Number Of Supraventricular Extrasystoles Research Articles

ИЗМЕНЕНИЯ ЭЛЕКТРОКАРДИОГРАФИЧЕСКИХ ПОКАЗАТЕЛЕЙ ДЕПОЛЯРИЗАЦИИ И РЕПОЛЯРИЗАЦИИ НА ФОНЕ ХИМИОТЕРАПИИ РАКА МОЛОЧНОЙ ЖЕЛЕЗЫ ДОКСОРУБИЦИНОМ

Aim. To study changes in electrocardiographic parameters of the myocardium in patients with verified breast cancer (BC) after completion of chemotherapy (CT) with doxorubicin. Material and methods. The study included 100 patients with a confirmed diagnosis of breast cancer who were treated at the healthcare institution “Grodno University Clinic” (Grodno, Belarus). A number of electrocardiographic parameters of the myocardium were measured in patients before and after chemotherapy using electrocardiography and Holter monitoring. Based on the echocardiography data and the selected threshold value for the relative decrease in GLS (more than 12%), the subjects were divided into two subgroups: those with the presence of cardiotoxicity – CTx+ (n=19) and those without it – CTx- (n=81). Results. An increase in electrocardiographic parameters of depolarization and repolarization (P, P-Q, QRSc, J-Tc, Tpic-Tendc, Q-Tc, Q-Tdc – p<0.001; p<0.001; p=0.005; p=0.023; p=0.009; p<0.001; p=0.006, respectively), as well as in the number of supraventricular extrasystoles (p<0.001) in the general group before and after chemotherapy was detected. The J-Tc and Q-Tc intervals (longer in the CTx- subgroup compared to the CTx+ subgroup: p=0.033 and p=0.037, respectively), the number and total time of sinus tachycardia episodes (p=0.011 and p=0.010, respectively) after chemotherapy differed statistically significantly in the cardiotoxicity subgroups. Conclusions. During chemotherapy with doxorubicin, an increase in the duration of the J-Tc and Q-Tc intervals was observed, the number and duration of episodes of sinus tachycardia also increased. Assessment of the dynamics of these indicators at the stages before/after chemotherapy can provide additional information about the state of the myocardium even before identifying functional disorders by echocardiography.

ПОТЕНЦИАЛ ИСПОЛЬЗОВАНИЯ ДИНАМИКИ ЭЛЕКТРОКАРДИОГРАФИЧЕСКИХ ПОКАЗАТЕЛЕЙ ПРИ ВЫЯВЛЕНИИ КАРДИОТОКСИЧНОСТИ ЧЕРЕЗ 12 МЕСЯЦЕВ ПОСЛЕ ОКОНЧАНИЯ ХИМИОТЕРАПИИ РАКА МОЛОЧНОЙ ЖЕЛЕЗЫ ДОКСОРУБИЦИНОМ

Background. Changes in electrocardiographic parameters of the heart, reflecting the processes of depolarization and repolarization of the myocardium, can be signs of early cardiotoxicity (CT). Aim. To study changes in electrocardiographic parameters of the myocardium in patients with verified breast cancer 12 months after the end of chemotherapy with doxorubicin. Material and methods. The study included 100 patients with a confirmed diagnosis of breast cancer who were treated at the health care institution “Grodno University Clinic” (Grodno, Belarus). A number of electrocardiographic parameters of the myocardium were measured in patients before and 12 months after the end of chemotherapy using electrocardiography and 24-hour Holter monitoring. Results. A statistically significant increase in electrocardiographic parameters of depolarization and repolarization was revealed (P, P-Q, Tpeak-Tend, Q-Tc / QRS, Q-Tc - p<0.007; p<0.001; p=0.042; p=0.009; p<0.001, respectively) before and 12 months after the end of chemotherapy. A change in the time and total number of episodes of sinus tachycardia and supraventricular extrasystoles was also noted (p=0.029, p=0.026 and p=0.002). The Tpeak-Tend indicator changed statistically significantly in the CT+ subgroup (p=0.032) after 12 months. The dynamics of the Q-Tc indicator before and 12 months after the end of chemotherapy was observed in almost all patients. However, in the CT+ subgroup, an increase in Q-Tc was recorded statistically significantly more often compared to the CT- subgroup (p <0.005). Conclusion. During chemotherapy with doxorubicin, an increase in Tpeak-Tend and Q-Tc was observed. An especially significant increase in these indicators was noted in the CT+ subgroup. The number and duration of sinus tachycardia episodes as well as the number of supraventricular extrasystoles also increased. This may correlate with the relationship between chemotherapy with doxorubicin and the dynamics of electrocardiographic parameters.

Excessive supraventricular activity and risk of atrial fibrillation in patients with cryptogenic ischaemic stroke.

Atrial fibrillation (AF) is one of the leading causes of ischaemic stroke. However, screening for AF is often time-consuming in clinical practice. Therefore, the determination of an appropriate marker to detect the presence of AF would improve the diagnostic process. The aim of the current study was to evaluate the efficacy of prolonged and early inpatient event Holter monitoring in the detection of AF in patients with ESUS-related cryptogenic ischaemic stroke (CIS), and to determine the possible relationship between excessive supraventricular activity and AF detection. All consecutive patients with documented cerebral or cerebellar infarction were included. The diagnostic work-up included brain neuroimaging (CT/MRI), ultrasound of the carotid and vertebral arteries, admission ECG followed by 24 hours of Holter monitoring, and transthoracic echocardiography. The 24-hour Holter ECG was analysed, and supraventricular ectopic activity (supraventricular extrasystoles, runs and pairs of supraventricular extrasystoles) was recorded in all patients. If these examinations did not reveal the cause of ischaemic stroke, the patients underwent subsequent prlonged 14-day event Holter recorder monitoring. We included 48 patients (mean age 69.9 ± 8.5 years, 60.4% men) who had been diagnosed with CIS. Of these 48 patients, atrial fibrillation was detected in seven (14.6%) during the prolonged 14-day Holter event monitoring. Patients with newly diagnosed atrial fibrillation had a higher burden of supraventricular ectopic activity. The number of supraventricular extrasystoles (SVES) per hour, as well as the number of SV pairs and SV runs, was significantly higher in patients with new onset AF (p < 0.022; p < 0.043; p < 0.022). In our study, we confirmed that prolonged ECG event Holter monitoring in patients with CIS-ESUS subtype led to a higher rate of AF detection. Likewise, frequent supraventricular ectopic activity predicted the development of AF.

Influence of Tocolytic Therapy with Hexoprenaline on Heart Rate Variability, Lipid Spectrum and Glycemic Level in Obese Pregnant Women

Background. Obesity is associated with the risk of spontaneous preterm birth. Hexoprenaline is the effective and most widely used tocolytic agent, possessing however a significant number of side effects. The effect of hexoprenaline tocolysis on heart rate variability, lipid spectrum and glycaemia level in obese pregnant women remain unexplored.Aim of the research. To study the effect of tocolytic therapy with hexoprenaline on heart rate variability, lipid spectrum and glycemic level in obese pregnant women.Materials and methods. The study included two groups of pregnant women with threatened preterm labor who received tocolysis with hexoprenaline. One group consisted of 68 obese patients, the other – 72 non-obese pregnant women (control group). Patients underwent Holter monitoring. Fasting serum glucose and lipids spectrum were measured before starting tocolytic therapy and after 24 hours of tocolysis.Results. In obese pregnant women with hexoprenaline infusion, the heart rate, the 24-hours number of supraventricular extrasystoles and ventricular extrasystoles during the day are significantly higher. Frequency domain parameters, very low frequency during the day, low frequency at night and 24-hours high frequency were significantly decreased than in control group. After a day of tocolysis in obese pregnant women, the level of total cholesterol, low density lipoproteins, triglycerides, and glucose significantly increases when compared with the results before therapy. For patients in the control group treated with hexoprenaline, only the concentration of high-density lipoproteins is increased.Conclusion. Obesity in pregnant women receiving hexoprenaline tocolysis is associated with low heart rate variability and an increase in the number of cardiac arrhythmias, as well as lipid disorders and an increase in glucose level.

КЛИНИКО-ФУНКЦИОНАЛЬНЫЕ ОСОБЕННОСТИ СОСТОЯНИЯ СЕРДЦА У ПАЦИЕНТОВ СТАБИЛЬНОЙ СТЕНОКАРДИЕЙ С СОПУТСТВУЮЩЕЙ БРОНХИАЛЬНОЙ АСТМОЙ

Objective: to analyze the frequency of the combination of coronary heart disease (CHD) and bronchial asthma (BA) in clinical practice and to identify the features of the clinical course of stable angina in concomitant BA of varying severity. Materials and methods. CHD patients with BA were divided into 3 groups depending on the severity of the BA course: Group 1 – CHD with mild persistent BA (38 patients), Group 2 – CHD with moderate persistent BA (52 patients), Group 3 – CHD with severe BA (21 patients). All patients underwent a general clinical examination, as well as daily ECG monitoring and echodopplercardiography (ECHODPCG). Results. The patients of the CHD/mild BA group manifested significant differences from the patients of CHD/moderate BA group (p&lt;0.001) and from the CHD/severe BA group (p&lt;0.001) in the level of systolic blood pressure (BP) and diastolic blood pressure, which increased with increasing BA severity. According to the ECHODPCG data, there were significant differences between the study groups concerning both the right and left parts of the heart. The data of 24-hour ECG monitoring confirm that the more severe the BA, the more pronounced the ischemic changes in the myocardium are, which suggests a more severe course of CHD. The number of supraventricular extrasystoles and ventricular extrasystoles in the patients with CHD with BA increases significantly with increasing severity of BA. The analysis of the lipid spectrum revealed that hypercholesterolemia increases with the progression of BA. Conclusion. The results of the study show that with an increase in the BA severity in the patients with a combination of BA and CHD there occur more pronounced changes in hemodynamics related to an increase in the level of systolic and diastolic blood pressure. Mutual aggravation and progression in the combination of bronchial asthma and arterial hypertension is based on the commonality of some links of pathogenesis. This can lead to the progression of heart failure and the early development of cardiorespiratory complications. The data indicate that the progression of BA severity is associated with acceleration of the heart rate, as well as with an increase in the frequency of detection of supraventricular and ventricular extrasystoles, and major myocardial remodeling affecting both the left and the right parts of the heart. This allows us to conclude that chronic inflammation in BA activates the renin-angiotensin-aldosterone and sympathoadrenal systems, which leads to the development of atherosclerosis and an increase in the severity of CHD.

Risk of heart rhythm disorders in patients with chronic obstructive pulmonary disease, combined with ischemic heart disease during computer spirography

The aim — to evaluate the safety of spirography with bronchodilation test in patients with a combination of stable ischemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD).Materials and methods. 148 patients were examined including 53 patients with a combination of stable IHD and COPD, 53 IHD patients without concomitant COPD and 42 patients with COPD. Patients underwent general clinical examination, monitoring of an electrocardiogram, echocardiography, spirography.Results and discussion. An increase in the number of extrasystoles within 1 hour after performing spirography was noted, the greatest increase in the number of supraventricular extrasystoles (SVE) was observed in patients with combined pathology — on average (12.6 ± 6.8, p = 0.23). The number of ventricular extrasystoles (VE) within 1 hour after spirography in patients with combined pathology increased by (27.8 ± 12.6, p = 0.0064), whereas in patients with IHD — by (3.4 ± 2.2, p = 0.19), in patients with COPD — by (15.7 ± 12.5, p = 0.076). An increase in the number or occurrence of polytropic VE was reported in 4 (7.5 %) persons with combined pathology, in 2 (3.8 %) patients with IHD and in 3 (7.1 %) patients with COPD. The occurrence of high‑grade VE during spirography was established in 11 (20.7 %, p = 0.008) patients with a combination of IHD and COPD, in 5 (9.4 %, p = 0.06) patients with isolated course of IHD and in 3 (7.1 %, p = 0.23) patients with COPD. The predictors of an increase in the number of VE within 1 hour after performing spirography for patients with IHD and COPD were identified.Conclusions. Spirography is associated with the occurrence of rhythm disorders in patients with a combination of IHD and COPD. Prior to spirography, patients with IHD should undergo echocardiography and daily monitoring of the electrocardiogram.

Results of Holter monitoring in patients with angina pectoris treated by combination of trimethazidine with fabomotisol in the area of former armed conflict

Aim. To assess the effectiveness of trimetazidine and fabomotisol adding to standard treatment in patients with stable angina in the area of former armed conflict in point of improving of Holter monitoring parameters.Material and methods. One hundred and twelve patients with stable angina of the II-III functional classes (FC) living in the area of former armed conflict were randomly divided into two groups. For 6 months 54 patients (control group) received standard treatment (isosorbide dinitrate 40 mg/day, metoprolole tartras 50-100 mg/day, acetylsalicylic acid 100 mg/day, simvastatin 40 mg/day). Fifty eight patients (study group) in addition to a standard treatment, took trimetazidine 70 mg/day and fabomotisol 30 mg/day. Initially and after 6 months they underwent Holter monitoring.Results. In patients of the control group the number of episodes of silent myocardial ischemia was statistically significantly reduced (p&lt;0,05). The duration of episodes of silent and manifest myocardial ischemia, ST segment depression &gt;1 mm, and the number of patients with supraventricular and ventricular extrasystoles decreased not statistically significant (p&gt;0,05). The number of episodes of manifest myocardial ischemia did not change. In the study group, the number of silent ischemia episodes, the duration of silent and manifest myocardial ischemia significantly decreased. ST segment depression and the frequency of ventricular extrasystoles were also decreased (p&lt;0,05). At the same time, the changes in number of supraventricular extrasystoles was not statistically significant (p&gt;0,05). Conclusion. Using a combination of trimetazidine with fabomotisol in comparison with standard treatment in patients with angina reduces the frequency of angina episodes, the duration of myocardial ischemia, ST segment depression, the frequency of supraventricular and ventricular extrasystoles.

The condition of the cardiovascular system in patients with relapsing-remitting multiple sclerosis

The aim of the reserch was to study the state of the cardiovascular system, systemic inflammation and balance oxidant/|antioxidant in patients with relapsing-remitting multiple sclerosis. Material and methods . The study included 45 patients with relapsing-remitting multiple sclerosis (17 men and 28 women), age 28 [24; 32] years, disease duration 5.5 [2; 7] years. The control group included practically healthy patients, age 30 [25; 33] years. Patients with multiple sclerosis were examined neurologically with Expanded Disability Disease Score rating of disability. Instrumental methods included a comprehensive assessment of the cardiovascular system (24-hour Holter ECG monitoring and 24-hour blood pressure monitoring with determination of the daily arterial vascular stiffness, echocardiography). Laboratory methods included clinical and biochemical analysis of blood, lipid profile, glycemia, C-reactive protein. The indices of oxidative stress (acylhydroperoxide) and antioxidant protection (glutathione peroxidase, superoxide dismutase) were studied; a marker of endothelial dysfunction (vascular cellular adhesion molecule-1) were researched. Results. In the group of patients with multiple sclerosis, there was an increase in C-reactive protein, the marker of endothelial dysfunction compared with the control group (p<0.001). The indicators of oxidative stress and antioxidant protection were statistically significantly increased (p<0.001). According to the results of Daily Blood Pressure Monitoring the variability of systolic blood pressure and diastolic blood pressure during daytime hours was reduced comparison to the control group (р<0,026) and (p<0.002) respectively. The indicators of daily arterial stiffness in the group of patients with multiple sclerosis was statistically significantly increased (p<0.001). According to the results of Holter ECG monitoring, no heart rhythm disorder was detected in both groups. In the group of patients with remitting course of multiple sclerosis, an increase in the number of supraventricular extrasystoles was detected compared with the control group (p<0.005). The main indicators of echocardiography were within normal values, no significant differences between the groups were found. Conclusion. The study showed that multiple sclerosis patients are at risk of developing cardiovascular diseases and require increased attention to prevent the development.

Comorbid pathology of the cardiovascular system in young patients with relapsing-remitting multiple sclerosis

To study the state of the cardiovascular system and peripheral microcirculation in young patients with relapsing-remitting multiple sclerosis (MS). The study included 45 MS patients (17 men and 28 women, age 28 [24; 32] years, disease duration 5.5 [2; 7] years). The control group included healthy controls (age 30 [25; 33] years). Neurological and cardiologic examinations included 24-hour Holter ECG monitoring and 24-hour blood pressure monitoring with determination of the daily arterial vascular stiffness, echocardiography, laser doppler flowmetry followed by an occlusive test to assess the state of microvasculation, levels of serum vascular cellular adhesion molecule-1 (VCAM-1). In MS group, the results of 24-hour blood pressure monitoring showed that the variability of systolic blood pressure and diastolic blood pressure during daytime hours was reduced compared to the control group (p<0.026 and p<0.002, respectively). The indicators of daily arterial stiffness in MS group were significantly increased (p<0.001). According to the results of Holter ECG monitoring, no heart rhythm disorder was detected in both groups, except an increase in the number of supraventricular extrasystoles in MS patients compared to the control group (p<0.005). There were no between group differences in echocardiography indicators. The level of VCAM-1 was significantly increased in MS group compared to controls (p<0.001). Young MS patients are at risk of cardiovascular diseases associated with the variability of blood pressure and indexes of daily arterial vascular stiffness.

Comorbid pathology of the cardiovascular system in young patients with relapsing-remitting multiple sclerosis

To study the state of the cardiovascular system and peripheral microcirculation in young patients with relapsing-remitting multiple sclerosis (MS). The study included 45 MS patients (17 men and 28 women, age 28 [24; 32] years, disease duration 5.5 [2; 7] years). The control group included healthy controls (age 30 [25; 33] years). Neurological and cardiologic examinations included 24-hour Holter ECG monitoring and 24-hour blood pressure monitoring with determination of the daily arterial vascular stiffness, echocardiography, laser doppler flowmetry followed by an occlusive test to assess the state of microvasculation, levels of serum vascular cellular adhesion molecule-1 (VCAM-1). In MS group, the results of 24-hour blood pressure monitoring showed that the variability of systolic blood pressure and diastolic blood pressure during daytime hours was reduced compared to the control group (p<0.026 and p<0.002, respectively). The indicators of daily arterial stiffness in MS group were significantly increased (p<0.001). According to the results of Holter ECG monitoring, no heart rhythm disorder was detected in both groups, except an increase in the number of supraventricular extrasystoles in MS patients compared to the control group (p<0.005). There were no between group differences in echocardiography indicators. The level of VCAM-1 was significantly increased in MS group compared to controls (p<0.001). Young MS patients are at risk of cardiovascular diseases associated with the variability of blood pressure and indexes of daily arterial vascular stiffness.

Влияние омакора на показатели аритмической активности и вариабельности сердечного ритма у пациентов с острым инфарктом миокарда

We conducted the open-label randomized trial (n=60) to estimate antiarrhythmic effect of Omacor and its influence on the parameters of heart rate variability. The patients were divided into two groups, the basic group patients (n=30) were added Omacor in a dose of 1 g/day to the complex therapy, the control group patients were given the standard drug therapy. In the basic group a decrease in the total number of supraventricular extra systoles was noted as compared to the control one, as well as an increase in the level of parasympathetic and neurohumoral regulation of the heart activity that might have a beneficial effect on the subsequent treatment.

Conduction Abnormality and Arrhythmia After Transcatheter Closure of Atrial Septal Defect

Background:The aim of this study was to prospectively perform ambulatory 24-h ECG monitoring to assess the effects of transcatheter closure of atrial septal defect (ASD).Methods and Results:A total of 235 consecutive subjects (female, n=163; male, n=72; age, 44.6±14.4 years) were enrolled in the study, who were due undergo ASD closure. Holter monitoring was performed before procedure and at 1, 6 and 12 months of follow-up. During the procedure transient supraventricular arrhythmia occurred in 8 patients (3.4%), and bradycardia in 3 (1.3%). In 3 patients (1.3%) an episode of atrial fibrillation occurred in the first hour after the procedure. In 8 patients (3.4%) transient first-degree atrioventricular block was noted. A significant increase in number of supraventricular extrasystoles (SVES)/24 h was noted 1 month after the procedure (P<0.001). On multiple forward stepwise regression analysis, device size and fluoroscopy time had an influence on increase in number of SVES seen 1 month after the procedure (P<0.001).Conclusions:Transcatheter closure of ASD is associated with a transient increase in supraventricular premature beats and a small risk of conduction abnormalities and paroxysmal atrial fibrillation in early follow-up. Transcatheter closure of ASD does not reduce arrhythmia that appears prior to ASD closure. Larger device size and longer procedure time are associated with increased risk of supraventricular arrhythmia on early follow-up.