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Introduction Continuous cardiac monitoring in non-critical care settings is expensive and overutilised. As such, it is an important target of hospital interventions to establish cost-effective, high-quality care. Since inappropriate telemetry use was persistently elevated at our institution, we devised an electronic best practice alert (BPA) and tested it in a randomised controlled fashion. Methods Between 4 March 2018 and 5 July 2018 at our 600-bed academic hospital, all non-critical care patients who had at least one telemetry order were randomised to the control or intervention group. The intervention group received daily BPAs if telemetry was active. Results 275 and 283 patients were randomised to the intervention and control groups, respectively. The intervention group triggered 1042 alerts and trended toward fewer telemetry days (3.8 vs 5.0, p=0.017). The intervention group stopped telemetry 31.7% of the alerted patient-days compared with 23.3% for the control group (OR 1.53, 95% CI 1.24 to 1.88, p Conclusions Using a randomised controlled design, we show that BPAs significantly reduce telemetry without negatively affecting patient outcomes. They should have a role in promoting high-value telemetry use.

Background Standalone thoracoscopic surgical ablation may be more effective than catheter ablation in patients with long-standing persistent atrial fibrillation. Objectives To determine whether or not surgical ablation is clinically superior to catheter ablation as the first-line treatment strategy in long-standing persistent atrial fibrillation. Design This was a prospective, multicentre, randomised control trial. Setting Four NHS tertiary centres in England. Participants Adults with long-standing persistent atrial fibrillation, who had European Heart Rhythm Association symptom scores > 2 and who were naive to previous catheter ablation or thoracic/cardiac surgery. Interventions Minimally invasive thoracoscopic surgical ablation and conventional catheter ablation (control intervention). Main outcome measures The primary outcome was freedom from atrial fibrillation/tachycardia ≥ 30 seconds after a single procedure without antiarrhythmic drugs (class 1C/3) at 1 year, excluding a 3-month blanking period. The secondary outcomes include the intervention-related major complication rate; clinical success (≥ 75% reduction in arrhythmia burden); and changes in symptoms, quality of life and cost-effectiveness. Methods Patients (n = 120) were randomised to surgical ablation (n = 60) or catheter ablation (n = 60). An implanted loop recorder provided continuous cardiac monitoring following ablation. Follow-up visits were at 3, 6, 9 and 12 months. Loop recorder data were reviewed monthly by a physiologist who was blinded to the randomisation outcome. Results The study treatment was received by 55 patients in the surgical ablation arm and 60 patients in the catheter ablation arm; five patients withdrew from surgical ablation before treatment. Data from randomised and treated patients were analysed as per intention to treat. Patients had a mean age of 62.3 (standard deviation 9.6) years, were predominantly male (74%), had a mean left atrial diameter of 44.6 mm (standard deviation 6 mm) and were in continuous atrial fibrillation for 22 months (range 16–31 months). At 12 months, 26% of patients in the surgical ablation arm (14/54) and 28% of patients in the catheter ablation arm (17/60) were free from atrial arrhythmias after a single procedure without antiarrhythmic drugs (odds ratio 1.13, 95% confidence interval 0.46 to 2.83; p = 0.84). An arrhythmia burden reduction of ≥ 75% was seen in 36 out of 54 (67%) patients in the surgical ablation arm, compared with 46 out of 60 (77%) patients in the catheter ablation arm (odds ratio 1.64, 95% confidence interval 0.67 to 4.08; p = 0.3). Procedure-related serious complications within 30 days of the intervention occurred in 15% (8/55) of patients in the surgical ablation arm (including one death) compared with 10% (6/60) of patients in the catheter ablation arm (p = 0.46). Surgical ablation was associated with significantly higher costs (£23,221 vs. £18,186; p = 0.02) and fewer quality-adjusted life-years than catheter ablation (0.76 vs. 0.83; p = 0.02). Limitations This study was conducted in four highly specialised cardiology centres that have substantial experience in both treatment modalities; therefore, the results may not be widely generalisable. The study was not powered to detect small differences in efficacy. Conclusions We found no evidence to suggest that standalone thoracoscopic surgical ablation outcomes were superior to catheter ablation outcomes in achieving freedom from atrial arrhythmia after a single procedure without antiarrhythmic drugs. Moreover, surgical ablation is associated with a longer hospital stay, smaller improvements in quality of life and higher health-care costs than catheter ablation (standard care therapy). Future work Evaluation of the impact of ablation treatments on sinus rhythm maintenance and quality of life with extended follow-up to 3 years. Model-based economic analysis to estimate long-term benefits, harms and costs of surgical and catheter ablation compared with antiarrhythmic drug therapy in long-standing persistent atrial fibrillation patients. Trial registration Current Controlled Trials ISRCTN18250790 and ClinicalTrials.gov NCT02755688. Funding This project was funded by the Efficacy and Mechanism Evaluation (EME) programme, a Medical Research Council (MRC) and National Institute for Health Research (NIHR) partnership. This study was supported by the UK Clinical Research Collaboration-registered King’s Clinical Trials Unit at King’s Health Partners, which is part funded by the NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King’s College London and the NIHR Evaluation, Trials and Studies Coordinating Centre. This will be published in full in Efficacy and Mechanism Evaluation; Vol. 8, No. 18. See the NIHR Journals Library website for further project information.

Remdesivir is an antiviral used for the treatment of COVID-19 requiring hospitalisation. Information on its cardiovascular safety profile is scarce. We report the case of a 37-year-old man with COVID-19 who developed bradycardia after receiving remdesivir. We recommend a baseline ECG for all patients prior to receiving remdesivir and continuous cardiac monitoring during treatment, especially among those with underlying cardiovascular disease, elderly and using β-blockers.

Calcitonin (CT) stimulation tests have great value and could help to: differentiate thyroid causes of elevated CT apart from non-thyroid sources, determine whether the patients with slightly elevated basal CT could/could not be candidates for surgery, and indicate the right moment for prophylactic thyroidectomy in children with MEN syndromes when with normal basal CT. This triggered the requests for development of CT stimulation tests, taking into consideration their safety and aimed us to write a systematic review of literature regarding the rationale, technical issues, and side effects of CT stimulating tests used for diagnosis of MTC. After a thorough review of the literature, we classified the reported side effects by severity, as defined by United States Food and Drug Administration. A statistical analysis was performed using IBM SPSS Statistics version 20. Various side effects were noticed during stimulation tests that differ by intensity, duration and severity, depending on types of substances and protocols used. The side effects after pentagastrin test were significantly more severe than those reported after calcium stimulation test (p=0.0396). There are also significant gender-specific differences in side effects induced by stimulation tests. In conclusion, we recommend performing Ca CT stimulation test when needed, considering preventive evaluation of some clinical, instrumental, and biochemical aspects of each patient. Precise instructions should be followed before a stimulation test and furthermore continuous cardiac monitoring is essential during and after the test to minimize the possibility of a serious event.

Research on traditional cardiac telemetry demonstrates that excessive alarms are related to lead failures and noise-related interruptions. Patch-based continuous cardiac rhythm monitoring (CCRM) has emerged in outpatient ambulatory monitoring situations as a means to improve recording fidelity. In this study, patients hospitalized but not in the intensive care unit were simultaneously monitored via telemetry in parallel with the use of the Vital Signs Patch™ (VSP) CCRM system (LifeWatch Services, Rosemont, IL, USA), applying standardized monitoring and notifications provided by an off-site central monitoring unit (CMU). Among 11 patients (55% male; age: 66.8 ± 12.5 years), there were 42 CMU detections and 98 VSP detections. The VSP device was successfully applied by nursing with connectivity established in all 11 patients (100%). There were no VSP device–related adverse events or skin eruptions during the study. The CMU agreed with 59 (60%) of 98 VSP detections. Among those detections marked by disagreement 30 (77%) of 39 VSP detections were related to clinically meaningful arrhythmias (atrial: n = 9; ventricular: n = 7; brady-: n = 14) undetected by VSP due to noise. In two patients (18%), there were four clinically meaningful atrial fibrillation detections not recorded by the CMU. In conclusion, patch-based CCRM requires further development and review to replace traditional cardiac telemetry monitoring but could evolve into an appropriate method to detect clinically meaningful events missed by traditional methods if noise issues can be mitigated.

Background Cardiac telemetry monitoring is widely utilized for a variety of clinical indications, yet indication‐specific event rates for monitored patients are seldomly reported. Hypothesis High‐risk hospitalized patients for clinical deterioration can be identified using standardized telemetry monitoring indications. Methods Adjudicated data from events triggering emergency response team (ERT) activation were systematically characterized at the Cleveland Clinic from among standardized telemetry indications ordered over a 13‐month period. Results Among 72 199 orders created for telemetry monitored patients, ERT activation occurred in 2677 patients (3.7%), of which 1326 (49.5%) were cardiac‐related. Patients with deep venous thrombosis or pulmonary embolism (DVT/PE) demonstrated the highest overall event rate (ERT: n = 41 of 593 pts [6.9%]; 25/41 cardiac related [61%]). Cardiac‐related events were proportionally highest among patients with coronary disease awaiting revascularization (ERT: n = 19 of 847 patients [2.2%]; 13/19 cardiac‐related [68.4%]). Arrhythmia‐specific events were highest among patients who underwent cardiac surgery (n = 78 of 193 cardiac‐related ERT [40.4%]), and patients with known or suspected tachyarrhythmias (n = 318 of 788 cardiac‐related ERT [40.4%]). Bubble plot analysis identified patients hospitalized with DVT/PE, drug or alcohol exposures, and acute coronary syndrome as among the highest overall and cardiac‐related events while identifying patients with respiratory disorder monitoring indications as carrying the highest noncardiac event rate. Conclusion High‐risk hospitalized patients can be identified by telemetry indication and prioritized according to concerns for cardiac, arrhythmia‐specific and noncardiac clinical deterioration. This is particularly useful when monitored bed resources are constrained.

Introduction 2019 novel coronavirus (COVID‐19) patients frequently develop QT interval prolongation that predisposes them to Torsades de Pointes and sudden cardiac death. Continuous cardiac monitoring has been recommended for any COVID‐19 patient with a Tisdale Score of seven or more. This recommendation, however, has not been validated. Methods We included 178 COVID‐19 patients admitted to a non‐intensive care unit setting of a tertiary academic medical center. A receiver operating characteristics curve was plotted to determine the accuracy of the Tisdale Score to predict QT interval prolongation. Multivariable analysis was performed to identify additional predictors. Results The area under the curve of the Tisdale Score was 0.60 (CI 95%, 0.46–0.75). Using the cutoff of seven to stratify COVID‐19, patients had a sensitivity of 85.7% and a specificity of 7.6%. Risk factors independently associated with QT interval prolongation included a history of end‐stage renal disease (ESRD) (OR, 6.42; CI 95%, 1.28–32.13), QTc ≥450 ms on admission (OR, 5.90; CI 95%, 1.62–21.50), and serum potassium ≤3.5 mmol/L during hospitalization (OR, 4.97; CI 95%, 1.51–16.36). Conclusion The Tisdale Score is not a useful tool to stratify hospitalized non‐critical COVID‐19 patients based on their risks of developing QT interval prolongation. Clinicians should initiate continuous cardiac monitoring for patients who present with a history of ESRD, QTc ≥450 ms on admission or serum potassium ≤3.5 mmol/L.

Workplace stress and fatigue due to long working hours and prolonged cognitive workload has been reported to be a significant predictor of cardiovascular diseases. Continuous monitoring of cardiac activity could provide to be a way to identify the early onset of stress and fatigue. However, the discomfort brought by ECG measurement electrodes has been a challenge for long term ubiquitous monitoring at the workplace. In this study, we have developed tin-coated copper active electrodes embedded onto a mat that can be fastened to an office chair or bed allowing unobtrusive measurement of cardiac activity. The experimental results from filtering and R peak detection of cECG measurements show high accuracy, and the heart rate calculated had a very high correlation with the conventional ECG measurements for both chair (r = 0.991, p < 0.01) and bed (r = 0.981, p < 0.01) form factors. The decrease in the mean squared error of computed heart rates from cECG measurements on chair (MSE = 0.43 bpm) could be attributed to increased lumbar contact as compared to lying down on bed (MSE = 1.13 bpm). The developed cECG sensor and measurement system could be seamlessly integrated into everyday objects such as chair, bed and car seat for unobtrusive cardiac monitoring with no prior preparations. Further heart rate variability studies to identify the markers of changes in sympathetic nervous activity could provide an early indicator of stress and fatigue to promote an active and healthy lifestyle in the workplace.

Background Arrhythmias are considered a prominent phenomenon in pulmonary hypertension (PH) as the disease progresses. In short-term retrospective studies with up to 24 hours of monitoring, supraventricular tachycardia (SVT) has been found in 8–35% of patients, with significant impact on survival. The incidence of arrhythmias and their clinical role is based on a small number of retrospective studies. Purpose Assessment of arrhythmias in PH by continuous long-term cardiac monitoring Methods Patients diagnosed with PH were included in this prospective single-centre study where the diagnosis of PAH was established according to international guidelines. Patients received a Reveal LINQ (Medtronic) insertable cardiac monitor (ICM). ICM's continuously monitor the heart rhythm for arrhythmias according to algorithms; and an ECG of the episode will automatically be transmitted whenever an arrhythmia is detected. Results Twenty-eight patients were included, of whom 24 patients had pulmonary arterial hypertension (PAH) and four had chronic thromboembolic pulmonary hypertension (table 1) treated according to Table 1. During 168 patient-months of continuous monitoring (median: 206 days per patient) no long-lasting arrhythmias were observed, but only transient SVTs in one patient lasting a total of 2.5 days. Two had SVTs lasting 4.5 hours, and two hours. Five patients had isolated episodes of SVTs lasting 0–10 minutes and two patients had an episode of bradycardia for 10 seconds. The total arrhythmic burden was a period prevalence of less than 0.001%, despite a RVEF of 20.3% and 35.7% in WHO FC IV and III, respectively. Conclusion This is the first study with long-term continuous rhythm monitoring in patients with PH. In contrast to earlier observations no long-lasting arrhythmias occurred during 168 patient-months with a period prevalence of arrhythmias as low as less than 0.001% in this cohort of PH patients with WHO FC I-IV and the majority on modern specific PAH therapy. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Actelion

Continuous cardiac monitoring using electrocardiograms (ECG) provides a range of patient information, essential for making clinical decisions, to healthcare providers. Unfortunately, the clinical standard of ECG recording requires the use of rigid metal electrodes, conductive gels, and wired electronic devices, which often cause skin injuries and health risks for pediatric patients with underdeveloped, fragile skin. Here, we introduce a wireless, soft, comfortable electronic system that obviates the need for skin preparation, electrolyte gels, or aggressive tapes. The low-profile device incorporates a thin-film circuit and nanomembrane sensors, encapsulated in a hyperelastic elastomer. The soft elastomeric membrane offers an optimized adhesion that ensures a conformal lamination of stretchable electrodes on the skin for recording of high-fidelity biopotentials. The combined set of on-board Bluetooth module, front-end amplifier, and voltage regulator enables a real-time, long-range, wireless monitoring of physiological data, including ECG, heart rate (HR) and respiratory rate (RR). A pilot study with pediatric patients demonstrates the clinical feasibility of the device as a comfortable, reliable biopotential monitor, suggesting a new standard for safe and effective pediatric care.

This retrospective study assessed the pattern of telemetry usage and rates of atrial fibrillation (AF) detection in the 6 months pre- and post-implementation of stroke unit monitored telemetry; 122/154 (79%) of patients had telemetry prior to implementation of stroke unit based telemetry and 164/194 (85%) in the 5 months post (P = 0.31). The use of stroke unit based telemetry was associated with a small increase of telemetry usage and significant increase in telemetry hours per patient. AF detection was similar during the two study periods.

Early and Late Recurrences in AF CryoablationIntroduction Recurrences within the blanking period (early recurrences) are common after atrial fibrillation (AF) ablation by pulmonary vein isolation (PVI), but their clinical significance is still controversial. We aimed at evaluating the significance of within-blanking recurrences at 12-month follow-up after cryoballoon (CB) PVI, and to assess the real procedural success rate by continuous monitoring of cardiac rhythm. Methods and Results Sixty consecutive AF patients (34 paroxysmal, 56.7%) underwent their first CB-PVI at one Italian center (May 2013 to April 2015), and subsequent implantation of an implantable loop recorder (ILR). Overall, 12-month success rate after the blanking period was 55%. The shortest detected event was 7 minutes long. Late recurrences were more frequent in non-paroxysmal (19/26, 73.1%) than in paroxysmal AF (8/34, 23.5%; P

The purpose of this article is to describe the impact of an evidence-based alarm management strategy on patient safety. An alarm management program reduced alarms up to 30%. Evaluation of patients on continuous cardiac monitoring showed a 3.5% decrease in census. This alarm management strategy has the potential to save $136 500 and 841 hours of registered nurses' time per year. No patient harm occurred during the 2-year project.

Inappropriate cardiac monitoring leads to increased hospital resource utilization and alarm fatigue, which is ultimately detrimental to patient safety. Our institution implemented a continuous cardiac monitoring (CCM) policy that focused on selective monitoring for patients based on the American Heart Association (AHA) guidelines. The primary goal of this study was to perform a three-year median follow-up review on the longitudinal impact of a selective CCM policy on usage rates, length of stay (LOS), and mortality rates across the medical center. A secondary goal was to determine the effect of smaller-scale interventions focused on reeducating the nursing population on the importance of cardiac alarms. A system-wide policy was developed at The Ohio State University in December 2013 based on guidelines for selective CCM in all patient populations. Patients were stratified into Critical Class I, II, and III with 72 hours, 48 hours, or 36 hours of CCM, respectively. Pre- and post-implementation measures included average cardiac monitoring days (CMD), emergency department (ED) boarding rate, mortality rates, and LOS. A 12-week evaluation period was analyzed prior to, directly after, and three years after implementation. There was an overall decrease of 53.5% CMDs directly after implementation of selective CCM. This had remained stable at the three-year follow-up with slight increase of 0.5% (p = 0.2764). Subsequent analysis by hospital type revealed that the largest and most stable reductions in CMD were in noncardiac hospitals. The cardiac hospital CMD reduction was stable for roughly one year, then dipped into a lower stable level for nine months, then returned to the previous post-implementation levels. This change coincided with a smaller intervention to further reduce CMD in the cardiac hospital. There was no significant change in mortality rates with a slight decrease of 3.1% at follow-up (p = 0.781). Furthermore, there was no significant difference in LOS with a slight increase of 1.1% on follow-up (p = 0.649). However, there was a significant increase in ED boarding rate of 7.7% (p < 0.001) likely due to other hospital factors altering boarding times. Implementing selective CCM decreases average cardiac monitoring rate without affecting LOS or overall mortality rate. Selective cardiac monitoring is also a sustainable way to decrease overall hospital resource utilization and more appropriately focus on patient care.

AIMS Early recurrences (ER) of atrial arrhythmias are common after catheter ablation of atrial fibrillation (AF). The significance of these ER is controversial. Based on data of continuous cardiac monitoring, we sought to investigate the characteristics of ER and their impact on late recurrences (LR) during follow-up. METHODS One hundred twenty-six patients with paroxysmal (49%) or persistent (51%) AF underwent an AF ablation with subsequent implantation of implantable loop recorder. Follow up was 12 months using remote monitoring. All atrial arrhythmia (AF or atrial tachycardia-AT-) episodes >30 seconds. within the 3-month blanking period were considered and the AF burden evaluated every 3 months. RESULTS Within the 3-months blanking period, 72 patients (57%) experienced an AF/AT recurrence. Survival free from any arrhythmia recurrence during follow-up was 40% in patients with ER vs 69% in those without ER. AF burden during the blanking period and timing of ER correlated significantly with LR at 12 months (area under curve = 0.74, P

Cardiac arrhythmias were reported in cases of West Nile Virus (WNV) encephalitis; however, the underlying pathophysiology remains incompletely understood. We present a 67-year-old male with altered mental status, later diagnosed with WNV encephalitis. Hospital course was complicated by progressive sinus bradycardia and corrected QT (QTc) prolongation. These findings persisted despite the absence of classical causes and resolved only after improvement of the underlying encephalitis. After excluding classical causes, autonomic dysfunction is one of the proposed mechanisms behind cardiac arrhythmias in WNV encephalitis. Resolution of arrhythmias is expected after the improvement of underlying encephalitis and should be taken into consideration before proceeding for pacemaker placement or other cardiac intervention. Furthermore, this case highlights the importance of continuous cardiac monitoring in WNV encephalitis patients.

Objective: A novel ECG classification algorithm is proposed for continuous cardiac monitoring on wearable devices with limited processing capacity. Methods: The proposed solution employs a novel architecture consisting of wavelet transform and multiple LSTM recurrent neural networks. Results: Experimental evaluations show superior ECG classification performance compared to previous works. Measurements on different hardware platforms show the proposed algorithm meets timing requirements for continuous and real-time execution on wearable devices. Conclusion: In contrast to many compute-intensive deep-learning based approaches, the proposed algorithm is lightweight, and therefore, brings continuous monitoring with accurate LSTM-based ECG classification to wearable devices. Significance: The proposed algorithm is both accurate and lightweight. The source code is available online [1]., Accepted for publication in IEEE Journal of Biomedical and Health Informatics (J-BHI)

The electrocardiogram (ECG) is a well-established diagnostic tool extensively used in clinical settings. Knowledge of cardiac rhythm and mastery of cardiac waveform interpretation are fundamental for intensive care nurses. Recognition of the normal findings for the 12-lead ECG and understanding the significance of changes from baseline in continuous cardiac monitoring are essential steps toward ensuring safe patient care. This article highlights historical developments in electrocardiography, describes the normal resting 12-lead ECG, and discusses the need for continuous cardiac monitoring. In addition, future directions for the ECG are explored briefly.

Background Atrial fibrillation (AF) is an arrhythmia that can be difficult to identify and classify with short-term monitoring. However, current standard of practice requires only short-term monitoring to determine AF classifications and identify symptom-arrhythmia correlations prior to AF ablation procedures. Insertable cardiac monitors (ICMs) offer continuous arrhythmia monitoring, which could lead to a more accurate measurement of AF burden than standard of practice. Methods This analysis focused on 121 patients enrolled in the LINQ Usability Study indicated for an AF ablation. Patients were followed for up to 1 year after ICM insertion. Clinical AF classifications were made by physicians prior to ICM implantation based on available clinical information. Device-detected AF burden and maximum daily burden were collected from device interrogations and remote transmissions. Device AF classifications were determined by categorizing the AF burden based on guidelines. Results Agreement between clinical and device AF classifications preablation was poor (48.3%, N = 58). The strongest agreement was in the paroxysmal AF group but still was only 61.8%. Furthermore, device-detected preablation AF burden led to the decision to defer AF ablation procedures in 16 (13.2%) patients. The median AF burden in patients with ≥6 months follow-up postablation (n = 71) was reduced from 7.8% (interquartile range [IQR]: 0-32.1%) to 0% (IQR: 0-0.7%). Conclusions ICM monitoring to determine AF burden pre- and post-AF ablation may have clinical utility for management of ablation candidates through more accurate AF classification and guiding treatment decisions.

Introduction: Cardiac arrhythmias are frequent in acute stroke. Stroke units are widely equipped with cardiac monitoring systems. Pre-existing heart diseases and heart–brain interactions may be implicated in causing cardiac arrhythmias in acute stroke. This article analyses cardiac arrhythmias detected in patients hospitalised in a stroke unit. Method: Prospective observational study of consecutive patients admitted to a stroke unit with cardiac monitoring. We collected clinical data from patients and the characteristics of their cardiac arrhythmias over a 1-year period (2013). Time of arrhythmia onset, associated predisposing factors, and the therapeutic decisions made after detection of arrhythmia were examined. All patients underwent continuous cardiac monitoring during no less than 48 hours. Results: Of a total of 332 patients admitted, significant cardiac arrhythmias occurred in 98 patients (29.5%) during their stay in the stroke unit. Tachyarrhythmia (ventricular tachyarrhythmias, supraventricular tachyarrhythmias, complex ventricular ectopy) was present in 90 patients (27.1%); bradyarrhythmia was present in 13 patients (3.91%). Arrhythmias were independently associated with larger size of brain lesion and older age. In 10% of the patient total, therapeutic actions were taken after detection of significant cardiac arrhythmias. Most events occurred within the first 48 hours after stroke unit admission. Conclusions: Systematic cardiac monitoring in patients with acute stroke is useful for detecting clinically relevant cardiac arrhythmias. Incidence of arrhythmia is higher in the first 48 hours after stroke unit admission. Age and lesion size were predicted appearance of arrhythmias. Detection of cardiac arrhythmias in a stroke unit has important implications for treatment. Resumen: Introducción: Las arritmias cardiacas son frecuentes en el ictus agudo. La monitorización cardiaca telemétrica es una técnica extendida en las unidades de ictus. La aparición de arritmias en el ictus agudo puede relacionarse con las interacciones cerebro-corazón o con la patología cardiaca. Se analiza las arritmias relevantes en pacientes ingresados en una unidad de ictus. Método: Estudio descriptivo observacional prospectivo de pacientes ingresados en una unidad de ictus con monitorización cardiaca. Se analizan las características de los pacientes y las arritmias registradas durante un año (2013). Se investigó el tiempo de aparición, su asociación con factores predisponentes y las consecuencias terapéuticas de la detección. Todos los pacientes al menos tuvieron 48 h de monitorización cardiaca. Resultados: Se analizó a 332 pacientes, de los cuales 98 (29,5%) presentaron algún tipo de arritmia relevante. Se registraron taquiarritmias (taquiarritmias ventriculares, taquiarritmias supraventriculares, actividad ectópica ventricular compleja) en 90 pacientes (27,1%), y bradiarritmias en 13 pacientes (3,91%). La aparición de arritmias se asoció a un mayor tamaño de la lesión y mayor edad de los pacientes. La detección de arritmias relevantes tuvo consecuencia terapéuticas en el 10% de todos los pacientes. La incidencia de arritmias fue mayor durante las primeras 48 h. Conclusiones: La evaluación sistemática de la monitorización cardiaca en pacientes con ictus agudo permite detectar arritmias cardiacas clínicamente relevantes. Su incidencia es mayor durante las primeras 48 h. La edad y el tamaño de la lesión cerebral se relacionan con su aparición. La detección de arritmias en una unidad de ictus tiene consecuencias terapéuticas fundamentales. Keywords: Cardiac arrhythmias, Stroke unit, Stroke, Telemetry, Cardiac monitoring, Therapeutic implications, Palabras clave: Arritmias cardiacas, Unidad de ictus, Ictus, Telemetría, Monitorización cardiaca, Consecuencias terapéuticas

The paper presents an algorithm of cardio complex classification as part of processing the data of continuous cardiac monitoring. R-wave detection concurrently with cardio complex sorting is discussed. The core of this approach is the use of prior information about. cardio complex forms, segmental structure, and degree of kindness. Results of the sorting algorithm testing are provided.

Arrhythmias are considered a prominent phenomenon in pulmonary hypertension (PH) as the disease progresses. According primarily to retrospective studies with up to 24 hours of monitoring, supraventricular tachycardia (SVT) can be found in 8–35% of patients, with significant impact on survival.

Fabry disease is an X-linked lysosomal storage disorder. Female carriers were long thought to be asymptomatic; however, research has revealed the opposite. Cardiac conditions are the chief causes of death in women with Fabry disease. Although ventricular tachycardia has been reported in male patients with Fabry disease, it is not thought to be a frequent finding in females. We describe the case of a 50-year-old woman in whom we used 14-day continuous electrocardiographic monitoring to identify nonsustained ventricular tachycardia, after electrocardiograms and 24-hour Holter monitoring failed to detect the arrhythmia. A permanent implantable cardioverter-defibrillator relieved the patient's symptoms. We discuss why this case supports the need for more extensive electrophysiologic evaluation in women who have Fabry disease.

Guidelines for continuous cardiac monitoring (CCM) have focused almost exclusively on cardiac diagnoses, thus limiting their application to a general medical population. In this study, a retrospective chart review was performed to identify the reasons that general medical patients, cared for on hospitalist-led inpatient teaching teams between April 2017 and February 2018, were initiated and maintained on CCM, and to determine the incidence of clinically significant arrhythmias in this patient population. The three most common reasons for telemetry initiation were sepsis (24%), arrhythmias (12%), and hypoxia (10%). Most patients remained on telemetry for more than 48 hours (62%) and a significant number of patients were on telemetry until they were discharged from the hospital (39%). Of the cumulative total of more than 20,573 hours of CCM provided to this patient population, 37% of patients demonstrated only normal sinus rhythm and 3% had a clinically significant arrhythmia that affected management.

Background Long‐term continuous cardiac monitoring would aid in the early diagnosis and management of atrial fibrillation ( AF ). This study examined the accuracy of a novel approach for AF detection using photo‐plethysmography signals measured from a wrist‐based wearable device. Methods and Results ECG and contemporaneous pulse data were collected from 2 cohorts of AF patients: AF patients (n=20) undergoing electrical cardioversion ( ECV ) and AF patients (n=40) that were prescribed for 24 hours ECG Holter in outpatient settings ( HOL ). Photo‐plethysmography and acceleration data were collected at the wrist and processed to determine the inter‐pulse interval and discard inter‐pulse intervals in presence of motion artifacts. A Markov model was deployed to assess the probability of AF given irregular pattern in inter‐pulse interval sequences. The AF detection algorithm was evaluated against clinical rhythm annotations of AF based on ECG interpretation. Photo‐plethysmography recordings from apparently healthy volunteers (n=120) were used to establish the false positive AF detection rate of the algorithm. A total of 42 and 855 hours (AF: 21 and 323 hours) of photo‐plethysmography data were recorded in the ECV and HOL cohorts, respectively. AF was detected with >96% accuracy ( ECV, sensitivity=97%; HOL , sensitivity=93%; both with specificity=100%). Because of motion artifacts, the algorithm did not provide AF classification for 44±16% of the monitoring period in the HOL group. In healthy controls, the algorithm demonstrated a AF detection rate. Conclusions A novel AF detection algorithm using pulse data from a wrist‐wearable device can accurately discriminate rhythm irregularities caused by AF from normal rhythm.

Patients at short-term risk of paroxysmal atrial fibrillation (PAF) often exhibit increased RR interval variability during sinus rhythm. We studied if RR dynamic analysis, applied in the first hours after stroke unit (SU) admission, identified acute ischemic stroke patients at higher risk for subsequent PAF episodes detected within the SU hospitalization. Acute ischemic stroke patients underwent continuous cardiac monitoring (CCM) using standard bedside monitors immediately after SU admission. The CCM tracks from the first 48 h were analyzed using a telemedicine service (SRA clinic, Apoplex Medical, Germany). Based on the RR dynamics, the stroke risk analysis (SRA) algorithm stratified the risk for PAF as follows: low risk for PAF, high risk for PAF, presence of manifest AF. The subsequent presence/absence of PAF during the whole SU hospitalization was ruled out using all available CCMs, standard ECGs, or 24-h Holter ECGs. Two hundred patients (40% females, mean age 71 ± 16 years) were included. According to the initial SRA analysis, 111 patients (56%) were considered as low risk for PAF, 52 (26%) as high risk while 37 patients (18%) had manifest AF. A low-risk level SRA was associated with a reduced probability for subsequent PAF detection (1/111, 0.9%, 95% CI 0–4.3%) while a high-risk level SRA predicted an increased probability (20/52, 38.5% (95% CI 25–52%). RR dynamic analysis performed in the first hours after ischemic stroke may stratify patients into categories at low or high risk for forthcoming paroxysmal AF episodes detected within the SU hospitalization.

Convulsive syncope can be difficult to distinguish from seizures at times. Misdiagnosis can result in unnecessary, and usually unsuccessful, treatment with antiepileptic drugs. A detailed history taking and physical examination along with continuous cardiac monitoring can help in making the correct diagnosis. Our patient was eventually found to have viral myocarditis. Moredetailed studies for the role of noninvasive cardiac testing such as Cardiac MRI (CMR) and newer treatment modalities such as anti-thymocyte immunoglobulin are required for the management of Viral Myocarditis.

Electrocardiographic abnormalities and cardiac arrhythmias are commonly noted after acute stroke. Risk of malignant ventricular arrhythmias is increased after a stroke and is associated with sudden cardiac death. Autonomic imbalance modulated by direct injury to neurogenic structures and enhanced by catecholamine storm can lead to myocardial damage and arrhythmogenesis. Experimental and clinical evidence suggests that insular cortex infarcts play a key role in autonomic dysregulation that lead to arrhythmias in the acute setting. Management of ventricular arrhythmias associated with acute stroke should focus on continuous cardiac monitoring, drug therapy, and electrolyte correction. Further research is needed to identify neurological structures involved in autonomic control and risk factors for ventricular arrhythmogenesis after acute stroke.

In today's advancement in technology, affordable healthcare services still not in pace for constrained population. Especially cardiac-related screening needs special attention which increases the mortality rate of chronic cardiac patients every day. Several studies showed that most of the rural healthcare centre does not have the Electro Cardiogram (ECG) System for recording the physiological conditions of the patients. This specific study attempts to investigate the usage of Vernier EKG sensor with real time processor for developing portable ECG system. The preliminary work investigates the suitability of the ECG signal quantitatively and qualitatively for clinical support. A case study was shown with two feature extraction, namely, R-R interval, beats per minute and spectral entropy and the application of KNN classifier to distinguish two different physiological conditions. It was observed that the proposed configuration found to be a cost effective procedure. The quantitative and qualitative results confirm the suitability of the proposed system for real time cardiac monitoring of patients as well as screening tool.

Pacemakers are currently identified as a contraindication for the use of magnetic growth rods (MGRs). This arises from concern that magnetic fields generated by the MGR external remote controller (ERC) during lengthening procedures may induce pacemaker dysfunction. We investigated (1) whether MGR lengthening affects pacemaker function, and (2) if the magnetic field of a pacemaker affects MGR lengthening. MGRs were tested in conjunction with an magnetic resonance imaging-compatible pacemaker, which was connected to a virtual patient under continuous cardiac monitoring. To determine whether pacemaker function was affected during MGR lengthening, the electrocardiogram trace was monitored for arrhythmias, whereas an ERC was applied to lengthen the MGRs at varying distances from the pacemaker. To investigate if MGR lengthening was affected by the presence of a pacemaker, at the start and end of the experiment, the ability of the rods to fully elongate and shorten was tested to check for conservation of function. When the pacemaker was in normal mode

Most health institutes and common hospitals use a continuous cardiac monitoring machine that is immobile, big and heavy, costly and is not equipped with an option to send warnings if there is an alarming change in the patient's heart rate. Thus, the purpose of this research is to design and develop a device prototype that detects alarming changes of a person's heart rate and sends a warning immediately via Short Message Service (SMS) to receivers such as doctors, family members, a person in charge, or monitoring system application. The objective is achieved by developing a program for Arduino microcontroller that enables a pulse sensor module to detect alarming changes of a user's heart rate through photoplethysmography technique and utilizes a GSM Shield module to act as an SMS interface between the device prototype and receivers. The relevancy of Mobile Heart Rate Detection System (MoHeRDS) device is investigated through a survey that has resulted in positive responses from 70 respondents mainly from the health sector where 100% of them agree that MoHeRDS is relevant and some deem it very relevant to be one of the helping factors for early warning of Potentially-Fatal Heart Diseases (such as heart attacks, heart failures, etc.). Furthermore, MoHeRDS is palm-sized, portable and has a reasonable low cost. Thus, with the implementation of MoHeRDS in the health sectors, individuals with risk of potentially-fatal heart diseases can get immediate treatment hence reducing their death statistics.

Background Hospitals have been slow to adopt guidelines from the American Heart Association (AHA) limiting the use of continuous cardiac monitoring for fear of missing important patient cardiac events. A new continuous cardiac monitoring policy was implemented at a tertiary-care hospital seeking to monitor only those patients who were clinically indicated and decrease the number of false alarms in order to improve overall alarm response. Methods Leadership support was secured, a cross-functional alarm management task force was created, and a system-wide policy was developed based on current AHA guidelines. Process measures, including cardiac monitoring rate, monitored transport rate, emergency department (ED) boarding rate and the percentage of false, unnecessary and true alarms, were measured to determine the policy's impact on patient care. Outcome measures, including length of stay and mortality rate, were measured to determine the impact on patient outcomes. Results Cardiac monitoring rate decreased 53.2% (0.535 to 0.251 per patient day, p

An electrocardiography SoC is integrated into a form-fitting textile along with flexible electrodes, battery and antenna. Clinically standard 12-lead ECG is recorded from this “smart shirt.” The data is encrypted and wirelessly transmitted via an on-chip ISM band radio and flexible antenna allowing secure, continuous cardiac monitoring on a smartphone while dissipating less than 1mW.

BackgroundThere’s scarce evidence about cardiovascular events (CV) in patients with hospitalization for acute heart failure (HF) and no indication for immediate device implant. ObjectiveThe CARdiac RhYthm monitorING after acute decompensatiON for Heart Failure study was designed to assess the incidence of prespecified clinical and arrhythmic events in this patient population. MethodsIn this pilot study, 18 patients (12 (67%) male; age 72±10; 16 (89%) NYHA II-III), who were hospitalized for HF with low left ventricular ejection fraction (LVEF) (