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Стратегии лечения пациентов с фибрилляцией предсердий и сердечной недостаточностью
Терещенко С.Н., Ускач Т.М. Стратегии лечения пациентов с фибрилляцией предсердий и сердечной недостаточностью. Терапевтический архив.2021;93(12):1545–1550. DOI: 10.26442/00403660.2021.12.201205
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Tereshchenko SN, Uskach TM. Treatment strategies for patients with atrial fibrillation and chronic heart failure. Terapevticheskii Arkhiv (Ter. Arkh.). 2021;93(12):1545–1550. DOI: 10.26442/00403660.2021.12.201205
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Аннотация
Фибрилляция предсердий (ФП) связана со значительной заболеваемостью и смертностью, и одним из наиболее важных ее последствий является развитие хронической сердечной недостаточности (ХСН). ФП и ХСН оказывают взаимное влияние на течение каждого из заболеваний, создавая необходимость тщательного выбора методов лечения пациентов. Статья посвящена вопросам распространенности и прогностического значения сочетания ФП и ХСН. В статье представлены данные метаанализов и регистров, касающиеся ведения этой группы больных. Освещены актуальные проблемы тактики контроля ритма при ФП и сопутствующей ХСН в свете последних исследований и клинических рекомендаций. Изложены особенности антикоагулянтной терапии у пациентов с ФП и ХСН. Особое внимание уделено значению профиля безопасности антикоагулянта с точки зрения риска кровотечений у больных при сочетании двух состояний.
Ключевые слова: фибрилляция предсердий, сердечная недостаточность, контроль ритма, антикоагулянтная терапия
Ключевые слова: фибрилляция предсердий, сердечная недостаточность, контроль ритма, антикоагулянтная терапия
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Atrial fibrillation (AF) is associated with significant morbidity and mortality and may lead to the development of chronic heart failure (CHF). Each condition predisposes to the other, requiring a careful choice of the treatment strategy. This article is devoted to the prevalence and prognostic implications of both diseases. The article presents data from meta-analyzes related to the management of this group of patients. The aspects of rhythm control strategy in AF and concomitant CHF are described according to the recent studies and clinical guidelines. The features of anticoagulant therapy in patients with AF and CHF are outlined. Much attention is given to the importance of the safety profile of the anticoagulant therapy in terms of the bleeding risk in patients with concomitant AF and CHF.
Keywords: atrial fibrillation, chronic heart failure, rhythm control, anticoagulant therapy
Полный текст
Список литературы
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18. Wyse DG, Waldo AL, DiMarco JP, 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(23):1825-33.
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26. Marrouche NF, Brachmann J, Andresen D, et al.; CASTLE-AF Investigators. Catheter ablation for atrial fibrillation with heart failure. N Engl J Med. 2018;378:417-27. DOI:10.1056/NEJMoa1707855
27. Kuck KH, Merkely B, Zahn R, et al. Catheter ablation versus best medical therapy in patients with persistent atrial fibrillation and congestive heart failure: the randomized AMICA trial. Circ Arrhythm Electrophysiol. 2019;12:e007731. DOI:10.1161/CIRCEP.119.007731
28. Packer DL, Piccini JP, Monahan KH et al. Ablation Versus Drug Therapy for Atrial Fibrillation in Heart Failure: Results From the CABANA Trial. Circulation. 2021;143(14):1377-90. DOI:10.1161/CIRCULATIONAHA.120.050991
29. Mulder BA, Rienstra M, Gelder IC, Blaauw Y. Update on management of atrial fibrillation in heart failure: a focus on ablation. Heart. 2021;heartjnl-2020-318081.
DOI:10.1136/heartjnl-2020-318081
30. Zhao L, Wang WYS, Yang X. Anticoagulation in atrial fibrillation with heart failure. Heart Fail. Rev. 2018;23(4):563-71. DOI:10.1007/s10741-018-9693-0
31. Banerjee A, Taillandier S, Olesen JB, et al. Ejection fraction and outcomes in patients with atrial fibrillation and heart failure: the Loire Valley Atrial Fibrillation Project. Eur J Heart Fail. 2012;14(3):295-301. DOI:10.1093/eurjhf/hfs005
32. Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin inpatients with atrial fibrillation. New Engl J Med. 2009;361:1139-51. DOI:10.1056/NEJMoa0905561
33. Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. New Engl J Med. 2011;365:883-91. DOI:10.1056/NEJMoa1009638
34. Granger CB, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365:981-92.
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35. Giugliano RP, Ruff CT, Braunwald E, et al. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2013;369:2093-104. DOI:10.1056/NEJMoa1310907
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37. Lip GY, Keshishian A, Kamble S, et al. Real-world comparison of major bleeding risk among non-valvular atrial fibrillation patients initiated on apixaban, dabigatran, rivaroxaban, or warfarin. A propensity score matched analysis. Thromb Haemost. 2016;116(05):975-86. DOI:10.1160/TH16-05-0403
38. McMurray JJ, Ezekowitz JA, Lewis BS, et al. Left Ventricular Systolic Dysfunction, Heart Failure, and the Risk of Stroke and Systemic Embolism in Patients With Atrial Fibrillation Insights From the ARISTOTLE Trial. Circ Heart Fail. 2013;6(3):451-60.
DOI:10.1161/CIRCHEARTFAILURE.112.000143
39. Graham DJ, Baro E, Zhang R, et al. Comparative Stroke, Bleeding, and Mortality Risks in Older Medicare Patients Treated with Oral Anticoagulants for Nonvalvular Atrial Fibrillation. Am. J. Med. 2019;132:596-604. DOI:10.1016/j.amjmed.2018.12.023
40. Lip GYH, Keshishian A, Li X, et al. Effectiveness and Safety of Oral Anticoagulants Among Nonvalvular Atrial Fibrillation Patients. The ARISTOPHANES Study. Stroke. 2018;49(12):2933-44. DOI:10.1161/STROKEAHA.118.020232
41. Jackevicius CA, Lu L, Ghaznavi Z, Warner AL. Bleeding Risk of Direct Oral Anticoagulants in Patients With Heart Failure And Atrial Fibrillation. Circ Cardiovasc Qual Outcomes. 2021;14(2):e007230. DOI:10.1161/CIRCOUTCOMES.120.007230
42. Jina H, Zhub K, Wangc L, et al. Efficacy and safety of non-vitamin K anticoagulants and warfarin in patients with atrial fibrillation and heart failure: A network meta-analysis. Thromb Res. 2020;196:109-19. DOI:10.1016/j.thromres.2020.08.021
43. Telles-Garcia N, Dahal K, Kocherla C, et al. Non-vitamin K antagonists oral anticoagulants are as safe and effective as warfarin for cardioversion of atrial fibrillation: a systematic review and meta-analysis. Int J Cardiol. 2018;268:143-8. DOI:10.1016/j.ijcard.2018.04.034
44. Аракелян М.Г., Бокерия Л.А., Васильева Е.Ю., и др. Фибрилляция и трепетание предсердий. Клинические рекомендации 2020. Российский кардиологический журнал. 2021;26(7):4594 [Arakelyan MG, Bockeria LA, Vasilieva EYu, et al. 2020 Clinical guidelines for Atrial fibrillation and atrial flutter. Rossiiskii kardiologicheskii zhurnal. 2021;26(7):4594 (in Russian)]. DOI:10.15829/1560-4071-2021-4594
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2. Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics-2016 update: a report from the American Heart Association. Circulation. 2016;133:e38-60. DOI:10.1161/CIR.0000000000000350
3. Фомин И.В. Хроническая сердечная недостаточность в Российской Федерации: что сегодня мы знаем и что должны делать. Российский кардиологический журнал. 2016;8:7-13 [Fomin IV. Chronic heart failure in Russian Federation: what do we know and what to do. Rossiiskii kardiologicheskii zhurnal. 2016;8:7-13 (in Russian)].
DOI:10.15829/1560-4071-2016-8-7-13
4. Odutayo A, Wong CX, Hsiao AJ, et al. Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: systematic review and metaanalysis. BMJ. 2016;354:i4482. DOI:10.1136/bmj.i4482
5. Chua W, Fabritz L. Heart failure in patients with atrial fibrillation: why it matters now more than ever. Heart. 2021;107(16):heartjnl-2021-319145.
DOI:10.1136/heartjnl-2021-319145
6. Wang TJ, Larson MG, Levy D, et al. Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Circulation. 2003;107(23):2920-5. DOI:10.1161/01.CIR.0000072767.89944.6E
7. Santhanakrishnan R, Wang N, Larson MG, et al. Atrial fibrillation begets heart failure and vice versa: temporal associations and differences in preserved versus reduced ejection fraction. Circulation. 2016;133(5):484-92. DOI:10.1161/CIRCULATIONAHA.115.018614
8. Chamberlain AM, Gersh BJ, Alonso A, et al. No decline in the risk of heart failure after incident atrial fibrillation: a community study assessing trends overall and by ejection fraction. Heart Rhythm. 2017;14(6):791-8. DOI:10.1016/j.hrthm.2017.01.031
9. Karnik AA, Gopal DM, Ko D, et al. Epidemiology of Atrial Fibrillation and Heart Failure: A Growing and Important Problem. Cardiol Clin. 2019;37(2):119-29. DOI:10.1016/j.ccl.2019.01.001
10. Cha YM, Redfield MM, Shen WK, Gersh BJ. Atrial fibrillation and ventricular dysfunction: a vicious electromechanical cycle. Circulation. 2004;109:2839-43. DOI:10.1161/01.CIR.0000132470.78896.A8
11. Tsigkas G, Apostolos A, Despotopoulos S, et al. Heart failure and atrial fibrillation: new concepts in pathophysiology, management, and future directions. Heart Fail Rev. 2021. DOI:10.1007/s10741-021-10133-6
12. Piccini JP, Hammill BG, Sinner MF, et al. Clinical course of atrial fibrillation in older adults: the importance of cardiovascular events beyond stroke. Eur Heart J. 2014;35(4):250-6. DOI:10.1093/eurheartj/eht483
13. Терещенко С.Н., Галявич А.С., Ускач Т.М., и др. Хроническая сердечная недостаточность. Клинические рекомендации 2020. Российский кардиологический журнал. 2020;25(11):4083 [Tereshchenko SN, Galyavich AS, Uskach TM, et al. 2020 Clinical practice guidelines for chronic heart failure. Rossiiskii kardiologicheskii zhurnal. 2020;25(11):4083 (in Russian)]. DOI:10.15829/1560-4071-2020-4083
14. Zafrir B, Lund LH, Laroche C, et al. Prognostic implications of atrial fibrillation in heart failure with reduced, mid-range, and preserved ejection fraction: a report from 14 964 patients in the European Society of Cardiology Heart Failure Long-Term Registry. Eur Heart J. 2018;39:4277-84. DOI:10.1093/eurheartj/ehy626
15. Pandey A, Kim S, Moore C, et al. Predictors and Prognostic Implications of Incident Heart Failure in Patients With Prevalent Atrial Fibrillation. JACC Heart Fail. 2017;5(1):44-52. DOI:10.1016/j.jchf.2016.09.016
16. Zhirov I, Safronova N, Osmolovskaya Y, et al. Predictors of Unfavorable Outcomes in Patients with Atrial Fibrillation and Concomitant Heart Failure with Different Ejection Fractions: RIF-CHF Register One-Year Follow-Up. Cardiol Res Pract. 2019;2019:1692104. DOI:10.1155/2019/1692104
17. Weber C, Hung J, Hickling S, et al. Incidence, predictors, and mortality risk of new heart failure in hospitalised atrial fibrillation. BMJ Heart. 2021;16:107.
DOI:10.1136/heartjnl-2020-318648
18. Wyse DG, Waldo AL, DiMarco JP, 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(23):1825-33.
DOI:10.1056/NEJMoa021328
19. Zimetbaum P. Antiarrhythmic drug therapy for atrial fibrillation. Circulation. 2012;125(2):381-9. DOI:10.1161/CIRCULATIONAHA.111.019927
20. Roy D, Talajic M, Nattel S, et al. Rhythm control versus rate control for atrial fibrillation and heart failure. N Engl J Med. 2008;358(25):2667-77.
DOI:10.1056/NEJMoa0708789
21. Haegeli LM, Calkins H. Catheter ablation of atrial fibrillation: an update. Eur Heart J. 2014;35(36):2454-9. DOI:10.1093/eurheartj/ehu291
22. Morillo CA, Verma A, Connolly SJ, et al. Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of paroxysmal atrial fibrillation (raaft-2): a randomized trial. JAMA. 2014;311(7):692-700. DOI:10.1001/jama.2014.467
23. Amit G, Nyong J, Morillo CA. Efficacy of catheter ablation for nonparoxysmal atrial fibrillation. JAMA Cardiol. 2017;2(7):812-3. DOI:10.1001/jamacardio.2017.0901
24. Samuel M, Tsadok AM, Joza J, et al. Catheter ablation for the treatment of atrial fibrillation is associated with a reduction in health care resource utilization. J Cardiovasc Electrophysiol. 2017;28(7):733-41. DOI:10.1111/jce.13225
25. AlTurki A, Proietti R, Dawas A, et al. Catheter ablation for atrial fibrillation in heart failure with reduced ejection fraction: a systematic review and meta-analysis of randomized controlled trials. BMC Cardiovasc Disord. 2019;19:18.
DOI:10.1186/s12872-019-0998-2
26. Marrouche NF, Brachmann J, Andresen D, et al.; CASTLE-AF Investigators. Catheter ablation for atrial fibrillation with heart failure. N Engl J Med. 2018;378:417-27. DOI:10.1056/NEJMoa1707855
27. Kuck KH, Merkely B, Zahn R, et al. Catheter ablation versus best medical therapy in patients with persistent atrial fibrillation and congestive heart failure: the randomized AMICA trial. Circ Arrhythm Electrophysiol. 2019;12:e007731. DOI:10.1161/CIRCEP.119.007731
28. Packer DL, Piccini JP, Monahan KH et al. Ablation Versus Drug Therapy for Atrial Fibrillation in Heart Failure: Results From the CABANA Trial. Circulation. 2021;143(14):1377-90. DOI:10.1161/CIRCULATIONAHA.120.050991
29. Mulder BA, Rienstra M, Gelder IC, Blaauw Y. Update on management of atrial fibrillation in heart failure: a focus on ablation. Heart. 2021;heartjnl-2020-318081.
DOI:10.1136/heartjnl-2020-318081
30. Zhao L, Wang WYS, Yang X. Anticoagulation in atrial fibrillation with heart failure. Heart Fail. Rev. 2018;23(4):563-71. DOI:10.1007/s10741-018-9693-0
31. Banerjee A, Taillandier S, Olesen JB, et al. Ejection fraction and outcomes in patients with atrial fibrillation and heart failure: the Loire Valley Atrial Fibrillation Project. Eur J Heart Fail. 2012;14(3):295-301. DOI:10.1093/eurjhf/hfs005
32. Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin inpatients with atrial fibrillation. New Engl J Med. 2009;361:1139-51. DOI:10.1056/NEJMoa0905561
33. Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. New Engl J Med. 2011;365:883-91. DOI:10.1056/NEJMoa1009638
34. Granger CB, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365:981-92.
DOI:10.1056/NEJMoa1107039
35. Giugliano RP, Ruff CT, Braunwald E, et al. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2013;369:2093-104. DOI:10.1056/NEJMoa1310907
36. Chen F, Zhou Y, Wan Q, et al. Effect of non-vitamin K antagonist oral anticoagulants versus warfarin in heart failure patients with atrial fibrillation. Heart Fail Rev. 2021;26(6):1391-7. DOI:10.1007/s10741-020-09946-8
37. Lip GY, Keshishian A, Kamble S, et al. Real-world comparison of major bleeding risk among non-valvular atrial fibrillation patients initiated on apixaban, dabigatran, rivaroxaban, or warfarin. A propensity score matched analysis. Thromb Haemost. 2016;116(05):975-86. DOI:10.1160/TH16-05-0403
38. McMurray JJ, Ezekowitz JA, Lewis BS, et al. Left Ventricular Systolic Dysfunction, Heart Failure, and the Risk of Stroke and Systemic Embolism in Patients With Atrial Fibrillation Insights From the ARISTOTLE Trial. Circ Heart Fail. 2013;6(3):451-60.
DOI:10.1161/CIRCHEARTFAILURE.112.000143
39. Graham DJ, Baro E, Zhang R, et al. Comparative Stroke, Bleeding, and Mortality Risks in Older Medicare Patients Treated with Oral Anticoagulants for Nonvalvular Atrial Fibrillation. Am. J. Med. 2019;132:596-604. DOI:10.1016/j.amjmed.2018.12.023
40. Lip GYH, Keshishian A, Li X, et al. Effectiveness and Safety of Oral Anticoagulants Among Nonvalvular Atrial Fibrillation Patients. The ARISTOPHANES Study. Stroke. 2018;49(12):2933-44. DOI:10.1161/STROKEAHA.118.020232
41. Jackevicius CA, Lu L, Ghaznavi Z, Warner AL. Bleeding Risk of Direct Oral Anticoagulants in Patients With Heart Failure And Atrial Fibrillation. Circ Cardiovasc Qual Outcomes. 2021;14(2):e007230. DOI:10.1161/CIRCOUTCOMES.120.007230
42. Jina H, Zhub K, Wangc L, et al. Efficacy and safety of non-vitamin K anticoagulants and warfarin in patients with atrial fibrillation and heart failure: A network meta-analysis. Thromb Res. 2020;196:109-19. DOI:10.1016/j.thromres.2020.08.021
43. Telles-Garcia N, Dahal K, Kocherla C, et al. Non-vitamin K antagonists oral anticoagulants are as safe and effective as warfarin for cardioversion of atrial fibrillation: a systematic review and meta-analysis. Int J Cardiol. 2018;268:143-8. DOI:10.1016/j.ijcard.2018.04.034
44. Аракелян М.Г., Бокерия Л.А., Васильева Е.Ю., и др. Фибрилляция и трепетание предсердий. Клинические рекомендации 2020. Российский кардиологический журнал. 2021;26(7):4594 [Arakelyan MG, Bockeria LA, Vasilieva EYu, et al. 2020 Clinical guidelines for Atrial fibrillation and atrial flutter. Rossiiskii kardiologicheskii zhurnal. 2021;26(7):4594 (in Russian)]. DOI:10.15829/1560-4071-2021-4594
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Авторы
С.Н. Терещенко, Т.М. Ускач*
1 ФГБУ «Научный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия;
2 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия
*tuskach@mail.ru
1 ФГБУ «Научный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия;
2 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия
*tuskach@mail.ru
________________________________________________
Sergei N. Tereshchenko, Tatiana M. Uskach*
1 National Medical Research Center of Cardiology, Moscow, Russia;
2 Russian Medical Academy of Continuous Professional Education, Moscow, Russia
*tuskach@mail.ru
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