Heart Rhythm O2最新文献

{"title":"Reduced continuity index with proactive esophageal cooling compared to luminal temperature monitoring during radiofrequency ablation","authors":"Catherine Lazarus BA ,&nbsp;Jacob Sherman ,&nbsp;Natalie Putzel ,&nbsp;Cameron Randolph ,&nbsp;William Zagrodzky BA ,&nbsp;Tiffany Sharkoski MPH, MBE ,&nbsp;Alex Ro MD, FHRS ,&nbsp;Jose Nazari MD, FHRS ,&nbsp;Westby Fisher MD, FHRS ,&nbsp;Erik Kulstad MD, MS ,&nbsp;Mark D. Metzl MD, FHRS","doi":"10.1016/j.hroo.2025.02.010","DOIUrl":"10.1016/j.hroo.2025.02.010","url":null,"abstract":"<div><h3>Background</h3><div>Proactive esophageal cooling is Food and Drug Administration (FDA) cleared to reduce the likelihood of esophageal injury during radiofrequency ablation for treatment of atrial fibrillation (AF). Long-term follow-up data have also shown improved freedom from arrhythmia with proactive esophageal cooling compared with luminal esophageal temperature (LET) monitoring during pulmonary vein isolation (PVI). One hypothesized mechanism is improved lesion contiguity (as measured by the continuity index) with the use of cooling.</div></div><div><h3>Objective</h3><div>We aimed to compare the continuity index of PVI cases using proactive esophageal cooling with those using LET monitoring.</div></div><div><h3>Methods</h3><div>We calculated the continuity index for PVI cases at 2 different hospitals within the same health system, using a slightly modified continuity index to facilitate retrospective determination from review of recorded cases. The results were then compared between cases using proactive esophageal cooling and those using LET monitoring.</div></div><div><h3>Results</h3><div>Continuity Indices for a total of 236 cases were determined: 118 cases using proactive esophageal cooling and 118 cases using traditional LET monitoring. With proactive esophageal cooling, the average continuity index was 10.6 (5.6 on the left pulmonary vein and 4.9 on the right pulmonary vein). With LET monitoring, the average continuity index was 37.0 (18.7 on the left and 18.3 on the right), for a difference of 26.4 (<em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>Proactive esophageal cooling during PVI is associated with significantly improved lesion contiguity when compared with LET monitoring. This finding may offer a mechanism for the greater freedom from arrhythmia seen with proactive cooling in long-term follow-up.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 5","pages":"Pages 606-611"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144088901","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":"Agreement on site of latest electrical activation between right ventricular pacing and intrinsic conduction as target for left ventricular lead position in cardiac resynchronization therapy","authors":"Henrik Laurits Bjerre MD ,&nbsp;Jens Cosedis Nielsen MD, PhD, DMSc ,&nbsp;Anders Lehmann Dahl Pedersen MD ,&nbsp;Christian Gerdes MD, PhD ,&nbsp;Jens Kristensen MD, PhD ,&nbsp;Jesper Møller Jensen MD, PhD, DMSc ,&nbsp;Bjarne Linde Nørgaard MD PhD, DMSc ,&nbsp;Mads Brix Kronborg MD, PhD, DMSc","doi":"10.1016/j.hroo.2025.02.006","DOIUrl":"10.1016/j.hroo.2025.02.006","url":null,"abstract":"<div><h3>Background</h3><div>In cardiac resynchronization therapy (CRT), studies indicate that targeting the left ventricular (LV) lead toward the site of latest electrical activation could improve clinical outcomes. Whether this site should be determined during right ventricular (RV) pacing or intrinsic conduction is unknown.</div></div><div><h3>Objective</h3><div>The study sought to investigate agreement between RV pacing and intrinsic conduction in identifying the site of latest electrical activation in patients undergoing CRT.</div></div><div><h3>Methods</h3><div>During CRT implantation, we obtained pairwise measurements of the interval from QRS onset to local LV activation during intrinsic conduction (Q-LV) and the interval from the paced signal on the RV lead electrogram to the sensed local LV activation during RV pacing (RV_p-LV_s) in the basal, mid, and apical positions of eligible veins in patients randomized to the intervention arm in the DANISH-CRT (Does Electric Targeted LV Lead Positioning Improve Outcome in Patients With Heart Failure and Prolonged QRS) trial. Venous anatomy and final lead positions were verified by computed tomography.</div></div><div><h3>Results</h3><div>We included 61 patients and measured intervals in 209 veins with 531segments. We found substantial agreement between RV_p-LV_s and Q-LV in identifying the latest activated vein (Cohen’s weighted kappa coefficient 0.69 [95% confidence interval 0.62–0.76]). The RV lead was predominantly positioned toward the anteroseptal region and RV_p-LV_s favored a posterior vein more often than Q-LV. We found high intra- and interobserver reliability for RV_p-LV_s and Q-LV measurements.</div></div><div><h3>Conclusion</h3><div>There is substantial agreement between RV_p-LV_s during RV pacing and Q-LV during intrinsic conduction in identifying the optimal target for LV lead position in CRT. Still, the optimal target vein changed for one-third of patients as RV_p-LV_s favored a posterior target vein more often than Q-LV.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 5","pages":"Pages 566-575"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144089016","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":"Evaluating electrical stability in left bundle branch area pacing for bradycardia patients at follow-up","authors":"Sem Briongos-Figuero MD, PhD ,&nbsp;Álvaro Estévez Paniagua MD, PhD ,&nbsp;Manuel Tapia Martínez MD ,&nbsp;Silvia Jiménez Loeches MD ,&nbsp;Ana Sánchez Hernández MD ,&nbsp;Delia Heredero Palomo RN ,&nbsp;Elena Sánchez López RN ,&nbsp;Arantxa Luna Cabadas RN ,&nbsp;Roberto Muñoz-Aguilera MD, PhD","doi":"10.1016/j.hroo.2025.02.011","DOIUrl":"10.1016/j.hroo.2025.02.011","url":null,"abstract":"<div><h3>Background</h3><div>Physiologic pacing is safe and feasible, but whether electrical synchrony persists at follow-up in patients undergoing left bundle branch area pacing (LBBAP) is unknown.</div></div><div><h3>Objective</h3><div>To determine performance of electrical synchrony in LBBAP patients at follow-up.</div></div><div><h3>Methods</h3><div>Consecutive patients with successful LBBAP for bradycardia pacing indication and preserved left ventricular ejection fraction were selected. At follow-up, a 12-lead electrocardiogram (ECG) was recorded along with echocardiography for myocardial work analysis. V6-R wave peak time (RWPT), V1-RWTP, and QRS duration were compared.</div></div><div><h3>Results</h3><div>One hundred forty-nine patients were studied. After 18.2 ± 7.3 months, V6-RWTP decreased from 74.4 ± 8.9 milliseconds to 71.5 ± 10.6 milliseconds (<em>P</em> &lt; .001) in LBBP captures and from 90.9 ± 7.2 to 85.7 ± 9.3 milliseconds (<em>P</em> = .011) in left ventricular septal pacing (LVSP) captures. V1-RWPT decreased from 120.5 ± 13.1 to 111.7 ± 11.8 milliseconds at follow-up (<em>P</em> &lt; .001) in LBBP and from 118.6 ± 9.9 to 115.2 ± 12.1 milliseconds (<em>P</em> = .052) in LVSP. Paced QRS duration was also significantly reduced in LBBP (from 115.3 ± 13.6 to 107.6 ± 12.8 milliseconds at follow-up; <em>P</em> &lt; .001). At follow-up, 29 patients lost the right bundle branch (RBB) delay pattern in lead V1, but QRS duration remained unchanged (111.3 ± 10.7 at implant vs 109.6 ± 12.5 milliseconds at follow-up; <em>P</em> = .413), as did V6-RWPT, in both LBBP (73.4 ± 5.9 at implant vs 73.1 ± 6.9 milliseconds at follow-up; <em>P</em> = .860) and LVSP captures (86.3 ± 5.6 at implant vs 85.3 ± 8.1 milliseconds at follow-up; <em>P</em> = .658). Mechanical synchrony in patients with and without RBB delay pattern was similar.</div></div><div><h3>Conclusions</h3><div>In patients undergoing LBBAP for bradycardia pacing, electrical synchrony remained stable over time, suggesting that LBBAP is a reliable and durable method for physiologic pacing.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 5","pages":"Pages 576-587"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144089017","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":"Uncovering the mystery of the atrioventricular node dual-pathway electrophysiology","authors":"Shuangtao Ma MD,&nbsp;James Rail BS,&nbsp;Youhua Zhang MD, PhD","doi":"10.1016/j.hroo.2025.02.004","DOIUrl":"10.1016/j.hroo.2025.02.004","url":null,"abstract":"<div><div>With the discovery and validation of a novel index of dual-pathway electrophysiology, known as the His electrogram alternans, major advances have been made in understanding the electrical propagation through the atrioventricular (AV) node. At slow rates, AV conduction starts at the interatrial septal boundary of the node (superior nodal domain) and spreads toward the tricuspid annulus side (inferior nodal domain) in a direction perpendicular to the AV axis and across fiber orientation. Such activation results in an early, superior input into the superior His bundle. This is the fast pathway (FP) conduction. At fast rates, the FP wavefront gradually withdraws from the inferior nodal domain, permitting excitation formed at the crista terminalis end of the node to propagate longitudinally through the inferior nodal domain (also along the fiber orientation) to activate the inferior His bundle. This is the slow pathway (SP) conduction. The failure of FP conduction in the superior nodal domain permits retrograde invasion of the SP wavefront, forming a re-entry, but normally not AV nodal re-entrant tachycardia. The described dual-pathway electrophysiology is a normal inherent property of AV node conduction. The potential electrophysiological basis for a jump in the AV conduction curve and AV nodal re-entrant tachycardia is also discussed.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 5","pages":"Pages 696-708"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144089135","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":"Ischemia induced repolarization dispersion changes and ventricular arrhythmia: Validation of Frank vectorcardiography parameters: A review","authors":"Lennart Bergfeldt MD, PhD,&nbsp;Lennart Gransberg MSc, PhD,&nbsp;Gunilla Lundahl MSc","doi":"10.1016/j.hroo.2025.02.005","DOIUrl":"10.1016/j.hroo.2025.02.005","url":null,"abstract":"<div><div>Changes in dispersion of ventricular repolarization is a salient electrophysiological feature of acute myocardial ischemia and linked to life-threatening arrhythmias. In 9 studies, we applied Frank vectorcardiography not only for noninvasive monitoring of cardiac electrophysiology during acute ischemia induced during percutaneous coronary interventions, during clinical myocardial infarction, and in an occlusion-reperfusion pig model, but also for prognostic purposes after coronary events. Myocardial ischemia was in humans and pigs associated with significant changes in the ST segment, Tamplitude, Tarea, ventricular gradient, and T vector loop morphology. In the pig model, a link between dispersion changes and the occurrence and suppression (by spinal cord stimulation) of ventricular arrhythmias was found. Prognostically, after recent acute coronary events, the spatial peak and mean QRS-T angles were superior. In summary, vectorcardiography-based parameters were validated as reflecting changes in repolarization dispersion during myocardial ischemia in humans and pigs, and in pigs linked to the occurrence and suppression of ventricular arrhythmias.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 5","pages":"Pages 709-719"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144089136","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":"Neighborhood characteristics and outcomes in patients with atrial fibrillation: A large cohort study in the Midwest","authors":"Peter S. Salama BS ,&nbsp;Walker J. Tordsen BS ,&nbsp;Sheila M. Manemann MPH ,&nbsp;Alvaro Alonso MD, PhD ,&nbsp;Peter A. Noseworthy MD, FHRS ,&nbsp;Konstantinos C. Siontis MD, FHRS ,&nbsp;Bernard J. Gersh MB, ChB, DPhil ,&nbsp;Jill M. Killian BS ,&nbsp;Susan A. Weston MS ,&nbsp;Lisa E. Vaughan MS ,&nbsp;Euijung Ryu PhD ,&nbsp;Véronique L. Roger MD, MPH ,&nbsp;Alanna M. Chamberlain PhD, MPH","doi":"10.1016/j.hroo.2025.02.002","DOIUrl":"10.1016/j.hroo.2025.02.002","url":null,"abstract":"<div><h3>Background</h3><div>The communities in which people live may affect their health.</div></div><div><h3>Objective</h3><div>The purpose of this study was to investigate the relationship between neighborhood characteristics and outcomes in patients with atrial fibrillation (AF).</div></div><div><h3>Methods</h3><div>Between 2013 and 2017, patients with new-onset AF were identified from a 27-county region. Addresses were linked to population density (rural–urban commuting area [RUCA] categorized as urban, large town, small town, and isolated rural) and neighborhood socioeconomic status (area deprivation index [ADI] categorized into quartiles of the national percentile rankings). Cox regression determined associations between RUCA and ADI with outcomes (ascertained through 2021). Analyses were restricted to 90-day survivors.</div></div><div><h3>Results</h3><div>Among 13,233 patients (mean age 73.8 years, 57% men), 744 had an ischemic stroke/transient ischemic attack (TIA), 3077 developed congestive heart failure (CHF), and 5989 died over a mean of 4.6 years. Persons living in isolated areas experienced a higher risk of death compared to urban areas (hazard ratio [HR] 1.14, 95% confidence interval [CI] 1.05–1.24). An increasing risk of death was observed with increasing ADI (HR 1.59, 95% CI 1.37–1.85 for ADI quartile 4 vs 1). When stratified by age, no differences in survival were observed across RUCA or ADI categories for those aged ≥85 years. In individuals aged &lt;65 years, an increased risk of CHF was observed with increasing ADI. There was no association between ischemic stroke/TIA and RUCA categorization or ADI quartile.</div></div><div><h3>Conclusion</h3><div>Patients with AF living in isolated areas and more socioeconomically disadvantaged regions experience increased risk of death. Understanding this connection is vital for both current and future attempts to mitigate these disparities.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 5","pages":"Pages 641-651"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144088941","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":"Conduction characteristics in the left atrium of patients with perimitral atrial tachycardia post–pulmonary vein isolation","authors":"Mitsuru Takami MD, PhD ,&nbsp;Ryudo Fujiwara MD, PhD ,&nbsp;Atsushi Suzuki MD, PhD ,&nbsp;Kunihiko Kiuchi MD, PhD ,&nbsp;Kimitake Imamura MD, PhD ,&nbsp;Kenichi Tani MD ,&nbsp;Hidehiro Iwai MD ,&nbsp;Yusuke Nakanishi MD ,&nbsp;Mitsuhiko Shoda MD ,&nbsp;Atsushi Murakami MD ,&nbsp;Shogo Yonehara MD ,&nbsp;Mari Yamamoto MD ,&nbsp;Hiroyuki Asada MD ,&nbsp;Takahiro Kunigita MD ,&nbsp;Ryosuke Takahashi MD ,&nbsp;Hiromasa Otake MD, PhD ,&nbsp;Junya Shite MD, PhD ,&nbsp;Koji Fukuzawa MD, PhD","doi":"10.1016/j.hroo.2025.02.003","DOIUrl":"10.1016/j.hroo.2025.02.003","url":null,"abstract":"<div><h3>Background</h3><div>The electrical conduction properties of the left atrium (LA) in patients with perimitral atrial tachycardia (PMAT) after pulmonary vein isolation (PVI) are not completely understood.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to investigate the characteristics of the segmental conduction velocity (CV) in the LA using multisite pacing in patients with PMAT.</div></div><div><h3>Methods</h3><div>After PVI in 179 patients, LA anterograde and retrograde propagation maps were created via pacing at different sites. Segmental CVs were measured in 7 distinct segments of the LA in both maps. Burst pacing was performed to induce atrial tachyarrhythmias.</div></div><div><h3>Results</h3><div>Twelve PMATs (7 clockwise rotation, 5 counterclockwise rotation) were induced in 11 patients (PMAT group), whereas no atrial tachyarrhythmias were induced in 56 (no induction group). Comparing the segmental CVs between the PMAT and no induction groups, we observed significant reductions in the PMAT group CVs, not only in the anterior and septal regions but also in the roof and bottom regions. Direction-dependent conduction delays were also observed in regions without or with small low-voltage areas, especially in the LA septum, lateral, and bottom. In the PMAT group, the very slow conduction area during PMAT consistently matched the region of the most reduced CV during either anterograde or retrograde propagation. Additionally, the direction of greater conduction delays in the anterior LA identified during pacing studies matched the direction of the PMAT rotation in 9 of 11 patients.</div></div><div><h3>Conclusion</h3><div>Patients with PMAT showed distinct segmental CVs in the LA, which may influence the tachycardia circuit formation and rotational direction.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 5","pages":"Pages 612-621"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144088902","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":"Glutathione peroxidase 4 as a potential biomarker for atrial fibrosis and recurrence of atrial fibrillation","authors":"Tong Liu MD,&nbsp;Dong-tao Zhou ME,&nbsp;Fang Liu MD,&nbsp;De-yong Long MD,&nbsp;Yang Yang MD,&nbsp;Meng-meng Li MD,&nbsp;Xin Zhao MD,&nbsp;Chang-yi Li MD,&nbsp;Wei Wang MD,&nbsp;Chen-xi Jiang MD,&nbsp;Ri-Bo Tang MD","doi":"10.1016/j.hroo.2025.02.001","DOIUrl":"10.1016/j.hroo.2025.02.001","url":null,"abstract":"<div><h3>Background</h3><div>Atrial fibrosis mediates the development and maintenance of atrial fibrillation (AF). Glutathione peroxidase 4 (GPX4) is a ferroptosis biomarker. Little is known about ferroptosis in AF or the relationship between GPX4 and atrial fibrosis.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate the predictive value of GPX4 for AF recurrence after ablation and the relationship between atrial fibrosis and ferroptosis.</div></div><div><h3>Methods</h3><div>This study included 249 patients with AF who underwent ablation. The levels of serum GPX4 and transforming growth factor β (TGFβ) were evaluated by enzyme-linked immunosorbent assay. The primary outcome was AF recurrence during 12 months of follow-up.</div></div><div><h3>Results</h3><div>According to the tertiles of TGFβ, 249 patients were divided into 3 groups. With the increase of TGFβ, the serum level of GPX4 was decreased. After 12 months of follow-up, 54 patients experienced recurrence of AF. Multivariate Cox regression analysis revealed that the GPX4 level was an independent predictor of F recurrence (hazard ratio 0.308). After adjusting for potential confounding factors, the tertiles of GPX4 remained predictors of AF recurrence. Correlation analysis indicated that GPX4 was associated with atrial fibrosis and left atrial size. Receiver-operating characteristic analysis showed that the cutoff value for AF recurrence was 3740 pg/mL. Furthermore, incorporating GPX4 into the left atrial dimensional index and TGFβ model significantly improved the prediction of recurrent AF risk.</div></div><div><h3>Conclusion</h3><div>GPX4 showed excellent predictive value for AF recurrence and is negatively correlated with TGFβ, indicating that ferroptosis may be involved in atrial fibrosis. This model can serve as a reference for clinical decision making.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 5","pages":"Pages 622-630"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144088903","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":"Validation of a handheld electrocardiogram 6 lead recorder to obtain chest lead equivalents: An Africa Heart Rhythm Association study","authors":"Thomas A. Slater PhD ,&nbsp;Redemptar Kimeu MD ,&nbsp;Mohamed Jeilan MD ,&nbsp;Kamilu M. Karaye PhD ,&nbsp;Reuben K. Mutagaywa PhD ,&nbsp;Isiaka Alfa BMBCh ,&nbsp;Vincent Y. Shidali MBBS ,&nbsp;Emmanuel Gushi MBBS ,&nbsp;Julius C. Mwita MD ,&nbsp;Omphemetse Mocheko RN ,&nbsp;Lamyaa Allam PhD ,&nbsp;Okechukwu S. Ogah PhD ,&nbsp;Bashir G. Ahmad MBBS ,&nbsp;Ashley Chin MPhil ,&nbsp;Razeen Gopal MD ,&nbsp;Philip Durkin BSc ,&nbsp;Robert Bowes BSc ,&nbsp;Lucy Leese BSc ,&nbsp;Marcus Ngantcha MSc ,&nbsp;Berthold Stegemann PhD ,&nbsp;Muzahir H. Tayebjee MD","doi":"10.1016/j.hroo.2025.03.009","DOIUrl":"10.1016/j.hroo.2025.03.009","url":null,"abstract":"<div><h3>Background</h3><div>Handheld electrocardiograms (ECGs) can be used easily in remote centers at low cost and are therefore attractive options for rural, low-income settings. A modification to the Kardia 6L ECG has been developed to record chest leads V2 and V4 by placing the device electrodes in standard V2 and V4 position.</div></div><div><h3>Objective</h3><div>The study sought to validate this novel technique against the 12-lead ECG in a multicenter cohort from Africa and the United Kingdom to determine whether recordings are adequate for clinical use.</div></div><div><h3>Methods</h3><div>Adults &gt;18 years of age who required an ECG as part of routine care were invited to participate. A 12-lead ECG was obtained followed by a 6-lead ECG using the Kardia 6L, then V2 and V4 chest lead equivalents were recorded. The primary endpoint was agreement between QT interval measurement in V2 and V4 on 12-lead ECG and Kardia 6L. Secondary endpoints assessed included rate, rhythm, PR interval, QRS duration, QRS amplitude, and ST-segment abnormalities.</div></div><div><h3>Results</h3><div>A total of 1786 recordings were collected from 11 sites. Hypertension was the primary indication for ECG (28%). The coefficient of determination for QT interval in leads V2 and V4 was 0.59 and 0.61, respectively, within the prespecified limit of agreement. The adjusted R² for multiple ECG parameters was &gt;0.5, indicating satisfactory agreement.</div></div><div><h3>Conclusion</h3><div>Modified chest lead recordings using the Kardia 6L handheld ECG recorder compared well with gold standard 12-lead ECG recordings and provide a basis for future simulated 12-lead ECG recordings using the Kardia 6L. This could improve accessibility of high-quality ECG recording and interpretation in rural, low-income settings.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 5","pages":"Pages 687-695"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144089134","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":"Screening cognitive impairment in patients with atrial fibrillation: A deep learning model based on retinal fundus photographs","authors":"Zhen Wang MD ,&nbsp;Mingxiao Li MD ,&nbsp;Peng Xia BS ,&nbsp;Chao Jiang MD ,&nbsp;Ting Shen MD ,&nbsp;Jiaming Ma MD ,&nbsp;Yu Bai MD ,&nbsp;Suhui Zhang MD ,&nbsp;Yiwei Lai MD ,&nbsp;Sitong Li MS ,&nbsp;Hui Xu MD ,&nbsp;Yang Xu MD ,&nbsp;Tong Ma MS ,&nbsp;Lie Ju PhD ,&nbsp;Liu He PhD ,&nbsp;Li Dong MD ,&nbsp;Caihua Sang MD ,&nbsp;Deyong Long MD ,&nbsp;Yuzhong Chen PhD ,&nbsp;Xin Du MD ,&nbsp;Changsheng Ma MD","doi":"10.1016/j.hroo.2025.01.019","DOIUrl":"10.1016/j.hroo.2025.01.019","url":null,"abstract":"<div><h3>Background</h3><div>Patients with atrial fibrillation (AF) have a higher risk of cognitive impairment (CI). However, complexity of CI diagnosis and lack of simple screening approaches limited early screening and intervention of CI in AF patients.</div></div><div><h3>Objective</h3><div>Our study aimed to develop deep learning models based on fundus photographs for easy screening of CI in AF patients.</div></div><div><h3>Methods</h3><div>From May 2021 to April 2023, patients who completed fundus examination and cognitive function evaluation in the Chinese Atrial Fibrillation Registry Study were included. The training and validation sets were randomly split at an 8:2 ratio. Participants from the Beijing Eye Study served as the external validation set. Different deep learning models were trained, and their CI detection ability was validated.</div></div><div><h3>Results</h3><div>A total of 899 patients in the Chinese Atrial Fibrillation Registry Study were included. In the validation set, the vision-ensemble model based on fundus images alone had an area under the receiver-operating characteristic curve (AUROC) of 0.855 (95% confidence interval 0.816–0.894) for CI screening. The multimodal model (AUROC 0.861, 95% confidence interval 0.823–0.898), based on fundus photographs and 4 clinical variables, performed comparably to the vision-ensemble model. The AUROC of the vision-ensemble model for CI screening achieved 0.773 (95% confidence interval 0.709–0.837) in the external test set. In the saliency map, the vision-ensemble model focused on areas around retinal vessels and the optic disc.</div></div><div><h3>Conclusion</h3><div>A vision-ensemble model based on fundus images might be practical for preliminary screening of CI in AF patients.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 5","pages":"Pages 678-686"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144088897","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}