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Electrocardiogram

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181. A randomized trial evaluating the accuracy of AF detection by four external ambulatory ECG monitors compared to permanent pacemaker AF detection. (Abstract)

A randomized trial evaluating the accuracy of AF detection by four external ambulatory ECG monitors compared to permanent pacemaker AF detection. Several external cardiac monitors (ECMs) have recently been developed. These have never been compared to 'gold standard' monitoring with concurrently implanted DDDRP pacemakers. The accuracy of AF detection of Zio XT Monitor (ZM), NUUBO Vest (NV) and Carnation Ambulatory Monitor (CAM) compared with Novacor 'R' Test 4 (RT) in patients (pts) with DDDRP (...) PPM advanced Holters as the comparator, was evaluated.Twenty-one pts. with AF and a DDDRP PPM, each acting as their own control subject, wore every ECM for 2 weeks in randomized order. PPM downloads were performed at application and removal. Device ECGs were compared for AF burden and individual AF episodes with PPM Holters. Pt acceptability, wear time, costs and time expenditure were evaluated.RT AF burden was less accurate than the ZM, NV or CAM (p < 0.05). Probability of inaccurate AF diagnosis

2019 Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing Controlled trial quality: uncertain

182. The impact of ECG synchronization during acquisition of left‑atrium computed tomography model on radiation dose and arrhythmia recurrence rate after catheter ablation of atrial fibrillation - a prospective, randomized study. Full Text available with Trip Pro

The impact of ECG synchronization during acquisition of left‑atrium computed tomography model on radiation dose and arrhythmia recurrence rate after catheter ablation of atrial fibrillation - a prospective, randomized study. The impact of ECG gating during computed tomography (CT) acquisition of left atrium (LA) model on radiation dose, image quality and ablation event-free survival rate after catheter ablation (CA) of atrial fibrillation (AF) is not well defined.Sixty-two patients (...) with paroxysmal atrial fibrillation were randomized for two types of LA CT (with vs without ECG gating) before CA. Pulmonary veins isolation was performed in all patients. Patients were followed for 12 months after CA.There was no difference between the groups in CA length (131.61±32.57 vs 119.84±33.18 min; p=0.108), CA fluoroscopy time (4.48±2.19 vs 3.89±1.83 min; p=0.251), CA fluoroscopy dose (3.99±2.79 vs 3.91 vs2.91 Gy*cm2; p=0.735), visual data quality (1.77±0.88 vs 2.0±0.63; p=0.102) and registration

2019 Bratislavske Lekarske Listy Controlled trial quality: uncertain

183. Home use of a compact, 12‑lead ECG recording system for newborns. Full Text available with Trip Pro

Home use of a compact, 12‑lead ECG recording system for newborns. An easy-to-operate ECG recorder should be useful for newborn screening for heart conditions, by health care workers - or parents. We developed a one-piece electrode strip and a compact, 12‑lead ECG recorder for newborns.We enrolled 2582 newborns in a trial to assess abilities of parents to record a 12‑lead ECG on their infants (2-4 weeks-old). Newborns were randomized to recordings by parents (1290) or our staff (1292 controls (...) ). Educational backgrounds of parents varied, including 64% with no more than a high school diploma.For newborns randomized to parent recorded ECGs, 94% of parents completed a 10-minute recording. However, 42.6% asked for verbal help, and 12.7% needed physical help. ECG quality was the same for recordings by parents versus staff.By use of a one-piece electrode strip and a compact recorder, 87% of parents recorded diagnostic quality ECGs on their newborn infants, with minimal assistance.Copyright © 2019

2019 Journal of electrocardiology Controlled trial quality: uncertain

184. Number of ECG Replicates and QT Correction Formula Influences the Estimated QT Prolonging Effect of a Drug. Full Text available with Trip Pro

Number of ECG Replicates and QT Correction Formula Influences the Estimated QT Prolonging Effect of a Drug. The present analysis addressed the effect of the number of ECG replicates extracted from a continuous ECG on estimated QT interval prolongation for different QT correction formulas.For 100 healthy volunteers, who received a compound prolonging the QT interval, 18 ECG replicates within a 3-minute window were extracted from 12-lead Holter ECGs. Ten QT correction formulas were deployed (...) , and the QTc interval was controlled for baseline and placebo and averaged per dose level.The mean prolongation difference was >4 ms for single and >2 ms for triplicate ECG measurements compared with the 18 ECG replicate mean values. The difference was <0.5 ms after 14 replicates. By contrast, concentration-effect analysis was independent of replicate count and also of the QT correction formula.The number of ECG replicates impacted the estimated QT interval prolongation for all deployed QT correction

2019 Journal of cardiovascular pharmacology Controlled trial quality: uncertain

185. Accuracy and Safety Study of Intracavitary Electrocardiographic Guidance for Peripherally Inserted Central Catheter Placement in Neonates. (Abstract)

Accuracy and Safety Study of Intracavitary Electrocardiographic Guidance for Peripherally Inserted Central Catheter Placement in Neonates. The purpose of this study is to investigate the accuracy and safety of intracavitary electrocardiogram (IC-ECG) guidance for the localization of peripherally inserted central catheter (PICC) in neonatal patients. A total of 160 neonatal patients were randomly assigned to receive either anthropometric measurement combined with IC-ECG guidance (n = 80 (...) ) or conventional anatomical landmark guidance (n = 80) for PICC catheter tip positioning. The catheter tip position was confirmed by postinsertion radiograph and data were interpreted by independent radiologists. Subsequent catheter-related complications of neonates between 2 groups were also compared. The first-attempt target rate was 95.0% (95% confidence interval, 90.1%-99.9%) in IC-ECG-guided PICCs, significantly higher than 78.8% (95% confidence interval, 69.6%-87.9%) in the anatomical landmark guidance

2019 The Journal of perinatal & neonatal nursing Controlled trial quality: uncertain

186. Seizure detection based on heart rate variability using a wearable electrocardiography device. (Abstract)

Seizure detection based on heart rate variability using a wearable electrocardiography device. To assess the feasibility and accuracy of seizure detection based on heart rate variability (HRV) using a wearable electrocardiography (ECG) device. Noninvasive devices for detection of convulsive seizures (generalized tonic-clonic and focal to bilateral tonic-clonic seizures) have been validated in phase 2 and 3 studies. However, detection of nonconvulsive seizures still needs further research, since (...) currently available methods have either low sensitivity or an extremely high false alarm rate (FAR).In this phase 2 study, we prospectively recruited patients admitted to long-term video-EEG monitoring (LTM). ECG was recorded using a dedicated wearable device. Seizures were automatically detected using HRV parameters computed off-line, blinded to all other data. We compared the performance of 26 automated algorithms with the seizure time-points marked by experts who reviewed the LTM recording. Patients

2019 Epilepsia

187. A Statewide Assessment of Prehospital Electrocardiography Approaches of Acquisition and Interpretation for ST-Elevation Myocardial Infarction Based on Emergency Medical Services Characteristics. (Abstract)

A Statewide Assessment of Prehospital Electrocardiography Approaches of Acquisition and Interpretation for ST-Elevation Myocardial Infarction Based on Emergency Medical Services Characteristics. Background: The American Heart Association recommends acquiring and interpreting prehospital electrocardiograms (ECG) for patients transported by Emergency Medical Services (EMS) to the emergency department with symptoms highly suspicious of acute coronary syndrome. If interpreted correctly, prehospital (...) ECGs have the potential to improve early detection of ST-elevation myocardial infarction (STEMI) and inform prehospital activation of the cardiac catheterization laboratory, thus reducing total ischemic time and improving patient outcomes. Standardized protocols for prehospital ECG interpretation methods are lacking due to variations in EMS system design, training, and procedures. Objectives: We aimed to describe approaches for prehospital ECG interpretation in EMS systems across North Carolina (NC

2019 Prehospital emergency care

188. Cardiac electrical instability in newly diagnosed/chronic epilepsy tracked by Holter and ECG patch. (Abstract)

Cardiac electrical instability in newly diagnosed/chronic epilepsy tracked by Holter and ECG patch. We hypothesized that cardiac electrical instability and abnormal autonomic tone result from cumulative cardiac injury sustained in recurrent seizures. We tested this hypothesis by comparing T-wave alternans (TWA) and heart rate variability (HRV), both established markers of sudden cardiac death (SCD) risk, in patients with chronic as compared to newly diagnosed epilepsy.In this prospective (...) , observational cohort study, patients (newly diagnosed epilepsy, n = 6, age 41.8 ± 6.8 years; chronic epilepsy, n = 6, age 40.2 ± 5.6 years [p = 0.85]) were monitored either with Holter recorder alone or simultaneously with 14-day Zio XT extended continuous ECG patch monitor. TWA was assessed by Food and Drug Administration-cleared Modified Moving Average analysis; HRV was calculated by rMSSD.TWA levels in chronic epilepsy were significantly higher than in newly diagnosed epilepsy (62 ± 5.4 vs 35 ± 1.3 μV, p

2019 Neurology

189. Plasma steroid profiles and ovarian response in llamas treated with eCG for superovulation combined with exogenous progesterone during early luteal phase. (Abstract)

Plasma steroid profiles and ovarian response in llamas treated with eCG for superovulation combined with exogenous progesterone during early luteal phase. The objective of this study was to evaluate the effects of plasma progesterone (P4) concentrations during eCG-ovarian follicular superstimulatory treatment performed in early luteal phase and estradiol concentrations during peri-ovulatory period on ovarian response, number and embryo quality. On Day -2, females (n = 75) having a follicle (...) ≥7 mm were treated with GnRH to induce ovulation. On Day 0, females that had ovulations (n = 54) were treated with 1000 IU eCG and were assigned to one of two treatments: (1) intravaginal device (ID) containing 0.5 g P4 (P4 group) and (2) no ID (Control group). On Day 5, females were administered PGF2α and the ID was removed. On Day 7 and 8, females were mated and embryo recovery was performed 7 or 8 days later. Blood samples were collected from Day 0 to 9. Number (± SD) of follicles ≥7 mm on day

2019 Animal reproduction science Controlled trial quality: uncertain

190. An Easy and Reliable Way to Prevent Electrocardiographic Deteriorations of Patients Undergoing Off-Pump Coronary Artery Bypass Surgery: Preoperative Anxiolytic Treatment. Full Text available with Trip Pro

(Sedation group) was administered 0.04 mg/kg lorazepam per os (PO) twice before the operation. Group C (control group) was not administered with any anxiolytic premedication. State Trait Anxiety Inventory (STAI-I) and Beck Anxiety Inventory (BAI) were used to evaluate the level of anxiety. Electrocardiography (ECG), pulse oximeter and standard monitoring were performed for each patient. QT and P dispersions in each derivation of all ECGs were calculated.Preoperative STAI-I scores were significantly (...) An Easy and Reliable Way to Prevent Electrocardiographic Deteriorations of Patients Undergoing Off-Pump Coronary Artery Bypass Surgery: Preoperative Anxiolytic Treatment. To investigate the effects of preoperative anxiety relieving on electrophysiological changes in patients undergoing off-pump coronary artery bypass surgery.A total of 61 patients at ASA III risk group in the age range of 18-65 years were enrolled in the present study. Patients were randomly divided into two groups. Group S

2019 Brazilian journal of cardiovascular surgery Controlled trial quality: uncertain

191. Comparing the effect of STan (cardiotocographic electronic fetal monitoring (CTG) plus analysis of the ST segment of the fetal electrocardiogram) with CTG alone on emergency caesarean section rates: study protocol for the STan Australian Randomised contro Full Text available with Trip Pro

Comparing the effect of STan (cardiotocographic electronic fetal monitoring (CTG) plus analysis of the ST segment of the fetal electrocardiogram) with CTG alone on emergency caesarean section rates: study protocol for the STan Australian Randomised contro Cardiotocography is almost ubiquitous in its use in intrapartum care. Although it has been demonstrated that there is some benefit from continuous intrapartum fetal monitoring using cardiotocography, there is also an increased risk (...) of caesarean section which is accompanied by short-term and long-term risks to the mother and child. There is considerable potential to reduce unnecessary operative delivery with up to a 60% false positive diagnosis of fetal distress using cardiotocography alone. ST analysis of the fetal electrocardiogram is a promising adjunct to cardiotocography alone, and permits detection of metabolic acidosis of the fetus, potentially reducing false positive diagnosis of fetal distress.This study will be a single

2019 Trials Controlled trial quality: predicted high

192. [Impact assessment of new sick clothes in patients with electrocardiogram monitoring]. (Abstract)

[Impact assessment of new sick clothes in patients with electrocardiogram monitoring]. To design a new modified sick clothes for electrocardiogram (ECG) monitoring, and to observe its clinical application effect.In order to overcome the shortcomings of the existing modified ECG monitoring clothes, a new type of modified sick clothes was designed on the basis of the traditional sick clothes, and a national utility model patent was obtained. 408 conscious patients with ECG monitoring admitted (...) to department of neurology of the First Affiliated Hospital of Fujian Medical University from January 2015 to June 2018 were enrolled, and they were randomly divided into three groups according to the order of admission for comparing the wearing effect of three kinds of sick clothes. 133 patients dressed traditional clothes, while 139 patients dressed modified ECG monitoring clothes. According to the method reported in the literature, the pockets were removed on the basis of the traditional patient clothes

2019 Zhonghua wei zhong bing ji jiu yi xue Controlled trial quality: uncertain

193. Allele-specific NKX2-5 binding underlies multiple genetic associations with human electrocardiographic traits. (Abstract)

Allele-specific NKX2-5 binding underlies multiple genetic associations with human electrocardiographic traits. The cardiac transcription factor (TF) gene NKX2-5 has been associated with electrocardiographic (EKG) traits through genome-wide association studies (GWASs), but the extent to which differential binding of NKX2-5 at common regulatory variants contributes to these traits has not yet been studied. We analyzed transcriptomic and epigenomic data from induced pluripotent stem cell-derived (...) cardiomyocytes from seven related individuals, and identified ~2,000 single-nucleotide variants associated with allele-specific effects (ASE-SNVs) on NKX2-5 binding. NKX2-5 ASE-SNVs were enriched for altered TF motifs, for heart-specific expression quantitative trait loci and for EKG GWAS signals. Using fine-mapping combined with epigenomic data from induced pluripotent stem cell-derived cardiomyocytes, we prioritized candidate causal variants for EKG traits, many of which were NKX2-5 ASE-SNVs

2019 Nature Genetics

194. Toluene toxicity presenting with hypokalemia, profound weakness and U waves in the electrocardiogram. (Abstract)

Toluene toxicity presenting with hypokalemia, profound weakness and U waves in the electrocardiogram. We present the case of a 25-year-old man with progressive limb weakness. His electrocardiogram showed prominent U waves which made us consider hypokalemia. The final diagnosis was toluene intoxication with severe hypokalemia and metabolic acidosis. Intravenous potassium administration and hydration effectively corrected the electrolyte and acid-base alterations; weakness resolved (...) and the patient was discharged. The approach to a patient with acute weakness can be challenging. This case reminds us that the electrocardiogram can be a valuable tool in the evaluation and differential diagnosis of patients presenting to the emergency department with these conditions.Copyright © 2018. Published by Elsevier Inc.

2019 American Journal of Emergency Medicine

195. Is experienced physician gestalt with an ECG sufficient to accurately exclude acute MI in a patient with suspected ACS? (Abstract)

Is experienced physician gestalt with an ECG sufficient to accurately exclude acute MI in a patient with suspected ACS? We read with interest, "Can emergency physician gestalt 'rule in' or 'rule out' acute coronary syndrome: validation in a multi-center prospective diagnostic cohort study" by Oliver et al.1 In this large multi-center, prospective diagnostic accuracy study, the investigators conclude that gestalt (including ECG interpretation) is not sufficient to exclude acute MI (AMI

2019 Academic Emergency Medicine

196. Impact of electronic cardiac (ECG) monitoring on delivery room resuscitation and neonatal outcomes. Full Text available with Trip Pro

Impact of electronic cardiac (ECG) monitoring on delivery room resuscitation and neonatal outcomes. In 2016, the neonatal resuscitation guidelines suggested electronic cardiac (ECG) monitoring to assess heart rate for an infant receiving positive pressure ventilation immediately after birth. Our aim was to study the impact of ECG monitoring on delivery room resuscitation interventions and neonatal outcomes.Observational cohort study compared maternal, perinatal and infant characteristics (...) , before (retrospective cohort, calendar year 2015) and after (prospective cohort, calendar year 2017) implementation of ECG monitoring in the delivery room. Association of ECG monitoring with delivery room resuscitation practice interventions and neonatal outcomes was assessed using unadjusted and adjusted multivariable regression analyses.Of 632 newly born infants who received positive pressure ventilation in the delivery room, ECG monitoring was performed in 369 (the prospective cohort) compared

2019 Resuscitation

197. Coronary angiographic findings after cardiac arrest in relation to ECG and comorbidity. (Abstract)

Coronary angiographic findings after cardiac arrest in relation to ECG and comorbidity. The relations between specific ECG patterns and coronary angiographic findings in cardiac arrest patients with different comorbidities are not properly assessed. More evidence is needed to identify patients with the highest risk for acute coronary artery disease as a cause of the cardiac arrest. This study aims to describe the coronary artery findings after cardiac arrest in relation to ECG and comorbidity.A (...) retrospective study of out-of-hospital cardiac arrest patients, with coronary angiography performed within 28 days. ECG on admission, comorbidity, PCI attempts and angiographic findings are described. Data were retrieved from national registries in Sweden.Among 1133 patients with available ECG and angiography information the mean age was 64 years. The rate of shockable rhythm was 79%. The total incidence of any significant stenosis in cardiac arrest patients without ST-elevation who underwent coronary

2019 Resuscitation

198. Diagnostic value of lead aVR in electrocardiography for identifying acute coronary lesions in patients with out-of-hospital cardiac arrest. (Abstract)

Diagnostic value of lead aVR in electrocardiography for identifying acute coronary lesions in patients with out-of-hospital cardiac arrest. There is no simple clinical tool that reliably indicates the presence of acute coronary lesions in out-of-hospital cardiac arrest (OHCA) patients without typical ST-segment elevations. ST-segment elevation in electrocardiographic lead aVR suggests global subendocardial ischemia. This study aimed to evaluate the diagnostic value of lead aVR for identifying

2019 Resuscitation

199. Atypical Electrocardiographic Presentations in Need of Primary Percutaneous Coronary Intervention. (Abstract)

Atypical Electrocardiographic Presentations in Need of Primary Percutaneous Coronary Intervention. Early initiation of reperfusion therapy remains the cornerstone of successful management for ST-elevation myocardial infarction (STEMI). Rapid restoration of coronary blood flow relies on prompt recognition of the typical ST-segment elevation on a 12-lead electrocardiogram (ECG)-a surrogate for coronary occlusion or critical stenosis-allowing timely activation of the STEMI protocol cascade (...) , with a major positive impact in mortality and clinical outcomes. However, atypical, very high risk ECG patterns-known as "STEMI equivalents"-are present in 10% to 25% of patients with ongoing myocardial ischemia in need of urgent primary percutaneous coronary intervention. Though briefly mentioned in the current recommendations, structured clinical data on those specific ECG presentations are lacking. By thoroughly searching MEDLINE and EMBASE we conducted a structured review of non-STEMI, albeit very high

2019 American Journal of Cardiology

200. The prevalence of atrial fibrillation on 48-hour ambulatory electrocardiography in African Americans compared to Whites: The Atherosclerosis Risk in Communities (ARIC) study. Full Text available with Trip Pro

The prevalence of atrial fibrillation on 48-hour ambulatory electrocardiography in African Americans compared to Whites: The Atherosclerosis Risk in Communities (ARIC) study. A lower prevalence of atrial fibrillation (AF), but paradoxically higher burden of cardiovascular disease risk factors, has been observed among African Americans compared to Whites in studies of AF identified by mostly 12-lead electrocardiograms (ECGs) and clinically.We performed 48-hour ambulatory electrocardiography (...) (aECG) in a biracial sample of 1,193 participants in the Atherosclerosis Risk in Communities (ARIC) (mean age = 78 years, 62% African Americans, 64% female). Atrial fibrillation was identified from aECG, study visit ECGs, and discharge codes from cohort hospitalizations. We used covariate-adjusted logistic regression to estimate prevalence odds ratios (ORs) for AF in African Americans versus Whites, with adjustment for sampling and nonresponse.African Americans were more likely than Whites to have

2019 American Heart Journal

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