cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLC10.15829/1728-8800-2015-3-89-94cardiovascular-147Research ArticleОБЗОРЫREVIEWSКАРДИОСТИМУЛЯЦИЯ И НАРУШЕНИЯ РИТМА У ПАЦИЕНТОВ С ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТЬЮCARDIOSTIMULATION AND RHYTHM DISORDERS IN PATIENTS WITH CHRONIC HEART FAILUREСтупаковС. И.StupakovS. I.

к. м.н., с. н.с. лаборатории электрофизиологических исследований и рентгенохирургических методов лечения аритмий

sergej-stupakov@yandex.ruФГБНУ Научный центр сердечно-сосудистой хирургии им. А. Н. Бакулева. Москва, РоссияFSBSI Scientific Center of Cardiovascular Surgery n.a. A. N. Bakulev. Moscow, Russia2015200620151438994Copyright © Ступаков С.И., 20152015Ступаков С.И.Stupakov S.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/147

 

Хроническая сердечная недостаточность (ХСН) сопровождает мно­гие сердечно-сосудистые заболевания. У пациентов с ХСН часто наблюдаются предсердные и желудочковые нарушения ритма. В последнее время возрос интерес к фибрилляции предсердий (ФП), в связи с ее влиянием на прогноз у пациентов с ХСН, сочета­ние ХСН и ФП обладает худшим прогнозом по сравнению с изоли­рованной ФП или ХСН. Этим пациентам необходим контроль часто­ты желудочковых сокращений с помощью постоянной правожелу- дочковой стимуляции. Однако постоянная правожелудочковая сти­муляция приводит к ухудшению функции левого желудочка через сложные механизмы нарушения синхронии в работе сердца. При возникновении диссинхронии с прогрессированием ХСН этим паци­ентам необходимо применение сердечной ресинхронизирующей терапии. Желудочковые нарушения ритма также часто встречаются у этих пациентов и приводят к увеличению риска смерти, поэтому таким больным необходима имплантация кардиовертеров-дефи- брилляторов, а в сочетании с бивентрикулярной стимуляцией про­исходит не только снижение риска смертности от желудочковых аритмий, но и снижение количества эпизодов этих аритмий, сер­дечная ресинхронизирующая терапия может предотвращать раз­витие ФП у пациентов с ХСН.

 

 

Chronic heart failure (CHF) is common complication of a variety of cardiovascular diseases. In patients with CHF it common to find atrial and ventricular rhythm disorders. Recently the interest to atrial fibrillation (AF) is growing due to its influence on the prognosis of patients with CHF, combination of CHF with AF has worse outcome comparing to isolated AF or CHF. These patients need to be controlled for their ventricular rate by continuous right-ventricular stimulation. However continuous right- ventricular stimulation leads to worsening of the left ventricle function through complicated mechanisms of synchrony impairment. In dyssynchrony with progression of CHF these patients need cardiac resynchronization therapy. Ventricular rhythm disorders are common in these patients and lead to the increase of death risk, hence such patients need to implant cardioverter-defibrillator, and if with biventricular stimulation there is not only a decrease of death from ventricular arrhythmias, but also decrease of the quantity of onsets of these arrhythmias, so cardiac resynchronizing therapy can prevent AF development in CHF.

 

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The authors declare that there are no conflicts of interest present.