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Disease-Modifying Therapy of Chronic Heart Failure on the Background of Heart Rhythm and Conductivity Disorders (Clinical Case)

The article presents a clinical case of the development and progression of chronic heart failure (CHF) in a patient with postinfarction cardiosclerosis after implantation of a permanent pacemaker due to binodal dysfunction. The progression of CHF was exacerbated by the patient's transition to a permanent form of atrial fibrillation. Complex therapy for CHF, including cardiac resynchronization therapy, drug therapy with valsartan + sacubitril, empagliflozin, eplerenone, metoprolol succinate (quadrotherapy) led to a complete recovery of the ejection fraction (EF) of the left ventricle. After the patient stopped taking one of the components of quadrotherapy (valsartan + sacubitril), there was a tendency to decrease in EF. The clinical case emphasizes the importance of the timely transformation of traditional permanent pacing into cardiac resynchronization therapy and the appointment of complex modern drug therapy for CHF. When an improvement or restoration of EF is achieved, it is advisable to continue the therapy against which the improvement was obtained in order to avoid the negative consequences that are possible when the components of the quadrotherapy are cancelled.