Cardiac Rhythm Monitoring Research Articles

Is there a temporal relationship between atrial fibrillation and stroke? A review

ImportanceAtrial fibrillation (AF) is an established risk factor for ischaemic stroke. The introduction of continuous cardiac rhythm monitoring devices has enabled detection of brief and asymptomatic episodes of AF.ObservationsThe search...

Hearables: feasibility of recording cardiac rhythms from single in-ear locations.

The ear is well positioned to accommodate both brain and vital signs monitoring, via so-called hearable devices. Consequently, ear-based electroencephalography has recently garnered great interest. However, despite the considerable potential of hearable based cardiac monitoring, the biophysics and characteristic cardiac rhythm of ear-based electrocardiography (ECG) are not yet well understood. To this end, we map the cardiac potential on the ear through volume conductor modelling and measurements on multiple subjects. In addition, in order to demonstrate real-world feasibility of in-earECG, measurements are conducted throughout a long-time simulated driving task. As a means of evaluation, the correspondence between the cardiac rhythms obtained via the ear-based and standard Lead I measurements, with respect to the shape and timing of the cardiac rhythm, is verified through three measures of similarity: the Pearson correlation, and measures of amplitude and timingdeviations. A high correspondence between the cardiac rhythms obtained via the ear-based and Lead I measurements is rigorously confirmed through agreement between simulation and measurement, while the real-world feasibility was conclusively demonstrated through efficacious cardiac rhythm monitoring during prolonged driving. This work opens new avenues for seamless, hearable-based cardiac monitoring that extends beyond heart rate detection to offer cardiac rhythm examination in the community.

Hospital-Level Variability in Reporting of Ischemic Stroke Subtypes and Supporting Diagnostic Evaluation in GWTG-Stroke Registry.

Secondary prevention of ischemic stroke (IS) requires adequate diagnostic evaluation to identify the likely etiologic subtype. We describe hospital-level variability in diagnostic testing and IS subtyping in a large nationwide registry. We used the GWTG-Stroke (Get With The Guidelines-Stroke) registry to identify patients hospitalized with a diagnosis of acute IS at 1906 hospitals between January 1, 2016, and September 30, 2017. We compared the documentation rates and presence of risk factors, diagnostic testing, achievement/quality measures, and outcomes between patients with and without reported IS subtype. Recording of diagnostic evaluation was optional in all IS subtypes except cryptogenic, where it was required. Of 607 563 patients with IS, etiologic IS subtype was documented in 57.4% and missing in 42.6%. Both the rate of missing stroke pathogenesis and the proportion of cryptogenic strokes were highly variable across hospitals. Patients missing stroke pathogenesis less frequently had documentation of risk factors, evidence-based interventions, or discharge to home. The reported rates of major diagnostic testing, including echocardiography, carotid and intracranial vascular imaging, and short-term cardiac monitoring were <50% in patients with documented IS pathogenesis, although these variables were missing in >40% of patients. Long-term cardiac rhythm monitoring was rarely reported, even in cryptogenic stroke. Reporting of IS etiologic subtype and supporting diagnostic testing was low overall, with high rates of missing optional data. Improvement in the capture of these data elements is needed to identify opportunities for quality improvement in the diagnostic evaluation and secondary prevention of stroke.

Outcomes of a Remote Cardiac Rehabilitation Program for Patients Undergoing Atrial Fibrillation Ablation: Pilot Study.

Risk factor modification, in particular exercise and weight loss, has been shown to improve outcomes for patients with atrial fibrillation (AF). However, access to structured supporting programs is limited. Barriers include the distance from appropriate facilities, insurance coverage, work or home responsibilities, and transportation. Digital health technology offers an opportunity to address this gap and offer scalable interventions for risk factor modification. This study aims to assess the feasibility and effectiveness of a 12-week asynchronous remotely supervised exercise and patient education program, modeled on cardiac rehabilitation programs, in patients with AF. A total of 12 patients undergoing catheter ablation of AF were enrolled in this pilot study. Participants met with an exercise physiologist for a supervised exercise session to generate a personalized exercise plan to be implemented over the subsequent 12-week program. Disease-specific education was also provided as well as instruction in areas such as blood pressure and weight measurement. A digital health toolkit for self-tracking was provided to facilitate monitoring of exercise time, blood pressure, weight, and cardiac rhythm. The exercise physiologist remotely monitored participants and completed weekly check-ins to titrate exercise targets and provide further education. The primary end point was program completion. Secondary end points included change in self-tracking adherence, weight, 6-minute walk test (6MWT), waist circumference, AF symptom score, and program satisfaction. The median participant age was 67.5 years, with a mean BMI of 33.8 kg/m2 and CHADs2VASC (Congestive Heart Failure, Hypertension, Age [≥75 years], Diabetes, Stroke/Transient Ischemic Attack, Vascular Disease, Age [65-74 years], Sex [Female]) of 1.5. A total of 11/12 (92%) participants completed the program, with 94% of expected check-ins completed and 2.9 exercise sessions per week. Adherence to electrocardiogram and blood pressure tracking was fair at 81% and 47%, respectively. Significant reductions in weight, waist circumference, and BMI were observed with improvements in 6MWT and AF symptom scores (P<.05) at the completion of the program. For program management, a mean of 2 hours per week or 0.5 hours per patient per week was required, inclusive of time for follow-up and intake visits. Participants rated the program highly (>8 on a 10-point Likert scale) in terms of the impact on health and wellness, educational value, and sustainability of the personal exercise program. An asynchronous remotely supervised exercise program augmented with AF-specific educational components for patients with AF was feasible and well received in this pilot study. While improvements in patient metrics like BMI and 6MWT are encouraging, they should be viewed as hypothesis generating. Based on insights gained, future program iterations will include particular attention to improved technology for data aggregation, adjustment of self-monitoring targets based on observed adherence, and protocol-driven exercise titration. The study design will need to incorporate strategies to facilitate the recruitment of a diverse and representative participant cohort.

Atrial Fibrillation Detection and Load: Knowledge Gaps Related to Stroke Prevention.

Atrial fibrillation is a major cause of ischemic stroke. Technological advances now support prolonged cardiac rhythm monitoring using either surface electrodes or insertable cardiac monitors. Four major randomized controlled trials show that prolonged cardiac monitoring detects subclinical paroxysmal atrial fibrillation in 9% to 16% of patients with ischemic stroke, including in patients with potential alternative causes such as large artery disease or small vessel occlusion; however, the optimal monitoring strategy, including the target patient population and the monitoring device (whether to use an event monitor, insertable cardiac monitor, or stepped approach) has not been well defined. Furthermore, the clinical significance of very short duration paroxysmal atrial fibrillation remains controversial. The relevance of the duration of monitoring, burden of device-detected atrial fibrillation, and its proximity to the acute ischemic stroke will require more research to define the most effective methods for stroke prevention in this patient population.

Frequency and risk factors of atrial fibrillation after acute abdominal surgery: A prospective cohort study.

Scarce data exist on the true incidence of postoperative atrial fibrillation (POAF) after acute abdominal surgery and associated outcomes. The current study aimed to identify the frequencies of clinically recognized POAF and associated complications, along with their risk factors. This study was a prospective, single-center cohort study of unselected adult patients referred for acute abdominal surgery during a 3-month period. Through careful review, demographics, comorbidity, and surgical characteristics were prospectively drawn from medical charts. The primary outcome was clinically recognized POAF occurring in-hospital. Logistic regression was used to determine the risk factors of POAF and associated complications. A subgroup was enrolled in a feasibility study of peri- and postoperative continuous cardiac rhythm monitoring. In total, 450 patients were enrolled. Clinically recognized in-hospital POAF was observed in 22 patients (4.9%). All cases were observed in patients aged ≥60 years, corresponding to 22 of 164 patients (13.4%). Multiple risk factors were observed, such as age, prior atrial fibrillation, heart failure, hypertension, diabetes mellitus, chronic renal disease, and major (vs. minor) surgery. POAF was associated with severe in-hospital complications (POAF group 45.5% vs. non-POAF group 8.6%, p < .001) and in-hospital mortality (POAF group 13.6% vs. non-POAF group 3.0%, p = .043). In total, 295 patients were monitored by continuous cardiac rhythm monitoring for 12,148 h, yielding five patients with asymptomatic AF. In conclusion, this prospective study of POAF in patients undergoing acute abdominal surgery showed that one in 20 patients developed clinically recognized in-hospital POAF. Multiple risk factors of POAF were identified. POAF was associated with severe complications up to 30 days after surgery.

Abstract 18687: Cardio-Rheumatology: Coronary and Cerebrovascular Thromboses in Antiphospholipid Antibody Syndrome

Description of Case: A 27-year-old male with antiphospholipid antibody syndrome (APLS) with a high-risk antibody profile presented for cardiac evaluation. APLS was diagnosed after presentation with acute cardioembolic stroke requiring thrombolysis. Echocardiography showed a normal ejection fraction, with multiple small echo-densities attached to the anterior and posterior leaflet tips of the mitral valve suggesting non-bacterial thrombotic endocarditis (NBTE). The patient was treated with warfarin and aspirin was recommended but declined. As the patient reported lightheadedness, a cardiac rhythm monitor was placed and showed two episodes of non-sustained ventricular tachycardia (NSVT). A cardiac MRI was then obtained, showing multifocal, subendocardial and mesocardial delayed gadolinium enhancement suggesting fibrosis, in a distribution most consistent with a multivessel embolic event. A CT coronary angiogram was performed to further evaluate the coronary arteries, revealing normal coronary anatomy, free from atherosclerotic plaque or thrombus. Beta-blocker therapy was initiated for arrhythmic episodes, with resolution of symptoms and no recurrence of NSVT on follow-up monitoring. Left ventricular (LV) function continued to remain preserved on follow-up imaging, with no progression of mitral valve vegetations on anticoagulation. Discussion: Cardiac involvement in APLS has been well described but largely centers around valvular disease and de novo venous and arterial thromboses. This case of cerebrovascular and coronary pathology in APLS as a likely consequence of thromboembolic phenomena is an unusual presentation and highlights the potential downstream consequences of left-sided valvular NBTE. A high index of suspicion is required to specifically evaluate for myocardial scarring despite normal LV function on echocardiography. The presence of myocardial fibrosis in these cases can act as a focus for scar-related ventricular arrhythmias, which if diagnosed and treated in a timely manner can limit further cardiovascular complications for the patient.

Abstract 16707: Clinical Validation of a Chest-Worn Personal ECG Device for the Detection of Atrial Fibrillation

Introduction: Novel consumer-focused personal ECG devices have the potential to revolutionise the way that cardiac arrhythmias are diagnosed and managed. These devices can be used remotely to monitor patients for arrhythmias, which could lead to earlier detection and treatment. In this study, we aimed to compare the cardiologist's interpretation of clinical 12-lead ECG recordings to a consumer-focused dry-electrode ECG chest strap device (Fourth Frontier FX+). Methods: We included patients seen in an outpatient cardiology clinic at the Sri Jayadeva Institute of Cardiovascular Science and Research, Bangalore, India. A total of 163 paired ECG recordings were captured from 85 adult patients (50% female, median age 54 years, AF present at the time of recording in 38%). Patients with critical cardiac problems or life support systems were excluded. ECG data from the Fourth Frontier FX+ (Fourth Frontier, Bangalore, India) and a standard 12-lead ECG were obtained simultaneously in the supine position. PDF reports for both devices were then generated, and the cardiologist's interpretation of the Fourth Frontier FX+ ECG was compared to the cardiologist's interpreted 12L ECG. Results: The cardiologist's interpretation of the Fourth Frontier FX+ data matched the cardiologist-interpreted 12L data for all patients. One FX+ ECG was excluded from the analysis due to not enough data being captured by the device. A total of 33 patients were correctly identified as having atrial fibrillation. Conclusion: The results of this study demonstrate that the Fourth Frontier FX+ ECG monitor is comparable to a 12-lead ECG for cardiac rhythm monitoring and that it can be used remotely to monitor patients for cardiac arrhythmias. This has the potential to change the way that arrhythmias are diagnosed and managed and lead to earlier detection and treatment at scale.

Abstract 15005: Gender Differences in the Evaluation and Clinic Outcomes of Patients With Palpitations

Background: Palpitations represent a common complaint in primary care clinics. Although usually benign, palpitations are occasionally a manifestation of cardiac arrhythmias. Aims: This study aimed to investigate whether there are gender differences in the cardiac testing pattern and clinical outcomes of patients evaluated in outpatient clinics for palpitations. Methods: This is a retrospective observational study that included adult men and women who presented to an outpatient primary care or cardiology office in an integrated health system in California with a chief complaint of palpitations. Cardiac testing pattern was captured using electronic health records. The primary endpoint was hospitalization for arrhythmia at one year. The secondary endpoint was all-cause mortality at one year. Logistic regression models were constructed to evaluate the association between female gender and the outcomes. Results: Between 2017 and 2021, 89,680 patients were evaluated for palpitations, among whom 61,064 (68.1%) were women. A high proportion of women were Hispanic. Women were more likely to be obese and less likely to have hypertension, diabetes, atrial fibrillation, heart failure, or a history of myocardial infarction. A slightly higher proportion of women were started on beta-blockers (12.8% women vs. 12.2% men, p=0.004). Women were more likely to be referred for cardiac rhythm monitoring (19.8% women vs. 18.8% men, p &lt;0.001). At one year, women had a lower rate of hospitalization for arrhythmias (0.5% in men versus 0.3% in women, adjusted OR 0.73, 95% CI 0.58-0.91). All-cause mortality was also lower for women at one year (adjusted OR 0.55, 95% CI 0.48-0.62). Conclusion: Among patients with palpitations, women were more likely than men to be treated with beta-blockers and referred for cardiac rhythm monitoring. Women had a better clinical prognosis, with a lower risk of hospitalization for arrhythmias and death at one year.

Abstract 13938: Trends in In-Hospital Implantation of Implantable Cardiac Monitors in the Unites States: 2016-2019

Introduction: Implantable cardiac monitors (ICM) are widely employed for long-term cardiac rhythm monitoring. While a majority of ICMs are implanted on an outpatient basis, national estimates on their use in the inpatient setting are lacking. Methods: The National Inpatient Sample and the National Readmission Database were queried to identify inpatient ICM implantations between 2016 and 2019. Baseline characteristics, in-hospital outcomes, readmission rates, and trends over time were assessed for the study population and compared between the largest diagnostic cohorts: neurologic and cardiac. Results: A total of 101,430 adults underwent in-hospital ICM implantation between 2016 and 2019 (52.9% neurologic, 39.2% cardiac). Patient characteristics and outcomes are shown in Table 1. There was a 170% increase in inpatient ICM procedures from 2016 to 2019. Significant changes in patient profiles and readmission rates were observed over the study period. The trends are shown in Table 2a. After adjusting for confounders, patients with cardiac indications were more likely to have complications and be readmitted, but had lower mortality, length of stay, and hospitalization cost compared with the neurology cohort. The ORs are shown in Table 2b. Conclusions: The number of inpatient ICM implantations has increased significantly, likely reflecting expanding indications. The profiles of patients receiving ICM also changed to include more primary neurologic indications, comorbidities, and non-white races. Small and medium sized hospitals performed the procedure more frequently. Complication rates were extremely low and remained constant during the study period.

Abstract 15584: Artificial Intelligence-Guided Screening for Atrial Fibrillation Detection Among Patients With Different Socioeconomic Status

Introduction: Recently, an artificial intelligence (AI) algorithm was validated for identifying ECG signatures of atrial fibrillation (AF) risk during normal sinus rhythm. Traditionally, socioeconomically disadvantaged populations are less likely to receive novel or guideline-recommended treatments, and have high chronic disease burden, including cardiovascular diseases. There have also been concerns about new technologies creating a digital divide, worsening existing health disparities. Hypothesis: An AI algorithm will detect AF risk unequally across patients with different levels of social determinants of health (SDOH). Methods: The initial prospective, non-randomized, interventional study leveraged EHR and digital technologies to prospectively enroll 1004 patients with a broad range of AI-ECG risks of AF, who received continuous cardiac rhythm monitoring for up to 30 days. The Area Deprivation Index (ADI) was used as a composite measure of SDOH which is comprised of indicators spanning four domains: income, education, employment, and house quality. 904 intervention patients linked to the ADI data were matched to 904 real-world control patients derived from eligible but unenrolled patients. Those with ADI under 33% were defined as having better SODH; and patients with ADI above 33% were defined as having worse SODH. Results: Median age was 74 years and 38% were women. After matching, the intervention and control arms were balanced in all baseline characteristics, including HF, HTN, diabetes, stroke, CAD and ADI. A hazard ratio of 3.11 (P&lt;0.001) was computed when comparing intervention to control for primary AF diagnosis outcome. In patients with worse SDOH, the intervention increased AF detection from 2.6% to 8.8% (HR 3.63 [2.09, 6.32]); in the better SDOH, the intervention increased AF detection from 3.9% to 9.3% (2.41 [1.23, 4.74]). Conclusions: An AI-guided AF screening program increased the detection of AF in both patients with better or worse SDOH. The current study validates the use of AI in historically disadvantaged populations displaying the possibility for broad implementation with decreased possibility of perpetuating disparities.

P040 Comparisons of Heart Rate Variability Indices Derived from the Sheet-type Device beneath the Mattress with those from the Electrocardiogram

Abstract Introduction A sheet-type device beneath the mattress was developed for non-invasive monitoring of cardiac rhythm during sleep and in bedridden end-of-life elderly patients, enabling the acquisition of ballistocardiography (BCG) signals. BCG represents minute vibrations in the body associated with cardiac ejection of blood and has recently been utilized to estimate heart rate variability (HRV) indices. This study aimed to compare HRV indices derived from BCG with those obtained from simultaneously measured electrocardiogram (ECG) and assess their agreement. Methods Healthy subjects (14 males, 11 females; age 40.6±12.8 yrs.) were recruited between August 2022 and April 2023. Subjects laid on a bed with the device placed under their pillow, while ECG was recorded for 20 minutes. Time-domain indices (mean normal-to-normal (NN) interval) and frequency-domain indices (low frequency (LF) and high frequency (HF)) were calculated, and linear associations were examined by correlation analysis. Bland-Altman analysis was employed to evaluate the agreement between the indices. Results Significant positive associations were observed between BCG and ECG indices in mean NN interval (r=0.994, p&amp;lt;0.001) and LF (r=0.685, p&amp;lt;0.001) and HF (r=0.687, p&amp;lt;0.001). Bland-Altman analysis demonstrated good agreement in mean NN (mean of pairwise difference (MPD): 1.07; limits of agreement (LA): -12.57-14.70; ratio: 0.01), but poor agreement in LF (MPD: -4.32; LA: -30.42-21.78; ratio: 0.63) and HF (MPD: 4.29; LA: -21.70-30.28; ratio: 0.45) based on the ratios (&amp;gt; 0.2). Conclusion The high correlation and good agreement between mean NN intervals suggest that the BCG device can serve as an alternative to HRV for estimating NN interval.

Atrial fibrillation detected with outpatient cardiac rhythm monitoring in patients with ischemic stroke or TIA of undetermined cause

ObjectivesGuidelines advise cardiac rhythm monitoring for 3 up to 30 days for detecting atrial fibrillation (AF) in patients with ischemic stroke of undetermined cause. However, the optimal monitoring duration is unknown. We aimed to determine the AF detection rate during 7-day outpatient cardiac rhythm monitoring in this patient group. MethodsParticipants from a large tertiary hospital in a prospective observational study (ATTEST) underwent outpatient cardiac rhythm monitoring after a negative standard diagnostic evaluation (i.e., 12-lead electrocardiogram and in-hospital telemetry). Primary outcome was the rate of newly detected AF. ResultsWe examined 373 patients [age: 67.8±11.6 years; women: 166(44.5%); stroke: 278(74.5%)]. Median monitoring duration was 7 days (Inter Quartile Range (IQR) 7-7), performed after median of 36 days (IQR 27-47). AF was newly detected in 17(4.6%) patients, 5.4% of patients with ischemic stroke and 2.1% of patients with TIA. 53% of AF was detected on day-1, after day-3 73% of new AF was found. First AF episodes were detected up to day-7. Diabetes and increasing age were independent predictors of new AF. ConclusionAfter ischemic stroke or TIA of undetermined cause, 7-day outpatient cardiac rhythm monitoring detected new AF in 4.6%. Patients with AF had significantly more cardiovascular risk factors. Although about 50% of first AF episodes occurred during the first day of monitoring, new AF was detected up to day-7, implying that the recommended minimum of 3 days cardiac rhythm monitoring after ischemic stroke of undetermined cause is insufficient. Subsequent long-term rhythm monitoring should be considered in selected patients.

Comparison of the 11-Day Adhesive ECG Patch Monitor and 24-h Holter Tests to Assess the Response to Antiarrhythmic Drug Therapy in Paroxysmal Atrial Fibrillation.

Accurate assessment of the response to the antiarrhythmic drug (AAD) in atrial fibrillation (AF) is crucial to achieve adequate rhythm control. We evaluated the effectiveness of extended cardiac monitoring using an adhesive ECG patch in the detection of drug-refractory paroxysmal AF. Patients diagnosed with paroxysmal AF and receiving AAD therapy were enrolled. The subjects simultaneously underwent 11-day adhesive ECG patch monitoring and a 24-h Holter test. The primary study outcome was a detection rate of drug-refractory AF or atrial tachycardia (AT) lasting ≥30 s. A total of 59 patients were enrolled and completed the study examinations. AF or AT was detected in 28 (47.5%) patients by an 11-day ECG patch monitor and in 8 (13.6%) patients by a 24-h Holter test (p < 0.001). The 11-day ECG patch monitor identified an additional 20 patients (33.8%) with drug-refractory AF not detected by the 24-h Holter, and as a result, the treatment plan was changed in 11 patients (10 catheter ablations, one medication change). In conclusion, extended cardiac rhythm monitoring using an adhesive ECG patch in patients with paroxysmal AF under AAD therapy led to over a threefold higher detection of drug-refractory AF episodes, compared to the 24-h Holter test.

GSM Based Heart Rhythm Monitoring System Using ECG

In today's fast-paced society, the human body is becoming more susceptible to heart-related ailments, and the number of fatalities from heart disease is increasing. This project details the design and development of a GSM-based cardiac rhythm monitoring system. The existing model uses a Wi-Fi module to send data, but this is only feasible in Wi-Fi-enabled regions. Therefore, data cannot be communicated where the internet is not accessible. As a result, GSM is recommended as a solution. This heart-monitoring device detects numerous physiological and pathological cardiac problems. This heart monitoring equipment also detects whether he or she has any cardiac issues. This is accomplished by measuring the heart rate. Electrocardiography is used to make this diagnosis (ECG). The ECG monitors the heart's rhythm. In this system, Arduino and ECG sensor is used to scan the ECG signal and look for patterns in the common range. Arduino processes the measured data from the sensor. The processed data is sessnt to the Cloud through G.S.M in real-time. The user may access the ECG graph on the cloud from anywhere in the world. In the future, the proposed GSM-based ECG system reduces healthcare costs and improve the accessibility of healthcare equipment.

A Multidisciplinary Algorithm for the Evaluation of Acute Neurologic Deficits Improves Management of Cryptogenic Stroke or Transient Ischemic Attack.

The appropriate diagnosis and management of cryptogenic stroke and transient ischemic attack (TIA) is challenging and requires multidisciplinary involvement. Joint societal guidelines exist to guide the comprehensive evaluation of these entities. This study aimed to implement a standardized multidisciplinary diagnostic algorithm for cryptogenic stroke/TIA. We performed a retrospective analysis of patients admitted to the largest regional military healthcare center with stroke or TIA considered to be cryptogenic at the time of discharge. We abstracted baseline demographics and rates of extra- and intracranial imaging, transthoracic and transesophageal echocardiography, and event monitor orders at the time of discharge. The incidence of event monitor results at 30 days and six months were included. A diagnostic algorithm for evaluation of cryptogenic stroke/TIA was created and disseminated hospital-wide using increased compliance with neuroimaging, echocardiography, and cardiac rhythm monitoring as primary endpoints for our intervention. Post-intervention data abstraction revealed similar rates of extra- and intracranial imaging, but significantly greater rates of transthoracic echocardiography (70% vs. 87%, p 0.0073), inclusion of agitated saline study (41% vs. 65%, p 0.0024), and event monitors ordered at discharge (18% vs. 35%, p 0.0045). At six months there was a higher rate of event monitors obtained (24% vs. 45%, p 0.001). Our study showed implementation of an evidence-based diagnostic algorithm for evaluation of cryptogenic stroke/TIA increases appropriate use of echocardiography and event monitoring.

A Wireless Wearable Patch for Remote Monitoring of Respiratory and Cardiac Rhythm in Children.

Remote patient monitoring (RPM) is an innovative strategy to promote health and improve patient management and care. Recent advances in healthcare technologies have seen the emergence of wearable sensors allowing longitudinal physiological measurements in any environment. This paper introduces a wireless wearable patch 'Leo' for continuous remote monitoring of physiological data at home and healthcare settings. This includes single lead ECG, chest impedance, heart rate (HR), respiration rate (RR) and body posture. To test Leo's ability to capture longitudinal physiological data at home, 15 children experiencing acute severe asthma exacerbations were recruited during their emergency department (ED) visits. Participants wore the Leo device for 7 (+/-2) days post-hospital discharge. Nocturnal RR and HR and variability were higher during the first half of the night on Day1 compared to Day7 (p<0.005). Participants also completed a usability questionnaire and reported the patch wear to be comfortable (average score of 3.3 out of 5) and easy to wear during the night (average score of 3.5 out of 5) with 5/15 (33%) reported very slight barely perceptible skin irritation/redness and 2 (13%) reported well defined skin irritation and redness.Clinical Relevance- These results highlight the potential use of the Leo device in clinical practice for continuous un-obstructive monitoring of diseased populations, such as asthma.

Wearable Cardiac Rhythm Monitoring Device for Detection of Postoperative Atrial Fibrillation

PurposeThis study evaluated the use of a wearable, patch-based cardiac rhythm monitoring device in detecting postoperative atrial fibrillation (POAF) among cardiac surgical patients within 30 days after hospital discharge. DescriptionFrom the SEARCH-AF (The Post-Surgical Enhanced Monitoring for Cardiac Arrhythmias and Atrial Fibrillation) CardioLink-1 trial, this study examined rates of POAF according to surgery type and the incremental value of continuous cardiac rhythm monitoring among patients who underwent valve surgery. The primary outcome was cumulative atrial fibrillation or atrial flutter lasting for ≥6 minutes detected by continuous monitoring or atrial fibrillation or atrial flutter documented by a 12-lead electrocardiogram within 30 days of randomization. EvaluationThe primary outcome occurred in 8.2%, 13.5%, and 21.2% of patients who underwent isolated coronary artery bypass grafting (CABG), isolated valve surgery, and combined CABG and valve surgery. Relative to patients who underwent isolated CABG, those patients who had valve surgery were more likely to experience POAF. A higher diagnostic yield was obtained when the patch-based cardiac rhythm monitor was applied in patients who underwent valve surgery. ConclusionsUse of a wearable, patch-based cardiac monitoring device was an effective detection strategy among patients undergoing valve surgery, given their higher risk of developing POAF.

Monitoring for arrhythmia in transthyretin cardiac amyloidosis with remote patch devices

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Transthyretin cardiac amyloidosis (ATTR-CA) is associated with an increased incidence of arrhythmias. We hypothesized that non-invasive, two-week outpatient cardiac rhythm monitoring of patients with ATTR-CA would detect high rates of ventricular tachycardia and atrial fibrillation/flutter (AF). Purpose To characterize arrhythmia in patients with ATTR-CA on two-week, non-invasive cardiac rhythm monitors. Methods 38 patients with ATTR-CA (mean age 76.9 SD 10.0 years, 89.5% male) who underwent two-week remote external patch monitoring were included in this single center retrospective study. An age-matched control group included 38 patients (mean age 73.9 SD 12.3, 76.3% male) who underwent the same cardiac rhythm monitoring as part of neurological workups. Results NSVT was detected on the remote monitor in 81.6% of ATTR-CA patients and AF was detected in 26.3% of patients. ATTR-CA was associated with higher rates of NSVT and AF compared to the control group (28.9% with NSVT and 5.3% with AF). As seen in Figure 1, there were only three ATTR-CA patients without either AF, NSVT, advanced atrioventricular block, or a significant pause detected on remote monitor. Among the ATTR-CA group, at median 45 weeks follow-up, there were 4 heart failure hospitalizations, 2 cardiovascular events (1 episode of sustained VT and 1 stroke), 6 permanent pacemakers placed, and 3 implantable cardioverter-defibrillators placed, including one for sustained VT. NSVT and AF were not associated with a composite of these adverse outcome. Conclusion ATTR-CA was associated with high rates of NSVT and AF on noninvasive remote monitors. While evidence regarding the management of arrhythmias, particularly NSVT/VT, in ATTR-CA remains limited, two-week noninvasive cardiac monitoring can be considered to aid in risk stratification for both atrial and ventricular arrhythmias in ATTR-CA.

Fingolimod-related atrioventricular block in paediatric age group with multiple sclerosis: two case reports.

Multiple sclerosis is a chronic inflammatory and demyelinating disease of the central nervous system, usually seen in young adults. Early onset of multiple sclerosis at age younger than 18 years is called paediatric multiple sclerosis. Unlike adult multiple sclerosis, paediatric multiple sclerosis causes morbidity at earlier ages and often progresses in a relapsing-remitting form. Although fingolimod is an effective drug used as a disease-modifiying therapy agent in relapsing-remitting paediatric multiple sclerosis patients, it can cause dysryhthmia in the early period after first dose. Our first case is a 14-year-old girl with relapsing-remitting paediatric multiple sclerosis patients who was started to take fingolimod treatment. In the fifth hour of the follow-up, asymptomatic bradycardia was seen and the electrocardiogram was consistent with first-degree atrioventricular block. Her rhythm got spontaneously normal after 12 hours. Second case was 13 years old girl. Steroid treatment was started after her first paediatric multiple sclerosis attack. Despite treatment, she had a second attack 2 weeks after the first attack. Therefore, the neurologist switched to fingolimod therapy. Second-degree atrioventriculer block developed after 4 hours from the initiation of therapy. After 8 hours, rhythm regressed to first-degree atrioventricular block then returned to normal up to 13th hours of follow up. The aim of this article is to draw attention to dysrhythmia side effect of fingolimod which can be fatal. Therefore, the clinician must take precautions. Close cardiac rhythm monitoring is mandatory after the initiation fingolimod theraphy.