Предупреждение эпизодов фибрилляции предсердий у больных с хронической сердечной недостаточностью: новый взгляд на старую проблему

Aim. To study clinical effectiveness and safety of propafenone and amiodarone in patients with arterial hypertension (AH), coronary heart disease (CHD), chronic heart failure (CHF) with preserved left ventricular (LV) systolic function, and atrial fibrillation (AF). Material and methods. The study included 110 34-66-year-old patients from various Russian regions, with paroxysmal and/or persistent AF. To prevent AF episodes, the participants were administered propafenone (n=59) or amiodarone (n=51) for 12 months. Results. The treatment of the leading pathology resulted in achieving target blood pressure levels (in 67,3 % of the patients), as well as in reducing functional class of angina (70 %) and CHF (94,5 %). In its turn, this resulted in reduced incidence (-72,9 %) of hospitalisations due to CHF decompensation. After 12 months of the treatment, propafenone effectiveness was 54,2 % — similar to that for amiodarone (52,9 %). In 33,9 % of the patients taking propafenone, the number of AF episodes was reduced by 86,6 %, their total duration — by 70,1 %, ventricular rate during the paroxysm — by 43,1 %, while the number of asymptomatic episodes increased by 30,9 %. Propafenone was also safer than amiodarone: the respective incidence of adverse effects was 0 % vs. 31,6 %. Conclusion. Propafenone, a Class IC antiarrythmic medication, was characterised by high antiarrythmic effectiveness and safety, and could also be combined with beta-adrenoblockers in CHF patients with preserved LV systolic function, AH, CHD, and paroxysmal and/or persistent AF.