Modern opportunities for treatment of patient having chronic heart failure with low ejection fraction

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Аннотация

Worldwide, the prevalence of chronic heart failure (CHF) is increasing every year, representing a serious medical and social problem. Medicinal drugs can help manage the symptoms of CHF and improve the prognosis in patients, but often the use of drug therapy alone may not be enough. Modern approaches to the treatment of CHF with low ejection fraction (CHFnEF), in addition to drug therapy, also include the use of various electrophysiological methods: implantation of cardioresynchronizing devices, cardioverter defibrillators, interventional treatment of arrhythmias. Article presents an analysis of a clinical case of successful treatment of a comorbid patient with severe CHFrEF using optimal drug therapy, as well as such interventional cardiac surgical interventions as implantation of a cardioresynchronization device with defibrillator function and radiofrequency ablation of arrhythmogenic heart zones.

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Авторлар туралы

Grigory Roitberg

JSC «Meditsina» (Clinic of Academician Roitberg); N.I. Pirogov Russian National Research University of the Ministry of Healthcare of Russia

Хат алмасуға жауапты Автор.
Email: contact@medicina.com
ORCID iD: 0000-0003-0514-9114

MD, professor, academician of RAS, head of the Department of therapy, general medical practice and nuclear medicine of the Faculty of additional professional education; head

Ресей, Moscow; Moscow

Andrey Ardashev

M.V. Lomonosov Moscow State University

Email: ardashev@yahoo.com
ORCID iD: 0000-0003-1908-9802

MD, professor, Medical Scientific and Educational Center

Ресей, Moscow

Evgeniy Zhelyakov

JSC «Meditsina» (Clinic of Academician Roitberg)

Email: zheleu@rambler.ru
ORCID iD: 0000-0003-1865-8102

PhD in Medical Sciences, associate professor of the Department of cardiovascular surgery of the Faculty of additional professional education

Ресей, Moscow

Natalya Kondratova

JSC «Meditsina» (Clinic of Academician Roitberg); N.I. Pirogov Russian National Research University of the Ministry of Healthcare of Russia

Email: kondratova@medicina.ru
ORCID iD: 0000-0003-2421-0558

MD, professor of RAS, professor of the Department of therapy, general medical practice and nuclear medicine of the Faculty of additional professional education; head of hospital

Ресей, Moscow; Moscow

Larisa Merzyavko

JSC «Meditsina» (Clinic of Academician Roitberg)

Email: larisa.konst@gmail.com

doctor of functional diagnostics

Ресей, Moscow

Natalya Ponkina

N.I. Pirogov Russian National Research University of the Ministry of Healthcare of Russia

Email: bauhaus33@yandex.ru

resident of the Department of therapy, general medical practice and nuclear medicine of the Faculty of additional professional education

Ресей, Moscow

Irina Slastnikova

N.I. Pirogov Russian National Research University of the Ministry of Healthcare of Russia

Email: slastid@mail.ru
ORCID iD: 0000-0002-4076-2849

PhD in Medical Sciences, associate professor of the Department of therapy, general medical practice and nuclear medicine of the Faculty of additional professional education

Ресей, Moscow

Denis Sokolov

JSC «Meditsina» (Clinic of Academician Roitberg)

Email: sokolovdv@medicina.ru
ORCID iD: 0000-0002-5120-4594

PhD in Medical Sciences, cardiologist

Ресей, Moscow

Әдебиет тізімі

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2. Fig.1. Electrocardiogram of patient L. from 2018

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3. Fig.2. Ventricular tachycardia No. 1 registered in patient L. during Holter monitoring of electrocardiography in 2020

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4. Fig.3. 12-lead surface electrocardiogram against the background of three-chamber cardiac stimulation after restoration of sinus rhythm in patient L. QRS complex width 140 ms (initial QRS duration-150 ms)

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5. Fig.4. 12 leads of a surface electrocardiogram against the background of clinical ventricular extrasystole (Fig. 4.1. panel A) and stimulation mapping of clinical ventricular tachycardia No. 1 (Fig. 4.2. panel B) in the area of the free wall of the myocardium, closer to the posterolateral regions, at the border of the basal and middle third left ventricle

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6. Fig.5. Three-dimensional amplitude reconstruction of the left atrium (front view), performed for patient L. using a non-fluoroscopic mapping system during radiofrequency ablation of atrial fibrillation

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7. Fig.6. 12 leads of a surface electrocardiogram during ventricular tachycardia No. 2 (horizontal electrical axis of the heart, QRS configuration according to the type of right bundle branch block, QRS duration - 196 ms, transition zone V6, tachycardia cycle length 490 ms)

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8. Fig.7. Sustained ventricular tachycardia No. 3 due to the circulation of the excitation front along the legs of the bundle of His (bundle branch re-entery)

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