bluuebunny/crossref_metadata_2025 huggingface dataset:
Late ventricular potential for risk prediction of sudden cardiac death risk: a valuable tool or an unnecessary step?
Authors: Jeong J , Choi J I , Kim Y G , Choi Y Y , Min K J , Roh S Y , Shim J M , Kim J S , Kim Y H
Published: October 2022

Background/Introduction

Signal-averaged electrocardiography (SA-ECG) is a high-resolution electrocardiography that can detect late ventricular potential, which known to be a noninvasive tool for risk stratification of sudden cardiac death (SCD) by predicting reentrant ventricular tachyarrhythmia. There is a paucity of data with SA-ECG on SCD survivors without structural heart disease, whereas majority of previous studies had been focused on post myocardial infarction survivors.

Purpose

This study assessed the clinical utility of SA-ECG as a risk stratification modality for lethal arrhythmic event in patients at risk of SCD without definite structural heart disease.

Methods

Total 629 patients who experienced or had potential risk of SCD were studied with SA-ECG. Among them, 48 patients who were found to have significant structural heart disease were excluded, except arrhythmogenic right ventricular cardiomyopathy. Major arrhythmic event (MAE) was defined as composite of all-cause death, aborted SCD, and sustained VT during any time either before visit of clinic or during follow up period. Syncope and non-sustained VT was defined as non-major arrhythmic event. SA-ECG was defined positive when fulfilling three or more criterion: (1) unfiltered QRS duration ≥114ms, (2) filtered QRS duration ≥114ms, (3) duration of terminal QRS <40uV exceeding 40ms, and (4) root mean square voltage in the terminal 40ms of ≤20ms.

Results

Among total 581 patients, 145 patients with positive SA-ECG showed higher incidence of MAE compared to patients with negative SA-ECG (21.4% vs. 6.7%, OR 3.816 [95% CI 2.208–6.597], p<0.001, Table). As the number of positive SA-ECG criteria increases, incidence of MAE tended to increase sequentially, which was markedly noted from 2 positive to 3 positive criteria (10.7% to 20.8%, p<0.001, Figure). In particular, patient with inherited arrhythmia showed higher rate of positive late potential compared to those with non-inherited arrhythmia (51.0% vs. 19.3%, p<0.001).

Conclusion

This study showed that at least 3 out of 4 diagnostic criteria in SA-ECG can independently predict lethal arrhythmic events and the positive late potential was associated with lethal arrhythmic event that leads to SCD, suggesting risk prediction for SCD using SA-ECG in patients even without structural heart disease including inherited arrhythmias.

Funding Acknowledgement

Type of funding sources: None.
Premature atrial contraction on Holter electrocardiogram predicts the recurrence of atrial fibrillation after catheter ablation
Authors: Sunaga A , Tanaka N , Masuda M , Watanabe T , Kida H , Oeun B , Sato T , Sotomi Y , Dohi T , Okada K , Mizuno H , Nakatani D , Hikoso S , Inoue K , Sakata Y
Published: October 2022

Introduction

It is important to detect the recurrence of atrial fibrillation (AF) after catheter ablation (CA) early, but the method of detection has not been established. The purpose of this study is to determine whether 24-h Holter electrocardiogram (ECG) can predict the recurrence of AF after CA.

Methods

We studied 336 patients of 497 patients enrolled in EARNEST-PVI trial to investigate whether the total number of premature atrial contraction (PAC) and the maximum number of PAC run by 24-h Holter ECG at 6 months after CA predicted AF recurrence after 6 months. We excluded 86 patients with recurrence by 6 months after CA and 75 patients without Holter ECG at 6 months after CA.

Results

Median age was 66 years, male were 77% and median follow-up period was 1138 days. Receiver operating characteristic curve analysis identified the total number of PAC ≥270 beats and the maximum number of PAC run ≥8 beats as the optimal cutoff for prediction of AF recurrence. Kaplan-Meier analysis showed patients with the total number of PAC ≥270 beats had more frequent AF recurrence than those without (Kaplan-Meier estimated 3-year AF recurrence rate 34% vs. 17%, Log-rank P=0.001) and patients with the maximum number of PAC run ≥8 beats had more frequent AF recurrence than those without (Kaplan-Meier estimated 3-year AF recurrence rate 33% vs. 20%, Log-rank P=0.006). Multivariate analysis revealed that the total number of PAC ≥270 beats and the maximum number of PAC run were significantly associated with AF recurrence (hazard ratio [95% confidence interval] 1.83 [1.16–2.91], P=0.01 and 1.01 [1.01–1.02], P=0.001, respectively)

Conclusion

The total number of PAC and the maximum number of PAC run on the Holter ECG may be useful in predicting AF recurrence after CA.

Funding Acknowledgement

Type of funding sources: None.
Evaluation of cardiovascular autonomic dysfunction in symptomatic post COVID-19 patients
Authors: Noureldin A M , Bassem M , Abdelsalam Z
Published: October 2022

Background

The COVID-19 disease is known for its severe respiratory complications, however it was found to have some cardiovascular complication in post COVID-19 patients. The heart rate variability (HRV) is a non invasive, objective and reliable method for assessment of autonomic dysfunction in those recovered patients.

Purpose

We aimed to evaluate the cardiac autonomic function by using valid HRV indices in subjects who recovered from mild to moderate acute COVID-19 but still symptomatic.

Methods

The study Group composed of 50 subjects with confirmed history of mild to moderate post COVID 19. All subjects underwent routine 2D echocardiography assessment in addition to 2D speckle tracking and 24 hours Holter monitoring for HRV analysis.

Results

The mean age of the study population was 42±18 years, symptoms were reported as follows 27 (54%) had Dyspnea, 17 (34%) had palpitations, 7 (14%) had dizziness. Time domain parameters SDNN, SDANN and rMSSD were diminished with mean SDNN value being markedly impaired in 12 (24%) patient, while frequency domain parameters as assessed by LF/HF ratio with mean of 1.837 with 8% of patients being impaired. SDNN was significantly reduced in elderly patients (p=0.001), smokers (p=0.019) and hypertensive (p=0.016) and those complaining mainly of palpitation (p=0.006). SDNN was significantly reduced in patient with impaired LV diastolic function (p=0.009), in patients with reduced MAPSE (p=0.047), reduced TAPSE (p=0.00) and impaired Global longitudinal strain (0.000).

Conclusion

Patients with post COVID-19 syndrome have abnormalities in the HRV which indicates some degree of dysfunction in the autonomic nervous system and consequently impaired parasympathetic function in this population, however this have been also correlating with subtle impairment of the left ventricular systolic function. We believe that this preliminary research can serve a starting point for future research in this direction.

Funding Acknowledgement

Type of funding sources: None.
Atrial fibrillation diagnosis by a systematic 14-day continuous ECG-Holter in patients with high cardiovascular risk and clinical palpitation: the prospective AFTER study
Authors: Halimi F , Sabouret P , Huberman J P , Cohen S , Ouazana L , Hoffman O , Assouline S , Guedj-Meynier D , Schwartz J , Weiss P , Lafont C , Lellouche N
Published: October 2022

Background

Atrial Fibrillation (AF) is asymptomatic in 20–30% of cases. New technologic tools for continuous ECG monitoring have been developed to detect and potentially treat AF in specific population with high cardiovascular risk.

Purpose

We aimed to evaluate the prevalence and the management of AF diagnosed in patients with no previous documented AF but with a high cardiovascular risk and clinical palpitation undergoing systematic 14-day continuous ECG-Holter monitoring and associated characteristics.

Methods

Patients were prospectively enrolled from December 2019 to December 2021 in this multicentered study, sponsored by the French National College of Cardiology. Patients needed to meet the following criteria: CHA2DS2VASc score ≥3 in women >2 in men associated with clinical palpitation without previous documented arrhythmia, particularly AF. Exclusion criteria were: previous documented AF, participation to another study that could interfere with the current study, pregnancy, previous skin intolerance to ECG-Holter electrodes. Included patients underwent a 14-day monitoring Holter-ECG to detect cardiac arrhythmia, particularly AF. Patients' characteristics, type of arrythmias and management of detected AF were described.

Results

Among the 336 included patients, 39% were men, median age was 73 [64.5–78] years, 71.5% had hypertension and 46.5% had a previous history of stroke. AF was detected in 14% of patients, among which 23.4% in the first 24 hours monitoring. In univariate analyses, older age (p=0.045) was significantly associated with AF, and a trend was observed regarding male gender (p=0.067) and less antiplatelet therapy (p=0.058). Patients with diagnosed AF had a prescription of anticoagulation therapy in 90% of cases consisting in apixaban and rivaroxaban for 72% and 28% respectively. Antiarrhythmic drugs were administered in 90% of AF patients and 13% underwent AF ablation.

Conclusions

The systematic AF screening of selected patients based on CHA2DS2VASc score ≥3 in women >2 in men associated with palpitations allows to diagnose AF in 14% of the population with a 14-day continuous ECG-Holter. This strategy seems efficient as it induced the prescription of anticoagulation and antiarrhythmic therapy in 90% of individuals.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): NATIONAL COLLEGE OF FRENCH CARDIOLOGISTS
A prediction model for ventricular tachycardia events using 24h ambulatory ECG
Authors: Economou Lundeberg J , Engstrom G , Dziubinski M , Sridar A , Healey J S , Bhavnani S , Persson A , Johnson L
Published: October 2022

Background

Ventricular tachycardia (VT) is a potentially lethal condition that occurs intermittently. The aim of this study was to derive a risk prediction model for VT episodes detected on ≤30 day mobile cardiac telemetry using a 24 hour ambulatory ECG recording.

Methods

We included patients who were monitored for 2–30 full days in the USA using a full-disclosure mobile cardiac telemetry device in 2017. Patients with a VT episode ≥10 beats duration (VT≥10 beats) on the first full recording day were excluded. Arrhythmias were algorithmically detected and manually verified. A LASSO model was derived for the outcome of a VT≥10 beats detected on days 2–30. Potential predictors included age, sex, and ECG data from the first 24h: heart rate (max, min and mean), premature atrial and ventricular complexes occurring as singles, couplets, triplets, and runs ≥4 beats as well as the fastest rate for each event. The population was split into equal random training and testing samples.

Results

In a population of 19,789 patients (mean age 65.3, 43.4% men), and during a median recording time of 18 days there were 1,511 patients with at least one VT≥10 beats. The LASSO model had good discrimination in the testing sample, ROC-statistic 0.7586, 95% CI 0.7398–0.7774 (Figure 1a). A model excluding age and gender had similar discrimination (ROC 0.7528, 95% CI 0.7339–0.7717). In the testing sample the model was well calibrated (Figure 1b). In the top quintile more than one in five patients had a VT≥10 beats, enough to warrant extended monitoring.

Conclusion

A risk score based on variables easily derived from a standard 24h ECG can be used to predict high risk of VT episodes ≥10 beats within 30 days. In the top quintile VT events ≥10 beats were ten times more common than in the bottom quintile.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Hjärt-LungfondenSwedish Society for Medical Research
The state of systolic and diastolic functions of the left ventricle and heart rate variability in patients with atrial fibrillation after infection of COVID-19
Authors: Sychov O S , Nesukay O G , Stasyshena O V , Getman T V , Sribna O V , Romanova O M , Ilchyshyna O Y A , Deyak S I
Published: October 2022

Introduction

It is known that atrial fibrillation (AF) is one of the most common arrhythmias in patients (pts) who have had a COVID-19 infection (CI).

The aim of our study was to evaluate systolic and diastolic functions of the left ventricle (LV) and heart rate variability (HRV) in pts with AF depending on the past CI.

Research material and methods 131 pts with paroxysmal or persistent forms of AF in sinus rhythm were studied. 93 people had a history of an average of 6.2±0.5 months ago of COVID-19 infection. They made up the 1st group of examined pts. The remaining 38 patients did not have a history of this infection. They constituted the 2nd group of the study group, which was the control group. Transthoracic echocardiography and Holter monitoring ECG were performed according to the standard technique.

Results of the study

We did not find any difference in hemodynamic parameters characterizing the systolic function of LV. So, the values of the end-diastolic volume (117.0±7.6 mm and 116.0±7.2 mm), end-systolic volume (55.7±4.9 mm and 55.2±4.7 mm) and ejection fractions (55.0±2.1% and 54.4±2.0%) in the groups did not differ significantly. However, statistical significance was obtained in indicators characterizing LV diastolic function. So, significantly different flow rates in the 1st and 2nd groups of pts – E (60.8±1.63 sm/s and 94.6±2.97 sm/s, p<0.001), A (61.8±0.83 sm/s and 73.1±1.03 sm/s, p<0.001), their E/A ratios (0.98±0.02 and 1.39 + 0.03, p<0.001) and DE score (175.9±2.20 ms and 202.5±4.03 ms, p<0.001). A more significant violation of LV diastolic function after CI led to an increase in the diameter of the left atrium (LA) (4.99±0.14 cm in the 1st group compared with 4.40±0.004 sm in the 2nd group, p<0.001) and LA index (46.4±0.011 sm in the 1st group compared with 42.93±0.08 in the 2nd group, p<0.001). We also found a significant difference in such indicators of HRV between groups “1” and “2” as – SDANN (102.7±2.33 and 151.7±1.23 ms, p<0.001), SDNN (124, 3±4.06 and 181.3±4.83 ms, p<0.001), and RMSSD (100.4±4.57 and 173.2±13.51 ms, p<0.001).

Conclusion

In pts with AF, after undergoing CI, the LV diastolic function begins to suffer first, which leads to an increase in the size of the LA. Pts after CI also had a change in the autonomic regulation of the heart rhythm, and as a result, an increase in the electrical instability of the atria.

Funding Acknowledgement

Type of funding sources: None.
Agreement between ultrashort-term and long-term heart rate variability based on 24-hour Holter monitoring
Authors: Bantolo A P , Purino F M A
Published: October 2022

Introduction

Heart rate variability (HRV) measured for 24 hours (long-term HRV) serves as the clinical gold standard in the risk stratification of patients with comorbidities such as myocardial infarction, stroke, multiple sclerosis, end stage renal disease, and diabetic neuropathy.

Previous studies explored the utility of ultra-short (US) HRV, measured for less than five minutes which could be used for bedside prognostication, for future research, or as a cheaper diagnostic alternative.

Purpose

This study determined the agreement between US-HRV and long-term HRV based on 24-hour holter monitoring results at a tertiary Filipino hospital. It also found the agreement in the US-HRV and long-term HRV by time of day and condition, age, sex, comorbidities, and by ability to detect abnormal HRV.

Methods

Tracings of 24-hour holter monitoring from January 2017 and December 2019 were reviewed. Excluded from the study were those who had arrhythmias or were taking medications affecting the autonomic nervous system.

Samples of three-minute excerpts were obtained at 7am (daytime, awake), 12nn (daytime, awake, with activity), 7pm (evening, awake), and 12mn (evening, asleep). RR intervals were measured and HRV through SDNN and RMSSD were determined.

Interclass correlation coefficient and kappa statistic were used to analyze the agreement between values of US and long-term HRV. Bland-Altman plots were constructed, and the limits of agreement (LOA) were reported. Kappa statistic was used to determine the agreement between the two methods in detecting abnormal HRV.

Results

A total of 92 results were reviewed for this study, with most patients having hypertension. Results showed that US-HRV by SDNN underestimates HRV by 47.35 to 60.58 ms (mean difference). The average discrepancy was found to be highest during daytime, awake with activity.

Meanwhile, US-HRV by RMSSD was found to overestimate HRV by −29.86 to −85.24 ms (mean difference). The average discrepancy was found to be highest during evening, awake.

There is poor agreement between SDNN and RMSSD measured using long-term HRV and US-HRV in all four samples, even with age, gender, and comorbidities factored in. Likewise, there is poor agreement between US-HRV and long-term HRV values in detecting abnormal HRV. At best, evening US-HRV RMSSD values have moderate agreement in detecting abnormal US-HRV.

However, the study was done in a less controlled environment. Also, long-term time-domain variables (RMSSD and SDNN) are known to reflect circadian rhythms and the overall change in the autonomic nervous system, hence three-minute measurements might poorly reflect changes occurring in the autonomic nervous systems.

Conclusion

There is poor agreement between three-minute US-HRV and long-term HRV obtained through 24-hour holter monitoring. Studies done in a more controlled environment are recommended.

Funding Acknowledgement

Type of funding sources: None.
Race disparities in atrial fibrillation detection using implantable loop recorder for cryptogenic stroke
Authors: Aslam F , Al-Sadawi M , Gore A , Ijaz H , Dhar K , Dhaliwal A , Singh A
Published: October 2022

Background

Cryptogenic stroke represents about 25–30% of all ischemic strokes. Continuous electrocardiographic monitoring using implantable loop recorder (ILR) can detect asymptomatic and undiagnosed atrial fibrillation (AF).

Purpose

To assess patient-specific factors in ILR implantation and AF detection in patients with cryptogenic strokes.

Methods

We retrospectively reviewed 379 patients with cryptogenic stroke indicated for ILR implantation, from January 2017 to June 2021 at our university hospital. We evaluated patient demographic and clinical characteristics to assess the risk factors associated with higher incidence of AF detection, using logistic regression models.

Results

Of the 379 ILRs implanted, 60.4% were males with 71.2% Caucasian, mean age 67.6 years, and mean BMI 28.5. The mean CHADSVASC score of 3.9 at the time of ischemic stroke. These patients had prior diagnosis of diabetes mellitus (27.4%), hypertension (65.7%), chronic kidney disease (19.5%), coronary artery disease (20%) and congestive heart failure (2%). Of the entire cohort, AF was diagnosed in 16% of patients with 14 months mean follow up. There were more females diagnosed with AF on ILR (20% v. 18.7%, p>0.05). Caucasians were more likely to have AF detected compared to non-Caucasians (OR 2.3, 95% CI, p<0.02). There were 52 patients with mobile cardiac outpatient telemetry (MCOT) before having ILR implantation. AF was not detected on MCOT, but 15% were diagnosed with AF with ILR monitoring. In univariate analysis, increasing age is strongly associated with the detection of AF (p=0.03).

Conclusions

There continues to exist race disparities in ILR implantation and eventual AF detection, leading to further socioeconomic health disparities. ILR should be considered especially in elderly with cryptogenic stroke given the higher incidence of AF detection.

Funding Acknowledgement

Type of funding sources: None.
Accurate respiratory rate determination using a novel insertable cardiac monitor algorithm: implications for diagnostic and monitoring potentials beyond heart rhythm disorders
Authors: Kennedy L P , Reddy R K , Health K M , Pitman B P , Hnin K , De Voir C , Whittington H , Lau D
Published: October 2022

Background

Respiratory rate (RR) is a critical vital sign that is highly relevant in patients with cardiopulmonary disorders. The implantable cardiac monitor (ICM) provides useful data pertaining to heart rhythm, but little is known up to this point regarding its potential diagnostic value in the direct measurement of respiratory parameters. The addition of respiration information could improve understanding of overall health status of heart rhythm patients with ICM.

Objective

The primary objective of this study was to evaluate the accuracy of the RR detected by an existing implanted ICM as compared to gold-standard polysomnography (PSG) measurement of respiration.

Methods

This prospective single center study enrolled 25 patients (17 male, 62.7±12.2 yesrs) with an implanted ICM and suspected sleep-disordered breathing. The ICM was custom configured with research software to collect respiration data (Fig. 1). Simultaneous, time-synchronized PSG and ICM data were evaluated in two-minute epochs episodically during the night. The offline novel prototype RR algorithm was evaluated on episodes collected by the ICM and compared against expert manual adjudicated RR from PSG by two separate investigators. The interobserver agreement was assessed using intraclass correlation coefficient (ICC). The performance of the novel algorithm was assessed using Bland-Altman analysis with 95% limits of agreement (LOA).

Results

A total of 495 epochs were graded by two independent observers, with good ICC of 0.83 (95% C.I. 0.79–0.86). Epochs free of severe sleep disordered breathing/apnea (n=363) were included in this analysis with 106 of these containing periods of hypopnea. The development and validation datasets were comprised of 235 and 128 epochs, respectively. In the development data, the mean RR was 14.99±3 breaths per minute, and the mean RR was 13.44±2 breaths per minute in the test data. Using Bland-Altman analysis, the bias for the novel prototype algorithm was only −0.13 and +0.32 breaths per minute with 95% LOA of −2.24 to +1.98 and −2.56 to +3.19 breaths per minute (Fig. 2), in the in the development and test dataset respectively.

Conclusion

The novel prototype algorithm applied to the ICM data provided accurate determination of respiratory rate as compared to gold-standard PSG data. The capability to determine respiratory rate accurately from an existing ICM platform demonstrates the potential to extend the diagnostic power of ICMs beyond heart rhythm abnormalities to address a broad range of comorbidities including breathing disorders and heart failure.

Funding Acknowledgement

Type of funding sources: None.
Comparison of adhesive single-lead ECG device and Holter test for atrial fibrillation monitoring
Authors: Kwon S , Lee S R , Choi E K , Ahn H J , Song H S , Lee Y S
Published: October 2022

Background

There is insufficient validation of diagnostic benefits of extended monitoring with an adhesive single-lead ECG device compared to Holter test for routine medical care of AF patients.

Purpose

The study aimed to compare AF detection rates between 72-hour monitoring using an adhesive single-lead ECG device (mobiCARE MC-100, Seers Technology, Republic of Korea) and 24-hour Holter test among AF patients at outpatient clinics.

Methods

A total of 200 AF patients indicated for Holter test at cardiology outpatient clinics enrolled in the study. Study participants equipped both Holter and MC-100 for the first 24 hours (Figure 1). After then, only MC-100 continued ECG monitoring for additional 48 hours. AF detection during the first 24 hours was compared between two devices. The diagnostic benefits of extended monitoring with MC-100 were evaluated.

Results

During the first 24 hours, both monitoring methods detected AF in the same 40/200 (20.0%) patients (20 patients with paroxysmal and persistent AF each). Compared to 24-hour Holter, MC-100 increased AF detection rate by 1.5-fold (58/200; 29.0%) and 1.6-fold (64/200; 32.0%) with 48- and 72-hour monitoring, respectively (Figure 2A). With MC-100, the number of newly discovered patients with paroxysmal AF was 20/44 (45.5%), 18/44 (40.9%), and 6/44 (13.6%) for 24-, 48-, and 72-hour monitoring. Compared to 24-hour Holter, 72-hour monitoring with MC-100 increased the detection rate of paroxysmal AF by 2.2-fold (44/20). If only the episodes lasting over 30 seconds were counted as AF with MC-100, the detection rate of paroxysmal AF was decreased by 9.1% (Figure 2B).

Conclusion

Compared to Holter, AF detection rates could be improved with an adhesive single-lead device, especially for patients with paroxysmal AF. This device is expected to be useful for AF detection among patients whose conventional ECG tests were ineffective in documenting AF episodes.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Korea Medical Device Development Fund grant funded by the Korean government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, Republic of Korea, the Ministry of Food and Drug Safety)
Patients parameters and results of the tilt table test depending on referrals
Authors: Kirnosova K , Keller H , Stoellberger C
Published: October 2022

Introduction

The tilt table examination (TTT) is used to investigate patients with syncope for 50 years, and was downgraded by the 2018 Guidelines of the European Society of Cardiology for syncope-evaluation from class I to II a/b.

Aim

Aim of the study was to assess changes in the referrals for TTT from 2014 to 2018. In addition, it was examined if there were differences in the history, clinical findings, and results of the TTT among patients depending on the referral for TTT.

Patients and methods

Included in the retrospective cohort study were 205 patients, 49% females, mean age 52 (15–82) years, in whom TTT was carried out between 2014 and 2018 in a cardiology department. Information from the discharge letters and electronic hospital information system was collected.

Results

Referrals for TTT were suspected orthostatic hypotension (OH) (n=53), suspected reflex syncope (n=98), and unexplained syncope (n=54). By TTT the diagnosis of OH was established in 32%, reflex syncope in 27%, and postural orthostatic tachycardia syndrome in 16%. There was an increase of positive TTT findings from 2016 to 2018 (54 to 79%, p=0.039). The referrals for unexplained syncope decreased from 2014 to 2018 (33 vs. 14%, p=0.039). Compared to patients with suspected reflex syncope, patients with unexplained syncope suffered more from coronary artery disease (CHD) (19 vs. 5%, p=0.011) and arrhythmias (24 vs. 10%, p=0.032), were more often taking beta-blockers (26 vs. 7%, p=0.002) and more often had ST-segment abnormalities (11 vs. 1%, p=0.008). Compared to patients with suspected OH, patients with unexplained syncope suffered more from palpitations (11 vs. 8%, p=0.0024). Compared to patients with suspected reflex syncope, patients with suspected OH had more comorbidities such as CHD (17 vs. 5%, p=0.036), hypertension (45 vs. 18%, p=0.01), diabetes mellitus (25 vs. 3%, p=0.0) and synucleinopathies (6 vs. 0%, p=0.042) and took more antidiabetic (23 vs. 4%, p=0.001), antithrombotic (42 vs. 12%, p=0.0), diuretic (15 vs. 2%, p=0.004), beta blocking (23 vs. 7%, p=0.009), anticonvulsant (6 vs. 0%, p=0.042), antiparkinsonian (6 vs. 0%, p=0.042), antidepressant agents (26 vs. 11%, p=0.022) and statins (26 vs. 8%, p=0.004). Compared to patients with suspected OH, patients with suspected reflex syncope suffered more from prodromes like flushing (17 vs. 2%, p=0.001) and nausea (33 vs. 8%, p=0.004).

Conclusions

If patients are referred for appropriate reasons, the TTT has a high diagnostic value. The results confirm other studies indicating that unexplained syncope may suggest a cardiac origin.

Funding Acknowledgement

Type of funding sources: None.
Echocardiographic pattern of left ventricular function recovery in tachycardia-induced cardiomyopathy patients
Authors: Serban T , Du Fay De Lavallaz J , Mannhart D , Knecht S , Kuehne M , Sticherling C , Badertshcer P
Published: October 2022

Background

Tachycardia-induced Cardiomyopathy (TIC) represents a reversible type of cardiomyopathy (CM) that is underdiagnosed. Prior pilot studies suggested a specific left ventricular (LV) function recovery pattern in TIC patients. Cardiac chamber remodeling in TIC, however, remains incompletely understood.

Purpose

We aimed to explore differences in LV dimensions and functional recovery in TIC patients when compared to a control group of patients with other forms of CM and functional recovery.

Methods

We identified patients with reduced left ventricular ejection fraction (≤50%) and/or atrial fibrillation or flutter treated between 2015 and 2022. Patients had at least two serial transthoracic echocardiographies (TTE). The minimal interval between the TTEs had to be at least 3 months, and the left ventricular ejection fraction (LVEF) had to either improve (≥15% in absolute value) or normalize (LVEF at follow-up ≥50%). Patients were then divided into two groups: A) patients with atrial fibrillation or atrial flutter at baseline and sinus rhythm at follow-up. These patients were assumed to have TIC. B) Patients with sinus rhythm at both baseline and follow-up, consisting of patients with other forms of CM. The change in ventricular dimensions and function (indexed left ventricular end-systolic – LVESDI, end-diastolic diameters – LVEDDI – and volumes – LVEDVI, LVEF, and fractional shortening – FS) were compared within and across group A and B at baseline and at follow-up. The groups were compared using Kruskal (for independent data) and Wilcoxon (for paired data) tests. A p<0.05 was considered significant.

Results

A total of 261 patients were included (34% female, median age 68 years). The median time between TTEs was 25 months. 104 (39.8%) patients were considered to suffer from TIC and 157 (60.2%) patients were considered to suffer from other forms of CM. The changes in ventricular dimensions and function in both groups are shown in Figure 1 and Table 1. The TIC group showed no improvement in LVEDVI from baseline to the follow-up examination, while the control group showed significant improvement in LVEDVI (1.7% [−24.7, 22.8] vs. 12.4% [−7.1, 29.3], p=0.008). There was no difference in LVEDDI recovery between TIC and control patients (1.7% [−7.3, 10.3] versus 3.1% [−5.4, 10.2], p=0.578).

Conclusions

TIC patients have a specific pattern of functional recovery with similar improvements in systolic function and diameters compared with patients with other CMs, while diastolic parameters remained impaired.

Funding Acknowledgement

Type of funding sources: None.
Left atrial overload detection in ECG using frequency domain features with convolutional neural network
Authors: Kucukseymen S , Uslu S , Ozdemir S
Published: October 2022

Background/Introduction

Volume and pressure alterations in the left atrium (LA) are utilized as important biomarkers due to their association with numerous cardiac pathologies. Because of the anatomical peculiarities of the LA, echocardiographic evaluation is quite challenging. There are many conducted studies to determine LA hemodynamic biomarkers using ECG signals, however, the low specificity has been seen as a common problem.

Purpose

Within the scope of this study, we aimed to develop a fully automatic artificial intelligence algorithm. Therefore, the frequency domain properties of the ECG signal were examined by wavelet transform and deep learning algorithm to detect the left atrial overload (LAO) from the ECG signal. We also compared the effectiveness of lead selection (Lead II and V1 Lead) to detect LAO.

Methods

Physionet-PTB-XL database was used for ECG inputs. 10 s ECG waveform of 403 healthy people and 352 LAO patients used for feature extraction after carefully filtering. Each signal was segmented to a 1.5 s epoch and in total 4530 ECG was used for training (70%) and test (30%) of deep learning algorithms. Two different deep learning models were developed for the automatic detection of LAO. In the first approach (1D convolutional neural network, 1D-CNN) segmented raw ECG was used, and in the second approach (2D convolutional neural network, 2D-CNN) each segmented ECG was transformed to scalograms with continuous wavelets transform. All models were tested for both leads.

Results

Our results show that frequency-domain features are highly capable to detect LAO compared to time-domain features and either Lead II and V1 Lead can be used for the detection of LAO. The success rate of 1D-CNN is 72% for Lead-II and 75% for V1 Lead while the success rate of 2D-CNN is 92% for both leads.

Conclusions

The most important limitation in the diagnosis of LAO by ECG is the low specificity. In this study, a model that eliminates this limitation has been developed by using the frequency characteristics of the ECG and artificial intelligence algorithms and tested with a large population. Considering its high success rate, 2D-CNN model has the potential to help the clinician by detecting the pathology with a cheaper, operator-independent method, and a short-term measurement.

Funding Acknowledgement

Type of funding sources: None.
Evaluation of a multisensory algorithm to prevent acute decompensation of heart failure in patients implanted with a cardioverter defibrillator: rationale and design
Authors: Garcia R , Mansourati J , Gras D , Probst V , Khattar P , Himbert C , Saulnier P J , Constantin-Jacquot V , Gueffet J P , Minois D , Pierre B , Defaye P , Marijon E , Boveda S , Degand B
Published: October 2022

Background

Heart failure (HF) is a chronic disease affecting 64 million people worldwide and places a severe burden on society because of its mortality, numerous re-hospitalizations and associated costs [1–4]. HeartLogic is an algorithm incorporating several biometric parameters which aims to predict HF episodes. It provides an index which can be monitored remotely, allowing preemptive treatment of congestion to prevent acute decompensation [5–7].

Objectives

We aim to provide real-world data on the impact of pre-emptive HF management, guided by the HeartLogic index on unscheduled HF hospitalizations in a substantial cohort of patients.

Methods

The HeartLogic French Study is an investigator-initiated, prospective, multi-centre, non-randomized study. All in all, 310 patients with a history of HF (left ventricular ejection fraction ≤40%; or at least one episode of clinical HF with elevated NT-proBNP ≥450 ng/L) and implanted with a cardioverter defibrillator enabling HeartLogic index calculation will be included across 10 French centers. The HeartLogic index will be monitored remotely on a weekly basis for 12 months and in case of HeartLogic index ≥16, the local investigator will contact the patient for assessment and adjust HF treatment as necessary. The primary endpoint is unscheduled hospitalization for HF. Secondary endpoints are all-cause mortality, cardiovascular death, HF-related death, and unscheduled hospitalizations for ventricular or atrial arrhythmia. Blood samples will be collected for biobanking, and quality of life will be assessed. A blind and independent committee will adjudicate the events.

Conclusions

The HeartLogic French Cohort Study will provide robust real-world data on HF hospitalization in a cohort of patients managed with the HeartLogic algorithm allowing preemptive treatment of congestion.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Boston Scientific
Incidence of thyroid dysfunction following initiation of amiodarone treatment in patients with and without heart failure: a nationwide cohort study
Authors: Ali S A A , Ersboll M E , Vinding N J V , Butt J H B , Rorth R R , Selmer C S , Westergaard L M W , Mogensen U M M , Weeke P E W , Jons C J , Gustafsson F G , Fosbol E F , Kober L K , Kristensen S L K
Published: October 2022

Background

Although thyroid dysfunction is a well-known complication of amiodarone treatment, population-based estimates of the short- and long-term incidence of this complication are lacking. In addition, it is not clear whether heart failure (HF) exacerbates this risk.

Purpose

To examine the short- and long-term incidence of thyroid dysfunction following initiation of amiodarone treatment in patients with and without HF.

Methods

All Danish residents who initiated amiodarone treatment between 2000–2018 without a history of thyroid dysfunction was identified using nationwide registries. Thyroid dysfunction, defined as a composite of levothyroxine, anti-thyroid medication, or a diagnosis of hypothyroidism, hyperthyroidism, or thyroiditis, was assessed at 1-year follow-up. In a landmark analysis, we estimated the 5-year outcomes with patients grouped according to the cumulated dose (CD) of amiodarone within the first year (regardless of whether treatment duration was shorter than 1 year). The Aalen-Johansen estimator and a cause-specific Cox regression model were applied to compare risk across groups.

Results

In total, 43,724 patients were identified of whom 16,939 (38%) had a history of HF. Compared to patients without HF, those with HF were at a similar age (71 vs 70 years), more likely men (74% vs 65%), and more often had a history of ventricular tachycardia (19% vs 6%), ischemic heart disease (60% vs 43%), aborted cardiac arrest (8.0% vs. 3.0%), ICD or CRT (30% vs 19%), all p-value <0.01 and less atrial fibrillation (72% vs 73%, p-value 0.02). At 1-year follow-up, the cumulative incidence of thyroid dysfunction was 5.3% in patients with a history of HF vs. 4.2% in patients without HF, adjusted hazard ratio (HR) 1.55 (95% CI, 1.47–1.62), Figure 1. In the landmark analysis, the 5-year cumulative incidences and adjusted HRs of thyroid dysfunction were 5.3% (HR 0.66 [95% CI 0.62–0.70]) in patients with 1-year CD of amiodarone <27.38 g (average daily dose [ADD] <75 mg), 14.0% (reference) for patients with CD 27.38–45.63 g (ADD 75–125 mg), 20.0% (HR 1.28 [95% CI 1.21–1.36]) for patients with CD 45.64–63.88 g (ADD 126–175 mg), and 24.5% (HR 1.39 [95% CI 1.31–1.47]), for patients with CD>63.88 g (ADD >175 mg), (Figure 2).

Conclusions

In patients who initiated amiodarone treatment, around 5% had evidence of thyroid dysfunction at 1-year follow-up with a slightly higher incidence in those with a history of HF. A dose-response relationship was observed between the 1-year amiodarone cumulative dose and the subsequent 5-year cumulative incidence of thyroid dysfunction.

Funding Acknowledgement

Type of funding sources: None.
Alleviation of AF related symptoms following acute conversion of recent-onset, symptomatic atrial fibrillation to sinus rhythm with flecainide acetate oral inhalation solution
Authors: Camm A J , Crijns H J G M , Elvan A , Tuininga Y , Badings E , Kuijper A F M , De Jong J S S G , Lee M , Schellings D , Van Gelder I C , Ruskin J , Kowey P , Dufton C , Maupas J , Belardinelli L
Published: October 2022

Introduction

Pharmacological restoration of sinus rhythm (SR) in patients with symptomatic atrial fibrillation (AF) is expected to be accompanied by prompt alleviation of symptoms to avoid the need for electrical cardioversion (ECV) and/or hospitalization. The feasibility and safety of acute cardioversion of recent-onset (≤48 hours) symptomatic AF to SR with flecainide acetate oral inhalation (FlecIH) solution was shown in the Phase 2, open-label INSTANT trial. We examined symptoms, heart rate, time to discharge and need for ECV reported among patients in the INSTANT trial whose AF was successfully converted to SR (“conversion group”; N=25) versus those whose AF did not convert to SR (“no conversion group”; N=29).

Methods

Conversion success was determined using 12-lead Holter monitoring during a 90-minute observation period. Patients in the no conversion group were offered alternative treatment per the investigator discretion. Symptoms, vital signs, time to discharge, and the need for ECV were evaluated through Day 5.

Results

Data from 54 patients (33.3% female) with a mean age of 62.1 years and a mean BMI of 26.8 kg/m2 were analyzed. All patients reported at least one AF-related symptoms at baseline (palpitations=85%; dizziness=35%; shortness of breath=37%; chest discomfort=39%) and 83.3% presented with AF symptoms ≤24 hours in duration. At 90 minutes, 80.0% of the conversion group were asymptomatic compared to 37.9% of the no conversion group (p<0.001). Mean (SD) ventricular rate at 90 minutes was 70.6 (12.5) bpm in the conversion group compared to 100.4 (29.4) bpm in the no conversion group (p<0.001). Median time to discharge was 2.3 (IQR: 0.75) hours for the conversion group compared to 3.6 (IQR: 1.02) hours for the no conversion group (p=0.001). By Day 5, 23 (79.3%) patients in the no conversion group had undergone ECV; no patients in the conversion group experienced AF recurrence by Day 5 (0% required ECV; p<0.001).

Conclusions

Conversion of recent onset AF to SR with inhaled flecainide was associated with a reduction in symptoms, normalization of heart rate, rapid hospital discharge and avoidance of ECV during a 5-day follow-up period.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): InCarda Therapeutics
Absence of atrial fibrillation in the blanking period following cryoballoon pulmonary vein isolation – does it always portend a good prognosis?
Authors: Milstein N , Saberito M , Bhatt A , Habibi M , Sichrovsky T , Preminger M , Shaw R , Mittal S , Musat D
Published: October 2022

Background

Cryoballoon (CB) pulmonary vein isolation (PVI) is an accepted method for ablation in patients with paroxysmal and persistent atrial fibrillation (PAF, PeAF). Freedom from AF in the blanking period (BP), conventionally defined as the first 3-months post-PVI, has been associated with the best long-term outcomes. However, the influence of antiarrhythmic drugs (AADs) during the BP on long-term outcomes is not well understood.

Objective

To compare long-term outcomes between patients who were and were not on an AAD prior to ablation and remained free from AF during the 3-month BP post CB PVI.

Methods

We enrolled consecutive AF patients undergoing CB PVI; all pts had an implantable loop recorder (ILR). No patient had any AF in the first 90 days post CB PVI. We divided the patients into three groups: (1) never had exposure to an AAD; (2) were intolerant to/failed AAD and thus were not taking an AAD at time of ablation; and (3) were on AAD at time of ablation. In the latter group, every effort was made to stop the AAD before the end of the BP.

Results

The cohort included 96 pts (66±10 years; 60 [63%] male; 55 [57%] PAF; CHA2DS2-VASc 2.5±1.4). There were 23 (24%) patients in group 1, 13 (14%) patients in group 2, and 60 (63%) pts in group 3. Patients in group 3 were more likely to have PeAF; AADs were stopped at a median of 36 days IQR (27, 91) in this group. Patients were followed for 1-year during which time 28 (29%) patients had recurrent AF (despite having no AF during the BP). The best outcome was seen in patients who never used an AAD; the worst outcome was seen in patients who were on an AAD at time of ablation (Figure 1).

Conclusion

Our data show that absence of AF during a 3-month post CB PVI BP alone does not guarantee good-long term outcome, unless the patient was never treated with an AAD. In contrast, in patients ablated while taking an AAD, recurrent AF was observed in 37% even though they were completely AF-free during the BP.

Funding Acknowledgement

Type of funding sources: None.
Chronic amiodarone therapy and mortality among atrial fibrillation patients; insights from a real-life contemporary population
Authors: Tsaban G , Gordon M , Omari Y , Kezerle L , Alnsasra H , Buturlin K , Bareza S , Wagshal A , Novack V , Konstantino Y , Haim M
Published: October 2022

Background

Although associated with potentially serious side effects, amiodarone is the most effective pharmacotherapy to achieve rhythm control among patients with atrial fibrillation (AF). Recent clinical trials advocate early rhythm control in AF. The effect of amiodarone treatment on mortality among patients with AF in real-life remains largely debatable. The primary aim of this analysis was to compare all-cause mortality rates across amiodarone treatment status

Methods

This is a retrospective study among patients from the Southern district of Clalit Health Services in Israel between January 1st, 1999 and July 1st, 2021 including all prevalent atrial fibrillation cases, hospitalized with AF as a primary diagnosis. Patients treated with amiodarone were matched in a 1:1 manner with controls not exposed to amiodarone based on age, sex, living area, and atrial fibrillation diagnosis duration. To avoid immortal time bias, follow-up times of the matched controls were left adjudicated to truncate the amiodarone-free period of their matched cases. We performed survival analyses using multivariable Cox regression controlling for potential confounders.

Results

During the study period, 7,048 patients who initiated amiodarone treatment were identified, of whom 6,449 were matched with controls. The mean age was 71.5 years, and 46.4% were women among the matched population. At baseline, the amiodarone-treatment group had higher rates of diabetes (38.3% vs. 32.6%, chronic renal failure (17.2% vs. 10.8%), coronary heart disease (31.6% vs. 19.6%) peripheral vascular disease (13.1% vs. 9.8%), and congestive heart failure (33.8% vs. 20.7%; p<0.001 for all). The amiodarone-treatment group had higher rates of oral-anticoagulant therapy (82.0% vs. 59.4%, p<0.001). During a mean follow-up time of 5.7 years, 2849 (44.2%) patients died in the amiodarone group and 3072 (47.6%) patients in the control group [adjusted-hazard-ratio: 0.85 (confidence-interval 95%: 0.80,0.91), p<0.001].

Conclusion

In a large contemporary real-life population with AF, amiodarone treatment was associated with a lower risk for death, despite a higher burden of comorbidities among patients treated with amiodarone. These results support findings from randomized clinical trials advocating aggressive rhythm control therapy to reduce mortality and suggest that amiodarone is a potentially effective treatment to achieve this aim.

Funding Acknowledgement

Type of funding sources: None.