Dynamics of daily blood pressure rhythm and heart rate variability in patients with arterial hypertension during a new form of nifedipine (Nifecad XL) treatment.

Aim. To study efficiency and safety of propafenone internally used for recovery and support of sinus rhythm in patients with the persistent form of auricular fibrillation (AF). Material and methods. 503 patients with the persistent form of A F, aged 31-68 years were included into multicenter study. Patients were randomized into 2 groups. First group included 285 patients, who were prescribed propafenone (Propanorm, PRO.MED.CS Praha a.s., Czech Republic) in a single per oral dose of 600 mg for AF paroxysm relief. Second group included 218 patients, who took propafenone for AF paroxysm prevention in daily dose of 450 mg. Efficiency of sustaining antiarrhythmic therapy was assessed in 1, 3 and 9 months after the treatment started by carrying out daily monitoring of EKG. Results. Propafenone in a single per oral dose of 600 mg leaded to sinus rhythm recovery in 230 (81%) patients. Average time for sinus rhythm recovery made up 210±50 minutes. Relief, caused by propafenone within 4 hours after taking the drug, was observed in 182 (64%) patients. Propafenone in dose of 450 mg daily lets keep sinus rhythm after 1 month of treatment in 161 patients (74%), after 3 months in 130 patients (60%) and after 9 months in 98 patients (45%). Effect of preventive antiarythmic therapy within first 3 months of treatment with propafenone can be regarded good, and within 9 months satisfactory. Conclusion. Propafenone in per oral single dose of 600 mg is an efficient method of sinus rhythm recovery in patients with the persistent form of A F, and its long-term usage in dose 450 mg daily is an efficient and safe method of sinus rhythm support

Aim. To study the effects of three-month propafenone antiarrhythmic therapy (daily dose 450 mg) on inotropic myocardial function in patients with recurrent atrial fibrillation (AF). Material and methods. The study included 18 (100%) patients aged 39-59 years (mean age 51.7±6.7 years), receiving propafenone (450 mg/d) for 3 months, to prevent recurrent AF. To assess antiarrhythmic therapy effects on inotropic myocardial function, all participants underwent balanced radionuclide ventriculography at baseline; in patients with maintained sinus rhythm, it was repeated after 3 months of treatment. Results. In first 3 days after restoring sinus rhythm in recurrent AF patients, diastolic function dynamics was observed: significant reduction in 1/3 diastole filling and peak filling velocity. After 3 months of propafenone treatment, left ventricular (LF) 1/3 diastole filling (p<0.05), as well as LV and right ventricular (RV) filling peak velocity (p<0.05), significantly increased. Ejection fraction, systolic and volumic parameters of LV and RV stayed within the normal range and did not change significantly. After 3-month propafenone therapy, recurrent AF patients demonstrated significant increase in atrial input into LV diastole – from 17.1±5.7% to 22.1±6.5%, and RV diastole – from 17.3±5.1% to 21.1±6.2% (р<0.05). Conclusion. Propafenone therapy (450 mg/d) facilitated 3-month sinus rhythm maintenance in 77% patients with recurrent AF. The therapy did not affect LF and RV inotropic myocardial function. Maintaining sinus rhythm for 3 moths facilitated normalization of atrial contractility and ventricular diastolic dysfunction improvement.

Every year, sudden cardiac death (SCD) takes lives of 400 000 American citizens, and in 10-20% ofthe cases, fatal outcome is explained by hereditary pathology. Short QT interval syndrome remains rarely diagnosed, and virtually unknown, as it was described just recently. Its clinical course is characterized by syncope or fainting episodes, and SCD in patients with corrected QT interval <320 ms. In patients with short QT syndrome, syncope can be caused by atrial fibrillation (AF) paroxysms or ventricular arrhythmias. AF episodes are typically the first manifestation ofthe disease, being registered more often in children and adolescents; some cases in new-born babies have been described. According to genetic examination results, short QT syndrome is a hereditary pathology, explained by various mutations of potassium channel gene. Genetic polymorphism in short QT syndrome manifests during antiarrhythmic treatment. At present, the single effective therapeutic method for such patients is cardioverter-defibrillator implantation.

Aim. To study inotropic myocardial function of left and right ventriculum (LV, RV) in patients with recurrent atrial fibrillation (AF), according to balanced radionuclide ventriculography (BRVG) data. Material and methods. The study included 72 patients: 30 individuals with coronary heart disease (CHD) and recurrent AF (Group I), as well as 42 CHD patients without cardiac arrhythmias (Group II). Participants’ age varied from 39 to 79 years (mean age 60.3±2.5 years). To assess systolic and diastolic LV and RV function, all participants underwent BRVG. Results. LV and RV ejection fraction was normal in all subjects. LV peak filling velocity was significantly reduced in patients with recurrent AF, comparing to arrhythmia-free individuals (p<0.05). LV end-diastolic volume in Group I was substantially lower than in Group II (p<0.05). At echocardiography, left and right atrium sizes were increased in patients with recurrent AF. Conclusion. Heart remodeling in patients with recurrent AF manifested by diastolic LV and RV dysfunction, combined with atrium size increase.

Aim. To assess blood pressure (BP) increase type and circadian BP profile in young hypertensive men aged under 35 years. To describe the association between renal function and 24-hour BP monitoring (BPM) parameters. Material and methods. Twenty-four-hour BPM was performed in 58 patients by «SpaceLabs»device (USA), during 24 hours, with 15-minute intervals in daytime (7 AM - 11 PM), and 30-minute intervals in nighttime (11 PM - 7 AM). Dynamic angionephroscintigraphy with DTPA 99mTc was performed in all participants. Most young patients had Stage I arterial hypertension (AH) (n=51; 43%), or Stage II AH (n=49; 42%). Stage III AH was diagnosed in 18 individuals (15%). Results. Transitory AH was diagnosed by temporal index (TI) in 36 patients (72%). Stable AH with AH TI>50% was observed in 14 participants (28%). Glomerular hyperfiltration was more manifested in stable AH, comparing to transitory AH: 132.0±33.5 ml/min vs 165.57±38.5 ml/min (р=0.04). Significant difference in mean glomerular filtration rates (GFR) was observed in patients with isolated inadequate systolic BP (SBP) decrease, or simultaneous inadequate SBP and diastolic BP (DBP) decrease. In patients with disturbed SBP rhythm, hyperfiltration was observed. Circadian BP profile disturbances were associated with lower mean GFR. Conclusion. In stable AH, hyperfiltration is significantly more pronounced, that is a symptom of kidney pathology as target organ damage. Twenty-four-hour BPM helped to identify a substantial group of patients non-dippers among young males: in 60% of participants, for SBP, in 24% - for SBP and DBP. Circadian BP rhythm disturbances resulted in hyperfiltration development, and inadequate DBP decrease – in reduced GFR.

Aim . To study efficacy and safety of propafenone in restoring and maintaining sinus rhythm (SR), comparing to placebo, in patients with recurrent atrial fibrillation (AF). Material and methods . The study included 60 patients with recurrent AF. For restoring SR, all patients were administered propafenone (300-600 mg/d). Twenty-four hours later, all participants with normalized SR were randomized into two groups: Group I (n=31) received propafenone (450 mg/d), Group 2 (n=15) – placebo. Follow-up lasted for 3 months. Results . Twenty-four hours after propafenone administration (300-600 mg), SR was registered in 46 individuals (76.6%), including 2 patients (3%) with SR normalization 2 hours later, 5 patients (10.9%) – 4 hours later, 23 (50%) – 6 hours later, and 16 (34.8%) – 8 hours later. Mean time to SR normalization was 364±22 minutes. Adverse effects included moderate hypotension to 105-100/70 mm Hg in 2 patients (3.3%), and transitory atrioventricular block II in 1 patient (1.7%). No other adverse reactions were registered. During 3-month propafenone treatment (450 mg/d), SR was maintained in 80.6% of patients, compared to 26.6% in placebo group. No adverse reactions were observed. Conclusion . Oral propafenone treatment is effective and safe for restoring and maintaining SR in patients with recurrent AF.

The review is devoted to an actual problem of modern cardiology – atrial fibrillation (AF) treatment in patients with chronic heart failure (CHF). Multicenter clinical trials demonstrated that CHF patients have AF more often than individuals without CHF. Algorhythms for choosing optimal antiarrhythmic therapy in AF and CHF are proposed. Possible therapeutic strategies, including use of ACE inhibitors and angiotensin II receptor antagonists, are discussed.