In the theoretical part of the thesis, we described the conducting system of the heart, cardiac automaticity, physiological impulse formation and its conduction in the myocardium and mechanisms of arrhythmias. Furthermore, we focused on the classification of arrhythmias and their description in different types of arrhythmias, possibilities of treatment and the role of nurses in the care of patients with heart rhythm disorders. For the thesis, we chose a qualitative research conducted by the form of interviews with nurses. The research took place in three hospitals in the Czech Republic and three in the Slovak Republic. Before realization of the qualitative research, we contacted the management of every hospital in order to obtain a permission to carry on with our research. In each of these hospitals, we spoke to five nurses and then subsequently interviewed them. In overall, we interviewed 30 nurses, 15 of them work in the Czech Republic and 15 hospitals in the Slovak Republic. Research was conducted at the Cardiology departments of these hospitals. The criterion of selection was work of nurses with their patients with heart rhythm disorders. Interviews were recorded and then rewritten. The results were categorized into schemes and then finally compared. The first aim we set was to find out the specific knowledge of nurses care about patients with abnormal heart rhythm in the Czech Republic and the Slovak Republic. Most of them knew what is important for patients and what especially do they need to focus on, what to watch over and in what they need to draw patient?s attention. Nurses often spoke in general and especially in the case of education of the patient in this field. Despite nurses? work with patients with abnormal heart rhythm and their knowledge about arrhythmias, their treatment and their roles, we have decided to develop a handbook for them. This manual can expand knowledge of nurse working with these patients, but its main purpose is to serve nurses who have little knowledge in this field. Therefore, nurses are about to begin to work with patients with abnormal heart rhythm and would like to learn the basic information about arrhythmias, their treatment and the fraction of nurses? to care of these patients. The second aim we set to ourselves was to find out the workflow of the nurses working with patients with abnormal heart rhythm in the Czech Republic and the Slovak Republic. There were differences between the Czech Republic and the Slovak Republic. When asking Czech nurses what workflow do they use, the most common responses were invasive and non-invasive treatment methods. In the Slovak Republic, nurses talked about providing their patients with proper care and workflow according to developed standards. The ultimate aim was to compare the results of nursing care of patients with abnormal heart rhythm in the Czech Republic and the Slovak Republic. All in all we came to the conclusion that nursing care in both countries are in a good condition and complication rate is very low. None of interviewed nurses stated frequent occurrences of complications at her workplace.

Stress hormones, adrenaline and noradrenaline, have been shown to be critical for heart development. Mice lacking dopamine greek lower case letter beta]-hydroxylase (Dbh), an enzyme responsible for synthesis of these adrenergic hormones, die during mid-gestation due to cardiac failure. Prior research showed that adrenergic cells are found within the electrical conduction system of the heart, and adrenergic deficiency leads to slowed cardiac conduction during embryogenesis. Microarray analysis of wild-type (Dbh+/+) and knockout (Dbh-/-) mouse hearts revealed significant differences in expression of retinoic acid (RA) signaling genes. RA signaling has also been shown to be critical for heart development. These data suggest that heart failure due to adrenergic deficiency may be dependent upon RA signaling. This led to the hypothesis that adrenergic hormones promote the development of the electrical conduction system through modulation of RA signaling. To test this, embryonic mouse hearts were cultured with LE 135, a RA receptor blocker. Heart rate, arrhythmic index (AI) and conduction time were measured. Under these conditions there was a marked increase in arrhythmias. Hearts treated with LE 135 showed a mean AI of 0.232±0.057 after 24 hours of treatment while when untreated had an AI of 0.083±0.028 (p<0.05;n=15). In contrast, there was no significant change in heart rate or conduction speed after 24 hours with or without the retinoic acid receptor blocker. To determine if adrenergic stimulus influences retinoic acid response, an established RA-sensitive reporter cell line was employed. These F9-RARE-LacZ cells were treated with forskolin (cAMP regulator) and isoproterenol (greek lower case letter beta]-agonist) to measure changes in RA signaling. Evaluation of RA signaling showed an increase in retinoic acid responsiveness when treated with an adrenergic signaling agonist.; These results suggest that proper retinoic acid signaling is essential for maintaining cardiac rhythmicity during embryonic development and adrenergic stimulation can influence this response.

Ce travail a été réalisé en cotutelle entre l'Université Nationale de Technologie de Ternopil Ivan Pul'uj (TNTU, Ukraine) et l’Université Blaise Pascal (France). Il appartient au domaine scientifique de la biomécanique et de l'informatique. Le but de l'étude est de développer les modèles et les méthodes de traitement des signaux biomécaniques cardiaques par les systèmes de diagnostic assisté par ordinateur avec une précision accrue, informativité et de la complexité de calcul inférieure. La méthode d'analyse statistique du rythme cardiaque a été mise au point. Cette méthode possède une plus grande précision et informativité par rapport aux méthodes connues d'analyse du rythme cardiaque. Dans cette thèse, le logiciel existant de l'analyse des signaux cardiaques biomécaniques a été améliorée par l'ajout de nouveaux modules logiciels, qui mettent en œuvre les nouvelles méthodes de l'analyse du rythme cardiaque et de l'analyse morphologique des signaux cardiaques biomécaniques. / This work has been performed under the co-tutelle agreement between Ternopil Ivan Pul’uj National Technical University in Ternopil (TNTU, Ukraine) and the University Blaise Pascal in Clermont-Ferrand (France). It belongs to the scientific field of biomechanics and informatics. The aim of the study is to develop the mathematical models and methods of the processing of biomechanical heart signals in computer-based diagnostic systems with increased accuracy, informativeness and lower computational complexity. The method of statistical analysis of heart rhythm was developed, which is characterised by higher accuracy and informativeness compared with the known methods of heart rhythm analysis. In this thesis, the existing software of the analysis of biomechanical heart signals was improved by means of adding new software modules that implement the new methods of the analysis of heart rhythm and morphologic analysis of biomechanical heart signals.

Il existe une association étroite entre la santé cardiovasculaire et la santé cognitive au cours du vieillissement. Bien que la recherche dans le domaine de la santé cardiovasculaire soit vaste, le lien entre l'électrophysiologie cardiaque et la cognition est peu étudié. La présente thèse met en évidence les liens entre l'électrophysiologie cardiaque et la cognition en examinant la régulation autonomique chez les individus sains et des marqueurs de maladie chez les patients souffrant de fibrillation auriculaire (FA ; maladie du rythme cardiaque la plus prévalente). Les résultats présentés dans le chapitre 2 démontrent pour une première fois qu'un marqueur de repolarisation cardiaque, le QTcD, est lié aux performances cognitives (fonctions globales et exécutives) chez des personnes âgées sédentaires en bonne santé. Ces observations étaient plus évidentes chez les personnes présentant des valeurs élevées de QTcD, suggérant que des altérations plus importantes du rythme cardiaque pourraient avoir une association plus forte avec les performances cognitives. Les résultats présentés au chapitre 3 montrent que chez les patients souffrant de FA, une plus grande morbidité (mesurée par le sous-type de FA) serait associée à une performance cognitive plus faible (fonctions globales et exécutives). Cette même étude démontre que le volume de l'oreillette gauche agît comme facteur modérateur de l’association entre le sous-type de FA et la performance cognitive. Ceci suggère que plus l'arythmie est sévère, plus le déficit cognitif observé est important. Le chapitre 4 présente les résultats d'une étude pilote portant sur les changements dans les performances cognitives et l'oxygénation régionale du tissu cérébral chez les patients souffrant de FA qui subissent une cardioversion électrique (une procédure visant à rétablir du rythme sinusal). Les résultats de cette étude pilote montrent qu'un tel devis est effectivement réalisable et pourrait permettre de détecter des changements cognitifs dans cet échantillon. Bien que la modification de l'oxygénation du tissu cérébral en lien avec la cardioversion n’ait pas été démontrée pour le moment, des changements au niveau de la cognition ont été observé, ce qui pourrait être partiellement expliqué par la réduction des symptômes liés à la FA post-cardioversion. Parmi toutes les capacités cognitives, la flexibilité (mesurée par le Trail-Making Test) semble être plus sensible aux détériorations du rythme cardiaque, tant chez les individus sains que chez les patients souffrant de FA, dans toutes les études présentées. Les résultats sont discutés dans le contexte d'un continuum cœur-cerveau dans lequel les détériorations du cœur ou du cerveau peuvent avoir des impacts bidirectionnels et altérer davantage le fonctionnement de cet axe. Les orientations futures porteront sur les avantages potentiels de la prévention cognitive par l'exercice et la stimulation cognitive chez les personnes présentant des détériorations électrophysiologiques cardiaques. / There is a close association between cardiovascular and cognitive health in aging. While the cardiovascular health domain is vast, the link between cardiac electrophysiology and cognition is understudied. The present thesis will bring evidence linking cardiac electrophysiology and cognition by looking at autonomic regulation in healthy older individuals and disease markers in patients with atrial fibrillation (AF; most prevalent disease of heart rhythm). Chapter 2 shows for the first time that a cardiac repolarization marker, QTcD, is linked to cognitive performance (global and executive functions) in healthy sedentary older individuals. This relationship was more evident in individuals with elevated QTcD values suggesting that higher impairments in cardiac rhythm might have stronger association with cognitive performance. Results presented in Chapter 3 show that among patients with AF, higher disease burden (as measured by the subtype of AF) was associated with lower cognitive performance (global and executive functions). The study also found that the left atrial volume was a moderator of this association between AF subtype and cognitive performance. This shows that the more severe the condition is the higher the cognitive deficit observed. Chapter 4 shows the results of a pilot study investigating the changes in cognitive performance and regional cerebral tissue oxygenation in AF patients undergoing electrical cardioversion (a sinus rhythm restoration procedure). The pilot results show that such a study is indeed feasible and could detect cognitive changes in this sample. While the change in cerebral tissue oxygenation is unconclusive at this moment, the recorded change in cognition could partially be explained by the reduction in AF related symptoms. Among all cognitive abilities, switching (as measured with the Trail-Making Test) appears to be more sensitive to deteriorations in heart rhythm both in healthy individuals and patients with AF across all studies presented. The results are discussed in the context of a heart-brain continuum in which deteriorations from either the heart or the brain can have bidirectional impacts and further impair the functioning of this axis. Future directions will address the potential benefit of cognitive prevention through exercise and cognitive stimulation in older individuals with cardiac electrophysiological deteriorations.