Turkiye Klinikleri Journal of Internal Medical Sciences

Aritmiler Özel Sayısı
Aritmilerin Güncel Tedavisi
CONTEMPORARY TREATMENT OF THE ARRHYTHMIAS
Kamil ADALETa
aKardiyoloji AD, İstanbul Üniversitesi Istanbul Tıp Fakültesi, İSTANBUL
Turkiye Klinikleri J Int Med Sci. 2005;1(15):88-109
Article Language: TR
ÖZET
 Antiaritmik ilaçlar supraventriküler ve ventriküler taşikardi (VT)lerin sonlandırılmasında oldukça etkili olmakla birlikte uzun dönemde taşiaritmileri kontrol etmedeki başarıları için aynı şeyi söylemek mümkün değildir, diğer yandan supraventriküler taşiaritmilerin bazı formlarında ve organik kalp hastalığı zemininde gelişen ventriküler taşiaritmilerde yeterince güvenli değildir. Radyofrekans kateter ablasyonu taşiaritmilerin hemen her türünde etkili ve güvenilir bir tedavi metodudur ve atriyal taşikardi, common atriyal flutter, atriyoventrikülodal nodal reentrant taşikardi, atriyoventriküler taşikardi tedavisinde ilk tedavi seçeneği olabilir. Pulmoner ven izolasyonu antiaritmik ilaçlara dirençli semptomatik atriyal fibrilasyon tedavisinde giderek en çok kullanılan ablasyon metodu olmuştur, ancak halen hastaların çoğunda değeri sınırlıdır. Ablasyon idiyopatik VTli hastaların çoğunda şifa sağlayabilir. Kateter ablasyonu, organik kalp hastalığı bulunan hastalarda gelişen VTde de oldukça yüksek oranda etkili olabilir, ancak nüks oranı yüksektir ve ilk nüks yaşamı tehdit edebilir. Bu nedenle bu tür hastalarda implante edilebilen kardiyoverter defibrilatör (ICD) ilk tedavi seçeneği olmalıdır. Katater ablasyonu yapısal kalp hastalığı bulunanlarda tamalayıcı tedavi olarak katkı sağlayabilir. ICD ayrıca yüksek riskli hastaların ani kardiyak ölümden primer korunmasında çok önemli bir rol oynar. Yeni haritalama (temassız haritalama ?ENSITE- ve üç boyutlu elektroanatomik haritalama ?CARTO-) ve görüntüleme (intrakardiyak eko, spiral bilgisayarlı tomografi, magnetik rezonans) tekniklerinin kullanılması kompleks aritmili hastalarda kateter ablasyonunun başarı şansını arttırabilir, ve önceden haritalama imkanı olmadığı düşünülen taşiaritmilerde haritalama imkanı yaratabilir. Kardiyak resenkronizasyon tedavisi, optimal medikal tedaviye dirençli konjestif kalp yetersizliği bulunan hastalarda, yaşam kalitesini düzeltebilir, egzersiz kapasitesi ve ejeksiyon fraksiyonunu attırabilir, hatta yaşam beklentisini uzatabilir.

Anahtar Kelimeler: Ablasyon, antiaritmik ilaçlar, aritmi, haritalama, implante edilebilir kardiyoverter defibrilatör, kardiyak resenkronizasyon
ABSTRACT
 The antiarrhytmic drugs are highly effective to terminate the supraventricular and ventricular tachycardias (VT), but it is not easy to say that same thing controlling tachyarrhythmias during the long term follow-up, and otherwise these drugs are not reliable for some form of supraventricular tachyarrhythmias and ventricular tachycardia in patients with organic heart disease. Radiofrequency catheter ablation is very effective and safe method to cure for nearly all kinds of tachyarrhythmias, and may be first treatment option in patients with atrial tachycardia, common atrial flutter, atrioventriculonodal reentrant tachycardia, atrioventricular reentrant tachycardia. Pulmonary vein isolation is the choice of ablation method to treat the symptomatic atrial fibrillation resistant to antiarrhythmic drugs, but it has still limited value to cure the many patients. Ablation may cure the most of patients with idiopathic VT. Catheter ablation is also highly effective, but recurrence rate of any VT following ablation procedure is high and may be life threatening in patients with organic heart disease, and implantable cardioverter defibrillator (ICD) implantation is the first treatment option. Catheter ablation may serve as an adjunctive therapy to ICD in patients with structural heart disease. ICD has also very important role for primary prevention of sudden cardiac death in high risk patients. New mapping (non-contact mapping-ENSITE-, three dimensional electroanatomic mapping ?CARTO-) and imaging (intracardiac echo, spiral CT, MR) techniques may increase the success rate of catheter ablation in patients with complex arrhythmias (scar related tachycardia, ischemic VT), and mapping may be possible to perform ablation previously considered as an unmappable tachyarrhythmias. Cardiac resynchronization therapy may improve quality of life, increase exercise capacity and ejection fraction, and even may increase survival in patients with congestive heart failure resistant to optimal medical therapy.

Keywords: Ablation, antiarrhythmic drugs, arrhythmia, cardiac resynchronization, implantable cardioverter defibrillator, mapping

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