clinmedКлиническая медицинаClinical Medicine (Russian Journal)0023-21492412-1339ООО «Медицинское информационное агентство»10.30629/0023-2149-2025-103-7-521-530clinmed-1204Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL INVESTIGATIONSКатетерное лечение фибрилляции предсердий у пациентов с систолической дисфункцией ЛЖ: анализ ранних послеоперационных результатовCatheter treatment of atrial fibrillation in patients with left ventricular systolic dysfunction: analysis of early postoperative resultshttps://orcid.org/0009-0001-2835-9571ХузиахметовР. Д.KhuziahmetovR. D.

Хузиахметов Рустам Джалилевич — врач-сердечно-сосудистый хирург кардиохирургического отделения №3

Пермь

Rustam Ja. Khuziahmetov — Cardiovascular surgeon of Cardiac Surgery Department No. 3

Perm 

rustam-huziahmetov@yandex.ruhttps://orcid.org/0000-0001-6965-7869ШишкинаЕ. А.ShishkinaE. A.

Шишкина Екатерина Андреевна — д-р мед. наук, профессор кафедры госпитальной терапии и кардиологии

Пермь

Ekaterina A. Shishkina — Doctor of Medical Sciences, Professor of the Department of Hospital Therapy and Cardiology

Perm 

https://orcid.org/0000-0002-4007-7665КадыралиевБ. К.KadyralievB. K.

Кадыралиев Бакытбек Кайыпбекович — д-р мед. наук, врач-сердечно-сосудистый хирург кардиохирургического отделения №1

Пермь

Bakytbek K. Kadyraliev — Doctor of Medical Sciences, cardiovascular surgeon of Cardiac Surgery Department No.1

Perm 

https://orcid.org/0000-0002-0945-8208БеловВ. А.BelovV. A.

Белов Вячеслав Александрович — врач-сердечно-сосудистый хирург, главный врач

Пермь

Vyacheslav A. Belov — cardiovascular surgeon, Chief physician  

Perm 

https://orcid.org/0009-0006-1678-9175АзизовС. Н.AzizovS. N.

Азизов Сардор Норматович — канд. мед. наук, врач-сердечно-сосудистый хирург кардиохирургического отделения №3

Пермь

Sardor N. Azizov — Candidate of Medical Sciences, cardiovascular surgeon of Cardiac Surgery Department No. 3

Perm 

https://orcid.org/0000-0003-4860-0112ХлыноваО. В.KhlynovaO. V.

Хлынова Ольга Витальевна — д-р мед. наук, профессор, член-корр. РАН, заведующая кафедрой госпитальной терапии и кардиологии

Пермь

Olga V. Khlynova — Doctor of Medical Sciences, Professor, Corresponding Member of the Russian Academy of Sciences, Head of the Department of Hospital Therapy and Cardiology

Perm 

ФГБУ «Федеральный центр сердечно-сосудистой хирургии им. С.Г. Суханова» Минздрава РоссииРоссияFederal Center of Cardiovascular Surgery named after S.G. Sukhanov of the Ministry of Health of the RussiaRussian FederationФГБОУ ВО «Пермский государственный медицинский университет им. академика Е.А. Вагнера» Минздрава РоссииРоссияPerm State Medical University named after Academician E.A. Vagner of the Ministry of Health of the RussiaRussian FederationФГБОУ ВО «Пермский государственный медицинский университет им. академика Е.А. Вагнера» Минздрава РоссииРоссияFederal Center of Cardiovascular Surgery named after S.G. Sukhanov of the Ministry of Health of the RussiaRussian Federation2025261120251037521530Copyright © Хузиахметов Р.Д., Шишкина Е.А., Кадыралиев Б.К., Белов В.А., Азизов С.Н., Хлынова О.В., 20252025Хузиахметов Р.Д., Шишкина Е.А., Кадыралиев Б.К., Белов В.А., Азизов С.Н., Хлынова О.В.Khuziahmetov R.D., Shishkina E.A., Kadyraliev B.K., Belov V.A., Azizov S.N., Khlynova O.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.clinmedjournal.com/jour/article/view/1204

Фибрилляция предсердий (ФП) является значимой причиной развития хронической сердечной недостаточности. Результаты рандомизированных клинических исследований, посвященных интервенционному лечению ФП у пациентов с систолической дисфункцией левого желудочка (ЛЖ), демонстрируют различную эффективность и безопасность катетерных вмешательств. Цель исследования: оценка эффективности и безопасности катетерной аблации ФП у пациентов с систолической дисфункцией ЛЖ в сравнении с пациентами без систолической дисфункции ЛЖ. Материал и методы. После проведения «псевдорандомизации» 395 пациентов, перенесших изоляцию устьев легочных вен, были сформированы 2 группы: основная группа (фракция выброса ЛЖ < 50%, n = 42) и группа сравнения (фракция выброса ЛЖ ≥ 50%, n = 81). Результаты. Не было выявлено статистически значимой разницы между основной группой и группой сравнения в частоте возникновения послеоперационных рецидивов пароксизмов ФП во время госпитализации (7,1% (3) против 14,8% (12), p = 0,218), частоте возникновения интраоперационных осложнений (2,4% против 9,9%, p = 0,130) и их структуре (p = 0,442). В основной группе отмечалось увеличение фракции выброса ЛЖ на 2-е сутки после операции (изменение на +6,6 ± 7,9%, p < 0,001) преимущественно за счет купирования тахисистолии и восстановления синусового ритма при наличии жизнеспособного миокарда левого желудочка. Заключение. Интервенционное лечение ФП у пациентов с систолической дисфункцией левого желудочка является сопоставимым по безопасности и эффективности с результатами в случае сохранной фракции выброса ЛЖ.

Atrial fibrillation (AF) is a significant cause of chronic heart failure development. The results of randomized clinical trials focusing on interventional treatment of AF in patients with systolic left ventricular (LV) dysfunction demonstrate varying effectiveness and safety of catheter interventions. Objective. The main aim of this study is to evaluate the efficacy and safety of catheter ablation of AF in patients with systolic LV dysfunction compared to patients without systolic LV dysfunction. Material and methods. Following “pseudo-randomization” 395 patients who underwent pulmonary vein isolation were divided into 2 groups: the main group (LV ejection fraction < 50%, n = 42) and the comparison group (LV ejection fraction ≥ 50%, n = 81).Results. There was no statistically significant difference between the main group and the comparison group in the frequency of postoperative AF recurrence during hospitalization (7.1% (3) vs. 14.8% (12), p = 0.218), the frequency of intraoperative complications (2.4% vs. 9.9%, p = 0.130), and their structure (p = 0.442). The main group showed an increase in LV ejection fraction by +6.6 ± 7.9% on the 2nd day post-operation (p < 0.001), primarily due to the control of tachysystole and restoration of sinus rhythm in the presence of viable LV myocardium. Conclusion. Interventional treatment of AF in patients with systolic LV dysfunction is comparable in safety and efficacy to outcomes in cases with preserved LV ejection fraction.

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