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Gard KE, Dries D, House C. Performing Accurate Standard 12 Lead ECGs on patients with Burns to the Chest. Air Med J 2024; 43:8-10. [PMID: 38154846 DOI: 10.1016/j.amj.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/01/2023] [Indexed: 12/30/2023]
Abstract
The use of the electrocardiogram (ECG) in critical care settings is a long-established cardiovascular monitoring tool. The effectiveness of the routine 12-lead ECG relies on accurate lead placement that is consistent and replicable. Improper lead placement may display erroneous ECG patterns and affect patient management decisions.1,2 In the setting of an acute injury, such as a torso burn to the ventral surface, accurate lead placement may be compromised or impossible. The regional burn center, which is part of our organization, sees approximately 500 patients per year. Of those patients, burns to the chest accounted for 21% of admissions during 2020 and 2021. This significant fraction of burn injury patients requires modification of our standard approach to provide an accurate ECG. Baseline ECGs are routinely acquired on the burn unit per protocol and for monitoring of patient response to numerous pharmaceutical therapies.
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Abstract
This case report describes a patient in their 70s with chronic obstructive pulmonary disease and hypertension who presented with a 2-day history of cough, expectoration, and shortness of breath.
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Affiliation(s)
- Hao Zhang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Kang-Yin Chen
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China
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Lesina K, Szili-Torok T, Peters E, de Wit A, Wijchers SA, Bhagwandien RE, Yap SC, Hirsch A, Hoogendijk MG. Performance and Robustness Testing of a Non-Invasive Mapping System for Ventricular Arrhythmias. Front Physiol 2022; 13:870435. [PMID: 35557970 PMCID: PMC9086357 DOI: 10.3389/fphys.2022.870435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 03/31/2022] [Indexed: 11/17/2022] Open
Abstract
Background: The clinical value of non-invasive mapping system depends on its accuracy under common variations of the inputs. The View Into Ventricular Onset (VIVO) system matches simulated QRS complexes of a patient-specific anatomical model with a 12-lead ECG to estimate the origin of ventricular arrhythmias. We aim to test the performance of the VIVO system and its sensitivity to changes in the anatomical model, time marker placement to demarcate the QRS complex and body position. Methods: Non-invasive activation maps of idiopathic premature ventricular complexes (PVCs) using a patient-specific or generic anatomical model were matched with the location during electrophysiological studies. Activation maps were analyzed before and after systematically changing the time marker placement. Morphologically identical PVCs recorded in supine and sitting position were compared in a subgroup. Results: Non-invasive activation maps of 48 patients (age 51 ± 14 years, 28 female) were analyzed. The origin of the PVCs as determined by VIVO system matched with the clinical localization in 36/48 (75%) patients. Mismatches were more common for PVCs of left than right ventricular origin [11/27 (41%) vs. 1/21 (5%) of cases, p < 0.01]. The first 32 cases were analyzed for robustness testing of the VIVO system. Changing the patient-specific vs. the generic anatomical model reduced the accuracy from 23/32 (72%) to 15/32 (47%), p < 0.05. Time marker placement in the QRS complex (delayed onset or advanced end marker) or in the ST-segment (delaying the QRS complex end marker) resulted in progressive shifts in origins of PVCs. Altered body positions did not change the predicted origin of PVCs in most patients [clinically unchanged 11/15 (73%)]. Conclusion: VIVO activation mapping is sensitive to changes in the anatomical model and time marker placement but less to altered body position.
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Affiliation(s)
- Krista Lesina
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Tamas Szili-Torok
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Emile Peters
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - André de Wit
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Sip A Wijchers
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Rohit E Bhagwandien
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Alexander Hirsch
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Mark G Hoogendijk
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
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Roccia H, Argaud L, Le Goic M, Guérin C, Cour M. Electrocardiogram monitoring in the prone position in coronavirus disease 2019 acute respiratory distress syndrome. Eur J Cardiovasc Nurs 2021; 20:792-796. [PMID: 34694381 PMCID: PMC8574317 DOI: 10.1093/eurjcn/zvab094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/11/2021] [Accepted: 10/01/2021] [Indexed: 01/27/2023]
Abstract
Aims Prone positioning is increasingly used for treating coronavirus disease 2019 (COVID-19)-induced acute respiratory distress syndrome (ARDS). In these high-risk patients for cardiovascular events who may spend more than 16 h a day in the prone position, an adequate monitoring of electrocardiogram (ECG) is mandatory. However, effects of prone positioning on the ECG are unknown as is the validity of the ECG recorded with electrodes placed dorsally. We aimed to compare ECG data obtained in the prone position from five electrodes positioned conventionally and dorsally, and to assess the effects of the change of position (from supine to prone) on the ECGs in patients with COVID-19 ARDS. Methods and results In patients with COVID-19 ARDS for whom the prone position was indicated, seven-lead ECG (frontal plane leads and V6) performed in the supine and the prone position with electrodes positioned conventionally and dorsally were compared. A total of 22 patients [20 (91%) males] were included. Among them, 10 (45%) patients had structural or ischaemic heart disease. After prone positioning, PR duration significantly increased and QRS duration significantly decreased whereas QT interval did not significantly change. In the prone position, there were excellent correlations between QRS axis, PR, RR, QRS, and QT intervals durations measured with electrodes placed on the torso and dorsally (with no change in the position of V6). Conclusion Prone positioning induced significant change in the ECG. In the prone position, ECG can be reliably monitored with four electrodes translated from conventional position to the back and with a precordial electrode left in V6 position.
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Affiliation(s)
- Hugo Roccia
- Service de Médecine Intensive - Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Intensive - Réanimation, 5, place d'Arsonval, Lyon F-69437, France.,Université de Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Est, Lyon F-69373, France
| | - Laurent Argaud
- Service de Médecine Intensive - Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Intensive - Réanimation, 5, place d'Arsonval, Lyon F-69437, France.,Université de Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Est, Lyon F-69373, France
| | - Maëva Le Goic
- Service de Médecine Intensive - Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Intensive - Réanimation, 5, place d'Arsonval, Lyon F-69437, France.,Université de Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Est, Lyon F-69373, France
| | - Claude Guérin
- Service de Médecine Intensive - Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Intensive - Réanimation, 5, place d'Arsonval, Lyon F-69437, France.,Université de Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Est, Lyon F-69373, France
| | - Martin Cour
- Service de Médecine Intensive - Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Intensive - Réanimation, 5, place d'Arsonval, Lyon F-69437, France.,Université de Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Est, Lyon F-69373, France
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