Method for predicting the risk for the development of paroxysmal atrial fibrillation in patients with ischemic cardiac disease

FIELD: medicine, cardiology.

SUBSTANCE: one should register a standard electrocardiogram (ECG) and measure the duration of a "P"-wave. Moreover, it is necessary to conduct daily ECG monitoring to calculate single, paired and group atrial extrasystoles. Then one should calculate diagnostic coefficient DC by the following formula: DC=DC1+DC2+DC3+DC4, DC1 =-8.8 at duration of "P"-wave below 106 msec, 9.3 at duration of "P"-wave above 116 msec, -3.5 at duration of "P"-wave ranged 106-116 msec. DC2=-1.9 at the absence of group atrial extrasystoles during a day, 8.3 -at daily quantity of group atrial extrasystoles being above 4, 2.5 - at daily quantity of group atrial extrasystoles ranged 1-4. DC3=-2.9 at daily quantity of paired atrial extrasystoles being below 3, 8.1 - at daily quantity of paired extrasystoles being above 35, -1.4 - at daily quantity of paired atrial extrasystoles ranged 3-35. DC4=-5.1 at daily quantity of single atrial extrasystoles being below 15, 4.3 - at daily quantity of single atrial extrasystoles being above 150, -1.0 - at daily quantity of single atrial extrasystoles ranged 15-150, if DC is above or equal to 13 one should diagnose high risk for the development of paroxysmal atrial fibrillation, in case if DC is below or equal -13 it is possible to diagnose no risk for the development of paroxysmal atrial fibrillation, and if DC is above -13 and below 13 - the diagnosis is not established.

EFFECT: higher sensitivity of diagnostics.

5 ex

 

The invention relates to cardiology, in particular to methods of diagnosing arrhythmias.

According to Moscosco, the incidence of paroxysmal atrial fibrillation (AF) has acquired the character of epidemic spread. Atrial fibrillation occurs in 0.4% among the adult population of people. In the population of persons aged 60 years and older it is registered already in 2-4% of cases, whereas older people with heart disease suffer FC in 9.1% of cases. The share of AF accounts for about 40% of all disorders of the heart rhythm. In General, the prevalence of AF is second only arrythmia. From "arrhythmic" patients seeking outpatient care in clinical Cabinet of St. Petersburg antiarrhythmic center, 40% suffered from AF. Almost 80% of patients it was paroxysmal, and the rest of the chronic [1, 2].

The relevance of timely and accurate diagnosis of the risk of paroxysmal atrial fibrillation is difficult to overestimate. It is widely known negative impact of atrial fibrillation on cardiohemodynamic: increased heart rate, decreased stroke volume, irregular contraction of the ventricles. The meaning of all these adverse factors increases dramatically in people with coronary heart disease. In such conditions, the paroxysm of atrial fibrillation threatens to fall arter the social pressure, a choking (pulmonary edema), increased angina, ischemic stroke. Special of the dangers of thromboembolic complications of AF (heart lung and especially emboli in the vessels of the brain). Listed complications of paroxysmal atrial fibrillation (pressure drop, brain ischemia, pulmonary edema) require immediate urgent measures, including electro-therapy to interrupt paroxysm of atrial [1, 2].

With confidence about paroxysmal AF can speak only from registered on electrocardiogram (ECG) paroxysm. Most often used for this purpose monitoring of ECG, however, if seizures occur rarely, they may not be recorded during monitoring. A number of authors recommends 48 - and 72-hour monitoring. But even the duration of ECG monitoring during one month may be uninformative. Besides the monthly monitoring - investigation expensive and inconvenient for the patient [3, 4, 5]. It is therefore important to predict the risk of paroxysmal atrial fibrillation.

There is a method of diagnosing the risk of paroxysmal AF, we have chosen as a prototype, by registering the standard ECG followed by measuring the length of prong "P" in the second standard is nom lead (at least in lead V1). If the length of the tooth "P" exceeds 110 MS, diagnosed with high risk of paroxysmal AF [6]. However, the sensitivity of this method is not high enough, because the length "P" of more than 110 MS is observed only 30-55% of patients with paroxysmal AF. Additionally, the method has a low specificity, because the increase in the duration of P-wave can be observed in diseases that are not associated with paroxysmal atrial fibrillation. In these cases, the diagnosis of paroxysmal AF, based on the increase in the duration of tooth "R"gives a false positive result [1, 2].

The aim of our invention is to improve the sensitivity and specificity of the method for diagnosing the risk of paroxysmal AF. It is solved in that in addition to measuring the length of prong "P" on the standard ECG is conducted daily monitoring of ECG, during which reveal a single, paired and group atrial extrasystoles, count the number for a certain period of time. Then calculated diagnostic factor, which takes into account the number listed PVCs and duration of tooth "P". If the diagnostic value of the coefficient is equal to or exceeds a certain number, then diagnose high risk of paroxysmal AF, if the and equal to or less than a certain other number, it is diagnosed in the absence of risk of paroxysmal AF, if the diagnostic value of the coefficient lies between these two numbers, then the diagnosis is not defined and required additional clinical research.

The positive effect of the introduction of the invention is to improve the sensitivity and specificity of diagnosing the risk of paroxysmal AF. This will save the patient from additional methods for diagnosis and save time and money. Early diagnosis will allow time to plan the appropriate therapy for the prevention of further paroxysms of AF. If the result of the application of the present invention there is no risk of paroxysmal AF, it will relieve the patient from the appointment of unreasonable treatment.

The method is as follows. The research is conducted on the background of the abolition of anti-arrhythmic therapy, in periods of not less than five elimination half-life of the drug. Removed ECG in 12 standard leads and measured the length of the tooth "R" in the second standard lead. For ECG registration is necessary to use high-resolution vehicle that records ECG signal with a sampling frequency of 1000 Hz and above. After this the patient is daily monitoring of ECG, which is calculated daily the number of singles, paired and group atrial extrasystoles. Next is calculated diagnostic factor of the DC according to the formula

DK=DK1+DC+DC+DC,

where DK1=-8.8 the length "P" is less than 106 MS, 9.3 the duration of the "R" more 116 MS 3.5 in the length "P" of 106 MS to 116 MS.

DK=-1.9 in the absence of the group of atrial extrasystoles during the day, 8.3 when the daily number of group atrial extrasystoles more than 4, 2.5 daily number of group atrial extrasystoles from 1 to 4.

DK=-2.9 when the daily number of paired atrial extrasystoles less than 3, 8.1 when the daily number of paired atrial extrasystoles are over 35, -1.4 when the daily number of paired atrial extrasystoles from 3 to 35.

DK=-5.1 when the daily number of single atrial extrasystoles less than 15, 4.3 when the daily number of single atrial extrasystoles more than 150, -1.0 if the daily number of single atrial extrasystoles from 15 to 150.

If DC is greater than or equal to 13, diagnosed with high risk of paroxysmal atrial fibrillation, if DK is less than or equal to -13, diagnose the absence of risk of paroxysmal atrial fibrillation, and if DK -13 more and less than 13, then the diagnosis is not defined.

Diagnostic factors for each characteristic, we have determined on groups of patients with the presence and absence is the influence of paroxysmal AF with the use described in the literature as the method of statistical processing of Yu in the modification Gen [7, 8]. After that, the algorithm was evaluated on a test sample of patients with and without paroxysmal AF (a total of 180 people). Assessed the sensitivity and specificity of the procedure of recognition of the paroxysms. The results showed that in patients with paroxysmal AF correct result into a training and a test sample was obtained in 86.7%, incorrect in 2.2%. Information was not enough for decision making in 11.1% of patients. In addition, in the group of patients with absence seizures OP correct operation of the algorithm noted in 88.9%, the error was equal to 3.3%. Information was not enough for decision-making in 7.8%.

EXAMPLE 1. Patient C., 67 years old, which was about coronary heart disease, was aimed at monitoring ECG with complaints arising every few days, the attacks of palpitation. On the standard ECG revealed an increase in "R" tooth 135 MS. When ECG monitoring daily the number of single atrial extrasystoles was 1340, paired - 52, group - 10. Total diagnostic coefficient equal to +30.0. It was concluded that the presence of high risk of paroxysmal AF. To verify this conclusion, ECG monitoring was extended by two days. During the third day of observation registered paroxysm of AF. This example illustrates the coincidence of financial p the tats diagnosing the risk of paroxysmal AF by way of a prototype of this invention.

EXAMPLE 2. Patient S. 43 years old, suffering from coronary heart disease. On the standard ECG duration "P" wave is equal to 114 MS. When ECG monitoring daily the number of single atrial extrasystoles was 10, double - 1, group extrasystoles are not registered. According to the prototype, the patient increased the duration of the P wave and it should be paroxysmal atrial fibrillation. According to the invention, the total diagnostic factor equal to 13.4, indicating the absence of the risk of paroxysmal AF. Complaints against the attacks of palpitation, the patient did not show. Subsequent medical supervision for three years with repeated daily ECG monitoring the main disease paroxysmal AF were not registered.

EXAMPLE 3. Patient K., 53 years (primary diagnosis of ischemic heart disease) suffered frequent bouts of palpitations that are not associated with physical exercise. On the standard ECG duration "P" wave is equal to 108 MS, which according to the prototype exclude paroxysmal AF. When the daily ECG monitoring registered a large number of atrial extrasystoles: single 3120 per day, paired - 104, group - 62. The amount of diagnostic ratios equal to 17.2, which allowed us to diagnose high risk of paroxysmal FPO subsequent two-day ambulatory ECG was registered short period of AF.

As can be seen from the above data, examples 2 and 3 show the discrepancy in the diagnosis of the risk of paroxysmal AF method prototype of the invention and show the advantage of the invention.

EXAMPLE 4. Patient M., aged 65, suffering from coronary heart disease, complained of a rare heart attacks that are not associated with physical exercise. On the standard ECG "R" wave is equal to 112 MS. When ECG monitoring daily the number of single atrial extrasystoles was 74, paired - 19, a group of 8, the total diagnostic ratio was 2.4, which is insufficient for decision making. Due to occasional bouts of palpitations, does not affect hemodynamics, additional tests to determine the type of seizures (multi-day monitoring, electrophysiologic testing) was conducted. When the daily monitoring of ECG, made three months regarding coronary heart disease, was registered by a paroxysm of AF.

EXAMPLE 5. Patient I., aged 45, suffering from coronary heart disease. On the standard ECG "R" wave is equal to 115 MS. When ECG monitoring daily the number of single atrial extrasystoles was 18, paired - 6, group - 3, the total diagnostic ratio amounted to 3.4, which is insufficient for decision making. Subsequent Dispensationalism for three years with repeated daily ECG monitoring the main disease paroxysmal AF were not registered.

Examples 4 and 5 demonstrate ways in which survey data are not sufficient for making decisions about the presence or absence of the risk of paroxysmal AF.

The list of references

1. Maskouski. Atrial fibrillation (causes, mechanisms, clinical manifestations, treatment and prevention). SPb., Folio, 1999.

2. Chabichou Atrial fibrillation. SPb, 2001.

3. Dombrowski A., Dombrowski B., piotrowicz R. monitoring of ECG. // Moscow - 1999. - Malpractice.

4. Morrison G.W. Kumar E.B. Portal F.W. Aber C.P. Cardiac arrhythmias 48 hours before, during and 48 hours after discharge from hospital following acute myocardial infarction. // Brit. Heart J. 1981 Vol.45 N 5 P.500-511.

5. S.H. Rahimtoola Ziper D.P. Akhtar M. e.a. Consensus statement of the conference on the state of the art of electrophysiologic testing in diagnosis and treatment of patients with cardiac arrhythmias // Mod. Cone. Cardiovasc. Dis. 1987 Vol.56 N 10 P 55-59.

6. Miller OP, Bataeva O.V. causes of paroxysmal atrial fibrillation in individuals with healthy hearts". // Abstracts of the 5th International Slavic Congress on cardiac stimulation and clinical cardiac electrophysiology. VA N 25 2002, p.20.

7. Wald, A. Sequential analysis. M. - 1967. - 148 C.

8. Gubler E.B. Computational methods of diagnosis. - HP - 1987. - 97 C.

A method for diagnosing the risk of paroxysmal atrial fibrillation in patients with ischemic heart disease by registering a standard electrocardiogram and measurement duration subs the "P", characterized in that it further spend daily monitoring of an electrocardiogram, it calculates the number of single, paired, group atrial extrasystoles and calculated diagnostic factor of the DC according to the formula

DK=DK1+DC+DC+DC,

where DK1=-8.8 the length "P" is less than 106 MS, 9.3 the duration of the "R" more 116 MS 3.5 in the length "P" from 106 to 116 MS;

DK=-1.9 in the absence of the group of atrial extrasystoles during the day, 8.3 when the daily number of group atrial extrasystoles more than 4, 2.5 daily number of group atrial extrasystoles from 1 to 4;

DK=-2.9 when the daily number of paired atrial extrasystoles less than 3, 8.1 when the daily number of paired atrial extrasystoles are over 35, -1.4 when the daily number of paired atrial extrasystoles from 3 to 35;

DK=-5.1 when the daily number of single atrial extrasystoles less than 15, 4.3 when the daily number of single atrial extrasystoles more than 150, -1.0 if the daily number of single atrial extrasystoles from 15 to 150, if the DF is greater than or equal to 13, diagnosed with high risk of paroxysmal atrial fibrillation, if DK is less than or equal to -13, diagnose the absence of risk of paroxysmal atrial fibrillation, and if DK -13 more and less than 13,then the diagnosis is not defined.



 

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