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Cardiac Electrophysiology Clinics Jun 2018Arrhythmias have acquired a specific identity in pediatric cardiology, but for pediatric cardiologists it has always been difficult to recognize and treat them. Changes... (Review)
Review
Arrhythmias have acquired a specific identity in pediatric cardiology, but for pediatric cardiologists it has always been difficult to recognize and treat them. Changes in anatomy and physiology result in electrocardiogram features that differ from the normal adult pattern and vary according to the age of the child. Sinus arrhythmia, ectopic atrial rhythm, "wandering pacemaker," and junctional rhythm can be normal characteristics in children (15%-25% of healthy children can have these rhythms on the electrocardiogram). Tachyarrhythmias and bradyarrhythmias must be treated according to the severity of symptoms, and the patient's age and weight.
Topics: Arrhythmias, Cardiac; Child; Diagnosis, Differential; Electrocardiography; Heart Rate; Humans; Infant, Newborn
PubMed: 29784491
DOI: 10.1016/j.ccep.2018.02.008 -
Animals : An Open Access Journal From... Jun 2021The Lorenz plot (LP), a graphical representation of heart rate variability, has been poorly studied in dogs to date. The present study aimed to describe the graphic...
The Lorenz plot (LP), a graphical representation of heart rate variability, has been poorly studied in dogs to date. The present study aimed to describe the graphic features of LP in dogs with sinus rhythm (SR) and tachyarrhythmias, and to analyze the usefulness of its pattern recognition. One hundred and nineteen canine Holter recordings were retrospectively evaluated. Cardiac rhythms were classified as: SR; SR with frequent (>100) premature ectopies (atrial, SR-APCs; ventricular, SR-VPCs; atrial and ventricular, SR-APCs-VPCs); atrial fibrillation (AF); and AF with frequent VPCs (AF-VPCs). Lorenz plots were studied qualitatively and quantitatively, and classified by distinct LP patterns (LPPs). Repeatability and reproducibility of LPP classification and diagnostic value were determined. Recordings included: 48 SR, 9 SR-APCs, 35 SR-VPCs, 5 SR-APCs-VPCs, 4 AF, and 18 AF-VPCs. Ten LPPs were identified: comet ( = 12), torpedo ( = 3), Y-shaped ( = 6), diamond ( = 10), diamond with a central silent zone ( = 17), double side-lobe (DSL) ( = 47), triple side-lobe ( = 1), quadruple side-lobe ( = 2), fan ( = 18), and fan with DSL ( = 3). Repeatability and reproducibility of LPP classification were excellent. The DSL pattern was both highly sensitive (91.3%) and specific (94.5%) for SR with frequent premature ectopies, either APCs, or VPCs, or both. The remaining LPPs had lower diagnostic value (high specificity but low sensitivity). Distinct rhythms imprint distinct and reproducible LPPs in dogs. The majority of canine LPPs are specific but insensitive indicators of SR and tachyarrhythmias.
PubMed: 34206036
DOI: 10.3390/ani11061645 -
Best Practice & Research. Clinical... Jul 2019Fetal dysrhythmias are common abnormalities, usually manifesting as irregular rhythms. Although most irregularities are benign and caused by isolated atrial ectopics, in... (Review)
Review
Fetal dysrhythmias are common abnormalities, usually manifesting as irregular rhythms. Although most irregularities are benign and caused by isolated atrial ectopics, in a few cases, rhythm irregularity may indicate partial atrioventricular block, which has different etiological and prognostic implications. We provide a flowchart for the initial management of irregular rhythm to help select cases requiring urgent specialist referral. Tachycardias and bradycardias are less frequent, can lead to hemodynamic compromise, and may require in utero therapy. Pharmacological treatment of tachycardia depends on the type (supraventricular tachycardia or atrial flutter) and presence of hydrops, with digoxin, flecainide, and sotalol being commonly used. An ongoing randomized trial may best inform about their efficacy. Bradycardia due to blocked bigeminy normally resolves spontaneously, but if it is due to established complete heart block, there is no effective treatment. Ongoing research suggests hydroxychloroquine may reduce the risk of autoimmune atrioventricular block. Sinus bradycardia (rate <3rd centile) may be a prenatal marker for long-QT syndrome.
Topics: Arrhythmias, Cardiac; Echocardiography; Female; Fetal Diseases; Fetal Therapies; Heart Block; Heart Rate, Fetal; Humans; Pregnancy; Risk Assessment; Ultrasonography, Doppler; Ultrasonography, Prenatal
PubMed: 30738635
DOI: 10.1016/j.bpobgyn.2019.01.002 -
Journal of Cardiovascular... Aug 2023Improved sinus rhythm (SR) maintenance rates have been achieved in patients with persistent atrial fibrillation (AF) undergoing pulmonary vein isolation plus additional...
INTRODUCTION
Improved sinus rhythm (SR) maintenance rates have been achieved in patients with persistent atrial fibrillation (AF) undergoing pulmonary vein isolation plus additional ablation of low voltage substrate (LVS) during SR. However, voltage mapping during SR may be hindered in persistent and long-persistent AF patients by immediate AF recurrence after electrical cardioversion. We assess correlations between LVS extent and location during SR and AF, aiming to identify regional voltage thresholds for rhythm-independent delineation/detection of LVS areas. (1) Identification of voltage dissimilarities between mapping in SR and AF. (2) Identification of regional voltage thresholds that improve cross-rhythm substrate detection. (3) Comparison of LVS between SR and native versus induced AF.
METHODS
Forty-one ablation-naive persistent AF patients underwent high-definition (1 mm electrodes; >1200 left atrial (LA) mapping sites per rhythm) voltage mapping in SR and AF. Global and regional voltage thresholds in AF were identified which best match LVS < 0.5 mV and <1.0 mV in SR. Additionally, the correlation between SR-LVS with induced versus native AF-LVS was assessed.
RESULTS
Substantial voltage differences (median: 0.52, interquartile range: 0.33-0.69, maximum: 1.19 mV) with a predominance of the posterior/inferior LA wall exist between the rhythms. An AF threshold of 0.34 mV for the entire left atrium provides an accuracy, sensitivity and specificity of 69%, 67%, and 69% to identify SR-LVS < 0.5 mV, respectively. Lower thresholds for the posterior wall (0.27 mV) and inferior wall (0.3 mV) result in higher spatial concordance to SR-LVS (4% and 7% increase). Concordance with SR-LVS was higher for induced AF compared to native AF (area under the curve[AUC]: 0.80 vs. 0.73). AF-LVS < 0.5 mV corresponds to SR-LVS < 0.97 mV (AUC: 0.73).
CONCLUSION
Although the proposed region-specific voltage thresholds during AF improve the consistency of LVS identification as determined during SR, the concordance in LVS between SR and AF remains moderate, with larger LVS detection during AF. Voltage-based substrate ablation should preferentially be performed during SR to limit the amount of ablated atrial myocardium.
Topics: Humans; Atrial Fibrillation; Catheter Ablation; Electrophysiologic Techniques, Cardiac; Heart Atria; Atrial Appendage
PubMed: 37365931
DOI: 10.1111/jce.15984 -
Frontiers in Cardiovascular Medicine 2023Patients with advanced heart failure have a high incidence of atrial fibrillation (AF) and develop into heart failure with reduced ejection fraction (HFrEF), and require...
Patients with advanced heart failure have a high incidence of atrial fibrillation (AF) and develop into heart failure with reduced ejection fraction (HFrEF), and require higher doses of inotropes. However, it is uncertain about the differences in the effects of levosimendan in HFrEF patients with sinus rhythm or AF. A total of 63 advanced HFrEF subjects (ejection fraction < 40%) were divided into sinus rhythm (SR, = 34) and atrial fibrillation (AF, = 29) cohorts. All patients received six cycles of intermittent repeated levosimendan infusion. After 3 months of treatment, B-type natriuretic peptide (BNP), estimated glomerular filtration rate, resting heart rate (rHR), creatinine, left ventricle ejection fraction (LVEF), left ventricular end diastolic diameter and blood pressure body weight, NYHA classification were measured. After completing the course of treatment, LVEF, BNP, and rHR were significantly decreased ( < 0.0.5), and no significant differences between the two groups were observed ( > 0.05). The NYHA classification improved in the SR group but not in the AF group. There was no significant difference between patients with different rHRs (≤70 bpm vs. >70 bpm) in the SR group ( > 0.05) or in the AF group (rHR ≤ 90 bpm vs. rHR >90 bpm) ( > 0.05). This study showed no difference in the therapeutic effect of intermittent repeated levosimendan infusion on advanced HFrEF with different heart rhythms (SR or AF); Advanced HFrEF patients receive levosimendan treatment without taking the inference of heart rhythm.
PubMed: 36910542
DOI: 10.3389/fcvm.2023.1084300 -
Annual International Conference of the... Jul 2019The aim of our work herein was to design a photoplethysmographic (PPG) peak detection algorithm which automatically detect and discriminate various cardiac...
The aim of our work herein was to design a photoplethysmographic (PPG) peak detection algorithm which automatically detect and discriminate various cardiac rhythms-normal sinus rhythms (NSR), premature atrial contraction (PAC), premature ventricle contraction (PVC), and atrial fibrillation (AF)-for PPG signals collected on smartwatch. Compared with peak detection algorithm designed for NSR, the novelty is that our proposed peak detection algorithm can accurately estimate heart rates (HR) among various arrhythmias, which enhances the accuracy of AF screening. Our peak detection method is composed of a sequential series of algorithms that are combined to discriminate various arrhythmias, as described above. Moreover, a novel Poincaré plot scheme is used to discriminate AF with Rapid Ventricular Response (RVR) from normal basal heart rate AF. Moreover, the method is also able to differentiate PAC/PVC from NSR and AF. Our results show that the proposed peak detection algorithm provides significantly lower average beat-to-beat estimation error (> 40% lower) and mean heart rate estimation error (> 50% lower) when compared to a traditional peak detection algorithm that is known to be accurate for NSR. Our new approach allows more accurate HR estimation as it can account for various arrhythmias which previous PPG peak detection algorithms were designed solely for NSR.
Topics: Algorithms; Atrial Fibrillation; Heart Rate; Humans; Photoplethysmography; Ventricular Premature Complexes; Wearable Electronic Devices
PubMed: 31946821
DOI: 10.1109/EMBC.2019.8857325 -
Diagnostics (Basel, Switzerland) Sep 2023This study aims to compare the effectiveness of using discrete heartbeats versus an entire 12-lead electrocardiogram (ECG) as the input for predicting future occurrences...
This study aims to compare the effectiveness of using discrete heartbeats versus an entire 12-lead electrocardiogram (ECG) as the input for predicting future occurrences of arrhythmia and atrial fibrillation using deep learning models. Experiments were conducted using two types of inputs: a combination of discrete heartbeats extracted from 12-lead ECG and an entire 12-lead ECG signal of 10 s. This study utilized 326,904 ECG signals from 134,447 patients and categorized them into three groups: true-normal sinus rhythm (T-NSR), atrial fibrillation-normal sinus rhythm (AF-NSR), and clinically important arrhythmia-normal sinus rhythm (CIA-NSR). The T-NSR group comprised patients with at least three normal rhythms in a year and no atrial fibrillation or arrhythmias history. Clinically important arrhythmia included atrial fibrillation, atrial flutter, atrial premature contraction, atrial tachycardia, ventricular premature contraction, ventricular tachycardia, right and left bundle branch block, and atrioventricular block over the second degree. The AF-NSR group included normal sinus rhythm paired with atrial fibrillation or atrial flutter within 14 days, and the CIA-NSR group comprised normal sinus rhythm paired with CIA occurring within 14 days. Three deep learning models, ResNet-18, LSTM, and Transformer-based models, were utilized to distinguish T-NSR from AF-NSR and T-NSR from CIA-NSR. The experiments demonstrated the potential of using discrete heartbeats in predicting future arrhythmia and atrial fibrillation incidences extracted from 12-lead electrocardiogram (ECG) signals alone, without any additional patient information. The analysis reveals that these discrete heartbeats contain subtle patterns that deep learning models can identify. Focusing on discrete heartbeats may lead to more timely and accurate diagnoses of these conditions, improving patient outcomes and enabling automated diagnosis using ECG signals as a biomarker.
PubMed: 37685387
DOI: 10.3390/diagnostics13172849 -
Proceedings (Baylor University. Medical... Jan 2019Pheochromocytomas are rare catecholamine-producing neuroendocrine tumors that can lead to detrimental outcomes; if identified and treated, they are associated with a...
Pheochromocytomas are rare catecholamine-producing neuroendocrine tumors that can lead to detrimental outcomes; if identified and treated, they are associated with a good prognosis. The clinical presentation can vary greatly but is classically associated with tachycardia, headaches, and hypertension. Bradyarrhythmias and sinus node dysfunction are uncommon complications of this condition. We present a case of pheochromocytoma associated with sinus pauses and junctional escape rhythms that had complete resolution of sinus node dysfunction after adrenalectomy.
PubMed: 30956604
DOI: 10.1080/08998280.2018.1533310 -
Zeitschrift Fur Kardiologie Dec 1994The term accelerated idioventricular rhythm describes an ectopic ventricular rhythm with 3 or more consecutive ventricular premature beats with a rate faster than the... (Review)
Review
The term accelerated idioventricular rhythm describes an ectopic ventricular rhythm with 3 or more consecutive ventricular premature beats with a rate faster than the normal ventricular intrinsic escape rate of 30 to 40 beats per minute, but slower than ventricular tachycardia. Accelerated idioventricular rhythm differs from ventricular tachycardia by additional features such as the onset with a long coupling interval, the end by a gradual decrease of the ventricular rate or increase of the sinus rate and, last but not least, by a good prognosis. Clinically, accelerated idioventricular rhythm can occur in any form of structural heart disease and occasionally in adults or children without structural heart disease. Accelerated idioventricular rhythm most often can be seen in patients with coronary artery disease. Its occurrence after thrombolysis during acute myocardial infarction is a marker of successful reperfusion. Since accelerated idioventricular rhythm is usually hemodynamically well tolerated and not associated with malignant ventricular tachycardias; as a rule, no specific treatment other than care of the underlying heart disease is necessary. The present overview discusses electrocardiographic criteria, possible mechanisms, and the clinical significance of accelerated idioventricular rhythms.
Topics: Accelerated Idioventricular Rhythm; Diagnosis, Differential; Electrocardiography; Heart Rate; Hemodynamics; Humans; Tachycardia, Ventricular
PubMed: 7846928
DOI: No ID Found