Impact of Nonhormonal Therapy for Climacteric Syndrome on the Efficacy of Antiarrhythmic Drugs in Women with Paroxysmal Atrial Fibrillation

BACKGROUND: The interaction between antiarrhythmic agents and nonhormonal therapies in women with paroxysmal atrial fibrillation and vasomotor symptoms associated with climacteric syndrome is clinically significant.

AIM: To investigate the relationship between the severity of vasomotor symptoms in women with climacteric syndrome and occurrence of paroxysmal atrial fibrillation and evaluate the impact of nonhormonal therapy antiarrhythmic drug efficacy.

MATERIAL AND METHODS: Eighty-seven women aged 42–59 years (mean age: 48.8 ± 1.3 years) with paroxysmal atrial fibrillation and vasomotor symptoms associated with climacteric syndrome, including hot flashes, a sensation of skipped or irregular heartbeats, tachycardia, and chest pain, were studied. The severity of vasomotor symptoms was assessed using the Greene Scale. Electrocardiography, 24-hour Holter monitoring, echocardiography, and laboratory evaluation of female sex hormone levels and the international normalized ratio were conducted. Paroxysmal atrial fibrillation therapy included amiodarone, beta-alanine, and anticoagulants. For each variable, the arithmetic mean and standard error of the mean were calculated. The distribution type was determined using the Kolmogorov–Smirnov test. Statistical significance was evaluated using the paired Student’s t-test for related groups and Mann–Whitney U test for independent groups. Multivariate analysis was performed to calculate the independent predictors of atrial fibrillation recurrence. P < 0.05 indicated a significant difference.

RESULTS: Regression analysis showed that the number of paroxysmal atrial fibrillation episodes was associated with hot flash daily frequency (β = 1.1694, p < 0.001) and duration (β = −0.1239, p = 0.0052). Arrhythmia duration was related to hot flash frequency (β = 0.9561, p < 0.001), duration (β = −0.1391, p < 0.001), and intensity (β = 0.1735, p = 0.0012). Moreover, ventricular rate during paroxysmal atrial fibrillation was affected by hot flash frequency (β = 0.8893, p < 0.001) and intensity (β = 0.1910, p = 0.0029). ROC analysis revealed that a hot flash frequency > 19.5 episodes/day (AUC = 0.941), duration > 28.7 seconds (AUC = 0.918), and intensity >52.3% on the Greene Scale (AUC = 0.932) were associated with an increased paroxysmal atrial fibrillation episodes. Amiodarone combined with nonhormonal therapy reduced the frequency of paroxysmal atrial fibrillation by 78.9% (p < 0.001), arrhythmia duration by 54.1% (p < 0.001), and ventricular rate during paroxysmal atrial fibrillation by 21.6% (p < 0.001). The incidence rate of adverse events was 2.3%.

CONCLUSION: Vasomotor symptom severity is directly associated with paroxysmal atrial fibrillation frequency in women with climacteric syndrome. The combination of amiodarone and nonhormonal therapy demonstrates high antiarrhythmic efficacy.