The aim of the study was a comparative assessment of the results of various mental stress-tests (MT) and the development of a common MT protocol to assess the contribution of psychogenic factors in arrhythmogenesis in patients with ventricular arrhythmias (VA) in the absence of structural heart disease. There were 66 patients with idiopathic VA and anxiety neurotic disorders (AND) drawn from 400 patients after examination (ECG, Holter ECG monitoring, echocardiography, treadmill exercise test, coronary angiography and MRI when necessary; psychological examination and a consultation by a psychotherapist). MT were performed all patients according to the study protocol. Results. Correlation analysis of hemodynamic parameters in a rest period between all MT showed there were no differences in the period of rest between MT. Consequently, the test sequence does not affect its results. According to a comparative and correlation analysis there were stasistically significant differences between MT only in hemodynamic parameters changes. There were not stasistically significant differences in the change of VA during the conduct of MT. Conclusion. Use of MT allows to evaluate the contribution of psyhoemotional factor in the genesis of VA in patients with idiopathic arrhythmia and AND. The whole complex of MT must be used to evaluate the psychoemotional factors in the genesis of VA considering that the more tests we spend, the more likely to get a patient’s response to some test.

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.

The actual condition of a problem of ventricular arrhythmias in pregnant women without structural heart diseases is reviewed; pathophysiologic mechanisms, diagnostic, treatment are discussed.

The paper proposes an original scheme for the management of patients with ventricular arrhythmia from the stage of its first registration to choosing of management. Using the modern diagnostic methods the scheme step-by-step helps to reason out the answer to a diagnostic problems considering the role of structural and ischemic myocardial transformations, the role of autonomic and central nervous system. Multiday electrocardiogram monitoring with telemetric data transmission is the possibility for quick and out-patient treatment even continuing working. The key point of suggested scheme is the prevention of sudden cardiac death.

Accelerated idioventricular rhythm is a ventricular rhythm consisting of three or more consequent mono- or polymorphic complexes. It might be registered in patients with structural heart diseases, rarer in completely normal heart, might be found in sportsmen and children. Idioventricular rhythm might be seen in myocardial infarction, in reperfusion and under medications influence.The article focuses on the literature data that led to identification of this important ventricular arrhythmia.

In this article are considered the etiology, the pathogenesis, the clinical соurse, the differential diagnostics and is demonstrated a successful treatment using psychotherapy and psychotropic drugs administration for psychogenic ventricular tachycardia on the background of spontaneous remission of alcoholic dependence in the young man with structurally normal heart.

To assess potentialities of application of multi-day (MD) ECG monitoring with telemetry to reach an optimal time of correction of already diagnosed clinically significant arrhythmias, 30 patients were examined, including 8 patients with arterial hypertension, 5 patients with coronary artery disease, 2 patients with the connective tissue systemic dysplasia, cardiomyopathy of an undetermined origin, and congenital heart disease each, and 1 patient with idiopathic pulmonary hypertension, catecholaminergic ventricular tachycardia (VT), long QT syndrome, dilated cardiomyopathy and hypertrophic cardiomyopathy each. Nine patients had idiopathic arrhythmias. Ventricular arrhythmias (VA) were revealed in 18 patients, 12 patients constituted the patient group with paroxysmal atrial fibrillation (AF). For MD ECG, the “Kardiotekhnika 07” device with wireless channels in the GSM, G3, G4 standard and transfer of current or saved ECG onto CardioServer any time. The duration of selection of an effective antiarrhythmic therapy (AAT) in 30 patients was 11.3±3.2 days (4 30 days). The effectiveness of AAT, its doses and the time of intake was verified in all study subjects no less than within 3 days following the achievement of the treatment effect. In 3 patients with idiopathic VA, none of AATs taken was effective; the patients were referred for surgical treatment. In all patients with ventricular arrhythmias, MD ECG permitted one to select an optimal treatment strategy, either to find an optimal or to confirm ineffectiveness (and impossibility) of the medical treatment (conservative therapy) and to persuade patients to undergo RFA of an ectopic focus. In a half of patients with paroxysmal AF, the MD ECG technique permitted one to select the effective protecting AAT to maintain the sinus rhythm for 8.3±3.6 months. Thus, the use of MD ECG permitted one to perform the fast AAT selection in most patients.

The differential effects of positive versus negative emotions on autonomic nervous system activity are insufficiently understood. This study examined the role of acute mood responses and central nervous system activity on heart rate variability (HRV) using 5-min event recall tasks (happiness and anger recall) and a 5-min Stroop Color Word Test (SCWT) in 20 healthy individuals (mean age 25 ± 4 years, 55% female). HRV was measured in high frequency (HF) and low frequency (LF) domains, and frontal brain activity using electroencephalography (EEG) in the alpha frequency band in F3 and F4. Happiness Recall resulted in increased LF-HRV (p = 0.005) but not HF-HRV (p = 0.71). Anger Recall did not change HRV (p-values > 0.10). The SCWT produced decreases in HF-HRV (p = 0.001) as well as LF-HRV (p = 0.001). The magnitude of feeling “happy” during Happiness Recall was positively correlated with ΔHF-HRV (p = 0.050), whereas an incongruent mood state (“frustrated”) was associated with smaller ΔHF-HRV (p = 0.070). Associations between frontal EEG activation and HRV responses were mostly non-significant, except for increased right frontal activation during Happiness Recall which was associated with a decrease in LF/HF ratio (p = 0.009). It is concluded that positive and negative mood induction result in differential HRV responses, which is related to both task valence and the intensity of task-induced emotions.

To clarify advantages of the method of long-term ECG monitoring, assess its diagnostic value with regard to rare arrhythmic events, and document its correlation (or lack of correlation) with clinical symptoms, 84 patients (27 women and 57 men) aged 48.3±22.6 years (7 months - 80 years) were examined. Twenty nine patients had arterial hypertension, 22 ones had coronary artery disease; cardiomyopathy of undetermined origin was diagnosed in 4 patients, dilated cardiomyopathy, in 2 ones, and hypertrophic cardiomyopathy, in 2 ones. The systemic connective tissue dysplasia was revealed in 1 patient, idiopathic pulmonary hypertension, in 1 patient, and syndrome X, in 1 patient. In 23 subjects, cardiac arrhythmias were considered idiopathic. Before long-term ECG monitoring, the patients were counseled in depth in ECG transfer through the Internet, the diary was given for recording subjective feelings, additional electrodes for replacement and recommendations for daily activities during long-term ECG monitoring were given, as well. The long-term ECG monitoring device with telemetric control was installed to study subjects, in which the system of 3 canal ECG recording of 7 leads was used. A laptop was also given to the study patients to be used for ECG upload into the server. When receiving the information on the server via the Internet, a physician analyzed it using the KTResult 3 software product. Indications to long-term ECG monitoring were as follows: symptomatic palpitations and painful irregular heartbeats, which were not recorded during previous Holter monitoring, in 69 patients and syncope/pre-syncope of unknown origin, in 15 patients. The duration of long-term ECG monitoring with the telemetric control was 7.9±3.2 days (4 39 days). During long-term ECG monitoring, the correlation of palpitations and irregular heartbeats with cardiac arrhythmias was documented in all 69 study subjects: ventricular tachycardia was documented in 31 subjects, paroxysmal atrial fibrillation/flutter, in 14 patients, paroxysms of sustained atrial tachycardia, in 8 subjects, and sinus tachycardia, in 16 patients. In 15 patients with complaints of syncope or pre-syncope, their correlation with cardiac arrhythmias was confirmed only in 5 cases. No complications during long-term ECG monitoring were documented. The authors’ experience in the long-term ECG monitoring gives evidence that a novel effective technique has been introduced which permits one to speed up the diagnosis of severe cardiac arrhythmia, contributes to confirmation/exclusion of arrhythmic origin of rare syncope and episodes of palpitations. This, in its turn, can contribute to selection of the optimal treatment strategy, including timeliness of surgical procedures (implantation of pacemakers and cardioverters-defibrillators, radiofrequency catheter ablation). The novel method will be indeed of importance in case of conservative management of arrhythmic patients.

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.

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.