Accuracy of the OMRON HEM-7361T blood pressure monitor in the differentiation between atrial fibrillation and sinus rhythm.

OBJECTIVE: We investigated the accuracy of the OMRON HEM-7361T automated oscillometric blood pressure (BP) monitor in the differentiation between atrial fibrillation and sinus rhythm. METHODS: An approximately equal number of patients with persistent atrial fibrillation and individuals with sinus rhythm were recruited from outpatients and inpatients of Ruijin Hospital, Shanghai, China. BP was measured three times consecutively with a 30-s interval with the OMRON HEM-7361T automatic electronic BP monitor for atrial fibrillation detection. A hand-held single lead electrocardiogram device was used for simultaneous electrocardiogram recordings. RESULTS: The device accurately identified atrial fibrillation in 100 (99.0%) of the 101 patients, with only 1 patient incorrectly classified as non-atrial fibrillation. The device correctly identified 99 (95.2%) of the 104 participants with sinus rhythm as non-atrial fibrillation, with five participants incorrectly classified as atrial fibrillation. The device had a positive predictive value of 95.2%, negative predictive value of 99.0%, and overall accuracy of 97.1%. Among the six misclassified participants, one with atrial fibrillation had a heart rate of 65 beats/min, and four of the five participants with sinus rhythm had cardiac arrhythmias (atrial or ventricular premature beat in one participants, sinus tachycardia in one participant, and both arrhythmias in one participant). CONCLUSION: The OMRON HEM-7361T BP monitor is accurate in the differentiation between atrial fibrillation and sinus rhythm. Whether the device is sufficiently accurate in the differentiation between atrial fibrillation and other cardiac arrhythmias remains under investigation.

"But for the blind spot": Accuracy and diagnostic performance of smart watch cardiac features in pediatric patients.

BACKGROUND: The Apple Watch™ (AW) offers heart rate (HR) tracking by photoplethysmography (PPG) and single-lead electrocardiographic (ECG) recordings. The accuracy of AW-HR and diagnostic performance of AW-ECGs among children during both sinus rhythm and arrhythmias have not been explored. OBJECTIVE: The purposes of this study were to assess the accuracy of AW-HR measurements compared to gold standard modalities in children during sinus rhythm and arrhythmias and to identify non-sinus rhythms using AW-ECGs. METHODS: Subjects ≤18 years wore an AW during (1) telemetry admission, (2) electrophysiological study (EPS), or (3) exercise stress test (EST). AW-HRs were compared to gold standard modality values. Recorded AW-ECGs were reviewed by 3 blinded pediatric electrophysiologists. RESULTS: Eighty subjects (median age 13 years; interquartile range 1.0-16.0 years; 50% female) wore AW (telemetry 41% [n = 33]; EPS 34% [n = 27]; EST 25% [n = 20]). A total of 1090 AW-HR measurements were compared to time-synchronized gold standard modality HR values. Intraclass correlation coefficient (ICC) was high 0.99 (0.98-0.99) for AW-HR during sinus rhythm compared to gold standard modalities. ICC was poor comparing AW-HR to gold standard modality HR in tachyarrhythmias (ICC 0.24-0.27) due to systematic undercounting of AW-HR values. A total of 126 AW-ECGs were reviewed. Identification of non-sinus rhythm by AW-ECG showed sensitivity of 89%-96% and specificity of 78%-87%. CONCLUSIONS: We found high levels of agreement for AW-HR values with gold standard modalities during sinus rhythm and poor agreement during tachyarrhythmias, likely due to hemodynamic effects of tachyarrhythmias on PPG-based measurements. AW-ECGs had good sensitivity and moderate specificity in identification of non-sinus rhythm in children.

Respiratory sinus arrhythmia (RSA), vagal tone and biobehavioral integration: Beyond parasympathetic function.

Linchpin to the entire area of psychophysiological research and discussion of the vagus is the respiratory and cardiovascular phenomenon known as respiratory sinus arrhythmia (RSA; often synonymous with high-frequency heart-rate variability when it is specifically linked to respiratory frequency), i.e. rhythmic fluctuations in heart rate synchronized to inspiration and expiration. This article aims 1) to clarify concepts, terms and measures commonly employed during the last half century in the scientific literature, which relate vagal function to psychological processes and general aspects of health; and 2) to expand upon an earlier theoretical model, emphasizing the importance of RSA well beyond the current focus upon parasympathetic mechanisms. A close examination of RSA and its relations to the vagus may 1) dispel certain commonly held beliefs about associations between psychological functioning, RSA and the parasympathetic nervous system (for which the vagus nerve plays a major role), and 2) offer fresh perspectives about the likely functions and adaptive significance of RSA, as well as RSA's relationship to vagal control. RSA is neither an invariably reliable index of cardiac vagal tone nor of central vagal outflow to the heart. The model here presented posits that RSA represents an evolutionarily entrenched, cardiovascular and respiratory phenomenon that significantly contributes to meeting continuously changing metabolic, energy and behavioral demands.

Long-term stability of respiratory sinus arrhythmia among adults with and without a history of depression.

Respiratory sinus arrhythmia (RSA) is an index of parasympathetic nervous system activity reflecting respiratory influences on heart rate. This influence is typically measured as high frequency heart rate variability (HF-HRV) or root mean square of successive differences (RMSSD) of adjacent inter-beat intervals. Examining the long-term stability of its measurement is important as levels of resting RSA have been conceptualized as a marker of individual differences; in particular, of an individual's autonomic regulation and affect-related processes, including emotion regulation. At present, it is not known if resting RSA levels reflect stable differences over a long-term period (i.e., >1 year). Even less is known about how RSA stability differs as a function of depression history and whether it relates to depression risk trajectories. In the present study, we examined the 1.5-year test-retest reliability of resting RSA using the intraclass correlation coefficient (ICC) in 82 adults: n = 41 with a history of depression (ever-depressed); n = 41 controls with no depression history (never-depressed). HF-HRV was fairly stable in both groups (ever-depressed ICC = 0.55, never-depressed ICC = 0.54). RMSSD was also fairly stable in ever-depressed adults (ICC = 0.57) and never-depressed controls (ICC = 0.40). ICC values for both indices did not differ between groups per overlapping 95% confidence intervals. Therefore, RSA stability as assessed by both frequency (HF-HRV) and time domain (RMSSD) measures was not attenuated by a depression history. Implications and the need for future research are discussed.

Respiratory sinus arrhythmia in spontaneously breathing, unanesthetized newborn and adult Wistar rats.

We examined respiratory sinus arrhythmia (RSA) and possible interaction with respiratory frequency (fR) and heart rate (HR) in spontaneously breathing, unanesthetized newborn Wistar rats (2- to 5-day-old; n = 54) and the adult rats (8-week-old; n = 34). Instantaneous heart rate (inst-HR) was calculated as the reciprocal of the inter-beat-interval. For each breath, RSA was determined as the difference between the maximum and minimum inst-HR value. The absolute RSA or RSA% (RSA per HR) were calculated as the average RSA of 10 consecutive breaths. RSA (or RSA%) in the newborn rats was significantly lower than that in the adult rats. Correlation coefficient between RSA (or RSA%) and 1/fR or HR/fR, but not HR, was significant in newborn rats, whereas only that between RSA (or RSA%) and HR was significant in adult rats. The power spectrum density of heartbeat fluctuation was detectable in both age groups. The present findings suggest that RSA exists and could be influenced by fR, rather than HR, in newborn rats.

Estudio transversal: Prevalencia de arritmias cardiacas supraventriculares y factores asociados en pacientes adultos atendidos en consulta cardiológica. Hospital José Carrasco Arteaga, Cuenca, 2018 / Cross sectional Study: Prevalence of supraventricular cardiac arrhythmias and associated factors in adult patients seen at the outpatient cardiology service. Hospital José Carrasco Arteaga, Cuenca, 2018.

INTRODUCCIÓN: Las arritmias cardiacas son enfermedades cardiovasculares, causadas por alteraciones en la conducción o formación de estímulos eléctricos. La detección oportuna de estas alteraciones es crucial, pues a largo plazo mejora la calidad de vida de las personas que padecen estas patologías. El objetivo del presente estudio fue determinar la prevalencia de arritmias cardiacas supraventriculares y sus factores asociados en paciente adultos atendidos en la consulta externa de la unidad de cardiología del Hospital José Carrasco Arteaga, Cuenca, 2018. MATERIALES Y MÉTODOS: Se realizó un estudio observacional, transversal, descriptivo y de correlación con una muestra de 608 pacientes mayores de 18 años atendidos en la Institución mencionada que se realizaron electrocardiograma durante el año 2018. Se estudiaron las variables: estado nutricional, hipertensión arterial, diabetes, tabaquismo, medicamentos utilizados; edad y sexo; presencia de arritmia supraventricular. Se utilizó la prueba Chi cuadrado para buscar asociación entre las variables cualitativas; considerando diferencias estadísticamente significativas una p < 0.05. RESULTADOS: De 608 pacientes, el 57.1% fueron mujeres; 61.84% fueron menores de 65 años. El 43.9% tuvo sobrepeso, el 27.6% presentó IMC normal. Las enfermedades crónicas como HTA y Diabetes tuvieron una frecuencia de 44.4% y 16% respectivamente. La prevalencia de las arritmias supraventriculares fue del 3.8%. La fibrilación auricular fue la arritmia supraventricular más frecuente con el 47.8%, seguida de la arritmia sinusal con el 26.08%. Hubo mayor prevalencia de arritmias supraventriculares en el sexo femenino que en el masculino (4.6% vs 2.7%), en los pacientes con sobrepeso u obesidad que en los que tenían IMC normal ( 4.4% vs 2.3%), en los pacientes hipertensos en relación a los que no padecían de hipertensión (5.2% vs 2.7%), en los pacientes usuarios de medicamentos antitiroideos en relación a los que los consumían (50% vs 3.6%); sin embargo no se encontró asociación estadísticamente significativa con ninguna de estas variables. CONCLUSIÓN: La prevalencia de las arritmias supraventriculares fue del 3.8%. La principal de arritmia cardiaca diagnosticada fue la fibrilación auricular seguida de la arritmia sinusal. No se encontró asociación estadísticamente significativa entre la frecuencia de las arritmias supraventriculares y las variables estudiadas.(AU)

BACKGROUND: Cardiac arrhythmias are cardiovascular diseases, caused by disturbances in the initiation or conduction of electrical stimuli. The timely detection of these alterations is crucial, since in the long term it improves the quality of life of people suffering from these pathologies. The aim of this study was to determine the prevalence of supraventricular cardiac arrhythmias and their associated factors in adult patients treated in the outpatient clinic of the cardiology unit of Hospital José Carrasco Arteaga, Cuenca, 2018. METHODS: An observational, cross-sectional, descriptive and correlation study was carried out with a sample of 608 patients older than 18 years, at the mentioned Institution, who underwent electrocardiography during 2018. We studied the variables: nutritional status, arterial hypertension, diabetes, smoking, used drugs; age and sex; presence of supraventricular arrhythmia. We used Chi Square test to search for an association between the qualitative variables; considering statistical significance a p <0.05. RESULTS: of 608 patients, 57.1% were women; 61.84% were under 65 years of age. 43.9% were overweight, 27.6% had normal body mass index (BMI). Chronic diseases such as hypertension and diabetes had a frequency of 44.4% and 16% respectively. The prevalence of supraventricular arrhythmias was 3.8%. Atrial fibrillation was the most frequent supraventricular arrhythmia with 47.8%, followed by sinus arrhythmia with 26.08%. There was a higher prevalence of supraventricular arrhythmias in females than males (4.6% vs 2.7%), in overweight or obese patients than in those with normal BMI (4.4% vs 2.3%), in hypertensive patients than in those who didn't suffer from hypertension ( 5.2% vs 2.7%), in patients who used antithyroid drugs than in those who didn't use them (50% vs 3.6%); however, no statistically significant association was found with any of these variables. CONCLUSION: The prevalence of supraventricular arrhythmias was 3.8%. The most common cardiac arrhythmia was atrial fibrillation followed by sinus arrhythmia. No statistically significant association was found between the frequency of supraventricular arrhythmias and the variables studied.(au)

Cardiovascular Physiotherapy on Respiratory Sinus Arrhythmia of Patients Undergoing Coronary Artery Bypass Grafting

Abstract Introduction: Patients in the postoperative period of coronary artery bypass grafting (CABG) present respiratory and autonomic dysfunctions. In this sense, cardiovascular physiotherapy has been offered as an indispensable differential for the improvement of the prognosis of this population. Heart rate variability is a simple, noninvasive method to analyze autonomic modulation, as well as the accentuation maneuver of respiratory sinus arrhythmia, which demonstrates the parasympathetic autonomic control over the heart. Five patients undergoing cardiac surgery performed a protocol of cardiovascular physiotherapy in the postoperative period and had their data referring to the preoperative period, the 1st and 4th postoperative days analyzed.

Síndrome de Bayés. Lo que todo clínico debe conocer / What every clinician should know about Bayés syndrome

El síndrome de Bayés es una nueva entidad clínica, caracterizada por la combinación de bloqueo interauricular (BIA) avanzado en el electrocardiograma de superficie con fibrilación auricular (FA) y otras arritmias auriculares. Este síndrome se asocia con un riesgo incrementado de ictus, demencia y mortalidad. El BIA avanzado se diagnostica con la presencia de una onda P ≥ 120ms de morfología bifásica (±) en derivaciones de cara inferior. Se produce por un bloqueo completo del haz de Bachmann que causa una despolarización retrógrada de la aurícula izquierda desde zonas cercanas a la unión auriculoventricular. La miocardiopatía auricular fibrótica es el sustrato anatómico del BIA avanzado. La disincronía inducida por el BIA avanzado funciona como desencadenante y mecanismo de mantenimiento de la FA. Esta alteración de la arquitectura auricular produce remodelado auricular, estasis sanguínea e hipercoagulabilidad, lo cual desencadena la cascada trombogénica. El BIA avanzado, incluso sin arritmias auriculares documentadas, también se ha relacionado con FA, ictus, demencia y mortalidad. Sin embargo, todavía no se ha demostrado el beneficio de la anticoagulación para los pacientes sin FA documentada. Por lo tanto, es recomendable una búsqueda proactiva de FA en los pacientes con BIA avanzado

Bayés syndrome is a new clinical entity, characterized by the association of advanced interatrial block (IAB) on surface electrocardiogram with atrial fibrillation (AF) and other atrial arrhythmias. This syndrome is associated with an increased risk of stroke, dementia, and mortality. Advanced IAB is diagnosed by the presence of a P-wave ≥ 120ms with biphasic morphology (±) in inferior leads. The cause of IAB is complete Bachmann bundle blockade, leading to retrograde depolarization of the left atrium from areas near the atrioventricular junction. The anatomic substrate of advanced IAB is fibrotic atrial cardiomyopathy. Dyssynchrony induced by advanced IAB is a trigger and maintenance mechanism of AF. This alteration of the atrial architecture produces atrial remodeling, blood stasis and hypercoagulability, triggering the thrombogenic cascade. The presence of advanced IAB, even in patients without documented atrial arrhythmias, has also been associated with AF, stroke, dementia, and mortality. However, in these patients, there is no evidence to support the use of anticoagulation. Therefore, in patients with advanced IAB, a proactive search for AF is recommended

Acute pericarditis due to covid-19 infection: an underdiagnosed disease? / Pericarditis aguda secundaria a covid-19 ¿una enfermedad infradiagnosticada?

No disponible

Cicatriz miocárdica arritmogénica localizada mediante el uso combinado de la SPECT con 123I-MIBG y la RMN cardíaca / Arrhythmogenic myocardial scar localized through the combined use of 123I-MIBG SPECT and cardiac MRI

No disponible

¿Vía accesoria aturdida o conducción intermitente? / Stunned accessory pathway or intermittent conduction?

No disponible

Restricción de crecimiento intrauterino probablemente asociado al uso de metoprolol: reporte de caso / Intrauterine growth restriction probably associated with the use of metoprolol: a case report

Se presenta el caso de una paciente vinculada al programa de atención prenatal de una entidad promotora de salud (EPS). Se trata de una femenina de 30 años de edad, con embarazo de 20.5 semanas por fecha de última menstruación, con extrasístoles ventriculares aisladas sin fenómenos repetitivos y taquicardia sinusal inapropiada. A los 31 días de iniciado el tratamiento con metoprolol 25mg cada 12 horas vía oral, el feto presentó disminución progresiva del crecimiento. La restricción del crecimiento intrauterino fue el principal hallazgo durante los sesenta y tres días de uso de metoprolol. Se realizó una evaluación por la sospecha de evento adverso, utilizando el algoritmo de Naranjo y se determina que los efectos de metoprolol en el crecimiento intrauterino fetal eran plausibles (categoría probable). Se realiza la intervención para la suspensión del metoprolol y se observa ganancia de peso progresiva. Se logró un feto con adecuado peso al nacer

This is the case of a patient who was attended by a health care entity. She was a 30-year-old patient and 20.5 weeks pregnant according to the first day of the last menstrual period. She was diagnosed by a cardiologist with isolated ventricular extra-systoles without repetitive phenomena and inappropriate sinus tachycardia. After 31 days being treated with oral metoprolol 25mg bid, the fetus showed a progressive decline of growth rate. The intrauterine growth restriction was the main clinical finding during the sixty-three days of metoprolol consumption. Naranjo algorithm was used to evaluate the causality of the adverse event. It was determined that the effects of metoprolol on fetal intrauterine growth were plausible (probable). Metoprolol was ceased. Then a progressive borned of weight was observed. A fetus with adequate birth weight was achieved

Respuesta al ECG de octubre de 2019 / Response to ECG, October 2019

No disponible

Efecto de memoria cardiaca / Cardiac memory effect

No disponible

Fibrosis endomiocárdica aislada del ventrículo derecho. Una entidad cada vez más frecuente en España / Isolated right ventricle endomyocardial fibrosis. An increasingly frequent disease in Spain

No disponible

Variabilidade da frequência cardíaca em diferentes posições corporais e durante MASR em amputado unilateral de membro inferior / Variability of heart beat frequency in different body positions and during MASR in a person with lower member unilateral amputation

A amputação leva a redução da mobilidade e atividade física afetando os sistemas musculoesquelético, respiratório e cardiovascular. Nosso objetivo foi analisar a variabilidade da frequência cardíaca (VFC) em diferentes posições corporais e durante a Manobra de Arritmia Sinusal Respiratória (MASR) em amputados unilaterais de membros inferiores (MMII) protetizados. Estudo transversal, amostra de conveniência, avaliou 07 amputados homens de origem traumática e registradas as variáveis clínicas e VFC nas posições supino, ortostase, sedestação (10 minutos) e durante a MASR (4 minutos). Em repouso os sujeitos apresentam predominância da modulação simpática que se acentua quando assume a posição de ortostase (p = <0.01) e atenuação da complexidade autonômica (p = 0,04). Os amputados não responderam de modo adequado à MASR e observou-se alteração na complexidade da VFC (0,04). Amputados unilaterais de MMII protetizados demonstraram comportamento esperado durante a mudança ativa de postura e respostas adversas à MASR

Amputation causes decrease of mobility and physical activities, affecting the muscle-skeleton, respiratory and cardiovascular systems. Variability of heart frequency (VFC) at different body positions and during Respiratory Sinus Arrhythmia (RSA) was analyzed in people with amputation of unilateral lower members with prosthesis (MMII). Current transversal study, with convenience sample, evaluated seven males with trauma-caused amputations. Clinical variations and VFC were registered with regard to supine position, orthostasis, sedestation (10 min) and during RSA (4 min). The subjects at rest showed a predominance in increasing sympathetic modulation as the orthostatic position is achieved (p = <0.01) and attenuation of autonomic complexity (p = 0.04). People with amputation failed to respond adequately to RSA and alterations were detected in VFC complex (0.04). Unilateral amputated people with prosthesis showed expected behavior during active changes in posture and adverse responses to RSA

Digoxina en insuficiencia cardíaca reducida y ritmo sinusal. ¿Cuándo debemos indicarla en el año 2018? / Digoxin in reduced heart failure and sinus rhythm. When should it be indicated in 2018?

No disponible

Respuesta al ECG de febrero de 2018 / Response to ECG, February 2018

No disponible