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Wireless Telecardiology
Published in Rajarshi Gupta, Dwaipayan Biswas, Health Monitoring Systems, 2019
Luca Monzo, Michele Schiariti, Paolo Emilio Puddu
AF remote detection and management deserve a particular mention in this setting. Remote monitoring is advantageous in patients with paroxysmal AF because alerts could identify the start-point of the arrhythmia, resulting in an unscheduled follow-up either in office or by phone, and appropriate interventions (e.g., antiarrhythmic medication, anticoagulation or antiplatelet medication, external cardioversion, device reprogramming) [113]. AF may trigger inappropriate therapy or promote loss of effective cardiac resynchronization and may places patients at risk for stroke, especially if they are not receiving anticoagulation therapy, or for HF decompensation. Almost all modern CIEDs have AF detection criteria that will trigger a remote alert when the CIED and/or the alert notification criteria in the remote monitoring web portal are programmed to do so. Timely access to arrhythmia data, including electrogram, rate, onset, and duration of episodes, enables clinicians to assess the appropriateness of anticoagulation therapy and rate control in accordance with evidence-based AF management guidelines.
Tone–Entropy Analysis of Heart Rate Variability in Cardiac Autonomic Neuropathy
Published in Herbert F. Jelinek, David J. Cornforth, Ahsan H. Khandoker, ECG Time Series Variability Analysis, 2017
Chandan Karmakar, Ahsan H. Khandoker, Herbert F. Jelinek, Marimuthu Palaniswami
Exclusion criteria included those with a history of cardiac pathology, hypertension, or use of antihypertensive or antiarrhythmic medication, and those with less than 85% qualified sinus beats. ECGs were recorded over 20 minutes using a lead-II configuration (Maclab ADInstruments, Australia) and recorded on Macintosh Chart Version 5 with a sampling rate set at 400 Hz and a notch filter at 50 Hz. ECG signals were edited using the MLS310 HRV module (version 1.0, ADInstruments, Australia) included with the Chart software package. A 45 Hz low-pass filter and a 3 Hz high-pass filter were applied prior to determining the RRIs. Ectopic beats were identified visually and deleted from the ECG recording. QRS peaks were determined using the algorithm developed by Pan and Tomkin (Pan and Tompkins 1985) and RRIs calculated. The presence of CAN+ was assessed using the complete Ewing battery (Ewing et al. 1985).
Treatment of brief episodes of highly symptomatic supraventricular and ventricular arrhythmias: a methodological review
Published in Expert Review of Medical Devices, 2021
Rita B. Gagyi, Mark Hoogendijk, Sing-Chien Yap, Tamas Szili-Torok
The diagnosis of short-lived arrhythmias is difficult; therefore, it can be established with certainty only by an electrophysiology (EP) study. The current mapping approaches are described in the next section. Data for an evidence-based choice of drugs for the pharmacological therapy of supraventricular arrhythmias are deficient. However, current guidelines recommend initiation of therapy with beta-blockers or calcium channel blockers. In the case of nonsustained or short-lived arrhythmias guidelines recommend no drug therapy but targeted CA [10]. At the ventricular level, guidelines recommend beta-blocker therapy for PVCs and nonsustained VTs as pharmacological approach. Catheter ablation, however, is an important treatment option for patients with ventricular arrhythmias when antiarrhythmic medication is ineffective, not tolerated or not desired by the patient [11].
Innovative tools for atrial fibrillation ablation
Published in Expert Review of Medical Devices, 2020
Laura Rottner, Daniela Waddell, Tina Lin, Andreas Metzner, Andreas Rillig
The multielectrode catheter ‘PVAC’ (PVAC, Medtronic, Minneapolis, MN, USA) can deliver RF energy in different unipolar and multipolar modes and was originally developed to reduce ablation and overall procedure times when compared to single-tip point-by-point ablation. One-year AF-free-survival off antiarrhythmic medication was 61% in patients with PAF using the first-generation device [46]. As a main limitation, its use was associated with the occurrence of asymptomatic cerebral embolism [47,48], whose long-term effects we have not been able to estimate accurately so far and which may have been caused by an interaction of electrodes. Therefore this device has been overworked and the novel-generation system (PVAC-Gold, Medtronic, Minneapolis, MN, USA) was touted as effective and safe. The current-generation catheter has only nine electrodes with larger inter-electrode spacing and different electrode compositions for better heat conductivity. Phased RF-ablation using the PVAC-Gold catheter for PVI in patients with PAF has demonstrated convincing acute efficacy. The Precision-GOLD trial furthermore reported a low overall complication rate, especially in regards to ischemic stroke or transient ischemic attack [49]. However, this could not be consistently confirmed by a newer analysis [50].
Predicting the cardiac toxicity of drugs using a novel multiscale exposure–response simulator
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2018
Francisco Sahli Costabal, Jiang Yao, Ellen Kuhl
In October 1999, a new class III antiarrhythmic drug, dofetilide, was approved for treatment of atrial fibrillation in the United States (Pfizer 2011). Atrial fibrillation, the most common sustained cardiac arrhythmia, affects more than 6 million people in the United States (American Heart Association 2015) and 33 million worldwide (Chugh et al. 2014). Dofetilide cardioverts persistent atrial fibrillation to sinus rhythm by selectively blocking the rapid delayed rectifier potassium current, which slows the efflux of potassium ions, reduces the repolarization rate of the cell, and widens the plateau of the action potential (Mirams et al. 2011). However, on the whole heart level, this controlled widening of the action potential induces a pronounced prolongation of the QT interval, a signature that has been associated with a high risk of torsades de pointes (Bohnen et al. 2017). Torsades de pointes is a special form of ventricular tachycardia characterized by a rapid twisting of QRS complexes around the electrocardiogram baseline that can lead to sudden cardiac death (Dessertenne 1966). The reporting rate of torsades de pointes increased exponentially in the early 1990s when numerous drugs–not just cardiac drugs–were recognized to trigger QT interval prolongation and increase proarrhythmic potential (Stockbridge et al. 2013). In response, 14 drugs were removed from the market, among them dofetilide, the first oral antiarrhythmic agent approved for treatment of atrial arrhythmias in almost a decade (Allen LaPointe et al. 2002) and the only drug that was approved after the implementation of new the regulatory guidelines (Stockbridge et al. 2013).