A comparison of over-the-counter available smartwatches and devices for electrocardiogram based detection of atrial fibrillation

Background There is an increasing number of smartwatches and devices commercially available that can generate and automatically interpret an electrocardiogram (ECG). Such devices have an enormous potential to improve population screening and telemonitoring of atrial fibrillation (AF). Purpose There is limited data on the sensitivity, specificity and interpretability of these devices and comparative studies are lacking. Our purpose was to compare three frequently used devices for AF detection. Methods We performed a single-center, prospective study in consecutive patients with AF presenting for electrical cardioversion (ECV). We collected a standard 12-lead ECG recording immediately followed by four times 30 seconds of ECG recordings from different devices for every patient prior to the ECV. These paired measurements were considered simultaneous. If the ECV was performed, the same measurements were repeated afterwards. The standard 12L-ECGs were interpreted by a cardiologist and used as golden standard for heart rhythm. The different devices used for the 30 second ECGs were: Withings Move ECG (lead I), Apple Watch series 5 (lead I), Kardia Mobile 6L (six leads) and Withings/Apple (1:1 ratio) on left knee (lead II). Sensitivity and specificity were determined for each AF detection algorithm excluding patients with atrial flutter (AFL) or uninterpretable ECGs. In addition, proportions of uninterpretable ECGs were determined including all patients and including only patients with sinus rhythm (SR) and compared between devices using McNemar's test. Results A total of 220 patients were included (age 70±10 years, female 35%, first ECV 44%) and in total 415 12-lead ECGs were performed (45% SR, 45% AF, 10% AFL). The sensitivity/specificity were overall similar for all devices (Withings 98%/95%, Apple 94%/98%, Kardia 99%/91%. P>0.05 for all). In detail, Kardia was the most sensitive test with highest proportion of suspected AF (57%) whereas Apple was the most specific, as shown by the highest proportion of normal heart rate results by the device (55%, P=0.003 compared to Kardia (43%)). Overall, Withings, Apple and Kardia had a comparable proportion of uninterpretable ECGs (20%, 20%, 24%, respectively. P>0.05 for all). Lead II had higher proportion of uninterpretable ECGs (32%, p<0.01 compared to all). More specifically, Kardia had a higher rate of uninterpretable ECGs in those with SR (P<0.05 compared to Withings (lead I) and Apple (lead I)). Conclusion In all devices, we found sensitivity/specificity for AF detection between 91%-99%, better than previous studies reported, and 20–24% of uninterpretable ECGs. Kardia was the most sensitive device, but less useful to rule out atrial fibrillation whereas Apple had numerically highest specificity. We aim to further evaluate both cardiologist interpretation and accuracy of atrial flutter detection using different leads to inform clinical use. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Tergooi Cardiology department, J.P. Bokma was supported with a research grant by Amsterdam Cardiovascular Sciences Overview and comparison

P088 Prolonged fever in a boy revealing Takayasu disease: a case report

Background Takayasu's arteritis (TA) is a chronic inflammatory vasculitis of unknown origin. It affects the large vessels, especially the aorta, its main branches, and the pulmonary arteries. It begins acutely in children with severe general manifestations. The diagnosis of TA remains a challenge to clinicians due to many reasons such as its rarity, its great clinical polymorphism, and the lack of specific biological criteria. Case report A 13-years old boy with no pathological history, was admitted for prolonged fever with intermittent abdominal pain. The clinical examination has found a conscious boy, febrile with a BP of 130/90mmhg, a normal heart rate, and stable respiratory function. The cardiovascular examination noted a decrease in pedal pulses, without signs of ischaemia or necrosis, and the cardiac auscultation was normal. Examination of the lymph node areas has shown upper and left later cervical adenopathy measuring 1.7 cm in long axis, mobile, and painless. All joints were free. The complementary biological workups revealed an inflammatory syndrome (ESR: 120 mm, fibrinogen: 5 g/l, microcytic hypochromic anaemia at 9 g/dl, ferritin: 1051, low serum iron: 11µg/dl and thrombocytosis: 692 000 elements/l). Chest X-ray showed a dilated aortic button. A thoracic angioscan revealed a peri-aortitis more evident at the level of the emergence of the mesenteric artery with a pseudo-aneurysmal aspect and arteritis of the right primary carotid artery. Echocardiography was performed and showed a dilated aspect of the aorta with irregular wall. Renal ultrasound was normal. The diagnosis of Takayasu disease was made on the basis of clinical biological and essentially radiological arguments according to the diagnostic criteria of the American College of Rheumatology. The patient was treated with corticosteroid (prednisone: 2 mg/kg/d) for one month then then gradually reduced doses The disease course was marked by several relapses and the patient was then treated with mycophenolate mofetil (cellcept). Conclusion Takaysu's disease is a chronic inflammatory vasculitis of unknown origin, which affects the large- vessels, mainly the aorta, its main branches, and the pulmonary arteries; but it remains rare in children and its treatment is not well codified.

A prelude to wearable technology for the measurement and restoration of core body temperature and heart rate in athletes suffering from hypothermia

An individual who is in good physical health tends to exhibit an internal core temperature of 37°C and a heart rate of 60–100 beats per minute. Increase in the temperature of the surrounding environment can serve as the basis for the onset of the condition of Hypothermia. Hypothermia acts as one of the most significant barriers being faced by winter athletes and starts initially with an increase in the heart and breathing rate. However, if the condition persists it can lead to reduction in the heart and breathing rate and ultimately results in cardiac failure. Although, jackets are commercially available, they tend to operate manually and furthermore, do not serve the primary purpose of counteracting the condition of hypothermia, particularly experienced by athletes taking part in winter sports. The objective of this study is to design a heating jacket that enables effective counteraction of the condition of Hypothermia. It enables precise measurement of the of core body temperature with the aid of a pyroelectric sensor. Along with this, a pulse rate sensor for detecting the accurate heart rate has been incorporated on the index finger. Five heating pads would get activated to attain optimal temperature, in case the core body temperature of <37°C is detected. If the condition of hypothermia advances to the moderate stage, two additional heating pads will get activated and provide extra warmth to attain normal heart rate along with core body temperature. Overall, this wearable technology serves as a definitive solution to counteract the condition of hypothermia only when the internal parameters exhibit that you actually have it. The results of the study exhibited that this prototype can be utilized for detecting and treating the condition of Hypothermia.

PSIV-4 Characterization of heat stress condition on productive performance and physiological indicators, milk composition, gene expression, and metabolomics in blood and milk of early lactating Holstein cows

We aimed to characterize heat stress (HS) effects in early lactating Holstein cows using measures of productive performance, physiological and genetic indicators, blood and milk parameters, and metabolomics in blood and milk. Eight cows (milk yield = 29.27 ± 0.38 kg/d, days in milk = 40 ± 8 d) were equally housed in environmentally controlled chambers by providing temperature-humidity index (THI) at two levels of 70~71 (25°C, 35~50% humidity, threshold) and 86~87 (31°C, 80~95% humidity, severe). For each treatment, the environment inside the chamber was adjusted for 7 days of adaptation at 67~68 THI (22°C, 50~60% humidity, normal) level. After the adjustment period, cows were subjected to HS for 7 days. Feed and water intake and milk yield were measured daily, and blood was collected and physiological indicators were monitored on the 7th and 14th days. Data were analyzed using GLM procedure of SAS. Feed intake and milk yield were lower (P&lt; 0.05) and water intake was higher (P &lt; 0.05) in the severe than the threshold and normal. Lactose tended to be lower (P = 0.082) in the severe than the threshold and normal. Heart rate, rectal and skin temperature were higher (P &lt; 0.05) in the severe than the threshold and normal. Blood HSP90 and HSPB1 were higher (P &lt; 0.05) in the severe than threshold and normal. Alanine, proline, glutamic acid, tryptophan, lactic acid, and citric acid in milk and blood were lower (P &lt; 0.05) in the severe than threshold and normal. In conclusion, early lactating Holstein cows are characterized to receive higher HS by showing the changes in historical measures of productive performance, physiological and genetic indicators, and blood and milk parameters under severe HS condition whereas the new approach of metabolomics in blood and milk are recognized as sensitive and reliable indicators of severe HS.

The importance of maintaining normal perioperative physiological parameters in children during anaesthesia

Every year, millions of neonates, infants and young children need general anesthesia for a variety of procedures. As pediatric anesthesia remains at high risk of perioperative morbidity and mortality, attention has been directed towards the anesthesia training and the anesthetics safety. We are now reassured about the relatively safeness of the anesthetic drugs, but the safest intraoperative conduct has still to be determined. In the absence of clear evidence, it appears logical to prevent perturbations of the child “baseline”, by avoiding preoperative distress, maintaining normal intraoperative parameters and preventing postoperative discomfort. Recently, ten “N” principles (no fear/awareness, normovolemia, normotension, normal heart rate, normoxemia, normocapnia, normonatremia, normoglycemia, normotermia and no pain/nausea/vomiting/emergence delirium) have been proposed as the base of a safer anesthesia care. The current paper aims to summarize the current evidence behind the “10-Ns” rational and to help guide anesthesiologists in their practice.

Is Cluster Analysis the Appropriate Statistical Method for Planning the Optimal Locations for Automated External Defibrillators?

The Automated External Defibrillator (AED) is an intuitive device used by witnesses of an incident without medical training in cases of sudden cardiac arrest. Its operation consists in delivering an electrical pulse to the cardiac conduction system, as a result of which normal heart rate is restored. The lack of awareness in society concerning the usefulness of the device and the inadequate deployment of AEDs result in their too infrequent application by witnesses of incidents. The aim of this paper is to verify whether cluster analysis is the appropriate statistical method to determine the appropriate deployment of AED devices on the basis of cases of sudden cardiac arrest in out-of-hospital conditions. The initial cluster analysis showed the validity of using the method in question for planning the appropriate locations of AEDs.

Changes in heart rate from 5 s to 5 min after birth in vaginally delivered term newborns with delayed cord clamping

ObjectiveTo determine heart rate centiles during the first 5 min after birth in healthy term newborns delivered vaginally with delayed cord clamping.DesignSingle-centre prospective observational study.SettingStavanger University Hospital, Norway, March–August 2019.PatientsTerm newborns delivered vaginally were eligible for inclusion. Newborns delivered by vacuum or forceps or who received any medical intervention were excluded.InterventionsA novel dry electrode electrocardiography monitor (NeoBeat) was applied to the newborn’s chest immediately after birth. The newborns were placed on their mother’s chest or abdomen, dried and stimulated, and cord clamping was delayed for at least 1 min.Main outcome measuresHeart rate was recorded at 1 s intervals, and the 3rd, 10th, 25th, 50th, 75th, 90th and 97th centiles were calculated from 5 s to 5 min after birth.Results898 newborns with a mean (SD) birth weight 3594 (478) g and gestational age 40 (1) weeks were included. The heart rate increased rapidly from median (IQR) 122 (98–146) to 168 (146–185) beats per minute (bpm) during the first 30 s after birth, peaking at 175 (157–189) bpm at 61 s after birth, and thereafter slowly decreasing. The third centile reached 100 bpm at 34 s, suggesting that heart rates <100 bpm during the first minutes after birth are uncommon in healthy newborns after delayed cord clamping.ConclusionThis report presents normal heart rate centiles from 5 s to 5 min after birth in healthy term newborns delivered vaginally with delayed cord clamping.

SARS-CoV-2 infection in an infant with severe dilated cardiomyopathy

A four- and a half-month-old girl with severe dilated cardiomyopathy due to neonatal enterovirus myocarditis, treated with diuretics and milrinone for the past 4 months, was infected with SARS-CoV-2. The disease course was characterised by high fever and gastrointestinal symptoms. Cardiac function, as measured by echocardiography, remained stable. The treatment focused on maintaining a normal heart rate and a stable fluid balance. In children with severe underlying cardiac disease, even a mild SARS-CoV-2 infection can require close monitoring and compound treatment.

Management of polyhydramnios pregnancy without risk factors: a case report

Introduction: Polyhydramnios is a condition in which the amount of amniotic fluid increases more than 2 litres. The causes of polyhydramnios are multifactorial, and most are idiopathic. Here we report challenging management of polyhydramnios case without apparent risk factors. Case: A 30-year-old woman G2P1001, 27-28 weeks of gestational age referred due to our tertiary health care center due to polyhydramnios. The patient chief complaint was progressively enlarged abdomen since a month ago. Her previous pregnancy, medical history and family history were unremarkable. The obstetric examination reflects the size of uterus equivalent to 36 weeks of gestational age. The fetomaternal ultrasound reveals a life, single fetus with normal heart rate and fetal movement, estimated fetal weight about 1057 grams, placenta corpus posterior grade I, Maximum Vertical Pocket 22.83 cm, no major congenital abnormalities were visible and bladder appears filled. Laboratory tests revealed blood glucose levels 90 mg/dl, Hb-A1c 5.2%, Ureum 27.30 mg/dl, Creatinine 3.39 mg/dl, and numerous leukocytes on urine sediment. Amnioreduction and fetal pulmonary maturation were conducted by Dexamethason protocol. Amnioreduction yield 1500 ml of clear, yellowish amniotic fluid. Regarding abnormality in renal function, diagnosis of Acute on Chronic Kidney Disease (ACKD were established by Internal medicine department, and the patients were given a series of ceftriaxone injection. The patient was planned for indomethacin therapy; however, Indomethacin was not available in Bali. Conclusion: Careful search for causes both from the maternal factor and fetal abnormalities can help to determine the prognosis of pregnancy. Ideally, amnioreduction, coupled with indomethacin therapy, are needed to reduce amniotic fluid, and serial monitoring of the amniotic fluid volume is required to prevent preterm labor.

P953Smartphone monitor kardia: an effective diagnostic tool for paroxysmal palpitations

Funding Acknowledgements no grants to declare OnBehalf not applicable Background : Paroxysmal palpitations are diagnostic challenge because the ECG and the 24-hour holter ECG monitoring without palpitations is usually normal. We report a 1 year experience of a new diagnostic tool for paroxysmal palpitations: the smartphone monitor Kardia®. Patients with paroxysmal palpitation and negative 24 hour holter ECG was ask to sent iECG during symptoms during the 1 month follow-up. Results Between January and December 2018, 20 patients have received Kardia®, mean age 40 years, the mean duration kardia-monitoring was 26 days. A total of 235 iECGs were sent by email, a median of 6 iECG/patients. 9 (45%) patients remained without rhythmic diagnosis (sinus rhythm, normal heart rate), 11 (55%) patients had at least one pathological iECG: 4 atrial fibrillation, 4 junctional tachycardia including 1 with paroxysmal pre-excitation, 2 atrial flutters. These diagnosis had therapeutic consequences: 2 AF ablations, 2 AF treated by antiarythmic drugs (AAD), 2 atrial flutters ablation, 1 ILR was implanted for absence of diagnosis with kardia®. The other patients without diagnosis at the time of palpitations were reassured on the absence of cardiac rhythm disturbance. Conclusion The purchase of 5 Kardia® as a new diagnostic tool for paroxtysmal palpitations is a reasonable investment for a cardiology derpartment, the diagnostic performance is higher than current standards (24 hours holters ECG monitoring), since it allows an arhythmic diagnosis in more than 50% of cases in 1 mounth. The main limitation is the selection of patients, most often young, who already have a smartphone and can send an email. patient age (years) duration (days) i-ECG sent number diagnosis treatment patient 1 23 11 3 AF AF ablation patient 3 51 23 7 AF AA Drugs patient 10 65 20 5 AF AA Drugs patient 11 35 29 6 SVT : AVNRT no ablation patient 12 48 22 27 atrial flutter flutter ablation patient 13 34 1 13 SVT : AVNRT no ablation patient 14 56 7 18 atrial flutter flutter ablation patient 15 59 21 80 AF and PVC AF Ablation patient 16 50 1 3 SVT : AVRT no ablation patient 17 28 28 2 SVT : AVNRT no ablation patient 19 49 35 8 PVC AA Drugs 1 year kardia experience : diagnosis performance in the 11/20 patients with abnormal iECG Abstract Figure. iECG : termination of SVT (patient 17)