ATRIAL FIBRILLATION: RISK ASSESSMENT AND PRINCIPLES OF PRIMARY PREVENTION
https://doi.org/10.17802/2306-1278-2025-14-2-200-210
Abstract
Highlights
The review describes the current state of the problem of assessing the risk of development, early diagnosis and primary prevention of atrial pre-fibrillation.
Abstract
The presented review describes the principles of primary prevention of atrial fibrillation from the standpoint of assessing the mechanisms of its formation and the risk of developing this arrhythmia. The first stage of atrial pre-fibrillation is characterized by the presence of potentially modifiable risk factors for its occurrence, and the second – by electrical and structural remodeling of the heart. The article presents the results of correction of potentially modifiable risk factors of atrial pre-fibrillation, and evaluates the effectiveness of using pharmacological and non-drug therapy. The article presents literature data on the effectiveness of correction of potentially modifiable risk factors, the use of pharmacological and non-drug therapy at the stages of atrial pre-fibrillation.
About the Authors
Natalia N. Tyuteleva
Federal State Budgetary Educational Institution of Higher Education “North-Western State Medical University named after. I.I. Mechnikov” Ministry of Healthcare of the Russian Federation
Russian Federation
Russian Federation
MD, PhD, Assistant at the Department of Advanced Therapy and Cardiology named after M.S. Kushakovsky, Federal State Budgetary Educational Institution of Higher Education “North-Western State Medical University named after. I.I. Mechnikov” Ministry of Healthcare of the Russian Federation, St. Petersburg, Russian Federation
Aleksandr I. Olesin
Federal State Budgetary Educational Institution of Higher Education “North-Western State Medical University named after. I.I. Mechnikov” Ministry of Healthcare of the Russian Federation
Russian Federation
Russian Federation
PhD, Professor, Department of Advanced Therapy and Cardiology named after M.S. Kushakovsky, Federal State Budgetary Educational Institution of Higher Education “North-Western State Medical University named after. I.I. Mechnikov” Ministry of Healthcare of the Russian Federation, St. Petersburg, Russian Federation
Irina V. Konstantinova
Federal State Budgetary Educational Institution of Higher Education “North-Western State Medical University named after. I.I. Mechnikov” Ministry of Healthcare of the Russian Federation
Russian Federation
Russian Federation
MD, PhD, Associate Professor at the Department of Advanced Therapy and Cardiology named after M.S. Kushakovsky, Federal State Budgetary Educational Institution of Higher Education “North-Western State Medical University named after. I.I. Mechnikov” Ministry of Healthcare of the Russian Federation, St. Petersburg, Russian Federation
References
1. Arakelyan M.G., Bockeria L.A., Vasilieva E.Yu., Golitsyn S.P., Golukhova E.Z., Gorev M.V., Davtyan K.V., Drapkina O.M., et al. 2020 Clinical guidelines for Atrial fibrillation and atrial flutter. Russian Journal of Cardiology. 2021;26(7):4594. doi:10.15829/1560-4071-2021-4594 (In Russian)
2. Lane D.A., Skjøth F., Lip G.Y.H., Larsen T.B., Kotecha D. Temporal Trends in Incidence, Prevalence, and Mortality of Atrial Fibrillation in Primary Care. J Am Heart Assoc. 2017;6(5):e005155. doi: 10.1161/JAHA.116.005155.
3. Mareev Yu.V., Polyakov D.S., Vinogradova N.G., Fomin I.V., Mareev V.Yu., Belenkov Yu.N., Ageev F.T., Artemjeva E.G., et al. Epidemiology of atrial fibrillation in a representative sample of the European part of the Russian Federation. Analysis of EPOCH-CHF study. Kardiologiia. 2022;62(4):12-19. doi:10.18087/cardio.2022.4.n1997 (In Russian)
4. Kasimova A.R., Tufanova O.S., Kolbina A.S. Socio-economic burden of atrial fibrillation in the Russian Federation: dynamics over 12 years. High-quality clinical practice.2023;(2):53-58. doi: 10.37489/2588-0519-2023-2-53-58 (In Russian)
5. Khubulova L.N., Klimchuk I.Ya., Bokeria O.L. Are strokes in women with atrial fibrillation more frequent and more dangerous? Annals of Arrhythmology. 2022; 19(1): 39-46. doi: 10.15275/annaritmol.2022.1.6. doi: 10.15275/annaritmol.2022.1.6 (In Russian)
6. Joglar, J, Chung, M., Armbruster A.L., Benjamin E.J., Chyou J.Y., Cronin E.M., Deswal A., Eckhardt L.L., et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. JACC. 2024;83 (1): 109–279. doi:10.1016/j.jacc.2023.08.017
7. Goette A., Kalman J.M., Aguinaga L., Akar J., Cabrera J.A., Chen S.A., Chugh S.S., Corradi D., et al. EHRA/HRS/APHRS/ SOLAECE expert consensus on atrial cardiomyopathies: Definition, characterization, and clinical implication. Heart Rhythm. 2017;14 (1): 3–40. doi: 10.1016/j.hrthm.2016.05.028.
8. Mason F., Pronto J.R.D., Alhussini K., Maack C., Voigt N. Cellular and mitochondrial mechanisms of atrial fibrillation. Basic Res Cardiol. 2020; 115(6): 72–78. doi: 10.1007/s00395–020-00827–7
9. Medvedev R.Y., Saheed O Afolabi S.O., Daniel G.P., Turner D.G.P., Glukhov A.V. Mechanisms of stretch-induced electro-anatomical remodeling and atrial arrhythmogenesis. J Mol Cell Cardiol. 2024;193(1):11-24. doi: 10.1016/j.yjmcc.2024.05.011.
10. Andersen J.H., Andreasen L., Olesen M.S. Atrial fibrillation-a complex polygenetic disease. Eur J Hum Genet. 2021;29(7):1051-1060. doi: 10.1038/s41431-020-00784-8.
11. Hu Z., Ding L., Yao Y. Atrial fibrillation: mechanism and clinical management. Chin Med J. 2023;136(22):2668-2676. doi: 10.1097/CM9.0000000000002906.
12. Dedov I.I., Shestakova M.V., Melnichenko G.A., Mazurina N.V., Andreeva E.N., Bondarenko I.Z., Gusova Z.R., Dzgoeva F.K., et al. Interdisciplinary Clinical Practice Guidelines "Management of obesity and its comorbidities". Obesity and metabolism. 2021;18(1):5-99. doi:10.14341/omet12714 (In Russian)
13. Wang W., Tan J.S., Wang J., Xu W., Bai L., Jin Y., Gao P., Zhang P., Li Y., Yang Y., Liu J. Genetically predicted waist circumference and risk of atrial fibrillation. Chin Med J. 2024;137(1):82-86. doi: 10.1097/CM9.0000000000002775.
14. Al-Kaisey A.M., Parameswaran R., Kalman J.M. Atrial Fibrillation Structural Substrates: Aetiology, Identification and Implications. Arrhythm Electrophysiol Rev. 2020; 9(3): 113–120. doi: 10.15420/aer.2020.19
15. Mazur E.S., Mazur V.V., Bazhenov N.D., Kolbasnicov S.V., Nilova O.V. Epicardial obesity and atrial fibrillation: emphasis on atrial fat depot. Obesity and metabolism. 2020;17(3):316–325. doi:10.14341/omet12614 (In Russian)
16. Shalov R. Z., Filatov A. G. Comorbid pathology and risk factors in patients with atrial fibrillation. Annals of Arrhythmology. 2023;20(1):43-51. doi 10.15275/annaritmol.2023.1.5 (In Russian)
17. Golukhova E.Z., Gromova O.I., Bulaeva N.I., Arakelyan M.G. Mechanisms of arrhythmogenesis and risk factors for thromboembolic events in patients with atrial fibrillation without concomitant valvular pathology and coronary heart disease. Bulletin of the Russian Academy of Medical Sciences. 2020;75(5):523-531. doi 10.15690/vramn1337 (In Russian)
18. Konecny T., Miles W.M. Treating Obstructive Sleep Apnea and Atrial Fibrillation: Focus on Substrate, Triggers, and Those Evasive Outcomes. JACC Clin Electrophysiol.2022;8(7):878-881. doi: 10.1016/j.jacep.2022.06.001.
19. Mazur VV, Mazur E.S., Bazhenov N.D., Nilova O.V., Nikolaeva T.O.Epicardial fat and left atrial appendage thrombosis in patients with persistent atrial fibrillation. Obesity and Metabolism. 2024;21(1):24-30. doi 10.14341/omet13030 (In Russian)
20. Berdysheva V.A., Ionin V.A., Vakulenko A.S., Shuncheva V.V., Bakulin G.G., Baranova E.I. Atrial fibrillation and obstructive sleep apnea syndrome: results of a retrospective study. "Arterial’naya Gipertenziya" ("Arterial Hypertension"). 2024;30(1):58-69. doi:10.18705/1607-419X-2024-2395. (In Russian)
21. Varma N., Cyqankiewicz I., Terakhia M., Heidbuchel H., Hu Y., Chen L.Y., Couderc J.P., Cronin E.M., et al. 2021 ISHNE/ HRS/EHRA/APHRS collaborative statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals. From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society. J Arrhythm. 2021;37(2): 271–319. doi: 10.1002/ joa3.12461
22. Himmelrech J.C.L., Veeler L., Lucassen W.A.M., Schnabel RB, Rienstra M, van Weert HCPM, Harskamp RE. Prediction models for atrial fibrillation applicable in the community: a systematic review and meta-analysis. Europace. 2020;22(5): 684–694. doi: 10.1093/europace/euaa005
23. Alonso A., Krijthe B.P., Aspelund T., Stepas K.A., Pencina M.J., Moser C.B., Sinner M.F., Sotoodehnia N., et al. Simple risk model predicts incidence of atrial fibrillation in a racially and geographically diverse population: the CHARGEAF consortium. J Am Heart Assoc. 2013;2(2): e000102. doi: 10.1161/JAHA.112.000102 25.
24. Himmelrech J.C.L., Lucassen W.A.M., Harskamp R.E., Aussems C., van Weert H.C.P.M., Nielen M.M.J. CHARGE-AF in a national routine primary care electronic health records database in the Netherlands: validation for 5-year risk of atrial fibrillation and implications for patient selection in atrial fibrillation screening. Open Heart. 2021; 8(1): e001459. doi:10.1136/openhrt-2020–001459
25. Gregory Y.H. L., Skjøth F., Nielsen P.B., Larsen T.B. Evaluation of the C2HEST Risk Score as a Possible Opportunistic Screening Tool for Incident Atrial Fibrillation in a Healthy Population (From a Nationwide Danish Cohort Study). Am J Card. 2020;125(1):48-55. doi:10.1016/j.amjcard.2019.09.034
26. Habib Haybar H., Shirbandi K., Rahim F. C2HEST score for atrial fibrillation risk prediction models: a Diagnostic Accuracy Tests meta-analysis. Egypt Heart J. 2021;73(1):104-112. doi: 10.1186/s43044-021-00230-0.
27. Wu Y., Xie Z., Liang W., Xue R., Wu Z., Wu D., He J, Zhu W, Liu C. Usefulness of CHADS2, R2CHADS2, and CHA2DS2-VASc scores for predicting incident atrial fibrillation in heart failure with preserved ejection fraction patients. ESC Heart Fail. 2021; 8(2): 1369–1377. doi:10.1002/ ehf2.13217
28. Aizawa Y., Watanabe H., Okumura K. Electrocardiogram (ECG) for the Prediction of Incident Atrial Fibrillation: An Overview. J Atr Fibrillation. 2017;10(4):1724. doi: 10.4022/jafib.1724.
29. Chousou P.A., Chattopadhyay R., Tsampasian V., Vassiliou V.S., Pugh P.J. Electrocardiographic Predictors of Atrial Fibrillation. Med Sci (Basel) . 2023;11(2):30. doi: 10.3390/medsci11020030.
30. Rafaqat S., Rafaqat S., Ijaz H. Affiliations expand Role of Biochemical Cardiac Markers in Atrial Fibrillation. J Innov Card Rhythm Manag. 2023;14(10):5611-5621. doi: 10.19102/icrm.2023.14101.
31. Matei L.L., Popescu R.M., Popescu A.C., Bălănescu S.M. Early Echocardiographic Predictors for Atrial Fibrillation Propensity: The Left Atrium Oracle. Rev Cardiovasc Med. 2022;23(6):205. doi: 10.31083/j.rcm2306205
32. Olesin A.I., Litvinenko V.A., Al-Barbari A.V., Konstantinova I.V., Smolin Z.Yu., Prosynikova O.N. Atrial fibrillation onset risk in patient with metabolic syndrome: prospective study. Russian Journal of Cardiology, 2014; 12 (116): 25–30. doi:10.15829/1560-4071-2014-12-25-30 (In Russian)
33. Olesin A.I., Konstantinova I.V., Ivanov S.V. Patients with metabolic syndrome and premature atrial contractions: predicting the atrial fibrillation onset. Fundamental and Clinical Medicine. 2022;7(2): 75-83. doi:10.23946/2500-0764-2022-7-2-75-83 (In Russian)
34. Olesin A.I., Konstantinova I.V. The possibility of using pharmacological antiarrhythmic therapy and modulated kinesotherapy as a primary prevention of atrial fibrillation in patients with metabolic syndrome and with premature atrial complexes: prospective study. Complex Issues of Cardiovascular Diseases. 2022;11(1): 17-25. doi: 10.17802/2306-1278-2022-11-1-17-25 (In Russian)
35. Olesin A.I., Konstantinova I.V. Primary prevention of atrial fibrillation in patients with metabolic syndrome: correction of modifiable risk factors. Fundamental and Clinical Medicine. 2021;6(2):103-115. doi:10.23946/2500-0764-2020-6-2-103-115 (In Russian)
36. Chung M.K., Eckhardt L.L., Chen L.Y., Ahmed H.M., Gopinathannair R., Joglar J.A., Noseworthy P.A., Pack Q.R., et al. Lifestyle and Risk Factor Modification for Reduction of Atrial Fibrillation: A Scientific Statement From the American Heart Association. Circulation . 2020;141(16):e750-e772. doi: 10.1161/CIR.0000000000000748.
37. Isakadze N., Pratik B., Sandesara B., Patel R., Baer J., Isiadinso I., Alonso A., Lloyd M., Sperling L. Life’s Simple 7 Approach to Atrial Fibrillation Prevention. J Atr Fibrillation. 2018;11(3): 2051-2058. doi: 10.4022/jafib.2051.
38. O'Keefe E.L., Sturgess J.E., O'Keefe J.H., Gupta S., Lavie C.J. Prevention and Treatment of Atrial Fibrillation via Risk Factor Modification. Am J Cardiol. 2021:160:46-52. doi: 10.1016/j.amjcard.2021.08.042.
39. Lim M.W., Kalman J.M. The impact of lifestyle factors on atrial fibrillation. J Mol Cell Cardiol . 2024:193:91-99. doi: 10.1016/j.yjmcc.2024.05.015.
40. Chen Y.C., Voskoboinik A., Gerche A., Marwick T.H., McMullen J.R. Prevention of Pathological Atrial Remodeling and Atrial Fibrillation: JACC State-of-the-Art Review. J Am Coll Cardiol. 2021;77(22):2846-2864. doi: 10.1016/j.jacc.2021.04.012.
41. Matei L.L., Siliste C., Vinereanu D. Modifiable Risk Factors and Atrial Fibrillation: the Quest for a Personalized Approach. Maedica (Bucur). 2021;16(1): 88–96. doi: 10.26574/maedica.2020.16.1.88
42. Olesin A.I., Konstantinova I.V., Tyuteleva N.N., Ivanov V.S. Comorbid Patients with Abdominal Obesity and High Risk of Atrial Fibrillation: Correction of Modifiable Risk Factors as a Strategy of Primary Prevention (Prospective Study). Fundamental and Clinical Medicine. 2024;9(1):53-63. doi:10.23946/2500-0764-2024-9-1-53-63 (In Russian)
43. Zheng Y., Xie Z., Li J., Chen C., Cai W., Dong Y., Xue R., Liu C. Meta-analysis of metabolic syndrome and its individual components with risk of atrial fibrillation in different populations. BMC Cardiovasc Disord. 2021;21(1): 90– 101. doi: 10.1186/s12872–021-01858–1
44. Ahn H. J., Han K.D., Choi E.K., Jung J.H., Kwon S., Lee S.R., Oh S., Lip G.Y.H. Cumulative burden of metabolic syndrome and its components on the risk of atrial fibrillation: a nationwide population-based study. Cardiovasc Diabetol. 2021;20(1): 20–29. doi: 10.1186/s12933–021-01215–8
45. Olesin A.I., Litvinenko V.A., Konstantinova I.V., Shlapakova A.V. A possibility to use antiarrhythmic medication from II class and modulated kinesitherapy as primary prevention of atrial fibrillation in metabolic syndrome patients. Russian Journal of Cardiology. 2015;(11):75-80. doi:10.15829/1560-4071-2015-11-75-80 (In Russian)
46. Mareev Yu.V., Ezhov M.V., Villevalde S.V., Alieva A.S., Obrezan A.G., Tarasov A.V., Panov A.V., Konstantinov V.O., et al. Cardiovascular effects of omega-3 polyunsaturated fatty acids: position of omega-3 polyunsaturated fatty acids in Russian and international guidelines. Council of Experts. Kardiologiia. 2023;63(2):11-18. doi:10.18087/cardio.2023.2.n2388 (In Russian)
47. Trohman R.G., Parikshit H.D.H., Sharma S. Atrial fibrillation: primary prevention, secondary prevention, and prevention of thromboembolic complications: part 1. Front. Cardiovasc. Med. 2023;10(1):1-44. doi:10.3389/fcvm.2023.1060030
48. Lip G.Y.H., Feng Q., Fei Y., Tse Y.K., Wu M.Z., Ren Q.W., Tse H.F., Cheung B.Y., Yiu K.H. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) and cardiac arrhythmias: a systematic review and meta-analysis. Cardiovasc Diabetol. 2021 ;20(1):100. doi: 10.1186/s12933-021-01293-8
49. Zhang H.-D., Dien L., Mi L.-J., Zhang A.-K., Zhang K., Jiang Zi.-H., Yu F.Y., Yan X.X., Shen Y.J., Tang M. Sodium-glucose co-transporter-2 inhibitors for the prevention of atrial fibrillation: a systemic review and meta-analysis. Eur J Prev Cardiol. 2024;31(7):770-779. doi: 10.1093/eurjpc/zwad356.
50. Riesinger L., Siebermair J., Wakili R. Mapping strategies and ablation of premature atrial complexes. Herzschrittmacherther Elektrophysiol. 2021;32(1):9-13. doi: 10.1007/s00399-021-00744-9.
51. Vakhrushev A.D., Condori Leandro E.I., Korobchenko L.E., Mitrofanova L.B., Lebedev D.S., Mikhailov E.N. Laser catheter ablation of atrial zones with ganglionated plexi: impact on atrial fibrillation inducibility and the risk of esophageal damage in experimental settings. Journal of Arrhythmology. 2024;31(2):44-53. doi:10.35336/VA-1209 (In Russian)
Supplementary files
Review
For citations:
Tyuteleva N.N., Olesin A.I., Konstantinova I.V. ATRIAL FIBRILLATION: RISK ASSESSMENT AND PRINCIPLES OF PRIMARY PREVENTION. Complex Issues of Cardiovascular Diseases. 2025;14(2):200-210. (In Russ.) https://doi.org/10.17802/2306-1278-2025-14-2-200-210
Views:
148
