Rational Pharmacotherapy in Cardiology

Advanced search


Full Text:


Aim. To analyze current clinical practice in the treatment of atrial fibrillation (AF) in emergency care department of multidisciplinary hospital in 2008-2009. Material and methods. Retrospective continuous pharmacoepidemiology study was carried out. Hospital history sheets of the patients admitted to the emergency care department in the period from 01.01.2008 to 31.12.2009 were analyzed. Results. Physicians of emergency care department mainly chose strategy of sinus rhythm restoration and maintenance in patients with paroxysmal and persistent AF . To implement this strategy pharmacological cardioversion was performed in patients with stable hemodynamics. The most frequently used medicine for pharmacological cardioversion was procainamide (60% of all prescriptions). Its efficacy was about 50% as compared with this of 80% for amiodarone and propafenone. In order to maintain sinus rhythm monotherapy with beta-blockers or amiodarone was preferred. Conclusion. Overall, AF treatment corresponded to current guidelines. Physicians preferred strategy of sinus rhythm restoration and maintenance.

About the Authors

I. V. Graifer
Saratov Research Institute of Cardiology
Russian Federation

O. V. Reshet'ko
Saratov State Medical University named after V.I. Razumovsky
Russian Federation

N. V. Furman
Saratov Research Institute of Cardiology
Russian Federation


1. Falk R.H. Atrial Fibrillation. N Engl J Med 2001; 344(14):1067-1078

2. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation-executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation). Eur Heart J 2006; 27(16):1979-2030

3. Go A.S., Hylek EM., Phillips K.A. et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Facrots In Atrial Fibrillation (ATRIA) Study. JAMA 2001; 285(18):2370-2375

4. Bialy D., Lehmann M.N., Schumacher D.N. et al. Hospitalisation for arrhythmias in the United States: Importance of atrial fibrillation (Abstr). J Am Coll Cardiol 1992; 19: 41A

5. Bokeriya L.A., Revishvili A.Sh., Oganov R.G. et al. Clinical guidelines on the diagnosis and treatment of patients with atrial fibrillation. Vestnik aritmologii 2010; 59:53-77. Russian (Бокерия Л.А., Ревишвили А.Ш., Оганов Р.Г. и др. Клинические рекомендации по диагностике и лечению пациентов с фибрилляцией предсердий. Вестник аритмологии 2010; 59:53-77)

6. The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC) Guidelines for the management of atrial fibrillation. Eur Heart J 2010;31:2369– 2429

7. Lloyd-Jones D.M, Wang T.J., Leip E.P., Larson M.G., Levy D, Vasan R.S., et al. Lifetime risk for development of atrial fibrillation:the Framingham Heart Study. Circulation. 2004;110: 1042-1046

8. Wang T.J., Larson M.G, Levy D., et al. Temporal relations of atrial fibrillation and congestive heart failure and their joint infl uence on mortality: the Framingham Heart Study. Circulation 2003; 107: 2920–2925

9. Serdechnaya E.V., Tatarskiy B.A., Kazakevich E.V. Prevalence and clinical features of atrial fibrillation in north-west of the Russian Federation. Klinicheskaya meditsina 2009; 1:17-20. Russian (Сердечная Е.В., Татарский Б.А., Казакевич Е.В. Особенности распространенности и течения фибрилляции предсердий на северо-западе Российской Федерации. Клиническая медицина 2009; 1:17-20)

10. Krahn A.D., Benjamin E.J., Wolf P.A., Agostino R.B. el al. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation 1998;98:946-952

11. Wyse D.G., LoveJ.C, Yao Q. et al. Atrial fibrillation: a risk factor for increased mortality — an AVID registry analysis. J Interv Card Electrophysiol 2001; 5:267—273

12. Dries D.L., Exner D.V., Gersh B.J. et al. Atrial fibrillation is associated with an increased risk for mortality and heart failure progression in patients with asymptomatic and symptomatic left ventricular systolic dysfuntion: a retrospective analysis of the SOLVD trials. J Am Coil Cardiol 1998;32:695-703

13. REALISE atrial fibrillation registry 2010. Available on:

14. National guidelines for diagnosis and treatment of atrial fibrillation. Kardiovaskulyarnaya terapiya i profilaktika 2005; 4(4) Suppl 1: 1-32. Russian (Национальные рекомендации по диагностике и лечению фибриляции предсердий. Кардиоваскулярная терапия и профилактика 2005; 4(4) Приложение 1: 1-32)

15. Le Heuzey J.Y., Breithardt G., Camm J. et al. The RecordAF study: design, baseline data, and profile of patients according to chosen treatment strategy for atrial fibrillation. Am J Cardiol 2010;105(5):687-693

16. Miller O.N., Belyalov F.I. Atrial fibrillation: pre-hospital, hospital, and ambulatory management tactics. Rossiyskiy kardiologicheskiy zhurnal 2009; 4: 94-111. Russian (Миллер О.Н., Белялов Ф.И. Фибрилляция предсердий. Тактика ведения пациентов на догоспитальном, стационарном и амбулаторном этапах. Российский кардиологический журнал 2009; 4: 94-111)

17. Tatarsky B.A. Strategy for atrial fibrillation treatment: rate control or rhythm control. Serdtse 2010; 9(2): 114-122 (Татарский Б.А. Стратегия лечения фибрилляции предсердий: контроль частоты или контроль ритма. Сердце 2010; 9(2): 114-122)

18. Tatarsky B.A. Paroxysmal atrial fibrillation: choice of therapy suppresses. Kardiovaskulyarnaya terapiya i profilaktika 2007; 7(3): 78-85. Russian (Татарский Б.А. Пароксизмальные формы фибрилляции предсердий: выбор купирующей терапии. Кардиоваскулярная терапия и профилактика 2007; 7(3): 78-85)

19. Nieuwlaat R., EurlingsL.W., Capucci A. Atrial fibrillation in the ‘real world’: undecided issues. Eur Heart J Supplements. 2007; 9 (Supplement I): I122–I128

20. Petrov V.I., editor. Applied Pharmacoepidemiology. M.:GEOTAR-Media; 2008. Russian (Пет-ров В.И., редактор. Прикладная фармакоэпидемиология. М.:ГЭОТАР-Медиа; 2008)

21. Zyryanov S.K. Фармакоэпидемиология: вчера, сегодня, завтра. Farmateka 2003; 3: 13-17. Russian (Зырянов С.К. Фармакоэпидемиология: вчера, сегодня, завтра. Фарматека 2003; 3: 13-17)

22. Bergman U. Pharmacoepidemiology — from description to quality assessment. Norwegian Journal of Epidemiology 2001. 11: 31-36

23. Begaud B. Dangoumau J. Pharmacoepidemiology: definitions, problems, methodology. Therapie 2000. 55(1): 113-117

24. Miyasaka Y., Barnes M.E., Gersh B.J. et al. Coronary ischemic events after first atrial fibrillation: risk and survival. Am J Med 2007;120: 357-363

25. Heeringa J., van der Kuip D.A., Hofman A. et al. Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J 2006;27:949-953

26. Sato H, Ishikawa K, Kitabatake A. et al. Low-dose aspirin for prevention of stroke in low-risk patients with atrial fibrillation: Japan Atrial Fibrillation Stroke Trial. Stroke 2006;37:447-451

27. Nieuwlaat R., Capucci A., Camm J. Atrial fibrillation management: a prospective survey in ESC Member Countries The Euro Heart Survey on Atrial Fibrillation. Eur Heart J 2005. 26: 2422–2434

28. Padeletti L., Pieragnoli P., Jentzen V. The comorbidity of atrial fibrillation and heart failure a challenge for electrical therapies. Eur Heart J Supplements. 2007;. 9 (Supplement I): I81– I86

29. Carlsson J., Miketic S., Windeler J. et al. Randomized trial of rate-control versus rhythm-control in persistent atrial fibrillation: the Strategies of Treatment of Atrial Fibrillation (STAF) study. J Am Coll Cardiol 2003; 4:1690–1696

30. Wyse DG, Waldo AL, DiMarco J.P. et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med 2002;347:1825–1833]

31. Van Gelder I., Hessel F., Groenveld H. et al Lenient versus Strict Rate Control in Patients with Atrial Fibrillation N Engl J Med 2010 362-370

32. UK Propafenone PSVT Study Group. A randomized, placebo-controlled trial of propafenone in the prophylaxis of paroxysmal supraventricular tachycardia and paroxysmal atrial fibrillation. Circulation 1995;92:2550 –2557

33. Pritchett E.L., Page R.L., Carlson M. et al. Efficacy and safety of sustained-release propafenone (propafenone SR) for patients with atrial fibrillation. Am J Cardiol 2003;92:941– 946

34. Capucci A., Villani G.Q., Piepoli M.F. Reproducible efficacy of loading oral propafenone in restoring sinus rhythm in patients with paroxysmal atrial fibrillation. Am J Cardiol 2003;92:1345-1347

35. Fomina I.G., Tarzimanova A.I., Vetluzhsky A.V., Abramova A.A. Propafenone in restoring sinus rhythm among patients with persistent atrial fibrillation. PROMETEY — an open, multicenter, pilot study performed in the Russian Federation. Kardiovaskulyarnaya terapiya i profilaktika 2005;4 (4):65-69. Russian (Фомина И.Г., Тарзиманова А.И., Ветлужский А.В., Абрамова А.А. Пропафенон при восстановлении синусового ритма у больных с персистирующей формой фибрилляции предсердий. «ПРОМЕТЕЙ» — открытое, мультицентровое, пилотное исследование в Российской Федерации. Кардиоваскулярная терапия и профилактика 2005;4 (4):65-69)

36. Tatarsky B.A. “Pill in the pocket” strategy for atrial fibrillation treatment. Rossiyskiy kardiologicheskiy zhurnal 2005;4:72-75. Russian (Татарский Б.А. Стратегия «таблетка в кармане» при купировании фибрилляции предсердий. Российский кардиологический журнал 2005;4:72-75)

37. Nerga A., Rosenqvist M., Nordlander R. et al Maintenance of sinus rhythm with metoprolol CR initiated before cardioversion and repeated cardioversion of atrial fibrillation: a randomized double-blind placebo-controlled study Eur Heart J 2007; 28:1351–1357

38. Katritsis D.G., Panagiotakos D.B., Karvouni E. et al. Comparison of effectiveness of carvedilol versus bisoprolol for maintenance of sinus rhythm after cardioversion of persistent atrial fibrillation. Am J Cardiol 2003;92:1116-1119

39. Steeds R.P., Birchall A.S., Smith M. et al. An open label, randomised, crossover study comparing sotalol and atenolol in the treatment ofsymptomatic paroxysmal atrial fibrillation. Heart 1999;82:170 –175

40. Roy D., Talajic M., Dorian P. et al. Amiodarone to prevent recurrence of atrial fibrillation. Canadian Trial of Atrial Fibrillation Investigators. N Engl J Med 2000;342:913–920

41. Kochiadakis G.E., Igoumenidis N.E., Marketou M.E. et al. Low dose amiodarone and so-talol in the treatment of recurrent, symptomatic atrial fibrillation: a comparative, placebo controlled study. Heart 2000;84: 251–257

42. Zimetbaum Р. Amiodarone for Atrial Fibrillation N Engl J Med 2007;356:335-341

43. Khan I.A., Mehta N.J., Gowda R.M. Amiodarone for pharmacological cardioversion of recent-onset atrial fibrillation. Int J Cardiol 2003;89:239-248

44. Kushakovskiy M.S. Atrial fibrillation. SPb: «Foliant»; 1999. Russian (Кушаковский М.С. Фибрилляция предсердий. СПб: «Фолиант»; 1999).

45. Nedostup A.V., Blagova O.V. How to treat arrhythmias. M: Medpress-info; 2007. Russian (Недоступ А.В., Благова О.В. Как лечить аритмии. М: Медпресс-инфо; 2007)

46. Neuberger H., Mewis C., Veldhuisen D. et al Management of atrial fibrillation in patients with heart failure Eur Heart J 2007; 28: 2568–2577

47. Goto S., Bhatt D., Rother J. et al. Prevalence, clinical profile, and cardiovascular outcomes of atrial fibrillation patients with atherothrombosis Am Heart J 2008 156; 5:855-863

48. Lakshminarayan K., Solid C.A., Collins A.J. et al. Atrial fibrillation and stroke in the general Medicare population: a 10-year perspective (1992 to 2002). Stroke 2006;37: 1969-1974

For citation:


Views: 423

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

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