[Interrelationship between polymorphic markers of methylenetetrahydrofolate reductase gene and development of acute disturbance of brain circulation in families of patients with atrial fibrillation].

In the present work we for the first time on the clinic-genetic material revealed genetic predictors of development of acute disturbance of brain circulation (ADBC) in families of patients with atrial fibrillation (AF) namely polymorphism of the methylenetetrahydrofolate reductase (MTHFR) gene. Genotype CC was significantly more often found among patients with AF and ADBC compared with controls (58.1 and 35.2%, respectively, p=0.02) as well as in relatives of probands compared with the control group (59.3 and 35.2%, respectively, p=0.008). With this in relatives with revealed paroxysmal AF and ADBC we also noted presence of CC genotype. Taking into consideration the relationship obtained between polymorphysms of MTHFR gene and AF it was possible to assume that polymorphic marker CC appeared to be a predictor of ADBC in these families.

[Functional state of the sinoatrial node in patients with intraventricular block]. / Funktsiona'lnoe sostoianie sinusovogo uzla u bo'lnykh s vnutrizheludochkovymi blokadami.

The function of sinus node (SN) was studied in 101 subjects with intraventricular blocks (IVB) and 30 controls. The patients with IVB showed a significant increase in the corrected time of SN function recovery and that of sinoatrial conduction both before and after medicamentous++ autonomic block, as compared to the controls. In general, signs of SN dysfunction were detected in 47 (46.5%) subjects with IVB. In 18.8% of the examinees, SN dysfunction was due to abnormal autonomic exposures, 27.7% had abnormalities in SN proper or perinodal tissue. ++Tachy-bradycardia was found in 53.5% patients with the sick sinus syndrome and IVB, 25% had concurrent atrioventricular conduction disturbances. A concomitant SN lesion was common in patients with IVB. One should take into account a type of this syndrome and the status of atrioventricular conduction when the optimal conditions of continuous electrical cardiostimulation are applied to patients with IVB and clinical signs of the sick sinus syndrome.

[Use of transesophageal stimulation of the left atrium in the diagnosis of ischemia and cicatricial myocardial changes in patients with complete block of the left fascicle of the bundle of His]. / Primenenie chrespishchevodnoi stimuliatsii levogo predserdiia dlia diagnostiki ishemii i rubtsovykh izmenenii miokarda u bo'lnykh s polnoi blokadoi levoi nozhki puchka Gisa.

Transesophageal stimulation of the left atrium was performed in 52 patients who had signs of complete left bundle branch block as evidenced by ECG, 48 patients having sustained block, 4, intermittent one. In 42 (80.8%) patients, the block was temporarily arrested during and/or after discontinuation of the electric stimulation, in 28 of them, the block was stopped during the stimulation without any drugs, in 1, only after obsidan, and in 13, following obsidan and atropine. When the block was being arrested, 13 patients showed ECG ischemic changes, 7 exhibited myocardial scarring alterations, 8 had nonspecific T wave alterations, 8 displayed signs of left ventricular hypertrophy with impaired repolarization. No ECG changes were found in 7 patients. The use of transesophageal electrical stimulation of the left atrium to temporarily abolish complete left bundle branch block may contribute to elucidation of the etiology of the block and choice of the most adequate therapy.

[Clinico-electrocardiographic variants of combined lesions of the sinoatrial and atrioventricular nodes]. / Kliniko-elektrokardiograficheskie varianty pri sochetannom porazhenii sinusovogo i atrioventrikuliarnogo uzlov.

A study of 71 patients with atrioventricular blocks and 57 patients with the sick-sinus syndrome (SSS) revealed electrophysiologic evidence of sinus dysfunction in 38 (53.5%) patients with atrioventricular blocks. Sinus dysfunction was due to pathologic vegetative effects in 15 (21.1%) patients with AV blocks, and a pathology of the sinus node itself in 23 (32.4%). Impaired atrioventricular conductivity, was registered in 29 (38.7%) patients with the SSS. A disorder of atrioventricular automatism was detected in 38 patients, and was combined with impaired AV conductivity in 19 of those. Five clinico-electrocardiographic variants of binodal heart disease have been identified, and possible therapies are discussed for each of those.

[Intraventricular blocks in myocardial infarct]. / Vnutrizheludochkovye blokady pri infarkte miokarda

The examination was carried out in 787 patients with macrofocal myocardial infarction. The most frequently encountered variant of intraventricular block in males was the right bundle branch block, in females--the left bundle branch block. The rarest variant of intraventricular conductivity disorders in myocardial infarction was the left-posterior hemiblock. The prognostically severest variant of bilateral block consists in a combination of the right bundle branch block with the left-posterior hemiblock. The leading causes of death among the patients with myocardial infarction and intraventricular blocks were acute (cardiogenic shock, pulmonary oedema) and chronic cardiac insufficiency. In patients with bilateral blocks the frequent causes of death were, along with cardiac insufficiency, also arrhythmias (ventricular fibrillation, asystole).

[Auricular fibrillation in myocardial infarct]. / Mertsatel'naia aritmiia pri infarkte miokarda

Auricular fibrillation was observed in 17.8% of patients with large-focal myocardial infarction, mainly in females (p 0.01). The localization of myocardial infarction had no impact on the incidence of auricular fibrillation. The precursors of auricular fibrillation included atrial extrasystoli and an elevated electrolyte coefficient of the blood NaeKe. In the group of patients with myocardial infarction and auricular fibrillation mortality was more common among the females. Auricular fibrillation developing beyond the first postinfarction day worsened the prognosis considerably. The outcome of myocardial infarction did not much depend on the duration of auricular fibrillation and on the cardiac contraction frequency.