[Noninvasive analysis of atrial and ventricular rhythm in atrial fibrillation: past, present and future of the method in clinical practice].
Explore the source record for details and available documents.
Arrhythmias, Cardiac↗
Biomedical subjects
A V Nedostup
Publications and source records attributed to A V Nedostup.
[Some features of cardiac arrythmia treatment in outpatient practice].
Explore the source record for details and available documents.
Ambulatory Care↗
[Characteristics of action of various drugs blocking atrioventricular conduction (beta-blockers, verapamil, diltiazem) in constant fibrillation tachyarrhythmia. Is monotherapy optimal?].
AIM: To characterize actions of beta-blockers and Ca antagonists (verapamil and diltiazem) on the rate, structure and parameters of ventricular rhythm variability in constant cardiac fibrillation (CCF) and to evaluate validity of monotherapy with these drugs. MATERIAL AND METHODS: Thirty patients with CCF (mean age 64.5 +/- 9.5 years) received beta-blockers (n = 10, atenolol in a dose 50.0 +/- 23.2 mg/day or metoprolol in a dose 45.0 +/- 20.9 mg/day), verapamil (n = 10, 192.0 +/- 83.9 mg/day) and diltiazem (n = 10, 286.6 +/- 107.2 mg/day). The patients were studied with Holter ECG monitoring (Schiller MT-100, Switzerland) and high resolution ECG (electrocardioanalyser Cardis, Geolink-electronics, RF) with construction of periodograms of ff waves and interval histograms RR (IHrr), estimation of the rhythm variability (SDRR, rMSSD, PNN50). RESULTS: Beta-blockers (atenolol, metoprolol), verapamil and diltiazem had no significant effect on the period of ff waves. The degree of a mean heart rate lowering decreased in the following order: beta-blockers-verapamil-diltiazem (30.1 +/- 12.5, 25.0 +/- 18.8 and 22.0 +/- 23.6 beat/min, differences are insignificant), this corresponded to the degree of Rrmin increase (0.12 +/- 0.04, 0.08 +/- 0.07 and 0.07-0.08). In CCF the inhibiting effect of beta-blockers and verapamil is substrate-dependent: the shorter baseline Rrmin (and higher heart rate), the more potent is the effect due to action of beta-blockers and verapamil (r = -0.58 and r = -0.57, p < 0.05) and reduction of a mean heart rate (r = -0.74 and r = -0.84, p < 0.05). Dependence of diltiazem effect on initial Rrmin is inverse. In contrast to Ca antagonists (verapamil, diltiazem), beta-blockers increased latent conduction manifesting in a significant rise of Rrmax, range of RR intervals (the difference between Rrmax and Rrmin) and in increased latent conduction (Rrmax/Rrmin) by 0.4 versus 0 and 0.1 in the groups on verapamil and diltiazem). In addition to insufficient shift RRmod, there appeared non-optimal rhythm structure--combination of a large number of short and long RR in small number of middle ones. Verapamil and diltiazem improved the rhythm pattern due to proportional increase of RRmin shift RRmod (r = 0.72 and r = 0.71, p < 0.05) and absence of a distinct effect on latent conduction. The between groups differences by SDRR, RMSSD and PNN50 dynamics were insignificant. Diltiazem in doses 360-480 mg/ day moderately increased latent conduction, but was low effective in the presence of early peak RR (0.28-0.46 s). CONCLUSION: Monotherapy with AB-blocking drugs was possible only in patients with moderate tachycardia, no waves of fibrillation of large and middle periods (0.15 s and higher) and should be conducted under Rrmin control. In the other cases, the above drugs are either low effective or promote non-optimal rhythm structure. Therefore, combined therapy with AB-blocking drugs and cardiac glycosides is indicated for CCF patients.
Adrenergic beta-Antagonists↗
[On the possibility of amiodarone use in some cases of persistent atrial fibrillation].
Aim of the study was to investigate mechanisms of amiodarone action on atrial and ventricular rhythm during persistent atrial fibrillation (PAF), and to assess efficacy of amiodarone as monotherapy or in combination with digoxin. Holter ECG monitoring and registration of high resolution ECG with construction of periodograms of ff waves and histograms of RR intervals (MATLAB 5.3 environment) were carried out in 34 patients (mean age 63.1+/-11.0 years) with PAF. Amiodarone (550.0+/-143.4 mg/day), digoxin (0.30+/-0.09 mg/day) with amiodarone (571.4+/-106.9 mg/day) were given for 21 days with recordings of high resolution ECG at baseline and on day 21. Long term therapy (1.7 years) with combination of digoxin 0.19+/- 0.07 mg/day) and amiodarone (254+/-82.0 mg/day) was controlled by Holter ECG monitoring. Monotherapy with amiodarone was not associated with significant lowering of heart rate (HR) (small er, Cyrillic=0.054) because of complex effect of amiodarone of HR: significant increase of period of ff waves (by 0.031+/-0.011 s), with facilitation of their conduction to ventricles combined with significant 0.10+/-0.08 s increment of minimal RR. Amiodarone combined with digoxin caused significantly lesser (by 0.009+/-0.017 s) enlargement of ff waves and significant lowering of HR (by 21.24+/-15.77 bpm) at the account of slowing of AV conduction (minimal RR increased by 0.12+/-0.08 s) and suppression of early RR peaks (0.28-0.46 s). The combination effectively suppressed tachysystolia resistant to other therapy (maximal HR 170-215 bpm) with significant lowering of mean (by 16.5+/-13.1 bpm) and maximal (by 43.3+/-35.6 s) HR, with suppression of ventricular extrasystoles in 83% of patients, and without significant lowering of minimal HR and appearance of pauses from 3 s. Level of thyrotrophic hormone rose from 2.4 to 5/9 IU/ml (p >0.05).
Adult↗
[Effect of clonazepam and antiarrhythmic drugs on heart rate variability in patients with paroxysmal atrial fibrillation].
AIM: To study direction and intensity of autonomic changes in patients with paroxysmal atrial fibrillation (PAF) treated with clonazepam and their dynamics during antiarrhythmic therapy. MATERIAL: Patients with nonrheumatic PAF during effective clonazepam monotherapy or ineffective antiarrhythmic therapy (n=95), untreated patients with PAF (n=22), healthy persons (n=10). METHODS: Clinical cardiological and neurological examination, assessment of the state of autonomic nervous system, emotional sphere, patterns of sleep, and spectral analysis of heart rate variability (HRV). RESULTS: Effective monotherapy with clonazepam was associated with clinical and psychovegetative improvement, positive changes of autonomic tone and normalization of vegetative support of activity of patients with PAF. Analysis of HRV showed that ineffective (insufficiently effective) antiarrhythmic therapy was associated with stabilization of cardiac rhythm and domination of ergotropic activation which correlated with severity of psychovegetative syndrome. This could be considered as indication for supplementary use of clonazepam. CONCLUSION: Analysis of HRV confirmed expediency of the use of clonazepam in patients with PAF both as monotherapy and in combination with ineffective antiarrhythmic therapy.
Adult↗
[G. A. Zakharyin--a founder of the Moscow Therapeutic School].
Explore the source record for details and available documents.
Anniversaries and Special Events↗
[Anxiodepressive and neuromediatory disorders in hypertensive patients. Effects of cypramil therapy].
AIM: To investigate psychic status and characteristics of neuromediatory metabolism in hypertensive patients, efficacy of antihypertensive therapy with lisinopril and hydrochlorthiaside with adjuvant citalopram (cipramil) which is a selective inhibitor of serotonin reuptake. MATERIAL AND METHODS: Fifty patients with hypertension stage II (37 females, 13 males, mean age 48 years, mean duration of the disease 10.6 years) have undergone psychometric examination, estimation of evoked potentials P-300, 24-h monitoring of blood pressure. Plasma levels of epinephrine and norepinephrine, plasma and platelet levels of serotonin and 5-OIAA were measured at high-performance liquid chromatography. RESULTS: Hypertensive patients were found to have high levels of depression, reactive and personality anxiety, subnormal quality of life. Blood pressure lowered more in patients given adjuvant cipramil. CONCLUSION: Hypertensive patients have anxiodepressive disorders accompanied by monoamines disbolism. Cipramil effectively corrects these disorders.
Adult↗
[Correction of rate and structure of ventricular rhythm in permanent atrial fibrillation: a novel pathogenetic approach].
AIM: To analyze action of digoxin and some non-digitalis drugs (beta-blockers, verapamil, amiodarone, d,l-sotalol) and their combinations on electrical activity of atria, frequency and structure of ventricular rhythm in patients with permanent atrial fibrillation. MATERIAL AND METHODS: One hundred patients with permanent atrial fibrillation and heart rate at rest above 80 bpm were divided into 9 treatment groups. High-resolution orthogonal Frank lead ECG was recorded before and after allocated treatment. Analysis included construction of ff-waves periodograms, histograms of RR interval, cardiointervalograms and application of autocorrelation function. RESULTS: It was demonstrated that frequency and form (structure) of ventricular rhythm was determined not only by the state of AV conduction but also by value of basic period of ff-waves. The mechanisms of ventricular rate deceleration by investigated drugs were not identical. beta-blockers and verapamil directly slowed AV conduction without changing parameters of ff-waves and differed from each other only in action on parameters of concealed conduction in AV node. Action of digoxin in patients with ff-waves period equal to or exceeding 0,15 s was biphasic. During phase I shortening of ff-wave period (by 0.025+/-0.012 s) occurred. This was associated with increase of their concealed conduction through AV node. The latter phenomenon represented independent mechanism of ventricular rhythm deceleration. During phase II of digoxin action direct inhibition of AV conduction took place. Amiodarone and d,l-sotalol increased basic ff-waves period. This facilitated their conduction through AV node. Greater heart rate slowing effect of d,l-sotalol was attributed to its ability to augment concealed conduction. Due to their antiarrhythmic qualities amiodarone and d,l-sotalol slowed heart rate in patients with peak RR duration in the region of 0.28-0.46 s. These patients often had bi- and tri-modal structure of interval RR histogram. Changes of ventricular rhythm structure during use of various drugs were different. Action of digoxin was most whilst that of beta-blockers least favorable. CONCLUSION: Choice of a drug for treatment of permanent atrial fibrillation should be conducted with consideration of ff-waves periodicity, parameters of RR interval histogram, and characteristics of ventricular rhythm structure.
Amiodarone↗
[Assessment of phenomenology of attacks of atrial fibrillation before and after treatment with clonasepam].
AIM: To assess phenomenology of attacks of atrial fibrillation using psychovegetative index (PVI) and to compare PVI values obtained before and after treatment with clonasepam in patients with paroxysmal atrial fibrillation. MATERIAL: Patients with nonrheumatic atrial fibrillation (n=105). METHODS: PVI was calculated as ratio of difference between sums (numbers) of cardiac and noncardiac symptoms to sum (number) of cardiac symptoms. RESULTS: Psychovegetative disturbances predominated during attacks of atrial fibrillation and because of that PVI was less than zero. Greatest values of PVI were noted during attacks of idiopathic atrial fibrillation, in women, in patients with high initial level of personal anxiety, in patients with frequent and nocturnal attacks. CONCLUSION: Patients with negative or zero PVI require drugs for correction of psychovegetative disturbances. Therefore it is expedient to use PVI in patients with attacks of atrial fibrillation to select candidates for psychotropic therapy and to evaluate its efficacy.
Atrial Fibrillation↗
[Comparative analysis of phenomenology of paroxysms of atrial fibrillation and panic attacks].
AIM: To study phenomenology of attacks of atrial fibrillation (AF) and to compare it with phenomenology of panic attacks for elucidation of pathogenesis of atrial fibrillation and for elaboration of rational therapeutic intervention including those aimed at correction of psychovegetative abnormalities. MATERIAL: Patients with nonrheumatic paroxysmal AF (n=105) and 100 patients with panic attacks (n=100). METHODS: Clinical, cardiological and neurological examination, analysis of patients complaints during attacks of AF, and comparison them with diagnostic criteria for panic attack. RESULTS: It was found that clinical picture of attacks of AF comprised vegetative, emotional and functional neurological phenomena similar to those characteristic for panic attacks. This similarity as well as positive therapeutic effect of clonazepam allowed to propose a novel pathogenic mechanism of AF attacks. Severity of psychovegetative disorders during paroxysm of AF could be evaluated by calculation of psychovegetative iudex: CONCLUSION: Psychovegetative index should be used for detection of panic attack-like component in clinical picture of AF paroxysm and thus for determination of indications for inclusion of vegetotropic drugs, e. g. clonazepam, in complex preventive therapy.
Atrial Fibrillation↗
[Psychosomatic ratios and their correction in the autonomic dysfunction of the sinus node].
The study was undertaken to examine the ratio of mental to somatic disorders in patients with autonomic sinus nodal dysfunction (ASND) and the capacities of correction of revealed disorders with the atypical benzodiazepine drug clonazepam. Thirty-two patients with ASND were examined. The diagnosis of ASND was verified by 24-hour ECG monitoring and transesophageal atrial pacing, by performing autonomic cardiac block with atropine and obsidan. In addition to physical examination, heart rhythm variability was studied during relaxed and intensive wake; psychological studies using the conventional tests were conducted, and autonomic disorders were explored by means of original scored somatic, hyperventilation) questionnaires. After examination, the patients received a 1.5-to-2-month course of therapy with clonazepam in a daily dose of 1.5-2 mg. The study has revealed that clinical symptomatology in ASND is greatly determined by psychosomatic disorders. ASND was marked by anxious depressions in combination with inadequate peripheral (to a greater extent, sympathetic) neurovegetative exposures with the simultaneous activation of cerebral ergotropic effects. The use of clonazepam in ASND greatly improved its clinical picture, by eliminating, in the overwhelming majority of cases, clinical symptoms, including rhythm and conduction disturbances that are characteristic of ASND.
Adult↗
[Spectral analysis of heart rate variability in diagnosis of vegetative autonomic dysfunction in patients with attacks of atrial fibrillation.].
AIM: Elucidation of possible role of suprasegmental and segmental autonomic vegetative disturbances in pathogenesis of paroxysmal atrial fibrillation. MATERIAL: Untreated patients (n=22) with nonrheumatic paroxysmal atrial fibrillation and 10 healthy subjects. METHODS: Clinical cardiological and neurological examination, assessment of the state of vegetative nervous system, emotional sphere, patterns of sleep, and spectral analysis of heart rate variability. RESULTS: According to data of spectral analysis of heart rate variability patients with paroxysmal atrial fibrillation were characterized by marked vegetative dysfunction which was more pronounced in women, patients older than 52 years, with higher level of anxiety, with duration of symptoms longer than 6 years, and with predominantly nocturnal attacks. CONCLUSION: The data obtained should be considered in selection of therapy aimed at prevention of attacks of atrial fibrillation.
Atrial Fibrillation↗
[Use of clonazepam for treatment of patients with paroxysmal atrial fibrillation with regard to their psychoautonomic status].
AIM: To study the efficacy of clonazepam in patients with paroxysmal atrial fibrillation (PAF) with reference to their psychovegetative status. MATERIAL AND METHODS: 50 patients with PAF of non-rheumatic origin entered the study group, 20 healthy examinees served control. All of them were examined using a clinicocardiological, cliniconeurological tests; their autonomic nervous system, emotional sphere, sleep disorders were studied before and after clonazepam treatment in a dose 0.5 mg 2 times a day for 30 days. RESULTS: A positive effect of clonazepam was noted in 20 (80%) patients with PAF, less frequent paroxysms occurred in 12 (48%) patients, in 5 patients they stopped, 12 (48%) patients tolerated the paraxysms better. The paraxysms became shorter in 10 (40%) patients, 10 (40%) patients felt better in the postparoxysmal period. A marked relief of psychovegetative syndrome, improvement of activity, mood and quality of sleep were noted in all the patients. CONCLUSION: Clonazepam is recommended for patients with PAF to improve antiarrhythmia therapy.
Adult↗
[Medication reducing therapy of atrial fibrillation: a new approach to an old problem].
AIM: To study influence of different rate-reducing medicine groups on atrial electrical activity and ventricular thyrhms structure in chronic atrial fibrillation (CAF) and thus to optimize treatment. MATERIAL AND METHODS: 57 patients with CAF treated with digitalis, beta-blockers, their combinations, verapamil, amiodaron and sotalol were studied. Repeatedly highly-resolution ECG analysis was made. RESULTS: Atrial fibrillation is characterized by ff-waves basic period from 0.12 s to 0.20 s. Ventricular characteristics were determined both by AV conduction and basic ff-waves periods. The reducing of basic ff-period is the leading mechanism of digitalis rate-reducing actions in typical cases. The direct AV block appears on the late stage of therapy and is moderate. CONCLUSION: Combined therapy by medicines with different mechanisms of rate-reducing actions is the most efficient. The choice of the drug and its doses is determined by basic ff-waves periods value and the ventricular rhythm structure.
Anti-Arrhythmia Agents↗
[Use of plasmapheresis in the treatment of drug-resistant cardiac arrhythmias].
AIM: To study the therapeutical efficiency of plasmapheresis (PA) in patients with drug-resistant cardiac arrhythmias (CA) and its mechanisms. MATERIALS AND METHODS: Discrete PA sessions were carried out in 56 patients with drug-resistant CA: paroxysmal atrial arrhythmia (AA), ventricular and supraventricular premature contractions, supraventricular tachycardia of various etiology. Biochemical blood values, coagulographic parameters, lipid peroxidation (LPO), the spectrum of nonesterified fatty acids (NEFA), the level of medium-sized molecules were determined, ECG monitoring, EchoCG, and left ventricular radioisotope computed tomography were performed before and after a PA session. RESULTS: PA was effective in 50% of cases. The duration of its effect averaged 3.0 (1.25-5.0) months. PA was more beneficial for patients with IHD, AA with normal left atrial dimensions, and hyperlipidemia. The duration of the effect was significantly higher when antiarrhythmic drug therapy was continued after PA. Due to PA, there were significant decreases in the blood concentrations of cholesterol, medium-sized molecules, malonic dialdehyde (MDA) and in the proportion of polyunsaturated NEFA. The antiarrhythmic effect was associated with the decreases in MDA and NEFA, with a tendency for a reduction in the rate of chemiluminescence. CONCLUSION: PA may be used in the treatment of drug-resistant CA. The most significant mechanism of its antiarrhythmic activity is to recover sensitivity to antiarrhythmics. The intrinsic antiarrhythmic activity may be associated with its effect on NEFA metabolism and LPO; however, its mechanisms await further studies.
Adult↗
[Clonazepam in the treatment of labile arterial hypertension in the elderly].
AIM: To investigate effectiveness of clonazepam and its influence on autonomic function. MATERIAL AND METHODS: 56 patients with LHE aged 67.0 + 6.3 years were examined. 50 of them were treated with clonazepam in daily dose 1-2 mg. Their results were compared with age and sex matched normotensive persons. The routine clinical examination, regular measurement of blood pressure (BP), psychological tests, investigation of heart rate variability and evoked cutaneous sympathetic potentials (ECSP) were made. These tests were performed before and after treatment with clonazepam. RESULTS: Clonazepam significantly reduced fluctuations of BP in 82.0% of patients with LHE: the fluctuation range of systolic BP was reduced 2 times, diastolic BP--1.6. At the same time clonazepam diminished the level of anxiety, heart rate variability with increasing normalized VLF (central influence) and lowering LF and HF (segmental sympathetic and parasympathetic influences). ECSP were characterized by slowing sympathetic conduction and reduction of ECSP amplitude. CONCLUSION: Clonazepam, by changing autonomic properties, leads to stabilization of blood pressure in most patients with LHE. It is recommended to use clonazepam in daily dose 1-2 mg in combination with conventional antihypertensive medications for prevention of excessive fluctuation of BP in patients with LHE.
Age Factors↗
[Psychoautonomic correlations in patients with paroxysmal atrial fibrillation].
AIM: To study psychovegetative correlations in patients with paroxysmal atrial fibrillation (PAF). MATERIAL AND METHODS: The trial included 50 patients with non-rheumatic PAF and 20 healthy subjects. Clinical cardiological and cliniconeurological examinations, assessment of autonomic nervous system, emotional sphere, sleep disorders were performed. RESULTS: The diagnosis of marked psychovegetative syndrome was made in all PAF patients. It manifested stronger in older women, young men, survivors of myocardial infarction or acute disorders of cerebral circulation, in frequent paroxysms of cardiac fibrillation, its long-term history, in night PAF attacks, in sleep apnea. CONCLUSION: The policy of antiarrhythmic antirecurrence therapy should consider modalities correcting psychovegetative disorders.
Adult↗
[Labile hypertension in elderly: clinical features, autonomic regulation of circulation, approaches to treatment].
Blood pressure in some elderly hypertensive patients is characterized by marked lability. This affects quality of life and may deteriorate prognosis. Conventional anti-hypertensive medication does not lead to stabilization of blood pressure. We call this form of hypertension "labile hypertension of the elderly" (LHE). The aim of the study was investigation of autonomic regulation of blood pressure and of clonazepam effectiveness in patients with LHE. Fifty-six patients with LHE (mean age 67.0 +/- 6.3 years) entered the study (87.5% women). Control group consisted of 38 patients with stable hypertension and 27 normotensives matched by sex and age. The patients and the controls underwent clinical and psychological examinations, regular measurement of blood pressure during one month before and after the treatment, cardiovascular tests and spectral analysis of the heart rate variability. It was found that LHE patients have higher level of anxiety and depression, low standard deviation of RR interval, low normalized LF and HF components and increased normalized VLF component. The cardiovascular tests showed signs of diminished parasympathetic regulation. Clonazepam treatment in a dose 1-2 mg/day brought about a significant stabilization of blood pressure in 82.0% of patients with LHE. Thus, LHE is an original form of hypertension in patients over 60 years old characterized by frequent, short-term, small symptomatic, spontaneous fluctuations of blood pressure with development of both hypertensive and hypotensive reactions. Pathogenesis of LHE is linked with disorders of heart rate autonomic regulation, marked anxiety and depression. Clonazepam stabilizes blood pressure in most LHE cases.
Aged↗