-
Scientific Reports Feb 2024Worldwide, Cardiovascular Diseases (CVDs) are the leading cause of death. Patients at high cardiovascular risk require long-term follow-up for early CVDs detection....
Worldwide, Cardiovascular Diseases (CVDs) are the leading cause of death. Patients at high cardiovascular risk require long-term follow-up for early CVDs detection. Generally, cardiac arrhythmia detection through the electrocardiogram (ECG) signal has been the basis of many studies. This technique does not provide sufficient information in addition to a high false alarm potential. In addition, the electrodes used to record the ECG signal are not suitable for long-term monitoring. Recently, the photoplethysmogram (PPG) signal has attracted great interest among scientists as it provides a non-invasive, inexpensive, and convenient source of information related to cardiac activity. In this paper, the PPG signal (online database Physio Net Challenge 2015) is used to classify different cardiac arrhythmias, namely, tachycardia, bradycardia, ventricular tachycardia, and ventricular flutter/fibrillation. The PPG signals are pre-processed and analyzed utilizing various signal-processing techniques to eliminate noise and artifacts, which forms a stage of signal preparation prior to the feature extraction process. A set of 41 PPG features is used for cardiac arrhythmias' classification through the application of four machine-learning techniques, namely, Decision Trees (DT), Support Vector Machines (SVM), K-Nearest Neighbors (KNNs), and Ensembles. Principal Component Analysis (PCA) technique is used for dimensionality reduction and feature extraction while preserving the most important information in the data. The results show a high-throughput evaluation with an accuracy of 98.4% for the KNN technique with a sensitivity of 98.3%, 95%, 96.8%, and 99.7% for bradycardia, tachycardia, ventricular flutter/fibrillation, and ventricular tachycardia, respectively. The outcomes of this work provide a tool to correlate the properties of the PPG signal with cardiac arrhythmias and thus the early diagnosis and treatment of CVDs.
Topics: Humans; Photoplethysmography; Bradycardia; Arrhythmias, Cardiac; Signal Processing, Computer-Assisted; Electrocardiography; Tachycardia, Ventricular; Algorithms
PubMed: 38336980
DOI: 10.1038/s41598-024-53142-9 -
Indian Pacing and Electrophysiology... 2022Macroreentrant atrial circuits are frequently associated with scarring. Previous reports have shown the possible development of scar tissue that is adjacent to pacemaker...
Macroreentrant atrial circuits are frequently associated with scarring. Previous reports have shown the possible development of scar tissue that is adjacent to pacemaker (PM) leads. However, reports of PM lead-related reentrant tachycardia are scarce. We report the case of a 63-year-old woman who presented with macroreentrant atrial tachycardia (MAT), related to the atrial trajectory of an old single-lead ventricular PM, that was successfully treated with radiofrequency ablation after a conventional electrophysiological study ruled out isthmus-dependent atrial flutter and provided sufficient data to confirm this diagnosis. This report presents a case of MAT originating around the trajectory of a PM lead, probably because of scar tissue that developed adjacent to the lead. Experimental studies have already shown that interstitial atrial fibrosis may develop adjacent to a ventricular single-lead. This finding suggests that MAT develops in patients with this specific condition. Recognizing this condition is important for managing these arrhythmias and performing safe ablation with the preservation of PM lead integrity.
PubMed: 35598811
DOI: 10.1016/j.ipej.2022.05.001 -
Chest Mar 2024Atrial arrhythmia (AA) are common in patients with pulmonary hypertension (PH) and contribute to morbidity and mortality. Given the growing PH population, understanding... (Review)
Review
TOPIC IMPORTANCE
Atrial arrhythmia (AA) are common in patients with pulmonary hypertension (PH) and contribute to morbidity and mortality. Given the growing PH population, understanding the pathophysiology, clinical impact, and management of AA in PH is important.
REVIEW FINDINGS
AA occurs in PH with a 5-year incidence of 10% to 25%. AA confers a higher morbidity and mortality, and restoration of normal sinus rhythm improves survival and functionality. AA is thought to develop because of structural alterations of the right atrium caused by changes to the right ventricle (RV) due to elevated pulmonary artery pressures. AA can subsequently worsen RV function. Current guidelines do not provide comprehensive recommendations for the management of AA in PH. Robust evidence to favor a specific treatment approach is lacking. Although the role of medical rate or rhythm control, and the use of cardioversion and ablation, can be inferred from other populations, evidence is lacking in the PH population. Much remains to be determined regarding the optimal management strategy. We present here our institutional approach and discuss areas for future research.
SUMMARY
This review highlights the epidemiology and pathophysiology of AA in patients with PH, describes the relationship between AA and RV dysfunction, and discusses current management practices. We outline our institutional approach and offer directions for future investigation.
PubMed: 38453002
DOI: 10.1016/j.chest.2024.03.002 -
ESC Heart Failure Aug 2023Tachycardia-induced cardiomyopathy (TCM) represents a partially reversible type of cardiomyopathy (CM) that is often underdiagnosed and cardiac chamber remodelling in...
AIMS
Tachycardia-induced cardiomyopathy (TCM) represents a partially reversible type of cardiomyopathy (CM) that is often underdiagnosed and cardiac chamber remodelling in TCM remains incompletely understood. We aim to explore differences in the dimensions of the left ventricle and functional recovery in patients with TCM compared with patients with other forms of CM.
METHODS AND RESULTS
We identified patients with reduced ejection fraction (≤50%) and/or atrial fibrillation or flutter with a left ventricular ejection fraction that improved from baseline (≥15% in left ventricular ejection fraction at follow-up or normalization of cardiac function with at least 10% improvement). Patients were then divided into two groups: (A) TCM patients and (B) patients with other forms of CM (controls). Two hundred thirty-eight patients were included (31% female, 70 years median age), 127 patients had TCM, and 111 had other forms of CM. Patients with TCM did not significantly improve indexed left ventricular volume (LVEDVI) after treatment (60 [45, 84] mL/m versus 56 [45, 70] mL/m , P = ns) compared with controls (67 [54, 81] mL/m versus 52 [42, 69] mL/m , P < 0.001). Patients with TCM patients had significantly worse fractional shortening at baseline than controls (15.5 [12, 23] vs. 20 [13, 30], P = 0.01) and higher indexed left atrial volume (LAVI) at baseline than controls (48 [37, 58] vs. 41 [33, 51], P = 0.01) that remained dilated at follow-up (follow-up LAVI 41 [33, 52] mL/m ). Good predictors of TCM were: normal LVEDVI (LVEDVI < 58 mL/m (M) and < 52 mL/m (F)) (odds ratio [OR] 5.2; 95% confidence interval [CI] 2.2-13.3, P < 0.001), fractional shortening < 30% (OR 3.5; 95% CI 1.4-9.2, P = 0.009), LAVI >40 mL/m (OR 3.4; 95% CI 1.6-7.3, P = 0.001) and normal wall thickness left ventricle (OR 3.2; 95% CI 1.4-7.8, P = 0.008). 54% of patients with TCM demonstrated diastolic dysfunction at follow-up, without differences from controls (54% vs. 43%, P = ns). 21% of patients with TCM showed persistent heart failure symptoms at follow-up compared with 4.5% of controls, P = 0.004.
CONCLUSIONS
TCM patients have a specific pattern of functional recovery with persistent remodelling of the left atria and left ventricle. Several echocardiographic parameters might help identify TCM before treatment.
Topics: Humans; Female; Male; Ventricular Function, Left; Stroke Volume; Cardiomyopathies; Echocardiography; Tachycardia
PubMed: 37218391
DOI: 10.1002/ehf2.14365 -
Chinese Journal of Integrative Medicine Mar 2018To exam the effect and safety of conventional acupuncture (CA) on cardiac arrhythmia. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To exam the effect and safety of conventional acupuncture (CA) on cardiac arrhythmia.
METHODS
Nine medical databases were searched until February 2016 for randomized controlled trials. Heterogeneity was measured by Cochran Q test. Meta-analysis was conducted if I was less than 85% and the characteristics of included trials were similar.
RESULTS
Nine qualified studies involving 638 patients were included. Only 1 study had definitely low risk of bias, while 7 trials were rated as unclear and 1 as high. Meta-analysis of CA alone did not have a significant benefit on response rate compared to amiodarone in patients with atrial fibrillation (Af) and atrial flutter (AF) [relative risk (RR): 1.09; 95% confidence interval (CI): 0.79-1.49; P=0.61; I=61%, P=0.11]. However, 1 study with higher methodological quality detected a lower recurrence rate of Af in CA alone as compared with sham acupuncture plus no treatment, and benefits on ventricular rate and time of conversion to normal sinus rhythm were found in CA alone group by 1 study, as well as the response rate in CA plus deslanoside group by another study. Meta-analysis of CA plus anti-arrhythmia drug (AAD) was associated with a significant benefit on the response rate when compared with AAD alone in ventricular premature beat (VPB) patients (RR, 1.19, 95% CI: 1.05-1.34; P=0.005; I=13%, P=0.32), and an improvement in quality-of-life score (QOLS) of VPB also showed in 1 individual study. Besides, a lower heart rate was detected in the CA alone group by 1 individual study when compared with no treatment in sinus tachycardia patients (MD-21.84 [-27.21,-16.47]) and lower adverse events of CA alone were reported than amiodarone.
CONCLUSIONS
CA may be a useful and safe alternative or additive approach to AADs for cardiac arrhythmia, especially in VPB and Af patients, which mainly based on a pooled estimate and result from 1 study with higher methodological quality. However, we could not reach a robust conclusion due to low quality of overall evidence.
Topics: Acupuncture Therapy; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Humans; Randomized Controlled Trials as Topic; Treatment Outcome; Ventricular Premature Complexes
PubMed: 28432528
DOI: 10.1007/s11655-017-2753-9 -
International Journal of Cardiology Jul 2020Atrial arrhythmias after heart transplantation have rarely been investigated. The aim of this study is to assess incidence, type and predictors of atrial arrhythmias...
OBJECTIVES
Atrial arrhythmias after heart transplantation have rarely been investigated. The aim of this study is to assess incidence, type and predictors of atrial arrhythmias during a long-term follow-up in a large population of heart-transplanted patients.
METHODS
Consecutive patients undergone to heart transplantation at our Centre from 1990 to 2017 were enrolled. All documented atrial arrhythmias were systematically reviewed during a long-term follow-up after heart transplantation. Atrial fibrillation (AF), atrial flutter and tachycardias were defined according to current guidelines.
RESULTS
Overall, 364 patients were included and followed for 120 ± 70 months. During the follow-up period 108 (29.7%) patients died and 3 (0.8%) underwent re-transplantation. Sinus rhythm was present in 355 (97.5%) patients. Nine patients had persistent atrial arrhythmias: 8 (2.2%) presented atypical flutter and one (0.3%) patient AF. Paroxysmal sustained arrhythmias were detected in 42 (11.5%) patients, always atrial flutters. At univariate analysis several echocardiographic (left ventricular end-diastolic diameter, TEI index, mitral and tricuspid regurgitation grade) hemodynamic (systolic and diastolic pulmonary pressure, capillary wedge pressure) and clinical (dyslipidaemia, weight, pacemaker implantation) parameters related to higher incidence of atrial arrhythmias.
CONCLUSION
Persistent atrial arrhythmias, and most of all AF, are rare among heart transplantation carriers, despite substantial comorbidities resulting in significant mortality. It can be speculated that the lesion set provided by the surgical technique, a complete and transmural electrical isolation of the posterior left atrium wall, represents an effective lesion set to prevent persistent AF.
Topics: Atrial Fibrillation; Atrial Flutter; Catheter Ablation; Heart Atria; Heart Transplantation; Humans; Incidence; Treatment Outcome
PubMed: 32331908
DOI: 10.1016/j.ijcard.2020.04.019 -
Frontiers in Medicine 2019Pulmonary arterial hypertension (PAH) is a devastating, life-limiting disease driven by small vessel vascular remodeling leading to a rise in pulmonary vascular... (Review)
Review
Pulmonary arterial hypertension (PAH) is a devastating, life-limiting disease driven by small vessel vascular remodeling leading to a rise in pulmonary vascular resistance (PVR). Patients present with a range of symptoms including shortness of breath, exercise intolerance, palpitations or syncope. Symptoms may be related to vascular disease progression or arrhythmia secondary to the adaptation of the right heart to pressure overload. Arrhythmic burden is high in patients with left heart disease and guideline-based treatment of arrhythmias improves quality of life and prognosis. In PAH the incidence and prevalence of arrhythmias is less well-defined and there are no PAH-specific guidelines for arrhythmia management. We undertook a literature search identifying 13 relevant papers; detection of arrhythmias was acquired from 12-lead electrocardiogram (ECG) or Holter monitors. In all forms of pulmonary hypertension (PH) the prevalence of supraventricular arrhythmias (SVA) was 26-31%, ventricular arrhythmias (VA) 24% and a 5-year incidence of SVA ~13.2-25.1%. Prevalence and incidence of arrhythmias in PAH is less clear due to limited study numbers and the heterogenous nature of the patient population studied. For arrhythmia treatment, only single-arm studies of therapeutic strategies were reported using antiarrhythmic drugs (AAD), direct current cardioversion (DCCV) and ablation. Periods between ECG or Holter have not been investigated, highlighting the possibility that significant arrhythmias may be undetected. Advances in monitoring allow long-term surveillance via implanted/non-invasive monitors. Use of such technologies may provide an accurate estimate of incidence and prevalence of arrhythmias in patients with PAH, further defining relationships to adverse outcomes, and therapeutic options.
PubMed: 31396515
DOI: 10.3389/fmed.2019.00169 -
Journal of Interventional Cardiac... Aug 2018Alterations of normal intra- and interatrial conduction are a common outcome of multiple cardiovascular conditions. They arise most commonly in the context of advanced... (Review)
Review
Alterations of normal intra- and interatrial conduction are a common outcome of multiple cardiovascular conditions. They arise most commonly in the context of advanced age, cardiovascular risk factors, organic heart disease, atrial fibrosis, and left atrial enlargement. Interatrial block (IAB), the most frequent and extensively studied atrial conduction disorder, affects up to 20% of the general primary care population. IAB can be partial (P wave duration ≥ 120 ms on any of the 12 ECG leads) or advanced (P wave ≥ 120 ms and biphasic morphology (positive-negative) in inferior leads). Advanced IAB is an independent risk factor for supraventricular tachyarrhythmias and embolic stroke in a variety of clinical settings. Advanced IAB is a cause of left atrial electromechanical dysfunction and left atrioventricular dyssynchrony and has been associated with left ventricular diastolic dysfunction. P wave duration is associated with cardiovascular and all-cause mortality in the general population. Atrial conduction abnormalities should be identified as markers of atrial remodeling, prognostic indicators, and, in the case of advanced IAB, a true arrhythmologic syndrome. IAB and other P wave abnormalities should prompt the search for associated conditions, the treatment of which may partially reverse atrial remodeling or prevent it if administered upstream. Future studies will help define the role of preventive therapeutic interventions in high-risk patients, including antiarrhythmic drug therapy and oral anticoagulation. Implications for the treatment of heart failure and for pacing should also be further investigated.
Topics: Anti-Arrhythmia Agents; Atrial Fibrillation; Atrial Flutter; Cardiac Conduction System Disease; Electrocardiography; Female; Heart Atria; Heart Block; Hemodynamics; Humans; Male; Prognosis; Severity of Illness Index; Stroke; Survival Rate; Thromboembolism
PubMed: 30128800
DOI: 10.1007/s10840-018-0413-4 -
Europace : European Pacing,... Sep 2018Recurring questions when dealing with arrhythmias in athletes are about the cause of the arrhythmia and, more importantly, about the eligibility of the athlete to... (Review)
Review
Recurring questions when dealing with arrhythmias in athletes are about the cause of the arrhythmia and, more importantly, about the eligibility of the athlete to continue sports activities. In essence, the relation between sports and arrhythmias can be understood along three lines: sports as arrhythmia trigger on top of an underlying problem, sports as arrhythmic substrate promotor, or sports as substrate inducer. Often, there is no sharp divider line between these entities. The athlete's heart, a heart that adapts so magically to cope with the demands of exercise, harbours many structural and functional changes that by themselves predispose to arrhythmia development, at the atrial, nodal and ventricular levels. In essence, the athlete's heart is a proarrhythmic heart. This review describes the changes in the athlete's heart that are related to arrhythmic expression and focuses on what this concept means for clinical decision making. The concept of the athlete's heart as a proarrhythmic heart creates a framework for evaluation and counselling of athletes, yet also highlights the difficulty in predicting the magnitude of associated risk. The management uncertainties are discussed for specific conditions like extreme bradycardic remodelling, atrioventricular nodal reentrant tachycardia, atrial fibrillation and flutter, and ventricular arrhythmias.
Topics: Adaptation, Physiological; Arrhythmias, Cardiac; Asymptomatic Diseases; Athletes; Atrial Fibrillation; Atrial Flutter; Atrial Remodeling; Bradycardia; Clinical Decision-Making; Death, Sudden, Cardiac; Defibrillators, Implantable; Eligibility Determination; Heart; Humans; Risk Assessment; Sports; Tachycardia, Atrioventricular Nodal Reentry; Ventricular Remodeling
PubMed: 29244075
DOI: 10.1093/europace/eux294 -
Structural Cardiac Abnormalities in Patients with Atrial Fibrillation/Flutter and Myocardial Injury.The American Journal of Medicine Dec 2022High-sensitivity cardiac troponin (hs-cTnT) is often increased in patients with atrial fibrillation/flutter, portending a poor prognosis. The etiologies for these... (Observational Study)
Observational Study
BACKGROUND
High-sensitivity cardiac troponin (hs-cTnT) is often increased in patients with atrial fibrillation/flutter, portending a poor prognosis. The etiologies for these increases have not been systematically investigated. Our aim was to define prevalence/significance of structural cardiac abnormalities in patients with atrial fibrillation/flutter and high-sensitivity cardiac troponin T (hs-cTnT) increases.
METHODS
This is a retrospective observational cohort study of patients with atrial fibrillation/flutter diagnosis with hs-cTnT measurements, echocardiograms, and coronary angiograms. Myocardial injury was defined as hs-cTnT >10 ng/L for women and >15 ng/L for men. Cases with myocardial injury were adjudicated according to the Fourth Universal Definition of Myocardial Infarction.
RESULTS
Patients with definite causes for increased hs-cTnT (n = 875) were tabulated but not evaluated further; common diagnoses were type 1 myocardial infarction, critical illness, and known heart failure. Of the remaining 401, increased hs-cTnT was present in 336 (84%) patients. Of those, 78% had nonischemic myocardial injury, the remaining (n = 75, 22%) had type 2 myocardial infarction. Patients with elevated hs-cTnT had greater left ventricular mass index, left ventricular filling pressures, and right ventricular systolic pressure. They more frequently had significant coronary artery disease (47% vs 31%, P = .016), especially in type 2 myocardial infarction. With logistic regression, age, sex (F), diabetes, left ventricular mass index, e' medial velocity, and right ventricular systolic pressure were independent determinants of myocardial injury. One-year mortality was higher in patients with myocardial injury.
CONCLUSIONS
Structural heart abnormalities are common in patients with atrial fibrillation/flutter and increased hs-cTnT. Causes of myocardial injury should be elucidated in each patient to craft appropriate therapies.
Topics: Humans; Male; Female; Atrial Fibrillation; Troponin T; Cohort Studies; Biomarkers; Atrial Flutter; Heart Injuries; Myocardial Infarction; Diabetes Mellitus, Type 2
PubMed: 35830903
DOI: 10.1016/j.amjmed.2022.06.005