[Assessment of clinical-instrumental, morphological data and expression of coxsackie adenovirus receptor in patients with inflammatory cardiac pathology].

In 22 patients with heart failure and/or ventricular arrhythmias presumably of inflammatory etiology the results of clinical and instrumental investigation were analyzed and compared to the endomyocardial biopsy data. In the subgroup of patients with left bundle branch block (LBBB) we revealed features indicative of lesser contribution of inflammatory destruction in pathogenesis of cardiomyopathy. The only virus, detected in biopsy samples, was parvovirus B19. Its persistence in myocardium was not related to activity of inflammation and severity of clinical course. Increased expression of Coxsackie adenovirus receptor (CAR) was found in 20 patients. It was not related to inflammatory cells infiltration and virus persistence in myocardium. Patients with most prominent CAR expression were characteried by right heart dilatation, more severe heart failure and absence of LBBB. Enhancement of CAR expression could reflect the attempt of organism to repair intercellular communications between cardiomyocites and to protect cells from the products of necrotic lysis during long standing inflammation.

[Efficiency and safety of allapinin in short- and long-term treatment of patients with normal heart and ventricular premature beats].

UNLABELLED: Allapinin, class 1C antiarrhythmic drug, is highly effective in treatment of patients with ventricular premature beats (VPB). The purpose of work was retrospective assessment of efficacy and safety of allapinin in patients with benign ventricular arrhythmias. 73 patients with VPB and no structural heart disease were selected from a database. In short course allapininin in dose of 75-150 mg per os daily decreased the number of VPB for more than 90% in 46,6% of patients. In 34,4% cases tolerable drug side effects were observed. Among patients with VPB burden of 10% and higher allapinin reduced this quantity below the indicated value in 76% of cases with tolerable drug side effects in 38,6% of cases. In long treatment study antiarrhythmic effect of allapinin persisted and no other side effects of the drug were documented. CONCLUSION: Allapinin is highly effective in treatment of patients with VPB without structural heart disease.

[Role of atrial structural and functional changes in the development and progression of atrial fibrillation].

Atrial fibrillation (AF) is one of the most common reasons for decreased life quality and increased mortality rates. Experimental and clinical data show that atrial structural and functional changes contribute to the development and progression of AF. The survey article considers the role of the systemic and local activities of the renin-angiotensin-aldosterone system and inflammatory mediators in the development of atrial structural remodeling, which may be a cause and a consequence of AF.

[First experience of clinical use of new class III antiarrhythmic agent niferidil in patients with persistent atrial fibrillation and flutter].

The aim of the study was to evaluate the efficacy and safety of administered intravenously niferidil in doses 10, 20 and 30 mkg per kg in patients with persistent atrial fibrillation (AF) and flutter (AFL) for pharmacological cardioversion. The study included 30 patients (22 male) with persistent AF (n = 28) and AFL (n = 2) without structural heart diseases with median arrhythmia duration 6.1 +/- 4.8 months (2 weeks to 24 months). Niferidil was administered as 3 bolus injections (10 mkg per kg each) performed with the interval of 15 minutes. Antiarrhythmic efficacy of niferidil in dose of 10 mkg per kg was 60%, in dose of 20 mkg per kg it was 70%, and in dose of 30 mkg per kg reached 90% prespectively. The part of the patients, in whom QTc prolongation exceeded potentionally dangerous value of 500 mc, was 22.2% (6 of 27). None of the patients developed proarrhythmic side effect as torsade de pointes.

[Prediction of results of antiarrhythmic drug therapy in patients with malignant ventricular tachyarrhythmias, based on the prognostic value of left ventricular contractility parameters].

In 44 patients (3 women and 41 men, mean age 54 +/- 11 years) with malignant ventricular tachyarrhythmias (MVT) we assessed dependence of results of testing of antiarrhythmic drugs and efficacy of their long term use for prevention of recurrences of MVT on topography of derangement of local left ventricular (LV) contractility. Regional LV contractility was assessed with transthoracic echocardiography and radionuclide ventriculography (RNV). Testing of antiarrhythmic drugs was performed under control of repetitive intracardiac electrophysiological studies. Duration of follow-up was 28 (13 - 61) months. According to ROC-analysis most precise markers of positive results of drug testing were values of local ejection fraction (EF) in apical LV segment (10th segment on RNV) above 55%. Signs predisposing to absence of MVT recurrences during long term use of antiarrhythmic drugs were lack of mitral regurgitation (above I degree) according to echocardiography data, values of local EF in segment of lateral LV wall (4th segment on RNV) exceeding 42%, or value of LV end diastolic volume less than 365 ml according to RNV data. Parameters of local LV contractility are most precise markers of results of the use of antiarrhythmic drugs in patients with MVT, their diagnostic value is hair than that of global LVEF. Efficacy of antiarrhythmic drugs at electrophysiologic testing and long term follow-up are associated with different parameters of local LV contractility.

[Incidence and predictors of thyroid dysfunction caused by long-term intake of amiodaron].

AIM: To analyze occurrence of thyroid dysfunction due to regular long-term intake of amiodaron (for one year), to search for predictors of amiodaron-induced hypothyroidism and thyrotoxicosis. MATERIAL AND METHODS: Sixty two patients with different types of arrhythmia have undergone examination including tests for TTH (once in three months), free T3 and T4 (once in 6 months), ultrasound thyroid investigation, general clinical and physical check-up, resting ECG in 12 leads, echocardiography, chest x-ray, biochemical blood tests, blood count, urinalysis. RESULTS: Amiodaron intake for 1 year was associated with amiodaron-induced thyroid dysfunction in 25% patients: 19.2% developed hypothyroidism, 5.8%--thyrotoxicosis. Organic pathology of cardiovascular system, cardiac failure, left ventricular aneurysms, low global myocardial contractility, organic thyroid pathology, elevated levels of antithyroid antibodies predicted hypothyroidism. Thyrotoxicosis was associated with a young age and male sex. CONCLUSION: Amiodaron may cause thyroid dysfunction in patients with arrhythmia.

[Lipid blood spectrum in patients with amiodarone associated hypothyroidism. Effect of replacement therapy with L-thyroxine].

Blood lipid levels were measured in 23 patients with amiodarone associated hypothyroidism (most of them had ischemic heart disease). Abnormalities of lipid spectrum were found in 12 of these patients. All 12 patients were subjected to replacement therapy with l-thyroxine. Compensation of thyroid status was associated with average 12.6 and 12.3% lowering of total and low density lipoprotein cholesterol, respectively. However target levels of low density lipoprotein cholesterol were achieved only in 1 patient. There were no significant changes of high density lipoprotein cholesterol and triglycerides.

[Thyroid dysfunction in long-term amiodarone administration. Correlation of the antiarrhythmic activity of amiodarone with its effect on thyroid function].

Relationship between amiodarone-associated thyroid dysfunction and antiarrhythmic activity of amiodarone was studied in 27 patients (13 with hypothyroidism, 8 with hyperthyroidism, 6 with euthyroid hyperthyroxinemia). Amiodarone-associated hypothyroidism and euthyroid hyperthyroxinemia were not associated with loss of antiarrhythmic efficacy of amiodarone. Hypothyroidism did not require amiodarone withdrawal and therapy with L-thyroxin was conducted at the background of continued amiodarone intake. Achievement of euthyroid state was not followed by recurrence of heart rhythm disturbances. Development of amiodarone-associated thyrotoxicosis was accompanied with loss of antiarrhythmic efficacy of amiodarone in all cases. In 87.5% of patients with thyrotoxicosis correction of the thyroid status was conducted under conditions of continued amiodarone intake as this drug had been given because of life threatening arrhythmias or proven resistance to other antiarrhythmic therapy. In 12.5% of patients it was possible to substitute other drugs for amiodarone. Correction of thyroid status and achievement of euthyroidosis in these patients was associated with restoration of amiodarone antiarrhythmic activity.

[Amiodarone-associated thyroid dysfunction: prevalence and possibilities of correction]. / Amiodaron-assotsiirovannaia disfunktsiia shchitovidnoi zhelezy: chastota razvitiia, vozmozhnosti korrektsii.

During 1 year of amiodarone intake development of amiodarone-associated thyroid dysfunction was observed in 25% of patients (hypothyroidism and thyrotoxicosis in 19.2 and 5.8%, respectively). Development of hypothyroidism was not accompanied with loss of antiarrhythmic efficacy of amiodarone and therapy with L-thyroxin was conducted at the background of continued amiodarone intake. In all patients with clinical and in less than one half (47.6%) of patients with subclinical forms of hypothyroidism replacement therapy with L-thyroxin was carried out. Development of amiodarone-associated thyrotoxicosis was accompanied with loss of antiarrhythmic efficacy of amiodarone in all cases. In all patients with thyrotoxicosis which developed during amiodarone intake thyrostatic therapy with mercasolil was carried out and in case of its inefficacy prednisolone was added. In 87.5% of patients with thyrotoxicosis correction of the thyroid status was conducted under conditions of continued amiodarone intake as this drug had been prescribed because of life saving indications. Achievement of euthyroid state was followed by restoration of antiarrhythmic efficacy of amiodarone. Amiodarone was discontinued just in 1 patient with ventricular extrasystole as correction of thyroid status and restoration of euthyroidosis enabled effective use of other antiarrhythmic drugs.

[The specific features of thyrotoxicosis and euthyroid hyperthyroxinemia developed due to the use of cordarone]. / Osobennosti tireotoksikoza i eutireoidnoi gipertiroksinemii, razvivaiushchikhsia na fone priema kordarona.

Thyrotoxicosis (TT) is one of the thyroid (T) dysfunctions occurring with the use of cordarone. The clinical features of TT were studied in cordarone-treated patients living in Moscow and its regions (mild and moderate iodine deficiency regions). The patients were examined by using currently available procedures for measuring thyroid-stimulating hormone, free thyroxine, free triiodothyronine, antibodies to TH, TPO, interleukin-6 (IL-6), and C-reactive protein (CRP), and by employing T ultrasound study, Holter ECG monitoring. TT was ascertained to develop in the presence of both the pathologically altered (16/23, 69%) and intact T (7/23, 31%). Examining the course of cardiac arrhythmias (CA) in developed TT has established that this condition gives rise to their recurrence. As compared with the control group, the patients with TT were not found to have higher levels of IL-6 and CRP (p > 0.05; Mann-Whitney test). Therapy with thyrostatic agents alone or in combination with glucocorticosteroids normalizes the levels of thyroid hormonesfollowing, on the average, 2-3 months. Euthyroid hyperthyxinemia (EHT) is frequently recorded with the use of cordarone. Examination of 20 patients with EHT has revealed organic pathology in 13 (65%) patients and its absence in 7 (35%). Recurrences of prior CA have not been found in EHT (p < 0.05; McNemar test). The confidence interval for the difference of relative frequencies of signs did not include 0). Thus, TT is a condition that leads to the fact that cordarone loses its antiarrhythmic effects and TT requires compulsory treatment. If required, therapy should be performed during the continued administration of the drug. EHT is not thyrotoxicosis, which is to be followed up.

[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.

[Clinical and electrophysiologic variants of false ventricular tachycardia (supraventricular tachycardia with wide QRS complex)]. / Kliniko-élektrofiziologicheskie varianty lozhno zheludochkovykh takhikardii (supraventrikuliarnykh takhikardii s ushirennymi kompleksami QRS).

Electrophysiological abnormalities of the heart conduction system and their role in development of different forms of supraventricular tachycardias, are discussed. Electrophysiological mechanisms and diagnostic criteria of the supraventricular tachycardias with wide QRS complex, are described.

[Permanent repetitive nonparoxysmal ventricular tachycardia. I. The electrocardiographic manifestations and possible mechanisms of its occurrence]. / Nepreryvno retsidiviruiushchaia neparoksizmal'naia zheludochkovaia takhikardiia. Soobshchenie I. Elektrokardiograficheskie proiavleniia i vozmozhnye mekhanizmy vozniknoveniia.

A total of 20 patients (16 males and 4 females) with repetitive nonparoxysmal ventricular tachycardia (RNVT) underwent Holter monitoring of ECG, bicycle exercise test, intracardiac electrophysiological measurements. The findings evidence for a principal difference of this tachycardia form from paroxysmal ventricular tachycardia by trigger mechanism. All the tests performed showed rhythm-dependence of RNVT, tachycardia cannot be initiated by electrocardiostimulation, but can be stopped after intravenous introduction of finoptin. It is evident that this form of cardiac arrhythmia is due to the mechanism of pathological ectopic automatism represented, most likely, by trigger activity, but not re-entry, as it is in the majority of patients with paroxysmal ventricular tachycardia.

[Permanent repetitive nonparoxysmal ventricular tachycardia. II. The results of using anti-arrhythmia preparations and the characteristics of its long-term course]. / Nepreryvno retsidiviruiushchaia neparoksizmal'naia zheludochkovaia takhikardiia. Soobshchenie II. Rezul'taty primeneniia antiaritmicheskikh preparatov i osobennosti dlitel'nogo techeniia.

A total of 20 patients with repetitive nonparoxysmal ventricular tachycardia (RNVT) underwent Holter ECG monitoring to test efficacy of successive oral antiarrhythmic drugs. The response was recorded in 50% of the patients. Although the effect of the drugs persisted for a few months only, RNVT ran without severe symptoms, in contrast to paroxysmal ventricular tachycardia. Long-term course of RNVT is characterized by dilatation of the left ventricular compartment under increasing ejection fraction and absence of cardiac insufficiency. A close relationship exists between the end-diastolic volume, ejection fraction of the left ventricle and RNVT duration. This is attributed to heart adaptation to long-term activity in the conditions of tachycardia.

[Anti-arrhythmic therapy of patients with recurrent ventricular tachycardias after prior myocardial infarction]. / Antiaritmicheskoe lechenie bol'nykh s retsidiviruiushchimi zheludochkovymi takhikardiiami posle perenesënnogo infarkta miokarda.

An examination of 30 patients with paroxysmal ventricular tachycardias following prior myocardial infarction showed that drug tests by using invasive and noninvasive monitoring of the action of antiarrhythmic agents allowed beneficial pharmacotherapy to be chosen for their long-term use in 20% of this category of patients. The remaining 80% were resistant to antiarrhythmic drug therapy, which was associated with the highly unfavourable prognosis confirmed by 50% mortality on a 2-year follow-up. Open heart surgeries were performed in 3 cases refractory to antiarrhythmic therapy. The operations aimed at liquidating the source of tachycardia produced a full antiarrhythmic effect. The application of this method for treating patients with postinfarction cardiosclerosis is limited by severe organic heart lesion that determines the high risk of operative mortality. This makes it necessary to intensively develop other methods of non-drug therapy providing less surgical intervention and to introduce them into practice.

[The use of the phase-image method for noninvasive topical diagnosis in certain forms of heart rhythm disorders]. / Ispol'zovanie metoda fazovykh izobrazhenii dlia neinvazivnoi topicheskoi diagnostiki pri nekotorykh formakh narushenii ritma serdtsa.

The authors describe the results of mapping additional conduction pathways in WPW syndrome and ectopic sources of the ventricular rhythm with the aid of phasic images (PI). The mapping data were compared to the readings of 12 ECG leads and to the electrophysiological findings. The mapping with the aid of PI turned out informative in both patients' groups. The PI method demonstrated the possibility of Kent's bundle mapping in latent WPW syndrome. The use of the PI method is suggested to be the first stage in the mapping of Kent's bundle in WPW patients suffering from supraventricular tachycardias as well as of pathological rhythm sources in ventricular tachycardias refractory to drug therapy in patients who are to undergo surgical treatment.

[Etatsizin efficacy in patients with ventricular tachycardias. The results of intracardiac electrophysiological research]. / Effektivnost' étatsizina u bol'nykh s zheludochkovymi takhikardiiami. Rezul'taty vnutriserdechnogo élektrofiziologicheskogo issledovaniia.

As many as 30 patients with different pathologies of the cardiovascular system and paroxysms of ventricular tachycardias were examined. According to the ultrasonography data, an ejection fraction was not lower than 35% in all the patients. It has been shown by electrophysiological studies that intravenous injection of ethacizine in a dose of 0.6 +/- 0.1 mg/kg prevented induction of ventricular tachycardia in 66.7% of patients. In 16.7% of patients, the drug exerted an arrhythmogenic effect that showed up by a decrease of the cycle of tachycardia. Oral administration of ethacizine in the daily dose 100 or 150 mg prevented tachycardia induction by endocardial stimulation in 20.8% of patients. The arrhythmogenic effect of the drug was recorded in 12.5% of patients. The action of ethacizine when administered by both routes was accompanied by a significant elongation of the P--Q interval, QRS complex and of the cycle of ventricular tachycardia. Continuous administration of ethacizine in the daily dose 150 mg to patients with a positive antiarrhythmic drug action (according to the electrophysiological data) prevented paroxysms of ventricular tachycardia, with the observation period being 2 to 6.5 years.

[The diagnosis and possibilities for the anti-arrhythmia treatment of malignant ventricular disorders of the heart rhythm]. / Diagnostika i vozmozhnosti protivoaritmicheskogo lecheniia zlokachestvennykh zheludochkovykh narushenii ritma serdtsa.

Altogether 130 patients with malignant ventricular disorders of cardiac rhythm were examined to demonstrate a possibility of obtaining the diagnostically significant data with the aid of Holter's monitoring of the ECG in 89.2%, with the aid of bicycle ergometry exercise tests in 72.3%, and by means of an electrophysiological examination of the heart in 82.5% of the above-indicated group of patients. The drug testing with the use of invasive and noninvasive techniques of monitoring the action of antiarrhythmic drugs given per os makes it possible to choose effective therapy on an individual basis. The long-term use of such therapy may prevent ventricular tachycardia relapses and noticeably enhance the patients' survival. Severe organic pathology of the heart associated with a decrease of its pump function seen in the majority of patients with malignant ventricular disorders of cardiac rhythm refractory to pharmacotherapy restricts, in a considerable number of cases, the potentialities of drastic surgical treatment because of the risk of operative death. To improve the disease prognosis of these patients, it is necessary that other methods of nonmedicamentous treatment may be used, requiring a less scope of surgical intervention, such as implantation of a cardioverter-defibrillator.