We reported a case of a twenty-one-year-old man with an atrial flutter as the first manifestation of progressive cardiac conduction disease. The patient was admitted to the cardiology department due to complaints of shortness of breath and a decrease in exercise tolerance, which had happened after physical exercises (running). During ambulatory ECG monitoring persistent AFL was observed with atrial rate 262-297 bpm and ventricular rate 26-136 bpm (average 56 bpm). AV conduction was very variable – 4:1-14:1. The results of ambulatory ECG monitoring during the whole period of recording indicated signs of atrioventricular conduction disturbances. After cardioversion sinus rhythm was restored additional rhythm and conduction disorders were revealed. Ambulatory ECG monitoring was performed two weeks after the initial one, and throughout this recording were registered sinus rhythm on the background of first-degree AV block; transient Mobitz I AV block; and type 2 second-degree sinoatrial block. Trans-esophageal electrophysiology study was performed. During pharmacological denervation of the heart, signs of slowing of the atrioventricular conduction and sinus node recovery time persisted. These changes along with right bundle branch block were regarded as a progressive cardiac conduction disease with an apparently hereditary cause.
Late Miocene continental deposits overlying the Khersonian marine sediments near the city of Maikop bordering the Belaya River (North Caucasus) yielded a diverse biotic record including palynology, ostracods, fresh-water and terrestrial molluscs, fishes, amphibians and reptiles, birds, and mammals. The obtained data indicate predominantly wooded landscapes along the banks of a large fresh-water estuarine or lagoonal basin with occasional connection with the sea. The basin existed in a warm temperate to subtropical climate with a high humidity and an estimated mean annual precipitation above 800 mm. The mammalian assemblage with Hipparion spp., Alilepus sp., Paraglirulus schultzi, Eozapus intermedius, Parapodemus lugdunensis, Collimys caucasicus sp. nov., Neocricetodon cf. progressus, etc. is referable to the early Turolian, MN 11. The data regarding composition and stage of evolution of the small mammal content combined with mostly normal polarity of the fossiliferous deposits, and the age estimates of the upper Khersonian boundary as between 8.6 and 7.9 Ma indicate a plausible correlation with Chron C4n and an age range between 8.1–7.6 Ma.