30) included patients who received standard drug therapy without additional prescription of spironolactone. The study groups were comparable in age, gender, prevalence of hypertension, coronary heart disease, diabetes mellitus, obesity and severity of CHF; the drug therapy given to the patients had no significant differences. Assessment of LV systolic function, exercise tolerance (six-minute walk test, TSW), quality of life (questionnaire EQ-5D-5L) were performed.Results. When repeated echocardiography was performed after 6 months of treatment, there was a significant improvement in LV systolic function in group I patients. In group I, after 6 months of treatment, there was a significant decrease in the proportion of patients with moderately reduced LVEF (from 30 [50%] to 12 [20%]; pConclusion. A significantly more pronounced improvement in systolic and diastolic left ventricle function, as well as quality of life, was found in the group of CHF patients with preserved or moderately reduced LVEF, who received spironolactone for 6 months after the SARS-CoV-2 infection in addition to standard therapy, compared with patients without aldosterone antagonists.

The coronavirus pandemic showed not only an increase in levels of excess morbidity and mortality in the acute phase, but also persisting symptoms 4 weeks after the onset of the disease. A review of international studies on the prevalence and diversity of the manifestations of postcoid syndrome is presented. The data on such a manifestation of post-COVID syndrome as postural orthostatic tachycardia syndrome (POTS) are accumulating. Pathogenetic mechanisms, modern diagnostic criteria and research data on the prevalence of this syndrome are presented in the article. The Canadian Cardiovascular Society has proposed medications as a treatment for POTS, including the sinus node If channel inhibitor ivabradine. Data from several studies showing the effectiveness of this drug for POTS, including after suffering COVID-19, are presented in the article. Clinical data on the prevalence of tachycardia among patients admitted to the Sechenov University hospital are presented. About 18% of patients with hypertension and 21% of patients with normal blood pressure had a high heart rate. A clinical example of the use of ivabradine in a patient after a coronavirus infection is presented. Drug interactions and individual tolerance of ivabradine in patients after coronavirus infection are being discussed. The authors put forward the hypothesis about the further prospect of using ivabradine in the treatment of clinical manifestations of postcoid syndrome on the basis of literature data and their own experience.

The emergence of new research methods makes it possible to study the tissue, structural, cellular, and molecular causes of atrial fibrillation (AF). Recently, the role of interstitial telocyte cells in the pathogenesis of AF has been actively discussed. Telocytes are a special type of interstitial cells identified in many organs and tissues, including the heart. The roles of telocytes in the myocardium are diverse: they have pacemaker activity, and carry out structural and coordination communication between cells. The ability of these cells to change the speed of the electrical pulse in the atrial and ventricular myocardium has been proven. Telocytes form "atypical" connections with almost all types of cells in the human heart, which collects them in an integrated network. Using electron microscopy, it was found that interstitial cells have different types of connections in the network and can integrate "information" from the vascular and nervous systems, interstitial, immune system, stem cells, progenitor cells, and contractile cardiomyocytes. Currently, the results of studies have been obtained that prove both positive and negative effects of telocytes on the occurrence of various diseases of the cardiovascular system. The role of telocytes in AF arrhythmogenesis remains a subject of discussion. The unique properties of telocytes in providing intercellular contacts, transmitting genetic information, and their ability to regenerate heart tissue are undoubtedly the most promising areas of modern cardiology. There is evidence of both direct and indirect effects of telocytes on the electrophysiological properties of the myocardium. There is no doubt that the development of this area opens up new therapeutic targets for the prevention and treatment of AF.

Aim. To identify predictors of progression of atrial fibrillation (AF) in patients with hypertension (HT), coronary heart disease (CHD) and chronic heart failure (CHF) with recurrent AF. Material and methods . The study included 31 2 patients with recurrent AF. The patients were divided into 3 groups according to a leading underlying condition: essential HT (n=1 36), CHD (n=11 2), and CHF with III-IV functional class by NYHA (n=64). The average follow-up duration was 60±3 months. Progression of AF was defined as development of long-standing persistent or permanent AF. Results. All three groups of patients with recurrent AF revealed progression of the arrhythmia from paroxysmal or persistent to a sustained permanent form during the 5-year prospective follow-up. The rate of AF progression in the patients with CHF was significantly higher and accounted for 59% as compared to 46% in the patients with hypertension (p=0.002) and 51% in the patients with CHD (p=0.008). AF progression in patients with HT correlated significantly with left ventricular (LV) hypertrophy (odds ratio [OR] 1.25; 95% confidence interval [95%CI] 1.03-1.52) and increased arterial wall stiffness (OR 2.3; 95%CI 1.95-2.65). The independent predictors of arrhythmia progression in patients with CHD were a history of myocardial infarction (OR 1.23; 95%CI 0.9-1.5), irreversible LV wall motion abnormalities (OR 1.41; 95%CI 1.1-1.7), and increased plasma level of N-terminal pro-A-type natriuretic peptide (Nt-proANP; OR 1.16; 95%CI 0.8-1.4). Reduction in LV ejection fraction below 40% (OR 0.84; 95%CI 0.7-0.89) and increased plasma N-terminal pro-B-type natriuretic peptide (Nt-proBNP; OR 2.3; 95%CI 1.93-2.67) were independent predictors of AF progression from persistent to permanent form in the patients with systolic heart failure. Conclusion. Progression of AF is related to the underlying cardiovascular disease. The early vascular aging syndrome and LV hypertrophy are the main factors of AF progression in patients with HT. Previous myocardial infarction with irreversible hypokinesia is associated with AF progression in patients with CHD. Reduced LV ejection fraction and increased plasma BNP predict AF progression in patients with CHF.

Data on angiotensin II receptor blockers, one of the main drug classes used in cardiology , are presented. The advantages of this drugs class are highlighted with the focus on telmisartan. Additionally clinical example of successful telmisartan application in patients with hypertension, high risk of cardiovascular complications, and obesity is presented.

Influence of the combined antihypertensive therapy, including combination of ACE inhibitors and dihydropyridine calcium channel blocker (DCCB), on frequency of cardiovascular events is studied in many trails. Advantages of the combination of ACE inhibitor and DCCB which is one of the most rational are discussed. Both components are vasodilators and have synergistic mode of action in arterial hypertension. Combination of ACE inhibitor and DCCB allows neutralizing of antiregulatory mechanisms reducing drug efficacy. Results of clinical trails which promoted of the fixed combination of lisinopril (10 mg) and amlodipine (5 mg) are presented. Safety and organoprotective properties of this combination are also shown according to the trail results.

Aim. To study effects of sympathomimetic agents on electrocardiogram (ECG) indexes in patients with bronchial asthma (BA) in exacerbation stage complicated by respiratory insufficiency and sympathomimetic agents overdose.Material and methods. 40 patients with persistent BA of various severities with respiratory insufficiency and sympathomimetic agents overdose were investigated. ECG was performed and P wave, QRS, duration and dispersion of corrected QT interval (QTc) were analyzed.Results. Mean QTc dispersion correlated with asthma severity and was 76,8±5,9 ms1/2, 87,9±5,1 ms1/2, 87,8±3,1 ms1/2 in patients with mild, moderate and severe BA, respectively. Significant correlation between QTc dispersion and BA duration was found. QTc dispersion level was directly connected with duration of use of β-agonists and their overdose. Average QTc dispersion in patients who used more than 20 daily doses of inhaled β-agonists was 89,0±5,8 ms1/2.Conclusion. Increase in QTc dispersion directly depends on BA duration and severity. β-agonist overdose results in growth of QTc dispersion, which has arrhythmogenic potential.

Comments on American College of Cardiology, American Heart Association and European Society of Cardiology Guidelines (2006) for the management of patients with atrial fibrillation.