Currently, studies of the causes of atrial fibrillation are actively conducted. However, molecular and cellular mechanisms of atrial fibrillation have not been precisely established so far. Great success in the treatment of atrial fibrillation was achieved thanks to the development of surgical methods. However, these approaches, unfortunately, are not always applicable to elderly and senile patients. Antiarrhythmic drugs used in atrial fibrillation, exhibit a large number of side effects. Much attention of researchers is now attracted by fundamentally new directions in the drug treatment of atrial fibrillation. These include predserdno-selective antifibrillatory funds. Drugs, the action of which is aimed at at atrial remodeling, inflammation and fibrosis, so is of interest. Effective suppression of atrial remodeling, inflammation and fibrosis prevents the formation of a permanent form of atrial fibrillation. A new approach to the treatment of atrial fibrillation, taking into account the vegetative status of the patient, will undoubtedly increase its effectiveness.

Background. Atrial Fibrillation is one of the most common arrhythmias. Despite the different attitude to the pharmacotherapy of Atrial Fibrillation, the problem of selection of adequate antiarrhythmic therapy for the prevention and treatment of persistent Atrial Fibrillation remains relevant and is of great interest to researchers. For the effective selection of drugs in the treatment of arrhythmia can be successfully used the method of spectral analysis of heart rhythm variability. Aims: to study the effect of antiarrhythmic drug Sotalol and β-adrenoblocker Bisoprolol on the spectral parameters of heart rhythm variability in patients with Atrial Fibrillation. Methods. 167 patients with Atrial Fibrillation of both sexes aged 46 to 94 years were examined. The study included patients with the first diagnosed Atrial Fibrillation, and with persistent Atrial Fibrillation during of 6 months to 8 years. Arterial hypertension has diagnosed in all patients. Also, patients were diagnosed with coronary heart disease with a history of myocardial infarction and without myocardial infarction. Spectral analysis of heart rhythm variability was conducted in patients with Atrial Fibrillation. Therapy in patients was performed with the antiarrhythmic drug Sotalol (80−160 mg, orally) and Bisoprolol (2.5−5 mg, orally). Results. Spectral analysis of heart rhythm variability in patients Atrial Fibrillation using Sotalol showed that the proportion of VLF in patients with the first diagnosed Atrial Fibrillation is more than half of the spectrum, whereas in patients with persistent Atrial Fibrillation this parameter is 18%, the proportion of LF is higher in patients with persistent Atrial Fibrillation. The coefficient LF/HF in patients with persistent Arial Fibrillation is two times lower than in patients with the first diagnosed Atrial Fibrillation. Spectral analysis of heart rhythm variability in patients Atrial Fibrillation using Bisoprolol, it was shown that the proportion of LF in patients with the first diagnosed Atrial Fibrillation was 2 times lower, and the proportion of HF was twice higher than in patients with persistent Atrial Fibrillation. Conclusions. In this study, a spectral analysis of heart rate variability in patients with Atrial Fibrillation, who receive antiarrhythmic drug therapy with sotalol and bisoprolol, was carried out. It was found that humoral factors play a significant role in patients with the first diagnosed Atrial Fibrillation during sotalol therapy, the role of the vagus in this group of patients is minimal, while in patients with bisoprolol therapy the vagus has a dominant effect on the activity of the heart.

Aim. To study the effect of class III antiarrhythmic drugs (amiodarone and sotalol), and the β-blocker bisoprolol on the spectral parameters of heart rate variability in patients with different forms of atrial fibrillation (AF).Material and methods. Spectral analysis of heart rate variability of 5-minute electrocardiography intervals was used. The study included patients with newly diagnosed AF and having a duration of the disease from 6 months to 8 years. Arterial hypertension, coronary artery disease, myocardial infarction (in history), conduction disorders and type 2 diabetes mellitus were diagnosed as comorbidities. The following parameters were calculated: the total power (TP) of the spectrum, the power of very low frequencies (VLF), low frequencies (LF) and high frequencies (HF).Results. In the group of patients with newly diagnosed AF without concomitant diseases after administration of amiodarone, VLF prevails in the spectrum structure, which indicates a significant role of humoral factors in the regulation of heart rate. The power of LF, reflecting the activity of the sympathetic nervous system, prevails over HF power after administration of amiodarone. In patients with newly diagnosed AF, having concomitant diseases, sympathetic influences prevail over parasympathetic ones by 3.6 times after administration of amiodarone. In the group of patients who have reduced the number of comorbidities, the LF/HF decreases and is only 1.66 after administration of amiodarone. The decrease in the number of negative factors is also accompanied by an increase in the influence of the vagus nerve on the activity of the heart. In the study of the effects of sotalol, the LF/HF in this group was twice lower in the group of patients with long-term AF. In patients receiving bisoprolol as antiarrhythmic therapy, the proportion of LF in the group of patients with newly diagnosed AF is 2 times lower, and the proportion of HF is twice higher than in the group of patients with long-term AF.Conclusion. The effect of antiarrhythmic drugs on the spectral parameters of heart rate variability depends on the duration AF. The presence of concomitant diseases of the cardiovascular system can significantly change the effect of antiarrhythmic drugs on the spectral parameters of heart rate variability and is accompanied by an increase in sympathetic activity. In patients with newly diagnosed AF, amiodarone and sotalol cause a similar effect – the predominance of sympathetic influence; when using bisoprolol, the predominant influence belongs to the vagus nerve. In patients with long-term AF, the opposite effect of drugs is observed: the use of amiodarone is accompanied by a more pronounced influence of the vagus nerve, and bisoprolol – the predominance of sympathetic influence. When using sotalol, sympathetic influences also prevail, more pronounced in patients with newly diagnosed AF.

Spectral analysis of heart rate variability gives an idea of the role of the autonomic nervous system in the regulation of chronotropic heart function. This method can be used to evaluate the effectiveness of drug therapy. Drug therapy should be carried out taking into account the individual clinical form of atrial fibrillation. Information about the vegetative status of the patient will undoubtedly increase the effectiveness of treatment. In this study, spectral parameters were studied in patients with newly diagnosed atrial fibrillation. The effect of antiarrhythmic drug class III amiodarone on the spectral parameters of heart rate variability was studied.

Spectral analysis of heart rate variability gives an idea of the role of the autonomic nervous system in the regulation of chronotropic heart function. This method can be used to evaluate the effectiveness of drug therapy. Drug therapy should be carried out taking into account the individual clinical form of atrial fibrillation. Information about the vegetative status of the patient will undoubtedly increase the effectiveness of treatment. In this study, spectral parameters were studied in patients with atrial fibrillation. The effect of sotalol on the spectral parameters of heart rate variability was studied.

The aim of this review was to study the role of the autonomic nervous system in the pathogenesis of atrial fibrillation (AF), as well as to establish the relationship of autonomic regulation with other mechanisms underlying the AF At present, the molecular and cellular mechanisms underlying the AF have not been precisely established. There is interest in evidence showing that both sympathetic outflow and an increased vagal tone can initiate and support AF. As modern studies have shown, autonomic cardiac regulation can be an important factor in the pathogenesis of AF.

Spectral analysis of heart rate variability can be successfully used to evaluate the effectiveness of therapy. The use of this method gives an idea of the role of the autonomic nervous system in the regulation of chronotropic function of the heart. These data help to define conditions of manifestation of efficiency of antiarrhythmic drugs. In this study, spectral analysis were studied in patients with persistent atrial fibrillation. The effect of amiodarone class III antiarrhythmic drug were studied this study.

Фибрилляция предсердий является важной проблемой в кардиологии. Она часто встречается в клинической практике и может способствовать развитию тромбоэмболических осложнений. Основными механизмами развития фибрилляции предсердий считают re-entry и нарушение автоматизма, вызванное триггерной активностью. Кроме того, установлено, что повышение тонуса блуждающего нерва также способствует развитию фибрилляции предсердий. Наиболее эффективными антиаритмическими препаратами для лечения и профилактики фибрилляции предсердий являются препараты I и III классов, которые удлиняют рефрактерность и угнетают проведение. Наличие антихолинергических свойств у антиаритмических препаратов повышает их эффективность.

Проблема ослабления действия антиаритмических препаратов в условиях активации симпатической нервной системы стала предметом внимания многих исследователей. Такая ситуация часто встречается при ишемии и инфаркте миокарда, а также у пациентов, имеющих устойчивую желудочковую аритмию. Кроме того, симпатическая гиперактивность является характерной чертой сердечно-сосудистых заболеваний, в том числе, сердечной недостаточности. Стимуляция β-адренорецепторов может значительно модулировать электрофизиологические эффекты антиаритмических препаратов. Существуют значительные различия в способности антиаритмических средств сохранять свою эффективность на фоне симпатической стимуляции. Дополнительное введение β-адреноблокаторов пациентам с желудочковой тахикардией, а также с сердечной недостаточностью, кардиомиопатией, перенесшим инфаркт миокарда, демонстрирует высокую эффективность при таких состояниях и заслуживает дальнейшего исследования. Поиск антиаритмических препаратов, действие которых не ослабевает при симпатической стимуляции, сохраняет актуальность в настоящее время.

В обзоре представлены данные об основных патофизиологических механизмах аритмий и сведения об электрофизиологических механизмах действия антиаритмических препаратов. Проводится анализ развития классификации антиаритмических средств до настоящего времени.