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Electrocardiogram

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121. Noninvasive assessment of dofetilide plasma concentration using a deep learning (neural network) analysis of the surface electrocardiogram: A proof of concept study. (Full text)

Noninvasive assessment of dofetilide plasma concentration using a deep learning (neural network) analysis of the surface electrocardiogram: A proof of concept study. Dofetilide is an effective antiarrhythmic medication for rhythm control in atrial fibrillation, but carries a significant risk of pro-arrhythmia and requires meticulous dosing and monitoring. The cornerstone of this monitoring, measurement of the QT/QTc interval, is an imperfect surrogate for plasma concentration, efficacy (...) , and risk of pro-arrhythmic potential.The aim of our study was to test the application of a deep learning approach (using a convolutional neural network) to assess morphological changes on the surface ECG (beyond the QT interval) in relation to dofetilide plasma concentrations.We obtained publically available serial ECGs and plasma drug concentrations from 42 healthy subjects who received dofetilide or placebo in a placebo-controlled cross-over randomized controlled clinical trial. Three replicate 10-s

2018 PLoS ONE PubMed abstract

122. Feasibility and outcomes of atrial fibrillation screening using intermittent electrocardiography in a primary healthcare setting: A cross-sectional study. (Full text)

Feasibility and outcomes of atrial fibrillation screening using intermittent electrocardiography in a primary healthcare setting: A cross-sectional study. Atrial fibrillation (AF) is a major risk factor for ischemic stroke unless treated with an anticoagulant. Detecting AF can be difficult because AF is often paroxysmal and asymptomatic. The aims of this study were to develop a screening model to detect AF in a primary healthcare setting and to initiate oral anticoagulant therapy in high-risk (...) patients to prevent stroke.This was a cross-sectional study. All 70- to 74-year-old individuals registered at a single primary healthcare center in Stockholm were invited to participate in AF screening upon visiting the center during a ten-month period. Those who did not have contact with the center during this period were invited to participate by letter. Thirty-second intermittent ECG recordings were made twice a day using a handheld Zenicor device over a 2-week period in participants without AF

2018 PLoS ONE PubMed abstract

123. Perspectives of human verification via binary QRS template matching of single-lead and 12-lead electrocardiogram. (Full text)

Perspectives of human verification via binary QRS template matching of single-lead and 12-lead electrocardiogram. This study aims to validate the 12-lead electrocardiogram (ECG) as a biometric modality based on two straightforward binary QRS template matching characteristics. Different perspectives of the human verification problem are considered, regarding the optimal lead selection and stability over sample size, gender, age, heart rate (HR).A clinical 12-lead resting ECG database, including (...) , HR.The optimal QRS pattern projection for single-lead ECG biometric modality is found in the frontal plane sector (60°-0°) with best (Test-AUC/TVR) for lead II (0.941/86.8%) and slight accuracy drop for -aVR (-0.017/-1.4%), I (-0.01/-1.5%). Chest ECG leads have degrading accuracy from V1 (0.885/80.6%) to V6 (0.799/71.8%). The multi-lead ECG improves verification: 6-chest (0.97/90.9%), 6-limb (0.986/94.3%), 12-leads (0.995/97.5%). The QRS pattern matching model shows stable performance

2018 PLoS ONE PubMed abstract

124. Correction: Electrocardiographic Biomarkers for Detection of Drug-Induced Late Sodium Current Block. (Full text)

Correction: Electrocardiographic Biomarkers for Detection of Drug-Induced Late Sodium Current Block. [This corrects the article DOI: 10.1371/journal.pone.0163619.].

2018 PLoS ONE PubMed abstract

125. Electrocardiogram-synchronized pulsatile extracorporeal life support preserves left ventricular function and coronary flow in a porcine model of cardiogenic shock. (Full text)

function and coronary flow during standard continuous-flow ECLS support and electrocardiogram (ECG)-synchronized pulsatile ECLS flow in a porcine model of cardiogenic shock.Sixteen female swine (mean body weight 45 kg) underwent ECLS implantation under general anesthesia and artificial ventilation. Subsequently, acute cardiogenic shock, with documented signs of tissue hypoperfusion, was induced by initiating global myocardial hypoxia. Hemodynamic cardiac performance variables and coronary flow were (...) Electrocardiogram-synchronized pulsatile extracorporeal life support preserves left ventricular function and coronary flow in a porcine model of cardiogenic shock. Veno-arterial extracorporeal life support (ECLS) is increasingly being used to treat rapidly progressing or severe cardiogenic shock. However, it has been repeatedly shown that increased afterload associated with ECLS significantly diminishes left ventricular (LV) performance. The objective of the present study was to compare LV

2018 PLoS ONE PubMed abstract

126. Accuracy and reliability of noninvasive stroke volume monitoring via ECG-gated 3D electrical impedance tomography in healthy volunteers. (Full text)

Accuracy and reliability of noninvasive stroke volume monitoring via ECG-gated 3D electrical impedance tomography in healthy volunteers. Cardiac output (CO) and stroke volume (SV) are parameters of key clinical interest. Many techniques exist to measure CO and SV, but are either invasive or insufficiently accurate in clinical settings. Electrical impedance tomography (EIT) has been suggested as a noninvasive measure of SV, but inconsistent results have been reported. Our goal is to determine (...) measurements derived from the oxygen uptake. Results revealed a dramatic impact of posture on the EIT images. Therefore, the analysis was restricted to measurements in supine position under controlled conditions (low noise and stable heart and lung regions). In these measurements, amplitudes of impedance changes in the heart and lung regions could successfully be derived from EIT using ECG gating. However, despite a subject-specific calibration the heart-related estimates showed an error of 0.0 ± 15.2 mL

2018 PLoS ONE PubMed abstract

127. A pyramid-like model for heartbeat classification from ECG recordings. (Full text)

A pyramid-like model for heartbeat classification from ECG recordings. Heartbeat classification is an important step in the early-stage detection of cardiac arrhythmia, which has been identified as a type of cardiovascular diseases (CVDs) affecting millions of people around the world. The current progress on heartbeat classification from ECG recordings is facing a challenge to achieve high classification sensitivity on disease heartbeats with a satisfied overall accuracy. Most of the work take

2018 PLoS ONE PubMed abstract

128. Two-stage motion artefact reduction algorithm for electrocardiogram using weighted adaptive noise cancelling and recursive Hampel filter. (Full text)

Two-stage motion artefact reduction algorithm for electrocardiogram using weighted adaptive noise cancelling and recursive Hampel filter. The presence of motion artefacts in ECG signals can cause misleading interpretation of cardiovascular status. Recently, reducing the motion artefact from ECG signal has gained the interest of many researchers. Due to the overlapping nature of the motion artefact with the ECG signal, it is difficult to reduce motion artefact without distorting the original ECG (...) signal. However, the application of an adaptive noise canceler has shown that it is effective in reducing motion artefacts if the appropriate noise reference that is correlated with the noise in the ECG signal is available. Unfortunately, the noise reference is not always correlated with motion artefact. Consequently, filtering with such a noise reference may lead to contaminating the ECG signal. In this paper, a two-stage filtering motion artefact reduction algorithm is proposed. In the algorithm

2018 PLoS ONE PubMed abstract

129. A lightweight piecewise linear synthesis method for standard 12-lead ECG signals based on adaptive region segmentation. (Full text)

A lightweight piecewise linear synthesis method for standard 12-lead ECG signals based on adaptive region segmentation. This paper presents a lightweight synthesis algorithm, named adaptive region segmentation based piecewise linear (ARSPL) algorithm, for reconstructing standard 12-lead electrocardiogram (ECG) signals from a 3-lead subset (I, II and V2). Such a lightweight algorithm is particularly suitable for healthcare mobile devices with limited resources for computing, communication (...) and data storage. After detection of R-peaks, the ECGs are segmented by cardiac cycles. Each cycle is further divided into four regions according to different cardiac electrical activity stages. A personalized linear regression algorithm is then applied to these regions respectively for improved ECG synthesis. The proposed ARSPL method has been tested on 39 subjects randomly selected from the PTB diagnostic ECG database and achieved accurate synthesis of remaining leads with an average correlation

2018 PLoS ONE PubMed abstract

130. Temporal changes in electrocardiographic frontal QRS-T angle and survival in patients with heart failure. (Full text)

in the frontal QRS-T angle and its effect on survival in patients with HF.Baseline and follow-up QRS-T angle were calculated from the frontal QRS and T axis of the 12-lead surface electrocardiogram. Patients were followed for survival.2,929 HF patients were evaluated. Median interval between baseline ECG and follow-up ECG was 895 days, median follow-up time was 1526 days. Overall, the QRS-T angle tended to be stable, with minor changes in the angle over time. The median QRS-T angle change was +3° (IQR -19 (...) Temporal changes in electrocardiographic frontal QRS-T angle and survival in patients with heart failure. Heart failure (HF) is associated with considerable mortality. The electrocardiographic frontal QRS-T angle is a simple parameter to measure, reflects changes in the direction of the repolarization sequence and predicts outcome in patients with HF. Data regarding temporal changes in the frontal QRS-T angle in patients with HF and its impact on outcome is limited.To evaluate temporal changes

2018 PLoS ONE PubMed abstract

131. Cardiac electrophysiological adaptations in the equine athlete-Restitution analysis of electrocardiographic features. (Full text)

Cardiac electrophysiological adaptations in the equine athlete-Restitution analysis of electrocardiographic features. Exercising horses uniquely accommodate 7-8-fold increases in heart rate (HR). The present experiments for the first time analysed the related adaptations in action potential (AP) restitution properties recorded by in vivo telemetric electrocardiography from Thoroughbred horses. The horses were subjected to a period of acceleration from walk to canter. The QRS durations, and QT

2018 PLoS ONE PubMed abstract

132. Association between electrocardiographic and echocardiographic markers of stage B heart failure and cardiovascular outcome (Full text)

Association between electrocardiographic and echocardiographic markers of stage B heart failure and cardiovascular outcome The detection of non-ischaemic (mainly hypertension, diabetes, and obesity) stage B heart failure (SBHF) may facilitate the recognition of those at risk of progression to overt HF and HF prevention. We sought the relationship of specific electrocardiographic (ECG) markers of SBHF to echocardiographic features of SBHF and their prognostic value for development of HF. The ECG (...) markers were Cornell product (Cornell-P), P-wave terminal force in lead V1 (PTFV1), ST depression in lead V5 V6 (minSTmV5V6), and increased heart rate. Echocardiographic assessment of SBHF included left ventricular hypertrophy (LVH), impaired global longitudinal strain (GLS), and diastolic dysfunction (DD).Asymptomatic subjects ≥65 years without prior cardiac history, but with HF risks, were recruited from the local community. At baseline, they underwent clinical assessment, 12-lead ECG

2017 ESC heart failure PubMed abstract

133. Multi-arrhythmias detection with an XML rule-based system from 12-Lead Electrocardiogram (Full text)

Multi-arrhythmias detection with an XML rule-based system from 12-Lead Electrocardiogram The computer-aided detection of cardiac arrhythmias stills a crucial application in medical technologies. The rule based systems RBS ensure a high level of transparency and interpretability of the obtained results.To facilitate the diagnosis of the cardiologists and to reduce the uncertainty made in this diagnosis.In this research article, we have realized a classification and automatic recognition (...) , for the experiments, an international data set with 279 features and 452 records characterizing 12 leads of ECG signal and social information of patients. The data sets were constructed and published at Bilkent University of Ankara, Turkey. In addition, the second version of the self-developed software "XMLRULE" was used; the software can infer more than one class and facilitate the interpretability of the obtained results.The 12 first experiments give 82.80% of correct detection as the mean of all experiments

2017 Electronic physician PubMed abstract

134. Electrocardiographic Early Repolarization

Access article Electrocardiographic Early Repolarization A Scientific Statement From the American Heart Association , MD, Chair , MD, PhD , MBChB, DPhil, FAHA , MD, FAHA , MD, MPH, FAHA , MD , MD, FAHA , MD, MAS , and MD, FAHA MDon behalf of the American Heart Association Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology and Council on Functional Genomics and Translational Biology Kristen K. Patton , Patrick T. Ellinor , Michael Ezekowitz , Peter Kowey , Steven (...) , the elevation of the ST segment, and concomitant electrocardiographic findings such as J-wave augmentation or short coupled premature ventricular contractions. , Figure 1. Examples of early repolarization pattern. Currently, the term ER is used to refer to nonspecific ST-segment elevation in algorithms used in commercial ECG machines. , The 2009 American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society recommendations for the standardization and interpretation of the ECG

2016 American Heart Association

135. Association of electrocardiogram alterations of rescuers and performance during a simulated cardiac arrest: A prospective simulation study. (Full text)

Association of electrocardiogram alterations of rescuers and performance during a simulated cardiac arrest: A prospective simulation study. Performance of cardiopulmonary resuscitation (CPR) causes significant mental stress for rescuers, especially if performed by inexperienced individuals. Our aim was to study electrocardiogram (ECG) alterations in rescuers and its association with gender and CPR performance.We included 126 medical students in this prospective, observational simulator study (...) . Each student was equipped with a 3-lead continuous ECG device tracking the individual electrocardiographic output before, during and after CPR. We analyzed variations in heart rate, heart-rate variability (HRV) and ST- and T-wave morphology.Compared to baseline, mean heart rate (bpm) significantly increased during resuscitation and again decreased after resuscitation (from 87 to 97 to 80, p<0.001). Heart-rate variability (the standard deviation of all N-N intervals, SDNN) (ms2) showed the opposite

2018 PLoS ONE PubMed abstract

136. Pacemaker Essentials: How to Interpret a Pacemaker ECG

Hesselson A B. Simplified Interpretation of Pacemaker ECGs: An Introduction . Massachussetts, USA: Willey-Blackwell; 2003. Marx J, Walls R, Hockberger R. Rosen’s Emergency Medicine – Concepts and Clinical Practice . 8th ed. Elsevier Health Sciences; 2013. Sgarbossa E, Pinski S, Gates K, Wagner G. Early electrocardiographic diagnosis of acute myocardial infarction in the presence of ventricular paced rhythm. GUSTO-I investigators. Am J Cardiol . 1996;77(5):423-424. PMID: Maloy K, Bhat R, Davis J, Reed K (...) Pacemaker Essentials: How to Interpret a Pacemaker ECG Pacemaker Essentials: How to Interpret a Pacemaker ECG - CanadiEM Pacemaker Essentials: How to Interpret a Pacemaker ECG In , by Lorne Costello May 24, 2016 Is that pesky pacemaker still causing you trouble? It means well but sometimes it can rub emergency physicians the wrong way. Let’s shift our focus to the ECG, and hopefully we’ll discover some pearls to help us with these troublesome devices. This is part 2 of a 3 part series. Check

2016 CandiEM

137. The clinical and cost effectiveness of lead-I electrocardiogram (ECG) devices for detecting atrial fibrillation using single-time point testing in primary care

The clinical and cost effectiveness of lead-I electrocardiogram (ECG) devices for detecting atrial fibrillation using single-time point testing in primary care Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites. Email salutation (e.g. "Dr

2018 PROSPERO

138. A Pathognomonic ECG. What is it?

A Pathognomonic ECG. What is it? Dr. Smith's ECG Blog: A Pathognomonic ECG. What is it? Tuesday, March 19, 2019 This patient presented with weakness, decreased urine output, and vomiting: What is the ECG diagnosis? There is a very long QT (computer says the QTc is 525 ms) due to a long ST segment. This is pathognomonic for hypocalcemia. The ionized Ca was 2.34 mg/dL (normal is 4.4-5.2) The Cr was 12.1 indicating (new onset) of renal failure. Calcium was given without much change. The next AM (...) the non-ionized Ca was 5.7 mg/dL (normal: 8.6-12.0). Here was a repeat ECG: QTc 523. Long ST segment remains. Although the QT is very long, long QT due to hypocalcemia is rarely associated with Torsades de Pointes. =================================== Comment by K EN G RAUER, MD ( 3/19/2019 ): =================================== There are a number of ECG patterns that should immediately suggest a clinical diagnosis. This is one of them! The value of recognizing this particular ECG pattern

2019 Dr Smith's ECG Blog

139. A Patient with Respiratory Failure and a Computer "Normal" ECG

A Patient with Respiratory Failure and a Computer "Normal" ECG Dr. Smith's ECG Blog: A Patient with Respiratory Failure and a Computer "Normal" ECG Monday, March 11, 2019 This ECG was presented in a conference. The patient had presented many times for SOB. On this occasion he was intubated for respiratory failure due to presumed asthma. I was asked to interpret his ECG in the conference. I had never seen it before. ECG-1: What do you think I said? Here is the computer interpretation (...) : This is what I said: "This is diagnostic of an acute inferior MI. There is upsloping ST elevation in III, with reciprocal ST depression in aVL. You do NOT see this in normal variant STE, nor in pericarditis. The only time you see this without ischemia is when there is an abnormal QRS, such as LVH, LBBB, LV aneurysm (old MI with persistent STE) or WPW." This was not seen by the providers. He had another ECG 2 hours and 45 minutes later, before being admitted to the ICU: ECG-2: Now it is more obvious

2019 Dr Smith's ECG Blog

140. Chest pain resolved, and a "Normal" ED ECG

Chest pain resolved, and a "Normal" ED ECG Dr. Smith's ECG Blog: Chest pain resolved, and a "Normal" ED ECG Friday, March 8, 2019 A previously healthy middle-aged male presented shortly after the acute onset of chest pain very shortly before calling 911. On arrival, he was pain free: What do you think? There is a very subtle inferior MI. Some may quibble that this ECG is not diagnostic of MI (although I would say it is "all but diagnostic.") Notice the computer called it normal (...) -- but it is clearly not normal. The computer should at least call this "Nonspecific ST-T abnormalities." Jerry Jones commented: "Any ST depression on the ECG of a patient with chest pain credible for ACS represents a reciprocal change until proved otherwise." And also: " I have, for many years now, taken exception to the term "non-specific ST-T changes."" There is a finality to that term that suggests "inconsequential, unimportant, pay-no-attention or let's-move-on." I prefer the term "unexplained ST-T changes

2019 Dr Smith's ECG Blog

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