Aim. To study the efficacy and safety of antithrombotic therapy in patients with paroxysmal atrial fibrillation (AF) after catheter treatment during 36 months of follow-up.Material and methods. The retrospective observational study included 592 patients (283 men) who underwent catheter treatment of AF, aged 26 to 86 years (median age was 61.0 [55; 67]) with paroxysmal AF, treated in cardiac arrhythmias department of the Institute of Cardiology of Tomsk National Research Medical Center from 01.01.2017 to 31.12.2019. All patients were retrospectively divided into 2 groups: the first group consisted of patients with effective AF ablation, the second - with ineffective AF ablation. During follow-up after 12, 24 and 36 months, patients' complaints, documented arrhythmia recurrences, adherence to the prescribed treatment, and adverse clinical events were taken into account.Results. In patients with paroxysmal AF, the effectiveness of catheter treatment was 73.1% after 12 months of follow-up, 69.3% – after 24 months, 71.6% – after 36 months. The analysis of our data showed that during the follow-up period of 36 months, the incidence of ischemic stroke against the background of anticoagulant therapy and effective catheter treatment of paroxysmal AF was significantly lower than in patients with unsuccessful ablation (0.3% (n=1) and 3.7% (n=4), respectively), even despite the fact that not all patients from the first group received prescribed medication.Conclusion. The use of anticoagulant therapy in patients with paroxysmal AF after interventional treatment is safe, since the invasive strategy in combination with anticoagulant therapy does not increase the risk of major and minor bleeding, and in the case of effective intervention allows statistically significantly reduce the risk of ischemic stroke and almost completely eliminate the likelihood of other thromboemolic complications.
Aim To evaluate efficacy and safety of the anticoagulant therapy in patients with atrial fibrillation (AF) during a 36-month follow-up after an interventional treatment.Material and methods This study included 302 patients aged 29 to 81 years with various forms of AF. Catheter ablation (CA) of AF foci was performed for all patients. The patients were divided into 3 groups: group 1 with paroxysmal AF, group 2 with persistent AF, and group 3 with longstanding persistent AF. Two subgroups were isolated in each group, with effective and ineffective CA. Results of the follow-up were analyzed at 12, 24, and 36 months after discharge from the hospital. The follow-up interview recorded complaints of palpitation attacks, effectiveness of administered CA, compliance with the treatment, adverse clinical outcomes, including thromboembolic complications (TEC), bleeding, and hospitalizations.Results Efficacy of the interventional treatment for 36 months was 65.3 % in patients with paroxysmal AF, 59.7 % in patients with persistent AF, and 57.1 % in patients with longstanding persistent AF. Patients with paroxysmal AF and effective CA had no adverse events throughout the same period during the antithrombotic treatment (ATT). In contrast, the group with ineffective ablation had both TEC and hemorrhagic complications during the ATT. In the group with persistent AF and effective CA throughout the follow-up period, TECs were less frequent than in the group of ineffective ablations during the ATT treatment. Patients with longstanding persistent AF and effective CA throughout the follow-up period, had no TECs in contrast to patients with ineffective ablation during the ATT treatment. There were no fatal outcomes in patients with effective procedure.Conclusion A successful CA procedure for AF provides a significant decrease in the risk of ischemic stroke. Furthermore, the invasive strategy does not increase the risk of major and minor bleedings.
Background. Worldwide, research continues into various factors that may influence the success of catheter treatment of atrial fibrillation. In this regard, the influence of the state of the sympathoadrenal system of the body has not been studied enough. Aims to evaluate the effectiveness of interventional treatment of atrial fibrillation (AF) in patients with and without myocarditis, depending on the level of beta-adrenergic responsiveness of the organism. Materials and methods. The study sample included 40 patients. Of these, 27 (67.5%) are men. The age in the sample was 49 (44; 55) years. The study included 25 (62.5%) patients with paroxysmal AF, 10 (25.0%) with persistent and 5 (12.5%) with long-term persistent. All patients underwent surgical treatment of AF using radiofrequency (RFA) or cryoablation (CBA). Endomyocardial biopsy was performed in 18 patients to verify the diagnosis. Beta-adrenergic responsiveness (beta-ARM) was assessed in dynamics 3 days after surgery, 3 months and 12 months. The follow-up period for patients was 12 months. Results. All patients underwent surgical treatment of AF, in 7 cases (17.5%) CBA of the pulmonary veins was performed, in 33 (82.5%) cases RFA was performed. According to the biopsy results, signs of myocarditis were detected in 9 patients (22.5%). Focal myocarditis was found in 7 patients, diffuse in 2. The effectiveness of catheter treatment in general was 72.5%, for CBA 71.5%, for RFA 73.5%. Beta-ARM before ablation was 19.16% [12.46; 27.46], 3 days after ablation 24.43% [15.38; 33.65], after 3 months was 20.27% [9.90; 27.71], in 4 patients after 12 months, beta-ARM was 32.5% [20.0; 43.2]. The dynamics and influence of beta-ARM on the effectiveness of interventional treatment of AF in patients with early and late relapses, the presence of myocarditis was assessed. Conclusions. The results obtained showed no effect of the level of beta-ARM on the effectiveness of RFA and CBA in patients with and without myocarditis. Beta-ARM showed no association with the development of early arrhythmia recurrences after ablation. No statistically significant differences were found when comparing beta-ARM levels in patients with and without diagnosed myocarditis.
Aim. To evaluate the clinical efficacy and safety of direct oral anticoagulants versus warfarin as part of antithrombotic therapy (ATT), namely, to study the frequency of bleeding and thromboembolic complications in patients with atrial fibrillation (AF) after direct myocardial revascularization in combination with radiofrequency isolation of pulmonary veins.Material and Methods. A total of 44 patients (36 men) aged 44–77 years (average age of 63.5 ± 7.8 years) with coronary heart disease, indications for direct myocardial revascularization, and AF were included in the study from 2014 to 2016. The observation period was 24 months.Results. Warfarin was one of the components of ATT in 20 patients (48%). However, the target values of international normalized ratio (INR) within the therapeutic range for over 70% of the time were achieved only in seven patients. Two patients who were taking warfarin without achieving target INR values for 24 months suffered from ischemic stroke. One patient taking warfarin (without regular INR control) had gastrointestinal bleeding requiring hospitalization and conservative therapy; ten patients had minor bleedings (nasal and gingival bleeding). All patients, who suffered from thromboembolic and hemorrhagic complications and had inadequate warfarin intake, were recommended to switch to direct oral anticoagulants (DOAC). Thirteen patients (29%) were administered with DOAC: five patients took rivaroxaban 20 mg/day, four patients took dabigatran 300 mg/day, and four patients took apixaban 10 mg/day. DOAC therapy was administered in combination with one of the antiplatelet drugs (aspirin or clopidogrel). In the case of DOAC administration, only minor bleedings were observed: one patient had hemorrhoidal bleeding and four patients had nasal bleedings, which did not require hospitalization, medical intervention, or suspension of anticoagulant therapy. There were no other adverse events in patients taking DOAC.Conclusions. Patients administered with DOAC as a part of antithrombotic therapy after coronary bypass surgery and surgical epicardial radiofrequency isolation of the pulmonary veins had lower incidence rates of thromboembolic and hemorrhagic complications compared with the rates in patients taking warfarin. However, no statistically significant differences were found between the groups due to the small sample size.
Aim. To study the efficacy and safety of anticoagulant therapy in patients with persistent atrial fibrillation (AF) after interventional treatment during 36 months of follow-up.Material and methods. The study included 135 patients (78 men and 58 women) in the age from 31 to 80 years (mean age 61.0 [55; 66]) with persistent AF who underwent catheter treatment. All patients were treated in the arrhythmia department of the Research Institute of Cardiology (Tomsk National Research Medical Center from 01.01.2017 to 31.12.2017.Results. In patients with persistent AF, the effectiveness of catheter treatment was 60% after 12 months of follow-up (81 patients had no documented AF during this period) and 63.7 % (n=86) - after 24 and 36 months. No fatal outcomes, myocardial infarction, or ischemic stroke were observed within 12 months after catheter treatment in patients with an effective procedure. During 36 months of follow-up, the incidence of ischemic stroke on the background of receiving anticoagulant therapy and effective catheter treatment of persistent AF was significantly lower than in patients with unsuccessful ablation (1.16% and 10%, respectively), even though not all patients from the first group received prescribed medication.Conclusion. Successful radiofrequency procedure/cryo-ablation of AF persistent form significantly reduced the risk of ischemic stroke from 10% to 1.16% and almost eliminated the likelihood of other thromboembolic complications, while the invasive strategy did not increase the risk of large and small bleeding in this group of patients.
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