Khaniukov O. O., Sapozhnychenko L. V., Meleschyk L. V., Balaban Y. S.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Electrical cardioversion (ECV) in patients with atrial fibrillation (AF) is associated with a high risk of developing cardioembolic stroke. The article represents the using of the rivaroxaban for the prevention of thromboembolic complications (TEC) in patients with AF both during and after ECV. The study included 30 patients with nonvalvular AF. Patients were received rivaroxaban at a dose 20 mg or 15 mg once a day, depending on the glomerular filtration rate and the risk of bleeding. The average age of the patients was 68 ± 7 years. The average duration of atrial fibrillation was about 5 months (0.4 ± 0.05 years). According to the EHRA classification, functional class (FC) II was established in 26 (87%) patients, FC III – in 4 (13%). Stable angina pectoris (I – III FC) was diagnosed in 13 (44%) patients. Hypertensive disease was found in 23 patients (77%) – stage I in 1 (3%) patient, stage II – in 22 (74%) patients. All patients were diagnosed with chronic heart failure, of which 25 (83%) had II functional class (FC) according to NYHA classification and 5 (17%) patients had III FC according to NYHA. Type 2 diabetes was diagnosed in 4 (13%) patients and in 4 (13%) renal dysfunction. The need for long-term anticoagulant therapy in patients with AF was determining using the CHA2DS2-VASc score. The average score on the CHA2DS2-VASc score was 4 and on the HAS-BLED score – 2 points.During trans-esophageal echocardiography, organized blood clots were detected in 20 patients (66%), 19 (63%) of them in the left atrial appendage and one (3%) patient in the right atrial appendage. In the absence of an arterial blood clots, ECV was performed. In all patients ECV was effective and the sinus rhythm was being maintained throughout the observation period. During electrical cardioversion of TEC were not registered. According to the survey, during the reception of rivaroxaban, TEC and “major” bleedings were not registered. There were 2 cases (7%) of the appearance of subcutaneous bruisings that it did not need treatment correction. During 1 year, one (3%) patient stopped taking rivaroxaban oneself, three (10%) patients were taking irregularly for financial reasons. It was estimated that patients with AF had a high risk TEC. Therefore, to detect thrombosis it is necessary to perform transesophageal echocardiography with visualization of the atrial appendage 4 weeks after taking rivaroxaban. Taking rivaroxaban at a dose of 20 mg or 15 mg once a day is effective and safely for the prevention of feasibility studies in patients with AF, atrial appendage thrombosis and a high risk of hemorrhagic complications both during and after the ECV. Compliance with rivaroxaban in preventing stroke in patients with non-valvular atrial fibrillation makes 87%, which is comparable to global data on rivaroxaban.

atrial fibrillation, electrical cardioversion, thromboembolic complications, rivaroxaban, treatment, compliance.

1. Bonfanti L, Annovi A, Sanchis-Gomar F, Saccenti C. Effectiveness and safety of electrical cardioversion for acute-onset atrial fibrillation in the emergency department: a real-world 10-year single center experience. Clinical and Experimental Emergency Medicine. 2019 Mar;6(1):64-9.
2. Cappato R, Ezekowitz MD, Klein AL. On behalf of the X-VeRT Investigators. Rivaroxaban vs. vitamin K antagonists for cardioversion in atrial fibrillation. European Heart Journal. 2014;35:3346-55.
3. Vorob’eva NM, Karpov JuA. Priverzhennost’ k lecheniju peroral’nymi antikoaguljantami u pacientov s neklapannoj fibrilljaciej predserdij v real’noj klinicheskoi praktike. Novosti kardiologii. 2017;3:38-46. [in Russian].
4. Diahnostyka ta likuvannya fibrylyatsiyi peredserd. Rekomendatsiyi robochoyi hrupy po porushennyakh sertsevoho rytmu Asotsiatsiyi kardiolohiv Ukrayiny. Kyyiv: 2011. 160 s. [in Ukrainian].
5. Voronkov LH, Amosova KM, Dzyak HV. Rekomendatsiyi Asotsiatsiyi kardiolohiv Ukrayiny z diahnostyky ta likuvannya khronichnoyi sertsevoyi nedostatnosti. Dodatok № 1 do zhurnalu «Sertseva nedostatnist ta komorbidni stany». 2017;1:6-66. [in Ukrainian].
6. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. European Heart Journal. 2016;37(38):2893-962. Available from: https://doi.org/10.1093/eurheartj/ehw210.
7. Guidelines for Performing a Comprehensive Transesophageal Echocardiographic Examination in Children and All Patients with Congenital Heart Disease, JASE. 2018.
8. Guidelines for Performing a Comprehensive Transesophageal Echocardiography Examination: Recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists, JASE, September 2013.
9. Anter E, Silverstein J, Tschabrunn CM, Shvilkin A, Haffajee CI, Zimetbaum PJ, et al. Comparison of intracardiac echocardiography and transesophageal echocardiography for imaging of the right and left atrial appendages. Heart Rhythm. 2014;11:1890-7.
10. Moiseev SV. Priverzhennost’ k antikoaguljantnoj terapii: problemy i puti reshenija. Klinicheskaja farmakologija i terapija. 2014;23(4):23-8. [in Russian].
11. Zamorano JL, Greiner W, Sandberg A, Oberdiek AM, Bakhai A. Patient preferences for chronic treatment for stroke prevention: results from the European Patients survey in Atrial Fibrillation (EUPS-AF). Proceedings of the Annual Congress of the European Society of Cardiology; 2012 Aug 2529; Munich, Germany.
12. Coleman CI, Roberts MS, Sobieraj DM. Effect of dosing frequency on chronic cardiovascular disease medication adherence. Current Medical Research and Opinion. 2012;28(5):669-80.
13. Caldeira D, Vaz-Carneiro A, Costa J. The impact of dosing frequency on medication adherence in chronic cardiovascular disease: systematic review and meta-analysis. Revista Portuguesa de Cardiologia. 2014;33(7-8):431-7.
14. Camm AJ, Amarenco P, Haas S, Hess S, Kirchhof P, Kuhls S, et al. XANTUS: a real-world, prospective, observational study of patients treated with rivaroxaban for stroke prevention in atrial fibrillation. European Heart Journal. 2016;37(14):1145-53.

«Bulletin of problems biology and medicine» Issue 4 Part 2 (154), 2019 year, 221-226 pages, index UDK 616.125−008.313−085: 615.273

10.29254/2077-4214-2019-4-2-154-221-226