Search for an optimal therapy of patients with atrial fibrillation (results of many years of comparison of three treatment strategies).

Patients with nonrheumatic atrial fibrillation (n=465, mean age 59.4+/-3.8 years) received controlled therapy for 7.4+/-1.6 years. Group 1 comprised 306 patients with paroxysmal and persistent atrial fibrillation who after restoration of sinus rhythm received antiarrhythmic therapy aimed at prevention of recurrences and repetitive cardioversions. Group 2 consisted of 67 similar patients who did not receive continuous antiarrhythmic therapy. Therapy of patients with persistent atrial fibrillation (group 3, n=92) included heart rate slowing drugs and anticoagulants. Group 1 was characterized by lowest rate of complications and all cause mortality, and best quality of life. There were more nonfatal strokes in group 2. All cause mortality in group 2 was 15% (p<0.05). Highest rate of nonfatal strokes, and deaths due to chronic heart failure was observed in group 3. All cause mortality in this group was 22.8% (p<0.001 vs group 1).     

Influence of perindopril, rosuvastatin, or omega-3 polyunsaturated fatty acids on efficacy of antirecurrence therapy with sotalol in patients with persistent atrial fibrillation

Patients (n=187) with symptomatic persistent atrial fibrillation at the background of ischemic heart disease after restoration of sinus rhythm were randomized for treatment with sotalol 80 - 160 mg/day (n=48), or with combinations of sotalol with perindopril 4 - 8 mg/day (n=48), rosuvastatin 5 - 20 mg/day (n=45), or omega-3 polyunsaturated fatty acids containing preparation 1 g/day (n=45). After 12 months sinus rhythm was maintained in 77.6, 93.8 (p < 0.05), 86.7, and 84.4% of cases, respectively, after conduction on the average 7.9 +/- 1.6, 4.3 +/- 1.0 (p < 0.05), 6.5 +/- 1.7, 7.2 +/- 1.8 pharmacological cardioversions per 1 patient in groups of comparison, respectively. Plasma level of high sensitivity C-reactive protein was lowered by all variants of combination therapy, while anterior-posterior left atrial diameter - only under the influence of perindopril. Antiinflammatory effect of nonarrhythmic drugs is able to play substantial role in prevention of atrial fibrillation, however antiremodeling and hemodynamic effects of therapy probably possess no less important significance.