holter ecg
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2022 ◽  
Vol 2022 ◽  
pp. 1-7
Author(s):  
Haitao Sun ◽  
Jing Li ◽  
Yue Wang ◽  
Xiaoke Ma

Objective. To explore the effect of mobile Internet on attitude and self-efficacy of patients with coronary heart disease (CHD) diagnosed by 12-lead Holter ECG. Methods. The clinical data of 62 patients with CHD who underwent routine ECG examination (control group I) and 12-lead dynamic electrocardiogram (control group II) in our hospital (June 2017–December 2020) were retrospectively analyzed, and the clinical data of another 62 patients with CHD who received 12-lead Holter ECG examination combined with mobile Internet in our hospital at the same time (study group) were retrospectively analyzed. The clinical observation indexes of the three groups were compared. Results. No obvious difference in general data among groups ( P > 0.05 ). Compared with the control group I, the positive detection rate (PDR) of the study group and the control group II was obviously higher ( P < 0.05 ), and the PDR of the study group was obviously higher than that of the control group II, without remarkable difference between both groups ( P > 0.05 ). Compared with the control group, the scores of CAS-R of the study group were obviously higher ( P < 0.05 ), and self-efficacy of daily life, health behaviors, medication compliance, and compliance behavior of the study group was obviously better ( P < 0.05 ). The diagnostic efficacy was derived by ROC curve analysis, 12-lead Holter ECG combined with mobile Internet + routine ECG > 12-lead Holter ECG combined with mobile Internet > 12-lead Holter ECG > routine ECG. Conclusion. Compared with the routine ECG, the sensitivity of 12-lead Holter ECG in the diagnosis of CHD is conspicuously higher. Meanwhile, 12-lead Holter ECG combined with mobile Internet can enhance the diagnostic efficiency and improve patients’ perceived control attitude and self-efficacy.


2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Claudia Carrarini ◽  
V. Di Stefano ◽  
M. Russo ◽  
F. Dono ◽  
M. Di Pietro ◽  
...  

AbstractPost-stroke arrhythmias represent a risk factor for complications and worse prognosis after cerebrovascular events. The aims of the study were to detect the rate of atrial fibrillation (AF) and other cardiac arrhythmias after acute ischemic stroke, by using a 7-day Holter ECG which has proved to be superior to the standard 24-h recording, and to evaluate the possible association between brain lesions and arrhythmias. One hundred and twenty patients with cryptogenic ischemic stroke underwent clinical and neuroimaging assessment and were monitored with a 7-day Holter ECG. Analysis of the rhythm recorded over 7 days was compared to analysis limited at the first 24 h of monitoring. 7-day Holter ECG detected AF in 4% of patients, supraventricular extrasystole (SVEB) in 94%, ventricular extrasystole (VEB) in 88%, short supraventricular runs (SVRs) in 54%, supraventricular tachycardia in 20%, and bradycardia in 6%. Compared to the first 24 h of monitoring, 7-Holter ECG showed a significant higher detection for all arrhythmias (AF p = 0.02; bradycardia p = 0.03; tachycardia p = 0.0001; SVEB p = 0.0002; VEB p = 0.0001; SVRs p = 0.0001). Patients with SVRs and bradycardia were older (p = 0.0001; p = 0.035) and had higher CHA2DS2VASc scores (p = 0.004; p = 0.026) respectively, in the comparison with patients without these two arrhythmias. An association was found between SVEB and parietal (p = 0.013) and temporal (p = 0.013) lobe lesions, whereas VEB correlated with insular involvement (p = 0.002). 7-day Holter ECG monitoring proved to be superior as compared to 24-h recording for the detection of all arrhythmias, some of which (SVEB and VEB) were associated with specific brain areas involvement. Therefore, 7-day Holter ECG should be required as an effective first-line approach to improve both diagnosis and therapeutic management after stroke.


Author(s):  
Nazar Pavlyk ◽  
◽  
Ulyana Chernyaha-Royko ◽  
Oleg Zharinov ◽  
Mykhaylo Sorokivskyy ◽  
...  

Introduction. The existing guidelines do not contain a clear algorithm for predicting the late recurrences of atrial fibrillation (AFib). Objectives. We have studied the predictors of late recurrence of arrhythmia in patients with persistent AFib after the restoration of sinus rhythm (SR). Research methods. A prospective single-center study included 120 hospitalized patients with persistent AFib who underwent successful cardioversion. The recurrence of AFib was assessed in the early period after cardioversion by recording 12-channel ECG, Holter ECG monitoring and event ECG monitoring. After a nine-month period follow-up visit was performed. Baseline demographic, clinical-functional features and comorbidities were compared in group with (n = 87) and without (n = 33) late recurrences of Afib. Results. There were no differences in demographic, anthropometric data and comorbidities. Patients with late recurrence of AFib had a lower heart rate (HR) after SR recovery (p <0.001). Early recurrences of AFib were found in 43 (49.4%) patients with late recurrences of arrhythmia and only in two (6.0%) without late recurrences (p <0.001). Patients with late recurrences of arrhythmia had a lower average daily HR (p <0.001), a higher number of single atrial extrasystoles (p = 0.001), atrial pairs and runs (p = 0.01) recorded by Holter ECG monitoring. Conclusions. Late recurrences of arrhythmia during the nine-month follow-up period were reported in 72.5% of patients. Groups of patients with and without late recurrence of arrhythmia had significant differences in the incidence of early recurrences, mean HR on SR, and the presence of atrial extrasystoles after rhythm recovery.


2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Giovanni Peretto ◽  
Alessandra Marzi ◽  
Gabriele Paglino ◽  
Patrizio Mazzone ◽  
Simone Sala ◽  
...  

Abstract Aims Although potentially life-threatening, arrhythmias in myocarditis are under-reported. To assess diagnostic yield and clinical impact of continuous arrhythmia monitoring (CAM) in patients with arrhythmic myocarditis. Methods and results We enrolled consecutive adult patients (n = 104; 71% males, age 47 ± 11 years, mean LVEF 50 ± 13%) with biopsy-proven active myocarditis and de novo ventricular arrhythmias (VA). All patients underwent prospective monitoring by both sequential 24-h Holter ECGs (4/y in the first year; 2/y in years 2–5; 1/y later) and CAM, including either ICD (n = 62; 60%) or loop recorder (n = 42; 40%). By 3.7 ± 1.6 year follow-up, 45 patients (43%) had VT, 67 (64%) NSVT, and 102 (98%) premature ventricular complexes (PVCs). As compared to Holter ECG (average 9.5 exams per patient), CAM identified more patients with VA (VT: 45 vs. 4; NSVT: 64 vs. 45; both P &lt; 0.001), more VA episodes (VT: 100 vs. 4%; NSVT: 91 vs. 12%), and earlier NSVT timing (median 6 vs. 24 months, P &lt; 0.001). Conversely, Holter ECG allowed VA morphology characterization and daily PVC quantification. The time to first treatment modification was 12 ± 9 months by CAM vs. 33 ± 16 months by Holter ECG (P &lt; 0.001), and drug withdrawal was always CAM-dependent. Guided by CAM findings, 8 patients (8%) started anticoagulants for newly diagnosed atrial arrhythmias. Differently from ICDs, loop recorders did not interfere with the interpretation of cardiac magnetic resonance. Conclusions In patients with arrhythmic myocarditis, CAM allowed accurate arrhythmia detection and showed a considerable clinical impact. As a complementary exam, VA characterization and PVC burden were better assessed by repeated Holter ECGs.


2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Alessandro Trancuccio ◽  
Andrea Mazzanti ◽  
Deni Kukavica ◽  
Carlo Arnò ◽  
Matteo Sturla ◽  
...  

Abstract Aims Myocardial involvement has been reported in SARS-CoV-2 infection, especially in hospitalized patients during the acute phase of the disease. However, the exact prevalence and the clinical implications of cardiac involvement in young individuals with paucisymptomatic SARS-CoV-2 infection are debated. Methods and results We gathered data on 100 young patients with previous paucisymptomatic SARS-CoV-2 infection, not undergoing hospitalization and without previous diagnosis of structural heart disease, who underwent cardiological evaluation in our clinic at IRCCS ICS Maugeri (Pavia, Italy). Results were validated in an external cohort of 28 patients who underwent cardiac magnetic resonance (MRI) at Humanitas Research Hospital (Rozzano, Italy). The study population included 100 patients with previous paucisymptomatic SARS-CoV-2 infection: 60 (60%) males; median age 36 years (IQR: 22–50 years); median time after SARS-CoV-2 infection 181 days (IQR: 76–218 days). At the cardiological evaluation, 31/100 (31%) of patients referred cardiological symptoms, including dyspnoea, palpitations, chest pain or syncope. Overall, 26/100 (26%) patients showed on or more of the following instrumental alterations at first level assessment: 4/100 (4%) increase of TnI; 7/100 (7%) electrocardiographic abnormalities, 12/100 (12%) ventricular arrhythmias, and 11/100 (11%) echocardiographic abnormalities. Of 32 patients who underwent cardiac MRI, myocardial involvement was detected in 6/32 (19%) patients (Figure 1), similarly to what was observed in the validation cohort [54% males; median age 47 years (IQR: 26–55 years); myocardial involvement at MRI 4/28, 14%]. Furthermore, the proportion of patients with myocardial involvement was significantly higher in patients with first-level cardiac alterations (6/18, 28%) as compared with patients without cardiac alterations at first-level examination (0/14, 0%, P = 0.024). When analysing possible predictors for the occurrence of cardiac involvement at the MRI, documentation of ventricular arrhythmias at Holter ECG or exercise test was associated with an 87-fold higher probability of cardiac involvement at the MRI (OR: 87.3; 95% CI: 4.0–1914.3; P &lt; 0.001). Conclusions Around 15–20% of patients with paucisymptomatic SARS-CoV-2 infection exhibit cardiac involvement documented at the cardiac MRI after a mean of 6 months from the onset of the disease. The presence of instrumental alterations detected with first level diagnostic tests, and in particular the documentation of ventricular arrhythmias at the 24 h-Holter ECG or at the exercise stress test, is a powerful predictor of myocardial involvement.


2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Valentina Conti ◽  
Claudio Moretti ◽  
Chiara Rovera ◽  
Erica Franco

Abstract Aims Mitral valve prolapse (MVP) is frequently found in the population (3% prevalence). MVP prognosis is generally benign; however, malignant arrhythmias and increased risk of arrhythmic sudden cardiac death (0.2% to 0.4% per year) was described in patients, usually female, mostly affected by bileaflet myxomatous disease, mid-systolic click, ripolarization abnormalities in the inferior leads, and complex ventricular arrhythmias with polymorphic/right bundle branch block morphology, without significant regurgitation. The actual burden, risk stratification, and treatment of the so-called arrhythmic MVP are unknown. Methods Z.T. is a 32 years old woman who was admitted to the Emergency Department (ED) with left arm and face paraesthesia. She also reported having suffered from migraine and hypertension a few days earlier. ECG: normal sinus rhythm, no ripolarization abnormalities. CT and MRI were executed to rule out cerebral ischaemic events and both resulted negative. No SCD was reported in the anamnesis and the patient denied syncopal and pre-syncopal episodes. Z.T. had undergone cardiologic examination for tachycardia 2 years before the present events, during her second pregnancy (she produced no documentation to this effect). No chronic therapy. Low blood pressure at home. Due to the patient’s cardiologic history, ECG monitoring was performed, evidencing frequent premature ventricular beats (PVBs), some couples, and triplets. Cardiologic evaluation was requested. On Echocardiogram: Normal bi-ventricular function. Bileaflet mitral valve prolapse with myxomatous degeneration. Minimal valve regurgitation. Mitral annulus disjunction. TE echocardiogram: no PFO. Nadolol 20 mg was prescribed and after 24 h of observation the patient was discharged, scheduling Holter ECG, cardiac MRI and arrhythmologic evaluation. Results One month later, the patient reported intolerance to nadolol due to hypotension and pre-syncopal episodes during postural changes. Holter ECG revealed: polymorphic PVBs (2009), couples (383), triplets (40). Cardiac MRI: mitral valve prolapse (11 mm), mitral annulus disjunction (8mm) systolic curling (3mm). No LGE. No oedema. Nadolol was discontinued and substituted with bisoprolol 2.5 mg. Physical activity was discouraged; Ergometric test and Holter ECG were ordered under treatment with bisoprolol. The Ergometric test revealed reduced extrasystolia during physical effort, isolated PVBs and some couples during recovery. Holter ECG revealed continuing isolated PVBs (980) and some couples (37). No complex arrhythmia. Conclusion Z.T. is affected by an arrhythmic MVP syndrome characterized by complex PVBs, mitral annular disjunction, and systolic curling, which have been described by pathological and cardiac magnetic resonance studies in sudden death victims. However, Z.T. is asymptomatic: no ECG ripolarization abnormalities at rest and good response to medical therapy with β-blockers. Our patient strategy was conservative and we decided to follow up with trimestral cardiologic evaluation and Holter ECG. Further research is needed to best identify high-risk patients and suggest treatments aimed to prevent sudden death.


2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Grosse ◽  
R Surber ◽  
K Kirsch ◽  
P C Schulze

Abstract Background Arrhythmias in elderly patients (&gt;70 years) are common in daily clinical practice. Most frequently, they are based on atrial fibrillation or other atrial tachycardia with an indication for oral anticoagulation and specific antiarrhythmic medications. The electrographic (ECG) documentation related to symptoms is essential before therapy initiation. In case of suspected AVNRT based on surface ECG, an electrophysiological study (EP) with ablation as curative strategy should be planned. Methods We analysed all patients &gt;70 years with AVNRT diagnosed by electrophysiologic (EP) studies between May 2018 and December 2020. Results An EP study for suspected AVNRT was performed in 27 patients &gt;70 years. The diagnosis of AVNRT was confirmed in 20 patients (75%). From all EP- studies with the diagnosis of AVNRT (n=93) in this period, 20 patients (22%) were older than 70 years (mean age 77 years with a range of 70–85 years), 12 were women. In most of the patients, the duration of symptoms was short (3 month). Only 4 patients had symptoms of paroxysmal tachycardia longer than 10 years. Except for 2 patients, all patients had at least one ECG- documentation (12- lead- ECG, Holter- ECG, telemetric ECG and/or in the loop recorder). In 12 patients, a 12- lead- ECG- documentation was available, in 5 patients the tachycardia has been registered in the Holter-ECG and in 1 in a loop recorder. In the 12- lead- ECG before ablation in sinus rhythm the PQ interval was with 196 (120- 300) ms in the upper range. In 16/ 20 patients was during the EP- study a sustained AVNRT (CL 410, 314- 538 ms) inducible. In the others, up to 3 typical AV- nodal- echo beats were induced in the EP- study. A slow pathway ablation/ modification was performed in all patients in typical position. In 2 patients, the implantation of a dual- chamber- pacemaker was necessary due to intermittent high- degree AV-nodal-block during the same hospital stay. In both patients, a first degree AV-block with PQ- interval of 250 and 300 ms was pre-existing. Discussion Especially for the elderly patients with new onset of clinical symptoms of arrhythmia, clinical anamnesis including an ECG- documentation is required for planning the therapeutic strategy. A borderline long PQ- interval as sign of an age- dependent fibrosis in the AV- node and, therefore, altered conduction properties in the AV node can be a cause of AVNRT in these older patients. In patients with pre-existing long PQ- interval (&gt;250 ms), the risk of pacemaker implantation after successful ablation is higher. In this group of patients, medical therapeutic options are limited and often associated with the need of pacemaker implantation. FUNDunding Acknowledgement Type of funding sources: None.


2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
T Nishimura ◽  
K Senoo ◽  
I Hibiki ◽  
T Okura ◽  
T Miki ◽  
...  

Abstract Background Atrial fibrillation (AF) is associated with increased risks of stroke and heart failure. AF risk prediction can facilitate the efficient deployment of diagnosis or interventions to prevent AF. Purpose We sought to assess the combination prediction value of Holter electrocardiogram (Holter ECG) and the CHARGE-AF score (Cohorts for Aging and Research in Genomic Epidemiology-AF) for the new-onset of AF in a single center study. We also investigated the association between clinical findings and the new-onset of cerebral cardiovascular events. Methods From January 2008 and May 2014, 1246 patients with aged≥20 undergoing Holter ECG for palpitations, dizziness, or syncope were recruited. Among them, 350 patients were enrolled in this study after exclusion of 1) AF history at the time of inspection or before, 2) post cardiac device implantation, 3) follow-up duration &lt;1 year, and 4) no 12-lead ECG records within 6 months around Holter ECG. Results During the 5.9-year follow-up, 40 patients (11.4%) developed AF incidence. Multivariate cox regression analysis revealed that CHARGE-AF score (hazard ratio [HR]: 1.59, 95% confidence interval (95% CI): 1.13–2.26, P&lt;0.01), BMI (HR: 0.91, 95% CI: 0.83–0.99, P=0.03), frequent supraventricular extrasystoles (SVEs) ≥1000 beats/day (HR: 4.87, 95% CI: 2.59–9.13, P&lt;0.001) and first-degree AV block (HR: 3.52, 95% CI: 1.63–7.61, P&lt;0.01) were significant independent predictors for newly AF. The area under the ROC curve (AUC) of the combination of the CHARGE-AF score and frequent SVEs (≥1000) was greater than the CHARGE-AF score alone (0.73, 95% CI: 0.64–0.82 vs 0.66, 95% CI: 0.56–0.75, respectively). On the ROC curve, the CHARGE-AF score of 12.9 was optimum cut-off value for newly AF. Patients with both the CHARGE-AF score≥12.9 and SVEs≥1000 developed AF at 129.0/1000 person-years, compared with those with the CHARGE-AF score&lt;12.9 and SVEs≥1000 (48.9), the CHARGE-AF score≥12.9 and SVEs&lt;1000 (40.0) and the CHARGE-AF score&lt;12.9 and SVEs&lt;1000 (7.4), respectively. In multivariate cox regression analysis, age, past history of congestive heart failure and myocardial infarction, and antihypertensive medication were significant predictors of cerebral cardiovascular events (n=43), all of which signifying the components of the CHARGE-AF score. The AUC of the combination of the CHARGE-AF score and frequent SVEs (≥1000) was not different from the CHARGE-AF score alone (0.73, 95% CI: 0.64–0.81 vs 0.73, 95% CI: 0.64–0.82, respectively). Conclusion CHARGE-AF score has higher predictive power of both the new incident AF and cerebral cardiovascular events. The combination of CHARGE-AF score and SVEs≥1000 beats/day in Holter ECG can demonstrate the additional effect of prediction ability for the new incident AF, but not for cerebral cardiovascular events. FUNDunding Acknowledgement Type of funding sources: None.


2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
G Peretto ◽  
P Mazzone ◽  
P Della Bella ◽  
S Sala

Abstract Background Although potentially life-threatening, arrhythmias in myocarditis are under-reported. Purpose To assess diagnostic yield and clinical impact of continuous arrhythmia monitoring (CAM) in patients with arrhythmic myocarditis. Methods We enrolled consecutive adult patients (n=104; 71% males, age 47±11y, mean LVEF 50±13%) with biopsy-proven active myocarditis and de novo ventricular arrhythmias (VA). All patients underwent prospective monitoring by both sequential 24-hour Holter ECGs (4/y in the first year; 2/y in years 2–5; 1/y later) and CAM, including either ICD (n=62; 60%) or loop recorder (n=42; 40%). Results By 3.7±1.6 y follow-up, 45 patients (43%) had VT, 67 (64%) NSVT, and 102 (98%) premature ventricular complexes (PVC). As compared to Holter ECG (average 9.5 exams per patient), CAM identified more patients with VA (VT: 45 vs. 4; NSVT: 64 vs. 45; both p&lt;0.001), more VA episodes (VT: 100 vs. 4%; NSVT: 91 vs. 12%), and earlier NSVT timing (median 6 vs. 24 months, p&lt;0.001). Conversely, Holter ECG allowed VA morphology characterization and daily PVC quantification. The time to first treatment modification was 12±9 months by CAM vs. 33±16 months by Holter ECG (p&lt;0.001), and drug withdrawal was always CAM-dependent. Guided by CAM findings, 8 patients (8%) started anticoagulants for newly-diagnosed atrial arrhythmias. Differently from ICDs, loop recorders did not interfere with the interpretation of cardiac magnetic resonance. Conclusion In patients with arrhythmic myocarditis, CAM allowed accurate arrhythmia detection and showed a considerable clinical impact. As a complementary exam, VA characterization and PVC burden were better assed by repeated Holter ECGs. FUNDunding Acknowledgement Type of funding sources: None.


2021 ◽  
pp. 10-15
Author(s):  
Vira Tseluyko ◽  
Tetyana Pylova

The aim of the study to evaluate the effect of supplementation of basic therapy by ranolazine in patients with INOCA on exercise test parameters and Holter ECG monitoring. Materials and methods. 53 patients with stable coronary heart disease were examined, including 18 men (33.9 %) and 35 (66 %) women, the average age of patients was 57 (±9.68) years. According to the results of coronary angiography all patients had non-obstructive coronary arteries. In addition to physical and laboratory examination, bicycle ergometry, Holter ECG monitoring and echocardiography were included in the examination of patients. Patients were divided into 2 groups: group I - patients who in addition to standard therapy received ranolazine at a dose of 1000 mg twice a day for 6 months, and group II patients with standard coronary heart disease therapy. After 6 months from the beginning of the observation an objective examination, echocardiography, exercise test, Holter ECG monitoring were repeated. Results. The study found that patients receiving ranolazine in addition to standard therapy had a statistically significant increase in exercise duration after 6 months compared with baseline and group II. Before treatment in group I, the duration of the exercise test was 356.51±180.24s, and after treatment 414.32±142.10s (p=0.03). In group II, the duration of the test before treatment was 361.4±160.24 c, and after 380.5±152.2 s (p=0.15). It was also found that the duration of the test differed significantly in group I after treatment of patients from group II after treatment of patients with a standard treatment regimen (p=0.04). According to the results of Holter ECG monitoring in group I found a positive effect of ranolazine on the frequency of ventricular arrhythmias: before treatment n=1142 [30; 2012], after treatment n=729 [23; 1420], while in group II a significant difference between the number of extrasystoles before treatment and after not detected (n=1026 [17; 1920], n=985 [15; 1680], respectively) p=0.18. Conclusions. The addition of ranolazine to the basic therapy of patients with non-obstructive coronary arteries disease helps to increase exercise tolerance (according to the loading stress test) and contributes to a significant reduction in the number of ventricular arrhythmias (according to Holter-ECG) compared with both baseline and group II


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