avkАрхивъ внутренней медициныThe Russian Archives of Internal Medicine2226-67042411-6564“SINAPS” LLC10.20514/2226-6704-2019-9-2-107-116avk-901Research ArticleОБЗОРНЫЕ СТАТЬИREVIEW ARTICLESРоль альдостерона в развитии фибрилляции предсердий: современный взгляд на проблемуThe role of aldosterone in the development of atrial fibrillation: modern understanding of problemВатутинН. Т.VatutinN. T.

Донецк

ШевелёкА. Н.ShevelokA. N.

Донецк

shevelyok@mail.ruКравченкоИ. Н.KravchenkoI. N.

Donetsk

ГОО ВПО Донецкий национальный медицинский университет им. М. Горького; Институт неотложной и восстановительной хирургии им. В.К. ГусакаУкраинаState Educational Organization of Higher Professional Education «M. Gorky Donetsk National Medical University»; State Institution «V.K. Gusak Institute of Urgent and Recovery Surgery»UkraineИнститут неотложной и восстановительной хирургии им. В.К. ГусакаУкраинаState Institution «V.K. Gusak Institute of Urgent and Recovery Surgery»Ukraine20193003201992107116Copyright © Ватутин Н.Т., Шевелёк А.Н., Кравченко И.Н., 20192019Ватутин Н.Т., Шевелёк А.Н., Кравченко И.Н.Vatutin N.T., Shevelok A.N., Kravchenko I.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medarhive.ru/jour/article/view/901

В обзоре литературы изложены современные представления о роли альдостерона в развитии и поддержании фибрилляции предсердий. Показано, что гормон принимает участие во всех этапах электрофизиологического и структурного ремоделирования предсердий, способствуя формированию субстрата аритмии. Отмечено, что неблагоприятные эффекты гормона в миокарде реализуются не только за счет его системной гиперпродукции, но и ввиду непосредственного синтеза гормона в тканях предсердий. Немаловажную роль в развитии фибрилляции предсердий играет повышенная экспрессия минералокортикоидных рецепторов кардиомиоцитов. Продемонстрировано, что гиперальдо-стеронемия может являться не только причиной, но и следствием фибрилляции предсердий. Эпизод аритмии характеризуется выраженной нейрогормональной активацией, сопровождающейся повышением интрамиокардиального синтеза альдостерона и экспрессии рецепторов к нему. Это способствует дальнейшему прогрессированию ремоделирования предсердий, создавая условия для рецидивирования аритмии и замыкая тем самым порочный круг.

The review of literature presents modern ideas about the role of aldosterone in the development and maintenance of atrial fibrillation. It is shown that hormone takes part in all stages of the electrophysiological and structural atrial remodeling, contributing to the formation of the arrhythmia substrate. It was noted that adverse effects of the aldosterone in the myocardium are realized not only due to its high systemic production but also because of its direct synthesis in the atrial tissues. Increased expression of mineralocorticoid receptors in cardiomyocytes also play important role in the development of atrial fibrillation. It is demonstrated that hyperaldosteronemia can be a cause as well as effect of atrial fibrillation. The episode of arrhythmia is characterized by neurohormonal activation, increased intramyocardial aldosterone synthesis and high mineralocorticoid receptors expression. This contributes to the further progression of atrial remodeling and makes conditions for the arrhythmia recurrences.

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