Continuous Ambulatory Monitoring Research Articles

Extended Ambulatory ECG Monitoring Enhances Identification of Higher-Risk Ventricular Tachyarrhythmias in Patients With Hypertrophic Cardiomyopathy

BackgroundIn hypertrophic cardiomyopathy (HCM), 48-hour ambulatory monitoring has been standard practice to detect nonsustained ventricular tachycardia (NSVT), a sudden death risk marker. Extended-wear ambulatory electrocardiographic (ECG) devices have more recently used for monitoring patients with HCM. ObjectiveWe aimed to evaluate NSVT burden identified with continuous ambulatory monitoring for up to 2 weeks compared with initial 48 hours. MethodsThere were 236 consecutive patients with HCM (49 ± 12 years) who underwent 14-day continuous ambulatory monitoring (Zio XT, iRhythm Technologies, San Francisco, CA); diagnostic yield of NSVT compared for initial 48 hours vs extended for 14 days. ResultsOf 236 patients, 114 (48%) had ≥ 1 runs of NSVT (median 2) over 14 days. Median length of NSVT was 7 beats (range: 3 to 67) at rates of 120 to 240 beats per minute (bpm) (median, 167 bpm). In 42 of the 114 patients (37%), initial NSVT occurred ≤ 48 hours and in 72 (63%) only during the extended monitoring period (3 to 14 days). Diagnostic yield for detecting NSVT over 14 days was 2.7-fold greater than ≤ 48 hours (P < .001). NSVT judged at higher risk (≥ 8 beats, > 200 bpm, ≥ 2 runs in consecutive 2-day period) was identified more frequently during extended monitoring, diagnostic yield 3-fold greater than ≤ 48 hours (P < .001). ConclusionIn HCM, NSVT episodes are frequent; however, in most patients, both NSVT and higher-risk NSVT were not detected during initial 48 hours and were confined solely to extended monitoring period. These data support additional clinical studies to evaluate the significance of NSVT on extended monitoring on sudden death risk in HCM.

Radiofrequency catheter ablation of persistent atrial fibrillation by pulmonary vein isolation with or without left atrial posterior wall isolation: long-term outcomes of the CAPLA trial.

Posterior wall isolation (PWI) is commonly incorporated into catheter ablation (CA) strategies for persistent atrial fibrillation (AF) in an attempt to improve outcomes. In the CAPLA randomized study, adjunctive PWI did not improve freedom from atrial arrhythmia at 12 months compared with pulmonary vein isolation (PVI) alone. Whether additional PWI reduces arrhythmia recurrence over the longer term remains unknown. In this multicenter, international, randomized study patients with persistent AF undergoing index CA using radiofrequency (RF) were randomized to PVI+PWI versus PVI alone. Patients underwent regular follow-up including rhythm monitoring for a minimum of 3 years post CA. AF burden at 3 years post-ablation was evaluated with either 28-day continuous ambulatory ECG monitoring, twice daily single-lead ECG or from cardiac implanted device. Evaluated endpoints included freedom from any documented atrial arrhythmia recurrence after a single procedure, AF burden, need for redo catheter ablation, rhythm at last clinical follow-up, healthcare utilisation metrics and AF-related quality of life. 333 of 338 (98.5%) patients (mean age 64.3±9.4 years, 23% female) completed 3-year follow-up, with 169 patients randomized to PVI+PWI and 164 patients to PVI alone. At a median of 3.62 years post-index ablation, freedom from recurrent atrial arrhythmia occurred in 59 patients (35.5%) randomized to PVI+PWI vs 68 patients (42.1%) randomized to PVI alone (HR 1.15, 95% CI 0.88-1.51, p=0.55). Median time to recurrent atrial arrhythmia was 0.53 years (IQR 0.34-1.01 years). Redo ablation was performed in 54 patients (32.0%) in the PVI+PWI group vs 49 patients (29.9%, p=0.68) in the PVI alone group. Pulmonary vein reconnection was present in 54.5% (mean number of reconnected PVs 2.2±0.9) and posterior wall reconnection in 75%. Median AF burden at 3 years was 0% in both groups (IQR 0-0.85% PVI+PWI vs 0-1.43% PVI alone, p=0.49). Sinus rhythm at final clinical follow-up was present in 85.1% with PVI+PWI vs 87.1% with PVI alone (p=0.60). Mean AF Effect On Quality-Of-Life (AFEQT) score at 3 years post-ablation was 88.0±14.8 with PVI+PWI vs 88.9±15.4 with PVI alone (p=0.63). In patients with persistent AF, the addition of PWI to PVI alone at index RF catheter ablation did not significantly improve freedom from atrial arrhythmia recurrence at long-term follow-up. Median AF burden remains low and AF quality of life high at 3 years with either ablation strategy.

Índice de masa corporal y presión arterial en adolescentes de una zona urbana en México

Introduction: The changes brought about by the COVID-19 pandemic in adolescent activities have affected recreational aspects due to limited contact to prevent virus spread. This has contributed to increased indicators of overweight and obesity and could impact blood pressure levels. Objective: To determine the degree of association between Body Mass Index (BMI) and systemic blood pressure in adolescents. Methods: Systemic blood pressure was measured using continuous ambulatory blood pressure monitoring over 24 hours (ABPM). The sample consisted of 42 high school students with similar urban geographic characteristics in Mexico. All participants underwent anthropometric evaluation to identify notable group characteristics. The correlation was assessed using Spearman's Rho test. Results: Of the 42 participants included, 28.5% showed obesity, 21.45% were overweight, and no patient had hypertension. However, 23.8% showed prehypertension. A significant correlation was evidenced between BMI and both systolic and diastolic blood pressure values, at 0.390 and 0.382, respectively (p-value: 0.013 and 0.015, respectively). Conclusion: BMI was significantly associated with systolic and diastolic blood pressure levels in adolescents from an urban area in Mexico.

Deep learning model to identify potential occurrence of reduced LVEF in patients with implantable loop recorders

Abstract Background Early detection of left ventricular systolic dysfunction (LVSD) using minimally invasive electrocardiographic assessment in an ambulatory setting may be important considering the increasing economic burden of HF. Recently artificial intelligence (AI) algorithms have been reported to classify reduced ejection fraction using snapshot 12-lead ECG measurements, however the ability of AI to identify LVSD using only a single lead ambulatory ECG is unknown. Purpose We aimed to develop a convolution neural network (CNN) based deep learning algorithm using single lead ECG to predict ejection fraction less than 40% in ambulatory patients implanted with implantable loop recorders (ILRs). Methods We linked ILR patients with LVEF measurements from a de-identified database of aggregated electronic health record (EHR) data during the period of 2007-2021 to a manufacturer’s device database with ambulatory single lead ECGS. The routine ECG transmissions from the ILR devices were paired with LVEF measured within a week. The data was pre-processed to obtain the time-frequency components of ECG using wavelet transform. The wavelet coefficients were then used as input to train and validate a 2D-CNN model. An independent test dataset consisting of data from patient not included in training/validation dataset was used to assess the performance of CNN model to classify LVEF&amp;lt; = 40% using the metrics area under the curve (AUC), sensitivity and specificity. Results A total of 35,741 unique LVEF-ECG pairs collected from 2,249 ILR patients were used to train the model; an independent validation dataset consisted of 6,721 unique LVEF ECG pairs from 750 patients and independent test dataset consisted of 6,611 unique LVEF ECG pairs from 750 patients. In our CNN model, cross entropy was used as loss function and adaptive moment estimation (ADAM) was used as the optimizer. The initial learning rate was selected as 0.0001, epochs as 20 and mini batch size as 64. The threshold to delineate reduced ejection fraction (LVEF&amp;lt; = 40%) was set as 0.1 (Figure 1). The model yielded accuracy, sensitivity, specificity, AUC of 75%,70%, 76% and 0.8 respectively in the independent test set (Figure 2). Conclusion A deep learning algorithm applied to ambulatory single lead ECGs acquired by ILR can detect LVEF&amp;lt; = 40%. This continuous ambulatory AI-ECG monitoring may allow to identify longitudinal changes in LVEF post ILR implant via remote monitoring.Figure 1:Model output vs Actual EF rangeFigure 2:ROC

Transcutaneous electrical vagus nerve stimulation to suppress premature ventricular complexes (TREAT PVC): study protocol for a multi-center, double-blind, randomized controlled trial

BackgroundThe autonomic nervous system can be responsible for the initiation and maintenance of arrhythmias. Low-level tragus stimulation (LLTS), a noninvasive form of autonomic neuromodulation, has been shown to be effective in treating atrial fibrillation. We intended to treat frequent premature ventricular complexes (PVCs) with LLTS.Methods and designThe present study will be a prospective multicenter, double-blind, randomized, controlled trial to assess the antiarrhythmic effects of LLTS on frequent PVCs in patients without structured heart disease (SHD). A total of 100 patients with PVC burden > 10% will be randomly assigned to the active or sham LLTS in 1:1 fashion and receive the proposed intervention for 6 months. The primary outcome is PVC burden at 6 months as assessed by 10 days of continuous ambulatory electrocardiographic monitoring. Secondary outcomes include heart rate variability (HRV), quality of life, skin sympathetic nerve activity, and inflammatory markers. Adverse events will also be recorded.DiscussionThe present trial will be the first to evaluate the effect of LLTS on frequent PVCs on patients without SHD. LLTS may serve as a low-cost, minimal-risk, and non-invasive alternative to conventional antiarrhythmic therapy.Trial registrationClinicalTrial.gov NCT04909528. Registered on 17 June 2021. World health organization trial registration data set was shown in Supplementary Table 1.

157 Budget impact analysis of Holter monitors provision in an outpatient clinic

Abstract Background Outpatient clinic attendees (aged &amp;gt;64) commonly present with falls, dizziness, syncope and palpitations. The most common non-invasive investigation ordered includes continuous ambulatory electrocardiography monitoring, namely the Holter monitor. The clinic is outsourcing Holter monitor requests to the Cardiology Department, with a long waiting list. If the patient wishes the test to be done sooner in a private hospital, it costs between 160 to 295 euros, covered by the patient’s private healthcare insurance. Methods A budget analysis was carried out to further evaluate by provisioning 5 Holter monitors in the outpatient clinic to quicken patient turnover and reduce the cardiology department waiting list. The intervention scope was limited to the designated clinic of approximately 450 patients a month. The intervention is not for generating revenue for the clinic. The budget analysis doesn’t include sensitivity analysis from the best-case towards worst-case scenarios of Holter frequency usage and duration of Holter monitoring. The objectives of the proposed change are to lessen the turnaround time by 20% for the patients from being assessed until discharge from the clinic without having delayed investigation of the Holter monitor, to have a timely and accurate diagnosis of suspected arrhythmia and the appropriate management within the new intervention. Results The decision tree, utilising the Decision analytic modelling, resource identification, cost implication, estimated changes including 2-hour staff training, capital, year one to year five costs, potential cost savings year-on-year, cost-per-wear comparison against the private hospital provider, pre and post-intervention scenario analysis were constructed. Conclusion The budget impact analysis designed a simple cost calculator to add additional tests of Holter monitors that rely on the decision model approach. It shows a potential cost saving within a five-year horizon and increases the number of patients’ attendance by optimising patient turnover. Apart from the cost and organisation, there are other positive impacts towards financial and clinical areas, ensuring high-quality service for the population.

Assessment of daily blood pressure parameters in patients after injury

ABSTRACT. Many studies have highlighted the impact of various significant risk factors on the occurrence of arterial hypertension. However, few papers have examined the effect of psychoemotional factors as important contributors to the risk of arterial hypertension for such a specific population group as contracted servicemen performing military service under conditions of performing special tasks. Furthermore, there is a lack of data on the daily profile of blood pressure in this particular group of individuals. This thesis aims to substantiate the claim that injury, as a risk factor, greatly influences changes in the daily profile of blood pressure. The study examined 118 patients, divided into an experimental group (65 people) and a control group (53 people). The daily profile of blood pressure was assessed using continuous ambulatory blood pressure monitoring. Questionnaires were used to evaluate the quality of sleep, anxiety, and depression. The findings indicated that the patients of the experimental group, following trauma, exhibited a higher index of systolic and diastolic blood pressure duration, while the mean values remained within the normal range. Additionally, these patients more frequently exhibited a blood pressure profile characterized by an insufficient nocturnal decrease in blood pressure, known as non-dipping. This could be attributed to impaired sleep quality, as well as subclinically significant manifestations of anxiety and depression caused by stress. The early detection of changes in the index of systolic and diastolic blood pressure duration, along with deviations in the daily blood pressure profile observed through continuous ambulatory blood pressure monitoring, would enable specialists to promptly address alterations in the hemodynamics of these patients and prescribe appropriate therapy. Therefore, psychoemotional stress in people who have experienced trauma is one of the trigger mechanisms for increased blood pressure. If left unaddressed, this can progress to persistent arterial hypertension.

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.

PO-03-223 EXTENDED AMBULATORY ECG MONITORING ENHANCES IDENTIFICATION OF HIGHER-RISK PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY

In the 2020 AHA/ACC hypertrophic cardiomyopathy (HCM) guidelines, a 24 or 48 hour continuous ambulatory ECG monitor is recommended for risk stratification to detect nonsustained ventricular tachycardia (NSVT), with greatest weight placed on frequent, long, and/or rapid runs as a sudden death (SD) risk marker. ECG monitoring devices with extended wear capability are now available, although the utility of longer monitoring in HCM is uncertain. To evaluate the prevalence, burden and clinical significance of NSVT identified during initial 48 hours of continuou ambulatory monitoring compared to 14 days. We evaluated 236 HCM patients (49 ± 12 years; 72% male) without primary prevention ICDs judged previously to be at low or intermediate SD risk with 14-day continuous ambulatory monitoring (Zio-patch XT, iRhythm Technologies). Episodes of NSVT were evaluated during the initial 48 hours of monitoring and compared to NSVT identified in subsequent 2 to 14 days. NSVT episodes with ≥1 of the following criteria was considered higher risk as a SD marker: ≥ 200 bpm, ≥ 8 beats, ≥ 3 runs within consecutive 48 hour period. Among the 236 patients, 114 (48%) had ≥ 1 runs of NSVT, with a median of 2 runs (IQR: 1-4) during the complete monitoring period, including 86 patients with ≤ 4 runs (36%), 13 with 5-9 runs (6%), and 15 with ≥10 runs (7%). Median length of NSVT was 7 beats (5-13) at 167 bpm (148-186). Diagnostic yield of detecting NSVT was 18% during the first 48 hours of monitoring compared to 48% at 14 days, with 63% of the initial NSVT episodes occurring after the first 48 hours (72 of 114). Similarly, diagnostic yield of detecting high risk NSVT episodes was 8% during the first 48 hours as compared to 24% at 14 days, with 64% of the initial high-risk NSVT runs occurring after the first 48 hours (36 of 56). There was no significant difference in clinical profile between patients with NSVT at < 48 hours and those with NSVT from 2-14 days, including age or presence of ≥1 major SD risk markers. In HCM, prevalence of NSVT is common, occurring in nearly half of patients over 14 days of continuous monitoring. Diagnostic yield for detecting NSVT was substantially increased using 14 days of monitoring, with 48 hours of monitoring missing nearly two-thirds of patients with high risk NSVT episodes that impact risk stratification. These data support 14-day ambulatory monitoring periods to enhance identification of higher risk HCM patients.

A Chest‐Conformable, Wireless Electro‐Mechanical E‐Tattoo for Measuring Multiple Cardiac Time Intervals

AbstractCardiovascular diseases are the leading cause of death globally. Noninvasive, accurate, and continuous cardiovascular monitoring can enable the preemptive detection of heart diseases and timely intervention to prevent serious cardiac complications. However, unobtrusive, ambulatory, and comprehensive cardiac monitoring is still a challenge as conventional electronics are rigid, heavy, or consume too much power for long‐term measurement. This work presents a thin (200 µm), stretchable (20%), lightweight (2.5 g), wireless, and low‐power (&lt;3 mW) cardiac monitoring device that conforms to the human chest like a temporary tattoo sticker, correspondingly known as an e‐tattoo. This chest e‐tattoo features dual‐mode electro‐mechanical sensing—bio‐electric cardiac signals via electrocardiography and mechanical cardiac rhythm via seismocardiography. A unique peripheral synchronization strategy between the two sensors enables the measurement of systolic time intervals like the pre‐ejection period and the left ventricular ejection time with high accuracy (error = −0.44 ± 8.74 ms) while consuming very low power. The e‐tattoo is validated against clinically approved gold‐standard instruments on five human subjects. The good wearability and low power consumption of this e‐tattoo permit 24‐h continuous ambulatory monitoring.

Continuous Ambulatory Wireless Cardiac Monitoring: A Screening Tool for Cardiac Rhythm Disorders

Continuous Ambulatory Wireless Cardiac Monitoring: A Screening Tool for Cardiac Rhythm Disorders

Screening of Cardiac Rhythm Disorders in Women Working at Information Technology Sector Using Continuous Ambulatory Wireless Cardiac Monitoring – A Community-Based Study

Objectives: The role of screening cardiac arrhythmias provides continuum of care to rediscover the causes and prevention strategies. This study was taken up to screen women working in the information and technology sector for cardiac rhythm disorders using continuous ambulatory cardiac monitoring and asses various risk factors along with work-related stress. Materials and Methods: A cross-sectional study was taken up at the workplace to screen women for cardiac rhythm disorders using wireless continuous ambulatory cardiac monitoring. Various risk factors and work-related stress were assessed using a standardized questionnaire. Differences in ECG parameters such as heart rate, heart rate variability (HRV), and frequency corrected QT (QTc) were compared on working and non-working days. Results: A total of 109 women were screened to find a proportion of 4.58% having cardiac arrhythmias. We found two cases of second-degree AV block (type 1), two cases of atrial tachycardia in the age group of 21–30 years, and one case of sinus pauses. Risk factors such as alcohol usage were statistically associated with cardiac arrhythmias. Others included a sedentary lifestyle, being underweight, a lesser number of sleep hours, no physical activity, work-related stress, and the presence of past-COVID-19 infection, but these were not statistically significant. There were significant changes in heart rate, HRV, and QTc prolongation on working day compared to non-working days. Among the domains of work-related stress, the influence at work and perceived stress due to individual demands and commitments contributed the highest mean score. Moreover, those with higher work-related stress scores were at 3.66 times the increased risk of QTc prolongation. Conclusion: The present study implies the combination of the need for the screening tool in younger age groups and lifestyle factors with more elucidation of work-related stress on autonomic cardiac function.

PS-C23-1: EFFECT OF OMEGA3,6,9 BLENDED OIL ON CIRCADIAN VARIATIONS OF AMBULATORY BLOOD PRESSURE IN PATIENTS WITH HYPERTENSION AND CAD

Flaxseed oil is considered to be a rich source of Alpha-Linolenic Acid(ALA), along with Lignans, fibers, protein, vitamins,s, and minerals. A number of studies have proved the beneficial role of ALA, EPA, and DHA found in flaxseed on health. Besides providing nutrition, they have anti-inflammatory, antihypertensive and cardioprotective properties. However pure flaxseed oil does not have oxidative stability due to which it could not be stored for long-term edible use. The blending process can be an alternative method for Partial hydrogenation, therefore we used this process to reduce the percentage of unsaturated linoleic and linolenic acids of Flaxseed oil with Palm oil in a stabilized ratio which helps in maintaining the overall oxidative stability and proper ratio of Omega 3, omega 6 and omega 9 content in the Blended product. Aim of this study was to access the effect of blended flaxseed oil on 24 hour seven day circadian variations of blood pressure in subjects with essential hypertension. Many Studies have proved that Chronobiological analysis of blood pressure by four to Seven-day continuous ambulatory blood pressure monitoring and assessment of CHAT (circadian hyper amplitude tension) is the best marker for cardiovascular function. We registered 100 subjects with Coronary Artery Disease (Group1) and Essential hypertension (Group2) and 100 control subjects with CAD/ Hypertension. Group 1 and 2 participants were supplemented with blended flaxseed oil (BFO) (30 ml/day) for the period of six months while the control group was not given any BFO (They were using their routine edible oil). Twenty-four hour seven days continuous ambulatory blood pressure monitoring was done initially, after three months and after six months of supplementation. There were significant changes noted in lipid profile along with Ambulatory blood pressure parameters like MESOR, ACROPHASE, Hyperbaric Indexes, and CHAT. Circadian hyper amplitude tension (CHAT) incidence decreased after BFO supplementation. Study results suggest that optimized doses of blended flaxseed oil have the required amount of ALA and essential fatty acids as per guidelines of AHA, Blended flaxseed oil administration can be a potent antihypertensive and helps in the synchronization of cardiac rhythms, and an effective vegetarian source in maintaining Omega 3 and omega 6 ratios.

A Wearable Bioimpedance Chest Patch for Real-Time Ambulatory Respiratory Monitoring.

This paper aims to introduce a wearable solution and a low-complexity algorithm for real-time continuous ambulatory respiratory monitoring. A wearable chest patch is designed using a bioimpedance (BioZ) sensor to measure the changes in chest impedance caused by breathing. Besides, a medical-grade infrared temperature sensor is utilized to monitor body temperature. The computing algorithm implemented on the patch enables computation of breath-by-breath respiratory rate and chest temperature in real-time. Two wireless communication protocols are included in the system, namely Bluetooth and Long Range (LoRa), which enable both short-range and long-range data transmission. The breathing rate measured in static (i.e., standing, sitting, supine, and lateral lying) and dynamic (i.e., walking, running, and cycling) positions by our device yielded an accuracy of more than 97.8% and 98.5% relative to the ground truth, respectively. Additionally, the device's performance is evaluated in real-world scenarios both indoors and outdoors. The proposed system is capable of measuring breathing rate throughout a variety of daily activities. To the best of our knowledge, this is the first BioZ-based wearable patch capable of detecting breath-by-breath respiratory rate in real-time remotely under unrestricted ambulatory conditions. This study establishes a strategy for continuous respiratory monitoring that could aid in the early detection of cardiopulmonary disorders in everyday life.

GENDER BIAS IN ICM RELATED OUTCOMES AND POST-ICM INSERTION PROCEDURES

Over the past 5 years insertable cardiac monitors (ICMs) have revolutionized cardiac care through continuous remote monitoring to help identify AF (Atrial Fibrillation) conditions and help clinicians (and specialists) take appropriate timely actions for at-risk patients who need ICDs, pacemakers or ablations. ICMs are implanted devices offering continuous ambulatory electrocardiogram monitoring. ICMs have been proven to identify AF conditions in unexplained syncope and palpitations, as well as in AF driven medication management.

Associations between personal noise exposure and heart rate variability were modified by obesity and PM2.5: The study among obese and normal-weight adults (SONA)

Noise pollution has been documented to increase the risks of cardiovascular disorders, which can be predicted by heart rate variability (HRV), nevertheless, there has been limited evidence on the modifiers of noise pollution. Environmental fine particulate matter (PM2.5) and obesity status are both growing major concerns of cardiovascular disease burden. Our study aims to investigate whether these two factors may modify the associations between noise exposure and HRV indices. An investigation was performed on 97 (53 normal-weight and 44 obese) participants aged 18–26 years, with continuous 5-min personal exposure assessment and ambulatory electrocardiogram monitoring for 24 h. This study found that personal exposure to noise was associated with decreased HRV level and imbalanced cardiac autonomic function, as indicated by decreases in standard deviation of normal-to-normal intervals (SDNN), square root of the mean squared differences of successive intervals (rMSSD), the percentage of R-R intervals that differ from each other by more than 50 ms (pNN50), low-frequency (LF) power, high-frequency (HF) power, and increases in LF–HF–Ratio. Stronger associations between personal noise exposure and HRV indices were observed among obese participants and participants with higher PM2.5 exposure levels compared to their counterparts. For SDNN, a 1 dB(A) increment in personal noise exposure at 3h-average was associated with a 1.25% (95%CI: -1.64%, −0.86%) decrease among obese participants, and a 0.11% (95%CI: -0.38%, 0.16%) decrease among normal-weight participants (P for subgroup difference<0.001); and a 0.87% (95%CI: -1.20%, −0.54%) decrease among participants with higher PM2.5 exposure levels, and a 0.22% (95%CI: -0.58%, 0.14%) decrease among participants with lower PM2.5 exposure levels (P for subgroup difference = 0.008). Obesity and PM2.5 may aggravate the adverse effects of noise on HRV, which has implications for targeted prevention of cardiovascular disease burden associated with noise pollution.

An Artificial Intelligence Algorithm With 24-h Holter Monitoring for the Identification of Occult Atrial Fibrillation During Sinus Rhythm.

BackgroundSubclinical atrial fibrillation (AF) is one of the pathogeneses of embolic stroke. Detection of occult AF and providing proper anticoagulant treatment is an important way to prevent stroke recurrence. The purpose of this study was to determine whether an artificial intelligence (AI) model can assess occult AF using 24-h Holter monitoring during normal sinus rhythm.MethodsThis study is a retrospective cohort study that included those who underwent Holter monitoring. The primary outcome was identifying patients with AF analyzed with an AI model using 24-h Holter monitoring without AF documentation. We trained the AI using a Holter monitor, including supraventricular ectopy (SVE) events (setting 1) and excluding SVE events (setting 2). Additionally, we performed comparisons using the SVE burden recorded in Holter annotation data.ResultsThe area under the receiver operating characteristics curve (AUROC) of setting 1 was 0.85 (0.83–0.87) and that of setting 2 was 0.84 (0.82–0.86). The AUROC of the SVE burden with Holter annotation data was 0.73. According to the diurnal period, the AUROCs for daytime were 0.83 (0.78–0.88) for setting 1 and 0.83 (0.78–0.88) for setting 2, respectively, while those for nighttime were 0.85 (0.82–0.88) for setting 1 and 0.85 (0.80–0.90) for setting 2.ConclusionWe have demonstrated that an AI can identify occult paroxysmal AF using 24-h continuous ambulatory Holter monitoring during sinus rhythm. The performance of our AI model outperformed the use of SVE burden in the Holter exam to identify paroxysmal AF. According to the diurnal period, nighttime recordings showed more favorable performance compared to daytime recordings.

Effects of Supervised Exercise Training on Atrial Fibrillation: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS.

Atrial fibrillation (AF) is associated with the comorbidities of a sedentary lifestyle. Endurance athletes also show an increased incidence of AF. The role of exercise in the treatment of AF is unknown so this study aimed to examine the effects of supervised exercise on AF. A meta-analysis of randomized controlled trials (RCTs) examining supervised exercise training in participants with AF was performed. The primary outcome was AF recurrence and burden. Secondary outcomes included AF symptoms, quality of life, and cardiorespiratory fitness (CRF). Thirteen RCTs, involving 1155 participants, were included. Paroxysmal AF was present in 34% and persistent AF in 64%. The types of exercise were diverse and included cardiac rehabilitation (64%), aerobic training (7%), Qi Gong (4%), interval training (11%), and yoga (15%). Exercise training reduced AF recurrence (relative risk = 0.77: 95% CI, 0.60-0.99), improved quality of life in 5 of the 10 components of the Short Form 36 survey, and improved CRF (standardized mean difference [SMD] = 0.56: 95% CI, 0.27-0.85). The AF burden was reduced only in studies that included continuous ambulatory monitoring (SMD =-0.49: 95% CI, -0.96 to -0.01) but not when all studies were included (SMD =-0.12: 95% CI, -0.61 to 0.38). There was no difference in adverse events between exercise and control. Supervised exercise training is safe, reduces AF recurrence, and improves quality of life and CRF in participants with AF. Further large RCTs with ambulatory monitoring and robust exercise regimens are needed to assess the effects of exercise training on AF burden and AF symptoms.

Augmented wide area circumferential catheter ablation for reduction of atrial fibrillation recurrence (AWARE) trial: Design and rationale

Recurrence of atrial fibrillation (AF) after a pulmonary vein isolation procedure is often due to electrical reconnection of the pulmonary veins. Repeat ablation procedures may improve freedom from AF but are associated with increased risks and health care costs. A novel ablation strategy in which patients receive "augmented" ablation lesions has the potential to reduce the risk of AF recurrence. The Augmented Wide Area Circumferential Catheter Ablation for Reduction of Atrial Fibrillation Recurrence (AWARE) Trial was designed to evaluate whether an augmented wide-area circumferential antral (WACA) ablation strategy will result in fewer atrial arrhythmia recurrences in patients with symptomatic paroxysmal AF, compared with a conventional WACA strategy. The AWARE trial was a multicenter, prospective, randomized, open, blinded endpoint trial that has completed recruitment (ClinicalTrials.gov NCT02150902). Patients were randomly assigned (1:1) to either the control arm (single WACAlesion set) or the interventional arm (augmented- double WACA lesion set performed after the initial WACA). The primary outcome was atrial tachyarrhythmia (AA; atrial tachycardia [AT], atrial flutter [AFl] or AF) recurrence between days 91 and 365 post catheter ablation. Patient follow-up included 14-day continuous ambulatory ECG monitoring at 3, 6, and 12 months after catheter ablation. Three questionnaires were administered during the trial- the EuroQuol-5D (EQ-5D) quality of life scale, the Canadian Cardiovascular Society Severity of Atrial Fibrillation scale, and a patient satisfaction scale. The AWARE trial was designed to evaluate whether a novel approach to catheter ablation reduced the risk of AA recurrence in patients with symptomatic paroxysmal AF.

ECG-based real-time arrhythmia monitoring using quantized deep neural networks: A feasibility study

Continuous ambulatory cardiac monitoring plays a critical role in early detection of abnormality in at-risk patients, thereby increasing the chance of early intervention. In this study, we present an automated ECG classification approach for distinguishing between healthy heartbeats and pathological rhythms. The proposed lightweight solution uses quantized one-dimensional deep convolutional neural networks and is ideal for real-time continuous monitoring of cardiac rhythm, capable of providing one output prediction per second. Raw ECG data is used as the input to the classifier, eliminating the need for complex data preprocessing on low-powered wearable devices. In contrast to many compute-intensive approaches, the data analysis can be carried out locally on edge devices, providing privacy and portability. The proposed lightweight solution is accurate (sensitivity of 98.5% and specificity of 99.8%), and implemented on a smartphone, it is energy-efficient and fast, requiring 5.85 mJ and 7.65 ms per prediction, respectively.