Yu.V. Zinchenko, M.R. Ikorkin. The use of rivaroxaban in restoring sinus rhythm in patients with atrial flutter

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.

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