mvjrМедицинский вестник Юга РоссииMedical Herald of the South of Russia2219-80752618-7876The Rostov State Medical University10.21886/2219-8075-2016-3-78-86mvjr-424Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESКОРРЕЛЯЦИЯ МЕЖДУ СЕРДЕЧНЫМ РИТМОМ И СИМПТОМАМИ У ПАЦИЕНТОВ С ПАРОКСИЗМАЛЬНОЙ ФОРМОЙ ФИБРИЛЛЯЦИИ ПРЕДСЕРДИЙ ПОСЛЕ КАТЕТЕРНОЙ АБЛАЦИИ И АНТИАРИТМИЧЕСКОЙ ТЕРАПИИ ПО ДАННЫМ ИМПЛАНТИРУЕМЫХ КАРДИОМОНИТОРОВCORRELATION BETWEEN HEART RHYTHM AND SYMPTOMS IN PATIENTS WITH PAROXYSMAL ATRIAL FIBRILLATION AFTER CATHETER ABLATION AND ANTIARRHYTHMIC THERAPY BASED ON DATA OBTAINED FROM IMPLANTABLE CARDIAC MONITORSСимонянА. А.SimonyanA. A.kardio@stv.runnet.ruКолесниковВ. Н.KolesnikovV. N.kardio@stv.runnet.ruВиленскийЛ. И.VilenskyL. I.kardio@stv.runnet.ruКривошеевЮ. С.KrivosheevYu. S.kardio@stv.runnet.ruБаштаД. И.BashtaD. I.kardio@stv.runnet.ruГатилоМ. Ю.GatiloM. Yu.kardio@stv.runnet.ruМодниковК. В.ModnikovK. V.kardio@stv.runnet.ruРомановА. Б.RomanovA. B.Краевой клинический кардиологический диспансерРоссияRegional clinical cardiological dispensaryRussian FederationНовосибирский научно-исследовательский институт патологии кровообращения имени академика Е. Н. МешалкинаРоссияNovosibirsk research institute of blood-circulation pathology n.a. Acad. E. N. MeshalkinRussian Federation201630092016037886Copyright © Симонян А.А., Колесников В.Н., Виленский Л.И., Кривошеев Ю.С., Башта Д.И., Гатило М.Ю., Модников К.В., Романов А.Б., 20162016Симонян А.А., Колесников В.Н., Виленский Л.И., Кривошеев Ю.С., Башта Д.И., Гатило М.Ю., Модников К.В., Романов А.Б.Simonyan A.A., Kolesnikov V.N., Vilensky L.I., Krivosheev Y.S., Bashta D.I., Gatilo M.Y., Modnikov K.V., Romanov A.B.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medicalherald.ru/jour/article/view/424Цель

Цель: выявление корреляции между симптомами и сердечным ритмом, а также оценка частоты встречаемости симптомных и бессимптомных пароксизмов фибрилляции предсердий (ФП) у пациентов с пароксизмальной формой ФП после катетерной аблации ФП и антиаритмической терапии (ААТ) в ходе длительного наблюдения по данным анализа имплантируемых кардиомониторов (ИКМ).

Материалы и методы

Материалы и методы: 92 пациента с пароксизмальной формой ФП были рандомизированы на две группы: 1) катетерная аблация ФП + имплантация ИКМ (группа I; n=46); 2) ААТ + имплантация ИКМ (группа II; n=46). Данные, записанные устройством, сопоставляли с дневниками симптомов, которые вели все пациенты.

Результаты

Результаты: в течение периода наблюдения, составившего 24 месяца, у 17 (40%) пациентов из группы катетерной аблации и у 33 (71,8%) пациентов из группы ААТ отмечались рецидивы ФП, из которых у 4 (23,5%) пациентов из группы катетерной аблации и у 1 (3%) пациента из группы ААТ пароксизмы носили бессимптомный характер. Только 30% зарегистрированных ИКМ эпизодов в группе катетерной аблации ФП + ИКМ и 78% эпизодов у пациентов, получающих ААТ+ИКМ, соответствовали истинным пароксизмам ФП.

Заключение

Заключение: состояние ритма не соответствует симптомам пациента в отношении фибрилляции предсердий, что проявляется у 70% пациентов после катетерной аблации и 22% после ААТ. Бессимптомная ФП чаще встречается у пациентов в группе катетерной аблации (23,5%) по сравнению с группой пациентов, получающих ААТ (3%). Субьективная оценка симптомов пациентами в отношении аритмии не соответствует истинному состоянию ритма сердца и не может быть использована для оценки эффективности лечения.

Purpose

Purpose: to reveal a correlation between the symptoms and heart rhythm as well as to evaluate the incidence of symptomatic and asymptomatic paroxysmal atrial fibrillation (AF) in patients with paroxysmal AF after catheter ablation and antiarrhythmic drug therapy (AAD) through long-term observation based on data from implantable cardiac heart monitors (ICM).

Materials and Methods

Materials and Methods: 92 patients with paroxysmal AF were randomly broken into two groups: 1) AF catheter ablation + ICM (Group I; n=46); 2) AAD + ICM (Group II; n=46). The data recorded by the device were matched against the symptoms diaries kept by the patients.

Results

Results: through the follow-up period (24 months), 17 (40%) patients of the catheter ablation Group and another 33 (71.8%) patients belonging to the AAD Group had AF relapse, whereas in 4 (23.5%) patients of the catheter ablation group and in 1 (3%) patients of the AAD group the paroxysms were asymptomatic. Only 30% of episodes recorded by the ICM in the AF catheter ablation + ICM Group and 78% of episodes in patients receiving AAD + ICM were found to be true AF paroxysms.

Summary

Summary: the rhythm status did not match the patients’ symptoms in terms of AF, which was observed in 70% of the cases after catheter ablation and in 22% of cases in the AAD group. Asymptomatic AF was more common among the patients belonging to the catheter ablation group (23.5%) if compared to those who underwent AAD (3%). The subjective evaluation of the symptoms done by the patients regarding their arrhythmia did not reflect the true state of things related to the heart rhythm, which makes such evaluation not reliable if employed to judge the treatment efficiency.

пароксизмальная фибрилляция предсердийимплантируемые кардиомониторыкатетерная аблацияантиаритмическая терапиясимптомная и бессимптомная фибрилляция предсердийparoxysmal atrial fibrillationimplantable cardiac monitorscatheter ablationantiarrhythmic drug therapysymptomatic and asymptomatic atrial fibrillationReferencesChugh S.S., Blackshear J.L., Shen W.K., et al. Epidemiology and natural history of atrial fibrillation: clinical implications. J Am Coll Cardiol 2001; 37: 371–378.Chugh S.S., Blackshear J.L., Shen W.K., et al. Epidemiology and natural history of atrial fibrillation: clinical implications. J Am Coll Cardiol 2001; 37: 371–378.Botto G.L., Padeletti L., Santini M., et al. Presence and duration of atrial fibrillation detected by continuous monitoring: Crucial implications for the risk of thromboembolic events. J Cardiovasc Electrophysiol 2009;20:241–248.Botto G.L., Padeletti L., Santini M., et al. Presence and duration of atrial fibrillation detected by continuous monitoring: Crucial implications for the risk of thromboembolic events. J Cardiovasc Electrophysiol 2009;20:241–248.Pappone C., Augello G., Sala S., et al. A randomized trial of circumferential pulmonary vein ablation versus antiarrhythmic drug therapy in paroxysmal atrial fibrillation. J Am Coll Cardiol 2006;48:2340-2347.Pappone C., Augello G., Sala S., et al. A randomized trial of circumferential pulmonary vein ablation versus antiarrhythmic drug therapy in paroxysmal atrial fibrillation. J Am Coll Cardiol 2006;48:2340-2347.Calkins H., Reynolds M.R., Spector P., et al. Treatment of atrial fibrillation with antiarrhythmic drugs or radiofrequency ablation. Two systematic literature reviews and meta-analyses. Circ Arrhythm Electrophysiol 2009;2:349-361.Calkins H., Reynolds M.R., Spector P., et al. Treatment of atrial fibrillation with antiarrhythmic drugs or radiofrequency ablation. Two systematic literature reviews and meta-analyses. Circ Arrhythm Electrophysiol 2009;2:349-361.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 Apr;14(4):528-606. doi: 10.1093/europace/eus027.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 Apr;14(4):528-606. doi: 10.1093/europace/eus027.Jacob Pontoppidan, M.D., Jens Cosedis Nielsen, M.D., D.M.SC., Steen Hvitfeldt Poulsen, M.D., D.M.SC., et al. Symptomatic and Asymptomatic Atrial Fibrillation after Pulmonary Vein Ablation and the Impact on Quality of Life (PACE 2009; 32:717–726).Jacob Pontoppidan, M.D., Jens Cosedis Nielsen, M.D., D.M.SC., Steen Hvitfeldt Poulsen, M.D., D.M.SC., et al. Symptomatic and Asymptomatic Atrial Fibrillation after Pulmonary Vein Ablation and the Impact on Quality of Life (PACE 2009; 32:717–726).Hanke T., Charitos E.I., Stierle U. et al. Twenty-four-hour holter monitor follow-up does not provide accurate heart rhythm status after surgical atrial fibrillation ablation therapy: Up to 12 months experience with a novel permanently implantable heart rhythm monitor device. Circulation 2009;120:S177–84.Hanke T., Charitos E.I., Stierle U. et al. Twenty-four-hour holter monitor follow-up does not provide accurate heart rhythm status after surgical atrial fibrillation ablation therapy: Up to 12 months experience with a novel permanently implantable heart rhythm monitor device. Circulation 2009;120:S177–84.Evgeny Pokushalov, M.D., Ph.D., Alexander Romanov, M.D., Giorgio Corbucci, Ph.D., Sergey Artyomenko, M.D., et. al. Ablation of Paroxysmal and Persistent Atrial Fibrillation: 1-Year Follow-Up Through Continuous Subcutaneous Monitoring. J Cardiovasc Electrophysiol, Vol. 22, pp. 369–375, April 2011.Evgeny Pokushalov, M.D., Ph.D., Alexander Romanov, M.D., Giorgio Corbucci, Ph.D., Sergey Artyomenko, M.D., et. al. Ablation of Paroxysmal and Persistent Atrial Fibrillation: 1-Year Follow-Up Through Continuous Subcutaneous Monitoring. J Cardiovasc Electrophysiol, Vol. 22, pp. 369–375, April 2011.Pokushalov E., Romanov A., Cherniavsky A., et al. Ablation of paroxysmal atrial fibrillation during coronary artery bypass grafting: 12 months’ follow up through implantable loop recorder. Eur J Cardiothorac Surg 2011;40:405–411.Pokushalov E., Romanov A., Cherniavsky A., et al. Ablation of paroxysmal atrial fibrillation during coronary artery bypass grafting: 12 months’ follow up through implantable loop recorder. Eur J Cardiothorac Surg 2011;40:405–411.Hindricks G., Piorkowski C., Tanner H., et al. Perception of atrial fibrillation before and after radiofrequency catheter ablation: Relevance of asymptomatic arrhythmia recurrence. Circulation 2005;112:307-313.Hindricks G., Piorkowski C., Tanner H., et al. Perception of atrial fibrillation before and after radiofrequency catheter ablation: Relevance of asymptomatic arrhythmia recurrence. Circulation 2005;112:307-313.Senatore G., Stabile G., Bertaglia E., et al. Role of transtelephonic electrocardiographic monitoring in detecting short-term arrhythmia recurrences after radiofrequency ablation in patients with atrial fibrillation. J Am Coll Cardiol 2005;45:873-876.Senatore G., Stabile G., Bertaglia E., et al. Role of transtelephonic electrocardiographic monitoring in detecting short-term arrhythmia recurrences after radiofrequency ablation in patients with atrial fibrillation. J Am Coll Cardiol 2005;45:873-876.Quirino G., Giammaria M., Corbucci G., et al. Diagnosis of paroxysmal atrial fibrillation in patients with implanted pacemakers: Relationship to symptoms and other variables. Pacing Clin Electrophysiol 2009;32:91–98.Quirino G., Giammaria M., Corbucci G., et al. Diagnosis of paroxysmal atrial fibrillation in patients with implanted pacemakers: Relationship to symptoms and other variables. Pacing Clin Electrophysiol 2009;32:91–98.Kottkamp H., Tanner H., Kobza R., et al. Time courses and quantitative analysis of atrial fibrillation episode number and duration after circular plus linear left atrial lesions. Trigger elimation or substrate modification: Early or delayed cure? J Am Coll Cardiol 2004;44:869–877.Kottkamp H., Tanner H., Kobza R., et al. Time courses and quantitative analysis of atrial fibrillation episode number and duration after circular plus linear left atrial lesions. Trigger elimation or substrate modification: Early or delayed cure? J Am Coll Cardiol 2004;44:869–877.Oral H., Veerareddy S., Good E., et al. Prevalence of asymptomatic recurrences of atrial fibrillation after successful radiofrequency catheter ablation. J Cardiovasc Electrophysiol 2004;15:1-5.Oral H., Veerareddy S., Good E., et al. Prevalence of asymptomatic recurrences of atrial fibrillation after successful radiofrequency catheter ablation. J Cardiovasc Electrophysiol 2004;15:1-5.Israel C.W., Gronefeld G., Erhlich J.R., et al. Long-term risk of recurrent atrial fibrillation as documented by an implantable monitoring device: Implications for optimal patient care. J Am Coll Cardiol 2004;43:47–52.Israel C.W., Gronefeld G., Erhlich J.R., et al. Long-term risk of recurrent atrial fibrillation as documented by an implantable monitoring device: Implications for optimal patient care. J Am Coll Cardiol 2004;43:47–52.Callans D. Asymptomatic atrial fibrillation in symptomatic patients. J Cardiovasc Electrophiol 2004;15:925–926.Callans D. Asymptomatic atrial fibrillation in symptomatic patients. J Cardiovasc Electrophiol 2004;15:925–926.Hanke T., Charitos E.I., Stierle U., et al. Twenty-four-hour holter monitor follow-up does not provide accurate heart rhythm status after surgical atrial fibrillation ablation therapy: Up to 12 months experience with a novel permanently implantable heart rhythm monitor device. Circulation 2009;120:S177–84.Hanke T., Charitos E.I., Stierle U., et al. Twenty-four-hour holter monitor follow-up does not provide accurate heart rhythm status after surgical atrial fibrillation ablation therapy: Up to 12 months experience with a novel permanently implantable heart rhythm monitor device. Circulation 2009;120:S177–84.Evgeny Pokushalov, MD, Alexander Romanov, MD, Giorgio Corbucci, PhD, et al. Does atrial fibrillation burden measured by continuous monitoring during the blanking period predict the response to ablation at 12-month follow-up? Heart Rhythm, Vol 9, No 9, September 2012.Evgeny Pokushalov, MD, Alexander Romanov, MD, Giorgio Corbucci, PhD, et al. Does atrial fibrillation burden measured by continuous monitoring during the blanking period predict the response to ablation at 12-month follow-up? Heart Rhythm, Vol 9, No 9, September 2012.Vasamreddy C.R., Dalal D., Dong J., et al. Symptomatic and asymptomatic atrial fibrillation in patients undergoing radiofrequency catheter ablation. J Cardiovasc Electrophysiol 2006; 17:134–139.Vasamreddy C.R., Dalal D., Dong J., et al. Symptomatic and asymptomatic atrial fibrillation in patients undergoing radiofrequency catheter ablation. J Cardiovasc Electrophysiol 2006; 17:134–139.Pokushalov E., Romanov A., Cherniavsky A., et al. Ablation of paroxysmal atrial fibrillation during coronary artery bypass grafting: 12 months’ follow up through implantable loop recorder. Eur J Cardiothorac Surg 2011;40:405–411.Pokushalov E., Romanov A., Cherniavsky A., et al. Ablation of paroxysmal atrial fibrillation during coronary artery bypass grafting: 12 months’ follow up through implantable loop recorder. Eur J Cardiothorac Surg 2011;40:405–411.

The authors declare that there are no conflicts of interest present.