Author/Editor		Vokač, Damijan; Granda, Samo; Nedog, Viljemka; Naji, Husam Franjo
Title		Nemedikamentno zdravljenje končne odpovedi srca
Translated title		Nonmedical therapy of the advanced heart failure
Type		članek
Source		In: Hojs R, editor. Zbornik prispevkov 20. srečanje internistov in zdravnikov družinske medicine "Iz prakse za prakso" ; 2009 maj 8-9; Maribor. Maribor: Univerzitetni klinični center,
Publication year		2009
Volume		str. 125-31
Language		slo
Abstract		Patients with advanced heart failure bears bad prognosis, despite modern medical treatment year mortality rate spans from 30 up to 70 %. Besides terminal heart failure the second most frequent cause is sudden death due to ventricular tachyarrhythmias as ventricular tachycardia and fibrillation. Clinical studies have presented improvement of heart function by use of biventricular stimulation of patients with advanced heart failure and intraventricular conduction defects as left bundle branch block. This method very successfully improves acute hemodynamic parameters due to resynchronization of septal and lateral wall of left ventricle and improves economy of the heart contraction. Method improves quality of life and also decreases mortality rate provided by clinical studies. Despite successful therapy mortality rate due to sudden death remains high. Cardioverters defibrillators are successful in prevention of sudden cardiac death but they do not improve quality of life of heart failure patients like resynchronization therapy. Thus, combined therapy resynchronization and cardioverter defibrillator as a single implantable device has been developed. Due to very successful combined therapy the application of biventricular cardioverters defibrillators into clinical practice has increased. Large multicentric randomized clinical trials have proved better quality of life and reduced mortality rate in both younger and aged group of patients which also represent large group of patients on resynchronization therapy. Patients on resinhronization therapy are more suitable for optimal medical therapy because they tolerate higher dosage of common heart failure medication. Because of fewer hospitalizations due to advanced heart failure in resynchronization group the method is also economically suitable kind of therapy.
Summary		Bolniki z napredovalim srčnim popuščanjem imajo slabo prognozo. Kljub sodobnemu zdravljenju z zdravili letna smrtnost znaša do 70 %, najpogostejši vzrok je končna odpoved srca in nenadna srčna smrt. Klinične raziskave so pokazale, da je pri bolnikih s hudo sistolično disfunkcijo in levokračnim blokom zelo uspešno zdravljenje prekatna resinhronizacija z uporabo biventrikularne srčne stimulacije. Metoda pomembno izboljšuje akutne hemodinamske učinke zaradi resinhronizacije krčljivosti in bolj ekonomičnega krčenja srčne mišice. Metoda bistveno izboljšuje kakovost in preživetje bolnikov. Kljub zelo uspešnemu zdravljenju je smrtnost zaradi nenadne srčne smrti še zmeraj velika. Vsadni kardioverterji defibrilatorji uspešno preprečujejo nastanek nenadne srčne smrti s prekinitvijo malignih prekatnih tahiaritmij. Zaradi tega je v zadnjem času opaziti porast resinhronizacijske terapije s kardioverterjem defibrilatorjem. Resinhronizacijska terapija z ali brez vsadnega defibrilatorja je zelo uspešna in pri pravilni indikaciji ekonomsko sprejemljiva oblika zdravljenja, pri čemer starost nad 65 let ne predstavlja nikakršne meje glede uspešnosti in izboljšanja preživetja. Bolniki na resinhronizacijski terapiji bolje prenašajo optimalno medikamentno terapijo, zaradi tega je število hospitalizacij manjše. Ta terapija je racionalna in ekonomsko uspešna.
Descriptors		DEFIBRILLATORS, IMPLANTABLE PACEMAKER, ARTIFICIAL