mocimcime ariTmiis klasifikaciis, diagnostikisa da mkurnalobis zogierTi sakiTxi axali rekomendaciebis mixedviT

 

 

g. abulaZe, i. jaSi, d.baxtaZe, e. narsia, n. Wanturia

 

m.winamZRvriSvilis sax. kardiologiis instituti, Tbilisi

 

mocimcime ariTmia (winagulTa fibrilacia-wf) sxvadasxva saxis ariTmiaTa Soris upiratesad gavrcelebuli darRvevaa da misi sixSire izrdeba populaciaSi asakTan erTad. winagulTa fibrilacias Tan sdevs Tromboemboliuri garTulebani, romelTagan 75% iwvevs sxvadasxva tipis cerebralur darRvevebs.

winagulTa fibrilaciisTvis damaxasiaTebelia Sromisunarianobis dakargva an daqveiTeba, cxovrebis xarisxis gauareseba da sicocxlis xangrZlivobis Semcireba. am paTologiis aRmoceneba zrdis avadobas, ganmeorebiT hospitalizacias, iwvevs sikvdilianobis matebas da adamianis janmrTelobis SesanarCuneblad xasiaTdeba maRali ekonomikuri RirebulebiT.

amasTan dakavSirebiT, amerikis kardiologTa kolejis, amerikis gulis asociaciisa da evropis kardiologTa sazogadoebis mier erToblivad SemuSavebul iqna (2001w) saxelmZRvanelo principebi winagulTa fibrilaciis marTvisaTvis.

wf Seteva xangrZlivobis mixedviT SeiZleba iyos paroqsizmuli, persistirebadi da mudmivi (permanentuli)

 

cxr.1     wf-is klinikuri mimdinareobis variantebi

 

       pirvelad gamovlenili
 

    permanentuli wf    

        

 

  paroqsizmuli wf 1

   TviTkupirebadi
 

   persistirebadi wf 2

    araTviTkupirebadi
 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       

 

1-        epizodebi Cveulebriv grZeldeba 7 dRe an naklebi (upiratesad 24 sT-ze naklebi

2-      epizodebi grZeldeba 7 dReze meti drois ganmavlobaSi; kardioversia ar iyo Sedegiani an ar Catarebula.

 

amerikeli da evropeli eqspertebis mier miRebulia axlad gamovlenili wf-is mkurnalobis taqtika (cxr.2)

 

ar aris saWiro xangrZlivi

antiariTmiuli Terapia
 

eleqtruli kardioversia
 

antikoagulanturi Tera-

pia da parkuWovani

riTmis kontroli saWi-

roebis dros

 
 

antiariTmiuli Terapia
 

antikoagulanturi Tera-

pia da parkuWovani

riTmis kontroli saWi-

roebis dros
 

wf ganixileba ro-

gorc permanentuli
 

antikoagulanturi

Terapia saWiroebis

dros
 

ar saWiroebs mkurna-

lobas mZime simptome-

bis gamovlinebamde

(hipertonia, gulis ukmarisoba)
 

pirvelad gamovlenili wf
 

persistirebadi wf
 

paroqsizmuli wf
 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               

 

 

 

 

paroqsizmulad ganixileba wf, Tu misi Sewyveta xdeba TavisTavad, xolo persistirebadia fibrilacia, Tu igi ar wydeba TavisTavad da ganmeorebiTi Setevebis sixSire mdgradia, xSirad morecidivea. aseTi tipis wf-s SemTxvevaSi gamoiyeneba ariTmiuli saSualebani an eleqtruli kardioversia. Tu persistirebadi wf grZeldeba 1 weli da meti, eleqtruli kardioversia ar aris naCvenebi da ganixileba, rogorc permanentuli wf. Tu registrirebulia Setevis 2 an meti epizodi, Sefasebulia, rogorc recidiuli forma.

mniSvnelovania wf-s pirvelad gamovlenili epizodis gamoyofa. mas SeiZleba Tan sdevdes mkveTrad gamoxatuli klinikuri simptomebi an mimdinareobdes mis gareSe da Sewydes TavisTavad.

wf-s paTogenezi ganpirobebulia mravlobiTi “ri-entris”fenomeniT fibrilirebad winagulebSi. mniSvnelovani roli am procesSi miekuTvneba refraqteruli periodis araerTgvarovnebis zrdas da gamtarobis siCqaris Senelebas. wf-s aRmocenebisaTvis mniSvnelovani pirobaa marcxena winagulis qsovilis kritikuli masa.

 

antiariTmiuli Terapia sinusis riTmis SesanarCuneblad morecidive persistirebadi formis wf-s dros (cxr.3)

 

 

 


arafarmako-logiuri midgoma
 

novokainamidi propafenoni qinidini
 

sotaloli
 

gulis qr. ukmarisoba
 

diax
 

amiodaroni dofeTilidi
 

amio-daroni
 

diax
 

ara
 

marcxena parkuWis hipertrofia

1.4 sm an meti
 

arteriuli

hipertenzia
 

amiodaroni dofeTilidi
 

gid
 

propafenoni, sotaloli

flekainidi
 

simptomebi ar aris an minimaluria
 

arafarmakologiuri midgoma
 

novokainamidi

dizopiramidi

qinidini
 
                                                                                                                                                                                                                                                      

 

 

 

 

propafenoni flekainidi
 

sotaloli

amiodaroni

difeTilidi
 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   

 

 

 

novokainamidi

dizopiramidi

qinidini

 
 
 

 

 

 


wf 48 saaTze meti xangrZlivobis dros

saWiroebs antikoagulantur Terapias 3 kviris

manZilze kardioversiamde da 4 kviris manZilze kardioversiis Semdeg.

wf recidivsawinaaRmdego prevenciuli Terapia Catarebuli iyo kardiologiis institutis ariTmiis ganyofilebaSi 92 pacientze. preparatebis sotalolis, propafenonis, amiodaronis efeqturoba Sefasebuli iyo 1 Tvis, 6 Tvis da 1 wlis manZilze. monacemebi obieqtivizirebuli iyo saylapavSida marcxena winagulis eleqtrostimulaciiT. mkurnalobis efeqti iTvleboda dadebiTad sinusis riTmis myarad SenarCunebis SemTxvevaSi da eleqtrostimulaciiT reinducirebis SeuZleblobaSi profilaqtikuri mkurnalobis safuZvelze. eleqtrostimulacia meordeboda 10-14 dRis Semdeg.

wf-s recidivsawinaaRmdego Terapiisas sotalolis fonze ganmeorebiTi Setevebis SeuZlebloba gamoixata- 61,3%-iT (160-240 mg.dR/d), propafenonis SemTxvevaSi-75,8%-iT (300-600 mg.dR./d), amiodaronis-81,2%-iT (200-600 mg.dR/d)

kvlevaSi gamoyenebuli iyo antiariTmiuli preparatebisSeuRleba angiotenzingardamqmneli fermentis inhibitorTan-enalaprilTan.kombinirebuli mkurnalobis safuZvelze aRiniSna marcxena winagulis da marcxena parkuWis diametrebis Semcireba 6 Tvidan 1 wlamde periodSi uwyveti farmakoTerapiis pirobebSi. kerZod, marcxena winagulis zoma 4,15 +/_ 0.2dan Semcirda 3,8 +/_ 0,13-mde 1 wlisaTvis.

amrigad, wf-s mniSvnelovani prediqtori – upiratesad marcxena winagulis dilataciis saxiT ganapirobebs makoregirebel RonisZiebaTa Catarebis aucileblobas mdgradi, persistirebadi formis SemTxvevaSi.

sinusis riTmis SenarCunebis pirobebSic ki farmakologiuri Terapiis fonze marcxena gulis zomebis TandaTanobiT regresiis miuxedavad marcxena winagulis diametri mainc ar aRwevs normalizacias. aqedan, fibrilaciis recidivs farmakoTerapiis Sewyvetis pirobebSi gaaCnia realuri morfologiuri safuZveli- marcxena winagulis dilataciis SenarCuneba.

wf-is mkurnalobis Tanamedrove principebi 2001 wlis rekomendaciebis Tanaxmad gamoyenebuli unda iyos eqimTa yoveldRiur klinikur praqtikaSi.

 

Lliteratura

 

1.        Кушаковский М.С. Фибрилляция предсердий. СПБ, ИКФ «Фолиант» 1999; 176с.

2.        Golitsin S; Fomina J; Sidorenko B et el. Efficacy and safety of d,L-Sotalol in the maintenance of sinus rhithmbefore and following electrical cardioversion in subjects with chronic atrial fibrillation, XXII Congress of the ESC. Eur. Heart J., vol. 21, August, 10 1771

3.        ACC/AHA/ESC/ guidelines for the management of patients with atrial fibrillation. Eur. Heart J. 2001; 22: 1852-923

4.        Brugada R; Familial form of atrial fibrillation, in the book: Atrial Fibrillation: A Practice Approach. Ed. J. Brugada. Prons Science, Barcelona, Spain. 2000, p. 65-68

                                                                                               

 

Summary

                                                                                               

Diagnostic and Therapeutic Aspects of Atrial Fibrillation in the Light of New Guidelines                        G.Abuladze, I. Jashi, D. Bakhtadze, E. Narsia, N, Chanturia

Institute of Cardiology, Tbilisi

 

     The paper is dedicated to therapeutic and preventive efficacy of antiarrythmic drugs and    to the new classification of AF worked out in 2001 by American College of Cardiology, American Heart Association and European Society of Cardiology.

Based on the study performed in the Institute on 92 patients with AF, the article provides description of the effects of sotalol, propafenon and amiodarone in prevention of AF recurrence. The results of the study establish high efficacy if the combination of amiodarone and ACE inhibitor enalapril, which proved to have stronger antiarrythmic action and was found to reduce left atrium dimensions in patients with AF secondary to organic heart disease.