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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="en"><front><journal-meta><journal-id journal-id-type="publisher-id">rpcardio</journal-id><journal-title-group><journal-title xml:lang="en">Rational Pharmacotherapy in Cardiology</journal-title><trans-title-group xml:lang="ru"><trans-title>Рациональная Фармакотерапия в Кардиологии</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">1819-6446</issn><issn pub-type="epub">2225-3653</issn><publisher><publisher-name>«SILICEA-POLIGRAF» LLC</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.20996/1819-6446-2021-04-16</article-id><article-id custom-type="elpub" pub-id-type="custom">rpcardio-2437</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>POINT OF VIEW</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ТОЧКА ЗРЕНИЯ</subject></subj-group></article-categories><title-group><article-title>Rotor Drivers in Induction and Maintenance of Atrial Fibrillation</article-title><trans-title-group xml:lang="ru"><trans-title>Роторные механизмы в индукции и поддержании фибрилляции предсердий</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-0043-6472</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Куликов</surname><given-names>А. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Kulikov</surname><given-names>A. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Куликов Алексей Алексеевич - eLibrary SPIN 3828-0829</p><p>Москва</p></bio><bio xml:lang="en"><p>Alexey A. Kulikov - eLibrary SPIN 3828-0829</p><p>Moscow</p></bio><email xlink:type="simple">Zeart@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-5186-2474</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Сапельников</surname><given-names>О. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Sapelnikov</surname><given-names>O. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Сапельников Олег Валерьевич – eLibrary SPIN 7490-0049</p><p>Москва</p></bio><bio xml:lang="en"><p>Oleg V. Sapelnikov - eLibrary SPIN 7490-0049</p><p>Moscow</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-4318-0315</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Ускач</surname><given-names>Т. М.</given-names></name><name name-style="western" xml:lang="en"><surname>Uskach</surname><given-names>T. M.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Ускач Татьяна Марковна – eLibrary SPIN 8752-9657</p><p>Москва</p></bio><bio xml:lang="en"><p>Tatiana M. Uskach - eLibrary SPIN 8752-9657</p><p>Moscow</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-1679-1719</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Черкашин</surname><given-names>Д. И.</given-names></name><name name-style="western" xml:lang="en"><surname>Cherkashin</surname><given-names>D. I.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Черкашин Дмитрий Игоревич – eLibrary SPIN 3671-5200</p><p>Москва</p></bio><bio xml:lang="en"><p>Dmitry I. Cherkashin - eLibrary SPIN 4228-8351</p><p>Moscow</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-5839-1858</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Гришин</surname><given-names>И. Р.</given-names></name><name name-style="western" xml:lang="en"><surname>Grishin</surname><given-names>I. R.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Гришин Игорь Романович – eLibrary SPIN 4228-8351</p><p>Москва</p></bio><bio xml:lang="en"><p>Igor R. Grishin - eLibrary SPIN 3671-5200</p><p>Moscow</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-6726-4612</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Акчурин</surname><given-names>Р. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Akchurin</surname><given-names>R. S.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Акчурин Ренат Сулейманович – eLibrary SPIN 6756-8930</p><p>Москва</p></bio><bio xml:lang="en"><p>Renat S. Akchurin – eLibrary SPIN 6756-8930</p><p>Moscow</p></bio><xref ref-type="aff" rid="aff-1"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Национальный медицинский исследовательский центр кардиологии</institution><country>Россия</country></aff><aff xml:lang="en"><institution>National Medical Research Center of Cardiology</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2021</year></pub-date><pub-date pub-type="epub"><day>06</day><month>05</month><year>2021</year></pub-date><volume>17</volume><issue>2</issue><fpage>270</fpage><lpage>277</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Kulikov A.A., Sapelnikov O.V., Uskach T.M., Cherkashin D.I., Grishin I.R., Akchurin R.S., 2021</copyright-statement><copyright-year>2021</copyright-year><copyright-holder xml:lang="ru">Куликов А.А., Сапельников О.В., Ускач Т.М., Черкашин Д.И., Гришин И.Р., Акчурин Р.С.</copyright-holder><copyright-holder xml:lang="en">Kulikov A.A., Sapelnikov O.V., Uskach T.M., Cherkashin D.I., Grishin I.R., Akchurin R.S.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.rpcardio.online/jour/article/view/2437">https://www.rpcardio.online/jour/article/view/2437</self-uri><abstract><p>Atrial fibrillation is the most common arrhythmia in clinical practice. It is associated with an increased risk of stroke, chronic heart failure, and sudden cardiac death. Our options of restoring and maintaining sinus rhythm have a very limited effect, both in the case of antiarrhythmic and catheter treatment. Catheter ablation has proven to be a more effective approach than antiarrhythmic therapy. The success rate of the procedure reaches 70%. However, radiofrequency ablation is associated with a risk of complications, with 4.5% of patients likely to develop major complications, including tamponade (1.31%), femoral pseudoaneurysm (0.71%), and death (0.15%). Given the generally recognized dominant role of the pulmonary veins in the induction of atrial fibrillation, their electrical isolation has become the recommended tactic of the catheter approach. In the case of patients with paroxysmal form of atrial fibrillation, the success rate of the procedure reaches 87%. Unfortunately, in the case of persistent forms of atrial fibrillation, the effectiveness of the primary procedure decreases to 28% and reaches 51% with repeated interventions. In addition to the anatomically oriented isolation of the pulmonary veins, a number of strategies have been proposed to reach the secondary zones of atrial fibrillation induction. The results of recent studies on the effectiveness of strategies for ablation of rotor regions and their role in the induction and maintenance of AF may lead to the further development of catheter ablation techniques and an individual radiofrequency ablation approach in a particular patient.</p></abstract><trans-abstract xml:lang="ru"><p>Фибрилляция предсердий - наиболее часто встречающееся в клинической практике нарушение ритма сердца. Она ассоциирована с повышенным риском инсульта, развития хронической сердечной недостаточности и внезапной сердечной смерти. Современные возможности восстановления и поддержания синусового ритма у пациентов с фибрилляцией предсердий обладают весьма ограниченным эффектом как в случае медикаментозного, так и катетерных методик лечения. Тем не менее, катетерная аблация зарекомендовала себя как более эффективный подход в поддержании синусового ритма, чем антиаритмическая терапия. Вероятность успешности процедуры доходит до 70%. Однако радиочастотная аблация (РЧА) связана с риском осложнений, у 4,5% пациентов могут развиться большие осложнения, включая тампонаду (1,31%), бедренную псевдоаневризму (0,71%) и смерть (0,15%). С учетом общепризнанной главенствующей роли легочных вен в индукции фибрилляции предсердий, их электрическая изоляция стала рекомендованной тактикой катетерного подхода. В случае пациентов с пароксизмальной формой фибрилляции предсердий успешность процедуры доходит до 87%, но, к сожалению, при персистирующих формах фибрилляции предсердий эффективность первичной процедуры снижается до 28% и доходит до 51% при повторных вмешательствах. Вдобавок к анатомически ориентированной изоляции легочных вен предложен ряд стратегий воздействий на дополнительные зоны индукции фибрилляции предсердий. Результаты недавних исследований по эффективности стратегий аблации роторных очагов и их роли в индукции и поддержании ФП могут привести к дальнейшему развитию катетерных методик и индивидуальному подходу к выбору объема РЧА-воздействий у конкретного пациента.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>фибрилляция предсердий</kwd><kwd>ионные каналы</kwd><kwd>ремоделирование</kwd><kwd>«upstream» терапия</kwd></kwd-group><kwd-group xml:lang="en"><kwd>atrial fibrillation</kwd><kwd>ion channels</kwd><kwd>reentry</kwd><kwd>reentrant driver</kwd><kwd>upstream therapy</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Wann LS, Curtis AB, January CT, et al. 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