Peculiarities of pharmacotherapy of chronic heart failure with retained left ventricular efficiency and associated atrial fibrilation depending on the method of heart rhythm control

Abstract

Introduction. Only small studies in selected centers have examined the effect of rhythm control strategy, including catheter ablation, on major cardiovascular events, mortality in patients with long-term atrial fibrillation and concomitant chronic heart failure with preserved left ventricular ejection fraction and features of pharmacotherapy. The aim. To study the peculiarities of pharmacotherapy in patients with heart failure with preserved left ventricular ejection fraction and concomitant atrial fibrillation over a long period of observation, depending on the implementation of a rhythm control strategy: radiofrequency ablation or pharmacotherapy and their impact on endpoints. Materials and Methods. The study included 194 patients with a mean age of 59.3 ± 8.5 years with atrial fibrillation and concomitant heart failure with preserved left ventricular ejection fraction I–III of the NYHA functional class. Patients were divided into 2 groups: 136 patients who underwent radiofrequency ablation, and 58 patients in the control group who did not undergo intervention and continued antiarrhythmic pharmacotherapy. The patients were compared according to the main clinical and demographic indicators. An assessment was made of the characteristics of pharmacotherapy and different stages of observation by group and its impact on endpoints. Results. In the control group, the use of antiarrhythmic drugs other than amiodarone and oral anticoagulants at the baseline of the study was associated with the primary endpoint. The chance of its occurrence was 3.9 times higher among patients taking other antiarrhythmic drugs (odds ratio–3.949, 95 % confidence interval 1.198–13.013) and 1.8 times lower among patients taking anticoagulants (odds ratio - 0.556, 95 % confidence interval 0.399–0.965). In the ablation group, the chance of a primary endpoint event occurring was 3.1 times higher among patients taking diuretics at 2-year follow-up (odds ratio –3.130, 95 % confidence interval 1.111–8.824), and beta-blockers were associated with 3.4 times lower chance of these events (odds ratio – 0.296, 95 % confidence interval 0.128–0.688). In the ablation group, there was a statistically significant decrease in the percentage of patients requiring diuretics 2 years after inclusion in the study compared with the 3-month stage (p < 0.001) and the inclusion stage (p < 0.001). Conclusions. Long-term use of beta-blockers after intervention is associated with a reduced risk of primary endpoint events in the ablation group. Taking diuretics, beta-adrenergic receptors, and renin-angiotensin-aldosterone system inhibitors during the first 3 months after the intervention reduces the risk of atrial fibrillation recurrence in the long-term follow-up period in the ablation group.

Keywords

• heart failure
• preserved ejection fraction
• radiofrequency ablation
• pharmacotherapy
• atrial fibrillation