Abstract
Atrial fibrillation (AF) is the most common tachyarrhythmia complicating ST segment elevation myocardial infarction (STEMI), while ventricular arrhythmias (VA) can, not only be accompanied by a hemodynamic disorder, but in some cases, worsen its prognosis. The article presents a modern view on risk factors for development of AF (elderly age, left ventricle systolic dysfunction, heart failure, etc.), strategy and tactics of AF treatment in patients with STEMI, the indications for its pharmacological cardioversion and electro-impulse therapy. It is shown that I.V. administration of betablockers and in some cases amiodarone for reducing the frequency of ventricular contractions is advisable. Features and argumentative issues of triple antithrombotic therapy in patients with AF with STEMI, the possibilities and indications for the use of double antithrombotic therapy instead of triple one are described. Clinical significance and peculiarities of treatment of various types of VA have been determined, the role of myocardial revascularization, radiofrequency catheter ablation, normalization of electrolyte imbalance, use of beta-blockers and amiodarone in the prevention and therapy of lifethreatening ventricular arrhythmias has been emphasized. The irrationality, and sometimes the risk of carrying out prophylactic antiarrhythmic therapy for AF and VA in the acute stage of STEMI, as well as the role of the implantable cardioverter-defibrillator in primary prevention of death in certain groups of patients with low left ventricle ejection fraction after myocardial infarction was noted. The value of various antiarrhythmic drugs in their effect on the improvement of prognosis in patients after STEMI is estimated. The material is presented based on modern recommendations for the treatment of patients with STEMI, therapy of AF and VA, prevention of sudden cardiac death, as well as data from several controlled studies and own clinical experience of pharmacotherapy of arrhythmias.
Highlights
Фибрилляция предсердий (ФП) – самая частая тахиаритмия, осложняющая течение инфаркта миокарда с подъемом сегмента ST (ИМпST), в то же время желудочковые аритмии (ЖА) могут не только сопровождаться нарушением гемодинамики, но и в ряде случаев ухудшать его прогноз
The article presents a modern view on risk factors for development of Atrial fibrillation (AF), strategy and tactics of AF treatment in patients with segment elevation myocardial infarction (STEMI), the indications for its pharmacological cardioversion and electro-impulse therapy
It is shown that I.V. administration of betablockers and in some cases amiodarone for reducing the frequency of ventricular contractions is advisable
Summary
Выраженная ишемия и некроз миокарда, приводя к метаболическим, морфологическим и электрофизиологическим изменениям, могут сопровождаться развитием предсердных и желудочковых аритмий. За последние 10-15 лет было показано, что профилактическая антиаритмическая фармакотерапия при инфаркте миокарда (ИМ) с подъемом сегмента ST (ИМпST) не всегда оправдывает свои ожидания, особенно, в остром периоде заболевания, хотя до сих пор является важной составной частью лечения нарушений ритма сердца у больных с постинфарктным кардиосклерозом [1]. Своевременное применение бета-адреноблокаторов, ингибиторов АПФ, статинов, а также, по показаниям, катетерная аблация и имплантация кардиовертерадефибриллятора позволяют как предупреждать развитие нарушений ритма сердца, так и улучшать прогноз больных с ИМпST
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