Atrial fibrillation characterized by irregular atrial waves and an irregular AV conduction sequence, resulting in an irregular occurrence of QRS complexes. Atrial fibrillation waves are best seen in standard lead V1, but are usually seen in leads II, III, and aVF as well. They can be large and deformed or small, up to invisible. In the latter case, a completely irregular ventricular rhythm indicates the presence of atrial fibrillation.

First episode of atrial fibrillation. When atrial fibrillation occurs for the first time, a thorough clinical examination is required to determine whether this arrhythmia is primarily an electrical phenomenon or it is secondary to hemodynamic disturbances. The likelihood of atrial fibrillation increases with age and in the presence of organic heart disease. Fibrillations without organic lesions are called solitary. Significant mitral or aortic valve disease, hypertension, coronary artery disease, cardiomyopathy, atrial septal defect, and myopericarditis are diseases often associated with the development of atrial fibrillation.

Thromboembolism pulmonary artery, thyrotoxicosis, smoking, drinking coffee and alcohol, excessive stress, or fatigue are also well-known causes of atrial fibrillation.

In the absence of organic heart disease or Wolff-Parkinson-White syndrome it is enough to eliminate the provoking factors and monitor for the occurrence of relapses. If there is a severe heart disease, then therapy should be directed to the treatment of a specific cardiac pathology; otherwise, the risk of recurrence is high, even with pharmacological therapy and/or electrical cardioversion. Cardioversion is indicated to arrest the first episode of atrial fibrillation if the patient's condition requires taking advantage of the hemodynamic contribution of atrial contraction (eg, in aortic stenosis) or slowing the ventricular rate to prolong the diastolic filling period (eg, in mitral stenosis).

Paroxysmal form of atrial fibrillation. The therapy of choice for the relief of short paroxysms in the absence of underlying heart disease is rest, the appointment of sedatives and cardiac glycosides. The need for long-term therapy is due to the need to limit the frequency of ventricular contractions during attacks. Therapy is with digitalis preparations, beta-blockers, or calcium channel blockers (see description of treatment of atrial flutter).

In the presence of a disease hearts the development of hemodynamic disturbances or congestive heart failure requires immediate restoration of sinus rhythm. Emergency cardioversion to prevent or treat pulmonary edema is mandatory if atrial fibrillation develops against the background of hemodynamically significant aortic or mitral stenosis. The preferred method is electrical (DC) defibrillation synchronized with the QRS complex, with energies ranging from 100 W/s initially to 200 W/s on the second and subsequent shocks.

If state hemodynamics the patient is stable, the ventricular rate can be corrected by intravenous administration of digoxin, beta-blockers, or calcium antagonists. Today, intravenous administration of verapamil or diltiazem is considered to be preferred due to their rapid onset of action. In addition, unlike digoxin, whose vagotonic effects are not manifested against the background of the prevailing sympathetic tone, verapamil retains the ability to cause depression of the AV node, although dose adjustment may be required over time. The class IA antiarrhythmic drugs quinidine, procainamide, and disopyramide are effective in restoring and maintaining sinus rhythm in atrial fibrillation.

Most commonly used quinidine. Traditional dosages and regimens (200 to 600 mg orally every 6 to 8 hours) are used today, while in the past aggressive and potentially toxic methods of administration of quinidine drugs were used. During an attempt at medical cardioversion, it is necessary, in addition to monitoring serum drug levels, to carefully monitor the duration of the Q-T interval, for fear of its excessive lengthening (when the corrected Q-T interval becomes 25% longer than the original one). If class IA drugs are ineffective, class 1C antiarrhythmic drugs (flecainide and propafenone) are prescribed, which transfer atrial fibrillation to sinus rhythm. Class 1C drugs are also effective in maintaining sinus rhythm. The intravenous forms of these drugs are very effective, but they are not approved for use in the US.

Ibutilid for intravenous administration, a new class III agent, restored the sinus rhythm in 31% of patients, but it is allowed to be used only under strict control, since it can dramatically increase the QT interval and, accordingly, the risk of short-term episodes of torsades de pointes.

Effective in relapse prevention atrial fibrillation and amiodarone- class III drug. The main limitations in the use of amiodarone are determined by the spectrum of its negative side effects and its unusually long half-life, which prevents flexible adjustment of therapy. However, the use of low doses of amiodarone (Cordarone, cordarone; 200-300 mg/day) resulted in a significant reduction in negative side effects. Another class III drug, sotalol (Betapace, Betapace) can also be used successfully to prevent recurrence of atrial fibrillation, but is not currently approved for this indication in the United States of America. In patients with atrial fibrillation refractory to all drug therapies (both traditional and experimental), and in patients in whom rhythm disturbances are accompanied by severe clinical manifestations, catheter destruction of the zone adjacent to the His bundle is used as an alternative method in order to modification of the conduction or formation of a complete AV block.

However, since this procedure often leads to pacemaker dependence and should be used as a last resort in correcting the ventricular rate in atrial fibrillation.

Persistent form of atrial fibrillation. Unless repeated episodes of persistent atrial fibrillation (lasting days or weeks) cause hemodynamic compromise, most physicians avoid multiple electrical cardioversions. This type of atrial fibrillation eventually leads to the development of a permanent form of atrial fibrillation. Therefore, the best approach in therapy is to correct the ventricular rate during relapses. Membrane-stabilizing antiarrhythmic drugs can be used to try to reduce relapse rates, but their effectiveness is unpredictable and the risk of side effects is high. Flecainide has been successfully used in patients with preserved left ventricular function without signs of coronary heart disease. If the clinical manifestations of recurrences cause severe subjective sensations, consider the possibility of performing catheter destruction of the AV node.

Chronic form of atrial fibrillation. Performing pharmacological or electrical cardioversion for chronic atrial fibrillation is indicated primarily in cases where it is possible to hope for an improvement in the patient's hemodynamics. Usually, no more than one attempt at electrical cardioversion is performed with the appointment of adequate doses of membrane-stabilizing antiarrhythmic drugs. This is due to the extremely low likelihood that sinus rhythm will be maintained for a long time if after cardioversion there has been a return to a permanent form of atrial fibrillation. In this case, the treatment will be aimed at correcting the ventricular response rate according to the above rules.

Anticoagulant therapy in patients with atrial fibrillation

Target anticoagulant therapy in patients with atrial fibrillation- reduction in the number of deaths from systemic and pulmonary embolism. The decision to start anticoagulant treatment for atrial fibrillation is based on a balance between the relative risk of embolism and the risk of bleeding complications secondary to anticoagulant therapy. In table. 2.4 contains indications and relative contraindications for anticoagulant therapy in patients with atrial fibrillation. The same indications apply to elective cardioversion for recent persistent atrial fibrillation or chronic atrial fibrillation. Anticoagulant therapy with warfarin (Coumadin, Coumadin) is started 3 weeks before elective cardioversion and continued for 4 weeks after cardioversion due to an increased risk of embolism in the first days after returning to sinus rhythm. When carrying out anticoagulant therapy, warfarin is prescribed in doses sufficient to increase the prothrombin time to a value corresponding to an indicator of 2.0-3.0 on the INR (International Normalized Ratio) scale.

Indications for anticoagulant therapy in atrial fibrillation:
- Hypertension, previous episodes of transient ischemic attacks or strokes, congestive heart failure, dilated cardiomyopathy, symptomatic coronary heart disease, mitral stenosis, heart valve insufficiency, thyrotoxicosis
- More than 3 weeks or more than 4 weeks after elective cardioversion
- Age over 65

Here you will learn which vitamin and amino acid deficiencies and other natural substances can lead to coronary heart disease, atherosclerosis and arrhythmia, how to strengthen the wall of blood vessels with herbs, which herbs for the heart and blood vessels have been used in folk medicine for centuries and their effect has been proven by modern research .

Perhaps you underestimate the effect that can be obtained in case of problems with the heart and blood vessels with the help of vitamins and other natural substances.

We are used to hearing that “vitamins” for the heart are potassium, magnesium, and a maximum of vitamin E. They are usually prescribed by every doctor. But this is far from the whole truth. In this article, you will learn which natural substances have a deeper positive effect on the heart. In modern European nutrition, their effect on the heart and blood vessels is well studied. Take the time to read more about heart vitamins like Arginine. Coenzyme Q10. Megapolyene (omega-3 acids) and Carnitine, and wonder why they haven't started using them yet. It's so simple and effective!

Why vitamins, amino acids and herbs are needed for diseases of the heart and blood vessels.

The main group of diseases that deprives a person of his ability to work with age, makes him drink medicine every day or even go to the hospital - problems with the heart and blood vessels. But it is important to understand that coronary heart disease and atherosclerosis and many types of arrhythmias are based on a long-term disturbed metabolism.

For example, atherosclerosis develops, i.e. more and more fatty plaques are deposited on the wall of the artery, which eventually become hard, the lumen of the vessel narrows and the wall becomes completely inelastic. The result is a risk of heart attack or stroke. At a later stage, natural remedies are no longer sufficient for such a vessel.

But at the very beginning, it was damage to the vessel wall by free radicals due to a deficiency of vitamins and trace elements-antioxidants (C, E, selenium and others), and the vessel wall was also damaged by homocysteine ​​due to a deficiency of folic acid in the blood, and finally sugar could jump and it accelerated vessel damage in case of deficiency of chromium, zinc, amino acid taurine.

At any stage of atherosclerosis it is possible, by taking natural vitamins and minerals, to save some part of the vessels that are not yet completely overgrown. The vessel wall becomes less sensitive to the deposition of cholesterol.

Plus, you can control your cholesterol levels. Cholesterol is made in the liver, and through a liver cleanse, herbs, and good quality omega-3s, you can save yourself the prospect of lifelong statin use.

The cause of arrhythmia, pain in the heart, heart failure is in malnutrition and metabolic processes in the heart muscle, the cause of hypertension is a violation of water-salt metabolism and vascular tone. Natural remedies help to nourish the heart and improve vascular tone, eliminate the causes of fluid retention. They do not relieve pain in the heart and do not stop an arrhythmia attack. Natural remedies are needed to eliminate the causes of these phenomena.

Coenzyme Q10 is the #1 natural remedy for the heart

On the site you will find the most accurate information about the correct dosage of this natural remedy, since with its help a cardiologist could work wonders in the literal sense of the word, regardless of the degree of damage to the heart muscle, the level of arrhythmia and hypertension. But in real life, doctors often under-dose. Read about what is known about the correct dosage of Q10. And where can I find it at the right price.

What is the best complex of vitamins for the heart

Surprisingly, we will not recommend popular synthetic vitamin complexes from a pharmacy, where a beautiful heart is drawn and it is written that they are the best for cores. Why? Because microdoses of B vitamins, tocopherol acetate can make little difference in your health. Of course, they are easier to take, but it’s better to delve into it and then the effect will be completely different. World studies and Russian dissertations on the effectiveness of natural substances usually concern individual components. We, selecting vitamins for the heart and blood vessels in our program in accordance with scientific data from foreign literature, did not discover America. In fact, what is important is in terms of chemistry and is not called vitamins. These are more often amino acids, omega-3 acids, coenzyme Q10. They are added to pharmacy complexes a little bit, and if you listen to our recommendations, you can use not a psychological, but a real dose of what is useful. You just need to agree to take not two capsules a day, but four. But already 100% natural nutrient.

Medicines or herbs. Folk treatment of blood vessels?

So the question is not posed. Medications save lives, that is, they make it so that the pain in the heart, an arrhythmia attack disappears, a heart attack does not happen right now, high blood pressure decreases. But they do not act on the causes of the development of diseases of the heart and blood vessels. Because the causes are metabolic disorders, poor functioning of the liver and intestines, low physical activity, deficiency of nutrients in the diet, chronic stress.

For that, folk remedies - natural vitamins and trace elements extracted from herbs and foods, herbs and products for cleansing the body just affect the prospect of the development of the disease.

In other words, medicines are so that it does not hurt today, natural remedies - so that tomorrow does not hurt. Even if you have to take already regularly hypotensive, antiarrhythmic, vasodilating, diuretic cardiovascular drugs, this does not mean that it is too late to drink vitamins and minerals, herbs. Tomorrow, the same is important what will be ...

When we take natural remedies, we do not set ourselves the task of replacing them with a remedy for acute cases. For example, with atrial fibrillation, the task of corbalance, export Zyflane, Megapolien and others is to influence the cause - to improve the nutrition of the heart muscle and, as a result, reduce the likelihood of arrhythmia.

All improvement by natural means is achieved through improved nutrition of the heart, vessel wall, vessel tone, blood flow. those. restoration of self-regulation.

"Sokolinsky system" for the heart and blood vessels

Be sure to read the book by V.E. Sokolinsky "Clear methods of health promotion: for the busy and reasonable". It will turn your idea of ​​what to do so that vascular diseases stop slowly destroying you from head to foot (in the correct position).

The expression vitamins for the heart is, of course, a simplification. In fact, vitamins (natural tocopherol) and omega-3 acids and amino acids (carnitine, arginine) and coenzyme Q10 and herbs are also used to improve its nutrition.

Of great importance at the first stage is the cleansing of the liver and the normalization of the stool, since with constipation it is not possible to achieve self-regulation of cholesterol levels.

For that, you will notice a difference in the general condition within a month. The body, having received nutritional support aimed at the heart and blood vessels, freed from toxins, will behave much more stable.

We have been collecting a collection of natural products for more than 10 years. Behind each of them are positive reviews from hundreds of people.

The Sokolinsky system is a way to feel better, be more productive, and use fewer drugs in the long run.

Consultation on the selection of an individual program for taking vitamins, minerals, herbs for the heart

Products

Cardiac arrhythmia - violations of the frequency, rhythm and sequence of excitation and contraction of the heart.

The term "arrhythmia" combines different mechanisms, clinical manifestations and prognostic value of violations of the formation and conduction of an electrical impulse.

In ordinary life, when everything is in order with the heart, a person, as a rule, does not feel its beating, does not perceive its rhythm. And when an arrhythmia appears, interruptions, a sinking heart or a sharp chaotic heartbeat are clearly felt.

Normal rhythm. Tachycardia. Bradycardia.

In the heart, as you know, there are special cells that can independently produce an electrical impulse. Under the influence of an electrical impulse, the heart contracts. The cells that produce the impulse are called the pacemaker. Normally, the pacemaker is the sinus node located in the wall of the right atrium, therefore, the heart rhythm that is normal according to the source of origin is called sinus. The normal resting heart rate for an adult is 55-80 beats per minute. The sinus node is under the control of the autonomic nervous system and very clearly responds to all the needs of the body.

If the sinus node does not work properly, the following arrhythmia options are possible:

- frequent regular sinus rhythm or "sinus tachycardia";

- rare regular sinus rhythm or "sinus bradycardia";

- irregular sinus rhythm or "sinus arrhythmia";

It should be noted that frequent or rare sinus rhythm may be a manifestation of the norm. For example, during physical or emotional stress, the heart contracts more often. In athletes, due to the high fitness of the cardiovascular system, the pulse can normally be rare - 35-40 beats. in min. Many medicinal substances affect the heart rate, can cause it to slow down or increase.

The pacemaker can also be cells located in the atria, the atrioventricular node, in the ventricles. For example, the term "atrial rhythm" means that the pacemaker is located in the atria, but not in the sinus node.

Rice. 2. Pacemakers: S-A - sinus node, A-V - atrioventricular node.

In the natural pacemaker of the heart, electrical impulses arise that pass through the atria, causing them to contract, to the atrioventricular (i.e., atrioventricular) node located at the border of the atria and ventricles. Then the excitation spreads through the conductive tissues in the ventricles, causing them to contract. After that, the heart rests until the next impulse, from which a new cycle begins.

The problem of cardiac arrhythmias remains constantly relevant - and no matter how many works on this topic, it is impossible to exhaust it. Cardiac arrhythmias occur daily in medical practice, the spectrum of cardiac arrhythmias in the etiological, clinical, diagnostic, and prognostic terms is extremely wide.

Cardiac arrhythmias can be detected in a healthy person, and in these cases they are quite benign, without affecting the quality of life in any way.

And at the same time, heart rhythm disturbances are one of the most frequent and significant complications of completely different diseases.

Arrhythmias often determine the prognosis for work and life. Cardiac arrhythmias, even if they do not seriously disturb hemodynamics, can be quite difficult for patients to tolerate and change their entire lifestyle.

Arrhythmias can occur with structural changes in the conduction system in diseases of the heart and (or) under the influence of autonomic, endocrine, electrolyte and other metabolic disorders, with intoxication and some medicinal effects.

Often, even with pronounced structural changes in the myocardium, arrhythmia is due in part or mainly to metabolic disorders. The factors listed above affect the main functions (automatism, conductivity) of the entire conduction system or its departments, cause electrical inhomogeneity of the myocardium, which leads to arrhythmia.

In some cases, arrhythmias are caused by individual congenital anomalies of the conduction system. The severity of the arrhythmic syndrome may not correspond to the severity of the underlying heart disease. Arrhythmias are diagnosed mainly by ECG.

Most arrhythmias can be diagnosed and differentiated by clinical and electrocardiographic features. Occasionally, a special electrophysiological study (intracardiac or intraesophageal electrography with stimulation of the conduction system departments) is needed, performed in specialized cardiological institutions.

The following types of arrhythmias are distinguished

1. Arrhythmias due to a violation of the heart rate:

• Tachycardia - frequent contractions of the heart (more than 100 beats per minute);
• Bradycardia - infrequent heartbeats (less than 55 beats per minute)

2. Arrhythmias due to a change in the source of the pacemaker:

• Atrial arrhythmias (eg, atrial fibrillation);
• atrioventricular arrhythmias;
• ventricular arrhythmias.

3. Arrhythmias due to a violation of the regularity of the appearance of the next contraction:

• Premature contractions (extrasystoles);
• Delayed contractions (intracardiac blockade).

4. Arrhythmias due to origin:

• Organic (arising against the background of heart disease);
• Functional (arising on a healthy heart).

5. Arrhythmias according to the forecast:

• Favorable (not threatening the life and health of the patient)
• Unfavorable (high risk of severe complications - sudden circulatory arrest, arrhythmogenic shock, pulmonary edema, ischemic stroke, myocardial infarction, thromboembolism).

Causes of cardiac arrhythmias are diverse.

Factors in the development of arrhythmias include:

• functional disorders and organic lesions of the central nervous system (stress, neuroses, tumors, skull injuries, cerebrovascular accidents, vagotonia, etc.). neuro-reflex effects (visiero-visceral reflexes in diseases of the gastrointestinal tract, pathology of the spine, etc.);
• damage to the myocardium and the cardiovascular system (IHD and MI, myocarditis, cardiomyopathy, heart defects, pathology of large vessels, hypertension, pericarditis, heart tumors);
• electrolyte imbalance, especially potassium, calcium and magnesium;
• the influence of toxins - bacterial, industrial, habitual intoxications (alcohol, nicotine).
• drug intoxication (cardiac glycosides, beta-blockers, urinary, etc.);
• hypoxia and hypoxemia of any origin;
• endocrinopathy (thyrotoxicosis, pheochromocytoma, etc.).

Some types of arrhythmias.

Extrasystoles- premature contractions of the heart, due to the appearance of an impulse outside the sinus node. Extrasystole can accompany any heart disease. In at least half of the cases, extrasystole is not associated with a heart disease, but is caused by vegetative and psycho-emotional disorders, drug treatment (especially cardiac glycosides), electrolyte imbalances of various nature, alcohol and stimulants, smoking, reflex influence from the internal organs. Occasionally, extrasystole is detected in apparently healthy individuals with high functional capabilities, for example, in athletes. Physical activity generally provokes extrasystole associated with heart disease and metabolic disorders, and suppresses extrasystole due to autonomic dysregulation.

Paroxysmal tachycardia is a sudden attack of palpitations with a frequency of 130-240 beats per minute. There are 3 forms: atrial, nodal, ventricular.

The etiology is similar to that in extrasystole, but supraventricular paroxysmal tachycardia is more often associated with an increase in the activity of the sympathetic nervous system, and the ventricular form is associated with severe dystrophic changes in the myocardium.

Paroxysmal tachycardia usually felt like an attack of palpitations with a distinct beginning and end, lasting from a few seconds to several days. Supraventricular tachycardias are often accompanied by other manifestations of autonomic dysfunction - sweating, profuse urination at the end of an attack, increased intestinal motility, and a slight increase in body temperature. Protracted attacks may be accompanied by weakness, fainting, discomfort in the heart area, and in the presence of heart disease - angina pectoris, the appearance or increase in heart failure.

Ventricular tachycardia is less common and almost always associated with heart disease. Ventricular tachycardia, especially in the acute period of myocardial infarction, may be a precursor to ventricular fibrillation.

Atrial fibrillation - heart contractions, most often irregular, erratic, from 50 to 480 beats per minute. Atrial fibrillation may not be felt by the patient or felt like a heartbeat. With atrial fibrillation and flutter with an irregular ventricular rhythm, the pulse is arrhythmic, the sonority of heart sounds is changeable. The filling of the pulse is also variable and some of the contractions of the heart do not give a pulse wave at all (pulse deficit). Atrial flutter with a regular ventricular rhythm can only be diagnosed by ECG. Atrial fibrillation with a frequent ventricular rhythm contributes to the onset or increase in heart failure. Both persistent and especially paroxysmal atrial fibrillation causes a tendency to thromboembolic complications.

ventricular fibrillation and flutter, ventricular asystole, characterized by a chaotic contraction of myocardial fibers, the absence of a coordinated contraction of the ventricles, in essence, cardiac arrest with the shutdown of the vital functions of the body. It, as a rule, is a complication of extensive transmural myocardial infarction, but can occur with any severe heart disease (often in the acute phase of myocardial infarction), with pulmonary embolism, with an overdose of cardiac glycosides, antiarrhythmic drugs, with severe general metabolic disorders.

Symptoms - a sudden cessation of blood circulation, a picture of clinical death: no pulse, heart sounds, consciousness, hoarse agonal breathing, sometimes convulsions, dilated pupils (begins 45 seconds after the cessation of blood circulation). It is an emergency requiring immediate chest compressions.

Heart blocks- violations of cardiac activity associated with a slowdown or cessation of the conduction of an impulse through the conduction system. By localization, blockades are sinoatrial (at the level of the atrial myocardium), atrioventricular (at the level of the atrioventricular node) and intraventricular (at the level of the bundle of His and its branches). By severity, they distinguish between conduction slowdown (each impulse is slowly conducted to the underlying parts of the conducting system, blockade of the 1st degree), incomplete blockades (only part of the impulses are carried out, blockade of the II degree) and complete blockades (impulses are not carried out, cardiac activity is supported by the ectopic center of rhythm control, blockade III degree).

Clinically, the manifestations of certain arrhythmias, felt subjectively by patients, are largely similar. With arrhythmias accompanied by an increase in heart rate (sinus tachycardia, paroxysmal tachycardia), there is severe weakness, sometimes fainting, sweating, dizziness, a feeling of lack of air, pain in the heart area. Paroxysmal tachycardias begin and end suddenly, with a push in the region of the heart, which is clearly felt by patients. On examination, one or another violation of the heart rhythm is detected, low numbers of blood pressure are recorded.

With the development of extrasystole, patients complain of interruptions in the work of the heart, weakness, shortness of breath, pain in the heart, dizziness.

Attacks of arrhythmia are felt by patients as life-threatening conditions (which is most often true). Patients usually call an ambulance, often hospitalization takes place. Patients remember every attack, they can say exactly how many times they called an ambulance in a month, a year.

Methods for diagnosing arrhythmias

• electrocardiography,
• 24-hour Holter ECG monitoring
• Transesophageal electrophysiological study
• Intracardiac electrophysiological study

Treatment of arrhythmias

Treatment of arrhythmias is prescribed only by a doctor, depending on the type and severity of the arrhythmia! Self-medication is not allowed! Carrying out antiarrhythmic therapy requires frequent ECG monitoring, especially during the period of drug selection.

Types of treatment

1. Medical.
2. Surgical - installation of a pacemaker, catheter destruction.

Correction with parapharmaceuticals of the Dienai line.

Arrhythmias are rarely an isolated condition, more often they manifest as a symptom complex in diseases of the heart - coronary heart disease, cardiosclerosis, chronic heart failure, etc. First of all, it is necessary to correct the underlying disease that caused the arrhythmia, with the exception of factors provoking rhythm disturbance.

Application Dianaya, Venomax, Midivirina beneficial effect on the course of arrhythmias. Bioadditives are taken in courses sequentially, one after another, with a break of 7-14 days between drugs. It is recommended to repeat courses of Venomax and Midivirin up to 4-6 times a year.

When choosing a dose for correction, it is important to assess the initial state, the brightness of the manifestation of arrhythmias. Start with small doses, gradually increasing them.

As a result of taking parapharmaceuticals, arrhythmia attacks slow down, become shorter, and are easier to tolerate. Patients note that ambulance calls have become much less frequent or did not occur at all.

For patients after implantation of a pacemaker, an individual dosage is recommended. It is recommended to start with small doses and increase the dosage slowly, gradually, for example, according to the following scheme:

For example, according to this scheme:

1 week: 1 capsule daily on Monday and Thursday;

Week 2: 1 capsule per day on Monday, Wednesday, Friday;

Week 3: 1 capsule per day daily;

Week 4: 1 capsule 2 times a day. At this dosage, drink the capsules to the end of the jar.

Dianay, Venomax, Midivirine

In the presence of arrhythmias, it makes sense to include in the correction VitakinV. as a source of B vitamins that improve the functional state of the nervous tissue.

Internet Shop of food supplements with delivery in Belarus, Russia, Ukraine, Kazakhstan, Europe, USA, Georgia, Uzbekistan, Tajikistan, Armenia and other countries >> +375295730844

What do people usually do when it hurts heart ?

They grab the first-aid kit and take Validol, Corvalol, nitroglycerin and other chemical drugs that quickly give an effect by spurring hearts. that is, they force it to work in an unusual mode. But any medicine is an even greater burden, like a whip for hearts. How long will it last heart if you drive him with a whip? Of course not. The best way to strengthen heart natural substances: herbs, vitamins, minerals, important biologically active substances that will make his work easier and more reliable.

It is useful to get acquainted with the properties of hawthorn (Crataegus oxyacantha) included in hyper preparations. passilat. nortia

Hawthorn

The hawthorn begins to defend heart from the most important thing - it calms the nervous system, then improves blood circulation in the vessels, making it easier for the heart to pump blood through the vessels and therefore the heart rhythm returns to normal. High-quality hawthorn extract in hyper, passilat, nortia preparations relieves pain in the area hearts. will make you sleep better and feel good. This is due to the fact that its active substances (bioflavonoids) lower blood pressure. These active substances are necessary for the heart muscle to work well and not to go astray, therefore, if these biologically active substances are not enough in the body, such a malfunction develops. hearts which doctors call arrhythmia

There is another interesting property of the hawthorn extract, which is included in the preparations of hyper, passilat, nortia, this is a rejuvenating (antioxidant) effect on the cells from which it consists heart. this is due to the fact that hawthorn biosubstances cleanse and protect cells hearts at the molecular level, which no chemical preparations are capable of.

If you are prone to hypertension, insomnia, or are worried about heart beat. as well as if the doctor has diagnosed you with such diagnoses as: heart attack, arrhythmia, angina pectoris, heart failure, myocarditis, defect hearts then taking dietary supplements like hyper, passilat, nortia with hawthorn extract of high purity will allow you to improve your well-being and reduce the likelihood of exacerbations of these diseases.

Ginkgo biloba

It is worth paying attention to the extract of the plant Ginkgo biloba (Ginkgo biloba) in the food supplement Antiox. Thanks to this plant, Antiox is a champion in terms of the number of useful for hearts biologically active substances. One of the most important properties of these natural substances is the improvement of blood flow through small vessels and protection against thrombosis. With age, the condition of the vessels worsens, which means that the likelihood that the blood will stop in the vessel and form a cork grows from year to year, it is Antiox that contains Ginkgo biloba extract with the necessary biological substances to protect against blood clots and for their resorption, and also contains substances that restore flexibility to capillaries (small vessels).

The largest number of vital small vessels is in the brain. If such a vessel is clogged and the blood stops moving inside it, then a stroke will occur. In old age, blood cells acquire a bad property of sticking together (property of aggregation), it is in the Antiox preparation that there are biologically active substances that prevent this process, thereby providing double protection against blockage of blood vessels.

Each vessel of the brain is responsible for very important functions in the body. for example, motor or mental, therefore blockage of such vessels is unacceptable. Daily intake of Antiox with giant biloba is recommended for all people over the age of 50, as well as younger ones who already have problems with the vascular system

Purple grape extract (powder)

Scientists studying work hearts found that grape pomace extract and fine-grained grape powder have a unique ability to lower blood pressure, which is the main cause of heart attacks and strokes. In order to assess the degree of such an impact, scientists conducted a series of experiments on hypertensive patients.

People suffered from hypertension due to the fact that a lot of salt was recorded in their diet. As already described above in our article, a high-salt diet causes the development of hypertension. People were divided into groups, one of which was additionally caramelized with grape pomace extract and fine-grained grape powder. the other group was prescribed chemical drugs to reduce blood pressure.

After 3 months of the experiment, scientists assessed the condition of people.

It turned out that those people in whose diet grape powder was added, blood pressure decreased, and work hearts significantly improved compared to the second group. In addition, grape extract reduced myocardial damage caused by the harmful effects of salt.

The chemical preparation only reduced the pressure, and did not have such a complex effect on the body as grape powder. Scientists believe that this result was obtained due to the high content of bioflavonoids in the skin, pulp and seeds of grapes, which have an extremely positive effect on the cardiovascular system. You can get the required amount of fine-grained grape extract from the Vinex supplement. Grape pomace extract contains dietary supplement Antiox and Vinex

Very often, due to unrest and sometimes due to physical activity (in a modern metropolis, it is rarely physically possible for a person to load himself) in heart spasms occur. This is due to the fact that during excitement or stress, he needs much more oxygen than usual. At this point, pain occurs as the muscles hearts tense up a lot. If heart weak then frequent stresses are very dangerous, therefore, in order to relieve spasms, a person needs to calm down.

Natural sedatives contain bad pax forte. These substances are isolated from plants such as lemon balm. lavender, valerian. The drug Pax contains an extract of these substances, so it acts quickly enough and is not addictive.

The beginning of all heart disease lies at the cellular level. This means if you eliminate the very cause of the disease, then you can prevent heart disease altogether, and if they already exist, then prevent their further development and sometimes even return heart into a healthy state. vascular cells and hearts They begin to deteriorate when a lot of harmful substances enter the body and the cleaning organs do not have time to remove them in time.

Most of all, free radicals harm the heart - these are molecules that damage healthy cells and cause mutations (the birth of unhealthy cells) Free radicals enter the body with fatty foods, smoking, alcohol, vegetables containing nitrates, as well as other foods containing chemical additives and preservatives.

But there is also an antidote to free radicals - these are antioxidants. Antioxidants are special vitamins and minerals that break down free radicals.

Astragalus

Astragalus refers to plants that accumulate selenium, its content is up to 1.5 mg% of selenium, and as described above, selenium is very important for work hearts. Astragalus contains biologically active substances that have calming and pressure-reducing properties. e occurs due to the properties of these substances to expand the caronary vessels responsible for the vital functions of work hearts. In addition, astrogal improves cerebral circulation, which is very important for the prevention and protection against strokes. Astragalus contains a unique natural complex of tocopherols (varieties of vitamin E) necessary for muscle activity. hearts. A quality Astragalus extract can be found in Artemis preparation.

Antioxidants for hearts :

vitamin C - is part of the dietary supplement Antiox. thanks to its natural formula, Vitamin C in Antiox strengthens the walls of blood vessels hearts and is necessary for the nervous system to protect against stress Vitamin A, namely its form called beta-carotene, it is also contained in the Antiox preparation strengthens the walls of capillaries (very small vessels hearts) Vitamin E, as well as the above vitamins, successfully cleanses free radicals and reduces blood viscosity, which facilitates its movement through the vessels

Vitamins for hearts

Vitamin B1 (Thiamin)

Vitamin B1 is another name - Thiamine helps maintain your muscles. hearts in an elastic state and makes them work evenly, which is why the rhythm hearts returns to normal, improves the activity of the cardiovascular system, regulates the activity hearts and heart vessels.

Vitamin B1 is actively involved in the process of digestion and absorption of neutral fats, which means that it does not allow an increase in fat in the blood, which leads to pollution and poor performance. hearts .

Thiamine is a water-soluble vitamin that requires daily replenishment. It has been proven that an insufficient amount of thiamine can cause disturbances in the normal functioning of the cardiovascular system: pain appears in heart. heart attacks, arrhythmia and shortness of breath. By helping your heart maintain a healthy level of vitamin B1 at all times, you are also doing an important job of protecting and preserving it. Its special need increases during illness hearts .

Thiamine is the first of the B vitamins that was discovered by man. The only vitamin of its kind that takes care of our heart and helps him pump blood.

To help replenish the required content of vitamin B1 and maintain it in a normal state, biologically active food supplements were developed: Passilat a for children Junior

Minerals for hearts.

Potassium is a mineral that protects the body from high blood pressure and therefore protects against heart attacks and strokes. This is due to the fact that potassium does not allow excess sodium (table salt) to accumulate. Almost all foods contain table salt, so the presence of potassium in modern nutrition is vital for all people over 40 years old and especially for those who are prone to high blood pressure. The level of potassium in the blood predicts the level of a heart attack, since its deficiency can disrupt the rhythm hearts. lead to a stroke. Potassium in a chelate, that is, in an easily digestible form, is contained in the Junior supplement, which can be taken by both adults and children.

The balance of potassium in the body is very closely related to the content of another very important mineral for the heart - magnesium. A decrease in one element usually leads to a lack of another.

Symptoms of magnesium deficiency: muscle weakness. fatigue, leg cramps that wake you up at night.

Magnesium

More than three hundred enzymes depend on magnesium, which are necessary for work. hearts. therefore, the intake of this mineral provides: - equalization of the heart rhythm; - lowering blood pressure; - maintaining potassium balance; - improved blood flow; - relief of pain in angina pectoris; - Decreased formation of blood clots. In the human body, the amount of magnesium is approximately 20-28 g - mostly inside the cells themselves, where, along with potassium, it is the second most important mineral. The famous American cardiologist, Dr. Atkins, believes that 98% of people with complaints of heart need magnesium. Doctors conducted a study: out of 25 patients with cardiac arrhythmia, which did not respond to conventional methods of treatment, 20 turned out to be magnesium deficient. After the appointment of the mineral in injections, the situation stabilized in all twenty.

Magnesium improves oxygen supply to tissues and blood vessels hearts At the same time, magnesium exhibits a vasodilating effect and helps to reduce blood pressure, that is, a calming effect on heart and nervous system. Adequate intake of magnesium allows the heart to beat smoothly, blood vessels and muscles to maintain the necessary tone, and the whole body is better able to withstand stress.

The vessels of the brain, or rather their walls, contain twice as much magnesium as any other tissue of the body, so a deficiency of this mineral is especially dangerous for them. Sufficient amount of easily digestible magnesium for hearts can be obtained daily by taking such food supplements for children Junior for adults from 12 years old Senior, Nutrimax, Pax Forte, Nortia

Many clinical studies have found that people with low levels of selenium in their blood have an increased risk of disease. hearts 70% higher than those with a normal content of this mineral. The lower the level of selenium, the higher the degree of blockage of the arteries associated with heart m. A unique property of selenium is its ability to neutralize harmful free radical molecules that destroy living cells, in addition, selenium is necessary for better absorption of vitamins and other minerals. It is no coincidence that the Ministry of Health has ordered the food industry to add selenium to bread, mineral water and other foods. For example, poultry farms produce eggs enriched with selenium. Sufficient daily requirement for selenium can help ensure the intake of dietary supplement Antiox.

Chromium

Chromium is of great importance for the prevention of cardiovascular disease and hypertension. Chromium is a mineral that helps the body and enhance the action of insulin. And impaired insulin metabolism is a major risk factor for heart disease.

Chromium deficiency increases the risk of coronary disease hearts. causes a diabetic condition that contributes to the development of atherosclerosis, arterial hypertension and increased blood cholesterol levels.

Chrome not only protects our heart. lowering cholesterol levels, but increasing life expectancy. heart is a muscular organ that maintains blood flow in the circulatory system. In order for blood to circulate freely throughout the body, arteries and capillaries must remain clean - for this they need Chromium.

Chromium helps increase arterial-clearing "good" (HDL) cholesterol while lowering "bad" (LDL) cholesterol levels. For optimal performance hearts and blood circulation Chromium is included in the program of biologically active food supplements: Chromvitala and Sveltform and for children Be cheerful and Be Smart

Coenzyme Q10 and heart

The highest concentration of coenzyme Q10 is in the heart muscle, since the coenzyme is necessary for the synthesis of molecules responsible for energy transfer. The heart needs to constantly contract, and without these carriers of energy this is impossible.

It has been proven that with age, the amount of coenzyme Q10 decreases and by the age of 60 is only 50% of the maximum value. Therefore, it is with the lack of coenzyme Q10 that heart failure is associated.

Large-scale study of the effect of coenzyme Q10 on patients with diseases hearts was held in Italy. For three months, 2665 people took coenzyme Q10, - edema, insomnia, dizziness, arrhythmia decreased in patients, the condition of patients with coronary disease improved hearts and atherosclerosis. Therefore, the conclusions are logical: in order to do the work hearts effective, you can start taking coenzyme Q10 after 30 years, and after 40 years take coenzyme Q10 constantly. Sufficient amount of coenzyme can be obtained by supplementing garnetine q10

Amino acids for hearts

L-carnitine

We can say that by using carnitine, we kill two birds with one stone: we burn excess fat and get additional energy due to the fact that L-carnitine converts fat into energy for hearts. Two thirds of your energy heart gets from burning fat. heart must constantly work and this requires a lot of energy, so patients with cardiovascular diseases especially need carnitine. Even a gram of carnitine per day significantly improves their well-being. Carnitine reduces the level of bad cholesterol and triglycerides, a large accumulation of which leads to the development of cardiovascular diseases. Carnitine moderately lowers blood pressure in hypertension. You can get extra carnitine by taking the Lamin food supplement.

lecithin

Exactly heart has the highest content of lecithin in our body. Therefore, Lecithin is essential for hearts substance. After all, Lecithin is the main vehicle for delivering nutrients, vitamins to our heart.

Lecithin has the ability to keep cholesterol in a dissolved state, preventing it from being deposited on the walls of our blood vessels. hearts. increases the level of hemoglobin, and also stabilizes and does not allow an increase in fat in the blood, which also leads to pollution and poor performance hearts. That is why the regular use of lecithin is especially useful for the prevention and treatment of atherosclerosis, coronary disease. hearts. hypertension, cardiomyopathy, heart failure.

Especially important is the use of lecithin after a stroke and the post-infarction period. After all, during the recovery period, the tissues of our hearts Higher lecithin content is needed more than ever for fast recovery. And its lack leads to the most negative consequences, the delivery of nutrients and vitamins to cells slows down. hearts.

This nutrient LECITHIN was first developed from egg yolks in 1850 by Maurice Bobley. Studies have shown that plant-based lecithin (soybeans) is more effective than animal-based lecithin (egg). Lecithin is present in human milk, which ensures the normal development of the nervous system of infants. It is not present in cow's milk. Lecithin is found in biologically active food supplements specially designed for health: Brain o Flex

Omega 3 for hearts

Most people believe that all fats are bad for our body. As surprising as it is to hear, there are also healthy fats, such as omega-3s.

Omega-3 stands out as essential and essential for work hearts human fatty acid. Unsaturated fatty acids, which are generally used as an energy material, form the basis of cell membranes, making them more flexible, which ensures high-quality work of the heart muscles.

For the normal functioning of the cardiovascular system, a person must consume at least 1 gram of Omega-3 daily. A person can get the required amount of healthy fat by taking just 1 capsule of Mega food supplement.

Omega-3 fats may protect against the likelihood of disease hearts. in at least five ways:

- Lowers the total level of cholesterol, removing it from the body. - Prevents the accumulation of cholesterol on the walls of arteries. – Reduces the level of harmful fats in the blood that lead to disease hearts. - Adjusts the heart rhythm, the violation of which often causes a heart attack. - Allows you to normalize blood pressure. - Reduces the load on the cardiovascular system. - Prevents the formation of large blood clots in the vessels, which can lead to heart attacks and strokes. - Increases the elasticity of blood vessels. The human body cannot synthesize Omega-3.

Omega-3 fatty acids are the most effective and affordable, non-prescription, way to protect against diseases. hearts to date.

Long-term medical studies of the Italian Coordinative Center have shown that people who regularly consume Omega-3 are less prone to heart attacks and strokes. Of the 11,324 experimental patients who had a heart attack, 6,500 used omega-3, the rest were treated with other drugs. The incidence of recurrent myocardial infarction among patients who used omega-3s was significantly reduced, and the number of deaths was not observed at all.

Omega-3 acids are recommended for both sick people and healthy people. Healthy people will protect themselves from the occurrence of heart disease, patients will be able to significantly improve their condition, cleanse blood vessels of cholesterol and normalize blood pressure, which is the main cause of heart attacks and strokes.

Doctor of the highest qualification Anton Rodionov states: “In medicine of the 21st century, it is no longer enough just to make the patient feel better, to improve the “quality of life” (there is such a strange term that has firmly taken root in our dictionary). Every time I prescribe some kind of treatment, I must answer myself and my patient a simple question: how will my treatment affect a person's life expectancy? Will I be able to prevent heart attack, stroke, heart failure and kidney failure?

“The Complete Course of Medical Literacy” is the material of 5 vital books of the “Academy of Dr. Rodionov” series, structured and creatively revised by the author himself for your convenience. You will remember:

- what factors affect the cardiovascular system and when an increase in pressure is dangerous and when not;

– how to assess your risk at any age and what can really be done right now to reduce it;

- how to strengthen blood vessels and what pseudo-methods will only clear your wallet;

- why an ECG should not be done for a healthy person, how to understand the doctor's conclusion and how to help with a heart attack;

- whether cancer tests are needed, how to check the condition of internal organs and when deviations themselves are the norm;

- what medicines should be in the home first aid kit so as not to harm - and prolong the life of yourself and your loved ones.

"Complete Course of Medical Literacy" - your personal family doctor, who can be contacted for advice and help at any time

Book:

Sections on this page:

How to live with atrial fibrillation. About atrial fibrillation and flutter

Atrial fibrillation (atrial fibrillation) is one of the most common heart rhythm disorders. About 5% of people over 60 live with it. In a healthy person, at regular intervals, the atria contract first, then the ventricles. With atrial fibrillation, full-fledged atrial contractions disappear and their muscle fibers only twitch randomly - “flicker”. In this case, the ventricles, as a rule, contract at a higher frequency and are completely non-rhythmic.

Atrial fibrillation and atrial fibrillation are synonyms.

The cause of atrial fibrillation can be almost any cardiovascular disease: coronary heart disease, including myocardial infarction, acquired and congenital heart defects, long-term arterial hypertension. Another reason is an increase in thyroid function (thyrotoxicosis). An excess of thyroxine, the main thyroid hormone, can provoke an increase in heart rate, rhythm disturbance, and an increase in blood pressure. Therefore, people, especially young people who suddenly have atrial fibrillation, must, among other things, determine the function of the thyroid gland (do a blood test for TSH - thyroid-stimulating hormone). Fans of frequent alcoholic libations can also “flicker”. True, in such patients, if they take up their minds and stop drinking, the prognosis is usually good: the work of the heart, as far as possible, is restored.

Predisposing anatomical factor to the development of atrial fibrillation is often an increase in the left atrium. The fact is that it is there that the pathways responsible for normal atrial contractions are located. If your ECG or echocardiography reveals enlargement (hypertrophy) of the left atrium, your risk of developing an arrhythmia is greatly increased. How to warn her? Carefully and accurately treat the underlying disease - heart failure, arterial hypertension.

There are two types of atrial fibrillation (actually three, but we will not go into medical details): paroxysmal (paroxysmal) and permanent. In the case of paroxysmal arrhythmia, the heart rhythm is disturbed for several hours (sometimes days), and then restored on its own or with medical help. With a constant form of atrial fibrillation, the rhythm is no longer restored, and such arrhythmia persists for life.

How to recognize atrial fibrillation? Most often, patients talk about a sudden, rapid, non-rhythmic (this is a prerequisite) heartbeat - the heart begins to pound, “jump out of the chest”, “go wild” ... This is approximately how patients describe atrial fibrillation paroxysm. However, some do not feel arrhythmia at all, and it is detected only with random ECG registration.

What is the main danger of atrial fibrillation? On the one hand, this arrhythmia is not life-threatening; with proper treatment, the life expectancy of a patient with atrial fibrillation will be no less than that of a healthy person. On the other hand, a serious problem is that when there is no full contraction of the atria, the linear blood flow in them is disturbed. There is swirling or "turbulence" (remember how the plane sometimes dangles in the air?). Turbulent blood flow contributes to its stagnation and the formation of blood clots. If a blood clot breaks away from the wall of the left atrium, then, along with the blood flow, it will most likely enter the vessels of the brain, and a stroke will develop. To prevent this from happening, almost all patients with atrial fibrillation must take special blood thinners (anticoagulants) that prevent blood clots from forming.

How do you know if you need anticoagulants?

Let's calculate the risk factors for thrombotic complications:

Chronic heart failure - 1 point;

Arterial hypertension - 1 point;

Age over 75 years - 2 points;

Diabetes mellitus - 1 point.

Stroke or transient ischemic attack - 2 points;

At vascular damage (myocardial infarction in the past, atherosclerosis of peripheral arteries, aorta) - 1 point;

Age 65–74 years - 1 point;

Female - 1 point.

If you scored at least 1 on this scale, then you already need anticoagulants. The exception is when this 1 point is obtained only in the female category.

In patients taking warfarin, the INR should be in the range of 2.0 to 3.0

If it is difficult for you to determine some items on your own (for example, atherosclerosis of peripheral arteries), discuss this scale with your doctor.

For many years, the gold standard of anticoagulant therapy has been a drug called warfarin. Unfortunately, it has a huge drawback. Warfarin does not have a fixed dose; when it is prescribed, we cannot predict in advance how it will work in a particular person and how many pills need to be prescribed to achieve the goal. If you prescribe an insufficient dose, the drug will not work and the risk of thrombosis will remain high. Overdose

Important: anticoagulants should be taken for both paroxysmal and permanent atrial fibrillation.

can cause serious bleeding, including cerebral hemorrhage, so it is very important to closely monitor blood clotting indicators. For this, there is a special analysis called INR (International Normalized Ratio). According to an individually selected scheme, the patient donates blood every 1-2 months. If going to the lab is inconvenient, you can purchase a portable device for home use, like a glucometer, that you can use yourself.

When a doctor prescribes you warfarin, he is obliged (yes, he is obliged! I rarely use categorical verbs, but in this case it is so) to tell you about the features of the drug and teach you the rules of dose adjustment, or at least explain the importance of controlling INR. The following tablet is presented here not for amateur performance, but to help you and your doctor. So you've been prescribed warfarin. As a rule, the starting dose of the drug is 2 tablets of 2.5 mg (i.e., the daily dose is 5 mg). In the first days of dose selection, you can focus on this table:

If the INR is steadily kept in the range of 2.0–3.0, then further analysis can be taken once every 2–3 weeks (at least once every 2 months).

However, it rarely happens that clotting indicators remain unchanged if the INR indicator goes beyond the target values, we use the following plate:

* What means weekly dose?

For example, if your daily dose of warfarin is 2.5 tablets, this is 17.5 tablets per week. If you need to reduce the weekly dose by 1 tablet, then there should be 16.5 tablets per week

See how it's done:

Hello, dear Anton Vladimirovich, I am 64 years old, I am actively engaged in martial arts (aikido). Recently diagnosed with atrial fibrillation. According to the results of transesophageal echocardiography, the left atrial appendage is filled with loose thrombotic masses. They recommend electrical impulse therapy, but the INR should be 2.0-3.0, and I have only 1.18 on warfarin. Is it possible to correct the situation with therapeutic fasting? Talk about the impact of training. Leonid.

Dear Leonid, you are now thinking a little about that. The threat of a very serious complication is now hanging over you, which is called a cardioembolic stroke: loose thrombotic masses can break off at any moment and fly to the brain, after which it will no longer be able to think about either aikido or therapeutic starvation. Normal you need immediately. You need to increase warfarin therapy to achieve the target INR, or discuss with your doctor the transition to new anticoagulants that do not require monitoring of blood tests. The procedure for restoring the rhythm can be discussed no earlier than after three weeks of conscientious use of these drugs.

Again, this is not a self-medication guide. Therapy with warfarin should be carried out under the supervision of the attending physician. Come to an appointment with this book and discuss the points you don't understand.

Science advances, and in the last few years, new drugs have emerged that protect patients with atrial fibrillation from stroke without requiring clotting control. Now we are increasingly offering these drugs to our patients. Three drugs are registered in Russia - dabigatran(pradaxa), rivaroxaban(xarelto) And apixaban(eliquis). The only limitation to the use of these drugs is the presence of a prosthetic heart valve and mitral stenosis. In these situations, only warfarin can be used.

If you are taking warfarin and find it difficult to determine INR or indicators INR very much fluctuate, discuss with your doctor a replacement for new drugs.

Many patients with atrial fibrillation take aspirin instead of anticoagulants for years. Indeed, it was previously believed that aspirin could prevent the formation of blood clots. However, it has now been proven that its effect is many times weaker than that of anticoagulants, despite the fact that the risk of bleeding is almost the same, so aspirin is practically not used in patients with atrial fibrillation. The exception is patients after myocardial infarction with atrial fibrillation. They are usually prescribed a combination of aspirin (or Plavix) with anticoagulants for a year.

If you have atrial fibrillation (atrial fibrillation) and you are taking aspirin, ask your doctor if you should change it to anticoagulants.

Anticoagulants thin the blood (which is why they are taken), so they can increase the risk of bleeding. When prescribing these drugs, the doctor necessarily weighs all the pros and cons, but there is one point that sometimes escapes the doctor's field of vision. We are talking about those drugs that can increase the risk of bleeding and about which the patient is in no hurry to tell the doctor.

First of all, these are painkillers belonging to the group of so-called non-steroidal anti-inflammatory drugs (diclofenac, ibuprofen, paracetamol, nimesulide, etc.). The second is aspirin. Sometimes the combination of aspirin with anticoagulants is acceptable, but this is a rather rare and very responsible situation. Thirdly, these are the well-known valocordin and corvalol, which include the potent hypnotic phenobarbital. It can increase the concentration of anticoagulants in the blood and also increases the risk of bleeding.

Dear Anton Vladimirovich, my mother is 65 years old, she has a heart disease (unfortunately, I don’t have an exact diagnosis, my mother says that she has atrial fibrillation), since 2007 she has been taking concor, warfarin, lisinopril. In November, I had an ischemic stroke, spent 10 days in a hospital, now she is at home, she cannot move on her own yet. Now he takes the following drugs from the heart: lisinopril 10 mg, warfarin 2.5 mg - 1 time in the evening, concor 5 mg, digoxin. As we were explained, the stroke was due to problems with the heart. Please tell me how to help a sick heart?

As far as I understand, the main reason for the development of a stroke is that my mother, with atrial fibrillation, took warfarin without INR control. In this situation, it is necessary to discuss the transition to new anticoagulants (dabigatran, rivaroxaban, apixaban).

Anton Vladimirovich, thanks for the answer. Tell me, please, what should be the INR with such a diagnosis? Now he is 1.17.

It's AMAZING! INR on the background of warfarin should be from 2.0 to 3.0! If it is difficult to control the INR and deal with it, you need to switch to new drugs (see above).

Here's my word of honor, every time after such questions I want to tear the hair on my head out of annoyance. How many strokes could be prevented if patients followed a simple rule: there is atrial fibrillation - prescribe an anticoagulant and monitor its effectiveness!

There are quite a lot of options for the course of atrial fibrillation, and in order not to delve into the theory, I will just show you a few questions from my correspondence, maybe you will find your own case here.

Situation one: frequent paroxysms of atrial fibrillation

Hello, Anton Vladimirovich, my mother is 61 years old, in August of this year she had an attack of atrial fibrillation, and so far it has repeated three more times. The prescribed therapy, apparently, does not help, since for health reasons she is forced to call an ambulance almost once every three days. What should we do?

Come for a consultation. Your mother needs to select antiarrhythmic drugs (it is impossible to do this in absentia, there are a lot of conditions to keep in mind) and prescribe anticoagulants to prevent stroke.

This is perhaps the most unsympathetic scenario - frequent attacks that spoil life, do not remove themselves and require an ambulance call. In such situations, it is necessary to select antiarrhythmic treatment for a permanent intake in order to reduce the frequency of attacks.

How to stop an attack of atrial fibrillation at home?

This is one of the most difficult questions that a cardiologist has to answer. I must say right away that there is no universal recommendation. First of all, you need to understand that half of the attacks go away on their own during the day. Sometimes it is recommended to use large doses of sedatives (valocordin, motherwort, tranquilizers); this is possible once, but we must remember that repeated frequent use of tranquilizers (phenazepam), valocordin (phenobarbital) can cause addiction. For some patients, doctors recommend that they additionally take those antiarrhythmics that they use for planned treatment (the “pill in the pocket” strategy). And this is permissible, but only in agreement with the attending physician. The most undesirable option is a combination of several antiarrhythmics: I take one, add another during an attack, an ambulance arrives and introduces a third. The combination of several antiarrhythmic drugs may increase the likelihood of complications.

Antiarrhythmics are very serious and responsible drugs. Appointment, cancellation and dose adjustments should be made only by a doctor.

If the attack does not go away on its own within a day, call an ambulance or come to the emergency room of the nearest hospital on your own. The fact is that if you do not restore the rhythm during the first two days, then this procedure will become more complicated, the drugs will work worse, you may need electrical impulse therapy (defibrillation).

Antiarrhythmic drugs Most antiarrhythmic drugs are not indifferent to the body. Therefore, if the attacks are rare, say, once a year, every 2-3 years, if there are no risk factors, serious diseases, if the patient easily tolerates an attack, then we can not prescribe him a constant intake of antiarrhythmic drugs. They are not antiarrhythmic drugs and should not be used in this situation, such popular remedies as panangin, magnerot, trimetazidine, mildronate, etc. This is a waste of money and an extra drug burden on the body.

Situation two: alternating correct rhythm and atrial fibrillation

Dear Doctor. I am a hypertensive patient with experience, I take Enap and Norvask, the pressure is normal. In recent years, extrasystoles have been disturbing. I recently had a Holter monitor, it turns out that during the day I have atrial fibrillation several times. Doctors disagree: the therapist says that I need to take antiarrhythmics, and the cardiologist says that this is not necessary if I feel well. Which of them is right?

I think the cardiologist is right. Under the condition of taking anticoagulants, the alternation of the correct rhythm and atrial fibrillation does not pose a danger to life.

If the alternation of arrhythmia and a normal rhythm is asymptomatic, the use of antiarrhythmics can be refrained from. The main thing is to take anticoagulants daily so that there are no blood clots. It is likely that over time the rhythm will turn into permanent atrial fibrillation. However, we cannot speed up this process; until the conditions for constant arrhythmia are formed in the heart, the alternation of its own (sinus) rhythm and atrial fibrillation will remain. The promises of some doctors to “translate the arrhythmia into a permanent form” (as a rule, they prescribe digoxin) are absolutely groundless. In practice, this simply means giving up actively trying to maintain a rhythm with antiarrhythmics.

Situation three: the attack of atrial fibrillation dragged on, doctors offer electrical impulse therapy (defibrillation)

If the paroxysm has dragged on, but the patient has a good prognosis for recovery and maintenance of a normal rhythm (young age, no expansion of the heart chambers according to echocardiography), then a so-called cardioversion procedure (electropulse therapy, defibrillation) is offered. In this case, after at least three weeks of taking blood thinners (anticoagulants), anesthesia is given and an electric shock is applied with a defibrillator, after which the heart rate returns to normal. After that, it will be necessary to take antiarrhythmic drugs for a long time to prevent the “breakdown” of the rhythm, and for some time anticoagulants.

Hello, Anton Vladimirovich. I am 45 years old. I used to drink heavily, because of this, as the doctors said, I had atrial fibrillation. I have not taken a drop in my mouth for half a year, but the arrhythmia does not go away. Tell me, please, is it possible to somehow restore the heart or is it forever?

To answer this question, you must first perform echocardiography and assess the size of the chambers of the heart, primarily the left atrium. If the patient seriously takes up the mind, then alcoholic heart damage is partly reversible. If the heart has not yet expanded, then electropulse therapy can be discussed. Do not delay, address this question to your doctors.

Situation four: permanent form of atrial fibrillation

Hello! The father's paroxysmal atrial fibrillation became permanent. Complains of a constant decline in strength, loss of working capacity, a concor is taken. Age 58 years. Could you please tell me if RFA surgery is reasonable in this case?

Hello, as a rule, with permanent atrial fibrillation (atrial fibrillation), RFA surgery is not needed. Prescribe rhythm-lowering therapy (beta-blockers, sometimes digoxin) and anticoagulants (warfarin or new drugs: dabigatran, apixaban, or rivaroxaban). Of course, all this is done according to the doctor's prescription.

Contrary to popular belief, it's not that scary. Approximately 5% of adults on the planet live quietly with such an arrhythmia. Doctors have calculated that if such patients are treated correctly, their life expectancy will be no less than that of people with a normal rhythm. It remains to understand what "correct treatment" means.

The fact is that with atrial fibrillation in people who do not receive treatment, the heart, as a rule, contracts faster than usual, at a rate of about 100-130 beats per minute. Such tachycardia is difficult to tolerate, often there is shortness of breath, the very feeling of a heartbeat interferes. Therefore, the main task of treatment with a permanent form of atrial fibrillation is to slow down the rhythm. To do this, use beta-blockers (metoprolol, bisoprolol), cardiac glycosides (digoxin), less often verapamil.

Beta-blockers (metoprolol, bisoprolol, carvedilol) should not be combined with verapamil. This can lead to the development of heart block and a serious slowing of the rhythm.

Of course, taking anticoagulants is still a mandatory component of treatment for almost all patients.

How to control treatment for atrial fibrillation?

All patients with atrial fibrillation should definitely have 24-hour ECG monitoring. It is far from always possible to see all the nuances on a regular cardiogram and build therapy correctly. It happens that during the day the pulse rate looks quite decent, and at night there are large pauses in the work of the heart (3 seconds or more). In these cases, doctors reduce the dose of rhythm-reducing drugs, and sometimes suggest the installation of a pacemaker.

Is it possible to radically eliminate fibrillation?

It is possible, but not always. Sometimes relatively young patients with long-term atrial fibrillation, who do not yet have serious irreversible changes in the heart, are offered defibrillation (electrical cardioversion). The rhythm will almost certainly be restored, but the main problem will be maintaining the rhythm, i.e. after the procedure, you will need to take antiarrhythmic drugs constantly or for a long time. Oddly enough, a good effect with this approach is observed in patients with alcoholic heart disease, of course, provided that alcohol is completely abandoned.

The most radical method of treating (sometimes curing) atrial fibrillation is radiofrequency ablation (RFA), which is a small operation for the patient, but technically very difficult for the doctor. A special catheter is inserted through a puncture in the femoral vein first into the right and then into the left atrium and cauterization is performed around the confluence of the pulmonary veins. The success of this procedure, according to major world centers, is about 70%. There are not very many centers in Russia that are well versed in this technique, and its results are not as brilliant as, for example, with WPW syndrome. As a rule, RFA is offered to those patients in whom the possibilities of antiarrhythmic therapy have been completely exhausted. Sometimes, to achieve the effect, the operation has to be repeated several times.

Separately, it must be said about those situations when atrial fibrillation develops in patients with serious, but potentially treatable diseases. This applies, first of all, to those who have heart defects, especially mitral stenosis, as well as patients with thyrotoxicosis - excessive thyroid function. In these cases, atrial fibrillation can be eliminated only after the treatment of the underlying disease.

Remember: alcohol abuse is one of the main causes of "break in the rhythm", especially in men.

Eternal theme. It all depends on the quantity: in principle, alcohol is not contraindicated for patients with cardiovascular diseases. However, it all depends on the dose. A dose of 30 ml in terms of pure alcohol is considered relatively safe, i.e. a small glass of wine or ONE (!) glass of strong drink. Exceeding this dose increases the risk of complications.

If you take the prescribed drugs on time and follow the recommendations of the attending physician, then you can, within reasonable limits, not limit yourself to anything. In patients with heart failure, the allowable load depends on how well the function of the myocardium (heart muscle) is preserved.

How to eat?

There is no special diet for patients with atrial fibrillation. As a rule, any cardiovascular disease is combined with an increase in cholesterol levels, so animal fats should be limited. If you also have high blood pressure, reduce your salt intake.

Remember that if you are taking warfarin, then the amount of "green foods" (cabbage, lettuce, spinach, etc.) containing vitamin K must be the same from day to day, otherwise significant fluctuations in INR are possible.

Atrial fibrillation (AF), the most common heart rhythm disorder (HRD) leading to thromboembolic complications, is receiving great attention because it is associated with significant costs in the healthcare system and affects the quality of life and prognosis of patients.

The first recommendations for the management of patients with AF were developed by the American Society of Cardiology (AHA / ACC) in conjunction with the European Society of Cardiology (ESC) in 2001, then reissued in 2006, 2008. and updated in 2011-2012. On August 29, 2010, recommendations were published based on data from European research centers only.

In 2011, the Russian Society of Cardiology/All-Russian Scientific Society of Arrhythmologists (RSC/VNOA) published domestic recommendations for the first time, which were based mainly on the European recommendations of 2010, although they had a number of adaptations to Russian realities.

In 2012, the ESC re-issued an addendum to the 2010 guidelines for the management of patients with non-valvular AF. Then, in 2012, domestic recommendations were also updated in accordance with European data.

The main purpose of this article is to analyze the updated European guidelines (ESC) for AF in recent years and compare them with the American (AHA/ACC) and Russian guidelines of 2012 (RKO, VNOA and the Association of Cardiovascular Surgeons - ASSH).

The 2010 ESC guidelines for the management of patients with AF contained 78 items: 66 general and 12 for the management of comorbidities. The new version of the 2012 European guidelines includes 25 items on the use of new oral anticoagulants (NOACs), antiarrhythmic drugs and catheter ablation.

Terminology and classification of atrial fibrillation

In Russian recommendations, the terms "atrial fibrillation" (AF) and "atrial fibrillation" are considered as equally used synonyms and are combined with left atrial flutter, since their electrophysiological mechanisms are close, the hemodynamic nature and treatment are the same.

• The term "non-valvular atrial fibrillation" refers to cases of its occurrence in patients without rheumatic mitral valve disease, prosthetic or valvular heart repair.
• In all other cases, the term "valvular atrial fibrillation" is used.
• Isolated is the form of AF that occurs in patients without structural heart disease.

Since 2010, the ESC has been using a new classification of AF, which was also adopted in the domestic recommendations of the RSC / VNOA / ASSH in 2012. According to new data, it is customary to distinguish 5 types of AF:

• newly diagnosed AF, any newly diagnosed episode;
• paroxysmal form lasting up to 7 days, characterized by spontaneous termination (usually within the first 48 hours);
• persistent form lasting more than 7 days, requiring medical or electrical cardioversion to stop it;
• long-term persistent form lasting more than 1 year with the chosen rhythm control strategy (restoration of sinus rhythm and its maintenance with antiarrhythmic therapy and / or ablation);
• permanent form (restoration of sinus rhythm is impossible).

The ANA in its 2011 guidelines maintains a classification that includes 4 types of AF: newly diagnosed, paroxysmal (an episode lasting up to 7 days or less than 24 hours with spontaneous termination), persistent (an episode lasting 7 days or more), permanent (cardioversion was ineffective or not was carried out).

As a certain innovation, it should be noted that the European Heart Rhythm Association (EHRA) classification proposed by the ESC in 2010 and RKO / VNOA / ASSH in 2012 for assessing the index of symptoms associated with AF. It includes 4 classes (I-IV) and is designed to assess symptoms before and after rhythm recovery, which indirectly reflects the effectiveness of ongoing therapeutic measures.

Diagnosis of atrial fibrillation

In the American recommendations, there is a basic minimum examination (history and examination, electrocardiography (ECG), transthoracic echocardiography (EchoCG), biochemical blood test, assessment of thyroid hormone levels) and additional tests (6-minute walk test, stress tests, daily ECG monitoring according to Holter, transesophageal echocardiography, electrophysiological examination, chest x-ray) without class and degree of evidence.

In the European recommendations of 2012, it is proposed to perform an ECG in patients over 65 years of age for the timely detection of an asymptomatic form of HRS, including AF (I B). The importance of this measure is also emphasized in domestic recommendations, since the risk of developing thromboembolic complications (primarily cardioembolic stroke) in asymptomatic and symptomatic forms of AF is the same.

In 2013, the All-Russian Scientific Society of Cardiology (VNOK) published an addendum to the recommendations regarding an implantable heart monitor for the detection of AF. Its installation is recommended for patients with persistent and paroxysmal AF in order to determine the frequency and duration of arrhythmia episodes, evaluate the effectiveness of treatment, optimize it, and prevent thromboembolic complications after radiofrequency ablation (RFA) (IIa, B).

Treatment of atrial fibrillation

Classification of therapeutic measures

• heart rate control;
• heart rate control;
• prevention of thromboembolic complications.

In the recommendations of the ESC 2010 and the RSC / VNOA / AAA 2011-2012. the leading positions are given to determining the risk of stroke and adequate prescription of anticoagulant therapy. In the American guidelines of 2011, the main strategy remains the therapy of AF itself, followed by the prevention of thromboembolic complications, although all three recommendations note that if a patient has severe hemodynamic disorders, the priority tactic is to reduce the symptoms of AF.

Currently, the main predictors of thromboembolism in AF have been identified, leading, among other things, to the development of acute cerebrovascular accident (ACV). In transthoracic echocardiography, such predictors are moderate and severe left ventricular (LV) systolic dysfunction; in transesophageal echocardiography, the presence of a thrombus in the left atrium and its appendage, atherosclerotic plaques in the aorta, and a decrease in blood flow velocity in the left atrial appendage.

Old age, arterial hypertension (AH), diabetes mellitus (DM) and organic heart disease are also considered additional risk factors for thromboembolic complications.

To stratify patients according to the risk of stroke and thromboembolism, the ESC in 2010 proposed using specially designed scales - CHADS2 and CHA2DS2VASc, which are based on a scoring of risk factors in patients with non-valvular AF. RKO/VNOA/ASSH in 2011-2012 also approved these scales in domestic recommendations.

CHADS2 is based on 5 risk factors for stroke: hypertension, chronic heart failure (CHF), diabetes, age >75 years, and a history of stroke or transient ischemic attack (TIA). The presence of each factor is estimated at 1 point, with the exception of CVA/TIA (2 points). Accordingly, low risk is determined with a score of 0 points, medium - 1-2 points, high - 2 points or more.

In 2010, the CHADS2 score was found to be effective in assessing the risk of stroke in patients with non-valvular AF. However, since it does not take into account many additional risk factors for thromboembolic complications, it was later modified into the CHA2DS2VASc scale. In 2012, the ESC and RKO/VNOA recommended only the CHA2DS2VASc score as the most effective in predicting stroke risk (IA).

CHA2DS2VASc scale

• Congestive heart failure / left ventricular dysfunction - 1 point
• AG - 1
• Age > 75 years - 2
• SD - 1
• Stroke / TIA / thromboembolism - 2
• Vascular diseases - 1
• Age 65-74 years - 1
• Gender (female) - 1

Maximum score - 9

Note. The maximum score is 9 because age is scored as 0, 1 or 2 points.

American experts adhere to a slightly different methodology, which was published in 2011. The scheme they use to identify risk factors is presented in Table.

Risk factors for stroke

Less significant risk factors

• Female
• Age 65-74 years
• coronary heart disease
• Thyrotoxicosis

Medium Risk Factors

• Age ≥ 75 years
• EF LV< 35%

High Risk Factors

• history of stroke/TIA
• mitral stenosis
• Mitral valve replacement

Note. The presence of a mechanical valve prosthesis requires a target international normalized ratio (INR) > 2.5.

For American experts, the European CHA2DS2 system remains controversial. At the heart of the differences between American recommendations from European and domestic ones is the division of patients into 3 risk groups (less significant risk factors, factors of medium and high risk) with the inclusion of such diseases and conditions as thyrotoxicosis, left ventricular ejection fraction (LVEF)< 35% и наличие митрального стеноза/протезирования митрального клапана.

Another important aspect that needs to be paid attention to is that the use of this approach to assessing the risk of thromboembolic events actually equalizes paroxysmal, permanent and persistent forms of AF when choosing an antithrombotic therapy strategy.

In 2010, the ESC gave the highest preference to oral anticoagulants (OACs) over acetylsalicylic acid (ASA) in the prevention of thromboembolic events, based on data from many large multicenter studies such as BAFTA, WASPO, EAFT, AFFIRM, SPAF-I, SPAF- II, SPAF-III, AF ASAK, BATAAF.

Patients with 2 risk factors on the CHA2DS2 scale were recommended to immediately prescribe OAC (warfarin) at a dose that provides the target INR value of 2.0-3.0 (I, A). Patients with an average risk on the CHA2DS2 scale were recommended to take antiplatelet agents or OAC (aspirin 75-325 mg/day or warfarin with a target INR of 2.0-3.0), and in the absence of risk (isolated form of AF, age less than 65 years), therapy you can skip or prescribe aspirin 75-325 mg / day.

The first NOAC, dabigatran (Pradaxa), was also presented in the recommendations, but the class and level of evidence for this position had not yet been determined.

In 2012, important additions were made to the European and Russian recommendations that radically changed the approach to thromboprophylaxis. Patients with a CHA2DS2VASc score of 0 (including women <65 years of age with isolated AF), which is at low risk, should not be treated with antithrombotic therapy (I, B). If the patient scores at least 1 on this scale, it is recommended to prescribe warfarin (target INR 2.0-3.0) or dabigatran/apixaban/rivaroxaban (IIa, A; I, A if total score > 2).

The strategy for choosing antithrombotic therapy outlined in the American guidelines of 2011 is schematically presented in Table 1; its main difference from European and Russian recommendations lies in the attitude towards ASA. In the American recommendations, ASA in therapy is retained not only in the absence of risk factors (I, A), but also for the primary prevention of thromboembolism in the presence of at least one of them (IIa, A). Warfarin may also be prescribed depending on the risk of bleeding and the ability to maintain therapeutic INR values.

Antithrombotic therapy for patients with AF according to AHA/ACC guidelines, 2011

• No risk factors - Aspirin 81-325 mg/day
• One medium risk factor – Aspirin 81–325 mg/day or warfarin (INR 2.0–3.0, target 2.5)
• One high risk factor or more than one medium risk factor - Warfarin (INR 2.0-3.0, target 2.5)

Optimal INR value

This section has not changed in 2012 in both European and domestic recommendations compared to 2010-2011. In non-valvular AF, the optimal balance between the efficacy and safety of vitamin K antagonist (VKA) therapy is achieved at INR values ​​of 2.0-3.0.

An approach to selecting anticoagulant therapy using genotyping and identifying the patient's sensitivity to warfarin by determining the cytochrome P450 2C9 gene variant (CYP2C9) and the vitamin K epoxide reductase complex 1 gene (VKORC1) is recommended only in the case of a high risk of bleeding in the patient.

In 2010, the US Food and Drug Administration (FDA) published a table on the website for selecting the dose of warfarin depending on the patient's genotype.

In the American guidelines, an INR of 2.0-3.0 is also considered optimal, with the exception of a few groups of patients. In patients aged 75 years and older with a high risk of bleeding, without contraindications to warfarin, or if it is impossible to maintain an INR in the range of 2.0 to 3.0, values ​​of 1.6-2.5 can be considered as targets (IIb, C). If stroke develops despite reaching an INR of 2.0–3.0 on anticoagulant therapy, the dose of warfarin can be increased to increase the INR to 3.0–3.5 (IIb, C).

Oral anticoagulants

The appointment of antithrombotic therapy in AF for the prevention of thromboembolism is recommended for all patients in the absence of contraindications to it or at a low risk of thromboembolic complications (isolated AF, age< 65 лет) (I, А). Это признано во всех рассматриваемых рекомендациях.

For half a century, VKAs (warfarin) have been the main drugs considered most effective for preventing thromboembolism. After a meta-analysis of large controlled trials, it was found that taking VKAs reduced the overall risk of stroke by 64-67%, i.e. by about 2.7% per year. Overall mortality compared with the control group also decreased by 26%.

The widespread use of VKAs was limited by a number of their shortcomings, such as a narrow therapeutic window, a long period from the onset of anticoagulant action after administration to the achievement of the maximum adequate concentration, and individual intolerance. Studies have shown that when VKA therapy is discontinued or if target INR values ​​are not achieved, the risk of stroke increases dramatically.

Frequent laboratory monitoring (INR determination), difficulties in dose selection made it necessary not only to carefully stratify the risk of stroke and bleeding, but also to create drugs that could simplify treatment.

In the last decade, drugs have appeared that are fundamentally different from VKAs in terms of the mechanism of action and method of application. These are NOACs: direct thrombin inhibitors (dabigatran) and clotting factor Xa inhibitors (rivaroxaban, apixaban, edoxaban). These drugs are used in fixed doses without laboratory control, and their bioavailability allows you to achieve the predicted level of hypocoagulation in a short time (3-4 hours).

Dabigatran in the ESC 2010, RKO/VNOA 2011, AHA/ACC 2011 guidelines, it is allowed as an alternative to VKA for the prevention of stroke and arterial embolism in patients with AF in the absence of hemodynamically significant severe defects or artificial heart valves, severe renal failure ( creatinine clearance< 30 мл/мин по европейским данным и < 15 мл/мин согласно американским рекомендациям), заболеваний печени со снижением свертываемости крови и инсульта в предшествующие 14 дней или инсульта с большим очагом поражения в предшествующие 6 мес (I, B).

Dabigatran 150 mg twice daily is more effective than warfarin in reducing the risk of stroke or arterial embolism with the same risk of major bleeding. The dose of dabigatran 110 mg twice daily is comparable in prophylactic efficacy to warfarin and is safer in terms of the risk of major bleeding.

All of the prescribing conditions listed above in the 2010 ESC guidelines and the 2011 RSC/GNCA recommendations were Grade I recommendations with Level B evidence, as data from ongoing studies were not available at the time of their release. In 2012, the level of evidence in the ESC, RKO/VNOA recommendations for the use of NOACs (dabigatran, rivaroxaban, apixaban) was upgraded to A. In the 2011 US guidelines for dabigatran, class I recommendations were retained with a level of evidence of B.

The main purpose of updating the ESC recommendations in 2012 was not only to argue for the need for more accurate screening of the LDC (AF) itself and the assessment of risk factors for stroke and bleeding, but also to provide a detailed presentation of the results obtained in studies with NOACs. The 2012 ESC guidelines describe the results of the RE-LY (with dabigatran), ROCKET-AF (with rivaroxaban) and AVERROES (with apixaban).

In the recommendation of the ESC and RSC/VNOA 2012-2013. introduced chapters on the determination of blood clotting and the treatment of bleeding while taking NOACs. Data on drug interactions with NOACs (dabigatran, rivaroxaban), their administration before elective surgery and invasive procedures are included.

Separate chapter in ESC/EHRA 2012-2013 recommendations. and RKO/VNOA 2012 is devoted to the peculiarities of prescribing NOACs to patients with chronic kidney disease. All NOACs (dabigatran, rivaroxaban, apixaban) require dose adjustment in patients with renal/hepatic impairment.

Chronic kidney disease in AF should be considered as an additional risk factor for stroke. In such patients, the risk of bleeding is also increased, especially when using OAC (VKA and NOAC).

In patients receiving NOACs, it is necessary to carefully monitor renal function at least 1 time per year to identify violations of their function and, if necessary, adjust the dose of the drug (ESC, RKO/VNOA/ACS, 2012 - IIa, B). It is especially important to regularly measure GFR in patients with a decrease in creatinine clearance to ≤ 60 ml/min.

Renal monitoring is especially important when using dabigatran, which is predominantly excreted by the kidneys: in elderly (> 75 years) or debilitated patients taking this drug, renal function should be monitored at least once every 6 months. Any acute disease often affects renal function (infection, acute heart failure, etc.), so in such cases it is always necessary to re-analyze.

Kidney function may deteriorate over several months, and the nature of the kidney disease, as well as comorbid conditions, may change the course of renal pathology, which should be considered when choosing a monitoring regimen:

• in patients with chronic kidney disease stage I-II (creatinine clearance> 60 ml/min) control once a year;
• in patients with stage III chronic kidney disease (creatinine clearance 30-60 ml / min) control every 6 months;
• in patients with stage IV chronic kidney disease (creatinine clearance< 30 мл/ мин) контроль каждые 3 мес.

In the recommendations of the ANA / ACC 2011-2012. For patients with creatinine clearance > 30 ml min, dabigatran is recommended at a dose of 150 mg twice daily. In the presence of severe renal insufficiency (creatinine clearance 15-30 ml / min), therapy with a direct thrombin inhibitor is not indicated due to its predominant elimination through the kidneys and the absence of an antidote to dabigatran (I, B). Rivaroxaban has not yet been reviewed by American experts.

Antiplatelet therapy

One of the differences between the updated recommendations of the ESC and RSC/VNOA 2012 from the versions of 2010-2011. was the recognition of the ineffectiveness of the use of ASA for the prevention of stroke in non-valvular AF. Patients with a CHA2DS2VASc score of 0 (age< 65 лет, редкие эпизоды ФП) и низкий уровень риска, какая-либо антитромботическая терапия не рекомендована (I, А).

The American College of Cheit physicians (ACCP) in its 2012 guidelines retains the definition of stroke risk using the CHADS2 scale and the choice of therapy, including patients with 0 points on this scale (II, B). The presence of 1 point suggests the appointment of OAC (I, B), combination therapy with aspirin and clopidogrel at a dose of 75-325 mg daily (II, B). If the patient has 2 points on the CHA2DS2 scale, it is necessary to prescribe OAC (I, A), aspirin and its combination with clopidogrel (I, B).

Bleeding risk assessment

According to the recommendations of the ESC and RKO/VNOA 2010-2012, before prescribing any antiplatelet drugs or anticoagulants, it is necessary to assess the risk of bleeding (I, A), especially intracranial, as the most dangerous and disabling complications of OAC therapy.

ESC in 2010 published a new scale to assess the risk of bleeding in patients with AF receiving OAC - HAS-BLED. This scale also has a scoring system, 1 point for each disease or condition included in the scale:

• impaired liver or kidney function,
• stroke,
• bleeding,
• labile INR,
• age over 65 years old,
• taking certain medications and alcohol.

As the number of points increases (maximum score 9), the risk of bleeding increases. The HEMORR2HAGES and ATRIA scales were found to be ineffective and have little predictive value.

The HAS-BLED scale is recognized as an effective scale for determining the risk of bleeding. If a patient has a score of ≥ 3, care should be taken to monitor the anticoagulant effect, as the patient is at high risk for bleeding (IIa, A).

Risk reduction is possible through intervention on modifiable risk factors, such as achieving blood pressure control, more careful selection of the dose of warfarin with tight control of INR, reduction in consumption of non-steroidal anti-inflammatory drugs (eg, ASA) and alcohol (IIa, B). A high score on the HAS-BLED scale should not serve as a basis for not prescribing an OAC (IIa, B).

The American approach to assessing the risk of bleeding involves assessing the following factors: age over 75 years, the presence of cerebrovascular diseases and operations in history; otherwise it is similar to the European one.

Special attention deserves the section on the treatment of bleeding that develops while taking NOACs, which appeared in the recommendations of the ESC and RKO / VNOA / ACSH 2012.

In such situations, it is necessary to assess the state of hemodynamics, coagulogram parameters to determine the degree of hypocoagulation (APTT for dabigatran, PT or anti-Xa factor for rivaroxaban). In addition, kidney function and other indicators are evaluated.

The 2012 ESC guidelines do not clearly define the types of bleeding, in contrast to the EHRA, which in 2013 divided bleeding into life-threatening and non-life-threatening. According to European recommendations, if small changes are detected, it is recommended to delay the next dose or stop treatment.

If the changes are moderate or severe, it is advisable to start symptomatic (supportive) treatment, mechanical compression, infusion therapy, blood transfusion. In severe changes, the question is raised about the use of activated recombinant blood coagulation factor VII (rFVIIa) or prothrombin complex concentrate, hemofiltration.

Anticoagulant therapy in the perioperative period

This section is compared to 2010-2011. both in European and domestic guidelines in 2012 was supplemented with a clearer description of the strategy for perioperative management of patients with the transfer from indirect to direct anticoagulants (low molecular weight and unfractionated heparin - LMWH and UFH).

These drugs are prescribed after the abolition of VKA and the achievement of an INR value of 2.0. UFH is canceled 4-6 hours before surgery, LMWH - 24 hours before surgery. Optimal hemostasis after surgery is achieved after 12-24 hours, respectively, with a low risk of bleeding, you can again start titrating the dose of VKA to therapeutic INR values ​​(2.0-3.0).

Minimally invasive procedures such as tooth extractions, dermatological procedures, and cataract surgery do not require discontinuation of OAC. It is necessary to bring the INR value to the minimum allowable (2.0) and ensure local hemostasis.

In 2012, the ANA/ACC presented data from several large randomized trials (PERIOP-2, BRIDGE, BRUISCONTROL) that investigated the possibility of perioperative use of LMWH and UFH in patients on permanent anticoagulant therapy.

Switching to UFH increased the risk of all bleeding 5-fold and major bleeding 3-fold, without changing the risk of thromboembolism. The use of LMWH at therapeutic doses increased the risk of bleeding compared with prophylactic doses, and the risk of thromboembolism was identical in both groups.

Stable ischemic heart disease

In the 2010 ESC and 2011 RSC/GNOA guidelines, in the presence of stable coronary artery disease (CHD), it was considered possible to use aspirin to prevent myocardial infarction (MI) simultaneously with VKA. The updated 2012 guidelines do not recommend the addition of antiplatelet agents. According to the CHA2DS2VASc score, vascular disease atherosclerosis scores over 1, requiring VKA monotherapy (IIb, C).

In 2012, the ANA/ACS also approved VKA monotherapy in these patients, assigning it a Class II recommendation with Level C evidence. Thus, VKA monotherapy has been proven to be effective in patients with stable CAD who have not undergone revascularization (IIb, C).

Acute coronary syndrome, percutaneous coronary intervention

Both in European and domestic recommendations 2010-2012. the class of recommendations and the level of evidence for all items related to antithrombotic therapy in acute coronary syndrome (ACS)/percutaneous coronary intervention (PCI) have not changed.

In 2012, the ESC and RCT/VNOA for elective PCI recommend triple antithrombotic therapy (VKA + ASA + clopidogrel) for 1 month after implantation of a bare metal stent and 3–6 months after implantation of a coated stent (IIa, C).

Previously, in accordance with the recommendations of 2010-2011. it was considered necessary to use VKA and clopidogrel (75 mg / day) or ASA at a dose of 75-100 mg / day in combination with gastroprotectors (proton pump inhibitor or H2 receptor blocker or antacid) for up to 1 year.

The duration of triple antithrombotic therapy after elective PCI in the updated guidelines has been increased from 1 to 6 months. Combination therapy with VKA and clopidogrel 75 mg/day or ASA 75–325 mg/day should then be given for a year (IIa, C).

If a patient who has undergone ACS has not undergone stenting, it is advisable to continue combined therapy with warfarin and aspirin at a dose of 75–325 mg/day or warfarin monotherapy with a target INR value of 2.5–3.5 for a year (IIa, C).

In the recommendations of the ESC and GNCA / GNCA 2010-2011. regardless of the presence or absence of a stent, triple antithrombotic therapy was prescribed for a period of 3 to 6 months, and then permanent dual therapy (VKA + aspirin at a dose of 75–100 mg/day or clopidogrel 75 mg/day). All other recommendations remained unchanged in terms of interpretation, class and level of evidence.

In the 2012 ACCP/ANA guidelines, antithrombotic therapy is divided into two types: with or without a stent. For patients who have not undergone interventional procedures after ACS, with an average or high risk of stroke (≥ 1 point on the CHADS2 scale), dual therapy is recommended: warfarin (target INR 2.0-3.0) + aspirin / clopidogrel during the year. Dual antithrombotic (aspirin + clopidogrel) or triple (VKA + aspirin + clopidogrel) therapy is inappropriate.

If the patient has a low risk of stroke (CHADS2 score 0), dual antiplatelet therapy (aspirin + clopidogrel) can be limited. Dual therapy with warfarin and aspirin or triple therapy (VKA + aspirin + clopidogrel) is not beneficial (II, C).

For patients who have undergone stenting and have a high risk of thromboembolism (CHADS2 score 2), it makes sense to prescribe triple (VKA + aspirin + clopidogrel) rather than dual antithrombotic (aspirin + clopidogrel) therapy for 1 month with the use of bare metal stents and 3- 6 months - coated stents (II, C). After initial triple therapy, dual therapy (VKA + aspirin/clopidogrel) rather than OAC monotherapy is recommended (II, C).

In low-risk patients (CHADS2 score 0-1) within 12 months after stenting (bare-metal or coated stents), dual antithrombotic therapy is preferable to triple antithrombotic therapy with the inclusion of warfarin (II, C).

Acute ischemic stroke

Acute ischemic or hemorrhagic stroke complicates the use of OAC. The 2010 ESC and 2011-2012 RSC/VNOA recommendations regarding management of these patients have not changed. The EHRA released guidelines for NOACs in 2013, but the sections on stroke while taking them still contain a lot of anecdotal evidence.

The ACCP/ANA in 2012 recommended that stroke patients receive VKAs with a target INR of 2.0–3.0 (I, A). If stroke has developed despite OAC therapy, with an INR of 2.0-3.0, it is advisable to increase their dose to INR values ​​of 3.0-3.5 (IIb, C).

If VKA is not available, combination therapy with aspirin and clopidogrel may be considered (I, B). Possible administration of dabigatran 150 mg twice daily (II, B). If the patient refuses to take OAC, it is necessary to prescribe dual antithrombotic therapy (aspirin + clopidogrel).

However, 1–2 weeks after a stroke, it is recommended to add warfarin if there is a low risk of bleeding, intracranial hemorrhage, and a small focus of ischemia (I, B). Dabigatran has not been well studied in these situations, especially in patients with renal insufficiency.

Patients with a history of hemorrhagic stroke also require long-term antithrombotic therapy to prevent recurrent ischemic stroke (II, C). Long-term antithrombotic therapy is not recommended in patients younger than 60 years without structural heart disease (III, C).

Anticoagulation during cardioversion

This section of the 2010 ESC recommendations, 2011 RSC/VNOA did not change significantly compared to the 2012 recommendations. Updated guidelines include dabigatran for 3 weeks before and 4 weeks after cardioversion, whether electrical or medical (I, B). Therefore, in patients at high risk of stroke, both warfarin and dabigatran are given long-term (I, B).

ASSR/ANA 2011-2012 in contrast to European and Russian experts, it is recommended that if AF paroxysm lasts less than 48 hours in combination with unstable hemodynamics, cardioversion be performed without prior anticoagulant therapy (I, C).

If a patient fails to detect a thrombus in the left atrial appendage (LAA) on transesophageal echocardiography, cardioversion is performed on the background of anticoagulant therapy. Within 4 weeks it is necessary to take OAC (IIa, B according to the recommendations of the ACCP / ANA 2011-2012). In the recommendations of the ESC 2010, RSC/GNOA 2012, similar recommendations already have a class I, level of evidence B.

There is very little information in the 2011-2012 ASSR/ANA version. on the effectiveness of LMWH in the absence of a thrombus in the LAA during rhythm recovery (IIa, C). Russian scientists, on the contrary, recommend LMWH at low risk of bleeding and renal failure (I, C).

If the presence of a thrombus in the cavity of the heart is proven, anticoagulant therapy is prescribed 3 weeks before and 4 weeks (sometimes more) after cardioversion (IIb, C) according to ACCP / ANA 2011-2012 recommendations), but ESC in 2010 and RKO /VNOA in 2012 raised the recommendation class to I, and the level of evidence (C) did not change.

Closure of the left atrial appendage

ESC / ESC / ESC in 2010-2011 dedicated a small section to mechanical percutaneous (catheter) LAA closure. In 2012, both ESC and RCT/VANOA (class and level of evidence are the same) identified two groups of patients in whom LAA occlusion could be considered: patients at high risk of stroke and unable to take OAC (IIb, B) and patients undergoing open-heart surgery (IIb, C).

So far, the recommendations presented are based only on the opinion of the expert commission. Russian scientists tend to prescribe KLA in the postoperative period after the installation of an occluder. The final data on the effectiveness of LAA occlusion will most likely be presented during 2014. For now, the decision to perform both a surgical and an interventional procedure with LAA occlusion requires an individual approach of doctors.

Pharmacological cardioversion

The section on pharmacological cardioversion was also updated by the ESC in 2012 compared to the 2010 version with data for two drugs: vernakalant and dronedarone.

Vernakalant

In 2010, vernakalant was approved by the European Medical Agency (EMA) as a drug for restoring sinus rhythm in patients with acute paroxysmal AF lasting less than 7 days and less than 3 days after open heart surgery in the presence of hypertension, atherosclerotic coronary disease, CHF I-II functional class (FC) according to NYHA.

In 2010, despite EMA approval, vernakalant was not given a grade of recommendation and level of evidence. In a 2012 update, the ESC approved levels of evidence based on pooled data from vernakalant studies, including comparative studies, in AF/atrial flutter (AFL): CRAFT, ACT I, ACT II, ​​ACT III, ACT IV, AVRO, Scene 2.

Intravenous infusion of vernakalant, ibutilide, propafenone, flecainide is indicated in the case of preferable pharmacological cardioversion and in the absence or minimal structural changes in the heart (I, A).

In patients with a paroxysmal AF duration of less than 7 days and moderate structural heart disease, but without hypotension (systolic blood pressure<100 мм рт.ст.), ХСН III-IV ФК по NYHA, предшествующим ОКС (менее 30 дней до эпизода ФП), тяжелым аортальным стенозом можно проводить внутривенную инфузию вернакаланта. С осторожностью следует применять препарат у пациентов с ХСН I-II ФК по NYHA (IIb, В).

In patients undergoing open-heart surgery, vernakalant instead of cardioversion is reasonable when a paroxysm of AF has developed for less than 3 days (IIb, C).

Side effects are described in more detail in the 2012 guidelines and range from mild (symptomatic) resolving within 15 minutes such as taste disturbance (30%), sneezing (16%), paresthesia (10%) and nausea (9%) to heavy. It is noteworthy that the development of side effects was observed in almost the same proportions both in the vernakalant group and in the placebo group (4.1% vs. 3.9%).

Vercanalant is not registered in the Russian Federation, but (according to the 2012 recommendations) after registration in our country it will be included in the treatment regimen for paroxysmal AF (I, A).

Dronedarone

The class of recommendation and level of evidence for dronedarone in the 2012 ESC and GNCA guidelines are similar. Dronedarone is recommended for patients with paroxysmal AF as a moderately active antiarrhythmic drug to maintain sinus rhythm (I, A). This drug is not recommended for patients with permanent AF (IIb, B). A short course of antiarrhythmic therapy (4 weeks) is reasonable after cardioversion in patients at risk of post-treatment complications (III, B).

The key points presented in the updated 2012 ESC recommendations were supplemented by the RSC/VNOA specialists in 2012 with the following points:

• Dronedarone is not recommended for reducing heart rate in patients with AF/AFL.
• Dronedarone should not be used in patients with atrial fibrillation/atrial fibrillation who have clinical manifestations of CHF or LV systolic dysfunction with a decrease in LVEF to< 40%.
• If a recurrence of AF/AFL develops against the background of its administration and sinus rhythm is not restored, further administration of the drug should be discontinued.
• The appointment of dronedarone and monitoring of the patient's condition is carried out by a specialist.
• Co-administration of dronedarone with dabigatran is not acceptable.
• Concomitant therapy with digoxin requires careful administration of dronedarone.
• This drug should not be prescribed to patients with impaired liver and lung function on the background of previous therapy with amiodarone.
• In the first 6 months of taking dronedarone, it is necessary to monitor liver function (monitoring the level of liver enzymes in the blood plasma) and lungs.

RKO/VNOA in 2011-2012 introduced into the recommendations such drugs as ibutilide, nibentan, flecainide (I, A), however, their use in clinical practice will be approved only after registration of these drugs in the Russian Federation. A common feature of all drugs is their high efficiency in stopping paroxysmal and persistent (nibentan) forms of AF, however, they should be used with caution in the presence of structural heart damage, blockade of the bundle legs, coronary artery disease, CHF with a decrease in EF. In these cases, continuous ECG monitoring and electrical cardioversion are recommended.

The AHA/ACC did not change the pharmacological cardioversion section in 2012.

Catheter ablation

Numerous small studies such as MANTRA-PAF, RAAFT II, ​​and FAST show that catheter ablation is preferable to antiarrhythmic therapy in patients with paroxysmal AF without structural myocardial disease and at low risk of thromboembolism on the CHA2DS2VASc score.

Due to the lack of data on long-term follow-up in the postoperative period in this category of patients, the position of further analysis still remains without the formation of a final opinion about RFA.

The ESC paid special attention to the material of several reports in which it was alleged that some RFA patients had a "silent" cerebral embolism, confirmed by MRI. Depending on the method of ablation, the risk of developing such an embolism varied from 4 to 35%. Since the mechanism of such changes remains unclear, these statements require further study.

Male patients with a low risk of thromboembolism according to the CHA2DS2VASc scale (0-1 points), according to some data, are at a minimal risk of developing adverse complications after RFA, in contrast to females, older people and those with a high risk of stroke.

If in 2010 and 2011 ACCF/AHA assigned the ablation procedure a class II recommendation and a level of evidence A, the updated recommendations of 2012 already included a decision to increase the class to I.

Catheter ablation for AF should be aimed at isolating the pulmonary veins (IIa, A) and should be considered as a first-line intervention in selected patients with symptomatic paroxysmal AF as an alternative to antiarrhythmic drug therapy based on patient choice and risk/benefit ratio (IIa, A). B).

If catheter ablation is planned, continued OAC (warfarin) should be considered during the procedure with an INR target of 2.0 (IIa, B). If AF recurs within the first 6 weeks after catheter ablation, expectant management should be considered (IIa, B).

The 2012 ESC and RSC/VNOA updates are the same as compared to the 2010-2011 version regarding catheter ablation and have the same grade and level of evidence.

I class is divided into 3 types. RFA should be performed:

• patients resistant to any drug therapy, with its intolerance or complete unwillingness of the patient to use the tablet form of drugs;
• patients with atrial tachycardia in combination with "focal" paroxysmal AF from the couplings of the pulmonary veins, the superior vena cava and the mouth of the coronary sinus, the right and left atria, resistant to drug therapy;
• patients with drug-resistant AFL, or RFA AF with drug intolerance or the patient's refusal to take long-term tablets.

• the presence of atrial fibrillation with paroxysmal/persistent form of AF;
• the presence of a clearly localized source of arrhythmia (pulmonary veins, atria).

• the presence of a chaotic form of atrial tachycardia;
• the presence of atrial arrhythmias in combination with good tolerability of drug therapy.

Conclusion

Given the large volume of updates to European, domestic and American recommendations in 2010-2012, we do not provide an analysis of the recommendations regarding comorbidities in patients with AF. Differences in these recommendations exist, but they are not significant and do not affect the treatment in clinical practice.

A number of significant changes have been made to the European guidelines of 2012, which allow more actively prescribing NOACs as an alternative to VKA for the prevention of thromboembolic complications in patients with non-valvular AF. Due to the relatively “young” clinical period of NOAC prescription, studies of these drugs are currently ongoing.

The joint work of Russian and foreign specialists will make it possible to create detailed and in-depth recommendations on the tactics of managing patients with this pathology and develop domestic treatment standards at the modern level, which in turn will not only satisfy the requirements of medical specialists, but also increase the duration and quality of life of patients, which is a priority in modern medicine.

Storozhakov G.I., Alekseeva E.M., Melekhov A.V., Gendlin G.E.

Atrial fibrillation therapy depends primarily on the form of this disease and requires a person to change lifestyle, diet, taking certain medications, and in some cases, certain procedures or even surgery.

Without a doubt, AF is a condition that needs to be carefully monitored. Fortunately, there are a number of ways to manage AF today, and for many people there are medications and other treatment options that can help reduce the risks associated with the condition. To understand what AF is (causes and symptoms of the disease), you can read this material - Atrial Fibrillation: causes, symptoms, treatment.

Once you understand the causes and symptoms of atrial fibrillation, you probably want to know what can be done to correct or at least control your condition. The answer to this question usually depends on the form of atrial fibrillation, how the condition affects your daily life, and how much AF increases your risk of having a stroke or other serious complications. Most likely, your doctor will strongly recommend that you make some lifestyle changes, and depending on the situation, he may also recommend medications, medical procedures, or surgery.

Lifestyle changes in atrial fibrillation

In addition to taking medication, there are a number of steps you can take to control AF by making changes to your lifestyle. These changes can help you improve your heart health.

• Eat Healthy Foods: The Atrial Fibrillation Diet aims to improve your heart health. Your diet should be rich in fresh fruits, vegetables and whole grains. It is necessary to limit the intake of salt (see Harm of salt) and solid fats.
• Bring your body weight back to normal: People who are overweight or obese are at an increased risk of developing many heart diseases. A balanced diet can also help you with this, which you can learn more about here - The right diet for every day.
• Be physically active every day A: Regular exercise is one of the key lifestyle changes that improves heart health. Most doctors recommend increasing physical activity in daily life, such as taking the stairs to your floor instead of the elevator; walk to work rather than driving or using public transport (if work is within 30-40 minutes of walking); more walking and running. Be sure to check with your doctor before attempting any self-treatment of atrial fibrillation.
• Quit smoking: Smoking is one of the main causes of heart health problems. If you don't smoke, don't start. If you smoke, now is the time to quit smoking.
• Keep your blood pressure and cholesterol levels normal: High blood pressure and cholesterol buildup are a silent threat to the heart. High blood pressure (hypertension), high levels of "bad" cholesterol, or low levels of "good" cholesterol can take a toll on your heart and blood vessels. Over time, these conditions can lead to myocardial infarction, stroke, peripheral arterial disease, and other types of cardiovascular disease.

These foods will help you lower your bad cholesterol levels - 12 Foods That Lower Cholesterol Naturally.

These foods will help you raise your good cholesterol levels - 15 Omega-3 Foods Your Body Needs.

You can learn about high blood pressure here - Hypertension: symptoms and complications.

• Minimize (or eliminate) alcohol and caffeinated foods: Excessive consumption of alcoholic beverages or caffeinated foods can lead to heart problems.

Medicines for the treatment of atrial fibrillation

The treatment of atrial fibrillation has two goals:

1. stroke prevention
2. AF symptom control

To help prevent a stroke, doctors prescribe blood-thinning drugs (anticoagulants). These drugs help maintain normal blood viscosity by preventing the occurrence of slow blood flow in the region of the heart - the left atrial appendage (LAA), which can occur during atrial fibrillation. If blood flow slows down, blood clots (thrombi) can form and travel through the blood vessels to reach the brain. A clot can block blood flow, resulting in a stroke.

People with atrial fibrillation and high blood pressure (hypertension), diabetes, heart failure, or the elderly, or those who have had a stroke, are advised to take blood-thinning medications. The risk of bleeding with anticoagulants is lower than the risk of stroke without them.

Blood-thinning medicines used to prevent blood clots (clots) from forming include the following:

• Warfarin (Coumadin): Is perhaps the most famous of all anticoagulants. However, it has its drawbacks, including the risk of heavy bleeding. You need to have regular blood tests while taking this drug.
• Dabigatran (Pradaxa): Does not require blood tests. However, it is worth considering the fact that dabigatran is a drug of shorter duration.
• Rivaroxaban (Xarelto): Taken once a day and does not require regular blood tests.
• Apixaban (Eliquis): Very effective remedy for reducing the risk of stroke.

Atrial fibrillation leads to arrhythmias and palpitations. That is why doctors often prescribe drugs whose action is aimed at controlling the speed and normalizing the heart rhythm. In some cases, the drug is used to control both.

• Beta blockers: They are a class of drugs that are commonly used to control heart rate. These drugs block some of the effects of adrenaline, which causes the heart to beat faster. Metoprolol is an example of a widely used beta blocker.
• Calcium channel blockers: These are other commonly used drugs for heart rate control. An example is the drug Diltiazem, which belongs to this class of drugs. These drugs affect channels in heart cells that regulate the flow of calcium in and out of those cells. Blocking the transport of calcium through these channels slows down the speed of the heart.
• Digoxin: Is a drug still used to control the heartbeat in people with atrial fibrillation.
• Amiodarone: This medicine is prescribed to restore the normal sinus rhythm of the heart. Or it can be used to normalize the heart after a procedure called electrical cardioversion, which is used to treat symptoms of persistent and persistent atrial fibrillation.
• Sotalol: Can be used to control heart rate.
• propafenone and flecainide: Referred to as the IC class of drugs. Class I drugs transport sodium across cell membranes into the heart. These drugs are used to control the heart rate in people who have only atrial fibrillation as a heart problem. People with coronary heart disease, dysfunction of the heart muscle, and a weakened heart muscle are generally not prescribed these drugs.
• Quinidine: Can be used for heart rate monitoring.
• Dronedarone: It is a heart rate control drug.

If your doctor sees the need to use any of the above medicines, then an appropriate treatment plan will be drawn up for you and the necessary drugs will be prescribed.

If medications don't help control atrial fibrillation

Following a healthy lifestyle and taking medication works in most cases of atrial fibrillation. Unfortunately, this strategy does not work for everyone. For some people, lifestyle changes and medications relieve the symptoms of atrial fibrillation for only a short time, and over time, these methods may no longer have any effect at all. Despite these kinds of problems, you should not despair, as your doctor can still help you.

• He can refer you to a cardiac rehabilitation program that helps people with heart problems.
• They may also try to adjust your medications to make it easier for you to take them.

If you find that your AF is not responding well to lifestyle changes and medications, don't give up. The medical team should be able to develop a treatment plan that will help you control your heart rate and reduce your risk of blood clots, stroke, and other complications.

Procedures and surgery for atrial fibrillation

Today, there are a number of options for the treatment of atrial fibrillation through special procedures and surgical operations aimed at restoring the normal rhythm of the heart. These include the following:

• Electrical cardioversion: While the patient is under anesthesia, the doctor, by applying a high-energy pulsed electrical discharge to the heart area, restores a normal heart rhythm.
• Catheter ablation: If the cause of atrial fibrillation is one or more arrhythmias that cause flutter (fibrillation) in the heart, you may consider catheter ablation. During this procedure, the electrophysiologist guides long, thin tubes (catheters) through the blood vessels to the heart. After the catheter has reached the focus of the arrhythmia, the electrophysiologist destroys it with heat or cold. This procedure destroys the cells that cause abnormal heart activity.
• : In some cases, especially those with sick sinus syndrome (sinus node disease or sinus node dysfunction), doctors may recommend implanting a pacemaker to help keep the heart beating normally. A pacemaker is a small electronic device that is surgically implanted in the chest. It produces electrical impulses that stimulate the heart to beat at a normal pace.
• Ablation of the atrioventricular (AV) node: In AV node ablation, RF energy is delivered along the path between the upper chambers of the heart (atria) and the lower chambers of the heart (ventricles). Energy is directed to an area called the atrioventricular node to destroy a small amount of tissue, which results in irregular impulses to the ventricles, which is what causes atrial fibrillation. Typically, a small pacemaker is also implanted to help the heart maintain a normal rhythm.
• Surgical operation "labyrinth" A: If you are scheduled for open-heart surgery to treat a heart condition, such as a malfunctioning heart valve or blocked arteries, the surgeon may also perform a surgical procedure called a maze to treat AF. The surgeon will make tiny incisions in the upper chambers of the heart. These incisions will heal, but scar tissue will remain in their place. Why do you need scar tissue in your heart? Because scar tissue does not conduct unorganized electrical impulses. In fact, as a result of this surgical operation, electrical impulses are interrupted, which lead to the symptoms of atrial fibrillation.

Procedures to reduce the risk of stroke

Some people have untreated atrial fibrillation, the symptoms of which are difficult to control. In these situations, doctors tend to focus on treatment options that reduce the risk of stroke.

Closure of the left atrial appendage is a procedure that seals an area of ​​the heart called the left atrial appendage (LAA). The LAA is a small sac located on the upper left side of the heart, in close proximity to the upper left ventricle of the heart. The LAA is the area of ​​the heart where blood pools the most during episodes of atrial fibrillation. When blood collects in the LAA, blood clots can begin to form there, forming blood clots.

If at least one thrombus bypasses the LAA, floats with the bloodstream through the arteries and enters the brain, an ischemic stroke can occur. A stroke is an emergency that requires immediate medical attention to restore proper blood flow to the brain. Depending on how severe the stroke is or how long the brain is not fed enough, the condition can lead to disability or even death.

The purpose of closing the LAA is to completely seal it so that blood cannot enter or escape from the LAA. There are various methods for closing the left atrial appendage, including retraction of the left atrial appendage with the Lasso tool or implantation of a tiny device (WATCHMAN or AMPLATZER Cardiac Plug). Both of these procedures are considered minimally invasive, meaning that the patient does not undergo open-heart surgery.