Abstract
Aim. To assess the effectiveness and safety of refralon based cardioversion on the experience of the cardiology department of Orenburg Regional Clinical Hospital.Methods. The archival medical histories of 14 patients with persistent atrial fibrillation (AF) and 2 patients with persistent atrial flutter (AFL) (overall 16 patients), who underwent an attempt to restore sinus rhythm with refralon, were analyzed. The mean age of the patients was 51.7±10.4 years. The mean duration of AF/AFL since its last detection was 8.0±6.5 weeks (from 8 days to 8 months). Fifteen patients had hypertension, 3 of them had coronary artery disease (CAD), and 1 patient had CAD with type 2 diabetes mellitus. One of the patients had lone AF. Before cardioversion, all patients underwent the following examination: clinical and biochemical blood tests, clinical urine tests, electrocardiography (ECG), echocardiography (Echo), transesophageal Echo, Holter ECG, the determination of the level of thyroid-stimulating hormone, thyroxine, electrolytes, including potassium and magnesium.Results. According to Echo, initially, the transverse size of the left atrium in patients was 4.3±0.3 cm. Its increase was noted in 68.7% of patients (from 4.3 to 5.0 cm). Restoration of sinus rhythm after the first step of refralon administration at a dose of 10 μg/kg was achieved in 8 patients, after the second step of administration (total dose 20 μg/kg) - in 5 patients and after the third step (total dose 30 μg/kg) - in 2 patients. In 1 patient, restoration of sinus rhythm was not achieved after the administration of the third bolus. Out of 15 patients with restored sinus rhythm, AF recurrence occurred in three. In one of the patients with successful cardioversion, the sinus rhythm was restored the next day. The duration of the last episode of AF and the size of the left atrium did not significantly affect the effectiveness of cardioversion and amounted to 62±54 days and 4.3±0.35 cm, respectively, in patients with successful cardioversion, and with a recurrence of AF - 34.3±28 days and 4.2±0.35 cm (p=0.2; р=0.6). The efficacy of cardioversion with refralon was 71.4% in patients with AF, and 100% in patients with AFL. No adverse events of refralon were found in patients.Conclusion. At the time of discharge, sinus rhythm was recorded in 12 out of 16 patients (75%). The ineffectiveness of cardioversion with refralon was noted only in patients with AF; in all patients with AFL the sinus rhythm was restored.
Highlights
Restoration of sinus rhythm after the first step of refralon administration at a dose of 10 μg/kg was achieved in 8 patients, after the second step of administration - in 5 patients and after the third step - in 2 patients
In 1 patient, restoration of sinus rhythm was not achieved after the administration of the third bolus
No adverse events of refralon were found in patients
Summary
CLINICAL HOSPITAL L.K.Kozlova, N.V.Sokolova, A.V.Sivkova, A.E.Kamyshanova, O.Y.Abramova, G.B.Kuchma, B.T.Turmukhambetova, E.N.Nikonova1 1Orenburg State Medical University of the Ministry of Healthcare of the Russian Federation, Orenburg, 6 Sovetskaya str; 2Orenburg Regional Clinical Hospital, Russian Federation, Orenburg, 23 Aksakova str. In one of the patients with successful cardioversion, the sinus rhythm was restored the day. The ineffectiveness of cardioversion with refralon was noted only in patients with AF; in all patients with AFL the sinus rhythm was restored. При персистирующей форме ФП или трепетания предсердий (ТП) последнее время используются антиаритмические препараты, относящиеся к III классу, преимуществом которых является не замедление проведения импульса, а блокада К+ каналов, что приводит к удлинению фазы реполяризации потенциала действия и к удлинению рефрактерного периода волокон сердца. Первым отечественным антиаритмическим препаратом III класса, рекомендованным для кардиоверсии пациентам с персистирующей ФП или ТП стал нибентан, который приводил к восстановлению синусового ритма в 68% случаев при ФП и во всех случаях ТП. Основным электрокардиографическим проявлением действия препарата является удлинение интервалов QT и QTc. Антиаритмический эффект (купирование аритмии) может развиваться непосредственно после введения первой дозы или быть отсроченным, в том числе по отношению ко времени введения повторных доз. Целью нашего исследования явилась оценка эффективности и безопасности рефралона, основываясь на опыте его применения в кардиологическом отделении Государственного автономного учреждения здравоохранения «Оренбургская областная клиническая больница»
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