Irregular Heart Rhythm Research Articles

Acquiring Wearable Photoplethysmography Data in Daily Life: The PPG Diary Pilot Study †.

The photoplethysmogram (PPG) signal is widely measured by smart watches and fitness bands for heart rate monitoring. New applications of the PPG are also emerging, such as to detect irregular heart rhythms, track infectious diseases, and monitor blood pressure. Consequently, datasets of PPG signals acquired in daily life are valuable for algorithm development. The aim of this pilot study was to assess the feasibility of acquiring PPG data in daily life. A single subject was asked to wear a wrist-worn PPG sensor six days a week for four weeks, and to keep a diary of daily activities. The sensor was worn for 75.0% of the time, signals were acquired for 60.6% of the time, and signal quality was high for 30.5% of the time. This small pilot study demonstrated the feasibility of acquiring PPG data during daily living. Key lessons were learnt for future studies: (i) devices which are waterproof and require charging less frequently may provide signals for a greater proportion of the time; (ii) data should either be stored on the device or streamed via a reliable connection to a second device for storage; (iii) it may be beneficial to acquire signals during the night or during periods of low activity to achieve high signal quality; and (iv) there are several promising areas for PPG algorithm development including the design of pulse wave analysis techniques to track changes in cardiovascular properties in daily life.

An Assessment of Azithromycin Prescribed Interactions’ at the Outpatient Setting

Aims: The present study was designed to identify and assess the severity of azithromycin interactions with other drugs in the outpatient setting in Alkharj.
 Methodology: A retrospective analysis was performed of azithromycin prescriptions in the outpatient setting in a public hospital in Alkharj in order to determine the incidence of interactions between azithromycin and other medications.
 Results: There were 182 prescriptions included in the study. There was a major interaction in only 1 prescription (0.55%) and moderate interactions in 15.30% of the prescriptions. So the percentage of overall interactions was about 20.88%. The most common drug interactions in the present study were between azithromycin and salbutamol.
 Conclusion: It can be concluded that the interactions between azithromycin with other medications were common, but these interactions could lead to irregular heart rhythm and lead to muscle pain and weakness. Adoption of international standard and locally conformable guidelines of antibiotic use can help in avoiding such problems.

Mechanical Dispersion as a powerful echocardiographic predictor of outcomes after Myocardial Infarction

Abstract Introduction Several studies have addressed the importance of transthoracic echocardiography (TTE) in risk prediction of subsequent adverse events after ST elevation myocardial infarction (STEMI). While several traditional echo parameters have a well-established prognostic value, data derived from 2D-Speckle Tracking Echocardiography (2DSTE) needs further investigation. Objectives To determine if 2DSTE parameters provide additional information beyond conventional echocardiography to predict long-term adverse outcomes in patients admitted with STEMI Methods Retrospective, single-center study, that included all patients without previous cardiovascular events admitted with STEMI (who underwent primary coronary angioplasty) between 2015 and 2017. Patients with poor acoustic windows, severe valvular disease, irregular heart rhythm, and those who died during hospital stay were excluded. We reviewed all pre-discharge TTE to assess conventional parameters of LV systolic and diastolic function and data obtained by 2DSTE: global longitudinal strain (GLS) and peak strain dispersion (PSD), an index that is the standard deviation from time to peak strain of all segments over the entire cardiac cycle. Demographic and clinical data was obtained through electronic hospital records. Minimum follow-up was 2 years. The primary endpoint was a composite of all-cause mortality and cardiovascular re-admission at follow-up. Survival analysis was used to determine independent predictors of the primary endpoint. Results 377 patients were included, mean age 62±13 years, 72% male. Mean LVEF was 50±10% with 19% of patients having LVEF <40%. Mean indexed left atrium volume (LAVi) was 33±10 ml/m2, mean GLS was −14±4%, and PSD was 60±22 msec. Average follow-up was 36±11 months, with a combined endpoint of mortality and hospitalization of 27% (n=102) Univariate analysis of echocardiographic variables revealed an association between heart rate, LVEF, indexed LV end-systolic volume, indexed stroke volume, LAVi, GLS and PSD with the endpoint. However, on multivariate analysis only LAVi [HR 1.030 (95% CI 1.009 - 1.051), p-value = 0.005] and PSD [HR 1.011 (95% CI 1.002 - 1.020), p-value = 0.012] remained independent predictors of the primary endpoint. We determined that a PSD value higher than 52 msec has a sensitivity of 76% and a negative predictive value of 83% for mortality and hospitalization, and that this cut-off point discriminates patients at a higher risk of events in Kaplan-Meier Survival analysis with a Log-Rank p-value=0.001. Conclusion PSD derived by longitudinal strain analysis is a promising prognostic predictor after STEMI. PSD outperformed conventional echocardiographic parameters in the risk stratification of STEMI patients at discharge. Kaplan-Meier Survival Curves Funding Acknowledgement Type of funding source: None

Prognostic implications of supraventricular ectopy

Abstract Background According to consensus atrial fibrillation (AF) is an irregular heart rhythm with absence of p-waves, lasting for at least 30 seconds. However, AF is most likely a continuous disease ranging from occasional bursts of AF-like activity to permanent AF, rather than a dichotomous condition. Regardless, the 30-second AF definition leaves cardiologists without clear guidelines on how to manage patients with shorter episodes of seemingly atrial fibrillation-like activity and/or an abundance of supraventricular ectopic beats. Purpose The aim of this study was to establish the prevalence and prognostic implication of frequent supraventricular ectopic beats, isolated, in bi- or trigeminy, and supraventricular tachycardias with different characteristics. Methods In the STROKESTOP I mass-screening study for AF in 75- and 76-year olds in Sweden, 7173 participants did 30-second intermittent ECG twice daily for two weeks. ECG-recordings from STROKESTOP I were re-evaluated using an automated algorithm to detect individuals with frequent supraventricular ectopic beats or runs. Detected episodes were manually re-examined to confirm the findings. The primary endpoint was atrial fibrillation as ascertained from the nationwide Swedish Patient register. Secondary endpoints were stroke and death. Median follow-up was 4.2 (3.8–4.4) years. Results Of the 6100 examined participants 85% were free of significant supraventricular arrhythmia. Frequent supraventricular ectopic beats were the most common arrhythmia, n=709 (11.6%), and irregular SVTs were more common than regular SVTs. During follow-up 387 participants developed AF, 161 had a stroke event and there were 354 deaths. Individuals with the most AF-like SVT, irregular and lacking p-waves, n=97 (1.6%), had the highest risk of developing AF (hazard ratio 4.3 (95% confidence interval 2.7–6.8), Figure 1. They also had an increased risk of death, 2.0 (1.1–3.8). We found no significant increase in stroke risk. Conclusion Progression of atrial arrhythmias from supraventricular ectopic beats to more organized arrhythmic episodes are associated with development of AF. Extended screening for AF should be considered in individuals with frequent supraventricular activity, especially in those with supraventricular tachycardias with AF characteristics. Figure 1. Kaplan-Meier curve showing primary end-point event rate (atrial fibrillation) in participants with different arrhythmias. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): This study was supported by Stiftelsen Hjärtat, Boehringer Ingelheim, The Swedish Heart and Lung Association, Capio Forskningsstiftelse and Åke Wibergs Stiftelse. STROKESTOP I was founded by Stockholm County Council, the Swedish Heart & Lung Foundation, King Gustav V and Queen Victoria's Freemasons' Foundation, the Klebergska Foundation, the Tornspiran Foundation, the Scientific Council of Halland Region, the Southern Regional Healthcare Committee, the Swedish Stroke Fund, Boehringer-Ingelheim, Bayer and Pfizer. Emma Svennberg is supported by the Stockholm County Council (Clinical postdoctorial appointment) and has received research funding from the Swedish Society of Medicine.

Monitoring great ape heart health through innovative electrocardiogram technology: Training methodologies and welfare implications.

Assessing and treating cardiovascular disease (or heart disease) is a growing concern for institutions housing great apes, as it is a major cause of mortality in all four taxa managed in human care. As part of a proactive monitoring plan, zoological managers and veterinarians often elect to perform electrocardiograms (ECGs) on their great ape populations. ECGs noninvasively evaluate cardiac electrical activity, and are thereby capable of providing information regarding heart function. This electrical signature is transcribed as a visual display of waveforms, referred to as telemetry strips, and can detect irregularities in heart rhythm, also known as arrhythmia. While traditional 6- or 12-lead ECGs are recommended periodically as part of a thorough heart performance evaluation, here we discuss the KardiaMobile (KM) device as an additional primate welfare tool. KM is a small, Food and Drug Administration-cleared, clinical-grade mobile ECG monitor that requires only 30 s of pressure to flag heart rate or arrhythmic abnormalities. We detail the training process and applicability to great apes in human care.

Infective endocarditis due to Erysipelothrix rhusiopathiae in a dog \u2013 a case report

BackgroundInfective endocarditis is a rare but severe condition associated with a high mortality rate in small animal patients. This condition is caused by a microbial (most often bacterial) infection of the valvular portion of the endocardium, from which proliferative and/or erosive lesions on the cardiac valves or immediately adjacent structures develop. The two most commonly affected cardiac valves are the aortic and mitral valves.Case presentationWe report the clinical case of a 4-year old male neutered Bull terrier, 27.6 kg, body condition score 4/9, that presented with a 3-months history of pyrexia and general weakness. The patient history also revealed a transient left hind limb lameness (grade 2/4), which coincided with the onset of clinical signs about 3 months before presentation. On physical examination, a left-sided systolic heart murmur (grade 3/6) with the same intensity at the left heart base and apex, and an irregularly irregular heart rhythm were noted. Electrocardiography showed ventricular premature complexes, and echocardiography revealed lesions consistent with endocarditis involving the aortic and mitral valve. Bacterial culture of blood yielded a positive result, and the organism isolated was identified as Erysipelothrix rhusiopathiae. The extended patient history revealed that the dog lived close to a farm housing pigs and other livestock.ConclusionWe report a rare case of the premortal diagnosis of infective bacterial endocarditis in a dog due to E. rhusiopathiae infection. Most reports about this condition are from necropsy series. This clinical case report emphasizes that E. rhusiopathiae infection and bacteremia should be considered as a differential diagnosis in dogs with suspected infective endocarditis, especially in dogs living in rural areas with access to livestock and particularly farm pigs. Also, particular emphasis should be placed on the zoonotic potential of this infectious disease.

Exploring mechanisms of action in clinical trials of complex surgical interventions using mediation analysis.

Background:Surgical interventions allow for tailoring of treatment to individual patients and implementation may vary with surgeon and healthcare provider. In addition, in clinical trials assessing two competing surgical interventions, the treatments may be accompanied by co-interventions.Aims:This study explores the use of causal mediation analysis to (1) delineate the treatment effect that results directly from the surgical intervention under study and the indirect effect acting through a co-intervention and (2) to evaluate the benefit of the surgical intervention if either everybody in the trial population received the co-intervention or nobody received it.Methods:Within a counterfactual framework, relevant direct and indirect effects of a surgical intervention are estimated and adjusted for confounding via parametric regression models, for the situation where both mediator and outcome are binary, with baseline stratification factors included as fixed effects and surgeons as random intercepts. The causal difference in probability of a successful outcome (estimand of interest) is calculated using Monte Carlo simulation with bootstrapping for confidence intervals. Packages for estimation within standard statistical software are reviewed briefly. A step by step application of methods is illustrated using the Amaze randomised trial of ablation as an adjunct to cardiac surgery in patients with irregular heart rhythm, with a co-intervention (removal of the left atrial appendage) administered to a subset of participants at the surgeon’s discretion. The primary outcome was return to normal heart rhythm at one year post surgery.Results:In Amaze, 17% (95% confidence interval: 6%, 28%) more patients in the active arm had a successful outcome, but there was a large difference between active and control arms in the proportion of patients who received the co-intervention (55% and 30%, respectively). Causal mediation analysis suggested that around 1% of the treatment effect was attributable to the co-intervention (16% natural direct effect). The controlled direct effect ranged from 18% (6%, 30%) if the co-intervention were mandated, to 14% (2%, 25%) if it were prohibited. Including age as a moderator of the mediation effects showed that the natural direct effect of ablation appeared to decrease with age.Conclusions:Causal mediation analysis is a useful quantitative tool to explore mediating effects of co-interventions in surgical trials. In Amaze, investigators could be reassured that the effect of the active treatment, not explainable by differential use of the co-intervention, was significant across analyses.

Benign arrhythmias in pediatric patients

An irregular heart rhythm is a common concern among children. Recognizing the cause of the irregular rhythm is crucial for the proper diagnosis and management by primary physicians as well as pediatric specialists. The cause of pediatric arrhythmias can be identified based on the clinical history, physical examination, presenting symptoms, and electrocardiogram. Pediatric arrhythmias are classified as benign and non-benign. Both benign and non-benign arrhythmias can originate from the sinoatrial node, atrial myocardium, atrioventricular node, and ventricle myocardium. The common form of benign arrhythmias, including sinus arrhythmia, premature atrial contraction, premature ventricular contraction, and Wenckebach atrioventricular block, have no clinical significance or need for therapy. On the other hand, non-benign arrhythmias, such as supraventricular tachycardia, ventricular tachycardia, high-degree atrioventricular conduction abnormalities, and genetic arrhythmia, can affect the hemodynamic state and may cause a serious condition in pediatric patients. Most cases of benign arrhythmia are asymptomatic, and the prognosis is favorable for the normal heart. In this article, we review our current understanding of the electrocardiographic characteristics, clinical presentation, etiology, and natural history of benign arrhythmias in pediatric patients.

Bulimia Nervosa: A Psychological Eating Disorder

Eating disorders are multifaceted mental health problems which require medical treatments and counseling from a psychological expert.In extreme condition,these eating disorders can cause serious health problems and may be lethal if these are not diagnosed and treated timely.Eating Disorder Hope organization has conducted a survey which revealed thatalmost 40% of teen age girls were suffering from at least one kind of eating disorder while91% of young females do dieting to reduce their weight. It has been estimated that about one million males and ten million females suffer from various types of eating disorders. 
 Bulimia nervosa is one of the eating disorders. It oftens develops in teenage or early adulthood.It is common in women than men. In bulimia nervosa, a person usually eats a lot in a short period of time. It seems that the personcannot control himself fromeating food. It happens until they are painfully full and then they will purge to end their discomfort and to compensate their calories. They will purge by forced vomitinglaxatives,diuretics or excessive exercise.Frequent self-induced vomiting can contribute to inflammation of parotidgland and can result in hand calluses. It is more common in families appearing in generations.There are many risk factors for this disease like being overweight/obesity, socio-cultural pressures to have a well tonned body, psychological impacts resulting in stress and poor self-esteem. Dieting has become a part of our culture. There are manysymptoms of bulimia. For example, patients live in a fear of gaining weight, they go through the repeated episodes of abnormal eating large amounts of food in single sitting. There is a feeling which develops in patients that they cannot control what they eat and what type of food they eat, and after bingering they are forcing themselves to vomit and do more exercise to stop weight gain.
 If we leave bulimia untreated it will cause kidney problems, irregular heart rhythms, digestive issues and dental problems etc. In time treatment and diagnosis of bulimia helps the person to recover well and quick and the person can get rid of this disorder completely otherwise it can be life threatening. A person experiences bulimia to manage the emotional pain he is undergoing but it only worsens the condition and the response may be to ramp up obsessive thoughts and compulsive behaviors. Nearly half of bulimia patients have a co-occuring mood disorder and more than half of bulimia patients have co-occuring anxiety disorders. Self-harm is a common condition affecting 34% of those with bulimia. Recent studies on bulimia show that in 10-15% of male members of our society who are living with this disorder, risk of suicide has increased. Statistics show that relapse of this disorder isvery common.Relapse is occurring in about30-50% of the cases, and it isleading to common cause of death in suicide.For treatment of bulimia nervosa, you may need to go for several types. Bulimia can be reduced by taking anti-depressants or psychotherapy, but using both in combination is more fruitful to overcome this disorder. Psychotherapy is very important for patients, in which the person goes to the psychiatrist to discuss the issues related to bulimia. Educating the patient on nutrition also helps in this regard. Anutritionist can prescribe the food by which a person will feel the cravings for food to a lesser extent. In severe conditions,the patient can be admitted to a hospital because sometimes there is a need fortreatment in a hospital. In many cases it is not possible to eradicate it completely.But before the situation goes wrong, we can guide a person to lead a healthier life with the help of professionally used treatments. Since we are living in an era where everyone is busy, it is important to guide and educate the children about a healthy lifestyle. There is a need to give them confidence about their physical appearance, no matter what their weight, size and shape is. Enjoyable family meals should be arranged on daily basis or regularly. Talks on physical appearances, body weight and dieting should be discouraged at home. Exercise, walk, activities like sports and swimming can help young generation to adopt a healthy lifestyle and streamline their daily life. If you observe that someone in your friends or relatives is having issues related to food which is indicating thathe or she can possibly has an eating disorder, you should talk to the person supportively and discuss the issue and help them in any way you can before the situation gets worse.

EDMD-Causing Emerin Mutant Myogenic Progenitors Exhibit Impaired Differentiation Using Similar Mechanisms.

Mutations in the gene encoding emerin (EMD) cause Emery–Dreifuss muscular dystrophy (EDMD1), an inherited disorder characterized by progressive skeletal muscle wasting, irregular heart rhythms and contractures of major tendons. The skeletal muscle defects seen in EDMD are caused by failure of muscle stem cells to differentiate and regenerate the damaged muscle. However, the underlying mechanisms remain poorly understood. Most EDMD1 patients harbor nonsense mutations and have no detectable emerin protein. There are three EDMD-causing emerin mutants (S54F, Q133H, and Δ95–99) that localize correctly to the nuclear envelope and are expressed at wildtype levels. We hypothesized these emerin mutants would share in the disruption of key molecular pathways involved in myogenic differentiation. We generated myogenic progenitors expressing wildtype emerin and each EDMD1-causing emerin mutation (S54F, Q133H, Δ95–99) in an emerin-null (EMD−/y) background. S54F, Q133H, and Δ95–99 failed to rescue EMD−/y myogenic differentiation, while wildtype emerin efficiently rescued differentiation. RNA sequencing was done to identify pathways and networks important for emerin regulation of myogenic differentiation. This analysis significantly reduced the number of pathways implicated in EDMD1 muscle pathogenesis.

ECG signal classification with binarized convolutional neural network

Arrhythmias are a group of common conditions associated with irregular heart rhythms. Some of these conditions, for instance, atrial fibrillation (AF), might develop into serious syndromes if not treated in time. Therefore, for high-risk patients, early detection of arrhythmias is crucial. In this study, we propose employing deep convolutional neural network (CNN)-based algorithms for real-time arrhythmia detection. We first build a full-precision deep convolutional network model. With our proposed construction, we are able to achieve state-of-the-art level performance on the PhysioNet/CinC AF Classification Challenge 2017 dataset with our full-precision model. It is desirable to employ models with low computing resource requirements. It has been shown that a binarized model requires much less computing power and memory space than a full-precision model. We proceed to verify the feasibility of binarization in our neural network model. Network binarization can cause significant model performance degradation. Therefore, we propose employing a full-precision model as the teacher to regularize the training of the binarized model through knowledge distillation. With our proposed approach, we observe that network binarization only causes a small performance loss (the F1 score decreases from 0.88 to 0.87 for the validation set). Given that binarized convolutional networks can achieve favorable model performance while dramatically reducing computing cost, they are ideal for deployment on long-term cardiac condition monitoring devices. (Source code is available at https://github.com/yangfansun/bnn-ecg).

Point-of-Care, Cable Type Electrochemical Sensor with Ultrahigh Sensitivity for Detection of Metabolites in Human Perspiration

Point-of-Care, Cable Type Electrochemical Sensor with Ultrahigh Sensitivity for Detection of Metabolites in Human Perspiration

Therapeutic efficacy of catalpol against apoptosis in cardiomyocytes derived from human induced pluripotent stem cells

Cardiac arrhythmia is an irregular heart rhythm that can lead to serious heart conditions and various organ disorders, and may cause sudden cardiac death. Catalpol belongs to the iridoid glycoside family and is highly abundant in Rehmannia glutinosa Libosch. The study included five groups such as group I (normal control), group II (treatment control), group III (low-dose treatment), group IV (medium-dose treatment) and group V (high-dose treatment). We investigated the therapeutic effects of catalpol on cardiac arrhythmia in human-induced pluripotent stem cells (iPSCs). Cell viability, lactate dehydrogenase (LDH) levels, lipid peroxidation, antioxidant activity, and caspase-3 and caspase-9 activities and protein levels were measured in normal control, treatment control, and treated (1, 10, and 100 µM) iPSC groups. Compared with the treatment control group, catalpol supplementation (1, 10, and 100 µM) increased iPSC cell viability by 7.5, 27.3, and 65.8%, respectively; reduced the LDH levels by 10.4, 31.3, and 75.2%, respectively; and reduced the lipid peroxidation levels by 7.7, 33.0, and 62.6%, respectively. The antioxidant levels were significantly higher in the treatment control group than in the normal control group. Catalpol (100 µM) reduced the caspase-3 and caspase-9 activities by more than 30% and increased expression of the corresponding proteins by more than 50%. These findings suggest that the naturally occurring iridoid glycoside catalpol is effective against aconitine-induced cardiac arrhythmia in iPSCs.

Polymorphic tachycardia in an anaesthetised horse with an undiagnosed pheochromocytoma undergoing emergency coeliotomy

A 17-year-old, 550-kg, neutered male Oldenburger horse was referred for an exploratory coeliotomy after acute collapse, profuse sweating and abdominal pain refractory to conventional analgesics. Clinical evaluation was only possible...

Approach to Paroxysmal Atrial Fibrillation Type Arrhythmia in a Cardiology Service: A Case Report

Atrial fibrillation is a cardiac arrhythmia of high prevalence in the population, especially in the elderly. Its main electrical characteristics are the interval between two successive irregular R waves, absence of P waves and presence of f waves between QRS complexes. The most common symptoms of atrial fibrillation are irregular palpitations associated with dyspnea, dizziness, feeling tired, fatigue and general malaise, but not all patients have any symptoms. The present report presents the history of an elderly patient who arrived at the hospital’s emergency department with irregular heart rhythm and palpitations. The patient’s symptoms, associated with the electrocardiogram results, indicated paroxysmal atrial fibrillation. Electrical cardioversion was performed, and after, cardiac ablation via the femoral vein at the hospital’s cardiology service. There were no complications during the procedure. As a routine imaging exam after ablation, control esophagogastroduodenoscopy was requested to verify that there was no formation of atrio-esophageal fistula developed by the invasive ablation procedure and electrocardiogram, which showed normal sinus rhythm. The patient remained in the cardiac intensive care unit for observation for 24 hours. After the electrical cardioversion and catheter ablation procedures, the patient improved his clinical picture of atrial fibrillation and was discharged after 24 hours of hospitalization. He received treatment to perform at home, to reduce acid reflux into the esophagus and to prevent thrombosis. He did not present pulmonary thromboembolism after hospital discharge. It is believed, therefore, that this form of treatment and management of paroxysmal atrial fibrillation is effective for the solution of the proposed problem and can also serve as a reference for other professionals within the cardiology service.

Formulation, Characterization and Ex vivo Evaluation of Epinephrine Transdermal Patches

Cardiac arrest is the abrupt loss of heart function in a person who may or may not have been diagnosed with heart disease. Cardiac arrest may be caused by irregular heart rhythms, called arrhythmias. A common arrhythmia associated with cardiac arrest is ventricular fibrillation. Ventricular fibrillation means that the heart's lower chambers suddenly start beating chaotically and don't pump blood. Cardiac arrest is the sudden cessation of cardiac mechanical activity because of dysrhythmia or electromechanical dissociation. Unless reversed within minutes, cardiac arrest results in lethal brain and other end-organ damage. Epinephrine is the primary drug administered during cardiopulmonary resuscitation (CPR) to reverse cardiac arrest. Epinephrine increases arterial blood pressure and coronary perfusion during CPR via alpha-1-adrenoceptor agonist effects. The main objective of this study was to prepare the optimized formulation of Trandermal patches of epinephrine for the treatment of cardiac arrest. Transdermal drug delivery (TDD) is a non-invasive route of drug administration, although its applications are limited by low skin permeability. It is an attractive alternative technique over the conventional techniques for administration of systemic approaches. For both local and systemic effects skin is the major site of application. However, to penetrate the drug through skin, stratum corneum is the main barrier. This study is further aimed to analyse, concentration of drug reaching in the body and to study its effect.

Management of Atrial Fibrillation in Europe: Current Care Pathways and the Clinical Impact of Antiarrhythmic Drugs and Catheter Ablation

Atrial fibrillation (AF), the most common form of arrhythmia, increases the risk of heart failure, stroke, and death. Management of AF focusses on effectively and safely controlling irregular heart rhythm, improving symptoms, and reducing complications. Early treatment of AF is important as it may improve patient life expectancy and quality of life (QoL). Current European guidelines recommend an integrated approach to AF management that involves shared decision making between patients and multidisciplinary teams of healthcare professionals to improve access to care and patient compliance. Treatment options include the use of anticoagulants, cardioversion, rate control therapies, and rhythm control therapies. Over the long term, rhythm control strategies that include antiarrhythmic drugs (AAD) and catheter ablation are the most common methods for controlling AF. The objective of this review is to highlight current European AF care pathway management recommendations and to examine the clinical, economic, and patient impact of different treatment options, including AAD and catheter ablation. While AAD have been shown to improve QoL and are affordable in the short term, treatment is moderately effective, associated with significant side effects, and can be costly long term. Catheter ablation is a highly effective therapy choice that improves patient wellbeing and is associated with a low rate of ablation-related complications. Compared to drug therapy, catheter ablation provides a significant reduction in AF burden, reduces rates of recurrence, provides a greater improvement in QoL, and facilitates long-term cost savings.

Exertional rhabdomyolysis and causes of elevation of creatine kinase

ABSTRACT Background Rhabdomyolysis is a potentially fatal condition that can be triggered by a variety of inciting events, including excessive muscular exertion. The purpose of this study was to investigate the causes of creatine kinase elevation (CK≥1000U/L) to determine what percentage result from exRML, the etiology, and kinetics of CK levels, as well as the complications of exRML and comorbidities that may predispose an individual to this condition. Methods We performed a cross-sectional analysis of the emergency department database for patients with CK≥1000U/L between 2012 and 2017. In total, there were 1957 cases of rhabdomyolysis diagnosed based on laboratory data and documentation. Trauma was the most common cause for rhabdomyolysis (n = 726/1957; 37.1%, respectively). Results ExRML was identified in 2.1% (n = 42/1957) of the total cases. Patients with ExRML were significantly younger (30.1 ± 10.6 years) with a significantly higher maximal level of CK compared to the non-exertional causes of rhabdomyolysis, (CK = 16,884.4 ± 41,645.6U/L; both p < 0.005). The far majority of cases were sport or exercise related (n = 35/42; 83.3%), with strength training at the gym making up the largest group of athletes (n = 16/42; 38.1%). The main complication amongst the ExRML group was acute kidney insufficiency, which was observed in 42.9% of patients. The CK levels of the patients in the ExRML cohort steadily decreased after initiation of aggressive hydration. Conclusion ExRML may be more prevalent than the current literature predicts, which is important to recognize as it has the potential to cause kidney failure, irregular heart rhythm, and death. Therefore, physicians and active individuals should be sensitized to the signs and symptoms that may lead to earlier recognition and proper treatment in exercising individuals.

ECG Signal Based Arrhythmia Detection System using Optimized Hybrid Classifier

An essential diagnostic tool in identifying heart rhythm irregularities, known as arrhythmias, is the ECG (Electrocardiogram). Accurate identification of arrhythmias in clinical environments is critical to patient well-being, as both acute and chroni

The Integrative Regulatory Network of circRNA, microRNA, and mRNA in Atrial Fibrillation.

Atrial fibrillation (AF) is the most common irregular heart rhythm which influence approximately 1–2% of the general population. As a potential factor for ischemic stroke, AF could also cause heart failure. The mechanisms behind AF pathogenesis is complex and remains elusive. As a new category of non-coding RNAs (ncRNAs), circular RNAs (circRNAs) have been known as the key of developmental processes, regulation of cell function, pathogenesis of heart diseases and pathological responses which could provide novel sight into the pathogenesis of AF. circRNAs function as modulators of microRNAs in cardiac disease. To investigate the regulatory mechanism of circRNA in AF, especially the complex interactions among circRNA, microRNA and mRNA, we collected the heart tissues from three AF patients and three healthy controls and profiled their circRNA expressions with circRNA Microarray. The differentially expressed circRNAs were identified and the biological functions of their interaction microRNAs and mRNAs were analyzed. Our results provided novel insights of the circRNA roles in AF and proposed highly possible interaction mechanisms among circRNAs, microRNAs, and mRNAs.