[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.

[Spectral analysis of heart rate variability in diagnosis of vegetative autonomic dysfunction in patients with attacks of atrial fibrillation.]. / Spektral'nyi analiz variabel'nosti ritma serdtsa v diagnostike vegetativnoi disfunktsii u bol'nykh s paroksizmal'noi formoi mertsatel'noi aritmii.

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.

[The nature of very low frequency component of the heart rate variability and the role of sympathetic-parasympathetic interactions]. / O prirode nizkochastotnoi sostavliaiushchei variabel'nosti ritma serdtsa i roli simpatiko-parasimpaticheskogo vzaimodeistviia.

A method of separate monitoring "instant" changes of the VLF, LF and HF power spectral components of heart rate variability, has been developed. The power of the LF and HF spectral components were proved to be continuously changing. The period of these power fluctuations could stay within 15 to 150 sec. Comparison of the heart rate variability spectrum with LF and HF spectral components power fluctuations' spectrums has shown that the frequencies of the LF and HF spectral components power fluctuations stay within the VLF range. The co-operative spectrum form of these fluctuations repeats the form of the VLF peak. In cases when the LF and HF spectral components power fluctuations' periods do not coincide, VLF has two peaks. The frequency of one VLF peak coincides with frequency of the HF power fluctuations, and the frequency of another--with the frequency of LF power fluctuations.

[The role of clinical-electrophysiological indices in therapy for late-stage residual stroke by dynamic correction of proprioception]. / Rol' kliniko-élektrofiziologicheskikh pokazatelei v terapii pozdnei rezidual'noi stadii insul'ta metodom dinamicheskoi propriokorrektsii.

The new method dynamic proprioceptive correction using a medical loading costume was included into complex therapy in patients with late-stage residual stroke. Application of the costume promoted normalization of complex locomotor acts of walking by correcting proprioceptive pulsation resulted from the system of elastic draughts. Thus, a new motor stereotype was forced upon the patients. Clinical observation, computer analysis of the motor potential, spectrum of heart rhythm variabilities before and after therapy, and psychological testing were performed in 120 patients with motor disorders (pareses, paralyses) resulted from acute cerebral circulatory disorders. A steady-state clinical effect (p < 0.05) was found in 71.9% of the patients after 15 sessions of therapy. The patients became to walk independently, a possibility to self-attendance appeared, their speech became better. Lateralization of a damage and preservation of both the most significant homeostatic vasomotor mechanisms and the cerebral mechanisms of preparation of a movement with the minimal manifestations of emotional-affective disorders were shown to have impact on the patients' rehabilitation and on the early clinical features of pyramidal defect.

[Variability of heart rhythm in dynamic study of the psychovegetative relationship in neurogenic syncope]. / Variabel'nost' ritma serdtsa v dinamicheskom issledovanii psikhovegetativnykh sootnoshenii pri neirogennykh obmorokakh.

Physiological changes accompanying syncopes of neural origin (SNO) in patients with psychovegetative syndrome are still insufficiently studied. The data concerning the role of the autonomic nervous system are discrepant. Heart rate variability was analyzed in 68 patients with SNO in a supine position and during the active 20-min orthostatic test taking into account the heart rate components of very low frequency (VLF, an index of cerebral sympathetic activity) and high frequency (HF, a marker of vagal modulation). Steady growth of the VLF and progressive decrease in the LF within 15-20 min of the orthostasis were observed in all the patients (n = 33), who fainted after this period. The predominance of the VLF in the heart rate power spectra was correlated with a high level of anxiety. It is suggested that this fact indicates the stable cerebral sympathetic activation resulting in a baroreceptor dysfunction, i.e., a failure of vasomotor regulation in patients with SNO.

[Dynamic proprioceptive correction in the rehabilitation of patients with a late residual stage of stroke]. / Dinamicheskaia propriotseptivnaia korrektsiia v reabilitatsii patsientov s pozdnei rezidual'noi stadiei insul'ta.

Space gravity suit has been used for over 20 years in Russian space stations to prevent harmful consequences of being in zero gravity (osteoporosis, muscle atrophies, etc.). The space suit is designed in such a way that it enables to create a payload on muscles, temporarily out of function, which is adequate to the natural one. Stroke patients with motor defect of hemiparesis are quite limited in their movement. To develop walking and self-serving skills we conducted 2-hour sessions of treatment using space gravity suit. Neuro-physiological and psychological methods confirm the positive effect of treatment. The predictors of positive effect of treatment were also observed. Our experience has shown that the method is simple to use, very effective and can be applied in both clinics and home conditions.

[A trial of the use of aekol in preventing psychoautonomic disorders]. / Opyt primeneniia aekola v profilaktike psikhovegetativnykh rasstroistv.

Autonomic dysfunction in chronic emotional stress is well documented. The aim of this study was to analyze the effects of natural antioxidant vitamin E (aekol). Twenty persons (16 women and 4 men, mean age 38 +/- 4 years) who reported recent occurrence of emotional stress were examined before and after a 4-week treatment with aekol (5 ml twice a day). Heart rate variability (taking into account very low-frequency (VLF, 0.003-0.04 Hz), low-frequency (LF, 0.04-0.15 Hz), and high-frequency (HF, 0.15-0.40 Hz) components) was computed from the power spectra (5-min epochs) of the EKG recorded in the patients in supine position. After the treatment, the HF power of the heart rate variability (an index of cardiac parasympathetic activity) increased (p < 0.05), whereas the VLF power (an index of the cerebral sympathetic activity) decreased (p < 0.01). The decrease in the VLF was accompanied by a reduction of anxiety level (p < 0.01). According to our hypothesis, the absolute and relative power of the VLF can be used as an index of anxiety or cerebral sympathetic activity, which significantly decreases after the aekol treatment.

[Migraine: dynamics of psychophysiologic pattern]. / Migren': dinamika psikhofiziologicheskogo patterna.

85 patients with migraine without aura and 20 healthy individuals were examined between the attacks, before the attack, during and after it (1-2 days). The examination included clinical-neurological analysis; psychological Spilberger's and Beck's tests, scale of alexithymia and complex algesic questionnaire; recording of the conditional negative wave; determination of nociceptive flexor reflex; recording of trigeminal evoked potentials; spectral analysis of the heart's rhythms; polysomnographic study. Psychophysiologic pattern characteristic for all the patients was established. Psychological and neurophysiological parameters changed synchronously in the periods before the attack, during and after it. Before the migraineous attack a specific pathologic integration increased and presented maximally (the activity of antinociceptive system weakens anxiety increased, tension of catecholaminergic systems grew, hyperactivity in trigeninal sphere elevated, tolerance to the pain decreased). A clear tendency to the reversibility of these changes was observed after an attack. A dynamics revealed in the psychophysiological pattern could serve as a predictor of a migraineous attack and open some perspectives for prophylaxis of the algesic attack.

[Defects in autonomic regulation in myocardial ischemia]. / Narusheniia vegetativnoi reguliatsii pri ishemii miokarda.

AIM: To evaluate cerebral and peripheral mechanisms of autonomic regulation of the cardiovascular system, their role in development of myocardial ischemia in coronary heart disease (CHD) patients with coronary atherosclerosis and X syndrome. MATERIALS AND METHODS: Psychometric testing, questionnaires, cardiovascular tests (by D. Y. Ewing), automatic spectral analysis of cardiac rhythm variability were used in investigation of psychovegetative regulation in 36 patients and 19 healthy subjects. Group 1 consisted of 26 CHD patients with coronary atherosclerosis and stable angina class I-II. Group 2 consisted of 10 patients with symptoms of myocardial ischemia and coronarographically intact coronary arteries. RESULTS: Patients of both groups demonstrated initial activation of cerebral sympathicoadrenal mechanisms manifesting with high anxiety, depression, vegetative defects in regulation of both initial autonomic tone and autonomic support of the orthostatic test. CHD patients with coronary atherosclerosis were characterized by persistent activation of cerebral sympathicoadrenal mechanisms and resistance of homeostatic baroreflex sympathetic systems. Vagal insufficiency was moderate and arose only at rest. In X syndrome patients with the same initial cerebral activation of the sympathicoadrenal mechanisms had dystonic trend in hemodynamic autonomic parameters: higher systolic blood pressure in subnormal heart rate, lability of baroreflex and cerebral mechanisms under the orthostatic test. The above features of psychovegetative relations make such patients very close to those with psychovegetative syndrome. CONCLUSION: CHD patients with coronary atherosclerosis and patients with X syndrome differ by mechanisms of maladaptation of autonomic regulation.

[Autonomic regulation in patients with panic attacks based on longitudinal study data on the variability of the heart rhythm]. / Vegetativnaia reguliatsiia u bol'nykh panicheskimi atakami po dannym longitudinal'nogo issledovaniia variabel'nosti ritma serdtsa.

During a repeated study in recumbent position as well as during 48-hour monitoring of the indices of variability of RR intervals of ECG (MDRR) in patients with panic attacks (PA) a stable dominance of VLF (0.07-0.01 Hz) and rigidity of the spectrum typical for patients with panic attacks (PA) in period between the attacks was found. Prevalence of fear emotions as well as accompanying hypothalamic insufficiency were also associated with a decrease of HF. In prodromic period, in attack and after it, there was no dynamics in the frequency of heart's contractions, but there was a sharp increase of MDRR. In prodromic period VLF and LF considerably increased, while HF decreased. In a moment of a panic attack LF and HF continued to increase, while VLF significantly lowered. Activation of vasomotor (LF), vagal (HF) and cerebral (VLF) mechanisms was maintained during 5 minutes of the study after PA completion with a clear predominance of LF component.

[State of autonomic regulation mechanisms in arterial hypotension]. / Sostoianie mekhanizmov vegetatibnoi reguliatsii pri arterial'noi gipotenzii.

To investigate the role of suprasegmental and segmental parts of autonomic nervous systems (ANS) in genesis of arterial hypotension (AH) 75 individuals with arterial hypotension as well as 30 healthy persons were examined using clinical and psychological methods, evaluation of the state of ANS segmental part by means of evoked skin sympathetic potentials, spectral analysis of the variability of the heart rhythm, 5 standard cardiovascular tests according to Ewing. The conclusion was made that individuals with AH had combination of alterations of both emotional-personality sphere and autonomic functions in all systems of organism tested. Exactly they had psychoautonomic syndrome presenting as combination of asthenic manifestations, elements of Reynaud phenomenon and headaches pronounced differently (headaches of tension more frequently). Clinical alterations were combined with changes of indices of functional testing, that reflected disorders in some link of sympathetic regulation including baroreflex one. Decompensation in individuals with AH and change for the worse of the indices of functional testing were due both to the increase of psychoautonomic disorders, growing of desintegrational processes in ANS and the decrease of adaptive mechanisms in its sympathetic part.

[The characteristics of the autonomic regulation of the heart rhythm in patients with the obstructive sleep apnea syndrome]. / Osobennosti vegetativnoi reguliatsii ritma serdtsa u bol'nykh s sindromom obstruktuivnykh apnoé vo sne.

15 patients with polysomnographically verified syndrome of obstructive apnoea in sleep (apnoea index value was equal to 35.6) were examined. The peculiarities of cardiac rhythm vegetative regulation were investigated with the help of cardiorhythmintervalography technique. The decrease of amplitude of the middle-frequency peak (the slow waves of the first order, SW1) as well as the predominance of the low-frequency peak (slow waves of the second order, SW2) were observed in cardiac rhythm spectrum. These findings reflected the insufficiency in sympathetic-adrenal mechanisms of regulation. Besides, unlike the healthy individuals SW2 peak in patients exceeded significantly respiratory waves peak. The last observation combined with the weak influence of respiratory waves on the total rhythm dispersion was estimated as the initial parasympathetic regulation insufficiency manifestation.

[The hypothalamic syndrome in childhood (its epidemiological and clinico-electrophysiological aspects)]. / Gipotalamicheskii sindrom v detskom vozraste (épidemiologicheskie i kliniko-élektrofiziologicheskie aspekty).

The epidemiological survey covered 2000 city schoolchildren. They ranged in age from 7 to 15 years. Hypothalamic deficiency (HD) was detected in 5% of the examinees. Clinical and physiological findings on HD children are provided. They were found to have the history of hereditary or natal damage evidencing the acquired nature of the disease. Special emphasis is placed on HD manifestations in prepubertal and pubertal age. The authors show defective regulation of nonspecific brain systems in the form of predominant activation of the septohippocampal system and relative insufficiency of the brain stem mesencephalic reticular formation. Activation of cerebral ergotropic vegetative mechanisms combines with peripheral vegetative failure (sympathetic and parasympathetic), probably, of congenital origin.

[An analysis of the autonomic manifestations of Raynaud's phenomenon by the spectrum of heart rhythm variability]. / Analiz vegetativnykh proiavlenii fenomena Reino po spektru variativnosti ritma serdtsa.

A study was made of the specificity of segmental and suprasegmental vegetative disorders seen in patients with Raynaud's phenomenon (RP). The sympathetic-parasympathetic interrelations were estimated according to the dynamics of the spectral constituents of heart rhythm under different functional conditions. There was a decrease of the sympathetic activity modulated by the stem and segmental mechanisms, accompanied by activation and rigidity of the suprasegmental ergotropic systems, leading to a stable vasospasm on the periphery. This may determine the low efficacy of vegetotropic peripheral drugs and a higher therapeutic effect of psychotropic drugs which reduce ergotropic activation.

[Evaluation of the effectiveness of drug therapy of autonomic paroxysms in relation to the variability of cardiac rhythm]. / Otsenka éffektivnosti lekarstvennoi terapii vegetativnykh paroksizmov po spektru variativnosti ritma serdtsa.

A study was made of changes in the amplitude and percentile contribution of respiratory waves and slow waves of heart rhythm (SW1 with a period of 8-14 s and SW2 with a period of 14-60 s) in 13 patients with panic attacks (PA) in the lying position after the 3-day monotherapy with the beta-blocker propranolol, alpha-blocker phentolamine and diazepam. Propranolol normalized baroreflex regulation of arterial pressure and raised SW1. Phentolamine, producing an analogous effect, enhanced sympathoadrenal activation and the rate of PA, reducing RW. The amplitude of SW2 that correlated with emotional tension and anxiety fell only as a result of the administration of diazepam. The latter drug did not influence the baroreflex (via SW1) and vagal (via RW) mechanisms of regulation.

[Evaluation of sympathetic and parasympathetic mechanisms of regulation in autonomic paroxysms]. / Otsenka simpaticheskikh i parasimpaticheskikh mekhanizmov regu- liatsii pri vegetativnykh paroksizmakh.

Patients with autonomic paroxysms (AP) and hysterical attacks (HA) have been examined with the use of ECG wave structure analysis. Domination of slow and reduction of respiratory waves reflect the background stress of the sympathetic and insufficiency of vagal mechanisms with rigidity of heart rhythm pulsation structure in AP patients or excessive reactivity to emotional stress in HA patients. The efficacy of beta-adrenoblocker anaprilin and diazepam and the inefficacy of alpha-adrenoblocker phentolamine for AP treatment are validated.

[Paroxysmal conditions in neuroses]. / Paroksizma'lnye sostoianiia pri nevrozakh.

Sixty-eight patients with paroxysmal conditions of neurotic genesis were examined. The patients' condition was marked by demonstrative (hysterical) attacks and vegetovascular crises (panic attacks). The clinical and psychophysiological analyses were made. The clinical criteria were elaborated for differential diagnosis of vegetative crises in hysterical and obsessive-phobic neuroses. The psychophysiological patterns are provided, characteristic of the whole patients' group with neurotic paroxysms and specific patterns for different types of paroxysms are distinguished.