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Real Time Non-Invasive Hemodynamic Assessment of Ventricular Tachycardia

Besleaga, T; Lambiase, PD; Graham, AJ; Demosthenous, A; Orini, M; (2020) Real Time Non-Invasive Hemodynamic Assessment of Ventricular Tachycardia. IEEE Access , 8 pp. 138652-138660. 10.1109/access.2020.3012494. Green open access

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Abstract

Hemodynamically unstable ventricular tachycardia (VT) is a critical cardiac arrhythmia associated with hemodynamic compromise that requires immediate cardioversion to prevent sudden cardiac death. Since unnecessary cardioverter defibrillators shocks damage the heart and increase the risk of mortality, the discrimination between unstable (i.e. requiring cardioversion) and stable (i.e. not requiring cardioversion) VT is of paramount importance. The aim of this study was to propose and assess non-invasive identification of hemodynamically unstable VT using photoplethysmography (PPG). Seventy-five (n = 75) episodes of VT were recorded in 14 patients undergoing invasive electrophysiological studies for VT catheter ablation. Invasive continuous arterial blood pressure (ABP), PPG and electrocardiogram (ECG) were simultaneously recorded. VTs were classified as unstable if during the first 10 seconds from onset, the mean ABP (PVT < 60PVT) was PVT < 60PVT <60 mmHg or if PVT dropped more than 30% with respect to a 10 seconds baseline (i.e. ratio RABP <0.70). Five PPG morphological features were derived and compared to the heart rate from the ECG. PPG markers detected hemodynamically unstable VT with accuracy as high as 86% and were more accurate than the heart rate. The mean absolute slope was the best PPG parameter for classification of PVT< 60PVT <60PVT < 60 mmHg (AUC = 0.85, Sensitivity = 72%, Specificity = 86%) and RABP <0.70RABP< 0.70 (AUC = 0.90, Sensitivity = 83%, Specificity = 89%) and it was automatically selected in the best two-variables logistic regression, for which AUC = 0.94. In conclusion, PPG analysis can accurately identify haemodynamically unstable VTs and has potential to enable optimization of VT therapy and reduce unnecessary and harmful cardioversion shocks.

Type: Article
Title: Real Time Non-Invasive Hemodynamic Assessment of Ventricular Tachycardia
Open access status: An open access version is available from UCL Discovery
DOI: 10.1109/access.2020.3012494
Publisher version: https://doi.org/10.1109/access.2020.3012494
Language: English
Additional information: This work is licensed under a Creative Commons Attribution 4.0 License. For more information, see https://creativecommons.org/licenses/by/4.0/.
Keywords: Assistive technology, biomedical signal processing, cardiology
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Clinical Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Population Science and Experimental Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Population Science and Experimental Medicine > MRC Unit for Lifelong Hlth and Ageing
UCL > Provost and Vice Provost Offices > UCL BEAMS
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science > Dept of Electronic and Electrical Eng
URI: https://discovery.ucl.ac.uk/id/eprint/10107133
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