Abnormal Electrocardiogram Research Articles

Pulmonary involvement in systemic sclerosis: can sex play a role?

Systemic sclerosis (SSc) is a rare and complex autoimmune disease with significant complications. During the last few years, research interest focuses on the differences between female and male patients. However, there is a lack of data regarding the role of sex in the presence of small airway disease (SAD). Therefore, we aimed to investigate the impact of sex on pulmonary involvement in a cohort of SSc patients, focusing primarily on small airways. For this retrospective study, consecutive patients with a diagnosis of SSc, that visited our department until January 2024, were recruited. Demographic data, disease manifestations, serological profile, and internal organ involvement were compared between the two groups. In total 393 patients (female-to-male ratio 6:1) were included. Median time to diagnosis after the onset of Raynaud's was significantly longer for female patients. Electrocardiogram abnormalities were more common in male patients, while telangiectasias, calcinosis and arthralgias were more common in female individuals. Moreover, male SSc patients exhibited a higher prevalence of ILD and shorter time until the diagnosis of ILD. However, female individuals demonstrated a lower maximal-mid expiratory flow rate (MMEF) and higher ratio of residual volume to total lung capacity. Interestingly, sex remained an independent predictor of MMEF, in the multivariate analysis. Our results showed that, although ILD is more common in male SSc patients, SAD was more prevalent among female individuals. Importantly, female sex remained an independent predictor of SAD. This study further supports the presence of sex-related differences in SSc, with important implications in disease course and management.

Sepsis, Hypothermia, and the Emergence of Osborn Waves: A Case Report

Hypothermia and sepsis are two serious clinical entities with overlapping presentations, both capable of inducing electrocardiogram (ECG) abnormalities. We present a rare case of a 43-year-old male patient with coincident sepsis, acute kidney injury, and profound hypothermia that was complicated by the development of Osborn ( J) waves and conduction abnormalities on the ECG. The patient’s core temperature was gradually restored to normal utilizing both passive and active rewarming techniques, resulting in the disappearance of the Osborn wave. Concurrently, his cognitive state and cardiovascular parameters became stable after intensive sepsis treatment. Osborn waves arise from changes in the action potential and ion channel activity between the epicardium and the endocardium. These phenomena can be detected in several medical circumstances, including hypothermia, sepsis, subarachnoid hemorrhage, Brugada syndrome, and acute coronary syndrome. This case highlights the complexity of the diagnosis and management of such clinical scenarios.

Analysis of the influencing factors of abnormal blood pressure and electrocardiogram in occupational motor vehicle drivers

Objective: To explore the influencing factors of abnormal blood pressure and electrocardiogram (ECG) in occupational motor vehicle drivers. Methods: In January 2024, a cluster sampling method was used to study 606 occupational motor vehicle drivers from a transportation service enterprise in Beijing who completed occupational health examination in 2023 in Peking University Third Hospital as observation group and 596 non-occupational motor vehicle drivers as control group. The data of personal history, occupational history, blood pressure and ECG were collected, and the effects of occupational motor vehicle driving on hypertension and ECG were analyzed by multivariate logistic regression. Results: The age of workers in the observation group was (34.1±7.8) years old, and the length of service was (7.0±7.1) years. The age of the control group was (33.8±7.6) years old, and the working age was (7.7±6.5) years. There was no significant difference in age and length of service between the two groups (t=0.62, -1.90, P=0.538, 0.057). Systolic blood pressure (133.0±14.7) mmHg, diastolic blood pressure (83.7±11.6) mmHg, hypertension detection rate of 33.0% (200/606), ECG abnormality detection rate of 39.9% (242/606). They were significantly higher than those in the control group [ (127.8±14.4) mmHg, (77.5±11.0) mmHg, 24.7% (147/596), 31.0% (185/596) ], and the differences were statistically significant (P<0.05). Multivariate logistic regression analysis showed that occupational motor vehicle driving were risk factors for hypertension and abnormal ECG (OR= 1.210, 1.578; 95% CI: 1.145-1.231, 1.237-2.012; P<0.001) . Conclusion: Occupational motor vehicle driving may increase the risk of hypertension and abnormal ECG in workers.

Genetic and clinical characteristics of 26 cases with glycogen storage disease type Ⅲ

Objective: To investigate the genetic, clinical, and post-treatment characteristics of patients with glycogen storage disease type Ⅲ (GSD Ⅲ). Methods: A retrospective cohort analysis was performed on the genetic and clinical data of 26 cases with GSD Ⅲ who visited the Children's Hospital affiliated with Fudan University from June 2017 to December 2023. The patients were divided into non-missense variation and missense variation groups according to the types of mutation in the AGL gene.The correlation between genotype and phenotype was analyzed. All patients were treated with uncooked cornstarch after diagnosis. The changes before and after treatment were compared in patients who underwent more than twelve months of follow-up. A P value of <0.05 was used to denote statistical significance. Results: Among the 26 cases enrolled, 13 were female and 13 were male, and the median age of diagnosis was 28 (6 to 134) months. A total of thirty-five different types of AGL gene variation were detected, with c.1735+1G＞T (9/52, 17.3%) as the hotspot variation. The common clinical manifestations were elevated aminotransferases (26/26, 100%), hepatomegaly (25/26, 96.2%), fasting hypoglycemia (25/26, 96.2%), hyperketonemia (16/18, 88.9%), hypertriglyceridemia (TG) (20/26, 76.9%), elevated CK (16/25, 64.0%), and an abnormal electrocardiogram (12/16, 75.0%). Four cases (15.4%) had symptoms of myopathy at diagnosis. Liver biopsy was performed in eighteen cases, among whom 83.3% (15/18) had liver fibrosis≥S2. The number of cases with elevated levels of CK (P＝0.031) and ALT (P＝0.038)was pronounced in the non-missense variation group compared to that in the missense variation group. There were no statistically significant differences in age, height, liver size, degree of fibrosis, fasting blood glucose (Glu) and TG (P>0.05). The median follow-up time of 14 cases was 40.5 (20-73) months, with improvement in body stature, reduced liver size, decreased ALT and TG, and improved Glu. However, four (28.6%) cases had new myopathy symptoms with raised CK (P<0.05) and with advancing age, increased ALT diminished while CK level elevated (P<0.05). Conclusions: The common clinical manifestations at the early stage of the GSD Ⅲdiagnosis are elevated aminotransferases, hepatomegaly, fasting hypoglycemia, hyperketonemia, high triglycerides, elevated CK, and fibrotic liver in China. Myopathy symptoms may arise following uncooked cornstarch treatment; however, there is significant improvement in height, liver-related, and metabolic parameters.

Aeromedical Fitness Considerations in Myocardial Bridging: A Case Study and Literature Review

Aims: Management of cardiac disease in aeromedical expertise can be challenging for asymptomatic crew members, especially during the first aeromedical examination, myocardial bridging is a good example. Presentation of Case: A 24-year-old student pilot candidate shows repolarization disorders at the ECG in the aeromedical examination, the exploration allowed the discovery of a myocardial bridge on The Coronary computed tomographic angiography (CCTA) of the left anterior descending (LAD) coronary artery responsible for tight stenosis. Discussion: The prevalence of MB varies according to the method of investigation, ranging from 2% in coronary angiography and 19% in coronary computed tomography to 42% in autopsy.The prevalence among active civilian aircrew (pilots and cabin crew) monitored at CEMPN is 0.4%, all revealed by electrocardiogram abnormalities. MB are usually small and of no clinical significance, the myocardial bridge proximal segment has been associated with atherosclerosis. Symptomatic patients with myocardial bridges as their only cardiac abnormality may present with myocardial ischemia, acute coronary syndromes, coronary spasm, syncope or even sudden death. The initial therapeutic strategy in the treatment of MB is medical management. Revascularization is indicated by PCI or surgery, including coronary artery bypass grafting (CABG) or myotomy in the case of symptoms recalcitrant to maximal medical treatment. The aviation environment may expose aircrew to additional physiological stressors, including hypobaria, hypoxia and sustained acceleration (+Gz). Such exposure may present a risk if associated with cardiovascular abnormalities, potentially leading to incapacity to fly due to symptoms or complications of the myocardial bridge. Conclusion: The myocardial bridge is an anatomical variant rather than a congenital anomaly with varied symptomatology (ECG abnormality, stable or unstable angina or sudden death), the aeromedical decision is made on a case-by-case basis, and makes a challenge diagnostic, particularly for asymptomatic crews.

Abstract 4144526: A Case Presentation of Severe Left Ventricular Dysfunction from Focal Myocarditis due to Immune Checkpoint Inhibitor

Introduction: Immune checkpoint inhibitors (ICI), such as pembrolizumab, are an effective immunotherapy for several malignancies, however, have been associated with adverse events including myocarditis and accelerated atherosclerosis. ICI myocarditis is associated with a mortality rate of up to 33%. This case reports a patient on pembrolizumab with an atypical presentation. Case presentation: A 75-year-old female with a past medical history significant for lung cancer on pembrolizumab and myasthenia gravis presented to the hospital with dyspnea and mild, intermittent exertional chest discomfort. She denied nausea, radiation of pain, diplopia, weakness in extremities, or dysphagia. Workup revealed a leucocyte count of 13,500 cells/uL, pro-brain natriuretic peptide of 13,458 pg/mL, troponin of 26 ng/L, and a normal erythrocyte sedimentation rate and C reactive protein. A chest computed tomography was performed that showed mild bilateral pleural effusion and no pulmonary embolism. A nuclear stress test showed no evidence of ischemia but showed a severely reduced left ventricular ejection fraction (LVEF) at 29%. An echocardiogram confirmed that the ejection fraction was reduced at 23% (baseline LVEF was 60% from 1 year ago). Cardiac MRI revealed a mildly increased regional T2 signal in the anterolateral wall, mildly elevated extracellular volume fraction, and no late gadolinium enhancement. With ongoing clinical suspicion despite equivocal findings on cardiac MRI, an endomyocardial biopsy was done that revealed a single small aggregate of lymphocytes present in 1 of 6 tissue samples. Ultimately, with the single site of aggregated lymphocytes on biopsy, a diagnosis of ICI myocarditis was determined, and the patient was started on high-dose intravenous glucocorticoids as well as bisoprolol, empagliflozin, spironolactone, and Entresto for heart failure management as she was able to tolerate. Discussion: Myocarditis due to pembrolizumab is a rare, but potentially lethal adverse effect. Patients typically have abnormal electrocardiograms and elevated cardiac biomarkers. Cardiac MRIs have sensitivity and specificity of 68% and 91% respectively for diagnosis, and the gold standard is endomyocardial biopsy however, it is limited due to sampling error. Our patient had an unusual presentation, but with both imaging and biopsy, we found a case of focal myocarditis with severe left ventricular dysfunction, which typically is seen with fulminant myocarditis.

Holter Monitoring Analysis of Women Infected with the Human Immunodeficiency Virus.

The aim of the study was to assess the clinical features of women infected with the human immunodeficiency virus (HIV) using Holter monitoring. Thirty-five female patients infected with HIV using a Holter monitor at the Ditan Hospital were retrospectively analyzed. In terms of basic rhythms, there were 30 cases of sinus rhythm, 27 cases of ventricular premature beat, 26 cases of supraventricular premature beat, 12 cases of mild reduction of HRV, 9 cases of normal heart rate variability (HRV), 8 cases of supraventricular tachycardia, 5 cases of abnormal ST-segment changes and 2 cases of sinus bradycardia 2 cases of paroxysmal atrial fibrillation 2 cases of junctional escape rhythm. There was only one case in each of the following ECG changes: persistent atrial fibrillation, sinus tachycardia, couplet supraventricular premature beats, accelerated idioventricular rhythm, sinoatrial block, second-degree Mobitz type I atrioventricular block, second-degree Mobitz type II atrioventricular block, complete right bundle branch block, T-wave abnormality, and significant reduction of HRV. The Holter monitor can show more changes in the electrocardiogram (ECG) of HIV-- positive patients, particularly significant ECG abnormalities, such as paroxysmal atrial fibrillation, and can direct early clinical treatment to serious adverse results.

Epilepsy and Cardiac Arrhythmias: A State-of-the-Art Review.

Epilepsy is an important cause of disability and mortality worldwide. It can be frequently misdiagnosed, and detailed history and relevant investigations are needed to differentiate epilepsy from syncope. Electroencephalogram is a key noninvasive assessment of neurological function, and the diagnostic yield is increased when performed for an extended period in the ambulatory setting with concurrent electrocardiogram and video monitoring. People living with epilepsy may be affected by a diverse range of ictal (seizure-associated) arrhythmias. The prevalence of detected arrhythmias in people living with epilepsy is anticipated to rise in the context of increasingly available wearable technology and improved survival. Ictal bradycardia and asystole sometimes observed in temporal lobe epilepsy may be associated with falls and injury that can be prevented by cardiac pacing; however, seizure control with medical therapy is still crucial. Sudden unexpected death in epilepsy is likely explained by a different mechanism, in particular central cardiorespiratory autonomic dysfunction sometimes associated with generalized tonic-clonic seizures. Channelopathies encompassing the heart-brain axis are increasingly recognized and may explain the overlap between certain epileptic and arrhythmogenic syndromes, with potential for targeted therapy in the future. The QT interval is prognostically significant in epilepsy, with various seizure types affecting the QT interval differently. Certain antiseizure medications may cause electrocardiogram abnormalities and arrhythmias although there remains limited clinical data. This State-of-the-Art Review describes our current understanding regarding the relationship between epilepsy and cardiac arrhythmias, as well as delineating areas of unmet need.

Severe cardiotoxic characteristics associated with allogeneic hematopoietic stem cell transplantation preconditioning in patients with aplastic anemia

Objective: To delineate the clinical characteristics and outcomes associated with severe cardiac toxicity during the preconditioning phase of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with aplastic anemia (AA). Methods: This retrospective case series study included 31 patients with severe AA who underwent allo-HSCT and were diagnosed with severe cardiac toxicity at the Hematology Department of Peking University People's Hospital from August 2012 to June 2022. The clinical manifestations of severe cardiac toxicity observed during the preconditioning process were assessed. Patient survival was assessed using the Kaplan-Meier method. Results: In this cohort of 31 patients, the median follow-up period was 9 days (range: 4-365 days). Severe cardiac toxicity manifested within 6 days after the initial cyclophosphamide (Cy) administration. Twenty patients died within 30 days of initiating Cy preconditioning, of which 16 patients died due to severe cardiac toxicity within 25 days. Patients whose cardiac function improved within 30 days post-preconditioning showed a median survival duration of 222 days (n=11). Troponin I (TNI) levels in patients who died within 30 days of initiating Cy preconditioning began increasing on day 5 post-Cy, peaking sharply by day 9 after a notable rise on day 8. B-type natriuretic peptide (BNP) levels in patients who died within 30 days of initiating Cy preconditioning started to rise from day 1, stabilized between days 2 and 5, and then doubled daily from days 6 to 8, remaining elevated thereafter. Notably, the initial increases in BNP and TNI correlated with electrocardiogram (ECG) signs of low voltage and T-wave inversion in 83.87% of cases (n=26). Most patients (n=28, 90.32%) were administered corticosteroid therapy. In those with restored cardiac function, the ejection fraction returned to >50% within 30 days of initiating Cy preconditioning. Conclusions: Patients with severe cardiac toxicity during the preconditioning phase of allo-HSCT typically exhibit early, sustained, and marked elevations in myocardial damage markers, including BNP and TNI, accompanied by ECG abnormalities following Cy administration, with BNP often increasing first. These indicators are associated with rapid disease progression and high mortality. Prompt initiation of treatment upon clinical diagnosis is critical for improving survival outcomes.

121 year after Einthoven: show me the normal ECG?

Abstract Background The clinical electrocardiogram (ECG) is measured about 120 years. The interpretations of the ECG is an art mastered by only few. Rhythm and Interval analysis is relative reliable and well supported by the available ECG machines. However, the interpretation of the ECG waveform and where it starts to deviate from the normal waveforms is poorly defined for the clinical practice. To support the anatomical relationship of the ECG, the PathECG has been developed as part of the CineECG tool, expanding the view on the ECG. In this study normal ECG distributions were created from a public available database to enable a) visual comparison of the ‘normality’ of the ECG and PathECG and b) build a predictive model to classify an ECG as normal or abnormal. Purpose To create an objective and 3D visual comparison of an ECGs to "normal ECGs". Methods From the (Physionet) PTB-XL database (Germany) all verified ECGs with known gender were selected. From the these ECGs a median ventricular beat was automatically constructed and subsequently resampled to have a standardized number of samples (Figure: Normal ECGs on top of abnormal ECGs). These resampled ECGs were also converted to their equivalent PathECG. From the normal labeled ECGs (3124 female, 2283 male) distributions were created, representing the normal ECG for male, female or the combined group. With these distributions a percentage of ECG segments (QRS, ST, T wave) can be identified as being outside this distribution, and thus as potentially abnormal. A logistic regression model was fitted to determine the optimal outlier removal per segment for the ECG waveforms and the PathECG to classify and ECG as normal or abnormal per gender group. The performance was tested on the CPSC (Hong Kong) public available ECG database. Results The abnormal ECG data in both databases contained approximately 1/3 normal ECG, atrial and ventricular arrhythmias and 1/3 ischemia and conduction disorders. The performance (AUC) of the logistic regression model on the PTB-XL and CPSC data respectively was MALES: 87.5% - 81.5%, FEMALES: 86.7% - 83.7%, and COMBINED: 86.8%-82.9%. The visual overlay of the ECG significantly supports the identification of abnormal segments (Figure: Normal ECG distribution example). Conclusions The overlay of an ECG and PathECG on the normal distribution supports the identification and verification of abnormal ECGs. This method might increase the ability of less experienced ECG readers, like general practitioners, to identify patients that need to be transferred to a cardiologist. This method could also be used for the classification of P-waves, paediatric ECGs or ECGs in specific patient groups.Normal ECGs on top of abnormal ECGsNormal ECG distribution example

Generative adversarial networks (GANs) to produce synthetic 12-lead electrocardiogram signals for specific and rare diseases: a novel, powerful tool towards clinical advancements

Abstract Background Remarkable technological advancements in electrocardiogram (ECG) analysis face challenges due to insufficiently diverse and extensive real-world datasets. This limitation hampers both the development of sophisticated deep learning (DL) models for ECG analysis and the exposure of new physicians to substantial training examples. Purpose To leverage Generative Adversarial Networks (GANs), a novel AI algorithm type, to generate synthetic yet realistic ECG signals resembling specific diseases. Methods We initially employed a general-purpose GAN on more than 21,000 ECG samples from the PTB-XL database, encompassing normal and abnormal ECGs across various diseases. The GAN outputs served as inputs for training "DeceptionECG", a novel GAN model inspired by the InceptionTime architecture (code available online). DeceptionECG focused on generating disease-specific ECG signals, trained on annotated ECGs validated by two electrophysiologists. Post-training, we generated synthetic ECGs for common diseases like atrial fibrillation (AF) and anterior ST-segment elevation myocardial infarction (STEMI), as well as rarer conditions like Wolf-Parkinson White (WPW) syndrome. Authentication involved an independent discriminator DL model and two cardiologists who were asked to distinguish real from synthetic ECGs. Additionally, a DL model, a variant of the InceptionTime architecture, discerned specific diseases in the ECG signals to assess their realism. Finally, we trained a DL model for detecting abnormalities in ECGs with the augmented dataset to evaluate potential performance improvement. Results We generated sets of 5,000 synthetic ECGs for various abnormalities, at a rate of 2,500 12-lead ECG signals per minute. The generated ECGs were indistinguishable from real ones, evidenced by low accuracy (Accuracy, ACC: 48.9%) of the discriminator model and two clinicians (ACC: 56% and 51%), on test sets with anterior STEMI. A DL model trained on real ECGs accurately differentiated between synthetic normal ECGs and those hosting the target disease in nearly 9 out of 10 cases (ACC: 88.7%). Furthermore, the employed DL model detector trained on the augmented dataset, encompassing both real (n=1,589) and synthetic (n=5,000) ECGs, outperformed its counterpart trained solely on real ECGs, when tested on a 1,000-sample set of real signals (ACC: 94.6% vs. 89.3%). Conclusion Our GAN-based approach showcases the potential of generating high-quality synthetic ECGs tailored for specific diseases, overcoming data scarcity challenges, and enhancing the training and performance of machine learning models. Additionally, it holds promise in advancing medical professional training by providing diverse signals with distinct "disease stamps" at massive amounts, addressing privacy concerns associated with extensive data exposure. Further testing is warranted for the applicability of the approach, especially in exceedingly rare conditions with limited available training data.Project workflow and outcomesGAN-generated ECGs: Which is fake?

Navigating the Uncommon: Case Report of Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) Successfully Managed with Implantable Cardioverter Defibrillator (ICD)

With a high risk of sudden cardiac mortality, arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare inherited cardiomyopathy characterized by right ventricular dysfunction and ventricular arrhythmias (VA). In this case study, a 35-year-old presented with palpitations and revealed epsilon waves on the right precordial electrocardiogram (ECG) leads which led to the suspicion of ARVC. A 24-hour Holter monitoring revealed frequent ventricular extrasystoles (&gt;500 per 24 hours), a CMRI revealed RV dyskinesia and transmural LGE in the apical RV, and an electrophysiologic study detected spontaneous polymorphic ventricular tachycardia (VT) despite the presence of induction ventricle fibrillation (VF). These results validated the diagnosis of ARVC and indicated that an implantable cardioverter defibrillator was necessary treatment. The ability to identify potential ARVC’s ECG abnormalities, the timing to pursue further studies, and determining necessary treatment execution are critical. The evaluation of cardiac, electrophysiological, and clinical imaging parameters is essential for the risk stratification, diagnosis, and management of patients with ARVC.

Preventing unnecessary echocardiograms in de novo patients referred to the cardiology outpatient clinic using electrocardiogram-based deep learning

Abstract Introduction The growing demand on European echocardiography labs, driven by the rise in structural heart disease (SHD), is further complicated by a shortage of skilled sonographers, necessitating resource optimisation strategies. Electrocardiogram (ECG)-based deep learning models may assist in streamlining the echocardiography workflow. Purpose This study sought to develop a deep learning model capable of identifying patients at very low risk of SHD in a population of de novo patients referred to the cardiology outpatient clinic. Methods We identified all adult patients who underwent a 12-lead ECG and echocardiogram at a Dutch academic teaching hospital between 2011 and August 2023. Echocardiogram outcomes were extracted from reports, including left ventricular systolic dysfunction (LVSD), left ventricular dilatation (LVD), aortic stenosis (AS), aortic regurgitation (AR), mitral regurgitation (MR), and tricuspid regurgitation (TR), from which a composite outcome label was derived. A cohort of patients newly referred to our cardiology outpatient clinic with a primary complaint of chest pain, dyspnea, palpitations, dizziness, a murmur, or an abnormal ECG was held out as a test set, while the remaining dataset was split patient-wise into training (90%) and validation (10%) sets. A convolutional neural network was trained using only the ECG tracing as input and the composite label as outcome. Results We included 92,210 ECG-echo pairs from 44,785 patients (19,717 female) with 25,543 (27.7%) abnormal ECG-echo pairs. Among 2724 newly referred patients in the test set, 210/1389 males (15.1%) and 201/1335 females (15.1%) were diagnosed with SHD. In the test set, the model for predicting composite outcome demonstrated an area-under-the-curve, negative predictive value, and specificity of 0.74 (95% confidence interval [CI] 0.71-0.79), 0.94 (95% CI 0.92-0.95), and 0.47 (95% CI 0.45-0.49), respectively. Conclusion This study demonstrates the feasibility of employing deep learning models based solely on electrocardiogram (ECG) data to identify patients at very low risk of structural heart disease (SHD). Further validation and prospective studies are warranted to confirm the generalizability and clinical utility of our findings in diverse patient populations and healthcare settings.

Long-term efficacy and safety of ablation for atrial fibrillation in patients with hypertrophic cardiomyopathy

Abstract Background Hypertrophic cardiomyopathy (HCM) is often accompanied by atrial fibrillation (AF) but data on safety and long-term outcomes after catheter ablation for AF in HCM are scarce. Purpose To investigate safety, long-term efficacy and clinical outcomes following AF ablation in patients with HCM and in matched controls. Methods Patients with HCM (n=76) undergoing a first catheter ablation for AF or atrial flutter between 1999 and 2022 at a University Hospital in Sweden were included (age 64±12 years, 43% female). Diagnosis of HCM was based on the European Society of Cardiology definition (left ventricular wall thickness ≥15 mm or ≥13 mm not solely explained by abnormal loading conditions, and combined with family history, genetic components and/or electrocardiogram abnormalities). Patients with HCM were matched with controls (n=152) based on age, gender, ablation type and intervention-year. Patients were followed for a mean of 5 years and study endpoints included heart failure hospitalization (HFH), stroke and mortality. Cox regression analyses were performed for the association between HCM and the endpoints. Results Among the overall population, 121 (53%) underwent pulmonary vein isolation (PVI), 62 (27%) isthmus ablation and 45 (20%) His-Bundle ablation. Patients with HCM had a shorter mean duration of AF before ablation (48 months vs. 66 months; p=0.047) and more severe symptoms as indicated by a higher EHRA class (EHRA class IV: 30% vs. 10%; p&amp;lt;0.01). Procedural success rate of PVI and isthmus ablation was lower in patients with versus without HCM (88% vs. 97%; p=0.02). Procedure related complications (vascular complications, tamponade) were overall similar in both groups (9% in HCM vs. 5% in controls, p=0.17) except for higher rates of pulmonary oedema in patients with HCM (7% vs 1%, p=0.03). There was a nearly two-fold increase in risk of AF recurrence after PVI or isthmus ablation in patients with HCM compared to controls (OR 1.95; 95% CI 1.06-3.58; p=0.03). During follow-up, patients with HCM had an increased risk of HFH (HR 2.55, 95% CI 1.21-5.36, p=0.01) but not of stroke or mortality (Figure 1). Conclusion AF ablation was overall safe in patients with HCM but less effective. Patients with HCM had an increased risk of the individual endpoint of HFH after AF ablation but not stroke or mortality during long-term follow-up.

Barriers and facilitators for implementation of AI algorithms for ECG analysis and triage in patients with chest pain

Abstract Introduction Numerous artificial intelligence (AI) algorithms have been developed to assist in clinical decision-making, with a focus on areas like electrocardiogram (ECG) analysis due to the signal complexity and the varying levels of expertise among healthcare professionals. However, ensuring acceptance of these algorithms by end-users is paramount for successful implementation. Purpose This study aimed to identify barriers and facilitators related to implementation of an AI algorithm for ECG analysis and triage in patients with chest pain. Methods A three-round modified electronic Delphi study was conducted among Dutch potential end-users of an ECG-AI algorithm, including physicians, nurses and ambulance professionals. During the first round, participants brainstormed on barriers and facilitators, which were subsequently mapped to the Consolidated Framework for Implementation Research (CFIR). In the following two rounds, participants reviewed the identified barriers and facilitators for relevance and ranked them according to their importance. Results Twenty-five out of the initial forty respondents completed all three rounds, resulting in a dropout rate of 38%. Four barriers and twelve facilitators were identified. The most important facilitator was "Faster recognition of subtle ECG abnormalities", while "Poor model performance" emerged as the most important barrier. The most frequently mentioned corresponding CFIR domains were the innovation and inner setting domains. Conclusion The identification of barriers and facilitators provides valuable insights into the acceptance and utilisation of ECG-AI algorithms by end-users. By considering the CFIR domains, including innovation and inner setting, this study offers a comprehensive understanding of the contextual factors that influence the successful implementation of AI algorithms in healthcare settings. Addressing these barriers and facilitators will be crucial to facilitating future implementation processes.Barriers and facilitators

High Detectability of Prehospital 12-Lead Electrocardiogram in Diagnosing Spasm-Induced Acute Coronary Syndrome.

The importance of prehospital (PH) electrocardiograms (ECG) recorded by emergency medical services (EMS) for diagnosing coronary artery spasm-induced acute coronary syndrome (CS-ACS) remains unclear. We enrolled 340 consecutive patients with ACS who were transported by EMS within 12 h of symptom onset. According to Japanese Circulation Society guidelines, CS-ACS (n=48) was diagnosed with or without a pharmacological provocation test (n=34 and n=14, respectively). Obstructive coronary artery-induced ACS (OC-ACS; n=292) was defined as ACS with a culprit lesion showing 99% stenosis or >75% stenosis with plaque rupture or thrombosis observed via angiographic and intravascular imaging. Ischemic ECG findings included ST-segment deviation (elevation or depression) and negative T and U waves. In CS-ACS, the prevalence of ST-segment deviation decreased significantly from PH-ECG to emergency room (ER) ECG (77.0% vs. 35.4%; P<0.001), as did the prevalence of overall ECG abnormalities (81.2% vs. 45.8%; P<0.001). Conversely, in OC-ACS, there was a similar prevalence on PH-ECG and ER-ECG of ST-segment deviations (94.8% vs. 92.8%, respectively; P=0.057) and abnormal ECG findings (96.9% vs. 95.2%, respectively; P=0.058). Patients with abnormal PH-ECG findings that disappeared upon arrival at hospital without ER-ECG or troponin abnormalities were more frequent in the CS-ACS than OC-ACS group (20.8% vs. 1.0%; P<0.001). PH-ECG is valuable for detecting abnormal ECG findings that disappear upon arrival at hospital in CS-ACS patients.

Cardiovascular events in estimated glomerular filtration rate-mutation non-small-cell lung cancer patients on osimertinib

ObjectivesThere have been cases of cardiotoxicity induced by osimertinib in patients with non-small-cell lung cancer (NSCLC). However, limited data exist for a comprehensive cardiotoxicity profile analysis for osimertinib use in...

Clinical predictive value of PD-1/PD-L1-induced electrocardiogram changes for cardiotoxicity

Objective: To observe the electrocardiogram (ECG) changes of programmed death receptor 1 (PD-1)/programmed death receptor-ligand 1 (PD-L1) immune checkpoint inhibitors before and after immunotherapy of patients during clinical antitumor process, and to explore the occurrence and influencing factors of cardiotoxicity of immune checkpoint inhibitors. Methods: A total of 93 patients with locally advanced or metastatic solid tumors confirmed by pathological diagnosis in Cancer Hospital of Chinese Academy of Medical Sciences from October 1, 2019 to September 30, 2020 were selected and treated with PD-1/PD-L1 inhibitor monotherapy. Groups were divided according to immunotherapy regimen: Group A (drug code: 609A), 16 patients were given 1 mg/kg of the drug for 21 days; Group B (drug code: HX008), 23 patients were treated with 200mg for 21 days; Group C (drug code: GB226), 28 patients were treated with 3mg/kg for 14 days; Group D (drug code: LP002), 26 patients were treated with 900mg for 14 days. The patients were monitored and followed up for 10 cycles. The ECG results of each group were recorded, and the correlation between ECG abnormality and cardiotoxicity was analyzed. Results: A total of 75 patients showed abnormal ECG that met the diagnostic criteria. There was no significant difference in abnormal ECG rate after immunotherapy in group A (P＞0.05), while the incidence of adverse cardiac events increased after immunotherapy in group B (P＜0.05), and the abnormal ECG rate increased significantly after chemotherapy in group C and group D. There was statistical difference before and after immunotherapy (P＜0.001). The number of abnormal cases in group A (8 cases, 50.0%, 8/16) was significantly lower than that of group B (20 cases, 87.0%, 20/23). The number of abnormal cases in group C and group D was 24 (85.7%) and 23 (88.4%), respectively, without statistical difference (P＞0.05), but their abnormal rates of ECG were higher than that in group A. The incidence of electrical adverse events in immunotherapy center of patients with underlying diseases was 1.93 times higher than that of patients without underlying diseases. The incidence of central electrical adverse events during immunotherapy in group B, C and D was 6.667, 6.000 and 7.667 times higher than that in group A, respectively. Conclusions: The high sensitivity of early ECG changes induced by immune checkpoint inhibitors enables early prediction of related cardiotoxicity. The presence or absence of comorbid underlying disease and drug dosage are correlated with the occurrence of adverse cardiac events, and these early changes provide a evidence for clinical treatment and prevention.

Association between exposure to greenspace and ECG abnormalities in China: a nationwide longitudinal study

BackgroundGreenspace is an important modifiable environmental factor that is associated with health and well-being. Although previous research has shown that exposure to greenspace is beneficial for cardiovascular diseases, studies have rarely focused on early subclinical health outcomes such as electrocardiogram (ECG) abnormality.MethodsWe developed a longitudinal study using data from the China National Stroke Screening Survey (2013–2019). Monthly exposure to greenspace was assessed by the Normalized Difference Vegetation Index (NDVI) values. ECG abnormality was diagnosed by physicians based on the results of the 12-lead electrocardiogram. We used fixed-effects logistic regression with participant-specific intercepts to estimate the association between exposure to greenspace and ECG abnormalities.ResultsA total of 132,108 visits from 61,029 participants with ≥ 2 ECG measurements were included. At baseline, the lag-1 month average NDVI value was 0.29 (SD = 0.15). In the fully adjusted model, per 0.1-unit increment in lag-1 month average NDVI value was associated with a 3.0% (95% CI -1.6 ∼ 7.4%) decreased risk of ECG abnormality. In urban areas, the decreased risk associated with per 0.1-unit increment in NDVI was 14.81% (95% CI 9.38 ∼ 19.92%).ConclusionOur study found that higher exposure to greenspace was associated with a decreased risk of ECG abnormality, especially in urban areas. Our findings suggested that monthly exposure to greenspace might be beneficial to cardiovascular health, and greenspace provision and maintenance could be considered an important public health intervention in urban planning.

Analysis of factors affecting health status and abnormal lung function of workers exposed to welding fumes in Tianjin from 2020 to 2022

Objective: To investigate the health status and the influencing factors of abnormal lung function of welding fumes exposure workers in Tianjin from 2020 to 2022, and to provide theoretical basis for the protection and intervention of key occupational diseases. Methods: In October 2023, the relevant data of occupational health examination of welding fumes exposure workers in Tianjin from 2020 to 2022 (10831, 10758 and 21717 in 2020, 2021 and 2022, respectively) were collected from the China Disease Prevention and Control Information Platform. The electrocardiogram, chest radiograph and lung function abnormalities of workers in each year were analyzed, as well as the association between lung function abnormalities and gender, age, working age, region, etc. With gender, age and years of service as independent variables, logistic regression analysis was performed year by year on the influencing factors of abnormal lung function. Results: From 2020 to 2022, electrocardiogram, chest radiograph and lung function abnormality rates of workers exposed to welding fumes had statistical significances (χ(2)=301.79, 7.87, 1614.54, P<0.05), and the lung function abnormality rate showed a downward trend year by year (χ(2)(trend)=1516.19, P<0.001). The abnormal rates of lung function in male workers exposed to welding fumes were higher than those in female workers (χ(2)=61.65, 8.04, 15.22, P<0.05). With the increase of age, the abnormal rate of lung function showed an increasing trend (χ(2)(trend)=6.47, 10.81, 4.72, P<0.05). The abnormal rates of lung function in the four districts around the city in each year were 22.05% (318/1442), 8.91% (171/1919) and 6.48% (273/4212), respectively. Year by year logistic regression analysis showed that females were the protective factors for abnormal lung function (OR=0.369, 0.568, 0.546; 95%CI: 0.298-0.458, 0.367-0.879, 0.388-0.767; P<0.05) . Conclusion: Attention should be paid to the health status of welding fumes workers in Tianjin, focusing on the protection of middle-aged male workers, and effective prevention measures should be taken for key areas and industries such as the four districts around the city.