Rhythym changes are the changes that emerge in different populations. However, some acute rhythm changes do not affect hemodynamic changes to a great extent and can be tolerated for a longer period of time.

Some rhythm changes that have no large hemodynamic effects even in the short run, if not treated properly, can lead to heart failure like in cases of tachycardia induced car diomyopathy. Changes like ventricular tachycardia (VT) require urgent intervention aimed at saving the patients’ life by applying DC shock. On the other hand, changes like left bundle branch block (LBBB), lead to dysynchrony of the function of the left vetricle (LV) with an important effect on the ejection fraction (EF) of the LV (1-3).

The study was designed for analysis of the LV function changes that emerge in the same patient during rhythm changes as well as its conversion.

Five patients with different rhythm changes have been analyzed at University Hospital Tetovo. Every patient was analyzed in the same way during the rhythm changes and afterwards, aimed at rhythm changes effects in LV function analysis.

Echocardiography was made with a commercial echocardiograph Philips® SONOS® 7500 with live 3D option (S3 sceanhead with harmonic Plus option, Philips Healthcare, USA) and one patient was analyzed with X4 Matrix sceanahead, with an option of 3D echocardiography.

For analysis of 2D and 3D images, we use the commercial software (Cardiac Performance Analysis package, TomTec Imaging Systems GmbH), with a 2D strain option including EF. 3D images have been analyzed with a software for 4D strain (4D LV Analysis, version 3.1), from the same company, with an 3D strain option. Through software we can analyze EF, global strain, longitudinal strain, circumpherencial strain, radial strain, twist with torsion, as well as calculation of dysynchrony index. The EF values in the study represent 2D EF and 3D EF in %, generated from the CPA software and 4D software. We have not used M mode EF values in this study.

The value of EF, radial strain, longitudinal strain, dV/dT, and wall motion delay have been analyzed, which shows changes in wall contraction of the LV during and after the rhythm changes.

Some acute rhythm changes do not affect extensive hemodynamic changes and can be tolerated for a longer period of time. Contrary to such rhythm changes, there are rhythm changes which exert extensive impact on LV function and require their urgent correction. The patients in this study show different rhythm changes with the different effect on LV function.

In the first case, the patient with implanted ICD, with VT episodes converted by ICD, with the data presented in Table 1, we can clearly see the dramatic changes of hemodynamic variables of the heart, expressed with EF after conversion, where EF icreases from 19% during VT to 55% in SR (4). Also the increase of the value of dV/dT is recorded which a change of 600%, as well as an increase of the radial values and the LS that go beyond 400% (3.89% to 11.9%) in RS until 250% (-5.4% to -13.4%) in LS. A very good synchronization of the LV can be clearly seen after the conversion of the VT in SR, with a decrease in the wall delay values. These hemodynamic values indicate the requirement for urgency for conversion of VT. The application of the DC shock is extremely necessary because the improvement of the heart performance from 400% in this case, justifies the use of the DC shock.

Table 2 shows values of the patient with a permanent AF which after several months were converted spontaneously. The data show a great improvement of EF as well as of the values of dV/dT2, (5-7). An enhanced improvement of the radial and longitudinal strain values can be verified, however one of the most pronounced characteristic is the improvement of dysychrony which is characterized by a decrease in the wall motion delay which was improved from 170 msec to 64 msec.

In Table 3 values of the heart function have been analyzed in patient with paroxysmal AF. Based on these values and measurements of the EF in 3D a significant improvement of the global strain values (3, 5, 7) can be verified. An emphasized improvement of the SDI I can be verified as well as of the index of systolic electromechanical dysychrony indicated as SDI II which shows a significant improvement. In this table it is clear that a good control of the LV rhythm shows an enhanced improvement of EF from 26% to 39% indicated by an improvement of the strain values as well as of myocardium synchronization indexes SDI and SDII (5, 6).

In Table 4 the EF values have been given with LBBB which withdrew in a spontaneous way during the same control. Based on such data, the improvement of EF has doubled, as well as RS and LS and the decrease of pronounced dysychrony like a wall motion delay was recorded, which speaks in favor of better synchronization of LV in the patients after the spontaneous withdrawal of the LBBB (8, 9).

In the latter case, the patient with PSVT, we can clearly see that there is no great difference in LV function during the attack of PSVT vs sinus rhythm (1). The shown values in Table 5, like those with EF, dV/dT, radial strain, longitudinal strain as well as wall motion delay are approximate, which means that in this case of PSVT there is no big hemodynamic effect. This explains the sustainability of the patient during PSVT, because in most of the cases the global function of the heart is not changed.

From the data presented in these cases, one can conclude the following: