Arrhythmias Other Than Atrial Fibrillation in Those With an Irregular Pulse Detected With a Smartwatch: Findings From the Apple Heart Study

Background: The Apple watch irregular pulse detection algorithm was found to have a positive predictive value of 0.84 for identification of atrial fibrillation (AF). We sought to describe the prevalence of arrhythmias other than AF in those with an irregular pulse detected on a smartwatch. Methods: The Apple Heart Study investigated a smartwatch-based irregular pulse notification algorithm to identify AF. For this secondary analysis, we analyzed participants who received an ambulatory ECG patch after index irregular pulse notification. We excluded participants with AF identified on ECG patch and described the prevalence of other arrhythmias on the remaining participant ECG patches. We also reported the proportion of participants self-reporting subsequent AF diagnosis. Results: Among 419 297 participants enrolled in the Apple Heart Study, 450 participant ECG patches were analyzed, with no AF on 297 ECG patches (66%). Non-AF arrhythmias (excluding supraventricular tachycardias <30 beats and pauses <3 seconds) were detected in 119 participants (40.1%) with ECG patches without AF. The most common arrhythmias were frequent PACs (burden ≥1% to <5%, 15.8%; ≥5% to <15%, 8.8%), atrial tachycardia (≥30 beats, 5.4%), frequent PVCs (burden ≥1% to <5%, 6.1%; ≥5% to <15%, 2.7%), and nonsustained ventricular tachycardia (4–7 beats, 6.4%; ≥8 beats, 3.7%). Of 249 participants with no AF detected on ECG patch and patient-reported data available, 76 participants (30.5%) reported subsequent AF diagnosis. Conclusions: In participants with an irregular pulse notification on the Apple Watch and no AF observed on ECG patch, atrial and ventricular arrhythmias, mostly PACs and PVCs, were detected in 40% of participants. Defining optimal care for patients with detection of incidental arrhythmias other than AF is important as AF detection is further investigated, implemented, and refined.

August 2021 Imaging Case of the Month: Unilateral Peripheral Lung Opacity

No abstract available. Article truncated after 150 words. Clinical History: A 56-year-old post-menopausal woman was referred to endocrinology after a routine screening bone densitometry scan suggested osteoporosis. She had undergone this testing after she developed back pain following a pulled muscle for which she saw a chiropractor. The patient had no significant past medical history and she was actively involved in exercise. She denied use of alcohol, drugs, and smoking. She had no allergies and was not taking any medications. Her past surgical history included Lasik surgery, breast augmentation 15 years earlier, and surgery for a deviated septum. Physical examination showed a thin patient, afebrile, with a largely normal physical exam, although her pulse was intermittently irregular. Her blood pressure was 130 / 80 mmHg with a normal respiratory rate. Pulse oximetry showed a room air saturation of 98%. When asked about her irregular pulse, the patient recalled that she had episodes of “heart racing” for which she …

Atrial fibrillation following low voltage electrical injury

Electrical injuries can have myriad presentations, including significant cardiac involvement. Arrhythmias are the most frequently experienced cardiac affliction, of which sinus tachycardia or bradycardia, ventricular fibrillation, atrial or ventricular premature beats and bundle branch block are most commonly reported. A 50-year-old man, with no prior history of cardiac disease, presented with palpitations following low voltage electrical injury. On examination, he was tachycardic with an irregularly irregular pulse. An ECG confirmed atrial fibrillation with rapid ventricular rate. Chemical cardioversion was attempted successfully, following which the patient reverted to sinus rhythm. Atrial fibrillation following electrical injury has been rarely described in the literature, and is rarer so without associated high voltage electrical exposure or pre-existing cardiac ailment.

Limnology of rock pools in the river Chenab at Dhoomi, Akhnoor, in Jammu region of the Union Territory of Jammu and Kashmir

Small and temporary freshwater rock pools, compared to lakes, ponds and rivers, have received a very little scientific attention in India. For the present limnological study, six rock pools in the river Chenab at Dhoomi, Akhnoor, were analysed seven times for water quality and fauna during 17-01-2011 to 26-01-2011 and have been described. Among various water parameters depth (6-11 cm), transparency (6-11 cm) and turbidity (1.4-6.88 NTU) recorded a decrease after high record on first observation. Salinity remained constant (0.1 ppt) on all the seven observations. Dissolved oxygen (DO) observed maximum (12.81 mg/l) record on 19-01-2011 and minimum (9.99 mg/l) on 26-01-2011. Chloride (Cl?) was minimum (2.73 mg/l) on 17-01-2011 and 18-01-2011 and maximum (6.81 mg/l) on 24-01-2011. Conductivity (75.50 – 178.8 µS cm?¹), total dissolved solids (TDS) (40.13 – 85.5 mg/l), Biological oxygen demand (BOD) (2.5 – 6.63 mg/l), pH (8.26 – 9.12), carbonate ( CO3-2) (2.31 – 22.84 mg/l), bicarbonate (HCO3-) (29.83 – 71.29 mg/l), calcium (Ca+2) (9.45 – 29.50 mg/l), magnesium (Mg+2) (2.24 – 5.38 mg/l), total hardness (TH) (35.34 – 95.80 mg/l) and sodium (Na+) (0.44 – 1.05 mg/l) showed highest record on last observation. Potassium (K+) (0.60 – 1.70 mg/l) was minimum on 18-01-2011 and maximum on 24-01-2011. Nitrate (NO3?) (0.084-0.373 mg/l), phosphate (PO4³? ) (0.043 – 0.140 mg/l), silicate (SiO4-4) (1.28 – 3.95 mg/l) and sulphate (SO4-2) (4.89 – 7.84 mg/l) observed an irregular pulse. Fauna in these rock pools was represented by zooplankton (passive dispersers) belonging to Protozoa (27 species), Rotifera (3 species), gemmules of Porifera (2 species) and Turbellaria (1 species) only. Zooplanktonic maximum qualitative record was observed on 6th observation and quantitative on 7th observation. In the absence of any earlier study on freshwater rock pools in the Himalayan rivers, present work shall be of great help for future workers.

The Relationship between Poor Pulmonary Function and Irregular Pulse in the Elderly: Findings from a Nationwide Cross-Sectional Survey in Korea

Arrhythmia may be caused by reduced pulmonary function, and pulse palpation is a useful screening method for the early detection of cardiac arrhythmia. The aim of this study was to investigate the association between reduced pulmonary function and abnormal findings on pulse palpation in 2347 subjects aged ≥65 years using data from a nationwide survey. Pulse palpation was initially performed for 15 s and, if felt to be abnormal, it was performed again for 60 s. The prevalence of irregular pulse (IP) determined by the 60-second palpation was 61 (2.6%). The mean age of subjects with an IP was 73.0 (95% CI 71.7–74.3) years, and 45.8% were male. After adjustment for covariates, forced vital capacity (FVC)/predicted FVC, forced expiratory volume in one second (FEV1)/predicted FEV1, and the lowest FEV1 remained significant risk factors for IP. A restrictive or obstructive spirometry pattern was also an independent risk factor for IP. In summary, an IP is more prevalent when pulmonary function is reduced in the elderly, in whom careful pulse palpation may be necessary for the early detection of arrhythmia.

The relationship between poor pulmonary function and irregular pulse in the elderly: findings from a nationwide cross-sectional survey in Korea

Background: Pulse palpation is a useful screening method for early detection of cardiac arrhythmia, which may result from reduced pulmonary function. The aim of this study is to investigate the association between reduced pulmonary function and pulse palpation finding in the elderly. Methods: Secondary analysis was performed using the Korea National Health and Nutrition Examination Survey (n=2347 subjects aged ≥65 years). Pulse palpation was initially performed for 15 seconds and confirmed again for 60 seconds. Results: The prevalence of IP was 61 (2.6%). The mean age of subjects with IP was 73.0 (95% CI 71.7-74.3) years, and 45.8% were male. After adjustment, the lowest FVC or FEV 1 and predicted FVC <80% remained significant risk factors for IP. A restrictive or obstructive pattern also independently predicted IP. Conclusions: The elderly with reduced pulmonary function had a significant risk of irregular pulse, in whom careful pulse palpation may be required for early detection of arrhythmia.

Lead-I ECG for detecting atrial fibrillation in patients with an irregular pulse using single time point testing: a systematic review and economic evaluation

Background Atrial fibrillation (AF) is the most common type of cardiac arrhythmia and is associated with an increased risk of stroke and congestive heart failure. Lead-I electrocardiogram (ECG) devices are handheld instruments that can be used to detect AF at a single time point in people who present with relevant signs or symptoms. Objective To assess the diagnostic test accuracy, clinical impact and cost-effectiveness of using single time point lead-I ECG devices for the detection of AF in people presenting to primary care with relevant signs or symptoms, and who have an irregular pulse compared with using manual pulse palpation (MPP) followed by a 12-lead ECG in primary or secondary care. Data sources MEDLINE, MEDLINE Epub Ahead of Print and MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, PubMed, Cochrane Databases of Systematic Reviews, Cochrane Central Database of Controlled Trials, Database of Abstracts of Reviews of Effects and the Health Technology Assessment Database. Methods The systematic review methods followed published guidance. Two reviewers screened the search results (database inception to April 2018), extracted data and assessed the quality of the included studies. Summary estimates of diagnostic accuracy were calculated using bivariate models. An economic model consisting of a decision tree and two cohort Markov models was developed to evaluate the cost-effectiveness of lead-I ECG devices. Results No studies were identified that evaluated the use of lead-I ECG devices for patients with signs or symptoms of AF. Therefore, the diagnostic accuracy and clinical impact results presented are derived from an asymptomatic population (used as a proxy for people with signs or symptoms of AF). The summary sensitivity of lead-I ECG devices was 93.9% [95% confidence interval (CI) 86.2% to 97.4%] and summary specificity was 96.5% (95% CI 90.4% to 98.8%). One study reported limited clinical outcome data. Acceptability of lead-I ECG devices was reported in four studies, with generally positive views. The de novo economic model yielded incremental cost-effectiveness ratios (ICERs) per quality-adjusted life-year (QALY) gained. The results of the pairwise analysis show that all lead-I ECG devices generated ICERs per QALY gained below the £20,000–30,000 threshold. Kardia Mobile (AliveCor Ltd, Mountain View, CA, USA) is the most cost-effective option in a full incremental analysis. Limitations No published data evaluating the diagnostic accuracy, clinical impact or cost-effectiveness of lead-I ECG devices for the population of interest are available. Conclusions Single time point lead-I ECG devices for the detection of AF in people with signs or symptoms of AF and an irregular pulse appear to be a cost-effective use of NHS resources compared with MPP followed by a 12-lead ECG in primary or secondary care, given the assumptions used in the base-case model. Future work Studies assessing how the use of lead-I ECG devices in this population affects the number of people diagnosed with AF when compared with current practice would be useful. Study registration This study is registered as PROSPERO CRD42018090375. Funding The National Institute for Health Research Health Technology Assessment programme.