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Influence of radiofrequency ablation on quality of life of patients with ventricular arrhythmia
Retinoids -izotretinoin — appointed in severe forms of acne, propensity to scarring and inefficiency of traditional treatment methods. He is stable remission even in severe forms of the acne and has expressed sebosupressive, leading to lysis of the comedones, anti-inflammatory and immunomodulatory effects. Consequently, retinoids act on all the main links in the pathogenesis of acne. The
duration of treatment with retinoids is 16-20 weeks. Side effects of retinoids — dose-dependent.
Thus, the appointment of an adequate effective therapy due to its influence on the pathogenetic mechanisms of the disease. An important prognostic are diagnosis, proper clinical evaluation, the timely appointment of adequate and safe treatments.
References:
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DOI: http://dx.doi.org/10.20534/ESR-16-11.12-71-73
Kurbanov Ravshan Davletovich, doctor of medicine, professor, director of Republican Specialized Center of Cardiology Mullabaeva Guzal Uchkunovna, candidate of medicine, senior research worker of the Cardiac Arrhythmia Department of the Republican Specialized Center of Cardiology
Khamraev Ramesh Ravshanovich, head of Department of surgical treatment for heart arrhythmias
Salaev Ojbek Sabirzhanovich, junior research worker of the Cardiac Arrhythmia Laboratory Republican Specialized Center of Cardiology E-mail: Guzal-m@inbox.ru
Influence of radiofrequency ablation on quality of life of patients with ventricular arrhythmia
Abstract: This article provides information about dynamics of quality-of-life indicators relating to 53 patients with ventricular arrhythmia after catheter ablation. It was demonstrated that before surgery all patients had low indicators of life quality and mental health. Following the radiofrequency ablation, it was observed that quality-of-life indicators improved, reaching the reliable values by the 6th month of observation.
Keywords: ventricular arrhythmia, radiofrequency ablation, quality of life, mental health.
Non-ischemic (non-coronarogenic) ventricular arrhythmias (VA) amount to 10-30% of all heart rhythm disorders (HRD) and predominantly occur in people of working age [1; 2]. In 25-80% of patients these rhythm disorders provoke syncope, what significantly
deteriorates prognosis and increases the risk of a sudden arithmetic death in this category of patients [3; 4]. The effectiveness of drug therapy of non-ischemic ventricular arrhythmias does not exceed 50-60% [5]. It is known that a continued intake generates a drug
Section 7. Medical science
tolerance in 50-70% of patients [6]. 5-30% of patients have various adverse effects as a result of drug intake; its arrhythmogenic effect can be realized in 15% of cases [7]. Finally, 30% of patients are totally resistant to any anti-arrhythmic therapy (Fabricio K., 2001). The abovementioned factors determine the relevance of an operative treatment — radiofrequency catheter ablation of the arrhythmia substrate. Along with various methods for assessment of antiarrhythmic activity, nowadays there is a method that evaluates quality of life (QOL) of patients.
The aim of this study was to evaluate QOL of patients with non-coronarogenic ventricular arrhythmias (VA) before and after radiofrequency ablation.
Material and methods:
We observed 53 patients. All patients were divided into two groups: main group and clinical comparison group. The main group consisted of 33 patients with non-ischemic ventricular arrhythmias (main group). The average age — 35,4± 13,0 years, of men - 19 (%), of women - 14 (33,8%), arrhythmic anamnesis - 4,98± 3,5 years. The clinical comparison group included 20 "practically healthy" persons at the age of 34.6±7.0 years, who according to the research results had no structural pathology of the cardiovascular system. Among them there were 15 men (75,0%) and 5 women (25,0%). Groups of examined persons were comparable by age and sex.
Ventricular extrasystoles (VE) of the II gradation according to Lown (70,5%) prevailed in the structure ofventricular arrhythmias. Gradations IIIA and IIIB were 19% and 17.6%, respectively. The average number ofventricular extrasystoles per day was 17506+13200, the maximum number - 48702. Polymorphism ofventricular ectopia (the number of morphological classes - more than 2) was observed in more than a third of patients, while one leading or dominant focus was always discovered.
Arrhythmogenic zones, according to endocardial electrophysiological study (endo-EFI), were detected in 36 cases (52.9 %) in the region of right ventricular outflow tract, in 8 cases (11,8%) - in
the region of right ventricular inlet tract, in 9 cases (13,2%) - in the region of the right and left sinuses of Valsalva, in 4 cases (5.9 per cent) - in the region of the tricuspid valve, in 2 cases (2,9%) - paraxial localization. Much less arrhythmogenic zones were detected in the region of the pulmonary valve (in 2 cases - 2.9%), in mitral valve (in 2 cases - 2.9%); in 1 case (1,5%) - in the region of right ventricular apex. Fascicular left ventricular tachycardia was verified in 3 patients (4,4%), tachycardia with bundle branch reentry - in 1 case (1,5%).
During a clinical examination all patients with non-ischemic ventricular arrhythmias underwent the test with exercise load (bicycle ergometry), body surface mapping and coronary-graphic testing. The following examinations were conducted initially and at the lapse of 2 and 6 months after radiofrequency ablation of arrhythmogenic focus: Holter monitoring of ECG in 12 deflections; quality-of-life examination with use of a common survey SF-36 and a specific survey "Life ofpatient with arrhythmia"; examination of central hemodynamics by method of transthoracic echocardiog-raphy (ECHOCG);
The endo-EFI protocol was performed following the standard method and included determination of an anatomic localization of the arrhythmogenic focus, inducibility of tachycardia and establishment of the way of its reduction. The activation- and stimulation mapping were carried out in order to determine the point of application of the radiofrequency-exposure.
Results and discussion:
The quality-of-life examination revealed that in patients with non-ischemic ventricular arrhythmias before RFA significantly low parameters of QOL were detected on such scales as "physical activity" (PA) and "role ofphysical problems in vital activity restriction" (RP). The values of such scales as "pain", "general health", "vitality", "social activity", "role of emotional problems in vital activity restriction" in this category of patients were also lower than in the control group, but did not have significant differences.
Table 1. - The quality-of-life parameters of patients with non-ischemic ventricular arrhythmias and patients of the clinical comparison group
Criteria for quality of life Patients with non-ischemic ventricular arrhythmias before RFA (n=33) Clinical comparison group (n=20) P
Physical activity 70,58±25,34* 90,01±14,78* <0,05
Role of physical problems in vital activity restriction 45,21±35,26* 72,0±20,1* <0,05
Pain 59,32±24,56 70,32±15,8 >0,05
General health 58,6±23,1 69,32±13,2 >0,05
Vitality 48,65±19,8 61,3±15,4 >0,05
Social activity 59,36 ±28,69 74,21±10,08 >0,05
Role of emotional problems in vital activity restriction 59,2±36,55 67,54±20,21 >0,05
Mental health 59,02±23,21 62,5±10,32 >0,05
Two months after the surgery we observed a significant increase in the scale "physical activity" and reliable improvement of the parameter "role of physical problems in vital activity restriction". In a third of patients the highly intensive physical and occupational loads still caused difficulties.
Six months after the surgery the daily and professional activities ofpatients were less constrained by health problems and doctors' prescriptions than in the previous period, as evidenced by further growth in such scales as "physical activity" and "role ofphysical problems in vital activity restriction". Indicators ofboth scales, which characterize physical health, 6 months after RFA became comparable with
similar parameters of the clinical comparison group, what illustrates a complete physical health restoration and absence of restrictions in fulfillment of highly intensive daily and professional loads.
The obtained results of the survey "Life of patient with arrhythmia" in patients with non-ischemic ventricular arrhythmias before a surgical treatment permitted to claim that the main causes of decrease in quality of life were as follows:
1) bouts ofpalpitation and heart activity interruptions, feeling of cardiac failure — in 25 patients (75%);
2) emergence of depression, worry and anxiety for health and life, mood lowering — in 21 patients (65%);
Assessment of the relationship of Gln 551Arg polymorphism of a-chain receptor of gene interleukin-4 (IL4RA).
3) need for self-restriction in use of alcohol, coffee, strong tea, smoking, and difficulties in realization of usual rest, housework, sport activities and hobbies — in 18 patients (55%);
4) dizziness, difficulty in breathing, general weakness, fatigue, cardialgia — in 14 patients (43%).
The average QOL before a surgical treatment of patients with non-ischemic ventricular arrhythmia amounted to 14.02+0.95 points, what corresponds to a high quality of life. Two months after the surgery we revealed a significant decrease in the number offactors, which contribute to decrease in quality of life. The total quality-of-life in-
dicator in patients with non-ischemic ventricular arrhythmia was 6.1+2.58 points (p<0.05). The main factors of quality-of-life improvement were upturn of mood, disappearance of anxiety and depressive symptoms, lack of dietary restrictions. The considerable dynamics of quality of life after 6 months (3,98±2.56 points) was not observed in comparison with an average quality-of-life indicator after 2 months.
Conclusion: Thus, analysis of dynamics of quality-of-life parameters confirms that already 2 months after RFA there is a growth of indicators of both physical and psycho-emotional health. A complete physical health restoration is observed after 6 months.
References:
1. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC) The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website URL: http://www.escardio.org/guidelines.
2. Курбанов Р. Д. Желудочковые нарушения ритма сердца. - Ташкент - 2012.
3. United Nations Economic Commission for Europe. UNECE statistical database. Available at URL: http://w3.unece.org/pxweb
4. Jouven X., Desnos M., Guerot C., Ducimetiere P. Predicting sudden death in the population: the Paris Prospective Study I. Circulation - 1999; - 99: - 1978-1983.
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6. Кабаев У Т. Непосредственные результаты катетерного лечения желудочковых-фасцикулярных тахикардий: научное издание/У Т. Кабаев, Т. К. Есенов//Кардиология Узбекистана. - Ташкент, - 2010. - N 2-3. - C. 339 (Шифр К 9/2010/2-3).
7. Соколов С. Аллапинин и современные подходы к лечению нарушений ритма сердца: научное из-дание/С. Соколов//Врач. -М., - 2012. - № 4. - C. 55-59.
DOI: http://dx.doi.org/10.20534/ESR-16-11.12-73-75
Muminova Sevara Rustamovna, Specialized Scientific practical Medical Center Dermatology and Venereology of Republic of Uzbekistan.
E-mail: fattahov-bob@mail.ru
Assessment of the relationship of Gln 551Arg polymorphism of a-chain receptor of gene interleukin-4 (IL4RA) with atopic dermatitis in Uzbekistan
Abstract: The article presents the data of molecular-genetic study of polymorphism Gln551Arg IL4RA gene in patients with atopic dermatitis. As a result of the PCR analysis is installed genetic significant association of this marker with the development of atopic dermatitis.
Keywords: atopic dermatitis, atopy, IL4RA gene, the SNP, polymorphisms Gln551Arg.
Introduction.
Recent years there is the role of cytokine in atopic dermatitis (AD) clinical implications nascency exhaustively covered. Various researchers have made investigations on polymorphism association of allelic variant of a cytokine gene with atopic dermatitis. There have been positive associations [1, 6, 7], as well as absence of positive associations [4, 5] revealed. Cytokine gene receptors play an important role in the development of atopic diseases clinical progression. In this regard, it is reasonable to analyze the allelic polymorphism of cytokines genes and their receptors directly involved in the progression of atopic dermatitis. a-chain of receptor of cytokine interleukin-4-gene (IL4RA) plays an important role in the progression of atopic diseases. Various polymorphisms in the gene IL4RA have been described. In particular: -33C> TIL4 and 576Q> R of IL4RA gene were firmly associated with atopy and bronchial asthma [2; 3].
The aim of research: To optimize oligoprimers system operation for testing IL4RA gene's Gln551Arg polymorphism and study
contribution (affect) of this marker to AD progression.
Materials and methods. Materials for our research were the DNA samples isolated (taken) from the peripheral blood ofpatients with AD and apparently healthy donors — individuals without any signs of atopic diseases. Total studied Gln551 and Arg551 alleles were 150 (100 chromosomes of patients and 50 chromosomes of healthy individuals). DNA purification was carried out by standard methods with some modifications. Amplification of polymorphic (multi-form) loci was performed using polymerase chain reaction on a programmable thermal cycler of «Applied Biosysteems» company (USA). The specificity of the synthesized fragment and the quantity of amplifier was checked by electrophoresis' technique with 2% agarose gel and then conducted hydrolytic cleavage of the resulting fragment with the restrictase — Avail. Restriction of PCR product was performed at + 37 °C during 12 hours, as indicated in the manufacturer's recommendations. Products DNA fragment amplifiers and amplitude of restriction was separated with 2-3%
