Возможности контроля безопасности антиаритмической терапии: современное состояние проблемы (обзор литературы)

Ененков Н.В., Селезнев С.В., Щулькин А.В., Филоненко С.П., Якушин С.С. Возможности контроля безопасности антиаритмической терапии: современное состояние проблемы (обзор литературы) // CardioСоматика. 2025. Т. 16, № 3. С. 230–239. DOI: 10.17816/CS645388 EDN: JXARCC

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Enenkov NV, Seleznev SV, Shchulkin AV, Filonenko SP, Yakushin SS. Safety Monitoring of Antiarrhythmic Therapy: Current State of the Problem A Review. CardioSomatics. 2025;16(2):230–239. DOI: 10.17816/CS645388 EDN: JXARCC

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Аннотация

Антиаритмическая терапия сопряжена с высоким риском развития побочных эффектов, среди которых выделяют экстракардиальные и кардиальные (в т.ч. проаритмические) осложнения, а также осложнения, связанные с межлекарственными взаимодействиями. В настоящее время для контроля безопасности при приёме антиаритмических препаратов (ААП) проводят мониторинг параметров электрокардиограммы, функций печени, почек, щитовидной железы и лёгких, а также выявление кардиологической патологии, в т.ч. скрытых нарушений проводящей системы сердца (например, синдром врождённого удлинения интервала Q–T). Однако данные подходы не всегда позволяют избежать нежелательных лекарственных реакций. Проводился отбор литературы по базам данных PubMed и eLibrary в период с января 2019 по декабрь 2024 года (в ряде случаев, в связи с ограниченным количеством источников, диапазон увеличивался). Глубина поиска источников — с 1979 по 2024. В настоящем обзоре представлены современные подходы к контролю безопасности наиболее часто назначаемых в клинической практике ААП IC класса (пропафенон, лаппаконитина гидробромид и диэтиламинопропионилэтоксикарбониламинофенотиазин), а также III класса (амиодарон и соталол). Описаны перспективы применения терапевтического лекарственного мониторинга ААП и оценки генных полиморфизмов.

Ключевые слова: побочные эффекты, безопасность, антиаритмические препараты, пропафенон, лаппаконитина гидробромид, амиодарон, соталол, терапевтический лекарственный мониторинг

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Antiarrhythmic therapy is associated with a high risk of adverse effects, including extracardiac and cardiac (particularly proarrhythmic) complications, as well as events related to drug–drug interactions. Currently, safety monitoring during treatment with antiarrhythmic drugs (AADs) includes electrocardiographic surveillance and assessment of hepatic, renal, thyroid, and pulmonary function, along with screening for underlying cardiac pathology, including latent conduction system disorders (eg, congenital long QT syndrome). However, these measures do not always prevent adverse drug reactions. A search was conducted in PubMed and eLibrary for the period from January 2019 through December 2024 (in some cases, because of the limited number of sources, the range was extended). The total search depth spanned 1979–2024. This review summarizes contemporary approaches to safety monitoring for the most commonly prescribed AADs in clinical practice, including class IC agents (propafenone, lappaconitine hydrobromide, and diethylaminopropionylethoxycarbonylaminophenothiazine) and class III agents (amiodarone and sotalol). Prospects for implementing therapeutic drug monitoring and pharmacogenetic testing of AADs are also discussed.

Keywords: adverse effects, patient safety, anti-arrhythmia agents, propafenone, lappaconitine hydrobromide, amiodarone, sotalol, therapeutic drug monitoring

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Авторы

Н.В. Ененков*, С.В. Селезнев, А.В. Щулькин, С.П. Филоненко, С.С. Якушин

Рязанский государственный медицинский университет им. академика И.П. Павлова, Рязань, Россия
*enenckow2013@yandex.ru

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Nikita V. Enenkov*, Sergey V. Seleznev, Aleksey V. Shchulkin, Sergey P. Filonenko, Sergey S. Yakushin

Ryazan State Medical University named after Academician I.P. Pavlov, Ryazan, Russia
*enenckow2013@yandex.ru

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