Vol 2, No 3 (2022)

The review presents new indications to help with diagnosis and treatment of ventricular arrhythmia (VA) in patients with various etiologies of rhythm disturbances, including patients with coronary artery disease, cardiomyopathies, channelopathies, inflammatory heart disease, neuromuscular disease, and congenital heart defects. Algorithms for diagnostic evaluation at first presentation with VAs in patients without known cardiac disease are given.

Embolic myocardial infarction (EMI) is more common than gets to be diagnosed. EMI is often associated with atrial fibrillation (AF). The incidence of this pathology, prognosis and treatment tactics remain unclear.

AIM: To assess the incidence of EMI among patients with myocardial infarction (MI), genesis of coronary embolism (CE), initial characteristics, treatment and prognosis in group of patients with EMI.

MATERIALS AND METHODS: The group of patients with EMI was selected among 1989 patients with MI admitted to the cardiology department of the North-Western State Medical University named after I.I. Mechnikov between 2013 to December 2019. The CE verification criteria were the SUITA criteria. Statistical data processing was carried out using the SAS program.

RESULTS: 16 cases of EMI were registered (0.8% of all MI and 4.3% of patients with MI and AF). 68.7% (95% CI = 41.5%–88.9%) of patients with EMI had AF. All patients with EMI and AF did not have adequate anticoagulant therapy before admission. Among patients with EMI, men predominated, they were younger, had fewer comorbidities than patients with MI and without AF. 13 of 16 patients with EMI were prescribed anticoagulants. During hospitalization, the composite endpoint (pulmonary embolism + stroke + cardiovascular death) was recorded in 25% (95% CI = 7.3%–52.2%), in the long-term period — in 30% of cases (95 % CI = 6.7–65.2). All these patients had AF. EMI in patients with AF was associated with the development of severe chronic heart failure (CHF) by the time of discharge and with decompensation of CHF in the long-term period.

CONCLUSIONS: EMI often occur in group of patients with AF, always in the absence of adequate anticoagulant therapy. Patients with EMI and AF have a worse prognosis due to recurrent thromboembolic events.

Keywords: anticoagulants; atrial fibrillation; coronary embolism; embolic myocardial infarction; prognosis; thrombaspiration.

Differential diagnosis of wide QRS complex arrhythmias is one of the most challenging tasks in routine practice arrhythmology. The analysis of the wide QRS complex morphology has been introduced due to the complex problem of detecting atrial waves on ECG. A slow conduction index based on the ratio of the initial and terminal QRS amplitudes is one of the solutions to evaluate conduction velocity based on the surface ECG due to a significant variability of QRS morphology and real complexity of its detailed assessment. However, one of the significant limitations of this algorithm is a need to search for the RS wide complex type and randomly select an ECG lead with this morphology which can finally create a contradictory result.

AIM: To evaluate a possibility of using the slow conduction index for differential diagnosis of wide QRS complex arrhythmias with left bundle branch (LBBB) morphology in any of 12-leads ECG followed by evaluation of the obtained diagnostic accuracy values.

MATERIALS AND METHODS: The study included 280 single premature wide QRS complexes with LBBB morphology recorded during holter ECG monitoring in randomly selected 28 patients. Atrial extrasystoles were recorded in 14 patients and ventricular extrasystoles were captured during sinus rhythm in other 14 patients. A ROC analysis was used for the qualitative and quantitative assessment of a slow conduction index diagnostic values based on sensitivity (Sn), specificity (Sp) and accuracy (Acc).

RESULTS: The highest values of Sn and Sp were obtained for a slow conduction index in the leads aVL, V2, aVF, V5 and III, and the lowest — for the leads I, V3 and V6 based on the calculated area (AUC) under the ROC curves (p < 0.001 for all leads).

CONCLUSION: The study presented the fundamental possibility of using a slow conduction index in any of 12-lead ECG for the differential diagnosis of wide QRS complex arrhythmias with LBBB morphology.

Born on 1 December 1922 in the small Ukrainian town of Zvenigorodka, Cherkasy region; died on 11 Juni 2002 in Saint Petersburg.

In 1947, M.S. Kushakovky graduated from the Military Medical Academy with merits, and his name was among the first to be put on Academy's marble plaque of honor after the war. At the beginning of 1951, M.S. Kushakovky defended his PhD. thesis on the topic “Hemodynamic disorders and the condition of the precapillary bed in advanced stages of hypertension (on the issue of adaptive mechanisms)”. In September 1960 he received the academic title of Associate Professor. At the department, he was in charge of the clinical department, conducted practical classes with students of the 3^rd and 6^th years of the Military Medical Academy, lectured for military doctors of advanced courses on various sections of internal diseases, functional diagnostics of diseases of the heart and blood vessels. In 1965, the doctoral dissertation was successfully defended. In total, he published 17 monographs (including reprints) and more than 220 articles. Max Solomonovich was a member of the editorial boards of the journals Arterial Hypertension and Bulletin of Arrhythmology. For a long time, Max Solomonovich was a board member of the therapeutic and cardiological societies of Leningrad and St. Petersburg. Prof. M.S. Kushakovsky was a scientific advisor for 30 PhD students. In 2001, he was awarded the title of "Honorary Doctor" of the St. Petersburg Medical Academy of Postgraduate Education, as well as the title of "Honorary Cardiologist of Russia".

In 2003, the Department of Cardiology of St. Petersburg Medical Academy of Postgraduate Education was named after him. Since 2011, after the merger of St. Petersburg Medical Academy of Postgraduate Education and Leningrad Sanitary and Hygienic Medical Institute, the combined Department of Hospital Therapy and Cardiology has born his name.