Купирование фибрилляции предсердий на догоспитальном и стационарном этапах с позиций доказательной медицины
Купирование фибрилляции предсердий на догоспитальном и стационарном этапах с позиций доказательной медицины
Миллер О.Н., Тарасов А.В., Дик И.С., Беляева И.Е. Купирование фибрилляции предсердий на догоспитальном и стационарном этапах с позиций доказательной медицины. Consilium Medicum. 2016; 18 (10): 8–18. DOI: 10.26442/2075-1753_2016.10.8-18
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Miller O.N., Tarasov A.V., Dik I.S., Belyaeva I.E. Atrial fibrillation management on prehospital and in-hospital phases, based on the principles of evidence-based medicine. Consilium Medicum. 2016; 18 (10): 8–18. DOI: 10.26442/2075-1753_2016.10.8-18
Купирование фибрилляции предсердий на догоспитальном и стационарном этапах с позиций доказательной медицины
Миллер О.Н., Тарасов А.В., Дик И.С., Беляева И.Е. Купирование фибрилляции предсердий на догоспитальном и стационарном этапах с позиций доказательной медицины. Consilium Medicum. 2016; 18 (10): 8–18. DOI: 10.26442/2075-1753_2016.10.8-18
________________________________________________
Miller O.N., Tarasov A.V., Dik I.S., Belyaeva I.E. Atrial fibrillation management on prehospital and in-hospital phases, based on the principles of evidence-based medicine. Consilium Medicum. 2016; 18 (10): 8–18. DOI: 10.26442/2075-1753_2016.10.8-18
Фибрилляция предсердий (ФП) является наиболее распространенной формой аритмии и ассоциируется с повышением риска инсульта и системной тромбоэмболии, сердечной недостаточности, ухудшением качества жизни. Несмотря на высокую эффективность электрической кардиоверсии, в настоящее время антиаритмические препараты (ААП) остаются основным терапевтическим инструментом при купировании ФП, особенно на догоспитальном этапе. До сих пор остаются нерешенными многие вопросы относительно эффективности, переносимости и безопасности этих препаратов, особенно с учетом того, что ФП не является жизнеугрожающей аритмией. В настоящей статье в свете последних рекомендаций AHA/ACC/HRS 2014 г. представлены современные возможности фармакологической кардиоверсии пароксизмальной и/или персистирующей форм ФП, где экспертами основной акцент сделан на результаты плацебо-контролируемых исследований и метаанализов с использованием разных ААП. На сегодня доказанные высокая эффективность ААП IC класса, быстрое восстановление синусового ритма после внутривенного и/или перорального применения, отсутствие тяжелых побочных эффектов и необходимости в госпитализации позволили поставить их в рекомендациях 2014 г. с классом I, уровнем доказательности А.
Atrial fibrillation (AF) is the most common type of arrhythmia and is associated with an increased risk of stroke and systemic thromboembolism, heart failure, deterioration in quality of life. The antiarrhythmic drugs (AD) remain the main therapeutic approach in case of AF management, especially on prehospital phase despite the high efficiency of electrical cardioversion (ECV), nowadays. Still, many questions remain unsolved especially the efficacy, tolerability and safety of these drugs, taking into account that AF is not life-threatening. This article, according to the 2014 AHA/ACC/HRS guideline, deals with the modern pharmacological cardioversion of paroxysmal and/or persistent AF, where experts focus on the results of a placebo-controlled studies and meta-analyses using different AD, nowadays. We prove the high efficiency of class IC AD, immediate restoration of sinus rhythm after intravenous and/or oral AD administration, the absence of serious adverse events and the absence of requirement for hospital admission after AD application, and included AD in the recommendations 2014 – class I, level of evidence A, now.
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1. Ruksin V.V. Kratkoe rukovodstvo po neotlozhnoi kardiologii. SPb: InformMed, 2010. [in Russian]
2. Tatarskii B.A., Batalov R.E., Popov S.V. Fibrilliatsiia predserdii: patofiziologicheskie podkhody k vyboru antiaritmicheskoi terapii. Tomsk: STT, 2013. [in Russian]
3. Van Gelder IC, Brugemann J, Crijns HJ. Current treatment recommendations in antiarrhythmic therapy. Drugs 1998; 55 (3): 331–46.
4. Von Besser K, Mills AM. Is discharge to home after emergency department cardioversion safe for the treatment of recent-onset atrial fibrillation? Ann Emerg Med 2011; 58: 517–20.
5. Bjerkelund CJ, Orning OM. The efficacy of anticoagulant therapy in preventing embolism related to D.C. electrical conversion of atrial fibrillation. Am J Cardiol 1969; 23: 208–16.
6. Arnold AZ, Mick MJ, Mazurek RP et al. Role of prophylactic anticoagulation for direct current cardioversion in patients with atrial fibrillation or atrial flutter. J Am Coll Cardiol 1992; 19: 851–5.
7. Fatkin D, Kuchar DL, Thorburn CW et al. Transesophageal echocardiography before and during direct current cardioversion of atrial fibrillation: evidence for 'atrial stunning' as a mechanism of thromboembolic complications. J Am Coll Cardiol 1994; 23: 307–16.
8. Falcone RA, Morady F, Armstrong WF. Transesophageal echocardiographic evaluation of left atrial appendage function and spontaneous contrast formation after chemical or electrical cardioversion of atrial fibrillation. Am J Cardiol 1996; 78: 435–9.
9. Bellotti P, Spirito P, Lupi G et al. Left atrial appendage function assessed by transesophageal echocardiography before and on the day after elective cardioversion for nonvalvular atrial fibrillation. Am J Cardiol 1998; 8: 1199–202.
10. Harjai K, Mobarek S, Abi-Samra F et al. Mechanical dysfunction of the left atrium and the left atrial appendage following cardioversion of atrial fibrillation and its relation to total electrical energy used for cardioversion. Am J Cardiol 1998; 81: 1125–9.
11. Sparks PB, Jayaprakash S, Vohra JK et al. Left atrial 'stunning' following radiofrequency catheter ablation of chronic atrial flutter. J Am Coll Cardiol 1998; 32: 468–75.
12. Mitusch R, Garbe M, Schmucker G et al. Relation of left atrial appendage function to the duration and reversibility of nonvalvular atrial fibrillation. Am J Cardiol 1995; 75: 944–7.
13. Manning WJ, Silverman DI, Katz SE et al. Temporal dependence of the return of atrial mechanical function on the mode of cardioversion of atrial fibrillation to sinus rhythm. Am J Cardiol 1995; 75: 624–6.
14. Grimm RA, Leung DY, Black IW et al. Left atrial appendage 'stunning' after spontaneous conversion of atrial fibrillation demonstrated by transesophageal Doppler echocardiography. Am Heart J 1995; 1 (30): 174–6.
15. Black IW, Fatkin D, Sagar KB et al. Exclusion of atrial thrombus by transesophageal echocardiography does not preclude embolism aftercardioversion of atrial fibrillation. A multicenter study. Circulation 1994; 89: 2509–13.
16. Berger M, Schweitzer P. Timing of thromboembolic events after electrical cardioversion of atrial fibrillation or flutter: a retrospective analysis. Am J Cardiol 1998; 82: 1545–7.
17. Collins LJ, Silverman DI, Douglas PS et al. Cardioversion of nonrheumatic atrial fibrillation. Reduced thromboembolic complications with 4 weeks of precardioversion anticoagulation are related to atrial thrombus resolution. Circulation 1995; 92: 160–3.
18. Goette А, Honeycutt С, Langberg JJ. Electrical remodelling in atrial fibrillation. Circulation 1996; 94 (7): 2968–74.
19. Sra J, Zaidi ST, Krum D et al. Correlation of spontaneous and induced premature atrial complexes initiating atrial fibrillation in humans: electrophysiologic parameters for guiding therapy. J Cardiovasc Electrophysiol 2001; 12 (12): 1347–52.
20. Van Gelder IC, Brugemann J, Crijns HJ. Current treatment recommendations in antiarrhythmic therapy. Drugs 1998; 55 (3): 331–46.
21. 2014 AHA/ACC/HRS Guideline for the management of patients with atrial fibrillation. Http://circ.ahajournals.org/content/early/ 2014/04/10/CIR.
22. Sulimov V.V. Medikamentoznoe lechenie narushenii ritma serdtsa. M.: GEOTAR-Media, 2011; s. 409–16. [in Russian]
23. Khan IA. Single oral loading dose of propafenonefor pharmacological cardioversion of recent onset atrial fibrillation. J Am Coll Cardiol 2001; 37: 542–7.
24. Boriani G, Martignani C, Biffi M et.al. Oral loading with propafenone for oral conversion of recent-onset atrial fibrillation. A review of in-hospital treatment. Drugs 2002; 62: 415–23.
25. Naccarelli GV, Walbrette DL, Khan M et al. Old and new antiarrhythmic drugs for converting and maintaining sinus rhythm in atrial fibrillation. Comparative efficacy and results of trials. Am J Cardiol 2003; 91 (Suppl.): 15D–26D.
26. Rresco C, Proclemer A. Clinical challenge II. Management of recent onset atrial fibrillation. Eur Heart J 1996; 17 (Suppl. C): 41–7.
27. Conti A, Del Taglia B, Mariannini Y et al. Management of patients with acute atrial fibrillation in the ED. Am J Emerg Med 2010; 28: 903–10.
28. Kosior DA, Kochanowski V, Scislo P et al. Efficacy and tolerability of oral propafenone versus quinidine in the treatment of recent onset atrial fibrillation. A randomized, prospective study. Cardiol J 2009; 16: 521–7.
29. Balla I, Petrela E, Kondili A. Pharmacological conversion of recent atrial fibrillation: a randomized, placebo-controlled study of three antiarrhythmic drugs. Anadolu Kardiyol Derg 2011; 11 (7): 600–6.
30. Sestito A, Molina E. Atrial fibrillation and the pharmacological treatment: the role of propafenone. Eur Rev Med Pharmacol Sci 2012; 16 (2): 242–53.
31. Boriani G, Biffi M, Capucci A et al. Oral propafenone to convert recent-onset atrial fibrillation in patients with and without underlying heart disease. A randomized controlled trial. Ann Intern Med 1997; 126: 621–4.
32. Capucci A, Villiani G, Aschieri D. Safety of oral propafenone in the convertion of recept-onset atrial fibrillation to sinus rhythm: a prospective parallel placebo – controlled multicentred study. Int J Cardiol 1999; 68: 187–96.
33. Antonelli D, Darawsha A, Rimbrot S et al. Propafenone dose for emergency room conversion of paroxysmal atrial fibrillation. Harefuah 1999; 136 (11): 857–915.
34. Khan IA. Single oral loading dose of propafenone for pharmacological cardioversionofrecent-onsetatrial fibrillation. JACC 2001; 37: 542–7.
35. Alboni P, Botto GL, Baldi N et al. Outpatient treatment of recent-onset atrial fibrillation with the “pill-in-the-pocket” approach. N Engl J Med 2004; 351: 2384–91.
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1 ГБОУ ВПО Новосибирский государственный медицинский университет Минздрава России. 630091, Россия, Новосибирск, Красный пр-т, д. 52;
2 ФГБУ Государственный научно-исследовательский центр профилактической медицины Минздрава России. 101990, Россия, Москва, Петроверигский пер., д. 10, стр. 3;
3 ЗАО Медицинский центр «Авиценна» группы компаний «Мать и дитя». 630004, Россия, Новосибирск, пр-т Димитрова, д. 7;
4 ГБУЗ НСО Городская клиническая больница №34. 630054, Россия, Новосибирск, ул. Титова, д. 18
*miller.olga@list.ru
1 Novosibirsk State Medical University. 630091, Russian Federation, Novosibirsk, Krasnyi pr-t, d. 52;
2 State Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation. 101990, Russian Federation, Moscow, Petroverigskii per., d. 10, str. 3;
3 Medical center "Avicenna" group of companies "Mother and child". 630004, Russian Federation, Novosibirsk, pr-t Dimitrova, d. 7;
4 City Clinical Hospital №34. 630054, Russian Federation, Novosibirsk, ul. Titova, d. 18
*miller.olga@list.ru