emcardioНеотложная кардиология и кардиоваскулярные рискиEmergency Cardiology and Cardiovascular Risks journal2616-633XБелорусский государственный медицинский университет10.51922/2616-633X.2022.6.2.1673emcardio-77Research ArticleОригинальные научные публикацииOriginal Scientific ResearchХарактеристика пациентов-кандидатов на абляцию атриовентрикулярного узла с тахикардиомиопатией вследствие фибрилляции предсердийCharacteristics of patients-candidates for atrioventricular node ablation with tachycardiomyopathy due to atrial fibrillationЧаснойтьА. Р.ChasnoitsA.

Минск

Minsk

achasnoits@yandex.ruРебекоЕ. С.RebekoYe.

Минск

Minsk

ГончарикД. Б.GoncharikD.

Минск

Minsk

БарсукевичВ. Ч.BarsukevichV.

Минск

Minsk

ПлащинскаяЛ. И.PlashchinskayaL.

Минск

Minsk

КоваленкоО. Н.KovalenkoO.

Минск

Minsk

ПодпаловаО. В.PodpalovaO.

Минск

Minsk

Республиканский научно-практический центр «Кардиология»Republican Scientific and Practical Center of Cardiology2022230620256216731680Copyright © Часнойть А.Р., Ребеко Е.С., Гончарик Д.Б., Барсукевич В.Ч., Плащинская Л.И., Коваленко О.Н., Подпалова О.В., 20252025Часнойть А.Р., Ребеко Е.С., Гончарик Д.Б., Барсукевич В.Ч., Плащинская Л.И., Коваленко О.Н., Подпалова О.В.Chasnoits A., Rebeko Y., Goncharik D., Barsukevich V., Plashchinskaya L., Kovalenko O., Podpalova O.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://emcardio.bsmu.by/jour/article/view/77

Цель. Оценить функциональный статус, состояние показателей ЭКГ, параметры сердечной гемодинамики и качества жизни у пациентов кандидатов на абляцию атриовентирикулярного узла с имплантацией электрокардиостимуляторов (ЭКС), ресинхронизирующих устройств (СРТ) по причине тахи-формы фибрилляции предсердий.Материалы и методы: в исследование включен 61 пациент среднего возраста 59,4 ± 10,4 лет, ИМТ 31,3 ± 5,8; тест 6-мин. ходьбы 315 ± 173 м. Группа 1 ЭКС – пациенты с имплантированным ЭКС 19 человек, группа 2 СРТ 42 человека. Качество жизни по миннесотскому опроснику в когорте – 49 [32; 65] баллов (неудовлетворительно), ХСН ФК 2 в целом и ФК 3 в группе ЭКС и ФК 2 в группе СРТ, но без достоверности в отличиях. Средняя длительность QRS составила 115 [90,146], мс. без достоверных отличий между группами. Только соотношение R6/S6 и значение (S1+R6)-(S6+R1) достоверно отличались в подгруппах с разной шириной QRS, что может быть предиктором эффективности электрокардиотерапии. Фракция выброса (ФВ) составила 32,0 ± 7,6% вследствие тахикардиомиопатии. Зарегистрированы признаки межжелудочковой и внутри желудочковой диссинхронии.Заключение: пациенты с тахикардиомиопатией имеют признаки достоверного снижения качества жизни и сердечной функции, однако, эти изменения, по-видимому не обусловлены шириной комплекса QRS, наличием диссинхронии и критериев отнесения к СРТ –терапии, а в первую очередь тахисистолией и снижением общей сократительной способности миокарда.

Aim. To assess the functional status, the state of ECG parameters, parameters of cardiac hemodynamics and quality of life in patients candidates for ablation of the atrioventricular node with the implantation of pacemakers, resynchronization devices (CRT) due to tachyform of atrial fibrillation.Materials and methods: the study included 61 patients with a mean age of 59.4 ± 10.4 years, BMI 31.3 ± 5.8; test 6-min. walk 315 ± 173 m. Group 1 pacemaker – patients with implanted pacemaker 19 people, group 2 CRT – 42 people. Quality of life according to the Minnesota questionnaire in the cohort – 49 [32; 65] points (unsatisfactory), CHF FC 2 in general and FC 3 in the pacing group and FC 2 in the CRT group, but no significant differences. The mean QRS duration was 115 [90.146], ms. no significant differences between groups. Only the ratio of R6/S6 and the value of (S1+R6)-(S6+R1) were significantly different in subgroups with different QRS widths, which may be a predictor of the effectiveness of electrocardiotherapy. Ejection fraction (EF) was 32.0 ± 7.6% due to tachycardiomyopathy. Signs of interventricular and intraventricular dyssynchrony were registered.Conclusion: patients with tachycardiomyopathy have signs of a significant decrease in the quality of life and cardiac function, however, these changes, apparently, are not due to the width of the QRS complex, the presence of dyssynchrony and the criteria for referring to CRT therapy, but primarily tachysystole and a decrease in the overall contractility of the myocardium.

фибрилляция предсердийабляция атриовентирикулярного узлатахикардиомиопатияЭКССРТatrial fibrillationatrioventricular node ablationtachycardiomyopathypacemakerCRTReferencesPacker D.L., Bardy G.H., Worley S.J., Smith M.S., Cobb F.R., Coleman R.E., Gallagher J.J., German L.D. Tachycardia-induced cardiomyopathy: a reversible form of left ventricular dysfunction. Am J Cardiol, 1986, vol. 57, no. 8, pp. 563–570. doi: 10.1016/0002-9149(86)90836-2.Packer D.L., Bardy G.H., Worley S.J., Smith M.S., Cobb F.R., Coleman R.E., Gallagher J.J., German L.D. Tachycardia-induced cardiomyopathy: a reversible form of left ventricular dysfunction. Am J Cardiol, 1986, vol. 57, no. 8, pp. 563–570. doi: 10.1016/0002-9149(86)90836-2.Gossage A.M., Braxton Hicks J.A. On auricular fibrillation. Q J Med, 1913, vol. 6, pp. 435–440.Gossage A.M., Braxton Hicks J.A. On auricular fibrillation. Q J Med, 1913, vol. 6, pp. 435–440.Persidskikh Yu.A., Rebeko E.S., Chasnojt’ A.R., Goncharik D.B., Barsukevich V.Ch., Plashchinskaya L.I. Takhiinducirovannaya kardiomiopatiya: patofiziologiya, diagnostika i lechenie [Induced cardiomyopathy: pathophysiology, diagnosis and treatment]. Kardiologiya v Belarusi, 2020, vol. 12, no. 6, pp. 874–887. (in Russian).Persidskikh Yu.A., Rebeko E.S., Chasnojt’ A.R., Goncharik D.B., Barsukevich V.Ch., Plashchinskaya L.I. Takhiinducirovannaya kardiomiopatiya: patofiziologiya, diagnostika i lechenie [Induced cardiomyopathy: pathophysiology, diagnosis and treatment]. Kardiologiya v Belarusi, 2020, vol. 12, no. 6, pp. 874–887. (in Russian).Chugh S.S., Havmoeller R., Narayanan K., Singh D., Rienstra M., Benjamin E.J., Gillum R.F., Kim Y.H., McAnulty J.H.Jr, Zheng Z.J., Forouzanfar M.H., Naghavi M., Mensah G.A., Ezzati M., Murray C.J. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation, 2014, vol. 129, pp. 837–847.Chugh S.S., Havmoeller R., Narayanan K., Singh D., Rienstra M., Benjamin E.J., Gillum R.F., Kim Y.H., McAnulty J.H.Jr, Zheng Z.J., Forouzanfar M.H., Naghavi M., Mensah G.A., Ezzati M., Murray C.J. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation, 2014, vol. 129, pp. 837–847.Glikson M., Nielsen J.C., Kronborg M.B., Michowitz Y., Auricchio A., Barbash I.M., Barrabés J.A., Boriani G., Braunschweig F. [et al.] 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J, 2021, vol. 42, no. 35, pp. 3427–3520. doi: 10.1093/eurheartj/ehab364.Glikson M., Nielsen J.C., Kronborg M.B., Michowitz Y., Auricchio A., Barbash I.M., Barrabés J.A., Boriani G., Braunschweig F. [et al.] 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J, 2021, vol. 42, no. 35, pp. 3427–3520. doi: 10.1093/eurheartj/ehab364.Tomita M., Spinale F.G., Crawford F.A., Zile M.R. Changes in left ventricular volume, mass, and function during the development and regression of supraventricular tachycardia-induced cardiomyopathy. Disparity between recovery of systolic versus diastolic function. Circulation, 1991, vol. 83, no. 2, pp. 635–644.Tomita M., Spinale F.G., Crawford F.A., Zile M.R. Changes in left ventricular volume, mass, and function during the development and regression of supraventricular tachycardia-induced cardiomyopathy. Disparity between recovery of systolic versus diastolic function. Circulation, 1991, vol. 83, no. 2, pp. 635–644.Shinbane J.S., Wood M.A., Jensen D.N., Ellenbogen K.A., Fitzpatrick A.P., Scheinman M.M. Tachycardia-induced cardiomyopathy: a review of animal models and clinical studies. J Am Coll Cardiol, 1997, vol. 29, no. 4, pp. 709–715.Shinbane J.S., Wood M.A., Jensen D.N., Ellenbogen K.A., Fitzpatrick A.P., Scheinman M.M. Tachycardia-induced cardiomyopathy: a review of animal models and clinical studies. J Am Coll Cardiol, 1997, vol. 29, no. 4, pp. 709–715.Maisel W.H., Stevenson L.W. Atrial fibrillation in heart failure: epidemiology, pathophysiology, and rationale for therapy. Am J Cardiol, 2003, vol. 91, no. 6A, pp. 2D–8D.Maisel W.H., Stevenson L.W. Atrial fibrillation in heart failure: epidemiology, pathophysiology, and rationale for therapy. Am J Cardiol, 2003, vol. 91, no. 6A, pp. 2D–8D.Santhanakrishnan R., Wang N., Larson M.G., Magnani J.W., McManus D.D., Lubitz S.A., Ellinor P.T., Cheng S., Vasan R.S., Lee D.S., Wang T.J., Levy D., Benjamin E.J., Ho J.E. Atrial fibrillation begets heart failure and vice versa: temporal associations and differ-ences in preserved vs. reduced ejection fraction. Circulation, 2016, vol. 133, no. 5, pp. 484–492Santhanakrishnan R., Wang N., Larson M.G., Magnani J.W., McManus D.D., Lubitz S.A., Ellinor P.T., Cheng S., Vasan R.S., Lee D.S., Wang T.J., Levy D., Benjamin E.J., Ho J.E. Atrial fibrillation begets heart failure and vice versa: temporal associations and differ-ences in preserved vs. reduced ejection fraction. Circulation, 2016, vol. 133, no. 5, pp. 484–492Simantirakis E.N., Prassopoulos V.K., Chrysostomakis S.I., Kochiadakis G.E., Koukouraki S.I., Lekakis J.P., Karkavitsas N.S., Vardas P.E. Effects of asynchronous ventricular activation on myocardial adrenergic innervation in patients with permanent dual-chamber pacemakers; an I(123)-metaiodobenzylguanidine cardiac scintigraphic study. Eur Heart J, 2001, vol. 22, no. 4, pp. 323–332.Simantirakis E.N., Prassopoulos V.K., Chrysostomakis S.I., Kochiadakis G.E., Koukouraki S.I., Lekakis J.P., Karkavitsas N.S., Vardas P.E. Effects of asynchronous ventricular activation on myocardial adrenergic innervation in patients with permanent dual-chamber pacemakers; an I(123)-metaiodobenzylguanidine cardiac scintigraphic study. Eur Heart J, 2001, vol. 22, no. 4, pp. 323–332.Prabhu S., Voskoboinik A., Kaye D.M., Kistler P.M. Atrial fibrillation and heart failure - cause or effect? Heart Lung Circ, 2017, vol. 26, no. 9, pp. 967–974.Prabhu S., Voskoboinik A., Kaye D.M., Kistler P.M. Atrial fibrillation and heart failure - cause or effect? Heart Lung Circ, 2017, vol. 26, no. 9, pp. 967–974.Clark D.M., Plumb V.J., Epstein A.E., Kay G.N. Hemodynamic effects of an irregular sequence of ventricular cycle lengths during atrial fibril-lation. J Am Coll Cardiol, 1997, vol. 30, no. 4, pp. 1039–1045.Clark D.M., Plumb V.J., Epstein A.E., Kay G.N. Hemodynamic effects of an irregular sequence of ventricular cycle lengths during atrial fibril-lation. J Am Coll Cardiol, 1997, vol. 30, no. 4, pp. 1039–1045.Chatterjee N.A., Upadhyay G.A., Ellenbogen K.A., McAlister F.A., Choudhry N.K., Singh J.P. Atrio-ventricular nodal ablation in atrial fibrillation: a meta-analysis and systematic review. Circ Arrhythm Electrophysiol, 2012, vol. 5, no. 1, pp. 68–76.Chatterjee N.A., Upadhyay G.A., Ellenbogen K.A., McAlister F.A., Choudhry N.K., Singh J.P. Atrio-ventricular nodal ablation in atrial fibrillation: a meta-analysis and systematic review. Circ Arrhythm Electrophysiol, 2012, vol. 5, no. 1, pp. 68–76.Spragg D.D., Dong J., Fetics B.J., Helm R., Marine J.E., Cheng A., Henrikson C.A., Kass D.A., Berger R.D. Optimal Left Ventricular Endocardial Pacing Sites for Cardiac Resynchronization Therapy in Patients With Ischе`ic Cardiomyopathy. J. of the Am. Coll. of Cardiol, 2010, vol. 56, no. 10, pp. 774–781.Spragg D.D., Dong J., Fetics B.J., Helm R., Marine J.E., Cheng A., Henrikson C.A., Kass D.A., Berger R.D. Optimal Left Ventricular Endocardial Pacing Sites for Cardiac Resynchronization Therapy in Patients With Ischе`ic Cardiomyopathy. J. of the Am. Coll. of Cardiol, 2010, vol. 56, no. 10, pp. 774–781.Poposka L., Boskov V., Risteski D., Taleski J., Janusevski F., Srbinovska E., Georgievska-Ismail L. Electrocardiographic Parameters as Predictors of Response to Cardiac Resynchronization Therapy. Open Access Maced J Med Sci, 2018, vol. 6, no. 2, pp. 297–302. doi: 10.3889/oamjms.2018.092.Poposka L., Boskov V., Risteski D., Taleski J., Janusevski F., Srbinovska E., Georgievska-Ismail L. Electrocardiographic Parameters as Predictors of Response to Cardiac Resynchronization Therapy. Open Access Maced J Med Sci, 2018, vol. 6, no. 2, pp. 297–302. doi: 10.3889/oamjms.2018.092.

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