cardiotomskСибирский журнал клинической и экспериментальной медициныSiberian Journal of Clinical and Experimental Medicine2713-29272713-265XTSU publishing10.29001/2073-8552-2022-37-3-136-143cardiotomsk-1515Research ArticleКЛИНИЧЕСКИЕ СЛУЧАИCLINICAL CASESПрагматический подход к выявлению фибрилляции предсердий, определение программы вторичной профилактики у пациентки с эмболическим криптогенным инсультом: представление клинического случая с учетом современного состояния проблемыA pragmatic approach to detection of atrial fibrillation and choice of a secondary prevention program in a patient with cryptogenic embolic stroke: Presentation of a clinical case taking into account the current state of the problemhttps://orcid.org/0000-0001-5679-4100МехряковС. А.MekhryakovS. A.

Мехряков Сергей Александрович, врач ультразвуковой диагностики, Региональный сосудистый центр

614107, Пермь, ул. Ким, 2

Sergey A. Mekhryakov, Ultrasound Doctor, Regional Vascular Center

2, Kim str., Perm, 614107

heartolog@gmail.comhttps://orcid.org/0000-0002-8305-1115СыромятниковаЛ. И.SyromyatnikovaL. I.

Сыромятникова Людмила Илариевна, д-р мед. наук, профессор кафедры пропедевтики внутренних болезней № 1; руководитель Регионального сосудистого центра

614107, Пермь, ул. Ким, 2

614990, Пермь, ул. Петропавловская, 26

Liudmila I. Syromyatnikova, Dr. Sci. (Med.), Professor, Department of Propaedeutics of Internal Diseases No. 1; Head of Regional Vascular Center

2, Kim str., Perm, 614107

26, Petropavlovskaya str., Perm, 614990

ilarievna@gmail.comhttps://orcid.org/0000-0001-6061-8118КулешА. А.KuleshA. A.

Кулеш Алексей Александрович, д-р мед. наук, профессор кафедры неврологии, заведующий неврологическим отделением для лечения больных с острыми нарушениями мозгового кровообращения

614107, Пермь, ул. Ким, 2

614990, Пермь, ул. Петропавловская, 26

Alexey A. Kulesh, Dr. Sci. (Med.), Professor, Department of Neurology; Head of Department of Neurology for Patients with Acute Cerebrovascular Events

2, Kim str., Perm, 614107

26, Petropavlovskaya str., Perm, 614990

aleksey.kulesh@gmail.comГородская клиническая больница № 4РоссияCity Clinical Hospital No. 4Russian FederationГородская клиническая больница № 4; Пермский государственный медицинский университет имени академика Е.А. Вагнера Министерства здравоохранения Российской ФедерацииРоссияCity Clinical Hospital No. 4; Perm State Medical University named after academician E. A. WagnerRussian Federation202220102022373136143Copyright © Мехряков С.А., Сыромятникова Л.И., Кулеш А.А., 20222022Мехряков С.А., Сыромятникова Л.И., Кулеш А.А.Mekhryakov S.A., Syromyatnikova L.I., Kulesh A.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sibjcem.ru/jour/article/view/1515

Представлен клинический пример использования диагностического алгоритма выявления критериев предсердной кардиопатии (ПК) у пациентки с криптогенным инсультом (КИ), что определило необходимость выполнения продленного мониторирования электрокардиограммы (ЭКГ), обнаружения субклинической фибрилляции предсердий (ФП) и последующего коллегиального установления показаний для инициации антикоагулянтной терапии с учетом высокого риска повторного инсульта.

The article presents a clinical example of using the diagnostic algorithm for identifying the criteria for atrial cardiopathy in a patient with cryptogenic stroke. This clinical case required prolonged ECG monitoring, detection of subclinical atrial fibrillation, and subsequent collegial establishment of indications for initiation of anticoagulant therapy taking into account the high risk of recurrent stroke.

фибрилляция предсердийкриптогенный инсультпредсердная кардиопатияантикоагулянтная терапияatrial fibrillationcryptogenic strokeatrial cardiopathyanticoagulationReferencesHindricks G., Potpara T., Dagres N., Arbelo E., Bax J.J., Blomström-Lundqvist C. et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur. Heart J. 2021;42(5):373–498. DOI: 10.1093/euheart/ehaa612.Hindricks G., Potpara T., Dagres N., Arbelo E., Bax J.J., Blomström-Lundqvist C. et al. 2020 ESC Guidelines for the diagnosis and management of atrial fi brillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fi brillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur. Heart J. 2021;42(5):373–498. DOI: 10.1093/euheart/ehaa612.Grond M., Jauss M., Hamann G., Stark E., Veltkamp R., Nabavi D.G. et al. Improved detection of silent atrial fibrillation using 72-hour Holter ECG in patients with ischemic stroke a prospective multicenter cohort study. Stroke. 2013;44(12):3357–3364. DOI: 10.1161/STROKEAHA.113.001884.Grond M., Jauss M., Hamann G., Stark E., Veltkamp R., Nabavi D.G. et al. Improved detection of silent atrial fi brillation using 72-hour Holter ECG in patients with ischemic stroke a prospective multicenter cohort study. Stroke. 2013;44(12):3357–3364. DOI: 10.1161/STROKEAHA.113.001884.Haeusler K.G., Kirchhof P., Heuschmann P.U., Laufs U., Busse O., Kunze C. et al. Impact of standardized MONitoring for Detection of Atrial Fibrillation in Ischemic Stroke (MonDAFIS): Rationale and design of a prospective randomized multicenter study. Am. Heart J. 2016;172:19–25. DOI: 10.1016/j.ahj.2015.10.010.Haeusler K.G., Kirchhof P., Heuschmann P.U., Laufs U., Busse O., Kunze C. et al. Impact of standardized MONitoring for Detection of Atrial Fibrillation in Ischemic Stroke (MonDAFIS): Rationale and design of a prospective randomized multicenter study. Am. Heart J. 2016;172:19–25. DOI: 10.1016/j.ahj.2015.10.010.Tsivgoulis G., Katsanos A.H., Köhrmann M., Caso V., Perren F., Palaiodimou L. et al. Duration of implantable cardiac monitoring and detection of atrial fibrillation in ischemic stroke patients: A systematic review and meta-analysis. J. Stroke. 2019;21(3):302–311. DOI: 10.5853/jos.2019.01067.Tsivgoulis G., Katsanos A.H., Köhrmann M., Caso V., Perren F., Palaiodimou L. et al. Duration of implantable cardiac monitoring and detection of atrial fi brillation in ischemic stroke patients: A systematic review and meta-analysis. J. Stroke. 2019;21(3):302–311. DOI: 10.5853/jos.2019.01067.Sanna T., Diener H.C., Passman R.S., Di Lazzaro V., Bernstein R.A., Morillo C.A. et al. Cryptogenic stroke and underlying atrial fibrillation. N. Engl. J. Med. 2014;370(26):2478–2486. DOI: 10.1056/NEJMoa1313600.Sanna T., Diener H.C., Passman R.S., Di Lazzaro V., Bernstein R.A., Morillo C.A. et al. Cryptogenic stroke and underlying atrial fi brillation. N. Engl. J. Med. 2014;370(26):2478–2486. DOI: 10.1056/NEJMoa1313600.Wachter R., Gröschel K., Gelbrich G., Hamann G.F., Kermer P., Liman J. et al. Holter-electrocardiogram-monitoring in patients with acute ischaemic stroke (find-AF RANDOMISED): An open-label randomised controlled trial. Lancet Neurol. 2017;16(4):282–290. DOI: 10.1016/S1474-4422(17)30002-9.Wachter R., Gröschel K., Gelbrich G., Hamann G.F., Kermer P., Liman J. et al. Holter-electrocardiogram-monitoring in patients with acute ischaemic stroke (fi nd-AF RANDOMISED): An open-label randomised controlled trial. Lancet Neurol. 2017;16(4):282–290. DOI: 10.1016/S1474-4422(17)30002-9.Kamel H., Bartz T.M., Elkind M.S.V., Okin P.M., Thacker E.L., Patton K. et al. Atrial cardiopathy and the risk of ischemic stroke in the CHS (Cardiovascular Health Study). Stroke. 2018;49(4):980–986. DOI: 10.1161/strokeaha.117.020059.Kamel H., Bartz T.M., Elkind M.S.V., Okin P.M., Thacker E.L., Patton K. et al. Atrial cardiopathy and the risk of ischemic stroke in the CHS (Cardiovascular Health Study). Stroke. 2018;49(4):980–986. DOI: 10.1161/strokeaha.117.020059.Tandon K., Tirschwell D., Longstreth W.T. Jr., Smith B., Akoum N. Embolic stroke of undetermined source correlates to atrial fibrosis without atrial fibrillation. Neurology. 2019;93(4):e381–e387. DOI: 10.1212/WNL.0000000000007827.Tandon K., Tirschwell D., Longstreth W.T. Jr., Smith B., Akoum N. Embolic stroke of undetermined source correlates to atrial fi brosis without atrial fi brillation. Neurology. 2019;93(4):e381–e387. DOI: 10.1212/WNL.0000000000007827.Meisel K., Yuan K., Fang Q., Bibby D., Lee R., Schiller N.B. Embolic stroke of undetermined source: A population with left atrial dysfunction. J. Stroke Cerebrovasc. Dis. 2019;28(7):1891–1896. DOI: 10.1016/j.jstrokecerebrovasdis.2019.04.004.Meisel K., Yuan K., Fang Q., Bibby D., Lee R., Schiller N.B. Embolic stroke of undetermined source: A population with left atrial dysfunction. J. Stroke Cerebrovasc. Dis. 2019;28(7):1891–1896. DOI: 10.1016/j.jstrokecerebrovasdis.2019.04.004.Мехряков С.А., Кулеш А.А., Сыромятникова Л.И., Собянин К.В. Биомаркеры предсердной кардиопатии у пациентов с разными патогенетическими подтипами ишемического инсульта. Неврология, нейропсихиатрия, психосоматика. 2020;12(6):33–41. DOI: 10.14412/2074-2711-2020-6-33-41.Mekhryakov S.A., Kulesh A.A., Syromyatnikova L.I., Sobyanin К.V. Biomarkers of atrial cardiopathy in patients with diff erent pathogenetic subtypes of ischemic stroke. Neurology, Neuropsychiatry, Psychosomatics. 2020;12(6):33–41. (In Russ.). DOI: 10.14412/2074-2711-2020-6-33-41.Кулеш А.А., Голосова Ю.А., Сыромятникова Л.И., Шестаков В.В. Дополнительные клинические и инструментально-лабораторные маркёры основных патогенетических вариантов ишемического инсульта. Клиническая медицина. 2018;96(3):240–247. DOI: 10.18821/0023-2149-2018-96-3-240-247.Kulesh A.A., Golosova Y.A., Syromyatnikova L.I., Shestakov V.V. Additional clinical and instrumental laboratory markers of the main pathogenetic variants of ischemic stroke. Klinicheskaia Meditsina. 2018;96(3):240–247. (In Russ.). DOI: 10.18821/0023-2149-2018-96-3-240-247.Swiryn S., Orlov M.V., Benditt D.G., DiMarco J.P., Lloyd-Jones D.M., Karst E. et al. Clinical implications of brief device-detected atrial tachyarrhythmias in a cardiac rhythm management device population: Results from the Registry of Atrial Tachycardia and Atrial Fibrillation Episodes. Circulation. 2016;134(16):1130–1140. DOI: 10.1161/circulationaha.115.020252.Swiryn S., Orlov M.V., Benditt D.G., DiMarco J.P., Lloyd-Jones D.M., Karst E. et al. Clinical implications of brief device-detected atrial tachyar-rhythmias in a cardiac rhythm management device population: Results from the Registry of Atrial Tachycardia and Atrial Fibrillation Episodes. Circulation. 2016;134(16):1130–1140. DOI: 10.1161/circulationaha.115.020252.Mahajan R., Perera T., Elliott A.D., Twomey D.J., Kumar S., Munwar D.A. et al. Subclinical device-detected atrial fibrillation and stroke risk: A systematic review and meta-analysis. Eur. Heart J. 2018;39(16):1407–1415. DOI: 10.1093/eurheartj/ehx731.Mahajan R., Perera T., Elliott A.D., Twomey D.J., Kumar S., Munwar D.A. et al. Subclinical device-detected atrial fibrillation and stroke risk: A systematic review and meta-analysis. Eur. Heart J. 2018;39(16):1407–1415. DOI: 10.1093/eurheartj/ehx731.Boriani G., Glotzer T.V., Ziegler P.D., De Melis M., Mangoni di S.S.L., Sepsi M. et al. Detection of new atrial fibrillation in patients with cardiac implanted electronic devices and factors associated with transition to higher device-detected atrial fibrillation burden. Heart Rhythm. 2018;15(3):376–383. DOI: 10.1016/j.hrthm.2017.11.007.Boriani G., Glotzer T.V., Ziegler P.D., De Melis M., Mangoni di S.S.L., Sepsi M. et al. Detection of new atrial fibrillation in patients with cardiac implanted electronic devices and factors associated with transition to higher device-detected atrial fibrillation burden. Heart Rhythm. 2018;15(3):376–383. DOI: 10.1016/j.hrthm.2017.11.007.Pastori D., Miyazawa K., Li Y., Szekely O., Shahid F., Farcomeni A. et al. Atrial high-rate episodes and risk of major adverse cardiovascular events in patients with cardiac implantable electronic devices. Clin. Res. Cardiol. 2020;109(1):96–102. DOI: 10.1007/s00392-019-01493-z.Pastori D., Miyazawa K., Li Y., Szekely O., Shahid F., Farcomeni A. et al. Atrial high-rate episodes and risk of major adverse cardiovascular events in patients with cardiac implantable electronic devices. Clin. Res. Cardiol. 2020;109(1):96–102. DOI: 10.1007/s00392-019-01493-z.Gonzalez M., Keating R.J., Markowitz S.M., Liu C.F., Thomas G., Ip J.E. et al. Newly detected atrial high rate episodes predict long-term mortality outcomes in patients with permanent pacemakers. Heart Rhythm. 2014;11(12):2214–2221. DOI: 10.1016/j.hrthm.2014.08.019.Gonzalez M., Keating R.J., Markowitz S.M., Liu C.F., Thomas G., Ip J.E. et al. Newly detected atrial high rate episodes predict long-term mortality outcomes in patients with permanent pacemakers. Heart Rhythm. 2014;11(12):2214–2221. DOI: 10.1016/j.hrthm.2014.08.019.

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