[The Use of Rivaroxaban in Perioperative Period of Pulmonary Vein Antrum Isolation in Patients With Paroxysmal Atrial Fibrillation].

Results of an observational study. devoted to prevention of thromboembolic complications in patients with atrial fibrillation undergoing catheter pulmonary vein atrium isolation are discussed. Patients (n= 199) were divided into two comparable groups depending on the anticoagulant (rivaroxaban or warfarin) used. Clinical thromboembolic and/or hemorrhagic complications as well as rate of development of asymptomatic cerebral thromboembolisms in various periods after procedure were assessed. Main conclusion: rivaroxaban was not inferior to warfarin for thromboprophylaxis in patients with atrial fibrillation undergoing catheter pulmonary vein antrum isolation.

[Spectral indices of heart rate variability in patients with vasovagal syncopes according to evidence of 5-min ECG].

AIM: To compare autonomic nervous system activity estimated by power spectral analysis of heart rate variability in patients with vasovagal syncopes and healthy volunteers. MATERIAL AND METHODS: Seventeen health volunteers and 25 patients with vasovagal syncope were included in the study. In 16 cases faints were induced by head-up tilt table test (HTT), in 9 cases--by bicycle exercise test (BET). Power spectral analysis of heart rate variability in 5-th min ECG records was performed in supine and upright position while breath was fixed. RESULTS: In supine position the data of low frequency (LF) and high frequency (HF) of spectral power in both groups of patients were significantly higher than in volunteers. During upright the HF of spectral power significantly decreased in patients and volunteers. In upright position LF of spectral power significantly decreased in patients with syncope induced by HTT, did not change in patients with syncope induced by BET, but significantly increased in volunteers. CONCLUSION: Patients with vasovagal syncope had abnormal autonomic nervous system activity: a high level of parasympathetic influence in supine position and poor reaction of sympathetic nervous system during upright.

[Dynamics of parameters of heart rate variability after radiofrequency ablation in patients with paroxysmal supraventricular tachycardia: holter ECG monitoring data].

Changes of parameters of heart rate variability (HRV) in patients with supraventricular tachycardia (SVT) immediately after radiofrequency ablation (RFA) have been demonstrated earlier. However dynamics of HRV parameters after RFA has not been sufficiently studied. For elucidation of dynamics of HRV parameters in patients with SVT after RFA we conducted analysis of HRV basing on data of 24 hour Holter ECG monitoring before RFA, on day 2, in 1 week and 1 month after intervention in 27 patients with paroxysmal SVT. Statistically significant lowering of temporal (SDNNi, RMSSD, NN50, pNN50) and spectral (VLF, LF, HF) HRV parameters were found on day 2 and in 1 week after RFA compared with data obtained before intervention. In 1 month after RFA the studied parameters of HRV did not differ from baseline values. Reversible changes of HRV parameters evidencing for transitory autonomic dysfunction are observed after RFA.

[New approaches to treatment of bradyarrhythmia in patients with obstructive sleep apnea syndrome].

AIM: To confirm or reject effects of CPAP on sleep asystole and to elucidate possible dependence on correction of respiratory disorders. MATERIAL AND METHODS: Thirteen patients (11 males and 2 females aged 19 to 66 years) with bradyarrhythmia (BA) arising in sleep participated in the study. BA was caused by transient atrioventricular block of the degree II-III in 9 cases (69%), episodes of sinus node arrest and/or synoatrial block in 6 (46%) cases. Two (15%) patients had combination of BA forms. To diagnose sleep respiratory disorders, polysomnography (PSG) was made. Diagnostic criteria of sleep obstructive apnea syndrome (SOAS) were apnea/hypopnea index (AHI) more than 5 episodes for 1 hour sleep. The patients were divided into two groups. Individual selection of therapeutic pressure under PSG control was performed in SOAS patients (the study group). CPAP-therapy was effective in AHI < 5. In the control group (AHI < 5) such selection was made too. CPAP-therapy was effective in the controls if episodes of apnea/hypopnea were not registered through the night of monitoring. RESULTS: In the study group CPAP-therapy was effective. The AHI decreased from 73.2 to 4.4, oxygen saturation of arterial blood increased from 74 to 85%, mean duration of asystoles fell from 5.2 to 1.3 s, pauses with duration more than 2 s disappeared. In the control group sleep apnea/hypopnea episodes disappeared but in asystole CPAP was uneffective. CONCLUSION: CPAP-therapy is effective and pathogenetically sound method of treating patients with nocturnal bradyarrhythmia associated with sleep respiratory disorders.

[Heart rate variability in patients with paroxysmal atrial fibrillation of various etiologies].

Heart rate variability (HRV) was assessed on 24 hour Holter ECG recordings from 32 healthy persons and 54 patients with paroxysmal atrial fibrillation (AF) of different etiology (hypertension, ischemic heart disease, rheumatic mitral valve disease, idiopathic AF) aged 45-73 years. Nocturnal, diurnal and 24 hour HRV was measured. Time and frequency domain HRV measures were lower in patients with AF and underlying heart disease compared with healthy persons and for most of the parameters with patients with idiopathic AF (p<0,05). Patients with idiopathic AF compared with healthy persons had higher values of high frequency power during nighttime (p<0.05), what reflected activation of parasympathetic nervous system in this category of patients.

[Effect of radio frequency catheter ablation on spectral parameters of heart rate variability in patients with paroxysmal supraventricular tachyarrhythmias]. / Vliianie radiochastotnoi kateternoi ablatsii na spektral'nye pokazateli variabel'nosti ritma serdtsa u bol'nykh s paroksizmal'nymi nadzheludochkovymi takhiaritmiiami.

AIM: To assess effect of radio frequency catheter ablation (RFCA) on heart rate variability (HRV) in patients with supraventricular tachyarrhythmias (SVT). METHODS: Spectral analysis of HRV on 5-minute ECG strips was carried out in 19 patients with SVT before and 2 days after RFCA. RESULTS: Both total and high frequency power significantly decreased (p<0,05) after RFCA in supine and orthostatic positions. Significant decrease of low frequency power occurred after RFCA in orthostatic position. CONCLUSION: In patients with SVT RFCA alters autonomic regulation of chronotropic function of the heart. Sympathetic and parasympathetic influences on the chronotropic function of the heart are attenuated in early period after the procedure.

[Efficiency of antiarrhythmic therapy and resistance to it in patients with malignant ventricular tachyarrhythmias: formulation of prognosis]. / Effektivnost' antiaritmicheskoi terapii i refrakternost' k nei u bol'nykh so zlokachestvennymi zheludochkovymi takhiaritmiiami: postroenie prognoza.

AIM: To study feasibility of predicting results of drug antiarrhythmic therapy in patients with malignant ventricular arrhythmias (MVA) basing on the results of clinical and device examinations. MATERIALS AND METHODS: 136 patients with documented MVA entered the study. 100 patients were in the retrospective analysis group, 36 patients comprised the study group. All the patients underwent physical examination, resting ECG, chest x-ray, radionuclide ventriculography. Intracardiac electrophysiological examination, Holter 24-h ECG monitoring and bicycle exercise provided data for diagnosis of MVA and control over effects of antiarrhythmic drugs. The mathematical model was derived using discriminant analysis. RESULTS: Significant differences were obtained in patients with positive and negative results of drug testing by the number and recurrence time of ventricular tachycardia (VT) for 3 years, survival, cardiac and sudden death, some other parameters. A mathematic model has been designed which allows prognosis of the results of antiarrhythmic therapy (AAT) in patients with MVA. 7 independent predictors of AAT efficiency are shown: left ventricular ejection fraction, duration of P-Q interval, cardiac failure, left ventricular aneurysm, age, number of VT morphologies, insufficiency of aortic valve. Verification of the model on the study group patients showed that prognostic accuracy of the model was 82%. CONCLUSION: The results of the drug tests predict life span of MVA patients. The developed mathematical model allows prediction of AAT results in such patients before the pharmacological test with accuracy 82-87%. The model can help objectivize indications to use of non-pharmacological methods for each patient basing on prognosis of resistance to drug AAT.