NONINVASIVE DIAGNOSTICS OF ELECTRICAL MYOCARDIAL INSTABILITY

Objective: To study the electrical myocardial instability markers in patients with idiopathic ventricular arrhythmias (VA). Design and methods: 123 patients with more than 100 ventricular ectopic complexes (VEC)/hour were divided into 2 groups: the 1st group - 98 patients with idiopathic VA, the 2nd group (control) - 25 patients with coronary artery disease (CAD). 65 pregnant women without structural myocardial pathology were included in the 3rd group (substudy). Results: In the 1st group VA was monomorphic with night type. Fragmentation QRS (FQRS) in sinus complexes was not registered, fQRS in VEC - in 25 (25.5%). Microvolt T-wave alternans (MTWA) was positive in 58 (59.2%), abnormal turbulence onset (TO) - in 35 (35.7%), abnormal turbulence slope (TS) - in 25 (25.5%). In the 2nd group VA was polimorphic with day type. FQRS in sinus complexes was observed in 3 (12%), fQRS VEC - in 11 patients (44%), positive MTWA test - in 13 patients (52%), abnormal TO - in 6 (24%), TS - in 8 patients (32%). In 3rd group VEC were registered in 28 (43%), FQRS, MTWA and abnormal TS were not registered, abnormal TO - in 4 (26.6%). Conclusion: Pathological electrical myocardial instability markers in patients with idiopathic VA and in the subgroup of pregnant women are likely to be caused by an imbalance of the autonomic nervous system, while in patients with CAD features of myocardial heterogeneity were observed.

неинвазивные маркеры, электрическая нестабильность миокарда, желудочковые нарушения ритма, фрагментация QRS-комплекса, микровольтная альтернация зубца Т, турбулентность сердечного ритма, non-invasive markers, electrical myocardial instability, ventricular arrhythmias, fragmentation of QRS complex, microvolt T wave alternans, heart rate turbulence

1. Smith J.M, Clancy E.A, Valeri R. et al. Electrical alternans and cardiac electrical instability. Circulation. 1988;77:110-121

2. Кушаковский М.С. Аритмии сердца. СПб.: Гиппократ, 1992 с. 524

3. Chow Т, Kereiakes D.J, Onufer J. et al. Does microvolt T-wave alternans testing predict ventricular tachyarrhythmias in patients with ischemic cardiomyopathy and prophylactic defibrillators? The MASTER (Microvolt T Wave Alternans Testing for Risk Stratification of Post-Myocardial Infarction Patients) trial. J Am Coll Cardiol. 2008; 52:1607-1615.

4. Turbulence dynamics: an independent predictor of late mortality after acute myocardial infarction. Int J Cardiol. 2006;107(1):42-47.

5. Das M.K, Maskoun W, Shen C. et al. Fragmented QRS on twelve--lead electrocardiogram predicts arrhythmic events in patients with ischemic and nonischemic cardiomyopathy. Heart Rhythm. 2010;7:74-80.

6. Priori S.G, Blomstrom-Lundqvist C, Mazzanti A. et al. 2015 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: the Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Eur Heart J. 2015;17:1601-1687.

7. Goldberger J.J, Subacius H, Patel T, Cunnane R. et al. Sudden cardiac death risk stratification in patients with nonischemic dilated cardiomyopathy. J Am Coll Cardiol. 2014;63:1879-1889.

8. Pietrasik G, Zarçba W. QRS fragmentation: diagnostic and prognostic significance. Cardiol J. 2012;19(2):114-121.

9. Gong B, Li Z. Total Mortality, Major Adverse Cardiac Events, and Echocardiographic-Derived Cardiac Parameters with Fragmented QRS Complex. Ann Noninvasive Electrocardiol. 2016;21(4):404-412.

10. Bloomfield D.M, Bigger J.T, Steinman R.C. et al. Microvolt T-wave alternans and the risk of death or sustained ventricular arrhythmias in patients with left ventricular dysfunction. J Am Coll Cardiol. 2006;47:456-463.

11. Verrier R.L, Nieminen T.T. Usefulness of T-wave alternans in sudden death risk stratification and guiding medical therapy. Ann Noninvasive Electrocardiol. 2010;15(3):276-88.

12. Salerno-Uriarte J.A. et al. Prognostic value of T-wave alternans in patients with heart failure due to nonischemic cardiomyopathy: results of the ALPHA Study. J Am Coll Cardiol. 2007 Nov 6;50(19):1896-1904.

13. Shlyahto E.V, Berngardt E.R, Parmon E.V. et al. Heart rate turbulence in the assessment of sudden cardiac death risk. Vestnik arhytmologii=Journal of arrhythmology. 2005;38:49-55. In Russian. [Шляхто, Е. В., Бернгардт, Э. Р., Пармон, Е. В. и др. Турбулентность сердечного ритма в оценке риска внезапной сердечной смерти. Вестник аритмологии. 2005;38:49-55].

14. Schmidt G, Malik M, Barthel P. et al. Heart-rate turbulence after ventricular premature beats as a predictor of mortality after acute myocardial infarction. Lancet. 1999; 353:1390-1396.

15. Пармон Е.В., Трешкур Т.В., Шляхто Е.В. Идиопатические желудочковые нарушения ритма (анализ проблемы). Vestnik arhytmologii=Journal of arrhythmology. 2003;31:60-71

16. Arrhythmias in Women: Diagnosis and Management. Edited by Cha Y-M, Lloyd M.A, Birgersdotter-Green U.M. New York: Oxford University Press, 2014. p. 270.

17. Wellens H.J, Schwartz P.J, Lindemans F.W. et al. Risk stratification for sudden cardiac death: current status and challenges for the future. Eur Heart J. 2014;35(25):1642-51.

18. Das M.K, Khan B, Jacob S. et al. Significance of a fragmented QRS complex versus a Q wave in patients with coronary artery disease. Circulation. 2006;113(21):2495-501.

19. Tanriverdi Z, Dursun H, Kaya D. The Importance of the Number of Leads with fQRS for Predicting In-Hospital Mortality in Acute STEMI Patients Treated with Primary PCI. Ann Noninvasive Electrocardiol. 2016;21(4):413-419.

20. Verrier R.L, Klingenheben T, Malik M. Microvolt T-Wave Alternans: Physiological Basis, Methods of Measurement and Clinical Utility-Consensus Guideline by International Society for Holter and Noninvasive Electrocardiology. J Am Coll Cardiol. 2011;58(13):1309-1324.

21. Pinnacchio G, Lanza G.A, Stazi A. et al. Determinants of heart rate turbulence in individuals without apparent heart disease and in patients with stable coronary artery disease. Europace. 2015;17(12):1855-61.