astmedАстраханский медицинский журналAstrakhan medical journal1992-6499ФГБОУ ВО Астраханский ГМУ Минздрава России10.17021/1992-6499-2026-2-148-161astmed-736Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL INVESTIGATIONSОсобенности терапии фибрилляции предсердий у женщин с вазомоторными симптомами после хирургической менопаузыFeatures of atrial fibrillation therapy in women with vasomotor symptoms after surgical menopausehttps://orcid.org/0000-0002-2157-544XРахматулловР. Ф.RakhmatullovR. F.

Рахматуллов Руслан Фагимович - кандидат медицинских наук, доцент кафедры внутренних болезней.

Пенза

Ruslan F. Rakhmatullov - Cand. Sci. (Med.), Associate Professor of the Department, Penza State University.

Penza

pgu-vb2004@mail.ruhttps://orcid.org/0000-0002-9094-8772ВиноградоваО. П.VinogradovaO. P.

Виноградова Ольга Павловна - доктор медицинских наук, заведующий кафедрой акушерство и гинекология.

Пенза

Olga P. Vinogradova - Dr. Sci. (Med.), Head of the Department, Penza Institute of Advanced Training.

Penza

o_vinogradova69@mail.ruПензенский государственный университетРоссияPenza State UniversityRussian FederationПензенский институт усовершенствования врачейРоссияPenza Institute of Advanced Training of DoctorsRussian Federation202605082026212148161Copyright © Рахматуллов Р.Ф., Виноградова О.П., 20262026Рахматуллов Р.Ф., Виноградова О.П.Rakhmatullov R.F., Vinogradova O.P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.astmedj.ru/jour/article/view/736

В исследованиях последних лет показана важная роль комбинированного применения антиаритмических средств с негормональными препаратами у женщин с пароксизмами фибрилляции предсердий и вазомоторными симптомами после хирургической менопаузы. Цель: изучить гуморальные и вазомоторные нарушения у женщин с пароксизмами фибрилляции предсердий после хирургической менопаузы и оценить эффективность антиаритмической и негормональной терапии. Материал и методы. Обследованы 38 здоровых женщин в возрасте от 32 до 53 лет (1-я группа) и 46 женщин с пароксизмами фибрилляции предсердий в возрасте от 36 до 57 лет с тяжелыми вазомоторными симптомами после хирургической менопаузы (2-я группа). Методы исследования включали суточное мониторирование электрокардиограммы, оценку концентрации женских половых гормонов, оценку тяжести вазомоторных симптомов по шкале Грина. Результаты исследования. По результатам регрессионного анализа установлено, что частота пароксизмов фибрилляции предсердий зависит от частоты приливов (β = –0,3387, p = 0,00009), их продолжительности (β = 0,2894, p = 0,00007) и процента тяжелых приливов (β = 1,0301, p < 0,001). На длительность пароксизмов фибрилляции предсердий влияет продолжительность приливов (β=0,20347, p = 0,0019) и процент тяжелых приливов (β = 0,70824, p < 0,001). Частота желудочковых сокращений при пароксизме фибрилляции предсердий зависит от частоты приливов (β = 0,43395, p < 0,001) и продолжительности приливов (β = 0,65372, p < 0,001). По результатам ROC – анализа установлены пороговые значения частоты приливов и процента тяжелых приливов, вызывающих увеличение количества и продолжительности пароксизмов фибрилляции предсердий у женщин с вазомоторными симптомами после хирургической менопаузы. Выводы. Выявлена связь фибрилляции предсердий у женщин после хирургической менопаузы с половыми гормонами и вазомоторными симптомами. Установлена высокая эффективность комбинации Метопролола с Пропафеноном в сочетании с негормональной терапией.

Recent studies have shown the important role of combined use of antiarrhythmic agents with non-hormonal therapy in women with paroxysms of atrial fibrillation with vasomotor symptoms after surgical menopause. The purpose of the article is to study humoral and vasomotor disorders in women with paroxysms of atrial fibrillation after surgical menopause and to evaluate the effectiveness of antiarrhythmic and non-hormonal therapy. Materials and methods. The study included 38 healthy women aged 32 to 53 years (Group 1) and 46 women with paroxysms of atrial fibrillation aged 36 to 56 years with severe vasomotor symptoms after surgical menopause (Group 2). The research methods included daily electrocardiogram monitoring, assessment of the concentration of female sex hormones, assessment of the severity of vasomotor symptoms using the Greene scale. Results. It was found that the frequency of atrial fibrillation paroxysms depends on the frequency of hot flashes (β = –0,3387, p = 0,00009), their duration (β = 0,2894, p = 0,00007) and the percentage of severe hot flashes (β = 1,0301, p < 0,001). The duration of atrial fibrillation paroxysms is affected by the duration of hot flashes (β = 0,20347, p=0,0019) and the percentage of severe hot flashes (β = 0,70824, p < 0,001). It was found that the ventricular rate during atrial fibrillation paroxysms depends on the frequency of hot flashes (β = 0,43395, p < 0,001) and the duration of hot flashes (β = 0,65372, p<0,001). Based on the results of ROC-analysis, threshold values for the frequency of hot flashes and the percentage of severe hot flashes are established that cause an increase in the number and duration of atrial fibrillation paroxysms in women with vasomotor symptoms after surgical menopause. Conclusion. A relationship was found between atrial fibrillation in women after surgical menopause and sex hormones and vasomotor symptoms. A high efficiency of a combination of metoprolol with propafenone in combination with non-hormonal therapy is established.

фибрилляция предсердийхирургическая менопаузавазомоторные симптомыМетопрололПропафеноннегормональная терапияatrial fibrillationsurgical menopausevasomotor symptomsmetoprololpropafenonenon-hormonal therapyReferencesРаспоряжение Правительства Российской Федерации № 4356-р от 29.12.2022 г. URL: http://government.ru/docs/all/145532.Order of the Government of the Russian Federation № 4356-р from 29.12.2022. URL: http://government.ru/docs/all/145532 (In Russ.).Linde C., Bongiorni M. G., Birgersdotter-Green U., Curtis A. B, Deisenhofer I., Furokawa T. Sex differences in cardiac arrhythmia: a consensus document of the European Heart Rhythm Association, endorsed by the Heart Rhythm Society and Asia Pacific Heart Rhythm Society // Europace. 2018. № 20 (10). P. 1565–1565. doi: 10.1093/europace/euy067.Linde C., Bongiorni M. G., Birgersdotter-Green U., Curtis A. B, Deisenhofer I., Furokawa T. Sex differences in cardiac arrhythmia: a consensus document of the European Heart Rhythm Association, endorsed by the Heart Rhythm Society and Asia Pacific Heart Rhythm Society. Europace. 2018; 20 (10): 1565–1565. doi: 10.1093/europace/euy067.Arnett D. K., Blumenthal R. S., Albert M. A., Buroker A. B., Goldberger Z. D., Hahn E. J. Ziaeian B. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: executive summary: A report of the American College of Cardiology/ American Heart Association Task Force on Clinical Practice Guidelines // Journal of the American College of Cardiology. 2019. No. 74 (10). P. 1376–1414.Arnett D. K., Blumenthal R. S., Albert M. A., Buroker A. B., Goldberger Z. D., Hahn E. J. Ziaeian B. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: executive summary: A report of the American College of Cardiology/ American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology. 2019; 74 (10): 1376–1414.Wenger N. K., Lloyd-Jones D. M., Elkind M. S. V. Call to action for cardiovascular disease in women: epidemiology, awareness, access, and delivery of equitable health care: A presidential advisory from the american heart association // Circulation. 2022. No. 145 (23). P. 82–88. doi: https://doi.org/10.1161/CIR.0000000000001071.Wenger N. K., Lloyd-Jones D. M., Elkind M. S. V. Call to action for cardiovascular disease in women: epidemiology, awareness, access, and delivery of equitable health care: A presidential advisory from the american heart association. Circulation. 2022; 145 (23): 82–88. doi: https://doi.org/10.1161/CIR.0000000000001071.Vogel B., Acevedo M., Appelman Y. The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030 // Lancet. 2021. No. 397 (10292). P. 2385–2438. doi: https://doi.org/10.1016/S0140-6736(21)00684-X.Vogel B., Acevedo M., Appelman Y. The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030. Lancet. 2021; 397 (10292): 2385–2438. doi: https://doi.org/10.1016/S0140-6736(21)00684-X.Magnussen C., Niiranen T. J., Ojeda F. M. Sex differences and similarities in atrial fibrillation epidemiology, risk factors, and mortality in community cohorts: Results from the BiomarCaRE Consortium (Biomarker for Cardiovascular Risk Assessment in Europe) // Circulation. 2017. No. 136 (17). P. 1588–1597.Magnussen C., Niiranen T. J., Ojeda F. M. Sex differences and similarities in atrial fibrillation epidemiology, risk factors, and mortality in community cohorts: Results from the BiomarCaRE Consortium (Biomarker for Cardiovascular Risk Assessment in Europe). Circulation. 2017; 136 (17): 1588–1597.Fleury M. A., Clavel M. A. Sex and race differences in the pathophysiology, diagnosis, treatment, and outcomes of valvular heart diseases // Canadian Journal of Cardiology. 2021. № 37 (7). P. 980-991. doi: https://doi.org/10.1016/j.cjca.2021.02.003.Fleury M. A., Clavel M. A. Sex and race differences in the pathophysiology, diagnosis, treatment, and outcomes of valvular heart diseases. Canadian Journal of Cardiology. 2021; 37 (7): 980–991. doi: https://doi.org/10.1016/j.cjca.2021.02.003.Lee J., Kim Y., Park H. Clinical impact of hormone replacement therapy on atrial fibrillation in postmenopausal women: A nationwide cohort study // Journal of Clinical Medicine. 2021. No. 10 (23). P. 5497. doi: https://doi.org/10.3390/jcm10235497.Lee J., Kim Y., Park H. Clinical impact of hormone replacement therapy on atrial fibrillation in postmenopausal women: A nationwide cohort study. Journal of Clinical Medicine. 2021; 10 (23): 5497. doi: https://doi.org/10.3390/jcm10235497.Wong J. A., Rexrode K. M., Sandhu R. K. Menopausal age, postmenopausal hormone therapy and incident atrial fibrillation // Heart. 2017. No. 103 (24). P. 1954–1961. doi: https://doi.org/10.1136/heartjnl-2016-311002.Wong J. A., Rexrode K. M., Sandhu R. K. Menopausal age, postmenopausal hormone therapy and incident atrial fibrillation. Heart. 2017; 103 (24): 1954–1961. doi: https://doi.org/10.1136/heartjnl-2016-311002.Шляхто Е. В., Сухих Г. Т., Серов В. Н., Дедов И. И., Арутюнов Г. П., Сучков И. А., Орлова Я. А., Андреева Е. Н., Юренева С. В., Явелов И. С., Ярмолинская М. И., Виллевальде С. В., Григорян О. Р., Дудинская Е. Н., Илюхин Е. А., Козиолова Н. А., Сергиенко И. В., Сметник А. А., Тапильская Н. И. Российские критерии приемлемости назначения менопаузальной гормональной терапии пациенткам с сердечно-сосудистыми и метаболическими заболеваниями. Согласительный документ Российского кардиологического общества, Российского общества акушеров-гинекологов, Российской ассоциации эндокринологов, Евразийской ассоциации терапевтов, Ассоциации флебологов России // Проблемы эндокринологии. 2023. № 69 (5). C. 115–136. doi: https://doi.org/10.14341/probl13394.Shlyakhto E. V., Sukhikh G. T., Serov V. N., Dedov I. I., Arutyunov G. P., Suchkov I. A., Orlova Ya. A., Andreeva E. N., Yureneva S. V., Yavelov I. S., Yarmolinskaya M. I., Villevalde S. V., Grigoryan O. R., Dudinskaya E. N., Ilyukhin E. A., Koziolova N. A., Sergienko I. V., Smetnik A. A., Tapilskaya N. I. Russian criteria for acceptability of menopausal hormone therapy for patients with cardiovascular and metabolic diseases. Consensus document of the Russian Society of Cardiology, Russian Society of Obstetricians and Gynecologists, Russian Association of Endocrinologists, Eurasian Association of Therapists, Association of Phlebologists of Russia. Problemy endokrinologii = Problems of Endocrinology. 2023; 69 (5): 115–136. doi: https://doi.org/10.14341/probl13394 (In Russ.).Boardman H. M. P, Hartley L., Eisinga A. Hormone therapy for preventing cardiovascular disease in post-menopausal women // Cochrane Database of Systematic Reviews. 2015. № 2015 (8). doi: https://doi.org/10.1002/14651858.CD002229.pub4.Boardman H. M. P., Hartley L., Eisinga A. Hormone therapy for preventing cardiovascular disease in post-menopausal women. Cochrane Database of Systematic Reviews. 2015; 2015 (8). doi: https://doi.org/10.1002/14651858.CD002229.pub4.Clementy N., Fourquet A., Andre C. Benefits of an early management of palpitations // Medicine (Baltimore). 2018. No. 97 (28). P. 11466. doi: 10.1097/MD.0000000000011466.Clementy N., Fourquet A., Andre C. Benefits of an early management of palpitations. Medicine (Baltimore). 2018; 97 (28): 11466. doi: 10.1097/MD.0000000000011466.Greene J. G. Constructing a standard climacteric scale // Maturitas. 1998. Vol. 20, no. 29 (1). P. 25–31. doi: 10.1016/s0378-5122(98)00025-5.Greene J. G. Constructing a standard climacteric scale. Maturitas. 1998; 20, 29 (1): 25–31. doi: 10.1016/s0378-5122(98)00025-5.Wu H. C., Chen K. H., Hwang J. S. Association of menopausal symptoms with different constitutions in climacteric women // Complementary Medicine Research. 2018. No. 25 (6). P. 398–405. doi: 10.1159/000491389.Wu H. C., Chen K. H., Hwang J. S. Association of menopausal symptoms with different constitutions in climacteric women. Complementary Medicine Research. 2018; 25 (6): 398–405. doi: 10.1159/000491389.Trento S., Madeiro A., Rufino A. C. Sexual function and associated factors in postmenopausal women // Revista Brazileira de Gynecologia e Obstetricia. 2021. No. 43. P. 522–529. doi: 10.1055/s-0041-1735128.Trento S., Madeiro A., Rufino A. C. Sexual function and associated factors in postmenopausal women. Revista Brazileira de Gynecologia e Obstetricia. 2021; 43: 522–529. doi: 10.1055/s-0041-1735128.Jaber R. M., Khalil I. A., Almohtasib Y. S. Association of menopausal symptom severity and osteoporotic fractures: a case-control study // Journal of Women and Aging. 2022. Vol. 34 (1). P. 93–100.Jaber R. M., Khalil I. A., Almohtasib Y. S. Association of menopausal symptom severity and osteoporotic fractures: a case-control study. Journal of Women and Aging. 2022; 34 (1): 93–100.Im E. O., Ham O. K., Chee E. Racial/ethnic differences in cardiovascular symptoms in four major racial/ethnic groups of midlife women: a secondary analysis // Women Health. 2015. № 55. P. 525–547. doi: 10.1080/03630242.2015.1022813.Im E. O., Ham O. K., Chee E. Racial/ethnic differences in cardiovascular symptoms in four major racial/ethnic groups of midlife women: a secondary analysis. Women Health. 2015; 55: 525–547. doi: 10.1080/03630242.2015.1022813.Hickey M., Riach K., Kachouie R. No sweat: managing menopausal symptoms at work // Journal of Psychosomatic Obstetrics and Gynaecology. 2017. No. 38 (3). P. 202–209.Hickey M., Riach K., Kachouie R. No sweat: managing menopausal symptoms at work. Journal of Psychosomatic Obstetrics and Gynaecology. 2017; 38 (3): 202–209.Hartmann B. W., Kirchengast S., Albrecht A. Hysterectomy increases the symptomatology of postmenopausal syndrome // Gynecology and Endocrinology. 1995. No. 9 (3). P. 247–252. doi: 10.3109/09513599509160453.Hartmann B. W., Kirchengast S., Albrecht A. Hysterectomy increases the symptomatology of postmenopausal syndrome. Gynecol Endocrinol. 1995; 9 (3): 247–252. doi: 10.3109/09513599509160453.Lee J., Kim Y., Park H. Clinical impact of hormone replacement therapy on atrial fibrillation in postmenopausal women: A nationwide cohort study // Journal of Clinical Medicine. 2021. № 10 (23). P. 5497. doi: https://doi.org/10.3390/jcm10235497.Lee J., Kim Y., Park H. Clinical impact of hormone replacement therapy on atrial fibrillation in postmenopausal women: A nationwide cohort study. Journal of Clinical Medicine. 2021; 10 (23): 5497. doi: https://doi.org/10.3390/jcm10235497.Wong J. A., Rexrode K. M., Sandhu R. K. Menopausal age, postmenopausal hormone therapy and incident atrial fibrillation // Heart. 2017. No. 103 (24). P. 1954–1961. doi: https://doi.org/10.1136/heartjnl-2016-311002.Wong J. A., Rexrode K. M., Sandhu R. K. Menopausal age, postmenopausal hormone therapy and incident atrial fibrillation. Heart. 2017 ; 103 (24): 1954–1961. doi: https://doi.org/10.1136/heartjnl-2016-311002.Kirchhof P., Benussi S., Kotecha D. ESC Scientific Document Group. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS // European Heart Journal. 2016. No. 37 (38). P. 2893–2962. doi: https://doi.org/10.1093/eurheartj/ehw210.Kirchhof P., Benussi S., Kotecha D. ESC Scientific Document Group. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. European Heart Journal. 2016; 37 (38): 2893–2962. doi: https://doi.org/10.1093/eurheartj/ehw210.El Khoudary S. R., Aggarwal B., Beckie T. M. Menopause transition and cardiovascular disease risk: Implications for timing of early prevention: A scientific statement from the American Heart Association // Circulation. 2020. No. 142 (25). P. 967–984. doi: https://doi.org/10.1161/CIR.0000000000000912.El Khoudary S. R., Aggarwal B., Beckie T. M. Menopause transition and cardiovascular disease risk: Implications for timing of early prevention: A scientific statement from the American Heart Association. Circulation. 2020; 142 (25): 967–984. doi: https://doi.org/10.1161/CIR.0000000000000912.Maas A. H. E. M, Rosano G., Cifkova R. Cardiovascular health after menopause transition, pregnancy disorders, and other gynaecologic conditions: a consensus document from European cardiologists, gynaecologists, and endocrinologists // European Heart Journal. 2021. No. 42 (10). P. 967–984. doi: https://doi.org/10.1093/eurheartj/ehaa1044.Maas A. H. E. M., Rosano G., Cifkova R. Cardiovascular health after menopause transition, pregnancy disorders, and other gynaecologic conditions: a consensus document from European cardiologists, gynaecologists, and endocrinologists. European Heart Journal. 2021; 42 (10): 967–984. doi: https://doi.org/10.1093/eurheartj/ehaa1044.O’Neal W. T., Sandesara P., Hammadah M., Venkatesh S., Samman-Tahhan A., Kelli H. M. Gender differences in the risk of adverse outcomes in patients with atrial fibrillation and heart failure with preserved ejection fraction // American Journal of Cardiology. 2017. No. 119. P. 1785–1790. doi: 10.1016/j.amjcard.2017.02.045.O’Neal W. T., Sandesara P., Hammadah M., Venkatesh S., Samman-Tahhan A., Kelli H. M. Gender differences in the risk of adverse outcomes in patients with atrial fibrillation and heart failure with preserved ejection fraction. American Journal of Cardiology. 2017; 119: 1785–1790. doi: 10.1016/j.amjcard.2017.02.045.Liao J. N., Chao T. F., Kuo J. Y., Sung K. T., Tsai J. P., Lo C. I. Age, sex, and blood pressure-related influences on reference values of left atrial deformation and mechanics from a large-scale Asian population // Circulation: Cardiovascular Imaging. 2017. No. 10. P. e006077. doi: 10.1161/CIRCIMAGING.116.006077.Liao J. N., Chao T. F., Kuo J. Y., Sung K. T., Tsai J. P., Lo C. I. Age, sex, and blood pressure-related influences on reference values of left atrial deformation and mechanics from a large-scale Asian population // Circulation: Cardiovascular Imaging. 2017; 10: e006077. doi: 10.1161/CIRCIMAGING.116.006077.Akoum N., Mahnkopf C., Kholmovski E. G., Brachmann J., Marrouche N. F. Age and sex differences in atrial fibrosis among patients with atrial fibrillation // Europace. 2018. № 20. P. 1086. doi: 10.1093/europace/eux260.Akoum N., Mahnkopf C., Kholmovski E. G., Brachmann J., Marrouche N. F. Age and sex differences in atrial fibrosis among patients with atrial fibrillation. Europace. 2018; 20: 1086. doi: 10.1093/europace/eux260.Perez M. V., Wang P. J., Larson J. C. Effects of postmenopausal hormone therapy on incident atrial fibrillation: the Women’s Health Initiative randomized controlled trials // Circulation: Arrhythmia and Electrophysiology. 2012. No. 5 (6). P. 1108–1116. doi: https://doi.org/10.1161/CIRCEP.112.972224.Perez M. V., Wang P. J., Larson J. C. Effects of postmenopausal hormone therapy on incident atrial fibrillation: the Women’s Health Initiative randomized controlled trials. Circulation: Arrhythmia and Electrophysiology. 2012; 5 (6): 1108–1116. doi: https://doi.org/10.1161/CIRCEP.112.972224.Liu L., Klein L., Eaton C. Menopausal hormone therapy and risks of first hospitalized heart failure and its subtypes during the intervention and extended postintervention follow-up of the women’s health initiative randomized trials // Journal of Cardiac Failure. 2020. No. 26 (1). P. 2–12. doi: https://doi.org/10.1016/j.cardfail.2019.09.006.Liu L., Klein L., Eaton C. Menopausal hormone therapy and risks of first hospitalized heart failure and its subtypes during the intervention and extended postintervention follow-up of the women’s health initiative randomized trials. Journal of Cardiac Failure. 2020; 26 (1): 2–12. doi: https://doi.org/10.1016/j.cardfail.2019.09.006.

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