ECG Screening Research Articles

Layman electrocardiographic screening using smartphone-based multiple‑lead ECG device in school children

BackgroundPre-partecipation ECG screening of large populations has a significant socioeconomic impact. Technological progress now allows for high-tech-low-cost ECG screening using validated smartphone-based devices capable of guiding to the correct performance of a 12‑lead ECG by layman with no medical background. MethodsWe enrolled 728 (364, 52% males) individuals, aged 12–13 years who underwent ECG screening with a smartphone 12‑lead ECG during school hours by layman volunteers. Correct electrodes placement was provided by a validated image-processing algorithm by the smartphone camera in the App. ECG interpretation was via a telecardiology platform and alterations classified following current standards. ResultsA total of 741 ECGs were recorded, of which 13(2%) were technically not interpretable. Mean PR, QRS and QTc were: 145 ± 22, 85 ± 19 and 387 ± 57 msec. No QTc prolongation was observed. Mean QRS axis was 15°; 26 (4%) patients presented an iRBB. T-wave inversion from V1-V3 was present in 145 (21%) subjects. Twenty-one(3%) patients were referred to second level examination: deep Q-waves in inferior leads in 12(1.6%), ventricular ectopics in 5(0.7%), anterior T-waves inversions V1-V4 in 3(0.4%); extreme right axis deviation in 1(0.3%). Second line investigations did not provide any definitive diagnosis. Total project costs (material equipment and human cost) was 14.460€, 19.51€ per individual. The potential net saving with respect to current pre-participation screening cost was 19%. ConclusionsLayman 12‑lead Smartphone-ECG population screening proved feasible and effective, with a rate of non-interpretable ECG of <5%. Potential cost-saving in ECG screening and recording was 19%, providing an appealing opportunity when large campaigns should be addressed also in developing countries.

Serial 7-Day Electrocardiogram PatchScreening for AF inHigh-Risk Older Women by the CHARGE-AF Score.

Asymptomatic atrial fibrillation (AF) is associated with an increased risk of stroke. The yield of serial electrocardiographic (ECG) screening for AF is unknown. The aim of this study was to determine the frequency of AF detected by serial, 7-day ECG patch screenings in older women identified as having an elevated risk of AF according to the CHARGE (Cohorts for Heart and Aging Research in Genomic Epidemiology)-AF clinical prediction score. Postmenopausal women with a 5-year predicted risk of new-onset AF≥5% according to CHARGE-AF were recruited from the ongoing WHISH (Women's Health Initiative Strong and Healthy) randomized trial of a physical activity intervention. Participants with AF at baseline by self-report or medical records review were excluded. Screening with 7-day ECG patch monitors was performed at baseline, 6months, and 12months from study enrollment. On baseline monitoring, 2.5% of the cohort had AF detected, increasing to 3.7% by 6months and 4.9% cumulatively by 12months. Yield of patch screening was higher among participants with a higher (≥10%) CHARGE-AF score: 4.2% had AF detected at baseline, 5.9% at 6months, and 7.2% at 12months. Most participants with patch-identified AF never had a clinical diagnosis of AF (36 of 46 [78%]). Older women with an elevated CHARGE-AF score had a high prevalence of AF on 7-day ECG patch screening. Serial screening over 12months substantially increased the detection of AF. These data can be useful in helping identify high-risk participants for enrollment in future studies of the management of asymptomatic AF.(Women'sHealth Initiative Silent Atrial Fibrillation Recording Study [WHISH STAR]; NCT05366803.).

Multiple problems of school medicine: state of health and organization of nutrition for schoolchildren

Introduction. In recent years, there has been an increase in the number of schoolchildren with chronic diseases. Employees of the Astrakhan State Medical University, together with colleagues from Children’s City Polyclinic №4, worked to study the impact of nutrition on the growth of disease cases in educational institutions.Aim. Study of the impact of nutrition in educational institutions on the state of health of modern schoolchildren in the city of Astrakhan, as well as the understanding of children and their parents of the principles of healthy nutrition of children.Materials and methods. The health status of 9063 schoolchildren was monitored in general education institutions located in the service area of Children’s City Polyclinic No. 4. Data from preventive examinations 2018–2020 were used. Schoolchildren (579 people) in grades 8–11 and parents (591 people) were surveyed for the state of the child’s health and attitude to healthy nutrition in schools.Results. According to the results of monitoring by the Office of Rospotrebnadzor in the Astrakhan region in the region, no educational institution has a balanced diet. Preventive examinations of schoolchildren showed that only 7% of children with health group I entered the first grades. In a significant part of schoolchildren, various functional violations were noted (57%). In the structure of such disorders, the first place is diseases of the musculoskeletal system, the second place is the pathology of the digestive organs, and the third place is the violation of neuropsychiatric health. There was a high level of allergopathology, eye diseases. 3% of children showed hearing loss. When examining the cardiovascular system (ECG screening), only 63% of schoolchildren had no significant abnormalities.Conclusion. Unsustainable nutrition of schoolchildren is one of the reasons for the high level of incidence of schoolchildren, the prevalence of chronic diseases, and physical disorders. It is necessary to introduce healthy-saving technologies in schools and control the organization of nutrition for schoolchildren.

Kennedy’s disease presented with mastication fatigue combined with positive titin antibody: a case report

BackgroundSpinal and bulbar muscular atrophy (SBMA) is an X-linked recessive hereditary neuromuscular disorder caused by the expanded trinucleotide repeat in the androgen receptors gene. The major clinical manifestations of SBMA consist of weakness in the bulbar and limb muscles, fasciculations, tremors, cramps, sensory impairment, and gynecomastia. However, atypical SBMA cases may lead to misdiagnosis. Muscular fatigue and decremental responses to repetitive nerve stimulation (RNS), despite being observed in some SBMA patients, are usually occurred in MG patients, and patient with the symptom of mastication fatigue was rarely reported. In addition, cardiological investigations have been performed in SBMA patients and several ECG alterations were identified. Here we report an SBMA patient presenting with a rare onset symptom of mastication fatigue, who has been detected with a positive titin antibody in the serum and showed a WPW pattern electrocardiogram.Case presentationThe patient showed mildly progressive fatigue in the muscles of mastication over 3 years. Neurological examination showed facial muscle weakness and a wasting tongue with fasciculations, but the weakness, wasting, or fasciculations were not obvious in the limbs. 3-Hz RNS showed a decremental response in bilateral orbicularis oculi. The test of titin antibody was positive in the serum, and the electrocardiogram showed a WPW pattern ECG. Genetic analysis revealed an increased number (39 repeats) of tandem CAG repeats in the AR gene, which confirmed the diagnosis of SBMA. The fatigue symptom was significantly improved after oral pyridostigmine bromide treatment.ConclusionThis case calls for more attention to muscular fatigue as the onset symptoms of Kennedy’s disease. ECG screening is of importance in SBMA patients and further studies are needed to investigate the titin antibody in SBMA patients as well as other neurogenic disorders.

Wolff-Parkinson-White Presenting as QRS Alternans and Other Differential Diagnoses in a Large Pre-Participation ECG Screening Cohort.

Wolff-Parkinson-White (WPW) syndrome is a proarrhythmic condition that may require restriction from strenuous activities and is characterized by ECG signs, including delta waves. We observed cases of intermittent WPW patterns presenting as QRS alternans ('WPW alternans') in a large pre-participation ECG screening cohort of young men reporting for military conscription. We aimed to determine the WPW alternans pattern, case characteristics, and the prevalence of other relevant differential diagnoses presenting as QRS alternans in a pre-participation setting. One hundred twenty-five thousand one hundred fifty-eight prospective male military recruits were reviewed from January 2016 to December 2019. A review of electronic medical records identified cases of WPW alternans and WPW patterns or syndrome. Reviewing electronic medical records identified cases of relevant differential diagnoses that might cause QRS alternans. Four individuals (2.2%) had WPW alternans out of 184 individuals with a final diagnosis of WPW pattern or syndrome. Two of these individuals manifested symptoms or ECG findings consistent with supraventricular tachycardia. The overall prevalence of WPW alternans was 0.003%, and the prevalence of WPW was 0.147%. WPW alternans represented 8.7% of individuals presenting with QRS alternans, and QRS alternans had a prevalence of 0.037% in the entire population. WPW alternans is a variant of intermittent WPW, which comprised 2.2% of WPW cases in our pre-participation screening cohort. It does not necessarily indicate a low risk for supraventricular tachycardia. It must be recognized at ECG screening and distinguished from other pathologies that also present with QRS alternans.

Abstract 13811: A Percentile Approach to Refining ECG Criteria for Screening Female Athletes for Cardiac Risk

Introduction: Despite known differences in electrocardiographic (ECG) findings by sex, only empirical thresholds for both sexes exist in current ECG guidelines for screening athletes for risk of sudden cardiac death (SCD). We hypothesize that our large dataset - with diversity in age, race, and sport participation - can be utilized to improve ECG screening in female athletes. Methods: Computerized 12-lead ECGs were recorded and analyzed in female athletes who underwent PPE between 06/2010 and 09/2021. The 2017 international criteria for ECG interpretation were compared to either the 99th percentile in our cohort or the percentile that corresponded to the known disease prevalence for HCM and Long QT syndrome. For ST depression the 99.5th percentile, a marker for HCM, was used; for QTc prolongation, the 99.9th percentile was used. RS wave amplitude was considered a marker for hypertrophy or low voltage. Results: Of 3476 athletes, the 2017 international criteria classified 2.2% with at least one ECG abnormality requiring cardiological evaluation. Rates were similar across ages, race/ethnicity, and sporting discipline. Using a percentile approach based on our population, 3.3% would require additional workup. Surprisingly, ST depression up to 0.03 mV was a normal finding in this cohort. If RS voltage extremes were considered abnormal findings, an additional 9.6% of the population would be flagged using current definitions. This number decreases to 3.4% if using the 99th percentile. Conclusions: These results highlight a difference in the reported prevalence of ECG abnormalities when comparing empirically derived thresholds to statistically derived ranges that fall outside the 99th percentile. Consideration of new metrics specific to the female athlete population has the potential to further refine athlete ECG screening.

Abstract 10745: Return to Play After Covid-19 Infection: Cardiac Imaging Findings in Youth

Introduction: SARS CoV2 has been associated with acute and subacute myocarditis. Screening after COVID-19 has been recommended prior to returning to physical activity. The yield of such investigations, particularly in youth, remains unknown. Methods: Retrospective chart review was performed of patients evaluated in a cardiology clinic for return to play (RTP) after COVID-19 between 01/20 - 06/21. Iteratively updated guidance for testing was provided to ambulatory providers. Patients with MIS-C were excluded. We reviewed demographics, clinical evaluation, and cardiac imaging. Results: Of 429 patients (age 16.3 ± 2.7 [range 8-21] yrs, 44% male) evaluated including 9 with pre-existing heart disease, 318 underwent echocardiograms and 23 also had cardiac MRI. Cardiac MRI was performed for abnormal screening ECG or echocardiogram or cardiovascular symptoms. New echocardiographic abnormalities were detected in 69 patients: 4 were possibly related to COVID-19 infection, 3 were new structural heart disease (2 anomalous coronary, 1 bicuspid aortic valve), and 62 were normal variants or trivial findings. New ventricular dysfunction (right or left, qualitative dysfunction or LV ejection fraction [EF] &lt;55%) was noted in 11 patients (LV EF mean 52.7 ± 2.6%, minimum 46%). Eight underwent cardiac MRI confirming trivial to no ventricular dysfunction and none of the 23 MRIs demonstrated late gadolinium enhancement or met Lake Louise criteria for myocarditis. All patients without new diagnoses of structural heart disease were ultimately deemed safe to return to previous levels of physical activity. Conclusions: Cardiovascular evaluation for RTP of youth after COVID-19 demonstrated mild transient abnormalities and incidental findings, but no diagnoses of myocarditis. These data suggest early concerns about subclinical myocarditis may have been overestimated. Future studies should consider the costs and benefits of current society algorithms for such evaluations.

Screen-detected atrial fibrillation (AF) and “micro-AF” after myocardial infarction in patients 70–82 years and risk of cardiovascular events in the OMEMI trial

Abstract Background Incident atrial fibrillation (AF) occurs in 5–10% of patients after acute myocardial infarction (AMI) and is associated with adverse outcomes. Guidelines now recommend screening for AF in all elderly patients. However, the yield of extended AF screening after AMI has not been investigated. Short episodes of consecutive irregular supraventricular ectopic beats, entitled “micro-AF”, are associated with the development of AF, but the prognostic importance of such findings after an AMI is unknown. Purpose To investigate the added value of two-week intermittent ECG screening to detect incident AF and “micro-AF” in elderly patients 12 months after an AMI, and its relation to risk of cardiovascular endpoints. Methods The OMega-3 fatty acids in Elderly patients with Myocardial Infarction (OMEMI) study investigated the effect of Omega-3 fatty acid supplementation on 2-year risk of major cardiovascular events (MACE; non-fatal AMI, stroke, revascularization, or hospitalization for heart failure) in 70–82 years old patients with a recent AMI. All patients had a 12-lead ECG performed at 3, 12 and 24 months. In addition, patients without known AF one year after the index AMI underwent a 2-week period of intermittent 30-second “thumb ECG” screening. Incident AF and “micro-AF” (episodes of ≥3 consecutive irregular supraventricular ectopic beats) were registered and adjudicated by at least two investigators who were blinded to outcome, and the association with risk of MACE was analyzed with logistic regression. Results Among 1014 patients in the OMEMI trial, 255 (25.1%) had known AF or AF identified at baseline. New-onset AF was detected clinically or at study visits in 39 patients. Screening by 2-week “thumb ECG” was performed in 567 participants without known AF, and identified unknown AF in 4 (0.7%) patients. Another 27 (4.8%) patients had “micro-AF” in at least one ECG recording. In 43 patients with incident AF, 21 (48.8%) experienced a MACE, compared to 114 out of 716 without any AF (15.9%; p&amp;lt;0.001), driven by a higher risk of new AMI or revascularization. Nine (33.3%) patients with “micro-AF” and 63 (12.2%) without “micro-AF” experienced a MACE (p=0.002), explained mostly by a higher risk of hospitalization for heart failure (p&amp;lt;0.001). Using patients without AF and “micro-AF” as reference, “micro-AF” was associated with an intermediate risk of MACE (OR 2.8: 95% CI 1.2–6.4) and new-onset AF with a high risk of MACE (OR 5.3; 95% CI 2.8–10.0). Conclusion Two-week intermittent ECG screening identified few new cases of new-onset AF, but a substantial number of patients with “micro-AF”. “Micro-AF” was associated with an increased risk of major cardiovascular events, albeit with an intermediate risk compared to a higher risk of major cardiovascular events associated with new-onset AF. Funding Acknowledgement Type of funding sources: None.

The Risk of Fatal Arrhythmias Associated With Sertraline in Patients With Post-myocardial Infarction Depression.

Sertraline is a first-line antidepressant and the most commonly used in the treatment of selective serotonin reuptake inhibitor (SSRI) in major depression. It is preferred due to its central and peripheral actions on the serotonergic system in patients with mental health issues as well as cardiovascular disease, particularly post-myocardial infarction depression. Some of the feared adverse effects include QT prolongation, arrhythmias including Torsades de pointed, and sudden cardiac death, which are associated with older antidepressants and are rarely seen with SSRIs, including sertraline. We tried to understand the risks associated with sertraline use in cardiac patients. We reviewed all the relevant information from inception up to July 2022 regarding the risks of sertraline use in cardiovascular diseases, particularly with a focus on post-myocardial infarction depression, and gathered around 500 articles in our research and narrowed it down to 37 relevant articles. The database used was PubMed and the keywords used are sertraline, arrhythmia, major depression, post-myocardial infarction, and ventricular tachycardia. We carefully screened all relevant articles and found articles supporting and refuting the effects of sertraline in increasing cardiovascular morbidity and mortality. We concluded that there is a significant variability due to confounding factors affecting individual cases. Overall, sertraline has no increased risk in comparison with other antidepressants and a comparatively preferable safety profile to other SSRIs like citalopram in general cases. Any patient with a high risk of arrhythmias due to any etiology should receive a screening ECG before sertraline prescription for baseline QT interval and genotyping for any serotonin transporter/receptor variations. Patients should also be periodically monitored for drug-drug interactions while on therapy. We encourage further research, including randomized clinical trials and post-marketing surveillance regarding the use of sertraline in high-risk cases.

Ventricular arrhythmia and sudden cardiac death in hypertrophic cardiomyopathy: From bench to bedside.

Patients with hypertrophic cardiomyopathy (HCM) mostly experience minimal symptoms throughout their lifetime, and some individuals have an increased risk of ventricular arrhythmias and sudden cardiac death (SCD). How to identify patients with a higher risk of ventricular arrythmias and SCD is the priority in HCM research. The American College of Cardiology/American Heart Association (ACC/AHA) and the European Society of Cardiology (ESC) both recommend the use of risk algorithms to identify patients at high risk of ventricular arrhythmias, to be selected for implantation of implantable cardioverters/defibrillators (ICDs) for primary prevention of SCD, although major discrepancies exist. The present SCD risk scoring systems cannot accurately identify early-stage HCM patients with modest structural remodeling and mild disease manifestations. Unfortunately, SCD events could occur in young asymptomatic HCM patients and even as initial symptoms, prompting the determination of new risk factors for SCD. This review summarizes the studies based on patients' surgical specimens, transgenic animals, and patient-derived induced pluripotent stem cells (hiPSCs) to explore the possible molecular mechanism of ventricular arrhythmia and SCD. Ion channel remodeling, Ca2+ homeostasis abnormalities, and increased myofilament Ca2+ sensitivity may contribute to changes in action potential duration (APD), reentry circuit formation, and trigger activities, such as early aferdepolarization (EAD) or delayed afterdepolarization (DAD), leading to ventricular arrhythmia in HCM. Besides the ICD implantation, novel drugs represented by the late sodium current channel inhibitor and myosin inhibitor also shed light on the prevention of HCM-related arrhythmias. The ideal prevention strategy of SCD in early-stage HCM patients needs to be combined with gene screening, hiPSC-CM testing, machine learning, and advanced ECG studies, thus achieving individualized SCD prevention.

Accuracy of the "International Criteria" for ECG screening in athletes in comparison with previous published criteria: rationale and design of a diagnostic meta-analysis.

The impact of the International Criteria for ECG interpretation in athletes has further improved the diagnostic accuracy of the 12-lead ECG use for preparticipation screening (PPS); moreover, these criteria have been evaluated in different populations of athletes and settings proving good results. We aimed to perform a comprehensive review of the use of the International Criteria for ECG interpretation in athletes, stemming from a systematic review to diagnostic meta-analysis, limiting our inclusion only to observational studies to determine the diagnostic accuracy of ECG for detecting cardiac anomalies related to sudden cardiac death in athletes. This meta-analysis is expected to include several important studies related to PPS on different populations of athletes comparing different ECG criteria and detail important data on the diagnostic accuracy of ECG in PPS. Furthermore, we intend to highlight the advantage of using ECG in PPS. The present diagnostic meta-analysis results will aid sports medicine physicians and cardiologist in adhering to the most accurate criteria for ECG evaluation in athletes and it may help to solve controversies aroused regarding the excess cost of ECG in PPS related to the amount of false positive cases.

The Impact of Ethnicity on Athlete ECG Interpretation: A Systematic Review

Athlete ECG interpretation criteria have been developed and refined from research in athlete populations; however, current guidelines are based on available data primarily from Caucasian and Black athletes. This study aimed to assess the impact of ethnicity on ECG interpretation in athletes. A systematic review was conducted of the MEDLINE, EMBASE, Scopus, SPORTDiscus, and Web of Science databases, for papers that assessed athlete screening ECGs and compared findings on the basis of ethnicity. Fifty-one papers which compared ECGs from various ethnicities were included. Most studies assessed Black athletes against Caucasian athletes and found a greater prevalence of T-wave inversion (TWI) (2.6–22.8% vs. 0–5.0%) and anterior TWI (3.7–14.3% vs. 0.6–2.0%). Black athlete subgroups in Africa had TWI (20–40%) and anterior TWI (4.3–18.7%) at a higher prevalence than other Black athletes. Athletes who were defined as mixed-race, Asian, and Pacific Islander are potentially more like Black athletes than Caucasian athletes. Black ethnicity is known to have an impact on the accurate interpretation of athlete ECGs; however, there is nuance related to origin of both parents. Asian and Pacific Islander origin also may impact athlete ECG interpretation. Further research is required to assist in distinguishing abnormal and normal athlete ECGs in different ethnic populations.

Diagnostic accuracy of the 12-lead electrocardiogram in the first 48 hours of life for newborns of a parent with congenital long QT syndrome.

Long QT syndrome (LQTS) is an autosomal dominant disorder characterized by a prolonged QT interval. Electrocardiographic (ECG) screening in the first 48 hours of life may be misleading, even in newborns with a genotype-positive LQTS parent. The purpose of this study was to determine the ECG's diagnostic accuracy in the first 48 hours of life for neonates born to a parent with LQTS. We conducted a retrospective review of all neonates born at Mayo Clinic to a parent with ≥1 pathogenic variant in a LQTS-causative gene who had least 1 ECG in the first 48 hours and genetic test results were available. The sensitivity and specificity of the diagnostic ECG were calculated using Bazett's heart rate-corrected QT (QTc) thresholds of 440, 450, 460, and 470 ms. Overall, 74 newborns (36 females [49%]) were included (mean QTc interval on the first ECG 489 ± 54 ms; 50 [68%] LQTS genotype-positive). The mean QTc interval in the first 48 hours for neonates that ultimately were genotype-positive was greater (506 ± 52 ms) than that for genotype-negative neonates (455 ± 41 ms) (P = .0004). When using a recommended threshold QTc interval of ≥440 ms, 6 of 50 genotype-positive neonates (12%) were missed (underdiagnosed) and 17 of 24 genotype-negative neonates (71%) were overdiagnosed (sensitivity 88%; specificity 29%). The newborn ECG should not be used in isolation to make the diagnosis of LQTS since it will result in many misclassifications. Genetic testing must be initiated before discharge, and proper anticipatory guidance is vital while awaiting test results.

QRS transitional zone rotations and the risk of atrial fibrillation: the Suita Study.

ECG screening can detect people at risk of developing atrial fibrillation (AF). Recent literature indicated that QRS transitional zone rotations could predict several cardiovascular events. Herein, we investigated the association between QRS transitional zone rotations and the future risk of AF. This prospective cohort study included 6794 participants (3178 men and 3616 women), aged 30-84years, from the urban Japanese city of Suita. QRS transitional zone rotations were diagnosed by ECG during baseline, while AF was diagnosed by ECG, hospital records, and checkups during follow-up. The Cox regression was used to compute the sex-specified hazard ratios (HRs) and 95% confidence intervals (CIs) of incident AF for participants with counterclockwise and clockwise QRS transitional zone rotations compared to those with normal rotation. Within a median follow-up period of 14.6years, 311 participants (206 men and 105 women) developed AF. Counterclockwise rotation was associated with the reduced risk of AF among men, but not women, in the age-adjusted model: HR (95% CI) = 0.66 (0.44, 0.98) and the multivariable-adjusted model: HR (95% CI) = 0.65 (0.43, 0.97). Clockwise rotation was not associated with AF risk in either sex. To the best of our knowledge, this is the first study to indicate that counterclockwise rotation could be associated with the reduced risk of AF in men. More studies are needed to confirm our findings and elucidate possible mechanisms.

Patterns and associated factors of electrocardiographic abnormality among type 2 diabetic patients in Amhara National Regional State Referral Hospitals, Ethiopia: a multicenter institution-based cross-sectional study

BackgroundCardiovascular diseases are the most causes of mortality and morbidity among diabetes mellitus (DM) patients. Electrocardiographic (ECG) changes are common in the early course of the disease. Little is known about the electrocardiographic abnormalities among type 2 DM patients in Ethiopia. This study determined the overall prevalence, its patterns, and the associated factors of ECG abnormalities among people living with T2DM in Amhara National Regional State referral hospitals, Ethiopia.MethodsA multicenter institution-based cross-sectional study was conducted from 01 April to 30 May 2021. A simple random sampling and systematic sampling techniques were employed to select the referral hospitals and study participants, respectively. A digital electrocardiograph was used to measure the ECG parameters and the other data were collected using an interviewer-administered questionnaire. Epi-data version-4.6 and Stata-14 were used for data entry and statistical analysis, respectively. The descriptive statistics were presented with tables and graphs. A binary logistic regression model was fitted to identify associated factors of ECG abnormality. In the final model, statistical significance was decided at p≤0.05, and the strength of association was indicated using an adjusted odds ratio with 95% CI.ResultsTwo-hundred and fifty-eight participants (response rate = 99.6%) were included for the analysis. The prevalence of overall ECG abnormality was 45% (95% CI: 39, 51%). On the basis of the electrocardiographic patterns, 57 (21.1%; 95% CI: 14.6, 32.6%) were presented with T-wave abnormality, 36 (14%; 95% CI: 10.1, 18.8%) left axis deviation, and 24 (9.3% [6.3, 13.5%]) sinus tachycardia. Higher monthly income (> 90$) (AOR = 0.51 [0.31, 0.83]), over 10 years duration of DM (AOR = 4.5[1.05, 18.94]), hypertension (AOR = 3.9 [1.6, 9.40]), fasting blood sugar of ≥ 130 mg/dl (AOR = 5.01[2.13, 12.20]), and overweight (AOR = 2.65[1.17, 5.98]) were statistically significant factors of overall ECG abnormality.ConclusionsNearly, half of the participants had at least one ECG abnormality. Higher-income, prolonged disease duration, hypertension, higher fasting blood sugar, and overweight were significantly associated with ECG abnormality. The findings of this study suggest the need to institute routine ECG screening for all T2DM patients to reduce ECG abnormalities and further complications.

P170 VALUE OF ELECTROCARDIOGRAPHIC SCREENING FOR EARLY DETECTION OF ARRHYTHMIC AND MALIGNANT HEART DISEASE IN CHILDREN

Abstract Background Twelve–lead electrocardiography (ECG) is a tool that can identify cardiac conduction abnormalities that predispose to sudden cardiac death (SCD) in completely asymptomatic subjects. The rate of sudden cardiac death in childhood is estimated at 1–1.5 cases per 100,000 individuals and 10–15% of events occur during physical activity. We evaluated the importance of the electrocardiogram performed in childhood in the early diagnosis of asymptomatic electrocardiographic changes suggestive for electrical or structural heart disease potentially at risk of sudden death. Materials and Methods we analyzed 623 patients aged 0–16 years who were referred to the pediatric arrhythmology clinic in Padua Hospital between October 2013 and March 2020. Patients were referred to our second–level clinic after a first electrocardiographic alteration found out in ECG screening performed for sports activity. All patients were evaluated with clinical history and ECG. Then, depending on the suspected pathology, Holter ECG, ergometric test, echocardiogram, MRI were performed for adequate risk stratification. Results Of the 623 patients evaluated, 393 (63%) were referred by sports medicine, 179 (29%) by the hospital pediatric clinic or family pediatrician, and 51 patients (8%) were referred for familiarity. 45% of patients (280) were referred for suspected WPW; 124 patients (20%) for many BEV and suspected ARVD; 85 patients (14%) for suspected long QT, 31 patients (5%) for suspected Brugada pattern; 7 patients (1%) for suspected CPVT; 8 patients (1%) for electrocardiographic changes with suspected HCM; 1 patient (0.01%) for suspected short QT and 88 patients (14%) for other arrhythmic disorders not at risk of sudden death. The diagnosis of WPW was confirmed in 280 patients (100%), LQTS in 45 patients (52%), SQTS in 1 patient (100%), S. of Brugada in 8 patients (25%), CPVT in 5 patients (71%), HCM in 8 patients (100%) and ARVD in 6 patients (5%). Conclusions Our study demonstrates that electrocardiographic screening in childhood allows early diagnosis and treatment of life–threatening arrhythmic heart disease.

Cardiac screening in police and armed forces: a pilot project

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Most international bodies now recommend cardiac screening for all individuals undertaking high intensity physical activity. The sensitivity and specificity of the ECG in cardiac screening is undisputed. Study Objective Two major national institutions (Police Force and the Armed Forces) have now recognized the importance of having a cardiac screening program. As of 2020, the department of Cardiology has been offering remote ECG interpretation for all new recruits. The aim of the study was to retrospectively review this service, specifically looking at the diagnostic yield. Methodology All reported ECGs were retrospectively evaluated. ECG changes were labelled as training related, borderline or pathological ECG patterns as depicted in the 2017 International Recommendations for ECG interpretation in athletes. Demographic, symptom and ECG data were tabulated. The clinical outcomes of those referred were also recorded. Categorical data was presented as percentages. Statistical analysis was performed using SPSS v23. Results 318 recruits were screened, mean age 31.42 ± 13.2 years. The majority (n=196, 61.6%) were younger than 35 years. It was a predominant male population (n=262, 82.4%), all being Caucasian. Armed forces and police force recruits were equally represented (n=154, 48.4% vs n=164, 51.6%). No one reported symptoms (0.0%). The commonest training related changes included early repolarisation (22.3%), left ventricular hypertrophy (15.4%), sinus bradycardia (14.2%) and partial right bundle branch block (7.5%). Some had pathological ECG patterns (Anterior T Wave Inversion n=6 [1.9%], ST segment depression n=6 [1.9%], pathological Q waves n=5 [1.6%], ventricular ectopics n=3 [0.9%], pre-excitation n=2 [0.6%], inferior T Wave inversion n=1 [0.3%], Short QT n=1 [0.3%]). Most were cleared at the initial assessment (n=292, 91.5%). 26 (8.2%) were referred for further evaluation. 14 (4.4%) needed a repeat ECG. Most (n=6, 23.1%) were cleared after secondary evaluation. Another 4 (15.4%) needed surveillance. 6 (23.1%) had a clinical diagnosis, equating to 1 in 53 individuals screened (1.9% of initial cohort). Two patients were already under the care of a cardiologist (n=1 sinus venosus defect with PAPVD, n=1 ischaemic cardiomyopathy). 4 were newly diagnosed cardiac patients (n=1 HCM, n=2 WPW, n=1 Aortopathy). Age did not have any significant impact on the diagnostic yield (&amp;lt;35 [50%] vs ≥35 [50%] years, p=0.244). Conclusion 8.2% were referred for further evaluation (1 in 12). 1.9% (1 in 53) had a clinical diagnosis. This highlights the importance of an ECG based screening algorithm in close liaison with experts in cardiac screening. A clinical diagnosis in law enforcement and army personnel may have important lifelong career implications.

Acquired long QT interval in athletes

Long QT syndrome (LQTS) is a common disorder that leads to dramatic patient outcomes, chief among which is sudden cardiac death. This review provides detailed data on the diagnosis, prevalence, classification, etiology. The variety of causes leading to LQTS creates difficulties in the differential diagnosis of this condition and, as a result, LQTS often remains outside the attention of physicians who monitor the health of athletes. Particular attention is paid to the acquired forms of LQTS, particularly, the drug-induced form. The results of studies aimed at studying the prevalence of LQTS and the effect of drugs on the QT interval are presented. The influence of non-steroidal anti-inflammatory drugs on the QT interval is discussed in detail because they are often used by athletes. The purpose of this review is to expand understanding of the etiology of LQTS and justify the need for careful ECG screening and pharmacological monitoring in athletes.

Fallacy of Median Door-to-ECG Time: Hidden Opportunities for STEMI Screening Improvement.

BackgroundST‐segment elevation myocardial infarction (STEMI) guidelines recommend screening arriving emergency department (ED) patients for an early ECG in those with symptoms concerning for myocardial ischemia. Process measures target median door‐to‐ECG (D2E) time of 10 minutes.Methods and ResultsThis 3‐year descriptive retrospective cohort study, including 676 ED‐diagnosed patients with STEMI from 10 geographically diverse facilities across the United States, examines an alternative approach to quantifying performance: proportion of patients meeting the goal of D2E≤10 minutes. We also identified characteristics associated with D2E>10 minutes and estimated the proportion of patients with screening ECG occurring during intake, triage, and main ED care periods. We found overall median D2E was 7 minutes (IQR:4–16; range: 0–1407 minutes; range of ED medians: 5–11 minutes). Proportion of patients with D2E>10 minutes was 37.9% (ED range: 21.5%–57.1%). Patients with D2E>10 minutes, compared to those with D2E≤10 minutes, were more likely female (32.8% versus 22.6%, P=0.005), Black (23.4% versus 12.4%, P=0.005), non‐English speaking (24.6% versus 19.5%, P=0.032), diabetic (40.2% versus 30.2%, P=0.010), and less frequently reported chest pain (63.3% versus 87.4%, P<0.001). ECGs were performed during ED intake in 62.1% of visits, ED triage in 25.3%, and main ED care in 12.6%.ConclusionsExamining D2E>10 minutes can identify opportunities to improve care for more ED patients with STEMI. Our findings suggest sex, race, language, and diabetes are associated with STEMI diagnostic delays. Moving the acquisition of ECGs completed during triage to intake could achieve the D2E≤10 minutes goal for 87.4% of ED patients with STEMI. Sophisticated screening, accounting for differential risk and diversity in STEMI presentations, may further improve timely detection.

PO-629-04 PHENOTYPES OF OVERDIAGNOSED LONG QT SYNDROME

Long QT syndrome (LQTS) is a potentially lethal, yet highly treatable, genetic heart disease that predisposes individuals to arrhythmic syncope/seizure, sudden cardiac arrest, or sudden cardiac death (SCD). Although well intended, increased physician and public awareness of LQTS-associated warning signs and an increase in ECG screening programs may contribute to an overdiagnosis of this condition. To identify the various avenues or phenotypes that can lead to an overdiagnosis of LQTS. Electronic medical records were reviewed for all patients evaluated in Mayo Clinic’s Windland Smith Rice Genetic Heart Rhythm Clinic between July 2000 and March 2021 who arrived with an outside diagnosis of LQTS but were dismissed subsequently as normal. Data was abstracted for patient demographics, clinical characteristics, and cardiac and genetic test results. Overall, 291/1909 (15%) originally diagnosed LQTS patients [174 (60%) female, mean age at first Mayo evaluation 22 ± 14 years, mean QTc of 426 ± 25 ms] were dismissed as either normal (276, 95%) or having a different diagnosis altogether (15, 5%). The main cause of LQTS misdiagnosis was misinterpretation of the QTc in 93 (32%) patients, including a borderline QT, inclusion of the U-wave in QTc calculation, or prolonged QTc associated with exercise training. This was closely followed by a prolonged QTc recorded in the emergency department following vasovagal syncope (n=89 [31%]). Furthermore, 47 patients (16%) were diagnosed because of positive family history of LQTS or SCD but dismissed as normal after the SCD was found to be unrelated to LQTS or the patient was negative for family’s LQTS-associated variant. Forty-seven (16%) patients had a variant of uncertain significance (VUS) in one of the main LQTS genes (KCNQ1, KCNH2, SCN5A), however after evaluation, the variant was demoted to likely benign and/or there was no LQTS phenotype in family members. Knowing that the four main determinants of discordance between a previously rendered diagnosis of LQTS and full diagnostic reversal/removal were misinterpretation of the QTc, vasovagal syncope, family history of LQTS, and a VUS in LQTS-causative genes, awareness and screening strategies can be fine-tuned to reduce this ongoing burden of overdiagnosed LQTS.