Prolonged implantable electrocardiographic monitoring indicates a high rate of misdiagnosis of epilepsy--REVISE study.

AIMS: Syncope, epilepsy, and psychogenic pseudo-syncope are the most common causes of transient loss of consciousness (T-LOC or blackout). All can present with similar features, including abnormal limb movements. It is reported that somewhere between 13 and 42% of patients with 'epilepsy' may be misdiagnosed. A UK Parliamentary working group found that at least 74 000 English patients are misdiagnosed with epilepsy, and taking antiepileptic drugs. The likely alternative diagnosis is 'convulsive' syncope, mimicking an epileptic seizure. We hypothesized that many patients misdiagnosed with epilepsy have convulsive reflex syncope, and that prolonged electrocardiographic (ECG) monitoring with an implantable ECG recorder (ILR) would show reflex cardioinhibition during T-LOC. This would respond to permanent pacing and allow antiepileptic drugs to be withdrawn. We also aimed to evaluate tilt testing and other tests done in these patients. METHODS AND RESULTS: We included patients previously diagnosed with epilepsy, but considered to have a definite or likely misdiagnosis of epilepsy after specialist neurological review. All received an ILR (Reveal Plus(®)/Reveal DX(®), Medtronic Inc.), and tilt-table testing. One hundred and three patients were included, mean age of 46 ± 17 years, with 58 of 103 (56%) female patients. A diagnosis of epilepsy was previously made by a neurologist in 69%, but definite tonic-clonic seizures were only noted in the history in 4%. In 22 patients (21%), the ILR recorded profound bradyarrhythmia or asystole with convulsive features, and they were offered pacemaker implantation. After pacing and withdrawal of antiepileptic drugs, 60% of these patients were asymptomatic. Only 14% of patients had a positive tilt-table test. In these, there was no correlation with the ECG findings of a spontaneous blackout during ILR recording. CONCLUSION: This study shows a high incidence of the cardioinhibition of reflex syncope in patients with convulsive T-LOC previously diagnosed as epilepsy and treated with antiepileptic drugs. We believe that reflex syncope with convulsive features mimics generalized epilepsy, leading to a misdiagnosis. This may be a widespread problem accounting for many wrong diagnoses of epilepsy. There was also poor correlation in ECG findings between tilt testing and ILR recording.

Simplified electrocardiogram sampling maintains high diagnostic capability for atrial fibrillation: implications for opportunistic atrial fibrillation screening in primary care.

AIMS: Atrial fibrillation (AF) is a major cause of morbidity, mortality, and health resource consumption. However, as many patients with chronic AF are asymptomatic, rapid, accurate opportunistic screening is needed in primary care to detect AF. Conventional electrocardiogram (ECG) technology is too clumsy and time consuming for mass opportunistic screening, thus technology that allows easy, rapid, yet accurate AF screening is required. To address this requirement a prototype hand-held electrode assembly was developed. We hypothesized that a 6-lead frontal-plane ECG acquired from this apparatus in a seated, clothed patient would be as accurate at detecting AF as conventional 12-lead ECG in the undressed, supine patient (the 'gold standard'). METHODS AND RESULTS: Electrocardiograms were obtained from 78 patients with AF and 79 with sinus rhythm (SR). All had a conventional 12-lead ECG, a 6-lead ECG from conventionally positioned limb electrodes, a supine 6-lead recording using the prototype recorder placed on the lower thorax/upper abdomen, and a 6-lead prototype recording in the seated patient, the latter with loosened clothing only. Electrocardiograms were randomly and blindly assessed by two cardiologists for (i) diagnosis of AF vs. SR and (ii) tracing quality (subjectively assessed as good, adequate, or bad). Compared with conventional 12-lead ECG recordings, all 'new' recording methods performed satisfactorily with sensitivities ≥90% (90-99%), specificities ≥94% (94-100%), positive predictive values ≥94% (94-100%), negative predictive values ≥90% (90-99%), and accuracies ≥93% (93-99%). Tracing quality was higher in conventional 12-lead recordings (71 and 80% were assessed as good by the two observers) compared with conventional 6-lead (57 and 59%), supine prototype (41 and 31%), and sitting prototype (39 and 19%). CONCLUSIONS: Despite inferior electrocardiographic quality a 6-lead frontal plane ECG acquired by a simple prototype hand-held electrode assembly allowed reliable differentiation of AF from SR compared with standard 12-lead ECG.

A Preliminary Exploration of the Effects of a 6-week Interactive Video Dance Exercise Program in an Adult Population.

PURPOSE: The purpose of this study was to determine the effects of a 6-week interactive video dance game (IVDG) program on adult participants' cardiorespiratory status and body mass index (BMI). METHODS: Twenty-seven healthy adult participants attended IVDG sessions over a 6-week period. Participants completed pre- and post-testing consisting of a submaximal VO(2) treadmill test, assessment of resting heart rate (RHR) and blood pressure (BP), BMI, and general health questionnaires. Data were analyzed using descriptives, paired t-tests to assess pre-to post-testing differences, and one-way ANOVAs to analyze variables among select groups of participants. Questionnaire data was manually coded and assessed. RESULTS: Twenty participants attended at least 75% of available sessions and were used in data analysis. Mean BMI decreased significantly (from 26.96 kg/m(2) to 26.21 kg/m(2); 2.87%) and cardiorespiratory fitness measured by peak VO(2) increased significantly (from 20.63 ml/kg/min to 21.69 ml/kg/min; 5.14%). Most participants reported that the IVDG program was a good workout, and that they were encouraged to continue or start an exercise routine. Forty percent reported improvements in sleep, and nearly half stated they had or were considering purchasing a home version of a video dance game. CONCLUSIONS: Interactive video dance game is an effective and enjoyable exercise program for adults who wish to decrease their BMI and improve components of cardiorespiratory fitness.