Search

Aim. To identify predictors of cardiovascular events (CVEs) in patients with heart failure (HF) and P. aeruginosa pneumonia.Material and methods. The study included 92 patients with HF with mildly reduced or reduced ejection fraction and nosocomial pneumonia. Based on sputum or bronchoalveolar lavage microbiological examination, patients were divided into 2 following groups: group I — 51 patients with HF and P. aeruginosa pneumonia, group II — 41 patients with HF and pneumonia caused by other pathogens (Staphylococcus aureus, Streptococcus pneumoniae). During the hospital stay, the following morbidities were assessed: cardiovascular death, acute coronary syndrome, non-fatal cerebrovascular accident, pulmonary embolism, lower extremity venous thrombosis.Results. CVEs were significantly more often observed in patients with HF and P. aeruginosa pneumonia — 30 (58,8%) than in patients with HF and pneumonia caused by S. aureus or S. pneumoniae — 5 (12,1%). Complete blood count in group I patients revealed a decrease in hemoglobin level to 114 [95; 133] g/l, when compared with patients in group II — 139 [118; 150] g/l (p11×109/l (RR 2,412; 95% CI 1,399-4,158; p=0,048), CRP >133 mg/l (RR 3,115; 95% CI 1,611-6,025; p

Aim. To assess the contribution of Pseudomonas aeruginosa pneumonia to the development of cardiovascular events in patients with heart failure (HF).Material and methods. The study included 219 patients who were divided into a group of patients with pneumonia caused by P. aeruginosa (Group I) and a group of patients with pneumonia caused by S. aureus, S. pneumoniae (Group II). All patients underwent chest computed tomography (CT), blood tests, echocardiography, electrocardiography (ECG), 24-hour Holter ECG monitoring, pulse oximetry (SpO2), and Doppler ultrasound of the lower limb veins.Results. According to the study, cardiovascular events were more often observed in the group of patients with P. aeruginosa pneumonia as follows: death from cardiovascular events was registered in 11,4% of patients in group I and 0% of patients in group II (p=0,001); acute coronary syndrome — in 8,7 vs 0% (p=0,002), lower limb thrombosis — in 14 vs 1,9% (p=0,001). The occurrence of P. aeruginosa pneumonia in patients with HF increased the cardiovascular death risk by 8,8 times (95% confidence interval (CI): 1,2-65,7; p=0,005), acute coronary syndrome — in 8,0 times (95% CI: 1,1-60,2; p=0,014), lower limb thrombosis — in 9,6 times (95% CI: 1,3-71,2; p=0,004).Conclusion. Patients with HF and P. aeruginosa pneumonia are at greater risk of cardiovascular events than patients with pneumonia caused by S. pneumonia and S. aureus.

Aim. To evaluate cardiovascular risk factors as predictors of the post-coronavirus disease 2019 (COVID-19) syndrome.Material and methods. This prospective cohort study included adult patients admitted to a university hospital with a clinically or laboratory-confirmed diagnosis of COVID-19. A number of cardiovascular risk factors were assessed at admission, including the Cardio-Ankle Vascular Index (CAVI). After hospital discharge, patients were observed for 6 months. Then, data on the course of the post-COVID-19 period was collected from electronic medical records and discharge summaries. Two following outcomes were assessed: the development of post-COVID-19 syndrome and the development of newly diagnosed diseases or worsening of existing chronic diseases in the post-COVID-19 period.Multivariable logistic regression was used to assess the association between potential predictors and outcomes, and odds ratios (OR) with 95% confidence intervals (95% CI) were calculated to assess the association strength. The statistical significance level was p

Aim. To assess the association of hypertension with the severe forms and fatal outcomes of Coronavirus disease 2019 (COVID-19).Material and Methods. This retrospective cohort study involved adult patients (≥18 years old), admitted to the University hospital №4 of Sechenov University (Moscow, Russia) between 08 April 2020 and 19 November 2020 with clinically diagnosed or laboratory-confirmed COVID-19. The cohort included 1637 patients. The primary outcome was all-cause in-hospital mortality. The secondary outcomes included intensive care unit admission (ICU) and invasive ventilation. Multiple logistic regression was performed to assess the independent association between risk factors and endpoints.Results. A total of 1637 patients were included in the study. 51.80% (n=848) of the subjects were males. The median age was 59.0 (48.0; 70.0) years and 55.90% (n=915) had pre-existing diagnosis of hypertension. Patients with hypertension had significantly more severe lung injury based on chest CT scan findings as well as lower oxygen saturation (SрO2). More of them were admitted to ICU and placed on invasive ventilation. The hypertension group also had higher mortality. Age, hypertension, glucose, C-reactive protein and decreased platelet count were independently associated with mortality, hypertension having the strongest association (OR 1.827, 95% CI 1.174-2.846, p=0.008). Age, hypertension, neutrophil count, platelet count, glucose, and CRP were independently associated with ICU admission, with hypertension having the strongest association (OR 1.595, 95% CI 1.178-2.158, p=0.002). Age, hypertension, glucose, CRP and decreased platelet count were independently associated with invasive ventilation, with hypertension having the strongest association (OR 1.703, 95% CI 1.151-2.519, p=0.008).Based on the multiple logistic regression models, odds of death, ICU admission, and invasive ventilation were higher in the hypertension group as compared to the group without hypertension.Conclusion. Hypertension can be an independent predictor of severe COVID-19 and adverse outcomes, namely death, ICU admission, and invasive ventilation in hospitalized patients.

The article presents the main mechanisms of development of lipid metabolism disorders and endothelial dysfunction in patients with hypertension (HTN) and type 2 diabetes (T2D), and their contribution to cardiovascular events. Modern approaches to the treatment of hypertension and dyslipidemia in people with type 2 diabetes are considered from the standpoint of the latest clinical guidelines, focusing on fixed-dose combinations as a means of an integrated approach to managing risk factors in comorbid patients. Data are presented on the efficacy and safety of fixed-dose combination of lisinopril, amlodipine and rosuvastatin in patients with hypertension and T2D.

Aim: present clinical guidelines, aimed at general practitioners, gastroenterologists, cardiologists, endocrinologists, comprise up-to-date methods of diagnosis and treatment of non-alcoholic fatty liver disease.Key points. Nonalcoholic fatty liver disease, the most wide-spread chronic liver disease, is characterized by accumulation of fat by more than 5 % of hepatocytes and presented by two histological forms: steatosis and nonalcoholic steatohepatitis. Clinical guidelines provide current views on pathogenesis of nonalcoholic fatty liver disease as a multisystem disease, methods of invasive and noninvasive diagnosis of steatosis and liver fibrosis, principles of nondrug treatment and pharmacotherapy of nonalcoholic fatty liver disease and associated conditions. Complications of nonalcoholic fatty liver disease include aggravation of cardiometabolic risks, development of hepatocellular cancer, progression of liver fibrosis to cirrhotic stage.Conclusion. Progression of liver disease can be avoided, cardiometabolic risks can be reduced and patients' prognosis — improved by the timely recognition of diagnosis of nonalcoholic fatty liver disease and associated comorbidities and competent multidisciplinary management of these patients.

Hypertension and dyslipidemia are key risk factors for cardiovascular disease. Despite the currently existing possibilities for the combined use of various classes of antihypertensive and lipid-lowering drugs, the problem of treating patients with a high risk of cardiovascular events has not lost its significance and its solution in a specific clinical situation often remains very difficult. The review analyzes current data on the efficacy and safety of the fixed-dose combination of lisinopril, amlodipine and rosuvastatin to solve the problem of a personalized approach in the treatment of comorbid patients with a high risk of car­diovascular events.

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%]; p

Aim. To evaluate the effect of sinus tachycardia and reduced left ventricular ejection fraction (LVEF) on the prognosis of patients with a verified diagnosis of a new coronavirus infection SARS-CoV-2.Material and methods. The study included 1,637 patients with a verified diagnosis of a new coronavirus infection SARS-CoV-2. The average age of the patients was 58.8±16.1 years. More than half of the patients admitted to the hospital had a history of cardiovascular diseases: hypertension was diagnosed in 915 (56%) patients, coronary artery disease – in 563 (34%), chronic heart failure – in 410 (25%). 294 (17.9%) patients suffered from diabetes mellitus. The unfavorable course of new coronavirus infection was assessed by the fact of being in the intensive care unit (ICU), the use of mechanical ventilation and death.Results. An unfavorable course of coronavirus infection was observed in 160 (9.8%) patients. Statistical analysis revealed that 341 (20.8%) patients with COVID-19 were diagnosed with sinus tachycardia, which required the appointment of pulse-reducing therapy. The occurrence of sinus tachycardia in patients with COVID-19 significantly increased the risk of death (odds ratio [OR] 1.248, confidence interval [CI] 1.038-1.499, p=0.018), increased the likelihood of mechanical ventilation use (OR 1.451, CI 1.168-1.803, p

Aim. To evaluate the changes of the N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration in patients with sinus tachycardia after coronavirus disease 2019 (COVID-19) during ivabradine monotherapy or in combination with β-blockers (BBs) compared to BB monotherapy.Material and methods. This randomized comparative study included 90 patients discharged from the hospital after an acute period of COVID-19. The main group (n=60) included patients who received ivabradine monotherapy or in combination with BB in addition to standard therapy, while the control group (n=30) — standard therapy in combination with BB. The follow-up period lasted 24 weeks. Serum NT-proBNP concentration was determined by enzyme immunoassay at the first and last visit (0 and 24 weeks). Statistical processing was performed using STATISTICA 8.0 software. The level of statistical significance was p

Aim. To assess the change in the activity of the matrix metalloproteinase (MMP) system after 6-month spironolactone therapy in patients with heart failure (HF) with preserved (HFpEF) and mildly reduced ejection fraction (HFmrEF) after coronavirus disease 2019 (COVID-19).Material and methods. The study included 90 patients treated at the University Clinical Hospital № 4 of the I.M. Sechenov First Moscow State Medical University with a laboratory-confirmed COVID-19. There were following inclusion criteria: age of 18-85 years; the presence of HFpEF and HFmrEF. The patients were randomized into two groups: group I (n=60) — patients with 6-month spironolactone therapy (25 mg/day) in addition to the standard therapy for HF, spironolactone was taken at a dose of 25 mg/day; Group II (comparison group, n=30) — patients who received standard therapy without spironolactone. All patients were determined plasma MMP concentrations.Results. There were no significant differences in the levels of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) between the groups when included in the study. A repeated investigation revealed a significant decrease in the concentrations of MMP-9 and TIMP-1 only in group I. In patients of group II, there were no significant changes in the plasma concentrations of MMP-9 and TIMP-1. The MMP-9/TIMP-1 ratio during the initial examination of patients did not have significant differences. After 6-months therapy, a significant decrease in the ratio of MMP-9/TIMP-1 was observed only in patients taking spironolactone.Conclusion. The results obtained confirm a significant decrease in MMP system activity after 6-month spironolactone therapy in patients with HFpEF and HFmrEF after COVID-19. The described antifibrotic effects of spironolactone make it possible to recommend the use of this drug in this category of patients to reduce the negative effect of MMPs on cardiovascular system.

Early diagnosis of atrial fibrillation (AF) predictors in coronavirus disease 2019 (COVID-19) and the appointment of additional therapy to prevent arrhythmias will improve the prognosis of patients.Aim. To identify predictors of AF in patients with COVID-19.Material and methods. This retrospective study included 1473 patients hospitalized with COVID-19. Depending on AF occurrence, the patients were divided into 2 groups as follows: group I included 95 patients with AF episodes during hospitalization; group II consisted of 1378 patients who did not have AF during hospitalization. All patients underwent a complete blood count and urine tests, a biochemical and coagulation blood tests, 12-lead electrocardiography, chest computed tomography (CT), and echocardiography.Results. Chest CT found that lung tissue involvement in patients of group I was significantly greater than in group II (p50% (CT-3 and CT-4) was significantly higher in the AF group than in the control group. The average room air oxygen saturation upon admission to the hospital were significantly lower in patients with AF than in the comparison group (p60 years, hypertension, coronary artery disease, heart failure, increased left atrial volume, large lung tissue involvement, and increased interleukin- 6 level.Conclusion. There are two following groups of predictors initiating AF in COVID-19: generally known (older age, cardiovascular disease, increased left atrial volume) and those that determine the severe COVID-19 course (large lung damage and high interleukin-6 levels).

Aim. To assess the changes of heart rate (HR), exercise tolerance and quality of life in patients after coronavirus disease 2019 (COVID-19) during treatment with ivabradine monotherapy or in combination with beta-blockers (BB) compared with BB monotherapy.Material and methods. This randomized comparative study included 90 patients discharged from a university hospital after an acute COVID-19. The main group (n=60) received, in addition to standard therapy, ivabradine monotherapy or in combination with BB, while the control one (n=30) — standard therapy in combination with BB. The follow-up period lasted 24 weeks. Statistical processing was performed using the STATISTICA 8.0 program. The level of statistical significance was p

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.

At the end of 2020, a new term “post-COVID-19 syndrome” appeared in the medical community. The prevalence of this syndrome reaches more than 30% among patients who have had COVID-19, and its duration can vary from 12 weeks to 6 months. One of the most severe consequences of COVID- 19 is the defeat of the cardiovascular system, which has a variety of mechanisms: dysregulation of the renin-angiotensin-aldosterone system; pathological systemic inflammatory response; direct action of the virus on the myocardium with the development of myocarditis; respiratory failure with hypoxia, leading to damage to cardiomyocytes; microvascular damage due to hypoperfusion, increased vascular permeability, angiospasm and the direct damaging effect of the virus on the endothelium of the coronary arteries; thrombotic complications due to the procoagulant and prothrombogenic effect of systemic inflammation. One of the most promising directions in the treatment and prevention of damage to the cardiovascular system in patients with hypertension who have undergone COVID-19 is the appointment of antihypertensive drugs that have the most pronounced organoprotective properties together with statins. The single pill combination of lisinopril, amlodipine and rosuvastatin is an effective drug that allows achieving not only adequate hypotensive and lipid-lowering effects, but also due to its pronounced organoprotective properties, to expect a reduction in cardiovascular risk and complications in patients who have suffered a new coronavirus infection caused by the SARS-CoV-2 virus.

Aim. To study changes in vascular wall stiffness in patients with obesity and paroxysmal atrial fibrillation (AF) during sinus rhythm retention.Material and methods. The study included 86 obese patients aged 38 to 72 years. Patients were divided into 2 groups: 42 patients with paroxysmal AF and obesity (Group I) and 44 patients with obesity and without rhythm disturbance (Group II). All patients were evaluated for the main parameters of arterial wall stiffness: the heart-ankle vascular index (CAVI) and the ankle-brachial index (ABI) in the right and left main arteries.Results. Body mass index (BMI) did not differ significantly between groups. The prevalence of visceral obesity in patients with paroxysmal AF was significantly higher than in patients without heart rhythm disorders. The study of vascular wall rigidity revealed a significant increase in the CAVI index in patients with paroxysmal AF compared with this in patients without cardiac arrhythmia. The average value of the CAVI index was 9.61±1.51 and 7.92±0.18, respectively (p=0.0003). In patients with obesity and paroxysmal AF, correlations were found between waist circumference to hip circumference (WC/HC) ratio and CAVI index (r=0.455, p=0.004); WC/height ratio and CAVI index (r=0.443, p=0.003); between WC and CAVI index (r=0.493, p=0.002). A positive direct relationship was found between CAVI index and the frequency of AF attacks during the year: r=0.782 (p=0.001).Conclusion. A significant increase in the CAVI index, indicating a change in vascular wall stiffness, was found in patients with obesity and paroxysmal AF when compared with overweight patients without heart rhythm disorders. The increase in the CAVI index was correlated with the increase in WC, the WC/HC ratio, and WC/height ratio. There was a significant direct relationship between the CAVI index and the frequency of arrhythmia attacks in patients with obesity and paroxysmal AF.

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.

One of the trends in modern cardiology is the use of omega-3 polyunsaturated fatty acids (ω-3 PUFA) in the prevention of heart rhythm disorders and the prevention of sudden cardiac death. In experimental studies, it was found that ω-3 PUFAs have a variety of pleiotropic effects: they reduce the formation of oxygen radicals, reduce reperfusion complications, reduce the level of thromboxane and platelet aggregation, and improve endothelial function. The ability of ω-3 PUFA to have an anti-inflammatory effect, which includes the inhibition of leukocyte chemotaxis, the expression of adhesion molecules, the formation of eicosanoids and biologically active substances with powerful anti-inflammatory properties. One of the most significant effects of ω-3 PUFA can be considered their anti-atherogenic effect. Antiarrhythmic properties of го-3 PUFA are associated with the effect on the ion channels of cardiomyocytes, they are able to activate "slow" calcium channels, increase the activity of Ca2+/Mg2+-ATPase and reduce the work of sodium channels. In animal experiments, it has been shown that in conditions of ischemia or adrenergic stimulation, ω-3 PUFA stabilizes the cardiomyocyte membrane, can increase the duration of the effective refractory period, and prevent the development of various heart rhythm disorders. Clinical studies have shown that the administration of ω-3 PUFA in addition to standard treatment reduces the risk of new cases of atrial fibrillation, ventricular arrhythmias and sudden cardiac death.

The treatment of atrial fibrillation (AF) remains one of the most difficult tasks in modern cardiology. In 2020, the European Society of Cardiology (ESC), together with the European Association for Cardio-Thoracic Surgery (EACTS), published guidelines for the diagnosis and management of AF, which include several new directives.ESC experts have formulated a novel concept for treatment of AF patients. The first component of treatment ‘A' (Anticoagulation/ Avoid stroke) is anticoagulant therapy in patients with increased risk of thromboembolic events. The second line of treatment ‘B' (Better symptom control) is the control of arrhythmia symptoms, selection of a rhythm control strategy or ventricular rate control. The third direction ‘C' includes cardiovascular risk factors and comorbid conditions management.The most challenging tasks in AF treatment are the control of arrhythmia symptoms. As in the previous version of 2016 guidelines, the latest ones identify 2 following strategies in treatment of AF: rhythm control and ventricular rate control.According to the current ESC/EACTS guidelines (2020), antiarrhythmic therapy continues to be one of the important directions in AF management. Early prescription f antiarrhythmic and anticoagulant agents with an increased risk of thromboembolic events, catheter ablation can not only improve the quality of life, but also the prognosis of patients with AF.

Atrial fibrillation (AF) is one of the most common heart rhythm disorders. AF worsens the quality of life of patients and increases the risk of fatal cardiovascular complications. Obesity is a worldwide epidemic which prevalence has doubled in the past 30 years. The role of obesity as one of the predisposing factors for AF is currently being discussed. The modern literature describes several mechanisms of the influence of overweight on the development of arrhythmias: activation of the sympatho-adrenal nervous system, increased activity of the reninangiotensin-aldosterone system, development of arterial hypertension, insulin resistance, and lipid metabolism. Despite the large number of studies in this area, the pathogenesis of the development and progression of AF in obesity is not fully understood.The molecular mechanisms of AF development in obese patients include the occurrence of systemic inflammation. The most significant inflammatory activity is observed in the epicardial adipose tissue. It is proven that pro-inflammatory cytokines and adipocyte dysfunction negatively influence over development of AF. Evaluation of the patient’s clinical status and study of subtle mechanisms of arrhythmogenesis in obese patients allows discussing specific approaches to treatment. This approach is consistent with modern ideas about personalized medicine.

Atrial fibrillation (AF) is the most common heart rhythm disorder encountered in clinical practice. Each year, the number of patients with AF significantly increases. It is associated with an increase of life expectancy and frequency of cardiovascular pathologies. Treatment of AF remains one of the most difficult tasks of modern cardiology. Currently, only a few antiarrhythmic drugs are available for use in Russia. More and more new attempts are being made to create a universal antiarrhythmic drug with a high level of anti-relapsing efficacy and adverse effects. The accumulated information suggests that the tactics of management of patients with arrhythmias will be intended to improving the new surgical and interventional treatment methods with use of anticoagulants and antiarrhythmic drugs. The multidisciplinary team of specialists on AF treatment should include an expert (cardiologist) in antiarrhythmic drug therapy, an interventional electrophysiologist, and a cardiac surgeon — master the technology of interventional or surgical ablation. Effective interaction of specialists of various levels will improve the results of rhythm control and prevention of complications in patients with 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.

Due to the spectacular progress made in human genomic studies, molecular biology and genetics have become an essential part of modern medicine making it possible to early detect the risk factors and select the personalized treatment. The genetic studies have been widely used in the diagnosis and treatment of arrhythmias. Significant advances in the study of electrophysiological and genetic mechanisms of life-threatening arrhythmias have been achieved through studies of familial conditions with high risk of sudden cardiac death. However, the area of special interest for a practitioner is the identification of mutations associated with atrial fibrillation (AF). The novel methods enable us to study histological, structural, cellular and molecular causes of this arrhythmia. The two main directions of molecular genetic studies of AF are the identification of genetic mutations causing familial atrial fibrillation and the study of different genes polymorphism predisposing to arrhythmia in general population. Gene polymorphism screening helps both identify AF risk factors and predict its evolution from paroxysmal to chronic type. Emerging genetic studies provided explanation for the variable efficacy of antiarrhythmic drugs. It can be assumed that the clinical use of genetic methods will allow accurate and personalized selection of antiarrhythmics. Currently, therapeutic drug monitoring is widely recommended for a number of medications including cytostatics, aminoglycosides, anticonvulsants, and, by some researchers, antiarrhythmic and anticoagulant drugs. Medicine from the very beginning was intended to be personalized, but until recently it was a little more than a myth. The discovery of the human genome makes it possible to choose the most effective treatment with minimal adverse drug reactions for a particular patient.

Obesity is a progressing epidemic, the prevalence of which has doubled over the past 30 years. The distribution of adipose tissue is an important factor in predicting the risk of cardiovascular events. The most significant inflammatory activity is characteristic of epicardial adipose tissue (EAT), the role of which in the development of atrial fibrillation (AF) remains a subject of discussion.Aim. To study the effect of EAT size on the development of AF in hypertensive (HTN) patients.Material and methods. The study included 95 patients with HTN aged 38-72 years (mean age, 61,5±1,8 years), including 45 patients with paroxysmal AF (group I) and 50 patients in the comparison group (group II). In order to assess the severity of visceral obesity, all patients underwent a general examination and echocardiography. To determine the EAT volume, cardiac multislice computed tomography was performed.Results. Echocardiography revealed that the EAT thickness was significantly greater in hypertensive patients with paroxysmal AF than in the comparison group: 11,6±0,8 and 8,6±0,4 mm, respectively (p10 mm and volume >6 ml can serve as integral markers of the onset of paroxysmal AF.Conclusion. Integral markers of AF in hypertensive patients are an increase in the EAT thickness >10 mm (odds ratio, 4,1; 95% confidence interval, 1,1-5,6) and volume >6 ml (odds ratio 3,7; 95%, confidence interval 1,0-4,2).

Supraventricular tachycardia (SVT) is one of the most common arrhythmias. The prevalence of SVT varies widely in different countries and is 2,25 per 1,000 people in the general population. SVT reduce the quality of life of patients, and in some cases can worsen the prognosis. In patients with cardiovascular disease, the risk of SVT increases. Therapy of SVT is selected depending on the stability of hemodynamic and the QRS width. Until now, the treatment of SVT remains an urgent issue of modern cardiology, since despite the high effectiveness of catheter ablation, antiarrhythmic therapy plays an important role.

The pandemic of the novel coronavirus infection (COVID-19), caused by SARS‑CoV‑2, has become a challenge to healthcare systems in all countries of the world. Patients with comorbidity are the most vulnerable group with the high risk of adverse outcomes. The problem of managing these patients in context of a pandemic requires a comprehensive approach aimed both at the optimal management in self-isolated patients not visiting medical facilities, and management of comorbidities in patients with COVID-19. The presented consensus covers these two aspects of managing patients with cardiovascular disease, diabetes, chronic obstructive pulmonary disease, gastrointestinal disease, and also pay attention to the multiple organ complications of COVID-19.

Aim. To evaluate the changes of endothelial function in arterial hypertension (AH) patients with paroxysmal atrial fibrillation (AF) in treatment with propafenone (Propanorm, PRO.MED.CS Praha a. s.) in comparison with bisoprolol.Material and methods. To the study, 62 AH patients included with paroxysmal AH, age 45-63 y. o. (mean age 54,5±3,7 y. o.). Patients were randomized to 2 groups: 32 of group 1 (main) for rhythm-control were taking propafenone (Propanorm, PRO.MED.CS Praha a. s.) 450 mg daily, and 30 of group 2 (comparison) were taking bisoprolol for rate control. The groups were comparable by gender, age, severity of AH and duration of arrhythmia. Changes in endothelium vascular motion function and biochemical markers of endothelial dysfunction were assessed at inclusion and in 12 months of therapy.Results. Sinus rhythm retention in propafenone group facilitated the improvement of vascular motion function of endothelium — endothelium dependent vasodilatation of brachial artery showed tendency to rise significantly from 5,4±0,3% to 6,9±0,1% (р=0,01). In patients taking bisoprolol for pulse reduction during 12 months, there was negative tendency from 4,8±0,2% to 3,6±0,1% (р=0,003), that points on worsening of endothelial function with persistent AF. Repeat measurement of biochemical markers of endothelial dysfunction revealed that in 12 months there is raise of endothelin concentration in both groups. Value of the collagen-binding activeness of von Willebrand factor in 12 months significantly reduced from 131±12 to 118±6 U/dL (р

Aim. To study the changes in the stiffness of the arterial wall, vasomotor function of the endothelium, and appearance of new cases of atrial fibrillation (AF) in patients with arterial hypertension with long-term treatment with lisinopril.Material and method. 66 hypertensive patients with cardiac sinus rhythm at the age of 48-64 years (mean age 58.4±4.2 years) were included into the study. They were randomized into 2 groups: patients of group 1 (n=35) were prescribed lisinopril or a combination of lisinopril with hydrochlorothiazide over the 5-year follow-up; patients of group 2 (control) did not receive angiotensin converting enzyme inhibitors or angiotensin II receptor blockers. The follow-up duration was from September 2010 until June 2016. It included telephone calls once every 3 months and annual clinical, instrumental and laboratory examination. The new-onset AF was identified by the 24-hour Holter ECG monitoring results and by patient symptom diaries.Results. New-onset AF was registered in 2 patients (6%) in the lisinopril group and in 4 patients (13%) from the control group (p=0.001) over the 5-year follow-up. Lisinopril significantly reduced AF incidence in hypertensive patients. The patients on lisinopril were found to have no significant changes in the left ventricular mass index and left atrial size according to echocardiography done after the 5-year follow-up whereas in the patients of control group both parameters increased significantly. Lisinopril contributed to the maintenance of endothelial vasodilator function and prevented increase in arterial wall stiffness.Conclusion. Long term lisinopril treatment was found to significantly reduce the AF incidence in hypertensive patients over the 5-year follow-up. Lisinopril demonstrated organoprotective properties throughout the cardiovascular disease continuum and can be recommended for primary prevention of arrhythmia in hypertensive patients.

Arterial hypertension (AH) remains one of the most prevalent cardiovascular disorder in the world, as one of the main risk factors of myocardial infarction and stroke development. Monotherapy of AH is effective in no more than one half of patients even with moderate increase of blood pressure. Combinational antihypertension treatment does influence pathogenetic mechanisms of AH being an optimal solution. It is worthful to apply a fixed combination of telmisartan and hydrochlorothiazide. Such combination provides additional antihypertensive effect with more significant decrease of blood pressure than for the components separately. Also it is protective for organs and tissues that makes it to prescribe such combination to a broad range of patients.

Aim. To study the effect of atorvastatin on the progression of the arrhythmia in hypertensive patients with paroxysmal atrial fibrillation (AF) in the longterm follow-up.Material and methods. Patients with paroxysmal AF (n=65) were included into the study. The patients were divided into two groups depending on the level of lipid metabolism: group I (n=33) received atorvastatin (10-40 mg/day), and control group II (n=32) did not take statins. The duration of follow-up was 4 years. The evolution of the AF clinical course was evaluated by the number of arrhythmia episodes for 3 months. Increase in the frequency of paroxysms of AF over the past 3 months, the appearance of the long-standing persistent AF or permanent AF considered as the arrhythmia progression.Results. The increase in rate and duration of AF episodes was found in 14 (42%) patients of group I and in 13 (41%) patients of group II. Progression of AF was observed with equal frequency in groups I and II. The average value of arrhythmia progression was 10.5% per year in patients of group I and 10.3% in group II. Significant differences between groups in the progression of AF were not found (p=0.2).Conclusion. Atorvastatin in hypertensive patients with paroxysmal AF did not lead to a change in rate and duration of arrhythmia paroxysms. The average value of paroxysmal AF progression was comparable regardless of atorvastatin use.

Aim. To study efficiency and safety of propafenone internally used for recovery and support of sinus rhythm in patients with the persistent form of auricular fibrillation (AF). Material and methods. 503 patients with the persistent form of AF, aged 31-68 years were included into multicenter study. Patients were randomized into 2 groups. First group included 285 patients, who were prescribed propafenone (Propanorm, PRO.MED.CS Praha a.s., Czech Republic) in a single per oral dose of 600 mg for AF paroxysm relief. Second group included 218 patients, who took propafenone for AF paroxysm prevention in daily dose of 450 mg. Efficiency of sustaining antiarrhythmic therapy was assessed in 1, 3 and 9 months after the treatment started by carrying out daily monitoring of EKG. Results. Propafenone in a single per oral dose of 600 mg leaded to sinus rhythm recovery in 230 (81%) patients. Average time for sinus rhythm recovery made up 210±50 minutes. Relief, caused by propafenone within 4 hours after taking the drug, was observed in 182 (64%) patients. Propafenone in dose of 450 mg daily lets keep sinus rhythm after 1 month of treatment in 161 patients (74%), after 3 months – in 130 patients (60%) and after 9 months – in 98 patients (45%). Effect of preventive antiarythmic therapy within first 3 months of treatment with propafenone can be regarded good, and within 9 months – satisfactory. Conclusion. Propafenone in per oral single dose of 600 mg is an efficient method of sinus rhythm recovery in patients with the persistent form of AF, and its long-term usage in dose 450 mg daily is an efficient and safe method of sinus rhythm support.

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.

The most socially significant cardiovascular diseases are recently considered from the standpoint of "cardiovascular continuum". Changes in neurohumoral factors especially activation of the renin-angiotensin-aldosterone system (RAAS) play a key role in the pathogenesis of the cardiovascular continuum. The first drugs that block RAAS were ACE inhibitors. Lisinopril deserves special attention among the ACE inhibitors. Lisinopril — one of the most known and well-studied drugs in this group with proven organoprotective properties. This allows its use in various clinical situations. Lisinopril is used for hypertension treatment long ago and there are a lot of evidences of its high antihypertensive efficacy currently. Lisinopril provides organ protection in various stages of the cardiovascular continuum and improves the life prognosis in patients with ischemic heart disease and chronic heart failure.

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.

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.

Only few hypertensive patients are treated effectively despite of the variety of antihypertensive drugs. There is a linear relationship between blood pressure levels and the risk of complications (myocardial infarction, stroke, chronic heart and renal failure). Angiotensin receptor blockers are the first-line drugs for initial therapy of uncomplicated hypertension. Irbesartan is one of the most studied angiotensin receptor blockers. Data supporting the high antihypertensive and nephroprotection efficacy of irbesartan as well as its ability to reduce cardiovascular risk in hypertensive patients are presented.

Concept of deterioration of myocardial contractile function under long-term intake of antiarrhythmic drugs may be regarded as one of the myths of modern cardiology. Multiple references to negative influence of majority of antiarrhythmic drugs on myocardial inotropic function are speculative. Studies on estimation of influence of arrhythmia treatment strategy on myocardial contractile function are almost absent.Aim. To estimate dynamics of myocardial contractile function in patients with ischemic heart disease (IHD) and persistent atrial fibrillation (AF) compared among those treated with amiodarone 200 mg daily and with bisoprolol 5 mg daily.Material and methods. A total of 47 IHD patients with persistent AF were enrolled into the study. Sinus rhythm (SR) was restored during the first 24 hours of hospitalization in all the pa- tients. After SR restoration the patients were randomly allocated to two groups receiving either amiodarone 200 mg daily during 6 months for SR maintenance (group 1) or bisoprolol 5 mg daily for ventricular rate (VR) control (group 2). To estimate myocardial inotropic function all patients underwent steady-state radionuclide ventriculography (RVG) and echocardiography during the first 24 hours after SR restoration and 6 months later.Results. We revealed changes in left ventricle (LV) diastolic function, reduction of left atrium (LA) contribution to LV diastole and enlargement of LA anterior-posterior dimension during the first 24 hours after SR restoration in the patients of both groups.6-month SR maintenance in the first group of patients promoted significant decrease in isovolumic relaxation time (IVRT) from 103.4±1.01 ms to 96.4±1.1ms (р=0.02) and reduction of LA anterior-posterior dimension up to 36.1±3.8 mm (р=0.03). Target VR achievement in the second group of patients promoted restoration of LV diastolic function (decrease in IVRT from104.3±1.2 ms to 97.3±1.2 ms; р=0.03) but did not influence LA size (44.1±3.1 mm and 43.5±3.0 mm, respectively). Atrial inotropic function was only changed in the patients of group 1, the patients of group 2 did not reveal significant change in LA contribution to LV diastole.Conclusion. 6-month SR maintenance at amiodarone intake in IHD patients with persistent AF resulted in LA contraction, restoration of its contractility and improvement of LV diastolic parameters. Target VR for 6 months of bisoprolol intake led to LV diastolic function improvement, but did not influence LA dimension and contractile function.

Aim. To study the change of local myocardial contractility in patients with ischemic heart disease (IHD) and paroxysmal atrial fibrillation (AF) during treatment with amiodarone 200 mg daily compared with bisoprolol therapy 5 mg daily.Material and methods. A total of 47 IHD patients with persistent AF were enrolled in the study. Sinus rhythm (SR) was restored during the first 24 hours after admission in all the patients. After SR restoration patients were randomly allocated into two groups receiving either amiodarone 200 mg/day during 6 months for SR maintenance (group 1) or bisoprolol 5 mg daily for ventricular rate (VR) control (group 2). To estimate a local myocardial systolic function all the patients were undergone steady-state radionuclide ventriculography in the first 24 hours after SR restoration and 6 months later.Results. Sinus rhythm saving at amiodarone therapy within 6 months led to an improvement of the local myocardial contractility of the left ventricle with a significant increase in normokinesis zones from 79 (58.1%) to 92 (67.6%), hypokinesis and akinesia zones reduction from 46 (33.8%) to 41 (30.2%) and from 11 (8.1%) to 3 (2.2%) (p

Just a small part of hypertensive patients is treated effectively despite the wide variety of antihypertensive drugs. Combined antihypertensive therapy can solve the problem of influence on the various pathogenic mechanisms of hypertension. The combination of an ACE inhibitor and a dihydropyridine calcium channel blocker is one of the most efficient, since both groups of drugs act as vasodilators and have therapeutic synergy in blood pressure reduction. A fixed combination of ramipril with amlodipine is an effective antihypertensive drug with a good tolerability profile. It effectively provides both blood pressure control and positive cardioprotective and nephroprotective effect.

Aim. To study the changes of plasma levels of NT-proBNP and NT-proANP in patients with persistent atrial fibrillation (AF) treated with various antiarrhythmic drugs.Material and methods. Patients with persistent AF (n=123) aged 39-83 years old were included into the study. The patients were divided into 2 groups: group 1 included patients with arterial hypertension (n=61), group 2 - patients with ischemic heart disease (IHD; n=62). After sinus rhythm restoration the patients were divided into 4 subgroups. Patients of 1A subgroup used propafenone to maintain sinus rhythm during the next 6 months, while patients of 2A subgroup used amiodarone. Patients of 1B and 2B subgroups used bisoprolol to control ventricular rate. Plasma natriuretic peptide levels were evaluated in all patients during the first 3 days after the sinus rhythm restoration and 6 months after.Results. Increased levels of NT-proBNP and NT-proANP in the first days after the sinus rhythm restoration were found in patients of both groups and were associated with the episode of AF. After 6 months of treatment the reduction of NT-proBNP and NT-proANP levels was found in patients of 1A subgroup (NT-proBNP: from 160.5±15.2 pg/ml to 130.1±12.2 pg/ml; NT-proANP: from 15.3±6.4 nmol/L to 11.5±5.3 nmol/L, p

Aim. To study inotropic myocardial function of left and right ventriculum (LV, RV) in patients with recurrent atrial fibrillation (AF), according to balanced radionuclide ventriculography (BRVG) data. Material and methods. The study included 72 patients: 30 individuals with coronary heart disease (CHD) and recurrent AF (Group I), as well as 42 CHD patients without cardiac arrhythmias (Group II). Participants’ age varied from 39 to 79 years (mean age 60.3±2.5 years). To assess systolic and diastolic LV and RV function, all participants underwent BRVG. Results. LV and RV ejection fraction was normal in all subjects. LV peak filling velocity was significantly reduced in patients with recurrent AF, comparing to arrhythmia-free individuals (p

Aim. To study the effects of three-month propafenone antiarrhythmic therapy (daily dose 450 mg) on inotropic myocardial function in patients with recurrent atrial fibrillation (AF). Material and methods. The study included 18 (100%) patients aged 39-59 years (mean age 51.7±6.7 years), receiving propafenone (450 mg/d) for 3 months, to prevent recurrent AF. To assess antiarrhythmic therapy effects on inotropic myocardial function, all participants underwent balanced radionuclide ventriculography at baseline; in patients with maintained sinus rhythm, it was repeated after 3 months of treatment. Results. In first 3 days after restoring sinus rhythm in recurrent AF patients, diastolic function dynamics was observed: significant reduction in 1/3 diastole filling and peak filling velocity. After 3 months of propafenone treatment, left ventricular (LF) 1/3 diastole filling (p

Aim. To evaluate local contractility of left and right ventricular (LV, RV) myocardium, as well as its dynamics in acute drug test (AMT) with nitroglycerin (NG) in patients with recurrent atrial fibrillation (AF), during sinus rhythm maintenance period. Material and methods. The study included 120 patients aged 39-82 years (mean age 61.3±8.9 years): 20 patients with recurrent AF and arterial hypertension (AH) (Group IA); 50 patients with coronary heart disease (CHD) and recurrent AF (Group IB); 50 individuals from control group (Group II). To assess inotropic myocardial function, balanced radionuclide ventriculography was performed in all participants. Local LV and RV contractility was studied in unified 16-segment ventricular model. After registering baseline hemodynamic parameters, local contractility was assessed again in ADT with NG – 30 minutes after sublingual NG administration (0.5-1.0 mg). Results. In Groups IA and IB, local hypo- and akinesis were observed. In ADT with NG, patients from Groups IA and IB demonstrated improved local contractility: akinetic segment number significantly reduced, normokinetic LV and RV zone number substantially increased. In Group II, during ADT with NG, local contractility increased due to hypokinetic segments. Conclusion. Local contractility disturbances in patients with recurrent AF during sinus rhythm maintenance were manifested as hypo- and akinetic zones. In ADT with NG, patients demonstrated significant improvement of local contractility, due to decreased number of akinetic segments. In control group, number of hypokinetic segments significantly decreased.

Aim. To study efficacy and safety of propafenone (450 mg/d per os) in maintaining sinus rhythm among patients with persistent atrial fibrillation (AF). Material and methods. The study included 200 patients with persistent AF, aged 39-68 (mean age 56.4±4.2 years), from 10 Russian regions. For AF paroxysm prevention, all patients received propafenone (Propanorm, 450 mg per os, 3 times per day) for 9 months. Results. Propafenone (450 mg/d) restored sinus rhythm in 148 patients (74%) after one month of treatment, in 122 (61%) after 3 months, and in 90 (45%) after 9 months. Propafenone was effective and well tolerated: during 9-month therapy, only 8 patients (4%) complained of dyspepsia, which regressed without additional therapy or treatment discontinuation. Arrhythmogenic effects of propafenone were not registered. In 7 patients (3.5%), PQ interval increased significantly, by 18% comparing to baseline, but the parameter stayed in the normal range. Moderate increase of QT interval (+28%), without being over 460 ms, was observed in 8 patients (4%), and did not require therapy discontinuation. Conclusion. According to the results of open, multi-center study “PROMETEY”, propafenone (450 mg/d per os) was effective and safe for maintaining sinus rhythm in patients with persistent AF. In patients with normal left ventricular ejection fraction, propafenone did not affect inotropic myocardial function.

The review is devoted to an actual problem of modern cardiology – atrial fibrillation (AF) treatment in patients with chronic heart failure (CHF). Multicenter clinical trials demonstrated that CHF patients have AF more often than individuals without CHF. Algorhythms for choosing optimal antiarrhythmic therapy in AF and CHF are proposed. Possible therapeutic strategies, including use of ACE inhibitors and angiotensin II receptor antagonists, are discussed.

Aim. To study efficacy and safety of propafenone in restoring and maintaining sinus rhythm (SR), comparing to placebo, in patients with recurrent atrial fibrillation (AF). Material and methods. The study included 60 patients with recurrent AF. For restoring SR, all patients were administered propafenone (300-600 mg/d). Twenty-four hours later, all participants with normalized SR were randomized into two groups: Group I (n=31) received propafenone (450 mg/d), Group 2 (n=15) – placebo. Follow-up lasted for 3 months. Results. Twenty-four hours after propafenone administration (300-600 mg), SR was registered in 46 individuals (76.6%), including 2 patients (3%) with SR normalization 2 hours later, 5 patients (10.9%) – 4 hours later, 23 (50%) – 6 hours later, and 16 (34.8%) – 8 hours later. Mean time to SR normalization was 364±22 minutes. Adverse effects included moderate hypotension to 105-100/70 mm Hg in 2 patients (3.3%), and transitory atrioventricular block II in 1 patient (1.7%). No other adverse reactions were registered. During 3-month propafenone treatment (450 mg/d), SR was maintained in 80.6% of patients, compared to 26.6% in placebo group. No adverse reactions were observed. Conclusion. Oral propafenone treatment is effective and safe for restoring and maintaining SR in patients with recurrent AF.

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

High prevalence of atrial fibrillation (AF) and low effectiveness of antiarrhythmic therapy are the reasons for searching a new therapeutic strategy focused on this arrhythmia. Recent studies have demonstrated the link between anatomical atrial structure changes and pro-inflammatory cytokine levels, that led to a new direction in AF pathogenesis investigation. Whether AF paroxysm is primary, or on the contrary, inflammation provokes AF, is still unknown. Inflammation might be not the only cause of atrial arrhythmogenicity but it plays an important role in myocardial predisposition for AF paroxysm. Results of multi-center studies have shown that early administration of ACE inhibitors, angiotensin receptor antagonists, and statins in cardiac patients significantly reduces AF risk, and could be a promising therapeutic strategy.

Aim. To assess the role of medico-genetic counseling in diagnostics of the insufficiently explored premature ventricular complex (PVC) syndrome. Material and methods. Medico-genetic counseling and prospective follow-up (1973-present) was performed in the families of 36 patients with Wolf-Parkinson-White (WPW) syndrome (222 relatives examined), and in the families of 40 patients with Clerc-Levy-Cristesco (CLC) syndrome (227 relatives examined). Results. PVC phenomenon in I-IV line relatives was regarded as a manifestation of hereditary arrhythmia predis-position and an indication for preventive measures, electrocardiographic assessment included. Healthy relatives were examined at least every 6-months, then once per year, including psychotherapeutic counseling on lifestyle modification. During the 30-year follow-up period, PVC patients’ relatives complying with healthy lifestyle recommendations did not have any complaints and regarded themselves as healthy persons. Conclusion. Therefore, medico-genetic counseling is the most sensitive method for PVC syndrome diagnostics. Widely available psychotherapeutic counseling on healthy lifestyle facilitates the healthy status maintenance in III-IV line relatives.