О выборе лечения желудочковых аритмий при ишемической болезни сердца

Aim . To study trigger factors of ventricular arrhythmias (VA) in patients with stable coronary artery disease (CAD) and evaluate the effectiveness of individualized treatment. Material and methods . The study included 155 patients with CAD aged 36 to 83 years (61,5±9,8 years); 73,5% were men with frequent single and coupled ventricular ectopic complexes (VEC) and the left ventricle ejection fraction (LVEF) of 56,4±8,5%. Exclusion criteria were class IV angina, acute coronary syndrome, LV aneurysm, LVEF ≤45%. Treatment and examination of patients was carried out according to the algorithm we proposed in 2017 for managing patients with CAD and high-grade VA. Results. Depending on association between ventricular ectopy and transient myocardial ischemia (TMI) during an exercise tolerance test, patients were divided into 2 groups. Group I included 84 patients (54,2%) with ischemic VA. According to noninvasive topical diagnostics, the arrhythmogenic focus in all patients with ischemic VA was located in the left ventricle. Group II consisted of 71 (45,8%) patients with nonischemic VA, and two subgroups were distinguished depending on presence/absence of TMI: 2A and 2B. During the exercise test, several types of VA were identified. Myocardial revascularization (MR) was indicated in 84,5% of cases in both groups. Six months after MR in group I, the antiarrhythmic effect (AAE) was observed in 55 (77,5%) patients. In group IIA, AAE was significantly lower at 61,7% (p=0,048). We also revealed anxiety in 15 patients of group II. Anxiolytic therapy showed AAE in 75% of group IIA patients and in 63,6% of group IIB patients. Nine patients of group II were referred to radiofrequency ablation of VA with a positive effect of 55,5%. Antiarrhythmic drugs (amiodarone, sotalol) were taken by 5 people of group I. Conclusion. The search for trigger factors and their elimination provides a high AAE for VA therapy in patients with CAD.