heart rhythm disorders
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Author(s):  
Andreas Müssigbrodt ◽  
Fabrice Demoniere ◽  
Rishika Banydeen ◽  
Steeve Finoly ◽  
Max Mommarche ◽  
...  

Abstract The treatment of heart rhythm disorders has been significantly impacted by direct consequences of the current CoVid-19 pandemic, as well as by restrictions aimed towards constraining viral spread. Usually, catheter ablations of cardiac arrhythmias are guided by electro-anatomic mapping systems. Technical staff with medical training, or medical staff with technical training, is needed to assist the operator. Travel restrictions due to the current COVID-19 pandemic have limited the in-person availability of technical support staff. To overcome these limitations, we explored the feasibility of a trans-atlantic remote technical support for electro-anatomic mapping, with an internet based communication platform, for complex electrophysiological ablation procedures. Our first experience, based on nine ablation procedures of different arrythmias, highlights the feasibility of this approach. Remote support for electro-anatomic mapping might therefore facilitate continuous care for patients with arrhythmias during the COVID-19 pandemic, particularly in insular settings. Beyond COVID-19 related challenges, this approach will likely play a greater role in the cardiology field in years to come, due to its significant advantages.


2021 ◽  
Vol 17 (7) ◽  
pp. 36-38
Author(s):  
A.L. Sidelkovskiy

Holmes-Adie syndrome, or tonic pupil syndrome, is a condition characterized by a triad of main symptoms: unilateral tonic pupil dilation, accommodative paresis without or with a significant reduction in pupillary light reflex, and decreased tendon reflexes. The disease is based on dysfunction of the parasympathetic nervous system. The syndrome results from damage to the ciliary ganglion, which carries parasympathetic innervation to the m.sphincter pupillae, cornea, and eyeball. Often the condition is accompanied by dysfunction of the spinal ganglia and, as a consequence, autonomic dysfunction in the form of sweating disorders, usually on one side of the body, rarely — by heart rhythm disorders, lability of blood pressure. A frequent sign of Adie syndrome is the absence or reduction in patellar, rarely Achilles, reflexes. The etiology of the disease is not definitively determined, bacterial or viral factors are not excluded. The diagnosis of Adie syndrome is mainly based on a clinical comparison of the symptoms of the disease, as well as on a thorough and comprehensive examination by a neuroophthalmologist with mandatory testing of pupillary responses with low doses of pilocarpine (narrowing of the pupil is characteristic). Despite the positive prognosis for the patient’s life and his ability to work, the condition belongs to the group of difficult-to-treat ones, and the management consists in symptomatic vision correction.


2021 ◽  
Vol 17 (8) ◽  
pp. 55-60
Author(s):  
O.V. Filyk ◽  
A.V. Ryzhkovskyi

Background. The effectiveness and widespread use of regional anesthesia in combination with a multimodal approach to perioperative analgesia allow them to be used for an increasing number of patients, including those undergoing surgery in gyneco­logy. The purpose of the study was to determine the effectiveness of transversus abdominis plane block as a component of multimodal analgesia compared to no regional methods of analgesia for a total abdominal hysterectomy. Materials and methods. We conducted a retrospective single-center study at the Department of Anaesthesiology and Intensive Care and the Department of Gynecology of Yuriy Semenyuk Rivne Regional Clinical Hospital (Ukraine). The study included patients aged 40–65 years with symptomatic fibroids complicated by vaginal bleedings, who required a total abdominal hysterectomy (supravaginal amputation of the uterus with ovaries). Exclusion criteria were: patient’s refusal to participate in the study at any of its stages, ASA class > IV, body mass index > 40 kg/m2, use of opioid receptor agonists/agonists-antagonists before surgery, uncontrolled arterial hypertension, heart rhythm disorders. Forty-three patients were included in data analysis. Results. It was found that the level of pain on visual analogue scale in the first group reached its maximum values at h12 and h24 stages of the study and was 4.8 [3.3; 5.8] and 5.3 [3.9; 6.4] points, respectively, while in patients of the second group at same stages of the study pain seve-rity was 2.7 [2.3; 3.5] and 2.1 [1.6; 4.1] points (p < 0.05). Significant differences were found in heart rate between the first and the second groups at h24 stage of the study (93 [87; 98] bpm in the first group and 72 [63; 79] bpm in the second, p = 0.05). There were no significant differences in mean blood pressure at all stages of the study; however, there was a tendency towards a decrease in these data throughout the study in the first group of patients. The ave-rage daily dose of nalbuphine at h24 stage has a tendency (p = 0.07) towards a decrease in the second group (40.9 ± 1.1 mg/day) compared with the first group (51.4 ± 2.9 mg/day). At h72 stage, the need in nalbuphine was significantly lower (p < 0.05) in the second group (5.8 ± 0.8 mg/day) compared to the first group (22.5 ± 4.1 mg/day). The average length of hospital stay in the first group was 6.8 ± 0.5 days, in the second one — 4.2 ± 0.2 days (p < 0.05). Conclusions. The use of bilateral transversus abdominis plane block with 0.25% bupivacaine and dexamethasone showed a tendency towards a reduction in the need for nalbuphine in the first postoperative day by 25.7 %, on the third postoperative day — by 3.9 times (p < 0.05). The length of hospital stay in the second group was decreased by 2.6 days compared to the first group (p < 0.05).


Author(s):  
Maria Vitalievna Lomakina

The high prevalence of cardiovascular diseases among the adult population leads to the risk of disability and mortality of people of working age. At the same time, this group of patients also needs comprehensive dental management and consideration of pharmacotherapeutic features. The growing cost of dental services leads to a decrease in the availability of dental care, especially taking into account the age criteria of patients with heart rhythm disorders. According to opinion polls, less than 5% go to the dentist for preventive purposes. However, patients taking anticoagulant therapy are at high risk of developing complications during dental interventions, which means they require increased preventive control by the dental care organization system. Purpose: to evaluate aspects of the organization of dental care for patients with a history of cardiac arrhythmia and taking anticoagulant therapy. Methodology: a prospective study based on the data of the copy, based on the results of an objective examination conducted by dentists (n=105), as well as an anonymous questionnaire of patients with rhythm disorders (N= 100) about the subjective assessment of the oral cavity and their awareness of methods and tools of prevention. Results: patients with cardiac arrhythmia taking anticoagulant therapy have an increased risk of bleeding as part of dental interventions. For the studied group of patients, an objective examination revealed a characteristic clinical picture of the oral cavity. The characteristics required for drawing up a personalized treatment plan for patients with cardiac arrhythmia were also identified. As part of the study, data on the degree of awareness of patients and their subjective assessment of the state of the oral cavity were obtained. Conclusion: patients taking anticoagulant therapy require increased attention during an appointment with a dentist. It is important to identify all predictors of the development of complications, during the collection of anamnesis, to identify and level the low awareness of the patient about the methods and tools of prevention, as well as to conduct personalized oral care training.


Author(s):  
Mina K. Chung ◽  
Angela Fagerlin ◽  
Paul J. Wang ◽  
Tinuola B. Ajayi ◽  
Larry A. Allen ◽  
...  

Shared decision-making (SDM) has been advocated to improve patient care, patient decision acceptance, patient-provider communication, patient motivation, adherence, and patient reported outcomes. Documentation of SDM is endorsed in several society guidelines and is a condition of reimbursement for selected cardiovascular and cardiac arrhythmia procedures. However, many clinicians argue that SDM already occurs with clinical encounter discussions or the process of obtaining informed consent and note the additional imposed workload of using and documenting decision aids without validated tools or evidence that they improve clinical outcomes. In reality, SDM is a process and can be done without decision tools, although the process may be variable. Also, SDM advocates counter that the low-risk process of SDM need not be held to the high bar of demonstrating clinical benefit and that increasing the quality of decision-making should be sufficient. Our review leverages a multidisciplinary group of experts in cardiology, cardiac electrophysiology, epidemiology, and SDM, as well as a patient advocate. Our goal is to examine and assess SDM methodology, tools, and available evidence on outcomes in patients with heart rhythm disorders to help determine the value of SDM, assess its possible impact on electrophysiological procedures and cardiac arrhythmia management, better inform regulatory requirements, and identify gaps in knowledge and future needs.


2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Emilia De Luca ◽  
Andrea Madeo ◽  
Giovanni San Pasquale ◽  
Gianluca Ponturo ◽  
Francescantonio Rosselli ◽  
...  

Abstract Aims Heart rhythm disorders, both bradyarrhythmias and tachyarrhythmias, are the most frequently observed complication in the acute phase and after primary angioplasty in patients with acute myocardial infarction (AMI). New onset atrial fibrillation (Afib) represents the most frequent arrhythmia found between 6% and 21% in patients with AMI and its onset increases the thromboembolic and mortality risk of all causes of those patients. Troponin levels measured with modern assays represent today the most specific cardiac biomarker of myocardial injury and its measurement represents the cornerstone for the diagnosis of AMI in accordance with the ESC Guidelines 2018; however, also Afib itself causes an increase in troponin values (troponinopathy). Therefore, the single biohumoral value cannot assume prognostic value in helping the clinician to recognize patients with AMI who are more predisposed to encounter Afib. So, the object of our evaluation was to support the elevated troponin values with echocardiographic biomarkers, such as the evaluation of the left atrial strain (LAS), to perform a more accurate stratification of the arrhythmic risk in patients with AMI. Methods and results A prospective multiparametric study was carried out at our Interventional Cardiology Hub Center. 240 patients with ACS-STEMI diagnosed were recruited over one year from March 2020 to March 2021. Patients included were all ≥18 (55 ± 23 y), predominantly male (88% male, 12% female). Exclusion criteria were: permanent atrial fibrillation; valvular heart disease (moderate or severe heart valve stenosis or valve replacement); implantation of a pacemaker or defibrillator; (4) poor image quality. Emergency coronary angiography (CAG) was carried out to execute primary percutaneous intervention (primary PCI with DES) on the culprit vessel. All patients underwent echocardiography by GE Vivid 80 (GE Ultrasound, Horten, Norway) in order to evaluate changes in segmental kinetics, left ventricular ejection fraction (LVEF). The ratio of peak early filling velocity of mitral inflow to early diastolic annulus velocity (E′) of the medial annulus (E/E′) was calculated. Left atrial volumes (LAVi, ml/m2) and diameter were obtained through standard apical 4 and 2 chamber views with a frame-rate range of 40–71 frames/s; then, offline analysis of images was performed using EchoPAC version 201 (GE Vingmed Ultrasound) (VSSLV) software in order to calculate LAS for each one. Patients were subjected to serial sampling to evaluate temporally troponin values and the possible Afib appearance was recognized by telemetry monitoring. Statistical analysis was performed using SPSS version 20 (IBM, Armonk, New York), continuous variables were expressed as mean ± standard deviation (SD). Pearson’s correlation coefficient was used to assess the correlation between strain value, baseline characteristics and troponin levels. All statistical tests are two-sided, and a P-value &lt; 0.05 is considered statistically significant. Two groups were recognized: high troponin levels with pathological LAS and new Afib (N = 47); medium-high troponin levels with normal LAS and no Afib (N = 143). Respectively, LAS were 8.4 ± 4.0% vs. 16 ± 4.5%, P &lt; 0.001, LAVi 44 ± 5 ml/m2 vs. 30 ± 3.2, P = 0.001, and peak of troponin levels (3.45 ± 0.46 ng/ml vs. 2.34 ± 0.22 ng/ml, P = 0.002). Multivariate analysis identified that peak troponin levels alone wasn’t a prognostic index of increased arrhythmic burden, while the correlation between high peak levels and altered LAS were independent predictors of new AFib in AMI. Conclusions The evaluation of atrial dysfunction by new echo-derived parameters and its correlation with troponin values allows a more accurate stratification of arrhythmic risk in patients with ACS. The applicability of the obtained data would allow a more careful evaluation of the clinical trend and the prognostic outcome in the subcategory analysed. Therefore, the association between biohumoral and instrumental parameters could become new biomarkers capable of predicting an increase in thromboembolic risk in AMI patients. The creation of an app that takes into account the parameters listed could be a possible future support that can help the clinician calculate the increased risk rate of new Afib in patients with ACS.


2021 ◽  
Vol 7 (2) ◽  
pp. 144-160
Author(s):  
Aulia Eka Putra ◽  
Kiki Prawiroredjo ◽  
Henry Candra ◽  
Engelin Shintadewi Julian ◽  
Gunawan Tjahjadi

Penyakit jantung masih menjadi ancaman di Indonesia, menurut Kementerian Kesehatan, pada tahun 2014 penyakit jantung koroner (PJK) merupakan penyebab kematian tertinggi setelah stroke. Persentase terbesar penyakit kardiovaskuler adalah pada gangguan irama jantung. Instrumentasi medik elektrokardiograf (EKG) digunakan untuk mendeteksi sinyal biopotensial yang dihasilkan jantung sehingga dapat didiagnosis oleh dokter spesialis jantung. Penelitian ini mengusulkan sebuah prototipe sistem rekam jantung EKG yang ekonomis, dengan memanfaatkan suatu program aplikasi menggunakan bahasa pemrograman C Sharp. Sistem menggunakan 3 buah surface electrodes, modul AD8232, dan modul Arduino Uno sebagai komponen pembentuk instrument elektrokardiograf. Surface electrodes berfungsi menangkap sinyal aktivitas listrik pada jantung yang dikondisikan oleh modul AD8232 dan diubah menjadi sinyal digital pada  Arduino.  Tampilan pada layar komputer memperlihatkan jumlah denyut jantung per menit (BPM) dan grafik gelombang EKG yang dapat dibaca nilai amplitudo dan lebar waktu gelombangnya. Berdasarkan hasil perbandingan pengujian antara prototype EKG terhadap Portable Easy ECG Monitor PC-08B didapati kesalahan rata-rata parameter gelombang jantung yaitu pada denyut jantung per menit 1,19%, pada interval R-R 2.44%, pada interval P-R 2,05 %, pada interval Q-T 1,16 %, pada interval waktu gelombang P 2,58 %, pada interval waktu gelombang QRS 2,07 %, pada interval waktu gelombang T 3,26 %, pada nilai amplitudo QRS 3,40 %, pada nilai amplitudo gelombang P  4 %, dan pada nilai amplitudo gelombang T 4,10 %. Heart disease was a threat in Indonesia, according to the Ministry of Health in 2014 coronary heart disease (CHD) was the highest cause of death after stroke. The largest percentage of cardiovascular disease was in heart rhythm disorders. Electrocardiograph (ECG) was used to detect biopotential signals generated by the heart. This research proposed a low cost electrocardiograph (ECG) prototype by utilizing an application using C Sharp. The system consisted of three surface electrodes, an AD8232 module, and an Arduino Uno module. Surface electrodes detected the electrical activity signal from the heart that was conditioned using AD8232 module and converted to digital signal in Arduino Uno. The bit per minute (BPM) of the heart and the ECG graph are displayed on the laptop screen with graticule to measure the amplitude and the width of the wave. Based on the test results of the ECG prototype compare to the Portable Easy ECG Monitor PC-08B, it is found that the average error of heartbeat per minute  is 1.19 %, the R-R time interval is 2.44 %, the P-R time interval is 2.05 %, the Q-T time interval is 1.16 %, the P wave time interval is 2.58 %, the QRS time interval is 2.07 %,  T wave time interval is 3.26 %, the QRS amplitude is 3.40 %, the P amplitude is 4 %, and the T amplitude is 4.10 %.


2021 ◽  
Vol 12 ◽  
Author(s):  
Xinyang Li ◽  
Xili Shi ◽  
Balvinder S. Handa ◽  
Arunashis Sau ◽  
Bowen Zhang ◽  
...  

Background: Atrial fibrillation (AF) and ventricular fibrillation (VF) are complex heart rhythm disorders and may be sustained by distinct electrophysiological mechanisms. Disorganised self-perpetuating multiple-wavelets and organised rotational drivers (RDs) localising to specific areas are both possible mechanisms by which fibrillation is sustained. Determining the underlying mechanisms of fibrillation may be helpful in tailoring treatment strategies. We investigated whether global fibrillation organisation, a surrogate for fibrillation mechanism, can be determined from electrocardiograms (ECGs) using band-power (BP) feature analysis and machine learning.Methods: In this study, we proposed a novel ECG classification framework to differentiate fibrillation organisation levels. BP features were derived from surface ECGs and fed to a linear discriminant analysis classifier to predict fibrillation organisation level. Two datasets, single-channel ECGs of rat VF (n = 9) and 12-lead ECGs of human AF (n = 17), were used for model evaluation in a leave-one-out (LOO) manner.Results: The proposed method correctly predicted the organisation level from rat VF ECG with the sensitivity of 75%, specificity of 80%, and accuracy of 78%, and from clinical AF ECG with the sensitivity of 80%, specificity of 92%, and accuracy of 88%.Conclusion: Our proposed method can distinguish between AF/VF of different global organisation levels non-invasively from the ECG alone. This may aid in patient selection and guiding mechanism-directed tailored treatment strategies.


2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Edvard Liljedahl Sandberg ◽  
Bjørnar Leangen Grenne ◽  
Trygve Berge ◽  
Jostein Grimsmo ◽  
Dan Atar ◽  
...  

Background. Heart rhythm disorders, especially atrial fibrillation (AF), are increasing global health challenges. Conventional diagnostic tools for assessment of rhythm disorders suffer from limited availability, limited test duration time, and usability challenges. There is also a need for out-of-hospital investigation of arrhythmias. Therefore, the Norwegian ECG247 Smart Heart Sensor has been developed to simplify the assessment of heart rhythm disorders. The current study aimed to evaluate the diagnostic accuracy and usability of the ECG247 Smart Heart Sensor compared to conventional Holter monitors. Methods. Parallel tests with ECG247 Smart Heart Sensor and a Holter monitor were performed in 151 consecutive patients referred for out-of-hospital long-term ECG recording at Sorlandet Hospital Arendal, Norway. All ECG data were automatically analysed by both systems and evaluated by hospital physicians. Participants were asked to complete a questionnaire scoring usability parameters after the test. Results. A total of 150 patients (62% men, age 54 (±17) years) completed the study. The ECG quality from both monitors was considered satisfactory for rhythm analysis in all patients. AF was identified in 9 (6%) patients during the period with parallel tests. The diagnostic accuracy for automatic AF detection was 95% (95% CI 91–98) for the ECG247 Smart Heart Sensor and 81% (95% CI 74–87) for the Holter system. The proportion of false-positive AF was 4% in tests analysed by the ECG247 algorithm and 16% in tests analysed by the Holter algorithm. Other arrhythmias were absent/rare. The system usability score was significantly better for ECG247 Smart Heart Sensor compared to traditional Holter technology (score 87.4 vs. 67.5, p < 0.001 ). Conclusions. The ECG247 Smart Heart Sensor showed at least comparable diagnostic accuracy for AF and improved usability compared to conventional Holter technology. ECG247 allows for prolonged monitoring and may improve detection of AF. This trial is registered with https://clinicaltrials.gov/ct2/show/NCT04700865.


Heart Rhythm ◽  
2021 ◽  
Author(s):  
Thomas D. Gossios ◽  
Rui Providencia ◽  
Antonio Creta ◽  
Oliver R. Segal ◽  
Nikoletta Nikolenko ◽  
...  

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