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      ECG Parameters for Malignant Ventricular Arrhythmias: A Comprehensive Review

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          Abstract

          Many studies showed electrocardiogram (ECG) parameters are useful for predicting fatal ventricular arrhythmias (VAs). However, the studies have several shortcomings. Firstly, all studies lack of effective way to present behavior of various ECG parameters prior to the occurrence of the VAs. Secondly, they also lack of discussion on how to consider the parameters as abnormal. Thirdly, the reports do not include approaches to increase the detection accuracy for the abnormal patterns. The purpose of this study is to address the aforementioned issues. It identifies ten ECG parameters from various sources and then presents a review based on the identified parameters. From the review, it has been found that the increased risk of VAs can be represented by presence and certain abnormal range of the parameters. The variation of parameters range could be influenced by either gender or age. This study also has discovered the facts that averaging, outliers elimination and morphology detection algorithms can contribute to the detection accuracy.

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          Heart rate turbulence: standards of measurement, physiological interpretation, and clinical use: International Society for Holter and Noninvasive Electrophysiology Consensus.

          Axel Bauer, Marek Malik, Georg Schmidt … (2008)
          This consensus statement has been compiled on behalf of the International Society for Holter and Noninvasive Electrophysiology. It reviews the topic of heart rate turbulence (HRT) and concentrates on technologies for measurement, physiologic background and interpretation, and clinical use of HRT. It also lists suggestions for future research. The phenomenon of HRT refers to sinus rhythm cycle-length perturbations after isolated premature ventricular complexes. The physiologic pattern of HRT consists of brief heart rate acceleration (quantified by the so-called turbulence onset) followed by more gradual heart rate deceleration (quantified by the so-called turbulence slope) before the rate returns to a pre-ectopic level. Available physiologic investigations confirm that the initial heart rate acceleration is triggered by transient vagal inhibition in response to the missed baroreflex afferent input caused by hemodynamically inefficient ventricular contraction. A sympathetically mediated overshoot of arterial pressure is responsible for the subsequent heart rate deceleration through vagal recruitment. Hence, the HRT pattern is blunted in patients with reduced baroreflex. The HRT pattern is influenced by a number of factors, provocations, treatments, and pathologies reviewed in this consensus. As HRT measurement provides an indirect assessment of baroreflex, it is useful in those clinical situations that benefit from baroreflex evaluation. The HRT evaluation has thus been found appropriate in risk stratification after acute myocardial infarction, risk prediction, and monitoring of disease progression in heart failure, as well as in several other pathologies.
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            Ventricular arrhythmias and sudden cardiac death.

            Roy John, Usha B. Tedrow, Bruce A. Koplan … (2012)
            Management strategies for ventricular arrhythmias are guided by the risk of sudden death and severity of symptoms. Patients with a substantial risk of sudden death usually need an implantable cardioverter defibrillator (ICD). Although ICDs effectively end most episodes of ventricular tachycardia or ventricular fibrillation and decrease mortality in specific populations of patients, they have inherent risks and limitations. Generally, antiarrhythmic drugs do not provide sufficient protection from sudden death, but do have a role in reducing arrhythmias that cause symptoms. Catheter ablation is likewise important for reducing the frequency of spontaneous arrhythmias and is curative for some patients, usually those with idiopathic arrhythmias and no heart disease. Arrhythmia surgery is now infrequent, offered by only a few specialised centres for refractory arrhythmias. Advances in understanding of genetic arrhythmia syndromes and in technology for mapping and ablation of ventricular arrhythmias, and enhanced algorithms in implantable devices for rhythm management, have contributed to improved outcomes. Copyright © 2012 Elsevier Ltd. All rights reserved.
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              QRS fragmentation: diagnostic and prognostic significance.

              Grzegorz Pietrasik, Wojciech Zareba (2012)
              Fragmentation of QRS (fQRS) complex is an easily evaluated non-invasive electrocardiographic parameter. Fragmentation of narrow QRS is defined as presence of an additional R wave (R') or notching in the nadir of the S wave, or the presence of > 1 R' in 2 contiguous leads, corresponding to a major coronary artery territory on the resting 12-lead ECG. Fragmentation of wide complex QRS consists of various RSR patterns, with more than 2 R waves (R'') or more than 2 notches in the R wave, or more than 2 notches in the downstroke or upstroke of the S wave. Presence of fQRS has been associated with alternation of myocardial activation due to myocardial scar and myocardial fibrosis. Initial studies reported higher sensitivity of fQRS than Q wave for detecting myocardial scar and postulated that the presence of fQRS could be a good predictor of cardiac events among the patients with coronary artery disease. The presence of fQRS has been investigated among the patients with ischemic and non-ischemic cardiomyopathy suggesting that this ECG parameter may affect prognosis and risk of sudden cardiac death, risk of implantable cardioverter-defibrillator therapy and response to cardiac resynchronization therapy. In addition, there is evidence that fQRS could play an important role as screening and prognostic tool among the patients with Brugada syndrome, long QT syndrome, arrhythmogenic right ventricular dysplasia and cardiac sarcoidosis. This paper reviews definition, diagnostic and prognostic value of fQRS in different patient populations.
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                Author and article information

                Contributors
                Satria Mandala:
                ORCID: http://orcid.org/0000-0001-6997-5875
                +62-22 7565 931 , satriamandala@telkomuniversity.ac.id
                Journal
                Journal ID (nlm-ta): J Med Biol Eng
                Journal ID (iso-abbrev): J Med Biol Eng
                Title: Journal of Medical and Biological Engineering
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Print): 1609-0985
                Publication date (Electronic): 28 June 2017
                Publication date PMC-release: 28 June 2017
                Publication date (Print): 2017
                Volume: 37
                Issue: 4
                Pages: 441-453
                Affiliations
                [1 ]Fakultas Informatika, Universitas Telkom, Jl. Telekomunikasi Terusan Buah Batu, Bandung, 40257 Indonesia
                [2 ]ISNI 0000 0001 2296 1505, GRID grid.410877.d, IJN-UTM Cardiovascular Engineering Centre, , Universiti Teknologi Malaysia, ; Johor, Malaysia
                Author information
                http://orcid.org/0000-0001-6997-5875
                Article
                Publisher ID: 281
                DOI: 10.1007/s40846-017-0281-x
                PMC ID: 5562779
                PubMed ID: 28867990
                SO-VID: fc1857ed-da23-44e3-ae07-b45fb4e66dc2
                Copyright © © The Author(s) 2017
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Date received : 26 April 2016
                Date accepted : 31 August 2016
                Categories
                Subject: Review Article
                Custom metadata
                issue-copyright-statement © Taiwanese Society of Biomedical Engineering 2017

                Keywords: ventricular arrhythmia,prediction,ecg parameter,behavior pattern
                Data availability:
                Keywords: ventricular arrhythmia, prediction, ecg parameter, behavior pattern

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