Supraventricular extrasystole

Supraventricular extrasystole is one of the types of arrhythmia. In this case, an extraordinary excitation of any part of the heart occurs, caused by the occurrence of a premature impulse in the upper parts of the heart or in the antiventricular node.

The causes of supraventricular extrasystole are varied. Extrasystoles are functional and organic. Functional ones can occur in people with a healthy heart, in particular in children and tall young men. This is a rare single supraventricular extrasystole with the number of contractions less than 30 per hour.

Functional extrasystoles are usually classified as having the following origin: neurogenic; diselectrolyte; dishormonal; toxic; medicinal.

Neurogenic, in turn, are divided into hypoadrenergic, hyperadrenergic and vagal.

Hyperadergic extrasystoles are associated with increased physical and mental work, emotional arousal, drinking alcohol, smoking, and eating spicy foods.

Hypoadergic ones are difficult to recognize. Their existence is confirmed by experimental data and clinical observations.

With vagal extrasystole, interruptions in heart contraction occur after eating and during sleep, that is, in a horizontal position.

Organic supraventricular extrasystoles are caused by heart diseases, including:

cardiac ischemia;
heart defects;
cardiomyopathy;
myocarditis;
tricuspid valve prolapse;
mitral valve prolapse with blood returning to the left atrium;
minor atrial septal defect;
expansion of the pulmonary artery trunk;
atrial dilatation in obesity, diabetes mellitus, chronic alcohol intoxication.

Sinus extrasystole is most often caused by chronic ischemic heart disease. We can talk about the organic nature of supraventricular extrasystole if it develops:

with sinus tachycardia; comes from several foci (polytopic); associated with angina pectoris; extrasystoles more than 30 per hour during ECG monitor recording and more than 5 per minute during examination by a doctor.

Extrasystoles of the following origin are usually classified as functional:

neurogenic;
diselectrolyte;
dishormonal;
toxic;
medicinal.

Enlargement of the thyroid gland and its increased function can often be the cause of supraventricular extrasystole

Neurogenic, in turn, are divided into hypoadrenergic, hyperadrenergic and vagal.

Hyperadergic extrasystoles are associated with increased physical and mental work, emotional arousal, drinking alcohol, smoking, and eating spicy foods.

Hypoadergic ones are difficult to recognize. Their existence is confirmed by experimental data and clinical observations.

With vagal extrasystole, interruptions in heart contraction occur after eating and during sleep, that is, in a horizontal position.

Organic supraventricular extrasystoles are caused by heart diseases, including:

cardiac ischemia;
heart defects;
cardiomyopathy;
myocarditis;
tricuspid valve prolapse;
mitral valve prolapse with blood returning to the left atrium;
minor atrial septal defect;
expansion of the pulmonary artery trunk;
atrial dilatation in obesity, diabetes mellitus, chronic alcohol intoxication.

Sinus extrasystole is most often caused by chronic ischemic heart disease. We can talk about the organic nature of supraventricular extrasystole if it develops:

with sinus tachycardia;
comes from several foci (polytopic);
associated with angina pectoris;
extrasystoles more than 30 per hour during ECG monitor recording and more than 5 per minute during examination by a doctor.

In addition, supraventricular extrasystole is classified as follows:

According to the number of ectopic foci: monotopic (one foci), polytopic (several foci).
By localization: atrial with the source of excitability in the atria and antiventricular - in the septum between the upper and lower parts of the heart.
By frequency: paired (two extrasystoles in a row), single (less than 5 per minute), multiple (more than 5 per minute), group (several premature contractions in a row).

Often people with supraventricular premature beats have no symptoms. The most characteristic signs:

Dizziness, feeling of weakness.
Shortness of breath, lack of air.
Fear, anxiety, panic, fear of death.
Interruptions in the work of the heart, a feeling of its revolutions.
Feeling of heart stopping or freezing.
After freezing, a push to the chest.

MODERN SOFTWARE DIAGNOSTICS OF HOLTER ECG Recognition The most difficult task in recognizing a Holter ECG is recognizing moderately noisy fragments. Such areas cannot be ignored, because the doctor visually deals with such areas, and there can be up to 30% or more. In many XM systems there are very big problems with recognition: extrasystoles are classified as interference, interference is classified as extrasystoles. Very strong recognition was performed in the Myocard-Holter system (Sarov), since we used a unique image recognition algorithm using the artificial intelligence. This method has two main unique points: 1) automatic formation of a system of images and sub-images of cardiac complexes; 2) the recognition process “Assumption - confirmation” is similar to natural intelligence. The following images are automatically generated in the Myocard-Holter program: 1) Images of P waves. 2) Images of QRST of various cardiac complexes (normal, ventricular, draining, transient LBBB, BPW, WPW, imposed by a pacemaker). 3) Images of ventricular flutter waves. 4) Images of respiratory waves of the rhythmogram. 5) Images of cardiac pacemakers. Most XMs do not recognize the P wave. This is very bad. Many AV blockades, when the RR interval is increased by much less than 2 times (for example, 1.5 times) will be missed, although there is a blocked P wave. Short episodes of non-sinus rhythm, with a small change in heart rate, may be missed by the doctor during visual inspection. It is impossible without the P wave to analyze the operation of pacemakers with a control signal from the atrium or with atrial stimulation. Of course, recognizing P waves makes sense only in areas with a low degree of noise, but on average there will be 70–95% of such areas. In the Myocard-Holter system, P waves are used in all sections of the analysis of rhythm and conduction disorders. Currently, most XM systems are not capable of forming QRST images in full (they do not distinguish BPN, BLN, WPW, and do not classify drain complexes). The Myocard-Holter program can build any images. This makes it possible to qualitatively diagnose intraventricular conduction disorders and ectopic activity. In 2003, testing of the QRS classification was carried out on three foreign test bases: A.H.A. – The American Heart Association database for assessing ventricular arrhythmia (80 records, 30 minutes each); MIT – The Massachusetts Institute of Technology-Beth Israel Hospital arrhythmia database (48 records, 30 minutes each); NST – Noise Stress Test Database (12 recordings, 30 min each; comes with MIT database); Testing consisted of an automatic comparison of the QRS codes described in the database and those recognized by the program. The resulting reliability is 97%. Moreover, more than 90% of all records have a reliability percentage of at least 99.7%. We did not even expect such good results. The images of ventricular flutter waves are formed separately from the QRS images, because there is little left of the QRST in them and they are highly variable, for example, during a pirouette. We introduced rhythmogram images, i.e., images of RR intervals for the first time. They are useful for preventing false supraventricular extrasystoles and pauses. Electrocardiogram analysis In modern XM systems, the protocol is automatically generated from approximately 10 sections: 1. pulse; 2. rhythm variability; 3. analysis of IVR; 4. rhythm, episodes of rhythm; 5. pauses; 6. PQ interval analysis; 7. supraventricular ectopic activity; 8. ventricular ectopic activity; 9. analysis of the ST segment and negative T; 10. QT interval analysis. Pulse To find the places of maximum and minimum heart rate, the program offers three methods for counting heart rate: 1). By averaging over 5 seconds. In this case, artifacts and extrasystoles are excluded from averaging. However, extrasystole of the bigeminy type falls into the trend. Ventricular complexes also fall within the ventricular rhythm. 2). In areas with a stable pulse, when the RR intervals differ by less than 10%. 3). By unit intervals. This makes sense for short episodes of tachycardia. At the same time, the program prepares the minimum, average and maximum heart rate values “per day”, “at night” and “day”, as well as separately for each pacemaker and in general, regardless of the rhythm. Those. the minimum pulse values for sinus rhythm and supraventricular tachycardia will be different. The program accumulates the duration of tachycardia and bradycardia in the ranges <30, 30–40, 40–50, 90–100, 100–120, 120–150, >150 beats/min. Builds tables and histograms by hour: minimum, average and maximum heart rate. Rate variability The analysis of rhythm variability does not use areas with rhythm disturbances. The program calculates the main parameters of time analysis for the entire duration of the survey: * SDNN – standard (mean square) deviation from the arithmetic mean RR of the entire study. * SDANNi – standard deviation of RR intervals averaged over 5 minutes. * SDNNi – average value of standard deviations of five-minute sections. * RMSSD – root mean square difference between adjacent RR intervals * PNN50 – percentage of differences between adjacent RR intervals exceeding 50 ms. * Circadian index - the ratio of the average heart rate of the night to the average heart rate of the day. We present the norms of these parameters for healthy individuals in the monograph by L.M. Makarov. /2/. For a more accurate assessment of rhythm variability, taking into account heart rate and time of day, the method of “analysis of short sections” is recommended, according to the monograph by G.V. Ryabykina, developed at the Research Institute of Cardiology named after. Myasnikov. Throughout the entire ECG examination, short sections consisting of 33 RR intervals without rhythm disturbances or interference are searched. Analysis is being carried out on these areas. The variability of one short section is calculated as the sum of the differences between adjacent RR intervals. Next, all selected areas are divided into 8 ranges according to the average heart rate of the area. For each range, the average variability is calculated. The norms of variability for each heart rate range were empirically obtained. The analysis is carried out for night hours (1–5 hours), morning hours (8–12 hours) and all days. Next, the number of areas with low variability (below the norm) and their percentage of the total number of areas suitable for analysis are calculated. The integral conclusion on variability is made based on the percentage of areas with low variability: if more than 60%, then “Sharply reduced”, from 30 to 60% - “Moderately reduced”, less than 30% - “Normal”. For a deeper analysis of the influence of the sympathetic and parasympathetic systems on rhythm variability, spectral analysis of RR intervals is recommended. IVR analysis It is possible to expand this section only using the example of “Myocard-Holter”. For more correct operation of the program, it is advisable to indicate the type of pacemaker according to the monograph /4/. If the type is not known, the program will determine it itself. The program recognizes forced, confluent and spontaneous complexes, various modes of stimulation of the heart chambers, unresponsive impulses, premature forced complexes and some allorhythmias. In episodes of spontaneous rhythm, a rhythm change analysis program works. The protocol for this section contains estimates of the number of different cardio complexes, as well as parameters of the periods VA, AV, PV, PQ, slip periods and heart rate of imposed rhythms. Using these parameters allows you to more fully evaluate the pacemaker settings. Rhythm, episodes of rhythm Editing identified rhythm episodes becomes possible if you use the “Episode” editing unit. This should not be confused with “episodes” in the Cardiotechnika-4000 system. There, the name would be more accurate not as “Episode No. 38”, but as “Fragment No. 38”. In the Myocard-Holter system, an “episode” corresponds to the electrocardiographic concept and can last from several seconds to several hours. A form for representing episodes on the rhythmogram and convenient means for editing them were developed (add an episode, change an episode, change the boundaries of an episode, select an episode with the mouse). All episodes in the program are divided into three groups: 1) rhythm episodes; 2) episodes of transient conduction disturbances; 3) sleep-wake episodes. The diagnostic program identifies the following rhythm episodes: sinus, atrial, AV rhythm, atrial fibrillation, pacemaker migration, supraventricular paroxysmal tachycardia, ventricular rhythm, ventricular flutter. The program includes transient LPN, BPN, and WPW as episodes of transient conduction disturbances. It is interesting to note that after detecting episodes of transient conduction disturbances, the program fairly accurately diagnoses (starting from the beginning of the recording) single complexes with this disturbance. By the way, against the background of these disorders, ventricular extrasystoles are still diagnosed. In most XM systems, the section of rhythm episodes is partially implemented, in some systems it is completely absent. Pauses It turned out to be completely wrong to identify pauses only by a sharp increase in the RR interval to the previous one. There are examples of second degree AV block when RR is increased by only 1.5 times. In these cases, the presence of a blocked P wave helps to diagnose the blockade. On the other hand, there are examples of respiratory arrhythmia when the RR interval is approximately 2 times larger than the previous one. If we take a separate episode for consideration, then we could perform a sinoauricular block with Wenckebach periodics /1 p.67/. But taking into account such neighboring episodes, where fluctuations in RR and the RR interval are less pronounced, but have the same waves, these episodes should be classified as sinus arrhythmia (the program refers to “pauses under?”). By the way, in /1/ it is noted that in 50% of healthy subjects sinus arrhythmia is detected with a change in the duration of the PP intervals up to 100% or more in relation to the previous cycle. To correctly diagnose such situations, the parameters of the respiratory waves of the rhythmogram have been developed. A similar approach to diagnosing pauses and supraventricular extrasystoles is currently available only in Myocard-Holter. PQ interval analysis The increase in the PQ interval in the program is assessed in two ways: 1 – relative to the PQ norm, which is calculated depending on heart rate and age, 2 – relative to the absolute threshold, which is set by the doctor, for example, 0.23 s. In the case of a noisy ECG, the PQ is considered uncertain. Supraventricular ectopic activity In all CM systems, the classification of supraventricular extrasystoles (SE) is approximately the same: single, intercalated, paired, “NE + PVC,” group, bigeminy, trigeminy. If the program detects a pronounced respiratory arrhythmia, some extrasystoles are marked as “under?”. NEs are not placed within episodes of atrial fibrillation and pacemaker migration. The protocol for this section includes the total number of extrasystoles, the maximum per hour, as well as a breakdown by type. Ventricular ectopic activity The classification of ventricular extrasystoles (PVS) is similar to NE. But there is an additional classification: parasystole, SLS sequence, and single complexes with transient conduction disturbances. All PVCs are classified by the parameter “early” or not. If a P wave is detected in front of the ventricular complex, the complex is classified as “NE with aberrant conduction” (in the absence of transient conduction disturbances). According to the direction of the QRS, all PVCs are divided into several morphological clusters. A similar division can be observed in most imported and domestic chemical products. Some systems allow many clusters of PVCs, and given the poor quality of interference recognition, most of them are just interference. The doctor has to spend quite a lot of time dealing with them. In the Myocard-Holter system, at the end of the analysis, the program once again reviews all clusters of PVCs, combines them, and classifies something as interference. As a result, the number of clusters remains no more than 7. The analysis of parasystole occurs at the end of the program, when all the images have already been “settled” and the confluent complexes are visible. ST segment and negative T analysis In what cases is ST not analyzed? ST measurement is not performed on complexes: ventricular, pacemaker-induced, drain, single complexes with transient conduction disturbances, with interference, in episodes of atrial flutter with P waves above the threshold. In episodes with transient bundle branch blocks or WPW, ST is measured but not analyzed for “ischemic shift.” During cardiac pacing, ST is analyzed only in areas of spontaneous rhythm. What is being measured In order to measure the ST level of the current complex, the program builds an averaged cardio complex, selecting 4 more complexes on the left and 4 on the right for averaging. In this case, interference and other complexes that are not subject to measurement are discarded. Next, the program analyzes the similarity of the complexes, especially the ST segments. In this case, the threshold of permissible segment discrepancies is set by the user, for example, 1 mm. The user also sets the “number of similar complexes” threshold, for example, 5. If there are fewer similar complexes than this threshold, then the measurement is canceled. The averaged complex turns out smooth, it is displayed on the screen and the user can control the measurement with an “electronic ruler”. Where to take measurements A deviation of the ST segment lasting 0.08 s, starting from point j, is considered diagnostically significant. In this program, this duration is slightly reduced for tachycardia according to the formula from the root of RR. So with a pulse up to 90 u/m – 0.08 s, 120 u/m – 0.07 s, 150 u/m – 0.065 s, 180 u/m – 0.06 s, 210 u/m – 0.055 s. Previously, in the Myocard-Holter system, ST was measured at 3 points of the segment, then, depending on the shape and slope of ST, one point was selected. This approach is weak because the entire ST segment needs to be assessed. In this program, the displacement level ST is understood as the distance from the isoline to the point of the segment closest to the isoline. But with a small correction: not from point j, but from point j+0.01 s. The line connecting the QRS beginning points of the current complex and the next one is taken as an isoline. Note that the PQ segment can be oblique, so only the QRS origin is taken. The TP segment also cannot be used to construct an isoline, because often above the isoline (Fig. 1).

What's on the screen in the ST section The leftmost window shows the averaged “resting ECG” complexes. For averaging, the program selects a fragment of a pure ECG from the entire study at the very minimum pulse without rhythm disturbances. Next to it is a window in which the averaged current cardio complex is presented. In this window, as well as in the main window with the ECG, measurement rulers work. In all windows, the measured ST segment from point j+0.01 s to point j+0.08 s is highlighted. What is considered an ischemic ST deviation ? At a minimum, ST segment displacement beyond the “working threshold” should be considered. The operating threshold is calculated by the program as a ST deviation of 1 mm relative to the resting ECG (at minimum pulse) and further than the “initial thresholds”, which depend on the lead. "Initial thresholds" can be changed in system settings. We propose the following values: Thus, the working threshold for elevation is taken as the upper limit of: – the initial threshold, – the ST level at rest +1 mm. The working threshold for depression is taken to be the lower limit of: – the initial threshold, – the ST level at rest minus 1 mm. For example, if lead V5 ST at rest is -1 mm, then the threshold for elevation will remain 1 mm, and for depression the “working threshold” will become -2 mm. You can change working thresholds when working in the ST section by clicking the “Thresholds” button. Unlike ST shifts during hypertrophy, which are permanent, ischemic ST-T changes are fleeting. We understand the basic rule of “1x1x1” as follows: “in less than 1 minute, the ST segment has shifted by more than 1 mm (0.1 mV) and the duration of the displacement is at least 1 minute.” However, in practice this rule needs slight adjustment. For example, the transition time should sometimes be allowed to be 2 minutes or more. The duration of the displacement is sometimes less than a minute. In the latest version of the program, all thresholds of the “1x1x1” rule are available for adjustment. We have added one more unit to the rule: the duration of the preceding non-ischemic section must also be at least 1 minute, otherwise the rule may work falsely due to interference. In addition, it is proposed to use the “ST/HR” Index when calculating ST in μV. Ischemia criterion if the index decreases below -1.4. The user can change the index threshold or disable its use. All three criteria for “ischemic displacement” are used in the program through the logical “AND” function. Those. to classify a site as “ischemic” there must be: – and the ST deviation is greater than the working threshold, – and the implementation of the “1x1x1” rule (or disabling the rule) – and the ST/HR index value is less than the threshold (or disabling.). Thresholds So, the user can adjust: 1. ST deviation thresholds. In this case, of course, it must start from the level at rest 2. Threshold “Permissible level of interference in the ST section.” 2 mm is recommended out of an acceptable range of 0.5 - 4 mm. 3. Threshold “Minimum number of similar complexes out of 9 possible.” 5 is recommended out of an acceptable range of 3–7. 4. Rule thresholds “1x1x1x1” are recommended 1. 5. Index threshold “ST/HR”. Recommended -1.4 from a possible range of -1 – -2. Protocol In the protocol, the program reflects the number of ischemic episodes, the total time of ischemic ST deviation, the longest ischemic episode, the time and values of the maximum deviations. Negative T trends In order not to overload the program interface in some versions, we removed the analysis of negative T. It turned out that this is such a necessary tool that some users for this reason refused to replace the version. The analysis has now been restored. The user can estimate the maximum values of negative T, the duration of the ECG with T, deeper than a specified threshold. Analysis of the QT interval The duration of the QT interval characterizes the process of repolarization, i.e. the process of restoring the ionic balance of myocardial cells, which begins immediately after depolarization. A strong shortening or strong prolongation of the QT indicates a violation in both cases of the same mechanism of synchronization of the repolarization process, which is a strong arrhythmogenic factor leading to the occurrence of ventricular rhythms, most often in the form of a “pirouette”, which has a high risk of sudden death. Historically, one QT rate has been used to evaluate a long QT and a different QT rate has been used to evaluate a short QT. 1. The prolongation of the QT interval in the program can be assessed in absolute value and relative to the QT norm, depending on heart rate. In this case, to evaluate relative to the norm, you can use the systolic indicator (SP) or QT corrected (QTc), which is basically the same thing, because both QT-norms and QTc are calculated using the Bazet formula: QTm,d=0.37*root (RR) – for men and children. QTf=0.40*root(RR) – for women. These formulas work for heart rates from 40 to 120, and for significant bradycardias and tachycardias they have adjustments depending on age and gender. QTc=QT/root(RR). The program diagnoses “Long QT syndrome” in two cases: a) if QTc> Threshold1 (460 ms for men and children, 470 ms for women) b) if QTc> Threshold2 (440 ms for men and children, 450 ms for women) and there is at least one of the additional signs: - tachyform ventricular rhythm (although it is believed that a long QT provokes the occurrence of ventricular tachycardia in the “pirouette” form, the program still does not exclude the connection of a long QT with any ventricular tachycardia.); - ventricular extrasystole with a preceding SLS sequence (short-long-short, i.e. short-long-short. SLS is a manifestation of the Ashman phenomenon - slowing down of repolarization in the complex after a pause); – “T wave alternation” (this is when the amplitude of the T waves changes greatly from complex to complex on the ECG without interference); – an increase in QT dispersion (QTd) of more than 50 ms (QTd is the maximum difference in QT durations of different leads, provided that the T amplitude is more than 0.3 mV); – decrease in circadian index below 1.2; – reduced heart rate variability in areas of bradycardia; – history of “syncope or sudden death of unknown cause at a young age among close relatives”; - history of diabetes mellitus. 2. QT shortening in the program is evaluated relative to QTp (predict), i.e. due, calculated using the formula proposed by P.Rautaharju based on a survey of 14 thousand practically healthy people. The parameters QTp88 and QTp80 are used, i.e. 88% and 80% of QTp, respectively. For example, with a pulse of 60 beats/min QTp=410, QTp88= 361, QTp80=328 ms. (p. 269, Makarov L.M. Holter monitoring. 2nd ed. - M.: ID "Medpraktika-M". - 2003. - 340 p.) The program puts the conclusion “Short QT syndrome” in two cases: a) QT is less than QTp80, b) QT is less than QTp88 and there is at least one of the additional signs: - a history of “syncope or the fact of sudden death of an unknown cause at a young age among close relatives”, - ventricular rhythm of tachyform, - ventricular extrasystole with a preceding SLS sequence . 3. Program street trends QT, QTp, QTc, QTd, alternations T. The program finds the largest deviations QT, QTc, calculates the total time of deviation QT, QTc is greater than threshold values. Main windows of the interface program 1) ECG viewing window. Here you can set the scale, speed, number of leads. Between two cardiac complexes, either the heart rate or the RR duration is displayed. It is possible to measure the duration and amplitude of ECG parameters. 2) Histograms and tables. There are approximately 90 histograms of the number of violations or deviations by hour. It is very clear to see at what hour there were the greatest number of violations or deviations. By marking with the mouse in the histogram at the right time, you can immediately go to view the ECG at that time. This information is printed in the form of histograms or tables. 3) List of violations. It is represented in the form of a tree. It is the primary mechanism for selecting disorders for review by a physician. It is convenient to view violations with both detailed and general classification. For example, you can view all PVCs or only paired ones or only early ones, etc. In principle, this is a development of the “Super Imposition” mode. 4) Rhythmogram. On it, various violations and interference are marked in different colors. Separately, episodes of rhythm, transient conduction disturbances, etc. are noted. Over time, this window becomes the doctor’s favorite window for analyzing rhythm disturbances. 5) Trends (graphs) of pulse, ST, PQ, QT, etc. There is a mechanism for accessing the brightest places (minimum, maximum pulse, maximum ST deviation, etc.) Conveniently, it is possible to change the trend scale (all 24 hours, 6 hours, 1 hour, 30 minutes), i.e. It is possible to generally evaluate, for example, the pulse or ST graph for the entire examination time, and look at the dynamics in more detail. Editing and receiving the protocol 1) Study by sections. As already noted, the protocol is automatically generated from 10 sections. Therefore, it is logically recommended that the entire study be carried out in sections. Having selected a section, it is convenient to move within this topic between histograms, a list of violations, ECG graphs, trends and a fragment of the protocol conclusion. Convenience stems from the fact that when working on some topic, for example, ST, everything related to ST is, as it were, “at hand.” 2) Transitions. A common cursor strategy has been implemented for the ECG window, rhythmogram and all trends. Those. Scrolling through the ECG, the cursor will move on the rhythmogram and trends. If you click the mouse anywhere on the rhythmogram or trends, the ECG will also move. 3) Versatility of editing. It is possible to edit at different levels: – classification of individual cardiac complexes, – entire groups of disorders at once, for example, the entire group of ventricular extrasystoles of a certain shape can be classified at once as “supraventricular extrasystoles with aberrant conduction” – ECG episodes (rhythm, transient blockades, etc.), – text of the protocol conclusion. 4) Unified list of violations. Wherever editing is performed, it automatically affects everywhere: in the conclusion and in histograms and in tables and in lists of violations. 5) Printing graphs. As the ECG is examined, the doctor sends examples of ECGs, trends, and rhythmograms to the print queue. Moreover, the program will automatically prepare a comment, for example, “maximum pulse”, “paired ventricular extrasystole”, etc. The doctor can correct the comment. The doctor can view the selected fragments and remove them from the queue, for example, replacing them with a more successful one. At the end of the study, the doctor sends the fragments to the printer, and you can set the page orientation (landscape or portrait). The program will try to make the most of each page by placing several fragments on them. 6) Research protocol So, the protocol consists of fragments of graphs, a conclusion, which is formed from fragments for each section, a summary table, which can be on one or several pages, depending on the volume of identified violations. Conveniently, the structure of the conclusion and tables can be specified using checkboxes. For example, if you don’t need the rhythm variability section, or the QT section, you just need to uncheck the corresponding box. Recorder At the moment, there are two types of recorders supplied with the complex: 1) 2/3-channel recorder (2-channel recording is used for infants). Up to 24 hours of continuous recording. 2) Universal recorder. Possibility of recording 3/12 leads. IVR detector. Up to 72 hours of continuous recording. References 1. A. Dabrowski, B. Dabrowski, R. Piotrovich. Daily ECG monitoring: (translation: Korneev N.V., Grabko N.N., Bannikova S.D.) - M.: Medpraktika, 1998. - 208 p. 2. Makarov L.M. “Holter monitoring” M.: Medpraktika publishing house, 2000, p. 216 3. Ryabykina G.V., Sobolev A.V., Heart rate variability. M.: Star'Ko, 1998, 200 p. 4. Grigorov S.S., Votchal F.B., Kostyleva O.V. Electrocardiogram with artificial cardiac pacemaker. – M.: Medicine, 1990. 240 p.

magazine "Polyclinic No. 2", pp. 16–20, 2007

Classification and types

There are many types of NLEs, divided according to different characteristics.

Depending on the source of the impulse, atrial extrasystoles and extrasystoles (ES) from the atrioventricular (AV) connection are distinguished. Based on the number, they distinguish between single and double. Three or more ES in a row is already considered an episode of tachycardia (also called a “jog”).

In my patients, I often observe such an ECG phenomenon as allorhythmia - the regular occurrence of extrasystoles. There are the following types:

bigeminy - the appearance of ES on the cardiogram after each normal contraction of the heart (read more about this phenomenon here)
trigeminy - after every second complex;
quadrigeminy - after every third complex.

Depending on the cause, the following types of NVEs are distinguished:

functional - during physical activity, reflex effects;
organic - for heart diseases;
toxic - in case of drug overdose;
mechanical - for injuries.

Single extrasystoles

The most benign variant of NVE, mainly found in healthy individuals, are single supraventricular extrasystoles. They almost always go unnoticed by humans and do not pose a threat to health.

Symptoms of supraventricular tachycardia

cardiopalmus;
severe dizziness, lightheadedness, fainting;
feeling of lack of air and difficulty breathing, chest pain;
pronounced decrease in blood pressure;
Feelings of fear, panic and anxiety may often be present.

More often, an attack of arrhythmia lasts up to 1 hour (usually 5-20 minutes), attacks can be repeated with varying frequencies. Some patients can independently cope with the next attack by taking certain medications (“a pill in the pocket”) or so-called vagal tests (pressing on the eyeballs, wiping with cold water, etc.)

It is also worth remembering that some types of arrhythmia have absolutely identical symptoms, but unlike supraventricular rhythms, they are life-threatening. That is why a full examination is necessary in order to determine the type of arrhythmia and decide on the need for treatment.

general description

Supraventricular tachycardia
is a common type of arrhythmia that originates in a zone located above the ventricles of the heart. The main features of this type of arrhythmia are a sharp increase in heart rate and the persistence of a pathological rhythm for a certain period of time. Currently, this heart disorder is very common in people over 20 years of age.

There are five main types of supraventricular arrhythmias, different in etiology and pathophysiology: atrioventricular nodal tachycardia, atrioventricular tachycardia, atrial tachycardia, intraatrial tachycardia, sinoatrial reentrant tachycardia (it should be noted that such types of supraventricular arrhythmias as atrial fibrillation and atrial flutter, as a rule, are worth apart from this group).

At risk:

men and women regardless of age

Treatment: when, how and with what

Supraventricular extrasystoles are almost always benign. If extraordinary contractions of the heart are single, are not accompanied by any symptoms and do not provoke the occurrence of severe rhythm disturbances, treatment of supraventricular extrasystole is not required. The main thing is to fight its cause.

When EVE worsens the patient's condition, I prescribe drug therapy. The most effective drugs for stopping SE are beta-blockers - Bisoprolol, Metoprolol. If there are contraindications to their use (for example, severe bronchial asthma), I transfer the patient to slow calcium channel blockers - Verapamil, Diltiazem. Read about how extrasystole is treated with medications here.

As for traditional methods, to date there is no convincing evidence of their effectiveness. In my practice, I recommend that patients under no circumstances replace traditional treatment with traditional medicine. But if you have a different opinion, we invite you to read the material here.

If the development of NVE is associated with emotional stress or a neurotic disorder, you can take sedatives and make an appointment with a psychotherapist.

The main criteria for the success of therapy are the cessation of symptoms and normalization of the patient’s condition.

In rare cases, when drug treatment does not have the expected positive effect, surgical intervention is used, in particular, a technique such as radiofrequency catheter ablation. I usually prescribe this operation to young patients, since with age the risk of developing severe complications, including death, increases.

It is extremely rare, for health reasons, that an open access operation is performed, with dissection of the chest and removal of the portion of the myocardium where extraordinary impulses are formed.