RU2497446C1 - Method of determining risk of atrium fibrillation development - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to cardiology. ECG examination is performed to patient. Registration of signal-averaged ECG and transesophageal electrocardiostimulation (TE ECS) are carried out. Duration of filtered wave "P" (FiP-P) of signal-averaged ECG, dispersion of wave "P" (Pd), frequency threshold of arrhythmia induction (FTAI) and its duration are determined by means of TE ECS, risk of atrium fibrillation development (RAFD) being determined by original mathematical formula. If RAFD values are to 0.5, high during 1-3 months risk of AF development is identified. If values are from 0.5 to 1.5 - average from 3 months to 1 year risk of AF development. If values are higher than 1.5 - low, more than 1 year risk of AF development is identified after the first examination of patient.

EFFECT: method increases accuracy of determining risk of AF development after the first examination due to analysis of interaction of ECG and TEECS indices.

5 tbl, 4 ex

Description

The invention relates to medicine, namely to cardiology, in particular to methods for predicting the development of supraventricular cardiac arrhythmias (NDS), namely, atrial fibrillation (AF).

An analogue of the proposed solution is a method for predicting the development of AF paroxysms, which consists in determining the width and amplitude of the P wave of the electrocardiogram (ECG), and when a P wave is detected more than 0.12 s and (or) with an amplitude of more than 2.5 mm, the development of paroxysms of these arrhythmias is predicted several years after the first examination (Kushakovsky M.S. Heart arrhythmias: a guide for doctors / M.S. Kushakovsky. - 3rd ed., rev. and add. - St. Petersburg: Foliant, 2004. - 672 p.).

According to the closest technical essence, the method for determining the risk of AF paroxysms is selected as a prototype, which consists in determining the size or volume of the right and left atria, and with atrial dilatation of more than 4.0 cm, the risk of developing this arrhythmia for 1-3 years or more is determined after the first examination (Kushakovsky M.S. Heart arrhythmias: a guide for doctors / M.S. Kushakovsky. - 3rd ed., rev. and add. - St. Petersburg: Foliant, 2004. - 672 p.).

The disadvantage of analogue and prototype is the lack of accuracy in determining the risk of AF.

The technical result of the invention is to increase the accuracy of determining the risk of AF after the first examination.

The technical result of the invention is achieved by the fact that the patient undergoes an ECG study, registration of a signal-averaged ECG and transesophageal electrocardiostimulation (PEX), then the duration of the filtered wave "P" (FiP-P), signal-averaged ECG, the dispersion of the tooth "P" (Pd) , the frequency threshold of arrhythmia induction (NPIA) and its duration with the help of NPEX and the risk of AF development are determined by the formula: RRPP = (FiP-P / Pd) × (CPIA / A), where RRPP is the risk of AF, FiP-P is the duration filtered wave "P" signal-averaged ECG in ms, Pd - d ispersia of the P wave in ms, defined as the difference between the maximum and minimum values of the P wave duration when registering 12 leads of a standard ECG, NPIA is the frequency threshold of arrhythmia induction, defined as the product of the number of stimuli during CPECS and the duration of stimulation in minutes, A - the duration of induced arrhythmia in minutes, and with RRPP values of up to 0.5, they determine high (within 1-3 months), from 0.5 to 1.5 - average (from 3 months to 1 year), more than 1.5 - low (more than 1 year) risk of AF After the first examination of the patient.

The method is as follows.

The patient undergoes an ECG study, recording a signal-averaged ECG and CPEX. Pd is then determined from a standard ECG recorded in 12 leads, the duration of the filtered wave “P” (FiP-P) is the signal-averaged ECG, CPIA and the duration of arrhythmia using CPEC. Then the risk of AF is determined by the formula:

RRFP = (FiP-P / Pd) × (NPIA / A), where RRFP is the risk of AF, FiP-P is the duration of the filtered wave "P" signal-averaged ECG (in ms), Pd is the dispersion of the P wave ( in ms), defined as the difference between the maximum and minimum values of the P wave during registration of 12 leads of a standard ECG, CPIA is the frequency threshold for arrhythmia induction, defined as the product of the number of stimuli during CPECS and the duration of stimulation (in minutes), A is the duration induced arrhythmias (in minutes), with RRPP values of up to 0 5 determine a high (within 1-3 months), from 0.5 to 1.5 - average (from 3 months to 1 year), more than 1.5 - low (more than 1 year) risk of AF after the first examination of the patient .

The salient features of the proposed method and the causal relationship between them and the achieved result:

- determine the duration of the filtered wave "P" (FiP-P) signal-averaged ECG, the dispersion of the tooth "P" (Pd), the frequency threshold of the induction of arrhythmia (CPIA) and its duration using CPECS;

- the risk of developing atrial fibrillation (RRF) is determined by the formula: RRF = (FiP-P / Pd) × (NPIA / A), where RRP is the risk of AF, FiP-P is the duration of the filtered wave "P" signal-averaged ECG in ms, Pd is the dispersion of the P wave (in ms), defined as the difference between the maximum and minimum values of the P wave during registration of 12 leads of the standard ECG, CPIA is the frequency threshold of arrhythmia induction, defined as the product of the number of stimuli during CPEC on duration of stimulation (in minutes), A - duration l induced arrhythmia (in minutes);

- with RRPF values of up to 0.5, high (within 1-3 months) is predicted, from 0.5 to 1.5 - medium (from 3 months to 1 year), more than 1.5 - low (more than 1 year) risk AF after the first examination of the patient.

Currently, it is known that when registering excitation on the myocardium of the atria or ventricles, the conduct of excitation (PV) obeys the law of “flow” from one cardiomyocyte to another (Physiology and pathophysiology of the heart: T. 1 .: transl. From English - Ed. N. Sperlaxis. - M .: Medicine, 1990., Olshansky B., Okumura K., Hess PO, Waldo AL Demonstration of the area of slow conduction in human atrial flytter. // J. Amer. Coll. Cardiol. -1991 . - Vol.16, N. 6. - P. 1639 - 1648., Shimisu A., Nosaki A., Rudy Y., Waldo AL Multiplexing studies of effects of rapid atrial pacing on the area of slow conduction during atrial flutter in canine pericarditis model. // Circulation. - 1991.-Vol. 83, N. 3. - P.983-994.). Therefore, by directly applying electrodes to the myocardium, the nature and direction of the excitation along the cardiac muscle is recorded. In addition, the atrial myocardium is a tissue with a quick response, i.e. the membrane potential of the contractile fibers of the atria is characterized by rapid depolarization (Physiology and pathophysiology of the heart: T. 1.: transl. from English. - Ed. by N. Sperlaksis. - M .: Medicine, 1990).

The presence of supraventricular arrhythmias is due to the fact that there is a slowdown and uneven conduction of excitation in the upper and middle parts of the atria, which reflects the variance of the excitability of the myocardium of the atria (L. Bokeria, Lectures on cardiology / L.A. Bokeria, E.Z. Golukhova. - M., 2002. - 296 p., Braunwald's Heart Disease: a textbook of cardiovascular medicine / Ed. By P. Libby et al. - Phyladelfhia, WB Saunders Company, 2007. -2183 p.), And in these patients atrial conduction disturbance It is noted long before the increase in atria and other predictors of AF development (Shabrov A.V., Olesin A.I., Golub Y.V., Golub V.I. Clinical evaluation of the use of the non-invasive method for determining intra- and interatrial conduction in patients with coronary heart disease // Ter. Archive.-1999.-No. 1. - P.34-39). One of the methods that detect the presence of a dispersion of atrial myocardial excitability is the recording of signal-averaged ECG and Pd, as well as the induction of AF using NPEX (Olesin A.I., Shabrov A.V., Razumova T.V., Aleksandrov BC pacemaker modes for choosing anti-relapse therapy for paroxysms of atrial fibrillation and atrial flutter in patients with coronary artery disease // Ter. archive. - 2000. - No. 11. - P.39-43, Braunwald's Heart Disease: a textbook of cardiovascular medicine / Ed. by P Libby et al. - Phyladelfhia, WB Saunders Company, 2007 .-- 2183 pp.).

In the proposed method, it is assumed that the presence of a dispersion of the excitation, detected according to the signal-averaged ECG and Pd, indicates the possible development of reentry circulation in the atrial myocardium or around the anatomical obstruction, for example, when the wave moves around the vena cava or pulmonary veins. Inducing AF with CPEX reflects the possibility of developing this arrhythmia due to various trigger mechanisms (Braunwald's Heart Disease: a textbook of cardiovascular medicine / Ed. By P. Libby et al. - Phyladelfhia, WB Saunders Company, 2007. - 2183 p.) that after the formation of the front of the excitation wave, it is fractionated, divided into daughter waves, each of which becomes independent, and when a larger wave is separated in a local area of blocked conduction or with active movement towards another atrium, a critical the number of stray waves necessary for the formation of AF, and the formation of these waves is a random or “chaotic” process (Allessie MA, Rensma PL, Brugada J. et al. Pathophysiology ofatrial fibrillation.// Cardiac electrophysiology. From cell to bedside. - Eds. Zipes DP, Jalife J. - Philadelphia: WB Saunders, 1990. - P.548-559, Allessie MA, Konings K., Kirchhof C. Mapping of atrial fibrillation. In: Ollson S. B., Allesie M. A., Campbel R. W. F., eds. Atrial fibrillation: mechanism and therapeutic strategies. Armonk NY: Futura Publishing Company, 1994 .-- P.37-49). In addition, the formation of AF paroxysm requires 3 or more recirculation waves, and if the number of moving waves decreases less than 3 - the arrhythmia stops, and this determines the duration, including induced, of this arrhythmia (Allessie MA, Konings K., Kirchhof C. Mapping of atrial fibrillation. In: Ollson SB, Allesie MA, Campbel RWF, eds. Atrial fibrillation: mechanism and therapeutic strategies. Armonk NY: Futura Publishing Company, 1994. - P.37-49). Therefore, RRFP is an independent predictor of the development of AF, determined by a comprehensive assessment of the predictors of the development of AF, including determining the possibility of its induction.

The set of distinctive essential features is new and can improve the accuracy of determining the risk of atrial fibrillation.

To illustrate the proposed method, we give examples from clinical practice.

Example 1

IS No. 1258. Patient A., 69 years old, was admitted to a day hospital on 07/12/2011 in the direction of a district doctor regarding coronary heart disease: angina pectoris, periodic heart attacks. From the anamnesis it is known that the patient suffers from coronary heart disease: angina pectoris of functional class II over the past 4-5 years. He constantly takes preductal MB, aspirin at a dose of 300-400 mg per day, metoprolol at a dose of 25-50 mg per day. In the last 3-4 months, I began to notice the appearance of interruptions in the work of the heart. With daily ECG monitoring performed on an outpatient basis on December 10, 2004, a single ventricular extrasystole was detected with a frequency of up to 2 extrasystoles per hour.

According to the clinical and instrumental examination, the patient’s condition was regarded as coronary heart disease in a hospital: stable angina pectoris of functional class II, data for the presence of “fresh” focal myocardial changes were not detected. The patient was continued therapy with preductal MB, aspirin at a dose of 300 mg per day, enalopril (ednit) at a dose of 5 mg per day.

On the second day of the patient’s stay in the hospital, ECG was recorded simultaneously in 12 standard leads, a signal-averaged ECG for 5 minutes using the Polispectrum-Rhythm computer complex (Neurosoft, Ivanovo). Then, after computer processing, FiP-P was determined — the duration of the filtered wave “P” of the signal-averaged ECG (in ms) and Pd — the variance of the “P” wave (in ms), defined as the difference between the maximum and minimum values of the “P” wave when registering 12 leads of a standard ECG. In patient A., 69 years old, FiP-P and Pd were 135 ms and 65 ms, respectively. AF was induced into the patient by the method of volley super-frequent stimulation with the help of CPEX, and the NPI was 3 imp / min (30 stimuli were stimulated for 6 sec (0.1 min), and the NPI was calculated as the product of 30 stimuli for 0.1 min, which amounted to 3 pulses / min). Arrhythmia stopped on its own after 23 minutes. It should be noted that with CPEX, indicators reflecting the function of the sinus node, such as the time of restoration of the function of the sinus node, the corrected time of restoration of the function of the sinus node, the time of sinoatrial conduction, determined according to the generally accepted technique (Kushakovsky M.S. Cardiac arrhythmias. - L .: Medicine , 1993), did not go beyond the limits of fluctuations of normal values. Then it was calculated RRFP determined by the formula: RRFP = (FiP-P / Pd) × (NPIA / A),

where RRFP is the risk of AF, FiP-P is the duration of the filtered wave “P” of the signal-averaged ECG (in ms), Pd is the dispersion of the P wave (in ms), defined as the difference between the maximum and minimum values of the P wave "When registering 12 leads of a standard ECG, CPIA is the frequency threshold of arrhythmia induction, defined as the product of the number of stimuli during CPECS and the duration of stimulation (in minutes), A is the duration of induced arrhythmia (in minutes),

Subsequently, the patient was treated with preductal, aspirin, renitek (enalapril) at the doses indicated above. Antiarrhythmic drugs were not prescribed. Spontaneous AF attacks lasting from 20 seconds to 35 minutes were detected during 24-hour ECG monitoring a day after the above examination.

This example illustrates that when detecting RRFP values of 0.19, a high risk of AF is determined, that is, within 2 days after the first examination.

Example 2

IS No. 1244. Patient S., 56 years old, was admitted to the hospital 09/21/2010 in the direction of an ambulance doctor about coronary heart disease: progressive angina pectoris. From the anamnesis it is known that the patient suffers from coronary heart disease: angina pectoris of functional class II over the past 3 years. Constantly takes nitrosorbide, antiplatelet agents. Two days before hospitalization, the patient increased anginal pain in frequency, duration, intensity, and the nature of the pain syndrome changed. Hospitalization in hospital.

In a hospital, according to clinical and instrumental examination, the patient's condition was regarded as coronary heart disease: progressive angina pectoris, data for the presence of "fresh" focal myocardial changes were not detected. The patient was continued with nitrosorbide therapy at a dose of 30 mg per day, aspirin at a dose of 300 mg per day, renitec at a dose of 5 mg per day, a polarizing mixture with nitroglycerin.

On the third day of the patient's stay in the hospital, the nature of anginal pain stabilized.

On the third day of the patient’s stay in the hospital, ECG was recorded simultaneously in 12 standard leads for 40 minutes using the Polyspectrum-Rhythm computer complex (Neurosoft, Ivanovo). Then, after computer processing, FiP-P was determined — the duration of the filtered wave “P” of the signal-averaged ECG (in ms) and Pd — the variance of the “P” wave (in ms), defined as the difference between the maximum and minimum values of the “P” wave when registering 12 leads of a standard ECG. In patient S., 56 years old, FiP-P and Pd were 132 ms and 53 ms, respectively.

Patient S., 56 years old, was predicted to develop AF. AF was induced into the patient by the method of volley super-frequent stimulation with the help of CPEX, and the NPI was 4 imp / min. Arrhythmia stopped on its own after 15 minutes. It should be noted that with CPEX, indicators reflecting the function of the sinus node, such as the time of restoration of the function of the sinus node, the corrected time of restoration of the function of the sinus node, the time of sinoatrial conduction, determined according to the generally accepted technique (Kushakovsky M.S. Cardiac arrhythmias. - L .: Medicine , 1993), did not go beyond the limits of fluctuations of normal values. Then was calculated RRFP, determined by the formula:

RRFP = (FiP-P / Pd) × (NPIA / A),

where RRFP is the risk of AF, FiP-P is the duration of the filtered wave “P” of the signal-averaged ECG (in ms), Pd is the dispersion of the P wave (in ms), defined as the difference between the maximum and minimum values of the P wave "When registering 12 leads of a standard ECG, CPIA is the frequency threshold of arrhythmia induction, defined as the product of the number of stimuli during CPECS and the duration of stimulation (in minutes), A is the duration of induced arrhythmia (in minutes),

Subsequently, the patient was treated with nitrates, aspirin in the doses indicated above. Antiarrhythmic drugs were not prescribed.

Spontaneous AF attacks lasting from 15 seconds to 10-25 minutes were detected during 24-hour ECG monitoring 1.5 months after the aforementioned examination, and when performing PEEX in the same period (3 weeks after the first stimulation), the NPIA was 2.6 imp / min

This example illustrates that when detecting RRPF values of 0.40, a high risk of AF development is determined, that is, within 1.5 months after the first examination.

Example 3

IS No. 269. Patient O., 60 years old, was admitted to the hospital on January 21, 2010 in the direction of a doctor at the polyclinic about coronary artery disease: first-time angina pectoris. From the anamnesis it is known that the patient previously considered himself practically healthy.

In the hospital, according to clinical and instrumental examination, the patient's condition was regarded as coronary heart disease: the first angina pectoris, data for the presence of "fresh" focal myocardial changes were not detected. The patient was started therapy with olicardium at a dose of 40 mg per day, aspirin at a dose of 300 mg per day, zoocore 20 mg per day, a polarizing mixture with nitroglycerin.

On the third day of the patient's stay in the hospital, the nature of anginal pain stopped and did not recur in the future.

On the third day of the patient’s stay in the hospital, ECG was recorded simultaneously in 12 standard leads for 35 minutes using the Polyspectrum-Rhythm computer complex (Neurosoft, Ivanovo). Then, after computer processing, FiP-P was determined — the duration of the filtered wave “P” of the signal-averaged ECG (in ms) and Pd — the variance of the “P” wave (in ms), defined as the difference between the maximum and minimum values of the “P” wave when registering 12 leads of a standard ECG. In patient C., 56 years old, FiP-P and Pd were 122 ms and 61 ms, respectively.

Patient O., 68 years old, was predicted to develop AF. AF was induced into the patient by the method of volley super-frequent stimulation with the help of CPEX, and the NPI was 6 imp / min. Arrhythmia stopped on its own after 10 minutes. It should be noted that with CPEX, indicators reflecting the function of the sinus node, such as the time of restoration of the function of the sinus node, the corrected time of restoration of the function of the sinus node, the time of sinoatrial conduction, determined according to the generally accepted technique (Kushakovsky M.S. Cardiac arrhythmias. - L .: Medicine , 1993), did not go beyond the limits of fluctuations of normal values.

Then was calculated RRFP, determined by the formula:

RRFP = (FiP-P / Pd × (CPIA / A),

where RRFP is the risk of AF, FiP-P is the duration of the filtered wave “P” of the signal-averaged ECG (in ms), Pd is the dispersion of the P wave (in ms), defined as the difference between the maximum and minimum values of the P wave "When registering 12 leads of a standard ECG, CPIA - the frequency threshold of induced arrhythmias, defined as the product of the number of stimuli during CPEX with the duration of stimulation (in minutes), A - the duration of induced arrhythmia (in minutes),

Subsequently, the patient was treated with nitrates, aspirin, zoocor in the doses indicated above. Antiarrhythmic drugs were not prescribed.

During follow-up during the year, including daily ECG monitoring once every 3 months, unstable AF paroxysms lasting from 15 seconds to 5 minutes were detected within 7 months after the first examination.

This example illustrates that when detecting RRPP values of 1.20, the average risk of AF is determined, that is, within 7 months after the first examination.

Example 4

IS No. 97. Patient K., 68 years old, was admitted to the hospital on 01/11/2010 in the direction of the district doctor about coronary heart disease: angina pectoris, periodic heart attacks. From the anamnesis it is known that the patient suffers from coronary heart disease: angina pectoris of functional class II over the past 6 years. Constantly takes monochinqua at a dose of 50 mg per day, aspirin at a dose of 300-400 mg per day, enalapril (renitec) at a dose of 20 mg per day. In the last 3-4 months, I began to notice the appearance of interruptions in the work of the heart. During daily ECG monitoring performed on an outpatient basis on December 10, 2009, a single PE was detected with a frequency of up to 1 extrasystole per hour.

According to the clinical and instrumental examination, the patient’s condition was regarded as coronary heart disease in a hospital: stable angina pectoris of functional class II, data for the presence of “fresh” focal myocardial changes were not detected. The patient was continued with monocinque therapy at a dose of 50 mg per day, aspirin at a dose of 300-400 mg per day, enalapril (renitec) at a dose of 20 mg per day.

On the second day of the patient’s stay in the hospital, ECG was recorded simultaneously in 12 standard leads for 25 minutes using the Polyspectrum-Rhythm computer complex (Neurosoft, Ivanovo). Then, after computer processing, FiP-P was determined — the duration of the filtered wave “P” of the signal-averaged ECG (in ms) and Pd — the variance of the “P” wave (in ms), defined as the difference between the maximum and minimum values of the “P” wave when registering 12 leads of a standard ECG. In patient C., 56 years old, FiP-P and Pd were 121 ms and 43 ms, respectively.

AF was induced into the patient by the method of volley super-frequent stimulation with the help of CPEX, and the NPI was 17.5 imp / min. Arrhythmia stopped on its own after 12 minutes. It should be noted that with CPEX, indicators reflecting the function of the sinus node, such as the time of restoration of the function of the sinus node, the corrected time of restoration of the function of the sinus node, the time of sinoatrial conduction, determined according to the generally accepted technique (Kushakovsky M.S. Cardiac arrhythmias. - L .: Medicine , 1993), did not go beyond the limits of fluctuations of normal values.

Then was calculated RRFP, determined by the formula:

RRFP = (FiP-P / Pd) × (NPIA / A),

where RRFP is the risk of AF, FiP-P is the duration of the filtered wave “P” of the signal-averaged ECG (in ms), Pd is the dispersion of the P wave (in ms), defined as the difference between the maximum and minimum values of the P wave "When registering 12 leads of a standard ECG, CPIA is the frequency threshold of arrhythmia induction, defined as the product of the number of stimuli during CPECS and the duration of stimulation (in minutes), A is the duration of induced arrhythmia (in minutes),

Subsequently, the patient was treated with nitrates, aspirin, renitec (enalopril) at the doses indicated above. Antiarrhythmic drugs were not prescribed. A spontaneous AF attack developed 1.5 years after the examination, stopped by sublingual administration of metoprolol at a dose of 50 mg. As an anti-relapse treatment of AF paroxysms, the patient was prescribed metoprolol in a dose of 100 mg per day in addition to the therapy. Arrhythmia did not recur for 2 years.

This example illustrates that when detecting RRPP values of 4.10, a low risk of AF is determined, that is, within 1.5 years after the first examination.

There were 212 patients with coronary artery disease. All patients underwent prolonged-action nitrate therapy, antiplatelet agents, angiotensin-converting enzyme inhibitors (renitec, enalopril, enap). Antiarrhythmic drugs were not prescribed. In all patients, the determination of RRFP was carried out according to the proposed method and according to the prototype.

Statistical analysis of the results is carried out on a computer. A comparison of the accuracy of predicting the development of AF in the examined patients, determined by the proposed method depending on the values of RRPP and according to the prototype are presented in table 1.

Table 1
Comparison of the accuracy of the development of AF in the examined patients, determined by the proposed method depending on the values of RRS and according to the prototype RRFP RRFP values I group RRFP <0.5 II group RRFP - 0.5-1.5 Group III RRFP> 1.5 AF prediction as declared method (number of patients) fifty 90 72 The development of AF according to the declared. the method (number of patients, the accuracy of the forecast) 45 (90%) 80 (88.89%) 25 (34.72%) Prediction of AF according to the prototype (number of patients) 5 45 65 The development of AF according to the prototype (number of patients, forecast accuracy) 0 (0%) 5 (11.11%) 15 (23.08%)

In 50 (23.58%) patients according to the claimed method, the values of RRPP were <0.5 (average 0.2 ± 0.06) (in these patients the development of AF was predicted within 1-3 months after the first examination) (group I ), in 90 (42.45%) - from 0.5 to 1.5 (0.8 ± 0.01 on average) (AF was predicted in these patients from 3 months to 1 year after the first examination) ( Group II), and the remaining 72 patients (33.96%)> 1.5 (average 3.2 ± 0.2) (in these patients, AF was predicted to develop for more than 1 year after the first examination) (group III )

AF development was observed in 45 of 50 (90.00%) patients of group I within 1-3 months after the first examination, in 80 of 90 (88.89%) patients of group II within 3 months to 1 year after the first examination and 25 of 72 (34.72%) patients of group III more than 1 year after the first examination.

In 115 (54.25%) of all the examined patients, that is, out of 212, according to the prototype, RRFP was determined within 1-3 years after the examination. In 5 (2.36%), 45 (21.23%) and 65 (30.66%) patients, according to the prototype, RRFP was determined in patients of groups I, II and III, respectively.

The development of AF when using the prototype was not observed in any patient from group 5 of group I - within 1-3 months after the first examination, the accuracy of determination of RRPP is 0.00%; in 5 patients from group II II - within 3 months to 1 year after the first examination, the accuracy of determination of RRFP is 11.11% and in 15 of 65 patients of group III - more than 1 year after the first examination, the accuracy of determination of RRS is 23 , 08%.

Comparative data on the claimed method and the prototype method are presented in tables 2-5.

table 2
The definition of RRFP in the examined patients according to the proposed method, depending on the values of RRFP and according to the prototype RRFP RRFP values I group RRFP <0.5 n = 50 II group RRFP = 0.5-1.5 n = 90 Group III RRFP> 1.5 n = 72 The definition of RRFP according to the prototype 5 (10.00%) 45 (50.00%) 65 (90.28%) The development of AF according to the proposed method 45 (90.00%) 80 (88.89%) 25 (34.72%)

Table 3
Comparison of the accuracy of determination of RRFP in patients of group I after the first examination using the proposed method and prototype Patient groups The proposed method Prototype ΔM BUT B BUT B Predictable value,% 100.00 90.00 10.00 0.00 + 100.00% Number of patients fifty 45 5 0.00 Note: A is the predicted, B is the real result of the development of AF, ΔM is the accuracy of the determination of RRS in comparison with the prototype.

Table 4
Comparison of the accuracy of determining RRFP in patients of group II after the first examination using the proposed method and prototype Patient groups The proposed method Prototype ΔM BUT B BUT B Predictable value,% 100.00 88.89 44,44 25.00 + 1600.00% Number of patients 90 80 45 5 Note: A is the predicted, B is the real result of the development of AF, ΔM is the accuracy of the determination of RRS in comparison with the prototype.

Table 5
Comparison of the accuracy of determination of RRFP in patients after the first examination using the proposed method and prototype Patient groups The proposed method Prototype ΔM BUT B BUT B Predictable value,% 100.00 34.72 90.28 23.08 + 66.47% Number of patients 72 25 65 fifteen

Note: A is the predicted, B is the real result of the development of AF, ΔM is the accuracy of the determination of RRS in comparison with the prototype.

The accuracy of the method for determining RRSF according to the claimed method compared with the prototype within 1-3 months after the first examination increases by almost 100.00% for 3 months to 1 year - by 1600.00% and more than 1 year - by 66, 47%, which will ensure the timely appointment of adequate therapy.

Claims (1)

A method for determining the risk of developing atrial fibrillation (AF) by conducting an electrocardiographic (ECG) study, a signal-averaged ECG and transesophageal electrocardiostimulation (CPEX), characterized in that the duration of the filtered wave "P" (FiP-P) signal-averaged ECG, dispersion P wave (Pd), the frequency threshold of arrhythmia induction (NPIA) and its duration with the help of NPEX and the risk of AF development are determined by the formula:
RRFP = (FiP-P / Pd) × (NPIA / A),
where RRFP is the risk of AF, FiP-P is the duration of the filtered wave “P” signal-averaged ECG in ms, Pd is the dispersion of the “P” wave in ms, defined as the difference between the maximum and minimum values of the “P” wave during registration 12 of leads of a standard ECG, CPIA - the frequency threshold of arrhythmia induction, defined as the product of the number of stimuli during CPEX by the duration of stimulation in minutes, A is the duration of induced arrhythmia in minutes,
and with RRFP values of up to 0.5, a high RRFP is determined, within 1-3 months, from 0.5 to 1.5 - average, from 3 months to 1 year, more than 1.5 - low, more than 1 year, after the first examination of the patient.