scholarly journals Incidence and type of arrhythmias recorded by one-month continuous ECG monitoring in stroke patients

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
S Castrejon Castrejon ◽  
G Ruiz-Ares ◽  
M Martinez Cossiani ◽  
R Rigual ◽  
R Gutierrez Zuniga ◽  
...  
Keyword(s):  
Cryptogenic Stroke ◽  
Paroxysmal Supraventricular Tachycardia ◽  
Av Block ◽  
Ecg Monitoring ◽  
Recording Time ◽  
Non Invasive ◽  
Funding Sources ◽  
Ectopic Beats ◽  
Sinus Dysfunction

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND The incidence of atrial fibrillation (AF) following stroke has been studied with implantable loop recorders.  However, these devices do not record short lasting AF episodes (<30-120 seconds [s]). In addition, the incidence and type of other clinically relevant arrhythmias is poorly understood in this clinical setting. PURPOSE To evaluate the incidence, type and clinical relevance of arrhythmias detected by one-month continuous ECG monitoring in patients after cryptogenic stroke. MATERIAL AND METHODS Consecutive patients (p) with stroke and no previous AF or other cardioembolic or atheroembolic causes were prospectively enrolled in the study. An external wearable 2-lead ECG monitoring system (NUUBO) was used for 30 days (d) in all of them after the acute phase of the stroke. In the absence of documented AF, a parafibrillatory status was defined as >3000 atrial ectopic beats/d or >2 "micro AF" episodes (fibrillatory burst <30 s)/d or ≥1 episode of "micro AF" >14 s. RESULTS 130 p. were included in the study (age 73 ± 12, 57% males, 19% previous stroke, 7% ischemic cardiopathy, CHA2DSVA2Sc pre-stroke 3.1 ± 1.7).  3 were withdrawn from the study due to inadequate use (recording time <14 d) and 1 due to stroke during SARS-CoV2 infection. Total recording time was 28 ± 3 d, total analyzable ECG time was 23 ± 5 d. ECG monitoring was repeated in 12 (9.5%) p due to poor ECG quality in 6 p or high suspicion of AF despite an initial negative result in 6 p.  AF >30 s was detected in a total of 27 (21.4%) p, average AF duration was 52 hours (range 30 s-22 d). AF >30s was detected in 2 (17%) p with repeated monitoring. All these patients were placed on anticoagulation. Sustained paroxysmal supraventricular tachycardia (SVT) was documented in 4 (4.4%) p without AF. All episodes of AF and SVT were asymptomatic. Mobitz I second degree AV block in 4 (3.2%) p. 3 (2.4%) p had a pacemaker implanted: 2 for severe sinus dysfunction and 1 for AV block. High-density ventricular ectopy (>3000/d) was present in 7 (6%) p and ≥1 episode of non-sustained ventricular tachycardia was detected in 26 (21%) p. A parafibrillatory status was identified in 27 (21%) p with no AF >30 s. At 1-year follow up 4/22 (18%) of patients with parafibrillatory status and 3/59 (5%) without parafibrillatory status suffered a new stroke (p = 0.08). CONCLUSIONS AF and other potentially relevant arrhythmias are frequent after stroke and easily detectable with one-month non-invasive continuous ECG monitoring. Patients with a parafibrillatory status could benefit from longer monitoring time to detect AF.

scholarly journals Implantable loop recorder follow-up

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
J Pena Mellado ◽  
R Macias ◽  
L Tercedor ◽  
M Alvarez Lopez
Keyword(s):  
Head Trauma ◽  
Type I ◽  
Av Block ◽  
Implantable Loop Recorder ◽  
Ecg Monitoring ◽  
Loop Recorder ◽  
Tertiary Center ◽  
Unexplained Syncope ◽  
Baseline Characteristics

Abstract Introduction Long ambulatory ECG monitoring can be a useful component in the evaluation of the patient with unexplained syncope or syncope with suspected arrhythmic origin, as well as a sensitive tool for detecting asymptomatic spontaneous cardiac arrhythmias or conduction abnormalities in predisposed patients. Purpose To determine the diagnostic cost-effectiveness of the implantable loop recorder (ILR) in the origin of unexplained syncope in our center. Methods A retrospective observational study was carried out in a tertiary center, those patients with an ILR between August 2014 and March 2021 were included. Baseline characteristics of the population and their previous ECG, arrythmias detected during follow-up and pacemaker implant rate were evaluated. Results One hundred twenty-seven patients with a ILR were included (age 67 years, 49.6% males). Most often cause of ILR was unexplained syncope (90.6%) followed by monitoring after TAVI implant (3.9%). Normal LVEF (>50%) was present in 85.6%,and 75.6% had NYHA I functional class. 118 patients (92.9%) presented sinus rhythm at implant time, and 8 (6.3%) presented AF. 12.6% presented first degree atrioventricular (AV) block, 2 patients (1.6%) had presented previously Mobitz Type I AV block and one patient 2:1 block. Left bundle branch block (LBBB) was present in 13.4%,RBBB in 3.1%,LAFB in 9.4%, RBBB+LAFB in 11% and RBBB+LPFB in 2.4%. Median time of follow-up was 21 months. 3rd degree AV block was the most frequent arrhythmia detected (12.1%), followed by >3s pause (8%) and previously unknown AF (2.4%).The patients with syncope who suffered head trauma (33%) presented a higher rate of pacemaker (PCM) implant compared to those without head trauma: 31.6% vs 14.7%. In total,19.8% PCM rate implant during follow-up. No complications ILR related. Conclusion In conclusion, long home ECG monitoring with ILR is a powerful and helpful tool to find out or rule out potentially dangerous arrhythmias as cause of syncope, with no complications in our experience. FUNDunding Acknowledgement Type of funding sources: None. Baseline characteristics Arrhythmias detected during follow-up

scholarly journals EFFICACY OF ATRIAL FIBRILLATION DETECTION IN CRYPTOGENIC STROKE ACCORDING TO DATA OF IMPLANTABLE LOOP RECORDERS: PILOT STUDY

2019 ◽  
Vol 34 (2) ◽  
pp. 47-53
Author(s):  
S. E. Mamchur ◽  
E. A. Ivanitskiy ◽  
O. M. Polikutina ◽  
T. Yu. Chichkova ◽  
I. N. Mamchur ◽  
...  
Keyword(s):  
Recurrent Stroke ◽  
Cryptogenic Stroke ◽  
Ecg Monitoring ◽  
Group Iii ◽  
External Monitoring ◽  
Group I ◽  
Monitoring Group ◽  
Group Ii

Aim. To estimate the efficacy of invasive and non-invasive long-term ECG monitoring in comparison with conventional follow-up for the detection of silent atrial fibrillation (AF)/atrial flutter (AFL)/atrial tachycardia (AT) in patients with a cryptogenic stroke.Methods. The randomized, prospective, two-center study enrolled 36 patients who suffered cryptogenic stroke (CS) or transient ischemic attack (TIA) without past history of AF/AFL/AT. Patients were randomized in a 1:1:1 ratio to one of the three ECG monitoring strategies: standard arrhythmia monitoring (group I, n=12), ECG-monitoring with implantable loop recorder (group II, n=12), and ambulatory noninvasive ECG monitoring (group III, n=12). The primary endpoint was the time to the first detection of AF/AFL/AT. Patients, assigned to the group I, underwent an assessment at scheduled and unscheduled visits and received ambulatory ECG monitoring 28 days and 1 year after randomization. Patients in the group II underwent implantation of Reveal XT (Medtronic, USA) with the daily remote data transmission to CareLink Network. In the group III, for long-term external monitoring, Spyder system (WEB Biotechnology, Singapore) was used for up to 28 days.Results. During the first 28 days of observation, there were no significant differences in AF detection rates between groups I, II, and III: 0 (0%), 1 (8%), and 2 (17%) cases, respectively, р=0.537. During the year of observation, AF/AFL/AT episodes were detected in 1 case (8%) in the group I, 6 cases (50%) in the group II, and 2 cases (17%) in the group III, p=0.0486. The mean time from enrollment into the study to detection of the first AF/AFL/AT episode was 67 days (15; 97) in all groups. In the groups II and III, the first arrhythmia episodes were detected by monitoring devices on days 24 and 6, respectively. In most cases, arrhythmia episodes detected by long-term monitoring were asymptomatic. Recurrent stroke or TIA events occurred in group I and III (1 case in each group), but not in the group with implantable cardiac monitors. Subgroup analysis showed that significantly higher AF/AFL/AT detection rate was associated with stroke, CHA2DS2VASc score ≥2, and the presence of hypertension. For the 12 months of follow-up, the mean AF burden in the group II was 0.4 (0.2; 0.5) hours per day (1.6%). In the patients with recurrent stroke, AF burden was 3.2% compared to 0.9% in the rest of patients.Conclusion. Detection of silent AF with implantable cardiac monitors is superior to standard and long-term external monitoring in cryptogenic stroke patients.

Abstract 14972: Sub-clinical Atrial Fibrillation in Elderly Primary Care Patients Without Clinical Atrial Fibrillation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Jeff S Healey ◽  
Stuart J Connolly ◽  
Veena Manja ◽  
Yan Liu ◽  
Kim D Simek ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Primary Care ◽  
Coronary Disease ◽  
Cryptogenic Stroke ◽  
Left Ventricular ◽  
Ecg Monitoring ◽  
High Background ◽  
Non Invasive ◽  
History Of

Introduction: Sub-clinical AF has been reported in 10% of pacemaker patients (≥ 6 minutes, with 3 months of monitoring) and 16% of patients following cryptogenic stroke (≥ 30 seconds, with 1 month of monitoring). It is unknown how common sub-clinical AF is among other patient groups, including the elderly. These data are needed to give context to the detection of sub-clinical AF in clinical practice. Methods: We prospectively investigated the prevalence of sub-clinical AF among individuals ≥ 80 years, without known AF or symptoms of arrhythmia, attending primary care clinics. Subjects had a history of hypertension and at least one of the following: diabetes, BMI ≥ 30, sleep apnea, smoking, coronary disease, heart failure or left ventricular hypertrophy. Patients were recruited from 7 Ontario family practice clinics (n=119) and one general medicine clinic (n=10). Patients underwent 30 days of continuous, non-invasive ambulatory ECG monitoring using a device with automatic AF detection (Vitaphone 3100). The primary outcome was a composite of atrial flutter (AFL) or AF ≥ 6 minutes in duration. Those without AF were invited to complete an additional 30 days of monitoring. Results: Of 129 patients screened and consented, 100 patients initiated monitoring for an average monitoring duration of 36± 21 days. The mean (SD) age was 84 ± 3 years and systolic blood pressure was 138 ± 17 mmHg; 50% had coronary disease, 28% had diabetes and 6% had heart failure. Only 4% had a history of prior stroke. Thirty days of monitoring was completed by 57% of patients and 31% completed an additional 30 days. AFL or AF ≥ 30 seconds duration was documented in 19/100 patients; ≥ 6 minutes in 15; ≥ 30 minutes in 12; ≥ 6 hours in 8 and ≥ 24 hours in 2. Shorter episodes of atrial tachycardia lasting less than 30 seconds were observed in 47 patients. Conclusions: In this prospective, outpatient study, using non-invasive ECG monitoring, we found AFL or AF ≥ 6 minutes in 15% of elderly individuals with stroke risk factors. This high background prevalence of AFL/AF among elderly patients suggests a possible role for AF screening in this population; but also should be taken into consideration when interpreting the prevalence of AFL/AF in other populations.

scholarly journals Long-term impact of transient atrioventricular block during atrioventricular nodal re-entrant tachycardia ablation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
I Marco Clement ◽  
M Cossiani Martinez ◽  
S Castrejon Castrejon ◽  
C Alvarez Ortega ◽  
L Martin Polo ◽  
...  
Keyword(s):  
Pacemaker Implantation ◽  
Cardiac Pacing ◽  
Safe Procedure ◽  
Av Block ◽  
Energy Delivery ◽  
Funding Sources ◽  
Long Term Follow Up ◽  
Long Term Impact

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Ablation of atrioventricular nodal re-entrant tachycardia (AVNRT) is an extremely safe procedure, being complete atrioventricular (AV) block the most feared complication.  Transient AV or ventriculoatrial (VA) block during ablation is considered a risk marker of immediate AV permanent block. Purpose To study whether TB (transient block) during AVNRT ablation is associated with a higher risk of AV permanent block and pacemaker implantation during long term follow-up. Methods Retrospective analysis of all patients who underwent ablation for AVNRT in our center and had a minimum five years follow-up. Patients carrying a cardiac pacing device were excluded. Data was extracted from electronic medical records and follow-up was performed by telephone contact. TB was defined as AV or VA loss of conduction of at least 1 beat during energy delivery. Results We included 689 patients who underwent AVNRT ablation from March 1995 to December 2015: mean age 52.6 ± 18.6 years; 240 (34.8%) male; 677 radiofrequency and 12 cryotherapy ablations. TB was observed in 106 (15,4%) patients. Baseline characteristics are described in Table 1. Within the TB group, 44 (41.5%) patients presented with AV block, 60 (56.6%) with VA block, and 2 patients presented with both. TB concerned more than one beat in 65 (61.9%) cases and persisted after cessation of energy delivery in 15 (14.2%) cases.  Two patients did not recover AV conduction, requiring pacemaker implantation before discharge. During a median 12.5 years follow-up (IQR 9.5-16.6), 3 of the remaining 104 TB patients required pacemaker implantation due to AV block. All 3 had presented AV TB and had undergone radiofrequency ablation; they were not significantly older (67.0 ± 9.3 vs 48.8 ± 19.8, p = 0.12) but presented longer basal PR (237.0 ± 115.2 vs 152.6 ± 26.5, p < 0.001) and HV (57.3 ± 6.7 vs 44.2 ± 7.6, p = 0.004) intervals. When compared to the non-TB group, there were no differences in pacemaker implantation due to AV block during follow-up (7 (1.2%) p = 0.19). However, median time to pacemaker implantation was shorter in TB patients than in non-TB: 0.7 [0.1-1.4] vs 13.7 [5.2-22.0], p = 0.02. Conclusion Long term incidence of permanent AV block did not differ between TB and non-TB groups, however AV block occurred significantly earlier in TB patients. Non-TB group(n = 583) TB group(n = 106) p Age (mean ± SD) 53.2 ± 18.3 49.3 ± 19.8 0.05 PR (mean ± SD) 153.0 ± 28.4 155.0 ± 33.8 0.54 AH (mean ± SD) 83.3 ± 23.6 82.1 ± 22.2 0.64 HV (mean ± SD) 44.4 ± 7.8 44.6 ± 7.9 0.76

Predictors of atrial fibrillation in patients with cryptogenic stroke and fifteen-days electrocardiographic monitoring. Preliminary results of the DECRYPTORING study

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Vera Sainz ◽  
A Cecconi ◽  
P Martinez Vives ◽  
A Ximenez Carrillo ◽  
C Aguirre ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Retrospective Studies ◽  
Cryptogenic Stroke ◽  
P Value ◽  
Ecg Monitoring ◽  
Funding Sources ◽  
Electrocardiographic Monitoring ◽  
3D Volume ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. onbehalf DECRYPTORING study Introduction Cryptogenic stroke (CS) represents up to 30% of all stroke types.  In one third of CS, atrial fibrillation (AF) is identified as the underlying cause. Predictors of AF in the setting of CS have been described, however these findings were based on retrospective studies and with maximum ECG monitoring of 72 hours. To overcome these limitations, we designed the prospective Decryptoring study whose objective is to create a comprehensive predictive model for AF in patients with CS. Methods From April 2019, 41 consecutive patients with a CS and age > 60 years were included. On admission, a transthoracic echocardiogram with 3D volume and left atrial (LA) strain was performed. All patients were monitored with a 15-day ECG-Holter after discharge. Patients were classified according to AF detection. Results AF was detected in 9 patients (22%). Patients with AF were older (75.9 ± 8 vs. 81.9 ± 4.3 years, p = 0.041). There was no difference in T-troponin levels. NTproBNP was higher in the group with AF (350 ± 586 pg / ml vs. 1084 ± 1416 pg / ml, p = 0.018). Regarding LA strain, patients with AF presented reservoir LA strain (25.5 ± 8.2% vs 17.4 ± 4.3%; p = 0.006) and conduct LA strain (12 ± 5.2% vs 7.2 ± 1.5%; p = 0.01) lower than patients without AF. There were no differences in contraction LA strain or other echocardiographic variables. The risk of developing AF was higher in patients with NTproBNP> 165 pg / ml (OR 11.3 [95% CI 1.2-102.9] p = 0.031), LA reservoir strain <19.1% (OR 7.7 [IC 95 % 1.5-40.0] p = 0.016) and LA conduct strain <9.1% (OR 7.8 [95% CI 1.3-45.0] p = 0.022) (Table). Conclusions This prospective study, demonstrates that high NTproBNP, low reservoir LA strain and low conduct LA strain are associated with underlying AF in patients with cryptogenic stroke. No AF (n = 32) AF (n = 9) P value Age (years) 75.9 ± 8 81.9 ± 4.3 p = 0.041 NTPROBNP (pg/ml) 350 ± 586 1084 ± 1416 P = 0.018 LA indexed diastolic volume (ml/m2) 30 ± 11.8 33.8 ± 9.8 P = 0.35 LA EF (%) 45 ± 16.7 45 ± 12.8 P = 1 Reservoir LA strain (%) 25.5± 8.2 17.4± 4.3 P = 0.006 Conduct LA strain (%) 12 ± 5.2 7.2 ± 1.5 P = 0.01 Contraction LA strain (%) 13.5 ±5.3 10.2± 3.9 P = 0.10 NTPROBNP > 165 pg/ml 12 (41%) 8 (89%) OR 11.3 [IC 95% 1.2-102.9]; p = 0.031 Reservoir LA strain <19.1% 6 (20%) 6 (67%) OR 7.7 [IC 95% 1.5-40.0]; p = 0.016 Conduct LA strain <9.1% 9 (31%) 7 (78%) OR 7.8 [IC 95% 1.3-45.1]; p = 0.022

scholarly journals Supraventricular Runs in 7-Day Holter Monitoring Are Related to Increased Incidence of Atrial Fibrillation in a 3-Year Follow-Up of Cryptogenic Stroke Patients Free from Arrhythmia in a 24 h-Holter

2021 ◽  
Vol 8 (7) ◽  
pp. 81
Author(s):  
Andrzej Kułach ◽  
Milena Dewerenda ◽  
Michał Majewski ◽  
Anetta Lasek-Bal ◽  
Zbigniew Gąsior
Keyword(s):  
Atrial Fibrillation ◽  
Cryptogenic Stroke ◽  
Holter Monitoring ◽  
Ecg Monitoring ◽  
Stroke Patients ◽  
Long Term Monitoring ◽  
In Cis ◽  
Term Monitoring

Introduction: Silent atrial fibrillation (AF) is a common cause of cryptogenic ischemic stroke (CIS). The 24-h-Holter is insufficient to reveal an occult arrhythmic cause of stroke and the strategy to select the patients for long-term monitoring is missing. Objectives: The aim of the study was to evaluate 7-day-Holter monitoring to identify cases with the arrhythmic cause of stroke in CIS patients in whom 24-h-Holter was free from arrhythmia, and to assess the relation between supraventricular (SV) runs in baseline Holter and the incidence of AF in a 3-year follow-up period. Methods: 78 patients (aged 60 ± 9 years, 45 males) with CIS and no arrhythmic findings in 24-h-Holter were enrolled. All patients had 7-day-Holter monitoring after stroke and were followed up for 36 months, and then 7-day Holter was repeated. We assessed SV runs (≥5 QRS) in the initial 7-day Holter and analyzed the relation of the findings with clinical characteristics of novel AF episodes revealed early after stroke and during a 3-year follow-up. Results: Baseline 7-day-Holter revealed SV runs in 36% of patients and AF in 9% of cases. During a 3-year follow-up, 8 additional cases were confirmed, both in standard care and in repeated Holter (a total of 19% of AF cases). There was no difference with regard to CHADS2VASc score (3.6 ± 1.1 vs. 3.4 ± 1.5; p = NS) and left atrium parameters between patients with SV runs and the non-arrhythmic group. Patients with SV runs had a higher incidence of AF both after stroke and in a 3-year follow-up (46% vs. 4%, RR 11.6, p < 0.001). In 8 cases, patent foramen ovale was detected during follow-up. Conclusions: A strategy of baseline 7-day-Holter monitoring after stroke allows for disclosing SV runs in every third case and AF in 9% of stroke survivors. Patients with SV runs have a higher incidence of AF (RR 11.6, p < 0.001) and should be considered for extended continuous ECG monitoring.

scholarly journals Long-term Non-Invasive ECG-based Risk Stratification of Sudden Cardiac Death: Extended 5-year Results

2017 ◽  
Vol 11 ◽  
Author(s):  
Elena Okisheva ◽  
Dmitry Tsaregorodtsev ◽  
Vitaly Sulimov
Keyword(s):  
Sudden Cardiac Death ◽  
Risk Stratification ◽  
Predictive Value ◽  
Cardiac Death ◽  
Ecg Monitoring ◽  
Non Invasive ◽  
Increased Risk ◽  
All Cause Mortality ◽  
High Negative Predictive Value

<p>Objectives: To evaluate predictive value of heart rate turbulence (HRT), deceleration capacity (DC) and microvolt T-wave alternans (mTWA) for risk stratification for sudden cardiac death (SCD) in patients after myocardial infarction (MI) during 60 months of follow-up.</p><p>Methods: We studied 111 patients after MI occurred &gt; 60 days (27 [9; 84] months) before enrollment (84 men; mean age 64.1±10.5 years). All subjects had 24-hour ambulatory ECG monitoring with HRT, DC and mTWA evaluation. Follow-up period was 60 months; primary endpoint was SCD, secondary endpoint included all non-sudden cardiovascular deaths.</p><p>Results: During follow-up, we registered 19 cases of SCD and 11 cases of non-sudden cardiovascular deaths (including 7 fatal MI and 3 fatal strokes). DC had high negative predictive value (97.4% for all-cause mortality and 93.7% for SCD). DC values below 4.15 for all-cause mortality and 2.0 for SCD significantly increased risk of all-cause mortality (OR 8.5, 95% CI 2.9 to 24.6, р&lt;0.001) и SCD (OR 9.6, 95% CI 3.2 to 28.5, р&lt;0.001). Combined risk assessment at 12 months revealed that the most significant combination was HRT2 and mTWA100 &gt; 53 mcV, which increased risk both of all-cause mortality (30.7-fold) and SCD (63.3-fold); however, at 60 months this predictive value for SCD decreased (OR = 20.8 (95% CI 2.8 to 114.0), p &lt;0.001).</p>Conclusion: Evaluation of HRT, DC and mTWA during 24-hour ECG monitoring may define the high risk of cardiovascular mortality and SCD in post-MI patients especially during the first 12 months after the baseline examination.

scholarly journals Electrocardiographic markers of incident atrial fibrillation in patients with cryptogenic stroke

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
S Couto Pereira ◽  
P Silverio Antonio ◽  
B Valente Silva ◽  
J Brito ◽  
T Rodrigues ◽  
...  
Keyword(s):  
Imaging System ◽  
Cryptogenic Stroke ◽  
Wave Dispersion ◽  
P Wave ◽  
Atrial Remodeling ◽  
P Wave Dispersion ◽  
Funding Sources ◽  
Electrocardiographic Markers ◽  
The Difference

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Prolonged screening of AF in patients (pts) with cryptogenic stroke (CS) is recommended and electrocardiographic markers of atrial remodeling, like p-wave dispersion, have been described in literature. Electrocardiographic changes in pts with CS to predict AF in the follow up are not well-established. Purpose To identify ECG predictors of AF in a subset of pts with cryptogenic stroke. Methods We prospectively included consecutive pts admitted with CS. A surface 12-lead ECG was performed at admission, recorded at 25 mm/second and 10 mV/cm with commercially available imaging system. P-wave analysis of maximum (P max) and minimum (P min) duration, p-wave dispersion (PWD, defined as the difference between the P max and P min, being abnormal if &gt; 40 msec) and amplitude were evaluated by a two independent operator. P-wave axis was determined by an automated mode available in the equipment. ROC curve was analyzed to determine the optimal cut-off values. Results We enrolled 105 pts (55.2% males), with mean age of 68.18 ± 8.83 years, 79% had hypertension, 18.1% had diabetes, 44.8% with dyslipidemia, 21% current smokers. During follow up period, 18 pts (17.1%) developed AF. We found that only PWD (AUC 0.706, IC95%: 0.564-0.848, p = 0.006) and P-wave axis (AUC 0.715, IC95%: 0.870-0.860, p = 0.004) were strong predictors of AF. PWD cut-off of 47.50 presented a sensitivity of 77.8% and specificity of 59.8% and P-wave axis cut off value of 75.50 had a specificity of 95.4%. Age (p = 0.032) and current smoking (p = 0.014) were associated with occurrence of AF during the follow up.   Conclusion: PWD and P-wave axis predicted incident AF in this subset of pts with cryptogenic stroke. The ECG may be a toll to identify pts at risk of developing AF, although larger studies are needed to confirm these results. Abstract Figure.

scholarly journals Telemedicine-based early rule out and followup ECG algorithm for COVID-19 patients

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
OE Turan ◽  
RY Yilancioglu ◽  
C Alak ◽  
AA Baskurt ◽  
B Hunuk ◽  
...  
Keyword(s):  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Retrospective Cohort ◽  
Care Group ◽  
Ecg Monitoring ◽  
Funding Sources ◽  
Increased Risk ◽  
Rule Out ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Background Drugs with the potential to prolong QT are used in the treatment of coronavirus 19 (COVID-19) pneumonia. We have developed a telemedicine-based corrected QT (QTc) follow-up algorithm that allows early rule out for follow up. Aims In this study, we investigated the availability and safety of the algorithm. Study design Retrospective cohort Methods Consecutive patients; administered hydroxychloroquine (HCQ) for COVID-19 pneumonia were enrolled into digital ECG recording program which includes QTc follow-up algorithm. Results Patients were classified into three groups as those, excluded promptly from the QTc follow-up based on two consecutive ECG findings (early rule out, n = 92) and those, for whom the follow-up was continued (n = 12) and usual care group (n = 68). Of note, 237 ECG tracings were performed in our algorithm population contrary to standard practice of daily recommended ECG monitoring which could have yielded 975 ECG tracings along with accompanied risks of exposure. This way; we ended in 738 (75.7%) fewer ECG tracings. Sustained ventricular arrhythmia or sudden cardiac death was not observed in the entire patient population. Conclusions It is safe to rely on telemedicine-based early rule out algorithm in COVID-19 patients, receiving hydroxychloroquine treatment. This algorithm abolished the need for further ECG in majority of patients without increased risk during follow up. These algorithms can significantly reduce the healthcare worker exposures by eliminating the need for ECG follow-up promptly. Abstract Figure. Covid-19 Follow up Algorithm

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