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1.
Nan Fang Yi Ke Da Xue Xue Bao ; 39(9): 1071-1077, 2019 Sep 30.
Artigo em Chinês | MEDLINE | ID: mdl-31640959

RESUMO

OBJECTIVE: We propose a heartbeat-based end-to-end classification of arrhythmias to improve the classification performance for supraventricular ectopic beat (SVEB) and ventricular ectopic beat (VEB). METHODS: The ECG signals were preprocessed by heartbeat segmentation and heartbeat alignment. An arrhythmia classifier was constructed based on convolutional neural network, and the proposed loss function was used to train the classifier. RESULTS: The proposed algorithm was verified on MIT-BIH arrhythmia database. The AUC of the proposed loss function for SVEB and VEB reached 0.77 and 0.98, respectively. With the first 5 min segment as the local data, the diagnostic sensitivities for SVEB and VEB were 78.28% and 98.88%, respectively; when 0, 50, 100, and 150 samples were used as the local data, the diagnostic sensitivities for SVEB and VEB reached 82.25% and 93.23%, respectively. CONCLUSIONS: The proposed method effectively reduces the negative impact of class-imbalance and improves the diagnostic sensitivities for SVEB and VEB, and thus provides a new solution for automatic arrhythmia classification.


Assuntos
Arritmias Cardíacas/diagnóstico , Eletrocardiografia , Algoritmos , Arritmias Cardíacas/classificação , Frequência Cardíaca , Humanos , Complexos Ventriculares Prematuros/classificação , Complexos Ventriculares Prematuros/diagnóstico
2.
Undersea Hyperb Med ; 46(4): 421-427, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31509898

RESUMO

Introduction: About 26% of diving-related fatalities are caused by cardiac disease, part of which might be associated with fatal arrhythmias. This raises the question as to whether fatal arrhythmias are being provoked by hyperbaric conditions themselves or if exercise or stress provokes the fatal arrhythmias in cases of underlying (ischemic) cardiac disease. Objective: To measure the influence of hyperbaric conditions (50 msw) on cardiac conduction and arrhythmias in professional divers by means of ECG. Methods: This is a prospective study on military divers in a hyperbaric chamber with continuous ECG monitoring using Holter registrations. Supraventricular and ventricular ectopy was registered during hyperbaric conditions. RR, PR, QRS, QT and QTc intervals were calculated at 50 msw and compared with ECGs at rest. Results: Included were 17 male military divers who made 20 dives. A total of 10 PVCs, 45 PACs, four atrial runs and four atrial pairs were seen. Significant prolongation of the PR interval was seen and a decrease of in QRS duration at 50 msw. There was no significant change in the RR, QT and QTc intervals. Conclusion: In these divers, no clinically relevant arrhythmias were observed during wet dives in a recompression chamber at 50 msw. We observed a small prolongation of PR interval that is probably not clinically relevant in divers without any known conduction disorders.


Assuntos
Arritmias Cardíacas/diagnóstico , Mergulho/efeitos adversos , Pressão/efeitos adversos , Adulto , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/fisiopatologia , Descompressão , Mergulho/fisiologia , Eletrocardiografia Ambulatorial/instrumentação , Eletrocardiografia Ambulatorial/métodos , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Militares , Estudos Prospectivos , Água do Mar , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/etiologia , Taquicardia Supraventricular/fisiopatologia , Fatores de Tempo , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/etiologia , Complexos Ventriculares Prematuros/fisiopatologia
3.
Circ Arrhythm Electrophysiol ; 12(6): e007336, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31113232

RESUMO

Background Radiofrequency ablation of intramural ventricular substrate is often limited by insufficient tissue penetration despite high energy settings. As lesion dimensions have a direct and negative relationship to impedance, reducing the baseline impedance may increase the ablation effect on deep ventricular tissue. Methods This study included 16 patients with ventricular tachycardia or frequent ventricular premature complexes refractory to ablation with irrigated catheters. After a failed response to radiofrequency ablation, impedance was modulated by adding or repositioning return patches in an attempt to decrease the circuit impedance. Ablation was repeated at a similar location and power settings, and the effect on arrhythmia suppression and adverse effects were evaluated. Results Six patients with idiopathic ventricular premature complexes originating from the left ventricular summit (n=4) or papillary muscles (n=2), 6 patients with noninfarct related ventricular tachycardia and 4 patients with infarct-related ventricular tachycardia had unsuccessful response to radiofrequency ablation at critical sites (number of applications: 10.4±3.1, power: 42.3±2.9 W, duration: 55.3±25.5 seconds, impedance reduction: 14.6±3.5 Ω, low-ionic solution was used in 81.25%). Modulating the return patches resulted in reduced baseline impedance (111.7±8.2 versus 134.7±6.6 Ω, P<0.0001), increased current output (0.6±0.02 versus 0.56±0.02 Amp; P<0.0001) and greater impedance drop (16.8±3.0 Ω, P<0.001). Repeat ablation at similar locations had a successful effect in 12 out of 16 (75.0%) patients. During a follow-up duration of 13±5 months, 10 out of 12 (83.3%) patients remained free of arrhythmia recurrence. The frequency of steam pops was similar between the higher and lower baseline impedance settings (7.1 versus 8.2%; P=0.74). Conclusions In patients with deep ventricular substrate, reducing the baseline impedance is a simple, safe, and effective technique for increasing the effect of radiofrequency ablation. However, its combination with low-ionic solutions may increase the risk for steam pops and neurological events.


Assuntos
Ablação por Cateter/instrumentação , Ventrículos do Coração/cirurgia , Taquicardia Ventricular/cirurgia , Complexos Ventriculares Prematuros/cirurgia , Potenciais de Ação , Idoso , Ablação por Cateter/efeitos adversos , Impedância Elétrica , Feminino , Frequência Cardíaca , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Intervalo Livre de Progressão , Recidiva , Estudos Retrospectivos , Fatores de Risco , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Fatores de Tempo , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/fisiopatologia
5.
Pac Symp Biocomput ; 24: 42-53, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30864309

RESUMO

The accurate detection of premature ventricular contractions (PVCs) in patients is an important task in cardiac care for some patients. In some cases, the usefulness to physicians in detecting PVCs stems from their long-term correlations with dangerous heart conditions. In other cases their potential as a precursor to serious cardiac events may make their detection a useful early warning mechanism. In many of these applications, the long-term nature of the monitoring required and the infrequency of PVCs make manual observation for PVCs impractical. Existing methods of automated PVC detection suffer from drawbacks such as the need to use difficult to extract morphological features, domain-specific features, or large numbers of estimated parameters. In particular, systems using large numbers of trained parameters have the potential to require large amounts of training data and computation and may have issues generalizing due to their potential to overfit. To address some of these drawbacks, we developed a novel PVC detection algorithm based around a convolutional autoencoder to address these weaknesses and validated our method using the MIT-BIH arrhythmia database.


Assuntos
Algoritmos , Eletrocardiografia/estatística & dados numéricos , Complexos Ventriculares Prematuros/diagnóstico , Biologia Computacional/métodos , Bases de Dados Factuais , Diagnóstico por Computador , Frequência Cardíaca , Humanos , Aprendizado de Máquina não Supervisionado , Complexos Ventriculares Prematuros/fisiopatologia
6.
G Ital Cardiol (Rome) ; 20(4): 223-228, 2019 Apr.
Artigo em Italiano | MEDLINE | ID: mdl-30920549

RESUMO

Premature ventricular complexes (PVCs) are usually benign, and commonly only severely symptomatic patients are treated. In the literature, frequent PVCs have been reported to cause ventricular dysfunction, which may improve after PVC treatment. PVCs can also worsen the prognosis in patients with structural heart disease. Catheter PVC ablation is often the treatment of choice considering the high success rates. Ventricular dysfunction due to frequent PVCs is not always easy to identify as patients can be asymptomatic and the interpretation of imaging tests may be challenging in the presence of frequent PVCs. Treatment of patients with mild ventricular dysfunction is still a matter of debate.


Assuntos
Ablação por Cateter/métodos , Disfunção Ventricular/terapia , Complexos Ventriculares Prematuros/terapia , Cardiopatias/fisiopatologia , Humanos , Prognóstico , Disfunção Ventricular/diagnóstico , Disfunção Ventricular/etiologia , Complexos Ventriculares Prematuros/complicações , Complexos Ventriculares Prematuros/diagnóstico
7.
G Ital Cardiol (Rome) ; 20(4): 229-241, 2019 Apr.
Artigo em Italiano | MEDLINE | ID: mdl-30920550

RESUMO

Adolescents and adults with cardiovascular disease who are engaged in sports activity have an increased risk of sudden cardiac death (SCD) related to the sports practice that acts as a trigger for life-threatening ventricular arrhythmias. Premature ventricular beats (PVBs) detected in athletes at the time of pre-participation screening may be a sign of heart disease at risk of SCD but are also found in athletes without cardiovascular abnormalities. Thus, the interpretation of PVBs could represent a clinical dilemma. However, while some characteristics of PVBs can be considered common and benign, others occur uncommonly in the athletic population and raise the suspicion of underlying cardiovascular disease. This review discusses the prevalence and the clinical significance of PVBs in the athlete, with a focus on exercise-induced PVBs, on the analysis of PVB's morphology at 12-lead ECG, and on the morphological substrates identified by imaging techniques. The implications on eligibility for competitive sports participation are also discussed, according to the relevance of PVBs detection for disqualifying athletes from competitions.


Assuntos
Atletas , Morte Súbita Cardíaca/prevenção & controle , Complexos Ventriculares Prematuros/diagnóstico , Adolescente , Adulto , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/diagnóstico , Eletrocardiografia/métodos , Humanos , Programas de Rastreamento/métodos , Esportes , Complexos Ventriculares Prematuros/complicações
9.
Rev Port Cardiol ; 38(2): 83-91, 2019 02.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30797606

RESUMO

INTRODUCTION AND AIMS: Frequent premature ventricular contractions (PVCs) originating from the right ventricular outflow tract (RVOT) are usually considered a benign entity and the ECG is typically normal. The aim of this study was to assess whether upward displacement of the ECG to the second intercostal space (ICS) would reveal any abnormal pattern. METHODS: A total of 18 consecutive patients with apparently normal hearts were studied, mean age 44±16 years, 12 women, who underwent catheter ablation of the RVOT due to frequent PVCs. A 12-lead ECG was performed in the standard position and repeated in a higher position, at the level of the second ICS. Three-dimensional bipolar electroanatomical voltage mapping (EVM) was performed in all patients and low voltage areas (LVAs) were defined as areas with amplitude <1.5 mV. RESULTS: The ECG in the second ICS was normal in eleven patients but in seven (39%) it revealed a pattern of ST-segment elevation in V1. EVM revealed the presence of LVAs in six patients (33%) which included the earliest activation site (EAS) in five. The ST elevation was associated with the presence of LVAs (p<0.0001) and with the LVAs at the EAS (p=0.002). CONCLUSION: In this group of patients with apparently normal hearts and with frequent PVCs of the RVOT, upward displacement of the ECG revealed the presence of ST elevation in more than one third of patients, and the ST elevation was associated with the presence of LVAs in the RVOT.


Assuntos
Mapeamento Potencial de Superfície Corporal/métodos , Eletrocardiografia , Sistema de Condução Cardíaco/fisiopatologia , Ventrículos do Coração/fisiopatologia , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Função Ventricular Direita/fisiologia , Complexos Ventriculares Prematuros/diagnóstico , Adulto , Ecocardiografia Doppler , Feminino , Seguimentos , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Complexos Ventriculares Prematuros/etiologia , Complexos Ventriculares Prematuros/fisiopatologia
10.
Comput Methods Programs Biomed ; 169: 59-69, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30638592

RESUMO

BACKGROUND AND OBJECTIVE: Premature ventricular contraction is associated to the risk of coronary heart disease, and its diagnosis depends on a long time heart monitoring. For this purpose, monitoring through Holter devices is often used and computational tools can provide essential assistance to specialists. This paper presents a new premature ventricular contraction recognition method based on a simplified set of features, extracted from geometric figures constructed over QRS complexes (Q, R and S waves). METHODS: Initially, a preprocessing stage based on wavelet denoising electrocardiogram signal scaling is applied. Then, the signal is segmented taking into account the ventricular depolarization timing and a new set of geometrical features are extracted. In order to validate this approach, simulations encompassing eight different classifiers are presented. To select the best classifiers, a new methodology is proposed based on the Analytic Hierarchy Process. RESULTS: The best results, achieved with an Artificial Immune System, were 98.4%, 91.1% and 98.7% for accuracy, sensitivity and specificity, respectively. When artificial examples were generated to balance the dataset, the recognition performance increased to 99.0%, 98.5% and 99.5%, employing the Support Vector Machine classifier. CONCLUSIONS: The proposed approach is compared with some of latest references and results indicate its effectiveness as a method for recognizing premature ventricular contraction. Besides, the overall system presents low computation load.


Assuntos
Algoritmos , Eletrocardiografia , Aprendizado de Máquina , Complexos Ventriculares Prematuros/diagnóstico , Diagnóstico por Computador , Humanos , Razão Sinal-Ruído , Análise de Ondaletas
11.
Ann Cardiol Angeiol (Paris) ; 68(3): 175-180, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30683482

RESUMO

INTRODUCTION: Premature ventricular complexes (PVC) are generally considered as a benign electrocardiographic abnormality in the athletic population. However it may be indicative of underlying heart disease which may increase the risk of sudden death. This implies the need for cardiological evaluation before indicating the ability to practice competitive sports. AIM: The aim of this study was to evaluate an athlete population with PVC and establish underlying etiologies in order to take a decision regarding practicing sports. METHODS: This is a prospective study which included athletes examined in the Tunisian National Centre of Sports Medicine and Sports Science (TNCSM) from January 2013 to June 2015 who presented PVC on an electrocardiogram. RESULTS: Five thousand seven hundred and ninety eight athletes were referred to the TNCSM. We identified 42 athletes having PVC with a prevalence of 1.8%. The average age of the study population was 21.6±5.99 years. 83% were men. 88% were asymptomatic. The electrocardiogram was considered normal in 62% of the athletes according to the Seattle criteria. At the Holter monitoring, the average number of PVC was 920 PVC/24hours. Thirteen athletes had doublets and 11 had triplets. One patient had polymorphic PVC and an R/T phenomenon. The transthoracic echocardiography (TTE) was normal in 71% of cases. Three athletes had hypertrophic cardiomyopathy (HCM). All patients underwent a stress test. The PVC disappeared in 12% of athletes MRI was performed in 10 athletes confirming the three cases of HCM and revealing a case of arrhythmogenic right ventricular dysplasia and a case of compression of the right ventricle by pectus exacavatum. CONCLUSION: After this assessment, five athletes were not allowed to practice sport. This study shows the necessity of a thorough cardiological assessment of athletes with ventricular arrhythmia in order to detect underlying heart disease and prevent sudden death in this young apparently healthy population.


Assuntos
Atletas , Complexos Ventriculares Prematuros/diagnóstico , Adolescente , Adulto , Displasia Arritmogênica Ventricular Direita/diagnóstico , Doenças Assintomáticas/epidemiologia , Atletas/estatística & dados numéricos , Cardiomiopatia Hipertrófica/diagnóstico , Eletrocardiografia , Feminino , Humanos , Masculino , Prevalência , Estudos Prospectivos , Estudos Retrospectivos , Esportes/classificação , Tunísia/epidemiologia , Complexos Ventriculares Prematuros/epidemiologia , Complexos Ventriculares Prematuros/etiologia , Adulto Jovem
12.
BMC Cardiovasc Disord ; 19(1): 3, 2019 01 05.
Artigo em Inglês | MEDLINE | ID: mdl-30611199

RESUMO

BACKGROUND: When the coupling interval is matched, ventricular parasystole can form a stable fusion QRS complex with sinus rhythm. Ablation of a fusion QRS complex has been rarely reported and is unexpectedly difficult. CASE PRESENTATION: We describe a case of ventricular parasystole from muscle sleeves of the right ventricular outflow tract. The patient was a 54-year-old woman who was admitted to the hospital because of frequent palpitations for 3 months. Anti-arrhythmic drugs had been ineffective, and she had no history of cardiovascular disease. Because the fusion QRS complex interfered with the conventional mapping technique, we could not eliminate the ventricular parasystole successfully. RESULTS AND CONCLUSIONS: Finally, we used the reversed U curve method and found that the source of ventricular arrhythmia was in the right cusp according to the special local potential. A fusion QRS complex formed by ventricular parasystole and nodal ventricular activation make mapping and ablation difficult. The special local potential was the only evidence available to confirm the target of ablation satisfactorily.


Assuntos
Ablação por Cateter , Ventrículos do Coração/cirurgia , Parassístole/cirurgia , Complexos Ventriculares Prematuros/cirurgia , Potenciais de Ação , Técnicas Eletrofisiológicas Cardíacas , Feminino , Frequência Cardíaca , Ventrículos do Coração/fisiopatologia , Humanos , Pessoa de Meia-Idade , Parassístole/diagnóstico , Parassístole/fisiopatologia , Resultado do Tratamento , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/fisiopatologia
14.
Heart Lung Circ ; 28(3): 379-388, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29482954

RESUMO

BACKGROUND: Ectopy-mediated cardiomyopathy (EMC) is a potentially reversible form of left ventricular systolic dysfunction. Various risk factors for the development of EMC have been proposed in the literature. We aim to assess medium term outcomes of focal ventricular arrhythmia (VA) ablation in the setting of cardiomyopathy (CMP) and to validate published risk factors for EMC. METHODS: Medium term recovery of left ventricular (LV) function and freedom from VA recurrence was assessed and compared between patients undergoing focal VA ablation in the setting of CMP and a control group with normal LV function. Univariate and multivariate analyses for CMP risk factors were performed and compared against prior published risk factors. RESULTS: Of 152 patients who underwent 170 focal VA ablation procedures, 54 (36%) had CMP and the remaining 98 patients had normal LV systolic function. At medium term follow-up, 85% of patients with CMP were free of VA recurrence and median left ventricular ejection fraction (LVEF) had improved from 40 to 52%. Age, male gender, premature ventricular complex (PVC) burden, non- right ventricular outflow tract (RVOT) sites of origin, PVC QRS duration and PVC minimum coupling interval were predictive of CMP on univariate analysis, but only gender persisted on multivariate analysis. CONCLUSIONS: Medium term outcome in patients undergoing focal VA in the setting of CMP are satisfactory with improvement in LV function achievable in most patients. Prior risk factors described in the literature are variable and inconsistent, likely reflecting heterogeneous study populations.


Assuntos
Ablação por Cateter/métodos , Eletrocardiografia , Sistema de Condução Cardíaco/fisiopatologia , Ventrículos do Coração/fisiopatologia , Volume Sistólico/fisiologia , Disfunção Ventricular Esquerda/complicações , Complexos Ventriculares Prematuros/etiologia , Ecocardiografia , Feminino , Seguimentos , Sistema de Condução Cardíaco/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Sístole , Resultado do Tratamento , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/fisiopatologia , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/cirurgia
15.
Trends Cardiovasc Med ; 29(5): 249-261, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30268648

RESUMO

Ventricular arrhythmias can present as asymptomatic premature ventricular complexes (PVCs) or non-sustained ventricular tachycardia (VT), symptomatic presentation of the former arrhythmias, or sustained VT with minimal symptoms to full hemodynamic collapse. The most important and feared consequence of VT is sudden cardiac death (SCD). Independent of SCD risk, frequent ventricular arrhythmias can cause substantial symptoms. Implantable cardioverter defibrillators (ICDs) are the foundation of managing patients at high risk for SCD due to their ability to automatically identify and defibrillate malignant ventricular arrhythmias. Unfortunately, defibrillation is associated with significant physical and emotional adverse effects. Other treatment options include antiarrhythmic drugs, which have substantial toxicities and limited efficacy, and catheter ablation. The techniques and strategies for VT ablation have advanced considerably in recent years leading to a rapid expansion of indications and use. In this review, we discuss current state of the art therapies for ventricular arrhythmias and highlight some of the most promising areas of ongoing development.


Assuntos
Antiarrítmicos/uso terapêutico , Ablação por Cateter , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Cardioversão Elétrica/instrumentação , Taquicardia Ventricular/terapia , Complexos Ventriculares Prematuros/terapia , Antiarrítmicos/efeitos adversos , Ablação por Cateter/efeitos adversos , Ablação por Cateter/mortalidade , Tomada de Decisão Clínica , Cardioversão Elétrica/efeitos adversos , Cardioversão Elétrica/mortalidade , Humanos , Seleção de Pacientes , Valor Preditivo dos Testes , Fatores de Risco , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/mortalidade , Taquicardia Ventricular/fisiopatologia , Resultado do Tratamento , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/fisiopatologia
17.
Int Heart J ; 60(1): 199-203, 2019 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-30464133

RESUMO

A 60-year-old female with premature ventricular contractions (PVCs) originating from the bottom of the posteromedial papillary muscle of the left ventricle underwent radiofrequency catheter ablation (RFCA) using an irrigated-tip catheter. During ablation of the PVCs, a loud steam pop was observed. Intracardiac echocardiography (ICE) revealed a growing, hyperechogenic intramyocardial microbubble formation around the catheter tip. The formation disappeared slowly and completely, leaving an endocardial laceration without pericardial effusion. ICE imaging is valuable during a difficult RFCA procedure, because ICE reveals the exact anatomical position of the catheter and thus allows rapid evaluation of the occurrence of steam popping and any possible subsequent complication.


Assuntos
Ablação por Cateter/métodos , Ecocardiografia/métodos , Ventrículos do Coração/fisiopatologia , Músculos Papilares/fisiopatologia , Complexos Ventriculares Prematuros/diagnóstico , Cateteres Cardíacos , Ablação por Cateter/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Complexos Ventriculares Prematuros/fisiopatologia , Complexos Ventriculares Prematuros/terapia
18.
Curr Opin Cardiol ; 34(1): 65-72, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30407229

RESUMO

PURPOSE OF REVIEW: Premature ventricular beats (PVCs) are frequently identified in healthy children with structurally normal hearts and generally have a benign clinical course often disappearing spontaneously. However, a small percentage of children may develop a cardiomyopathy. The purpose of this review is to understand which children may be at risk of development of left ventricular (LV) dysfunction with idiopathic PVCs. RECENT FINDINGS: There is increasing evidence that a ventricular ectopic burden more than 24% in adults may lead to LV dysfunction. Most of the pediatric studies to date are retrospective, small case series from single institutions and have conflicting results regarding a direct correlation of the PVC burden to LV dysfunction. Development of a cardiomyopathy from frequent PVCs in children is likely multifactorial relating to the burden itself, presence of higher levels of ectopy (couplets and runs of ventricular tachycardia) as well as the duration of ventricular ectopy. Understanding the duration of ectopy is often unknown as patients are asymptomatic and the irregular heart beat was identified at a well-child examination. SUMMARY: Asymptomatic children with normal ventricular function and a low ectopy burden can be followed without any intervention and generally reassured. Children with an ectopy burden more than 30% are at some risk of developing LV dysfunction and should be more closely followed with noninvasive imaging. Development of symptoms attributed to the ectopy or signs of increasing LV dimensions or LV dysfunction should be treated with medication or catheter ablation.


Assuntos
Cardiomiopatias , Ablação por Cateter , Taquicardia Ventricular , Disfunção Ventricular Esquerda , Complexos Ventriculares Prematuros , Criança , Humanos , Estudos Retrospectivos , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/terapia , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/terapia
19.
Circulation ; 139(3): 313-321, 2019 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-30586734

RESUMO

BACKGROUND: Case studies have suggested the efficacy of catheter-free, electrophysiology-guided noninvasive cardiac radioablation for ventricular tachycardia (VT) using stereotactic body radiation therapy, although prospective data are lacking. METHODS: We conducted a prospective phase I/II trial of noninvasive cardiac radioablation in adults with treatment-refractory episodes of VT or cardiomyopathy related to premature ventricular contractions (PVCs). Arrhythmogenic scar regions were targeted by combining noninvasive anatomic and electric cardiac imaging with a standard stereotactic body radiation therapy workflow followed by delivery of a single fraction of 25 Gy to the target. The primary safety end point was treatment-related serious adverse events in the first 90 days. The primary efficacy end point was any reduction in VT episodes (tracked by indwelling implantable cardioverter defibrillators) or any reduction in PVC burden (as measured by a 24-hour Holter monitor) comparing the 6 months before and after treatment (with a 6-week blanking window after treatment). Health-related quality of life was assessed using the Short Form-36 questionnaire. RESULTS: Nineteen patients were enrolled (17 for VT, 2 for PVC cardiomyopathy). Median noninvasive ablation time was 15.3 minutes (range, 5.4-32.3). In the first 90 days, 2/19 patients (10.5%) developed a treatment-related serious adverse event. The median number of VT episodes was reduced from 119 (range, 4-292) to 3 (range, 0-31; P<0.001). Reduction was observed for both implantable cardioverter defibrillator shocks and antitachycardia pacing. VT episodes or PVC burden were reduced in 17/18 evaluable patients (94%). The frequency of VT episodes or PVC burden was reduced by 75% in 89% of patients. Overall survival was 89% at 6 months and 72% at 12 months. Use of dual antiarrhythmic medications decreased from 59% to 12% ( P=0.008). Quality of life improved in 5 of 9 Short Form-36 domains at 6 months. CONCLUSIONS: Noninvasive electrophysiology-guided cardiac radioablation is associated with markedly reduced ventricular arrhythmia burden with modest short-term risks, reduction in antiarrhythmic drug use, and improvement in quality of life. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov/ . Unique identifier: NCT02919618.


Assuntos
Potenciais de Ação , Técnicas Eletrofisiológicas Cardíacas , Ventrículos do Coração/efeitos da radiação , Ablação por Radiofrequência/métodos , Radiocirurgia/métodos , Taquicardia Ventricular/radioterapia , Complexos Ventriculares Prematuros/radioterapia , Idoso , Idoso de 80 Anos ou mais , Antiarrítmicos/uso terapêutico , Feminino , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Missouri , Valor Preditivo dos Testes , Estudos Prospectivos , Qualidade de Vida , Ablação por Radiofrequência/efeitos adversos , Radiocirurgia/efeitos adversos , Recidiva , Fatores de Risco , Inquéritos e Questionários , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/fisiopatologia
20.
J Nippon Med Sch ; 85(6): 337-342, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30568061

RESUMO

BACKGROUND: Premature ventricular contractions (PVCs) are often found in healthy workers at medical checkups. In this study, we aimed to investigate the frequency of PVCs recorded during medical checkups in Japanese office workers without heart disease or other known contributing factors. METHODS: Participants in this study were 17,641 office workers, who underwent an electrocardiogram examination during a regular medical checkup between April 1 2015 and March 31 2016 and had no known heart disease. The frequency of PVCs was recorded. Participants with PVCs were included in the PVC group and a control group of participants without PVCs was set in a nested case-control study to calculate the rate of complications for lifestyle-related diseases and the risk rate of PVCs for lifestyle-related habits. RESULTS: Within the participant group, PVCs were observed in 303 individuals (1.7%). When compared with the control group, the occurrence of regularly drinking alcohol (P=0.009) and insomnia (P=0.006) were significantly higher in the PVC group. Factors related to the onset of PVCs were examined using univariate analysis. The odds ratio (OR) was 1.731 in participants who regularly drank alcohol (95% CI: 1.146-2.633, P=0.009) when compared with participants who did not regularly drink alcohol, and 1.569 in participants with insomnia (95% CI: 1.023-2.422, P=0.040) when compared with participants without insomnia. CONCLUSION: The frequency of PVCs recorded at regular medical checkups in Japanese office workers without heart disease was 1.7%. Within our group of participants, the factors related to the onset of PVCs were a history of regularly drinking alcohol and sleep disorders.


Assuntos
Eletrocardiografia/métodos , Hábitos , Estilo de Vida , Complexos Ventriculares Prematuros/diagnóstico , Adulto , Grupo com Ancestrais do Continente Asiático , Estudos de Casos e Controles , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Inquéritos e Questionários , Complexos Ventriculares Prematuros/etnologia , Complexos Ventriculares Prematuros/fisiopatologia , Adulto Jovem
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