Современное лечение аритмий сердца: сравнение медикаментозных и немедикаментозных методов

DOI: https://doi.org/10.29296/25877305-2020-04-05
Номер журнала: 
4
Год издания: 
2020

С.Г. Канорский, доктор медицинских наук, профессор Кубанский государственный медицинский университет, Краснодар E-mail: kanorskysg@mail.ru

Лечение аритмий сердца в современных условиях проводится с использованием медикаментозных и немедикаментозных методов. Их роль в лечении отдельных форм нарушений ритма сердца существенно различается. На основе клинических рекомендаций, опубликованных в 2019–2020 гг., обсуждается выбор врачебной тактики в типичных клинических ситуациях. В статье рассматриваются результаты важнейших рандомизированных исследований (CASTLE-AF, CABANA и др.), посвященных влиянию медикаментозного лечения и катетерной аблации на клинические исходы больных с наиболее распространенной устойчивой аритмией сердца – фибрилляцией предсердий (ФП). Представлены возможности комплексного пациентоориентированного подхода к антиаритмической терапии ФП.
Ключевые слова: 
кардиология, аритмии сердца, антиаритмические препараты, катетерная аблация, фибрилляция предсердий, желудочковые аритмии, пароксизмальная суправентрикулярная тахикардия

Список литературы: 
  1. Bassil G., Markowitz S., Liu C. et al. Robotics for catheter ablation of cardiac arrhythmias: Current technologies and practical approaches // J. Cardiovasc. Electrophysiol. – 2020; 31 (3): 739–52. DOI: 10.1111/jce.14380
  2. Bennett R., Campbell T., Kumar S. Catheter and Device Management of Inherited Cardiac Conditions // Heart Lung Circ. – 2020; 29 (4): 594–606. DOI: 10.1016/j.hlc.2019.12.009
  3. Lei M., Wu L., Terrar D. et al. Modernized Classification of Cardiac Antiarrhythmic Drugs // Circulation. – 2018; 138 (17): 1879–96. DOI: 10.1161/CIRCULATIONAHA.118.035455
  4. Cronin E., Bogun F., Maury P. et al. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias: Executive summary // J. Arrhythm. – 2020; 36 (1): 1–58. DOI: 10.1002/joa3.12264
  5. Santangeli P., Marchlinski F. Ablation Therapy for Refractory Ventricular Arrhythmias // Annu. Rev. Med. – 2020; 71: 177–90. DOI: 10.1146/annurev-med-041818-020033
  6. Towbin J., McKenna W., Abrams D. et al. 2019 HRS expert consensus statement on evaluation, risk stratification, and management of arrhythmogenic cardiomyopathy // Heart Rhythm. – 2019; 16 (11): e301–72. DOI: 10.1016/j.hrthm.2019.05.007
  7. Willems S., Tilz R., Steven D. et al. Preventive or Deferred Ablation of Ventricular Tachycardia in Patients with Ischemic Cardiomyopathy and Implantable Defibrillator (BERLIN VT): A Multicenter Randomized Trial // Circulation. – 2020; 141 (13): 1057–67. DOI: 10.1161/CIRCULATIONAHA.119.043400.
  8. Rizzo A., de Asmundis C., Brugada P. et al. Ablation for the treatment of Brugada syndrome: current status and future prospects // Expert Rev. Med. Devices. – 2020; 17 (2): 123–30. DOI: 10.1080/17434440.2020.1719831
  9. Bennett R., Campbell T., Kumar S. Catheter and Device Management ofInherited Cardiac Conditions // Heart Lung Circ. – 2020; 29 (4): 594–606. DOI: 10.1016/j.hlc.2019.12.009
  10. Ortmans S., Daval C., Aguilar M. et al. Pharmacotherapy in inherited and acquired ventricular arrhythmia in structurally normal adult hearts // Expert Opin. Pharmacother. – 2019; 20 (17): 2101–14. DOI: 10.1080/14656566.2019.1669561
  11. Brugada J., Katritsis D., Arbelo E. et al. 2019 ESC Guidelines for the management of patients with supraventricular tachycardiaThe Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC) // Eur. Heart J. – 2020; 41 (5): 655–720. DOI: 10.1093/eurheartj/ehz467
  12. Zylla M., Brachmann J., Lewalter T. et al. Symptomatic arrhythmias after catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT): results from the German Ablation Registry // Clin. Res. Cardiol. – 2019 Nov 29. DOI: 10.1007/s00392-019-01576-x. [Epub ahead of print]
  13. Rottner L., Bellmann B., Lin T. et al. CatheterAblationofAtrial Fibrillation: State of the Art and Future Perspectives // Cardiol. Ther. – 2020 Jan 2. DOI: 10.1007/s40119-019-00158-2. [Epub ahead of print]
  14. Marrouche N., Brachmann J., Andresen D. et al. Catheter Ablation for Atrial Fibrillation with Heart Failure // N. Engl. J. Med. – 2018; 378 (5): 417–27. DOI: 10.1056/NEJMoa1707855
  15. Packer D., Mark D., Robb R. et al. Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation (CABANA) Trial: Study Rationale and Design // Am. Heart J. – 2018; 199: 192–9. DOI: 10.1016/j.ahj.2018.02.015
  16. Packer D., Mark D., Robb R. et al. Effect of Catheter Ablation vs Antiarrhythmic Drug Therapy on Mortality, Stroke, Bleeding, and Cardiac Arrest Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial // JAMA. – 2019; 321 (13): 1261–74. DOI: 10.1001/jama.2019.0693
  17. Balabanski T., Brugada J., Arbelo E. et al. Impact of monitoring on detection of arrhythmia recurrences in the ESC-EHRA EORP atrial fibrillation ablation long-term registry // Europace. – 2019; 21 (12): 1802–8. DOI: 10.1093/europace/euz216. [Epub ahead of print]
  18. Mark D., Anstrom K., Sheng S. et al. Effect of Catheter Ablation vs Medical Therapy on Quality of Life Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial // JAMA. – 2019; 321 (13): 1275–85. DOI: 10.1001/jama.2019.0692
  19. Dan G. Rhythm Control in AF: Have We Reached the Last Frontier? // Eur. Cardiol. – 2019; 14 (2): 77–81. DOI: 10.15420/ecr.2019.8.1
  20. Cheng E., Liu C., Yeo I. et al.Risk of Mortality Following CatheterAblation of Atrial Fibrillation // J. Am. Coll. Cardiol. – 2019; 74 (18): 2254–64. DOI: 10.1016/j.jacc.2019.08.1036
  21. Wyse D., Waldo A., DiMarco J. et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N. Engl. J. Med. – 2002; 347 (23): 1825–33.
  22. January C., Wann L., Calkins H. et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society // J. Am. Coll. Cardiol. – 2019; 74 (1): 104–32. DOI: 10.1016/j.jacc.2019.01.011
  23. Reese-Petersen A., Olesen M., Karsdal M. et al. Atrial Fibrillationand Cardiac Fibrosis: A Review on the Potential of Extracellular Matrix Proteins as Biomarkers // Matrix Biol. – 2020; pii: S0945-053X(20)30026-3. DOI: 10.1016/j.matbio.2020.03.005. [Epub ahead of print]
  24. Prabhu S., Costello B., Taylor A. et al. Regression of Diffuse Ventricular FibrosisFollowing Restoration of SinusRhythm With Catheter Ablation inPatients With Atrial Fibrillation andSystolic Dysfunction: A Substudy of the CAMERA MRI Trial // JACC. Clin. Electrophysiol. – 2018; 4 (8): 999–1007. DOI: 10.1016/j.jacep.2018.04.013
  25. Park J., Yu H., Kim T. et al. Atrial Fibrillation Catheter Ablation Increases the Left Atrial Pressure // Circ. Arrhythm. Electrophysiol. – 2019; 12 (4): e007073. DOI: 10.1161/CIRCEP.118.007073
  26. Packer M. Effect of catheter ablation on pre-existing abnormalities of left atrial systolic, diastolic, and neurohormonal functions in patients with chronic heart failure and atrial fibrillation // Eur. Heart J. – 2019; 40 (23): 1873–9. DOI: 10.1093/eurheartj/ehz284
  27. Zelniker T., Bonaca M., Furtado R. et al. Effect of Dapagliflozin on Atrial Fibrillation in Patients with Type 2 Diabetes Mellitus: Insights from the DECLARE-TIMI 58 Trial // Circulation. – 2020; 141 (15): 1227–34. DOI: 10.1161/CIRCULATIONAHA.119.044183
  28. Hamilton D., Nandkeolyar S., Lan H. et al. Amiodarone: A Comprehensive Guide for Clinicians // Am. J. Cardiovasc. Drugs. – 2020 Mar 13. DOI: 10.1007/s40256-020-00401-5. [Epub ahead of print]
  29. Valembois L., Audureau E., Takeda A. et al. Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation // Cochrane Database Syst. Rev. – 2019; 9: CD005049. DOI: 10.1002/14651858.CD005049.pub5
  30. Rouini M., Afshar M. Effect of CYP2D6 polymorphisms on the pharmacokinetics ofpropafenoneand its two main metabolites // Therapie. –2017; 72 (3): 373–82. DOI: 10.1016/j.therap.2016.10.005
  31. Pantlin P., Bober R., Bernard M. et al.Class 1C antiarrhythmic drugs in atrial fibrillation and coronary artery disease // J. Cardiovasc. Electrophysiol. – 2020; 31 (3): 607–11. DOI: 10.1111/jce.14335
  32. Kipp R., Askari M., Fan J. et al. Real-World Comparison of ClassesICandIII Antiarrhythmic Drugs asan Initial Rhythm Control Strategy inNewly Diagnosed Atrial Fibrillation: From the TREAT-AF Study // JACC. Clin. Electrophysiol. – 2019; 5 (2): 231–41. DOI: 10.1016/j.jacep.2018.08.025
  33. Dan G., Martinez-Rubio A., Agewall S. et al. Antiarrhythmic drugs-clinical use and clinical decision making: a consensus document from the European Heart Rhythm Association (EHRA) and European Society of Cardiology (ESC) Working Group on Cardiovascular Pharmacology, endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS) and International Society of Cardiovascular Pharmacotherapy (ISCP) // Europace. – 2018; 20 (5): 731-2an. DOI: 10.1093/europace/eux373
  34. Канорский С.Г. Антиаритмическая терапия у больных с пароксизмальной и персистирующей формами фибрилляции предсердий: определение достижимой цели и оценка имеющихся средств // Кардиология.– 2014; 54 (2): 70–4 [Kanorsky S.G. Antiarrhythmic Therapy in Patients With Paroxysmal and Persistent Atrial Fibrillation: Identification of Achievable Goals and Assessment of Available Funds // Kardiologiya.– 2014; 54 (2): 70–4 (in Russ.)].
  35. Kotecha D., Breithardt G., Camm A. et al. Integrating new approaches to atrial fibrillation management: the 6th AFNET/EHRA Consensus Conference // Europace. –2018; 20 (3): 395–407. DOI: 10.1093/europace/eux318
  36. Duytschaever M., Demolder A., Phlips T. et al. PulmOnary vein isolation With vs. without continued antiarrhythmic Drug trEatment in subjects with Recurrent Atrial Fibrillation (POWDER AF): results from a multicentre randomized trial // Eur. Heart J. – 2018; 39 (16): 1429–37. DOI: 10.1093/eurheartj/ehx666
  37. Shantha G., Alyesh D., Ghanbari H. et al.Antiarrhythmic drug therapy and all-cause mortality after catheter ablation of atrial fibrillation: Apropensity-matched analysis // Heart Rhythm. – 2019; 16 (9): 1368–73. DOI: 10.1016/j.hrthm.2019.06.007
  38. Hendriks J., Tieleman R., Vrijhoef H. et al. Integrated specialized atrial fibrillation clinics reduce all-cause mortality: post hoc analysis of a randomized clinical trial // Europace. – 2019; 21 (12): 1785–92. DOI: 10.1093/europace/euz209. [Epub ahead of print]
  39. Chung M., Eckhardt L., Chen L. et al. Lifestyle and Risk Factor Modification for Reduction of Atrial Fibrillation: A Scientific Statement From the American Heart Association // Circulation. – 2020; 141 (16): e750–72. DOI: 10.1161/CIR.0000000000000748
  40. Qin M., Zeng C., Liu X. The cardiac autonomic nervous system: A target for modulation of atrial fibrillation // Clin. Cardiol. –2019; 42 (6): 644–52. DOI: 10.1002/clc.23190