How to use digital devices to detect and manage arrhythmias: an EHRA practical guide

Svennberg, Emma; Tjong, Fleur V.Y.; Goette, Andreas; Akoum, Nazem; Biaise, Luigi Di; Bordachar, Pierre; Boriani, Giuseppe; Burri, Haran; Conte, Giulio; Deharo, Jean‐Claude; Deneke, Thomas; Drossart, Inga; Duncker, David; Han, Janet K.; Heidbüchel, Hein; Jaı̈s, Pierre; Figueiredo, M.J.D.O.; Linz, Dominik; Lip, Gregory Y.H.; Małaczyńska-Rajpold, Katarzyna; Márquez, Manlio F.; Ploem, Corrette; Soejima, Kyoko; Stiles, Martin K.; Wierda, Eric; Vernooy, Kevin; Leclercq, Christophe; Meyer, Christian; Pisani, Cristiano; Pak, Hui-Nam; Gupta, Dhiraj; Pürerfellner, Helmut; Crijns, Harry J.G.M.; Chávez, Edgar; Willems, Stephan; Waldmann, Victor; Dekker, Lukas; Wan, Elaine; Kavoor, Pramesh; Turagam, Mohit K.; Sinner, Moritz F.

doi:10.1093/europace/euac038

Cited by 133 publications

(117 citation statements)

References 157 publications

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“…There is a growing trend in utilizing new wearable devices for screening for AF or even mitigating the risks of patients with known AF, guided by the newest consensus document of the European Heart Rhythm Association [41]. This is especially so as previous randomized controlled trials have demonstrated that a composite outcome of 'ischemic stroke/systemic thromboembolism, death, and rehospitalization' could be lower with mobile AF application interventions compared with usual care [42].…”

Section: Discussionmentioning

confidence: 99%

High Prevalence of Atrial Fibrillation in a Lithuanian Stroke Patient Cohort

et al. 2022

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Background and Objectives: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with a five-fold increased risk for acute ischemic stroke (AIS). We aimed to estimate the prevalence of AF in a Lithuanian cohort of stroke patients, and its impact on patients regarding case fatality, functional outcome, and health-related quality of life (HRQoL) at 90 days. Materials and Methods: A single-center prospective study was carried out for four non-consecutive months between December 2018 and July 2019 in one of the two comprehensive stroke centers in Eastern Lithuania. A telephone-based follow-up was conveyed at 90 days using the modified Rankin Scale (mRS) and EuroQoL five-dimensional three-level descriptive system (EQ-5D-3L) with a self-rated visual analog scale (EQ-VAS). One-year case fatality was investigated. Results: We included 238 AIS patients with a mean age of 71.4 ± 11.9 years of whom 45.0% were female. A striking 97 (40.8%) AIS patients had a concomitant AF, in 68 (70.1%) of whom the AF was pre-existing. The AIS patients with AF were at a significantly higher risk for a large vessel occlusion (LVO; odds ratio 2.72 [95% CI 1.38–5.49], p = 0.004), and had a more severe neurological impairment at presentation (median NIHSS score (interquartile range): 9 (6–16) vs. 6 (3–9), p < 0.001). The LVO status was only detected in those who had received computed tomography angiography. Fifty-five (80.9%) patients with pre-existing AF received insufficient anticoagulation at stroke onset. All patients received a 12-lead ECG, however, in-hospital 24-h Holter monitoring was only performed in 3.4% of AIS patients without pre-existing AF. Although multivariate analyses found no statistically significant difference in one-year stroke patient survival and favorable functional status (mRS 0–2) at 90 days, when adjusted for age, gender, reperfusion treatment, baseline functional status, and baseline NIHSS, stroke patients with AF had a significantly poorer self-perceived HRQoL, indicated by a lower EQ-VAS score (regression coefficient ± standard error: β = −11.776 ± 4.850, p = 0.017). Conclusions: In our single-center prospective observational study in Lithuania, we found that 40.8% of AIS patients had a concomitant AF, were at a higher risk for an LVO, and had a significantly poorer self-perceived HRQoL at 90 days. Despite the high AF prevalence, diagnostic tools for subclinical AF were greatly underutilized.

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Section: Discussionmentioning

confidence: 99%

High Prevalence of Atrial Fibrillation in a Lithuanian Stroke Patient Cohort

et al. 2022

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“…The DoubleCheck-AF study opens the door for new screening strategies In post stroke patients, searching for AF is of utmost importance and strongly recommended (3,8). Wouters, Gruwez, Vranken, Ernon, et al present a nice case report of a patient simultaneously monitored by an implantable loop recorder and a PPG device.…”

Section: Discussionmentioning

confidence: 99%

“…Still, these new technologies require validation in clinical settings and a substantiated choice of the appropriate method using the appropriate device for the patient or user ( 3 , 4 ). The DoubleCheck-AF validation study from Bacevicius et al prospectively evaluated a wrist-worn device providing both continuous PPG-based rhythm monitoring and simultaneous 6-lead ECG.…”

Section: Discussionmentioning

confidence: 99%

“…The optimal screening strategy remains to be found ( 5 ). Following important screening trials like the STROKESTOP study ( 6 ), current consensus documents extended their recommendations on target populations and settings for screening for atrial fibrillation ( 3 ). Furthermore, the implementation of systematic screening for AF to achieve long-term reduction in a combined outcome of mortality, stroke, and severe bleeding is supported by current evidence ( 7 ), but will require establishment of clear diagnostic patient pathways.…”

Section: Discussionmentioning

confidence: 99%

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Editorial: Wearable Devices for Cardiac Rhythm Monitoring

Duncker

Svennberg

2022

Front. Cardiovasc. Med.

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Editorial on the Research Topic Wearable Devices for Cardiac Rhythm MonitoringNew wearable technologies for cardiac rhythm monitoring are gaining more importance in clinical routine in the field of cardiology and electrophysiology -by physicians as well as patients. These include, but are by far not restricted to, smartphone-based electrocardiogram (ECG) or photoplethysmograpy (PPG), finger-ECG, smartwatches, smart garments and more. This opens new horizons for mobile (m) Health-based patient care, mHealth-enhanced teleconsultations, but also mass screening for heart rhythm disorders.The current Research Topic includes new research on these technologies covering methodological aspects on wearable single-and multiple-lead ECG or PPG devices as well as clinical implementation of digital devices (Figure 1).Xintarakou et al. present an elaborated review about smart wearables for monitoring and management of cardiac arrhythmias. The sensitivity and specificity of PPG-based devices in detecting AF is very good. Interpreting the PPG waveforms and tracings, however, requires some training (1). The INTERPRET-AF study by Gruwez et al. show that the accuracy of physicians interpreting PPGs is quite high and that using all available information from the PPG signal, the tachogram, the Poincaré plot and an automated algorithm increases the diagnostic accuracy and is comparable to a single lead ECG or 12-lead ECG. However, a call for training and education of PPG tracings and validity and limitations of interpretation should be made as this is rare in cardiological curricula, except in the recently updated curricula by the German Cardiac Society (2). NEW DEVICESComparative studies on different devices are rare. Abu-Alrub et al. compared recording quality of three single-lead smartwatches in 100 patients with atrial fibrillation vs. 100 patients in sinus rhythm. Diagnosing AF is possible using various ECG smartwatch models, but differences in diagnostic accuracy of the related automated algorithms were noted.An electronic-textile-based ECG monitoring was evaluated by Teferra et al. showing an effective option for continuous cardiac monitoring implemented into textiles.Combining digital devices with machine learning algorithms represents a unique opportunity for individualized approaches or early identification of patients at risk. Luongo et al. evaluated a machine learning algorithm using a single-lead Holter ECG to identify patients with AF-induced cardiomyopathy. In clinical routine this could be a time and cost-efficient discriminator for general practitioners performing Holter ECG to identify patients requiring referral to a cardiologist.

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“…During recent years, opportunities for AF detection have improved with more resources such as Holter devices, wearables, patches and implantable recorders, which significant helped towards more AF identification. 6 From an optimistic point of view, If you seek you shall find , and since it is getting easier to seek, we shall find and treat more AF holistically in order to reduce the burden of stroke and other cardiovascular events.…”

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confidence: 99%