mesЭкстремальная биомедицинаExtreme Medicine3033-89643033-8972Centre for Strategic Planning of the Federal Medical and Biological Agency10.47183/mes.2022.026mes-183Research ArticleМНЕНИЕOPINIONЗвено патогенеза ночной внезапной смерти при сердечной недостаточностиThe component of pathogenesis of sudden nocturnal death in patients with heart failureМакаровЛ. М.MakarovL. M.

Леонид Михайлович Макаров

ул. Москворечье, д. 20, г. Москва, 115409

Leonid M. Makarov

Moskvorechye, 20, Moscow, 115409,

dr.leonidmakarov@mail.ruФедеральный научно-клинический центр детей и подростков Федерального медико-биологического агентства России, Центр синкопальных состояний и сердечных аритмийРоссияFederal Scientific and Clinical Center for Children and Adolescents of the Federal Medical and Biological Agency, Center for Syncope and Cardiac ArrhythmiasRussian Federation2022271020242437476Copyright © Макаров Л.М., 20242024Макаров Л.М.Makarov L.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.extrememedicine.ru/jour/article/view/183

Основную часть группы с наибольшим риском внезапной смерти (ВС) составляют больные c хронической сердечной недостаточностью (ХСН). В большинстве случаев ВС происходит в ночное время. При этом степень ХСН и фракция выброса не всегда определяет риск именно ВС в исходе заболевания. Основываясь на анализе исследований по теме и описанных механизмов ВС, высказано мнение о возможной роли нарушенной адаптации («гиперадаптации»: QT/RR slope > 0,24) интервала QT к ЧСС у больных с ХСН, с максимальным удлинением интервала QT именно в ночное время, что может приводить к запуску жизнеугрожающих желудочковых тахиаритмий, запускающих механизм ВС при ХСН. Возможно, что выявление «гиперадаптации» QT у больных с ХСН может формировать группу повышенного риска по ВС при СН и быть дополнительным показанием в имплантации кардиовертера  дефибриллятора.

Patients with chronic heart failure (CHF) constitute the bulk of the group at the highest risk of sudden death (SD). The majority of SDs occur at night. However, CHF grade and ejection fraction do not always determine the risk of SD in the outcome of the disease. The following view has been expressed based on the research on the topic and the described mechanisms underlying SD: impaired QT interval adaptation (“hyperadaptation”: QT/RR slope > 0.24) to HR in patients with CHF who show maximum QT interval prolongation during the night, capable of triggering life-threatening ventricular tachyarrhythmias that trigger the mechanism of SD associated with CHF, can play some role. It is possible that identification of QT interval hyperadaptation in patients with CHF makes it possible to form the group at high risk of SD associated with HF and can become an additional indication for implantation of cardioverter-defibrillator.

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