Sergey Pavlovich Golitsyn

Aim . To collect data on the use of Refralon (cavutilide) in real-world practice, to evaluate the efficacy and safety of pharmacological cardioversion (PCV) with Refralon in patients with various forms of atrial fibrillation and atrial flutter (AF/AFL), and to study the impact of cardiovascular comorbidities and prior pulmonary vein catheter ablation on the outcomes of Refralon PCV. Material and methods . This retrospective multicenter study of patients with various forms of AF/AFL undergoing PCV with Refralon. Efficacy endpoints included the restoration of sinus rhythm at 6 and 24 hours after Refralon administration for paroxysmal and persistent AF/AFL, and its maintenance at 24 hours. Safety endpoints included the incidence of mortality, acute cardiovascular events, polymorphic ventricular tachycardia, QT interval >500 ms, and heart rate 500 ms in 14,72%, and bradyarrhythmias in 5,43%. No associations were found between efficacy and safety outcomes and the nature of concomitant cardiovascular pathology, except for a decrease in the rate of sinus rhythm restoration in paroxysmal AF/AFL with left ventricular hypertrophy compared to patients without it (87,9% vs 96,3%; difference in proportions -8,4 percentage points; 95% confidence interval: -18,7; -1,7). Conclusion . In real-world practice, Refralon safely terminates AF/AFL of varying duration in the vast majority of patients. A history of cardiovascular disease and pulmonary vein catheter ablation does not affect the outcomes of cardioversion.

Aim. To identify clinical and instrumental factors associated with clinical outcomes in patients with implanted implantable cardioverterdefibrillators (ICD) / cardiac resynchronization therapy defibrillators (CRTD). Material and methods. A singlecenter retrospective registry included clinical and instrumental data from 315 patients with an implanted ICD (n=208; 66.0%) or CRTD (n=107; 34.0%). Median age at implantation was 59 years (IQR 50-67); 74.6% were male. Coronary artery disease (CAD) was diagnosed in 131 patients (41.6%), dilated cardiomyopathy (DCM) in 112 (35.6%), and other heart diseases in 72 (22.9%). Device implantation was performed for primary prevention of sudden cardiac death (SCD) in 207 (65.7%) patients and for secondary prevention in 108 (34.3%). In patients with CRTD, the effect of therapy was prospectively assessed at 6-12 months. The study endpoints were: endpoint 1 (EP1) - appropriate ICD therapy; endpoint 2 (EP2) - electrical storm (ES); endpoint 3 (EP3) - death from any cause / heart transplantation / left ventricular assist device (LVAD) implantation. Median followup was 40.9 months (IQR 15.5-89.8 months). Results. EP1 - Data on device function were available for 278 of 315 patients; EP1 was reached in 89 (32.0%) of them. Independent factors for reaching EP1 were implantation for secondary prevention of SCD (OR 2.50; p=0.002) and CAD (OR 2.03; p=0.007). The rate of EP1 differed significantly among etiological groups (logrank p=0.003): 42.7% in CAD; 23.8% in DCM; and 26.9% in “Other” (χ²=9.78; p=0.008). In the CRT-D group, the risk of appropriate ICD therapy was lower than in the ICD group: 20.4% vs 38.3%, but did not reach statistical significance (HR 0.50 [0.25-1.01] p=0.054). EP2 was reached in 18 patients (5.7%). Due to the small number of events, no independent predictors of EP2 were identified. EP3 - Clinical status was known for 286 patients (90.8%). EP3 was reached in 24 patients (8.4%). The only independent factor associated with EP3 was NYHA functional class of chronic heart failure (OR 2.95; p=0.005). Etiology did not affect the occurrence of EP3 (logrank p=0.125). In 100 of 107 patients in the CRT-D group, significant left ventricular reverse remodelling was recorded as an increase in left ventricular (LV) ejection fraction (LVEF) from 27% to 40.5%, a decrease in LV enddiastolic volume by 58.5 mL and LV endsystolic volume by 59 mL (pConclusion. The severity of CHF (NYHA functional class) is the leading factor associated with death/transplantation/LVAD implantation, whereas CAD and implantation for secondary prevention of SCD were independent factors associated with appropriate ICD therapy.

Aim. To evaluate the efficacy and safety of a single intravenous fixed dose of cavutilide 350 μg compared to propranolol in patients with paroxysms of atrial fibrillation (AF) and atrial flutter (AFl) Material and methods. 70 patients with paroxysmal AF/AFl (36 women and 34 men, mean age 64.8±10.6 years) were divided into two groups. In the first group (n=35) a single intravenous injection of cavutilide 350 μg was administered to restore sinus rhythm (SR). In the second group (n=35) rate-control therapy with propranolol (10-20 mg per os every 3-4 hours) was performed. The main endpoints were SR restoration within 60-min and 24h, time to arrhythmia termination, and absence of AFib/AFl relapses. Safety was assessed by monitoring for major adverse cardiovascular events and proarrhythmia. Results . Within the first 60-min period SR was restored in 77.1% of patients in cavutilide group and in none of the patients in propranolol group (0; pConclusion. A single fixed dose of cavutilid 350 μg is safe and highly effective for restoration of SR in paroxysmal AF/AFl, outperforming propranolol in likelihood of SR recovery, time to relief, and relapse prevention. Notably SR recovery after administration of cavutilide in 100% of patients with AFl, who are characterized by extremely low efficacy of other antiarrhythmic drugs. The high efficiency and rapid achievements of results, without significant adverse events, indicate the potential prospects for the use of a fixed dose of cavutilide 350 mg in outpatient settings.

Objective. To compare characteristics of myocardial electrical dyssynchrony in patients with long-term right ventricular pacing and iatrogenic left bundle branch block (LBBB) following transcatheter aortic valve implantation (TAVI) using non-invasive activation cardiac mapping (NIAM); to evaluate the effect of pacing electrode location on cardiac activation maps. Material and methods. The study included 50 patients. The main group consisted of 30 patients with implanted pacemakers and right ventricular pacing (RVCP) rate of 100%. The control group consisted of 20 patients with LBBB after TAVI (TAVI-LBBB group). All patients underwent NIAM to construct isochronous maps. We assessed ventricular endo- and epicardium activation time (AT), activation time difference (ATD), localization of late activation points (LAPs), and conduction block lines (CBLs). In the RVCP group, additional analysis of activation map formation was performed with different stimulating electrode positions (apical, middle third of interventricular septum, basal). Results. The RVCP group was characterized by more severe electrical dyssynchrony: QRS duration 157 versus 140 ms (p=0.001), interventricular activation delay on the epicardium 17.8 versus 12 ms (p<0.001). Ventricular myocardial activation maps in the RVCP group were highly variable. LAP zone typical for LBBB was detected in only 30% of patients (versus 90% in the TAVI-LBBB group), and conduction block line was absent in 20% of cases. Full compliance with LBBB criteria according to NIAM data was found in only 10% of patients with RVCP. Within the RVCP group, electrode position did not affect topography of LAP and CBL. However, apical pacing resulted in the shortest endocardial interventricular activation delay (18 ms) compared to basal and mid-positions (41 ms and 50 ms; p=0.035, respectively). Conclusion. Ventricular electrical activation during cardiac pacing is not equivalent to that in LBBB after TAVI. These processes are characterized by more severe electrical dyssynchrony and variability of activation maps. Apical electrode position, despite small endocardial conduction delay, creates effect of “pseudosynchrony of onset” followed by significant slowing of impulse propagation across the epicardium. These differences indicate that ventricular pacing forms independent pathophysiological model of ventricular myocardial electrical dyssynchrony distinct from that in proximal LBBB after TAVI.

In the treatment of patients with atrial fibrillation (AF) and atrial flutter (AFL), the best results are achieved using a comprehensive approach. This facilitates the selection of the optimal management strategy for each individual patient based on current clinical guidelines. Cardioversion is a crucial component of the rhythm control strategy, aimed at both managing symptoms and improving the patient’s prognosis. Selecting the optimal method for restoring sinus rhythm, proper patient preparation, including anticoagulant therapy, and the correct implementation of all procedure stages are essential for achieving an effective and safe outcome. This paper discusses methods for terminating AF and AFL, and provides guidelines for strategies for restoring sinus rhythm and anticoagulant therapy in cardioversion in various clinical situations.

In the treatment of patients with atrial fibrillation (AF) and atrial flutter (AFL), the best results are achieved using a comprehensive approach. This facilitates the selection of the optimal management strategy for each individual patient based on current clinical guidelines. Cardioversion is a crucial component of the rhythm control strategy, aimed at both managing symptoms and improving the patient’s prognosis. Selecting the optimal method for restoring sinus rhythm, proper patient preparation, including anticoagulant therapy, and the correct implementation of all procedure stages are essential for achieving an effective and safe outcome. This paper discusses methods for terminating AF and AFL, and provides guidelines for strategies for restoring sinus rhythm and anticoagulant therapy in cardioversion in various clinical situations.

Aim . To evaluate the relationship between mechanical dyssynchrony, defined as myocardial work components and manifestations of cardiac dysfunction in patients with permanent right ventricular pacing. Material and methods . The study included 55 patients (25 men, mean age 63±12 years) with implanted permanent pacemakers and left bundle branch block type paced QRS complex morphology and 20 healthy volunteers (15 men, mean age 32.4±7.4 years). The patients included in the study were examined twice: initially before pacemaker implantation and again at the time of study inclusion. A standard echocardiographic study was performed with an additional assessment of the degree of global longitudinal strain (GLS) and myocardial performance parameters - global constructive myocardial work (GCW), global wasted myocardial work (GWW), global work index (GWI) and global work efficiency (GWE) before and after pacemaker implantation. In all patients, segments with maximum and minimum GWI were determined. The parameters of myocardial function were analyzed depending on the localization of the pacemaker stimulating head, and a comparison was made with the parameters of myocardial function in 20 healthy volunteers. Results . In 18.2% of patients, against the background of right ventricular pacing, a decrease in left ventricular ejection fraction (LVEF) from normal values to 55 (53.5; 55.8) % was recorded, in 5 (50%) of them, signs of chronic heart failure functional class II-III were recorded. An increase in the degree of tricuspid regurgitation (TR) was found in 29.9% of patients. In patients against the background of long-term pacing, the GLS, GWI, GCW and GWE indicators were statistically significantly lower than in the group of healthy volunteers, and the GWW indicator was higher than the reference values of the control group. Patients with an apical-septal localization of the stimulating electrode head have statistically lower GWI and GCW values than patients with a more “basal” location of the electrode head in the middle third of the interventricular septum (1042.23±308.85 versus 1430±514 mmHg%, p = 0.049 and 1457 (1256; 1766) versus 2089 (1831; 2186) mmHg%, p = 0.04). Conclusion . The localization of the stimulating electrode head does not affect the development of negative dynamics of LVEF and TR, but has a significant effect on the myocardial performance indicators. In patients with the apical-septal localization of the electrode, the worst values of the constructive work of the myocardium were noted, and in patients with the localization of the stimulating electrode head in the right ventricular outflow tract area, the best indicators of the constructive work of the myocardium were noted.

Aim. The purpose of this study is to compare the single use of a fixed minimum dose of cavutilid (refralon; Russian Federation, E.I. Chazov National Medical Cardiology Research Centre) 350 μg with amiodarone in patients with paroxysms of atrial fibrillation and flutter. Materials and methods. The study included 62 patients with paroxysmal atrial fibrillation and flutter, divided into two groups (31 patients each). The first group received single fixed dose of cavutilid 350 μg, the second — amiodarone at a starting dose of 5 mg / kg with a possible continuation of the infusion up to 1200 mg in case of failure to achieve sinus rhythm recovery. The patients did not differ in main clinical and instrumental parameters, except for the higher weight and duration of medical history in the amiodarone group. The effectiveness of cardioversion (restoration of sinus rhythm within 1 and 24 hours, time to restoration of sinus rhythm, reduction of heart rate, achievement of " lenient " heart rate control, absence of sustained relapses) and safety (presence of serious cardiovascular complications, ventricular arrhythmias, prolongation of QT/QTc intervals, severe bradycardia and pauses >3,0 sec, arterial hypotension). Results. In the cavutilid group, sinus rhythm restoration within 1 hour was achieved in 87.1% of patients, in the amiodarone group — in 19.4% (pDiscussion. The high efficacy and safety of a single fixed dose of cavutilid 350 μg for pharmacological cardioversion of atrial fibrillation and flutter paroxysms demonstrate low risk of arrhythmogenic effects of the drug and the possibility of reducing patient follow-up time both in intensive care units and in general inpatient setting. Taking these advantages into consideration, we may suggest that fixed dose of cavutilid 350 μg has potential for outpatient use.

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.

Aim. To evaluate the effectiveness and safety of cavutilide in patients with a history of unsuccessful cardioversion to terminate current persistent and paroxysmal atrial fibrillation (AF) episode.Material and methods. The retrospective study included 55 patients (mean age 60±8 years; male/female ratio 37/18) with paroxysmal (n=15) and persistent (n=40), who had unsuccessfully attempted to terminate the current episode of arrhythmia using electrocardiography. All patients received сavutilide in the intensive care unit according to the following regimen: 5 μg/kg-5 μg/kg-10 μg/kg-10 μg/kg. After each bolus and before the next one, ECG parameters (rhythm, QT interval) and the patients’ general condition were assessed; the interval between administrations was 15 minutes. Administration was halted if sinus rhythm (SR) was restored, heart rate (HR) fell below 50 bpm, QTc exceeded 500 ms, or arrhythmogenic effects occurred. Patients were monitored telemetrically for 24 hours to assess efficacy and safety.Results. SR was restored in 47 (85.4%) out of 55 patients, with a median restoration time of 40 [15-240] minutes. Five patients (9%) achieved SR after the initial of 5 μg/kg dose. Sixteen additional patients responded to 10 μg/kg (cumulative efficacy: 38%). Nine further patients achieved SR at 20 μg/kg (cumulative efficacy: 54.5%). The remaining patients required the maximum 30 μg/kg dose. QTc prolongation >500 ms occurred in 12 (21.8%) patients, though none developed sustained ventricular arrhythmias. Transient HR reduction Conclusion. Cavutilide demonstrates high effectiveness and safety in restoring heart rhythm in patients with prior unsuccessful electrical cardioversion attempts. These findings support considering pharmacological cardioversion with cavutilide in such cases.