VENTRICULAR EXTRASYSTOLIA IN PATIENTS WITH NON-ST ELEVATION ACUTE CORONARY SYNDROME: ASSESSING THE RISK OF LIFE-THREATENING VENTRICULAR ARRHYTHMIAS (CLINICO-EXPERIMENTAL STUDY)

The study aimed to assess the risk of life-threatening ventricular arrhythmias (LTVA) in patients with non-ST elevation acute coronary syndrome (ACS) and ventricular extrasystolia (VE) developing in the first 24 hours of ACS. In 46 dogs, VE with early, postponed post-depolarisation, re-entry and ischemic mechanisms was modelled. In total, 168 patients with non-ST elevation ACS and Class II-V Lawn VE were examined. All patients underwent general clinical examination as well as the assessment of late ventricular potentials (LVP), QT interval dispersion (QTd), and heart rate turbulence (HRT). In the experimental study, persistent ventricular tachycardia and/or ventricular fibrillation developed in 100%, 75%, and 85,71% of the animals with early post-depolarisation, re-entry and ischemic VE mechanisms, respectively. In the clinical study, LTVA was observed in 13,76 % of ACS patients, including 69,32 % with arrhythmia development in the first 3 days. Positive predictive value for LVP, QTd>80 ms and pathologic HRT was no more than 42%. LTVA risk could be assessed by the formula: LTVAR = А ÷ В, where LTVAR is LTVA risk in units, A – linear deviation of corrected pre-ectopic interval (ms) for at least 20 ventricular extrasystoles, calculated separately for left and right VE, and B – analysed ventricular extrasystole number (per hour). LTVAR<0,5 could be a marker of high LTVA risk, with positive predictive value of 96,34%, in non-ST elevation ACS patients with VE.

Acute coronary syndrome, ventricular extrasystolia, life-threatening ventricular arrhythmia risk assessment

1. Бокерия Л.А., Голухова Е.З. Лекции по кардиологии. – М, 2002.- 296 с.

2. Всероссийское научное общество кардиологов. Рекомендации по лечению острым инфарктом с подъемом сегмента ST электрокардиограммы. // Кардиоваcкулярная терапия и профилактика. – 2007.-№ 6, приложение. – 66 с.

3. Клиническая кардиология. Пер с англ. под ред. В.Н. Хирманова. – 2-е издание, перераб. и доп. – М.; СПб.: «Издательство БИНОМ» – «Невский Диалект», 2002. – 672 с.

4. Мазур Н.А. Пароксизмальные тахикардии.– М.: ИД Медпрактика. – М, 2005. – 252 с.

5. Олесин А.И., Шабров А.В., Голуб Я.В. и др. Оценка эффективности лечения желудочковых нарушений сердечного ритма у больных ишемической болезнью сердца в зависимости от механизма их развития. // Кардиология.-2000.-№ 1.-С.64– 68.

6. Олесин А.И., Шабров А.В., Синенко В.И. и др. Возможность дифференцированного лечения желудочковых нарушений сердечного ритма в зависимости от механизма их развития. // Кардиолгия.-2005.-№ 5.-С.75–76.

7. Олесин А.И., Шабров А.В., Козий А.В. и др. Способ прогнозирования внезапной смерти у больных с лево- и правожелудочковой экстрасистолией – Патент Российской Федерации № 2312591// Бюллетень изобретений № 35.

8. Bogun F., Crawford T., Chalfoun N. et al. Relationship of frequent postinfarction premature ventricular complexes to the reentry circuit of scar-related ventricular tachycardia. // Heart Rhythm. – 2008. –Vol.5, N 3. – P. 367–374.

9. Braunwald E., Antman E.M., Beasley J.W. et al. ACC/AHA 2007 Guidelines for the Management of Patient with unstable angina/Non-ST-Elevation Myocardial Infarction. A Report of the American College of Cardiology/ American Yeart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patient with unstable angina/Non-ST-Elevation Myocardial Infarction). // J. Am. Coll. Cardiol. – 2007. – Vol. 50, N1 suppl. Е. – P. Е1-Е157.

10. Braunwald’s Heart Disease. A textbook of cardiovascular medicine. 8/ed Libby P. et al.– Phyladelfhia, W.B. Saunders Company, 2007.- 2183 p.

11. Breithardt G., Cain M.E., el-Sherif N. et al. Standards for analysis of ventricular late potentials using high resolution or signal-averaged electrocardiography. A statement by a Task Force Committee between the European Society of Cardiology, the American Heart Association and the American College of Cardiology// Eur. Heart J.- 1991.- Vol.12., N 4. – P. 473–80.

12. Фейгенбаум Х. Эхокардиография. Пер. с англ. Под ред. В.В. Митькова. – М.: Видар, 1999. – 512 с.

13. Физиология и патофизиология сердца: Т.1: Пер. с англ./Под ред. Н.Сперлаксисиса. – М.: Медицина, 1990. – 624 с.

14. Schmidt G., Malik M., Berthel P. et al. Heart rate turbulence after ventricular premature beats as predictor mortality after acute myocardial infarction // Lancet. – 1999.- Vol. 353, N 2. – P.130–196.