Erdi Babayiğit MD, Gurbet Özge Mert MD, Bülent Görenek MD, FACC, FESC
Dear Editor,
We have read with great interest the article published in your journal titled “Predictors of stroke or systemic embolism in patients with non-valvular atrial fibrillation with CHA2DS2-VASc score of 0” by Choi et al. (2023). The authors evaluated the predictors of atrial fibrillation in patients with CHA2DS2-VASc score of 0. We would like to draw attention to a few points about this article.
The major finding of the study was that risk of stroke or embolism rate was very low. Interestingly, the most of the patients were followed up without anticoagulation and no stroke was observed. We believe that especially the short follow-up period has shown a significantly lower risk of stroke in the study. On the other hand, it has been reported that atrial fibrillation (AF) is observed in 24% of all strokes and 12% in non-fatal strokes (Akyea et al., 2021; Tsao et al., 2022). Considering the retrospective nature of the study and the fact that two patients were even on anticoagulants, it may be difficult to say exactly how many of the patients who reached the primary outcome were guilty of AF.
Another point, the fact that patients with left ventricular end diastolic diameter of 46 mm and above were not evaluated in terms of heart failure with preserved ejection fraction (HFpEF) seems to be the limitation of the study. It is possible that the CHA2DS2-VASc score was calculated as 0 even though some patients had heart failure, ignoring the fact that the incidence of heart failure is approximately 1% especially under the age of 55, the lack of natriuretic peptide evaluation and the threshold for the resting E/e’ ratio is 9 in HFpEF diagnosis (McDonagh et al., 2021).
Finally, we would like to draw attention to obesity that is important in the development of AF and stroke and systemic embolism, as the mean weight was almost close to overweight range in the study. We also have seen that age is actually an important predictor in terms of shedding light on future studies on the prediction of outcomes.
The article was prepared with the contributions of all authors.
{"title":"Stroke and systemic embolism risk in patients with CHA2DS2-VASc score of 0","authors":"Erdi Babayiğit MD, Gurbet Özge Mert MD, Bülent Görenek MD, FACC, FESC","doi":"10.1111/anec.13060","DOIUrl":"https://doi.org/10.1111/anec.13060","url":null,"abstract":"<p>Dear Editor,</p><p>We have read with great interest the article published in your journal titled “Predictors of stroke or systemic embolism in patients with non-valvular atrial fibrillation with CHA<sub>2</sub>DS<sub>2</sub>-VASc score of 0” by Choi et al. (<span>2023</span>). The authors evaluated the predictors of atrial fibrillation in patients with CHA<sub>2</sub>DS<sub>2</sub>-VASc score of 0. We would like to draw attention to a few points about this article.</p><p>The major finding of the study was that risk of stroke or embolism rate was very low. Interestingly, the most of the patients were followed up without anticoagulation and no stroke was observed. We believe that especially the short follow-up period has shown a significantly lower risk of stroke in the study. On the other hand, it has been reported that atrial fibrillation (AF) is observed in 24% of all strokes and 12% in non-fatal strokes (Akyea et al., <span>2021</span>; Tsao et al., <span>2022</span>). Considering the retrospective nature of the study and the fact that two patients were even on anticoagulants, it may be difficult to say exactly how many of the patients who reached the primary outcome were guilty of AF.</p><p>Another point, the fact that patients with left ventricular end diastolic diameter of 46 mm and above were not evaluated in terms of heart failure with preserved ejection fraction (HFpEF) seems to be the limitation of the study. It is possible that the CHA<sub>2</sub>DS<sub>2</sub>-VASc score was calculated as 0 even though some patients had heart failure, ignoring the fact that the incidence of heart failure is approximately 1% especially under the age of 55, the lack of natriuretic peptide evaluation and the threshold for the resting E/e’ ratio is 9 in HFpEF diagnosis (McDonagh et al., <span>2021</span>).</p><p>Finally, we would like to draw attention to obesity that is important in the development of AF and stroke and systemic embolism, as the mean weight was almost close to overweight range in the study. We also have seen that age is actually an important predictor in terms of shedding light on future studies on the prediction of outcomes.</p><p>The article was prepared with the contributions of all authors.</p><p>None.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"28 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2023-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.13060","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50142017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sok-Sithikun Bun MD, PhD, Fabien Squara MD, Didier Scarlatti MD, Pamela Moceri MD, PhD, Emile Ferrari MD
Common atrium (CA), also called three-chambered heart, is one of the rare congenital anomalies, defined by a complete absence of the atrial septum, eventually associated with malformation of the atrioventricular (AV) valves. We report the case of a 57-year-old woman with CA complicated with Eisenmenger syndrome and inferior vena cava interruption, who suffered from symptomatic persistent atrial fibrillation (AF). She underwent an initial successful pulmonary vein isolation procedure. A repeat procedure for perivalvular atrial flutter was complicated with inadvertent complete AV block, due to unusual AV node location in this challenging anatomy.
{"title":"Atrial fibrillation ablation in a single atrium with inferior vena cava interruption","authors":"Sok-Sithikun Bun MD, PhD, Fabien Squara MD, Didier Scarlatti MD, Pamela Moceri MD, PhD, Emile Ferrari MD","doi":"10.1111/anec.13057","DOIUrl":"10.1111/anec.13057","url":null,"abstract":"<p>Common atrium (CA), also called three-chambered heart, is one of the rare congenital anomalies, defined by a complete absence of the atrial septum, eventually associated with malformation of the atrioventricular (AV) valves. We report the case of a 57-year-old woman with CA complicated with Eisenmenger syndrome and inferior vena cava interruption, who suffered from symptomatic persistent atrial fibrillation (AF). She underwent an initial successful pulmonary vein isolation procedure. A repeat procedure for perivalvular atrial flutter was complicated with inadvertent complete AV block, due to unusual AV node location in this challenging anatomy.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"28 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.13057","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9780455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sarim Rashid MBBS, Tayyiba Ahmed Noor MBBS, Hamayle Saeed MBBS, Asma Sabir Ali MBBS, Govinda Meheshwari MBBS, Asad Mehmood MBBS, Laveeza Fatima MBBS, Syed Muhammad Jawad Zaidi MBBS, Jahanzeb Malik MBBS, Amin Mehmoodi MD, Azmat Hayat MBBS, MRCP, FRCP, FHRS
Objective
Many clinical and preclinical studies have implicated an association between atrial fibrillation (AF) and its progression to imbalances in the gut microbiome composition. The gut microbiome is a diverse and complex ecosystem containing billions of microorganisms that produce biologically active metabolites influencing the host disease development.
Methods
For this review, a literature search was conducted using digital databases to systematically identify the studies reporting the association of gut microbiota with AF progression.
Results
In a total of 14 studies, 2479 patients were recruited for the final analysis. More than half (n = 8) of the studies reported alterations in alpha diversity in atrial fibrillation. As for the beta diversity, 10 studies showed significant alterations. Almost all studies that assessed gut microbiota alterations reported major taxa associated with atrial fibrillation. Most studies focused on short-chain fatty acids (SCFAs), whereas three studies evaluated TMAO levels in the blood, which is the breakdown product of dietary l-carnitine, choline, and lecithin. Moreover, an independent cohort study assessed the relationship between phenylacetylglutamine (PAGIn) and AF.
Conclusion
Intestinal dysbiosis is a modifiable risk factor that might provide newer treatment strategies for AF prevention. Well-designed research and prospective randomized interventional studies are required to target the gut dysbiotic mechanisms and determine the gut dysbiotic-AF relationship.
{"title":"Association of gut microbiome dysbiosis with the progression of atrial fibrillation: A systematic review","authors":"Sarim Rashid MBBS, Tayyiba Ahmed Noor MBBS, Hamayle Saeed MBBS, Asma Sabir Ali MBBS, Govinda Meheshwari MBBS, Asad Mehmood MBBS, Laveeza Fatima MBBS, Syed Muhammad Jawad Zaidi MBBS, Jahanzeb Malik MBBS, Amin Mehmoodi MD, Azmat Hayat MBBS, MRCP, FRCP, FHRS","doi":"10.1111/anec.13059","DOIUrl":"10.1111/anec.13059","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Many clinical and preclinical studies have implicated an association between atrial fibrillation (AF) and its progression to imbalances in the gut microbiome composition. The gut microbiome is a diverse and complex ecosystem containing billions of microorganisms that produce biologically active metabolites influencing the host disease development.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>For this review, a literature search was conducted using digital databases to systematically identify the studies reporting the association of gut microbiota with AF progression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In a total of 14 studies, 2479 patients were recruited for the final analysis. More than half (<i>n</i> = 8) of the studies reported alterations in alpha diversity in atrial fibrillation. As for the beta diversity, 10 studies showed significant alterations. Almost all studies that assessed gut microbiota alterations reported major taxa associated with atrial fibrillation. Most studies focused on short-chain fatty acids (SCFAs), whereas three studies evaluated TMAO levels in the blood, which is the breakdown product of dietary <span>l</span>-carnitine, choline, and lecithin. Moreover, an independent cohort study assessed the relationship between phenylacetylglutamine (PAGIn) and AF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Intestinal dysbiosis is a modifiable risk factor that might provide newer treatment strategies for AF prevention. Well-designed research and prospective randomized interventional studies are required to target the gut dysbiotic mechanisms and determine the gut dysbiotic-AF relationship.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"28 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2023-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/94/bd/ANEC-28-e13059.PMC10335625.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9844806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>It is a great honor to take over as Editor-in-Chief of the Annals of Noninvasive Electrocardiology from my longtime friend, ISHNE colleague, and collaborator Wojciech Zareba, MD, PhD. Having inherited the editorship from Arthur Moss, Wojciech has worked tirelessly for 11 years to strengthen the Annals. In this time, Wojciech has successfully delivered this journal through a period of great upheaval in publishing, leaving it stronger than ever. In 2021 alone, downloads increased by over 35%, outstripping Wiley's other cardiovascular journals which grew by 21.5%. This spectacular record reflects the quality of the manuscripts that were submitted, but ultimately the person in charge must accept the blame for failure or, in this case, the credit for success. Wojciech accomplished this while continuing research activities at the University of Rochester, serving as Principal Investigator in numerous NIH and industry funded trials, and publishing at a furious pace. This September, I had the pleasure of seeing him installed as the inaugural David Mortara Endowed Professor of Cardiology at the University of Rochester, the highest academic honor that can be bestowed. His will be a tough act to follow.</p><p>No less important to the success of the Annals has been Grazyna Zareba, PhD, who has acted as Managing Editor for over a decade. Grazyna has been responsible for shepherding every manuscript through the stages of publication, and the readers of the Annals owe her a debt of gratitude.</p><p>I look forward to working closely with three superb associate editors. Yi-Gang Li, MD, is professor of medicine and Director of Cardiology at Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University. Dr. Li is an electrophysiologist who serves as Vice President of the Chinese Heart Rhythm Society, and is a very busy and productive investigator in the treatment of atrial fibrillation and other rhythm disorders.</p><p>Craig Dobson, MD, is the Director, Cardiac Clinical Operations, University of Pittsburgh Children's Hospital, in Pittsburgh, Pennsylvania. We have worked closely for 15 years. Craig is an expert in inherited cardiac diseases, and as a pediatric cardiologist brings a unique perspective. Noninvasive techniques for the diagnosis and follow up of congenital heart disease are pivotal in pediatric cardiology, and I believe the Annals will benefit from his experience, expertise, and perspective. In addition, Dr. Dobson is a retired US Army officer who has seen service in Afghanistan and Iraq, where he practiced medicine under the worst conceivable circumstances.</p><p>Mori Krantz, MD, is also a non-electrophysiologist who nevertheless has spent tremendous energy improving our understanding of the impact of drugs and disease on the surface electrocardiogram. As a professor of medicine at the University of Colorado in Denver, Colorado, Mori has dedicated himself to the use of electrocardiography to prevent sudden death in traditionally underserved popu
{"title":"Hail and Farewell","authors":"Mark Haigney MD","doi":"10.1111/anec.13055","DOIUrl":"10.1111/anec.13055","url":null,"abstract":"<p>It is a great honor to take over as Editor-in-Chief of the Annals of Noninvasive Electrocardiology from my longtime friend, ISHNE colleague, and collaborator Wojciech Zareba, MD, PhD. Having inherited the editorship from Arthur Moss, Wojciech has worked tirelessly for 11 years to strengthen the Annals. In this time, Wojciech has successfully delivered this journal through a period of great upheaval in publishing, leaving it stronger than ever. In 2021 alone, downloads increased by over 35%, outstripping Wiley's other cardiovascular journals which grew by 21.5%. This spectacular record reflects the quality of the manuscripts that were submitted, but ultimately the person in charge must accept the blame for failure or, in this case, the credit for success. Wojciech accomplished this while continuing research activities at the University of Rochester, serving as Principal Investigator in numerous NIH and industry funded trials, and publishing at a furious pace. This September, I had the pleasure of seeing him installed as the inaugural David Mortara Endowed Professor of Cardiology at the University of Rochester, the highest academic honor that can be bestowed. His will be a tough act to follow.</p><p>No less important to the success of the Annals has been Grazyna Zareba, PhD, who has acted as Managing Editor for over a decade. Grazyna has been responsible for shepherding every manuscript through the stages of publication, and the readers of the Annals owe her a debt of gratitude.</p><p>I look forward to working closely with three superb associate editors. Yi-Gang Li, MD, is professor of medicine and Director of Cardiology at Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University. Dr. Li is an electrophysiologist who serves as Vice President of the Chinese Heart Rhythm Society, and is a very busy and productive investigator in the treatment of atrial fibrillation and other rhythm disorders.</p><p>Craig Dobson, MD, is the Director, Cardiac Clinical Operations, University of Pittsburgh Children's Hospital, in Pittsburgh, Pennsylvania. We have worked closely for 15 years. Craig is an expert in inherited cardiac diseases, and as a pediatric cardiologist brings a unique perspective. Noninvasive techniques for the diagnosis and follow up of congenital heart disease are pivotal in pediatric cardiology, and I believe the Annals will benefit from his experience, expertise, and perspective. In addition, Dr. Dobson is a retired US Army officer who has seen service in Afghanistan and Iraq, where he practiced medicine under the worst conceivable circumstances.</p><p>Mori Krantz, MD, is also a non-electrophysiologist who nevertheless has spent tremendous energy improving our understanding of the impact of drugs and disease on the surface electrocardiogram. As a professor of medicine at the University of Colorado in Denver, Colorado, Mori has dedicated himself to the use of electrocardiography to prevent sudden death in traditionally underserved popu","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"28 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2023-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.13055","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9181766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mohamed ElRefai MBBCh, MRCP, PhD, Mohamed Abouelasaad MBBCh, MSc, MRCP, Benedict M. Wiles PhD, MA, MBBS, MRCP, Anthony J. Dunn BSc, Stefano Coniglio PhD, Alain B. Zemkoho PhD, John Morgan MA, MB, MBBChir, MD(Cantab), FRCP, FESC, FBHRS, Paul R. Roberts MD, FRCP
Background
Machine learning methods are used in the classification of various cardiovascular diseases through ECG data analysis. The concept of varying subcutaneous implantable cardiac defibrillator (S-ICD) eligibility, owing to the dynamicity of ECG signals, has been introduced before. There are practical limitations to acquiring longer durations of ECG signals for S-ICD screening. This study explored the potential use of deep learning methods in S-ICD screening.
Methods
This was a retrospective study. A deep learning tool was used to provide descriptive analysis of the T:R ratios over 24 h recordings of S-ICD vectors. Spearman's rank correlation test was used to compare the results statistically to those of a “gold standard” S-ICD simulator.
Results
A total of 14 patients (mean age: 63.7 ± 5.2 years, 71.4% male) were recruited and 28 vectors were analyzed. Mean T:R, standard deviation of T:R, and favorable ratio time (FVR)—a new concept introduced in this study—for all vectors combined were 0.21 ± 0.11, 0.08 ± 0.04, and 79 ± 30%, respectively. There were statistically significant strong correlations between the outcomes of our novel tool and the S-ICD simulator (p < .001).
Conclusion
Deep learning methods could provide a practical software solution to analyze data acquired for longer durations than current S-ICD screening practices. This could help select patients better suited for S-ICD therapy as well as guide vector selection in S-ICD eligible patients. Further work is needed before this could be translated into clinical practice.
{"title":"Correlation analysis of deep learning methods in S-ICD screening","authors":"Mohamed ElRefai MBBCh, MRCP, PhD, Mohamed Abouelasaad MBBCh, MSc, MRCP, Benedict M. Wiles PhD, MA, MBBS, MRCP, Anthony J. Dunn BSc, Stefano Coniglio PhD, Alain B. Zemkoho PhD, John Morgan MA, MB, MBBChir, MD(Cantab), FRCP, FESC, FBHRS, Paul R. Roberts MD, FRCP","doi":"10.1111/anec.13056","DOIUrl":"10.1111/anec.13056","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Machine learning methods are used in the classification of various cardiovascular diseases through ECG data analysis. The concept of varying subcutaneous implantable cardiac defibrillator (S-ICD) eligibility, owing to the dynamicity of ECG signals, has been introduced before. There are practical limitations to acquiring longer durations of ECG signals for S-ICD screening. This study explored the potential use of deep learning methods in S-ICD screening.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective study. A deep learning tool was used to provide descriptive analysis of the T:R ratios over 24 h recordings of S-ICD vectors. Spearman's rank correlation test was used to compare the results statistically to those of a “gold standard” S-ICD simulator.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 14 patients (mean age: 63.7 ± 5.2 years, 71.4% male) were recruited and 28 vectors were analyzed. Mean T:R, standard deviation of T:R, and favorable ratio time (FVR)—a new concept introduced in this study—for all vectors combined were 0.21 ± 0.11, 0.08 ± 0.04, and 79 ± 30%, respectively. There were statistically significant strong correlations between the outcomes of our novel tool and the S-ICD simulator (<i>p</i> < .001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Deep learning methods could provide a practical software solution to analyze data acquired for longer durations than current S-ICD screening practices. This could help select patients better suited for S-ICD therapy as well as guide vector selection in S-ICD eligible patients. Further work is needed before this could be translated into clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"28 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2023-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.13056","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10164696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michele M. Pelter RN, PhD, Mary G. Carey RN, PhD, Salah Al-Zaiti RN, PhD, Jessica Zegre-Hemsey RN, PhD, Claire Sommargren RN, PhD, Lamberto Isola MS, Priya Prasad PhD, David Mortara PhD, Fabio Badilini PhD
Background
False ventricular tachycardia (VT) alarms are common during in-hospital electrocardiographic (ECG) monitoring. Prior research shows that the majority of false VT can be attributed to algorithm deficiencies.
Purpose
The purpose of this study was: (1) to describe the creation of a VT database annotated by ECG experts and (2) to determine true vs. false VT using a new VT algorithm created by our group.
Methods
The VT algorithm was processed in 5320 consecutive ICU patients with 572,574 h of ECG and physiologic monitoring. A search algorithm identified potential VT, defined as: heart rate >100 beats/min, QRSs > 120 ms, and change in QRS morphology in >6 consecutive beats compared to the preceding native rhythm. Seven ECG channels, SpO2, and arterial blood pressure waveforms were processed and loaded into a web-based annotation software program. Five PhD-prepared nurse scientists performed the annotations.
Results
Of the 5320 ICU patients, 858 (16.13%) had 22,325 VTs. After three levels of iterative annotations, a total of 11,970 (53.62%) were adjudicated as true, 6485 (29.05%) as false, and 3870 (17.33%) were unresolved. The unresolved VTs were concentrated in 17 patients (1.98%). Of the 3870 unresolved VTs, 85.7% (n = 3281) were confounded by ventricular paced rhythm, 10.8% (n = 414) by underlying BBB, and 3.5% (n = 133) had a combination of both.
Conclusions
The database described here represents the single largest human-annotated database to date. The database includes consecutive ICU patients, with true, false, and challenging VTs (unresolved) and could serve as a gold standard database to develop and test new VT algorithms.
{"title":"An annotated ventricular tachycardia (VT) alarm database: Toward a uniform standard for optimizing automated VT identification in hospitalized patients","authors":"Michele M. Pelter RN, PhD, Mary G. Carey RN, PhD, Salah Al-Zaiti RN, PhD, Jessica Zegre-Hemsey RN, PhD, Claire Sommargren RN, PhD, Lamberto Isola MS, Priya Prasad PhD, David Mortara PhD, Fabio Badilini PhD","doi":"10.1111/anec.13054","DOIUrl":"10.1111/anec.13054","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>False ventricular tachycardia (VT) alarms are common during in-hospital electrocardiographic (ECG) monitoring. Prior research shows that the majority of false VT can be attributed to algorithm deficiencies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The purpose of this study was: (1) to describe the creation of a VT database annotated by ECG experts and (2) to determine true vs. false VT using a new VT algorithm created by our group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The VT algorithm was processed in 5320 consecutive ICU patients with 572,574 h of ECG and physiologic monitoring. A search algorithm identified potential VT, defined as: heart rate >100 beats/min, QRSs > 120 ms, and change in QRS morphology in >6 consecutive beats compared to the preceding native rhythm. Seven ECG channels, SpO<sub>2</sub>, and arterial blood pressure waveforms were processed and loaded into a web-based annotation software program. Five PhD-prepared nurse scientists performed the annotations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 5320 ICU patients, 858 (16.13%) had 22,325 VTs. After three levels of iterative annotations, a total of 11,970 (53.62%) were adjudicated as true, 6485 (29.05%) as false, and 3870 (17.33%) were unresolved. The unresolved VTs were concentrated in 17 patients (1.98%). Of the 3870 unresolved VTs, 85.7% (<i>n</i> = 3281) were confounded by ventricular paced rhythm, 10.8% (<i>n</i> = 414) by underlying BBB, and 3.5% (<i>n</i> = 133) had a combination of both.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The database described here represents the single largest human-annotated database to date. The database includes consecutive ICU patients, with true, false, and challenging VTs (unresolved) and could serve as a gold standard database to develop and test new VT algorithms.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"28 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2023-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/46/9c/ANEC-28-e13054.PMC10335615.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10164664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Clinically, the pulse oxygen saturation of patients with chronic heart failure does not decrease significantly, and the clinical manifestations of labor-related dyspnea are not typical. As such, it is difficult to make a rapid diagnosis.
Objective
To investigate changes in pulse oxygen saturation in patients with chronic heart failure and examine the relationship between B-type natriuretic peptide (BNP) and normal pulse oxygen saturation.
Methods
A total of 80 hospitalized patients with chronic heart failure and increased BNP were randomly selected as the study group; the family members of 60 patients without dyspnea were randomly selected as the control group. The researchers measured the value of pulse oxygen saturation before and after upper arm compression, calculating the difference and analyzing the correlation between this difference and BNP values. The data were statistically analyzed using the SPSS Statistics 17.0 program.
Results
The decrease in pulse oxygen saturation in the study group was greater than in the control group; the decrease in pulse oxygen saturation of patients with chronic heart failure positively correlated with BNP.
Conclusion
The value of pulse oxygen saturation in patients with chronic heart failure decreased more than in the control group, and this difference positively correlated with BNP. The measurement of pulse oxygen saturation before and after upper arm compression is a simple and effective method for diagnosing and evaluating chronic heart failure.
{"title":"A study on the rapid diagnosis of chronic heart failure by measuring the difference in pulse oxygen saturation before and after arm compression","authors":"Jian-feng Jia MD, Li-fei Wang MD, Xing-li Gao MD","doi":"10.1111/anec.13049","DOIUrl":"10.1111/anec.13049","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Clinically, the pulse oxygen saturation of patients with chronic heart failure does not decrease significantly, and the clinical manifestations of labor-related dyspnea are not typical. As such, it is difficult to make a rapid diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate changes in pulse oxygen saturation in patients with chronic heart failure and examine the relationship between B-type natriuretic peptide (BNP) and normal pulse oxygen saturation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 80 hospitalized patients with chronic heart failure and increased BNP were randomly selected as the study group; the family members of 60 patients without dyspnea were randomly selected as the control group. The researchers measured the value of pulse oxygen saturation before and after upper arm compression, calculating the difference and analyzing the correlation between this difference and BNP values. The data were statistically analyzed using the SPSS Statistics 17.0 program.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The decrease in pulse oxygen saturation in the study group was greater than in the control group; the decrease in pulse oxygen saturation of patients with chronic heart failure positively correlated with BNP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The value of pulse oxygen saturation in patients with chronic heart failure decreased more than in the control group, and this difference positively correlated with BNP. The measurement of pulse oxygen saturation before and after upper arm compression is a simple and effective method for diagnosing and evaluating chronic heart failure.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"28 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2023-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.13049","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9566267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Antoni Bayés-de-Luna MD, PhD, FACC, FESC, Ljuba Bacharova MD, DSc, MBA
In this article, we will comment on new aspects of P-wave morphology that help us to better diagnose atrial blocks and atrial enlargement, and their clinical implications. These include: (1) Atypical ECG patterns of advanced interatrial block; (2) The ECG diagnosis of left atrial enlargement versus interatrial block; (3) Atrial fibrillation and advanced interatrial block: The two sides of the same coin; and (4) P-wave parameters: Clinical implications.
{"title":"New electrocardiographic aspects of the P wave: Its value in clinical cardiology","authors":"Antoni Bayés-de-Luna MD, PhD, FACC, FESC, Ljuba Bacharova MD, DSc, MBA","doi":"10.1111/anec.13053","DOIUrl":"10.1111/anec.13053","url":null,"abstract":"<p>In this article, we will comment on new aspects of P-wave morphology that help us to better diagnose atrial blocks and atrial enlargement, and their clinical implications. These include: (1) Atypical ECG patterns of advanced interatrial block; (2) The ECG diagnosis of left atrial enlargement versus interatrial block; (3) Atrial fibrillation and advanced interatrial block: The two sides of the same coin; and (4) P-wave parameters: Clinical implications.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"28 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2023-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/76/b4/ANEC-28-e13053.PMC10196095.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9514856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kevin Liu MD, Kai Chen MD, Ekin C. Uzunoglu MD, Azeem Rathore MD, Tanya Deol MD, Ele Wu MD, Claude S. Elayi MD, FHRS, Prakash G. Suryanarayana MD, Stephen G. Keim MD, John N. Catanzaro MD, FHRS
Aims
To summarize published case reports of patients diagnosed with coronavirus disease 2019 (COVID-19) and Brugada pattern electrocardiogram (ECG).
Methods
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist were followed. A literature search was conducted using PubMed, EMBASE, and Scopus up until September 2021. The incidence, clinical characteristics, and management outcomes of COVID-19 patients with a Brugada pattern ECG were identified.
Results
A total of 18 cases were collected. The mean age was 47.1 years and 11.1% were women. No patients had prior confirmed diagnosis of Brugada syndrome. The most common presenting clinical symptoms were fever (83.3%), chest pain (38.8%), shortness of breath (38.8%), and syncope (16.6%). All 18 patients presented with type 1 Brugada pattern ECG. Four patients (22.2%) underwent left heart catheterization, and none demonstrated the presence of obstructive coronary disease. The most common reported therapies included antipyretics (55.5%), hydroxychloroquine (27.7%), and antibiotics (16.6%). One patient (5.5%) died during hospitalization. Three patients (16.6%) who presented with syncope received either an implantable cardioverter defibrillator or wearable cardioverter defibrillator at discharge. At follow-up, 13 patients (72.2%) had resolution of type 1 Brugada pattern ECG.
Conclusion
COVID-19-associated Brugada pattern ECG seems relatively rare. Most patients had resolution of the ECG pattern once their symptoms have improved. Increased awareness and timely use of antipyretics is warranted in this population.
{"title":"COVID-19-associated Brugada pattern electrocardiogram: Systematic review of case reports","authors":"Kevin Liu MD, Kai Chen MD, Ekin C. Uzunoglu MD, Azeem Rathore MD, Tanya Deol MD, Ele Wu MD, Claude S. Elayi MD, FHRS, Prakash G. Suryanarayana MD, Stephen G. Keim MD, John N. Catanzaro MD, FHRS","doi":"10.1111/anec.13051","DOIUrl":"10.1111/anec.13051","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To summarize published case reports of patients diagnosed with coronavirus disease 2019 (COVID-19) and Brugada pattern electrocardiogram (ECG).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist were followed. A literature search was conducted using PubMed, EMBASE, and Scopus up until September 2021. The incidence, clinical characteristics, and management outcomes of COVID-19 patients with a Brugada pattern ECG were identified.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 18 cases were collected. The mean age was 47.1 years and 11.1% were women. No patients had prior confirmed diagnosis of Brugada syndrome. The most common presenting clinical symptoms were fever (83.3%), chest pain (38.8%), shortness of breath (38.8%), and syncope (16.6%). All 18 patients presented with type 1 Brugada pattern ECG. Four patients (22.2%) underwent left heart catheterization, and none demonstrated the presence of obstructive coronary disease. The most common reported therapies included antipyretics (55.5%), hydroxychloroquine (27.7%), and antibiotics (16.6%). One patient (5.5%) died during hospitalization. Three patients (16.6%) who presented with syncope received either an implantable cardioverter defibrillator or wearable cardioverter defibrillator at discharge. At follow-up, 13 patients (72.2%) had resolution of type 1 Brugada pattern ECG.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>COVID-19-associated Brugada pattern ECG seems relatively rare. Most patients had resolution of the ECG pattern once their symptoms have improved. Increased awareness and timely use of antipyretics is warranted in this population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"28 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2023-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.13051","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9513559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zao-Xian Xu MD, Yi Yang MD, Shang-Ping Xin MD, Rong-Fang Zhou MD, Xiao-Ling Shou MD
Coronary artery tortuosity (CAT) is frequently detected during coronary angiography or coronary electron-beam computed tomography angiography by cardiovascular interventionalists. In this article, we described the case of a 69-year-old female patient with recurrent chest discomfort for 1 month and recurrence 1 week ago, accompanied by emaciation, gastrointestinal discomfort, and low skin temperature at the extremities. After a series of tests, the patient was finally diagnosed with severe CAT and coexisting connective tissue disease. Accordingly, she was treated with conventional medications, and diet and lifestyle modifications. The symptoms of the patient resolved gradually after 1 year of follow-up. Although there is no unanimous conclusion on the pathogenesis and clinical characteristics of CAT, this disease may provide a clue to the diagnosis of connective tissue disease, and warrants exploration through further research.
{"title":"Case report of severe coronary artery tortuosity with coexisting connective tissue disease","authors":"Zao-Xian Xu MD, Yi Yang MD, Shang-Ping Xin MD, Rong-Fang Zhou MD, Xiao-Ling Shou MD","doi":"10.1111/anec.13052","DOIUrl":"10.1111/anec.13052","url":null,"abstract":"<p>Coronary artery tortuosity (CAT) is frequently detected during coronary angiography or coronary electron-beam computed tomography angiography by cardiovascular interventionalists. In this article, we described the case of a 69-year-old female patient with recurrent chest discomfort for 1 month and recurrence 1 week ago, accompanied by emaciation, gastrointestinal discomfort, and low skin temperature at the extremities. After a series of tests, the patient was finally diagnosed with severe CAT and coexisting connective tissue disease. Accordingly, she was treated with conventional medications, and diet and lifestyle modifications. The symptoms of the patient resolved gradually after 1 year of follow-up. Although there is no unanimous conclusion on the pathogenesis and clinical characteristics of CAT, this disease may provide a clue to the diagnosis of connective tissue disease, and warrants exploration through further research.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"28 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2023-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.13052","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9842666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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