bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term QT interval analysis for real world patients with Insertable cardiac monitors taking antiarrhythmic drugs
Authors: Deus M , Rajagopal G , Sarkar S , Landman S , Koehler J 
Published: May 2024

Abstract

Background
The QT interval serves as a surrogate biomarker for ventricular repolarization. Variance in QT intervals can clinically lead to pro-arrhythmia and sudden cardiac death. An insertable cardiac monitor (ICM) device capable of continuously monitoring the QT interval over a long period can provide diagnostic value for evaluating physiologic or drug induced variations in QT interval.

Objective
To analyze feasibility of continuous QTc interval monitoring in patients with ICM and evaluate the QTc interval changes in patients taking antiarrhythmic drugs.

Methods
Patients QT intervals detected from daily ICM ECG data from real-world patients taking antiarrhythmic drugs such as sotalol, amiodarone and dofetilide during hospitalization while implanted with ICM were analyzed from the de-identified Electronic Health Record (EHR) database linked with ICM device data warehouse. The ICM ECG was processed through the previously defined QT detection algorithm which calculates the QTc interval for every beat to generate continuous long term QTc trends. A patient contributed to the prescription group if they were prescribed antiarrhythmics drugs prior to hospitalization in the EHR database otherwise they contributed to the non-prescription group. Patients from the prescription group who were administered antiarrhythmic drugs via injection or IV during hospitalization were removed from the analysis. A 30-day median QTc interval from 30-60 days prior to hospitalization was used as baseline. Wilcoxon signed-rank test was used to compare the paired difference from days 1-5, 1-10, 30-60, and 60-90 after hospitalization to their respective baseline.

Results
441 patients (avg. age: 70±11, 50.5% female) were included with 220 prescription and 221 non-prescription. The baseline QTc intervals were 414 and 417.3 msec for non-prescription and prescription groups, respectively. There was a significant increase in QTc on days 1-5, 1-10, 30-60, and 60-90 after hospital admission compared to the baseline (all p &lt; 0.001) for the non-prescription group. The prescription group showed increase in QTc only on days 30-60 after hospitalization when compared to baseline (p&lt;0.05). A larger QTc increase was observed in non-prescription receiving anti-arrhythmic loading on days 1-5 after hospitalization compared to patients on prescription prior to hospitalization (P&lt;0.05).

Conclusion
Utilizing a QT interval detection algorithm from an ICM can provide long term QT trends for patients with an ICM. Continuous monitoring of QT can help to detect sudden changes in QT due to antiarrhythmic drugs which may lead to increased risk of arrhythmias or cardiac arrest.
Feasibility and diagnostic yield of a photoplethysmography-based arrhythmia screening and integrated management pathway in a chronic obstructive pulmonary disease outpatient clinic
Authors: Hereijgers M , Van Der Velden R , Reinders L , Weerts Z , Luermans J , Chaldoupi M , Vernooy K , Hermans A , Posthuma R , Franssen F , Simons S , Linz D 
Published: May 2024

Abstract

Background
Guidelines recommend opportunistic screening for atrial fibrillation (AF) in high-risk populations, including chronic obstructive pulmonary disease (COPD) patients.

Purpose
We aimed to assess the feasibility and yield of a photoplethysmography (PPG) smartphone app-based pathway for AF detection within a COPD outpatient clinic.

Methods
Ninety-nine eligible patients from the COPD outpatient clinic at the Maastricht University Medical Center+ underwent a 14-days PPG app-based AF screening. PPG-based AF detection triggered an electrocardiogram (ECG) for AF diagnosis and initiation of a comprehensive AF management. Patients’ adherence and system usability were assessed.

Results
Patient onboarding was easy, and patients demonstrated good adherence to the protocol (101% [82%-123%]). The usability of the PPG app was satisfactory with a high score in the System Usability Score questionnaire (80.0 [55.0-92.5]). Among 99 patients (mean age 66±9 years; 54% female), 8% had a prior AF diagnosis. Premature beats were common, with 96% of patients showing isolated premature beats (&lt;6 in 960 PPG recordings) and 32% frequent premature beats (≥6 in 210 PPG recordings). The PPG algorithm suspected paroxysmal AF in 6 new cases. AF could be confirmed in 2 patients through resting 12-lead ECG and 1-lead handheld ECG device. One patient who was lost to follow-up. In the remaining 3 patients with suspected AF PPG recordings, analysis of 24-hour, 48-hour and 7-day Holter recordings revealed high burden premature (supra)ventricular beats. Two of these patients manifested self-terminating short episodes of supraventricular tachycardia.

Conclusion
14-days opportunistic PPG app-based screening is feasible in COPD outpatient care and results in the detection of new AF cases and premature beats. This novel digital approach offers a practical method to implement recommended AF screening in COPD patients.
Real-world validation of smartphone-based photoplethysmography for heart rate monitoring in atrial fibrillation
Authors: Gruwez H , Ezzat D , Van Puyvelde T , Dhont S , Meekers E , Wouters F , Kellens M , Bruckers L , Van Herendael H , Rivero-Ayerza M , Nuyens D , Haemers P , Pison L 
Published: May 2024

Abstract

Introduction
Photoplethysmography (PPG) based smartphone applications facilitate heart rate monitoring that may enable physicians to guide rate control in patients with atrial fibrillation (AF). Despite extensive validation of PPG-derived heart rate, validation studies in the presence of AF are lacking, particularly in unsupervised free-living conditions.

Purpose
To evaluate the accuracy of PPG-derived heart rate using a smartphone application in patients with an established diagnosis of AF, both during sinus rhythm and AF, in a real-world setting.

Methods
Consecutive patients undergoing AF ablation were enrolled four weeks prior to the procedure. They were instructed to assess their heart rate twice daily during eight weeks with a one-minute finger-over-the-camera smartphone-PPG recording. The reference heart rate was obtained from two 30-seconds handheld single-lead electrocardiogram (ECG) recordings performed immediately before and after the PPG recording. Measurements were valid if the heart rate did not change by more than 10% between the first and second ECG and maintained sinus rhythm or AF consistently.

Results
In total, fifty patients (age 63 ±11 years, 68% male) performed 3407 high-quality PPG measurements accompanied with two high-quality ECGs measurements both in sinus rhythm or AF. After excluding 223 measurements due to inconsistent heart rate between the first and second ECG, 3184 measurements remained. The mean heart rate (71.5 ± 17.3 beats per minute (bpm)) was significantly higher during AF (94.7 ± 19.4 bpm) compared to sinus rhythm (65.7 ± 10.7 bpm) (p-value &lt; 0.001). The heart rate assessment was accurate within a 10% margin in 93.8% of PPG measurements. Inaccurate heart rate assessments were more frequent in AF (161/637; 25.3%) compared to sinus rhythm (35/2547; 1.4%) (p-value &lt; 0.001). PPG underestimated the heart rate in sinus rhythm with 0.4 bpm (95% CI: -0.3 to -0.5 bpm) and in AF with 6.6 bpm (95% CI: -5.8 to -7.4 bpm). The deviation of PPG-derived heart rate from the ECG-derived true heart rate was significantly greater during AF (root mean square error (RMSE) = 11.8 bpm) compared to sinus rhythm (RMSE = 2.2 bpm) (p-value &lt; 0.001). The heart rate correlation plots and corresponding Bland-Altman plots demonstrate a skewed underestimation of the heart rate in AF with PPG, particularly for high heart rates.

Conclusions
Heart rate can accurately be derived from PPG recordings using a smartphone application in real-world conditions. However, PPG measurements may underestimate high heart rates in the presence of AF.Heart Rate in Sinus RhythmHeart Rate in Atrial Fibrillation
Non-invasive detection of cardiac arrhythmias using photoplethysmography signals
Authors: Jeanningros L , Van Zaen J , Le Bloa M , Teres C , Herrera C , Porretta A , Domenichini G , Pascale P , Luca A , Solana Munoz J , Vesin J M , Thiran J P , Lemay M , Pruvot E , Braun F 
Published: May 2024

Abstract
Cardiac arrhythmias (CAs) are associated with critical heart-related complications such as stroke or heart failure. Because of the intermittent and asymptomatic presentation of some CAs in their early stages, the screening remains limited using traditional methods based on ECG. Recent advances in photoplethysmography (PPG) have revealed substantial potential for wearable devices to detect CAs within large populations. Although PPG has demonstrated efficiency in discriminating atrial fibrillation (AF) from normal sinus rhythm, it remains unclear whether AF detection methods remains effective in the presence of CAs other than AF.
In this study, we applied a recurrent neural network on a dataset containing eight different types of CAs (Table 1). The classifier processes sequences of interbeat intervals (IBIs) as input and discriminates between normal and abnormal rhythms. The algorithm was evaluated on 64 patients (45 males and 19 females , with a mean age of 55.9 ± 16.0) undergoing a diagnostic or therapeutic electrophysiological procedure. This dataset includes simultaneous recordings of PPG signals from a wrist-bracelet and 12-lead ECG, with the latter used as the gold-standard for annotating cardiac rhythms.
The classifier achieved 84% accuracy, 77% sensitivity and 88% specificity in detecting abnormal rhythms. Table 1 shows that AF (99.6%), atrial tachycardia (100%) and AVRT (96.4%) were well classified as abnormal rhythm, whereas the reliability of the detection decreased for atrial flutter (65.4%), atrial or ventricular bigeminy (72.4%) and ventricular tachycardia (80.2%). Undetected abnormal rhythms were often characterized by a rather regular rhythm (illustrated by VT in Figure 1) and CAs for which PPG heartbeat detection was initially not optimal (Bigeminy in Figure 1).
In conclusion, this study shows the capability of PPG-based technology to detect various CAs extending beyond AF. It highlights the merits and limitations of IBI-based detection of abnormal rhythms, highlighting the need for a better comprehension of the peripheral hemodynamic signature of CAs.
Feasibility and determinants of short-term heart rate variability in patients using photoplethysmography-based wearable devices - data derived from TeleCheck-AF
Authors: Hillmann H , Hermans A , Gawalko M , Mueller-Leisse J , Betz K , Van Der Velden R , Pluymaekers N , Evens S , De Cooman T , Sultan A , Gruwez H , Hendriks J , Manninger M , Linz D , Duncker D 
Published: May 2024

Abstract

Background
Heart rate variability (HRV), especially short-term HRV, is known to be associated with development of atrial fibrillation (AF). Nevertheless, it is not known if short-term HRV can be feasibly derived from digital devices in patients at risk for AF. In this analysis, we aimed to evaluate the feasibility and determinants of short-term HRV using non-continuous photoplethysmography (PPG) recordings derived from digital hand-held device.

Methods
TeleCheck-AF is a project implementing an on-demand app-based infrastructure for the management of AF. Briefly, one week prior to the scheduled teleconsultation, patients were provided with a smartphone app to assess heart rate/rhythm three times a day and in case of symptoms. Patients from the project with at least one PPG recording in sinus rhythm (SR) during the study period were analyzed. For every recording in SR, the short-term HRV parameter, root mean square of successive normal-to-normal interval differences (RMSSD), was calculated. The PPG parameters, heart rate and RMSSD, were compared between groups (men vs women, presence vs absence of previous AF, atrial flutter, atrial tachycardia, pulmonary vein isolation (PVI) within 12 months).

Results
Overall, 855 patients [60.5% men, median age 63 (56;70) years] with a total number of 13465 recordings were included in the analysis. Median number of recordings per patient was 15 (7;20) with a median heart rate of 66 (59;75)bpm and a RMSSD of 39.7 (30.6 ;56.1)ms. Results revealed a significant difference in RMSSD for gender and previously known AF, whereas no difference was seen e.g., for patients with known atrial flutter or atrial tachycardia (table 1). In patients with previously known AF, patients who underwent PVI within the last 12 months had a reduced RMSSD in comparison to patients without previous PVI (36.7 (31.8; 47.0)ms vs 42.2 (34.4; 54.3)ms, p&lt;0.001).

Conclusion
Assessing short-term HRV based on RMSSD using PPG recordings is feasible. Short-term HRV recorded by digital hand-held devices may be especially helpful in patients after PVI as such patients were shown to have a reduced HRV in this analysis.
Table 1: Differences in short-term heart rate variability in patients at risk for atrial fibrillation. AF = Atrial fibrillation.Table 1
The effect of antiphospholipid antibodies on the frequency of extrasystoles in men with coronary heart disease and and myocardial infarction
Authors: Nazarova M , Burdeina L , Stanislavchuk M , Ivankova A 
Published: May 2024

Abstract

Background
Coronary heart disease (CHD) is one of the most socially significant diseases of the cardiovascular system. Acute myocardial infarction (MI) develops 10 years earlier in men than in women. Manifestation of MI in young men quite often happen without clinically significant stenosis of coronary vessels. And fatal arrhythmias are one of the main causes of death in patient with cardiovascular diseases.

Purpose
To evaluate the clinical and pathogenetic significance of antiphospholipid antibodies (aPL) in patients with MI and disorders of rythm.

Methods
107 patients men (average age 51.2 ± 6.15 years) with CHD and MI were examined. The content of aPL IgG - antibodies to cardiolipin, phosphatidylserine, phosphatidylinositol, phosphatidylacetate in the blood serum were determined by enzyme-linked immunosorbent assay and electrocardiography Holter monitor 24 hours tests were done.

Results
aPL IgG were detected in 56 patients (52,3% of the total number of patients with MI), it concentration threshold 10 GPL U/ml in blood serum. The median age of first acute MI in men 56 years, according to the literary data. In our investigation average age of aPL positive patients is 44.8 ± 5.47 years. They had first MI on average 12 years earlier than general population.
The level of aPL IgG in blood serum was higher in 1,7 times (19,3 ± 7,32 GPL U/ml and 11,4 ± 5,41 GPL U/ml (p &lt;0.05) in patients with recurrent MI compared to one MI. Also the results of the study showed that the highest prevalence of polytopic extrasystoles is observed among aPL positive CHD patients with recurrent MI (68,3%) compared to one MI in anamnesis (26,3%). Moreover, 23.2% of people who had recurrent MI had ventricular extrasystole of high gradations.
It is important to note, that іn patients with first Q-MI levels of aFL IgG were in 1.27 times higher (p&lt;0.05) than in patients with first non-Q-MI. And the frequency of the polytopic extrasystoles was on 38% higher (p&lt;0.01) іn patients with first Q-MI compared to patients with first non-Q-MI.

Conclusion
The results obtained by us indicate the possible involvement of the autoimmune factor, in particular aPL IgG, in the pathogenesis of CHD. Positive correlation of aPL IgG with the frequency of rhythm disorders indicates the severity of condition in men with CHD and MI in anamnesis and need for further research.
Imageless electrocardiographic imaging for atrial electrophysiological characterization: a validation study
Authors: Ros S , Reventos J , Fambuena C , Lundback D , Arenal A , Torrecilla E G , Avila P , Carta A , Bermejo J , Mombiela T , Delgado A , Climent A M , Guillem M S , Atienza F 
Published: May 2024

Abstract

Background
The mechanisms responsible for atrial fibrillation (AF) are not yet fully understood and treatment strategies remain suboptimal. Electrocardiographic imaging (ECGi) could provide new insights into the arrhythmogenic substrate’s characterization.

Objective
To validate a novel imageless ECGi technique against electroanatomical mapping (EAM) systems to evaluate its use in guiding therapeutic decisions.

Methods
Periprocedural ECGi was implemented on 12 patients submitted for pulmonary vein isolation with EAM arriving in sinus rhythm. As opposed to current methods requiring patient-specific torso-heart geometries from CT/MRI scans, the employed ECGi system computes a cardiac anatomical model from a 3D-camera torso reconstruction. Both ECGi signals and intracavitary recordings were acquired simultaneously during catheter stimulation from a single atrial site at two different pacing cycles and local activation time (LAT) maps were derived. As a result, an ECGi and an EAM map were obtained for both 300 and 600 ms distal coronary sinus pacing for each patient. These were then compared by splitting the left atrial geometries from both mapping methodologies into 7 predefined, clinically relevant regions and identifying the earliest and latest activation sites in each.

Results
For all 24 LAT maps under consideration, the pacing sites identified by non-invasive ECGi maps were consistent with those determined through EAM as 100% accuracy was obtained in terms of detecting the first activated region. As well as the correct stimulation area, according to the corresponding EAM instance, the earliest ECGi activations were also found in one of its immediate neighbours in 38% of the maps, indicating a broader region of interest. Regarding the latest activation sites, ECGi achieved an accurate localisation in 92% of the activation sequences and, similarly, other neighbouring regions showed the maximum LAT in one third of the studied maps.

Conclusions
Considering the spatial resolution constraints inherent to its non-invasive nature, imageless ECGi activation patterns are congruent with the gold-standard technique for substrate mapping without the need for prior medical imaging.
Impact of continuous positive airway pressure for severe sleep apnea on very late recurrence in patients receiving catheter ablation of atrial fibrillation
Authors: Tanaka N , Okada M , Tanaka K , Hirao Y , Harada S , Miyazaki N , Iwasa K , Koyama Y , Watanabe H , Iwakura K , Iwanaga Y , Okamura A 
Published: May 2024

Abstract

Background
Sleep apnea (SA) represents a risk for arrhythmia recurrence following catheter ablation (CA) of atrial fibrillation (AF). Continuous positive airway pressure therapy (CPAP) is the established standard treatment for moderate to severe SA. While CPAP exhibits promise in reducing AF recurrences post-CA, the evidence is not entirely consistent. The impact of CPAP for severe SA on very late recurrence post-CA of AF has not been elucidated.

Methods
This study employed a retrospective, single-center, observational design. Data were derived from SA screening tests routinely performed in patients scheduled for CA of AF in our facility. We defined severe SA as an apnea-hypopnea index (AHI)≥30 by a home sleep apnea test or polysomnography. After excluding patients already diagnosed with sleep apnea before CA, we enrolled 466 consecutive severe SA patients. We divided them into two groups according to whether they had more than 1-year usage of continuous positive airway pressure after CA (CPAP group) or not (non-CPAP group). CPAP usage was monitored through telemonitoring and regular follow-up visits at our outpatient clinic every three months. Very late AF recurrence was defined as AF recurrence more than 1-year after the index CA.

Results
The age was 65±10 years, 17.4% were females, and 60.3% had non-paroxysmal AF. The mean AHI was 38.0±15.2. The CPAP group included 33.7% (n=157) and non-CPAP group 66.3% (n=309). The AF recurrence rates within 1-year post-CA were similar between the two groups (CPAP group vs. non-CPAP group, 16.6% vs. 16.2%, log-rank p=0.91). However, the very late AF recurrence rate was lower in the CPAP group than non-CPAP group (CPAP group vs. non-CPAP group, 7.6% vs. 21.6%, log-rank p=0.0002).

Conclusion
Among the untreated severe sleep apnea patients at the time of the catheter ablation of AF, CPAP treatment during 1-year post-CA was associated with fewer AF recurrences beyond 1-year post-CA.KM curve according to CPAP group
Physical activity change after early rhythm control after new-onset atrial fibrillation and major adverse cardiovascular event risk
Authors: Lee S R , Ahn H J , Choi E K , Kim B S , Han K D 
Published: May 2024

Abstract

Background
There is paucity of information about major adverse cardiovascular event (MACE) related to physical activity change after early rhythm control (ERC) after new-onset atrial fibrillation (AF). We investigated the association between physical activity after ERC and clinical outcomes in new-onset AF patients.

Methods
This study was performed based on the Korean National Health Insurance Service database. We included adults with new-onset AF between 2009 and 2018. Patients who received national health screening examination before and after AF diagnosis within 2-year were finally included (n=161,379). Among these, 48,243 patients were received rhythm control within 2-year after AF diagnosis. Patients were categorized into 4 groups as follows: persistent non-exerciser, new exerciser (after AF diagnosis and ERC), exercise maintainer, and exercise quitter (after AF diagnosis and ERC). The primary outcome was MACE defined as the composite of ischemic stroke, myocardial infarction, and hospitalization for heart failure. Multivariable Cox analysis was performed.

Results
Among 48,243 patients receiving ERC, 63% (n=30,540) was persistent non-exerciser, 13% (n=6260) was new exerciser, 11% (n=5102) was exercise maintainer, and 13% (n=6341) was exercise quitter. After multivariable adjustment, compared to persistent non-exerciser, new exerciser and exercise maintainer with ERC showed lower risk of MACE by 10% and 19%, respectively (adjusted hazard ratio [aHR], 95% confidence interval [95% CI], 0.903 [0.802-0.994] for new exerciser, and 0.810 [0.725-0.906] for exercise maintainer) (Table 1). However, exercise quitter did not show significant benefit compared to persistent non-exerciser (Table 1). To assess the synergistic effect of ERC and starting or maintaining physical activity, we performed exploratory analysis including patients who did not receive ERC. Compared to persistent non-exerciser without ERC, persistent non-exerciser with ERC was associated with a significantly lower risk of MACE (0.832 [0.797-0.868], Table 2). Patients who received ERC and started or maintained physical activity with ERC showed greatest risk reduction for MACE by 27% and 36%, respectively (0.732 [0.668-0.802] for new exerciser and 0.641 [0.576-0.713] for exercise maintainer) (Table 2).

Conclusion
Even in context with beneficial effect of ERC in patients with new-onset AF, maintaining or starting regular physical activity after ERC might bring greater reduction on the risk of MACE. Physician should emphasize healthy lifestyle behavior with rhythm control in patients with new-onset AF.