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"Palpitasi merupakan keluhan yang paling sering membuat seorang penderita datang ke unit gawat darurat. Wolf-Parkinson White (WPW) syndrome merupakan gangguan konduksi pada jantung dengan gejala palpitasi yang dapat menyebabkan kematian mendadak. WPW dapat dideteksi dengan pemeriksaan electrocardiogram (EKG). Dalam tulisan ini dilaporkan dua kasus WPW yang terjadi pada usia muda dengan riwayat keluhan palpitasi yang berulang dan progresif. EKG pasien pertama menunjukkan takikardi supraventrikel yang berubah menjadi irama sinus setelah pemberian propanolol. Pada EKG dengan irama sinus ditemukan gelombang delta pada sandapan II,III,aVF, V1 yang biasanya disebabkan oleh accessory pathway (AP) pada dinding left lateral. Studi elektrofisiologi mengkonfirmasi adanya AP dan radio frequency catheter ablation berhasil dilakukan, Gelombang delta tidak terdeteksi pada saat pasien kontrol ke poliklinik. Pasien tidak ada keluhan dan tidak harus minum obat lagi. EKG pasien kedua menunjukkan takikardi supraventrikel dengan aberansi. Setelah pemberian amiodarone terekam irama sinus dengan gelombang delta pada sandapan I,II,aVL, kemungkinan accessory pathway pada dinding anteroseptal. Pasien kedua tidak dilakukan studi elektrofisiologi dan ablasi karena masalah biaya, namun amiodarone perlu diminum untuk mencegah takikardi supraventrikel berulang.

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Palpitation is a common presenting symptom in the emergency department. Wolf-Parkinson White (WPW) syndrome is a cardiac conduction disorder that may present with palpitation and lead to sudden cardiac death. WPW could be detected by electrocardiogram (ECG). In this case report, we present two young male patients with WPW syndrome admitted to our hospital with history of repeated and progressive palpitation. ECG of the first patient revealed supraventricular tachycardia which converted to sinus rhythm after propanolol treatment. ECG showed sinus rhythm with delta wave in lead II,III,aVF, V1 suggesting the presence of accessory pathway (AP) in left lateral wall.

Electrophysiology study confirmed the presence of AP and radio frequency catheter ablation was successfully done resulted in disappearance of delta on outpatient clinic ECG. Patient has no symptom and he do not have to take medication. ECG of the second patient revealed supraventricular tachycardia with abberancy. After amiodarone infusion, ECG showed sinus rhythm with delta wave in lead I,II,aVL suggesting the presence of accessory pathway in anteroseptal wall. Electrophysiology study and catheter ablation did not perform for this patient because of financial problem, however amidarone has to be taken regularly to prevent the recurrence of supraventricular tachycardia."

"Latar Belakang : Telah banyak dipublikasikan berbagai macam algoritme untukmenentukan lokasi jaras tambahan pada pasien dengan sindroma Wolff-ParkinsonWhite.Algoritme-algoritme tersebut memiliki akurasi yang baik meskipunmemiliki alur yang komplek dan sulit untuk diingat. Berbagai macam algoritmeyang berkembang menggunakan morfologi delta wave dan polaritas komplek QRSdalam penyusunannya. Dengan adanya teknologi kateter ablasi yang ada saat inialgoritme yang komplek tidak diperlukan lagi. Diperlukan suatu algoritme yangsederhana, memiliki akurasi yang baik dan mudah diingat. Penelitian ini bertujuan untuk menilai akurasi algoritme sederhana untuk memprediksi lokasi jarastambahan. Metode : Penelitian ini merupakan studi potong lintang yang dilakukan diDepartemen Kardiologi dan Kedokteran Vaskuler FKUI/ Pusat Jantung NasionalHarapan Kita PJNHK. Data yang diambil berupa elektrokardiografi EKG pada67 pasien dengan sindroma Wolff-Parkinson-White yang menjalani tindakan ablasiperiode Januari 2014 - Oktober 2016. Data EKG yang terkumpul dibacaberdasarkan algoritme baru oleh dua orang penilai independen kemudiandibandingkan dengan hasil ablasi pada tabel 2x2. Hasil Penelitian : sampel akhir sebanyak 47 data hasil bacaan EKG observerterpercaya dihitung berdasarkan tabel 2x2 dengan hasil ablasi. Hasil menunjukkanalgoritme ini memiliki sensitivitas left free wall 45, septal 80, right free wall92, spesifisitas left free wall 96, septal 69, right free wall 85. Nilai dugapositif NDP left free wall 90, septal 55, dan right free wall 67. Nilai duganegatif NDN left free wall 70, septal 88, dan right free wall 97. Akurasialgoritme bervariasi dari 73 -87. Didapatkan perhitungan kesepahaman antarpenilai dengan nilai kappa 0,74-0,93. Perhitungan likelihood ratio menunjukkanlikelihood ratio positif left free wall 11,23, septal 2,23, dan right free wall 6,57.Likelihood ratio negatif left free wall 0,57, septa 0,28, dan right free wall 0,09. Kesimpulan : Algoritme baru yang lebih sederhana ini memiliki akurasi yang baikdengan angka kesepahaman antar penilai yang baik sehingga dapat digunakansecara umum.

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Background : A lot of algorithms in localizing accessory pathway AP in patientswith Wolff Parkinson White Syndrome have been published. Although many ofthose methods have high accuracy, they are complicated and difficult to memorize.Most of the established algorithm use delta wave morphology and QRS polarity todetermine the location. With the technology of catheter ablation nowadays suchcomplex algorithms are not really needed. This study aim to investigate theaccuracy of a simple algorithm to predict the location of accessory pathways.

Methods : This was a cross sectional study conducted in the NationalCardiovascular Center Harapan Kita RSJPDHK Department Cardiology andVascular Medicine, FMUI. The electrocardiography ECG findings of 67 patientswith Wolff Parkinson White syndrome underwent ablations from January 2014until October 2016 were used in the current study. Those ECGs were analyzed usingthe new algorithm and were evaluated by two independent observers and comparedwith ablation results in a 2x2 table.

Results : The final number of samples was 47 ECGs. The algorithm showed it hada sensitivity of 45 on left free wall, 80 on septal, 92 on right free wall APs inaddition to the specificity of 96 on left free wall, 69 on septal, 85 on right freewall APs. Positive predictive value PPV were 90 on left free wall, 55 on septaland 67 on right free wall APs. Negative predictive value NPV were 70 on leftfree wall, 88 on septal and 97 on right free wall APs. Algorithm accuracy variedfrom 73 to 87. Inter observer agreement calculation was a kappa of 0.74 mdash 0.93.Likelihood ratio calculation identified the positive likelihood ratio of 11.23 on leftfree wall, 2.23 on septal and 6.57 on right free wall APs and negative likelihoodratio of 0.57 on left free wall, 0.28 on septal and 0.09 on right free wall APs.

Conclusion : This new and simple algorithm provide a remarkable accuracy with agood inter observer agreements. Therefore this algorithm is potential to beimplemented in general practice."

"High mortality in Indonesia, caused by acute coronary syndrome, has reached 26 %. In 10 years, National housing health survey or Survei Kesehatan Rumah Tangga Nasional ( SKRTN), under health departement of Republic of Indonesia, stated mortality which is caused by acute coronary syndrome has increased enourmously. It can be avoided by doing early acute coronary syndrome detection like ECG recording. Anyway, some those patients rarely do ECG recording because of expenses and time. By using Blutooth feature on PDA (Personal Digital Assistant) or a Bluetooth dongle on computer, a Telecardiology can be done anywhere and anytime so that coronary syndrome can be detected earlier by medics. Telecardiology research used a microcontroler, a computer and a PDA to record ECG signals. ECG recording is taken in real-time then stored in computer or PDA data base. To detec QRS waves in ECG signals, PanTompkins were used."

"Telah dibuat sistem pemantauan aktivitas jantung dan fisik manusia dengan menggunakan elektrokardiograf tiga lead dan sebuah sensor akselerometer 3-sumbu MMA7260Q yang diaplikasikan sebagai sistem perhitungan konsumsi energi dan pemantau kecepatan gerak. Dengan menggunakan sensor elektrode penulis merekam biopotensial yang dihasilkan oleh otot-otot jantung kemudian mengakuisisi data ini dengan menggunakan rangkaian elektrokardiograf dimana didalamnya terdapat penguat bertahap sebesar 4 kali, 101 kali, dan 5 kali. Untuk menghilangkan noise dirancang pula filter 0,5-100 Hz. Pada keluaran sinyal dari akselerometer dilakukan filter high-pass 0,5 Hz, sehingga elektrokardiograf mampu membaca aktivitas jantung kemudian data analog aktivitas jantung didigitasi menggunakan ADC mikrokontroler 128l, demikian juga data percepatan tubuh manusia mengalami proses digitasi menggunakan ADC mikrokontroler. Kedua data ini disimpan ke dalam sebuah kartu memori. Data aktivitas jantung dan percepatan tubuh manusia kemudian diolah secara digital menggunakan program LabVIEW8.5. Penganalisaan data elektrokardiograf dilakukan dengan tujuan mendapatkan pola perbandingan tetap antara luasan, amplitudo, dan periode sinyal P Q R S dan T. Sedangkan pengolahan data percepatan langkah tubuh digunakan untuk menghitung konsumsi energi dan kecepatan gerak tubuh manusia. Perubahan pola sinyal elektrokardiograf dibandingkan dengan perhitungan konsumsi energi dan kecepatan aktivitas tubuh manusia. Sehingga didapatkan sebuah hubungan antara sinyal P Q R S dan T dengan konsumsi energi dan kecepatan aktivitas tubuh manusia.

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Monitoring system of heart activity and human physical have made using electrocardiograph three leads and an accelerometer censor 3-axis MMA7260Q which is applied as calculation system of energy consumption and monitoring moving acceleration. Using electrode censor, the writer recorded biopotential which resulted from heart muscle and then process data using electrocardiograph series which have stronger in stage 4x, 101x, and 5x. To reduce the noise, filter 0,5-100 Hz was designed. In output signal from accelerometer, filter high-pass 0,5 Hz installed that electrocardiograph be able reading heart activity and then the data analog of heart activity digitized using ADC microcontroller 128l, and so did the data acceleration of human body. Both of these data saved in a memory card. The data of heart activity and human body acceleration processed digitally using LabVIEW8.5 program. Analyzing electrocardiograph data was done in goal to find a ratio for area, amplitude, and signal period of P Q R S and T. Processing data of body step acceleration used for counting energy consumption and moving velocity of human body. Alteration of electrocardiograph signal was compared with result of calculation from energy consumption and velocity of human activity. So, writer got a correlation in P Q R S and T signal with energy consumption and velocity of human activity."