The utility of implantable loop recorders (ILR) in patient management: an age and indication stratified study in the outpatient-implant era

2021 ◽  
Author(s):  
Mihir M Sanghvi ◽  
Daniel M Jones ◽  
Jeremy Kalindjian ◽  
Christopher Monkhouse ◽  
Rui Providencia ◽  
...  
Keyword(s):  
Cryptogenic Stroke ◽  
Cardiac Monitoring ◽  
Management Decision ◽  
Device Implantation ◽  
History Of ◽  
Recorded Data ◽  
Implantable Loop Recorders ◽  
Age Range ◽  
Made In

Abstract Introduction Implantable loop recorders (ILR) are now routinely implanted for long-term cardiac monitoring in the clinic setting. This study examined the real-world performance of these devices, focusing on the management decision changes made in response to ILR-recorded data. Methods and Results This was a single centre, prospective observational study of consecutive patients undergoing ILR implantation. All patients who underwent implantation of a Medtronic Reveal LINQ device from September 2017 to June 2019 at Barts Heart Centre were included. 501 patients were included. 302 (60%) patients underwent ILR implantation for an indication of pre-syncope/syncope, 96 (19%) for palpitations, 72 (14%) for atrial fibrillation (AF) detection with a history of cryptogenic stroke and 31 (6%) for patients deemed to be high risk of serious cardiac arrhythmia. The primary outcome of this study was that an ILR-derived diagnosis altered management in 110 (22%) of patients. Secondary outcomes concerned sub-group analyses by indication: in patients who presented with syncope/presyncope, a change in management resulting from ILR data was positively associated with age (HR: 1.04 [95%CI 1.02–1.06]; p < 0.001) and negatively associated with a normal ECG at baseline (HR 0.54 [0.31–0.93]; p = 0.03). Few patients (1/57, 2%) aged < 40 years in this group underwent device implantation, compared to 19/62 patients (31%) aged 75 years and over (p = 0.0024). 22/183 (12%) of patients in the 40–74 age range had a device implanted. In patients who underwent ILR insertion following cryptogenic stroke, 13/72 patients (18%) had AF detected leading to a decision to commence anticoagulation. Conclusion These results inform the utility of ILR in the clinical setting. Diagnoses provided by ILR that lead to changes in management are rare in patients under age 40, particularly following syncope, presyncope or palpitations. In older patients new diagnoses are frequently made and trigger important changes in treatment.

scholarly journals Predictors of Occult Paroxysmal Atrial Fibrillation in Cryptogenic Strokes Detected by Long-Term Noninvasive Cardiac Monitoring

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Archit Bhatt ◽  
Arshad Majid ◽  
Anmar Razak ◽  
Mounzer Kassab ◽  
Syed Hussain ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Paroxysmal Atrial Fibrillation ◽  
Cryptogenic Stroke ◽  
Cardiac Monitoring ◽  
High Signal ◽  
Detection Rates ◽  
Non Invasive ◽  
Patient Reported ◽  
Premature Beats

Background and Purpose. Paroxysmal Atrial fibrillation/Flutter (PAF) detection rates in cryptogenic strokes have been variable. We sought to determine the percentage of patients with cryptogenic stroke who had PAF on prolonged non-invasive cardiac monitoring.Methods and Results. Sixty-two consecutive patients with stroke and TIA in a single center with a mean age of 61 (+/− 14) years were analyzed. PAF was detected in 15 (24%) patients. Only one patient reported symptoms of shortness of breath during the episode of PAF while on monitoring, and 71 (97%) of these 73 episodes were asymptomatic. A regression analysis revealed that the presence of PVCs (ventricular premature beats) lasting more than 2 minutes (OR 6.3, 95% CI, 1.11–18.92;P=.042) and strokes (high signal on Diffusion Weighted Imaging) (OR 4.3, 95% CI, 5–36.3;P=.041) predicted PAF. Patients with multiple DWI signals were more likely than solitary signals to have PAF (OR 11.1, 95% CI, 2.5–48.5,P<.01).Conclusion. Occult PAF is common in cryptogenic strokes, and is often asymptomatic. Our data suggests that up to one in five patients with suspected cryptogenic strokes and TIAs have PAF, especially if they have PVCs and multiple high DWI signals on MRI.

P087 Polyarteritis nodosa: a case report

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_5) ◽  
Author(s):  
A Azirar ◽  
A Ghannam ◽  
A Elaouli ◽  
M Rkain ◽  
N Benaajiba ◽  
...  
Keyword(s):  
Polyarteritis Nodosa ◽  
Skin Lesions ◽  
Lower Limbs ◽  
Periarteritis Nodosa ◽  
Minimal Effective Dose ◽  
First Child ◽  
History Of ◽  
Inflammatory Syndrome ◽  
Made In

Abstract Background Polyarteritis nodosa is a necrotizing vasculitis of small and medium caliber arteries. Rarely described in children, its pathophysiology is complex and remains poorly elucidated. Two main forms were described in the literature: cutaneous and visceral. Material and results We report the cases of two boys, aged of 7 and 11 years old. They had a history of recurrent sore throat with a recurrent aphthosis in the 11-year-old child. Both boys presented with polyarthralgias, myalgias, polymorphous skin lesions made of livedo reticularis with subcutaneous nodosa on the lower limbs in the first child and distal necrosis of the toes with oedema of the lower limbs in the second. Patients suffered also of cough evolving in a context of alteration of the general state made of fever and asthenia. A biological inflammatory syndrome was present in both children and the skin histology confirmed periarteritis nodosa. The evolution was marked by the disappearance of arthralgias and myalgias after a corticosteroid-based treatment with progressive dose reduction until minimal effective dose. Conclusion The diagnosis of Polyarteritis nodosa should be made in any child presenting with the following signs: fever, altered general condition, myalgias, arthralgias and skin manifestations. The prognosis is usually benign but long-term surveillance is necessary.

scholarly journals 30 Years Trend of Competitive Balance in Turkish Football Super League

2017 ◽  
Vol 6 (1) ◽  
pp. 63 ◽  
Author(s):  
Tuğbay Inan
Keyword(s):  
Competitive Balance ◽  
Media Effect ◽  
Balance Analysis ◽  
History Of ◽  
Income Sharing ◽  
Balance Factor ◽  
Score Table ◽  
Made In ◽  
Super League

We must point out that the results of football games affect the competitive balance degree. In other words, the calculations we made in the score table at the end of the season give us a degree of competitive balance. The degree on which the concept of competitiveness is based is cited as competitive balance in football. Sports economics can be defined as the degree to which overall league attendances are raised by such measures as media effect, home advantage, income sharing, all of which aim to strengthen the competitive balance. The aim of this study was to gauge the competitive balance in Turkish football league. Using long term competitive balance analysis, some of the matters encountered and possible precautions to be taken were approached in a way that can discuss the mentioned subjects throughout the 1987-2017 seasons in Turkish Football Super League (TSL). The present study examined the way that competitive balance level followed in the history of super league (30 years). For this purpose, C5 Competitive Balance Index (C5CBI) and a Herfindahl index of competitive balance (HICB) were benefited. Finally, competitive balance factor was observed to have occured time to time; however, when looked in terms of total, a view apart from competitive balance can be clearly seen.

scholarly journals The presence of symptons and symptom-rhythm correlation in patients with Implantable loop recorders

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
ML Goncalves ◽  
MARIA Goncalves ◽  
INÊS Pires ◽  
JOÃO Santos ◽  
JOANA Correia ◽  
...  
Keyword(s):  
Previous History ◽  
Heart Rhythm ◽  
Coronary Intervention ◽  
Ventricular Rate ◽  
Presenting Symptoms ◽  
Device Implantation ◽  
History Of ◽  
Implantable Loop Recorders ◽  
Diagnostic Outcome

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION Implantable loop recorders (ILR) are a powerful diagnostic tool for heart rhythm diseases, and particularly useful when symptoms are infrequent or when long-term data are required. The main indication is for study of syncope/presyncope due to suspected cardioinhibitory etiology. OBJECTIVE To evaluate the diagnostic profitability of ILR in patient (P) with syncope/ presyncope and to evaluate the effect of symptons on follow-up. METHODS Included P undergoing ILR implantation in 6 consecutive years, to study syncope/presyncope. Information was collected on P characteristics, indication, diagnostic outcome and subsequent management and complications. A follow-up (FU) of 1 year and 3 years were done. Diagnostic outcome was based in symptom-rhythm correlation. Symptons and correlation to ECG during the FU and management after the diagnosis were assessed. RESULTS 99 P were selected. Evaluation of syncope in 91.9% (n = 91) and presyncope in 8.1% (n = 8). 54.5% female, median age 59.4 ± 17.4 years. 55.8% (n = 53) completed the 3 years FU and 84.2% (n = 80) completed the 1 year FU. Death occurred in 4% (n = 4) during the FU. ILR results led to device implantation in 35% of the P (22 pacemakers and 1 ICD) in 1 year FU, with a median time to implantation of 11.6 months after ILR, and the majority of ILR motivated by syncope (87%). If we consider only P that finished the 3 years of FU, in 47.2% P were implanted a device. The most common arrhythmic finding were AV block (47.8%), followed by sinus pauses / asystole (43.5%), AF with slow ventricular rate (4.3%) and VT (4.3%). 4.9% of P experienced a complication related to the device (2 infection and 3 non-infectious pain), that resulted in explantation. 60.9% of the P were symptomatic during the FU, with 24.1% achieving symptom-rhythm correlation and 36.8% who did not. Device implantation was associated with the presence of symptons in FU (82.6% vs 17.4%, p = 0.012) and symptom-rhythm correlation (95% vs 5%,p = 0.001). 38.7% (n = 27) of the P finished the 3 years of FU without a diagnostic outcome or detectable event, with 44.4% being assymptomatic and 55.6% presenting symptoms without ECG correlation. Compared to the P that implanted a device, this type of P was frequently of female sex (57.6% vs 30.4%, p = 0.045), younger age (54.8 ± 18.1 vs 65.8 ± 12.8 years, p = 0.014), with less cardiovascular risk factors like dyslipidemia (37.0% vs 78.3%, p = 0.003) and arterial hypertension (48.1% vs 73.9%, p = 0.05), AF (0% vs 19%, p = 0.025), previous history of myocardial infarction and percutaneous coronary intervention (3.2% vs 17.4%, p = 0.05; 3.0% vs 21.7%, p = 0.028) and more frequently with history of depression (51.9% vs 22.7%, p = 0.037). CONCLUSION In this study, ILR monitoring led to a device implantation in 47.2% of the P that finished the 3 years FU. The presence of symptons and symptom-rhythm correlation during FU was associated with device implantation.

scholarly journals Boris Valkh and the development of zoology and museology in the East of Ukraine

2018 ◽  
Keyword(s):  
20Th Century ◽  
Plant Protection ◽  
Type Locality ◽  
Main Attention ◽  
The Family ◽  
History Of ◽  
The One ◽  
Ancient Maps ◽  
Made In

The details of biography and scientific works of Boris Valkh (1876–1942), one of the leading zoologists who worked in eastern Ukraine in the first half of the 20th century, were analysed. Boris Valkh worked at the interface of zoology, plant protection, and epidemiology and he was a leading specialist in controlling the abundance of economically important groups of rodents and insects (plant protection stations) and an epidemiologist (studying zoonoses). At the same time, he was a nature protector, one of the key organizers of nature reserves in the southeast of Ukraine (Kamiani Mohyly, Bilosaraiska Kosa). The main attention in this review is paid to Valkh's research into zoology (ornithology, entomology, and theriology), and his work upon creation of zoological collections, including the one in the Bakhmut Museum of Local Lore, which was organized with his participation. All of these developments made by the scientist are considered along with details of his biography analysed using family archives and by conversations with Valkh’s descendents, including his grandson Boris Valkh, granddaughter Olympiada Gryshchenko, and great-grandson Sergei Valkh. Significant clarifications and important additions to the biography of Boris Valkh have been made, in particular regarding his education (once in Pavlohrad Gymnasium and twice in Kharkiv University), wife and children, as well as his long-term trips to Turkestan and Azerbaijan. The location of "Hory-Mohyly hamlet", from which most of the zoological samples collected by the Valkhs are derived, is clarified and determined as the same place that was marked on ancient maps as "Horemohylove" The history of the species Mus sergii described by Boris Valkh and its type locality were analysed. The information about the history of accumulation and further fate of his and his son Sergey’s zoological collections including mammal specimens from Hory-Mohyly is summarized. Unique original photographs from the family archives have been used, for most of which the dates and places of taking were determined. Pictures of collections and original zoological labels are also presented.

Abstract WP255: Can Normal Electrocardiogram Rule Out Newly Diagnosed Atrial Fibrillation in Ischemic Stroke Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Joshua Santucci ◽  
Takashi Shimoyama ◽  
Ken Uchino
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cryptogenic Stroke ◽  
Cardiac Monitoring ◽  
Large Artery ◽  
Newly Diagnosed ◽  
Stroke Patients ◽  
Stroke Subtype ◽  
History Of

Introduction: Electrocardiogram (ECG) findings of premature atrial contraction and prolonged PR interval are associated with risk of onset atrial fibrillation (AF) in cryptogenic stroke. We sought to see if normal ECG and AF incidence is incompletely understood. Methods: From a prospective single-hospital stroke registry from 2018, we identified ischemic stroke patients who had ECG done on admission for review. We excluded patients with AF on admission ECG, history of AF, and implanted device with cardiac monitoring capability. Normal ECG was interpreted based on the standardized reporting guidelines for ECG studies evaluating risk stratification of emergency department patients. Stroke subtype was diagnosed according to the TOAST classification: large artery atherosclerosis (LAA), small vessel occlusion (SVO), cardioembolism, others/undetermined and embolic stoke of undetermined source (ESUS) criteria. We compared the incidence of newly diagnosed AF during hospitalization and from outpatient cardiac event monitoring between normal and abnormal ECG. Results: Of the 558 consecutive acute ischemic stroke patients, we excluded 135 with AF on admission ECG or history of AF and 9 with implanted devices. Of the remaining 414 patients that were included in the study, ESUS (31.2%) was the most frequent stroke subtype, followed by LAA (30.0%), SVO (14.0%), others/undetermined (15.7%), and cardioembolism (9.2%). Normal ECG was observed in 125 patients (30.2%). Cardioembolic subtype was less frequent in the normal versus abnormal ECG group (1.6% vs. 12.5%, p<0.001). New AF was detected in 17/414 patients (4.1%) during hospitalization. Of these 17 patients, none had normal ECG (0/125) and all had abnormal ECG (17/289, 5.9%) (p=0.002). After discharge, of 111 patients undergoing 4-week outpatient cardiac monitoring, new AF was detected in 16 (14.4%). Of these 16 patients, only 1 had a normal ECG (1/35, 2.9%) while 15 had abnormal ECG (15/76, 19.7%) (p=0.02). Conclusions: Normal ECG at admission for acute ischemic stroke is associated with low likelihood of detection of new atrial fibrillation in either the inpatient or outpatient setting.

Population estimates of emperor penguins at Amanda Bay, Ingrid Christensen Coast, Antarctica

Polar Record ◽  
2009 ◽  
Vol 45 (3) ◽  
pp. 207-214 ◽  
Author(s):  
Barbara Wienecke ◽  
Peter Pedersen
Keyword(s):  
Breeding Population ◽  
Emperor Penguin ◽  
Emperor Penguins ◽  
History Of ◽  
Penguin Colony ◽  
Antarctic Treaty ◽  
To Receive ◽  
Made In

ABSTRACTIn 2008, the emperor penguin Aptenodytes forsteri colony at Amanda Bay, East Antarctica, was designated an Antarctic Specially Protected Area by the 31st Antarctic Treaty Consultative Meeting in Kyiv, Ukraine. It is only the third emperor penguin colony in the Australian Antarctic Territory to receive this status. The colony has been known to exist since 1956 and numerous visits have been made to it, especially by personnel from Australia's Davis station. On a number of occasions, attempts were made to estimate the number of birds in the colony in order to obtain an insight into the size of the breeding population. Here we report on the history of visitation to the colony since the 1950s and examine the quality of information collected with regard to the usefulness of this information in terms of population analyses. We also report the results of the first visit to the Amanda Bay colony made in winter with the specific purpose of estimating the number of birds present and of highlighting the need for long term monitoring programmes to assess the viability of emperor penguins in future.

Abstract 14083: Implantable Loop Recorders Change Management in Patients With Cryptogenic Stroke With or Without Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Danni Fu ◽  
Richard Jones ◽  
Xing Dai ◽  
Michael Wu ◽  
Tina Burton
Keyword(s):  
Atrial Fibrillation ◽  
Rhode Island ◽  
Clinical Management ◽  
Cryptogenic Stroke ◽  
Cardiac Risk ◽  
Structural Features ◽  
Battery Life ◽  
Single Center Study ◽  
Implantable Loop Recorders

Introduction: Implantable loop recorders (ILR) are widely used for long term arrhythmia monitoring in patients with cryptogenic stroke (CS). Single center study has shown that some patients with incidental arrhythmias found by ILR, aside from atrial fibrillation (AF), resulted in changes in clinical management. Unfortunately, a large portion of the patients had premature ILR explantation before the end of battery life and other studies on incidental arrhythmias are limited. Hypothesis: We sought to determine the rate of occurrence of incidental arrhythmias other than AF on ILR monitoring among patients with CS and to characterize the rate of these incidental arrhythmias that result in a change in clinical management. Methods: All adult patients with ILR for CS at Rhode Island Hospital between 1/2015-1/2019 were included. Demographics, cardiac risk factors and structural features, and ILR tracings were reviewed. Results: Three hundred and twelve patients were identified with a median follow up time of 27.9 months (IQR 18.5-35.8 months). Incidental arrhythmias were identified in 110 patients (35.2%) with a median of 7.8 months (IQR 4.4-16.2 months) at a rate of 20.1 per 100 person-years. AF was detected in 51 patients (16.3%) with a median of 3.9 months (IQR 1.3-12.3 months). Eighteen patients had both AF and incidental arrhythmias and incidental arrhythmias were found after AF in 8 of those patients. Premature explantation occurred in 9.3% of patients with the most common reason being patient preference. Twelve patients with incidental arrhythmias (10.9%) had a resultant change in management; 9 with procedural interventions and 3 with medication adjustments. Overall, the rate of actionable incidental arrhythmias is 2.2 per 100 person-years. Conclusions: Other than AF detection, long term EKG monitoring in patients with CS with ILR allows for detection of other arrhythmias. These incidental findings can result in changes in management and potentially favorable clinical outcomes.

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