Clinical significance and possibilities for correction of hyperammonemia in patients with atrial fibrillation

Introduction. Atrial fibrillation (AF) is the most common type of supraventricular tachyarrhythmia. Despite the established link between hyperammonemia and cardiac rhythm disorders, data on ammonia levels in patients with AF are currently lacking in both domestic and international medical literature.

Aim. To assess the ammonia levels in the blood of patients with atrial fibrillation and evaluate the effectiveness of standard therapy combined with L-ornithineL-aspartate in patients with atrial fibrillation and hyperammonemia.

Materials and methods. The study involved 88 patients with permanent or persistent forms of AF (47 women, 41 men, aged 69.9±2.2 years), who underwent assessment of ammonia levels in capillary blood (using the portable analyzer PocketChem BA PA 4140), as well as levels of fatigue and active attention using validated "Fatigue Assessment Scale" and "Number Connection Test". Among 36 selected patients with AF and hyperammonemia, undergoing a 10-day treatment course, two randomized groups were formed: the first group (n=18) received standard therapy (angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, antiarrhythmic, diuretic, anticoagulant drugs), and the second group (n=18) received additional therapy (L-ornithine-Laspartate) to reduce hyperammonemia.

Results. Hyperammonemia was detected in 79.55% of the 88 patients, with an average value of 146±5.45 µg/dL (normal up to 75 µg/dL). Ammonia levels in women (115.97±6.78 µg/dL) were significantly lower than in men (150.90±6.62 µg/dL) (p=0.001). During the standard therapy, ammonia levels in the first group did not change significantly (153.63±7.45 µg/dL to 161.53±9.55 µg/dL; p=0.103), active attention levels worsened (p=0.031), and mental fatigue progressed (p=0.06). The second group of patients showed a decrease in ammonia levels from 158.44±8.91 µg/dL to 123.94±11.9 µg/dL (p=0.035), improved active attention (p=0.002), and decreased fatigue (p=0.02).

Conclusion. The results indicate the appropriateness of assessing ammonia levels in the blood of patients with atrial fibrillation and correcting hyperammonemia in this category of patients.

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