Zaburzenia rytmu serca
Rokowania, prognozy i postęp choroby
Zaburzenia rytmu serca (arytmie) obejmują szerokie spektrum schorzeń o zróżnicowanym rokowaniu, zależnym od typu arytmii, choroby podstawowej oraz zastosowanego leczenia. Migotanie przedsionków (AF) jest najczęstszą arytmią i główną przyczyną udarów mózgu, zwiększając ryzyko zawału serca, niewydolności serca oraz przedwczesnej śmierci. Wysoka zmienność rytmu serca (HRV) u pacjentów z nadciśnieniem tętniczym stanowi niezależny czynnik ryzyka rozwoju AF. W przypadku tachyarytmii komorowej, szczególnie u pacjentów po zawale serca z obniżoną frakcją wyrzutową, implantacja defibrylatora (ICD) jest kluczowa w zapobieganiu nagłej śmierci sercowej. Nowoczesne technologie oparte na głębokim uczeniu, takie jak model SSCAR, umożliwiają precyzyjne prognozowanie ryzyka nagłej śmierci sercowej do 10 lat z c-indeksem 0,71-0,89, co może znacząco wspomóc indywidualizację decyzji klinicznych.
Zaburzenia rytmu serca (arytmia) – rokowanie i przewidywanie wyników
Zaburzenia rytmu serca (arytmie) stanowią zróżnicowaną grupę schorzeń kardiologicznych o różnym nasileniu i rokowaniu. Rokowanie pacjentów z zaburzeniami rytmu serca znacząco różni się w zależności od rodzaju arytmii, choroby podstawowej oraz zastosowanego leczenia. Niektóre z arytmii są łagodne i nie wymagają terapii, podczas gdy inne mogą zwiększać ryzyko nagłego zatrzymania krążenia i śmierci sercowej.1
Znaczenie prognostyczne różnych typów arytmii
Łagodne arytmie to takie, które nie powodują objawów ani zaburzeń hemodynamicznych i nie mają znaczenia prognostycznego. Charakteryzują się one przemijającym charakterem i mogą występować w odpowiedzi na określone czynniki wyzwalające.23
Natomiast arytmie o istotnym znaczeniu prognostycznym są bardziej złożone. Podstawowa arytmia jest często przejściowym zaburzeniem, którego pacjent może być nieświadomy, a głównym czynnikiem determinującym rokowanie jest podstawowa patologia układu sercowo-naczyniowego. Większość prognostycznie ważnych arytmii stanowi jedynie markery ryzyka i same w sobie nie zagrażają życiu.4
Rokowanie w migotaniu przedsionków
Migotanie przedsionków (AF) jest najczęstszym zaburzeniem rytmu serca i główną przyczyną udarów mózgu prowadzących do niepełnosprawności. Nieleczone AF może zwiększać ryzyko problemów takich jak zawał serca, udar mózgu i niewydolność serca, co może skrócić oczekiwaną długość życia. Jednak odpowiednie leczenie i zmiany stylu życia mogą pomóc w zapobieganiu tym powikłaniom i zarządzaniu ryzykiem.56
Migotanie przedsionków rzeczywiście zwiększa ryzyko przedwczesnej śmierci. Niewydolność serca i udar mózgu są dwiema głównymi przyczynami zgonu u osób z AF. Jednak dzięki poprawie metod leczenia, ogólna śmiertelność z powodu AF uległa zmniejszeniu.7
Prognozowanie nagłej śmierci sercowej z powodu arytmii
Nagła śmierć sercowa z powodu arytmii (SCDA – Sudden Cardiac Death from Arrhythmia) stanowi główną przyczynę śmiertelności na całym świecie. Pacjenci z chorobą wieńcową są najbardziej narażeni na nagłą śmierć sercową z powodu arytmii.8
Nowe technologie oparte na głębokim uczeniu (DL) pozwalają na przewidywanie przeżycia z dokładnością do 10 lat oraz umożliwiają oszacowanie niepewności w prognozach. Podejście znane jako Survival Study of Cardiac Arrhythmia Risk (SSCAR) osadza w modelu przeżycia sieci neuronowe w celu oszacowania indywidualnego czasu do SCDA dla poszczególnych pacjentów.910
Przewidywane krzywe przeżycia dla poszczególnych pacjentów oferują dokładne prawdopodobieństwa SCDA we wszystkich punktach czasowych do 10 lat. SSCAR osiąga wysoką zgodność w zbiorze wewnętrznym (0,82-0,89) dla wszystkich czasów do 10 lat, a jego wydajność dobrze przenosi się na kohortę zewnętrzną, dając wskaźnik c-indeks wynoszący 0,71-0,77 i zintegrowany wynik Briera 0,03-0,14.11
Technologia ta ma na celu transformację procesu podejmowania decyzji klinicznych dotyczących ryzyka arytmii i rokowania pacjenta. Zachęca lekarzy do odejścia od postrzegania przewidywanego ryzyka jako pojedynczej liczby wygenerowanej przez algorytm typu „czarna skrzynka”, a zamiast tego do kierowania się szacowanym czasem do wystąpienia zdarzenia w kontekście niepewności predykcji czasowej specyficznej dla danego pacjenta.12
Przewidywanie wyników dla arytmii u pacjentów krytycznie chorych
Arytmia jest poważnym powikłaniem u krytycznie chorych pacjentów niechirurgicznych i wiąże się z wysoką śmiertelnością. Występowanie arytmii, szczególnie migotania komór, objawowej bradykardii zatokowej i bradykardii węzłowej u pacjentów na oddziałach intensywnej terapii internistycznej, wiąże się z wyższą śmiertelnością szpitalną (bradyarytmia 88,7%, tachyarytmia 66,70%) w porównaniu z grupą bez arytmii (18,1%).13
Odpowiednie postępowanie w przypadku wstrząsu wraz z właściwym wsparciem metabolicznym może zapobiec temu stanowi.14
Narzędzia i metody prognozowania arytmii
Wskaźniki zmienności rytmu serca (HRV)
Badania wykazały, że wyższa zmienność rytmu serca (HRV) u pacjentów z nadciśnieniem tętniczym może przewidywać rozwój migotania przedsionków niezależnie od danych demograficznych lub znanych czynników ryzyka sercowo-naczyniowego.15
Wyższe parametry HRV, w tym parametry wysokiej częstotliwości (P≤0.001), pierwiastek kwadratowy średnich kwadratów różnic kolejnych odstępów NN (P≤0.001) oraz procent odstępów NN, które różnią się o ponad 50 ms od poprzedniego odstępu (P≤0.001), były związane z wystąpieniem AF w analizie jednowymiarowej.16
W analizie regresji Coxa wyższa zmienność rytmu serca (reprezentująca nadmierne wahania autonomiczne) była niezależnym czynnikiem ryzyka AF. Wyższa HRV u pacjentów z nadciśnieniem tętniczym jako zastępczy marker nadmiernych wahań autonomicznych może przewidzieć wystąpienie AF.17
Wykorzystanie uczenia głębokiego w prognozowaniu arytmii
Badania porównujące skuteczność wykorzystania pojedynczych pobudzeń serca (dyskretnych uderzeń serca) w porównaniu z całym 12-odprowadzeniowym elektrokardiogramem (EKG) jako danych wejściowych do przewidywania przyszłych wystąpień arytmii i migotania przedsionków przy użyciu modeli głębokiego uczenia wykazały obiecujące wyniki.18
Eksperymenty wykazały potencjał wykorzystania dyskretnych pobudzeń serca w przewidywaniu przyszłych incydentów arytmii i migotania przedsionków wyodrębnionych z 12-odprowadzeniowych sygnałów elektrokardiogramu (EKG) bez żadnych dodatkowych informacji o pacjencie.19
Wyniki badań wskazują, że wykorzystanie dyskretnych pobudzeń serca jako danych wejściowych dało lepsze wyniki w porównaniu z konwencjonalnym podejściem i może być cennym narzędziem dla pracowników służby zdrowia w przewidywaniu przyszłych arytmii serca z prawidłowego rytmu zatokowego, poprawiając opiekę nad pacjentem i zarządzanie chorobą.20
Badanie wykazało, że same sygnały EKG były wystarczające do dokładnego przewidywania, a potencjalny biomarker może być obecny w sygnale EKG prawidłowego rytmu zatokowego. Sugeruje to, że użycie dyskretnych pobudzeń serca z modelami głębokiego uczenia może umożliwić wykrycie subtelnych wzorców w sygnałach EKG, co może prowadzić do dokładniejszej i wcześniejszej diagnozy klinicznie ważnej arytmii i migotania przedsionków.21
Skale oceny ryzyka dla migotania przedsionków
Z licznych czynników klinicznych, które były związane z wynikami kontroli rytmu lub progresją arytmii u pacjentów z AF, te, które są częstsze, zostały wykorzystane do sformułowania skal stratyfikacji ryzyka, aby pomóc przewidzieć wyniki kontroli rytmu lub progresję arytmii.22
Wartość predykcyjna w progresji AF skali HATCH jest wciąż kontrowersyjna, ale wyniki ostatnich badań walidacyjnych na nowo powstałym AF wykazały dobrą zdolność predykcyjną.23
Opracowano i przetestowano kilka skal predykcyjnych dla wyniku rytmu nawrotu AF po ablacji przezskórnej, ale dowody na ich wartość predykcyjną wciąż wymagają dalszej oceny. Wiele komponentów czynników ryzyka tych skal zostało zgłoszonych jako niezależne predyktory wyniku ablacji przezskórnej, czy to bezpośrednio, czy pośrednio przyczyniając się do formowania substratu AF. Obecnie skale ryzyka nawrotów po ablacji przezskórnej mają ograniczoną walidację.24
Skala FLAME dla ablacji przeztkankowej
Skala FLAME jest pierwszą skalą przewidywania wyników specyficzną dla kohorty (nie-napadowe AF) dla pacjentów poddawanych ablacji prądem o częstotliwości radiowej. Skala została zastosowana do danych (882 ablacje nie-napadowego AF) w ośrodku kalifornijskim i przewidywała wynik zarówno pojedynczych (p≤0,0001), jak i wielu (p≤0,0001) procedur.25
U pacjentów z wysokim wynikiem nawet wiele procedur jest zwykle nieskutecznych. Zmienne, które niezależnie związały się z wynikiem, są intuicyjnie zrozumiałe i zgodne z istniejącą literaturą.26
Wyniki pokazały, że przy wynikach FLAME 0-4, pacjenci mogą uzyskać dobre długoterminowe wyniki przy średnio 1,5 procedury. Jednak w przypadku szczególnie wysokiego wyniku FLAME, najlepsza strategia leczenia powinna być starannie oceniona, a alternatywne techniki, takie jak ablacja chirurgiczna lub hybrydowa, mogą być rozważone.27
Czynniki wpływające na rokowanie w zaburzeniach rytmu serca
Znaczenie podstawowych chorób i czynników ryzyka
Prawdopodobieństwo rozwoju migotania przedsionków rośnie wraz z wiekiem, nadciśnieniem tętniczym, otyłością, cukrzycą i wcześniejszym zawałem serca. U pacjentów z migotaniem przedsionków możliwość udaru mózgu zwiększa się wraz z zaawansowanym wiekiem, niewydolnością serca, nadciśnieniem tętniczym, cukrzycą, wcześniejszym udarem lub zawałem serca oraz u kobiet.28
Badania pokazują, że leki przeciwzakrzepowe drastycznie zmniejszają ryzyko udaru u pacjentów z kombinacją tych czynników. Przy dobrej ocenie ryzyka można uniknąć niepotrzebnych udarów.29
Jeśli chodzi o tachyarytmię komorową, najczęstszym czynnikiem predysponującym jest przebyty zawał serca. W połączeniu ze słabą funkcją pompującą serca (tzw. frakcją wyrzutową), pacjenci są narażeni na zwiększone ryzyko zatrzymania akcji serca i śmierci. Nagłą śmierć można zapobiec implantując defibrylator (tzw. ICD lub wszczepialny kardiowerter-defibrylator).30
Znaczenie wczesnej diagnostyki i interwencji
Dokładna ocena ryzyka umożliwia wcześniejszą diagnozę i interwencję – ze zmianami stylu życia lub lekami – które mogą mieć charakter zapobiegawczy.31
Międzynarodowy konsensus ekspertów w sprawie oceny ryzyka arytmii serca został opracowany przez Europejskie Stowarzyszenie Rytmu Serca (EHRA), oddział ESC; Towarzystwo Rytmu Serca (HRS); Azjatycko-Pacyficzne Towarzystwo Rytmu Serca (APHRS); i Latynoamerykańskie Towarzystwo Rytmu Serca (LAHRS).32
Oświadczenie eksperckie zaleca, jak najlepiej określić prawdopodobieństwo rozwoju zaburzeń rytmu serca i jak ocenić ryzyko złego wyniku u pacjentów z tym schorzeniem. Dokument koncentruje się na migotaniu przedsionków, najczęstszym zaburzeniu rytmu serca i głównej przyczynie udaru powodującego niepełnosprawność, oraz tachyarytmii komorowej (szybki rytm serca), głównej przyczynie nagłej śmierci sercowej.33
Celem jest zwiększenie świadomości na temat stosowania odpowiedniego narzędzia do oceny ryzyka dla danego wyniku w danej populacji oraz dostarczenie lekarzom praktycznych propozycji, które mogą prowadzić do poprawy opieki nad pacjentem w tym zakresie.34
Nowoczesne technologie w monitorowaniu i prognozowaniu
Istnieją dowody na to, że urządzenia mogą pomóc w wykrywaniu migotania przedsionków, ale dokładność jest różna. Urządzenia ubieralne mogą być bardzo wartościowe w przyszłości, ale w tej chwili nie mają określonego miejsca w ocenie ryzyka.35
Technologia SSCAR reprezentuje innowacje w ekstrakcji cech obrazowania CMR i uczenia się nieliniowych relacji wśród standardowych współzmiennych klinicznych.36
Podsumowanie rokowania dla różnych typów arytmii
Rokowanie pacjentów z zaburzeniami rytmu serca znacząco różni się w zależności od rodzaju arytmii. Niektóre arytmie są nieszkodliwe i nie wymagają leczenia, inne mogą zwiększać ryzyko nagłego zatrzymania krążenia.37
W zależności od rodzaju arytmii sercowej, pacjent może mieć łagodne lub ciężkie objawy, lub nie mieć żadnych objawów. Niektórzy pacjenci mogą nie potrzebować leczenia, ale inni potrzebują leków lub procedur. Dzięki leczeniu zaburzeń rytmu serca, wiele osób może prowadzić pełne życie. Niektóre osoby z poważniejszymi arytmiami mają zatrzymanie akcji serca i mogą przeżyć lub nie.38
Nieszkodliwe arytmie pojawiają się i znikają w odpowiedzi na to, co je wywołuje. Jednak osoby z innymi rodzajami arytmii – zwłaszcza tymi, które narażają na ryzyko zatrzymania akcji serca – potrzebują leczenia przez całe życie.39
Dla zindywidualizowanej prognozy, pacjenci powinni zapytać swojego lekarza, czego mogą się spodziewać i jakie leczenie oraz zmiany stylu życia mogą pomóc. Ćwiczenia, utrata wagi, zdrowe odżywianie i leczenie, takie jak leki rozrzedzające krew i leki na ciśnienie krwi, mogą pomóc pacjentom żyć dłużej – i lepiej – z arytmią.40
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Materiały źródłowe
- #1 Arrhythmia: Symptoms & Treatmenthttps://my.clevelandclinic.org/health/diseases/16749-arrhythmia
An arrhythmia is a heart rhythm that isnt normal. The prognosis varies greatly depending on the type. […] Some types of arrhythmia are harmless and dont require treatment. Others can put you at risk for cardiac arrest. […] Depending on the type of cardiac arrhythmia you have, you may have mild or severe symptoms or none at all. You may not need treatment, but some people need medicine or a procedure. With heart arrhythmia treatment, many people can live full lives. Some people with more serious arrhythmias have a cardiac arrest and may or may not survive. […] Harmless arrhythmias go away and come back in response to what triggers them. However, people with other types of arrhythmias especially those that put you at risk for cardiac arrest need treatment for the rest of their lives.
- #2 Distinguishing Potentially Lethal from Benign Arrhythmias | SpringerLinkhttps://link.springer.com/chapter/10.1007/978-3-642-73666-7_6
Benign cardiac arrhythmias are those which cause neither symptoms nor haemodynamic upset and which have no prognostic significance. […] Prognostically important arrhythmias are more complex. The basic arrhythmia is often a transient disturbance of which the patient is unaware and it is the underlying cardiovascular pathology which is the major determinant of prognosis. The majority of prognostically important arrhythmias are merely markers of risk and do not in themselves jeopardize life.
- #3 Arrhythmia: Symptoms & Treatmenthttps://my.clevelandclinic.org/health/diseases/16749-arrhythmia
An arrhythmia is a heart rhythm that isnt normal. The prognosis varies greatly depending on the type. […] Some types of arrhythmia are harmless and dont require treatment. Others can put you at risk for cardiac arrest. […] Depending on the type of cardiac arrhythmia you have, you may have mild or severe symptoms or none at all. You may not need treatment, but some people need medicine or a procedure. With heart arrhythmia treatment, many people can live full lives. Some people with more serious arrhythmias have a cardiac arrest and may or may not survive. […] Harmless arrhythmias go away and come back in response to what triggers them. However, people with other types of arrhythmias especially those that put you at risk for cardiac arrest need treatment for the rest of their lives.
- #4 Distinguishing Potentially Lethal from Benign Arrhythmias | SpringerLinkhttps://link.springer.com/chapter/10.1007/978-3-642-73666-7_6
Benign cardiac arrhythmias are those which cause neither symptoms nor haemodynamic upset and which have no prognostic significance. […] Prognostically important arrhythmias are more complex. The basic arrhythmia is often a transient disturbance of which the patient is unaware and it is the underlying cardiovascular pathology which is the major determinant of prognosis. The majority of prognostically important arrhythmias are merely markers of risk and do not in themselves jeopardize life.
- #5 Atrial Fibrillation: Prognosis, Life Expectancyhttps://www.webmd.com/heart-disease/atrial-fibrillation/atrial-fibrillation-prognosis-life-expectancy
When your doctor diagnoses you with atrial fibrillation (AFib), you might wonder what to expect. Your prognosis is a prediction of how your disease could affect you in the future and how long you might live. […] Untreated AFib can raise your risk for problems like a heart attack, stroke, and heart failure, which could shorten your life expectancy. But treatments and lifestyle changes can help prevent these problems and manage your risks. […] AFib does raise the risk of dying early. Heart failure and stroke are two of the main causes of death in people with AFib. But with improved treatments, overall deaths from AFib have dropped. […] There arent life expectancy statistics for people with AFib. For a personalized prognosis, ask your doctor what you can expect and what treatments and lifestyle changes can help. Exercise, weight loss, healthy eating, and treatments like blood thinners and blood pressure medicines might help you live longer — and better — with AFib.
- #6 EHRA/HRS/APHRS/LAHRS Expert Consensus on Risk Assessment in Cardiac Arrhythmias: Use the Right Tool for the Right Outcome – HRShttps://www.hrsonline.org/guidance/clinical-resources/ehrahrsaphrslahrs-expert-consensus-risk-assessment-cardiac-arrhythmias-use-right-tool-right-outcome
The expert consensus statement recommends how best to determine the likelihood of developing a heart rhythm disorder and how to assess the risk for poor outcome in patients with that condition. […] The document focuses on atrial fibrillation, the most common heart rhythm disorder and a major cause of disabling stroke, and ventricular tachyarrhythmia (fast heart rate), a leading cause of sudden cardiac death. […] The objective is to raise awareness of using the right risk assessment tool for a given outcome in a given population and to provide physicians with practical proposals that may lead to improvement of patient care in this regard.
- #7 Atrial Fibrillation: Prognosis, Life Expectancyhttps://www.webmd.com/heart-disease/atrial-fibrillation/atrial-fibrillation-prognosis-life-expectancy
When your doctor diagnoses you with atrial fibrillation (AFib), you might wonder what to expect. Your prognosis is a prediction of how your disease could affect you in the future and how long you might live. […] Untreated AFib can raise your risk for problems like a heart attack, stroke, and heart failure, which could shorten your life expectancy. But treatments and lifestyle changes can help prevent these problems and manage your risks. […] AFib does raise the risk of dying early. Heart failure and stroke are two of the main causes of death in people with AFib. But with improved treatments, overall deaths from AFib have dropped. […] There arent life expectancy statistics for people with AFib. For a personalized prognosis, ask your doctor what you can expect and what treatments and lifestyle changes can help. Exercise, weight loss, healthy eating, and treatments like blood thinners and blood pressure medicines might help you live longer — and better — with AFib.
- #8 Arrhythmic sudden death survival prediction using deep learning analysis of scarring in the heart | Nature Cardiovascular Researchhttps://www.nature.com/articles/s44161-022-00041-9
Sudden cardiac death from arrhythmia is a major cause of mortality worldwide. […] The DL-predicted survival curves offer accurate predictions at times up to 10 years and allow for estimation of uncertainty in predictions. […] This technology has the potential to transform clinical decision-making by offering accurate and generalizable predictions of patient-specific survival probabilities of arrhythmic death over time. […] Patients with coronary artery disease are at the highest risk of arrhythmic sudden cardiac death (SCDA). […] A robust, generalizable SCDA risk stratifier with the ability to predict individualized, patient-specific risk trajectories and confidence estimates could considerably enhance clinical decision-making. […] Therefore, computational models are impractical as a first-stage screening tool in a broad population.
- #9 Arrhythmic sudden death survival prediction using deep learning analysis of scarring in the heart | Nature Cardiovascular Researchhttps://www.nature.com/articles/s44161-022-00041-9
Sudden cardiac death from arrhythmia is a major cause of mortality worldwide. […] The DL-predicted survival curves offer accurate predictions at times up to 10 years and allow for estimation of uncertainty in predictions. […] This technology has the potential to transform clinical decision-making by offering accurate and generalizable predictions of patient-specific survival probabilities of arrhythmic death over time. […] Patients with coronary artery disease are at the highest risk of arrhythmic sudden cardiac death (SCDA). […] A robust, generalizable SCDA risk stratifier with the ability to predict individualized, patient-specific risk trajectories and confidence estimates could considerably enhance clinical decision-making. […] Therefore, computational models are impractical as a first-stage screening tool in a broad population.
- #10 Arrhythmic sudden death survival prediction using deep learning analysis of scarring in the heart | Nature Cardiovascular Researchhttps://www.nature.com/articles/s44161-022-00041-9
Our approach, which we term Survival Study of Cardiac Arrhythmia Risk (SSCAR), embeds, within a survival model, neural networks to estimate individual patient times to SCDA. […] The predicted patient-specific survival curves offer accurate SCDA probabilities at all times up to 10 years. […] SSCAR has excellent concordance on the internal set (.82.89) for all times up to 10 years. […] SSCAR performance carries over well to the external cohort, resulting in a c-index of 0.710.77 and integrated Brier score of 0.030.14. […] The predicted location parameter estimates the most probable TSCDA, and the predicted scale parameter provides a measure of confidence for the location. […] SSCAR achieves performance that is beyond the state-of-the-art in both relative terms SCDA risk ordering among patients and absolute terms accurately calibrated probabilities of SCDA.
- #11 Arrhythmic sudden death survival prediction using deep learning analysis of scarring in the heart | Nature Cardiovascular Researchhttps://www.nature.com/articles/s44161-022-00041-9
Our approach, which we term Survival Study of Cardiac Arrhythmia Risk (SSCAR), embeds, within a survival model, neural networks to estimate individual patient times to SCDA. […] The predicted patient-specific survival curves offer accurate SCDA probabilities at all times up to 10 years. […] SSCAR has excellent concordance on the internal set (.82.89) for all times up to 10 years. […] SSCAR performance carries over well to the external cohort, resulting in a c-index of 0.710.77 and integrated Brier score of 0.030.14. […] The predicted location parameter estimates the most probable TSCDA, and the predicted scale parameter provides a measure of confidence for the location. […] SSCAR achieves performance that is beyond the state-of-the-art in both relative terms SCDA risk ordering among patients and absolute terms accurately calibrated probabilities of SCDA.
- #12 Arrhythmic sudden death survival prediction using deep learning analysis of scarring in the heart | Nature Cardiovascular Researchhttps://www.nature.com/articles/s44161-022-00041-9
SSCAR represents innovation in CMR imaging feature extraction and learning of non-linear relationships among standard clinical covariates. […] The technology aims to transform clinical decision-making regarding arrhythmia risk and patient prognosis by encouraging practitioners to eschew the view of predicted risk as a single number outputted by a black-box algorithm but, rather, to be guided by the estimated time-to-outcome in the context of patient-specific time prediction uncertainty.
- #13 Predicting factors, incidence and prognosis of cardiac arrhythmia in medical, non-acute coronary syndrome, critically ill patients – PubMedhttps://pubmed.ncbi.nlm.nih.gov/23590048/
Background: Cardiac arrhythmia is an important complication of critically ill patients, especially in perioperative period and early after myocardial infarction. However, the information regarding this condition in medical critically ill without active coronary artery disease patients is limited. […] Objective: To identify the predictive factors, incidence, and prognosis of tachyarrhythmia and bradyarrhythmia in non-coronary critically ill medical patients. […] The presence of arrhythmia, especially ventricular fibrillation, symptomatic sinus bradycardia and junctional bradycardia in medical ICU is associated with higher hospital mortality (bradyarrhythmia 88.7%, tachyarrhythmia 66.70%) than the absent group (18.1%, p 0.001). […] Conclusion: Arrhythmia is a serious complication of medical critically ill patients and associated with high mortality rate. Appropriate shock management together with proper metabolic support may prevent this condition.
- #14 Predicting factors, incidence and prognosis of cardiac arrhythmia in medical, non-acute coronary syndrome, critically ill patients – PubMedhttps://pubmed.ncbi.nlm.nih.gov/23590048/
Background: Cardiac arrhythmia is an important complication of critically ill patients, especially in perioperative period and early after myocardial infarction. However, the information regarding this condition in medical critically ill without active coronary artery disease patients is limited. […] Objective: To identify the predictive factors, incidence, and prognosis of tachyarrhythmia and bradyarrhythmia in non-coronary critically ill medical patients. […] The presence of arrhythmia, especially ventricular fibrillation, symptomatic sinus bradycardia and junctional bradycardia in medical ICU is associated with higher hospital mortality (bradyarrhythmia 88.7%, tachyarrhythmia 66.70%) than the absent group (18.1%, p 0.001). […] Conclusion: Arrhythmia is a serious complication of medical critically ill patients and associated with high mortality rate. Appropriate shock management together with proper metabolic support may prevent this condition.
- #15 Higher heart rate variability as a predictor of atrial fibrillation in patients with hypertension | Scientific Reportshttps://www.nature.com/articles/s41598-022-07783-3
The main finding of this study was that higher HRV in patients with hypertension could predict the development of AF independent of demographics or known cardiovascular risk factors. […] Our findings suggest that higher HRV representing abnormal autonomic fluctuation is associated with a higher risk of AF development. […] Higher HRV parameters including high-frequency (P0.001), the square root of the mean squared differences of successive NN intervals (P0.001), and the percentage of NN intervals that are more than 50 ms different from the previous interval (P0.001) were associated with the occurrence of AF in univariate analysis. […] In Cox regression analysis, higher HRV (representing excessive autonomic fluctuation) was an independent risk factor for AF. […] Higher HRV in patients with hypertension as surrogate markers for excessive autonomic fluctuation could predict the occurrence of AF.
- #16 Higher heart rate variability as a predictor of atrial fibrillation in patients with hypertension | Scientific Reportshttps://www.nature.com/articles/s41598-022-07783-3
The main finding of this study was that higher HRV in patients with hypertension could predict the development of AF independent of demographics or known cardiovascular risk factors. […] Our findings suggest that higher HRV representing abnormal autonomic fluctuation is associated with a higher risk of AF development. […] Higher HRV parameters including high-frequency (P0.001), the square root of the mean squared differences of successive NN intervals (P0.001), and the percentage of NN intervals that are more than 50 ms different from the previous interval (P0.001) were associated with the occurrence of AF in univariate analysis. […] In Cox regression analysis, higher HRV (representing excessive autonomic fluctuation) was an independent risk factor for AF. […] Higher HRV in patients with hypertension as surrogate markers for excessive autonomic fluctuation could predict the occurrence of AF.
- #17 Higher heart rate variability as a predictor of atrial fibrillation in patients with hypertension | Scientific Reportshttps://www.nature.com/articles/s41598-022-07783-3
The main finding of this study was that higher HRV in patients with hypertension could predict the development of AF independent of demographics or known cardiovascular risk factors. […] Our findings suggest that higher HRV representing abnormal autonomic fluctuation is associated with a higher risk of AF development. […] Higher HRV parameters including high-frequency (P0.001), the square root of the mean squared differences of successive NN intervals (P0.001), and the percentage of NN intervals that are more than 50 ms different from the previous interval (P0.001) were associated with the occurrence of AF in univariate analysis. […] In Cox regression analysis, higher HRV (representing excessive autonomic fluctuation) was an independent risk factor for AF. […] Higher HRV in patients with hypertension as surrogate markers for excessive autonomic fluctuation could predict the occurrence of AF.
- #18 Predicting Future Incidences of Cardiac Arrhythmias Using Discrete Heartbeats from Normal Sinus Rhythm ECG Signals via Deep Learning Methodshttps://pmc.ncbi.nlm.nih.gov/articles/PMC10487044/
This study aims to compare the effectiveness of using discrete heartbeats versus an entire 12-lead electrocardiogram (ECG) as the input for predicting future occurrences of arrhythmia and atrial fibrillation using deep learning models. […] The experiments demonstrated the potential of using discrete heartbeats in predicting future arrhythmia and atrial fibrillation incidences extracted from 12-lead electrocardiogram (ECG) signals alone, without any additional patient information. […] Focusing on discrete heartbeats may lead to more timely and accurate diagnoses of these conditions, improving patient outcomes and enabling automated diagnosis using ECG signals as a biomarker. […] The primary aim of our study is to demonstrate that utilizing discrete heartbeats extracted from 10-s 12-lead sinus rhythm ECGs as inputs yields superior results compared to using an entire 12-lead heartbeat as the input for predicting future incidences of cardiac arrhythmias and atrial fibrillation.
- #19 Predicting Future Incidences of Cardiac Arrhythmias Using Discrete Heartbeats from Normal Sinus Rhythm ECG Signals via Deep Learning Methodshttps://pmc.ncbi.nlm.nih.gov/articles/PMC10487044/
This study aims to compare the effectiveness of using discrete heartbeats versus an entire 12-lead electrocardiogram (ECG) as the input for predicting future occurrences of arrhythmia and atrial fibrillation using deep learning models. […] The experiments demonstrated the potential of using discrete heartbeats in predicting future arrhythmia and atrial fibrillation incidences extracted from 12-lead electrocardiogram (ECG) signals alone, without any additional patient information. […] Focusing on discrete heartbeats may lead to more timely and accurate diagnoses of these conditions, improving patient outcomes and enabling automated diagnosis using ECG signals as a biomarker. […] The primary aim of our study is to demonstrate that utilizing discrete heartbeats extracted from 10-s 12-lead sinus rhythm ECGs as inputs yields superior results compared to using an entire 12-lead heartbeat as the input for predicting future incidences of cardiac arrhythmias and atrial fibrillation.
- #20 Predicting Future Incidences of Cardiac Arrhythmias Using Discrete Heartbeats from Normal Sinus Rhythm ECG Signals via Deep Learning Methodshttps://pmc.ncbi.nlm.nih.gov/articles/PMC10487044/
Our study results indicate that using discrete heartbeats as the input yielded superior results compared to the conventional approach and could be a valuable tool for healthcare providers in predicting future cardiac arrhythmias from normal sinus rhythm and improving patient care and disease management. […] The findings from our study indicate that utilizing discrete heartbeats from normal sinus rhythm ECG signals as the input in deep learning models demonstrated higher efficacy in predicting future occurrences of arrhythmia and atrial fibrillation. […] The study demonstrated that ECG signals alone were sufficient for accurate prediction, and a potential biomarker may be present in the normal sinus rhythm ECG signal. […] This suggests that using discrete heartbeats with deep learning models may enable the detection of subtle patterns in ECG signals, which could lead to a more accurate and earlier diagnosis of clinically important arrhythmia and atrial fibrillation.
- #21 Predicting Future Incidences of Cardiac Arrhythmias Using Discrete Heartbeats from Normal Sinus Rhythm ECG Signals via Deep Learning Methodshttps://pmc.ncbi.nlm.nih.gov/articles/PMC10487044/
Our study results indicate that using discrete heartbeats as the input yielded superior results compared to the conventional approach and could be a valuable tool for healthcare providers in predicting future cardiac arrhythmias from normal sinus rhythm and improving patient care and disease management. […] The findings from our study indicate that utilizing discrete heartbeats from normal sinus rhythm ECG signals as the input in deep learning models demonstrated higher efficacy in predicting future occurrences of arrhythmia and atrial fibrillation. […] The study demonstrated that ECG signals alone were sufficient for accurate prediction, and a potential biomarker may be present in the normal sinus rhythm ECG signal. […] This suggests that using discrete heartbeats with deep learning models may enable the detection of subtle patterns in ECG signals, which could lead to a more accurate and earlier diagnosis of clinically important arrhythmia and atrial fibrillation.
- #22https://link.springer.com/article/10.1007/s00392-017-1123-0
Patients with atrial fibrillation (AF) are commonly managed with rhythm control strategy, but the natural history of this common arrhythmia leads itself to progression from paroxysmal to persistent or permanent AF, and recurrences despite rhythm control treatments using cardioversion or catheter ablation (CA). […] Numerous clinical factors have been associated with outcomes of rhythm control or arrhythmia progression in patients with AF. […] The more common factors have been used to formulate risk stratification scores, to help predict the outcomes of rhythm control treatments or AF progression. […] The objective of this review article is to provide an overview on the published clinical risk scores related to outcomes of rhythm control strategy or arrhythmia progression. […] Of the numerous clinical factors that have been associated with outcomes of rhythm control or arrhythmia progression in patients with AF, those which are more common have been used to formulate risk stratification scores, to help predict outcomes of rhythm control or arrhythmia progression.
- #23https://link.springer.com/article/10.1007/s00392-017-1123-0
The predictive value in AF progression of the HATCH score is still controversial, but result of recent validation study on new-onset AF demonstrated good predictive ability. […] Several predictive scores for rhythm outcome of AF recurrence postCA have been developed and tested, but evidence of their predictive value still requires further evaluation. […] Many risk factor components of these scores have been reported as independent predictors of CA outcome, whether directly or indirectly contributing to AF substrate formation. […] For now, the risk scores for recurrences following CA have limited validation.
- #24https://link.springer.com/article/10.1007/s00392-017-1123-0
The predictive value in AF progression of the HATCH score is still controversial, but result of recent validation study on new-onset AF demonstrated good predictive ability. […] Several predictive scores for rhythm outcome of AF recurrence postCA have been developed and tested, but evidence of their predictive value still requires further evaluation. […] Many risk factor components of these scores have been reported as independent predictors of CA outcome, whether directly or indirectly contributing to AF substrate formation. […] For now, the risk scores for recurrences following CA have limited validation.
- #25 Internationally validated score to predict the outcome of non-paroxysmal atrial fibrillation ablation: the âFLAME scoreâ | Open Hearthttps://openheart.bmj.com/content/8/2/e001653
The FLAME score was applied to data (882 non-PAF ablations) at a Californian centre, and predicted the outcome of both single (p0.0001) and multiple (p0.0001) procedures. […] In patients with a high score, even multiple procedures are usually ineffective. […] The FLAME score is the first cohort-specific (non-PAF) outcome prediction score for patients undergoing radiofrequency ablation. […] The variables we found independently associated with the outcome are intuitively understandable and consistent with existing literature. […] Our results showed that with FLAME scores 04, patients could obtain good long-term results with a mean of 1.5 procedures. […] However, in the presence of a particularly high FLAME score, the best treatment strategy should be carefully evaluated, and alternative techniques such as surgical or hybrid ablation might be considered.
- #26 Internationally validated score to predict the outcome of non-paroxysmal atrial fibrillation ablation: the âFLAME scoreâ | Open Hearthttps://openheart.bmj.com/content/8/2/e001653
The FLAME score was applied to data (882 non-PAF ablations) at a Californian centre, and predicted the outcome of both single (p0.0001) and multiple (p0.0001) procedures. […] In patients with a high score, even multiple procedures are usually ineffective. […] The FLAME score is the first cohort-specific (non-PAF) outcome prediction score for patients undergoing radiofrequency ablation. […] The variables we found independently associated with the outcome are intuitively understandable and consistent with existing literature. […] Our results showed that with FLAME scores 04, patients could obtain good long-term results with a mean of 1.5 procedures. […] However, in the presence of a particularly high FLAME score, the best treatment strategy should be carefully evaluated, and alternative techniques such as surgical or hybrid ablation might be considered.
- #27 Internationally validated score to predict the outcome of non-paroxysmal atrial fibrillation ablation: the âFLAME scoreâ | Open Hearthttps://openheart.bmj.com/content/8/2/e001653
The FLAME score was applied to data (882 non-PAF ablations) at a Californian centre, and predicted the outcome of both single (p0.0001) and multiple (p0.0001) procedures. […] In patients with a high score, even multiple procedures are usually ineffective. […] The FLAME score is the first cohort-specific (non-PAF) outcome prediction score for patients undergoing radiofrequency ablation. […] The variables we found independently associated with the outcome are intuitively understandable and consistent with existing literature. […] Our results showed that with FLAME scores 04, patients could obtain good long-term results with a mean of 1.5 procedures. […] However, in the presence of a particularly high FLAME score, the best treatment strategy should be carefully evaluated, and alternative techniques such as surgical or hybrid ablation might be considered.
- #28 Azthena logo with the word Azthenahttps://www.news-medical.net/news/20200615/Experts-outline-best-way-to-predict-common-heart-rhythm-disorders.aspx?showform=email
Use the right tool for the job. Today experts outline the best way to identify people most likely to develop common and devastating heart rhythm disorders. […] The paper recommends how best to determine the likelihood of developing a heart rhythm disorder and also how to assess the risk for poor outcome in patients with that condition. […] Accurate risk assessment enables earlier diagnosis and intervention–with lifestyle changes or medication–that could be preventative. […] To take an example, the probability of developing atrial fibrillation rises with increasing age, high blood pressure, obesity, diabetes, and prior heart attack. […] In patients with atrial fibrillation, the possibility of stroke increases with advanced age, heart failure, high blood pressure, diabetes, prior stroke or heart attack, and in women.
- #29 Azthena logo with the word Azthenahttps://www.news-medical.net/news/20200615/Experts-outline-best-way-to-predict-common-heart-rhythm-disorders.aspx?showform=email
Research shows that anticoagulant drugs dramatically reduce stroke risk in patients with a combination of these factors. […] With a good risk assessment, we can avoid needless strokes. […] When it comes to ventricular tachyarrhythmia, the most common predisposing factor is a previous heart attack. […] When combined with a poor pump function of the heart (called ejection fraction), patients are at increased risk of cardiac arrest and death. […] Sudden death can be prevented by implanting a defibrillator (called an ICD or implantable cardioverter defibrillator). […] There is evidence that devices can help detect atrial fibrillation, but the accuracy varies. […] Wearables may be very valuable in the future but at the moment they do not have a defined place in risk assessment. […] The international consensus statement on risk assessment in cardiac arrhythmias was developed by the European Heart Rhythm Association (EHRA), a branch of the ESC; the Heart Rhythm Society (HRS); the Asia Pacific Heart Rhythm Society (APHRS); and the Latin American Heart Rhythm Society (LAHRS).
- #30 Azthena logo with the word Azthenahttps://www.news-medical.net/news/20200615/Experts-outline-best-way-to-predict-common-heart-rhythm-disorders.aspx?showform=email
Research shows that anticoagulant drugs dramatically reduce stroke risk in patients with a combination of these factors. […] With a good risk assessment, we can avoid needless strokes. […] When it comes to ventricular tachyarrhythmia, the most common predisposing factor is a previous heart attack. […] When combined with a poor pump function of the heart (called ejection fraction), patients are at increased risk of cardiac arrest and death. […] Sudden death can be prevented by implanting a defibrillator (called an ICD or implantable cardioverter defibrillator). […] There is evidence that devices can help detect atrial fibrillation, but the accuracy varies. […] Wearables may be very valuable in the future but at the moment they do not have a defined place in risk assessment. […] The international consensus statement on risk assessment in cardiac arrhythmias was developed by the European Heart Rhythm Association (EHRA), a branch of the ESC; the Heart Rhythm Society (HRS); the Asia Pacific Heart Rhythm Society (APHRS); and the Latin American Heart Rhythm Society (LAHRS).
- #31 Azthena logo with the word Azthenahttps://www.news-medical.net/news/20200615/Experts-outline-best-way-to-predict-common-heart-rhythm-disorders.aspx?showform=email
Use the right tool for the job. Today experts outline the best way to identify people most likely to develop common and devastating heart rhythm disorders. […] The paper recommends how best to determine the likelihood of developing a heart rhythm disorder and also how to assess the risk for poor outcome in patients with that condition. […] Accurate risk assessment enables earlier diagnosis and intervention–with lifestyle changes or medication–that could be preventative. […] To take an example, the probability of developing atrial fibrillation rises with increasing age, high blood pressure, obesity, diabetes, and prior heart attack. […] In patients with atrial fibrillation, the possibility of stroke increases with advanced age, heart failure, high blood pressure, diabetes, prior stroke or heart attack, and in women.
- #32 Azthena logo with the word Azthenahttps://www.news-medical.net/news/20200615/Experts-outline-best-way-to-predict-common-heart-rhythm-disorders.aspx?showform=email
Research shows that anticoagulant drugs dramatically reduce stroke risk in patients with a combination of these factors. […] With a good risk assessment, we can avoid needless strokes. […] When it comes to ventricular tachyarrhythmia, the most common predisposing factor is a previous heart attack. […] When combined with a poor pump function of the heart (called ejection fraction), patients are at increased risk of cardiac arrest and death. […] Sudden death can be prevented by implanting a defibrillator (called an ICD or implantable cardioverter defibrillator). […] There is evidence that devices can help detect atrial fibrillation, but the accuracy varies. […] Wearables may be very valuable in the future but at the moment they do not have a defined place in risk assessment. […] The international consensus statement on risk assessment in cardiac arrhythmias was developed by the European Heart Rhythm Association (EHRA), a branch of the ESC; the Heart Rhythm Society (HRS); the Asia Pacific Heart Rhythm Society (APHRS); and the Latin American Heart Rhythm Society (LAHRS).
- #33 EHRA/HRS/APHRS/LAHRS Expert Consensus on Risk Assessment in Cardiac Arrhythmias: Use the Right Tool for the Right Outcome – HRShttps://www.hrsonline.org/guidance/clinical-resources/ehrahrsaphrslahrs-expert-consensus-risk-assessment-cardiac-arrhythmias-use-right-tool-right-outcome
The expert consensus statement recommends how best to determine the likelihood of developing a heart rhythm disorder and how to assess the risk for poor outcome in patients with that condition. […] The document focuses on atrial fibrillation, the most common heart rhythm disorder and a major cause of disabling stroke, and ventricular tachyarrhythmia (fast heart rate), a leading cause of sudden cardiac death. […] The objective is to raise awareness of using the right risk assessment tool for a given outcome in a given population and to provide physicians with practical proposals that may lead to improvement of patient care in this regard.
- #34 EHRA/HRS/APHRS/LAHRS Expert Consensus on Risk Assessment in Cardiac Arrhythmias: Use the Right Tool for the Right Outcome – HRShttps://www.hrsonline.org/guidance/clinical-resources/ehrahrsaphrslahrs-expert-consensus-risk-assessment-cardiac-arrhythmias-use-right-tool-right-outcome
The expert consensus statement recommends how best to determine the likelihood of developing a heart rhythm disorder and how to assess the risk for poor outcome in patients with that condition. […] The document focuses on atrial fibrillation, the most common heart rhythm disorder and a major cause of disabling stroke, and ventricular tachyarrhythmia (fast heart rate), a leading cause of sudden cardiac death. […] The objective is to raise awareness of using the right risk assessment tool for a given outcome in a given population and to provide physicians with practical proposals that may lead to improvement of patient care in this regard.
- #35 Azthena logo with the word Azthenahttps://www.news-medical.net/news/20200615/Experts-outline-best-way-to-predict-common-heart-rhythm-disorders.aspx?showform=email
Research shows that anticoagulant drugs dramatically reduce stroke risk in patients with a combination of these factors. […] With a good risk assessment, we can avoid needless strokes. […] When it comes to ventricular tachyarrhythmia, the most common predisposing factor is a previous heart attack. […] When combined with a poor pump function of the heart (called ejection fraction), patients are at increased risk of cardiac arrest and death. […] Sudden death can be prevented by implanting a defibrillator (called an ICD or implantable cardioverter defibrillator). […] There is evidence that devices can help detect atrial fibrillation, but the accuracy varies. […] Wearables may be very valuable in the future but at the moment they do not have a defined place in risk assessment. […] The international consensus statement on risk assessment in cardiac arrhythmias was developed by the European Heart Rhythm Association (EHRA), a branch of the ESC; the Heart Rhythm Society (HRS); the Asia Pacific Heart Rhythm Society (APHRS); and the Latin American Heart Rhythm Society (LAHRS).
- #36 Arrhythmic sudden death survival prediction using deep learning analysis of scarring in the heart | Nature Cardiovascular Researchhttps://www.nature.com/articles/s44161-022-00041-9
SSCAR represents innovation in CMR imaging feature extraction and learning of non-linear relationships among standard clinical covariates. […] The technology aims to transform clinical decision-making regarding arrhythmia risk and patient prognosis by encouraging practitioners to eschew the view of predicted risk as a single number outputted by a black-box algorithm but, rather, to be guided by the estimated time-to-outcome in the context of patient-specific time prediction uncertainty.
- #37 Arrhythmia: Symptoms & Treatmenthttps://my.clevelandclinic.org/health/diseases/16749-arrhythmia
An arrhythmia is a heart rhythm that isnt normal. The prognosis varies greatly depending on the type. […] Some types of arrhythmia are harmless and dont require treatment. Others can put you at risk for cardiac arrest. […] Depending on the type of cardiac arrhythmia you have, you may have mild or severe symptoms or none at all. You may not need treatment, but some people need medicine or a procedure. With heart arrhythmia treatment, many people can live full lives. Some people with more serious arrhythmias have a cardiac arrest and may or may not survive. […] Harmless arrhythmias go away and come back in response to what triggers them. However, people with other types of arrhythmias especially those that put you at risk for cardiac arrest need treatment for the rest of their lives.
- #38 Arrhythmia: Symptoms & Treatmenthttps://my.clevelandclinic.org/health/diseases/16749-arrhythmia
An arrhythmia is a heart rhythm that isnt normal. The prognosis varies greatly depending on the type. […] Some types of arrhythmia are harmless and dont require treatment. Others can put you at risk for cardiac arrest. […] Depending on the type of cardiac arrhythmia you have, you may have mild or severe symptoms or none at all. You may not need treatment, but some people need medicine or a procedure. With heart arrhythmia treatment, many people can live full lives. Some people with more serious arrhythmias have a cardiac arrest and may or may not survive. […] Harmless arrhythmias go away and come back in response to what triggers them. However, people with other types of arrhythmias especially those that put you at risk for cardiac arrest need treatment for the rest of their lives.
- #39 Arrhythmia: Symptoms & Treatmenthttps://my.clevelandclinic.org/health/diseases/16749-arrhythmia
An arrhythmia is a heart rhythm that isnt normal. The prognosis varies greatly depending on the type. […] Some types of arrhythmia are harmless and dont require treatment. Others can put you at risk for cardiac arrest. […] Depending on the type of cardiac arrhythmia you have, you may have mild or severe symptoms or none at all. You may not need treatment, but some people need medicine or a procedure. With heart arrhythmia treatment, many people can live full lives. Some people with more serious arrhythmias have a cardiac arrest and may or may not survive. […] Harmless arrhythmias go away and come back in response to what triggers them. However, people with other types of arrhythmias especially those that put you at risk for cardiac arrest need treatment for the rest of their lives.
- #40 Atrial Fibrillation: Prognosis, Life Expectancyhttps://www.webmd.com/heart-disease/atrial-fibrillation/atrial-fibrillation-prognosis-life-expectancy
When your doctor diagnoses you with atrial fibrillation (AFib), you might wonder what to expect. Your prognosis is a prediction of how your disease could affect you in the future and how long you might live. […] Untreated AFib can raise your risk for problems like a heart attack, stroke, and heart failure, which could shorten your life expectancy. But treatments and lifestyle changes can help prevent these problems and manage your risks. […] AFib does raise the risk of dying early. Heart failure and stroke are two of the main causes of death in people with AFib. But with improved treatments, overall deaths from AFib have dropped. […] There arent life expectancy statistics for people with AFib. For a personalized prognosis, ask your doctor what you can expect and what treatments and lifestyle changes can help. Exercise, weight loss, healthy eating, and treatments like blood thinners and blood pressure medicines might help you live longer — and better — with AFib.