Репозиторий Университета

© 2019, The Author(s). Background: Sudden cardiac death (SCD) refers to unanticipated death as a consequence of cardiac failure which takes place over a brief time period (typically within an hour of the commencement of symptoms) in an individual, who may or may not be known to be subject to cardiac disease, but in whom no fatal condition has been diagnosed. The objective of this investigation was to identify the potential cause of SCD in the young population in Moscow. Result: Analysis revealed that the mean age of the deceased amongst men was 24.6 years, and amongst women was 29.1 years. Seventy-six percent of sudden deaths were found to result from some previously undiagnosed pathology of the cardiovascular system, and cardiomyopathy is the most common cause of death in young people. Coronary heart disease is the most common cause of death in people above 40 years old. Conclusion: Investigation to diagnose the causes of SCD constitutes a relevant, comprehensive, and multidisciplinary undertaking, which ought to be founded upon the application of novel and current diagnostic methodologies. An integrated strategy to the quest for the underlying reason for sudden death ought to be founded upon the outcomes of biochemical, anatomical, genetic, pathophysiological, and other investigations. The search and development of objective risk factors will permit timely therapeutic intervention for patients with cardiovascular pathology to minimise and prevent the risk of sudden cardiac death.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. The article covers the development of the problem of sudden cardiac death prevention with the implantable cardioverterdefibrillators from the moment of creation of these devices to our days. The current concept of primary prevention of sudden cardiac death, based on the severity of manifestation of heart failure and left ventricular dysfunction, is not effective enough. Its practical application is difficult because it requires mass application of implantable defibrillators, with low predictive accuracy of these criteria in terms of development of lifethreatening arrhythmias. The development of methods for visualizing the myocardium, allowing to assess the severity of myocardial fibrosis, as well as the possibilities of medical genetics, at the present stage, allows us to clarify indications for implantation of cardioverterdefibrillators and thereby significantly improve the concept of preventing sudden cardiac death with these instruments.

© 2018 GEOTAR Media. All rights reserved. Aim: to value the significance of various predictors of sudden cardiac death (SCD) and clarify the selection criteria for implantation of cardioverter-defibrillators in patients with cardiomyopathies [dilated (DCM), arrhythmogenic right ventricular (ARVC), left ventricular noncompaction (LVNC)]. Material and methods. 220 patients with DCM syndrome were observed, 151 men, average age 47.5±12.5 years [mean left ventricular end-diastolic dimension (LV EDD) 6.5 [6.0, 7.1] cm, LV EF 30.3±10.1%], 50 patients with ARVC (definite diagnosis in 26 patients, probable in 13, possible in 11), 20 men, average age 38.1±14.6 years and 108 patients with a definite diagnosis of LVNC, 63 men, average age 45.4±14.8 years [mean LV ejection fraction (LF EV) 38.4±14.4%, LV EDD 5.9±0.8 cm]. The average follow-up periods were 16 [6, 37], 13.5 [4, 34] and 14 [3, 5, 36.0] months accordingly. The decision to implant the ICD / CRT-D was taken individually. The endpoints of the study were overall mortality, SCD, death + transplantation, appropriate defibrillators shocks and the "shocks + SCD". Results. The overall mortality in DCM, ARVC, and LVNC was 19.1%, 14.0% and 14.8%. It was mainly determined by terminal heart failure; SCD was recorded in 2.7%, 4.0% and 2.8%. Cardioverter-defibrillators were implanted in 66 (30%) patients with DCM (37 ICD, 29 CRT-D, 93.9% as the primary prevention of SCD), in 13 (26%) patients with ARVC (only ICD, primary prevention in 32,1%) and in 33 (30,6%) patients with LVNC (24 ICD, 9 CRTD, primary prevention in 88,1%). The frequency of appropriate shocks was 18.2% (15.0% in the primary prevention group and 50.0% in the secondary group) in patients with DCM syndrome, 69.2% (33.3% and 80.0% %) in ARVC, and 27.2% in LVNC (22.2% and 50.0%). The primary (genetic) nature of DCM (RR 1.58, OR 10.93), stable VT (RR 18, OR 26.5), and unstable VT (RR 1.43), a low QRS voltage (RR 1.75, OR 1.98), absence of LV hypertrophy signs on the ECG (RR 1.37, OR 2.56) were identified as criteria for selection for the implantation of a defibrillators in patients with DCM syndrome. In the patients with ARVC, these were a stable VT/VF and syncope (RR 4.75, OR 19), male sex (RR 1.25, OR 2), the low QRS voltage (RR 2.2, OR 10.5), chronic heart failure (OR 2.4, OR 8.0), the size of RV 2.85 cm (RR 1.55, OR 3.5), LV EDD> 5.5 cm (RR 2.1, OR 16, 7). In patients with LVNC the criteria were a stable VT/ VF, the presence of myocarditis (RR 3.3, OR 6.3), more than 500 PVBs per day (RR 3.3, OR 4.9), the low QRS voltage (RR 1,1, ОR 1,1), the follow up more than one year (RR 1,5, ОR 1,8). EF is not a statistically significant predictor of appropriate defibrillators shocks. Conclusions. In patients with various cardiomyopathies, which are accompanied by a high risk of SCD, the implantation of a cardioverter-defibrillators is an effective method of preventing SCD, including primary prevention. Due to adequate use of cardioverter-defibrillators in patients with DCM, ARVC and LVNC implanted in view of conventional and additional indications established in the study, mortality is determined primarily not by SCD, but terminal heart failure. Isolated myocarditis as the cause of DCM syndrome is not accompanied by a high risk of SCD, but its adherence to genetic cardiomyopathy determines the high risk of SCD.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. This review includes main positions of the revision of diagnostic criteria of “J-wave syndromes in the J-Wave Syndromes Expert Consensus Conference Report: Emerging Concepts and Gaps in Knowledge” (2016). The article, systematized according to the sections of the above-mentioned document, outlines the questions of terminology, new criteria for diagnosis of the Brugada syndrome (BrS) and early repolarization syndrome (ERS). The section devoted to ERS on the issues of new terminology and standardization of measurements, is supplemented with material from the Consensus Paper - The Early Repolarization Pattern (2015). The article also presents the issues of differential diagnosis in BrS, presents modulating factors, defines acquired Brugada-pattern and Brugada phenocopies. The similarities and differences between BrS and ERS are presented in a comparative aspect.