Prognostic value of pharmacotherapy in patients with atrial fibrillation after radiofrequency ablation

The aim of the work: to evaluate the prognostic effect of pharmacotherapy before and after radiofrequency ablation (RFA) in patients with atrial fibrillation (AF) on all-cause mortality, supraventricular arrhythmia recurrence and non-fatal cardiovascular events. Materials and methods. Patients with paroxysmal, persistent and long-term persistent forms of AF were examined before and after RFA – isolation of pulmonary veins. The primary endpoint was patient survival, secondary – a composite endpoint of freedom from recurrence and/or non-fatal cardiovascular events for 2 years of a follow-up. Frequency and doses of pharmacotherapy were evaluated. Standard statistical procedures were used for initial data evaluation. Results. 116 patients were consecutively enrolled in the study. In the long-term post-ablation, 23 patients (19.8 %) continued to take amiodarone, 2 patients (1.7 %) – propafenone for arrhythmic events, 38 patients (32.8 %) needed anticoagulants, and 37 patients (31.9 %) received beta-adrenoceptor blockers over the entire follow-up period. The use of RAAS inhibitors decreased from 81.0 % before the ablation to 56.0 % in the long-term period following RFA. Multifactorial logistic regression analysis showed that the prolonged (more than 3 months) anticoagulation (P = 0.032) after RFA was an independent predictor of patient survival in the two-year follow-up; doses of anticoagulants before the procedure, use and doses of beta-adrenoceptor blockers in the long-term post-ablation period were associated with the secondary endpoint. Conclusions. RFA for AF significantly reduced the frequency of medications use in the long-term postoperatively. Independent predictors of survival were the doses of anticoagulants more than 3 months after ablation, arrhythmia recurrence and non-fatal cardiovascular events – the doses of anticoagulants before the procedure, and the use and doses of beta-adrenoceptor blockers in the long-term period after RFA.

Cardiovascular system

This chapter describes the pharmacology of the cardiovascular system as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of cardiac glycosides, diuretics, antiarrhythmics, beta-adrenoceptor blockers, hypertension and heart failure, nitrates and antianginal drugs, sympathomimetics, anticholinergics, anticoagulants, antiplatelet drugs, fibrinolytics, and lipid-regulating drugs. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.

Drugs for the heart

Antiplatelet agents 82Antiplatelet agents: aspirin 84Antiplatelet agents: thienopyridines 88Antiplatelet agents: clopidogrel 90Antiplatelet agents: prasugrel 94Intravenous antiplatelet agents 96Angiotensin-converting enzyme inhibitors 98Angiotensin receptor blockers (ARBs, also referred to as angiotensin II receptor antagonists, AIIRAs) 102Aldosterone antagonists 106Beta-adrenoceptor blockers (...

Cardiovascular system

2.1 Cardiac glycosides (digoxin), 347 2.2 Diuretics, 348 2.3 Antiarrhythmics, 350 2.4 Beta-adrenoceptor blockers, 351 2.5 Hypertension and heart failure, 353 2.6 Nitrates and antianginal drugs, 356 2.7 Sympathomimetics, 358 2.8 Anticholinergics (antimuscarinics), 360 2.9 Anticoagulants, 361 2.10 Antiplatelet drugs, 363 2.11 Fibrinolytics (thrombolytics), 365...