Method for optimising atrioventricular delay in patients with cardiac resynchronising therapy
SUBSTANCE: continuous monitoring and ECG recording are performed. The ECG findings are used to specify a delay in shape of R wave and a length of an antrioventricular interval. The final result of atrioventricular delay is a symmetrical crowned P wave.
EFFECT: method provides increasing the effectiveness of cardiac resynchronising therapy by reducing complications and improving the patient's quality of life.
1 tbl, 1 ex, 1 dwg
The invention relates to medicine, namely to cardiology, and can be used for the treatment of chronic heart failure in patients with implanted cardiac systems.
The use of cardiac resynchronization therapy (CRT) in patients with chronic heart failure functional class showed significant decrease of the disease symptoms, improving the quality of life, fewer hospitalizations and mortality [Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, Carson P, DiCarlo L, DeMets D, White BG, DeVries DW, Feldman AM: Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004; 350: 2140-2150; Bradley DJ, Baughman KL, Berger RD, Calkins H, Goodman SN, Kass DA. Powe NR. Cardiac resynchronization and death from progressive heart failure: a meta-analysis of randomized controlled trials. JAMA. 2003 Nov 12; 289(6): 730-40]. However, one third of patients with implanted CRT devices do not respond to this type of treatment that requires the identification and correction of contributing factors. One of the most frequent causes of insufficient response to CRT is suboptimal atrioventricular delay (FD occupations) [Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E, Kocovic DZ, Packer M, Clavell AL, Hayes DL, Ellestad M, Trupp RJ, Underwood J, Pickering F, Truex C, McAtee P, Messenger J: Cardiac resynchronization in chronic heart failure. N Engl J Med 2002; 346: 1845-1853; Cleland JG, Freemantle N, Erdmann E, Gras D, Kappenberger L, Tavazzi L, Daubert JC. Long-term mortality with cardiac resynchronization therapy in the Cardiac Resynchronization-Heart Failure (CARE-HF) trial. EurJ Heart Fail. 2012 Jun; 14(6): 628-34]. To date, there is no universal optimization method FD occupations [Patrick Houthuizen. Frank A L E Bracke. Berry M van Gelder: Atrioventricular and interventricular delay optimization in cardiac resynchronization therapy: physiological principles and overview of available methods. Heart Failure Reviews 2011; 12; 16(3): 263-276; Vardas PE, Auricchio A, Blanc JJ et al.: Guidelines for cardiac pacing and cardiac resynchronization therapy: the task force for cardiac pacing and cardiac resynchronization therapy of the European society of cardiology. Developed in collaboration with the European Heart Rhythm Association. Eur Heart J 2007; 28(18): 2256-2295].
The most known and used and echocardiographic automated algorithms for analysis FD occupations. However, the subjectivity of the method of echocardiography (ECHOCG), high measurement accuracy, and the inability to change the algorithms for automated selection FD occupations in some cases can cause a decrease the effectiveness of resynchronization therapy and worsening of CHF clinic [Chung ES, Leon AR, Tavazzi L, Sun JP, Nihoyannopoulos P, Merlino J, Abraham WT, Ghio S, Leclercq C, Bax JJ, Yu CM, Gorcsan J 3rd, St John Sutton M, De Sutter J, Murillo J, Results of the Predictors of Response to CRT (PROSPECT) trial. Circulation. 2008 May 20; 117(20): 2608-16, Thomas DE, Yousef ZR, Fraser AG. A critical comparison of echocardiographic measurements used for optimizing cardiac resynchronization therapy: stroke distance is best. Eur J Heart Fail. 2009 Aug; 11(8): 779-88].
Optimal atrioventricular delay for CRT devices represents a time interval during which fills with blood to the ventricles through the atrio-ventricular pressure gradient during diastole (�assigny period) and by reducing - systole of the Atria (the active period). After the optimal interval FD occupations comes the contraction of the ventricles - biventricular stimulation with a maximum preloading. The expected effect of such a temporal correlation - increasing pressure gradient of blood in the ventricular myocardium and therefore the increase in the stroke volume and cardiac output. When extending the interval FD occupations occur conditions to late diastolic regurgitation of blood through the atrioventricular valves by the pressure gradient back into the Atria, which leads to the syndrome of small emissions, increased pressure in the pulmonary circulation and worsen CHF. Excessively short FD occupations leads to insufficient filling of blood in the ventricles of the heart is interrupted due to the systole of the Atria, which also reduces stroke volume and cardiac output [Yaariv Khaykin, Derek Exner. David Birnie et al. Adjusting the timing of left-ventricular pacing using electrocardiogram and device electrograms. Europace. 2011, 13: 1464-1470].
Impact of drug therapy on the conductivity of the myocardium, different PR intervals surface ECG when the conduction in the myocardium (normal or prolonged PR interval), interatrial delay - blockade intraatrial and the change of parameters in time - exercise, rest, reverse remodeling myocar�and - all these factors contribute to the feasibility of dynamic optimization in FD occupations CRT devices [Steven R. Bailey, Andrew E Epstein, Paul A Heidenreich et al. ACCF/HRS/AHA/ASE/HFSA/SCAI/Marsaxlokk as its next/SCMR 2013 Appropriate Use Criteria for Implantable Cardioverter-Defibrillators and Cardiac Resynchronization Therapy. Heart Rhythm. April 2013; 10(4): 2-48].
One non-invasive way to optimize FD occupations can be considered electrocardiographic method. Pathophysiological rationale of this approach is that the P wave on surface ECG reflects the electrical systole is the depolarization of the right and left Atria. FD occupations selected on the basis of morphology and duration of your own teeth and stimulated R, where the end result interval FD occupations is taken symmetrical finished the P wave in lead with the best visualization - often in the II standard lead ECG [Cristian Statescu, Radu A. Sascay, Vasile Maciuc et al. Programming an Optimal Atrioventricular Interval in a Dual Chamber Pacemaker Regional Population. Maedica a Journal of Clinical Medicine 2011, 6 (4): 272-276].
From the known analogues and prototype to the claimed method is selected method of dynamic optimization FD occupations on the basis of atrial electrogram Quik-Opt [Ravindu Kamdar, Evelyn Frain, Fiona Warburton et al. A prospective comparison of echocardiography and device algorithms for atrioventricular and interventricular interval optimization in cardiac resynchronization therapy. Europace 2010, 12: 84-91]. This type of selection FD occupations relates to automated algorithms of the manufacturer of the pacemaker St. Jue Medical (USA). For optimal detektirovanie FD occupations taken time calculated from the beginning of atrial electrogram up to its end - atrial time of the pulse (electrical activation of the right and left Atria) with the addition of index +30 MS, if the timing of ≥100 MS, or +60 MS when the time of the <100 MS. Stimulated FD occupations is defined as the sum of the interval detektirovanie FD occupations +50 MS. The value of the index increases are empirically selected and reflects the average time interval for the completion of the mechanical systole of the Atria. Selection FD occupations using the algorithm Quik-Opt can be carried out during the programming CRT devices; automatic selection FD occupations without a doctor impossible [Ravindu Kamdar, Evelyn Frain, Fiona Warburton et al. A prospective comparison of echocardiography and device algorithms for atrioventricular and interventricular interval optimization in cardiac resynchronization therapy. Europace 2010, 12: 84-91]. In a randomized controlled study of FREEDOM (A Frequent Optimization Study using the Quick Opt Method comprising 1647 patients, we demonstrated the effectiveness of dynamic optimization FD occupations in this way, comparable with echocardiographic methods [Abraham WT, Gras D, Yu CM et al. Results from the FREEDOM trial to assess the safety and efficacy of frequent optimization of cardiac resynchronization therapy. Abstract SP08. Late-Breaking Clinical Trials, HRS 2010. Denver, Colorado].
The main disadvantages of the above-described method of optimizing FD occupations are: the need required�of the device only with this manufacturer, the inability to adjust settings of the automated algorithm, empirical indices to calculate the total FD occupations, dependent on the settings of the CPT system (the level of sensitivity on the atrial channel, the recording quality of electrogram).
The technical result achieved by the invention is to improve the hemodynamic response of the myocardium of the left ventricle, with the consequent increase of its systolic function due to selection of the atrio-ventricular delay based on the morphology of the P wave with the trend towards a narrowing of the stimulated QRS complex on surface ECG.
The claimed technical result is achieved in a method for optimizing atrioventricular delay in patients with cardiac resynchronization therapy based on surface ECG registration. According to the invention is the selection of the atrio-ventricular delay when the continuous recording of ECG, wherein the delay is selected according to the shape of the P wave, the duration of atrioventricular interval; for the final result of the atrio-ventricular delay is taken symmetrical finished prong R.
The difference between the proposed method from the prototype is the principle of optimization of FD occupations with only electrocardiographic data.
The claimed invention is new, as identical sookun�STI signs in the reviewed literature is not detected. Distinctive features showed in the inventive combination of new properties that are not explicitly derived from the prior art in this field and not obvious to the expert.
The proposed technical solution can be applied in medicine, particularly in cardiology.
Based on the above, you should consider this solution with the relevant conditions of patentability: novelty", "inventive step", "industrial applicability".
The method is as follows.
For the selection of FD occupations employ a system for monitoring and recording ECG with standard and reinforced leads. During programming FD occupations selected on the basis of the ECG in the form of your own teeth and stimulated R, the duration of a native atrioventricular interval, the width of the excited ORS complex in lead with the best visualization. For a end result accepted FD occupations symmetrical finished the P wave as their own, and stimulated.
The method is illustrated by the following clinical example and the circuit of Fig.1, which illustrates the procedure of the selection of FD occupations (patient K., selection PG - detection):
A - measurement of P-wave - 134 MS,
B - excessively short FD occupations - 85 MS: PR interval is 120 MS, QRS complex - 209 MS,
In long FD occupations - 130 MS: PR interval 167 MS, visible from�line between the P wave and QRS; the QRS complex is 199 MS,
G - optimal FD occupations - 100 MS: PR interval of 136 MS, the QRS complex is 192 MS.
Example. Patient S. 62 years with coronary heart disease, postinfarction cardiosclerosis (transmural myocardial infarction from 2008) with the outcome in dilated cardiomyopathy, functional class III heart failure (NYHA). Condition after angioplasty with stenting of the circumflex artery from 2009, According to the ECHO - reduced LVEF (25%), ECG - sinus rhythm, complete blockade of the left bundle branch (PAMNG), prong R - 134 MS, interval PQ 204 MS, QRS - 191 MS. 21.08.2011 implanted system resynchronization therapy with function defibrillation, CRT-D with positioning propresenter electrode in the left atrial appendage, right ventricular electrode in the apex of the right ventricle, the left ventricular electrode in a lateral coronary sinus vein (basal section). After implantation of the device is made of standard programming Protocol with the selection of FD occupations on the shape of the P wave in private and stimulated atrial events selected FD occupations detection/stimulation 90/125 MS; the original value FD occupations default was 100/130 MS; sensitivity to R - 0.3 mV. Left synchronous biventricular stimulation. During the control visit after 3 months, marked by moderate positive dynamics of size and LV volumes, ejection fraction. Then at each ambulato�nom programming CPT apparatus according to the scheme 0-3-6-12 months selection was carried out FD occupations, control ECHOCARDIOGRAPHY.
Dynamics of ECG, FD occupations, echocardiographic parameters at 12 months of follow-up this patient presented in the table.
After 12 months from the date of implantation of the device revealed a significant increase in LVEF, decrease the size and LV volumes, the clinical effect in the form of increased tolerance to physical activity, reduction of FC (NYHA) according to the test with a six-minute walk.
This example demonstrates the versatility of measurements, reproducibility, and safety of the proposed method FD occupations optimization in CRT devices. Ease of practical application without the use of additional time and financial resources, the possibility of correction of septal myocardial dyssynchrony on the basis of ECG data indicate the advantages of the proposed method of selection FD occupations before known algorithm Quik-Opt. The inventive method allows to increase the effectiveness of cardiac resynchronization therapy to reduce FC CHF, improve the quality of life of patients. Thus, the proposed method of optimization of atrioventricular delay in patients with cardiac resynchronization therapy based on surface ECG is an important part of active surveillance and treatment of patients with high FC and it has been successfully implemented in practice.
A method for optimizing atrioventricular delay in patients with cardiac resynchronization therapy based on surface ECG registration, characterized in that carry out the selection of the atrio-ventricular delay with continuous monitoring and recording of ECG, wherein the delay is selected based on the ECG by the shape of the P wave, the duration of atrioventricular interval and for the final result of the atrio-ventricular delay take symmetrical finished barb R.
SUBSTANCE: invention refers to medicine, namely to cardiology and gynaecology, and can be used in the differential diagnostics of cardiogenic myocardial ischemia and the genital-cardial inhibitory reflex accompanied by pain syndrome caused by a gynaecological pathology. That is ensured by ECG recording. That is followed by two-side block of round ligaments of the uterus by an anaesthetic solution in an amount of 15.0-20.0 ml from each side. The ECG is recorded again 60-90 min after the block, and the recording is compared to the pre-block ECG. If the ECG findings tend to be positive, ischemia caused by the genital-cardial inhibitory reflex accompanied by pain syndrome caused by a gynaecological pathology is diagnosed. If no positive dynamic is observed, cardiogenic myocardial ischemia is diagnosed.
EFFECT: technique provides the effective differential diagnosis of cardiogenic myocardial ischemia and the genital-cardial inhibitory reflex accompanied by pain syndrome caused by a gynaecological pathology.
SUBSTANCE: invention relates to medicine, namely to obstetrics and gynaecology. After anamnesis analysis, the presence of the foetoplacental failure of a compensated form, oligohydramnios are identified. The day before labour cardiotocographic (CTG) examination is carried out, its results are evaluated, and the index STV is determined. Foetal monitoring is carried out, during which the sum of areas of decelerates in the active phase of I period of labour is determined with the external CTG and STV index with direct CTG after 1 hour of monitoring. The obtained data are processed with the calculation of a prognostic index. On the basis of the obtained index value the development of acute foetus hypoxia is predicted.
EFFECT: method makes it possible to predict the development of acute foetus hypoxia in labour, which makes it possible to determine further obstetric tactics of labour management in due time.
SUBSTANCE: in the patients diagnosed with breast cancer and recommended to have a chemotherapeutic course, the heart rate is measured one week before the treatment according to electrocardiography after a 5-minute rest. If the measured heart rate is 70 beats per minute or more, ivabradine is prescribed in a daily dose of 10 mg. Electrocardiography is repeated after a 5-minute rest 4 weeks later. If the measured heart rate is 70 beats per minute or more, the dose is titration is made to 15 mg a day. If the measured follow-up heart rate is less than 70 beats per minute, the daily dose is kept at 10 mg. If the initial heart rate is less than 70 beats per minute, trimetasidine is prescribed in a daily dose of 70 mg for the whole period of treatment independent from the further heart rate measurement. All the patients take the preparation throughout the duration of 6 months.
EFFECT: method enables reducing the cardiotoxic action of the anthracycline chemopreparations in the patients with breast cancer.
3 ex, 4 dwg
SUBSTANCE: Holter ECG monitoring with recording total vegetative activity and measuring heart rate variability is conducted on the 21st day following ischemic stroke. Daily standard deviation of NN intervals (SDNN) is determined. If SDNN<71 ms, a high risk of cardiovascular complications following ischemic stroke is predicted.
EFFECT: method enables providing the informative and most accurate possible prediction of the risk of cardiovascular complications following ischemic stroke on the ground of daily standard deviation of NN intervals, which represent an independent predictive factor.
3 ex, 1 dwg, 2 tbl
SUBSTANCE: on the 21st day following an acute ischemic stroke, the patient has continuous Holter monitoring and ventricular extra systole recording. Observing frequent single ventricular extra systoles in number of more than ten an hour and grouped ventricular extra systoles enables predicting the high risk of cerebral complications following the ischemic stroke.
EFFECT: method enables predicting the high-grade risk of cerebral complications on the basis of ventricular extra systoles, which are an independent predictive factor of recurrent cerebral complications.
3 ex, 3 tbl
SUBSTANCE: estimation of the heart rate variability is realised by a method of 24-hour Holter monitoring of the 21st day from the moment of ischemic stroke development. After that, the power of a low-frequency spectrum is determined by means of spectral analysis and, if its value is lower than 117 ms2, a high risk of cardiac complications after the ischemic stroke is predicted.
EFFECT: method makes it possible to increase the accuracy of predicting a risk of development of cardiac complications after the ischemic stroke due to the identification of a certain LF value, an independent prognostic factor.
2 ex, 4 tbl, 2 dwg
SUBSTANCE: ECG is recorded. That is followed by a needle block of an ileocecal plexus with an anaesthetic solution in an amount of 60.0-80.0 ml; that is followed by recording another ECG after 60-90 min. The record is compared to the pre-block ECG record. If observing a positive dynamics in ECG results, ischemia caused by ileocecal-cardial inhibitory reflex is diagnosed, while no positive dynamics shows cardiogenic myocardial ischemia.
EFFECT: providing the more effective differential diagnostics of cardiogenic myocardial ischemia and ileocecal-cardial inhibitory reflex with underlying ileocecal patency.
SUBSTANCE: heart rate variability is assessed. The assessment procedure involves 24-hour Holter monitoring on the 21st day from the moment of the ischemic stroke occurred. And if observing brady-arrhythmias presented by degree 2-3 atrio-ventricular block or degree 2-3 sinoatrial block and sinus pauses of more than 2 sec long, a high risk of cardiovascular fatal complications following the ischemic stroke is predicted.
EFFECT: method provides the high informative and flexible prediction of the risk of cardiovascular fatal complications following the ischemic stroke in the patients with cerebrovascular, cardiac, endocrine comorbidities.
3 tbl, 3 ex
SUBSTANCE: electric cardio signal recorder in free motion activity comprises an amplifier (1), an analogue-to-digital converter with a multiplex switch (2) and series decomposition unit (3), second arithmetical-logical unit (4), an arithmetic unit (5), an increment code analyser (6), a switchover unit (7) and a digital modem (8), as well as a control unit (9), first (12) and second (10) memory units, an increment code counter (11). A second output of the second arithmetical-logical unit (4) is connected to a first input of a decomposition unit (3); an output of the second memory unit (10) is connected to a second output of the second arithmetical-logical unit (4); a second output of the increment code analyser (6) is connected to a first input of the first memory unit (12), while a third output - to a first input of the increment code counter (11), an output of which is connected to a second input of the first memory unit (12) an output of which us connected to an second input of the switchover unit (7); first, second, third, fourth, fifth and sixth outputs of the control unit (9) are connected respectively to a first input of the analogue-to-digital converter with the multiplex switch (2), a second input of the decomposition unit (3), an input of the second memory unit (10), a third input of the second arithmetical-logical unit (4), a second input of the increment code counter (11) and a third input of the switchover unit (7). The device also comprises an electrode break detector (13) and a heart critical state detector (14). The amplifier (1), the electrode break detector (13), the analogue-to-digital converter with the multiplex switch (2), the heart critical state detector (14) and the decomposition unit (3) are series connected. A seventh output of the control unit (9) is connected to a fourth input of the switchover unit (7); a second output (17) of the electrode break detector (13) is connected to a first input of the control unit (9), a second input of which is connected to a second output (24) of the heart critical state detector (14), and a second output of the second memory unit (10) is connected to a second input (22) of the heart critical state detector (14).
EFFECT: using the invention enables enhancement by detecting the electrode break and the heart critical state in free motion activity.
3 cl, 12 dwg
SUBSTANCE: invention relates to medicine, namely to paediatric cardiology and paediatric infectious diseases, and can be used for evaluation of indications for cardiometabolic therapy in case of infectious affection of myocardium in children. For this purpose quantitative evaluation of clinical, electrocardiographic, biochemical and echocardiographic indices is determined and realised. As clinical indices auscultative symptomatic: sonority of tones, presence of noises, parameters of arterial pressure are evaluated. As biochemical indices evaluated are: activity of cardiospeciphic enzymes: MB-fraction of creatine phosphokinase, α-hydroxybutyrate dehydrogenase, aspartic transaminase, alanine transaminase and cardiospecific troponin I protein. Echocardiographic examination is realised with application of Dopplerography for evaluation of diastolic ventricular function. Each of indices is evaluated by from 1 to 3 points. Points are summed up and obtained result is used to evaluate indications for cardiometabolic therapy. If the total sum is lower than 3 points, cardiometabolic therapy is not indicated. If the total sum is from 3 points to 7 point including, peroral introduction of cardiometabolic preparations is carried out. If the total sum is from 8 points and higher, parenteral introduction of cardiometabolic preparations is realised.
EFFECT: method provides possibility of determining presence of indications to administering cardiometabolic therapy objectively in minimal terms, including situations, when part of results of additional examination is absent because of some reasons, and of evaluating its efficiency in differential way.
1 tbl, 4 ex
SUBSTANCE: method involves carrying out pulsating Doppler echocardiographic examination. Mean pressure is determined in pulmonary artery. Mean pressure in pulmonary artery being less than 13 mm of mercury column, no cardiac rhythm disorders risk is considered to take place. The value being greater than 13 mm of mercury column, complex cardiac rhythm disorder occurrence risk is considered to be the case.
EFFECT: accelerated noninvasive method.
FIELD: medicine; medical engineering.
SUBSTANCE: method involves selecting reference point in every cardiac cycle on TP-segment. Values of neighboring N=2n+1 reference points also belonging to TP-segment are recorded, n=1,2,…, beginning from the first reference point. Other reference points are set to zero. The central reference point value is left without changes in a group of 2n+1 member. Reference point values of each of n pairs of reference points symmetrically arranged relative to the central reference point are scaled relative to condition Uj=U0Kj, where U0 is the central reference point amplitude, Uj is amplitude of j-th reference point pair, j=1,2,…,n is the number of each reference point pair relative to the central reference point, Kj is the scaling coefficients determined from received signal suppression condition of the first n spectral zones in spectrum. The so formed electrocardiogram signal reference point groups sequence is let pass through lower frequency filter with isoline drift signal being obtained being produced on output. The signal is amplified and subtracted from the initial electrocardiogram signal that is preliminarily delayed for lower frequency filter delay time. Device has the first lower frequency filter, discretization unit and unit for selecting anchor reference points connected in series, as well as subtraction unit, unit for saving N reference points, scaling unit, the second lower frequency filter, amplifier and delay unit. Output of the unit for selecting anchor reference points is connected to the first input of memory unit the second input of which is connected to discretization unit output. Each of N memory unit outputs is connected to one of N inputs of scaling units. Scaling unit output is connected to the second lower frequency filter input which output is connected to amplifier input. Amplifier output is connected to the first input of subtraction unit, the second output of subtraction unit is connected to delay unit output. Its input is connected to output of the first lower frequency filter. Subtraction unit output is the device output.
EFFECT: reliable removal of isoline drift.
2 cl, 8 dwg
FIELD: medicine; cardiology.
SUBSTANCE: device has amplifier, analog-to-digital converter provided with multiplexer, arithmetic unit, memory unit, digital modem, increment code analyzer, increment codes number counter, switching unit and control unit as well as second memory unit, digital filtration unit and decimation unit. Electrocardiogram signal is registered within frequency-time area. Increase in volume of diagnostic data is provided due to time localization of spectral components of electrocardiogram signal.
EFFECT: widened operational capabilities; improved precision of diagnosing; higher efficiency of treatment.
FIELD: medicine; radio electronics.
SUBSTANCE: device for taking cardiogram has set of electrodes, cardiologic unit, analog-to-digital converter, cardio signal preliminary treatment unit, computer, lower frequency filter, differentiator, functional converter and controlled filter. Power function calculation units are not included. Preliminary continuous filtering of cardio signal entering the computer is provided.
EFFECT: simplified design; improved precision of measurement.
FIELD: medical engineering.
SUBSTANCE: device has electrodes, input amplifier, unit for protecting against error influence when applying medical electric instruments, low frequency filter, signal analysis unit, unit for eliminating isoline drift and electric power supply units.
EFFECT: high accuracy in plotting rhythmograms; improved instruments manipulation safety.
SUBSTANCE: method involves modeling real three-dimensional patient heart image based on electrocardiogram and photoroentgenogram data and determining basic functional values of its myohemodynamics.
EFFECT: high accuracy and reliability of the method.
2 cl, 5 dwg
SUBSTANCE: method involves recording cardiac biopotentials with vector electrocardiograph, processing and visualizing signal with graphical plane integral cardiac electric vector projections (vector electrocardiograms) being built and analyzed. Shape, QRS-loop value and vector orientation-recording process are determined. Analysis is based on planar vector electrocardiograms in horizontal, frontal and sagittal planes and in spatial 3-D-form. Vector loop direction is studied in X-,Y-,Z-axis projections, values, dynamics and localization are evaluated in resulting integral cardiac electric vector delta-vector space. To do it, QRS-loop is divided into four segments, one of which characterizes excitation in middle part of axial partition surface, the second one is related to excitation in lower ventricular septum one-third with cardiac apex being involved and the third and the fourth one is related to excitation in basal parts of the left and right heart ventricles. Delta-vector existence and its magnitude are determined from changes in loop segment localization when compared to reference values.
EFFECT: improved data quality usable in planning surgical treatment.
FIELD: medical radio electronics.
SUBSTANCE: device can be used for testing cardio-vascular system of patient. Differential vector-cardiograph has high frequency oscillator, common electrode, unit for reading electrocardiogram and radio cardiogram provided with amplification channels and filtration channels, multiplexer, microprocessor unit with common bus, analog-to-digital converter, keyboard, mouse and indication unit. Device provides higher precision of measurements due to usage of electric component heart activity and truth of diagnostics due to ability of representation of results of testing in form of variety of vector-cardiograms in real time-scale.
EFFECT: improved precision.
FIELD: medicine, cardiology, arhythmology, functional diagnostics.
SUBSTANCE: one should register electrocardiogram in esophagus, apply an electrode in a site where the maximum signal amplitude is registered, increase the signal 5-fold, not less to be filtered in the range of 0.5-40 Hz to be registered at the rate of 100 mm/sec, not less. The time for intra-atrial process should be measured from the beginning of ascending part of the first positive wave of pre-P-tooth up to the top of the second adhesion of P-tooth; the time for inter-atrial process should be measured from the site of crossing a descending part of the first positive wave and the onset of obliquely ascending pre-P-interval up to crossing this interval with the point of abrupt increase of the first phase of P-tooth. The innovation provides more means for noninvasive evaluation of intra- and inter-atrial stimulation process.
EFFECT: higher accuracy of evaluation.
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.