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Medicina (Kaunas, Lithuania) Jan 2024Pediatric cardiomyopathies (CMs) and electrical diseases constitute a heterogeneous spectrum of disorders distinguished by structural and electrical abnormalities in the... (Review)
Review
Pediatric cardiomyopathies (CMs) and electrical diseases constitute a heterogeneous spectrum of disorders distinguished by structural and electrical abnormalities in the heart muscle, attributed to a genetic variant. They rank among the main causes of morbidity and mortality in the pediatric population, with an annual incidence of 1.1-1.5 per 100,000 in children under the age of 18. The most common conditions are dilated cardiomyopathy (DCM) and hypertrophic cardiomyopathy (HCM). Despite great enthusiasm for research in this field, studies in this population are still limited, and the management and treatment often follow adult recommendations, which have significantly more data on treatment benefits. Although adult and pediatric cardiac diseases share similar morphological and clinical manifestations, their outcomes significantly differ. This review summarizes the latest evidence on genetics, clinical characteristics, management, and updated outcomes of primary pediatric CMs and electrical diseases, including DCM, HCM, arrhythmogenic right ventricular cardiomyopathy (ARVC), Brugada syndrome (BrS), catecholaminergic polymorphic ventricular tachycardia (CPVT), long QT syndrome (LQTS), and short QT syndrome (SQTS).
Topics: Adult; Child; Humans; Arrhythmias, Cardiac; Heart Diseases; Heart; Long QT Syndrome; Cardiomyopathy, Hypertrophic; Cardiomyopathy, Dilated
PubMed: 38256355
DOI: 10.3390/medicina60010094 -
Artificial Intelligence in Medicine Aug 2023This paper presents ArrhyMon, a self-attention-based LSTM-FCN model for arrhythmia classification from ECG signal inputs. ArrhyMon targets to detect and classify six...
This paper presents ArrhyMon, a self-attention-based LSTM-FCN model for arrhythmia classification from ECG signal inputs. ArrhyMon targets to detect and classify six different types of arrhythmia apart from normal ECG patterns. To the best of our knowledge, ArrhyMon is the first end-to-end classification model that successfully targets the classification of six detailed arrhythmia types and compared to previous work does not require additional preprocessing and/or feature extraction operations separate from the classification model. ArrhyMon's deep learning model is designed to capture and exploit both global and local features embedded in ECG sequences by integrating fully convolutional network (FCN) layers and a self-attention-based long and short-term memory (LSTM) architecture. Moreover, to enhance its practicality, ArrhyMon incorporates a deep ensemble-based uncertainty model that generates a confidence-level measure for each classification result. We evaluate ArrhyMon's effectiveness using three publicly available arrhythmia datasets (i.e., MIT-BIH, Physionet Cardiology Challenge 2017 and 2020/2021) to show that ArrhyMon achieves state-of-the-art classification performance (average accuracy 99.63%), and that confidence measures show close correlation with subjective diagnosis made from practitioners.
Topics: Humans; Uncertainty; Arrhythmias, Cardiac
PubMed: 37316094
DOI: 10.1016/j.artmed.2023.102570 -
Journal of Cardiovascular... Sep 2023AVEIR-VR leadless pacemaker (LP) was recently approved for clinical use. Although trial data were promising, post-approval real world data with regard to its...
INTRODUCTION
AVEIR-VR leadless pacemaker (LP) was recently approved for clinical use. Although trial data were promising, post-approval real world data with regard to its effectiveness and safety is lacking. To report our early experience with AVEIR-VR LP with regard to its effectiveness and safety and compare it with MICRA-VR.
METHODS
The first 25 patients to undergo AVEIR-VR implant at our institution between June and November 2022, were compared to 25 age- and sex-matched patients who received MICRA-VR implants.
RESULTS
In both groups, mean age was 73 years and 48% were women. LP implant was successful in 100% of patients in both groups. Single attempt deployment was achieved in 80% of AVEIR-VR and 60% of MICRA-VR recipients (p = 0.07). Fluoroscopy, implant, and procedure times were numerically longer in the AVEIR-VR group compared to MICRA-VR group (p > 0.05). No significant periprocedural complications were noted in both groups. Incidence of ventricular arrhythmias were higher in the AVEIR-VR group (20%) compared to the MICRA-VR group (0%) (p = 0.043). At 2 and 8 weeks follow-up, device parameters remained stable in both groups with no device dislodgements. The estimated battery life at 8 weeks was significantly longer in the AVEIR-VR group (15 years) compared to the MICRA-VR group (8 years) (p = 0.047). With 3-4 AVEIR-VR implants, the learning curve for successful implantation reached a steady state.
CONCLUSION
Our initial experience with AVEIR-VR show that it has comparable effectiveness and safety to MICRA-VR. Larger sample studies are needed to confirm our findings.
Topics: Humans; Female; Aged; Male; Treatment Outcome; Equipment Design; Pacemaker, Artificial; Arrhythmias, Cardiac; Time Factors
PubMed: 37522245
DOI: 10.1111/jce.16019 -
Chaos (Woodbury, N.Y.) Dec 2023A cardiac arrhythmia is an abnormality in the rate or rhythm of the heart beat. We study a type of arrhythmia called a premature ventricular complex (PVC), which is...
A cardiac arrhythmia is an abnormality in the rate or rhythm of the heart beat. We study a type of arrhythmia called a premature ventricular complex (PVC), which is typically benign, but in rare cases can lead to more serious arrhythmias or heart failure. There are three known mechanisms for PVCs: reentry, an ectopic focus, and triggered activity. We develop minimal models for each mechanism and attempt the inverse problem of determining which model (and therefore which mechanism) best describes the beat dynamics observed in an ambulatory electrocardiogram. We demonstrate our approach on a patient who exhibits frequent PVCs and find that their PVC dynamics are best described by a model of triggered activity. Better identification of the PVC mechanism from wearable device data could improve risk stratification for the development of more serious arrhythmias.
Topics: Humans; Arrhythmias, Cardiac; Heart Failure; Heart Rate
PubMed: 38149994
DOI: 10.1063/5.0161210 -
JACC. Clinical Electrophysiology Dec 2023
Topics: Male; Female; Humans; Electrophysiologic Techniques, Cardiac; Arrhythmias, Cardiac; Electrophysiology; Cardiac Electrophysiology
PubMed: 37897464
DOI: 10.1016/j.jacep.2023.09.003 -
Trends in Cardiovascular Medicine May 2024Cardiac amyloidosis (CA) is an infiltrative cardiomyopathy caused by extracellular deposition of amyloid fibrils, mainly derived from transthyretin, either wild-type or... (Review)
Review
Cardiac amyloidosis (CA) is an infiltrative cardiomyopathy caused by extracellular deposition of amyloid fibrils, mainly derived from transthyretin, either wild-type or hereditary variants, or immunoglobulin light chains misfolding. It is characterized by an increased left ventricular (LV) mass and diastolic dysfunction, which can lead to heart failure with preserved ejection fraction and/or conduction disturbances. The diagnosis is based on invasive pathology demonstration of amyloid deposits, or non-invasive criteria using advanced cardiovascular imaging techniques. Nevertheless, 12-lead electrocardiogram (ECG) remains of crucial importance in the assessment of patients with CA, since they can manifest peculiar features such as low QRS voltages, in discordance with the LV hypertrophy, but also pseudo-infarction patterns, sinus node dysfunction, atrioventricular blocks, premature supraventricular and ventricular beats, which support the presence of a myocardial disease. Great awareness of these common ECG characteristics of CA is needed to increase diagnostic performance and improve patient's outcome. In the present review, we discuss the current role of the ECG in the diagnosis and management of CA, focusing on the most common ECG abnormalities and rhythm disorders.
Topics: Humans; Electrocardiography; Cardiomyopathies; Arrhythmias, Cardiac; Predictive Value of Tests; Amyloidosis; Heart Rate; Prognosis; Action Potentials; Ventricular Function, Left; Heart Conduction System
PubMed: 36841466
DOI: 10.1016/j.tcm.2023.02.006 -
Epilepsia Sep 2023In October 2020 and March 2021, the U.S. Food and Drug Administration (FDA) classified lamotrigine as a class IB antiarrhythmic, announcing an increased risk of heart...
OBJECTIVES
In October 2020 and March 2021, the U.S. Food and Drug Administration (FDA) classified lamotrigine as a class IB antiarrhythmic, announcing an increased risk of heart rhythm problems. We sought to investigate the nature of the arrhythmia signal with lamotrigine use compared to anticonvulsants with sodium-blocking and non-sodium-blocking mechanisms.
METHODS
This retrospective pharmacovigilance case-non-case study used disproportionality analysis to detect signals of adverse reaction of interest reported with lamotrigine to the FDA Adverse Event Reporting System (FAERS) between 1998 and 2022. Our regression model adjusted for interacting concomitant medications. Sensitivity analyses included stratifying by indication and publication date.
RESULTS
Overall, 2917 cases of heart rhythm problems with anticonvulsants were analyzed (1557 female [58.4%] and 1109 male [41.6%]). The mean age ± standard deviation (SD) was 43 ± 19, the groups did not differ significantly by age. Forty cases (7.91%) in the epileptic indication included more than one concomitant medication that influences cardiac conduction. The disproportionality signal for cardiac arrest did not differ for lamotrigine compared with other anticonvulsants, adjusted reporting odds ratio (adj.ROR, .88; 95% CI, .59-1.29) in the epileptic indication. A significantly lower reporting risk for bradyarrhythmia was identified with lamotrigine users in the epileptic population, (adj.ROR, .45; 95% confidence interval [CI], .29-.68). The psychiatric indication demonstrated a sixfold reporting risk for cardiac arrest compared to the epileptic indication. Concomitant medications that affect cardiac conduction, as well as reports on overdose and suicide attempts, were significant variables in psychiatric patients (ROR, 2.45; 95% CI, 2.21-2.71) and (ROR, 1.44; 95% CI, 1.34-1.55), respectively.
SIGNIFICANCE
Our results do not support a significant difference in the reporting risk for cardiac arrest, syncope, tachyarrhythmia, and bradyarrhythmia with lamotrigine in the epileptic indication. Signals of cardiac arrest in lamotrigine could be explained by confounding factors in the psychiatric indication, such as greater concomitant use of medications with cardiac adverse events, and greater reports on overdose and suicide attempts. We recommend that patients with polypharmacy undergo clinical and electrocardiographic monitoring. We illustrate the importance of examining signals for separate indications.
Topics: United States; Humans; Male; Female; Anticonvulsants; Lamotrigine; Bradycardia; United States Food and Drug Administration; Retrospective Studies; Arrhythmias, Cardiac; Epilepsy; Heart Arrest
PubMed: 37350356
DOI: 10.1111/epi.17696 -
Medical & Biological Engineering &... Aug 2023An electrocardiogram (ECG) plays a crucial role in identifying and classifying cardiac arrhythmia. Traditional methods employ handcrafted features, and more recently,...
An electrocardiogram (ECG) plays a crucial role in identifying and classifying cardiac arrhythmia. Traditional methods employ handcrafted features, and more recently, deep learning methods use convolution and recursive structures to classify heart signals. Considering the time sequence nature of the ECG signal, a transformer-based model with its high parallelism is proposed to classify ECG arrhythmia. The DistilBERT transformer model, pre-trained for natural language processing tasks, is used in the proposed work. The signals are denoised and then segmented around the R peak and oversampled to get a balanced dataset. The input embedding step is skipped, and only positional encoding is done. The final probabilities are obtained by adding a classification head to the transformer encoder output. The experiments on the MIT-BIH dataset show that the suggested model is excellent in classifying various arrhythmias. The model achieved 99.92% accuracy, 0.99 precision, sensitivity, and F1 score on the augmented dataset with a ROC-AUC score of 0.999.
Topics: Arrhythmias, Cardiac; Humans; Electrocardiography; Deep Learning; Datasets as Topic
PubMed: 37278886
DOI: 10.1007/s11517-023-02858-3 -
International Journal of Cardiology Sep 2023Risk prediction of arrhythmia during pregnancy in adult congenital heart disease (ACHD) patients is currently lacking, and the impact of preconception catheter ablation...
BACKGROUND
Risk prediction of arrhythmia during pregnancy in adult congenital heart disease (ACHD) patients is currently lacking, and the impact of preconception catheter ablation on future antepartum arrhythmia has not been studied.
METHODS
We conducted a single-center, retrospective cohort study of pregnancies in ACHD patients. Clinically significant arrhythmia events during pregnancy were described, predictors of arrhythmia were analyzed, and a risk score devised. The impact of preconception catheter ablation on antepartum arrhythmia was assessed.
RESULTS
The study included 172 pregnancies in 137 patients. Arrhythmia events occurred in 25 (15%) of pregnancies, with 64% of events occurring in the second trimester and sustained supraventricular tachycardia being the most common rhythm. Univariate predictors of arrhythmia were history of tachyarrhythmia (OR 20.33, 95% CI 6.95-59.47, p < 0.001, Fontan circulation (OR 11.90, 95% CI 2.60-53.70, p < 0.001), baseline physiologic class C/D (OR 3.72, 95% CI 1.54-9.01, p = 0.002) and history of multiple valve interventions (OR 3.10, 95% CI 1.20-8.20, p = 0.017). Three risk factors (excluding multiple valve interventions) were used to formulate a risk score, with a cutoff of ≥2 points predicting antepartum arrhythmia with sensitivity and specificity of 84%. While recurrence of the index arrhythmia was not observed following successful catheter ablation, preconception ablation did not impact odds of antepartum arrhythmia.
CONCLUSIONS
We provide a novel risk stratification scheme for predicting antepartum arrhythmia in ACHD patients. The role of contemporary preconception catheter ablation in risk reduction needs further refinement with multicenter investigation.
Topics: Female; Pregnancy; Adult; Humans; Heart Defects, Congenital; Retrospective Studies; Arrhythmias, Cardiac; Tachycardia; Tachycardia, Supraventricular; Catheter Ablation; Recurrence; Treatment Outcome
PubMed: 37178799
DOI: 10.1016/j.ijcard.2023.05.015 -
Journal of Interventional Cardiac... Mar 2024
Topics: Humans; Arrhythmias, Cardiac; Catheters; Electrodes; Catheter Ablation; Tachycardia, Ventricular
PubMed: 37966659
DOI: 10.1007/s10840-023-01683-w