Background. The use of antiarrhythmic (AA) drugs requires constant monitoring due to the risk of arrhythmic and side effects. It is impossible to quickly identify and respond to emerging adverse events using 24-hour monitoring of the electrocardiogram (ECG), due to the method technical features. The introduction into practice of multi-day telemonitoring (MTM) of ECG contributes to an increase in the detection of rare and asymptomatic arrhythmias, and improves control over the AA therapy effectiveness. Objective. To study the possibilities and advantages of MTM in the selection of AA therapy and the prevention of its complications in patients with ventricular arrhythmias (VA). Design and methods. The study included 73 patients with frequent symptomatic high-grade VA (44 women and 29 men) aged 28 to 86 years (56.6 ± 28.3 years), in whom MTM ECG was performed for the purpose of individual selection of AA therapy. Results. In 19 % patients using MTM, the psychogenic nature of VA and a necessity to avoid prescribing was suspected. In 63 % patients with VA the optimal AA therapy in the minimum effective doses was selected using MTM, in 18 % patients the futility of drug therapy was proven and radiofrequency ablation was recommended. Conclusion. MTM ECG is justified for the selecting AA therapy in patients with VA. MTM has undoubted advantages over daily monitoring and helps to reduce the time for AA agent choosing.

Aim. To evaluate the relationship between the clinical decision support system use (CDSS) and adherence to clinical guidelines.Materials and methods. Medical records of 300 patients with atrial fibrillation and hypertension from the electronic medical database of the Almazov National Medical Research Center were analyzed. Demographic and clinical data, as well as information on anticoagulant, antiarrhythmic and antihypertensive prescriptions were analyzed. The primary endpoint was adherence of prescribed treatment to current clinical guidelines for each of the three therapies. Firstly, a group of independent clinical experts assessed primary endpoint for retrospective prescriptions. Secondly, new prescriptions were simulated by another group of clinical experts using CDSS and blinded to previous therapy. Primary endpoint at the second step was analysed by independent experts. We compared adherence to relevant clinical guidelines with and without use of CDSS. Additionally, we analyzed predictors of failing to meet the current recommendations in the retrospective records.Results. Out of 300 patients, only 291 (97%) had all characteristics and were included in the analysis. In 26 patients (18%), all three treatment strategies were in accordance with current clinical guidelines. Anticoagulant therapy was adherent to the guidelines in 92% of cases. Experts who used CDSS were 15% (95% confidence interval [CI], 10-21%) more likely to prescribe novel oral anticoagulants and 14% (95% CI, 10-19%) less likely to prescribe warfarin compared to baseline. Antiarrhythmic therapy was adherent to the guidelines in 69% of cases. When the CDSS platform was applied, experts were 14% (95% CI 4-19%) more likely to prefer antiarrhythmic drug (AAD) monotherapy and 32% (95% CI 26-37%) more often prescribed radiofrequency ablation (RFA) of left atrium. At baseline, antihypertensive therapy combinations were adherent clinical guidelines in 28% of cases. The use of the CDSS platform by experts was significantly associated with an increase in the frequency of prescribing dual and triple antihypertensive therapy.Conclusion. CDSS use is associated with improved adherence to current clinical guidelines. Prospective randomized trials are needed to evaluate the CDSS effectiveness in the prevention of cardiovascular events.

КАРДИОЛОГИЧЕСКИЙ ВЕСТНИК, 1, 2019 www.cardioweb.ru Согласно данным литературы, существуют три основных направления при ведении пациентов с желудочковыми нарушениями ритма: «политика невмешательства», или наблюдательная тактика, медикаментозная терапия и радиочастотная абляция (РЧА). При этом в последнее время инвазивное лечение желудочковых аритмий (ЖА) зачастую считается предпочтительным [1—3]. В основном это связано с усовершенствованием техники абляций аритмогенных очагов, а также накопленным опытом аритмологов, позволившим упростить хирургические операции, сделать их доступнее. Кроме того, все большее предпочтение хирургических процедур можно объяснить ограниченным числом существующих эффективных и безопасных антиаритмических препаратов (ААП), укоренившимся мнением об их недолгосрочном эффекте. Хотя РЧА стала доминировать над другими антиаритмическими (АА) методами лечения ЖА, обсуждается и целый ряд недостатков инвазивных воздействий. Это прежде всего труднодоступность некоторых очагов эктопии, возможные осложнения процедуры, отсутствие современного оборудования и необхо© Коллектив авторов, 2019 https://doi.org/10.17116/Cardiobulletin20191401146

To assess the normal ranges of heart rate, PQ interval, QT interval, as well as to reveal cardiac arrhythmias typical for healthy subjects, the analysis of ECG Holter monitoring data of 200 healthy persons (69 women and 131 men) aged 30.78±0.77 years (16 52 years) was made.

Based on analysis of the literature data on the management of patients with ventricular arrhythmias, a unified Holter monitoring report containing clinical and electrocardiographic characteristics has been developed which may facilitate selecting the treatment strategy.

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 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.

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.

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.

This study was aimed at the assessment of antiarrhythmic (AA) effectiveness of myocardial revascularisation (MR), as well as the evaluation of the Mexicor (M) role in the complex management of coronary heart disease (CHD) patients with high-grade ischemic ventricular arrhythmia (VA). In total, 34 patients underwent MR, based on the clinical, instrumental, and angiographic indications. Another 20 patients, who refused MR, or did not have clinical and angiographic indications for it, received conservative treatment, with an addition of M (300 mg/d). AA effectiveness of MR and M was assessed during Holter ECG monitoring, stress tests, and radionuclide examination. MR effectiveness, regardless of the intervention type, was maximal in the early post-surgery period (79,4%) and decreased later, reaching 55,8% after 12 months. In patients who did not undergo MR, M therapy demonstrated good AA effectiveness (75-100%). Therefore, the restoration of coronary circulation and myocardial metabolism agrees with the principles of complex etiopathogenetic treatment of ischemic VA.