Different Types Of Arrhythmias Research Articles

Association between social phobia and the risk of arrhythmia using the Korean National Sample Cohort: a retrospective cohort study

BackgroundSocial phobia shares symptoms with arrhythmias, such as palpitations and chest discomfort. However, it is unclear how social phobia is associated with the actual risk of arrhythmia. This study aimed to investigate whether social phobia is associated with the risk of arrhythmia using a nationally representative sample cohort.MethodsThis retrospective cohort study assessed data from the 2002–2013 Korean National Health Insurance Service National Sample Cohort. Using 1:3 propensity score matching for sex, age, income, and insurance status, 1514 patients with social phobia and 4542 control group patients were included in the study. Social phobia and arrhythmia were defined per the International Classification of Diseases, 10th revision. Using cox proportional hazard regression, hazard ratios (HRs) were calculated to estimate the risk of arrhythmia in patients with social phobia.ResultsThere were statistically significant associations between social phobia history and elevated risks of arrhythmia. Patients with social phobia had a higher risk of arrhythmia after adjusting with covariates (HR = 1.78, 95%CI = 1.25–2.55). Among different types of arrhythmias, atrial fibrillation and flutter presented the highest risk (HR = 2.20, CI = 1.06–4.57) compared to paroxysmal tachycardia (HR = 1.07, CI = 0.39–2.91) and other cardiac arrhythmias (HR = 1.83, CI = 1.16–2.89).ConclusionThis study identified the association between social phobia and the risk of arrhythmia in a South Korean representative cohort. These results suggest that social phobia should be treated properly to reduce arrhythmia risks.

TF-Unet:An automatic cardiac MRI image segmentation method.

Personalized heart models are widely used to study the mechanisms of cardiac arrhythmias and have been used to guide clinical ablation of different types of arrhythmias in recent years. MRI images are now mostly used for model building. In cardiac modeling studies, the degree of segmentation of the heart image determines the success of subsequent 3D reconstructions. Therefore, a fully automated segmentation is needed. In this paper, we combine U-Net and Transformer as an alternative approach to perform powerful and fully automated segmentation of medical images. On the one hand, we use convolutional neural networks for feature extraction and spatial encoding of inputs to fully exploit the advantages of convolution in detail grasping; on the other hand, we use Transformer to add remote dependencies to high-level features and model features at different scales to fully exploit the advantages of Transformer. The results show that, the average dice coefficients for ACDC and Synapse datasets are 91.72 and 85.46%, respectively, and compared with Swin-Unet, the segmentation accuracy are improved by 1.72% for ACDC dataset and 6.33% for Synapse dataset.

The Deep Radial Basis Function Data Descriptor (D-RBFDD) Network: A One-Class Neural Network for Anomaly Detection

Anomaly detection is a challenging problem in machine learning, and is made even more so when dealing with instances that are captured in low-level, raw data representations without a well-known and well-behaved set of engineered features. Images or data streams from sensors are good examples of such low-level, raw data representations. The Radial Basis Function Data Descriptor (RBFDD) network is an effective solution for anomaly detection, however, it is a shallow model that does not deal effectively with raw data representations. This paper investigates approaches to improving the RBFDD network to transform it into a deep one-class classifier suitable for anomaly detection problems with low-level, raw data representations. We show that approaches based on simple transfer learning are not effective and our results suggest that this is because the latent representations learned by generic classification models are not suitable for anomaly detection. Instead, we show that an approach that adds multiple convolutional layers before the Radial Basis Function (RBF) layer of an RBFDD network—to form a Deep Radial Basis Function Data Descriptor (D-RBFDD) network—is very effective. This is shown in a set of evaluation experiments using multiple anomaly detection scenarios created from publicly available image classification datasets, and a real-world anomaly detection dataset in which different types of arrhythmia are detected in electrocardiogram (ECG) data. Our experiments show that the D-RBFDD network out-performs state-of-the-art anomaly detection methods including the Deep Support Vector Data Descriptor (Deep SVDD), One-Class Support Vector Machine (OCSVM), and Isolation Forest on the image datasets, and produces competitive results on the ECG dataset.

The Incidence of Dysarrhythmias, Their Types and Outcomes in Patients Hospitalized with COVID -19

Background: COVID-19 infection started in China and became a pandemic, the SARS-CoV-2 virus mainly affects the respiratory system but can insult the cardiovascular system as well, higher rate of cardiac arrhythmias noted during the pandemic, and many studies showed that COVID-19 (especially hospitalized patients) can develop different types of arrhythmias which cause higher mortality rate. Objective: To assess the incidence of dysrhythmias and their types and outcomes in hospitalized patients with COVID-19 in Erbil city. Patients and Methods: Patients with documented COVID-19 infection admitted in Erbil Teaching Hospital respiratory care unit and coronary care unit from 1-8-2020 to 30-10-2020 had been included (255 patients) in this cross-sectional study, demographic data, and outcomes were reported, the ECG analyzed by cardiologists and the type of arrhythmia documented. Results: Mean age was 47±12 years, 61% of the patients were male, 25% of them had previous cardiac diseases, 20% diabetes, 16% multiple comorbidities, 8% hypertension, 8% obesity and 23% had no comorbidities, 20.7% of in-hospital patients developed dysrhythmias, 5.9% of them developed sinus tachycardia, 4.7% atrial fibrillation, 3.9% ventricular premature contractions, 2% ventricular fibrillation, 1.9% ventricular tachycardia and 1.9% heart blocks. Most of the patients who developed ventricular arrhythmias, atrial fibrillation, and heart block had previous comorbidities 82%, 62%, and 80% respectively. Arrhythmias caused a higher in-hospital mortality rate (39.6% versus 21.7%) especially among male patients (mortality rate in male patients 43% compared with female patients 33%). Conclusion: Most of the admitted cases were male. Most of them had comorbidities especially previous cardiac diseases. Sinus tachycardia, atrial fibrillation, and ventricular extra-systoles were the most frequent arrhythmias. The mortality rate was increased by arrhythmias mainly in male patients. Keywords: COVID-19, Dysrhythmias, Outcomes, Pandemic

Frequency of Cardiovascular Complications and Its Association with Prognosis of COVID-19 Patients

Coronavirus disease 2019 (COVID-19) may lead to acute respiratory disease; cardiovascular, gastrointestinal, and coagulation complications; and even death. One of the major complications is cardiovascular disorders, including arrhythmias, myocarditis, pericarditis, and acute coronary artery disease. The aim of this study was to evaluate the frequency of cardiovascular complications and to determine its association with the prognosis of COVID-19 patients. In a prospective analytic study, 137 hospitalized COVID-19 patients were enrolled. During hospitalization, an electrocardiogram (ECG) was performed every other day, and laboratory tests such as cardiac troponin I (cTnI) and creatine kinase-MB (CK-MB) were done 0, 6, and 12 hours after admission. These tests were repeated for patients with chest pain or ECG changes. Patients were categorized into three groups (improved, complicated, and expired patients) and assessed for the rate and type of arrhythmias, cardiac complications, lab tests, and outcomes of treatments. There was no significant relationship among the three groups related to primary arrhythmia and arrhythmias during treatment. The most common arrhythmia during hospitalization and after treatment was ST-T fragment changes. There was a significant age difference between the three groups (P = 0.001). There was a significant difference among the three groups for some underlying diseases, including diabetes mellitus (P = 0.003) and hyperlipidemia (P = 0.004). In our study, different types of arrhythmias had no association with patients' outcomes but age over 60 years, diabetes mellitus, and hyperlipidemia played an important role in the prognosis of COVID-19 cases.

Human Physiological Parameters Related to Solar and Geomagnetic Disturbances: Data from Different Geographic Regions

It is well known that the various manifestations of space weather can influence a wide range of human activities, from technological systems to human health. Various earlier, as well as more recent multi-disciplinary heliobiological and biometeorological studies have revealed that the human organism is sensitive to environmental physical activity changes and reacts to them through variations of the physiological parameters of the human body. This paper constitutes an overview of the National and Kapodistrian University of Athens investigations in regard to the possible effect of solar, geomagnetic, and cosmic ray activity on human physiological parameters. The Athens Cosmic Ray and Solar Physics Groups collaborated with scientific teams from different countries, statistically processing and analyzing data related to human physiological parameters (such as mean heart rate, arterial systolic, and diastolic pressure), or the number of incidents of different types of cardiac arrhythmias and so forth, in relation to data concerning and describing geomagnetic activity (geomagnetic indices Ap and Dst) and variations in cosmic ray intensity (Forbush decreases and cosmic ray intensity enhancements). In total, four projects were carried out concerning data from different geographical regions (Baku, Azerbaijan; Kosice, Slovakia; Tbilisi, Georgia; Piraeus, Greece), covering different time periods and time scales (daily data or yearly data), and referring to different groups of individuals (selected healthy persons or random persons). The studies concluded with interesting results concerning the possible influence of geomagnetic and cosmic ray activity on the human physiological state.

Clinical comprehensive evaluation of Wenxin Granules in treatment of arrhythmia with deficiency of Qi and Yin

This study evaluated the safety, effectiveness, economy, innovation, suitability, accessibility, and characteristics of traditional Chinese medicine of Wenxin Granules in the treatment of arrhythmia(ventricular premature beat and atrial premature beat) with deficiency of Qi and Yin. The multi-criteria decision analysis(MCDA) model was adopted, and the criterion layer and index layer were weighted by experts. CSC v2.0 was used for clinical comprehensive evaluation. This study embodies the clinical value of Wenxin Granules, promotes its safe, effective and rational use, and provides a basis for national medical decision-making. The multi-source evidence shows that the major adverse reaction of Wenxin Granules is gastrointestinal damage. According to the available studies, Wenxin Granules has controllable risk and thus is rated as grade B in terms of safety. The systematic evaluation of effectiveness shows that compared with antiarrhythmic western medicine, Wenxin Granules demonstrates improved clinical efficacy and electrocardiogram efficacy, which is supported by high-quality evidence, and thus the effectiveness of Wenxin Granules is evaluated as grade A. Economic research shows that Wenxin Granules is more economical than antiarrhythmic western medicine, which is supported by sufficient evidence and clear results, and thus the economy of this preparation is rated as grade B. The indications and contraindications of Wenxin Granules are clear and detailed to different types of arrhythmia, which, together with the precise positioning and prominent clinical innovation and industrial innovation, rates it as grade A in terms of innovation. The suitability of drug storage, prescription circulation, dosage form and course of treatment basically meet the clinical medication needs of doctors and patients, and thus the suitability of Wenxin Granules is evaluated as grade B. Because of the few restrictions and the sustainable resources of medicinal materials, the accessibility of Wenxin Granules is evaluated as grade A. The prescription compatibility focuses on the pathogenesis characteristics of deficiency of Qi and Yin, and there are more than 3 000 cases studied. Therefore, the characteristics of traditional Chinese medicine of Wenxin Granules are evaluated as grade B. Based on the evidence from all the above dimensions, Wenxin Granules has the clinical comprehensive value of class A and prominent characteristics of traditional Chinese medicine. It is suggested to include Wenxin Granules into the policy results related to basic clinical medication management according to the procedure.

Abstract 12648: Improvements In Post-operative Cardiac Surgery Arrhythmia Identification Using The Atriamp Signals

Background: Following cardiac surgery, as many as 60% of patients will experience an arrhythmia. These arrhythmias are associated with increased morbidity and occasional mortality. Therefore, rapid and accurate identification is paramount to the improvement of patient outcome. Unfortunately, until now monitoring was limited by lack of timeliness or clarity. Here we evaluate the confidence and accuracy of rhythm diagnosis using the AtriAmp, a UW device that allows continuous arrhythmia monitoring. Methods: An ongoing IRB approved prospective observational study of children less than or equal to 18 years of age admitted to the PICU with atrial pacing wires following congenital heart surgery. The AtriAmp was connected to atrial pacing wires and the atrial ECG (AEG) was displayed along with a surface ECG on GE monitors. Nine different types of arrhythmias were collected over the course of the first five months of the study. A 20-question online survey was given to critical care and cardiology providers. Ten questions displayed signals from only the surface leads, the other ten showed the same arrhythmias with AtriAmp signal also displayed. Answers were evaluated for confidence and accuracy. Results: 40 providers were given the survey with 72% completing at the time of this abstract submission. Paired t-tests and mixed effects modeling were used to assess the data. The overall accuracy of diagnosis increased when using the Atriamp signals along with the surface ECG, but it was not statistically significant (p=0.07). Improvements in accuracy were most notable with atrial ectopic tachycardia (AET), Ventricular tachycardia (VT) and junctional ectopic tachycardia (JET). Provider confidence in diagnosis increased significantly when using the Atriamp signals (48%) compared to using only the surface ECG (62%) to diagnose arrhythmias (p<0.001). Conclusion: Use of the AtriAmp increased provider confidence in the diagnosis of post-operative arrhythmias when compared to the same arrhythmias seen on surface electrograms. Future research among a larger sample of providers is needed to further evaluate the use of AtriAmp in arrythmia diagnosis.

Incidence of Arrhythmias and Their Prognostic Value in Patients With Multiple Myeloma.

Background: Arrhythmias are common cardiovascular complications in multiple myeloma (MM) patients and are related to a poor prognosis.Objective: This study aimed to assess the burden of arrhythmias and their prognostic value in patients with MM.Methods: This was a retrospective study of patients with MM between January 2015 and April 2020 at the First Affiliated Hospital of Xi'an Jiaotong University. The incidence of arrhythmia and associated risk factors were evaluated. The relationship between the type of arrhythmia and survival was analyzed.Results: A total of 319 patients with MM were identified, and 48.0% (153/319) had arrhythmias. The most common type of arrhythmia was sinus tachycardia (ST) (15.0%, 48/319), followed by sinus bradycardia (SB) (14.4%, 46/319), premature atrial contractions (PACs) (6.3%, 20/319), conduction disorders (CDs) (6.0%, 19/319), atrial fibrillation (AF) (6.0%, 19/319), premature ventricular contractions (PVCs) (4.4%, 14/319) and paroxysmal supraventricular tachycardia (PSVT) (0.6%, 2/319). The patients with arrhythmias had higher levels of log NT-proBNP and creatinine, greater bortezomib use, and a higher incidence of diabetes than those without arrhythmias (P < 0.05). The all-cause mortality rates of patients without arrhythmias and those with AF, ST, PACs, CDs, SB, and PVCs were 50.6% (84/166), 73.7% (14/19), 60.4% (29/48), 60.0% (12/20), 52.6% (10/19), 34.8% (16/46), and 28.6% (4/14), respectively. In a subgroup analysis of patients experiencing different types of arrhythmias, patients with SB had lower all-cause mortality than patients with AF (P < 0.01). Univariate and multivariate Cox analyses showed that there was a positive statistically significant association between SB and survival (HR: 0.592 [0.352–0.998], P = 0.049) in a subgroup analysis of different arrhythmias.Conclusions: Patients with MM had a heavy arrhythmia burden, and in this study, approximately half of MM patients had arrhythmias. MM patients with SB were associated with lower all-cause mortality than those with AF. SB might be an independent positive factor for prognosis.

Review of interventional electrophysiology in Bulgaria in 2019 and 2020: data from the electronic ablation registry BG-EPHY

This study presents data from the national electronic registry BG-EPHY on electrophysiologic (EP) cardiac ablations in 2019 and 2020. Material and methods. This is a retrospective study of a full two-year sample of the BG-EPHY registry. Sex and age distribution of the patients, number of ablations, electroanatomic mapping (EAM), irrigated ablations, distribution of different types of arrhythmia, intraprocedural success and complications are presented. Results. In 2019 four EP laboratories performed 1033 ablations in 652 men (63.1%) and 381 women, incl. 12 pediatric ablations (1.2%). EAM was used in 46.7% of the procedures, irrigation catheter was used in 52.2%, and cryocatheter – in 0.5%. The most common procedure was pulmonary vein isolation, followed by ablation for AV nodal reentrant tachycardia and typical atrial flutter. In 2020 five EP laboratories performed 835 ablations in 508 men (60.8%) and 327 women, incl. 8 pediatric ablations (1%). EAM was used in 50.9% of the ablations, irrigation catheter – in 54.5%, and cryocatheter – in 3.8%. The most common procedure was again pulmonary vein isolation. Ablation of typical atrial flutter was the second most frequently performed procedure, ahead of AV nodal reentrant tachycardia. In 2020 the number of ablations of accessory pathways also distinctly dropped by 37%. In both years the acute success was over 98%, and the complications were less than 2%. Conclusion. The national registry of electrophysiology collects systematically and continuously basic data on all cardiac ablations performed in the country. The structure of the EP service is remarkably similar to other European countries. Acute success is very high, while intraprocedural complications are rare. In 2020 the number of the ablations dropped by 19% as a consequence of the COVID-19 pandemic.

Meta-analysis of cardiovascular outcome trials assessing the impact of glucagon-like peptide-1 receptor agonists on major cardiac arrhythmias

Abstract Background Type 2 diabetes mellitus poses a significant health burden, whereas growing attention has been focused on the novel classes of antidiabetic drugs. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) constitute such a group of antidiabetic agents. In recent large, placebo-controlled randomized clinical trials (RCTs), GLP-1RAs have demonstrated beneficial cardiovascular effects. Nevertheless, the clear antiarrhythmic benefit has not been underlined yet. Purpose The purpose of the present analysis was to clarify the impact of antidiabetic treatment with GLP-1RAs on the several different types of cardiac arrhythmias, based on data extracted from relevant cardiovascular outcome trials. Methods We searched PubMed plus grey literature for all available cardiovascular and renal outcome, placebo-controlled RCTs utilizing GLP-1RAs versus placebo. Results We pooled data from 7 cardiovascular outcome trials with GLP-1RAs in a total of 55,943 randomized participants patients. When compared to placebo, treatment with GLP-1RAs did not provide a significant benefit in the risk for atrial fibrillation (RR = 0.81, 95% CI: 0.78–1.15, I2=51%) (Figure 1a), atrial flutter (RR=0.79, 95% CI: 0.53–1.16, I2=0%) (Figure 1b), ventricular fibrillation (RR=0.99, 95% CI: 0.48–2.04, I2=0%) (Figure 1c), ventricular tachycardia (RR=1.41, 95% CI: 0.87–2.28, I2=10%) (Figure 1d), atrial tachycardia (RR=0.63, 95% CI: 0.10–3.90, I2=24%) (Figure 2a), sinus node dysfunction (RR=0.70, 95% CI: 0.40–1.23, I2=0%) (Figure 2b), ventricular extrasystoles (RR=1.37, 95% CI: 0.56–3.30, I2=0%) (Figure 2c), second-degree atrioventricular block (RR=0.96, 95% CI: 0.52–1.74, I2=0%) (Figure 2d) or complete atrioventricular block (RR=0.78, 95% CI: 0.39–1.54, I2=38%) (Figure 2e). Conclusions In patients with type 2 diabetes mellitus, treatment with GLP-1RAs does not significantly affect the risk for major cardiac arrhythmias. Funding Acknowledgement Type of funding sources: None. Figure 1Figure 2

LncRNA CDKN2B-AS1 associated to ventricular fibrillation during acute myocardial infarction

Abstract Introduction Sudden death (SD) due to ventricular fibrillation (VF) during acute myocardial infarction (AMI) is one of the leading causes of death in Western societies. However, the pathophysiology of the disease is not well defined. Recently, it has been proposed that non-coding RNA (ncRNA) may play a determinant role in the genesis of different diseases. In fact, alterations in the expression of long non-coding RNAs (lncRNAs) have been associated with different types of arrhythmias and, also, with acute coronary syndrome. However, little is known about the role of lncRNAs in VF in AMI. Purpose The aim of this preliminary study is to identify lncRNAs associated to VF in AMI. Methods This preliminary study included 24 patients with AMI, 12 with clinically proven VF and 12 without VF. Expression of 10 lncRNAs (CDKN2B-AS1, KCNQ1OT1, MT-LIPCAR, MALAT1, MIAT, NEAT1, SLC16A1-AS1, LNC-TK-2–4, TNFRSF14-AS1, UCA1) and 2 Housekeeping (ACTB and RPLP0) were analyzed using real-time PCR (qPCR). The Fold Change value with a logarithm transformation [log 2 (2–ΔΔCq)] was calculated. The D'Agostino &amp; Pearson and Shapiro-Wilk test and an unpaired t-test were performed in Graphpad-Prism and Qbase programs. Results The lncRNA “cyclin-dependent kinase inhibitor 2B antisense noncoding RNA” (CDKN2B-AS1), also named as ANRIL, showed a significantly lower expression in patients that with VF during AMI (2–ΔΔCq (IQ): Control = 1.099 [0.634–1.583] vs FV=0.507 [0.221–1.022], P=0.018). It is important to note that this lncRNA has been previously associated to myocardial infarction and other cardiovascular diseases as atherosclerosis and hypertension. Conclusions Our preliminary results suggest that lncRNA CDKN2B-AS1 could be related to the presence of VF during AMI. Most research must be done to clarify the role of lncRNA in the pathophysiology of VF during AMI. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): Sociedad Española de Cardiología

Burden of arrhythmias in patients with obstructive sleep apnea and its impact on mortality: a descriptive study from the National Inpatient Sample

Abstract Background Obstructive sleep apnea (OSA) accounts for significant mortality and morbidity worldwide. A limited but emerging literature has revealed increased risk of sudden cardiac death in patients with OSA. There is paucity of data on arrhythmia burden in patients with OSA, particularly in hospitalized patients. Purpose Therefore, we sought to study the prevalence of atrial and ventricular arrhythmias among hospitalized patients with OSA and examine its impact on sudden cardiac death and in-hospital mortality. Methods All patients over 18 years of age with OSA were extracted from the National Inpatient Sample (NIS) from 2009–10 using 9th revision of International Classification of Diseases (ICD-9) code 327.23. Demographic data, hospital characteristics, comorbid conditions, and arrhythmia burden including different types of arrhythmia were identified. Clinical outcomes were in-hospital mortality, length of stay and sudden cardiac death. Logistic regression analysis was performed to determine the impact of arrhythmia on in-hospital mortality in patients with OSA. Hospital level discharge weights provided by NIS were used to obtain national estimates of OSA hospitalizations. Results OSA was prevalent in 2.8% (n=1,114,297) of all hospitalizations among which 20.1% had any arrhythmia (n=223,974). Patients with arrhythmia were older, more likely to be males, and had higher prevalence of risk factors and comorbid conditions except for chronic liver disease, and smoking (p&amp;lt;0.0001 for all). Arrhythmia burden analysis revealed increase prevalence of both atrial and ventricular arrhythmia in patients with OSA compared to general population. In-hospital mortality (3.48% vs 1.27%; p&amp;lt;0.0001), length of hospital stay (6.4±0.1 vs 5±0.1; p&amp;lt;0.001) and sudden cardiac death (1.34% vs 0.4%; p&amp;lt;0.0001) were higher in OSA patients with arrhythmia compared to OSA patients without arrhythmia. Presence of arrhythmia in OSA patients was associated with increased in-hospital mortality in both unadjusted [OR 2.79 (2.62–2.98); p&amp;lt;0.001] and multivariable model adjusted for all risk factors and comorbid conditions [OR 1.83 (1.69–1.98); p&amp;lt;0.001]. Conclusion Arrhythmia burden was higher in patients with OSA compared to the general population. Presence of arrhythmia among OSA patients was independently associated with increased in-hospital mortality and longer hospital stays. Routine evaluation to assess arrhythmia burden in patients in OSA could be a potential target to decrease sudden cardiac death in this high risk population. Funding Acknowledgement Type of funding sources: None.

Real-world evaluation of follow up strategies after implantable cardiac-defibrillator therapies in patients with ventricular tachycardia (REFINE-VT)

Abstract Introduction Implantable cardiac-defibrillators (ICD) can prevent sudden cardiac death but the risk of recurrent ventricular arrhythmia (VA) and ICD therapies persists. Established strategies to minimize such risks include medication optimization, device reprogramming or ventricular tachycardia (VT) catheter ablation (CA). However, the timing and choice of these strategies at ICD follow-up may not be as consistent in the real-world as the regulated conditions of clinical trials. Furthermore, whether these decisions at follow-up are influenced by the type of arrhythmia, ICD therapy or patient characteristics remain unclear. Purpose We evaluated ICD follow-up strategies in patients with ischaemic (ICM) and non-ischaemic cardiomyopathy (NICM) to refine the outpatient management of these complex patients and ultimately improve overall patient outcome. Methods REFINE-VT is a retrospective study of 514 patients with ICD/CRT-D who attended ICD follow-up between June 2018 to September 2019 at the University Hospital Coventry &amp; Warwickshire (UHCW) tertiary cardiology department. All follow-ups were face-to-face. Patients were divided into 2 groups according to the absence or presence of sustained VA (e.g. &amp;gt;30 seconds of VT and/or appropriate ICD therapy), described as “negative event” and “positive event” groups respectively. The type of strategy employed in response to a positive event were categorized into 4 groups: (1) Medication change only (2) Device programming +/− medication (3) Referral for VT CA (4) No intervention Results 514 consecutive patients with ICD (52%) or CRT-D (48%) were analysed. Overall mean age was 67±14 years with 79% male patients. ICM was diagnosed in 329 (64%) patient and NICM in 185 (36%). 437 (85%) patients had no significant VA and/or ICD therapy referred to as the negative group. A total of 77 patients (15%) suffered VA and/or ICD therapies, of whom 22 patients (26%) experienced a second event. 31% (n=24) of this positive event group received no preventative strategy (Table 1). We observed an inconsistent approach to the choice of strategies across different types of arrhythmias and ICD therapies. E.g. the odds of intervening were significantly higher if ICD shock was detected compared to anti-tachycardia pacing (OR 8.4, 95% CI 1.7–39.6, p=0.007). Even in patients with two events, the rate of referral for VT ablation and escalation of antiarrhythmics were similarly as low as patients with a single event (Table 2). Conclusion This is the first contemporary study that has evaluated how strategies that reduce the risk of recurrent ICD events are executed in a real-world population. We have demonstrated that the decision to intervene and choices of strategy remain inconsistent and partially biased by the type of arrhythmia and ICD therapy at follow-up. This supports the need for an evidence-driven multi-disciplinary VT clinic to refine and standardize our approach to this heterogeneous population. Funding Acknowledgement Type of funding sources: None.

Assessment of Left Atrial Functions and Volume by Conventional Echocardiography in Patients with Atrial Arrhythmias

Background: Atrial tachyarrhythmia is a significant problem. The LA mechanical and pathological changes and its assessment usually share in treatment plan. Advanced tools are available. However, less advanced tools could have their role, especially in resource limited facilities.Aim of the work: The current work aimed to assess left atrial function and volume by trans-thoracic echocardiography among patients with atrial arrhythmias.Patients and Methods: One hundred patients with atrial tachyarrhythmia’s and 30 healthy individual [as a control group] were included in the current study. All patients had been evaluated by history taking and clinical examination. Then, all were subjected to resting electrocardiogram and standard resting transthoracic echocardiography [TTE].Results: The study and control groups revealed non-significant difference regarding patient age, gender, diabetes and thyroid disease. There was female sex predilection [69% in study and 63.0% in control group]. Hypertension and smoking were significantly increased among study than control group [40.0%, 20.0% vs 10.0% and 3.3% respectively]. Arrhythmias were in the form of fibrillation [80.0%], tachycardia [14%] and flutter [6.0%]. There was significant difference between study and control groups regarding clinical data, echocardiography, Doppler indices and LA volume. However, LVEF%, LA diameter and pulmonary S wave velocity did not significantly differ between groups. The different types of arrhythmia revealed significant increase of pEF, LA diameter and tissue Doppler among flutter than AF and AT. Otherwise, there was no significant differences regard other clinical data, echocardiography and Doppler indices.Conclusion: AF has effect on structural and functional remodeling of the LA function, and AF had more harmful effect than tachycardia and flutter and it may add significant value for development of HF. The conventional echocardiography could be considered a reliable assessment tool for atrial function in patients with atrial arrhythmias.

Performance evaluation of deep learning models in detection of different types of arrhythmia using photo plethysmography signals

Performance evaluation of deep learning models in detection of different types of arrhythmia using photo plethysmography signals

Artificial Intelligence-Enabled ECG Algorithm Based on Improved Residual Network for Wearable ECG

Heart disease is the leading cause of death for men and women globally. The residual network (ResNet) evolution of electrocardiogram (ECG) technology has contributed to our understanding of cardiac physiology. We propose an artificial intelligence-enabled ECG algorithm based on an improved ResNet for a wearable ECG. The system hardware consists of a wearable ECG with conductive fabric electrodes, a wireless ECG acquisition module, a mobile terminal App, and a cloud diagnostic platform. The algorithm adopted in this study is based on an improved ResNet for the rapid classification of different types of arrhythmia. First, we visualize ECG data and convert one-dimensional ECG signals into two-dimensional images using Gramian angular fields. Then, we improve the ResNet-50 network model, add multistage shortcut branches to the network, and optimize the residual block. The ReLu activation function is replaced by a scaled exponential linear units (SELUs) activation function to improve the expression ability of the model. Finally, the images are input into the improved ResNet network for classification. The average recognition rate of this classification algorithm against seven types of arrhythmia signals (atrial fibrillation, atrial premature beat, ventricular premature beat, normal beat, ventricular tachycardia, atrial tachycardia, and sinus bradycardia) is 98.3%.

Impact of Arrhythmia on Myocardial Perfusion: A Computational Model-Based Study

(1) Background: Arrhythmia, which is an umbrella term for various types of abnormal rhythms of heartbeat, has a high prevalence in both the general population and patients with coronary artery disease. So far, it remains unclear how different types of arrhythmia would affect myocardial perfusion and the risk/severity of myocardial ischemia. (2) Methods: A computational model of the coronary circulation coupled to the global cardiovascular system was employed to quantify the impacts of arrhythmia and its combination with coronary artery disease on myocardial perfusion. Furthermore, a myocardial supply–demand balance index (MSDBx) was proposed to quantitatively evaluate the severity of myocardial ischemia under various arrhythmic conditions. (3) Results: Tachycardia and severe irregularity of heart rates (HRs) depressed myocardial perfusion and increased the risk of subendocardial ischemia (evaluated by MSDBx), whereas lowering HR improved myocardial perfusion. The presence of a moderate to severe coronary artery stenosis considerably augmented the sensitivity of MSDBx to arrhythmia. Further data analyses revealed that arrhythmia induced myocardial ischemia mainly via reducing the amount of coronary artery blood flow in each individual cardiac cycle rather than increasing the metabolic demand of the myocardium (measured by the left ventricular pressure-volume area). (4) Conclusions: Both tachycardia and irregular heartbeat tend to increase the risk of myocardial ischemia, especially in the subendocardium, and the effects can be further enhanced by concomitant existence of coronary artery disease. In contrast, properly lowering HR using drugs like β-blockers may improve myocardial perfusion, thereby preventing or relieving myocardial ischemia in patients with coronary artery disease.

Incidence prevalence and management of different types of arrhythmia in patients with ischemic heart disease in Taif city

Background: Despite considerable progress in management over the recent years, coronary artery disease (CAD) remains the leading cause of death. Objectives: to assess the different types of arrhythmias in patients with ischemic heart diseases in Taif city. Methods: A retrospective study was done on 529 patients from Taif, Saudi Arabia aged 30 to &gt;75 years, of both genders and who had CAD, through the review of medical records of cardiac patients in AL Hada armed forces hospital. A checklist was used that included demographic features and risk factors for ischemic heart disease, symptoms of heart failure, medications that patients who had CAD used and types of arrhythmias. Results: All patients had a type of arrhythmia during their hospital stay. The main types of arrhythmias were AF (26.8 %), conduction disturbance (38.2%) and first-degree heart block (9.1 %). Patients who had STEMI with symptoms of heart failure and arrhythmias had a significantly higher percentage for the need of DC shock compared to other patients. Patients with UA who developed low EF were shown to be significant as regards arrhythmias rather than normal EF. The number of affected vessels had no effect on the development of arrhythmias during the acute stage. The development of arrhythmia that required DC shock was more common in STEMI patients especially those who developed heart failure symptoms. Conclusion: The need of assessment of heart failure symptoms and EF in patients with UA is essential to determine the need for implantable device insertion. Also, early administration of b-blocker decreases the risk of development of arrhythmia during an acute ischemic event. Key words: arrhythmias, patients, ischemic, heart, disease, Taif

A Brazilian Portuguese translation, cultural adaptation and validation of the Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia (ASTA) health-related quality of life (HRQOL) scale.

IntroductionThe health-related quality of life (HRQOL) of patients with tachyarrhythmia can be negatively influenced by the clinical manifestations. The evaluation of HRQOL with validated instruments can provide valuable information that will contribute to clinical decision-making and treatment. In Brazil, however, there is no available scale that evaluates HRQOL in different types of arrhythmia. The purpose of this study was to adapt the Arrhythmia-Specific Questionnaire in Tachycardia and Arrhythmia-HRQOL scale (ASTA-HRQOL scale) to the Brazilian culture, and to assess the psychometric properties of the adapted questionnaire.MethodsThe study used a methodological process of cultural adaptation based on international literature guidelines. The analyses were performed with 172 participants, 32 for cultural adaptation and 140 for psychometric validation. Calculation included analysis of reliability by Cronbach’s α coefficient, construct validity with convergent validity using the WHOQOL-BREF questionnaire and by the Spearman correlation coefficient, Average Variance Extracted, and assessment of confirmatory factor analysis.ResultsThe translation and adaptation processes showed a satisfactory degree of comprehension and applicability (93% reported them to be easy to understand). Confirmatory factor analysis indicated exclusion of one item from the mental scale, but after qualitative analysis the item was retained. The items presented adequate internal consistency (Cronbach’s alpha coefficient = 0.88), and an inverse correlation of moderate magnitude with the physical domain (rho = -0.63) and with the mental domain (rho = -0.58) of the WHOQOL-BREF.ConclusionsThe Brazilian Portuguese version of the ASTA-HRQOL scale, the ASTA-Br-HRQOL scale, can be a valuable tool for use in clinical practice and research.