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Russo V, Covino S, De Pasquale V, Parente E, Comune A, Rago A, Papa AA, Ammendola E, Spadaro Guerra A, Napoli P, Golino P, Nigro G. Remote monitoring of implantable cardiac monitors in patients with unexplained syncope: Predictors of false-positive alert episodes. Pacing Clin Electrophysiol 2023; 46:1500-1508. [PMID: 37885375 DOI: 10.1111/pace.14851] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/03/2023] [Accepted: 10/07/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Remote monitoring is recommended for patients with implantable cardiac monitors (ICMs), but compared to other cardiac implantable devices, ICMs are less accurate and transmit a higher number of alerts. OBJECTIVE The aim of this study was to investigate the predictors of false-positive (FP) arrhythmic alerts in patients with unexplained syncope who were implanted with ICM and followed by an automatic remote monitoring system. METHODS We retrospectively evaluated all consecutive patients who received a long-sensing vector ICM for unexplained syncope between January 2019 to September 2021 at our Syncope Unit. The primary endpoint was the incidence of the first FP episode. The secondary endpoints included assessing the incidence of FP episodes for all types of algorhythms and indentifying the reasons for the misdetection of these episodes. RESULTS Among 105 patients (44.8% males, median age 51 years), 51 (48.6%) transmitted at least one FP alert during a median follow-up of 301 days. The presence of pre-ventricular complexes (PVCs) on the resting electrocardiogram was the only clinical characteristic associated with an increased risk of FP alerts (adjusted Hazard ratio [HR] 5.76 [2.66-12.4], p = 0.010). The other significant device-related variables were a low-frequency filter at 0.05 Hz versus the default 0.5 Hz (adjusted HR 3.82 [1.38-10.5], p = 0.010) and the R-wave amplitude (adjusted HR 0.35 [0.13-0.99], p = 0.049). CONCLUSION Patients who have PVCs are at higher risk of inappropriate ICM activations. To reduce the occurrence of FP alerts, it may be beneficial to target a large R-wave amplitude during device insertion and avoid programming a low-frequency filter at 0.05 Hz.
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Affiliation(s)
- Vincenzo Russo
- Cardiology and Syncope Unit, Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli" - Monaldi Hospital, Naples, Italy
| | - Simona Covino
- Cardiology and Syncope Unit, Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli" - Monaldi Hospital, Naples, Italy
| | - Valentina De Pasquale
- Cardiology and Syncope Unit, Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli" - Monaldi Hospital, Naples, Italy
| | - Erika Parente
- Cardiology and Syncope Unit, Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli" - Monaldi Hospital, Naples, Italy
| | - Angelo Comune
- Cardiology and Syncope Unit, Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli" - Monaldi Hospital, Naples, Italy
| | - Anna Rago
- Cardiology and Syncope Unit, Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli" - Monaldi Hospital, Naples, Italy
| | - Andrea Antonio Papa
- Cardiology and Syncope Unit, Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli" - Monaldi Hospital, Naples, Italy
| | - Ernesto Ammendola
- Cardiology and Syncope Unit, Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli" - Monaldi Hospital, Naples, Italy
| | | | - Paola Napoli
- Clinical Research Unit, Biotronik Italia S.p.A., Milan, Italy
| | - Paolo Golino
- Cardiology and Syncope Unit, Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli" - Monaldi Hospital, Naples, Italy
| | - Gerardo Nigro
- Cardiology and Syncope Unit, Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli" - Monaldi Hospital, Naples, Italy
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Parkkari E, Vanhala V, Lindberg R, Tynkkynen J, Hernesniemi J. The incidence of atrial fibrillation, new oral anticoagulation, stroke, and significant bleeds in patients receiving a new dual-chamber pacemaker. IJC HEART & VASCULATURE 2023; 49:101307. [PMID: 38053982 PMCID: PMC10694644 DOI: 10.1016/j.ijcha.2023.101307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/02/2023] [Accepted: 11/15/2023] [Indexed: 12/07/2023]
Abstract
Background and objectives Atrial fibrillation and flutter (AF/AFL) can be easily detected in patients who have a dual-chamber pacemaker (PM). This can result in a high detection rate of these arrhythmias especially if patients are monitored remotely and detection limits are sensitive. Materials and methods A single-center retrospective registry analysis of 1,285 consecutive AF/AFL and anticoagulation naïve patients from a limited geographical area undergoing implantation of a new dual-chamber PM (between 2013 and 2019). Seven-year follow-up data for incident AF/AFL, initiation of new oral anticoagulation and for incident strokes and bleeds was obtained from an in-depth review of all relevant patient records including written medical records and death certificates detailing causes of death. Results During the follow-up, mortality reached 22.2 % and cumulative incidence of AF/AFL, new anticoagulation, strokes, and bleeds were 52.6 %, 40.4 %, 4.7 % and 10.4 %. In 92.6 % of the cases, AF/AFL was discovered by PM. Remote monitoring was initiated in 67 % (n = 856). Risk factor adjusted mortality in this group was significantly lower when compared to patients in regular out-patient clinic controls (HR 0.45, 95 % CI 0.35-0.57). Despite of their better overall prognosis, the AF/AFL was discovered, and oral anticoagulation was initiated more often in remote monitoring group (HR 1.58, 95 % CI 1.23-1.79 for AF/AFL and HR 1.67, 95 % CI 1.33-2.09 for anticoagulation). There was no significant difference in the incidence of strokes or bleeds. Conclusions The incidence of new AF/AFL is high in this population. Remote monitoring is associated with higher diagnostic yields of AF/AFL and initiated anticoagulation, but not with stroke and significant bleeds.
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Affiliation(s)
- Elias Parkkari
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ville Vanhala
- Tays Hearth Hospital, Tampere University Hospital, Tampere, Finland
| | - Ronja Lindberg
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juho Tynkkynen
- Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - Jussi Hernesniemi
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Tays Hearth Hospital, Tampere University Hospital, Tampere, Finland
- Finnish Cardiovascular Research Center Tampere, Tampere, Finland
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Svennberg E, Caiani EG, Bruining N, Desteghe L, Han JK, Narayan SM, Rademakers FE, Sanders P, Duncker D. The digital journey: 25 years of digital development in electrophysiology from an Europace perspective. Europace 2023; 25:euad176. [PMID: 37622574 PMCID: PMC10450797 DOI: 10.1093/europace/euad176] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/03/2023] [Indexed: 08/26/2023] Open
Abstract
AIMS Over the past 25 years there has been a substantial development in the field of digital electrophysiology (EP) and in parallel a substantial increase in publications on digital cardiology.In this celebratory paper, we provide an overview of the digital field by highlighting publications from the field focusing on the EP Europace journal. RESULTS In this journey across the past quarter of a century we follow the development of digital tools commonly used in the clinic spanning from the initiation of digital clinics through the early days of telemonitoring, to wearables, mobile applications, and the use of fully virtual clinics. We then provide a chronicle of the field of artificial intelligence, a regulatory perspective, and at the end of our journey provide a future outlook for digital EP. CONCLUSION Over the past 25 years Europace has published a substantial number of papers on digital EP, with a marked expansion in digital publications in recent years.
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Affiliation(s)
- Emma Svennberg
- Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden
| | - Enrico G Caiani
- Politecnico di Milano, Electronic, Information and Biomedical Engineering Department, Milan, Italy
- Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Nico Bruining
- Department of Clinical and Experimental Information processing (Digital Cardiology), Erasmus Medical Center, Thoraxcenter, Rotterdam, The Netherlands
| | - Lien Desteghe
- Research Group Cardiovascular Diseases, University of Antwerp, 2000 Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital, 2056 Edegem, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, 3500 Hasselt, Belgium
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, 3500 Hasselt, Belgium
| | - Janet K Han
- Division of Cardiology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
- Cardiac Arrhythmia Center, University of California Los Angeles, Los Angeles, CA, USA
| | - Sanjiv M Narayan
- Cardiology Division, Cardiovascular Institute and Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, 5005 Adelaide, Australia
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
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Russo V, Rago A, Grimaldi N, Chianese R, Viggiano A, D’Alterio G, Colonna D, Mattera Iacono A, Papa AA, Spadaro Guerra A, Gargaro A, Rapacciuolo A, Sarubbi B, D’Onofrio A, Nigro G. Remote monitoring of implantable loop recorders reduces time to diagnosis in patients with unexplained syncope: a multicenter propensity score-matched study. Front Cardiovasc Med 2023; 10:1193805. [PMID: 37388638 PMCID: PMC10303931 DOI: 10.3389/fcvm.2023.1193805] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 05/02/2023] [Indexed: 07/01/2023] Open
Abstract
Background There are little data on remote monitoring (RM) of implantable loop recorders (ILRs) in patients with unexplained syncope and whether it confers enhanced diagnostic power. Objective To evaluate the effect of RM in ILR recipients for unexplained syncope for early detection of clinically relevant arrhythmias by comparison with a historical cohort with no RM. Methods SyncRM is a propensity score (PS)-matched study prospectively including 133 consecutive patients with unexplained syncope and ILR followed up by RM (RM-ON group). A historical cohort of 108 consecutive ILR patients with biannual in-hospital follow-up visits was used as control group (RM-OFF group). The primary endpoint was the time to the clinician's evaluation of clinically relevant arrhythmias (types 1, 2, and 4 of the ISSUE classification). Results The primary endpoint of arrhythmia evaluation was reached in 38 patients (28.6%) of the RM-ON group after a median time of 46 days (interquartile range, 13-106) and in 22 patients (20.4%) of the RM-OFF group after 92 days (25-368). The PS-matched adjusted ratio of rates of arrhythmia evaluation was 2.53 (95% confidence interval, 1.32-4.86) in the RM-ON vs. RM-OFF group (p = 0.005). Conclusion In our PS-matched comparison with a historical cohort, RM of ILR patients with unexplained syncope was associated with a 2.5-fold higher chance of evaluations of clinically relevant arrhythmias as compared with biannual in-office follow-up visits.
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Affiliation(s)
- Vincenzo Russo
- Cardiology and Syncope Unit, Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”—Monaldi Hospital, Naples, Italy
| | - Anna Rago
- Cardiology and Syncope Unit, Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”—Monaldi Hospital, Naples, Italy
| | - Nicola Grimaldi
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Raffaele Chianese
- Cardiology Division, Sant'Anna and San Sebastiano Hospital, Caserta, Italy
| | - Aniello Viggiano
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Giuliano D’Alterio
- CardiologyDepartment, Electrophysiology and Cardiac Pacing Unit A.O.R.N. V. Monaldi, Naples, Italy
| | - Diego Colonna
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | | | - Andrea Antonio Papa
- Cardiology and Syncope Unit, Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”—Monaldi Hospital, Naples, Italy
| | | | - Alessio Gargaro
- Clinical Research Unit, Biotronik Italia S.p.A., Cologno, Italy
| | - Antonio Rapacciuolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Berardo Sarubbi
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Antonio D’Onofrio
- CardiologyDepartment, Electrophysiology and Cardiac Pacing Unit A.O.R.N. V. Monaldi, Naples, Italy
| | - Gerardo Nigro
- Cardiology and Syncope Unit, Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”—Monaldi Hospital, Naples, Italy
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Barracano R, Ciriello GD, Sarubbi B. Pharmacological therapy in adult congenital heart disease with coronary artery disease and atrial fibrillation. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2023. [DOI: 10.1016/j.ijcchd.2023.100446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
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Implantable Loop Recorder with Long Sensing Vector: Safety, Acceptability, and Sensing Performance in Pediatric Patients. Pediatr Cardiol 2022; 44:1068-1075. [PMID: 36576525 PMCID: PMC9795155 DOI: 10.1007/s00246-022-03082-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/18/2022] [Indexed: 12/29/2022]
Abstract
Implantable loop recorders (ILRs) are effective tools for detecting arrhythmias by long-term continuous heart rhythm monitoring. Benefits have been demonstrated even in pediatric patients. ILR with a long sensing vector has recently been designed to improve signal quality in terms of P wave visibility and R wave amplitude. However, there are no data on its use in pediatric patients. We considered a series of pediatric patients implanted with a long sensing vector ILR. Sensing performance, including R wave amplitude and P wave visibility, device-related complications, and diagnostic yield were collected. During follow-up, each patient guided by his/her parents/guardians was also asked to complete a brief questionnaire to assess patient acceptability of the device. Twenty-five consecutive pediatric patients (mean age 11.3 ± 3.5 years, 72% male) were enrolled. The insertion success rate was 100% on the first attempt with no complications. The median amplitude of the R wave was 1.15 mV (interquartile range, 1.01-1.42) with no significant differences between patients aged ≤ or > 10 years (p = 0.726) and between female and male (p = 0.483). P wave was classified as 'always visible' in 24/25 patients (96%). ILR was generally well accepted and tolerated by all involved patients. During a median follow-up of 297 days (117-317), we achieved in 5 patients a correlation between symptoms and rhythm disorders (20%) and ruled out significant arrhythmias in 6 symptomatic children (24%). Long sensing vector ILR showed to be well accepted, with good signal quality and an excellent safety profile even in pediatric patients.
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