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To study prevalence of obstructive sleep apnea syndrome (OSAS) in patients with nocturnal asystoles, and assess therapeutic efficiency of constant positive air pressure (CPAP) applied to upper respiratory tract in this category of patients.The study incorporated 37 patients (33 men and 4 women, average age 50+/-11 years) with nocturnal heart beat interruptions of over 3 seconds. Baseline examination revealed grade II-III arterial hypertension in 67.5%, coronary heart disease - in 19%, diabetes mellitus in 8% and no cardiovascular disease - in 5.5% of patients. Sinus rhythm was registered in 30 (81%) of patients, 7 (19%) patients had permanent atrial fibrillation. Causes of deteriorated cardiac conduction were as follows: sinoatrial blocks and sinoatrial arrests (n=18), grade II-III atrio ventricular block (n=10), combination of these forms of bradyarrhythmias (n=2) and block of conduction to ventricles in permanent atrial fibrillation (n=7). According to intra esophageal cardiac pacing, the function of sinus node and atrio ventricular conduction appeared to be undisturbed in all patients with sinus rhythm. All patients have undergone polysomnographic (PSG) examination. For patients with OSAS, an individual selection of therapeutic pressure was carried out using the CPAP apparatuses. CPAP therapy was considered effective against OSAS if normalization of apnea/hypopnea index (AHI) was observed.OSAS was registered in 25 cases (68%) (mean AHI 54.9+/-28.7), 20 patients (80%) had severe grade of the syndrome. CPAP therapy appeared to be effective in all patients. At the background of treatment AHI decreased from 60.7 to 5.5 episodes per hour of sleep, mean oxygen saturation of arterial blood rose from 74 to 90%. Effect of CPAP therapy relative to cardiac conduction abnormalities was attained in all 19 patients with sinus rhythm and only in one patient with permanent atrial fibrillation.OSAS was revealed in 68% of patients with nocturnal bradyarrhythmias. Individually selected therapy with constant positive pressure in patients with nocturnal asystoles and OSAS efficiently eliminated in sleep asystoles and made it possible to avoid pacemaker implantation in some patients.

Clinical effects of glycoprotein (GP) IIb-IIIa antagonist eptifibatide (Integrilin) and its inhibitory effects on platelet aggregation were studied upon administration of eptifibatide for the treatment of acute coronary syndrome (ACS) without ST segment elevation. Eptifibatide was introduced to 25 patients with unstable angina and non-Q-wave myocardial infarction (MI) according to the following scheme: two boluses with 10 min interval at the dose of 180 mg/kg followed by supporting infusion of 2 mg/kg per min for the first 24 hours and of 1.3 mg/kg for the next 48 hours. Comparative group in which GP IIb-IIIa antagonists were not used upon therapeutic treatment also included 25 patients. All patients received standard basic therapy. 11 patients from the control group and 13 patients from the group with administration of eptifibatide underwent coronary angioplasty during in hospital period. Eptifibatide completely inhibited ADP-induced platelet aggregation within the whole infusion period but after that platelet aggregating activity was quickly recovered--for more than 50% within 6 hours, and completely within 12 hours after the end of infusion. Eptifibatide administration in none of patients was accompanied with the development of dangerous side effects. Thrombocytopenia (50,000 platelets per mm3) was registered in one, and minor bleeding events--in 3 patients. The rate of unfavourable outcomes (MI, refractory or recurrent angina) within first 30 days was almost the same in eptifibatide and control group--32% (8 out of 25) and 36% (9 out of 25) respectively. Thus, despite the complete inhibition of platelet aggregation for 72 hours, eptifibatide administration failed to decrease the amount of adverse events upon treatment of patients with ACS without ST segment elevation.

This review of the problems of prognostication of electrical instability of the myocardium in patients with aortic stenosis is based on recommendations of European Society of Cardiology on prevention of sudden death in patients with aortic stenosis with special emphasis on potential of noninvasive assessment of myocardial electric instability (signal averaged ECG, heart rate variability, analysis of variability of QT-interval, dipole electrocardiotopography).

Value of heart fatty acid binding protein (FABP) for medium term prognosis in patients with non-ST elevation acute coronary syndrome (NSTEACS) is not well established.To compare prognostic value of FABP levels with those of troponin I (TnI) and creatine kinase MB (CK MB) activity in patients with NSTEACS.Serum FABP and TnI levels (HyTest), CK MB activity (Biocon) were measured in 203 patients with NSTEACS (mean age 63.9+/-11.5 years, 52.2% male). Blood was sampled at admission within 12 (median 3.83) hours and in 6 and 12 hours after onset of pain. Upper limits of normal range (ULN) for TnI and CK MB were 0.4 ng/ml and 25 U/l, respectively. Serum FABP was measured in 53 healthy volunteers (mean age 44.3+/-13.3) and 95th percentile was used as ULN (4.67 ng/ml). Deaths and nonfatal MIs (events) were registered during one year follow-up.There were 47 events (23%, 23 deaths and 24 nonfatal MIs). Patients with events compared with those without events had significantly higher TnI and CK MB 12 hours after onset of pain and significantly higher FABP at all time points of blood sampling. Multivariate (step-up) analysis selected the following independent predictors of events: elevated FABP 6 hours after pain onset (OR 2.45, 95% CI 1.14-5.24; p=0.021), T-wave inversion on admission ECG, age65 and regular use of nitrates before hospitalization. Sensitivity of elevated FABP 6 hours after pain onset was 78.4%, specificity -- 45.1%. After exclusion from analysis of all or just admission and 6 hours FABP data elevated TnI 12 hours after onset of pain became an independent predictor of events.In this group of patients with NSTEACS among markers of myocardial necrosis (FABP, TnI, MB CK) obtained serially during first 12 hours after pain onset elevated FABP was the best predictor of events during 1 year follow up for subjects in whom blood sample could be done 6 hours after pain onset.

The authors developed a method for recording the electrical activity directly from the human sinus node through the right subclavian vein. Electrical activity of the sinoatrial node (SA) was studied in 179 patients with CHD (angina pectoris, myocardial infarction). The sick-sinus syndrome (SSS) was revealed in 86 patients. The duration of slow deflection Sd, Ss -- P interval (from the onset of Ss to the onset of P wave), P -- A1 interval (from the onset of P wave to the first atrial spike) was prolonged in cases with SSS. The duration of Sd, Ss -- P and P -- A1 decreased after nitroglycerine and atropine administration but increased after benzodixin administration. The data on direct pacing of the SA node and the changes in the duration of phase Sd and Ss after the administration of drugs confirm that slow deflection Sd and rapid preatrial deflection Ss reflect the electrical activity of the SA node.

An electrocardiographic study was conducted in 126 patients with endocardial electric stimulation from the right-ventricular apex. All electrocardiograms were divided in 6 groups on the basis of the vector direction of the artificial ventricular complex in the frontal aspect and the complex' morphology in right and left standard leads. The clinical value of the proposed classification of artificial ventricular complexes is discussed.

The condition of the conducting system of the heart and the sinus node recovery time were studied in 27 patients with the cardiac rhythm pathology under consideration. On the grounds of the resultant data the question concerning the implantation of this or that type of pacemaker (operating in a fixed regimen or "on demand") and-the positioning of the fixing electrode in the atria or ventricle was resolved. The advantages and shortcomings of each of the suggested methods for surgical treatment of sick sinus node are discussed.

Seventy-nine patients with ischemic heart disease were examined. Weakness of the sinus node was suspected in 32 patients according to the clinical findings and the ECG; diagnostic atrial stimulation was conducted. Sinoatrial node potential was registered in the form of a spike in patients with ischemic heart disease. Direct stimulation from the region of the sinoatrial node was performed. The stimulator impulse was followed by a distinct potential of the sinoatrial node in the form of a spike which was continuous with the wave of atrial depolarization. The time of sinoatrial conduction (from the onset of the sinoatrial) node potential to the first atrial spike) was determined in 47 patients with ischemic heart disease. It was determined that under the effect of nitroglycerin the time of sinoatrial conduction becomes significantly shorter (reduced from 29 +/- 10.6 to 20 +/- 8.3 msec).

In this study involving 45 patients with the normal function of the sinus node and 10 patients showing signs of its damage (n-10), intravenous administration of ethmozine in a dose of 150 mg (1.5-2 mg/kg) exerted atropine like action. In four cases with dysfunction of the sinus node the drug significantly increased the time of the restoration of sinus node function. Ethmozine induced a Stage II sinoatrial block in 3 out of 10 patients with sinus node dysfunction. The above data suggest that ethmozine produces an atropine-like effect on the sinus node. In some patients with sinus node dysfunction, ethmozine may impair the function of the sinus node which calls for caution while employing the drug in such cases. The inhibitory effect of the agent on the sinoatrial conduction in the patients studied suggests that ethmozine may prove an effective antiarrhythmic drug for treating patients with paroxysmal sinoatrial tachycardia.

Under observation were kept 80 patients with signs pointing to the sick sinus syndrome. Most of them suffered from ischemic heart disease, from atherosclerotic cardiosclerosis and acute myocardial infarction. Persistent sinus bradycardia with active and passive heterotopic arrhythmias were recorded in 42 patients. Sino-auricular block of the II and III degrees or asystolia of the atria with ectopic arrhythmias were observed in 37 cases. A number of patients displayed fibrillary bradyarrhythmia, extrasystole with post-extrasystolic depression of the rhythm and other disturbances. The so-called tachycardia-bradycardia syndrome characterized by the presence of tachycardiac arrhythmias occurring against the background of a marked bradycardia was registered in 25 persons. Fifteen patients demonstrated attackes of the Morgagni-Adams-Stokes syndrome, usually associated with lengthy periods of cardiac asystole. The treatment of ectopic arrhythmias in patients with the sick sinus syndrome presents considerable difficulties, but in many of them these disorders could be successfully eliminated by a careful and rigidly controlled application of antiarrhythmic agents (isoptin, ajmalin, pulsnorma, rhythmodan, beta-adrenergical blocking agents). For some patients exhibiting a tendency toward asystole electric stimulation of the heart is indicated.

Computer served to study by automatic analysis the structure of the cardiac rhythm in 190 patients: 123 patients after removal of the persistent form of atrial fibrillation, 24 with neuro-circulatory dystonia and 43 healthy individuals. Sino-atrial block with Samoilov-Wenkebach periods was recorded in 26 individuals. The characteristic changes of the cardiointervalogram in the given disorder of intracardiac conduction are described, which facilitates diagnosis considerably. The sino-atrial block with Samoilov-Wenkebach periods in the observed was not accompanied by clinical symptoms and exerted no untoward effects on the distant results of electro-impulse therapy in patients with persistent forms of atrial fibrillation.