Статья
ВПЕРВЫЕ ВОЗНИКШАЯ ФИБРИЛЛЯЦИЯ ПРЕДСЕРДИЙ В УСЛОВИЯХ ОСТРОГО КОРОНАРНОГО СИНДРОМА. АКТУАЛЬНЫЕ ВОПРОСЫ
Настоящий обзор посвящен теме впервые возникшей фибрилляции предсердий (ФП) в условиях острого коронарного синдрома (ОКС). Использованы источники литературы баз PubMed, Scopus. ФП часто встречается в общей популяции и в популяции ОКС, при этом выделяют впервые возникшую ФП, и ФП, бывшую на момент развития ОКС. У пожилых пациентов с хронической сердечной недостаточностью, явлениями гемодинамической нестабильности и дилатацией левого предсердия возникновение ее более вероятно. Хорошо известно о предикторах неблагоприятного исхода ОКС. Согласно некоторым данным, впервые возникшая ФП приводит к ухудшению прогноза, по другим данным причина ее сочетания с высоким уровнем летальности обусловлена тяжестью протекания ОКС, и возникновение ее не является независимым предиктором смерти. Отсутствие субъективных симптомов во время пароксизма ФП не позволяет оценить его продолжительность, и тем самым дифференцировать впервые возникший пароксизм и постоянную или персистирующую форму ФП. Удается проследить связь между ишемией миокарда и возникновением ФП. Неэффективная реперфузия во время проведения чрескожного коронарного вмешательства или тромболитической терапии сопровождается возникновением фибрилляции предсердий, напротив, при достижении эффективной проходимости сосуда она возникает реже. Впервые возникшая при ОКС, и, в частности, сопровождающаяся кардиогенным шоком, ФП требует экстренной кардиоверсии: медикаментозной или электроимпульсной. В ряде случаев проведение активной кардиоверсии не требуется, поскольку восстановление синусового ритма происходит спонтанно. Неоднозначность и многофакторность данной проблемы указывает на необходимость более детального понимания механизмов аритмогенеза и разработки инструментов для стратификации рисков возникновения ФП при ОКС.
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