[Automatic detection of ventricular and supraventricular wide QRS arrhythmias using complex of morphological criteria and algorithms].

AIM: The aim of study is a detection of ventricular and supraventricular wide QRS arrhythmias using complex of morphological criteria and algorithms by method of automatic analysis. MATERIALS AND METHODS: For 100 patients (m/f - 61/39, Me (min; max) - 44.5 (10; 85) years) of researched group the analysis of 14306 single wide ectopic complexes (QRS 120-230 ms) has been done. Wide complexes include 11028 (77%) ventricular complexes and 3278 (23%) supraventricular complexes represented by 145 different forms of QRS. For verification of arrhythmias origin transesophageal ECG recording and endocardial electrophysiological study were done. The control group included 59 patients (m/f - 25/34, Me (min; max) - 49.5 (14,85) years) with 720 wide QRS, including 467 (65%) ventricular and 253 (35%) supraventricular complexes represented by 86 forms of QRS. The criteria Drew B.J., Scheinman M.M. (1995); Wellens H.J. (1978), RWPT II (Pava LF, 2010) and the algorithms of Brugada P. (1991); Bayesian (2000); Vereckei A. (2008) were used to evaluate sensitivity, specificity and diagnostic accuracy of wide QRS complexes recognition one by one and together, using the method of Wald sequential automatic analysis (KT Result3, CJSC INCART, Russia) and method of artificial neural networks. RESULTS: The best results for the detection of ventricular arrhythmias algorithms were demonstrated by the  Brugada  P., Drew  B.J., Scheinman  M.M. algorithm (sensitivity 86.43%, specificity 66.73%, diagnostic accuracy 82.14% in the study group, sensitivity 81.80%, specificity 73.12%, diagnostic accuracy 78.75% in the control group), and the Bayesian algorithm (sensitivity 87.81%, specificity 73.62%, diagnostic accuracy 84.72% in the study group, sensitivity 83.30%, specificity 77.08%, diagnostic accuracy 81.11% in the control group). A complex analysis of the Wald method recognized ventricular arrhythmias in the research group with sensitivity 83.11%, specificity 83.65%, diagnostic accuracy 83.23% and in the control group with a sensitivity 83.51%, specificity of 84.58% and diagnostic accuracy 83.89%. Artificial neural networks recognized ventricular arrhythmias with sensitivity 91.43%, specificity 91.30% and diagnostic accuracy 91.39% in the control group and with sensitivity 97.06%, specificity 99.39% and diagnostic accuracy 97.6% in the research group. CONCLUSION: Automatic analysis allows obtaining simultaneously the results of each algorithms/criteria and in combination. It significantly reduces the doctor's work in assessing of amplitude-time characteristics of the complexes. Using artificial neural networks increases the accuracy of of ventricular and supraventricular arrhythmias recognition.

[Algorithm for the management of patients with stable coronary artery disease and high-grade ventricular arrhythmias]. / Algoritm vedeniia patsientov so stabil'noi ishemicheskoi bolezn'iu serdtsa i zheludochkovymi aritmiiami vysokikh gradatsii.

The paper gives an original algorithm for the management of patients with stable coronary artery disease, preserved/moderately reduced left ventricular systolic function, and high-grade ventricular arrhythmias from the first registration of the latter to the choice of treatment policy. Great attention is paid to the assessment of a private clinical case, by determining the nature of arrhythmias, and to the involvement of autonomic regulation in the genesis of ventricular arrhythmias. The importance of topical diagnosis of ventricular arrhythmias and identification of psychological disorders is emphasized. Diagnostic problems are solved in a step-by-step fashion using up-to-date techniques. The key point of the algorithm proposed is to prevent sudden cardiac death.

[Algorithm for the management of patients with ventricular arrhythmias].

The paper proposes an original algorithm for the management of patients with ventricular arrhythmia from its first registration to choice of treatment policy. Using modern diagnostic methods, much attention is paid to the identification of myocardial structural and ischemic changes and also to the involvement of the autonomic and central nervous systems in ventricular arrhythmogenesis. The diagnostic problems are solved step-by-step. The role of psychological diagnosis is accentuated. Longitudinal electrocardiogram monitoring with telemetric data transmission can promptly initiate treatment of patients in an outpatient setting and, in a number of cases, without discontinuing work. The key point of the algorithm proposed is to prevent sudden cardiac death.

[A case of effective psychogenic ventricular arrhythmia treatment with the anxiolytic Adaptol].

There is a presents a clinical case of idiopathic ventricular arrhythmia developing in a 27-year-old young woman with anxiety neurosis successfully treated with the anxiolytic Adaptol used in daily dosage 1500 mg during a month.

[First experience of the study "Intramyocardial Multiple Precision Administration of Mononuclear Bone Marrow Cells in the Treatment of Myocardial Ischemia"].

Study aim - to elucidate possibilities of the use of precision administration of mononuclear bone marrow cells (MBMC) for the treatment of myocardial ischemia and heart failure. "Intramyocardial Multiple Precision Administration of Mononuclear Bone Marrow Cells in the Treatment of Myocardial Ischemia" was a double blind randomized placebo controlled study in which we included patients more or equal 6 months after Q-wave myocardial infarction with systolic myocardial dysfunction (ejection fraction <35%), not requiring myocardial revascularization, receiving stable optimal medical therapy for more or equal 8 weeks, and with implanted cardioverter-defibrillator. Transplantation of MBMC was guided by fluoroscopy and tridimensional NOGA XP Cardiac Navigation System. For assessment of efficacy of the method we used surrogate end points: decrease of number of fixed perfusion defects according to SPECT data and improvement of regional myocardial contractility according to data of echocardiography. Results of dynamic observation of the first experience of MBMC administration are presented in this paper.

[In search of optimal treatment for nonischemic ventricular arrhythmia in patients with anxiety disorders].

AIM: To assess whether arrhythmias may be corrected with the anxiolytic Adaptol in subjects with anxiety disorders. SUBJECTS AND METHODS: On the basis of the data of psychological and mental testing (Stroop test) and the results of Holter monitoring, the authors selected among 59 patients with non-coronarogenic ventricular arrhythmias (VA) and an inadequate response to antiarrhythmic therapy 21 patients with manifest anxiety disorders, in whom a psychogenic factor had played a significant role in the genesis of VA, which served as an indication for Adaptol use. Reexaminations were made 30 days after initiation of therapy with Adaptol 500 mg t.i.d. RESULTS: Adaptol used to treat VA in patients with high anxiety, unlike the controls, exerted a significant antiarrhythmic effect: the average daily and average hourly number of ventricular ectopic complexes significantly decreased while there were no changes in the control group (untreated with Adaptol). In 95% of the patients, the positive Stroop mental test became negative, i.e. it failed to provoke arrhythmia (p < or = 0.01), made test performance easy, and diminished a blood pressure response to the test. The number of patients with moderate and high situational anxiety decreased by 3 times (p < or = 0.01); the general condition improved in the majority of patients. CONCLUSION: The psychogenic factor plays a significant and sometimes determining role in the genesis of non-coronarogenic VA. When used alone and in combination with antiarrthythmics, Adaptol proved to be effective in treating non-coronarogenic VA in patients with higher anxiety.

[Microvolt T-wave alternans as a novel method of analysis of changes of repolarization phase and detection of latent electrical instability of the myocardium].

This review considers of modern concepts of microvolt T-wave alternans (TWA): its pathophysiological basis at cellular level, particulars of quantitative analysis of TWA, modulating effects of autonomic nervous system and drugs, prognostic efficacy in predicting susceptibility to ventricular arrhythmia in comparison with other modern prognostic factors of sudden cardiac death.

[Tachyinduced cardiomyopathy].

The authors consider modem views on tachyinduced cardiomyopathy, which occurs as a result of an increase in atrial or ventricular contraction rate. Data of experimental and clinical studies are presented. The issues of pathogenesis, the clinical significance, the questions of diagnostics, and possibilities of treatment of tachyinduced cardiomyopathy are reflected.

[A modulated type of ventricular parasystole]. / O modulirovannom tipe zheludochkovoi parasistolii.

The paper presents data (from 15 case histories) and the methods for ECG analysis of ventricular parasystole of the modulated type with accelerated or delayed paracenter activity entrainment and annihilation phenomena. A relationship between classical and modulated types of parasystole is discussed.

[Comparison of exercise test and ECG monitoring results in women with ischemic heart disease]. / Sopostavlenie rezul'tatov proby s fizicheskoi nagruzkoi i monitorivovaniia EKG u zhenshchin, stradaiushchikh ishemicheskoi bolezn'iu serdtsa.

To diagnose myocardial ischemia and differentiate the chest pain syndrome in 20 females with coronary heart disease and effort angina pectoris, exercise test and ECG monitoring were performed. Their results were then compared. The informative value of 24-hour ECG monitoring was higher than that of bicycle ergometry in detecting the objective signs of ischemia in patients with effort angina. The indisputable advantage of long-term ECG recording is that one can identify silent ischemia in females with routine physical activity in the outpatient settings. The method of 24-hour ECG monitoring cannot be considered to be sufficiently effective in the differential diagnosis of the atypical chest pain syndrome.