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1.
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
2.
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
3.
Eur J Appl Physiol ; 119(7): 1525-1532, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31004219

RESUMO

This study was designed to examine the RR interval signal qualities of a Holter device and a heart rate chest belt monitor at rest and during exercise. Ten healthy individuals completed five low- to high-intensity activities while simultaneously using the medilog® AR12plus Holter monitor and the Polar H10 heart rate monitor. The RR interval signal quality was based on the quantification of the missing RR intervals and RR interval detection errors. Therefore, both measurement systems were compared against visual inspection of the raw electrocardiography signal. The missing and wrong R-wave peak detections were counted manually for both measurement systems. RR interval signal quality was defined as the relative number of correctly detected RR intervals. Overall, RR interval signal qualities of 94.6% and 99.6% were demonstrated for the medilog® AR12plus and the Polar H10. During the high-intensity activities, the RR interval signal quality of the medilog® AR12plus dropped to 89.8%, whereas the Polar H10 maintained a signal quality of 99.4%. The correlation between both systems was high (r = 0.997, p > 0.001). The excellent RR interval signal quality during low- to moderate-intensity activities in the medilog® AR12plus and during low- to high-intensity activities in the Polar H10 demonstrates both measurement systems' validity for the detection of RR intervals throughout a wide range of activities. A simple chest strap such as the Polar H10 might be recommended as the gold standard for RR interval assessments if intense activities with strong body movements are investigated.


Assuntos
Eletrocardiografia Ambulatorial/métodos , Exercício/fisiologia , Frequência Cardíaca , Adulto , Eletrocardiografia Ambulatorial/instrumentação , Eletrocardiografia Ambulatorial/normas , Feminino , Humanos , Masculino , Padrões de Referência , Reprodutibilidade dos Testes
4.
Sensors (Basel) ; 19(7)2019 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-30986953

RESUMO

Wearable monitoring devices are now a usual commodity in the market, especially for the monitoring of sports and physical activity. However, specialized wearable devices remain an open field for high-risk professionals, such as military personnel, fire and rescue, law enforcement, etc. In this work, a prototype wearable instrument, based on reconfigurable technologies and capable of monitoring electrocardiogram, oxygen saturation, and motion, is presented. This reconfigurable device allows a wide range of applications in conjunction with mobile devices. As a proof-of-concept, the reconfigurable instrument was been integrated into ad hoc glasses, in order to illustrate the non-invasive monitoring of the user. The performance of the presented prototype was validated against a commercial pulse oximeter, while several alternatives for QRS-complex detection were tested. For this type of scenario, clustering-based classification was found to be a very robust option.


Assuntos
Eletrocardiografia Ambulatorial/instrumentação , Eletrocardiografia/instrumentação , Monitorização Fisiológica , Dispositivos Eletrônicos Vestíveis , Humanos , Oximetria/instrumentação , Processamento de Sinais Assistido por Computador
5.
J Med Syst ; 43(4): 81, 2019 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-30788605

RESUMO

Body channel communications (BCC) have been researched while an allowing technology to improve necessities for the low power and high reconfiguration power in wireless telemetry systems used at wireless communication purpose. Conventional features on BCC are concentrated mostly on modeling of channels by using of an efficient measurement technique, wireless transceiver design and then by means of a transmission technique. Particularly, the wireless digital transmitting, developed as a personalized method intended for the body channel, offers wanted to develop flexible and low power BCC systems. With the developing level of wearable communication protocol and applications, there may be an increasingly reliable on an adaptable BCC transmitter that helps both data reconfigure power and power reduction condition. In this paper, an extremely reconfigurable Hamming Encoding Digital Transmitter (HEDT) which works with both reconfigurable data and power reduction condition that supports from two innovative operation conditions is suggested. In a HEDT device, the overall data rate is controlled by the level of Hamming codes designed to make use of in the perfect BCC band of 20-100 MHz. The proposed Hamming Encoded Transmission method achieves seven times improved data rate when compared with conventional BCC processors. The next unique implementation technique is based on the usage of Frequency Shift Keying (FSK) of a Hamming encoded HEDT approach. This approach permits the BCC transceiver to use the perfect channel with bandwidth among 40-100 MHz. Thereby half the clock rate reduces 40% of overall power utilization. The HEDT system is completely designed in a 65 nm CMOS procedure. It uses a primary area of 0.14 × 0.2 mm. When functioning below a data-rate of 60 Mb/s (low power) condition, the BCC transmitter utilizes only 1.00 mW.


Assuntos
Fontes de Energia Elétrica , Eletrocardiografia Ambulatorial/instrumentação , Processamento de Sinais Assistido por Computador/instrumentação , Telemetria/instrumentação , Tecnologia sem Fio/instrumentação , Desenho de Equipamento , Humanos , Telemetria/métodos , Dispositivos Eletrônicos Vestíveis
6.
Biosensors (Basel) ; 9(1)2019 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-30669678

RESUMO

Diagnosis of arrhythmic disorders is challenging because of their short-lasting, intermittent character. Conventional technologies of noninvasive ambulatory rhythm monitoring are limited by modest sensitivity. We present a novel form of wearable electrocardiogram (ECG) sensors providing an alternative tool for long-term rhythm monitoring with the potential of increased sensitivity to detect intermittent or subclinical arrhythmia. The objective was to assess the signal quality and R-R coverage of a wearable ECG sensor system compared to a standard 3-lead Holter. In this phase-1 trial, healthy individuals underwent 24-h simultaneous rhythm monitoring using the OMsignal system together with a 3-lead Holter recording. The OMsignal system consists of a garment (bra or shirt) with integrated sensors recording a single-lead ECG and an acquisition module for data storage and processing. Head-to-head signal quality was assessed regarding adequate P-QRS-T distinction and was performed by three electrophysiologists blinded to the recording technology. The accuracy of signal coverage was assessed using Bland-Altman analysis. Fifteen individuals underwent simultaneous 24-h recording. Signal quality and accuracy of the OMgaments was equivalent to Holter-monitoring (84% vs 93% electrophysiologists rating, p = 0.06). Signal coverage of R-R intervals showed a very close overlay between the OMsignal system and Holter signals, mean difference in heart rate of 2 5 bpm. The noise level of OMgarments was comparable to Holter recording. OMgarments provide high signal quality for adequate rhythm analysis, representing a promising novel technology for long-term non-invasive ECG monitoring.


Assuntos
Eletrocardiografia Ambulatorial/métodos , Frequência Cardíaca , Dispositivos Eletrônicos Vestíveis , Adulto , Arritmias Cardíacas/fisiopatologia , Eletrocardiografia Ambulatorial/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Processamento de Sinais Assistido por Computador , Telemedicina
7.
Cardiol Rev ; 27(2): 60-62, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30628918

RESUMO

Public interest in health monitoring devices has increased with the availability of wearable technologies or wearables such as the Apple Watch. These devices are collecting health data that may be useful to health professionals. Most studies to date have been conducted with a limited sample size and with healthy subjects. Recent studies have suggested the usefulness of long-term cardiac monitoring to reveal atrial fibrillation and prevent cryptogenic stroke. Wearable devices may become useful in cardiac monitoring, and further studies are needed.


Assuntos
Arritmias Cardíacas/fisiopatologia , Eletrocardiografia Ambulatorial/instrumentação , Frequência Cardíaca/fisiologia , Dispositivos Eletrônicos Vestíveis , Desenho de Equipamento , Humanos
9.
Pacing Clin Electrophysiol ; 42(1): 38-45, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30357866

RESUMO

BACKGROUND: Implantable loop recorders (ILRs) are effective in achieving symptom-rhythm correlation. However, diagnostic yield in routine clinical practice is not well established. METHODS: Patients undergoing ILR implantation between April 2010 and May 2015 were included. All devices were enrolled in remote monitoring with automatic arrhythmia detection and P sense algorithms switched "ON." Symptom-rhythm correlation was assessed and changes in management were recorded. RESULTS: A total of 312 patients (57% male, age 53 ± 22 years; median CHADS2VaSc score  =  1) were included in this study. ILRs were implanted for evaluation of syncope in 206 (66.0%), presyncope in 23 (7.4%), unexplained palpitations in 51 (16.3%), and cryptogenic stroke in 27 (8.7%) patients. ILR monitoring yielded a diagnosis that changed management strategy in 146 (46.8%) patients over a median of 12 (1-42) months. Out of 163 (52.2%) patients with symptoms during the monitoring period, 100 (61.3%) had an arrhythmia. ILR was useful in ruling out an arrhythmic cause for symptoms in 63 (38.7%) patients. ILR results led to pacemaker implantation in 23 patients (7.4% overall and 11.2% of those with syncope) after median follow-up of 3 months. A new diagnosis of atrial fibrillation was made in 38 (12.2%) patients, 11 of whom were initiated on oral anticoagulants. ILR results led to pacemaker implantation in 31 patients (9.9% overall and 19.0% of those with syncope) after median follow-up of 3 months. A new diagnosis of atrial fibrillation was made in 38 (12.2%) patients, nine of whom were initiated on oral anticoagulants. Overall, ILR led to a change in management in 47% patients with a number needed to implant of 2.1 to change management. CONCLUSION: ILR monitoring is effective in achieving symptom-rhythm correlation and results in changes in management in nearly half of implanted patients. Additional studies are needed to evaluate cost efficacy of ILR and the optimal monitoring duration.


Assuntos
Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/terapia , Eletrocardiografia Ambulatorial/instrumentação , Anticoagulantes/administração & dosagem , Arritmias Cardíacas/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial , Centros de Atenção Terciária , Resultado do Tratamento
10.
Am Heart J ; 207: 66-75, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30392584

RESUMO

BACKGROUND: Smartwatch and fitness band wearable consumer electronics can passively measure pulse rate from the wrist using photoplethysmography (PPG). Identification of pulse irregularity or variability from these data has the potential to identify atrial fibrillation or atrial flutter (AF, collectively). The rapidly expanding consumer base of these devices allows for detection of undiagnosed AF at scale. METHODS: The Apple Heart Study is a prospective, single arm pragmatic study that has enrolled 419,093 participants (NCT03335800). The primary objective is to measure the proportion of participants with an irregular pulse detected by the Apple Watch (Apple Inc, Cupertino, CA) with AF on subsequent ambulatory ECG patch monitoring. The secondary objectives are to: 1) characterize the concordance of pulse irregularity notification episodes from the Apple Watch with simultaneously recorded ambulatory ECGs; 2) estimate the rate of initial contact with a health care provider within 3 months after notification of pulse irregularity. The study is conducted virtually, with screening, consent and data collection performed electronically from within an accompanying smartphone app. Study visits are performed by telehealth study physicians via video chat through the app, and ambulatory ECG patches are mailed to the participants. CONCLUSIONS: The results of this trial will provide initial evidence for the ability of a smartwatch algorithm to identify pulse irregularity and variability which may reflect previously unknown AF. The Apple Heart Study will help provide a foundation for how wearable technology can inform the clinical approach to AF identification and screening.


Assuntos
Algoritmos , Fibrilação Atrial/diagnóstico , Flutter Atrial/diagnóstico , Eletrocardiografia Ambulatorial/instrumentação , Aplicativos Móveis , Smartphone , Dispositivos Eletrônicos Vestíveis , Fibrilação Atrial/epidemiologia , Flutter Atrial/epidemiologia , Humanos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Medidas de Resultados Relatados pelo Paciente , Estudos Prospectivos , Telemedicina , Fatores de Tempo
11.
Cardiol J ; 26(1): 36-46, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29399750

RESUMO

BACKGROUND: Implantable loop recorders (ILR) are a valuable tool for the investigation of unexplainedsyncopal episodes. The aim of this retrospective single center study was to identify predictive factors for pacemaker implantation in patients with unexplained syncope who underwent ILR insertion. METHODS: One hundred six patients were retrospectively analyzed (mean age 59.1 years; 47.2% male) with unexplained syncope and negative conventional testing who underwent ILR implantation. The pri- mary study endpoint was detection of symptomatic or asymptomatic bradycardia requiring pacemaker implantation. RESULTS: The average follow-up period after ILR implantation was 20 ± 15 months. Pacemaker im- plantation according to current guidelines was necessary in 22 (20.8%) patients, mean duration until index bradycardia was 81 ± 88 (2-350) days. Ten (45.5%) patients received a pacemaker due to sinus arrest, 7 (31.8%) patients due to third-degree atrioventricular block, 2 (9.1%) patients due to second- degree atrioventricular block and 1 (4.5%) patient due to atrial fibrillation with a slow ventricular rate. Three factors remained significant in multivariate analysis: obesity, which defined by a body mass index above 30 kg/m2 (OR: 7.39, p = 0.014), a right bundle branch block (OR: 9.40, p = 0.023) and chronic renal failure as defined by a glomerular filtration rate of less than 60 mL/min (OR: 6.42, p = 0.035). CONCLUSIONS: Bradycardia is a frequent finding in patients undergoing ILR implantation due to un- explained syncope. Obesity, right bundle branch block and chronic renal failure are independent clinical predictors of pacemaker implantation.


Assuntos
Estimulação Cardíaca Artificial/métodos , Eletrocardiografia Ambulatorial/instrumentação , Eletrodos Implantados , Síncope/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Síncope/fisiopatologia , Síncope/terapia , Fatores de Tempo , Adulto Jovem
12.
Heart Lung Circ ; 28(2): 223-236, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30056014

RESUMO

Modern cardiac pacing systems have sophisticated software to document, evaluate and record intrinsic and paced rhythms as well as correct pacing abnormalities and rhythm disturbances by applying algorithms, which are generally company specific. To the cardiologist and technologist, these algorithms may be difficult to interpret on both the 12-lead electrocardiograph (ECG) and Holter ambulatory monitoring recordings, which are usually performed because of patient symptoms or physician concern. The tracings may appear bewildering and mimic pacemaker malfunction, thus leading to unnecessary tests or even surgery. This review will define the common programmed pacemaker modes and describe a range of ECG appearances of normal pacemaker function during the application of testing, correcting or therapy algorithms.


Assuntos
Algoritmos , Arritmias Cardíacas/diagnóstico , Eletrocardiografia Ambulatorial/instrumentação , Marca-Passo Artificial , Arritmias Cardíacas/fisiopatologia , Desenho de Equipamento , Humanos
13.
Clin Res Cardiol ; 108(3): 309-314, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30167809

RESUMO

BACKGROUND: Implantable loop recorders (ILR) may be used to detect occult atrial fibrillation (AF) in patients with cryptogenic stroke. At present, there has been no description on the incidental findings of stored episodes in these patients. Furthermore, no standard practice has been established with respect to the duration of continued ECG monitoring in these patients. MATERIALS AND METHODS: In the prospective monocentric study (TRACK-AF), a total of 173 patients with cryptogenic stroke received an ILR for detection of AF between November 2010 and December 2014. Before implantation all patients had undergone recommended protocols for detection of stroke causes. RESULTS: During a mean follow-up of 24.8 ± 11.5 months, atrial tachyarrhythmias were detected in n = 33 pts (19.1%). Diagnosis of AF was made after a mean of 10.7 ± 11.4 months, time to first AF detection ranged between 0.2 and 39.8 months. In 15 patients (8.7%), other incidental findings were stored in the ILR memory. Short episodes of sinus arrest at night not requiring a permanent pacemaker were present in 8 pts (4.6%). DDD-pacemaker implantation due to sinus arrest or symptomatic bradyarrhythmias occurred in 5 patients (2.9%) after a median monitoring period of 23.1 ± 7.4 months. Further incidental findings were atrial flutter and an AV-nodal-reentry tachycardia in one patient, respectively. Both patients underwent successful catheter ablation. So far, ILR were explanted in 111 pts, and 71 ILR were explanted before end of service status of the battery. Main reason for ILR explantation was patients' preference (51%), followed by battery depletion (24%) and diagnosis of AF (15%). CONCLUSION: The present study revealed a significant number of ECG findings during continued ECG monitoring for AF in patients with cryptogenic stroke. Apart from AF (17.5% during the first 1.5 years), other clinical relevant arrhythmias requiring, e.g., pacemaker implantations, were observed. With respect to these findings, we recommend to extend ILR monitoring to the end of battery life. However, acceptance of continued ECG monitoring until battery depletion was poor; in 71 patients (64%), the ILR were explanted before the end of battery life. TRIAL REGISTRATION: Registered at ClinicalTrials.gov: NCT02641678.


Assuntos
Fibrilação Atrial/diagnóstico , Isquemia Encefálica/diagnóstico , Ablação por Cateter/métodos , Remoção de Dispositivo/métodos , Eletrocardiografia Ambulatorial/instrumentação , Eletrodos Implantados , Sistema de Condução Cardíaco/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/complicações , Fibrilação Atrial/cirurgia , Isquemia Encefálica/etiologia , Feminino , Seguimentos , Humanos , Achados Incidentais , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Ultrassonografia Doppler
14.
Expert Rev Med Devices ; 16(1): 45-55, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30522350

RESUMO

INTRODUCTION: Recurrent unexplained syncope is a well-established indication for an insertable cardiac monitor (ICM). Recently, the indications for an ICM have been expanded. AREAS COVERED: This review article discusses the current indications for ICMs and gives an overview of the latest generation of commercially available ICMs. EXPERT COMMENTARY: The 2018 ESC Syncope guidelines have expanded the indications for an ICM to patients with inherited cardiomyopathy, inherited channelopathy, suspected unproven epilepsy, and unexplained falls. ICMs are also increasingly used for the detection of subclinical atrial fibrillation (AF) in patients with cryptogenic stroke. Whether treatment of subclinical AF (SCAF) with oral anticoagulation prevents recurrent stroke is yet unknown. The current generation of ICMs are smaller, easier to implant, have better diagnostics, and are capable of remote monitoring. The Reveal LINQ (Medtronic) is the smallest ICM and has the most extensive performance and clinical data. The BioMonitor 2 (Biotronik) is the largest ICM but has excellent R-wave amplitudes, longest longevity, and reliable remote monitoring. The Confirm Rx (Abbott) is capable to provide mobile data transmission enabled by a smartphone app. Future generation of ICMs will incorporate heart failures indices to facilitate remote monitoring of heart failure patients.


Assuntos
Eletrocardiografia Ambulatorial/instrumentação , Fibrilação Atrial/diagnóstico , Humanos , Medição de Risco , Acidente Vascular Cerebral/diagnóstico , Síncope/diagnóstico , Telemedicina
15.
J Electrocardiol ; 51(6): 1145-1152, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30497747

RESUMO

BACKGROUND: A novel signal-averaged electrocardiogram (SAECG) device and a novel ambulatory SAECG device are clinically available, but reference values have not been established. This study aimed to validate the novel SAECG and the novel ambulatory-based SAECG devices by comparison with the conventional SAECG device. METHODS AND RESULTS: High-resolution SAECGs were recorded consecutively in 83 healthy volunteers using the 3 devices. A novel ambulatory SAECG device was used as real-time recording within 15 min for validation study (15 min ambulatory-based SAECG). We examined the concordance of positive results (at least 2/3 abnormal SAECG parameters) and negative results (0 or 1/3 abnormal parameters), as well as the correlations between SAECG parameters (filtered QRS duration [fQRS]); duration of low-amplitude signals < 40 µV in the terminal filtered QRS complex [LAS40]; root mean square voltage of the terminal 40 ms of the filtered QRS complex [RMS40]). Qualitative analysis showed excellent concordance among the novel SAECG, the 15 min ambulatory-based SAECG, and the conventional SAECG methods (novel SAECG vs. conventional SAECG = 94%; 15 min ambulatory-based SAECG vs. conventional SAECG = 91.6%; p = 0.755), while quantitative analysis indicated strong correlations between the novel SAECG and the conventional SAECG values for fQRS, LAS40, and LnRMS40 (r = 0.838-0.805, p < 0.0001, respectively). Strong correlations were also seen between 15 min ambulatory-based SAECG and conventional SAECG values for fQRS, LAS40, and RMS40 (r = 0.943-0.888, p < 0.0001, respectively). However, Bland-Altman quantitative analysis showed better agreement in fQRS and LnRMS40 measured by the 15 min ambulatory-based SAECG and the conventional SAECG than those by the novel SAECG and the conventional SAECG (fQRS, Lin's rho_c = 0.923 vs. 0757; RMS40, Lin's rho_c = 0.932 vs. 0.818, respectively). CONCLUSION: In healthy subjects, the parameters of either the novel SAECG or the 15 min ambulatory-based SAECG and those of the conventional SAECG were strongly correlated. Relatively good agreements were observed among 3 SAECGs, especially better between the 15 min ambulatory-based SAECG and the conventional SAECG probably due to similar measurement system of 2 methods.


Assuntos
Eletrocardiografia Ambulatorial/instrumentação , Eletrocardiografia/métodos , Adulto , Desenho de Equipamento , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Processamento de Sinais Assistido por Computador
16.
J Electrocardiol ; 51(6): 997-1002, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30497763

RESUMO

BACKGROUND: Patch electrocardiographic (ECG) monitors permit extended noninvasive ambulatory monitoring. To guide use of these devices, information is needed about their performance. We sought to determine in a large general population sample the acceptability of patch ECG monitors, the yield of arrhythmia detection, and the consistency of findings in participants monitored twice. METHODS: In the Multi-Ethnic Study of Atherosclerosis, 1122 participants completed one or two monitoring episodes using the Zio Patch XT, a single-channel ECG patch monitor capable of recording for 14 days. Recordings were analyzed for atrial fibrillation (AF), atrial flutter, atrioventricular block, pauses, and supraventricular and ventricular ectopy. RESULTS: The mean(SD) age at the time of monitoring was 75(8) years, 52% were men, and 15% had a prior history of clinically-recognized AF/flutter. The median monitoring duration was 13.8 days. Among 804 participants with no prior clinical history of AF/flutter and at least 12 days of monitoring on a single device, AF/flutter was detected in 32 (4.0%); in 38% of these, AF/flutter was first detected during days 3 through 12 of monitoring. In participants monitored twice, findings from the two devices showed excellent agreement for supraventricular and ventricular ectopic beats per hour, but only fair agreement for high-grade atrioventricular block and pauses of >3 s duration. CONCLUSIONS: In a general population of older individuals, new diagnoses of AF/flutter were made in 4.0% of participants without a prior history. A single monitoring episode accurately estimated rates of supraventricular and ventricular ectopy.


Assuntos
Fibrilação Atrial/diagnóstico , Flutter Atrial/diagnóstico , Bloqueio Atrioventricular/diagnóstico , Eletrocardiografia Ambulatorial/instrumentação , Complexos Ventriculares Prematuros/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Aterosclerose/etnologia , Fibrilação Atrial/etnologia , Flutter Atrial/etnologia , Bloqueio Atrioventricular/etnologia , Feminino , Humanos , Masculino , Programas de Rastreamento/instrumentação , Pessoa de Meia-Idade , Estados Unidos , Complexos Ventriculares Prematuros/etnologia
17.
Trials ; 19(1): 711, 2018 Dec 29.
Artigo em Inglês | MEDLINE | ID: mdl-30594256

RESUMO

BACKGROUND: Palpitations and pre-syncope are together responsible for 300,000 annual Emergency Department (ED) attendances in the United Kingdom (UK). Diagnosis of the underlying rhythm is difficult as many patients are fully recovered on ED arrival; and examination and presenting electrocardiogram (ECG) are commonly normal. The only way to establish the underlying heart rhythm is to capture an ECG during symptoms. Recent technology advances have led to several novel ECG monitoring devices appearing on the market. This trial aims to compare the symptomatic rhythm detection rate at 90 days of one such smart phone-based event recorder (AliveCor Heart Monitor and AliveECG) with standard care for participants presenting to the ED with palpitations and pre-syncope and no obvious cause in the ED. METHODS/DESIGN: This is a multi-centre hospital ED / Acute Medical Unit (AMU) open label, randomised controlled trial. Participants will be recruited in 10 tertiary and district general hospitals in the UK. Participants aged ≥ 16 years presenting with an episode of palpitations or pre-syncope with no obvious cause and whose underlying ECG rhythm during these episodes remains undiagnosed after clinical assessment will be included. Participants will be randomised to either: (1) the intervention arm, standard care plus the use of a smart phone-based event recorder; or (2) the control arm, standard care. Primary endpoint will be symptomatic rhythm detection rate at 90 days. A number of secondary clinical, process and cost-effectiveness endpoints will be collected and analysed. Analysis will be on an intention-to-treat basis. DISCUSSION: The Investigation of Palpitations in the ED (IPED) study aims to recruit 242 participants across 10 hospital sites. It will be the first study to investigate the ability of a smart phone-based event recorder to detect symptomatic cardiac rhythms compared to standard care for ED patients with palpitations and pre-syncope with no obvious cause in the ED. This smart phone event recorder will allow ED patients who have presented with palpitations or pre-syncope to record their ECG tracing if they have a further episode and may increase the rate of underlying rhythm diagnosis. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02783898 . Registered on 26 May 2016.


Assuntos
Arritmias Cardíacas/diagnóstico , Eletrocardiografia Ambulatorial/instrumentação , Serviço Hospitalar de Emergência , Frequência Cardíaca , Aplicativos Móveis , Smartphone , Síncope/diagnóstico , Telemetria/instrumentação , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/terapia , Humanos , Estudos Multicêntricos como Assunto , Valor Preditivo dos Testes , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Síncope/fisiopatologia , Síncope/terapia , Fatores de Tempo , Reino Unido
18.
JACC Clin Electrophysiol ; 4(11): 1383-1396, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30466842

RESUMO

Insertable cardiac monitors (ICMs) are small, subcutaneously implanted devices offering continuous ambulatory electrocardiogram monitoring with a lifespan up to 3 years. ICMs have been studied and proven useful in selected cases of unexplained syncope and palpitations, as well as in atrial fibrillation (AF) management. The use of ICMs has greatly improved our ability to detect subclinical AF after cryptogenic stroke, and application of this technology is growing. Despite this, current stroke and cardiology society guidelines are lacking in recommendations for monitoring of subclinical AF following cryptogenic stroke, including the optimal timing from stroke event, duration, and method of electrocardiogram monitoring. This focused review outlines the current society guidelines, summarizes the latest evidence, and describes current and future use of ICMs with an emphasis on detection of subclinical AF in patients with cryptogenic stroke.


Assuntos
Eletrocardiografia Ambulatorial/instrumentação , Telemetria/instrumentação , Fibrilação Atrial/diagnóstico , Desenho de Equipamento , Humanos
20.
J Electrocardiol ; 51(5): 751-755, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30177307

RESUMO

INTRODUCTION: Implantable loop recorders (ILR) are leadless subcutaneous devices that allow cardiac monitoring for up to 3 years and are a valuable tool in the diagnosis of arrhythmias, cryptogenic stroke and unexplained syncope. The Biotronik BioMonitor 2 is a novel, insertable ILR allowing long-term continuous monitoring with wireless telemetry options. METHODS: A single-center, prospective, observational study investigating the reliability of sensing quality and detection performance in the BioMonitor 2 ILR, as well as post-implantation patient satisfaction. R-wave amplitude was recorded immediately post implantation and 1 day post implantation, followed by extensive patient instruction. Follow-up was scheduled after 3 months, or after an event. Data from the ILR were retrieved, with documentation of all episodes, R-wave amplitude and noise burden. The anatomical position of the ILR was determined 1 day post implantation and after 3 months. A patient questionnaire was conducted after 3 months. RESULTS: 30 consecutive patients (mean age 71 ±â€¯12 years, 56% male) were analyzed. Indications for ILR implantation were: unexplained syncope (n = 24, 80%), suspected atrial fibrillation (n = 4, 13%), cryptogenic stroke (n = 1, 3%) and palpitations (n = 1, 3%). Median time from skin cut to suture was 8 min. No complications occurred. Mean R-wave amplitude at implantation was 0.84 ±â€¯0.32 mV, at day 1 post implantation 0.96 ±â€¯0.31 mV, and after a mean follow-up of 85 ±â€¯24 days 1.02 ±â€¯0.47 mV (p = 0.01). The mean noise burden was 1.4 ±â€¯2%. CONCLUSION: Implantation of the novel BioMonitor 2 ILR is fast and uncomplicated. Initial sensing values are good and improve over time.


Assuntos
Fibrilação Atrial/diagnóstico , Eletrocardiografia Ambulatorial/instrumentação , Idoso , Idoso de 80 Anos ou mais , Bradicardia/diagnóstico , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Prospectivos , Próteses e Implantes , Reprodutibilidade dos Testes , Inquéritos e Questionários , Telemetria
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