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With the participation: All-Russian Scientific Society of Specialists in Clinical Electrophysiology, Arrhythmology and Pacing, Russian Association of Cardiovascular SurgeonsEndorsed by: Research and Practical Council of the Ministry of Health of the Russian Federation

С целью получения экспертного мнения по вопросам, связанным с актуальностью, протоколами и режимами антитромботической терапии у пациентов с COVID-19 на госпитальном и амбулаторном этапах лечения 25 июля 2020г была проведена Международная он-лайн встреча экспертов по научному обмену опытом.Группа экспертов различных специальностей (кардиологи, неврологи, эндокринологи, анестезиологи-реаниматологи), имеющих клинический опыт лечения пациентов с COVID-19, ответила на вопросы, касающиеся использования антикоагулянтов на различных этапах оказания помощи при COVID-19. Учитывая недостаточное количество структурированной научной информации, отсутствие рандомизированных контролируемых исследований в области использования антикоагулянтов у пациентов с COVID-19, наличие различных мнений в профессиональных медицинских сообществах было принято решение провести голосование с использованием Дельфийского метода экспертных оценок и прогнозирования. На первом этапе для экспертов формировались вопросы, которые касались нескольких областей терапии: тактика ведения больных, постоянно принимавших антикоагулянты до заболевания COVID-19, назначение антикоагулянтной терапии больным по поводу COVID-19 и особенности назначения антикоагулянтной терапии у больных с высоким риском венозной тромбоэмболии при COVID-19. После утверждения списка вопросов проводилось анонимное анкетирование экспертов вне очной встречи и затем обрабатывались полученные результаты, определяя обычное большинство при голосовании по каждому вопросу.

Clinical effectiveness, safety, and the impact on left ventricular (LV) systolic and diastolic function were assessed for Propanorm® and Cordarone® in patients with atrial fibrillation (AF), arterial hypertension (AH), coronary heart disease (CHD), and chronic heart failure (CHF) with preserved ejection fraction (EF). In total, 218 patients were randomised, and 189 were included in the study (132 in the Propanorm® group, and 57 in the Cordarone® group). The follow-up period lasted for 12 months. Primary end-points included all-cause mortality, cardiovascular mortality, fatal and non-fatal myocardial infarction or stroke, and hospitalisation due to decompensated CHF or recurrent AF. Secondary end-points included AF episode frequency, their duration, ventricular rate (VR) during AF paroxysms, blood pressure levels, dynamics of CHD and CHF functional class (FC), LV systolic and diastolic function, treatment safety and adverse effects in patients with CHF and preserved LV EF. At 12 months, Propanorm® effectiveness, in terms of AF paroxysm prevention, reached 61,4% and was similar to that for Cordarone®. In 31,8% of the patients from the Propanorm® group, the number of tachyarrhythmia episodes decreased by 82,4%, the total paroxysm duration was reduced by 86,6%, and VR during the paroxysm decreased by 16,1%. Improved LV diastolic filling resulted in the increased proportion of FC I CHF patients (by 50%), and reduced hospitalisation rates (by 72,9%) among the patients from the Propanorm® group. In patients with AH, CHD, and CHF with preserved LV EF, Propanorm® demonstrated a better safety profile, compared to Cordarone, since the respective adverse effect incidence was 1,5% vs. 45,6%.

Clinical effectiveness and safety of Propanorm® was studied in patients with arterial hypertension (AH), coronary heart disease (CHD), chronic heart failure (CHF) with intact systolic left ventricular (LV) function, and atrial fibrillation (AF). Effectiveness and safety of Propanorm® was compared to those in Cordarone®. Out of 137 randomised patients, 110 were included in the study (59 in the Propanorm® group, 51 – in the Cordarone® group) and followed up for 12 months. Primary end-points included all-cause mortality, cardiovascular mortality, fatal and non-fatal myocardial infarction and stroke. Secondary end-points included recurrent AF episodes, their duration, AF or decompensation-related hospitalisation rates, systolic and diastolic LF function dynamics during the treatment, and safety profile of Propanorm® and Cordarone® in CHF with intact systolic LF function. The treatment of the main pathology was associated with achieving target blood pressure (BP) levels in 67,3% of the patients, reduction in functional classes (FC) of angina (70%) and CHF (94,5%), and decrease in cardiac decompensation-related hospitalisation rates by 72,9%. After 6 and 12 months of the therapy, Propanorm® effectiveness was as high as 67,4% and 52,9%, respectively, being similar to that for Cordarone® (62,7% and 52,9%, respectively). In 33,9% of the patients, Propanorm® therapy was associated with a reduction in clinical AF symptoms, their duration, ventricular rate during AF paroxysm, and increased number of asymptomatic AF episodes by 30,9%. In cardiac patients, Propanorm® was safer than Cordarone®, with respective incidence of adverse effects of 0% vs. 31,6%. The study PROSTOR is being continued, and the present paper describes the results of 12-month therapy.

The study assessed clinical effectiveness and safety of propanorm in patients with arterial hypertension, chronic heart failure (CHF) without left ventricular systolic dysfunction, complicated with recurrent paroxysmal or persistent atrial fibrillation (AF). It was demonstrated that propanorm was effective and safe and could be combined with beta-adrenoblockers. In 29,3% of the participants, tachyarrhythmia terminated; in another 70,7% AF episode frequency reduced by 75,5%, and total time of AF episodes decreased by 81,1%.

The study is focused on assessing dynamics of left atrium volume and volume index after treatment of paroxysmal or persistent atrial fibrillation (AF), during ACE therapy with lipophilic (n=34) or hydrophilic (n=38) «standard» antihypertensive medications. After sinus rhythm restoration, mechanical dysfunction of left atrium was observed in 95, 8 % of the participants. Standard antihypertensive therapy, including lipophilic or hydrophilic ACE inhibitors, resulted in improved left atrium mechanical function and heart remodeling in 82, 1 %. Hydrophilic ACE inhibitor (Dapril) was no less effective than lipophilic medication (enalapril), being even more effective in terms of duration and dynamics of left atrium mechanical function recovery. Dapril demonstrated high effectiveness, no less than for enalapril, together with minimal adverse event rate (0 % vs 14 %>, respectively). This could improve patients' compliance to persistent medication therapy of the principal pathology.

112 patients were studied to evaluate the incidence of syncopal conditions caused by impaired cardiovascular regulation in young subjects. Complex evaluation has found hyperventilation syndrome to be the reason for syncopal conditions in 8.9 %, vasopressor syncopal conditions in 13.4 %, reflex in 16.1 %, postural hypertension in 13.4 %, «hypersensitive» carotid sinus syndrome in 5. 4 %; whereas the cause of syncopal conditions remained undetermined in 42.8 % patients.

Aim. To study clinical effectiveness, safety, and effects on left ventricular (LV) systolic and diastolic function for Class IC and Class III antiarrhythmic medications — propafenone and amiodarone, respectively — in patients with chronic heart failure (CHF), intact ejection fraction (EF), and atrial fibrillation (AF). Material and methods. Out of 227 patients, 198 were followed for 12 months (mean age 54,4±2,1 years). For AF prevention, 138 and 60 participants received propafenone and amiodarone, respectively. The assessed parameters included AF episode incidence, their duration, LV systolic and diastolic function, and therapy safety (incidence of adverse effects, AE) in CHF with intact LV EF. Results. After 12 months of the treatment, propafenone and amiodarone effectiveness for AF prevention was similar — 61,4 % and 63,2 %, respectively. ImprovedLV diastolic filling was associated with increased numbers of Functional Class I CHF patients (+50 %) and reduced hospitalization rates (-72,9). In CHF patients with intact LV EF, propafenone demonstrated a better safety profile than amiodarone: AE incidence was 0,72 % vs. 31,8 %, respectively.Conclusion. In CHF patients with intact LV EF and paroxysmal and/or persistent AF, the Class IC antiarrhythmic medication propafenone demonstrated high antiarrhythmic effectiveness, safety, and beneficial effects onLV diastolic function.

Aim. To study clinical effectiveness and safety of propafenone and amiodarone in patients with arterial hypertension (AH), coronary heart disease (CHD), chronic heart failure (CHF) with preserved left ventricular (LV) systolic function, and atrial fibrillation (AF). Material and methods. The study included 110 34-66-year-old patients from various Russian regions, with paroxysmal and/or persistent AF. To prevent AF episodes, the participants were administered propafenone (n=59) or amiodarone (n=51) for 12 months. Results. The treatment of the leading pathology resulted in achieving target blood pressure levels (in 67,3 % of the patients), as well as in reducing functional class of angina (70 %) and CHF (94,5 %). In its turn, this resulted in reduced incidence (-72,9 %) of hospitalisations due to CHF decompensation. After 12 months of the treatment, propafenone effectiveness was 54,2 % — similar to that for amiodarone (52,9 %). In 33,9 % of the patients taking propafenone, the number of AF episodes was reduced by 86,6 %, their total duration — by 70,1 %, ventricular rate during the paroxysm — by 43,1 %, while the number of asymptomatic episodes increased by 30,9 %. Propafenone was also safer than amiodarone: the respective incidence of adverse effects was 0 % vs. 31,6 %. Conclusion. Propafenone, a Class IC antiarrythmic medication, was characterised by high antiarrythmic effectiveness and safety, and could also be combined with beta-adrenoblockers in CHF patients with preserved LV systolic function, AH, CHD, and paroxysmal and/or persistent AF.