Résumé
Purpose@#To compare the predictive accuracy of five different algorithms as verified by successful ablation site using 3D electroanatomical non-contact mapping in patients with symptomatic and asymptomatic but high ventricular burden RVOT tachycardias. @*Methods@#28 Consecutive patients admitted for radiofrequency catheter ablation for symptomatic and asymptomatic, but high ventricular burden idiopathic VPC were recruited for this study. All patients had previous failed or intolerant to beta-blocker and/or at least one class IC anti-arrhythmic agents, and they had normal left ventricular ejection fraction. All patients had documented monomorphic VPC with left bundle branch block morphology and an inferior axis. Concordance of the arrhythmia origin based on ECG algorithm and 3D mapping system site were further evaluated. Of the five algorithms, two algorithms with easy-applicability and having a memorable design (Dixit and Joshi) and three algorithms with more complex and detailed design (Ito, Zhang, Pytkowski) were selected for comparisons. @*Results@#Assessment of the diagnostic accuracy showed that each of the five algorithms had only moderate accuracy, and the greatest accuracy was observed in the algorithm proposed by Pytkowski algorithm when assessed by a general cardiologist and Dixit algorithm when evaluated by the electrophysiologist. However, when the algorithms were compared for their accuracy, specificity, sensitivity, no significant differences were found (p = 0.99). @*Conclusions@#The ECG based algorithms for precise localising RVOTA origin simplify the mapping process, reduce the procedural and fluoroscopic time, and improve clinical outcomes, resulting in greater clinical utility. All the five published 12-lead ECG algorithms for ROTVA differentiation were similar in terms of the diagnostic accuracy, specificity, sensitivity and LRs.
Résumé
Background: Accreditation is a tool for assessing the patients' safety and quality improvement. The aim of this study was to compare quality management evaluation between Tehran hospitals with Europe hospital with accreditation approach
Materials and methods: This comparative, cross sectional, multilevel study was conducted among 21 systematic selected hospitals and their quality managers and hospital departments and patients between 2016, June and 2017, June. Anonymous Quality management system index [QMSI] questionnaire was conducted among quality managers. Quality management compliance index [QMCI] and clinical quality implementation index [CQII] and Clinical review [CR], specialized expertise and responsibility [SER], evidence base organization [EBO], patient safety strategy [PSS] were used during on- site visits by trained external surveyors. Retrospective and case note reviews, and direct observation were used for patient's level data gathering. The validity and reliabity of constructs were tested. The choice of instruments was based on "Deeping our understanding of quality improvement in Europe [DuQuE] project. Instruments were translated and back translated and changed base on third generation of Iran hospital accreditation that was developed by ministry of health and medical education [MOHME]. We assessed patient- specific process and outcomes for acute myocardial infarction, stroke, hip fracture and deliveries at patient level
Results: Management specific indexes at hospital level in Tehran hospitals, alike Europe hospitals, were related. In Tehran hospitals, an association was observed between QMSI and departmental levels in EBOP and CR and SER at four clinical conditions. In Europe hospitals, an association was observed between three levels of hospital quality management
Conclusion: The comparative evaluation for quality management for hospitals in Tehran and European hospitals showed similar results in terms of quality improvement at the management level