In this document we provide comprehensive review of contemporary approaches to diagnostic work-up and management of atrial fibrillation (AF) in adults. These guidelines are based on systematic methods to evaluate and classify evidence and provide a foundation for the delivery of quality cardiovascular care. Previous version of Eurasian clinical practice guidelines published in 2019 required revision due to a number of randomized clinical trials in major medical and surgical approaches to AF published in 2019-2024. Updated version of Eurasian Clinical practice guidelines based on methodology of European society of cardiology guidelines (2024) and American heart association/ American College of cardiology guidelines (2023). Revision included not only new scientific data but also took into consideration regional differences in healthcare systems, medical services and drugs availability and epidemiology of AF in Eurasian region.

Right ventricular outflow tract anomaly in young children can occur both in isolation and as part of a group of congenital heart defects. Such patients require radical correction of the defect from an early age, one of the elements of which is the formation of an outflow tract from the right ventricle to the pulmonary artery. Despite the wide variety of valve prostheses and valve-containing conduits on the world market (pulmonary allograft (CryoLife, USA), xenoconduits Contegra (Medtronic Inc., Minneapolis, MN), Freestyle (Medtronic Inc., Minneapolis, MN), ePTFE conduit (W.L. Gore & Associates Inc, Flagstaff, AZ, USA), DP-BYVC (Yaxin Medical Technology Co., Ltd., Wuhan, China)), there is currently no ideal graft that would be free from repeated prosthetics. The problem of choosing the optimal conduit for the reconstruction of the right ventricular outflow tract remains relevant, since one of a number of reasons for the development of RVPA conduit dysfunction is the lack of growth ability as the child grows. However, the development of tissue engineering technologies in cardiovascular surgery may lead to the development of new valve-containing conduits (Xeltis, XeltisXPC), which may become a worthy alternative to existing conduits for RVOT-PA reconstruction and reduce the number of reoperations in the group of patients with RV outflow tract anomalies.

Cardiovascular diseases (CVD) occupy the first place in the structure of morbidity, mortality and disability of the population, therefore, the problem of effective treatment of CVD is still one of the most important in modern cardiology.

CV diseases require lifelong therapy, so overcoming poor adherence is relevant in the treatment of patients. Suboptimal adherence is a proven risk factor that decreases the effectiveness of treatment, increases the risk of developing CV complications, as well as worsens the disease outcomes and quality of life. In addition, there is a large number of factors affecting adherence to treatment, which significantly complicates the solution of this problem. Coronary heart disease (CHD) due to high prevalence worldwide is a poorly managed risk factor for CV risk and death. Despite the wide range of available medications, adherence to therapy in CHD patients is extremely low and it is associated with an unfavorable CV prognosis. Prescription of adequate drug treatment improves the clinical condition of CHD patients and decreases the level of CV complications and death. Currently, there is no single strategy for improving adherence to treatment. There is a negative correlation between the level of adherence to therapy and the number of prescribed medications. According to current recommendations, one of the most reasonable ways to solve the problem of poor adherence to pharmacotherapy is prescribing single-pill combinations. The concept of using single-pill combinations is defined as the combination of several drugs contained in a single dosage form. This strategy helps to improve the control of several risk factors at the same time and reduce the risk of CV events. The results of many studies confirm the effectiveness of introducing single-pill combinations in the real clinical practice, since it simplifies the treatment regimen and leads to better CV prognosis by reducing the risk of developing CV complications.

This literature review presents a modern view on the problem of adherence to treatment in CHD patients.

Antiarrhythmic drugs (AAD) remain effective therapeutic option in patients with symptomatic atrial fibrillation and ventricular ectopic beats. Recent advances in catheter ablation include new sources of energy for tissue destruction and novel modalities in high-density 3D mapping systems. However, interventions are conducted in limited number of specialized centers and average success rate does not reach 100%. Contemporary clinical practice guidelines in management of both atrial fibrillation and ventricular arrhythmias recognize class Ic AADs as effective modality to prevent recurrent paroxysms and to suppress ectopic activity. The article reviews recent symposium «Modalities in antiarrhythmic drug therapy: from guidelines to daily practice» focused on indications, clinical pharmacology and monitoring of safety and effectiveness of class Ic AAD Ethacizine, relevant to daily cardiology practice.

The aim of the study was to evaluate the possibility of using an inspiratory electrocardiogram to detect pulmonary hypertension (PH) in patients with severe aortic stenosis (AS). Materials and methods. The study included 166 patients with severe AS aged 73±8 years. Pulmonary artery systolic pressure (PASP) was determined by echocardiography. The position of the heart electrical axis (HEA) was assessed during quiet breathing (HEAq) and deep inspiration (HEAin). Results. In 93 (56%) patients, PASP was <35 mmHg, in 45 (27%) from 35 to 44 mmHg, and in 28 (17%) patients ≥45 mmHg. In groups with PASP<45 mmHg, on inspiration, there was a shift in the HEA to the right of the initial value (p<0.0001), and at PASP ≥45 mm Hg, these changes did not reach statistical significance (p = 0.05). In the ROC analysis, the HEAq, HEAin, and the difference between them made it possible to separate the groups of patients with PASP<35 mm Hg and ≥35 mm Hg. The optimal threshold values were HEAq ≤-19° (sensitivity 34%, specificity 85%), HEAin ≤16° (sensitivity 49%, specificity 76%), and the difference between HEAin and HEAq <18° (sensitivity 70%, specificity 66%). Only the difference between the HEAq and HEAin with an optimal threshold value of <16° (sensitivity 79%, specificity 60%) allowed us to separate the groups of patients with PASP<45 mm Hg and ≥45 mm Hg. Conclusions. In patients with severe AS, there is a shift of the HEA to the right from the initial value during inhalation, which is most pronounced in patients without PH. A lesser degree of shift of the HEA to the right from the initial value during inhalation allowed us to distinguish both the patients with PASP ≥35 mmHg and ≥45 mmHg with a sensitivity of 70-79% and a specificity of 60-66%.

Objective. To evaluate the efficacy and safety of this method in patients with severe dysfunction of the mitral valve prosthesis.

Materials and methods. From May 2015 to March 2024, 25 patients with mitral valve prosthesis failure due to degenerative changes were treated in the Department of Cardiovascular Surgery. The patients underwent transapical implantation of the prosthesis in the mitral position using the valve-in-valve technique using the Edwards Sapien XT (Edwards Lifesciences USA – California) and Myval (Meril Life Sciences, Vapi, India) valve systems via transfemoral access.

Results.Implantation was successful in all cases, no conversion to open intervention was registered. Comparison of preoperative and postoperative echocardiographic parameters revealed a statistically significant decrease in the level of mean and maximum transprosthetic pressure gradients (12 [9.5; 16.2] versus 6 [4.7; 6] and 29.5 [22; 33.5] versus 12 [10; 14.75], respectively, p<0.0001), as well as the level of SPPA from 76 [62; 95] to 40 [35; 45] mmHg, p<0.0001

Conclusion. Transcatheter implantation in the mitral position using the "valvein-valve" technique for the treatment of patients with high surgical risk with degeneration of the mitral valve prosthesis is an effective and safe technique. An important stage in this intervention is careful preoperative planning with the selection of a prosthesis of the required size and assessment of an unfavorable clinical outcome depending on the anatomical features of the patient.

Aim: to assess the dynamic of cardiac remodeling by magnetic resonance imaging (MRI) in pulmonary arterial hypertension (PAH) patients as a result of combination specific therapy including selexipag intake in long-term use (up to 12-month).

Materials and methods. The study was performed on 50 PAH patients being observed at department of pulmonary hypertension and heart diseases of E.I. Chazov National Medical Research Center of Cardiology. A comparative analysis of clinical, functional and hemodynamic parameters, including cardiac MRI, was performed in all participants and resulted in selexipag administration.

Results. Right ventricular end-systolic volume index (RVESVI) correlated with N-terminal pro-brain natriuretic peptide (NT-proBNP) ratio (p=0,0002), RVESVI also correlated with systolic pulmonary arterial pressure (SPAP) (p=0,0019), right ventricle stroke volume index (RVSVI) correlated with NT-proBNP ratio (p<0,0001), RVSVI also correlated with SPAP (p=0,0007). The use of selexipag as part of a combined PAH-specific therapy resulted in right atrial volume reduction, right ventricle ejection fraction and RVSVI increase, which were assessed by cardiac MRI.

Conclusion. Cardiac MRI as noninvasive method for assessment of right ventricle size and function in PAH patients either at therapy administration or therapy effectiveness assess is a promising direction for approaches development of new prognostic parameters in PAH risk stratification.

Objective: to study psychological (questionnaires data), psychophysiological (electroencephalography and skin galvanic reaction) and biochemical parameters (hormones and cytokines) in patients with coronary artery disease (CAD) in comparison with healthy volunteers.

Materials and methods. The study included 23 patients with confirmed CAD and 25 healthy individuals. All participants underwent: psychological testing (questionnaires PSM-25, Leonova, Jenkins, SACS), biochemical blood analysis (cortisol, ACTH, ACTH releasing factor, neuropeptide Y, etc.), psychophysiological examination (skin galvanic reaction and electroencephalography (EEG) at rest and in response to stress).

Results. Patients with CAD experienced higher levels of acute (91% vs. 52% in the control group, p=0.0033) and chronic stress (p=0.0277) according to the Leonova questionnaire. Biochemical analysis revealed lower levels of ACTH-RF (p=0.0112) and neuropeptide Y (p=0.0011) in patients with CAD. Assessment of autonomic nervous system reactivity using a galvanic skin reaction confirmed a stronger sympathetic response to stress in patients with CAD (the potential difference between two skin areas under stress was 523±178 μV versus 415±169 μV in the control group, p=0.0363). No significant differences were found in other questionnaires (PSM-25, Jenkins, SACS), other hormones and neuropeptides (cortisol, ACTH, prolactin, etc.) and EEG parameters.

Conclusion. This study confirms that patients with coronary artery disease are characterized by a higher level of acute and chronic stress, increased autonomic reactivity to stress (according to skin galvanic reaction), and also revealed changes in regulatory peptides (ACTH releasing factor, neuropeptide Y).

A clinical case of pulmonary artery branches embolism with bone cement deposits after lumbar vertebral hemangioma's percutaneous vertebroplasty is presented. Pulmonary artery embolism with bone cement is a frequent, but not always clinically significant complication of vertebroplasty. However, some patients have severe and even life-threatening complications like massive thromboembolism in the pulmonary artery and heart chambers, so postoperative screening after percutaneous vertebroplasty is very important. The most common methods for visualizing embolic occlusions of pulmonary artery branches with bone cement are X-ray and computed tomography. Computed tomography is rightfully considered the gold standard for diagnosing pulmonary embolism, but modern digital X-ray also successfully identifies bone cement deposits in the pulmonary arteries. X-ray is an inexpensive, accessible and objective method of examination and can be used as a postoperative screening. The purpose of this report is paying attention to the possibilities of classical X-ray in visualizing pulmonary artery's bone cement deposits after percutaneous vertebroplasty.