Zdorovʹe Rebenka (Feb 2019)
Modern approaches to treatment of secondary arrhythmogenic cardiomyopathy in children
Abstract
Background. To study the peculiarities of the morphofunctional characteristics of the cardiovascular system in children and adolescents with rhythm disturbances, as well as the main neurohumoral factors that accompany the formation of secondary arrhythmogenic cardiomyopathy (aCMP) in this category of patients as well as to establish the effectiveness of therapeutic complexes in restoring the disturbed structure and function of the heart in adolescents with aCMP. Materials and methods. The study involved 134 teenagers aged 13–18 years old with violated rhythm and conduction, without organic heart pathology were examined, of which 55 (41.05 %) female and 79 (59.0 %) male youth. The functional state of the cardiovascular system was studied using electrocardiography, ultrasound examination. To evaluate the activity of the sympatho-adrenal system (SAS), urine catecholamine (norepinephrine, adrenaline) were studied. Research of the renin-angiotensin-aldosterone system (RAAS) included determination of renin plasma activity, angiotensin II and aldosterone content in peripheral venous blood. The study of subclinical inflammation included the determination of FNT-a, IL-1b, and IL-6 in the blood. Therapeutic complexes of pathogenetic or metabolic action were used to restore impaired heart function. Results. It has been established, that a long-time rhythm disturbance in a child of any age contributes to the development of aCMP, manifested in myocardium remodeling with the expansion of cavities and disorders, primarily diastolic, following systolic function violation. The maladaptive myocardial remodeling was revealed to be accompanied by a decrease in the variability of the cardiac rhythm, increased activity of SAS and RAAS, as well as pro-inflammatory cytokines. The use of the combined pathogenetic therapy, and mostly drugs of the group of ACE inhibitors and beta-blockers, more effectively promotes the restoring morpho-functional parameters of the heart, normalization of indicators of neurohumoral systems and factors of subclinical inflammation. Conclusions. Children with aCMP signs require more active supervision and prescribing medications to prevent the progression of myocardial dysfunction, as well as the agents for metabolic support.
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