Abstract
Aim. To identify possible predictors of atrial fibrillation (AF) recurrence in 6-month prophylactic propafenone therapy. Material and methods. Patients (n=63; aged 52.2±12.6 years; 25.4% women) with frequent AF recurrences who restored sinus rhythm with propafenone, were included into the study. Paroxysmal AF was observed in 84.1% of patients, and persistent AF — in 15.9% of patients. ECG, transthoracic echocardiography , chest radiography with the calculation of cardio-thoracic index (CTI) was performed at baseline. All patients received rpropafenone therapy (450–600 mg/day) during 6 months after sinus rhythm conversion. ECG and 24-hours ECG monitoring were performed in 1, 3 and 6 months of the therapy. Patients with 70–100% reduction in AF recurrence rate were included into the 1-st group, and patients with <70% reduction – into the 2-nd group. Results. 92%, 88.5% and 78% of patients were included into the group 1 after 1, 3 and 6 months of follow up, respectively. AF recurrences were observed 4.5, 3.8, and 1.7 times more often in women than these in men after 1, 3 and 6 months, respectively , (p>0.05). Mean age of patients in the group 2 was significantly older than this in patients of the group 1 (p<0.05). CTI, left atrium size and volume, interventricular septum thickness (IVST) were significantly larger in group 2. Myocardium mass of the left ventricle (MMLV) after 6 months of therapy was larger by 13.9% in patients of the group 2 vs this in patients of the group 1 (p<0.05). Conclusion. Insufficient preventive effect of propafenone was observed in 8%, 11.5% and 22% of patients in 1, 3 and 6 months of the follow-up, respectively. Propafenone prophylactic efficacy was slightly higher in men and younger patients. Patients with poor preventive effect of propafenone had a significantly larger baseline CTI, size and volume of the left atrium, IVST, and MMLV.
Highlights
Возможные предикторы рецидивирования фибрилляции предсердий на фоне длительного профилактического приема пропафенона Р.Д
Patients with 70–100% reduction in atrial fibrillation (AF) recurrence rate were included into the 1-st group, and patients with
В зависимости от результатов оценки противорецидивной эффективности к 1, 3 и 6 мес наблюдения в 1 группу вошли 92%, 88,5%, 78% больных, соответственно, тогда как количество больных во 2 группе в эти сроки составило 8%, 11,5% и 22%, соответственно
Summary
В исследование включено 63 больных с симптомными гемодинамически стабильными частыми рецидивами ФП, у которых на фоне нагрузочных или курсовых доз пропафенона был восстановлен синусовый ритм. Согласно протоколу исследования при появлении характерных симптомов ФП на фоне продолжительного приема пропафенона больные вызывали «скорую помощь» или обращались к врачу и документировали пароксизм ФП на ЭКГ. В зависимости от результатов оценки противорецидивной эффективности к 1, 3 и 6 мес наблюдения в 1 группу вошли 92%, 88,5%, 78% больных, соответственно, тогда как количество больных во 2 группе в эти сроки составило 8%, 11,5% и 22%, соответственно. Целесообразность объединения рецидивирования пароксизмальной и персистирующей форм ФП в одну группу объясняется тем, что принципы противорецидивной антиаритмической терапии после восстановления синусового ритма одинаковы при этих формах ФП [1,3], а также тем, что наблюдается относительно небольшое число рецидивов в целом и внутри отдельных клинических форм в обеих группах на каждом этапе и за весь период наблюдения.
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