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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 4182 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).

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.

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.