Aim. To study the efficacy of class IC arrhythmic drugs (AAD) and catheter ablation (CA) for paroxysmal form of atrial fibrillation (AF) in patients with without structural heart disease.Material and methods. The study included 122 patients (44 men, 78 women, mean age 63 [55;68] years) with symptomatic AF paroxysms. Patients was divided into the lappaconitine hydrobromide group (LH group; n=26), the propafenone group (P group; n=25) – 25 patients, the diethylaminopropionylethoxycarbonylaminophenothiazine hydrochloride (DH group; n=23), the CA groups: radiofrequency ablation (RFA group; n=24) and cryoballoon ablation (CRYO group; n=24) groups each included 24 patients. The primary endpoint was the AF recurrence within 6 and 12 months from the onset of antiarrhythmic drug therapyand in RFA and CRYO groups – within 6 and 12 months after the end of the blinding period. Additionally, in AAD groups a composite endpoint was assessed: the frequency of recurrence of AF within 6 months and the frequency of side effects requiring drug withdrawal.Results. Within the 6 months AF recurrence was observed in 13 (50%) patients of the LH group, 11 (44%) patients of the P group, and 13 (56.5%) patients of the DH group (p=0.687). Side effects requiring drug withdrawal were observed in the LH group in 2 patients (7.7%), in the P group in 3 patients (12%) and in the DH group in 3 patients (13%) (p=0.801). The difference in frequency of reaching the composite endpoint was not significant (p = 0.581) and the incidence was 57.7%, 56%, 69.5%, respectively in groups LH, P and DH. The efficacy of CA was higher than class IC AADs: 77% vs 39% (that including the withdrawals of AADs due to side effects) (p˂0.001). At the same time, there was no significant difference in the effectiveness of RFA and CRYO: AF recurrences within 6 months after the end of the blinding period were registered in the RFA group in 29% of cases, in the CRYO group – in 16.7% of cases (p=0.247). The overall effectiveness of CA after 12 months was 69%, which was significantly higher than the effectiveness of AADs that was 38% (p˂0.001).Conclusion. Starting the AAD therapy with IC class in patients with paroxysmal AF in the absence of structural pathology, despite acceptable safety, one should take into account that, regardless of the initially prescribed drug, less than half of patients can achieve prevention of AF recurrence within 1 year. CA for AF can be considered as a first line therapy or can be recommended if one of IC class AADs is ineffective.
Aim. To study the advantages of using a portable electrocardiographic (ECG) monitor in outpatients with paroxysmal atrial fibrillation (AF).Material and methods. We examined 88 patients (26 men, 62 women, mean age, 63 [57;68] years) with paroxysmal AF with an average frequency of arrhythmia episodes of 1,0 [0.3;3.75] per month. Forty three (49%) patients were included in the remote monitoring (RM) group using the ECG Dongle monitor, and 45 (51%) patients were included in the conventional monitoring (CM) group. Patients underwent scheduled examinations 2, 6 and 12 months after the start of therapy. Unscheduled consultations were carried out in case of AF recurrence. Patients from the RM group, using portable cardiac monitor, additionally self-registered ECG 1 time per week and in case of symptoms suggestive of AF. ECG strips were sent to the clinical investigator for analysis.Results. With the help of portable cardiac monitor, 2477 ECG strips were collected and analyzed: 2159 (87,2%) — sinus rhythm, 318 (12,8%) — AF and atypical atrial flutter. Forty four episodes of AF in 3 patients were asymptomatic. In addition, 211 (8,5%) sinus rhythm ECG strips were recorded by 13 patients with symptoms suggestive of AF. In the RM group, 7 (16%) patients were hospitalized due to recurrent AF, while in the CM group, 20 (44%) patients (p=0,004). The total number of emergency hospitalizations was 8 and 29 in the RM and CM groups, respectively. The number of patients who called an ambulance was significantly lower in the RM group: in the CM group, 37 calls for an ambulance were made by 22 patients, while in the RM group — 12 patients made 15 calls (p=0,044). The proportion of calls followed by hospitalization (40 vs 70%, p=0,043) was significantly lower in the RM group.Conclusion. Remote ECG monitoring using the ECG Dongle system is a useful way to monitor patients with paroxysmal AF, which make it possible to register asymptomatic AF episodes, differentiate the causes of palpitations, and significantly reduce the frequency of emergency calls and hospitalizations.
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