INFLUENCE OF ARTERIAL HYPERTENSION AND CHRONIC HEART FAILURE ON THE EFFECTIVENESS OF SINUS RHYTHM RESTORATION IN PATIENTS WITH ATRIAL FLUTTER

Abstract

The use of overdrive transesophageal cardiac pacing (OTECP) in atrial flutter (AF) can reduce the number of external electrical cardioversion (EEC) in arrhythmia refractory to drug-induced cardioversion. The conversion of AF to atrial fibrillation (AFib) with subsequent spontaneous sinus rhythm (SR) restoration with the help of OTECP and accompanying antiarrhythmic therapy (AAT) was carried out in 59 patients with diseases of the cardiovascular system aged 40 to 77 years. The duration of AF before pacing was 35.93 ± 5.25 days. The efficiency of OTECP was 71.19%, and the time for spontaneous SR restoration was on average 16.92 ± 2.67 h. During pacing, the combined AAT has no advantages over monotherapy, despite its higher efficiency before OTECP. The obtained results indicate that the duration of AF prior to the OTECP procedure did not affect either the effectiveness of the procedure or the timing of spontaneous SR restoration. Inadequate control of blood pressure during treatment was a risk factor for reducing the effectiveness of OTECP, and contributed to the persistence or recurrence of arrhythmia. In patients with AF without AH, a decrease in left ventricular contractility and severe grade of CHF with an increase in left ventricular chamber dimension at end systole, a decrease in ejection fraction (EF) and fractional shortening (FS), reduces the likelihood of spontaneous SR restoration after OTECP, while additional administration of digoxin to increase myocardial contractility did not influence the effectiveness the therapy being carried out. The enlarged dimensions of the left atrium, which did not go beyond the critical dimensions, also had no influence on the effectiveness of the therapy. The efficiency of SR restoration against the background of AAT was 71.19%. Taking into account the EEC accompanied by the treatment performed corresponds to 83.05%. The effectiveness of OTECP when performed on the background of mono- or combined AAT did not differ significantly and amounted to 70.83 and 71.43%, as well as the terms of spontaneous SR restoration — 16.94 ± 2.86 and 16.89 ± 2, 48 hours respectively. The effectiveness of OTECP during mono- or combined AAT was 70.83% and 71.43%, respectively, and the time for spontaneous SR restoration was 16.94 ± 2.86 and 16.89 ± 2.48 hours. Medicamentous cardioversion of AF prior to the OTECP procedure is effective in 54.29% of cases and only with the combined AAT.