Consilium MedicumConsilium MedicumConsilium MedicumConsilium Medicum2075-17532542-2170Consilium Medicum94534ArticlesСтатьиReview ArticleAtrial fibrillation management on prehospital and in-hospital phases, based on the principles of evidence-based medicineКупирование фибрилляции предсердий на догоспитальном и стационарном этапах с позиций доказательной медициныMillerO. NМиллерО. Н

д-р мед. наук, проф. каф. неотложной терапии, эндокринологии и профпатологии ФПК и ППВ ГБОУ ВПО НГМУ

miller.olga@list.ruTarasovA. VТарасовА. В

канд. мед. наук, кардиолог-аритмолог, врач высшей категории, ст. науч. сотр. ФГБУ ГНИЦ ПМ

DikI. SДикИ. С

терапевт высшей категории, кардиолог первой категории, ЗАО Медицинский центр «Авиценна»

BelyaevaI. EБеляеваИ. Е

кардиолог высшей категории, ГБУЗ НСО ГКБ №34

Novosibirsk State Medical UniversityГБОУ ВПО Новосибирский государственный медицинский университет Минздрава РоссииState Research Center for Preventive Medicine of the Ministry of Health of the Russian FederationФГБУ Государственный научно-исследовательский центр профилактической медицины Минздрава РоссииMedical center "Avicenna" group of companies "Mother and child"ЗАО Медицинский центр «Авиценна» группы компаний «Мать и дитя»City Clinical Hospital №34ГБУЗ НСО Городская клиническая больница №34151020161810VOL 18, NO10 (2016)ТОМ 18, №10 (2016)81828122021Copyright ©; 2016, Consilium MedicumCopyright ©; 2016, ООО "Консилиум Медикум"2016Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc-sa/4.0https://consilium.orscience.ru/2075-1753/article/view/94534

Atrial fibrillation (AF) is the most common type of arrhythmia and is associated with an increased risk of stroke and systemic thromboembolism, heart failure, deterioration in quality of life. The antiarrhythmic drugs (AD) remain the main therapeutic approach in case of AF management, especially on prehospital phase despite the high efficiency of electrical cardioversion (ECV), nowadays. Still, many questions remain unsolved especially the efficacy, tolerability and safety of these drugs, taking into account that AF is not life-threatening. This article, according to the 2014 AHA/ACC/HRS guideline, deals with the modern pharmacological cardioversion of paroxysmal and/or persistent AF, where experts focus on the results of a placebo-controlled studies and meta-analyses using different AD, nowadays. We prove the high efficiency of class IC AD, immediate restoration of sinus rhythm after intravenous and/or oral AD administration, the absence of serious adverse events and the absence of requirement for hospital admission after AD application, and included AD in the recommendations 2014 - class I, level of evidence A, now.

Фибрилляция предсердий (ФП) является наиболее распространенной формой аритмии и ассоциируется с повышением риска инсульта и системной тромбоэмболии, сердечной недостаточности, ухудшением качества жизни. Несмотря на высокую эффективность электрической кардиоверсии, в настоящее время антиаритмические препараты (ААП) остаются основным терапевтическим инструментом при купировании ФП, особенно на догоспитальном этапе. До сих пор остаются нерешенными многие вопросы относительно эффективности, переносимости и безопасности этих препаратов, особенно с учетом того, что ФП не является жизнеугрожающей аритмией. В настоящей статье в свете последних рекомендаций AHA/ACC/HRS 2014 г. представлены современные возможности фармакологической кардиоверсии пароксизмальной и/или персистирующей форм ФП, где экспертами основной акцент сделан на результаты плацебо-контролируемых исследований и метаанализов с использованием разных ААП. На сегодня доказанные высокая эффективность ААП IC класса, быстрое восстановление синусового ритма после внутривенного и/или перорального применения, отсутствие тяжелых побочных эффектов и необходимости в госпитализации позволили поставить их в рекомендациях 2014 г. с классом I, уровнем доказательности А.

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