Holter s monitoring HM ECG in permanent atrial fibrillation AF

1
Holter s monitoring (HM) ECG in permanent
atrial fibrillation (AF)
odd slide is English even slide is Russian

• Yabluchansky N. I., Martimyanova L. A., Makienko
  N. V.
• School of Fundamental Medicine
• Kharkiv National University named after V. N.
  Karazin

2
???????????? ??????????????? (??) ??????
?????????? ??????????? ?????????? (??)

• ?.?. ???????????, ?.?. ????????????, ?.?.
  ????????
• ????????? ??????????????? ????????
• ??????????? ???????????? ??????????? ??. ?.?.
  ????????

3
Recommendation of the Ukrainian scientific
society of cardiologists aims of therapy in
patient with AF

• Effective heart rate control
• Prevention of complications
• Life quality improvement
• Death risk decrease
• Life expectancy increase

4
???????????? ??????????? ???????? ????????
??????????????? ??????? ???????? ? ??

• ??????????? ???????? ??????? ????? ??????
• ?????????????? ??????????
• ????????? ???????? ?????
• ???????? ????? ??????
• ?????????? ????????????????? ?????

5
ACC/AHA Guidelines for Ambulatory
Electrocardiography indications for HM ECG in
antiarrhytmic therapy estimation

• Class I
• 1. To assess antiarrhythmic drug response in
  individuals in whom baseline frequency of
  arrhythmia has been characterized as reproducible
  and of sufficient frequency to permit analysis
• Class IIa1. To detect proarrhythmic responses to
  antiarrhythmic therapy in patients at high risk
• Class IIb
• 1. To assess rate control during atrial
  fibrillation 2. To document recurrent or
  asymptomatic nonsustained arrhythmias during
  therapy in the outpatient setting
• Class III1. None

6
ACC/AHA Guidelines for Ambulatory
Electrocardiography ????????? ??? ?? ??? ? ??????
???????????????? ???????

• ????? I
• 1. ?????? ???????? ???????????????? ?????????? ?
  ????????? ? ??????? ???????? ???????? ?
  ?????????????????? ???????????? ???????
• ????? II?
• 1. ????????? ??????????????? ????????
  ???????????????? ??????????
• ????? IIb
• 1. ???????? ??????? ????? ?????? ??? ??
• 2. ????????? ????????????? ???????? ???????
  ?? ???? ????????????????? ??????? ? ????????????
  ????????
• ????? III
• 1. ???

7
Let us talk only about heart rhythm frequency
control in AF
8
????? ???????? ?????? ? ???????? ??????? ?????
?????? ??? ??
9
What is AF regarding heart rhythm frequency
control

• AF - chaos
• AF - determinative chaos
• AF saving regulation
• AF saving blood circulation frequency-
  adaptive reactions
• AF saving heart rate circadian periodic
• AF - high probability of spontaneous
  brady/tachy arrhythmias

10
??? ???? ?? ? ????? ?????? ???????? ??????? ?????
??????

• ?? ????
• ?? ???? ???????????????
• ?? ?????????? ?????????
• ?? - ?????????? ????????????????? ???????
• ??????????????
• ?? ?????????? ???????????? ?????????
• ?????????? ?????
• ?? - ??????? ??????????? ??????????
• ?????/???????????

11
What does heart rate frequency control mean in AF

• Daily HR variety within physiological rates
• Recover and/or saving HR adaptive reactions
• Recover and/or saving HR circadian periodic
• Decrease of spontaneous brady/tachy arrhythmias
• frequency
• Decrease of ectopic electrophysiological heart
  events frequency

12
??? ???????? ???????? ??????? ????? ?????? ??? ??

• ???????? ????????? ??? ? ???????????????
  ?????????
• ?????????????? ?/??? ?????????? ?????????????????
  ??????? ???
• ?????????????? ?/??? ?????????? ????????????
  ????????? ???
• ????????? ??????? ?????????? ?????/???????????
• ????????? ??????? ???????????? ???????????????????
  ?? ??????? ? ??????

13
The method for control of heart rhythm frequency
at AF

• Only one method exist - HM ECG
• To make this method work well one needs
  Yabluchanskys diary
• Yablychanskys dairy - realized necessity for
  doctor/patient in repeated HM ECG standard
  management

14
?????????? ??? ???????? ??????? ?????????? ?????
??? ??

• ??????? ???? ?????????? ?? ???
• ???, ????? ?????????? ?????? ???????, ?????????
  ??????? ?? ????????????
• ??????? ?? ???????????? - ??????????
  ??????????? ??????? ? ???????? ? ???????????
  ?????????? ?????????? ?? ???

15
Clinical example of an effective heart rhythm
frequency control by amiodarone at AF
16
??????????? ?????????????????? ???????? ???????
????? ?????? ??? ?????????????
17
Patient N. before and after amiodarone administer
regarding most relevant" HM parameters
Positive amiodarone influence on all HM
parameters
18
????????? ?. ?? ? ????? ?????????? ? ???????
???????? ?????? ??????????? ??
????????????? ??????? ?????????? ?? ???
?????????? ??
19
Circadian changes of daily average HR in patient
N. before and after amiodarone administer
Night
Positive influences amiodarone on circadian
change of daily average HR
20
????????? ?. ?? ? ????? ?????????? ????????????
????????? ?????????????? ???
????
????????????? ??????? ?????????? ?? ????????????
????????? ?????????????? ???
21
Circadian changes of maximal HR in patient N.
before and after amiodarone administer
Night
Positive amiodarone influences on circadian
changes of maximal HR
22
????????? ?. ?? ? ????? ?????????? ????????????
????????? ???????????? ???
????
????????????? ??????? ?????????? ?? ????????????
????????? ???????????? ???
23
Circadian changes of minimal HR in patient N.
before and after amiodarone administer
Night
Positive influences of amiodarone on circadian
changes of minimal HR
24
????????? ?. ?? ? ????? ?????????? ????????????
????????? ??????????? ???
????
????????????? ??????? ?????????? ?? ????????????
????????? ??????????? ???
25
Circadian changes of tachycardia quantity in
patient N. before and after amiodarone administer
Night
????
Small circadian quantity tachycardia changes
under influence of amiodarone
26
????????? ?. ?? ? ????? ?????????? ????????????
????????? ?????????? ??????????
????
????? ??? ???????? ?????????? ????????????
????????? ?????????? ??????????
27
Circadian changes of bradicardia quantity in
patient N. before and after amiodarone administer

Night
Small circadian quantity bradicardia changes
under influence of amiodarone
28
????????? ?. ?? ? ????? ?????????? ????????????
????????? ?????????? ???????????
????
????? ??? ???????? ?????????? ????????????
????????? ?????????? ???????????
29
Circadian changes of pauses quantity in patient
N. before and after amiodarone administer
Night
????
Essential circadian changes of pauses quantity
under influence of amiodarone
30
????????? ?. ?? ? ????? ?????????? ????????????
????????? ?????????? ????
????
???????????? ??? ???????? ??????????
???????????? ????????? ?????????? ????
31
?ircadian changes of ventricular extrasistols
quantity in patient N. before and after
amiodarone administer
Night
Essential circadian changes of ventricular
extrasistols quantity under influence of
amiodarone
32
????????? ?. ?? ? ????? ?????????? ????????????
????????? ????? ???????????? ????????????
????
???????????? ??? ???????? ??????????
???????????? ????????? ?????????? ????????????
????????????
33
?ircadian changes of bigeminia quantity in
patient N. before and after amiodarone administer
Night
Essential circadian changes of bigeminia
quantity under influence of amiodarone
34
????????? ?. ?? ? ????? ?????????? ????????????
????????? ?????????? ?????????
????
???????????? ??? ???????? ??????????
???????????? ????????? ?????????? ?????????
35
SDNN circadian changes in patient N. before and
after amiodarone administer
Under influence of amiodarone circadian changes
of SDNN are not broken
36
????????? ?. ?? ? ????? ?????????? ????????????
????????? SDNN
??? ???????? ?????????? ?? ??????????
???????????? ????????? SDNN
37
Hard moments of patient N. life before and
after amiodarone administer regarding HRV
parameters
More physiological HRV changes under influence of
amiodarone
38
????????? ?. ?? ? ????? ?????????? ? ???????
??????????? ??? ? ??????? ??????? ?????
????? ????????????? ????????? ??? ??? ????????
??????????
39
Clinical example of heart rhythm frequency
effective control at AF with amiodarone plus
carvedilol, or in other words with favorite
combination of our command
40
??????????? ?????????????????? ???????? ???????
????? ?????? ??? ???????????? ?
????????????, ??? ??????? ?????????? ?????
???????
41
Patient before and after amiodarone plus
carvedilol administer regarding most relevant
HM parameters
Amiodarone and carvedilol positive influences on
HM parameters
42
????????? ?. ?? ? ????? ?????????? ? ????????????
? ??????? ???????? ?????? ??????????? ??
????????????? ??????? ?????????? ? ????????????
?? ?????????? ??
43
Patient B. before and after amiodarone with
carvedilol circadian changes of daily average
HR
Night
Amiodarone with carvedilol positive influences
on circadian changes of daily average HR
44
????????? ?. ?? ? ????? ?????????? ? ????????????
???????????? ????????? ?????????????? ???
????
????????????? ??????? ?????????? ? ????????????
?? ???????????? ????????? ?????????????? ???
45
Patient B. before and after amiodarone with
carvedilol circadian changes of maximal HR
Night
Amiodarone with carvedilol positive influences on
circadian changes of maximal HR
46
????????? ?. ?? ? ????? ?????????? ?
???????????????????????? ????????? ????????????
???
????
????????????? ??????? ?????????? ? ????????????
?? ???????????? ????????? ???????????? ???
47
Patient B. before and after amiodarone with
carvedilol circadian changes of minimal HR
Night
Amiodarone with carvedilol positive influences on
circadian changes of minimal HR
48
????????? ?. ?? ? ????? ?????????? ?
???????????? ???????????? ????????? ???????????
???
????
????????????? ??????? ?????????? ?
???????????? ?? ???????????? ?????????
??????????? ???
49
Patient B. before and after amiodarone with
carvedilol circadian changes of tachycardia
quantity
Night
Suppression of tachycardia by amiodaron together
with carvedilol
50
????????? ?. ?? ? ????? ?????????? ? ????????????
???????????? ????????? ?????????? ??????????
????
?????????? ??????????? ? ???????????? ??????????
51
Patient B. before and after amiodarone with
carvedilol circadian changes of bradicardia
quantity
Night
Suppression of bradicardia quantity by amiodarone
with carvedilol
52
????????? ?. ?? ? ????? ?????????? ? ????????????
???????????? ????????? ?????????? ???????????
????
?????????? ??????????? ? ???????????? ??????????
???????????
53
Patient B. before and after amiodarone with
carvedilol circadian changes of pauses quantity
Night
Amiodarone with carvedilol reduced pauses
54
????????? ?. ?? ? ????? ?????????? ? ????????????
???????????? ????????? ?????????? ????
????
????????? ? ???????????? ????? ?????
55
Patient B. before and after amiodarone with
carvedilol circadian changes of ventricular
extrasistols quantity
Night
Amiodarone with carvedilol have eliminated
ventricular extrasistols
56
????????? ?. ?? ? ????? ?????????? ? ????????????
???????????? ????????? ????? ????????????
????????????
????
????????? ? ???????????? ????????? ????????????
?????????????
57
Patient B. before and after amiodarone with
carvedilol circadian changes of SDNN
Under influence of amiodarone with carvedilol
circadian SDNN grows up
58
????????? ?. ?? ? ????? ?????????? ? ????????????
???????????? ????????? SDNN
??? ???????? ?????????? ? ????????????
?????????? ???????????? SDNN
59
Patient B. before and after amiodarone with
carvedilol from the point of HRV parameters in
difficult moments of life
More physiological HRV changes under the
influence of amiodarone with carvedilol
60
????????? ?. ?? ? ????? ?????????? ? ????????????
? ??????? ??????????? ??? ? ??????? ???????
?????
????? ????????????? ????????? ??? ??? ????????
?????????? ? ????????????
61
Our universities

• AF determinative chaos
• AF saving of regulation
• AF - problems with regulation
• Control of rhythm frequency at AF is possible
• Control of rhythm frequency at AF is possible
  with saving of all its physiological
  determinants
• Amiodarone - definitely best way for rhythm
  frequency control at AF
• AF is also a heart failure and in this case the
  best combination is amiodaronecarvedilol

62
???? ????????????

• ?? ??????????????? ????
• ?? ?????????? ?????????
• ?? ???????? ? ??????????
• ???????? ??????? ????? ??? ?? ????????
• ???????? ??????? ????? ??? ?? ???????? ?
  ??????????? ???? ?? ??????????????? ???????????
• ????????? ????????????? ?????? ????????
  ???????? ??????? ????? ??? ??
• ?? ??? ? ????????? ???????????????, ? ?????
  ?????? ?????????? ???????????????????

63
Thanks

• We are grateful to
• ?R?? company
• for free amiocordin and coryol given
• for our researches
• of amiodarone and carvedilol
• efficiency at AF
• in out-patient conditions

64
?????????????

• ??????? ???? ?????????????
• ???????? ????
• ?? ??????????????? ????????????
• ??? ????? ????????????
• ????????????? ?????????? ? ??????????? ??? ??
• ? ???????????? ????????
• ?????????? ? ??????