This article discusses relevant aspects in the treatment of patients with COVID-19. Up-to-date information about principles for administration of statins, antithrombotics, and antiarrhythmics is presented. The authors addressed in detail specific features of reversing heart rhythm disorders in patients with coronavirus infection and the interaction of antiarrhythmic and antiviral drugs. Recommendations are provided for outpatient and inpatient antithrombotic therapy for patients with COVID-19. Issues of antithrombotic and antiviral drug interaction are discussed.
The beginning of 2020 was characterized by the development of a new coronavirus pandemic (COVID-19). Information about the epidemiology, etiology, pathogenesis, clinical and laboratory diagnostics, as well as prevention and therapy for this disease is constantly being expanded and reviewed. The COVID-19 pandemic creates the need for the emergence of new conditions of specialized care for patients with heart rhythm and conduction disorders [1]. These recommendations are intended for general practitioners, internists, cardiologists, electrophysiologists/arrhythmologists, cardiovascular surgeons, functional diagnostics doctors, anesthesiologists-resuscitators, laboratory diagnostics specialists, health care organizers in the system of organizations and healthcare institutions that provide specialized care to patients with heart rhythm and conduction disorders.
Hereditary motor and sensory type 1A neuropathy (known as Charcot-Marie-Tooth disease) is a disease of peripheral nerves characterized by symptoms of progressive polyneuropathy with preferential damage of distal extremity muscles. Damage to the cardiovascular system is extremely rare and heterogenous in this pathology. This disease is not included in the list of indications for interventional antiarrhythmic aid. We could not find in available literature a clinical description of the development of sinus node dysfunction associated with this pathology. The present clinical report presents a case of detection and successful treatment of a damage to the cardiovascular system that manifested itself as sinus node dysfunction/sick sinus syndrome in the tachy-brady variant. A combination treatment approach using radiofrequency catheter ablation, implantation of a permanent pacemaker, and antiarrhythmic therapy associated with drug and non-drug treatment of motor sensory neuropathy resulted in recovery and long-term maintenance of sinus rhythm as well as in beneficial changes in the patient’s neurological status.
Below is a case report of treatment of a patient with persistent tachysystolic atrial fibrillation (AF), chronic heart failure (CHF) with a moderately reduced left ventricular ejection fraction (EF) and patent foramen ovale (PFO) with an atrial septal aneurysm. A 58-year-old man (with body mass index of 27.8 kg/ m2) with tachysystolic persistent AF (duration 3 months) was hospitalized due to an increase in CHF symptoms (CHF functional class according to NYHA is II-III). The patient had been constantly receiving therapy in accordance with current recommendations (angiotensin receptor blockers, diuretics, beta-blockers, amiodorone and rivaroxaban). Transthoracic echocardiography showed a moderate decrease in ejection fraction (EF) (41%), an increase in the left (47 mm) and right (51x74 mm) atria. The patient underwent AF radiofrequency catheter ablation (RFA) in the left atrium, which identified PFO. The final stage of RFA was performed by external electrical cardioversion with successful restoration of sinus rhythm. Four months after RFA, despite a stable sinus rhythm, the patient maintained a moderately reduced LV EF (44%) and dilatation of the left (44 mm) and right (43x65 mm) atria. Transesophageal echocardiography revealed an aneurysmally altered atrial septum and a positive bubble test with a large number of bubbles. In accordance with current recommendations, the patient had indications for primary prevention of stroke -endovascular occlusion of the PFO, which was performed. Three months after PFO closure, the patient discontinued diuretics, amiodarone, and rivaroxaban. Combined therapy in a patient with persistent AF, with a moderately reduced EF and verified PFO, which included pathogenetic therapy for CHF, prescription of antiarrhythmic drugs, RFA of the AF substrate, and interventional closure of the PFO, made it possible to effectively control sinus rhythm, significantly reduce the manifestations of CHF and provide primary prevention of embolic disorders.
The article described a clinical case of a patient with chronic heart failure (CHF) with preserved ejection fraction (CHF-PEF) and permanent normosystolic atrial fibrillation (AF). A 73 year-old man (body mass index, 26.4 kg /m2) with permanent normosystolic AF (duration, 10 years) was hospitalized for augmenting of CHF symptoms. The patient had NYHA II-III functional class CHF and a history of long-standing arterial hypertension. The patient received chronic therapy according to the effective guidelines (angiotensin receptor blockers, diuretics, beta-blockers, and new oral anticoagulants). Transthoracic echocardiography showed a normal ejection fraction (EF) (57 %), a moderate enlargement of the left atrium (48 mm), and moderate left ventricular (LV) hypertrophy. Radiofrequency catheter ablation (RFCA) of left atrial AF was performed. For preparation to the RFCA, the patient was administered propanorm two weeks prior to the procedure. Following external electrical cardioversion (ECV) after RFCA, sinus rhythm did not recover. The patient was prescribed amiodarone, and repeat ECV was performed in a month, which resulted in successful recovery of sinus rhythm. However, due to an increase in serum thyrotropic hormone, amiodaron was replaced with the sotalol therapy (240 mg/day). This resulted in development of symptomatic sinus bradycardia and AF relapse at 3 days after ECV. A dual-chamber cardioverter defibrillator was implanted to the patient; in another three months, repeat AF RFCA was performed with successful recovery of sinus rhythm. During the cardioverter testing for one year, the patient had one more AF episode, which was stopped by external ECV. Also, a 6-hour AF episode occurred at three months after the repeat RFCA. Symptoms of CHF disappeared by the 12th month. The combination therapy administered to the patient with normosystolic permanent AF and preserved EF, which included a pathogenetic therapy for CHF, antiarrhythmic drugs, implantation of a dual-chamber ECV, two sessions of AF RFCA, and repeat external ECVs, provided considerable improvement of CHF symptoms and stable sinus rhythm during a one-year follow-up. The return to sinus rhythm after 10 years of permanent AF necessitated changing the arrhythmia diagnosis to long-standing, persistent AF.
The case history of 19-year old patient with Ebstein's anomaly and WPW syndrome, which was held surgical correction of cardiac arrhythmias by radiofrequency ablation is described. 3-year observation of patient confirmed the success of the operation – absence episodes of arrhythmia
1ÔÃÎÓ ÂÏÎ Èíñòèòóò ïîâûøåíèÿ êâàëèôèêàöèè ÔÌÁÀ Ðîññèè, Ìîñêâà 2 ÔÃÁÓ Ôåäåðàëüíûé íàó÷íî-êëèíè÷åñêèé öåíòð ñïåöèàëèçèðîâàííûõ âèäîâ ìåäèöèíñêîé ïîìîùè è ìåäèöèíñêèõ òåõíîëîãèé ÔÌÁÀ Ðîññèè, Ìîñêâà В статье описывается клинический случай рецидива пароксизмальной атриовентрикуляр ной узловой реципрокной тахикардии (АВУРТ) в варианте типичного течения (slow fast) че рез 8 лет от момента радиочастотной катетерной абляции (РЧА) «медленной части» атриове нтрикулярного соединения (АВС) по поводу пароксизмальной АВУРТ у пациентки 42 лет.Ключевые слова: пароксизмальная атриовентрикулярная узловая реципрокная тахикар дия, радиочастотная катетерная абляция, рецидив после РЧА.
RECURRENCE OF TACHYCARDIA IN 8 YEARS AFTER RADIOFREQUENCY CATHETER ABLATION OF SLOW PATHWAY OF ATRIOVENTRICULAR JUNCTIONHimiy O.V., Zhelyakov E.G., Konev A.V., Ardashev A.V.In the article the clinical case of recurrence of typical atrioventricular nodal reentry tachycardia (AVNRT) in 8 years from the moment of a radiofrequency catheter ablation of slow pathway of atri oventricular junction concerning paroxysmal AVNRT at the patient of 42 years is described.
The present report describes a 20-year old man who developed an incessant atrial tachycardia several days after snakebite. Antiarrhythmic treatment was ineffective and six months later radiofrequency ablation of atrial tachycardia was successfully performed. A chronic arrythmia was considered as manifestation of toxic-allergic myocarditis. The possible mechanisms leading to myocarditis are discussed.
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