SPECTRAL HEART RATE VARIABILITY PARAMETERS, DELAYED VENTRICULAR POTENTIALS AND RATE TURBULENCE AS MARKERS OF CORONARY PERFUSION IN STEMI

Aim. To assess the dynamics of parameters representing rhythmical activity of the heart related to the efficacy of pharmaco-invasive revascularization in STEMI patients.

Material and methods. Totally 56 STEMI patients included that had undergone effective thrombolysis by ECG criteria of reperfusion, after that in 3-24 hours the coronary arteriography and stenting was done. Before and after PCI the telemetric ECG registration was done via “Astrocard® — Telemetry” (Meditek Ltd.,Russia). The automatic analysis of spectral parameters was done for HRV, LVP, RT.

Results. In coronary artery re-thrombosis development there is a decrease of spectrum power (TotP) (p=0,001) and increase of vagosympathic balance (L/H) (p=0,005) that points on the increase of autonomic regulation and decentralization of heart activity management. Backward dynamics is registered after successful PCI that might be related with the balance restoration between sympathetic and parasympathetic systems in effective revascularization. The tendency revealed to the increase of QRSf in re-thrombosis group and it is shown that in delayed PCI there is a growth of RMS (p=0,04), that points on the higher risk of electrical instability development.

Conclusion. The markers of developing re-thrombosis of infarction-related artery in STEMI are increase of lower frequency parameters of HRV (VLfp and LfP), decrease of total spectrum power of HRV, increase of L/H index and increase of the duration of QRSf. In delayed PCI there are higher values of RMS that represents electrical instability of myocardium for this type of patients. Telemetric ECG monitoring in STEMI patients significantly increases opportunities of the dynamic evaluation of coronary flow and electrical instability of myocardium. 

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