ECG monitoring of post-stroke occurring arrhythmias: an observational study using 7-day Holter ECG

Post-stroke arrhythmias represent a risk factor for complications and worse prognosis after cerebrovascular events. The aims of the study were to detect the rate of atrial fibrillation (AF) and other cardiac arrhythmias after acute ischemic stroke, by using a 7-day Holter ECG which has proved to be superior to the standard 24-h recording, and to evaluate the possible association between brain lesions and arrhythmias. One hundred and twenty patients with cryptogenic ischemic stroke underwent clinical and neuroimaging assessment and were monitored with a 7-day Holter ECG. Analysis of the rhythm recorded over 7 days was compared to analysis limited at the first 24 h of monitoring. 7-day Holter ECG detected AF in 4% of patients, supraventricular extrasystole (SVEB) in 94%, ventricular extrasystole (VEB) in 88%, short supraventricular runs (SVRs) in 54%, supraventricular tachycardia in 20%, and bradycardia in 6%. Compared to the first 24 h of monitoring, 7-Holter ECG showed a significant higher detection for all arrhythmias (AF p = 0.02; bradycardia p = 0.03; tachycardia p = 0.0001; SVEB p = 0.0002; VEB p = 0.0001; SVRs p = 0.0001). Patients with SVRs and bradycardia were older (p = 0.0001; p = 0.035) and had higher CHA2DS2VASc scores (p = 0.004; p = 0.026) respectively, in the comparison with patients without these two arrhythmias. An association was found between SVEB and parietal (p = 0.013) and temporal (p = 0.013) lobe lesions, whereas VEB correlated with insular involvement (p = 0.002). 7-day Holter ECG monitoring proved to be superior as compared to 24-h recording for the detection of all arrhythmias, some of which (SVEB and VEB) were associated with specific brain areas involvement. Therefore, 7-day Holter ECG should be required as an effective first-line approach to improve both diagnosis and therapeutic management after stroke.

Differentiated approach to rhythm conversion in patients with atrial fibrillation and flutter

The importance of relieving paroxysms of fibrillation and atrial flutter is determined by a huge number of patients suffering from this pathology and its recurrent course.Objective: To create an algorithm for the treatment of patients with atrial fibrillation and atrial flutter by comparing the efficacy and safety of drug-induced rhythm conversion with amiodarone, propafenone, procainamide, niferidil and electropulse therapy.Material and methods. Heart rate conversion was performed in 299 patients. Amiodarone was used as a drug for therapy in 93 patients, propafenone in 34, procainamide in 52, and niferidil in 50. 70 patients underwent electropulse therapy. A comparative analysis was carried out to establish the effectiveness and safety of heart rate conversion by these methods.Results. The effectiveness of conversion rhythm in atrial fibrillation with the help of electropulse therapy, propafenone, niferidil, procainamide and amiadarone has been established, which is 90,3%, 82,4%, 77,4%, 72,5% and 70.5%, respectively. It was also found that the use of electro-pulse therapy and niferidil, in which sinus rhythm recovery occurs in 94.4% and 78.9%, respectively, against 58.3% and 26.7% of patients receiving procainamide and amiodarone, respectively, is most appropriate for the relief of atrial flutter. Often, when using niferidil, ventricular extrasystole and prolongation of the QT interval during electrography developed in comparison with patients of other groups. Ventricular tachycardia, including the "pirouette" type, sinoatrial blockade, AV blockade of various degrees, were also slightly more often registered in these patients.Conclusions. In order to stop atrial fibrillation, there are no differences between medications, and it is better to perform rhythm conversion with atrial flutter with niferidil or electro-pulse therapy.

Acquired long QT syndrome, manifesting in the first complex after a ventricular extrasystole

A case report of unusual QT interval prolongation after ventricular premature beat is presented.

Pengelolaan Anestesi pada Pasien yang dilakukan Eksisi Tumor Medula Spinalis Servikal 2-3 dengan Ventrikel Ekstra Sistole

Compression of the spinal cord can cause irritation to the autonomic nervous system. Hyperinervation of sympathetic nerves at high risk for arrhythmias characterized by electrocardiographic results in changes in P-wave duration, QRS duration, ST-segment depression, T-wave peak interval, and ventricular extrasystole. A 52-year-old male with an intra-extramedullar tumor in cervical 2-3, tetraparesis, dysrhythmias, and ventricular extrasystole bigemini. Wide excision of tumor and posterior stabilization would be performed. The pulse was 90x/minute palpable irregularly. Electrocardiography examination revealed irregular rhythm 82 x/minute and ventricular extrasystole 10 x/minute. Echocardiography showed grade 3 diastolic dysfunction with preserved LV function. Before the procedure, the patient was given management for the dysrhythmia and ventricular extrasystole with analgetics and amiodaron 150mg (10ml) in the first 10 minutes followed by 360mg (200mg) for the next 6 hours, 540mg for the next 18 hours and analgetics. General anesthesia carried out with midazolam 3mg, fentanyl 200mcg, lidocaine 60mg, propofol 100mg, and atricurium 30mg, with manual intubation in-line. After arterial line and central venous catheter insertion, the patient was placed in the prone position. Surgery lasted for approximately 6 hours. The patient was treated in the ICU for 2 days before moving to the usual ward. Amiodarone can be considered in ventricular extrasystole requiring immediate treatment with stable hemodynamic.

Treatment of refractory ventricular premature beat from the left ventricle summit using intramyocardial retrograde transvenous ethanol administration

A clinical observation of intramyocardial transvenous ethanol administration for the treatment of refractory ventricular extrasystole is presented. The procedure was carried out as part of a prospective international multicenter study “Intramural venous ethanol infusion for refractory ventricular arrhythmias”.

Simultaneous electrocardiogram during routine electroencephalogram: arrhythmia rates through the eyes of the cardiologist

ABSTRACT Background: The importance of simultaneous 2-lead electrocardiogram (ECG) recording during routine electroencephalogram (EEG) has been reported several times on clinical grounds. Objective: To investigate arrhythmia rates detected by simultaneous 2-lead ECG in our patient sample undergoing routine EEG. Remarkably, we sought to assess the possible expansion of results with a more experienced interpretation of simultaneous ECG. Methods: Simultaneous 2-lead ECG recordings during routine EEG, performed between January and March, 2016, have been retrospectively analyzed by a cardiology specialist. In addition, EEG reports were screened with the keywords ‘arrhythmia, tachycardia, bradycardia, atrial fibrillation, extrasystole’ to evaluate the neurologist interpretation. Results: Overall, 478 routine EEG recordings were scanned. The mean age of the patients was 42.8±19.8 (16–95), with a sex ratio of 264/214 (F/M). In 80 (17%) patients, findings compatible with arrhythmia were identified on simultaneous ECG after a cardiologist's evaluation. The detected arrhythmia subtypes were: ventricular extrasystole (n=27; 5.6%), supraventricular extrasystole (n=23; 4.8%), tachycardia (n=9; 1.8%), prolonged QRS duration (n=7; 8.7%), atrial fibrillation (n=6; 1.2%), and block (n=6; 1.2%). On the other hand, keywords related to arrhythmia were present in 45 (9.4%) of EEG reports. The reported statements were tachycardia (3.3%), arrhythmia (2.5%), bradycardia (2.1%), and extrasystole (1.5%). Conclusions: A considerably high rate of arrhythmia cases was determined on simultaneous ECG during routine EEG after being interpreted by a cardiologist. However, the screening results of EEG reports revealed relatively low arrhythmia rates. These results suggest that the detection rates of ECG abnormalities during routine EEG may be potentially improved.

Comparative assessment of renal function by cystatin C level in patients with hypertension and extrasystole

Although the tight connection of the cardiovascular system and the kidneys is well known, using of cystatin C (Cys-C) opens new horizons in studying early renal failure stages. The study aimed to compare the functional status of the kidneys in patients with hypertension and extrasystole to the level of Cys-C. 156 patients with stage II hypertension (EH II) were examined. 124 of them had frequent symptomatic extrasystoles (74 – of supraventricular origin and 50 – ventricular), 32 patients had no arrhythmias, and were referred to the comparison group. The control group consisted of 30 healthy people with normal blood pressure (BP). All patients underwent a complete clinical examination, blood pressure measurement, daily blood pressure monitoring, daily electrocardiogram monitoring, echocardiography, and determination of renal function (creatinine, blood electrolytes, serum cystatin C) followed by calculation of glomerular filtration rate (GFR). The level of Cys-C in patients with hypertension was significantly higher (p<0.001) compared with healthy individuals. Among patients with arrhythmias, the highest level of Cys-C was noted in patients with ventricular arrhythmias. The correlation analysis showed that the level of Cys-C was higher in the presence of frequent extrasystoles (namely of ventricular origin), smoking, high blood pressure, increased systolic and pulse blood pressure, the presence of concentric left ventricular hypertrophy, dyslipidemia, increased creatinine level and decreased GFR. All three EH II patient groups had significantly lower GFR (calculated by creatinine level) (p<0.001). The lowest creatinine-based GFR was revealed in patients with ventricular extrasystole. All patients with EH II had significantly lower Cys-C based GFR than the control group (p<0.001). Mean Cys-C-based GFR values in patients with extrasystole were significantly lower than in patients without extrasystole (p<0.03). The analysis of GFR levels depending on the extrasystole origin was provided. The lowest level of GFR was recorded in patients with ventricular extrasystole. It was significantly different from the patients with supraventricular extrasystole (p=0.02). Our findings confirm the opinion of other researchers that Cys-C is an early marker of renal dysfunction in patients with hypertension, which is more sensitive than creatinine. Another finding is that ventricular extrasystole is more hemodynamically and metabolically unfavorable compared to supraventricular based on clinical and prognostic evaluation.

Quality of life, anxiety and depressive disorders in patients with extrasystolic arrhythmia

IntroductionThe aim of this study was to perform a comparative and economic analysis of the degree of development of anxiety-depressive disorder in patients with different types of extrasystolic arrhythmia using different assessment scales.Material and methodsThe study was conducted in 2018–2019 at the premises of clinic No. 4, involving 450 patients (Moscow, Russia). Patients were divided into three groups: with coronary heart disease (CHD) (147 patients), with myocardiodystrophy (MCD) (113) and with cardiopsychoneurosis (CPN) (190). Everyone underwent round-the-clock electrocardiography (ECG) and echocardiography. If symptoms of depressive disorder are detected in a timely manner, the risk of adverse cardiovascular diseases may be reduced.ResultsDepression and anxiety indicators on all three scales differed significantly (p ≤ 0.05) in patients with supraventricular extrasystole (more than 40 points on the Zung scale, 14 points on the Montgomery-Asberg depression scale, more than 38 points on Zung and 3 points on Covi anxiety scales). For patients with ventricular extrasystole, a significant difference was established between groups 1 and 2 only in terms of the level of depression on the Zung scale. Factors of psychogenic origin determine the development of cardiac rhythm disturbances.ConclusionsThe study showed that for supraventricular extrasystoles, these factors determine the overall health of the patient. The differences between the three groups are significant on all scales of depression and anxiety (p ≤ 0.05). The most susceptible to depression and anxiety are patients with extrasystolic arrhythmias diagnosed with CHD, as well as MCD.

Infusion therapy in treatment of patients with acute coronary syndrome

Objective. Introduction to the basic therapy of patients with acute coronary syndrome (ACS) without ST-segment elevation cardioprotective drug Tivorel (“Yuria-Pharm”) based on L-arginine and L-carnitine. Materials and methods. The present study was carried out in accordance with the requirements for clinical trials of drugs in the Department of Emergency Cardiology of the RSCEMPSF. Patients were admitted to the intensive care unit with a diagnosis of ACS without ST-segment elevation in the first 12 h after the onset of the disease. The study was carried out in two groups and included the following stages: screening and treatment period (10 days). The study involved 90 patients with ACS without ST segment elevation, who were allocated for treatment in the study and control groups in a 1:1 ratio. Patients of the study group, except for basic therapy (sublingual nitroglycerin, acetylsalicylic acid or clopidogrel, analgesics, β-adrenergic blockers or angiotensin-converting enzyme inhibitors), received the drug Tivorel 100 ml intravenously at a rate of 10 drops per minute for the first 10-15 min (then the rate of administration could be increased to 30 drops per minute) 1 time per day within 10 days. Control group patients were prescribed only basic therapy. Determination of markers of myocardial necrosis (troponin T), electrocardiography (ECG), echocardiography. Compulsory calculation of end-diastolic and end-systolic indices, left ventricular ejection fraction were performed. Results and discussion. It was found that the drug Tivorel, prescribed as part of complex therapy immediately after admission of patients to the hospital, improves the electrophysiological properties of the myocardium and prevents the appearance of temporary ECG disturbances, stabilizes the condition of patients. In patients of the main group, already in the first day after the development of acute myocardial infarction (AMI), late ventricular potentials were less often recorded, markers of the so-called arrhythmogenic substrate – 9.5 % compared to 18.7 % in patients in the control group. In the course of further observation, the prostate gland in the control group disappeared, and during treatment with Tivorel, it did not appear anymore. This suggests the presence of a pronounced anti-ischemic effect of the drug, which is also confirmed by clinical data. We have noted a reliably expressed positive dynamics of changes in the end part of the ventricular complex under the influence of therapy with Tivorel. Analysis of standard ECG and 24-hour monitoring data in a number of patients revealed rhythm disturbances. There were no significant differences between the groups in the frequency of occurrence of all manifestations of arrhythmic syndrome, both initially and after therapy, however, in the main group, during treatment, the number of cases of ventricular arrhythmias in the form of group ventricular extrasystole and ventricular tachycardia bursts significantly decreased. During the period of inpatient treatment, all patients showed positive clinical dynamics: a decrease in the frequency and severity of angina attacks, a decrease and stabilization of blood pressure, an increase in exercise tolerance. Already on the third day of treatment with the use of the study drug Tivorel, relapses of anginal pain occurred less frequently (21.9 % of cases in the main group and 33.0 % in the control group). At the same time, there was a decrease in the need for the use of nitroglycerin and narcotic analgesics in order to relieve recurrent pain syndrome (23.1 % and 35.3 % of cases, respectively). In addition, on the third day after the development of AMI in patients of the main compared with the control, a lower incidence of atrioventricular blockade was recorded (4.3 % and 13.6 %, respectively). In the course of the analysis of the entire hospital period, it was found that in patients receiving Tivorel, atrioventricular blockades occurred almost 3 times less often than in the control group. The frequency of registration of ventricular extrasystole decreased on the 7th (34.1 %) and 10th days (45.7 %) of the disease. Conclusions. The use of the drug Tivorel (“Yuria-Pharm”) in addition to basic therapy helps to optimize the management of ACS patients without ST-segment elevation. With complex treatment with the use of the drug Tivorel, a faster regression of clinical manifestations of ACS is observed. The use of Tivorel in ACS therapy without ST-segment elevation stabilizes the patient’s condition and reduces the incidence of complications.

To the question of S.S. Zimnitsky on the origin of the giant T wave after ventricular extrasystole on an electrocardiogram

The study of life, medical and scientific activities of the outstanding domestic scientist S.S. Zimnitsky always causes and will cause great interest. The versatility of his talent as a scientist continues to amaze. Many of the issues that remain relevant today raised by S.S. Zimnitsky, not fully resolved in the XXI century. There were no answers to the well-known question asked by the seriously ill S.S. Zimnitsky to another prominent Russian scientist, the beacon of Russian physiological science A.F. Samoilov. This question concerned the origin of the giant positive T wave in the first QRS complex after the ventricular extrasystole on the electrocardiogram. The question remained unanswered. We believe that this was because by the end of the 20s of the XX century (S.S. Zimnitsky died in 1927), the delicate mechanisms of repolarization processes were not able to understand, in both healthy and diseased myocardium. The article sets forth our original point of view on the genesis of such a T wave in S.S. Zimnitsky. We believe that a scientific discussion on this issue is quite possible. There is no doubt that both life and scientific activities of S.S. Zimnitsky has always attracted and will attract the attention of both medical historians and practical doctors, scientists and inquisitive students.