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Electrocardiogram

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141. Noninvasive long-term ECG monitoring vs. loop recorder implantation for the atrial fibrillation management. Full Text available with Trip Pro

Noninvasive long-term ECG monitoring vs. loop recorder implantation for the atrial fibrillation management. The objective of the study was to estimate the efficacy of a noninvasive ambulatory ECG monitoring (NIAM) in comparison with implantable loop recorder (ILR) in patients with atrial fibrillation (AF).Thirty-two patients 58 [47; 73] years of age with AF were included in the study. Patients were randomized into two groups: in group I (n = 15), "Reveal XT" ILR was used for invasive ECG (...) %; and negative predictive value-79.2%. The same parameters in ILR group were comparable with NIAM: sensitivity-78.6%; specificity-69%; positive predictive value-71%; and negative predictive value-77%. At the same time, continued monitoring with ILR for longer than two weeks did not lead to a significant change in the sensitivity and specificity of the method.In patients with paroxysmal AF, the diagnostic value of both NIAM and ILR is comparable. An increase in the duration of ECG monitoring for longer than

2019 Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc Controlled trial quality: uncertain

142. Evaluation of the Effect of 5 QT-Positive Drugs on the JTpeak Interval - An Analysis of ECGs From the IQ-CSRC Study. (Abstract)

Evaluation of the Effect of 5 QT-Positive Drugs on the JTpeak Interval - An Analysis of ECGs From the IQ-CSRC Study. The JTpeak interval has been proposed as a new biomarker to demonstrate mixed ion channel effects, potentially leading to reduced late-stage electrocardiogram (ECG) monitoring for mildly QT-prolonging drugs. ECG waveforms from the IQ-CSRC study were used. Twenty healthy subjects were enrolled with 6 subjects on placebo and 9 subjects on each of 5 mildly QT-prolonging drugs (...) - moxifloxacin, dofetilide, ondansetron, dolasetron, and quinine - and 1 negative drug, levocetirizine. A vector magnitude lead was derived from 12-lead ECGs, and measurements were made on a median beat from three 10-second replicates. Data were analyzed using a linear concentration-response model with QTcF and heart rate corrected JTpeak (JTpeak_c) as dependent variables. For moxifloxacin, dofetilide, and ondansetron, all pure hERG blockers, slopes of the concentration (C)-QTcF and C-JTpeak_c relationships

2019 Journal of clinical pharmacology Controlled trial quality: uncertain

143. Role of coronary angiography in patients with a non-diagnostic electrocardiogram following out of hospital cardiac arrest: Rationale and design of the multicentre randomized controlled COUPE trial. (Abstract)

Role of coronary angiography in patients with a non-diagnostic electrocardiogram following out of hospital cardiac arrest: Rationale and design of the multicentre randomized controlled COUPE trial. Coronary artery disease (CAD) is a major cause of out-of-hospital cardiac arrest (OHCA). The role of emergency coronary angiography (CAG) and percutaneous coronary intervention (PCI) following cardiac arrest in patients without ST-segment elevation myocardial infarction (STEMI) remains unclear.We aim

2019 European heart journal. Acute cardiovascular care Controlled trial quality: uncertain

144. Unique electrocardiographic pattern "w" wave in lead I of idiopathic ventricular arrhythmias arising from the distal great cardiac vein. Full Text available with Trip Pro

Unique electrocardiographic pattern "w" wave in lead I of idiopathic ventricular arrhythmias arising from the distal great cardiac vein. The ECG characteristics of the distal coronary venous system ventricular arrhythmias (VAs) share common features with VAs arising from the aortic cusps or the endocardial left ventricular outflow tract (LVOT) beneath the cusps. The purpose of this study was to identify specific electrocardiographic and electrophysiological characteristics of VAs originating

2019 BMC Cardiovascular Disorders

145. ECG-based Cardiac Screening Programs: Legal, Ethical and Logistical Considerations. (Abstract)

ECG-based Cardiac Screening Programs: Legal, Ethical and Logistical Considerations. Screening asymptomatic people with a resting electrocardiogram (ECG) has been theorised to detect latent cardiovascular disease. However, resting ECG screening is not recommended for numerous populations, such as asymptomatic middle-aged (sedentary) people, as it is not sufficiently sensitive to detect coronary artery disease. While the issues raised in this article are largely common to all screening programs (...) the beginning to end of the process. This includes consideration of who to screen, timing of screening, whether it is mandatory, consent issues, and auditing systems to ensure quality control. Good infrastructure for interpretation of ECG results according to expert guidelines, and follow-up testing for abnormal screening results, including a pathway to treatment, are essential. Finally, there may be significant implications for those diagnosed with cardiac disease, including insurance, employment

2019 Heart Rhythm

146. How to Use the 12-lead ECG to Predict the Site of Origin of Idiopathic Ventricular Arrhythmias. (Abstract)

How to Use the 12-lead ECG to Predict the Site of Origin of Idiopathic Ventricular Arrhythmias. Idiopathic ventricular arrhythmias (VAs) may arise from anywhere in the heart and the majority of them can be effectively treated with catheter ablation. The 12-lead electrocardiogram (ECG) is the initial mapping tool to predict the most likely site of origin and is valuable to choose the appropriate ablation strategy. Crucial to ECG interpretation is understanding the attitudinal orientation (...) of the heart within the chest and the relationship between the different cardiac structures. In this review, we provide a stepwise anatomical approach for localization of idiopathic VAs based on sequential analysis of most relevant ECG features.Copyright © 2019. Published by Elsevier Inc.

2019 Heart Rhythm

147. Atypical and delayed de Winter electrocardiograph pattern: A case report. Full Text available with Trip Pro

Atypical and delayed de Winter electrocardiograph pattern: A case report. de Winter electrocardiograph (ECG) pattern signifies proximal left anterior descending coronary artery (LAD) occlusion and extensive anterior myocardial infarction, and it is found in about 2% of patients with proximal LAD occlusion. However, it is often unrecognized by physicians. In this case report, we present a patient with chest pain but showing an atypical and delayed de Winter ECG pattern.A previously healthy 61 (...) -year-old man attended our emergency department with chest pain radiating to the left arm and back for 4 hours, who was without serious cardiovascular risk factors. ECG at emergency department showed no significant changes. High-sensitivity cardiac troponin I (hs-cTnI) was within normal limit.At 5 hours after onset, ECG showed significant upsloping ST depression at J point in precordial leads V3 to V6, slight ST elevation in aVR and depression in inferior leads, and hs-cTnI peaked at 2.610 μg/L

2019 Medicine

148. Simultaneous Comparison of Electrocardiographic Imaging and Epicardial Contact Mapping in Structural Heart Disease. Full Text available with Trip Pro

Simultaneous Comparison of Electrocardiographic Imaging and Epicardial Contact Mapping in Structural Heart Disease. The accuracy of ECG imaging (ECGI) in structural heart disease remains uncertain. This study aimed to provide a detailed comparison of ECGI and contact-mapping system (CARTO) electrograms.Simultaneous epicardial mapping using CARTO (Biosense-Webster, CA) and ECGI (CardioInsight) in 8 patients was performed to compare electrogram morphology, activation time (AT), and repolarization

2019 Circulation. Arrhythmia and electrophysiology

149. Contribution of Electrocardiographic Accelerated Ventricular Rhythm Alarms to Alarm Fatigue. Full Text available with Trip Pro

Contribution of Electrocardiographic Accelerated Ventricular Rhythm Alarms to Alarm Fatigue. Excessive electrocardiographic alarms contribute to "alarm fatigue," which can lead to patient harm. In a prior study, one-third of audible electrocardiographic alarms were for accelerated ventricular rhythm (AVR), and most of these alarms were false. It is uncertain whether true AVR alarms are clinically relevant.To determine from bedside electrocardiographic monitoring data (1) how often true AVR

2019 American Journal of Critical Care

150. ECG alterations suggestive of hyperkalemia in normokalemic versus hyperkalemic patients. Full Text available with Trip Pro

ECG alterations suggestive of hyperkalemia in normokalemic versus hyperkalemic patients. In periarrest situations and during resuscitation it is essential to rule out reversible causes. Hyperkalemia is one of the most common, reversible causes of periarrest situations. Typical electrocardiogram (ECG) alterations may indicate hyperkalemia. The aim of our study was to compare the prevalence of ECG alterations suggestive of hyperkalemia in normokalemic and hyperkalemic patients.170 patients (...) with normal potassium (K+) levels and 135 patients with moderate (serum K+ = 6.0-7.0 mmol/l) or severe (K+ > 7.0 mmol/l) hyperkalemia, admitted to the Department of Emergency Medicine at the Somogy County Kaposi Mór General Hospital, were selected for this retrospective, cross-sectional study. ECG obtained upon admission were analyzed by two emergency physicians, independently, blinded to the objectives of the study. Statistical analysis was performed using SPSS22 software. χ2 test and Fischer exact tests

2019 BMC Emergency Medicine

151. An emergency ECG sign of ST elevation myocardial infarction. Full Text available with Trip Pro

artery.Recognition of this atypical electrocardiogram (ECG) pattern can ensure immediate reperfusion therapy regarding acute myocardial infarction. (...) An emergency ECG sign of ST elevation myocardial infarction. The occlusion of the left anterior descending coronary artery (LAD) is usually characterized by the ST-segment elevation associated with a tall and peaked T wave in precordial leads.We reported a case who suffered from typical chest pain and tall and positively symmetrical T waves in leads V2-6, J point depression with upsloping ST-segment depression. However, the coronary angiogram demonstrated a 100% occlusion of midshaft LAD

2019 BMC Cardiovascular Disorders

152. Hemodynamic and ECG responses to stress test in early adolescent athletes explain ethnicity-related cardiac differences. (Abstract)

Hemodynamic and ECG responses to stress test in early adolescent athletes explain ethnicity-related cardiac differences. Ethnicity is an important determinant of athletes' cardiovascular adaptation. Black adolescent and adult athletes exhibit a left ventricular (LV) hypertrophy with a concentric remodelling higher than their Caucasian counterparts. Scant data, however, are available on race-related differences in hemodynamic response of adolescent athletes to exercise and its relation (...) thickness (RWT) implying a concentric remodelling. BA showed higher systolic blood pressure (SBP) compared to WA during the whole exercise test. ECG data showed that BA vs WA had a significant shorter QRS duration in each step considered with a significant greater QT dispersion. BA reached a higher relative pressure peak as compared to WA. RWT was strongly influenced by ethnicity and less by SBP at peak of exercise (PE), although LVM/BSA was significantly related to SBP at PE and just marginally to age

2019 International journal of cardiology

153. Prevalence and Cost of Care Cascades After Low-Value Preoperative Electrocardiogram for Cataract Surgery in Fee-for-Service Medicare Beneficiaries. (Abstract)

-value service, preoperative electrocardiogram (EKG) for patients undergoing cataract surgery.Observational cohort study using fee-for-service Medicare claims data from beneficiaries aged 66 years or older without known heart disease who were continuously enrolled between April 1, 2013, and September 30, 2015, and underwent cataract surgery between July 1, 2014 and June 30, 2015. Data were analyzed from March 12, 2018, to April 9, 2019.Receipt of a preoperative EKG. The comparison group included (...) Prevalence and Cost of Care Cascades After Low-Value Preoperative Electrocardiogram for Cataract Surgery in Fee-for-Service Medicare Beneficiaries. Low-value care is prevalent in the United States, yet little is known about the downstream health care use triggered by low-value services. Measurement of such care cascades is essential to understanding the full consequences of low-value care.To describe cascades (tests, treatments, visits, hospitalizations, and new diagnoses) after a common low

2019 JAMA Internal Medicine

154. Prognostic value of electrocardiography in elderly patients with acute pulmonary embolism. (Abstract)

Prognostic value of electrocardiography in elderly patients with acute pulmonary embolism. Electrocardiographic (ECG) signs of right ventricular strain could be used as a simple tool to risk-stratify patients with acute pulmonary embolism.We studied consecutive patients aged ≥65years with acute pulmonary embolism in a prospective multicenter cohort study. Two readers independently analyzed 12 predefined ECG signs of right ventricular strain in all patients. The outcome was the occurrence (...) of an adverse clinical event, defined as death from any cause within 90days or a complicated in-hospital course. We determined the interrater reliability for each ECG sign and examined the association between right ventricular strain signs and adverse events using logistic regression, adjusting for the Pulmonary Embolism Severity Index and cardiac troponin.Overall, 320/390 patients (82%) showed at least one ECG sign of right ventricular strain. The interrater reliability for individual ECG signs was highly

2019 American Journal of Medicine

155. Prehospital ECG transmission results in shorter door-to-wire time for STEMI patients in a remote mountainous region. (Abstract)

with ECG-transmission were enrolled in the study and compared with controls: patients' demographics and time to coronary wire were recorded.Forty-seven consecutive patients were enrolled in the study: 23 patients following ECG transmission and 24 STEMI patients who presented directly to the Emergency Department. At multivariable regression analysis, pre-hospital ECG-transmission electrocardiogram was an independent predictor of shorter time-to-wire (beta -0.34, p < 0.05). In case of transport times (...) Prehospital ECG transmission results in shorter door-to-wire time for STEMI patients in a remote mountainous region. Pre-hospital triage with ECG-transmission may reduce time to reperfusion in patients with ST-elevation acute myocardial infarction (STEMI). Less, however, is known on potential benefit of ECG-transmission triage in mountain areas, with complex orography.Patients admitted for STEMI and primary coronary angioplasty (pPCI) in a mountain area served by a single cathlab and triaged

2019 American Journal of Emergency Medicine

156. Underuse of ECG monitoring in oncology patients receiving QT-interval prolonging drugs. (Abstract)

Underuse of ECG monitoring in oncology patients receiving QT-interval prolonging drugs. We examined use of ECG monitoring in oncology patients prescribed QT-prolonging drugs.Patients ≥66 years diagnosed with cancer between 2005 and 2011 were identified through the Ontario Cancer Registry and linked to multiple population-based administrative databases to ascertain demographics, comorbidities, prescription drug use, systemic therapy and ECG. QT-prolonging drugs were identified as per drug lists (...) developed by the Arizona Center for Education and Research on Therapeutics. Univariable and multivariable analyses were used to examine factors associated with ECG use in patients on first-line systemic therapy.A total of 48 236 patients (median age 74; 49% women) received one or more drugs associated with a risk of QT-interval prolongation but only 27% of patients had an ECG performed. Factors associated with more ECG use on multivariable analysis included recent cancer diagnosis (p for trend <0.001

2019 Heart

157. Electrocardiographic landmarks of idiopathic ventricular arrhythmia origins. (Abstract)

Electrocardiographic landmarks of idiopathic ventricular arrhythmia origins. Idiopathic ventricular arrhythmias occur in the absence of underlying structural heart disease and less commonly in the presence of coexistent, but mechanistically unrelated, myocardial scar. These arrhythmias originate from several anatomical sites in both ventricles, with a predilection in outflow tract structures. The 12-lead surface ECG is the initial mapping tool, which is widely used to identify their origin (...) . Specific features can predict the site of idiopathic ventricular arrhythmias, thus differentiating right from left ventricular, as well as endocardial from epicardial origins. In this review, we aim to analyse electrocardiographic landmarks for determination of idiopathic ventricular arrhythmia sources, with specific emphasis on pertinent caveats and anatomical relationships.© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.

2019 Heart

158. Clinical implications of electrocardiographic bundle branch block in primary care. Full Text available with Trip Pro

Clinical implications of electrocardiographic bundle branch block in primary care. Electrocardiographic bundle branch block (BBB) is common but the prognostic implications in primary care are unclear. We sought to investigate the relationship between electrocardiographic BBB subtypes and the risk of cardiovascular (CV) outcomes in a primary care population free of major CV disease.Retrospective cohort study of primary care patients referred for electrocardiogram (ECG) recording between 2001

2019 Heart

159. Daily Electrocardiogram Electrode Change and the Effect on Frequency of Nuisance Alarms. (Abstract)

Daily Electrocardiogram Electrode Change and the Effect on Frequency of Nuisance Alarms. In 2018, The Joint Commission identified false telemetry alarms as a significant technology hazard placing patients at risk of injury. Reasons include poor skin preparation when applying electrodes and improper placement of electrodes.The purpose of this quality improvement project was to determine if changing electrocardiogram electrodes daily would decrease the frequency of nuisance alarms.Study design (...) was quantitative/comparative on all patients receiving telemetry monitoring on a 36-bed adult inpatient cardiac telemetry unit. Data collection occurred for 14 days before the intervention and 14 days during the intervention of daily electrode change. Comparison analysis determined if frequency of alarms decreased after the intervention with daily electrode change.Postintervention data showed a 74.15% reduction in telemetry alarms following implementation of a daily electrode change.Daily electrocardiogram

2019 Dimensions of critical care nursing

160. Increased prevalence of ECG suspicious for Brugada Syndrome in recent onset schizophrenia spectrum disorders. (Abstract)

Increased prevalence of ECG suspicious for Brugada Syndrome in recent onset schizophrenia spectrum disorders. Schizophrenia is associated with an increased risk of sudden cardiac death, traditionally attributed to prolonged QTc interval and increased prevalence of cardiovascular risk factors. However, defective ion channels implicated in both schizophrenia and Brugada Syndrome (BrS) may be associated with an increased risk of cardiac arrhythmias. Moreover, these cardiac arrhythmias can (...) be provoked by various drugs, including psychotropic drugs.To assess the prevalence of the occurrence of ECG suspicious for BrS (suspect BrS-ECG) and the prevalence of BrS in patients with recent onset schizophrenia spectrum disorders (SSD).In this case-control study, ECGs of 388 patients with recent onset SSD admitted between 2006 and 2015 and 844 healthy controls were made. All persons who had a suspect BrS-ECG were offered an ajmaline provocation test to diagnose or exclude BrS. Data on possible

2019 Schizophrenia Research

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