European Resuscitation Council Guidelines for Resuscitation.

The goal of therapy for bradycardia or tachycardia is to rapidly identify and treat patients who are hemodynamically unstable or symptomatic due to the arrhythmia. Drugs or, when appropriate, pacing may be used to control unstable or symptomatic bradycardia. Cardioversion or drugs or both may be used to control unstable or symptomatic tachycardia. ACLS providers should closely monitor stable patients pending expert consultation and should be prepared to aggressively treat those with evidence of decompensation.

/pdf/part-8-adult-advanced-cardiovascular-life-support-2010-344vtppnij.pdf

Part 8: Adult Advanced Cardiovascular Life Support 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

The International Liaison Committee on Resuscitation (ILCOR) Advanced Life Support (ALS) Task Force performed detailed systematic reviews based on the recommendations of the Institute of Medicine of the National Academies1 and using the methodological approach proposed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group.2 Questions to be addressed (using the PICO [population, intervention, comparator, outcome] format)3 were prioritized by ALS Task Force members (by voting). Prioritization criteria included awareness of significant new data and new controversies or questions about practice. Questions about topics no longer relevant to contemporary practice or where little new research has occurred were given lower priority. The ALS Task Force prioritized 42 PICO questions for review. With the assistance of information specialists, a detailed search for relevant articles was performed in each of 3 online databases (PubMed, Embase, and the Cochrane Library).

By using detailed inclusion and exclusion criteria, articles were screened for further evaluation. The reviewers for each question created a reconciled risk of bias assessment for each of the included studies, using state-of-the-art tools: Cochrane for randomized controlled trials (RCTs),4 Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 for studies of diagnostic accuracy,5 and GRADE for observational studies that inform both therapy and prognosis questions.6

GRADE evidence profile tables7 were then created to facilitate an evaluation of the evidence in support of each of the critical and important outcomes. The quality of the evidence (or confidence in the estimate of the effect) was categorized as high, moderate, low, or very low,8 based on the study methodologies and the 5 core GRADE domains of risk of bias, inconsistency, indirectness, imprecision, and other considerations (including publication bias).9

These evidence profile tables were then used to create a …

/pdf/part-4-advanced-life-support-2015-international-consensus-on-3s0zzf6w8u.pdf

Part 4: Advanced life support: 2015 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations

European Resuscitation Council Guidelines for Resuscitation 2015

European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support.

Comparative study of morphological and time-frequency ECG descriptors for heartbeat classification.

An analysis of electrocardiographic pattern recognition parameters for premature ventricular contraction (PVC) and normal (N) beat classification is presented. Twenty-six parameters were defined: 11 x 2 for the two electrocardiogram (ECG) leads, width of the complex and three parameters derived from a single-plane vectorcardiogram (VCG). Some of the parameters include amplitudes of maximal positive and maximal negative peaks, area of absolute values, area of positive values, area of negative values, number of samples with 70% higher amplitude than that of the highest peak, amplitude and angle of the QRS vector in a VCG plane. They were measured for all heartbeats annotated as N or PVC in all 48 ECG recordings of the MIT-BIH arrhythmia database. Two reference sets for the Kth nearest-neighbours rule were used-global and local. The classification indices obtained with the global reference set were 75.4% specificity and 80.9% sensitivity. Using the local reference set we increased the specificity to 96.7% and the sensitivity to 96.9%. The achieved specificity and sensitivity are comparable with, and greater than, the results reported in the literature.

https://iopscience.iop.org/article/10.1088/0967-3334/26/1/011/pdf

Premature ventricular contraction classification by the Kth nearest-neighbours rule.

Assessment and comparison of different methods for heartbeat classification.

We propose a quasi real-time method for discrimination of ventricular ectopic beats from both supraventricular and paced beats in the electrocardiogram (ECG). The heartbeat waveforms were evaluated within a fixed-length window around the fiducial points (100 ms before, 450 ms after). Our algorithm was designed to operate with minimal expert intervention and we define that the operator is required only to initially select up to three ‘normal’ heartbeats (the most frequently seen supraventricular or paced complexes). These were named original QRS templates and their copies were substituted continuously throughout the ECG analysis to capture slight variations in the heartbeat waveforms of the patient’s sustained rhythm. The method is based on matching of the evaluated heartbeat with the QRS templates by a complex set of ECG descriptors, including maximal cross-correlation, area difference and frequency spectrum difference. Temporal features were added by analyzing the R-R intervals. The classification criteria were trained by statistical assessment of the ECG descriptors calculated for all heartbeats in MIT-BIH Supraventricular Arrhythmia Database. The performance of the classifiers was tested on the independent MIT-BIH Arrhythmia Database. The achieved unbiased accuracy is represented by sensitivity of 98.4% and specificity of 98.86%, both being competitive to other published studies. The provided computationally efficient techniques enable the fast post-recording analysis of lengthy Holter-monitor ECG recordings, as well as they can serve as a quasi real-time detection method embedded into surface ECG monitors.

QRS template matching for recognition of ventricular ectopic beats.

The automatic external defibrillator (AED) is a lifesaving device, which processes and analyses the electrocardiogram (ECG) and delivers a defibrillation shock to terminate ventricular fibrillation or tachycardia above 180 bpm. The built-in algorithm for ECG analysis has to discriminate between shockable and non-shockable rhythms and its accuracy, represented by sensitivity and specificity, is aimed at approaching the maximum values of 100%. An algorithm for VF/VT detection is proposed using a band-pass digital filter with integer coefficients, which is very simple to implement in real-time operation. A branch for wave detection is activated for heart rate measurement and an auxiliary parameter calculation. The method was tested with ECG records from the widely recognized databases of the American Heart Association (AHA) and the Massachusetts Institute of Technology (MIT). A sensitivity of 95.93% and a specificity of 94.38% were obtained.

https://iopscience.iop.org/article/10.1088/0967-3334/25/5/007/pdf

Irena Jekova

Papers

Comparative study of morphological and time-frequency ECG descriptors for heartbeat classification.

Premature ventricular contraction classification by the Kth nearest-neighbours rule.

Assessment and comparison of different methods for heartbeat classification.

QRS template matching for recognition of ventricular ectopic beats.

Real time detection of ventricular fibrillation and tachycardia.