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Sababaha ugu waaweyn ee u dhintaan cudurka wadnaha waxaa ka mid ah wadnaha oo shaqeyn waayey iyo arrhythmias malignant oo ay keento fibrillation ventricular. Natiijooyinka tijaabada RAFT, oo lagu daabacay NEJM ee 2010, ayaa muujisay in isku-darka qalabka wadnaha ee wadnaha (ICD) iyo daaweynta mukhaadaraadka ee ugu wanaagsan ee dib-u-cusboonaynta wadnaha (CRT) ay si weyn hoos ugu dhigtay khatarta dhimashada ama isbitaal dhigga wadnaha ee shaqada. Si kastaba ha ahaatee, iyada oo kaliya 40 bilood oo dabagal ah wakhtiga daabacaadda, qiimaha muddada dheer ee istaraatiijiyadan daaweyntu ma cadda.

Kordhinta daaweynta wax ku oolka ah iyo kordhinta wakhtiga isticmaalka, waxtarka bukaan-socodka ee bukaanada leh jajabka wadnaha ee jaban ee hooseeya ayaa la hagaajiyay. Tijaabooyin la kala soocay ayaa caadi ahaan qiimeeya waxtarka daaweynta wakhti xaddidan, waxtarkeeda muddada dheer way adkaan kartaa in la qiimeeyo ka dib marka tijaabada la dhammeeyo sababtoo ah bukaanada kooxda xakamaynta ayaa u gudbi kara kooxda tijaabada ah. Dhanka kale, haddii daaweyn cusub lagu barto bukaannada qaba wadne-gabka sareeyo, waxtarkeeda ayaa laga yaabaa inay dhaqso u soo baxdo. Si kastaba ha ahaatee, bilawga daawaynta goor hore, ka hor inta aanay calaamadaha wadno-gabka aanay aad u darnayn, waxa laga yaabaa inay saamayn togan oo qotodheer ku yeelato natiijooyinka sannado ka dib marka ay tijaabadu dhammaato.

RAFT (Tijaabada Daaweynta Defibrillation Therapy in Ambed Heart Failure), kaas oo qiimeeyay waxtarka bukaan-socodka ee dib-u-soo-celinta wadnaha (CRT), waxay muujisay in CRT ay waxtar u leedahay badi New York Heart Society (NYHA) Fasalka II ee bukaannada wadnaha oo aan shaqeynin: celcelis ahaan dabagalka bilaha 40, CRT waxay hoos u dhigtay dhimashada bukaannada wadnaha iyo isbitaallada. Ka dib dabagal dhexdhexaad ah oo ku dhawaad ​​14 sano ah ee siddeedda xarumood ee leh tirada ugu badan ee bukaannada diiwaangashan ee tijaabada RAFT, natiijadu waxay muujisay horumar sii socota ee badbaadada.

Tijaabada muhiimka ah ee ku lug leh bukaanada qaba NYHA fasalka III ama ambulate fasalka IV ee wadnaha, CRT waxay hoos u dhigtay calaamadaha, awoodda jimicsiga oo wanaajisay, iyo hoos u dhigista isbitaallada. Caddaynta dib-u-habaynta wadnaha ee xiga - Tijaabada Wadnaha (CARE-HF) waxay muujisay in bukaannada helay CRT iyo daawaynta caadiga ah (iyada oo aan lahayn defibrillator cardioverter implanted [ICD]) ay ka badbaadeen in ka badan kuwa helay daawada keligood. Tijaabooyinku waxay muujiyeen in CRT ay yaraysay dib-u-soo-noolaynta mitral iyo dib-u-habaynta wadnaha, iyo hagaajinta jajabka ka bixista hawo-mareenka bidix. Si kastaba ha ahaatee, faa'iidada kiliinikada ee CRT ee bukaanada qaba NYHA Fasalka II ee wadnaha ayaa weli ah mid muran badan. Ilaa 2010, natiijooyinka tijaabada RAFT waxay muujiyeen in bukaanada helaya CRT marka lagu daro ICD (CRT-D) ay heleen heerar badbaado oo ka wanaagsan iyo isbitaal dhigis ka yar kuwa hela ICD oo keliya.

Xogtii dhowaa waxay soo jeedinaysaa in si toos ah loogu dhaqaaqo qaybta xidhmooyinka bidix ee qaybta bidix, halkii lagu meelayn lahaa CRT waxay horseedda sanbabada halbowlaha, ay keeni karto natiijooyin siman ama ka wanaagsan, sidaa darteed xamaasadda daaweynta CRT ee bukaannada qaba wadno-qabsi fudud ayaa laga yaabaa inay sii kordhiso. Tijaabo yar oo la kala soocay oo la isticmaalayo farsamadan bukaanada leh calaamadaha CRT iyo qaybta bidix ee ka saarista qaybta bidix ee ka yar 50% waxay muujisay suurtogalnimo weyn oo lagu dhejiyo rasaasta rasaasta iyo horumarinta weyn ee qaybta bidix ee bidixda marka la barbardhigo bukaanada helay CRT caadiga ah. Hagaajinta dheeraadka ah ee hogaanka socodka iyo galka kateetarka ayaa wanaajin kara jawaabta jireed ee CRT waxayna yareyn kartaa halista dhibaatooyinka qalliinka.

Tijaabada SOLVD, bukaanada leh calaamadaha wadne-gabka ee qaatay enalapril ayaa ka badbaaday in ka badan kuwa qaatay placebo intii lagu jiray tijaabada; Laakiin ka dib 12 sano oo dabagal ah, badbaadada kooxda enalapril waxay hoos ugu dhacday heerar la mid ah kuwa kooxda placebo. Taas bedelkeeda, bukaannada asymptomatic-ka ah, kooxda enalapril uma badna inay ka badbaadaan tijaabada 3-sano marka loo eego kooxda placebo, laakiin ka dib 12 sano oo dabagal ah, bukaannadani waxay aad ugu dhowdahay inay ka badbaadaan kooxda placebo. Dabcan, ka dib markii muddada tijaabada la dhammeeyey, ACE inhibitors ayaa si ballaaran loo isticmaalay.

Iyada oo ku saleysan natiijooyinka SOLVD iyo tijaabooyinka kale ee muhiimka ah ee wadnaha oo aan shaqeynin, hagitaanku waxay ku talinayaan in daawaynta calaamadaha wadne-gabka la bilaabo ka hor inta aysan muuqan calaamadaha wadno-gabka (marxaladda B). In kasta oo bukaannada ku jira tijaabada RAFT ay lahaayeen calaamado fudud oo ah wadne-gabowga wakhtiga diiwaangelinta, ku dhawaad ​​boqolkiiba 80 ayaa dhintay 15 sano ka dib. Sababtoo ah CRT waxay si weyn u wanaajin kartaa shaqada wadnaha ee bukaanka, tayada nolosha, iyo badbaadada, mabda'a daawaynta wadna xanuunka sida ugu dhaqsaha badan hadda waxaa ku jiri kara CRT, gaar ahaan marka tignoolajiyada CRT ay horumarto oo ay noqoto mid ku habboon oo ammaan ah in la isticmaalo. Bukaannada qaba jajab-jabka hawo-mareenka bidix ee hoose, waxay u badan tahay inay yareyso inay kordhiso jajabka ka-saarista daawada oo keliya, sidaas darteed CRT waxaa la bilaabi karaa sida ugu dhaqsaha badan ka dib marka la ogaado xannibaadda laanta garabka bidix. Aqoonsiga bukaanada qaba asymptomatic dysfunction ventricular bidix iyada oo loo marayo baaritaanka biomarker waxay gacan ka geysan kartaa horumarinta isticmaalka daawaynta waxtarka leh ee horseedi karta badbaado tayo sare leh oo dheer.

Waa in la ogaadaa in tan iyo markii natiijooyinka bilowga ah ee tijaabada RAFT la soo sheegay, waxaa jiray horumarin badan oo ku saabsan daaweynta dawooyinka ee wadnaha wadnaha, oo ay ku jiraan enkephalin inhibitors iyo SGLT-2 inhibitors. CRT waxay wanaajin kartaa shaqada wadnaha, laakiin ma kordhiso culeyska wadnaha, waxaana la filayaa inay ka ciyaarto door dhameystiran daaweynta daroogada. Si kastaba ha ahaatee, saameynta CRT ay ku leedahay badbaadada bukaanada lagu daweeyay daawada cusub ayaan la hubin.