cardiotomskСибирский журнал клинической и экспериментальной медициныSiberian Journal of Clinical and Experimental Medicine2713-29272713-265XTSU publishing10.29001/2073-8552-2023-38-4-20-28cardiotomsk-2047Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESХроническая болезнь почек и фибрилляция предсердий: подходы к выбору антиаритмической терапииChronic kidney disease and atrial fibrillation: approaches to the choice of antiarrhythmic therapyhttps://orcid.org/0000-0001-7303-9756ТатарскийБ. А.TatarskyB. A.

Татарский Борис Алексеевич, д-р мед. наук, профессор, руководитель научно-исследовательской лаборатории клинической аритмологии, главный научный сотрудник, научно-исследовательская лаборатория клинической аритмологии,

197341, Санкт-Петербург, ул. Аккуратова, 2

Boris A. Tatarsky, Dr. Sci. (Med.), Professor, Head of the Research Laboratory of Clinical Arrhymology, Chief Research Scientist, Research Laboratory of Clinical Arrhymology

2, Akkuratova str., St. Petersburg, 197341

btat@mail.ruhttps://orcid.org/0000-0001-6651-9428КазенноваН. В.KazennovaN. V.

Казеннова Наталья Владимировна, канд. мед. наук, научный сотрудник, научно-исследовательская лаборатория клинической аритмологии, Институт сердца и сосудов

197341, Санкт-Петербург, ул. Аккуратова, 2

Natalia V. Kazennova, Cand. Sci. (Med.), Research Scientist, Research Laboratory of Clinical Arrhymology

2, Akkuratova str., St. Petersburg, 197341

kazennova_nv@almazovcentre.ruНациональный медицинский исследовательский центр имени В.А. Алмазова Министерства здравоохранения Российской ФедерацииРоссияAlmazov National Research Medical Center of the Ministry of Health of the Russian FederationRussian Federation2023301220233842028Copyright © Татарский Б.А., Казеннова Н.В., 20232023Татарский Б.А., Казеннова Н.В.Tatarsky B.A., Kazennova N.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sibjcem.ru/jour/article/view/2047

В клинической практике нарушение функции почек достаточно часто сочетается с сердечно-сосудистыми заболеваниями, в частности с фибрилляцией предсердий (ФП). Как известно, почки осуществляют множество функций, включая выделительную, метаболическую и эндокринную. Кардио-ренальная ось регулируется таким образом, что нарушенный баланс приводит как к сердечному, так и к почечному ремоделированию. Следовательно, патофизиологические взаимосвязи между почками и сердцем имеют важное клиническое значение. Рассматривая необходимость создания основы для персонализированной помощи, ориентированной на пациента, в настоящее время представлены документы о позиции ряда ассоциаций и обществ, посвященных лечению больных с ФП и хронической болезнью почек (ХБП). Лечение ФП включает в себя профилактическую антикоагуляцию и фармакологическую терапию, направленную на удержание синусового ритма (СР) или коррекцию частоты желудочковых ответов. Вместе с тем при выборе оптимальной дозы пероральных прямых антикоагулянтных препаратов существует ряд разночтений в опубликованных регламентирующих документах различных кардиологических и нефрологических сообществ. Следует отметить, что в течение последних лет не было достигнуто значительного улучшения клинической фармакологии аритмий. Существующие фармакологические подходы коррекции аритмии у больных с ФП и ХБП лимитированы их ограниченной эффективностью и возможностью развития опасных эффектов, включающих проаритмический эффект в отношении желудочковых аритмий и органо-токсичные осложнения. Использование катетерной и хирургической аблации тормозится сложностью, стоимостью и высокой частотой рецидивов у больных с ХБП. Представляется, что антиаритмическим препаратам (ААП) придается недостаточно внимания по сравнению с антикоагулянтной терапией, особенно у больных с ФП и ХБП. В представленной обзорной статье рассматриваются подходы к выбору антиаритмической терапии у данной категории пациентов.

In clinical practice, impaired renal function is often combined with cardiovascular diseases, in particular with atrial fibrillation. As you know, the kidneys perform many functions, including excretory, metabolic and endocrine. The cardiorenal axis is regulated in such a way that an imbalance results in both cardiac and renal remodeling. Therefore, the pathophysiological relationships between the kidneys and the heart are of great clinical importance. Considering the need to create the basis for personalized patient-oriented care, documents on the position of a number of associations and societies dedicated to the treatment of patients with atrial fibrillation and chronic kidney disease are currently presented. Treatment of atrial fibrillation includes prophylactic anticoagulation and pharmacological therapy aimed at maintaining sinus rhythm or correcting the frequency of ventricular responses. At the same time, when choosing the optimal dose of oral direct anticoagulant drugs, there are a number of discrepancies in published regulatory documents of various cardiological and nephrological communities. It should be noted that in recent years there has been no significant improvement in the clinical pharmacology of arrhythmias. Existing pharmacological approaches for the correction of arrhythmias in patients with atrial fibrillation and chronic kidney disease are limited by their limited effectiveness and the possibility of developing dangerous effects, including the proarrhythmic effect against ventricular arrhythmias and organ-toxic complications. The use of catheter and surgical ablation is inhibited by the complexity, cost and high relapse rate in patients with chronic kidney disease. It seems that antiarrhythmic drugs are not given enough attention compared to anticoagulant therapy, especially in patients with atrial fibrillation and chronic kidney disease. This review article discusses approaches to the choice of antiarrhythmic therapy in this category of patients.

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The authors declare that there are no conflicts of interest present.