Holter

Brain oxygenation monitoring during head-up tilt test in patient with vasodepressive neurocardiogenic syncope Measurement of the brain oxygenation with the technique of NIRS (near infrared spectroscopy) can be useful in assessment of the vasovagal syncope (VVS). We present a case of 23-year old woman in which this technique was used during head-up tilt test (TT). She had periodical junctional rhythm in Holter monitoring, functional conduction disturbances in transesophageal atrial pacing and cardiodepressive VVS in TT. We have performed another TT with NIRS monitoring. She has demonstrated syncope in vasodepressive mechanism 4 minutes after nitroglycerin administration. We have observed in NIRS gradual increase of levels of oxygenated hemoglobin (HbO 2) and total hemoglobin (HbT) during initial sinus tacycardia before syncope and short very deep decrease of HbO 2 and HbT and increase of reduced hemoglobin during the syncope. During 1,5 years follow-up and treatment with diprophylline and edrophonium syncope didn't occur. (Folia Cardiol. 2000; 2: 125–130)

Streszczenie Wstęp: Celem pracy była analiza wiarygodności oceny komorowych zaburzeń rytmu uzyski-wanej dzięki funkcjom diagnostycznym rozruszników. Materiał i metody: Występowanie pobudzeń komorowych (w okresie 24 godzin) oceniono w 51 zapisach EKG metodą Holtera i porównano z wydrukami ze stymulatora, wykonanymi w tym samym okresie co 24-godzinne rejestracje EKG. U 38 osób funkcja diagnostyczna stymulatora pozwalała również na ocenę jakościową — oceniono u nich zgodność występowa-nia złożonych form komorowych zaburzeń rytmu, to jest przyspieszonych rytmów komorowych i częstoskurczów komorowych łącznie, oraz trójek i par. Jako warunek zgodności w zakresie wykrycia złożonych form komorowych zaburzeń rytmu uznano fakt stwierdzenia przynajmniej jednego zaburzenia danego typu przez obie metody. Wyniki: Rezultaty zliczeń pobudzeń komorowych różniły się istotnie w zakresie obu metod. U 3 (6%) pacjentów wyniki były zgodne, u 20 (39%) stymulator zaniżył wyniki, u 28 (55%) osób zawyżył. Stosując liberalne kryteria zgodności, różnice istotne klinicznie stwierdzono u 24 (47%) osób, w tym u 7 (29%) zliczenia pobudzeń komorowych przez stymulator były zaniżone, a u 17 (71%) — zawyżone. Częstoskurcze komorowe rejestrowano w 24-godzinnym EKG u 8 pacjentów. U 3 były one rozpoznane przez funkcję diagnostyczną. U 5 osób stymulator nie rozpoznał częstoskurczów (z powodu częstości < 120/min), u 9 pacjentów fałszywie rozpoznał ich obecność. W rozpoznawaniu częstoskurczów komorowych czułość opcji diagnostycznej wynosiła 38%, swoistość — 70%, wartość wyniku dodatniego — 25%, ujemnego — 81%. Wnioski: Funkcja oceniająca komorowe zaburzenia rytmu w stymulatorach nie może być jedyną wiarygodną metodą diagnostyczną arytmii. Stwierdzenie dużej liczby sekwencji, mogą-cych odpowiadać komorowym zaburzeniom rytmu lub zaburzeniom czuwania, powinno skła-niać do weryfikacji za pomocą 24-godzinnego badania EKG. (Folia Cardiologica Excerpta 2010; 5, 5: 258–265) Słowa kluczowe: funkcje diagnostyczne rozruszników, komorowe zaburzenia rytmu, 24-godzinne monitorowanie EKG metodą Holtera

The clinical studies done daily by physicians lead to the generation of huge amounts of data, the storage of which takes up large amounts of memory. Searching for useful information in the physical repositories is a long and difficult process if they are not properly organized. Increasing the use of information technology in health care in recent years is beneficial for doctors and patients. In the present work an overview of research on creation of ontologies in biomedicine has been made and an ontology model of some important physiological data in healthcare-the cardiac data (in terms of storing this information in databases) is presented

Objective: The antiepileptic sodium valproate (valproic acid; VPA) is thought to possess an antiarrhythmic action. We aimed to explore whether this medication influences cardiac atrial ectopics or not.
Methods: From December 1, 2009 to June 1, 2011, 80 consecutive patients who were newly diagnosed with cryptogenic generalized tonic-clonic seizures were enrolled in this prospective short-term longitudinal observational study, which was conducted at the Sulaimaniya General Teaching Hospital, Iraq. Forty patients were allocated to receive VPA and the rest (n=40) were given placebo. All patients underwent cardiac 24-hour Holter monitoring before and after one week of VPA or placebo administration. The minimum heart rate (MiHR) and maximum heart rate (MxHR) as well as the total number of atrial ectopics (TNAE) were evaluated.
Results: VPA significantly reduced the MiHR, MxHR, and the TNAE. In the placebo group, the reduction in the MiHR was statistically significant while the reduction in the MxHR and the TNAE were not. However, the reduction in the target parameters in the VPA-treated group did not demonstrate a dose-dependent effect. When both groups were evaluated head-to-head for the reduction in the MiHR before and after week of therapy, there was no statistically significant difference between them.
Conclusion: Sodium valproate therapy appears to be effective against atrial ectopic beats and may be used as an antiarrhythmic medication in patients who co-experience seizures and troublesome atrial ectopics.

Objective: The antiepileptic sodium valproate (valproic acid; VPA) is thought to possess an antiarrhythmic action. We aimed to explore whether this medication influences cardiac atrial ectopics or not. Methods: From December 1, 2009 to June 1, 2011, 80 consecutive patients who were newly diagnosed with cryptogenic generalized tonic-clonic seizures were enrolled in this prospective short-term longitudinal observational study, which was conducted at the Sulaimaniya General Teaching Hospital, Iraq. Forty patients were allocated to receive VPA and the rest (n=40) were given placebo. All patients underwent cardiac 24-hour Holter monitoring before and after one week of VPA or placebo administration. The minimum heart rate (MiHR) and maximum heart rate (MxHR) as well as the total number of atrial ectopics (TNAE) were evaluated. Results: VPA significantly reduced the MiHR, MxHR, and the TNAE. In the placebo group, the reduction in the MiHR was statistically significant while the reduction i...

To analyze the diagnostic yield of 24-h electrocardiographic monitoring (Holter) as a function of cardiac disease and electrocardiography (ECG) status in patients with unexplained syncope. Patients were considered as having unexplained syncope when a careful clinical history, physical and neurological examination, 12-lead ECG and testing for orthostatic hypotension were negative. All patients underwent 24-h Holter. According to the type of arrhythmias that occurred during monitoring, Holter was classified as: (1) normal, in the absence of significant arrhythmias; (2) abnormal, in the presence of significant (e.g. atrial fibrillation) but non-diagnostic arrhythmias; or (3) diagnostic, in the presence of serious arrhythmia (e.g. complete AV block) with simultaneous symptoms. Clinical features, ECG and echocardiography were used to stratify patients and identify those in whom electrophysiological studies (EPS) were indicated. 140 consecutive patients with unexplained syncope underwent 24-h Holter and 44 of them (31%) had non-diagnostic arrhythmias. These occurred more frequently in patients with a positive cardiac history or an abnormal ECG (31/73, 42%), compared to patients without these features (13/67, 19%, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). Nine of the 140 patients (6%) had serious arrhythmias during Holter considered as diagnostic because of the presence of simultaneous symptoms. These occurred exclusively in patients with a positive cardiac history or an abnormal ECG (9/67, 12%). All diagnostic arrhythmias recorded during Holter occurred in patients in whom EPS was beforehand deemed indicated based on the presence of structural heart disease and/or an abnormal ECG. When restricted to high-risk patients, 24-h Holter remained a useful initial step in the evaluation of unexplained syncope with a symptoms and arrhythmias correlation occurring in 12% of patients. When performed first, this procedure might avoid doing EPS.

The clinical studies done daily by physicians lead to the generation of huge
amounts of data, the storage of which takes up large amounts of memory. Searching
for useful information in the physical repositories is a long and difficult process if they
are not properly organized. Increasing the use of information technology in health
care in recent years is beneficial for doctors and patients. In the present work an
overview of research on creation of ontologies in biomedicine has been made and an
ontology model of some important physiological data in healthcare - the cardiac data
(in terms of storing this information in databases) is presented

Abstract
Background: The aim of this study was to evaluate the reliability of pacemaker diagnostic function in diagnosing ventricular arrhythmias.
Methods: We compared the occurrence of ventricular ectopic beats in 51 simultaneous 24-hour electrocardiogram (ECG) recordings and pacemaker event counters printouts. The diagnostic function of a pacemaker allowed also for a qualitative assessment in 38 patients. In
these cases, the occurrence of complex forms of ventricular arrhythmias was cross-checked for accelerated ventricular rhythms together with ventricular tachycardia, and triplets and couplets. The detection of at least one type of complex ventricular form of arrhythmia, diagnosed by
both methods, was considered as an agreement between the methods.
Results: The results of ventricular ectopic beat counts differed significantly between the methods. In three (6%) patients, the results were consistent; in 20 (39%) the pacemaker underestimated results; in 28 (55%) they were overestimated. When more liberal criteria of
agreement were applied, clinically significant differences were observed in 24 (47%) patients; in seven (29%) patients the count made by the pacemaker was lowered; and in 17 (71%) it was overestimated. Ventricular tachycardias were recorded in 24-hour ECG in eight patients. In three, they were identified by the pacemaker diagnostic function. In five, the pacemaker did not recognize tachycardia (because of its frequency being below 120/min). In nine, tachycardia was recognized falsely. The sensitivity in ventricular tachycardia diagnosis by pacemaker diagnostic function was 38%, specificity — 70%, the value of a positive result — 25%, negative — 81%. Conclusions: The evaluation of ventricular arrhythmias by pacemaker cannot serve as the only reliable diagnostic method of arrhythmias. The presence of a large number of sequences
that may correspond to ventricular arrhythmia or failure to sense, should result in verification via 24-hour ECG monitoring. (Cardiol J 2010; 17, 5: 495–502)