Роль статинів у комплексній терапії хворих із фібриляцією передсердь

Atrial fibrillation (AF) is one of the most common arrhythmia leading to disability in clinical practice. Diagnosis and treatment of atrial fibrillation remains a serious problem and that urges doctors and researchers to look for new solutions in the tactics of treating this disease.Despite enormous progress in the understanding of many electrophysiological mechanisms of the arrhythmia formation, now there is no universal method for AF treatment. Successful treatment of AF depends on the disease, which lies in the basis of arrhythmia. Currently available data researches indicate a tendency increasing for inflammation markers in patients with AF.The hypothesis of atrial fibrillation induction by inflammatory stress has become a prerequisite to the study of anti-inflammatory drugs influence on the frequency of AF relapses after cardioversion. Thanks to the discovery of pleiotropic properties of statins researchers began to investigate actively the possibility of expansion of indications for their use. Statins have been used for more than 20 years, and new information about their effects is accumulating.There is information about the effective use of statins’ application in the treatment of patients with arrhythmias, cardiomyopathy, gallstones, cancer, diabetes mellitus. The possibility of the impact of statins on AF has been actively studied in recent years.High-quality studies of statins use in the treatment of patients with AF are rare and most of the evidence have been obtained in observational and retrospectives studies. In randomized studies the effects of statins on AF revealed a positive correlation with the successful cardioversion. The preventive effect of statins in atrial fibrillation is likely to occur due to the improvement of lipid exchange and prevention of atherosclerosis, anti-inflammatory and antioxidant activity.Statins are involved in the regulation of various metalloprotei­nase that can play a role in the regulation of the structural adjustment associated with atrial fibrillation. In experiments of animal models statins have demonstrated the weakening of the electrical and structural adjustment of the atria and reduction of the paroxysms of AF. Today it became obvious that statins possess antiarrhythmic properties. However, the mechanisms of the action remain not completely understood.It is possible that statins have indirectly antiarrhythmiс activity, due to the inhibition of intracellular synthesis of mevalonic acid and an increase in the synthesis of nitric oxide, which stimulates anti-ischaemic effects and reduces arrhythmia.The statins have a direct membrane stabilizing effect, preventing the increase of intracellular calcium content on the background of hypoxia and apoptosis of cardiomyocytes. During to positive impact of statins on the inflammation, as well as hypertrophy and fibrosis of cardiomyocytes, that prevents the formation of zones with impaired electric impulse, the processes of electro-physiological and anatomical remodelling to support myocardial electric heterogeneity and arrhythmia persistence.Meta-analysis of the studies conducted by French researchers 2008, including 3557 patients, showed the true effectiveness of this class of drugs. In 3 studies statins are used in patients with paro­xysmal and persistent AF after the electric cardioversion, and in 3 other studies they were used for primary prevention in patients who had undergone heart surgery or in patients suffering from acute coronary syndrome. Coronary heart disease was diagnosed in 93 % of all participants. The duration of the observation was from 3 to 26 weeks. As a result of using statins there was a decrease in primary AF and recurrence of paroxysms by 61 % in comparison with the control group (p = 0.02).Retrospective analysis of research GISSI-HF found a reduction in the frequency of primary paroxysms of AF in 3690 patients with systolic heart failure without the history AF at 3.7 years. All paro­xysms occured in 15 % of patients, and in rosuvastatin group the rate of AF was for considerably lower as compared to the control group.The evidences supporting the use of statins in primary and se­condary prevention of AF, except postoperative AF, insufficient and require the further studies, until a consensus is reached on the intensity and duration of statin treatment, as well as their type.Фибрилляция предсердий является одним из наиболее часто встречающихся видов тахиаритмий. Имеющиеся на сегодняшний день данные научных исследований указывают на тенденцию увеличения маркеров воспаления при фибрилляции предсердий. Статины участвуют в регулировании различных металлопротеиназ, что может сыграть роль в регулировании структурной перестройки, связанной с фибрилляцией предсердий.Фібриляція передсердь є одним із видів тахіаритмій, що найбільш часто зустрічаються. Наявні на сьогодні дані наукових досліджень указують на тенденцію збільшення маркерів запалення при фібриляції передсердь. Статини беруть участь у регулюванні різних металопротеїназ, що може відіграти роль у регулюванні структурної перебудови, пов’язаної з фібриляцією передсердь