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Желудочковые аритмии при некоторых заболеваниях и синдромах: современные подходы к лечению и улучшению прогноза жизни
Желудочковые аритмии при некоторых заболеваниях и синдромах: современные подходы к лечению и улучшению прогноза жизни
Бунин Ю.А. Желудочковые аритмии при некоторых заболеваниях и синдромах: современные подходы к лечению и улучшению прогноза жизни. Consilium Medicum. 2016; 18 (10): 19–23. DOI: 10.26442/2075-1753_2016.10.19-23
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Аннотация
Рассматриваются актуальные проблемы диагностики, лечения, первичной и вторичной профилактики смерти при ряде генетически обусловленных желудочковых аритмий (ЖА), характеризующихся высоким риском внезапной сердечной смерти ( ВСС). Представлены данные основных клинических рекомендаций и исследований, посвященных возможности различных антиаритмических препаратов и имплантируемых кардиовертеров-дефибрилляторов (ИКД) в лечении ЖА при аритмогенной кардиомиопатии правого желудочка, синдроме укороченного интервала QT, синдроме Бругада, катехоламинергической полиморфной желудочковой тахикардии и некомпактном миокарде. Показано, что применение ИКД в большинстве случаев является основным методом вторичной профилактики ВСС у данной категории больных. Кроме этого, освещается ряд дискуссионных вопросов ведения больных с ЖА при некоторых заболеваниях и синдромах.
Ключевые слова: желудочковые аритмии, внезапная сердечная смерть, электрофизиологическое исследование, антиаритмические препараты, имплантируемые кардиовертеры-дефибрилляторы.
Ключевые слова: желудочковые аритмии, внезапная сердечная смерть, электрофизиологическое исследование, антиаритмические препараты, имплантируемые кардиовертеры-дефибрилляторы.
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The article discusses the current problems of diagnostics, treatment, primary and secondary prevention of death in patients with genetically caused ventricular arrhythmia (VA) associated with a high risk of sudden cardiac death (SCD). We showed the results of basic clinical recommendations and studies concerning the possibility of different antiarrhythmic drugs and implantable cardioverter defibrillators (ICD) in the treatment of VA associated with arrhythmogenic right ventricular cardiomyopathy, short QT syndrome, the Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia and non-compacted myocardial layer. It was shown, that ICD application, in most cases, was the main method of secondary prevention of SCD in this group of patients. In addition, we indicated the number of issues concerning the management of VA patients with several diseases and some syndromes.
Key words: ventricular arrhythmia, sudden cardiac death, electrophysiology study, antiarrhythmic drugs, implantable cardioverter defibrillators.
Key words: ventricular arrhythmia, sudden cardiac death, electrophysiology study, antiarrhythmic drugs, implantable cardioverter defibrillators.
Полный текст
Список литературы
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14. Priori SG, Napolitano C, Memmi M et al. Clinical and molecular characterization of patients with catecholaminergic polymorphic ventricular tachycardia. Circulation 2002; 106: 69–74.
15. Oechslin E, Jenni R. Left ventricular non-compaction revisited: a distinct phenotype with genetic heterogeneity? Eur Heart J 2011; 32: 1446–56.
16. Watanаbe H, Chopra N, Liaver D et al. Flecainide prevents catecholaminergic polymorphic ventricular tachycardia in mice and humans. Nat Med 2009; 15: 380–3.
2. 2015 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J; doi: 10.1093/eurheart/ehv316.
3. Treatment of arrhythmogenic right ventricular cardiomyopathy/dysplasia: an international task force consensus statement. Eur Heart J 2015; 36: 3227–37.
4. Nava F, Bauce B, Basso C et al. Clinical profile and long-term follow-up of 37 families with arrhythmogenic right ventricular cardiomyopathy. J Am Coll Cardiol 2000; 36: 2226–33.
5. Marcus FI, McKenna WJ, Shemill D. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia. Circulation 2010; 121: 1533–41.
6. Marcus GM, Glidden DV, Polonsky B et al. Efficacy of antiarrhythmic drugs in arrhythmogenic right ventricular cardiomyopathy. J Am Coll Cardiol 2009; 54: 609–15.
7. Moss AJ, Schuger C, Beck CA et al. Reduction in inappropriate therapy and mortality through ICD programming. N Engl J Med 2012; 367: 2275–83.
8. Gussak I, Brugada P, Brugada J et al. Idiopathic short QT interval: a new clinical syndrome? Cardiology 2000; 94: 99–102.
9. Mazzanti A, Kanthan A, Monteforte N. Novel insight into the natural history of short QT syndrome. J Am Coll Cardiol 2014; 63: 1300–8.
10. Executive summary: HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes. Europace 2013; 15: 1389–406.
11. Fowler SJ, Priori SG. Clinical spectrum of patients with Brugada ECG. Curr Opin Cardiol 2009; 24: 74–81.
12. Fauchier L, Isorni MA, Clementy N et al. Prognostic value of programmed ventricular stimulation in Brugada syndrome according to clinical presentation. Int J Cardiol 2013; 168: 3027–9.
13. Priori SG, Gasparini M, Napolitano C et al. Risk stratification in Brugada syndrome: results of the PRELUDE. J Am Coll Cardiol 2012; 59: 37–45.
14. Priori SG, Napolitano C, Memmi M et al. Clinical and molecular characterization of patients with catecholaminergic polymorphic ventricular tachycardia. Circulation 2002; 106: 69–74.
15. Oechslin E, Jenni R. Left ventricular non-compaction revisited: a distinct phenotype with genetic heterogeneity? Eur Heart J 2011; 32: 1446–56.
16. Watanаbe H, Chopra N, Liaver D et al. Flecainide prevents catecholaminergic polymorphic ventricular tachycardia in mice and humans. Nat Med 2009; 15: 380–3.
2. 2015 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J; doi: 10.1093/eurheart/ehv316.
3. Treatment of arrhythmogenic right ventricular cardiomyopathy/dysplasia: an international task force consensus statement. Eur Heart J 2015; 36: 3227–37.
4. Nava F, Bauce B, Basso C et al. Clinical profile and long-term follow-up of 37 families with arrhythmogenic right ventricular cardiomyopathy. J Am Coll Cardiol 2000; 36: 2226–33.
5. Marcus FI, McKenna WJ, Shemill D. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia. Circulation 2010; 121: 1533–41.
6. Marcus GM, Glidden DV, Polonsky B et al. Efficacy of antiarrhythmic drugs in arrhythmogenic right ventricular cardiomyopathy. J Am Coll Cardiol 2009; 54: 609–15.
7. Moss AJ, Schuger C, Beck CA et al. Reduction in inappropriate therapy and mortality through ICD programming. N Engl J Med 2012; 367: 2275–83.
8. Gussak I, Brugada P, Brugada J et al. Idiopathic short QT interval: a new clinical syndrome? Cardiology 2000; 94: 99–102.
9. Mazzanti A, Kanthan A, Monteforte N. Novel insight into the natural history of short QT syndrome. J Am Coll Cardiol 2014; 63: 1300–8.
10. Executive summary: HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes. Europace 2013; 15: 1389–406.
11. Fowler SJ, Priori SG. Clinical spectrum of patients with Brugada ECG. Curr Opin Cardiol 2009; 24: 74–81.
12. Fauchier L, Isorni MA, Clementy N et al. Prognostic value of programmed ventricular stimulation in Brugada syndrome according to clinical presentation. Int J Cardiol 2013; 168: 3027–9.
13. Priori SG, Gasparini M, Napolitano C et al. Risk stratification in Brugada syndrome: results of the PRELUDE. J Am Coll Cardiol 2012; 59: 37–45.
14. Priori SG, Napolitano C, Memmi M et al. Clinical and molecular characterization of patients with catecholaminergic polymorphic ventricular tachycardia. Circulation 2002; 106: 69–74.
15. Oechslin E, Jenni R. Left ventricular non-compaction revisited: a distinct phenotype with genetic heterogeneity? Eur Heart J 2011; 32: 1446–56.
16. Watanаbe H, Chopra N, Liaver D et al. Flecainide prevents catecholaminergic polymorphic ventricular tachycardia in mice and humans. Nat Med 2009; 15: 380–3.
________________________________________________
2. 2015 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J; doi: 10.1093/eurheart/ehv316.
3. Treatment of arrhythmogenic right ventricular cardiomyopathy/dysplasia: an international task force consensus statement. Eur Heart J 2015; 36: 3227–37.
4. Nava F, Bauce B, Basso C et al. Clinical profile and long-term follow-up of 37 families with arrhythmogenic right ventricular cardiomyopathy. J Am Coll Cardiol 2000; 36: 2226–33.
5. Marcus FI, McKenna WJ, Shemill D. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia. Circulation 2010; 121: 1533–41.
6. Marcus GM, Glidden DV, Polonsky B et al. Efficacy of antiarrhythmic drugs in arrhythmogenic right ventricular cardiomyopathy. J Am Coll Cardiol 2009; 54: 609–15.
7. Moss AJ, Schuger C, Beck CA et al. Reduction in inappropriate therapy and mortality through ICD programming. N Engl J Med 2012; 367: 2275–83.
8. Gussak I, Brugada P, Brugada J et al. Idiopathic short QT interval: a new clinical syndrome? Cardiology 2000; 94: 99–102.
9. Mazzanti A, Kanthan A, Monteforte N. Novel insight into the natural history of short QT syndrome. J Am Coll Cardiol 2014; 63: 1300–8.
10. Executive summary: HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes. Europace 2013; 15: 1389–406.
11. Fowler SJ, Priori SG. Clinical spectrum of patients with Brugada ECG. Curr Opin Cardiol 2009; 24: 74–81.
12. Fauchier L, Isorni MA, Clementy N et al. Prognostic value of programmed ventricular stimulation in Brugada syndrome according to clinical presentation. Int J Cardiol 2013; 168: 3027–9.
13. Priori SG, Gasparini M, Napolitano C et al. Risk stratification in Brugada syndrome: results of the PRELUDE. J Am Coll Cardiol 2012; 59: 37–45.
14. Priori SG, Napolitano C, Memmi M et al. Clinical and molecular characterization of patients with catecholaminergic polymorphic ventricular tachycardia. Circulation 2002; 106: 69–74.
15. Oechslin E, Jenni R. Left ventricular non-compaction revisited: a distinct phenotype with genetic heterogeneity? Eur Heart J 2011; 32: 1446–56.
16. Watanаbe H, Chopra N, Liaver D et al. Flecainide prevents catecholaminergic polymorphic ventricular tachycardia in mice and humans. Nat Med 2009; 15: 380–3.
Авторы
Ю.А.Бунин
ГБОУ ДПО Российская медицинская академия последипломного образования Минздрава России. 121552, Россия, Москва, ул. 3-я Черепковская, д. 15А
yabunin@outlook.com
ГБОУ ДПО Российская медицинская академия последипломного образования Минздрава России. 121552, Россия, Москва, ул. 3-я Черепковская, д. 15А
yabunin@outlook.com
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Yu.A.Bunin
Russian Medical Academy of Postgraduate Education of the Ministry of Health of the Russian Federation. 121552, Rossiia, Moskva, ul. 3-ia Cherepkovskaia, d. 15A
yabunin@outlook.com
Russian Medical Academy of Postgraduate Education of the Ministry of Health of the Russian Federation. 121552, Rossiia, Moskva, ul. 3-ia Cherepkovskaia, d. 15A
yabunin@outlook.com
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