RU2320328C2 - Method for treating persisting form of atrial fibrillation - Google Patents

Abstract

FIELD: medicine, cardiology.

SUBSTANCE: additionally to conventional antiarhythmic preparations - amiodaron and bisoprolol - one should introduce atorvastatin at the daily dosage of 10 mg daily. The innovation enables to achieve stable clinical remission and decreases side effects due to the ability of atorvastatin to decrease the duration of Q-T interval and increase inotropic myocardial function.

EFFECT: higher efficiency of therapy.

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Description

The invention relates to medicine, in particular to the section of cardiology - arrhythmology. It can be used in the complex antiarrhythmic therapy of patients with a persistent form of atrial fibrillation.

Modern pharmacological methods for treating persistent atrial fibrillation are known, including the use of antiarrhythmic drugs in combination with each other. A combination of amiodarone and a beta-blocker is highly effective (Mazur N.A. Atrial fibrillation and flutter - M .: ND Medpraktika, 2003, p.17). Amiodarone is administered orally at 200 mg every 6-8 hours (600-800 mg / day) in the first two weeks, then the dose is reduced by 200 mg every 10 days until a maintenance dose is reached (200 mg / day) and a beta blocker is prescribed. With a long course of treatment, amiodarone is used according to a five-day regimen.

The disadvantages of this method of combined antiarrhythmic treatment are: a negative inotropic effect, mainly due to the beta-blocker, as well as lengthening the Q-T interval (an independent predictor of sudden death) due to amiodarone. In addition, with prolonged treatment, the phenomenon of "slipping away" arrhythmias occurs - a gradual loss of drug activity without changing the dose taken.

Thus, constant monitoring of the duration of the Q-T interval is required (many food products, antihistamines, etc. provoke dispersion of the Q-T interval), inotropic function of the myocardium, which is almost difficult.

The purpose of the invention is to increase the effectiveness and safety of antiarrhythmic treatment of persistent atrial fibrillation, increase inotropic myocardial function, reduce the dispersion of the Q-T interval.

The essence of the invention lies in the fact that along with the traditional use of antiarrhythmic drugs: amiodarone in a maintenance dose of 200 mg / day according to a five-day regimen and beta-blocker (bisoprolol 2.5 mg / day) daily, atorvastatin 10 mg / day is also used at the same time, regardless of lipid spectrum of the patient.

The use of atorvastatin in the complex antiarrhythmic therapy of persistent atrial fibrillation can increase the effectiveness and safety of treatment (increase the duration of remission as a result of the cardioprotective effect of the drug, reduce the duration of the Q-T interval by about 14.3%), and also increase the inotropic function of the myocardium due to sensitization of cardiomyocyte receptors to Ca2 + ions. The cardioprotective (membrane-stabilizing) effect of lipophilic atorvastatin is probably associated with correction of the current of Na + ions and lipid peroxidation. These effects manifested themselves in the first few hours after taking atorvastatin and were not associated with its lipid-lowering effect, but were new pleiotropic. The listed properties of this drug are revealed for the first time.

The method is as follows. For a relief of an atrial fibrillation attack, a patient is prescribed an intravenous drip of amiodarone 300 mg 6.0 ml in a 5% glucose solution of 200 ml. After stabilization of the state, amiodarone is prescribed according to the saturation scheme: 600 mg / day during the first week, 400 mg / day during the second week, then 200 mg / day during the third week. Then amiodarone 200 mg / day is prescribed according to a five-day regimen. At the same time, bisoprolol 2.5 mg / day is prescribed daily. At the same time, in addition to this treatment, regardless of the patient’s lipid spectrum, atorvastatin 10 mg / day is prescribed continuously. A repeated comparative examination of the patient is carried out 8 hours after taking atorvastatin, i.e. long before the manifestation of its hypolipidemic effect; the properties of the drug during this period of time are pleiotropic (not associated with a decrease in cholesterol).

Example. Patient I.P. Born in 1946, resident of Smolensk, he was admitted to treatment at the Krasny Bor Sanatorium on February 9, 06 (medical history No. 151). On the fourth day there was an attack of atrial fibrillation, accompanied by a sensation of interruptions in the work of the heart, a feeling of “fear of death”, shortness of breath. The first attack occurred in 2004, was stopped by intravenous administration of amiodarone. Then the seizures were repeated with a frequency of about 4 times a year. The patient associates this exacerbation with psycho-emotional stress. On examination: satisfactory condition. The skin is clean. No swelling. HELL - 140/80 mm / Hg. Heart rate - 84 per minute. PS - 78 per minute. NPV - 18 per minute. Heart sounds are arrhythmic, muffled. Emphasis of the second tone on the aorta and pulmonary artery. In the lungs, vesicular breathing, no wheezing. The abdomen is soft, painless. Liver on the edge of the costal arch. On the ECG: atrial fibrillation, CHF ~ 86 per minute. EOS is not rejected. Heart rotation counterclockwise. Left ventricular myocardial hypertrophy. S. Amiodaroni 5% - 6.0 ml + S was introduced intravenously slowly. Glucosae 5% - 200.0 ml. The attack was stopped after 2 hours 15 minutes. On the ECG: sinus rhythm, heart rate - 66 per minute. EOS is not rejected. Heart rotation counterclockwise. Left ventricular myocardial hypertrophy. The Q-T interval is 420 ms. Ultrasound of the heart: the aorta is compacted. Not extended. AO = 3.2 cm. PL = 4.4 cm. CRC = 5.0 cm. CRC = 3.0 cm. LV ejection fraction = 54%. Zones of hypo- and akinesia were not detected. TMF = 1.5 cm. E> A. PZR = 2.1 cm. TZSLZH = 1.4 cm. SDL = 28 mm / Hg. Mitral valve insufficiency 0-1 degree. Tricuspid valve insufficiency 0-1. Conclusion: dilatation of the left atrium. Diastolic function of the left ventricle is not impaired. Trabecula of the left ventricle. Lipidogram: OXS = 6.8 mmol / L. HDL = 1.06 mm / L; LDL = 3.9 mmol / L. TG = 2.5 mmol / L. The atherogenic index is 4.2. Holter ECG monitoring: basic sinus rhythm. Maximum heart rate = 112 per minute, minimum heart rate = 48 per minute, average heart rate = 64 per minute. No changes in the S-T interval by ischemic type were recorded. Heart rate variability is sufficient.

Atorvastatin 10 mg / day was additionally assigned to the main antiarrhythmic treatment (amiodarone 200 mg / day according to a five-day regimen and bisoprolol 2.5 mg / day daily). 8 hours after taking atorvastatin, an ECG was done - a study in 12 leads. Conclusion: sinus rhythm, heart rate = 64 per minute. EOS is not rejected. Heart rotation counterclockwise. Q-T Interval: 360 ms. Ultrasound of the heart: the aorta is compacted Not extended. AO = 3.2 cm. PL = 4.3 cm. CRC = 4.9 cm. CRC = 2.9 cm. Fraction of LV ejection = 68%. Zones of hypo- and akinesia were not detected. TMF = 1.4 cm. E> A. PZR = 2.0 cm. TZSLZH = 1.3 cm. SDL = 2b mm / Hg. Mitral valve insufficiency 0-1 degree. Tricuspid valve insufficiency 0-1. Conclusion: dilatation of the left atrium. Diastolic function of the left ventricle is not impaired. Trabecula of the left ventricle. Lipidogram: OXS = 6.8 mmol / L. HDL = 1.06 mmol / L. LDL = 3.9 mmol / L. TG = 2.5 mmol / L. The atherogenic index is 4.2. Holter ECG monitoring: basic sinus rhythm. Maximum heart rate = 112 per minute, minimum heart rate = 48 per minute, average heart rate = 64 per minute. No changes in the S-T interval by ischemic type were recorded. Heart rate variability is sufficient.

When conducting complex antiarrhythmic treatment (amiodarone 200 mg / day according to a five-day regimen, bisoprolol 2.5 mg / day and atorvastatin 10 mg / day daily), there were no complications or side effects. The phenomenon of “escape” of arrhythmia described in the literature did not occur.

Thus, 23 patients with persistent atrial fibrillation were treated. The average age of the studied patients was 58.6 ± 1.10 years, the duration of the disease was 2.3 ± 0.6 years, and the duration of the attack was 3.2 ± 2.3 days. To stop an arrhythmia attack, patients were prescribed intravenous injections of amiodarone in generally accepted doses. Amiodarone was saturated with subsequent administration to its maintenance dose of 200 mg / day according to a five-day regimen of bisoprolol 2.5 mg / day daily. At the same time, atorvastatin 10 mg / day was additionally prescribed for this antiarrhythmic treatment. The timing of clinical remission during complex antiarrhythmic treatment with atorvastatin was noted earlier than without it. When observing the duration of remission, a lower percentage of relapses was observed in patients receiving complex antiarrhythmic therapy compared to those treated traditionally (amiodarone 200 mg / day according to the five-day regimen and bisoprolol 2.5 mg / day daily). In addition, in patients receiving complex antiarrhythmic treatment with atorvastatin 10 mg / day, an increase in the LV ejection fraction was noted, apparently associated with an improvement in Ca2 + ion transport. The Q-T interval in these patients was shorter than in patients treated traditionally and approached the control group (patients not receiving antiarrhythmic treatment), which is probably due to the inhibition of the Na + channel of the sarcolemma of cardiomyocyte as a result of the use of atorvastatin.

Thus, the complex antiarrhythmic treatment of patients with persistent atrial fibrillation, including the use of amiodarone 200 mg / day according to a five-day regimen, bisoprolol 2.5 mg / day and atorvastatin 10 mg / day daily is effective, cost-effective and safe for patients (allows achieving persistent clinical remission, which does not require a further increase in the dose of antiarrhythmics and constant monitoring, and also reduces the risk of sudden death, the development and progression of heart failure, t rhomboembolic complications).

Claims (1)

A method of treating a persistent form of atrial fibrillation, including the use of traditional antiarrhythmic drugs: amiodarone in a maintenance daily dose of 200 mg according to a five-day regimen and bisoprolol 2.5 mg daily, characterized in that atorvastatin is also used at the same time in a daily dose of 10 mg constantly.