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Health See other Health Articles Title: Wide Complex Tachycardia? There's an App for That NEW YORK (Reuters Health) - A smartphone app that uses the AliveCor cardiac monitor can detect and record wide complex tachycardias, doctors say. "These types of devices are easy to obtain and use in the general population and may be extremely useful for certain populations to complement clinical history and exam," Dr. Saumya Das, from Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, told Reuters Health by email. "Negative findings (e.g., sinus rhythm) that are contemporaneous with symptoms may be especially useful in excluding diagnoses of arrhythmias. Positive findings always need to be interpreted in a clinical context and perhaps complemented with additional testing," he said. Dr. Das and colleagues present the case of an active 62-year-old man who began to experience frequent, sudden episodes of exertional near-syncope and syncope. Neurological and echocardiographic exams were normal, as was his resting electrocardiogram. On his physician's advice, the patient purchased an AliveCor cardiac monitor and used his smartphone to record what turned out to be a six-second episode of wide complex tachycardia during an episode of near-syncope. The episodes were interpreted as polymorphic ventricular tachycardia or ventricular fibrillation, so he received an urgent referral to an electrophysiologist for consideration for an implantable cardioverter-defibrillator (ICD). His electrophysiology study induced monomorphic ventricular tachycardia that originated from the posteroseptal right ventricular outflow tract, the focal ablation of which eliminated the inducible rhythm. The patient's near-daily symptomatic episodes disappeared, and he had no further episodes of syncope or presyncope and no arrhythmia detected with follow-up continuous-loop event monitoring, according to the January 26 JAMA Internal Medicine online report. Published data support the sensitivity (94% to 100%) and specificity (91% to 95%) of the AliveCor monitor for detecting atrial fibrillation, but its use for recording and documenting ventricular arrhythmias has been limited. Limitations of the AliveCor monitor include noise or motion artifact, which can be reduced by improving contact between the patient and the monitor, as well as the fact that the cardiac rhythm recording can occur only if and when the patient is able to activate the smartphone during the symptoms and the putative arrhythmia causing them. "For ventricular arrhythmias, which have a low pretest probability in the general population without structural heart disease, a false-positive findings (due to poor contact, etc.) are likely higher (and specificity lower) than in a population with structural heart disease or prior MI," Dr. Das said. "Hence, such findings need to be interpreted in a clinical context, and perhaps complemented with other tests (such as a formal event recorder)." Another potential challenge, he said, is "overwhelming the responsible physician with transmission of multiple recordings." The AliveCor monitor for iPhone retails for $199.00. The AliveECG app is free. The authors report no disclosures. SOURCE: http://bit.ly/1z9jvJg JAMA Intern Med 2015. Poster Comment: syncope [sing´kah-pe] faint. adj. adj syn´copal, syncop´ic. cardiac syncope sudden loss of consciousness, either with momentary premonitory symptoms or without warning, due to cerebral anemia caused by ventricular asystole, extreme bradycardia, or ventricular fibrillation. Ventricular Fibrillation Definition Ventricular fibrillation is a very rapid, uncoordinated, ineffective series of contractions throughout the lower chambers of the heart. Unless stopped, these chaotic impulses are fatal. Description When the ventricles begin to quiver and do not employ coordinated contractions, the heart is said to be fibrillating. In this condition the ventricles cannot pump blood from the heart. Ventricular fibrillation (V-fib) is the worst kind of abnormal heart rhythm, and is a form of cardiac arrest. It involves the pumping of the lower chambers of the heart, while atrial fibrillation involves the upper chambers. Causes and symptoms Ventricular fibrillation often is associated with acute ischemic events (ischemia involves the deprivation of oxygenated blood to an area of tissue), and with chronic ischemic heart disease. It is frequently seen immediately following a heart attack. It also may develop during hypoxia, atrial fibrillation, or improper grounding of electrical devices. An extremely low level of potassium in the blood also can cause ventricular fibrillation. The first, and usually the only, symptom of V-fib is sudden unconsciousness. Diagnosis When an individual suddenly collapses, the possibility of ventricular fibrillation should be considered immediately. A quick assessment usually shows no pulse or heartbeat. The diagnosis of ventricular fibrillation is confirmed with an electrocardiogram. Treatment Basic life support with standard cardiopulmonary resuscitation (CPR) must be started within a few minutes, followed as soon as possible with cardioversion. Cardioversion is an electric shock delivered to the heart to stop the fibrillating. Early defibrillation is the key to survival. If left untreated, irreversible brain damage, due to lack of oxygen to the brain, occurs after about five minutes. After the heart resumes its normal rhythm, medications are given to help maintain the rhythm. Research continues into methods to deliver defibrillation as soon as possible to those experiencing ventricular fibrillation. One of the studies addressed in 2003 researched various clinical trials that implanted defibrillators into patients to prevent sudden cardiac death. The devices worked in many instances but more proof of their success was needed for widespread use. Prognosis Early and effective CPR may provide the time necessary for medical personnel to arrive with a defibrillator. If a defibrillator is able to promptly restore a normal rhythm, up to 25% of victims are able to leave the hospital without evidence of brain damage. If ventricular fibrillation occurs in the hospital in conjunction with a heart attack, defibrillation has a 95% success rate. If shock and heart failure are present at the time, even with immediate defibrillation, only about 30% of those stricken are successfully restored to a normal heart rate. Prevention A healthy lifestyle to reduce the risk of heart diseases which lead to ventricular fibrillation is the best prevention. For people who have experienced an episode of V-fib, an internal cardioverter-defibrillator may prevent further episodes. Post Comment Private Reply Ignore Thread
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