[A variant of the pre-fibrillation form of ventricular tachycardia].
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Biomedical subjects
Publications and source records attributed to P V Zabela.
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The authors studied 65 patients (mainly with chronic coronary heart disease) with 48 hours of continuous two-channel Holter recordings of antiarrhythmic drugs. Spontaneous qualitative day to day variations in ventricular premature beats (VPB) exceeding 50% were recorded in 22 (33.8%) cases, those exceeding 75%--in 10 (15.4%) cases. Additional cases of severe Lown grade VPB during the second day of monitoring were revealed in 8 (12.3%) cases. We conclude, that marked day to day variation in VPB require a strict criterion (greater than 75% decrease) to define antiarrhythmic drug efficacy.
Results are given of the rhythmographic study of the frequency of extrasystole at rest, in the orthostatic position and during exercise in 236 patients with chronic ischaemic disease of the heart. The frequency dependence of extrasystole (the rate dependence of premature beats) was seen in 75.4% of cases. In the absence of the rate dependence of extrasystole, novocainamide, propranolol and atropine exerted marked antiarrhythmic effect less frequently than when such a dependence was present.
The antiarrhythmic effect of a single intravenous atropine injection (0.02 mg/kg body mass) was studied in 202 patients with extrasystole of various origin by rhythmography. Record of the chronotropic reaction and dynamics of the extrasystole interval suggests that there are two variations of the antiarrhythmic effect of atropine: frequency suppression of extrasystole and a "pure" antiarrhythmic effect. The data obtained are evidence that the mechanism of the antiarrhythmic effect of atropine is heterogeneous and complex.
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In 300 patients with extrasystolia and 36 patients with parasystolia a systematic search for reciprocal impulses was conducted with the aid of oesophageal ECG leads. Within 10-min periods, reciprocal impulses were detected in 13 patients (3.9 per cent). Reciprocal impulses occurred in extrasystolias of both functional and organic origin. Exercise contributes to the appearance of postextrasystolic reciprocal impulses. After intravenous injection of 10 mg Obsidan (propranolol hydrochloride) the phenomenon was less marked; in two patients, Obsidan oral medication (40 mg three times daily) led to the disappearance of reciprocal supraventricular paroxysmal tachycardia elicited by ventricular extrasystolia.
The clinical experience of drug therapy of 673 patients with extrasystole of different genesis has demonstrated that the nature of the underlying pathology and the topical characteristics of the extrasystole produce a comparatively moderate effect upon the antiarrhythmic action of Novocainamide, Chinidine, Obsidan, Isoptine, Bellataminal. Of certain importance in this context is the determination of the degree of prematurity of the extrasystole, their stability, as well as the periodic structure of the sinus rhythm as shown by the rhythmogram.
The antiarrhythmic effect of Panangine and Strophantin was studied by way of rhythmography in patients with extrasystole of different etiology. The strophantin (0.25 mg) an Panangine (2 vials intravenously) tests, and therapeutic courses of Panagine (2 coated tablets 3 times a day for 5--7 days) or of Strophantin (0.25 mg) with Panagine (2 vials intravenously) for 7--10 days were conducted. A course of Strophantin with Panangine was given only to those patient who did not increase the number of their extrasystoles after the Strophantin test. Such a course resulted in the most striking antiarrhythmic effect (60.3% of the patients).
The rhythmographic technique was used to study the antiarrthythmic and chromotropic effect of intravenous injections of 10 mg of Obsidan (105 patients), of 10 mg of Isoptine (105 patients), and of oral administrations of 120 mg/day of Obsidan (160 patients) and Isoptine (128 patients). All patients demonstrated persistent extrasystole of different genesis against the background of the sinus rhythm. With intravenous injections the antiarrhythmic effect of Obsidan at rest did not differ from that of Isoptine. Under physical exercises Obsidan tended to display a more powerful negative bathmotropic effect. With the oral route of administration Obsidan was more effective both at rest, and under exercises. It produced a distinct negative chromotropic effect, while Isoptine displayed a biphasic effect. The results of automatic detection of the classes of the antiarrhythmic effect of Obsidan as judged by the dynamics of the sinus rhythm characteristics permit to suggest the possibility of using the later for an individual selection of the therapeutic means for extrasystole.
A rare clinical case is described pertaining to a 70-year-old female patient with atherosclerotic cardiosclerosis accompanied by a combination of sinus and ventricular extrasystole. The importance of rhythmography and the criterion of allorhythmia is emphasized as being he indices that help to improve the diagnosis of sinus extrasystole.
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