1,720,997 research outputs found
Atrial fibrillation screening with photo-plethysmography through a smartphone camera
No full textAims This cross-sectional study was set up to assess the feasibility of mass screening for atrial fibrillation (AF) with only the use of a smartphone. Methods and results A local newspaper published an article, allowing to subscribe for a 7-day screening period to detect AF. Screening was performed through an application that uses photo-plethysmography (PPG) technology by exploiting a smartphone camera. Participants received instructions on how to perform correct measurements twice daily, with notifications pushed through the application's software. In case of heart rhythm irregularities, raw PPG signals underwent secondary offline analysis to confirm a final diagnosis. From 12328 readers who voluntarily signed up for screening (49 +/- 14 years; 58% men), 120446 unique PPG traces were obtained. Photo-plethysmography signal quality was adequate for analysis in 92% of cases. Possible AF was detected in 136 individuals (1.1%). They were older (P<0.001), more frequently men (P<0.001), and had higher body mass index (P=0.004). In addition, participants who strictly adhered to the recommended screening frequency (i.e. twice daily) were more often diagnosed with possible AF (1.9% vs. 1.0% in individuals who did not adhere; P = 0.008). Symptoms of palpitations, confusion, and shortness of breath were more frequent in case of AF (P<0.001). The cumulative diagnostic yield for possible AF increased from 0.4% with a single heart rhythm assessment to 1.4% with screening during the entire 7-day screening period. Conclusion Mass screening for AF using only a smartphone with dedicated application based on PPG technology is feasible and attractive because of its low cost and logistic requirements.Qompium N.V. provided free use of the FibriCheckVR algorithm for every study participant during the 7-day study period. The local newspaper Het Belang van Limburg published a free article to inform its readers on this
smartphone-based algorithm and encourage people to participate in the screening programme
Revisiting diastolic filling time as mechanistic insight for response to cardiac resynchronization therapy
No full textIntraventricular dyssynchrony and commonly associated prolonged atrioventricular conduction both reduce diastolic filling time (DFT), which can be improved by cardiac resynchronization therapy (CRT). Our aim was to investigate whether change in DFT corrected for RR interval (DFTC) after CRT might serve to assess the mechanistic response to CRT. Echocardiography data of consecutive patients in sinus rhythm (n 91) were studied before and 6 months after implantation. Mortality and heart failure hospitalization data were collected. Patients with vs. without DFTC increase after 6 months were compared. The programmed atrioventricular delay, percentage of biventricular pacing, and change in PR interval were similar in both groups. DFTC increase after 6 months reflected favourable reverse left ventricular remodelling and was significantly associated with freedom from death or heart failure admission (P 0.008). In multivariate analysis including guideline criteria for CRT (i.e. QRS width, presence of left bundle branch block, and ejection fraction), interventricular mechanical delay, and Tei index, baseline DFTC was the strongest predictor of adverse outcome. Notably, while patients with impaired relaxation had a large and highly significant reduction in all-cause mortality and heart failure admissions when DFTC increased [hazard ratio (HR), 95 confidence interval (CI) 0.24, 0.080.73; P 0.012], this benefit was less pronounced and did not reach statistical significance in patients with pseudonormal or restrictive filling (HR, 95 CI 0.64, 0.231.77; P 0.388). DFTC increase after CRT reflects favourable reverse remodelling and is associated with better clinical outcome
Benefits of cardiac resynchronization therapy persist at advanced age
No full textObjective: To assess reverse left ventricular remodeling, improvement in functional capacity and clinical outcome, in older CRT patients typically not included in randomized clinical trials.
Methods: Consecutive CRT patients (n = 201) who were implanted between October 2008 and April 2011 including optimization afterwards in a dedicated clinic, were stratified into 3 groups according to age: < 70 years (n = 72); 70 - 79 years (n = 89); and 80 years (n = 40). Effects of CRT on left ventricular remodeling (i.e. change in left ventricular end-diastolic and end-systolic diameter), functional capacity and clinical outcome were assessed during follow-up.
Results: Change in left ventricular end-diastolic and end-systolic diameter (P-value = 0.092 and 0.660, respectively, between groups), improvement in New York Heart Association functional class (P-value = 0.597 between groups) and increase of maximal aerobic capacity (P-value = 0.350 between groups), were similar in all groups 6 months after implantation. During mean follow-up of 15 months, 21 patients died and 50 were admitted for heart failure. Time to all-cause mortality and time to first heart failure admission were independent from age (Figure). Progressive pump failure was the major cause of death (57 %), while malignant ventricular arrhythmias were rare (7 %).
Conclusions: Reverse ventricular remodeling and functional capacity improvement after CRT are sustained at advanced age. Moreover, clinical outcome (heart failure events and all-cause mortality) were similar, irrespective of age, in a context of maximized optimization including optimal medical therapy
Cardiac resynchronization therapy with or without defibrillator: experience from a high-volume Belgian implantation centre
No full textObjective: Cardiac resynchronization therapy (CRT) is an important treatment modality for heart failure with reduced ejection fraction and ventricular conduction delay. Considering limited health care budgets in an aging population, adding a defibrillator function to CRT remains a matter of debate. Our aim was to describe the experience of a high-volume Belgian implantation centre with CRT/without defibrillator (CRT-D/P). Methods and results: Consecutive CRT patients (n=221), implanted between October 2008 and April 2011 in Ziekenhuis Oost-Limburg (Genk) were reviewed. From 209 primo-implantations, 74 CRT-D and 98 CRT-P patients with complete follow-up inside the centre, were analysed. Despite differences in baseline characteristics, both groups demonstrated similar reverse left ventricular remodelling, improvement in New York Heart Association functional class and maximal aerobic capacity. During mean follow-up 18 +/- 9 months, 21 patients died and 83 spent a total of 1200 days in hospital. Annual mortality was 8% and equal among the groups. The mode of death differed between CRT-D (predominantly pump failure) and CRT-P patients (pump failure, comorbidity and sudden death). The yearly population attributable risk of malignant ventricular arrhythmia was 8.16% in CRT-D and 1.38% in CRT-P patients. Conclusions: With current guidelines applied to the Belgian reimbursement criteria and at physicians' discretion, patient selection for CRT-D/CRT-P was appropriate, with similar reverse remodelling, functional capacity improvement and good clinical outcome in both groups. High-risk patients for malignant ventricular arrhythmia were more likely to receive CRT-D, although the yearly attributable risk remained 1.38% in CRT-P patient
Cardiac resynchronization therapy with or without defibrillator: experience from a high-volume Belgian implantation centre
No full textBackground: Cardiac resynchronization therapy (CRT) is an important treatment modality for heart failure with reduced ejection fraction and ventricular conduction delay. With stringent reimbursement criteria in an aging population, adding a defibrilator function to CRT remains a matter of debate. Our aim was to describe the experience of a high-volume Belgian implantation centre with CRT with/without defibrilator (CRT-D/P). Methods: Consecutive CRT patients (n=221), implanted between October 2008 and April 2011 in Ziekenhuis Oost-Limburg (Genk), were screened. From 209 primo-implantations, 74 CRTD and 98 CRTP patients with complete follow up inside the centre were analysed. Results: Despite differences in baseline characteristics, both groups demonstrated similar reverse left ventricular remodelling, improvement in New York Heart Association functional class and maximal aerobic capacity
MADIT-ICD benefit score aids in selecting implantable cardioverter-defibrillator in cardiac resynchronisation therapy
No full textComparative evaluation of digital consumer devices for atrial fibrillation detection: a validation study
No full textBackground: Consumer-oriented digital devices, such as smartphones and smartwatches, have gained prominence for their ability to conduct heart rhythm analysis, specifically in detecting atrial fibrillation (AF) through proprietary algorithms using electrocardiography (ECG) and/or photoplethysmography (PPG)-based digital recordings. Despite numerous individual validation studies, a direct inter-device comparison of their performance remains elusive.
Objective: To evaluate and compare the ability of digital consumer devices to discriminate between sinus rhythm and AF.
Methods: Patients exhibiting sinus rhythm or AF were consecutively enrolled from the cardiology outpatient clinic. They were instructed to perform heart rhythm measurements, using a handheld six-lead ECG device, a smartwatch-derived single-lead ECG, and two PPG-based smartphone applications in a random sequence, with continuous gold standard 12-lead ECG reference monitoring. Only one confirmed measurement per patient for each digital device was included in the analysis.
Results: Overall, 122 patients were included (age 69 [61-77] years, 63.9% male, 25% with AF). The sensitivity, specificity, accuracy, Cramer's V, and AUROC of the used devices, compared with a reference 12-lead ECG, were comparable and are presented in Table 1. Cohen's kappa demonstrated a near-perfect intra-device algorithm agreement between the first and second measurements with sufficient quality. Remarkably, smartphone PPG app (A) yielded significantly fewer inconclusive tracings compared to the other digital devices (p 5 .002). Nevertheless, participants preferred the use of a smartwatch form factor to monitor their heart rhythm.
Conclusion: The discrimination between sinus rhythm and AF using digital consumer devices based on ECG or PPG was highly accurate, with no discernible variations across the examined devices
Comparative evaluation of digital consumer devices for atrial fibrillation detection: a validation study
No full textBackground: Consumer-oriented digital devices, such as smartphones and smartwatches, have gained prominence for their ability to conduct heart rhythm analysis, specifically in detecting atrial fibrillation (AF) through proprietary algorithms using electrocardiography (ECG) and/or photoplethysmography (PPG)-based digital recordings. Despite numerous individual validation studies, a direct inter-device comparison of their performance remains elusive.
Objective: To evaluate and compare the ability of digital consumer devices to discriminate between sinus rhythm and AF.
Methods: Patients exhibiting sinus rhythm or AF were consecutively enrolled from the cardiology outpatient clinic. They were instructed to perform heart rhythm measurements, using a handheld six-lead ECG device, a smartwatch-derived single-lead ECG, and two PPG-based smartphone applications in a random sequence, with continuous gold standard 12-lead ECG reference monitoring. Only one confirmed measurement per patient for each digital device was included in the analysis.
Results: Overall, 122 patients were included (age 69 [61-77] years, 63.9% male, 25% with AF). The sensitivity, specificity, accuracy, Cramer's V, and AUROC of the used devices, compared with a reference 12-lead ECG, were comparable and are presented in Table 1. Cohen's kappa demonstrated a near-perfect intra-device algorithm agreement between the first and second measurements with sufficient quality. Remarkably, smartphone PPG app (A) yielded significantly fewer inconclusive tracings compared to the other digital devices (p 5 .002). Nevertheless, participants preferred the use of a smartwatch form factor to monitor their heart rhythm.
Conclusion: The discrimination between sinus rhythm and AF using digital consumer devices based on ECG or PPG was highly accurate, with no discernible variations across the examined devices
REVISITING DIASTOLIC FILLING TIME AS MECHANISTIC INSIGHT FOR RESPONSE TO CARDIAC RESYNCHRONIZATION THERAPY
No full textIncreasing diastolic filling time as mechanistic insight for response to cardiac resynchronization therapy
No full text- …
