rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2012-8-4-561-568rpcardio-501Research ArticlePOINT OF VIEWТОЧКА ЗРЕНИЯUP TO DAY POSSIBILITIES OF ATRIAL FIBRILLATION PREVENTIONСОВРЕМЕННЫЕ ВОЗМОЖНОСТИ ПРОФИЛАКТИКИ ФИБРИЛЛЯЦИИ ПРЕДСЕРДИЙПротасоваЕ. А.ProtasovaE. A.

врач-ординатор

andrilena@yandex.ruФурманН. В.FurmanN. V.

к.м.н., зав. лабораторией неотложной кардиологии

РешетькоО. В.Reshet'koO. V.

д.м.н., профессор, зав. кафедрой фармакологии и клинической фармакологии

Саратовский научно-исследовательский институт кардиологииРоссияSaratov Research Institute for CardiologyRussian FederationСаратовский государственный медицинский университет им. В.И. РазумовскогоРоссияSaratov State Medical University named after V.I. RazumovskyRussian Federation20120201201684561568Copyright © Protasova E.A., Furman N.V., Reshet'ko O.V., 20152015Протасова Е.А., Фурман Н.В., Решетько О.В.Protasova E.A., Furman N.V., Reshet'ko O.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/501

Inhibitors of the renin-angiotensin-aldosterone system, statins, and possibly , ω-3 polyunsaturated fatty acids may influence the incidence of atrial fibrillation (AF), and can be used to prevent it. In recent medical literature, this approach is referred to as upstream treatment. The results of experiments and clinical studies show that the use of these drugs may be useful for AF primary prevention in certain categories of patients. Nevertheless, there are currently no sufficient evidences to justify these recommendations and apply them to a wider range of patients with AF risk factors. Thus, it is reasonable to continue studies on both primary and secondary AF prevention.

Ингибиторы ренин-ангиотензин-альдостероновой системы, статины, и, возможно, ω-3 полиненасыщенные жирные кислоты могут оказывать влияние на частоту развития фибрилляции предсердий (ФП), т.е. применяться для её профилактики, что в современной литературе обозначается термином «терапия вверх по течению» (upstream treatment). Приведены данные результатов экспериментов и клинических исследований, которые показывают , что применение данных препаратов может быть полезно для первичной профилактики ФП у отдельных категорий пациентов. Тем не менее, достаточных доказательств, чтобы оправдать данные рекомендации и применить их к более широкому кругу пациентов с факторами риска ФП, в настоящее время нет. Таким образом, обосновано продолжение изучения как первичной, так и вторичной профилактики ФП.

фибрилляция предсердийпрофилактикаatrial fibrillationpreventionReferencesBenjamin E.J., Levy D., Vaziri S.M. et al. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA 1994;271(11):840–844Benjamin E.J., Levy D., Vaziri S.M. et al. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA 1994;271(11):840–844Go A.S., Hylek E.M., Phillips K.A., et al. Prevalence of diagnosed atrial fibrillation in adults: National implications for rhythm management and stroke prevention: The anticoagulation and risk factors in atrial fibrillation (ATRIA) study. JAMA 2001; 285:2370–2375Go A.S., Hylek E.M., Phillips K.A., et al. Prevalence of diagnosed atrial fibrillation in adults: National implications for rhythm management and stroke prevention: The anticoagulation and risk factors in atrial fibrillation (ATRIA) study. JAMA 2001; 285:2370–2375Miyasaka Y ., Barnes M.E., Gersh B.J., et al. Secular trends in incidence of atrial fibrillation in Olmsted County , Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation 2006;114:119–25.Miyasaka Y ., Barnes M.E., Gersh B.J., et al. Secular trends in incidence of atrial fibrillation in Olmsted County , Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation 2006;114:119–25.Heeringa J., van der Kuip D.A., Hofman A., et al. Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J 2006;27(8):949–53.Heeringa J., van der Kuip D.A., Hofman A., et al. Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J 2006;27(8):949–53.Majeed A., Moser K., Carroll K. Trends in the prevalence and management of atrial fibrillation in general practice in England and Wales, 1994–1998: analysis of data from the general practice research database. Heart 2001;86:284–288.Majeed A., Moser K., Carroll K. Trends in the prevalence and management of atrial fibrillation in general practice in England and Wales, 1994–1998: analysis of data from the general practice research database. Heart 2001;86:284–288.Friberg J., Buch P ., Scharling H., et al. Rising rates of hospital admissions for atrial fibrillation. Epidemiology 2003;14:666–72.Friberg J., Buch P ., Scharling H., et al. Rising rates of hospital admissions for atrial fibrillation. Epidemiology 2003;14:666–72.Nieuwlaat R., Prins M.H., Le Heuzey J.Y ., et al. Prognosis, disease progression, and treatment of atrial fibrillation patients during 1 year: follow-up of the Euro Heart Survey on atrial fibrillation. Eur Heart J 2008;29(9):1181–9.Nieuwlaat R., Prins M.H., Le Heuzey J.Y ., et al. Prognosis, disease progression, and treatment of atrial fibrillation patients during 1 year: follow-up of the Euro Heart Survey on atrial fibrillation. Eur Heart J 2008;29(9):1181–9.van Veldhuisen D.J., Aass H., El Allaf D., et al.; MERIT-HF Study Group. Presence and development of atrial fibrillation in chronic heart failure. Experiences from the MERIT-HF Study . Eur J Heart Fail 2006;8:539–546.van Veldhuisen D.J., Aass H., El Allaf D., et al.; MERIT-HF Study Group. Presence and development of atrial fibrillation in chronic heart failure. Experiences from the MERIT-HF Study . Eur J Heart Fail 2006;8:539–546.Benjamin E.J., Wolf P .A., D’Agostino R.B., et al. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation 1998;98:946–952.Benjamin E.J., Wolf P .A., D’Agostino R.B., et al. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation 1998;98:946–952.Nieuwlaat R., Capucci A., Camm A.J. et al. Atrial fibrillation management: a prospective survey in ESC member countries: the Euro Heart Survey on atrial Fibrillation. Eur Heart J 2005; 26: 2422–2434.Nieuwlaat R., Capucci A., Camm A.J. et al. Atrial fibrillation management: a prospective survey in ESC member countries: the Euro Heart Survey on atrial Fibrillation. Eur Heart J 2005; 26: 2422–2434.Camm A.J., Kirchhof P ., Lip G.Y . et al. Guidelines for the management of atrial fibrillation: the T ask Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Europace 2010;12:1360–1420Camm A.J., Kirchhof P ., Lip G.Y . et al. Guidelines for the management of atrial fibrillation: the T ask Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Europace 2010;12:1360–1420Kozlowski D., Budrejko S., Lip GrY H., et al. Lone atrial fibrillation: what do we know? Heart 2010; 96: 498–503.Kozlowski D., Budrejko S., Lip GrY H., et al. Lone atrial fibrillation: what do we know? Heart 2010; 96: 498–503.Le Heuzy J.Y ., Paziaud O., Piot O., et al. Cost of care distribution in atrial fibrillation patients: The CO- CAF study. Am Heart 2004;147:121–6.Le Heuzy J.Y ., Paziaud O., Piot O., et al. Cost of care distribution in atrial fibrillation patients: The CO-CAF study. Am Heart 2004;147:121–6.Stewart S., Murphy N.F ., Walker A., et al. Cost of an emerging epidemic: an economic analysis of atrial fibrillation in the UK. Heart 2004;90(3):286–92.Stewart S., Murphy N.F ., Walker A., et al. Cost of an emerging epidemic: an economic analysis of atrial fibrillation in the UK. Heart 2004;90(3):286–92.Reynolds M.R., Essebag V., Zimetbaum P ., et al. Healthcare resource utilization and costs associated with recurrent episodes of atrial fibrillation: the FRACTAL registry. J Cardiovasc Electrophysiol 2007;18(6):628–33.Reynolds M.R., Essebag V., Zimetbaum P ., et al. Healthcare resource utilization and costs associated with recurrent episodes of atrial fibrillation: the FRACTAL registry. J Cardiovasc Electrophysiol 2007;18(6):628–33.Ringborg A., Nieuwlaat R., Lindgren P ., et al. Costs of atrial fibrillation in five European countries: results from the Euro Heart Survey on atrial fibrillation. Europace 2008;10(4):403–11.Ringborg A., Nieuwlaat R., Lindgren P ., et al. Costs of atrial fibrillation in five European countries: results from the Euro Heart Survey on atrial fibrillation. Europace 2008;10(4):403–11.Heemstra H. E., Nieuwlaat R., Meijboom M., Crijns H. J. The burden of atrial fibrillation in the Netherlands. Neth Heart J 2011;19:373–378.Heemstra H. E., Nieuwlaat R., Meijboom M., Crijns H. J. The burden of atrial fibrillation in the Netherlands. Neth Heart J 2011;19:373–378.Wolowacz S.E., Samuel M., Brennan V.K., et al. The cost of illness of atrial fibrillation: a systematic review of the recent literature. Europace 2011; 13:1375–85.Wolowacz S.E., Samuel M., Brennan V.K., et al. The cost of illness of atrial fibrillation: a systematic review of the recent literature. Europace 2011; 13:1375–85.National guidelines for diagnosis and treatment of atrial fibrillation. Kardiovaskuljarnaja Terapija i Profilaktika 2005; 4(4) suppl 1: 1–36. Russian (Национальные рекомендации по диагностике и лечению фибриляции предсердий. Кардиоваскулярная терапия и профилактика 2005; 4(4) Приложение 1: 1–36).National guidelines for diagnosis and treatment of atrial fibrillation. Kardiovaskuljarnaja Terapija i Profilaktika 2005; 4(4) suppl 1: 1–36. Russian (Национальные рекомендации по диагностике и лечению фибриляции предсердий. Кардиоваскулярная терапия и профилактика 2005; 4(4) Приложение 1: 1–36).Shilov A.M., Mel'nik M.V., Osija A.O., et al Pathophysiology and principles of treatment of atrial fibrillation. Russkij Medicinskij Zhurnal 2011; 14:877–883. Russian (Шилов А.М., Мельник М.В., Осия А.О., и др. Патофизиология и принципы лечения фибрилляции предсердий. Русский Медицинский Журнал 2011; 14:877–883).Shilov A.M., Mel'nik M.V., Osija A.O., et al Pathophysiology and principles of treatment of atrial fibrillation. Russkij Medicinskij Zhurnal 2011; 14:877–883. Russian (Шилов А.М., Мельник М.В., Осия А.О., и др. Патофизиология и принципы лечения фибрилляции предсердий. Русский Медицинский Журнал 2011; 14:877–883).Morrow JP ., Reiffel A J., Drug Therapy for Atrial Fibrillation: What Will Its Role Be in the Era of Increasing Use of Catheter Ablation? PACE 2009; 32:108–118.Morrow JP ., Reiffel A J., Drug Therapy for Atrial Fibrillation: What Will Its Role Be in the Era of Increasing Use of Catheter Ablation? PACE 2009; 32:108–118.Savelieva I., Kakouros N., Kourliouros A., Camm A. J. Upstream therapies for management of atrial fibrillation: review of clinical evidence and implications for European Society of Cardiology guidelines. Part I: primary prevention. Europace 2011;13:308–328.Savelieva I., Kakouros N., Kourliouros A., Camm A. J. Upstream therapies for management of atrial fibrillation: review of clinical evidence and implications for European Society of Cardiology guidelines. Part I: primary prevention. Europace 2011;13:308–328.Savelieva I., Kakouros N., Kourliouros A., Camm A. J. Upstream therapies for management of atrial fibrillation: review of clinical evidence and implications for European Society of Cardiology guidelines. Part II: Secondary prevention. Europace 2011;13:610–625.Savelieva I., Kakouros N., Kourliouros A., Camm A. J. Upstream therapies for management of atrial fibrillation: review of clinical evidence and implications for European Society of Cardiology guidelines. Part II: Secondary prevention. Europace 2011;13:610–625.Savelieva I., Camm A.J. Is there any hope for angiotensin-converting enzyme inhibitors in atrial fibrillation? Am Heart J 2007;154:403–406.Savelieva I., Camm A.J. Is there any hope for angiotensin-converting enzyme inhibitors in atrial fibrillation? Am Heart J 2007;154:403–406.Egorov D.F . Prospects for development of non-drug treatments for atrial fibrillation. Vestnik Aritmologii 2007;46: 68–78. Russian (Егоров Д.Ф. Перспективы развития немедикаментозных способов лечения фибрилляции предсердий. Вестник аритмологии 2007;46: 68–78).Egorov D.F . Prospects for development of non-drug treatments for atrial fibrillation. Vestnik Aritmologii 2007;46: 68–78. Russian (Егоров Д.Ф. Перспективы развития немедикаментозных способов лечения фибрилляции предсердий. Вестник аритмологии 2007;46: 68–78).Marcus G.M., Smith L.M., Vittinghoff E. et al. A fi rstdegree family history in lone atrial fibrillation patients Heart Rhythm 2008; 5: 826–830.Marcus G.M., Smith L.M., Vittinghoff E. et al. A fi rstdegree family history in lone atrial fibrillation patients Heart Rhythm 2008; 5: 826–830.Schotten U., Verheule S., Kirchhof P ., Goette A. Pathophysiological Mechanisms of Atrial Fibrillation: A Translational Appraisal. Physiol Rev 2011; 91: 265–325.Schotten U., Verheule S., Kirchhof P ., Goette A. Pathophysiological Mechanisms of Atrial Fibrillation: A Translational Appraisal. Physiol Rev 2011; 91: 265–325.Hobbs W.J., Van Gelder I.C., Fitzpatrick A.P ., et al. The role of atrial electrical remodeling in the progression of focal atrial ectopy to persistent atrial fibrillation. J Cardiovasc Electrophysiol 1999;10: 866–70.Hobbs W.J., Van Gelder I.C., Fitzpatrick A.P ., et al. The role of atrial electrical remodeling in the progression of focal atrial ectopy to persistent atrial fibrillation. J Cardiovasc Electrophysiol 1999;10: 866–70.Morillo C.A., Klein G.J., Jones D.L., et al. Chronic rapid atrial pacing: structural, functional and elec- trophysiological characteristics of a new model of sustained atrial fibrillation. Circulation 1995;91: 1588–95.Morillo C.A., Klein G.J., Jones D.L., et al. Chronic rapid atrial pacing: structural, functional and electrophysiological characteristics of a new model of sustained atrial fibrillation. Circulation 1995;91: 1588–95.Brundel B.J., Henning R.H., Kampinga H.H. et al. Molecular mechanisms of remodeling in human atrial fibrillation. Cardiovasc Res 2002;54:315–324.Brundel B.J., Henning R.H., Kampinga H.H. et al. Molecular mechanisms of remodeling in human atrial fibrillation. Cardiovasc Res 2002;54:315–324.Ravens U., Cerbai E. Role of potassium currents in cardiac arrhythmias. Europace 2008; 10(10): 1133–7.Ravens U., Cerbai E. Role of potassium currents in cardiac arrhythmias. Europace 2008; 10(10): 1133–7.Wang Z., Feng J., Nattel S. Idiopathic atrial fibrillation in dogs: electrophysiologic determinants and mechanism of antiarrhythmic action of flecainide. J Am Coll Cardiol 1995; 26:277–286.Wang Z., Feng J., Nattel S. Idiopathic atrial fibrillation in dogs: electrophysiologic determinants and mechanism of antiarrhythmic action of flecainide. J Am Coll Cardiol 1995; 26:277–286.Hoit B.D., Shao Y ., Gabel M. Et al. Left atrial mechanical and biomechanical adaptation to pacing induced heart failure. Cardivasc Res 1995; 29: 469–474.Hoit B.D., Shao Y ., Gabel M. Et al. Left atrial mechanical and biomechanical adaptation to pacing induced heart failure. Cardivasc Res 1995; 29: 469–474.Kumagai K., Nakashima H., Urata H. et al. Effects of angiotensin II type I receptor antagonist on electrical and structural remodeling in atrial fibrillation. J Am Coll Cardiol 2003; 41: 2197–2204.Kumagai K., Nakashima H., Urata H. et al. Effects of angiotensin II type I receptor antagonist on electrical and structural remodeling in atrial fibrillation. J Am Coll Cardiol 2003; 41: 2197–2204.Kistler P .M., Sanders P ., Dodic M. Et al. Atrial electrical and structural abnormalities in an ovine model of chronic blood pressure elevation after prenatal corticosteroid exposure: imlications for development of atrial fibrillation. Eur Heart J 2006;27:3045–56.Kistler P .M., Sanders P ., Dodic M. Et al. Atrial electrical and structural abnormalities in an ovine model of chronic blood pressure elevation after prenatal corticosteroid exposure: imlications for development of atrial fibrillation. Eur Heart J 2006;27:3045–56.Thijssen V., Ausma J., Lin G. et al. Structural changes of atrial myocardium during chronic atrial fibrillation ardiovasc. Path 2000;9:17–28.Thijssen V., Ausma J., Lin G. et al. Structural changes of atrial myocardium during chronic atrial fibrillation ardiovasc. Path 2000;9:17–28.Issac TT., Dokainish H, Lakkis N M., Role of Inflammation in Initiation and Perpetuation of Atrial Fibrillation A Systematic Review of the Published Data. J Am Coll Cardiol 2007;50:2021–28.Issac TT., Dokainish H, Lakkis N M., Role of Inflammation in Initiation and Perpetuation of Atrial Fibrillation A Systematic Review of the Published Data. J Am Coll Cardiol 2007;50:2021–28.Schnabel R.B., Sullivan L.M., Levy D. et al. Development of a risk score for atrial fibrillation (Framingham Heart Study): a community-based cohort study. Lancet 2009; 373: 739–45.Schnabel R.B., Sullivan L.M., Levy D. et al. Development of a risk score for atrial fibrillation (Framingham Heart Study): a community-based cohort study. Lancet 2009; 373: 739–45.Williams B. Angiotensin II and the pathophysiology of cardiovascular remodeling. Am J Cardiol 2001;87(8A):10–17.Williams B. Angiotensin II and the pathophysiology of cardiovascular remodeling. Am J Cardiol 2001;87(8A):10–17.Kourliouros A., Savelieva I., Kiotsekoglou A., et al. Current concepts in the pathogenesis of atrial fibrillation. Am Heart J 2009;157:243–52.Kourliouros A., Savelieva I., Kiotsekoglou A., et al. Current concepts in the pathogenesis of atrial fibrillation. Am Heart J 2009;157:243–52.Nasonov EL, Paniukova EV, Aleksandrova EN. C-reactive protein--marker of inflammation in atherosclerosis (new data). Kardiologiia 2002;42(7):53–62. Russian (Насонов Е.Л., Панюкова Е.В., Александрова Е.Н. С-реактивный белок — маркер воспаления при атеросклерозе (новые данные). Кардиология 2002; 7: 53—62).Nasonov EL, Paniukova EV, Aleksandrova EN. C-reactive protein--marker of inflammation in athero-Goette A., Staakc Th., Rocken Ch. Increased expression of extracellular signal_regulated kinase and angiotensin_con_verting enzyme in human atrial during atrial fibrillation. J Am Coll Cardiol 2000; 35:1669—77.sclerosis (new data). Kardiologiia 2002;42(7):53–62. Russian (Насонов Е.Л., Панюкова Е.В., Александрова Е.Н. С-реактивный белок — маркер воспаления при атеросклерозе (новые данные). Кардиология 2002; 7: 53—62).Cardin S., Li D., Thorin-Trescases N., et al. Evolution of the atrial fibrillation substrate in experimental congestive heart failure: angiotensin-dependent and -independent pathways. Cardiovasc Res 2003; 60: 315–25.Goette A., Staakc Th., Rocken Ch. Increased expression of extracellular signal_regulated kinase and angiotensin_con_verting enzyme in human atrial during atrial fibrillation. J Am Coll Cardiol 2000; 35:1669—77.Pedersen O.D., Bagger H., Kober L., Torp-Pedersen C. Trandolapril reduces the incidence of atrial fibrillation after acute myocardial infarction in patients with left ventricular dysfunction. Circulation 1999;100:376–80.Cardin S., Li D., Thorin-Trescases N., et al. Evolution of the atrial fibrillation substrate in experimetal congestive heart failure: angiotensin-dependent and -independent pathways. Cardiovasc Res 2003; 60: 315–25.Vermes E., Tardif J.C., Bourassa M.G. et al. Enalapril decreases the incidence of atrial fibrillation in patients with left ventricular dysfunction: insight from the Studies Of Left Ventricular Dysfunction (SOLVD) trials. Circulation 2003;107:2926–31.Pedersen O.D., Bagger H., Kober L., Torp-Pedersen C. Trandolapril reduces the incidence of atrial fibrillation after acute myocardial infarction in patients with left ventricular dysfunction. Circulation 1999;100:376–80.Maggioni A.P ., Latini R., Carson P .E. et al. Valsartan reduces the incidence of atrial fibrillation in patients with heart failure: results from the Valsartan Heart Failure Trial (Val-HeFT). Am Heart J 2005;149:548–57.Vermes E., Tardif J.C., Bourassa M.G. et al. Enalapril decreases the incidence of atrial fibrillation in patients with left ventricular dysfunction: insight from the Studies Of Left Ventricular Dysfunction (SOLVD) trials. Circulation 2003;107:2926–31.Ducharme A., Swedberg K., Pfeffer M.A. et al. Prevention of atrial fibrillation in patients with symptomatic chronic heart failure by candesartan in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program. Am Heart J 2006; 152:86–92.Maggioni A.P ., Latini R., Carson P .E. et al. Valsartan reduces the incidence of atrial fibrillation in patients with heart failure: results from the Valsartan Heart Failure Trial (Val-HeFT). Am Heart J 2005;149:548–57.Healey J.S., Baranchuk A., Crystal E. et al. Prevention of atrial fibrillation with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: a meta-analysis. J Am Coll Cardiol 2005;45:1832–9.Ducharme A., Swedberg K., Pfeffer M.A. et al. Prevention of atrial fibrillation in patients with symptomatic chronic heart failure by candesartan in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program. Am Heart J 2006; 152:86–92.Healey J.S., Baranchuk A., Crystal E. et al. Prevention of atrial fibrillation with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: a meta-analysis. J Am Coll Cardiol 2005;45:1832–9.Healey J.S., Baranchuk A., Crystal E. et al. Prevention of atrial fibrillation with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: a meta-analysis. J Am Coll Cardiol 2005;45:1832–9.

The authors declare that there are no conflicts of interest present.