Applied Health Sciences Technology PDF

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InspirationalLead9469

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2023

Menna Allah Yasser imam Abdelhalim

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ventricular arrhythmias smartphone ECG cardiology research health sciences

Summary

This research article investigates the accuracy of a 12-lead smartphone ECG device in detecting ventricular arrhythmias. Conducted at a hospital in India between August 2022 and December 2022, the study analyzed data from 84 participants. Results show potential for improvement in accuracy compared to traditional ECG methods.

Full Transcript

# Applied Health Sciences Technology ## Respiratory Care Department By Menna Allah Yasser imam Abdelhalim Academic number: 32230274 # Cross-Sectional, Non-Randomized, Single-Blinded, and Single-Center Study for the Accuracy of 12 Lead Smartphone ECG in the Detection of Ventricular Arrhythmias...

# Applied Health Sciences Technology ## Respiratory Care Department By Menna Allah Yasser imam Abdelhalim Academic number: 32230274 # Cross-Sectional, Non-Randomized, Single-Blinded, and Single-Center Study for the Accuracy of 12 Lead Smartphone ECG in the Detection of Ventricular Arrhythmias ## Research Article **Sahil Mahajan, Salil Garg, Yogendra Singh, Richa Sharma, Nitin Chandola, Tanuj Bhatia and Basundhara Bansal** **Department of Cardiology, Shree Mahant Indresh Hospital, Dehradun, India** **Department of Cardiology, Max Super-specialty Hospital, Dehradun, India** **Department of Research and Technology, Sunfox Technologies Pvt. Ltd, Dehradun, India** *Contributed equally* ## Article Info **Article history:** - Received: 4 July, 2023 - Accepted: 3 August, 2023 - Published: 16 August, 2023 **Keywords:** - Accuracy - smartphone - specificity - sensitivity - validation - ventricular arrhythmias ## Abstract Since ventricular arrhythmias are frequently transitory, diagnosing them can be difficult. It has been investigated in the past to diagnose atrial fibrillation (AF) using a smartphone-based ECG. Data on the diagnostic efficacy of smartphone-based ECGs for ventricular arrhythmias, however, is insufficient. **Objective:** Objectives of this study were a) to evaluate the accuracy of the spandan 12 lead ECG device in detection of the ventricular arrhythmias in comparison to the cardiologist, b) to evaluate the arrhythrnia detection accuracy of the conventional ECG machine and spandan smartphone ECG machine to cardiologist diagnosis, and c) to detect spontaneous ventricular arrhythmias (VAs), namely ventricular tachycardia (VT) and supraventricular ectopics (SVE), ventricular ectopics (VE), ventricular premature complexes (VPCs), AV-block and ventricular ectopics (VE) can be fatal. Patients who are susceptible to VT/SVTs always have a risk of sudden cardiac death. **Methods:** This cross-sectional study, single blinded and single-centric study was carried out at Shri Mahant Indresh Hospital (SMIH), Dehradun from 02-Aug-2022 to 29-Dec-2022. Patients with (n=1137) chest pain, syncope, palpitation, shortness of breath were enrolled from ECG department. A final total of 84 participants considered for the accuracy of interpretation of ventricular arrhythmia detected by the gold standard 12 lead ECG and smartphone-based ECG device along with the cardiologist's diagnosis. **Results:** Mean age (SD) was 54.42:14.58 years. The male gender (65.89%) shows the maximum frequency than female gender. Confusion matrix was referred to derive true positive cases for 12 lead standard ECG and smartphone ECG along with the cardiologist's diagnosis was 46 as compared to 30 from 12 lead geld standard. Sensitivity of smartphone spandan ECG (35.38%) was better than gold standard 12 lead ECG (15.625%), and, PPV and NPV of smartphone spandan ECG was recorded to be better than gold standard 12 lead ECG. Ventricular arrhythmia was detected correctly in 46 (54.7%) cases and 30 (36.58%) cases by smartphone ECG and 12 lead gold standard, respectively. **Conclusion:** Mobile ECG based devices can be used for detecting the arrhythmias as its overall accuracy of smartphone ECG in detecting the arrhythmias increase by 66.8%, i.e. the significance rise in accuracy of computer interpretation when compared to the cardiologist's diagnosis. # Introduction - Ventricular arrhythmias (VAs) are a prevalent cardiovascular illness. - VAs are often present in many cardiovascular disorders. - VAs can manifest as many symptoms. - Some VAs, like premature ventricular and atrial contractions, can be benign. - Some VAs, like third-degree heart block and ventricular tachycardia, can be fatal. - Others, like atrial fibrillation, are more problematic. - The frequency and severity of VAs vary. - Patient symptoms, family history, and the first ECG results might suggest a more or less problematic underlying rhythm. ### Electrocardiogram (ECG) - Frequently used in clinical practice to identify VAs. - Main diagnostic tool for cardiovascular diseases. - Ambulatory electrocardiography (ECG) enables prolonged arrhythmia monitoring in a practical context. ### Smartphone Technologies - Pervasive and easily accessible globally. - Sunfox Technologies Private Limited's new spandan smartphone ECG device can identify seven different forms of ventricular arrhythmias. - Non-medical persons may be able to utilize this device anywhere in the globe. - This technology may make it possible for even skilled medical staff in resource-constrained nations like India, where standard ECG equipment is not often accessible, to obtain a solid 12-lead ECG trace at a low cost. ## Methodology ### Participants - Patients who entered the ECG room at Shri Mahant Indresh Hospital (SMIH), Dehradun, Uttarakhand, India, between 02-Aug-2022 and 29-Dec-2022 with a prescription for an ECG screening. - Upon obtaining their written informed consent, researchers conducted this cross-sectional study at a single center that was not randomized, single-blinded, or multi-center. - There were 1337 individuals in the final study population, who might be either male or female. - By obtaining their written agreement and outlining the study's objectives, patients were included in the trial. - The study eliminated patients with loose skin, ECGs recorded with electrical anomalies, or who were unable to give informed permission. - Patients with chest pain, syncope, shortness of breath, or palpitations were included in the study. ### Analysis 1. **Ventricular Arrhythmias:** Ventricular tachycardia, AV-block, high degree AV-block, supraventricular ectopic, ventricular ectopic, supraventricular tachycardia, and V-paced rhythm were the ventricular arrhythmias that were taken into consideration for this study. 2. **12-Lead ECG Acquisition:** Under the direction of a cardiologist, the BPL cardiart 9108 device was used to record the 12-lead ECGs using the spandan 12-lead ECG and the goldberg 12-lead ECG for 10 seconds each. Using a standard 12 lead ECG and a spandan 12 lead ECG, the nurse took participants' 10-second resting ECGs. 3. **Statistical Methods:** The data was composed on a spread sheet and vivid statistical analysis was completed. Assessment of the accuracy of arrhythmia detection was done by calculation of error in detection of ventricular arrhythmia as compared to cardiologist's diagnosis. ## Results - In total, 1137 patients with chest pain, syncope, palpitation, and shortness of breath were enrolled in the ECG department. - A final total of 84 participants was considered for the accuracy of interpretation of ventricular arrhythmia detected on spandan, a smartphone-based ECG, and standard 12 lead ECG along with the comparison of the cardiologist's diagnosis. - The mean age was 54.42±14.58 years (range of years: 25 and above) and 881 patients (65.89%) were males and 455 subjects (34.03%) were females. ## Association Between Cardiac Radiation Exposure and the Risk of Arrhythmia in Breast Cancer Patients Treated With Radiotherapy: A Case-Control Study **Mohamed Yassir Errahmani, Médéa Locquet, Daan Spoor, Gaelle Jimenez, Jérémy Camilleri, Marie-Odile Bernier, David Broggio, Virginie Monceau, Jean Ferrières, Juliette Thariat, Serge Boveda, Youlia Kirova, Pierre Loap, Johannes A. Langendijk, Anne Crijns and Sophie Jacob** **Laboratory of Epidemiology, Institute for Radiation Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, France** **University Paris-Saclay, Gif-sur-Yvette, France** **Department of Radiation Oncology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, Netherlands** **Department of Radiation Oncology (Oncorad), Clinique Pasteur, Toulouse, France** **Department of Dosimetry, Institute for Radiation Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, France** **Laboratory of Radiotoxicology and Radiobiology, Institute for Radiation Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, France** **Department of Cardiology and INSERM UMR 1295, Rangueil University Hospital, Toulouse, France** **Department of Radiotherapy, Centre de Lutte Contre le Cancer A. Baclesse, University of Caen Normandie, Caen, France** **Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France** **Department of Radiation Oncology, Institut Curie, Paris, France** **Correspondence: sophie [email protected]** ## Background - Previous studies suggested that radiation therapy (RT) for breast cancer (BC) can induce cardiac arrhythmias and conduction disorders. - The association with mean heart dose and specific cardiac substructures doses was less studied. ## Materials and Methods - Researchers conducted a nested case-control study based on French BC patients, enrolled in the European MEDIRAD-BRACE study (https://clinicaltrials.gov/ Identifier: NCT03211442), who underwent three-dimensional conformal radiation therapy (3D-CRT) between 2009 and 2013 and were retrospectively followed until 2019. - Cases were incident cases of cardiac arrhythmia. - Controls without arrhythmia were selected with propensity-scored matching by age, duration of follow-up, chemotherapy, hypertension, and diabetes (ratio 1:4 or 5). - Doses to the whole heart (WH), left and right atria (LA and RA), and left and right ventricles (LV and RV) were obtained after delineation with multi-atlas-based automatic segmentation. ## Results - The study included 116 patients (21 cases and 95 controls). - Mean age at diagnosis was 64 ± 10 years, mean follow-up was 7.0 ± 1.3 years, and mean interval from RT to arrhythmia was 4.3 ± 2.1 years. - None of the results on association between arrhythmias and cardiac doses reached statistical significance. - The proportion of right-sided BC was higher among patients with arrhythmia than among controls (57% vs. 51%, p = 0.73). - Neither mean WH dose, nor LV, RV, and LA doses were associated with an increased risk of arrhythmia (OR = 1.00, p>0.90). - In contrast, the RA dose was slightly higher for cases compared to controls [interquartile range (0.61-1.46 Gy) vs. (0.49-1.31 Gy), p=0.44], and a non-significant trend toward a potentially higher risk of arrhythmia with increasing RA dose was observed (OR = 1.19, p = 0.60). - Subanalysis according to BC laterality showed that the association with RA dose was reinforced specifically for left-sided BC (OR = 1.76, p = 0.75), while for right-sided BC, the ratio of mean RA/WH doses may better predict arrhythmia (OR = 2.39, p = 0.35). ## Conclusion - Despite non-significant results, this exploratory investigation on BC patients treated with RT is the first study to suggest that right-sided BC patients and the right atrium irradiation may require special attention regarding the risk of cardiac arrhythmia and conduction disorders. - Further studies are needed to expand on this topic. ## Introduction - Adjuvant radiation therapy (RT) after surgery is commonly used to treat localized breast cancer (BC) and generally results in significant improvement in tumor control and reduces the risk of cancer-related death several years after treatment. - However, BC survivors can develop a wide array of cardiotoxic complications related to cardiac radiation exposure, arising from a few months to many years after RT. - Coronary artery disease is the most common manifestation of radiation-induced cardiovascular disease and also the most described in the literature. - A relative increase of 7.4% in lifetime risk of coronary events for each Gy (Gray) of radiation to the heart has been demonstrated in women with previous BC having received radiation, reaching 16.5% for the first 9 years after RT. - Such complications are more commonly seen in patients with left-sided rather than right-sided BC as a larger portion of the heart, in particular the left anterior descending artery, is included in the radiation field. - Among cardiac complications of thoracic RT, arrhythmia and conduction disorders are much less frequent than coronary artery disease and investigations on these complications were limited. - Several case reports suggested a link between RT for BC and atrioventricular nodal bradycardia, and all levels of heart block, including complete heart block and sick sinus syndrome. - Some cohort studies have shown that BC patients treated with RT had a higher risk of morbidity and mortality of cardiac arrhythmia than BC patients not treated with RT. - More recently, patients with BC who have undergone RT have been shown to have a 2.2-fold risk of conduction disorder requiring pacemaker implantation compared with the general population. - The question that remains is whether the risk of arrhythmia and conduction disorders, summarized under the general term "arrhythmia", is related to cardiac exposure due to RT. - There are distinct etiologies for different types of radiotherapy-associated cardiotoxicity, and the dose-response relationship previously observed between the mean heart dose and the coronary complications cannot be directly applied to arrhythmias. - Very few studies have evaluated whether the risk of arrhythmia increases with mean heart dose and specific cardiac substructure doses. - In a study performed on lung cancer patients treated with RT between 1996 and 2009, arrhythmic events showed borderline significant associations with the whole heart dose and right atrium doses, but not with left ventricle or left atrium doses. - However, cardiac radiation exposure and dose distributions are very different according to the type of cancer treated and further studies remain needed, particularly for BC patients who have undergone RT. ## Materials and Methods **Study Population:** - The nested case-control study was based on the French subgroup of left and right-sided BC patients (n = 347) included in the multicenter MEDIRAD BRACE study further detailed elsewhere (Clinical Trials.gov Identifier: NCT03211442). - The study population was composed of female patients, aged 40-75 years, who had undergone radiotherapy (3D-CRT) for a histologically proven diagnosis of BC (invasive and in situ) at Clinique Pasteur in Toulouse between January 2009 and December 2013. - After the surgical treatment of BC, all patients were treated with 3D-CRT with 6 and 25 MV photon beams by tangential fields, possibly including regional lymph node irradiation (internal mammary chain and supra-infraclavicular lymph nodes). - The planning target volume dose was mostly 50 Gy delivered in 25 daily fractions of 2 Gy over 5 weeks or less frequently 32.5 Gy delivered in 5 daily fractions of 6.5 Gy. - For most patients, 6 MV photons were used, except for a few cases of patients with big breast where 25 MV additional photons were used. - An additional boost of 9-15 Gy could be applied to the tumor site using photon/electron beams with energies ranging from 6 MeV to 18 MeV. ## The Association Between Cervical Spondylosis and Arrhythmia: A Population-Based Cohort Study **Li-Chuan Cheng¹, Chih-Yen Huang², Ching-Li Chang³, Ming-Jen Tsai¹, Li-Chuan Huang⁵, Chun-Lin Lin⁶, Zun-Lin Chen⁷, Shiun-Wei Huang⁸, Wen-Hsun Huang⁹, and Shang-Cheng Huang¹⁰** **China Medical University Hospital and China Medical University, Taichung 404, Taiwan** **Department of Family Medicine, China Medical University Hospital, Taichung 404, Taiwan** **Management Office for Health Data, China Medical University Hospital, Taichung 404, Taiwan** **College of Medicine, China Medical University, Taichung 404, Taiwan** **Department of Orthopedics, China Medical University Hospital, Taichung 404, Taiwan** **Department of Orthopedics, St. Martin De Porres Hospital, Chiayi 600, Taiwan** **Department of Nuclear Medicine, China Medical University Hospital, Taichung 404, Taiwan** **Department of Bioinformatics and Medical Engineering, Asia University, Taichung 413, Taiwan** **Correspondence: [email protected]; Tel.: +886-4-2205-2121 (ext. 7412)** **Received: 18 July 2018; Accepted: 21 August 2018; Published: 23 August 2018** ## Abstract **Background:** Sympathetic activity, including cervical ganglia, is involved in the development of cardiac arrhythmias. **Objective:** The present study investigated the association between cervical spondylosis and arrhythmia, which has never been reported before. **Methods:** Patients newly diagnosed with cervical spondylosis (CS) with an index date between 2000 and 2011 were identified from the National Health Insurance Research Database. Researchers performed a 1:1 case-control matched analysis. Cases were matched to controls according to their estimated propensity scores, based on demographics and existing risk factors. Cox proportional hazard models were applied to assess the association between CS and arrhythmia. **Results:** The CS cohort comprised 22,236 patients (males, 42.6%; mean age, 54.4 years) and non-CS cohort comprised 22,236 matched controls. There were 1441 events of arrhythmia in CS cohort and 537 events of arrhythmia in non-CS cohort, which 252 and 127 events of atrial fibrillation in CS and non-CS cohort, 33 and 12 events of ventricular tachycardia in CS cohort and non-CS cohort, 78 and 35 events of supraventricular tachycardia in CS cohort and non-CS cohort. The CS cohort had an arrhythmia incidence of 11.1 per 1000 person-years and a higher risk [adjusted hazard ratio (aHR) = 3.10, 95% confidence interval (CI) = 2.80-3.42] of arrhythmia, 2.54-fold aHR of ventricular tachycardia (95% CI = 1.70-3.79), and 2.22-fold aHR of atrial fibrillation (95% CI = 1.79-2.76) compared with non-CS cohort. **Conclusions:** Cervical spondylosis is associated with a higher risk of arrhythmia. ## Keywords: - Cervical spondylosis - arrhythmia - population cohort study ## Results - The case group comprised 22,236 subjects with CS and the control group comprised 22,236 subjects. ## Discussion - The autonomic nervous system (ANS) is composed of sympathetic and parasympathetic nervous systems [10]. When ANS is involved in triggering arrhythmia could be arrhythmogenic or antiarrhythmic: sympathetic activity and parasympathetic activity are triggers for atrial fibrillation whereas sympathetic activation and parasympathetic activation are arrhythmogenic and antiarrhythmic for ventricular fibrillation, respectively [10]. - The cervical spine harbors the cervical ganglia, which are the paravertebral ganglia of the sympathetic nervous system [10]. The sympathetic nerves of the right heart are predominantly from the right middle cervical ganglion and the sympathetic nerves of left heart is predominantly from the left middle cervical ganglion, while the remaining sympathetic innervation is from satellite ganglion, the distribution of which is more prominent in the left heart than right heart [10]. Cardiac parasympathetic innervation is through the vagusnerve [10]. - Previous research into the effects of ANS alterations has focused on triggers of sympathetic neuronal activity and blocking agents, and most of these studies have used animal models [11-13]. - Degenerative disease of cervical spine, naming cervical spondylosis (CS), might cause compression of spinal canal and irritation of ANS [14]. Cervical spondylosis is prevalent among people older than 50 years [14]. Most common clinical signs of CS are pain and motor function impairment [14]. - Peng et al. have described two cases of cervical spondylosis that had secondary hypertension and successfully treated the two cases with anterior cervical discectomy and fusion [15]. To our knowledge, no clinical research has investigated whether spondylosis of the spine is associated with a risk of arrhythmia, and the association between CS and arrhythmia is thus unknown. - This study, therefore, used the National Health Insurance Research Database (NHIRD) [15], which represents the Taiwanese population, to test the hypothesis that patients with CS have an increased risk of arrhythmia. ## Methods ### Data Source - A population-based retrospective cohort study was conducted using the Longitudinal Health Insurance Database 2000 (LHID2000) derived from the NHIRD of the Taiwan National Health Insurance (NHI) program. The Taiwan NHI program has covered 99% of the Taiwan population (including 23.74 million) since 1995 and is thus a thorough and representative sample of the population [16]. - Details of the NHI program and LHID2000 have been well documented [17,18]. ### Ethics Statement - The NHIRD encrypts patient personal information to protect privacy and provides researchers with anonymous identification numbers associated with relevant claims information, including sex, date of birth, medical services received, and prescriptions. - Therefore, patient consent is not required to access the NHIRD. This study was approved to fulfill the condition for exemption by the Institutional Review Board (IRB) of China Medical University (CMUH-104-REC2-115-CR2). The IRB also specifically waived the consent requirement.

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