Катетерная аблация фибрилляции предсердий в практике кардиолога и терапевта

Серова М.В., Сазонова Ю.С., Сафонов Н.В., Билая О.П., Андреев Д.А. Катетерная аблация фибрилляции предсердий в практике кардиолога и терапевта. Consilium Medicum. 2025;27(1):6–11. DOI: 10.26442/20751753.2025.1.203052

© ООО «КОНСИЛИУМ МЕДИКУМ», 2025 г.

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Serova MV, Sazonova YuS, Safonov NV, Bilaia OP, Andreev DA. Catheter ablation of atrial fibrillation in the practice of a cardiologist and therapist: A review. Consilium Medicum. 2025;27(1):6–11. DOI: 10.26442/20751753.2025.1.203052

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Аннотация

Фибрилляция предсердий (ФП) не только является самой распространенной аритмией, но и несет большую нагрузку на систему здравоохранения, что связано с затратами на повторные госпитализации, визиты к врачу и лечение осложнений. Поиск наиболее эффективных подходов к диагностике и лечению ФП является одной из приоритетных задач. Исследования последних лет свидетельствуют о преимуществе тактики контроля ритма над контролем частоты сердечных сокращений. При этом катетерная аблация (КА) является наиболее эффективным и безопасным методом удержания синусового ритма. В статье обсуждаются наиболее распространенные подходы к проведению данного вмешательства, современные показания к КА, результаты ключевых исследований последних лет, влияние КА на прогноз в отдельных группах пациентов. Кроме того, разбирается роль сопутствующих сердечно-сосудистых заболеваний и факторов риска не только в развитии ФП, но и в эффективности КА. Описываются значение «слепого периода» и тактика ведения пациентов после процедуры.

Ключевые слова: фибрилляция предсердий, катетерная аблация, тактика раннего контроля ритма

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Atrial fibrillation (AF) is not only the most common arrhythmia, but also carries a large burden on the health care system, which is associated with the costs of repeated hospitalizations, visits to the doctor and treatment of complications of this arrhythmia. The search for the most effective approaches to the diagnosis and treatment of AF is one of the priority tasks. Studies in recent years indicate in favor of the tactics of rhythm control over heart rate control. At the same time, catheter ablation (CA) is the most effective and safe method of sinus rhythm retention. The article discusses the most common approaches to this intervention, current indications for CA, the results of key studies in recent years, the impact of CA on prognosis in certain groups of patients. The role of concomitant cardiovascular diseases and risk factors not only in the development of AF, but also in the effectiveness of CA is also discussed. The meaning of the “blind period” and the tactics of patient management after the procedure are described.

Keywords: atrial fibrillation, catheter ablation, early rhythm control tactics

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Список литературы

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10. Ganesan AN, Chew DP, Hartshorne T, et al. The impact of atrial fibrillation type on the risk of thromboembolism, mortality, and bleeding: a systematic review and meta-analysis. Eur Heart J. 2016;37(20):1591-602. DOI:10.1093/eurheartj/ehw007
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17. Denus S, Sanoski CA, Carlsson J, et al. Rate vs rhythm control in patients with atrial fibrillation: a meta-analysis. Arch Intern Med. 2005;165(3):258-62. DOI:10.1001/archinte.165.3.258
18. Andrade JG, Wells GA, Deyell MW, et al.; EARLY-AF Investigators. Cryoablation or Drug Therapy for Initial Treatment of Atrial Fibrillation. N Engl J Med. 2021;384(4):305-15. DOI:10.1056/NEJMoa2029980
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20. Marrouche NF, Brachmann J, Andresen D, et al.; CASTLE-AF Investigators. Catheter Ablation for Atrial Fibrillation with Heart Failure. N Engl J Med. 2018;378(5):417-27. DOI:10.1056/NEJMoa1707855
21. Sohns C, Fox H, Marrouche NF, et al.; CASTLE HTx Investigators. Catheter Ablation in End-Stage Heart Failure with Atrial Fibrillation. N Engl J Med. 2023;389(15):1380-9. DOI:10.1056/NEJMoa2306037
22. Willems S, Borof K, Brandes A, et al. Systematic, early rhythm control strategy for atrial fibrillation in patients with or without symptoms: the EAST-AFNET 4 trial. Eur Heart J. 2022;43(12):1219-30. DOI:10.1093/eurheartj/ehab593
23. Valembois L, Audureau E, Takeda A., et al. Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation. Cochrane Database Syst Rev. 2019;9(9):CD005049. DOI:10.1002/14651858.CD005049.pub5
24. Arbelo E, Brugada J, Blomström-Lundqvist C, et al.; on the behalf of the ESC-EHRA Atrial Fibrillation Ablation Long-term Registry Investigators. Contemporary management of patients undergoing atrial fibrillation ablation: in-hospital and 1-year follow-up findings from the ESC-EHRA atrial fibrillation ablation long-term registry. Eur Heart J. 2017;38(17):1303-16. DOI:10.1093/eurheartj/ehw564
25. Tilz RR, Heeger CH, Wick A, et al. Ten-Year Clinical Outcome After Circumferential Pulmonary Vein Isolation Utilizing the Hamburg Approach in Patients With Symptomatic Drug-Refractory Paroxysmal Atrial Fibrillation. Circ Arrhythm Electrophysiol. 2018;11(2):e005250. DOI:10.1161/CIRCEP.117.005250
26. Gokoglan Y, Mohanty S, Gunes MF, et al. Pulmonary vein antrum isolation in patients with paroxysmal atrial fibrillation: More than a decade of follow-up. Circ Arrhythm Electrophysiol. 2016;9(5):e003660. DOI:10.1161/CIRCEP.115.003660
27. Asad ZUA, Yousif A, Khan MS, et al. Catheter Ablation Versus Medical Therapy for Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Circ Arrhythm Electrophysiol. 2019;12(9):e007414. DOI:10.1161/CIRCEP.119.007414
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29. Rillig A, Magnussen C, Ozga AK, et al. Early Rhythm Control Therapy in Patients With Atrial Fibrillation and Heart Failure. Circulation. 2021;144(11):845-58. DOI:10.1161/CIRCULATIONAHA.121.056323
30. Van Gelder IC, Ekrami NK, Borof K, et al.; EAST-AFNET 4 Trial Investigators. Sex Differences in Early Rhythm Control of Atrial Fibrillation in the EAST-AFNET 4 Trial. J Am Coll Cardiol. 2023;81(8):845-7. DOI:10.1016/j.jacc.2022.12.011
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1. Hindricks G, Potpara T, Dagres N, et al.; ESC Scientific Document Group. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021;42(5):373-498. DOI:10.1093/eurheartj/ehaa612
2. Arakelyan MG, Bockeria LA, Vasilieva EYu, et al. 2020 Clinical guidelines for Atrial fibrillation and atrial flutter. Russian Journal of Cardiology. 2021;26(7):4594 (in Russian). DOI:10.15829/1560-4071-2021-4594
3. Writing Committee Members; Joglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2024;83(1):109-279. DOI:10.1016/j.jacc.2023.08.017
4. Popovich LD. Analiz potentsial'nogo sotsial'no-ekonomicheskogo ushcherba, nanosimogo obshchestvu v sviazi s razvitiem fibrilliatsii predserdii u naseleniia raznykh vozrastnykh grupp v Rossiiskoi Federatsii. Otchet o nauchno-issledovatel'skoi rabote. 2023. Nomer gosudarstvennoi registratsii: NIOKTR 123041200046-7 (in Russian).
5. Rienstra M, Vermond RA, Crijns HJ, et al.; RACE Investigators. Asymptomatic persistent atrial fibrillation and outcome: results of the RACE study. Heart Rhythm. 2014;11(6):939-45. DOI:10.1016/j.hrthm.2014.03.016
6. Boriani G, Laroche C, Diemberger I, et al.; Asymptomatic atrial fibrillation: clinical correlates, management, and outcomes in the EORP-AF Pilot General Registry. Am J Med. 2015;128(5):509-18.e2. DOI:10.1016/j.amjmed.2014.11.026
7. Siontis KC, Gersh BJ, Killian JM, et al. Typical, atypical, and asymptomatic presentations of new-onset atrial fibrillation in the community: Characteristics and prognostic implications. Heart Rhythm. 2016;13(7):1418-24. DOI:10.1016/j.hrthm.2016.03.003
8. Xiong Q, Proietti M, Senoo K, Lip GY. Asymptomatic versus symptomatic atrial fibrillation: A systematic review of age/gender differences and cardiovascular outcomes. Int J Cardiol. 2015;191:172-7. DOI: 10.1016/j.ijcard.2015.05.011
9. Bakhai A, Darius H, De Caterina R, et al. Characteristics and outcomes of atrial fibrillation patients with or without specific symptoms: results from the PREFER in AF registry. Eur Heart J Qual Care Clin Outcomes. 2016;2(4):299-305. DOI:10.1093/ehjqcco/qcw031
10. Ganesan AN, Chew DP, Hartshorne T, et al. The impact of atrial fibrillation type on the risk of thromboembolism, mortality, and bleeding: a systematic review and meta-analysis. Eur Heart J. 2016;37(20):1591-602. DOI:10.1093/eurheartj/ehw007
11. Haïssaguerre M, Jaïs P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339(10):659-66. DOI:10.1056/NEJM199809033391003
12. Nattel S, Harada M. Atrial remodeling and atrial fibrillation: recent advances and translational perspectives. J Am Coll Cardiol. 2014;63(22):2335-45. DOI:10.1016/j.jacc.2014.02.555
13. Guichard JB, Nattel S. Atrial Cardiomyopathy: A Useful Notion in Cardiac Disease Management or a Passing Fad? J Am Coll Cardiol. 2017;70(6):756-65. DOI:10.1016/j.jacc.2017.06.033
14. Van Gelder IC, Rienstra M, Bunting KV, et al.; ESC Scientific Document Group. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2024;45(36):3314-414. DOI:10.1093/eurheartj/ehae176
15. Kuck KH, Brugada J, Fürnkranz A, et al.; FIRE AND ICE Investigators. Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial Fibrillation. N Engl J Med. 2016;374(23):2235-45. DOI:10.1056/NEJMoa1602014
16. Andrade JG, Champagne J, Dubuc M, et al.; CIRCA-DOSE Study Investigators. Cryoballoon or Radiofrequency Ablation for Atrial Fibrillation Assessed by Continuous Monitoring: A Randomized Clinical Trial. Circulation. 2019;140(22):1779-88. DOI:10.1161/CIRCULATIONAHA.119.042622
17. Denus S, Sanoski CA, Carlsson J, et al. Rate vs rhythm control in patients with atrial fibrillation: a meta-analysis. Arch Intern Med. 2005;165(3):258-62. DOI:10.1001/archinte.165.3.258
18. Andrade JG, Wells GA, Deyell MW, et al.; EARLY-AF Investigators. Cryoablation or Drug Therapy for Initial Treatment of Atrial Fibrillation. N Engl J Med. 2021;384(4):305-15. DOI:10.1056/NEJMoa2029980
19. Kuck KH, Lebedev DS, Mikhaylov EN, et al. Catheter ablation or medical therapy to delay progression of atrial fibrillation: the randomized controlled atrial fibrillation progression trial (ATTEST). Europace. 2021;23(3):362-9. DOI:10.1093/europace/euaa298
20. Marrouche NF, Brachmann J, Andresen D, et al.; CASTLE-AF Investigators. Catheter Ablation for Atrial Fibrillation with Heart Failure. N Engl J Med. 2018;378(5):417-27. DOI:10.1056/NEJMoa1707855
21. Sohns C, Fox H, Marrouche NF, et al.; CASTLE HTx Investigators. Catheter Ablation in End-Stage Heart Failure with Atrial Fibrillation. N Engl J Med. 2023;389(15):1380-9. DOI:10.1056/NEJMoa2306037
22. Willems S, Borof K, Brandes A, et al. Systematic, early rhythm control strategy for atrial fibrillation in patients with or without symptoms: the EAST-AFNET 4 trial. Eur Heart J. 2022;43(12):1219-30. DOI:10.1093/eurheartj/ehab593
23. Valembois L, Audureau E, Takeda A., et al. Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation. Cochrane Database Syst Rev. 2019;9(9):CD005049. DOI:10.1002/14651858.CD005049.pub5
24. Arbelo E, Brugada J, Blomström-Lundqvist C, et al.; on the behalf of the ESC-EHRA Atrial Fibrillation Ablation Long-term Registry Investigators. Contemporary management of patients undergoing atrial fibrillation ablation: in-hospital and 1-year follow-up findings from the ESC-EHRA atrial fibrillation ablation long-term registry. Eur Heart J. 2017;38(17):1303-16. DOI:10.1093/eurheartj/ehw564
25. Tilz RR, Heeger CH, Wick A, et al. Ten-Year Clinical Outcome After Circumferential Pulmonary Vein Isolation Utilizing the Hamburg Approach in Patients With Symptomatic Drug-Refractory Paroxysmal Atrial Fibrillation. Circ Arrhythm Electrophysiol. 2018;11(2):e005250. DOI:10.1161/CIRCEP.117.005250
26. Gokoglan Y, Mohanty S, Gunes MF, et al. Pulmonary vein antrum isolation in patients with paroxysmal atrial fibrillation: More than a decade of follow-up. Circ Arrhythm Electrophysiol. 2016;9(5):e003660. DOI:10.1161/CIRCEP.115.003660
27. Asad ZUA, Yousif A, Khan MS, et al. Catheter Ablation Versus Medical Therapy for Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Circ Arrhythm Electrophysiol. 2019;12(9):e007414. DOI:10.1161/CIRCEP.119.007414
28. Eckardt L, Sehner S, Suling A, et al. Attaining sinus rhythm mediates improved outcome with early rhythm control therapy of atrial fibrillation: the EAST-AFNET 4 trial. Eur Heart J. 2022;43(40):4127-44. DOI:10.1093/eurheartj/ehac471
29. Rillig A, Magnussen C, Ozga AK, et al. Early Rhythm Control Therapy in Patients With Atrial Fibrillation and Heart Failure. Circulation. 2021;144(11):845-58. DOI:10.1161/CIRCULATIONAHA.121.056323
30. Van Gelder IC, Ekrami NK, Borof K, et al.; EAST-AFNET 4 Trial Investigators. Sex Differences in Early Rhythm Control of Atrial Fibrillation in the EAST-AFNET 4 Trial. J Am Coll Cardiol. 2023;81(8):845-7. DOI:10.1016/j.jacc.2022.12.011
31. Rillig A, Borof K, Breithardt G, et al. Early Rhythm Control in Patients With Atrial Fibrillation and High Comorbidity Burden. Circulation. 2022;146(11):836-47. DOI: 10.1161/CIRCULATIONAHA.122.060274
32. Kim D, Yang PS, You SC, et al. Treatment timing and the effects of rhythm control strategy in patients with atrial fibrillation: nationwide cohort study. BMJ. 2021;373:n991. DOI:10.1136/bmj.n991
33. Wazni OM, Dandamudi G, Sood N, et al.; STOP AF First Trial Investigators. Cryoballoon Ablation as Initial Therapy for Atrial Fibrillation. N Engl J Med. 2021;384(4):316-24. DOI:10.1056/NEJMoa2029554
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Авторы

М.В. Серова*^1,2, Ю.С. Сазонова¹, Н.В. Сафонов¹, О.П. Билая², Д.А. Андреев²

¹ГБУЗ «Городская клиническая больница №1 им. Н.И. Пирогова» Департамента здравоохранения г. Москвы, Москва, Россия;
²ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*yamarfa@yandex.ru

________________________________________________

Maria V. Serova*^1,2, Yulia S. Sazonova¹, Nikita V. Safonov¹, Olesia P. Bilaia², Denis A. Andreev²

¹Pirogov City Clinical Hospital No. 1, Moscow, Russia;
²Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*yamarfa@yandex.ru

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