Rhythm Disturbances In Patients Research Articles

Analysis of the contribution of obstructive sleep apnea/hypopnea syndrome and glycemic level variability to the development and progression of cardiac arrhythmias in patients with type 2 diabetes mellitus

In this review, information is presented within the triad: obstructive sleep apnea/hypopnea syndrome (OSA), glycemic variability, and cardiac arrhythmias in patients with type 2 diabetes mellitus (DM2). Epidemiological aspects, pathogenetic relationships, possible instrumental and laboratory diagnostic methods, as well as approaches to personalized therapy are analyzed. Research is being actively conducted in certain areas of the designated triad, however, no studies have been found that include simultaneous monitoring of indicators reflecting these disorders in patients with DM2. Many issues are still controversial. Sleep disturbances in patients with DM2 are actively studied, but more often questionnaires are used for diagnosis, rather than instrumental methods. There is insufficient data examining the effect of hypoxia on the progression of complications in patients with DM2. Rhythm disturbances are being actively studied in patients with DM2 in combination with various cardiological problems. Of greatest interest is the study of rhythm disturbances in patients with DM2 without concomitant comorbid conditions of the cardiovascular system, in order to identify early signs of diabetic cardiovascular autonomic neuropathy and cardiomyopathy, as well as additional early risk factors for the development and progression of cardiovascular diseases. Most of the studies are devoted to the study of the association of OSA and various arrhythmias in cardiac patients. However, there is no data on the combined effect of glycemic variability and OSA on the development of cardiac arrhythmias in patients with DM2. Additional studies are needed to identify the features of the effect of OSA on cardiac arrhythmias in patients with DM2.

Structure of cardiac rhythm disorders in patients with obesity and associated with it dyslipidemia as an arrhythmogenic factor

Obesity is a global public health problem in the twenty-first century. The most adverse it’s effects are associated with visceral type, with accumulation of epicardial fat, showing high metabolic activity, dysfunction and important role in the development of lipotoxic cardiomyopathy linked with significant morphological and functional myocardial changes, accompanying by high risk of heart rhythm disorders. The aim of the study: to identify structure (frequency and character) of cardiac arrhythmias in men of employable age with visceral obesity, to establish the relationship of arrhythmias with features of the blood lipid spectrum of these patients. Material and methods. 98 men with abdominal obesity and 46 overweight patients were examined. The control group consisted of 40 healthy patients with normal body weight. All the patients were undergone ECG monitoring, echocardiography and analysis of serum lipid levels. Results. The presence of obesity is statistically significantly associated with the risk of supraventricular couplets, frequent ventricular extrasystoles, sinus arrhythmia and atrial fibrillation. The increase in the severity of obesity was accompanied by a tendency to a greater frequency of arrhythmias: in obesity of I degree, the frequency of atrial fibrillation was 12.3%, II–III degree — 21.2%, p = 0.25; frequent ventricular extrasystoles with similar degrees of obesity — 13.8% and 21.1%, respectively. Atrial fibrillation was significantly more often detected against the background of lipid disorders, mainly with a decrease in HDLP. Conclusion. The main type of heart rhythm disturbance in patients with obesity are supraventricular arrhythmias, mainly atrial fibrillation, the frequency of which increases in proportion to the increase in the patient's body weight. Abdominal obesity leads to an increase in ventricular ectopic activity. Dyslipidemia is the one of risk factors for arrhythmias in these patients.

Circadian rhythms in older adults are associated with sleep quality, cognitive function, and ß‐amyloid burden: an accelerometry analysis of the Lifestyle Enriching Activities for Research in Neuroscience Intervention Trial ‐ LEARNit

AbstractBackgroundSeveral studies demonstrate circadian rhythm disturbances in patients with Alzheimer’s disease. However, less is known about circadian rhythms in older adults with early mild cognitive impairment. Wrist‐worn accelerometers provide continuous, objective, high resolution quantification of 24‐hour rest activity rhythms. This study examines the relationship between circadian rhythms and sleep, cognition, and ß‐amyloid (Aß) burden.MethodThis study examines baseline data from the “Lifestyle Enriching Activities for Research in Neuroscience Intervention Trial” (LEARNit). Sixty‐six older adults ages 55‐80 experiencing early cognitive changes wore a GENEActiv accelerometer for approximately 30 consecutive days. Accelerometer data was analyzed using the R package GGIR (version 2.8‐1), and circadian rhythm measures were extracted using the GGIR secondary package ActCR (version 0.3.0). Circadian rhythm variables include intradaily variability (fragmentation), interdaily stability (rhythm synchronization to light‐dark cycle), acrotime (peak activity time), and Midline Estimated Statistics of Rhythm or MESOR (mean activity level). Up‐MESOR and Down‐MESOR represent the timing of activity increasing above or decreasing below MESOR, respectively—lower values of each indicate a phase advance (shift towards morning), whereas higher values indicate a phase delay (shift towards evening). Sleep was assessed as mean sleep efficiency and Wake After Sleep Onset, or WASO (accumulated wakefulness after sleep onset). Cognitive tests include the Montreal Cognitive Assessment (MoCA) for global cognition and attention/processing speed (Digit Symbol Task). Aß burden was measured by positron emission tomography standard uptake value ratio for fifty‐six participants. Age‐adjusted linear regression models were used to test associations between circadian rhythms and sleep, cognition, and Aß.ResultParticipant characteristics are summarized in Table 1 and results are summarized in Figure 1. Intradaily variability (b = ‐0.095, p = 0.03) and interdaily stability (b = 0.34, p = 0.01) were both associated with mean sleep efficiency. Intradaily variability (b = 1.41, p<0.001) and interdaily stability (b = ‐4.45, p<0.001) were associated with WASO. Up‐MESOR was associated with MoCA total score (b = ‐0.41, p = 0.03). Up‐MESOR (b = ‐2.12, p = 0.006), Down‐MESOR (b = ‐1.99, p = 0.02), and acrotime (b = ‐4.20, p<0.001) were associated with Digit Symbol score. Down‐MESOR was significantly associated with Aß (b = ‐0.029, p = 0.02).ConclusionCircadian rhythm robustness is positively associated with better sleep quality. Participants with dynamic circadian rhythm phases demonstrated poorer cognition and higher Aß burden.

Clinical factors that influence the onset of atrial fibrillation or worsen its course after infection with Covid - 19

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): In. of cardiology Introduction It is known that atrial fibrillation (AF) is not only one of the most common arrhythmias, but also a frequent rhythm disturbance in patients who have undergone SARS-CoV-2 infection. This arrhythmia often develops in the post-covid period. Purpose to determine clinical factors associated with the onset or worsening of the course of atrial fibrillation in patients with coronavirus disease (COVID-19). Materials and methods The study included 187 patients aged 62.5±0.9 years (47% men, 53% women). The vast majority of patients (89%) had arterial hypertension (II stage – 80%, III stage – 9%). Chronic forms of coronary heart disease were diagnosed in 53% of patients. The first three groups formed 116 patients who had AF and underwent coronavirus infection (CI). The first group (G1) consisted of 36 patients who did not have AF before CI. The second group (G2) was represented by 25 patients in whom the transition of the paroxysmal form of AF into persistent, or persistent AF into its permanent form occurred. The third group (G3) consisted of 55 patients in whom the form of AF did not change, but in 35 of them the frequency or duration of AF paroxysms increased (subgroup 3a), and in 20 people the frequency or duration of AF paroxysms did not change (subgroup 3b). Two control groups were also formed: K1 - 49 patients with AF who did not have a history of HF, and K2 - 22 patients with extrasystole who experienced HF, but who did not develop AF. The results. G1 patients were older than those in K2 (63.6±0.64 years vs. 50.7±1.1 years, respectively; p<0.001). At the same time, G2 patients at the time of inclusion in the study were older than those in G3 (66.5±1.04 years vs. 62.9±1.12 years, respectively; p<0.05). Women more often occurred in G1 than in K1 (51.7% vs. 30.6%, respectively; p<0.001), as well as in the combined group of G2-G3 compared to K1 (53.7% vs. 30.6% ,respectively; p<0.001). Concomitant hypertension was associated with an increase in the frequency and duration of AF paroxysms after COVID-19. Thus, group 2, compared to group 3, was characterized by more frequent detection of both stage II hypertension (72% vs. 65.5%; p<0.05) and its stage III (12% vs. 3.6%, p<0 ,05). Similarly, patients with chronic forms of CAD were more frequent in group 2, in contrast to group 3 (72.0% vs. 50%, p<0.001). In addition, the frequency of detection of patients with chronic forms of coronary heart disease was higher in subgroup 3a, compared to subgroup 3b (54.3% vs. 45.0%; p<0.005). Conclusion Older age, female sex, hypertension, and coronary heart disease were clinical factors associated with the occurrence of AF or worsening of previously diagnosed AF in patients with COVID-19.

НАРУШЕНИЕ РИТМА СЕРДЦА У БОЛЬНЫХ ПОСЛЕ ПЕРЕНЕСЕННОЙ КОРОНАВИРУСНОЙ ИНФЕКЦИИ: ОСОБЕННОСТИ ТЕЧЕНИЯ И ТЕРАПИИ

This paper presents data on the peculiarities of the course and treatment of rhythm disturbances in patients who have suffered a coronavirus infection in the cardiology department of the CHM "KB RZD-Medicine" in Tula. Among all patients who underwent therapy in a specialized cardiology department for various kinds of arrhythmias for the period from 2020 to 2022, 72% of rhythm disturbances occurred after COVID-19.
 The most common arrhythmic consequences of coronavirus infection are supraventricular and ventricular extrasystole, paroxysmal form of supraventricular tachycardia and atrial fibrillation. Based on the analysis of the data obtained by us, it was revealed that complex treatment with the use of beta-blockers, cardioprotectors, sedatives, antiarrhythmic agents of class I and III has the greatest effectiveness.

NON-INVASIVE METHODS OF DIAGNOSTICS OF GASTRO-ESOPHAGEAL REFLUX DISEASE IN PATIENTS WITH ISCHEMIC HEART DISEASE.

The aim: To determine the diagnostic value of non-invasive methods of GERD diagnosis based on questionnaire data and a diagnostic test with a proton pump inhibitor (PPI) with Rabeprazole in patients with coronary heart disease (CHD). Materials and methods: 90 patients were under observation, namely, 68 patients with coronary heart disease with concomitant essential arterial hyperten¬sion (EAH), 6 patients with coronary artery disease + arrhythmias, and 18 - others diseases. All patients were surveyed according to the GerdQ questionnaire, followed by PPI testing with Rabeprazole, and body mass index (BMI) was calculated for all the patients. A BMI of 18.5-24.9 kg/m2 was considered as normal body weight, and a BMI > 24.9 kg/m2 was considered overweight. Results: Based on the results of the questionnaire, it was established that the most common complaints typical for GERD were noted by patients with CHD in combination with EAH. There were 48 of such patients and, depending on BMI, they were divided into 2 groups: 1st group (n=14) - patients with CHD+EAH+GERD with normal body weight and 2nd group (n=34) - overweight patients with CHD+EAH+GERD. In patients of group 1, typical symptoms of GERD prevailed (in 71.4% of patients), and in patients group 2, the distribution of typical and extra-esophageal symptoms did not differ significantly (52.9% vs. 47.1%). Among the extraesophageal manifestations, pain behind the sternum (in the projection of the esophagus) was significantly more often recorded in patients of group 1, and rhythm disturbances in patients of group 2 (43.8% and 75.0% of patients, respectively, p<0.05). The results of the GerdQ questionnaire showed a direct relationship between GERD, body weight and symptom score. Patients with GERD+normal body weight had a mean score of 6 for classic gastroesophageal reflux symptoms, while patients with GERD+increased body weight had a mean score of 7. The sensitivity of the questionnaire was 78.7%, and the specificity - 92.9%. According to the PPI test, in the 1st and 2nd groups, already in the first three days, 28.5% and 23.5% of patients noted the disappearance of heartburn and after 10 days - 85.7% and 64.7%, respectively. Over the entire period, that is, after 14 days of observation, 85.7% of patients in the 1st group and 73.5% in the 2nd group noted improvement. Conclusions: It has been established that questionnaires based on the GerdQ questionnaire followed by a PPI test with Rabeprazole in patients with coronary heart disease combined with essential arterial hypertension have a high diagnostic value and can be used for early diagnosis and effective treatment of GERD.

Surveillance of Arrhythmia in Patients After Myocardial Infarction Using Wearable Electrocardiogram Patch Devices: Prospective Cohort Study.

BackgroundAcute myocardial infarction may be associated with new-onset arrhythmias. Patients with myocardial infarction may manifest serious arrhythmias such as ventricular tachyarrhythmias or atrial fibrillation. Frequent, prolonged electrocardiogram (ECG) monitoring can prevent devastating outcomes caused by these arrhythmias.ObjectiveWe aimed to investigate the incidence of arrhythmias in patients following myocardial infarction using a patch-type device—AT-Patch (ATP-C120; ATsens).MethodsThis study is a nonrandomized, single-center, prospective cohort study. We evaluated 71 patients who had had a myocardial infarction and had been admitted to our hospital. The ATP-C120 device was attached to the patient for 11 days and analyzed by 2 cardiologists for new-onset arrhythmic events.ResultsOne participant was concordantly diagnosed with atrial fibrillation. The cardiologists diagnosed atrial premature beats in 65 (92%) and 60 (85%) of 71 participants, and ventricular premature beats in 38 (54%) and 44 (62%) participants, respectively. Interestingly, 40 (56%) patients showed less than 2 minutes of sustained paroxysmal atrial tachycardia confirmed by both cardiologists. Among participants with atrial tachycardia, the use of β-blockers was significantly lower compared with patients without tachycardia (70% vs 90%, P=.04). However, different dosages of β-blockers did not make a significant difference.ConclusionsWearable ECG monitoring patch devices are easy to apply and can correlate symptoms and ECG rhythm disturbances in patients following myocardial infarction. Further study is necessary regarding clinical implications and appropriate therapies for arrhythmias detected early after myocardial infarction to prevent adverse outcomes.

About heart rhythm disturbances in patients after the coronavirus infection

About heart rhythm disturbances in patients after the coronavirus infection

Association between fragmented QRS and post-procedural rhythm disturbances in patients who underwent transcatheter aortic valve implantation with CoreValve system

Abstract Background Transcatheter aortic valve implantation (TAVI) is a less invasive and safe therapeutic alternative in patients who are at very high surgical risk or in whom there are contraindications to open surgery (1,2).On the other hand, life threatening complications including stroke, paravalvular leak, and rhythm disturbances that require permanent pacing still persist (3).Fragmented QRS (fQRS) is defined as RSR' pattern with different morphologies of QRS complexes with or without the Q wave on a resting 12-lead electrocardiogram (ECG) (4). Purpose In this study, we examined association between fQRS and post-procedural rhythm disturbances and the need for permanent pacing in patients who underwent TAVI with CoreValve system. Methods We analysed standard 12-lead electrocardiographic recordings of 124 consecutive patients in whom a CoreValve prosthesis (MedronicInc; Minneapolis; USA) was implanted. Patients having bundle branch block or QRS duration ≥120 ms in baseline ECG recordings and patients with prior history of permanent pacing were excluded from the study. We examined 12-lead ECGs before and after procedure along with one month and six month follow up. We documented QRS fragmentation and post-procedural rhythm disturbances. Results Based on our data, 39 out of 71 patients (54.9%) with fQRS developed temporary rhythm disturbances. However, only 4 out of 29 patients (13.7%) without fQRS developed temporary rhythm disturbances.The difference between two groups in terms of temporary rhythm disturbances was statistically significant (59.4% vs 13.7%, p=0.002). Furthermore, 28 out of 71 patients (39.4%) with fQRS and 1 out of 29 patients (3.4%) without fQRS developed permanent rhythm disturbances, (39.4% vs 3.4%, p&amp;lt;0.001).The difference in permanent rhythm disturbances was also maintained in 1st month and 6th-month follow-ups (37.1% vs 0%, p&amp;lt;0.0001, and 38.7% vs 0%; p&amp;lt;0.0001). According to our data, presence of QRS in anterior derivations was the only independent factor associated with development of post-procedural rhythm disturbances (p&amp;lt;0.05). Conclusion Our data showed an increased risk for development of new-onset LBBB and AV blocks following TAVI in patients whose baseline ECG recordings demonstrated fQRS. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Ankara Ataturk Training and Research Hospital

Safety and heart rate changes in Covid-19 patients treated with Remdesivir

ObjectivesLimited data are available regarding the occurrence and the extent of cardiac rhythm disturbances in patients with COVID-19 treated with Remdesivir. MethodsWe present a case series of 52 patients who underwent daily electrocardiogram (ECG) examination after Remdesivir administration. ResultsCompared to baseline, a significant heart rate reduction was observed after initiation of Remdesivir; however, no case of severe bradycardia or arrhythmias leading to significant clinical complications or Remdesivir discontinuation occurred. Heart rate reduction was proportional to baseline heart rate values (r=0.75, p<0.001). By multivariate analysis, a less severe clinical presentation of Covid-19 (beta=0.47, p<0.01) was related to lower heart rate levels observed after Remdesivir administration. ConclusionsDespite a significant reduction in heart rate observed after Remdesivir administration, no severe cardiovascular toxicity was observed in Covid-19 patients, even in the case of cardiovascular comorbidities.

Association between fragmented QRS and postprocedural rhythm disturbances in patients who underwent transcatheter aortic valve implantation.

According to recent studies, the rate of atrioventricular block requiring permanent pacing in patients following transcatheter aortic valve implantation varied between 5.7% and 42.5%. Fragmented QRS is a useful marker of myocardial scar and can predict adverse cardiac events. In this study, we examined association between f ragmented QRS and postprocedural rhythm disturbances and the need for permanent pacing in patients who underwent transcatheter aortic valve implantation. In this study, we examined association between fragmented QRS and postprocedural rhythm disturbances and the need for permanent pacing in patients who underwent transcatheter aortic valve implantation' sentence is enough for it. We retrospectively analyzed standard 12-lead electrocardiographic recordings of 124 consecutive patients in whom a CoreValve prosthesis was implanted. We examined 12-lead electrocardiogram before and after procedure along with one- and six-month follow-up. We documented QRS fragmentation and postprocedural rhythm disturbances. There was a significant increase in the frequency of left bundle branch block, (21.1 versus 0%, p<0.05) and the incidence of atrioventricular blocks requiring permanent pacing (21.1 versus 0%, p<0.05) following transcatheter aortic valve implantation in patients whose preprocedural electrocardiogram recordings revealed fragmented QRS compared to those without fragmented QRS. Based our collected data, the presence of QRS fragmentation in anterior derivations was the only independent factor associated with postprocedural rhythm disturbances (B-value 0.217; OR 0.805; 95%CI 0.136-4.78; p=0.004). Our data showed an increased risk for the development of new-onset left bundle branch block and atrioventricular blocks following transcatheter aortic valve implantation in patients whose baseline electrocardiogram recordings demonstrated QRS fragmentation.

Delayed repolarization and ventricular tachycardia in patients with heart failure and preserved ejection fraction.

Sudden death is the most common mode of mortality in patients with heart failure and preserved ejection fraction (HFpEF). Ventricular arrhythmias (VA) have been suspected as the etiology but the supporting evidence in patients with HFpEF is scarce. We sought to investigate VA prevalence, and to determine if VA are associated with prolonged repolarization, in patients with HFpEF. In a retrospective case-control study design, Cedars-Sinai patients who underwent prolonged ambulatory electrocardiographic monitoring (Zio Patch) between 2016 and 2018 were screened for a clinical diagnosis of HFpEF. Patients with normal diastolic and systolic function who underwent Zio Patch monitoring were also reviewed as controls. Multivariable logistic regression was used to compare the prevalence of rhythm disturbances in patients with and without HFpEF. Ventricular tachycardia (VT) was more prevalent in patients with HFpEF (37% vs. 16% in controls, p = 0.001). Most episodes were non-sustained except for one case of sustained VT in a patient with HFpEF. Covariate-adjusted logistic regression including HFpEF diagnosis, age, sex, body mass index, and the presence of comorbidities revealed that only HFpEF was associated with increased risk of VT (relative risk 2.86, p = 0.023). Subgroup-analyses revealed an association between increased QTc interval and risk of VT (460 ± 38 ms in HFpEF patients with VT vs. 445 ± 28 ms in HFpEF patients without VT, p = 0.03). Non-sustained VT was more prevalent in patients with HFpEF compared to patients without HFpEF, and QTc interval prolongation was associated with VT in HFpEF.

Sleep and circadian rhythm disturbances in intensive care unit (ICU)-acquired delirium: a case-control study.

ObjectiveThe relationships among sleep, circadian rhythm, and intensive care unit (ICU)-acquired delirium are complex and remain unclear. This study aimed to examine the pathophysiological mechanisms of sleep and circadian rhythm disturbances in patients with ICU-acquired delirium.MethodsThis study included critical adult patients aged 18 to 75 years who were treated in the ICU. Twenty-four-hour polysomnography was performed and serum melatonin and cortisol levels were measured six times during polysomnography. Receiver operating characteristic curves and binomial logistic regression were used to evaluate the potential of sleep, melatonin, and cortisol as indicators of delirium in the ICU.ResultsPatients with delirium (n = 24) showed less rapid eye movement (REM) sleep compared with patients without delirium (n = 24, controls). Melatonin levels were lower and cortisol levels were higher in the delirium group than in the control group. REM sleep, melatonin, and cortisol were significantly associated with delirium. The optimal cutoff values of REM sleep and mean melatonin and cortisol levels that predicted delirium were ≤1.05%, ≤422.09 pg/mL, and ≥212.14 ng/mL, respectively.ConclusionsREM sleep, and melatonin and cortisol levels are significantly associated with the risk of ICU-acquired delirium. Improved sleep and readjustment of circadian rhythmicity may be therapeutic targets of ICU-acquired delirium.

Нарушения ритма сердца при новой коронавирусной инфекции (COVID-19)

The article presents a literary review of the effect of the new coronavirus infection (COVID-19) on the cardiovascular system, namely cardiac arrhythmias. Probable etiopathogenetic factors of arrhythmia formation in patients with COVID-19 infections are described. The analysis of clinical forms of rhythm disturbances in patients with COVID-19 is presented. It was found that the probability of developing arrhythmias is associated with the patient’s age, their stay in an intensive care unit, and the presence of comorbid pathology. The data of foreign authors who note such rhythm disturbances as atrial fibrillation and fluttering, ventricular tachycardia, and high degree intermittent atrioventricular blockade as the most common among patients with a new coronavirus infection are presented. There was an association between malignant arrhythmias, including ventricular tachycardia / ventricular fibrillation and an increase in troponin T levels compared to patients with normal troponin T levels. The problem of side effects of the drugs used in COVID-19 treatment, namely arrhythmias, is stated. The dependence is shown between concomitant diseases, low PaO2/FiO2 balance and occurrence of arrhythmias in the form of a new atrial fibrillation.

Association of hemolysis with the incidence of heart rhythm disturbances following coronary artery bypass graft surgery

Introduction: Coronary artery bypass grafting (CABG) might be associated with the development of heart rhythm disturbances. We aimed at evaluating an association of intraoperative hemolysis (IOH) with the development of cardiac rhythm disturbances in patients with coronary artery disease after on-pump CABG.Methods. The assessment of the degree of IOH was performed according to the level of plasma free hemoglobin [Hb] at baseline, immediately after the patient was connected to the cardiopulmonary bypass (CPB) device and 15 minutes before cessation of CPB. We included 123 patients, and they were divided into 3 groups (gr.) according to free [Hb] level: gr.1 - ≤0.1 g/l; gr.2 - &gt; 0.1 g/l and &lt;0,5 g/l; gr.3 - ≥0.5 g/l. A variety of ECG screening methods were applied for the detection of cardiac arrhythmia in the postoperative period. The follow-up period was 1 months.Results. Arrhythmias were observed in 2.3% of patients in the 1st group, in 11.9% in the 2nd group, and in 52.6% in the 3rd group. The level of plasma free [Hb] in samples taken at the end of CPB was strongly associated with the arrhythmia detection (rs=0,70, p &lt;0.001). Life-threatening and hemodynamically unstable arrhythmias were more frequently detected in the group with a higher degree of IOH (p &lt;0.001), and accounted for about half of all arrhythmias.Conclusions. On-pump CABG is associated with the development of cardiac arrhythmias in the postoperative period in 22% of patients. A significant proportion of these arrhythmias are potentially life-threatening. The highest proportion of patients with cardiac rhythm disturbances after CABG was observed when the level of plasma free hemoglobin was &gt;0.5 g.

Performance of an implantable loop recorder in the detection of heart rhythm disturbances in patients with syncope and embolic strokes

Abstract Aims The primary goal of this study was the evaluation of the arrhythmia detection performance of an implantable loop recorder (ILR) in patients with syncope of unknown etiology and patients with embolic stroke of undetermined source (ESUS). Secondary goals were the evaluation of diagnostic yield, time to diagnosis and established therapeutical consequences. Methods The Reveal LINQ ILR was implanted in n=143 patients (n=84 after ESUS, n=59 after syncope). Automatically detected episodes (n=3213) were transmitted via internet and validated by two experienced cardiologists and either classified as correct or incorrect. Positive-predictive value (ppv = true-positive episodes/true-positive episodes + false-positive episodes) was calculated for each available arrhythmia type. Incorrect episodes were classified as undersensing, oversensing, artifacts or supraventricular/ventricular ectopic beats. The diagnostic yield was defined by asystole ≥3 seconds or the detection of atrial fibrillation. Time to diagnosis was calculated as the time from implantation to detection of an asystole or atrial fibrillation. Results Every second asystole episode in syncope-patients was false-positive (ppv 52%), mostly due to undersensing. The atrial fibrillation detection performance in ESUS-patients was 70% (ppv-average). The majority of false-positive episodes was due to premature atrial and ventricular complexes (80%), followed by artifacts (14%) and oversensing (4%). Undersensing accounted for 2%. 36% of syncope-patients were diagnosed with an asystole after a mean time to event of 114 days. In 47% of syncope-patients diagnosed with asystole, a pacemaker was implanted. In 31% of ESUS-patients a diagnosis of atrial fibrillation was established, after a mean time to event of 92 days. 85% of ESUS-patients diagnosed with atrial fibrillation were ultimately treated with an oral anticoagulant. Conclusion and discussion The Reveal Linq ILR - advertised as an automatic diagnostic tool for syncope- and ESUS-patients - has its caveats. A high number of false-positive detections due to undersensing limited the asystole detection performance. The atrial fibrillation detection performance presented more reliable, despite a substantial number of false-positive detections. A time-consuming manual episode review still represents an indispensable step in the diagnostic process, and enough human resources have to be factored before starting an ILR program. Funding Acknowledgement Type of funding source: None

Current views on heart rhythm disturbance in patients with type 2 diabetes mellitus who underwent implantation of a permanent pacemaker (a literature review)

Aim – to analyse specialized literature and study the effect of type 2 diabetes mellitus on the cardiac conduction system in patients with a permanent pacemaker.Conclusions. The complex, multifactorial pathogenesis of diabetes mellitus complicates the study of the relationship between the presence of this metabolic disease and arrhythmia. It is now evident that hyper- and hypoglycemia, variations in blood glucose levels can provoke the development of arrhythmias, including atrial fibrillation (AF). Changes in the heart architecture are responsible for electrical conduction slowing or acceleration and pulse transmission interruption. It is proved that the presence of type 2 diabetes mellitus increases the likelihood of heart failure progression. Further studies would be able to give an answer regarding the prognostic value of type 2 diabetes influence on the results of cardiac pacing after a device implantation, as well as to determine the most effective hypoglycemic drugs with antiarrhythmic properties which can prevent the development of AF recurrence, help slow down the progression of heart failure and possibly reduce a mortality rate among this group of patients.

Electrocardiographic markers for the prediction of ventricular arrhythmias in patients with systemic sclerosis.

SSc is an autoimmune disease characterized by microvascular damage, endothelial dysfunction and fibrosis of the skin and the internal organs. Cardiac manifestation in patients with SSc is one of the major organ involvements. Approximately 20% of SSc patients suffer from primary cardiovascular disease and another 20% may have secondary cardiac involvement. Although cardiac arrhythmias are mostly linked to myocardial fibrosis, atrioventricular conduction abnormalities are secondary to the fibrosis of the pulse conduction system. Despite the severe consequences of ventricular rhythm disturbances in patients with SSc, the exact role of electrocardiographic markers in the prediction of these arrhythmias has not yet been clearly elucidated. Therefore, the question is whether certain ECG parameters reflecting ventricular repolarization may help to recognize scleroderma patients with increased risk for ventricular arrhythmias and sudden cardiac death.

THE ROLE OF HEMOLYSIS IN THE EMERGENCE OF HEART RHYTHM DISORDERS AFTER CORONARY BYPASSING

The operation of coronary shunting in patients with coronary heart disease leads to the development of various complications in the postoperative period, the most frequent are heart rhythm disturbances.Purpose. To establish the connection of intraoperative hemolysis (IOH) with the development of cardiac rhythm disturbances in patients with coronary artery disease after coronary shunting in con-ditions of cardiopulmonary bypass (CB).Material and research methods. The assessment of the degree of IOH was made by the level of free hemoglobin [Hb] In the blood plasma at the beginning of the operation, immediately after the patient was connected to the CB device and 15 minutes before removal from the CB, using the HemoCue Plasma / Low Hb analyzer. According to the degree of IOH, patients (n = 123) are divided into 3 groups (gr.) in accordance with free [Hb]: gr.1 - ≤0,1 g/l; gr.2 - &gt; 0.1 g/l and &lt;0,5 g/l; gr.3 - ≥0,5g/l. Were used the following instrumental methods of investigation: electrocardiography, 24-hour ECG mon itoring. Was analyzed the frequency of heart rhythm disturbances in patients after coronary shunting with various levels of IOH in the perioperative (during the operation and during the first days after it) and in the early (up to 1 month) periods.Results. Arrhythmias were observed in 2.3% of patients of the 1st group, in 11.9% - the 2nd group, in 52.6% - the 3rd group. Associations were noted between [Hb]. In plasma at the end of cardio-pulmonary bypass and the frequency of arrhythmias (rs=0,70, p&lt;0.001). The share of life-threatening and hemodynamically significant arrhythmias in the study period in the group with a high degree of IOH accounted for about half of all arrhythmias that occur, which is significantly more than in the group without IOH and with low IOH, p &lt;0.001.Conclusion.The operation of coronary artery bypass surgery in conditions of artificial blood circu-lation leads to the development of arrhythmias in the postoperative period in 22% of patients with ischemic heart disease. A significant proportion of these are arrhythmias that pose a threat to the pa-tient’s life and arrhythmias, causing hemodynamic disturbances and hypoperfusion of vital organs. The largest number of patients with cardiac rhythm disturbances after coronary artery bypass graft-ing was observed in the group with the level of free hemoglobin in the blood plasma of 0.5 g/l or more (p &lt;0.001), which indicates the relationship between the occurrence of arrhythmias and the degree of intraoperative hemolysis. The high risk of arrhythmias in patients with coronary heart dis-ease after coronary artery bypass surgery is determined when the content of free hemoglobin is more than 0.85 g/l. One of the ways to assess the risk of heart rhythm disturbances should be to determine the level of free hemoglobin in the blood plasma of patients in the intraoperative period of coronary artery by-pass grafting, which is necessary for the timely prevention and correction of possible hemodynamic disorders.

Fine versus coarse atrial fibrillation in rheumatic mitral stenosis: The impact of aging and the clinical significance.

Atrial fibrillation (AF) as the most rhythm disturbance in patients with rheumatic mitral stenosis (MS), is classified in to coarse and fine subtypes according to the height of fibrillatory wave amplitude. The aim of this study is to identify the factors associated with the presence of fine versus coarse morphology in patients with rheumatic MS. In this cross-sectional study, patients with confirmed diagnosis of severe rheumatic MS admitted between March 2013 and March 2017 were screened. Patients were categorized to sinus rhythm (SR) and AF rhythm (coarse and fine subtypes) groups according to the admission electrocardiogram. The association between various clinical and echocardiographic factors and the development of fine versus coarse AF were examined. Among 754 patients with the diagnosis of rheumatic MS, 288 (198 female) were found to have AF (38%). Among them 206 (71.5%), and 82 (28.5%) patients had fine and coarse morphology respectively. Patient in these two groups were quite similar in terms of echocardiographic parameters and comorbidities. However, patients with fine morphology AF were significantly older. (p-Value=.007). Coarse morphology of AF is common in patients with rheumatic MS. While echocardiographic or most clinical parameters do not seem to associate with the occurrence of coarse or fine morphology, age seems to be the only independent factor correlated with the presence of fine subtype of AF in this population.