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1.
Am J Cardiol ; 129: 25-29, 2020 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-32600783

RESUMO

Occult atrial fibrillation (AF) can be the underlying cause for cryptogenic stroke (CS). Implantable loop recorders (ILRs) have become an important tool for long-term arrhythmia monitoring in CS patients. Office-based ILR implantation by nonelectrophysiologist physicians is increasingly common. To report the real world diagnostic yield and accuracy of remote ILR monitoring in high risk CS patients, we retrospectively analyzed 145 consecutive patients with CS who underwent ILR implantation between October 2014 and October 2018 at New York University Langone Health. A certified device technician and an electrophysiologist adjudicated all transmissions. The yield and accuracy of Reveal LINQ Intra Cardiac Monitor (ICM), a fourth generation device, was compared to that of TruRhythm Detection algorithm (fifth generation device). AF was diagnosed in 17 patients (12%) over a mean follow-up of 28 ± 12 months. The median time to diagnosis was 7.4 ± 21.3 months. A total of 1,637 remote transmissions (scheduled- and auto-triggered alerts: 756; patient-triggered: 881) were adjudicated. The positive predictive value for AF episodes in the scheduled interrogations increased from 4% in the Reveal LINQ ICM to 16% in the TruRhythm LINQ. Of 881 patient-triggered transmissions, none were found to be true positive. In the Reveal LINQ ICM, for scheduled transmissions, primary causes of false positive (FP) were atrial ventricular premature complexes (80%). In the TruRhythm LINQ, for scheduled transmissions, primary cause of FP were T-wave over-sensing (87%). In conclusion, the real world diagnostic yield of ILR for patients with CS remains suboptimal, with at least 84% of AF alerts being FP. Patient-riggered events did not correlate with arrhythmia and the necessity of patient triggering in this population should be questioned. Expert interpretation of recordings is critical to assure accurate diagnosis.


Assuntos
Algoritmos , Fibrilação Atrial/diagnóstico , Eletrocardiografia Ambulatorial/métodos , Próteses e Implantes , Acidente Vascular Cerebral/etiologia , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/complicações , Eletrocardiografia Ambulatorial/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
2.
Sensors (Basel) ; 20(4)2020 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-32054066

RESUMO

Wearable electrocardiogram (ECG) devices are universally used around the world for patients who have cardiovascular disease (CVD). At present, how to suppress motion artifacts is one of the most challenging issues in the field of physiological signal processing. In this paper, we propose an adaptive cancellation algorithm based on multi-inertial sensors to suppress motion artifacts in ambulatory ECGs. Firstly, this method collects information related to the electrode motion through multi-inertial sensors. Then, the part that is not related to the electrode motion is removed through wavelet transform, which improves the correlation of the reference input signal. In this way, the ability of the adaptive cancellation algorithm to remove motion artifacts is improved in the ambulatory ECG. Subsequent experimentation demonstrated that the wavelet adaptive cancellation algorithm based on multi-inertial sensors can effectively remove motion artifacts in ambulatory ECGs.


Assuntos
Algoritmos , Eletrocardiografia Ambulatorial/métodos , Artefatos , Doenças Cardiovasculares/diagnóstico por imagem , Eletrocardiografia Ambulatorial/instrumentação , Eletrodos , Humanos , Corrida , Processamento de Sinais Assistido por Computador , Razão Sinal-Ruído , Caminhada , Análise de Ondaletas , Dispositivos Eletrônicos Vestíveis
3.
J Stroke Cerebrovasc Dis ; 29(4): 104643, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32005569

RESUMO

BACKGROUND: Atrial fibrillation (AF) is a major cause of cardio-embolism in patients with stroke and transient ischemic attack (TIA). Insertable cardiac monitors (ICM) make long-term monitoring for AF possible, but limited health care resources make patient selection important. AF is associated with atherosclerosis and markers of this could potentially be used to guide AF monitoring. METHODS AND RESULTS: One-hundred fourteen TIA-patients without AF were thoroughly monitored for AF with ECG, 72-hour Holter monitoring and ICM with a median monitoring time of 2.2 years. Patients with AF (n = 18) were significantly older than patients without AF (age 71.1 versus 64.4 years, P = .008) but were otherwise similar in regards to comorbidities. AF patients had significantly thicker carotid intima-media and also more often presence of carotid plaques than patients without AF, but no difference was found after adjusting for age and sex. No difference in noncontrast cardiac CT calculated coronary artery calcium score was found between the 2 groups. Serum biomarkers did not differ between groups, except for brain natriuretic peptide (BNP), where patients with BNP in the upper tertile were more likely to have AF than patients with BNP in the lowest tertile, odds ratio 5.96 (95% confidence interval 1.04-34.07, P = .045). CONCLUSIONS: Carotid intima-media thickness and coronary artery calcium score were poor predictors of AF in patients with TIA. Apart from BNP, the examined biomarkers (hs-CRP, MR-proADM, c-TnI, copeptin) had no predictive value, but larger scale studies are needed to confirm these findings.


Assuntos
Fibrilação Atrial/diagnóstico , Eletrocardiografia Ambulatorial , Ataque Isquêmico Transitório/epidemiologia , Tecnologia de Sensoriamento Remoto , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/fisiopatologia , Biomarcadores/sangue , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/epidemiologia , Espessura Intima-Media Carotídea , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Dinamarca/epidemiologia , Eletrocardiografia Ambulatorial/instrumentação , Feminino , Humanos , Incidência , Ataque Isquêmico Transitório/diagnóstico , Ataque Isquêmico Transitório/fisiopatologia , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Valor Preditivo dos Testes , Tecnologia de Sensoriamento Remoto/instrumentação , Fatores de Risco , Processamento de Sinais Assistido por Computador , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/epidemiologia , Adulto Jovem
6.
Am J Cardiol ; 125(5): 767-771, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31948666

RESUMO

The standard for ambulatory arrhythmia detection in children is the Holter monitor. The Zio XT (Zio) patch has been FDA-approved for use in adults. However, its utility in children has not been directly compared with the Holter. We studied the ability to detect arrhythmias and patient comfort of the Zio versus the Holter in children. Patients <22 years old were prospectively enrolled to wear the Holter and Zio simultaneously for 48 hours at our institution. Detection of clinically significant arrhythmias was compared using McNemar's test. Wear-time and artifact time was compared using Wilcoxon sign test. Patient satisfaction ratings were analyzed with paired t tests. Two hundred patients (57% male) were included for analysis. The median age was 13.5 years (range 23 days to 21.7 years), and 40% had heart disease. The Zio and Holter had comparable median wear-times, 48.2 hours (interquartile range [IQR] 45.8 to 50.2]) versus 48.0 (48.0 to 48.0), respectively, p = 0.14, but the Zio had less artifact than the Holter, 2.8% (IQR 1.1 to 8.6) versus 5.6% (2.4 to 15.7), respectively, p <0.001. There was no difference in detection of clinically significant arrhythmias for the Zio versus the Holter (p = 0.23), however 75% of patients preferred the Zio over the Holter (p <0.001) due to lack of wires and the ability to shower. In conclusion, the Zio patch is as good as the Holter monitor in detection of clinically significant arrhythmias in children with less artifact. Patients/parents more often preferred the Zio over the Holter.


Assuntos
Arritmias Cardíacas/diagnóstico , Eletrocardiografia Ambulatorial/instrumentação , Preferência do Paciente , Satisfação do Paciente , Adolescente , Cardiomiopatias , Criança , Pré-Escolar , Feminino , Bloqueio Cardíaco , Cardiopatias Congênitas , Doenças das Valvas Cardíacas , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Adulto Jovem
7.
J Korean Med Sci ; 35: e11, 2020 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-31920017

RESUMO

BACKGROUND: An implantable loop recorder (ILR) is an effective tool for diagnosing unexplained syncope (US). We examined the diagnostic utility of an ILR in detecting arrhythmic causes of US and determining which clinical factors are associated with pacemaker (PM) implantation. METHODS: This retrospective, multicenter, observational study was conducted from February 2006 to April 2018 at 11 hospitals in Korea. Eligible patients with recurrent US received an ILR to diagnose recurrent syncope and document arrhythmia. RESULTS: A total of 173 US patients (mean age, 67.6 ± 16.5 years; 107 men [61.8%]) who received an ILR after a negative conventional workup were enrolled. During a mean follow-up of 9.4 ± 11.1 months, 52 patients (30.1%) had recurrent syncope, and syncope-correlated arrhythmia was confirmed in 34 patients (19.7%). The ILR analysis showed sinus node dysfunction in 24 patients (70.6%), supraventricular tachyarrhythmia in 4 (11.8%), ventricular arrhythmia in 4 (11.8%), and sudden atrioventricular block in 2 (5.9%). Overall, ILR detected significant arrhythmia in 99 patients (57.2%) irrespective of syncope. Among patients with clinically relevant arrhythmia detected by ILR, PM implantation was performed in 60 (34.7%), an intra-cardiac defibrillator in 5 (2.9%), and catheter ablation in 4 (2.3%). In a Cox regression analysis, history of paroxysmal atrial fibrillation (PAF) (hazard ratio [HR], 2.34; 95% confidence interval [CI], 1.33-4.12; P < 0.01) and any bundle branch block (BBB) (HR, 2.52; 95% CI, 1.09-5.85; P = 0.03) were significantly associated with PM implantation. CONCLUSION: ILR is useful for detecting syncope-correlated arrhythmia in patients with US. The risk of PM is high in US patients with a history of PAF and any BBB.


Assuntos
Eletrocardiografia Ambulatorial/métodos , Marca-Passo Artificial , Síncope/terapia , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/complicações , Arritmias Cardíacas/diagnóstico , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/etiologia , Eletrocardiografia Ambulatorial/instrumentação , Eletrodos Implantados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial/efeitos adversos , Modelos de Riscos Proporcionais , Recidiva , República da Coreia , Estudos Retrospectivos , Fatores de Risco , Síncope/complicações , Síncope/patologia
8.
Sensors (Basel) ; 20(3)2020 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-31979184

RESUMO

In this paper we proposed a wearable electrocardiogram (ECG) telemonitoring system for atrial fibrillation (AF) detection based on a smartphone and cloud computing. A wearable ECG patch was designed to collect ECG signals and send the signals to an Android smartphone via Bluetooth. An Android APP was developed to display the ECG waveforms in real time and transmit every 30 s ECG data to a remote cloud server. A machine learning (CatBoost)-based ECG classification method was proposed to detect AF in the cloud server. In case of detected AF, the cloud server pushed the ECG data and classification results to the web browser of a doctor. Finally, the Android APP displayed the doctor's diagnosis for the ECG signals. Experimental results showed the proposed CatBoost classifier trained with 17 selected features achieved an overall F1 score of 0.92 on the test set (n = 7,270). The proposed wearable ECG monitoring system may potentially be useful for long-term ECG telemonitoring for AF detection.


Assuntos
Fibrilação Atrial/diagnóstico , Eletrocardiografia Ambulatorial/instrumentação , Eletrocardiografia Ambulatorial/métodos , Eletrocardiografia/instrumentação , Eletrocardiografia/métodos , Algoritmos , Computação em Nuvem , Humanos , Aprendizado de Máquina , Processamento de Sinais Assistido por Computador/instrumentação , Smartphone , Dispositivos Eletrônicos Vestíveis , Tecnologia sem Fio/instrumentação
9.
Am Heart J ; 219: 117-127, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31699295

RESUMO

BACKGROUND: Recent studies have suggested a high prevalence of subclinical atrial fibrillation (AF) in various patient populations, and interest in AF screening has increased. However, knowledge about episode duration is scarce, and risk factors for short or long subclinical AF episodes have yet to be recognized. The aim of the study was to assess AF by long-term continuous screening and to investigate predictors of episodes lasting ≥6 minutes, ≥5.5 hours, or ≥24 hours, respectively. METHODS: A total of 597 patients aged ≥70 years and diagnosed with ≥1 of hypertension, diabetes, previous stroke, or heart failure were recruited from the general population to receive implantable loop recorder with remote monitoring. Exclusion criteria included history of AF or cardiac implantable electronic device. AF episodes were adjudicated by senior cardiologists. RESULTS: During 40 (37; 42) months of continuous monitoring, AF was detected in 209 (35%) of the patients. The cumulative incidences at 3 years were 33.8% (30.2%-37.8%), 16.1% (13.4%-19.4%), and 5.7% (4.1%-7.9%) for AF episodes lasting ≥6 minutes, ≥5.5 hours, and ≥24 hours, respectively. Slower resting sinus rate and higher body mass index, N-terminal prohormone of brain natriuretic peptide, and troponin T at baseline were independently associated with AF detection. Addition of these markers to a model of sex, age, and comorbidities improved prediction of AF episodes ≥24 hours (time-dependent area under the receiver operating characteristic curve 79% vs 65%, P = .037). CONCLUSIONS: A considerable burden of previously unknown AF was detected when long-term monitoring was applied in at-risk patients. Biomarkers were associated with AF incidence and improved prediction of long AF episodes.


Assuntos
Fibrilação Atrial/diagnóstico , Eletrocardiografia Ambulatorial/instrumentação , Eletrodos Implantados , Idoso , Área Sob a Curva , Fibrilação Atrial/sangue , Fibrilação Atrial/epidemiologia , Biomarcadores/sangue , Índice de Massa Corporal , Proteína C-Reativa/metabolismo , Feminino , Frequência Cardíaca , Humanos , Incidência , Masculino , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Fatores de Tempo , Troponina T/sangue
11.
Heart Lung ; 49(1): 86-91, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31399224

RESUMO

BACKGROUND: Little is known about the decision-making process for insertable cardiac monitors (ICM) in those with suspected arrhythmias. OBJECTIVE: The purpose of this qualitative study was to describe how individuals make a decision to insert an ICM. METHODS: A qualitative descriptive design was used. Data were analyzed using content analysis and constant comparison. NVivo 10 was used for data grouping and patterns. RESULTS: Participants (N = 12) ranged in age from 41to 95. Most (n = 7) had the device inserted because of syncope or atrial fibrillation (AF), and others (n = 5) for cryptogenic stroke. Three categories emerged: pre-decision, definitive decision, and deliberated decision. Event symptoms, including physical, cognitive and emotional, and trust emerged as factors in decision-making. CONCLUSIONS: Those who perceived their experience as life-threatening, trusted the healthcare provider and assented to the ICM insertion. Conversely, those who perceived symptoms as episodic, used other strategies to resolve symptoms prior to making the decision for insertion.


Assuntos
Fibrilação Atrial/diagnóstico , Eletrocardiografia Ambulatorial/instrumentação , Acidente Vascular Cerebral/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade
12.
Circ Cardiovasc Interv ; 13(1): e008290, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31884835

RESUMO

BACKGROUND: The clinical utility of routine electrocardiographic monitoring following percutaneous coronary interventions (PCI) is not well studied. METHODS: We prospectively evaluated the incidence, cost, and the clinical implications of actionable arrhythmia alarms on telemetry monitoring following PCI. One thousand three hundred fifty-eight PCI procedures (989 [72.8%] for acute coronary syndrome and 369 [27.2%] for stable angina) on patients admitted to nonintensive care unit were identified and divided into 2 groups; group 1, patients with actionable alarms (AA) and group 2, patients with non-AA. AA included (1) ≥3 s electrical pause or asystole; (2) high-grade Mobitz type II atrioventricular block or complete heart block; (3) ventricular fibrillation; (4) ventricular tachycardia (>15 beats); (5) atrial fibrillation with rapid ventricular response; (6) supraventricular tachycardia (>15 beats). Primary outcomes were 30-day all-cause mortality. Cost-savings analysis was performed. RESULTS: Incidence of AA was 2.2% (37/1672). Time from end of procedure to AA was 5.5 (0.5, 24.5) hours. Patients with AA were older, presented with acute congestive heart failure or non-ST-segment-elevation myocardial infarction, and had multivessel or left main disease. The 30-day all-cause mortality was significantly higher in patients with AA (6.5% versus 0.3% in non-AA [P<0.001]). Applying the standardized costing approach and tailored monitoring per the American Heart Association guidelines lead to potential cost savings of $622 480.95 for the entire population. CONCLUSIONS: AA following PCI were infrequent but were associated with increase in 30-day mortality. Following American Heart Association guidelines for monitoring after PCI can lead to substantial cost saving.


Assuntos
Arritmias Cardíacas/diagnóstico , Eletrocardiografia Ambulatorial , Frequência Cardíaca , Intervenção Coronária Percutânea/efeitos adversos , Telemetria , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/economia , Arritmias Cardíacas/mortalidade , Arritmias Cardíacas/terapia , Alarmes Clínicos , Redução de Custos , Análise Custo-Benefício , Eletrocardiografia Ambulatorial/economia , Eletrocardiografia Ambulatorial/instrumentação , Feminino , Custos de Cuidados de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/economia , Intervenção Coronária Percutânea/mortalidade , Valor Preditivo dos Testes , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Telemetria/economia , Telemetria/instrumentação , Fatores de Tempo , Resultado do Tratamento
13.
Neurology ; 93(10): 450-458, 2019 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-31477610

RESUMO

OBJECTIVE: We hypothesized that cardiac electrical instability and abnormal autonomic tone result from cumulative cardiac injury sustained in recurrent seizures. We tested this hypothesis by comparing T-wave alternans (TWA) and heart rate variability (HRV), both established markers of sudden cardiac death (SCD) risk, in patients with chronic as compared to newly diagnosed epilepsy. METHODS: In this prospective, observational cohort study, patients (newly diagnosed epilepsy, n = 6, age 41.8 ± 6.8 years; chronic epilepsy, n = 6, age 40.2 ± 5.6 years [p = 0.85]) were monitored either with Holter recorder alone or simultaneously with 14-day Zio XT extended continuous ECG patch monitor. TWA was assessed by Food and Drug Administration-cleared Modified Moving Average analysis; HRV was calculated by rMSSD. RESULTS: TWA levels in chronic epilepsy were significantly higher than in newly diagnosed epilepsy (62 ± 5.4 vs 35 ± 1.3 µV, p < 0.002); the latter did not differ from healthy control adults. In all patients with chronic epilepsy, TWA exceeded the established ≥47-µV TWA cutpoint and rMSSD HRV was inversely related to TWA levels. Patients with chronic epilepsy exhibited elevated TWA levels equivalently on Holter and ECG patch recordings (p = 0.38) with a high correlation (r 2 = 0.99, p < 0.01) across 24 hours. CONCLUSION: Based on the limited number of patients studied, it appears that chronic epilepsy, the common use of sodium channel antagonists, or other factors are associated with higher TWA levels and simultaneously with lower rMSSD HRV, which is suggestive of autonomic dysfunction or higher sympathetic tone. The ECG patch monitor used has equivalent accuracy to Holter monitoring for TWA and HRV and permits longer-term ECG sampling.


Assuntos
Eletrocardiografia Ambulatorial/métodos , Epilepsia/diagnóstico , Epilepsia/fisiopatologia , Frequência Cardíaca/fisiologia , Adulto , Doença Crônica , Estudos de Coortes , Eletrocardiografia/instrumentação , Eletrocardiografia/métodos , Eletrocardiografia Ambulatorial/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Ambulatorial/instrumentação , Monitorização Ambulatorial/métodos , Estudos Prospectivos
14.
Ann Cardiol Angeiol (Paris) ; 68(5): 306-309, 2019 Nov.
Artigo em Francês | MEDLINE | ID: mdl-31540700

RESUMO

BACKGROUND: Syncope or stroke remain frequently without any explained diagnosis. Long duration holter ECG is an available tool to diagnose arrhythmias. However, this tool is subject to availability of the recorders. AIM: Report a single center experience with long duration holter ECG in clinical practice, in the different cardiology and neurology indications, and to assess the different delays until achievement of a diagnosis. METHODS AND RESULTS: The device (Sorin Spiderflash) was used for 48 patients between January 2018 and June 2018. The holter was applied for a mean duration of 10±4days. The mean age was 55+19 years-old. 20 patients (42%) were explored for a stroke or transient ischemic attack (TIA), 18 (36%) for palpitations, 6 (12%) for syncope and 4 (8%) for evaluation of arrhythmias management. An abnormality has been recorded in 11 (22%) patients and a treatment has been administered in 5 patients (10%). Regarding, the timing of the exam, the mean time between the index event and the indication was 39 days. The mean time between the indication and the availability of the device was 32 days. 16 Days was the mean time for lecture and 23 days was the mean time between the result and the appointment with the cardiologist and neurologist. CONCLUSION: In this registry, the management of patients by non-invasive long duration holter ECG monitoring may be improved regarding the timing of the exams, their lecture and new appointments with the physicians.


Assuntos
Arritmias Cardíacas/diagnóstico , Eletrocardiografia Ambulatorial , Adulto , Idoso , Arritmias Cardíacas/complicações , Eletrocardiografia Ambulatorial/instrumentação , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo
15.
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
16.
Trials ; 20(1): 563, 2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31511057

RESUMO

BACKGROUND: The increasing use of implantable cardiac monitors (ICMs) allows early documentation of asymptomatic cardiac arrhythmias that would previously have gone unnoticed. The addition of remote monitoring to cardiac devices means that physicians receive an early warning in cases of new-onset arrhythmias. While remote monitoring has been suggested to increase survival in heart failure patients with implantable defibrillators, trials using ICMs for continuous electrocardiographic monitoring of cardiac arrhythmias in the postmyocardial infarction setting have shown that patients who experienced cardiac arrhythmias such as atrial fibrillation, bradycardia, and ventricular tachyarrhythmia have an increased risk of major adverse cardiac events. METHODS: The Biomonitoring in patients with preserved left ventricular function after diagnosed myocardial infarction (BIO-GUARD-MI) study is designed to investigate and clarify whether the incidence of major adverse cardiac events can be decreased by early detection and treatment of cardiac arrhythmias using an ICM in patients after myocardial infarction. In addition, the study will allow us to describe the interplay between baseline characteristics, arrhythmias, and clinical events to improve the treatment of this high-risk patient population. The study will enroll and randomize a cohort of high-risk postmyocardial infarction patients with CHA2DS2-VASc score ≥ 4 and left ventricular ejection fraction > 35% to an ICM or conventional treatment. Physicians are provided with suggestions on how to respond to ICM-documented arrhythmias. An estimated 1400 patients will be enrolled and followed until 372 primary endpoints have occurred. In this paper, we describe the literature and rationale behind the design and interventions towards new-onset arrhythmias, as well as future perspectives and limitations for the use of ICMs. DISCUSSION: Remote monitoring may improve clinical outcome if it uncovers conditions with low symptom burden which cause or indicate an increased risk. A simple and easily implementable response to the information is important. Cardiac arrhythmias frequently start as asymptomatic, shorter lasting, and nightly events. The BIO-GUARD-MI trial represents the first attempt to simplify the response to the rather complex nature of heart arrhythmias. TRIAL REGISTRATION: Clinical Trials, NCT02341534 . Registered on 19 January 2015.


Assuntos
Arritmias Cardíacas/diagnóstico , Infarto do Miocárdio/complicações , Ensaios Clínicos Controlados Aleatórios como Assunto , Eletrocardiografia Ambulatorial/instrumentação , Humanos , Estudos Prospectivos , Projetos de Pesquisa , Função Ventricular Esquerda
17.
Int J Med Inform ; 130: 103928, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31434042

RESUMO

BACKGROUND: Health monitoring is shifting towards continuous, ambulatory and clinically comparable wearable devices. Telemedicine and remote diagnosis could harness the capability of mobile cardiac health information, as the technology on bio-physical signal monitoring has improved significantly. OBJECTIVES: The purpose of this review article is (1) to systematically assess the viability of ambulatory electrocardiography (ECG), (2) to provide a systems level understanding of a broad spectrum of wearable heart signal monitoring approaches and (3) to identify areas of improvement in the existing technology needed to attain clinical grade diagnosis. RESULTS: Based on the included literature, we have identified (1) that the developments in ECG monitoring through wearable devices are reaching feasibility, and are capable of delivering diagnostic and prognostic information, (2) that reliable sensing is the major bottleneck in the entire process of ambulatory monitoring, (3) that there is a strong need for artificial intelligence and machine learning techniques to parse and infer the biosignals and (4) that aspects of wearer comfort has largely been ignored in the prevailing developments, which can become a key factor for consumer acceptance. CONCLUSIONS: Cardiac health information is crucial for diagnosis and prevention of several disease onsets. Mobile and continuous monitoring can aid avoiding risks involved with acute symptoms. The health information obtained through continuous monitoring can serve as the BigData of heart signals, and can facilitate new treatment methods and devise effective health policies.


Assuntos
Eletrocardiografia Ambulatorial/métodos , Monitorização Ambulatorial/métodos , Telemedicina/métodos , Dispositivos Eletrônicos Vestíveis/estatística & dados numéricos , Arritmias Cardíacas/fisiopatologia , Eletrocardiografia Ambulatorial/instrumentação , Humanos , Monitorização Ambulatorial/instrumentação
18.
Cleve Clin J Med ; 86(7): 483-493, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31291182

RESUMO

Ambulatory electrocardiography (ECG) allows for extended monitoring of arrhythmias in a real-world setting. This article reviews the currently available ambulatory ECG devices and their differences in design, function, indications, efficacy, cost, and optimal use in clinical practice.


Assuntos
Arritmias Cardíacas/diagnóstico , Eletrocardiografia Ambulatorial/instrumentação , Smartphone , Dispositivos Eletrônicos Vestíveis , Eletrocardiografia Ambulatorial/métodos , Humanos
19.
Am J Med ; 132(12): 1394-1400.e1, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31302077

RESUMO

Wearable devices have become a standard health care intervention with emerging health care technologies. These devices are designed to promote healthy behaviors and decrease risk for chronic disease like cardiovascular disease and diabetes. The purpose of this study was to provide evidence of the benefit of wearable devices in chronic disease outcomes among adults. Systematic search of PubMed, Web of Science, World Health Organization international clinical trials registry platform, BMC ISRCTN registry, and the Institute of Electrical and Electronics Engineers was performed based upon the PRISMA guideline. Included articles were randomized controlled trials or quasi-experimental studies with health outcomes published in English up to October 2018. Studies focusing on adults were selected. Three investigators reviewed the selected publications and made agreement on final selection. Of a total of 550 publications extracted, 6 studies met the final criteria. There was little indication that wearable devices provide a benefit for health outcomes. Of the 6 studies examined, only one study showed a significant reduction for weight loss among participants who used wearable devices. No significant reduction was discovered in cholesterol or blood pressure. Among the 6 studies, only one study examined hemoglobin A1c, and it showed a significant reduction in older patients with type 2 diabetes. The current literature evaluating wearable devices indicates little benefit of the devices on chronic disease health outcomes. Wearable devices play a role as a facilitator in motivating and accelerating physical activity, but current data do not suggest other consistent health benefits.


Assuntos
Monitores de Aptidão Física/estatística & dados numéricos , Monitorização Fisiológica/instrumentação , Dispositivos Eletrônicos Vestíveis/estatística & dados numéricos , Adulto , Automonitorização da Glicemia/instrumentação , Doença Crônica , Eletrocardiografia Ambulatorial/instrumentação , Desenho de Equipamento , Segurança de Equipamentos , Medicina Baseada em Evidências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Sensibilidade e Especificidade
20.
Res Vet Sci ; 125: 253-255, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31325639

RESUMO

Normal Holter reference intervals have not been established for dogs <1 year of age. This lack of Holter reference intervals inhibits the ability to screen puppies for early indicators of heart disease, especially in breeds that have inherited cardiac arrhythmias (e.g. German Shepherd Dogs) or a high incidence of arrhythmic heart disease (e.g. Boxer dogs). The objective of this project was to establish Holter minimum, average, and maximum heart rates and incidence of arrhythmias in clinically healthy dogs <1 year of age and to compare these results to previously reported Holter data for their adult counterparts. Forty-four client-owned clinically healthy puppies between 12 and 51 weeks of age were prospectively studied. Age was determined by date of birth and corroborated by dental examination. Puppies were deemed healthy based on history and physical examination. Puppies with heart murmurs underwent echocardiographic examination. Dogs with physiologic heart murmurs were included. Twenty-four hour ECG recordings were obtained using a digital Holter system. The median (interquartile range) Holter minimum, average, and maximum heart rates were 51 bpm (43-60 bpm), 99 bpm (85-113 bpm), and 274 bpm (257-291 bpm), respectively. The median for ventricular and supraventricular arrhythmias was 0. Ventricular and supraventricular premature complexes were identified in 4/44 (9%) and 6/44 (13%) puppies, respectively. Second degree atrioventricular block was identified in 2/44 puppies (5%). Overall, minimum, average, and maximum Holter heart rates of puppies are higher than adult dogs. The incidence of ventricular and supraventricular premature complexes in puppies is similar to adult dogs.


Assuntos
Eletrocardiografia Ambulatorial/veterinária , Animais , Cães , Eletrocardiografia Ambulatorial/instrumentação , Eletrocardiografia Ambulatorial/métodos , Feminino , Masculino , Valores de Referência
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