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Predicting reflex syncope based on plethysmography: a new wearable device development and preliminary results
Session:
CO 11- Síncope
Speaker:
Guilherme Lourenço
Congress:
CPC 2021
Topic:
C. Arrhythmias and Device Therapy
Theme:
07. Syncope and Bradycardia
Subtheme:
07.5 Syncope and Bradycardia - Prevention
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Guilherme Lourenço; Sérgio Laranjo; Lourenço Rodrigues; André Lourenço; Helena Fonseca; Catarina Oliveira; Pedro Cunha; Mário Oliveira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Recurrent reflex syncope (RSync) is a common clinical condition with a major impact on patients’ life. The underlying mechanism is a transient global cerebral hypoperfusion accompanied by rapid blood pressure (BP) drop. Isometric counterpressure maneuvers (legs/arms) induce BP increase during the phase of impending syncope, avoiding or delaying losing consciousness. Therefore, detecting the onset of syncope mechanism as early as possible it is of major importance, particularly in patients (P) without prodromes.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Aim:</strong> to develop an innovative wearable, efficient and reliable device with the ability to anticipate the RSync.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> P with recurrent syncope referred for head-up tilt testing (HUT) were monitored using a continuous non-invasive arterial BP system (TaskForce Monitor, CNSystems, Graz, Austria), complemented with the synchronized acquisition of plethysmography (PPG) signals using an innovative wearable device. The device used in this experiment is based on the Maxim platform - a wrist band PPG sensor with 3 integrated wavelengths. It uses two sensors with green LEDs, one red and a fourth infrared one to guarantee the required robustness, as well as a 3-axis accelerometer sensor. It allows monitoring of instantaneous heart rate and oxygen saturation, but also the extraction of the raw sensor data, enabling the analysis conducted in this study. The continuous BP signal was synchronized with the PPG by extracting the intervals between systolic peaks and finding the delay on PPG that minimized the quadratic difference between the tachogram time series. Synchronization was further refined by the human verification of the initial estimate. From the aligned signals, a segment of 120 sec was extracted from the basal period, as well as the 120 sec prior to the syncopal event.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> Ten P with HUT-induced RSync (1 cardioinhibitory, 5 mixed-type and 4 vasodepressor) were enrolled in this proof of concept study. By computing the areas in each segment, normalized by the amplitude of the basal pulses in each signal, a consistent and significant reduction of the PPG amplitude and wave patterns was found between pre-syncopal and basal periods, starting, at average, 60 sec before syncope, preceding the systolic BP, stroke volume and cardiac output changes.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion: </strong>Predicting RSync is feasible by monitoring PPG amplitude and morphology changes along the time. This new approach may have a relevant impact in the future management of RSync.</span></span></p>
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