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Vasankari, T. Kiviniemi, and J. Airaksinen provided clinical insights, contributed in ethical permission preparation, study design, and supervised all clinical data collections. M. Pänkäälä and T. ...doi:10.1038/s41598-018-27683-9 pmid:29921933 pmcid:PMC6008477 fatcat:sczl2km3k5bsxgry5id5h6hkbe
Electrical cardioversion (CV) is essential in rhythm management of atrial fibrillation (AF). However, optimal timing of CV remains unknown. Hypothesis.: Timing of CV in AF is associated with risk of adverse events. Methods: We analyzed the effect of AF episode duration on safety and efficacy of electrical CV in a multicenter, multicohort study exploring 4356 CVs in 2530 patients on oral anticoagulation. The composite adverse outcome included unsuccessful CV, acute arrhythmic complications,doi:10.1002/clc.22986 pmid:29802625 fatcat:2ogd3ohja5aurmcxekq3pb67ti
more »... boembolic events, mortality, and AF recurrence within 30-day follow-up. Results: Study groups were stratified according to duration of index AF episode (<24 h, 24-48 h, 48 h-30d, and > 30d), consisting of 1767, 516, 632, and 1441 CVs, respectively. CVs were unsuccessful in 8.5% (<24 h), 5.4% (24-48 h), 11.1% (48 h-30d), and 13.9% (>30d), respectively (P < 0.01). Occurrence of thromboembolic events (0.1%), mortality (0.1%), and asystole >5 seconds (0.7%) within 30-day follow-up was infrequent and comparable in the study groups. AF recurrence within 30 days after initially successful CVs was 29.8% (<24 h), 26.5% (24-48 h), 37.3% (48 h-30d), and 30.3% (>30d), respectively (P < 0.01). Composite adverse outcome occurred in 1669 (38.4%) CVs, and index AF episode >48 hours was an independent predictor for the composite endpoint (OR: 1.49, 95% CI: 1.28-1.74, P < 0.01) in multivariate analysis. Conclusions: Optimal timing of CV for AF showed a J-shaped curve, with fewest adverse outcomes in patients with CV performed 24 to 48 hours after onset of AF. In patients with rhythmcontrol strategy, delaying CV >48 hours is associated with increased risk for adverse outcomes.
The aim of the study was to assess the applicability of seismocardiogram (SCG) for the detection of atrial fibrillation (AF) in telemonitoring applications. SCG data used in this study consists of simultaneous SCG and ECG recordings of 12 patients during both AF and sinus rhythm (after cardioversion). An SCG-based AF-detection algorithm was developed and its performance tested with the acquired clinical data. The algorithm is able to distinguish AF positive samples from samples with sinus rhythm with high accuracy.doi:10.1109/cic.2015.7411039 dblp:conf/cinc/KoivistoPHVKSA15 fatcat:nd2yqydvxjfmzntpfhxrzyzuxa
Aims To determine the incidence and risk factors of arrhythmic complications after electrical cardioversion of acute atrial fibrillation (AF). Methods and results Our retrospective multicentre study collected data from 7660 cardioversions of acute (,48 h) AF in 3143 consecutive patients. Immediate arrhythmic complications were evaluated after 6906 (90.2%) electrical cardioversions performed in 2868 patients. We also assessed the predictors of arrhythmic complications and whetherdoi:10.1093/europace/eut106 pmid:23687124 fatcat:7vpbbcplqvcppcjl7st4guyqra
more »... on bradycardia or asystole led to later a permanent pacemaker implantation. Altogether, 63 (0.9%) electrical cardioversions resulted in bradyarrhythmia in 54 patients. Asystole (.5 s) occurred immediately after 51 cardioversions leading to a short resuscitation in seven cases and two patients needed extrinsic pacing after the cardioversion. In nine cases, asystole was followed by bradycardia. Bradycardic ventricular rate (,40 b.p.m.) alone was seen after 12 procedures. No ventricular arrhythmias needing intervention were detected. Old age [odds ratio (OR) 1.1; 95% confidence interval (CI) 1.05 -1.10, P , 0.0001], female sex (OR 2.5; 95% CI 1.4 -4.8, P ¼ 0.004), and unsuccessful cardioversion (OR 2.2; 95% CI 1.1 -4.6, P ¼ 0.03) were the independent predictors of bradycardic complications. Slow ventricular rate, use of digoxin, beta blocker, or antiarrhythmic medication did not increase the risk of bradycardic complications. Pacemaker was implanted in 24 (44.4%) patients after a median delay of 66 days. Conclusion Bradycardic complications are rare and usually benign after cardioversion of acute AF. They seem to reflect sinus node dysfunction and often result in later implantation of a permanent pacemaker. ---
Novel means to minimize treatment delays in patients with ST elevation myocardial infarction (STEMI) are needed. Using an accelerometer and gyroscope on the chest yield mechanocardiographic (MCG) data. We investigated whether STEMI causes changes in MCG signals which could help to detect STEMI. The study group consisted of 41 STEMI patients and 49 control patients referred for elective coronary angiography and having normal left ventricular function and no valvular heart disease or arrhythmia.doi:10.3390/s22124384 pmid:35746166 pmcid:PMC9228321 fatcat:e6lgw5vsb5h5tpmxvykc6g6zeq
more »... CG signals were recorded on the upper sternum in supine position upon arrival to the catheterization laboratory. In this study, we used a dedicated wearable sensor equipped with 3-axis accelerometer, 3-axis gyroscope and 1-lead ECG in order to facilitate the detection of STEMI in a clinically meaningful way. A supervised machine learning approach was used. Stability of beat morphology, signal strength, maximum amplitude and its timing were calculated in six axes from each window with varying band-pass filters in 2–90 Hz range. In total, 613 features were investigated. Using logistic regression classifier and leave-one-person-out cross validation we obtained a sensitivity of 73.9%, specificity of 85.7% and AUC of 0.857 (SD = 0.005) using 150 best features. As a result, mechanical signals recorded on the upper chest wall with the accelerometers and gyroscopes differ significantly between STEMI patients and stable patients with normal left ventricular function. Future research will show whether MCG can be used for the early screening of STEMI.
Atrial fibrillation (AF) is often asymptomatic and undiagnosed until an ischaemic stroke occurs. An irregular pulse is a key manifestation of AF. We assessed whether pulse self-palpation is feasible in screening of AF. Methods: Altogether 205 residents of Lieto municipality aged ≥75 years were randomized in 2012 to receive brief education on pulse palpation focusing on evaluating rhythm regularity. Self-detected pulse irregularity and new AF diagnoses were recorded, and the subjects' quality ofdoi:10.1186/s12877-017-0607-0 pmid:28915862 pmcid:PMC5602855 fatcat:nvulitrwcvchxfadrcyjunu7pi
more »... life and use of health care services were assessed during a three-year follow-up. Results: The subjects' median age was 78.2 [3.8] years, and 89 (43.4%) were men. Overall, 139 (68%) subjects had initial good motivation/capability for regular palpation. At four months, 112 (80.6%) subjects with good and 26 (39.4%) with inadequate motivation/capability palpated their pulse daily. At 12 months, 120 (58.5%) and at 36 months, 69 (33.7%) subjects palpated their pulse at least weekly. During the intervention, 67 (32.7%) subjects reported pulse irregularity. New AF was found in 10 (4.9%) subjects, 7 (70%) of whom had reported pulse irregularity. Pulse irregularity independently predicted new AF, but only one (0.5%) subject with new AF sought undelayed medical attention due to pulse irregularity. Quality of life and number of outpatient clinic visits remained unchanged during follow-up. Conclusion: Pulse palpation can be learned also by the elderly, but it is challenging to form a continuing habit. The low persistence of pulse self-palpation limits its value in the screening of AF, and strategies to promote persistence and research on alternative screening methods are needed. Trial registration: http://www.ClinicalTrials.gov identifier: NCT01721005. The trial was registered retrospectively on October 26, 2012.
Electronic health records (EHR) are a potential resource for identification of clinical trial participants. We evaluated how accurately a commercially available EHR Research Platform, InSite, is able to identify potential trial participants from the EHR system of a large tertiary care hospital. Patient counts were compared with results obtained in a conventional manual search performed for a reference study that investigated the associations of atrial fibrillation (AF) and cerebrovasculardoi:10.1016/j.conctc.2020.100692 pmid:33409423 pmcid:PMC7773855 fatcat:ssamqzjk6jevfhbo52jx34tete
more »... nts. The Clinical Data Warehouse (CDW) of Turku University Hospital was used to verify the capabilities of the EHR Research Platform. The EHR query resulted in a larger patient count than the manual query (EHR Research Platform 5859 patients, manual selection 2166 patients). This was due to the different search logic and some exclusion criteria that were not addressable in structured digital format. The EHR Research Platform (5859 patients) and the CDW search (5840 patients) employed the same search logic. The temporal relationship between the two diagnoses could be identified when they were available in structured format and the time difference was longer than a single hospital visit. Searching for patients with the EHR Research Platform can help to identify potential trial participants from a hospital's EHR system by limiting the number of records to be manually reviewed. EHR query tools can best be utilized in trials where the selection criteria are expressed in structured digital format.
Tuija Vasankari, RN, is a cardiac nurse and study coordinator at Heart Centre, Turku University Hospital. Raine Virtanen, MD, PhD, is a cardiologist at Heart Centre, Turku University Hospital. K.E. ...doi:10.1080/02813432.2017.1358858 pmid:28784027 pmcid:PMC5592357 fatcat:wj4wwh4snrbpzo2kwexsb3xo44
We present a novel method for estimating respiratory motion using inertial measurement units (IMUs) based on microelectromechanical systems (MEMS) technology. As an application of the method we consider the amplitude gating of positron emission tomography (PET) imaging, and compare the method against a clinically used respiration motion estimation technique. The presented method can be used to detect respiratory cycles and estimate their lengths with state-of-the-art accuracy when compared todoi:10.3390/s21123983 fatcat:qpn7o3bykveanorwcwyhlrbzxy
more »... her IMU-based methods, and is the first based on commercial MEMS devices, which can estimate quantitatively both the magnitude and the phase of respiratory motion from the abdomen and chest regions. For the considered test group consisting of eight subjects with acute myocardial infarction, our method achieved the absolute breathing rate error per minute of 0.44 ± 0.23 1/min, and the absolute amplitude error of 0.24 ± 0.09 cm, when compared to the clinically used respiratory motion estimation technique. The presented method could be used to simplify the logistics related to respiratory motion estimation in PET imaging studies, and also to enable multi-position motion measurements for advanced organ motion estimation.
In this paper, we attempt to classify the pre-and postoperation cardiac conditions of ST-elevation myocardial infarction (STEMI) utilizing seismocardiography (SCG) and gyrocardiography (GCG) signals recorded solely by a smartphone. SCG and GCG signals were recorded from 20 MI patients who were admitted to Emergency Department of Turku Hospital. Two measurements were recorded from each subject, one before they proceeded to percutaneous coronary intervention (pre-operation) and one afterwardsdoi:10.22489/cinc.2018.110 dblp:conf/cinc/MehrangTLKVKAPK18 fatcat:otjjid6nk5eqbcd5qvbigavvoy
more »... t-operation) with an average time interval of 2 days. Noise and artefact removal were applied to the signals and subsequently 25 features were extracted. Two classification algorithms, random forest (RF) and support vector machines (SVM), were deployed to discriminate the two cardiac conditions. Accuracy rates of 74% and 78% were obtained for RF and SVM, respectively. The results indicate that smartphone SCG-GCG based ischaemia analysis has clinical implications that warrants further investigations.
word count: 200 words HIGHLIGHTS • The safety and efficacy of currently available vascular closure devices (VCD) is debated. • This study showed that the risk of vascular injury during transfemoral transcatheter aortic valve implantation is substantial even when using VCDs for large-bore access. • The MANTA VCD may be not inferior to the ProGlide VCD and may significantly reduce the need of additional VCDs for completion of hemostasis. ABSTRACT Background: The MANTA system is a novel vasculardoi:10.1016/j.ijcard.2018.04.065 pmid:29681408 fatcat:awkv7etk7nbujbejaiee3hxgu4
more »... osure device (VCD) and its safety and efficacy were compared to the ProGlide VCD in patients undergoing transfemoral transcatheter aortic valve implantation (TAVI). Methods: This is a retrospective study including 222 patients who underwent transfemoral TAVI at three Finnish University Hospitals. The MANTA VCD was used in 107 patients and their outcome was compared with that of 115 patients in whom the arterial access was closed with the ProGlide VCD. Results: VARC-2 VCD failure occurred less frequently in the MANTA cohort (3.7% vs. 7.8%, p=0.378), but the difference did not reach statistical significance. When adjusted for the introducer outer diameter, the MANTA cohort had similar rates of VARC-2 major vascular complications (9.3% vs. 12.2%, adjusted: p=0.456), VARC-2 life-threatening/disabling bleeding (9.3% vs. 6.1%, adjusted: p=0.296) and need of invasive treatment of bleeding (4.7% vs. 7.0%, adjusted: p=0.416) compared to the ProGlide cohort. Additional VCDs were more frequently needed in the ProGlide cohort (58.3% vs. 1.9%, p<0.0001). Conclusions: In patients undergoing transfemoral TAVI, the MANTA VCD showed a similar risk of VARC-2 vascular and bleeding complications compared to the ProGlide VCD, but it reduced significantly the need of additional VCDs for completion of hemostasis. Continuous variables are reported as means and standard deviation and nominal variables as counts and percentages. TAVI: transcatheter aortic valve implantation;
Elective cardioversion (ECV) of atrial fibrillation (AF) is a standard procedure to restore sinus rhythm. However, predictors for ineffective ECV (failure of ECV or recurrence of AF within 30 days) are unknown. Methods: We investigated 1998 ECVs performed for AF lasting >48 h in 1,342 patients in a retrospective multi-center study. Follow-up data were collected from 30 days after ECV. Results: Median number of cardioversions was one per patient with a range of 1-10. Altogether 303/1998 (15.2%)doi:10.1186/s12872-017-0470-0 pmid:28100174 pmcid:PMC5241921 fatcat:asgwkliginborciqcgy3v3jhfm
more »... CVs failed. Long (>5 years) AF history and over 30 days duration of the index AF episode were independent predictors for ECV failure and low (<60/min) ventricular rate of AF predicted success of ECV. In patients with successful ECVs an early recurrence of AF was detected in 549 (32.4%) cases. Female gender, high (>60/min) ventricular rate, renal failure and antiarrhythmic agents at discharge were the independent predictors for recurrence. In total ECV was ineffective in 852 (42.6%) cases. Female gender (OR 1.44, CI95% 1.15-1.80, p < 0.01), young (<65 years) age (OR 1.31, CI95% 1.07-1.62, p = 0.01), ventricular rate >60/min (OR 1.92, CI95% 1.08-3.41, p = 0.03), antiarrhythmic medication at discharge (OR 1.48, CI95% 1.14-1.93, p < 0.01) and low (<60/ml/min) estimated glomerular filtration rate (OR 1.59, CI95% 1.08-2.33, p = 0.02) were predictors of ineffective ECV. Conclusions: Female gender, use of antiarrhythmic drug therapy and renal failure predicted both recurrence of AF and the composite end point. For the first time in a large real-life study several clinical predictors for clinically ineffective ECV were identified.
AbstractPatients undergoing cardiac surgery develop a marked postoperative systemic inflammatory response. Blood transfusion may contribute to disruption of homeostasis in these patients. We sought to evaluate the impact of blood transfusion on serum interleukin-6 (IL-6), hypoxia induced factor-1 alpha (HIF-1α) levels as well as adverse outcomes in patients undergoing adult cardiac surgery. We prospectively enrolled 282 patients undergoing adult cardiac surgery. Serum IL-6 and HIF-1α levelsdoi:10.1038/s41598-021-01695-4 pmid:34782683 pmcid:PMC8592994 fatcat:2xbhkrj4srexzlwjbjleodkvju
more »... measured preoperatively and on the first postoperative day. Packed red blood cells were transfused in 26.3% of patients (mean 2.93 ± 3.05 units) by the time of postoperative sampling. Postoperative IL-6 levels increased over 30-fold and were similar in both groups (p = 0.115), whilst HIF-1α levels (0.377 pg/mL vs. 0.784 pg/mL, p = 0.002) decreased significantly in patients who received red blood cell transfusion. Moreover, greater decrease in HIF-1α levels predicted worse in-hospital and 3mo adverse outcome. Red blood cell transfusion was associated with higher risk of major adverse outcomes (stroke, pneumonia, all-cause mortality) during the index hospitalization. Red blood cell transfusion induces blunting of postoperative HIF-1 α response and is associated with higher risk of adverse thrombotic and pulmonary adverse events after cardiac surgery. Clinical Trial Registration ClinicalTrials.gov Identifier: NCT03444259.
IEEE Sensors Journal
Atrial fibrillation (AFib) is the most common sustained heart arrhythmia and is characterized by irregular and excessively frequent ventricular contractions. Early diagnosis of AFib is a key step in the prevention of stroke and heart failure. In this paper, we present a comprehensive time-frequency pattern analysis approach for automated detection of AFib from smartphone-derived seismocardiography (SCG) and gyrocardiography (GCG) signals. We sought to assess the diagnostic performance of adoi:10.1109/jsen.2018.2882874 fatcat:2625v4e25rgjzpeah7obcdhtra
more »... phone mechanocardiogram (MCG) by considering joint SCG-GCG recordings from 435 subjects including 190 AFib and 245 sinus rhythm cases. A fully automated AFib detection algorithm consisting of various signal processing and multidisciplinary feature engineering techniques was developed and evaluated through a large set of cross-validation (CV) data including 300 (AFib = 150) cardiac patients. The trained model was further tested on an unseen set of recordings including 135 (AFib = 40) subjects considered as cross-database (CD). The experimental results showed accuracy, sensitivity, and specificity of approximately 97%, 99%, and 95% for the CV study and up to 95%, 93%, and 97% for the CD test, respectively. The F 1 scores were 97% and 96% for the CV and CD, respectively. A positive predictive value of approximately 95% and 92% was obtained, respectively, for the validation and test sets suggesting high reproducibility and repeatability for mobile AFib detection. Moreover, the kappa coefficient of the method was 0.94 indicating a near-perfect agreement in rhythm classification between the smartphone algorithm and visual interpretation of telemetry recordings. The results support the feasibility of self-monitoring via easy-to-use and accessible MCGs.
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