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1.
J Electrocardiol ; 64: 72-75, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33348137

RESUMO

In response to the COVID-19 pandemic, a protocol was designed for mail-out devices and educational materials created to teach patients how to install a device for 2 weeks of continuous ambulatory ECG monitoring. We compared data collection from two sequential patient populations; one who received standard device application in the same clinic in the months before the pandemic response, and another, who received their device by mail for self-installation. Patients received a single phone call when the device was mailed and were able to contact the manufacturer as needed for support. A total of 47 devices were assessed from each group. Each group was similar in age (70 vs 65 years), and clinical indication for monitoring. Noise signal magnitude (22.34 vs 26.28%), symptom based manual activation (10 vs 8 events) and APB/recorded hour burden measurements (37.05 vs 23.36%) were similar in both groups (all comparisons were statistically non-significant). Both groups had a similar mean of hours recorded (240.37 vs. 245.05 h). Zero patient kits were lost, and all reports were delivered. Overall, it was found that a mail-delivered home-based recording platform can be reliably used to acquire clinical data with similar data quality and patient compliance as a conventional in-clinic model for long term ambulatory ECG monitoring.


Assuntos
Eletrocardiografia Ambulatorial , Educação de Pacientes como Assunto/métodos , Idoso , Eletrocardiografia Ambulatorial/instrumentação , Eletrocardiografia Ambulatorial/métodos , Feminino , Serviços de Assistência Domiciliar , Humanos , Masculino , Pessoa de Meia-Idade , Autogestão
2.
BMJ Case Rep ; 13(12)2020 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-33323421

RESUMO

Long QT syndrome with Torsades de Pointes (TdP) is a life-threatening polymorphic ventricular arrhythmia. The corrected QT (QTc) prolongation >500 milliseconds (ms) has been associated with TdP. Hypocalcaemia due to severe vitamin D deficiency is an uncommon cause of acquired long QT. We hereby present a case of a 40-year-old woman with sensorineural deafness and having symptoms of palpitations and presyncope. She had a QTc interval of 556 ms (reference range, QTc 451-470 ms in adult healthy woman) on 24-hour Holter analysis. Genetic analysis for congenital long QT syndrome was negative. She was diagnosed with severe hypocalcaemia secondary to severe vitamin D deficiency. After treatment with intravenous calcium gluconate, followed by oral vitamin D and calcium supplementation, the QTc became normalised and no further episode of palpitations or presyncope occurred. The causes of vitamin D deficiency was due to inadequate exposure to sunlight and a strict vegan diet.


Assuntos
Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/etiologia , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/diagnóstico , Antagonistas de Receptores Adrenérgicos beta 1/uso terapêutico , Adulto , Cálcio/uso terapêutico , Gluconato de Cálcio/uso terapêutico , Eletrocardiografia Ambulatorial/métodos , Feminino , Humanos , Hipocalcemia/diagnóstico , Hipocalcemia/tratamento farmacológico , Hipocalcemia/etiologia , Síndrome do QT Longo/tratamento farmacológico , Metoprolol/uso terapêutico , Vitamina D/uso terapêutico , Deficiência de Vitamina D/tratamento farmacológico , Vitaminas/uso terapêutico
3.
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
4.
Medicine (Baltimore) ; 99(29): e21098, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702857

RESUMO

INTRODUCTION: Ventricular ectopic beats (VEBs) are very common and often occur in hypertensive or obese individuals, as well as in patients presenting with either sleep apnea or structural cardiac disease. Sympathetic overactivity plays a crucial role in the development, continuation, and exacerbation of ventricular arrhythmias. Recent studies have reported the relevance of sympathetic activation in patients with ventricular arrhythmias and suggested a potential role for catheter-based renal denervation (RDN) in reducing the arrhythmic burden. PATIENT CONCERNS: We describe a 38-year-old female symptomatic patient that at the time of presentation was complaining of fatigue in response to minor and medium efforts and not tolerating any physical activity, and episodes of tachycardia associated with dyspnoea, pre-syncope, and syncope. DIAGNOSIS: She had a high incidence of polymorphic VEBs on 24-hour-Holter monitoring who also presented with left ventricular (LV) hypertrophy for which she was treated with bisoprolol 10 mg/d. The 24-hour-Holter on bisoprolol at baseline showed sinus rhythm with an average heart rate of 92 bpm. There were 44,743 isolated VEBs. A total of 2538 nonsustained ventricular tachycardia events were registered. Her cardiac magnetic resonance imaging showed an increase in LV diastolic diameter and impairment of the right ventricle. INTERVENTIONS: The patient underwent endocardial ablation of the right ventricular outflow tract and the LV free lateral wall, and concomitantly underwent bilateral RDN. OUTCOMES: Three months post-procedure, her 24-hour-Holter off medication demonstrated an average heart rate 72 bpm and a substantially reduced number of 2823 isolated monomorphic VEBs. Thus far, 18-months follow-up, she has been asymptomatic and doing physical exercises. CONCLUSION: In our current patient, we used RDN as a synergistic method to attenuate the sympathetic overactivity, which is narrowly linked to VEBs appearance. Our case report highlighted that RDN may become a potential adjuvant treatment for VEBs in the future.


Assuntos
Denervação/normas , Rim/fisiopatologia , Complexos Ventriculares Prematuros/terapia , Adulto , Denervação/métodos , Eletrocardiografia/métodos , Eletrocardiografia Ambulatorial/métodos , Feminino , Humanos , Imagem por Ressonância Magnética/métodos
7.
PLoS One ; 15(6): e0233264, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32479554

RESUMO

The dogs' responses to training exercise are seldom monitored using physiological variables, and cardiac autonomic regulation (CAR) is a relevant determinant of endurance-training adaptation. There are studies in the literature establishing that regular exercise could interfere with CAR in dogs, measured by heart rate and vagal-derived indexes of heart-rate-variability (HRV). However, few studies were found using a prescribed training program based on the lactate threshold (LT) to determine HRV by a 24-h Holter analysis. The purpose of this study was to test whether an endurance-training program (ETP) guided individually by LT raises time-domain measures of HRV in healthy Beagle dogs. Twenty dogs were assigned to two groups: control (C) and trained (T). The dogs from group T underwent an incremental exercise test (IET) to determine their LT. Both LT and velocity corresponding to the LT (VLT) was determined by visual inspection. T group performed an eight-week endurance-training program consisting of treadmill runs set to 70-80% of the VLT. Next, dogs from the group T have submitted to IET again. The maximal velocities (Vmax) at which achieved by the trained dogs in both IETs were determined. The group S did not undergo IETs or ETP. HRV was determined by the 24-hour-Holter at rest, before and on the 2°, 4°, 6° and 8° training weeks. To examine the HR impact on HRV, standard HRV variables were normalized to prevailing HR. VLT and Vmax rose in group T, indicating an improvement of dogs' aerobic and anaerobic capacity. The normalized standard HRV indexes were relatively attenuated since these variables had a reduction in the degree of correlation concerning an average HR. The ETP resulted in decreased resting heart rate and increased time-domain indices, highlighting the log-transformed square root of the mean sum of the squared differences between R-R intervals (Ln rMSSD). The lactate-guided endurance-training program could lead to better parasympathetic cardiac modulation in Beagle dogs.


Assuntos
Frequência Cardíaca/fisiologia , Ácido Láctico/metabolismo , Condicionamento Físico Animal/métodos , Animais , Sistema Nervoso Autônomo/fisiologia , Cães , Eletrocardiografia Ambulatorial/métodos , Eletrocardiografia Ambulatorial/veterinária , Treino Aeróbico/métodos , Teste de Esforço , Feminino , Coração/fisiologia , Masculino , Resistência Física/fisiologia , Nervo Vago/fisiologia
8.
Sci Rep ; 10(1): 5866, 2020 04 03.
Artigo em Inglês | MEDLINE | ID: mdl-32246080

RESUMO

Accurate detection of accelerometer non-wear time is crucial for calculating physical activity summary statistics. In this study, we evaluated three epoch-based non-wear algorithms (Hecht, Troiano, and Choi) and one raw-based algorithm (Hees). In addition, we performed a sensitivity analysis to provide insight into the relationship between the algorithms' hyperparameters and classification performance, as well as to generate tuned hyperparameter values to better detect episodes of wear and non-wear time. We used machine learning to construct a gold-standard dataset by combining two accelerometers and electrocardiogram recordings. The Hecht and Troiano algorithms achieved poor classification performance, while Choi exhibited moderate performance. Meanwhile, Hees outperformed all epoch-based algorithms. The sensitivity analysis and hyperparameter tuning revealed that all algorithms were able to achieve increased classification performance by employing larger intervals and windows, while more stringently defining artificial movement. These classification gains were associated with the ability to lower the false positives (type I error) and do not necessarily indicate a more accurate detection of the total non-wear time. Moreover, our results indicate that with tuned hyperparameters, epoch-based non-wear algorithms are able to perform just as well as raw-based non-wear algorithms with respect to their ability to correctly detect true wear and non-wear episodes.


Assuntos
Acelerometria/métodos , Algoritmos , Eletrocardiografia Ambulatorial/métodos , Acelerometria/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Eletrocardiografia Ambulatorial/instrumentação , Exercício Físico , Feminino , Humanos , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Inquéritos e Questionários , Dispositivos Eletrônicos Vestíveis
9.
J Vet Cardiol ; 27: 78-87, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32086162

RESUMO

INTRODUCTION: The primary objective of this study was to test whether seven-day Holter recording improves the sensitivity of detecting dilated cardiomyopathy (DCM) predictive criteria (DCMp) compared with 24-h Holter recording in asymptomatic Doberman Pinscher (DP) dogs. ANIMALS: Twenty-eight asymptomatic DP dogs with normal echocardiographic examinations. METHODS: Dogs with normal echocardiographic examinations underwent seven-day Holter monitoring. The presence of ≥50 ventricular premature complexes and or ≥ one couplet/one triplet/one episode of ventricular tachycardia per 24-h period was considered positive for DCMp. RESULTS: Five dogs were positive on the first day, and an additional six dogs tested positive from day two to seven of the Holter recording. The number of dogs positive for DCMp detected by four days was significantly different (p = 0.031) compared with the first-day Holter recording. CONCLUSIONS: Seven-day Holter recording detected significantly more dogs with DCMp compared with the first-day Holter recording. Follow-up studies are warranted to evaluate the long-term accuracy of multiple-day Holter analysis in predicting the development of DCM in DP dogs.


Assuntos
Cardiomiopatia Dilatada/veterinária , Doenças do Cão/diagnóstico , Eletrocardiografia Ambulatorial/veterinária , Animais , Cardiomiopatia Dilatada/diagnóstico , Cães , Ecocardiografia/veterinária , Eletrocardiografia Ambulatorial/métodos , Feminino , Masculino , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/veterinária
11.
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
12.
Circ Arrhythm Electrophysiol ; 13(1): e007698, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31934795

RESUMO

BACKGROUND: African Americans are consistently found to have a lower prevalence of clinically detected atrial fibrillation (AF) than whites, despite a higher prevalence of major AF risk factors and higher risk of ischemic stroke. Long-term ambulatory ECG monitors provide the opportunity for unbiased AF detection. We determined differences by race/ethnicity in the prevalence of clinically detected AF and in the proportion with monitor-detected AF. METHODS: We conducted a cross-sectional analysis in the MESA (Multi-Ethnic Study of Atherosclerosis), a community-based cohort study that enrolled 6814 Americans free of clinically recognized cardiovascular disease in 2000 to 2002. At the 2016 to 2018 examination, 1556 individuals participated in an ancillary study involving ambulatory ECG monitoring and had follow-up for clinically detected AF since cohort entry. RESULTS: Among 1556 participants, 41% were white, 25% African American, 21% Hispanic, and 14% Chinese; 51% were women; and the mean age was 74 years. The prevalence of clinically detected AF after 14.4 years' follow-up was 11.3% in whites, 6.6% in African Americans, 7.8% in Hispanics, and 9.9% in Chinese and was significantly lower in African Americans than in whites, in both unadjusted and risk factor-adjusted analyses (adjusted rate difference, -6.6% [95% CI, -10.1% to -3.1%]; P<0.001). By contrast, in the same individuals, the proportion with monitor-detected AF using a 14-day ambulatory ECG monitor was similar in the 4 race/ethnic groups: 7.1%, 6.4%, 6.9%, and 5.2%, respectively (compared with whites, all P>0.5). CONCLUSIONS: The prevalence of clinically detected AF was substantially lower in African American than in white participants, without or with adjustment for AF risk factors. However, unbiased AF detection by ambulatory monitoring in the same individuals revealed little difference in the proportion with AF by race/ethnicity. These findings provide support for the hypothesis of differential detection by race/ethnicity in the clinical recognition of AF, which may have important implications for stroke prevention.


Assuntos
Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/etnologia , Grupos de Populações Continentais/etnologia , Eletrocardiografia/métodos , Grupos Étnicos , Afro-Americanos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Americanos Asiáticos/estatística & dados numéricos , Intervalos de Confiança , Estudos Transversais , Eletrocardiografia Ambulatorial/métodos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Estados Unidos/epidemiologia
13.
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
14.
Am J Cardiol ; 125(7): 1054-1062, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-31948665

RESUMO

Little information is available concerning the usefulness of electrophysiological confirmation followed by totally thoracoscopic ablation. This study aimed to examine whether postprocedural electrophysiological confirmation is always necessary after totally thoracoscopic ablation (TTA) in patients with isolated persistent atrial fibrillation. Forty-five patients with isolated persistent atrial fibrillation were randomized into 2 groups those who received routine electrophysiological confirmation and additional catheter ablation after totally thoracoscopic ablation (the hybrid group [n = 22]) and those who did not (the TTA group [n = 23]). Electrophysiological study was performed 4 or 5 days after surgery. No early or late mortality occurred. In the hybrid group, 5 patients (23%, 5/22) required additional ablation due to residual potential in the left atrium. At a year postoperatively, normal sinus rhythm was observed in 89% of patients (40/45) and similar in both groups (Odds ratio 0.80, 95% confidence interval 0.32 to 1.99). During follow-up, sinus rhythm was maintained in 16 patients (70%) in the TTA group without additional catheter ablation, which was similar (p = 0.920) to the results in the hybrid group (n = 15, 68.2%). Event-free survival rate at 12 months did not differ between groups (TTA group vs hybrid group, 78% vs 77%; p = 0.633). In simple Cox regression analysis, preoperative left atrium volume index was associated with atrial arrhythmia (p = 0.030, hazards ratio 1.087, 95% confidence interval 1.01-1.18). In conclusion, thoracoscopic ablation provided good 1-year durability in patients with isolated persistent AF irrespective of postprocedural electrophysiological confirmation. Seventy-percent of the TTA group did not need additional catheter ablation.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Eletrocardiografia Ambulatorial/métodos , Sistema de Condução Cardíaco/fisiopatologia , Cuidados Pós-Operatórios/métodos , Toracoscopia/métodos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Ecocardiografia Doppler de Pulso/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recidiva , Fatores de Tempo
15.
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
16.
Am Heart J ; 219: 128-136, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31862084

RESUMO

BACKGROUND: Reducing atrial fibrillation (AF)-related stroke requires timely AF diagnosis, but the optimal monitoring strategy is unknown. OBJECTIVE: We used insertable cardiac monitor (ICM) data from the REVEAL AF study to compare AF detection rates by various short-term continuous monitoring (STM) strategies. METHODS AND RESULTS: Patients without known AF, but with CHADS2 scores ≥3 (or = 2 with ≥1 additional AF risk factor) received an ICM for AF detection. One-time STM strategies were assessed by computing AF incidence at 1, 2, 7, 14, and 30 days post-ICM insertion. Repeated STM strategies (quarterly 24-hour, 48-hour, 7-day, or monthly 24-hour monitoring) were modeled by randomly selecting day(s) within a 30-day window around each nominal evaluation date over a 1-year period (simulated 10,000 times). Endpoints included AF ≥6 minutes, AF ≥1 hour, and daily AF burden ≥1 and ≥ 5.5 hours. The impact of compliance on AF detection was evaluated using daily compliance rates of 85%, 75%, 65% and 55% during follow-up months 1-3, 4-6, 7-9, and 9-12, respectively. Based on data from 385 patients (71.5 ±â€¯9.9 years; CHADS2 score 3.0 ±â€¯1.0) the incidence of AF ≥6 minutes via ICM at 12 months was 27.1% (95% CI, 22.5-31.5%). This exceeded the range of estimated rates from all modeled one-time and repeated STM strategies (0.8% for 24-hour Holter monitoring to 10.6% for quarterly 7-day monitoring). Findings were similar for all AF endpoints. Modeled non-compliance reduced AF detection by 4.5% to 22.9%. CONCLUSIONS: Most AF episodes detected via ICMs would go undetected via conventional STM strategies, thus preventing optimal prophylaxis for adverse consequences.


Assuntos
Fibrilação Atrial/diagnóstico , Eletrocardiografia Ambulatorial/métodos , Acidente Vascular Cerebral/prevenção & controle , Idoso , Fibrilação Atrial/complicações , Fibrilação Atrial/epidemiologia , Intervalos de Confiança , Feminino , Humanos , Incidência , Masculino , Cooperação do Paciente/estatística & dados numéricos , Acidente Vascular Cerebral/etiologia , Fatores de Tempo
17.
Pediatr Cardiol ; 41(1): 181-185, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31745583

RESUMO

Implantable loop recorders (ILR) are utilized for long-term rhythm monitoring. Typical placement of the Medtronic Reveal LINQ along the left parasternal border may compromise the quality and/or feasibility of future imaging studies. We sought to evaluate the utility of placing an ILR in the left anterior axillary position and the impact on the quality of cardiac imaging. We reviewed patients from May 2017 to June 2018 who had placement of a Reveal LINQ device in the left anterior axillary position. Demographic, procedural, and clinical data were collected via retrospective review. Cardiac magnetic resonance imaging (MRI) studies were reviewed for image quality after ILR placement. Eight patients met inclusion criteria for this study (median age 6 years, 50% female). Six patients (75%) had an ILR placed in the operating room, while all others were placed in the electrophysiology lab. All patients demonstrated acceptable R waves for diagnostic evaluation (median = 0.85 mV, range 0.24-1.7 mV). Cardiac MRI was obtained in 7 patients following ILR placement with diagnostic image quality and no adverse events. One device was explanted 28 days after placement due to concern for possible infection. No other devices required removal or revision (median follow up duration 11 months, IQR 8-13.5). ILR placement in the left anterior axillary position can record adequate signals in pediatric patients. In addition, axillary ILR device position may allow for completion of cardiac imaging, particularly cardiac MRI, without significant artifacts which is critical for patients with congenital heart disease.


Assuntos
Eletrocardiografia Ambulatorial/métodos , Próteses e Implantes , Adolescente , Artéria Axilar/cirurgia , Criança , Pré-Escolar , Eletrocardiografia Ambulatorial/normas , Feminino , Cardiopatias Congênitas/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Estudos Retrospectivos
18.
Am J Cardiol ; 125(3): 409-414, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31780074

RESUMO

Atrial fibrillation (AF) causes a substantial proportion of embolic strokes of undeterminded source (ESUS). Effective detection of subclinical AF (SCAF) has important therapeutic implications. We conducted a prospective study to determine the prevalence of SCAF in patients with ESUS through of a 21-day Holter monitoring. In an early-monitoring group, Holter was initiated immediately after hospital discharge. The results were compared with a previous cohort of patients in whom the Holter was initiated at least 1 week after hospital discharge (late-monitoring group). We included 100 patients (50 each group; 69 ± 13 years, 56% male). Mean time from ESUS to Holter was 1.2 ± 1 day in the early-monitoring group and 30 ± 15 days in the late-monitoring group. SCAF was detected in 22% of patients in the early-monitoring and 6% in the late-monitoring group (p <0.05). Patients with SCAF were older (77 ± 9 vs 67 ± 11 years, p <0.05), with a higher rate of left atrial enlargement (50% vs 20%, p<0.05), renal impairment (28% vs 5%; p<0.01), and a slower mean heart rate (55 ± 6 vs 70 ± 6 beats/min; p<0.001). On multivariate analysis, the presence of persistent bradycardia (≤60 beats/min) in the 21-day Holter was a powerful and significant risk factor for SCAF. In conclusion, the sooner 21-day Holter electrocardiogram monitoring is initiated after ESUS, the more likely SCAF can be detected. Sinus bradycardia is a powerful predictor of SCAF in patients with ESUS.


Assuntos
Fibrilação Atrial/diagnóstico , Eletrocardiografia Ambulatorial/métodos , Embolia Intracraniana/etiologia , Sistema de Registros , Idoso , Fibrilação Atrial/complicações , Feminino , Seguimentos , Humanos , Incidência , Embolia Intracraniana/epidemiologia , Masculino , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologia , Fatores de Tempo
19.
Stroke ; 51(2): 395-401, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31813354

RESUMO

Background and Purpose- Diagnosing paroxysmal atrial fibrillation (pAF) can be challenging after acute ischemic stroke. Enhanced and prolonged Holter-ECG monitoring (EPM) improves the detection rate but is not feasible for all patients. We hypothesized that brain natriuretic peptide (BNP) may help to identify patients with stroke at high risk for pAF to select patients for EPM more effectively. Methods- Patients with acute cerebral ischemia ≥60 years presenting in sinus rhythm and without history of AF were included into a prospective, randomized multicenter study to receive either EPM (3× 10-day Holter-ECG) or usual stroke care diagnostic work-up. BNP plasma levels were measured on randomization and 3 months thereafter. Levels were compared between patients with and without pAF detected by means of EPM or usual care. Furthermore, the number needed to screen for EPM depending on BNP cut offs was calculated. Results- A total of 398 patients were analyzed. In 373 patients (93.7%), BNP was measured at baseline and in 275 patients (69.1%) after 3 months. pAF was found in 27 patients by means of EPM and in 9 patients by means of usual care (P=0.002). Median BNP was higher in patients with pAF as compared to patients without AF in both study arms at baseline (57.8 versus 28.3 pg/mL in the EPM arm, P=0.0003; 46.2 versus 27.7 pg/mL, P=0.28 in the control arm) and after 3 months (74.9 versus 31.3 pg/mL, P=0.012 in the EPM arm, 99.3 versus 26.3 pg/mL, P=0.02 in the control arm). Applying a cut off of 100 pg/mL, the number needed to screen was reduced from 18 by usual care to 3 by EPM. Conclusions- BNP measured early after ischemic stroke identifies a subgroup of patients with stroke at increased risk for AF, in whom EPM is particularly efficacious. Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT01855035.


Assuntos
Fibrilação Atrial/diagnóstico , Isquemia Encefálica/etiologia , Eletrocardiografia Ambulatorial/métodos , Peptídeo Natriurético Encefálico/sangue , Acidente Vascular Cerebral/etiologia , Idoso , Fibrilação Atrial/sangue , Fibrilação Atrial/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
20.
Ital J Pediatr ; 45(1): 165, 2019 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-31856875

RESUMO

BACKGROUND: Cardiac arrhythmias are sometimes encountered in patients with hereditary myopathies and muscular dystrophies. Description of arrhythmias in myopathies and muscular dystrophies is very important, because arrhythmias have a strong impact on the outcomes for these patients and are potentially treatable. CASE PRESENTATION: A girl with severe congenital RYR1-related myopathy exhibited atrial tachycardia and sinus node dysfunction during infancy. She was born after uncomplicated caesarian delivery. She showed no breathing, complete ophthalmoplegia, complete bulbar paralysis, complete facial muscle paralysis, and extreme floppiness. At 5 months old, she developed persistent tachycardia around 200-210 beats per minutes. Holter monitoring revealed ectopic atrial tachycardia during tachyarrhythmia and occasional sinus pauses with junctional escape beats. Propranolol effectively alleviated tachyarrhythmia but was discontinued due to increased frequency and duration of the sinus pauses that led to bradyarrhythmia. There was no evidence of structural heart diseases or heart failure. The arrhythmia gradually resolved spontaneously and at 11 months old, she showed complete sinus rhythm. CONCLUSIONS: Although supraventricular arrhythmia is sometimes encountered in congenital myopathies, this is the first report of cardiac arrhythmia requiring drug intervention in RYR1-associated myopathy.


Assuntos
Predisposição Genética para Doença , Miopatias Congênitas Estruturais/genética , Canal de Liberação de Cálcio do Receptor de Rianodina/genética , Síndrome do Nó Sinusal/genética , Taquicardia Atrial Ectópica/genética , Taquicardia Supraventricular/genética , Eletrocardiografia/métodos , Eletrocardiografia Ambulatorial/métodos , Feminino , Seguimentos , Humanos , Lactente , Miopatias Congênitas Estruturais/complicações , Miopatias Congênitas Estruturais/diagnóstico , Propranolol/uso terapêutico , Medição de Risco , Índice de Gravidade de Doença , Síndrome do Nó Sinusal/complicações , Síndrome do Nó Sinusal/fisiopatologia , Taquicardia Atrial Ectópica/complicações , Taquicardia Atrial Ectópica/diagnóstico , Taquicardia Atrial Ectópica/tratamento farmacológico , Taquicardia Supraventricular/complicações , Taquicardia Supraventricular/fisiopatologia , Resultado do Tratamento
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