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Zvikonzero zvikuru zverufu kubva kuhosha yemoyo zvinosanganisira kukundikana kwemoyo uye yakaipa arrhythmias inokonzerwa ne ventricular fibrillation. Mhedzisiro kubva muyedzo yeRAFT, yakabudiswa muNEJM muna 2010, yakaratidza kuti kusanganiswa kweiyo implantable cardioverter defibrillator (ICD) pamwe nekurapa kwakanyanya kwezvinodhaka ne cardiac resynchronization (CRT) zvakanyanya kuderedza njodzi yerufu kana kuchipatara nekuda kwekutadza kwemoyo. Zvisinei, nemwedzi ye40 chete yekutevera panguva yekubudiswa, kukosha kwenguva refu kweiyi nzira yekurapa haina kujeka.

Nekuwedzera kwehutano hunobudirira uye kuwedzerwa kwekushandisa nguva, kushanda kwekliniki yevarwere vane low ejection fraction heart failure yakagadziridzwa. Randomized controlled trials inowanzoongorora kushanda kwerapi kwenguva shoma, uye kushanda kwayo kwenguva refu kunogona kuva kwakaoma kuongorora mushure mokunge kutongwa kwapera nokuti varwere vari muboka rekutonga vanogona kuyambukira kune boka rekuedza. Kune rumwe rutivi, kana kurapa kutsva kuchidzidzwa muvarwere vane mwoyo wakanyanya kukundikana, kushanda kwayo kungakurumidza kuoneka. Zvisinei, kutanga kurapwa pachine nguva, zviratidzo zvekutadza kwemoyo zvisati zvanyanya kuoma, zvinogona kuva nemigumisiro yakanyatsonaka pamigumisiro makore mushure mekuedzwa kwapera.

The RAFT (Resynchronization-Defibrillation Therapy Trial in Ambed Heart Failure), iyo yakaongorora kushanda kwekliniki ye cardiac resynchronisation (CRT), yakaratidza kuti CRT yakashanda muNew York Heart Society (NYHA) Chikamu chechipiri chekutadza kwemoyo varwere: neavhareji yekutevera-up yemwedzi ye40, CRT yakaderedza kufa kwevarwere vane mwoyo wekutadza. Mushure mekutevera kwepakati pemakore anoda kusvika 14 munzvimbo sere dzine nhamba huru yevarwere vakanyoresa mumuedzo weRAFT, zvigumisiro zvakaratidza kuenderera mberi kwekuvandudzwa mukupona.

Mumuyedzo wakakosha unosanganisira varwere vane NYHA giredhi III kana ambulate giredhi IV kutadza kwemoyo, CRT yakaderedzwa zviratidzo, kuvandudzwa kwesimba rekuita maekisesaizi, uye kuderedzwa kwekubvumidzwa muchipatara. Uchapupu hunobva pamwoyo unotevera Resynchronization - Heart Failure (CARE-HF) muedzo wakaratidza kuti varwere vakagamuchira CRT uye mishonga yakajairika (isina implantable cardioverter defibrillator [ICD]) vakararama kwenguva yakareba kupfuura avo vakagamuchira mishonga chete. Iyi miedzo yakaratidza kuti CRT yakaderedza mitral regurgitation uye kugadziriswa kwemwoyo, uye yakagadziridzwa kuruboshwe ventricular ejection chikamu. Zvisinei, rubatsiro rwekiriniki rweCRT muvarwere vane NYHA Grade II mwoyo kusakundikana kunoramba kuri kukakavara. Kusvikira 2010, migumisiro kubva kumuedzo weRAFT yakaratidza kuti varwere vanogamuchira CRT pamwe chete neICD (CRT-D) vaiva nehupenyu huri nani uye vashoma kuchipatara kune avo vanogamuchira ICD chete.

Zvinyorwa zvemazuva ano zvinoratidza kuti kufamba kwakananga munharaunda yebazi rekuruboshwe, panzvimbo yekuiswa kweCRT inotungamirira kuburikidza necoronary sinus, inogona kupa zvibereko zvakaenzana kana zviri nani, saka chido chekurapa kweCRT kune varwere vane mwoyo munyoro kukundikana kunogona kuwedzera kuwedzera. Muedzo muduku unoshandiswa uchishandisa nzira iyi kune varwere vane zviratidzo zveCRT uye chikamu chekuruboshwe che ventricular ejection chepasi pe50% chakaratidza mukana mukuru wekubudirira kutungamirira kuiswa uye kuvandudzwa kukuru muchikamu chekuruboshwe ventricular ejection kana ichienzaniswa nevarwere vakagamuchira CRT yakajairika. Kuwedzera optimization yekufambisa inotungamira uye catheter sheaths inogona kuvandudza physiological mhinduro kuCRT uye kuderedza njodzi yekuvhiya matambudziko.

Muchiedzo cheSOLVD, varwere vane zviratidzo zvekushaya simba kwemoyo vakatora enalapril vakararama kwenguva refu kupfuura avo vakatora placebo panguva yekuedzwa; Asi mushure memakore gumi nemaviri ekutevera, kupona muboka reenalapril kwakange kwadzika kusvika kumatanho akafanana neaya ari muboka replacebo. Kusiyana neizvi, pakati pevarwere vane asymptomatic, boka re enalapril rakanga risisina mukana wekupona muyedzo wemakore matatu kupfuura boka re placebo, asi mushure memakore gumi nemaviri ekutevera, varwere ava vainyanya kurarama kupfuura boka re placebo. Zvechokwadi, mushure mokunge nguva yekuedza yapera, ACE inhibitors yakashandiswa zvakanyanya.

Kubva pamigumisiro yeSOLVD uye mamwe maitiro anokosha ekukundikana kwemoyo, mirayiridzo inokurudzira kuti mishonga yechiratidzo chekukundikana kwemoyo inotanga zviratidzo zvekukundikana kwemoyo zvisati zvaonekwa (chikamu B). Kunyange zvazvo varwere vari mumuedzo weRAFT vaingova nezviratidzo zvishoma zvekushaya mwoyo panguva yekunyora, inenge 80 muzana yakafa mushure memakore gumi nemashanu. Nemhaka yokuti CRT inogona kuvandudza zvakanyanya kushanda kwemwoyo wevarwere, mararamiro ehupenyu, uye kurarama, nheyo yekurapa kukundikana kwemoyo nokukurumidza sezvinobvira inogona kusanganisira CRT, kunyanya sezvo teknolojia yeCRT inovandudza uye inova nyore uye yakachengeteka kushandisa. Kune varwere vane chikamu chakaderera chejection ventricular ejection, hazvikwanisi kuwedzera chikamu chejection nemishonga chete, saka CRT inogona kutangwa nokukurumidza sezvinobvira mushure mekuongororwa kwebhokisi rebazi rekuruboshwe. Kuziva varwere vane asymptomatic kuruboshwe ventricular dysfunction kuburikidza ne biomarker screening kunogona kubatsira kufambisira mberi kushandiswa kwemishonga inoshanda iyo inogona kutungamira kune yakareba, yemhando yepamusoro kupona.

Zvinofanira kuonekwa kuti kubva pamigumisiro yekutanga yeRAFT muedzo yakashumwa, kwakave nekufambira mberi kwakawanda mukurapa kwemishonga yekushaya simba kwemoyo, kusanganisira enkephalin inhibitors uye SGLT-2 inhibitors. CRT inogona kuvandudza kushanda kwemwoyo, asi haiwedzere mutoro wemwoyo, uye inotarisirwa kutamba chikamu chinopindirana mukurapa zvinodhaka. Zvakadaro, mhedzisiro yeCRT pakurarama kwevarwere vanorapwa nemushonga mutsva haina chokwadi.