Heart Rhythm Disturbances Research Articles

Перипартальна кардіоміопатія: сучасні можливості ведення пацієнток із важкою серцевою недостатністю

Peripartum cardiomyopathy (PCMP) is a cardiomyopathy with impaired LV systolic function that develops in pregnant women or in the first months after childbirth. Clinical manifestations can vary from mild or moderate to severe symptoms of heart failure with significant functional limitation and high mortality. The mechanisms of PCMP development are unknown, and there is no specific treatment. In the article, we wanted to demonstrate our own experience of managing a patient with severe PCMP, the course of which was complicated by heart rhythm disturbances, the development of cardiogenic shock and pulmonary edema. This clinical example will highlight basic information about the etiology, pathogenesis, prevention and treatment of PCMP at the current stage.

Characteristics of fatal COVID-19 among pregnant women admitted to hospitals in Kazakhstan

Abstract Background The factors contributing to the fatal outcome of COVID-19 in pregnant women remain not entirely clear. We compared the prevalence rates of comorbidities and laboratory test results in pregnant survivors and non-survivors. Methods This retrospective study relied on clinical and laboratory data obtained from medical records of pregnant women with COVID-19 admitted to three hospitals of the Republic of Kazakhstan from 16.07.2021 to 31.01.2022. Overall, we obtained data on 157 pregnant women with COVID-19, of whom 95.9 % survived and 4.1 % died in the hospitals. Results Arterial hypertension was present in 50% of non-survivors vs. 7.9% of survivors (P = 0.001), diabetes mellitus was diagnosed in 16.7% of non-survivors vs. 2.3% of survivors (P = 0.044), and the rate of hyperglycemia was 40% and 7.2%, respectively (P = 0.009). Heart rhythm disturbance was present in 50% of non-survivors vs. 6.4% of survivors (P < 0.001), and already at the time of admission to the hospital, the non-survivors had significantly higher heart and respiratory rates. Laboratory tests showed that non-survivors had higher erythrocytes sedimentation rate, C-reactive protein, leukocyte count, and D-dimer levels (P = 0.001, P < 0.001, P = 0.038, P = 0.014, respectively). The creatinine level was within the normal range in both study groups, but it was relatively higher in the deceased pregnant women (71.3; IQR: 66-251.75) vs. 52; IQR: 43-63; P = 0.001). Finally, a higher proportion of those who died presented with abnormal chest CT as compared with the survivors (33.3% vs. 4.2%, P < 0.001). Conclusions The deceased had a higher rate of comorbidities. Given the vulnerability of pregnant women to COVID-19, it is essential to plan a prospective study to provide insights into the factors that contribute to severe COVID-19 outcomes in pregnant women. Key messages • Determining risk factors for fatal COVID-19 is crucial for effective medical care of pregnant women. • Identifying potential risk factors of fatal COVID-19 among pregnant women could help inform public health policies and clinical guidelines.

Implantable loop recorders in children and adolescents with Brugada syndrome: the YoungBruLoop study

Abstract Background Young (<18 years of age) patients with Brugada syndrome (BrS) are often underrepresented in BrS studies and their management, especially related to syncopal episodes, remains unclear. Purpose To describe the arrhythmia prevalence and clinical implication derived from continuous rhythm monitoring by implantable loop recorder (ILR) among patients younger than 18 years of age, and to assess the etiology behind syncope of undetermined origin. Methods A total of 147 BrS patients with ILR were enrolled in 12 international centers and divided into pediatric (age <12 years; n=77, 52%) and adolescents (age 13 to 18 years; n=70, 48%). Results Mean age was 11.3 years (36.1% females, 21.1% spontaneous type I ECG). Forty-six patients (31.2%) underwent ILR implant due to syncope. Over a median follow-up of 3.6 years, an arrhythmic event was recorded in 22.4% of patients and in the vast majority of cases it was of non-ventricular origin (44% atrial, 47% bradyarrhythmias). Predictors of arrhythmias at univariate Cox Regression analysis were spontaneous type I ECG (HR 2.1 - 95%C.I. 1.1-4.1), history of syncope (HR 3.1 - 95%CI 1.5-6.3) and age >12 years (HR 2.0 - 95%C.I. 1.0-3.3). Ventricular arrhythmias occurred in 4 patients, all with spontaneous BrS, and were related to fever in half of cases. In patients with recurrent syncope, the prevalence of truly arrhythmic syncope was 17.8%, and it was due to brady-, atrial- and ventricular arrhythmias in 40%, 20% and 40% of cases, respectively. Conclusions Continuous rhythm monitoring with ILRs in BrS pediatric patients detects a broad range of heart rhythm disturbances including life-threatening arrhythmias. Ventricular arrhythmias occur predominantly in patients with spontaneous type I ECG and in half of cases are fever-related. Despite the young age, brady- and atrial arrhythmias are overall frequent and represent the cause of arrhythmic syncope in 60% of patients. Young BrS patients with syncope of undetermined origin may benefit from ILR implant.

Early arrhythmia after cardiac surgery in children with congenital heart disease

Objective. To analyze the frequency and risk factors for arrhythmia in children with congenital heart disease in the early period after cardiac surgery. Materials and methods. A retrospective analysis of the incidence and risk factors for arrhythmia in 285 children who underwent cardiac surgery in the Department of Surgical Treatment of Congenital Heart Diseases in Newborns and Young Children at the Amosov National Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine for the period from 2021 to 2023 was performed. There were 202 children under the age of 18. Results. In the early postoperative period, heart rhythm disturbances occurred in 53 (26.2%) of 202 patients: 28 had supraventricular tachycardia, 16 had bradyarrhythmia (atrioventricular block), 6 had ventricular tachycardia, and 3 had nodal ectopic tachycardia. It was found that plastic surgery of the interventricular and atrial septal defect in isolation or in combination with interventions for other defects (Fallot's tetrad, transposition of the great vessels, atrioventricular communication) and bidirectional and total cavopulmonary anastomoses are associated with a high risk of arrhythmia. Statistically significant (p < 0.05) risk factors for arrhythmia were: lactate level of more than 2 mmol/L, duration of cardiopulmonary bypass more than 185 minutes, duration of aortic clamping more than 67 minutes. Conclusions. Arrhythmia often complicates the course of the early period after cardiac surgery in children and requires timely and correct action. Prolonged cardiopulmonary bypass, aortic constriction, and lactatidosis are risk factors for arrhythmia. Plastic surgery of the interventricular and atrial septal defects, as well as palliative reconstructive heart surgery, are associated with frequent cardiac arrhythmias in the early postoperative period.

Beta-adrenergic reactivity of erythrocyte membranes in adolescents with supraventricular and ventricular arrhythmias before and after radiofrequency ablation

Aim. To evaluate β-adrenergic reactivity of erythrocyte membranes (β-ARM) in adolescents with ventricular and supraventricular arrhythmias before and after radiofrequency ablation (RFA) of heart rhythm disturbances.Materials and methods. The study included 49 adolescents aged 11–17 years, of which 15 had Wolff – Parkinson – White pattern (WPW), 13 – WPW syndrome, 10 – atrioventricular nodal reentry tachycardia (AVNRT), and 11 – ventricular arrhythmia (VA). The control group consisted of 11 adolescents without cardiovascular pathology. All patients received surgical treatment for heart rhythm disturbances (HRD) using RFA. In patients with HRD, β-ARM was determined by a set of reagents BETA-ARM AGAT (AGAT LLC, Russia) before RFA and 3 days after it. In the control group, the parameter was determined at the stage of inclusion in the study.Results. In adolescents with supraventricular arrhythmias, median values of β-ARM did not differ significantly from the control group. RFA in adolescents in these groups did not affect the value of β-ARM on day 3 after the surgery. In adolescents with VA, the median value of β-ARM was initially higher than in the control group (p = 0.026). On day 3 after RFA, an increase in β-ARM was noted in this group (p = 0.028) compared to baseline values.Conclusion. Activation of the sympathetic nervous system plays a significant role in the pathogenesis of VA in adolescence. The study showed the possibility of using β-ARM to assess the state of the sympathetic nervous system in patients with methodological limitations in analyzing heart rate variability.

B-257 Dont go breaking my heart: use and misuse of beta-blockers in clinical and forensic casework (2019-2023)

Abstract Background Beta-adrenergic antagonists, or beta-blockers, are commonly prescribed for the treatment and prevention of a variety of cardiovascular issues and other health conditions. These include, but are not limited to heart failure, heart rhythm disturbances, high blood pressure, hypertension, anxiety, asthma, glaucoma, and migraines. Beta-blockers work by blocking access to beta-receptors, which then enhance or inhibit cellular activity and result in dilating blood vessels and relaxing the heart muscle. When misused, accidentally or intentionally, serious adverse effects including dizziness, seizure, heart failure, QTc prolongation, coma, and death can occur. In routine toxicology testing, beta-blockers are often reported qualitatively, which likely underestimates the reporting of related adverse events. We performed a retrospective review to evaluate quantitative levels of beta-blockers in blood and identify trends of potential misuse. Methods We queried our laboratory’s data management system from 2019-2023 for reported findings of beta-blockers in blood. Analytes were quantified with liquid chromatography-tandem mass spectrometry (LC-MS/MS). Results were analyzed using Microsoft Office software. Results Blood results and a comparison of known therapeutic and adverse concentrations are shown in Table 1. Age and sex were reported in 50% and 74% of cases, respectively. Average age ranged from 43 years old (propranolol) to 59 years old (atenolol and metoprolol), without major differences between sexes. Overall use of beta-blockers was split evenly between men and women. Importantly, each analyte provided examples which far exceeded known therapeutic levels, with several cases submitted as potential overdoses. Conclusions Since beta-blockers are generally reported qualitatively during routine toxicology testing, concentrations are unknown. Quantitative testing has shown that beta-blocker concentrations often exceed known therapeutic ranges, which can lead to adverse effects and fatal outcomes. Physicians and death investigators should be aware of these adverse effects and the need for specialized testing in the event of suspected beta-blocker toxicity.

Heart Rhythm Disturbances in Cardiac Surgery Patients with Coronary Artery Disease

The aim. To analyze arrhythmological complications in cardiac surgery patients with coronary artery disease (CAD). Materials and methods. This was a retrospective data analysis of 354 cardiac surgery patients with various forms of CAD who were operated on and discharged from the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. The mean age of the patients was 61.9 ± 9.6 years. All the patients underwent laboratory examinations, electrocardiography, echocardiography, coronary angiography and cardiac surgery. The patients with uncomplicated forms of CAD (n = 194) underwent isolated surgical revascularization of the myocardium, in the case of complicated forms of CAD (n = 160), coronary bypass surgery was supplemented with valvular or ventricular correction. Results. Postoperative atrial fibrillation (AF) occurred in 40 (20.6%) patients with uncomplicated CAD and 43 patients with complicated CAD (26.8%), p = 0.1667. Among patients with complicated forms of CAD, 2 (1.25%) had paroxysms of ventricular tachycardia, which required the implantation of a cardioverter-defibrillator, also in this group of patients complete left bundle branch block occurred more often (p = 0.0020). The postoperative period in patients with impaired glucose metabolism was characterized by more frequent development of AF in patients with type 2 diabetes mellitus (33.3%, p = 0.0006), with impaired glucose tolerance (24.8%, p = 0.0156) compared to patients with normoglycemia (12.6%). Conclusions. There was no statistically significant difference in the frequency of postoperative AF in patients with various forms of CAD (p = 0.1667). In the occurrence of postoperative AF paroxysms, the negative influence of type 2 diabetes mellitus (p = 0.0006), impaired glucose tolerance (p = 0.0156), stage III-IV chronic kidney disease (p = 0.0015) and gouty arthritis (p = 0.0072) has been proven. The presence of postoperative AF was associated with acute encephalopathy (p = 0.0291) and panic attacks (p = 0.0043). The occurrence of postoperative AF increased the length of stay of cardiac surgery patients with CAD in the hospital from 8.2 ± 2.9 to 11.06 ± 6.8 days (p < 0.0001).

Application of UHPLC-QqQ-MS/MS Method for Quantification of Beta-Adrenergic Blocking Agents (β-Blockers) in Human Postmortem Specimens.

Betablockers are one of the most frequently used medications in cardiology. They can lead to fatal drops in blood pressure and heart rhythm disturbances. Death is functional, and poisoning with this group of drugs can be difficult to detect. The liquid-liquid extraction (LLE) method developed using ethyl acetate at pH 9 successfully identified 18 β-blockers in human blood. The method's limit of quantification (LOQ) was in the range of 0.1 to 0.5 ng/mL. No carryover of substances between samples was detected, and no interfering ion current signals were observed in the biological samples at the retention times of the compounds or internal standards. All compounds had a coefficient of determination (R2) above 0.995. Intraday and interday precision (RSD%) and accuracy (RE%) for low and high QC levels were within 1.7-12.3% and -14.4 to 14.1%, respectively. Very good recovery (80.0-119.6%) and matrix effect (±20.0%) values were achieved for all compounds. In addition, fragmentation spectra were collected for all the examined substances, and high-resolution spectra were presented for landiolol and metipranolol, because they are not available in commercial HRMS spectra databases. The developed method was applied in authentic postmortem samples.

Визначення предикторів стійких порушень серцевого ритму у військовослужбовців із тяжким перебігом міокардиту

The aim – to study heart rhythm and conduction disturbances in different localization and distribution of myocardial lesions in combatants with severe myocarditis based on the results of a 6-month follow-up.Materials and methods. 46 male military personnel with a severe course of acute myocarditis (AM) with a reduced ejection fraction (EF) of the left ventricle (LV) (≤ 40 %) with an average age of (35,1±2,4) years were examined. Examinations were carried out in the 1st month after the onset of symptoms of myocarditis and after 6 months of observation. The diagnosis of myocarditis and the severe course of the disease were established on the basis of the Recommendations for the diagnosis and treatment of myocarditis of the All-Ukrainian Association of Cardiologists of Ukraine. All patients underwent for 24-hour ECG monitoring with analysis of the frequency and spectrum of rhythm and conduction disturbances and cardiac magnetic resonance (CMR) imaging with contrast analysis of the topography of the lesion and counting the number of LV segments affected by inflammatory changes and LV segments with the presence of late gadolinium enhancement (LGE).Results and discussion. When comparing the results of heart MRI with the data of daily ECG monitoring, a clear association of the presence of frequent ventricular extrasystoles (VE) and paroxysms of non-sustained ventricular tachycardia (NSVT) with the localization of LGE in the interventricular septum (IS) was established – among patients with LGE lesions at the onset of AM more than in a third (37.0 %) had frequent VE, and NSVT paroxysms, which increase the risk of developing life-threatening ventricular arrhythmias, were detected in 25,9 % of cases. After 6 months of observation in the presence of LGE in the IS, the frequency of detection of frequent VE and NSVT paroxysms was also significantly higher compared to other localization of the lesion and amounted to 20,0 and 13,3 %, respectively. With the help of correlation analysis, an associative relationship was revealed between the presence of LGE in the IS and the presence of frequent VE and NSVT paroxysms in the debut of myocarditis – r=0.73 (р<0.01) and r=0.66 (р<0,01) respectively, and also after 6 months of observation – r=0.65 (р<0.01) and r=0.59 (р<0.05), respectively. According to the results of the multivariate regression analysis, predictors of frequent VE persistence after 6 months were: LVEF ≤30 %; LV end-diastolic volume index ≥105 ml/m2; presence of inflammatory changes in ≥5.0 LV segments; presence of LGE in ≥4.0 LV segments and its presence in the IS, determined in the 1st month from the onset of the disease. The predictors NSVT paroxysms persistence after 6 months were the same factors with the exception of LV EF, and, according to the value of the β coefficient (β=1.302; p<0.001), the most significant contribution was the presence of LGE in the IS.Conclusions. In combatants with severe myocarditis, the presence of late gadolinium enhancement in the interventricular septum is an additional risk factor for the persistence of frequent ventricular extrasystoles and paroxysms of non-sustained ventricular tachycardia during 6 months, while the presence of late gadolinium enhancement in the posterior and lateral walls of the left ventricle has no reliable relationship with the presence of rhythm and conduction disorders. On the basis of multivariate regression analysis, predictors of frequent ventricular extrasystoles and paroxysms of non-sustained ventricular tachycardia persistence were established in combatants with myocarditis.

Arrhythmias in oncological patients: acompact overview fortheclinician.

Chemotherapy is the cornerstone of antineoplastic treatment in patients with malignancies. The cardiotoxic effect of antineoplastic therapy has been known for many decades. Part of chemotherapy-induced cardiotoxicity is the development of heart rhythm disturbances. This short review aims to provide acompact overview for the clinical cardiologist of the dysrhythmic potential created by antineoplastic agents in cancer survivors.

A decision tree model for predicting high mono-N-desethylamiodarone concentrations and reducing tissue toxicity in patients with low-dose amiodarone therapy: A multicentral retrospective cohort study.

High plasma levels of mono-N-desethylamiodarone (MDEA), an active amiodarone metabolite, may be associated with tissue toxicity in heart failure (patients with heart rhythm disturbances); therefore, a tool that can identify patients for whom therapeutic drug monitoring (TDM) of MDEA is required. This multicenter study aimed to develop a decision tree (DT) model that can identify patients with heart rhythm disturbances at high MDEA concentrations. A multicenter retrospective cohort study was conducted, including 157 adult patients with heart failure who received oral amiodarone treatment. A χ2 automatic interaction-detection algorithm was used to construct a DT model. In the DT analysis, the dependent variable was set as an MDEA trough plasma concentration of ≥0.6 μg/mL during the steady-state period. Explanatory variables were selected as factors with p < 0.05 in multivariate logistic regression analysis. The adjusted odds ratios for the daily dose of amiodarone and body mass index were 1.01 (95% coefficient interval: 1.008-1.021, p<0.001) and 0.91 (95% confidence interval: 0.834-0.988, p=0.025), respectively. For DT analysis, the risk of reaching plasma MDEA concentrations ≥0.6μg/mL was relatively high, combined with a daily dose of amiodarone >100 mg and body mass index ≤22.3 kg/m2 at 69.0% (20/29), and its trend was also detected in the sensitivity analysis. Patients taking a daily amiodarone dose > 100 mg and with a body mass index ≤22.3 kg/m2 warrant TDM implementation for MDEA to minimize the risk of MDEA-induced tissue toxicity.

Patch angioplasty carotid endarterectomy versus eversion carotid endarterectomy.

To compare carotid endarterectomy patch angioplasty (p-CEA) with eversion carotid endarterectomy (e-CEA) and associated risks of early cardio-cerebrovascular complications. The study was a prospective randomized single-blind trial, monocentric, clinically applicable, descriptive analytical and comparative. From June 2021 to June 2023, 62 consecutive patients with symptomatic and asymptomatic stenosis of the internal carotid artery, admitted to our department and randomized into two groups: carotid endarterectomy with patch angioplasty and eversion carotid endarterectomy. Follow-up for 30 days after surgery. During surgery e-CEA, 70% patients had an arrhythmia, and 24 hours after 66.7%, seven days after 46.7% and month after 13.3%. During surgery p-CEA, 33.3% patients had an arrhythmia, 24 hours later 33.3%, 7 days after 13.3% and 30 days after 13.3% patients. Statistically significant difference observed during surgery (Fishers p=0.004). One day after the surgery rate of patients with arrhythmia that were treated e-CEA has decreased, but it was still higher than after p-CEA (Fishers p=0.010). The frequency and categorization of postoperative cardiac arrhythmias after eversion carotid endarterectomy, the clinical implications of various postoperative heart rhythm disturbances and their long-term effects on patients need to be further investigate through sufficiently powered randomized controlled studies.

Ambient temperature and cardiovascular disease-related emergency room visits in Lanzhou, China from 2013 to 2019: A time-series study.

This study assessed the links between daily mean temperature and emergency room (ER) admissions for total and cause-specific cardiovascular diseases (CVD) in Lanzhou, China from 2013 to 2019. A quasi-Poisson Generalized Additive Model (GAM) and a Distributed Lag Non-Linear Model (DLNM) were used to determine the effects of temperature on total and cause-specific cardiovascular emergency visits. The relative risks (RR) at cold (hot) temperatures were calculated by comparing the 5th (95th) centile of temperature with the minimum morbidity temperature (MMT). Exposure-response curves demonstrating an inverted U-shape or an irregular M-shape association were observed between temperature and total and cause-specific CVD. The study found that both cold and hot temperatures had negative impacts on emergency room visits for various cardiovascular diseases. For people with total CVD, heart rhythm disturbances (HRD), or cerebrovascular diseases (CD), females were more sensitive to temperature than males, while for ischemic heart disease (IHD) and heart failure (HF), males were more vulnerable to temperature. The < 65 years old with total CVD, IHD, HRD, or CD was more susceptible to the effects of temperature. The results indicated that the relationship between temperature and total and cause-specific CVD was nonlinear, and susceptibility to temperature varied across disease subtype, gender, and age.

Acquired control over proliferation and differentiation of ventricular cardiomyocytes to break down the mechanisms of cardiac repair

Abstract Funding Acknowledgements None. Loss of myocardial tissue remains a leading cause of morbidity and mortality by causing heart rhythm disturbances and heart failure. The (pre-)clinical effects of inducing cardiac regeneration by cardiac cell therapy have been disappointing. In order to find new curative options for these disabling cardiac diseases a shift of focus towards steering the heart to regenerate itself is needed. The aim of this study was to generate a robust ventricular cardiomyocyte model in which proliferation and differentiation could be tightly controlled to investigate cardiac regeneration. To accomplish this we have generated a line of immortalized neonatal rat ventricular cardiomyocytes (nrVMs) through expression of the cell cycle regulators cyclin-dependent kinase 4 and cyclin D1 (CDK4-D1). The CDK4-D1 expressing nrVMs were positive for the proliferation marker Ki67 in contrast to control nrVMs. Cardiomyogenic differentiation could still be induced after multiple passages (&amp;gt; passage 10) as evidenced by immunocytochemistry and optical voltage mapping. These contractile and excitable cells were indeed positive for the cardiac-specific sarcomeric proteins alpha actinin and troponin T in a sarcomeric pattern similar to native nrVMs. Passaging of the control nrVM cultures, however, ultimately led to a senescent cell population lacking sarcomeric markers after passage 3. Electrophysiological analysis of immortalized monolayers, after inducing cardiomyogenic differentiation, showed not only uniform propagation of electrical signal throughout the cultures, but also re-entrant activity although at low frequency. In conclusion, these data show that were able to immortalize ventricular cardiomyocytes by preserving their contractile and excitable phenotype upon significant expansion. Further optimisation of this model will lead to a research model of ventricular cardiomyocytes which will give us the opportunity to unravel the process of cardiomyogenesis and uncover mechanisms which could allow us to enhance the ability of the heart to regenerate itself.

Perioperative adverse cardiac events in maxillofacial surgery: A systematic review and meta-analysis.

Maxillofacial surgeries, including procedures to the face, oral cavity, jaw, and head and neck, are common in adults. However, they impose a risk of adverse cardiac events (ACEs). While ACEs are well understood for other non-cardiac surgeries, there is a paucity of data about maxillofacial surgeries. This systematic review and meta-analysis report the incidence and presentation of perioperative ACEs during maxillofacial surgery. We included primary studies that reported on perioperative ACEs in adults. To standardise reporting, ACEs were categorised as 1. heart rate and rhythm disturbances, 2. blood pressure disturbances, 3. ischaemic heart disease and 4. heart failure and other complications. The primary outcome was ACE presentation and incidence during the perioperative period. Secondary outcomes included the surgical outcome according to the Clavien-Dindo classification and trigeminocardiac reflex involvement. STATA version 17.0 and MetaProp were used to delineate proportion as effect size with a 95% confidence interval (CI). Twelve studies (34,227 patients) were included. The incidence of perioperative ACEs was 2.58% (95% CI 1.70, 3.45, I2 = 96.17%, P = 0.001). Heart rate and rhythm disturbances resulted in the greatest incidence at 3.84% among the four categories. Most commonly, these ACEs resulted in intensive care unit admission (i.e. Clavien-Dindo score of 4). Despite an incidence of 2.58%, ACEs can disproportionately impact surgical outcomes. Future research should include large-scale prospective studies that may provide a better understanding of the contributory factors and long-term effects of ACEs in patients during maxillofacial surgery.

Avaliable data for adverce cardiac events prognostication after ST segment elevation myocardial infarction

The treatment of acute myocardial infarction (AMI) is aimed at the long‑term survival of patients, so attention should be given to predicting adverse outcomes, specifically the development of heart failure, recurrent AMI, cardiovascular death, and so on. The combination of various data obtained in recent decades has helped improve prognosis, but challenges with long‑term survival after ST segment elevation myocardial infarction (STEMI) still exist.&#x0D; Objective — to find the optimal combination of data collected from patients with STEMI and prospectively analyzed during one‑year observation to improve the quality of prognostication.&#x0D; Materials and methods. One hundred and twenty‑eight enrolled patients visited research center to clinical examination and estimation of left ventricular (LV) function in 365±14 days follow up period after STEMI. End points such as major adverce cardiac events (MACE) — composite of cardiovascular death, recurrent MI, newly diagnosed heart failure, rhythm, and conduction disturbances were estimated. Primary percutaneous coronary intervention was successful, and all included patients had TIMI (Thrombolysis In Myocardial Infarction) &gt;2. Patients was divided into two cohorts depending on the presence of MACE: global longitudinal strain and mechanical dispersion are independent factors of it (p=0.0006 and p &lt;0.0001respectively).&#x0D; Results. We found the optimal combination of different data for prognostication of adverce outcome after 1 year after STEMI, among them occurred global longitudinal strain, left atrium volume index, left ventricular end diastolic diameter, mechanical dispersion, LV ejection fraction. They all reflect different hemodynamic sides of LV remodeling after STEMI.&#x0D; Conclusions. The model is simple and avaliable for use in medical practice.&#x0D;

Atrial Fibrillation After Spontaneous Intracerebral Hemorrhage

Introduction: Cardiac arrhythmias often occur during the acute phase of a stroke and can cause hemodynamic instability and sudden cardiac death. Data regarding determinants and the course of arrhythmia onset in the acute phase of stroke are still rare, especially in hemorrhagic stroke. Case report: A male, 74 years old, came to the emergency department with a complaint of weakness in the left hand and leg that had occurred suddenly 5 hours previously. Weakness is described by the left arm and leg still being able to be lifted a few seconds later and falling again. This complaint was accompanied by lips that appear pursed and severe dysarthria. The patient was said to have had a history of uncontrolled hypertension for 10 years. A previous history of heart disease was denied. A CT scan of the head without contrast showed intracerebral hemorrhage in the basal ganglia and right external capsule with a volume of 5 cc. An electrocardiography (ECG) examination showed sinus rhythm without any indication of heart rhythm disturbances. Further ECG examination after the 4th day of hospitalization showed atrial fibrillation with rapid ventricular response (AFRVR). The patient eventually died one day after the heart rhythm changed. Discussion: The incidence of AF varies depending on the type of stroke that occurred, the monitoring device used, the interval between initial monitoring and stroke onset, and the duration of cardiac monitoring. AF in patients can occur as a result of a hemorrhagic stroke, but it is also possible because of the presence of previously undetected paroxysmal AF. High NIHSS correlates with system disturbances in autonomous cardiovascular systems. According to current NIHSS measurements, hospital admission is required as a parameter for heart rhythm monitoring for more than 24 hours. Conclusion: Newly detected AF after ICH greatly influences the clinical outcome of patients. Understanding the mechanism and pathophysiology of new AF after ICH will contribute to a better understanding of the management of the patient. Keywords: atrial fibrillation, cardiac arrhythmia, case report, stroke, intracerebral hemorrhage

Нарушения сердечного ритма и профиль артериального давления у пациентов с боевыми травмами

Aim. To investigate possible rhythm and conduction disturbances, as well as the blood pressure (BP) profile in young and middle-aged patients with combat wounds. Materials and methods. The cross-sectional study enrolled 102 patients who suffered limb injuries in the period from 13 to 114 days (median 38 days) before admission to the hospital. The age of the patients included in the study ranged from 20 to 59 years, with an average of 35.7±8.5 years. Patients underwent Holter ECG monitoring and 24-hour BP monitoring. The following questionnaires and scales were used: a questionnaire to identify signs of autonomic changes (A. Vein), a scale for assessing the severity of psychophysiological response to stress, an insomnia severity index, the Hamilton scale for assessing anxiety, the Hamilton scale for assessing depression, a questionnaire for PTSD screening, visual analog pain scale. Results. The mean heart rate per day reached 84.6±11.1 per minute, the minimum heart rate was 56.9±10.1, the maximum heart rate was 134.4±18.6 per minute. The group mean duration of tachycardia was 498.1±316 minutes (8 hours 18 minutes). There was an inverse correlation between the age of patients and the duration of tachycardia per day (r=-0.29; p=0.04), maximum heart rate (r=-0.28; p=0.007), minimum heart rate per day (r=-0.23; p=0.02). In patients 20-29 years old, the maximum heart rate reached 141.4±19.4, in patients over 40 years old – 134.3±17.9 (p=0.009). The mean value of the circadian index for the group was 1.17±0.13 (0.68-1.47). In 69.7%, the circadian index was rigid. Heart rate variability was within normal values in 32.2% of the examined patients, in 48.8% it was reduced, and in 19.1% it was sharply reduced. Heart rhythm disturbances were recorded in 65.5% of patients. The most frequently detected sinus arrhythmia (in 76.2% of cases of all arrhythmias), migration of the supraventricular pacemaker (in 27.0%) and atrial rhythm (in 11.1%). Arterial hypertension was detected in 67.7% of the examined patients. The maximum systolic BP (SBP) corresponding to arterial hypertension of the 1st degree was registered in 43.9% of patients, grade 2 – in 19.7%, grade 3 – in 3.0%, high normal BP – in 16.7%, normal BP – in 16.7%. Maximum diastolic BP (DBP) corresponding to grade 1 hypertension was found in 30.8% of patients, grade 2 – in 30.8%, grade 3 – in 15.4%, high normal BP – in 10.8%, normal BP – in 12.3%. The mean daily SBP was 126 mm Hg, DBP was 81 mm Hg. The mean daytime SBP was 128 mm Hg, DBP was 82 mm Hg. The mean nighttime SBP is 118 mm Hg, DBP is 77 mm Hg. The maximum SBP was 148 mm Hg, DBP was 97 mm Hg. When analyzing the types of daily BP curves, the vast majority of patients (44.6%) were classified as “non-dipper” type, both for SBP and DBP. Conclusions. The study results indicate that patients with combat injuries very often have sinus tachycardia, which is recorded over a long period of time. Heart rate is highest in the youngest injured patients and decreases as age increases. Sinus arrhythmia is very common, other rhythm and conduction disorders are much less common. High BP, especially DBP, is often recorded.

Экстрасистолия у пациентов с синдромом дисплазии соединительной ткани

The ventricular heart rhythm disturbances occurring in individuals with no structural heart abnormality are a pressing issue not only due to their significance, but also due to the lack of clear approaches to treatment of such patients. In actual clinical practice, the physician faces a number of unresolved problems related to both causes and treatment of premature heath beats. This issue requires further research aimed to determine the optimal tactics of management for the specific patient with premature heath beats.

Treatment of heart rhythm disturbances associated with SARS-CoV-2 infection with anti-inflammatory drugs

Publications regarding cardiac arrhythmias associated with the new coronavirus infection (COVID-19) focus primarily on the high prevalence and symptoms of this complication. We have not found any studies on the specific treatment of arrhythmias associated with SARS-CoV2, since a standard therapeutic approach is probably implied. This observation describes a series of cases of various cardiac arrhythmias that occurred against the background of acute COVID-19 and were treated with anti-inflammatory, but not antiarrhythmic drugs. The cases are united by the occurrence of acute SARS-CoV-2 infection, the connection of relapses with inflammation symptoms, as well as the effectiveness of therapy with the main classes of anti-inflammatory drugs. A narrative review of the literature provides the rationale for the inflammatory theory of arrhythmias and sets the stage for discussion about how to integrate differentially anti-inflammatory drugs into the treatment regimen of such patients.