Background: Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and is associated with an increased risk of death, progression of heart failure, and the development of cardiogenic thromboemboli. Despite the significant success in the management of AF in the paroxysmal form, the results of the treatment for patients with persistent forms of AF remain unsatisfactory. Though the surgical approach provides higher rates of efficiency regarding the restoration of a sinus rhythm, transmural lesions are not always attainable, as a result, the rate of AF recurrence in the long-term period remains fairly high. It is also impossible to create ablative patterns to the mitral and tricuspid valves during thoracoscopic epicardial ablation, which can cause the development of recurrent AF, perimitral and typical atrial flutter. Therefore, the development of hybrid approaches combining the advantages of catheter and thoracoscopic techniques is an urgent task of contemporary surgical and interventional arrhythmology. Aims: to estimate the immediate results of a hybrid approach in the management of patients with persistent AF. Methods: We report the first experience of a hybrid treatment of patients with persistent AF. 6 patients aged 53-64 years (1 female, 5 males) were included in the study. At the first stage, thoracoscopic epicardial bipolar ablation was performed (modified GALAXY protocol); the second stage (in 3 to 6 months after the thoracoscopic stage) included an intracardiac electrophysiological study with three-dimensional endocardial mapping followed by endocardial ablation. Results: The thoracoscopic stage of the hybrid treatment included ablation according to the box lesion scheme using a bipolar irrigation equipment. No lethal outcomes and severe, life-threatening complications were registered. The duration of the inpatient period was 510 hospital-days. The 2nd stage of the hybrid treatment was limited to intracardiac electrophysiological examination only in 2 patients. In 4 patients, epicardial radiofrequency ablation was complemented by endocardial radiofrequency exposure. In 3 of the 4 patients who underwent endocardial radiofrequency ablation, catheter ablation of the mitral and cavotricuspid isthmus was required because of the induction of perimitral and typical flutter, respectively. After the 2nd stage of the hybrid treatment, at the time of discharge all the patients maintained a stable sinus rhythm. There were no severe complications or lethal outcomes. Conclusion: a hybrid approach in the AF management is a safe and effective method of treatment, which combines the advantages of minimally invasive surgery and endocardial intervention in patients with persistent AF. The technique is safe and has acceptable short-term results.

Background: Atrial fibrillation (AF) and coexistent typical atrial flutter (AFL) interventional treatment strategy remains unresolved in cardiology and cardiovascular surgery. Results of this approach remain suboptimal. There are several approaches to the interventional treatment of patients with coexistent AF and AFL: simultaneous pulmonary vein isolation (PVI) and cavotricuspid isthmus (CTI) radiofrequency catheter ablation (RFCA), PVI or CTI RFCA only and two-stage approach. To our knowledge, cumulative efficacy of two-stage approach has not been previously reported. The aim. This study aimed to evaluate the efficacy of two-stage approach for interventional treatment of coexistent AF and AFL for sinus rhythm maintenance in long-term. Methods: Patients (pts) (n=34) with AF and AFL aged 41–82 years (11 women) were divided into two groups (1:1): «One-stage Approach» (group 1; n=17): PVI+СTI RFСA and «Two-stage approach» (group 2; n=17): first stage — CTI RFCA (group 2.1); second stage — PVI in case of AF recurrence after RFCA (group 2.2). Primary endpoint (PEP) was defined as any recurrent atrial tachyarrhythmia at the end of follow-up; group 2 events have been considered after PVI. Secondary endpoint (SEP) — recurrent any atrial tachyarrhythmia in groups 1 and 2 after CTI RFCA in group 2. PEP and SEP were evaluated at the end of the «blind period» (3 months after procedure). Results: Registered recurrent atrial tachyarrhythmia in pts who reached PEP or SEP was AF. AFL has not been detected in any cases. PEP was noted in 8 (47.06%) pts in group 1 and 1 (5.88%) pts in group 2. Further, SEP was observed in 3 pts (17.65%) in group 1 and in 4 (23.53%) pts in group 2 (p=0.671). The probability of long-term maintenance of sinus rhythm was significantly higher in «Two-stage approach» than in «One-stage approach» (94.12% and 52.94%, respectively, p=0.001). Significant differences in procedure length and fluoroscopy time have been found. Those were longer in group 1 compared to group 2.1 (p 0.001) and in group 2.2 compared to group 2.1 (procedure duration — p 0.001; fluoroscopy time — p=0.013). No differences were noted in length of procedure and fluoroscopy time between groups 1 and 2.2 (p=0.374 and p=0.028, respectively). Conclusion: The «two-stage approach» for interventional treatment of coexistent AF and AFL results in better long-term arrhythmia-free survival than «one-stage approach» (94.12% and 52.94%, respectively, p=0.001). CTI RFCA alone in pts with coexistent AF and AFL cause 23.53% AF recurrence rate and associated with shorter procedure duration and fluoroscopy time compared to simultaneous PVI and CTI RFCA (p 0.001).

The study aims to neurological and functional recovery in patients after ischemic stroke depending on blood pressure (BP) parameters and its variability. Materials and methods : We examined 150 patients with ischemic stroke and arterial hypertension (AH) who were hospitalized in the neurological department (76 (50,7 %) men and 74 (49,3 %) women, mean age 67,4±7,3 years). All patients underwent standard physical and laboratory examinations, measurement of blood pressure in dynamics; The National Institutes of Health Stroke Scale (NIHSS) was used to assess the severity of neurological deficits at the time of admission to the hospital, in the dynamics of the acute period (up to 21 days) and on the 21st day. Results: It was found that the consequences of the acute period of stroke depend on the level of blood pressure and its variability at the beginning of the ac ute period. A more than 50 percent probability of a decrease in the NIHSS score by half (from baseline) is predicted if the patient has a standard deviation (SD) systolic blood pressure (SBP) less than 12,4 mm Hg on days 1–3. In addition, SD SBP on days 1–3 and 1–6 days, and SD diastolic blood pressure (DBP) from 1 to 3 days are the most significant in assessing the relationship with the degree of functional impairment at the end of the acute period of stroke. Conclusion: The level of blood pressure and its variability during the acute period of ischemic stroke makes it possible to predict the severity of the neurological deficit and the functional consequences of stroke in the recovery period (up to 21 days).

Purpose. To summarize and systematize the literature data on the pathogenetic aspects of the influence of seasonality on the health status of patients with chronic pathology of the cardiovascular system. Materials and methods. To analyze the literature, materials from the PubMed and PubMed Central resources of the US National Library of Medicine, Google Scholar, Elsevier Clinical Key and Elsevier Science Direct, as well as in the Russian RSCI database were used. The sample consisted of scientific papers devoted to the pathogenetic aspects of the influence of various meteorological factors on the course of cardiovascular pathology. Results. The generalized results of clinical and experimental studies presented in this review indicate both direct and indirect effects on the state of the cardiovascular system of seasonal changes in air temperature, atmospheric pressure, solar radiation, air humidity and geomagnetic indicators. Conclusion. Meteorological factors have a pronounced effect on the course of cardiovascular diseases both through direct mechanisms of influence, and through the inclusion in the pathogenesis of these diseases and the aggravation of existing risk factors. The pathogenetic mechanisms of the influence of weather factors on the state of the cardiovascular system are important for understanding the application points that can be influenced and improved by primary and secondary prevention of cardiovascular pathology.

The specifics of the anticoagulant therapy after radiofrequency ablation of the cavotricuspid isthmus have not been sufficiently studied, therefore, the recommendations for prescribing the anticoagulant therapy usually do not distinguish between atrial flutter and atrial fibrillation. In contrast to the case of atrial fibrillation, the effectiveness of the interventional treatment for typical atrial flutter reaches 90%. This procedure may save the patient from a long-term anticoagulant therapy in the absence of recurrence of typical atrial flutter. The decision to stop the anticoagulant therapy after successful radiofrequency ablation of the cavotricuspid isthmus should take into account the potential induction of atrial fibrillation in patients undergoing the interventional treatment. In addition to the CHA2DS2-VASc scale, which characterizes the patient's comorbidity, it is important to take into account the echocardiographic morphofunctional criteria to assess the risk of atrial fibrillation. Currently, this protocol is not regulated in the clinical guidelines. The analysis of the literature data and the authors' own experience allow us to conclude that the optimal time for stopping the anticoagulant therapy is a relapse-free period of 34 months after the radiofrequency ablation of the cavotricuspid isthmus, since it is at this time that the effectiveness of the interventional treatment can be objectified.

Objective. To study the features of the clinical duration of atrial fibrillation (AF) and the structure of concomitant cardiac arrhythmias in children. Patients and methods. The pilot retrospective controlled non-randomized two-center study included 39 children aged 3 to 17 years (tmain group) who were on inpatient treatment at the Research Clinical Institute of Pediatrics and Pediatric Surgery academician Yu.E.Veltischev in the period from 2010 to 2020. The comparison group consisted of 156 patients aged 29 to 77 years suffering from paroxysmal and persistent forms of AF, who underwent interventional treatment from 2013 to 2021 at the V.M. Buyanov City Clinical Hospital of Moscow City Health Department and the National Medical Research Endocrinology Center of the Ministry of Health of Russia. Statistical processing was performed using STATISTICA application package. Quantitative features are represented by minimum and maximum values, as well as median (Me) and interquartile range (Q1 – 25 percent quartile, Q3 – 75 percent, respectively). The criteria of Fisher, Mann–Whitney, Pearson, and Spearman were calculated. The differences were considered reliable at p < 0.05. Results. The paroxysmal form of disease was diagnosed in 24 children (61.5%) cases, in 121 adults (77.6%). Clinical manifestations of AF in children were significantly more often recorded in its paroxysmal form – in 23 (95.8%) cases versus 8 (53.3%). In the comparison group, regardless of the form of AF, all patients had severe symptoms; the severity of clinical manifestations was founded in 93 (59.6%) cases, according to the classification of the European Heart Rhythm Association, corresponding to class III and above. In the structure of concomitant cardiac arrhythmias in patients of the main group, typical atrial flutter was in 13 (33.3%) cases, and atrial extrasystole -in 9 (23.1%). Bradyarrhythmias and conduction disorders (sinus node weakness syndrome, and atrioventricular blockade of I–II degrees) were founded in 10 (25.6%) children and only in 6 (3.8%) patients from the comparison group. Antiarrhythmic therapy in the main group was received by 30 (76.9%) children; in 28 (71.8%) cases – monotherapy with antiarrhythmic drugs of IC, II and III classes; all patients in the comparison group received IC and Class III preparations. Interventional treatment was performed in 6 (15.4%) patients from the main group and all from the comparison group. Conclusion. During diagnosing AF in children we should know the possibility of a frequent asymptomatic duration of disease, as well as complaints which are not typical for tachysystolic cardiac arrhythmias, isolated or in combination with typical. Clinical manifestations were significantly more often founded in paroxysmal AF in children. In the structure of concomitant AF cardiac arrhythmias in children, as well as in adult patients, atrial flutter prevails, and atrial extrasystole in children was recorded significantly more often, as well as sinus node weakness syndrome and atrioventricular blockade of I–II degree. The results of the study confirm both the need for a personalized approach to the diagnosis and treatment of AF in all age groups, and the creation of Guidelines for children and interventional treatment of this variant of arrhythmia. Key words: antiarrhythmic therapy, children, clinical duration, concomitant cardiac arrhythmias, atrial fibrillation

Аннотация.Острый респираторный дистресс-синдром и дыхательная недостаточность являются основными угрожающими состояниями у больных COVID-19.Основной причиной является, прежде всего, нарушение перфузии легких.Неинвазивная вентиляция легких может устранить гипоксемию и снизить инспираторные усилия.Использование механической вентиляции для предотвращения самоиндуцированного повреждения легких (P-SILI) рассматривается как вариант оптимизации.Ведущей характеристикой прогрессирования COVID-19 является постепенный переход от отека или ателектаза к менее обратимым структурным изменениям легких, а именно к фиброзу.В итоге нарушается механика дыхания, повышается Рсо2 в артериальной крови

Background: The Improvement of quality of life (QOL) and its dynamics among patients with chronic heart failure (CHF) is an important task and one of the leading criteria for the therapy effectiveness among patients with CHF.Aim: The present study aimed to compare the QOL in patients with heart failure with mid-range ejection fraction (HFmrEF) in different age groups, taking into account gender differences.Method: This cross-sectional study was conducted on 377 participants with CHF and a control group of 30 subjects matched in age without CHF in Belgorod, Russia, in 2020. The participants were selected by the purposive sampling method. All patients were assigned into three groups, including middle age, elderly age, and senile age. The participants completed the Minnesota Living with Heart Failure Questionnaire (MLHFQ), Zung Self-Rating Anxiety Scale, and Zung Self-Rating Depression Scale. The collected data were analyzed with nonparametric statistic methods.Results: It was revealed that the QOL was significantly lower in patients with HFmrEF of ischemic genesis than in the control group. The lowest QOL, according to the MLHFQ questionnaire, was revealed in old age. In the female population, the QOL was significantly lower than in men in the same age group. Moreover, the most pronounced manifestations of anxiety and depressive disorders were observed in middle-aged men and middle-aged women, respectively.Implications for Practice: According to the findings of this study, it is suggested that physicians and therapists pay special attention to the QOL of the elderly and senile aged people with CHF.

Страница 57 МОРФОЛОГИЧЕСКИЕ ОСОБЕННОСТИ ДИСТАЛЬНОГО ОТДЕЛА ЛЕГОЧНЫХ ВЕН У БОЛЬНЫХ С ФИБРИЛЛЯЦИЕЙ ПРЕДСЕРДИЙ ПО ДАННЫМ МУЛЬТИСПИРАЛЬНОЙ КОМПЬЮТЕРНОЙ ТОМОГРАФИИ Хамнагадаев И.А. 1,3, Тарбаева Н.В. 2 , Булавина И.А. 3 , Термосесов С.А. 1,3, Ильич И.Л. 3 , Хамнагадаев И.И. 4 , Кармазановский Г.Г. 5 , Калашников В.Ю. 2 , Школьникова М.А. 1 , Коков Л

Rhythm and conduction disorders of the heart occupy one of the leading places in the structure of cardiovascular pathology in children. Supraventricular tachycardias means tachyarrhythmias, caused by abnormal myocardial excitation with the source of rhythm localization above the His bundle bifurcation — in the atria, atrioventricular junction (node), and also arrhythmias with circulation of the excitation wave between the atria and the ventricles with additional atrial compounds. The team of authors presents clinical recommendations developed on the principles of evidence-based medicine, including all stages of diagnosis and treatment of children with supraventricular tachycardias. The use of recommendations in clinical practice allows to selecte the best strategy for diagnosis and treatment of supraventricular tachycardia in a particular patient.

научный биометрический журнал, который знакомит читателя с клиническими рекомендациями и особенностями применения лекарственных и вакцинных средств у детей, предоставляет исчерпывающую информацию о воздействии лекарственных средств на плод, о проводимых в

Atrial fibrillation is the most frequent supraventricular tachyarrhythmia. Pulmonary veins isolation can be performed as the first line of treatment for this arrhythmia. Unfortunately, approximately 30% of patients in the first year after ablation have recurrence of atrial fibrillation. In this regard, we have attempted to identify the characteristics associated with long-term maintenance of sinus rhythm after pulmonary veins isolation.

Objective. To determine criteria for choosing management tactics in patients with ventricular arrhythmias (VA) in the absence of structural heart disease from the point of view of physicians and patients in clinical practice and to compare the immediate results of antiarrhythmic drug therapy (ADT) and radiofrequency ablation (RFA) with the trends in arrhythmic syndrome in the non-treatment group. Subjects and methods. Examinations were made in 90 patients (23 men and 67 women) (mean age, 44 (31; 57) years) with VA in the absence of structural heart disease. Preference was given to RFA (n = 32 (36%)), ADT (n = 37 (41%)), and follow-up tactics (n = 21 (23%)). At baseline and 1 month, Holter ECG monitoring was done; quality of life (QOL) was assessed; and anxiety and depression levels were detected using the SF-36 and HADS questionnaires. In addition, 71 physicians were surveyed about their preferences to the treatment of VA in individuals without structural heart disease. Results. In the total group of patients, VA was unambiguously accompanied by the symptoms only in 47%. The signs of anxiety and depression were identified in 41 and 14% of cases, respectively. The efficiency of RFA was comparable to that of ADT (p > 0.1): a positive antiarrhythmic effect was observed in 71.9% of the patients in the RFA group and in 67.6% in the ADT group. During one month, 38.1% of the patients in the follow-up group showed a spontaneous substantial reduction in the number of ventricular premature beats (VPBs) or disappearance of unstable ventricular tachycardia (UVT), which met the criteria for a positive effect. At baseline, the QOL indicators on a social functioning scale in the RFA group were worse than those in the ADT group. At the same time, most QOL indicators in the patients who have chosen a wait-and-see tactic were significantly higher than those in the RFA and ADT subgroups. The patients treated with ethacyzin in the ADT group more frequently achieved a positive effect. In the interviewed physicians’ opinion, the choice of a tactic depended on the impact of arrhythmia on health status (68%), the number of VPBs per day (61%), and the presence of UVT (56%). RFA or ADT was most often recommended when there were 10,000-15,000 or more VPBs per day ((49 and 35% of the respondents, respectively). 46.5% of the respondents stated that β-blockers were the drug of choice for idiopathic frequent VPBs. Only 30% of the respondents considered it appropriate to restrict to a follow-up in the presence of asymptomatic VPBs. Conclusion. Patient management in clinical practice generally complies with the current guidelines; however, much importance is attached to the severity of arrhythmia (the number of VPBs per day, the presence of UVT) in addition to the presence of symptoms. In the opinion of most physicians, the initiation of treatment is justified when there are 10,000-15,000 and more per day. QOL assessment may be promising in choosing the optimal management tactics for these patients. Treatment should not be initiated immediately in patients with a high level of QOL, especially in those with arrhythmia lasting less than 12 months, by taking into account that there can be a spontaneous improvement in 38% of cases within the next month. The immediate results of ADT and RFA are comparable in patients with VA in the absence of structural heart disease. The Class IC antiarrhythmic drug ethacyzin is the most effective agent that ensures positive changes in arrhythmic syndrome in 66.7% of cases with the rate of side effects being in 17.8%.

Aim. To study prevalence of left ventricular diastolic dysfunction (LVDD) and to evaluate the effect of pulmonary vein catheter isolation on left ventricular (LV) diastolic function in patients with paroxysmal and persistent forms of atrial fibrillation (AF). Materials and methods. 109 patients with paroxysmal (n=90; 82.6%) and persistent (n=19; 17.4%) AF were evaluated after 109 pulmonary vein catheter isolations. The patients were divided into two groups based on the operation efficacy. Heart ultrasound including evaluation of the LV diastolic function was performed for all patients on the day of operation and at 6 and 12 months. Results. After the surgery, 61 (56.5%) patients maintained sinus rhythm (SR) for 12 months and comprised Group 1. Group 2 consisted of patients with a relapse of AF (47 patients; 43.5%). At baseline, LVDD with SR was observed in 53 patients (48.6%), at 6 months - in 34 (31.2%) patients (p=0.001), and at 12 months - in 27 patients (24.8%) (p<0.001). In Group 1, the early LV filling velocity (peak E) was statistically significantly increased (p<0.001); the E/A ratio recovered (p<0.001); and mitral septal (e’ septal) (p=0.001) and lateral (e’ lateral) (p=0.03) annulus motion velocities were increased. Such changes in parameters did not occur in the group of patients with a relapse of AF. The increased velocity of peak E at 12 months of surgery statistically significantly influenced the absence of AF relapse (p=0.021). Conclusion. Approximately a half of patients with paroxysmal or persistent AF had LVDD. In patients who maintained SR following pulmonary vein catheter isolation, parameters of LV diastolic function recovered.

Aim. To study prevalence of left ventricular diastolic dysfunction (LVDD) and to evaluate the effect of pulmonary vein catheter isolation on left ventricular (LV) diastolic function in patients with paroxysmal and persistent forms of atrial fibrillation (AF). Materials and methods. 109 patients with paroxysmal (n=90; 82.6%) and persistent (n=19; 17.4%) AF were evaluated after 109 pulmonary vein catheter isolations. The patients were divided into two groups based on the operation efficacy. Heart ultrasound including evaluation of the LV diastolic function was performed for all patients on the day of operation and at 6 and 12 months. Results. After the surgery, 61 (56.5%) patients maintained sinus rhythm (SR) for 12 months and comprised Group 1. Group 2 consisted of patients with a relapse of AF (47 patients; 43.5%). At baseline, LVDD with SR was observed in 53 patients (48.6%), at 6 months in 34 (31.2%) patients (p=0.001), and at 12 months in 27 patients (24.8%) (p<0.001). In Group 1, the early LV filling velocity (peak E) was statistically significantly increased (p<0.001); the E/A ratio recovered (p<0.001); and mitral septal (e' septal) (p=0.001) and lateral (e' lateral) (p=0.03) annulus motion velocities were increased. Such changes in parameters did not occur in the group of patients with a relapse of AF. The increased velocity of peak E at 12 months of surgery statistically significantly influenced the absence of AF relapse (p=0.021). Conclusion. Approximately a half of patients with paroxysmal or persistent AF had LVDD. In patients who maintained SR following pulmonary vein catheter isolation, parameters of LV diastolic function recovered.

In spite of significant increasing of number of patients with disorders of diastolic function of heart and fibrillation of atria, understanding of mechanisms of their development and modes of treatment is still to be reached. The present review presents Actual view of the role of diastolic dysfunction of heart in development and progression of fibrillation of atria, including possibilities of its adjustment after interventional treatment.