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Современная стратегия лечения фибрилляции предсердий: трудный путь к «доказательству аксиомы»

DOI: https://doi.org/10.29296/25877305-2022-07-02
Номер журнала: 
7
Год издания: 
2022

С.Г. Канорский, доктор медицинских наук, профессор
Кубанский государственный медицинский университет, Краснодар
E-mail: kanorskysg@mail.ru

Фибрилляция предсердий (ФП) снижает работоспособность пациентов, а также повышает уровень заболеваемости и смертности. В исследованиях, завершившихся в начале XXI в., не удалось установить преимущества стратегии лечения ФП, направленной на восстановление и поддержание синусового ритма, в сравнении со стратегией урежения частоты желудочковых сокращений при сохраняющейся ФП. Вследствие чего на протяжении двух десятилетий в терапии пациентов с ФП предпочтительным был отказ от восстановления синусового ритма. Совершенствование медикаментозной терапии и методов катетерной аблации позволяют снижать риск неблагоприятных сердечно-сосудистых исходов с помощью стратегии раннего контроля синусового ритма при ФП. В обзоре представлены наиболее интересные результаты современных клинических исследований и рекомендации в отношении различных способов лечения ФП, данные об эффективности и безопасности антиаритмической лекарственной терапии, катетерной аблации, в том числе полученные при их непосредственном сравнении. Обсуждены проблемы применения стратегии контроля синусового ритма у пациентов с ФП и сердечной недостаточностью, риск и выгода лечения антиаритмическими препаратами IC и III классов. В будущем широкое применение активно развивающейся терапии с целью контроля синусового ритма поможет пациентам с ФП снизить тяжесть симптомов и частоту осложнений данной аритмии.

Ключевые слова: 
кардиология
фибрилляция предсердий
антиаритмические препараты
катетерная аблация
контроль синусового ритма

Для цитирования
Канорский С.Г. Современная стратегия лечения фибрилляции предсердий: трудный путь к «доказательству аксиомы» . Врач, 2022; (7): 9-17 https://doi.org/10.29296/25877305-2022-07-02


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