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Adasuriya G, Barsky A, Kralj-Hans I, Mohan S, Gill S, Chen Z, Jarman J, Jones D, Valli H, Gkoutos GV, Markides V, Hussain W, Wong T, Kotecha D, Haldar S. Remote monitoring of atrial fibrillation recurrence using mHealth technology (REMOTE-AF). EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2024; 5:344-355. [PMID: 38774381 PMCID: PMC11104468 DOI: 10.1093/ehjdh/ztae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 01/04/2024] [Accepted: 02/09/2024] [Indexed: 05/24/2024]
Abstract
Aims This proof-of-concept study sought to evaluate changes in heart rate (HR) obtained from a consumer wearable device and compare against implantable loop recorder (ILR)-detected recurrence of atrial fibrillation (AF) and atrial tachycardia (AT) after AF ablation. Methods and results REMOTE-AF (NCT05037136) was a prospectively designed sub-study of the CASA-AF randomized controlled trial (NCT04280042). Participants without a permanent pacemaker had an ILR implanted at their index ablation procedure for longstanding persistent AF. Heart rate and step count were continuously monitored using photoplethysmography (PPG) from a commercially available wrist-worn wearable. Photoplethysmography-recorded HR data were pre-processed with noise filtration and episodes at 1-min interval over 30 min of HR elevations (Z-score = 2) were compared with corresponding ILR data. Thirty-five patients were enrolled, with mean age 70.3 ± 6.8 years and median follow-up 10 months (interquartile range 8-12 months). Implantable loop recorder analysis revealed 17 out of 35 patients (49%) had recurrence of AF/AT. Compared with ILR recurrence, wearable-derived elevations in HR ≥ 110 beats per minute had a sensitivity of 95.3%, specificity 54.1%, positive predictive value (PPV) 15.8%, negative predictive value (NPV) 99.2%, and overall accuracy 57.4%. With PPG-recorded HR elevation spikes (non-exercise related), the sensitivity was 87.5%, specificity 62.2%, PPV 39.2%, NPV 92.3%, and overall accuracy 64.0% in the entire patient cohort. In the AF/AT recurrence only group, sensitivity was 87.6%, specificity 68.3%, PPV 53.6%, NPV 93.0%, and overall accuracy 75.0%. Conclusion Consumer wearable devices have the potential to contribute to arrhythmia detection after AF ablation. Study Registration ClinicalTrials.gov Identifier: NCT05037136 https://clinicaltrials.gov/ct2/show/NCT05037136.
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Affiliation(s)
- Gamith Adasuriya
- Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, Hill End Road, Harefield, London UB9 6JH, UK
| | - Andrey Barsky
- Health Data Research UK Midlands & the NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Ines Kralj-Hans
- Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, Hill End Road, Harefield, London UB9 6JH, UK
| | - Siddhartha Mohan
- Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, Hill End Road, Harefield, London UB9 6JH, UK
| | - Simrat Gill
- Health Data Research UK Midlands & the NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Zhong Chen
- Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, Hill End Road, Harefield, London UB9 6JH, UK
| | - Julian Jarman
- Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, Hill End Road, Harefield, London UB9 6JH, UK
| | - David Jones
- Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, Hill End Road, Harefield, London UB9 6JH, UK
| | - Haseeb Valli
- Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, Hill End Road, Harefield, London UB9 6JH, UK
| | - Georgios V Gkoutos
- Health Data Research UK Midlands & the NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Vias Markides
- Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, Hill End Road, Harefield, London UB9 6JH, UK
| | - Wajid Hussain
- Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, Hill End Road, Harefield, London UB9 6JH, UK
| | - Tom Wong
- Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, Hill End Road, Harefield, London UB9 6JH, UK
- National Heart and Lung Institute, Imperial College London, London, UK
- Kings College Hospital, London, UK
| | - Dipak Kotecha
- Health Data Research UK Midlands & the NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Shouvik Haldar
- Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, Hill End Road, Harefield, London UB9 6JH, UK
- National Heart and Lung Institute, Imperial College London, London, UK
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Vijapurapu R, Roy A, Demetriades P, Warfield A, Hughes DA, Moon J, Woolfson P, de Bono J, Geberhiwot T, Kotecha D, Steeds RP. Systematic review of the incidence and clinical risk predictors of atrial fibrillation and permanent pacemaker implantation for bradycardia in Fabry disease. Open Heart 2023; 10:e002316. [PMID: 37460269 DOI: 10.1136/openhrt-2023-002316] [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: 03/24/2023] [Accepted: 06/16/2023] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION Fabry disease (FD) is an X-linked lysosomal storage disorder caused by enzyme deficiency, leading to glycosphingolipid accumulation. Cardiac accumulation triggers local tissue injury, electrical instability and arrhythmia. Bradyarrhythmia and atrial fibrillation (AF) incidence are reported in up to 16% and 13%, respectively. OBJECTIVE We conducted a systematic review evaluating AF burden and bradycardia requiring permanent pacemaker (PPM) implantation and report any predictive risk factors identified. METHODS We conducted a literature search on studies in adults with FD published from inception to July 2019. Study outcomes included AF or bradycardia requiring therapy. Databases included Embase, Medline, PubMed, Web of Science, CINAHL and Cochrane. The Risk of Bias Agreement tool for Non-Randomised Studies (RoBANS) was utilised to assess bias across key areas. RESULTS 11 studies were included, eight providing data on AF incidence or PPM implantation. Weighted estimate of event rates for AF were 12.2% and 10% for PPM. Age was associated with AF (OR 1.05-1.20 per 1-year increase in age) and a risk factor for PPM implantation (composite OR 1.03). Left ventricular hypertrophy (LVH) was associated with AF and PPM implantation. CONCLUSION Evidence supporting AF and bradycardia requiring pacemaker implantation is limited to single-centre studies. Incidence is variable and choice of diagnostic modality plays a role in detection rate. Predictors for AF (age, LVH and atrial dilatation) and PPM (age, LVH and PR/QRS interval) were identified but strength of association was low. Incidence of AF and PPM implantation in FD are variably reported with arrhythmia burden likely much higher than previously thought. PROSPERO DATABASE CRD42019132045.
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Affiliation(s)
- Ravi Vijapurapu
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK
| | - Ashwin Roy
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | | | - Adrian Warfield
- Department of Histopathology, Queen Elizabeth Hospital, Birmingham, UK
| | | | - James Moon
- Department of Cardiology, Saint Bartholomew's Hospital Barts Heart Centre, London, UK
| | - Peter Woolfson
- Department of Cardiology, Salford Royal Hospital, Salford, UK
| | - Joseph de Bono
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK
| | - Tarekegn Geberhiwot
- Department of Metabolic Medicine, Queen Elizabeth Hospital, Birmingham, UK
- University of Birmingham, Birmingham, UK
| | - Dipak Kotecha
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Richard Paul Steeds
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK
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Seneviratne MG, Connolly SB, Martin SS, Parakh K. Grains of Sand to Clinical Pearls: Realizing the Potential of Wearable Data. Am J Med 2023; 136:136-142. [PMID: 36351523 DOI: 10.1016/j.amjmed.2022.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/15/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022]
Abstract
Despite the rapid growth of wearables as a consumer technology sector and a growing evidence base supporting their use, they have been slow to be adopted by the health system into clinical care. As regulatory, reimbursement, and technical barriers recede, a persistent challenge remains how to make wearable data actionable for clinicians-transforming disconnected grains of wearable data into meaningful clinical "pearls". In order to bridge this adoption gap, wearable data must become visible, interpretable, and actionable for the clinician. We showcase emerging trends and best practices that illustrate these 3 pillars, and offer some recommendations on how the ecosystem can move forward.
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Affiliation(s)
| | | | - Seth S Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Medicine, Johns Hopkins, Baltimore, MD
| | - Kapil Parakh
- Google Research, Washington, DC; Georgetown School of Medicine, Washington, DC
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Yao Y, Li Z, He Y, Zhang Y, Guo Z, Lei Y, Zhao Q, Li D, Zhang Z, Zhang Y, Liao X. Factors affecting wearable ECG device adoption by general practitioners for atrial fibrillation screening: cross-sectional study. Front Public Health 2023; 11:1128127. [PMID: 37213597 PMCID: PMC10196261 DOI: 10.3389/fpubh.2023.1128127] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/11/2023] [Indexed: 05/23/2023] Open
Abstract
Introduction Atrial fibrillation (AF) is a challenging cardiovascular disease worldwide. Wearable electrocardiograph devices (WEDs) have great potential to improve the detection rate of AF in primary care. However, the factors that influence general practitioners' (GPs) perception and acceptance of WEDs are not well understood. To identify factors that influence the intention of GPs to utilize WEDs in a clinical setting to screen patients for AF. Method The research hypotheses and questionnaire items were designed and developed based on the unified theory of acceptance and technology (UTAUT) framework. We used stratified sampling and obtained the data through an online survey. Structural equation modeling was used to analyze the collected data.Results: A total of 1,004 valid questionnaires from GPs across Sichuan province in China were collected. Three factors increased GPs' intention to utilize WEDs to screen patients for AF, including performance expectancy (β = 0.121, p = 0.004), social influence (β = 0.356, p < 0.001), and price perception (β = 0.587, p < 0.001). Perception risk (β = -0.059, p < 0.001) decreased usage intention, while effort expectancy (β = -0.079, p = 0.155) and facilitating conditions (β = -0.014, p = 0.868) did not affect usage intention. Gender (β = -0.022, p = 0.179), age (β = 0.006, p = 0.699), education level (β = -0.22, p = 0.184) and training (β = 0.007, p = 0.69) were not significantly correlated with usage intention, and these four factors had no moderating effect on the path coefficients. Discussion GPs' intention to utilize WEDs is affected by performance expectancy, price perception, perception risk and social influence. Researcher should improve the usability and perception of WEDs for screening and carry out studies to provide high-quality evidence for the security and efficacy of wearable devices.
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Affiliation(s)
- Yi Yao
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zhichao Li
- Day Surgery Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yi He
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
- Chengdu Seventh People Hospital, Chengdu, China
| | - Yalin Zhang
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zhaoxia Guo
- Business School, Sichuan University, Chengdu, China
| | - Yi Lei
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qian Zhao
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Dongze Li
- Department of Emergency Medicine and Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Zhi Zhang
- Chengdu Shuangliu District Xihanggang Community Hospital, Chengdu, China
| | - Yonggang Zhang
- Department of Periodical Press and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- Yonggang Zhang,
| | - Xiaoyang Liao
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Xiaoyang Liao,
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EL-Dosouky II, Ammar AS, El Sherbiny IA, Mahmoud MM. Can we explore AF-pacemakers' relationship using clinical and echocardiographic parameters in patients with permanent pacemaker? (Echocardiography and subclinical AF in permanent pacemaker). Int J Cardiovasc Imaging 2023; 39:287-293. [PMID: 36690798 PMCID: PMC9870955 DOI: 10.1007/s10554-022-02719-4] [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: 05/08/2022] [Accepted: 08/17/2022] [Indexed: 01/27/2023]
Abstract
Patients on implanted permanent pacemakers frequently develop atrial fibrillation (AF). We aimed to determine the Echocardiographic and clinical parameters predicting AF in patients with a dual-chamber (DDD) pacemaker. This retrospective study included 208 patients with permanent pacemaker, classified according to development of AF during follow up into 2 groups: AF (77, 37%) and non AF (131, 63%), baseline: clinical, ECG(P-wave dispersion) and echo {diastolic wall strain (DWS),left arial volume index (LAVI), left ventricular stiffness index(LVSI)} data were assessed. AF group were older with more P wave dispersion, lesser DWS, greater LVSI& LAVI, LVSI at a cut off > 0.13 and DWS at a cut off < 0.34 were predictors of AF in patients with DDD pacemakers. LVSI and DWS could be used as simple good predictors for AF in patients with DDD pacemakers, for timely initiation of anticoagulants according to CHA2DS2VASc score to decrease ischemic stroke burden.
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Affiliation(s)
- Ibtesam I. EL-Dosouky
- Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig, 44519 Egypt
| | - Ahmed Shafie Ammar
- Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig, 44519 Egypt
| | - Islam A. El Sherbiny
- Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig, 44519 Egypt
| | - Mohamed M. Mahmoud
- Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig, 44519 Egypt
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Emmanuel A. Do you need a weatherman to know which way the wind blows? Clin Med (Lond) 2022; 22:1. [PMID: 38589096 DOI: 10.7861/clinmed.ed.22.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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