Тематичний Архів | Category Archives: Heart Arrhythmias

G.M. Solovyan, S.Yu. Savitskyy. Complex approach for assessment of atrial electrical instability in patients with paroxysmal atrial fibrillation

The aim of the study – complex evaluation of atrial electrical instability based on structural and functional myocardial condition, electrophysiological heart properties and some neurohumoral markers in pts with paroxysmal atrial fibrillation (AF) depending on arrhythmia induction during transesophageal electrophysiological examination (TEE).

Material and methods. 133 pts with non-valvular paroxysmal AF were included in the study. Left atrial electrical stimulation with increasing frequency (up to 200 imp./min) and overfrequency was applied for stable paroxysmal AF induction. Observed pts were divided in 2 groups: 1st group consisted of 103 pts with induced paroxysmal AF; 2nd group included 30 pts without inducible paroxysmal AF. The following instrumental methods were used: Holter ECG monitoring with analysis of heart rate variability, two-dimensional, and Doppler echocardiography. The function of heart conducting system, atrial vulnerability (AV) and vasoactive substances blood levels were explored by TEE. Vasoactive substances levels in blood were studied by radioimmunoassay.

Results. Atrial electrical instability in pts with induced atrial fibrillation was associated with increased number of supraventricular extrasystoles, increased RMSSD and PNN50. High atrial vulnerability in pts with induced paroxysm was conditioned by decreased frequency characteristics of atrial fibrillation, reduction of atrial cycle length during arrhythmia, attenuation of sinus node function.

Conclusion. In pts with induced atrial fibrillation paroxysm atria vulnerability was associated with parasympathetic tonus increase. At the same time, sympathetic domination is found at the arrhythmia launch.

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O.S. Sychov, A.O. Borodai, S.V. Fedkiv, E.S. Borodai, A.Yu. Rybak, L.L. Vavilova.

The aim – to evaluate association between silent cerebral infarctions and death in patients with nonvalvular atrial fibrillation during two years follow-up.

Material and methods. In prospective longitudinal study with 25.3 months follow-up we examined 103 patients with nonvalvular atrial fibrillation without prior history of stroke. All patients underwent standard clinical examination, transthoracic echocardiography and multislice computed tomography. Transesophageal echocardiography was performed in 95 patients.

Results. Cortical-subcortical infarctions ≥ 15 mm were found in 10 (9.7 %) of patients and deep white matter or basal ganglia infarctions were found in 25 (24.3 %). Endpoint outcomes were registered in 10 (9.7 %) of patients: ischemic stroke – in 5 (4.85 %), death – in 3 (2.9 %), and thrombosis of peripheral arteries – in 2 (1.94 %) patients. The combined endpoint was associated with male gender (Р=0.03), functional class NYHA III–IV (Р=0.048), myocardial mass index ≥130 g/m2 (Р=0.009), left atrial volume index ≥ 48 ml/m2 (Р=0.008), spontaneous echo contrast in the left atrial appendage (LAA) 3–4+ (Р=0.04), and LV thrombus (Р=0.005). Left atrial appendage velocity ≤ 30 сm/s, was significantly associated with stroke (Р=0.03). Silent cerebral infarctions were not associated with cardio-vascular events.

Conclusions. Silent cerebral infarctions were not associated with thromboembolic events and/or death during two years follow-up. In multivariate logistic regression model LAA spontaneous echo contrast 3–4+ and left ventricular thrombus were independently associated with cardiovascular outcomes.

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O.S. Sychov, A.O. Borodai, L.L. Vavilova. Myocardial remodeling after cardioversion and predictors of rhythm control in patients with persistent atrial fibrillation of non-valvular origin

The aim – to assess myocardial remodeling after cardioversion and to evaluate predictors of rhythm control during follow-up of 21 month.

Material and methods. In prospective longitudinal study consecutive 95 patients were enrolled before cardioversion. Patients with history of paroxysmal atrial fibrillation (AF) just before current episode, permanent AF, unstable or acute heart failure, severe valvular diseases and rheumatic heart disease, recent open-heart surgery, major disorders, or an unsuccessful cardioversion were excluded. Transthoracic echocardiography was performed to all patients at the beginning and at the end of the study. Transoesophageal echocardiography was performed for all patients at the beginning of the study and only for a group with recurrent AF at the end of the study.

Results. At the end of follow-up of 21 months maintenance of SR was achieved in 52 (54.7 %) of patients. Patients with sinus rhythm had significantly higher left ventricular ejection fraction, smaller left atrial and right atrial volume indices comparing to patients before cardioversion. They also had milder severity of functional mitral regurgitation and better NYHA class. In univariate Cox’s-F test with rhythm control associated: age ≥ 65 y.o. (Р=0.003), use of amiodarone (Р<0.001), use of ACE/ARB (Р<0.001), septal thickness < 1.7 cm (Р=0.01), left atrial volume index < 48 ml/m2 (Р=0.04), and ∆EF2 – EF1 ≥ 10 % (Р=0.004). On the other hand, first diagnosed AF (Р=0.3), use of statins (Р=0.07), Em > 8 cm/s (Р=0.3), EF ≥ 40 % (Р=0.08), were not associated with sinus rhythm maintenance. In multivariate regression model we found that the use of amiodarone (Р=0.01), ACE/ARB (Р=0.02), age ≥ 65 y.o. (Р=0.03), septal thickness < 1.7 cm (Р=0.02), but not the ejection fraction ≥ 40 % (Р=0.14) and left atrial volume index < 48 ml/m2 (Р=0.07) were independently associated with rhythm control. Conclusions. Rhythm control was associated with significantly lower class NYHA, and myocardial remodeling which primarily included reduction of atrial volumes, improvement in left ventricular systolic function and reduction of mitral regurgitation severity. Use of amiodarone, ACE/ARB, age ≥ 65 y.o., septal thickness < 1.7 cm, but not the ejection fraction ≥ 40 % and left atrial volume index < 48 ml/m2 were independently associated with rhythm control.

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I.V. Shanina, D.E. Volkov, N.I. Yabluchansky. Changes of permanent pacing parameters in patients with implanted pacemakers depending on QRS complex duration at six months follow-up

66 patients (26 women, 40 men) with permanent pacemakers due to atrio-ventricular block II and III degrees, mean age 69±7 years were examined. Patients were divided into three groups depending on QRS complex duration: under 120 ms (normal), 120–149 ms (extended) and 150 and more ms (significantly extended). The programmer was used to define the basic pacing rate, atrioventricular delay (stimulated and detected), ventricular threshold and ventricular lead impedance, percentage of ventricular pacing, atrial fibrillation time percentage. Basic pacing rate, ventricular threshold, atrioventricular delay, the percentage of ventricular pacing in did not change in any group at six-month period of observation. Ventricular lead impedance decreased, and its rate of decrease was the largest in patients with increased QRS complex duration. Percentage of atrial fibrillation time was higher at the beginning of pacing in patients with significantly extended QRS complex. It gradually decreased during follow-up but didn’t reach the levels in patients with lower QRS complex duration where they remained almost at the same level.

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O.S. Sychov, A.O. Borodai. Myocardial function and quality of life in patients with new-onset atrial fibrillation

The aim – to evaluate clinical, echocardiographic characteristics and quality of life in patients with new-onset atrial fibrillation (AF).

Material and methods. In prospective, cross sectional study we examined consecutive 322 patients with non-valvular AF. New-onset AF was diagnosed in 104 (32.3 %) patients. All of them were studied by transthoracic and transesophageal echocardiography. Quality of life was assessed by HeartQol questionnaire and EHRA score. In order to assess anxiety and depression we used HADS scale.

Results. Functional class NYHA III–IV was more commonly detected in patients with chronic AF 24.4 % vs 11.9 % (Р=0.02). Ejection fraction < 40 % was found in 17.3 % vs 11.1 %, Р=0.1 for patients with new onset and chronic AF respectively. Low left atrial appendage velocity < 30 cm/s was equally common 46.6 % vs 43.4 %, Р=0.6 in patients with new onset and chronic AF respectively. Left atrial appendage (LAA) thrombus was found in 6.8 % of cases with new onset AF vs 11 % of cases with chronic AF, Р=0.25. Sludge in LAA was found in 4.8 % vs 11.1 %, Р=0.07 for patients with new onset AF and chronic AF respectively. Patients with chronic AF had significantly worse physical 1.5 vs 1.8, Р=0.0006 as well as emotional 2.0 vs 2.3, Р=0.0002 components of HeartQol. Very low physical HeartQol < 1.8 was detected in chronic AF group 58.4 % vs 46.3 %, Р=0.05, but difference between emotional HeartQol < 1.8 was significant, 40 % vs 20 %, Р=0.0007 for chronic AF and new onset AF respectively. Probable anxiety with HADSA ≥ 11 was found in 12.1 % of chronic AF patients vs 5.15 % of new onset AF patients, Р=0.05. The difference of incidence of probable depression with HADSD ≥ 11, was also insignificant for groups with new onset 9.2 % vs 4.7 % for chronic AF. Conclusions. There was no differences in detection of low left atrial appendage velocity, thrombus and sludge among patients with new onset and chronic AF. The worst indices of quality of life were registered in patients with chronic AF. Difference of the incidence of anxiety and depression was insignificant between groups.

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N.S. Pavlyk, U.P. Chernyaha-Royko, S.S. Pavlyk, O.J. Zharinov. Clinical characteristics of hospitalized patients with silent atrial fibrillation and flutter in one-center registry.

The aim – to study the prevalence of silent atrial fibrillation (AF) and atrial flutter (AFL) in hospitalized patients, to compare cardiovascular risk, clinical characteristics, myocardial structure and function in patients with and without symptoms of arrhythmia.

Material and methods. The study included 685 patients with different forms of AF/AFL, consecutively hospitalized into the regional cardiology centre from January to June 2013. All patients were divided into two groups depending on arrhythmia symptoms evaluated according to the EHRA classification. The first group consisted of 105 (15.3 %) patients with asymptomatic AF/AFL, second group – 580 (84.7 %) patients with symptomatic arrhythmia. Cardiovascular risk factors (CHA2DS2-VASc), clinical characteristics and echocardiographic parameters were compared between two groups.

Results. There were no significant differences between two groups regarding age, gender, anthropometric parameters and harmful habits. There were also no statistically significant differences regarding earlier stroke, hypertension, diabetes mellitus, thromboembolic events, thyroid pathology, rheumatism, cardiomyopathies, valvular diseases and CHA2DS2-VASc cardiovascular risk factors between two groups. Asymptomatic patients with AF/AFL more often had heart failure ІІІ–ІV classes NYHA (40 (38.1 %) against 123 (21.2 %), Р=0.001). They had larger left atrium (4.6 (4.1–5.1) against 4.5 (4.0–4.9) cm, Р=0.05) and left ventricle (5.5 (4.9–5.9) against 5.2 (4.8–5.8) cm, Р=0.04).

Conclusions. Arrhythmia is asymptomatic in 15.3 % hospitalized patients with AF/AFL. Patients with silent AF/AFL had more prevalence of heart failure ІІІ–IV classes NYHA, larger left atrium and left ventricle. Independent of arrhythmia symptoms, the investigated cohort had high risk of thromboembolic complications.

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O.S. Sychov, A.O. Borodai, O.M. Romanova, S.V. Lysogub, O.V. Sribna, O.V. Levchuk, E.S. Borodai. Gender issues of quality of life and emotional state in patients with non-valvular atrial fibrillation and flutter.

The aim – to evaluate gender issues of quality of life and emotional state in patients with non-valvular atrial fibrillation and flutter (AF-AFl).

Material and methods. We examined 322 patients with non-valvular atrial fibrillation and flutter, among them 223 (69.3 %) males and 99 (30.7 %) females. Clinical examination, laboratory tests, transthoracic echocardiography were performed in all patients. Quality of life was assessed by HeartQol, anxiety and depression were examined by HADS, additional questionnaires were applied for assessment of adherence to therapy.

Results. There were no significant differences of left ventricle ejection fraction between females (54.9±10.1 % and males 53.1±11.0 %, Р=0.19). In the meantime, there were significant differences in physical (1.8±0.9 vs 1.2±0.8, Р<0.0001), and emotional dimensions (2.3±0.9 vs 1.7±0.9, Р<0.0001) of quality of life for males and females, correspondingly. Also, females had higher level of anxiety (7.8±3.2 vs 5.4±2.7, Р<0.0001) and depression (5.6±3.6 vs 4.2±3.0, Р=0.001). Вesides, HADS anxiety ≥ 11 was revealed in 24.4 % females vs 3.1 % males, Р<0.0001, and HADS depression ≥ 11 – in 12.2 % females vs 3.6 % males, Р=0.005. Females had significantly more symptomatic course of arrhythmia with EHRA IV (19.3 % vs 5.6 % among males, Р=0.0002). In multivariate logistic regression model female gender was independently associated with low physical and emotional components of HeartQol < 1.8 (Р=0.01 for both) and with EHRA IV (Р=0.008). Conclusions. Females with AF-AFl had more symptomatic course of arrhythmia, lower quality of life and higher prevalence of anxiety and depression.

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O.S. Sychov, A.O. Borodai, E.S. Borodai. Thrombogenic milieu in patients with atrial flutter

The aim – to establish prevalence of thrombogenic milieu (TM) in heart cavities and associated clinical and echocardiographic findings in patients with typical atrial flutter (AFl) and evaluate silent cerebral infarctions in these patients.

Material and methods. Transesophageal and transthoracic echocardiographic examinations were performed in 100 consecutive patients with AFl in whom cardioversion or radiofrequency ablation procedures were planned. In each case, specific care was taken to identify atrial TM (either atrial thrombi and/or left atrial appendage sludge) or ventricular thrombi. Clinical and echocardiographic data were analyzed to determine frequency and relevant clinical associations of these thromboembolic risk markers. Brain multislice computed tomography was performed in 29 patients to evaluate prevalence of silent cerebral infarctions.

Results. Left atrial appendage (LAA) sludge was detected in 5 (5.2 %), LAA thrombus in 4 (4.2 %) and LV thrombus in 7 (7 %) cases. Reduced left ventricular ejection fraction (LV EF) < 40 % (Р≤0.005) and early diastolic tissue Doppler velocity on mitral valve lateral segment Em < 8 cm/s (Р<0.0001), were most significantly associated with left atrial TM, while LV EF < 40 % was most significantly associated with LV thrombus (Р<0.0001). Silent cerebral infarctions ≥ 15 mm were detected in 3 of 29 (10.3 %) cases and were associated with low LAA velocity (Р=0.03). Overt cardioembolic strokes not related to cardioversion were significantly associated with LV thrombi (Р=0.0005) and LAA sludge (Р=0.04). Conclusions. Although there were several significant echocardiographic associations with TM, none were strong enough to obviate the need for TEE in AFl patients. Silent cerebral infarctions ≥ 15 mm in patients with AFl had the same prevalence as in patients with atrial fibrillation. Thrombogenic milieu was significantly associated with overt strokes.

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A.O. Borodai, S.V. Fedkiv, E.S. Borodai, T.M. Shapovalov, O.V. Bachinskii, O.S. Sychov. MRI-defined brain lesions in patients with non-valvular atrial fibrillation

The aim – to evaluate MRI-defined brain lesions in patients with atrial fibrillation (AF) and sinus rhythm.

Material and methods. In a prospective cross sectional study we examined 88 patients, among them 39 (44.3 %) with atrial fibrillation (AF) and others with sinus rhythm without previous history of AF, by MRI. Arterial hypertension was detected in 89.7 % of patients with AF and in 98 % of patients with sinus rhythm.

Results. The prevalence of silent cerebral infarctions ≥ 15 mm was higher in patients with AF than in sinus rhythm (23.1 vs 6.1 %, Р=0.02). In univariate analysis periventricular leukoaraiosis (Р<0.0001), white matter hyperintensity (Р=0.006), heart failure NYHA class (Р=0.0001), CHA2DS2-VASc score (Р=0.006), atrial fibrillation (Р=0.002) and history of myocardial infarction (Р=0.03) were associated with cortical-subcortical cerebral infarctions ≥ 15 mm. Conclusions. White matter hyperintensity including leukoaraiosis was a main MRI-defined white matter lesion. Prevalence of cerebral infarctions was higher in patients with AF. Lesions in patients with AF were predominantly cortical and had a large ≥ 15 mm diameter. Periventricular leukoaraiosis was associated with overt stroke and silent cerebral infarctions with high degree of accuracy and according to current concepts should be considered a risk factor of the overt stroke.

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N.P. Levchuk, О.J. Zharinov, М.R. Ikorkin, О.S. Sychov. Changes of the myocardial structure and function in patients with persistent atrial fibrillation after cardioversion at long-term follow-up.

The aim – to compare dynamics of the myocardial structure and function parameters in patients with persistent non-valvular atrial fibrillation (AF) during 18 months after cardioversion depending on sinus rhythm maintenance.

Material and methods. The prospective follow-up included 225 consecutive patients selected for planned cardioversion. Apart from general clinical data, the protocol included transtorathic and transesophageal echocardiography for detailed evaluation of structure and function of atrial and ventricles.

Results. Sinus rhythm was maintained in 125 (55.6 %) patients at 18-months follow-up. Persistent or permanent AF was registered in 100 patients (44.4 %), including 47 – after 6 months, in 23 – after 12, in 30 – after 18 months follow-up. Maintenance of sinus rhythm at 18-months follow-up was associated with transition of the majority patients to better functional class NYHA, significant improvement of the myocardial structure and function parameters, decrease of mitral and tricuspidal regurgitation. AF recurrence was associated with decrease of the left atrial appendage function.

Conclusions. These data show that strategy of cardioversion and rhythm maintenance is an effective way to prevent «tachycardiomyopathy» in patients with symptomatic persistent AF.

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