Association between social phobia and the risk of arrhythmia using the Korean National Sample Cohort: a retrospective cohort study

Background Social phobia shares symptoms with arrhythmias, such as palpitations and chest discomfort. However, it is unclear how social phobia is associated with the actual risk of arrhythmia. This study aimed to investigate whether social phobia is associated with the risk of arrhythmia using a nationally representative sample cohort. Methods This retrospective cohort study assessed data from the 2002–2013 Korean National Health Insurance Service National Sample Cohort. Using 1:3 propensity score matching for sex, age, income, and insurance status, 1514 patients with social phobia and 4542 control group patients were included in the study. Social phobia and arrhythmia were defined per the International Classification of Diseases, 10th revision. Using cox proportional hazard regression, hazard ratios (HRs) were calculated to estimate the risk of arrhythmia in patients with social phobia. Results There were statistically significant associations between social phobia history and elevated risks of arrhythmia. Patients with social phobia had a higher risk of arrhythmia after adjusting with covariates (HR = 1.78, 95%CI = 1.25–2.55). Among different types of arrhythmias, atrial fibrillation and flutter presented the highest risk (HR = 2.20, CI = 1.06–4.57) compared to paroxysmal tachycardia (HR = 1.07, CI = 0.39–2.91) and other cardiac arrhythmias (HR = 1.83, CI = 1.16–2.89). Conclusion This study identified the association between social phobia and the risk of arrhythmia in a South Korean representative cohort. These results suggest that social phobia should be treated properly to reduce arrhythmia risks.

Paroxysmal tachycardia and anaphylaxis O. Weill (Rg. Med., No. 20, 1932)

O. Weill reports (Rg. Med., No. 20, 1932) about 6 cases of p.t., accompanied by one or another symptom of anaphylactic nature, such as migraine, eczema, urticaria, etc.

Paroxysmal tachycardia of anaphylactic origin Mussio-Furnier (Rg. Med. No. 10. 1932)

There is a relationship between pt and asthma, as between asthma and eczema, urticaria and migraine.

Psychological charactheristics of personality and internal pattern of the disease in patients with different types of heart rhythm disorders

Abstacts. We investigated psychological characteristics: anxiety, depression rate, hostility and aggression, subjective control level, dispositional optimism, and types of attitude to the disease in patients with different types of heart rhythm disorders.Objective. To determine psychological characteristics of personality, characteristics of the internal pattern of the disease, and quality of life in patients with different types of heart rhythm disorders.Results. 352 patients were examined. They were divided into 4 groups depending on the type of heart rate disorders: extrasystole (frequent – over 30 per 1 hour), atrial fibrillation, paroxysmal tachycardia, and deterioration of impulse conductivity, accompanied by bradycardia (sinoatrial block and sinus node dysfunction syndrome). All patients underwent a comprehensive psychodiagnostic study using the Toronto Alexithymia Scale, the Spielberger-Khanin Personal and Reactive Anxiety Scale, the Hospital Anxiety and Depression Scale (HADS), the Depression, Anxiety and Stress Questionnaire (DASS-21), the Bass-Darky test for aggressiveness and hostility diagnostics, study of the type of attitude to the disease (LOBI), the Rotter's Locus of Control Scale and the Dispositional Optimism Scale. It was found that with the same level of personality anxiety, patients with atrial fibrillation and life-threatening heart block demonstrated high levels of situational anxiety and depression. The index of aggression was the highest in patients with bradyarrhythmias and paroxysmal tachycardias. Harmonious, anxious and sensitive types of attitude to the disease are more common within all studied groups of patients with cardiac arrhythmias. Low levels of internality in health are observed in patients with extrasystole, especially in patients with atrial fibrillation. The Dispositional Optimism Test demonstrated a medium level of optimism among patients with extrasystole and paroxysmal tachycardia and a low level in patients with atrial fibrillation and cardiac conduction disorders.Conclusion. As a result of a comprehensive psychodiagnostic study, the psychological characteristics of the individual and the type of attitude to the disease in patients with various types of cardiac arrhythmias were determined. Mentioned disparities form the relevant internal pattern of the disease, which should be taken into account when planning treatment and rehabilitation measures.

Frequency and structure of cardiac arrhythmias in the early postoperative period following cardiac surgery

Funding Acknowledgements Type of funding sources: None. Background. Cardiac arrhythmias occupy one of the key places in the structure of complications of the early postoperative period following cardiac surgery. According to various literature sources, they range from 10% to 40% and often determine the course of the postoperative period. Purpose. To determine the frequency and structure of cardiac arrhythmias in the early postoperative period in the patients following cardiac surgery (up to 7 days). Methods. 56 patients were examined, among them 19 (33.9%) men and 37 (66,1%) women (p = 0.02). The age of patients ranged from 31 to 79 years, averaging 60.86 ± 8.87 years. Cardiac surgery was performed for coronary heart disease in 37 (66.1%) and valvular heart defects in 19 (33.9%) patients (p = 0.02). The duration of the operation ranged from 240 to 600 minutes, averaging 371.94 ± 102.04 minutes. In 25 (44.6%) cases, the operations were performed in conditions of bypass, the average duration of which did not differ from operations without bypass (389.44 ± 116.88 vs. 355.47 ± 86.16, p = 0.34). Assessment of cardiac arrhythmias was performed during the first 7 days after cardiac surgery. Statistical processing was performed by SPSS 12.0 for Windows. Results. 27 (48.2%) patients have developed arrhythmias within first 7 days of the postoperative period, among them in 12 (63.2%) women and 15 (40.5%) men (p = 0.24). Analysis of age structure showed that the patients <45 years didn’t have arrhythmias, 45-59 years - 8 (14.2%), 60-74 - 17 (30.4%), 75-90 - 2 (3,6%) of the patients have rhythm disorders, respectively. Atrial fibrilation (AF) dominates in the structure of arrhythmias - 17 (30.4%) patients, among them – in 11 (64.7%) patients was paroxysmal, in 6 (35.3%) – persistent form. The mean score of CHA2DS2VASc scale - 2.56 ± 0.89. Also registered atrial flutter – in 3 (5.4%), atrial tachycardia – in 2 (3.6%), supraventricular paroxysmal tachycardia – in 1 (1.8%), frequent supraventricular premarute beats (PB) – in 11 (19.6%) ), ventricular PB – in 12 (21.4%), among them ventricular PB 1st Laun class - 8 (66.7%), 2nd class - 2 (16.7%), 3rd class - 1 (8.3%), class 4A - 1 (8.3%) patients, respectively. Among the heart blocks were registered left bundle branch (LBB) block – in 4 (7.1%), anterior branch block of LBB – in 10 (17.9%), right bundle branch block – in 6 (10.7%), atrio-ventricular (AV) block 1 degree – in 4 (7.1%), complete AV block – in 8 (14.3%) patients, respectively. The implantation of the pacemaker was performed in 9 (16.1%) patients. Disorders of repolarization flattening / inversion of the T wave – in 31 (55.4%), elevation of the ST segment – in 5 (8.9%), depression of the ST segment – in 16 (28.6%), pathological Q wave – in 5 (8.9%) patients, respectively. Conclusions The prevalence of arrhythmias in the early postoperative period (7 days) following cardiac surgery is 48.2%, equally common in men and women. AF dominated in the structure of cardiac arrhythmias (30,4%).

Instrumental markers of frequent symptomatic atrial fibrillation in patients with arterial hypertension

Funding Acknowledgements Type of funding sources: None. Introduction Great attention of researchers is focused on the study of the features of electrical and structural remodeling of the heart in patients with atrial fibrillation (AF) and arterial hypertension (AH). Holter monitoring of the electrocardiogram (HM ECG) and echocardiography are used as methods for evaluating these changes. Objectives to determine instrumental markers of frequent symptomatic AF in patients with AH. Methods 146 patients with AH stage II with AF (males 68 (46.6%)) and 26 patients with AH stage II (males 11 (42.3%)) were examined in Vinnitsa regional center of cardiovascular pathology. Mean age of patients with AH and AF was (61.2 ± 0.7) years and in group with AH (59.3 ± 2.2) years. The duration of AF was (5,7 ± 0,5) years. The frequency of AF attacks was (23,6 ± 1,2) days. Paroxysmal AF was in 56 (38.4%) patients and persistent AF was in 90 (61.6%) patients. 31 (21.2%) patients have vagal, 70 (47.9%) patients have adrenal and 45 (30.9%) patients have mixed variant of AF (by Coumel). All patients underwent HM ECG and transthoracic echocardiography according to the standard protocol. Results ECG markers of frequent symptomatic AF are: amount of frequent supraventricular premature beats (SPB) (2198 vs 24, p < 0,0001), including paired and group SPBs (83,3% vs 0, p < 0,0001), presence of short asymptomatic episodes supraventricular paroxysmal tachycardia (SVPT)(33,3% vs 0, p < 0,0001) or AF (41,1% vs 0, p < 0,0001), increasing dispersion of QT interval (90 vs 70, p = 0,03) and decreasing dispersion ratio PQ/QT (0,50 vs 0,73, p = 0,03). Using the method of multiple linear regression, we determined the most informative combination of these markers: presence of SPBs more than 330 episodes/day + presence of pair and group SPBs and + presence of asymptomatic episodes of SVPT/AF (R = 0,52, p = 0,00002). Hemodynamic markers of frequent symptomatic AF are: significant increasing of absolute and relative indices of size/volume of left atrium (LA) (p < 0,0001), increasing of LA/right atrium (1,12 vs 0,92, p < 0,0001) and LA volume (LAV)/left ventricular myocardial mass (LVMM) (0,27 vs 0,21, p < 0,0001), decreasing Ve/Va (0,82, vs 0,92, p = 0,01) and isovolumic relaxation time (IVRT)(88 vs 97, p = 0,01); mitral (72,2% vs 46,2%, p = 0,01) and tricuspid (48% vs 23,1%, p = 0,02) regurgitation. Using the method of multiple linear regression, the most informative combination of these markers is: the ratio of LAV/LVMM > 0.23 ml/g + LA> 40 mm + presence of mitral regurgitation (R = 0,49, p = 0,00009). Conclusions As the most informative ECG markers of frequent symptomatic AF in patients with AH is combination of frequent SPBs (> 330 episodes/day) with pair and group SPBs and asymptomatic episodes SVPT/AF (R = 0,52, p = 0.00002 ), while echocardiography combination of markers is ratio of LAV/LVMM > 0.23 ml/g + LA> 40 mm + presence of mitral regurgitation (R = 0.49, p = 0.00009).

PROGNOSTIC FACTORS OF WOLFF-PARKINSON-WHITE SYNDROME IN CHILDREN

Objective: to determine the prognostic factors determining the severity of Wolff-Parkinson-White syndrome (WPW) in children. Methods: a retrospective analysis of the course of the disease was performed in 108 children with WPW syndrome aged 13.6 (12-16) years. Depending on the number of attacks of paroxysmal tachycardia (PT), all children were divided into 2 groups: group A consisted of 47 children (43.5%) with a history of no more than three attacks of PT and they were rare; group B included 61 children (56.5%) with frequent (more than once a month) attacks of PT, more than four in the history. We studied: the family history, the clinical picture of the disease, the nature of paroxysmal tachycardia, the effectiveness of treatment, and the results of instrumental studies. Using the method of mathematical modeling, the informative value of each feature was determined, and the diagnostic value was determined. Results: age and gender differences in the development of WPW syndrome in children were established. The presence of a family history of ECG signs of ventricular preexcitation is a reliable sign (p=0.02), contributing to more frequent PT attacks. More frequent development of PT attacks was noted in patients with mitral valve prolapse (p=0.03) and additional chords in the left ventricular cavity (p=0.001). In the group with frequent PT attacks, signs of sinus node dysfunction were detected more often (<0.001). According to the echocardiographic study, children with frequent PT attacks were more likely to have disorders in the form of thickening of the interventricular septum in the diastole (p=0.010) and signs of diastolic dysfunction of the right ventricle (p = 0.010). Conclusion: The factors of prognostic value include: male gender, the presence of the expressed symptoms of the attack of PT and PT frequency more than once per month, low vagal efficiency on relieving the attack, a history of frequent attacks, a family history of ECG characteristics of premature ventricular excitation, the presence of signs of sinus node dysfunction during 24 hours without the attack and the signs of arrhythmogenic myocardial dysfunction by echocardiography.

Induced drift of scroll waves in the Aliev–Panfilov model and in an axisymmetric heart left ventricle

The low-voltage cardioversion-defibrillation is a modern sparing electrotherapy method for such dangerous heart arrhythmias as paroxysmal tachycardia and fibrillation. In an excitable medium, such arrhythmias relate to appearance of spiral waves of electrical excitation, and the spiral waves are superseded to the electric boundary of the medium in the process of treatment due to high-frequency stimulation from the electrode. In this paper we consider the Aliev–Panfilov myocardial model, which provides a positive tension of three-dimensional scroll waves, and an axisymmetric model of the left ventricle of the human heart. Two relations of anisotropy are considered, namely, isotropy and physiological anisotropy. The periods of stimulation with an apical electrode are found so that the electrode successfully entrains its rhythm in the medium, the spiral wave is superseded to the base of the ventricle, and disappears. The results are compared in two-dimensional and three-dimensional media. The intervals of effective stimulation periods are sufficiently close to each other in the two-dimensional case and in the anatomical model. However, the use of the anatomical model is essential in determination of the time of superseding.

DISORDERS OF CARDIAC RHYTHM IN PATIENTS WITH PRE-EXCITATION SYNDROME OF VENTRICLES AND THEIR PHARMACOLOGICAL CORRECTION

The aim of the research was to analyze the possibility of using different antiarrhythmic agents in patients with pre-excitation syndrome and disorders of cardiac rhythm. Most typical disorders of cardiac rhythm in patients with pre-excitation syndrome are orthodromic reciprocating supraventricular tachycardia, antidromic supraventricular tachycardia, atrial fibrillation and atrial fibrillation. During attack of tachycardia in patients with syndrome of pre-excitation, different clinical symptoms can be observed. They can range from mild palpitation to syncope. This tachycardia can be even reason of sudden cardiac death. Main its mechanism is macroreentrant circuit involving the AV-node, the additional pathway, the atria, the ventricles. To arrest the attacks of atrioventricular reciprocating tachycardia in patients with WPW syndrome and with narrow complexes QRS, calcium channel blocker verapamil has efficacy in 95% of patients. However, for treatment this arrhythmia with wide complexes QRS verapamil is contraindicated. Besides, it should be taken in account that treatment with this type of cardiac arrhythmia cardiac glycosides is also forbidden. Verapamil and cardiac glycosides are contraindicated for termination of arrhythmia in patients with WPW syndrome and such disorders of cardiac rhythm as atrial fibrillation (flutter). For therapy of atrial fibrillation (flutter) in patients with WPW syndrome antiarrhythmic agents of agents of І A subclass (quinidine, procainamide, disopyramide, propafenone) and ІІІ class (amiodarone, sotalol) can be useful. For interruption of paroxysmal tachycardia in patients with pre-excitation syndrome antiarrhythmical preparations of plant origin (gilurytmal and allapinin) have high efficacy. Termination of paroxysmal tachycardia in patients with premature excitation of ventricles can be achieved after administration of antiarrhythmic agents of ІС subclass, in particular after using of propafenone and encainide. However, treatment with the help of these agents quite often leads to appearance of arrhythmogenic action. In pre-excitation syndrome and cardiac arrhythmias, it is impossible to use drugs, which cause the acceleration of conductivity of nerve impulses in additional pathways (cardiac glycosides, β-blocker agents, for example propranolol). In patients with paroxysmal atrioventricular reciprocating (circular) tachycardia digitalis and calcium channel blockers should be avoided. Such agents as digoxin and verapamil in this arrhythmia can turn out to be dangerous in WPW syndrome, since they raise the conductivity through additional conductive pathways.