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Выбор антиаритмической терапии после хирургического лечения фибрилляции предсердий
Выбор антиаритмической терапии после хирургического лечения фибрилляции предсердий
Базылев В.В., Немченко Е.В., Абрамова Г.Н., Карнахин В.А. Выбор антиаритмической терапии после хирургического лечения фибрилляции предсердий. Кардиосоматика. 2015; 6 (4): 30–34.
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Аннотация
Цель исследования: изучить эффективность разных схем антиаритмической терапии после хирургического лечения фибрилляции предсердий (ФП).
Материалы и методы. В ретроспективное исследование вошли 279 человек, прооперированных в ФГБУ ФЦССХ Минздрава России (Пенза) с 2009 по 2011 г. с известными отдаленными результатами. Давность наблюдения составила от 6 мес до 3 лет. В исследование вошли 141 (49%) женщина и 168 (51%) мужчин, средний возраст которых на момент операции составил 59±7,9 года. У 27 (9,7%) больных отмечалась пароксизмальная форма ФП, у 252 (90,3%) – длительно персистирующая форма (АСС/АНА). Медиана давности анамнеза аритмии 36 мес (от 1 до 180). Размер левого предсердия в среднем составил 52,4±8,4 мм (от 40 до 82 мм). Средний функциональный класс сердечной недостаточности (NYHA) составил 2,8±0,4. 63 (22,6%) пациента находились во II функциональном классе (ФК), 213 (76,3%) – в III и 3 (1,1%) – в IV ФК. Пациенты были разделены на 3 группы в зависимости от получаемой антиаритмической терапии в послеоперационном периоде. В 1-ю группу вошли 57 пациентов, длительно получавших амиодарон (более 6 мес), во 2-ю группу (b-адреноблокаторы – b-АБ) – 126 человек, которые постоянно длительно получали монотерапию b-АБ (бисопролол) и в 3-ю группу (амиодарон + b-АБ) – 96 человек, которые принимали амиодарон в течение 3–6 мес с дальнейшей постоянной терапией бисопрололом. Всем пациентам выполнялась процедура Cox-Maze IV.
Результаты. Отдаленные результаты оценивались в сроки от 6 мес до 3 лет. Во всех группах увеличилось число пациентов, находившихся в I и II ФК сердечной недостаточности с достоверным различием во 2-й группе (p1–2=0,01; p2–3=0,01; p1–3=0,73), и достоверно больше пациентов с синусовым ритмом во 2-й группе по сравнению с 3-й группой. Свобода от ФП в сроки наблюдения от 6 мес до 3 лет в 1-й группе составила 77%±0,89, во 2-й группе – 68%±0,98, в 3-й – 85%±0,95 с достоверным различием между 2 и 3-й группами (р1–2=0,61; p1–3=0,13; p2–3=0,01).
Выводы. Антиаритмическая терапия амиодароном в течение 3–6 мес с последующим приемом b-АБ (бисопролола) после операции Cox-Maze IV позволяет сохранить синусовый ритм в отдаленном периоде у 85% пациентов и по сравнению с монотерапией b-АБ (бисопрололом) позволяет более эффективно поддерживать синусовый ритм. Не выявлено статистически значимой разницы в эффективности между длительной антиаритмической монотерапией амиодароном по сравнению с терапией на протяжении 3–6 мес после операции Cox-Maze IV.
Ключевые слова: фибрилляция предсердий, хирургическое лечение, антиаритмическая терапия, Cox-Maze IV.
Material and methods. This retrospective study included 279 patients: 141 (49%) females and 168 (51%) males, aged 59±7.9 years who had got Сox-Maze IV procedure at Federal cardiovascular center (Penza). 27 patient (9.7%) had the paroxysmal AF,
252 (90.3%) – the persistent one. The AF’s duration was 36 months (from 1 to 180). The size of the left atrium was average 52.4±8.4 mm (from 40 to 82 mm). The medium functional class (FC) of heart failure (HF) (NYHA) was 2.8±0.4: II FC-63 (22.6%), III FC – 213 (76.3%), IV FC – 3 (1.1%). There were 3 groups of patients: 1 group had 57 patients who had got amiodaron over 6 months; 2 group – 126 patients who had got b-blocker (b-B) (bisoprolol) long monotherapy; 3 group – 96 patients who had got amiodaron during 3–6 months then had got bisoprolol long therapy. All patiens got Cox-Maze IV procedure.
Results. Remote results assessed after 6 months-3 years period after the operation. In all groups the number of patients with I and II FC HF increased; there was significant difference at 2 group (p1–2=0.01; p2–3=0.01; p1–3=0.73). And there were more patients with sinus rhythm at 2 group than at 3 group significantly. The freedom from AF at 1 group was 77%±0.89, at 2 group – 68%±0.98, at 3 group – 85%±0.95 with the significant difference between 2 and 3 groups (р1–2=0.61; p1–3=0.13; p2–3=0.01).
Conclusions. AAT by amiodaron during 3–6 months and then by beta-blocker (bisoprolol) longly after Cox-Maze IV procedure allows to keep sinus rhythm to 85% patiens at the distant period of time and comparing with the b-blocker-monotherapy allows to keep sinus rhythm more effectively. The difference of efficiency by long amiodaron-monotherapy and amiodaron-therapy during 3-6 months is not got statistical significant after Cox-Maze IV procedure.
Key words: atrial fibrillation, surgical treatment, antiarrythmic therapy, Cox-Maze IV.
Материалы и методы. В ретроспективное исследование вошли 279 человек, прооперированных в ФГБУ ФЦССХ Минздрава России (Пенза) с 2009 по 2011 г. с известными отдаленными результатами. Давность наблюдения составила от 6 мес до 3 лет. В исследование вошли 141 (49%) женщина и 168 (51%) мужчин, средний возраст которых на момент операции составил 59±7,9 года. У 27 (9,7%) больных отмечалась пароксизмальная форма ФП, у 252 (90,3%) – длительно персистирующая форма (АСС/АНА). Медиана давности анамнеза аритмии 36 мес (от 1 до 180). Размер левого предсердия в среднем составил 52,4±8,4 мм (от 40 до 82 мм). Средний функциональный класс сердечной недостаточности (NYHA) составил 2,8±0,4. 63 (22,6%) пациента находились во II функциональном классе (ФК), 213 (76,3%) – в III и 3 (1,1%) – в IV ФК. Пациенты были разделены на 3 группы в зависимости от получаемой антиаритмической терапии в послеоперационном периоде. В 1-ю группу вошли 57 пациентов, длительно получавших амиодарон (более 6 мес), во 2-ю группу (b-адреноблокаторы – b-АБ) – 126 человек, которые постоянно длительно получали монотерапию b-АБ (бисопролол) и в 3-ю группу (амиодарон + b-АБ) – 96 человек, которые принимали амиодарон в течение 3–6 мес с дальнейшей постоянной терапией бисопрололом. Всем пациентам выполнялась процедура Cox-Maze IV.
Результаты. Отдаленные результаты оценивались в сроки от 6 мес до 3 лет. Во всех группах увеличилось число пациентов, находившихся в I и II ФК сердечной недостаточности с достоверным различием во 2-й группе (p1–2=0,01; p2–3=0,01; p1–3=0,73), и достоверно больше пациентов с синусовым ритмом во 2-й группе по сравнению с 3-й группой. Свобода от ФП в сроки наблюдения от 6 мес до 3 лет в 1-й группе составила 77%±0,89, во 2-й группе – 68%±0,98, в 3-й – 85%±0,95 с достоверным различием между 2 и 3-й группами (р1–2=0,61; p1–3=0,13; p2–3=0,01).
Выводы. Антиаритмическая терапия амиодароном в течение 3–6 мес с последующим приемом b-АБ (бисопролола) после операции Cox-Maze IV позволяет сохранить синусовый ритм в отдаленном периоде у 85% пациентов и по сравнению с монотерапией b-АБ (бисопрололом) позволяет более эффективно поддерживать синусовый ритм. Не выявлено статистически значимой разницы в эффективности между длительной антиаритмической монотерапией амиодароном по сравнению с терапией на протяжении 3–6 мес после операции Cox-Maze IV.
Ключевые слова: фибрилляция предсердий, хирургическое лечение, антиаритмическая терапия, Cox-Maze IV.
________________________________________________
Material and methods. This retrospective study included 279 patients: 141 (49%) females and 168 (51%) males, aged 59±7.9 years who had got Сox-Maze IV procedure at Federal cardiovascular center (Penza). 27 patient (9.7%) had the paroxysmal AF,
252 (90.3%) – the persistent one. The AF’s duration was 36 months (from 1 to 180). The size of the left atrium was average 52.4±8.4 mm (from 40 to 82 mm). The medium functional class (FC) of heart failure (HF) (NYHA) was 2.8±0.4: II FC-63 (22.6%), III FC – 213 (76.3%), IV FC – 3 (1.1%). There were 3 groups of patients: 1 group had 57 patients who had got amiodaron over 6 months; 2 group – 126 patients who had got b-blocker (b-B) (bisoprolol) long monotherapy; 3 group – 96 patients who had got amiodaron during 3–6 months then had got bisoprolol long therapy. All patiens got Cox-Maze IV procedure.
Results. Remote results assessed after 6 months-3 years period after the operation. In all groups the number of patients with I and II FC HF increased; there was significant difference at 2 group (p1–2=0.01; p2–3=0.01; p1–3=0.73). And there were more patients with sinus rhythm at 2 group than at 3 group significantly. The freedom from AF at 1 group was 77%±0.89, at 2 group – 68%±0.98, at 3 group – 85%±0.95 with the significant difference between 2 and 3 groups (р1–2=0.61; p1–3=0.13; p2–3=0.01).
Conclusions. AAT by amiodaron during 3–6 months and then by beta-blocker (bisoprolol) longly after Cox-Maze IV procedure allows to keep sinus rhythm to 85% patiens at the distant period of time and comparing with the b-blocker-monotherapy allows to keep sinus rhythm more effectively. The difference of efficiency by long amiodaron-monotherapy and amiodaron-therapy during 3-6 months is not got statistical significant after Cox-Maze IV procedure.
Key words: atrial fibrillation, surgical treatment, antiarrythmic therapy, Cox-Maze IV.
Полный текст
Список литературы
1. Camm AJ, Kirchhof P, Lip GY еt al. Guidelines 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; 31: 2369–29.
2. Go AS, Hylek EM, Phillips KA 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: 2370–5.
3. Stewart S, Hart CL, Hole DJ еt al. Population prevalence, incidence, and predictors of atrial fbrillation in the Renfrew. Paisley study Heart 2001; 86: 516–21.
4. Ngaage DL, Schaff HV, Mullany CJ et al. Infuence of preoperative atrial fibrillation on late results of mitral repair: is concomitant ablation justified. Ann Thorac Surg 2007; 84: 434–442; discussion 442–443.
5. Cox JL, Boineau JP, Schuessler RB et al. Successful surgical treatment of atrial fibrillation. Rev and Clin update. JAMA 1991; 266: 1976–80.
6. HRS/EHRA/ ECAS expert Consensus Statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task Force on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2007; 4: 816–61.
7. Damiano RJJr, Gaynor SL, Bailey M et al. The long-term outcome of patients with coronary disease and atrial fibrillation undergoing the Cox maze procedure. Thorac Cardiovasc Surg 2003; 126: 2016–21.
8. Natale A, Raviele A. Atrial fibrillation ablation, 2011 update: 170–5.
9. 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design. Europace 2012; 14: 528–90.
10. Budera Р, Straka Z, Osmanc P et al. Comparison of cardiac surgery with left atrial surgical ablation vs. cardiac surgery with out atrial ablation in patients with coronary and/or valvular heart disease plus atrial fibrillation: final results of the PRAGUE-12 randomized multicentre study. Eur Heart J 2012; 33: 2644–52.
11. Wang J, Meng X, Li H et al. Prospective randomized comparison of left atrial and biatrial radiofrequency ablation in the treatment of atrial fibrillation. Eur j Cardio-thoracic Surg 2009; 35: 116-22.
12. Сулимов В.А., Голицын С.П., Панченко Е.П. и др. Диагностика и лечение фибрилляции предсердий. Рекомендации РКО, ВНОА и АССХ. Рос. кардиол. журн. 2014; 4 (Прил. 3): 80–98. / Sulimov V.A., Golitsyn S.P., Panchenko E.P. i dr. Diagnostika i lechenie fibrilliatsii predserdii. Rekomendatsii RKO, VNOA i ASSKh. Ros. kardiol. zhurn. 2014; 4 (Pril. 3): 80–98. [in Russian]
13. Оганов Р.Г., Салимов В.А., Бокерия Л.А. и др. Клинические рекомендации по диагностике и лечению пациентов с фибрилляцией предсердий. Вестн. аритмологии. 2010; 59: 53–77. / Oganov R.G., Salimov V.A., Bokeriia L.A. i dr. Klinicheskie rekomendatsii po diagnostike i lecheniiu patsientov s fibrilliatsiei predserdii. Vestn. aritmologii. 2010; 59: 53–77. [in Russian]
14. Lafuente-Lafuente C, Mouly S, Longas-Tejero MA et al. Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation. Cochrane Database Syst Rev 2007; 4: CD005049.
15. Piccini JP, Hasselblad V, Peterson ED et al. Comparative efficacy of dronedarone and amiodarone for the maintenance of sinus rhythm in patients with atrial fibrillation. JACC 2009; 54: 1089–95.
16. Oral H, Knight BP, Ozaydin M et al. Clinical significance of early recurrences of a trial fibrillation after pulmonary vein isolation. J Am Coll Cardiol 2002; 40 (1): 100–4.
17. Ouyang F, Tilz R, Chun J et al. Long-term results of catheter ablation in paroxysmal atrial fibrillation: lessons from a 5-year follow-up. Circulation 2010; 122 (23): 2368–77.
18. Weerasooriya R, Khairy P, Litalien J et al. Catheter ablation for atrial fibrillation: are results maintained at 5years of follow-up? J Am Coll Cardiol 2011; 57 (2): 160–6.
19. Leong-Sit P, Roux JF, Zado E et al. Antiarrhythmics after ablation of atrial fibrillation (5A Study): six-month follow-up study. Circ Arrhythm Electrophysiol 2011; 4 (1): 11–4.
20. Roux JF, Zado E, Callans DJ et al. Antiarrhythmics After Ablation of Atrial Fibrillation (5AStudy). Circulation 2009; 120 (12): 1036–40.
2. Go AS, Hylek EM, Phillips KA 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: 2370–5.
3. Stewart S, Hart CL, Hole DJ еt al. Population prevalence, incidence, and predictors of atrial fbrillation in the Renfrew. Paisley study Heart 2001; 86: 516–21.
4. Ngaage DL, Schaff HV, Mullany CJ et al. Infuence of preoperative atrial fibrillation on late results of mitral repair: is concomitant ablation justified. Ann Thorac Surg 2007; 84: 434–442; discussion 442–443.
5. Cox JL, Boineau JP, Schuessler RB et al. Successful surgical treatment of atrial fibrillation. Rev and Clin update. JAMA 1991; 266: 1976–80.
6. HRS/EHRA/ ECAS expert Consensus Statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task Force on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2007; 4: 816–61.
7. Damiano RJJr, Gaynor SL, Bailey M et al. The long-term outcome of patients with coronary disease and atrial fibrillation undergoing the Cox maze procedure. Thorac Cardiovasc Surg 2003; 126: 2016–21.
8. Natale A, Raviele A. Atrial fibrillation ablation, 2011 update: 170–5.
9. 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design. Europace 2012; 14: 528–90.
10. Budera Р, Straka Z, Osmanc P et al. Comparison of cardiac surgery with left atrial surgical ablation vs. cardiac surgery with out atrial ablation in patients with coronary and/or valvular heart disease plus atrial fibrillation: final results of the PRAGUE-12 randomized multicentre study. Eur Heart J 2012; 33: 2644–52.
11. Wang J, Meng X, Li H et al. Prospective randomized comparison of left atrial and biatrial radiofrequency ablation in the treatment of atrial fibrillation. Eur j Cardio-thoracic Surg 2009; 35: 116-22.
12. Sulimov V.A., Golitsyn S.P., Panchenko E.P. i dr. Diagnostika i lechenie fibrilliatsii predserdii. Rekomendatsii RKO, VNOA i ASSKh. Ros. kardiol. zhurn. 2014; 4 (Pril. 3): 80–98. [in Russian]
13. Oganov R.G., Salimov V.A., Bokeriia L.A. i dr. Klinicheskie rekomendatsii po diagnostike i lecheniiu patsientov s fibrilliatsiei predserdii. Vestn. aritmologii. 2010; 59: 53–77. [in Russian]
14. Lafuente-Lafuente C, Mouly S, Longas-Tejero MA et al. Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation. Cochrane Database Syst Rev 2007; 4: CD005049.
15. Piccini JP, Hasselblad V, Peterson ED et al. Comparative efficacy of dronedarone and amiodarone for the maintenance of sinus rhythm in patients with atrial fibrillation. JACC 2009; 54: 1089–95.
16. Oral H, Knight BP, Ozaydin M et al. Clinical significance of early recurrences of a trial fibrillation after pulmonary vein isolation. J Am Coll Cardiol 2002; 40 (1): 100–4.
17. Ouyang F, Tilz R, Chun J et al. Long-term results of catheter ablation in paroxysmal atrial fibrillation: lessons from a 5-year follow-up. Circulation 2010; 122 (23): 2368–77.
18. Weerasooriya R, Khairy P, Litalien J et al. Catheter ablation for atrial fibrillation: are results maintained at 5years of follow-up? J Am Coll Cardiol 2011; 57 (2): 160–6.
19. Leong-Sit P, Roux JF, Zado E et al. Antiarrhythmics after ablation of atrial fibrillation (5A Study): six-month follow-up study. Circ Arrhythm Electrophysiol 2011; 4 (1): 11–4.
20. Roux JF, Zado E, Callans DJ et al. Antiarrhythmics After Ablation of Atrial Fibrillation (5AStudy). Circulation 2009; 120 (12): 1036–40.
2. Go AS, Hylek EM, Phillips KA 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: 2370–5.
3. Stewart S, Hart CL, Hole DJ еt al. Population prevalence, incidence, and predictors of atrial fbrillation in the Renfrew. Paisley study Heart 2001; 86: 516–21.
4. Ngaage DL, Schaff HV, Mullany CJ et al. Infuence of preoperative atrial fibrillation on late results of mitral repair: is concomitant ablation justified. Ann Thorac Surg 2007; 84: 434–442; discussion 442–443.
5. Cox JL, Boineau JP, Schuessler RB et al. Successful surgical treatment of atrial fibrillation. Rev and Clin update. JAMA 1991; 266: 1976–80.
6. HRS/EHRA/ ECAS expert Consensus Statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task Force on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2007; 4: 816–61.
7. Damiano RJJr, Gaynor SL, Bailey M et al. The long-term outcome of patients with coronary disease and atrial fibrillation undergoing the Cox maze procedure. Thorac Cardiovasc Surg 2003; 126: 2016–21.
8. Natale A, Raviele A. Atrial fibrillation ablation, 2011 update: 170–5.
9. 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design. Europace 2012; 14: 528–90.
10. Budera Р, Straka Z, Osmanc P et al. Comparison of cardiac surgery with left atrial surgical ablation vs. cardiac surgery with out atrial ablation in patients with coronary and/or valvular heart disease plus atrial fibrillation: final results of the PRAGUE-12 randomized multicentre study. Eur Heart J 2012; 33: 2644–52.
11. Wang J, Meng X, Li H et al. Prospective randomized comparison of left atrial and biatrial radiofrequency ablation in the treatment of atrial fibrillation. Eur j Cardio-thoracic Surg 2009; 35: 116-22.
12. Сулимов В.А., Голицын С.П., Панченко Е.П. и др. Диагностика и лечение фибрилляции предсердий. Рекомендации РКО, ВНОА и АССХ. Рос. кардиол. журн. 2014; 4 (Прил. 3): 80–98. / Sulimov V.A., Golitsyn S.P., Panchenko E.P. i dr. Diagnostika i lechenie fibrilliatsii predserdii. Rekomendatsii RKO, VNOA i ASSKh. Ros. kardiol. zhurn. 2014; 4 (Pril. 3): 80–98. [in Russian]
13. Оганов Р.Г., Салимов В.А., Бокерия Л.А. и др. Клинические рекомендации по диагностике и лечению пациентов с фибрилляцией предсердий. Вестн. аритмологии. 2010; 59: 53–77. / Oganov R.G., Salimov V.A., Bokeriia L.A. i dr. Klinicheskie rekomendatsii po diagnostike i lecheniiu patsientov s fibrilliatsiei predserdii. Vestn. aritmologii. 2010; 59: 53–77. [in Russian]
14. Lafuente-Lafuente C, Mouly S, Longas-Tejero MA et al. Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation. Cochrane Database Syst Rev 2007; 4: CD005049.
15. Piccini JP, Hasselblad V, Peterson ED et al. Comparative efficacy of dronedarone and amiodarone for the maintenance of sinus rhythm in patients with atrial fibrillation. JACC 2009; 54: 1089–95.
16. Oral H, Knight BP, Ozaydin M et al. Clinical significance of early recurrences of a trial fibrillation after pulmonary vein isolation. J Am Coll Cardiol 2002; 40 (1): 100–4.
17. Ouyang F, Tilz R, Chun J et al. Long-term results of catheter ablation in paroxysmal atrial fibrillation: lessons from a 5-year follow-up. Circulation 2010; 122 (23): 2368–77.
18. Weerasooriya R, Khairy P, Litalien J et al. Catheter ablation for atrial fibrillation: are results maintained at 5years of follow-up? J Am Coll Cardiol 2011; 57 (2): 160–6.
19. Leong-Sit P, Roux JF, Zado E et al. Antiarrhythmics after ablation of atrial fibrillation (5A Study): six-month follow-up study. Circ Arrhythm Electrophysiol 2011; 4 (1): 11–4.
20. Roux JF, Zado E, Callans DJ et al. Antiarrhythmics After Ablation of Atrial Fibrillation (5AStudy). Circulation 2009; 120 (12): 1036–40.
________________________________________________
2. Go AS, Hylek EM, Phillips KA 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: 2370–5.
3. Stewart S, Hart CL, Hole DJ еt al. Population prevalence, incidence, and predictors of atrial fbrillation in the Renfrew. Paisley study Heart 2001; 86: 516–21.
4. Ngaage DL, Schaff HV, Mullany CJ et al. Infuence of preoperative atrial fibrillation on late results of mitral repair: is concomitant ablation justified. Ann Thorac Surg 2007; 84: 434–442; discussion 442–443.
5. Cox JL, Boineau JP, Schuessler RB et al. Successful surgical treatment of atrial fibrillation. Rev and Clin update. JAMA 1991; 266: 1976–80.
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Авторы
В.В.Базылев, Е.В.Немченко, Г.Н.Абрамова*, В.А.Карнахин
ФГБУ Федеральный центр сердечно-сосудистой хирургии Минздрава России. 440071, Россия, Пенза, ул. Стасова, д. 6.
*galana2004@mail.ru
Federal Centre of Cardiovascular Surgery of the Ministry of Health of the Russian Federation. 440071, Russian Federation, Penza, ul. Stasova, d. 6
*galana2004@mail.ru
ФГБУ Федеральный центр сердечно-сосудистой хирургии Минздрава России. 440071, Россия, Пенза, ул. Стасова, д. 6.
*galana2004@mail.ru
________________________________________________
Federal Centre of Cardiovascular Surgery of the Ministry of Health of the Russian Federation. 440071, Russian Federation, Penza, ul. Stasova, d. 6
*galana2004@mail.ru
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