russjcardiolРоссийский кардиологический журналRussian Journal of Cardiology1560-40712618-7620«SILICEA-POLIGRAF» LLC10.15829/1560-4071-2020-3942russjcardiol-3942Research ArticleКЛИНИЧЕСКОЕ НАБЛЮДЕНИЕКЛИНИЧЕСКОЕ НАБЛЮДЕНИЕПредсердная кардиомиопатия — новая концепция с давней историейAtrial cardiomyopathy — a new concept with a long historyhttps://orcid.org/0000-0002-2127-8525ВайханскаяТ. Г.VaikhanskayaT. G.

Вайханская Татьяна Геннадьевна — кандидат медицинских наук, ведущий научный сотрудник лаборатории медицинских информационных технологий.Минск.SPIN-код: 2783-2641

Minsk.

tat_vaikh@mail.ruhttps://orcid.org/0000-0001-5727-3219КурушкоТ. В.KurushkoT. V.

Курушко Татьяна Валентиновна — врач отделения функциональной диагностики.Минск.

Minsk.

tatkuko@mail.ruhttps://orcid.org/0000-0003-0279-912XПерсидскихЮ. А.PersianskikhYu. A.

Персидских Юлия Александровна — кандидат медицинских наук, научный сотрудник лаборатории нарушений сердечного ритма.Минск.

Minsk.

grevy@tut.byhttps://orcid.org/0000-0001-6359-4967СивицкаяЛ. Н.SivitskayaL. N.

Сивицкая Лариса Николаевна — кандидат биологических наук, ведущий научный сотрудник лаборатории нехромосомной наследственности.Минск.

Minsk.

cytoplasmic@mail.ruРеспубликанский научно-практический центр “Кардиология”БеларусьRepublican Science-Practical Centre “Cardiology”BelarusИнститут генетики и цитологии Национальной Академии наук БеларусиБеларусьInstitute of Genetics and CytologyBelarus202002072020251139423942Copyright © Вайханская Т.Г., Курушко Т.В., Персидских Ю.А., Сивицкая Л.Н., 20202020Вайханская Т.Г., Курушко Т.В., Персидских Ю.А., Сивицкая Л.Н.Vaikhanskaya T.G., Kurushko T.V., Persianskikh Y.A., Sivitskaya L.N.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/3942

Предсердная кардиомиопатия (ПКМ) — это достаточно часто встречающаяся, но клинически недооцениваемая патология, для которой характерно увеличение размеров предсердий и их дисфункция. Ранее ПКМ традиционно считалась первичным расстройством, но в 2016г эта концепция была пересмотрена международными экспертами во главе с рабочей группой Европейской ассоциации сердечного ритма (EHRA) с включением позиции вторичного ремоделирования предсердий. В согласованном документе EHRA детально представлены аспекты анатомии, патофизиологии предсердий, предложены дефиниции ПКМ, гистологическая классификация, изложены молекулярные механизмы, влияющие на развитие предсердной аритмии, обозначены проблемы персонифицированного лечения и оптимизации показаний к катетерной аблации.Аспекты практического применения предложенной системы классификации ПКМ, обоснованной с позиций патогистологической морфологии, вопросы клинической значимости новой концепции ПКМ и потенциальной роли этой информации для практического врача в выборе контроля ритма/частоты при фибрилляции предсердий и профилактике тромбоэмболических осложнений представлены в данной статье. В качестве иллюстративного материала продемонстрированы два клинических наблюдения ПКМ с “первичным” и “вторичным” ремоделированием предсердий (семейная форма ПКМ, ассоциированной с мутацией в гене NPPA, вызывающей первичный дефект структуры и функции предсердий; и случай “вторичной” ПКМ, обусловленной длительным периодом суправентрикулярной тахиаритмии, детерминированной мутацией в гене SCN1B).

Atrial cardiomyopathy (ACM) is a relatively common but clinically underestimated disorder, which is characterized by an increased atrial size and dysfunction. Previously, ACM was considered a primary disorder, but in 2016 this concept was revised by European Heart Rhythm Association (EHRA) working group with inclusion of secondary atrial remodeling. The EHRA document details aspects of atrial anatomy and pathophysiology, proposes definitions of ACM, histological classification, outlines the molecular mechanisms of atrial arrhythmia and the problems of personalized treatment and optimization of indications for catheter ablation.Practical application of the proposed ACM classification system, the clinical significance of novel ACM concept and the potential role of this information for a practitioner are presented in this article. Two clinical cases of ACM with “primary” (familial form of ACM due to NPPA gene mutation with primary defect in atrial structure and function) and “secondary” atrial remodeling (ACM caused by a longterm supraventricular tachyarrhythmias due to SCN1B gene mutation).

ремоделирование предсердийпредсердная кардиомиопатияфибрилляция предсердийэлектромеханическая дисфункция предсердийген NPPAatrial remodelingatrial cardiomyopathyatrial fibrillationatrial electromechanical dysfunctionNPPA geneReferencesNagle RE, Smith B, Williams DO. Familial atrial cardiomyopathy with heart block. Br Heart J. 1972;34(2):205.Nagle RE, Smith B, Williams DO. Familial atrial cardiomyopathy with heart block. Br Heart J. 1972;34(2):205.Hensey M, O'Neill L, Mahon C, et al. A review of the anatomical and histological attributes of the left atrial appendage with descriptive pathological examination of morphology and histology. J Atr Fibrillation. 2018;10(6):1650-5. doi:10.4022/jafib.1650.Hensey M, O'Neill L, Mahon C, et al. A review of the anatomical and histological attributes of the left atrial appendage with descriptive pathological examination of morphology and histology. J Atr Fibrillation. 2018;10(6):1650-5. doi:10.4022/jafib.1650.Mueller KL, Heinzmann D, Klingel K, et al. Histopathological and immunological characteristics of tachycardia-induced cardiomyopathy. J Am Coll Cardiol. 2017;69:2160-72. doi:10.1016/j.jacc.2017.02.049.Mueller KL, Heinzmann D, Klingel K, et al. Histopathological and immunological characteristics of tachycardia-induced cardiomyopathy. J Am Coll Cardiol. 2017;69:2160-72. doi:10.1016/j.jacc.2017.02.049.Kottkamp H. Fibrotic atrial cardiomyopathy: a specific disease/syndrome supplying substrates for atrial fibrillation, atrial tachycardia, sinus node disease, AV node disease, and thromboembolic complications. J Cardiovasc Electrophysiol. 2012;23(7):797-9. doi:10.1111/j.1540-8167.2012.02341.X.Kottkamp H. Fibrotic atrial cardiomyopathy: a specific disease/syndrome supplying substrates for atrial fibrillation, atrial tachycardia, sinus node disease, AV node disease, and thromboembolic complications. J Cardiovasc Electrophysiol. 2012;23(7):797-9. doi:10.1111/j.1540-8167.2012.02341.X.Goette A, Kalman JM, Aguinaga L, et al. EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication. Europace. 2016;18(10):1455-90. doi:10.1093/europace/euw161.Goette A, Kalman JM, Aguinaga L, et al. EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication. Europace. 2016;18(10):1455-90. doi:10.1093/europace/euw161.Nattel S, Harada M. Atrial remodeling and atrial fibrillation: recent advances and translational perspectives. J Am Coll Cardiol. 2014;63(22):2335-45. doi:10.1016/j.jacc.2014.02.555.Nattel S, Harada M. Atrial remodeling and atrial fibrillation: recent advances and translational perspectives. J Am Coll Cardiol. 2014;63(22):2335-45. doi:10.1016/j.jacc.2014.02.555.Nattel S. Close connections between contraction and rhythm: a new genetic cause of atrial fibrillation/cardiomyopathy and what it can teach us. Eur Heart J. 2017;38:35-7. doi:10.1093/eurheartj/ehw457.Nattel S. Close connections between contraction and rhythm: a new genetic cause of atrial fibrillation/cardiomyopathy and what it can teach us. Eur Heart J. 2017;38:35-7. doi:10.1093/eurheartj/ehw457.Gudbjartsson DF, Holm H, Sulem P, et al. A frameshift deletion in the sarcomere gene MYL4 causes early onset familial atrial fibrillation. Eur Heart J. 2017;38:27-34. doi:10.1093/eurheartj/ehw379.Gudbjartsson DF, Holm H, Sulem P, et al. A frameshift deletion in the sarcomere gene MYL4 causes early onset familial atrial fibrillation. Eur Heart J. 2017;38:27-34. doi:10.1093/eurheartj/ehw379.Fatkin D, Santiago CF, Huttner IG, et al. Genetics of atrial fibrillation: state of the art in 2017. Heart Lung Circ. 2017;26:894-901. doi:10.1016/j.hlc.2017.04.008.Fatkin D, Santiago CF, Huttner IG, et al. Genetics of atrial fibrillation: state of the art in 2017. Heart Lung Circ. 2017;26:894-901. doi:10.1016/j.hlc.2017.04.008.Perez-Serra A, Campuzano O, Brugada R. Update about atrial fibrillation genetics. Curr Opin Cardiol. 2017;32(3):246-52. doi:10.1097/hco.0000000000000387.Perez-Serra A, Campuzano O, Brugada R. Update about atrial fibrillation genetics. Curr Opin Cardiol. 2017;32(3):246-52. doi:10.1097/hco.0000000000000387.Lau DH, Nattel S, Kalman JM, Sanders P. Modifiable Risk Factors and Atrial Fibrillation. Circulation. 2017;136(6):583-96. doi:10.1161/CIRCULATIONAHA.116.023163.Lau DH, Nattel S, Kalman JM, Sanders P. Modifiable Risk Factors and Atrial Fibrillation. Circulation. 2017;136(6):583-96. doi:10.1161/CIRCULATIONAHA.116.023163.Mahajan R, Lau DH, Brooks AG, et al. Electrophysiological, electro-anatomical, and structural remodeling of the atria as consequences of sustained obesity. J Am Coll Cardiol. 2015;66:1-11. doi:10.1016/j.jacc.2015.04.058.Mahajan R, Lau DH, Brooks AG, et al. Electrophysiological, electro-anatomical, and structural remodeling of the atria as consequences of sustained obesity. J Am Coll Cardiol. 2015;66:1-11. doi:10.1016/j.jacc.2015.04.058.Pathak RK, Middeldorp ME, Lau DH, et al. Aggressive risk factor reduction study for atrial fibrillation and implications for the outcome of ablation: the ARREST-AF cohort study. J Am Coll Cardiol. 2014;64:2222-31. doi:10.1016/j.jacc.2014.09.028.Pathak RK, Middeldorp ME, Lau DH, et al. Aggressive risk factor reduction study for atrial fibrillation and implications for the outcome of ablation: the ARREST-AF cohort study. J Am Coll Cardiol. 2014;64:2222-31. doi:10.1016/j.jacc.2014.09.028.Mohanty S, Mohanty P, Di Biase L, et al. Long-term outcome of catheter ablation in atrial fibrillation patients with coexistent metabolic syndrome and obstructive sleep apnea: impact of repeat procedures versus lifestyle changes. J Cardiovasc Electrophysiol. 2014;25:930-8. doi:10.1111/jce.12468.Mohanty S, Mohanty P, Di Biase L, et al. Long-term outcome of catheter ablation in atrial fibrillation patients with coexistent metabolic syndrome and obstructive sleep apnea: impact of repeat procedures versus lifestyle changes. J Cardiovasc Electrophysiol. 2014;25:930-8. doi:10.1111/jce.12468.Miller JD, Aronis KN, Chrispin J, et al. Obesity, exercise, obstructive sleep apnea, and modifiable atherosclerotic cardiovascular disease risk factors in atrial fibrillation. J Am Coll Cardiol. 2015;66(25):2899-906. doi:10.1016/j.jacc.2015.10.047.Miller JD, Aronis KN, Chrispin J, et al. Obesity, exercise, obstructive sleep apnea, and modifiable atherosclerotic cardiovascular disease risk factors in atrial fibrillation. J Am Coll Cardiol. 2015;66(25):2899-906. doi:10.1016/j.jacc.2015.10.047.Wijffels MC, Kirchhof CJ, Dorland R, Allessie MA. Atrial fibrillation begets atrial fibrillation: a study in awake chronically instrumented goats. Circulation. 1995;92:1954-68. doi:10.1161/01.cir.92.7.1954.Wijffels MC, Kirchhof CJ, Dorland R, Allessie MA. Atrial fibrillation begets atrial fibrillation: a study in awake chronically instrumented goats. Circulation. 1995;92:1954-68. doi:10.1161/01.cir.92.7.1954.Melenovsky V, Hwang SJ, Redfield MM, et al. Left atrial remodeling and function in advanced heart failure with preserved or reduced ejection fraction. Circ Heart Fail. 2015;8:295-303. doi:10.1161/circheartfailure.114.001667.Melenovsky V, Hwang SJ, Redfield MM, et al. Left atrial remodeling and function in advanced heart failure with preserved or reduced ejection fraction. Circ Heart Fail. 2015;8:295-303. doi:10.1161/circheartfailure.114.001667.Berg DD, Ruff CT, Jarolim P, et al. Performance of the ABC scores for assessing the risk of stroke or systemic embolism and bleeding in patients with atrial fibrillation in ENGAGE AF-TIMI 48. Circulation. 2019;139:760-71. doi:10.1161/CIRCULATIONAHA.118.038312.Berg DD, Ruff CT, Jarolim P, et al. Performance of the ABC scores for assessing the risk of stroke or systemic embolism and bleeding in patients with atrial fibrillation in ENGAGE AF-TIMI 48. Circulation. 2019;139:760-71. doi:10.1161/CIRCULATIONAHA.118.038312.Gebreyohannes EA, Tegegn HG, Bhagavathula AS, et al. Poor outcomes associated with antithrombotic potential undertreatment in patients with atrial fibrillation: a retrospective cohort study. Value in Health. 2017;20(9):A625-A626. doi:10.1016/j.jval.2017.08.1377.Gebreyohannes EA, Tegegn HG, Bhagavathula AS, et al. Poor outcomes associated with antithrombotic potential undertreatment in patients with atrial fibrillation: a retrospective cohort study. Value in Health. 2017;20(9):A625-A626. doi:10.1016/j.jval.2017.08.1377.Habibi M, Zareian M, Ambale Venkatesh B, et al. Left atrial mechanical function and incident ischemic cerebrovascular events independent of AF: insights from the MESA study. J Am Coll Cardiol Img. 2019;12:2417-27. doi:10.1016/j.jcmg.2019.02.021.Habibi M, Zareian M, Ambale Venkatesh B, et al. Left atrial mechanical function and incident ischemic cerebrovascular events independent of AF: insights from the MESA study. J Am Coll Cardiol Img. 2019;12:2417-27. doi:10.1016/j.jcmg.2019.02.021.D'Souza M, Carlson N, Fosb0l E, et al. CHA2DS2-VASC score and risk of thromboembolism and bleeding in patients with atrial fibrillation and recent cancer. Eur J Prev Cardiol. 2018;25(6):651-8. doi:101177/2047487318759858.D'Souza M, Carlson N, Fosb0l E, et al. CHA2DS2-VASC score and risk of thromboembolism and bleeding in patients with atrial fibrillation and recent cancer. Eur J Prev Cardiol. 2018;25(6):651-8. doi:101177/2047487318759858.Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. European Heart Journal. 2016;37(38):2893-962. doi:10.1093/eurheartj/ehw210.Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. European Heart Journal. 2016;37(38):2893-962. doi:10.1093/eurheartj/ehw210.Turakhia MP, Ziegler PD, Schmitt S, et al. Atrial fibrillation burden and short-term risk of stroke: case-crossover analysis of continuously recorded heart rhythm from cardiac electronic implanted devices. Circ Arrhythm Electrophysiol. 2015;8:1040-7. doi:10.1161/circep.114.003057.Turakhia MP, Ziegler PD, Schmitt S, et al. Atrial fibrillation burden and short-term risk of stroke: case-crossover analysis of continuously recorded heart rhythm from cardiac electronic implanted devices. Circ Arrhythm Electrophysiol. 2015;8:1040-7. doi:10.1161/circep.114.003057.Brambatti M, Connolly SJ, Gold MR, et al. ASSERT Investigators Temporal relationship between subclinical atrial fibrillation and embolic events. Circulation. 2014;129:2094-9. doi:10.1161/circulationaha.113.007825.Brambatti M, Connolly SJ, Gold MR, et al. ASSERT Investigators Temporal relationship between subclinical atrial fibrillation and embolic events. Circulation. 2014;129:2094-9. doi:10.1161/circulationaha.113.007825.

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