[General surgical procedures in patients with electrical pacemaker].

Work of the implanted electric pacemaker (EP) was assessed in 99 patients, aged 62.4±9.6 years, during non-cardiological surgery. Inhibition of the EP stimuli was registered in 9 (9.1%) patients, short episodes of uneffective stimulation with synchronization disturbation--in 2 (2%) patients and change of stimulation regimen was registered in the same number of patients by electocoagulation. Episodes of myopotential inhibition not assotiated with electrocoagulation was registered in 4 cases. The ascertained rhythm disturbances require a thorough preoperative check-up, intraoperative ECG control and short use of monopolar electrocoagulation.

[Mental disorders in patients with complete heart block before and after a pacemaker implantation]. / Psikhicheskie narusheniia u bol'nykh s polnoi poperechnoi blokadoi serdtsa do i posle implantatsii élektrokardiostimuliatora.

Mental disorders were studied in 52 patients with acquired complete heart block (CHB) before and after pacemaker implantation. Mental state of the patients was characterized primarily by borderline mental pathology--asthenia, affective pathology, hysteria spectrum disorders with autonomic symptoms and hypochondriac disorders. The structure and expression of mental disorders depend on premorbid personality traits of the patients, duration, severity and stage of the disease, the phase in respect to surgery intervention as well as preoperative period duration. Being the main therapy method, the operative CHB treatment, in general, positively influences the dynamics of mental disorders. However, in some cases, pacemaker implantation changes the behavior and quality of life of patients. Peculiarities of mental disorders in the CHB demand to include of psychopharmacotherapy and psychotherapy in treatment process.

[Anesthesiology in the surgical treatment of supraventricular tachyarrhythmias]. / Anesteziologicheskoe obespechenie pri khirurgicheskom lechenii nadzheludochkovykh takhiaritmii.

Different anesthesias were used in 197 patients operated for supraventricular tachiarrhythmias through a transvenous access. Hypnoanalgesia based on preventive injection of a potent nonnarcotic antiinflammatory agent xefocame (lornoxicame), drip infusion of propofol (2-3 mg/kg/h), and bolus injection of dormicum under conditions of spontaneous respiration proved to be the best method.

Estudo multicêntrico comparativo de quatro diferentes tipos de sensores: atividade, acelerômetro, temperatura e período de pré-ejeçäo / Comparative study with different rate adaptive pacing systems

Recentemente diferentes princípios têm sido utilizado para estimular o coraçäo na tentativa de recuperar o débito cardíaco. Neste estudo multicêntrico, foram comparadas as respostas à estimulaçäo por 4 tipos de sensores, sendo 3 tipos de resposta de alça aberta (atividade física, acelerômetro e temperatura venosa central) implantados em 30 (SSIR-8 e DDDR-22), 9(SSIR-5 e DDDR-4) e 12 (SSIR) pacientes respectivamente. Um outro sensor do tipo alça fechada, sensível às variaçöes do sitema nervoso autôno, foi implantado em 57 pacientes, todos no modo DDDR. Os resultados obtidos durante a realizaçäo de atividade física diária, de teste ergométrico e de Holter de 24 horas foram comparados sendo possível observar uma maior fidelidade na curva de resposta de frequência frente a atividade física, nos pacientes submetidos à estimulaçäo de alça fechada

[Changes in central hemodynamics and the heart conduction system during total intravenous anesthesia using diprivan in extensive abdominal surgery]. / Izmeneniia tsentral'noi gemodinamiki i provodiashchei sistemy serdtsa pri total'noi vnutrivennoi anestezii s ispol'zovaniem diprivana vo vremia obshirnykh abdominal'nykh operatsii.

Diprivan was included in the multicomponent intravenous anesthesia during extensive prolonged and traumatic operations in abdominal surgery and gynecology. The investigations showed the minimal effect of anesthesia with diprivan, diazepam, and phentanyl on the central hemodynamics and conducting system of the heart. The suggested anesthetic scheme may be a method of choice in patients at a high risk of surgical anesthesiological injury.

[A new method for the diagnosis of myocardial ischemia in patients with an implanted programmable pacemaker]. / Novyi sposob diagnostiki ishemii miokarda u bol'nykh s implantirovannym programmiruemym élektrokardiostimuliatorom.

Implanted programmable pacemaker (IPP) applicability for detection of myocardial ischemia has been tried in patients with continuous pacing (CP). 28 patients (mean age 59 +/- 9 years) on CP in VVI and AAI regimens because of arrhythmia and abnormal cardiac conduction underwent loading test with enhanced stimulation made with IPP on the changed program. Impaired local contractility (ILC) of the left ventricle was registered at two-dimensional echoCG. The test reached diagnostic criteria in 27 cases. The results of the test appeared positive in 11 patients whose ILC index increased from 3 +/- 3 to 9 +/- 5 (p < 0.01), on the average. The authors believe this variant of stress-echoCG applicable for diagnosis of myocardial ischemia in IPP patients. Limitations are indicated in AAI and VVI CP regimens.

[Experience with the implantation of sensory multiple programmable pacemakers of the Siemens firm]. / Opyt implantatsii sensornykh mul'tiprogrammiruemykh élektrokardiostimuliatorov firmy Simens.

The paper summarizes the experience on 27 implantations of sensory multiprogrammable pacemakers (two-chamber Synchrony-II and one-chamber Sensolog-III) produced by Siemens-Elema. The implantations were performed in the Moscow Cardiostimulation Center in 1993. Primary pacemaker implantation was performed in 19 patients, 8 patients needed the replacement of one-chamber pacemakers because of the power source exhaustion or circulatory insufficiency. The two-chamber pacemaker was implanted to 14 patients with a complete AV-block and chronotropic sinus node incompetence and to 4 patients with sick sinus syndrome in intact AV-conduction. In 6 patients the one-chamber pacemaker was implanted to stimulate the right ventricle. They had permanent bradysystolic auricular fibrillation and complete AV block with persistent or transitory tachysystolic auricular fibrillation. 3 patients with sick sinus syndrome received one-chamber pacemaker. The authors think their experience with sensory Siemens-Elema pacemakers positive.

[Recommendations for implanting cardiac pacemakers in bradycardia]. / Rekomendatsii dlia implantatsii élektrokardiostimuliatorov pri bradikardiiakh.

The paper gives recommendations for cardiologists and cardiac surgeons who are engaged in working out indications, choice of the type and mode of cardiac pacing. Based on the understanding of the great importance of nomenclature documents concerning the development of indications for pacemakers implantation, the Working Group of the Expert Committee, Ministry of Health of the Russian Federation and Russian Academy of Medical Sciences, for implantable antiarrhythmic devices and electrophysiology has developed recommendations on pacemaker implantation in acquired atrioventricular (AV) block, in AV-block after myocardial infarction, chronic bi- and tri-fascicular block, sinoatrial nodal dysfunction, hypersensitive carotid sinus syndrome, neurovascular syndromes, as well as in childhood bradyarrhythmias. In developing the recommendations, the authors have used their own 25-year experience in implanting pacemakers and the recommendations proposed by the Working Group of the American College of Cardiologists and the American Association of Cardiologists in 1984 and 1991 for implanting pacemakers in bradyarrhythmias. The proposed recommendations define indications and contraindications for implantation of up-to-date pacemaker models and determine the behaviour policy of a specialist in selecting patients with bradyarrhythmias for the optimal pacing mode, which suggests a compulsory certification of the centers engaged in implanting pacemakers in bradyarrhythmias.

[The effect of diprivan on the indices of central hemodynamics and the heart conduction system]. / Vliianie diprivana na pokazateli tsentralnoi gemodinamiki i provodiashchuiu sistemu serdtsa.

Using impedance tetrapolar plethysmography and transesophageal electrical stimulation of the left ventricle, changes in central hemodynamic parameters have been assessed in 46 women during brief (up to 10 min) anesthesias with diprivanum. Bolus injection of diprivanum at a dose of 2.5 mg per 1 kg body weight was used. It has been demonstrated that diprivanum administration decreased BP, which was associated with a drop in total peripheral resistance and stroke volume that led to the absence of compensatory tachycardia to an increase in the cardiac output. The absence of compensatory tachycardia upon diprivanum administration is accounted for by a combined effect of vagotonic diprivanum action and its ability to inhibit moderately the automatic function of the sinoatrial node.

[Radionuclide ventriculography for evaluating left ventricular myocardial contractility in patients with implanted pacemaker]. / Radionuklidnaia ventrikulografiia v otsenke sokratimosti miokarda levogo zheludochka u bol'nykh s implantirovannym élektrokardiostimuliatorom.

An EKC-500 pacemaker was implanted in 16 patients with coronary heart disease (CHD) and 14 idiopathic conduction disturbance for complete atrioventricular block. After surgery, the patients underwent equilibrium radionuclide ventriculography by using a nuclear stethoscope at rest and during exercise at different stimulation rates with the aim of choosing their optimal values. It was established that patients with idiopathic conduction disturbances showed improved left ventricular contractility at all stimulation rates and their optimal values ranged 60-70 per minute. In patients with CHD, the stimulation rate of 60 impulses/min was optimal at rest, and with this, exercise resulted in a significant deterioration of myocardial contractility, but only the stimulation rate of 80 impulses/min led to a slight improvement, which was due to accessory mechanisms of contractility enhancement. The peak ejection rate was the most sensitive to progressive myocardial dysfunction, yet the basic contractility index was the mean ejection rate.

[Rhythmographic analysis of atrial extrasystole in patients with sick sinus syndrome]. / Ritmograficheskii analiz predserdnoi ékstrasistolii u bol'nykh s sindromom slabosti sinusovogo uzla.

The comparative analysis of 141 electrocardiograms showing premature atrial contraction from 43 patients with the sick sinus syndrome and 19 subjects with normal sinus nodal function revealed new electrocardiographic signs suggesting sinus dysfunction: an increase in the postextrasystolic pause by more than 135% of the preextrasystolic interval; greater full compensatory pause values; extrasystolic appearance of a full compensatory pause with the coupling interval of less than 68% of the presystolic interval; an increase in the sinus cycle followed the postextrasystolic pause by greater than 50 msec. The proposed criteria show a 5.7-fold increase in the informative value of ECG analysis in the diagnosis of the sick sinus syndrome in premature atrial contraction.

[Provocation of supraventricular arrhythmia in the diagnosis of sick sinus syndrome]. / Provokatsiia nadzheludochkovykh takhiaritmii v diagnostike sindroma slabosti sinusovogo uzla.

The diagnostic value of routine evaluations of sinus function and of analysis of sinus pause lengths were compared in 31 patients with a brady- and tachycardia types of the sick sinus syndrome after abolishing the tachyarrhythmic paroxysms provoked during an electrophysiological study. The study was performed by transesophageal electric stimulation. The sensitivity of the two modes of diagnosing the sick sinus syndrome was comparable: 55.5-65.2% for the former and 47.7-69.6% for the latter mode. Their concomitant application increases the diagnostic value of electrophysiological studies in patients with suspected brady- and tachycardia types of the sick sinus syndrome by more than 17%.

[Potential of the method of transesophageal stimulation of the left atrium]. / Vozmozhnosti metoda chrespishchevodnoi stimuliatsii levogo predserdiia.

The authors provide the results of examining the conduction system of the heart in 623 patients with different disorders of heart conduction and rhythm by means of transesophageal pacing (TEP). The non-invasive electrophysiological examination of patients with sick sinus syndrome with latent disorders of atrioventricular (AV) conduction, and with supraventricular tachyarrhythmias turned out to be of high diagnostic value, inducing no complications. Application of programmed TEP (scanning extrastimulus on basis pacemaking) employed by the authors for the first time during TEP considerably widens the diagnostic possibilities of the technique permitting the measurement of the refractory periods of the conduction system (the refractory periods of the sinus node, atria, and AV-conduction system along normal and additional pathways), the performance of the trigger and removal of supraventricular arrhythmias with diagnostic and treatment purposes in view. The use of TEP for the treatment of patients with the syndrome of the prolonged QT interval and ventricular premature heart beat accelerates the choice of adequate antiarrhythmic therapy and raises its efficacy.