System for Continuous and Prolonged Ambulatory ECG Monitoring with Hosting and Visualization on the Cloud

In this paper, we propose investigating the ability to integrate a portable Electrocardiogram (ECG) device to commercial platforms to analyze and visualize information hosted in the cloud. Our ECG system based on the ADX8232 microchip was evaluated regarding its performance of recordings of a synthetic ECG signal for periods of 1, 2, 12, 24, and 36 h on six different cloud services to investigate whether it maintains reliable ECG records. Our results show that there are few cloud services capable of 24 h or longer ECG recordings. But some existing services are limited to small file sizes of less than 1,000,000 lines or 100 MB, or approximately 45 min of an ECG recording at a sampling rate of 360 Hz, making it difficult an extended time monitoring. Cloud platforms reveal some limitations of storage and visualization in order to provide support to health care specialists to access information related to a patient at any time.

Cardiac magnetic resonance in athletes with ventricular arrhythmias

Funding Acknowledgements Type of funding sources: None. Background Ventricular arrhythmias in athletes represent an important issue in sport eligibility as they may be a marker of a concealed cardiomyopathy, potentially at risk of sudden cardiac death during sport activity. Purpose to assess the utility of cardiac magnetic resonance (CMR) to identify cardiac abnormalities in athletes with documented frequent premature ventricular beats (PVB) or complex ventricular arrhythmias (VA) undergoing competitive sport eligibility screening. Methods We enrolled 65 athletes with documented ventricular arrhythmias as follows: 1) frequent PVB at 24-hour ambulatory ECG monitoring (>100 PVB/24h); 2) polymorphic PVB; 3) repetitive PVB (couplets, triplets, or nonsustained ventricular tachicardia). All athletes were studied with rest ECG, exercise stress testing, 24-hour ambulatory ECG monitoring, transthoracic echocardiography and contrast-enhanced CMR. Results Sixty-five athletes (56 males, 9 females, age 30 ± 15years) underwent CMR with gadolinium contrast. In 55 patients (84.6%) CMR was normal, in 10 patients (15.4%) the following abnormalities were reported at CMR: four patients with isolated late gadolinium enhancement (LGE) of whom 3 patients with subepicardial LGE in the inferolateral wall and 1 patient with intramyocardial basal inferior LGE; 1 patient with hypertrophic cardiomyopathy with septal LGE; 1 patient with left ventricular non compaction; 3 patients with right ventricular abnormalities (a 13-year-old patient with dilated right ventricle and LGE located at the superior interventricular insertion point, 1 patient with a dilated and hypokinetic right ventricle, 1 patient with a focal right ventricular aneurysm). Transthoracic echocardiography was normal in 7/10 (70%) athletes with CMR abnormalities. Conclusion In athletes with frequent or complex ventricular arrhythmias cardiac magnetic resonance identifies cardiac abnormalities in a significant proportion of subjects and it may offer a diagnostic incremental value.

Predictors of Left Ventricular Scar Using Cardiac Magnetic Resonance in Athletes With Apparently Idiopathic Ventricular Arrhythmias

Background In athletes with ventricular arrhythmias (VA) and otherwise unremarkable clinical findings, cardiac magnetic resonance (CMR) may reveal concealed pathological substrates. The aim of this multicenter study was to evaluate which VA characteristics predicted CMR abnormalities. Methods and Results We enrolled 251 consecutive competitive athletes (74% males, median age 25 [17‐39] years) who underwent CMR for evaluation of VA. We included athletes with >100 premature ventricular beats/24 h or ≥1 repetitive VA (couplets, triplets, or nonsustained ventricular tachycardia) on 12‐lead 24‐hour ambulatory ECG monitoring and negative family history, ECG, and echocardiogram. Features of VA that were evaluated included number, morphology, repetitivity, and response to exercise testing. Left‐ventricular late gadolinium‐enhancement was documented by CMR in 28 (11%) athletes, mostly (n=25) with a subepicardial/midmyocardial stria pattern. On 24‐hour ECG monitoring, premature ventricular beats with multiple morphologies or with right‐bundle‐branch‐block and intermediate/superior axis configuration were documented in 25 (89%) athletes with versus 58 (26%) without late gadolinium‐enhancement ( P <0.001). More than 3300 premature ventricular beats were recorded in 4 (14%) athletes with versus 117 (53%) without positive CMR ( P <0.001). At exercise testing, nonsustained ventricular tachycardia occurred at peak of exercise in 8 (29%) athletes with late gadolinium‐enhancement (polymorphic in 6/8, 75%) versus 17 athletes (8%) without late gadolinium‐enhancement ( P =0.002), ( P <0.0001). At multivariable analysis, all 3 parameters independently correlated with CMR abnormalities. Conclusions In athletes with apparently idiopathic VA, simple characteristics such as number and morphology of premature ventricular beats on 12‐lead 24‐hour ambulatory ECG monitoring and response to exercise testing predicted the presence of concealed myocardial abnormalities on CMR. These findings may help cost‐effective CMR prescription.

Predictors of left ventricular scar at cardiac magnetic resonance in athletes with apparently idiopathic ventricular arrhythmias

Introduction In athletes with ventricular arrhythmias (VA) and otherwise unremarkable clinical findings, cardiac magnetic resonance (CMR) may reveal concealed pathological substrates. The aim of this multicentre study was to evaluate which VA characteristics were associated with CMR abnormalities. Methods We enrolled a consecutive series of 251 competitive athletes (74% males, mean age 28.5±14.5 years) who underwent CMR for evaluation of VA. We included athletes with &gt;100 premature ventricular beats (PVBs)/24-hour or ≥1 repetitive VA (couplets, triplets or non-sustained ventricular tachycardia) on 12-lead 24-hour ambulatory ECG monitoring and negative family history, electrocardiogram and echocardiogram. Features of VA that were evaluated included number, morphology, repetitivity and response to exercise testing. Results Left-ventricular late gadolinium-enhancement (LGE) was documented in 28 (11%) athletes, mostly (N=25) with a subepicardial/midmyocardial (non-ischemic) distribution. On 24-hour ECG monitoring, PVBs with a right-bundle-branch-block and intermediate/superior axis configuration or multiple morphologies were documented in 24/28 (86%) athletes with versus 55/223 (25%) without LGE (p&lt;0.001). More than 2000 PVBs were recorded in 6 (21%) athletes with versus 127 (57%) without positive CMR (p&lt;0.001). At exercise testing, repetitive VA occurred at high work-load in 12 (43%) athletes with versus 26 (12%) without LGE (p&lt;0.001). At multivariable analysis, all three VA features independently correlated with CMR abnormalities. Conclusions In athletes with apparently idiopathic VA, simple characteristics such as number and morphology of PVBs on 12-lead 24-hour ambulatory ECG monitoring and response to exercise testing predicted the presence of concealed myocardial abnormalities on CMR. These findings may help cost-effective CMR prescription. Flow chart Funding Acknowledgement Type of funding source: None