HRONOSTRUKTURA heart rate, and Environmental Factors

Hronostruktura heart rhythms and environmental factors
Astronomical time, biological time, Astronomical Clock, the biological clock. They are not only Earth.

These and Cosmos.

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TK Breus S.M.Chibisov, R.N.Baevsky and K.V.Shebzuhov. Hronostruktura heart rhythms and environmental factors:

Monograph. - M. Publisher Russian University of Peoples' Friendship, Polygraph Services, 2002, with -232. -, Silt.

Was experimentally investigated in a terrestrial laboratory and in space flight hronostruktury rhythms of various indicators of the cardiovascular system, as well as their changes under the influence of environmental factors. The data showing that the circadian system of the heart to respond flexibly and consistently changed in cycles that are perennial, infradiannye and multi-day periods, such as the eleven-year solar cycle of about 28 days, about - a 14-day, around-week rhythms. There were significant differences hronostruktury daily rhythm determined by the change of seasons.

It is shown that the reaction hronostruktury heart on a variety of patterns external stimuli, such as social factors and changes in the rhythm of time sensors, such as the rhythms of light and the geomagnetic field of the same type and is a typical adaptation stress. The problem of the influence of disturbances on the Earth's geomagnetic field hronostrukturu indicators of heart rhythm. The results obtained in laboratory animal studies and in studies of astronauts during the flight, confirmed by laboratory simulations indicate that the geomagnetic storms cause jet lag hronostruktury heart rhythms, corresponding to the adaptation to stress, stress at a similar circadian rhythm produced when transcontinental flights. The above material to evaluate the mechanisms underlying the morphological and functional changes in the activity of the heart, controlled by a temporary factor.

The book is intended for physiologists, pathophysiology, biophysicists and cardiologists.

ISBN 5-209-01404-5

ISBN 5-86388-X

UDC 612.17:577,3 +616.12-12-008

Reviewers: Prof. GG Avtandilov, Professor V.I.Torshin

From the authors

In the last decade gained rapid development of chronobiology (chronomedicine) - the science of the temporal patterns of functioning of the organism - the biological rhythms and temporal trends, their dependence on the state of the biological system, the physiological mechanisms underlying them. This science is also exploring the exterior clocks (or vremyadatchiki) biological rhythms, their basic properties and relationships with the organisms.

Biological objects, including the human body, are complex non-linear open systems that are critically dependent on the changing conditions of the environment and can respond to the macro microscopic fluctuations influencing factors. To survive and adapt to fluctuations in external factors (eg, temperature, climate, natural electromagnetic fields, food availability, etc.), biological systems have to exercise a significant degree of randomness in the behavior. Moreover, the weak external signals, the noise level could play a significant role in their self-organization.

To understand the organization of complex systems over time is essential to have long-term measurements of their physiological characteristics, which are usually quite difficult to implement. That is why the problem of the impact of environmental factors on biological systems has received an entirely new light, when they began to be used long-term monitoring data, characteristic methods of chronobiology.

In the development of modern domestic chronobiology (or, as we call it, biorhythmology) primacy belongs to the scientists, who began with laboratory experiments and theory, and then went on to research in the field of space medicine in the early sixties.

For more than 30 years at the Department of Pathological Physiology, People's Friendship University, led by Professor V.A.Frolova work was conducted on the experimental study of biological rhythms of the heart. The parameters of the contractile force of the heart healthy animals of the same type. The dynamic time series of changes in these indicators, traced the picture of their relationship with the cycle of solar activity, determine the parameters hronostruktury different frequency rhythms and their relationship with environmental factors. This multi-year study involved almost the entire staff of the department.

With special thanks to want to mention the invaluable contributions to this work, TA Kazan.

Since the early eighties at the Institute of Space Research, in conjunction with medical clinics in Moscow People's Friendship University, the Institute of Medicine of the Academy of Sciences co-authors of this book were hronomeditsinskie impact study solar and geophysical parameters, on the cardiovascular system of a person. These works were carried out under the leadership of Medical Sciences and a professor F.I.Komarova S.I.Rapoporta. In the last decade a significant contribution to the understanding of the role of external factors in the formation of stress the cardiovascular system of a person made the work carried out in conjunction with the co-authors of the book of the Laboratory of the Institute of Medical and Biological Problems of the Russian Ministry of Health, led by Professor RM Baevsky.

The authors of this book have taken the liberty to compile the materials and take stock of some of these исследований.Дополнительная mathematical treatment of a number of data and a discussion of some aspects of the work were kindly carried out by Professor N.L.Aslanyanom (Institute of Cardiology, Armenia, Armenia) and the Academy of Sciences of Kyrgyzstan E.S Matyevym.

We are deeply grateful A.A.Konradovu (Institute of Chem-Physics, Russian Academy of Sciences) for helpful discussions efficiency used in the book of mathematical methods of data processing.

We are also grateful to the outstanding professionals in the field of chronobiology and chronomedicine R.M.Zaslavskoy Professor, University of Minnesota Professor Franz Halberg and Dr. Sci. Sciences of the same university Zh.Kornelissen (USA) for its continued support of work, advice and useful criticism.

Breus TK

(Space Research Institute, Russian Academy of Sciences)

Lapwings SM (Russian University of Friendship of Peoples)

RM Baevsky

(Institute of Biomedical Problems, Russian Ministry of Health)

Shebzuhov KV

(Russian University of Friendship of Peoples)

INTRODUCTION

Cryoablation of atrial FIBRILLATION

Cryoablation of atrial fibrillation Atrial fibrillation (AF) - is the most common arrhythmia, which affects more than 2 million people in SSHA.1, 2 The prevalence of AF continues to grow, so that by 2050 the United States the number of people affected by the arrhythmia can udvoitsya.3 OP - it is a disease of aging. However, no increased incidence of AF only due to age population, but also due to increased incidence of cardiovascular risk factors and consequently cardiovascular zabolevaniy.4, 5 Many epidemiological studies have shown that the incidence of AF increases throughout the Terrestrial sharu.6 -8 Despite the widespread prevalence of AF, many large randomized trials (such as AFFIRM, RACE and AF-CHF) were not able to show the benefits of the pharmacological control ritma.9-11 All of these studies have shown that the control of heart rate may be a good alternative, and even has advantages over control of the rhythm. When choosing a treatment strategy must be carefully weighed the lack of proven benefit of rhythm control and reduced quality of life associated with symptomatic AF.

In population studies have shown an increased risk of death (1.5-2 times) in patients with AF compared with paired patients without AF. 12,13 The study compared rhythm management strategies and heart rate indicate that the failure to improve survival when using rate control strategy may be due to: 1) failure to restore and maintain the rhythm and / or 2) the possible side effects of existing antiarrhythmic drugs. Yet it remains unknown whether the successful restoration of sinus rhythm for a long period to improve survival. Single-center, non-randomized study in Milan (Italy) showed improved survival for catheter ablation of AF (compared with a group of medical treatment), but it is not clear from the group of patients or ablation and drug therapy had the same source risk.14 More recently, John Day and colleagues reported an improvement in long-term (3-year) survival in patients with AF who underwent catheter ablatsiya.15 In this retrospective study of 4212 patients with catheter ablation had a lower mortality rate than 33696 patients in the control group, paired by age and sex, without AF (AF 23.5%, 8.7% without AF, ablation of 6,0%; p0, 001).

In addition, after catheter ablation less common stroke or dementsiya.16 Although this study has its limitations (potentially confounding factors and selection bias), it has put forward an important hypothesis that catheter ablation may decrease the risk of stroke and improve the survival of patients with atrial fibrillation. Currently, this is an important hypothesis is tested in a large prospective randomized study CABANA.17

Methodist Hospital Offering CryoAblation

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Cardiologist Matthew Latacha, M.D., made a little history on Tuesday, May 24, when he performed Methodist Hospital's first cardiac CryoAblation procedure on a female patient suffering from atrial fibrillation.

ECG Phenomena of the Early repolarization

ECG phenomena of early repolarization clinical interest in the ECG phenomenon of early repolarization (RJR) has recently flared up, mainly due to the establishment of its clinical connection with fatal cardiac arrhythmias, particularly in patients without (or with minimal) organic changes of the heart .

For a long time ECG phenomena RJR misdiagnosed or misinterpreted because of the widespread opinion of their benign nature.

Thus, violations of repolarization in Brugada syndrome for over three decades been regarded as safe, and early repolarization syndrome (CPP) considered are normal, benign early repolarization until 2000.

In 2008, an article Ha? Ssaguerre et al., Dedicated to the increasing prevalence of CPP in patients with idiopathic ventricular fibrillation episodes. However, the clinical significance of the phenomenon of RJR as a marker for sudden cardiac death (SCD) and its role in risk stratification is not yet fully defined.

Ventricular repolarization begins after the end of ventricular depolarization. In a normal cardiac cycle transition from one process to another is relatively fast and the amount of overlap between the late and early repolarization depolarization does not exceed 10 ms.

The length of the overlap is largely determined by physiological and pathological cardiac and extracardiac conditions that cause or spread of excitation wavelength on the wall of the ventricle, or the return of the drive, or both processes simultaneously.

Among the cardiac factors play a central role CPP configuration early phase of action potentials (AP) in different layers of the ventricular wall, as well as the dispersion of repolarization of the ventricular wall and transmural voltage gradient.

The transition of ventricular depolarization repolarization corresponds to a point on the ECG J (moment of transition of the QRS complex in the segment ST).

For ECG phenomenon characterized by RJR:

? elevation contour line above the point J (J-deviation);

? smooth transition of the QRS complex in the ST segment or a notch, ie offset contour line on the J point on the downward bend of the R wave or an upward knee prong S;

? Prong J (increase in amplitude and duration of J-deflection taking the form of the dome or hump) with elevation (or without) the segment ST.

J-point elevation of the contour line is a characteristic feature of the CPP, and may also occur in acute myocardial ischemia, hyperkalemia, and intraventricular conduction disorders. It should be emphasized that the standard ECG is not always possible to find clear differences between the slowing intraventricular conduction and RJR. In this division the two phenomena is an important task, because in most cases RJR has a significantly higher risk of arrhythmias, particularly in patients without organic heart disease.

Tooth J

At various times, tooth J wore a variety of names: camel hump, prong K, tooth H, late delta tooth, tooth points of J, hypothermic prong hypothermic hump prong Osborne.

At the moment, there is the following classification of the teeth J:

? hypothermic

? negipotermichesky

? idiopathic

Hypothermic tooth J

Several studies have noted the emergence of J-wave on the electrocardiogram in patients with hypothermia, reflecting a violation of repolarization. Clinical and experimental evidence linking the hypothermic prong J with cardiac arrhythmias, are contradictory. Episodes of ventricular tachyarrhythmias in patients with hypothermic tooth J according to different studies ranged from 0 to nearly 100%.

Sodium channel blockers, such as lidocaine, procainamide, and are ineffective for the prevention and treatment of malignant ventricular tachyarrhythmias in patients with hypothermia.

Negipotermichesky tooth J

ECG changes similar to those of hypothermia have been observed in different clinical and experimental conditions in patients with normal body temperature. They include such conditions as acute myocardial ischemia, acute pulmonary thromboembolism, myocardial RV, electrolyte and metabolic disorders, pulmonary diseases, inflammatory diseases of the central or peripheral nervous system toxicity heterocyclic antidepressants and cocaine, and many other conditions. Among them the most arrhythmogenic potential was detected in teeth J acute myocardial ischemia and hyperkalemia.

Idiopathic tooth J

In the absence of organic heart disease and noncardiac diseases RJR considered primary or idiopathic.

Describes several forms of idiopathic J wave with concomitant segment elevation ST (or not). Among them, the most studied is the Brugada syndrome. Idiopathic prong J, followed by ST-segment elevation with T-wave inversion in the right precordial ECG is a marker of a typical Brugada syndrome.

In many cases, symptomatic Brugada syndrome (combination ECG characteristics with atrial and / or ventricular tachyarrhythmias or VSS) ST-T changes, and / or localization of ECG may differ from those of typical Brugada syndrome. In such cases, use the term atypical tooth or J-like Brugada syndrome.

CPP

The term early repolarization syndrome was introduced almost 50 years ago, and the RAF was traditionally considered as idiopathic and benign ECG phenomenon of RJR. In 2000, on the basis of pre-clinical experimental data Dr. Charles Antzelevitch, scientists have concluded that the CPP should not be regarded as normal or benign a priori, and in certain conditions (a predisposition to segment elevation ST) patients with SSR may be at high risk of fatal ventricular arrhythmias.

CPP is detected on an electrocardiogram as elevation contour line on the J-point, followed by a horizontal ST-segment elevation in leads V2-V4 (5). CPP is often associated with a shorter duration of the interval QT. When it (15%) may also slightly increase QRS (up to 110 ms).

True CPP is defined as a combination of ECG markers CPP with arrhythmogenic complications, and / or familial cases of SCD in healthy individuals. CPP is seen in 1-2% of the general population and is more common in men (77%), at a young age (27.5%), those with a predisposition to vagotonia, athletes, smokers, those with obstructive hypertrophic cardiomyopathy and defects and / or hypertrophy of the interventricular septum. Cases of the RAF family.

In many clinical situations is difficult to differentiate between changes in the USSR from those of Brugada syndrome, as well as various disorders of intraventricular conduction syndrome and short QT. Many clinical signs similar to those in the RAF and Brugada syndrome, including the prevalence in young healthy men, family history, transient normalization of ECG changes, and a similar response to an increase in heart rate and use of certain medications. So, slow heart rate increases the severity of the tooth and J-segment elevation ST, and the increase in heart rate during exercise or isoproterenol administration reduces or even eliminates these ECG changes.

Sodium channel blockers (known ability to initiate the Brugada syndrome) increase of ST segment elevation in the RAF and the hypothermia tooth J. Sympathetic stimulation and?-Agonists normalize the ST segment in these syndromes, while?-Blockers increase the segment elevation ST, and propranolol may even induce a classic version of the RAF.

The possible cellular and ionic mechanisms

ECG: "T" and "U" Waves

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