Monitoring Patch Research Articles

Effect of Screening for UndiagnosedAtrial Fibrillation onStrokePrevention.

Atrial 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. To 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. GUARD-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. Enrollment began on December 17, 2019, and involved 149 primary care sites across the United States. TheCOVID-19 pandemic led to premature termination of enrollment, with 11,905 participants in the intention-to-treat population. Median follow-up was 15.3months (Q1-Q3: 13.8-17.6months). 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. In 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).

Highly Adhesive and Stretchable Epidermal Electrode for Bimodal Recording Patch.

For numerous biological and human-machine applications, it is critical to have a stable electrophysiological interface to obtain reliable signals. To achieve this, epidermal electrodes should possess conductivity, stretchability, and adhesiveness. However, limited types of materials can simultaneously satisfy these requirements to provide satisfying recording performance. Here, we present a dry electromyography (EMG) electrode based on conductive polymers and tea polyphenol (CPT), which offers adhesiveness (0.51 N/cm), stretchability (157%), and low impedance (14 kΩ cm2 at 100 Hz). The adhesiveness of the electrode is attributed to the interaction between catechol groups and hydroxyls in the polymer blend. This adhesive electrode ensures stable EMG recording even in the presence of vibrations and provides signals with a high signal-to-noise ratio (>25 dB) for over 72 h. By integrating the CPT electrode with a liquid metal strain sensor, we have developed a bimodal rehabilitation monitoring patch (BRMP) for sports injuries. The patch utilizes Kinesio Tape as a substrate, which serves to accelerate rehabilitation. It also tackles the challenge of recording with knee braces by fitting snugly between the brace and the skin, due to its thin and stretchable design. CPT electrodes not only enable BRMP to assist clinicians in formulating effective rehabilitation plans and offer patients a more comfortable rehabilitation experience, but also hold promise for future applications in biological and human-machine interface domains.

Large-area stretchable dynamic 18-lead ECG monitoring patch integrated with deep learning for cardiovascular disease diagnosis

Large-area stretchable dynamic 18-lead ECG monitoring patch integrated with deep learning for cardiovascular disease diagnosis

Long-Term Detection of Glycemic Glucose/Hypoglycemia by Microfluidic Sweat Monitoring Patch.

A microfluidic sweat monitoring patch that collects human sweat for a long time is designed to achieve the effect of detecting the rise and fall of human sweat glucose over a long period of time by increasing the use time of a single patch. Five collection pools, four serpentine channels, and two different valves are provided. Among them, the three-dimensional valve has a large burst pressure as a balance between the internal and external air pressures of the patch. The bursting pressure of the two-dimensional diverter valve is smaller than that of the three-dimensional gas valve, and its role is to control the flow direction of the liquid. Through plasma hydrophilic treatment of different durations, the optimal hydrophilic duration is obtained. The embedded chromogenic disc detects the sweat glucose value at two adjacent time intervals and compares the information of the human body to increase or reduce glucose. The patch has good flexibility and can fit well with human skin, and because polydimethylsiloxane (PDMS) has good light transmission, it reduces the measurement error caused by the color-taking process and makes the detection results more accurate.

A reusable, healable, and biocompatible PEDOT:PSS hydrogel-based electrical bioadhesive interface for high-resolution electromyography monitoring and time–frequency analysis

As the most ideal interface between bioelectronic devices and biological tissues, the electrical bioadhesive interface (EBI) holds significant potential for various applications, including soft bioelectronics, wearable devices, and electrophysiological signal monitoring. However, most current EBIs are disposable products that lack repeatable adhesion and self-healing properties, thus hindering practical applications. Herein, we develop a reusable EBI by incorporating a dynamic non-covalent interaction enhancer polydopamine (PDA) and conductive PEDOT:PSS into an adhesive hydrogel matrix polyacrylamide (PAM). The EBI exhibits intriguing overall electrical and mechanical properties, including high conductivity (5.57 S m−1), tissue-like Young’s modulus (2.7 kPa), low interfacial impedance (1 kΩ), and excellent adhesion strength (46.45 ± 1.75 kPa on porcine skin) with excellent retention (87 %) after 200 adhering/detaching cycles, high self-healing efficiency of 94.11 %, and outstanding biocompatibility in HDF-a and HaCaT cell models. Benefiting from these superior properties, we further demonstrate the fabrication and application of an EBI-based reusable electromyography monitoring patch (EMP). The reusable EMP enables high-resolution electromyography signal monitoring capability with a higher signal-to-noise ratio (SNR) of 30.05 dB than commercial electrodes (12.06 dB). Remarkably, such reusable EMP maintains very stable SNR of 21.82 dB after 200 adhering/detaching cycles (3.8 times higher than commercial electrodes, 5.74 dB after 30 cycles), and showcases typical time and frequency-domain characteristics. These findings demonstrate a promising reusable EMP to enhance the accuracy and convenience of electromyography monitoring.

Adherence to adhesive patch electrocardiographic monitoring among adults with disabilities.

Individuals with developmental and/or intellectual disabilities (I/DD) are at a greater risk for atrial fibrillation (AF), the most common type of cardiac arrhythmia. AF is associated with heart failure, stroke, poor mental health, and reduced quality of life. Management and treatment decisions are based on the ability to detect AF; however, noninvasive, remote cardiac monitoring may not be tolerated by individuals with I/DD. To examine adherence to the placement of an ambulatory cardiac rhythm monitoring patch device by adult patients with I/DD. Investigators extracted chart data from a consecutive series of adult patients (18 years+) who received the patch device as part of standard treatment at an adult health center between November 1, 2015 and October 31, 2019. A total of 95 patients were included in data analysis. Average age of subjects was 53.8±13.9 years (range: 20.2-88.5); 66.7% were male. All subjects had intellectual disabilities as follows: mild, 37.9%; moderate, 29.5%; severe, 21.0%; and, profound, 11.6%. With a prescribed duration of 14 days, subjects wore the device a median (interquartile range [IQR]) of 12.2days (4.1-14.0); total analysis time was a median of 9.5 days (3.4-13.5). A total of 29 subjects (30.5%) received cardiac diagnoses not previously identified (median=1 new diagnosis; range: 1-5). This pilot study suggests the possible utility of an ambulatory monitoring patch device in an adult population with I/DD. Investigators recommend larger studies to confirm such preliminary findings to ultimately improve clinical management and patient quality of life.

Health behavior outcomes in stroke survivors prescribed wearables for atrial fibrillation detection stratified by age.

Smartwatches have become readily accessible tools for detecting atrial fibrillation (AF). There remains limited data on how they affect psychosocial outcomes and engagement in older adults. We examine the health behavior outcomes of stroke survivors prescribed smartwatches for AF detection stratified by age. We analyzed data from the Pulsewatch study, a randomized controlled trial that enrolled patients (≥ 50 years) with a history of stroke or transient ischemic attack and CHA2DS2-VASc ≥ 2. Intervention participants were equipped with a cardiac patch monitor and a smartwatch-app dyad, while control participants wore the cardiac patch monitor for up to 44 days. We evaluated health behavior parameters using standardized tools, including the Consumer Health Activation Index, the Generalized Anxiety Disorder questionnaire, the 12-Item Short Form Health Survey, and wear time of participants categorized into three age groups: Group 1 (ages 50-60), Group 2 (ages 61-69), and Group 3 (ages 70-87). We performed statistical analysis using a mixed-effects repeated measures linear regression model to examine differences amongst age groups. Comparative analysis between Groups 1, 2 and 3 revealed no significant differences in anxiety, patient activation, perception of physical health and wear time. The use of smartwatch technology was associated with a decrease in perception of mental health for Group 2 compared to Group 1 (β = -3.29, P = 0.046). Stroke survivors demonstrated a willingness to use smartwatches for AF monitoring. Importantly, among these study participants, the majority did not experience negative health behavior outcomes or decreased engagement as age increased.

Comparison of continuous 24-hour and 14-day ECG monitoring for the detection of cardiac arrhythmias in patients with ischemic stroke or syncope.

Previous studies show that using 12-lead electrocardiogram (ECG) or 24-h ECG monitor for the detection of cardiac arrhythmia events in patients with stroke or syncope is ineffective. The 14-day continuous ECG patch has higher detection rates of arrhythmias compared with conventional 24-h ECG monitoring in patients with ischemic stroke or syncope. This cross-sectional study of patients with newly diagnosed ischemic stroke or syncope received a 24-h ECG monitoring and 14-day continuous cardiac monitoring patch and the arrhythmia events were measured. This study enrolled 83 patients with ischemic stroke or syncope. The detection rate of composite cardiac arrhythmias was significantly higher for the 14-day ECG patch than 24-h Holter monitor (69.9% vs. 21.7%, p = .006). In patients with ischemic stroke, the detection rates of cardiac arrhythmias were 63.4% for supraventricular tachycardia (SVT), 7% for ventricular tachycardia (VT), 5.6% for atrial fibrillation (AF), 4.2% for atrioventricular block (AVB), and 1.4% for pause by 14-day ECG patch, respectively. The significant difference in arrhythmic detection rates were found for SVT (45.8%), AF (6%), pause (1.2%), AVB (2.4%), and VT (9.6%) by 14-day ECG patch but not by 24-h Holter monitor in patients with ischemic stroke or syncope. A 14-day ECG patch can be used on patients with ischemic stroke or syncope for the early detection of AF or other cardiac arrhythmia events. The patch can be helpful for physicians in planning medical or mechanical interventions of patients with ischemic stroke and occult AF.

Feasibility of remote screening for high risk valve disease using a new wearable cardiac monitoring patch with synchronized phonocardiogram and electrocardiogram in communities

Abstract Background The 2010 census data showed that the weighted prevalence rate of valvular disease was 3.8% in China. For many elderly people, COVID-19 pandemic has caused the situation that they have not received medical examination for years. Since many patients with moderate aortic/mitral stenosis/regurgitation do not have significant symptoms, early detection of high-risk groups of valve disease is essential. A new wearable cardiac monitoring patch with synchronized phonocardiogram(PCG) and electrocardiogram(ECG) function is introduced in this study. Unlike handheld auscultation, it minimizes the interference of the environment and the operator, and is not demanding for the operator. Methods We enrolled 3170 patients of over 65 years old. Patients with diagnosed moderate or severe aortic/mitral stenosis/regurgitation, congenital heart disease, hypertrophic cardiomyopathy were excluded. Data acquisition was done by social workers following strict instructions. The patch was attached to the mitral and aortic auscultation area on the patients. ECG and PCG signals can be detected simultaneously and sent to a phone or tablet via Bluetooth. The data would then be auto-uploaded to a cloud-based center for further analysis. The end-to-end algorithm for S1 and S2 heart sounds detection involves a CNN-LSTM model for R-peak detection and a 1-D CNN-based U-Net model for fine-grained segmentation based on the detected heartbeat. The segmentation network takes multi-modal PCG and ECG signals as inputs and applies Contrastive Learning as a pretraining technique for enhancement to a real-world problem: detecting heart murmur from high-risk valve disease. If the results indicate positive, the patient is recommended by family doctors to do ultrasonic cardiogram (UCG) and seek further medical advice (Figure 1). Results 3170 participants were recruited from March 2022 to December 2022 in different communities of Huangpu District in Shanghai(Figure 2). In total, 43.98% were men, and 85.81% of age distribution were among 65-79 years. Among 3170 participants, 119(3.8%) were suspected positive by ECG and PCG. Among 119 patients, 65.55% were among 65-79 years. After telephone follow-up 29(24.3%) patients finished clinical visit and UCG. About 66% were diagnosed as mild aortic/mitral stenosis/regurgitation, 24% were diagnosed as moderate aortic/mitral stenosis/regurgitation, 10% were diagnosed as hypertrophic cardiomyopathy. Conclusions This study demonstrated the feasibility of remote screening for high risk valve disease using a new wearable cardiac monitoring patch in community visit by social workers with no medical background. This technology may improve the efficacy of clinical diagnosis and reduce unnecessary examination, particularly in the absence of doctors' auscultation and UCG. Unfortunately, three quarters of the suspected positive patients lost contact or refused to do UCG due to COVID-19 pandemic. Further investigations are necessary to increase accuracy.Flow chart of community screeningbaseline and disease distribution

Abstract 17652: Association Between Ventricular Arrhythmias and Myocardial Fibrosis in Patients With Chagas Disease Without Known Cardiomyopathy

Introduction: Chagas disease (CD) is an important cause of cardiomyopathy, arrhythmias and sudden death. The presence of myocardial fibrosis detected by late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) in these patients has been correlated with an increased prevalence of ventricular arrhythmias. The incidence of ventricular arrhythmias in patients with CD without established cardiomyopathy has not been well described. Hypothesis: We aim to evaluate if there is an association between LGE on CMR and incidence of ventricular arrhythmias in patients with CD but without cardiomyopathy. Methods: Patients treated at a Chagas disease center of excellence were retrospectively analyzed for ambulatory rhythm monitoring (Holter and/or 14-day patch monitor) and CMR data. Significant ventricular arrhythmias were defined as either a PVC burden >/=1% or non-sustained ventricular tachycardia (NSVT) ≥4 beats. A Fisher exact test was used to compare categorical variables. Results: There were 191 patients treated between 12/2014 and 8/2022 available for analysis. Of these, 46 patients with CD and no prior history of cardiomyopathy received both ambulatory rhythm monitoring and CMR. There were 16 male and 30 female patients with average age of 52.2 ± 11.5 years, and LV ejection fraction of 58.8% ± 14.2%. Of the 46 patients, 15 (32.6%) were found to have LGE on cMRI while 31 (67.4%) had no evidence of LGE. Within the patients with LGE, 8/15 (53.3%) were found to have significant ventricular arrhythmias. Of the patients without LGE, only 7/31 (22.6%) were determined to have significant ventricular arrhythmias (p = 0.038). Conclusions: These data suggest that for patients with CD without cardiomyopathy, the presence of LGE on CMR is independently associated with incident ventricular arrhythmias detected on ambulatory rhythm monitoring. Whether these findings indicate increased risk of sudden cardiac death requires further study.

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

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

Continuous Monitoring of Vital Signs After Hospital Discharge: A Feasibility Study

Introduction Increasing demand for inpatient beds limits capacity and poses a challenge to the healthcare system. Early discharge may be one solution to solve this problem, and continuous vital sign monitoring at home could safely facilitate this goal. We aimed to document feasibility of continuous home monitoring in patients after hospital discharge. Methods Patients were eligible for inclusion if they were admitted with acute medical disease and scheduled for discharge. They wore three wireless vital sign sensors for four days at home: a chest patch measuring heart rate and respiratory rate, a pulse oximeter, and a blood pressure (BP) monitor. Patients with ≥6 hours monitoring time after discharge were included in the analysis. Primary outcome was percentage of maximum monitoring time of heart rate and respiratory rate. Results Monitoring was initiated in 80 patients, and 69 patients (86%) had ≥6 hours monitoring time after discharge. The chest patch, pulse oximeter, and BP monitor collected data for 88%, 60%, and 32% of the monitored time, respectively. Oxygen desaturation &lt;88% was observed in 92% of the patients and lasted for 6.3% (interquartile range [IQR] 0.9%–22.0%) of total monitoring time. Desaturation below 85% was observed in 83% of the patients and lasted 4.2% [IQR 0.4%–9.4%] of total monitoring time. 61% had tachypnea (&gt;24/minute); tachycardia (&gt;130/minute) lasting ≥30 minutes was observed in 28% of the patients. Conclusions Continuous monitoring of vital signs was feasible at home with a high degree of valid monitoring time. Oxygen desaturation was commonly observed.

Carotid artery monitoring patch using a supercapacitive pressure sensor with piezoelectricity

The carotid artery should be frequently examined to prevent sudden death by stroke. However, ultrasonography is limited because medical staff must perform the procedure directly in the hospital. Unfortunately, severe situations exist in which people miss treatment because of being unaware that their blood vessels are abnormal. Therefore, this work presents a patch-type pressure sensor using a supercapacitor and a poly (vinylidene fluoride-trifluoroethylene) (PVDF-TrFE). When PVDF-TrFE with 30 µm thickness as nanofibers exists in the electrolyte gel of the supercapacitor, the polarization of electrolyte ions is induced, and these ions move to the electrode fastly. Thus, the supercapacitive-type pressure sensor (sCPS) for pulse monitoring can detect slight skin fluctuation and show a pulse waveform with high accuracy. Furthermore, this study demonstrates a statistically significant equation that can calculate blood pressure from a pulse waveform. Finally, it is verified that sCPS detects differences in pulse waveforms due to various cardiovascular diseases.

PO-04-223 ASSOCIATION BETWEEN ANTIPARASITIC TREATMENT AND VENTRICULAR ARRYTHMIAS IN PATIENTS WITH CHAGAS DISEASE

Benznidazole and Nifurtimox are the two currently available antiparasitic treatments available for Chagas disease (CD), an important cause of cardiomyopathy and arrhythmias. There are limited data available describing impact of antiparasitic treatment on arrhythmia outcomes. Compare the incidence of ventricular arrhythmias in Chagas patients treated with anti-parasitic medication versus those who did not receive treatment. Patients treated at a Chagas disease center of excellence were retrospectively analyzed for ambulatory rhythm monitoring data (Holter and 14-day patch monitor). Patients with implantable cardiac devices were excluded. Significant ventricular arrhythmias were defined as either a PVC burden >/=1% or non-sustained ventricular tachycardia (NSVT) ≥4 beats. Patients were analyzed based on CD treatment: Benznidazole, Nifurtimox, or no treatment. Patients with incomplete treatment courses were excluded from analysis. A Fisher exact test was used to compare categorical variables. There were 191 patients with CD between 12/2014 and 8/2022 available for analysis, of whom 66 patients underwent ambulatory rhythm monitoring. Of these, 20 were male and 46 were female with an average age of 55.3 ± 12.6 years, and ejection fraction of 56.7 ± 10.5%. Of the 66 patients, 42 (63.6%) received treatment, 22 (33.3%) had no treatment, and 2 (3.0%) received incomplete treatment for CD. Among patients that received treatment for CD, 11/42 (26.2%) had significant ventricular arrhythmias on ambulatory rhythm monitoring. In comparison, among patients who did not receive CD treatment, 12/22 (54.5%) had significant ventricular arrhythmias (p = 0.031). No significant difference in the number of ventricular arrhythmias was observed between the Benznidazole (7/29, 24.1%) and Nifurtimox (4/12, 33.3%) treatment groups. These data demonstrate that treatment of CD is associated with a reduction in ventricular arrhythmias on ambulatory rhythm monitoring. Further studies are needed to determine if CD treatment can lead to reduced incidence of sudden death.

Diagnostic Yield of Extended Cardiac Patch Monitoring in Cryptogenic Stroke Patients (P11-5.032)

<h3>Objective:</h3> To evaluate the diagnostic yield of detecting atrial fibrillation (AF) and/or atrial flutter (AFL) with extended cardiac patch monitoring in our cryptogenic stroke population. <h3>Background:</h3> Cryptogenic stroke accounts for 15–40% of yearly strokes with increased incidence in younger patients. It is standard of care at our comprehensive stroke center located in the stroke belt to discharge cryptogenic stroke patients with a 14-day continuous cardiac monitoring patch (Zio) to evaluate for paroxysmal AF/AFL. <h3>Design/Methods:</h3> We propose to conduct a retrospective chart review from January 2019 to June 2022 (3.5 years) of all adult stroke patients with a discharge diagnosis of ischemic stroke using the Get With The Guidelines stroke database at our institute. We will be analyzing all cryptogenic stroke patients who were discharged with a Zio patch. The following data points will be collated; demographics, baseline stroke risk factors, left atrium volume, Zio patch results including wear time, analyzed time, AF burden, duration the first episode of AF detected, patient events, and other irregular arrhythmias. Our preliminary data from January 2021 to June 2022 (18 months), observed 270 cryptogenic stroke discharges. Out of which, 165 met the eligibility criteria and were discharged with a Zio patch. <h3>Results:</h3> AF/AFL was detected in 14 patients (8.5%). The mean duration before the first episode of paroxysmal AF (PAF) was 3.7 days and the median duration was 1.5 days. 43 percent of PAF occurred after 48 hours. <h3>Conclusions:</h3> The preliminary data demonstrated a relatively low yield of AF/AFL detection with Zio patch monitoring in our cryptogenic stroke population. We plan to complete the prespecified data collection period to achieve a larger sample size and further analyze independent risk factors for AF/AFL detection and patient compliance. <b>Disclosure:</b> Dr. Rice has nothing to disclose. Dr. Lucioni has nothing to disclose. Mr. Aiello has nothing to disclose. Dr. Ranasinghe has nothing to disclose.

Comparison of the diagnostic value of a small, single channel, electrocardiogram monitoring patch with a standard 3-lead Holter system over 24 hours in dogs

Introduction/ObjectivesThe aim of this study was to compare a novel small event recorder device, the Carnation Ambulatory Monitor (CAM), with a standard Holter. AnimalsNineteen adult dogs. Material and methodsComparative and explorative study. The two devices were simultaneously applied for approximately 24 h. ResultsAnalysis time (P=0.013) and percentage of artefacts (P<0.001) were greater for the CAM (110 min [40–264]; and 9% [0–34], respectively) compared to a standard Holter (30 min [18–270]; and 0.3% [0–9], respectively). The total number of beats (P=0.017) and maximum (P=0.02) and mean (P=0.037) heart rates were lower for the CAM (113,806 ± 23,619 beats; 227 ± 35 bpm; and 88 ± 22 bpm, respectively) compared to the standard Holter (131,640 ± 40,037 beats; 260 ± 64 bpm; and 92 ± 26 bpm, respectively). The minimal heart rate (P=0.725), number of pauses (P=0.078), duration of the longest pause (P=0.087), number of ventricular ectopic complexes (P=0.55), ventricular couplets (P=0.186), ventricular triplets (P=0.203), ventricular tachycardia (P=0.05), Lown grade (P=0.233), presence or absence of ventricular bigeminy, trigeminy, supraventricular tachycardia, and atrial fibrillation (P=0.98) did not differ. The CAM missed some relevant events, like complex ventricular arrhythmias, and the Lown grade did not match in 5/19 dogs when comparing the devices. ConclusionsCardiac Ambulatory Monitor can be used to record ECG traces in dogs over a prolonged period, allowing to detect arrhythmias. Due to some clinically relevant limitations, including a higher percentage of artefacts, a longer reading time (which precludes quantitative counts of >300ventricular premature complexes), and underestimation of complex ventricular arrhythmias, the CAM appears not suitable for quantitative arrhythmia analysis in dogs.

Seven-day holter monitoring detects more significant arrhythmias than 24-hour and 3-day monitoring

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction 24-hour Holter monitors have been used widely to assess patients with suspected and known arrhythmias. Recent studies have shown increased yield of arrhythmia detection with longer durations of Holter monitoring. Purpose The aim of the study was to evaluate the incremental yield in significant arrhythmias detected using a 7-day continuous Holter monitor, as compared to what can be achieved within a 24-hour and 48 to 72 hours study. Methods A retrospective study of patients from 72 sites in two geographical locations, A and B, who completed a continuous 7-days patch monitor study was performed. 801 of these studies detected significant arrhythmias; pauses 3 seconds or more (PA), ventricular tachycardia of 6 beats or more (VT), and paroxysmal atrial fibrillation (PAF). The day of the first occurrence of a significant arrhythmia was noted and tallied to determine the incremental yield of a multiday Holter monitoring. Results Of 801 total cases detected with significant arrhythmia, only 278 (35%) were detected in the first 24hours, while 523 (65%) cases were detected after Day 1. 331 (41%) had first significant arrhythmia detected after the 3rd day of monitoring, with 68 (44%) being PA, 125 (40%) PAF, and 138 (41%) VT. Notably, in Group A, 31 (72%) of total VT detected and 35 (72%) of total PAF detected were first picked up after Day 1, 21 (49%) of total VT were first detected only after the 3rd day of monitoring. Conclusions 1-day (24-hour) monitoring period fails to detect a significant number of potentially serious cardiac arrhythmias. Extended continuous Holter monitoring increases the yield of detection, with a substantial fraction (40-49%) detected after the 3rd day of monitoring. No difference in results obtained between two geographical locations demonstrates strong evidence that findings are consistent across different sites. Review of current practice and guidelines is necessary to further expand usage of multiday Holter monitoring, thus increasing benefits to patients.

Comparison of adhesive single-lead cardiac ECG patch device with Holter monitoring for detecting atrial fibrillation after an acute cerebral ischemic event: An interim analysis

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health Malaysia Background Stroke secondary to atrial fibrillation (AF) is common and often associated with higher risk of stroke recurrence. Detection of AF is challenging due to brief unpredictable episodes of AF runs, especially in patients whose admission electrocardiogram (ECG) demonstrates a sinus rhythm. Probability of AF detection may be higher with early initiation of prolonged ECG monitoring. Purpose To compare diagnostic yield of 7-day cardiac ECG patch versus 24-hour Holter monitoring for detecting AF≥30 seconds; to identify predictors of AF in stroke patients; to determine if 7-day cardiac ECG patch results in a change in clinical practice. Methods In this investigator-initiated prospective study with pairwise comparison of 24-hour Holter and 7-day cardiac ECG patch monitoring, 150 patients who were admitted to a tertiary referral centre with acute ischemic stroke (AIS) or transient ischemic attack (TIA) within 1 week, without known AF, and had sinus rhythm in the admission 12-lead ECG were enrolled. Each patient underwent simultaneous 24-hour Holter and 7-day cardiac ECG patch monitoring. Routine transthoracic echocardiography was performed on each patient to assess cardiac function and exclude intracardiac thrombus. Results There were 102 (68.0%) male patients. 12 (8.0%) patients had underlying history of coronary artery disease; 26 (17.3%) had recurrent stroke or TIA. On admission, median NIH Stroke scale was 4; 18 (12.0%) patients had thrombolysis with alteplase. On transthoracic echocardiography, none had intracardiac thrombus. Both Holter and cardiac ECG patch monitoring were initiated simultaneously at median 2 days after index stroke event. Of 150 patients, 17 (11.3%) detected AF ≥30 seconds. Of these 17 patients, 7 (4.7%) had AF detected within the first 24 hours on both Holter and cardiac ECG patch; 10 (6.7%) were detected after 24 hours on cardiac ECG patch only. Number needed to screen to detect one AF was 6. Compliance to 7-day cardiac ECG patch monitoring was 81.3%. There was no significant difference in age among patients with and without AF. Although left atrium (LA) was not found to be dilated in patients with AF, LA volume index was significantly higher (28.3±15.9 vs 21.8±8.5, p=0.018) and LA emptying fraction (LAEF) was significantly lower (38.0%±30.2 vs 52.6%±16.7, p=0.007). The prolonged 7-day cardiac ECG monitoring patch resulted in 1.5-fold increase in prescription of anticoagulation therapy. Conclusions A 7-day cardiac ECG patch monitoring detected more patients with AF ≥30 seconds than 24-hour Holter monitoring and resulted in increase in prescription of anticoagulation therapy. Higher LA volume index and lower LA emptying fraction were predictors of AF in patients with a recent stroke.

False Atrial Fibrillation Alerts from Smartwatches are Associated with Decreased Perceived Physical Well-being and Confidence in Chronic Symptoms Management.

Wrist-based wearables have been FDA approved for AF detection. However, the health behavior impact of false AF alerts from wearables on older patients at high risk for AF are not known. In this work, we analyzed data from the Pulsewatch (NCT03761394) study, which randomized patients (≥50 years) with history of stroke or transient ischemic attack to wear a patch monitor and a smartwatch linked to a smartphone running the Pulsewatch application vs to only the cardiac patch monitor over 14 days. At baseline and 14 days, participants completed validated instruments to assess for anxiety, patient activation, perceived mental and physical health, chronic symptom management self-efficacy, and medicine adherence. We employed linear regression to examine associations between false AF alerts with change in patient-reported outcomes. Receipt of false AF alerts was related to a dose-dependent decline in self-perceived physical health and levels of disease self-management. We developed a novel convolutional denoising autoencoder (CDA) to remove motion and noise artifacts in photoplethysmography (PPG) segments to optimize AF detection, which substantially reduced the number of false alerts. A promising approach to avoid negative impact of false alerts is to employ artificial intelligence driven algorithms to improve accuracy.

Technology engagement is associated with higher perceived physical well-being in stroke patients prescribed smartwatches for atrial fibrillation detection.

Increasing ownership of smartphones among Americans provides an opportunity to use these technologies to manage medical conditions. We examine the influence of baseline smartwatch ownership on changes in self-reported anxiety, patient engagement, and health-related quality of life when prescribed smartwatch for AF detection. We performed a post-hoc secondary analysis of the Pulsewatch study (NCT03761394), a clinical trial in which 120 participants were randomized to receive a smartwatch-smartphone app dyad and ECG patch monitor compared to an ECG patch monitor alone to establish the accuracy of the smartwatch-smartphone app dyad for detection of AF. At baseline, 14 days, and 44 days, participants completed the Generalized Anxiety Disorder-7 survey, the Health Survey SF-12, and the Consumer Health Activation Index. Mixed-effects linear regression models using repeated measures with anxiety, patient activation, physical and mental health status as outcomes were used to examine their association with smartwatch ownership at baseline. Ninety-six participants, primarily White with high income and tertiary education, were randomized to receive a study smartwatch-smartphone dyad. Twenty-four (25%) participants previously owned a smartwatch. Compared to those who did not previously own a smartwatch, smartwatch owners reported significant greater increase in their self-reported physical health (β = 5.07, P < 0.05), no differences in anxiety (β = 0.92, P = 0.33), mental health (β = -2.42, P = 0.16), or patient activation (β = 1.86, P = 0.54). Participants who own a smartwatch at baseline reported a greater positive change in self-reported physical health, but not in anxiety, patient activation, or self-reported mental health over the study period.