Cardiac 123I-mIBG scintigraphy for prediction of catheter ablation outcome in patients with atrial fibrillation.

BACKGROUND: Previous studies show inconsistent results on the role of innervation imaging (with 123I-mIBG) in predicting late atrial fibrillation (AF) recurrence after catheter ablation (CA). These studies included patients with paroxysmal AF and studied prognostic value of post-CA I-123-mIBG parameters. Current study investigated the ability of pre CA 123-I-mIBG imaging to predict late AF recurrence in patients with persistent AF. METHODS: 123I-mIBG cardiac imaging was performed before CA in 82 patients with persistent AF. Patient was followed for 12 months. RESULTS: Multivariable analysis demonstrated that late heart-to-mediastinum ratio (H/Mlate) and washout rate (WR) were independent predictors of AF recurrence. ROC-curve analysis data showed that H/Mlate <1.6 (sensitivity 73.53%, specificity 81.3%, AUC 0.792, P < .001) and WR > 25.11 (sensitivity 70.6%, specificity 70.8.3%, AUC 0.712, P < .001) indicate high probability of AF relapses during 12 months after CA. CONCLUSION: Pre-CA parameters of global cardiac sympathetic activity estimated by 123I-mIBG scintigraphy are associated with late AF relapses in persistent AF patients with normal LVEF and absence of significant CAD.

[A change in adrenal responsiveness in sotalol-treated patients with paroxysmal atrial fibrillation depending on autonomic nervous system tone].

AIM: To evaluate the efficacy of sotalol depending on the magnitude of changes in adrenal responsiveness and autonomic nervous system tone in patients with paroxysmal atrial fibrillation (AF). SUBJECTS AND METHODS: Twenty-six patients with paroxysmal AF in the presence of coronary heart disease (CHD) and hypertension were examined. Sinus rhythm variability and sympathicotonic and vagotonic disorders were studied in patients with paroxysmal AF before and during sotalol treatment. A commercial Beta-ARM-Agat kit was used to estimate the adrenal responsiveness of erythrocyte membranes (ß-APM), which can judge the body's individual sensitivity to ß-adrenoblockers. RESULTS: Sotalol used in the average therapeutic doses of 160-240 mg did not reduce ejection fraction or increase atrioventricular conduction up to abnormal values. In patients with borderline and mild hypertension, the drug lowered blood pressure statistically significantly (p=0.01) and was well tolerated. The drug increased the sensitivity of ß-adrenoblockers in patients with adrenergic AF. CONCLUSION: The effect of sotalol on the autonomic nervous system manifested in the higher power of a high-frequency spectral component of heart rate variability than in that of a low-frequency one. Long-term sotalol administration significantly reduced ß-APM, increasing the sensitivity of adrenoceptors.

[Dysaggregants effect of platelet aggregation in patients with non-ST segment elevation acute coronary syndrome]. / Vlilanie dezagregantov na agregatsiiu trombotsitov u bol'nykh s ostrym koronarnym sindromom bez pod'ema segmenta ST.

AIM: To study efficacy of treating patients with acute coronary syndrome (ACS) without ST segment elevation (STSE) with platelet dysaggregation drugs (aspirin, cardiomagnil, clopidogrel). MATERIAL AND METHODS: 78 ACS without STSE were randomized into five groups: group 1 patients (n = 17) received no dysaggregants; patients of group 2 (n = 26) received aspirin in the dose 250 mg on the day of admission and then 125 mg/day; group 3 was given cardiomagnil (150 mg on the day of admission and then 75 mg/day, n = 17); group 4--clopidogrel 75 mg/day (n = 7); group 5--combination of clopidogrel 75 mg/day with cardiomagnil 75 mg/day (n = 11). All the patients were administered fraxiparin 86 IU/kg sc each 12 hours for 5-8 days. RESULTS: Group 1 patients showed platelet hyperaggregation, platelet aggregation decreased in groups 2, 3 and 4 (6 patients of group 1 were resistant to aspirin). The highest antiaggregation effect was achieved in group 5. CONCLUSION: Control over antiaggregation treatment in patients with ACS without STSE by monitoring of platelet function open broad opportunities for selection of effective individual therapy.