A method of treating syndrome sick sinus

 

(57) Abstract:

The invention relates to medicine, namely cardiology, and for the treatment of patients with the syndrome sick sinus. To do this, in the absence of cerebral disorders/systemic circulation, and also by reducing the heart rate and increase recovery time of sinus node function less than 280 MS after medical autonomic blockade prescribed atenolol 12.5 mg 2 times a day for two weeks, then the dose is doubled. The drug continued for 6-24 months. The method allows to reduce the symptoms of circulatory failure and permanent atrial fibrillation.

The invention relates to medicine, namely to cardiology.

There is a method of treating syndrome sick sinus (SSU), which consists in the implantation of a pacemaker (Setnew A. S., Shevchenko N. M. , D. Gros, A. Dysfunction and weakness syndrome sinus node. Cardiology, 1988; 2: 5-10). It allows you to eliminate most of the patients syncopal States, to improve their quality of life.

The disadvantages of this method: invasiveness, lack of reliable impact on Ott.

Closest to the claimed method is conservative treatment of SSSU with receiving In-blocker talinolol (cardnum) (Desitin C. L., Martynova Century. N. , Lindo, I. N., Kuchinsky N. G., Chernov, E. C., Shatokhina E. Yu, A. N. R. the Use of katanuma in combination with corinfar-retard for the treatment of ectopic arrhythmias syndrome sick sinus in patients with ischemic heart disease. Therapeutic Archive, 1997; 9: 59-61). Receiving katanuma allows you to resolve a number of ectopic arrhythmias and effectively treat the background pathology (ischemic heart disease, arterial hypertension).

The disadvantages of this method: non-permanent effect, the possibility of worsening bradycardia.

The technical result of the invention is to improve the effectiveness of treatment.

The technical result is achieved by the fact that patients selected treatment for clinical indications and results of instrumental examination. Search patients with the syndrome sick sinus without rough cerebral disorders/systemic circulation (offset, SSSU) is carried out through the mass execution of Bicycle ergometry and samples with drug autonomic blockade (EBM) obsheprinyatoye ECG monitoring and transesophageal electrophysiological study. Use the following diagnostic criteria:

- minimum daily heart rate below 40 beats/min;

- maximum sinus heart rate below 140 beats per minute during intense physical activity (rapid rise on the 5th floor);

- registration breaks due to sinoatrial block II degree;

breaks other causes (postextrasystolic, postapokalistichesky, sinus arrhythmia, failure of the sinus node) with a duration of more than 1,500 MS;

the time of restoration of sinus node function after drug autonomic blockade 1600 MS and above;

- corrected recovery time of sinus node function after drug autonomic blockade not less than 525 MS.

Excluded patients with the following phenomena:

- syncopal condition or cash equivalents;

- circulatory failure or ejection fraction of the left ventricle below 40%;

- the need for pacemaker implantation;

- the weakness of the sinus node, which emerged sharply: in myocardial infarction, active rheumatic fever, myocarditis, etc.;

vegetative character sinus dysfunction;

- AV block second degree and above.

The decision to use the identified patient with SNIA data held instrumental examination:

to receiving medication only patients whose test EBM slow heart rate;

- increase recovery time of sinus node function after conducting a DHS 280 MS and more than a contraindication because of the high risk intolerance to medications.

Selected patients are prescribed In a-blocker atenolol, twice, in the starting dose of 12.5 mg/day. Further, the dose every 2 weeks increase in 2 times up to the maximum tolerated. The duration of treatment is 6 months, then re-perform the above tests. Patients even starting dose cause decompensation (syncope, dizziness, congestion, intolerance to physical activity level FC II and higher NYHA), atenolol is not appointed and sent for cardiac treatment.

Example 1. Patient K., 53, history 7453. Entered the cardiology Department for examination concerning episodes of palpitations lasting 2-3 hours, occurring several times a week. ECG: sinus rhythm, normogram, heart rate of 52 beats/min cycle ergometry: ischemic test is negative, the reaction is inappropriately low heart rate (150W - 95 BPM). Prebyterian: sinus rhythm with heart rate 35-94 BPM registered paroxysm of atrial fibrillation duration of 3.5 hours with JS 180 BPM, postapokalistichesky pause 2210 milliseconds. Transesophageal electrophysiological study: after EBM WFSU 1810 MS, CWFS 625 MS, TV 125 beats/min Diagnosed Hypertension II syndrome sick sinus (bradycardia - tachycardia) in the stage of compensation. He was appointed atenolol dose of 25 mg/day and arifona 2.5 mg/day, duration of admission was 19 months, after which re-examination. Holter monitoring: sinus rhythm with heart rate 38-96 BPM registered several intermittent paroxysmal atrial fibrillation with CIS 135 beats/min, maximum postapokalistichesky pause 2180 milliseconds. Transesophageal electrophysiological study: after EBM WFSU 1840 MS, CWFS 605 MS, TV 110 beats/min Clinical data: the control of hypertension is adequate, heart attacks do not bother, dizziness no.

Example 2. Patient S., 56 years history 2561. Entered the cardiology Department for examination concerning episodes of vertigo. ECG: sinus rhythm, normogram, heart rate of 50 beats/min cycle ergometry: ischemic test is negative, the reaction is inappropriately low heart rate (125W - 71 BPM).the second monitoring: sinus rhythm with heart rate 31 - 84 beats/min, documented a few episodes of the slide shaft rhythm with heart rate 36-38 beats/min, the maximum recorded pause 2830 milliseconds. Transesophageal electrophysiological study: after EBM WFSU 2140 MS, CWFS 670 MS, TV 130 beats/min Diagnosis: ischemic heart disease, atherosclerotic cardiosclerosis diffuse syndrome sick sinus at the stage of subcompensation. Due to the presence of dizziness atenolol has not been appointed, the patient took theopack 400 mg/day and aspirin 75 mg/day. After 6 months hospitalized again due to the occurrence of syncopal States. Holter monitoring: stem rhythm periodically alternates with sinus rhythm, heart rate 25-61 beats/min, maximum pause 3210 MS (was accompanied by a transient disturbance of consciousness). Transesophageal electrophysiological study: after EBM WFSU 2890 MS, CWFS 1010 MS, TV 120 beats/min. the Patient is directed to the implantation of the FORMER.

Using the proposed method of treatment in patients with the syndrome sick sinus in the stage of compensation will reduce among them the frequency of occurrence of circulatory failure from 37.5% to 10.7% (p=0.02) and permanent atrial fibrillation from 41.7 to 14.3% (p=0.03) for 6-24 months, to reduce consumption is (postinfarction cardiosclerosis, hypertension, ventricular arrhythmia physical activity), to reduce the number of cases of bradycardia-induced In-blocker; to improve the quality of life for this group of patients.

A method of treating syndrome sick sinus involving the introduction of a-blocker, characterized in that the as-blocker use atenolol and prescribe it for patients who have no symptoms of the disorder cerebral/systemic circulation, and after the medical autonomic blockade decreases heart rate and recovery time of sinus node function increases by less than 280 MS, at a dose of 12.5 mg in the morning and evening daily orally for 2 weeks, then increase the dose to 25 mg 2 times per day rate 6-24 months.

 

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