The EAC Guidelines represent the views of the EAC, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The EAC is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the EAC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EAC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the EAC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the EAC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription. 

 Purpose. To evaluate the genotype-phenotype association in Belarusian patients with non-compaction cardiomyopathy (NCCM) and clinically significant ventricular arrhythmias.

Materials and methods. The study included 170 unrelated patients with NCCM prospectively observed in the RSPC “Cardiology” for 36 months. [6; 42,0], who underwent 24-hour Holter ECG monitoring for 12 months after entering the study. The median age of patients was 42 [18; 69] years, men – 63,2%. The arrhythmic phenotype of NCСM was diagnosed by the presence of unexplained syncope; nonsustained ventricular tachycardia, the presence of ≥500 ventricular premature beats (VPB) per day. The diagnosis of NCCM was established on the basis of the following criteria: 1) Echocardiography of the Jenny criteria; 2) CMR of the S. Petersen and A. Jaquier criteria. The mutations search in the coding sequences of 174 genes was performed in 30 unrelated patients with NCCM using next generation sequencing (NGS).

Results. In 76 out of 170 (44,7%) patients, clinically significant arrhythmias were the leading manifestation of the disease. Nonsustained VT was recorded in 54 (71,1%) patients, sustained VT – in 11 (14,5%) patients, VPB more than 500 per day – in 50 (65,8%). During the follow-up period (median follow-up of 36 months), devices (ICD/CRT-D) were implanted in 16 (21,1%). NGS sequencing revealed 40 changes in the nucleotide sequence (5 pathogenic mutations, 30 variants with uncertain significance (VUS), 5 new substitutions) in 27 genes in 26 (86,7%) probands with the arrhythmic phenotype NCCM. The proportion of mutations in sarcomeric proteins genes of was 26,9%, and in ion channel proteins genes was 23,1%. Nucleotide changes in genes encoding structural proteins accounted for 11,5%. In 38,5% of cases, not one, but two or more rare mutations were detected, and in 30,8%, amino acid changes affected proteins of different functional classes.

Conclusions. In the group of patients with the arrhythmic NCCM phenotype, the proportion of individuals with genes mutations associated with various cardiomyopathies was 86,7% and was significantly higher than reported in patients with NCCM generally (59%). The frequency of multiple mutations was also higher (38,5%) in this cohort. The genetic characteristics of patients, along with their clinical characteristics, are markers of a high risk of developing life-threatening arrhythmias and can be additionally used for predicting adverse events in patients with NCCM, as well as for early diagnosis of the disease in their relatives. 

 Goal. To determine the possibilities of driver or rotor ablation with the pulmonary veins isolation in patients with persistent forms of atrial fibrillation in reducing the frequency of recurrences in comparison with the classical method of antral isolation of the pulmonary veins.

Material and methods. The study included 86 patients who were divided into group A of antral isolation of the pulmonary veins and group B, in which the isolation of the pulmonary veins was expanded by ablation of the rotary regions in the left atrium. Group B underwent non-invasive mapping of the rotors using the AmiCard system immediately before ablation. In this group of patients at the end of each procedure we implanted a Reveal XT cardiac monitor (Medtronic, USA).

Results. According to non-invasive mapping data, 98 drivers were identified in 43 patients (the average number per patient was 2.33 ± 1.09). Therefore, 84 rotors of the left atrium localization, of which 23 were in the pulmonary veins and only 14 were in the right atrium. Over two years of follow-up, the advantage of the driver ablation approach with pulmonary veins isolation demonstrated statistical significance (79% of stable sinus rhythm) compared with antral isolation of the pulmonary veins (58% efficiency).

Conclusion. Non-invasive mapping and driver ablation in addition to antral isolation of the pulmonary veins increases the efficiency of the procedure and reduces the frequency of recurrence in patients with persistent atrial fibrillation. 

 Currently, healthcare practice generates data exchange and stores a huge amount of patient-specific information in electronic medical records (EMC) and auxiliary databases. EMC used in normal clinical practice, can now be used for clinical research. The various methods available for obtaining data during research projects, in particular from integrated EMCs, have some unique capabilities. Of course, there are problems and obstacles to expanding the use of EMC, and one of the solutions to these obstacles is to address issues of semantic compatibility, privacy, and security. The collective efforts of numerous international associations involved in the development of standards have led to the emergence of standards for both the structure and the semantics of clinical information that provide semantic compatibility between different systems. It is always necessary to remember that when using EMC for clinical trials, it is first necessary to integrate various types of information, in accordance with the criteria for acceptability of the protocol, elements of clinical trial data, EMC data for only one purpose – to enable cohort identification. Electronic control systems should be able to exchange information through the use of recently published international standards for their compatibility and clinically proven information structures to ensure consistent complete recording and data exchange between different patient groups. Such systems eliminate obstacles when using various clinical languages and documentation styles, as well as recognized incomplete routine entries. Under these conditions, research projects can use data on patients from various EMC systems from various medical institutions, as well as in international multilingual environments. 

 Over the past few decades, there have been significant changes in approaches to the management of patients with pulmonary arterial hypertension (PAH). From the moment when the classification of this disease was first published, new diagnostic capabilities and new drugs have appeared that have improved the quality of life and survival of patients. The article is devoted to the issues of rapid diagnosis of PAH in the case of its high probability. Particular attention is paid to the rapid referral of such patients to an expert center, where it is possible to perform catheterization of the right heart. The importance of risk stratification of patients is also noted, which allows prescribing combination specific therapy at an early stage, which can significantly improve the quality of life and reduce the risk of adverse outcomes. Risk assessment is indicated for all patients at both regional and expert level by determining the risk of 1-year mortality in PAH. The article also discusses the issues of dispensary observation of such patients and dose titration when prescribing specific therapy by an expert center. Recommendations are given for non-specific therapy for PAH, the use of oxygen support, anticoagulants, and other drugs. It is emphasized that ACE inhibitors, angiotensin receptor blockers, betablockers, and  ivabradine are generally not used to treat PAH, and their use may limit the possibilities of specific therapy. Occasionally, patients with PH at the regional level require dose titration of PAH-specific therapy, as well as regular follow-up, which requires specialized knowledge. This dictates the need to create pulmonary hypertension rooms in each region or manage this group of patients in high-risk rooms, where medical workers will have the necessary knowledge and will regularly undergo training in expert centers. The described clinical case demonstrates the effectiveness of combination therapy of pulmonary arterial hypertension using an innovative selective agonist of prostacyclin receptors for oral administration – Selexipag. Practical recommendations are given for dose titration and its use in patients with PAH. 

 In this article the current problems of the use of combined antihypertensive drugs in the implementation of «tactics one tablet» in a wide range of patients with arterial hypertension are discussed. The results of the discussion of such a problem by experts, as well as the main provisions of the agreement document, are given, devoted to approaches to the implementation of tactics of wider use of combined antihypertensive drugs containing 2 or more antihypertensive drugs in one tablet. Both the advantages and disadvantages of «tactics one tablet « are considered. The results of clinical studies are discussed, which confirm the validity of the use of the combined antihypertensive therapy as an initial tactic of treatment of the majority of patients with arterial hypertension. The results of the assessment of pharmacoeconomic indicators are given when using combined antihypertensive therapy.