Method for predicting ventricular arrhythmia occurrence in surgical patients

FIELD: medicine.

SUBSTANCE: method involves setting electrode on epicardial surface of the right ventricle in making operation. Programmed right ventricle electrostimulation is carried out by means of the electrode. Superficial electrocardiogram is continuously recorded in process of stimulation. Ectopic ventricular activity being observed during electrostimulation, potential ventricular arrhythmia occurrence is predicted in postoperative period.

EFFECT: high reliability of prognosis with no arrhythmia indications in anamnesis.

3 dwg

 

The invention relates to medicine, namely to surgery, and can be used to predict the occurrence of ventricular arrhythmias after heart surgery.

A known method for predicting ventricular arrhythmias (ventricular tachycardia, ventricular fibrillation) by endocardial electrophysiological studies [1]. Under local anesthesia the dotted line in main vein, and then through them perform diagnostic electrodes and place them in different sections of the right ventricle. Through the electrode spend asynchronous, programmed, frequent stimulation. In the case of induction of ventricular tachycardia or ventricular fibrillation documented high risk of occurrence of these arrhythmias in a patient by further developing heart disease.

However, this method is a self-diagnostic operation and time-consuming in preparation for the study and subsequent rehabilitation of the patient, which lengthens the time spent by the patient in the hospital for 5-7 days and delays the operation on heart.

The purpose of this invention is to improve the quality of treatment of patients with cardiovascular disease cardiac profile after heart surgery. This requires the selection of patients who have had the rose of the development of life-threatening ventricular arrhythmias in the postoperative period and long-term after surgery, on the basis of the epicardial pacing.

This objective is achieved in that before the main phase of the operation to induce arrhythmogenic activity of the ventricles hold the programmed elektrocardiostimulyatsia the right ventricle through the electrode, which is placed on the epicardial surface of the heart.

The method is as follows: after thoracotomy and the opening of the cavity of the pericardium on the epicardial surface of the right ventricle establish diagnostic electrode (figure 1), through the electrode spend programmed electrical stimulation of the right ventricle with a base frequency of 10% in excess of your own rhythm and progressive diminution of delay extrastimuli 10 MS at each step in the process of stimulation conduct continuous recording of surface electrocardiogram.

Figure 2 illustrates the normal reaction of the myocardium of the ventricles during programmed electrical stimulation, when after applying the test stimulus (Fig. 2B) after the last base of the complex (Fig. 2A) premature ventricular complexes are absent.

In the case (Fig. 3)if the test pulse (Fig. 3A) followed by the elements of ectopic activity in the ventricles (ventricular extrasystoles - “echo answers, runs of ventricular tachycardia) (Fig. 3B), document those with whom the likelihood of this patient's ventricular arrhythmias after surgery.

Application of the method is illustrated by the following example.

Example. Patient L s, 5 years. Was admitted to the hospital with a diagnosis of Congenital heart disease. Ventricular septal defect. According to transesophageal echocardiography registered multiple ventricular septal defect: one perimembranous size 9 mm and two muscle size 3 mm and 4 mm No data for ventricular arrhythmia during the preoperative examination is not received. During heart surgery to canulli great vessels performed epicardial electrophysiological study by the described method. At the stages of programmed electrical stimulation with a delay of extrastimuli 280 MS and below was the emergence of multiple ventricular “echo reply” and short runs of ventricular tachycardia. In the future, if canulli vessels and during cardioplegia - multiple persistent paroxysmal ventricular tachycardia with a heart rate of 200 per minute. During the rehabilitation period for the return of sinus rhythm would be necessary to use four discharge of the defibrillator. During the week subsequently experienced frequent polymorphic ventricular extrasystoles and four attack of ventricular tachycardia, which itself is transformed into ventricular fibrillation and who has removal discharge of the defibrillator. Thus, the application of the described method allowed us to predict the occurrence of ventricular arrhythmias in patients in the postoperative period.

The method allows to select the category of patients who have a risk of geneprotein ventricular arrhythmias after cardiac surgery, which requires they have a preventive drug therapy. The method is part of heart surgery and does not extend the duration of hospitalization of the patient. Can be used in any heart surgery.

Literature

1. Richards D.A., Byth K., D.L. Ross, Uther JB What is the best Predictor of spontaneous ventricular tachycardia and sudden death after myocardial infarction? Circulation 1991; 83; 756-763.

Method of assessment of diastolic function of the right ventricle, including the use of programmed electrical stimulation of the right ventricle, characterized in that during heart surgery after thoracotomy and the opening of the cavity of the pericardium on the epicardial surface of the right ventricle set the electrode through the electrode spend programmed electrical stimulation of the right ventricle with a base frequency of 10% in excess of its own rhythm, and progressive diminution of delay Elektrostal 10 MS at each step in the process of stimulation conduct continuous recording of surface electrocardiogram who we are and when during the stimulation of ventricular ectopic activity predict the possibility of occurrence of ventricular arrhythmias.



 

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