Журнал «Медицина неотложных состояний» Том 20, №6, 2024

Повна атріовентрикулярна блокада є небезпечним ускладненням у пацієнтів похилого віку з ішемічною хворобою серця, що потребує хірургічного лікування. Лікування пацієнтів похилого віку з ішемічною хворобою серця й атріовентрикулярною блокадою є дискутабельною проблемою, і на даний момент не існує чітких рекомендацій щодо послідовності хірургічних втручань у даної вікової групи хворих. На нашу думку, в окремих випадках доцільна епікардіальна імплантація електродів для електрокардіостимуляції під час реваскуляризації, оскільки на фоні подвійної антиагрегантної терапії, яка потрібна після аорто-коронарного шунтування, зростає ризик ускладнень під час процедури імплантації. Крім цього, такий підхід забезпечує значний соціально-економічний ефект, усуваючи потребу в повторній госпіталізації та втручанні з приводу порушення провідності серця. У даній статі подано клінічне спостереження з покроковим алгоритмом дій при багатосудинному стенозуючому ураженні коронарних артерій з повною симптоматичною атріовентрикулярною блокадою.

Complete atrioventricular block is a dangerous complication in elderly patients with coronary artery disease that requires surgical treatment. Treatment of elderly patients with coronary artery disease and atrioventricular block is a debatable problem, and at the moment, there are no clear recommendations regarding the sequence of surgical interventions in this age group. In our opinion, in some cases it is advisable to perform epicardial lead placement during revascularization, because the risk of complications during the implantation procedure increases on the background of dual antiplatelet therapy, which is required after coronary artery bypass grafting. In addition, this approach provides a significant socio-economic effect, saving a patient from re-hospitalization and intervention for conduction disorders. This article presents a clinical observation with a step-by-step algorithm of actions in multivessel coronary artery disease with complete symptomatic atrioventricular block.

ішемічна хвороба серця; атріовентрикулярна блокада; реваскуляризація; аортокоронарне шунтування; постійна кардіостимуляція; епікардіальна імплантація

coronary artery disease; atrioventricular block; revascularization; coronary artery bypass grafting; permanent pacemaker; epicardial implantations

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