The aim – to compare clinical and morphofunctional characteristics of patients with nonvalvular persistent atrial fibrillation and flutter (AF and AFL) with and without early arrhythmia recurrence after cardioversion.
Material and methods. One hundred and fifty patients with documented persistent AF/AFL, who underwent successful cardioversion during hospitalization period, were involved in the prospective one-center study. Scheduled registration of ECG, continuous Holter ECG monitoring and event monitoring within 7 days were performed to identify AF/AFL recurrences. Demographic, clinical and functional characteristics, concomitant diseases, treatments were compared in groups of patients with (n=50) and without (n=100) early recurrence of atrial fibrillation after cardioversion.
Results. Isolated AF occurred more often in patients without AF/AFL recurrences (Р=0.00116); AF was more often combined with different types of AFL in patients with arrhythmia recurrent episodes (Р=0.001). Patients with AF/AFL recurrences had longer duration of arrythmia history (Р=0.00048) and also tendency towards longer duration of last AF/AFL episode (Р=0.077). Patients with AF/AFL recurrences had lower daily average and minimum heart rate, larger amount of supraventricular extrasystoles (Р=0.0001), couplets (Р=0.00002) and groups (Р=0.0001) during 24-hour Holter ECG monitoring. There were more paroxysms of atrial tachycardia (Р=0.0019) in patients with AF/AFL recurrences as well.
Conclusions. Recurrent episodes of AF/AFL during hospitalization occur in one third of the patients after successful electrical or chemical cardioversion. The 24-hour Holter monitoring of ECG and event monitoring raises possibility to detect rhythm disorder at early stages after cardioversion. Presence of AFL, detection of frequent supraventricular extrasystoles, couplets and groups and short paroxysms of atrial tachyarrhythmia could be strong predictors of AF/AFL early recurrence.
The aim – to evaluate the clinical efficiency and safety of ethacizine in patients with ventricular extrasystoles (VES) without severe structural damage of the myocardium during 3 and 6 months of treatment.
Material and methods. There were examined 56 patients aged 34 to 62 years without severe structural myocardial lesions with frequent symptomatic VES requiring antiarrhythmic therapy. Anamnesis of VES was 3–14 years, on average 6.2±1.5 years. All patients were prescribed antiarrhythmic agent in a fixed dose of 50 mg t.i.d. Efficiency and safety were assessed by subjective data and ECG.
Results. When applying ethacizine for 3 months, positive antiarrhythmic effect was observed in 92.9 % of patients: in 57.2 % it was considered complete (complete or almost complete disappearance of cardiac interruptions) and in 35.7 % – as partial (reduction of symptomatic arrhythmias in 50–75 %). After 6 months of treatment, the antiarrhythmic effect of ethacizine was retained in 84 % of patients: the total antiarrhythmic effect was observed in 53.6 % and partial – in 30.4 % of patients. In most patients, antiarrhythmic effect was achieved with usage of ethacizine at a dose of 100–150 mg/day. Treatment with ethacizine in 5.4 % patients was accompanied by transient extracardiac reactions (dizziness or disturbance of accommodation). Cardiac reactions – increase in the duration of the PQ interval and QRS complex – didn’t reach the level of atrioventricular blockade and left bundle branch block.
Conclusions. Treatment with ethacizine for 6 months in patients with VES without severe structural damage to the myocardium was accompanied by improvement of the contractile function and relaxation of the myocardium, as well as an increase in the physical and mental components of quality of life by the MOS SF-36 questionnaire.
The aim – to evaluate the psychometric properties of HeartQoL in patients with non-valvular atrial fibrillation-flutter (AF–AFl), by assessing its internal consistency, construct validity, and test-retest reliability.
Material and methods. The study consisted of two phases: cross sectional, including 329 patients with AF–AFl who filled in HeartQol, SF-12, AFEQT and HADS for the evaluation of internal consistency, construct, discriminative validities and longitudinal one, including 53 patients completing HeartQoL twice to evaluate test-retest reliability.
Results. Internal consistency was sufficient, Cronbach’s alpha (α)=0.94 for physical HeartQol scale and 0.88 for psychological HeartQol scale. The construct validity was sufficient, as subscales of HeartQoL had moderate to strong correlations with similar (r≥0.55) and weakly correlated (r≤0.55) with dissimilar subscales of other questionnairies. The HeartQoL demonstrated ability to distinguish between different clinical subgroups of patients, indicating sensitivity.
Conclusions. The HeartQoL showed overall satisfactory psychometric properties, demonstrating it to be a valid instrument in the evaluation of health related quality of life in patients with AF–AFl.
The aim – to compare concomitant diseases, myocardial structure and function, clinical symptoms and course of arrhythmia in patients with first diagnosed atrial fibrillation (FDAF) with and without severe cardiovascular complications at 6-month follow-up.
Material and methods. In total, the study group included 124 patients. We evaluated symptoms, cardiovascular disease, risk factors, comorbidities, renal and thyroid function, carbohydrate and lipid metabolism, results of echocardiography, background therapy. Overall, the 6-month observation period in 25 (20.1 %) patients registered cases of death and serious cardiovascular events. For comparison of clinical-anamnestic and instrumental characteristics, groups of patients with complications (n=25) and without complications (n=99) were formed.
Results. The features of the group of patients with complications were the senior age, as well as a significantly greater initial frequency of heart failure, previous heart attacks and strokes, and diabetes mellitus. The frequency of manifestation of hypertension and coronary heart disease (except post-infarction cardiosclerosis) did not differ in comparable groups. The likelihood of complications also depended on the form of the FDAF. In particular, complications were significantly more often registered in patients with a permanent form of AF. Patients from the complicated group were characterized by more pronounced changes in the structural and functional state of the myocardium: larger left ventricular myocardium mass index and end-diastolic volume, lower left ventricular ejection fraction, significantly more often they detected moderate or severe mitral and tricuspid regurgitation.
Conclusions. Independent predictors of adverse prognosis at 6-month follow proved to be heart failure III–IV functional class NYHA, mitral regurgitation II–III degree. Comparable groups did not differ regarding severity of clinical symptoms by EHRA scale.
The aim – to compare cardiovascular risk factors, clinical characteristics, myocardial structure and function in patients with isolated AFL to those in patients with AFL combined with AF; to summarize management data of hospitalized patients with atrial flutter in real-life clinical practice.
Material and methods. The study included 126 hospitalized patients with atrial flutter, 86 men (68.3 %) and 40 women (31.7 %), median age 65.5 (quartiles 55–73) years. All patients were divided into two groups. The first group consisted of 58 (46.0 %) patients with isolated AFL, second group – 68 (54.0 %) patients with AFL combined with AF. Cardiovascular risk factors, concomitant diseases, anthropometric data, laboratory and echocardiographic parameters were compared between two groups.
Results. Рatients with isolated AFL were older than patients with AFL combined with AF (69.5 (60–75) vs 60.5 (50.5–72.5), Р=0.003); more of them were males (46 (79.3 %) vs 40 (58.8 %), Р=0.02). No differences regarding prevalence of concomitant disease and cardiovascular risk factors in the compared groups were revealed, but significant prevalence of chronic lung disease in patients with isolated AFL. There was no significant differences between the CHA2DS2-VASc cardiovascular risk factors found [2.97 (1.48–4.5) vs 2.62 (1.31–4.3), Р=0.26]. Patients with AFL combined with AF had longer history of arrhythmias [84 (10–192) vs. 10 (1–48) weeks, Р=0.006]. Concomitant AF was significantly less common in patients with first-detected AFL (17 (29.3 %) versus 10 (14.7 %), Р=0.05). Warfarin use was less frequent in patients with isolated AFL (15 (25.9 %) versus 31 (45.6 %), Р=0.02), despite the same high cardiovascular risk of thromboembolic events in both groups.
Conclusions. AFL coexists with AF in 54 % of consecutively hospitalized patients. The results showed the difficulties of rhythm control in patients with AFL, high prevalence of concomitant diseases, high risk of thromboembolic events. Study showed underuse of anticoagulant therapy in patients with isolated AFL, low frequency of catheter ablation.
The aim – to identify factors that might predict reduced quality of life scores in patients with non-valvular atrial fibrillation-flutter (AF-AFl).
Material and methods. In prospective cross-sectional study we evaluated 328 patients with non-valvular AF-AFl, mean age 61.7±9.96 years, among them 126 (38.4 %) females. The quality of life was assessed by means of specific instruments AF-QоL and AFEQT.
Results. The lowest overall score by AFEQT (48.1±19.7) as well as by AF-Qol (38.3±17.6) was registered in patients with paroxysmal AF-AFl and the highest overall score – patients with persistent AF-AFl after cardioversion (68.7±20.8 and 52.5±19.1, correspondingly). In multivariate regression model independent predictors of global AF-Qol were class NYHA (β=0.22, Р<0.001), HADS anxiety (β=–0.21, Р<0.001), HADS depression (β=–0.20, Р<0.001), paroxysmal form of arrhythmia (β=–0.16, Р=0.001), CHA2DS2VASc score (β=–0.6, Р=0.002). Independent predictors of the overall AFEQT score were class NYHA (β=–0.38, Р<0.001), HADS anxiety (β=–0.25, Р<0.001), female gender (β=–0.22, Р<0.001) and paroxysmal form of arrhythmia (β=–0.14, Р=0.001).
Conclusions. Heart failure class NYHA, symptoms of anxiety, depression, female gender and paroxysmal form of arrhythmia were associated with significantly reduced quality of life in patients with non-valvular atrial fibrillation-flutter.
The aim – to evaluate predictors of cardiovascular outcomes in patients with non-valvular atrial fibrillation and flutter, to evaluate influence of medical therapy and adherence to therapy on their reduction.
Material and methods. In prospective observational study with mean follow up of 38.7±2.4 months we recruited 271 patients with atrial fibrillation and flutter. The primary endpoint was occurrence of ischemic stroke / ТІА and the combined end point (CEP) was stroke / TIA, peripheral embolism or death of any cause.
Results. Among 271 patient 46 (16.96 %) reached CEP and among them 27 (9.96 %) experienced ischemic stroke/TIA. In multivariate model spontaneous echo contrast 3–4+ and CHA2DS2-VASc were independent predictors of ischemic stroke and CEP (P<0.05 for both). Рermanent AF, class EHRAm III–IV and diameter of interventricular septum ≥ 1.7 sm were also independently associated with stroke. In patients with CHA2DS2-VASc ≥ 2, anticoagulants usage was associated with significant reduction of stroke compared to aspirin or no drugs (hazard ratio (HR) 0,23 (95 % CI 0.1–0.63), Р=0.002). On the other hand we haven’t found any reduction of stroke in aspirin patients compared to no drugs. Moreover, anticoagulation was associated with reduction of CEP compared to aspirin or no drugs (HR 0.33 (95 % CI 0.17–0.66), Р=0.0001). Adherence to recommendations for anticoagulation therapy was associated with reduction of stroke. There was reduction of CEP in the rhythm control group, comparing to rate control group (5 (6.17 %), vs 21 (21.2 %) appropriately, HR 0.29 (95 % CI 0.11–0.72), Р=0,001).
Conclusions. In patient with CHA2DS2-VASc ≥ 2 anticoagulation therapy and adherence to its recommendations was associated with significant reduction of ischemic stroke and CEP. Rhythm control was associated with reduction of CEP.
The aim – to demonstrate reliability, validity and responsiveness of the Russian language version of the AF-QоL questionnaire using it in patients with atrial fibrillation and flutter (AF – AFl).
Material and methods. In prospective observational study, we evaluated 288 patients with non-valvular AF – AFl. Mean age was 61.4±9.9 years. Persistent arrhythmia was registered in 167 (58.0 %), long-lasting persistent form in 21 (7.3 %), permanent form – in 63 (21.9 %) and paroxysmal – in 37 (12.8 %) patients. Participants completed AF-QоL at baseline and 75 of them at ≥ 1 month.
Results. Internal consistency was > 0.81 for all scales. AF-QоL had reasonably good convergent and divergent validity. Lower AF-QоL scores were observed along with increased EHRA and NYHA classes. Contrary to patients with recurrence of AF – AFl, patients with sinus rhythm had significantly better global and physical AF-QоL (41.4±18.8 vs 53.0±19.1, Р=0.01, and 35.7±21.5 vs 51.7±23.6, Р=0.003, respectively). Such changes translated into an effect sizes were consistent with moderate clinical changes.
Conclusions. Initial validation of russian version of AF – AFl supports possibility of its use as an instrument for measurement of health-related quality of life in patients with AF – AFl.
The aim – to demonstrate reliability, validity and responsiveness of the Russian version of the Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) questionnaire for using it in patients with atrial fibrillation and flutter (AF-AFl).
Material and methods. The prospective, observational study was performed in 274 patients with non-valvular AF-AFl. Mean age was 61.4±9.7 years. Persistent arrhythmia was in 160 (58.4 %), long-lasting persistent form – in 20 (7.3 %), permanent form – in 61 (22.3 %) and paroxysmal – in 33 (12 %) patients. Participants completed AFEQT at baseline and 69 of them at ≥ 1 month.
Results. Internal consistency was > 0.85 for all scales. Lower AFEQT scores were observed with increased EHRA and NYHA classes. Patients with recurrence of AF had the same scores of general AFEQT 58.1± 20.9 vs 60.4±20.9 at follow-up. Patients with sinus rhythm at time of follow-up had significantly better AFEQT 50.8±19.6, vs 65.8±23.5 (Р=0.005). Significant changes were found in all domains of AFEQT and their effect sizes were consistent with moderate or large clinical changes.
Conclusions. Initial validation of the Russian version of AFEQT supports its use as an outcome in clinical studies and as additional means to clinically follow patients with AF.
The aim – to work out an algorithm of anticoagulant therapy (ACT) with rivaroxaban in restoring sinus rhythm in patients with non-valvular atrial flutter (AFl) type I (TA), based on clinical data and parameters of transthoracic and transesophageal echocardiography (TEE).
Material and methods. We enrolled 88 patients with AFl; average age 58.9±0.8 years. TP occurred in 65.9 % of patients on the basis of coronary heart disease and 34.1 % of patients – myocardial fibrosis. All patients underwent TEE. Cardioversion was performed by means of transesophageal pacing. ACT with rivaroxaban 20 mg per day was administered during the first day after the arrhythmia detection.
Results. The frequency of the phenomenon of spontaneous echo contrast (SEC) 3–4+ in the left atrial appendage (LAA) was 8 %, thrombi – 1.1 %, and the average LAA ejection velocity 47.7±2.4 cm/sec. All patients were subdivided into two groups: the 1st (n=81) – SEC 0–2+; the 2nd (n=7) – SEC 3–4+. Both groups were comparable by age, duration of the current episode of AFl, the primary and secondary co-morbidities, and severity of heart failure. In the 2nd group LAA functional parameters were significantly lower compared to the 1st group. Additionally, the enlargement of all heart cavities and concomitant atrial fibrillation (AF) were more frequent in the 2nd group (Р=0.03). The cycle duration was longer in the 2nd group comparing with the 1st.
Conclusions. The original algorithm allows the use of rivaroxaban in order to optimize the protocol of the elective cardioversion and to reduce cost of the treatment. In case of arrhythmia identification rivaroxaban is administered as early as possible. TEE is performed, and in case of absence of the signs of thrombus formation (presence of thrombus or SEC 3–4+) the cardioversion is performed immediately or within the first few days. After restoration of the sinus rhythm, patients continue to receive ACT for 1 week, taking into consideration the possible early AFl recurrence or concomitant AF. In case of SEC 3–4+ ACT is prescribed according to the existing guidelines.