Changes in paced signals may predict in-hospital cardiac arrest (original) (raw)
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Electrocardiogram characteristics prior to in-hospital cardiac arrest
Journal of Clinical Monitoring and Computing, 2014
Survival after in-hospital cardiac arrest (I-HCA) remains \ 30 %. There is very limited literature exploring the electrocardiogram changes prior to I-HCA. The purpose of the study was to determine demographics and electrocardiographic predictors prior to I-HCA. A retrospective study was conducted among 39 cardiovascular subjects who had cardiopulmonary resuscitation from I-HCA with initial rhythms of pulseless electrical activity (PEA) and asystole. Demographics including medical history, ejection fraction, laboratory values, and medications were examined. Electrocardiogram (ECG) parameters from telemetry were studied to identify changes in heart rate, QRS duration and morphology, and time of occurrence and location of ST segment changes prior to I-HCA. Increased age was significantly associated with failure to survive to discharge (p \ 0.05). Significant change was observed in heart rate including a downtrend of heart rate within 15 min prior to I-HCA (p \ 0.05). There was a significant difference in heart rate and QRS duration during the last hour prior to I-HCA compared to the previous hours (p \ 0.05). Inferior ECG leads showed the most significant changes in QRS morphology and ST segments prior to I-HCA (p \ 0.05). Subjects with an initial rhythm of asystole demonstrated significantly greater ECG changes including QRS morphology and ST segment changes compared to the subjects with initial rhythms of PEA (p \ 0.05). Diagnostic ECG trends can be identified prior to I-HCA due to PEA and asystole and can be further utilized for training a predictive machine learning model for I-HCA.
Ambulatory ECG (AECG) is very commonly employed in a variety of clinical contexts to detect cardiac arrhythmias and/or arrhythmia patterns which are not readily obtained from the standard ECG. Accurate and timely characterization of arrhyth-mias is crucial to direct therapies that can have an important impact on diagnosis, prognosis or patient symptom status. The rhythm information derived from the large variety of AECG recording systems can often lead to appropriate and patient-specific medical and interventional management. The details in this document provide background and framework from which to apply AECG techniques in clinical practice, as well as clinical research.
Europace, 2015
The management of arrhythmias detected by implantable cardiac devices can be challenging. There are no formal international guidelines to inform decision-making. The purpose of this European Heart Rhythm Association (EHRA) survey was to assess the management of various clinical scenarios among members of the EHRA electrophysiology research network. There were 49 responses to the questionnaire. The survey responses were mainly (81%) from medium-high volume device implanting centres, performing more than 200 total device implants per year. Clinical scenarios were described focusing on four key areas: the implantation of pacemakers for bradyarrhythmia detected on an implantable loop recorder (ILR), the management of patients with ventricular arrhythmia detected by an ILR or pacemaker, the management of atrial fibrillation in patients with pacemakers and cardiac resynchronization therapy devices and the management of ventricular tachycardia in patients with implantable cardioverter-defibrillators.
Optimal duration and predictors of diagnostic utility of patient-activated ambulatory ECG monitoring
Heart Asia, 2018
ObjectiveWe studied the optimal duration of ambulatory event monitors for symptomatic patients and the predictors of detected events.MethodsPatients with palpitations or dizziness received a patient-activated handheld event monitor which records 30 s single-lead ECG strips. Patients were monitored in an ambulatory setting for a range of 1–4 weeks and ECG strips interpreted by five independent electrophysiologists. Event pick-up rates and clinical covariates were analysed.ResultsOf 335 consecutive adults (age 50±16 years, 58% female) with palpitations (94%) and dizziness (25%) monitored, 286 patients (85%) reported events, and clinically significant events were detected in 86 (26%) patients. Of these 86 patients, 26% had ≥2 significant events, and 73% had events detected in the first 3 days. No significant events were detected after 12 days. The most common ECG abnormalities detected were premature ventricular ectopy (38%), premature atrial ectopy (37%) and atrial fibrillation (AF)/a...
Cardiology research, 2012
Background: Cardiac rhythm monitoring is widely applied on hospitalized patients. However, its value has not been evaluated systematically. Methods: This study considered the utility of our institutional telemetry guidelines in predicting clinically significant arrhythmias. A retrospective analysis was performed of 562 patients admitted to the telemetry unit. A total of 1932 monitoring days were evaluated. Patients were divided into 2 groups based on telemetry guidelines: "telemetry indicated" and "telemetry not indicated". Results: Differences in arrhythmia event rates and pre-defined clinical significance were determined. One hundred and forty-four (34%) vs. 16 (11%) patients had at least one arrhythmic event in the "telemetry indicated" group compared with the "telemetry not indicated" group, respectively (P = 0.001). No patient in the "telemetry not indicated" group had a clinically significant arrhythmia. In contrast, of patients in the "telemetry indicated" group who had at least one arrhythmic event, 36% were considered clinically significant (P < 0.05). Conclusions: In conclusion, this study validates and supports the use of our institutional telemetry guidelines to allocate this resource appropriately and predict clinically significant arrhythmias.
IJC Heart & Vasculature, 2019
Background: Non-sustained ventricular tachycardia (NSVT) can occur asymptomatically and can be incidentally detected in the internal records of pacemakers (PM). The clinical value of NSVT in the population of PM patients is still uncertain. Our aim was to assess the prevalence of NSVT detected by remote PM control, to describe the clinical and demographic characteristics of patients with NSVT, and to assess the prognostic significance of NSVT in terms of both overall and cardiovascular mortality. Methods: Consecutive patients followed with PM remote interrogations from September 2010 to December 2015 were included. The transmissions pertaining to the first 12 months of remote control were analysed and the patients were divided by those presenting NSVT and those without NSVT. The two groups were compared in terms of total mortality and cardiovascular mortality based on the administrative data provided by the regional administration of the Italian National Health System. Results: The prevalence of NSVT in 408 patients (62% males, mean age 75.6; SD 10.6 years old) was 21% in a year. During a mean follow-up duration of 44 months, NSVT did not emerge as independently associated with overall mortality, but was associated with cardiovascular mortality in a competing risk regression model with older age, male gender, diabetes, chronic renal insufficiency, ischemic cardiomyopathy and chronic obstructive pulmonary disease. Conclusions: We show that NSVT episodes recorded by remote control in a PM population are independently associated with cardiovascular mortality with possible implications for risk stratification and therapeutic options.
Native QRS duration predicts the occurrence of arrhythmic events in ICD recipients
Europace, 2006
Aims Identification of implantable cardioverter/defibrillator (ICD) recipients at higher risk of future therapies may assist in preempting future shocks. Native QRS duration is an established predictor of overall mortality, but the role of this parameter as a clinical predictor of arrhythmic events warrants further investigation. Methods and results In an analysis of a single-centre, 13-year ICD implantation experience (1990-2002), multiple clinical parameters including QRS duration were analysed using a multiple logistic regression model. Of 562 patients followed for at least 1 year, 98 (17%) did not receive ICD therapies (event-free, group A). Comparisons were made with a randomly selected sample of 123 patients who received ICD therapies (arrhythmic events, group B). There were no significant differences in age, gender, frequency of coronary artery disease, and degree of left ventricular dysfunction. However, QRS duration was a significant determinant of arrhythmic events (100 vs. ,100 ms: adjusted OR 2.75, 95% CI 1.37-5.51; 120 vs. ,120 ms: adjusted OR 1.77, 95% CI 0.97-3.23). QRS duration was also a predictor of overall mortality in the logistic regression models (100 ms: adjusted OR 3.72, 95% CI 1.17-11.9; 120 ms: adjusted OR 3.09, 95% CI 1.39-6.85). Conclusion In this ICD population, consisting largely of secondary prevention ICD recipients, longer QRS duration predicted higher likelihood of arrhythmic events. Extent of QRS prolongation could guide the decision to initiate prophylactic anti-arrhythmic therapy in ICD patients.