Method of predicting recovery of sinus rhythm in patients with paroxysmal atrial fibrillation

FIELD: medicine.

SUBSTANCE: invention relates to the field of medicine, in particular to cardiology, and can be used for determining success in recovering the sinus rhythm in patients with paroxysmal atrial fibrillation. A rhythmogram is registered and the following mathematical averaging by a "sliding window" method is realised. The coefficient of rhythm biochronological ordering is calculated by formula lim m a m = 2 n ( n + 1 ) k = 0 n 1 ( k + 1 ) a k , where lim a is the coefficient of rhythm biochronological ordering (relative units), a stands for values of R-R intervals (milliseconds), n stands for the quantity of intervals, m is the quantity of averaging cycles, k is an averaged interval number. If the value of lim a<5.5, the possibility of recovering the sinus rhythm by both a pharmacological and an electric cardioversion is lower than 10%, in case of lim a (≥5,5; ≤6,5), the possibility of recovering the sinus rhythm by the electric cardioversion is higher than 90%, with lim a>6,5 the possibility of recovering the sinus rhythm by the pharmacological cardioversion is higher than 90%.

EFFECT: method makes it possible to estimate the probability of recovering the sinus rhythm in patients with paroxysmal atrial fibrillation with high sensitivity and specificity.

3 ex

 

The invention relates to medicine, in particular to cardiology, and can be used to measure the success of restoration of sinus rhythm in patients with paroxysmal form of atrial fibrillation.

Currently using a method such as correlation rithmography (KRG), the essence of which lies in the graphical display of the successive pairs of R-R (previous and next) in a two-dimensional coordinate plane, developed a number of domestic researchers [Berezny E. A. Correlation rithmography in the study and treatment of patients with atrial fibrillation. -Cardiology, 1981, No. 5, pp. 94-96].

A disadvantage of the existing method is the low specificity and sensitivity. At the same time, there is a need to assess the success of restoration of sinus rhythm.

The aim of the invention is to improve the accuracy of the assessment of sinus rhythm in patients with paroxysmal form of atrial fibrillation.

Currently the restoration of sinus rhythm can be performed by pharmacological cardioversion with antiarrhythmic drugs or electrical cardioversion defibrillator discharge (which is more traumatic, but more efficiently).

This object is achieved in that the patient is at the stage of preparation for farmacologiche�coy or electrical cardioversion were recorded electrocardiogram. During the registration electrodes were used with a silver chloride coating. Electrical signals from the electrocardiograph translated into digital code 12-bit analog-to-digital Converter.

Thus was formed the primary file ECG non-averaged one. Subsequent processing was performed using software package: Matlab 7.0, Microsoft Exel 2010. While in the program Matlab 7.0 from the digital code received sequence of time intervals R-R in milliseconds. Further processing was carried out in Microsoft Excel 2010 using averaging "sliding window", where the mathematical duration of the window was equal to the length of the source file.

The calculation was performed according to the following formula:

limamm=2n(n+1)k=0n-1(k+1)ak,

where

lim a - coefficient biochronological regularity of the rhythm (relative units),

a - values of the intervals R-R (milliseconds),

n is the number of intervals,

m - the number of cycles of averaging,

k - �Omer average interval.

At the end of the calculation, the patients were divided into 3 groups according to the degree biochronological regularity of the rhythm:

(A) Low probability - the likelihood of restoration of sinus rhythm of less than 10% (lim a<5,5).

(B) Electric - the probability of recovery of rhythm by electrical cardioversion, more than 90% (5,5≤lim a≤6,5).

C) Pharmacological - the probability of recovery of rhythm by pharmacological cardioversion, more than 90% (Lim a>6,5).

This allows high sensitivity and specificity to assess the likelihood of restoration of sinus rhythm in patients with paroxysmal form of atrial fibrillation.

This method can be implemented through the application of modern electrocardiographs with the possibility of registering a digital electrocardiogram, followed by the construction of the sequence of durations of R-R intervals.

The method is implemented as follows.

The patient at the stage of preparation for cardioversion is registered within 10 minutes of ECG, which is using the analog-to-digital Converter translates the digital code. Subsequent processing is performed using the software package Matlab 7.0, Microsoft Exel 2010. While in the program Matlab 7.0 from the digital code sequence obtained from the duration of the intervals R-R in milliseconds. Further processing is carried out in Microsoft Excel 2010 using averaging "sliding window", where the mathematical duration of the window is equal to the length of the source file.

This averaging is described by the formula:

limamm=2n(n+1)k=0n-1(k+1)ak,

the result is an indicator biochronological regularity of heart rhythm.

An example implementation of the method

1. Patient L., aged 57, case history No. 45551, was admitted to the hospital naval and military medical Academy hospital therapy 12.10.2010 G. with complaints of disruption of the heart, shortness of breath, inspiratory in nature, resulting from slight exertion. Diagnosis: Ischemic heart disease, arrhythmic option. Atherosclerosis of the aorta, the coronary arteries. Atherosclerotic cardiosclerosis with rhythm type-paroxysmal forms of atrial fibrillation. The paroxysm of atrial fibrillation from 12.10.2010 g, tachysystolic option.HK-I. II FC CHF. On ECG atrial fibrillation with a heart rate of 115 per minute. Blockade of the anterior-upper branching left leg PU�ka of GIS.

To determine the success of restoration of sinus rhythm was performed to identify the value of biochronological regularity of heart rhythm and obtained its value 6,7594, it means that the success of pharmacological correction.

On the background of a saturating dose antiarrhythmic drug class III was restored sinus rhythm.

2. Patient A., 54 years old, medical history, No. 39587, was admitted to the hospital naval and military medical Academy hospital therapy 18.09.2010 G. with complaints of faults in work of heart. Diagnosis: Ischemic heart disease, arrhythmic option. Atherosclerosis of the aorta, the coronary arteries. Atherosclerotic cardiosclerosis with rhythm type-paroxysmal forms of atrial fibrillation. The paroxysm of atrial fibrillation from 18.09.2010 G., tachysystolic option. On ECG atrial fibrillation with a heart rate of 108 per minute.

To determine the success of restoration of sinus rhythm was performed to identify the value of biochronological regularity of heart rhythm and obtained its value 5,854, which indicates the possibility of successful electrical cardioversion.

On the background of a saturating dose antiarrhythmic drug class III sinus rhythm was not restored. Restoration of sinus rhythm was achieved electrical dis�Ohm defibrillator energy 300 j.

3. Patient L., 55 years old, medical history, No. 48492, was admitted to the hospital naval and military medical Academy hospital therapy 25.10.2010 G., complaining of the disruption of the heart, shortness of breath, inspiratory character. Diagnosis: Ischemic heart disease, arrhythmic option. Atherosclerosis of the aorta, the coronary arteries. Atherosclerotic cardiosclerosis with rhythm type-paroxysmal forms of atrial fibrillation. The paroxysm of atrial fibrillation from 25.10.2010 g, tachysystolic option.HK-I. II FC CHF. On ECG atrial fibrillation with Sspov minute.

To determine the success of restoration of sinus rhythm was performed to identify the value of biochronological regularity of heart rhythm and obtained its value 4,586, indicating a low probability of successful relief of the paroxysm of atrial fibrillation.

On the background of a saturating dose antiarrhythmic drug class III sinus rhythm was not restored. Restoration of sinus rhythm was not achieved three posledovatelnyi electrical discharges defibrillator energy 300-360-360 J.

Thus, it is shown that the definition of the coefficient biochronological orderliness heart rhythm allows to identify patients who have a 90% chance that it will be docked a paroxysm of atrial preset�th.

The proposed method of determining the success of restoration of sinus rhythm is simple, affordable and can be used in clinical practice.

A method for predicting recovery of sinus rhythm in patients with paroxysmal form of atrial fibrillation by registration of rythmogram and subsequent mathematical averaging method "sliding window", characterized in that determine the coefficient biochronological regularity of the rhythm by the formula:
limmam=2n(n+1)k=0n-1(k+1)ak,
where
lim a - coefficient biochronological regularity of the rhythm (relative units),
a - values of the intervals R-R (milliseconds),
n is the number of intervals,
m - the number of cycles of averaging,
k is the number of the averaged interval,
and when the value of lim (a<5,5 - likelihood of restoration of sinus rhythm as pharmacological and electrical cardioversion less than 10%,
lim a (≥5,5; ≤6,5) - the probability of the restoration�termination of rhythm by electrical cardioversion, more than 90%,
lim a>6,5 - the probability of recovery of rhythm by pharmacological cardioversion of over 90%.



 

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3 ex, 6 tbl, 3 dwg

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2 ex, 2 tbl

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