[Factors associated with atrial fibrillation in patients with hypertension and preserved left ventricle systolic function].

The objective of our study was to define factors associated with atrial fibrillation (AF) in patients with hypertension (HTN) and preserved left ventricle systolic function. MATERIAL AND METHODS: Overall, 273 consecutive patients with HTN residing in urban area were included in the study. Patients were divided into 2 groups: the first - 60 patients with paroxysmal and persistent AF (33% men, age 62, 28 (10,02), the second - 213 patients without AF (33% men, age 59,37 (8,27). RESULTS: Stepwise logistic regression analysis demonstrated AF presence was associated with alcohol intake ≥ 7 drinks per week (OR 4,12; 95%CI: 1,04-16,35), low physical activity (OR 3,18; 95% CI: 1,32-7,68), higher hip circumference (OR 1,19; 95% CI: 1,08-1,31) and history of HTN (OR 1,10; 95% CI: 1,04-1,17). BMI was not associated with presence of AF (OR 0,75; 95% CI: 0,61-0,91). CONCLUSION: Thus in our urban population with hypertension, AF is associated with alcohol intake ≥ 7 drinks per week, low physical activity, increased hip circumference and history of hypertension.AF prevention should include modification of lifestyle.

Arrhythmic emergencies in ICCU.

Atrial fibrillation and sustained ventricular arrhythmias are the most common arrhythmias accompanying acute coronary syndromes. Arrhythmias are associated with worse clinical course and increased risk of in-hospital, short-term and long-term mortality in patients with ST-elevation myocardial infarction. This review summarizes the current knowledge on most prevalent arrhythmias in patients with ACS and their management in intensive coronary care unit.

Frequency of angiotensin-converting enzyme gene polymorphism in Turkish hypertensive patients.

Hypertension is a multifactorial disease, in which genetic factors play an important role. This study was carried out to determine angiotensin-converting enzyme levels and angiotensin-converting enzyme gene polymorphism in Turkish hypertensive patients, and to establish whether there is an association of angiotensin-converting enzyme gene polymorphism with clinical and echocardiographic parameters. We have investigated the association among the allelic distribution of the insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme gene identified by polymerase chain reaction, angiotensin-converting enzyme activity determined spectrophotometrically, cardiac morphology and function assessed by means of echocardiography. Distribution of angiotensin-converting enzyme gene I/D polymorphism and allele frequencies in hypertensive patients was not significantly different from controls. D allele frequency was 51.7% in hypertensives vs. 51.9% in controls and I allele 48.3 vs. 48.1%, respectively. The level of angiotensin-converting enzyme activity was significantly higher in the patients homozygotes for D allele (DD = 59.93 U/l) than in heterozygotes (ID = 39.49) and in homozygotes for I allele (II = 40.28 U/l). In addition to these, the level of angiotensin-converting enzyme activity was significantly lower in the ID and especially II patients receiving ACE inhibitors than the others. Also, it was determined that left atrium diameter was larger in the patients homozygotes for I allele than the others.

Electrical cardioversion of atrial fibrillation in a case of dextrocardia.

Although atrial fibrillation is one of the most frequent and widespread cardiac arrhythmias, there is not sufficient data on frequency and electrical cardioversion of this arrhythmia in cases of dextrocardia. The present case report describes a 66-year-old woman with atrial fibrillation and dextrocardia who was admitted to hospital with a complaint of palpitations; no cause of the atrial fibrillation was found. Electrical cardioversion was performed for termination of the arrhythmia. By placing the anterior paddle in the right parasternal area and the lateral paddle in the area where the apex of the left ventricle palpated at the right side of the chest, cardioversion was performed and sinus rhythm was achieved.

Detection of myocardial injury after internal cardioversion for atrial fibrillation.

BACKGROUND: Cardiac troponin levels do not rise to marked levels after external cardioversion of atrial fibrillation. Subsequent test discharges during implantation of cardioverter defibrillators may cause an elevation of cardiac troponin levels, but are still controversial. OBJECTIVE: To determine whether the biomarkers of cardiac injury increase after internal cardioversion (IC) of atrial fibrillation. METHODS: Forty-four patients with chronic atrial fibrillation were studied (mean age 59 +/-7 years). Electrode catheters were inserted through the femoral vein. One of these was positioned in the lower right atrium. A second defibrillation electrode was placed in the coronary sinus and an additional catheter was positioned in the right ventricular apex in order to obtain satisfactory R wave synchronization and to provide postshock ventricular pacing. The shocks were delivered by external defibrillator. Starting with a test shock of 1 J intensity, the energy was increased in steps (to maximum 15 J) until cardioversion was achieved. At least 1 min was permitted to elapse between unsuccessful defibrillation attempts before the next shock was applied. Blood samples for serum levels of cardiac troponin T, cardiac troponin I, creatine kinase MB and myoglobin were drawn before and 2 h, 4 h, 8 h and 24 h after IC. Each level of biomarker was compared with baseline. RESULTS: In 40 of 44 patients, IC was successful at a mean cardioversion threshold of 7.6+/-3.3 J. Although the serum levels of these biomarkers tended to rise, marked elevation was not detected in any of samples (P>0.05 for each). There was no correlation between the levels of biomarkers and the number and energy of shocks applied. No severe complications were observed. CONCLUSIONS: Following uncomplicated IC of atrial fibrillation, cardiac biomarkers do not rise to marked levels, which indicates that significant myocardial injury does not occur by shocks in the usual dosage.

Clinical importance of the initiation pattern of monomorphic ventricular tachycardia.

We investigated the clinical and electrophysiological features of monomorphic ventricular tachycardia (MVT) with different initiation patterns in patients with implantable cardioverter defibrillator to assess whether there is a relationship between the initiation patterns of sustained MVT and clinical characteristics, and the efficacy of antiarrhythmic and electrical therapy. Fifty-five stored IECGs in twenty-two patients with MVT were evaluated. All MVT episodes were classified as initiating with ventricular premature beats (non-sudden onset MVT) or without ventricular ectopy preceding tachycardia (sudden onset MVT). Non-sudden onset MVT was characterized by shorter tachycardia cycle length (CL) and required higher shock energy for termination. Sudden onset MVT was precipitated by shortening of the sinus CL before tachycardia and was more common with relatively better preserved systolic function.

Does short-term anticoagulation with heparin increase risk for microemboli patients undergoing transesophageal guided electrical cardioversion for atrial fibrillation? A transcranial Doppler ultrasonography study.

BACKGROUND: Electrical cardioversion (ECV) in patients with atrial fibrillation (AF) is known to be associated with an increased peri-procedural risk for thromboembolic events. ECV of AF for at least 3 weeks of effective oral anticoagulation was recently determined to be disassociated with occurrence of cerebral circulating microemboli (ME). Nonetheless, whether ECV in patients undergoing short-term anticoagulation with heparin is concomitant with cerebral ME still remains obscure. The objective of this study was to determine whether or not short-term anticoagulation with heparin helps avoid microemboli before and immediately after cardioversion of AF in patients undergoing transesophageal echocardiography (TEE)-guided ECV. METHOD: A total of 34 patients (21 women, aged 61+/-12 years) who underwent TEE-guided ECV were enrolled into the study. All the patients underwent treatment with heparin for 3 days for anticoagulation before ECV. Transcranial Doppler ultrasonography (TCD) of the right middle cerebral artery and left middle cerebral artery was simultaneously performed through the temporal skull with a two-channel 2-MHz probe in all patients lasting for 30 min before ECV and 30 min immediately after successive ECV. RESULTS: No ME were detected in 34 patients during the 30-min period during AF before ECV. Similarly, after ECV no ME were observed during 30-min monitoring in 27 patients who were converted to sinus rhythm. None of the patients presented with clinical signs or symptoms suggestive of manifest cerebral embolism either before or after ECV. CONCLUSION: TCD monitoring did not disclose any evidence of microemboli in short-term anticoagulated patients with heparin before and immediately after TEE-guided ECV.

Long-short sequence may predict immediate recurrence of atrial fibrillation after external cardioversion.

AIM: We thought, that analysis of surface electrocardiograms recorded immediately after electrical external cardioversion (EC) might enlighten the mechanisms responsible for immediate recurrence of atrial fibrillation (AF) and especially to test whether atrial ectopic beats (PAC) with long-short (LS) sequence are related to the recurrence of arrhythmia after cardioversion in patients with chronic AF. METHODS AND RESULTS: One hundred and thirty-seven patients (mean age 57+/-7 years) undergoing EC for chronic AF entered the study. Evaluation of the patients included clinical history, physical examination, ECG, routine laboratory tests, and transthoracic echocardiography. The cardioversion was performed with monophasic waveform shock and immediately after successful EC, 1 min of recording of the ECG lead II was analysed. One hundred and twenty patients (87%) of 137 patients enrolled in the study had had successful EC and 33 (27%) of them experienced immediate recurrence of AF within 1 min (Group I) and 87 patients had no arrhythmia recurrence (Group II). In group I in 24 patients (73%) recurrence of AF was initiated by PAC with LS sequence. In only 12 of 87 (13%) patients who did not experience immediate recurrence of AF (Group II) PACs were recorded. CONCLUSIONS: Atrial ectopic beats (PACs) with LS sequence, being responsible for AF relapse in about 70% of patients, might predict early re-initiation of arrhythmia after EC. Electrocardiograms, recorded immediately after EC, are a potentially feasible approach in establishing the patterns of AF relapse that may be useful in the management of AF recurrence.

Implantable event loop recorder prevents misdiagnosis of underlying arrhythmia in patients with unexplained palpitations--a case report.

The implantable event loop recorder is informative in the establishment of underlying arrhythmia and may aid in treatment of patients with infrequent unexplained palpitations.

Silent myocardial ischemia after myocardial infarction: severity of coronary artery disease, impact on left ventricular systolic and diastolic functions and prognosis.

The aim of the present study was assessment of the relationship of silent myocardial ischemia with clinical, coronary angiography findings, and left ventricular systolic and diastolic function, and its prognostic significance in patients early after myocardial infarction. One hundred nineteen male patients (mean age 48.2+/-1.2 years) with first Q wave myocardial infarction entered the study. Routine coronary angiography, 24-hour Holter electrocardiographic recordings, and two-dimensional and Doppler echocardiography with assessment of left ventricular systolic and diastolic function were performed in all the patients. Prospective follow-up was done during 1 year. Patients with signs of silent myocardial ischemia early after myocardial infarction had more severe coronary artery disease, pronounced disturbances of left ventricular systolic and diastolic performance, and adverse prognosis than those without ischemia appearance during Holter recordings.

Effects of trimetazidine on heart rate variability and left ventricular systolic performance in patients with coronary artery disease after percutaneous transluminal angioplasty.

Fifty-one patients (mean age 51.6 +/- 7.1 years) with angiographically proven coronary artery disease (CAD) entered the study. In 26 patients (Group I), trimetazidine treatment started twenty-four hours after percutaneous transluminal coronary angioplasty (PTCA). Another 25 patients (Group II) without trimetazidine treatment were kept as controls. The groups were comparable by age, gender, risk factors of CAD, coronary anatomy, left ventricular performance, and heart rate variability indices at baseline state. Power spectral analysis of heart rate variability and two-dimensional and Doppler echocardiographic examinations were performed before PTCA, and twenty-four hours, ten days, thirty days, and three months after PTCA. A statistically significant improvement of left ventricular systolic performance (P < 0.001), augmentation of the parasympathetic band of heart rate variability (P < 0.001), and decline of P1/P2 ratio (P < 0.01) were evident in patients treated with trimetazidine, while no apparent changes were observed in controls. The intergroup analysis also showed marked difference between groups as recorded on the day 30 and month 3 of observation (P < 0.001). During follow-up period recurrences of angina pectoris and ischemia were registered in Group II, while no evidence of ischemia was discerned in Group I patients. In conclusion, trimetazidine modulates the autonomic control of heart rate, ie, reduces sympathetic overactivity and augments vagal influences, improves left ventricular contractility, and diminishes the clinical manifestations of ischemia in patients with CAD after PTCA.

High-altitude pulmonary hypertension: effects of captopril on pulmonary and systemic arterial pressures.

The purpose of investigation was the assessment of the effect of captopril on both systemic (Pa) and pulmonary arterial pressures (PPA) in patients with high-altitude pulmonary hypertension (HAPH). Seventeen patients (mean age 44 +/- 6.8 years) with HAPH and mild-to-moderate systemic arterial hypertension were included in the study. All the patients underwent right heart catheterization with measurements of systolic PPA (PPA,syst), mean PPA (PPA) and diastolic PPA (PPA,diast). After a 4 week placebo phase, patients with PPA,syst > 25 mm Hg, PPA > 15 mm Hg and systemic diastolic blood pressure (Pa,diast) > 100 mm Hg received captopril (50-75 mg at 08.00) for a period of 12 weeks. The statistical evaluation of the results were made using the Student's t-test. It was found that captopril significantly decreases PPA and Pa.

Atrial natriuretic factor in high-altitude pulmonary hypertension: the influence of acute hypoxia on plasma atrial natriuretic factor, renin, and aldosterone concentrations in highlanders with initially normal or elevated pulmonary artery pressure and without evidence of right ventricular hypertrophy.

Since the renin-angiotensin-aldosterone system and atrial natriuretic factor are directly involved in the regulation of hemodynamics and structural alterations in the circulatory system, the interest of investigators in the observed changes in this system during exogenous hypoxia and the resultant development of high-altitude pulmonary hypertension is quite understandable. The authors measured the plasma levels of hormones from the major vasoconstrictor neurohumoral system and from one vasodilatory system and correlated them with hemodynamic variables in native highlanders of Tien-Shan.

[Painless ischemia in the acute period of myocardial infarct]. / Bezbolevaia ishemiia v ostrom periode infarkta miokarda.

The examination of 119 patients with primary acute macrofocal myocardial infarction included 24-hour monitoring to detect episodes of painful or painless ischemia. Three groups of patients were identified: 55 subjects with both painful and painless ischemia, 39 subjects with painless ischemia and 25 patients without ischemia. Diastolic and systolic functions of the left ventricle were assessed at Doppler echocardiography in all the patients who were followed up for 1 year. It was found that painless ischemia revealed early in myocardial infarction affects negatively left ventricular systolic and diastolic functions thus strongly suggesting an unfavorable short-term prognosis.