The arterial blood pressure and heart rate variability indexes in atrial fibrillation patients in ac

1
The arterial blood pressure and heart rate
variability indexes in atrial fibrillation
patientsin acute pharmacological testwith
amiodaron

• N. V. Makienko, N.A. Vodyanitskaya, N.I.
  Yabluchansky
• Department of internal diseases
• V.N. Karazin Kharkiv National University,
• Central clinical hospital N5

2
???????????? ???????? ? ??????????
?????????????? ?????????? ????? ??? ???????????
?????????? ? ?????? ????????????????? ??????
???????????

• ?.?. ????????,?.?. ??????????, ?.?. ???????????
• ??????? ?????????? ????????
• ??? ??? ??. ?.?. ????????
• ??????????? ??????????? ???????? N5

3
The aim of the investigation
Prognosis of results and increasing of the
therapy effectiveness in patients with
persistent and permanent atrial fibrillation on
basis of study of amiodaron influence on the
arterial blood pressure level, heart rate and
spectral indexes of heart rate variability in
acute pharmacological test
4
???? ????????????
??????????????? ??????????? ? ?????????
????????????? ??????? ????????? ?
?????????????? ? ?????????? ????????????
?????????? ????? ???????? ??????? ?????????? ?
?????? ????????????????? ????? ?? ???????
????????????? ????????, ??????? ?????????
?????????? ? ???????????? ??????????
?????????????? ?????????? ?????
5
The target of the present investigation is
to reveal the existence of different types of
adaptive reactions in acute pharmacological
test with amiodaron in small cohorts of
patients with persistent and permanent atrial
fibrillation and their possible influence on
the therapy results
6
?????? ?????????? ????????????
?? ????????? ??????? ?????????? ??????????????
????????????? ????? ????????????????? ??????? ?
?????? ????????????????? ????? ? ??????????? ?
????????? ? ?????????????? ? ??????????
???????????? ?????????? ? ????????? ??????? ??
????? ? ???????????? ???????
7
Materials and methods

• The object and the volume of observations
• Study group 7 (1 woman and 6 men) patients with
  atrial fibrillation (AF) ( 3 had persistent and
  4 had permanent forms)
• The age from 45 to 77 years
• The information concerning each patient is
  presented lower

8
????????? ? ??????

• ?????? ? ????? ??????????
• ?????? ?????????? 7 (1 ??????? ? 6 ??????)
  ????????? ? ???????????? ?????????? (??) (? 3 -
  ??????????????, ? 4 ?????????? ?????)
• ??????? ?? 45 ?? 77 ???
• ?????????? ?? ??????? ???????? ???????????? ????

9
Materials and methods

• Criteria of inclusion and exclusion
• Inclusion criteria AF in the present of arterial
  hypertension (?H) stages I-III, ischemic heart
  disease (IHD), stable stenocardia function class
  (FC) I III, postmiocarditis cardio sclerosis
• Exclusion criteria IV FC stable stenocardia,
  unstable stenocardia and acute myocardial
  infarction, IV FC heart failure, endocrine
  malfunctions, renal and liver failure,
  implantation of cardiac stimulators, the
  exacerbations of chronical diseases,
  cardiomyopathy

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

• ???????? ????????? ? ??????????
• ???????? ????????? ?? ??? ????????????
  ??????????? (??) I-III ??????, ???????????
  ??????? ?????? (???) ?? ?????????? ????????????
  ?????????? I III ?????????????? ????? (??),
  ???????????????????? ?????????????
• ???????? ?????????? IV ?? ??????????
  ???????????, ???????????? ??????????? ? ??????
  ??????? ????????, IV ?? ?????????
  ???????????????, ??????????? ?????????, ????????
  ? ?????????? ???????????????, ????????????????
  ?????????????????, ?????????? ?????????????
  ??????????? ???????????, ??????????????

11
Materials and methods

• The investigation protocol
• Exclusion of coffee, alcohol and drugs
  influencing the regulatory systems, for the
  period of 24 hours prior the investigation
• Evaluating of HRV on a 5 minutes intervals ECG
• Recording of 5-minutes ECG in two functional
  positions with arterial blood pressure measuring
  
• 1 initial positions
• 2 active tilt-test
• The acute pharmacological test (APhT)
• amiodaron 200 mg
• Evaluating of HRV on a 5 minutes intervals ECG in
  two hours
• Recording of 5-minutes ECG in two functional
  positions with arterial blood pressure measuring
  
• 1 initial positions
• 2 active tilt-test

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

• ???????? ????????????
• ?? 24 ???? ?? ???????????? ?????????? ????,
  ????????, ??????????, ???????? ?? ???????
  ?????????
• ??? ?? 5 ???????? ?????????? ???
• ???????????? ? 2-? ?????????????? ???????? ?
  ?????????? ??
• 1 ????????? ???????
• 2 - ???????? ??????????????? ?????
• ?????? ????????????????? ?????
• ????????? 200 ??
• ????? 2 ???? ??? ?? 5 ???????? ?????????? ???
• ???????????? ? 2-? ?????????????? ???????? ?
  ?????????? ??
• 1 ????????? ???????
• 2 - ???????? ??????????????? ?????

13
Materials and methods

• The instrument and parameters
• Computer electrocardiograph "Cardio Lab 2000
• The method of quick Fourier transformation
• The device for arterial blood pressure measuring
  (ABP)
• The following parameters
• ABP by Korotcovs methods - mm Hg
• Heart rate (HR) - beats perm minute
• TP, ?s2 - HRV spectrum
  total power
• VLF, ??2 - power in the
  very low frequency range HRV
• LF, ??2 - power in the
  low frequency range HRV
• HF, ??2 - power in the
  high frequency range HRV

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

• ?????? ? ??????????? ?????????
• ???????????? ????????????????? "Cardio Lab 2000
• ????? ???????? ?????????????? ?????
• ??????? ??? ????????? ????????????? ???????? (??)
• ??????????? ?????????
• ?? ?? ?????? ????????? - ?? ?? ??
• ??????? ?????????
• ?????????? (???) - ??/???
• TP, ??2 - ????? ????????
  ???
• VLF, ??2 - ???????? ??????
  ????? ?????? ??????
  ???
• LF, ??2 - ???????? ??????
  
• ??????
  ?????? ???
• HF, ??2 - ????????
  ??????
• 
  ??????? ?????? ???

15
The therapys method

• The persistent AF
• Re-establishment of sinus rhythm by means of
  amiodaron cardio version pharmacology, when
  non-effective electrical cardio version
• The permanent AF
• Control of HR by amiodaron, when non-effective
  -together with beta-adrenoblocker

16
?????? ???????

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

17
A persistent AFThe patient Z., 53 year, w
HR, ABP and indexes HRV in APhT
Diagnosis Postmiocardiatis (2002)
cardiosclerosis. Persistent atrial fibrillation,
tachysystolic forms. HF II a st, III FC

• The results of APhT are
• - positive adaptive reaction with adequate
  changes of HR, ABP, TP
• the effective lowering of HR with preservation of
  adaptive reaction
• The results of therapy are
• re-establishment of sinus rhythm after 2 week
  amiodaron 600 mg per day therapy, HR 63 beats per
  minute

18
?????????????? ????????? ?., 53 ????, ?
???, ?? ? ?????????? ??? ? ???
??????? ???????????????????? (2002 ?)
?????????????. ?????????????? ???????????
??????????, ????????????????? ?????. ?? II ? ??,
III ??
?????????? ??? - ?????????? ?????????????????
??????? ? ?????????? ?????????? ???, ?? ? ?? -
??????????? ????????? ??? ??? ?????? ?????????? ?
??????????? ????????????????? ??????? ??????????
??????? ?????????????? ?????????? ????? ????? 2
?????? ??????? ??????????? ? ???????? ???? 600
??, ??? 63??\???
19
A persistent AFThe patient Z., 53 year, w
The spectral indexes HRV in APhT with amiodarons
mc²

• Initially TP in rest conditions exceeded e TP in
  active tilt by 16. In both conditions HF
  dominated.
• of domain contribution in TP
• - initial - VLF-16, LF-21 and HF -46,
• - tilt test- VLF-18, LF-20 and HF -45
• After APhT
• the value of TP in rest conditions and tilt
  test exceeded the ones in initial conditions by
  7
• of domain contribution in TP
• - initial - VLF- 16, LF-18, HF-50
• - tilt test - VLF-30, LF-19, HF-39

20
?????????????? ????????? ?., 53 ????, ?
???????????? ?????????? ??? ? ??? ? ???????????
??²

• ??????? ?? ??????? ??? ???? ?? 16 ??????? ?
  ????????? ? ????????????? ??????????????? ??????
  
• ????? ????? ? ??
• - ???????? - VLF-16, LF-21 ? HF -46,
• - ? ????????? - VLF-18, LF-20 ? HF -45
• ????? ???
• ? ?????????? ? ? ????????? ??????? ?????????
  ?? ??????? ??? ?? 7
• ????? ????? ? ??
• - ???????? VLF- 16, LF-18, HF-50
• - ? ????????? VLF-30, LF-19, HF-39

21
A persistent AFThe patient O.,52 year,m
HR, ABP and indexes HRV in APhT
Diagnosis IHD Persistent atrial fibrillation,
tachisystolic forms. HF 1 st, II FC

• The results of APhT are
• negative reaction of HR and preservation
  reaction of ABP
• the absent are changes of TP
• The results of therapy are
• re-establishment sinus rhythm with aided ECV
  after three week amiodaron 600 mg per day
  therapy. HR 78 beats per minute

22
?????????????? ????????? ?., 52 ????, ?
???, ?? ? ?????????? ??? ? ???
??????? ???. ?????????????? ???????????
??????????, ?????????????? ??? ?????. ?? I ??,
II ??

• ?????????? ???
• ????????????? ??????? ?? ??????? ??? ?
  ??????????? ??????? ??
• ?????????? ??????????? ????????? ?? ??????? ??
• ?????????? ???????
• ?????????????? ?? ? ??????? ??? ????? 3 ??????
  ??????? ??????????? ? ???????? ???? 600 ??, ???
  78 ??\???

23
A persistent AFThe patient O.,52 year,m
The spectral indexes HRV in APhT with amiodarons
mc²

• Initially TP in rest conditions and active tilt
  test TP HRV spectrum are not changes essentials
• of domain contribution in TP
• - initial - VLF-12, LF-19 and HF -43,
• - tilt test - VLF-14, LF-52 and HF -18
• After APhT
• - the value of TP in rest conditions of fall
  by 1, tilt test degree of rise by 4
• of domain contribution in TP
• - initial - VLF- 15, LF-17, HF-53
• - tilt test- VLF-21, LF-19, HF-42

24
?????????????? ????????? ?. 52 ????, ?
???????????? ?????????? ??? ? ??? ? ???????????
??²

• ? ????????? ???????? ? ????????? ?? ??????? ???
  ??????????? ?? ??????????
• ????? ????? ? ??
• - ???????? - VLF-12, LF-19 ? HF -43,
• - ? ????????? - VLF-14, LF-52 ? HF -18
• ? ???? ???
• - ? ?????????? ??????? ????????? 1, ?
  ????????? ??????? ????????? 4
• ????? ????? ? ??
• - ???????? VLF- 15, LF-17, HF-53
• - ? ????????? VLF-21, LF-19, HF-42

25
A persistent AFThe patient G.,77 year,m
HR, ABP and indexes HRV in APhT
Diagnosis IHD Stability stenocardia II FC.
Persistent atrial fibrillation, tachi systolic
forms. HF II a st, III FC
The results APhT are - positive adaptive
reaction with adequate are changes of HR,
ABP, TP The results therapy are
re-establishment sinus rhythm after 12 days
amiodaron 600 mg per day therapy and verapamil
160 mg, per day. HR 62 beats per minute
26
?????????????? ????????? ?., 77 ???, ?
???, ?? ? ?????????? ??? ? ???
??????? ???. ?????????? ??????????? ?????????? 2
?? ?????????????? ??????????? ??????????,
????????????????? ?????. ?? II ? ??, III ??
?????????? ??? - ?????????? ?????????????????
??????? ? ?????????? ?????????? ??? ? ??, ??
?????????? ??????? - ??????????????
?????????? ????? ????? 12 ???? ???????
??????????? ? ???????? ???? 800 ?? ? ??????????
160 ??, ??? 62 ??\???
27
A persistent AFThe patient G.,77 year,m
The spectral indexes HRV in APhT with amiodarons
??²

• Initially and tilt tests the indexes TP HRV
  spectrum are not different
• of domain contribution in TP
• - initial - VLF-18, LF-25 and HF-44,
• - tilt test- VLF-18, LF-25 and HF-42
• After APhT
• - in rest conditions the degree of fall by
  17, at tilt test by 19
• of domain contribution in TP
• - initial- VLF- 20, LF-25, HF-53
• - tilt test- VLF-20, LF-23, HF-50

28
?????????????? ????????? ?.,77 ???, ?
???????????? ?????????? ??? ? ??? ? ???????????
??²

• ??????? ? ? ????????? ???????? ?? ??????? ??? ??
  ??????????
• ????? ????? ? ??
• - ???????? - VLF-18, LF-25 and HF-44,
• - ?????????- VLF-18, LF-25 and HF-42
• ? ???? ???
• - ? ?????????? ??????? ????????? 17, ?
  ?????????-19
• ????? ????? ? ??
• - ????????- VLF- 20, LF-25, HF-53
• - ?????????- VLF-20, LF-23, HF-50

29
? permanent AFThe patient N, 52 year, m
HR, ABP and indexes HRV in APhT
Diagnosis Arterial hypertension II st. IHD
Permanent atrial fibrillation tachi systolic
forms. HF I st., II FC
The results APhT are - Initially of HR, ABP
were deterioration. A positive adaptive reaction
were preservation with adequate are changes of
HR, systolic ABP. The TP rising in initial and
active tilt test The results therapy are -the
effective of HR deteriorations at 14 beats per
minute the amiodaron 600 mg per day therapy
30
?????????? ????????? ?., 52 ????, ?
???, ?? ? ?????????? ??? ? ???
??????? ???????????? ??????????? ?????????
??????? ??? ?????????? ??????????? ??????????
????????????????? ?????. ?? I ??????, II ??
?????????? ??? - ????????? ????????? ???, ??.
?????????? ?????????? ????????????????? ??????? ?
?????????? ?????????? ???, ?????????????? ??.
????????? ?? ? ????????? ???????? ?
????????? ?????????? ??????? - ???????????
???????? ??? ?? 14 ??/??? ??????????? ? ????????
???? 600 ?? ? ??????????? ??????????
?????????????????? ???????
31
? permanent AFThe patient N, 52 year, m
The spectral indexes HRV in APhT with amiodarons
??²

• Initially TP spectral HRV is below on 16 TP in
  active tilt test
• of domain contribution in TP
• - initial - VLF-14, LF-18 and HF -48,
• - tilt test - VLF-53, LF-18 and HF -23
• After APhT
• - in rest conditions degree of rise by 34, at
  active tilt test degree of fall by 32
• of domain contribution in TP
• - initial - VLF- 53, LF-18, HF-23
• - tilt test VLF-12, LF-23, HF-51

32
?????????? ????????? ?., 52 ????, ?
???????????? ?????????? ??? ? ??? ? ???????????
??²

• ??????? ?? ??????? ??? ???? ??????? ?? 69 ?
  ?????????
• ????? ????? ? ??
• - ???????? - VLF-14, LF-18 ? HF -48,
• - ? ????????? - VLF-53, LF-18 ? HF -23
• ????? ???
• ? ????????? ???????? ??????? ????????? ??
  ??????? 34, ? ????????? ??????? ????????- 32
• ????? ????? ? ??
• - ???????? VLF- 53, LF-18, HF-23
• - ? ????????? VLF-12, LF-23, HF-51

33
? permanent AFThe patient ?., 53 year, m
HR, ABP and indexes HRV in APhT
Diagnosis IHD. Permanent atrial fibrillation,
norm systolic forms. Arterial hypertension II st.
HF II a st., III FC
The results APhT are - positive adaptive
reaction with adequate are changes of HR, ABP,
TP The results therapy are - the effective of
HR deteriorations to 64 beats per minute the
amiodaron 600 mg day therapy
34
?????????? ????????? ?. 53 ????, ?
???, ?? ? ?????????? ??? ? ???
??????? ???. ?????????? ??????????? ??????????,
??????????????? ?????. ???????????? ???????????
????????? ???????. ?? IIa ??????, III ??
?????????? ??? - ?????????? ?????????????????
??????? ? ?????????? ?????????? ???, ?? ?
?? ?????????? ??????? - ??????????? ????????
??? ?? 64 ??\??? ? ???? ??????? ??????????? ?
???????? ???? 600 ??
35
? permanent AFThe patient ?., 53 year, m
The spectral indexes HRV in APhT with amiodarons
??²

• Initially TP spectral HRV is above on 32 TP in
  active tilt test
• of domain contribution in TP
• - initial - VLF-18, LF-18 and HF-53
• - tilt-test - VLF-15, LF-19 and HF -41
• After APhT
• in rest conditions degree of rise by 9,
  at active tilt test 16
• of domain contribution in TP
• - initial VLF- 10, LF-23, HF-51
• - tilt test - VLF-23, LF-22, HF-43

36
?????????? ????????? ?. 53 ????, ?
???????????? ?????????? ??? ? ??? ? ???????????
??²

• ??????? ?? ??????? ??? ???? ?? 32 ?? ??????? ?
  ?????????
• ????? ????? ? ??
• - ???????? - VLF-18, LF-18 ? HF-53,
• - ? ????????? - VLF-15, LF-19 ? HF -41
• ? ???? ???
• ? ?????????? ??????? ????????? ????????? 9,
  ? ????????? -16
• ????? ????? ? ??
• - ???????? VLF- 10, LF-23, HF-51
• - ? ????????? VLF-23, LF-22, HF-43

37
? permanent AFThe patient ?., 53 year, ?
HR, ABP and indexes HRV in APhT
Diagnosis IHD. Permanent atrial fibrillation,
norm systolic forms. Arterial hypertension II st.
HF I st, II FC
The results APhT are - the expressed positive
adaptive reaction with adequate changes of HR,
ABP, TP The results therapy are - the effective
of HR deteriorations to 72 beats per minute the
amiodaron 600 mg day therapy
38
?????????? ????????? ?., 53 ????, ?
???, ?? ? ?????????? ??? ? ???
??????? ???. ?????????? ??????????? ??????????,
??????????????? ?????. ???????????? ???????????
????????? ???????. ?? I ??????, II ??

• ?????????? ???
• - ?????????? ?????????? ????????????????? ???????
  ? ?????????? ?????????? ???, ?? ? ??
• ??????????? ????????? ??? ? ???? ??????????
  ?????
• ?????????? ???????
• - ??????????? ???????? ??? ???????? ??????????? ?
  ???????? ???? 600??

39
? permanent AFThe patient ?., 53 year, ?
The spectral indexes HRV in APhT with amiodarons
??²

• Initially TP spectral HRV is above on 19 TP
  than in active tilt test
• of domain contribution in TP
• - initial - VLF-15, LF-20 and HF-52,
• - tilt-test- VLF-21, LF-22 and HF -46
• After APhT
• in rest conditions degree of rise by 9, at
  active tilt test by 16
• of domain contribution in TP
• - initial VLF- 16, LF-21, HF-46
• - tilt test VLF-15, LF-19, HF-52

40
?????????? ????????? ?., 53 ????, ?
???????????? ?????????? ??? ? ??? ? ???????????
??²

• ??????? ?? ??????? ??? ???? ?? 19, ??? ?
  ?????????
• ????? ????? ? ??
• - ???????? - VLF-15, LF-20 ? HF-52,
• - ? ????????? - VLF-21, LF-22 ? HF -46
• ? ???? ???
• ? ?????????? ??????? ????????? 50, ?
  ??????????????? ????? 60
• ????? ????? ? ??
• - ???????? VLF- 16, LF-21, HF-46
• - ? ????????? VLF-15, LF-19, HF-52

41
? permanent AFThe patient M., 45 year, m
HR, ABP and indexes HRV in APhT
Diagnosis IHD Permanent atrial fibrillation,
norm systolic forms. HF I st, I FC
The results APhT are - The initial HR rises. A
positive adaptive reactions are preservation
with adequate changes of HR, systolic ABP and
TP The results therapy are the effective of HR
deteriorations to 70 beats per minute the
amiodaron 600 mg per day therapy and by added
metoprolol in dose 50 mg per day
42
?????????? ????????? ?., 45 ???, ?
???, ?? ? ?????????? ??? ? ???
??????? ??? ?????????? ??????????? ??????????,
??????????????? ?????. ?? I ??, I ??
?????????? ??? - ????????? ????????? ???.
?????????? ?????????? ????????????????? ???????
? ?????????? ?????????? ???, ?????????????? ?? ?
?? ?????????? ??????? - ??????????? ?????????
??? ??? ????????????? ? ?????????? ???????????
? ???? 50 ??/???
43
? permanent AFThe patient M., 45 year, m
The spectral indexes HRV in APhT with amiodarons
??²

• Initially TP spectral HRV is above on 19 TP
  than in active tilt test
• of domain contribution in TP
• - initial - VLF-15, LF-27 and HF -40,
• - tilt-test - VLF-16, LF-24 and HF -45
• After APhT
• in rest conditions degree of fall by 13,
  at active tilt test degree of rise by 7
• of domain contribution in TP
• - initial -VLF- 16, LF-20, HF-40
• - tilt test-VLF-16, LF-28, HF-38

44
?????????? ????????? ?., 45 ???, ?
???????????? ?????????? ??? ? ??? ???????????
??²

• ? ?????????? ?? ??????? ??? ???? ?? 46, ??? ?
  ?????????
• ????? ????? ? ??
• - ???????? - VLF-15, LF-27 ? HF -40,
• - ? ????????? - VLF-16, LF-24 ? HF -45
• ????? ???
• ???????? ??????? ????????? 13, ? ?????????
  ??????? ????????? 7
• ????? ????? ? ??
• - ???????? VLF- 16, LF-20, HF-40
• - ? ????????? VLF-16, LF-28, HF-38

45
Ours results by patients with persistent AF
Class HR 1 class lt 60 beats per minute 2
class 60-90 beats per minute 3 class gt91 beats
per minute
The results therapy are re-establishment
sinus rhythm 1- the efficient pharmacological
cardio version with amiodaron 2 non efficient
pharmacological cardio version with amiodaron
and connection of other drugs 3- non efficient
pharmacological cardio version with amiodaron,
electrical cardio version
Class ??, mc² 1- the absence reaction ??,
mc² 2- the reduce ??, mc²
Class adaptive reactions 1 class positive
(3 beats per minute) 2 class absence (-3 ?
?????beats per minute) 3 class negative ( 2
beats per minute)
46
???? ?????????? ? ????????? ? ?????????????? ??
????? ??? 1 ????? lt 60??\??? 2 ????? 60-90
??\??? 3 ????? gt91??\???
????????? ??????? ?????????????? ??????????
????? 1- ??????????? ?????????????????
???????????? ??????????? 2 ?????????????
????????????????? ???????????? ???????????,
????????????? ?????? ?????????? 3- ?????????????
????????????????? ???????????? ???????????,
????????????? ????????????
????? ??, ??² 1- ?????????? ??????? ??, ??² 2-
???????? ??, ??²
????? ????????????????? ??????? 1 ?????
?????????? (3 ??\???) 2 ????? ??????????? (-3 ?
?????) 3 ????? ????????????? ( 2 ??\???)
47
Ours results by patients with permanent AF
Class HR 1 class lt 60 beats per minute 2
class 60-90 beats per minute 3 class gt91 beats
per minute
Class ??, mc² 1- the absence reaction ??,
mc² 2- the reduce ??, mc²
Results therapy are control HR beats per
minute 1- the efficient to deterioration 2-
the non efficient to deterioration and connection
of beta-adrenoblocer
Class adaptive reactions are 1 class
positive (3 beats per minute) 2 class absence
(-3 ? ?????beats per minute) 3 class negative
( 2 beats per minute)
48
???? ?????????? ? ????????? ? ?????????? ??
????? ??? 1 ????? lt 60??\??? 2 ????? 60-90
??\??? 3 ????? gt91??\???
????? ??, ??² 1????? ?????????? ??????? ??,
??² 2 ????? ???????? ??, ??²
?????????? ??????? ???????? ??? ??\??? 1-
??????????? ???????? 2- ????????????? ????????,
????????????? ????-???????????????
????? ????????????????? ??????? 1 ?????
?????????? (3 ??\???) 2 ????? ??????????? (-3 ?
?????) 3 ????? ????????????? ( 2 ??\???)
49
Conclusion

• In patients with persistent AF after APhT with
  amiodaron
• the class of HR, TP and adaptive reactions did
  not change,
• even though on a tendency for reducing of HR and
  TP indexes
• partial adaptive reaction with adequate changes
  of HR and ABP was shown
• the reaction on therapy was individual
• the increasing of VLF and HF domains in
  structures of TP was found
• In patients with permanent AF after APhT with
  amiodaron
• the class of HR, TP and adaptive reactions were
  reducing in two patients
• adaptive reaction with adequate changes of HR,
  ABP and TP was found
• the increasing of HF domain in structures of TP
  was shown

50
??????

• ? ????????? ? ?????????????? ?? ? ???? ??????????
  ??? c ???????????
• ????? ???, ?? ? ?????????????????? ??????? ??
  ?????????, ???????? ?? ????????? ? ???????? ??? ?
  ???????? ??
• ?????????? ????????? ?????????? ?????????????????
  ??????? ? ?????????? ??????????? ???, ??
• ??????? ?? ??????? ???? ??????????????
• ??????????? ????????????????? ?????? ?? ???????
  ??? ? ??????? ????? VLF ? HF ?????????
• ? ????????? ? ?????????? ?? ? ??????????
  ?????????? ??? ? ???????????
• ????? ???, ?? ? ????????????????? ???????
  ????????? ? 2 ?????????
• ?????????? ????????????????? ??????? ? ????
  ????????? ? ?????????? ???, ?? ? ??
• ????????????????? ?????? ????? ?? ? ???????
  ???????????? HF