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Physiological Measurement Feb 2024Cardiac arrhythmias are a leading cause of mortality worldwide. Wearable devices based on photoplethysmography give the opportunity to screen large populations, hence...
Cardiac arrhythmias are a leading cause of mortality worldwide. Wearable devices based on photoplethysmography give the opportunity to screen large populations, hence allowing for an earlier detection of pathological rhythms that might reduce the risks of complications and medical costs. While most of beat detection algorithms have been evaluated on normal sinus rhythm or atrial fibrillation recordings, the performance of these algorithms in patients with other cardiac arrhythmias, such as ventricular tachycardia or bigeminy, remain unknown to date. Theopen-source framework, developed by Charlton and colleagues, evaluates the performance of the beat detectors named,andamong others. We applied theframework on two newly acquired datasets, one containing seven different types of cardiac arrhythmia in hospital settings, and another dataset including two cardiac arrhythmias in ambulatory settings. In a clinical setting, thebeat detector performed best on atrial fibrillation (with a medianscore of 94.4%), atrial flutter (95.2%), atrial tachycardia (87.0%), sinus rhythm (97.7%), ventricular tachycardia (83.9%) and was ranked 2nd for bigeminy (75.7%) behinddetector (76.1%). In an ambulatory setting, thebeat detector performed best on normal sinus rhythm (94.6%), and thedetector on atrial fibrillation (91.6%) and bigeminy (80.0%). Overall, the PPG beat detectors,andconsistently achieved higher performances than other detectors. However, the detection of beats from wrist-PPG signals is compromised in presence of bigeminy or ventricular tachycardia.
Topics: Humans; Heart Rate; Atrial Fibrillation; Photoplethysmography; Benchmarking; Tachycardia, Ventricular; Algorithms; Electrocardiography
PubMed: 38266291
DOI: 10.1088/1361-6579/ad2216 -
World Journal of Clinical Oncology Apr 2024Over the years, strides in colon cancer detection and treatment have boosted survival rates; yet, post-colon cancer survival entails cardiovascular disease (CVD) risks....
BACKGROUND
Over the years, strides in colon cancer detection and treatment have boosted survival rates; yet, post-colon cancer survival entails cardiovascular disease (CVD) risks. Research on CVD risks and acute cardiovascular events in colorectal cancer survivors has been limited.
AIM
To compare the CVD risk and adverse cardiovascular outcomes in current colon cancer survivors compared to a decade ago.
METHODS
We analyzed 2007 and 2017 hospitalization data from the National Inpatient Sample, studying two colon cancer survivor groups for CVD risk factors, mortality rates, and major adverse events like pulmonary embolism, arrhythmia, cardiac arrest, and stroke, adjusting for confounders multivariable regression analysis.
RESULTS
Of total colon cancer survivors hospitalized in 2007 ( = 177542) and 2017 ( = 178325), the 2017 cohort often consisted of younger (76 77 years), male, African-American, and Hispanic patients admitted non-electively the 2007 cohort. Furthermore, the 2017 cohort had higher rates of smoking, alcohol abuse, drug abuse, coagulopathy, liver disease, weight loss, and renal failure. Patients in the 2017 cohort also had higher rates of cardiovascular comorbidities, including hypertension, hyperlipidemia, diabetes, obesity, peripheral vascular disease, congestive heart failure, and at least one traditional CVD ( < 0.001) the 2007 cohort. On adjusted multivariable analysis, the 2017 cohort had a significantly higher risk of pulmonary embolism (PE) (OR: 1.47, 95%CI: 1.37-1.48), arrhythmia (OR: 1.41, 95%CI: 1.38-1.43), atrial fibrillation/flutter (OR: 1.61, 95%CI: 1.58-1.64), cardiac arrest including ventricular tachyarrhythmia (OR: 1.63, 95%CI: 1.46-1.82), and stroke (OR: 1.28, 95%CI: 1.22-1.34) with comparable all-cause mortality and fewer routine discharges (48.4% 55.0%) ( < 0.001) the 2007 cohort.
CONCLUSION
Colon cancer survivors hospitalized 10 years apart in the United States showed an increased CVD risk with an increased risk of acute cardiovascular events (stroke 28%, PE 47%, arrhythmia 41%, and cardiac arrest 63%). It is vital to regularly screen colon cancer survivors with concomitant CVD risk factors to curtail long-term cardiovascular complications.
PubMed: 38689632
DOI: 10.5306/wjco.v15.i4.548 -
Cureus Aug 2023Introduction Catheter ablation (CA) of atrial fibrillation (AF) represents a mainstay in the treatment of this increasingly prevalent arrhythmia. Prospective clinical...
Creation and Validation of an Algorithm for Predicting the Recurrence of Atrial Fibrillation Following Pulmonary Vein Isolation by Utilizing Real-World Data and Ensemble Modeling Techniques.
Introduction Catheter ablation (CA) of atrial fibrillation (AF) represents a mainstay in the treatment of this increasingly prevalent arrhythmia. Prospective clinical trials investigating the efficacy of CA may poorly represent real-world patient populations. However, many real-world clinical datasets possess missing data, which may impede their applicability in research. Thus, we sought to use ensemble modeling to address missing data and develop a model to estimate the probability of AF recurrence following CA. Methods We retrospectively analyzed clinical variables in 476 patients who underwent an initial CA of AF. Univariate and multivariate logistic regression was performed to determine those variables predictive of AF recurrence. A multivariate logistic model was created to estimate the probability of AF recurrence after CA. Missing data were addressed using ensemble modeling, and variable selection was performed using the aggregate of multiple models. Results After analysis, six variables remained in the model: AF during the post-procedural blanking period, coexistence of atrial flutter, end-stage renal disease, reduced left ventricular ejection fraction, prior failure of anti-arrhythmic drugs, and valvular heart disease. Predictive modeling was performed using these variables for 1000 randomly partitioned datasets (80% training, 20% testing) and 1000 random imputations for each partitioned dataset. The model predicted AF recurrence with an accuracy of 74.34 ± 3.99% (recall: 54.03 ± 8.15%; precision: 89.30 ± 4.21%; F1 score: 81.08 ± 3.65%). Conclusion We successfully identified six clinical variables that, when modeled, predicted AF recurrence following CA with a high degree of classification accuracy. Application of this model to patients undergoing CA of AF may help identify those at risk of post-procedural AF recurrence.
PubMed: 37577270
DOI: 10.7759/cureus.43234 -
Cureus Nov 2023Atrial flutter (AFL) is typically associated with structural heart diseases or metabolic abnormalities. However, isolated symptomatic AFL, which occurs without abnormal...
Atrial flutter (AFL) is typically associated with structural heart diseases or metabolic abnormalities. However, isolated symptomatic AFL, which occurs without abnormal heart anatomy, remains a rare occurrence and is underrepresented in the literature. This case report highlights the significance of recognizing and investigating symptoms suggestive of arrhythmias, especially in patients with autoimmune conditions.
PubMed: 38054141
DOI: 10.7759/cureus.48240 -
European Heart Journal. Case Reports Jun 2024Double-wave macrore-entry is a rare mechanism of atrial tachycardia with limited documentation in the literature. We present a three-dimensional documentation of a...
BACKGROUND
Double-wave macrore-entry is a rare mechanism of atrial tachycardia with limited documentation in the literature. We present a three-dimensional documentation of a double-wave 'typical' atrial flutter in a patient with extensive atrial cardiomyopathy.
CASE SUMMARY
A 78-year-old female with a history of atrial cardiomyopathy and dual-chamber pacemaker for sinus node disease presented with palpitations and incessant atrial flutter. Electrophysiological study revealed a regular tachycardia with a cycle length (TCL) of 230 ms, with proximal to distal coronary sinus (CS) activation. Three-dimensional mapping identified two independent wavefronts circulating the cavotricuspid isthmus (CTI), each with a TCL of 460 ms. Cavotricuspid isthmus ablation resulted in conversion into a distinct tachycardia with left atrial roof origin. Linear ablation in this location slowed the TCL to 435 ms with concentric CS activation and another CTI dependent atrial flutter was mapped, this time with only one wavefront of activation. Further ablation with a second, more lateral, line in the CTI led to tachycardia interruption. Given the extensive atrial scarring and high arrhythmic recurrence risk, atrioventricular node ablation was performed.
DISCUSSION
Double-wave re-entrant tachycardias were primarily observed in experimental models, precipitating acceleration of ventricular and supraventricular tachycardias via extrastimulation. In our case, there is documentation of a spontaneous double-wave of activation around the CTI, representing the first documented double-wave 'typical' atrial flutter. Unlike other cases in the literature, the two wavefronts were equidistant, which resulted in a regular tachycardia with TCL that was half of the single-wave cycle length. Three-dimensional propagation mapping was essential to visualize the two distinct wavefronts.
PubMed: 38863991
DOI: 10.1093/ehjcr/ytae272 -
European Heart Journal. Case Reports Jan 2024Deviations from usual coronary artery anatomy are well documented. The left circumflex artery (LCx) arising from the pulmonary artery is an example of one such deviation...
BACKGROUND
Deviations from usual coronary artery anatomy are well documented. The left circumflex artery (LCx) arising from the pulmonary artery is an example of one such deviation which is rarely seen. We present the case of a 26-year-old male with this coronary artery distribution presenting with an episode of ventricular flutter with late gadolinium enhancement and pluri-morphological ventricular arrhythmias.
CASE SUMMARY
A 26-year-old male with a history of cardiac surgery presented to his local hospital with an episode of symptomatic broad-complex tachycardia (BCT). It failed to revert to sinus rhythm following intravenous beta-blockers and amiodarone and required external cardioversion. Subsequently, the patient developed a aspiration pneumonia requiring ICU admission, after which he was transferred to our institute for ongoing cardiac management. Cardiac computed tomography CTA and coronary angiography revealed that the LCx was found to originate from the pulmonary artery. He underwent insertion of a subcutaneous pacemaker and was subsequently discharged. Despite the potential for steal syndrome of viable coronary territories. Multidisciplinary team discussion determined him to be fit for conservative management and not for surgical correction of his anomalous coronary artery anatomy.
DISCUSSION
Aberrant coronary artery anatomy can lead to diverse outcomes for patients in terms of both morbidity and mortality. The need for surgery in these situations varies on a case-by-case basis and little research exists to guide decision-making for healthcare professionals. As such there is a need for further study both to guide treatment and to ensure high-quality outcomes for patients with this condition.
PubMed: 38249112
DOI: 10.1093/ehjcr/ytad641 -
European Heart Journal. Case Reports Jan 2024The aetiological spectrum of heart failure with reduced ejection fraction is various. Tachycardiomyopathy is recognized as one of the cause, usually made...
BACKGROUND
The aetiological spectrum of heart failure with reduced ejection fraction is various. Tachycardiomyopathy is recognized as one of the cause, usually made retrospectively. In this clinical context, rhythm control with restoration of sinus rhythm is considered crucial to minimize ventricular function damage and allow contractility recovery. However, the presence of a thrombus in the left atrial appendage is a limiting factor, typically requiring anticoagulation until the thrombus resolves, at least 3 weeks, thus delaying the therapy.
CASE SUMMARY
We present a case of 65-year-old man with diagnosis of new-onset acute symptomatic heart failure with severe reduced ejection fraction (left ventricular ejection fraction 15%), in the context of a typical tachycardic atrial flutter and concomitant thrombus in the left atrial appendage confirmed by transoesophageal echocardiography. We successfully performed a thrombus entrapment procedure by means of percutaneous left atrial appendage closure, which allowed immediate restoration of sinus rhythm through cavotricuspid isthmus ablation. After the institution of the heart failure therapy, titrated up to the maximum tolerated dose, we observed a complete restoration of left ventricular function after 6 months.
DISCUSSION
Thrombus entrapment by means of left atrial appendage closure is a valid strategy that enables early cardioversion with arrhythmia ablation and rapid restoration of normal cardiac rhythm in severe heart failure with reduced ejection fraction, even in acute situations and typical atrial flutter.
PubMed: 38173782
DOI: 10.1093/ehjcr/ytad618 -
Cureus Jan 2024The global coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in various clinical...
The global coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in various clinical manifestations, including cardiovascular complications. This case report focuses on a unique instance where COVID-19 infection exacerbated heart failure and induced atrial fibrillation in a previously asymptomatic young male with undiagnosed rheumatic heart disease (RHD). RHD, a prevalent cause of valvular abnormalities in developing countries, poses an additional risk for severe outcomes when coexisting with COVID-19 infection, highlighting the need for prompt and tailored interventions.
PubMed: 38406011
DOI: 10.7759/cureus.52903 -
Kardiologia Polska 2024According to the present guidelines, transesophageal echocardiography (TEE) before scheduled catheter ablation (CA) for atrial arrhythmias (atrial fibrillation [AF] or... (Observational Study)
Observational Study
BACKGROUND
According to the present guidelines, transesophageal echocardiography (TEE) before scheduled catheter ablation (CA) for atrial arrhythmias (atrial fibrillation [AF] or atrial flutter [AFL]) is not deemed obligatory for optimally anticoagulated patients. However, daily clinical practice significantly differs from the recommendations.
AIMS
We aimed to identify transthoracic echocardiographic parameters that could be useful in identifying patients without left atrial thrombus (LAT), which makes it possible to avoid unnecessary TEE before scheduled CA.
METHODS
This is a sub-analysis of a multicenter, prospective, observational study - the LATTEE registry. A total of 1346 patients referred for TEE before scheduled CA of AF/AFL were included.
RESULTS
LAT was present in 44 patients (3.3%) and absent in the remaining 1302, who were younger, more likely to have paroxysmal AF, and displayed sinus rhythm during TEE. Additionally, they exhibited a lower incidence of heart failure, diabetes, systemic connective tissue disease, and chronic obstructive pulmonary disease. Furthermore, they had a lower CHA2DS2-VASc score and a higher prevalence of direct oral anticoagulants. Echocardiographic parameters, including left ventricular ejection fraction (LVEF) >65%, left atrial diameter (LAD) <40 mm, left atrial area (LAA) <20 cm2, left atrial volume (LAV) <113 ml, and left atrial volume index (LAVI) <51 ml/m2, demonstrated 100% sensitivity and 100% negative predictive value for the absence of LAT and were met by 417 patients. Additional echocardiographic indices: LVEF/LAD ≥1.4, LVEF/LAVI ≥1.6, and LVEF/LAA ≥2.7 identified 57 additional patients, bringing the total of predicted LAT-free patients to 474 (35%).
CONCLUSIONS
Simple echocardiographic parameters could help identify individuals for whom TEE could be safely omitted before elective CA due to atrial arrhythmias.
Topics: Humans; Female; Male; Catheter Ablation; Middle Aged; Echocardiography, Transesophageal; Registries; Atrial Fibrillation; Aged; Prospective Studies; Atrial Flutter; Heart Atria
PubMed: 38606739
DOI: 10.33963/v.phj.100081