The ESC Working Group on e-Cardiology Casado Arroyo, Ruben; Jensen, Magnus T; Dilaveris, Polychronis ...
European heart journal,
07/2024
Journal Article
Left ventricular (LV) scar on late gadolinium enhancement (LGE) cardiac magnetic resonance has been correlated with life-threatening arrhythmic events in patients with apparently idiopathic ...ventricular arrhythmias (VAs). We investigated the prognostic significance of a specific LV-LGE phenotype characterized by a ringlike pattern of fibrosis.
A total of 686 patients with apparently idiopathic nonsustained VA underwent contrast-enhanced cardiac magnetic resonance. A ringlike pattern of LV scar was defined as LV subepicardial/midmyocardial LGE involving at least 3 contiguous segments in the same short-axis slice. The end point of the study was time to the composite outcome of all-cause death, resuscitated cardiac arrest because of ventricular fibrillation or hemodynamically unstable ventricular tachycardia and appropriate implantable cardioverter defibrillator therapy.
A total of 28 patients (4%) had a ringlike pattern of scar (group A), 78 (11%) had a non-ringlike pattern (group B), and 580 (85%) had normal cardiac magnetic resonance with no LGE (group C). Group A patients were younger compared with groups B and C (median age, 40 vs 52 vs 45 years;
<0.01), more frequently men (96% vs 82% vs 55%;
<0.01), with a higher prevalence of family history of sudden cardiac death or cardiomyopathy (39% vs 14% vs 6%;
<0.01) and more frequent history of unexplained syncope (18% vs 9% vs 3%;
<0.01). All patients in group A showed VA with a right bundle-branch block morphology versus 69% in group B and 21% in group C (
<0.01). Multifocal VAs were observed in 46% of group A patients compared with 26% of group B and 4% of group C (
<0.01). After a median follow-up of 61 months (range, 34-84 months), the composite outcome occurred in 14 patients (50.0%) in group A versus 15 (19.0%) in group B and 2 (0.3%) in group C (
<0.01). After multivariable adjustment, the presence of LGE with ringlike pattern remained independently associated with increased risk of the composite end point (hazard ratio, 68.98 95% CI, 14.67-324.39,
<0.01).
In patients with apparently idiopathic nonsustained VA, nonischemic LV scar with a ringlike pattern is associated with malignant arrhythmic events.
Abstract
Aims
Atrial fibrillation (AF) is the most common sustained arrhythmia and an important risk factor for stroke and heart failure. We aimed to conduct a systematic review of the literature and ...summarize the performance of mobile health (mHealth) devices in diagnosing and screening for AF.
Methods and results
We conducted a systematic search of MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. Forty-three studies met the inclusion criteria and were divided into two groups: 28 studies aimed at validating smart devices for AF diagnosis, and 15 studies used smart devices to screen for AF. Evaluated technologies included smartphones, with photoplethysmographic (PPG) pulse waveform measurement or accelerometer sensors, smartbands, external electrodes that can provide a smartphone single-lead electrocardiogram (iECG), such as AliveCor, Zenicor and MyDiagnostick, and earlobe monitor. The accuracy of these devices depended on the technology and the population, AliveCor and smartphone PPG sensors being the most frequent systems analysed. The iECG provided by AliveCor demonstrated a sensitivity and specificity between 66.7% and 98.5% and 99.4% and 99.0%, respectively. The PPG sensors detected AF with a sensitivity of 85.0–100% and a specificity of 93.5–99.0%. The incidence of newly diagnosed arrhythmia ranged from 0.12% in a healthy population to 8% among hospitalized patients.
Conclusion
Although the evidence for clinical effectiveness is limited, these devices may be useful in detecting AF. While mHealth is growing in popularity, its clinical, economic, and policy implications merit further investigation. More head-to-head comparisons between mHealth and medical devices are needed to establish their comparative effectiveness.
Phrenic nerve palsy (PNP) is the most frequently observed complication during cryoballoon ablation (CB; Arctic Front, Medtronic, MN) occurring in roughly 7%-9% of the cases. The new second-generation ...cryoballoon ablation Arctic Front Advance (CB-A) (Arctic Front) has recently been launched in the market.
To evaluate the incidence of right PNP with the new CB-A in comparison with the first-generation balloon in a series of consecutive patients that underwent pulmonary vein isolation with this modality.
The study was designed as an observational study with a prospective follow-up. In total, 121 consecutive patients were included: 80 patients with the CB (group 1) and 41 with the CB-A (group 2).
Mean procedural times, fluoroscopic times, and time to pulmonary vein isolation documented by real-time recordings were significantly lower in group 2 (P ≤ .05). The occurrence of PNP was significantly higher in group 2 (6.25% 5 of 80 in group 1 vs 19.5% 8 of 41 in group 2; P = .033). At 7 months, PNP persisted in 1 (2.5%) patient in the CB-A group.
Right PNP seems to occur in a significantly larger number of patients with the second-generation CB-A. However, this complication is reversible in nearly all cases on short-term follow-up. More refined phrenic nerve monitoring during right-sided pulmonary vein ablation and less vigorous wedging maneuvers in the pulmonary vein ostia might significantly reduce the occurrence of this complication.
Introduction
Nonpulmonary vein (non‐PV) triggers of atrial fibrillation (AF) are targets for ablation but their localization remains challenging. The aim of this study was to describe P‐wave (PW) ...morphologic characteristics and intra‐atrial activation patterns and timing from multipolar coronary sinus (CS) and crista terminalis (CT) catheters that localize non‐PV triggers.
Methods and Results
Selective pacing from six right and nine left atrial common non‐PV trigger sites was performed in 30 consecutive patients. We analyzed 12 lead ECG features based on PW duration, amplitude and morphology, and patterns and timing of multipolar activation for all 15 sites. Regionalization and then precise localization required criteria present in at least 70% of assessments at each pacing site. The algorithm was then prospectively evaluated by four blinded observers in a validation cohort of 18 consecutive patients undergoing the same pacing protocol and 60 consecutive patients who underwent successful non‐PV trigger ablation.
The algorithm for site regionalization included 1) negative PW in V1, ≥30 µV change in PW amplitude across the leads V1‐V3, and PW duration ≤100 milliseconds in lead 2 and 2) unique intra‐atrial activation patterns and timing noted in the multipolar catheters. Specific ECG and intra‐atrial activation timing characteristics included in the algorithm allowed for more precise site localization after regionalization. In the prospective evaluation, the algorithm identified the site of origin for 72% of paced and 70% of spontaneous non‐PV trigger sites.
Conclusion
An algorithm based on PW morphology and intra‐atrial multipolar activation pattern and timing can help identify non‐PV trigger sites of origin.
The “MINimizE Right Ventricular pacing to prevent Atrial fibrillation and heart failure” (MINERVA) multicenter randomized study demonstrated that atrial anti-tachycardia pacing (A-ATP) can ...effectively decrease the burden of atrial fibrillation (AF) in patients with bradycardia and atrial tachyarrhythmias. We herein describe the unique electrophysiological results of AF ablation in a patient for whom atrial flutter (AFL) was terminated by A-ATP from a Medtronic dual-chamber pacemaker. In this case, the atrial activation sequence indicated that the tachycardia was a right atrial typical flutter and that A-ATP from the right atrial appendage would thus be more likely to terminate the tachycardia. This is a novel case involving documented intracardiac electrograms captured during an AF ablation study in a patient in whom AFL was successfully terminated by A-ATP. These findings provide insight into the mechanisms by which A-ATP can terminate atrial arrhythmias.
The extensive collection of electrocardiogram (ECG) recordings stored in paper format has provided opportunities for numerous digitization studies. However, the traditional 10 s 12-lead ECG printout ...typically splits the ECG signals into four asynchronous sections of 3 leads and 2.5 s each. Since each lead corresponds to different time instants, developing a synchronization method becomes necessary for applications such as vectorcardiogram (VCG) reconstruction.
A beat-level synchronization method has been developed and validated using a dataset of 21,674 signals. This method effectively addresses synchronization distortions caused by RR interval variations and preserves the time lags between R peaks across different leads for each beat.
The results demonstrate that the proposed method successfully synchronizes the ECG, allowing a VCG reconstruction with an average Pearson Correlation Coefficient of 0.9815±0.0426. The Normalized Root Mean Squared Error (NRMSE) and Mean Absolute Error (MAE) values for the reconstructed VCG are 0.0248±0.0214 mV and 0.0133±0.0123 mV, respectively. These metrics indicate the reliability of the VCG reconstruction achieved by means of the proposed synchronization method.
The synchronization method has demonstrated its robustness and high performance compared to existing techniques in the field. Its effectiveness has been observed across a wide variety of signals, showcasing its applicability in real clinical environments. Moreover, its ability to handle a large number of signals makes it suitable for various applications, including retrospective studies and the development of machine learning methods.
•Novel beat-level synchronization method for ECG signals, enhancing VCG reconstruction.•Validation on a dataset of 21,674 signals, ensuring robust synchronization across various leads.•A phantom model was created on the validation set for ECG printout replication.•Achieved high accuracy in VCG reconstruction with an average Pearson Correlation of 0.9815.•Method’s effectiveness in clinical settings and suitability for retrospective studies.
The aim of this study is to propose a method to reduce the sensitivity of the estimated omnipolar electrogram (oEGM) with respect to the angle of the propagation wavefront.
A novel configuration of ...cliques taking into account all four electrodes of a squared cell is proposed. To test this approach, simulations of HD grids of cardiac activations at different propagation angles, conduction velocities, interelectrode distance and electrogram waveforms are considered.
The proposed approach successfully provided narrower loops (essentially a straight line) of the electrical field described by the bipole pair with respect to the conventional approach. Estimation of the direction of propagation was improved. Additionally, estimated oEGMs presented larger amplitude, and estimations of the local activation times were more accurate.
A novel method to improve the estimation of oEGMs in HD grid of electrodes is proposed. This approach is superior to the existing methods and avoids pitfalls not yet resolved.
Robust tools for quantifying the cardiac substrate are crucial to determine with accuracy target ablation sites during an electrophysiological procedure.
•A robust method to estimate Omnipolar Electrograms is proposed for HD catheters.•A novel methodology based on a cross-oriented clique is proposed for the first time.•The direction of propagation is better estimated.•Local activation times are detected with higher accuracy.•Results may have a big impact on the design of novel catheters.
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