Risk stratification of patients with inherited arrhythmia syndromes (IASs) can be challenging. Recent guidelines acknowledge a place for considering the implantable loop recorder (ILR) to outrule malignant arrhythmia as a cause of syncope in certain inherited arrhythmia patients who are at low risk of sudden cardiac death. In this comprehensive literature review, we evaluate the available evidence for the use of the ILR in the IASs and in relatives of victims of sudden arrhythmic death syndrome.
Introduction:The risk of typical atrial flutter (AFL) is increased proportionately to right atrial (RA) size or right atrial scarring that results in reduced conduction velocity. These characteristics result in propagation of a flutter wave by ensuring the macro re-entrant wave front does not meet its refractory tail. The time taken to traverse the circuit would take account of both of these characteristics and may provide a novel marker of propensity to develop AFL. Our goal was to investigate right atrial collision time (RACT) as a marker of existing typical AFL.Methods: This single-centre, prospective study recruited consecutive typical AFL ablation patients that were in sinus rhythm. Controls were consecutive electrophysiology study patients >18 years of age. While pacing the coronary sinus (CS) ostium at 600 ms, a local activation time map was created to locate the latest collision point on the anterolateral right atrial wall. This RACT is a measure of conduction velocity and distance from CS to a collision point on the lateral right atrial wall.Results: Ninety-eight patients were included in the analysis, 41 with atrial flutter and 57 controls. Patients with atrial flutter were older, 64.7 ± 9.7 versus 52.4 ± 16.8 years (<.001), and more often male (34/41 vs. 31/57 [.003]). The AFL group mean RACT (132.6 ± 17.3 ms) was significantly longer than that of controls (99.1 ± 11.6 ms) (p < .001). A RACT cut-off of 115.5 ms had a sensitivity and specificity of 92.7% and 93.0%, respectively for diagnosis of atrial flutter. A ROC curve indicated an AUC of 0.96 (95% CI: 0.93-1.0, p < .01).
Conclusion:RACT is a novel and promising marker of propensity for typical AFL. This data will inform larger prospective studies.
Background: Obstructive sleep apnea (OSA) is strongly associated with atrial fibrillation (AF). Long-term ECG monitoring with implantable loop recorders facilitates the identification of undiagnosed AF in 20% of severe OSA cases. However, ambulatory ECG (AECG) monitoring is less resource intensive, and various parameters have been shown to predict AF. The aim of this study was to assess the efficacy of such AECGbased AF predictors in identifying patients with severe OSA most at risk. Methods: Prospective observational study including patients with severe OSA and no history of AF. Patients had two 24-hour AECG recordings, and if no AF was detected, implanted with a loop recorder (maximum 3 years). Results: Of 25 patients implanted, AF ≥ 10 seconds was detected in 5 patients. None of the parameters from the AECG recordings were significantly different between patients who did and did not develop AF. Conclusions: AECG-based parameters were not effective for the prediction of AF in this severe OSA cohort.
Introduction: The risk of typical atrial flutter (AFL) is
increased proportionately to right atrial (RA) size or right atrial
scarring that results in reduced conduction velocity. These
characteristics result in propagation of a flutter wave by ensuring the
macro re-entrant wave front does not meet its refractory tail. The time
taken to traverse the circuit would take account of both of these
characteristics and may provide a novel marker of propensity to develop
AFL. Our goal was to investigate right atrial collision time (RACT) as a
marker of existing or future typical AFL. Methods: This single
centre, prospective study recruited consecutive typical AFL ablation
patients that were in sinus rhythm. Controls were consecutive
electrophysiology study patients >18 years of age. While
pacing the coronary sinus (CS) ostium at 600 ms, a local activation time
map was created to locate the latest collision point on the
anterolateral right atrial wall. This RACT is a measure of conduction
velocity and distance from CS to a collision point on the lateral right
atrial wall. Results: 98 patients were included in the
analysis, 41 with atrial flutter and 57 controls. Patients with atrial
flutter were older, 64.7 ± 9.7 vs 52.4 ± 16.8 years (<0.001)
and more often male (34/41vs 31/57 (0.003)). The AFL group mean RACT
(132.6±17.3 ms) was significantly longer than that of controls
(99.1±11.6 ms) (p<0.001). A RACT cut-off of 115.5 ms had a
sensitivity and specificity of 92.7% and 93.0% respectively for
diagnosis of atrial flutter. An ROC curve indicated an AUC of 0.96 (95%
CI: 0.93-1.0, p<0.01). Conclusion: RACT is a novel
and promising marker of propensity for typical AFL. This data will
inform larger prospective studies. The ability to predict AFL would be
of significant clinical value to guide anticoagulation and ablation
decisions.
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