Uyewo Vimbiso kune dzimwe Dysautonomias, dzakadai sePOTS uye Vasovagal Syncope
Chivi chisina kukodzera tachycardia (IST) chirwere chinoratidzirwa nemhepo inomhanya nokukurumidza zvikuru (tachycardia), zvose pakuzorora uye panguva yekuedza, izvo zvinowanzokonzera vanhu vaduku avo vangave vane utano hwakakwana. Vaya vanotambura neIt vanowanzova nemapiratete akaoma uyewo kusagadzikana kwekuita uye kuneta, uye mamiriro acho anogona kunge asingagoni kudzivisa.
Kubudirira kwehutano hweIt, zvinosuruvarisa, kazhinji kunonetsa.
Ivabradine isiri mishonga mitsva yakashambadzirwa mukurapa angina uye mwoyo kusakundikana. Mumakore achangobva kupfuura ivabradine akaratidza chivimbiso chikuru chekurapa IST. Mishumo inoratidza kuti inogonawo kubatsira kune dzimwe dysautonomia syndromes umo tachycardia inowanzove yakakurumbira.
Ivabradine Inoshanda Sei?
Ivabradine inodzivirira I f channel, mutambo mu cell membranes inobvumira sodium uye potasium kupinda masero. I I f channel (iyo "f" inomiririra "inonakidza," yakadaro-nokuti zita iri rinoshanda nenzira dzakasiyana nedzimwe dzakawanda dzimwe nzira), rinotora basa guru mukupfura node ye sinus , iyo inotarisa inowanzoita mwoyo murefu. Nokudzivirira I f channel, ivabradine inononoka kupera kwekuputika kwekodhi ye sinus, uye nokudaro kunotadzisa kutengesa kwemoyo. Iyi nzira yekuderedza dambudziko remwoyo we sinus yakasiyana zvachose nemashandisirwo anoshandiswa ne beta blockers uye calcium channel blockers , saka ivabradine inowanzoita kuti kuderedza mwoyo kuwedzere kunyange kana mamwe mishonga asingakwanisi kudaro.
Ivabradine pakutanga yakagadzirwa mukurapa angina uye yakabvumidzwa kuti ishandiswe munyika dzakawanda muna 2005. Yakabvumirwa muU.S. munaApril 2015 kuti kurapwa kwemoyo kusakundikana , asi kwete yeIIS.
Ivabradine In IST
Mamwe mapepa mashomanana - kazhinji achitsanangura murwere mumwe chete kana vaviri - akatanga kuonekwa nguva pfupi mushure mekunge mishonga ichipinda mumakiriniki ekushandisa, zvichiratidza kuti ivabradine inogona kubatsira mukurapa varwere vane IST.
Zvadaro, muna 2012, chirongwa chakakonzerwa ne randomized, chinonzi placebo-chengetedzwa chirwere chemakiriniki chakataurwa kubva kuItaly, icho chakagumisa kuti ivabradine inogona kunge yakanyatsobudirira pamamiriro ezvinhu aya. Vachirwere veSIT randomized kuv ivabradine vakaratidza huwandu hwe 75% kuderedza zviratidzo, uye 50% yevanorapwa varwere vakataura kupedzisa nekugadzirisa kwezviratidzo. Zvimwe zvikanganiso zvaive zvishoma. Inofananidzwa neicho chinowanzoonekwa pamwe nedzimwe nzira dzokurapa dzinoshandiswa kuIt, zvakadaro zvinogumbura zvechokwadi.
Chimwe chiitiko chekare chisina kuongororwa nevabradine mu 24 varwere vane IST vakaratidza zvakafanana zvakazoitika. Muchiedza ichi, zvisinei, mishonga iyi yakagadzirirwa mune varwere gumi mushure megore rimwe kuti vaone kuti chii chaizoitika (vamwe varwere vakaramba kurega kutora mishonga), uye 8 paava 10 varwere ava vakanga vasina kudzoka kweIt.
Ivabradine yePOTS uye Vasovagal Syncope
Postural orthostatic tachycardia syndrome (POTS) uye vasovagal syncope kune mamwe maviri maviri eyyutonomia syndromes umo sinus node tachycardia inowanzoita basa rinokosha pakubudisa zviratidzo. Saka hazvishamisi kuti vanachiremba vangasarudza kuedza ivabradine mune izvi.
Pane zvishoma zvichinyatsozivikanwa pamusoro pekushandiswa kwe ivabradine kwePOTS, asi vanachiremba pasi rose vakashandisa mushonga muvanhu vakasarudzwa vane chirwere ichi.
Nhoroondo iyo iripo, zvisinei, inoratidza kuti, zvichida mune vamwe vanhu, kudzora tachycardia ne ivabradine kunogona kuderedza kana kubvisa zvimwe zviratidzo zvine chokuita nePOTS. Kuedzwa kwechirongwa chechipatara kusinganzwisisiki uchishandisa ivabradine kwePOTS ikozvino kuitwa muIsrael.
Kunyange zvazvo vasovagal syncope inobatanidza nekudonhera kunonyanya kubuda kweropa uye (kazhinji) mukudengenyeka kwemwoyo, zvinonyatsozivikanwa kuti kusati kwarasikirwa nekuziva (ndiko kuti, panguva ye "zviratidzo zvinonyevera" vanhu vanowanzotarisana nemamiriro ezvinhu), Kazhinji kushamiswa kwemwoyo kunowanzovapo. Muchikoro chekuongorora vatachiri 25 vane vasovagal syncope vakaratidza tachycardia yakadai vasati vabuda, zvinopfuura 70% zvakave nemigumisiro yakaisvonaka ne ivabradine - kana kuderedza kuderedza kana kubviswa kwezviratidzo.
Saka, ivabradine inoratidza vimbiso chaiye yeyodhautonomi yose iyo sinus tachycardia inokosha.
Migumisiro Yechipfuva yeIvabradine
Imwe chete yakakurumbira yechirwere yakataurwa ne ivabradine, inowanikwa mumapoteredza 15% yevarwere, inoratidzika seyakatarwa inonzi "chiedza chinoshamisa." Ichi chiitiko chinorondedzerwa sechine "kushamisa" kusinganzwisisiki muzvinhu zvinotaridzika, pasina chero kuchinja kwemaonero anooneka . Iyo inofungidzirwa inoguma nekudzivirira kereke mumasero e retinal akafanana neI f channel mumoyo. Nenzira yakanaka, iyi yechipfuva inowanzova yenyoro uye inowanzogadzirisa payo pachayo. Mumwe mushumo wapfuura unoratidza kuti varwere vari pamutemo uyu vanogona kuva nehuwandu hwehutachiona hwehutachiona . Mimwe migumisiro yakawanda isingawaniki inosanganisira misoro uye chizungu. Pasi pose mishonga inonzi inonzi yakanyatsoregererwa.
Ivabradine muUnited States
Kunyange zvazvo ichi chinodhaka chakashandiswa kwemakore anopfuura gumi muEurope, munzvimbo dzakawanda dzeAsia, uye muRussia, Australia, neCanada, yakagamuchirwa muU.S. munaApril 2015 chete. Uyezve, chete chiratidzo chinogamuchirwa ivabradine muU.S. nokuda kwokurapa mwoyo kusakundikana. (Ivabradine inotengeswa naAmgen, pasi pezita rekutengesa Corlentor.)
Kana iwe uchigara muUnited States uye uine IST (kana imwe yemamwe dysautonomias inogona kupindura kune ichi chinodhaka), uye kana chiremba wako achidavira kuti ivabradine inogona kukubatsira iwe, iye zvino iye zvino anokwanisa kuiraira. Zvisinei, sezvo ivabradine inongoratidzirwa kushaya mwoyo mukati meU.S., chiremba wako anofanira kunge achida kuritaura nokuda kwe "off label" kushandiswa. Chero zvingava, ivabradine ikozvino yakasarudzo chaiyo kunyange kune veAmerica vane IST.
> Sources:
> Cappato R., Castelvecchio S., Ricci C., Clinical Efficacy yeIvabradine muVachipatara Vasingafanirwi Sinus Tachycardia: Chiitiko, Randomized, Placebo-Controled, Double-Blind, Crossover Evaluation. J Am Coll Cardiol. 2012; 60: 1323-1329.
> Benezet-Mazuecos J1, Rubio JM, Farré J, et al. Migumisiro Yenguva Yakareba yeIvabradine muSinakakodzera Sinus Tachycardia Varwere: Efficacy Yakakodzera kana Vasingafaniri Kurapa. Pacing Clin Electrophysiol. 2013 Jul; 36 (7): 830-6. doi: 10.1111 / pace.12118. Epub 2013 Mar 19.
> McDonald C, Frith j, Newton JL. Single Center Chiitiko cheIvabradine mu Postural Orthostatic Tachycardia Syndrome. Europace (2011) 13 (3): 427-430. doi: 10.1093 / europace / euq390.
> Sutton R1, Salukhe TV, Franzen-McManus AC, et al. Ivabradine Mukurapa kweSinus Tachycardia Mediated Vasovagal Syncope.Europace. 2014 Feb; 16 (2): 284-8. doi: 10.1093 / europace / eut226. Epub 2013 Sep 26.