Number Of Ventricular Extrasystoles Research Articles

Predictors of paroxysmal atrial fibrillation: Analysis of 24-hour ECG Holter monitoring

main predictors of the development of this arrhythmia. Material and methods.A single-center, cross-control study was conducted. Of all 6630 protocols analyzed, according to 24-hour ECG monitoring, AF paroxysm was detected in 97 people as an accidental finding. These patients were included in the main study group. The control group consisted of 99 patients from the same cohort without paroxysmal AF, having the anthropometric and comorbidity parameters similar to the patients of the main group. Results.In the absolute majority (97.9%) of patients in the main group in whom paroxysmal AF was detected, a special variant of extrasystole was revealed – early atrial “P on T” type (versus 4.0% in patients in the control group) [OR 8461.648 (382.1983;187336)]. The number of supraventricular single, paired and group extrasystoles was significantly higher in the main group, but the number of ventricular extrasystoles did not differ significantly. Conclusion.One of the main ECG predictors for the development of paroxysmal AF in asymptomatic patients is the appearance of supraventricular extrasystole of the “P on T” type. In the mechanism of formation of AF paroxysm during supraventricular extrasystole of the “P on T” type, not only electrophysiological mechanisms play a role, but also the heart biomechanics.

CHARACTERISTICS OF HEART RHYTHM DISORDERS ACCORDING TO THE DATA OF HOLTER ECG MONITORING IN PATIENTS WITH HEART FAILURE AND ATRIAL FIBRILLATION

Chronic heart failure (CHF) is one of the most significant medical, economic and social problems of the 21st century and remains the main cause of morbidity and mortality worldwide.The purpose. To study the indicators of Holter ECG monitoring, the dynamics of ischemic changes, heart rate, indicators of heart rhythm variability and blood pressure in patients with heart failure and atrial fibrillation.Material and methods. 150 patients aged 45-65 were examined. All patients were divided into groups: Group I – patients with HF with sinus rhythm or atrial fibrillation (AF) (permanent or persistent form), (n=75). Group II – patients without HF with AF, (n=75). Group III – control group: 36 practically healthy people. All patients underwent a clinical examination, ECG, echocardiography (ECHOKG), Holter ECG monitoring (HM ECG) and daily BP monitoring (DMAT).Research results. The analysis of the ECG of the examined patients indicates the presence of heart rhythm disorders, which is an important risk factor and progression of CHF. The results of XM ECG indicate the presence of ventricular arrhythmias of various gradations along with AF. There was a probable difference in the direction of an increase in the number of ventricular extrasystoles (VAS), both single and, most importantly, extrasystoles of high gradations, in patients with CHF and AF compared with healthy subjects. In addition, the number of SHEs in patients with CHF and AF was likely lower than in patients with CHF with sinus rhythm. Indicators of maximum heart rate, ST segment depression and QT interval dispersion in patients with CHF and AF were significantly higher (p<0.05) than similar parameters in patients without CHF with AF.Conclusions: Ventricular heart rhythm disturbances were detected in the examined patients, which is a predictor of an unfavorable prognosis in patients with chronic heart failure. There was a probable difference in the direction of increased levels of maximum heart rate, maximum depression, ST segment elevation, dispersion of the QT interval, QTc, an increase in the total duration of episodes of myocardial ischemia, in patients with chronic heart failure and atrial fibrillation in comparison with healthy subjects.

Heart rhythm and autonomic regulation disorders in chronic coronary syndrome patients with community-aсquired pneumonia

Pneumonia presents a considerable challenge in patients with cardiovascular disease due to an increase in the incidence, difficulties of diagnosis and treatment, high mortality. Aim: to study the characteristics of cardiac arrhythmias and heart rhythm autonomic regulation in patients with chronic coronary syndrome (CCS) and community-acquired pneumonia (CAP), and to define their relationship with the clinical features of the disease. Materials and methods. A monocenter cross-sectional study analyzed 90 patients with CCS in parallel groups. The main group included 60 CCS patients with CAP; the control group consisted of 30 patients without concomitant CAP. A complex clinical examination of patients was performed on 1–3 days of hospital stay in accordance with the National Recommendations. Holter ECG monitoring was performed using a CARDIOSENS K device (XAI-MEDICA, Ukraine). Results. Based on the results of 24-hour ECG monitoring, heart rhythm disorders, increased duration of myocardial ischemia and ST-segment depression depth with an increase in the total duration of tachycardia episodes within 24 hours were more common in the main group patients. The severity of CAP on the PSI/PORT scale was correlated with the 24-hour mean heart rate (r = +0.31, P < 0.05), the number of ventricular extrasystoles – with respiratory rate (r = +0.29, P < 0.05), supraventricular extrasystoles – with the duration of ST-segment depression (r = +0.57, P < 0.05). In patients with CCS and CAP, there was a decrease in the total heart rate variability (HRV), mainly in the passive period, combined with an increase in the LF/HF ratio and stress index (SI), which was directly correlated with the severity of CAP and intoxication syndrome. Conclusions. Patients with CCS and CAP are characterized by the increased 24-hour heart rate, duration of ST-segment depression, frequency of supraventricular and ventricular arrhythmias on 24-hour Holter monitoring, paroxysms of atrial fibrillation with the decreased total HRV combined with significantly increased activity of the sympathetic autonomic nervous system.

Clinical and instrumental profile of patients with stage II essential hypertension with different forms of extrasystoles according to the level of apelin-13

Annotation. Essential hypertension (EH) is one of the leading causes of disability and mortality among cardiovascular diseases, so today new metabolic markers of cardiovascular risk are being actively studied. One of them is apelin-13. Objective – to evaluate the clinical and instrumental profile of patients with stage II hypertension with different forms of extrasystoles and different neurohumoral background – conditionally high/low serum apelin-13 levels. 156 patients with stage II essential hypertension were examined. 124 of them had frequent symptomatic extrasystoles, 32 patients had no arrhythmias and were considered to the comparison group. 30 practically healthy normotensive persons were considered to the control group. All patients underwent a complete clinical and anthropometric examination, blood pressure measurement, automatic daily blood pressure monitoring, daily electrocardiogram monitoring, echocardiography and the assessment of serum apelin-13 level. For statistical analysis, the procedure of non-linear data estimation was chosen, namely logistic regression or logit model. To form the basic statistical matrix of the analysis, we used clinical-instrumental and laboratory indicators, which passed a preliminary correlation analysis of Spearman with the level of apelin-13 serum and found a significant correlation (p<0.05). In the course of the logistic analysis at the final model, which allowed to predict “background of apelin” in patients with stage II EH entered 4 independent factors that revealed statistically significant (p<0.05) correlations with the initial parameter: the value of the systolic arterial pressure time index in%, the index of the left atrium in mm/m2, the average number of ventricular extrasystoles for 1 hour and the level of total cholesterol in plasma in mmol/l. The last indicator showed the least informativeness in predicting of the apelin-13 serum level. Interpreting the data of the obtained logit regression model, it should be said that in patients with EH of increasing the value of the systolic arterial pressure time index, the index of the left atrium and the average value of ventricular extrasystoles during 1 hour and decrease total cholesterol level in plasma increase the probability of determining relatively low (<920 pg/ml) and at the same time reduce the probability of determining a relatively high (≥920 pg/ml) level of apelin serum. These data also show that the highest informativeness in predicting the level of apelin-13 in patients with EH was the total number of ventricular extrasystole per hour. So, a high “apelin background” (≥920 pg/ml) in patients with EH will be accompanied by a benign course of the disease, so an increase serum apelin-13 in patients with EH should be considered as positive neurohumoral changes that promote cardioprotection, improve prognosis course of the disease and reduce cardiovascular risk.

Modern Possibilities of Metabolic Therapy in Improving the Quality of Life in Patients with Postinfarction Cardiosclerosis

95 patients with postinfarction cardiosclerosis and angina pectoris II and III functional classes were examined. The study included patients who refused intervention revascularization. The main group included 48 patients who were added taurine (Dibikor 750 mg / day) to enhance the effect of basic therapy, and the comparison group included 47 patients who received standard therapy and placebo. The duration of treatment was 3 months. The study demonstrated positive effects of taurine that was confirmed by significant improvements in the following indicators: subjective status, indicators of the Seattle questionnaire, echocardiographic parameters, cardiac arrhythmias. There was a decrease in the severity of fatigue by 2 times, a decrease in the intensity of complaints of palpitations by 72.3%, a decrease in the severity of dyspnea by 30.0% and a severity of pain in the heart area by 50%. Indicators of most scales of the Seattle questionnaire in patients of the main group at the end of the study significantly exceeded (p <0.05) the corresponding values in patients of the comparison group. In patients whose treatment was used taurine, a significant improvement in inotropic function was noted (the ejection fraction is significantly higher than in the comparison group, respectively 56.0 ± 1.8 and 53.5 ± 1.1%, p <0,05), the bathmotropic and chronotropic myocardial functions improved, which was shown by a 45% decrease in the number of ventricular extrasystoles, a 57% decrease in the frequency of supraventricular heart rhythm disturbances, a decrease in the incidence rate of ST segment depression (in the main group the number of episodes was significantly lower than p <0,05 than in the comparison group). The use of taurine in the complex treatment of patients with exertional angina, after suffering a myocardial infarction, is safe and not accompanied by side effects. Taurine is advisable to include in the complex treatment of patients with exertional angina pectoris, who have had a myocardial infarction in order to improve the myocardial inotropic function, enhance the antiarrhythmic and lipid-lowering effects of the basic therapy. The recommended dose of Taurine is 750 mg per day as a supplement to standard therapy with a duration of therapy of at least 3 months.

The impact of coronary stenting on long-term quality of life in patients with stable coronary heart disease

The purpose of the work is to assess the impact of percutaneous coronary intervention (PCI) on quality of life (QOL) parameters in patients with stable coronary heart disease (CHD).Material and methods. 175 people with stable CHD were examined, group I consisted of 77 people who underwent PCI for 1 year, group II - 98 patients who did not undergo myocardial revascularization. During the study, all patients underwent general clinical examination, ECG recording in standard 12 leads, echocardiography (ECHOCG), daily ECG monitoring to determine heart rate variability, determination of QOL parameters according to the Ukrainian version of the international questionnaire Medical Outcomes Study Short Form (MOS SF-36).Results. It was established that for patients with stable CHD is characterized by a decrease in all indicators of QOL. No significant difference was found in the parameters of QOL of persons who underwent PCI and patients who were not revascularized. There was a tendency to greater limitation of vital activity due to physical problems in the group of persons without revascularization - (13.9 ± 3.6) points against (22.3 ± 4.9) points in group I, (p = 0.16). The physical status of patients of group I was (44.8 ± 2.8) points, persons of group II - (41.7 ± 2.6) points, p = 0.42. Mental status was in group I (36.8 ± 1.8) points, in group II - (35.1 ± 2.0) points (p = 0.54). The general status of persons who underwent revascularization was (61.6 ± 3.1) points, persons without revascularization - (62.7 ± 3.2) points (p = 0.8). The negative correlation of physical status with the age of patients (r = -0.36), the presence of chronic respiratory diseases (r = -0.41), the presence of ventricular extrasystoles (VE) when recording the ECG (r = -0.25) , as well as the number of VE during the day according to daily monitoring (r = -0.29), the number of paired VE (r = -0.27), the number of episodes of ventricular bigeminy (r = -0.23) and trigeminy (r = -0.26).Conclusions. In persons with stable CHD there is a decrease in physical, mental and general status of QOL according to the questionnaire MOS SF36. The QOL values of patients with stable CHD who underwent PCI during the year do not differ significantly from the parameters of persons who did not undergo revascularization. The physical and mental status of patients with stable CHD is most associated with age, the presence of concomitant chronic pathology, ventricular arrhythmias.

Influence of Omega-3 PUFA on Non-invasive factors determining the risk of arrhYthmias eXcess and sudden cardiac death in patients with HFpEF with ischemic etiology (ONYX)

Aim Patients with heart failure with reduced left ventricular (LV) ejection fraction (HFrEF) who have had acute myocardial infarction have an unfavorable prognosis, largely due to ventricular arrhythmias (VA) and risk of sudden cardiac death (SCD). The optimal treatment (triple neurohormonal blockade plus implantable cardioverter defibrillator and cardiac resynchronization therapy) reduced the risk of SCD primarily due to reverse cardiac remodeling, but has not solved this problem completely. Efficacy of purified ω-3 polyunsaturated fatty acid esters (PUFA) in low doses (1 g/day) in reducing VA and risk of SCD in HFrEF patients was demonstrated in two large randomized clinical trials. The PUFA effects was suggested to be related also with increased heart rhythm variability (HRV) and chronotropic action, which might depend on the drug dose. The present open, prospective, randomized, comparative study in parallel groups evaluated the effect of Omacor in different doses on noninvasive markers of SCD risk in patients with ischemic HFrEF receiving the optimal drug therapy.Methods Patients (n=40) were randomized at a 1:1:2 ratio to the control group (n=10), the Omacor 1 g/day treatment group (n=10), and the Omacor 2 g/day treatment group (n=20) and were followed up for 12 months. Clinical evaluation included changes in the CHF functional class (FC) and Clinical Condition Scale (CCS) score; concentration of N-terminal pro-hormone brain natriuretic peptide (NT-proBNP); and peak oxygen consumption during exercise (peak VO2). The LV function was evaluated by LVEF. Holter ECG monitoring was used for evaluation of HRV (SDNN), average 24-h heart rate (HR), number of ventricular extrasystoles (VE) per hour and severity of VA, and presence of paired VE and VT runs.Results Improvement of CHF FC became significant only with the high-dose Omacor treatment (2 g/day). The CCS score showed a tendency towards decrease also with a lower dose (1 g/day) whereas the level of NT-proBNP significantly decreased with both Omacor doses. The increase in LV EF was significant only with the use of Omacor 2 g/day (+3 %, р=0.002). A negative chronotropic effect of ω-3 PUFA was observed. Average 24-h HR decreased by 8 bpm (р=0.05) and 11 bpm (р<0.001) with Omacor 1 g/day and 2 g/day, respectively. Either dose of ω-3 PUFA significantly improved VO2, which directly correlated with LV EF and inversely correlated with HR. The decrease in number of VE was associated not only with improved HRV (SDNN) but also with the decrease in 24-h HR, and thus Omacor 2 g/day significantly decreased the number of VE (by 16 per hour) and dangerous VA (paired VE and VT runs ceased to be detected in 40 % of patients).Conclusion Since HR, HRV, and VA are closely interrelated, the effect of ω-3 PUFA specifically on these noninvasive markers apparently determines its ability to decrease the risk of SCD in patients with ischemic HFrEF. The antiarrhythmic effect of Omacor was greater with higher doses of this drug.

New components of contemporary arrhythmology – the basics of pathogenesis and their clinical justification

The article highlights the positive experience with the use of the drug ranolazine as part of the complex treatment of coronary heart disease with rhythm or conduction disturbances. The problem of rhythm and conduction disturbances on the background of ischemic heart disease is one of the most relevant at present. The mechanisms of occurrence of rhythm and conduction disorders in this nosology have not been studied enough. The most likely underlying mechanism is ischemic.Purpose – the goal is to assess the effect of ranolazine on rhythm and conduc tion disturbances with an established diagnosis of IHD.Results. The article discusses various clinical situations in which a reduction in the number of rhythm and conduction disturbances (paroxysms of supraventricular tachycardia / tachyarrhythmias, supraventricular and ventricular extrasystoles), restoration of intraventricular and atrioventricular conductivity has been achieved. The effect was achieved when ranolazine was added to the standard treatment complex. The control was carried out using repeated registrations of the electrocardiogram (ECG), daily monitoring of ECG (SMECG). The dosage of ranolazine was 500 mg twice a day, followed by an increase to 1000 mg 2 times a day.Findings. The clinical examples show a positive result when prescribing ranolazine for the treatment of ranolazine against the background of standard therapy for CHD. Its effect on rhythm disturbances (decrease in the number of supraventricular tachycardias / tachyarrhythmias and supraventricular extrasystoles, decrease in the number of ventricular extrasystoles) and conductivity (restoration of atrioventricular (AV) and supraventricular conductivity) are noted.

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.

Abstract 576: Phosphodiesterase 2 in Cardiac Arrhythmias and Heart Failure

Heart failure (HF) patients often suffer from lethal ventricular arrhythmias leading to sudden cardiac arrests. Phosphodiesterase 2 (PDE2), a cGMP activated enzyme hydrolyzing cAMP, is upregulated in HF. Cardiac-specific PDE2 overexpression revealed strong anti-arrhythmic and heart rate lowering effects of PDE2. Here, we validated the cardioprotective role of PDE2 upon modulating cardiac PDE2 activity, first, via assessing cardiac function of cardiac-specific PDE2-KO mice and second, via potentiating PDE2 mediated cGMP/cAMP crosstalk using natriuretic peptide type C (CNP), which are upstream of the cGMP/PDE2 axis. Cardiac function and arrhythmia susceptibility of PDE2-KO were assessed via echocardiography and ECG telemetry under basal conditions and after myocardial infarction (MI). Patch clamp technique was used to investigate CNP effects on action potentials and ion currents in WT isolated cardiomyocytes and in-vivo via ECG-telemetry. Already under basal conditions, PDE2-KO displayed severe irregularities in RR-intervals. 14 days post MI, PDE2-KO showed lower cardiac function and delayed increase in heart rate after arrhythmia provocation (double isoprenaline (ISO) injection (2 mg/kg i.p.) compared to WT controls, indicating diminished cardiac responsiveness. On the other hand, CNP treatment in WT displayed a PDE2-dependent antiarrhythmogenic effect. CNP (1 μM) significantly reduced the total number of delayed afterdepolarizations and spontaneous action potentials upon acute ISO (10 nM) stimulation. Furthermore, CNP significantly reduced the ISO-mediated increase of the L-type Ca 2+ and late Na + currents as well as SR Ca 2+ waves. These effects were reversed upon specific PDE2 inhibition with BAY 60-7550. Finally, in vivo, CNP (33 μg/g i.p.) significantly reduced the number of ventricular extrasystoles after arrhythmia provocation. This effect was significantly attenuated after PDE2 inhibition with BAY 60-7550. Here we provide evidence for acute antiarrhythmic effects of CNP upon downstream stimulation of cGMP-stimulated PDE2 and a critical role of PDE2 on heart rate regulation. Therefore, pharmacologically enhancing myocardial PDE2 activity may represent a novel cardioprotective strategy in cardiac arrhythmia and HF.

CIRCADIAN-RELATED ECTOPIC RHYTHMS IN YOUNG PATIENTS: ETHIOPATHOLOGICAL FEATURES AND PRINCIPLES OF THERAPY

The autonomic nervous system plays a key role in the processes of adaptation, regulating the functioning of the whole organism. And a disturbance of the heart rhythm is typically one of the first manifestations of autonomic circadian maladaptation. The aim of this study was to assess the relationship between circadian rhythm disorders and autonomic misbalance with the occurrence of arrhythmic events in young patients with the further development of treatment strategy. Materials and methods: the study was performed at the Medical Centre «MEDION». 34 patients aged 18-35 years were enrolled to the study, divided into the test and control groups. Results: despite a significantly higher frequency of supraventricular arrhythmias in the test group compared to the control group, the supraventricular extrasystoles occurred in the control group predominantly at night time (with peak from 3 to 6 a.m.). In the test group, atrial ectopic beats were observed predominantly from 5 to 12 a. m. In the group of patients with the number of ventricular ectopic complexes over 500 / day, no time interval was found, during which the number of ventricular extrasystoles was statistically significantly predominant. The most important factors of ventricular ectopic events occurrence included: sleeping less than 6 hours, job lasting over 10 hours a day, and too little time spent outdoors. All individuals were recommended to modify their lifestyle and take when necessary autonomic normalization agents and antiarrhythmics. Conclusion: the modern lifestyle of the young generation leads to the disturbance of circadian biorhythms as a result of the unbalanced autonomic regulation and the subsequent occurrence of ectopic arrhythmic events. The most unfavourable factors in this case are sleeping less than 6 hours, a working day lasting over 10 hours, and outdoor-spent time lasting less than 2 hours a day.

Modern Possibilities of Metabolic Therapy in Improving the Quality of Life in Patients with Postinfarction Cardiosclerosis

95 patients with postinfarction cardiosclerosis and angina pectoris II and III functional classes were examined. The study included patients who refused intervention revascularization. The main group included 48 patients who were added taurine (Dibikor 750 mg / day) to enhance the effect of basic therapy, and the comparison group included 47 patients who received standard therapy and placebo. The duration of treatment was 3 months. The study demonstrated positive effects of taurine that was confirmed by significant improvements in the following indicators: subjective status, indicators of the Seattle questionnaire, echocardiographic parameters, cardiac arrhythmias. There was a decrease in the severity of fatigue by 2 times, a decrease in the intensity of complaints of palpitations by 72.3%, a decrease in the severity of dyspnea by 30.0% and a severity of pain in the heart area by 50%. Indicators of most scales of the Seattle questionnaire in patients of the main group at the end of the study significantly exceeded (p <0.05) the corresponding values in patients of the comparison group. In patients whose treatment was used taurine, a significant improvement in inotropic function was noted (the ejection fraction is significantly higher than in the comparison group, respectively 56.0 ± 1.8 and 53.5 ± 1.1%, p <0,05), the bathmotropic and chronotropic myocardial functions improved, which was shown by a 45% decrease in the number of ventricular extrasystoles, a 57% decrease in the frequency of supraventricular heart rhythm disturbances, a decrease in the incidence rate of ST segment depression (in the main group the number of episodes was significantly lower than p <0,05 than in the comparison group). The use of taurine in the complex treatment of patients with exertional angina, after suffering a myocardial infarction, is safe and not accompanied by side effects. Taurine is advisable to include in the complex treatment of patients with exertional angina pectoris, who have had a myocardial infarction in order to improve the myocardial inotropic function, enhance the antiarrhythmic and lipid-lowering effects of the basic therapy. The recommended dose of Taurine is 750 mg per day as a supplement to standard therapy with a duration of therapy of at least 3 months.

Acute response to 7-day therapy with CPAP in patients with moderate to severe obstructive sleep apnea and cardiac arrhytmia.

IntroductionObstructive Sleep Apnea (OSA) has been associated with an elevated risk of cardiac arrhythmia. Continuous positive airway pressure (CPAP) is the selected treatment for moderate to severe OSA and could improve arrhythmias in the long term. However, the acute effect of CPAP has not been studied in detail.MethodsWe conducted a prospective study with 25 patients with moderate to severe OSA diagnosed by home respiratory polygraphy (RP) and arrhythmia and/or pauses in 24-hour Holter ECG. We analyzed inflammatory parameters and the rate of arrhythmias/pauses after 7 days of auto-adjusting CPAP.Results92.5% of the patients were men with a mean age of 61.7±1.9 years. Body mass index (BMI) was 59.5±2.2 kg/m2, with a mean apnea hypopnea index (AHI) of 37.7±3.8 events/hour (ev/h), and a residual AHI (AHIr) of 5.3±0.53 ev/h. After short treatment with CPAP we observed a tendency to improvement in both the severity and number of ventricular extrasystoles (VE) (1595.0±850.3 vs. 926.4±434.5 respectively), pauses and the inflammatory parameters (CRP 3.9±3.1 vs. 1.7±1.2, glycemia 131.4±11.6 vs. 121.9±9.8, HOMA 24.4±3.1 vs. 21.7±2.8, insulin 7.6±1.4 vs. 7.2±1.2 (p>0.5).ConclusionWe didn't find significant changes in pauses, VE and inflammatory parameters with CPAP short therapy in CPAP naive patients recently diagnosed with OSA.

The impact of exogenous l-arginine on cardiohaemodynamics and heart rhythm variability in patients with coronary heart disease after community-acquired pneumonia

Aim of the work: to study the influence of exogenous L-arginine on structural-functional indices of heart, intensity degree of myocardium coronary changes and heart rhythm variability in patients with coronary heart disease after community-acquired pneumonia. Methods of research: the open prospective study included 60 patients with CHD, exertional angina, 2-3 f.c., who underwent community-acquired pneumonia of 3 clinical group (men – 34, women – 26, age median 72,50 (66,00; 75,00) years old). All patients underwent clinical examination, included clinical-laboratory methods of examination, two-dimensional echocardioscopy and impulse-wave dopplerography, daily monitoring of ECG by Holter at admission to hospital and in 3 months. After singing the informed consent, the patients were randomized in 2 groups. Main group included 30 persons, who received L-arginine in addition to basic CHD therapy, 30 patients of control group received only basic therapy.Results of research: patients of main group at secondary examination in three month demonstrated a tendency to decrease of final-diastolic volume of LV, reliable increase of fraction of left ventricle emission by 4,44% (р&lt;0,05), and decrease of mean pressure in pulmonary artery was more significant (8,33% vs 2,94%; р&lt;0,05). The inclusion of L-arginine in the scheme of CHD treatment favored the reliable (р&lt;0,05) decrease of tachycardia duration by 49,77%, number of ventricular extrasystoles by 63,2%, duration of ST segment depression by 56,52%, increase of general heart rhythm variability (rMSSD – by 70,00%, ТР – by 97,42%) and decrease of LF/HF index by 11,67% at the expanse of activity of parasympathetic component comparing with patients, who received only basic therapy.Conclusions: the addition of L-arginin to the basic therapy in patients with IHD has the positive influence of cardiohemodinamics, favors the decrease of intensity degree of coronary changes and normalization of sympatho-parasympathetic balance of vegetative nervous system

Which factors predict the behavior of ventricular extrasystoles in athletes over time?

Spontaneous behavior of ventricular extrasystoles (VE) was analysed. From a database containing 578 athletes with VE, 84 males and 11 females (29.9 ± 18.1 years) having ≥ 100 VE or repetitive VE [ventricular couplets (VC) or ventricular tachycardias (VT)] at first 24-hour Holter electrocardiographic monitoring (24-h-HM) (baseline) and at least 1-year of follow-up (3.1 ± 2.2 years) over the past 10 years were selected. The baseline was compared with the last 24-h-HM to establish DVE (VE reduction of at least 98%/24 h in the absence of VC or VT). SDVE was calculated as standard deviation of the number of VE on serial 24-h-HMs. DVE and SDVE were considered as dependent variables. Independent variables were: age, sex, type of sport, symptoms, baseline VE rate (BVE), baseline VC and VT, VE morphology, VE behavior during the baseline training session, disqualification from competitive sports, echocardiographic abnormalities. DVE occurred in 32 athletes (34%). SDVE varied from 0 to 12,658 VE/24 h (1916 ± 2649.9). Disappearance of VE during the baseline training session (DVET) correlated to DVE (P = 0.0319). BVE directly correlated to SDVE (P = 0.0008). Athletes' VE are highly variable over time, their variability depending on BVE, and they not infrequently tend to disappear. The only useful variable for predicting DVE is DVET.

Omega-3 index of erythrocytes and predictors of sudden cardiac death in patients with coronary heart disease and ventricular arrhythmias

Aim.To assess the association between ω-3 index of erythrocytes and demographic, electrophysiological, and echocardiographic (EchoCG) predictors of sudden cardiac death (SCD) in patients with coronary heart disease (CHD) and ventricular arrhythmias (VA).Material and methods.The study included 25 patients with a verified diagnosis of CHD and VA. Gas chromatography method was used to measure the content (%) of eicosapentaenoic (EPA) and docosahexaenoic (DHA) polyunsaturated fatty acids (PUFA) in peripheral blood erythrocytes, with the calculation of a summary (EPA + DHA) ω-3 index. All participants underwent 24-hour electrocardiography (ECG) monitoring, with the assessment of maximal, minimal, and mean heart rate (HR), heart rate variability (HRV) parameters (SDNN and pNN50), heart rate turbulence (TO and TS), microvolt T wave alternans (mTWA), and the number of ventricular extrasystoles (VE) and transient and persistent ventricular tachycardia (VT) episodes. All patients also underwent EchoCG.Results.In examined patients, the values of ω-3 index of erythrocytes varied from 1,12% to 6,4% (mean 3,74%, 95% CI 2,02-4,38%). There was a weak correlation between ω-3 index or EPA levels (%) and the HRV parameter of pNN50. In addition, ω-3 index or DHA levels (%) negatively correlated with the daily VE number. The 5:00 AM value of mTWA (II lead, update factor 1/8) weakly correlated withω-3 index and DHA levels. There was a moderate positive correlation between E/A ratio and omega-3 index, or EPA and DHA levels.Conclusion.Patients with CHD and VA were characterised by low ω-3 index values and high (56%) or moderate (44%) levels of cardiovascular risk. The values of ω-3 index positively correlated with the daily VE number and negatively correlated with E/A ratio and pNN50 parameter of HRV.

Age-related deficit of androgens in the male patients presenting with coronary heart disease

A total of 51 men at a mean age of 55±5.2 years with coronary heart disease were available for examination. Twenty of them presented with confirmed age-related androgen deficiency while the remaining 31 had the testosterone level within the normal reference values. The study included characteristic of lipid and carbohydrate metabolism, diagnosis of obesity and its type, estimation of the depression level, echocardiographic imaging, 24-hour ECG monitoring, and myocardial perfusion scintigraphy. The patients with androgen deficiency were shown to more frequently suffer abdominal obesity and high-level depression than those with the normal testosterone level. Moreover, patients of the former group usually had atypical anginal syndrome. The deficit of androgens was not infrequently associated with a rise in the number of ventricular extrasystoles. The correlation analysis demonstrated a significant negative relationship between the total testosterone level, blood glucose and triglyceride levels, the duration of ST segment ischemic depression.

Influence of leukotriene biosynthesis inhibition on heart rate in patients with atrial fibrillation

Atrialfibrillation (AF) is themost common cardiac arrhythmia. There is an increasing evidence linking systemic and/or local inflammation to AF pathogenesis [1–3]. Leukotrienes (LT) are potent proinflammatory mediators produced via 5-lipoxygenase (5-LO) pathway of arachidonic acid. Both experimental [4,5] and clinical [6,7] data point to their role in cardiac pathology. Our recent results [8] indicate that pharmacological inhibition of LT biosynthesis is associatedwith decrease in the heart rate and enhanced heart rate variability in patients with stable angina pectoris undergoing elective coronary catheterization or angioplasty. This suggested to us that LT biosynthesis inhibition could be of potential interest in patients with AF. We studied49 subjects, recruited from103 consecutive patientswith permanent AF, hospitalized in the Department of Medicine. Exclusion criteria encompassed: age over 80 years, heart failure, asthma, acute or chronic inflammatory diseases, renal or liver insufficiency, hyperthyroidism and pacemaker implantation. The clinical characteristics of the patients are presented in Table 1. Informed written consent was obtained from all patients. The study protocol, that complied with the Helsinki Declaration, was approved by the local Ethics Committee. The participants underwent a single-blind, placebo-controlled study with the inhibitor of 5-lipoxygenase (zileuton; Zyflo, Cornerstone Therapeutics Inc., Cary, NC USA). The study lasted 2 days; placebo was administered on the first day (4×1 tablets/day) and zileuton – in its standard daily dosage (4×600 mg/day) – on the second day. Measurements of the urinary leukotriene E4 , considered to reflect global leukotriene production (uLTE4) (ELISA; Cayman Chemicals, Ann Arbor, MI, USA) were carried out twice; at base and after zileuton treatment. They were expressed as LTE4 pg/mg of creatinine [9]. 24-h, threechannel digital ECG Holter recordings (Aspel, HolCARD 24W, Poland) were performed in all patients on thefirst and the second study day. The mean values of 24-h heart rate (HR), the number of ventricular extrasystoles (VEs), ST-segment depression, as well as episodes of tachycardia, bradycardia and pauses were evaluated. Echocardiography was performed to assess left ventricular ejection fraction and left atrial area. Datawere analyzedusing StatSoft, Inc. STATISTICA software. Theyare presented as mean±SD or median with interquartile range and log transformed when applicable. For comparisons between groups,

EFFECT OF FUROSEMIDE AND TORASEMIDE ON HEART RATE VARIABILITY AND VENTRICULAR RHYTHM DISORDERS IN PATIENTS WITH CHRONIC HEART FAILURE COMPLICATING ISCHEMIC HEART DISEASE: COMPARATIVE NONRANDOMIZED STUDY

Aim. To study effect of diuretic therapy with furosemide and torasemide on heart rate variability (HRV) and frequency of ventriclar rhythm disorders in patients with chronic heart failure (CHF) complicating ischemic heart disease (IHD). Material and methods. Patients (n=107) with CHF III-IV functional class (NYHA) complicating IHD were examined. The first group of patients received furosemide, 20-60 mg QD (n=52), the second group received torasemide, 5-20 mg QD (n=55). Analysis of heart rhythm disorders and the basic HRV indicators was performed by ECG 10-minute record￾ings initially and after 10 days of therapy. Results. Decrease in time and spectral HRV parameters and increase in daily number of ventricular extrasystoles was found in furosemide treated patients. Improvement of HRV parameters and reduction of daily number of ventricular rhythm disorders was found torasemide treated patients. Conclusion. Torasemide therapy improves an autonomic regulation of heart rhythm and leads to the reduction of ventricular heart rhythm disorders in patients with CHF complicating IHD.

INFLUENCE OF BRONCHOLYTIC THERAPY ON VENTRICULAR RHYTHM DISORDERS IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Aim. To evaluate effects of broncholytic therapy on ventricular rhythm disorders and high resolution electrocardiogram indices in patients with chronic obstructive pulmonary disease (COPD). Material and methods. 144 patients (54 women and 90 men; aged 47,1±1,5 y.o.) with COPD and 35 patients of control group without respiratory and cardiovascular diseases (23 men and 12 women; aged 42,4±2,8 y.o.) were examined. 24-hour ECG monitoring and high resolution ECG with time and spectral-time mapping of ventricular ECG complex were performed in patients additionally to routine examination. Results. Reduction of ventricular rhythm disorders rate was detected during therapy with extended-release theophylline or salmeterol/fluticasone in patients with moderate and severe COPD. This effect was more significant for salmeterol/fluticasone treatment. Treatment with extended-release theophylline led to increase of a number of ventricular extra systoles in patients with severe COPD. Salmeterol/fluticasone treatment did not influence number of ventricular extrasystoles. Broncholytic therapy had positive influence on processes of ventricular depolarization. It was shown by high resolution ECG indicators improvement and by late ventricular potential rate reduction. Conclusion. Salmeterol/fluticasone combination is more reasonable than extended-release theophylline for broncholytic therapy in patients with severe COPD and ventricular rhythm disorders.