Supraventricular Premature Beats Research Articles

Real-world utility of implantable loop recorders

Abstract Background Implantable loop recorders (ILRs) allow prolonged and continuous single-lead electrocardiogram recording and have significantly shortened time to electrocardiographic diagnosis and appropriate therapy of many bradyarrhythmias and tachyarrhythmias. Purpose The aim of this retrospective single center study was to evaluate ILR indications, diagnostic yield and ILR-guided interventions. Methods We retrospectively analyzed 388 patients (223 male / 165 female), who underwent Medtronic and Biotronik ILRs implantation at a heart center. Demographic and clinical data were obtained from the medical records. Remote monitoring was analyzed when no data of in-hospital follow up could be acquired. Results The mean age at ILR implantation was 63.4 ± 14.9 years with a mean follow-up of 20.7±17.6 months from ILR implantation. In total, 152 (39.2%) patients were followed by a remote monitoring system. Number of patients with ILR indication due to syncope (n=171; 44.1%) was significantly higher compared to patients with monitoring after ablation of atrial fibrillation or atrial flutter (n=108; 27.8%), cryptogenic stroke (n=50; 12.9%) and presyncope and dizziness (n=21; 5.4%) (p<0.05). After 12 months, arrhythmia was detected in 198 cases (79.2% out of 250 patients with detected arrhythmias). The most common type of arrhythmia was paroxysmal atrial fibrillation (31.7%) with a significantly higher prevalence compared to atrial tachycardias (16.5%) and supraventricular premature beats (9.8%) (p<0.05). Noteworthy, in 132 (52.8% out of 250) patients, ILR diagnosis corresponded to the suspected arrhythmia, whereas in 118 patients unexpected arrhythmias were detected. ILR diagnosis of arrhythmia lead in 147 (58.8%) patients to initiation of a new therapy or to a change of current medication. Changes of current medication occurred in 72 patients (28.8%), electrophysiology study/ablation in 66 patients (26.4%), pacemaker/ICD implantation in 46 (18.4%), electrical cardioversion in 6 patients (2.4%), and closure of the left atrial appendage in 1 patient. Conclusion Our study shows, that ILRs are an important diagnostic tool, providing clinical relevant data in about two thirds (65%) of the patients. About half (52.8%) of the detected arrhythmia correlated with the symptoms leading to ILR implantation (number needed to treat was around 2). Remote monitoring improves the diagnostic timing with a potential reduction of costs for health care. However, patient selection is critical and ILRs benefits needs to be proven in larger randomized trials.

Twenty-four hour Holter ECG in normocalcemic and hypercalcemic patients with hyperparathyroidism.

To investigate the occurrence of arrhythmias in patients with normocalcemic (NC) primary hyperparathyroidism (PHPT) compared to both hypercalcemic PHPT patients and control subjects by means of 24-h Holter ECG. Thirteen NCPHPT postmenopausal patients were enrolled and age-matched with 13 hypercalcemic PHPT patients and 13 controls. Every subject underwent basal ECG, 24-h Holter ECG and mineral metabolism biochemical evaluation. PHPT patients had higher mean serum calcium levels compared to both NCPHPT and controls; there was no difference in mean serum calcium levels between NCPHPT and controls. Both NCPHPT and PHPT patients had significantly higher mean PTH levels compared with controls. There were no differences in ECG parameters between the three groups, except for QTc interval. PHPT patients had normal QTc interval values, but significantly shorter mean values compared with those of controls and NCPHPT patients. During 24-h Holter ECG recording, 100% of PHPT patients had supraventricular premature beats (SVPBs), compared to 46% of NCPHPT (p = 0.005) and to 53% of controls (p = 0.01). PHPT patients experienced ventricular premature beats (VPBs) (69.2%) vs 15% of NCPHPT patients (p = 0.01) and 23% of controls (p = 0.04). There was no difference between NCPHPT and controls subjects concerning occurrence of both VPBs and SVPBs. NCPHPT patients did not experience an increased occurrence of arrhythmias compared to controls, while PHPT patients showed an increased occurrence compared to both controls and NCPHPT. Our findings are most probably related to the short QTc interval caused by hypercalcemia observed in PHPT patients, but not in NCPHPT.

The Fragmented QRS Complex in Lead V1: Time for an Update of the Athlete’s ECG?

Differentiating between ECG patterns related to athletes' heart remodeling and pathological findings is a challenge in sports cardiology. As the significance of fragmented complex in athletes remains uncertain, this study aimed to assess the presence of fragmented QRS in lead V1 (fQRSV1) among young athletes and its association with heart adaptations and arrhythmias. Young athletes referred for annual pre-participation screening receiving a maximal exercise testing and transthoracic echocardiography from January 2015 to March 2021 were included. The study included 684 young athletes. The prevalence of fQRSV1 was 33%. Subjects with fQRSV1 had higher exercise capacity and indexes of right ventricular function and remodeling. Among highly trained athletes, the fQRSV1 group demonstrated also increased left ventricular wall thickness. No significant association existed between fQRSV1 and exercise-induced arrhythmias, even in highly trained athletes. The high prevalence of fQRSV1 in young athletes is associated with training-induced heart adaptations but not exercise-induced ventricular arrhythmias.Graphical The fragmented QRS complex in lead V1 in young athletes. PPS = preparticipation screening; EST = exercise stress test; fQRSV1 = fragmented QRS in lead V1; PSBs = premature supraventricular beats; PVBs = premature ventricular beats.

Cardiac Magnetic Resonance Imaging Detects Myocardial Abnormalities in Naturally Infected Dogs with Chronic Asymptomatic Chagas Disease.

Trypanosoma cruzi infection causes inflammation and fibrosis, resulting in cardiac damage in dogs. The objectives of this study were to describe cardiac magnetic resonance imaging (CMR) in naturally infected dogs with chronic Chagas disease and the frequency of abnormalities for CMR and cardiac diagnostic tests. Ten asymptomatic, client-owned dogs seropositive for T. cruzi were prospectively enrolled in an observational study evaluating echocardiography, ECG (standard and ambulatory), cardiac troponin I (cTnI), and CMR. Standard ECG measurements (3/10) and cTnI concentration (1/10) outside the reference range were uncommon. Ambulatory ECG abnormalities were documented more frequently (6/10 dogs) than with standard ECG and included ventricular arrhythmias (4), supraventricular premature beats (3), second-degree atrioventricular block (2), and sinus arrest (1). Echocardiographic abnormalities were documented in 6/10 dogs including mildly increased left ventricular internal dimension in diastole (1) and decreased right ventricular (RV) systolic function based on reductions in tricuspid annular plane systolic excursion (3) and RV S' (4). Abnormalities were detected with CMR in 7/10 dogs including delayed myocardial enhancement in 5 of which 2 also had increased extracellular volume, abnormal wall motion in 5, and loss of apical compact myocardium in 1. In conclusion, CMR abnormalities were common, and the results of this study suggest CMR can provide useful information in dogs with T. cruzi infection and may support naturally infected dogs for future clinical investigation as an animal model for Chagas disease.

Clinical efficacy of a personalized exercise program in the rehabilitation of patients with atrial fibrillation after radiofrequency ablation

Aim. To study the clinical efficacy and safety of a personalized exercise program in the rehabilitation of patients with paroxysmal atrial fibrillation (AF) after primary pulmonary vein radiofrequency ablation (RFA).Material and methods. Patients (n=48) with paroxysmal AF who underwent RFA were randomized into two groups: main (n=24) — patients involved in the exercise program and received standard therapy; control (n=24) — patients received standard therapy. The program included exercise complexes with the calculation of energy consumption, step training and walking. The program lasted 6 months, while the follow-up period — 12 months. All patients in the study underwent a faceto-face learning interview.Results. After 6-month exercise program, bicycle ergometer test revealed an increase in duration (by 18,6%, p<0,001) and power (by 24,8%, p<0,01) of the load, while these changes were not revealed in the control group. The positive aftereffect of training on these parameters persisted even after the completion of program. Left atrial and left ventricular end-diastolic dimension remained stable in exercise program group and significantly increased in the control group. In contrast to the control group, the following parameters significantly decreased in trained patients after 6 months: body mass index by 2,8% (p<0,05), systolic blood pressure by 2,1% (p<0,05), heart rate by 12,1% (p<0,05), low-density lipoprotein cholesterol concentration by 18,8% (p<0,001), high-sensitivity C-reactive protein by 22,9% (p<0,05), N-terminal pro-brain natriuretic peptide by 28,2% ( p<0,05), aldosterone by 41,5% (p<0,001) and angiotensin II by 41,3%, p<0,05). In addition, in the exercise program group an increase in high-density lipoprotein cholesterol by 20,6% (p<0,05) and physical activity level by 23,8% (p=0,001) was revealed. At the same time, both groups showed a significant decrease in the concentration of fibrinogen and transforming growth factor-β1. After 6 months, in the exercise program group versus the control group, there was a decrease in the number of registered supraventricular premature beats (p<0,01), episodes of supraventricular tachyarrhythmia (p<0,05), including AF (p<0,05).Conclusion. Involvement of patients with AF after catheter RFA in a cardiac rehabilitation program based on moderate-intensity aerobic training improves exercise tolerance, cardiac function, corrects thrombogenic factors, and reduces the likelihood of arrhythmia recurrence, including AF.

Prognostic value of hypoxia-inducible factor-1 alpha gene polymorphism in patients with heart failure with preserved ejection fraction and obstructive sleep apnea

Aim. To study the associations of hypoxia-inducible factor-1 alpha (HIF-1α) gene polymorphism (rs11549465) with the clinical course of heart failure (HF) with reserved ejection fraction (HFpEF) in patients with obesity and moderate and severe obstructive sleep apnea (OSA).Material and methods. The study included 76 men with HFpEF and OSAS. Patients underwent a polysomnography, echocardiography, and a 6-minute walk test. In addition, apnea/hypopnea index was calculated, and the level of N-terminal pro-brain natriuretic peptide (NT-proBNP) was assessed. HIF1A gene polymorphisms (rs11549465) were analyzed using polymerase chain reaction. After 12-month follow-up, the clinical course of HF was assessed.Results. The T/T genotype of the HIF1A gene was associated with a high risk of HF progression (p=0,004), development of supraventricular premature beats (p=0,004) and atrial fibrillation (p=0,039). Carrying the T/T genotype was associated with severe OSA (p=0,006) and increased NT-proBNP (p=0,044), and also correlated with certain echocardiographic characteristics of myocardial remodeling.Conclusion. T/T genotype of the HIF1A gene is associated with OSA severity and increased NT-proBNP, as well as with the severity of left and right heart remodeling. The carriage of this genotype was associated with an unfavorable course of HF and an increased risk of atrial fibrillation in patients with HFpEF and OSA.

Arrhythmias in pregnant women without structural heart disease: characteristics and outcomes

Abstract Funding Acknowledgements Type of funding sources: None. Background Heart rhythm disorders are relatively common in pregnant women. There are few data of arrhythmia characteristics and perinatal outcomes in patients without any structural heart disease. Purpose To describe the clinical peculiarities, pregnancy course and characterize outcomes. Methods A total of 99 pregnant without structural heart disease with arrhythmia was included, aged: 29.05±5.37years with a mean gestation age 22.7±7.29 weeks. Clinical characteristics, obstetric and neonatal outcomes were determined. Results The most common reported arrhythmias were supraventricular tachycardia (n=46; 46.5%) and premature contractions (n=36; 36.3%). Advanced heart block (n=9; 9.1%) and ventricular tachycardia (n=8; 8.1%) were rare during pregnant with structurally normal heart. The 56% of arrhythmia cases among the examined patients first occurred during current pregnancy. Studying the peculiarities of arrhythmia manifestations, it was determined that in the I trimester of pregnancy the disease symptoms appeared in 11% of the examined women, in the II trimester – in 59%, in the III trimester – in 31%. In the clinic, the most common symptoms of arrhythmia were palpitations (62.6%), general weakness (59.6%), dyspnea (38,4%) and dizziness (29.9%). Pregnancy course was benign in the majority of cases. Termination of pregnancy was in three cases (3%) – in one case due to extracardial cause, in two cases due to life threatening course of ventricular tachycardia. Premature birth was in 2 cases (2.02%). In 75% of pregnancy was vaginal delivery, in 25% - cesarean section. Preeclampsia was in 2 cases (2.02%). There were 99 live births without maternal and fetal mortality. Conclusions In pregnant women with no structural heart disease supraventricular tachycardia and premature beats are most common. Majority of patients have good course of pregnancy and outcomes.

P168 A RARE CASE OF HYPERTROPHIC CARDIOMYOPATHY WITH HIGH RISK OF SUDDEN CARDIAC DEATH: WHAT CAN WE DO UNTIL MIECTOMY?

Abstract A 43–year–old Indian man with obstructive hypertrophic cardiomyopathy (HCMO) and a family history of sudden death presented with heart palpitations associated with chest discomfort and syncope during moderate physical activity despite beta–blocker therapy at maximum dose (New York Heart Association–NYHA III). Transthoracic echocardiography demonstrated ejection fraction 55% and ventricular septum (SIV) (23 mm) and posterior wall hypertrophy (12 mm). There was evidence of dynamic left ventricular outflow tract obstruction (maximum LVOT gradient 30 mmHg at baseline and 45 mmHg after Valsalva) and systolic anterior movement of the amterior mitral flap responsible of moderate regurgitation. It also showed a bicuspid aortic valve with fusion of the right and left cusps and mild regurgitation. ECG Holter showed sporadic supraventricular premature ectopic beats and abnormality of the ventricular repolarization that were accentuated during exercise. Exercise stress test showed 3 mm ST depression in V4–V5 leads. Cardiac magnetic resonance (CMR) and Cardio–CT confirmed HCMO diagnosis and showed a junctional origin of the coronaries, a bifurcated interventricular artery, coronaries free from significant stenosis, intramural late gadolinium enhancement (LGE) of the mid–ventricular SIV and sub–endocardium LGE of the basal SIV. The high HCM– Sudden Cardiac Death Risk score and the presence of LGE on CMR identified a high–risk status and prompt consideration for primary prevention automatic implantable cardioverter defibrillator (AICD) therapy. Thus, in order to treat major life–threatening ventricular arrhythmias, AICD was placed (ESC guidelines 2014 Class IIa). Invasive treatment is indicated for symptomatic patients, NYHA class III and IV refractory to optimized medication and who have gradients in the LVOT. Aortic transvalvular–myectomy is the procedure with the longest experience and considered the gold standard. However, in this case surgical treatment was temporarily postponed. So a sequential rhythm pacing with reduced A–V delay was set up in order to induce a left bundle branch block and a “paradoxical” movement of the SIV with reduction of LVOT gradient. After 2 weeks the LVOT gradient was 20 mmHg and the symptoms were improved. This case suggests the usefulness of a single device for the treatment of different aspects in HCMO waiting to undergo surgical treatment: prevention of sudden cardiac death and improvement of symptoms refractory to medical therapy.

Frequency of arrythmia depending on the severity of the functional class in patients with metabolic syndrome and heart failure

Study objective: to study the incidence of arrhythmias in patients with metabolic syndrome and heart failure in accordance with the severity of the functional class (1964, according to the NYNA classification).Materials and methods: The study included 90 patients with heart failure (HF) II and III functional class (FC), EF<50% and metabolic syndrome, who received outpatient and inpatient treatment at the J. Abdullaeva Scientific Researh Institute. Among the patients, 57 were with HF II (according to the NYNA classification), and 33 were with HF III functional class. The age of the patients ranged from 36 to 88 years. Of these, 27% were women, 63% were men. The patients underwent complex clinical, instrumental and laboratory examinations. Instrumental examinations included daily monitoring of the electrocardiogram by the Holter method (with CONTEC, TLC 5000), 6-minute walking test, blood ion analysis, MS indicators, and lipid spectrum research. Exclusion criteria were chronic obstructive pulmonary disease, bronchial asthma, cardiomyopathies,heart defects.Results: The incidence of ventricular premature beats (especially in an amount greater than 1000) among patients with heart failure of the III functional class (97.0%) is slightly higher than in patients of the II functional class (91.2%). However, supraventricular premature beats are more common (78.9%) in patients with functional class II heart failure than in functional class III patients (57.6%). Atrial fibrillation in patients with heart failure of functional class III (33.3%) occurs approximately 1.7 times more often than in patients of functional class II (19.3%). Almost the same frequency of occurrence of episodes of sinus rhythm and atrial fibrillation were observed. Shortterm ventricular tachycardia was recorded in 2 patients of functional class III.Conclusions: In patients with metabolic syndrome, the incidence of ventricular premature beats and atrial fibrillation correlate with the functional class of heart failure, and episodes of ventricular tachycardia are also observed.

Comparative analysis of echocardiographic and electrocardiographic data of survivors and deceased patients with COVID-19 (sub-analysis of the international register “Dynamics analysis of comorbidities in SARS-CoV-2 survivors”)

Aim . To carry out comparative analysis of echocardiographic and electrocardiographic (ECG) data of survivors and deceased patients with COVID-19 (sub-analysis of the international register “Dynamics analysis of comorbidities in SARS-CoV-2 survivors”). Material and methods. The study presents the results of a sub-analysis of the international AKTIV registry, which was called AKTIV CARDIO. Data were collected from 9 medical centers in the Russian Federation. AKTIV CARDIO included 973 hospitalized patients, of which 50 patients died during hospitalization. Results . Comparative analysis of echocardiographic parameters revealed that 4 parameters differed in deceased patients compared to survivors: left ventricular ejection fraction (LVEF), right ventricular end diastolic dimension (RV EDD), right atrial (RA) short axis diameter and pulmonary artery systolic pressure (PASP). RA short axis diameter was higher in deceased patients compared with survivors (38,0 [36,0; 39,0] versus 35,0 [33,0; 38,0] mm, p=0,011). RV EDD was higher in deceased patients than in survivors (3,0 [29,0; 33,0] vs 28,0 [27,0; 32,0] mm, p=0,019). LVEF was lower in deceased patients compared with survivors (55 [52; 55] vs 60 [56; 65]%, p<0,001). PASP was higher in deceased patients compared with survivors (25 [21; 35] vs 20 [19; 25] mm Hg, p=0,006). Correlation analysis found that the largest number of correlations with markers of the infection severity was observed for RA short axis diameter and RV EDD. A comparative analysis of ECG data revealed that in deceased patients, compared with survivors, atrial fibrillation (AF) (21,4% vs 6,06%, p=0,001) and supraventricular premature beats (14,3% vs 3,36%, р=0,004) occurred more often. In addition, deceased patients had longer QTc interval (440 [416; 450] vs 400 [380; 430] ms, p<0,001). Conclusion . Comparative analysis of echocardiographic data showed that deceased patients have more pronounced right heart remodeling, higher PASP and lower LVEF. Patient survival was related to RV and RA sizes. Right heart enlargement was associated with markers of infection severity. Echocardiographic parameters characterizing the right heart side can probably be independent prognostic factors in the acute COVID-19 period.

Antiaritmički efekti novosintetisanih derivata propafenona

It is well known that the presence of different chemical groups in drug molecules influences their pharmacological properties. The aim of our study is to investigate whether newly synthesized derivatives of propafenone, with changes in benzyl moiety, have a different effect upon arrhythmia, compared to propafenone. 5OCl-PF and 5OF-PF are derivatives of propafenone with -Cl or -F substituent on the ortho position of the benzyl moiety. For verification of their antiarrhythmic effect, we used an in vivo rat model of aconitine-induced arrhythmia. 5OCl-PF speeded the appearance of supraventricular premature beats (SVPB) and death more than aconitine. All animals treated with 5OCl-PF developed ventricular premature beats in salvos (VPBS), bigeminies (VPBB) and paroxysmal ventricular tachycardia (PVT). 5OF-PF had a negative chronotropic effect and potentiated atrial excitability (more SVPB). It had a positive effect on the occurrence and onset time of supraventricular tachycardia, VPBS, and PVT. Based on the obtained results, it can be concluded that newly synthesized propafenone derivatives have no better antiarrhythmic effect than the parent compound. In the future, our research will be focused on the synthesis of different derivatives and examining their antiarrhythmic effects.

The Relationship between Hypoglycaemic Episodes and Arrhythmias in Type 2 Diabetes Subjects after Acute Myocardial Infarction with ST-Segment Elevation—A Case Series

Background and Aims: Several studies have shown that hypoglycaemia, especially a severe episode is associated with an increased mortality rate in diabetes mellitus subjects with previous cardiovascular disease or acute coronary syndrome. One of the presumed mechanisms is the proarrhythmic effect of hypoglycaemia related to the prolongation of the action potential, or the catecholamine surge that follows an episode. The aim of this case series analysis was to investigate the relationship between hypoglycaemia and glucose variability with arrhythmic events in type 2 diabetes patients who suffered an acute myocardial infarction. Materials and Methods: We selected patients admitted consecutively to the cardiology department of Clinical Emergency Hospital in Bucharest for a period of three months with acute myocardial infarction and previously diagnosed type 2 diabetes. For each patient, a retrospective continuous glucose monitoring system (CGMS) or glucose sensor (Medtronic&#174 Enlite, USA) and a dual electrocardiograph and blood pressure monitor for 24 hours were available. Also, patients had an oscillometric device (Arteriograph&#174 TensioMed Ltd) for 24 hours or non-invasive monitoring of central blood pressure, pulse wave velocity and augmentation index. The data were analysed using Medtech&#174, TensioWin&#174 and Carelink iPro&#174 softwares. We used SPSS&#174 version 20.0 (IBM) for the statistical analysis. The results are presented as median and interquartile range (IQR). Results and Discussion: Ten type 2 diabetes patients (4 males, 6 females) with anterior (4/10) and inferior acute myocardial infarction (6/10) were included. They were treated with insulin (3/10), sulphonylurea (Gliclazide) plus Metformin (4/10), Metformin monotherapy (2/10), or all three (1/10). The patients had a median age of 67.5 (3.25) years with a median disease duration of 8 (7.75) years. The median body mass index was 29.54 (5.65) kg/m2. The median HbA1c was 7.9% (3.15) % and C-peptide 3.3 (2.66) ng/ml. There were no significant differences regarding the number of atrial or ventricular premature beats, ventricular or atrial tachycardia or fibrillation, the duration of QT interval, systolic and diastolic blood pressure, aortic pressure, augmentation index, pulse wave velocity between subjects with hypoglycaemia and those without. There was a negative correlation between QTc and glucose values in patients with hypoglycaemia (Spearman coefficient correlation r = -0.232; p Conclusion: Mild hypoglycaemia in type 2 diabetes patients with systolic dysfunction after ST-elevated myocardial infarction did not increase the number of supraventricular premature beats and QTc duration. We suggest that non-severe hypoglycaemia does not increase the risk of arrhythmias in patients with type 2 diabetes.

Cardiovascular toxicity of antitumor therapy: effect on myocardial and vascular remodeling

Aim. To study the effect of multiagent chemotherapy on structural and functional vascular, electrophysiological parameters and cardiac hemodynamics in patients with stomach cancer.Material and methods. The study included 3 groups of 25 people: healthy volunteers, those with established cardiac disease (hypertension + coronary artery disease), gastric adenocarcinoma (fluoropyrimidine/platinum-based chemotherapy). Cancer patients before and after chemotherapy courses underwent non-invasive assessment of vascular wall and endothelial dysfunction (videocapillaroscopy, digital photoplethysmography), as well as electrocardiography and echocardiography. Healthy volunteers and cardiac patients were examined once.Results. In cancer patients, even before chemotherapy courses, endothelial dysfunction (ED) (occlusal index, 1,7 (1,4; 1,9), normal values >1,8) and structural vascular disorders (stiffness index, 8,9 m/s (7,7; 9,7), normal values <8 m/s; refractive index, 32,4% (27,5; 37,7), normal values <30%). All above-mentioned parameters significantly worsened after multiagent chemotherapy (progression of ED and vascular wall remodeling: occlusal index, 1,3 (1,2; 1,5) (p<0,0002); stiffness index, 10,3 m/s (9,5; 11,2) (p<0,0001); reflection index, 40,2% (35,5; 43,6) (p<0,001) Decrease in left ventricular ejection fraction and diastolic function was detected. The number of supraventricular and ventricular premature beats during chemotherapy increased 9 and 10 times, respectively (p<0,05).Conclusion. The study for the first time assessed the effect of multiagent chemotherapy on ED, vascular stiffness and cardiac hemodynamics in patients with gastric cancer. A significant aggravation of all endothelial function parameters after treatment has been proven, which requires further study in order to develop criteria for early cardiovascular toxicity.

Significance of Ectopic Beats in Post Aortic Valve Replacement Arrhythmia Patients

Objective: The incidence of new onset arrhythmia after conventional aortic valve replacement (AVR) is relatively high whereby atrial fibrillation (AF) in particular (30-40%). Arrhythmias increase postoperative morbidity, mortality and consequently health costs. The need for a reliable method for early detection and discrimination between low and high risk patients is therefore indispensable. For this reason this study examined the possible correlation between electrophysiological abnormalities on continuous ECG recordings and the initiation of arrhythmia directly after surgery. Methods and Results: Both ECG and clinical data was collected from the hospitals filing system for all patient (n=107) who underwent surgical Aortic Valve Replacement (AVR) for non-rheumatic aortic valve stenosis or insufficiency for the period from January 2010 to December 2018. Continuous ECG data was converted into ISHNE-format and analyzed by using Synescope™ software. Data showed that one minute prior to arrhythmia, AF in particular, an increase of both supraventricular premature beats (SVPB) and missed beats (MB) was detected (n=33; P<0,05). However there was no correlation between arrhythmia and the overall SVPB incidence (n=33). Twenty-one out of 33 AVR patients developed a de novo intraventricular conductance delay directly after cardioplegic arrest, which persisted in 7 cases. Conclusions: Although there is an increase of both SVPB and MB prior to arrhythmia startup, it is still questionable what is the true predictive value of these findings are. Additionally it appeared that a temporarily intraventricular conduction delay (IVCD) is a common finding after AVR.

Assessment of ECG during hybrid comprehensive telerehabilitation in heart failure patients – subanalysis of the TELEREHabilitation in heart failure patients – TELEREH-HF randomized clinical trial

Abstract Background Exercise training in heart failure (HF) patients (pts) should be monitored to ensure patients safety. That is why we use ECG telemonitoring during hybrid comprehensive telerehabilitation (HCTR). Purpose Assessment of frequency of cardiac arrhythmias during telerehabilitation in HF patients. Methods The present analysis formed part of TELEREH-HF multicenter, randomized (1:1), controlled trial that enrolled 850 HF pts with New York Heart Association class I, II, or III and left ventricular ejection fraction (LVEF) of 40% or less. Patients were randomized 1:1 to 9 week HCTR plus usual care or usual care only. This subanalysis focuses on 386 pts (aged 62±11 years, LVEF 31±7%) randomized to HCTR based on Nordic walking training 5 times/week. HCTR was tele-monitored with an EHO mini device adjusted to record 16-second fragments of ECG (from three precordial leads) and to transmit the data via mobile phone network to the monitoring center. The timing of automatic ECG recording were pre-set and coordinated with exercise training. Results In all, 16622 HCTR sessions were registered and 66488 ECGs transmitted fragments were evaluated (four 16-second recording per patient per one session were recorded). A sinus rhythm was present in 320 (83%) pts, permanent atrial fibrillation in 66 (17%) pts. Assessment of ECG during HCTR procedure is presented in Table 1. Conclusions Telerehabilitation in heart failure patients is safe without evidence for symptomatic cardiac arrhythmias requiring discontinuation of training. Non-sustained ventricular tachycardia and paroxysmal atrial fibrillation episodes were rare but have required adjustment of the telerehabilitation regimen. The most common arrhythmias were ventricular and supraventricular premature beats. These arrhythmias did not result in any changes in rehabilitation and therapy regimens. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): The National Centre for Research and Development, Warsaw, Poland.

Predicting atrial fibrillation after cryptogenic stroke via a clinical risk score-a prospective observational study.

Background and purposeAtrial fibrillation (AF) often remains undiagnosed in cryptogenic stroke (CS), mostly because of limited availability of cardiac long‐term rhythm monitoring. There is an unmet need for a pre‐selection of CS patients benefitting from such work‐up. A clinical risk score was therefore developed for the prediction of AF after CS and its performance was evaluated over 1 year of follow‐up.MethodsOur proposed risk score ranges from 0 to 16 points and comprises variables known to be associated with occult AF in CS patients including age, N‐terminal pro‐brain natriuretic peptide, electrocardiographic and echocardiographic features (supraventricular premature beats, atrial runs, atrial enlargement, left ventricular ejection fraction) and brain imaging markers (multi‐territory/prior cortical infarction). All CS patients admitted to our Stroke Unit between March 2018 and August 2019 were prospectively followed for AF detection over 1 year after discharge.ResultsDuring the 1‐year follow‐up, 24 (16%) out of 150 CS patients with AF (detected via electrocardiogram controls, n = 18; loop recorder monitoring, n = 6) were diagnosed. Our predefined AF Risk Score (cutoff ≥4 points; highest Youden's index) had a sensitivity of 92% and a specificity of 67% for 1‐year prediction of AF. Notably, only two CS patients with <4 score points were diagnosed with AF later on (negative predictive value 98%).ConclusionsA clinical risk score for 1‐year prediction of AF in CS with high sensitivity, reasonable specificity and excellent negative predictive value is presented. Generalizability of our score needs to be tested in external cohorts with continuous cardiac rhythm monitoring.

Premature beats detection based on a novel convolutional neural network

Objective. Automatic detection of premature beats on long electrocardiogram (ECG) recordings is of great significance for clinical diagnosis. In this paper, we propose a novel deep learning model, the ECGDet, to detect premature beats, including premature ventricular contractions (PVCs) and supraventricular premature beats (SPBs) on single-lead long-term ECGs. Approach. The ECGDet is proposed based on a convolutional neural network and squeeze-and-excitation network. It outputs the probabilities that the ECG samples belong to a premature contraction. Non-max suppression was used to select the most appropriate locations for the premature beats. The ECGDet was trained and tested on the MIT-BIH arrhythmia database (MITDB) using a five-fold cross-validation approach. A novel loss calculation method was introduced in the model training process. Then it was tuned and further tested on the China Physiological Signal Challenge (2020) database (CPSCDB). Main results. The results showed that the average F1 value of PVC detection was 92.6%, while that of SPB detection was 72.2% on MITDB. The ECGDet bagged the 2nd place for PVC detection and ranked 7th place of SPB detection in the China Physiological Signal Challenge (2020). Significance. The proposed ECGDet can automatically detect premature heartbeats without manually extracting the features. This technique can be used for long-term ECG signal analysis and has potential for clinical applications.

A prospective study on the consequences of SARS-CoV-2 infection on the heart of young adult competitive athletes: Implications for a safe return-to-play

ObjectivesThe COVID-19 pandemic has shocked the sports world because of the suspension of competitions and the spread of SARS-CoV-2 among athletes. After SARS-CoV-2 infection, cardio-pulmonary complications can occur and, before the resumption of sports competitions, a screening has been recommended. However, few data are available and discrepancies exist in the screening modalities. We conducted this prospective study to investigate the incidence of cardiovascular consequences following SARS-CoV-2 infection in young adult competitive athletes and the appropriate screening strategies for a safe return-to-play. MethodsNinety competitive athletes (24 ± 10 years) after asymptomatic or mildly symptomatic SARS-CoV-2 infection were screened by physical examination, blood testing, spirometry, 12‑lead resting ECG, 24-h ambulatory ECG monitoring, echocardiogram, and cardiopulmonary exercise testing (CPET). ResultsSixty-four athletes (71.1%) were male, and most (76.7%) were mildly symptomatic. After SARS-CoV-2 infection, spirometry and resting ECG were normal in all athletes. Ambulatory ECG monitoring demonstrated <50/24 h supraventricular and ventricular premature beats in 53.3% and 52.2% of athletes, respectively, in the absence of malignant arrhythmias. CPET did not demonstrate cardiopulmonary limitations. Echocardiography showed pericardial effusion in 3 athletes (all females) with symptomatic SARS-CoV-2 infection (3.3%; 4.4% in the symptomatic group) with a definitive diagnosis of myopericarditis in 1 athlete (1.1%) and pericarditis in 2 athletes (2.2%). ConclusionsCardiac consequences of SARS-CoV-2 infection were found in 3.3% of competitive athletes. An appropriate screening primarily based on the detection of uncommon arrhythmias and cardiac symptoms should be recommended in competitive athletes after SARS-CoV-2 infection to detect a cardiac involvement and guarantee a safe return-to-play.

Instrumental markers of frequent symptomatic atrial fibrillation in patients with arterial hypertension

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Great attention of researchers is focused on the study of the features of electrical and structural remodeling of the heart in patients with atrial fibrillation (AF) and arterial hypertension (AH). Holter monitoring of the electrocardiogram (HM ECG) and echocardiography are used as methods for evaluating these changes. Objectives to determine instrumental markers of frequent symptomatic AF in patients with AH. Methods 146 patients with AH stage II with AF (males 68 (46.6%)) and 26 patients with AH stage II (males 11 (42.3%)) were examined in Vinnitsa regional center of cardiovascular pathology. Mean age of patients with AH and AF was (61.2 ± 0.7) years and in group with AH (59.3 ± 2.2) years. The duration of AF was (5,7 ± 0,5) years. The frequency of AF attacks was (23,6 ± 1,2) days. Paroxysmal AF was in 56 (38.4%) patients and persistent AF was in 90 (61.6%) patients. 31 (21.2%) patients have vagal, 70 (47.9%) patients have adrenal and 45 (30.9%) patients have mixed variant of AF (by Coumel). All patients underwent HM ECG and transthoracic echocardiography according to the standard protocol. Results ECG markers of frequent symptomatic AF are: amount of frequent supraventricular premature beats (SPB) (2198 vs 24, p &amp;lt; 0,0001), including paired and group SPBs (83,3% vs 0, p &amp;lt; 0,0001), presence of short asymptomatic episodes supraventricular paroxysmal tachycardia (SVPT)(33,3% vs 0, p &amp;lt; 0,0001) or AF (41,1% vs 0, p &amp;lt; 0,0001), increasing dispersion of QT interval (90 vs 70, p = 0,03) and decreasing dispersion ratio PQ/QT (0,50 vs 0,73, p = 0,03). Using the method of multiple linear regression, we determined the most informative combination of these markers: presence of SPBs more than 330 episodes/day + presence of pair and group SPBs and + presence of asymptomatic episodes of SVPT/AF (R = 0,52, p = 0,00002). Hemodynamic markers of frequent symptomatic AF are: significant increasing of absolute and relative indices of size/volume of left atrium (LA) (p &amp;lt; 0,0001), increasing of LA/right atrium (1,12 vs 0,92, p &amp;lt; 0,0001) and LA volume (LAV)/left ventricular myocardial mass (LVMM) (0,27 vs 0,21, p &amp;lt; 0,0001), decreasing Ve/Va (0,82, vs 0,92, p = 0,01) and isovolumic relaxation time (IVRT)(88 vs 97, p = 0,01); mitral (72,2% vs 46,2%, p = 0,01) and tricuspid (48% vs 23,1%, p = 0,02) regurgitation. Using the method of multiple linear regression, the most informative combination of these markers is: the ratio of LAV/LVMM &amp;gt; 0.23 ml/g + LA&amp;gt; 40 mm + presence of mitral regurgitation (R = 0,49, p = 0,00009). Conclusions As the most informative ECG markers of frequent symptomatic AF in patients with AH is combination of frequent SPBs (&amp;gt; 330 episodes/day) with pair and group SPBs and asymptomatic episodes SVPT/AF (R = 0,52, p = 0.00002 ), while echocardiography combination of markers is ratio of LAV/LVMM &amp;gt; 0.23 ml/g + LA&amp;gt; 40 mm + presence of mitral regurgitation (R = 0.49, p = 0.00009).

Anticardiac antibodies in patients with severe and moderate COVID-19 (correlations with the clinical performance and prognosis)

The level and significance of anticardiac antibodies (ACA) in patients with COVID-19 infection have not yet been studied.Aim. To assess the level of various ACA in patients with severe and moderate COVID-19 infection and to identify the correlation of antibody profile with the clinical performance and prognosis.Material and methods. The study included 86 (38 women and 48 men) patients aged 20-90 years (60,2±16,6 years) who were hospitalized for moderate and severe COVID-19 infection in April-June 2020. Nasopharyngeal swab confirmed the disease in 59,3% of patients. In addition to the standard examination, electrocardiography and chest scan, level of antinuclear antibodies (ANA), antiendothelial cell antibodies (AECA), anti-cardiomyocyte antibodies, antibodies to anti-smooth muscles (ASMA) and cardiac conduction system fibers. Echocardiography was performed in 17 patients. Mean length of stay was 14 [12; 18] days. Death was considered as the primary endpoint.Results. Prevalence of heart disease and symptoms (including hypertension and coronary artery disease) was 45,3%. The manifestations of coronavirus heart damage include arrhythmias (supraventricular premature beats, 3,6%; atrial fibrillation, 9,3%), heart failure (9,3%), low QRS voltage (11,4%), repolarization abnormalities (41,9%), pericardial effusion (30%). An increase in troponin levels was observed in low number of patients. All types of cardiovascular disease correlated with the maximum D-dimer level (AUC, 0,752, p&lt;0,01). Titers of two or more types of ACA were increased by 3 or more times in 25 (73,5%) patients. Significant (p&lt;0,05) correlations of ANA level with cardiovascular symptoms/diseases in general (r=0,459), anti-cardiomyocyte antibodies — with the prevalence of pneumonia (r=0,472), shortness of breath severity (r=0,370), respiratory failure (r=0,387), oxygen therapy (r=0,388) and mechanical ventilation (r=0,469), as well as the presence of chest pain (r=0,374), QRS voltage decrease (r=0,415), maximum level of CRP (r=0,360) and LDH (r=0,360). ANA and anti-cardiomyocyte antibody levels strongly correlated with pericardial effusion (r=0,721 and r=0,745, respectively, p&lt;0,05). The mortality rate was 9,3%. Heart failure was one of the death causes in 37,5%. The level of anti-cardiomyocyte antibodies and ASMA correlated with mortality (r=0,363, and r=0,426, p&lt;0,05) and had a predictive value. Mortality in patients with cardiovascular disease was 17,9%, without — 2,2% (p&lt;0,05). The most powerful predictive model for COVID-19 adverse outcomes includes age, diabetes, oxygen therapy extent, maximum leukocyte, C-reactive protein and D-dimer levels. However, a model that includes only age, diabetes, and cardiovascular disease also has sufficient predictive power (correlation coefficient, 0,568, p&lt;0,001).Conclusion. An increase in ACA titers was detected in 73,5% of patients, correlated with mortality, in most cases reflects the general activity and severity of the disease and can be regarded as part of response in COVID-19. At the same time, a direct correlation with signs of myocardial damage, the presence and volume of pericardial effusion confirms the direct role of ACA in the development of myopericarditis.