Aim. To study the advantages of using a portable electrocardiographic (ECG) monitor in outpatients with paroxysmal atrial fibrillation (AF).Material and methods. We examined 88 patients (26 men, 62 women, mean age, 63 [57;68] years) with paroxysmal AF with an average frequency of arrhythmia episodes of 1,0 [0.3;3.75] per month. Forty three (49%) patients were included in the remote monitoring (RM) group using the ECG Dongle monitor, and 45 (51%) patients were included in the conventional monitoring (CM) group. Patients underwent scheduled examinations 2, 6 and 12 months after the start of therapy. Unscheduled consultations were carried out in case of AF recurrence. Patients from the RM group, using portable cardiac monitor, additionally self-registered ECG 1 time per week and in case of symptoms suggestive of AF. ECG strips were sent to the clinical investigator for analysis.Results. With the help of portable cardiac monitor, 2477 ECG strips were collected and analyzed: 2159 (87,2%) — sinus rhythm, 318 (12,8%) — AF and atypical atrial flutter. Forty four episodes of AF in 3 patients were asymptomatic. In addition, 211 (8,5%) sinus rhythm ECG strips were recorded by 13 patients with symptoms suggestive of AF. In the RM group, 7 (16%) patients were hospitalized due to recurrent AF, while in the CM group, 20 (44%) patients (p=0,004). The total number of emergency hospitalizations was 8 and 29 in the RM and CM groups, respectively. The number of patients who called an ambulance was significantly lower in the RM group: in the CM group, 37 calls for an ambulance were made by 22 patients, while in the RM group — 12 patients made 15 calls (p=0,044). The proportion of calls followed by hospitalization (40 vs 70%, p=0,043) was significantly lower in the RM group.Conclusion. Remote ECG monitoring using the ECG Dongle system is a useful way to monitor patients with paroxysmal AF, which make it possible to register asymptomatic AF episodes, differentiate the causes of palpitations, and significantly reduce the frequency of emergency calls and hospitalizations.
Aim. To study the features of deceleration capacity (DC) and acceleration capacity (AC) in patients with hypertrophic cardiomyopathy (HCM) and assess the correlation of these indicators with known complications and risk factors for sudden cardiac death (SCD).Material and methods. A total of 50 patients with HCM were examined. Comparable by sex and age, the control group included 50 individuals without cardiovascular diseases. All patients underwent 24-hour electrocardiographic monitoring with the determination of DC and AC. The follow-up period lasted 5 years. Lethal outcomes were recorded in 6%, including SCD — 4%.Results. Patients with HCM were characterized by significantly lower mean DC — 5,5 [3,7; 7,4] vs 7,8 [7,1; 8,5] ms (p=0,0001) and significantly higher AC– -7,4 [-8,9; -5,8] vs -9,3 [-10,0; -8,6] ms (p=0,001) compared with the control group. In 36% of patients with HCM, pathological values of DC ≤4,5 ms were detected, while in all individuals in the control group, DC corresponded to a favorable prognosis (p=0,001). In patients with and without nonsustained ventricular tachycardia (NSVT), a decrease in DC was detected in 56% and 25,5% (p=0,043), respectively, while with and without heart failure (HF) — in 78% and 27% (p=0,016), respectively. In patients with HF (p=0,003) and paroxysmal atrial fibrillation (p=0,023), mean DC values were significantly lower than in patients without these complications. HF was an independent predictor of DC reduction. DC decrease was not associated with an increase in SCD risk estimated using the HCM Risk-SCD calculator.Conclusion. Patients with HCM compared with healthy individuals are characterized by lower DC and higher AC values. Among patients with HCM, a decrease in DC is typical for patients with a more severe disease course (HF, AF, NSVT). However, the rationale for using this indicator in SCD risk stratification needs to be clarified.
Aim. To study the efficacy of class IC arrhythmic drugs (AAD) and catheter ablation (CA) for paroxysmal form of atrial fibrillation (AF) in patients with without structural heart disease.Material and methods. The study included 122 patients (44 men, 78 women, mean age 63 [55;68] years) with symptomatic AF paroxysms. Patients was divided into the lappaconitine hydrobromide group (LH group; n=26), the propafenone group (P group; n=25) – 25 patients, the diethylaminopropionylethoxycarbonylaminophenothiazine hydrochloride (DH group; n=23), the CA groups: radiofrequency ablation (RFA group; n=24) and cryoballoon ablation (CRYO group; n=24) groups each included 24 patients. The primary endpoint was the AF recurrence within 6 and 12 months from the onset of antiarrhythmic drug therapyand in RFA and CRYO groups – within 6 and 12 months after the end of the blinding period. Additionally, in AAD groups a composite endpoint was assessed: the frequency of recurrence of AF within 6 months and the frequency of side effects requiring drug withdrawal.Results. Within the 6 months AF recurrence was observed in 13 (50%) patients of the LH group, 11 (44%) patients of the P group, and 13 (56.5%) patients of the DH group (p=0.687). Side effects requiring drug withdrawal were observed in the LH group in 2 patients (7.7%), in the P group in 3 patients (12%) and in the DH group in 3 patients (13%) (p=0.801). The difference in frequency of reaching the composite endpoint was not significant (p = 0.581) and the incidence was 57.7%, 56%, 69.5%, respectively in groups LH, P and DH. The efficacy of CA was higher than class IC AADs: 77% vs 39% (that including the withdrawals of AADs due to side effects) (p˂0.001). At the same time, there was no significant difference in the effectiveness of RFA and CRYO: AF recurrences within 6 months after the end of the blinding period were registered in the RFA group in 29% of cases, in the CRYO group – in 16.7% of cases (p=0.247). The overall effectiveness of CA after 12 months was 69%, which was significantly higher than the effectiveness of AADs that was 38% (p˂0.001).Conclusion. Starting the AAD therapy with IC class in patients with paroxysmal AF in the absence of structural pathology, despite acceptable safety, one should take into account that, regardless of the initially prescribed drug, less than half of patients can achieve prevention of AF recurrence within 1 year. CA for AF can be considered as a first line therapy or can be recommended if one of IC class AADs is ineffective.
Background. Class IC antiarrhythmic drugs (IC-AADs) are recommended as first-line therapy in treatment of lone paroxysmal atrial fibrillation (AF) along with catheter ablation of pulmonary veins. Despite previous attempts to identify predictors of IC-AADs` efficacy, the choice between IC-AADs agents is still most often carried out using empirical approach.Aim. To determine the predictors of IC-AADs ` efficacy in patients with paroxysmal AF in the absence of structural heart disease.Materials and methods. Seventy four patients (22 men, 52 women, average age 65 [57; 70] years) were treated with IC-AADs: 26 patients were prescribed lappaconitine hydrobromide (Al) (allapinin at a dosage of 75 mg/day or allaforte 50100 mg/day), 25 patients were prescribed propafenone (P) 450600 mg/day, 23 patients diethylaminopropionylethoxycarbonylaminophenothiazine hydrochloride (ethacizine, E) 150 mg/day. The average frequency of AF paroxysms was 2 [0.4; 6.25] per month. Patients were divided into 2 groups depending on the effect of AADs.Results. Over a 12 months follow-up IC-AADs therapy was effective in 28 (37.8%) patients (Eff+ group), in the remaining 46 (62.2%) patients AF recurrences or side effects demanding AADs withdrawal were registered (Eff-group). A DC value greater or equal to 5 ms predicted the effectiveness of IC-AADs therapy with 79% sensitivity and 77% specificity (OR 12, 95% CI 3.0749.5, p0.0001). In the Al group the deceleration capacity (DC) value greater or equal to 5.25 ms allowed predicting therapy effectiveness with 86% sensitivity and 100% specificity (OR 7, 95% CI 1.14; 43; p=0.002). In the E group, the DC index was characterized by high sensitivity (80%) and specificity (85%) for a threshold value of 5.9 ms. In case of DC above this value, the probability of E therapy efficacy increased by 22-times (OR 22, 95% CI 1.5; 314; p=0.009). In group P, the DC medians in the Eff+ and Eff- groups did not differ significantly (p=0.821). However, at low DC values (less than 4 ms) P turned out to be the most effective compared to other two IC-AADs: its effectiveness was 50%, which was significantly higher compared to E (0%) and Al (0%) (p=0.046).Conclusion. Estimation of the DC level before starting IC-AADs can make it easier to choose a specific drug from this group and improve treatment results: at DC above 5.2 ms, it is advisable to use Al, at DC6 ms Al or E, at DC less than 4 ms P.
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