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Huang Q, Fan Y, Wang J, Xu Z, Yang L, Wang J, Zhan Y, Kong X, Zhou N. The diagnostic efficiency of artificial intelligence based 2 hours Holter monitoring in premature ventricular and supraventricular contractions detection. Clin Cardiol 2024; 47:e24266. [PMID: 38587231 PMCID: PMC11000269 DOI: 10.1002/clc.24266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/17/2024] [Accepted: 03/28/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Electrocardiography (ECG) and 24 hours Holter monitoring (24 h-Holter) provided valuable information for premature ventricular and supraventricular contractions (PVC and PSVC). Currently, artificial intelligence (AI) based 2 hours single-lead Holter (2 h-Holter) monitoring may provide an improved strategy for PSVC/PVC diagnosis. HYPOTHESIS AI combined with single-lead Holter monitoring improves PSVC/PVC detection. METHODS In total, 170 patients were enrolled between August 2022 and 2023. All patients wore both devices simultaneously; then, we compared diagnostic efficiency, including the sensitivity/specificity/positive predictive-value (PPV) and negative predictive-value (NPV) in detecting PSVC/PVC by 24 h-Holter and 2 h-Holter. RESULTS The PPV and NPV in patients underwent 2 h-Holter were 76.00%/87.50% and 96.35%/98.55, respectively, and the sensitivity and specificity were 79.17%/91.30%, and 95.65%/97.84% in PSVC/PVC detection compared with 24 h-Holter. The areas under the ROC curves (AUCs) for PSVC and PVC were 0.885 and 0.741, respectively (p < .0001). CONCLUSIONS The potential advantages of the 2 h-Holter were shortened wearing period, improved convenience, and excellent consistency of diagnosis.
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Affiliation(s)
- Qiong Huang
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingJiangsuChina
| | - Yuansheng Fan
- Department of Cardiac SurgeryThe Second Affiliated Hospital of Nanjing Medical UniversityNanjingJiangsuChina
| | - Jialin Wang
- Department of General PracticeThe First Affiliated Hospital of Nanjing Medical UniversityNanjingJiangsuChina
| | - Zhiyang Xu
- Department of GeriatricsThe First Affiliated Hospital of Nanjing Medical UniversityNanjingJiangsuChina
| | - Linfeng Yang
- Department of General PracticeThe First Affiliated Hospital of Nanjing Medical UniversityNanjingJiangsuChina
| | - Junhong Wang
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingJiangsuChina
| | - Yiyang Zhan
- Department of GeriatricsThe First Affiliated Hospital of Nanjing Medical UniversityNanjingJiangsuChina
| | - Xiangqing Kong
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingJiangsuChina
| | - Ningtian Zhou
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingJiangsuChina
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Zahedivash A, Chubb H, Giacone H, Boramanand NK, Dubin AM, Trela A, Lencioni E, Motonaga KS, Goodyer W, Navarre B, Ravi V, Schmiedmayer P, Bikia V, Aalami O, Ling XB, Perez M, Ceresnak SR. Utility of smart watches for identifying arrhythmias in children. COMMUNICATIONS MEDICINE 2023; 3:167. [PMID: 38092993 PMCID: PMC10719318 DOI: 10.1038/s43856-023-00392-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/23/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Arrhythmia symptoms are frequent complaints in children and often require a pediatric cardiology evaluation. Data regarding the clinical utility of wearable technologies are limited in children. We hypothesize that an Apple Watch can capture arrhythmias in children. METHODS We present an analysis of patients ≤18 years-of-age who had signs of an arrhythmia documented by an Apple Watch. We include patients evaluated at our center over a 4-year-period and highlight those receiving a formal arrhythmia diagnosis. We evaluate the role of the Apple Watch in arrhythmia diagnosis, the results of other ambulatory cardiac monitoring studies, and findings of any EP studies. RESULTS We identify 145 electronic-medical-record identifications of Apple Watch, and find arrhythmias confirmed in 41 patients (28%) [mean age 13.8 ± 3.2 years]. The arrythmias include: 36 SVT (88%), 3 VT (7%), 1 heart block (2.5%) and wide 1 complex tachycardia (2.5%). We show that invasive EP study confirmed diagnosis in 34 of the 36 patients (94%) with SVT (2 non-inducible). We find that the Apple Watch helped prompt a workup resulting in a new arrhythmia diagnosis for 29 patients (71%). We note traditional ambulatory cardiac monitors were worn by 35 patients (85%), which did not detect arrhythmias in 10 patients (29%). In 73 patients who used an Apple Watch for recreational or self-directed heart rate monitoring, 18 (25%) sought care due to device findings without any arrhythmias identified. CONCLUSION We demonstrate that the Apple Watch can record arrhythmia events in children, including events not identified on traditionally used ambulatory monitors.
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Affiliation(s)
- Aydin Zahedivash
- Stanford University, Lucile Packard Children's Hospital, Department of Pediatrics, Pediatric Cardiology, Palo Alto, CA, USA
| | - Henry Chubb
- Stanford University, Lucile Packard Children's Hospital, Department of Pediatrics, Pediatric Cardiology, Palo Alto, CA, USA
| | - Heather Giacone
- Stanford University, Lucile Packard Children's Hospital, Department of Pediatrics, Pediatric Cardiology, Palo Alto, CA, USA
| | - Nicole K Boramanand
- Stanford University, Lucile Packard Children's Hospital, Department of Pediatrics, Pediatric Cardiology, Palo Alto, CA, USA
| | - Anne M Dubin
- Stanford University, Lucile Packard Children's Hospital, Department of Pediatrics, Pediatric Cardiology, Palo Alto, CA, USA
| | - Anthony Trela
- Stanford University, Lucile Packard Children's Hospital, Department of Pediatrics, Pediatric Cardiology, Palo Alto, CA, USA
| | - Erin Lencioni
- Stanford University, Lucile Packard Children's Hospital, Department of Pediatrics, Pediatric Cardiology, Palo Alto, CA, USA
| | - Kara S Motonaga
- Stanford University, Lucile Packard Children's Hospital, Department of Pediatrics, Pediatric Cardiology, Palo Alto, CA, USA
| | - William Goodyer
- Stanford University, Lucile Packard Children's Hospital, Department of Pediatrics, Pediatric Cardiology, Palo Alto, CA, USA
| | - Brittany Navarre
- Stanford University, Lucile Packard Children's Hospital, Department of Pediatrics, Pediatric Cardiology, Palo Alto, CA, USA
| | - Vishnu Ravi
- Stanford University, Stanford Byers Center for Biodesign, Palo Alto, CA, USA
| | - Paul Schmiedmayer
- Stanford University, Stanford Byers Center for Biodesign, Palo Alto, CA, USA
| | - Vasiliki Bikia
- Stanford University, Stanford Byers Center for Biodesign, Palo Alto, CA, USA
| | - Oliver Aalami
- Stanford University, Stanford Byers Center for Biodesign, Palo Alto, CA, USA
| | - Xuefeng B Ling
- Stanford University, Department of Surgery, Palo Alto, CA, USA
| | - Marco Perez
- Stanford University, Cardiovascular Medicine - Electrophysiology, Department of Medicine, Palo Alto, CA, USA
| | - Scott R Ceresnak
- Stanford University, Lucile Packard Children's Hospital, Department of Pediatrics, Pediatric Cardiology, Palo Alto, CA, USA.
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Xia H, Ma H, Sun D, Chen Z, Wang S, Li P, Huang J, Gui C. Fabrication of Textured Ni-Coated Carbon Tubes for a Flexible Strain Sensor: Effect of the Device Elastic Modulus on Sensor Performance. LANGMUIR : THE ACS JOURNAL OF SURFACES AND COLLOIDS 2023. [PMID: 37368651 DOI: 10.1021/acs.langmuir.3c01168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
The exploration of flexible resistive sensors with excellent performance remains a challenge. In this paper, a nickel-coated carbon tube with a textured structure was prepared as a conductive sensitive material and inserted into the poly(dimethylsiloxane) (PDMS) polymer; interestingly, the sensor performance was controlled by the elastic modulus of the matrix resin. The results show that Pd2+ may be adsorbed by the active groups on the surface of a plant fiber as a catalytic center for the reduction of Ni2+. After 300 °C annealing, the inner plant fiber would be carbonized and attached to the outside of the nickel tube; to be precise, the textured Ni-encapsulated C tube was fabricated successfully. It is worth noting that the C tube serves as a layer of support for the external Ni coating, providing sufficient mechanical strength. In addition, resistance sensors with different properties were prepared by controlling the elasticity modulus of the PDMS polymer by introducing different contents of curing agents. The limit uniaxial tensile strain was enhanced from 42 to 49% and sensitivity reduced from 0.2 to 2.0% with the elasticity modulus of the matrix resin increasing from 0.32 to 2.2 MPa. As expected, the sensor is obviously appropriate for the detection of elbow joints, human speaking, and human joints with the reduction of the elasticity modulus of the matrix resin. To be precise, the optimal elastic modulus of the sensor matrix resin would facilitate the improvement of its sensitivity to monitor different human behaviors.
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Affiliation(s)
- Housheng Xia
- School of Biological and Chemical Engineering, Zhejiang University of Science and Technology, Hangzhou City 310023, China
| | - Haodong Ma
- School of Energy Materials and Chemical Engineering, Hefei University, Hefei City 230601, China
- Guangxi Key Laboratory of Calcium Carbonate Resources Comprehensive Utilization, College of Materials and Chemical Engineering, Hezhou University, Hezhou City 542899, China
| | - Di Sun
- School of Energy Materials and Chemical Engineering, Hefei University, Hefei City 230601, China
- Guangxi Key Laboratory of Calcium Carbonate Resources Comprehensive Utilization, College of Materials and Chemical Engineering, Hezhou University, Hezhou City 542899, China
| | - Zhenming Chen
- School of Energy Materials and Chemical Engineering, Hefei University, Hefei City 230601, China
- Guangxi Key Laboratory of Calcium Carbonate Resources Comprehensive Utilization, College of Materials and Chemical Engineering, Hezhou University, Hezhou City 542899, China
| | - Shufeng Wang
- School of Energy Materials and Chemical Engineering, Hefei University, Hefei City 230601, China
| | - Peng Li
- Guangxi Key Laboratory of Calcium Carbonate Resources Comprehensive Utilization, College of Materials and Chemical Engineering, Hezhou University, Hezhou City 542899, China
| | - Junjun Huang
- School of Energy Materials and Chemical Engineering, Hefei University, Hefei City 230601, China
- Guangxi Key Laboratory of Calcium Carbonate Resources Comprehensive Utilization, College of Materials and Chemical Engineering, Hezhou University, Hezhou City 542899, China
| | - Chengmei Gui
- School of Energy Materials and Chemical Engineering, Hefei University, Hefei City 230601, China
- School of Chemistry and Chemical Engineering, Chaohu University, Hefei City 230009, China
- Guangxi Key Laboratory of Calcium Carbonate Resources Comprehensive Utilization, College of Materials and Chemical Engineering, Hezhou University, Hezhou City 542899, China
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Goto L, Witkowska O, Slusarczyk ME, Grotek AM, Dziubinski MJ, Clark BC. Diagnostic yield of ambulatory cardiac monitoring in pediatric patients with palpitations. Ann Pediatr Cardiol 2023; 16:109-113. [PMID: 37767173 PMCID: PMC10522156 DOI: 10.4103/apc.apc_107_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/01/2022] [Accepted: 02/04/2023] [Indexed: 09/29/2023] Open
Abstract
Background Palpitations are a frequent reason for referral to pediatric cardiology providers and diagnostic workup includes ambulatory cardiac monitoring. While common practice, the diagnostic yield is unknown in the pediatric population. The objective is to evaluate the diagnostic yield of 24-h Holter and extended ambulatory cardiac monitoring in pediatric patients with palpitations. Methods and Results All pediatric patients aged 10-18 years who had ambulatory cardiac monitoring (1-30 days) through the Pocket Electrocardiogram (PocketECG™) system (Medi-Lynx) between January 2016 and July 2020 were included. Patients with an International Classification of Diseases-10 diagnosis code of palpitations (R00.2) during enrollment were evaluated separately. Tachyarrhythmia diagnoses included atrial fibrillation (AF), nonsustained supraventricular tachycardia (nSVT), supraventricular tachycardia (SVT), nonsustained ventricular tachycardia (nVT), and ventricular tachycardia (VT). Age, heart rates, arrhythmia type, and symptomatic transmission data were collected and analyzed. A total of 2388 patients (mean age 11.6 years, 58% F) with the R00.2 code had ambulatory cardiac monitoring (28% 24-h Holter, 72% extended) performed during the study period and there were 6287 total patients (mean age 13.9 years, 54% F) that underwent ambulatory cardiac monitoring (42% 24-h Holter, 58% extended) during that time. Of 2388 patients, 321 (13%) were diagnosed with tachyarrhythmia: AF (9), nSVT (192), SVT (59), and nVT (61). In the overall cohort, 764 (12%) patients were diagnosed with tachyarrhythmia: AF (22), nSVT (478), SVT (85), nVT (177), and VT (2). Symptomatic transmissions with normal cardiac rhythm were common in the R00.2 (n = 1697, 71%) and overall (n = 3848, 61%) groups. No episodes of nSVT, SVT, nVT, or VT were associated with symptomatic transmissions. Conclusion Ambulatory cardiac monitors are an integral part of the diagnostic workup for pediatric palpitations patients and have demonstrated a high yield of combined positive arrhythmia diagnoses and symptomatic normal transmissions. Further prospective study of this population with the integration of clinical information is warranted.
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Affiliation(s)
- Lisa Goto
- Department of Pediatrics, Children’s Hospital at Montefiore, Bronx, NY, USA
| | | | | | | | | | - Bradley C. Clark
- Division of Pediatric Cardiology, Children’s Hospital at Montefiore, Bronx, NY, USA
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
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Cardiac arrhythmias in postural tachycardia syndrome and orthostatic intolerance. Cardiol Young 2023; 33:255-259. [PMID: 35249573 DOI: 10.1017/s1047951122000580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES There is sparse literature on cardiac arrhythmias and the utility of ambulatory rhythm monitoring in patients with postural tachycardia syndrome and orthostatic intolerance. This study's primary aim was to investigate the prevalence of arrhythmias in this population. Knowing the prevalence and types of arrhythmias in dysautonomia patients could influence the decision to pursue ambulatory rhythm monitoring and ultimately guide therapy. METHODS This retrospective descriptive study examined the frequency of cardiac arrhythmias, as detected by ambulatory rhythm monitoring, in children with postural tachycardia syndrome/orthostatic intolerance or syncope who were seen at the Children's National Hospital Electrophysiology Clinic between January 2001 and December 2020. RESULTS In postural tachycardia syndrome/orthostatic intolerance patients, arrhythmia was detected on 15% of 332 ambulatory rhythm monitors. In syncope patients, arrhythmia was detected on 16% of 157 ambulatory rhythm monitors, not significantly different from the postural tachycardia syndrome/orthostatic intolerance group. The difference in rate of arrhythmia detection between 24-hour Holter and 2-week Zio® monitoring was not statistically significant. CONCLUSION This study suggests that a substantial proportion of postural tachycardia syndrome/orthostatic intolerance patients may have concomitant underlying cardiac arrhythmias, at a frequency similar to what is seen in patients undergoing primary evaluation for cardiac symptoms such as chest pain, palpitations, and syncope. In the appropriate clinical context, physicians caring for postural tachycardia syndrome/orthostatic intolerance patients should consider additional evaluation for arrhythmias beyond sinus tachycardia.
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Jone PN, Gearhart A, Lei H, Xing F, Nahar J, Lopez-Jimenez F, Diller GP, Marelli A, Wilson L, Saidi A, Cho D, Chang AC. Artificial Intelligence in Congenital Heart Disease: Current State and Prospects. JACC. ADVANCES 2022; 1:100153. [PMID: 38939457 PMCID: PMC11198540 DOI: 10.1016/j.jacadv.2022.100153] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 10/04/2022] [Accepted: 10/07/2022] [Indexed: 06/29/2024]
Abstract
The current era of big data offers a wealth of new opportunities for clinicians to leverage artificial intelligence to optimize care for pediatric and adult patients with a congenital heart disease. At present, there is a significant underutilization of artificial intelligence in the clinical setting for the diagnosis, prognosis, and management of congenital heart disease patients. This document is a call to action and will describe the current state of artificial intelligence in congenital heart disease, review challenges, discuss opportunities, and focus on the top priorities of artificial intelligence-based deployment in congenital heart disease.
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Affiliation(s)
- Pei-Ni Jone
- Section of Pediatric Cardiology, Department of Pediatrics, Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Addison Gearhart
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Howard Lei
- Division of Pediatric Cardiology, Children’s Hospital of Orange County, Orange, California, USA
| | - Fuyong Xing
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jai Nahar
- Department of Cardiology, Children's National Hospital, Washington, DC, USA
| | | | - Gerhard-Paul Diller
- Department of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield National Health Service Foundation Trust, Imperial College London, London, UK
- National Register for Congenital Heart Defects, Berlin, Germany
| | - Ariane Marelli
- McGill Adult Unit for Congenital Heart Disease Excellence, Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Laura Wilson
- Department of Pediatrics, University of Florida-Congenital Heart Center, Gainesville, Florida, USA
| | - Arwa Saidi
- Department of Pediatrics, University of Florida-Congenital Heart Center, Gainesville, Florida, USA
| | - David Cho
- Department of Cardiology, University of California at Los Angeles, Los Angeles, California, USA
| | - Anthony C. Chang
- Division of Pediatric Cardiology, Children’s Hospital of Orange County, Orange, California, USA
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Hidalgo Corral NM, Witkowska O, Ślusarczyk M, Dziubiński M, Clark BC. Ambulatory Cardiac Monitoring in Infants with Supraventricular Tachycardia. Pediatr Cardiol 2022; 43:1864-1869. [PMID: 35570217 DOI: 10.1007/s00246-022-02925-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/21/2022] [Indexed: 11/26/2022]
Abstract
Supraventricular tachycardia (SVT) is a frequent cause of tachyarrhythmia in infants < 1 year of age and ambulatory cardiac monitoring is an important tool for diagnosis and follow-up of these patients. We retrospectively reviewed 594 infants (mean age 4.05 months, SD 3.55; 54% M) who underwent ambulatory cardiac monitoring (69% 24 h Holter, 31% extended monitor) through the Pocket ECG system (MediLynx) between January 2016 and July 2020. 170 patients who had the ICD-10 code I47.1 for SVT used at enrollment were analyzed separately. 49 (8.3%) patients had sustained SVT or non-sustained SVT (nSVT) during the study period, including 20 patients (11.8%) who had the ICD-10 code I47.1 at enrollment. Extended ambulatory cardiac monitors detected 61% of all patients with nSVT or SVT and was superior when compared to 24 h Holter (p < 0.0001). In the overall group, the first episode of SVT or nSVT was detected within 24 h of monitoring in 40/49 patients (82%). 48/49 patients (98%) were diagnosed within a week of monitoring and the single remaining patient was diagnosed with nSVT at day 15 of monitoring. There was no significant difference in minimal, maximal, and average heart rate between patients with and without ICD-10 code I47.1 at enrollment or between patients with and without SVT or nSVT. Despite their low yield, ambulatory cardiac monitors are an important diagnostic tool. The ideal length of monitoring in patients with known or suspected SVT has yet to be defined, although all patients in our cohort were identified by day 15 of monitoring.
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Affiliation(s)
- Nicolas M Hidalgo Corral
- Albert Einstein College of Medicine/Children's Hospital at Montefiore, 3415 Bainbridge Avenue, Bronx, NY, 10467, USA.
| | - Olga Witkowska
- MEDICALgorithmics US Holding Corporation, Warsaw, Mazowieckie, Poland
| | | | - Marek Dziubiński
- MEDICALgorithmics US Holding Corporation, Warsaw, Mazowieckie, Poland
| | - Bradley C Clark
- Albert Einstein College of Medicine/Children's Hospital at Montefiore, 3415 Bainbridge Avenue, Bronx, NY, 10467, USA
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Boszko M, Osak G, Żurawska N, Skoczylas K, Krzowski B, Wróblewski G, Maciejewski A, Sobiech J, Ostrowski S, Grabowski M, Kołtowski Ł. Assessment of a new KoMaWo electrode-patch configuration accuracy and review of the literature. J Electrocardiol 2022; 75:82-87. [PMID: 35918203 DOI: 10.1016/j.jelectrocard.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 07/06/2022] [Accepted: 07/13/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Standard 12‑lead electrocardiogram (ECG) is a basic element of routine everyday clinical practice. Traditional cardiac monitoring devices are associated with considerable limitations. Adhesive patches, novel digital solutions, may become a useful diagnostic tool for several cardiovascular diseases. MATERIALS AND METHODS We propose a new variation of ECG electrodes positioning called KoMaWo. 15 consecutive patients presenting with ST segment deviations due to coronary artery disease were enrolled. The accuracy and utility of the new configuration was assessed and compared with the Mason-Likar configuration, as well as with a standard 12‑lead ECG recording. The scans were blinded and interpreted by two independent cardiologists. RESULTS There were no statistically significant differences in morphology, as well as in the duration of individual waves, complexes, segments, and intervals between the scans obtained using all three methods. In a subgroup analysis, with regard to age, body mass and left ventricle ejection fraction (LVEF), KoMaWo was non-inferior to standard ECG with a 0.2 mm margin. DISCUSSION The role of traditional cardiac monitoring devices is recognized as the gold standard of patient management. However, certain limitations should be considered. Adhesive patches are light-weight, well-tolerated and do not interfere with daily activities of patients. These novel devices allow for extended monitoring, facilitating increased diagnostic accuracy, regarding cardiac arrhythmias. CONCLUSIONS The KoMaWo configuration is not inferior to standard electrode placement, nor to Mason-Likar configuration, including its ability to capture ST segment deviations. Adhesive patches may become a valid alternative for traditional cardiac monitoring methods.
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Affiliation(s)
- Maria Boszko
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Gabriela Osak
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Natalia Żurawska
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Kamila Skoczylas
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Bartosz Krzowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
| | - Grzegorz Wróblewski
- Institute of Metrology and Biomedical Engineering, Warsaw University of Technology, Warsaw, Poland
| | - Adrian Maciejewski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Judyta Sobiech
- Faculty of Physics, Warsaw University of Technology, Warsaw, Poland
| | - Szymon Ostrowski
- Institute of Metrology and Biomedical Engineering, Warsaw University of Technology, Warsaw, Poland
| | - Marcin Grabowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Łukasz Kołtowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
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Van den Eynde J, Kutty S, Danford DA, Manlhiot C. Artificial intelligence in pediatric cardiology: taking baby steps in the big world of data. Curr Opin Cardiol 2022; 37:130-136. [PMID: 34857721 DOI: 10.1097/hco.0000000000000927] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW Artificial intelligence (AI) has changed virtually every aspect of modern life, and medicine is no exception. Pediatric cardiology is both a perceptual and a cognitive subspecialty that involves complex decision-making, so AI is a particularly attractive tool for this medical discipline. This review summarizes the foundational work and incremental progress made as AI applications have emerged in pediatric cardiology since 2020. RECENT FINDINGS AI-based algorithms can be useful for pediatric cardiology in many areas, including: (1) clinical examination and diagnosis, (2) image processing, (3) planning and management of cardiac interventions, (4) prognosis and risk stratification, (5) omics and precision medicine, and (6) fetal cardiology. Most AI initiatives showcased in medical journals seem to work well in silico, but progress toward implementation in actual clinical practice has been more limited. Several barriers to implementation are identified, some encountered throughout medicine generally, and others specific to pediatric cardiology. SUMMARY Despite barriers to acceptance in clinical practice, AI is already establishing a durable role in pediatric cardiology. Its potential remains great, but to fully realize its benefits, substantial investment to develop and refine AI for pediatric cardiology applications will be necessary to overcome the challenges of implementation.
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Affiliation(s)
- Jef Van den Eynde
- The Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, Department of Pediatrics, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Cardiovascular Sciences, KU Leuven & Congenital and Structural Cardiology, UZ Leuven, Leuven, Belgium
| | - Shelby Kutty
- The Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, Department of Pediatrics, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - David A Danford
- The Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, Department of Pediatrics, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Cedric Manlhiot
- The Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, Department of Pediatrics, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Hitt JR, Carter E, May J. Patch versus traditional ambulatory ECG monitoring in children. PROGRESS IN PEDIATRIC CARDIOLOGY 2021. [DOI: 10.1016/j.ppedcard.2021.101408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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11
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Honarbakhsh S, Sporton S, Monkhouse C, Lowe M, Earley MJ, Hunter RJ. Remote Clinics and Investigations in Arrhythmia Services: What Have We Learnt During Coronavirus Disease 2019? Arrhythm Electrophysiol Rev 2021; 10:120-124. [PMID: 34401185 PMCID: PMC8335855 DOI: 10.15420/aer.2020.37] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 02/15/2021] [Indexed: 11/04/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has had a dramatic impact on the way that medical care is delivered. To minimise hospital attendance by both patients and staff, remote clinics, meetings and investigations have been used. Technologies including hand-held ECG monitoring using smartphones, patch ECG monitoring and sending out conventional Holter monitors have aided remote investigations. Platforms such as Google Meet and Zoom have allowed remote multidisciplinary meetings to be delivered effectively. The use of phone consultations has allowed outpatient care to continue despite the pandemic. The COVID-19 pandemic has resulted in a radical, and probably permanent, change in the way that outpatient care is delivered. Previous experience in remote review and the available technologies for monitoring have allowed the majority of outpatient care to be conducted without obviously compromising quality or safety.
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Affiliation(s)
- Shohreh Honarbakhsh
- Department of Arrhythmia Management, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Simon Sporton
- Department of Arrhythmia Management, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Christopher Monkhouse
- Department of Arrhythmia Management, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Martin Lowe
- Department of Arrhythmia Management, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Mark J Earley
- Department of Arrhythmia Management, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Ross J Hunter
- Department of Arrhythmia Management, Barts Heart Centre, Barts Health NHS Trust, London, UK
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Romme AG, Umapathi KK, Nguyen HH. Feasibility of P wave Centric Ambulatory Electrocardiogram Monitoring in Infants and Young Children. Pediatr Cardiol 2021; 42:1126-1132. [PMID: 33837839 DOI: 10.1007/s00246-021-02590-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
Abstract
P wave centric ambulatory electrocardiographic (ECG) monitoring has emerged as an important tool aiding the diagnosis of arrhythmias. However, their efficacy and user experience in infants and young children are not well established. A retrospective study was performed to detail clinical and user experience of ECG monitoring using the Carnation Ambulatory Monitor (CAM) patch (Bardy Diagnostics Inc., Seattle, WA) in patients less than 10 kg. Additionally, 2 different monitor locations (over the sternum and horizontal over the left axilla) were assessed to address the optimal placement in these patients. A total of 33 CAM reports from 25 patients, aged 0 to15 months were included in the study. Mean patient age was 4.2 months ± 5.0 and mean weight was 5.3 kg ± 2.4. Thirty-six percent of patients (9/25) had known congenital heart disease. Indications for monitoring included: tachyarrhythmia (15/33, 45%), bradyarrhythmia (6/33, 18%), ectopic rhythm (9/33, 27%), cardiac tumor (1/33, 1%), and prolonged QT interval (1/33, 1%). All CAM reports showed clear, identifiable P waves which were diagnostic and lead to changes in medical management for 30% of patients (e.g., medication adjustments or discharge from cardiology care). We found the upright placement over the sternum performed better than the horizontal placement over the left axilla for small infants and children less than 10 kg. A P wave centric single-lead ECG monitor is helpful in providing accurate diagnostics tracings in infants and small children aiding in their clinical management.
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Affiliation(s)
- Angela G Romme
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Krishna K Umapathi
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Hoang H Nguyen
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, 60612, USA. .,Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, 75390-9063, USA.
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Bennett J, Kertesz NJ. Management of rhythm disorders in Duchenne muscular dystrophy: Is sudden death a cardiac or pulmonary problem? Pediatr Pulmonol 2021; 56:760-765. [PMID: 33651920 DOI: 10.1002/ppul.25205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/28/2020] [Accepted: 11/12/2020] [Indexed: 11/06/2022]
Abstract
Dystrophin deficiency results in the cardiomyopathy of variable onset and deficiency. Myocardial scarring commonly results in cardiac dysfunction, with both atrial and ventricular dysrhythmias. Heart failure, rather than arrhythmia burden, remains the strongest cardiac predictor of mortality in this patient population. Current data suggest the overall rate of sudden cardiac death in pediatric dilated cardiomyopathy is significantly lower than in adults. Specifically, in the Duchenne cardiomyopathy population, sudden death from an arrhythmic cause appears to be rare, even in patients with previously diagnosed arrhythmias. Despite this, recommendations for implantable cardioverter-defibrillator (ICD) placement in patients with Duchenne cardiomyopathy has traditionally been extrapolated from adult heart failure recommendations based on decreased left ventricular ejection fraction <35%. Early involvement of the cardiologist in the care for patients with dystrophin-deficient cardiomyopathy is recommended for this reason. The indications for ICD placement to prevent sudden death in patients with Duchenne cardiomyopathy are not well defined. There is little evidence to suggest that placement meaningfully prolongs life in this population, and should be carefully considered in accordance with the care goals of the patient and his family.
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Affiliation(s)
- Jeffrey Bennett
- The Heart Center, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Naomi J Kertesz
- The Heart Center, Nationwide Children's Hospital, Columbus, Ohio, USA
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Enhanced detection of cardiac arrhythmias utilizing 14-day continuous ECG patch monitoring. Int J Cardiol 2021; 332:78-84. [PMID: 33727122 DOI: 10.1016/j.ijcard.2021.03.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/28/2021] [Accepted: 03/08/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND To evaluate the performance of a single‑lead, 14-day continuous electrocardiogram (ECG) patch for the detection of arrhythmias compared to conventional 24-h monitoring. METHODS This prospective clinical trial enrolled patients suspected of arrhythmias but not diagnosed by 12‑lead ECGs. Each patient underwent a 24-h Holter and 14-day ECG patch simultaneously. Seven types of arrhythmias were classified: supraventricular tachycardia (SVT, repetitive atrial beats >4 beats), irregular SVT without P wave (>4 beats), AF/AFL (irregular SVT without P wave ≥30 s), pause ≥3 s, atrioventricular block (AVB; Mobitz type II, third-degree, two to one or high degree AVB), ventricular tachycardia (VT), and polymorphic VT. RESULTS A total of 158 patients were recruited (mean wear time:12.3 ± 3.2 days). The overall arrhythmia detection rate was higher with 14-day ECG patches (59.5%) compared to 24-h Holter (19.0%, P < 0.001). Up to 87.2% of arrhythmias recorded with 14-day ECG patches were not associated with symptoms. The 14-day ECG patch was associated with higher detection rates compared to the 24-h Holter in patients with SVT (52.5% versus 15.8%, P < 0.001), irregular SVT without P wave (12.7% versus 4.4%, P = 0.002), AF/AFL (9.5% versus 3.8%, P = 0.042), and critical arrhythmias (pause ≥3 s, AVB, VT, polymorphic VT) (16.5% versus 2.5%, P < 0.001). The 14-day ECG patch detected more than 2 types of arrhythmias in 5.1% of patients. No serious adverse events in patients wearing the 14-day ECG patch were reported. CONCLUSIONS The 14-day ECG patch outperformed 24-h Holter to detect overall, asymptomatic, critical and multiple arrhythmias. It is safe and has the potential to identify individuals with hidden arrhythmias, especially those with critical arrhythmias.
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Krishna MR, Sennaiyan UN, Ramanathan K. The utility of patch recorders in neonatal ambulatory electrocardiogram recording. Indian Pacing Electrophysiol J 2020; 21:128-131. [PMID: 33352203 PMCID: PMC7952775 DOI: 10.1016/j.ipej.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/30/2020] [Accepted: 12/13/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Mani Ram Krishna
- Dr R.K. Hospital for Women and Children, Thanjavur, Tamil Nadu, India.
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Murali S, Brugger N, Rincon F, Mashru M, Cook S, Goy JJ. Cardiac Ambulatory Monitoring: New Wireless Device Validated Against Conventional Holter Monitoring in a Case Series. Front Cardiovasc Med 2020; 7:587945. [PMID: 33330650 PMCID: PMC7733961 DOI: 10.3389/fcvm.2020.587945] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/30/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Cardiac arrhythmias are very common but underdiagnosed due to their transient and asymptomatic nature. An optimization of arrhythmia detection would permit to better treat patients and could substantially reduce morbidity and mortality. The SmartCardia ScaAI wireless patch is a novel CE IIa approved, single-lead electrocardiographic (ECG) ambulatory monitor designed for cardiac arrhythmias detection. Hypothesis: The accuracy of the new SmartCardia wireless patch to detect arrhythmias is comparable to the conventional Holter monitoring. Methods: Patients referred for a suspicion of arrhythmia between February and March 2020 were included in the trial. Simultaneous ambulatory ECG were recorded using a conventional 24-h Holter and the SmartCardia. The primary endpoint was the detection of cardiac arrhythmias over the total wear time of the devices, defined as premature atrial contraction (PAC), supraventricular tachycardia ≥3 beats, premature ventricular contraction (PVC), and ventricular tachycardia ≥3 beats. Conduction abnormalities, pause ≥2 s and atrioventricular block (AVB), were also tracked. McNemar's test was used to compare the matched pairs of data from both devices. Results: A total of 40 patients were included in the trial. Over the total wear time, there was no significant difference between the devices for ventricular and supraventricular arrhythmias detection. Pauses and AVB were equally identified by the two devices in three patients. Conclusion: Over the total wear time, the SmartCardia device showed an accuracy to detect arrhythmia similar to the 24-h Holter monitoring: single-lead, adhesive-patch monitoring might become an interesting alternative to the conventional Holter monitoring.
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Affiliation(s)
- Srinivasan Murali
- École polytechnique fédérale de Lausanne Innovation Park, Lausanne, Switzerland
| | | | - Francisco Rincon
- École polytechnique fédérale de Lausanne Innovation Park, Lausanne, Switzerland
| | - Manoj Mashru
- Sir Harkisandas Narottamdas Reliance Hospital, Mumbai, India
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