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1.
Zhongguo Zhong Yao Za Zhi ; 49(5): 1397-1405, 2024 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-38621988

RESUMO

This study employed evidence mapping to systematically sort out the clinical studies about the treatment of premature ventricular contractions with Chinese patent medicines and to reveal the distribution of evidence in this field. The articles about the treatment of premature ventricular contractions with Chinese patent medicines were searched against PubMed, Cochrane Library, Web of Science, CNKI, Wanfang, and VIP with the time interval from January 2016 to December 2022. Evidence was analyzed and presented by charts and graphs combined with text. According to the inclusion and exclusion criteria, 164 papers were included, including 147 interventional studies, 4 observational studies, and 13 systematic reviews. A total of 27 Chinese patent medicines were involved, in which Shensong Yangxin Capsules and Wenxin Granules had high frequency. There were off-label uses in clinical practice. In recent years, the number of articles published in this field showed a decreasing trend. Eight types of outcome indicators were used in interventional studies. Ambulatory electrocardiography, clinical response rate, safety, and echocardiography had high frequency, while the rate of ß-blocker decompensation, major cardiovascular events, and pharmaceutical economic indicators were rarely reported. The evaluation was one-sided. The low quality of the included articles reduced the reliability of the findings. In the future, the clinical use of medicines should be standardized, and the quality of clinical studies should be improved. Comprehensive clinical evaluation should be carried out to provide a sound scientific basis for the treatment of premature ventricular contractions with Chinese patent medicines.


Assuntos
Medicamentos de Ervas Chinesas , Medicina Tradicional do Leste Asiático , Complexos Ventriculares Prematuros , Humanos , Complexos Ventriculares Prematuros/tratamento farmacológico , Medicamentos sem Prescrição/uso terapêutico , Reprodutibilidade dos Testes , Medicamentos de Ervas Chinesas/uso terapêutico , Cápsulas
2.
PLoS One ; 19(4): e0297551, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38593145

RESUMO

Arrhythmia is a life-threatening cardiac condition characterized by irregular heart rhythm. Early and accurate detection is crucial for effective treatment. However, single-lead electrocardiogram (ECG) methods have limited sensitivity and specificity. This study propose an improved ensemble learning approach for arrhythmia detection using multi-lead ECG data. Proposed method, based on a boosting algorithm, namely Fine Tuned Boosting (FTBO) model detects multiple arrhythmia classes. For the feature extraction, introduce a new technique that utilizes a sliding window with a window size of 5 R-peaks. This study compared it with other models, including bagging and stacking, and assessed the impact of parameter tuning. Rigorous experiments on the MIT-BIH arrhythmia database focused on Premature Ventricular Contraction (PVC), Atrial Premature Contraction (PAC), and Atrial Fibrillation (AF) have been performed. The results showed that the proposed method achieved high sensitivity, specificity, and accuracy for all three classes of arrhythmia. It accurately detected Atrial Fibrillation (AF) with 100% sensitivity and specificity. For Premature Ventricular Contraction (PVC) detection, it achieved 99% sensitivity and specificity in both leads. Similarly, for Atrial Premature Contraction (PAC) detection, proposed method achieved almost 96% sensitivity and specificity in both leads. The proposed method shows great potential for early arrhythmia detection using multi-lead ECG data.


Assuntos
Fibrilação Atrial , Complexos Atriais Prematuros , Complexos Ventriculares Prematuros , Humanos , Fibrilação Atrial/diagnóstico , Complexos Ventriculares Prematuros/diagnóstico , Eletrocardiografia/métodos , Algoritmos , Complexos Atriais Prematuros/diagnóstico , Aprendizado de Máquina
3.
Clin Cardiol ; 47(4): e24266, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38587231

RESUMO

BACKGROUND: Electrocardiography (ECG) and 24 hours Holter monitoring (24 h-Holter) provided valuable information for premature ventricular and supraventricular contractions (PVC and PSVC). Currently, artificial intelligence (AI) based 2 hours single-lead Holter (2 h-Holter) monitoring may provide an improved strategy for PSVC/PVC diagnosis. HYPOTHESIS: AI combined with single-lead Holter monitoring improves PSVC/PVC detection. METHODS: In total, 170 patients were enrolled between August 2022 and 2023. All patients wore both devices simultaneously; then, we compared diagnostic efficiency, including the sensitivity/specificity/positive predictive-value (PPV) and negative predictive-value (NPV) in detecting PSVC/PVC by 24 h-Holter and 2 h-Holter. RESULTS: The PPV and NPV in patients underwent 2 h-Holter were 76.00%/87.50% and 96.35%/98.55, respectively, and the sensitivity and specificity were 79.17%/91.30%, and 95.65%/97.84% in PSVC/PVC detection compared with 24 h-Holter. The areas under the ROC curves (AUCs) for PSVC and PVC were 0.885 and 0.741, respectively (p < .0001). CONCLUSIONS: The potential advantages of the 2 h-Holter were shortened wearing period, improved convenience, and excellent consistency of diagnosis.


Assuntos
Eletrocardiografia Ambulatorial , Complexos Ventriculares Prematuros , Humanos , Inteligência Artificial , Complexos Ventriculares Prematuros/diagnóstico , Eletrocardiografia , Valor Preditivo dos Testes
6.
Muscle Nerve ; 69(5): 572-579, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38426616

RESUMO

INTRODUCTION/AIMS: Duchenne muscular dystrophy (DMD) is characterized by fibrofatty replacement of muscle. This has been documented in the ventricular myocardium of DMD patients, but there is limited description of atrial involvement. The purpose of this study is to examine the arrhythmia and ectopy burden in patients with DMD and non-DMD dilated cardiomyopathy (DCM) and to characterize the cardiac histopathologic changes in DMD patients across the disease spectrum. METHODS: This was a retrospective analysis of age-matched patients with DMD and non-DMD DCM who received a Holter monitor and cardiac imaging within 100 days of each other between 2010 and 2020. Twenty-four-hour Holter monitors were classified based on the most recent left ventricular ejection fraction at the time of monitoring. Cardiac histopathologic specimens from whole-heart examinations at the time of autopsy from three DMD patients and one DCM patient were reviewed. RESULTS: A total of 367 patients with 1299 Holter monitor recordings were included over the study period, with 94% representing DMD patients and 6% non-DMD DCM. Patients with DMD had more atrial ectopy across the cardiac function spectrum (p < 0.05). There was no difference in ventricular ectopy. Four DMD patients developed symptomatic atrial arrhythmias. Autopsy specimens from DMD patients demonstrated fibrofatty infiltration of both atrial and ventricular myocardium. DISCUSSION: The atrial myocardium in patients with DMD is unique. Autopsy specimens reveal fibofatty replacement of the atrial myocardium, which may be a nidus for both ectopy and arrhythmias in DMD patients.


Assuntos
Cardiomiopatia Dilatada , Distrofia Muscular de Duchenne , Complexos Ventriculares Prematuros , Humanos , Lactente , Distrofia Muscular de Duchenne/complicações , Volume Sistólico , Estudos Retrospectivos , Função Ventricular Esquerda
7.
J Med Internet Res ; 26: e46098, 2024 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-38512332

RESUMO

BACKGROUND: Wearable electrocardiogram (ECG) monitoring devices are used worldwide. However, data on the diagnostic yield of an adhesive single-lead ECG patch (SEP) to detect premature ventricular complex (PVC) and the optimal duration of wearing an SEP for PVC burden assessment are limited. OBJECTIVE: We aimed to validate the diagnostic yield of an SEP (mobiCARE MC-100, Seers Technology) for PVC detection and evaluate the PVC burden variation recorded by the SEP over a 3-day monitoring period. METHODS: This is a prospective study of patients with documented PVC on a 12-lead ECG. Patients underwent simultaneous ECG monitoring with the 24-hour Holter monitor and SEP on the first day. On the subsequent second and third days, ECG monitoring was continued using only SEP, and a 3-day extended monitoring was completed. The diagnostic yield of SEP for PVC detection was evaluated by comparison with the results obtained on the first day of Holter monitoring. The PVC burden monitored by SEP for 3 days was used to assess the daily and 6-hour PVC burden variations. The number of patients additionally identified to reach PVC thresholds of 10%, 15%, and 20% during the 3-day extended monitoring by SEP and the clinical factors associated with the higher PVC burden variations were explored. RESULTS: The recruited data of 134 monitored patients (mean age, 54.6 years; males, 45/134, 33.6%) were analyzed. The median daily PVC burden of these patients was 2.4% (IQR 0.2%-10.9%), as measured by the Holter monitor, and 3.3% (IQR 0.3%-11.7%), as measured in the 3-day monitoring by SEP. The daily PVC burden detected on the first day of SEP was in agreement with that of the Holter monitor: the mean difference was -0.07%, with 95% limits of agreement of -1.44% to 1.30%. A higher PVC burden on the first day was correlated with a higher daily (R2=0.34) and 6-hour burden variation (R2=0.48). Three-day monitoring by SEP identified 29% (12/42), 18% (10/56), and 7% (4/60) more patients reaching 10%, 15%, and 20% of daily PVC burden, respectively. Younger age was additionally associated with the identification of clinically significant PVC burden during the extended monitoring period (P=.02). CONCLUSIONS: We found that the mobiCARE MC-100 SEP accurately detects PVC with comparable diagnostic yield to the 24-hour Holter monitor. Performing 3-day PVC monitoring with SEP, especially among younger patients, may offer a pragmatic alternative for identifying more individuals exceeding the clinically significant PVC burden threshold.


Assuntos
Complexos Ventriculares Prematuros , Masculino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Complexos Ventriculares Prematuros/diagnóstico , Eletrocardiografia , Eletrocardiografia Ambulatorial , Tecnologia
8.
Europace ; 26(3)2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38466042

RESUMO

AIMS: Premature ventricular contractions (PVC) and non-sustained ventricular tachycardia (NSVT) are commonly observed in light chain cardiac amyloidosis (AL-CA), but their association with prognosis is still unclear. We aimed to evaluate the prognostic value of PVCs and NSVT in patients with moderate-to-advanced AL-CA. METHODS AND RESULTS: We retrospectively included patients with AL-CA at modified 2004 Mayo stages II-IIIb between February 2014 and December 2020. Twenty-four-hour Holter recordings were assessed on admission. The outcomes included (i) new onset of adverse ventricular arrhythmia (VA) or sudden cardiac death (SCD) and (ii) cardiac death during follow-up. Of the 143 patients studied (60.41 ± 11.06 years, male 64.34%), 132 (92.31%) had presence of PVC, and 50 (34.97%) had NSVT on Holter. Twelve (8.4%) patients died in hospital and 131 patients were followed up (median 24.4 months), among whom 71 patients had cardiac death, and 15 underwent adverse VA/SCD. NSVT [hazard ratio (HR): 13.57, 95% confidence interval (CI): 3.06-60.18, P < 0.001], log-transformed PVC counts (HR: 1.46, 95%CI: 1.15-1.86, P = 0.002) and PVC burden (HR: 1.43 95%CI:1.14-1.80, P = 0.002) were predictive of new onset of adverse VA/SCD. The highest tertile of PVC counts (HR: 2.33, 95%CI: 1.27-4.28, P = 0.006) and PVC burden (HR: 2.58, 95%CI: 1.42-4.69, P = 0.002), rather than NSVT (HR: 1.16, 95%CI: 0.67-1.98, P = 0.603), was associated with cardiac death. Higher PVC counts/burden provided incremental value on modified 2004 Mayo stage in predicting cardiac death, with C index increasing from 0.681 to 0.712 and 0.717, respectively (P values <0.05). CONCLUSION: PVC count, burden, and NSVT significantly correlated with adverse VA/SCD during follow-up in patients with AL-CA. Higher PVC counts/burdens added incremental value for predicting cardiac death.


Assuntos
Taquicardia Ventricular , Complexos Ventriculares Prematuros , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Eletrocardiografia Ambulatorial , Morte Súbita Cardíaca
9.
Clin Cardiol ; 47(3): e24250, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38450791

RESUMO

BACKGROUND: Catheter ablation has become one of the main treatment strategies in patients with premature ventricular complexes (PVC). The successful mapping and ablation can be performed with an ablation catheter without additional diagnostic catheters. HYPOTHESIS: We hypothesize that using a single catheter for PVC ablation may decrease complications, procedure time, and fluoroscopy exposure while maintaining comparable success rates. METHODS: Sixty-nine consecutive patients with PVC were treated with a single catheter approach compared to a historical cohort, in which a conventional setup was used. Propensity score matching was conducted with a 1:1 ratio. Outcome parameters included acute procedural success with elimination of all premature ventricular contractions after catheter ablation, procedural data as well as complication rates. RESULTS: Patients treated with a single catheter approach had shorter total procedure (60 minutes [IQR: 47,5-69,0 minutes] vs. 90 minutes [IQR 60-120 minutes]; p = 0.001) and fluoroscopy times (218 seconds [IQR: 110,5-446 seconds] vs. 310 seconds [IQR 190-640 seconds]; p = 0.012), which consecutively leads to a reduction of radiation exposure signified by a lower dose area product (155 cGycm² [IQR 74.4-334.5 cGycm²] vs. 368.4 cGycm² [IQR: 126-905.4 cGycm²]; p value 0.009). Acute procedural success rates were comparable in both groups (54 [84.3%] in the single catheter approach group and 58 [90.6%] in the conventional group; p: 0.287). CONCLUSION: A single catheter approach for the treatment of PVC is associated with a reduction of procedure- and fluoroscopy time, as well as a lesser radiation exposure, while maintaining equivalent acute success and complication rates compared with a conventionally used catheter setup.


Assuntos
Ablação por Cateter , Complexos Ventriculares Prematuros , Humanos , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/cirurgia , Ablação por Cateter/efeitos adversos , Cateteres , Fluoroscopia , Pontuação de Propensão
11.
Int J Cardiol ; 401: 131849, 2024 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-38360096

RESUMO

BACKGROUND: Variants in Filamin-C (FLNC) have been associated with various hereditary cardiomyopathies. Recent literature reports a prevalence of sudden cardiac death (SCD) of 13-25% among carriers of truncating-variants, with mean age of 42±15 years for first SCD event. This study reports two familial cases of SCD and the results of cascade screening of their large family. METHODS: Molecular-autopsy of the SCD victims revealed a novel truncating-variant in the FLNC gene (chr 7:128496880 [hg19]; NM_001458.5; c.7467_7474del; p.(Ser2490fs)). We screened thirty-two family members following genetic counseling, and variant carriers underwent a comprehensive workup followed by consultation with a cardiologist with expertise in the genetics of cardiac diseases. RESULTS: Seventeen variant carriers were identified: ages between 9 and 85 (mean 47±26). Fifteen underwent clinical evaluation. To date, none of the identified carriers has had major adverse events. In evaluated patients, ECG showed right-axis deviation in 60% (n = 9). Holter recorded frequent premature ventricular contractions (PVCs) (991±2030 per 24 h) in 33% (n = 5) with 4 patients having polymorphic PVC morphology. Three carriers had echocardiographic evidence of mild left-ventricular (LV) systolic dysfunction and another with mild LV dilatation. Cardiac magnetic-resonance (CMR) exhibited late­gadolinium-enhancement in 10 out of 11 exams, mainly in the mid-myocardium and sub-epicardium, frequently involving the septum and the inferior-lateral wall. CONCLUSION: This large FLNC truncating variant carrier family exhibits high cardiomyopathy penetrance, best diagnosed by CMR, with variable clinical expressions. These findings present a challenge in SCD prevention management and underscoring the imperative for better risk stratification measures.


Assuntos
Cardiomiopatias , Complexos Ventriculares Prematuros , Humanos , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Mutação/genética , Filaminas/genética , Cardiomiopatias/genética , Miocárdio , Morte Súbita Cardíaca
12.
J Cardiovasc Med (Hagerstown) ; 25(4): 327-333, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38358902

RESUMO

BACKGROUND: Transcatheter aortic valve implantation (TAVI) has become a largely used treatment for severe aortic stenosis. There are limited data, however, about predictors of long-term prognosis in this population. In this study, we assessed whether ventricular arrhythmias may predict clinical outcomes in patients undergoing TAVI. METHODS AND RESULTS: We performed a 24 h ECG Holter monitoring in 267 patients who underwent TAVI for severe aortic stenosis within 30 days from a successful procedure. The occurrence of frequent premature ventricular complexes (PVCs; ≥30/h), polymorphic PVCs and nonsustained ventricular tachycardia (NSVT) was obtained for each patient. Clinical outcome was obtained for 228 patients (85%), for an average follow-up of 3.5 years (range 1.0-8.6). Cardiovascular events (CVEs; cardiovascular death or resuscitated cardiac arrest) occurred in 26 patients (11.4%) and 63 patients died (27.6%). Frequent PVCs but not polymorphic PVCs and NSVT were found to be associated with CVEs at univariate analysis. Frequent PVCs were indeed found in 12 patients with (46.2%) and 35 without (17.3%) CVEs [hazard ratio 2.30; 95% confidence interval (CI) 1.03-5.09; P  = 0.04], whereas polymorphic PVCs were found in 11 (42.3%) and 54 (26.7%) patients of the two groups, respectively (hazard ratio 1.44; 95% CI 0.64-3.25; P  = 0.38), and NSVT in 9 (34.6%) and 43 patients of the two groups, respectively (hazard ratio 1.18; 95% CI 0.48-2.87; P  = 0.72). Frequent PVCs, however, were not significantly associated with CVEs at multivariate Cox regression analysis (hazard ratio 1.53; 95% CI 0.37-6.30; P  = 0.56). Both frequent PVCs, polymorphic PVCs and NSVT showed no significant association with mortality. CONCLUSION: In our study, the detection of frequent PVCs at Holter monitoring after TAVI was a predictor of CVEs (cardiovascular death/cardiac arrest), but this association was lost in multivariable analysis.


Assuntos
Estenose da Valva Aórtica , Parada Cardíaca , Taquicardia Ventricular , Substituição da Valva Aórtica Transcateter , Complexos Ventriculares Prematuros , Humanos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/epidemiologia , Complexos Ventriculares Prematuros/etiologia , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/epidemiologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/etiologia , Parada Cardíaca/diagnóstico , Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Resultado do Tratamento , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia
14.
Echocardiography ; 41(2): e15768, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38411224

RESUMO

Peripheral venous stent migration is an exceedingly rare complication of endovascular stenting. In this clinical vignette, we present a case of a 74-year-old male with a history of endo-venous laser ablation therapy of the right greater saphenous vein complicated with an occlusion requiring a left iliac vein stent. The patient presented to the clinic months after the procedure with complaints of palpitations. Multimodality imaging revealed a stent that had become dislodged and was now located in the right ventricle, trapped within the tricuspid valve apparatus.


Assuntos
Embolia , Doenças Vasculares , Complexos Ventriculares Prematuros , Masculino , Humanos , Idoso , Ventrículos do Coração/diagnóstico por imagem , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/cirurgia , Stents/efeitos adversos , Resultado do Tratamento , Estudos Retrospectivos
16.
Medicina (Kaunas) ; 60(2)2024 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-38399501

RESUMO

Background and Objectives: Depression in childhood often co-occurs with anxiety disorders and a range of somatic symptoms. Recent studies have identified physical activity as a target for preventing the onset of depression. However, idiopathic ventricular extrasystoles (VEs) in children are sometimes associated with somatic symptoms and limitations in physical activity. The occurrence of arrhythmia can also be distressing for children and their parents. This study was conducted to determine the relationship between symptoms of depression, physical activity, and somatic symptoms in children with idiopathic VE. Materials and Methods: This study of children with structurally normal hearts and VE was approved by the local ethics committee (no. 2021/10-1383-859(1). The authors designed a questionnaire to assess symptoms, physical activity, and general well-being. As part of that, symptoms of depression were evaluated with a modified pediatric PHQ-9 (MP-PHQ-9) questionnaire, with scores ≤4 for no, 5-9 for mild, 10-14 for moderate, and ≥15 for severe depression. Children aged ≥12 years and parents who assessed their children's condition completed the questionnaires. All children also underwent 24-h electrocardiography and echocardiography to evaluate arrhythmia frequency and cardiac condition. Results: Questionnaires were completed by 60 children's parents and 39 children (≥12 years old). The median children's age was 13 years. Palpitations were experienced by 26 (43.3%), chest pain by 13 (21.7%), and exercise intolerance by 15 (25%) children. All patients had normal ventricular function and hemodynamically normal hearts. The median score of the MP-PHQ-9 completed by parents was 2, and by children was 4. The median VE frequency was 4.77 (0.1-32.77) % per 24 h. We found that 31 (51.7%) children engaged in extra-sports participation with a median time of 3.75 h per week. Eleven of the children were suspended from sports. There was no significant difference between VE frequency and MP-PHQ-9 scores. Higher MP-PHQ-9 scores were noted for symptomatic children who engaged in <5 h per week of physical activity. Conclusions: Higher depression scores were found for children with somatic symptoms than those without symptoms. Children who were physically active for less than 5 h per week also had higher depression risk scores than those who were more active. Our research has shown that parents underestimate the signs of depression in their children.


Assuntos
Sintomas Inexplicáveis , Complexos Ventriculares Prematuros , Humanos , Criança , Depressão/epidemiologia , Complexos Ventriculares Prematuros/complicações , Pais , Exercício Físico , Inquéritos e Questionários
17.
Comput Biol Med ; 170: 108072, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38301518

RESUMO

The scarcity of annotated data is a common issue in the realm of heartbeat classification based on deep learning. Transfer learning (TL) has emerged as an effective strategy for addressing this issue. However, current TL techniques in this realm overlook the probability distribution differences between the source domain (SD) and target domain (TD) databases. The motivation of this paper is to address the challenge of labeled data scarcity at the model level while exploring an effective method to eliminate domain discrepancy between SD and TD databases, especially when SD and TD are derived from inconsistent tasks. This study proposes a multi-module heartbeat classification algorithm. Initially, unsupervised feature extractors are designed to extract rich features from unlabeled SD and TD data. Subsequently, a novel adaptive transfer method is proposed to effectively eliminate domain discrepancy between features of SD for pre-training (PTF-SD) and features of TD for fine-tuning (FTF-TD). Finally, the adapted PTF-SD is employed to pre-train a designed classifier, and FTF-TD is used for classifier fine-tuning, with the objective of evaluating the algorithm's performance on the TD task. In our experiments, MNIST-DB serves as the SD database for handwritten digit image classification task, MIT-DB as the TD database for heartbeat classification task. The overall accuracy of classifying heartbeats into normal heartbeats, supraventricular ectopic beats (SVEBs), and ventricular ectopic beats (VEBs) reaches 96.7 %. Specifically, the sensitivity (Sen), positive predictive value (PPV), and F1 score for SVEBs are 0.802, 0.701, and 0.748, respectively. For VEBs, Sen, PPV, and F1 score are 0.976, 0.840, and 0.903, respectively. The results indicate that the proposed multi-module algorithm effectively addresses the challenge labeled data scarcity in heartbeat classification through unsupervised learning and adaptive feature transfer methods.


Assuntos
Aprendizado de Máquina não Supervisionado , Complexos Ventriculares Prematuros , Humanos , Frequência Cardíaca , Eletrocardiografia/métodos , Processamento de Sinais Assistido por Computador , Algoritmos
18.
BMJ Open ; 14(2): e081815, 2024 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-38382956

RESUMO

OBJECTIVES: Radiofrequency catheter ablation is the first-line treatment for idiopathic premature ventricular complexes (PVCs) and ventricular tachycardias (VTs). However, the outcomes were less compared among the categories. The study aims to assess the effectiveness and safety of catheter ablation for idiopathic PVC/VTs in a single high-volume centre, using the right ventricular outflow tract (RVOT) as a reference. DESIGN: Retrospective cohort study. SETTING: Patient data were collected from a tertiary hospital in Guizhou, China. PARTICIPANTS: Between September 2013 and September 2022, 1028 patients (male: 41.3%; age: 46.5±15.6 years) who underwent the first catheter ablation for idiopathic monomorphic PVC/VTs were enrolled. OUTCOME MEASURES: Acute success, procedure-related complications, and long-term recurrence were assessed. Antiarrhythmic drugs (AADs) were not administrated after procedures unless recurrence was identified. RESULTS: The overall acute success rate was 90.3%, with 368 patients (35.8%) experiencing left ventricular PVC/VTs. No cases of third-degree atrioventricular block or death were reported. Complications were more common in patients with left ventricular PVC/VTs than those with right-sided ones (4.6% vs 0.1%, p<0.001). A total of 926 patients (90.1%) were followed up for an average of 9.7±3.7 months, and only the PVC/VTs category was found to be associated with long-term success rates. The RVOT, endocardial left ventricular outflow tract (endoLVOT), tricuspid annulus (TA) free wall, posterior septum and fascicular VT had long-term success rates exceeding 85%. Other types of PVC/VTs showed significantly higher risks of recurrence. CONCLUSIONS: Besides RVOT and fascicular VT, single-procedure catheter ablation without AADs is highly effective for endoLVOT, TA-free wall and posterior septum. Patients with left ventricular PVC/VTs have higher complication risks compared with right ones.


Assuntos
Ablação por Cateter , Taquicardia Ventricular , Complexos Ventriculares Prematuros , Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Estudos Retrospectivos , Eletrocardiografia , Taquicardia Ventricular/etiologia , Complexos Ventriculares Prematuros/cirurgia , Complexos Ventriculares Prematuros/complicações , Antiarrítmicos/uso terapêutico , Ablação por Cateter/métodos , Resultado do Tratamento
19.
Eur J Prev Cardiol ; 31(4): 486-495, 2024 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-38198223

RESUMO

AIMS: Right bundle branch block (RBBB) morphology non-sustained ventricular arrhythmias (VAs) have been associated with the presence of non-ischaemic left ventricular scar (NLVS) in athletes. The aim of this cross-sectional study was to identify clinical and electrocardiogram (ECG) predictors of the presence of NLVS in athletes with RBBB VAs. METHODS AND RESULTS: Sixty-four athletes [median age 39 (24-53) years, 79% males] with non-sustained RBBB VAs underwent cardiac magnetic resonance (CMR) with late gadolinium enhancement in order to exclude the presence of a concealed structural heart disease. Thirty-six athletes (56%) showed NLVS at CMR and were assigned to the NLVS positive group, whereas 28 athletes (44%) to the NLVS negative group. Family history of cardiomyopathy and seven different ECG variables were statistically more prevalent in the NLVS positive group. At univariate analysis, seven ECG variables (low QRS voltages in limb leads, negative T waves in inferior leads, negative T waves in limb leads I-aVL, negative T waves in precordial leads V4-V6, presence of left posterior fascicular block, presence of pathologic Q waves, and poor R-wave progression in right precordial leads) proved to be statistically associated with the finding of NLVS; these were grouped together in a score. A score ≥2 was proved to be the optimal cut-off point, identifying NLVS athletes in 92% of cases and showing the best accuracy (86% sensitivity and 100% specificity, respectively). However, a cut-off ≥1 correctly identified all patients with NLVS (absence of false negatives). CONCLUSION: In athletes with RBBB morphology non-sustained VAs, specific ECG abnormalities at 12-lead ECG can help in detecting subjects with NLVS at CMR.


In athletes with right bundle branch block (RBBB) morphology non-sustained ventricular arrhythmias (VAs), the presence of a non-ischaemic left ventricular scar (NLVS) may be highly suspected if one or more of the following electrocardiogram (ECG) characteristics are present at the 12-lead resting ECG: low QRS voltages in limb leads, negative T waves in inferior leads, negative T waves in limb leads I­aVL, negative T waves in precordial leads V4­V6, presence of left posterior fascicular block, presence of pathologic Q waves, and poor R-wave progression in right precordial leads. This score should be externally validated in a larger population of athletes with VAs. In athletes with RBBB morphology non-sustained Vas, attention should be placed on the 12-lead resting ECG to suspect the presence of an NLVS. In athletes with RBBB VAs and the presence of one or more of the identified ECG characteristics, a cardiac magnetic resonance with late gadolinium enhancement is useful to rule out an NLVS.


Assuntos
Bloqueio de Ramo , Complexos Ventriculares Prematuros , Masculino , Humanos , Adulto , Feminino , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/etiologia , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/etiologia , Cicatriz/patologia , Meios de Contraste , Estudos Transversais , Gadolínio , Eletrocardiografia
20.
Biomed Phys Eng Express ; 10(2)2024 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-38277702

RESUMO

Background. Magnetocardiography (MCG) is a non-invasive and non-contact technique that measures weak magnetic fields generated by the heart. It is highly effective in the diagnosis of heart abnormalities. Multichannel MCG provides detailed spatio-temporal information of the measured magnetic fields. While multichannel MCG systems are costly, usage of the optimal number of measurement channels to characterize cardiac magnetic fields without any appreciable loss of signal information would be economically beneficial and promote the widespread use of MCG technology.Methods. An optimization method based on the sequential selection approach is used to choose channels containing the maximum signal information while avoiding redundancy. The study comprised 40 healthy individuals, along with two subjects having ischemic heart disease and one subject with premature ventricular contraction. MCG measured using a 37 channel MCG system. After revisiting the existing methods of optimization, the mean error and correlation of the optimal set of measurement channels with those of all 37 channels are evaluated for different sets, and it has been found that 18 channels are adequate.Results. The chosen 18 optimal channels exhibited a strong correlation (0.99 ± 0.006) between the original and reconstructed magnetic field maps for a cardiac cycle in healthy subjects. The root mean square error is 0.295 pT, indicating minimal deviation.Conclusion. This selection method provides an efficient approach for choosing MCG, which could be used for minimizing the number of channels as well as in practical unforeseen measurement conditions where few channels are noisy during the measurement.


Assuntos
Magnetocardiografia , Complexos Ventriculares Prematuros , Humanos , Magnetocardiografia/métodos , Análise Custo-Benefício , Coração , Eletrocardiografia
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