Method for determining risk of atrial fibrillation in patients with premature atrial contraction

FIELD: medicine.

SUBSTANCE: patient with premature atrial contraction (PAC) undergoes ECG study. A signal-averaged ECG is recorded. The method involves measuring the length of a filtered push-pull (FiP-P) wave of the signal-averaged ECG (ms), P wave dispersion determined as a difference of maximum and minimum P wave lengths while recording 12 leads of the standard ECG (Pd) (ms), a linear deviation (A), B that is the number of premature atrial contractions per hour, a risk index of developing atrial fibrillations (RIDAF) by an original formula. If the RIDAF is less than 0.5, the high risk of atrial fibrillation is predicted for 1-3 months; the RIDAF from 0.5 to 1.5 stands for the moderate risk during 3 months to 1 year, whereas the RIDAF of more than 1.5 shows the low risk for more than 1 year from the first examination of the patient suffering from premature atrial contraction.

EFFECT: method enables increasing the determination accuracy of the risk of atrial fibrillation following the first examination and correcting the therapy.

3 tbl, 4 ex

 

The invention relates to medicine, namely to cardiology, in particular to methods of forecasting of development of supraventricular cardiac arrhythmias, in particular atrial fibrillation (AF) in patients with atrial extrasystoles (PE).

Analogue of the proposed solution is a method of predicting the development of paroxysmal AF, which consists in determining the width and amplitude of the wave Ρ electrocardiogram (ECG), and the detection tine more than 0.12 Ρ and (or) amplitude more than 2.5 mm projected expansion of these paroxysms of arrhythmia within a few years after the first survey (kushakovskij M. S. cardiac Arrhythmias: a guide for physicians / M. S. Kushakovskij. - 3rd ed, Rev. and extra - SPb.: Folio, 2004. - 672 p.).

Closest to the technical essence as a prototype we have chosen the method of determining the risk of paroxysmal AF in patients with supraventricular extrasystoles, which consists in determining naclonal linear regression predstavitelskogo interval arrythmia (SOPS), corrected for heart rate (Dicor.) not less than 10 extrasystoles, and when values of the linear regression slope of 2 to 5 MS/Picor. predict the development of paroxysmal AF after 1 month, from 6 to 9 MS/Picor. in 1-2 months, 10-12 MS/Picor. - within 2-3 months, more than 12 MS/Picor. - in tech�tion from 3 months to 2 years after the first examination of the patient (Olesen A. I., Shabrov A.V., Prosyannikova O. N., Semenova E. A., Goat A.V. a Method of predicting epileptic flicker and atrial flutter in patients with supraventricular extrasystoles. Patent No. 2312592 from 2007, BI. No. 30).

The disadvantage of analog and prototype is the low accuracy of determining the risk of development of AF.

The technical result of the invention is to improve the accuracy of determining the risk of development of AF in patients with PE after the first survey.

The technical result of the invention is that the patient with PE is carried out ECG examination, registration of signal-averaged ECG. The risk of developing AF in patients with PE is determined by the formula: ERRFP=(FiP-P)÷Pd×(A÷B), where IRRPP - index of the risk of developing AF, FiP-P - duration of the filtered wave "P" signal-averaged ECG (MS), Pd - wave dispersion "P" (in MS), defined as the difference between the maximum and minimum values of the length of the tooth "R" at check 12 lead standard ECG, A - linear deviation korrelirovannoe predstavitelskogo interval of not less than 20 PE, In the number of atrial extrasystoles per hour. At values IRRPP to 0.5 predict a high risk of developing AF after 1-3 months, from 0.5 to 1.5 - average for 3 months up to 1 year, more than 1.5 - a low risk of developing AF than 1 year after the first examination of the patient.

Method �photos can be sent as follows:

The patient with PE is carried out ECG examination, registration of signal-averaged ECG and CPEX. Then determine Pd by standard ECG, registered in 12-lead, the duration of the filtered wave "P" (FiP-P) signal-averaged ECG, LO PDI-cor. PE is not less than 20 extrasystoles. Then the risk of developing AF in patients with PE is determined by the formula:

ERRFP=(FiP-P)÷Pd×(A÷B), where IRRPP - index of the risk of developing AF, FiP-P - duration of the filtered wave "P" signal-averaged ECG (MS), Pd - wave dispersion "P" (in MS), defined as the difference between the maximum and minimum values of the length of the tooth "R" at check 12 lead standard ECG, A - linear deviation korrelirovannoe predstavitelskogo interval of not less than 20 In the PE, the number of atrial extrasystoles per hour. At values IRRPP to 0.5 predict high, within 1-3 months, from 0.5 to 1.5 is average, from 3 months to 1 year more than 1.5 - low, more than 1 year, the risk of developing AF after the first examination of the patient with PE.

Essential features of the claimed method and the causal link between them and achieve results:

- determination of wave dispersion "R" (Pd) by standard ECG, registered in 12 leads;

- definition of LO Dicor. not less than 20 PE;

- the risk of developing AF in patients with PE define p� the formula:

ERRFP=(FiP-P)÷Pd×(A÷B), where IRRPP - index of the risk of developing AF, FiP-P - duration of the filtered wave "P" signal-averaged ECG (MS), Pd - wave dispersion "P" (in MS), defined as the difference between the maximum and minimum values of the length of the tooth "R" at check 12 lead standard ECG, A - linear deviation korrelirovannoe predstavitelskogo interval of not less than 20 In the PE, the number of atrial extrasystoles per hour;

- when values IRRPP to 0.5 predict high, within 1-3 months, from 0.5 to 1.5 is average, from 3 months to 1 year more than 1.5 - low, more than 1 year, the risk of developing AF after the first examination of the patient.

It is now known that during the registration of excitation in the myocardium of the Atria conduction of excitation obeys the law of "flow" from one cell to another (Physiology and pathophysiology of the heart: Vol. 1: per. s angl. - Under. ed. Sperelakis. - M.: Medicine, 1990., Olshansky V., Okumura K., Hess, P. G., Waldo A. L Demonstration of the area of slow conduction in human atrial flutter. // J. Amer. Coll. Cardiol. - 1991. - Vol. 16, N. 6. - P. 1639-1648., Shimisu A., Nosaki A., Y. Rudy, and A. L. Waldo Multiplexing studies of effects of rapid atrial pacing on the area of slow conduction during atrial flutter in canine pericarditis model. // Circulation. - 1991. - Vol. 83, N. 3. - P. 983-994.). Therefore, by directly applying electrodes on the myocardium record the nature and the direction of conduction of excitation in cardiac muscle. In addition, the myocardial performance�RDI is cloth with a quick response i.e. the membrane potential of the contractile fibers of the Atria characterized by rapid depolarization (Physiology and pathophysiology of the heart: Vol. 1: per. s angl. - Under. ed. Sperelakis. - M.: Medicine, 1990).

The presence of supraventricular arrhythmias due to the fact that there was a slow and non-uniform conduction of excitation in the upper and middle sections of the Atria, which reflects the dispersion of excitability of the myocardium of the Atria (Bokeria L. A. Lectures on cardiology /L. A. Bockeria, E. Z. golukhov. - M., 2002. - 296 p., Braunwald's Heart Disease: a textbook of cardiovascular medicine / Ed. by P. Libby et al. - Phyladelfhia, W. B. Saunders Company, 2007. - 2183 p.), moreover, in these patients, a violation of atrial conduction celebrated long before the enlargement of the Atria and other predictors of AF development (Shabrov A.V., Olesen A. I., Y. V. Golub, Golub V. I. Clinical evaluation of the use of non-invasive method of determining intra-and interatrial conduction in patients with coronary heart disease. // Ter. archive. - 1999. - No. 1. - P. 34-39). One of the methods for detecting the presence of a dispersion of excitability of the myocardium of the Atria, is the registration signal-averaged ECG and Pd (Braunwald's Heart Disease: a textbook of cardiovascular medicine / Ed. by P. Libby et al. - Phyladelfhia, W. B. Saunders Company, 2007. - 2183 p.).

In the claimed us the way it is assumed that the presence of dispersion of the excitation, detected according to the signal-averaged ECG and Pd indicates feasible�m the development of circulation of excitation (re-entry) in the myocardium of the Atria or around anatomical obstacles for example, the motion of the waves around a hollow or pulmonary veins. The decrease in the ratio of LO Dicor. not less than 20 PE, related to the number of PE used for the study, expressed in number of extrasystoles per hour, indicates the presence of a fixed ectopic foci in the Atria and(or) development of circulation of excitation (re-entry) in the myocardium of the Atria, and the definition of Payor. in not less than 20 extrasystoles due to the fact that this is the number of intervals Dicor., commitment to research, exclude the presence of false-positive data in the assessment of LO Dicor. PE (Glants S. Mediko-biological statistics. TRANS. angl. - M., Practice, 1998. - 459 p.). One possible cause of a "fixed" Picor., on the one hand, is a modulating effect, which have the PE the preceding sinus excitation, on the other, the development of PE in the period of excess phase excitation of the preceding sinus complex that "fixes" PE in a certain place by longitudinal dissociation loop re-entry PE (Physiology and pathophysiology of the heart: Vol. 1: per. s angl. - Under. ed. Sperelakis. - M.: Medicine, 1990, Bockeria L. A. Lectures on cardiology / L. A. Bockeria, E. Z. golukhov. - M., 2002. - 296 p.). After the formation of the wave front of excitation, for example, with the development of PE, it fractionised, divided into subsidiaries waves,each of which is independent, moreover, when splitting larger wave in a localized area blocked the holding of any active movement towards another auricle may form a critical number of stray waves required for the formation of the OP, with the formation of these waves is random or "chaotic" process (Allessie Μ.Α., P. L. Rensma, Brugada J. et al. Pathophysiology of atrial fibrillation. // Cardiac electrophysiology. From cell to bedside. - Eds. Zipes D. P., Jalife J. Philadelphia: W. B. Saunders, 1990. - P. 548-559, Allessie M. A., Konings K, Kirchhof C. Mapping of atrial fibrillation. In: Ollson B. S., Allesie M. A., Campbel R. W. F., eds. Atrial fibrillation: mechanism and therapeutic strategies. Armonk NY: Futura Publishing Company, 1994. - P. 37-49). It should be noted that M. A. Allessie et al. (1990, 1994) emphasizes that for the formation of paroxysmal AF, you must have 3 or more waves of recycling, but if the number of moving waves is reduced less than 3, the arrhythmia is terminated.

So IRPP is an independent predictor of AF development, determined by a comprehensive assessment of predictors of AF development.

The distinctive set of essential features is new and allows to increase the accuracy of determining the risk of development of AF in patients with PE.

To illustrate the proposed method give examples from clinical practice:

Example 1

Patient S., aged 65, was admitted to day hospital 03.09.2012 in the direction of the local doctor for IHD: angina, recurrent heart attacks�of Jenia. From the anamnesis it is known that the patient suffers from coronary artery disease (CAD): angina functional class II in the last 4-5 years. Constantly taking Preductal MB, aspirin at a dose of 300-400 mg daily, metoprolol at a dose of 25-50 mg per day. In the last 3-4 months he began to notice the appearance of faults in work of heart. Daily monitoring of ECG, performed outpatient 10.08.2012 G., was identified single ventricular premature beats with a frequency of up to 2 extrasystoles per hour, PE with a frequency of 25 extrasystoles per hour.

In the hospital according to clinical and instrumental examination of the patient's condition was regarded as ischemic heart disease: stable angina II functional class, the data for the presence of "fresh" focal changes of the myocardium have been identified. The patient continued therapy Preductal MB, aspirin at a dose of 300 mg per day, enalaprilat (adnic) at a dose of 5 mg daily, metoprolol at a dose of 50 mg per day.

On the second day of stay in hospital was carried out registration of ECG simultaneously in 12 standard leads, signal-averaged ECG for 5 minutes using a computer complex "Polispektr-rhythm" (firm "Neurosoft", Ivanovo). Then after computer processing was determined FiP-P - duration of the filtered wave "P" signal-averaged ECG (in MS) and Pd - wave dispersion "R" (m�), defined as the difference between the maximum and minimum values of the length of the tooth "R" at check 12 lead standard ECG. Patient S., aged 65, FiP-P and Pd was 138 MS and 63 MS, respectively. The patient was re-conducted daily monitoring of ECG revealed the presence of PE at 48 extrasystoles per hour and up to 2 ventricular extrasystoles per hour. LO Dicor. PE was 8 MS, calculated in 65 extrasystoles, which amounted to 52 PE/hour. Then the patient underwent a transesophageal pacing. The results showed that the indicators of sinus node function, such as the times of restoration of sinus node function, corrected recovery time function of the sinus node, the time of sinoatrial conduction defined by the standard technique (kushakovskij M. S. cardiac Arrhythmias. - L.: Medicine, 1993), were within limits of normal values. Was then calculated RHP determined by the formula: ERRFP=(FiP-P)÷Pd)×(A÷B)

where IRRPP - index of the risk of developing AF, FiP-P - duration of the filtered wave "P" signal-averaged ECG (MS), Pd - wave dispersion "P" (in MS), defined as the difference between the maximum and minimum values of the length of the tooth "R" at check 12 lead standard ECG, A - line otklonenie� korrelirovannoe predstavitelskogo interval of not less than 20 PE, B is the number of PE used for the study, expressed in number of extrasystoles per hour.

Subsequently the patient underwent therapy Preductal, aspirin, initcom (enalapril), with metoprolol in doses mentioned above. Antiarrhythmic drugs were not prescribed. Spontaneous episodes of AF lasting from 45 seconds to 23 minutes were identified with daily monitoring of ECG, performed 5 days after the above examination.

This example illustrates that the detection values IRRPP 0,33 define high risk of developing AF, that is, within 5 days after the first examination.

Example 2

Patient K., 58 years old, was admitted to the hospital 21.01.2012 G. in the direction of an ambulance doctor about coronary artery disease: progressive angina. From the anamnesis it is known that the patient suffers from ischemic heart disease: angina functional class II in the last 3 years. Constantly takes nitrosorbid, antiplatelet agents. Two days before admission, the patient increased anginal pain frequency, duration, intensity, and changed the nature of the pain syndrome. Admission to the hospital.

In the hospital according to clinical and instrumental examination of the patient's condition was regarded as ischemic heart disease: progressive angina, the data for the presence of "fresh" focal changes the myoko�autism have been identified. Patient was performed coronary angiography, which was revealed stenosis of more than 85% of the anterior descending artery. This was followed by revascularization method of stenting, and was then fully restored coronary blood flow. After revascularization continued therapy plavixa at a dose of 75 mg per day, aspirin at a dose of 300 mg per day, rentcom at a dose of 5 mg daily, metoprolol at a dose of 50 mg per day. After restoration of blood flow anginal pain were stopped and did not recur in the future.

On the third day of stay in hospital was carried out registration of ECG simultaneously in 12 standard leads for 40 minutes using a computer complex "Polispektr-rhythm" (firm "Neurosoft", Ivanovo). Then after computer processing was determined FiP-R - duration of the filtered wave "P" signal-averaged ECG (in MS) and Pd - wave dispersion "P" (in MS), defined as the difference between the maximum and minimum values of the length of the tooth "R" at check 12 lead standard ECG. Patient K., 58 years old, FiP-P and Pd was 146 MS and 57 MS, respectively. The patient was conducted daily monitoring of ECG revealed the presence of PE with a frequency of 23 extrasystoles per hour, and up to 5 ventricular extrasystoles per hour. LO Dicor. PE was 10 MS, calculated in 68 extras�tolah, that was 25 PE/hour.

Was then calculated RHP determined by the formula:

ERRFP=(FiP-P)÷Pd)×(A÷B)

where IRRPP - index of the risk of developing AF, FiP-P - duration of the filtered wave "P" signal-averaged ECG (MS), Pd - wave dispersion "P" (in MS), defined as the difference between the maximum and minimum values of the length of the tooth "R" at check 12 lead standard ECG, A - linear deviation korrelirovannoe predstavitelskogo interval of not less than 20 PE, B is the number of PE used for the study, expressed in number of extrasystoles per hour.

Subsequently the patient underwent therapy with plavixa, aspirin, initcom (enalapril), with metoprolol in doses mentioned above. Spontaneous episodes of AF lasting from 45 seconds to 16 minutes were identified with daily monitoring of ECG conducted at 4 months after the above examination.

This example illustrates that the detection values IRRPP 1,02 determine the average risk of developing AF, that is, within 4 months after the first survey.

Example 3

Patient R., 63 years old, was admitted to the hospital 27.11.2012. a doctor's clinic for IHD: new-onset angina. From history we know that the patient previously considered themselves healthy.

In the hospital �data about clinical and instrumental examination of the patient's condition was regarded as ischemic heart disease: new-onset angina, data for the presence of "fresh" focal changes of the myocardium have been identified. Patient was performed coronary angiography, which was revealed stenosis of more than 75% of the anterior descending and more than 80% of the envelope of the arteries. This was followed by revascularization method of stenting, and was then fully restored coronary blood flow. After revascularization continued therapy plavixa at a dose of 75 mg per day, aspirin at a dose of 300 mg per day, rentcom at a dose of 5 mg daily, metoprolol at a dose of 50 mg per day. After restoration of blood flow anginal pain were stopped and did not recur in the future.

On the third day of stay in hospital was carried out registration of ECG simultaneously in 12 standard leads for 35 minutes with the help of a computer complex "Polispektr-rhythm" (firm "Neurosoft", Ivanovo). Then after computer processing was determined FiP-P - duration of the filtered wave "P" signal-averaged ECG (in MS) and Pd - wave dispersion "P" (in MS), defined as the difference between the maximum and minimum values of the length of the tooth "R" at check 12 lead standard ECG. Patient R., age 63, FiP-P and Pd was 134 MS and 62 MS, respectively. The patient was conducted daily monitoring of ECG revealed the presence of PE with a frequency of 12 extrasystoles per hour, and takiego 2 ventricular extrasystoles per hour. LO Dicor. PE was 10 MS, calculated 45 extrasystoles, which amounted to 15 PE/hour.

Was then calculated RHP determined by the formula:

ERRFP=(FiP-P)÷Pd)×(A÷B)

where IRRPP - index of the risk of developing AF, FiP-P - duration of the filtered wave "P" signal-averaged ECG (MS), Pd - wave dispersion "P" (in MS), defined as the difference between the maximum and minimum values of the length of the tooth "R" at check 12 lead standard ECG, A - linear deviation korrelirovannoe predstavitelskogo interval of not less than 20 PE, B is the number of PE used for the study, expressed in number of extrasystoles per hour.

Subsequently the patient underwent therapy with plavixa, aspirin, initcom (enalapril), with metoprolol in doses mentioned above. Later it was repeatedly conducted daily monitoring of ECG, which persisted PE. Spontaneous episodes of AF lasting from 53 seconds to 15 minutes uncovered during the daily monitoring of ECG conducted at 10 months after the above examination.

This example illustrates that the detection values IRRPP 1,44 determine the average risk of developing AF, i.e. within 10 months after the first survey.

Example 4

Patient X., 66 years old, was admitted to the hospital 15.01.2011, direction�of GP for IHD: angina, periodic bouts of palpitations. From the anamnesis it is known that the patient suffers from ischemic heart disease: angina functional class II in the last 6 years. Constantly takes monocycle dose of 50 mg per day, aspirin at a dose of 300-400 mg daily), enalapril (Renitec) at a dose of 20 mg per day. In the last 3-4 months he began to notice the appearance of faults in work of heart. Daily monitoring of ECG, performed outpatient 14.12.2010, was identified single PE with frequency up to 11 extrasystoles per hour.

In the hospital according to clinical and instrumental examination of the patient's condition was regarded as ischemic heart disease: stable angina II functional class, the data for the presence of "fresh" focal changes of the myocardium have been identified. The patient continued therapy, monocycle dose of 50 mg per day, aspirin at a dose of 300-400 mg daily), enalapril (Renitec) at a dose of 20 mg per day.

On the second day of stay in hospital was carried out registration of ECG simultaneously in 12 standard leads for 25 minutes using a computer complex "Polispektr-rhythm" (firm "Neurosoft", Ivanovo). Then after computer processing was determined FiP-P - duration of the filtered wave "P" signal-averaged ECG (in MS) and Pd - wave dispersion "P" (in MS), defined as the difference between the maximum and minimalnayazhelaemy the length of the tooth "R" at check 12 lead standard ECG. Patient X., 66, FiP-P and Pd was 128 MS and 46 MS, respectively. The patient underwent a transesophageal pacing. The results showed that the indicators of sinus node function, such as the times of restoration of sinus node function, corrected recovery time function of the sinus node, the time of sinoatrial conduction defined by the standard technique (kushakovskij M. S. cardiac Arrhythmias. - L.: Medicine, 1993), were within limits of normal values.

The patient was conducted daily monitoring of ECG revealed the presence of PE with a frequency of 10 extrasystoles per hour. LO Dicor. PE was 16 MS, calculated in 57 extrasystoles, which amounted to 12 PE/hour.

Was then calculated RHP determined by the formula:

ERRFP=(FiP-P)÷Pd)×(A÷B)

where IRRPP - index of the risk of developing AF, FiP-P - duration of the filtered wave "P" signal-averaged ECG (MS), Pd - wave dispersion "P" (in MS), defined as the difference between the maximum and minimum values of the length of the tooth "R" at check 12 lead standard ECG, A - linear deviation korrelirovannoe predstavitelskogo interval of not less than 20 PE, B is the number of PE used for the study, expressed in number of extrasystoles per hour.

In p�following the patient underwent therapy with nitrates, aspirin, initcom (enalaprilat) in the doses given above. Antiarrhythmic drugs were not prescribed. Later it was repeatedly conducted daily monitoring of ECG, which persisted PE. Spontaneous bout of AF has evolved through 1.7 years after the survey, docked sublingual administration of metoprolol at a dose of 50 mg as anti-relapse therapy of paroxysmal AF in addition to the patient therapy was prescribed metoprolol at a dose of 100 mg per day. Arrhythmia did not recur for the past 2 years.

This example illustrates that the detection values IRRPP 3,71 define a low risk of developing AF, that is within 1.7 years after the first survey.

Was observed 228 patients with CHD complicated with PE. All patients underwent therapy with long-acting nitrates, antiplatelet agents, angiotensin converting enzyme inhibitors (Renitec, enalapril, Enap). Antiarrhythmic drugs were not prescribed.

All patients underwent ECG registration simultaneously in 12 standard leads, signal-averaged ECG for 5 minutes using a computer complex "Polispektr-rhythm" (firm "Neurosoft", Ivanovo). Then after computer processing was determined FiP-P - duration of the filtered wave "P" signal-averaged ECG (in MS) and Pd - wave dispersion "P" (� MS) defined as the difference between the maximum and minimum values of the length of the tooth "R" at check 12 lead standard ECG. All patients underwent Holter ECG monitoring. In all patients, according to the proposed method, calculated LO Dicor. PE in not less than 20 extrasystoles, and according to the prototype - was defined by the slope of the linear regression Dicor. PE in not less than 10 extrasystoles. If you cannot determine on the ECG, including ECG monitoring, start or end of a wave "P", for its detection was performed transesophageal ECG registration. In all patients, the definition IRHP was conducted according to the proposed method, as well as the prognosis of AF was performed according to the prototype.

Statistical analysis of the results carried out on the computer.

63 (27,63%) patients, according to the inventive method, the values IRRPP amounted to <0,5 (average 0,14±0,05) (these patients was predicted AF within 1-3 months after the first survey). AF was observed in 56 (88,89%) of 63 patients within 1-3 months after the first survey.

85 (37,28%) patients, according to the inventive method, the values IRRPP ranged from 0.5 to 1.5 (average of 0.76±0,09) (these patients predicted the development of AF after 3 months to 1 year after the first survey). AF affects�'m getting at 78 (91,76%) of 85 patients in a period from 3 months to 1 year after the first survey.

80 (35,09%) patients, according to the inventive method, the values IRRPP amounted to >1.5 m (on average 3.6±0,3) (these patients was predicted AF for more than 1 year after the first survey). AF was observed in 43 (of 53.75%) of 80 patients for more than 1 year (in an average of 2.1±0.3 years), and 26 (32.50 to%) of them AF was observed during 1-2 years after the first survey.

In 23 (of 10.09%) of all patients, according to the prototype, predicted the development of AF after 1-3 months, and the rest - from 3 months to 2 years after the test. AF was observed in 10 (of 43.48%) of 23 patients within 1-3 months after the first survey.

Comparative data of the claimed method and the prototype are presented in tables 1-3.

The accuracy of a prediction method RRFP of the claimed method in comparison with the prototype, within 1-3 months after the first survey increased by 106,97% within 3 months to 1 year - on 36,30% and more than 1 year - 76,63%.

Thus, the accuracy of a prediction method RRFP of the claimed method in comparison with the prototype, within 1-3 months after the first survey increased by 106,97% over the 3 months to 1 year� - on 36,30% and more than 1 year - 76,63%.

Method of determining the risk of development of atrial fibrillation (AF) in patients with atrial extrasystoles (PE) by means of an electrocardiographic (ECG) studies, registering signal-averaged ECG, characterized in that the risk of AF development is determined by the formula: ERRFP=(FiP-P)÷Pd×(A÷B), where IRRPP - index of the risk of developing AF, FiP-P - duration of the filtered wave "P" signal-averaged ECG (MS), Pd - wave dispersion "R" (MS) defined as the difference between the maximum and minimum values of the length of the tooth "R" at check 12 lead standard ECG, A - linear deviation correlated predstavitelskogo interval of not less than 20 In the PE, the number of atrial extrasystoles per hour, and at values IRRPP to 0.5 predict a high risk of developing AF after 1-3 months, from 0.5 to 1.5 - average for 3 months up to 1 year, more than 1.5 - a low risk of developing AF than 1 year after the first examination of the patient.



 

Same patents:

FIELD: medicine.

SUBSTANCE: method involves determining a period of time from the onset of symptoms to establishing a diagnosis (t); a functional class is rated at the time of establishing the diagnosis (FCinit); a cardiac output is calculated at the time of establishing the diagnosis (CO); an acute pharmacological test (APT) coefficient (X) is calculated as follows: (APT-)=0, (APT+)=1, (APT++)=2. A risk of the unfavourable clinical outcome in the patients suffering from idiopathic pulmonary hypertension (H) is calculated by an original formula. If the value H ≤0.35, a low risk is stated; H=0.36-0.55 shows a moderate risk, whereas H≥0.56 is a sign of a high risk of the unfavourable clinical outcome.

EFFECT: method enables the high-reliability detection of the unfavourable clinical outcome in the patients with idiopathic pulmonary hypertension, the determination of rates of the disease progression for the purpose of prescribing an adequate therapy.

2 ex

FIELD: medicine.

SUBSTANCE: group of inventions relates to medical equipment. A cuff contains a chamber for the application of pressure to the area of measurement; a screwable element for displacement of a chamber (161) for a flowing medium to the area of measurement, and a chamber-like covering element, which includes the chamber of the flowing medium and the screwable element and is configured in the form of a tape, wrapped around the area of measurement. The screwable element has a curved shape, which follows the direction, in which the screwable element is wrapped around the area of measurement, and has two curvilinear regions and a rectilinear connecting region, which connects the said curvilinear regions in the section in the points of bending, in which the radius of the screwable element curvature changes. The connecting region is located inside the curve, formed by the extension of the curvilinear regions. The central position between the first point of bending in the section and the second point of bending in the section is superposed on the central position of the chamber for the flowing medium in the direction, in which the chamber for the flowing medium is wrapped around the area of measurement. Versions of implementation of the device for pressure measurement and an additional version of the cuff are disclosed.

EFFECT: group of inventions makes it possible to reduce the measurement error due to the reduction of errors of the chamber volume change.

6 cl, 15 dwg

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to occupational medicine, and can be used for specifying the indications for the instant correction of the psychophysiological states. A cardiointervalogram is recorded before and after professional activity. A range of RR interval lengths (MxDMnbefore, MxDMnafter), a square root of a total difference of a sequence of RR intervals (RMSSDbefore, RMSSDafter) and a mode amplitude of RR interval lengths (AMobefore, AMoafter) are determined. Differentiation functions G1 and G2 are calculated. If G1 is less than G2, the individuals being tested are considered to be in need of the instant correction of their psychophysiological states. Otherwise, it is stated that the individuals being tested are not in need of the instant correction of their psychophysiological states.

EFFECT: examining the individual before and after the occupational activity, using the cardiointervalography findings and specifying the most significant criteria for the psychophysiological states assessment make the method increase the responsiveness to the process of detection if there are any individual-specific indications for the instant correction of the psychophysiological states.

2 ex

FIELD: medicine.

SUBSTANCE: assessing a risk of recurrent atrial fibrillation (AF) is ensured by determining the patient's age in years (A), the time following radio frequency ablation in months (B), postoperative inpatient recurrent atrial fibrillation (C), the degree of the aortic valve insufficiency (D), the left atrial diameter in mm (E), anti-arrhythmic therapy conducted (F) with F=l if the anti-arrhythmic therapy involves amiodarone, and F=2 if the anti-arrhythmic therapy with sotalol is conducted, the degree of the mitral valve insufficiency (J), the number of reference ablation points (I); the number of radio frequency applications (G); the radio frequency ablation type (H) with H=2 accompanying RF labyrinth, and H=3 with the radio frequency ablation of pulmonary vein basins and ganglia plexuses. The derived values are used to calculate the risk (R) of atrial fibrillation by three formulas. The highest of the three derived R values is further determined. If the highest R value has been derived by the first formula, the recurrent atrial fibrillation following the radio frequency ablation may not be predicted. The highest R value produced by the second formula enables predicting the recurrent atrial fibrillation to come during 6 months following the radio frequency ablation.The highest R value taken from the third formula shows that the recurrent atrial fibrillation is predicted to come during more than 6 months following the radio frequency ablation.

EFFECT: method enables predicting the risk of the recurrent atrial fibrillation following the radio frequency ablation in the patients, pre-selecting a set of medical products necessary for the anti-arrhythmic and anti-coagulant treatment of the patient, pre-specifying a follow-up visit schedule and additional functional diagnostic techniques and considering if the repeated radio frequency ablation is required.

2 ex

FIELD: medicine.

SUBSTANCE: invention refers to medical equipment. An electronic sphygmomanometer comprises a cuff, an inflation and pressure release unit for the cuff pressure adjustment, two pressure sensors, two generation circuits generating a rectangular signal at a pressure-dependent frequency, a generation circuit adjustment circuit ensuring passing an output signal from one of the above generation circuits, and a control circuit for generating an input rectangular signal from the circuit adjustment circuit and for calculating blood pressure at a rectangular signal frequency. The pressure sensors are connected to the cuff and matched with the generation circuits. The adjustment circuit is configured as a common one for the above generation circuits. The control circuit switches between the generation circuits by producing a signal of switching to one of the generation circuits. The control circuit generates the first signal of switching to the first generation circuit and determines the first cuff pressure dependent on the first rectangular signal frequency. The control circuit generates the second signal of switching to the second generation circuit and determines the second cuff pressure dependent on the second rectangular signal frequency. The control circuit detects if there is a failure of the above pressure sensors as shown by the first and second cuff pressure difference.

EFFECT: invention is expected to increase the measured blood pressure reliability when using more than one sensor.

4 cl, 9 dwg

FIELD: radio engineering, communication.

SUBSTANCE: invention relates to transceiver device for processing a medium access control (MAC) protocol used by a transceiver. The transceiver comprises a first antenna system for on-body communication and a second antenna system for off-body communication, the transceiver device being designed to reserve one or more data payloads for on-body communication and to allocate the first antenna system to the transceiver in the time interval occupied by said data payloads, and/or to reserve one or more data payloads for off-body communication and to allocate the second antenna system to the transceiver in the time interval occupied by said data payloads.

EFFECT: providing an optimally matched antenna system for on-body communication and off-body communication respectively, preventing collisions between data payloads on a radio channel, thereby increasing data throughput and, at the same time, reducing power consumption of the transceiver.

15 cl, 14 dwg

FIELD: medicine.

SUBSTANCE: patient's epicardial fat thickness is measured by transthoracic echocardiography by means of a sector transducer at a frequency of 2,500 MHz on a free anterior wall of the right ventricle. Pulse Doppler imaging is performed to determine the diastolic function of the left ventricle - the E/A ratio measured as a transmitral blood flow velocity in the early diastolic filling of the left ventricle (E peak) to a transmitral blood flow velocity in a left auricular systole (A peak). If the epicardial fat thickness is from 2.7 to 4.5 mm, whereas the E/A diastolic function is less than 0.80, insulin resistance is diagnosed.

EFFECT: higher diagnostic accuracy, as well as wider number of individuals, who had the insulin resistance diagnosis.

1 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: group of inventions relates to medicine, namely to cardiology. A microphone signal, simultaneously passing through two band filters with fixed pass bands, is registered. The pass band of the first pulse-wave filter is set at 3-6 Hz. The pass band of the second filter of Korotkov′s tones is set at 40-120 Hz. Reliable Korotkov′s tones in the determination of systolic pressure are considered to be exceeding of a threshold value of the amplitude of the first filter output signal after the local maximum of the output signal of the first filter. The reliable Korotkov′s tones in the determination of diastolic pressure are considered to be exceeding the threshold value of the amplitude of the output signal of the second filter to the local maximum of the first filter output signal. The claimed method is realised due to the device, which includes an air pressure sensor in a cuff, a microphone, the first pulse-wave filter has the pass band of 3-4 Hz, the second filter of the Korotkov′s tones has the pass band of 40-120 Hz, a unit for the determination of maximal values of output signals of the filters, a unit for the selection of the threshold values of comparison of the output signals of the filters, a unit for the comparison of the output values of the output signals of the filters with the threshold values, a unit for the comparison of the moment when the threshold value of the output signal of the second filter is exceeded, with the moment of achieving the local maximum of the first filter.

EFFECT: group of inventions makes it possible to increase the reliability of measurements due to the reduction of the impact of external noise and interference, conditioned by the patient's physiological activity.

2 cl, 2 dwg

FIELD: medicine.

SUBSTANCE: invention relates to means for the estimation of energy efficiency of a cardiovascular system. The method of automatic processing of blood pressure signals contains stages at which: a detected pressure signal P(t) for one or more heart contractions is discretised, with each heart contraction starting at an initial moment, coinciding with the moment of the diastolic pressure, and finishing at the last moment, coinciding with the moment of the following diastolic pressure, and containing a dicrotic point, the morphology of a discretised pressure signal P(t) for each heart contraction is analysed and separated, the moment and value of pressure in one or more characteristic points of the signal P(t) are determined. For each heart contraction a value of energy efficiency is determined by the determination of the impedance Zd-D(t) of a direct dynamic wave of pressure for each of one or more characteristic points, except the point of an initial diastolic pressure, and the impedance ZD of a direct pressure wave is determined by the addition with alternating signs of values of the impedances Zd-D(t) of the direct dynamic pressure wave, ordered in accordance with the direct time order, starting with the initial moment of the analysed heart contraction, to a dicrotic moment, the dynamic reflected impedance Zd_R(t) is determined for each of one or more characteristic points and the value of impedance ZR of reflected pressure waves is determined, energy efficiency is determined as a ratio between the impedance ZD of the direct pressure wave and the impedance ZR of the reflected waves RES=ZD/ZR. The method is realised by an automatic device for processing the blood pressure signal with the application of a storage medium, which contains stored software.

EFFECT: application of the invention makes it possible to increase the reliability of energy efficiency estimation.

14 cl, 6 dwg

FIELD: medicine.

SUBSTANCE: group of inventions refers to medicine. A device used in the group of inventions comprises an input interface designed to supply signals from at least two sensors for at least two individual's positions, including the blood-dependent signals, from the first signal when the individual is found in the first position; the blood-dependent signals from the first sensor when the individual is found in the second position; the blood-dependent signals, from the second sensor when the individual is found in the first position; and the blood-dependent signals, from the second sensor when the individual is found in the second position; as well as an operational circuit designed to determine and output measures by combining the supplied signals according to the pre-set calibration data.

EFFECT: group of inventions enables calculating the measures by experimental tests.

22 cl, 5 dwg, 2 tbl

FIELD: medicine.

SUBSTANCE: method involves recording heart beat rate and systolic arterial blood pressure before and after two-stage exercise stress. The first stage is of 50 W within 3 min and the second one is of 75 W during 2 min. Patient rest pause is available between loading stages to recover initial heart beat rate. Prognostic estimation of cardiopulmonary complications is carried out with mathematical formula applied.

EFFECT: reduced risk of complications in performing tests.

FIELD: medicine.

SUBSTANCE: method involves measuring cardio- and hemodynamic values, calculating estimates of the values and displaying the estimates on monitor. Measuring and calculating each cardio- and hemodynamic value is carried out during basic periods of their oscillations corresponding to heart contraction cycle and respiratory cycle related to absolute time.

EFFECT: high accuracy of estimation.

4 dwg, 1 tbl

FIELD: animal science.

SUBSTANCE: the present innovation deals with dynamic loading onto cardio-vascular system in animals. Selection should be carried out by the following parameters: , ΔT3 and Δn, where ΔT1 - the time for pulse increase at running, ΔT2 - the time for pulse stabilization after running, ΔT3 - the time for pulse increase after running, Δn - the increase of pulse frequency after running. One should select animals into milking herd at the following values; ΔT3 ≤ 10 sec, Δn ≤ 10 beats/min. The method enables to present perspective evaluation of lactation capacity in animals.

EFFECT: higher efficiency of selection.

1 dwg, 1 ex, 1 tbl

FIELD: medicine.

SUBSTANCE: method involves recording rheogram from feet and legs lifted and fixed at an angle of 45є. Then, rheogram is recorded on inhaling from legs directed vertically downward. Functional blood circulation reserve index is calculated as product of results of dividing and subtracting rheographic indices recorded under conditions of lifted and lowered extremities that means under conditions of functional venous system relief and venous hypertension, respectively.

EFFECT: enhanced effectiveness in recognizing patient group suffering from severe lower extremities ischemia.

6 dwg

FIELD: medicine.

SUBSTANCE: method involves recording rheogram from feet and legs lifted and fixed at an angle of 45є. Then, rheogram is recorded on inhaling from legs directed vertically downward. Functional blood circulation reserve index is calculated as product of results of dividing and subtracting rheographic indices recorded under conditions of lifted and lowered extremities that means under conditions of functional venous system relief and venous hypertension, respectively.

EFFECT: enhanced effectiveness in recognizing patient group suffering from severe lower extremities ischemia.

6 dwg

FIELD: medicine.

SUBSTANCE: method involves applying a set of reference values like body mass, arterial blood pressure, pulse rate in rest state and general physical condition values. Exercise stress is sequentially applied for evaluating vertebral column flexibility, response quickness, dynamic leg force, speed-and-force tolerance. Each value is compared to a reference value, the differences of each item between reference and actual values are summed and the total value is interpreted in terms of complex human physical condition.

EFFECT: high reliability of the method; simplified testing process requiring no complex and expensive equipment and high skill personnel.

6 cl

FIELD: medicine.

SUBSTANCE: method involves applying a set of reference values like body mass, arterial blood pressure, pulse rate in rest state and general physical condition values. Exercise stress is sequentially applied for evaluating vertebral column flexibility, response quickness, dynamic leg force, speed-and-force tolerance. Each value is compared to a reference value, the differences of each item between reference and actual values are summed and the total value is interpreted in terms of complex human physical condition.

EFFECT: high reliability of the method; simplified testing process requiring no complex and expensive equipment and high skill personnel.

6 cl

FIELD: medicine, juvenile clinical nephrology.

SUBSTANCE: disease duration in case of obstructive pyelonephritis should be detected by two ways: either by detecting the value of NADPH-diaphorase activity, as the marker of nitroxide synthase activity in different renal department and comparing it to established norm, or by detecting clinico-laboratory values, such as: hemoglobin, leukocytes, eosinophils, urea, beta-lipoproteides, lymphocytes, neutrophils, the level of glomerular filtration, that of canalicular reabsorption, urinary specific weight, daily excretion of oxalates, arterial pressure, and estimating their deviation against average statistical values by taking into account a child's age.

EFFECT: higher efficiency of detection.

7 dwg, 1 ex, 6 tbl

FIELD: medicine, neurosurgery.

SUBSTANCE: one should measure blood pressure in afferent vessel of cerebral arteriovenous malformation (AVM). If measured pressure is above that of functionally insignificant vessel being 25% against systemic arterial pressure for AVM at blood flow of 1000 ml/min and 50% for AVM at blood flow of 500 ml/min one should conclude the vessel to be functionally valuable. The method enables to decrease complications due to increased reliability in detecting functional value of ABM-supplying vessels.

EFFECT: higher efficiency of detection.

1 ex

FIELD: medicine, cardiology.

SUBSTANCE: in male patients of elderly and senile age one should register electrocardiogram and its first derivative in 12 leads to evaluate the rate of ventricular activation. In case of this rate being below 34.9 one should evaluate high degree of lethality risk. The method enables to detect the risk for availability of complex cardiac rhythmic disorders more rapidly and non invasively in case of exacerbation of bronchoobstructive diseases.

EFFECT: higher efficiency of diagnostics.

4 ex, 1 tbl

Up!