cardiotomskСибирский журнал клинической и экспериментальной медициныSiberian Journal of Clinical and Experimental Medicine2713-29272713-265XTSU publishing10.29001/2073-8552-2017-32-3-29-34cardiotomsk-322Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESПРАВИЛА И ПРИНЦИПЫ ОТБОРА ПАЦИЕНТОВ НА ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ ПРИОБРЕТЕННЫХ ПОРОКОВ СЕРДЦА, ОСЛОЖНЕННЫХ ФИБРИЛЛЯЦИЕЙ ПРЕДСЕРДИЙRULES AND PRINCIPLES OF PATIENT SELECTION FOR SURGICAL TREATMENT OF ACQUIRED HEART DISEASES COMPLICATED BY ATRIAL FIBRILLATIONЕвтушенкоВ. В.EvtushenkoV. V.

канд. мед. наук, сердечно-сосудистый хирург кардиохирургического отделения

evtushenko.vladimir@gmail.comМакогончукИ. С.MakogonchukI. S.

аспирант отделения сердечно- сосудистой хирургии

makogon4ukivan@yandex.ruЕвтушенкоА. В.EvtushenkoA. V.

докт. мед. наук, ведущий научный сотрудник отделения сердечно-сосудистой хирургии

ave@cardio-tomsk.ruНаучно-исследовательский институт кардиологии, Томский национальный исследовательский медицинский центр Российской академии наукРоссияCardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of SciencesRussian Federation2017231120173232934Copyright © Евтушенко В.В., Макогончук И.С., Евтушенко А.В., 20172017Евтушенко В.В., Макогончук И.С., Евтушенко А.В.Evtushenko V.V., Makogonchuk I.S., Evtushenko A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sibjcem.ru/jour/article/view/322

В данной статье приводится обзор современных рекомендаций и принципов отбора пациентов с приобретенной патологией сердца, осложненной фибрилляцией предсердий (ФП), на хирургическое лечение. Проведен анализ эффективности различных способов лечения ФП у таких пациентов, а также современных критериев отбора данной категории больных на операцию. Так, медикаментозное лечение пациентов с ФП малоэффективно, а при наличии пороков сердца и ишемической болезни сердца (ИБС), требующих хирургической коррекции, еще и нецелесообразно. Предпочтение в данном случае следует отдать хирургическому лечению основнопатологии с одномоментной хирургической коррекцией ФП. Показано, что при выборе тактики вмешательства важно учитывать не только наличие самой патологии, но и исходное функциональное состояние элементов проводящей системы сердца. Так, наличие у пациентов с длительно персистирующей ФП исходной дисфункции синусового узла (ДСУ) статистически значимо увеличивает вероятность имплантации пациенту искусственного водителя ритма и пролонгирует его нахождение в палате интенсивной терапии.

 

The present article provides an overview of the latest guidelines and the principles of selecting the patients with acquired heart diseases complicated by atrial fibrillation (AF) for surgical treatment. The effectiveness of various methods of AF treatment in such patients is analyzed. The criteria for selecting patients of this group for an operation are described. The use of antiarrhythmic drugs in patients with AF is ineffective and even inappropriate in cases of valvular heart disease and coronary artery disease requiring surgical correction. Surgical treatment of the main heart pathology and concomitant AF ablation in these patients is preferable. When choosing tactics of intervention, it is necessary to consider not only the presence of the pathology itself, but also the baseline functional state of the elements of cardiac conduction system. The presence of initial sinus node dysfunction in patients with long-lasting persistent AF significantly increases the probability of pacemaker implantation and prolongs a patient’s stay in the intensive care unit.

 

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