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Общие принципы лечения и дискуссионные вопросы фармакотерапии основных видов наджелудочковых тахикардий
Бунин Ю.А., Миклишанская С.В. Общие принципы лечения и дискуссионные вопросы фармакотерапии основных видов наджелудочковых тахикардий. Consilium Medicum. 2018; 20 (1): 71–78. DOI: 10.26442/2075-1753_2018.1.71-78
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Bunin Yu.A., Miklishanskaya S.V. Framework for management and controversial aspects of principal supraventricular tachycardia types pharmacotherapy. Consilium Medicum. 2018; 20 (1): 71–78. DOI: 10.26442/2075-1753_2018.1.71-78
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Аннотация
Наджелудочковые тахикардии (НЖТ) – собирательный термин, который включает разные виды тахикардий с узкими комплексами QRS (менее 0,12 с). Они достаточно широко распространены в общей популяции (2,2 на 1 тыс. населения) и бывают как пароксизмальными, так и, реже, хроническими. Установлено, что они возникают как в детском возрасте, так и у взрослых людей. В статье представлен современный взгляд на стратегию и тактику купирующей и профилактической терапии у больных с основными видами НЖТ. За основу изложения материала взяты международные рекомендации по ведению больных с НЖТ, а также данные ряда контролируемых исследований и собственный клинический опыт лечения аритмии. Вместе с тем в статье разбираются некоторые дискуссионные вопросы их лечения.
Ключевые слова: наджелудочковая тахикардия, атриовентрикулярная узловая реципрокная тахикардия, атриовентрикулярная реципрокная тахикардия, электроимпульсная терапия, фармакологическая кардиоверсия, антиаритмические препараты, радиочастотная катетерная деструкция.
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Supraventricular tachycardia (SVT) is a unifying term that embodies various types of tachycardia with narrow QRS complexes (less than 0.12 s). These types are widely represented in general population (2.2 per 1000 population) and can be whether paroxysmal or chronic. It was established that SVT can manifest both in children and in adults. The article presents a modern view on strategy and tactics of rescue and preventive therapy in patients with SVT. The information is presented according to international recommendations on patients with SVT management, results of several controlled trials and personal authors experience in arrhythmia management. Some controversial aspects of SVT management are also discussed.
Key words: supraventricular tachycardia, atrioventricular nodal reentry tachycardia, atrioventricular reentrant tachycardia, electrical cardioversion, pharmacological cardioversion, antiarrhythmic drugs, radiofrequency ablation.
Полный текст
Список литературы
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24. Chimienti M, Cullen MT, Casadei G. Safety of flecainide versus propafenone for the long-term management of symptomatic paroxysmal supraventricular tachyarrhythmias. Eur Heart J 1995; 16: 1943–51.
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1. ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias-executive summary. Eur Heart J 2003; 24: 1857–97.
2. 2015 ACC/AHA/HRS guidelines for the management adult patients with supraventricular tachycardia. Circulation 2015; http://circ.ahajournals.org/lookup/suppl/doi:10.1161
3. European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS) and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE). Europace 2017; 19: 465–511.
4. Orejarena LA, Vidaillet H, De Stefano F et al. Paroxysmal supraventricular tachycardia in the general population. J Am Coll Cardiol 1998; 31: 150–7.
5. Goyal R, Zivin A, Souza J et al. Comparison of the ages of tachycardia onset in patients with atrioventricular nodal reentrant tachycardia and accessory pathway-mediated tachycardia. Am Heart J 1996; 132: 765–7.
6. Lee SH, Chen SA, Wu TJ et al. Effects of pregnancy on first onset and symptoms of paroxysmal supraventricular tachycardia. Am J Cardiol 1995; 76: 675–8.
7. Cain N, Irving C, Webber S et al. Natural history of Wolff-Parkinson-White syndrome diagnosed in childhood. Am J Cardiol 2013; 112: 961–5.
8. Abe H, Nagatomo T, Kobayashi H et al. Neurohumoral and hemodynamic mechanisms of diuresis during atrioventricular nodal reentrant tachycardia. Pacing Clin Electrophysiol 1997; 20: 2783–8.
9. Olgin JE, Zipes DP. Specific arrhythmias: diagnosis and treatment. In Braunwald E, Zipes D, Libby P, Bonow R. (eds). Heart disease. Saunders Company 2005; 803–63.
10. Luber S, Brady WJ, Joyce T et al. Paroxysmal supraventricular tachycardia: outcome after EDcare. Am J Emerg Med 2001; 19: 40–2.
11. Lim SH, Anantharaman V, Teo WS et al. Slow infusion of calcium channel blokers compared with intravenous adenosine in the emergency treatment of supraventricular tachycardia. Resuscitation 2009; 80: 523–8.
12. Bigger JT, Goldreyer BN. The mechanism of paroxysmal supraventricular tachycardia in man. Circulation 1970; 42: 673–88.
13. Dougherty AH, Jackman WM, Naccarelli GV et al. Acute conversion of paroxysmal supraventricular tachycardia with intravenous diltiazem. Am J Cardiol 1992; 70: 587–92.
14. Alboni P, Tomasi C, Menozzi C et al. Efficacy and safety of out-of-hospital self-administered single-dose oral drug treatment in the management of infrecuent, well-tolerated paroxysmal supraventricular tachycardia. J Am Coll Cardiol 2001; 37: 548–53.
15. Winniford MD, Fulton KL, Hillis LD. Long-term therapy of paroxysmal supraventricular tachycardia: a randomizet, double-blind of digoxin, propranolol and verapamil. Am J Cardiol 1984; 54: 1138–9.
16. Ferguson JD, Di Marco J.P. Contemporary management of paroxysmal supraventricular tachycardia. Circulation 2003; 107: 1096–9.
17. Dorian P, Naccarelli GV, Coumel P et al. A randomized comparison of flecainide versus verapamil in paroxysmal supraventricular tachycardia. Am J Cardiol 1996; 77: 89A–95A.
18. Bunin Iu.A., Denisov O.N., Fediakina L.F. Profilakticheskaia antiaritmicheskaia farmakoterapiia chastykh paroksizmov fibrilliatsii predserdii i nekotorykh vidov nadzheludochkovykh takhikardii propafenonom v sravnenii s platsebo. Ros. kardiol. zhurn. 2010; 5: 77–82. [in Russian]
19. Malakhov V.I., Shugushev Kh.Kh. Mekhanizmy deistviia i effektivnost etatsizina u bolnykh s paroksizmalnoi atrioventrikuliarnoi uzlovoi retsiproknoi takhikardiei. Kardiologiia. 1986; 4: 48–54. [in Russian]
20. Pappone C, Vicedomini G, Manguso F et al. Wolff-Parkinson-White syndrome in the era of catheter ablation: insights from a registry of 2169 patients. Circulation 2014; 130: 811–9.
21. American heart association guidelines for cardiopulmonary resustitation and emergency cardiovascular care. Circulation 2010; 122: S729-S767.
22. Spector P, Reynolds MR, Calkins H et al. Meta-analysis of ablation of atrial flutter and supraventricular tachycardia. Am J Cardiol 2009; 104: 671–77.
23. Manolis AS, Katsaros C, Cokkinos DV. Electrophysiological and electropharmacological studies in pre-excitation syndromes. Eur Heart J 1992; 13: 1489–95.
24. Chimienti M, Cullen MT, Casadei G. Safety of flecainide versus propafenone for the long-term management of symptomatic paroxysmal supraventricular tachyarrhythmias. Eur Heart J 1995; 16: 1943–51.
25. Bunin Iu.A. Diagnostika i lechenie takhiaritmii serdtsa. Gl. 6. M.: Medpraktika-M, 2011; s. 219–68. [in Russian]
Авторы
Ю.А.Бунин, С.В.Миклишанская*
ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России. 125993, Россия, Москва, ул. Баррикадная, д. 2/1
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Yu.A.Bunin, S.V.Miklishanskaya*
Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation. 125993, Russian Federation, Moscow, ul. Barrikadnaia, d. 2/1
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