russjcardiolРоссийский кардиологический журналRussian Journal of Cardiology1560-40712618-7620«SILICEA-POLIGRAF» LLC10.15829/1560-4071-2018-1-37-42russjcardiol-2640Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESВОЗМОЖНЫЙ МЕДИКАМЕНТОЗНЫЙ ПОДХОД К ПРОФИЛАКТИКЕ ПОЗДНИХ РЕЦИДИВОВ ПОСЛЕ КАТЕТЕРНОЙ АБЛАЦИИ ФИБРИЛЛЯЦИИ ПРЕДСЕРДИЙ (ПИЛОТНОЕ ИССЛЕДОВАНИЕ)SUGGESTED CONSERVATIVE APPROACH TO PREVENTION OF LATE RECURRENT ATRIAL FIBRILLATION AFTER CATHETER ABLATION (PILOT STUDY)ТатарскийБ. А.TatarskyB. A.

Татарский Борис Алексеевич — доктор медицинских наук профессор, заведующий НИЛ клинической аритмологии.

Saint-Petersburg

btat@mail.ruФГБУ Национальный медицинский исследовательский центр им. В.А. Алмазова Минздрава РоссииРоссияFederal Almazov North-West Medical Research Centre of the Ministry of HealthRussian Federation201808032018013742Copyright © Татарский Б.А., 20182018Татарский Б.А.Tatarsky B.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://russjcardiol.elpub.ru/jour/article/view/2640Цель

Цель. Проверка гипотезы, что комбинированное использование блокатора позднего натриевого канала (ранолазин) с агонистом имидазолиновых рецепторов центрального действия (моксонидин) могут редуцировать частоту возникновения рецидивов фибрилляции предсердий (ФП) в позднем постаблационном периоде.

Материал и методы

Материал и методы. В исследование были включены 30 пациентов в возрасте от 35 до 60 лет (17 мужчин и 13 женщин) после катетерной радиочастотной аблации, проведенной по поводу симптомной, резистентной к антиаритмической терапии пароксизмальной формы ФП. За неделю до плановой процедуры аблации, пациенты получали моксонидин в дозе 0,2 мг/сут. и ранолазин 1000 мг/сут. После вмешательства и до окончания наблюдения (12 мес.) пациенты принимали эти препараты в указанных дозах.

Результаты

Результаты. Из 28-х пациентов, включенных в анализ после 3месячного “слепого” периода, к окончанию наблюдения осталось 25 больных. Из них у 4 пациентов (16%) регистрировались бессимптомные/малосимптомные рецидивы ФП. У остальных 21 (84%) больных пароксизмы не регистрировались при контрольных осмотрах, включавших длительное мониторирование электрокардиограммы.

Заключение

Заключение. Проведенный анализ данного пилотного исследования показал, что комбинированный прием блокатора поздних натриевых каналов ранолазина и агониста имидазолиновых рецепторов центрального действия моксонидина, является эффективной и безопасной терапией, направленной на снижение поздних постаблационных рецидивов ФП.

Aim

Aim. To workout a hypothesis that combinational usage of late sodium channel blocker ranolazine with imidazoline receptor agonist moxonidine might lead to reduced rate of recurrent atrial fibrillation (AF) in long-term post-ablation period.

Material and methods

Material and methods. To the study, 30 patients included, age 35 to 60 y. o. (17 males and 13 females) after catheter radiofrequency ablation for symptomatic, resistant to therapy paroxysmal AF. In a week before the scheduled procedure, patients had been taking moxonidine 0,2 mg per day and ranolazine 1000 mg per day. They continued to take these medications after the procedure for 12 months in the same dosages.

Results

Results. Among 28 patients included to the analysis after 3-month blanking period, 25 ended the study. Of those 4 (16%) had non-symptomatic or mild symptomatic recurrent AF. Rest 21 (84%) did not present with paroxysms at control visits with long term ECG monitoring.

фибрилляция предсердийблокаторы поздних натриевых каналовагонисты имидазолиновых рецепторовatrial fibrillationlate sodium channels blockersimidazoline receptors agonistsReferencesKirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J.2016; 37 (38): 2893-2962. DOI: 10.1016/j.rec.2016.11.033.Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J.2016; 37 (38): 2893-2962. DOI: 10.1016/j.rec.2016.11.033.January C, Wann L, Alpert J, et al. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation 2014; 2: 2071-104. DOI: 10.1161/CIR.0000000000000040.January C, Wann L, Alpert J, et al. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation 2014; 2: 2071-104. DOI: 10.1161/CIR.0000000000000040.Calkins H, Kuck K, 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; 14: 528-606. DOI: 10.1093/europace/eus027.Calkins H, Kuck K, 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; 14: 528-606. DOI: 10.1093/europace/eus027.Peter Leong-Sit P, Roux J-F, ZadoE, et al. Antiarrhythmics After Ablation of Atrial Fibrillation (5A Study) Circulation: Arrhythmia and Electrophysiology 2011; 4: 11-4. DOI: 10.1161/CIRCEP.110.955393.Peter Leong-Sit P, Roux J-F, ZadoE, et al. Antiarrhythmics After Ablation of Atrial Fibrillation (5A Study) Circulation: Arrhythmia and Electrophysiology 2011; 4: 11-4. DOI: 10.1161/CIRCEP.110.955393.Darkner S, Chen X, Hansen J, et al. Recurrence of arrhythmia following short-term oral amiodarone after catheter ablation for atrial fibrillation: A double-blind, randomized, placebo-controlled study (AMIO-CAT trial). EurHeart J. 2014; 35 (47): 3356-64. DOI: 10.1093/eurheartj/ehu354.Darkner S, Chen X, Hansen J, et al. Recurrence of arrhythmia following short-term oral amiodarone after catheter ablation for atrial fibrillation: A double-blind, randomized, placebo-controlled study (AMIO-CAT trial). EurHeart J. 2014; 35 (47): 3356-64. DOI: 10.1093/eurheartj/ehu354.Jason G, Khairy P, Verma A, et al. Early Recurrence of Atrial Tachyarrhythmias Following Radiofrequency Catheter Ablation of Atrial Fibrillation. Pacing Clin Electrophysiol. 2012; 35 (1): 106-16. DOI: 10.1111/j.1540-8159.2011.03256.Jason G, Khairy P, Verma A, et al. Early Recurrence of Atrial Tachyarrhythmias Following Radiofrequency Catheter Ablation of Atrial Fibrillation. Pacing Clin Electrophysiol. 2012; 35 (1): 106-16. DOI: 10.1111/j.1540-8159.2011.03256.Murdock D, Reiffel J, Kahebe J, et al. The conversion of paroxysmal of initial onset of atrial fibrillation with oral ranolazine: implications for “pill in the pocket” approach in structural heart disease. J Am Coll Cardiol. 2010; 55: A6. E58.Murdock D, Reiffel J, Kahebe J, et al. The conversion of paroxysmal of initial onset of atrial fibrillation with oral ranolazine: implications for “pill in the pocket” approach in structural heart disease. J Am Coll Cardiol. 2010; 55: A6. E58.Tatarsky BA. The use of a blocker of late sodium channels with arresting paroxysmal atrial fibrillation (pilot study) Russia Heart 2013; 2:34-40. (In Russ.) Татарский Б. А. Использование блокатора поздних натриевых каналов при купировании фибрилляции предсердий (пилотное исследование). Сердце. 2013; 2: 34-40. DOI: 10.18087/rhj.2013.2.1740.Tatarsky BA. The use of a blocker of late sodium channels with arresting paroxysmal atrial fibrillation (pilot study) Russia Heart 2013; 2:34-40. (In Russ.) Татарский Б. А. Использование блокатора поздних натриевых каналов при купировании фибрилляции предсердий (пилотное исследование). Сердце. 2013; 2: 34-40. DOI: 10.18087/rhj.2013.2.1740.Murdock D, Kaliebe J, Larrain G. The use of ranolazine to facilitate electrical cardioversion in cardioversion-resistant patients: A case series. Pacing ClinElectrophysiol 2012; 35: 3027. DOI: 10.1111/j.1540-8159.2011.03298.Murdock D, Kaliebe J, Larrain G. The use of ranolazine to facilitate electrical cardioversion in cardioversion-resistant patients: A case series. Pacing ClinElectrophysiol 2012; 35: 3027. DOI: 10.1111/j.1540-8159.2011.03298.Tatarsky BA. Protector therapy of atrial fibrillation by the blocker of late sodium channels (pilot study) Russia Heart 2014; 2: 48-53. (In Russ.) Татарский Б. А. Протекторная терапия фибрилляции предсердий блокатором поздних натриевых каналов (пилотноеисследование) Сердце. 2014; 2: 48-53. DOI: 10.18087/rhj.2014.2.1873.Tatarsky BA. Protector therapy of atrial fibrillation by the blocker of late sodium channels (pilot study) Russia Heart 2014; 2: 48-53. (In Russ.) Татарский Б. А. Протекторная терапия фибрилляции предсердий блокатором поздних натриевых каналов (пилотноеисследование) Сердце. 2014; 2: 48-53. DOI: 10.18087/rhj.2014.2.1873.Miles R, Passman R, Murdock D. Comparison of effectiveness and safety of ranolazine versus amiodarone for preventing atrial fibrillation after coronary artery bypass grafting. Am J Cardiol 2011; 108: 673-6. DOI: 10.1016/j.amjcard.2011.04.017.Miles R, Passman R, Murdock D. Comparison of effectiveness and safety of ranolazine versus amiodarone for preventing atrial fibrillation after coronary artery bypass grafting. Am J Cardiol 2011; 108: 673-6. DOI: 10.1016/j.amjcard.2011.04.017.Chen P, Tan A. Autonomic nerve activity and atrial fibrillation. Hart Rhythm. 2007; 4 (3 suppl): S61-S64. DOI: 10.1016/j.hrthm.2006.12.006.Chen P, Tan A. Autonomic nerve activity and atrial fibrillation. Hart Rhythm. 2007; 4 (3 suppl): S61-S64. DOI: 10.1016/j.hrthm.2006.12.006.Shen M, Zipes D. Role of the autonomic nervous system in modulating cardiac arrhythmias. Circ Res. 2014; 114: 1004-21. DOI: 10.1161/CIRCRESAHA.113.302549.Shen M, Zipes D. Role of the autonomic nervous system in modulating cardiac arrhythmias. Circ Res. 2014; 114: 1004-21. DOI: 10.1161/CIRCRESAHA.113.302549.Deftereos S, Giannopoulos G, Kossyvakis C, et al. Effectiveness of moxonidine to reduce atrial fibrillation burden in hypertensive patients. Am J Cardiol. 2013; 112: 684-7. DOI 10.1016/j.amjcard.2013.04.049.Deftereos S, Giannopoulos G, Kossyvakis C, et al. Effectiveness of moxonidine to reduce atrial fibrillation burden in hypertensive patients. Am J Cardiol. 2013; 112: 684-7. DOI 10.1016/j.amjcard.2013.04.049.Giannopulos G, Kossyvakis C, Efremidis M, et al. Central Sympathetic Inhibition to Reduce Postablation Atrial Fibrillation Recurrences in Hypertensive Patients A Randomized, Controlled Study. Circulation 2014; 130: 1346-52. DOI: 10.1161/CIRCULATIONAHA.114.010999.Giannopulos G, Kossyvakis C, Efremidis M, et al. Central Sympathetic Inhibition to Reduce Postablation Atrial Fibrillation Recurrences in Hypertensive Patients A Randomized, Controlled Study. Circulation 2014; 130: 1346-52. DOI: 10.1161/CIRCULATIONAHA.114.010999.Kirchhof P, Bax J, Blomstrom-Lundquist C, et al. Early and comprehensive managementof atrial fibrillation: executive summary of the proceedings from the 3nd AFNET-EHRA consensus conference “Research perspectives in AF”. EurHeart J. 2009; 24: 2969-77. DOI: 10.1093/eurheartj/ehp235.Kirchhof P, Bax J, Blomstrom-Lundquist C, et al. Early and comprehensive managementof atrial fibrillation: executive summary of the proceedings from the 3nd AFNET-EHRA consensus conference “Research perspectives in AF”. EurHeart J. 2009; 24: 2969-77. DOI: 10.1093/eurheartj/ehp235.Antzelevitch C, Burashnikov A, Sicouri S. Electrophysiologic basis for the antiarrhythmic actions of ranolazine. Heart Rhythm. 2011; 8: 1281-90. DOI: 10.1016/j.hrthm.2011.03.045.Antzelevitch C, Burashnikov A, Sicouri S. Electrophysiologic basis for the antiarrhythmic actions of ranolazine. Heart Rhythm. 2011; 8: 1281-90. DOI: 10.1016/j.hrthm.2011.03.045.Shryock J, Antzelevitch C, Belardinelli L, et al. The arrhythmogenic consequences of increasing late INa in the cardiomyocyte. Cardiovasc Res. 2013; 99 (4): 600-11. DOI: 10.1093/cvr/cvt145.Shryock J, Antzelevitch C, Belardinelli L, et al. The arrhythmogenic consequences of increasing late INa in the cardiomyocyte. Cardiovasc Res. 2013; 99 (4): 600-11. DOI: 10.1093/cvr/cvt145.Koskinas K, Fragakis N, Katritsis D, et al. Ranolazine enhances the efficacy of amiodarone for conversion of recent-onset atrial fibrillation. Europace 2014; 16: 973-9. DOI: 10.1093/europace/eut407.Koskinas K, Fragakis N, Katritsis D, et al. Ranolazine enhances the efficacy of amiodarone for conversion of recent-onset atrial fibrillation. Europace 2014; 16: 973-9. DOI: 10.1093/europace/eut407.Reiffel J, Camm J, Belardinelli L, et al. The HARMONY Trial: Combined Ranolazine and Dronedarone in the Management of Paroxysmal Atrial Fibrillation: Mechanistic and Therapeutic Synergism. Circ Arrhythm Electrophysiol. 2015; 8 (5): 1048-56. DOI: 10.1161/CIRCEP.115.002856.Reiffel J, Camm J, Belardinelli L, et al. The HARMONY Trial: Combined Ranolazine and Dronedarone in the Management of Paroxysmal Atrial Fibrillation: Mechanistic and Therapeutic Synergism. Circ Arrhythm Electrophysiol. 2015; 8 (5): 1048-56. DOI: 10.1161/CIRCEP.115.002856.Berkowitsch A, Neumann T, Kuniss M, et al. Therapy with rennin-angiotensin system blockers after pulmonary vein isolation in patients with atrial fibrillation: who is a responder? PACE. 2010; 33: 1101-11. DOI: 10.1111/j.1540-8159.2010.02769.Berkowitsch A, Neumann T, Kuniss M, et al. Therapy with rennin-angiotensin system blockers after pulmonary vein isolation in patients with atrial fibrillation: who is a responder? PACE. 2010; 33: 1101-11. DOI: 10.1111/j.1540-8159.2010.02769.Edwards L, Brown-Bryan Т, McLean L, et al. Pharmacological properties of the central antihypertensive agent, moxonidine. CardiovascTher. 2012; 30: 199-208. DOI: 10.1111/j.1755-5922.2011.00268.x.Edwards L, Brown-Bryan Т, McLean L, et al. Pharmacological properties of the central antihypertensive agent, moxonidine. CardiovascTher. 2012; 30: 199-208. DOI: 10.1111/j.1755-5922.2011.00268.x.

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