Holter Monitoring In Patients Research Articles

Interpretation of electrocardiograms and results of daily ECG Holter monitoring in patients with an implanted cardiac contractility modulator

Cardiac contractility modulation (CCM) is a method of non-drug treatment of chronic heart failure (CHF) in patients with no indications for resynchronization therapy. Now, a detailed study of this method and its capabilities is ongoing, and the indications for its use are expanding. As with any other implantable device, it is important to be able to monitor the operation of the CCM, identify its dysfunction and promptly refer patients to specialized institutions. Assessment of the function of CCM- therapy can be carrying out by recording a standard 12‑channel electrocardiogram (ECG), as well as 24‑hour Holter ECG monitoring (HM-ECG). The mechanism of action of CCM-therapy is fundamentally different from that of other implantable devices. Knowledge of the features of the manifestation of CCM-therapy during instrumental studies is necessary for their correct interpretation.

Effect of Piracetam and Iron Treatment on Heart Rate Variability in Patients With Breath-Holding Spell

BackgroundBreath-holding spells are a benign condition primarily seen in 3% to 5% of healthy children aged between six months and five years. Although no specific treatment is recommended due to its benign nature, iron and piracetam are used in severe or recurrent cases. We planned to compare the heart rate variability (HRV) before and after treatment with 24-hour Holter monitoring in patients receiving iron and piracetam treatment and investigate the treatment's effectiveness. MethodsTwenty-five patients who applied to the outpatient clinic between 2013 and 2015 due to breath-holding spells were included in the study. The patients who received piracetam and iron therapy and underwent 24-hour rhythm Holter monitoring were evaluated retrospectively. ResultsFourteen (56%) of these patients were evaluated as having cyanotic-type and 11 (44%) patients were assessed as having pale-type breath-holding spells. A significant difference was found only between hourly peak heart rate and total power in the group receiving iron treatment. Significant differences were also found among the minimum heart rate, mean heart rate, the standard deviation of RR intervals, the mean square root of the sum of the squares of their difference between adjacent RR intervals, spectpow, and low frequency before and after the treatment in the patients who started piracetam treatment (P < 0.05). ConclusionsOur study is critical as it is the first to investigate the effects of treatment options on various HRV in patients with breath-holding spells. There were statistically significant changes in HRV parameters in patients receiving piracetam, and the number of attacks decreased significantly. Piracetam treatment contributes positively to the breath-holding spell with regard to efficacy and HRV, therefore it can be used to treat breath-holding spells.

Evaluation of Autonomic Nervous System Through Spectral Analysis in Patients with Ischemic Heart Failure: A Systematic Review

Abstract Heart failure is one of the most complex pathologies and most prevalent diseases, with around 64 million people affected globally (2% of the total adult population). In the initial phase of heart failure, studies have shown that the autonomic nervous system is in a state of imbalance, with an increase in the influence of the sympathetic nervous system on the heart. Persistence of long-term activation of the autonomic nervous system produces a decrease in the levels of myocardial catecholamines and also promotes down-regulation of beta-1 receptors. This article is a systematic review of papers from four well-known and important scientific databases on the subject of power spectral analysis of ECG Holter monitoring in patients with heart failure. The PRISMA technique was used to identify the most relevant articles on this subject, and their results were presented based on importance of their use for the diagnosis of heart failure, for risk stratification of sudden death or arrhythmias, for the evaluation of certain treatments used, or for other possible pathophysiological mechanisms involved in the evolution of the disease.

The 24-Hour Cardiac Autonomic Activity in Patients With Allergic Rhinitis.

Definitive knowledge of the 24-hour cardiac autonomic activity in patients with allergic rhinitis (AR) is lacking. Thus, we aimed to evaluate heart rate variability (HRV), which is used to measure cardiac autonomic activity by 24-hour Holter monitoring in patients with AR. We enrolled 32 patients who visited our clinic and were diagnosed with AR. The control group was selected four-fold (n = 128) by matching (age, sex, hypertension, and diabetes) in the AR group from a Holter registry in the cardiology department. The HRV results, which were measured using 24-hour Holter monitoring, were compared between the AR and control groups. All time-domain parameters of HRV revealed no differences between the groups. However, among the frequency domain parameters of HRV, the low-frequency to high-frequency ratio and low-frequency power in normalized units were significantly lower in the AR group. Conversely, high-frequency power in normalized units was significantly higher in the AR group. In the multiple regression analysis, AR was independently associated with sympathetic withdrawal (adjusted odds ratio = 3.393, P = 0.020) after adjusting for age, sex, hypertension, diabetes mellitus, and hyperlipidemia. The present findings suggest differences in cardiac autonomic activity which are related with sympathetic withdrawal in patients with AR compared with that in the normal population over 24 hours.

Cardiac Dysrhythmia Characterization by Intradialytic Holter Monitoring in Patients with Chronic ESRD

Cardiac Dysrhythmia Characterization by Intradialytic Holter Monitoring in Patients with Chronic ESRD

Prognostic Significance of 24-Hour Ambulatory Blood Pressure and Holter Monitoring in Patients without Atrial Fibrillation

Prognostic Significance of 24-Hour Ambulatory Blood Pressure and Holter Monitoring in Patients without Atrial Fibrillation

Electrocardiography and Holter monitoring in patients with Cardiac AL Amyloidosis

Abstract Funding Acknowledgements Type of funding sources: None. Aim Cardiac amyloidosis (CA) reflects an infiltrative heart disease with poor prognosis. Aim of the study was to recognise differences between patients with and without CA in 12-lead electrocardiography (ECG) and 24hr Holter ECG monitoring and identify dependence of ECG and Holter ECG monitors on disease progression. Methods We prospectively analyzed clinical profile, echocardiographical pattern, ECG and 24hr Holter monitoring in 39 (66 (62; 71) years, 62% males) consecutive patients with AL amyloidosis screened to cardiac involvement. Results Out of all patients, CA was confirmed in 26 (67%) patients. All patients with cardiac AL amyloidosis manifested at least one pathology on ECG, what was contrast to low prevalence in patients without cardiac involvement (54%), p &amp;lt; 0.001. Abnormal Holter ECG was seen in 77 % and 62 % of patients with and without cardiac involvement, respectively. Patients with cardiac involvement and E/A or E/E´ ratio above median manifested higher numbers of VPBs than rest of subjects (median 195 (IQR 31; 546) vs. 6 (3; 40); p = 0.02, and 195 (31; 274) vs. 14 (5; 54); p = 0.04, respectively). During follow-up 19 (7; 59) month, 19 (73%) of patients with cardiac AL amyloidosis died. The proportion of surviving patients was higher in subjects with QRS &amp;lt; 100ms and QTc &amp;lt; 450ms (both p &amp;lt; 0.05). Conclusion Standard 12-lead ECG seems to be method with excellent negative predictive value for exclusion of CA. Advanced CA is associated with higher number of both premature atrial and ventricular beats. QRS and QTc duration seems to be a marker of earlier mortality of patients with CA.

Long-Term Outcome of ICD Therapy in Patients With Noncompaction Cardiomyopathy Compared With DCM and HCM

BackgroundImplantable cardioverter-defibrillators (ICDs) are frequently used for primary and secondary prevention in patients with cardiomyopathies due to different etiologies. However, long-term outcome studies in patients with noncompaction cardiomyopathy (NCCM) are scarce. ObjectivesThis study summarizes the long-term outcome of ICD therapy in patients with NCCM compared with those with dilated cardiomyopathy (DCM) or hypertrophic cardiomyopathy (HCM). MethodsProspective data from our single-center ICD registry were used to analyze the ICD interventions and survival in patients with NCCM (n = 68) compared with patients with DCM (n = 458) and patients with HCM (n = 158) from January 2005 to January 2018. ResultsThis NCCM population with an ICD for primary prevention comprised 56 (82%) patients with a median age of 43 years and 52% males, compared with 85% in patients with DCM and 79% in patients with HCM (P = 0.20). During a median follow-up of 5 years (IQR: 2.0-6.9 years), appropriate and inappropriate ICD interventions were not significantly different. Nonsustained ventricular tachycardia during Holter monitoring in patients with NCCM was the only significant risk factor for appropriate ICD therapy in patients with NCCM, with a HR of 5.29 (95% CI: 1.12-24.96). The long-term survival was significantly better in the univariable analysis in the NCCM group. However, there was no difference in multivariable Cox regression analyses between the cardiomyopathy groups. ConclusionsAt 5 years of follow-up, the rate of appropriate and inappropriate ICD interventions in NCCM was comparable to that in DCM or HCM. In multivariable analysis, no differences in survival were found between the cardiomyopathy groups.

Obstructive Sleep Apnoea and Cardiac Arrhythmias (OSCA) trial: a nested cohort study using injectable loop recorders and Holter monitoring in patients with obstructive sleep apnoea

IntroductionObstructive sleep apnoea (OSA) is associated with increased cardiovascular mortality despite continuous positive airways pressure (CPAP) therapy. This excess risk may be related to increased arrhythmia risk, especially atrial fibrillation...

An evaluation of 24 h Holter monitoring in patients with myotonic dystrophy type 1.

To evaluate the clinical effectiveness of routine 24 h Holter monitoring to screen for conduction disturbances and arrhythmias in patients with myotonic dystrophy type 1 (DM1). A retrospective two-centre study was conducted including DM1-affected individuals undergoing routine cardiac screening with at least one 24 h Holter monitoring between January 2010 and December 2020. For each individual, the following data were collected: Holter results, results of electrocardiograms (ECGs) performed at the same year as Holter monitoring, presence of cardiac complaints, and neuromuscular status. Holter findings were compared with the results of cardiac screening (ECG + history taking) performed at the same year. Cardiac conduction abnormalities and/or arrhythmias that would have remained undiagnosed based on history taking and ECG alone were considered de novo findings. A total 235 genetically confirmed DM1 patients were included. Abnormal Holter results were discovered in 126 (54%) patients after a mean follow-up of 64 ± 28 months in which an average of 3 ± 1 Holter recordings per patient was performed. Abnormalities upon Holter mainly consisted of conduction disorders (70%) such as atrioventricular (AV) block. Out of 126 patients with abnormal Holter findings, 74 (59%) patients had de novo Holter findings including second-degree AV block, atrial fibrillation/flutter and non-sustained ventricular tachycardia. Patient characteristics were unable to predict the occurrence of de novo Holter findings. In 39 out of 133 (29%) patients with normal ECGs upon yearly cardiac screening, abnormalities were found on Holter monitoring during follow-up. Twenty-four hour Holter monitoring is of added value to routine cardiac screening for all DM1 patients.

Excessive supraventricular activity and risk of atrial fibrillation in patients with cryptogenic ischaemic stroke.

Atrial fibrillation (AF) is one of the leading causes of ischaemic stroke. However, screening for AF is often time-consuming in clinical practice. Therefore, the determination of an appropriate marker to detect the presence of AF would improve the diagnostic process. The aim of the current study was to evaluate the efficacy of prolonged and early inpatient event Holter monitoring in the detection of AF in patients with ESUS-related cryptogenic ischaemic stroke (CIS), and to determine the possible relationship between excessive supraventricular activity and AF detection. All consecutive patients with documented cerebral or cerebellar infarction were included. The diagnostic work-up included brain neuroimaging (CT/MRI), ultrasound of the carotid and vertebral arteries, admission ECG followed by 24 hours of Holter monitoring, and transthoracic echocardiography. The 24-hour Holter ECG was analysed, and supraventricular ectopic activity (supraventricular extrasystoles, runs and pairs of supraventricular extrasystoles) was recorded in all patients. If these examinations did not reveal the cause of ischaemic stroke, the patients underwent subsequent prlonged 14-day event Holter recorder monitoring. We included 48 patients (mean age 69.9 ± 8.5 years, 60.4% men) who had been diagnosed with CIS. Of these 48 patients, atrial fibrillation was detected in seven (14.6%) during the prolonged 14-day Holter event monitoring. Patients with newly diagnosed atrial fibrillation had a higher burden of supraventricular ectopic activity. The number of supraventricular extrasystoles (SVES) per hour, as well as the number of SV pairs and SV runs, was significantly higher in patients with new onset AF (p < 0.022; p < 0.043; p < 0.022). In our study, we confirmed that prolonged ECG event Holter monitoring in patients with CIS-ESUS subtype led to a higher rate of AF detection. Likewise, frequent supraventricular ectopic activity predicted the development of AF.

The differences between daytime and nighttime heart rate variability may usefully predict the apnea-hypopnea index in patients with obstructive sleep apnea.

The association between daytime/nighttime heart rate variability (HRV) and the apnea-hypopnea index (AHI) remains unclear. We sought a relationship between AHI and the daytime-to-nighttime HRV ratio as measured by 24-hour Holter monitoring in patients with obstructive sleep apnea. We prospectively enrolled 66 patients who visited our sleep clinic complaining of habitual snoring or sleep apnea. All underwent 24-hour Holter monitoring (to measure HRV) combined with full-night polysomnography. Sixty-two met our enrollment criteria. We evaluated the associations between HRV frequency domains and the polysomnography indices. We also considered medical histories and anthropometric data. The nighttime very-low-frequency (VLF), low-frequency (LF), and high-frequency HRVs were significantly higher than the daytime values. On correlation analysis, the day/night VLF (r = .550, P < .001), LF (r = .556, P < .001), and high-frequency (r = .303, P = .017) HRVs were significantly related to the AHI. Of the day/night HRV ratios, the VLF (P for trend = .003) and LF (P for trend = .013) ratios decreased significantly by obstructive sleep apnea severity. Multivariable analysis showed that the day/night VLF (β = 16.387, P < .001) and day/night LF (β = 25.248, P < .001) were independently (and significantly) associated with the AHI. Twenty-four-hour Holter monitoring may usefully predict AHI. The day/night VLF and day/night LF ratios tended to decrease by obstructive sleep apnea severity and were independently associated with the AHI. Nam E-C, Chun KJ, Won JY, Kim J-W, Lee WH. The differences between daytime and nighttime heart rate variability may usefully predict the apnea-hypopnea index in patients with obstructive sleep apnea. J Clin Sleep Med. 2022;18(6):1557-1563.

Аналіз застосування Мексикору у хворих із гострим коронарним синдромом

Матеріали та методи. Під спостереженням знаходилися дві групи хворих із гострим коронарним синдромом. Перша група включала 48 хворих із нестабільною стенокардією (НС) віком 58,5 ± 3,8 року. Діагноз НС верифікований на підставі скарг хворих і змін на електрокардіограмі — підйому або депресії інтервалу на 1 мм тривалістю не більше 3 діб, відсутності зон гіпокінезії при УЗД серця, негативного тропонінового тесту. Другу групу становили 45 хворих із гострим інфарктом міокарда. Діагноз верифіковано за допомогою тропонінового тесту і змін на ЕКГ. У цю групу включалися хворі з Q-позитивним гострим інфарктом міокарда (ГІМ). Чоловіки — 83,2 %, жінки — 16,8 %. Середній вік хворих становив 60,3 ± 1,2 року. Задньобазальна локалізація виявлена у 40,2 %, передня — у 59,8 %. В анамнезі у 70 % хворих гіпертонічна хвороба ІІ ст. «Стаж» ішемічної хвороби серця становив у середньому 10,8 ± 4,5 року. 80 % хворих цієї групи неодноразово лікувалися в кардіологічних стаціонарах із приводу загострень ішемічної хвороби серця. У 38,5 % хворих на момент надходження відзначені надшлуночкові і шлуночкові (екстрасистолія) порушення ритму. Результати. Застосування Мексикору у хворих із ГІМ значно покращувало систолічну функцію серця, що проявлялося у вірогідній різниці основних показників, що її відображають (фракція викиду, швидкість циркуляторного скорочення волокон, серцевого викиду), і відповідних показників у хворих контрольної групи. Подібні сприятливі зміни були виявлені і при вивченні в динаміці показників діастолічної функції серця, що визначаються за швидкістю трансмітрального потоку. Обговорення. Зазначені зміни ми пов’язуємо з відновленням або поліпшенням скоротливості ішемізованого міокарда та функціонального стану так званих інтактних відділів серця, що компенсують своєю діяльністю втрату скоротливості некротизованих ділянок. Це підтверджується динамікою стану зон акінезії і дискінезії у хворих на ІМ, де відстежується відновлення скоротливості окремих ділянок серця на фоні застосування Мексикору (перехід граничних із зонами інфаркту сегментів зі стану акінезії в гіпокінез, гіпокинезу — в нормокінез), і практично зворотною динамікою у хворих контрольної групи. Мексикор сприяв поліпшенню клінічного перебігу ІМ, що проявлялося в обмеженні величини вогнища некрозу і стимуляції репаративних процесів, поліпшенні скорочувальної функції серця і газообміну, зменшенні частоти пролонгованого і рецидивного перебігу, ймовірності розвитку аневризми серця і випадків серцевої недостатності, порушень ритму і провідності, недостатності кровообігу і в кінцевому підсумку летальності. За результатами холтерівського моніторування у хворих на НС Мексикор прискорював стабілізацію стенокардії і зменшував, порівняно з контрольною групою, добову частоту і тривалість періодів ішемії міокарда, епізодів порушень ритму, сприятливо впливав на зміну інтеграла зміщення ST і співвідношення больових/безбольових періодів ішемії. Висновки. Включення Мексикору в традиційну терапію гострого коронарного синдрому вже на догоспітальному етапі дозволяє істотно зменшити прояви окислювального стресу, сприяє нормалізації діяльності серцево-судинної системи і покращує клінічний перебіг захворювань.

Heart rate variability in patients with tetralogy of Fallot

Abstract Background Heart rate variability (HRV) can be used to evaluate cardiac autonomic nervous system activity. In the adult population decreased HRV has been associated with increased mortality in patients with cardiac disease, however, application of HRV in patients with congenital heart disease is not well established. Purpose To describe and compare HRV parameters obtained by clinical Holter monitoring in patients with Tetralogy of Fallot (TOF) and healthy controls and to evaluate its association with different clinical outcomes. Methods Data from 489 patients were obtained; 150 had undergone repair of TOF and 339 were healthy controls. Using propensity score matching (PSM), 149 TOF patients were matched for sex, age at Holter,body mass index, use of beta-blockers, and ectopic beats with 149 healthy patients. Minimum, maximum, average heart rate and time domain HRV parameters (ASDNN5, SDANN5, SDNN, RMSSD, PNN50) and clinical outcomes (arrhythmias, hospital admission for cardiac disease, and functional class) were compared between groups using simple and multiple linear regression models as well as logistic regression analysis. Results No significantdifference was found in time domain HRV parameters between the two groups, though average (−7.0253, p=0.000) and maximum (−15.8585, p=0.000) heart rate values were significantly lower in patients with TOF compare with controls. Logistic regression analysis showed an association between maximum heart rate values and the development of arrhythmias (OR=0.9817, p=0.013), as well as the functional class (OR=0.9706, p=0.03). Conclusion Average and maximum heart rates are significantly lower in patients with repaired TOF compared to the control population. Time domain HRV parameters were not associated with clinical outcomes in patients with TOF when compared to healthy controls. Further investigation assessing frequency domain parameters may provide further insight. Funding Acknowledgement Type of funding sources: None.

ПОКАЗАТЕЛИ ТУРБУЛЕНТНОСТИ СЕРДЕЧНОГО РИТМА В КЛИНИЧЕСКОЙ ПРАКТИКЕ

Background. Heart disease is the leading cause of death in developed countries. Approximately half of these fatalities are due to sudden cardiac death. Electrocardiogram recording from the body surface allows stratification of patients according to the risk of cardiac arrest without the use of invasive methods. Arrhythmias, particularly ventricular extrasystole, can affect the sinus rhythm pattern. The change in sinus rhythm that occurs after an extrasystole is defined as heart rate turbulence. This phenomenon is not pathological, but some variants are associated with a risk of fatal arrhythmias. Aim. To analyze the indices and clinical significance of cardiac rhythm turbulence according to Holter monitoring in patients with various cardiological abnormalities at the hospital profile department. Material and methods. The study included 54 patients who were routinely treated in a cardiac hospital. Cardiac rhythm turbulence indices were obtained by Holter monitoring. Patients in severe and moderately severe clinical condition were not included in the study. Concomitant and past somatic diseases affecting the state of heart and cardiovascular system were considered. Results and discussion. Deviations in heart rhythm turbulence indices can be detected both in life- threatening arrhythmias and in benign extrasystoles. They are associated with the influence of the autonomic nervous system, but probably have different mechanisms. Deviations of heart rhythm turbulence indices were associated with left ventricular myocardial hypertrophy of concentric remodeling type and with an increased number of low-risk ventricular extrasystoles. To identify patients with arrhythmias of different risk, various threshold values of cardiac rhythm turbulence indices can be used. Conclusion. Factors likely to affect the indices of cardiac rhythm turbulence such as left ventricular myocardial remodeling and hypertrophy were revealed, as well as changes in autonomic nervous system regulatory function, including those associated with the constitutional features of the patient.

Results of holter monitoring in patients with coronary heart disease depending on the severity of atherosclerotic lesions of the coronary arteries

The aim – to conduct a comparative analysis of the presence, frequency and duration of episodes of myocardial ischemia and arrhythmias based on the results of Holter monitoring in patients with coronary heart disease depending on the condition of the coronary arteries.&#x0D; Materials and methods. We examined 53 patients (group I) with stable coronary heart disease (CHD) and slightly altered coronary arteries (INOCA), who were hospitalized in the period from October 2018 to February 2021 at the “City Clinical Hospital № 8” of Kharkiv City Council. Group II included 52 patients with a diagnosis of stable coronary heart disease, and according to coronary angiography (CAG) had stenosis of coronary arteries (CA) more than 50 %.&#x0D; Results. According to the results of comparative analysis, it was found that in group I there were signs of myocardial ischemia – depression of the ST segment in 62.3 % (n=33) and elevation of the ST segment in 11.3 % (n=6), compared with group II -73 % (n=38) and 5.66 % (n=3), respectively. Ventricular arrhythmias (VA) have been reported in 52 patients of group I, and in 44 patients of group II. VA 4 and 5 type according to Laun, was significantly higher in group II compared with group I (p=0.0324). The occurrence of ventricular tachycardia was recorded in 5.7 % (n=3) of patients in group I and 9.3 % (n=5) patients of group II (p=0.347). In group II, there was a tendency to more episodes of ischemia compared with group I (p=0.072). The duration of ischemia was significantly longer in group I, compared with group II (p=0.042).&#x0D; Conclusions. The results of the study did not show significant differences in the development of the number of episodes of myocardial ischemia according to Holter monitoring depending on the condition of the coronary arteries. The duration of episodes of ischemia in patients with INOCA is significantly longer than in patients with obstructive atherosclerosis. In patients with coronary heart disease with obstructive coronary arteries, ventricular arrhythmia was statistically significantly more severe according to Lown

Steroid use for recovery of advanced atrioventricular block immediately after valvular surgery (survival): a randomized clinical trial

Abstract Funding Acknowledgements Type of funding sources: None. Background Limited inconsistent evidence support use of steroids in recovery of atrioventricular block (AVB) after trans-catheter aortic valve implantation. However, there is no study to examine the efficacy of steroids in recovery of high-grade AVB following valvular surgery. Purpose To assess the effect of high-dose dexamethasone on recovery of advanced AVB following valvular heart surgery. Methods In this randomized controlled trial, patients with advanced postoperative AVB (either Mobitz type II or third degree) were randomly assigned to receive either dexamethasone (0.4 mg /kg, maximum 30 mg /day in three divided doses) intravenously for three days or conservative care only. Primary endpoint was recovery rate in day five since randomization. Secondary endpoints were recovery rate in day 7 and day 10, cumulative AVB time, PPM implantation rate, length of stay in critical care units, and post-operative major adverse events (MAE) during one month. We defined MAE as composite of all-cause mortality, all-type infections, major bleeding, prolonged sternal dehiscence, new stroke, postoperative MI, complicated uncontrolled hyperglycemia and readmission for decompensated heart failure. Results We enrolled 139 subjects (48.9% male) with mean age of 59.9 years who were randomly allocated to intervention group (n= 69) and control group (n= 70). Dexamethasone led to higher recovery rates at day 5 (82.6% vs. 62.9%, P= 0.009) and day 7 (88.4% vs. 61.4%, P&amp;lt; 0.0001) respectively. Random 24-hours ECG Holter monitoring of patients at day 5 revealed the same results and confirmed the superiority of dexamethasone for recovery of AVB (80.5% vs 61.2%, respectively, P = 0.024). Although this benefit ceased at day 10 (83.05 vs 78.6 %, P = 0.547), Generalized Estimating Equation analysis for recovery over 10 days favored intervention (odds ratio: 2.56, 95% CI: 1.27- 5.15, P = 0.008). Median cumulative AVB time was shorter in dexamethasone group compared to control group (41 hours vs 64 hours, P = 0.044). PPM implantation rates were similar between the dexamethasone and control groups (15.9% vs 17.1 %, respectively, P = 0.849). Median length of stay in ICU (10 days vs 12 days, P= 0.03) and MAE (17.4 % vs 25.7%, P = 0.133) tended to be lower with dexamethasone. Conclusion Our findings suggest that dexamethasone may serve as a safe and effective medication to improve recovery of advanced AVB after valvular surgery. Further studies are needed to confirm these findings, particularly regarding subsequent PPM implantation rate.

Abstract P624: High Detection of Atrial Fibrillation by 90 Days Textil Holter Monitoring in Patients With Cryptogenic Stroke

Introduction: External recorders allow for low-cost, non-invasive 1 to 4 weeks monitoring. However, the first 3 months of monitoring duration are the most effective to detect atrial fibrillation (AF). We show the results of the Thunder registry of patients monitored to detect AF during 90 days from the stroke. Methods: A prospective observational study was conducted with consecutive inclusion of patients with cryptogenic stroke after work up (neuroimaging, echocardiography and 24-hour cardiac monitoring) in 5 Comprenhensive Stroke Centers. Patients were continuously monitored for 90 days with a wearable Holter (Nuubo®) after the first 24 hours of the stroke onset. We analyzed the percentage of AF detection in each period (percentage of AF among those monitored), the quality of the monitoring (monitoring time), the percentage of AF by intention to monitor (detection of AF among patient included). Demographic, clinical and echocardiographic predictors of AF detection beyond one week of cardiac monitoring were assessed. Results: A total of 254 patients were included. The cumulative incidence of AF detection at 90 days was 34.84%. The monitoring time was similar among the 3 months (30 days: 544.9 hours Vs 60 days: 505.9 hours Vs 90 days: 591.25 hours) (p=0.512). The number of patients who abandoned monitoring was 7% (18/254). The cumulative percentage of intention to detect AF was 30.88% (Figure). Patients who completed monitoring beyond 30 days had higher score on the NIHSS basal scale (NIHSS 9 IQR 2-17) VS (NIHSS 3 IQR 1-9) (p=0.024). Patients with left atrial volume greater than 28.5ml/m2 had higher risk of cumulative incidence of AF according to the Kaplan Meyer curve beyond the first week of monitoring OR 2.72 (Log-rank (Mantel-Cox test) (p&lt;0.001). Conclusions: In conclusion, intensive 90-day- Holter monitoring with textile Holter was feasible and detected high percentage of AF. Enlarged left atrial volume predicted AF beyond the first week of monitoring.

Nurse Led Smartphone Electrographic Monitoring for Atrial Fibrillation after Ischemic Stroke: SPOT-AF.

Background and PurposeParoxysmal atrial fibrillation (PAF) underlying acute stroke frequently evades detection by standard practice, considered to be a combination of routine electrocardiogram (ECG) monitoring, and 24-hour Holter recordings. We hypothesized that nurse-led in-hospital intermittent monitoring approach would increase PAF detection rate. Methods We recruited patients hospitalised for stroke/transient ischemic attack, without history of atrial fibrillation (AF), in a prospective multi-centre observational study. Patients were monitored using a smartphone-enabled handheld ECG (iECG) during routine nursing observations, and underwent 24-hour Holter monitoring according to local practice. The primary outcome was comparison of AF detection by nurse-led iECG versus Holter monitoring in patients who received both tests: secondary outcome was oral anticoagulant commencement at 3-month following PAF detection. Results One thousand and seventy-nine patients underwent iECG monitoring: 294 had iECG and Holter monitoring. AF was detected in 25/294 (8.5%) by iECG, and 8/294 (2.8%) by 24-hour Holter recordings (P<0.001). Median duration from stroke onset to AF detection for iECG was 3 days (interquartile range [IQR], 2 to 6) compared with 7 days (IQR, 6 to 10) for Holter recordings (P=0.02). Of 25 patients with AF detected by iECG, 11 were commenced on oral anticoagulant, compared to 5/8 for Holter. AF was detected in 8.8% (69/785 patients) who underwent iECG recordings only (P=0.8 vs. those who had both iECG and 24-hour Holter). ConclusionsNurse-led in-hospital iECG surveillance after stroke is feasible and effective and detects more PAF earlier and more frequently than routine 24-hour Holter recordings. Screening with iECG could be incorporated into routine post-stroke nursing observations to increase diagnosis of PAF, and facilitate institution of guideline-recommended anticoagulation.

Disfunción diastólica y relación con arritmias: un vínculo más allá de la fibrilación auricular

IntroductionHeart failure is a public health problem, with a prevalence that increases with age. Up to 50% of cases have a preserve ejection fraction. Few studies have evaluated arrhythmias in this population type. It is known that there is an association with atrial fibrillation, but other types of arrhythmias that could be present are ignored. ObjectiveTo describe arrhythmias using 24 hour Holter monitoring in patients with diastolic dysfunction. Materials and methodsAn observational, descriptive, and retrospective study was performed in which the parameters from 24 hour Holter monitoring were evaluated and compared in patients with diastolic dysfunction from a single centre and resident in Medellin, during the year 2017. ResultsA total of 67 patients had diastolic dysfunction, in which the majority (65.7%) were women. The mean age was 71 years, with a mean body mass index of 26.8. The most frequent comorbidities were arterial hypertension (68.7%), atrial fibrillation (19.4%), and coronary disease (19.4%). The mean ejection fraction was 58%; 67.2% had a type I diastolic dysfunction, and the mean atrial volume was 33ml/m2. The most common arrhythmias were discontinuous atrial flutter (40.3%), atrial fibrillation (10.4%), monomorphic ventricular tachycardia (7.5%) and nodal re-entrant tachycardia (1.5%). First degree AV block (22.4%) and sinoatrial block (1.5%) were observed. The mean heart rate variability was 126.23. ConclusionsSeveral types of arrhythmias other than atrial fibrillation were documented in patients with type I and type II diastolic dysfunction. There were no changes in the heart rate variability or in the QTc time. Given the existence of a common pathophysiological background, further studies are needed in order to evaluate the relationship between arrhythmias and diastolic dysfunction, as well as any potential treatment and modification of its clinical course.