Preview

Rational Pharmacotherapy in Cardiology

Advanced search

CHANGE OF LOCAL MYOCARDIAL CONTRACTILITY DUE TO SELECTION OF DIFFERENT ARRHYTHMIA TREATMENT STRATEGIES IN PATIENTS WITH ISCHEMIC HEART DISEASE AND PAROXYSMAL ATRIAL FIBRILLATION

https://doi.org/10.20996/1819-6446-2014-10-2-160-165

Full Text:

Abstract

Aim. To study the change of local myocardial contractility in patients with ischemic heart disease (IHD) and paroxysmal atrial fibrillation (AF) during treatment with amiodarone 200 mg daily compared with bisoprolol therapy 5 mg daily.

Material and methods. A total of 47 IHD patients with persistent AF were enrolled in the study. Sinus rhythm (SR) was restored during the first 24 hours after admission in all the patients. After SR restoration patients were randomly allocated into two groups receiving either amiodarone 200 mg/day during 6 months for SR maintenance (group 1) or bisoprolol 5 mg daily for ventricular rate (VR) control (group 2). To estimate a local myocardial systolic function all the patients were undergone steady-state radionuclide ventriculography in the first 24 hours after SR restoration and 6 months later.

Results. Sinus rhythm saving at amiodarone therapy within 6 months led to an improvement of the local myocardial contractility of the left ventricle with a significant increase in normokinesis zones from 79 (58.1%)  to 92 (67.6%), hypokinesis and akinesia zones reduction from 46 (33.8%)  to 41 (30.2%)  and from 11 (8.1%) to 3 (2.2%) (p<0.05), respectively. Achieving the target values of ventricular rate during the remaining episodes of AF in patients of group II did not significantly affect the local left ventricle contractility.

Conclusion. 6-month SR maintenance with amiodarone intake in IHD patients with persistent AF resulted in significant reduction of akinesia zones and increase in the number of normokinesia segments.

About the Authors

V. I. Podzolkov
I.M. Sechenov First Moscow State Medical University
Russian Federation


A. I. Tarzimanova
I.M. Sechenov First Moscow State Medical University
Russian Federation


References

1. National guidelines for diagnosis and treatment of atrial fibrillation (2012). Available at: http://scardio.ru/content/Guidelines/FP_rkj_13.pdf. Accessed by: 21.04.2014. Russian (Национальные рекомендации по диагностике и лечению фибрилляции предсердий (2012). Доступно на: http://scardio.ru/content/Guidelines/FP_rkj_13.pdf. Дата доступа: 21.04.2014).

2. Guidelines for the management of atrial fibrillation. The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 2010;31(19):2369-429.

3. AFFIRM Investigators. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med 2002;347:1825-33.

4. Van Gelder IC, Hagens VE, Bosker HA et al. A comparison ofrate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med 2002;347:1834-40.

5. Carlsson J, Miketic S, Windeler J, STAF Investigators. Randomized trial of rate-control versus rhythmcontrol in persistent atrial fibrillation. J Am Coll Cardiol 2003;41:1690-96.

6. Opolski G, Torbicki A, Kosior DA. Rate control vs rhythm control in patients with nonvalvular persistent atrial fibrillation: the results of the Polish How to Treat Chronic Atrial Fibrillation (HOT CAFE) Study. Chest 2004;126:476-86.

7. Roy D, Talajic M, Nattel S, et al. Rhythm control versus rate control for atrial fibrillation and heart failure. N Engl J Med 2008;358:2667-77.

8. Hohnloser SH, Kuck KH, Lilienthal J et al. Rhythm or rate control in atrial fibrillation—Pharmacological Intervention in Atrial Fibrillation (PIAF): a randomised trial. Lancet 2000;356:1789-94.

9. Chung MK, Shemansk IL, Sherman DG. et al. Functional status in rateversus rhythm-control strategies for atrial fibrillation: results of the atrial fibrillation follow-up investigation of rhythm management (AFFIRM) functional status substudy. J Am Coll Cardiol 2005; 46: 1891-9.

10. Corley S. D., Epstein A. E., DiMarco J. P. et al. Relationships between sinus rhythm, treatment, and survival in the atrial fibrillation follow-up investigation of rhythm management (AFFIRM) study. Circulation 2004; 109: 1509-13.

11. Ionescu-Ittu R., Abrahamowicz M., Jack evicius C. A. et al. Comparative effectiveness of rhythm control vs rate control drug treatment effect on mortality in patients with atrial fibrillation. Arch Intern Med 2012; 172: 997-1004.

12. Nieuwlaat R., Capucci A., Camm A.J., et al. Atrial fibrillation management: a prospective survey in ESC member countries: the Euro Heart Survey on Atrial Fibrillation. Eur Heart J 2005; 26: 2422-34.

13. Goette A., Bukowska A., Dobrev D., et al. Acute atrial tachyarrhythmia induces angiotensin II type 1 receptor-mediated oxidative stress and microvascular flow abnormalities in the ventricles. Eur Heart J 2009; 30: 1411-20.

14. Hsu L.F., Jais P., Sanders P., et al. Catheter ablation for atrial fibrillation in congestive heart failure. N Engl J Med 2004; 351: 2373-83.

15. Khan M.N., Jais P., Cummings J., et al. Pulmonary-vein isolation for atrial fibrillation in patients with heart failure. N Engl J Med 2008; 359: 1778-85.

16. Rienstra M., Damman K., Mulder B.A. et al. Beta-blockers and outcomes in HF and AF. JACC 2013; (1):21-8.

17. Camm A. J., Savelieva I. Atrial fibrillation: the rate versus rhythm management controversy. J R Coll Physicians Edinb 2012; 42 Suppl 18: 23-34.

18. Kanorsky SG. Modern drug therapy for atrial fibrillation: the choice of strategy, antiarrhythmic drugs and regimens. Attending Physician 2012; (7): 1-5. Russian (Канорский С.Г. Современная медикаментозная терапия фибрилляции предсердий: выбор стратегии, антиаритмических препаратов и схем лечения. Лечащий Врач 2012; (7): 1-5).


For citation:


Podzolkov V.I., Tarzimanova A.I. CHANGE OF LOCAL MYOCARDIAL CONTRACTILITY DUE TO SELECTION OF DIFFERENT ARRHYTHMIA TREATMENT STRATEGIES IN PATIENTS WITH ISCHEMIC HEART DISEASE AND PAROXYSMAL ATRIAL FIBRILLATION. Rational Pharmacotherapy in Cardiology. 2014;10(2):160-165. (In Russ.) https://doi.org/10.20996/1819-6446-2014-10-2-160-165

Views: 517


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)