Impact of Anti-Hepatitis C Therapy on Cardiac rhythm

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohamed Medhat Awad ◽  
Ahmed Ibrahim El Desoky ◽  
Azza Ahmed Omran ◽  
Ghada Abdelrahman Mohamed ◽  
Ahmed Mohamed El Missiry ◽  
...  
Keyword(s):  
Heart Rate ◽  
Hepatitis C ◽  
Cardiac Rhythm ◽  
Holter Monitoring ◽  
Interval Duration ◽  
Hepatitis C Therapy ◽  
Pr Interval ◽  
The Mean ◽  
Significant Change ◽  
Post Therapy

Abstract Background The use of direct-acting antiviral (DAA) has raised some concerns about the possibilities of cardiac toxicity after US Food and Drug Administration (FDA) issued a safety announcement of serious slowing of the heart rate when Amiodarone was used with hepatitis C treatment . Aim The aim of the present study was to assess the impact of Anti-Hepatitis C Therapy on cardiac rhythm using 24 hours Holter monitoring. Methods The current study was conducted on fifty consecutive adult patients with chronic hepatitis C infection eligible for DAA therapy supplied in the outpatient clinic of Ain shams University Virology Center .Patients have received Sofosbuvir 400 mg and Daclatasvir 60 mg / day for 12 weeks. All patients underwent 24 hour Holter monitoring before and after the completion of therapy. Both recordings were compared as regards: heart rate, minimum and maximum heart rate, the presence and frequency of ectopic atrial or ventricular activity. The measurement of QRS intervals such PR, corrected QT intervals in msec. Results The pre and post analysis of the Holter recording was done with comparing different baseline and post therapy parameters, The pre and post therapy mean average heart rates were 79.44±10.14 bpm vs.79.96±8.77 bpm respectively (p = 0.534) which are non-significant changes. There is also non-significant change was observed in mean maximum and mean minimum heart rate 129.08±20.07 bpm 128.98±16.89 bpm (p = 0.964), 55.88±9.20 bpm 56.66±9.45 bpm (p = 0.457) respectively. And as regard corrected QT duration and PR interval duration, the mean pre-therapy PR interval was 154.00 ± 25.95 ms as compared to the mean post-medication PR interval duration 151.40 ± 23.82 ms (p = 0.124) and The mean premedication Corrected QT duration was 397.34 ± 29.38ms vs. post therapy 395.04 ± 30.23ms ( p = 0.403) Which showing a non-significant change of both intervals. And as regard the median pre-therapy and post medication PACs and PVCs numbers and the median pre-therapy and post medication attacks of tachycardia and bradycardia, they showed non-significant changes with P-value > 0.05 . Conclusions Novel DAAs are safe to use as regards its effect on cardiac rhythm

Assessment of heart rate variability in breath holding children by 24 hour Holter monitoring

2013 ◽  
Vol 25 (2) ◽  
pp. 317-323 ◽  
Author(s):  
Osman Yilmaz ◽  
Murat Ciftel ◽  
Kezban Ozturk ◽  
Omer Kilic ◽  
Hasan Kahveci ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Cardiac Rhythm ◽  
Holter Monitoring ◽  
Breath Holding ◽  
Control Group ◽  
Study Group ◽  
Autonomic Dysregulation ◽  
Cardiac Effects ◽  
The Mean

AbstractPurpose: Previous studies have shown that the underlying pathophysiologic mechanism in children with breath holding may be generalised autonomic dysregulation. Thus, we performed cardiac rhythm and heart rate variability analyses using 24-hour Holter monitoring to evaluate the cardiac effects of autonomic dysregulation in children with breath-holding spells. Methods: We performed cardiac rhythm and heart rate analyses using 24-hour Holter monitors to evaluate the cardiac effects of autonomic dysregulation in children during a breath-holding spell. Our study group consisted of 68 children with breath-holding spells – 56 cyanotic type and 12 pallid type – and 39 healthy controls. Results: Clinical and heart rate variability results were compared between each spell type – cyanotic or pallid – and the control group; significant differences (p<0.05) in standard deviation of all NN intervals, mean of the standard deviations of all NN intervals for all 5-minute segments, percentage of differences between adjacent RR intervals >50 ms, and square root of the mean of the sum of squares of the differences between adjacent NN intervals values were found between the pallid and cyanotic groups. Conclusions: Holter monitoring for 24 hours and heart rate variability parameters, particularly in children with pallid spells, are crucial for evaluation of cardiac rhythm changes.

scholarly journals Holter Monitoring (24-h Electrocardiography) of Holstein Calves

2018 ◽  
Vol 44 (1) ◽  
pp. 5 ◽  
Author(s):  
Rebecca Bastos Pessoa ◽  
Camila Freitas Batista ◽  
Kamila Reis Santos ◽  
Jéssyca Beraldi Bellinazzi ◽  
Alice Maria Melville Paiva Della Libera ◽  
...  
Keyword(s):  
Heart Rate ◽  
Cardiac Rhythm ◽  
Clinical Signs ◽  
Vagal Tone ◽  
Holter Monitoring ◽  
Farm Animals ◽  
Sinus Arrhythmia ◽  
Ectopic Beats ◽  
Holstein Calves ◽  
Second Degree

Background: Twenty-four h electrocardiographic monitoring is a noninvasive method of assessing cardiac rhythm. Holter monitoring in farm animals can help assessing heart rate variability and its relationship with stress and production. Several authors have reviewed the normal cardiac rhythm of bovines, but there is little information on heart rhythm in calves. The goal of this research is to elucidate which cardiac rhythms may be considered physiological in Holstein calves, from 3 to 6 months old.Materials, Methods & Results: Twenty-four h ambulatory electrocardiography (Holter monitoring) was performed in 10 male Holstein calves, with ages ranging from 3 to 6 months old. The animals came from private farms in São Paulo state and were housed in a semi-open stall during the study. The animals had their hair clipped from the third to the fifth intercostal spaces on both sides of the chest, from the sternal region to the glenohumeral joint, and seven electrodes were positioned in a diagonal configuration. Decoding of the recordings was performed using specialized software and in order to minimize digital mistakes, all of the beats marked as ectopic by the software were manually revised by the authors. Mean heart rate was 83.2 ± 11.06 beats per min (bpm), maximum heart rate was 147.1 ± 11.05 bpm, and minimum heart rate was 53.7 ± 7.45 bpm. In 90% of the calves, normal sinus rhythm was predominant, whereas in 10%, sinus arrhythmia (SA) was prevalent. Second degree atrioventricular blocks (AV blocks) were observed in 30% of the animals and supraventricular premature beats (SPB) were detected in 50%. Holter monitoring was repeated after three months in three of the animals; two showed no arrhythmias at the second exam, and in the other, the frequency of AV blocks was decreased by 88.64%.Discussion: In the present study, the authors observed a relatively high incidence of arrhythmias in Holstein calves, although there is little information available in the literature for comparison. The use of Holter monitoring is much more sensitive in the assessment of arrhythmias than a standard electrocardiogram, since it records the cardiac rhythm for 24 to 48 h, as opposed to only 2 to 3 min. Therefore, it is possible that the arrhythmias found in the calves in the current study were physiological events otherwise unidentified by conventional electrocardiogram. The AV blocks observed in the animals of the present study were intermittent and apparently non-related to any particular event or situation, so it was not possible to demonstrate whether they disappeared after exercise. As for the supraventricular ectopic beats, they are frequent in older bovines, mainly in dairy cows, and are usually related to increased vagal tone, stress, hormonal changes, ectopic atrial focus, and peak lactation volume overload. The animals used in the present study were otherwise healthy, and did not demonstrate any clinical signs of gastrointestinal dysfunction or other disease that might have justified an increase in their vagal tone. In addition, the decrease in the number of rhythm abnormalities in the older calves that were submitted to a second Holter exam supports the hypothesis that supraventricular ectopic beats and second degree AV blocks of Mobitz type II may be normal in calves up to six months old.

scholarly journals Electrocardiographic Changes during Normal Pregnancy

2017 ◽  
Vol 02 (03) ◽  
pp. 035-038
Author(s):  
Beeram Sumalatha ◽  
Maddury Jyotsna ◽  
Garre Indrani
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Systolic Blood Pressure ◽  
Pregnant Women ◽  
Qtc Interval ◽  
Normal Range ◽  
Cardiovascular Changes ◽  
Pr Interval ◽  
Qrs Duration ◽  
The Mean

Background Pregnancy is a physiologic condition which is unique in that it alters the physiology of each organ in the body. Cardiovascular changes during pregnancy are significant and start at 6 to 8 weeks of gestation. Physiologic cardiovascular changes during pregnancy suggest the chance of altered electrocardiographic (ECG) parameters during pregnancy. Study of variations in ECG in normal pregnant women serves as a basis to detect pathologic changes in pregnant women. Material and Methods This is a cross-sectional data of case series of pregnant women across all stages of gestation who attended antenatal clinic of our teaching hospital, on Women's Day (March 8, 2017). A 12-lead ECG was recorded in all the participants in supine position. The parameters noted from the ECG include heart rate, PR interval, QRS duration, QRS axis, corrected QT (QTc) interval, and ST-T changes. Results Total 151 pregnant women were studied. The average age was 23.38 ± 3.49 years. With respect to gestational age, 12 (7.94%), 48 (31.78%), and 91 (60.26%) women were in the first, second, and third trimesters of pregnancy, respectively. With respect to parity, 60 (39.7%) were primigravidae and 91 (60.26%) were multigravidae. The mean ECG heart rate was increased (100.15 ± 12.48 beats/min). The mean systolic blood pressure (109.67 ± 9.34 mm Hg) and the mean diastolic blood pressure (71.32 ± 6.89 mm Hg) were decreased. The mean of ECG intervals and durations (PR, QRS, QTc) were in normal range (0.14 ± 0.01, 0.08 ± 0.008, and 407.83 ± 11.98, respectively). There was no abnormal P-wave dispersion. Even though the QTc was in normal range in 63.56% of pregnant women, this parameter was in upper quadrant of the normal range. General linear regression demonstrated that systolic blood pressure and palpitations were the only variables to independently predict QTc in upper quadrant of normal range (p = 0.05, 0.03, respectively). Conclusion The cardiovascular hemodynamic adaptation to pregnancy is a well-established fact that is also seen in our study. There is shortening of PR interval and QRS duration. Even though QTc is with in normal range, in more than half (63.56%) of pregnant women, it is in the upper quadrant of the normal range.

Cluster Headache: Heart Rate and Blood Pressure Changes During Spontaneous Attacks

Cephalalgia ◽  
1982 ◽  
Vol 2 (2) ◽  
pp. 61-70 ◽  
Author(s):  
David Russell ◽  
Are von der Lippe
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cluster Headache ◽  
Diastolic Blood Pressure ◽  
Head Pain ◽  
The Mean ◽  
Significant Change ◽  
Pressure Changes ◽  
Change In Mean ◽  
Mean Heart Rate

The ECG findings before, during and following 81 spontaneous attacks of cluster headache in 24 patients have been recorded using a Holter cardiography system. No significant change in mean heart rate was found during attacks, when all attacks were considered as a group. Attacks which began when patients were awake differed from those which began during sleep as regards changes in mean heart rate. The mean heart rate decreased during the majority (61%) of attacks which began when patients were awake, whereas it remained unchanged or increased during the majority (67.5%) of attacks which began during sleep. The attacks which began when patients were awake also had higher absolute mean heart rate values before, during and following attacks compared to similar values for those attacks which began during sleep. Blood pressure was measured during 11 attacks and showed a significant increase in both systolic and diastolic blood pressure. The heart rate and blood pressure in six patients usually increased during induced head pain.

scholarly journals HEART RATE TURBULENCE INDICATORS IN CLINICAL PRACTICE

2021 ◽  
Vol 14 (5) ◽  
pp. 62-67
Author(s):  
GRIGORIY A. FADEEV ◽  
◽  
NIKOLAY A. TSIBULKIN ◽  
OLGA YU. MIKHOPAROVA ◽  
GRIGORIY G. BATYRSHIN ◽  
...  
Keyword(s):  
Heart Rate ◽  
Nervous System ◽  
Autonomic Nervous System ◽  
Sinus Rhythm ◽  
Cardiac Rhythm ◽  
Heart Rhythm ◽  
Holter Monitoring ◽  
Left Ventricular ◽  
Heart Rate Turbulence ◽  
Autonomic Nervous

Background. Heart disease is the leading cause of death in developed countries. Approximately half of these fatalities are due to sudden cardiac death. Electrocardiogram recording from the body surface allows stratification of patients according to the risk of cardiac arrest without the use of invasive methods. Arrhythmias, particularly ventricular extrasystole, can affect the sinus rhythm pattern. The change in sinus rhythm that occurs after an extrasystole is defined as heart rate turbulence. This phenomenon is not pathological, but some variants are associated with a risk of fatal arrhythmias. Aim. To analyze the indices and clinical significance of cardiac rhythm turbulence according to Holter monitoring in patients with various cardiological abnormalities at the hospital profile department. Material and methods. The study included 54 patients who were routinely treated in a cardiac hospital. Cardiac rhythm turbulence indices were obtained by Holter monitoring. Patients in severe and moderately severe clinical condition were not included in the study. Concomitant and past somatic diseases affecting the state of heart and cardiovascular system were considered. Results and discussion. Deviations in heart rhythm turbulence indices can be detected both in life- threatening arrhythmias and in benign extrasystoles. They are associated with the influence of the autonomic nervous system, but probably have different mechanisms. Deviations of heart rhythm turbulence indices were associated with left ventricular myocardial hypertrophy of concentric remodeling type and with an increased number of low-risk ventricular extrasystoles. To identify patients with arrhythmias of different risk, various threshold values of cardiac rhythm turbulence indices can be used. Conclusion. Factors likely to affect the indices of cardiac rhythm turbulence such as left ventricular myocardial remodeling and hypertrophy were revealed, as well as changes in autonomic nervous system regulatory function, including those associated with the constitutional features of the patient.

scholarly journals Validation of a 6-lead smartphone ECG against 12-lead ECG in athletes

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
J Orchard ◽  
JW Orchard ◽  
H Raju ◽  
A La Gerche ◽  
R Puranik ◽  
...  
Keyword(s):  
Heart Rate ◽  
Research Training ◽  
Complete Agreement ◽  
Rate Variation ◽  
Qtc Interval ◽  
Continuous Variables ◽  
Pr Interval ◽  
Qrs Duration ◽  
The Mean ◽  
Exercise Induced

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): JO is supported by an Australian Government Research Training Program scholarship. CS is the recipient of a National Health and Medical Research Council (NHMRC) Practitioner Fellowship (#1154992). Background Athletes sometimes experience transient arrhythmias during intense exercise, which may be difficult to capture with traditional monitors. New highly portable technology, such as smartphone electrocardiogram (ECG) devices, may be useful in documenting and diagnosing exercise-induced arrhythmias. Accuracy of the Kardia single-lead ECG (1L) has been documented, but little data exists for the 6-lead device (6L). Purpose To examine the level of similarity between resting 6L and 12L readings to build evidence for the utility of the 6L as a practical diagnostic tool in athletes. Methods Participants (n = 30 healthy athletes, mean age 18.9 years, 57% male) had a resting supine 12-lead ECG (12L) as part of cardiac screening required by their sport. Within 1 hour, a 30 second 6L reading (leads I, II, III, aVR, aVL, aVF) was taken whilst seated. Data were analysed by 4 expert cardiologists. Manual measurements were taken for PR, QT and RR intervals and QRS duration using EPS digital calipers. To calculate mean 6L RR interval and QT prior to QTc, &lt;10 sequential RR/QT measurements were taken from the middle 10 seconds. QTc was calculated using Bazett’s formula. ECGs were reviewed for rhythm and presence of atrial/ventricular ectopics. Continuous variables were expressed as the mean of 4 cardiologists’ values ± standard deviation. Two-tailed paired t-tests were used to compare continuous variables (p &lt; 0.05 significant). Bland-Altman plots were used to assess quantitative agreement between QRS axis and mean values for QTc interval, QRS duration and PR interval for paired 6L and 12L ECGs. Results There were relatively high levels of agreement between the mean 6L and 12L measures for QTc and PR interval and QRS duration, with the 6L readings slightly but significantly shorter on average. The largest difference was seen in the QTc intervals (391ms vs 401ms, p = 0.003). The 6L QRS durations were shorter on average by 3ms (89ms vs 92ms, p = 0.025) and PR intervals were shorter on average by 6ms (163ms vs 169ms, p &lt; 0.001). There was complete agreement for all cardiologists for sinus rhythm and the presence of ectopics for the 6L and 12L readings. Conclusions The 6L readings had relatively high agreement with the 12L. All 6L measures (except heart rate) were slightly shorter on average than 12L. These small differences are unlikely to have any clinical significance, and are similar to findings comparing the 1L to 12L. 6L heart rates were slightly higher, which is best explained by seated compared to lying position. The reading with the greatest variation was QT interval, some of which is explained by heart rate variation. These pilot data suggest the 6L is sufficiently accurate to be useful in an athletic population as an event monitor for exercise-induced arrhythmias. This may provide more useful diagnostic data than the 1L. Larger studies showing higher levels of agreement with 12L would be required to expand the role of 6L beyond an event monitor. Abstract Figure 1: 6L device, Bland-Altman plots

scholarly journals Clinical significance of heart rate variability and Q-T interval duration during Holter monitoring of ECG in patients with essential hypertension

2004 ◽  
Vol 10 (1) ◽  
pp. 39-42
Author(s):  
A. V. Shabalin ◽  
Ye. N. Gulyaeva ◽  
Ye. Ye. Torochkina ◽  
E. M. Verkoshanskaya ◽  
O. V. Kovalenko ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Essential Hypertension ◽  
Clinical Significance ◽  
Comparison Group ◽  
Low Frequency ◽  
Holter Monitoring ◽  
Total Power ◽  
Interval Duration ◽  
Healthy Individuals

The clinical significance of heart rate variability and Q-T interval duration during 24-hour bifunctional monitoring of ECG and blood pressure (BP) was studied in 81 patients aged 22-58 years (mean 41,40±0,72 years) who had Stages I-III essential hypertension (EH). A comparison group included 20 healthy individuals. Temporary and spectral methods were used to assess the parameters of heart rate variability; 24-hour Q-Tand O-Tk intervals, as well as echocardiographic data were analyzed. Patients with Stages I-III EH were ascertained to have a progressive decrease in diurnal heart rate variability along with a reduction in the total power of the spectrum, in the power of low-frequency constituents, and in their ratio. EH progression was found to be associated with an increase in the duration of the Q-T interval, its corrected values during daylight hours and with the degree of heart rate variability without circadian changes. The degree of autonomous cardiac control was statistically significantly related to heart rate variability and a risk for ventricular repolarization disorders.

On the Quantification of Heart Rate Changes in Autonomic Function Tests: Relations between Measures in Beats per Minute, Seconds and Dimensionless Ratios

1995 ◽  
Vol 89 (6) ◽  
pp. 557-564 ◽  
Author(s):  
Theo J. C. Faes ◽  
Nico N. D. De Neeling ◽  
Rene Kingma ◽  
Ben J. TenVoorde ◽  
John M. Karemaker
Keyword(s):  
Heart Rate ◽  
Autonomic Function ◽  
Rate Variation ◽  
Deep Breathing ◽  
Interval Duration ◽  
Heart Rate Variation ◽  
Correct Interpretation ◽  
Rr Interval ◽  
The Mean ◽  
Mean Heart Rate

1. Disorders of the autonomic nervous system are frequently diagnosed by measuring heart rate changes in response to deep-breathing and lying-to-standing manoeuvres. The heart rate changes in these manoeuvres are quantified in measures using various units, like beats per minute, seconds and dimensionless ratios. 2. In the present study we mathematically derived relationships between the measures which quantify heart rate changes in beats per minute, seconds and dimensionless ratios. The theoretical outcomes were experimentally confirmed by the results of the deep-breathing and the lying-to-standing test in 525 healthy and diabetic subjects. The measures were found to be non-equivalent, because the mean RR interval duration influenced the measures in different ways. 3. It is argued that measures in seconds are preferable to measures in beats per minute or ratios, because the physiological interpretation of this measure is easier, and the sensitivity of measures in seconds is expected to be greater. 4. Finally, we recommend that measures of heart rate variation in the deep-breathing and lying-to-standing manoeuvre are accompanied by information on the mean RR interval duration or mean heart rate to allow correct interpretation of the measures.

Cardiac dysrhythmia during sleep in the critically ill: a pilot study

1996 ◽  
Vol 5 (1) ◽  
pp. 26-33 ◽  
Author(s):  
KC Richards ◽  
N Curry ◽  
W Lyons ◽  
B Todd
Keyword(s):  
Cardiovascular Disease ◽  
Heart Rate ◽  
Critical Care ◽  
Eye Movement ◽  
Critically Ill ◽  
Cardiac Rhythm ◽  
Medical Center ◽  
Sleep Stages ◽  
The Mean ◽  
Mean Heart Rate

BACKGROUND: Few investigators have examined the hemodynamic status related to circadian and sleep-related cardiovascular events in critically ill patients. OBJECTIVE: To describe the relationships among nocturnal angina, myocardial infarction, and sleep, and to describe the cardiac rhythm, heart rate, and frequency of premature supraventricular and ventricular contractions during the sleep of critical care patients with cardiovascular disease. METHODS: A descriptive survey was done on nine patients in the medical intensive care unit of a large medical center. All subjects had cardiovascular disease and were studied during one night of sleep. RESULTS: There were no incidences of chest pain during the study and no changes in baseline cardiac rhythm associated with sleep staging. There was a significant statistical difference in mean heart rate among waking, stage 1 nonrapid-eye-movement sleep, and stage 2 nonrapid-eye-movement sleep; a lower heart rate was observed in stage 2 nonrapid-eye-movement sleep. The mean heart rate decreased by 3% to 4% from the waking state to sleep. No clinical or statistically significant differences in the frequency of premature supraventricular and ventricular contractions between sleep stages or sleeping and waking were found. CONCLUSIONS: The results of this pilot investigation do not suggest that dysrhythmia occurs more frequently during certain sleep stages or during the sleep state in critical care unit patients with cardiovascular disease. The mean heart rate slowed by 3% to 4% during rapid-eye-movement and nonrapid-eye-movement sleep, but decreases in heart rate were not as great as those noted in normal, healthy subjects.

scholarly journals The Value of Holter Monitoring in the Assessment of Non-Specific Symptoms

2018 ◽  
Vol 26 (3) ◽  
pp. 191-195
Author(s):  
Shokry Faaz Nassir
Keyword(s):  
Heart Rate ◽  
Working Hours ◽  
Holter Monitoring ◽  
Anterior Chest Wall ◽  
St Segment Elevation ◽  
St Segment ◽  
Cardiac Centre ◽  
The Mean ◽  
Specific Symptoms ◽  
Ventricular Ectopics

Background: To assess the importance of Holter monitoring in evaluation of non-specific symptoms (like presyncope, dizziness, palpitations, syncope, etc.). Patients and Methods: This is an observational , prospective descriptive study which was conducted at Shaheed Al-Mihrab cardiac centre at Babylon City - Iraq in which 100 patients referred from  the consultation department for the  assessment  of non-specific compliants were included in this study . Holter monitoring was done for all patients after initial evaluation. Holter monitoring was accomplished using GE Holter system with two channels and five leads, attached to the anterior chest wall. The recorder was attached to a strap, which was attached to the patient shoulder. The recording was started in the morning at hospital working hours and the patient was allowed to go home and to resume his normal activities. He was advised to maintain his activity and asked to return  back at the same time next day. Results: 87% of patients have less than 10% premature ventricular ectopics as an isolated event while 90% of the patients have Supraventricular arrythmias less than 10% as isolated events. The mean minimum heart rate was 47 , mean maximum heart rate was 117 and mean average heart rate was 65 . 18 % of patients have ST segment Shift  in which 4% were ST-segment elevation and 14% were ST segment depressions. Conclusion: Holter monitoring was found to have no important role for the early diagnosis of arrhythmias or ischaemia as a cause of compliant in patients with non-specific symptoms

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