New electrocardiographic score for the prediction of atrial fibrillation: The MVP ECG risk score (morphology-voltage-P-wave duration).

BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia and has significant morbidity. A score composed of easily measured electrocardiographic variables to identify patients at risk of AF would be of great value in order to stratify patients for increased monitoring and surveillance. The purpose of this study was to develop an electrocardiographic risk score for new-onset AF. METHODS: A total of 676 patients without previous AF undergoing coronary angiography were retrospectively studied. Points were allocated based on P-wave morphology in inferior leads, voltage in lead 1, and P-wave duration (MVP). Patients were divided into three risk groups and followed until development of AF or last available clinical appointment. RESULTS: Mean age was 65 years, and 68% were male. The high- and intermediate-risk groups were more likely to develop AF than the low-risk group (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.3-4.4; p = 0.006 and OR 2.1, 95% CI 1.4-3.27; p = 0.009, respectively). The high-risk group had a significantly shorter mean time to development of AF (258 weeks; 95% CI 205-310 weeks) compared to the intermediate- (278 weeks; 95% CI 252-303 weeks) and low-risk groups (322 weeks 95% CI 307-338 weeks), p = 0.005. CONCLUSIONS: A simple risk score composed of easy-to-measure electrocardiographic variables can help to predict new-onset AF. Further validation studies will be needed to assess the ability of this risk score to predict AF in other populations.

Radiotherapy for patients with cardiovascular implantable electronic devices: an 11-year experience.

PURPOSE: As cardiovascular implantable electronic devices (CIEDs) are increasingly indicated in older patients, and the burden of cancer is rising with the aging population, the management of patients with CIEDs who require radiotherapy (RT) is a timely concern. The objective of the study was to evaluate the management of, and malfunctions in, patients with CIEDs undergoing RT. METHODS: A retrospective study of patients with CIEDs receiving RT at Kingston Health Sciences Center from March 2007-April 2018 was conducted. Data on demographics, RT, devices, and management were compared for the primary outcome of device malfunction. RESULTS: Of the 189 patients with CIEDs receiving a total of 297 courses of RT, 4 patients (2.1%) experienced device malfunctions. Higher beam energy was associated with a malfunction (p < 0.05). Patients with malfunctions received a lower dose of radiation per fraction (267 ± 93 cGy vs. 477 ± 282 cGy; p < 0.05) and were significantly younger (71.4 ± 2.2 years vs. 77.8 ± 9.8 years; p < 0.01) compared to patients without malfunctions. CONCLUSION: RT-induced device malfunctions are rare, but given the potential complications, a better understanding of the potential predictors of malfunction and the development of evidence-based guidelines will help optimize patient safety.