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Синдром слабости синусового узла и мерцательная аритмия

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NEIAe?II NEAAINOE NEIONIAIAI OCEA

Neiae?ii neaainoe neioniaiai ocea (NNNO) – ia?ooaiea ooieoeee
neioniaiai ocea i?iyaeythuaany a?aaeeea?aeeae e nii?iaiaeaeathueie a?
a?eoieyie.

Nouiinoue neiae?iia ninoieo a o?aaeaiee na?aea/iuo nie?auaiee ec-ca
ia?ooaiey oi?ie?iaaiey eiioeuena neioniaui oceii, eee ia?ooaiey aai
i?iaaaeaiey e i?aaena?aeeyi. Oaeei ia?acii, neiae?ii aeeth/aao eae
nianoaaiii neioniaoth a?aaeeea?aeeth, oae e neiiao?eaeueioth aeieaaeo II
noaiaie. I?iyaeaiey e oneiaey aicieeiiaaiey yoeo ninoiyiee noiaee,
iiyoiio eo iau/ii ia ?acaeaeytho. A?aaeeea?aeey i?e NNNO /anoi
nii?iaiaeaeaaony a?eoieyie aicieeathueie a ?acoeueoaoa aeoeaecaoeee
ieaeaeaaeaueo ioaeaeia i?iaiaeyuae nenoaiu na?aeoea, eioi?ua ia?anoatho
eiio?iee?iaaoueny eiioeuenaie neioniaiai ocea.

I?e/eiu ia?ooaiey ?eoiii?iaeooee?othuae aeoeaiinoe neioniaiai ocea
iiaeii ?acaeaeeoue ia ia?ae/iua, iaoneiaeaiiua i?aaie/aneei ii?aaeaieai
naiiai ocea, e aoi?e/iua iaoneiaeaiiua yeno?aea?aeeaeueiuie i?ioeannaie.

Ia?ae/iia ii?aaeaiea NO /aua anaai aicieeaao i?e EAN, a?oa?eaeueiuo
aeia?oaiceyo, ii?ieao, ieiea?aeeoao, aaiio?iiaoica, iia?aoeeyo ia
na?aeoea, iniaaiii n eniieueciaaieai eneonnoaaiiiai e?iaiia?auaiey.
Anoue aeaiiua, /oi NNNO aicieeaao i?e eioa?eoa ieiea?aea a 5% neo/aaa,
/aua i?e eioa?eoa caaeiae noaiee, e?iainiaaaeaaiie, eae e NO, i?aaie
ei?iia?iie a?oa?eae.

E aoi?e/iui i?e/eiai ia?ooaiey aeayoaeueiinoe NO ioiinyo:

Iiauoaiea aeoeaiinoe aeoaeaeathuaai ia?aa eee /oanoaeoaeueiinoe e aai
aeeyieth eioi?ua iiaoo aicieeiooue o nii?oniaiia o?aie?othueony ia
auiineeainoue, a oaeaea i?e caaieaaaieyo ai?oaie, ieuaaiaea, iiauoaiiii
aioo?e/a?aiiii aeaaeaiee, yiioeeyo oaeeo eae no?ao, aieue.

Ia?ooaiey aaiinoaca: iiauoaiea a e?iae o?iaiy E, Na, iaoaie/aneay
aeaeoooa, aeiioa?eic, aiaiey.

I?eiaiaiea eaea?noaaiiuo n?aaenoa o?aaeathueo na?aea/iua nie?auaiey:
(-aeieaoi?ia, aeieaoi?ia eaeueoeeaauo eaiaeia, na?aea/iuo aeeeiceaeia.

Eeeie/aneea i?iyaeaiey NNNO aicieeatho a ?acoeueoaoa ?aceiai
nieaeaiey ieiooiiai iau?ia na?aeoea aicieeathuai i?e au?aaeaiiie
a?aaeeea?aeee. Oae eae aieiaiie iica yaeyaony iaeaieaa /oanoaeoaeueiui e
aeiienee i?aaiii e ia?aui ?aaae?oao ia ia?, oi eeeieea ino?i aicieeoeo
a?aaeeea?aeee e anenoieee en/a?iuaaaony i?iyaeaieyie iicaiaie eoaiee a
aeaea aieiaie?oaeaiee, iaii?ieia, aieioue aei ?acaeoey neiae?iia
Ii?aaiuee – Aaeaina – Noiena (aanniciaoaeueiiai ninoiyiey n noaei?iaaie)
/anoi i?eaiaeyuaai e nia?oe. Au?aaeaiiinoue yoeo neiioiiia caaeneo io
enoiaeiiai o?iaiy iicaiaiai e?iainiaaaeaiey. Ecaanoiu neo/ae eiaaea o
aieueiuo ionoonoaiaaee anyeea neiioiiu i?e iieiie anenoieee a oa/aiea 15
naeoiae e iiyaeyeinue eeoue e?aeia aieiaie?oaeaiea i?e anenoieee
aeeeaoaeny 30 naeoiae. I?e aeeeoaeueiie iinoiyiiie a?aaeeea?aeee
aiciiaeii aicieeiiaaiea ei?iia?iie iaaeinoaoi/iinoe, ieeaio?ee,
aeoeaecaoeey yeoiie/aneeo i/aaia ?eoia.

Ec aeiiieieoaeueiuo enneaaeiaaiee i?eiaiytho:

Nooi/iia iiieoi?e?iaaiea YEA (iniaaiii eiaaea auyaeaiu e eeeie/aneea
i?eciaee, e i?eciaee neioniaie a?aaeeea?aeee, ii ia onoaiiaeaia naycue
iaaeaeo ieie)

?eoiia?aoey n i?oinoaoe/aneie i?iaie (a?aoe/aneay aecoaeecaoeey
eioa?aaeia RR a aeaea oo?eoia ?aciie aeeeiu)

Iannaae ea?ioeaeiiai neiona, i?iaa Aaeuenaeueau.

I?iao n oece/aneie iaa?oceie (o no?aaeathueo NNNO *NN iiauoaaony
ia?aie/aii, aei 60 – 70 oae. a ieiooo)

Ecia?aiea a?aiaie ainnoaiiaeaiey ooieoeee neioniaiai ocea, iieacuaathuaa
a?aiy iaiaoiaeeiia aeey ainnoaiiaeaiey nianoaaiiiai ?eoia iinea
i?ae?auaiey /anoie noeioeyoeee i?aaena?aeee. O caei?iauo yoi a?aiy
ninoaaeyao 1,2 – 1,49 nae. , a o no?aaeathueo NNNO iii iiaeao
oaaee/eaaoueny aei 3 – 5 naeoiae.

Ea/aiea i?e ionoonoaee eeeie/aneeo i?iyaeaiee iiaeii ia?aie/eoue
oa?aieae iniiaiiai caaieaaaiey, /oi eiiaaea aea?o oi?ioea ?acoeueoaou,
iai?eia? i?ioeaiainiaeeoaeueiay oa?aiey i?e ieiea?aeeoa.

I?e aeieacaiiie nayce eeeie/aneeo i?iyaeaiee n a?aaeeea?aeeae,
oaeeeiaiee a?aiaie ainnoaiiaeaiey ooieoeee neioniaiai ocea aei 3 – 5
naeoiae, ?acaeoee o?iie/aneie na?aea/iie iaaeinoaoi/iinoe, ?ao?aeoa?iuo
iaaeaeaeoaei/eiauo oaoeea?aeeyo iieacaii aaeeaeaiea ea?aeeinoeioeyoi?a
?aaioathuaai a ?aaeeia “demand” o.a. aaia?e?othuai eiioeuenu oieueei i?e
iaaeaiee *NN aei e?eoe/aneiai o?iaiy.

Eaea?noaaiiay oa?aiey iaeiyooaeoeaia. I?e iiauoaiiie aeoeaiinoe
aeoaeaeathuaai ia?aa e ioeaca aieueiiai io ea?aeeinoeioeyoeee i?eiaiytho
yooeeei 0,45 – 0,9 a./noo., ai?annei 50 – 150 ia/noo. I?e ineiaeiaiee
a?aaeeea?aeee ia?oeaieai i?aaena?aeee, aioo?eaaiii aaiaeyo na?aea/iua
aeeeiceaeu n iiiiuueth eioi?uo eoie?otho i?enooi, eee, oioy au
eiio?iee?otho *NN. Aa?aiaiee e iaceaeai a yoii neo/aa i?eiaiyoue iaeuecy
oae eae iie i?eaiaeyo e au? aieueoaio oaiaoaieth neioniaiai ocea.

IA?OeAOAEUeIAss A?EOIEss I?AAeNA?AeEE

Iiae oa?ieiii “ia?oeaoaeueiay a?eoiey i?aaena?aeee” iauaaeeiytho
o?aiaoaiea i?aaena?aeee (/anoua, ii ?aaoey?iua eo nie?auaiey) e
ia?oeaiea (/anoua, ia?aaoey?iua nie?auaiey).

Yoe aeaa aeaea ia?ooaiey na?aea/iiai ?eoia /anoi ia?aoiaeyo ae?oa a
ae?oaa. Aiciiaeiu neooaoeee, eiaaea i?ienoiaeeo ia?oeaiea iaeiiai e
o?aiaoaiea ae?oaiai i?aaena?aeey, eee ia?ooaaony ?eoi oieueei a iaeiii
i?aaena?aeee.

O?aiaoaiea i?aaena?aeee.

I?e/eiaie aicieeiiaaiey o?aiaoaiey i?aaena?aeee neoaeao:

a 60-80% neo/aaa – ?aaiaoeci, iniaaiii nii?iaiaeaeathueeny ieo?aeueiui
ii?ieii, a?oa?eaeueiay aeia?oaicey, EAN

a 10-15% neo/aaa yoi oe?aioieneeic, eaai/iia na?aeoea, ia?eea?aeeo,
AeIII, ea?aeeiieiiaoee, i?eai aeeiaiey (aeaaea iaeiie?aoiue)

a 21-5% neo/aaa iaoieiaey iineo eciee?iaaiiue eaeeiiaoe/aneee oa?aeoa?.
Eiiaaea o?aiaoaiea aicieeaao i?e eioa?eoa ieiea?aea, o?iiaiyiaieee
eaai/iie a?oa?ee.

Iaoaieci aicieeiiaaiey o?aiaoaiey iauyniytho aica?aoii
aicaoaeaeaiey ii aieueoiio e?oao (iaaeaeo i?aaena?aeeyie) e
aicieeiiaaieai yeoiie/aneiai i/aaa aicaoaeaeaiey aneaaenoaea
oee?eoeyoeee eiioeuena ii iaeiio e?oao (iaaeaeo ninaaeieie aieieiaie).

Eeeie/aneay ea?oeia ai iiiaii caaeneo io /anoiou nie?auaiey
aeaeoaei/eia e eo i?aaeeueiinoe. A caaeneiinoe io yoiai aieueiie iiaeao
iuouaoue na?aeoeaaeaiea ?acee/iie noaiaie oyaeanoe, aoaeao iaiyoueny
eioaineaiinoue I oiia, ?aaeno?e?iaaoueny iai?aaeeueiue ioeuen e aai
aeaoeoeeo, ioeuenaoeey oaeiuo aai.

Ia YEA coaaoe ? ionoonoaoao, aeaeiu i?aaena?aeiua aieiu,
aicieeathuea n /anoioie 200-350 a ieiooo, n ?aaiuie i?iiaaeooeaie e
ionoonoaeai eciyeaeo?e/aneie eeiee iaaeaeo aieiaie. Eioa?aaeu RR
iaeeiaeiau i?e i?aaeeueiie oi?ia o?aiaoaiey e ioee/athony i?e
iai?aaeeueiie oi?ia.

Ea/aiea i?iaiaeeony n iiiiuueth iaaeeeaiaioia, yeaeo?e/aneie
noeioeyoeee e aeaoea?eeeyoeee.

Iaeaieaa yooaeoeaiui n?aaenoaii yaeyaony iiaieaeiaieae. Aai aaiaeyo
aioo?eaaiii ni nei?inoueth 50-100 ia/iei. aei aeinoeaeaiey yooaeoa eee
aeicu 1 a. A iaiaa n?i/iuo neo/ayo iiaeii i?eieiaoue oeieaeei aei
noiia?iie aeicu 1,2 – 1,6 a. Yoe i?aia?aou iiaoo niinianoaiaaoue
oeo/oaieth AA i?iaiaeeiinoe e oiaaea ?acei aic?anoaao /anoioa nie?auaiee
aeaeoaei/eia. A yoii neo/aa neaaeoao i?eaaaiooue e yeaeo?e/aneie
aeaoea?eeeyoeee.

Yeaeo?e/aneay aeaoea?eeeyoeey – iaeaieaa auno?ue e yooaeoeaiue
iaoiae i?ae?auaiey o?aiaoaiey i?aaena?aeee. Iau/ii ia/eiatho n ?ac?yaea
iiuiinoueth a 25-50 eAeae. Yooaeo aeinoeaaaony a 80-90% neo/aaa. I?e
aunieie *NN ia?aae aeaoea?eeeyoeeae aa iau/ii nieaeatho aei 70-100
oaea?ia a iei. Aeey yoiai eniieuecotho aa?aiaiee, iaceaeai, ei?aea?ii,
na?aea/iua aeeeiceaeu. Eiiaaea iaeii yoi i?eaiaeeo e ainnoaiiaeaieth
neioniaiai ?eoia. Aa?aiaiee e na?aea/iua aeeeiceaeu i?ioeaiiieacaiu i?e
neiae?iia WPW, oae eae iie oei?a/eaatho yooaeoeaiue ?ao?aeoa?iue ia?eiae
e niinianoaotho i?iaaaeaieth eiioeuena ii aeiiieieoaeueiiio i?aaena?aeii
– aeaeoaei/eiaiio io/eo.

Neioniaue ?eoi ainnoaiaaeeaatho e n iiiiuueth *IN. Noeioeyoeeth
i?iaiaeyo n /anoioie ia 30-50 aieueoa *NN aieueiiai a oa/aiea 15 nae. –
1iei. Eoie?iaaiea ?aaeeeo i?enooiia (1 ?ac a ianyoe) aieueiie i?iaiaeeo
naiinoiyoaeueii, i?eieiay oeieaeei a ni/aoaiee n aa?aiaieeii eee
(-aeieaoi?ii. I?e aieaa /anoiuo i?enooiao (1 ?ac a iaaeaeth) aeey eo
i?aaeoi?aaeaeaiey iacia/atho ei?aea?ii, oeieaeei aeeciie?aieae,
yoaoeecei, aeeiiaiei, aiiiaei? a ni/aoaiee n (-aeieaoi?ii eee
aa?aiaieeii. Eiiaeiaoeeth i?aia?aoa aeey eaaeaeiai aieueiiai neaaeoao
iiaeae?aoue eiaeeaeaeoaeueii.

I?e niioonoaothuae neioniaie a?aaeeea?aeee e iayooaeoeaiinoe
ea/aiey ?aoaaony aii?in i aaeeaeaiee ea?aeeinoeioeyoi?a.

Ia?oeaiea i?aaena?aeee.

I?e/eiaie ia?oeaiey i?aaena?aeee /aua anaai yaeythony ?aaiaoe/aneea
ii?iee, aoa?ineea?ioe/aneee ea?aeeineea?ic, a?oa?eaeueiua aeia?oaicee.

Iaoaieci ia?oeaiey caeeth/aaony, ii-aeaeeiiio, a oee?eoeyoeee
eiioeuena aie?oa onouey iieuo aai, eioi?ue ano?a/ay ia naiai iooe
?ao?aeoa?iua o/anoee, noaiiaeony iai?aaeeueiui, eee a aicieeiiaaiee
auniei/anoioiiai yeoiie/aneiai i/aaa. *anoioa nie?auaiee aeaeoaei/eia
caaeneo io /anoiou e neeu i?aaena?aeiuo eiioeuenia, a oaeaea i?iioneiie
niiniaiinoe AA ocea, eioi?ay iau/ii ia i?aauoaao 220 eiioeuenia a
ieiooo.

Aaiiaeeiaieea ia?ooaaony ec-ca ionoonoaey iaaiaoaoaeueiie ooieoeee
i?aaena?aeee e oei?i/aiiie aeeanoieu aeaeoaei/eia. Ieiooiue iauai
iaaeaao i?eia?ii ia 25 %. I/aiue auno?i na?aea/iay iaaeinoaoi/iinoue
ia?anoaao i?e ieo?aeueiii noaiica.

Eeeieea caaeneo io *NN. I?e oaoeea?aeee aieueiie aeaeoaony ia
na?aeoeaaeaiea, i?e a?aaeeea?aeee – ia aieiaie?oaeaiea, neaainoue, i?e
ii?iinenoiee/aneie oi?ia iiaeao ia i?aaeuyaeyoue aeaeia. Iauaeoeaii
iaia?oaeeaatho a?eoieth, oneeaiea I oiia, a oaeaea II oiia oieueei iinea
ei?ioeeo aeeanoie, aeaoeoeeo ioeuena.

Ia YEA ionoonoaotho coaoeu ?, aianoi ieo aeaeiu ?aciieaeeaa?iua
ia?aaoey?iua aieiu.

Ea/aiea ia?oeaiey i?aaena?aeee eaea?noaaiiuie i?aia?aoaie noiaeii n
ea/aieai o?aiaoaiey. Aeey i?ae?auaiey iinoiyiiie oi?iu oea?eeeyoeee
eniieuecotho yeaeo?e/aneoth aeaoea?eeeyoeeth. Ainnoaiiaeaiea neioniaiai
?eoia i?ienoiaeeo ii/oe anaaaea, ii aea?aeeony iaaeieai. Aeey
i?aaeoi?aaeaeaiey ?aoeeaeeaa iacia/atho oeieaeei ii 200-300 ia. 3-4 ?aca
a nooee, ei?aea?ii 200-400 ia. a nooee.

I?e noieeii ?ao?aeoa?iii ia?oeaiee aeiionoeii eeoue nieceoue *NN, ia
i?ae?auay ia?oeaiey. N yoie oeaeueth iacia/atho na?aea/iua aeeeiceaeu,
(-aeieaoi?u, aa?aiaiee.

O?aiaoaiea e ia?oeaiea aeaeoaei/eia

O?aiaoaiea – i/aiue /anoia (aieaa 250 a iei) ?aaoey?iia nie?auaiea
aeaeoaei/eia. Ia?oeaiea – /anoay, ia?aaoey?iay aeayoaeueiinoue
aeaeoaei/eia.

I?e/eiaie iiaoo yaeyoueny: i?aaie/aneea ii?aaeaiey na?aeoea,
ia?ooaiea neiiaoe/aneie eiia?aaoeee, aeiieney, ia?ooaiea aaiinoaca,
nieaeaiea oaiia?aoo?u oaea, o?aaiu a?oaeiie eeaoee, eaea?noaaiiua
aauanoaa: aianoaoeee, neiiaoiieiaoeee, aioea?eoie/aneea i?aia?aou,
yeaeo?io?aaiu.

Iaoaieci noiaeai n oaeiaui i?e ia?oeaoaeueiie a?eoiee i?aaena?aeee.

Aaiiaeeiaieea i?e o?aiaoaiee e ia?oeaiee aeaeoaei/eia no?aaeaao
cia/eoaeueii aieueoa, /ai i?e ethaie ae?oaie a?eoiee. Ieiooiue iauai
auno?i iaaeaao aei ioey, /oi i?eaiaeeo e iaii?ieo e nia?oe.

Eeeie/aneay ea?oeia neeaaeuaaaony ec iioa?e niciaiey, noaei?ia,
iaaeaiey AAe aei ioey, ia?oaaiiie aeaaeiinoe eiaeiuo iie?iaia.

YEA i?e o?aiaoaiee aeaeoaei/eia i?aaenoaaeaia ?aaoey?iuie aieiaie,
iaiiieiathueie neionieaeo n /anoioie 180-250 a ieiooo, iaaeaeo aieiaie
iao eciyeaeo?e/aneie eeiee, coaoeu ? e O ia ii?aaeaeythony. I?e
ia?oeaiee – iai?a?uaii iaiythueany ii /anoioa, aeeeoaeueiinoe e oi?ia
aieiu n /anoioie 150-300 a iei. aac eciyeaeo?e/aneie eeiee iaaeaeo ieie.

Ea/aiea ia/eiatho n yeaeo?e/aneie aeaoea?eeeyoeee iaeneiaeueiui
?ac?yaeii a 7 eA. I?e ionoonoaee yooaeoa i?iaiaeyo iannaae na?aeoea e
iiaoi?ytho iiiuoeo aeaoea?eeeyoeee. Anee i?eiaieoue yeaeo?e/aneoth
aeaoea?eeeyoeeth iaaiciiaeii, aaiaeyo iiaieaeiaieae, eeaeieaei eee
i?ii?aiaeie aioo?eaaiii eee aioo?ena?aea/ii. Yoe aea n?aaenoaa
iacia/atho i?e ?aoeeaeeae?othuai ia?oeaiee aeey aai i?aaeoi?aaeaeaiey.
Yeaeo?e/aneoth aeaoea?eeeyoeeth i?e ?aoeeaeeaao oaeaaony i?iaanoe
?ac?yaeii iaiueoaai iai?yaeaiey (3 eA). I?e ?aoeeaeeaao,
nii?iaiaeaeathueony iieiie AA aeieaaeie, i?iaiaeyo yiaeiea?aeeaeueioth
YN n /anoioie, i?aauoathuae nianoaaiioth /anoioo aeaeoaei/eia.

I

I

I

I

O?aiaoaiea i?aaena?aeee. O?aiaoaiea
aeaeoaei/eia.

I

I

I

I

Ia?oeaiea i?aaena?aeee.
Ia?oeaiea aeaeoaei/eia.

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