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Sun X, Teng Y, Mu S, Wang Y, Chen H. Diagnostic accuracy of different ECG-based algorithms in wide QRS complex tachycardia: a systematic review and meta-analysis. BMJ Open 2023; 13:e069273. [PMID: 37487685 PMCID: PMC10373685 DOI: 10.1136/bmjopen-2022-069273] [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: 07/26/2023] Open
Abstract
OBJECTIVE Several ECG-based algorithms have been proposed to enhance the effectiveness of distinguishing Wide QRS complex tachycardia (WCT), but a comprehensive comparison of their accuracy is still lacking. This meta-analysis aimed to assess the diagnostic precision of various non-artificial intelligence ECG-based algorithms for WCT. DESIGN Systematic review with meta-analysis. DATA SOURCES Electronic databases (PubMed, MEDLINE, the Cochrane Library, and Web of Science) are searched up to May 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES All studies reporting the diagnostic accuracy of different ECG-based algorithms for WCT are included. The risk of bias in included studies is assessed using the Cochrane Collaboration's risk of bias tools. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and assessed risk of bias. Data were pooled using random-effects model and expressed as mean differences with 95% CIs. Heterogeneity was calculated by the I2 method. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was applied to assess the internal validity of the diagnostic studies. RESULTS In total, 467 studies were identified, and 14 studies comprising 3966 patients were included, involving four assessable ECG-based algorithms: the Brugada algorithm, Vereckei-pre algorithm, Vereckei-aVR algorithm and R wave peak time of lead II (RWPT-II) algorithm. The overall sensitivity was 88.89% (95% CI: 85.03 to 91.86), with a specificity of 70.55% (95% CI: 62.10 to 77.79) and a diagnostic OR (DOR) of 19.17 (95% CI: 11.45 to 32.10). Heterogeneity of the DOR was 89.1%. The summary sensitivity of each algorithm was Brugada 90.25%, Vereckei-pre 94.80%, Vereckei-aVR 90.35% and RWPT-II 78.15%; the summary specificity was Brugada 64.02%, Vereckei-pre 75.40%, Vereckei-aVR 60.88% and RWPT-II 88.30% and the summary DOR was Brugada 16.48, Vereckei-pre 60.70, Vereckei-aVR 14.57 and RWPT-II 27.00. CONCLUSIONS ECG-based algorithms exhibit high sensitivity and moderate specificity in diagnosing WCT. A combination of Brugada or Vereckei-aVR algorithm with RWPT-II could be considered to diagnose WCT. PROSPERO REGISTRATION NUMBER CRD42022344996.
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Affiliation(s)
- Xingxing Sun
- Department of Cardiology, The Second People's Hospital of Lianyungang, Affiliated to Kangda College of Nanjing Medical University, Lianyungang, China
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yanling Teng
- Department of Cardiology, The First people's Hospital of Lianyungang, The First Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang, China
| | - Shengnan Mu
- Department of Cardiology, The Second People's Hospital of Lianyungang, Affiliated to Kangda College of Nanjing Medical University, Lianyungang, China
| | - Yilian Wang
- Department of Cardiology, The Second People's Hospital of Lianyungang, Affiliated to Kangda College of Nanjing Medical University, Lianyungang, China
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hongwu Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Yilmazer B, Sali M, Cosan F, Cefle A. Sinus node dysfunction in adult systemic lupus erythematosus flare: A case report. Mod Rheumatol 2013; 25:472-5. [PMID: 24252017 DOI: 10.3109/14397595.2013.843744] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Cardiac involvement can affect up to 50% of the systemic lupus erythematosus (SLE) patients but conduction system disturbances in SLE are less commonly described. For an early detection of this complication in the acute phase of SLE a whole cardiovascular examination and periodic electrocardiographic monitoring are recommended. We describe a patient who was diagnosed with flare up of lupus activity manifesting as sinus node dysfunction presenting as profound sinus bradycardia. She was successfully treated with high-dose methylprednisolone therapy.
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Affiliation(s)
- Baris Yilmazer
- Department of Rheumatology, Kocaeli University, Faculty of Medicine , Kocaeli , Turkey
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Chen JY, Liou YM, Wu HDI, Lin KH, Chang KC. Promoter polymorphism G-6A, which modulates angiotensinogen gene expression, is associated with non-familial sick sinus syndrome. PLoS One 2012; 7:e29951. [PMID: 22242192 PMCID: PMC3252346 DOI: 10.1371/journal.pone.0029951] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 12/07/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND It is well known that familial sick sinus syndrome (SSS) is caused by functional alterations of ion channels and gap junction. Limited information is available on the mechanism of age-related non-familial SSS. Although evidence shows a close link between arrhythmia and the renin-angiotensin system (RAS), it remains to be determined whether the RAS is involved in the pathogenesis of non-familial SSS. METHODS In this study, 113 patients with documented non-familial SSS and 125 controls were screened for angiotensinogen (AGT) and gap junction protein-connexin 40 (Cx40) promoter polymorphisms by gene sequencing, followed by an association study. A luciferase assay was used to determine the transcriptional activity of the promoter polymorphism. The interaction between nuclear factors and the promoter polymorphism was characterized by an electrophoretic mobility shift assay (EMSA). RESULTS Association study showed the Cx40 -44/+71 polymorphisms are not associated with non-familial SSS; however, it indicated that four polymorphic sites at positions -6, -20, -152, and -217 in the AGT promoter are linked to non-familial SSS. Compared to controls, SSS patients had a lower frequency of the G-6A AA genotype (OR 2.88, 95% CI 1.58-5.22, P = 0.001) and a higher frequency of the G allele at -6 position (OR 2.65, 95% CI 1.54-4.57, P = 0.0003). EMSA and luciferase assays confirmed that nucleotide G at position -6 modulates the binding affinity with nuclear factors and yields a lower transcriptional activity than nucleotide A (P<0.01). CONCLUSION G-6A polymorphism, which modulates the transcriptional activity of the AGT promoter, may contribute to non-familial SSS susceptibility.
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Affiliation(s)
- Jan-Yow Chen
- Department of Life Sciences, National Chung Hsing University, Taichung, Taiwan
- Division of Cardiology, Department of Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Ying-Ming Liou
- Department of Life Sciences, National Chung Hsing University, Taichung, Taiwan
- Graduate Institute of Basic Medical Science, China Medical University, Taichung, Taiwan
- * E-mail:
| | - Hong-Dar Isaac Wu
- Department of Applied Mathematics and Institute of Statistics, National Chung Hsing University, Taichung, Taiwan
| | - Kuo-Hung Lin
- Division of Cardiology, Department of Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Kuan-Cheng Chang
- Division of Cardiology, Department of Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
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4
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Lin Y, Liou YM, Chen JY, Chang KC. Sinus node dysfunction as an initial presentation of adult systemic lupus erythematosus. Lupus 2011; 20:1072-5. [PMID: 21478288 DOI: 10.1177/0961203310396747] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cardiac involvement in systemic lupus erythematosus (SLE) has been well described. However, sinus node involvement with profound sinus bradycardia as an early manifestation of adult SLE has not been reported. A 27-year-old previously healthy female was admitted due to intermittent fever for 4 days. SLE was diagnosed based on clinical manifestations and laboratory data. Profound sinus bradycardia (heart rate = 41/min) with weakness was noted during hospitalization. ECG abnormalities completely resolved after a high-dose intravenous steroid infusion. Sinus node involvement with significant bradycardia is one of the possible complications in the early stage of adult SLE. Close cardiovascular monitoring and serial ECGs are suggested for early detection of this serious complication of adult SLE.
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Affiliation(s)
- Yn Lin
- Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
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Cappato R, Schlüter M, Weiss C, Willems S, Meinertz T, Kuck KH. Mapping of the coronary sinus and great cardiac vein using a 2-French electrode catheter and a right femoral approach. J Cardiovasc Electrophysiol 1997; 8:371-6. [PMID: 9106422 DOI: 10.1111/j.1540-8167.1997.tb00802.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Local electrograms recorded from the coronary sinus and great cardiac vein provide important information for the diagnosis of various arrhythmias and identification of target sites for ablation of left-sided accessory pathways. One limitation of present techniques is the inability, in many cases, to probe the great cardiac vein at the anterior mitral annulus. We tested the feasibility of a new technique for catheterization of the coronary sinus and great cardiac vein by means of a small-diameter electrode catheter advanced via a right femoral approach through an angiography catheter. METHODS AND RESULTS Of 22 patients (12 men and 10 women; ages 44.5 +/- 13.4 years) undergoing radiofrequency ablation of a supraventricular tachycardia, cannulation of the coronary sinus orifice using a 6-French 1L or 2L Amplatz catheter was achieved in 20 patients (91%) within 0.9 +/- 0.6 minutes; after cannulation, a 2-French octapolar electrode catheter with a soft radiopaque tip and a 3-mm interelectrode distance could be advanced in all 20 patients through the guiding catheter to the great cardiac vein in the anterior region of the AV sulcus within 0.8 +/- 0.7 minutes. Atrial and ventricular local potentials were recorded all along the mitral annulus during sinus rhythm, atrial and ventricular pacing, or supraventricular tachycardia. Variation of local potential amplitude never exceeded 20% of the mean and presented similar stability at all annular regions. The arrhythmogenic substrate was identified in all patients. Of 18 patients with 21 left-sided accessory pathways, an accessory pathway potential could be recorded at the ablation site by one or more adjacent epicardial electrode pairs in 10 pathways. No procedure-related complications were observed. CONCLUSIONS The technique introduced in this study proved feasible in 91% of patients. Its main advantages are the simplicity and rapidity of coronary sinus cannulation and the ability to advance the electrode catheter to the anterior cardiac vein. In addition, closely spaced bipolar electrograms resulted in enhanced atrial, ventricular, and accessory pathway potential resolution.
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Affiliation(s)
- R Cappato
- Second Department of Internal Medicine, St. Georg Hospital, Hamburg, Germany
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Kaufman JD, Morgan MS, Marks ML, Greene HL, Rosenstock L. A study of the cardiac effects of bromochlorodifluoromethane (halon 1211) exposure during exercise. Am J Ind Med 1992; 21:223-33. [PMID: 1536156 DOI: 10.1002/ajim.4700210212] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Bromochlorodifluoromethane (halon 1211, a fire extinguisher), like other fluorocarbons, has been linked with ventricular arrhythmias and myocardial depression. Ten healthy firefighters, aged 40-50, were exposed to 1,000 ppm halon while exercising, in a double-blind, placebo-controlled crossover experiment, and were monitored during and after exposure. Complex ectopy (ventricular couplets and idioventricular rhythm) occurred in two subjects with halon, but none with placebo. One subject had 49.5 ventricular premature beats (VPB)/hour during the period of halon exposure and subsequent 8 hours and only 8.7 VPB/hour during the same period of placebo. In addition, 8 of the 10 subjects had a smaller systolic blood pressure rise during exercise with halon than with placebo. None of the observed differences was statistically significant. These results are consistent with findings in other investigations, suggesting that occupational fluorocarbon exposures may be cardiotoxic in certain individuals, although the small sample sizes used in this and other studies have resulted in limited statistical power to demonstrate this effect.
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Affiliation(s)
- J D Kaufman
- Department of Medicine, University of Washington, Seattle
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Vanerio G, Maloney J, Rashidi R, McCowan R, Castle L, Morant V, Wilkoff B, Simmons T. The effects of percutaneous catheter ablation on preexisting permanent pacemakers. Pacing Clin Electrophysiol 1990; 13:1637-45. [PMID: 1704517 DOI: 10.1111/j.1540-8159.1990.tb06866.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
STUDY OBJECTIVE Determine the effect of percutaneous catheter ablation (CA) on permanent pacemakers. MEASUREMENTS AND RESULTS Twenty-three patients who underwent CA at The Cleveland Clinic Foundation from September 1983 to January 1990, and had a previously implanted pacemaker were studied. Electrocardiographic data during the CA procedure and clinic data including pacemaker evaluations were analyzed. Fifty-two percent (12/23) of the pacemakers malfunctioned: five developed transient ventricular loss of capture; two undersensing; one oversensing; three could not be interrogated or programmed, and one did not respond to the magnet test. Four patients developed syncopal episodes and two severe dizziness after the procedure. All had their pacemakers replaced. In total, seven were explanted. Destructive analysis by the individual manufacturer identified pacemaker circuitry failure in five. Unipolar pacemakers and anodal ablation procedures had more frequent and severe malfunctions, but the difference was not statistically significant. CONCLUSIONS Pacemaker malfunction is frequent during CA. It may be prevented by programming the pacemaker, when possible, to the nonfunctioning mode (000 mode). Temporarily disconnecting the pacemaker during ablation requires further evaluation as an alternative approach. Close follow-up can detect pacemaker malfunction and prevent complications.
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Affiliation(s)
- G Vanerio
- Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195
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Faust M, Fraser J, Schurig L, Ching B, Gillette PC, Goldschlager N, Haran C, Magro S, Ozahowski T, Sweesy M. Educational guidelines for the clinically associated professional in cardiac pacing and electrophysiology. Pacing Clin Electrophysiol 1990; 13:1448-55. [PMID: 1701899 DOI: 10.1111/j.1540-8159.1990.tb04020.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Abstract
Clinical electrophysiology testing is now a standard, useful technique for assessing patients with bradyarrhythmias or tachyarrhythmias. The technique requires specialized training and equipment. The recording equipment and program stimulator have evolved to sophisticated devices allowing accurate reproduction of intracardiac electrograms and timing of programmed extrastimuli. Electrophysiologic studies are useful for determining the mechanisms of a tachycardia or bradycardia and identifying the most appropriate therapy, whether it be pacing, antiarrhythmic medications, transvenous ablation, or electrosurgery.
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Affiliation(s)
- S C Hammill
- Department of Medicine, Mayo Clinic, Rochester, Minnesota
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Rinkenberger RL, Naccarelli GV, Leahy E, Dougherty AH. Invasive and noninvasive evaluation of arrhythmias. HOSPITAL PRACTICE (OFFICE ED.) 1988; 23:115-20, 125-35. [PMID: 3141441 DOI: 10.1080/21548331.1988.11703584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Abstract
The diagnostic utility of memory-equipped transtelephonic electrocardiographic monitors was evaluated in a series of 31 patients referred for evaluation of unexplained syncope (16), presyncope (8), or palpitations (7). Previous nondiagnostic workups included 4 +/- 1 days (mean +/- standard error of the mean) of 24-hour Holter and/or in-hospital telemetric monitoring per patient. The duration of monitoring averaged 31 +/- 2 days per patient. Electrocardiographic recordings were made during a typical symptom episode in 9 of 31 (29%) patients, including 0 of 16 with syncope, 3 of 8 (37%) with presyncope, and 6 of 7 (86%) with palpitations (p less than .001). The probability of recording typical symptoms was strongly influenced by their previous frequency. Potentially causal arrhythmias were documented in 5 of 7 (71%) patients with palpitations, but in none of the other symptom subgroups (p less than .001). Monitoring led to changes in therapy in only two patients. During followup of 9 +/- 1 months, symptoms continued in 4 of 16 (25%) with syncope, 7 of 8 (87%) with presyncope, and 7 of 7 (100%) with palpitations (p = .001). The diagnostic utility of these devices thus appears to be low in patients with previously unexplained syncope or presyncope. The yield was high in those monitored for palpitations, which may be in part attributable to the greater frequency of symptoms observed in this group.
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Affiliation(s)
- S B Schmidt
- West Virginia University School of Medicine, Section of Cardiology, Morgantown 26506
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Abstract
This report describes the inadvertent induction of non-sustained atrial and ventricular arrhythmias due to the malfunction of a programmable cardiac stimulator. The malfunction occurred when line power resumed after a brief municipal power outage ("blackout") during an invasive electrophysiological study. The stimulator spontaneously delivered very high frequency pulses through the electrode catheter to the myocardium which resulted in atrial and ventricular arrhythmias. During bench testing, the stimulator delivered a continuous train of high frequency output pulses (greater than or equal to 1 mA) when line voltage resumed normal level after it had dropped below 65 VAC. Electrical safety during electrophysiological testing requires a stimulator design which is immune to altered operating conditions, and which shuts down if abnormal operating or output conditions are detected.
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Affiliation(s)
- S A Rubin
- Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA 90048
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Abstract
Tocainide, mexiletine, flecainide, encainide, and amiodarone are antiarrhythmic agents that have recently been approved by the Food and Drug Administration for general use in the treatment of ventricular arrhythmias. All five agents are effective in the treatment of patients with ventricular arrhythmias, whereas encainide, flecainide, and amiodarone are also useful in patients with supraventricular arrhythmias and the Wolff-Parkinson-White syndrome (although not yet approved for these indications). Tocainide and mexiletine are similar to lidocaine and are as effective as quinidine in patients with ventricular arrhythmias. Encainide and flecainide are superior to quinidine for the control of ventricular ectopic beats and as effective as quinidine for patients with ventricular tachycardia. Amiodarone is the most effective agent available for treating patients with ventricular tachycardia, but it is also the most toxic antiarrhythmic agent and should be used only when other antiarrhythmic drugs have not been effective or tolerated.
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Affiliation(s)
- R W Kreeger
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905
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