Dr. V. Volkov, Dr. T. Volkov, 
Private Clinic for Low Level Laser Therapy, 
P.O. Box 11-689, Wellington, New Zealand 
e-mail: v-volkov@paradise.net.nz

Treatment and prophylaxis of ischaemic cardiac disease, cardiac arrythmia is a cornerstone question in cardiology. Cardiac cells have the faculty of self- excitation. The pacemaking of the heart is normally controlled by sinoatrial (SA) node - which are under nervous control; vagal activity and sympathetic activity. At the other times the natural rate of lower centers may be increased as a result of disturbances of cellular metabolism; as a result of cellular damage from myocardial disease.

Antiarrhythmic drug therapy is the mainstay of management for most important arrhythmias. There is no universally effective drug; all have important safety limitations and can aggravate or promote arrhythmia (arrhythmogenessis, proarrhythmia). Drug selection is difficult and often involves trial and error. Surgical treatment of cardiac arrhythmia is very expensive and the waiting list is very long.

Low Level Laser Therapy (LLLT) has several advantages:
it is non-invasive, safe, cost effective, and has not side effects.

Antiarrhythmic drug actions based on cellular electrophysiological effects have been classified by Vaughen Williams and provide a general logic for grouping drugs. There are:

1. Na channel blockers - all reduce the maximal rate of depolarization of the action potential and thereby slow conduction.
2. B-blockers - their antiarrhythmic effects have poor efficacy in conventional antiarrhythmic test (eg, VEB suppression), but they raise the threshold of VF and may be potent prevents VF.
3. Drugs interfere with the K_ channel to alter the plateau phase of the action potential and increase refractoriness. (The Merck Manual, 1999, Section 16, Chapter 205).

Infrared irradiation of the skin applied to the projection heart and its reflexogenic areas is reported to be successful by several Russian authors (Jan Turner and Lars Hode - LLLT - Clinical Practice and Scientific Background, 1999). Reported effects include reduced need of nitroglycerin tablets, decreased number of angina attacks, alleviation of pain, suppression of lipid peroxidation, promotion of antioxidant protection of erythrocyte membranes, reduction of fibrinogen level, normalization of antithrombin - III, reduction of the activites of the hypophyseoadrenocortical and aldosteron - renin - angiotensin systems. (Jan Turner and Lars Hode - LLLT - Clinical Practice and Scientific Background, 1999).

Action infrared irradiation of the skin applied to the projections of the heart has pathogenetical explanations:
- blood circulation improvement
- acceleration of metabolic processes and normal mitotic activity (stimulated ATP and nucleic acid Synthesis)
- acceleration of regenerative processes
- sedative and anti-histamine effects
- analgesic effect
- stabilization of cellular membranes
- stimulation of the whole body
- anti-arrhythmic and anti-fibrillative effects
- improvement of adhesive and oxidative blood functions

Transcutaneus infrared irradiation of the heart diseases is reported to be successful but at the same time the terapeutic effect of LLLT for heart diseases has been discussed at length in various studies, there has, as yet, not been scientifically proven.

Since 1991 we have applied LLLT for ischaemic heart disease, cardiac arrhythmia (Uzbekistan, 1991-1993) by using a magnetic/infrared laser therapeutic apparatus, with the action of three medical physical factors at one time: a constant magnetic field, a laser coherent pulse IR - radiation and continuos monochrome incoherent IR - radiation.

During this period of time we observed in 65 - 70% (47 patients) positive results in the treatment of cardiac arrhythmia. Most of our patients half-decreased their dose of antiarrhythmic drugs.

Since 1999 in our private clinic we have started to apply an infrared laser probe 830nm, with output - 40mW for treatment of oschaemic heart disease, cardiac arrhythmia and hypertension disease. So far, we have applied LLLT to 11 patients with above mentioned complaints.
The age of patients is 48 - 78 years (9 women and 2 men).
Ischaemic heart disease with cardiac arrhythmia - 7 patients.
Hypertension disease with cardiac arrhythmia - 2 patients.
Hypertension disease - 2 patients.


Methods

1. Skin contact technique.
2. LLLT was applied as mono - therapy in 5 patients and with combination LLLT and antiarrhythmic drugs in 6 patients.
3. The first 3 sessions are done twice a week, than once a week.
4. IR laser , wavelength 830nm, output - 40mW, Frequency - 5Hz, ED - 1,5 J/cm2.
5. Principal areas for Laser irradiation as follows (Prof. Korepanov V.I. - Russian Medical Academy for Postgraduate Education, Moscow - 1995):

Left cervical neurovascular bundle, left major fossa supraclavicularis, middle part of breast bone: 
the aim of the laser application is to modify functions of the parasympathetic nervous system that controls the coronary blood circulation, and activity of the conductive heart system.
Point of outlet of greater occipital nerve, where is the projection of a.vertebral, too:
the aims of the laser application are the improvement of blood circulation in the areas of the upper vertebrae and organs of the posterior cranial fossa; reduction of the tissue edema and intensity of pathologic refleses on coronary heart arteries and conductive heart system.

Paravertebral area Th5 - Th6:
The aim of the laser application is to stumulate spasmolytic reaction of coronary arteries.
Projection of the heart:
The aim of the Laser application is normalization of activity of the conductive heart system, improvement of the coronary blood circulation, stimulation of the myocardial metabolic processes.
Projection of the kidneys:
The aim of the Laser application is to accelerate the kidneys blood circulation and reduce the volume of circulating blood at the expense of water phase.
Area of Gallbladder projection:
The aim of the Laser application is to suppress the bile - cardiac reflex, if any, and to accelerate the coronary circulation.
Area of femoral vessel projection:
The aim of the Laser application is to laser the blood transcutaneously.

All our patients were taking antioxidants and having 10 sessions of LLLT.

Results

In our observation, 11 patients have obtained positive results in treatment of ischaemic heart disease, cardiac arrhythmia and hypertension disease, and had positive dynamic - that were proved by BP and ECG. Blood prossure had decreased 15 - 20-mm. and cardiac arrhythmia was rare or disappeared. In 1 case blood pressure had declined from 180/100 to 165/90 but cardiac arrhythmia was still prosented. In 2 patients blood pressure was close to normal without taking drugs. Cardiac arrhythmia disappeared after LLLT in 3 patients without taking antiarrhythmic drugs. The dose of nitrates and Ca-antagonists were lowered by 2 times (patients) and B-blockers discontinued completely (3 patients).

All 11 patients received 10 sessions of LLLT. After the third session 3 our patients were tired and we decreased ED to 1 J/cm2. It is very important that frequency of LLLT for cardiac disease should be not more than 5 Hz.

Contraindicated for LLLT of heart disease are patients with decompensated functions - heart, liver, kidneys.

If it is necessary; a repeat course should be carried out 1 month later.

According to our observation (Uzbekistan, New Zealand), we did not see side effects of applying LLLT in treatment patients with heart disease.

Discussion

LLLT in-patients with ischaemic heart disease; cardiac arrhythmia could be use as a method for provention myocardial infarction.

In some patients, LLLT allows the patients to refuse completely or partly their medication.

LLLT could improve positive dynamic of ECG and BP in-patients with heart disease.

It is very important to apply LLLT with frequency not more than 5 Hz and ED 1 - 1,5 J/cm2 in-patients with heart disease.

Case history

Mrs. P. D., born 14. 03. 1937, Wellington, New Zealand

Mrs. P. D. has had arthritis and ischaemic heart disease since 1996, and she has been taking NSAID and sotalol. 

Since February 1999 she had had problems with palpatations and on ECG showing ventricular ectopic beats was a manifestation of ischaemic heart disease.

The patient underwent exercise treadmill testing the standing Bruce protocol. The test was stopped at 1:41 minutes because of marked fatique. What became apparent on the ECG tracings was the development of a rapid atrial flutter at rates of 170 bpm with physical activity.

She has been feeling an initial symptomatic improvement with the increasing doses of sotalol, but there has been the problem with fatigue associated with this drug. She has a dosing schedule to withdraw the sotalol. She was continuing to take tambocor CR - 200mg once a day.

Since May 1999 she has been taking LLLT, IR laser probe 830nm, Fr - 5 Hz, ED - 1,5 J/cm2, output - 40 mW.

Principal areas - method after Korepanov V.I.

Treatment twice a week - 6 sessions, than once a week.

After ten sessions she has been feeling a positive improvement: venticular ectopic beats were rare on ECG. The problems with fatigue had disappeared and medication was discontinued. In November and December 1999 she repeated a course of LLLT - 10 sessions, once a week.

After treatment she confirmed that she feels a significant improvement in her health - palpatations, fatique and ventricular ectopic beats (ECG) had not returned.

ECG of Mrs. P. D. is enclosed