scholarly journals Artificial Intelligence and Atrial Fibrillation

2021 ◽  
Author(s):  
Ojasav Sehrawat ◽  
Anthony Kashou ◽  
Peter Noseworthy
Keyword(s):  
Artificial Intelligence ◽  
Atrial Fibrillation ◽  
Oral Anticoagulation ◽  
Current Knowledge ◽  
External Validation ◽  
Complex Problem ◽  
Clinical Practices ◽  
Knowledge Gaps ◽  
Patients At Risk

In the context of atrial fibrillation (AF), traditional clinical practices have thus far fallen short in several domains such as identifying patients at risk of incident AF or patients with concomitant undetected paroxysmal AF. Novel approaches leveraging artificial intelligence have the potential to provide new tools to deal with some of these old problems. In this review we focus on the roles of artificial intelligence-enabled ECG pertaining to AF, potential roles of deep learning (DL) models in the context of current knowledge gaps, as well as limitations of these models. One key area where DL models can translate to better patient outcomes is through automated ECG interpretation. Further, we overview some of the challenges facing AF screening and the harms and benefits of screening. In this context, a unique model was developed to detect underlying hidden AF from sinus rhythm and is discussed in detail with its potential uses. Knowledge gaps also remain regarding the best ways to monitor patients with ESUS and who would benefit most from oral anticoagulation. The AI-enabled AF model is one potential way to tackle this complex problem as it could be used to identify a subset of high-risk ESUS patients likely to benefit from empirical oral anticoagulation. Role of DL models assessing AF burden from long duration ECG data is also discussed as a way of guiding management. There is a trend towards the use of consumer-grade wristbands and watches to detect AF from photoplethysmography data. However, ECG currently remains the gold standard to detect arrythmias including AF. Lastly, role of adequate external validation of the models and clinical trials to study true performance is discussed.

scholarly journals Population-Based Screening for Atrial Fibrillation

2020 ◽  
Vol 127 (1) ◽  
pp. 143-154 ◽  
Author(s):  
Shaan Khurshid ◽  
Jeffrey S. Healey ◽  
William F. McIntyre ◽  
Steven A. Lubitz
Keyword(s):  
Atrial Fibrillation ◽  
Current Literature ◽  
Oral Anticoagulation ◽  
Electronic Devices ◽  
Population Based ◽  
Consensus Guidelines ◽  
Consumer Electronic ◽  
Receive Treatment

Atrial fibrillation (AF) is a common and morbid arrhythmia. Stroke is a major hazard of AF and may be preventable with oral anticoagulation. Yet since AF is often asymptomatic, many individuals with AF may be unaware and do not receive treatment that could prevent a stroke. Screening for AF has gained substantial attention in recent years as several studies have demonstrated that screening is feasible. Advances in technology have enabled a variety of approaches to facilitate screening for AF using both medical-prescribed devices as well as consumer electronic devices capable of detecting AF. Yet controversy about the utility of AF screening remains owing to concerns about potential harms resulting from screening in the absence of randomized data demonstrating effectiveness of screening on outcomes such as stroke and bleeding. In this review, we summarize current literature, present technology, population-based screening considerations, and consensus guidelines addressing the role of AF screening in practice.

Wolff–Parkinson–White syndrome: lessons learnt and lessons remaining

2017 ◽  
Vol 27 (S1) ◽  
pp. S62-S67 ◽  
Author(s):  
D. Woodrow Benson ◽  
Mitchell I. Cohen
Keyword(s):  
Atrial Fibrillation ◽  
Sudden Death ◽  
Accessory Pathway ◽  
Minimal Risk ◽  
Asymptomatic Patients ◽  
High Prevalence ◽  
High Negative Predictive Value ◽  
Patients At Risk ◽  
Accessory Atrioventricular Pathway

AbstractThe Wolff–Parkinson–White pattern refers to the electrocardiographic appearance in sinus rhythm, wherein an accessory atrioventricular pathway abbreviates the P-R interval and causes a slurring of the QRS upslope – the “delta wave”. It may be asymptomatic or it may be associated with orthodromic reciprocating tachycardia; however, rarely, even in children, it is associated with sudden death due to ventricular fibrillation resulting from a rapid response by the accessory pathway to atrial fibrillation, which itself seems to result from orthodromic reciprocating tachycardia. Historically, patients at risk for sudden death were characterised by the presence of symptoms and a shortest pre- excited R-R interval during induced atrial fibrillation <250 ms. Owing to the relatively high prevalence of asymptomatic Wolff–Parkinson–White pattern and availability of catheter ablation, there has been a need to identify risk among asymptomatic patients. Recent guidelines recommend invasive evaluation for such patients where pre-excitation clearly does not disappear during exercise testing. This strategy has a high negative predictive value only. The accuracy of this approach is under continued investigation, especially in light of other considerations: Patients having intermittent pre-excitation, once thought to be at minimal risk may not be, and the role of isoproterenol in risk assessment.

scholarly journals Toward Understanding the Role of Aryl Hydrocarbon Receptor in the Immune System: Current Progress and Future Trends

2014 ◽  
Vol 2014 ◽  
pp. 1-14 ◽  
Author(s):  
Hamza Hanieh
Keyword(s):  
Immune System ◽  
Aryl Hydrocarbon Receptor ◽  
Immune Cells ◽  
Immune Cell ◽  
Current Knowledge ◽  
Physiological Role ◽  
Clinical Practices ◽  
Aryl Hydrocarbon ◽  
Active Research

The immune system is regulated by distinct signaling pathways that control the development and function of the immune cells. Accumulating evidence suggest that ligation of aryl hydrocarbon receptor (Ahr), an environmentally responsive transcription factor, results in multiple cross talks that are capable of modulating these pathways and their downstream responsive genes. Most of the immune cells respond to such modulation, and many inflammatory response-related genes contain multiple xenobiotic-responsive elements (XREs) boxes upstream. Active research efforts have investigated the physiological role of Ahr in inflammation and autoimmunity using different animal models. Recently formed paradigm has shown that activation of Ahr by 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) or 3,3′-diindolylmethane (DIM) prompts the differentiation of CD4+Foxp3+regulatory T cells (Tregs) and inhibits T helper (Th)-17 suggesting that Ahr is an innovative therapeutic strategy for autoimmune inflammation. These promising findings generate a basis for future clinical practices in humans. This review addresses the current knowledge on the role of Ahr in different immune cell compartments, with a particular focus on inflammation and autoimmunity.

scholarly journals Bioethics in the 21st century: challenges and perspectives

2021 ◽  
Author(s):  
EG Grebenshchikova ◽  
AG Chuchalin
Keyword(s):  
Artificial Intelligence ◽  
Deep Learning ◽  
Genome Editing ◽  
21St Century ◽  
Social Order ◽  
Complex Problem ◽  
Innovative Development ◽  
Ethical Challenges ◽  
Family Connections

In this article, the authors review the role of bioethics in the processes of risk communication and socio-humanistic support for innovative development of technoscience, and analyze its commitment to the concepts of precaution and prevention. More focus is put on certain ethical challenges of the 21st century associated with the development of artificial intelligence, deep learning in medicine, genome editing and ‘new parenthood’ practices. They have exploited the potential of bioethics in ethical and axiological reflection on the prospects of healthcare far-reaching reforms and in sociohumanistic assessment of transformed ideas about the human nature, family connections and established social order. It is shown that the experience of complex problem discussion and solving alongside with advisory mechanisms and bioethical procedures respond to pressing challenges of biotechnoscience and will be in demand in future.

Abstract 12993: Oral Anticoagulation Prescription Depends on Both Atrial Fibrillation Duration and CHA 2 DS 2 -VASc Score

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Rachel M Kaplan ◽  
Paul D Ziegler ◽  
Jodi L Koehler ◽  
Sean Landman ◽  
Shantanu Sarkar ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulation ◽  
Index Date ◽  
Stroke Risk ◽  
Data Availability ◽  
Current Guideline ◽  
Cardiac Implantable Electronic Devices ◽  
Prescription Rates

Introduction: Current guideline recommendations for oral anticoagulation (OAC) in patients with atrial fibrillation (AF) are based on CHA 2 DS 2 -VASc score alone. In patients with cardiac implantable electronic devices (CIEDs), it is poorly understood how the interaction between AF duration and CHA 2 DS 2 -VASc score influence the decision to prescribe OAC. Methods: Data from the Optum® de-identified Electronic Health Record dataset were linked to the Medtronic CareLink database of CIEDs. An index date was assigned as the later of 6 months after device implant or 1 year after EHR data availability. CHA 2 DS 2 -VASc score was assessed via EHR data prior to the index date. Maximum daily AF burden (No AF, 6 minutes-23.5 hours, and >23.5 hours) was assessed over the 6 months prior to index date. OAC prescription rates were computed prior to the index date as a function of both AF duration and CHA 2 DS 2 -VASc score. Results: A total of 35,779 patients with CHA 2 DS 2 -VASc scores ≥1 were identified, including 8,581 who were prescribed OAC and 27,198 not prescribed OAC during the observation period. The overall OAC prescription rate among the subset of 12,938 patients with device-detected AF >6 minutes was 36.7% and the rate was nearly 60% higher for patients with a maximum daily AF burden >23.5 hours (45.4%) compared to those with 6 minutes-23.5 hours (28.7%). OAC prescription rates increased monotonically with both increasing AF duration and CHA 2 DS 2 -VASc score, reaching a maximum of 67.2% for patients with AF >23.5 hours and a CHA 2 DS 2 -VASc score ≥5 (Table). Conclusion: In contrast with guideline recommendations, real-world prescription of OAC increased with both increasing duration of AF and CHA 2 DS 2 -VASc score. This mirrors recent evidence demonstrating that stroke risk also increases with both of these features and highlights the need for further research into the role of AF duration, stroke risk, and the need for anticoagulation in patients with devices capable of long-term AF monitoring.

scholarly journals HCN4, Sinus Bradycardia and Atrial Fibrillation

2015 ◽  
Vol 4 (1) ◽  
pp. 1 ◽  
Author(s):  
Dario DiFrancesco ◽  
Keyword(s):  
Atrial Fibrillation ◽  
Current Knowledge ◽  
Sinus Bradycardia ◽  
Short Review ◽  
Loss Of Function ◽  
Predominant Type ◽  
Av Conduction ◽  
Structural Abnormalities ◽  
And Control

Based on their established role in the generation of spontaneous activity in pacemaker cells and control of cardiac rate, funny/hyperpolarisation-activated, cyclic nucleotide gated 4 (HCN4) channels are natural candidates in the search for causes of sinus arrhythmias. Investigation of funny current-related inheritable arrhythmias has led to the identification of several mutations of the HCN4 gene associated with bradycardia and/or more complex arrhythmias. More recently, the search has been extended to include auxiliary proteins such as the minK-related peptide 1 (MiRP1) β-subunit. All mutations described so far are loss-of-function and in agreement with the role of funny channels, the predominant type of arrhythmia found is bradycardia. Funny channel-linked arrhythmias, however, also include atrioventricular (AV) block and atrial fibrillation, in agreement with an emerging new concept according to which defective funny channels have a still unexplored role in impairing AV conduction and triggering atrial fibrillation. Also, importantly, recent work shows that HCN4 mutations can be associated with cardiac structural abnormalities. In this short review I briefly address the current knowledge of funny/HCN4 channel mutations and associated sinus and more complex arrhythmias.

scholarly journals Artificial Intelligence for the Diagnosis and Treatment of Diabetes Kidney Disease: a systematic review

2021 ◽  
Author(s):  
Shams Mohammad Abrar
Keyword(s):  
Artificial Intelligence ◽  
Systematic Review ◽  
Data Extraction ◽  
External Validation ◽  
Data Availability ◽  
Reference List ◽  
Data Generation ◽  
Clinical Practices ◽  
Treatment Of Diabetes ◽  
Applications Of Ai

Background: Diabetic nephropathy (DN) is a serious microvascular complication that affects 40% of diabetes patients. In the last decade, artificial intelligence (AI) has been widely used in both structured and unstructured clinical data to improve the treatment of patients/potential patients with DN. Methods: This systematic review aims to cover all applications of AI in the clinical use of DN or related topics. Studies were searched in four open-access databases (Pubmed, IEEE Xplore, DBLP Computer Science Bibliography, and ACM digital library). Finally, the author manually searched the reference list of included studies in the study for additional relevant articles. Results: Finally, a total of 24 original peers reviewed articles were included in this study. Through a manual data extraction, the summary of key information such as applied AI algorithm, main outcomes, performance evaluation etc. was taken. Then the included studies underwent a quality assessment criterion, assessing the reproducibility, generalizability etc. Most of the included studies revealed that the AI frameworks outperformed conventional statistical methods. A summary of the limitations, such as lack of data availability or external validation of the framework, in the included studies, was also included. Conclusion: The rapid advancement of the AI framework and the exponential data generation in healthcare can be utilized and applied in clinical practices. The aid of AI can be instrumental in the treatment of DN.

Decision-making interventions to stop the global atrial fibrillation-related stroke tsunami

2017 ◽  
Vol 12 (3) ◽  
pp. 222-228 ◽  
Author(s):  
Joshua O Cerasuolo ◽  
Manuel Montero-Odasso ◽  
Agustin Ibañez ◽  
Shannon Doocy ◽  
Gregory YH Lip ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Ischemic Stroke ◽  
Oral Anticoagulation ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Catastrophic Event ◽  
Income Levels ◽  
Atrial Fibrillation Burden

Atrial fibrillation affects 33.5 million people worldwide and its prevalence is expected to double by 2050 because of the aging population. Atrial fibrillation confers a 5-fold higher risk of ischemic stroke compared to sinus rhythm. We present our view of the role of shared medical decision-making to combat global underutilization of oral anticoagulation for stroke prevention in atrial fibrillation patients. Oral anticoagulation underuse is widespread as it is present within atrial fibrillation patients of all risk strata and in countries across all income levels. Reasons for oral anticoagulation underuse include but are probably not limited to poor risk stratification, over-interpretation of contraindications, and discordance between physician prescription preferences and actual administration. By comparing a catastrophic event to the consequences of atrial fibrillation related strokes, it may help physicians and patients understand the negative outcomes associated with oral anticoagulation under-utilization and the magnitude to which oral anticoagulations neutralize atrial fibrillation burden.

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