To simulate thrombotic occlusion of catheters and develop a model for thrombotic occlusion in peripherally inserted central catheters (PICC), providing a framework for research on catheter occlusion and post-occlusion recanalization.
Methods
Following preparatory steps prior to modeling, sterile anticoagulant bovine blood was drawn and injected into the PICC. Subsequently, the catheter tip was clamped and left to stand for 72 h.
Results
A total of 140 catheter models were produced, all of which exhibited thrombosis, resulting in a 100% success rate for intra-catheter thrombus production. Of these, 118 models experienced no blood reflux when the syringe plunger was withdrawn and triggered an infusion pump alarm, achieving a catheter occlusion modeling success rate of 84.29%. There were 127 cases where syringe plunger withdrawal resulted in no blood reflux within the thrombotic catheter occlusion models, yielding an incidence rate of 90.71%, while 13 cases revealed blood reflux mixed with fine thrombosis, with an incidence rate of 9.29%. Additionally, 126 models triggered infusion pump alarms, with an incidence rate of 90%, while 14 models did not trigger alarms due to thrombus overflow at the catheter tip, with an incidence rate of 10%. The infusion pump alarm method and the syringe withdrawal method demonstrated a significant correlation in diagnosing thrombotic catheter occlusion.
Conclusion
The method for modeling thrombotic catheter occlusion used in this study is reliable, producing a model that accurately simulates the fundamental characteristics of thrombotic catheter occlusion. This model has the potential for application in clinical practice.
{"title":"Simulation and Modeling Thrombotic Occlusion in Peripherally Inserted Central Catheters","authors":"Feng-Xian Li, Qiao-hong Guo","doi":"10.1111/anec.70090","DOIUrl":"https://doi.org/10.1111/anec.70090","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To simulate thrombotic occlusion of catheters and develop a model for thrombotic occlusion in peripherally inserted central catheters (PICC), providing a framework for research on catheter occlusion and post-occlusion recanalization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Following preparatory steps prior to modeling, sterile anticoagulant bovine blood was drawn and injected into the PICC. Subsequently, the catheter tip was clamped and left to stand for 72 h.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 140 catheter models were produced, all of which exhibited thrombosis, resulting in a 100% success rate for intra-catheter thrombus production. Of these, 118 models experienced no blood reflux when the syringe plunger was withdrawn and triggered an infusion pump alarm, achieving a catheter occlusion modeling success rate of 84.29%. There were 127 cases where syringe plunger withdrawal resulted in no blood reflux within the thrombotic catheter occlusion models, yielding an incidence rate of 90.71%, while 13 cases revealed blood reflux mixed with fine thrombosis, with an incidence rate of 9.29%. Additionally, 126 models triggered infusion pump alarms, with an incidence rate of 90%, while 14 models did not trigger alarms due to thrombus overflow at the catheter tip, with an incidence rate of 10%. The infusion pump alarm method and the syringe withdrawal method demonstrated a significant correlation in diagnosing thrombotic catheter occlusion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The method for modeling thrombotic catheter occlusion used in this study is reliable, producing a model that accurately simulates the fundamental characteristics of thrombotic catheter occlusion. This model has the potential for application in clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70090","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143950153","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}
The objective of this study is to examine the evolving cardiac characteristics of patients with cardiac amyloidosis (CA) and hypertrophic cardiomyopathy (HCM) by integrating multimodal imaging techniques, including conventional echocardiography, strain echocardiography, and cardiac magnetic resonance imaging.
Methods
A retrospective study was conducted, comprising 38 patients with CA, 20 patients with HCM, and 16 healthy individuals in the control group. Statistical analyses were conducted to assess conventional and strain echocardiography parameters across these groups. Furthermore, cardiac magnetic resonance imaging data from 15 patients with CA and 15 patients with HCM were analyzed and compared, focusing on correlations between imaging parameters and myocardial amyloid load.
Results
Analysis of conventional and strain echocardiography revealed that left ventricular ejection fraction, E/e′, relative apical longitudinal sparing, and the ejection fraction-to-longitudinal strain ratio were strongly associated with the diagnosis of CA and served as key differentiators between the CA and HCM groups. The combination of these four parameters yielded optimal diagnostic efficiency, with an area under the curve of 0.916.
Conclusion
The integration of conventional and strain multiparametric echocardiography demonstrated superior diagnostic efficacy in differentiating CA from HCM. Furthermore, the analysis of cardiac magnetic resonance parameters indicated that an increase in cardiac amyloid load is associated with changes in cardiac indices, with parameters such as E/e′, basal longitudinal strain, global longitudinal strain, and ejection fraction-to-strain ratio effectively reflecting the extent of amyloid infiltration in the myocardium.
{"title":"Evaluating the Role of Multimodal Imaging in the Diagnosis of Cardiac Amyloidosis and Hypertrophic Cardiomyopathy","authors":"Zi-xin Yang, Rong-hui Zheng, Cui-yan Wang, Hai-tao Yuan, Yong-le Sun, Mei Zhu","doi":"10.1111/anec.70086","DOIUrl":"https://doi.org/10.1111/anec.70086","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The objective of this study is to examine the evolving cardiac characteristics of patients with cardiac amyloidosis (CA) and hypertrophic cardiomyopathy (HCM) by integrating multimodal imaging techniques, including conventional echocardiography, strain echocardiography, and cardiac magnetic resonance imaging.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective study was conducted, comprising 38 patients with CA, 20 patients with HCM, and 16 healthy individuals in the control group. Statistical analyses were conducted to assess conventional and strain echocardiography parameters across these groups. Furthermore, cardiac magnetic resonance imaging data from 15 patients with CA and 15 patients with HCM were analyzed and compared, focusing on correlations between imaging parameters and myocardial amyloid load.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Analysis of conventional and strain echocardiography revealed that left ventricular ejection fraction, E/e′, relative apical longitudinal sparing, and the ejection fraction-to-longitudinal strain ratio were strongly associated with the diagnosis of CA and served as key differentiators between the CA and HCM groups. The combination of these four parameters yielded optimal diagnostic efficiency, with an area under the curve of 0.916.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The integration of conventional and strain multiparametric echocardiography demonstrated superior diagnostic efficacy in differentiating CA from HCM. Furthermore, the analysis of cardiac magnetic resonance parameters indicated that an increase in cardiac amyloid load is associated with changes in cardiac indices, with parameters such as E/e′, basal longitudinal strain, global longitudinal strain, and ejection fraction-to-strain ratio effectively reflecting the extent of amyloid infiltration in the myocardium.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70086","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143930238","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}
Mustafa Gabarin, Mahmoud Suleiman, Adi Elias, Ibrahim Marai, Roy Beinart, Eyal Nof, Yoav Michowitz, Michael Glikson, Yuval Konstantino, Moti Haim, David Luria, David Pereg, Avishag Laish-Farkash, Alexander Omelchenko, the Israeli Working Group on Pacing Electrophysiology
Background
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in adults, associated with serious cardiovascular complications such as ischemic stroke, heart failure, and myocardial infarction. Pulmonary vein isolation (PVI) is an established rhythm-control strategy for AF. Although the CHA2DS2-VASc score is primarily used to estimate stroke risk in patients with AF, its potential utility in predicting AF recurrence after PVI has not been fully explored in contemporary, real-world multicenter settings.
Aim
To evaluate the association between the CHA2DS2-VASc score and both AF recurrence and adverse clinical outcomes following PVI.
Methods
We conducted a retrospective cohort study using the Israeli Catheter Ablation Registry (ICAR), including 860 patients undergoing their first PVI for AF. Patients were grouped by CHA2DS2-VASc score (0–1, 2–4, > 5). The primary endpoint was AF recurrence within 12 months. Secondary endpoints included re-hospitalization, major adverse cardiovascular events (MACE), and all-cause mortality.
Results
AF recurrence occurred in 32% of patients. Recurrence rates were 25.7%, 31.4%, and 51% across the low, intermediate, and high CHA2DS2-VASc score groups, respectively. A higher score was independently associated with increased recurrence risk (HR = 2.88; 95% CI, 1.75–4.74; p < 0.001). Elevated CHA2DS2-VASc scores also correlated with higher MACE and re-hospitalization rates. No significant difference in all-cause mortality was observed.
Conclusion
The CHA2DS2-VASc score is an independent predictor of AF recurrence and adverse outcomes after PVI. Its simplicity, availability, and routine use make it a clinically useful tool to support preprocedural risk stratification in AF patients undergoing ablation.
{"title":"CHA2DS2-VASc Score as a Predictor for Atrial Fibrillation Recurrence and Clinical Outcomes Following Pulmonary Vein Isolation","authors":"Mustafa Gabarin, Mahmoud Suleiman, Adi Elias, Ibrahim Marai, Roy Beinart, Eyal Nof, Yoav Michowitz, Michael Glikson, Yuval Konstantino, Moti Haim, David Luria, David Pereg, Avishag Laish-Farkash, Alexander Omelchenko, the Israeli Working Group on Pacing Electrophysiology","doi":"10.1111/anec.70088","DOIUrl":"https://doi.org/10.1111/anec.70088","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in adults, associated with serious cardiovascular complications such as ischemic stroke, heart failure, and myocardial infarction. Pulmonary vein isolation (PVI) is an established rhythm-control strategy for AF. Although the CHA<sub>2</sub>DS<sub>2</sub>-VASc score is primarily used to estimate stroke risk in patients with AF, its potential utility in predicting AF recurrence after PVI has not been fully explored in contemporary, real-world multicenter settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To evaluate the association between the CHA<sub>2</sub>DS<sub>2</sub>-VASc score and both AF recurrence and adverse clinical outcomes following PVI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study using the Israeli Catheter Ablation Registry (ICAR), including 860 patients undergoing their first PVI for AF. Patients were grouped by CHA<sub>2</sub>DS<sub>2</sub>-VASc score (0–1, 2–4, > 5). The primary endpoint was AF recurrence within 12 months. Secondary endpoints included re-hospitalization, major adverse cardiovascular events (MACE), and all-cause mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>AF recurrence occurred in 32% of patients. Recurrence rates were 25.7%, 31.4%, and 51% across the low, intermediate, and high CHA<sub>2</sub>DS<sub>2</sub>-VASc score groups, respectively. A higher score was independently associated with increased recurrence risk (HR = 2.88; 95% CI, 1.75–4.74; <i>p</i> < 0.001). Elevated CHA<sub>2</sub>DS<sub>2</sub>-VASc scores also correlated with higher MACE and re-hospitalization rates. No significant difference in all-cause mortality was observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The CHA<sub>2</sub>DS<sub>2</sub>-VASc score is an independent predictor of AF recurrence and adverse outcomes after PVI. Its simplicity, availability, and routine use make it a clinically useful tool to support preprocedural risk stratification in AF patients undergoing ablation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70088","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143919658","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}
Asma Dilawari, Mori J. Krantz, Ilynn Bulatao, Hee-Koung Joeng, Marc Neilson, Suparna Wedam, Xin Gao, Mallorie H. Fiero, Abhilasha Nair, Marc Theoret, Laleh Amiri-Kordestani
Background
Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment. By releasing blocks (checkpoints) on the immune system, they elicit powerful antitumor effects. Despite improving survival, ICIs are associated with serious cardiac toxicities. Previous reports have focused on advanced cancer; cardiotoxicity data are therefore limited in the curative setting. We evaluated ICI cardiotoxicity in the non-metastatic setting, where long-term cardiac safety is a growing public health concern.
Methods
ICIs approved in the adjuvant setting were pooled and trials with combination chemotherapy were excluded. Cardiac adverse events (AEs) and emerging cardio-metabolic risks (hyperglycemia, weight gain, hypothyroidism) were assessed. The relative risk (RR) of cardiotoxicity was assessed.
Results
Ten randomized controlled trials of atezolizumab, ipilimumab, nivolumab, and pembrolizumab in multiple solid tumors were evaluated; among 9244 patients, 5338 received ICIs. No trial performed routine cardiac monitoring. Six percent of ICI patients vs. 4.6% in placebo (RR 1.24, 95% CI 1.04, 1.49) had a cardiac AE and 13 (0.2%) of ICI patients experienced a fatal cardiac AE (RR 4.76, 95% CI 1.07, 21.06). Older age and male sex were associated with a higher risk for cardiac fatality. Arrhythmia was the most common cardiac AE; hypothyroidism was more frequent (14% vs. 2.5%) among ICI-treated patients.
Conclusion
This is the largest pooled analysis of cardiac AEs associated with ICIs in the adjuvant setting. Despite no formalized testing for subclinical cardiotoxicity, ICI treatment increased cardiac AEs. These findings are relevant for long-term cancer survivors, clinicians, and particularly in new drug development, where cardiotoxicity may be substantially underestimated.
免疫检查点抑制剂（ICIs）已经彻底改变了癌症治疗。通过在免疫系统上释放阻滞（检查点），它们引发了强大的抗肿瘤作用。尽管可以提高生存率，但ici与严重的心脏毒性有关。以前的报告主要关注晚期癌症；因此，心脏毒性数据在治疗环境中是有限的。我们在非转移性环境中评估了ICI心脏毒性，长期心脏安全是一个日益增长的公共卫生问题。方法汇总已批准用于辅助治疗的ICIs，排除联合化疗的试验。评估心脏不良事件（ae）和新出现的心脏代谢风险（高血糖、体重增加、甲状腺功能减退）。评估心脏毒性的相对危险度（RR）。结果评估了atezolizumab、ipilimumab、nivolumab和pembrolizumab治疗多发性实体瘤的10项随机对照试验；在9244例患者中，5338例接受了ICIs。没有试验进行常规心脏监测。6%的ICI患者与安慰剂组的4.6% （RR 1.24, 95% CI 1.04, 1.49）发生心脏AE， 13例（0.2%）的ICI患者发生致命性心脏AE （RR 4.76, 95% CI 1.07, 21.06）。年龄较大和男性与较高的心脏死亡风险相关。心律失常是最常见的AE；在接受ici治疗的患者中，甲状腺功能减退更为常见（14%对2.5%）。结论：这是对辅助治疗中与ICIs相关的心脏ae进行的最大的汇总分析。尽管没有正式的亚临床心脏毒性测试，但ICI治疗增加了心脏ae。这些发现与长期癌症幸存者、临床医生，特别是新药开发相关，在这些领域，心脏毒性可能被大大低估。
{"title":"Cardiac Adverse Events in Patients Receiving Immune Checkpoint Inhibitors in the Adjuvant Setting: An FDA Pooled Analysis","authors":"Asma Dilawari, Mori J. Krantz, Ilynn Bulatao, Hee-Koung Joeng, Marc Neilson, Suparna Wedam, Xin Gao, Mallorie H. Fiero, Abhilasha Nair, Marc Theoret, Laleh Amiri-Kordestani","doi":"10.1111/anec.70087","DOIUrl":"https://doi.org/10.1111/anec.70087","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment. By releasing blocks (checkpoints) on the immune system, they elicit powerful antitumor effects. Despite improving survival, ICIs are associated with serious cardiac toxicities. Previous reports have focused on advanced cancer; cardiotoxicity data are therefore limited in the curative setting. We evaluated ICI cardiotoxicity in the non-metastatic setting, where long-term cardiac safety is a growing public health concern.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>ICIs approved in the adjuvant setting were pooled and trials with combination chemotherapy were excluded. Cardiac adverse events (AEs) and emerging cardio-metabolic risks (hyperglycemia, weight gain, hypothyroidism) were assessed. The relative risk (RR) of cardiotoxicity was assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ten randomized controlled trials of atezolizumab, ipilimumab, nivolumab, and pembrolizumab in multiple solid tumors were evaluated; among 9244 patients, 5338 received ICIs. No trial performed routine cardiac monitoring. Six percent of ICI patients vs. 4.6% in placebo (RR 1.24, 95% CI 1.04, 1.49) had a cardiac AE and 13 (0.2%) of ICI patients experienced a fatal cardiac AE (RR 4.76, 95% CI 1.07, 21.06). Older age and male sex were associated with a higher risk for cardiac fatality. Arrhythmia was the most common cardiac AE; hypothyroidism was more frequent (14% vs. 2.5%) among ICI-treated patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This is the largest pooled analysis of cardiac AEs associated with ICIs in the adjuvant setting. Despite no formalized testing for subclinical cardiotoxicity, ICI treatment increased cardiac AEs. These findings are relevant for long-term cancer survivors, clinicians, and particularly in new drug development, where cardiotoxicity may be substantially underestimated.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70087","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143919632","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}
Dillon J. Dzikowicz, Mehmed Aktas, Betty Mykins, Xiaojuan Xia, Wojciech Zareba, Jean-Phillippe Couderc
Introduction
Atrial fibrillation (AF), affecting 3% of the US adults, is the most common arrhythmia. While ambulatory electrocardiogram (ECG) monitoring is essential for AF detection, conventional technologies have diagnostic limitations due to AF's sporadic nature. ECG patches offer extended monitoring periods, though their effectiveness is primarily limited by deteriorating skin-electrode contact rather than battery or memory constraints.
Objectives
This analysis reports our experience with the Zio ECG patch (iRhythm, San Francisco, CA) in 256 AF patients.
Method
We analyzed human and technical factors and their association with ECG recording duration using previously recorded data which employed the ECG patch as a reference. Descriptive statistics and logistic regression were used to identify associations.
Results
Body mass index (BMI) was found to be an independent predictor of poorer compliance in a dose-dependent manner (B = −0.046, OR = 0.955, 95% CI: 0.916–0.996, p = 0.033). Loss of adhesive was the primary reason for poor compliance (n = 25; 11%). These findings can guide researchers and clinicians in determining the appropriateness of a 14-day ECG patch based on expected wear time and patient compliance.
Conclusion
BMI significantly impacts ECG patch compliance, primarily through adhesive failures. These findings indicate the need for improved adhesive technologies for higher BMI patients. Future device development should prioritize maintaining electrode-skin contact across diverse patient populations.
Trial Registration
ClinicalTrials.gov Identifier: NCT04267133
房颤（AF）是最常见的心律失常，影响3%的美国成年人。虽然动态心电图（ECG）监测对房颤检测至关重要，但由于房颤的散发性，传统技术具有诊断局限性。心电图贴片可以延长监测周期，但其有效性主要受到皮肤电极接触恶化的限制，而不是受到电池或记忆的限制。本分析报告了我们在256例房颤患者中使用Zio ECG贴片（irhym, San Francisco， CA）的经验。方法以心电贴片为参考，分析人为因素和技术因素与心电记录时间的关系。使用描述性统计和逻辑回归来确定关联。结果体重指数（BMI）是依从性较差的独立预测因子，且呈剂量依赖性（B = - 0.046, OR = 0.955, 95% CI: 0.916-0.996, p = 0.033）。粘接剂的丧失是依从性差的主要原因(n = 25；11%)。这些发现可以指导研究人员和临床医生根据预期佩戴时间和患者依从性来确定14天ECG贴片的适当性。结论BMI显著影响心电图贴片的依从性，主要通过贴片失效影响。这些发现表明需要改进黏附技术来治疗高BMI患者。未来的设备开发应优先考虑在不同的患者群体中保持电极-皮肤接触。临床试验注册：ClinicalTrials.gov标识符：NCT04267133
{"title":"Identifying Demographic Factors Affecting the ECG Duration Collected Using a Single-Lead ECG Patch Device","authors":"Dillon J. Dzikowicz, Mehmed Aktas, Betty Mykins, Xiaojuan Xia, Wojciech Zareba, Jean-Phillippe Couderc","doi":"10.1111/anec.70068","DOIUrl":"https://doi.org/10.1111/anec.70068","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Atrial fibrillation (AF), affecting 3% of the US adults, is the most common arrhythmia. While ambulatory electrocardiogram (ECG) monitoring is essential for AF detection, conventional technologies have diagnostic limitations due to AF's sporadic nature. ECG patches offer extended monitoring periods, though their effectiveness is primarily limited by deteriorating skin-electrode contact rather than battery or memory constraints.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This analysis reports our experience with the Zio ECG patch (iRhythm, San Francisco, CA) in 256 AF patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>We analyzed human and technical factors and their association with ECG recording duration using previously recorded data which employed the ECG patch as a reference. Descriptive statistics and logistic regression were used to identify associations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Body mass index (BMI) was found to be an independent predictor of poorer compliance in a dose-dependent manner (<i>B</i> = −0.046, OR = 0.955, 95% CI: 0.916–0.996, <i>p</i> = 0.033). Loss of adhesive was the primary reason for poor compliance (<i>n</i> = 25; 11%). These findings can guide researchers and clinicians in determining the appropriateness of a 14-day ECG patch based on expected wear time and patient compliance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>BMI significantly impacts ECG patch compliance, primarily through adhesive failures. These findings indicate the need for improved adhesive technologies for higher BMI patients. Future device development should prioritize maintaining electrode-skin contact across diverse patient populations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>ClinicalTrials.gov Identifier: NCT04267133</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143904928","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}
Zhi Luo, Yi Liu, Yuwei Chen, Xiaobo Pu, Xiangbin Xiao
A 66-year-old man with 5-year intermittent palpitation underwent an electrophysiologic (EP) study. Electrocardiograms (ECGs) on admission showed sinus rhythm with right bundle branch block (RBBB). During palpitation, regular tachycardia with RBBB occurred. Through detailed analysis, the diagnosis of Wolff-Parkinson-White (WPW) syndrome with orthodromic atrio-ventricular reentry tachycardia (AVRT) was established. The case emphasizes the significance of comparing sinus rhythm and tachycardia ECGs for accurate diagnosis.
{"title":"Narrowed Right Bundle Branch Block Pattern in Tachycardia","authors":"Zhi Luo, Yi Liu, Yuwei Chen, Xiaobo Pu, Xiangbin Xiao","doi":"10.1111/anec.70072","DOIUrl":"https://doi.org/10.1111/anec.70072","url":null,"abstract":"<p>A 66-year-old man with 5-year intermittent palpitation underwent an electrophysiologic (EP) study. Electrocardiograms (ECGs) on admission showed sinus rhythm with right bundle branch block (RBBB). During palpitation, regular tachycardia with RBBB occurred. Through detailed analysis, the diagnosis of Wolff-Parkinson-White (WPW) syndrome with orthodromic atrio-ventricular reentry tachycardia (AVRT) was established. The case emphasizes the significance of comparing sinus rhythm and tachycardia ECGs for accurate diagnosis.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70072","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143883952","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}
A 66-year-old male patient diagnosed with dilated cardiomyopathy, heart failure with reduced EF (32%), and complete left bundle branch block (CLBBB) received cardiac resynchronization therapy (CRT)-D implantation. Left bundle branch pacing (LBBP) was successfully performed, but during the follow-up 6 weeks later, the electrocardiogram (ECG) showed a sinus rhythm tracked by ventricular pacing with a ratio of approximately 2:1 due to T-wave over-sensing, which might be caused by the changes in T-wave morphology due to electrotonic modulation and hyperkalemia or by the lower sensitivity threshold set by the auto sensing algorithm of the ICD. Shortening post-ventricular atrial refractory period (PVARP) restored the ventricular pacing tracking of the atrium, and the T-wave changes improved as time went by.
{"title":"A Case Report: Electrotonic Modulation-Related T-Wave Over-Sensing After Left Bundle Branch Pacing","authors":"Linlin Li, Manxin Lin, Jincun Guo, Qiang Li, Fanqi Meng, Xinyi Huang, Simei Chen, Binni Cai","doi":"10.1111/anec.70083","DOIUrl":"https://doi.org/10.1111/anec.70083","url":null,"abstract":"<p>A 66-year-old male patient diagnosed with dilated cardiomyopathy, heart failure with reduced EF (32%), and complete left bundle branch block (CLBBB) received cardiac resynchronization therapy (CRT)-D implantation. Left bundle branch pacing (LBBP) was successfully performed, but during the follow-up 6 weeks later, the electrocardiogram (ECG) showed a sinus rhythm tracked by ventricular pacing with a ratio of approximately 2:1 due to T-wave over-sensing, which might be caused by the changes in T-wave morphology due to electrotonic modulation and hyperkalemia or by the lower sensitivity threshold set by the auto sensing algorithm of the ICD. Shortening post-ventricular atrial refractory period (PVARP) restored the ventricular pacing tracking of the atrium, and the T-wave changes improved as time went by.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70083","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143879947","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}
Murat Özmen, Onur Altunkaya, Selim Aydemir, Sidar Şiyar Aydın, Faruk Aydınyılmaz, Emrah Aksakal, Emre Alkan
Introduction
Implantable cardioverter defibrillator (ICD) and pacemaker (PM) implantation may lead to anxiety and depression, which may reduce patients' quality of life. The aim of our study was to compare depression and anxiety following device implantation.
Methods
This prospective study was conducted on 202 patients admitted to our hospital with ICD and PM implants between January 2024 and January 2025.
Results
The prevalence of anxiety in PM and ICD recipients was 25.9% and 38.8%, respectively. There was a significant difference in anxiety in ICD patients (< 0.001). In terms of depression, the results in the PM and ICD groups were 18.9 and 38.9, respectively. The results showed a significant difference in the prevalence of depression between PM and ICD recipients. The tendency toward depression was statistically significant in both device recipients (PM; p = 0.008, ICD; p < 0.001).
Conclusion
Considering the prevalence of anxiety and depression, it seems necessary to pay closer attention to the anxiety and depression states of patients who have been treated with PM and ICD devices and to provide more widespread education to these patients.
{"title":"Evaluatıon of Depressıon and Anxıety Status in Patıents After Cardıac Devıce Implantatıon","authors":"Murat Özmen, Onur Altunkaya, Selim Aydemir, Sidar Şiyar Aydın, Faruk Aydınyılmaz, Emrah Aksakal, Emre Alkan","doi":"10.1111/anec.70085","DOIUrl":"https://doi.org/10.1111/anec.70085","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Implantable cardioverter defibrillator (ICD) and pacemaker (PM) implantation may lead to anxiety and depression, which may reduce patients' quality of life. The aim of our study was to compare depression and anxiety following device implantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective study was conducted on 202 patients admitted to our hospital with ICD and PM implants between January 2024 and January 2025.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The prevalence of anxiety in PM and ICD recipients was 25.9% and 38.8%, respectively. There was a significant difference in anxiety in ICD patients (< 0.001). In terms of depression, the results in the PM and ICD groups were 18.9 and 38.9, respectively. The results showed a significant difference in the prevalence of depression between PM and ICD recipients. The tendency toward depression was statistically significant in both device recipients (PM; <i>p</i> = 0.008, ICD; <i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Considering the prevalence of anxiety and depression, it seems necessary to pay closer attention to the anxiety and depression states of patients who have been treated with PM and ICD devices and to provide more widespread education to these patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70085","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143871640","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}
Arrhythmia induction and identifying the functional characteristics of accessory pathways in Wolff-Parkinson-White (WPW) syndrome typically requires an invasive electrophysiological study. This case reports a 13-year-old boy with a five-year history of paroxysmal palpitations, where transesophageal atrial pacing (TEAP) was used to identify accessory pathways. TEAP revealed multiple tachycardia forms, differentiating orthodromic atrioventricular reentrant tachycardia with narrow and wide QRS complexes. EPS confirmed two pathways, diagnosing WPW syndrome. TEAP effectively assessed accessory pathways' functional characteristics and their roles in tachycardia, showcasing its potential as a minimally invasive diagnostic tool for this condition.
{"title":"Transesophageal Atrial Pacing for the Evaluation of Accessory Atrioventricular Pathways in Wolff-Parkinson-White Syndrome: A Pediatric Case Report and Literature Review","authors":"Jing Chen, Ping Zuo, Xiaoyun Yang, Bei Wang","doi":"10.1111/anec.70084","DOIUrl":"https://doi.org/10.1111/anec.70084","url":null,"abstract":"<p>Arrhythmia induction and identifying the functional characteristics of accessory pathways in Wolff-Parkinson-White (WPW) syndrome typically requires an invasive electrophysiological study. This case reports a 13-year-old boy with a five-year history of paroxysmal palpitations, where transesophageal atrial pacing (TEAP) was used to identify accessory pathways. TEAP revealed multiple tachycardia forms, differentiating orthodromic atrioventricular reentrant tachycardia with narrow and wide QRS complexes. EPS confirmed two pathways, diagnosing WPW syndrome. TEAP effectively assessed accessory pathways' functional characteristics and their roles in tachycardia, showcasing its potential as a minimally invasive diagnostic tool for this condition.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143861865","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}
Visual expertise is pivotal for accurate ECG interpretation. We aimed to identify and measure expertise-based differences in visual search patterns, cognitive load, and diagnostic accuracy during ECG analysis using eye-tracking technology.
Methods
First- to third-year residents and board-certified expert cardiologists interpreted ECGs of patients with suspected acute coronary syndrome, while eye-tracking glasses recorded fixation count, duration, and pupil dilation. Diagnostic accuracy and cognitive load via NASA Task Load Index were analyzed. Heatmaps illustrated relationships between cognitive load, perceived workload, and self-assessed performance across experience levels and ECG task complexities.
Results
Expert readers interpreted ECGs significantly faster than residents (107.6 ± 32.8 vs. 205.31 ± 57.43 s; p < 0.001) and demonstrated higher diagnostic accuracy across all levels of task difficulty (p < 0.001). Eye-tracking analysis revealed that experts exhibited fewer fixations (67.7 ± 25.7 vs. 143.7 ± 29.9; p < 0.001) and longer fixation durations (3.9 ± 0.7 vs. 3.2 ± 1 s; p = 0.032) than residents. Experts also showed lower pupil dilation changes (4.8% ± 2% vs. 10.5% ± 4.2%; p = 0.015). Increased task difficulty was associated with greater pupil dilation, particularly among novices (mean pupil dilation for difficult tasks 13.4% ± 4.1% vs. 7.3% ± 2.3% for easy tasks; p = 0.008), indicating higher cognitive demand. Experts maintained superior self-assessed performance (8 ± 0 vs. 7 ± 1.2; p = 0.009) and reported lower perceived negative workload (4.5 ± 1.45 vs. 6 ± 0.55; p = 0.041).
Conclusions
In this pilot study, expert readers achieved faster and more accurate diagnoses, exhibiting more efficient visual search patterns and lower cognitive load. Pending external validation, our findings suggest that ECG training programs should focus on developing targeted visual techniques, cognitive efficiency, and adaptive coping strategies to enhance accurate interpretation.
视觉专业知识对于准确的心电解释至关重要。我们的目的是在使用眼动追踪技术进行心电图分析时，识别和测量视觉搜索模式、认知负荷和诊断准确性方面的专业差异。方法1 - 3年住院医师和委员会认证的心脏病专家解释疑似急性冠脉综合征患者的心电图，同时眼动追踪眼镜记录注视次数、持续时间和瞳孔扩张。通过NASA任务负荷指数分析诊断准确性和认知负荷。热图说明了认知负荷、感知负荷和自我评估性能之间的关系，包括经验水平和ECG任务复杂性。结果专家读者解读心电图的速度明显快于普通居民（107.6±32.8 vs. 205.31±57.43 s）；P < 0.001)，并在所有任务难度水平上表现出更高的诊断准确性（P < 0.001）。眼球追踪分析显示，专家的注视次数较少（67.7±25.7 vs. 143.7±29.9）；P < 0.001)和更长的固定时间(3.9±0.7 vs. 3.2±1 s；P = 0.032)。专家还显示瞳孔扩张变化(4.8%±2% vs. 10.5%±4.2%；p = 0.015)。任务难度的增加与瞳孔扩大有关，特别是在新手中(困难任务的平均瞳孔扩大13.4%±4.1%，而简单任务的平均瞳孔扩大7.3%±2.3%；P = 0.008)，表明认知需求较高。专家保持较好的自我评估表现（8±0比7±1.2）；P = 0.009)，报告的感知负工作负荷较低(4.5±1.45比6±0.55；p = 0.041)。在本初步研究中，专家读者的诊断速度更快、更准确，表现出更高效的视觉搜索模式和更低的认知负荷。在外部验证之前，我们的研究结果表明，ECG训练计划应侧重于开发有针对性的视觉技术，认知效率和适应性应对策略，以提高准确的解释。
{"title":"Tracing Visual Expertise in ECG Interpretation: An Eye-Tracking Pilot Study","authors":"Alessandro Bortolotti, Fabrizio Ricci, Carmelita Cieri, Federica Cocco, Chiara Martini, Marcello Panunzi, Davide Rossi, Anna Sorella, Silvio Saraullo, Davide Scordo, Giulia Renda, Sabina Gallina, Riccardo Palumbo","doi":"10.1111/anec.70082","DOIUrl":"https://doi.org/10.1111/anec.70082","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Visual expertise is pivotal for accurate ECG interpretation. We aimed to identify and measure expertise-based differences in visual search patterns, cognitive load, and diagnostic accuracy during ECG analysis using eye-tracking technology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>First- to third-year residents and board-certified expert cardiologists interpreted ECGs of patients with suspected acute coronary syndrome, while eye-tracking glasses recorded fixation count, duration, and pupil dilation. Diagnostic accuracy and cognitive load via NASA Task Load Index were analyzed. Heatmaps illustrated relationships between cognitive load, perceived workload, and self-assessed performance across experience levels and ECG task complexities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Expert readers interpreted ECGs significantly faster than residents (107.6 ± 32.8 vs. 205.31 ± 57.43 s; <i>p</i> < 0.001) and demonstrated higher diagnostic accuracy across all levels of task difficulty (<i>p</i> < 0.001). Eye-tracking analysis revealed that experts exhibited fewer fixations (67.7 ± 25.7 vs. 143.7 ± 29.9; <i>p</i> < 0.001) and longer fixation durations (3.9 ± 0.7 vs. 3.2 ± 1 s; <i>p</i> = 0.032) than residents. Experts also showed lower pupil dilation changes (4.8% ± 2% vs. 10.5% ± 4.2%; <i>p</i> = 0.015). Increased task difficulty was associated with greater pupil dilation, particularly among novices (mean pupil dilation for difficult tasks 13.4% ± 4.1% vs. 7.3% ± 2.3% for easy tasks; <i>p</i> = 0.008), indicating higher cognitive demand. Experts maintained superior self-assessed performance (8 ± 0 vs. 7 ± 1.2; <i>p</i> = 0.009) and reported lower perceived negative workload (4.5 ± 1.45 vs. 6 ± 0.55; <i>p</i> = 0.041).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this pilot study, expert readers achieved faster and more accurate diagnoses, exhibiting more efficient visual search patterns and lower cognitive load. Pending external validation, our findings suggest that ECG training programs should focus on developing targeted visual techniques, cognitive efficiency, and adaptive coping strategies to enhance accurate interpretation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70082","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143845926","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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