Heart Rhythm O2最新文献

{"title":"Activated clotting time for anticoagulation management during catheter ablation of left atrial arrhythmias: Comparison of point-of-care devices in clinical routine","authors":"Diana Fülkell MD, Andreas Koltzau MD, Leon Dinshaw MD","doi":"10.1016/j.hroo.2025.03.014","DOIUrl":"10.1016/j.hroo.2025.03.014","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 6","pages":"Pages 903-905"},"PeriodicalIF":2.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-hospital and long-term outcomes in spontaneous coronary artery dissection with concurrent cardiac arrest: Systematic review and meta-analysis","authors":"Omar Baqal MBBS ,&nbsp;Suganya A. Karikalan MBBS ,&nbsp;Elfatih A. Hasabo MBBS ,&nbsp;Haseeb Tareen MBBS ,&nbsp;Pragyat Futela MBBS ,&nbsp;Rakhtan K. Qasba MBBS ,&nbsp;Areez Shafqat MBBS ,&nbsp;Ruman K. Qasba MBBS ,&nbsp;Sharonne N. Hayes MD ,&nbsp;Marysia S. Tweet MD, MS ,&nbsp;Hicham Z. El Masry MD, FHRS ,&nbsp;Kwan S. Lee MBBCh, MD ,&nbsp;Win-Kuang Shen MD, FHRS ,&nbsp;Dan Sorajja MD, FHRS","doi":"10.1016/j.hroo.2025.03.023","DOIUrl":"10.1016/j.hroo.2025.03.023","url":null,"abstract":"<div><h3>Background</h3><div>Our understanding of factors predisposing patients with spontaneous coronary artery dissection (SCAD) to worse outcomes, such as concurrent sudden cardiac arrest (CA) and secondary prevention of sudden cardiac death in those patients, is limited.</div></div><div><h3>Objective</h3><div>We conducted the largest systematic review of studies assessing clinical outcomes in SCAD with concurrent CA.</div></div><div><h3>Methods</h3><div>This study was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Cochrane, and Scopus were searched using relevant search terms including “Spontaneous Coronary Artery Dissection,” “Ventricular Tachycardia,” “Ventricular Fibrillation,” “Sudden Cardiac Death,” and “Cardiac Arrest.” The search was conducted from database inception to January 2025.</div></div><div><h3>Results</h3><div>Out of 269 studies that underwent screening, 10 were included (n = 3978). In-hospital mortality, postdischarge mortality, recurrent myocardial infarction (MI) and recurrent SCAD occurred in 20%, 3%, 12%, and 9% of patients with SCAD and CA, respectively. When compared with patients with SCAD without CA, patients with SCAD and CA were at significantly higher risk of in-hospital mortality (risk ratio [RR] 6.7, 95% confidence interval [CI] 4.5–10.1, <em>P</em> &lt; .00001), postdischarge mortality (RR = 5.9, 95% CI 1.7–19.9, <em>P</em> = .005), recurrent MI (RR = 3.3, 95% CI 2.0–5.4, <em>P</em> &lt; .00001), and recurrent SCAD (RR = 1.9, 95% CI 1.1–3.3, <em>P</em> = .02). Out of a pooled 35 implanted cardiac defibrillators (ICDs) and wearable cardiac defibrillators (WCDs), there was only 1 appropriate and 1 inappropriate defibrillator discharge recorded over the follow-up period.</div></div><div><h3>Conclusion</h3><div>SCAD with concurrent CA is associated with worse in-hospital and long-term outcomes, although long-term rate of administered defibrillator therapies was low, supporting a conservative approach.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 6","pages":"Pages 843-853"},"PeriodicalIF":2.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preprocedural neutrophil-to-lymphocyte ratio: A novel predictor of permanent pacemaker implantation in self-expandable vs balloon-expandable valve cohorts following transcatheter aortic valve implantation","authors":"Haitham Abu Khadija MD ,&nbsp;Mohammad Alnees MD ,&nbsp;Omar Ayyad MD ,&nbsp;Gera Gandelman MD ,&nbsp;Gal Sella MD ,&nbsp;Nizar Abu Hamdeh MD ,&nbsp;Amir Haim MD ,&nbsp;Yazan Hamdan MD ,&nbsp;Alena Kirzhner MD ,&nbsp;Abdalaziz Darwish MD ,&nbsp;Duha Najajra MD ,&nbsp;Tal Schiller MD ,&nbsp;Alex Blatt MD ,&nbsp;Jacob George MD","doi":"10.1016/j.hroo.2025.03.003","DOIUrl":"10.1016/j.hroo.2025.03.003","url":null,"abstract":"<div><h3>Background</h3><div>Transcatheter aortic valve implantation (TAVI) is the preferred treatment for severe aortic stenosis. This study examines the neutrophil-lymphocyte ratio (NLR) as a predictor of permanent pacemaker implantation (PPI) outcomes, comparing self-expandable valves (SEVs) and balloon-expandable valves (BEVs).</div></div><div><h3>Objective</h3><div>This study aims to evaluate the effectiveness of the NLR in predicting PPI outcomes in patients undergoing TAVI with SEVs and BEVs.</div></div><div><h3>Methods</h3><div>This retrospective cohort study at Kaplan Medical Center analyzed 305 patients with severe symptomatic aortic stenosis referred for TAVI from January 2010 to December 2019. Data on baseline characteristics, laboratory results, and clinical outcomes were collected, including NLR and PPI rates. Two logistic regression models were developed to identify predictors of TAVI-PPI outcomes for SEV and BEV cohorts.</div></div><div><h3>Results</h3><div>In the SEV cohort, 59 of 199 patients (29.6%) required PPI, compared with 15 of 106 patients (14.2%) in the BEV cohort. The receiver operating characteristic (ROC) curve for SEV showed an area under the curve (AUC) of 0.70, indicating predictive ability of the NLR for TAVI-PPI outcomes. The BEV cohort had a lower AUC of 0.40 (<em>P</em> = .03). In the SEV model, significant predictors included NLR (odds ratio [OR]: 1.146, <em>P</em> =.040) and total protein levels (OR: 0.012, <em>P</em> = .029). In the BEV model, the QTc interval was significant (OR: 1.023, <em>P</em> = .018).</div></div><div><h3>Conclusion</h3><div>The NLR significantly predicts permanent pacemaker implantation after TAVI, especially for SEVs, but less for BEVs.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 6","pages":"Pages 766-780"},"PeriodicalIF":2.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes in diabetic vs nondiabetic patients requiring cardiac resynchronization therapy for heart failure: A meta-analysis","authors":"Aman Goyal MD ,&nbsp;Muhammad Daoud Tariq MBBS ,&nbsp;Abdul Moiz Khan MBBS ,&nbsp;Sonia Hurjkaliani MBBS ,&nbsp;Areeba Ahsan MBBS ,&nbsp;Humza Saeed MBBS ,&nbsp;Rhea Trivedi MBBS ,&nbsp;Gauranga Mahalwar MD ,&nbsp;Mohamed Daoud MD ,&nbsp;Agastya D. Belur MD","doi":"10.1016/j.hroo.2025.02.020","DOIUrl":"10.1016/j.hroo.2025.02.020","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure (HF) affects millions globally, causing severe symptoms and poor prognosis. Cardiac resynchronization therapy (CRT) has been shown to improve heart function and quality of life in HF patients with electrical dyssynchrony, but its effectiveness in diabetic patients remains unclear due to the complexities associated with diabetes.</div></div><div><h3>Objective</h3><div>This study evaluates the impact of diabetes mellitus on CRT by comparing outcomes between diabetic and nondiabetic patients through a meta-analysis.</div></div><div><h3>Methods</h3><div>A comprehensive literature search identified studies on CRT in HF patients both with and without diabetes mellitus. Pooled risk ratios (RRs) and mean differences were calculated using a random-effects model with 95% confidence intervals and statistical significance set at <em>P &lt;</em> .05.</div></div><div><h3>Results</h3><div>Analysis of 13 observational studies involving 20,073 participants revealed that diabetic patients had a significantly increased risk of all-cause mortality (RR 1.34, <em>P &lt;</em> .00001) and cardiovascular death (RR 1.49, <em>P =</em> .002) compared with nondiabetic patients. However, no statistically significant differences were observed between groups in the risk of stroke (RR 3.99, <em>P =</em> .05), myocardial infarction (RR 1.16, <em>P =</em> .30), changes in left ventricular (LV) ejection fraction (<em>P</em> = .22), LV end-systolic volume (<em>P</em> = .10), and LV end-diastolic volume (<em>P</em> = .63).</div></div><div><h3>Conclusion</h3><div>These findings suggest that diabetic patients undergoing CRT face a higher risk of all-cause and cardiovascular mortality compared with nondiabetic patients. The increased mortality risk highlights the need for tailored treatment strategies, emphasizing the judicious use of CRT in diabetic patients.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 6","pages":"Pages 753-765"},"PeriodicalIF":2.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to “Comparison of Cryoballoon vs. Pulsed Field Ablation in Patients with Symptomatic Paroxysmal Atrial Fibrillation (SINGLE SHOT CHAMPION): Study protocol for a randomized controlled trial”, Heart Rhythm O2, Volume 5, Issue 7, (July 2024) P460-467","authors":"","doi":"10.1016/j.hroo.2025.03.002","DOIUrl":"10.1016/j.hroo.2025.03.002","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 6","pages":"Pages 909-910"},"PeriodicalIF":2.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pain after subcutaneous implantable cardioverter-defibrillator implantation: A secondary analysis of the PRAETORIAN-DFT trial","authors":"Jolien A. de Veld MD ,&nbsp;Lonneke Smeding PhD ,&nbsp;Mikhael F. El-Chami MD, FHRS ,&nbsp;Christelle Marquie MD ,&nbsp;Peter Nordbeck MD ,&nbsp;Anne-Floor B.E. Quast MD, PhD ,&nbsp;Roland R. Tilz MD, PhD, FHRS ,&nbsp;Tom F. Brouwer MD, PhD ,&nbsp;Pier D. Lambiase BCH, BM, MBChB, PhD, FHRS ,&nbsp;Christopher J. Cassidy MD ,&nbsp;Lucas V.A. Boersma MD, PhD ,&nbsp;Martin C. Burke DO ,&nbsp;Shari Pepplinkhuizen MD ,&nbsp;Leonard A. Dijkshoorn MD ,&nbsp;Anouk de Weger MSc ,&nbsp;Harish Manyam MD ,&nbsp;Vincent Probst MD, PhD ,&nbsp;Timothy R. Betts MD ,&nbsp;Nick R. Bijsterveld MD, PhD ,&nbsp;Pascal Defaye MD ,&nbsp;Reinoud E. Knops MD, PhD, FESC","doi":"10.1016/j.hroo.2025.03.011","DOIUrl":"10.1016/j.hroo.2025.03.011","url":null,"abstract":"<div><h3>Background</h3><div>The subcutaneous implantable cardioverter-defibrillator (S-ICD) overcomes transvenous lead-related complications. Its extrathoracic design results in a generator twice the size of transvenous ICDs.</div></div><div><h3>Objective</h3><div>We investigated pain after S-ICD implantation and explore predictors for severe pain.</div></div><div><h3>Methods</h3><div>The PRAETORIAN-DFT (PRospective randomized compArative trial of subcutanEous implanTable cardiOverter-defibrillatoR ImplANtation with and without DeFibrillation Testing) trial included 965 patients undergoing S-ICD implantation in 37 centers across Europe, the United States, and Israel. Pain was assessed using the numeric rating scale (NRS), ranging from no pain to unbearable pain. The NRS was measured before implantation, and 1 to 4 hours, 5 to 7 hours, 1 day, and 1 to 4 months after implantation. Two questions about implantation experience were asked at follow-up. Logistic regression analysis was used to identify predictors. Implanting physicians were asked their expectations on pain experience.</div></div><div><h3>Results</h3><div>In the PRAETORIAN-DFT trial, 24% was female, mean age was 54 ± 14 years and 45% had ischemic cardiomyopathy. The median NRS within 1 day after implantation was 4. Pain was most frequently experienced at the pocket. There were 262 (29%) of 918 patients who reported severe pain (NRS ≥7) within 1 day after implantation. Predictors for severe pain were female sex (adjusted odds ratio [aOR] 2.23, <em>P</em> &lt; .001), procedure duration &gt;48 minutes (aOR 1.84, <em>P</em> &lt; .001), and severe pain at baseline (aOR 3.97, <em>P</em> = .026). Additionally, female sex was a predictor for disappointment in pain perception during and after implantation. Physician anticipated NRS and location corresponded with reported pain, and females were expected to have more pain by 4 of 24 physicians.</div></div><div><h3>Conclusion</h3><div>In the period surrounding S-ICD implantation, attention should be paid to analgesia and expectation management in patients with longer procedure duration, severe pre-existing pain, and especially female sex.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 6","pages":"Pages 799-807"},"PeriodicalIF":2.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automatic measurement of short-term variability of repolarization captures modulation by pacing on human electrograms","authors":"Cheyenne S.L. Chiu MD ,&nbsp;Vera Loen MD, PhD ,&nbsp;Alfonso Aranda Hernandez PhD ,&nbsp;Agnieszka Smoczyńska MD, PhD ,&nbsp;David J. Sprenkeler MD, PhD ,&nbsp;Anton E. Tuinenburg MD, PhD ,&nbsp;Coert O.S. Scheerder MS ,&nbsp;Paul J. DeGroot PhD ,&nbsp;Marc A. Vos PhD ,&nbsp;Mathias Meine MD, PhD","doi":"10.1016/j.hroo.2025.03.005","DOIUrl":"10.1016/j.hroo.2025.03.005","url":null,"abstract":"<div><h3>Background</h3><div>Short-term variability of repolarization (STV) increases prior to ventricular arrhythmias in both humans and animal models, making it a promising tool for real-time arrhythmic risk monitoring.</div></div><div><h3>Objective</h3><div>An automatic STV measurement algorithm was developed for intracardiac electrograms (EGMs) to enable integration into cardiac devices. This method previously demonstrated high accuracy in predicting life-threatening ventricular arrhythmias in animals. This study compared the performance of the automatic method to the gold standard on EGMs in humans.</div></div><div><h3>Methods</h3><div>EGM signals were recorded in 14 patients with a dual-chamber implantable cardioverter-defibrillator during de novo implantation (n = 5) or replacement (n = 9) procedures. Recordings were obtained in sinus rhythm (SR), atrial pacing at 80 beats/min, and dual-chamber pacing at 80 beats/min. STV was determined on the EGM from the activation recovery interval with the automatic method (STV-ARI_auto) and with fiducial segment averaging (STV-ARI_FSA), the gold standard. STV-ARI_auto was compared with STV-ARI_FSA for all pacing modes.</div></div><div><h3>Results</h3><div>STV-ARI_auto and STV-ARI_FSA decreased from 0.90 ± 0.51 ms and 0.99 ± 0.39 ms in SR (53 ± 9 beats/min) to 0.60 ± 0.37 ms (and 0.68 ± 0.39 ms in atrial pacing at 80 beats/min, and to 0.32 ± 0.15 ms and 0.59 ± 0.24 ms in dual-chamber pacing at 80 beats/min, respectively (all <em>P &lt;</em> .05 compared with SR). STV-ARI_auto strongly correlated with STV-ARI_FSA (r = 0.80, <em>P &lt;</em> .0001), with a small bias of 0.18 ms and limits of agreement between –0.35 and 0.70 ms.</div></div><div><h3>Conclusion</h3><div>The novel automatic STV measurement method accurately reflects pacing-induced changes, comparable to the gold standard. Future integration of this technique in implantable cardioverter-defibrillators could furnish continuous monitoring of arrhythmic risk and initiate preventive strategies.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 6","pages":"Pages 854-863"},"PeriodicalIF":2.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An alternative method for phrenic nerve monitoring during cryoballoon procedures","authors":"Alessio Marinelli MD ,&nbsp;Konstantinos Trachanas MD, PhD ,&nbsp;Maurizio Corso BD ,&nbsp;Davide Fasoli BD ,&nbsp;Michele Canton BD ,&nbsp;Alessandro Costa MD ,&nbsp;Federico Cecchini MD ,&nbsp;Stefano Bonapace MD ,&nbsp;Alessandro Mantovani MD, PhD ,&nbsp;Melania Bonocore MD ,&nbsp;Antonino Mignano MD, PhD ,&nbsp;Carlo Cicerone MD ,&nbsp;Giulio Molon MD, FACC, FESC","doi":"10.1016/j.hroo.2025.03.016","DOIUrl":"10.1016/j.hroo.2025.03.016","url":null,"abstract":"<div><h3>Background</h3><div>Cryoballoon ablation is associated with a consistent risk of phrenic nerve (PN) damage. Abdominal palpation associated with other strategies such as the diaphragmatic compound motor action potential (CMAP) has been shown to be an effective and reliable method for preventing this complication.</div></div><div><h3>Objective</h3><div>The purpose of this study was to evaluate the diagnostic performance of a new surface CMAP electrodes positioning.</div></div><div><h3>Methods</h3><div>A total of 150 patients underwent cryoballoon ablation. During the procedure, we placed the CMAP leads per the manufacturer’s instructions and our alternative method, named NeedMAP, by placing electrocardiographic electrodes on the anterior axillary line. We simultaneously recorded the CMAP and the NeedMAP. CMAP monitoring with a 35% decrease cutoff for the diagnosis of nerve threatening was considered the gold standard. The NeedMAP decrease threshold also was set at 35%.</div></div><div><h3>Results</h3><div>A total of 438 cryoballoon applications were performed on the right pulmonary veins. Mean CMAP amplitude was 0.60 ± 0.33 mV compared to NeedMAP amplitude 0.85 ± 0.46 mV (<em>P</em> &lt;.001). Among the 150 patients, 15 (10%) showed a nerve threat. In our population, the CMAP with regard to nerve damage had sensitivity of 38%, specificity 76%, negative predictive value (NPV) 89%, and positive predictive value (PPV) 19%. The NeedMAP showed sensitivity of 61%, specificity 86%, NPV 93%, and PPV 40%.</div></div><div><h3>Conclusion</h3><div>The NeedMAP signal for PN monitoring during cryoballoon ablation seems to be a reliable method, shows good sensitivity and specificity, and can help clinicians in preventing PN damage.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 6","pages":"Pages 739-744"},"PeriodicalIF":2.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic performance of single-lead electrocardiograms from a smartwatch and a smartring for cardiac arrhythmia detection","authors":"Andre Briosa e Gala MD ,&nbsp;Alexander James Sharp MBBS, BSc ,&nbsp;David Schramm MBiochem ,&nbsp;Michael Timothy Brian Pope PhD BM ,&nbsp;Milena Leo PhD ,&nbsp;Richard Varini MBBCh ,&nbsp;Abhirup Banerjee PhD ,&nbsp;Kyaw Zaw Win MD ,&nbsp;Manish Kalla DPhil ,&nbsp;John Paisey DM ,&nbsp;Nick Curzen PhD ,&nbsp;Timothy Rider Betts DM","doi":"10.1016/j.hroo.2025.03.019","DOIUrl":"10.1016/j.hroo.2025.03.019","url":null,"abstract":"<div><h3>Background</h3><div>Wearable devices are widely used for atrial fibrillation (AF) detection, yet most validation studies include only sinus rhythm or AF, likely overestimating diagnostic performance.</div></div><div><h3>Objective</h3><div>This multicenter study assessed the performance of automated AF detection and physician interpretation of single-lead electrocardiograms (SL-ECGs) from the Apple Watch and CART Ring.</div></div><div><h3>Methodology</h3><div>Participants underwent simultaneous 12-lead ECG and SL-ECGs from Apple Watch and CART Ring. Two cardiologists independently adjudicated all ECGs. Apple Watch and CART Ring classified recordings as “AF,” “Not AF,” or “Unclassified.” Diagnostic performance for automated AF detection was evaluated in “worst-case” (all SL-ECGs) and lenient (excluding unclassified SL-ECGs) scenarios. Physician interpretation of SL-ECGs was also compared to 12-lead ECG.</div></div><div><h3>Results</h3><div>Among 483 patients (median age, 66 years; 29% female), 196 (39%) had AF across 3 United Kingdom centers. A total of 2398 ECGs were analyzed. Interobserver variability was excellent (Cohen’s kappa: Apple Watch, 0.85; CART Ring, 0.84). In the “worst-case” analysis, CART Ring outperformed Apple Watch (sensitivity, 84.6% vs 69.1%; specificity, 89.9% vs 72.6%). Apple Watch had more unclassified SL-ECGs (20.1%) than CART Ring (1.9%). The lenient analysis showed an improvement in sensitivity (CART Ring, 84.8 %; Apple Watch, 86.4%) and specificity (CART Ring, 91.2%; Apple Watch, 91.7%). Physician interpretation improved diagnostic performance for AF and sinus rhythm but remained limited for other arrhythmias</div></div><div><h3>Conclusion</h3><div>Apple Watch missed approximately 1 in 3 episodes of AF and a high number of unclassified SL-ECG. CART Ring demonstrated superior performance. Physician interpretation significantly improved AF diagnosis but remained unreliable for other arrhythmias, emphasizing the need for cautious integration of wearable ECGs into clinical practice.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 6","pages":"Pages 808-817"},"PeriodicalIF":2.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal trends of atrioventricular block in acute coronary syndrome patients from the ACSIS registry","authors":"Shir Tal MD ,&nbsp;Alon Barsheshet MD ,&nbsp;Gal Sella MD ,&nbsp;Yoni Kogan MD ,&nbsp;Roy Beigel MD ,&nbsp;Tal Ovdat ,&nbsp;Gregory Golovchiner MD ,&nbsp;Ran Kornowski MD ,&nbsp;Katia Orvin MD","doi":"10.1016/j.hroo.2025.03.001","DOIUrl":"10.1016/j.hroo.2025.03.001","url":null,"abstract":"<div><h3>Background</h3><div>High-degree atrioventricular block (HDAVB) is a life-threatening complication among acute coronary syndrome (ACS).</div></div><div><h3>Objective</h3><div>Our aim was to investigate temporal trends of the last two decades in incidence and prognosis of patients with HDAVB among patients who present with ACS.</div></div><div><h3>Methods</h3><div>We evaluated 18,717 ACS patients from the multicenter ACSIS (Acute Coronary Syndrome Israeli Survey) registry. Temporal trends were examined in early (2000–2010) and late (2013–2021) periods.</div></div><div><h3>Results</h3><div>Overall, HDAVB was diagnosed in 657 (3.5%) patients: 489 (4.25%) patients in the early period vs 168 (2.33%) in the late period (<em>P &lt;</em> .001). Temporary pacemakers were implanted more frequently in the early vs the late period (59.4% vs 47%, <em>P =</em> .007), though implantation rate of permanent pacemakers was similar in both periods (11.3% vs 16.7%, <em>P =</em> .095). Patients with HDAVB from the late period experienced lower major adverse cardiovascular events (30.3% vs 43.8%, <em>P =</em> .003), 30-day mortality (18.9% vs 29.2%, <em>P =</em> .013) and 1-year mortality (26.1% vs 36.5%, <em>P =</em> .022). In multivariable analysis, admission Killip class &gt;II (hazard ratio [HR] 2.85, <em>P &lt;</em> .001), diabetes mellitus (HR 1.46, <em>P =</em> .01), and late period (vs early period, HR 1.44, <em>P =</em> .05) were independent predictors for 1-year mortality</div></div><div><h3>Conclusion</h3><div>ACS patients with HDAVB experience elevated short- and long-term mortality rates overall. However, there is improvement in outcomes for this population throughout the years.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 6","pages":"Pages 827-834"},"PeriodicalIF":2.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}