Analyzable Time Research Articles

Prevalence of Subclinical Atrial Fibrillation in Heart Failure With Preserved Ejection Fraction

BackgroundAtrial fibrillation (AF) is common in patients with heart failure with preserved ejection fraction (HFpEF) and is associated with poorer clinical outcomes. The prevalence of subclinical AF in patients with HFpEF remains unknown. ObjectivesThe aim of this study was to determine whether subclinical AF was more prevalent in individuals with HFpEF than in individuals without histories of heart failure (HF). MethodsPatients with HFpEF with no prior diagnoses of AF were screened for subclinical AF, and the prevalence of subclinical AF was compared with that among control subjects without HF drawn from MESA (Multi-Ethnic Study of Atherosclerosis) who underwent the same electrocardiographic monitoring. Multivariable logistic regression was used to adjust for demographic and clinical comorbidities. ResultsNinety patients with HFpEF and 1,230 MESA participants were included. Patients with HFpEF were younger (median age 69 years [Q1-Q3: 63-76 years] vs 72 years [Q1-Q3: 66-80 years]; P = 0.02), more obese (median body mass index 36 kg/m2 [Q1-Q3: 30-45 kg/m2] vs 27 kg/m2 [Q1-Q3: 24-30 kg/m2]; P < 0.001), and more likely to have diabetes (34% vs 21%; P = 0.01). The prevalence of subclinical AF was 8.9% in patients with HFpEF and 4.1% in non-HF participants. After multivariable adjustment for age, sex, race, body mass index, diabetes, smoking, and total analyzable time on electrocardiographic monitor, there was a significantly higher odds of subclinical AF in patients with HFpEF compared with MESA (OR: 3.01; 95% CI: 1.13-7.99; P = 0.03). ConclusionsPatients with HFpEF had a higher prevalence of subclinical AF than participants without HF from a community-based study. Screening for atrial arrhythmias may be appropriate among patients with HFpEF for timely initiation of thromboembolic prophylaxis and may identify individuals at greater risk for clinical decompensation.

Feasibility and safety of a single patch-based device for 30 days of continuous, uninterrupted ambulatory ecg monitoring

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): iRhythm Technologies, Inc. Background 14-day continuous ambulatory ECG monitoring (AEM) has been shown to have superior diagnostic yield to traditional 48-hour Holter monitoring for paroxysmal or undiagnosed atrial fibrillation and a wide range of clinical arrhythmias. 30-day recordings are typically from event recorders (non-continuous) and require frequent adhesive/electrode and battery replacement, all of which can impair patient compliance, wear time, and diagnostic yield. A new, uninterrupted patch-based AEM with next-generation breathable adhesive, storage, and battery life has received FDA clearance for 14-day wear. We evaluated the safety and feasibility of using this device for 30-days of continuous AEM. Methods We enrolled 30 participants with indications for AEM and applied a single Zio Monitor device for 30-days and analyzed wear time, analyzable time, and diagnostic yield, compared to with Zio Monitor 14-day use and with our standard, previous-generation product. Results In the cohort (76% female, 35% non-white, age 37±9 years, BMI 30.6±6.8), the median wear time was 29 continuous days (IQR 28-30) with no device changeouts and no clinically significant skin irritation. Although median analyzable times were high and similar across the previous (XT) and next-generation (Monitor) devices, the mean was significantly higher with Monitor, indicating fewer outliers that experienced premature termination of wear time. Arrhythmia yield (AF ≥30 sec, SVT ≥90 bpm &amp; ≥4 bt, VT ≥100 bpm &amp; ≥4 bt, inc PVT/TdP/VF, Pause ≥3 s, and/or AVB (any 2nd Deg or CHB) was significantly higher with the new Zio Monitor Device compared to Zio XT (80.9% vs 77.1%; p=0.017). Conclusion The application of a single, continuous, patch-based AEM for 30 days without adhesive (electrode) or battery replacement is feasible and safe. Analyzable time was high for 14-day and 30-day wear. The uninterrupted wear time and high compliance could lead to higher diagnostic yield than with traditional 30-day event recorders.

Comparison of data quality and monitoring completion rates between clinic and self-applied ECG patches

Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, direct-to-patient, self-applied ECG patch use has substantially increased. There are limited data comparing clinic with self-applied electrocardiogram (ECG) patches. The purpose of this study was to compare rates of ECG patch return, percentages of time patches yielded analyzable data (analyzable time), and percentages of prescribed time ECG patches were worn between clinic and self-applied ECG patches before and during COVID-19. A retrospective analysis of patients prescribed an ECG patch during "pre-COVID" (March 1, 2019, through March 1, 2020) and "COVID" (April 4, 2020, through April 1, 2021) years was performed. ECG patch return rates, mean percentages of analyzable time, and mean percentages of prescribed wear time were compared between clinic and self-applied groups. Among the 29,093 ECG patch prescriptions (19% COVID self-applied), the COVID self-applied group had a lower return rate (90.8%) than did both clinic-applied groups (COVID: 97.1%; pre-COVID: 98.1%; P < .001). Among the 28,048 ECG patches (17.5% self-applied) returned for analysis, the COVID self-applied group demonstrated a lower mean percentage of analyzable time (95.9% ± 8.2%) than did both clinic-applied groups (COVID: 96.6% ± 6.6%; pre-COVID 96.6% ± 7.4%; P < .001). There were no differences in the mean percentage of prescribed wear time between groups (pre-COVID clinic-applied: 96.7% ± 34.3%; COVID clinic-applied: 97.4% ± 39.8%; COVID self-applied: 98.1% ± 52.1%; P = .09). Self-applied ECG patches were returned at a lower rate and had a statistically lower percentage of analyzable time than clinic-applied patches. However, there were no differences between groups in mean percentages of prescribed wear time, and mean percentages of analyzable time were >95% in all groups.

Abstract 14871: Ambulatory Cardiac Rhythm Monitoring in Individuals With Chronic Kidney Disease

Introduction: Chronic kidney disease (CKD) is associated with arrhythmias such as atrial fibrillation (AF) and sudden cardiac death, but limited rigorous data exist on the prevalence of AF, ventricular tachycardia (VT), nonsustained VT (NSVT), and high-degree atrioventricular (AV) block in a CKD cohort. Hypothesis: In participants with CKD, worse kidney function is associated with a higher burden of atrial and ventricular arrhythmias. Methods: We evaluated the prevalence of AF, VT, NSVT, and high degree AV block in participants in the Chronic Renal Insufficiency Cohort (CRIC) Study who underwent monitoring using the ZIO XT patch, a noninvasive, 14-day continuous single-lead electrocardiogram monitor. We evaluated patient characteristics and the association between kidney function and each arrhythmia. Results: Among 1182 participants (mean age 69±9 years; 48% women), mean patch wear time was 11.9±3.8 days, and mean analyzable time was 95±11%. AF was detected in 82 (7.4%) participants, with AF burden (% time spent in AF) ranging from 0.1% to 100%, and the majority had long-standing, persistent AF. Participants with AF were older (74 vs 69 years, p&lt;0.001), had a higher prevalence of cardiovascular disease including prior MI and heart failure (48% versus 34%, p&lt;0.05); and had a higher body mass index (34 vs 32 kg/m 2 ; p&lt;0.05) than those without AF. NSVT occurred in 31% of participants, while no participant experienced sustained VT. High-degree AV block was present 2 participants (&lt;1%). Overall, pre-monitoring mean estimated glomerular filtration rate was 51±18 ml/min/1.73m2, and median urine albumin-to-creatinine ratio was 9.2 [4.4 - 44.6] mg/g. Kidney function or proteinturia were not independently associated with any of the arrhythmias. Conclusions: In adults with CKD undergoing 14-day continuous monitoring, AF was present in 1 in 14 indivduals, and nearly one-third had evidence of NSVT. Worsening kidney function was not independently associated with the prevalence of arrhythmias in this cohort. Future studies will need to assess the signficance of NSVT on cardiovascular events across the spectrum of CKD severity.

Arrhythmia Assessment With 30-day MCT Patch Challenges Traditional Holter Monitoring

<h3>Introduction</h3> : Delayed diagnosis of episodic and asymptomatic arrhythmias can lead to adverse outcomes, especially for patients in the outpatient setting. Ambulatory Holter monitoring has been a cornerstone for diagnosing arrhythmias. While a traditional Holter records ECG signal for 24-48 hrs, the mobile cardiac telemetry (MCT) patch allows real-time ECG monitoring for up to 30 days. An MCT patch provides the ability to analyze long-term ECG data in real-time for timely and improved diagnosis. <h3>Objective</h3> : This study aims to identify if cardiac monitoring with a 30-day MCT patch provides better patient outcome than with the 24-hr Holter. To do so, we compared the arrhythmia and ectopy diagnostic yield of both modalities. <h3>Methods</h3> : A retrospective study was designed to analyze data recorded from 14,514 patients (male-43%, female-57%, median age-64 years) who were prescribed to be monitored with Zywie ECG monitors (Zywie, Inc., Georgia). The mean ECG analyzable time from 12,974 patients who used Holter and 1,540 patients who used MCT patch was 18.60±1.07 hrs and 28.2±2.4 days, respectively. We evaluated data to find the incidences of ectopic beats, including premature atrial contraction (PAC) and premature ventricular contraction (PVC), and any of 5 arrhythmias, including, sinus bradycardia (SB), sinus tachycardia (ST), atrial fibrillation (AF), pause, and ventricular tachycardia (VT). <h3>Results</h3> : Fig.1 suggests that the mean arrhythmia diagnostic yield of 38.1% in 30-day MCT studies is significantly different from 29.1% in 24-hr Holter studies (<i>p< 0.001</i>). We also analyzed the dataset to identify patients in which at least one arrhythmia was identified excluding SB and ST events. We identified 25% critical arrhythmias (excluding SB and ST) in patients with MCT patches in contrast to 9.6% in Holter. Fig. 2 shows that PVC beats were identified in 85.9% and 65.7%, whereas PAC beats in 92.3% and 78.2% of MCT and Holter studies, respectively. <h3>Conclusion</h3> : Results demonstrate that 30-day monitoring with MCT patch provides a better diagnostic yield than 24-hr Holter monitoring. Timely diagnosis with MCT patch can aid in early therapeutic intervention resulting in better patient care.

A pilot study of patch Holter electrocardiograph recordings in healthy cats.

Background:A patch Holter electrocardiograph (P-Holter) is cordless, making it lightweight, unlike the conventional Holter electrocardiograph (C-Holter). A P-Holter can also take continuous measurements for up to 14 days without replacing the battery or SD card.Aim:To compare the performance of the P-Holter and the C-Holter in healthy cats. Additionally, we aimed to investigate whether multiday recordings with the P-Holter decrease sympathetic nerve activity or improve the accuracy of arrhythmia detection.Methods:Five healthy domestic short-haired cats were used for this study. Both a P-Holter and C-Holter were used on the first day, but only the P-Holter was used on days 2–6. The evaluated variables were the analyzable time of both Holter types, heart rate (HR), HR variability (HRV), and the number of arrhythmia occurrences.Results:For two out of the five cats, measurement of P-Holter was interrupted. Eventually, continuous recordings using the P-Holters were able to be collected from all individuals for 6 days. The 24 hours analyzable time from the P-Holter and C-Holter was almost identical (p = 0.94). The 24 hours mean HR did not differ across Holter types (p = 0.67). In addition, the timing of the occurrences of arrhythmias was almost identical to the P-Holter and C-Holter. Results of HRV suggested that sympathetic nerve activity was likely to decrease and vagal nerve activity was likely to increase after 4–5 days of measurement, compared to the second day of measurement (p < 0.05). When only the P-Holter was installed, the number of arrhythmia occurrences was similar on days 2–6.Conclusion:In this study, the P-Holter may be as useful as the C-Holter in cats with suspected intermittent arrhythmias, although the P-Holters were placed on cats without a clinical indication. However, cats may have individual differences in their adaptation to the device. P-Holter recordings taken for more than 4–5 days may allow the cat to acclimate to the device and reduce sympathetic nerve activity. The accuracy of arrhythmia detection across multiday P-Holter recordings requires further investigation using clinical cases.

Abstract 10057: Subclinical Atrial Fibrillation is More Prevalent in Heart Failure with Preserved Ejection Fraction Compared to the General Population

Introduction: Atrial fibrillation (AF) is a common in patients with heart failure with preserved ejection fraction (HFpEF), and is associated with higher filling pressures, reduced exercise capacity, and reduced survival. The prevalence of subclinical AF in HFpEF remains unknown. Hypothesis: We hypothesized that subclinical AF was more prevalent in individuals with HFpEF when compared to individuals without clinical heart failure history. Methods: We evaluated subclinical AF in 101 HFpEF patients with no prior diagnosis of clinical AF using 14 day ambulatory ECG patch monitoring (Ziopatch XT, iRhythm Technologies). We compared the prevalence of subclinical AF in HFpEF with controls drawn from 3303 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) exam 6 follow-up, excluding those with known heart failure or high H2FpEF score who underwent the same ECG patch monitoring. Case-control comparisons of participants between the ages of 55 to 93 years were performed using multivariable logistic regression to adjust for demographic and clinical comorbidities, as well as patch monitoring duration. Results: 80 HFpEF patients and 1356 MESA participants were included. The HFpEF patients were younger (69 [63, 76] v. 72 [66, 80], p=0.02), more obese (BMI of 36 [30, 45] v. 27 [24, 30], p&lt;0.001) and more likely to have diabetes (34 v. 21%, p=0.01). There was a higher proportion of African Americans in the HFpEF group (57.5 v. 22.8%, p&lt;0.001). The prevalence of subclinical AF was 9.8% in HFpEF group and 6.2% in MESA participants. After multivariable adjustment for age, sex, race, body mass index, hypertension, diabetes, smoking pack-years and total analyzable time on ECG monitor there was a significantly higher odds of subclinical AF in HFpEF compared to MESA (OR 4.26 [1.2, 16.2], p=0.03). Conclusions: HFpEF patients have a higher prevalence of subclinical AF than the general population. Screening for atrial arrhythmias may be appropriate in HFpEF patients for timely initiation of thromboembolic prophylaxis, and may identify individuals at greater risk for clinical decompensation in light of the well documented risks associated with AF in HFpEF.

Association between human immunodeficiency virus serostatus and the prevalence of atrial fibrillation.

Atrial fibrillation (AF) leads to increased risk for stroke. Human immunodeficiency virus (HIV) is associated with cardiovascular disease (CVD), although it is unclear if HIV is associated with AF. The purpose of this study was to evaluate the association between HIV serostatus and the prevalence of AF in the Multicenter AIDS Cohort Study.A cross sectional study was conducted among 1674 HIV-infected (HIV+) and uninfected (HIV–) men who completed resting 12-lead electrocardiograms, and/or ambulatory electrocardiogram monitoring. Multivariable logistic regression was used to evaluate the association between AF, defined as the presence of either AF or atrial flutter, and HIV+ serostatus. Associations were adjusted for demographic variables, and then also for CVD risk factors.HIV+ men were younger than HIV– men (median 55.5 vs 61.7 years, P < .001) and were more frequently African-American (30.5% vs 17.8%, P < .001). Most HIV+ men (81%) had undetectable viral load. The age and race adjusted prevalence of AF was 3.0% in HIV+ and 3.3% in HIV– men. There was only 1 case of AF among African-American men. There were no associations between AF and HIV serostatus after adjusting for demographic factors (odds ratio 0.76; 95% CI 0.37 to –1.58; P = .47) or after further adjustment for CVD risk factors (odds ratio 0.84; 95% CI 0.39 to –1.81; P = .66).We found no association between HIV and AF in this cohort in which viral replication among the HIV+ men is generally suppressed. The overall prevalence of AF was low and was rare in African-American men.

Frequent Premature Atrial Contractions Are Associated With Poorer Cognitive Function in the Atherosclerosis Risk in Communities (ARIC) Study

ObjectiveTo evaluate the association of premature atrial contraction (PAC) frequency with cognitive test scores and prevalence of dementia or mild cognitive impairment (MCI). Materials and MethodsWe conducted a cross-sectional analysis using Atherosclerosis Risk in Communities study visit 6 (January 1, 2016, through December 31, 2017) data. We included 2163 participants without atrial fibrillation (AF) (age mean ± SD, 79±4 years; 1273 (58.9%) female; and 604 (27.97.0% Black) who underwent cognitive testing and wore a leadless, ambulatory electrocardiogram monitor for 14 days. We categorized PAC frequency based on the percent of beats: less than 1%, minimal; 1% to <5%, occasional; greater than or equal to 5%, frequent. We derived cognitive domain-specific factor scores (memory, executive function, language, and global z-score). Dementia and MCI were adjudicated. ResultsDuring a mean analyzable time of 12.6±2.6 days, 339 (15.7%) had occasional PACs and 107 (4.9%) had frequent PACs. Individuals with frequent PACs (vs minimal) had lower executive function factor scores by 0.30 (95% CI, -0.46 to -0.14) and lower global factor scores by 0.20 (95% CI, -0.33 to -0.07) after multivariable adjustment. Individuals with frequent PACs (vs minimal) had higher odds of prevalent dementia or MCI after multivariable adjustment (odds ratio, 1.74; 95% CI, 1.09 to 2.79). These associations were unchanged with additional adjustment for stroke. ConclusionIn community-dwelling older adults without AF, frequent PACs were cross-sectionally associated with lower executive and global cognitive function and greater prevalence of dementia or MCI, independently of stroke. Our findings lend support to the notion that atrial cardiomyopathy may be a driver of AF-related outcomes. Further research to confirm these associations prospectively and to elucidate underlying mechanisms is warranted.

Serum magnesium and burden of atrial and ventricular arrhythmias: The Atherosclerosis Risk in Communities (ARIC) Study

IntroductionLow serum magnesium (Mg) is associated with an increased incidence of atrial and ventricular arrhythmias. A richer phenotyping of arrhythmia indices, such as burden or frequency, may provide etiologic insights. ObjectivesTo evaluate cross-sectional associations of serum Mg with burden of atrial arrhythmias [atrial fibrillation (AF), premature atrial contractions (PAC), supraventricular tachycardia (SVT)], and ventricular arrhythmias [premature ventricular contractions (PVC), non-sustained ventricular tachycardia (NSVT)] over 2-weeks of ECG monitoring. MethodsWe included 2513 ARIC Study visit 6 (2016–2017) participants who wore the Zio XT Patch—a leadless, ambulatory ECG-monitor—for up to 2-weeks. Serum Mg was modeled categorically and continuously. AF burden was categorized as intermittent or continuous based on the percent of analyzable time spent in AF. Other arrhythmia burdens were defined by the average number of abnormal beats per day. Linear regression was used for continuous outcomes; logistic and multinomial regression were used for categorical outcomes. ResultsParticipants were mean ± SD age 79 ± 5 years, 58% were women and 25% black. Mean serum Mg was 0.82 ± 0.08 mmol/L and 19% had hypomagnesemia (<0.75 mmol/L). Serum Mg was inversely associated with PVC burden and continuous AF. The AF association was no longer statistically significant with further adjustment for traditional lifestyle risk factors, only the association with PVC burden remained significant. There were no associations between serum Mg and other arrhythmias examined. ConclusionsIn this community-based cohort of older adults, we found little evidence of independent cross-sectional associations between serum Mg and arrhythmia burden.

Fast-Track Long Term Continuous Heart Monitoring in a Stroke Clinic: A Feasibility Study.

Background: Paroxysmal atrial fibrillation (PAF) or flutter is prevalent among patients with cryptogenic stroke. The goal of this study was to investigate the feasibility of incorporating a fast-track, long term continuous heart monitoring (LTCM) program within a stroke clinic.Method: We designed and implemented a fast-track LTCM program in our stroke clinics. The instrument that we used for the study was the ZioXT® device from IRhythm™ Technologies. To implement the program, all clinic support staff received training on the skin preparation and proper placement of the device. We prospectively followed every patient who had a request from one of our inpatient or outpatient stroke or neurology providers to receive LTCM. We recorded patients' demographics, the LTCM indication, as well as related quality measures including same-visit placement, wearing time, analyzable time, LTCM application to the preliminary finding time, as well as patients' out of pocket cost.Results: Out of 501 patients included in the study, 467 (93.2%) patients (mean age 65.9 ± 13; men: 48%) received LTCM; and 92.5% of the patients had the diagnosis of stroke or TIA. 93.7% of patients received their LTCM during the same outpatient visit in the stroke clinic. The mean wearing time for LTCM was 12.1 days (out of 14 days). The average analyzable time among our patients was 95.0%. Eighteen (3.9%, 95%CI: 2.4–6.0) patients had at least one episode of PAF that was sustained for more than 30 s. The rate of PAF was 5.9% (95% CI: 3.5–9.2) among patients with the diagnosis of stroke. Out of 467 patients, 392 (84%) had an out-of-pocket cost of < $100.Conclusion: It is feasible to implement a fast-track cardiac monitoring as part of a stroke clinic with proper training of stroke providers, clinic staff, and support from a cardiology team.

Preliminary Assessment of a Novel 14-Day Electrocardiographic Adhesive Patch Monitor in Dogs.

Cardiac arrhythmias often are transient and might not be detected using conventional electrocardiographic (ECG) techniques. The adhesive patch monitor (APM) is a single-lead, lightweight, up to 14-day continuous ambulatory ECG monitor. This study aimed to prospectively assess its usability in four boxer dogs considered either to be healthy or to have arrhythmogenic right ventricular cardiomyopathy. Optimal recording was obtained by placing the APM on the left side of the animal's thorax, at the fifth intercostal space, slightly dorsal to the costochondral junction, and oriented either vertically or parallel to the long axis of the heart. In three dogs, the APM remained attached for 14 days. One dog removed the APM after 59 hr. Skin irritation was documented in all dogs and resolved spontaneously after removal of the APM. The analyzable time was >93% of the total wear time and recordings provided an unambiguous rhythm diagnosis at rest. Walking, running, or playing caused intermittent motion artifact that could impair ECG interpretation. APM results were comparable to those obtained with 24-hr Holter monitoring. Extended continuous ECG monitoring with the APM is feasible in boxer dogs and provides interpretable recordings.

Влияние Арктического колебания на температурный режим восточной части Балтийского региона

Statistical estimations of Arctic Oscillation (AO) impact on air temperature regime in the Eastern part of Baltic region are presented. The region is characterized by high inter-annual and inter-seasonal variabilities. It is important to note that in the region of global warming extremely low winter temperatures can be observed on the European territory of Russia. AO is one of large-scale global structures of atmospheric circulation closely associated with weather variability in Northern Europe. AО anomalies occur in the upper atmosphere (stratosphere) and only then transferred to tropospheric lower layers. The anomalies can be preserved during long period up to two months, so they can be predictors in long-range weather forecast. In turn, changes in stratospheric polar vortex and sudden stratospheric warmings can be related to the geomagnetic activity. Perhaps, the geomagnetic activity influences the meridional temperature gradient and then changes in the structure of the stratospheric zonal wind. In turn, the changes have an impact on the tropospheric circulation. The stratosphere–troposphere connection occurs during winter months. Therefore, the paper presents the analysis of extremely cold winter anomalies in the Eastern part of Baltic Sea region. At the same time, we considered atmospheric circulation peculiarities related to AO phase change. The analyzable time interval covers 1951–2014.

Incidence and timing of potentially high-risk arrhythmias detected through long term continuous ambulatory electrocardiographic monitoring.

BackgroundAmbulatory electrocardiographic (ECG) monitoring is the standard to screen for high-risk arrhythmias. We evaluated the clinical utility of a novel, leadless electrode, single-patient-use ECG monitor that stores up to 14 days of a continuous recording to measure the burden and timing of potentially high-risk arrhythmias.MethodsWe examined data from 122,815 long term continuous ambulatory monitors (iRhythm ZIO® Service, San Francisco) prescribed from 2011 to 2013 and categorized potentially high-risk arrhythmias into two types: (1) ventricular arrhythmias including non-sustained and sustained ventricular tachycardia and (2) bradyarrhythmias including sinus pauses >3 s, atrial fibrillation pauses >5 s, and high-grade heart block (Mobitz Type II or third-degree heart block).ResultsOf 122,815 ZIO® recordings, median wear time was 9.9 (IQR 6.8–13.8) days and median analyzable time was 9.1 (IQR 6.4–13.1) days. There were 22,443 (18.3 %) with at least one episode of non-sustained ventricular tachycardia (NSVT), 238 (0.2 %) with sustained VT, 1766 (1.4 %) with a sinus pause >3 s (SP), 520 (0.4 %) with a pause during atrial fibrillation >5 s (AFP), and 1486 (1.2 %) with high-grade heart block (HGHB). Median time to first arrhythmia was 74 h (IQR 26–149 h) for NSVT, 22 h (IQR 5–73 h) for sustained VT, 22 h (IQR 7–64 h) for SP, 31 h (IQR 11–82 h) for AFP, and 40 h (SD 10–118 h) for HGHB.ConclusionsA significant percentage of potentially high-risk arrhythmias are not identified within 48-h of ambulatory ECG monitoring. Longer-term continuous ambulatory ECG monitoring provides incremental detection of these potentially clinically relevant arrhythmic events.

Abstract 11721: Feasibility of Using a Leadless Patch Heart Rhythm Monitor to Measure Atrial Fibrillation Burden in Community-Based Epidemiological Studies: The Multiethnic Study of Atherosclerosis (MESA)

Background: Whether or not higher atrial fibrillation (AF) burden (% time a person is in AF) is associated with higher risk of adverse outcomes such as stroke remains controversial. Research on AF burden in community-based studies has been hampered by lead-based heart rhythm monitors that only record continuously for short durations and have poor patient compliance. Hypothesis: We hypothesized that it is feasible to use a novel leadless patch monitor (Zio ® Patch [iRhythm Technologies, Inc, San Francisco, CA] that can record continuously for 2 weeks) to investigate AF burden in a sample of MESA participants. Methods: Between November 2013 and January 2014, we included 45 (mean age, 71.6 ± 6.2 years; 58% men) participants at the Minnesota field center without prior diagnoses or symptoms suggestive of AF or other arrhythmias; 30 and 15 were randomized to self-application (Group 1) and application by MESA staff (Group 2), respectively. Monitors were mailed to Group 1 and were applied at the field centers by MESA staff for Group 2 participants. We compared the wear time and analyzable time between the 2 groups. Results: The mean and median wear and analyzable times were not significantly different between the 2 groups (Table). Only 1 participant in Group 1 wore the monitor for &lt;2 days. Two (4%) participants were diagnosed by the monitor with AF (1 with burden of 0.02% and 1 with burden of 1.34%) and 1 with frequent non-sustained ventricular tachycardia; all participants were referred to their physicians for appropriate treatment and none suffered serious consequences. Conclusions: A leadless continuous recording patch monitor can be used effectively to investigate AF burden in asymptomatic subjects in community-based studies. Self-application of the monitor is equivalent to application by research staff which further facilitates the use of this monitor in community-based studies.

Time Series-Based School Sports System Form Reformation Research

With Chinese reform and opening-up, Chinese society gains stable development, economy rapidly grows, and Chinese sports also go through a series of reforms. The paper carries on time series analysis of sports reformation form of Chinese regular institutions of higher learning, it lists events changing situation in accordance with time, and con- structs an analyzable time series. Then we go ahead with effective observation and research on time series, find out its corresponding changes and development law. From documents, educational to relevant colleges sports system, all are in the rising trend with time changes, and system documents rising trend is the largest, though relevant colleges sports has certain rising trends, by comparing, its rising trend is the smallest. Then analyze problems that colleges sports reformation process come across to make statistics, it is clear that the top three with larger influences are respectively teacher's confusion with reformation purposes, teachers feel that reformation is not good for them, allocated sports reformation funds is deficient.

Abstract W P191: Patient Compliance High with Long-Term Continuous ECG Monitor

Introduction: Long term ECG monitoring to detect atrial fibrillation in a cryptogenic stroke is now the emerging standard of care. The advent of patch based ECG monitors raises the question of patient compliance with this new modality. Hypothesis: We assessed the hypothesis that patient compliance, as measured by Leads-On detection for patch based ECG monitoring, is constant over time. Methods: We performed a retrospective analysis from ZIO® Patch (Patch) devices (iRhythm, San Francisco, CA). The Patch is a continuous recording single lead ECG monitor that can be worn for up to 14 days. The primary endpoint of Leads-On is the percentage of time the device is applied to the patient during the wear period, which was derived from a second channel in the device. The data are gathered by ZEUS software and exported in a CSV file. The compliance data were analyzed overall and in categories at days: 0-1, 1-2, 2 to 7, &gt;7 to 10 and &gt;10 to 14. A secondary endpoint, percent Analyzable Time (percentage of ECG record that was available for detection by the algorithm during the wear period and signifies signal quality), was assessed for the same time increments. Results: The dataset consisted of 18,885 records. The total wear time ranged from 0.10 up to 14.01 days, with a median of 12.51. The medians and interquartile ranges for the percent Leads On and percent of Analyzable Time were 100% (99.99-100%) and 97.99% (94.64-99.26%). In Table 1, the interquartile ranges for percent Leads On and Analyzable Time was wider when the Patch was worn less than a day, but remains above 74%. Total wear time in days n Percent Leads On Percent Analyzable Time Median Interquartile Range Median Interquartile Range 0.10-&lt;1 105 99.65 86.52-100 92.86 74.19-96.97 1-&lt;2 407 100 99.88-100 97.37 90.96-99.02 2-&lt;7 4124 100 100-100 97.96 94.3-99.26 7-&lt;10 2963 100 99.98-100 97.79 94.33-99.19 10+ 11286 100 100-100 98.07 95.00-99.29 Conclusion: Patient compliance with long term ECG patch monitors is high as measured by Leads-On detection. High patient compliance results in a large volume of quality ECG. Further study is needed to compare patient compliance with ECG patch based monitors with other monitoring modalities, particularly in the cryptogenic stroke population.

Diagnostic Yield of Extended Cardiac Patch Monitoring in Patients with Stroke or TIA.

Background: It is important to evaluate patients with transient ischemic attack (TIA) or stroke for atrial fibrillation (AF) because the detection of AF changes the recommended anti-thrombotic regimen from treatment with an antiplatelet agent to oral anticoagulation. This study describes the diagnostic yield of a patch-based, single-use, and water-resistant 14-day continuous cardiac rhythm monitor (ZIO Patch) in patients with stroke or TIA.Methods: We obtained data from the manufacturer and servicer of the ZIO Patch (iRhythm Technologies). Patients who were monitored between January 2012 and June 2013 and whose indication for monitoring was TIA or stroke were included. The duration of monitoring, the number and type of arrhythmias, and the time to first arrhythmia were documented.Results: One thousand one hundred seventy-one monitoring reports were analyzed. The mean monitor wear time was 10.9 days and the median wear time was 13.0 days (interquartile range 7.2–14.0). The median analyzable time relative to the total wear time was 98.7% (IQR 96.0–99.5%). AF was present in 5.0% of all reports. The mean duration before the first episode of paroxysmal AF (PAF) was 1.5 days and the median duration was 0.4 days. 14.3% of first PAF episodes occurred after 48 h. The mean PAF burden was 12.7% of the total monitoring duration.Conclusion: Excellent quality of the recordings and very good patient compliance coupled with a substantial proportion of AF detection beyond the first 48 h of monitoring suggest that the cardiac patch is superior to conventional 48-h Holter monitors for AF detection in patients with stroke or TIA.

Abstract 16305: Incidence and Timing of High-Risk Arrhythmias With Long-Term Continuous Ambulatory Electrocardiographic Monitoring

Background: Ambulatory electrocardiographic (ECG) monitoring is the standard of care to screen patients for arrhythmias. However, there is marked variation in the technological features and patient adherence among different ECG monitoring systems. We evaluated a novel adhesive, wireless, single-lead, full-disclosure, up to 14-day ECG monitoring system to measure the burden and timing of high-risk arrhythmias. Methods: We examined data from 122,815 long term continuous ambulatory ECG Monitors. (ZIO® Patch Service, iRhythm Technologies, San Francisco, CA) from 2011-2013 and categorized high-risk arrhythmias into two types: (1) ventricular arrhythmias including non-sustained and sustained ventricular tachycardia and (2) high risk bradyarrhythmias including sinus pauses &gt;3 seconds, atrial fibrillation pauses &gt;5 seconds, and high grade heart block including Mobitz Type II or third-degree heart block. We calculated the proportion of patients with each arrhythmia and the elapsed wear time until each arrhythmia. Results: Of 122,815 Ziopatch recordings, median wear time was 9.9 (IQR 6.8-13.8) days and median analyzable time was 9.1 (IQR 6.4-13.1) days. There were 22,443 (18.3%) with at least one episode of non-sustained ventricular tachycardia (NSVT), 238 (0.2%) with sustained VT, 1,766 (1.4%) with a sinus pause &gt;3 seconds (SP), 520 (0.4%) with a pause during atrial fibrillation &gt;5 seconds (AFP), and 1,486 (1.2%) with high-grade heart block. Median time to first arrhythmia was 74 hours (IQR 26 -149 hours) for NSVT, 22 hours (IQR 5-73 hours) for sustained VT, 22 hours (IQR 7-64 hours) for SP, 31 hours (IQR 11-82 hours) for AFP, and 40 hours (SD 10-118 hours) for high-grade heart block. The yield over time is shown in the Figure 1. Conclusions: A significant percentage of high-risk arrhythmias can be identified by long term continuous monitoring for longer than 24 to 48 hours. The clinical impact from better identification of high-risk arrhythmias warrants further study.

Abstract W MP63: Diagnostic Yield of an Extended Ambulatory Cardiac Rhythm Monitor in Patients With TIA or Stroke

Background: In the evaluation of patients with TIA or stroke, the detection of AF changes the recommended anti-thrombotic regimen from treatment with an antiplatelet agent to oral anticoagulation. Detection of supraventricular tachycardia (SVT) may also be relevant as it is associated with an increased risk of AF. This study describes the feasibility and diagnostic yield of the Zio® Patch, a leadless, single-use, small, lightweight, and water-resistant cardiac rhythm monitor that provides continuous cardiac monitoring for up to 14 days. Methods: We obtained de-identified monitoring data from the manufacturer and servicer of the ZioPatch (iRhythm Technologies). Patients who were monitored between January 2012 and June 2013 and whose indication for monitoring, as entered by the ordering provider, was TIA or stroke were included. The duration of monitoring, the number and type of arrhythmias, and the time to first arrhythmia were documented. AF was defined as R-R irregularity for more than 30 seconds in duration. Results: 1,171 monitoring reports were analyzed. The average patient age was 67.9 years. Fifty-five percent of patients were male. The mean monitor wear time was 10.9 days and the median wear time was 13.0 days (interquartile range 7.2-14.0). The median analyzable time relative to the total wear time was 98.7% (IQR 96.0-99.5%). AF was present in 4.8% of all reports (4.2% PAF and 0.6% chronic AF). The mean duration before the first episode of PAF was 1.5 days and the median duration was 0.4 days. 14.3% of first PAF episodes occurred after 48 hours. The mean PAF burden was 12.7% of the total monitoring duration. SVT of 8 beats or more was present in 51% of the records. Conclusion: Virtually the entire duration of monitoring with the ZioPatch yields analyzable data that allows for the detection of cardiac arrhythmias. Among TIA and stroke patients, AF was present in approximately 5% of the records and SVT in 50%. The first episode of PAF frequently occurred more than 48 hours after the start of monitoring. This suggests that Holter (24-48 hour) monitoring is insufficient and supports extended cardiac monitoring in TIA and stroke patients. Further studies are needed to determine which stroke patients are at greatest risk for AF and to assess the clinical significance of SVT.