Electrocardiographic Monitoring Research Articles

Characteristics associated with prevalent atrial fibrillation and risk profile for future atrial fibrillation among those in sinus rhythm in an elderly population in the ELSA Brasil Study

Abstract Background Atrial fibrillation (AF) is an arrhythmia that can lead to limiting symptoms and increases the risk of stroke and heart failure (HF). Purpose To evaluate the association of clinical, electrocardiographic, and echocardiographic parameters with prevalent AF or flutter (AFF), and the risk profile for future AFF according to Charge-AF and EHR scores in an elderly population. Methods The ELSA-Brasil is a prospective cohort study designed to investigate cardiovascular disease and diabetes in 15,105 men and women, civil servants from universities or research institutions in six cities of Brazil. We included all participants in ELSA-Brasil aged 60 and over whose diagnosis of AFF could be assessed and had echocardiography performed at the study's baseline. From the initial sample with participants ≥ 60 years (n = 3,263), 400 participants were excluded due to missing data about AFF, and 775 who did not have echocardiographic studies. Results There were 88 (4.2%) participants with AFF at baseline among the 2,088 (65 ± 4.1 years; 53% women) included in this analysis. Those with AFF were older (66.8 ± 4.4 vs 65 ± 4.0 y-o) and had a higher prevalence of HF (16% vs 3.1%), previous myocardial infarction (14.8% vs 3.8%), left bundle branch block (LBBB: 4.6% vs 0,9%), prolonged QT interval (7.9% vs 2.0%), supraventricular extrasystoles (4.6% vs 1.2%), and sinus bradycardia (11.3% vs 2.9%). AFF individuals also presented larger left atrial volume index - LA (33.3 mL/m2 versus 27 mL/m2), left ventricular end-diastolic diameter (4,63 ± 0,6 cm versus 4,47 ± 0,4 cm) and lower left ventricular ejection fraction (LVEF: 63.6 ± 9.1% vs 67.4 ± 6.4%) that non-AFF (all p-values <0.05). In multivariable analysis, prevalent HF, LBBB, larger LA, and lower LVEF were independently associated with the presence of AFF. Among those in sinus rhythm at study baseline, both risk models showed that most individuals in our sample were at low risk. In the Charge-AF, 63% of individuals were identified as presenting low risk (<2.5%), and 12% of the sample was categorized as high risk, with a risk of five-year AFF greater than 5%. Similarly, in the EHR, 67% of participants were classified as low risk, and 13% were considered high risk. Conclusion We found that AFF was present in 4.2% of the subset of older participants in a cohort composed of free-living individuals in Brazil. The presence of AFF was associated with HF history, altered cardiac electrical activity, LA dilation, and worse LV systolic function. Among those with sinus rhythm, 12-13% were considered at high risk of developing AFF (> 5% in five years) based on two clinical scores. Clinical surveillance and monitoring of electrocardiography and echocardiography parameters may help the early identification of risk factors for AFF.

No reimbursement policy and implantable loop recorders in the real world setting

Abstract Background Prolonged heart rhythm evaluation is indicated in patients with suspected arrhythmias. Routine electrocardiographic Holter monitoring is often associated with poor adherence and may lead to little to no clinically relevant findings. Implantable loop recorders (ILRs) are small, subcutaneous cardiac devices providing semi-continuous electrocardiographic recording. Despite strong evidence supporting their effectiveness, ILRs are yet to be fully reimbursed by the National Health Fund- the public insurer in Poland. Purpose We aimed to investigate the feasibility, as well as the diagnostic yield of ILRs in a real world setting of a tertiary cardiovascular center. Methods We retrospectively analyzed data of consecutive patients admitted for ILR implantation between March 2013 nad November 2023. Hospitalization and procedural costs were covered by the clinic's statutory and hospital funds and not by the National Health Fund, the public payer. All patients were remotely monitored for device follow-up. Baseline demographic characteristics, as well as data regarding observation period, clinical outcomes and safety were collected. Results Data for 51 ILR implants in 50 patients was assessed. Insertion success rate was 100% on first attempt with no complications. Mean age was 54,43 ±18,56 years old. 52,94% of patients were female. Coronary artery disease was present in 21,57% patients, hypertension in 50,98%, diabetes in 13,73%. The indications for ILR implantation were unexplained syncope (n= 42; 82,35%), palpitations (n= 16; 31,37%), ischemic stroke of unknown origin (n= 6; 11,76%), monitoring of ventricular arrhythmia (n= 2; 3,92%). Mean time between occurrence of first symptoms and ILR implantation was 80,86 ±112,95 months. Mean monitoring period was 1067,62 ±668,89 days. 23 (45,1%) patients had an actionable event detected. Mean time to clinical outcome was 190,34 ±514,85 days. Based on the obtained recordings, in 13 (25,49%) patients a cardiac electronic device was implanted and 6 (11,76%) underwent an electrophysiological procedure. Time to intervention was 435,17 ± 542,9 days and 338,8 ± 273,44 days, respectively. ILR prompted medication modification in 14 (27,45%) patients. Antiarrhythmic drugs were modified in 6 (11,76%) patients. Oral anticoagulation was initiated in 3 (5,88%) patients. Mean time to any pharmacotherapy modification was 654,68 ± 604,32 days. Skin infections occurred in 2 patients, leading to early device removal. Conclusions This is the first study to present a comprehensive evaluation of ILR patients in Poland, along with a substantial observation period. We report a high prevalence of treatable cardiac conditions in patients with previous unsuccessful diagnostic work up. In the light of the upcoming favourable changes in governmental healthcare policy, demonstrating evidence supporting ILR application in everyday clinical practice is crucial for advocating their wider utilization and reimbursement.

Early prediction of sudden cardiac death using multimodal fusion of ECG Features extracted from Hilbert–Huang and wavelet transforms with explainable vision transformer and CNN models

Background and Objective:Sudden cardiac death (SCD) is a critical health issue characterized by the sudden failure of heart function, often caused by ventricular fibrillation (VF). Early prediction of SCD is crucial to enable timely interventions. However, current methods predict SCD only a few minutes before its onset, limiting intervention time. This study aims to develop a deep learning-based model for the early prediction of SCD using electrocardiography (ECG) signals. Methods:A multimodal explainable deep learning-based model is developed to analyze ECG signals at discrete intervals ranging from 5 to 30 min before SCD onset. The raw ECG signals, 2D scalograms generated through wavelet transform and 2D Hilbert spectrum generated through Hilbert–Huang transform (HHT) of ECG signals were applied to multiple deep learning algorithms. For raw ECG, a combination of 1D-convolutional neural networks (1D-CNN) and long short-term memory networks were employed for feature extraction and temporal pattern recognition. Besides, to extract and analyze features from scalograms and Hilbert spectra, Vision Transformer (ViT) and 2D-CNN have been used. Results:The developed model achieved high performance, with accuracy, precision, recall and F1-score of 98.81%, 98.83%, 98.81%, and 98.81% respectively to predict SCD onset 30 min in advance. Further, the proposed model can accurately classify SCD patients and normal controls with 100% accuracy. Thus, the proposed method outperforms the existing state-of-the-art methods. Conclusions:The developed model is capable of capturing diverse patterns on ECG signals recorded at multiple discrete time intervals (at 5-minute increments from 5 min to 30 min) prior to SCD onset that could discriminate for SCD. The proposed model significantly improves early SCD prediction, providing a valuable tool for continuous ECG monitoring in high-risk patients.

Premature ventricular contraction patterns associated with nonsustained ventricular tachycardia

BackgroundOccurrence of nonsustained ventricular tachycardia (NSVT) is associated with negative outcomes. It is not clear whether specific electrocardiographic characteristics of premature ventricular contractions (PVCs) are associated with the occurrence of NSVT. The aim of this study was to identify electrocardiographic patterns associated with the presence of NSVT during 24-h electrocardiographic monitoring in patients with >10 PVCs per hour. MethodsThis was a retrospective, observational, cross-sectional study. We reviewed consecutive patients who received 24-h ECG monitoring performed at a single outpatient cardiology center. Patients who received 24-h electrocardiographic monitoring, with a PVC burden ≥10 PVCs/h were included. Occurrence of NSVT during 24-h electrocardiographic monitoring was the main outcome. ResultsA total of 343 patients were analyzed (mean [SD] age, 69.7 [12.5] years; 177 men [51.6 %]). NSVT occurred in 72 patients who were compared with 271 patients without NSVT. The novel term “premature beat ratio”, which aims to correlate the coupling interval and compensatory pause, was introduced; a value >0.5 was independently associated with NSVT according to the multivariate model (OR = 3.73, 95 % CI = 1.57–8.82; P = 0.002). PVC burden (OR = 1.09, 95 % CI = 1.02–1.17; P = 0.006), and triplets (OR = 18.19, 95 % CI = 7.32–45.18 P = 0.0) were also associated with NSVT in the multivariate model. ConclusionThese findings suggest that patients with a high PVC burden, triplets, and a premature beat ratio greater than 0.5 have an increased probability of presenting with NSVT and may benefit from more rigorous follow-up.

Somatometric characteristics of patients with Wolff-Parkinson-White syndrome

Aim. To study the distribution of somatometric indicators and indices of patients with Wolff-Parkinson-White (WPW) syndrome.Material and methods. All patients underwent following clinical and paraclinical investigations: electrocardiography (ECG), Holter ECG monitoring, echocardiography. In addition, we performed somatometric study according to the standard method of V.V. Bunak. The main group consisted of 200 patients with WPW syndrome (men, n=97 (32,6±9,4 years); women, n=103 (47,92±11,6 years)).Results. Anthropometry performed according to James Tanner revealed that in the general group of WPW syndrome individuals, mesomorphs prevailed (57%). A similar pattern was observed both in the groups of women (25,5%) and men (31,5%). According to the Rees-Eysenck index, the general group of WPW syndrome individuals, normosthenics (37%) and pyknics (38%) prevailed. However, in the group of women, normosthenics prevailed (24%), and in the group of men, pyknics (23,5%). The relationship analysis using Pearson's chi-squared test revealed the following: in the group of women, the WPW syndrome was moderately correlated with the thigh fat fold (0,52), and in the group of men — with the abdominal fat fold (0,56).Conclusion. Somatometric study, taking into account the indices (J. Tanner, Rees-Eysenck), confirms the relationship between the risk of cardiovascular diseases and overweight. This can be useful for taking preventive measures in relation to groups of people with certain anthropometric features, when assessing the risk of arrhythmias within the concept of personalized medicine.

Advanced ECG Monitoring: Machine Learning And Robotics For Real-Time Health Management

Cardiovascular diseases are becoming increasingly prevalent due to lifestyle factors such as poor diet, lack of exercise, and conditions like diabetes and hypertension. Electrocardiography (ECG) is a widely used diagnostic tool for detecting various heart conditions, including arrhythmias and myocardial infarction. However, manual analysis of ECG signals is often subjective, time-consuming, and prone to variability. To address these challenges, this paper proposes a comprehensive system that integrates an Arduino-based ECG acquisition module with neural networks for automatic analysis and a robotic system for autonomous sensor placement and intervention. The main objective is to create a smart, real-time ECG monitoring and Computer-Aided Diagnosis (CAD) system capable of early detection and management of heart diseases. The system utilizes machine learning and deep learning techniques to enhance diagnostic accuracy, focusing on implementing a neural network model for ECG classification. A robotic arm is also integrated into the system to ensure precise sensor placement and emergency response

Diagnostic capability of long-term electrocardiographic telemonitoring for detection of heart rhythm disorders

prevalence of cardiac rhythm and conduction disorders is increasing and associated with the growing amount of people of older age groups. The extended use of traditional electrocardiography (ECG) recorders is currently limited due to duration of the investigation, possible skin irritation and withdrawal of consent by the patients. The aim: evaluation of the frequency of arrythmia incidents in adult patients of different ages by assessing the patch monitoring results, and the impact of the monitoring duration on the possibility of diagnosis. Materials and methods: study included 1123 patients aged from 18 to 99 (599 women and 524 men), data about whom was collected in 2021-2022. ECG was recorded by the «Mawi Heart patch» – a single-use dual-channel device for continuous ECG recording for up to2 7 days. Results: the average ECG monitoring time was 81,03±18,5 hours or 3,37±0,7 days. The majority of the participants (74,35%) received the continuous 3-day ECG monitoring. Most rhythm disorders were recorded in the first 24 hours, but over the next 2 days, atrial fibrillation (AF) was detected in 7,66%, more often in men (48 participants, p=0,048) and with some differences in age groups. Starting above 50 years of age, the frequency of AF diagnosing on the first monitoring days is decreased and it is significantly statistically lower (61,11%, p<0,05). Three-day ECG monitoring is associated with a higher chance of detecting AF (OR=2,03; 1,53-3,02, p=0,031) regardless of gender, while the 5-day monitoring wasn’t as effective. The prolonging of the monitoring time increased the number of diagnosed supraventricular tachycardia (SVT) cases by 5,53% in men and 8,35% in women. The 3 days of monitoring are associated with a higher chance of SVT detection (OR = 4,18; 3,32–4,95, p=0,009). There is a direct correlation between SVT detection and the older age groups (r=0,53, p<0,05). SVT detection is higher in patients of 71-80 years old (OR = 2,71; 2,35–3,75, p=0,0041), and of 81-99 years (OR = 2,92; 2,56–3,49, p=0,0039). Conclusion: The frequency of arrhythmia detection, in patients referred to long-term patch monitoring, is high both for AF and SVT. The sex and age patterns for the prevalence of the described arrhythmias were statistically confirmed. The use of long-term ECG patch monitoring increases the chance of arrhythmia detection, primarily for older patients.

A Three-Day Prehabilitation Program is Cost-Effective for Preventing Pulmonary Complications after Heart Valve Surgery: A Health Economic Analysis of a Randomized Trial.

While prehabilitation (pre surgical exercise) effectively prevents postoperative pulmonary complications (PPCs), its cost-effectiveness in valve heart disease (VHD) remains unexplored. This study aims to evaluate the cost-effectiveness of a three-day prehabilitation program for reducing PPCs and improving quality adjusted life years (QALYs) in Chinese VHD patients. A cost-effectiveness analysis was conducted alongside a randomized controlled trial featuring concealed allocation, blinded evaluators, and an intention-to-treat analysis. In total, 165 patients scheduled for elective heart valve surgery at West China Hospital were randomized into intervention and control groups. The intervention group participated in a three-day prehabilitation exercise program supervised by a physiotherapist while the control group received only standard preoperative education. Postoperative hospital costs were audited through the Hospital Information System, and the EuroQol five-dimensional questionnaire was used to provide a 12-month estimation of QALY. Cost and effect differences were calculated through the bootstrapping method, with results presented in cost-effectiveness planes, alongside the associated cost-effectiveness acceptability curve (CEAC). All costs were denominated in Chinese Yuan (CNY) at an average exchange rate of 6.73 CNY per US dollar in 2022. There were no statistically significant differences in postoperative hospital costs (8484 versus 9615 CNY, 95% CI -2403 to 140) or in the estimated QALYs (0.909 versus 0.898, 95% CI -0.013 to 0.034) between the intervention and control groups. However, costs for antibiotics (339 versus 667 CNY, 95% CI -605 to -51), nursing (1021 versus 1200 CNY, 95% CI -330 to -28), and electrocardiograph monitoring (685 versus 929 CNY, 95% CI -421 to -67) were significantly lower in the intervention group than in the control group. The CEAC indicated that the prehabilitation program has a 92.6% and 93% probability of being cost-effective in preventing PPCs and improving QALYs without incurring additional costs. While the three-day prehabilitation program did not significantly improve health-related quality of life, it led to a reduction in postoperative hospital resource utilization. Furthermore, it showed a high probability of being cost-effective in both preventing PPCs and improving QALYs in Chinese patients undergoing valve surgery. This trial is registered in the Chinese Clinical Trial Registry (URL: https://www.chictr.org.cn/) with the registration identifier ChiCTR2000039671.

The Prevalence of Arrhythmias, Including Premature Supraventricular and Ventricular Beats and Other Electrocardiographic Patterns, in 24-Hour Holter Monitoring in Patients with Overweight and Obesity.

this study aims to evaluate the prevalence of various arrhythmias and other electrocardiographic patterns within the group of individuals with overweight and obesity. One hundred eighty-one adults (90 females and 91 males) were qualified for inclusion in the experimental group. All participants had a body mass index (BMI) exceeding 25 kg/m2 (98 patients with obesity and 83 with overweight). The mean BMI in the obesity group was 33.6 kg/m2, and all participants had class 1 obesity. The control group comprised 69 individuals (56 females and 13 males) with normal BMI. The basic measurements were performed, and the participants filled out questionnaires describing their health conditions and lifestyles. Each participant underwent an electrocardiographic (ECG) examination and a 24 h Holter ECG examination. In patients with class 1 obesity compared to the control patients, the average numbers of premature ventricular beats (PVBs) and premature supraventricular beats (SPBs) were statistically significantly higher (p = 0.030 and p = 0.042). There was a positive correlation between body weight and PVB (p = 0.028) and between body weight and SPB (p = 0.028). Moreover, BMI and waist circumference were correlated with SPB (p = 0.043 and p = 0.031). In the backward stepwise multivariate regression model considering 24 h Holter ECG monitoring, concerning SPB as the dependent variable, it was observed that BMI (especially obesity class 1), type 2 diabetes, and thyroid disease exhibited the highest regression coefficients. obesity, even in class 1, might be a factor in a more frequent occurrence of abnormalities in electrocardiographic tests.

Effect of Screening for Undiagnosed Atrial Fibrillation on Stroke Prevention

BackgroundAtrial fibrillation (AF) often remains undiagnosed, and it independently raises the risk of ischemic stroke, which is largely reversible by oral anticoagulation. Although randomized trials using longer term screening approaches increase identification of AF, no studies have established that AF screening lowers stroke rates. ObjectivesTo address this knowledge gap, the GUARD-AF (Reducing Stroke by Screening for Undiagnosed Atrial Fibrillation in Elderly Individuals) trial screened participants in primary care practices using a 14-day continuous electrocardiographic monitor to determine whether screening for AF coupled with physician/patient decision-making to use oral anticoagulation reduces stroke and provides a net clinical benefit compared with usual care. MethodsGUARD-AF was a prospective, parallel-group, randomized controlled trial designed to test whether screening for AF in people aged ≥70 years using a 14-day single-lead continuous electrocardiographic patch monitor could identify patients with undiagnosed AF and reduce stroke. Participants were randomized 1:1 to screening or usual care. The primary efficacy and safety outcomes were hospitalization due to all-cause stroke and bleeding, respectively. Analyses used the intention-to-treat population. ResultsEnrollment began on December 17, 2019, and involved 149 primary care sites across the United States. The COVID-19 pandemic led to premature termination of enrollment, with 11,905 participants in the intention-to-treat population. Median follow-up was 15.3 months (Q1-Q3: 13.8-17.6 months). Median age was 75 years (Q1-Q3: 72-79 years), and 56.6% were female. The risk of stroke in the screening group was 0.7% vs 0.6% in the usual care group (HR: 1.10; 95% CI: 0.69-1.75). The risk of bleeding was 1.0% in the screening group vs 1.1% in the usual care group (HR: 0.87; 95% CI: 0.60-1.26). Diagnosis of AF was 5% in the screening group and 3.3% in the usual care group, and initiation of oral anticoagulation after randomization was 4.2% and 2.8%, respectively. ConclusionsIn this trial, there was no evidence that screening for AF using a 14-day continuous electrocardiographic monitor in people ≥70 years of age seen in primary care practice reduces stroke hospitalizations. Event rates were low, however, and the trial did not enroll the planned sample size.(Reducing Stroke by Screening for Undiagnosed Atrial Fibrillation in Elderly Individuals [GUARD-AF]; NCT04126486)

ИЗМЕНЕНИЯ ЭЛЕКТРОКАРДИОГРАФИЧЕСКИХ ПОКАЗАТЕЛЕЙ ДЕПОЛЯРИЗАЦИИ И РЕПОЛЯРИЗАЦИИ НА ФОНЕ ХИМИОТЕРАПИИ РАКА МОЛОЧНОЙ ЖЕЛЕЗЫ ДОКСОРУБИЦИНОМ

Aim. To study changes in electrocardiographic parameters of the myocardium in patients with verified breast cancer (BC) after completion of chemotherapy (CT) with doxorubicin. Material and methods. The study included 100 patients with a confirmed diagnosis of breast cancer who were treated at the healthcare institution “Grodno University Clinic” (Grodno, Belarus). A number of electrocardiographic parameters of the myocardium were measured in patients before and after chemotherapy using electrocardiography and Holter monitoring. Based on the echocardiography data and the selected threshold value for the relative decrease in GLS (more than 12%), the subjects were divided into two subgroups: those with the presence of cardiotoxicity – CTx+ (n=19) and those without it – CTx- (n=81). Results. An increase in electrocardiographic parameters of depolarization and repolarization (P, P-Q, QRSc, J-Tc, Tpic-Tendc, Q-Tc, Q-Tdc – p<0.001; p<0.001; p=0.005; p=0.023; p=0.009; p<0.001; p=0.006, respectively), as well as in the number of supraventricular extrasystoles (p<0.001) in the general group before and after chemotherapy was detected. The J-Tc and Q-Tc intervals (longer in the CTx- subgroup compared to the CTx+ subgroup: p=0.033 and p=0.037, respectively), the number and total time of sinus tachycardia episodes (p=0.011 and p=0.010, respectively) after chemotherapy differed statistically significantly in the cardiotoxicity subgroups. Conclusions. During chemotherapy with doxorubicin, an increase in the duration of the J-Tc and Q-Tc intervals was observed, the number and duration of episodes of sinus tachycardia also increased. Assessment of the dynamics of these indicators at the stages before/after chemotherapy can provide additional information about the state of the myocardium even before identifying functional disorders by echocardiography.

Diagnostics and treatment of syncope

The 2018 guidelines of the European Society of Cardiology (ESC) provide improved algorithms for the diagnostics and treatment of syncope. New guidelines on ventricular tachycardia, on the prevention of sudden cardiac death and on cardiomyopathies and pacemakers have refined the recommendations. The detailed medical history and examination are crucial for differentiating between cardiac and noncardiac causes and determining the appropriate treatment. High-risk patients need urgent and comprehensive diagnostics. The basic diagnostics include medical history, physical examination and a12-lead electrocardiography (ECG). Further tests, such as long-term ECG monitoring, implantable loop recorders and electrophysiological investigations are helpful in unclear cases. The treatment depends on the cause, with pacemaker implantation and implantable cardioverter defibrillators (ICD) being important for cardiac causes, while behavioral measures and medication management have priority for noncardiac syncope.

Multi-Modal Assessment of Cerebral Hemodynamics in Resuscitated Out-of-Hospital Cardiac Arrest Patients: A Case-Series.

We assessed the feasibility of concurrent monitoring of cerebral hemodynamics in adult, comatose out-of-hospital cardiac arrest (OHCA) patients admitted to the National University Heart Centre Singapore from October 2021 to August 2023. Patients underwent continuous near-infrared spectroscopy (NIRS) monitoring in the first 72 h after return of spontaneous circulation (ROSC) and 30-min transcranial Doppler ultrasound (TCD) monitoring at least once. With constant mechanical ventilatory settings and continuous electrocardiographic, pulse oximeter and end-tidal carbon dioxide monitoring, blood pressure was manipulated via vasopressors and cerebral autoregulation assessed by measuring changes in regional cerebral oxygenation (NIRS) and cerebral blood flow velocities (TCD) in response to changes in mean arterial pressure. The primary outcome was neurological recovery at hospital discharge. Amongst the first 16 patients (median age 61, 94% males), we observed four unique patterns: preserved cerebral autoregulation, loss of cerebral autoregulation, cardio-cerebral asynchrony and cerebral circulatory arrest. Patients with preserved cerebral autoregulation had lower levels of neuro-injury biomarkers (neurofilaments light and heavy) and the majority (86%) were discharged with good neurological recovery. Multi-modal assessment of cerebral hemodynamics after OHCA is feasible and derived patterns correlated with neurological outcomes. The between- and within-patient heterogeneity in cerebral hemodynamics calls for more research on individualized treatment strategies.

Recurrent vascular events and mortality outcomes in patients with known atrial fibrillation, compared to atrial fibrillation detected early after stroke.

Atrial fibrillation (AF) detected after stroke (AFDAS) may represent a distinct clinical entity to that of known AF (KAF). However, there is limited long-term outcome data available for patients with AFDAS. More information regarding prognosis in AFDAS is required to inform future trial design in these patients. We used data (2015-2019) from a national prospective stroke registry of consecutive patients with acute ischaemic stroke and AF. AFDAS was defined as a new diagnosis of AF after stroke detected on electrocardiograph or cardiac monitoring. The co-primary endpoints were: (1) all-cause mortality; (2) recurrent major adverse cardiovascular events (MACE) at 3 years. Secondary endpoints were: (1) recurrent stroke; (2) functional outcome at discharge; (3) presence of co-existing stroke mechanisms. 583 patients were included. After a median follow-up of 2.65 years (cumulative 1064 person-years) 309 patients died and 23 had recurrent MACE. Compared with AFDAS, KAF was associated with a higher risk of all-cause mortality (adjusted Hazard Ratio (aHR) 1.56, 95% CI 1.12-2.18), a higher prevalence of co-existing stroke mechanisms (adjusted odds ratio (aOR) 2.28, 95% CI 1.14-4.59), but not poor functional outcome (aOR 1.61, 95% CI 0.98-2.64). A trend towards a higher risk of MACE was observed in patients with KAF, but this was limited by statistical power (aHR 2.90, 95% CI 0.67-12.51). All 14 recurrent strokes occurred in the KAF group (Log-rank p = 0.03). These data provide further evidence that AFDAS differs to KAF with respect to risk of recurrent stroke, MACE, and all-cause mortality.

Utility and acceptability of remote 6-lead electrocardiographic monitoring in children with inherited cardiac conditions

ObjectiveThis pilot study sought to investigate the utility and acceptability of the KardiaMobile 6-lead ECG (KM6LECG) as a tool for remote monitoring in children with inherited cardiac conditions.DesignA single-centre prospective...

Mavacamten in real-life practice: Initial experience at a hypertrophic cardiomyopathy centre.

In clinical trials, mavacamten reduced left ventricular outflow tract obstruction (LVOTO) and improved symptoms in patients with symptomatic obstructive hypertrophic cardiomyopathy (oHCM). We aimed to share our real-world experience with the efficacy and safety of mavacamten in this patient population. This retrospective, single-centre study included patients with symptomatic oHCM from March 2023 to November 2023. Inclusion criteria were oHCM, age >18years, significant LVOTO (gradient >50mmHg at rest or with Valsalva), New York Heart Association (NYHA) class ≥II despite maximally tolerated medical therapy, and left ventricular ejection fraction (LVEF) >55%. Patients were evaluated by echocardiography, NYHA class, electrocardiography and Holter monitor on each monthly visit for 3months. A total of 31 patients were included in this study. The mean (SD) age was 58 (16.5) years, and 14 (45%) were female. Mean provoked left ventricular outflow tract gradient (LVOTG) reduced by -49.4mmHg (P<0.001) at 4weeks, -59.2mmHg (P<0.001) at 8weeks, and -60.8mmHg (P<0.001) at 12weeks. Twenty-six of the 31 patients (83.8%) achieved an LVOTG ≤30mmHg at Week 12. No major side effects were reported. Sixty-seven percent experienced ≥2 NYHA class improvements, LVEF remained above 55% and no dose titration was made. Our real-world experience aligns with established mavacamten trial outcomes. Continuous vigilance and longitudinal investigations are needed to further assess potential long-term impacts.

Fabric and Fiber-Integrated, Washable Hydrogel Electrodes for Clinically Accurate Sleep Monitoring in-Home

Longitudinal tracking of sleep metrics is important for detecting and managing various diseases, spanning cardiorespiratory disorders to dementia. However, at present, sleep monitoring primarily occurs in specialized medical facilities that are not conducive to longterm studies. In-home solutions either compromise user comfort or signal accuracy in tracking sleep variables and have not yet provided reliable longitudinal data. We believe that human-centered design of multimodal, low-form-factor, comfortable sensing systems is needed for this increasingly-important area of preventative health monitoring. Our lab developed a suite of fabric-based and/or garment-integrated sensors and sensing modalities that accurately and reliably extract important sleep metrics, such as posture, cardiorespiratory signals, eye movement and brain activity, over the course of an eight-hour sleep session. Our garment-integrated sensing arrays do not require a medical professional for on-body positioning, maintain their function independent of sizing and fit on individual users, and can be laundered or cleaned with antibacterial wipes without compromising its varied sensing elements. Here, we describe one of these two key sensors, a fabric or fiber-based electrochemical hydrogel electrode that enables wearable biopotential monitoring, including electrocardiography (ECG), eletrooculography (EOG) and electroencephalography (EEG), from which the aforementioned sleep metrics can be recorded and quantified with clinical precision and accuracy. The hydrogel is fabricated as a coating on either commodity fabrics or threads using a low-temperature reactive deposition process, termed photoinitiated chemical vapor deposition (piCVD), during which hydrogel monomers react with a photoinitator in the vapor phase to create a polymeric hydrogel coating directly on the surface of fabrics or threads that have been temporarily surface modified with a skin-safe electrolyte gel. The resulting composite hydrogel coating isolated from this operation is ionically conductive, can be reversibly swelled in water and dried without losing ionic conductivity, and transduces the ionic signals (fluxes) experienced by the body into an electrical signal that can be captured by any commercial ECG, EOG or EEG monitoring instrument. An array of these fabric or thread-based hydrogel electrodes can be integrated into readily-available garments using simple cut-sew techniques and these garments can then be worn throughout the night to effect continuous ECG, EOG and EEG monitoring at home. Design elements of a custom-made circuit board that allows simultaneous capture of these signals will be described. Results from an ongoing user study of >50 adults will be presented to validate the clinical precision and accuracy of these garment sensor for sleep quality monitoring.

Adrenaline intravenous therapy persistence grade I severe allergic reaction: A case report and literature review.

At present, there is still insufficient understanding of the progression from persistent allergic reactions to severe reactions. Adrenaline remains the preferred medication for severe allergic reactions, and intramuscular injection of adrenaline can also be considered for patients with grade I reactions that are difficult to alleviate gastrointestinal symptoms. It is worth further discussing whether it is possible to break the conventional intramuscular injection recommended by the guidelines when the effect of intramuscular injection is not ideal for persistent grade I severe allergic reactions. A young male, 20 years of age, was admitted to emergency department because of repeated rash for 3 days and abdominal pain for 6 hours after taking traditional Chinese medicine. After hormone therapy, the rash continued to recur and secondary gastrointestinal symptoms occurred on the 3th day. Adrenaline intramuscular injection was given to temporarily relieve the rash and abdominal pain, but symptoms still persisted. The patient was diagnosed with persistent severe allergic reaction (grade I). Continuous intravenous infusion of low-dose adrenaline under electrocardiographic monitoring, real-time monitoring of heart rate and blood pressure, and routine treatment with methylprednisolone, diphenhydramine, calcium gluconate, and cetirizine. During this period, adrenaline intramuscular injection is temporarily added when abdominal pain symptoms are obvious. The entire treatment process used a total of 6.8 mg of adrenaline. During the entire period of adrenaline intervention, the patient did not experience any new discomfort, and there were no abnormal fluctuations in heart rate, rhythm, or blood pressure. The symptoms of rash and abdominal pain gradually improved. For patients with persistent grade I severe allergic reactions, intravenous administration of low-dose adrenaline under close vital sign monitoring is safe, feasible, and highly effective in preventing biphasic, persistent, or worsening allergic reactions.

Risk of corrected QT interval prolongation in patients receiving antipsychotics.

Antipsychotic (AP) use has been associated to QT interval prolongation on the surface electrocardiogram (ECG). Our study aimed to determine the incidence of corrected QT (QTc) interval prolongation among patients admitted to a psychiatric hospitalization unit requiring AP treatment and to assess the relationship between administered dose and QTc interval changes. We enrolled 179 patients admitted to the Hospital Psiquiátrico Departamental Universitario del Valle in Cali, Colombia. ECGs were conducted upon admission, and again at 3 and 7 days postadmission. The QT interval was measured, and QTc interval correction was performed using Bazzet's formula. QTc interval prolongation at time points B or C was observed in 9.5% of patients. Clozapine was the most common AP associated with QTc interval prolongation (20.59%), followed by olanzapine (15.38%). The relative risk of QT interval prolongation with clozapine compared to haloperidol was 4.17 (95% confidence interval, 1.14-15.17, P = 0.02). AP use upon hospital admission was linked to early (within 3 days) QTc interval prolongation. Clozapine and olanzapine were associated with a greater increase in QTc interval compared to haloperidol, indicating a need for rigorous electrocardiographic monitoring with their use.

Evaluation of cardiac clues in patients admitted to pediatric cardiology outpatient clinic with syncope

Background: In our study, we aimed to determine the incidence rates of children admitted to the pediatric cardiology outpatient clinic with syncope according to their etiologies; and especially to reveal the clues that distinguish cardiac syncope cases from other cases. Materials and Methods: The study was conducted by obtaining the information of 795 children aged 5-17 years who were diagnosed with syncope in the pediatric cardiology outpatient clinic of our tertiary university hospital between 01.01.2021 and 01.06.2024 from the data in our hospital automation system. Medical history of the patient and his/her family, syncopal event, physical examination findings, 12-lead electrocardiography (ECG), echocardiography, 24-hour rhythm holter and exercise ECG records were analyzed. Results: Cardiac syncope was 14.5% (10.8% arrhythmia and 3.7% structural heart disease) while noncardiac syncope was 85.5% (VVS 60.6%, OH 18.6%, situational 1% and 4.8% idiopathic). The most common conditions associated with cardiac syncope were a history of arrhythmia and heart disease, a family history of sudden death at a young age, and syncope associated with exercise-palpitations-chest pain. Rhythm holter test had a low diagnostic rate, while exercise ECG test had a high diagnostic rate. Conclusion: It is important to diagnose cardiac syncope as it can cause sudden death. Standard 12-lead ECG, echocardiography and rhythm holter examination should be performed in all suspected patients; exercise ECG, head-up tilt test, genetic arrhythmia/cardiomyopathy investigations and electrophysiologic study should be performed in selected cases. In addition, simultaneous ECG monitoring during electroencephalography (EEG) examination in patients presenting with atonic seizures will be very useful in terms of clarifying the etiology.