Treatment of polymorphic tachycardia
Author Ольга Кияница
Polymorphic tachycardia refers to malignantly violent cardiac arrhythmias, the development of which often depends on physical activity. Isoproterenol can also be used to promote an attack. The standard ECG is manifested as a ventricular tachycardia of two or more morphologies.
The risk of a polymorphic tachycardia is a high risk of heart failure. Also, on the background of an attack of the heartbeat, syncope states often occur.
The appearance of polymorphic tachycardia may be due to heredity, especially if the variant of catecholamic ventricular tachycardia is considered. It is important to understand that if timely treatment is not started, then the risk of mortality rises to 50% until 30 years.
Video Modern approaches to drug therapy for ventricular arrhythmias
Medicinal treatment of polymorphic tachycardia
First of all, patients are prescribed beta-blockers, which reduce the heart rate by affecting the beta-receptors located in the heart muscle.
Frequently used drugs for polymorphic tachycardia from the group of beta-blockers are as follows:
- Bisoprolol, he is concor.
- Nadolol is considered to be the most effective.
For each patient, the individual doses are selected, which are usually several times higher than those prescribed for patients with an elongated QT syndrome. For qualitative selection of doses ECG and Holter monitoring are used, which help to take into account the process of saturation of the body with the drug.
Effective antiarrhythmic therapy is often based on several drugs, which is why it is called combined. In severe cases, several antiarrhythmic drugs, for example, nadolol and mexiletin, can be prescribed at the same time. Such a combination helps to prevent supraventricular tachycardia, formed by trigger activity. Also, adrenoblockers are often added a remedy from another pharmacological group, to improve the general condition of the patient and metabolism in the body.
Additional remedy for beta-blockers:
- Young people may be prescribed verapamil, propafenone, eta cysine, mexiletin, lapapaconitine hydrobromide. The most commonly used amiodarone.
- For children, complex therapy is supplemented with carbamazepine.
- Metabolic agents, selected from the groups of antioxidants and antihypoxants.
- ACE inhibitors prescribed in the presence of chronic heart failure in order to improve hemodynamics.
For each drug the maximum therapeutic efficacy is determined. During the calculation of this indicator, the data on the highest severity of polymorphic tachycardia during the day are used. Just for this purpose Holter monitoring is used. If there is an intention to use amiodarone or another long-acting drug, then such a calculation is not necessary.
Interventional treatment of polymorphic tachycardia
There are certain indications for this type of therapy that is relatively common in the development of polymorphic tachycardia:
- On the background of medical treatment, syncope states arise.
- The critical sinus bradycardia, which does not allow antiarrhythmic therapy to be performed, is determined.
- The likelihood of a sudden death is preserved, for which the concentration of individual risk factors is studied.
To solve the problem with attacks of polymorphic tachycardia, the following variants of surgical treatment are considered:
- Implantation of cardioverter defibrillator - is performed in the case of syncope attacks in children who are not helped by antiarrhythmic treatment of polymorphic tachycardia of ventricular localization. In the presented device, the mode of anti-tachycardia stimulation, which helps to cope with the trigger activity causing ventricular tachycardia.
- Radiofrequency catheter ablation - This option is considered when polymorphic tachycardia is characterized by a severe recurrent course.
In some cases, implantation of the pacemaker is contraindicated, as the device may unnecessarily work. The same applies to those patients who have frequent attacks of polymorphic tachycardia, or very often develop supraventricular arrhythmias, accompanied by heart rates of 200 bw / min or more. If the situation is extremely difficult then left-sided sympathectomy may be performed, which has proved to be a fairly effective method for today.