ECG de agosto de 2018 Andrés Lahuerta, Ana; Osca Asensi, Joaquín; Donoso Trenado, Víctor José
Revista española de cardiologia,
August 2018, Letnik:
71, Številka:
8
Journal Article
Pacemaker manufacturers have developed new algorithms to preserve intrinsic conduction in order to reduce unnecessary stimulation and looking for physiological pacing. This case report highlights ...some of the new challenges related to these algorithms which include possible ECG misinterpretations and inaccurate programming leading to potential negative consequences.
La detección precoz de la fibrilación auricular (FA) es prioritaria para reducir su riesgo embólico mediante la instauración del tratamiento anticoagulante. El objetivo de este estudio es evaluar la ...capacidad diagnóstica de un dispositivo de muñeca diseñado para la monitorización del ritmo cardiaco y la detección automática de la FA.
El RITHMI es un estudio prospectivo, comparativo y observacional, realizado en 167 pacientes remitidos a una consulta cardiológica o para cardioversión eléctrica, en el que se comparó la capacidad de detección automática de FA de un monitor de pulsera que emplea la señal de fotopletismografía (PPG) frente a una derivación electrocardiográfica con el diagnóstico realizado por 2 cardiólogos con un ECG de 12 derivaciones.
El algoritmo de detección de FA basado en la señal de PPG mostró una sensibilidad del 91% y una especificidad del 96% (exactitud diagnóstica del 93%). El algoritmo automático basado en la señal del ECG mostró una sensibilidad del 94% y una especificidad del 96% (exactitud diagnóstica: 95%). Ambos algoritmos coincidieron en el diagnóstico en el 96% de los casos. El monitor, en general, mostró una sensibilidad y una especificidad del 95% (exactitud diagnóstica del 95% y κ = 0,98).
El estudio RHITMI mostró que la detección automática de FA mediante un monitor que incorpora detectores y algoritmos que analizan la señal de PPG y la señal electrocardiográfica correspondiente a la derivación I es factible y presenta una gran exactitud diagnóstica.
Early detection of atrial fibrillation (AF) is a priority to reduce embolic events by initiating oral anticoagulation therapy. The aim of this study was to evaluate the diagnostic ability of a wrist device designed for automatic AF detection.
RITHMI is a prospective, comparative, observational study that included 167 patients referred to a cardiology outpatient clinic for a general consultation or for electrical cardioversion. The study evaluated the ability of a wrist monitor that uses a photoplethysmography (PPG) signal and an electrocardiographic lead to automatically detect AF compared with diagnosis established by 2 cardiologists using the 12-lead electrocardiogram.
The AF detection algorithm based on the PPG signal had a sensitivity of 91% and a specificity of 96% (diagnostic accuracy: 93%). The automatic algorithm based on the electrocardiographic signal had a sensitivity of 94% and a specificity of 96% (diagnostic accuracy: 95%). The 2 algorithms concurred in the diagnosis in 96% of the cases. Overall, the monitor had a sensitivity and specificity of 95% (diagnostic accuracy: 95% and Kappa index: 0.98).
This study shows that automatic AF detection through the use of a heart rhythm monitor incorporating sensors and algorithms that analyze the PPG signal and the electrocardiographic signal corresponding to lead I is feasible and has high diagnostic accuracy.
Full English text available from:www.revespcardiol.org/en
Abstract Introduction and objectives The Spanish Automatic Defibrillator Registry has provided activity data since 2002. Methods The data in this registry are submitted by implantation centers that ...voluntarily complete a data collection sheet. Results During 2017, a total of 6273 implant sheets were received, compared with 6429 reported by Eucomed (European Confederation of Medical Suppliers Associations). Therefore, the registry contains data on 97.6% of the devices implanted in Spain. Compliance ranged from 99.7% for the field “name of the implanting hospital” to 46.1% for the variable “New York Heart Association functional class”. A total of 181 hospitals reported data to the registry, representing an increase compared with the number of participating hospitals in 2016 (177) and in previous years (169 in 2015, 162 in 2014, 154 in 2013, and 153 in 2012). Conclusions The number of implants per million inhabitants in Spain increased for several years but decreased in 2017. As in previous years, the total number of implants in Spain is still much lower than the European Union average, and the gap continues to widen. There are still substantial differences between autonomous communities.
Response to ECG, August 2018 Andrés Lahuerta, Ana; Osca Asensi, Joaquín; Donoso Trenado, Víctor José
Revista española de cardiología (English ed.)
71, Številka:
9
Journal Article
ECG, August 2018 Andrés Lahuerta, Ana; Osca Asensi, Joaquín; Donoso Trenado, Víctor José
Revista española de cardiología (English ed.)
71, Številka:
8
Journal Article
The aim of the SYNSEQ (Left Ventricular Synchronous vs. Sequential MultiSpot Pacing for CRT) study was to evaluate the acute hemodynamic response (AHR) of simultaneous (3P-MPP
) or sequential (3P-MPP
...) multi-3-point-left-ventricular (LV) pacing vs. single point pacing (SPP) in a group of patients at risk of a suboptimal response to cardiac resynchronization therapy (CRT). Twenty five patients with myocardial scar or QRS ≤ 150 or the absence of LBBB (age: 66 ± 12 years, QRS: 159 ± 12 ms, NYHA class II/III, LVEF ≤ 35%) underwent acute hemodynamic assessment by LV + dP/dt
with a variety of LV pacing configurations at an optimized AV delay. The change in LV + dP/dt
(%ΔLV + dP/dt
) with 3P-MPP
(15.6%, 95% CI: 8.8%-22.5%) was neither statistically significantly different to 3P-MPP
(11.8%, 95% CI: 7.6-16.0%) nor to SPP
(11.5%, 95% CI:7.1-15.9%) or SPP
(12.2%, 95% CI:7.9-16.5%), but higher than SPP
(10.6%, 95% CI:5.3-15.9%,
= 0.03). AHR (defined as a %ΔLV + dP/dt
≥ 10%) varied between pacing configurations: 36% (9/25) for SPP
, 44% (11/25) for SPP
, 54% (13/24) for SPP
, 56% (14/25) for 3P-MPP
and 48% (11/23) for 3P-MPP
patients (15/25, 60%) had an AHR in at least one pacing configuration. AHR was observed in 10/13 (77%) patients with a LBBB but only in 5/12 (42%) patients with a non-LBBB (
= 0.11). To conclude, simultaneous or sequential multipoint pacing compared to single point pacing did not improve the acute hemodynamic effect in a suboptimal CRT response population.
ClinicalTrials.gov, identifier: NCT02914457.
Se presentan los resultados del Registro español de ablación con catéter correspondientes a 2022.
Registro de actividad restrospectivo de los datos introducidos en la plataforma REDCap utilizando un ...formulario específico.
Participaron 103 centros (75 públicos, 28 privados) que comunicaron 23.360 procedimientos de ablación, con una media de 227±173 y una mediana de 202 intervalo intercuartílico, 77-312 procedimientos por centro. Se ha producido un incremento muy significativo de la actividad (+5.419 casos,+30,2%) y de los centros participantes (10 centros más que en 2021). El procedimiento más frecuente sigue siendo la ablación de fibrilación auricular (FA) (el 35%, 8.185 casos) seguido de la ablación del istmo cavotricuspídeo (el 20%, 4.640 casos) y la taquicardia por reentrada intranodular (el 17%, 3.898 casos). Crecen todos los sustratos, especialmente la ablación de FA (+40%), y aumenta ligeramente el éxito agudo global, que alcanza el 96%, y disminuyen las tasas de complicaciones hasta el 1,8% (n=422) y de mortalidad (0,04%; n=10). Se realizaron 525 ablaciones en pacientes pediátricos (2,2%).
El Registro español de ablación con catéter recoge de manera sistemática e ininterrumpida la trayectoria nacional, que este año muestra un incremento muy significativo de la actividad en todos los sustratos, pero especialmente la referente a ablación de FA. Aumenta ligeramente la tasa de éxito y se reducen tanto la tasa de complicaciones como la mortalidad.
This article presents results of the Spanish catheter ablation registry for the year 2022.
Data were retrospectively entered into a REDCap platform using a specific form.
A total of 103 centers participated (75 public, 28 private), which reported 23 360 ablation procedures, with a mean of 227±173 and a median of 202 interquartile range, 77-312 procedures per center. Activity significantly increased (+5419 procedures,+30.2%) with more centers participating in the registry (10 more than in 2021). The most common procedure continued to be atrial fibrillation ablation (35%, 8185 procedures) followed by cavotricuspid isthmus ablation (20%, 4640 procedures), and intranodal re-entrant tachycardia (17%, 3898 procedures). There was an increase in all reported substrates, especially atrial fibrillation ablation (+40%), with slightly higher global acute success (96%) and lower complication rates (1.8%) and mortality (0.04%, n=10). In total, 525 procedures were performed in pediatric patients (2.2%)
The Spanish catheter ablation registry systematically and continuously collects the national trajectory, which experienced a significant activity increase in 2022 in all of the reported substrates but especially in atrial fibrillation ablation. Acute success increased, while both complications and mortality decreased.
Full English text available from:www.revespcardiol.org/en
Early detection of atrial fibrillation (AF) is a priority to reduce embolic events by initiating oral anticoagulation therapy. The aim of this study was to evaluate the diagnostic ability of a wrist ...device designed for automatic AF detection.
RITHMI is a prospective, comparative, observational study that included 167 patients referred to a cardiology outpatient clinic for a general consultation or for electrical cardioversion. The study evaluated the ability of a wrist monitor that uses a photoplethysmography (PPG) signal and an electrocardiographic lead to automatically detect AF compared with diagnosis established by 2 cardiologists using the 12-lead electrocardiogram.
The AF detection algorithm based on the PPG signal had a sensitivity of 91% and a specificity of 96% (diagnostic accuracy: 93%). The automatic algorithm based on the electrocardiographic signal had a sensitivity of 94% and a specificity of 96% (diagnostic accuracy: 95%). The 2 algorithms concurred in the diagnosis in 96% of the cases. Overall, the monitor had a sensitivity and specificity of 95% (diagnostic accuracy: 95% and Kappa index: 0.98).
This study shows that automatic AF detection through the use of a heart rhythm monitor incorporating sensors and algorithms that analyze the PPG signal and the electrocardiographic signal corresponding to lead I is feasible and has high diagnostic accuracy.
La detección precoz de la fibrilación auricular (FA) es prioritaria para reducir su riesgo embólico mediante la instauración del tratamiento anticoagulante. El objetivo de este estudio es evaluar la capacidad diagnóstica de un dispositivo de muñeca diseñado para la monitorización del ritmo cardiaco y la detección automática de la FA.
El RITHMI es un estudio prospectivo, comparativo y observacional, realizado en 167 pacientes remitidos a una consulta cardiológica o para cardioversión eléctrica, en el que se comparó la capacidad de detección automática de FA de un monitor de pulsera que emplea la señal de fotopletismografía (PPG) frente a una derivación electrocardiográfica con el diagnóstico realizado por 2 cardiólogos con un ECG de 12 derivaciones.
El algoritmo de detección de FA basado en la señal de PPG mostró una sensibilidad del 91% y una especificidad del 96% (exactitud diagnóstica del 93%). El algoritmo automático basado en la señal del ECG mostró una sensibilidad del 94% y una especificidad del 96% (exactitud diagnóstica: 95%). Ambos algoritmos coincidieron en el diagnóstico en el 96% de los casos. El monitor, en general, mostró una sensibilidad y una especificidad del 95% (exactitud diagnóstica del 95% y κ = 0,98).
El estudio RHITMI mostró que la detección automática de FA mediante un monitor que incorpora detectores y algoritmos que analizan la señal de PPG y la señal electrocardiográfica correspondiente a la derivación I es factible y presenta una gran exactitud diagnóstica.
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