RU1804865C - Method for treatment cardiac rhythm damage - Google Patents

Abstract

The invention relates to medicine, in particular cardiology, namely to the treatment of supraventricular cardiac arrhythmias (not associated with additional conductive bundles). The goal is to increase the duration of remission. If the anti-arrhythmic drug therapy is ineffective in the treatment of supraventricular cardiac arrhythmias, laser irradiation of venous blood with an additional 632.8 nm helium-neon laser is performed in a dose of not more than 0.2 J / kg for one session and in a total dose of not more than 1 , 0 J / kg. The invention allows to increase the duration of remission of supraventricular cardiac arrhythmias, reduce the doses of medication antiarrhythmic drugs used, as well as complications and side effects of their use.

Description

The invention relates to medicine, in particular cardiology, namely to the treatment of supraventricular cardiac arrhythmias (not associated with additional conductive bundles).

The purpose of the invention is to increase the duration of NNSR remission in patients refractory to ongoing antiarrhythmic drug therapy.

The goal is achieved by the fact that in the known method for the treatment of NDSR, laser irradiation of venous blood (VOC) is additionally carried out with light of a 632.8 nm helium-neon laser in a dose of not more than 0.2 J / kg for one session and in a total dose of not more than 1, 0 J / kg

The method is carried out as follows.

To a patient along with the use of anti-arrhythmic drugs while maintaining frequent bouts of NNSR additionally

TRAIN: a vein is punctured with a needle (ulnar or subclavian) .- and a fiber guide is inserted through it. The flowing blood is irradiated with the light of a 632.8 nm long-wave helium-neon laser at a dose of no higher than 0.2 J / kg for one session and in a total dose of no more than 1.0 J / kg. The calculation of the radiation dose is carried out according to the formula

DRXT

AT

where D is the total dose of radiation, J / kg,

P is the irradiation power, W,

T is the irradiation time, s ,.

In - the mass of the patient, kg

Example. Patient K., 57 years old, has been suffering from IHD with angina pectoris of functional class II-III for the past 10 years. Constantly takes prolonged-action nitrates (Sustak-forte. Nitrosorbide), periodically with amplification

ate

with

00

about

-N 00 ABOUT

anginal pain anaprilin. In the last 4 years, he began to notice attacks of focal arrhythmias with a frequency of 1 year 2 times a month and in recent years 2 3 times a week. Attacks of atrial fibrillation were stopped with the help of combined antiarrhythmic therapy of novocaine with a mid, a polarizing mixture of atropine, strophanthin. Taking into account frequent episodes of atrial fibrillation, the patient was hospitalized in the Leningrad City Antiarrhythmic Center (IS No. 3265. 1987), where he was given anti-toxic therapy with cordarone at a dose of 200 kg / day, corinfarum at a dose of 40 kg / day / potassium preparations (panangin or esparkam), etatsizin in a dose of UO-150 mg per day. The selection of therapy was carried out taking into account the effectiveness of the drugs (when stopping the attack and its counter-stimulation with the help of the esophageal heart increasing electrostimulation). However, despite the selected anti-relapse therapy, atrial fibrillation episodes persisted with a frequency of 1-2 times in the divide (instead of 2-3 times a week). Due to the insignificant effectiveness of drug antiarrhythmic therapy, the patient was hospitalized in a hospital for laser therapy (IB No. 3568). A patient along with the use of the aforementioned drug antiarrhythmic therapy was additionally treated with 632.8 nm helium-neon laser with a DROC at a dose of 0.1 J / kg for one session in a total dose of 1.0 J / kg. After the course of laser irradiation, the arrhythmia episodes subsided up to 1 time in 2 months (i.e. 5-6 times). The duration of the effect was 6 months.

This example showed that PERA increases the effectiveness and prolongs the effect of drug antiarrhythmic therapy, increases the duration of remission of the NNSR.

Example 2. Patient E., 60 years old, was admitted to the hospital on 10.11.89 in the direction of an ambulance with a non-stopping attack of atrial fibrillation (IB No. 15019). At the prehospital stage, they tried to supervise arrhythmia with procainamide. atropine, potassium chloride. From the anamnesis it was found that for 10 years he suffers from hypertension with a max, blood pressure (BP) of 2207110 mm Hg. Normal BP is 150-160/90 mm Hg. In addition, IHD suffers from angina pectoris of functional class III IV for 4 pet. Angina attacks are rare and stop with 1-2 tablets of nitroglycerin. Over the past b years

there are attacks of atrial fibrillation which R last 2 years were observed with a frequency of 1 2 times per week (despite the constant intake of previously selected individual antiarrhythmic tera

FDI gorderonom at a dose of 400 mg / day. Belloid 1 table. 3 times a day, digoxin 0.25 mg per day).

Upon receipt, the condition is satisfactory. The skin is of normal color, elastic, dry. Pulse 100 beats. in minutes heart rate 120 beats. in min pulse deficit of 20 beats. in minutes HELL 150 90 mmHg Tones are muffled, 1 tone is weakened, no noise. Vesicular breathing, no wheezing. The tongue is moist, not overlaid. The abdomen is of the usual form, soft, painless in all departments. The liver, kidneys, spleen are not palpable. Electrocardi

The program registered upon receipt: RR - 0.50 sec, RR 0.10 sec, OT - 0.36 sec. Fibrillation of qi and atrial flutter with holding 2: 1 3: 1 with a heart rate of 120 beats. in minutes hyper5 trophy of the left ventricle, incomplete blockade of the right leg of the bundle of His. The patient was prescribed scheduled therapy with nitrosorbide at 40 mg / day, adelfan at 1 table. per day, as well as antiarrhythmic therapy, for example, lice with outpatient care (see above). An hour after admission to the hospital, due to a non-stopping attack of atrial fibrillation, a 632.8-nm long wavelength-of-fiber exposure test was performed in the zone of 0.2 J / kg. After 5 hours

5, after conducting the first session of DIC, the sinus rhythm was restored with a heart rate of 70 beats. in minutes Subsequently, the patient was continued with TWF of the same wavelength until a total dose of 1.2 J / kg was reached. After the last session, when the total dose of DOS exceeded 1.0 J / kg, sharp weakness, dizziness, and nausea appeared. At this moment (with the appearance of the above symptoms), blood pressure is 150-80 mm Hg, on the electrocardiogram - sinus rhythm with a heart rate of 80 beats. in minutes The last SHOW session was discontinued. After 4 hours, these symptoms (weakness, nausea.

0 dizziness) stopped on their own without the use of additional funds. After the end of the course of DIC, the patient experienced a decrease in atrial fibrillation attacks up to 1-2 months (i.e.

5 less often 4 times in comparison with the previous observation period). The duration of the effect was 5.0 months.

This example has shown that VLAF increases efficacy and prolongs the action of anti-arrhythmic drugs.

at | 1 q1 1g. .p1 Remission performance lUli .f When uhmc) it imiii up to PO B K greater than 1.0D, / kg Motyi observed side effects of late dizziness, dizziness, dizziness

PRI me R J. Ash At, 56 years old, drank 10 .12 89 g to the hospital (IB No. 26643) in a planned case in the direction of the clinic to correct therapy due to the onset of atrial tachycardia, which was observed 2-3 once a day and stopped with finoptin. administered intravenously at a dose of 10 mg. From the anamnesis: suffers from coronary heart disease Angina 11-111 functional class for 3 years. Angina attacks 1–2 times a week and are stopped by validol or nitroglycerin. Attacks of atrial tachycardia have been noted for the last 2 years, and are stopped by finoptin. less commonly anaprilinom. In the last 4 months, atrial tachycardia attacks became more frequent up to 1-2 times a day, but were stopped by finoptin, administered intravenously at a dose of 10 mg. Outpatiently took finoptin at a dose of 160 mg / day, kinylentin at a dose of 400 mg / day, without a significant effect.

Upon receipt, the condition is satisfactory. The skin is of normal color, elastic, dry. Pulse 75 beats in minutes, rhythmic. HELL 130/80 mm Hg The tones are muffled; no noise. Rhythmic breathing, vesicular, no wheezing. The tongue is moist, not overlaid. The abdomen is soft, painless in all departments. The liver, kidneys, spleen are not palpable. An electrocardiogram is recorded. On admission: RR 0.80 sec, P-0 - 0.18 sec, OR 0.10 sec, 0-T 0.38 sec. Sinus rhythm with a heart rate of 75 beats. in min, local intraventricular block in the area of the posterior wall of the left ventricle (leads III, a G), The patient underwent an electrophysiological study (EFI) using increasing esophageal stimulation of the left atrium - data for the presence of additional conductive bundles, sinus node syndrome was not detected (the recovery time of the function of the sinus node is 860 ms at normal values, according to the data of the All-Russian Scientific Center for Medical Sciences of the USSR (1984), 800-900 ms). An attack of atrial tachycardia was provoked by 2-4 frequent premature stimuli and was stopped by frequent esophageal stimulation. The patient underwent an individual selection of antiarrhythmic drugs, as a result of which the most effective therapy with cordarone at a dose of 400 mg / day and finoptin at a dose of 120 mg / day was revealed

the use of the above antiarrhythmic drugs, atrial tachycardia attacks decreased up to 1 time per day (i.e. 2–3 times in comparison with the previous 5th observation period). Due to the low efficacy of antiarrhythmic drugs, the patient was additionally tested for exposure to wavelength 632.8 nm in a total dose of 1.0 J / kg. After the end of the course of VIC, atrial tachycardia has waned

up to 1 per week (i.e. 7 times in comparison with

source data). Before discharge from

hospital conducted EFI - attack

 atrial tachycardia is not reproducible5 The duration of the effect was 4 months. There were no complications during the treatment.

This example showed that PERV increases the effectiveness and prologues the action of antiarrhythmic drugs, prolongs the period of remission of the occurrence of NNSR, in particular atrial tachycardia.

Example 4. Patient S., 66 years old, was admitted to hospital 12.12.89 (IB No. 3956) in the direction of the clinic with suspected coronary heart disease. Progressive angina pectoris, as well as in connection with frequent and refractory atrial therapy

0 extrasystole. From the anamnesis: suffers from ischemic heart disease with angina pectoris of the NNU. Functional class for the last 3 years, seizures are rare up to 1-2 times a week, are stopped by nitroglycerin. Constantly taking

5 nitrosorbide in a dose of 40-60 mg / day or su-fort for 6.4 mg 3 times a day, finoptin in a dose of 120-160 mg / day. 4 months before hospitalization, frequent interruptions in the heart area appeared. When examining in a polyclinic on an electrocardiogram, frequent atrial extrasystoles were revealed by the type of bi- and trigemia. Data for the presence of focal myocardial lesions were not found. Outpatient treatment was carried out with practically all antiarrhythmic drugs: cordaron, kinylentin, finoptin, rhythmylene, ethmosin, ztacisin without effect. 3-5 days before hospitalization, the patient's frequency increased

0 anginal pains (up to 1-3 times a day), their intensity, spread according to localization and irrigation (in comparison with previous attacks of anginal pains). Hospitalization in the hospital.

5 Upon receipt, the condition is satisfactory. The skin is of normal color, elastic, dry. Pulse 80 beats. in minutes, rhythmic, frequent extrasystoles. HELL NOVO mm Hg, Heart sounds are muffled, T-tone is weakened, short systolic murmur on

top Breathing vesicular, wheezing neg. Yyk shade, not: lined. The abdomen is of the usual form, soft, painless in the ps.ech departments. The liver, kidneys, spleen are not palpable. Electrocardiogram upon admission: P P-0.70 sec, P O-0.16 sec. OR - 0.10 sec. About T - 0.38 sec. Sinus rhythm with a ventricular contraction rate of 85 per min, partial atrial extrasystoles of the type of bi- and trigemia, the initial signs of left ventricular hypertrophy, no data were found for the presence of focal myocardial changes. The patient underwent 12-hour monitoring of the electrocardiogram after decoding of which an atrial extrasystole was detected with a frequency of 600-800 extrasystoles per hour. The patient was prescribed scheduled therapy with nitrosorbide at a dose of 40 mg / day, finoptin at a dose of 160 mg / day, a polarizing mixture (for 5-7 days), aspirin at a dose of 300 mg / day. Taking into account that previously ambulatory antiarrhythmic therapy was ineffective, the patient was additionally treated with 632.8 nm long wavelength AHF, in a total dose of 1.0 J / kg. After the course of DIC, during repeated monitoring, the atrial extrasystole decreased to 20-30 per hour (ie, 20-27 times in comparison with the initial data). There were no complications during the exposure to the total dose of 1.0 J / kg. The duration of the effect after TOVA was 4.5 months.

This example showed that PERV increases efficacy and prolongs the duration of the action of antiarrhythmic drugs, reduces atrial extrasystoles. those. increases the duration of remission NNSR, in particular atrial extrasystole. There were no complications during the treatment of VHF at a dose of 1.0 J / kg.

Example 5. Patient R., 56 years old, was admitted to the hospital on 10.01.89 (BI No. 778) in the direction of the ambulance, with a non-stopping attack of atrial tachycardia. At the prehospital stage, the patient was injected with finoptin at a dose of 10 mg internally without a lasting effect (after administration of finoptin, arrhythmias were stopped for 5-7 minutes, and then resumed again). A similar attack of tachycardia for the first time in my life. From the anamnesis: suffers from BS Angina of functional class II-III for 6-7 years, angina attacks are rare up to 1-2 times a month and stop at rest or when using nitroglycerin. Outpatient took prolonged nitrates.

action (nitrosobid 40 mg / day or g, mustache forte 6.4 kg 3 times a day (finoptin at a dose of 120 160 mg per day, aspirin at a dose of 250 mg / day.

Upon receipt, the condition is satisfactory. The skin is of normal color, elastic, dry. Pulse 180 beats. in many, without deficit. HELL 90-60 mm Hg Tones are muffled, 1 tone is weakened, no noise. The respiration is vesicular, no wheezing. The tongue is moist, not overlaid. The abdomen is of the usual form, soft, painless in all departments. The liver, kidneys, spleen are not palpable. There is no edema, an electrocardiogram at the onset: RR 0.33 sec, OR 0.10 sec, 0-T 0.34 sec. Atrial tachycardi with a heart rate of 180 beats per minute, the initial signs of left ventricular hypertrophy. An attack of atrial tachycard0 days was stopped by increased esophageal stimulation. The sinus rhythm was restored with a heart rate of 80 beats. in min and frequent atrial extrasystoles were noted, data for the presence of focal 5 changes were not detected. An electrocardiogram was monitored for 12 hours and an atrial extrasystole was detected with a frequency of 400-500 extrasystoles per hour. The patient was prescribed terapi nitrosorbide at a dose of 40 mg per day, verapamil at a dose of 160 mg per day, aspirin at a dose of 300 mg per day, asparkamrm at a dose of 1 table. 3 times a day. However, in spite of the treatment carried out, the atrial extrasystems persisted with the same frequency. After 10 days, due to the ineffectiveness of drug antiarrhythmic therapy, the patient was additionally treated with a 632.8 nm long wavelength exposure limiter in a total dose

0 1.2 J / kg. Upon reaching a total dose of TOVA of 1.0 J / kg, the frequency of atrial extrasystole decreased to 20-40 extrasystoles per hour during a 12-hour monitoring). However, after reaching 5 neither the total dose of TOR to 1.2 J / kg of atrial extrasystoles, up to 200-300 extrasystoles per hour became more frequent. Only after a day did the atrial extrasystole persist to 20-40 extrasystoles per hour (without additional therapy). During repeated esophageal accelerating stimulation, atrial tachycardia did not appear. The duration of effect after application of TOVA was 3 months. Complications and side effects after the use of VOCA in a total dose of 1.0 J / kg were not observed,

Thus, this example has shown that DICA in a total dose of 1.0 J / kg increases efficacy and prolongs

the action of prohypoarrhythmic drugs increases the duration of remission of UUCP, in particular atrial tachycardia, atrial extrasystole. With an increase in the total dose of TOVA over 1.0 J / kg (in particular 1.2 J / kg), a paradoxical increase in the frequency of 1 cardiac extrasystoles is observed.

The advantages of the invention in comparison with the prototype:

1: An increase in the duration of remission of the NNDS (3-7 times depending on the initial frequency of occurrence of arrhythmia).

2. The absence of side effects and complications.

3. Reducing the dose of antiarrhythmic drugs used, which helps to reduce the development of complications and side effects in their application ..

56 patients with coronary heart disease (I B C) were observed without acute myocardial infarction complicated by paroxysms of atrial fibrillation and atrial flutter (AF and TP). supraventricular tachycardia (NAD), atrial extrasystole (PE) aged 45 to 67 years. According to the electrocardiographic study (outside an attack of AF. TP. NADT), as well as by the increasing esophageal stimulation of the left atrium of the heart, all patients were excluded from the presence of additional conductive bundles and the function of the sinus node was determined, including the presence of the syndrome , in particular, latent weakness of the sinus node, which was detected in 23 (3.82-%) patients.

All patients to prevent relapse of NLT. FP and TP. PEs received individually selected mono- and combined anti-relapse therapy with drugs such as kinylentin, cordarone, corinfarum, finoptin. Belloid, potassium preparations, etc. Doses of the preparations used did not exceed the known higher single and daily doses. The criterion for the effectiveness of the therapy was the absence of an attack of NLB, AF and TP during the test with physical activity or esophageal stimulation of the left atrium that was increasing. In 12 patients, despite the ongoing anti-arrhythmic drug therapy, the frequency of AF and TP attacks was maintained up to 1 attack per month (group I), in 12 - up to 2-3 attacks per month (group II), in 10 - up to 2-3 seizures per week (group III), in 12 - seizures of NLHT persisted with a frequency of 2-3 seizures per month (IY group), in 10 patients, despite the ongoing anti-arrhythmic therapy, PE remained

frequency 60 100 extra, igul n hour (Y corpse pa). Since in the I Y groups of white children, the ongoing entarrhythmic therapy persisted in frequent attacks of UDHH. AF and 5 TP, often PE, they were assigned to the group of patients refractory to drug therapy.

Due to the ineffectiveness of drug anti-arrhythmic therapy to everyone

0 patients of groups I - Y were additionally exposed to VLBF using a 632.8 nm long wavelength helium-neon laser at a total dose of 1.0 J / kg. Duration of observation of patients of groups I-Y Prior to the treatment of VLAF, it was 5 l from 8 months to 6 years. After conducting VLAF, a reduction in the onset of AF and TP with achieving complete remission was observed only in patients of group I and II, and the greatest efficiency of using VLAF was observed in patients of group I. In the first month, complete remission was achieved in all patients of group I and in 75% of patients of group II, in the second month of 75% of patients of group I and in 41.7% of patients of II

5 groups, in the third month c — in 41.7% of patients of group I, in 16.7% of patients of group II, in the fourth month - only in 16.7% of patients of group I. In patients of these groups, in which complete remission was not achieved, it was noted

0 reduction of arrhythmia attacks 2-4 times in comparison with the initial data. In all patients of group III, complete remission was not observed. In these patients, only a decrease in the frequency of seizures was noted.

5 AF and TP in 1 month 5-6 times, 2 - 3-4 times, 3 - 2 times in comparison with the initial data, and 4 - 5 months after LRVC, the frequency of arrhythmia paroxysms was the same in compared with previous observations. In patients of the IY group, after the course of DIC, the complete remission in 1 month was observed in 41.6% of patients, in 2 16.7% of patients, in 3-month reduction of attacks 2 times, and in 4-5 months - the frequency of attacks

5 arrhythmias was the same in comparison with baseline data. In all patients. Group Y complete remission was not observed. In patients of this group there was only a decrease in PE at 1 month 5-6 times, 2 and 3

0 months - 3-4 times, 4 - 2 times, and from 5 months the frequency of PE was the same in comparison with the initial data. Complications during the treatment of VLAW were not observed in any patient both during laser irradiation and in the subsequent observation period.

Thus, exposure to 632.8 nm long-wavelength helium-neon laser light at a total dose of 1.0 J / kg is an effective method of increasing remission (and with

responsible for the prevention of relapse) and with the fact that. for the purpose of treatment of ventricular arrhythmia due to a decrease in the re-Formula of the invention, acid lipid oxidation, aggregation

platelets and cyclic nucleotides,

A method of treating cardiac abnormalities5 irradiation is carried out in addition to meditation by means of irradiation of venous blood with Sveta-chemotherapy with a dose of not more than 0.2 volumes of a helium-neon laser, I distinguish J / kg per session and 1.0 J / kg per course.