Images in Sleep MedicineIdentification of significant PVC clusters through PPG waveform review
Section snippets
Introduction to the case
A 54-year-old male was referred for a titration PSG in the setting of treatment emergent central sleep apnea. History was notable for chronic pain, cirrhosis secondary to Hepatitis B infection. Medications included: hydromorphone, gabapentin, cyclobenzaprine, and tenofovir. He reported no history of coronary artery disease. Transthoracic echocardiogram (TTE) was performed prior to titration, showing an ejection fraction of 60% without valvular abnormalities.
Abnormal patterns in the
Image analysis
Photoplethysmography (PPG) uses infrared light to measure arterial blood volume changes with each pulse-beat [1]. With normal sinus rhythm, there is regular contraction of the heart. The corresponding PPG waveform will reflect a normal amplitude, area under the waveform, and interval between the two systolic peaks (P–P interval) (Fig. 3). Heart rhythm variations, resulting in perfusion alterations will be reflected in the plethysmography waveform. If heart rhythm does not generate a significant
Discussion
PVCs can be unifocal (from one focus on the ventricle wall) or multifocal (two or more different foci). Unifocal PVCs have similar QRS morphologies and multifocal PVCs have differing QRS morphologies. The ST-segment of the PVC has no bearing on localization [2]. These images suggest that even without an ECG, specific cardiac arrhythmias are recognizable from the PPG signal, such as available in–home sleep apnea testing systems.
For patients with frequent PVCs, especially in bigeminy or trigeminy
Credit author statement
Francis Christian: Conceptualization, Writing – original draft, Writing – review & editing.
Alexandra Pollak: Writing – original draft, Writing – review & editing, Visualization.
Robert Thomas: Conceptualization, Writing – review & editing.
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