Роль острых и хронических стрессов в возникновении пароксизмальной формы мерцательной аритмии

У пациентов с пароксизмальной формой мерцательной аритмии были изучены личностные особенности и характеристики предшествующих манифестации нарушений ритма сердца стрессов. Проведена сравнительная оценка эффективности коррекции соматического состояния в динамике у пациентов с пароксизмами мерцательной аритмии на фоне лечения только соматотропными препаратами и комбинацией соматотропных и психотропных препаратов с учетом особенностей личностного реагирования и характера стрессов.

The role of acute and chronic stress in the manifestation of paroxysmal atrial fibrillation

145 patients with paroxysmal atrial fibrillation were examined to evaluate the pathogenic role of acute and chronic stress and effectiveness of the correction of physical state in the course of complex (somatotropic and psychotropic) therapy. The personality characteristics of patients with arrhythmias, the structure and severity of stress (using the scale of human exposure to the stress), anxiety - depressive disorders preceding manifestation of paroxysmal atrial fibrillation were studied. Patients were thoroughly clinicaly and instrumentaly examinated (Holter ECG monitoring), scoring was performed on a scale of Beck Depression Inventory, Zung scale for self-assessment anxiety scale, Hamilton depression rating, the Hamilton scale for assessing anxiety at the first and at the twenty first days of psychopharmacotherapy. Using in the complex therapy of patients with paroxysmal atrial fibrillation SSRI antidepressants (paroxetine, fluvoxamine, sertraline) allowed rapidly reduce anxiety - neurotic depressive disorders. After 21 days of SSRI-therapy a significant positive trend was revealed in the course and frequency of paroxysms of atrial fibrillation. These remedies help to reduce the duration of arrhythmia’s attack which has already begun. The patients with idiopathic paroxysmal atrial fibrillation survived acute stresses just before the onset of disease in 43.9% of cases. 51.4% patients with myocardial infarction in anamnesis had non severe chronic stress, which provocated arrhythmia’s attack. 38.6% patients without arrhythmia’s attack, but with myocardial infarction in anamnesis, had not severe prolonged stress. Follow-up investigation 18 months later showed that in patients with certain personality traits and positive dynamics of paroxysmal atrial fibrillation on a complex (somatotropic and psychotropic) therapy in recurrent significant stress situation can develop cardiophobia’ attacks.