Статья
Лекарственно-индуцированная фибрилляция/трепетание предсердий (ЛИФП/ТП) представляет собой серьезное и потенциально угрожающее жизни осложнение фармакотерапии. Цель работы: систематизация и анализ данных научной литературы о лекарственных средствах (ЛС), применение которых может вызвать развитие ЛИФП/ТП, а также об эпидемиологии, патофизиологических механизмах, факторах риска, клинической картине, диагностике и дифференциальной диагностике, лечении и профилактике ЛИФП/ТП. Анализ литературы показал, что многие группы ЛС могут вызывать развитие ЛИФП/ТП, с большей частотой – на фоне приема противоопухолевых ЛС, ЛС для лечения сердечно-сосудистой, бронхолегочной и центральной нервной систем. Механизмы и основные факторы риска развития ЛИФП/ТП окончательно не установлены и известны лишь для отдельных ЛС, поэтому данный раздел требует дальнейшего изучения. Основные симптомы ЛИФП/ТП обусловлены выраженностью тахикардии и их влиянием на параметры центральной гемодинамики. Для диагностики необходимо проведение электрокардиограммы (ЭКГ) и холтеровского мониторирования ЭКГ и эхокардиографии. Дифференциальный диагноз следует проводить с ФП/ТП, которые могут быть вызваны иными причинами, а также с другими нарушениями ритма и проводимости. Успешное лечение ЛИФП/ТП базируется на принципе быстрого распознавания и немедленной отмены ЛС (если это возможно), применение которого потенциально явилось причиной развития нежелательных лекарственных реакций (НЛР). Выбор стратегии ведения: контроль частоты сердечных сокращений или контроль ритма, а также способ достижения (медикаментозно или немедикаментозно) зависит от конкретной клинической ситуации. Для профилактики ЛИФП/ТП необходимо проинструктировать пациентов о возможных симптомах и рекомендовать самоконтроль пульса. Практикующим врачам важно иметь настороженность в отношении риска возникновения ЛИФП/ТП ввиду многообразия ЛС, которые потенциально могут стать причиной развития данной НЛР.
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