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Progress in Cardiovascular Diseases 2021The medical community's understanding of the consequences of premature ventricular contractions (PVCs) and PVC-induced cardiomyopathy has been derived mostly from... (Review)
Review
The medical community's understanding of the consequences of premature ventricular contractions (PVCs) and PVC-induced cardiomyopathy has been derived mostly from observational and large population-based studies. Due to the difficulty of predicting the development of PVC-cardiomyopathy, the acute and chronic cardiac effects of PVCs and the mechanism of PVC-cardiomyopathy have been derived from pre-clinical studies with large animal models. Recently, these studies have described myocardial substrates that could potentially increase morbidity and mortality in patients with frequent PVCs and PVC-cardiomyopathy. In this paper, we provide an up-to-date comprehensive review of these pre-clinical and clinical studies.
Topics: Action Potentials; Animals; Cardiomyopathies; Heart Conduction System; Heart Rate; Humans; Prevalence; Prognosis; Risk Factors; Translational Research, Biomedical; Ventricular Premature Complexes
PubMed: 33857575
DOI: 10.1016/j.pcad.2021.04.001 -
Cardiovascular Journal of Africa 2018The correct differentiation of an irregular, narrow-complex tachycardia has crucial implications for the therapeutic management of these conditions. In this article we...
The correct differentiation of an irregular, narrow-complex tachycardia has crucial implications for the therapeutic management of these conditions. In this article we present a differential diagnostic and treatment approach to irregular, narrow-complex tachycardias.
Topics: Action Potentials; Atrial Fibrillation; Diagnosis, Differential; Electrocardiography; Female; Heart Conduction System; Heart Rate; Humans; Middle Aged; Predictive Value of Tests; Prognosis; Tachycardia, Supraventricular; Time Factors
PubMed: 30067274
DOI: No ID Found -
Prediction of atrial fibrillation using a home blood pressure monitor with a high-resolution system.Open Heart Sep 2022The usefulness of screening for atrial fibrillation (AF) using several home blood pressure (BP) monitors has been reported. We evaluated the accuracy of a...
OBJECTIVE
The usefulness of screening for atrial fibrillation (AF) using several home blood pressure (BP) monitors has been reported. We evaluated the accuracy of a high-resolution system (HiRS) for AF prediction and its usefulness when installed in home BP monitors.
METHODS
In patients with paroxysmal, persistent or permanent AF, ECG recording and BP measurements were performed simultaneously. The relationship between ECG rhythm diagnosis and pulse irregularity recognition, using a home BP monitor with HiRS, was investigated. The severity of a pulse disturbance during BP measurement was displayed as an irregular pulse rhythm symbol (IPRS) in three instances. The IPRS was not displayed if the pulse was regular, turned on if there was a weak variation in the pulse, and blinked if there was a strong variation in the pulse.
RESULTS
One hundred and seven patients (44 paroxysmal AF, 63 persistent or permanent AF) were enrolled, and a total of 333 recordings were analysed. The rhythms recorded by each ECG were 73 sinus regular rhythms, 35 extrasystoles, 222 AFs and 3 atrial flutters. Sensitivity and specificity for the prediction of any arrhythmia by the IPRS display of the BP monitor were 95.8% (95% CI 92.6% to 97.6%) and 96.8% (95% CI 92.6% to 100%), respectively. In addition, sensitivity and specificity for the prediction of AF were 100% (95% CI 97.5% to 100%) and 74.8% (95% CI 65.6% to 82.5%), respectively. Sensitivity and specificity for the prediction of AF by the IPRS blinking display were 88.3% (95% CI 83.3% to 92.2%) and 94.6% (95% CI 88.6% to 98.0%%), respectively. IPRS exhibited lighting or blinking during AF occurrence; however, during sinus rhythm, IPRS was not displayed in 72 out of 73 recordings.
CONCLUSION
The IPRS device predicted AF with precision and may be particularly useful for predicting an arrhythmia attack in patients with paroxysmal AF.
Topics: Atrial Fibrillation; Blood Pressure Monitors; Electrocardiography; Heart Rate; Humans; Sensitivity and Specificity
PubMed: 36170999
DOI: 10.1136/openhrt-2022-002006 -
European Heart Journal. Digital Health Mar 2022Atrial fibrillation (AF) is a major cause of morbidity and mortality. Current guidelines support performing electrocardiogram (ECG) screenings to spot AF in high-risk...
AIMS
Atrial fibrillation (AF) is a major cause of morbidity and mortality. Current guidelines support performing electrocardiogram (ECG) screenings to spot AF in high-risk patients. The purpose of this study was to validate a new algorithm aimed to identify AF in patients measured with a recent FDA-cleared contact-free optical device.
METHODS AND RESULTS
Study participants were measured simultaneously using two devices: a contact-free optical system that measures chest motion vibrations (investigational device, 'Gili') and a standard reference bed-side ECG monitor (Mindray). Each reference ECG was evaluated by two board certified cardiologists that defined each trace as: regular rhythm, AF, other irregular rhythm or indecipherable/missing. A total of 3582, 30-s intervals, pertaining to 444 patients (41.9% with a history of AF) were made available for analysis. Distribution of patients with active AF, other irregular rhythm, and regular rhythm was 16.9%, 29.5%, and 53.6% respectively. Following application of cross-validated machine learning approach, the observed sensitivity and specificity were 0.92 [95% confidence interval (CI): 0.91-0.93] and 0.96 (95% CI: 0.95-0.96), respectively.
CONCLUSION
This study demonstrates for the first time the efficacy of a contact-free optical device for detecting AF.
PubMed: 36713997
DOI: 10.1093/ehjdh/ztab108 -
Cardiology Research Feb 2022Quadricuspid aortic valve (QAV) is a congenital heart anomaly in which the aortic valve has four cusps of various size possibilities, as opposed to the three symmetrical... (Review)
Review
Quadricuspid aortic valve (QAV) is a congenital heart anomaly in which the aortic valve has four cusps of various size possibilities, as opposed to the three symmetrical cusps generally observed. This cardiac valvular abnormality is rarely identified, with an estimated incidence rate of 0.013% to 0.043%, although recent technological advancements in diagnostics have contributed to an increase in detection. Historically, it had been typically encountered during open heart surgery or postmortem; however, it is presently diagnosed primarily via ultrasound echocardiography, and could go undetected unless specifically considered. It was first reported by Babington in 1847, and since then approximately 300 cases have been published. This condition is sporadically associated with additional congenital cardiovascular defects, with coronary artery irregularities being the most common. In more than half of published QAV incidences it has led to the progressive development of aortic regurgitation (AR) usually aortic stenosis, particularly amongst elderly patients, often requiring surgical intervention after 50 years of age. A fifth of total instances, but two-thirds of instances with AR, warrant surgery seldom amidst complications, with reconstructive tricuspidization preferred over valve replacement.
PubMed: 35211218
DOI: 10.14740/cr1308 -
Clinical Cardiology May 2021The 2020 European Society of Cardiology atrial fibrillation guidelines recommend opportunistic screening for atrial fibrillation by pulse taking or ECG rhythm strip in...
BACKGROUND
The 2020 European Society of Cardiology atrial fibrillation guidelines recommend opportunistic screening for atrial fibrillation by pulse taking or ECG rhythm strip in those aged over 65 years.
HYPOTHESIS
We aimed to compare the diagnostic accuracy of pulse palpation to ECG rhythm strip when screening for atrial fibrillation. A secondary aim was to investigate whether participants with palpitations were more likely to be diagnosed with new atrial fibrillation.
METHODS
The study population were 75/76 year old individuals that participated in the STROKESTOP II study, a Swedish screening study for atrial fibrillation. Pulse palpation of the radial pulse for 30 sec was performed by healthcare professionals and recorded as regular or irregular. Thereafter a 30-sec single-lead ECG was registered. Patients were asked also if they had a history of palpitations.
RESULTS
Of the 6159 participants included in the study, 461 (7.5%) had irregular pulse. Twenty-two (4.8%) of those with irregular pulse were diagnosed with atrial fibrillation on single-lead ECG rhythm strip. Among those with regular pulse, 6 (0.1%) cases of new atrial fibrillation were found. The sensitivity of the pulse palpation test was 78.6% and positive predictive value 4.8%. The proportion of newly diagnosed atrial fibrillation was not different between those with and without history of palpitations.
CONCLUSION
Pulse palpation was inferior to single-lead ECG when screening for atrial fibrillation. We therefore advocate the use of single-lead ECG rather than pulse palpation when screening for atrial fibrillation. Palpitations did not predict atrial fibrillation.
Topics: Aged; Aged, 80 and over; Atrial Fibrillation; Cohort Studies; Electrocardiography; Female; Heart Rate; Humans; Male; Mass Screening; Palpation
PubMed: 33724492
DOI: 10.1002/clc.23595 -
International Journal of Chronic... 2017In this century, the rapid development of large data storage technologies, mobile network technology, and portable medical devices makes it possible to measure, record,... (Review)
Review
In this century, the rapid development of large data storage technologies, mobile network technology, and portable medical devices makes it possible to measure, record, store, and track analysis of large amount of data in human physiological signals. Entropy is a key metric for quantifying the irregularity contained in physiological signals. In this review, we focus on how entropy changes in various physiological signals in COPD. Our review concludes that the entropy change relies on the types of physiological signals under investigation. For major physiological signals related to respiratory diseases, such as airflow, heart rate variability, and gait variability, the entropy of a patient with COPD is lower than that of a healthy person. However, in case of hormone secretion and respiratory sound, the entropy of a patient is higher than that of a healthy person. For mechanomyogram signal, the entropy increases with the increased severity of COPD. This result should give valuable guidance for the use of entropy for physiological signals measured by wearable medical device as well as for further research on entropy in COPD.
Topics: Entropy; Gait; Heart Rate; Hormones; Humans; Lung; Pattern Recognition, Automated; Predictive Value of Tests; Pressure; Prognosis; Pulmonary Disease, Chronic Obstructive; Respiration; Respiratory Muscles; Respiratory Sounds; Severity of Illness Index; Signal Processing, Computer-Assisted; Telemetry; Time Factors
PubMed: 29066881
DOI: 10.2147/COPD.S140636 -
The Cochrane Database of Systematic... Jun 2016Atrial fibrillation (AF), the most common arrhythmia in clinical practice, is a leading cause of morbidity and mortality. Screening for AF in asymptomatic patients has... (Review)
Review
BACKGROUND
Atrial fibrillation (AF), the most common arrhythmia in clinical practice, is a leading cause of morbidity and mortality. Screening for AF in asymptomatic patients has been proposed as a way of reducing the burden of the disease by detecting people who would benefit from prophylactic anticoagulation therapy before the onset of symptoms. However, for screening to be an effective intervention, it must improve the detection of AF and provide benefit for those detected earlier as a result of screening.
OBJECTIVES
This review aims to answer the following questions.Does systematic screening increase the detection of AF compared with routine practice? Which combination of screening population, strategy and test is most effective for detecting AF compared with routine practice? What safety issues and adverse events may be associated with individual screening programmes? How acceptable is the intervention to the target population? What costs are associated with systematic screening for AF?
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid) and EMBASE (Ovid) up to 11 November 2015. We searched other relevant research databases, trials registries and websites up to December 2015. We also searched reference lists of identified studies for potentially relevant studies, and we contacted corresponding authors for information about additional published or unpublished studies that may be relevant. We applied no language restrictions.
SELECTION CRITERIA
Randomised controlled trials comparing screening for AF with routine practice in people 40 years of age and older were eligible. Two review authors (PM and CT) independently selected trials for inclusion.
DATA COLLECTION AND ANALYSIS
Two review authors (PM and CT) independently assessed risk of bias and extracted data. We used odds ratios (ORs) and 95% confidence intervals (CIs) to present results for the primary outcome, which is a dichotomous variable. As we identified only one study for inclusion, we performed no meta-analysis. We used the GRADE (Grades of Recommendation, Assessment, Development and Evaluation Working Group) method to assess the quality of the evidence and GRADEPro to create a 'Summary of findings' table.
MAIN RESULTS
One cluster-randomised controlled trial met the inclusion criteria for this review. This study compared systematic screening (by invitation to have an electrocardiogram (ECG)) and opportunistic screening (pulse palpation during a general practitioner (GP) consultation for any reason, followed by an ECG if pulse was irregular) versus routine practice (normal case finding on the basis of clinical presentation) in people 65 years of age or older.Results show that both systematic screening and opportunistic screening of people over 65 years of age are more effective than routine practice (OR 1.57, 95% CI 1.08 to 2.26; and OR 1.58, 95% CI 1.10 to 2.29, respectively; both moderate-quality evidence). We found no difference in the effectiveness of systematic screening and opportunistic screening (OR 0.99, 95% CI 0.72 to 1.37; low-quality evidence). A subgroup analysis found that systematic screening and opportunistic screening were more effective in men (OR 2.68, 95% CI 1.51 to 4.76; and OR 2.33, 95% CI 1.29 to 4.19, respectively) than in women (OR 0.98, 95% CI 0.59 to 1.62; and OR 1.2, 95% CI 0.74 to 1.93, respectively). No adverse events associated with screening were reported.The incremental cost per additional case detected by opportunistic screening was GBP 337, compared with GBP 1514 for systematic screening. All cost estimates were based on data from the single included trial, which was conducted in the UK between 2001 and 2003.
AUTHORS' CONCLUSIONS
Evidence suggests that systematic screening and opportunistic screening for AF increase the rate of detection of new cases compared with routine practice. Although these approaches have comparable effects on the overall AF diagnosis rate, the cost of systematic screening is significantly greater than the cost of opportunistic screening from the perspective of the health service provider. Few studies have investigated effects of screening in other health systems and in younger age groups; therefore, caution needs to be exercised in relation to transferability of these results beyond the setting and population in which the included study was conducted.Additional research is needed to examine the effectiveness of alternative screening strategies and to investigate the effects of the intervention on risk of stroke for screened versus non-screened populations.
Topics: Aged; Asymptomatic Diseases; Atrial Fibrillation; Electrocardiography; Female; Humans; Male; Mass Screening; Palpation; Pulse; Randomized Controlled Trials as Topic
PubMed: 27258214
DOI: 10.1002/14651858.CD009586.pub3 -
PloS One 2022Atrial fibrillation (AF) remain a prevalent undiagnosed condition frequently encountered in primary care.
BACKGROUND
Atrial fibrillation (AF) remain a prevalent undiagnosed condition frequently encountered in primary care.
OBJECTIVE
We aimed to find the parameters that optimize the diagnostic accuracy of pulse palpation to detect AF. We also aimed to create a simple algorithm for selecting which individuals would benefit from pulse palpation and, if positive, receive an ECG to detect AF.
METHODS
Nurses from four Cardiology outpatient clinics palpated 7,844 pulses according to a randomized list of arterial territories and durations of measure and immediately followed by a 12-lead ECG, which we used as the reference standard. We calculated the sensitivity and specificity of the palpation parameters. We also assessed whether diagnostic accuracy depended on the nurse's experience or on a list of clinical factors of the patients. With this information, we estimated the positive predictive values and false omission rates according to very few clinical factors readily available in primary care (age, sex, and diagnosis of heart failure) and used them to create the algorithm.
RESULTS
The parameters associated with the highest diagnostic accuracy were palpation of the radial artery and classifying as irregular those palpations in which the nurse was uncertain about pulse regularity or unable to palpate pulse (sensitivity = 79%; specificity = 86%). Specificity decreased with age. Neither the nurse's experience nor any investigated clinical factor influenced diagnostic accuracy. We provide the algorithm to select the ≥40 years old individuals that would benefit from a pulse palpation screening: a) do nothing in <60 years old individuals without heart failure; b) do ECG in ≥70 years old individuals with heart failure; c) do radial pulse palpation in the remaining individuals and do ECG if the pulse is irregular or you are uncertain about its regularity or unable to palpate it.
CONCLUSIONS
Opportunistic screening for AF using optimal pulse palpation in candidate individuals according to a simple algorithm may have high effectiveness in detecting AF in primary care.
Topics: Adult; Aged; Ambulatory Care Facilities; Atrial Fibrillation; Cardiology; Electrocardiography; Heart Failure; Humans; Mass Screening; Middle Aged; Palpation; Pulse
PubMed: 35446875
DOI: 10.1371/journal.pone.0266955 -
Biomedical Optics Express Apr 2020With the popularity of smart phones, non-contact video-based vital sign monitoring using a camera has gained increased attention over recent years. Especially, imaging...
With the popularity of smart phones, non-contact video-based vital sign monitoring using a camera has gained increased attention over recent years. Especially, imaging photoplethysmography (IPPG), a technique for extracting pulse waves from videos, conduces to monitor physiological information on a daily basis, including heart rate, respiration rate, blood oxygen saturation, and so on. The main challenge for accurate pulse wave extraction from facial videos is that the facial color intensity change due to cardiovascular activities is subtle and is often badly disturbed by noise, such as illumination variation, facial expression changes, and head movements. Even a tiny interference could bring a big obstacle for pulse wave extraction and reduce the accuracy of the calculated vital signs. In recent years, many novel approaches have been proposed to eliminate noise such as filter banks, adaptive filters, Distance-PPG, and machine learning, but these methods mainly focus on heart rate detection and neglect the retention of useful details of pulse wave. For example, the pulse wave extracted by the filter bank method has no dicrotic wave and approaching sine wave, but dicrotic waves are essential for calculating vital signs like blood viscosity and blood pressure. Therefore, a new framework is proposed to achieve accurate pulse wave extraction that contains mainly two steps: 1) preprocessing procedure to remove baseline offset and high frequency random noise; and 2) a self-adaptive singular spectrum analysis algorithm to obtain cyclical components and remove aperiodic irregular noise. Experimental results show that the proposed method can extract detail-preserved pulse waves from facial videos under realistic situations and outperforms state-of-the-art methods in terms of detail-preserving and real time heart rate estimation. Furthermore, the pulse wave extracted by our approach enabled the non-contact estimation of atrial fibrillation, heart rate variability, blood pressure, as well as other physiological indices that require standard pulse wave.
PubMed: 32341854
DOI: 10.1364/BOE.380646