Синдром обструктивного апноэ сна и фибрилляция предсердий: двунаправленная связь

Highlights. The data regarding the relationship between obstructive sleep apnea syndrome and atrial fibrillation were analyzed.Abstract. The review article presents current data on the relationship between obstructive sleep apnea syndrome and atrial fibrillation. The spread of these pathological processes increases with age and is associated with a significant risk of cardiovascular complications. In this regard, this review seems to be quite relevant. Possible pathophysiological mechanisms influencing the relationship between obstructive sleep apnea syndrome and atrial fibrillation are discussed. The role of CPAP therapy - Continuous Positive Airway Pressure in the prevention and treatment of atrial fibrillation is highlighted.Основные положения. Проанализированы и приведены данные о взаимосвязи синдрома обструктивного апноэ сна и фибрилляции предсердий.Резюме. В обзорной статье представлены современные данные о взаимосвязи синдрома обструктивного апноэ сна и фибрилляции предсердий. Распространение этих патологических процессов увеличивается с возрастом больных и сопряжено со значительным риском сердечно-сосудистых осложнений, что определяет актуальность представленной работы. Проанализированы возможные патофизиологические механизмы, влияющие на взаимосвязь синдрома обструктивного апноэ сна и фибрилляции предсердий. Освещена роль СИПАП-терапии (от англ. Continuous Positive Airway Pressure, СРАР) в профилактике и лечении фибрилляции предсердий

Синдром обструктивного апноэ сна и нарушения ритма сердца: современное состояние проблемы

The factors contributing to the development of cardiac arrhythmias in obstructive sleep apnea syndrome and the main methods of treating this syndrome have been analyzed and summarized.The review discusses the relationships of obstructive sleep apnea syndrome (OSAS) with various types of heart rhythm disorders. Pathogenetic factors of obstructive sleep apnea syndrome leading to the development of cardiac arrhythmias, current treatment strategies and their impact on heart rhythm disorders are summarized.Проанализированы и обобщены данные о факторах, способствующих развитию нарушений ритма сердца при синдроме обструктивного апноэ сна, и основных методах лечения синдрома.В обзоре представлен анализ современных данных о связи синдрома обструктивного апноэ сна с различными видами нарушений ритма сердца; патогенетических факторах синдрома, приводящих к развитию нарушений ритма сердца; существующих методах лечения обструктивного апноэ сна и их влиянии на нарушения ритма сердца

ABLATION FOR UNINTERRUPTEDLY RECURRENT VENTRICLE TACHYCARDIA

We present a clinical case with continuous recurrent ventricle tachycardia. Patient, 60, admitted with complaints on heart disorders, periods of unexpected total weakness, repeated episodes of pre-syncopal condition, frequent dizziness, which he has been experiencing for about a year. In the anamnesis patient had diagnosis of intermittent syndrome WPW with paroxysmal antidromic tachycardia, and we performed ablation for additional conducting atrioventricular connection. By results of examination we recommended ablation of arrhythmia substrate with the subsequent solution whether implantation of a cardioverter defibrillator was required. Stimulation and activation mapping was performed. The area of ventricular tachycardia substrate was defined in the septal part of the right ventricle outflow tract, and frequent ventricular ectopic activity – in the area of the anterio-lateral wall of LV outflow tract under the aortal valve. On the basis of radiofrequency impact series we observed ventricular disturbances discontinuation. After the performed operation the patient demonstrated clinical improvement. According to Holter ECG monitoring for jogging of group ventricular activity, and also ventricular tachycardia was not registered

CLINICAL CHRACTERISTICS OF PATIENTS AND RESULTS OF CATHETER ABLATION IN ATRIAL FIBRILLATION IN RUSSIA: SUBANALYSIS OF THE EUROPEAN REGISTRY 2012-2016

Aim. The results presented, of subanalysis of the catheter ablation (CA) registry in atrial fibrillation (AF) with the patients properties, specifics of CA and treatment results, in Russia comparing to European countries.Material and methods. During 2012 to 2015, totally 3742 patients included to the registry, of those 477 in Russia. In 467 Russian patients (males 56,5%; mean age 58,5 y. o.) CA AF was done. During one year 392 patients were followed up. Minimum requirements to follow-up: routine ECG registration and non less than one contact after 12 months passed.Results. In Russian patients there were more common obesity (46,1% and 29,2%, p<0,001), hypertension heart disease (40,2% and 22,8%, p<0,0001), coronary heart disease (31,7% and 16,2%, p<0,0001), chronic heart failure (67,3% and 13,0%, p<0,0001). In Russia the patients more commonly underwent primary CA (83,5% in Russia and 77,6% in European countries, p<0,05), more rare in Russia the cryoballoon ablation was done (3% and 18%, p<0,05). Generally adverse events were reported more rare in Russia (10,5% and 16,6%, p=0,0007), including cardiovascular adverse events (2,6% and 5,2%, p<0,05). Tachiarrhythmias recurs were diagnosed more rare in Russia, including by the subsutaneous ECG monitors (17% and 1,6% in other countries, р<0,001). Within the year of follow-up, full absence of tachiarrhythmias recurs in Russia was found in 65,8% of patients, in other countries — in 74,7% (р=0,0003).Conclusion. In real clinical setting, high efficacy of CA AF was shown, resistant to antiarrhythmic therapy. In most of Russian patients there were cardiovascular comorbidities. There was lower rate of reported adverse events in Russian centers of interventional treatments

Antiarrhythmic drug therapy after atrial fibrillation ablation: data of the ESC-EHRA registry

Aim. Catheter ablation (CA) is an effective approach for rhythm control in atrial fibrillation (AF), however antiarrhythmic therapy (AAT) remains important. There is a lack of data about long-term AAT use after CA. This study evaluates AAT after CA for AF.Material and methods. In 2012-2016, EURObservational Research Programme of Atrial Fibrillation Ablation Long-Term (EORP AFA L-T) registry was conducted, which included 476 Russian patients (57,1% — men; mean age — 57,1±8,7 years). The follow-up after CA was 12 months (available in 81,9% of patients). The use of AAT was evaluated prior to hospitalization, during hospitalization for CA, as well as at 3, 6 and 12 months of follow-up.Results. Prior to CA, 439 (92,2%) patients received AAT During CA, 459 (96,4%) patients were treated with AAT. After CA, AAT was used by 463 (97,3%), 370 (94,8%), and 307 (78,7%) patients at 3, 6 and 12 months of follow-up, respectively. There was no arrhythmia recurrence in 187 (47,9%) subjects. Among these patients, 40 (21,4%) received class IC or III AAT. The peak of AAT use was found for class IC agents within 3 months after CA (P<0,05), while for other drugs this trend was not observed. There were no factors associated with AAT usage in patients without arrhythmia recurrence after CA. A positive correlation of arrhythmia non-recurrence with a minimum number of previously used antiarrhythmic agents was revealed (RR=0,85; 95% CI 0,73-0,98; P=0,03).Conclusion. The frequency of AAT use after AF ablation is significantly reduced. However, there is a cohort of patients without documented arrhythmia recurrence still receiving AAT, which requires special attention of physicians. There were no clinical predictors of continued AAT in subjects without arrhythmia recurrence