medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2026-179medsovet-10191Research ArticleПРИКЛАДНЫЕ АСПЕКТЫ ЭНДОКРИНОЛОГИИ И КАРДИОЛОГИИAPPLIED ASPECTS OF ENDOCRINOLOGY AND CARDIOLOGYФибрилляция предсердий при сепсисе и потенциальные возможности пропафенона и левокарнитинаAtrial fibrillation in sepsis and the potential effects of propafenone and levocarnitinehttps://orcid.org/0000-0003-4168-1853СемиголовскийН. Ю.SemigolovskiiN. Yu.

Семиголовский Никита Юрьевич, д.м.н., профессор кафедры пропедевтики внутренних болезней, врач анестезиолог-реаниматолог, кардиолог, Санкт-Петербургский государственный университет; врач отделения реанимации и интенсивной терапии, Северо-Западный окружной научно-клинический центр имени Л.Г. Соколова

199034, Санкт-Петербург, Университетская наб., д. 7/9; 194291, Санкт-Петербург, проспект Культуры, д. 4

Nikita Yu. Semigolovskii, Dr. Sci. (Med.), Professor of the Department of Propaedeutic of Internal Diseases, Intensive Care Specialist, Cardiologist, Saint Petersburg State University; Doctor of the Intensive Care Unit, Sokolov’ North-West Regional Scientific and Clinical Center 

7/9, Universitetskaya Emb., St Petersburg, 199034; 4, Kultury Аve., St Petersburg, 194291

semigolovski@yandex.ruhttps://orcid.org/0000-0002-1915-2237МазуренкоС. О.MazurenkoS. O.

Мазуренко Сергей Олегович, д.м.н., профессор, заведующий кафедрой пропедевтики внутренних болезней 

199034, Санкт-Петербург, Университетская наб., д. 7/9

Sergey O. Mazurenko, Dr. Sci. (Med.), Professor, Head of the Department of Propaedeutic of Internal Diseases 

7/9, Universitetskaya Emb., St Petersburg, 199034

dr_mazurenko@mail.ruhttps://orcid.org/0000-0002-5040-6768ЕрмолаеваЛ. Г.ErmolaevaL. G.

Ермолаева Лариса Геннадьевна, к.м.н., врач-терапевт, доцент кафедры пропедевтики внутренних болезней 

199034, Санкт-Петербург, Университетская наб., д. 7/9

Larisa G. Ermolaeva, Cand. Sci. (Med.), General Practitioner, Associate Professor of the Department of Propaedeutics of Internal Diseases 

7/9, Universitetskaya Emb., St Petersburg, 199034

larerm@mail.ruhttps://orcid.org/0000-0002-7115-1768БалуковаЕ. В.BalukovaE. V.

Балукова Екатерина Владимировна, к.м.н., врач-терапевт, доцент кафедры пропедевтики внутренних болезней 

199034, Санкт-Петербург, Университетская наб., д. 7/9

Ekaterina V. Balukova, Cand. Sci. (Med.), General Practitioner, Associate Professor of the Department of Propaedeutics of Internal Diseases 

7/9, Universitetskaya Emb., St Petersburg, 199034

balukova@yandex.ruhttps://orcid.org/0000-0002-8017-3395СемиголовскийС. Н.SemigolovskiiS. N.

Семиголовский Савва Никитович, врач-хирург, сосудистый хирург, Многопрофильная клиника имени Н.И. Пирогова

199178, Санкт-Петербург, Васильевский Остров, Большой проспект, д. 49/51

Ekaterina V. Balukova, Cand. Sci. (Med.), General Practitioner, Associate Professor of the Department of Propaedeutics of Internal Diseases, Saint Petersburg State University

7/9, Universitetskaya Emb., St Petersburg, 199034

semigolovski@yandex.ruСанкт-Петербургский государственный университет; Северо-Западный окружной научно-клинический центр имени Л.Г. СоколоваРоссияSaint Petersburg State University; Sokolov’ North-West Regional Scientific and Clinical Center of the Federal Medical and Biological AgencyRussian FederationСанкт-Петербургский государственный университетРоссияSaint Petersburg State UniversityRussian FederationСанкт-Петербургский государственный университет; Многопрофильная клиника имени Н.И. ПироговаРоссияSaint Petersburg State University; Pirogov Multidisciplinary ClinicRussian Federation20262706202607280287Copyright © Семиголовский Н.Ю., Мазуренко С.О., Ермолаева Л.Г., Балукова Е.В., Семиголовский С.Н., 20262026Семиголовский Н.Ю., Мазуренко С.О., Ермолаева Л.Г., Балукова Е.В., Семиголовский С.Н.Semigolovskii N.Y., Mazurenko S.O., Ermolaeva L.G., Balukova E.V., Semigolovskii S.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/10191

Сегодня сепсис представляет одну из важнейших проблем здравоохранения, поскольку заболеваемость им в мире высока и продолжает расти, а летальность достигает 40–60%, особенно при развитии септического шока. Частое поражение сердца при сепсисе – септическая кардиомиопатия (неустоявшийся термин, обозначающий сепсис-обусловленный синдром острой сердечной дисфункции, не связанной с ишемией вследствие поражения венечных артерий) – нередко осложняется возникновением сердечных аритмий. Желудочковые аритмии при этом возникают редко, а фибрилляция предсердий развивается в 20–30% случаев, достигая 45% при септическом шоке. При этом летальность увеличивается примерно в 2–3 раза в случае безуспешности попыток кардиоверсии. Вместе с тем вопросы антиаритмической терапии до сих пор не отрегулированы. Российские и Евразийские клинические рекомендации по лечению фибрилляции предсердий (2025 г.) не содержат упоминаний о сепсисе. А рекомендации Европейских кардиологического общества и ассоциации кардиоторакальных хирургов (2024 г.), дополненные Европейской ассоциацией сердечного ритма (2025 г.), всего лишь констатируют, что сепсис является триггером возникновения фибрилляции предсердий и фактором риска последующего ее рецидивирования почти у половины выписанных пациентов с сепсисом, причем степень воспаления коррелирует с частотой развития и рецидивирования. Обычно используемые для купирования препараты – бета-адреноблокаторы, антагонисты кальция, амиодарон – способны ухудшить ситуацию, отрицательно влияя на гемодинамику септических больных, особенно при шоке. Виновниками гипотензивного действия амиодарона, в частности, является присутствие в его составе эмульгатора полисорбата-80 и бензилового спирта. В статье на основании анализа актуальных клинических исследований и собственного клинического опыта рассматривается применение в этом случае пропафенона, лишенного кардиодепрессивных свойств. Целесообразно также адъювантное использование левокарнитина, обладающего положительными инотропными и антиоксидантными свойствами, а также способного противостоять воспалительным и проаритмическим звеньям патогенеза сепсиса и предотвращать рецидивирование.

Actually sepsis is one of the most important health problems, as the incidence of it in the world is high and continues to grow, and mortality reaches 40–60%, especially with the development of septic shock. Frequent heart damage in sepsis – septic cardiomyopathy (an established term for sepsis-caused by acute cardiac dysfunction syndrome unrelated to ischemia due to damage to the coronary arteries) – is often complicated by the occurrence of cardiac arrhythmias. Ventricular arrhythmias are rare, and atrial fibrillation develops in 20–30% of cases, reaching 45% with septic shock. At the same time, mortality increases by about 2–3 times if attempts at cardioversion are unsuccessful. However, the issues of antiarrhythmic therapy have not yet been regulated. The Russian and Eurasian clinical guidelines for the treatment of atrial fibrillation (2025) do not mention sepsis. And the recommendations of the European Society of Cardiology and the Association of Cardiothoracic Surgeons (2024), supplemented by the European Heart Rhythm Association (2025), only state that sepsis is a trigger for atrial fibrillation and a risk factor for its subsequent recurrence in almost half of the discharged patients with sepsis, and the degree of inflammation correlates with the frequency of its development and recurrence. Drugs commonly used for cardioversion – beta-blockers, calcium antagonists, amiodarone – can worsen the situation, negatively affecting the hemodynamics of septic patients, especially in shock. The culprits of the hipotensive effect of amiodarone, in particular, are due of the emulsifier polysorbate-80 and benzyl alcohol in its composition. Based on an analysis of current clinical studies and our own clinical experience, the article examines the use of propafenone in this case, devoid of cardiodepressive properties. It is also advisable to use levocarnitine adjuvantly, which has positive inotropic and antioxidant properties, as well as being able to resist inflammatory and proarrhythmic links in the pathogenesis of sepsis, and prevent recurrence.

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The authors declare that there are no conflicts of interest present.