TACHYARRHYTHMIAS AND WAYS TO RESOLVING THEM

Аннотация

Tachyarrhythmias are a group of heart rhythm disorders characterized by rapid heartbeat (HR over 100 bpm). They can be of both supraventricular and ventricular origin, ranging from benign to life-threatening forms. This article discusses the main types of tachyarrhythmias, their pathophysiology, clinical manifestations, diagnostic methods, as well as modern approaches to drug and interventional therapy. Keywors: tachyarrhythmia, supraventricular tachycardia, ventricular tachycardia, ablation, antiarrhythmics, heart rate. Introduction. Tachyarrhythmias are a form of arrhythmia in which the heart rate is abnormally high. These disorders can be episodic or constant, symptomatic or asymptomatic, and have varying degrees of life-threatening effects. Their timely diagnosis and correct treatment are critically important, especially in structural heart diseases. With the development of cardiology, new effective methods for monitoring and eliminating tachyarrhythmias have emerged, including radiofrequency ablation, modern antiarrhythmic drugs, and devices such as implantable cardioverter- defibrillators (ICDs). Classification of tachyarrhythmias Supraventricular tachyarrhythmias (SVT) Sinus tachycardia Physiological response to stress, anemia, thyrotoxicosis, etc. Paroxysmal supraventricular tachycardia (PSVT) Occurs as a result of re-entry mechanisms (eg, AV nodal reciprocating tachycardia) Atrial fibrillation Ordered atrial activity with heart rate ~250–350/min Atrial fibrillation (AF) Chaotic electrical activity of the atria (discussed separately in other works) Ventricular tachyarrhythmias Ventricular tachycardia (VT) Potentially life-threatening condition, especially in coronary artery disease, cardiomyopathy Ventricular fibrillation (VF) The cause of most sudden cardiac deaths https://scientific-jl.com/wsrj 1 3 2 Volume-40_Issue-1_June-2025 World scientific research journal Polymorphic ventricular tachycardia (including torsades de pointes) Associated with prolongation of the QT interval Pathophysiology of tachyarrhythmias Basic mechanisms: 1. Increased automatism - for example, with sinus tachycardia 2. Trigger activity - postdepolarizations, especially with prolonged QT 3. Re-entry (repeated entry of the excitation wave) is the most common mechanism of SVT and VT Predisposing factors: Electrolyte disturbances Myocardial ischemia Structural changes (hypertrophy, fibrosis) Genetic syndromes (Brugada, long QT) Diagnostics Diagnosis of tachyarrhythmia includes: ECG (at rest, under load, daily monitoring) EFS (electrophysiological study) - invasive rhythm mapping Laboratory tests - to exclude metabolic causes Echocardiography - to assess structural abnormalities Cardiac MRI - if myocarditis or cardiomyopathy is suspected Clinical manifestations Symptoms depend on the type of tachyarrhythmia and the presence of concomitant diseases: Heartbeat Dyspnea Chest pain Fainting Dizziness In severe cases, cardiac arrest Approaches to the treatment of tachyarrhythmias Non-drug assistance Treatment of PSVT: Valsalva maneuver, carotid sinus massage Cardioversion: for hemodynamic instability or VF Defibrillation: for VF, unstable polymorphic VT Drug therapy Antiarrhythmic drugs Class I - sodium channel blockers (propafenone, flecainide) Class II - β-blockers (metoprolol, bisoprolol) Class III - potassium channel blockers (amiodarone, sotalol) Class IV - calcium channel blockers (verapamil, diltiazem) https://scientific-jl.com/wsrj 1 3 3 Volume-40_Issue-1_June-2025 World scientific research journal The choice depends on the type of arrhythmia, the presence of coronary artery disease, LV function and concomitant conditions. Additional funds: Magnesium - for torsades de pointes Anticoagulants - for atrial fibrillation/flutter Correction of electrolytes - potassium, magnesium Invasive treatment methods Catheter ablation Indications: refractory PSVT, atrial flutter, VT in ICM High efficiency (up to 95% with PSVT) Methods: radiofrequency, cryoablation Implantable devices ICD - in case of previous VF or VT with high risk CRT (cardiac resynchronization therapy) - for CHF and blocks with AF/VT Portable rhythm recorders - for seizure diagnosis Specific syndromes and their therapy WPW (Wolff-Parkinson-White) syndrome The reason is the additional path (Kent's bundle) Risk: atrioventricular tachycardia, AF with transition to the ventricles Treatment: Ablation of the accessory pathway Long QT syndrome Hereditary or drug-induced Risk of torsades de pointes Treatment: beta blockers, QT correction, ICD for high risk Brugada syndrome Congenital disorder with high risk of VF Diagnosis: specific changes on ECG Treatment: ICD, avoidance of triggers Prevention and rehabilitation Correction of arterial pressure, CHF, ischemic heart disease Treatment of the underlying disease Elimination of provoking factors: alcohol, stimulants, stress Continuous monitoring and correction of therapy Patient-centered education Conclusion. Tachyarrhythmias are a diver