Implantabilni kardioverter defibrilator – moćno oružje u primarnoj i sekundarnoj prevenciji iznenadne srčane smrti

  • Tomislav Kostic Clinical Centre Niš, Clinic for Cardiovascular Diseases, Niš, Serbia
  • Dragana Stanojevic Military Medical Academy, †Clinic for Cardiology, Belgrade, Serbia
  • Ognjen Gudelj Military Medical Academy, Clinic for Cardiology, Belgrade, Serbia
  • Dragan Milić Clinical Centre of Serbia, Clinic for Cardiac Surgery, Belgrade, Serbia
  • Svetozar Putnik Clinical Centre of Serbia, Clinic for Cardiac Surgery, Belgrade, Serbia
  • Zoran Perisic Clinical Centre Niš, Clinic for Cardiovascular Diseases, Niš, Serbia
  • Boris Djindjic Clinical Centre Niš, Clinic for Cardiovascular Diseases, Niš, Serbia
  • Milan Pavlovic Clinical Centre Niš, Clinic for Cardiovascular Diseases, Niš, Serbia
  • Goran Koracevic Clinical Centre Niš, Clinic for Cardiovascular Diseases, Niš, Serbia
  • Mladjan Golubovic Clinical Centre Niš, Clinic for Cardiothoracic and Transplantation Surgery, Niš, Serbia
  • Vladimir Mitov Health Centre Zaječar, Serbia
  • Stefan Momcilovic Health Centre Zaječar, Serbia
  • Sanja Bankovic Clinical Centre Niš, Clinic for Cardiovascular Diseases, Niš, Serbia
DOI: https://doi.org/10.2298/VSP171003010K
Ključne reči: smrt, iznenadna, srčana, srce, insuficijencija, defibrilacija srca, defibrilatori, implantabilni, lečenje lekovima, elektrostimulator srca, mortalitet

Sažetak


Apstrakt

 

Uvod/Cilj. Iznenadna srčana smrt (ISS) jedan je od najvećih problema savremene medicine. Velike studije pokazale su da antiaritmici, uključujucći amiodaron, nisu efikasni u prevenciji ISS kod bolesnika sa srčanim oboljenjima koji su bili na medikamentnoj terapiji. Bolesnici kojima je ugrađen implantabilni kardioverter defibrilator (ICD) imali su bolje preživljavanje. Cilj ovog rada bio je da se utvrdi da li bolesnici kojima se ugrađuje ICD u primarnoj i sekundarnoj prevenciji ISS imaju duže preživljavanje u odnosu na one lečene isključivo lekovima. Metode. Uključili smo 1 260 bolesnika sa srčanom insuficijencijom i smanjenom ejekcionom frakcijom leve komore (LVEF < 35%) koji su imali povišeni rizik od maligne ventrikularne aritmije i ISS. Kod 540 bolesnika ugrađen je ICD pejsmejker. Terapija resinhronizacionim pejsmejkerom i ICD-om (CRT/ICD grupa) (n = 270) obuhvatila je bolesnike sa srčanom insuficijencijom i CRT/ICD pejsmejkerom uz optimalnu medicinsku terapiju. U kontrolnoj grupi n = 450) bili su bolesnici sa srčanom insuficijencijom (NYHA funkcionalna klasa 3–4, LVEF ≤ 35%, QRS trajanje ≥ 130 ms, na optimalnoj terapiji lekovima). Rezultati. U ICD grupi postojalo je statistički značajno povecćanje ESV (end-sistolni volumen) od 92,68 mL do 99,05 mL. U grupi bolesnika sa srčanom insuficijencijom, koji su bili na terapiji lekovima, došlo je do značajnog smanjenja LVEF (33.15% vs. 30.2%; p = 0,017), distance nakon 6 minuta hodanja [6 MVT (216,55 m vs. 203,27 m; p = 0,003)]. U istoj grupi došlo je do povećanja vrednosti ESV (90,19 mL vs. 95,41 mL; p = 0,011). Povecćanje smrtnosti u grupi bolesnika sa terapijom samo lekovima u poređenju sa smrtnošću u CRT/ICD i ICD grupi bilo je statistički značajno (p < 0.05). Zaključak. Ugradnja ICD pejsmejkera značajno smanjuje smrtnost u poređenju sa lečenjem samo lekovima. Pored toga, bolesnici koji imaju CRT uz ICD pejsmejker, imaju znatno bolji kvalitet života i povecćanje LVEF.

Reference

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Objavljeno
2021/05/11
Broj časopisa
Vol. 76 Br. 10 (2019): Vojnosanit Pregl
Rubrika
Originalni članak