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AIM: To analyse the results of using transesophageal pacing (TEP) for correction of atrial fibrillation of type I (AF). MATERIAL AND METHODS: The study included 1283 patients with coronary heart disease (CHD) and newly diagnosed AF. All the patients were examined with transthoracic echocardiography, received basic antianginal treatment. AF was corrected with TEP. RESULTS: Sinus rhythm was reestablished in 83.48% patients, in 67.33% TEP was made without previous antiarrhythmic therapy, in the rest patients with this pretreatment. The best result was observed in pre-pacing administration of amiodaron or its combination with hinidin-durules. Only 2.88% patients retained AF after TEP. CONCLUSION: TEP is an effective method of type I AF treatment.

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Modulated kinesitherapy (MK) is a new method based on synchronization of vegetative and motor components in walking at a pace corresponding to actual heart rate which is maintained during the procedure with cardiotrainer Marafon. MK produced the following therapeutic effects: optimization of cardiovascular functions (weakening of postload on the heart with lowering of arterial pressure; improvement of coronary blood flow, stabilization of the heart rate and cardiac pump function); marked antiarrhythmic effect, normalization of autonomic nervous system tonicity, neurohumoral and psychoemotional state. MK is indicated in ischemic heart disease, essential hypertension, cardiac arrhythmia, vegetovascular asthenia.

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AIM: To determine optimal mode of transesophageal pacing for selection of appropriate antiarrhythmic therapy for prevention of attacks of atrial fibrillation and flutter in patients with ischemic heart disease. MATERIAL AND METHODS: Two hundred eighteen patients with ischemic heart disease and attacks of atrial fibrillation or flutter. Selection of antiarrhythmic drugs was carried out with the use of competitive, rapid, salvos of ultra rapid, and slowly accelerating ultra rapid modes of pacing. Results. Most effective and reproducible method for induction of attacks of atrial flutter and fibrillation was slowly accelerating ultra rapid mode of pacing. Average duration of positive clinical effect of preventive antiarrhythmic therapy selected basing on the results of this mode in patients with ischemic heart disease was 3.1-/+0.3 years. Unfavorable prognostic sign decreasing preventive effect of antiarrhythmic therapy was left atrial dilatation. CONCLUSION: Slowly accelerating mode of transesophageal pacing was most effective tool for selection of antiarrhythmic therapy aimed at prevention of attacks of atrial fibrillation and flutter in patients with ischemic heart disease.

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AIM: Prediction of the rate of recurrent paroxysms of atrial fibrillation (AF) and flutter (AFl) after the first arrhythmia episode; determination of relevant antiarrhythmic treatment. MATERIAL AND METHODS: 157 patients with ischemic heart disease (IHD) complicated by new episodes of AF and AFl entered the study. After the initial episode and 1-2 arrhythmia recurrences all the patients have undergone assessment of hemodynamics, atrial conduction of excitation, sinus node function using transesophageal pacing. The patients were divided into two groups: group 1 consisted of 42 patients having no recurrent paroxysms of AF or AFl for at least 6 months; 115 patients of group 2 had at least one episode of recurrent arrhythmia for 6 months after the first paroxysm. RESULTS: Patients of group 2 vs those of group 1 had a significantly longer first episode, more frequent occurrence of calcinosis of mitral and/or aortic valve, more serious systolic and diastolic dysfunctions and most frequent retrograde atrial excitation conduction after the first paroxysm. CONCLUSION: In detection of only disturbed intraatrial conduction in IHD patients after the first paroxysm of AF and AFl predicted are clinical recurrences of arrhythmia with the recurrence-free period more than 6 months. In retrograde atrial conduction of excitation combined with systolic and diastolic left ventricular dysfunction, sinus node dysfunction prognosis was made of more frequent episodes of AF and AFl.

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AIM: Choice of optimal cardiostimulation regimens using transesophageal pacing for design of antirecurrence antiarrhythmic therapy (AAT) in IHD patients. MATERIAL AND METHODS: 198 patients with IHD complicated by paroxysms of atrial fibrillation (AF) and atrial flutter (AFl) received AAT chosen at concurrent, frequent, volley UHF and slowly increasing UHF stimulation using transesophageal pacing. RESULTS: Slowly increasing UHF stimulation proved most effective both in detection and reproduction of induced paroxysms of AF and AFl. The duration of positive clinical effect of antirecurrence AAT of AF and AFl paroxysms in IHD patients determined at using this regimen of cardiostimulation averaged 3.1 +/- 0.3 years. Left atrial dilatation is an unfavorable prognostic criterion in respect to efficacy of the recurrence AAT. CONCLUSION: Slowly increasing UHF stimulation is most effective in determination of antirecurrence AAT of AF and AFl paroxysms in IHD patients.

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AIM: To try feasibility of non-invasive registration of intra- and interatrial conduction by means of simultaneous registration of echo-CG (in B and M modes) and ECG. MATERIALS AND METHODS: The time of intra- and interatrial conduction was measured at simultaneous registration of echo- CG (B and M modes) and ECG in standard lead II. The time of atrial conduction was registered in ms from the start of ECG wave "P" to beginning of echo-CG mechanical contractions. The results were compared to those obtained at the direct method (registration of atrial conduction by electrode fixed on the atrial myocardium). RESULTS: The data by the two above methods showed high correlation (for intraatrial conduction r = 0.93, for the interatrial one r = 0.85). The study confirmed the leading role of end-diastolic volume of the left ventricle and/or uneven wave movement along the atria in development of supraventricular arrhythmia in coronary heart disease. CONCLUSION: The proposed non-invasive method can find application for estimation of atrial conduction both in clinical practice and experiment. The time of exitation conduction through the atria measured by the new non-invasive method and the direct method is almost the same.

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AIM: To ascertain optimal antiarrhythmic therapy (AAT) in paroxysms of atrial fibrillation (AF) and atrial flutter (AFl) basing on their pretreatment duration. MATERIALS AND METHODS: A total of 2851 coronary heart disease (CHD) patients with AF and AFl paroxysms aged 40-75 years were treated from 1982 to 1996. The patients received sublingual or oral drugs (anaprilin, ethacizine, quinidine, etc.) or intravenous antiarrhythmic drugs (ritmilen, isoptin, novocainamide, etc). RESULTS: In pretreatment duration of AF and AFl up to 3 hours more pronounced effect was observed with sublingual and intravenous antiarrhythmic drugs. In the paroxysm duration up to 6 days, maximal antiarrhythmic effectiveness occurred in the use of intravenous antiarrhythmic drugs or quinidine, quinidine + verapamil. In the paroxysm duration from 7 days to several months, positive effect was achieved only in administration of quinidine or quinidine + verapamil. CONCLUSION: The principle of differentiated therapy of AF and AFl in CHD patients depending on the paroxysm duration before treatment allows choice of adequate therapy by enhancing its antiarrhythmic and weakening arrhythmogenic effects.

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Selective coronarography, assessment of hemodynamics, sinus node function, sinoatrial and intraatrial conduction were performed in 53 coronary heart disease (CHD) patients with supraventricular arrhythmia. The severity of cardiac rhythm paroxysms was evaluated at transesophageal pacing by measurements of arrhythmia induction frequency threshold. 29 patients underwent aortocoronary shunting. No relationships were found between the pattern of arrhythmia, degree of stenosis, number of coronary lesions. Aortocoronary bypass changed neither pattern nor severity of supraventricular arrhythmia.

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Antiarrhythmic treatment (AAT) adjusted to the variety of arrhythmia and risk to develop complications was given to 336 patients with ischemic heart disease associated with paroxysms of supraventricular tachycardia (SVT), atrial fibrillation or atrial flutter. In the presence of risk to develop AAT complications, the method of choice for SVT patients is transesophageal pacing and impulse therapy. In the presence of arrhythmic collapse, cardiac asthma and pulmonary edema it is preferable to correct arrhythmia by electric impulse therapy.

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Experiments were conducted on Wistar rats to study the effect of laser radiation (LR) with a wavelength of 632.8 and 890.0 nm and power of 0.0005-0.005 and 0.003-0.003 W/cm2, respectively, on the action potential (AP) and mechanical contraction of smooth muscle cells, as well as myocardial ATPase activity. LR with a wavelength of 632.8 and 890.0 nm in a dose of 3.0 J/cm2 activates Ca-ATP-ase activity, increases the activity of the myocardial antioxidant system, reduces the Na-Ca current through the membrane, and accelerates the return of Ca2+ into the sarcoplasmic reticulum. LR with a wavelength of 632.8 nm reduces mainly the Ca flow, while LR with a wavelength of 890.0 nm reduces the Na current In a dose of more than 3.0 J/cm2 LR causes a damaging effect manifested by increased Ca2+ current in the slow channels, increase of amplitude, duration of AP and repolarization phase. Synergism of the action of LR with a wavelength of 632.8 and 890.0 nm and that of some antiarrhythmic agents (procainamide, lidocaine, ethmosin, ethacisin, verapamil) was encountered.

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The antioxidant effect encountered in laser irradiation of venous blood suggested the study of the possibility of its use for the prevention of the reperfusion syndrome in myocardial infarction (MI). Analysis of biochemical, electrophysiological, hemodynamic, and morphohistological data obtained in experiments on male rats and in clinical cases showed that irradiation of venous blood by the LG-75 helium-neon laser with a wavelength of 632.8 nm produced the best effect. The effect is realized through increase of collateral blood supply in the region of the MI and the antioxidant and antihypoxic action.

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ACTH, hydrocortisone and cyclic nucleotides levels, beta-receptors sensitivity, lipid peroxidation (LPO), antioxidant system, hemodynamics were investigated in 93 coronary patients without myocardial infarction in the presence of cardiac arrhythmia and after its correction. The clinical and laboratory findings indicate that it is primarily LPO activation and LPO products excessive accumulation in the blood that are responsible for arrhythmia emergence. Experimental data support these results by showing possibility of cardiac arrhythmia onset due to LPO products which raise the density of Na-Ca channels and inhibit the activity of Ca-dependent ATPase.

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Overall 93 patients suffering from coronary heart disease /CHD/ (without acute myocardial infarction) complicated by cardiac rhythm impairment were followed up. Investigation of lipid peroxidation (LPO) and of the antioxidant system (AOS) in those patients revealed LPO activation and a decrease of the AOS activity both at the moment of arrhythmia and after its arrest, with the highest LPO activation being seen in the hyper- and hypokinetic hemodynamic variants. The experimental studies have demonstrated a reverse relationship between the rise of LPO products in the blood, LPO activation in myocytes and the onset of arrhythmia because of an increase in the density of Na(+)-Ca++ channels of the membrane, accumulation of those ions by the cell, and an increase of the transmembranous potential at rest. Therefore, to prevent and treat cardiac rhythm impairment in CHD patients, it is necessary to administer the blockers of Na(+)-Ca++ channels (etmozin, ethacizine, verapamil and so forth) and antioxidants that raise the reserve capacity of the AOS, including laser therapy.

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Proceeding from analysis of hemodynamic parameters at the time of paroxysmal supraventricular arrhythmia in 333 CHD patients observed by a specialized first aid cardiological team, differentiated therapy of these arrhythmias was proposed with relation to the nature of arrhythmia and the hemodynamic status at the time of arrhythmia. A method was proposed for the detection of a hemodynamic variant at the time of occurrence of paroxysmal arrhythmia according to clinical manifestations without resort to instrumental methods of investigation.

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Basing on an analysis of left ventricular myocardial segmental contractility (according to the results of ultrasonic scanning) diagnostic criteria have been defined for patients with myocardial infarction and unstable angina to detect these diseases on the 1st day of a patient's stay in the in-patient department and to diagnose myocardial infarction when findings of electrocardiography and enzymatic diagnostics provide little information.

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