From precordial ECG leads, the conventional determination of the negative derivative of the QRS complex (ND-ECG) assesses epicardial activation. Recently we showed that ultra-high-frequency electrocardiography (UHF-ECG) determines the activation of a larger volume of the ventricular wall. We aimed to combine these two methods to investigate the potential of volumetric and epicardial ventricular activation assessment and thereby determine the transmural activation sequence. We retrospectively analyzed 390 ECG records divided into three groups-healthy subjects with normal ECG, left bundle branch block (LBBB), and right bundle branch block (RBBB) patients. Then we created UHF-ECG and ND-ECG-derived depolarization maps and computed interventricular electrical dyssynchrony. Characteristic spatio-temporal differences were found between the volumetric UHF-ECG activation patterns and epicardial ND-ECG in the Normal, LBBB, and RBBB groups, despite the overall high correlations between both methods. Interventricular electrical dyssynchrony values assessed by the ND-ECG were consistently larger than values computed by the UHF-ECG method. Noninvasively obtained UHF-ECG and ND-ECG analyses describe different ventricular dyssynchrony and the general course of ventricular depolarization. Combining both methods based on standard 12-lead ECG electrode positions allows for a more detailed analysis of volumetric and epicardial ventricular electrical activation, including the assessment of the depolarization wave direction propagation in ventricles.

• MeSH
• blokáda Tawarova raménka diagnóza   MeSH
• elektrokardiografie * metody   MeSH
• lidé MeSH
• retrospektivní studie MeSH
• srdeční arytmie MeSH
• srdeční komory * diagnostické zobrazování   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: The present study introduces a new ultra-high-frequency 14-lead electrocardiogram technique (UHF-ECG) for mapping ventricular depolarization patterns and calculation of novel dyssynchrony parameters that may improve the selection of patients and application of cardiac resynchronization therapy (CRT). METHODS: Components of the ECG in sixteen frequency bands within the 150 to 1000 Hz range were used to create ventricular depolarization maps. The maximum time difference between the UHF QRS complex centers of mass of leads V1 to V8 was defined as ventricular electrical dyssynchrony (e-DYS), and the duration at 50% of peak voltage amplitude in each lead was defined as the duration of local depolarization (Vd). Proof of principle measurements was performed in seven patients with left (left bundle branch block) and four patients with right bundle branch block (right bundle branch block) before and during CRT using biventricular and His-bundle pacing. RESULTS: The acquired activation maps reflect the activation sequence under the tested conditions. e-DYS decreased considerably more than QRS duration, during both biventricular pacing (-50% vs -8%) and His-bundle pacing (-77% vs -13%). While biventricular pacing slightly increased Vd, His-bundle pacing reduced Vd significantly (+11% vs -36%), indicating the contribution of the fast conduction system. Optimization of biventricular pacing by adjusting VV-interval showed a decrease of e-DYS from 102 to 36 ms with only a small Vd increase and QRS duration decrease. CONCLUSIONS: The UHF-ECG technique provides novel information about electrical activation of the ventricles from a standard ECG electrode setup, potentially improving the selection of patients for CRT and application of CRT.

• MeSH
• akční potenciály MeSH
• blokáda Tawarova raménka diagnóza   patofyziologie   terapie   MeSH
• časové faktory MeSH
• elektrokardiografie * MeSH
• funkce levé komory srdeční MeSH
• funkce pravé komory srdeční MeSH
• Hisův svazek patofyziologie   MeSH
• lidé MeSH
• ověření koncepční studie MeSH
• prediktivní hodnota testů MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• srdeční frekvence * MeSH
• srdeční resynchronizační terapie * MeSH
• srdeční selhání diagnóza   patofyziologie   terapie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

INTRODUCTION: Cardiac resynchronization therapy (CRT) is an effective treatment that reduces mortality and improves cardiac function in patients with left bundle branch block (LBBB). However, about 30% of patients passing the current criteria do not benefit or benefit only a little from CRT. Three predictors of benefit based on different ECG properties were compared: 1) "strict" left bundle branch block classification (SLBBB); 2) QRS area; 3) ventricular electrical delay (VED) which defines the septal-lateral conduction delay. These predictors have never been analyzed concurrently. We analyzed the relationship between them on a subset of 602 records from the MADIT-CRT trial. METHODS & RESULTS: SLBBB classification was performed by two experts; QRS area and VED were computed fully automatically. High-frequency QRS (HFQRS) maps were used to inspect conduction abnormalities. The correlation between SLBBB and other predictors was R = 0.613, 0.523 and 0.390 for VED, QRS area in Z lead, and QRS duration, respectively. Scatter plots were used to pick up disagreement between the predictors. The majority of SLBBB subjects- 295 of 330 (89%)-are supposed to respond positively to CRT according to the VED and QRS area, though 93 of 272 (34%) non-SLBBB should also benefit from CRT according to the VED and QRS area. CONCLUSION: SLBBB classification is limited by the proper setting of cut-off values. In addition, it is too "strict" and excludes patients that may benefit from CRT therapy. QRS area and VED are clearly defined parameters. They may be used to optimize biventricular stimulation. Detailed analysis of conduction irregularities with CRT optimization should be based on HFQRS maps.

• MeSH
• akční potenciály MeSH
• blokáda Tawarova raménka patofyziologie   terapie   MeSH
• elektrická defibrilace MeSH
• elektrokardiografie metody   normy   MeSH
• funkce levé komory srdeční MeSH
• lidé MeSH
• prediktivní hodnota testů MeSH
• prostředky srdeční resynchronizační terapie normy   MeSH
• srdeční frekvence MeSH
• srdeční resynchronizační terapie metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

PURPOSE: The aim of this proof-of-concept study is to introduce new high-dynamic ECG technique with potential to detect temporal-spatial distribution of ventricular electrical depolarization and to assess the level of ventricular dyssynchrony. METHODS: 5-kHz 12-lead ECG data was collected. The amplitude envelopes of the QRS were computed in an ultra-high frequency band of 500-1000 Hz and were averaged (UHFQRS). UHFQRS V lead maps were compiled, and numerical descriptor identifying ventricular dyssynchrony (UHFDYS) was detected. RESULTS: An electrical UHFQRS maps describe the ventricular dyssynchrony distribution in resolution of milliseconds and correlate with strain rate results obtained by speckle tracking echocardiography. The effect of biventricular stimulation is demonstrated by the UHFQRS morphology and by the UHFDYS descriptor in selected examples. CONCLUSIONS: UHFQRS offers a new and simple technique for assessing electrical activation patterns in ventricular dyssynchrony with a temporal-spatial resolution that cannot be obtained by processing standard surface ECG. The main clinical potential of UHFQRS lies in the identification of differences in electrical activation among CRT candidates and detection of improvements in electrical synchrony in patients with biventricular pacing.

• MeSH
• dospělí MeSH
• dysfunkce levé srdeční komory diagnostické zobrazování   terapie   MeSH
• echokardiografie trojrozměrná metody   MeSH
• elektrokardiografie metody   MeSH
• interpretace obrazu počítačem * MeSH
• lidé středního věku MeSH
• lidé MeSH
• remodelace komor fyziologie   MeSH
• senioři MeSH
• srdeční resynchronizační terapie metody   MeSH
• stupeň závažnosti nemoci MeSH
• výsledek terapie MeSH
• vzorkové studie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Průlomové studie MADIT II, SCD-HeFT a COMPANION v letech 2002–2005 prokázaly pozitivní výsledky ve snížení výskytu náhlé srdeční smrti. Od té doby došlo k podstatnému rozšíření indikací pro použití implantabilních kardioverterů-defibrilátorů (ICD). Výskyt vhodné terapie ICD se v jednotlivých studiích liší. Retrospektivně jsme analyzovali výskyt komorové tachykardie / komorové fibrilace (KT/KF) z databáze vzdáleného monitorování ICD (Biotronik Home Monitoring TM, www.biotronik-homemonitoring.com). Nebyl zjištěn žádný významný rozdíl mezi podskupinami rozdělenými na základě indikace implantace, programované stimulace komor, agresivity protokolu programované stimulace komor, ejekční frakce levé komory, typu ICD, procenta stimulace pravé komory, diabetes mellitus, renální dysfunkce a pohlaví. Komorové tachykardie / komorové fibrilace se statisticky významně častěji vyskytovaly u pacientů se záchytem nesetrvalé KT během preimplantační holterovské monitorace EKG, a to u pacientů s ischemickou chorobou srdeční z primárně preventivní indikace, ale ne u pacientů s neischemickou dilatační kardiomyopatií z primárně preventivní indikace. U pacientů s preimplantační synkopou nebo presynkopou jsme pozorovali vyšší výskyt KT/KF, a to vyšší než u pacientů po kardiopulmonální resuscitaci. Trend pro vyšší výskyt KT/KF byl patrný u pacientů s pozitivní programovanou stimulací komor, zvláště u málo agresivního protokolu a u pacientů s ejekční frakcí levé komory 30 % a méně. Autoři shledali preimplantační nesetrvalé komorové tachykardie (NSKT) na holterovské monitoraci EKG jako jediný nezávislý prediktor výskytu KT/KF.

The landmark trials MADIT II, SCD-HeFT, and COMPANION in 2002–2005 years have reported their positive results to sudden cardiac death reduction. Since that time the indications for the use of implantable cardioverter-defibrillators (ICDs) have substantially broadened. The occurrence of appropriate ICD therapy differs in the individual trials. We were retrospectively analyzing the occurrence of ventricular tachycardia/ventricular fibrillation (VT/VF) from ICD remote monitoring database (Biotronik Home Monitoring TM, www.biotronik-homemonitoring.com). No significant difference was found between subgroups divided by the implantation indication, the programmed ventricular stimulation, the aggressivity of programmed ventricular stimulation protocol, left ventricular ejection fraction, ICD types, percentage of right ventricular pacing, diabetes mellitus, renal dysfunction and gender. VT/VF occurred statistically significantly more often in patients with non-sustained VT on the preimplant Holter monitoring report in patients with primary preventive indication for postinfarction coronary artery disease but not in primary preventive indication for non-ischemic dilated cardiomyopathy. We observed higher VT/VF occurrence in patients with preimplant syncope or presyncope even higher than in patients after cardiopulmonary resuscitation. There was a visible trend for higher VT/VF occurrence in patients with positive programmed ventricular stimulation especially with less aggressive protocol and in patients with left ventricular ejection fraction of 30% and less. Authors found the preimplant nonsustained ventricular tachycardia (NSVT) on Holter monitoring as the only independent predictor of VT/VF occurrence.

• MeSH
• defibrilátory implantabilní * MeSH
• fibrilace komor MeSH
• komorová tachykardie MeSH
• lidé středního věku MeSH
• lidé MeSH
• monitorování fyziologických funkcí metody   MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH

• Klíčová slova
• Systémy dálkového monitorování kardiovaskulárních implantabilních elektronických přístrojů (CIEDs),
• MeSH
• defibrilátory implantabilní trendy   využití   MeSH
• ekonomika a organizace zdravotní péče MeSH
• hodnocení biomedicínských technologií metody   trendy   využití   MeSH
• kardiostimulace umělá * metody   trendy   využití   MeSH
• kardiostimulátor trendy   využití   MeSH
• lidé MeSH
• monitorování fyziologických funkcí * metody   přístrojové vybavení   trendy   MeSH
• služby domácí péče trendy   využití   MeSH
• srdeční resynchronizační terapie metody   trendy   využití   MeSH
• srdeční selhání ošetřování   prevence a kontrola   terapie   MeSH
• statistika jako téma MeSH
• technologie dálkového snímání metody   trendy   využití   MeSH
• telemedicína * metody   trendy   využití   MeSH
• Check Tag
• lidé MeSH

INTRODUCTION: The SD1 and SD2 indexes (standard deviations in two orthogonal directions of the Poincaré plot) carry similar information to the spectral density power of the high and low frequency bands but have the advantage of easier calculation and lesser stationarity dependence. METHODS: ECG signals from metabolic syndrome (MetS) and control group patients during tilt table test under controlled breathing (20 breaths/minute) were obtained. SD1, SD2, SDRR (standard deviation of RR intervals) and RMSSD (root mean square of successive differences of RR intervals) were evaluated for 31 control group and 33 MetS subjects. RESULTS: Statistically significant lower values were observed in MetS patients in supine position (SD1: p=0.03, SD2: p=0.002, SDRR: p=0.006, RMSSD: p=0.01) and during tilt (SD2: p=0.004, SDRR: p=0.007). CONCLUSION: SD1 and SD2 combining the advantages of time and frequency domain methods, distinguish successfully between MetS and control subjects.

• MeSH
• algoritmy MeSH
• diagnóza počítačová MeSH
• dospělí MeSH
• elektrokardiografie MeSH
• lidé MeSH
• metabolický syndrom diagnóza   patofyziologie   MeSH
• oscilometrie metody   MeSH
• reprodukovatelnost výsledků MeSH
• senzitivita a specificita MeSH
• srdeční arytmie diagnóza   patofyziologie   MeSH
• srdeční frekvence * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• Publikační typ
• abstrakt z konference MeSH

• Publikační typ
• abstrakt z konference MeSH

AIMS: Intracardiac electrograms (IEGMs) are essential for the assessment of implantable cardioverter-defibrillator (ICD) function. The Biotronik Home Monitoring systems transmit an 'IEGM Online' that is shorter than the full-length programmer IEGM due to technical constrains. The aim of this study was to evaluate the accuracy of the physician's classification of the underlying rhythm based on the second-generation IEGM Online. METHODS AND RESULTS: In total, 1533 patients treated with single- and dual-chamber ICDs and cardiac resynchronization therapy defibrillators were enrolled at 67 investigational sites and followed for 15 months. The investigators classified the rhythm shown in IEGM Online as ventricular tachycardia, ventricular fibrillation, atrial fibrillation, other supraventricular tachyarrhythmia, oversensing due to lead failure, T-wave oversensing, or other rhythm. At the next in-office follow-up, the investigators classified independently the rhythm seen in the corresponding programmer IEGM. The two rhythm classifications were compared thereafter. Both IEGM Online and programmer IEGM were available in 2099 arrhythmic or oversensing events, of which 146 (7.0%) were classified as other rhythm or artefacts and were excluded as inconclusive or atypical. The remaining 1953 events, affecting 352 patients (23.0%), were classified correctly in 1803 cases (92.3%). The accuracy of rough rhythm classification as ventricular, supraventricular, or oversensing was 97.2%. CONCLUSION: The Lumax and IEGM Online HD Evaluation study demonstrates that remote IEGM analysis is reasonably accurate in a remote monitoring system that transmits shorter IEGM than the full-length programmer IEGM for the sake of frequent, fully automatic data transmission.

• MeSH
• defibrilátory implantabilní * MeSH
• elektrokardiografie metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• odchylka pozorovatele MeSH
• on-line systémy MeSH
• reprodukovatelnost výsledků MeSH
• senzitivita a specificita MeSH
• srdeční arytmie diagnóza   terapie   MeSH
• telemedicína metody   MeSH
• uživatelské rozhraní počítače MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• práce podpořená grantem MeSH