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2.
Adv Clin Exp Med ; 30(3): 279-288, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33754502

RESUMO

BACKGROUND: Prediction of sudden cardiac death remains a significant challenge. There is some evidence that ventricular ectopic activity could be regarded as a predictive marker. OBJECTIVES: We carried out an analysis to explore whether premature ventricular complexes (PVCs) are a risk factor in implantable cardioverter-defibrillator (ICD) interventions. MATERIAL AND METHODS: The study method was a RR interval series analysis (n = 184) of arrhythmic events and controls from the ICD. Study group consisted of patients with a mean age of 55 ±27 years; 74% of them were male, 85% were secondary prevention patients, 62% had coronary artery disease (CAD), 15% hypertropic cardiomyopathy (HCM), 15% dilated cardiomyopathy (DCM), and 8% diseases of other etiology. The mean follow-up time was 64 months (range: 3-126 months). The study population was divide into patients with at least 1 appropriate intervention ventricular tachycardia/ventricular fibrillation (VT/VF) (group A, n = 101) and controls without interventions (group B, n = 83). The number of PVC/4000 RR cycles, the shortest coupling intervals between a PVC and preceding R as well as the number of PVCs of very short (180-220 ms), short (220-280 ms) and different cycle lengths (CL) as well as the incidence of short-long-short (SLS) sequences were compared. RESULTS: The number of PVCs/4000 RR cycles was significantly higher in group A (263 ±32 compared to 43 ±17, p < 0.0001). The mean shortest PVC CL was significantly shorter in group A (320 ±13 compared to 400 ±38, p = 0.029). The number of PVCs with a very short CL was 1 ±0.4 compared to 0.1 ±0.1 (p = 0.028). The number of PVCs with a short CL was 5 ±1.2 compared to 0.6 ±0.4 (p = 0.0007) in groups A and B, respectively. The incidence of SLS sequences was significantly higher in group A than in group B (67 (94% of patients) and 4 (33% of patients) respectively (p < 0.0001)). CONCLUSIONS: Significant differences were found in the characteristics of PVCs and SLS sequences between patients with appropriate ICD interventions and controls. A newly developed basic computer program called PCRR was applied for RR interval analysis. This simple method could be a predictor of PVC burden and life-threatening arrhythmias in different populations.


Assuntos
Desfibriladores Implantáveis , Taquicardia Ventricular , Complexos Ventriculares Prematuros , Adulto , Idoso , Idoso de 80 Anos ou mais , Morte Súbita Cardíaca/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Taquicardia Ventricular/terapia , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/terapia , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/terapia
3.
Herzschrittmacherther Elektrophysiol ; 32(1): 14-20, 2021 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-33523285

RESUMO

Premature ventricular contractions (PVC) are very common arrhythmias in cardiology. In structural normal hearts they usually represent a benign entity. If the ECG morphology is not consistent with idiopathic PVC, further diagnostic workup should be performed. They can occur due to structural heart disease and may be associated with sudden cardiac death. Polymorphic PVC or a high PVC burden should also always lead to further diagnostics and an individual risk-stratification. Therapeutic options include drug therapy and invasive catheter ablation.


Assuntos
Ablação por Cateter , Cardiopatias , Complexos Ventriculares Prematuros , Morte Súbita Cardíaca/prevenção & controle , Humanos , Prognóstico , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/cirurgia
4.
Herzschrittmacherther Elektrophysiol ; 32(1): 27-32, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33533994

RESUMO

A high premature ventricular contraction (PVC) burden is associated with an increase in cardiovascular mortality and may become clinically apparent through palpitations, reduced physical capacity or PVC-induced cardiomyopathy. Catheter ablation has been shown to be a more effective tool to treat patients with a high PVC burden than medical therapy alone. Current recommendations list catheter ablation as a class I option in patients with symptomatic idiopathic outflow tract PVCs as well as in patients with suspected PVC-induced cardiomyopathy. Careful planning is necessary to maximize efficiency and outcome of the ablation procedure. Prediction of the most likely PVC origin by studying the 12-lead electrocardiogram (ECG) is important. A high burden of spontaneous PVCs is associated with a better outcome during and after the procedure; pharmacological provocation can be performed. Developments in high density mapping systems have greatly advanced accuracy and efficiency of arrhythmia mapping in recent years. Different systems are now available that allow the simultaneous use and integration of different mapping information in an automated manner. Voltage mapping, activation mapping and pace mapping are used in clinical practice today. Activation mapping is used to visualize the area of earliest activation. While it is a very accurate tool, it relies on a high burden of spontaneous PVCs. Pace mapping aims to find the target area by means of stimulation and comparison of paced QRS complexes with the clinical PVC. Today, mostly a combination of both methods is used to maximize procedure outcome and efficiency. While voltage mapping plays a primary role in the mapping of substrate-based sustained arrhythmias in patients with underlying structural heart disease, activation and pace mapping are the methods of choice for PVC mapping.


Assuntos
Cardiomiopatias , Ablação por Cateter , Complexos Ventriculares Prematuros , Eletrocardiografia , Humanos , Resultado do Tratamento , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/cirurgia
5.
Herzschrittmacherther Elektrophysiol ; 32(1): 21-26, 2021 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-33533995

RESUMO

The advances in imaging and 3D mapping systems in the last decade allowed a better correlation of ventricular premature contractions (PVCs) with anatomical structures. With regard to PVCs, interpretation of the 12-lead ECG is still crucial for the management of patients and the planning of therapies. Although there is an armamentarium of indices and algorithms to exactly pinpoint the origin of a PVC in advance, a thorough understanding of cardiac anatomy and impulse propagation, together with an awareness of the surface ECGs limitations, provides a sufficiently close approximation. PVCs from the diaphragmatic part of the ventricular cavae exhibit a superiorly directed axis, whereas PVCs from superior parts of the heart show an inferior axis. A right bundle branch block morphology or positive concordance of the precordial leads yields a high probability of left ventricular origin of a PVC. A left bundle branch block morphology is indicative of a right ventricular or septal origin of a PVC. Using the transition zone, one can estimate the origin of a PVC with regard to anterior or posterior regions of the heart: A late precordial transition is indicative of a right ventricular origin, an early precordial transition suggests a left ventricular focus. An absent transition in the sense of negative concordance is indicative for an apical origin. The intertwined course of the ventricular outflow tracts makes PVC localization more difficult. Here, shape and height of the R­wave in V1-V3 help to narrow the origin down. PVCs from structures like the papillary muscles, the moderator band or infundibular bands are challenging to interpret and evidence of the limitations of the surface ECG. Based on the information gained by the aforementioned approach, a prediction of prognosis and possible treatment success is possible.


Assuntos
Ablação por Cateter , Taquicardia Ventricular , Complexos Ventriculares Prematuros , Bloqueio de Ramo , Eletrocardiografia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Taquicardia Ventricular/cirurgia , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/cirurgia
6.
Herzschrittmacherther Elektrophysiol ; 32(1): 48-53, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33507368

RESUMO

The prevalence of congenital heart disease (CHD) is estimated to be almost one in 100 newborns, with > 90% of patients with CHD surviving into adulthood due to medical and surgical advances in recent decades. The rationale for treatment of ventricular premature beats (VPBs) in the general population without underlying structural heart disease is mainly based on the presence of symptoms and/or the risk for developing VPB-induced cardiomyopathy in patients with very frequent VPBs. In CHD, the same general principles apply, but the clinical picture is often more complicated due to the presence of symptoms and/or systolic dysfunction resulting from the underlying heart disease itself. Sudden cardiac death due to ventricular arrhythmias is a major concern in the CHD population, although its incidence is relatively low (<0.1%/year). Beta-blockers are the first-line medical treatment for CHD patients with VPBs, although no dedicated studies are available on the use of beta-blockers or anti-arrhythmic drugs in patients with CHD for this indication. Catheter ablation has evolved in recent years as an important treatment modality for cardiac arrhythmias, generally showing superior efficacy over medical treatment for most types of arrhythmias. However, recent technological advances have led to improved methods for ablation even in complex underlying anatomical substrates, with possibilities for image fusion between three-dimensional imaging modalities and electroanatomical mapping systems during the procedure. In addition to a discussion of the above, the article also presents two examples of VPB ablation in CHD patients.


Assuntos
Ablação por Cateter , Cardiopatias Congênitas , Complexos Ventriculares Prematuros , Adulto , Morte Súbita Cardíaca , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/terapia , Humanos , Incidência , Recém-Nascido , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/cirurgia
7.
Herzschrittmacherther Elektrophysiol ; 32(1): 41-47, 2021 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-33515111

RESUMO

Cardiac resynchronization therapy (CRT) is an integral part in the treatment of chronic heart failure. However, a high degree of biventricular pacing is essential for the effectiveness of this therapy. In addition to atrial fibrillation, premature ventricular contractions (PVC) are a common cause of reduced biventricular stimulation in CRT. In addition to the prognostically unfavorable reduction of biventricular pacing, PVC are generally associated with reduced outcome in the presence of structural heart disease. Options to increase biventricular stimulation percentage by reprogramming the CRT devices are limited in the majority of cases. Due to the mutual relationship between cardiomyopathy and ventricular arrhythmias, adequate heart failure therapy is essential for the reduction of ventricular ectopy. In addition to beta-blocker therapy, specific antiarrhythmic medication is mostly limited to class III antiarrhythmic drugs due to the structural heart disease usually present in CRT patients. Catheter ablation is superior to pharmacological therapy especially in the field of idiopathic PVC, but promising data are also available for catheter ablation of PVC in structural heart disease and CRT nonresponders.


Assuntos
Terapia de Ressincronização Cardíaca , Insuficiência Cardíaca , Complexos Ventriculares Prematuros , Dispositivos de Terapia de Ressincronização Cardíaca , Insuficiência Cardíaca/terapia , Humanos , Resultado do Tratamento , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/terapia
9.
BMJ Case Rep ; 13(12)2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33334749

RESUMO

Gastrointestinal pathology can cause cardiac symptoms and disorders. We present a case of a patient who had worsening of her palpitations with food intake. She was found to have a high burden of premature ventricular contractions in the setting of hiatal hernia and gastro-oesophageal reflux disease. After extensive investigations and ruling out cardiac causes, her arrhythmia resolved with the surgical correction of hiatal hernia.


Assuntos
Refluxo Gastroesofágico/diagnóstico , Hérnia Hiatal/diagnóstico , Obesidade/complicações , Complexos Ventriculares Prematuros/etiologia , Antagonistas Adrenérgicos beta/uso terapêutico , Diagnóstico Diferencial , Eletrocardiografia , Endoscopia do Sistema Digestório , Feminino , Fundoplicatura , Refluxo Gastroesofágico/etiologia , Hérnia Hiatal/complicações , Hérnia Hiatal/cirurgia , Humanos , Pessoa de Meia-Idade , Síndrome , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/tratamento farmacológico
10.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 337-340, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33017997

RESUMO

In this paper, we propose a technique for detection of premature ventricular complexes (PVC) based on information obtained from single-lead electrocardiogram (ECG) signals. A combination of semisupervised autoencoders and Random Forests models are used for feature extraction and PVC detection. The ECG signal is first denoised using Stationary Wavelet Transforms and denoising convolutional autoencoders. Following this, PVC classification is performed. Individual ECG beat segments along with features derived from three consecutive beats are used to train a hybrid autoencoder network to learn class-specific beat encodings. These encodings, along with the beat-triplet features, are then input to a Random Forests classifier for final PVC classification. Results: The performance of our algorithm was evaluated on ECG records in the MIT-BIH Arrhythmia Database (MITDB) and the St. Petersburg INCART Database (INCARTDB). Our algorithm achieves a sensitivity of 92.67% and a PPV of 95.58% on the MITDB database. Similarly, a sensitivity of 88.08% and a PPV of 94.76% are achieved on the INCARTDB database.


Assuntos
Complexos Ventriculares Prematuros , Algoritmos , Bases de Dados Factuais , Eletrocardiografia , Humanos , Complexos Ventriculares Prematuros/diagnóstico , Análise de Ondaletas
11.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 349-352, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018000

RESUMO

Premature ventricular contraction (PVC) is associated to the risk of ventricular dysfunction and cardiovascular events. Its diagnosis depends on a long-time monitoring, and computational tools for PVC recognition can provide significant assistance to specialists. For this purpose, we present an automatic algorithm for the recognition PVC beat based on long-term 12-lead ECG.A total of 249 patients with PVC were included in this study. Initially, a novel QRS onset detection function was used to automatically extract QRS complexes from massive original ECG data. Then, non-personalized but shared QRS-width features of 12-lead QRS complexes were extracted and fed to a binary classifier based on SVM. In order to verify the model, 17, 512 normal beats and 17, 690 PVC beats extracted from 35 patients were used for training, and another 215 normal beats and 291 PVC beats selected randomly from the remaining 214 patients were used for testing.As a result, the achieved accuracy, sensitivity, specificity in training data and testing data are 98.9%, 98.3%, 99.5% and 97.2%, 97.7%, 96.7%, respectively. The high accuracy of PVC recognition makes it promising to be an efficient technique being used in clinical settings to automatically analyze huge ECG data so as to replace the tedious manual interpretation.


Assuntos
Complexos Ventriculares Prematuros , Algoritmos , Eletrocardiografia , Humanos , Sensibilidade e Especificidade , Complexos Ventriculares Prematuros/diagnóstico
12.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2594-2597, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018537

RESUMO

Detection of Atrial fibrillation (AF) from premature atrial contraction (PAC) and premature ventricular contraction (PVC) is challenging as frequent occurrences of these ectopic beats can mimic the typical irregular patterns of AF. In this paper, we present a preliminary study of using density Poincare plot based machine learning method to detect AF from PAC/PVCs using electrocardiogram (ECG) recordings. First, we propose creation of this new density Poincare plot which is derived from the difference of the heart rate. Next, from this density Poincare plot, template correlation and discrete wavelet transform are used to extract suitable image-based features, which is followed by infinite latent feature selection algorithm to rank the features. Finally, classification of AF vs PAC/PVC is performed using K-Nearest Neighbor, discriminant analysis and support vector machine (SVM) classifiers. Our method is developed and validated using a subset of Medical Information Mart for Intensive Care (MIMIC) III database containing 8 AF and 8 PAC/PVC subjects. Both 10-fold and leave-one-subject-out cross validations are performed to show the robustness of our proposed method. During the 10-fold cross-validation, SVM achieved the best performance with 99.49% sensitivity, 94.51% specificity and 97.29% accuracy with the extracted features while for the leave-one-subject-out, the highest overall accuracy is 90.91%. Moreover, when compared with two state-of-the-art methods, the proposed algorithm achieves superior AF vs. PAC/PVC discrimination performance.Clinical Relevance-This preliminary study shows that with the help of density Poincare plot, AF can be separated from PAC/PVC with better accuracy.


Assuntos
Fibrilação Atrial , Complexos Ventriculares Prematuros , Fibrilação Atrial/diagnóstico , Complexos Atriais Prematuros/diagnóstico , Átrios do Coração , Ventrículos do Coração , Humanos , Complexos Ventriculares Prematuros/diagnóstico
13.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4071-4074, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018893

RESUMO

The aim of our work is to design an algorithm to detect premature atrial contraction (PAC), premature ventricular contraction (PVC), and atrial fibrillation (AF) among normal sinus rhythm (NSR) using smartwatch photoplethysmographic (PPG) data. Novel image processing features and two machine learning methods are used to enhance the PAC/PVC detection results of the Poincaré plot method. Compared with support vector machine (SVM) methods, the Random Forests (RF) method performs better. It yields a 10-fold cross validation (CV) averaged sensitivity, specificity, positive predicted value (PPV), negative predicted value (NPV), and accuracy for PAC/PVC labels of 63%, 98%, 83%, 94%, and 93%, respectively, and a 10-fold CV averaged sensitivity, specificity, PPV, NPV, and accuracy for AF subjects of 92%, 96%, 85%, 98%, and 95%, respectively. This is one of the first studies to derive image processing features from Poincaré plots to further enhance the accuracy of PAC/PVC detection using PPG recordings from a smartwatch.


Assuntos
Fibrilação Atrial , Complexos Ventriculares Prematuros , Fibrilação Atrial/diagnóstico , Complexos Atriais Prematuros , Eletrocardiografia , Humanos , Fotopletismografia , Complexos Ventriculares Prematuros/diagnóstico
15.
Circ Arrhythm Electrophysiol ; 13(5): e008173, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32302210

RESUMO

BACKGROUND: Premature ventricular complex (PVC) with narrow QRS duration originating from proximal left anterior fascicle (LAF) is challenging for ablation. This study was performed to evaluate the safety and feasibility of ablation from right coronary cusp (RCC) for proximal LAF-PVC and to investigate this PVC's characteristics. METHODS: Mapping at RCC and left ventricle and ECG analysis were performed in 20 patients with LAF-PVC. RESULTS: The earliest activation site (EAS), with Purkinje potential during both PVC and sinus rhythm, was localized at proximal LAF in 8 patients (proximal group) and at nonproximal LAF in 12 patients (nonproximal group). The Purkinje potential preceding PVC-QRS at the EAS in proximal group (32.6±2.5 ms) was significantly earlier than that in nonproximal group (28.3±4.5 ms, P=0.025). Similar difference in the Purkinje potentials preceding sinus rhythm QRS at the EAS was also observed between proximal and nonproximal groups (35.1±4.7 versus 25.2±5.0 ms, P<0.001). In proximal group, the distance between the EAS to left His bundle and to RCC was shorter than that of nonproximal group (12.3±2.8 versus 19.7±5.0 mm, P=0.002, and 3.9±0.8 versus 15.7±7.8 mm, P<0.001, respectively). No difference in the distance from RCC to proximal LAF was identified between the 2 groups. PVCs were successfully eliminated from RCC for all proximal groups but at left ventricular EAS for nonproximal groups. The radiofrequency application times, ablation time, and procedure time of nonproximal group were longer than that of proximal group. Electrocardiographic analysis showed that, when compared with nonproximal group, the PVCs of proximal group had narrower QRS duration; smaller S wave in leads I, V5, and V6; lower R wave in leads I, aVR, aVL, V1, V2, and V4; and smaller q wave in leads III and aVF. The QRS duration difference (PVC-QRS and sinus rhythm QRS) <15 ms predicted the proximal LAF origin with high sensitivity and specificity. CONCLUSIONS: PVCs originating from proximal LAF, with unique electrocardiographic characteristics, could be eliminated safely from RCC.


Assuntos
Potenciais de Ação , Ablação por Cateter , Átrios do Coração/cirurgia , Frequência Cardíaca , Complexos Ventriculares Prematuros/cirurgia , Adulto , Fascículo Atrioventricular/fisiopatologia , Ablação por Cateter/efeitos adversos , Eletrocardiografia , Técnicas Eletrofisiológicas Cardíacas , Estudos de Viabilidade , Feminino , Átrios do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Ramos Subendocárdicos/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/fisiopatologia
16.
Sci Data ; 7(1): 98, 2020 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-32251335

RESUMO

Cardiac catheter ablation has shown the effectiveness of treating the idiopathic premature ventricular complex and ventricular tachycardia. As the most important prerequisite for successful therapy, criteria based on analysis of 12-lead ECGs are employed to reliably speculate the locations of idiopathic ventricular arrhythmia before a subsequent catheter ablation procedure. Among these possible locations, right ventricular outflow tract and left outflow tract are the major ones. We created a new 12-lead ECG database under the auspices of Chapman University and Ningbo First Hospital of Zhejiang University that aims to provide high quality data enabling detection of the distinctions between idiopathic ventricular arrhythmia from right ventricular outflow tract to left ventricular outflow tract. The dataset contains 334 subjects who successfully underwent a catheter ablation procedure that validated the accurate origins of idiopathic ventricular arrhythmia.


Assuntos
Eletrocardiografia , Taquicardia Ventricular/diagnóstico , Complexos Ventriculares Prematuros/diagnóstico , Ablação por Cateter , Ventrículos do Coração , Humanos
18.
J Cardiovasc Electrophysiol ; 31(2): 474-484, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31930658

RESUMO

INTRODUCTION: Minimal data exist on the Advisor HD Grid (HDG) catheter and the Precision electroanatomic mapping (EAM) system for ventricular arrhythmia (VA) procedures. Using the HDG catheter, the EAM uses the high-density (HD) wave mapping and best duplicate software to compare the maximum peak-to-peak bipolar voltages within a small zone independent of wavefront direction and catheter orientation. This study aimed to summarize the procedural experience for VAs using the HDG catheter. METHODS: Clinical and procedural characteristics of VA ablation procedures were retrospectively reviewed that used the HDG catheter and the Precision EAM over a 12-month period. RESULTS: A total of 22 patients, 18 with sustained ventricular tachycardia and 4 with premature ventricular contractions were included. Clinically indicated left and/or right ventricular (LV, RV, respectively), and aortic maps were created. LV substrate maps (n = 13) used a median 1700 points (interquartile range [IQR]25%-75% , 1427-2412) out of a median 18 573 (IQR25%-75% , 15 713-41 067) total points collected. RV substrate maps (n = 11) used a median 1435 points (IQR25%-75% , 1114-1871) out of a median 16 005 (IQR25%-75% , 11 063-21 405) total points collected. Total point utilization, used vs collected, was 9%. Mean mapping time was 43 ± 17 minutes (substrate, 34 ± 18 minutes; activation/pace mapping, 9 ± 13 minutes). Acute success was achieved in 56 (86%) and short-term success achieved in 16 patients (73%) at a median follow-up of 145 days (IQR25%-75% , 62-273 days). There were no procedural complications. CONCLUSION: HD wave mapping using the novel HDG catheter integrated with the Precision EAM is safe and feasible in VA procedures in the LV, RV, and aorta. Mapping times are consistent with other multielectrode mapping catheters.


Assuntos
Potenciais de Ação , Cateterismo Cardíaco/instrumentação , Cateteres Cardíacos , Ablação por Cateter/instrumentação , Técnicas Eletrofisiológicas Cardíacas/instrumentação , Frequência Cardíaca , Taquicardia Ventricular/cirurgia , Complexos Ventriculares Prematuros/cirurgia , Adulto , Idoso , Cateterismo Cardíaco/efeitos adversos , Ablação por Cateter/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Processamento de Sinais Assistido por Computador , Software , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/fisiopatologia
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