transmedТрансляционная медицинаTranslational Medicine2311-44952410-5155Almazov National Medical Research Centre, Saint Petersburg, Russia10.18705/2311-4495-2017-4-2-17-28transmed-250Research ArticleСЕРДЕЧНО-СОСУДИСТЫЕ ЗАБОЛЕВАНИЯCARDIOVASCULAR MEDICINEСХЕМА ВЕДЕНИЯ ПАЦИЕНТА СО СТАБИЛЬНОЙ ИШЕМИЧЕСКОЙ БОЛЕЗНЬЮ СЕРДЦА И ЖЕЛУДОЧКОВЫМИ АРИТМИЯМИALGORITHM THE MANAGEMENT OF PATIENTS WITH STABLE CORONARY ARTERY DISEASE AND VENTRICULAR ARRHYTHMIASТатариноваАнна АндреевнаTatarinovaAnna A.

к.м.н., с.н.с. НИЛ электрокардиологии

PhD, senior researcher, laboratory of electrocardiology

antsvet.18@mail.ruТрешкурТатьяна ВасильевнаTreshkurTatiana V.

к.м.н., доц. кафедры внутренних болезней, зав. НИЛ электрокардиологии

PhD, assistant professor of department of internal diseases, head of the laboratory of electrocardiology

meinetvt@mail.ruРыньгачЕлена АлександровнаRyngachElena A.

н.с. НИЛ электрокардиологии

ул. Аккуратова, д. 2, Санкт-Петербург, Россия, 197341

researcher, laboratory of electrocardiology

Akkuratova str. 2, Saint Petersburg, 197341

elenapanova09@gmail.comФедеральное государственное бюджетное учреждение «Северо-Западный федеральный медицинский исследовательский центр им. В. А. Алмазова» Минздрава России, Санкт-ПетербургРоссияFederal Almazov North-West Medical Research Centre, Saint PetersburgRussian Federation201704062017421728Copyright © Татаринова А.А., Трешкур Т.В., Рыньгач Е.А., 20172017Татаринова А.А., Трешкур Т.В., Рыньгач Е.А.Tatarinova A.A., Treshkur T.V., Ryngach E.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://transmed.almazovcentre.ru/jour/article/view/250

К обсуждению представляется алгоритм ведения пациентов со стабильной ишемической болезнью сердца, сохранной/умеренно сниженной систолической функцией левого желудочка и желудочковыми аритмиями «высоких градаций». В основу схемы положена оценка частного клинического сценария с определением характера аритмий, основанная на международных и национальных рекомендациях. Подчеркивается важность участия вегетативной регуляции в аритмогенезе, определения топики эктопических очагов, а также коморбидных тревожно-невротических расстройств. Ключевым моментом предложенного алгоритма является улучшение качества жизни пациента и профилактика внезапной сердечной смерти.

The paper proposes the algorithm for the management of patients with stable coronary artery disease, preserved left ventricular ejection fraction and ventricular arrhythmias. Particular clinical case with the definition of arrhythmias nature is discussed in the algorithm based on international and national guidelines. In the algorithm underlined the importance to the involvement of autonomic regulation in the arrhythmogenesis, of topical diagnosis of ventricular arrhythmias and existence of anexity or distress. The key points of suggested algorithm is improve quality of life of the patient and the prevention of sudden cardiac death.

стабильная ишемическая болезнь сердцажелудочковые аритмиихолтеровское мониторированиепробы с физической нагрузкойпсиходиагностикаstable coronary artery diseaseventricular arrhythmiasHolter monitoringexercise testpsycho￾logical diagnostics¹ФГБУ «Северо-Западный федеральный медицинский исследовательский центр им. В.А. Алмазова» Министерства здравоохранения РФ, Санкт-Петербург, РоссияReferencesLown B, Wolf M. Approaches to Sudden Death from Coronary Heart Disease.Circulation/ 1971;44(1):130-142. doi.org/10.1161/01.CIR.44.1.130.Lown B, Wolf M. Approaches to Sudden Death from Coronary Heart Disease.Circulation/ 1971;44(1):130-142. doi.org/10.1161/01.CIR.44.1.130.Ryan M, Lown B, Horn H. Comparison of ventricular ectopic activiti during 24-hour monitoring and exercise testing in patients with coronary heart disease. New England J of Medicine. 1975;292:224-229.Ryan M, Lown B, Horn H. Comparison of ventricular ectopic activiti during 24-hour monitoring and exercise testing in patients with coronary heart disease. New England J of Medicine. 1975;292:224-229.Myerburg RJ, Kessler KM, Luceri RM et al. Classification of ventricular arrhythmias based on parallel hierarchies of frequency and form. Am J Cardiol. 1984 Dec 1;54(10):1355-8.Myerburg RJ, Kessler KM, Luceri RM et al. Classification of ventricular arrhythmias based on parallel hierarchies of frequency and form. Am J Cardiol. 1984 Dec 1;54(10):1355-8.Myerburg RJ, Huikuri HV, Castellanos A. Origins classification and significance of ventricular arrhythmias. In: Spooner PM, Rosen MR, eds. Foundations of Cardiac Arrythmias. New York – Basel: Marcel Dekker Inc.;2001:547-569.Myerburg RJ, Huikuri HV, Castellanos A. Origins classification and significance of ventricular arrhythmias. In: Spooner PM, Rosen MR, eds. Foundations of Cardiac Arrythmias. New York – Basel: Marcel Dekker Inc.;2001:547-569.Moss AJ, Zareba W, Hall WJ et al.; Multicenter Automatic Defibrillator Implantation Trial II Investigators. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med, 2002; 346:877–883.Moss AJ, Zareba W, Hall WJ et al.; Multicenter Automatic Defibrillator Implantation Trial II Investigators. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med, 2002; 346:877–883.Bardy GH, Lee KL, Mark DB et al. Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) Investigators. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med, 2005; 352: 225–237.Bardy GH, Lee KL, Mark DB et al. Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) Investigators. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med, 2005; 352: 225–237.Cannom DS, Prystowsky EN. Management of ventricular arrhythmias: detection, drugs, and devices. JAMA. 1999;281(2):172-179. doi:10.1001/jama.281.2.172.Cannom DS, Prystowsky EN. Management of ventricular arrhythmias: detection, drugs, and devices. JAMA. 1999;281(2):172-179. doi:10.1001/jama.281.2.172.Buxton A.E., Kirk M.M., Miehaud G.T. Current approaches to evaluation and management of patients with ventricular arrhythmias/Med. Health R.I.2001;2:58-62 PMID: 11272662.Buxton A.E., Kirk M.M., Miehaud G.T. Current approaches to evaluation and management of patients with ventricular arrhythmias/Med. Health R.I.2001;2:58-62 PMID: 11272662.Epstein A.E. ACC/AHA/HR 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalieties. J Am Coll Cardiol. 2008;51(21):1-62.Epstein A.E. ACC/AHA/HR 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalieties. J Am Coll Cardiol. 2008;51(21):1-62.Shlyakhto E.V., Arutyunov G.P., Belenkov Yu.N. et al. National Guidelines for risk identification and prevention of sudden cardiac death 2012. Klinicheskaya praktika. 2012;10:21-27. In Russian Шляхто Е.В., Арутюнов Г.П., Беленков Ю.Н. и др. Национальные рекомендации по определению риска и профилактики внезапной сердечной смерти 2012. Клиническая практика. 2012;4:1-94.Shlyakhto E.V., Arutyunov G.P., Belenkov Yu.N. et al. National Guidelines for risk identification and prevention of sudden cardiac death 2012. Klinicheskaya praktika. 2012;10:21-27. In Russian Шляхто Е.В., Арутюнов Г.П., Беленков Ю.Н. и др. Национальные рекомендации по определению риска и профилактики внезапной сердечной смерти 2012. Клиническая практика. 2012;4:1-94.Priori SG, Blomström-Lundqvist C, Mazzanti A, et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. http://eurheartj.oxfordjournals.org.Priori SG, Blomström-Lundqvist C, Mazzanti A, et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. http://eurheartj.oxfordjournals.org.Gorgels A. P., Gijsbers C., de Vreede-Swagemakers J. et al. Out-of-hospital cardiac arrest — the relevance of heart failure. The Maastricht Circulatory Arrest Registry // Eur. Heart J. 2003:24;1204–1209.Gorgels A. P., Gijsbers C., de Vreede-Swagemakers J. et al. Out-of-hospital cardiac arrest — the relevance of heart failure. The Maastricht Circulatory Arrest Registry // Eur. Heart J. 2003:24;1204–1209.Stecker E. C., Vickers C., Waltz J. et al. Population-based analysis of sudden cardiac death with and without left ventricular systolic dysfunction: two-year findings from the Oregon Sudden Unexpected Death Study // J. Am. Coll. Cardiol. 2006:47:1161–1166.Stecker E. C., Vickers C., Waltz J. et al. Population-based analysis of sudden cardiac death with and without left ventricular systolic dysfunction: two-year findings from the Oregon Sudden Unexpected Death Study // J. Am. Coll. Cardiol. 2006:47:1161–1166.Treshkur TV Clinical and electrocardiographic characteristics of ischemic ventricular arrhythmias. Vestnik Aritmologii 2002, 30: 31–9. In Russian Трешкур Т.В. Клинико-электрокардиографическая характеристика ишемических желудочковых аритмий. Вестник Аритмологии 2002, 30: 31–9.Treshkur TV Clinical and electrocardiographic characteristics of ischemic ventricular arrhythmias. Vestnik Aritmologii 2002, 30: 31–9. In Russian Трешкур Т.В. Клинико-электрокардиографическая характеристика ишемических желудочковых аритмий. Вестник Аритмологии 2002, 30: 31–9.Wittstein IS, Thiemann DR, Lima JAC, et al. Neurohumoral Features of Myocardial Strunning Due to Sudden Emotional Stress. N Eng J Med 2005; 35: 539–48.Wittstein IS, Thiemann DR, Lima JAC, et al. Neurohumoral Features of Myocardial Strunning Due to Sudden Emotional Stress. N Eng J Med 2005; 35: 539–48.Rachel Lampert, Diwaker Jain, Matthew M. Burg et al. Destabilizing Effects of Mental Stress on Ventricular Arrhythmias in Patients With Implantable Cardioverter-Defibrillators.Circulation. 2000;101:158-164.Rachel Lampert, Diwaker Jain, Matthew M. Burg et al. Destabilizing Effects of Mental Stress on Ventricular Arrhythmias in Patients With Implantable Cardioverter-Defibrillators.Circulation. 2000;101:158-164.Christian Torp Pedersen, G. Neal Kayemail, Jonathan Kalman et. al. EHRA/HRS/APHRS expert consensus on ventricular arrhythmias. Heart Rhythm. 2014;11(10):166-96. doi: 10.1016/j.hrthm.2014.07.024.Christian Torp Pedersen, G. Neal Kayemail, Jonathan Kalman et. al. EHRA/HRS/APHRS expert consensus on ventricular arrhythmias. Heart Rhythm. 2014;11(10):166-96. doi: 10.1016/j.hrthm.2014.07.024.Gilles Montalescot, Udo Sechtem, Stephan Achenbach et al. 2013 ESC Guidelines on the management of stable coronary artery disease. European Heart Journal.2013;34:2949-3003.Gilles Montalescot, Udo Sechtem, Stephan Achenbach et al. 2013 ESC Guidelines on the management of stable coronary artery disease. European Heart Journal.2013;34:2949-3003.E. V. Shlyakhto, T. V. Treshkur, T. E. Tulintseva et al. Algorithm for the management of patients with ventricular arrhythmias. Terapevticheskii arkhiv. 2015;5:106-112. In Russian. Е.В. Шляхто, Т.В. Трешкур, Т.Э. Тулинцева и др. Алгоритм ведения пациентов с желудочковыми аритмиями. Терапевтический архив.2015;5:106-11E. V. Shlyakhto, T. V. Treshkur, T. E. Tulintseva et al. Algorithm for the management of patients with ventricular arrhythmias. Terapevticheskii arkhiv. 2015;5:106-112. In Russian. Е.В. Шляхто, Т.В. Трешкур, Т.Э. Тулинцева и др. Алгоритм ведения пациентов с желудочковыми аритмиями. Терапевтический архив.2015;5:106-11Fihn S.D., Gardin J.M., Abrams J. et al. ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society Thoracic Surgeons. J.Am. Coll.Cardiol.2012; 24:44-164.Fihn S.D., Gardin J.M., Abrams J. et al. ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society Thoracic Surgeons. J.Am. Coll.Cardiol.2012; 24:44-164.Fihn S.D., Blankenship J.C., Alexander K.P. et al. ACCF/AHA/ACP/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society Thoracic Surgeons.Circulation.2014; 130:1749-1767Fihn S.D., Blankenship J.C., Alexander K.P. et al. ACCF/AHA/ACP/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society Thoracic Surgeons.Circulation.2014; 130:1749-1767Michael W. Hanson, Edward I. Morris, Salvador Borges-Neto et al. Analysis of cardiac arrhythmias during dobutamine pharmacologic stress testing in nuclear cardiology as related to the presence or absence of baseline arrhythmias Journal of Nuclear Cardiology, 4, 5, 372–378.Michael W. Hanson, Edward I. Morris, Salvador Borges-Neto et al. Analysis of cardiac arrhythmias during dobutamine pharmacologic stress testing in nuclear cardiology as related to the presence or absence of baseline arrhythmias Journal of Nuclear Cardiology, 4, 5, 372–378.D.M. Aronov, V.P. Lupanov Functional tests in cardiology.Moskva. MEDpress-inform. 2003:68-69. (In Russ.). Д.М. Аронов, В.П. Лупанов Функциональные пробы в кардиологии. Москва. МЕДпресс-информ.2003:68-69D.M. Aronov, V.P. Lupanov Functional tests in cardiology.Moskva. MEDpress-inform. 2003:68-69. (In Russ.). Д.М. Аронов, В.П. Лупанов Функциональные пробы в кардиологии. Москва. МЕДпресс-информ.2003:68-69Karpov Yu.A, Kukharchuk V.V., Lyakishev A.A. et al. Diagnosis and treatment of chronic ischemic heart disease. Klinicheskie rekomendatsii. Moskva. 2013. In Russian Карпов Ю.А, Кухарчук В.В., Лякишев А.А. и соавторы Диагностика и лечение хронической ишемической болезни сердца.Клинические рекомендации. Москва. 2013Karpov Yu.A, Kukharchuk V.V., Lyakishev A.A. et al. Diagnosis and treatment of chronic ischemic heart disease. Klinicheskie rekomendatsii. Moskva. 2013. In Russian Карпов Ю.А, Кухарчук В.В., Лякишев А.А. и соавторы Диагностика и лечение хронической ишемической болезни сердца.Клинические рекомендации. Москва. 2013Тreshkur TV, Parmon EV, Demidova MM, et al. Method for diagnosing ischemic ventricular arrhythmias in patients with coronary artery disease 2006. In Russian Трешкур Т.В. Пармон Е.В., Демидова М.М. и др. Способ диагностики ишемических желудочковых аритмий у больных ишемической болезнью сердца 2006). http://bd.patent.su/2280000-2280999/pat/servl/servlet4390.html (18 February 2017)Тreshkur TV, Parmon EV, Demidova MM, et al. Method for diagnosing ischemic ventricular arrhythmias in patients with coronary artery disease 2006. In Russian Трешкур Т.В. Пармон Е.В., Демидова М.М. и др. Способ диагностики ишемических желудочковых аритмий у больных ишемической болезнью сердца 2006). http://bd.patent.su/2280000-2280999/pat/servl/servlet4390.html (18 February 2017)Makarov L.M., Komolyatova V. N., Kupriyanova O. O. et al. Russian National recommendations on the use of techniques Holter monitoring in clinical practice. Journal of Cardiology. 2014;2(106):6—71. In Russian Макаров Л.М., Комолятова В. Н., Куприянова О. О. и др. Национальные российские рекомендации по применению методики холтеровского мониторирования в клинической практике. Российский кардиологический журнал. 2014;2(106):6—71.Makarov L.M., Komolyatova V. N., Kupriyanova O. O. et al. Russian National recommendations on the use of techniques Holter monitoring in clinical practice. Journal of Cardiology. 2014;2(106):6—71. In Russian Макаров Л.М., Комолятова В. Н., Куприянова О. О. и др. Национальные российские рекомендации по применению методики холтеровского мониторирования в клинической практике. Российский кардиологический журнал. 2014;2(106):6—71.Stephan Windecker, Philippe Kolh, Fernando Alfonso et al. 2014 ESC/EACTS GUIDELINES ON MYOCARDIAL REVASCULARIZATION. European Heart Journal. 2014.Stephan Windecker, Philippe Kolh, Fernando Alfonso et al. 2014 ESC/EACTS GUIDELINES ON MYOCARDIAL REVASCULARIZATION. European Heart Journal. 2014.Shivalkar B, Maes M, Borgers B, Ausma J, Scheys I, Nuyts J, Mortelmans L, Flameng W. Only hibernating myocardium invariably shows early recovery after coronary revascularization. Circulation 1996;94:308-15.Shivalkar B, Maes M, Borgers B, Ausma J, Scheys I, Nuyts J, Mortelmans L, Flameng W. Only hibernating myocardium invariably shows early recovery after coronary revascularization. Circulation 1996;94:308-15.Tatarinova A.A. Effect of revascularization on ventricular arrhythmias high grade and myocardial electrical instability in patients with coronary heart disease. Sankt-Peterburg; 2011. Available at: http://www.dslib.net/kardiologia/vlijanie-revaskuljarizacii-miokarda-na-zheludochkovye-aritmii-vysokih-gradacij-i.html. Accessed February 20, 2017. In Russian Татаринова А.А. Влияние реваскуляризации миокарда на желудочковые аритмии высоких градаций и показатели электрической нестабильности миокарда у больных ишемической болезнью сердца. Санкт-Петербург; 2011. Доступно по: http://www.dslib.net/kardiologia/vlijanie-revaskuljarizacii-miokarda-na-zheludochkovye-aritmii-vysokih-gradacij-i.html. Ссылка активна на 20.02.2017.Tatarinova A.A. Effect of revascularization on ventricular arrhythmias high grade and myocardial electrical instability in patients with coronary heart disease. Sankt-Peterburg; 2011. Available at: http://www.dslib.net/kardiologia/vlijanie-revaskuljarizacii-miokarda-na-zheludochkovye-aritmii-vysokih-gradacij-i.html. Accessed February 20, 2017. In Russian Татаринова А.А. Влияние реваскуляризации миокарда на желудочковые аритмии высоких градаций и показатели электрической нестабильности миокарда у больных ишемической болезнью сердца. Санкт-Петербург; 2011. Доступно по: http://www.dslib.net/kardiologia/vlijanie-revaskuljarizacii-miokarda-na-zheludochkovye-aritmii-vysokih-gradacij-i.html. Ссылка активна на 20.02.2017.A.YU. Teregulov, YU.E. Teregulov, V.A. Phadeev et al. Differential treatment of the ventricular arrhythmias induced by physical activity at patients suffering from coronary heart disease. Prakticheskaya meditsina 2013, 69 (1): 117–9. In Russian. Терегулов А.Ю., Терегулов Ю.Э., Фадеев В.А. и др. Дифференцированное лечение желудочковых аритмий, индуцированных физической нагрузкой у пациентов ишемической болезнью сердца. Практическая медицина 2013, 69 (1): 117–9.A.YU. Teregulov, YU.E. Teregulov, V.A. Phadeev et al. Differential treatment of the ventricular arrhythmias induced by physical activity at patients suffering from coronary heart disease. Prakticheskaya meditsina 2013, 69 (1): 117–9. In Russian. Терегулов А.Ю., Терегулов Ю.Э., Фадеев В.А. и др. Дифференцированное лечение желудочковых аритмий, индуцированных физической нагрузкой у пациентов ишемической болезнью сердца. Практическая медицина 2013, 69 (1): 117–9.Berntsen RF, Gunnes P, Lie M et al. Surgical revascularization in the treatment of ventricular tachycardia and fibrillation exposed by exercise-induced ischemia. Eur Heart J 1993;14:1297-1303.Berntsen RF, Gunnes P, Lie M et al. Surgical revascularization in the treatment of ventricular tachycardia and fibrillation exposed by exercise-induced ischemia. Eur Heart J 1993;14:1297-1303.Sudzinova A, Stancak B, Sedlak J et al. The effect of myocardial revascularization on malignant ventricular arrhythmias in coronary artery disease. Bratisl Lek Listy. 2009;110(4):226-32.Sudzinova A, Stancak B, Sedlak J et al. The effect of myocardial revascularization on malignant ventricular arrhythmias in coronary artery disease. Bratisl Lek Listy. 2009;110(4):226-32.Brugada J, Aguinaga L, Mont L et a. Coronary artery revascularization in patients with sustained ventricular arrhythmias in the chronic phase of a myocardial infarction: effects on the electrophysiologic substrate and outcome. J Am Coll Cardiol 2001;37:529-33.Brugada J, Aguinaga L, Mont L et a. Coronary artery revascularization in patients with sustained ventricular arrhythmias in the chronic phase of a myocardial infarction: effects on the electrophysiologic substrate and outcome. J Am Coll Cardiol 2001;37:529-33.Kuchar DL, Rskin JN, Garan H. Electrocardiographic localization of the site of origin of ventricular tachycardia in patients with prior myocardial infarction. Journal of American College of Cardiology.1989;13(4):893-903.Kuchar DL, Rskin JN, Garan H. Electrocardiographic localization of the site of origin of ventricular tachycardia in patients with prior myocardial infarction. Journal of American College of Cardiology.1989;13(4):893-903.Segal OR, Chow AW, Wong T et al. A novel algorithm for determining endocardial VT exit site from 12-lead surface ECG characteristics in human, infarct-related ventricular tachycardia. Journal of Cardiovascular Electrophysiology.2007;18(2):161-168.Segal OR, Chow AW, Wong T et al. A novel algorithm for determining endocardial VT exit site from 12-lead surface ECG characteristics in human, infarct-related ventricular tachycardia. Journal of Cardiovascular Electrophysiology.2007;18(2):161-168.L.A. Bokeriya, A.Sh. Revishvili, S.P. Golitsyn et al. Clinical guidelines for the electrophysiologic studies, catheter ablation and the use of implantable antiarrhythmic devices. 2013.http://vnoa.ru/upload/Recomend2013. In Russian. Л.А. Бокерия, А.Ш. Ревишвили, С.П. Голицын и др. Клинические рекомендации по проведению электрофизиологических исследований, катетерной абляции и применению имплантируемых антиаритмических устройств.2013.http://vnoa.ru/upload/Recomend2013L.A. Bokeriya, A.Sh. Revishvili, S.P. Golitsyn et al. Clinical guidelines for the electrophysiologic studies, catheter ablation and the use of implantable antiarrhythmic devices. 2013.http://vnoa.ru/upload/Recomend2013. In Russian. Л.А. Бокерия, А.Ш. Ревишвили, С.П. Голицын и др. Клинические рекомендации по проведению электрофизиологических исследований, катетерной абляции и применению имплантируемых антиаритмических устройств.2013.http://vnoa.ru/upload/Recomend2013M.P. Chmelevskii, S.V. Zubarev, M.A. Budanova Non-Invasive Electrocardigraphic Imaging of Ventricular Arrhythmias: from Scientific Research to Clinical Practice. Translyatsionnaya meditsina. 2015;5(34):91-103. In Russian. М.П. Чмелевский, С.В. Зубарев, М.А. Буданова Неинвазивное электрофизиологическое картирование в диагностике желудочковых аритмий: от научных исследований к клинической практике. Трансляционная медицина.2015;5(34):91-103M.P. Chmelevskii, S.V. Zubarev, M.A. Budanova Non-Invasive Electrocardigraphic Imaging of Ventricular Arrhythmias: from Scientific Research to Clinical Practice. Translyatsionnaya meditsina. 2015;5(34):91-103. In Russian. М.П. Чмелевский, С.В. Зубарев, М.А. Буданова Неинвазивное электрофизиологическое картирование в диагностике желудочковых аритмий: от научных исследований к клинической практике. Трансляционная медицина.2015;5(34):91-103Yillmaz A, Hill S, Schaufele T et al. Exercise-induced spastic coronary artery occiusion at th site of a moderate stenosis:neither Prinzmetal’s angina nor cardiac syndrome X but “Prinzmetal X”. Circulation.2010;122:570-574.Yillmaz A, Hill S, Schaufele T et al. Exercise-induced spastic coronary artery occiusion at th site of a moderate stenosis:neither Prinzmetal’s angina nor cardiac syndrome X but “Prinzmetal X”. Circulation.2010;122:570-574.Gregorini L., Marco J., Palombo C. et al. Postischemic left ventricular dysfunction is abolished by alpha-adrenergic blocking agents.J. Am. Coll. Cardiol.1998;31:992-1001.Gregorini L., Marco J., Palombo C. et al. Postischemic left ventricular dysfunction is abolished by alpha-adrenergic blocking agents.J. Am. Coll. Cardiol.1998;31:992-1001.Boldueva S. A., Leonova I. A. Primary microvascular angina (cardiac syndrome X). The controversial and unsolved issues: terminology, definitions, pathogenetic mechanisms. The Heart J. 2016;15 (4):223–234. In Russian. Болдуева С. А., Леонова И. А. Первичная микроваскулярная стенокардия (кардиальный синдром Х). Спорные и нерешенные вопросы: терминология, дефиниции, патогенетические механизмы. СЕРДЦЕ.2016;15 (4):223–234.Boldueva S. A., Leonova I. A. Primary microvascular angina (cardiac syndrome X). The controversial and unsolved issues: terminology, definitions, pathogenetic mechanisms. The Heart J. 2016;15 (4):223–234. In Russian. Болдуева С. А., Леонова И. А. Первичная микроваскулярная стенокардия (кардиальный синдром Х). Спорные и нерешенные вопросы: терминология, дефиниции, патогенетические механизмы. СЕРДЦЕ.2016;15 (4):223–234.Camici P.G., Crea F. Coronary Microvascular Dysfunction. N.Engl.J.Med. 2007; 356(8):830-840.Camici P.G., Crea F. Coronary Microvascular Dysfunction. N.Engl.J.Med. 2007; 356(8):830-840.Golitsyn S.P. Elimination of ventricular arrhythmias and reduced the risk of death: is the way in one direction? In Russian. The Heart J. 2006;1:4-11. (In Russ.). Голицын С.П. Устранение желудочковых аритмий и снижение риска смерти: всегда ли пути в одном направлении? Сердце. 2006;1:4-11.Golitsyn S.P. Elimination of ventricular arrhythmias and reduced the risk of death: is the way in one direction? In Russian. The Heart J. 2006;1:4-11. (In Russ.). Голицын С.П. Устранение желудочковых аритмий и снижение риска смерти: всегда ли пути в одном направлении? Сердце. 2006;1:4-11.Chilson D.A. Peigh P., Mahomed Y. et al., Encircling endocardial incision interrupts efferent vagal-induced prologation of endocardial and epicardial refractoriness in the dog. J.Am.Coll.Cardiol.1985:5;290-296.Chilson D.A. Peigh P., Mahomed Y. et al., Encircling endocardial incision interrupts efferent vagal-induced prologation of endocardial and epicardial refractoriness in the dog. J.Am.Coll.Cardiol.1985:5;290-296.N.Dagres, G.Hindricks Risk stratification after myocardial infarction:is left ventricular ejection fraction enough to prevent sudden cardiac death? European Heart Journal.2013:34(26);1964-1971.N.Dagres, G.Hindricks Risk stratification after myocardial infarction:is left ventricular ejection fraction enough to prevent sudden cardiac death? European Heart Journal.2013:34(26);1964-1971.Kasanuki H., Ohnishi S., Ohtuka M. et al. Idiopathic ventricular fibrillation induced with vagal activity in patients without obvious heart disease.Circulation.1997:95;2277-2285.Kasanuki H., Ohnishi S., Ohtuka M. et al. Idiopathic ventricular fibrillation induced with vagal activity in patients without obvious heart disease.Circulation.1997:95;2277-2285.Treshkur T.V., Ermilov L.P., Tikhonenko V.M. Veloergometry in the diagnosis of ventricular arrhythmias. Klinicheskaya meditsina 1988. - № 8.-С. 84-87. In Russian. Трешкур Т.В., Ермилов Л.П., Тихоненко В.М. Велоэргометрия в диагностике и оценке желудочковой парасистолии. Клиническая медицина 1988. - № 8.-С. 84-87.Treshkur T.V., Ermilov L.P., Tikhonenko V.M. Veloergometry in the diagnosis of ventricular arrhythmias. Klinicheskaya meditsina 1988. - № 8.-С. 84-87. In Russian. Трешкур Т.В., Ермилов Л.П., Тихоненко В.М. Велоэргометрия в диагностике и оценке желудочковой парасистолии. Клиническая медицина 1988. - № 8.-С. 84-87.James Beckerman, Teresa Wu, Sarah Jones et al. Exercise Test–Induced Arrhythmias Progress in Cardiovascular Diseases, Vol. 47, No. 4 (January/February), 2005: pp 285-305.James Beckerman, Teresa Wu, Sarah Jones et al. Exercise Test–Induced Arrhythmias Progress in Cardiovascular Diseases, Vol. 47, No. 4 (January/February), 2005: pp 285-305.Shlyakhto E.V., Treshkur T.V., Kapanadze S.T. When are beta-adrenoblocators medicine of choice in the ventricular arrhythmia treatment? Arterial'naya gipertenziya. 2006;2(12):149-155. In Russian. Шляхто Е.В., Трешкур Т.В., Капанадзе С.Т. Когда бета-блокаторы являются препаратами выбора в лечении желудочковых аритмий? Артериальная гипертензия. 2006;2(12):149-155.Shlyakhto E.V., Treshkur T.V., Kapanadze S.T. When are beta-adrenoblocators medicine of choice in the ventricular arrhythmia treatment? Arterial'naya gipertenziya. 2006;2(12):149-155. In Russian. Шляхто Е.В., Трешкур Т.В., Капанадзе С.Т. Когда бета-блокаторы являются препаратами выбора в лечении желудочковых аритмий? Артериальная гипертензия. 2006;2(12):149-155.Kopylov F.Iu. Psikhosomaticheskie aspekty serdechno-sosudistykh zabolevanii (gipertonicheskoi bolezni, ishemicheskoi bolezni serdtsa, fibrilliatsii predserdii): Avtoref. dis. d-ra med. nauk. M., 2009. In Russian Копылов Ф.Ю. Психосоматические аспекты сердечно-сосудистых заболеваний (гипертонической болезни, ишемической болезни сердца, фибрилляции предсердий): Автореф. дис.д-ра мед. наук. М., 2009Kopylov F.Iu. Psikhosomaticheskie aspekty serdechno-sosudistykh zabolevanii (gipertonicheskoi bolezni, ishemicheskoi bolezni serdtsa, fibrilliatsii predserdii): Avtoref. dis. d-ra med. nauk. M., 2009. In Russian Копылов Ф.Ю. Психосоматические аспекты сердечно-сосудистых заболеваний (гипертонической болезни, ишемической болезни сердца, фибрилляции предсердий): Автореф. дис.д-ра мед. наук. М., 2009Leor J, Poole WK, Kloner RA. Sudden cardiac death triggered by an earthquake. N Engl J Med 1996; 15: 334(7): 413–9.Leor J, Poole WK, Kloner RA. Sudden cardiac death triggered by an earthquake. N Engl J Med 1996; 15: 334(7): 413–9.Massimo F.Piepoli, Arno W. Hoes, Stefan Agewall et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. European Heart Journal.2016;37(29):2315-2381.Massimo F.Piepoli, Arno W. Hoes, Stefan Agewall et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. European Heart Journal.2016;37(29):2315-2381.Dargie HJ. Effect CAPRICORN Investigators. Effect of carvedilol on outcome after myocardial infarction in patients with left ventricular dysfunction: the CAPRICORN randomized trial. Lancet 2001;357: 1385-1390.Dargie HJ. Effect CAPRICORN Investigators. Effect of carvedilol on outcome after myocardial infarction in patients with left ventricular dysfunction: the CAPRICORN randomized trial. Lancet 2001;357: 1385-1390.Cardiac Arrhythmia Suppression Trial (CAST) Investigators. Preliminary report: effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. N Engl J Med. 1989;321:406-412.Cardiac Arrhythmia Suppression Trial (CAST) Investigators. Preliminary report: effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. N Engl J Med. 1989;321:406-412.The Cardiac Arrhythmia Suppression Trial-II Investigators. Effect of antiarrhythmic agent moricizine on survival after myocardial infarction: the Cardiac Arrhythmia Suppression Trial-II. N Engl J Med. 1992;327:227-233.The Cardiac Arrhythmia Suppression Trial-II Investigators. Effect of antiarrhythmic agent moricizine on survival after myocardial infarction: the Cardiac Arrhythmia Suppression Trial-II. N Engl J Med. 1992;327:227-233.Аmiodarone Trials Meta-Analysis Investigators. Effect of prophylactic amiodarone on mortality after acute myocardial and in congestive heart failure: meta-analysis of individual data from 6500 patients in randomised trials. Lancet 1997;350:1417-1424.Аmiodarone Trials Meta-Analysis Investigators. Effect of prophylactic amiodarone on mortality after acute myocardial and in congestive heart failure: meta-analysis of individual data from 6500 patients in randomised trials. Lancet 1997;350:1417-1424.Boldueva SA, Leonova IA Primary microvascular angina (cardiac syndrome X): clinical manifestations, prognosis, diagnosis, treatment. Heart: journal for practitioners physicians. 2016;15 (5):307–319. In Russian Болдуева С.А., Леонова И.А. Первичная микроваскулярная стенокардия (кардиальный синдром Х): клинические проявления, прогноз, диагностика, лечение. Сердце: журнал для практикующих врачей. 2016;15 (5):307–319.Boldueva SA, Leonova IA Primary microvascular angina (cardiac syndrome X): clinical manifestations, prognosis, diagnosis, treatment. Heart: journal for practitioners physicians. 2016;15 (5):307–319. In Russian Болдуева С.А., Леонова И.А. Первичная микроваскулярная стенокардия (кардиальный синдром Х): клинические проявления, прогноз, диагностика, лечение. Сердце: журнал для практикующих врачей. 2016;15 (5):307–319.Pauly DF, Johnson BD, Anderson RD et al. In women with symptoms of cardiac ischemia, nonobstructive coronary arteries, and microvascular dysfunction, angiotensin-converting enzyme inhibition is associated with improved microvascular function: a double-blind randomized study from the National Heart, Lung and Blood Institute Women’s Ischemia Syndrome Evaluation (WISE). Am Heart J. 2011 Oct;162 (4):678–84. 58.Pauly DF, Johnson BD, Anderson RD et al. In women with symptoms of cardiac ischemia, nonobstructive coronary arteries, and microvascular dysfunction, angiotensin-converting enzyme inhibition is associated with improved microvascular function: a double-blind randomized study from the National Heart, Lung and Blood Institute Women’s Ischemia Syndrome Evaluation (WISE). Am Heart J. 2011 Oct;162 (4):678–84. 58.Fabian E, Varga A, Picano E et al. Effect of simvastatin on endothelid Function in cardiac syndrome X patients. Am J Cardiol 2004;94:652-5.Fabian E, Varga A, Picano E et al. Effect of simvastatin on endothelid Function in cardiac syndrome X patients. Am J Cardiol 2004;94:652-5.Villano A, Di Franco A, Nerla R et al. Effects of ivabradine and ranolazine in patients with microvascular angina pectoris. Am J Cardiol. 2013 Jul 1;112 (1):8–13.Villano A, Di Franco A, Nerla R et al. Effects of ivabradine and ranolazine in patients with microvascular angina pectoris. Am J Cardiol. 2013 Jul 1;112 (1):8–13.Ryngach EA, Tatarinova AA, Ryzcova DV et al. The antiarrhythmic effect in the treatment of cardiocytoprotectors the patients with coronary artery disease and ventricular arrhythmias.Russ J of Cardiology 2016, 9 (137): 29–34. In RussianRyngach EA, Tatarinova AA, Ryzcova DV et al. The antiarrhythmic effect in the treatment of cardiocytoprotectors the patients with coronary artery disease and ventricular arrhythmias.Russ J of Cardiology 2016, 9 (137): 29–34. In RussianРыньгач Е. А., Татаринова А. А., Рыжкова Д. В. и др. В. Антиаритмические возможности кардиоцитопротекторов в лечении пациентов ишемической болезнью сердца и желудочковыми аритмиями. Российский кардиологический журнал 2016, 9 (137): 29–34.Рыньгач Е. А., Татаринова А. А., Рыжкова Д. В. и др. В. Антиаритмические возможности кардиоцитопротекторов в лечении пациентов ишемической болезнью сердца и желудочковыми аритмиями. Российский кардиологический журнал 2016, 9 (137): 29–34.Treshkur T, Panova E, Chmelevsky M et al. Determination of genesis and localization of ventricular ectopic focus in a patient with coronary artery disease. Exp Clin Cardiol.2014;20(8):2388-2394.Treshkur T, Panova E, Chmelevsky M et al. Determination of genesis and localization of ventricular ectopic focus in a patient with coronary artery disease. Exp Clin Cardiol.2014;20(8):2388-2394.

The authors declare that there are no conflicts of interest present.