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1.
Bol. méd. Hosp. Infant. Méx ; 79(5): 334-339, Sep.-Oct. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1403658

ABSTRACT

Abstract Background: Atrial flutter is a rare condition in pediatrics that usually occurs as a late complication after surgery for congenital heart diseases, although it can also appear in structurally normal hearts. Clinical cases: We conducted a retrospective study of cases of atrial flutter with no structural heart disease diagnosed in a pediatric population (between 0 and 15 years of age) during 2015-2021 in a tertiary hospital. A total of seven cases were diagnosed, with a clear predominance of males (6/7). Of the seven patients, five debuted in the perinatal period: two were diagnosed at 20 and 36 hours of life, and three, prenatally. Among these perinatal cases, more than half (3/5) were preterm. The treatment was electrical cardioversion. The evolution was satisfactory in these cases, and there were no tachycardias in their subsequent development. In contrast, when the debut occurred at a later age (5-7 years), it was associated with channelopathy (Brugada syndrome and catecholaminergic polymorphic ventricular tachycardia), and electrical ablation of the ectopic focus was required due to poor response to pharmacological treatment. Conclusions: This study confirms the low incidence of this pathology in pediatrics and the benignity and good prognosis of neonatal flutter in most cases. The prognosis worsens when atrial flutter is diagnosed in older children, and the probability of concomitant associated heart disease increases.


Resumen Introducción: El flutter o aleteo auricular es una patología poco frecuente en pediatría que suele presentarse como complicación tardía tras la cirugía de cardiopatías congénitas, aunque también puede aparecer en corazones estructuralmente normales. Casos clínicos: Se llevó a cabo un estudio retrospectivo de los casos de flutter auricular sin cardiopatía estructural diagnosticados en una población pediátrica (entre 0 y 15 años de edad) durante el periodo 2015-2021 en un hospital terciario. En total fueron diagnosticados siete casos, con un claro predominio de varones (6/7). De los siete, cinco debutaron en periodo perinatal: dos fueron diagnosticados a las 20 y 36 horas de vida y tres de ellos, prenatalmente. Entre estos casos perinatales, más de la mitad (3/5) fueron pretérmino. El tratamiento fue la cardioversión eléctrica. La evolución fue satisfactoria en estos casos, y no se presentaron taquicardias en su evolución posterior. Por el contrario, cuando el debut se produjo en edades posteriores (5-7 años), se asoció con canalopatía (síndrome de Brugada y taquicardia ventricular polimorfa catecolaminérgica) que requirió de una ablación eléctrica del foco ectópico por escasa respuesta al tratamiento farmacológico. Conclusiones: En este trabajo se confirma la baja incidencia de esta patología en pediatría, además de la benignidad y el buen pronóstico de flutter neonatal en la mayoría de casos. Cuando el diagnóstico se realiza en niños mayores, el pronóstico empeora, y aumenta la probabilidad de presentar de forma concomitante cardiopatías asociadas.

2.
Rev. Assoc. Med. Bras. (1992, Impr.) ; 68(10): 1441-1446, Oct. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1406553

ABSTRACT

SUMMARY OBJECTIVE: The main objectives of this investigation were to determine whether there were any relationships between corrected cardiac-electrophysiological balance value and National Institutes of Health Stroke Scale scores at admission and discharge in patients with acute ischemic stroke and to assess whether cardiac-electrophysiological balance value was an independent predictor of high National Institutes of Health Stroke Scale scores (National Institutes of Health Stroke Scale score ≥5). METHODS: In this retrospective and observational study, 231 consecutive adult patients with acute ischemic stroke were evaluated. The cardiac-electrophysiological balance value was obtained by dividing the corrected QT interval by the QRS duration measured from surface electrocardiography. An experienced neurologist used the National Institutes of Health Stroke Scale score to determine the severity of the stroke at the time of admission and before discharge from the neurology care unit. The participants in the study were categorized into two groups: those with minor acute ischemic stroke (National Institutes of Health Stroke Scale score=1-4) and those with moderate-to-severe acute ischemic stroke (National Institutes of Health Stroke Scale scores ≥5). RESULTS: Acute ischemic stroke patients with National Institutes of Health Stroke Scale score ≥5 had higher heart rate, QT, corrected QT interval, T-peak to T-end corrected QT interval, cardiac-electrophysiological balance, and cardiac-electrophysiological balance values compared with those with an National Institutes of Health Stroke Scale score of 1-4. The cardiac-electrophysiological balance value was shown to be independently related to National Institutes of Health Stroke Scale scores ≥5 (OR 1.102, 95%CI 1.036-1.172, p<0.001). There was a moderate correlation between cardiac-electrophysiological balance and National Institutes of Health Stroke Scale scores at admission (r=0.333, p<0.001) and discharge (r=0.329, p<0.001). CONCLUSIONS: The findings of this study demonstrated that the cardiac-electrophysiological balance value was related to National Institutes of Health Stroke Scale scores at admission and discharge. Furthermore, an elevated cardiac-electrophysiological balance value was found to be an independent predictor of National Institutes of Health Stroke Scale score ≥5.

3.
Medwave ; 22(8): e2646, 30/09/2022.
Article in English | LILACS-Express | LILACS | ID: biblio-1396251
4.
Rev. Assoc. Med. Bras. (1992, Impr.) ; 68(8): 1059-1063, Aug. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1406612

ABSTRACT

SUMMARY OBJECTIVE: This study aimed to evaluate the agreement in the indication of implantable cardioverter-defibrillators in patients with Hypertrophic cardiomyopathy, as per the 2014 European Society of Cardiology and 2020 American Heart Association recommendations, and evaluate fragmented QRS as a predictor of cardiovascular outcome. METHODS: Retrospective cohort with 81 patients was evaluated between 2019 and 2021. Patients with hypertrophic cardiomyopathy ≥16 years old were included. Exclusion criteria include secondary myocardiopathy and follow-up <1 year. Kappa coefficient was used to determine the agreement. Survival and incidence curves were determined by Kaplan-Meier method. A p<0.05 was considered significant. RESULTS: The fragmented QRS was identified in 44.4% of patients. There were no differences between patients with and without fragmented QRS regarding clinical parameters, echocardiography, fibrosis, and sudden cardiac death risk. During follow-up of 4.8±3.4 years, there was no sudden cardiac death, but 20.6% patients with implantable cardioverter-defibrillator had at least one appropriate shock. Three of the seven appropriate shocks occurred in European Society of Cardiology low- to moderate-risk patients. Three shocks occurred in moderate-risk patients and four in American Heart Association high-risk patients. Overall recommendations agreement was 64% with a kappa of 0.270 (p=0.007). C-statistic showed no differences regarding the incidence of appropriate shock (p=0.644). CONCLUSION: sudden cardiac death risk stratification algorithms present discrepancies in implantable cardioverter-defibrillator indication, both with low accuracy.

5.
Rev. chil. cardiol ; 41(2)ago. 2022.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1407760

ABSTRACT

Resumen La ablación con radiofrecuencia (RF) o con Criobalón (CRIO) en pacientes con fibrilación auricular (FA) paroxística y persistente es un tratamiento seguro y eficaz en pacientes seleccionados. Datos recientes demuestran que la ablación proporciona mejores resultados en comparación con fármacos antiarrítmicos (FAA) en el tratamiento de la FA temprana. Los estudios que comparan RF y CRIO mostraron una eficacia y seguridad comparables en el aislamiento de venas pulmonares (PVI) para pacientes con FA paroxística sintomática. Objetivos: Revisar estudios clínicos que comparan el tratamiento de la FA con ablación versus FAA como terapia de primera línea en pacientes con FA sin tratamiento previo. La eficacia y la seguridad se compararán entre las dos cohortes y entre los subgrupos. Método: Se incluye un total de 6 estudios en los que participaron 1212 pacientes con FA: 609 pacientes fueron aleatorizados a ablación de FA y 603 a tratamiento farmacológico En comparación con el tratamiento con FAA, la ablación se asoció con una reducción en la recurrencia de arritmias auriculares (32,3 % frente a 53 %; riesgo relativo [RR], 0,62; IC del 95 %, 0,51-0,74; P < 0,001; I 2 = 40 %, NNT: 5). El uso de ablación también se asoció con una reducción de las arritmias auriculares sintomáticas (11,8 % frente a 26,4 %; RR, 0,44; IC del 95 %, 0,27-0,72; P = 0,001; I 2 = 54%) y hospitalización (5,6% vs 18,7%; RR, 0,32; IC 95%, 0,19-0,53; P< 0,001) sin diferencias significativas en los eventos adversos graves entre los grupos (4,2 % frente a 2,8 %; RR, 1,52; IC del 95 %, 0,81-2,85; P = 0,19). Conclusión: En pacientes con FA paroxística, una estrategia de control precoz del ritmo cardíaco, se asocia con una mayor probabilidad de supervivencia, menos procedimientos repetidos, menos hospitalizaciones y, probablemente, una disminución en la progresión a FA persistente.


Abstract Introduction: Radiofrequency (RF) or cryoballoon (CRYO) ablation in patients with paroxysmal and persistent atrial fibrillation (AF) are safe and effective treatments in selected patients. Recent data show that ablation provides better results compared to antiarrhythmic drugs (AAD) in the treatment of early AF. Studies comparing RF and CRYO showed comparable efficacy and safety in pulmonary vein isolation (PVI) for patients with symptomatic paroxysmal AF. Objectives: Review of clinical trials comparing treatment of AF with ablation versus AAD as first-line therapy in patients with AF with no previous treatment. Efficacy and safety are compared between the two cohorts and between subgroups. Methods: A total of 6 studies involving -212 AF patients were included: 609 were randomized to AF ablation and 603 to pharmacological treatment. Ablation, compared with AAD, was associated with a reduction in recurrence of atrial arrhythmias (32.3% vs. 53%; relative risk [RR], 0.62; 95% CI, 0.51-0.74, P< 0.001, I2 = 40%, NNT: 5). The use of ablation was also associated with a reduction in symptomatic atrial arrhythmias (11.8% vs. 26.4%; RR, 0.44; 95% CI, 0.27-0.72; P= 0.001; I2 = 54%) and hospitalization (5.6% vs 18.7%; RR, 0.32; 95% CI, 0.19-0.53; P <0.001) with no significant differences in major adverse events (4.2% vs. 2.8%; RR, 1.52; 95% CI, 0.81-2.85; P=0.19). Conclusion: In patients with paroxysmal AF, an early cardiac rhythm control with ablation is associated with a higher probability of survival, fewer repeat procedures, fewer hospitalizations, and probably a decrease in progression to persistent AF.

6.
Nursing (Säo Paulo) ; 25(290): 8183-8194, julho.2022.
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1379914

ABSTRACT

Objetivo: as arritmias cardíacas acometem mais de 20 milhões de brasileiros, desse modo, o presente estudo objetiva realizar um levantamento sobre as intervenções de enfermagem diante de um quadro de arritmia em ambiente hospitalar. Método: trata-se de revisão integrativa de literatura de caráter descritivo, realizada entre janeiro e fevereiro de 2022. Por meio de buscas na biblioteca virtual de saúde BVS (Lilacs, Medline, BDEnf, IBECs, PAHO) e Scielo BDenf de artigos publicados nos últimos 5 anos. Resultados: os enfermeiros têm aptidão para identificar anormalidades no ritmo cardíaco. A compreensão das complicações pós-operatórias contribui para a elaboração de um plano de cuidado mais eficaz. As intervenções de enfermagem devem ser pautadas no monitoramento da arritmia, bem como orientação sobre o uso dos antiarrítmicos e esclarecimento de dúvidas sobre a doença. Conclusão: é imprescindível a atuação do enfermeiro na assistência a pacientes com arritmias cardíacas, o qual necessitam monitorar os sinais vitais para determinar o efeito hemodinâmico de tal problema cardíaco, manter uma atitude tranquilizadora e compartilhar informações sobre a patologia e seu tratamento.(AU)


Objective: cardiac arrhythmias affect more than 20 million Brazilians, thus, the present study aims to carry out a survey on nursing interventions in the face of arrhythmia in a hospital environment. Method: Method: this is an integrative literature review of a descriptive nature, carried out between January and February 2022. Through searches in the virtual health library VHL (Lilacs, Medline, BDEnf, IBECs, PAHO) and Scielo. Results: nurses are able to identify heart rhythm abnormalities. Understanding postoperative complications contributes to the development of a more effective care plan. Nursing interventions should be guided by the monitoring of arrhythmia, as well as guidance on the use of antiarrhythmics and clarification of doubts about the disease. Conclusion: it is essential for nurses to assist patients with cardiac arrhythmias, who need to monitor vital signs to determine the hemodynamic effect of such a heart problem, maintain a reassuring attitude and share information about the pathology and its treatment.(AU)


Objetivo: las arritmias cardíacas afectan a más de 20 millones de brasileños, por lo tanto, el presente estudio tiene como objetivo realizar una encuesta sobre las intervenciones de enfermería frente a la arritmia en un ambiente hospitalario. Método: se trata de una revisión integrativa de la literatura de carácter descriptivo, realizada entre enero y febrero de 2022. Mediante búsquedas en la biblioteca virtual en salud BVS (Lilacs, Medline, BDEnf, IBECs, PAHO) y Scielo. Resultados: los enfermeros logran identificar alteraciones del ritmo cardíaco. Comprender las complicaciones posoperatorias contribuye al desarrollo de un plan de atención más eficaz. Las intervenciones de enfermería deben estar guiadas por el seguimiento de la arritmia, así como orientación sobre el uso de antiarrítmicos y aclaración de dudas sobre la enfermedad. Conclusión: es fundamental que los enfermeros ayuden a los pacientes con arritmias cardíacas, que necesitan monitorear los signos vitales para determinar el efecto hemodinámico de tal problema cardíaco, mantener una actitud tranquilizadora y compartir información sobre la patología y su tratamiento.(AU)


Subject(s)
Arrhythmias, Cardiac , Nursing Care
7.
Arq. bras. cardiol ; 119(1): 87-94, abr. 2022. tab, graf
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1383725

ABSTRACT

Resumo Fundamento A ablação por cateter é uma terapia bem estabelecida para controle do ritmo cardíaco em pacientes refratários ou intolerantes a drogas antiarrítmicas (DAA). Porém, a eficácia desse procedimento comparada à de DAA como estratégia de primeira linha no controle do ritmo cardíaco na fibrilação atrial é menos conhecida. Objetivos Conduzir uma revisão sistemática e metanálise da ablação por cateter vs. DAA em pacientes sem nenhum tratamento prévio para controle do ritmo. Métodos Buscamos, nos bancos de dados do PubMed, EMBASE, e Cochrane, ensaios randomizados controlados que compararam ablação por cateter com DAA para controle do ritmo cardíaco em pacientes com FA sintomática e descreveram os seguintes desfechos: (1) recorrência de taquiarritmia atrial (TA); (2) FA sintomática; (3) internações hospitalares; e (4) bradicardia sintomática. A heterogeneidade foi avaliada por estatística I2. Valores de p menores que 0,05 foram considerados estatisticamente significativos. Resultados Incluímos cinco ensaios com 994 pacientes, dos quais 502 (50,5%) foram submetidos à ablação por cateter. O período médio de acompanhamento foi de um a cinco anos. Recorrências de TA (OR 0,36; IC95% 0,25-0,52; p<0,001) e de FA sintomática (OR 0,32; IC95% 0,18-0,57; p<0,001), e internações hospitalares (OR 0,25; IC95% 0,15-0,42; p<0,001) foram menos frequentes nos pacientes tratados com ablação por cateter que naqueles tratados com DAA. Bradicardia sintomática não foi diferente entre os grupos (OR 0,55; IC95% 0,18-1,65; p=0,28). Derrame ou tamponamento pericárdico significativo ocorreu em oito dos 464 (1,7%) pacientes no grupo submetido à ablação. Conclusão Esses achados sugerem maior eficácia da ablação por cateter que das DAA como estratégia inicial de controle do ritmo cardíaco em pacientes com DA sintomática.


Abstract Background Catheter ablation is a well-established therapy for rhythm control in patients who are refractory or intolerant to anti-arrhythmic drugs (AAD). Less is known about the efficacy of catheter ablation compared with AAD as a first-line strategy for rhythm control in atrial fibrillation (AF). Objectives We aimed to perform a systematic review and meta-analysis of catheter ablation vs. AAD in patients naïve to prior rhythm control therapies. Methods PubMed, EMBASE, and Cochrane databases were searched for randomized controlled trials that compared catheter ablation to AAD for initial rhythm control in symptomatic AF and reported the outcomes of (1) recurrent atrial tachyarrhythmias (ATs); (2) symptomatic AF; (3) hospitalizations; and (4) symptomatic bradycardia. Heterogeneity was examined with I2statistics. P values of < 0.05 were considered statistically significant. Results We included five trials with 994 patients, of whom 502 (50.5%) underwent catheter ablation. Mean follow-up ranged from one to five years. Recurrences of AT (OR 0.36; 95% CI 0.25-0.52; p<0.001) and symptomatic AF (OR 0.32; 95% CI 0.18-0.57; p<0.001), and hospitalizations (OR 0.25; 95% CI 0.15-0.42; p<0.001) were significantly less frequent in patients treated with catheter ablation compared with AAD. Symptomatic bradycardia was not significantly different between groups (OR 0.55; 95% CI 0.18-1.65; p=0.28). Significant pericardial effusions or tamponade occurred in eight of 464 (1.7%) patients in the catheter ablation group. Conclusion These findings suggest that catheter ablation has superior efficacy to AAD as an initial rhythm control strategy in patients with symptomatic AF.

8.
Article in Chinese | WPRIM | ID: wpr-932664

ABSTRACT

Objective:To introduce the stereotactic cardiac radioablation (SCRA) based on the stereotactic body radiotherapy (SBRT), and comprehensively evaluate the new approach by short-term effectiveness and safety.Methods:Patients with ventricular arrhythmia (VA) were evaluated and included in this clinical trial, who were immobilized by vacuum bag and performed simulation with 4-dimensional computed tomography (4DCT). In this study, the planning target volume (PTV) was set as the target to design a SBRT plan using volumetric modulated arc therapy (VMAT), which was evaluated by dose parameters such as R 50%, homogeneity index and conformity index, etc. The results of Holter and echocardiography were monitored during the follow-up and compared with the data before treatment. Results:Three subjects with ventricular tachycardia (VT) and one with premature ventricular contraction (PVC) received the same prescription of 25 Gy in a single fraction. The average volume of PTV was 71.4 cm 3(60.3-89.4 cm 3). The average time of beam delivery was 12.0 min (4.5-21.0 min). And the short-term follow-up lasted for an average of 18 weeks (14-25 weeks), which showed significant decrease in both VT and PVC load without complications. Conclusion:This study reports the implementation method of SCRA and proves its short-term effectiveness and safety, but the effects and standards of the key radiotherapy techniques still need to be explored.

9.
Article in Chinese | WPRIM | ID: wpr-930795

ABSTRACT

Arrhythmia-induced cardiomyopathy(AIC) is an reversible dilated cardiomyopathy and appears to occur at any age.The morbidity of AIC is unclear and likely underestimated.The pathophysiology and mechanism of AIC is unknown.It is often difficult to determine whether arrhythmias are the cause or result of cardiac dysfunction.The diagnosis of AIC can be only confirmed after recovery or improvement of cardiac function after elimination of the tachyarrhythmia.Tachycardias, ventricular premature contraction, left bundle branch block and ventricular preexcitation are known to trigger AIC.Appropriate diagnosis and treatment of AIC can reverse cardiac function.However, arrhythmia recurrence can lead to rapid recurrence of AIC and symptoms of heart failure.

10.
Article in Chinese | WPRIM | ID: wpr-930231

ABSTRACT

Objective:To evaluate the effect of gabapentin on myocardial ischemia-reperfusion injury and its mechanism.Methods:Sixty male clean SD rats, aged 10 weeks and weighing 250 g~300 g, were divided into 5 groups ( n=12) with 12 rats in each group by random number table method: Sham group, myocardial ischemia reperfusion group (group I/R), gabapentin group (group Gap), LY294002 group (group LY) and gabapentin +LY294002 group (group Gap +LY). The model of myocardial ischemia reperfusion injury was established by ligation of the left anterior descending coronary artery for 30 min and reperfusion for 120 min. Heart rate (HR), mean arterial pressure (MAP) and the rate pressure product (RPP) were recorded at baseline before ischemia (T 0) for 30 min (T 1) and reperfusion for 120 min (T 2) to evaluate hemodynamic changes during ischemia and reperfusion; The frequency of PVCs and VT/VF were recorded to evaluate the occurrence of arrhythmias during ischemia/reperfusion. TTC staining was used to detect myocardial infarction area. And the protein expression levels of PI3K and Akt in myocardial tissue were detected by Western blotting. Results:Compared with group I/R, the myocardial infarction area, PVCs and VT/VF times, and the protein expression levels of PI3K and p-Akt were significantly increased in group Gap ( P<0.05). Compared with group Gap, the area of myocardial infarction, the number of PVCs and VT/VF, and the protein expression of PI3K and p-Akt were significantly decreased in the group Gap +LY ( P<0.05). Conclusions:Gabapentin can alleviate myocardial ischemia-reperfusion injury, and its mechanism is related to the activation of PI3K-AKT signaling pathway.

11.
Article in Chinese | WPRIM | ID: wpr-940570

ABSTRACT

ObjectiveTo explore the material basis and mechanism of Nardostachyos Radix et Rhizoma (NRER)-Agrimoniae Herba (AH), the herbal pair effective in regulating the liver, invigorating Qi, and calming palpitations, in the treatment of premature ventricular contractions (PVCs) by network pharmacology and molecular docking. MethodThe chemical components and targets of NRER and AH were collected from the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP) combined with relevant literature. GeneCards,Online Mendelian Inheritance in Man(OMIM),and DrugBank were used to predict the potential targets against PVCs. STRING platform was used for protein-protein interaction (PPI) analysis. Metascape platform was used for Gene Ontology(GO) and Kyoto Encyclopedia of Genes and Genomes(KEGG) enrichment analysis. Cytoscape 3.8.0 was used to construct the NRER-AH component-potential target-signaling pathway network. The main target proteins underwent molecular docking to the active components of NRER-AH by AutoDock 4.2.6. ResultThe targets of nine active components in NRER-AH (such as quercetin,kaempferol,and acacetin) against PVCs mainly involved tumor necrosis factor (TNF),mitogen-activated protein kinase 1(MAPK1),and protein kinase B1(Akt1). The potential targets were mainly enriched in 26 signaling pathways,such as pathways in cancer and the advanced glycosylation end product (AGE)-receptor of advanced glycosylation end product(RAGE) signaling pathway. The results of molecular docking showed that the majority of the active components (92.59%) of NRER-AH had good binding activities with the main target proteins TNF,MAPK1,and Akt1. ConclusionThe active components of NRER-AH can regulate cardiac ion channels,resist inflammation, and combat oxidative stress to treat PVCs through multi-target and multi-pathway interventions. They can also improve symptoms related to depression and anxiety by inhibiting monoamine oxidase activity and protecting nerves from damage. This study is expected to provide research ideas and the theoretical basis for further exploring the material basis and mechanism of NRER-AH in the treatment of PVCs.

12.
Article in Chinese | WPRIM | ID: wpr-939625

ABSTRACT

The judgment of the type of arrhythmia is the key to the prevention and diagnosis of early cardiovascular disease. Therefore, electrocardiogram (ECG) analysis has been widely used as an important basis for doctors to diagnose. However, due to the large differences in ECG signal morphology among different patients and the unbalanced distribution of categories, the existing automatic detection algorithms for arrhythmias have certain difficulties in the identification process. This paper designs a variable scale fusion network model for automatic recognition of heart rhythm types. In this study, a variable-scale fusion network model was proposed for automatic identification of heart rhythm types. The improved ECG generation network (EGAN) module was used to solve the imbalance of ECG data, and the ECG signal was reproduced in two dimensions in the form of gray recurrence plot (GRP) and spectrogram. Combined with the branching structure of the model, the automatic classification of variable-length heart beats was realized. The results of the study were verified by the Massachusetts institute of technology and Beth Israel hospital (MIT-BIH) arrhythmia database, which distinguished eight heart rhythm types. The average accuracy rate reached 99.36%, and the sensitivity and specificity were 96.11% and 99.84%, respectively. In conclusion, it is expected that this method can be used for clinical auxiliary diagnosis and smart wearable devices in the future.


Subject(s)
Algorithms , Arrhythmias, Cardiac/diagnosis , Databases, Factual , Electrocardiography/methods , Heart Rate , Humans
13.
Article in Chinese | WPRIM | ID: wpr-928226

ABSTRACT

Electrocardiogram (ECG) can visually reflect the physiological electrical activity of human heart, which is important in the field of arrhythmia detection and classification. To address the negative effect of label imbalance in ECG data on arrhythmia classification, this paper proposes a nested long short-term memory network (NLSTM) model for unbalanced ECG signal classification. The NLSTM is built to learn and memorize the temporal characteristics in complex signals, and the focal loss function is used to reduce the weights of easily identifiable samples. Then the residual attention mechanism is used to modify the assigned weights according to the importance of sample characteristic to solve the sample imbalance problem. Then the synthetic minority over-sampling technique is used to perform a simple manual oversampling process on the Massachusetts institute of technology and Beth Israel hospital arrhythmia (MIT-BIH-AR) database to further increase the classification accuracy of the model. Finally, the MIT-BIH arrhythmia database is applied to experimentally verify the above algorithms. The experimental results show that the proposed method can effectively solve the issues of imbalanced samples and unremarkable features in ECG signals, and the overall accuracy of the model reaches 98.34%. It also significantly improves the recognition and classification of minority samples and has provided a new feasible method for ECG-assisted diagnosis, which has practical application significance.


Subject(s)
Algorithms , Arrhythmias, Cardiac/diagnosis , Electrocardiography , Humans , Memory, Short-Term , Neural Networks, Computer , Signal Processing, Computer-Assisted
14.
Acta Pharmaceutica Sinica ; (12): 1367-1374, 2022.
Article in Chinese | WPRIM | ID: wpr-924754

ABSTRACT

Drug-induced long QT syndrome (LQTS) has become an important clinical research topic, and the occurrence of acquired long QT syndrome (acLQTS) is mainly caused by drug inhibition of the human ether-α-go-go related gene (hERG) channel. The hERG gene encodes the α subunit of the fast-activating delayed rectifying potassium ion channel (Ikr), which plays an important role in the process of action potential phase 3 repolarization and is also the target of most antiarrhythmic drugs. The purpose of this study was to investigate the effect of hydroxyrutaecarpine (HRU) on the hERG channel and to evaluate its cardiotoxicity. The whole cell patch clamp technique was used to detect the effects of HRU on the current and kinetics of the hERG channel, and to confirm the binding site on the hERG channel. PCR was used to determine the effect of HRU on hERG mRNA expression. Western blotting was used to detect the effects of HRU on the expression of hERG protein and transcription factor Sp1. Immunofluorescence was used to confirm the effects of HRU on localization and expression of hERG protein and transcription factor Sp1. Studies have shown that transient HRU can inhibit hERG current and shorten the inactivation time constant. Its binding sites to the hERG channel are F656 and Y652. After incubation for 24 h, HRU can reduce the expression of hERG protein, inhibit the hERG current, reduce the level of hERG mRNA, and reduce the expression of transcription factor Sp1 in the nucleus and hERG protein in the cytoplasm. Immunofluorescence experiments also showed the same results suggesting that the inhibition of Sp1 expression by HRU is the cause of the decreased expression of hERG mRNA. In conclusion, the acute inhibition of HRU accelerates the channel inactivation process and reduces the inactivation time constant by binding to the F656 and Y652 sites in the hERG channel, thus reducing the hERG current. In addition, HRU also inhibits the expression of hERG protein, mainly by inhibiting the expression of transcription factor Sp1, the transcription function of hERG channel protein is down-regulated, so that the hERG protein is reduced.

15.
China Pharmacy ; (12): 699-705, 2022.
Article in Chinese | WPRIM | ID: wpr-923005

ABSTRACT

OBJECTIVE To study th e pharmacodynamics and pha rmacokinetics of Qinglian ningxin capsule in rats with ischemic arrhythmia. METHODS Totally 30 male SD rats were randomly divided into blank control group ,model control group , Qinglian ningxin capsule group (4.00 g/kg),Artemisia annua group(1.43 g/kg),Coptis chinensis group(0.42 g/kg),with 6 rats in each group. Administration groups were given relevant medicine intragastrically ;model control group and blank control group were given normal saline intragastrically ,once a day ,for consecutive 7 days. After last medication ,except for blank control group,other groups were given Posterior pituitary injection via tail vein (1 u/kg) to induce ischemic arrhythmia model. electrocardiogram changes of rats in each group were recorded. Another 36 rats were randomly divided into Qinglian ningxin capsule model group and Qinglian ningxin capsule control group (4.00 g/kg),A. annua model group and A. annua control group (1.43 g/kg),C. chinensis model group and C. chinensis control group (0.42 g/kg). After the rats in each model group were injected with Posterior pituitary injection (1 u/kg)via tail vein ,administration groups were given relevant drugs intragastrically , and control groups were given constant volume of normal saline intragastrically. Blood was taken from the orbit at different time points(0,0.25,0.75,1,2,4,6,8,12 and 24 h). The concentrations of berberine hydrochloride and artemisinin in plasma were determined by HPLC ,and the pharmacokinetic parameters were calculated by WinNonlin 7.0 software. RESULTS Compared with the model control groups ,Qinglian ningxin capsule could significantly improve the heart rate slowing of rats and redu ced the prolongation of PR interval and QT interval significantly ,and the effects were generally better than those of A. annua group and C. chinensis group(P<0.05). Compared with A. annua control group and C. chinensis control group ,cmax,AUC0-t and AUC 0-∞ of berberine hydrochloride and artemisinin were increased significantly in Qinglian ningxin capsule control group,while CL was decreased significantly ;t1/2z of artemisinin was prolonged significantly (P<0.05). Compared with Qinglian ningxin capsule control group ,cmax(except artemisinin ),AUC0-t,AUC0-∞,MRT0-t and MRT 0-∞(except artemisinin )of berberine hydrochloride and artemisinin were increased significantly in Qinglian ningxin capsule model group ,while CL was decreased significantly(P<0.05). CONCLUSIONS Qinglian ningxin capsule could significantly improve ischemic arrhythmia better than A. annua and C. chinensis ,and can improve the absorption of berberine hydrochloride and artemisinin in model rats and slow down their elimination.

16.
Clinics ; 77: 100014, 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1375193

ABSTRACT

ABSTRACT Arterial stiffness has been investigated as part of the physiopathology of arterial hypertension since the 1970s. Its role in increasing the "pulsatile load" imposed over the Left Ventricle (LV) has been intensely studied recently and has helped in understanding the mechanisms of Atrial Fibrillation (AF) in hypertensive patients. This paper aims to review the main evidence on this issue and establish possible mechanisms involved in the development of AF in patients with arterial stiffness. A PubMed search was performed, and selected articles were searched for references focusing on this topic. In the long term, lower blood pressure levels allow for arterial wall remodeling, leading to a lower stiffness index. To this day, however, there are no available treatments that directly promote the lowering of arterial wall stiffness. Most classes of anti-hypertensive drugs ‒ with stronger evidence for beta-blockers and diuretics ‒ could be effective in reducing arterial stiffness. There is strong evidence demonstrating an association between arterial stiffness and AF. New studies focusing on arterial stiffness and pre-fibrillatory stages would strengthen this causality relation.

17.
Rev. chil. cardiol ; 40(3)dic. 2021.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1388098

ABSTRACT

Resumen: Se presenta una serie de 4 casos clínicos de pacientes con y sin cardiopatía estructural, que tuvieron uno o más episodios de tormenta arrítmica. Se describen los tratamientos con sus resultados y una revisión bibliográfica con los avances en el tema más allá de la ablación con catéter.


Abstract: We present 4 clinical cases of patients with and without structural heart disease, who had one or more episodes of arrhythmic storm. Treatments, results and a bibliographic review with advances beyond catheter ablation are described.

18.
Rev. urug. cardiol ; 36(2): e702, ago. 2021. fot.
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1290000

ABSTRACT

Un gossypiboma, oblitoma o textiloma se define como todo cuerpo extraño olvidado en el interior de un paciente durante una intervención quirúrgica. Representa una complicación posquirúrgica poco frecuente pero de consecuencias potencialmente graves. En general, se manifiesta con cuadros clínicos variables: una masa o pseudotumor, sangrados, fiebre, dolor, varios meses o años después de la cirugía original. También puede ser un hallazgo accidental. Describimos el caso clínico de una paciente con un gossypiboma vinculado a una cirugía cardíaca que se realizó 40 años antes al cuadro clínico actual, que se presenta con arritmia ventricular maligna.


A gossypiboma, oblitoma or textiloma is defined as a surgical object left in the interior of the body after surgery. It represents an uncommon but potentially life threatening post-surgery complication. Clinical manifestations are variable and depend on location, relations and size, from pseudo-tumoral masses, bleeding, fever, pain and other nonspecific presentations. The onset of symptoms is unpredictable, occurring from months or years after surgery. Patients may course asymptomatically and be diagnosed incidentally as an imaging finding. We describe a case of a patient with gossypiboma diagnosed 40 years after undergoing cardiac surgery, who presented with a malignant ventricular arrhythmia.


Um gossypiboma, oblitoma ou textiloma está definido como todo corpo estranho esquecido no interior de um paciente durante um procedimento cirúrgico, representando uma complicação pos cirúrgica pouco frequente, mas com consequências potencialmente graves. Geralmente, se manifesta com quadros clínicos variáveis: uma massa ou pseudotumor, sangramentos, febre, dor, varios meses ou anos após a cirurgia original ou ser um hachado acidental. Descrevemos o caso clínico de uma paciente com um gossypiboma vinculado a uma cirurgia cardíaca realizada 40 anos antes do quadro clínico atual, que se apresenta com arritmia ventricular maligna.


Subject(s)
Humans , Female , Middle Aged , Arrhythmias, Cardiac/etiology , Surgical Sponges , Foreign Bodies/diagnostic imaging , Postoperative Complications/surgery , Postoperative Complications/diagnostic imaging , Thoracic Surgery , Foreign Bodies/surgery
20.
Rev. costarric. cardiol ; 23(1)jun. 2021.
Article in Spanish | LILACS-Express | LILACS, SaludCR | ID: biblio-1389033

ABSTRACT

Resumen Introducción y objetivo: Comunicar el primer informe del del registro nacional de dispositivos de estimulación cardíaca de agosto 2019 a agosto 2020, registro prospectivo de participación voluntaria. Métodos: Se analiza la información registrada, en forma voluntaria, por los centros implantadores con respecto a la población de pacientes a quienes se implantó un marcapaso, un desfibrilador o un resincronizador entre el 22 de agosto de 2019 hasta setiembre de 2020. Resultados: Se registraron un total de 317 procedimientos de marcapasos, por 10 centros implantadores, lo que corresponde a una participación en el registro de un 40%. La tasa de uso de marcapasos de 6,27 x 100 mil habitantes. Un 83% de los marcapasos fueron implantados en centros públicos, un 70% correspondió a dispositivos bicamerales. La edad media de la población fue de 73,7 años. La indicación más frecuente fue el trastorno de conducción AV (70,3%). Los electrodos de fijación activa fueron los más utilizados (97,8%). Un 83,3% de los sistemas implantados tuvieron compatibilidad con resonancia magnética. El uso de marcapasos unicamerales fue más frecuente en pacientes con 80 o más años. Con respecto a la terapia DAI se registraron un total de 63 procedimientos, por 5 centros implantadores, con una participación del 41%. La tasa total de implantes durante el período fue de 1,25 x 100 mil habitantes. La cardiomiopatía dilatada no isquémica fue la cardiopatía más frecuente en la población registrada. Conclusiones: El registro permite conocer la dinámica de procedimientos e indicaciones más usuales para el uso de dispositivos electrónicos cardíacos así como establecer la tasa de uso de las terapias en nuestro país. El porcentaje de participación en el registro puede mejorar. La implantación de dispositivos de estimulación cardíaca es financiada predominantemente por el sistema de seguridad social. La tasa de implantación es baja con respecto a otras regiones.


Abstract Costa Rican Registry of Resynchronizers, Automatic Defibrillators and Endovascular Pacemakers (RECORDAME). I Official Report of the Electrophysiology Commission of the Costa Rican Cardiology Association (2019-2020) Introduction and objective: To communicate the results of the first national registry of cardiac stimulation devices from August 2019 to August 2020. Methods: We analyze the information recorded prospectively, on a voluntary basis, by the implant centers with respect to the population of patients who were implanted with a pacemaker, a defibrillator or a resynchronizer between August 22, 2019 and September 2020. Results: A total of 317 pacemaker procedures were registered from 10 centers participated. Participation was 40% of total procedures reported by companies. The pacemaker implantation rate was 6.27 per hundred thousand. A 83% of pacemakers were implanted in public centers, 70% corresponded to dual chamber devices. Mean age of the population was 73.7 years. Most frequent indication was AV conduction disorder (70.3%). Active fixation electrodes were the most used (97.8%). A 83.3% were MRI conditional. Use of single chamber pacemakers was more frequent in patients aged 80 years or older. Regarding ICD therapy, a total of 63 procedures were registered. from 5 centers, with a participation of 41%. Rate of ICD use was 1.25 per hundred thousand. Non-ischemic dilated cardiomyopathy was the most common heart disease in the recorded population. Conclusions: The registry allowed to know the frequency of procedures and more usual indications as well as to establish the rate of use of therapies in our country. The percentage of participation in the registration can be improved. The implementation of cardiac stimulation devices is predominantly financed by the social security system. The implantation rate is low compared to other regions.


Subject(s)
Humans , Male , Female , Aged , Biological Clocks , Defibrillators, Implantable , Cardiac Resynchronization Therapy Devices , Costa Rica , Forms and Records Control
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