Development of portable device to detect arrhythmias in real time

Portable device to detect arrhythmias in real time

Researchers at the Technological Institute of Morelia (ITM) in Mexico created a portable device for detecting cardiac arrhythmias in real time using electrodes placed on the chest of the patient or as part of clothing. It also alerts medical personnel of any irregularity in the heartbeat.

26 may 2016--Dr. Jose Gutierrez explained that the device sends real-time results to doctors with a wireless measurement system. It also stores data for subsequent analysis.
One of the advantages of this new technology is that it is smaller than existing devices on the market. The device developed at the ITM measures less than half of typical devices, at 20 x 20 centimeters.
The device enables the detection of eight different types of arrhythmias. Its design considers user safety as a primary factor. One of the challenges in the development of this device, explains Gutierrez, is improved recharging. He adds that future devices can be made even smaller.
In addition, this technology can be used by people who currently have not been found to have a cardiovascular disease for prevention and, where appropriate, early detection, essential to diagnose the development of this disease.
Moreover, the device fits the patient's body, which allows detection of heart rhythm through electrodes placed in a shirt.
The specialist explained that given the high amount of data to analyze, both computer systems and specialists have trouble detecting irregularities, especially occasional ones.
For five years, the researchers developed various measurement systems for both detection and signal processing. This technology has social importance, since cardiovascular disease is a common cause of mortality and morbidity around the world . In Mexico, these diseases are increasing due to widespread unhealthy eating habits with high content of saturated and trans fats, increased sodium intake, smoking and alcohol abuse and physical inactivity.
Gutiérrez Gnecchi and other researchers at ITM are also working on a device to determine deafness in babies, and another for detecting breast cancer without the hassles of current mammography.


Provided by Investigación y Desarrollo

High levels of intense exercise may be unhealthy for the heart

Increased incidence of arrhythmias in the athlete's heart. There is a well demonstrated association between atrial fibrillation and/or flutter and endurance exercise training. There is also an increase in premature ventricular beats, although this tends to be benign in most athletes. Although there is some speculation that extreme exercise might cause serious arrhythmias in some cases, these events remain very uncommon. PPM, permanent pacemaker; RV, right ventricular. Credit: Canadian Journal of Cardiology

26 feb 2016--There is growing evidence that high levels of intense exercise may be cardiotoxic and promote permanent structural changes in the heart, which can, in some individuals, predispose them to experience arrhythmias (abnormal heart rhythm). A review published in the Canadian Journal of Cardiology explores current controversies and makes the case for investing in large prospective research studies into the effect of intense exercise on heart structure and function.

There are unquestionable benefits to "getting off the couch." However, there is already fairly compelling evidence supporting the association between long-term sports practice and increased prevalence of atrial fibrillation, and the fact that this relates to chronic altered atrial substrate. Without challenging the undeniable evidence supporting low and moderate intensity exercise, this review by sports cardiologist André La Gerche, MD, PhD, provides a balanced discussion of the available data for and against the concept that intense exercise, particularly endurance exercise, may cause adverse cardiac changes in some athletes.

"Much of the discussion regarding the relative risks and benefits of long-term endurance sports training is hijacked by definitive media-grabbing statements, which has fueled an environment in which one may be criticized for even questioning the benefits of exercise," explains Dr. La Gerche, who is Head of Sports Cardiology at the Baker IDI Heart and Diabetes Institute, Melbourne, Australia. "This paper discusses the often questionable, incomplete, and controversial science behind the emerging concern that high levels of intense exercise may be associated with some adverse health effects."

As Dr. La Gerche points out, all available therapies, pharmacological or otherwise, have a dose-response relationship whereby benefits diminish at high doses and the risk of adverse events increases. An open mind would consider that this may even be possible for exercise.

A commonly held view is that adverse clinical events in athletes are explained by exercise acting as a trigger in individuals who are susceptible because of an underlying abnormality. Dr. La Gerche excludes inherited conditions from this discussion, focusing instead on whether exercise may affect a change in the heart that may serve as a cause of arrhythmias in its own right. He reviews the following emerging controversies:

• Is there a non-linear dose-response relationship with exercise?
• Elite athletes tend to live longer but is this the effect of exercise or other factors such as the absence of smoking and alcohol consumption?
• Is endurance exercise in athletes associated with arrhythmias?
• What are the potential mechanisms that predispose athletes to arrhythmias?
• Is chronic cardiac remodelling a consequence of repeated bouts of injury?
• Why is there disproportionate right ventricular (RV) injury following an acute bout of intense exercise and are there any long-term consequences?
• Is the risk of ischemic heart disease increased with intense exercise?

Many of these controversies are based on small cross-sectional cohort studies and small mechanistic studies that are dwarfed by the large population studies supporting the benefits of exercise, albeit in doses of exercise less than those commonly practiced by elite sportspersons, notes Dr. La Gerche.

"The answers regarding the healthfulness of 'extreme' exercise are not complete and there are valid questions being raised," continues Dr. La Gerche. "Given that this is a concern that affects such a large proportion of society, it is something that deserves investment. The lack of large prospective studies of persons engaged in high-volume and high-intensity exercise represents the biggest deficiency in the literature to date, and, although such work presents a logistical and financial challenge, many questions will remain controversies until such data emege."

More information: "The potential cardiotoxic effects of exercise," by Andre La Gerche, MBBS PhD (DOI: dx.doi.org/10.1016/j.cjca.2015.11.010). Published online in advance of Volume 32/Issue 4 (April 2016) of the Canadian Journal of Cardiology. 

Provided by Elsevier

Common antibiotics increase risk of cardiac arrhythmias, cardiac death

Macrolides—a group of commonly used antibiotics for bacterial infections like pneumonia, bronchitis, and some sexually transmitted diseases—are associated with a small but statistically significant increased risk of sudden cardiac death, according to a meta-analysis of 33 studies involving more than 20 million patients published today in the Journal of the American College of Cardiology

12 nov 2015--Researchers from China analyzed data from studies conducted between 1966 and 2015, comparing patients treated with macrolides to similar patients treated with other antibiotics or with no antibiotic therapy.
The researchers found an average of 80 cases of ventricular tachyarrhythmias—rapid heartbeat that can lead to sudden cardiac death—per million treatment courses in patients who were not taking macrolides. The current use of macrolides accounted for an additional 118 ventricular tachyarrhythmias or related sudden cardiac deaths per million treatment courses; 36 additional sudden cardiac deaths from causes other than ventricular tachyarrhythmia; and 38 additional cardiovascular deaths per million treatment courses.
Past use of macrolides and use of other antibiotics were not associated with increased cardiovascular risk in the study. In addition, the use of macrolides was not associated with increased all-cause death, possibly because of the relatively small effect and an increased risk of cardiac death might be partly offset by the survival benefit of anti-infection by macrolides.
"The absolute risks of sudden cardiac death and cardiac death are small, so it should likely have limited effect on prescribing practice," said Su-Hua Wu, M.D., Ph.D., of the Department of Cardiology at the First Affiliated Hospital at Sun Yat-Sen University in Guangzhou, China, and one of the study authors. "However, given that macrolides are one of the most commonly used antibiotic groups and millions of patients are prescribed these drugs annually, the total number of sudden cardiac deaths or ventricular tachyarrhythmias and cardiac deaths may not be negligible."
In an accompanying editorial, Sami Viskin, M.D., of the Tel Aviv Medical Center and Sackler School of Medicine at Tel Aviv University in Tel Aviv, Israel, put the numbers into perspective saying that the data shows that 1-in-8,500 patients treated with a macrolide antibiotic could develop a serious arrhythmic event, and 1-in-30,000 patients treated might die from the treatment.
Researchers separately examined commonly used macrolides azithromycin, clarithromycin, and erythromycin. In this analysis, researchers found all were associated with increased risk of sudden cardiac death or ventricular tachyarrhythmias; and azithromycin and clarithromycin were associated with increased risk of cardiovascular death, but only clarithromycin was associated with increased risk of all-cause mortality. "The heart safety of each macrolide needs to be better understood to help guide clinical treatment decisions," Wu said.
Study limitations include limited data on macrolide doses in observational studies, the lack of individual participant data and the retrospective nature of all meta-analyses. The study authors said large randomized controlled trials are needed to confirm these findings.
In the editorial, Viskin said macrolides are the first-line agents for a variety of illnesses and he noted methods for mitigating the risk while calling for "a consensus paper on how to deal with these hot potatoes."
"Today, when antimicrobial resistance represents a major threat to global health and new treatment options are frighteningly few, losing an entire class of antibiotics would represent a major setback in the fight against infections. Furthermore, it takes years to fully understand the consequences of a drug's disappearance."


Provided by American College of Cardiology

First multidisciplinary recommendations on management of arrhythmias in ACS patients

The first multidisciplinary recommendations on the management of arrhythmias in patients with acute coronary syndromes (ACS) are published today in EP Europace.

01 sept 2014--The position paper was written jointly by the European Heart Rhythm Association (EHRA), the Acute Cardiovascular Care Association (ACCA) and the European Association of Percutaneous Cardiovascular Interventions (EAPCI), all of the ESC.

Professor Bulent Gorenek (Turkey), chairperson of the task force, said: "Sudden cardiac death is the leading cause of death in Europe, the US and other developed countries. These deaths are mainly due to cardiac arrhythmias. This is the first document to provide clear recommendations on how to manage patients with ACS who develop arrhythmias. This topic has received limited coverage in guidelines and at congresses, and clinicians have many unanswered questions."

He added: "During the last decade the clinical approach to arrhythmia management in ACS has changed. Previously, antiarrhythmic drugs were the mainstay of treatment but today interventions in the cardiac catheterisation lab are preferred. This shift has been so substantial that EHRA, ACCA and the EAPCI established a task force to define the current position."

The position paper provides recommendations on how to identify ACS patients at risk for arrhythmias and how to manage tachy- and bradyarrhythmias using drugs, devices and catheter-based approaches.

Clear guidance is provided on the use of antiarrhythmic drugs in patients with ACS and ventricular arrhythmias. Amiodarone is recommended as the first line antiarrhythmic drug, with lidocaine added as second line if necessary. In patients with ACS without ventricular arrhythmias, the paper says that prophylactic antiarrhythmic drug treatment should not be administered.

Professor Gorenek said: "The use of antiarrhythmic drugs for the treatment of sustained ventricular arrhythmias in ACS has been the subject of strong debate. No big randomised trials have been conducted on this topic. Our recommendations will help clinicians prescribe the most appropriate antiarrhythmic drug for the situation."

Another controversial area was the use of triple therapy (dual antiplatelet therapy and oral anticoagulation) in patients with ACS who develop atrial fibrillation. Professor Gorenek said: "Triple therapy is underused by clinicians which goes against current guidelines. We clarify when triple therapy should be used and for how long, and provide clear messages on the use of the non-vitamin K antagonist oral anticoagulants (NOACs)."

Novel detailed recommendations are given on the use of antithrombotic therapy in patients with atrial fibrillation and ACS, catheter ablation in ACS patients with sustained ventricular arrhythmias, and management of patients with arrhythmias who are undergoing primary percutaneous coronary intervention (pPCI) for ST-elevation myocardial infarction (STEMI).

An entire chapter is devoted to the management of arrhythmias in patients with acute myocardial infarction and cardiogenic shock. The document says that "regardless of the type of arrhythmia, treatment of the underlying cardiogenic shock with prompt revascularisation should be done as the primary procedure and should not be delayed by arrhythmia treatment".

Professor Gorenek said: "The management of patients with ACS and cardiac arrhythmias requires a multidisciplinary approach involving specialists in acute cardiac care, interventional cardiology and electrophysiology. The recommendations in this document should help all clinicians who manage these patients to provide the best treatment available."

Provided by European Society of Cardiology

Patch outperforms Holter for prolonged heart rhythm tracking

Research by the Scripps Translational Science Institute (STSI) has found that a small adhesive wireless device worn on the chest for up to two weeks does a better job detecting abnormal and potentially dangerous heart rhythms than the Holter monitor, which is typically used for 24 hours and has been the standard of care for more than 50 years.

09 jan 2014--The findings, which were published and made publically available online by the American Journal of Medicine today, suggest that the ZIO Service—which includes the ZIO Patch, data analysis and a diagnostic report provided by device maker iRhythm Technologies of San Francisco—could replace the Holter monitor as the preferred method of tracking electrical heart activity in ambulatory patients.

"This is the first large prospective validation that this new technology superseded the device invented by Norman Holter in 1949," said study senior author Eric Topol, M.D., a cardiologist who directs STSI and serves as the chief academic officer of Scripps Health. "By tracking every heart beat for up to two weeks, the ZIO Service proved to be significantly more sensitive than the standard Holter, which uses multiple wires and typically is only used or tolerated for 24 hours.

"For millions of people who present each year with suspected arrhythmia, this may prove to be the new standard for capturing the culprit heart rhythm electrical disturbance, most commonly atrial fibrillation which carries a significant risk of stroke," he said.

The ZIO Patch is a Food and Drug Administration-cleared compact, low-profile, noninvasive, water-resistant device that is worn for up to two weeks throughout normal activity then mailed by the patient to iRhythm for data analysis with a proprietary algorithm. The Holter monitor, which was first introduced in the 1940s, includes a cell-phone sized recorder typically worn at the waist and five to seven lead wires that attach to the chest.

The STSI study used electrocardiograph data collected from 146 patients who were fitted with a ZIO Patch and a Holter monitor after being referred to the cardiac investigations laboratory at Scripps Green Hospital for ambulatory heart monitoring. The Holter monitor was worn for 24 hours, and the ZIO Patch was worn for up to 14 days.

Over the course of the study, the ZIO Service detected 96 arrhythmia events while the Holter monitor detected 61. The researchers credited the patch's superior performance primarily to prolonged monitoring.

Physicians who reviewed data from both devices reported reaching a definitive diagnosis 90 percent of the time when using the patch results and 64 percent of the time when using Holter monitor data. A survey of study participants found that 81 percent of them preferred wearing the patch over the Holter monitor, with 76 percent saying the Holter monitor affected their daily living activities.

One unexpected finding was that the Holter monitor detected 11 more arrhythmias than the ZIO Service during the initial 24 hour period when both devices were working simultaneously. However, all of those arrhythmias were picked beyond 24 hours by the patch during the device's extended monitoring period. The ZIO Service detected two arrhythmias not captured by the Holter during the initial 24 hour period.

Provided by The Scripps Research Institute

Big disparities in the treatment of arrhythmias across Europe

The latest statistics regarding the use of pacemakers and implantable cardiac devices in Europe was presented on Sunday 21 June, at EUROPACE 2009, the meeting of the European Heart Rhythm Association (EHRA)¹ which takes place in Berlin, Germany from 21 to 24 June.

22 june 2009--These facts and figures, including the current status of healthcare systems across the continent, were included in the EHRA White Book².

"This document is intended to be the starting point in a move towards a homogeneous way of looking at data, resources, physicians, etc., across Europe. Comparison among the countries belonging to the European Society of Cardiology (ESC)³, should help to standardise health resources by promoting knowledge of the status and bringing it to the attention of all public authorities" explained Christian Wolpert, Chairman of the National Societies who contributed the information gathered in the White Book.

"One of the roles of a European Association like the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC), is to promote equal access to therapy for all patients across Europe. To do so, the first step is to compile data on the current situation in various ESC membership countries, compare them, and propose actions to move towards harmonization. The current leadership of EHRA agreed on the importance of obtaining as much current information as possible concerning the situation of the practice of electrophysiology in Europe" stressed Wolpert.

Under the leadership of Professors Christian Wolpert from Germany, Panos Vardas from Greece and Josep Brugada from Spain, a group worked to collect the most recent figures. To ensure up to date data, Presidents of the different Working Groups and National Societies were contacted and asked not only to provide data, but also to verify and authorize all the information that became available through various sources.

Wolpert declared that this data is also the point of comparison for the future: " By knowing where we are today, we will be able to benchmark in the future and see how diverse countries evolve. This means that this book must be an ongoing process, with updated information, new and additional data, and the inclusion of information from those countries that have not yet been able to collect and transmit their records."

Explaining the data, Prof Wolpert highlighted certain trends, such as the fact that "more and more, cardiologists represent the majority of implanters while surgeons are decreasingly active in these procedures."

There is a disparate coverage of diseases and treatments within the European Union and the European Society of Cardiology member countries outside of the EU. Some of the countries have no reimbursement e.g. for ICD or pacemaker therapy and the penetration of catheter ablation of atrial fibrillation is very different. Data shows big differences across ESC member countries in:

• Guideline implementation.
• The number of trained physicians and specialised centres
• The number of implantations which seems to depend not only on reimbursement and financial resources, but also to be a function of the number of centres and physicians dedicated to electrophysiology and implantation of devices.
• The numbers of ICD implanting centres range from less than 1 to 6.87 per million citizens.
• Pacemaker therapy is performed in the range of 88 to a maximum of around 1200/ million inhabitants.
• ICD implant rates including CRT-D devices range from approx. 2.5 to 354 per million inhabitants. The data shows an increase for a subset of 16 western and northern European countries around 15% from 2006 to 2007.
• Regarding a potentially different medical consensus in specific countries the use of biventricular pacemakers vs. biventricular ICDs shows a 8:1 ratio at the highest down to 1:1.2 ratio as the lowest.
• In the field of invasive electrophysiology and catheter ablation for supraventricular and ventricular arrhythmias the number of centres available is variable ranging from less than 0.2 to more than 3 centres/ million. The total number of catheter ablations is increasing and reaches a maximum of more than 200/ million in approx. half of the countries. However, there is a strong discrepancy comparing all 35 countries, displaying a wide range from less than 20 to more than 450/ million.
• The same is true for catheter ablation of atrial fibrillation which varies tremendously, linked to reimbursement policies but also to different approaches in the various EP societies.

"As an example, Germany, hosting the EUROPACE meeting this year, has one of the highest implant rates for ICD's in Europe with a total of 1037 centres which implant pacemakers; 200 centres implanting CRT resynchronisation devices and a total of 360 ICD implanting institutions" highlights Prof Wolpert.

"Within the Non-EU ESC member countries, there has been a steady increase of therapy availability and disease coverage, however, there are still many countries that struggle with reimbursement, trained personnel and technical support, which requires a strong effort and leaves much space for improvement. It is the task and the intention of EHRA to support any initiative to improve steadily the situation for these countries in order to reduce the disparities".

The first EHRA White Book was published in 2008 containing information for 2006 and 2007 from 35 of the 51 ESC member countries from all sites of Europe and parts of the Middle East. The book was made fully available to the public in an electronic version and within short time it became one of the most popular downloads in the EHRA website.

"We hope that this book will be useful to all electrophysiologists and health care providers in Europe and will initiate an era of evolution towards a more unified Europe in terms of equal access to therapy for all patients, regardless of their country origin", concluded Prof Wolpert.

###

NOTES:

1 EHRA, the European Heart Rhythm Association, aims to serve as the leading organisation in the field of arrhythmias and electrophysiology in Europe, and to attract physicians from all of Europe and beyond to foster the development of this area of expertise. EHRA is a registered branch of the European Society of Cardiology (ESC). EHRA is based in Sophia Antipolis, France. Visit us at www.escardio.org/EHRA

Anger Induces Heart Instability and Arrhythmias

Possible link between stress and sudden death

02 mar 2009-- Anger-induced T-wave alternans, a marker of repolarization instability, predicts ventricular arrhythmias in patients with implantable cardioverter-defibrillators (ICDs), providing a link between stress and sudden death, according to a report in the Mar. 3 issue of the Journal of the American College of Cardiology.

Rachel Lampert, M.D., from Yale University School of Medicine in New Haven, Conn., and colleagues determined whether T-wave alternans induced during a mental stress protocol could predict ventricular arrhythmias in 62 patients with ICDs.

During a follow-up of at least one year, the researchers found that the 10 patients with ICD-terminated arrhythmias had significantly higher anger-induced T-wave alternans (13.2 versus 9.3 microvolts). Arrhythmias were more common in patients in the highest quartile of anger-induced T-wave alternans (greater than 11.9 microvolts) on extended follow-up (40 versus 9 percent), the investigators report. After controlling for confounding factors, anger-induced T-wave alternans was an independent predictor of ICD-terminated arrhythmia, with patients in the highest quartile having a 10.8-fold higher risk of arrhythmia, the authors write.

"The investigators provide the first evidence that patients with higher levels of anger-induced T-wave alternans during provocative testing are at greater risk for ventricular arrhythmias detected by ICDs during follow-up," Eric J. Rashba, M.D., from Stony Brook University Medical Center in Stony Brook, N.Y., writes in an accompanying editorial.

PinMed Inc. provided the repolarization analysis software used in the study, and two of the study authors are employees of the company and one has a significant ownership stake. Authors of the study and editorial report relationships with device companies.

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