RU2261041C2 - Method for predicting paroxysmal ectopic atrioventricular tachycardia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves setting electrodes in left and right atrium, right ventricle and His bundle positions. Superficial electrocardiogram, endocardial hisogram and epicardial ventriculogram are recorded. Programmed electrostimulation is carried out via atrial electrode. Recorded interval growth jumps being found greater than 40 ms with extrastimulus delay drop reaching 10 ms, atrioventricular node conduction switch to the other channel is documented. Two or more switches taking place, paroxysmal ectopic atrioventricular tachycardia occurrence is to be predicted.

EFFECT: high accuracy of early stage prognosis.

2 dwg

Description

The invention relates to medicine, namely to cardiology and arrhythmology, and can be used for the diagnosis and prevention of cardiac arrhythmias.

A known method for predicting the ectopic activity of the atrioventricular (AV) node based on the number of atrioventricular extrasystoles [1].

At the same time, a surface electrocardiogram is recorded throughout the day. Registration of extrasystoles from the atrioventricular node (especially paired and group) allows us to suggest the appearance in the subsequent AV-node ectopic tachycardia. The number of extrasystoles is directly proportional to the degree of automatic activity of the AV node. At the same time, this method is applicable if the activity of the AV node is already manifested by extrasystoles.

The aim of this invention is to improve the quality of diagnosis of cardiac arrhythmias, the accuracy of predicting paroxysmal AV nodal ectopic tachycardia and the detection of automatic activity of the AV node even before the appearance of atrioventricular extrasystoles.

This goal is achieved by the fact that using diagnostic pacemaking evaluate the conduct in the AV connection when scanning its relative refractory period. The method is as follows:

diagnostic stimulating transesophageal, endocardial or epicardial electrode is installed in the projection of the atrium;

for registration, respectively, a surface electrocardiogram, an endocardial histogram or an epicardial ventriculogram are used;

through the atrial electrode, program pacing is performed with a base frequency of 10 pulses per minute higher than the spontaneous sinus rhythm, and a sequential decrease in the delay of the extrastimulus by 10 ms at each step;

at each stage, registration and measurement of intervals are carried out: respectively, St ₂ -R ₂ , A ₂ -H ₂ , A ₂ -V ₂ ;

in the case of an abrupt increase in the indicated intervals by more than 40 ms with a decrease in the extrastimulus delay by 10 ms, the pulse is transmitted through another channel of the AV node;

the number of spasmodic switching indicates the number of functional channels in the atrioventricular node;

with the dissociation of AV connections in more than 2 channels, the possibility of paroxysms of AV nodal ectopic tachycardia is predicted.

The curve of atrioventricular conduction during the operation of the AV node in the form of a single channel is shown in Fig. 1, in the form of four channels - in Fig. 2.

The application of the method is illustrated by the following example.

Example. Patient K., 2 years 4 months. He was operated on in a clinic in 2002 for a congenital heart disease: a ventricular septal defect. An epicardial electrophysiological study was performed intraoperatively before cannulation of the great vessels. Two diagnostic electrodes are installed on the ear of the right atrium and on the front wall of the right ventricle. With programmed electrical stimulation of the right atrium, functional dissociation of the AV node into 3 channels was detected. The first switching with an extra-stimulus delay of 290 ms with an abrupt increase in the A ₂ -V ₂ interval by 55 ms, the second switching with an extra stimulus delay of 230 ms with an abrupt increase in the A ₂ -V ₂ interval by 60 ms. After the operation, the ectopic activity of the AV node in the form of a group atrioventricular extrasystole on the first day of the postoperative period, the accelerated rhythm of the AV node on the second day of the postoperative period and frequent paroxysms of ectopic AV nodular tachycardia on the third day of the postoperative period was noted. Thus, the described method allowed predicting the development of postoperative ectopic tachycardia from the AV node even before the main stage of the operation.

The method described above allows predicting the appearance of subsequent paroxysms of ectopic AV nodal tachycardia even before the clinical manifestations of automatic activity of the AV node.

Literature:

1. Fisch C., Sipes D.P., McHenry P.L. Electrocardiographic manifestations of concealed junctional ectopic impulses // Circulation. - 1976; 53. - P.217.

Claims (1)

A method for predicting paroxysmal ectopic atrioventricular tachycardia, including recording an electrocardiogram, characterized in that the electrodes are installed: a transesophageal electrode to the left atrium or epicardial electrodes to the right atrium and right ventricle or endocardial electrodes to the right atrium and the monitor’s exit and electrograms from all electrodes, after which a program is carried out through the atrial electrode Mixed electrical stimulation with a base frequency of 10 pulses per minute higher than the spontaneous sinus rhythm, and with a sequential decrease in the delay of the extra stimulus by 10 ms, at each stage of electrical stimulation, the intervals St ₂ -R ₂ or A2-V2 or A2-H2 are recorded and in the case of a jump-like increase in the recorded intervals by more than 40 ms with a decrease in the extrastimulus delay by 10 ms, the switching of the atrioventricular node to another channel is documented, and in the presence of two or more switches, the possibility of paroxysmal ectopic atrioventricular tachycardia.

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