CARDIOVERSION AND PRESERVATION OF SINUS RHYTHM IN PATIENTS WITH PERSISTENT ATRIAL FIBRILLATION: EFFECTIVE TREATMENT STRATEGIES

Introduction. Atrial fibrillation (AF) is a very common cardiac arrhythmia that affects millions of people worldwide. The prevalence of AF is increasing due to an aging population, an increase in comorbidities, and increased recognition and detection of asymptomatic cases. AF is associated with an increased risk of stroke, heart failure, and mortality, making early and effective treatment of AF is an important public health issue. Increasing the effectiveness of cardioversion allows for a shorter time to restore sinus rhythm and improved treatment outcomes. Despite the high success rate of cardioversion, recurrence of AF is quite common. Maintaining sinus rhythm is important to reduce the risk of AF-related complications, such as heart failure, which is why this issue is so important.Objective. To identify predictors of the effectiveness of restoring and maintaining sinus rhythm, to determine the optimal treatment strategy for patients with persistent atrial fibrillation.Materials and methods. An analysis of literature sources was conducted, including international clinical guidelines, original studies and meta-analyses of existing sources, their systematic analysis and generalization were conducted to identify predictors of effective restoration and maintenance of sinus rhythm in patients with atrial fibrillation.Results. As a result of the analysis of the literature, a number of important factors were identified that are predictors of the restoration and maintenance of sinus rhythm in patients with persistent AF: age, duration of AF paroxysm, the presence of structural heart pathology and concomitant pathology, such as arterial hypertension, diabetes mellitus, the presence of left ventricular dysfunction, etc. Another important factor is the treatment strategy, which should be selected for each patient individually.Conclusions. Treatment of persistent atrial fibrillation requires a multidisciplinary approach that includes both pharmacological and non-pharmacological measures. Pharmacological strategies include antiarrhythmic drugs, heart rate control drugs, and anticoagulant therapy, while non-pharmacological strategies include ablation therapy, electrical cardioversion, and ablation therapy. The available literature on the efficacy of different approaches to restore and maintain sinus rhythm in patients with atrial fibrillation suggests that ablation therapy may be more effective than pharmacological therapy alone, but further studies are needed to confirm these findings. It is important to note that the choice of treatment strategy should be individualized based on the patient's clinical profile, comorbidities, and patient choice.Prospects for further research. Despite significant achievements in the study and treatment of patients with atrial fibrillation, the question of choosing the optimal treatment strategy for patients with persistent atrial fibrillation remains open. There is ongoing debate about the effectiveness of pharmacological and non-pharmacological approaches to cardioversion in patients with persistent atrial fibrillation. Several studies have compared the effectiveness of these two approaches, but the results have been conflicting. Thus, further studies are needed to compare the efficacy of catheter ablation and pharmacological treatment with antiarrhythmic agents not only in terms of the effectiveness of maintaining sinus rhythm, but also in the context of long-term prognosis for these patients. Further studies are also needed to determine the optimal strategy for restoring sinus rhythm.