- Pulmonary Hypertension Manifesting as Atrial Arrhythmia in an Anesthetized Child; Diagnosis Using Focused Cardiac Ultrasound (FoCUS). [Journal Article]
- PAPaediatr Anaesth 2019 Jun 05
- We write to you to present an interesting solution to a diagnostic challenge we recently encountered. We performed a sevoflurane induction on a healthy 7-year-old male presenting with esotropia for c…
We write to you to present an interesting solution to a diagnostic challenge we recently encountered. We performed a sevoflurane induction on a healthy 7-year-old male presenting with esotropia for corrective surgery who developed persistent atrial bigeminy of greater than 5 minutes duration before spontaneous resolution. He maintained hemodynamic stability but a cardiac arrhythmia in anesthetized non-cardiac pediatric patients receiving a sevoflurane induction is uncommon and, therefore, unsettling.1 While usually benign and self-limited, arrhythmias can result from primary cardiomyopathies and this knowledge created a desire for expanded clinical clarity. This article is protected by copyright. All rights reserved.
- ECG anomaly class identification using LSTM and error profile modeling. [Journal Article]
- CBComput Biol Med 2019; 109:14-21
- Automatic diagnosis of cardiac events is a current problem of interest in which deep learning has shown promising success. We have earlier reported the use of Long Short Term Memory (LSTM) networks-t…
Automatic diagnosis of cardiac events is a current problem of interest in which deep learning has shown promising success. We have earlier reported the use of Long Short Term Memory (LSTM) networks-trained on normal ECG patterns-to the detection of anomalies from the prediction errors for real-time diagnostic applications. In this work, we extend our anomaly detection algorithm by introducing a second stage predictor that can identify the actual anomaly class from the error outputs of the first stage model. Results from seven types of anomalies have been presented including Atrial Premature Contraction (APC), Paced Beat (PB), Premature Ventricular Contraction (PVC), Right Bundle Branch Block (RBBB), Ventricular Bigeminy (VB), Ventricular Couplets (VCs) and Ventricular Tachycardia (VT). To optimize anomaly class prediction performance, multiple choices of second stage models such as multilayer perceptron (MLP), support vector machine (SVM) and logistic regression have been employed. A featurization scheme for LSTM prediction errors in the form of overall summaries has been proposed and a successful predictor for the same was developed with good performance. Our results indicate that the error vectors represented by their summary features carry useful predictive information about actual ECG anomaly type. We discuss how the accuracy scores without attention to inherent class imbalances and paucity of data instances may produce misleading performance estimates and hence accurate background models are needed to estimate true predictive performance of multi-class predictors such as those presented in this work. The training data sets and related resources for this study are provided at http://ecg.sciwhylab.org.
- Progesterone pretreatment reduces the incidence of drug-induced torsades de pointes in atrioventricular node-ablated isolated perfused rabbit hearts. [Journal Article]
- JCJ Cardiovasc Electrophysiol 2019; 30(6):941-949
- CONCLUSIONS: Pretreatment with progesterone reduces the incidence of drug-induced TdP, bigeminy, and trigeminy in isolated perfused AV node-ablated rabbit hearts.
- Ventricular bigeminy and trigeminy caused by hypophosphataemia during diabetic ketoacidosis treatment: a case report. [Journal Article]
- IJItal J Pediatr 2019 Apr 02; 45(1):42
- CONCLUSIONS: The clinical signs of hypophosphatemia are potentially life-threatening. Therefore, physicians should be vigilant when treating patients who are at risk of hypophosphatemia. Severe hypophosphatemia accompanied by clinical symptoms requires oral or intravenous supplementation of phosphate.
- Risk of cardiac arrhythmias after electrical accident: a single-center study of 480 patients. [Journal Article]
- CRClin Res Cardiol 2019 Feb 15
- CONCLUSIONS: Most of cardiac arrhythmias in patients presenting after EA can be diagnosed by an ECG on admission, thus routine ECG monitoring appears to be unnecessary. In our patient cohort cardiac troponin I and CK-MB were not useful in risk assessment after EA. Late-onset malignant arrhythmias were not observed.
- Exercise testing oversights underlie missed and delayed diagnosis of catecholaminergic polymorphic ventricular tachycardia in young sudden cardiac arrest survivors. [Journal Article]
- HRHeart Rhythm 2019 Feb 11
- CONCLUSIONS: Of the 15 SCA survivors diagnosed ultimately with CPVT, one-third had a delay in diagnosis because an EST was either never performed or performed but misdiagnosed. EST/CPT must become the standard of care after SCA in the young, especially if the SCA occurred during wither exertion or emotion.
- Fetal dysrhythmias. [Review]
- BPBest Pract Res Clin Obstet Gynaecol 2019 Jan 09
- Fetal dysrhythmias are common abnormalities, usually manifesting as irregular rhythms. Although most irregularities are benign and caused by isolated atrial ectopics, in a few cases, rhythm irregular…
Fetal dysrhythmias are common abnormalities, usually manifesting as irregular rhythms. Although most irregularities are benign and caused by isolated atrial ectopics, in a few cases, rhythm irregularity may indicate partial atrioventricular block, which has different etiological and prognostic implications. We provide a flowchart for the initial management of irregular rhythm to help select cases requiring urgent specialist referral. Tachycardias and bradycardias are less frequent, can lead to hemodynamic compromise, and may require in utero therapy. Pharmacological treatment of tachycardia depends on the type (supraventricular tachycardia or atrial flutter) and presence of hydrops, with digoxin, flecainide, and sotalol being commonly used. An ongoing randomized trial may best inform about their efficacy. Bradycardia due to blocked bigeminy normally resolves spontaneously, but if it is due to established complete heart block, there is no effective treatment. Ongoing research suggests hydroxychloroquine may reduce the risk of autoimmune atrioventricular block. Sinus bradycardia (rate <3rd centile) may be a prenatal marker for long-QT syndrome.
- Detection of atrial fibrillation using a wrist-worn device. [Journal Article]
- PMPhysiol Meas 2019 Feb 22; 40(2):025003
- CONCLUSIONS: The proposed detector offers promising performance and is particularly well-suited for implementation in low-power wearable devices, e.g. wrist-worn devices, with significance in mass screening applications.
- Concealed Pulmonary Vein Bigeminy during Sinus Rhythm in Patients with Paroxysmal Atrial Fibrillation: A Useful Marker for Pulmonary Vein Firing. [Journal Article]
- CRCardiol Res Pract 2018; 2018:1834514
- CONCLUSIONS: cPVB during SR was observed prior to index ablation in 11% of PAF patients. Such a potential itself may be a PV firing in a concealed manner, which does not reactivate LA. The PV exhibiting cPVB required a greater number of radiofrequency applications for isolation. Compared to patients without cPVB, the recurrence rate of AF in patients with cPVB was greater.
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- [Ventricular bigeminy in relation to fluoxetine]. [Journal Article]
- SSemergen 2019; 45(2):e9-e10