rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2011-7-3-323-333rpcardio-806Research ArticlePOINT OF VIEWТОЧКА ЗРЕНИЯPROSPECTS FOR THE TREATMENT OF PATIENTS WITH ATRIAL FIBRILLATIONПЕРСПЕКТИВЫ ЛЕЧЕНИЯ ПАЦИЕНТОВ С ФИБРИЛЛЯЦИЕЙ ПРЕДСЕРДИЙСулимовВ. А.SulimovV. A.

д.м.н., профессор, заведующий кафедрой факультетской терапии №1 лечебного факультета

ЛишутаА. С.LishutaA. S.

к.м.н., ассистент кафедры госпитальной терапии №1 лечебного факультета

alexeylish@gmail.comГОУ ВПО Первый московский медицинский университет (МГМУ) им. И.М. СеченоваРоссияI.M. Setchenov First Moscow State Medical UniversityRussian Federation20111701201673323333Copyright © Sulimov V.A., Lishuta A.S., 20162016Сулимов В.А., Лишута А.С.Sulimov V.A., Lishuta A.S.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/806

Basic principles of the management of patients with atrial fibrillation (AF) are discussed taking into account recommendations of the European Society of Cardiology (2010). Peculiarities of AF diagnosis, clinical course and severity estimation, approaches to complications prevention and therapy strategy choice in patients with AF (rhythm control or heart rate control) are presented.

Рассматривают основные принципы ведения пациентов с фибрилляцией предсердий (ФП) с учетом рекомендаций Европейского общества кардиологов (2010). Освещают особенности диагностики ФП с оценкой ее течения и тяжести, принципы профилактики осложнений и выбора стратегии лечения пациентов с ФП (контроль ритма или контроль частоты сердечных сокращений).

фибрилляция предсердийантитромботическая терапияантиаритмическая терапиядронедаронatrial fibrillationantithrombotic therapyantiarrhythmic therapydronedaroneReferencesGuidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J. 2010 Oct;31(19):2369-429Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J. 2010 Oct;31(19):2369-429Schmutz M., Beer-Borst S., Meiltz A., Urban P., Gaspoz J.-M., Costanza M.C. et al. Low prevalence of atrial fibrillation in asymptomatic adults in Geneva, Switzerland. Europace 2010;12:475-81Schmutz M., Beer-Borst S., Meiltz A., Urban P., Gaspoz J.-M., Costanza M.C. et al. Low prevalence of atrial fibrillation in asymptomatic adults in Geneva, Switzerland. Europace 2010;12:475-81Bonhorst D., Mendes M., Adragão P. et al. Prevalence of atrial fibrillation in the Portuguese population aged 40 and over: the FAMA study. Rev Port Cardiol. 2010 Mar;29(3):331-50Bonhorst D., Mendes M., Adragão P. et al. Prevalence of atrial fibrillation in the Portuguese population aged 40 and over: the FAMA study. Rev Port Cardiol. 2010 Mar;29(3):331-50Stefansdottir H., Aspelund T., Gudnason V., Arnar D.O. Trends in the incidence and prevalence of atrial fibrillation in Iceland and future projections. Europace. 2011 May 7. doi: 10.1093/europace/eur132Stefansdottir H., Aspelund T., Gudnason V., Arnar D.O. Trends in the incidence and prevalence of atrial fibrillation in Iceland and future projections. Europace. 2011 May 7. doi: 10.1093/europace/eur132Naccarelli G.V., Varker H., Lin J., Schulman K.L. Increasing prevalence of atrial fibrillation and flutter in the United States. Am J Cardiol 2009;104:1534-9.Naccarelli G.V., Varker H., Lin J., Schulman K.L. Increasing prevalence of atrial fibrillation and flutter in the United States. Am J Cardiol 2009;104:1534-9.Miyasaka Y., Barnes M.E., Gersh B.J., Cha S.S., Bailey K.R., Abhayaratna W.P. 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;114:119-25Miyasaka Y., Barnes M.E., Gersh B.J., Cha S.S., Bailey K.R., Abhayaratna W.P. 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;114:119-25Sellers M.B., Newby L.K. Atrial fibrillation, anticoagulation, fall risk, and outcomes in elderly patients. Am Heart J. 2011 Feb;161(2):241-6.Sellers M.B., Newby L.K. Atrial fibrillation, anticoagulation, fall risk, and outcomes in elderly patients. Am Heart J. 2011 Feb;161(2):241-6.ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation. Circulation 2006;114(7):e257-354.ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation. Circulation 2006;114(7):e257-354.Reinhold T., Lindig C., Willich S.N., Brüggenjürgen B. The costs of atrial fibrillation in patients with cardiovascular comorbidities — a longitudinal analysis of German health insurance data. Europace. 2011 Apr 21. doi: 10.1093/europace/eur116Reinhold T., Lindig C., Willich S.N., Brüggenjürgen B. The costs of atrial fibrillation in patients with cardiovascular comorbidities — a longitudinal analysis of German health insurance data. Europace. 2011 Apr 21. doi: 10.1093/europace/eur116Kolbin A.S., Biserova I. N., Balykina Yu.E., et al. Socio-economic burden of atrial fibrillation in the Russian Federation. Kachestvennaya klinicheskaya praktika 2010; 19 (4): 17-22. Russian (Колбин А.С., Бисерова И.Н., Балыкина Ю.Е. и др. Социально-экономическое бремя мерцательной аритмии в Российской Федерации. Качественная клиническая практика 2010; 19 (4): 17-22).Kolbin A.S., Biserova I. N., Balykina Yu.E., et al. Socio-economic burden of atrial fibrillation in the Russian Federation. Kachestvennaya klinicheskaya praktika 2010; 19 (4): 17-22. Russian (Колбин А.С., Бисерова И.Н., Балыкина Ю.Е. и др. Социально-экономическое бремя мерцательной аритмии в Российской Федерации. Качественная клиническая практика 2010; 19 (4): 17-22).Hindricks G., Pokushalov E., Urban Let al. Performance of a new leadless implantable cardiac monitor in detecting and quantifying atrial fibrillation — results of the XPECT trial. Circ Arrhythm Electrophysiol 2010;3:141–147Hindricks G., Pokushalov E., Urban Let al. Performance of a new leadless implantable cardiac monitor in detecting and quantifying atrial fibrillation — results of the XPECT trial. Circ Arrhythm Electrophysiol 2010;3:141–147Kirchhof P., Bax J., Blomstrom-Lundquist C. et al. Early and comprehensive management of atrial fibrillation: Proceedings from the 2nd AFNET/EHRA consensus conference on atrial fibrillation entitled ‘research perspectives in atrial fibrillation. Europace 2009;11:860—885Kirchhof P., Bax J., Blomstrom-Lundquist C. et al. Early and comprehensive management of atrial fibrillation: Proceedings from the 2nd AFNET/EHRA consensus conference on atrial fibrillation entitled ‘research perspectives in atrial fibrillation. Europace 2009;11:860—885Kirchhof P., Auricchio A., Bax J. et al. Outcome parameters for trials in atrial fibrillation: executive summary. Recommendations from a consensus conference organized by the German Atrial Fibrillation Competence NETwork (AFNET) and the European Heart Rhythm Association (EHRA). Eur Heart J 2007;28:2803–2817Kirchhof P., Auricchio A., Bax J. et al. Outcome parameters for trials in atrial fibrillation: executive summary. Recommendations from a consensus conference organized by the German Atrial Fibrillation Competence NETwork (AFNET) and the European Heart Rhythm Association (EHRA). Eur Heart J 2007;28:2803–2817Gage B.F., Waterman A.D., Shannon W., Boechler M., Rich M.W., Radford M.J. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 2001;285:2864–2870Gage B.F., Waterman A.D., Shannon W., Boechler M., Rich M.W., Radford M.J. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 2001;285:2864–2870Lip G.Y., Frison L., Halperin J.L., Lane D.A. Identifying patients at high risk for stroke despite anticoagulation: a comparison of contemporary stroke risk stratification schemes in an anticoagulated atrial fibrillation cohort. Stroke. 2010 Dec;41(12):2731-8Lip G.Y., Frison L., Halperin J.L., Lane D.A. Identifying patients at high risk for stroke despite anticoagulation: a comparison of contemporary stroke risk stratification schemes in an anticoagulated atrial fibrillation cohort. Stroke. 2010 Dec;41(12):2731-8Israel C.W., Gronefeld G., Erlich J.R. et al. Long-term risk of recurent atrial fibrillation as documented by implantable monitoring device: implications for optimal patient care J Am Coll Cardiol 2004;34:47— 52Israel C.W., Gronefeld G., Erlich J.R. et al. Long-term risk of recurent atrial fibrillation as documented by implantable monitoring device: implications for optimal patient care J Am Coll Cardiol 2004;34:47— 52Hart R.G., Pearce L.A., Aguilar M.I. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med 2007;146:857–867Hart R.G., Pearce L.A., Aguilar M.I. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med 2007;146:857–867Pisters R., Lane D.A., Nieuwlaat R. et al. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010 Nov;138(5):1093-100Pisters R., Lane D.A., Nieuwlaat R. et al. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010 Nov;138(5):1093-100Le Heuzey J.Y., Breithardt G., Camm J. et al. The RecordAF study: design, baseline data, and profile of patients according to chosen treatment strategy for atrial fibrillation. Am J Cardiol 2010;105(5):687-93Le Heuzey J.Y., Breithardt G., Camm J. et al. The RecordAF study: design, baseline data, and profile of patients according to chosen treatment strategy for atrial fibrillation. Am J Cardiol 2010;105(5):687-93Camm J. Differences in Clinical Outcomes with Rhythm and Rate Control Therapies for Atrial Fibrillation in the RecordAF Registry (REgistry on Cardiac rhythm disORDers: an international, observational, prospective survey assessing the control ofAtrial Fibrillation) Available at: www.clinicaltrial-results.org/Slides/RecordAF.ppt.Camm J. Differences in Clinical Outcomes with Rhythm and Rate Control Therapies for Atrial Fibrillation in the RecordAF Registry (REgistry on Cardiac rhythm disORDers: an international, observational, prospective survey assessing the control ofAtrial Fibrillation) Available at: www.clinicaltrial-results.org/Slides/RecordAF.ppt.Lafuente-Lafuente C., Mouly S., Longas-Tejero M.A. et al. Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation. Cochrane Database Syst Rev. 2007; Issue 4. Art. No.: CD005049Lafuente-Lafuente C., Mouly S., Longas-Tejero M.A. et al. Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation. Cochrane Database Syst Rev. 2007; Issue 4. Art. No.: CD005049Hohnloser S.H., Kuck K.H., Lilienthal J. Rhythm or rate control in atrial fibrillation: Pharmacological Intervention in Atrial Fibrillation (PIAF): a randomized trial. Lancet 2000;356:1789—1794.Hohnloser S.H., Kuck K.H., Lilienthal J. Rhythm or rate control in atrial fibrillation: Pharmacological Intervention in Atrial Fibrillation (PIAF): a randomized trial. Lancet 2000;356:1789—1794.Wyse D.G., Waldo A.L., DiMarco J.P. et al.; Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Investigators: A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med 2002;347:1825—1833.Wyse D.G., Waldo A.L., DiMarco J.P. et al.; Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Investigators: A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med 2002;347:1825—1833.Steinberg J.S., Sadaniantz A., Kron J. et al. Analysis of cause-speciёc mortality in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. Circulation 2004;109:1973— 1980.Steinberg J.S., Sadaniantz A., Kron J. et al. Analysis of cause-speciёc mortality in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. Circulation 2004;109:1973— 1980.Van Gelder I.C., Hagens V.E., Bosker H.A. et al.; Rate Control versus Electrical Cardioversion for Persistent Atrial Fibrillation Study (RACE) Group: A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med 2002;347:1834—1840.Van Gelder I.C., Hagens V.E., Bosker H.A. et al.; Rate Control versus Electrical Cardioversion for Persistent Atrial Fibrillation Study (RACE) Group: A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med 2002;347:1834—1840.Carlsson J., Miketic S., Windeler J. et al.; STAF Investigators: Randomized trial of rate-control versus rhythm-control in persistent atrial fibrillation: the Strategies of Treatment of Atrial Fibrillation (STAF) study. J Am Coll Cardiol 2003;41:1690—1696.Carlsson J., Miketic S., Windeler J. et al.; STAF Investigators: Randomized trial of rate-control versus rhythm-control in persistent atrial fibrillation: the Strategies of Treatment of Atrial Fibrillation (STAF) study. J Am Coll Cardiol 2003;41:1690—1696.Opolski G., Torbicki A., Kosior D.A. et al. Rate control vs rhythm control in patients with nonvalvular persistent atrial fibrillation: the results of the Polish How to Treat Chronic Atrial Fibrillation (HOT CAFE). Chest 2004;126:476—486.Opolski G., Torbicki A., Kosior D.A. et al. Rate control vs rhythm control in patients with nonvalvular persistent atrial fibrillation: the results of the Polish How to Treat Chronic Atrial Fibrillation (HOT CAFE). Chest 2004;126:476—486.Roy D., Talajic M., Nattel S. et al.; Atrial Fibrillation and Congestive Heart Failure Investigators (AFCHF ). N Engl J Med 2008;358:2667—2677.Roy D., Talajic M., Nattel S. et al.; Atrial Fibrillation and Congestive Heart Failure Investigators (AFCHF ). N Engl J Med 2008;358:2667—2677.Freudenberger R.S., Wilson A.C., Kostis J.B. et al. Comparison of rate versus rhythm control for atrial fibrillation in patients with left ventricular dysfunction (from the AFFIRM Study). Am J Cardiol. 2007 Jul 15;100(2):247-52Freudenberger R.S., Wilson A.C., Kostis J.B. et al. Comparison of rate versus rhythm control for atrial fibrillation in patients with left ventricular dysfunction (from the AFFIRM Study). Am J Cardiol. 2007 Jul 15;100(2):247-52Camm A.J. Evolution in the Clinical Care of Atrial Fibrillation: Observations on Rate vs Rhythm Control. Available on: http://www.theheart.org/documents/sitestructure/en/content/programs/1081033/camm.htmlCamm A.J. Evolution in the Clinical Care of Atrial Fibrillation: Observations on Rate vs Rhythm Control. Available on: http://www.theheart.org/documents/sitestructure/en/content/programs/1081033/camm.htmlWyse D.G., Waldo A.L., DiMarco J.P. et al. Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Investigators: A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med 2002;347:1825—1833Wyse D.G., Waldo A.L., DiMarco J.P. et al. Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Investigators: A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med 2002;347:1825—1833Singh D., Cingolani E., Diamond G.A., Kaul S. Dronedarone for atrial fibrillation have we expanded the antiarrhythmic armamentarium? J Am Coll Cardiol. 2010 Apr 13;55(15):1569-76,Singh D., Cingolani E., Diamond G.A., Kaul S. Dronedarone for atrial fibrillation have we expanded the antiarrhythmic armamentarium? J Am Coll Cardiol. 2010 Apr 13;55(15):1569-76,Zimetbaum P.J. Dronedarone for atrial fibrillation — an odyssey. N Engl J Med 2009;360:1811—1813Zimetbaum P.J. Dronedarone for atrial fibrillation — an odyssey. N Engl J Med 2009;360:1811—1813Hohnloser S.H., Crijns H.J., van Eickels M. et al. Effect of dronedarone on cardiovascular events in atrial fibrillation. N Engl J Med 2009;360:668—678Hohnloser S.H., Crijns H.J., van Eickels M. et al. Effect of dronedarone on cardiovascular events in atrial fibrillation. N Engl J Med 2009;360:668—678Kober L., Torp-Pedersen C., McMurray J.J.V. et al. Increased Mortality after Dronedarone Therapy for Severe Heart Failure. N Engl J Med 2008;358:2678—2687Kober L., Torp-Pedersen C., McMurray J.J.V. et al. Increased Mortality after Dronedarone Therapy for Severe Heart Failure. N Engl J Med 2008;358:2678—2687Connolly S.J., Crijns H.J., Torp-Pedersen C. et al. Analysis of stroke in ATHENA: a placebo-controlled, double-blind, parallel-arm trial to assess the efficacy of dronedarone 400 mg BID for the prevention of cardiovascular hospitalization or death from any cause in patients with atrial fibrillation/atrial flutter. Circulation. 2009 Sep 29;120(13):1174-80.Connolly S.J., Crijns H.J., Torp-Pedersen C. et al. Analysis of stroke in ATHENA: a placebo-controlled, double-blind, parallel-arm trial to assess the efficacy of dronedarone 400 mg BID for the prevention of cardiovascular hospitalization or death from any cause in patients with atrial fibrillation/atrial flutter. Circulation. 2009 Sep 29;120(13):1174-80.Sulimov V.A. Novel Targets in the Treatment of Patients With Atrial Fibrillation: From Elimination of Symptoms to Improvement of Clinical Outcomes. Kardiologiia 2010; 10:4—10. Russian (Сулимов В.А. Новые цели в лечении больных с фибрилляцией предсердий: от устранения симптомов к улучшению клинических исходов. Кардиология 2010; 10:4-10).Sulimov V.A. Novel Targets in the Treatment of Patients With Atrial Fibrillation: From Elimination of Symptoms to Improvement of Clinical Outcomes. Kardiologiia 2010; 10:4—10. Russian (Сулимов В.А. Новые цели в лечении больных с фибрилляцией предсердий: от устранения симптомов к улучшению клинических исходов. Кардиология 2010; 10:4-10).

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