This prospective study evaluates the impact of radiofrequency ablation (RFA) on cardiorespiratory indicators in patients with long-standing persistent atrial fibrillation admitted to the Heart Center UMC between January 2022 and April 2024 in Astana, Kazakhstan. The study aims to assess the functional cardiac benefits of RFA. Out of 717 registered atrial fibrillation patients, 104 were examined before and 3 months after ablation, focusing on cardiorespiratory parameters. A before-and-after analysis using linear mixed models was applied to evaluate changes in cardiorespiratory parameters post-RFA. Significant improvements were noted across various measures. VO₂ max increased from 11.5 ± 4.4 mL/kg/min to 18.0 ± 4.5 mL/kg/min (p < 0.001). Oxygen uptake improved from 7.2 ± 2.6 mL/beat to 11.0 ± 3.4 mL/beat (p < 0.001). The 6-min walking test distance rose from 306 ± 82 m to 400 ± 48 m (p < 0.001). METs increased from 4.4 ± 1.6 to 8.0 ± 1.3 (p < 0.001). Heart rate at peak exercise decreased from 175.5 ± 18.6 to 147.2 ± 12.3 beats per minute (p < 0.001). NT-proBNP levels decreased from 1357 ± 1182 to 415 ± 339 pg/mL (p < 0.001). Patients with persistent atrial fibrillation undergoing RFA showed functional improvements in CPET indicators such as VO₂ max, METs, O₂ pulse, heart rate, and the 6-min walking test. Improvements were also seen in Nt-proBNP analysis. These results emphasize the need for longitudinal follow-up to optimize outcomes and minimize medical risks.

Background: Severe and difficult-to-control asthma occurs in 3–10% of patients in developed countries. The aim of our study was to investigate the association of the prognostic role of leptin and adiponectin, as well as the leptin receptor gene polymorphism Gln223Arg, in patients with difficult-to-control and severe asthma. Methods: The present study included 200 patients with asthma hospitalized in the Department of Pulmonology between January 2018 and December 2021. In all patients, in addition to routine clinical investigations, adiponectin, leptin and their ratio were analyzed, as well as levels of pro-inflammatory cytokines (IL-6, IL-8 and TNF-alpha). External respiratory function was also assessed. LEPR Gln223Arg single-nucleotide polymorphisms were genotyped by real-time PCR method. Results: Patients were randomized into two groups, depending on the severity of asthma: an uncontrolled asthma group and a controlled asthma group, according to the GINA criteria. Among patients with uncontrolled asthma, 101 subjects (74.3%) had metabolic syndrome (p < 0.001). There was an inverse association of the adiponectin/leptin ratio with the eosinophil count (B = −0.305, p < 0.001), IL-6 (B = −0.026, p < 0.001), IL-8 (B = −0.062, p < 0.001) and TNF-alpha (B = −0.047, p < 0.001) and a direct correlation with the level of FEV1 (B = 0.121, p < 0.001) and FVC (B = 0.104, p < 0.001). A probable association of homozygous A/A allele with increased risk of uncontrolled asthma was shown (p = 0.007). Conclusions: Leptin receptor polymorphism with A/A genotype may be associated with a higher probability of developing severe and difficult-to-control asthma.

Objective. Development of principles for personalized selection of patients for renal denervation (RD) based on the evaluation of procedural response predictors. Design and methods. In the period from 2016 to 2022, 91 patients with resistant arterial hypertension (RHTN) underwent a RD procedure using 2 types of catheters — monopolar and spiral. All patients were assessed for basic demographic, clinical, functional, and laboratory characteristics. The reassessment was carried out on the 7th day, then after 6 and 12 months. A predictive model for determining the probability of response to RD was constructed using the logistic regression method. Results. The final analysis included data from 91 RHTN patients, the mean age was 57,79 ± 9,5 years. At baseline, patients received 4,5 ± 1,4 antihypertensive drugs. Initial office systolic blood pressure (SBP) was 190 (interquartile range (IQR) 100; 140, 240) mm Hg, diastolic blood pressure (DBP) — 100 (IQR 60; 80, 140) mm Hg. Among the responders, a significant reduction in blood pressure (BP) was achieved, with maintenance of the antihypertensive effect during 1 year of follow-up (p < 0,001 for SBP and DBP). The multivariate regression analysis showed that the initial DPB (p < 0,001), the diameter of the right (p = 0,049) and left renal arteries (RA) (p = 0,038) were significant predictors. Based on these data, a prognostic model was developed (p < 0,001). Conclusions. Our results confirmed effectiveness and safety of RD. The stability of the clinical effect is important. However, there was a high variability in the degree of BP reduction after the procedure. The initial DBP, the diameter of the left and right RA, and the use of drugs that reduce the activity of the sympathetic nervous system can be used as possible predictors of response to RD.

According to recommendations of ESC 2020-year, de-escalation of therapy with a P2Y12 receptor inhibitor (transition from prasugrel or ticagrelor to clopidogrel) It can be considered as an alternative strategy of dual antiplatelet therapy (DAPT) for patients with acute coronary syndrome (ACS) who are unsuitable for the use of a strong platelet inhibitor.De-escalation can be performed based on an individual clinical evaluation under the supervision of platelet function testing or CYP2C19 genotyping, depending on the patient’s risk profile and the availability of appropriate diagnostic methods. The optimal dosage of strong P2Y12 receptor inhibitors, such as ticagrelor or prasugrel is not entirely clear and is especially difficult to define for patients of Asian nationality.The article describes a clinical case of antiplatelet therapy de-escalation, particularly a dose reduction of the potent P2Y12 receptor inhibitor ticagrelor in a patient after percutaneous coronary intervention (PCI) with a high risk of bleeding based on platelet function determination and genetic testing. A 47-year-old patient of Kazakh nationality was hospitalized with gastrointestinal bleeding.Given bleeding type 3 by BARC (Bleeding Academic Research Consortium) associated with DAPT, it was decided to apply a strategy to de-escalate antiplatelet therapy under the control of platelet function testing (PFT) and genetic testing.In this case, replacement of ticagrelor with the weak P2Y12 receptor inhibitor clopidogrel was not possible as the patient appeared to be a carrier of the CYP2C19*2 polymorphism contributing to loss of function of the cytochrome P-450(CYP) enzyme.

Background: Pulsed field ablation (PFA) is a novel non-thermal ablation modality that has demonstrated efficacy and safety in the treatment of common arrhythmias such as atrial fibrillation (AF) and atrial flutter (AFL). However, evidence regarding its use in patients with dextrocardia remains scarce. Case summary: A 63-year-old woman with dextrocardia and situs in vs. totalis, and with prior surgical atrial septal defect (ASD) repair, presented with heart palpitations that did not respond to antiarrhythmic drugs. Ambulatory and Holter monitoring documented short episodes of AF and AFL. Computed tomography (CT) of the heart and its structures before the procedure enabled anatomical orientation and planning of the procedure. Catheter ablation was performed using a Pentaspline PFA system (FARAPULSE, Boston Scientific) under fluoroscopic guidance without electroanatomical mapping. Pulmonary vein isolation, along with ablation of the left atrial roof, posterior wall of the left atrium, and cavotricuspid isthmus, was successfully achieved. The procedure was successful, and no recurrence of arrhythmia was observed on 6-month Holter monitoring. Discussion: This case demonstrates that combined PFA for AF and AFL is feasible in patients with complex congenital anatomy, including dextrocardia following ASD repair. Mirror-image cardiac anatomy presents unique challenges for catheter navigation and anatomical orientation. Pre-procedural cardiac CT was essential for procedural planning and accurate spatial orientation, facilitating successful PFA in this anatomically complex setting.

Aim: To assess the clinical efficacy and safety of cardioneuroablation (CNA) in patients with vagally-mediated dysfunction of sinus and atrioventricular (AV) nodes. Methods: Between August 2023 and March 2025, 21 CNA procedures were performed in patients with autonomic dysfunction of the sinus node and functional second- and third-degree AV block. Clinical follow-up assessments were conducted at 3, 6, 12, and 24 months post-procedure, including 24-hour Holter monitoring and validated quality-of-life questionnaires. Results: A total of 21 patients (mean age 37.4 ± 10.2 years) were included. CNA resulted in a significant increase in mean heart rate (HR) from 53.2 ± 9.6 beats per minute (bpm) to 70.4 ± 7.8 bpm (mean difference +17.1 bpm; 95% confidence interval [CI]: 13.5-20.8; p < 0.001; Cohen’s d = 2.13). Significant improvement in antegrade AV conduction (Wenckebach point: 541.9 ± 139.9 to 393.8 ± 63.7 ms; p < 0.001; d = 1.34) and corrected sinus node recovery time (cSNRT: 524.5 ± 273.1 to 320.5 ± 76.9 ms; p = 0.030) was observed. PR, AH, and HV intervals showed no significant changes (all p > 0.05). All six patients with prior syncope remained syncope-free throughout follow-up. Statistically significant improvement was observed in all five EQ-5D domains (p ≤ 0.025). Conclusion: In selected patients with confirmed vagally mediated bradyarrhythmias, CNA is a feasible catheter-based procedure that may reduce the need for permanent pacemaker implantation. These preliminary results from a single-center pilot cohort study demonstrate significant improvement in HR, electrophysiological parameters, and health-related quality of life. Confirmation in larger multicenter controlled studies is required before broader clinical implementation.