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Aim: To study the postictal changes in the autonomic regulation of the heart rhythm and its functional capabilities in different periods after epistatus and to assess the risk of life-threatening arrhythmias., Material and Methods: The study was conducted on Wistar rats after epileptic status (ES). Telemonitoring of EEG and ECG was performed in the online mode using the system of the company 'ADInstruments'. Functional stress test with dobutamine was used., Results: ES leads to a long-lasting disturbance of autonomic regulation (AR) of the heart and reduces its functional capabilities. The heart's AR balance is shifted towards sympathetic tonus 5 days after ES. This increases the predictors of life-threatening arrhythmias. The decrease in SWD activity increases the activity of parasympathetic tonus 10 days after ES. However, this is due to the tension of regulation mechanisms and the risk of life-threatening arrhythmias., Conclusion: The high degree of seizure activity of the brain in the ES predetermines prolonged postictal disorders of the AR heart, which reduce its functional capabilities and increase the risk of life-threatening arrhythmias.

A syndrome of early repolarization, common in professional athletes, has recently been considered as a possible predictor of acute arrhythmias. It is known that for this category of young people the development of compensatory hypertrophy of the heart is also common. The aim of the study was to investigate the features of early ventricular repolarization in professional athletes, depending on the presence of signs of cardiac hypertrophy. The study included 28 high-level competition athletes who had regular intensive physical activity for at least six months. Syndrome of early repolarization was diagnosed on the basis of ECG registration, in case of elevation of the J-point on 1 mm and more above the isoelectric line in the lower or lateral leads was detected. Diagnosis of cardiac hypertrophy was established by electrocardiography and echocardiography. On the background of high prevalence of early repolarization syndrome in professional athletes, we did not reveal the statistically significant relationship between its presence and cardiac hypertrophy. However, the combination of these two syndromes in the examined athletes was accompanied by a statistically significant shortening of the corrected QT interval, the last, in a case of the presence of certain anamnestic data, may be one of the risk factors for acute arrhythmias. This necessitates a deeper examination of such patients and monitoring of them. Further studies are needed to determine the prognostic value of early repolarization in athletes with cardiac hypertrophy.

Objective: to investigate possibilities of noninvasive electrophysiological mapping (NEM) during biventricular (BiV) pacing and to compare the results with data of 12 lead ECG and tissue Doppler echocardiography (TDI)., Material and Methods: The study included 25 patients with complete left bundle branch block (LBBB) and implanted cardiac resynchronization therapy (CRT) system. Twenty-two patients were CRT responders, three other patients did not demonstrate a clear effect. NEM was performed with "Amycard 01C EP LAB" system and multi slice computed tomography., Results: Qualitative analysis of isochronous maps at NEM showed that the most homogenous color coding of the left ventricle (LV) may correspond to the optimal BiV pacing mode. A statistically significant positive correlation between the width of the QRS complex during a set BiV pacing mode and the standard activation deviation time, measured at NEM, for 12 segments (SD12) LV (r= 0,88, p<0,0001) was observed. With the minimum value of SD12 and biventricular QRS width at the same time, three patients had intraventricular dyssynchrony. A comparative analysis of NEM and TDI methods in terms of interventricular dyssynchrony (IVD) at LBBB revealed statistically significant positive correlation (r=0,58, p=0,005)., Conclusion: These data show that both minimal values of QRS and SD12 at BiV pacing are not accompanied by the effect of CRT in all patients. The lack of response from this type of therapy is associated with a non-optimal position of the LV electrode. Qualitative assessment of isochronous maps at NEM demonstrates intraventricular dyssynchrony and can help in selecting the optimal mode of BiV pacing.

Definition of the most important factors and their combination, causing the disturbances of heart rhythm in patients with the pulmonary tuberculosis and diabetes, now attracts more and more attention. For this purpose, extensively used the capabilities of multifactorial analysis, which allowed to evaluate the distribution of the pathological factors and their interaction with each other. The objects of the study were complex examination the data of 90 patients with pulmonary tuberculosis and diabetes (insulin-dependent diabetes-27, non-insulin- dependent diabetes-63). In the mathematical processing of the instrumental methods we analyzed the results of echocardiography, indicators of respiratory function and the results of the Holter ECG monitoring. The use multifactorial mathematical analysis has allowed to establish the most significant pathogenetic factors and their combinations, causing disrhythmogenesis. In patients with pulmonary tuberculosis and diabetes with a combinations of right ventricular hypertrophy with a tendency to pulmonary hypertension and respiratory function parameters most commonly observed ventricular arrhythmias. On the occurrence of supraventricular arrhythmia mainly influenced by pulmonary hypertension and left ventricular hypertrophy.

Data on the pathophysiological mechanisms of arrhythmias and the elecrophysiological mechanisms of antiarrhythmic drug action are reviewed. Development of the classification of antiarrhythmic drugs is analyzed.

Two mechanisms responsible for the emergence of arrhythmia are known: a change of part of the cells to a self-oscillatory mode and generation of circulating waves. In this paper, we investigate the generation mechanism of the circulating waves using the unidirectional block. One of the variants of its realization is a narrow gap between two non-conducting regions. Implementation of this mechanism in the human heart turns out to be impossible, since in the heart in which the duration of cardiac action potential lasts 0.3 s and the velocity of wave propagation is equal to 33 cm/s, the minimal length of the pathway for wave circulation is approximately 10 cm, while the distance between the ventricular apex and atrioventricular septal is, on the average, 8 cm. Therefore, that inhomogeneity cannot exist at the scale of human heart. To adapt this mechanism to the size of the human heart, we introduce into the scheme the regions with low conductivity, which provide slow propagation of the wave. The value of conductivity is chosen based on the results of evaluation of the "conductivity-wave velocity" correlation. The analysis of wave propagation through the boundary between two regions with different conductivities has shown that the refractory period depends on the conductivity ratio. To minimize this dependence we introduce the transition zone, in which conductivity changes linearly from some normal value to a reduced one. This allowed us to generate a 12-mm inhomogeneity area, provoking the appearance of the circulating wave.

Cardiac manifestations of gastroesophageal reflux disease (GERD) including retrosternal pain and cardiac rhythm disorders were often mentioned in early publications. However, classification of GERD adopted at the 2005 Montreal congress does not include such conditions. Non-coronarogenic pain in the thoracic cage is recognized to be a typical esophageal syndrome while the reflex spasm of coronary arteries and cardiac rhythm disorders associated with GERD should be regarded as manifestations of comorbidity of GERD and cardiovascular diseases. Arrhythmias occur in 30% of patients with GERD, but relevant therapeutic and preventive modalities are poorly developed. Nor are there reliable predictors of arrhythmias. An important role in their pathogenesis in patients with GERD is played bydisbalance of sympathetic and parasympathetic components of vegetative nervous system (VNS). One of the approaches to studying this issue is the analysis of heart rhythm variability (HRV). We consider basic principles of clinical interpretation of the results of HRV research that allow to evaluate the state of VNS and interaction of its components. Analysis of recent publications gives evidence that many HRV parameters depend not only on the balance between components of VNS as was believed by earlier authors (for the lack of their reciprocal relationship) but also on the activity of these components. Other modulating factors include the heart rate, respiratory pattern, intrathoracic pressure, and diastolic atrial extension. We report the results of HRV assessment in patients with GERD that illustrate heart rhythm rigidity and predominant disorders of activity of the parasympathetic component of VNS especially well apparent in patients with erosive reflux esophagitis. However, other authors demonstrate oppositely directed changes and the involvement of the sympathetic component. A possible cause of this discrepancy is factors other than VNS influencing HRV. It is concluded that analysis of HRV can be used to develop a method for the prevention of GERD-associated arrhythmia. The diagnostic value of such method is limited and requires new algorithms for data interpretation taking account of their multifactorial origin.

Based on the results of experiments on nonlinear white awake male rats it is established that 2-ethyl-6-methyl-3-hydroxypyridine hemisuccinate and mexidol exhibit a pronounced antiarrhythmic (antifibrillatory) activity on the calcium chloride arrhythmia model. The maximum effect was observed for hemisuccinate 2-ethyl-6-methyl-3-hydroxypyridine. This substaned; unlike mexidol, also showed high activity on the model of aconitine arrhythmia, which is typical of class I antiarrhytmics. Mexidol did not show this activity. Consequently, 2-ethyl-6-methyl-3-hydroxypyridine hemisuccinate possesses a wider therapeutic spectrum than the well-known antiarrhythmic drugs of class I (lidocaine, procainamide) and is comparable in this respect with class IV drug verapamil.

The effectiveness of drug remaxol inclusion in the scheme of treatment of patients with myocardial infarction on the background of degree III - III acute cardiac insufficiency was evaluated by the analysis of clinical and laboratory data of 126 patients with newly diagnosed acute myocardial infarction including ST-segment elevation on the background of acute cardiac insufficiency. Depending on the regimen, patients were divided into two groups. The first (control) group included 60 patients who received conventional thrombolytic therapy; the second (main) group included 66 patients which, after thrombolytic therapy, received remaxol (single daily intravenous administration, 400 mL at 3 - 4 mL/min rate) with controlled central venous pressure, arterial pressure, and diuresis. The course lasted for 3 - 5 days, depending on the severity of condition. A high efficiency of the treatment regimen including remaxol was established as characterized by more rapid (in comparison to conventional therapy) stabilization of disturbed systemic hemodynamics and recovery of weakened myocardial contractility, decreased risk of cardiac arrhythmias, and relieved hyperhomocysteinemia that, in turn, reduced the risk of complications such as thrombosis and thromboembolism.

The autonomic and central nervous system, a number of humoral and reflex effects regulate the heart rate. The main role in the heart rate regulation belongs to the autonomic nervous system. A common method for studying the autonomic influences on the heart rate is the analysis of heart rate variability (HRV), which allows to evaluate the neuro-vegetative status of the organism, determine its adaptive capacity, to evaluate the level of stress and the degree of tension of regulatory systems. An age-related decrease of HRV measurements in healthy people reflects the weakening of the autonomic regulation of cardiac activity. The most pronounced changes are found in patients older than 60 years. The HRV depression is preceded by hemodynamic and metabolic disorders is associated with high cardiovascular risk and is a predictor of life-threatening arrhythmias and sudden death in the elderly.The reasons for HRV changes with age stay unclear. In the light of modern ideas about the mechanisms of aging, several complementary theories proposed. Telomere shortening, the role of oxidative stress and inflammation as possible mechanisms of age-related changes in the autonomic regulation of the heart rhythm, will be discussed in this article.

Sudden cardiac death (SCD) persists as one of challenging problems in cardiology and cardiac surgery, only in Russia costing more than 350,000 deaths annually. Arrhythmias and ischemic heart disease (IHD) prevail as SCD immediate direct mechanisms. Unfortunately, timely diagnostics of heart diseases is far below the satisfactory level. On the other hand, the number of patients to be followed up is increasing faster than the healthcare capacity. To close the gap, new approaches to diagnostics and prophylaxis of cardiovascular diseases are needed, involving innovative medical technologies. Implantable and external devices for heart arrhythmia and CAD early diagnostics are extensively used in modern cardiologic praxis. Impetuous development of this technique in combination with information and telecommunication technologies during last decade led to origination of completely new medical service based on mobile remote monitoring of patients. Relying on the experience in remote patient monitoring with implantable devices for recording heart electrical activity, Russian Scientific Society.

60 patients were observed with chronic destructive pulmonary tuberculosis which was diagnosed rhythm disturbance and conduction of the heart. It should be noted that the most frequently occurred among patients with heart rhythm disturbances in the form of sinus tachycardia (27.4%) and sinus arrhythmia (24.2%). Almost half of the patients (48, 1%) in the electrocardiogram (EKQ) were diagnosed disturbance of intraventricular conduction. The disturbance of atrioventricular conduction noted in 33.3% of cases. As a result of Halter ECG monitoring sunpeventricular disturbances are diagnosed most frequently and take place in 63,6% of cases. Ventricular arrhythmias were diagnosed in 12% of patients. Conduction of the first of degree atrioventricular block transitory character was noted in 55.6% of cases. Intraventricular blockades of Hiss right branch were determined in 44.4% of cases. The most frequently (41.6%) among the associated with rhythm disturbances and cardiac conduction diagnosed a rare combination of supraventricular monotypic extrasystole with first class ventricular extrasystole.

To study the features of cardiovascular system in patients with diabetes mellitus type 2 considering the thyroid pathology and age, 264 patients were examined. They were divided into three groups: 1st - patients with diffuse-nodular changes in the thyroid gland, 2nd - patients with autoimmune thyroid disease, 3rd - a control group of patients without thyroid disease. The patients of different ages were examined in each of these groups. All patients were in euthyroid state. It was established that identified in diabetes mellitus type 2 thyroid pathology and the thyroid disease contribute special features to the clinical picture for combined diabetic and cardiovascular pathology even in a euthyroid state including the age features. The laboratory and instrumental researches showed that the patients with combined diabetes and thyroid pathology have a higher incidence of atrial fibrillation, ischemic heart disease, and ventricular arrhythmias of high grades. They also were noticed to have a more adverse form of the left ventricle remodeling, also the combination of diastolic and systolic dysfunctions were found to be more frequent. It was concluded about the necessity of early diagnosis and correction of the cardiovascular disorders and thyroid systems in type 2 diabetes mellitus patients, including euthyroid patients.

Aim: to assess prognostic value of clinical and instrumental parameters, results of noninvasive electrophysiological tests and biomarkers as predictors of malignant ventricular arrhythmias in patients with ischemic heart disease (IHD) during long-term follow-up as well as during myocardial revascularization surgery and early postoperative period., Material: We prospectively enrolled 97 patients (mean age 61 ± 10 years) with angiographically confirmed coronary artery disease. Most patients (68%) had heart failure NYHA functional class II-III. Mean left ventricular ejection fraction (LVEF) was 50 ± 13%; 20% of patients had LVEF ≤ 35%. Sixty two patients had revascularization procedures during follow-up., Methods: We used 24-hour Holter monitoring and signal-averaged electrocardiography to obtain the following parameters: microvolt T-wave alternans, QT-interval duration and dynamics, heart rate turbulence (HRT) and variability. Laboratory tests included serum creatinine and creatinine clearance, brain natriuretic peptide (BNP), NT-proBNP, C-reactive protein and troponin T levels. RESULTS. During mean follow-up period of 25 ± 11 months life-threatening ventricular arrhythmias were observed in 11 patients (11%). On univariate analysis, history of percutaneous coronary intervention (p < 0.05), history of malignant arrhythmias or syncope (p < 0.05), LVEF ≤ 47% (p < 0.01), left atrium size 24.7 cm (p < 0.05), left atrium index (p = 0.01), filtered QRS duration (p < 0.05), abnormal heart rate turbulence (HRT) (chi-square test = 6.2, p = 0.01), abnormal turbulence slope (chi-square test = 9.5, p < 0.01), BNP ≥ 158 picogram/ml (p < 0.01), NT-proBNP ≥ 787 rg/ml (chi-square test = 4.4, p < 0.05) were significantly associated with malignant arrhythmias in long-term follow-up. History of malignant arrhythmias or syncope (OR 11.1, 95% Cl 2.8-44.4; p < 0.01), abnormal HRT (OR 13.6, 95% Cl 2.8-66.1; p < 0.01), and plasma BNP ≥ 158 picogram/ml (OR 14.3, 95% CI 3.2-65.0; p < 0.01) were independent predictors of malignant arrhythmias on multivariate Cox regression analysis., Conclusion: History of malignant arrhythmias, pathological HRT and plasma brain natriuretic peptide level ≥ 158 picogram/ml were independent predictors of malignant ventricular arrhythmias during 2 years follow-up of patients with IHD.

Unlabelled: Microvolt T-wave alternans (MTA) is one of markers of electrical myocardial instability., Study Aim: To elucidate normal range of MTA parameters during bicycle exercise test (ET) in adolescent elite athletes., Material and Methods: We examined 500 athletes aged 9-18 (mean 16.1 ± 2.2) years members of national teams of 27 kinds of sport. There were 333 females with mean age 16.0 ± 1.01 years and 167 males with mean age 16.3 ± 1.4. All athletes underwent ECG registration in clino- and ortho- positions and bicycle ET with automatic analysis of MTAT-wave alternans., Results: Mean MTA value was 26 ± 13 (9-51) mV. MTA above 65 mV was registered in 10 persons (2.1%) 5 of whom had signs of overtraining. Sensitivity (Se) of MTA for detection of overtraining state was 21%, specificity (Sp)--99%, positive and negative predictive value--50 and 96%, respectively., Conclusion: Normal MTA range during ET is 9-51 mV. MTA values during ET do not depend on age and sex but are determined by duration of participation in sports and myocardial mass. MTA value is related to length of QT-interval. Increase of maximal MTA values above 65 mV is insensitive (Se 21%) but highly specific (Sp 99%) sign of overtraining in adolescent elite athletes.

Bioelectrical activity and refractoriness in ventricular myocardium of the hibernator--ground squirrel Citellus undulatus were investigated during hypothermia. Experiments were performed with use of isolated, perfused preparations of papillary muscle from right ventricular. Preparations were obtained from hibernating (HS), summer active (SAS) squirrels and from rats. Bioelectrical activity was registered using the standard microelectrode technique at 37-17 degrees C. Action potentials duration (APD), refractoriness duration (RD) and the velocity of the action potential wave front (dV/dt) were estimated. Hypothermia induced APD and RD prolongation were demonstrated in all groups of experimental animals. However, normalized RD was significantly longer in the HS group during hypothermia than in SAS and rats. Ratio of RD to APD in HS group exceeds unity at 17 degrees C, which allows to suggest so called "postrepolarization refractoriness" during hypothermia. Also, HS reveal more prominent preservation of dV/dt during hypothermia than SAS and rat. Significant prolongation of RD and maintenance of normal excitation conduction during hypothermia probably plays essential role in hibernators resistivity to cold induced arrhythmias.

The authors summarized the experience of the use of the stimulus and the activation mapping under fluoroscopic control to search for sources of ventricular ectopic followed by radio-frequency effects on the vulnerable zone arrhythmias. The authors presented an algorithm for finding a pathological focus on the basis of an evaluation of the surface electrocardiogram, followed by sequential endocardial mapping. The results of radiofrequency ablation of ventricular arrhythmia in different localization of the source are presented. The authors generalized and systematized the experience detection and cure of ventricular ectopy in 65 patients. The regularities of changes in the ventricular complex according to surface electrocardiogram in certain localizations of ectopic focus are revealed. Effectiveness of the operation of radiofrequency ablation with ventricular arrhythmias was about 90%, which is generally consistent with data from other clinics. Complications requiring additional interventions were not. Highlight the work areas of the endocardium, analysed the causes of inefficient operations and poor results. Alternative methods of destruction of the endocardium in complex localization of ectopic focus are suggested.

Age-dependent increase of seizure activity at absence epilepsy exacerbates hemodynamic and autonomic regulation of heart rate. Cardiac dysfunction is accompanied by an increasing duration of intervals repolarization left ventricular QTc, which causes the risk of life-threatening arrhythmias, increases the threat of sudden cardiac death. Anticonvulsant drug therapy provides an opportunity to improve the functional state of the cardiovascular system, if not exceeded a certain level of seizure activity of the brain. This possibility remains as long as the progressive seizure activity isn't reaches a certain level. Later anticonvulsant drug therapy reduces seizure activity of the brain, but does not improve the functional state of heart.

Aim: To estimate the effectiveness and safety of the balneotherapeutic treatment of the of mechanical transport drivers (MTD) suffering heart rhythm and cardiac conduction (HR&CC) disorders with concomitant arterial hypertension (AH) treated based at a Nalchik health resort., Material and Methods: A total of 42 MTD (all men) presenting with HR&CC disorders and I-II grade AH were admitted for the balneotherapeutic treatment at a Nalchik health resort using two main approaches, viz. (a) thermal nitrogen mineral baths 36-37 degrees C in the form of 22 courses consisting of 8-10 sessions each (10-15 min every other day) and (b) bromine-iodine mineral baths 36-37 degrees C in the form of 20 courses consistingof 8-10 sessions each (10-15 min every other day). The outcomes of the treatment were estimated based on the results of general clinical examination and laboratory analyses supplemented by round-the-clock monitoring of arterial pressure and ECG, psychological and psychophysiological testing (PPT)., Results: The results of clinical and instrumental investigations into dynamics of the general health status, peripheral and coronary hemodynamics in the drivers with HR&CC disorders and AH give evidence of the improvement of their psychosomatic status following the treatment with the use ofthermal nitrogen and bromine-iodine mineral baths in 86.4 and 80.0% of the cases, respectively. In the subjects of the former group, significant changes in the dynamic response system were documented. 75% of MTD included in the latter group were characterized by the absence of improvement of professionally significant functions and skills that were found to deteriorate in the remaining 25%., Conclusion: The balneotherapeutic treatment of MTD presenting with HR&CC disorders and I-II grade AH with the use of thermal nitrogen mineral baths proved to be a highly effective, specific, and safe method in 86.4% of the cases. The use of bromine-iodine mineral baths resulted in clinical and hemodynamic changes of the psychosomatic status in 80.0% of the drivers concomitant with the deterioration of their professional activities. It is concluded that PPT is mandatory for the mechanical transport drivers presenting with HR&CC disorders and I-II grade AH before they resume their professional activities after the balneotherapeutic treatment.

Unlabelled: The aim of the work was to study character, frequency and peculiarities of arrhythmia in patients with chronic heart insufficiency (CHI) depending on its etiology and type 2 diabetes mellitus (DM2)., Materials and Methods: In-depth clinical observation of 197 patients (mean age 61.3 +/- 0.63 yr, 56-61% men) included EchoCG, 6 min walk test, Holter ECG monitoring. Group 1 was comprised of 74 patients with CHI (NYHA FC II), group of 280 patients with HPI an DM2, group 3 of 50 patients with CD2 (ADA criteria, 2011). The groups were matched for sex, age, severity of disease and complications. Exclusion criteria were acute coronary heart disease, CHI and DM2 decompensation, CHI according to BHOK and OCCH National recommendations (2009)., Results: 43.2% of the patients showed ventricular arrhythmia (VA) (p < 0.02), 10.8% had ciliary arrhythmia. Combined arrhythmia (ventricular and supraventricular arrhythmias, hemodynamically significant atrial fibrillation and high-grade ventricular arrhythmias) occurred in 41.2% of the patients having CHI+DM2 62.8% of the DM2 patients had supraventricular arrhythmias., Conclusion: Hemodynamically and prognostically unfavourable arrhythmias are most frequently diagnosed in the patients with CHI and DM2 due to more pronounced myocardial failure and DM2-associated pathogenetic factors (dysglycemia, cardiac neuropathy, nephropathy).

Aim: of the study was to elucidate nosological nature of "idiopathic" arrhythmias by means of complex clinical-morphological examination and to assess efficacy of differentiated (including etiotropic and pathogenetic) treatment., Material and Methods: We examined 190 patients (117 women, mean age 45.33 ± 14.84 years) with "idiopathic" arrhythmias: atrial fibrillation (38.9%) (AF,) and flutter (11.1%), supraventricular (44.7%) and ventricular (55.3%) extrasystoles (SVE and VE), bouts of ventricular tachycardia (15.8%), atrioventricular block (22,6%) et al. Mean number of antiarrhythmic drugs per patient was 3 (from 1 to 8). Examination included Holter ECG monitoring, echocardiography, determination of anticardiac antibodies (97.4%) and markers of cardiotropic viruses (87.4%), treadmill test (26.3%), transesophageal cardiac pacing (12.1%), electrophysiological investigation (10%), multispiral computed tomography (22.1%), magnetic resonance tomography (21.6%), scintigraphy (27.4%), coronary angiography (10.0%), endomyocardial biopsy (EMB) (10.0%), DNA diagnostics (8.9%)., Results: EMB revealed immune-inflammatory (myo/endocarditis, systemic/myocardial vasculitis) or genetic pathology in 78.9 and 21.1% of cases, respectively. Level of anticardiac antibodies (including specific antinuclear factor) most closely correlated with EMB findings. On the basis of comparison of EMB data with data of complex examination we created algorithm of nosological diagnostics in "idiopathic" arrhythmias. According to nosology all patients were distributed in the following way: 1) chronic infectious-immune myocarditis (n=144, 75.7%), morphologically verified in 14, viral in 27 patients; 2) genetic cardiomyopathy (n=15, 7.9%), morphologically verified in 4, virus positive in 1 (arrhythmogenic right ventricular dysplasia, non-compaction myocardium, Fabri disease, Brugada syndrome, undetermined); in 4 patients mutations in plakophilin 2, desmoglein, desmin, -galactosidase A genes were found; 3) combination of genetic diseases with myocarditis (n=18; 9.5%) including viral (n=3); 4) isolated myocardiodystrophy (tonsillogenic< dyshormonal, n=3, 1.6%); 5) proper idiopathic arrhythmias (n=10, 5.3%). Therapy of myocarditis included antiviral (43.2%) and immunosuppressive (76.3%) drugs. Cardiotropic and antiarrhythmic therapy was also administered. Only in patients with myocarditis it was possible to withdraw effective antiarrhythmic (16.7%) and to improve effect of previously ineffective drugs. Surgical treatment (implantation of pacemaker or cardioverter-defibrillator, radiofrequency ablation) was more frequently used in patients with genetic (39.4%) and idiopathic arrhythmias (53.8%) than in patients with myocarditis (16.0%)., Conclusion: Etiology of idiopathic arrhythmias can be established in most cases. Their main causes are immune-inflammatory diseases, genetic cardiomyopathies and their combination. Therapy of myocarditis improves antiarrhythmic activity of treatment, in some patients allows to withdraw antiarrhythmic drugs, decrease requirements in surgical treatment and to optimally prepare patients to radiofrequency ablation.

The mechanisms of L-carnitine action and ergogenic pleiotropic effects of drugs, which play important role in sports medicine are described. Results of a comparative, parallel-group randomized clinical trial of L-carnitine (Elkar, PikFarma) in young athletes (football players, walkers) are reported. Elkar increases the body adaptation to physical stress and has a pronounced therapeutic effect in athletes with stress-induced cardiomyopathy by reducing the representation of potentially dangerous arrhythmia (sinus bradycardia less than 2 - 5 centile, 2nd degree atrioventricular block type II, T-wave inversion in more than 2 leads, and/or ST segment depression) and severity of benign ECG disturbances and hemodynamic changes, and decreasing the concentration of biochemical markers of myocardial damage (troponin, natriuretic peptide, creatine phosphokinase MB fraction) and cortisol. In general, Elkar contributed to a significant reduction in symptoms of cardiac remodeling in 75% of patients and had a weak effect in 25% of patents. It is concluded that the use of Elkar in playing sports and sports coaching quality of endurance is appropriate, especially in terms of myocardial remodeling.

In 22 patients with heart failure and/or ventricular arrhythmias presumably of inflammatory etiology the results of clinical and instrumental investigation were analyzed and compared to the endomyocardial biopsy data. In the subgroup of patients with left bundle branch block (LBBB) we revealed features indicative of lesser contribution of inflammatory destruction in pathogenesis of cardiomyopathy. The only virus, detected in biopsy samples, was parvovirus B19. Its persistence in myocardium was not related to activity of inflammation and severity of clinical course. Increased expression of Coxsackie adenovirus receptor (CAR) was found in 20 patients. It was not related to inflammatory cells infiltration and virus persistence in myocardium. Patients with most prominent CAR expression were characteried by right heart dilatation, more severe heart failure and absence of LBBB. Enhancement of CAR expression could reflect the attempt of organism to repair intercellular communications between cardiomyocites and to protect cells from the products of necrotic lysis during long standing inflammation.

The aim of the study is the comparative study of treatment of heart and brain damages during the hypoxia with magnesium sulfate, verapamil, diltiazem. As a result of the experiment carried out on rats it was proved that magnesium sulfate and its prolonged form are not less active than the blockers of calcium channels, such as verapamil and diltiazem. It is possible to avoid lethal fibrillations caused by calcium chloride with the help of 25% magnesium sulfate solution (after intraperitoneal administration with the dose of 1000 mg/kg) in case we make arrythmogenic injection 5 minutes after inputting magnesium sulfate solution. During the arrhythmia induced by calcium chloride prolonged form of magnesium sulfate is also effective only if we inject the drug subcutaneous 30 minutes before the arrythmogenic injection. If the interval is 5 minutes lethal fibrillations cant be avoided as the release of magnesium ions from the drug form is slowed down. The drugs containing magnesium ions also displayed cytoprotective activity on the model of normobaric hypoxia. This was resulted in the increase of protective index. Neuroprotective action of magnesium ions (in the condition of hypoxia) is caused by maintaining homeostasis of calcium ions and by inhibition of exocytosis of neuromediators in the synaptic cleft. Thus, magnesium sulfate and its prolonged form can be used with the purpose of pharmacocorrection of heart and brain injuries during hypoxic conditions.

Structure and prevalence of various forms of noncoronary heart diseases (NCHD) and cardiac rhythm disorders (CRD) in state aviation pilots, as well as rates of ensuing grounding were studied. The total of 220 NCHD and 100 essentially healthy pilots were examined. Cardiovascular clinical and functional investigations consisted of physical examination, ECG, dispersion mapping (DM ECG), provocative tests and other techniques used for pilots' certification. Effectiveness of the clinical and instrumental methods of diagnosing arrhythmias was evaluated. CRD presence was verified by Holter monitoring. Extrasystoles prevalence was recorded in NCHD pilots; clinically significant forms of the diseases were commonly detected in pilots with chronic infections of the tonsils. In addition, radiodiagnostics of the immune status was applied to confirm the role of infection and immunology factor. DM ECG screening for differentiation between the norm and pathology was found useful in detecting early metabolic shifts and CVS functional evaluation. These results provided the basis for guidelines concerning medical expertise of pilots with noncoronary arrhythmias.

The experiments on white outbred awaken male rats have shown that derivatives of adamant-2-ylamides of alkylamidocarbonic acids exhibit prominent antiarrhythmic (antifibrillatory) effect on the model of calcium chloride arrhythmia. The most pronounced effect was demonstrated by N-[2(adamant-2-yl)aminocarbonylmethyl]-N'-[3-(diethylamino)propyl]-4-nitrobenzamide. This compound was also active on the model of aconitine arrhythmia, which is characteristic of class-I antiarrhythmic agents. It is established that N-[2-(adamant-2-yl)aminocarbonylmethyl]-N'-[3-(diethylamino)propyl]-4-nitrobenzamide has prominent antiarrhythmic activity and is more safe than other antiarrhythmic drugs of class I (lidocaine, ethmosine, novocainamide), class IV (verapamil), and class III (cardiocyclide).

Cardioprotective effects of coenzyme Q10 (CoQ10) injected intravenously 30 min before coronary artery occlusion were assessed on the model of myocardial ischemia/reperfusion in Wistar rats. Rats treated with CoQ10 after 30 min of ischemia and 120 min of reperfusion exhibited smaller (by 35%, p < 0.01) size of irreversibly damaged myocardium, shorter duration and decreased number of arrhythmias during reperfusion, and increased content of myocardial CoQ10 (by 210%, p < 0.01) as compared to saline-treated rats. Increased CoQ10 levels in myocardium were accompanied by smaller size of damaged myocardium (r = -0.77, p = 0.0002). Thus, there is evidence of the cardioprotective effect of CoQ10 injected intravenously before myocardial ischemia/reperfusion.

The adaptive mechanisms of action of reflexotherapy are analysed. It was shown in physiological and biochemical experiments on the whole organism, the isolated hearts and strips of resistive arteries of animals that stimulation of acupuncture points by different physical factors increased the activity of opioid, antioxidative, and other stress-limiting systems, reduced secretion of corticosteron during stress, stimulated biosynthesis of stress proteins, induced cyto- and cardioprotective effects, prevented or limited functional and structural hyperadrenal damages. Clinical investigations demonstrated significant hypothensive, anti-ishemic and anti-arrhythmic effects of reflexotherapy, improved resistance of healthy subjects and patients with cardiovascular diseases to physical and emotional loadings.

Using the experimental model of rat heart ischemia/reperfusion, it is established that zoniporide (inhibitor of Na+/H+ exchanger) produces a significant (1.4-fold) decrease in the area of myocardial necrosis, 2.1-fold decrease in the serum troponin I level, and 2-fold decrease in the severity of post-reperfusion arrhythmias.

The publication presents discussion of the modern vision of mechanisms of mechanoelectric feedback in heart as well as most recent findings regarding possible regulation of cardiomyocyte mechanically gated ion channels by endogenous compounds of immune origin--cytokines. Special attention is devoted to description of cytokine action on cardiac cells, in particular to nitrogen oxide effects on ionic currents, which contribute to generation of the action potential of the cardiomyocyte. We hypothesize that cytokines can potentially trigger such mechano-dependent cardiac pathologies as arrhythmias and fibrillation.

We observed 15 patients with arrhythmogenic right ventricular dysplasia (ARVD): 9 with definite and 5 with probable ARVD (modified European Criteria, 2010). Eight patients had typical ARVD (frequent right ventricular extrasystoles, nonsustained right ventricular tachycardia without heart failure with or without myocarditis). Five patients had ARVD with progressive heart failure (right- or biventricular with or without myocarditis). Two patients had full scale arrhythmic form (sustained right ventricular tachycardia without or with right ventricular dilation, with or without myocarditis). In 3 cases diagnosis was confirmed morphologically or with DNA-diagnostics. This material allowed us to highlight the following specific points related to diagnostics of ARVD. Detection of fat at MRT is not obligatory for diagnosis, fat can be detected by MSCT; ventricular arrhythmias can move backwards in the picture of the disease; leading clinical manifestation can be unexplained right ventricular insufficiency; ARVD can be combined with other genetic cardiomyopathies as well as with infectious immune myocarditis (up to 50% of patients); elevated titer of anticardiac antibodies is not characteristic for isolated ARVD; myocardial biopsy allows to verify both ARVD and concomitant myocarditis. The paper also contains discussion of the role of myocarditis in various forms of ARVD and possibilities of its diagnosis and treatments.

Aim: To study intraventricular asynchrony and effects of pacemaker implantation on asynchrony severity in patients with rhythm and conduction disorders., Material and Methods: The study of 46 patients with cardiac arrhythmia (atrial fibrillation, sick sinus syndrome, AB-block of the third degree) included such examinations as echocardiography, tissue dopplerography (PWTDI) before pacemaker implantation and 7 days after it. Electromechanic systolic and diastolic myocardial asynchrony was assessed by intraventricular heterogeneity index (IHb, IHm, TSD) in 8 segments of the left ventricle (LV) at the basal and mean levels. Values obtained in examination of 32 healthy volunteers were considered normal., Results: Parameters of systolic and diastolic asynchrony in patients with cardiac arrhythmia significantly differ from normal ones. Basal LV diastolic asynchrony was detected in 41-48% patients, systolic one--in 62-100%, systolodiastolic--in 41% cases. Pacemaker implantation into the right heart significantly reduces LV systolic asynchrony while diastolic one was unaffected in an early postoperative period. The best sensitivity in detection of systolic asynchrony is achieved with TsSD index. Informative value of diastolic asynchrony parameters is much less than of the systolic one., Conclusion: Indices of systolic asynchrony (TsSD, IhbS, IhmS) can be used for heart condition control after pacemaker implantation.

Aim: To estimate the prognostic value of the parameters of the microcirculatory bed for the assessment of risk for in-hospital death and cardiovascular events in patients with myocardial infarction (MI)., Subjects and Methods: Thirty (62.5%) and 18 (37.5%) of 48 patients (mean age 63.5 +/- 10.2 years) admitted to an intensive care unit for acute coronary syndrome subsequently developed MI in the anterior and lower walls of the left ventricle (LV), respectively., Results: According to the GRACE scale, 28 (58.3%), 7 (14.6%), and 13 (18.1%) patients had high, low, and moderate risks for in-hospital death, respectively. Uncomplicated MI was noted in 18 (37.5%) of the patients; acute LV aneurysm was formed in 12 (25%); 14 (29.1%) had cardiac arrhythmias as frequent ventricular and supraventricular premature beats, paroxysms of ventricular fibrillation, ventricular tachycardia, atrial fibrillation and flutter. Early post-infarction angina pectoris was noted in 2 (4.2%) patients, Killip Class I and II heart failure in 36 (75%) and 12 (25%), respectively; 3 patients died (2 from myocardial rupture and 1 from ventricular fibrillation). According to GRACE scores, complicated MI was significantly more frequently encountered in patients at high risk for in-hospital death (75% versus 28.5% in those at low risk; p = 0.03). Analysis of the microcirculatory bed revealed substantial changes in microcirculation (MC), which reflected its hypereremic type and characterized high perfusion and high MC flow index. Moreover, the coefficient of variation (CV) was significantly higher than that in the control; on days 4 and 20 it did not virtually differ from that in the control on day 2., Conclusion: The found changes in MC parameters (MC value and CV) may suggest the higher influence of active mechanisms for regulation of vascular tone as a response to myocardial necrosis. The role of the autonomic nervous system in the regulation of vascular tone is supported by the significant change in the normalized amplitudes of low- and high-frequency oscillations while the intravascular resistance index remained considerably higher at all follow-up stages, which may suggest that central hemodynamics is unstable in patients with MI and necessitates monitoring of their clinical status.

Results of estimation of variability of cardiac rhythms in patients with coronary heart disease during coronary artery bypass surgery are presented. The aim of the study was to search for innovative methods for the assessment of the patients' conditions as a criterion for their rational choice for cardiosurgical intervention to enable adequate anesthesiological support and postoperative follow-up. We revealed additional characteristics of cardiac rhythm variability facilitating such choice and predictors of the risk of life-threatening heart arrhythmias. It is shown that high-resolution analysis of cardiac rhythms allows such peculiarities of dynamics of patient's conditions to be revealed that can not be exposed by the existing standard methods.

We have studied the frequency and structure of cardiac rhythm (CR) disturbances in the women presenting with abdominal obesity (AO) in the postmenopausal period. The single-step study involved 210 postmenopausal women (median age 57 years) who were examined by 24-hour ECG monitoring, measurement of arterial pressure, body mass index, and the relationship between waist and hip circumferences. CR disturbances were revealed in all 159 women with abdominal obesity, ischemia in 16.9%, supraventricular extrasystole in 89.3%, ventricular extrasystole (VE) in 58.5%, high-grade extrasystole in 23.9%, paroxysms of supraventricular tachycardia in 1.9%, periods of asystole in 1.3%, synoatrial and atrioventricular blockade in 9.9%, His bundle branch block in 3.3%, sinus tachycardia in 48.8%, and sinus brachycardia in 23.9% of the patients. The risk of development of VE in the women with AO increased by 3.8 times in the presence of concomitant coronary heart disease and by 2.9 times in case of chronic cardiac failure. The frequency of VE was significantly higher in the patients with abdominal obesity than without it (odds ratio 2.2). It is concluded that women presenting with abdominal obesity during the postmenopausal period are characterized by the high frequency of cardiac rhythm disturbances and ischemia, with each fourth patient being at high risk of sudden death. The elevated risk of ventricular extrasystole in the postmenopausal period is associated with AO, coronary heart disease, and chronic heart failure. The frequency of VE is unrelated to ulcer disease, chronic cholecystitis, cholelithiasis, chronic pancreatitis, and impaired function of the thyroid gland.

Cardiac arrhythmias and conduction disturbances are an important cause of morbidity and mortality in many countries all over the world Etiology of these disorders remains unclear in many patients. Experimental and clinical studies show that autoimmune reactions may be involved in development of arrhythmias and cardiac blocks. Precise identification of an autoantibody-mediated mechanism opens new perspectives in the treatment and prevention of cardiac arrhythmias including use of immunosuppressive agents or removal of autoantibodies by absorption technique. The review focuses on cardiac autoantigens, autoantibodies and their interactions that may be involved in development of cardriac arrhythmias.

Aim: To assess diagnostic potential of cardiac rhythm symbolic dynamics., Material and Methods: PhysyoNet base data on ECG heart rhythm for 24 hours were analysed by characteristics of the symbolic lines: size of vocabularies and entropic properties of symbol distribution in the lines. The following ECGs were analysed: 54 ECGs of healthy individuals with normal sinus rhythm aged 28.5-76 years; 44 ECGs of patients with congestive cardiac failure aged 34-79 years; 84 ECGs of patients with cardiac fibrillation aged 34-79 years; 19 ECGs of patients with sudden cardiac death syndrome aged 34-79 years., Results: The index of variety of cardiac rhythm regulation is proposed which is effective not only for analysis of 24-h but also of 40-60 min rhythmograms., Conclusion: The quantitative analysis of symbolic dynamics can be used for differential chronodiagnosis of different cardiac diseases. Application of words which vary by length allows examination of rhythms with different time scale, detection and comparison of hierarchical desynchronization.

Results of evaluation of cardiac rhythm variability (CRV) in Parkinson's disease (PD) are presented. High-resolution rhythmocardiography with a KAP-RK-01-Mikor diagnostic system was used to register CRY, peripheral and autonomous dysregulation of pacemaker activity of the synoatrial node. Reduced CRV was documented in 107 PD patients of whom 26% exhibited synoatrial dysfunction. The temporal statistical and spectral analysis of CRV, comparison of its results with clinical data suggest dissociation between cerebral and peripheral vegetative effects in PD, relatively well preserved suprasegmental ergotropic regulatory afferent impacts, and inadequate vegetative control at the post-ganglionic level.

Preventive action of new antioxidant SkQ1 has been studied in rats on model of cardiac arrhythmia caused by epinephrine. The SkQ1 substance was given in dosages from 0.02 up to 20 moles/kg per os 2 weeks prior to experiment. Intravenous bolus introduction of epinephrine (10 or 6 mkg/kg in different experimental series) caused an immediate rise of arterial pressure in average by 19% and decrease in heart rate in average by 44%. The degree of changes of these parameters was approximately identical in all groups. Arrhythmia in the form of ventricular extrasystolia arose in the first 5 min. The total number of extrasystoles, and index of arrhythmia intensity have been 2-3 times lower in rats receiding SkQ1 in doses of 0.5, 2 and 20 moles/kg. It was combined with increased survival rate of animals. Smaller dosages of SkQ1 (0.02-0.1 moles/kg) were ineffective. Results have shown that administration of mitochondrial antioxidant SkQ1 raises stability of the myocardium to arrhythmogenic action of epinephrine.

This review considers of modern concepts of microvolt T-wave alternans (TWA): its pathophysiological basis at cellular level, particulars of quantitative analysis of TWA, modulating effects of autonomic nervous system and drugs, prognostic efficacy in predicting susceptibility to ventricular arrhythmia in comparison with other modern prognostic factors of sudden cardiac death.

The injection of dinitrosyliron iron complexes with glutathione at the onset of 40-min rat regional myocardial ischemia was shown to exert a clear cardioprotective action by decreasing the infarct size and suppressing the cardiac rhythm disturbance. After the introduction of the preparation, its effective accumulation with protein thiol-containing ligands in the myocardial tissue was registered be the EPR method. It was also found that, as a result of postischemic reperfusion, the rate of the decrease in the content of these complexes in the ischemic area increases, which demonstrates the effective scavenging of short-lived reactive oxygen species by molecules of dinitrosyl iron complexes.

Experiments on conscious male rats have shown that, under conditions of the aconitine-induced arrhythmia model, afobazole and other 2-mercaptobensimidazole derivatives exhibit antiarrhythmic effect, i.e. possess properties of rapid Na+ channel antagonists. The effect of afobazole under these conditions was significantly more pronounced than that of the reference drugs lidocaine and procainamide. The antiarrhythmic (antifibrillatory) effect of afobazole was also detected under the conditions of arrhythmia caused by high doses of calcium chloride. This drug was 1.5 times more effective in its antifibrillatory action than lidocaine, but it was less effective than verapamil. It has been also found that afobazole possesses a wider therapeutic spectrum than the well-known antiarrhythmic drugs of class I and IV (lidocaine, procainamide, ethmosine and verapamil).

For investigation of character and frequency of detection of violations of rhythm and conductivity there was effectuated monitoring of ECG using Holter monitor. In investigation were included 238 military servicemen of young age (23-35 years old), situated in similar conditions of life, chosen according to practical health. Normative indexes of daily variation of arrhythmia were determined using method of non-parametric analyze of qualitative data. On the base of this method, acceptable for using in elaboration of normative values of physiological indexes, the norm could be called isolated cases of ectopic complexes of 5 ventricular and of 24 supraventricular extrasystoles (SVE) for a day. Ventricular extrasystoles (VE) are monotypic, SVE could be polytypic, also could be singular paired complexes. Also could be combination of VE and SVE. Other, more complicated violations of rhythm could be referred either to pathological evidence or to premorbid conditions. Violations of conductivity should be absent in norm.

In this review we discuss mechanisms of antiarrhythmic and adverse proarrhythmic action of class III drugs. Special attention is given to ionic currents and channels which determine specific features of their effects (IKr, IKa, IKur). We consider general patterns of changes of bioelectrical activity in atria and ventricles leading to development of arrhythmias or stabilization of rhythm. We also discuss value of QT interval as predictor of torsade de pointes. Perspectives and limitations of development of novel class III antiarrhythmic drugs are discussed as well. We present consideration of efficacy and mechanisms of action of such compounds as dronedarone and vernacalant suggested for termination of atrial fibrillation and maintenance of sinus rhythm. Special attention is given to RG 2 - a novel compound with class III activity.