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Aim      Evaluating the efficacy and safety of early administration of antirecurrence antiarrhythmic therapy (AAT) following restoration of sinus rhythm (SR) with refralon.Aim      Evaluating the efficacy and safety of early administration of antirecurrence antiarrhythmic therapy (AAT) following restoration of sinus rhythm (SR) with refralon.Material and methods  The study included 247 patients with atrial fibrillation/atrial flutter (AF/AFL) (142 men) who underwent pharmacological cardioversion (PCV) with refralon. A 4-step schedule of drug administration was used (successive intravenous infusions at doses of 5, 5, 10, and 10 µg/kg; maximum total dose was 30 µg/kg). Patients who recovered SR and had no contraindications were prescribed antirecurrence AAT in the early (≤24 h; n=101) or delayed (≥24 h; n=95) period. Lappaconitine hydrobromide, propafenone, and sotalol were administered orally as the antirecurrence therapy. The decision on the time of initiating ATT and the choice of the drug and its dose was taken by the attending physician individually. The safety criteria included a prolonged PQ interval >200 ms; second- or third-degree atrioventricular block; QRS complex duration >120 ms; QT prolongation >500 ms; and heartbeat pauses >3 s. The efficacy criteria included the absence of sustained recurrence of AF/AFL after initiation of AAT and the duration of hospitalization after PCV. Patients were followed up during the study until they were discharged from the hospital.Results SR was recovered in 229 (92.7 %) patients. In the group of early AAT initiation, a PQ duration >200 ms was observed in 8 (7.9 %) patients, whereas in the group of delayed AAT initiation, in 7 patients (7.4 %; p=1.000). A wide QRS complex >120 ms was recorded in 1 (1.1 %) patient of the delayed AAT initiation group and in none of the patients of the early AAT initiation group (p=0.485). Ventricular arrhythmogenic effects and QT prolongation >500 ms were not detected in any patient. Numbers of early AF recurrence did not differ in the groups of early and delayed AAT initiation: 6 (5.9 %) vs. 5 (5.3 %), respectively (p=1.000). Median duration of hospitalization after PCV was 4 days in the group of early AAT initiation and 5 days in the group of delayed AAT initiation (р=0.009).Conclusion      Early initiation of the refralon AAT does not increase the risk of drug adverse effects and reduces the duration of stay in the hospital.

The study is devoted to assessment of effect of physical effort of sinus rhythm rate and the state of the process of repolarization in children with 1 and 2 molecular-genetic variants of the long QT syndrome (LQT). We have shown that LQT1 is characterized by inadequate increment of heart rate (HR) and substantial increase of QTc interval during exercise. In LQT2 compared with control reduction of HR increment also takes place while shortening of QTc interval is more pronounced. Delta QTc<0 is an important differential diagnostic criterion in patients with LQT1 and LQT2. Variatins in T wave morphology in LQT1 and LQT2 diminish at the background of physical exercise. The use of β-blockers influences relationship between length of QT interval and HR in patients with LQT but does not eliminate distinction from a group of patients with analogous variant of the syndrome not taking these drugs.

In this review we discuss mechanisms of antiarrhythmic and adverse proarrhythmic action of class III drugs. Special attention is given to ionic currents and channels which determine specific features of their effects (IKr, IKa, IKur). We consider general patterns of changes of bioelectrical activity in atria and ventricles leading to development of arrhythmias or stabilization of rhythm. We also discuss value of QT interval as predictor of torsade de pointes. Perspectives and limitations of development of novel class III antiarrhythmic drugs are discussed as well. We present consideration of efficacy and mechanisms of action of such compounds as dronedarone and vernacalant suggested for termination of atrial fibrillation and maintenance of sinus rhythm. Special attention is given to RG 2 - a novel compound with class III activity.

Aim: To evaluate effects of carvedilol (Akridilol, AKRIKHIN, Russia) on central hemodynamics, microvascular bed, hemorheology, von Willebrand factor (VWF) activity, clinical efficacy of the drug and influence on exercise tolerance in patients with Q myocardial infarction (QMI) compared to therapy with atenolol., Material and Methods: The trial covered 90 patients with acute QMI. All the patients had cardiac failure and were divided into 3 comparable groups. Group 1 received carvedilol in a dose 6.25-50 mg/ day. Group 2 received atenolol in a dose 12.5-50 mg/day. Group 3 had contraindications to therapy with beta-adrenoblockers. The patients were followed up for 60 +/- 2 days. The following methods were employed in the study: clinical examination, echocardiography, laser Doppler flowmetry (LDF), Holter ECG monitoring, examination of platelet-vessel hemostasis, VWF activity, treadmill-test, statistical processing with the program Excel 7.0., Results: Inclusion of beta-adrenoblockers in combined therapy of QMI patients with cardiac failure considerably improves treatment efficacy. These drugs, carvedilol in particular, inhibit postinfarctional remodeling and thus development and progress of cardiac failure. Carvedilol reduces stasis in the microcirculatory bed, corrects abnormal response of microhemodynamics to sympathic activation and operation of venuloarteriolar mechanisms of capillary blood flow regulation. High clinical efficacy of the combined therapy of QMI patients is explained by marked antianginal and antiischemic effects of carvedilol. Treadmill test showed that the addition of beta-adrenoblockers to therapy raised exercise tolerance in the postinfarctional period.

Ethiopathological and clinical factors of vertebral blood flow insufficiency development are discussed in the article. Distinct connection between pathogenesis and stages of clinical manifestation is proved and nosological independence of vertebrobasilar disease is validated. Used in combined therapy of patients with the disease, cavinton is shown to exert a positive effect on the main clinical symptoms.