Preventivna ugradnja implantabilnog kardioverter defibrilatora kod bolesnika sa ishemijskom bolešću srca i aortokoronarnim bajpasom
Preventive implantation of implantable cardioverter defibrillator in patients with ischemic heart disease and aortocoronary bypass
Докторанд
Kovačević-Kostić, NatašaМентор
Milašinović, GoranЧланови комисије
Đukić, PetarObrenović-Kirćanski, Biljana
Bumbaširević, Vesna
Arsov, Vladislav
Метаподаци
Приказ свих података о дисертацијиСажетак
Uvod: Naprasna srčana smrt (NSS) je prirodna smrt koja nastaje iz srčanih
razloga, unutar jednog sata od početka akutnih kardiovaskularnih događaja, a prethodi
joj nagli gubitak svesti. Najčešći uzrok je koronarna bolest (80%). Naprasna srčana smrt
može nastupiti u bilo koje vreme od srčanog infarkta, a usled pojave komorske
fibrilacije (VF) ili brze prolongirane komorske tahikardije (VT) koja alterira u VF.
Perioperativni srčani zastoj kod operacija na otvorenom srcu se javlja u 0,7-2,9%
bolesnika. Preživljavanje ovih bolesnika je 17-79%. Terapije beta blokatorima i
amiodaronom nije dala zadovoljavajuće rezultate u prevenciji NSS uzrokovane
malignim poremećajima ritma za razliku od profilaktičke implantacije implantabilnog
kardioverter defibrilatora (ICD). Ovo je potvrdilo nekoliko studija: Multicenter
Automatic Defibrillator Implantation Trial (MADIT), The Multi-center Unsustained
Tachycardia Trial (MUSTT), MADIT II i Sudden Cardiac Death-Heart Failure Trial
(SCD-HeFT).
U The Coronar...y-Artery Bypass Graft-Patch (CABG-Patch) studiji primarne
prevencije NSS, u koju su, kao i kod nas, uključeni bolesnici kojima je urađena hirurška
revaskularizacija miokarda i sa ejekcionom frakcijom EF≤36%, nije dokazana
povezanost preživljavanja sa implantacijom ICD-a na osnovu kumulativnih krivi
preživljavanja. Razlika između naše i CABG-Patch studije bila je u tome što su oni
intraoperativno implantirali ICD bolesnicima koristeći epikardnu „patch― elektrodu, a
mi između prvog i trećeg meseca po revaskularizaciji miokarda, plasirajući elektrodu
transvenoznim putem, endokardno.
Primarni cilj ove studije bio je da ispita da li je opšte preživljavanje duže kod
bolesnika sa ishemijskom bolesti srca, EFLV≤35%, bez predhodno registrovanih NSVT, VT i VF, a posle učinjenog aortokoronarnog bajpasa i kojima je preventivno
implantiran ICD, nego kod bolesnika sa antiaritmijskom terapijom β-blokatorima i
Amiodaronom...
Introduction: Sudden cardiac death (SCD) is a natural death from cardiac
causes happening within one hour of the onset of acute cardiovascular symptoms, and is
preceded by a sudden loss of consciousness. The most common cause of SCD is a
coronary artery disease (80%). Sudden cardiac death can develop at any time after the
acute myocardial infarction, due to the ventricular fibrillation (VF), or fast prolonged
ventricular tachycardia (VT) progressing to VF. Cardiac revascularization, either by
percutaneous coronary intervention (balloon angioplasty or stenting) or by surgical
revascularization improves cardiac function, and with that survival of patients with low
left ventricular ejection fraction (EF). Incidence of perioperative cardiac arrest after the
open heart surgery is 0,7-2,9%. Survival of these patients is 17-79%. Beta blocker
therapy, and amiodarone therapy haven’t yielded satisfying results in prevention of SCD
caused by ventricular tachyarrhythmias as has prophylactic implan...tation of ICDs. This
has been confirmed by several studies: Multicenter Automatic Defibrillator
Implantation Trial (MADIT), The Multi-center Unsustained Tachycardia Trial
(MUSTT), MADIT II and Sudden Cardiac Death-Heart Failure Trial (SCD-HeFT).
Primary prevention of SCD trial - The CABG-Patch Trial included, as our trial
did, patients with EF≤36%, that were scheduled for surgical revascularization. This trial
didn’t show correlation of survival with ICD implantation. Difference between our trial
and CABG-Patch was that in CABG-Patch trial they implanted ICD patch electrode
epicardially during CABG surgery, while we implanted ICD patch electrode
transvenously endocardially between the first and the third month after CABG surgery.
The primary aim of the study was evaluation of overall survival of patients with
IHD, EF≤35%, without prior NSVT,VT, VF and after CABG surgery with prophylactic
ICD implantation compared to overall survival of patients on conservative medical
therapy amiodarone and beta blockers...