{"id":66115,"date":"2021-03-16T13:44:45","date_gmt":"2021-03-16T15:44:45","guid":{"rendered":"https:\/\/www.pasveik.lt\/?p=66115\/sveikatos-ir-medicinos-naujienos"},"modified":"2021-03-16T13:44:46","modified_gmt":"2021-03-16T15:44:46","slug":"ritmo-kontrole-sergant-priesirdziu-virpejimu","status":"publish","type":"post","link":"https:\/\/www.pasveik.lt\/lt\/naujausi-medicinos-straipsniai\/ritmo-kontrole-sergant-priesirdziu-virpejimu\/66115\/","title":{"rendered":"Ritmo kontrol\u0117 sergant prie\u0161ird\u017ei\u0173 virp\u0117jimu"},"content":{"rendered":"\n

Senstant populiacijai sergamumas prie\u0161ird\u017ei\u0173 virp\u0117jimu (PV) did\u0117ja. Tik\u0117tina, kad per ateinan\u010dius 2\u20133 de\u0161imtme\u010dius sergamumas PV ir mir\u0161tamumas nuo jo gali padid\u0117ti 2\u20133 kartus. Net ir taikant optimal\u0173 antikoaguliacin\u012f gydym\u0105 ir kontroliuojant \u0161irdies susitraukim\u0173 da\u017en\u012f pacientai, sergantys PV, vis dar turi didesn\u0119 rizik\u0105 mirti d\u0117l kardiovaskulini\u0173 lig\u0173 ar \u0161irdies nepakankamumo. Ritmo kontrol\u0117 antiaritminiais vaistais, kardioversija, abliacija \u2013 tai gydymo metodai, skirti suma\u017einti su PV susijusius simptomus. \u0160i\u0173 metod\u0173 efektyvumas vis da\u017eniau aptariamas tarp skirting\u0173 pacient\u0173 grupi\u0173. CABANA (angl. Catheter Ablation vs. Antiarrhytmic Drug Therapy for Atrial Fibrillation<\/em>) studijoje neseniai informacija apie abliacijos saugum\u0105 PV sergantiems ir turintiems insulto rizik\u0105 pacientams. CASTLE-AF (angl. Catheter Ablation vs. Standart Conventional Therapy in Patiens with Left Ventricular Dysfunction and Atrial Fibrillation<\/em>) studijoje teigiama, kad PV abliacija, palyginti su medikamentine terapija, sud\u0117tine \u0161irdies susitraukim\u0173 da\u017enio kontrol\u0117s terapija ir antiaritmine medikamentine terapija, gali labiau pagerinti i\u0161eitis sergantiesiems PV ir sunkiu \u0161irdies nepakankamumu.<\/p>\n\n\n\n

Ritmo kontrol\u0117 ir su PV susij\u0119 simptomai<\/strong><\/p>\n\n\n\n

Sinusinio ritmo atk\u016brimas ir i\u0161laikymas, net ir esant adekva\u010diai \u0161irdies susitraukim\u0173 da\u017enio kontrolei, i\u0161lieka pagrindiniu gydymo tikslu simptominiams pacientams. \u012edomu tai, kad ritmo kontrol\u0117s poveikis gyvenimo kokybei tarp tiriam\u0173j\u0173 yra ma\u017eiau vienodas ir ai\u0161kus, nei j\u0173 poveikis palaikant sinusin\u012f ritm\u0105. Tiek individual\u016bs pacient\u0173 skirtumai, tiek netiksl\u016bs gyvenimo kokyb\u0117s \u012fvertinimo instrumentai ir skirtingas ritmo kontrol\u0117s efektas gali pad\u0117ti paai\u0161kinti \u0161\u012f heterogeni\u0161kum\u0105. Europos \u0161irdies ritmo asociacijos (angl. The European Heart Rhythm Association<\/em>) simptom\u0173 skal\u0117, prad\u0117ta naudoti 2007 metais (v\u0117liau patikslinta), yra naudingas \u012frankis vertinant su PV susijusius simptomus. Ne tik \u0161is, bet ir keletas kit\u0173 ligai specifini\u0173 \u012franki\u0173 yra prieinami vertinant su PV susijusius simptomus. Tiesa,  visi jie turi tr\u016bkum\u0173 ir privalum\u0173. Svarbu nepamir\u0161ti, kad su PV susijusius simptomus ne visada sukelia pats PV \u2013 be aritmijos, paciento sveikatos suvokimui \u012ftak\u0105 turi ir gretutin\u0117s \u0161irdies ir kraujagysli\u0173 ligos, individual\u016bs rizikos veiksniai. Galima tik\u0117tis, kad pacientai, sergantys paroksizminiu PV, labai skirtingai apib\u016bdins savo gyvenimo kokyb\u0119. Tam \u012ftak\u0105 tur\u0117s ne tik dabartinis \u0161irdies ritmas, bet ir sugeb\u0117jimas prisiminti bei vertinti praeityje buvusius simptomus tarp PV epizod\u0173 ir nerim\u0105, susijus\u012f su dar gresian\u010diais epizodais.<\/p>\n\n\n\n

\u0160irdies ritmo kontrol\u0117<\/strong><\/p>\n\n\n\n

Ar \u0161irdies ritmo kontrol\u0117 bus s\u0117kminga, priklauso nuo daugelio veiksni\u0173 \u2013 gretutini\u0173 lig\u0173 skai\u010diaus, tipo ir sunkumo, paciento am\u017eiaus, lyties, medikamentin\u0117s ritmo terapijos re\u017eimo laikymosi ir veiksni\u0173, susijusi\u0173 su PV abliacijos proced\u016bros kokybe. PV pasikartojim\u0173 da\u017enis priklauso nuo ritmo steb\u0117jimo elektrokardiografu intensyvumo ir paciento steb\u0117jimo trukm\u0117s. Taigi numatyti PV pasikartojimo rizik\u0105 yra gan\u0117tinai sud\u0117tinga.<\/p>\n\n\n\n

Antiaritminiai vaistai<\/strong><\/p>\n\n\n\n

Antiaritmini\u0173 vaist\u0173 vartojimas vidutini\u0161kai 2 kartus padidina pacient\u0173, kuriems s\u0117kmingai palaikomas sinusinis ritmas, skai\u010di\u0173. Pasteb\u0117ta, kad i\u0161laikant sinusin\u012f ritm\u0105 amiodaronas yra efektyvesnis u\u017e kit\u0105 medikamentin\u0119 aritmij\u0173 kontrol\u0117s terapij\u0105, o PV abliacija \u2013 u\u017e antiaritminius vaistus. Pasteb\u0117ta, kad ilgalaikis antiaritmini\u0173 vaist\u0173 komplikacij\u0173 da\u017enis yra pana\u0161us \u012f pacient\u0173, gydyt\u0173 PV abliacija, patirt\u0173 komplikacij\u0173 da\u017en\u012f. Nors amiodaronas tam tikruose neatsitiktini\u0173 im\u010di\u0173 tyrimuose jau buvo sietinas su neigiamais rezultatais didel\u0117s rizikos pacientams, remiantis naujesniais atsitiktini\u0173 im\u010di\u0173 tyrimais, antiaritmin\u0117 medikamentin\u0117 terapija vis dar kelia susir\u016bpinim\u0105 d\u0117l tinkamumo sergantiesiems \u0161irdies nepakankamumu. Skirtingai nei ankstesniuose tyrimuose, pasteb\u0117ta, kad antiaritmin\u0117 terapija dronedaronu, palyginti su placebu, yra tinkamesn\u0117, t. y. susijusi su ma\u017eesniu stacionarizavimo d\u0117l kardiovaskulini\u0173 \u012fvyki\u0173 ir mir\u010di\u0173 da\u017eniu. Tyrimo PALLAS duomenimis, sergantiems persistuojan\u010diu PV pacientams drodedaronas, vartotas kaip medikamentas ritmui kontroliuoti, buvo siejamas su didesniu \u0161irdies nepakankamumo, insulto ir kardiovaskulini\u0173 mir\u010di\u0173 da\u017eniu. \u012e tyrim\u0105 PALLAS \u012ftraukti pacientai nebuvo atrinkti tinkamais kandidatais ritmo kontrol\u0117s terapijai, jiems nebuvo atliktos intervencijos sinusiniam ritmui atkurti (pvz., kardioversija, PV abliacija) ir jie sirgo sunkiu \u0161irdies nepakankamumu. Tyrime ATHENA gydyt\u0173 dronedaronu pacient\u0173 ritmas buvo atkuriamas \u012f sinusin\u012f. B\u016btent \u0161ie veiksniai gal\u0117jo lemti teigiamus tyrimo ATHENA rezultatus.<\/p>\n\n\n\n

Antiaritmini\u0173 vaist\u0173 efektyvumas \u012frodytas ir po atliktos PV abliacijos. Dvi gan\u0117tinai naujos atsitiktini\u0173 im\u010di\u0173 studijos (AMIO-CAT ir POWDER-AF) atskleid\u0117, kad, PV abliacij\u0105 papild\u017eius medikamentine antiaritmine terapija, pagerinamas sinusinio ritmo i\u0161laikymas. \u0160is antiaritmini\u0173 vaist\u0173 ir PV abliacijos sinergizmas pagrind\u017eia da\u017en\u0105 (ma\u017edaug 50 proc. pacient\u0173) antiaritmini\u0173 vaist\u0173 vartojim\u0105 pirmaisiais metais po atliktos PV abliacijos. Vienoje AMIO-CAT studijos dalyje vertinta smegen\u0173 natriuretinio peptido koncentracija parod\u0117, kad tam tikri bio\u017eymenys gali pad\u0117ti nusp\u0117ti PV pasikartojimo rizik\u0105 \u2013 tik\u0117tina, kad b\u016btent tai ateityje pad\u0117s atrinkti ir individualizuoti ritmo kontrol\u0117s metodus.<\/p>\n\n\n\n

PV abliacija<\/strong><\/p>\n\n\n\n

Studijoje CABANA vertinant PV sergan\u010dius jaunus (vidutinis am\u017eius \u2013 55 metai) pacientus, kuriems nustatytas atsparumas antiaritminiams vaistams, pasteb\u0117ta, kad PV abliacija yra efektyvesnis b\u016bdas i\u0161laikyti sinusin\u012f ritm\u0105, palyginti su antiaritminiais vaistais. Atsitiktini\u0173 im\u010di\u0173 (6 167 pacientai) tyrimas parod\u0117, kad PV abliacija ma\u017edaug pus\u0119 PV sergan\u010di\u0173 pacient\u0173 apsaugo nuo PV pasikartojimo, ypa\u010d tiems, kuriems nustatyta l\u0117tin\u0117 ligos forma. Pirm\u0105 kart\u0105 atlikus PV abliacij\u0105, proced\u016br\u0105 kartoti prireikia 20\u201350 proc. pacient\u0173. Stebint pacientus ilgiau nei 10 met\u0173, daugiau nei 60 proc. PV abliacij\u0105 patyrusi\u0173 pacient\u0173 nepatiria klini\u0161kai reik\u0161mingo PV pasikartojimo, o ma\u017edaug pusei j\u0173 gydymas derinamas su antiaritminiais vaistais. Tiesa, siekiant geresni\u0173 rezultat\u0173 ir ie\u0161kant papildom\u0173 sprendim\u0173, kaip pagerinti pacient\u0173 i\u0161eitis, reikia atlikti daugiau tyrim\u0173.<\/p>\n\n\n\n

PV abliacijos ir antiaritmini\u0173 vaist\u0173 palyginimas: tyrimas CABANA<\/strong><\/p>\n\n\n\n

Vienas CABANA tyrimo tiksl\u0173 buvo i\u0161siai\u0161kinti, ar PV abliacija, esant ritmo kontrol\u0117s poreikiui bei turint insulto rizikos veiksni\u0173, gali suma\u017einti mirtingum\u0105, palyginti su gydymu antiaritminiais vaistais. Remiantis pirmaisiais duomenimis ir i\u0161gryninus tiriam\u0173j\u0173 grupes, gauti \u0161ie rezultatai: i\u0161 2 204 atrinkt\u0173 pacient\u0173 (vidutinis am\u017eius \u2013 68 metai; 37 proc. moter\u0173; 57 proc. buvo persistuojantis PV) tyrim\u0105 baig\u0117 89,3 proc. pacient\u0173. Paai\u0161k\u0117jo, kad ritmo kontrol\u0117 vyresniems pacientams yra gana saugi, o komplikacij\u0173 po PV abliacijos pasitaiko santykinai neda\u017enai: tamponada (0,8 proc.), hematomos (2,3 proc.), pseudoaneurizmos (1,1 proc.). Pacientams, atrinktiems medikamentinei ritmo kontrolei, buvo nustatyta skydliauk\u0117s funkcijos sutrikim\u0173 (1,6 proc.) ir proaritmij\u0173 (0,8 proc.). Pirmin\u0117s ir antrin\u0117s pacient\u0173 i\u0161eitys nesiskyr\u0117.<\/p>\n\n\n\n

\u012edomu tai, kad pacientams, kurie buvo atrinkti PV abliacijai, PV pasikartojo re\u010diau toje grup\u0117je, kuri gydomuoju laikotarpiu buvo stebima elektrokardiografu. Remiantis AFEQT (angl. The Atrial Fibrillation Effect on Quality of Life<\/em>) suvestiniu balu ir MAFSI (angl. Mayo AF-Specific Symptom Inventory<\/em>) pacient\u0173 gyvenimo kokyb\u0117s vertinimu, steb\u0117ti teigiami abiej\u0173 gydymo metod\u0173 rezultatai, ta\u010diau PV abliacija gyvenimo kokyb\u0119 pagerino labiau. Tai, kad PV abliacija turi didesn\u0119 \u012ftak\u0105 gyvenimo kokybei, pasteb\u0117ta ir \u0161ved\u0173 tyrime CAPTAF.<\/p>\n\n\n\n

Ritmo kontrol\u0117 pacientams, sergantiems PV ir \u0161irdies nepakankamumu<\/strong><\/p>\n\n\n\n

PV ir \u0161irdies nepakankamumas da\u017enai lydi vienas kit\u0105, o tai susij\u0119 ir su dideliu pacient\u0173 sergamumu bei mirtingumu. Siekiant pagerinti i\u0161eitis, \u0161i\u0173 pacient\u0173 gydymo metodikose kaip vienas sprendimo b\u016bd\u0173 pasi\u016blytas sinusinio ritmo atk\u016brimas ir palaikymas. Amiodaronas \u2013 vienintelis vaistas, apie kurio saugumo profil\u012f pacientams, kuriems suma\u017e\u0117jusi kairiojo skilvelio i\u0161st\u016bmio frakcija, surinkta pakankamai duomen\u0173. Atsitiktini\u0173 im\u010di\u0173 tyrimuose, kuriuose lyginti antiaritminiai vaistai ir \u0161irdies susitraukim\u0173 da\u017enio kontrol\u0117 pacientams, sergantiems PV ir \u0161irdies nepakankamumu, ne\u012frodytas skirtumas tarp bendrojo mirtingumo, kardiovaskulinio mirtingumo ar stacionarizavimo d\u0117l \u0161irdies nepakankamumo da\u017enio. Nesiskyr\u0117 ir i\u0161gyvenamumas tarp pacient\u0173, kuriems ritmo kontrol\u0117 buvo s\u0117kminga \u2013 sinusinis ritmas buvo i\u0161laikomas, ir t\u0173, kuriems PV kartojosi. Keletas nedideli\u0173 atvej\u0173 ir kontroliuojam\u0173j\u0173 tyrim\u0173 atskleid\u0117, kad 80 proc. pacient\u0173, kuriems atlikta PV abliacija ir b\u016bkl\u0117 steb\u0117ta elektrokardiografu, i\u0161matuota pager\u0117jusi kairiojo skilvelio i\u0161st\u016bmio frakcija. Bene did\u017eiausias tyrimas, kuriame lyginta PV abliacija ir medikamentin\u0117 terapija (\u012fskaitant tiek \u0161irdies susitraukim\u0173 da\u017enio kontrol\u0119, tiek gydym\u0105 antiaritminiais vaistais) pacientams, sergantiems PV ir \u0161irdies nepakankamumu, yra CASTLE-AF. Pasteb\u0117ta, kad kateterin\u0117 abliacija reik\u0161mingai suma\u017eino mirtingum\u0105 ir stacionarizavimo d\u0117l \u0161irdies nepakankamumo atvej\u0173 skai\u010di\u0173. Tyrimo pabaigoje 63 proc. pacient\u0173, kuriems buvo atlikta abliacija, i\u0161laik\u0117 sinusin\u012f ritm\u0105, medikamentinio gydymo grup\u0117je \u0161is skai\u010dius buvo 22 proc.<\/p>\n\n\n\n

Atsi\u017evelgiant \u012f \u0161ias i\u0161vadas, AHA\/ACC\/HRS gairi\u0173 redakcijoje buvo \u012ftraukta IIb klas\u0117s rekomendacija PV ir \u0161irdies nepakankamumu sergan\u010di\u0173 pacient\u0173 gydymui rinktis PV abliacij\u0105. Tiesa, informacijos apie PV abliacijos rezultatus gydant \u010dia pacient\u0173 grup\u0119 kol kas n\u0117ra. Tyrimuose CASTLE-AF ir AATAC pateikta \u012frodym\u0173, kad atrinktiems pacientams, sergantiems PV ir \u0161irdies nepakankamumu, PV abliacija yra efektyvi. Kad ir kaip b\u016bt\u0173, pacient\u0173 atrankos klausimas vis dar i\u0161lieka neatsakytas. Norint galutinai \u012fvertinti PV abliacijos efektyvum\u0105 PV ir \u0161irdies nepakankamumu sergan\u010di\u0173j\u0173 kardiovaskulin\u0117ms i\u0161eitims, reikia atlikti daugiau tyrim\u0173.<\/p>\n\n\n\n

\u0160irdies ritmo kontrol\u0117 ir insultas<\/strong><\/p>\n\n\n\n

Neabejotinas PV ir i\u0161eminio insulto ry\u0161ys gali kelti klausim\u0105, ar sinusinio ritmo i\u0161laikymas pacientui gali pad\u0117ti i\u0161vengti insulto? Anks\u010diau publikuotuose tyrimuose \u0161i hipotez\u0117 nepatvirtinta \u2013 net dideli\u0173 im\u010di\u0173 tyrime AF-CHF ma\u017eesnis insulto da\u017enis nepasteb\u0117tas.<\/p>\n\n\n\n

Tyrimo ATHENA analiz\u0117 atskleid\u0117, kad dronedaronu gydyti pacientai tur\u0117jo ma\u017eesn\u0119 insulto ir praeinan\u010diojo smegen\u0173 i\u0161emijos priepuolio rizik\u0105. Retrospektyviai i\u0161nagrin\u0117jus \u0160vedijos pacient\u0173 registro duomenis (PV sergan\u010di\u0173j\u0173 pogrup\u012f) nustatyta, kad PV abliacija gali b\u016bti sietina su ma\u017eesniu i\u0161eminio insulto da\u017eniu. Pana\u0161\u016bs duomenys gauti Izraelyje atliktame tyrime palyginus 3 772 PV sergan\u010dius ir 969 juo sergan\u010dius pacientus, kuriems atlikta PV abliacija.<\/p>\n\n\n\n

\u0160irdies ritmo kontrol\u0117s ir kognityvini\u0173 funkcij\u0173 ry\u0161ys<\/strong><\/p>\n\n\n\n

\u017dinoma, kad PV tikrai yra susij\u0119s su pa\u017einimo funkcij\u0173 silpn\u0117jimu ir demencija.<\/p>\n\n\n\n

Klausim\u0173 apie ritmo kontrol\u0117s ir kognityvini\u0173 funkcij\u0173 s\u0105sajas kelia ir labai \u012fvair\u016bs tyrim\u0173 rezultatai. Nors medikamentinis antiaritminis gydymas retai pa\u017eeid\u017eia smegenis (insultas, praeinantysis smegen\u0173 i\u0161eminis priepuolis ar kognityvini\u0173 funkcij\u0173 silpn\u0117jimas), periproced\u016brin\u0117 rizika po PV abliacijos i\u0161lieka \u2013 labai retai galimas i\u0161eminis insultas, atlikus magnetinio rezonanso tomografij\u0105 (MRT), gali b\u016bti nustatoma besimptomi\u0173 smegen\u0173 pa\u017eeidim\u0173. Visi jie gali padidinti smegen\u0173 pa\u017eaid\u0105 ir pama\u017eu prisid\u0117ti prie kognityvini\u0173 funkcij\u0173 silpn\u0117jimo. Tiesa, tyrim\u0173 rezultatai atskleid\u0117 gana stebinan\u010di\u0173 rezultat\u0173. AXAFA-AFNET 5 tyrime \u012frodyta, kad nors net 30 proc. pacient\u0173 po pirmosios PV abliacijos (gydant antikoaguliantais) MRT rasta smulki\u0173 smegen\u0173 pa\u017eeidim\u0173. Tiriamuosius \u012fvertinus po 3 m\u0117nesi\u0173 Monrealio kognityviniu testu (angl. Montreal Cognitive Assessment<\/em>), steb\u0117tas kognityvini\u0173 funkcij\u0173 pager\u0117jimas.<\/p>\n\n\n\n

Ritmo kontrol\u0117 gali pad\u0117ti suma\u017einti su PV susijusi\u0105 embolijos, taigi ir insulto, rizik\u0105, sp\u0117jama, kad gerina smegen\u0173 kraujotak\u0105 bei med\u017eiag\u0173 apykait\u0105. Atliktas did\u017eiulis retrospektyvusis stebimasis tyrimas parod\u0117, kad PV sergantiems pacientams, kuriems buvo atlikta PV abliaicja (4 212 pacient\u0173), demencijos rizika buvo ma\u017eesn\u0117 nei t\u0173, kuriems \u0161is ritmo kontrol\u0117s metodas nepritaikytas (16 848 pacientai). Teigiami rezultatai gauti ir AXAFA studijoje. Joje steb\u0117ta teigiama koreliacija tarp ritmo kontrol\u0117s ir kognityvini\u0173 funkcij\u0173 pager\u0117jimo per 3 m\u0117nesius po 674 pacientams atliktos PV abliacijos, palyginti su baziniu lygiu. Atsitiktini\u0173 im\u010di\u0173 tyrimo AFFIRM substudijoje teigiamo ritmo kontrol\u0117s terapijos poveikio kognityvin\u0117ms funkcijoms nepasteb\u0117ta. Tiesa, rezultatai priklauso nuo daugelio veiksni\u0173, toki\u0173 kaip jau nustatyta prie\u0161ird\u017ei\u0173 kardiomiopatija, gretutin\u0117s kardiovaskulin\u0117s ligos, kurios taip pat gali pa\u017eeisti smegenis ir paskatinti i\u0161sivystyti tiek insult\u0105, tiek ir kognityvini\u0173 funkcij\u0173 silpn\u0117jim\u0105 nesergant PV.<\/p>\n\n\n\n

\u0160irdies ritmo kontrol\u0117 ir prie\u0161ird\u017ei\u0173 kardiomiopatija: s\u0105sajos<\/strong><\/p>\n\n\n\n

Terminas prie\u0161ird\u017ei\u0173 kardiomiopatija<\/em> apibendrina strukt\u016brinius, architektoninius, kontraktilinius ir elektrofiziologinius pa\u017eeist\u0173 prie\u0161ird\u017ei\u0173 poky\u010dius. \u0160i\u0105 patologij\u0105 gali sukelti \u012fvairios kardiovaskulin\u0117s ligos (pvz., arterin\u0117 hipertenzija, \u0161irdies nepakankamumas, \u0161irdies vo\u017etuv\u0173 ydos, i\u0161emin\u0117 \u0161irdies liga), cukrinis diabetas bei am\u017einiai pakitimai. PV taip pat pagreitina pagrindinius ligos patofiziologinius procesus, kartu skatindamas ir prie\u0161ird\u017ei\u0173 kardiomiopatijos vystym\u0105si.<\/p>\n\n\n\n

Kairiojo skilvelio padid\u0117jimas i\u0161 dalies yra gr\u012f\u017etamas, tod\u0117l skilvelio dydis gali normalizuotis po PV abliacijos. Nustatyta, kad ankstyva ritmo kontrol\u0117, \u012fskaitant ir PV abliacij\u0105, l\u0117tina \u0161iuos procesus, palengvina gydym\u0105 ir pagerina ilgalaikius rezultatus.<\/p>\n\n\n\n

Taigi ankstyva ritmo kontrol\u0117 gali sul\u0117tinti PV i\u0161sivystym\u0105.<\/p>\n\n\n\n

Apibendrinimas<\/strong><\/p>\n\n\n\n

Naujausi atsitiktini\u0173 im\u010di\u0173 ir stebimieji tyrim\u0173 duomenys, \u012fskaitant CASTLE-AF ir CABANA studijas, pateikia svarius argumentus, pagrind\u017eian\u010dius, kad ritmo kontrol\u0117 yra saugus \u0161iuolaikinis PV sprendimo b\u016bdas, \u012fskaitant ir senolius bei sergan\u010diuosius gretutin\u0117mis \u0161irdies ir kraujagysli\u0173 ligomis. Remiantis \u0161iais duomenims, PV abliacija, palyginti su aritminiais vaistais, yra efektyvesnis b\u016bdas sinusiniam ritmui palaikyti, ta\u010diau \u012frodyta, kad antiaritminiai vaistai turi savo ni\u0161\u0105 bei i\u0161lieka veiksmingi po atliktos PV abliacijos.<\/p>\n\n\n\n

Keletas ma\u017eesni\u0173 tyrim\u0173 parod\u0117, kad PV abliacija (stebint echokardiografu) sergantiesiems PV ir \u0161irdies nepakankamumu gali pagerinti kairiojo skilvelio funkcij\u0105. Norint patvirtinti \u0161i\u0105 hipotez\u0119, reikia atlikti daugiau ir detalesni\u0173 tyrim\u0173.<\/p>\n\n\n\n

Siekiant i\u0161siai\u0161kinti ritmo kontrol\u0117s terapijos poveik\u012f mirtims d\u0117l kardiovaskulini\u0173 prie\u017eas\u010di\u0173, sergamumui insultu, \u0161irdies nepakankamumu, \u016bminiu koronariniu sindromu, reikia atlikti i\u0161samesnius tyrimus.<\/p>\n\n\n\n

Parengta pagal Willems S, et al. Cabins, castles, and constant hearts: rhythm control therapy in patients with atrial fibrillation. Eur Heart J 2019;40:3793\u20133799c.<\/em><\/p>\n\n\n\n

Kamil\u0117 Po\u010depavi\u010di\u016bt\u0117<\/strong>
Vilniaus universiteto Medicinos fakultetas<\/p>\n\n\n\n

LITERAT\u016aRA<\/strong><\/p>\n\n\n\n

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    Senstant populiacijai sergamumas prie\u0161ird\u017ei\u0173 virp\u0117jimu (PV) did\u0117ja. Tik\u0117tina, kad per ateinan\u010dius 2\u20133 de\u0161imtme\u010dius sergamumas PV ir mir\u0161tamumas nuo jo gali padid\u0117ti 2\u20133 kartus. Net ir taikant optimal\u0173 antikoaguliacin\u012f gydym\u0105 ir kontroliuojant \u0161irdies susitraukim\u0173 da\u017en\u012f pacientai, sergantys PV, vis dar turi didesn\u0119 rizik\u0105 mirti d\u0117l kardiovaskulini\u0173 lig\u0173 ar \u0161irdies nepakankamumo. Ritmo kontrol\u0117 antiaritminiais vaistais, kardioversija, abliacija \u2013…<\/p>\n","protected":false},"author":35,"featured_media":66116,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[27322],"tags":[],"site":[],"post_item_type":[27345],"class_list":["post-66115","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ligu-gydymas"],"acf":{"post_sites":false},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/66115","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/users\/35"}],"replies":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/comments?post=66115"}],"version-history":[{"count":0,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/66115\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/media\/66116"}],"wp:attachment":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/media?parent=66115"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/categories?post=66115"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/tags?post=66115"},{"taxonomy":"site","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/site?post=66115"},{"taxonomy":"post_item_type","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/post_item_type?post=66115"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}