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1.
JAMA ; 325(21): 2169-2177, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34061145

RESUMO

Importance: Patients with ischemic stroke attributed to large- or small-vessel disease are not considered at high risk for atrial fibrillation (AF), and the AF incidence rate in this population is unknown. Objectives: To determine whether long-term cardiac monitoring is more effective than usual care for AF detection in patients with stroke attributed to large- or small-vessel disease through 12 months of follow-up. Design, Setting, and Participants: The STROKE-AF trial was a randomized (1:1), multicenter (33 sites in the US) clinical trial that enrolled 496 patients between April 2016 and July 2019, with primary end point follow-up through August 2020. Eligible patients were aged 60 years or older or aged 50 to 59 years with at least 1 additional stroke risk factor and had an index stroke attributed to large- or small-vessel disease within 10 days prior to insertable cardiac monitor (ICM) insertion. Interventions: Patients randomized to the intervention group (n = 242) received ICM insertion within 10 days of the index stroke; patients in the control group (n = 250) received site-specific usual care consisting of external cardiac monitoring, such as 12-lead electrocardiograms, Holter monitoring, telemetry, or event recorders. Main Outcomes and Measures: Incident AF lasting more than 30 seconds through 12 months. Results: Among 492 patients who were randomized (mean [SD] age, 67.1 [9.4] years; 185 [37.6%] women), 417 (84.8%) completed 12 months of follow-up. The median (interquartile range) CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65 to 74 years, sex category) score was 5 (4-6). AF detection at 12 months was significantly higher in the ICM group vs the control group (27 patients [12.1%] vs 4 patients [1.8%]; hazard ratio, 7.4 [95% CI, 2.6-21.3]; P < .001). Among the 221 patients in the ICM group who received an ICM, 4 (1.8%) had ICM procedure-related adverse events (1 site infection, 2 incision site hemorrhages, and 1 implant site pain). Conclusions and Relevance: Among patients with stroke attributed to large- or small-vessel disease, monitoring with an ICM compared with usual care detected significantly more AF over 12 months. However, further research is needed to understand whether identifying AF in these patients is of clinical importance. Trial Registration: ClinicalTrials.gov Identifier: NCT02700945.


Assuntos
Fibrilação Atrial/diagnóstico , Eletrocardiografia Ambulatorial/métodos , Doenças Arteriais Intracranianas/complicações , Acidente Vascular Cerebral/etiologia , Idoso , Fibrilação Atrial/complicações , Eletrocardiografia , Eletrocardiografia Ambulatorial/efeitos adversos , Eletrocardiografia Ambulatorial/instrumentação , Eletrodos Implantados , Feminino , Humanos , Ataque Isquêmico Transitório/etiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Acidente Vascular Cerebral/prevenção & controle
2.
Medicina (Kaunas) ; 57(5)2021 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-34065703

RESUMO

Background and Objectives: People with epilepsy (PWE) have a 2-3 times higher mortality rate than the general population. Sudden unexpected death in epilepsy (SUDEP) comprises a significant proportion of premature deaths, whereas sudden cardiac death (SCD) is among the leading causes of sudden death in the general population. Cardiac pathologies are significantly more prevalent in PWE. Whether electrocardiographic (ECG) parameters are associated with remote death in PWE has yet to be elucidated. The study objective was to assess whether interictal ECG parameters are associated with mortality in the long-term. Materials and Methods: The study involved 471 epilepsy patients who were hospitalized after a bilateral tonic-clonic seizure(s). ECG parameters were obtained on the day of hospitalization (heart rate, PQ interval, QRS complex, QT interval, heart rate corrected QT interval (QTc), ST segment and T wave changes), as well as reported ECG abnormalities. Mortality data were obtained from the Latvian National Cause-of-Death database 3-11, mean 7.0 years after hospitalization. The association between the ECG parameters and the long-term clinical outcome were examined. Results: At the time of assessment, 75.4% of patients were alive and 24.6% were deceased. Short QTc interval (odds ratio (OR) 4.780; 95% confidence interval (CI) 1.668-13.698; p = 0.004) was associated with a remote death. After the exclusion of known comorbidities with high mortality rates, short QTc (OR 4.631) and ECG signs of left ventricular hypertrophy (OR 5.009) were associated with a remote death. Conclusions: The association between routine 12-lead rest ECG parameters-short QTc interval and a pattern of left ventricular hypertrophy-and remote death in epilepsy patients was found. To the best of our knowledge, this is the first study to associate rest ECG parameters with remote death in an epileptic population.


Assuntos
Arritmias Cardíacas , Epilepsia , Arritmias Cardíacas/epidemiologia , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/etiologia , Eletrocardiografia , Epilepsia/complicações , Frequência Cardíaca , Humanos , Fatores de Risco
3.
Sensors (Basel) ; 21(11)2021 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-34067397

RESUMO

Early detection of exposure to a toxic chemical, e.g., in a military context, can be life-saving. We propose to use machine learning techniques and multiple continuously measured physiological signals to detect exposure, and to identify the chemical agent. Such detection and identification could be used to alert individuals to take appropriate medical counter measures in time. As a first step, we evaluated whether exposure to an opioid (fentanyl) or a nerve agent (VX) could be detected in freely moving guinea pigs using features from respiration, electrocardiography (ECG) and electroencephalography (EEG), where machine learning models were trained and tested on different sets (across subject classification). Results showed this to be possible with close to perfect accuracy, where respiratory features were most relevant. Exposure detection accuracy rose steeply to over 95% correct during the first five minutes after exposure. Additional models were trained to correctly classify an exposed state as being induced either by fentanyl or VX. This was possible with an accuracy of almost 95%, where EEG features proved to be most relevant. Exposure detection models that were trained on subsets of animals generalized to subsets of animals that were exposed to other dosages of different chemicals. While future work is required to validate the principle in other species and to assess the robustness of the approach under different, realistic circumstances, our results indicate that utilizing different continuously measured physiological signals for early detection and identification of toxic agents is promising.


Assuntos
Substâncias para a Guerra Química , Eletroencefalografia , Animais , Eletrocardiografia , Cobaias , Aprendizado de Máquina , Respiração
4.
Sensors (Basel) ; 21(11)2021 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-34070412

RESUMO

This study presents a noncontact electrocardiogram (ECG) measurement system to replace conventional ECG electrode pads during ECG measurement. The proposed noncontact electrode design comprises a surface guard ring, the optimal input resistance, a ground guard ring, and an optimal voltage divider feedback. The surface and ground guard rings are used to reduce environmental noise. The optimal input resistor mitigates distortion caused by the input bias current, and the optimal voltage divider feedback increases the gain. Simulated gain analysis was subsequently performed to determine the most suitable parameters for the design, and the system was combined with a capacitive driven right leg circuit to reduce common-mode interference. The present study simulated actual environments in which interference is present in capacitive ECG signal measurement. Both in the case of environmental interference and motion artifact interference, relative to capacitive ECG electrodes, the proposed electrodes measured ECG signals with greater stability. In terms of R-R intervals, the measured ECG signals exhibited a 98.6% similarity to ECGs measured using contact ECG systems. The proposed noncontact ECG measurement system based on capacitive sensing is applicable for use in everyday life.


Assuntos
Artefatos , Eletrocardiografia , Eletrodos , Movimento (Física) , Ruído
5.
Sensors (Basel) ; 21(11)2021 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-34072986

RESUMO

Atrial fibrillation (AF) is the most common cardiac arrhythmia. It tends to cause multiple cardiac conditions, such as cerebral artery blockage, stroke, and heart failure. The morbidity and mortality of AF have been progressively increasing over the past few decades, which has raised widespread concern about unobtrusive AF detection in routine life. The up-to-date non-invasive AF detection methods include electrocardiogram (ECG) signals and cardiac dynamics signals, such as the ballistocardiogram (BCG) signal, the seismocardiogram (SCG) signal and the photoplethysmogram (PPG) signal. Cardiac dynamics signals can be collected by cushions, mattresses, fabrics, or even cameras, which is more suitable for long-term monitoring. Therefore, methods for AF detection by cardiac dynamics signals bring about extensive attention for recent research. This paper reviews the current unobtrusive AF detection methods based on the three cardiac dynamics signals, summarized as data acquisition and preprocessing, feature extraction and selection, classification and diagnosis. In addition, the drawbacks and limitations of the existing methods are analyzed, and the challenges in future work are discussed.


Assuntos
Fibrilação Atrial , Balistocardiografia , Acidente Vascular Cerebral , Fibrilação Atrial/diagnóstico , Eletrocardiografia , Coração , Humanos
6.
BMC Neurol ; 21(1): 217, 2021 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-34102997

RESUMO

BACKGROUND: Lacosamide (LCM) is the antiepileptic drug approved by the U.S. Food and Drug Administration in 2008 that facilitates slow activation of the voltage-gated sodium channels. Neutropenia and cardiac events including sinus node dysfunction (SND) and atrioventricular block have been previously reported as adverse effects of LCM. To date, there have been no reports of severe agranulocytosis resulting in death associated with LCM. Additionally, there have been no reports of concomitant SND and agranulocytosis after LCM administration. Herein we report the first case of LCM-induced severe SND followed by agranulocytosis. CASE PRESENTATION: The patient with focal epilepsy was initiated on LCM 100 mg/day and the dose was increased to 200 mg/day on the 9th hospital day. Severe SND developed on the 10th hospital day and LCM was discontinued. Thereafter agranulocytosis appeared on the 11th hospital day, and the patient died from septic shock on the 15th hospital day. CONCLUSIONS: This case illustrates the need for careful follow-up of the electrocardiogram and the complete blood cell counts when initiating LCM. Moreover, it should be noticed that various side effects may occur simultaneously in the early period of LCM use, even for a short time and at low dosages.


Assuntos
Agranulocitose/induzido quimicamente , Anticonvulsivantes/efeitos adversos , Lacosamida/efeitos adversos , Síndrome do Nó Sinusal/induzido quimicamente , Idoso , Anticonvulsivantes/uso terapêutico , Eletrocardiografia , Epilepsias Parciais/tratamento farmacológico , Feminino , Humanos , Lacosamida/uso terapêutico
7.
Medicina (Kaunas) ; 57(5)2021 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-34064932

RESUMO

Background and objectives: Persistent left bundle branch block (P-LBBB) has been associated with poor clinical outcomes of transcatheter aortic valve implantation (TAVI) procedures. We hypothesized that the distance from the aortic valve to the proximal conduction system, expressed as the effective distance between the aortic valve and conduction system (EDACS), can predict the occurrence of P-LBBB in patients undergoing a TAVI procedure. Materials and methods: In a retrospective study, data from 269 patients were analyzed. EDACS was determined using two longitudinal CT sections. Results: Sixty-four of the patients developed P-LBBB. EDACS ranged between -3 and +18 mm. EDACS was significantly smaller in P-LBBB than in non-P-LBBB patients (4.6 (2.2-7.1) vs. 8.0 (5.8-10.2) mm, median values (interquartile range); p < 0.05). Receiver operating characteristic analysis showed an area under the curve of 0.78 for predicting P-LBBB based on EDACS. In patients with EDACS of ≤3 mm and >10 mm, the chance of developing P-LBBB was ≥50% and <10%, respectively. Conclusions: A small EDACS increases the risk for the development of P-LBBB during TAVI by a factor of >25. As EDACS can be measured pre-procedurally, it may be a valuable additional factor to weigh the risks of transcatheter and surgical aortic valve replacement.


Assuntos
Estenose da Valva Aórtica , Substituição da Valva Aórtica Transcateter , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Bloqueio de Ramo , Eletrocardiografia , Humanos , Incidência , Estudos Retrospectivos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
8.
Sensors (Basel) ; 21(10)2021 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-34065516

RESUMO

Heart rate (HR) and HR variability (HRV) infer readiness to perform exercise in athletic populations. Technological advancements have facilitated HR and HRV quantification via photoplethysmography (PPG). This study evaluated the validity of WHOOP's PPG-derived HR and HRV against electrocardiogram-derived (ECG) measures. HR and HRV were assessed via WHOOP and ECG over 15 opportunities. WHOOP-derived pulse-to-pulse (PP) intervals were edited with WHOOP's proprietary filter, in addition to various filter strengths via Kubios HRV software. HR and HRV (Ln RMSSD) were quantified for each filter strength. Agreement was assessed via bias and limits of agreement (LOA), and contextualised using smallest worthwhile change (SWC) and coefficient of variation (CV). Regardless of filter strength, bias (≤0.39 ± 0.38%) and LOA (≤1.56%) in HR were lower than the CV (10-11%) and SWC (5-5.5%) for this parameter. For Ln RMSSD, bias (1.66 ± 1.80%) and LOA (±5.93%) were lowest for a 200 ms filter and WHOOP's proprietary filter, which approached or exceeded the CV (3-13%) and SWC (1.5-6.5%) for this parameter. Acceptable agreement was found between WHOOP- and ECG-derived HR. Bias and LOA in Ln RMSSD approached or exceeded the SWC/CV for this variable and should be interpreted against its own level of bias precision.


Assuntos
Fotopletismografia , Punho , Eletrocardiografia , Frequência Cardíaca , Articulação do Punho
9.
Sensors (Basel) ; 21(9)2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-34067051

RESUMO

Heart rate variability, which is the fluctuation of the R-R interval (RRI) in electrocardiograms (ECG), has been widely adopted for autonomous evaluation. Since the HRV features that are extracted from RRI data easily fluctuate when arrhythmia occurs, RRI data with arrhythmia need to be modified appropriately before HRV analysis. In this study, we consider two types of extrasystoles-premature ventricular contraction (PVC) and premature atrial contraction (PAC)-which are types of extrasystoles that occur every day, even in healthy persons who have no cardiovascular diseases. A unified framework for ectopic RRI detection and a modification algorithm that utilizes an autoencoder (AE) type of neural network is proposed. The proposed framework consists of extrasystole occurrence detection from the RRI data and modification, whose targets are PVC and PAC. The RRI data are monitored by means of the AE in real time in the detection phase, and a denoising autoencoder (DAE) modifies the ectopic RRI caused by the detected extrasystole. These are referred to as AE-based extrasystole detection (AED) and DAE-based extrasystole modification (DAEM), respectively. The proposed framework was applied to real RRI data with PVC and PAC. The result showed that AED achieved a sensitivity of 93% and a false positive rate of 0.08 times per hour. The root mean squared error of the modified RRI decreased to 31% in PVC and 73% in PAC from the original RRI data by DAEM. In addition, the proposed framework was validated through application to a clinical epileptic seizure problem, which showed that it correctly suppressed the false positives caused by PVC. Thus, the proposed framework can contribute to realizing accurate HRV-based health monitoring and medical sensing systems.


Assuntos
Complexos Cardíacos Prematuros , Eletrocardiografia , Algoritmos , Complexos Cardíacos Prematuros/diagnóstico , Frequência Cardíaca , Humanos , Redes Neurais de Computação
10.
Medicina (Kaunas) ; 57(5)2021 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-34067941

RESUMO

BACKGROUND: Percutaneous coronary intervention (PCI) is known as a very rare possible trigger of pericarditis. Most frequently it develops after a latent period or early in the case of periprocedural complications. In this report, we present an atypical early onset of pericarditis after an uncomplicated PCI. CASE SUMMARY: A 58-year-old man was admitted to the hospital for PCI of the chronic total occlusion of the left anterior descending (LAD) artery. An initial electrocardiogram (ECG) was unremarkable. The PCI attempt was unsuccessful. There were no procedure-related complications observed at the end of the PCI attempt and the patient was symptom free. Six hours after the interventional procedure, the patient complained of severe chest pain. The ECG demonstrated ST-segment elevation in anterior and lateral leads. Troponin I was mildly elevated but a coronary angiogram did not reveal the impairment of collateral blood flow to the LAD territory. Due to pericarditic chest pain, typical ECG findings and pericardial effusion with elevated C-reactive protein, the diagnosis of acute pericarditis was established, and a course of nonsteroidal anti-inflammatory drugs (NSAIDs) was initiated. Chest pain was relieved and ST-segment elevation almost completely returned to baseline after three days of treatment. The patient was discharged in stable condition without chest pain on the fourth day after symptom onset. CONCLUSIONS: Acute pericarditis is a rare complication of PCI. Despite the lack of specific clinical manifestation, post-traumatic pericarditis should be considered in patients with symptoms and signs of pericarditis and a prior history of iatrogenic injury or thoracic trauma.


Assuntos
Intervenção Coronária Percutânea , Pericardite , Dor no Peito/etiologia , Angiografia Coronária , Eletrocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Pericardite/etiologia
11.
Sensors (Basel) ; 21(10)2021 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-34069374

RESUMO

Ventricular fibrillation (VF) is a type of fatal arrhythmia that can cause sudden death within minutes. The study of a VF detection algorithm has important clinical significance. This study aimed to develop an algorithm for the automatic detection of VF based on the acquisition of cardiac mechanical activity-related signals, namely ballistocardiography (BCG), by non-contact sensors. BCG signals, including VF, sinus rhythm, and motion artifacts, were collected through electric defibrillation experiments in pigs. Through autocorrelation and S transform, the time-frequency graph with obvious information of cardiac rhythmic activity was obtained, and a feature set of 13 elements was constructed for each 7 s segment after statistical analysis and hierarchical clustering. Then, the random forest classifier was used to classify VF and non-VF, and two paradigms of intra-patient and inter-patient were used to evaluate the performance. The results showed that the sensitivity and specificity were 0.965 and 0.958 under 10-fold cross-validation, and they were 0.947 and 0.946 under leave-one-subject-out cross-validation. In conclusion, the proposed algorithm combining feature extraction and machine learning can effectively detect VF in BCG, laying a foundation for the development of long-term self-cardiac monitoring at home and a VF real-time detection and alarm system.


Assuntos
Balistocardiografia , Algoritmos , Animais , Arritmias Cardíacas , Eletrocardiografia , Humanos , Suínos , Fibrilação Ventricular/diagnóstico
12.
Sensors (Basel) ; 21(10)2021 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-34069396

RESUMO

The availability of simple, accurate, and affordable cuffless blood pressure (BP) devices has the potential to greatly increase the compliance with measurement recommendations and the utilization of BP measurements for BP telemonitoring. The aim of this study is to evaluate the correlation between findings from routine BP measurements using a conventional sphygmomanometer with the results from a portable ECG monitor combined with photoplethysmography (PPG) for pulse wave registration in patients with arterial hypertension. METHODS: The study included 500 patients aged 32-88 years (mean 64 ± 7.9 years). Mean values from three routine BP measurements by a sphygmomanometer with cuff were selected for comparison; within one minute after the last measurement, an electrocardiogram (ECG) was recorded for 3 min in the standard lead I using a smartphone-case based single-channel ECG monitor (CardioQVARK®-limited responsibility company "L-CARD", Moscow, Russia) simultaneously with a PPG pulse wave recording. Using a combination of the heart signal with the PPG, levels of systolic and diastolic BP were determined based on machine learning using a previously developed and validated algorithm and were compared with sphygmomanometer results. RESULTS: According to the Bland-Altman analysis, SD for systolic BP was 3.63, and bias was 0.32 for systolic BP. SD was 2.95 and bias was 0.61 for diastolic BP. The correlation between the results from the sphygmomanometer and the cuffless method was 0.89 (p = 0.001) for systolic and 0.87 (p = 0.002) for diastolic BP. CONCLUSION: Blood pressure measurements on a smartphone-case without a cuff are encouraging. However, further research is needed to improve the accuracy and reliability of clinical use in the majority of patients.


Assuntos
Hipertensão , Fotopletismografia , Pressão Sanguínea , Determinação da Pressão Arterial , Eletrocardiografia , Humanos , Hipertensão/diagnóstico , Análise de Onda de Pulso , Reprodutibilidade dos Testes , Smartphone
13.
Biosensors (Basel) ; 11(5)2021 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-34069456

RESUMO

Classification performances for some classes of electrocardiographic (ECG) and electroencephalographic (EEG) signals processed to dimensionality reduction with different degrees are investigated. Results got with various classification methods are given and discussed. So far we investigated three techniques for reducing dimensionality: Laplacian eigenmaps (LE), locality preserving projections (LPP) and compressed sensing (CS). The first two methods are related to manifold learning while the third addresses signal acquisition and reconstruction from random projections under the supposition of signal sparsity. Our aim is to evaluate the benefits and drawbacks of various methods and to find to what extent they can be considered remarkable. The assessment of the effect of dimensionality decrease was made by considering the classification rates for the processed biosignals in the new spaces. Besides, the classification accuracies of the initial input data were evaluated with respect to the corresponding accuracies in the new spaces using different classifiers.


Assuntos
Eletrocardiografia , Eletroencefalografia , Algoritmos , Humanos , Reconhecimento Automatizado de Padrão
14.
Sensors (Basel) ; 21(10)2021 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-34069717

RESUMO

Early detection of atrial fibrillation from electrocardiography (ECG) plays a vital role in the timely prevention and diagnosis of cardiovascular diseases. Various algorithms have been proposed; however, they are lacking in considering varied-length signals, morphological transitions, and abnormalities over long-term recordings. We propose dynamic symbolic assignment (DSA) to differentiate a normal sinus rhythm (SR) from paroxysmal atrial fibrillation (PAF). We use ECG signals and their interbeat (RR) intervals from two public databases namely, AF Prediction Challenge Database (AFPDB) and AF Termination Challenge Database (AFTDB). We transform RR intervals into a symbolic representation and compute co-occurrence matrices. The DSA feature is extracted using varied symbol-length V, word-size W, and applied to five machine learning algorithms for classification. We test five hypotheses: (i) DSA captures the dynamics of the series, (ii) DSA is a reliable technique for various databases, (iii) optimal parameters improve DSA's performance, (iv) DSA is consistent for variable signal lengths, and (v) DSA supports cross-data analysis. Our method captures the transition patterns of the RR intervals. The DSA feature exhibit a statistically significant difference in SR and PAF conditions (p < 0.005). The DSA feature with W=3 and V=3 yield maximum performance. In terms of F-measure (F), rotation forest and ensemble learning classifier are the most accurate for AFPDB (F = 94.6%) and AFTDB (F = 99.8%). Our method is effective for short-length signals and supports cross-data analysis. The DSA is capable of capturing the dynamics of varied-lengths ECG signals. Particularly, the optimal parameters-based DSA feature and ensemble learning could help to detect PAF in long-term ECG signals. Our method maps time series into a symbolic representation and identifies abnormalities in noisy, varied-length, and pathological ECG signals.


Assuntos
Fibrilação Atrial , Algoritmos , Fibrilação Atrial/diagnóstico , Bases de Dados Factuais , Eletrocardiografia , Humanos , Aprendizado de Máquina
15.
Zhonghua Xin Xue Guan Bing Za Zhi ; 49(6): 615-620, 2021 Jun 24.
Artigo em Chinês | MEDLINE | ID: mdl-34126730

RESUMO

Objective: To investigate the clinical and electrophysiological features of ventricular tachycardia (VT) in tetralogy of Fallot (TOF) patients post surgical repair (rTOF) and to analyze the therapeutic effect and prognosis of radiofrequency ablation of rTOF-VT. Methods: This is a retrospective study. Consecutive patients with rTOF-VT, who were treated in Fuwai Hospital from January 2015 to March 2020, were enrolled. All the patients underwent right ventricular voltage mapping following routine cardiac electrophysiological examination, followed by linear or homogenizing radiofrequency ablation based on the low-voltage substrate. The clinical features, 3-dimentional electrophysiological substrate mapping, radiofrequency ablation and long-term prognosis of the enrolled patients were analyzed. Acute ablation success was defined as completion of linear or homogenizing ablation or intraoperative evoked VT as destination of the procedure. Patients were followed up at 3 and 6 months post operation and every year thereafter. The endpoints were sudden cardiac death (SCD) and recurrence of ventricular tachycardia. Results: A total of 20 patients with rTOF-VT were enrolled including 14 males with an age of (35.8±11.8) years. The electrocardiogram identified 23 types of ventricular tachycardia, 19 of which were originated from right ventricular inflow tract outlet. The most common clinical manifestations were heart murmur (19 cases, 95%) and syncope (4 cases, 25%). Electroanatomical substrate mapping was performed in 20 patients and evidenced localized or diffuse scar or low-voltage area of right ventricle. Intraoperative electrophysiological tests provoked ventricular tachycardia in 6 patients (30%), including 5 patients with hemodynamics disturbance. The acute success rate of radiofrequency ablation was 95% (19/20). The follow-up time was (31.1±17.7) months and the recurrence rate of ventricular tachycardia was 30% during follow-up period and 5 cases received repeat radiofrequency ablation and there was no recurrent ventricular tachycardia during follow-up post repeat radiofrequency ablation. Conclusions: The voltage substrate mapping under sinus rhythm is a feasible mapping method for rTOF-VT. Linear or flaky radiofrequency ablation of the slow conduction zone is safe and effective treatment strategy, the recurrence rate after the first radiofrequency ablation is still high, and the effectiveness of repeat radiofrequency ablation is satisfactory in this patient cohort.


Assuntos
Ablação por Cateter , Taquicardia Ventricular , Tetralogia de Fallot , Adulto , Arritmias Cardíacas , Eletrocardiografia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taquicardia Ventricular/cirurgia , Tetralogia de Fallot/cirurgia , Resultado do Tratamento , Adulto Jovem
16.
Sci Rep ; 11(1): 11648, 2021 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-34078942

RESUMO

Cardiovascular magnetic resonance (CMR) imaging provides reliable assessments of biventricular morphology and function. Since manual post-processing is time-consuming and prone to observer variability, efforts have been directed towards novel artificial intelligence-based fully automated analyses. Hence, we sought to investigate the impact of artificial intelligence-based fully automated assessments on the inter-study variability of biventricular volumes and function. Eighteen participants (11 with normal, 3 with heart failure and preserved and 4 with reduced ejection fraction (EF)) underwent serial CMR imaging at in median 63 days (range 49-87) interval. Short axis cine stacks were acquired for the evaluation of left ventricular (LV) mass, LV and right ventricular (RV) end-diastolic, end-systolic and stroke volumes as well as EF. Assessments were performed manually (QMass, Medis Medical Imaging Systems, Leiden, Netherlands) by an experienced (3 years) and inexperienced reader (no active reporting, 45 min of training with five cases from the SCMR consensus data) as well as fully automated (suiteHEART, Neosoft, Pewaukee, WI, USA) without any manual corrections. Inter-study reproducibility was overall excellent with respect to LV volumetric indices, best for the experienced observer (intraclass correlation coefficient (ICC) > 0.98, coefficient of variation (CoV, < 9.6%) closely followed by automated analyses (ICC > 0.93, CoV < 12.4%) and lowest for the inexperienced observer (ICC > 0.86, CoV < 18.8%). Inter-study reproducibility of RV volumes was excellent for the experienced observer (ICC > 0.88, CoV < 10.7%) but considerably lower for automated and inexperienced manual analyses (ICC > 0.69 and > 0.46, CoV < 22.8% and < 28.7% respectively). In this cohort, fully automated analyses allowed reliable serial investigations of LV volumes with comparable inter-study reproducibility to manual analyses performed by an experienced CMR observer. In contrast, RV automated quantification with current algorithms still relied on manual post-processing for reliability.


Assuntos
Interpretação de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética/métodos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Adulto , Algoritmos , Eletrocardiografia , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Volume Sistólico , Disfunção Ventricular Esquerda/fisiopatologia
17.
Am J Case Rep ; 22: e930381, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34086663

RESUMO

BACKGROUND Cardiac perforation leading to cardiac tamponade is one of the possible complications of endocardial mapping during catheter-based ablation procedures. The early diagnosis of catheter-induced perforation is critical for effective management of these patients. We hereby present the diagnosis and management of left ventricular perforation during mapping of ventricular tachycardia in a patient with left ventricular aneurysm. CASE REPORT A 70-year-old man with a history of ischemic heart disease, arterial hypertension, type 2 diabetes mellitus, and obesity was referred to our institution for the ablative treatment of recurrent, sustained monomorphic ventricular tachycardia that was resistant to medication. One particularity was the presence of a left ventricular aneurysm secondary to a non-ST segment elevation myocardial infarction, which was unusual and could increase the risk of cardiac perforation. During left ventricular mapping, several points were acquired in an apparently unusual position and the pericardial location of the mapping catheter was confirmed fluoroscopically. After setting a pericardial pigtail catheter, we successfully finished the ablation procedure using a second ablation catheter. The perforating catheter was thereafter removed by open surgery, and no significant bleeding occurred. The patient did not experience tachycardia during the follow-up period of 29 months. CONCLUSIONS Left ventricular aneurysms might increase the cardiac perforation risk during endocardial mapping in ventricular tachycardia ablation procedures. In patients with this condition, a careful manipulation of the catheters could prevent such complications. The periodic fluoroscopic assessment of the catheter's position is essential for early recognition of the perforation.


Assuntos
Ablação por Cateter , Diabetes Mellitus Tipo 2 , Taquicardia Ventricular , Idoso , Eletrocardiografia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Masculino , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/cirurgia
18.
Zhongguo Yi Liao Qi Xie Za Zhi ; 45(3): 276-279, 2021 Jun 08.
Artigo em Chinês | MEDLINE | ID: mdl-34096235

RESUMO

In order to improve the clarity of ECG waveforms and the anti-interference ability of ECG acquisition under abnormal conditions, this study proposes a high-definition ECG recording method based on superimposed averaging algorithm. The results show that the proposed method can more clearly reflect the details of the ECG. Meanwhile, it has a significant inhibitory effect on EMG interference. As a result, the proposed method has a positive significance for improving the anti-interference ability of ECG equipment.


Assuntos
Algoritmos , Eletrocardiografia
19.
BMJ Case Rep ; 14(6)2021 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-34108154

RESUMO

Lithium is frequently used in the treatment of bipolar disorders and is known to induce ECG alterations. This case study describes various patterns of lithium-induced ECG modifications in a patient with acute-on-chronic lithium intoxication. Clinicians should be familiar with this problem as it can have life-threatening consequences and lead to important changes in patient's management. Our patient was admitted for acute delirium with an ECG showing atrial fibrillation with wide QRS and ST-segment elevation. These modifications were first mistaken for an acute myocardial infarction and a diagnosis of Brugada syndrome was finally reached. Treatment after the acute phase implied changes in the therapeutic modality and required frequent monitoring.


Assuntos
Síndrome Coronariana Aguda , Fibrilação Atrial , Síndrome de Brugada , Síndrome Coronariana Aguda/induzido quimicamente , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/tratamento farmacológico , Síndrome de Brugada/induzido quimicamente , Síndrome de Brugada/diagnóstico , Eletrocardiografia , Humanos , Lítio/efeitos adversos
20.
Medicine (Baltimore) ; 100(22): e25978, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087840

RESUMO

BACKGROUND: The early repolarization pattern (ERP) has recently been associated with cardiac events such as ventricular arrhythmias and sudden cardiac death. However, estimates of the prevalence of ERP vary widely, especially between the general population and physically active individuals. We performed this systematic review and meta-analysis to quantitatively evaluate the worldwide prevalence of ERP in the general population and physically active individuals. METHODS: We thoroughly searched the PubMed, EMBASE, Web of science, the Cochrane Library, and Scopus databases for relevant studies published until December 20, 2020. Studies in which prevalence was presented or could be estimated from eligible data were included. The pooled prevalence was analyzed using a random-effect model. RESULTS: Finally, we included 29 studies (182,135 subjects) in the general population and 14 studies (8087 subjects) in the physically active individuals. The worldwide pooled prevalence of ERP in the general population was 11.6% (95% confidence interval [CI]: 10.0%-13.3%). The incidence of ERP was 17.0% and 6.2% in men and women, respectively. The prevalence was 20.9% in blacks, 13.4% in Asians, and 10.1% in Caucasians. Additionally, the prevalence of ERP in physically active individuals was 33.9% (95% CI: 25.3%-42.6%). CONCLUSION: A significant difference in the worldwide prevalence of ERP is revealed in this study. The ERP is highly prevalent in men, blacks, and physically active individuals.


Assuntos
Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/fisiopatologia , Exercício Físico/fisiologia , Fatores Etários , Grupos de Populações Continentais , Eletrocardiografia , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Características de Residência , Fatores Sexuais
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