A large number of studies have demonstrated that remote control of implantable devices (home moni... more A large number of studies have demonstrated that remote control of implantable devices (home monitoring, HM) is beneficial for patients, as it allows strict and tailored controls with earlier identification of potential problems, by avoiding unnecessary visits. HM is also beneficial for hospitals, as it progressively reduces the resources necessary for routine controls and contributes to a better management of critical patients. According to current European and Italian guidelines, HM can replace standard ambulatory monitoring, thereby decreasing the number of outpatient visits for each individual patient (it is possible to schedule a comprehensive clinical evaluation at 1 year rather than every 6-8 months, while performing controls at 1 and 3 months by remote transmission). At present, however, reimbursement of HM services is not covered by the National Health System and, as a consequence, cannot be performed as an institutional activity within the hospital. In addition, many critical issues remain to be resolved before the HM system can be fully implemented into daily clinical management, particularly in patients with heart failure at higher risk for sudden cardiac death.
Abstract Supraventricular premature beats (SVPBs) are atrial contractions arising in ectopic foci... more Abstract Supraventricular premature beats (SVPBs) are atrial contractions arising in ectopic foci rather than in the sinoatrial node. SVPBs are found in healthy individuals or in patients with underlying heart disease and can be asymptomatic or felt as palpitations. External triggers (alcohol, caffeine, smoking, stress) and several disease conditions (arterial hypertension, chronic obstructive pulmonary disease, obstructive sleep apnea syndrome, thyroid malfunction, electrolyte imbalances, or drug toxicity) may favor SVPB occurrence. SVPBs increase with age and are slightly more common in males than in females. SVPBs are generally a benign condition; however, frequent SVPBs may beget prolonged repolarization, atrial fibrillation, or even ventricular tachycardia and, rarely, ventricular fibrillation. Asymptomatic SVPBs without underlying structural heart defects generally do not require treatment, while the concomitant disease conditions should be treated, and potential external triggers should be avoided. β-Blockers, calcium antagonists, class 1c antiarrhythmic drugs or amiodarone, or radiofrequency catheter ablation can be used in selected patients with persistent symptoms.
The common arrhythmia atrial fibrillation (AF) is incompletely understood. The mechanism of initi... more The common arrhythmia atrial fibrillation (AF) is incompletely understood. The mechanism of initiation and the perpetuation of AF remain speculative. This article summarizes current knowledge of the complex relationship between arrhythmias triggering AF and their long-term effects on atrial tissue, leading to perpetuation of tachycardia. It focuses on the role of the electrocardiogram (ECG) from AF diagnosis to identification of sinus P wave abnormalities predicting future occurrences. The role of ambulatory ECG recordings in managing AF and the use of frequency analysis determining degree of organization and identification of AF triggers are discussed.
The 12-lead standard electrocardiogram (ECG) is a 10 second recording of human myocytes electrica... more The 12-lead standard electrocardiogram (ECG) is a 10 second recording of human myocytes electrical activity. Filters and oversampling are necessary in order to acquire a smooth signal without distortion. ECG recordings may display ongoing arrhythmias, and some leads may be helpful in formulating the diagnosis. Advanced modalities of baseline ECG recording can be used to extract additional information with significant prognostic value. Ambulatory ECG (AECG) recording is a long-term and low-cost external recording obtained with 1 to 12 leads lasting from 24 to 30 days. For patient comfort, longer AECG recordings use fewer leads.
A large number of studies have demonstrated that remote control of implantable devices (home moni... more A large number of studies have demonstrated that remote control of implantable devices (home monitoring, HM) is beneficial for patients, as it allows strict and tailored controls with earlier identification of potential problems, by avoiding unnecessary visits. HM is also beneficial for hospitals, as it progressively reduces the resources necessary for routine controls and contributes to a better management of critical patients. According to current European and Italian guidelines, HM can replace standard ambulatory monitoring, thereby decreasing the number of outpatient visits for each individual patient (it is possible to schedule a comprehensive clinical evaluation at 1 year rather than every 6-8 months, while performing controls at 1 and 3 months by remote transmission). At present, however, reimbursement of HM services is not covered by the National Health System and, as a consequence, cannot be performed as an institutional activity within the hospital. In addition, many critical issues remain to be resolved before the HM system can be fully implemented into daily clinical management, particularly in patients with heart failure at higher risk for sudden cardiac death.
Abstract Supraventricular premature beats (SVPBs) are atrial contractions arising in ectopic foci... more Abstract Supraventricular premature beats (SVPBs) are atrial contractions arising in ectopic foci rather than in the sinoatrial node. SVPBs are found in healthy individuals or in patients with underlying heart disease and can be asymptomatic or felt as palpitations. External triggers (alcohol, caffeine, smoking, stress) and several disease conditions (arterial hypertension, chronic obstructive pulmonary disease, obstructive sleep apnea syndrome, thyroid malfunction, electrolyte imbalances, or drug toxicity) may favor SVPB occurrence. SVPBs increase with age and are slightly more common in males than in females. SVPBs are generally a benign condition; however, frequent SVPBs may beget prolonged repolarization, atrial fibrillation, or even ventricular tachycardia and, rarely, ventricular fibrillation. Asymptomatic SVPBs without underlying structural heart defects generally do not require treatment, while the concomitant disease conditions should be treated, and potential external triggers should be avoided. β-Blockers, calcium antagonists, class 1c antiarrhythmic drugs or amiodarone, or radiofrequency catheter ablation can be used in selected patients with persistent symptoms.
The common arrhythmia atrial fibrillation (AF) is incompletely understood. The mechanism of initi... more The common arrhythmia atrial fibrillation (AF) is incompletely understood. The mechanism of initiation and the perpetuation of AF remain speculative. This article summarizes current knowledge of the complex relationship between arrhythmias triggering AF and their long-term effects on atrial tissue, leading to perpetuation of tachycardia. It focuses on the role of the electrocardiogram (ECG) from AF diagnosis to identification of sinus P wave abnormalities predicting future occurrences. The role of ambulatory ECG recordings in managing AF and the use of frequency analysis determining degree of organization and identification of AF triggers are discussed.
The 12-lead standard electrocardiogram (ECG) is a 10 second recording of human myocytes electrica... more The 12-lead standard electrocardiogram (ECG) is a 10 second recording of human myocytes electrical activity. Filters and oversampling are necessary in order to acquire a smooth signal without distortion. ECG recordings may display ongoing arrhythmias, and some leads may be helpful in formulating the diagnosis. Advanced modalities of baseline ECG recording can be used to extract additional information with significant prognostic value. Ambulatory ECG (AECG) recording is a long-term and low-cost external recording obtained with 1 to 12 leads lasting from 24 to 30 days. For patient comfort, longer AECG recordings use fewer leads.
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