COMPARISON OF EFFECTIVENESS OF ANTIARRHYTHMIC THERAPIES IN POSTOPERATIVE PERIOD OF PULMONARY VEIN OSTIA CATHETER ISOLATION FOR PREVENTION OF EARLY RECURRENCES OF ATRIAL TACHYARRHYTHMIAS IN THE PROOF STUDY

. Aim. To study the effectiveness of antiarrhythmic drugs: propafenone, sotalol and verapamil for the prevention of recurrence of atrial fibrillation (AF) and other atrial tachyarrhythmias in the early postoperative period after pulmonary vein ostia catheter isolation in patients with paroxysmal AF.

Material and methods. Patients (n=243) were included into a prospective, comparative, open-label, randomized study with a control. They were divided into 4 groups: Patients of Group 1 (n=61) received verapamil retard 240 mg/day., Group 2 (n=62) – propafenone 450 mg/day, group 3 (n=60) – sotalol 160 mg/day. Patients of control Group 4 (n=60) did not receive antiarrhythmic drugs. Patient's diary, ECG, 24-hour Holter ECG monitoring, and percutaneous heart monitor were used to detect arrhythmias in the early postoperative period.

Results. During the first 3 months of postoperative period we registered 8.62±9.37 pharmacological cardioversions in Group 2, 13.24±10.77 in Group 1 (p=0.013), and 11.93±12.02 in Group 3 (p=0.123). Besides we performed 0.40±1.03 electrical cardioversions in Group 2, 1.016±1.74 in Group 1 (p=0.024), and 1.033±1.52 in Group 3 (p=0.0096). A number of hospitalizations was 0.447±0.57 in Group 2, 0.684±0.73 in Group 1 (p=0.0012), and 0.592±0.67 in Group 3 (p=0.074).

Conclusion. Better clinical effectiveness for prevention of atrial tachyarrhythmias recurrence in the early postoperative period was found in the propafenone group.

atrial fibrillation, radiofrequency ablation of pulmonary veins, the early postoperative period, verapamil, propafenone, sotalol, PROOF study

1. Kirchhof P., Benussi S., Kotecha D., et al. 2016 Esc Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. The Task Force for the management of atrial fibrillation of the ESC. Developed with the special contribution of the EHRA of the ESC. Endorsed by the ESO. Eur Heart J. 2016;37(38):2893-962.

2. January C.T., Wann S., Alpert J.S., et al. 2014 AHA/ACC/HRS Guidelines for the Management of Pa- tients With Atrial Fibrillation: Executive Summary. J Am Coll Cardiol. 2014;64(21):e1-76.

3. Diagnostics and management of atrial fibrillation. RSC and RNSA guidelines, 2012. Rossiyskiy Kardi- ologicheskiy Zhurnal. 2013;4(102) suppl 3:6-76. (In Russ.) [Диагностика и лечение фибрилляции предсердий. Рекомендации РКО и ВНОА, 2012. Российский Кардиологический Журнал. 2013; 4(102) приложение 3: 6-76].

4. Schotten U., Verheule S., Kirchhof P., Goette A. Pathophysiological mechanisms of atrial fibrillation: a translational appraisal. Physiol Rev. 2011;91(1):265-325.

5. Pappone E., Rosanio S., Oreto G., et al. Circumferential Radiofrequency Ablation of Pulmonary Vein Os- tia A New Anatomic Approach for Curing Atrial Fibrillation Carlo. Circulation. 2000;102:2619-28.

6. Julio J., Chierchia G.B., Chierchia C., et al. Regular atrial tachycardias following vein isolation for parox- ysmal atrial fibrillation: a comparison between the cryoballoon and radiofrequency techniques. J In- terv Card Electrophysiol. 2015;42:161-9.

7. Calkins H., Brugada J., Packer D.L., et al. HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Heart Rhythm. 2007;4(6): 816-61.

8. Calkins H., Kuck K.H., Cappato R., et al. 2012 HRS/EHRA/ECAS Expert Consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Europace. 2012;14(4):528-606.

9. Tarasov A.V., Davtyan K.V., Martsevich S.Yu., Shatakhtsyan V.S. Prevention of atrial tachyarrhythmia in post-operation period of pulmonary veins ostia catheter isolation in paroxysmal atrial fibrillation. Kar- diovaskulyarnaya Terapiya i Profilaktika. 2016;15(5):43-9. (In Russ.) [Тарасов А.В., Давтян К.В., Мар- цевич С.Ю., Шатахцян В.С. Профилактика предсердных тахиаритмий в послеоперационном пе- риоде катетерной изоляции устьев легочных вен у пациентов с пароксизмальной формой фиб- рилляции предсердий. Кардиоваскулярная Терапия и Профилактика. 2016;15(5):43-9].

10. Sokolov S.F. Allapinin and modern approaches to the treatment of cardiac arrhythmias. Russkiy Med- itsinskiy Zhurnal. 2012;(4):77. (In Russ.) [Соколов С.Ф. Аллапинин и современные подходы к лечению нарушений ритма сердца. Русский Медицинский Журнал. 2012;(4):77].

11. Elesin D.A., Romanov A.B., Turov A.N., et al. Radiofrequency ablation of paraxysmal and prolonged persistent atrial fibrillation: one-year follow-up with the use of continuous subcutaneous monitoring. Vestnik Aritmologii. 2011;63:5-11. (In Russ.) [Елесин Д.А., Романов А.Б., Туров А.Н. и др. Ра- диочастотная аблация пароксизмальной и длительно персистирующей форм фибрилляции пред- сердий: 1-летний период наблюдения с помощью непрерывного подкожного мониторирования. Вестник Аритмологии. 2011;63:5-11].

12. Goldenberg G.R., Burd D., Lodzinski P., et al. Antiarrhythmic therapy as an adjuvant to promote post pulmonary vein isolation success - a meta-analysis. J Interv Card Electrophysiol. 2016;21:98-109.

13. Turco P, De Simone A., La Rocca V., et al. Antiarrhythmic drug therapy after radiofrequency catheter ablation in patients with atrial fibrillation. Pacing Clin Electrophysiol. 2007;30:S112-5.

14. Wu G., Jiang H., Huang C., et al. Effects of early postoperative antiarrhythmic drugs on atrial fibril- lation recurrence in the circumferential ablation of pulmonary vein. Chin J Canliol. 2008;36:7.

15. Darcner S., Chen X., Hansen J., et al. Recurrence of arrhythmia following short-term oral AMIOdarone after CATheter ablation for atrial fibrillation: a double-blind,radiomized, placebo-controlled study (AMIO- CAT trial). Eur Heart J. 2014;35:3356-64.

16. Kaitani K., Inoue K., Kobori A., et al. EAST-AF trial investigators. Efficacy of antiarrhythmic drugs short- term use after catheter ablation for atrial fibrillation (EAST-EF) trial. Eur Heart J. 2016;37(7);610-8.