Supraventricular Ectopy Research Articles

Accuracy of a Single-Lead ECG Device for Diagnosis of Cardiac Arrhythmias Compared Against Cardiac Electrophysiology Study

Single-lead electrocardiogram (ECG) devices may allow detection and diagnosis of cardiac rhythms. However, data on their accuracy for detecting cardiac arrhythmias beyond atrial fibrillation are limited. We aimed to determine the accuracy of the AliveCor KardiaMobile (AC) (AliveCor Inc, Mountain View, CA, USA) for the diagnosis of arrhythmias against gold standard cardiac electrophysiology study (EPS). Patients undergoing clinically indicated EPS underwent simultaneous rhythm recording with an AC, standard 12-lead ECG, and EP catheters for intracardiac electrograms. Rhythms recorded during EPS were classified based on electrogram, 12-lead ECG, and clinical findings. Blinded reviewers provided differential diagnoses for the single-lead AC tracings; a separate reviewer compared diagnoses made between the AC tracings and EPS findings. In 49 patients, 843 cardiac rhythms were captured during 502 AC recordings. Analysis of tracings containing sinus rhythm (n=273) returned an overall accuracy of 92%, with sensitivity and specificity values of 93% and 92%, respectively. Accuracy for tracings per rhythm was atrial fibrillation 91% (n=51); supraventricular tachycardia accuracy was 89% (n=191), ventricular tachycardia 91% (n=198), ventricular fibrillation 98% (n=11), and asystole 100% (n=5). Accuracy for supraventricular ectopy was 93% (n=28) and for premature ventricular complexes was 91% (n=86). Overall accuracy was 94% for solitary rhythms and 93% in tracings from patients with baseline bundle branch block. When compared against the gold standard EPS diagnosis, the interpretation of arrhythmias recorded by an AliveCor single-lead ECG device had reasonable diagnostic accuracy.

Cardiac troponin I release after transcatheter closure of atrial septal defects is associated with supraventricular arrhythmias on early follow-up.

Atrial septal defects (ASD) are prevalent congenital heart anomalies found in the adult population. Percutaneous ASD closure has become a routine clinical practice. Elevation of postprocedural transient cardiac biomarkers and exacerbation of supraventricular arrhythmias have been reported in the subject literature. To explore the relationship between cardiac troponin I (cTnI) elevation and supraventricular ectopy (SVE) following percutaneous closure of secundum atrial septal defect (ASD) in adult patients. 600 consecutive patients who underwent successful transcatheter ASD secundum closure were analyzed. Serum levels of cTnI were measured before and within 72 h of device implantation. 24-hour Holter monitoring was performed before the procedure, at 1 month, and at 6 months of follow-up. SVE burden increased 1 month after the procedure (median 1021.00; min.-max. 11.00-29 862.00) compared to baseline values (median 146.00; min.-max. 0-1865.00; p < 0.01). 61.7% of patients demonstrated a cTnI rise exceeding 50% of the upper reference limit within 24 h of the procedure. A statistically significant positive correlation between SVE burden 1 month after the procedure and periprocedural cTnI increase (p < 0.05, r = 0.41) was observed, while cTnI levels significantly correlated with procedure and fluoroscopy time (p < 0.001), device size (p < 0.001) and maximal ASD diameter (p < 0.001). A significant increase of cTnI is noted frequently after transcatheter ASD closure and seems to predict exacerbation in SVE burden on short-term follow up. The independent risk factors of cTnI rise are prolonged procedure duration and larger device sizes.

How reliable are single day electrocardiogram measurements to detect excessive supraventricular ectopic activity?

Abstract Background Excessive Supraventricular Activity (ESVEA) is widely recognized as a significant risk marker for incident atrial fibrillation, but the diagnostic reliability of ESVEA measured by 24-hour electrocardiogram (ECG) is unknown. Objectives To study the variability of ESVEA over 14 days using mobile cardiac telemetry (MCT). Methods We included US patients aged 17-100 years with ≥14 full days of ambulatory full-disclosure ECG using an MCT device during 2017, without atrial fibrillation during any of the recording days. ESVEA was defined as the presence of ≥720 premature atrial complexes and/or a ≥20 beat long supraventricular tachycardia, and calculated for each recording day. Results The study population consisted of 9,899 patients (median age 70 (interquartile range 59-77) years, 57% female). ESVEA was very common: 45% (n= 4,453) had ESVEA on at least one day. Of the patients with ESVEA, it occurred on one day only in 28% and on all registered days in 18%. The median number of ESVEA positive days was 4 (IQR 1-12). On the first monitoring day, 20% were ESVEA positive, resulting in a sensitivity of 44.64% and a negative predictive value of 68.84% of a single day measurement of ESVEA. Conclusions ESVEA occurs in almost half of an MCT population, but less than half of the patients with any occurrence of ESVEA are detected on the first monitored day. Reliable diagnosis of supraventricular ectopy requires longer monitoring durations.

B-045 A Descriptive Study of the Clinical Impacts on COVID-19 Survivors Using Telemonitoring (The TeleCOVID Study)

Abstract Background There is increasing evidence that COVID-19 survivors are at increased risk of experiencing a wide range of cardiovascular complications post infection; however, there are no validated models or clear guidelines for remotely monitoring the cardiac health of COVID-19 survivors. This study aims to test a virtual, in-home healthcare monitoring model of care for detection of clinical symptoms and impacts on COVID-19 survivors. It also aims to demonstrate system usability and feasibility. Methods This open label, prospective, descriptive study was conducted in South Western Sydney. Included in the study were patients admitted to the hospital with the diagnosis of COVID-19 between June 2021 and November 2021. Eligible participants after consent were provided with a pulse oximeter to measure oxygen saturation and a S-Patch EX to monitor their electrocardiogram (ECG) for a duration of 3 months. Data was transmitted in real-time to a mobile phone via Bluetooth technology and results were sent to the study team via a cloud-based platform. All the data was reviewed in a timely manner by the investigator team, for post COVID-19 related symptoms, such as reduction in oxygen saturation and arrhythmia. This study was designed for feasibility in real clinical setting implementation, enabling the study team to develop and utilise a virtual, in-home healthcare monitoring model of care to detect post COVID-19 clinical symptoms and impacts on COVID-19 survivors. Results During the study period, 23 patients provided consent for participation. Out of which 19 patients commenced monitoring. Sixteen patients with 81 (73.6%) valid tests were included in the analysis and amongst them seven patients were detected by artificial intelligence to have cardiac arrhythmias but not clinically symptomatic. The patients with arrhythmias had a higher occurrence of supraventricular ectopy, and most of them took at least 2 tests before detection. Notably, patients with arrhythmia had significantly more tests than those without (t-test, t (13) = 2.29, P &amp;lt; 0.05). Conclusions Preliminary observations have identified cardiac arrhythmias on prolonged cardiac monitoring in 7 out of the first 16 participants who completed their 3 months follow-up. This has allowed early escalation to their treating doctors for further investigations and early interventions.

A descriptive study of the clinical impacts on COVID-19 survivors using telemonitoring (The TeleCOVID Study).

There is increasing evidence that COVID-19 survivors are at increased risk of experiencing a wide range of cardiovascular complications post infection; however, there are no validated models or clear guidelines for remotely monitoring the cardiac health of COVID-19 survivors. This study aims to test a virtual, in-home healthcare monitoring model of care for detection of clinical symptoms and impacts on COVID-19 survivors. It also aims to demonstrate system usability and feasibility. This open label, prospective, descriptive study was conducted in South Western Sydney. Included in the study were patients admitted to the hospital with the diagnosis of COVID-19 between June 2021 and November 2021. Eligible participants after consent were provided with a pulse oximeter to measure oxygen saturation and a S-Patch EX to monitor their electrocardiogram (ECG) for a duration of 3 months. Data was transmitted in real-time to a mobile phone via Bluetooth technology and results were sent to the study team via a cloud-based platform. All the data was reviewed in a timely manner by the investigator team, for post COVID-19 related symptoms, such as reduction in oxygen saturation and arrhythmia. This study was designed for feasibility in real clinical setting implementation, enabling the study team to develop and utilise a virtual, in-home healthcare monitoring model of care to detect post COVID-19 clinical symptoms and impacts on COVID-19 survivors. During the study period, 23 patients provided consent for participation. Out of which 19 patients commenced monitoring. Sixteen patients with 81 (73.6%) valid tests were included in the analysis and amongst them seven patients were detected by artificial intelligence to have cardiac arrhythmias but not clinically symptomatic. The patients with arrhythmias had a higher occurrence of supraventricular ectopy, and most of them took at least 2 tests before detection. Notably, patients with arrhythmia had significantly more tests than those without [t-test, t (13) = 2.29, p < 0.05]. Preliminary observations have identified cardiac arrhythmias on prolonged cardiac monitoring in 7 out of the first 16 participants who completed their 3 months follow-up. This has allowed early escalation to their treating doctors for further investigations and early interventions.

Impact of simulated flight conditions on supraventricular and ventricular ectopy

Though billions of passengers and crew travel by air each year and are exposed to altitude equivalents of 7000–8000 feet, the health impact of cabin oxygenation levels has not been well studied. The hypoxic environment may produce ectopic heartbeats that may increase the risk of acute in-flight cardiac events. We enrolled forty older and at-risk participants under a block-randomized crossover design in a hypobaric chamber study to examine associations between flight oxygenation and both ventricular (VE) and supraventricular ectopy (SVE). We monitored participant VE and SVE every 5 min under both flight and control conditions to investigate the presence and rate of VE and SVE. While the presence of VE did not differ according to condition, the presence of SVE was higher during flight conditions (e.g. OR ratio = 1.77, 95% CI: 1.21, 2.59 for SVE couplets). Rates of VE and SVE were higher during flight conditions (e.g. RR ratio = 1.25, 95% CI: 1.03, 1.52 for VE couplets, RR ratio = 1.76, 95% CI: 1.39, 2.22 for SVE couplets). The observed higher presence and rate of ectopy tended to increase with duration of the flight condition. Further study of susceptible passengers and crew may elucidate the specific associations between intermittent or sustained ectopic heartbeats and hypoxic pathways.

Left Atrial Function and Arrhythmias in Relation to Small Vessel Disease on Brain MRI: The Multi-Ethnic Study of Atherosclerosis.

Background Atrial fibrillation (AF) is associated with increased stroke risk and accelerated cognitive decline, but the association of early manifestations of left atrial (LA) impairment with subclinical changes in brain structure is unclear. We investigated whether abnormal LA structure and function, greater supraventricular ectopy, and intermittent AF are associated with small vessel disease on magnetic resonance imaging of the brain. Methods and Results In the Multi-Ethnic Study of Atherosclerosis, 967 participants completed 14-day ambulatory electrocardiographic monitoring, speckle tracking echocardiography and, a median 17 months later, magnetic resonance imaging of the brain. We assessed associations of LA volume index and reservoir strain, supraventricular ectopy, and prevalent AF with brain magnetic resonance imaging measures of small vessel disease and atrophy. The mean age of participants was 72 years; 53% were women. In multivariable models, LA enlargement was associated with lower white matter fractional anisotropy and greater prevalence of microbleeds; reduced LA strain, indicating worse LA function, was associated with more microbleeds. More premature atrial contractions were associated with lower total gray matter volume. Compared with no AF, intermittent AF (prevalent AF with <100% AF during electrocardiographic monitoring) was associated with lower white matter fractional anisotropy (-0.25 SDs [95% CI, -0.44 to -0.07]) and greater prevalence of microbleeds (prevalence ratio: 1.42 [95% CI, 1.12-1.79]). Conclusions In individuals without a history of stroke or transient ischemic attack, alterations of LA structure and function, including enlargement, reduced strain, frequent premature atrial contractions, and intermittent AF, were associated with increased markers of small vessel disease. Detailed assessment of LA structure and function and extended ECG monitoring may enable early identification of individuals at greater risk of small vessel disease.

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

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

PC-578-02 JUNCTIONAL TACHYCARDIA

Junctional ectopic tachycardia (JET) is a rare tachyarrhythmia in adults. The precise site of origin within the AV junction is unknown. N/A N/A A 71-year-old male presented with dyspnea on exertion and recently diagnosed tachycardia in March 2021. He had a history of diabetes mellitus, obesity, hypertension, obstructive sleep apnea, and COVID-19 in 2020. A 14-day monitor demonstrated 43% supraventricular ectopy SVE burden and short runs of SVT. He presented for an electrophysiology (EP) study. He presented to the EP lab in sinus rhythm with frequent SVE. Multipolar catheters were placed in the His bundle region, right atrium, coronary sinus, and right ventricle. The SVE beats had the same QRS morphology, and an identical HV interval and His-right bundle activation sequence as in sinus rhythm and no retrograde conduction, consistent with premature junctional complexes (PJCs). Occasional short bursts of junctional tachycardia were noted. Isoproterenol was titrated to a maximum dose of 8 mcg/min. No other SVT was inducible with atrial overdrive pacing or programmed stimulation or with isoproterenol infusion. A 6 mm tip cryoablation catheter was advanced to the right atrium to the anatomical location of the slow pathway in the inferior triangle of Koch using an electroanatomic mapping system (EnSite NavX). Signals immediately prior to ablation (Figure 1) were notable for a pre-potential 26 ms prior to the His with PJCs. Cryoablation was performed at this site (Figure 2) with resolution of the PJCs at the onset of the freeze. After thawing, a second freeze was administered. No further PJCs were noted at baseline or with isoproterenol infusion. JET could originate from anywhere within the AV node or proximal His bundle. The application of cryoablation at a typical AV nodal slow pathway location with a preceding pre- potential and immediate obliteration of PJCs suggests that the origin in this case was from this region rather than a true His bundle extrasystole. Identification of pre-potentials to the junctional ectopy can guide safe ablation of this dysrhythmia.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Life's Simple 7 Cardiovascular Health Score in Relation to Arrhythmias on Extended Ambulatory Electrocardiographic Monitoring (from the Multi-Ethnic Study of Atherosclerosis)

The Life's Simple 7 (LS7) metric consists of 7 modifiable health behaviors and measures that are known health factors for cardiovascular wellness. Relatively little is known about the association of LS7 score with cardiac arrhythmias. In the setting of the Multi-Ethnic Study of Atherosclerosis, we studied the LS7 score (range 0 to 14), assessed at the 2010 to 2102 study visit, in relation to cardiac arrhythmias assessed by Zio Patch ambulatory electrocardiographic monitoring in 2016 to 2018. In participants free of clinically recognized cardiovascular disease and atrial fibrillation, we used logistic and linear regression to examine the association of total LS7 score with atrial fibrillation, supraventricular ectopy, and ventricular ectopy. In 1,329 participants in the analysis, the mean (SD) age was 67 (8) years and 48% were men. A more favorable total LS7 score was associated with fewer premature ventricular contractions (PVCs) per hour (ratio of geometric means for optimal [11 to 14] versus inadequate [0 to 7] score 0.52 [95% confidence interval 0.34 to 0.81]). After adjustment for sociodemographic characteristics, the association was attenuated (0.66 [0.43 to 1.01]). =Among the LS7 components, a more favorable body mass index was associated with less ventricular ectopy. We did not detect associations of total LS7 score with atrial arrhythmias. In conclusion, in this longitudinal study of older participants free of clinically recognized cardiovascular disease, there was little evidence of association of the LS7 cardiovascular health score with subclinical cardiac arrhythmias. However, there was a suggestion that a more favorable LS7 score was associated with fewer PVCs and specifically, that a more favorable body mass index was associated with fewer PVCs.

Ambulatory electrocardiography, heart rate variability, and pharmacologic stress testing in cats with subclinical hypertrophic cardiomyopathy

The utility of ambulatory electrocardiography (AECG) to evaluate cats with subclinical hypertrophic cardiomyopathy (HCM) for arrhythmias and heart rate variability (HRV) is not well defined but may provide information regarding risk stratification. This prospective study used AECG to evaluate ectopy and HRV in subclinical HCM cats compared to healthy controls and is the first to implement a pharmacologic cardiac stress test. Twenty-three purpose-bred, Maine coon cross cats (16 HCM, 7 control) underwent 48-h of continuous AECG. Terbutaline (0.2–0.3 mg/kg) was administered orally at 24 and 36 h. Heart rate, ectopy frequency and complexity and HRV parameters, including standard deviation of normal R-R intervals (SDNN), were compared pre-terbutaline and post-terbutaline and across phenotype, genotype and sex. Genotype for an HCM-causative mutation was significantly associated with the frequency of supraventricular (P = 0.033) and ventricular (P = 0.026) ectopy across all cats. Seven HCM cats and zero healthy cats had a sinus arrhythmia. Mean heart rate was significantly higher post-terbutaline (p < 0.0001). HCM cats had significantly greater HRV compared to controls (SDNN: p = 0.0006). Male cats had significantly higher HRV (SDNN: p = 0.0001) and lower mean heart rates (p = 0.0001). HRV decreased post-terbutaline (SDNN: p = 0.0008) and changes in HRV observed between sexes were attenuated by terbutaline.

Abstract 11836: Higher Burden of Supraventricular Ectopy is Independently Associated With Greater Risk of Dementia in Older Adults Without Atrial Fibrillation: The Atherosclerosis Risk in Communities Study

Introduction: In older adults without atrial fibrillation (AF), it is unclear if higher burden of supraventricular ectopy (SVE) is associated with dementia risk independent of cardiovascular risk factors and clinically documented stroke. Hypothesis: In older adults without AF, higher burden of SVE including premature atrial contractions (PAC) and atrial tachycardias (AT) are associated with a higher risk of dementia. Methods: Among 2167 participants (mean age, 79 years, 60% female, 26% Black) without adjudicated dementia, stroke or AF, at baseline (2016-17), AT and PAC were measured over 2 weeks by an ambulatory, continuous electrocardiogram recorder (Zio XT patch, iRhythm Technologies, Inc.). We quantified burden of PACs and ATs as: 1) natural log of frequency (episodes/day) due to skewed distributions, and 2) a dichotomous frequency measure, split at the median. Additionally, we dichotomized duration of the longest AT episode at the median. Dementia was adjudicated based on cognitive assessments through 2019 using the Clinical Dementia Rating scale at study visits or by telephone cognitive interviews, informant interviews, and ongoing linkage to medical records. We calculated relative risk of incident dementia using Poisson regression with robust error variance. Results: At baseline, median Zio XT patch wear time was 13.8 days (interquartile interval 13-14 days). Over 2 years of follow-up, 66 (3.0%) participants developed dementia. Higher frequency of AT and PAC (continuous or dichotomous) were associated with a higher risk of dementia independent of incident AF, stroke, and cardiovascular risk factors (Table). Conclusions: In older adults without AF, higher burden of SVE is associated with a greater risk of dementia independent of incident AF, stroke, and cardiovascular risk factors. Future research should define underlying mechanisms and evaluate the effect of lowering SVE burden on the risk of dementia in older adults with a higher SVE burden.

Abstract 10763: Atrial Fibrillation and Supraventricular Ectopy in Relation to Brain Morphology and Subclinical Vascular Brain Injury: The Multi-Ethnic Study of Atherosclerosis

Introduction: Atrial fibrillation (AF) increases stroke risk and is associated with accelerated cognitive decline. Information is mixed about the relationship of AF and other supraventricular (SV) arrhythmias with brain changes on magnetic resonance imaging (MRI). Hypothesis: Prevalent AF and SV ectopy are associated with reduced gray matter (GM) volume and subclinical vascular brain injury. Methods: In the Multi-Ethnic Study of Atherosclerosis (MESA), participants completed Zio Patch monitoring and brain MRI. Prevalent AF was estimated from ambulatory monitoring, hospital surveillance, Medicare claims, and MESA electrocardiogram (ECG). For secondary analyses, AF was categorized into continuous - AF during 100% of monitoring - and intermittent - prevalent AF with &lt;100% AF during monitoring. Brain MRI measures included GM volume, white matter (WM) lesion volume, WM fractional anisotropy, and presence of cerebral microbleeds (CMBs). Linear and Poisson regression analyses were adjusted for cardiovascular risk factors and socioeconomic status. Results: In MESA, 967 participants without a history of stroke or transient ischemic attack (TIA) completed &gt;24 hours of ECG monitoring (median, 14.0 days) and completed brain MRI a median 17 months later. Mean (standard deviation) age was 72 (8) years; 53% were women. A total of 116 participants had prevalent AF, of whom 20 had continuous AF. Compared with no AF, prevalent AF was associated with lower WM FA (-0.22 standard deviations, 95% CI: -0.39, -0.04) and higher prevalence of CMBs (prevalence ratio: 1.46, 95% CI: 1.18, 1.80). In secondary analyses, compared with no AF, continuous but not intermittent AF was associated with lower GM volume (-18.6 mL, 95% CI: -31.4, -5.8). Rates of premature atrial contractions and runs of SV tachycardia were not significantly associated with brain MRI measures. Conclusions: In a multi-ethnic sample free of a history of stroke or TIA, prevalent AF was associated with lower WM FA, a measure of WM injury, and presence of CMBs. These results highlight the importance of AF prevention for brain health. Further analysis of subclinical infarcts is needed in this sample, and study in other settings is needed to confirm whether greater AF burden is associated with reduced GM volume.

Differences in Left Atrial Size and Function and Supraventricular Ectopy Between Black and White Participants in the ARIC Study.

BackgroundBlack Americans have more atrial fibrillation risk factors but lower atrial fibrillation risk than White Americans. Left atrial (LA) enlargement and/or dysfunction, frequent atrial tachycardia (AT), and premature atrial contractions (PAC) are associated with increased atrial fibrillation risk. Racial differences in these factors may exist that could explain the difference in atrial fibrillation risk.Methods and ResultsWe included 2133 ARIC (Atherosclerosis Risk in Communities) study participants (aged 74±4.5 years[mean±SD], 59% women, 27% Black participants) who had echocardiograms in 2011 to 2013 and wore the Zio XT Patch (a 2‐week continuous heart monitor) in 2016 to 2017. Linear regression was used to analyze (1) differences in AT/day or PAC/hour between Black and White participants, (2) differences in LA measures between Black and White participants, and (3) racial differences in the association of LA measures with AT or PAC frequency. Compared with White participants, Black participants had a higher prevalence of cardiovascular risk factors and disease, lower AT frequency, greater LA size, and lower LA function. After multivariable adjustments, Black participants had 37% (95% CI, 24%–47%) fewer AT runs/day than White participants. No difference in PAC between races was noted. Greater LA size and reduced LA function are associated with more AT and PAC runs; however, no race interaction was present.ConclusionsDifferences in LA measures are unlikely to explain the difference in atrial fibrillation risk between Black and White individuals. Despite more cardiovascular risk factors and greater atrial remodeling, Black participants have lower AT frequency than White participants. Future research is needed to elucidate the protective mechanisms that confer resilience to atrial arrhythmias in Black individuals.

Arrhythmias in repaired pediatric and adolescent Fallot tetralogy, correlation with cardiac MRI parameters

BackgroundTetralogy of Fallot (TOF) is a common congenital cyanotic heart disease in which arrhythmias could develop even after successful operative repair. Pulmonary regurgitation and right ventricular dilatation develop in many cases. The relation between arrhythmias and right ventricular dilatation is not established. Our aim is to assess the relation in between the degree of right ventricular volume affection and the severity of the pulmonary regurgitation, associated arrhythmias and the need for pulmonary valve repair in Egyptian pediatric and adolescent cases after successful TOF repair.ResultsA cross sectional descriptive study was conducted on 32 cases after successful surgical repair. Transthoracic Doppler echocardiography, 24 h Holter monitoring and cardiac MRI for assessment of pulmonary regurgitation fraction (PRF), ventricular volumes and function were measured. Cases were classified according to right ventricular end diastolic volume index (RVEDVI) into 2 groups with cut off value 150 ml/m2. Mean age of the studied cases was (12.96 ± 3.384) years, mean age at time of surgical repair was (34.23 ± 22.1) months, and mean duration postoperatively was (121.72 ± 41.028) months. Eighteen cases (56%) had RVEDVI ≥ 150 ml/m2, PRF was significantly higher in cases with increased RVEDVI (p value 0.007), with positive significant correlation between RVEDVI and PRF (p value = 0.0001, r = 0.61). Arrhythmias were detected in 18 cases (56%), the most common of which was infrequent supraventricular ectopy. No significant difference in incidence of arrhythmias between the 2 groups (p value = 1) with also no significant correlation between arrhythmias and increased RVEDVI (p value = 0.76, r = 0.05). No difference between cases with and without arrhythmias regarding RVEDVI (p value = 0.56) or PRF (p value = 0.5).ConclusionHolter detected arrhythmias after successful surgical repair of TOF were significantly associated with increased postoperative duration but not with PRF or RVEDVI.

Abstract P036: Little Evidence Of Association Between Kidney Function And Subclinical Arrhythmias Measured By Extended Ambulatory Cardiac Monitoring: The Multi-Ethnic Study Of Atherosclerosis (MESA)

Introduction: Chronic kidney disease (CKD) patients are at high risk for atrial fibrillation (AF) and ventricular arrhythmias. Arrhythmias are often asymptomatic and not detected clinically, so the true prevalence among CKD patients is unknown. Extended ambulatory cardiac monitoring is a sensitive and unbiased method for detecting arrhythmias. Hypothesis: We assessed the hypothesis that impaired kidney function is associated with atrial and ventricular arrhythmias as measured by extended ambulatory cardiac monitoring. Methods: In the Multi-Ethnic Study of Atherosclerosis (MESA), kidney function was assessed at the 2016-2018 study visit: estimated glomerular filtration rate (eGFR) using the 2009 Chronic Kidney Disease Epidemiology Collaboration creatinine equation and urinary albumin-creatinine ratio (UACR). UACR was log 2 transformed for analysis. At the same visit, extended ambulatory cardiac monitoring was conducted for up to two 14-day periods per participant using the Zio Patch XT (iRhythm Technologies, Inc., San Francisco, CA). Device information was consolidated for participants with 2 devices, and 7 arrhythmia outcomes were studied: presence of monitor-detected AF (&gt;30 seconds), presence of subclinical AF (in those with no history of clinically detected AF), frequency of premature atrial contractions, frequency of runs of ≥ 4 beats of supraventricular tachycardia (SVT), frequency of premature ventricular contractions, presence of runs of ≥ 4 beats of ventricular tachycardia (VT), and frequency of runs of VT. Continuous outcome variables were natural log transformed. Analyses used logistic regression for binary outcomes and linear regression for continuous outcomes, adjusted for demographic and clinical risk factors. Results: A total of 1459 participants had eGFR measures and 1369 had UACR measures; 178 had a history of clinically detected AF. Mean (standard deviation (SD)) age was 74 (8) years; with 52% women. Median (interquartile range) kidney function measures were eGFR 77 (62, 88) ml/min/1.73 m 2 and UACR 6 (3, 18) mg/g, and total monitoring duration was 14 (14, 26) days. AF was detected in 7%, all but one participant had supraventricular ectopy, and 99% had ventricular ectopy. A doubling of UACR was associated with increased odds of monitor-detected AF (odds ratio 1.18; 95% confidence interval (CI): 1.06-1.32) while eGFR was not significantly associated. Neither eGFR nor UACR was associated with subclinical AF or with ventricular arrhythmias. The analysis of eGFR and frequency of runs of SVT yielded results opposite of the expected direction: a 10 ml/min/1.73 m 2 greater eGFR was associated with a 7% greater frequency of SVT (95% CI: 1%-12%). Conclusion: In summary, in a large population of older individuals across a wide range of kidney function, we found little evidence that impaired kidney function was associated with increased monitor-detected arrhythmias.

Abstract MP62: Longitudinal Measures Of Blood Pressure And Subclinical Atrial Arrhythmias: The Multi-ethnic Study Of Atherosclerosis And The Atherosclerosis Risk In Communities Study

Purpose: High blood pressure (BP) is a well-known risk factor for atrial fibrillation (AF), but a single BP measurement may provide limited information about AF risk in older adults. We evaluated whether longitudinal measures of BP were associated with subclinical arrhythmias after adjustment for more conventional BP measures such as a single cross-sectional BP value. Methods: This study included 1,256 Multi-Ethnic Study of Atherosclerosis (MESA) and 1,948 Atherosclerosis Risk in Communities study (ARIC) participants who underwent extended ambulatory electrocardiographic monitoring and who were free of clinically-detected cardiovascular disease, including AF. Using BP measurements from six exams (2000-2018 in MESA, 1987-2017 in ARIC), we examined cross-sectional BP at the most recent exam, individual long-term mean BP from exams 1-5, BP trend during exams 1-5, and visit-to-visit variability during exams 1-5 in systolic BP (SBP) and pulse pressure (PP) for each participant. Logistic regression models were used to examine BP exposures in relation to subclinical AF and linear regression models were used to examine BP exposures in relation to frequency of supraventricular ectopy. Models adjusted for participant demographics, height, weight, diabetes, antihypertensive medication use and cross-sectional BP. Results from each study were combined with inverse variance-weighted meta-analysis. Results: At Exam 6, the mean age was 73 years in MESA and 79 years in ARIC, and 4% had subclinical AF. A 10 mmHg higher cross-sectional SBP and a 10 mmHg higher cross-sectional PP were associated with less AF (odds ratio [OR] SBP 0.86, 95% confidence interval [CI] 0.76, 0.96 and OR PP 0.73, 95% CI 0.63, 0.84). In contrast, a 4 mmHg higher visit-to-visit variability in SBP was associated with a greater prevalence of subclinical AF (OR 1.20, 95% CI 1.02, 1.38) and with a greater frequency of premature atrial contractions/hour (8%, 95% CI 1%, 15%). For PP as well, a 4 mmHg higher visit-to-visit variability was associated with a greater prevalence of AF (OR 1.18, 95% CI 1.00-1.37). In addition, a 10 mmHg higher long-term mean PP was associated with a greater prevalence of subclinical AF (OR 1.36, 95% CI 1.08-1.70). Conclusion: Our results indicate that information on BP assessed longitudinally for several years, especially visit-to-visit BP variability, is associated with a greater prevalence of subclinical atrial arrhythmias, while cross-sectional BP values alone were not associated with a greater prevalence of subclinical atrial arrhythmias. Prior longitudinal BP assessment, rather than current BP, may be more helpful in identifying older adults who are at higher risk of atrial arrhythmias.

Longitudinal Measures of Blood Pressure and Subclinical Atrial Arrhythmias: The MESA and the ARIC Study.

BackgroundHigh blood pressure (BP) is a well‐known risk factor for atrial fibrillation (AF), but a single BP measurement may provide limited information about AF risk in older adults.Methods and ResultsThis study included 1256 MESA (Multi‐Ethnic Study of Atherosclerosis) and 1948 ARIC (Atherosclerosis Risk in Communities) study participants who underwent extended ambulatory electrocardiographic monitoring and who were free of clinically detected cardiovascular disease, including AF. Using BP measurements from 6 examinations (2000–2018 in MESA and 1987–2017 in ARIC study), we calculated individual long‐term mean, trend, and detrended visit‐to‐visit variability in systolic BP and pulse pressure for each participant. Outcomes, assessed at examination 6, included subclinical AF and supraventricular ectopy. Results from each study were combined with inverse variance‐weighted meta‐analysis. At examination 6, the mean age was 73 years in MESA and 79 years in ARIC study, and 4% had subclinical AF. Higher visit‐to‐visit detrended variability in systolic BP was associated with a greater prevalence of subclinical AF (odds ratio [OR], 1.20; 95% CI, 1.02–1.38) and with more premature atrial contractions/hour (geometric mean ratio, 1.08; 95% CI, 1.01–1.15). For pulse pressure as well, higher visit‐to‐visit detrended variability was associated with a greater prevalence of AF (OR, 1.18; 95% CI, 1.00–1.37). In addition, higher long‐term mean pulse pressure was associated with a greater prevalence of subclinical AF (OR, 1.36; 95% CI, 1.08–1.70).ConclusionsAntecedent visit‐to‐visit variability in systolic BP and pulse pressure, but not current BP, is associated with a higher prevalence of subclinical atrial arrhythmias. Prior longitudinal BP assessment, rather than current BP, may be more helpful in identifying older adults who are at higher risk of atrial arrhythmias.

Major impact of left auricular cardiopathy when associated to supraventricular ectopy?

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION Left atrial cardiopathy (LAC) is an independent predictor of atrial fibrillation (FA) and embolic stroke. It is more frequent in patients with embolic stroke of undetermined source (ESUS) than in non-embolic strokes. The current definition doesn’t include supraventricular ectopy. AIM The aim of this work was to describe the importance of LAC in ESUS and to study the impact of adding the number of atrial premature complexes per hour (APC/h) to LAC criteria. METHODS Retrospective analysis of 123 ESUS patients (pts) admitted to Neurology service from 2014 to 2019. LAC was defined according to two criteria (LAC2: severe left atrial enlargement or p-wave terminal force in lead V1 [PTFV1] &amp;gt;5000 µV*ms) or 3 criteria (LAC3: additionally, &amp;gt;30 APC/h). Survival analysis for the occurrence of AF, stroke recurrence and death according to LAC2 and LAC3. Diagnostic test performance analysis for each criterion with ROC curves. RESULTS 43 (35%) of the ESUS pts had LAC2. Pts with LAC2 (35.0%) were older (p = 0.007), more frequently had hypertension (p = 0.004) and lower total cholesterol levels (p = 0.044) than patients without LAC2. The incidence of AF (median follow-up 21 months, IQR = 9-35) was higher both in LAC2 (p = 0.038) and LAC3 (p = 0.001). There were no differences in stroke recurrence or death between patients with or without LAC2 or 3. Among the 3 atrial dysfunction criteria included in LAC3 definition, the number of APC/h was associated with a higher area under the curve for the occurrence of AF (AUC = 0.822). Cox regression revealed that PTFV1 &amp;gt; 5000 µV·ms (HR = 5.12, IC95%=1.28-20.56, p = 0.021) and &amp;gt;30 APC/h (HR = 13.02, IC95%=3.57-47.56) were independent predictors of AF. In addition, the single predictor of the composite endpoint (occurrence of AF, stroke recurrence and death) was &amp;gt;30 APC/h (HR = 5.2, p &amp;lt; 0,001). CONCLUSION In ESUS pts, the subgroup with LAC2 had different clinical characteristics and a higher AF incidence. APC/h were also independently associated with AF incidence and had better diagnostic test performance than the other criteria. In sum, APC/h inclusion as a diagnostic criterion for LAC should be considered and may help in a better therapeutic approach.

Aortic Regurgitation as a Complication of Electrophysiologic Ablation Techniques: A Narrative Review.

Radiofrequency catheter ablation is a well-established treatment for several cardiac arrhythmias. Arrhythmias originating from the left side of the heart including ventricular and supraventricular tachycardia and ectopy can be successfully ablated through either transseptal or retrograde aortic approach. Although these techniques have a generally low rate of complications, aortic valve injury is a potential complication of ablation at the left cardiac side that warrants more investigation. The purpose of this review is to evaluate the incidence of iatrogenic aortic valve regurgitation and explore the potential mechanisms and risk factors that might contribute to aortic valve injury during radiofrequency ablation. Additionally, the course and progression of aortic regurgitation in the reported cases will be described. Authors searched PubMed for articles using the keywords "ablation" AND "aortic insufficiency" OR "aortic valve injury" OR "aortic regurgitation". Case reports and series as well as retrospective and prospective studies were included, and relevant review articles and editorial comments were used as a supplementary source of data. A total of 19 references were used and a detailed description of patient characteristics, procedural techniques, and incidence, predictors, and fate of aortic regurgitation were reported by 11 clinical studies. There is a small risk of significant iatrogenic aortic regurgitation after radiofrequency ablation of left-sided cardiac arrhythmias, especially techniques performed via a retrograde aortic approach. Although the risk is not confined to procedures applying direct energy to the aortic cusp region, a more aggressive ablation applied in the vicinity of the valvular complex seems to be associated with a higher risk. Routine post-procedural surveillance should be adopted to detect de novo aortic valve injury following radiofrequency ablation techniques.