medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2020-19-56-64medalphabet-1712Research ArticleСтатьиЛекарственно‑индуцированная атриовентрикулярная блокадаDrug-induced atrioventricular blockagesКуликоваМ. И.KulikovaM. I.

ординатор кафедры клинической фармакологии и терапии

г. Москва

Moscow

ОстроумоваО. Д.OstroumovaO. D.

д.м.н., проф., зав. кафедрой терапии и полиморбидной патологии; проф. кафедры клинической фармакологии и пропедевтики внутренних болезней

г. Москва

Moscow

КомароваА. Г.KomarovaA. G.

Moscow

ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииРоссияRussian Medical Academy for Continuing Professional EducationRussian FederationФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России; ФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский университет)» Минздрава РоссииРоссияRussian Medical Academy for Continuing Professional Education; First Moscow State Medical University n.a. I.M. SechenovRussian FederationГБУЗ г. Москвы «Городская клиническая больница имени С.П. Боткина» Департамента здравоохранения г. МосквыРоссияCity Clinical Hospital n.a. S.P. BotkinRussian Federation202002112020119Коморбидные состояния (1)5664Copyright © Куликова М.И., Остроумова О.Д., Комарова А.Г., 20202020Куликова М.И., Остроумова О.Д., Комарова А.Г.Kulikova M.I., Ostroumova O.D., Komarova A.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/1712

Атриовентрикулярные (АВ) блокады являются серьезным нарушением сердечного ритма. Одной из причин развития данной патологии может являться прием определенных лекарственных препаратов (ЛП). Таким эффектом обладает значительное число ЛП, используемых для лечения заболеваний сердечно-сосудистой системы, центральной нервной системы, общие и местные анестетики, противоопухолевые препараты и многие другие. Основным механизмом развития лекарственно-индуцированных АВ-блокад является ингибирование проводимости АВ-узла. Наиболее часто факторами риска развития лекарственно-индуцированных АВ-блокад являются прием двух и более ЛП, оказывающих ингибирующий эффект на АВ-проводимость, исходная продолжительность интервала PQ более 0,2 с, изначальная дисфункция АВ-узла, повышенная плазменная концентрация потенциального препарата-индуктора в связи с наличием заболевания почек и (или) печени, межлекарственные взаимодействия, также существуют и специфические факторы риска в отношении отдельных ЛП. Особое внимание в решении данной проблемы должно быть уделено как купированию развившегося нарушения АВ-проводимости – медикаментозному или же с использованием электрокардиостимулятора, так и его профилактике. В статье систематизированы литературные данные о лекарственно-индуцированных АВ-блокадах с целью повышения информированности практикующих врачей и пациентов об их распространенности, факторах риска, подходах к диагностике, лечению и профилактике.

Atrio-ventricular (AV) blockages are a serious violation of the heart rhythm. One of the reasons for the development of this pathology may be taking medications. This effect has a significant number of drugs used for the treatment of diseases of the cardiovascular system, central nervous system, general and local anesthetics, antineoplastic drugs, and many others. The main mechanism for the development of drug-induced AV blockades is the inhibition of AV node conduction. The most common risk factors for the development of drug-induced AV blockades are taking two and more drugs that have an inhibitory effect on AV conduction, the initial duration of the PQ interval more than 0.2 second, initial dysfunction of the AV node, increased plasma concentration of a potential inducer drug due to the presence of kidney and/or liver disease, drugdrug interactions, and specific risk factors for individual drugs. Special attention in solving this problem should be paid to both stopping the developed AV conduction disorder – medication or using an electric cardiostimulator, and its prevention. This article systematizes the literature data on drug-induced AV blockades in order to increase the awareness of practitioners and patients about their prevalence, risk factors, approaches to diagnosis, treatment and prevention.

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