kpcczКомплексные проблемы сердечно-сосудистых заболеванийComplex Issues of Cardiovascular Diseases2306-12782587-9537Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases”10.17802/2306-1278-2018-7-4S-86-93kpccz-510Research ArticleАНАЛИТИЧЕСКИЙ ОБЗОРANALYTICAL REVIEWКомбинированное лечение неклапанной фибрилляции предсердий: изоляция легочных вен и окклюзия ушка левого предсердияCombination of pulmonary vein isolation and left atrial appendage closure for non-valvular atrial fibrillationКочергинН. А.KocherginN. A.

Кочергин Никита Александрович - кандидат медицинских наук, младший научный сотрудник лаборатории интервенционных методов диагностики и лечения.

Сосновый бульвар, 6, Кемерово, Кемеровская область, 650002, тел. +79089523235

Kochergin Nikita A. - PhD, research assistant at the Laboratory of Interventional Cardiology.

6, Sosnovy Blvd., Kemerovo, 650002, tel. +79089523235

nikotwin@mail.ruГанюковВ. И.GanyukovV. I.

Ганюков Владимир Иванович - доктор медицинских наук, заведующий лабораторией интервенционных методов диагностики и лечения.

Сосновый бульвар, 6, Кемерово, Кемеровская область, 650002

Ganyukov Vladimir I. - PhD, Head of the Laboratory of Interventional Cardiology.

6, Sosnovy Blvd., Kemerovo, 650002

МамчурС. Е.MamchurS. E.

Мамчур Сергей Евгеньевич - доктор медицинских наук, заведующий отделом диагностики сердечно-сосудистых заболеваний.

Сосновый бульвар, 6, Кемерово, Кемеровская область, 650002

Mamchur Sergey E. - PhD, Head of Cardiovascular Disease Diagnostics.

6, Sosnovy Blvd., Kemerovo, 650002

ТрубниковаО. А.TrubnikovaO. A.

Трубникова Ольга Александровна - доктор медицинских наук, заведующая лабораторией нейрососудистой патологии.

Сосновый бульвар, 6, Кемерово, Кемеровская область, 650002

Trubnikova Olga A. - PhD, Head of the Laboratory of Neurovascular Pathology.

6, Sosnovy Blvd., Kemerovo, 650002

Федеральное государственное бюджетное научное учреждение Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеванийРоссияFederal State Budgetary Institution Research Institute for Complex Issues of Cardiovascular DiseasesRussian Federation20180202201974S8693Copyright © Кочергин Н.А., Ганюков В.И., Мамчур С.Е., Трубникова О.А., 20202020Кочергин Н.А., Ганюков В.И., Мамчур С.Е., Трубникова О.А.Kochergin N.A., Ganyukov V.I., Mamchur S.E., Trubnikova O.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.nii-kpssz.com/jour/article/view/510

Распространенность фибрилляции предсердий составляет до 2% в общей популяции с увеличением риска до 24% у лиц старше 40 лет. Основным методом хирургического лечения фибрилляции предсердий является катетерная радиочастотная изоляция легочных вен. Однако долгосрочная эффективность аблации составляет около 50%. Инсульт является одним из основных осложнений фибрилляции предсердий из-за образования тромбов в левом предсердии. Вероятность инсульта у больных фибрилляцией предсердий составляет 5%, увеличиваясь до 15% у пациентов с высоким риском тромбоэмболических событий. Ушко левого предсердия является источником тромбов более чем у 90% пациентов с неклапанной фибрилляцией предсердий. Для профилактики тромбоэмболических событий назначаются оральные антикоагулянты. Однако антикоагулянтная терапия имеет ряд недостатков, таких как кровотечения, взаимодействие с некоторыми продуктами питания и лекарственными средствами, узкий терапевтический диапазон. Кроме того, больные фибрилляцией предсердий, особенно пожилые, имеют низкую комплаентность. Исключение ушка левого предсердия из кровообращения является альтернативой оральным антикоагулянтам. Таким образом, сочетание окклюзии ушка левого предсердия с изоляцией легочных вен представляется рациональным методом лечения фибрилляции предсердий. Данный подход нивелирует потребность в антикоагулянтах и снижает риск инсульта.

Atrial fibrillation might occur up to 2% of the general population, with a lifetime risk of 24% in persons > 40 years of age. Catheter ablation is increasingly being used to treat drug-refractory atrial fibrillation. The long-term efficacy of catheter ablation is disappointing, with success rates about 50%. Stroke is one of the major complications of atrial fibrillation because of atrial thrombus formation. The overall annual stroke risk is 5% in patients with atrial fibrillation, increasing up to 15% in high-risk patients. The left atrial appendage was the source of thrombi in >90% of the patients with non-valvular atrial fibrillation. Anticoagulation should be given to prevent thromboembolic events. However, anticoagulant therapy has several disadvantages, such as (major) bleedings, interactions with some dietary components and other medications, and a narrow therapeutic range. In addition, patients with atrial fibrillation, especially the elderly, have low compliance. Exclusion of the left atrial appendage from the systemic circulation could be an alternative. Thus, the combination of the left atrial appendage closure with the isolation of the pulmonary veins appears to be a rational method for the treatment of atrial fibrillation. This approach eliminates the need for anticoagulants and reduces the risk of stroke.

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