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This economic study aimed to evaluate the clinical and cost outcomes of using mid-term cardiac monitors (referred to as "ePatch") versus ILR-only in post-CS patients in the UK, Netherlands (NL) and Sweden. Methods: An existing cost-minimization model was modified to fit healthcare settings in the UK, Netherlands and Sweden. The model's target population was composed of adult patients who had previously experienced a CS, but had no documented history of AF. The model compares the one-year direct medical costs between two groups: one group receiving wearable ePatch, the other group proceeding directly to ILR. Results: When applied to a group of 1,000 patients, the ePatch versus ILR approach resulted in cost savings, due to combination of reduced expenses and decreased modelled occurrence of recurrent strokes in all three countries studied. In the base case analysis, the cost savings per patient with detected AF for ePatch ranged from 3.4– 6.0 times, depending on the country. Conclusion: Utilizing ePatch extended wear Holter for mid-term ECG monitoring in CS patients represents a cost-saving alternative to monitoring with ILR. The cost savings were achieved by reducing device expenses and by prevention of recurrent strokes via earlier anticoagulation initiation. Preventing recurrent strokes in this population is highly significant, as it can lead to improved long-term health outcomes and reduced overall healthcare costs. [ABSTRACT FROM AUTHOR]

[Display omitted] • Optimal timing and combinations of screening tools for AF after stroke remains unclear. • A sequential screening approach allows for early (in-hospital) detection of AF in many patients. • Proactive acute monitoring can avoid invasive long-term monitoring. • Implantable cardiac monitoring remains complementary for the detection of late AF. Although guidelines recommend screening patients for atrial fibrillation (AF) after stroke, the optimal timing and combination of screening tools remain unclear. We evaluated the suitability of a sequential combination of screening techniques for AF detected after stroke (AFDAS). We also compared patient characteristics according to the timing of AFDAS. Patients without previous AF admitted for acute ischaemic stroke were prospectively enrolled. After a stepwise screening approach for AFDAS based on electrocardiogram, telemetry monitoring and in-hospital long-term Holter, patients with cryptogenic stroke underwent implantation of an implantable cardiac monitor (ICM). Early AFDAS was defined as AF diagnosed during hospitalization and late AFDAS as AF diagnosed on an ICM. Of the 240 patients included, 104 (43.3%) had a documented cause of stroke not related to AF. Among the 136 remaining patients, AFDAS was detected in 82 (60.3%) during the acute screening phase or during the 3-year follow-up by ICM. Early AFDAS was diagnosed by ECG, telemetry and in-hospital long-term Holter monitoring in 17 (20.7%), 25 (30.5%) and 18 (22.0%) patients, respectively. Among 76 patients who had an ICM implanted for cryptogenic stroke, AF was detected in 22 patients (28.9%). Except for age and stroke location, patients with early AFDAS did not differ from those with late AFDAS, particularly with regard to the prevalence of atrial cardiomyopathy markers. A stepwise approach to AFDAS screening allows early detection of AF in a considerable number of patients during their hospitalization. ICMs remain complementary to non-invasive screening tools for the detection of remote episodes of AF. [ABSTRACT FROM AUTHOR]

Background: A significant atrial septal defect leads to atrial interstitial fibrosis, arrythmia and right ventricle remodelling. Objective: This study aimed to investigate the outcomes of transcatheter closure of secundum atrial septal defects on cardiac remodelling by electrocardiography and Holter study in pediatric population Patients and Methods This prospective observational study was conducted on 69 patients (35 males and 34 females), aged from 1.5 to 16 years, diagnosed with secundum ASD who were referred for elective transcatheter secundum ASD device closure at Department of Pediatrics, Faculty of Medicine, Sohag University Hospitals, between April 2022 and June 2023. Results: There was a significant reduction in all ECG parameters including HR, PR interval, QRS duration, QRS Axis and QTc interval immediately, one day post-procedure, after 1 month, 6 months and after 1year compared to pretranscatheter (P value<0.05). Sinus tachycardia, prolonged QTC duration, prolonged PR interval, prolonged QRS duration and rt axis deviation were insignificantly different between males and females pre transcatheter, post transcatheter ASD closure. Heart rate variability indices (Pnn50, RMS-SD, SDNN, SDANN and tri) were significantly higher one day post transcatheter, also after one month, after 6 months and after one year compared to the baseline values pre-closure (P value 0.05). Conclusions: It could be concluded that transcatheter ASD device closure leads immediately to a significant improvement in electrical reverse remodelling parameters. Holter ECG study is considered a beneficial tool to evaluate cardiac autonomic functions and the influence of transcatheter closure of ASD on cardiac autonomic function and magnitude of arrhythmia. [ABSTRACT FROM AUTHOR]

Background: Wireless Holter monitors can be a great alternative to the traditional wired holter monitoring potentially giving better patient outcomes. However, the technology is new and less explored for the quality of ECG wave forms. Objective: This study was taken up to compare the quality of electrocardiogram (ECG) and arrhythmia detection using a traditional Holter and a wireless ambulatory smart ECG – Vigo SmartHeart (VSH) that functions with a Mobile application. Materials and Methods: The present study was cross-sectional in nature. We enrolled the patients indicated for continuous ECG monitoring. All the enrolled patients were connected to VSH wireless Holter solution and a conventional Holter monitor simultaneously. The ECGs generated were compared through descriptive statistics such as mean, standard deviation, and correlation by Pearson’s correlation method. Results: Seventy-one patients had simultaneous ECG recordings by both systems. The Pearson correlation for P wave, QRS, PR, QT, and ST was measured as 0.93, 0.93, 0.99, 0.36, and 0.98, respectively. The minimum heart rate (HR), maximum HR, RR interval, P wave, QRS complex, PR, and ST segments showed a statistically significant correlation between Smart Heart and Conventional Holter. 17 ECG events were reported, of which 14 were detected by both. The events missed by conventional Holter and detected by VSH were Atrioventricular block (2), Supraventricular tachycardia (1), and Intraventricular conduction delay (1). Conclusions: The quality of the report generated by both the methods was comparable to ECG wave quality, However, arrhythmia was picked up by the SmartHeart with better precision compared to conventional Holter. Thus, VSH can serve as a viable and potential alternative tool to screen and help in reducing the morbidity and mortality related to arrhythmias.

Luigi Galvani (1737-1798) studied the contractions of the leg muscle of a decapitated frog, becoming the founder of electrophysiology. His work even inspired artists such as Paul Peel (1860- 1892), who painted his famous painting “The Young Biologist” in 1891. Galvani’s work was the foundation for the revolutionary inventions of many other scientists, such as Willem Einthoven (1860-1927), the inventor of the electrocardiogram (ECG). The scientist whose name is pronounced daily by almost every cardiologist in the world is Norman Jefferis Holter (1914-1983), who brought together all previous research and merged them with the ideas of Nikola Tesla on the wireless transfer of energy and information. As his most famous invention, the holter ECG monitor is only one derivate of what can be termed Holter’s technology and can be considered the biomedical part of the discipline called telemetry. Today, we use a number of devices that are fundamentally based on Holter’s technology, e.g. implantable loop recorders or pacemaker interrogations. The technique called continuous arterial pressure monitoring is also based on Holter’s technology, and it is an open question whether we can call this method holter blood pressure monitoring. Regardless, the implantable pulmonary artery pressure monitoring device is the result of the fundamental ideas of Holter and Tesla, and, like many other great scientists, Jeff Holter deserves to have his eponym – holter – used in biomedical literature and in the general history of science. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to retrospectively assess cardiac autonomic activity in children with LQTS, considering genotype, symptoms, sex, age, and beta‐blocker therapy (BB) and compare it to healthy controls. Methods: Heart rate variability (HRV), using power spectrum analysis, was analyzed in 575 Holter recordings from 116 children with LQTS and in 69 healthy children. The data were categorized into four age‐groups and four heart rate (HR) ranges. Results: In LQT1 and LQT2, increasing HR corresponded to significantly lower low (LF) and high frequency (HF) compared to controls. Total power (PTOT) was lower in all LQT1 age‐groups compared to controls at HR 120–140 bpm (1–15 years: p <.01; 15–18 years: p =.03). At HR 80–100, LQT1 patients aged 1–10 years had lower HF than LQT2 patients (1–5 years: p =.05; 5–10 years: p =.02), and LQT2 patients aged 15–18 years had lower HF than LQT1 patients (p <.01). Symptomatic patients aged 10–15 years had lower PTOT at HR 100–120 bpm than asymptomatic patients (p =.04). LQT1 girls aged 10–15 and 15–18 years had a lower PTOT (10–15 years: p =.04; 15–18 years: p =.02) than boys. Conclusion: This study shows a correlation between HR and changes in HRV parameters. At higher HRs, LQTS patients generally had lower HRV values than controls, suggesting an abnormal autonomic response. These results may strengthen the link between physical activity and arrhythmias in LQTS. [ABSTRACT FROM AUTHOR]

Simple Summary: Working dogs, specifically search and rescue dogs, represent a fundamental resource in the social field for their activities carried out both in daily life and in disaster conditions. Canine well-being must therefore represent an obligation for the governance of a country as well as veterinary clinical research. Our aim was to verify the use of accurate tools for monitoring cardiac activity during operating in the field. The study conducted with electrocardiogram and Holter methods highlighted, in 31 healthy dogs, the presence of few electrical alterations during work with the use of the Holter or, immediately afterwards, with the use of the electrocardiogram. The aim of this study was to observe electric cardiac activity in real working conditions, with the application of Holter and the electrocardiogram in search and rescue dogs. Thirty-one handlers of search and rescue dogs voluntarily participated in this study. Nine dogs were selected to wear the Holter, and twenty-three were submitted to electrocardiographic recordings (one dog, excluded by Holter examination, was then included in the ECG group). Our results showed few cardiac rhythm alterations, such as escape beats, premature ventricular beat, and depression and elevation of the ST segment, particularly during the working phase in the Holter group and during recovery time immediately after activity in the electrocardiographic group. Detected alterations in real working conditions may provide more information than routine checks, and Holter monitoring can be more functional. However, not all dogs tolerate wearing the Holter harness, and more time is thus needed to apply the equipment. In addition, the results are not immediate, and the absence of water is essential because it would damage the equipment. [ABSTRACT FROM AUTHOR]

Background Ambulatory ECG (AECG) monitoring is pivotal to the diagnosis of arrhythmias and can be performed with near “real‐time” notification of abnormalities. There are limited data on the relative benefit of real‐time monitoring compared with traditional Holter monitoring. Methods and Results This is a retrospective observational analysis of University of Utah Health patients who underwent ambulatory ECG studies from 2010 to 2022. The study cohort was stratified by patients with an ambulatory ECG that provides real‐time event notification (non‐Holter) versus those who do not (Holter). The outcomes were cardiac implantable electronic device procedure, ablation procedure, emergency department/hospitalization visit, and initiation of anticoagulation out to 6 months. We identified 20 259 patients, 16 650 with non‐Holter studies and 3609 with Holter studies. Holter patients were younger (mean 52 versus 55, P

Aim: To evaluate the definition and causes of neonatal bradycardias. Methods: This retrospective study included 135 term‐born newborns referred for 24‐hour Holter monitoring due to bradycardia. Bradycardia was defined as either a heart rate below 80 beats per minute (standard definition) or a heart rate below our recently published age‐specific reference values for neonatal heart rate. Results: The mean (SD) age was 6.1 (1.3) days. With standard definition, 107 newborns (79%) had bradycardia, whereas only 20 (15%) had a minimum heart rate lower than the age‐specific reference. Younger newborns had lower heart rates. Each day increased the minimum, mean and maximum heart rate by 1.8 (95% CI: 1.0, 2.6), 4.2 (95% CI: 3.0, 5.3) and 2.1 beats per minute (95% CI: 0.3, 3.8), respectively. Male sex and maternal levothyroxine medication were negatively associated with the mean and maximum heart rate. None of the newborns had a cardiac cause for low heart rate. Conclusion: Among term newborns with bradycardias, younger age, male sex and maternal levothyroxine medication were associated with a lower heart rate on Holter monitoring. Given the age‐related increase in heart rate, the 80 beats per minute limit as a universal threshold for abnormal heart rate in newborns appears inappropriate. [ABSTRACT FROM AUTHOR]

Background and Aim: Scarce data exist on the true incidence of postoperative atrial fibrillation (POAF) after acute abdominal surgery and associated outcomes. The current study aimed to identify the frequencies of clinically recognized POAF and associated complications, along with their risk factors. Methods: This study was a prospective, single‐center cohort study of unselected adult patients referred for acute abdominal surgery during a 3‐month period. Through careful review, demographics, comorbidity, and surgical characteristics were prospectively drawn from medical charts. The primary outcome was clinically recognized POAF occurring in‐hospital. Logistic regression was used to determine the risk factors of POAF and associated complications. A subgroup was enrolled in a feasibility study of peri‐ and postoperative continuous cardiac rhythm monitoring. Results: In total, 450 patients were enrolled. Clinically recognized in‐hospital POAF was observed in 22 patients (4.9%). All cases were observed in patients aged ≥60 years, corresponding to 22 of 164 patients (13.4%). Multiple risk factors were observed, such as age, prior atrial fibrillation, heart failure, hypertension, diabetes mellitus, chronic renal disease, and major (vs. minor) surgery. POAF was associated with severe in‐hospital complications (POAF group 45.5% vs. non‐POAF group 8.6%, p <.001) and in‐hospital mortality (POAF group 13.6% vs. non‐POAF group 3.0%, p =.043). In total, 295 patients were monitored by continuous cardiac rhythm monitoring for 12,148 h, yielding five patients with asymptomatic AF. Conclusions: In conclusion, this prospective study of POAF in patients undergoing acute abdominal surgery showed that one in 20 patients developed clinically recognized in‐hospital POAF. Multiple risk factors of POAF were identified. POAF was associated with severe complications up to 30 days after surgery. [ABSTRACT FROM AUTHOR]

BackgroundEvaluating cardiovascular risk in patients experiencing acute ST-elevation myocardial infarction (STEMI) and undergoing percutaneous coronary intervention (PCI) is crucial for early intervention and improving long-term outcomes. 24 h Holter monitoring provides continuous cardiac electrophysiological data, enabling the detection of arrhythmias and autonomic dysfunction that are not captured during routine examinations. This study aimed to examine the relationship between Holter monitoring metrics and the occurrence of out-of-hospital major adverse cardiovascular events (MACEs) following PCI in patients with STEMI, offering insights into cardiovascular risk evaluation.MethodsThis prospective cohort study included STEMI patients undergoing PCI. 24 h Holter monitoring data were recorded, including heart rate, heart rate variability (HRV) metrics such as SDNN and SDANN index, heart rate deceleration capacity (DC) at different time scales (DC2, DC4, DC8), and the frequency of premature ventricular contractions (PVCs). Independent correlations between these indices and MACEs, as well as cardiovascular deaths, were investigated using multifactorial logistic regression. Predictive capacities were assessed through receiver operating characteristic (ROC) curves.ResultsA total of 172 participants were enrolled in this study. Over the 3-year follow-up period, MACEs were observed in 57 patients, including 20 cases of cardiac death. In logistic regression models adjusted for confounding variables, SDNN [OR: 0.980; 95% CI: (0.967, 0.994); p = 0.005] and SDANN index [OR: 0.982; 95% CI: (0.969, 0.996); p = 0.009] were negatively associated with the incidence of MACEs. Conversely, the slowest heart rate [OR: 1.075; 95% CI: (1.022, 1.131); p = 0.005] and frequent PVCs [OR: 2.685; 95% CI: (1.204, 5.987); p = 0.016] demonstrated a positive association with MACEs. Furthermore, SDNN [OR: 0.957; 95% CI: (0.933, 0.981); p = 0.001], DC [OR: 0. 702; 95% CI: (0.526, 0.938); p = 0.017]) and DC4 [OR: 0.020; 95% CI: (0.001, 0.664); p = 0.029] were negatively associated with cardiac death. The ROC analysis results indicated that SDNN was an effective predictor of both MACEs [AUC: 0.688 (95% CI: 0.601–0.776)] and cardiac death [AUC: 0.752 (95% CI: 0.625–0.879)].ConclusionHRV, DC metrics, and frequent PVCs obtained by 24 h Holter monitoring were associated with the risk of MACEs in STEMI patients. These metrics can help clinicians identify at-risk patients early so that timely interventions.

Abstract Objectives This study aimed to retrospectively assess cardiac autonomic activity in children with LQTS, considering genotype, symptoms, sex, age, and beta‐blocker therapy (BB) and compare it to healthy controls. Methods Heart rate variability (HRV), using power spectrum analysis, was analyzed in 575 Holter recordings from 116 children with LQTS and in 69 healthy children. The data were categorized into four age‐groups and four heart rate (HR) ranges. Results In LQT1 and LQT2, increasing HR corresponded to significantly lower low (LF) and high frequency (HF) compared to controls. Total power (PTOT) was lower in all LQT1 age‐groups compared to controls at HR 120–140 bpm (1–15 years: p

The database is constituted by 50 datasets containing cardiorespiratory signals acquired from 50 healthy volunteer subjects (one dataset for each subject; 23 males and 27 females; age: 23±5 years) while performing normal breathing, deep breathing, and breath holding, and two spreadsheet files, namely the “SubjectsInfo.xlsx” and “DBInfo.xlsx” containing the metadata of subjects (including demographic data) and of acquired signals, respectively.Cardiorespiratory signals consisted in simultaneously recorded 12-lead electrocardiograms acquired by the clinical M12 Global InstrumentationⓇ digital Holter ECG recorder, and single-lead electrocardiograms and respiration signals acquired by the wearable chest strap BioHarness 3.0 by Zephyr.The database may be useful to: (1) validate the use of wearable sensors in the acquisition of cardiorespiratory data during different respiration kinds, including apnea; (2) investigate the physiological association between cardiovascular and respiratory systems; (3) validate algorithms able to indirectly extract the respiration signal from the electrocardiogram; (4) study the fatigue level induced by a series ofcontrolled respiration patterns; and (5) investigate the effect of COVID-19 infection on the cardiorespiratory system.

Objective: To evaluate paroxysmal atrial fibrillation (AF) prevalence in Indian adults who completed 24-Hour Holter monitoring. Methods: A total of 23,847 patients (36.9 % women) were analyzed for AF duration using a software algorithm. Results: AF was diagnosed in 4153 (17.4 %) patients with a median AF duration of 13 min and 55 s. Conclusion: AF prevalence was high and largely untreated. The short duration of AF episodes indicates a low likelihood of detection during clinical visits, highlighting its potential underestimation in Indian healthcare.

Abstract Background Holter electrocardiographic monitoring is a cornerstone of diagnostic testing for arrhythmogenic cardiomyopathy (ACM) in Boxer dogs, but physical activity during monitoring is not controlled. In humans, exercise testing (ExT) can identify latent tachyarrhythmias associated with cardiomyopathy, and exercise increases serum cardiac troponin‐I concentrations ([hs‐cTnI]). These effects have not yet been investigated in Boxer dogs. Hypothesis/Objectives Subjecting Boxer dogs to brief, moderate‐intensity ExT can identify changes in Holter recordings and [hs‐cTnI] compared to baseline results. Animals Thirty overtly healthy, client‐owned Boxer dogs. Methods Prospective interventional study. Dogs underwent baseline diagnostic testing including 24‐hour Holter monitoring and [hs‐cTnI], followed by brief ExT (accompanied, brisk stair‐climbing and ‐descending for 100 premature ventricular complexes (PVCs)/24 hours at baseline (3), ExT (3), or both (5). After ExT, these dogs had more PVCs/24 hours and greater increases in [hs‐cTnI] compared to those with ≤100 PVCs/24 hours. Dogs with the striatin mutation had more PVCs/24 hours and a greater increase in [hs‐cTnI] after ExT than did dogs without the striatin mutation. Conclusions and Clinical Importance Exercise testing may improve the binary classification of Boxer dogs with or without ACM by increasing the number of PVCs and [hs‐cTnI] in affected dogs to a greater degree than in unaffected dogs. This effect also is associated with presence or absence of the striatin mutation. Exercise should be a controlled variable when screening Boxer dogs for ACM.

Background: STAT-ON™ is an objective tool that registers ON-OFF fluctuations making possible to know the state of the patient at every moment of the day in normal life. Our aim was to analyze the opinion of different Parkinson's disease experts about the STAT-ON™ tool after using the device in a real clinical practice setting (RCPS). Methods: STAT-ON™ was provided by the Company Sense4Care to Spanish neurologists for using it in a RCPS. Each neurologist had the device for at least three months and could use it in PD patients at his/her own discretion. In February 2020, a survey with 30 questions was sent to all participants. Results: Two thirds of neurologists (53.8% females; mean age 44.9 ± 9 years old) worked in a Movement Disorders Unit, the average experience in PD was 16 ± 6.9 years, and 40.7% of them had previously used other devices. A total of 119 evaluations were performed in 114 patients (range 2–9 by neurologist; mean 4.5 ± 2.3). STAT-ON™ was considered “quite” to “very useful” by 74% of the neurologists with an overall opinion of 6.9 ± 1.7 (0, worst; 10, best). STAT-ON™ was considered better than diaries by 70.3% of neurologists and a useful tool for the identification of patients with advanced PD by 81.5%. Proper identification of freezing of gait episodes and falls were frequent limitations reported. Conclusion: STAT-ON™ could be a useful device for using in PD patients in clinical practice. Resumen: Introducción: STAT-ON es un dispositivo que registra las fluctuaciones on-off que permite conocer el estado del paciente con enfermedad de Parkinson (EP) en cada momento del día.Nuestro objetivo fue analizar la opinión de diferentes expertos en EP sobre STAT-ON, después de usar el dispositivo en un entorno de práctica clínica real (PCR). Métodos: STAT-ON fue proporcionado por la compañía Sense4Care a neurólogos españoles para usarlo en PCR. Cada neurólogo dispuso del dispositivo durante al menos tres meses y podía usarlo en pacientes con EP, según su criterio. En febrero de 2020, se envió una encuesta con 30 preguntas a todos los participantes. Resultados: Dos tercios de los neurólogos (53,8% mujeres; edad promedio 44,9 ± 9 años) trabajaban en una Unidad de Trastornos del Movimiento, con una experiencia en EP de 16 ± 6,9 años, habiendo el 40,7% usado otros dispositivos previamente. Se realizaron un total de 119 evaluaciones en 114 pacientes (rango dos a nueve por neurólogo; media 4,5 ± 2,3). STAT-ON fue considerado «bastante» a «muy útil» por el 74% de los neurólogos, con una opinión general de 6,9 ± 1,7 (0, peor; 10, mejor). STAT-ON fue considerado mejor que los diarios por el 70,3% de los neurólogos y una herramienta útil para la identificación de pacientes con EP avanzada por un 81,5%. La identificación adecuada de los episodios de congelación de la marcha y las caídas fueron las limitaciones más reportadas. Conclusiones: STAT-ON podría ser un dispositivo útil para usar en la PCR.

Background: Risk stratification for sudden cardiac death in post‐myocardial infarction (post‐MI) patients remains a challenging task. Several electrocardiographic noninvasive risk factors (NIRFs) have been associated with adverse outcomes and were used to refine risk assessment. This study aimed to evaluate the performance of NIRFs extracted from 45‐min short resting Holter ECG recordings (SHR), in predicting ventricular tachycardia inducibility with programmed ventricular stimulation (PVS) in post‐MI patients with preserved left ventricular ejection fraction (LVEF). Methods: We studied 99 post‐MI ischemia‐free patients (mean age: 60.5 ± 9.5 years, 86.9% men) with LVEF ≥40%, at least 40 days after revascularization. All the patients underwent PVS and a high‐resolution SHR. The following parameters were evaluated: mean heart rate, ventricular arrhythmias (premature ventricular complexes, couplets, tachycardias), QTc duration, heart rate variability (HRV), deceleration capacity, heart rate turbulence, late potentials, and T‐wave alternans. Results: PVS was positive in 24 patients (24.2%). HRV, assessed by the standard deviation of normal‐to‐normal R–R intervals (SDNN), was significantly decreased in the positive PVS group (42 ms vs. 51 ms, p =.039). SDNN values <50 ms were also associated with PVS inducibility (OR 3.081, p =.032 in univariate analysis, and 4.588, p =.013 in multivariate analysis). No significant differences were identified for the other NIRFs. The presence of diabetes, history of ST‐elevation MI (STEMI) and LVEF <50% were also important predictors of positive PVS. Conclusions: HRV assessed from SHR, combined with other noninvasive clinical and echocardiographic variables (diabetes, STEMI history, LVEF), can provide an initial, practical, and rapid screening tool for arrhythmic risk assessment in post‐MI patients with preserved LVEF. [ABSTRACT FROM AUTHOR]

Accurate assessment of the response to the antiarrhythmic drug (AAD) in atrial fibrillation (AF) is crucial to achieve adequate rhythm control. We evaluated the effectiveness of extended cardiac monitoring using an adhesive ECG patch in the detection of drug-refractory paroxysmal AF. Patients diagnosed with paroxysmal AF and receiving AAD therapy were enrolled. The subjects simultaneously underwent 11-day adhesive ECG patch monitoring and a 24-h Holter test. The primary study outcome was a detection rate of drug-refractory AF or atrial tachycardia (AT) lasting ≥30 s. A total of 59 patients were enrolled and completed the study examinations. AF or AT was detected in 28 (47.5%) patients by an 11-day ECG patch monitor and in 8 (13.6%) patients by a 24-h Holter test (p < 0.001). The 11-day ECG patch monitor identified an additional 20 patients (33.8%) with drug-refractory AF not detected by the 24-h Holter, and as a result, the treatment plan was changed in 11 patients (10 catheter ablations, one medication change). In conclusion, extended cardiac rhythm monitoring using an adhesive ECG patch in patients with paroxysmal AF under AAD therapy led to over a threefold higher detection of drug-refractory AF episodes, compared to the 24-h Holter test. [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD) is dangerous and has a high mortality rate. One of the signs of CVD is arrhythmia. The method to find out the symptoms of arrhythmia is an electrocardiogram (ECG) long-term monitoring. The duration of ECG analysis on long-term monitoring is 6 hours, 12 hours, or 24 hours. The device used for long-term ECG is a Holter device. Arrhythmia analysis has followed: detect QRS complex and continue arrhythmia classification. Holter data is stored in local memory or on the server. Storage on local storage makes it difficult for cardiologists to perform analysis. However, using server storage causes access times to slow if patient data increases. Because of this, the cardiologist needs a powerful processing unit to analyze arrhythmia. This study proposes Arrhythmia analysis in the long-term ECG monitoring system. ECG acquisition is sent and stored in the processing unit. We use a single-board computer (SBC) Raspberry Pi as a processing unit. Besides storing data, SBC is also analyzing arrhythmias. The analysis steps are detecting R-peak using the Pan-Tompkins (PTK) algorithm, removing P and T waves using the Gaussian filter, and arrhythmia classification using the multi-layer perceptron (MLP). MLP is a low computational deep learning, which is suitable for SBC. The total storage delay consists of sending and storing data in the database. In the experiment, the propagation data to the broker is 0.023 s., and the storage time to the SQLite database is 15.16 s. The limited recording time for acquisition data is 21 hours and 36 minutes. The success rate of the device in detecting the QRS complex has a precision (+P) of 98.61% and a sensitivity (Se) of 99.8%. Our classification has good in Acc, Se, Spe, +P, and F1-scores are 99.77, 99.55, 99.55,99.85, and 99.55, respectively. The method is superior to several other arrhythmia classification studies. [ABSTRACT FROM AUTHOR]

Background: Holter electrocardiographic monitoring is a cornerstone of diagnostic testing for arrhythmogenic cardiomyopathy (ACM) in Boxer dogs, but physical activity during monitoring is not controlled. In humans, exercise testing (ExT) can identify latent tachyarrhythmias associated with cardiomyopathy, and exercise increases serum cardiac troponin‐I concentrations ([hs‐cTnI]). These effects have not yet been investigated in Boxer dogs. Hypothesis/Objectives: Subjecting Boxer dogs to brief, moderate‐intensity ExT can identify changes in Holter recordings and [hs‐cTnI] compared to baseline results. Animals: Thirty overtly healthy, client‐owned Boxer dogs. Methods: Prospective interventional study. Dogs underwent baseline diagnostic testing including 24‐hour Holter monitoring and [hs‐cTnI], followed by brief ExT (accompanied, brisk stair‐climbing and ‐descending for <5 minutes). Results: Eleven dogs (37%) had >100 premature ventricular complexes (PVCs)/24 hours at baseline (3), ExT (3), or both (5). After ExT, these dogs had more PVCs/24 hours and greater increases in [hs‐cTnI] compared to those with ≤100 PVCs/24 hours. Dogs with the striatin mutation had more PVCs/24 hours and a greater increase in [hs‐cTnI] after ExT than did dogs without the striatin mutation. Conclusions and Clinical Importance: Exercise testing may improve the binary classification of Boxer dogs with or without ACM by increasing the number of PVCs and [hs‐cTnI] in affected dogs to a greater degree than in unaffected dogs. This effect also is associated with presence or absence of the striatin mutation. Exercise should be a controlled variable when screening Boxer dogs for ACM. [ABSTRACT FROM AUTHOR]

Abstract Background The optimal heart rate (HR) in dogs with atrial fibrillation (AF) is unknown. Impact of HR on survival needs elucidation. Hypothesis/Objectives Dogs with a 24 hours Holter‐derived meanHR ≤125 beats per minute (bpm; rate controlled) survive longer than dogs with higher meanHR. We further aimed to determine which variables predict ability to achieving rate control. Animals Sixty dogs with AF. Methods Holter‐derived meanHR, clinical, echocardiographic, and biomarker variables were analyzed prospectively. Survival was recorded from time of rate control, with all‐cause mortality as primary endpoint. Cox proportional hazards analysis identified variables independently associated with survival; Kaplan‐Meier survival analysis estimated the median survival time of dogs with meanHR ≤125 bpm vs >125 bpm. Logistic regression explored baseline variables associated with inability to achieve rate control. Results Structural heart disease was present in 56/60 dogs, 50/60 had congestive heart failure, and 45/60 died. Median time to all‐cause death was 160 days (range, 88‐303 days), dogs with meanHR >125 bpm (n = 27) lived 33 days (95% confidence interval [CI], 15‐141 days), dogs with meanHR ≤125 bpm (n = 33) lived 608 days (95% CI, 155‐880 days; P

Abstract Background Risk stratification for sudden cardiac death in post‐myocardial infarction (post‐MI) patients remains a challenging task. Several electrocardiographic noninvasive risk factors (NIRFs) have been associated with adverse outcomes and were used to refine risk assessment. This study aimed to evaluate the performance of NIRFs extracted from 45‐min short resting Holter ECG recordings (SHR), in predicting ventricular tachycardia inducibility with programmed ventricular stimulation (PVS) in post‐MI patients with preserved left ventricular ejection fraction (LVEF). Methods We studied 99 post‐MI ischemia‐free patients (mean age: 60.5 ± 9.5 years, 86.9% men) with LVEF ≥40%, at least 40 days after revascularization. All the patients underwent PVS and a high‐resolution SHR. The following parameters were evaluated: mean heart rate, ventricular arrhythmias (premature ventricular complexes, couplets, tachycardias), QTc duration, heart rate variability (HRV), deceleration capacity, heart rate turbulence, late potentials, and T‐wave alternans. Results PVS was positive in 24 patients (24.2%). HRV, assessed by the standard deviation of normal‐to‐normal R–R intervals (SDNN), was significantly decreased in the positive PVS group (42 ms vs. 51 ms, p = .039). SDNN values

A standardized examination regime for ischemic stroke (IS) patients was implemented in Greenland in 2010. Prevalence of atrial fibrillation (AF) of 32% was found among discharged IS patients from 2011 to 2012, and our study aims to estimate the use of Holter ECGs for AF diagnostics and the current prevalence of AF among IS patients in Greenland. Patients discharged from Queen Ingrid's Hospital in Nuuk between 2016 and 2021 with an ICD-10 diagnosis of IS or stroke without specification were included. Data on Holter recordings, age, gender, medical treatment with rivaroxaban or warfarin, and ICD-10 and ICPC codes for AF were extracted for each patient. The overall incidence of IS from 2016 to 2021 was 133/100,000 and unchanged since 2012. Sixty-eight of the study's IS patients (14.5%) had AF, and 46% of IS patients with Holter data accessible had a recording according to international recommendations. Our results indicate that fewer IS patients in Greenland have AF than previously. However, the insufficient use of Holter as a diagnostic tool may explain part of the drop, as well as improved preventive treatment with rivaroxaban among AF patients in Greenland. Regardless, IS remains common, and a focus on diagnostics and preventable risk factors should be maintained. [ABSTRACT FROM AUTHOR]

To evaluate heart rate (HR), the presence of extrasystoles and other Holter findings among healthy newborns, and to collect data for new normal limits for Holter parameters in newborns. For this cross-sectional study, 70 healthy term newborns were recruited to undergo 24-h Holter monitoring. Linear regression analysis was used in HR analyses. The age-specific limits for HRs were calculated using linear regression analysis coefficients and residuals. The mean (SD) age of the infants was 6.4 (1.7) days during the recording. Each consecutive day of age raised the minimum and mean HR by 3.8 beats per minute (bpm) (95% CI: 2.4, 5.2; P <.001) and 4.0 bpm (95% CI: 2.8, 5.2; P <.001), respectively. Age did not correlate with maximum HR. The lowest calculated limit for minimum HR ranged from 56 bpm (aged 3 days) to 78 bpm (aged 9 days). A small number of atrial extrasystoles and ventricular extrasystoles were observed in 54 (77%) and 28 (40%) recordings, respectively. Short supraventricular or ventricular tachycardias were found in 6 newborns (9%). Conclusion: The present study shows an increase of 20 bpm in both the minimum and mean HRs of healthy term newborns between the 3rd and 9th days of life. Daily reference values for HR could be adopted in the interpretation of HR monitoring results in newborns. A small number of extrasystoles are common in healthy newborns, and isolated short tachycardias may be normal in this age group. What is Known: • The current definition of bradycardia in newborns is 80 beats per minute. • This definition does not fit into the modern clinical setting of continuously monitored newborns, where benign bradycardias are commonly observed. What is New: • A linear and clinically significant increase in heart rate was observed in infants between the ages of 3 and 9 days. • It appears as though lower normal limits for heart rate could be applied to the youngest newborns. [ABSTRACT FROM AUTHOR]

Background: Cryptogenic stroke (CS) is a symptomatic cerebral infarct with no identifiable cause after adequate diagnostic workup. Subclinical atrial arrhythmias are increasingly recognized as a source of CS. The study aimed to investigate the association between cryptogenic stroke and atrial tachyarrhythmias using 24-hour Holter monitoring. Methods: This was a case-control study that was conducted on a total of 30 adult patients with CS who were admitted at Mansoura University Hospital during the period From December 2019 to December 2021 as a case study group matched with another 40 normal persons as a control study group using 24-hour Holter monitoring. Results: There was no statistically significant difference between the studied groups as regards age, sex, and history of the previous stroke. There was a statistically significant higher mean systolic blood pressure (BP) among cases than in the control group (p=0.02). There was no statistically significant difference between the studied groups as regards Holter findings. Among cases, one case showed frequent premature atrial ectopics (PACs), one supraventricular tachycardia (SVT) run, frequent premature ventricular ectopics (PVCs), 2 cases showed runs of non-sustained ventricular tachycardia (VT) and 3 cases (10% of cases) showed low burden atrial fibrillation (AF) runs. Conclusions: 24-hour Holter monitoring could detect subclinical AF or other tachyarrhythmias in CS and could guide subsequent treatment as regards anticoagulants use. However, it could not be enough, and a longer duration of follow-up is required. [ABSTRACT FROM AUTHOR]

Background: The optimal heart rate (HR) in dogs with atrial fibrillation (AF) is unknown. Impact of HR on survival needs elucidation. Hypothesis/Objectives: Dogs with a 24 hours Holter‐derived meanHR ≤125 beats per minute (bpm; rate controlled) survive longer than dogs with higher meanHR. We further aimed to determine which variables predict ability to achieving rate control. Animals: Sixty dogs with AF. Methods: Holter‐derived meanHR, clinical, echocardiographic, and biomarker variables were analyzed prospectively. Survival was recorded from time of rate control, with all‐cause mortality as primary endpoint. Cox proportional hazards analysis identified variables independently associated with survival; Kaplan‐Meier survival analysis estimated the median survival time of dogs with meanHR ≤125 bpm vs >125 bpm. Logistic regression explored baseline variables associated with inability to achieve rate control. Results: Structural heart disease was present in 56/60 dogs, 50/60 had congestive heart failure, and 45/60 died. Median time to all‐cause death was 160 days (range, 88‐303 days), dogs with meanHR >125 bpm (n = 27) lived 33 days (95% confidence interval [CI], 15‐141 days), dogs with meanHR ≤125 bpm (n = 33) lived 608 days (95% CI, 155‐880 days; P <.0001). Congenital heart disease and N‐terminal pro‐B‐type natriuretic peptide were independently associated with higher risk of death (P <.01 and <.0001, respectively) whereas meanHR ≤125 bpm decreased the risk of death (P <.001). Increased left atrial size, increased C‐reactive protein concentration and lower blood pressure at admission were associated with failure to achieve rate control. Conclusions and Clinical Importance: Rate control affects survival; an optimal target meanHR <125 bpm should be sought in dogs with AF. Baseline patient variables can help predict if rate control is achievable. [ABSTRACT FROM AUTHOR]

Piaoliu Yuan,1 Xueying Li,2 Chunyan Tao,1 Xiaojuan Du,1 Chunyu Zhang,1 Junbao Du,1,3 Yaqian Huang,1 Ying Liao1 1Department of Pediatrics, Peking University First Hospital, Beijing, People’s Republic of China; 2Department of Medical Statistics, Peking University First Hospital, Beijing, People’s Republic of China; 3Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing, People’s Republic of ChinaCorrespondence: Ying Liao; Yaqian Huang, Department of Pediatrics, Peking University First Hospital, Xi-An Men Street No. 1, West District, Beijing, 100034, People’s Republic of China, Tel +8610-83573238 ; +8610-83575807, Fax +8610-66530532, Email liaoyingwww@163.com; yaqianhuang@126.comPurpose: To explore the value of the longitudinal axis/transverse axis ratio (L/T) of Poincaré plot in selecting children with vasovagal syncope (VVS) who were suitable for metoprolol therapy.Patients and Methods: Children with VVS hospitalized in Peking University First Hospital between January 2012 and June 2019 and treated with metoprolol were retrospectively included as the training set, and children with VVS hospitalized between July 2019 and December 2020 were included as the validation set. The sex, age at admission, height, weight, body mass index, course of disease, syncope symptom score before metoprolol treatment, treatment duration, supine heart rate (HR), supine systolic pressure, supine diastolic pressure, peak HR during the head-up tilt test (HUTT), changes of HR during HUTT, hemodynamic response during HUTT, left ventricular ejection fraction, left ventricular fractional shortening and the L/T of Poincaré plot were compared between responders and nonresponders in the training set. Logistic regression analysis was conducted to explore predictors. Receiver operating characteristic curve was utilized to determine the value of the predictors for selecting potential responders. Finally, the value of the predictors was further verified.Results: In the training set including 105 children, the L/T in responders was distinctly higher than that in nonresponders (P < 0.001), and there was no apparent difference between the two groups in other indexes. The L/T was statistically related to the efficacy of metoprolol (P < 0.001). The L/T > 2.7 yielded a sensitivity of 88.2% and a specificity of 82.8% for indicating responders to metoprolol. Taking L/T > 2.7 to select potential responders in another 43 children with VVS in the validation set, the sensitivity was 96.6%, specificity 71.4%, and accuracy 88.4%.Conclusion: The L/T of Poincaré plot > 2.7 can be a useful tool to select potential responders to metoprolol therapy in children with VVS.Keywords: Poincaré plot, metoprolol, vasovagal syncope, children, Holter

AimsDiagnosis of Long QT syndrome (LQTS) is based on prolongation of the QT interval corrected for heart rate (QTc) on surface ECG and genotyping. However, up to 25% of genotype positive patients have a normal QTc interval. We recently showed that individualized QT interval (QTi) derived from 24 h holter data and defined as the QT value at the intersection of an RR interval of 1,000 ms with the linear regression line fitted through QT-RR data points of each individual patient was superior over QTc to predict mutation status in LQTS families. This study aimed to confirm the diagnostic value of QTi, fine-tune its cut-off value and evaluate intra-individual variability in patients with LQTS.MethodsFrom the Telemetric and Holter ECG Warehouse, 201 recordings from control individuals and 393 recordings from 254 LQTS patients were analysed. Cut-off values were obtained from ROC curves and validated against an in house LQTS and control cohort.ResultsROC curves indicated very good discrimination between controls and LQTS patients with QTi, both in females (AUC 0.96) and males (AUC 0.97). Using a gender dependent cut-off of 445 ms in females and 430 ms in males, a sensitivity of 88% and specificity of 96% were achieved, which was confirmed in the validation cohort. No significant intra-individual variability in QTi was observed in 76 LQTS patients for whom at least two holter recordings were available (483 ± 36 ms vs. 489 ± 42 ms, p = 0.11).ConclusionsThis study confirms our initial findings and supports the use of QTi in the evaluation of LQTS families. Using the novel gender dependent cut-off values, a high diagnostic accuracy was achieved.

We aimed to demonstrate the feasibility of 90-day cardiac monitoring with an external Holter device and to find a target population able to benefit from such a technique. Cryptogenic stroke patients were continuously monitored for 90 days with a textile wearable Holter (TWH). Compliance and quality of the monitoring were assessed by the number of hours of ECG stored per month. Mean predictors of pAF, including age, gender, stroke severity, and atrial size (LAVI), were evaluated. One-year follow-up assessed pAF detection outside per protocol monitoring. Out of 224 patients included in 5 stroke centers, 163 patients (72.76%) fulfilled the criteria for the protocol. Median monitoring time was similar among the three months. Per protocol pAF detection reached 35.37% at 90 days. The age (OR 1.095; 95% CI 1.03–1.14) and the LAVI (OR 1.055; 95% CI 1.01–1.09) independently predicted pAF. The cut-off point of 70 years (AUC 0.68) (95% CI 0.60–0.76) predicted pAF with a sensitivity of 75.8% and specificity of 50.5%. The LAVI cut-off point of 28.5 (AUC 0.67) (95% CI 0.56–0.77) had a sensitivity of 63.6% and a specificity of 61.8% to detect pAF. The combination of both markers enhanced the validity of pAF detection sensitivity to 89.6%, with a specificity of 27.59%. These patients had increased risk of pAF during the 90-day monitoring HR 3.23 (χ2 7.15) and beyond 90 days (χ2 5.37). Intensive 90-days TWH monitoring detected a high percentage of pAF. However, a significant number of patients did not complete the monitoring. Patients older than 70 years and with enlarged left atria benefitted more from the protocol. [ABSTRACT FROM AUTHOR]

Age is an important determinant of heart rate variability (HRV) in healthy individuals. The incidence of arrhythmia is high in patients with mitral valve prolapse (MVP). However, the correlation of HRV in patients with MVP in different age groups is not well established. We presumed that increasing age would be prospectively associated with declining HRV measurement in MVP. Sixty patients with MVP and 120 control individuals were included and underwent 24 h HRV analysis. No significant difference was found in all parameters calculated in the time domain or in the frequency domain between the two groups. However, as patients' age increased, a significant time domain (SDNN, RMSSD, NN50, and pNN50) decline was found in the MVP group, but not in the control group. This suggests that patients with MVP may have autonomic nervous system involvement that increases the risk of arrhythmia and heart disease with increasing age. [ABSTRACT FROM AUTHOR]

Goran Medic,1,2 Nikos Kotsopoulos,3 Mark P Connolly,2,3 Jennifer Lavelle,4 Vincent Norlock,4 Manish Wadhwa,4 Belinda A Mohr,5 Wayne M Derkac4 1Chief Medical Office, Philips Healthcare, Eindhoven, Netherlands; 2Department of Pharmacy, University of Groningen, Groningen, Netherlands; 3Global Market Access Solutions LLC, Charlotte, NC, USA; 4BioTelemetry, Inc., A Philips Company, Malvern, PA, USA; 5Chief Medical Office, Philips, Cambridge, MA, USACorrespondence: Goran MedicChief Medical Office, Philips Healthcare, High Tech Campus 37-3.009, Eindhoven, 5656 AG, NetherlandsTel +31-61-819-3782Email goran.medic@philips.comPurpose: The aim of this study was to compare costs and outcomes of mobile cardiac outpatient telemetry (MCOT) patch followed by implantable loop recorder (ILR) compared to ILR alone in cryptogenic stroke patients from the US health-care payors’ perspective.Patients and Methods: A quantitative decision tree cost-minimization simulation model was developed. Eligible patients were 18 years of age or older and were diagnosed with having a cryptogenic stroke, without previously documented atrial fibrillation (AF). All patients were assigned first to one then to the alternative monitoring strategies. Following AF detection, patients were initiated on oral anticoagulants (OAC). The model assessed direct costs for one year attributed to MCOT patch followed by ILR or ILR alone using a monitoring duration of 30 days post-cryptogenic stroke.Results: In the base case modeling, the MCOT patch arm detected 4.6 more patients with AFs compared to the ILR alone arm in a cohort of 1000 patients (209 vs 45 patients with detected AFs, respectively). Using MCOT patch followed by ILR in half of the patients initially undiagnosed with AF leads to significant cost savings of US$4,083,214 compared to ILR alone in a cohort of 1000 patients. Cost per patient with detected AF was significantly lower in the MCOT patch arm $29,598 vs $228,507 in the ILR only arm.Conclusion: An initial strategy of 30-day electrocardiogram (ECG) monitoring with MCOT patch in diagnosis of AF in cryptogenic stroke patients realizes significant cost-savings compared to proceeding directly to ILR only. Almost 8 times lower costs were achieved with improved detection rates and reduction of secondary stroke risk due to new anticoagulant use in subjects with MCOT patch detected AF. These results strengthen emerging recommendations for prolonged ECG monitoring in secondary stroke prevention.Keywords: ambulatory cardiac monitoring, Holter, atrial fibrillation, electrocardiography, economic evaluation, secondary prevention

Recent technological advances have facilitated and diversified the options available for the diagnosis of cardiac arrhythmias. Ranging from simple resting or exercise electrocardiograms to more sophisticated and expensive smartphones and implantable cardiac monitors. These tests and devices may be used for varying periods of time depending on symptom frequency. The choice of the most appropriate heart rhythm test should be guided by clinical evaluation and optimized following accurate characterization of underlying symptoms, 'red flags', risk factors, and consideration of cost-effectiveness of the different tests. This review provides evidence-based guidance for assessing suspected arrhythmia in patients who present with symptoms or in the context of screening, such as atrial fibrillation or advanced conduction disturbances following transcatheter aortic valve implantation in high-risk groups. This is intended to help clinicians choose the most appropriate diagnostic tool to facilitate the management of patients with suspected arrhythmias. [ABSTRACT FROM AUTHOR]

Technological advances have made diagnosis of heart rhythm disturbances much easier, with a wide variety of options, including single-lead portable devices, smartphones/watches to sophisticated implantable cardiac monitors, allowing accurate data to be collected over different time periods depending on symptoms frequency. This review provides an overview of the novel and existing heart rhythm testing options, including a description of the supporting evidence for their use. A description of each of the tests is provided, along with discussion of their advantages and limitations. This is intended to help clinicians towards choosing the most appropriate test, thus improving diagnostic yield management of patients with suspected arrhythmias. Graphical Abstract Illustration of novel monitoring technologies for the diagnosis of intermittent arrhythmias. Legend: (1) Twelve-lead resting electrocardiogram (ECG); (2) treadmill exercise stress test; (3) single-lead portable devices: (A) AliveCor® KardiaMobile®, (B) Smartphones and smartwatches; (4) (A) Cardiostat™, (B) Washable 5G smart T-shirt to monitor ECG and other biosignals: YouCare™ (ZTE© and AccYouRate©); (5) (A) Holter and event monitors, (B) Zenicor™Smart, (C) MyDiagnostic ™; (6) (A) Implant location of cardiac monitors, (B) BioMonitor III™ (Biotronik©), (C) CONFIRM Rx™ (Abbott©), (D) Reveal LINQ™ (Medtronic©), (E) LUX-Dx™ (Boston Scientific©). [ABSTRACT FROM AUTHOR]

Alternatives for out-of-clinic heart rate (HR) measurement are required to optimise the management of atrial fibrillation (AF) in dogs. Additionally, the presence of circadian variation (CV) in HR in pet dogs remains unknown. We aimed to identify the number and duration of spot-checks required for an accurate estimation of 24-hour HR in canine AF. Circadian variation in HR was examined in healthy dogs and dogs with AF, and spot-check-derived HR was compared with a CV-derived gold standard. Ambulatory electrocardiogram data from healthy dogs and dogs with AF were retrospectively analysed. Heart rate was calculated from the entire recording and pre-defined periods (spot-checks) of one hour to 30 and 60 s in duration. Circadian variation in HR was determined by cosinor analysis. Bias and limits of agreement of means and median HR with mesor HR were determined by correlation and Bland–Altman analysis. Circadian variation in HR was identified not only in 18/22 healthy dogs and 14/21 AF dogs but only on ambulatory electrocardiogram recordings. Four-hourly spot-checks provided the most accurate estimate of mesor HR in healthy dogs (bias of the median over 30 s 7.70, limits of agreement 7.48), whereas, in dogs with AF, four, six and eight-hourly spot-checks provided reliable estimates of mesor HR (bias within −1.29 and −29.5). Four, six and eight-hourly HR spot-checks can estimate 24-hourly HR in dogs with AF. There was CV in HR in most healthy pet dogs and dogs with AF. Spot-check protocols cannot identify CV in HR. [ABSTRACT FROM AUTHOR]

Resumo Fundamento Na fibrilação atrial paroxística (FAP), o isolamento das veias pulmonares com criobalão (IVP-CB) tem eficácia semelhante à da ablação por radiofrequência (IVP-RF). Em procedimentos de reablação após IVP-RF, a reconexão das VPs é alta, ao passo que em pacientes com reablação após IVP-CB, as informações são escassas. Objetivo Determinar os locais de reconexão das VPs em pacientes que foram submetidos à reablação após IVP-CB inicial. Métodos Pacientes que foram submetidos a um procedimento de reablação de fibrilação atrial, após um IVP-CB inicial para FAP foram incluídos. O mapeamento eletroanatômico do AE foi utilizado. Um local de reconexão foi definido com a presença de uma voltagem de 0,3mV ou maior nas VPs e condução unidirecional ou bidirecional nas VPs durante o ritmo sinusal. Os locais de reconexão foram identificados por meio de corte paraesternal longitudinal e posteriormente ablacionados com radiofrequência. Resultados Dos 165 pacientes submetidos ao IVP inicial, 27 necessitaram reablações, dos quais 18 (66,6%) eram do sexo masculino, com média de idade de 55+12,3 anos. O tempo de recorrência foi de 8,9+6,4 meses. A reconexão das VPs foi encontrada em 21 (77,8%) pacientes. Houve um total de 132 lacunas de condução, seis por paciente, 3,6 por VP. Um número significativo de lacunas ocorreu na região ântero-superior da VP superior esquerda (VPSE) e nas regiões septal e inferior da VP superior direita (VPSD). Conclusões As VPs superiores apresentaram os locais de maior reconexão, principalmente na região anterior da VPSE e na região septal da VPSD. A razão por trás disso pode ser devido à maior espessura da parede atrial e à dificuldade em alcançar o contato de criobalão adequado.

Arterial hypertension in pediatric patients is still an underdiagnosed entity. There are described numerous factors that can potentially interfere with blood pressure values and therefore influence arterial blood pressure variations such as: strong emotions, emotional stress, all of which, under normal blood pressure measuring techniques, can be associated with high blood pressure values, thus being established the diagnosis of arterial hypertension. An extremely important step towards the correct diagnosis of arterial hypertension in pediatric patients as well as for adults is represented by continuos holter monitoring of arterial blood pressure devices. This paper presents the importance of such devices for diagnosing arterial hypertension, and “whitecoat” hypertension, respectively, in pediatric patients.

Effect of exercise has been studied on electrocardiography and stress behavioral parameters of 12 male Kangal shepherd dogs with ankyloglossia and 15 male Kangal shepherd dogs without ankyloglossia were compared. In this study, electrocardiography recordings were obtained from Kangal shepherd dogs with the holter device at resting state and during 15-min exercise. All data collection were conducted in the same environmental conditation. In addition, behavioral parameters captured with a video camera during resting state and the end of 15-min exercise period. While no statistical diff erence was detected in two groups in terms of all electrocardiographic parameters at resting state, statistical diff erences were detected in both groups in the P wave amplitude, T wave amplitude, duration of PR interval, duration of QT interval and heart rate parameters during exercise. Following 15-min of exercise, all stress parameters were observed in dogs with ankyloglossia, while only two parameters were observed at resting state. Following a 15-min exercise, without ankyloglossia dogs showed only two stress parameters, while no parameters were observed at resting state. This study will have an important area in the literature in terms of examining the electrocardiographic data and stress behavioral parameters of Kangal shepherd dogs with ankyloglossia.

Physicians use Holter electrocardiography (ECG) monitoring to evaluate some patients with syncope in the internal medicine department. We questioned whether Holter ECG should be used in the presented setting. Included were all consecutive patients admitted with syncope to one of our nine internal medicine departments who had completed a 24 h Holter ECG between 2018 and 2021. A diagnostic Holter was defined as one which altered the patient's treatment and met ESC/ACC/AHA diagnostic criteria. A total of 478 Holter tests were performed for syncope evaluation during admission to an internal medicine department in the study period. Of them, 25 patients (5.2%) had a diagnostic Holter finding. Sinus node dysfunction was the most frequent diagnostic recording (13 patients, 52%). In multivariant analysis, predictors for diagnostic Holter were older age (OR 1.35, 95% CI 1.08–1.68), heart failure with preserved ejection fraction (OR 4.1, 95% CI 1.43–11.72), and shorter duration to Holter initiation (OR 0.73, 95% CI 0.56–0.96). There was a positive correlation between time from admission to Holter and hospital stay, r(479) = 0.342, p < 0.001. Our results suggest that completing a 24 h Holter monitoring during admission to the internal medicine department should be restricted to patients with a high pre-test probability to avoid overuse and possible harm. [ABSTRACT FROM AUTHOR]

Artificial intelligence is increasingly being used on the clinical electrocardiogram workflows. Few electrocardiograms based on artificial intelligence algorithms have focused on detecting myocardial ischemia using long-term electrocardiogram data. A main reason for this is that interference signals generated from daily activities while wearing the Holter monitor lowered the ability of artificial intelligence to detect myocardial ischemia. In this study, an automatic system combining denoising and segmentation modules was developed to detect the deviation of the ST-segment and J point. We proposed a ECG Bidirectional Transformer network that applied in both denoising and segmentation tasks. The denoising model achieved RMSEde, SNRimp, and PRD values of 0.074, 10.006, and 16.327, respectively. The segmentation model achieved precision, sensitivity (recall), and F1-score of 96.00, 93.06, and 94.51%, respectively. The system's ability to distinguish the depression and elevation of the ST-segment and J point was also verified by cardiologists as well. From our ECG dataset, 103 patients with ST-segment depression and 10 patients with ST-segment elevation were detected with positive predictive values of 80.6 and 60% respectively. Using Holter ECG and transformerbased deep neural networks, we can detect subtle ST-segment changes in noisy ECG signals. This system has the potential to improve the efficacy of daily medicine and to provide a broader population-level screening for asymptomatic myocardial ischemia. [ABSTRACT FROM AUTHOR]

BackgroundIntensive screening for atrial fibrillation (AF) has led to a better recognition of this cause in stroke patients. However, it is currently debated whether AF Detected After Stroke (AFDAS) has the same pathophysiology and embolic risk as prior-to-stroke AF. We thus aimed to systematically approach AFDAS using a multimodal approach combining clinical, imaging, biological and electrocardiographic markers.MethodsPatients without previously known AF admitted to the Dijon University Hospital (France) stroke unit for acute ischemic stroke were prospectively enrolled. The primary endpoint was the presence of AFDAS at 6 months, diagnosed through admission ECG, continuous electrocardiographic monitoring, long-term external Holter during the hospital stay, or implantable cardiac monitor if clinically indicated after discharge.ResultsOf the 240 included patients, 77 (32%) developed AFDAS. Compared with sinus rhythm patients, those developing AFDAS were older, more often women and less often active smokers. AFDAS patients had higher blood levels of NT-proBNP, osteoprotegerin, galectin-3, GDF-15 and ST2, as well as increased left atrial indexed volume and lower left ventricular ejection fraction. After multivariable analysis, galectin-3 ≧ 9 ng/ml [OR 3.10; 95% CI (1.03–9.254), p = 0.042], NT-proBNP ≧ 290 pg/ml [OR 3.950; 95% CI (1.754–8.892, p = 0.001], OPG ≥ 887 pg/ml [OR 2.338; 95% CI (1.015–5.620), p = 0.046) and LAVI ≥ 33.5 ml/m2 [OR 2.982; 95% CI (1.342–6.625), p = 0.007] were independently associated with AFDAS.ConclusionA multimodal approach combining imaging, electrocardiography and original biological markers resulted in good predictive models for AFDAS. These results also suggest that AFDAS is probably related to an underlying atrial cardiopathy.Clinical Trial Registration[www.ClinicalTrials.gov], identifier [NCT03570060].

Background An increase in beat‐to‐beat variability of repolarization (BVR) predicts arrhythmia onset in experimental models, but its clinical translation is not well established. We investigated the temporal changes in BVR before nonsustained ventricular tachycardia (nsVT) in patients with implantable cardioverter defibrillator (ICD). Methods and Results Patients with nsVT on 24‐hour Holter before ICD implantation for ischemic cardiomyopathy (ischemic cardiomyopathy+nsVT, n=43) or dilated cardiomyopathy (dilated cardiomyopathy+nsVT, n=37), matched ICD candidates without nsVT (ischemic cardiomyopathy‐nsVT, n=29 and dilated cardiomyopathy‐nsVT, n=26), and patients without ICD without structural heart disease (n=50) were studied. Digital Holter recordings from these patients were analyzed using a modified fiducial segment averaging technique to detect the QT interval. The nsVT episodes were semi‐automatically identified and QT‐BVR was assessed 1‐, 5‐, and 30‐minutes before nsVT, and at rest (at 3:00 am). Resting BVR was higher in ICD patients compared with controls without structural heart disease. In ICD patients with nsVT, BVR increased significantly 1‐minute pre‐nsVT in ischemic cardiomyopathy (2.21±0.59 ms, versus 5 minutes pre‐nsVT: 1.78±0.50 ms, P

Belt-type ambulatory electrocardiograph (EV-201) is an arrhythmia diagnostic device that can record an electrocardiogram (ECG) for a maximum of 2 weeks. Here, we report the novel utility of EV-201 in detecting arrhythmias in two professional athletes. Treadmill exercise test and Holter ECG failed to detect arrhythmia because of insufficient exercise, electrocardiogram noise. However, by wearing EV-201 only during a marathon run, supraventricular tachycardia onset and termination were successfully detected. Throughout, both athletes were diagnosed with fast–slow atrioventricular nodal re-entrant tachycardia. Therefore, EV-201 enables long-term belt-type recording, thereby being useful in detecting tachyarrhythmias that occur infrequently and during strenuous exercises. Diagnosis of arrhythmias during high-intensity exercise in athletes by conventional electrocardiography is sometimes difficult due to inducibility and frequency of arrythmias or motion artifacts. The primary finding of this report is that EV-201 is useful in diagnosing such arrhythmias. The secondary finding is that fast-slow atrioventricular nodal re-entrant tachycardia is a common occurrence in arrhythmias among athletes. [ABSTRACT FROM AUTHOR]

Abstract Background Hypertension (HTN) remains a serious risk factor for cardiovascular mortality across the world. Hypertensive state has been shown to be associated with autonomic nervous function. This study aimed to explore the association between autonomic nervous impairment assessed by heart rate variability (HRV) and HTN. Methods A total of 52 hypertensive and 55 non‐hypertensive patients were consecutively studied using 24‐hour Holter. The hypertensive patients were grouped into controlled blood pressure (BP) and uncontrolled BP. This study compared HRV in non‐hypertensive and hypertensive patients; and hypertensive patients with controlled and uncontrolled BP. HRV parameters include time and frequency domain. Results Mean age for hypertensive and non‐hypertensive patients were 53.58 ± 14.31 and 44.89 ± 16.63 years old, respectively. Median (IQR) SDNN for hypertensive and non‐hypertensive group were 109.00 (90.00‐145.00) and 129.00 (107.00‐169.00), respectively. SDNN, ASDNN, rMSSD, pNN50, BB50, VLF, and HF values were significantly lower in the hypertensive group compared to non‐hypertensive group (all P

Aim: To retrospectively assess the indications for and findings on 24‐hour electrocardiographic (Holter) monitoring in newborns, focussing on bradycardias and extrasystoles. Methods: Data included 337 term‐born infants. Holter indications were categorised into bradycardias below 80 beats per minute, extrasystoles, any tachycardia and other. Heart rate below 60 beats per minute, pathological atrioventricular conduction, supraventricular or ventricular tachycardia, or either atrial premature contractions over 10% or ventricular premature contractions over 5% of total beats were defined as significant arrhythmia on Holter. Results: The median age was 6 days (range: 2–62 days). Bradycardia (42%) or extrasystoles (32%) were the most common Holter indications. Fifty‐three infants (16%) had significant arrhythmia on Holter. Heart disease or 12‐lead electrocardiogram expressing extrasystoles or conduction abnormalities were associated with significant arrhythmias (p = 0.046 and p < 0.001, respectively). Twenty‐seven of 109 infants (25%) with extrasystoles as a Holter indication had abnormal Holter results, but only seven (6.4%) had significant arrhythmia on Holter if the 12‐lead electrocardiogram was normal. No pathology was found behind bradycardias below 80 beats per minute in the absence of heart disease. Conclusion: Among term newborns with extrasystoles or bradycardias, Holter monitoring could be targeted to infants with heart disease or abnormal electrocardiograms. [ABSTRACT FROM AUTHOR]