Use of a Smart Watch for Early Detection of Paroxysmal Atrial Fibrillation: Validation Study.

BACKGROUND: Wearable devices with photoplethysmography (PPG) technology can be useful for detecting paroxysmal atrial fibrillation (AF), which often goes uncaptured despite being a leading cause of stroke. OBJECTIVE: This study is the first part of a 2-phase study that aimed at developing a method for immediate detection of paroxysmal AF using PPG-integrated wearable devices. In this study, the diagnostic performance of 2 major smart watches, Apple Watch Series 3 and Fitbit (FBT) Charge HR Wireless Activity Wristband, each equipped with a PPG sensor, was compared, and the pulse rate data outputted from those devices were analyzed for precision and accuracy in reference to the heart rate data from electrocardiography (ECG) during AF. METHODS: A total of 40 subjects from patients who underwent cardiac surgery at a single center between September 2017 and March 2018 were monitored for postoperative AF using telemetric ECG and PPG devices. AF was diagnosed using a 12-lead ECG by qualified physicians. Each subject was given a pair of smart watches, Apple Watch and FBT, for simultaneous pulse rate monitoring. The heart rate of all subjects was also recorded on the telemetry system. Time series pulse rate trends and heart rate trends were created and analyzed for trend pattern similarities. Those trend data were then used to determine the accuracy of PPG-based pulse rate measurements in reference to ECG-based heart rate measurements during AF. RESULTS: Of the 20 AF events in group FBT, 6 (30%) showed a moderate or higher correlation (cross-correlation function>0.40) between pulse rate trend patterns and heart rate trend patterns. Of the 16 AF events in group Apple Watch (workout [W] mode), 12 (75%) showed a moderate or higher correlation between the 2 trend patterns. Linear regression analyses also showed a significant correlation between the pulse rates and the heart rates during AF in the subjects with Apple Watch. This correlation was not observed with FBT. The regression formula for Apple Watch W mode and FBT was X=14.203 + 0.841Y and X=58.225 + 0.228Y, respectively (where X denotes the mean of all average pulse rates during AF and Y denotes the mean of all corresponding average heart rates during AF), and the coefficient of determination (R2) was 0.685 and 0.057, respectively (P<.001 and .29, respectively). CONCLUSIONS: In this validation study, the detection precision of AF and measurement accuracy during AF were both better with Apple Watch W mode than with FBT.

Autologous Pericardial Patch Repair for Papillary Fibroelastoma on an Aortic Valve Leaflet.

A 50-year-old man with no history of cardiovascular disease was referred to our hospital because of an abnormal electrocardiogram. Echocardiograms and computed tomograms revealed a 9-mm mass on the underside of an aortic valve leaflet. We chose surgical treatment, to prevent embolic events. The tumor's appearance and intraoperative frozen section were consistent with myxoma. We resected the tumor and its attachment, including the free margin of the aortic valve leaflet, and repaired the defect with use of a glutaraldehyde-treated autologous pericardial patch. The postoperative histopathologic diagnosis was papillary fibroelastoma. Six months later, echocardiograms showed mild aortic regurgitation and no recurrence of the aortic valve mass. Papillary fibroelastoma and myxoma can be difficult to distinguish intraoperatively, yet the diagnosis has considerable influence on the surgical strategy, including whether valve-sparing excision is an option. Therefore, it is necessary to at least suspect both entities if the tumor characteristics are unusual. This case is instructive for surgeons and pathologists.

[Impact of Patent False Lumen at the Descending Aorta after Total Aortic Replacement for Acute type A Aortic Dissection].

OBJECTIVE: Acute type A aortic dissection remains one of the most challenging diseases facing cardiovascular surgeons. It is associated with high mortality and morbidity. However, prevention of disease process progression in the residual dissected aorta is an important aspect of the patient's long-term outcome. The aim of this study was to examine the impact of patent false lumen at the descending aorta after total arch replacement for acute type A aortic dissection. METHODS: Between December 1994 and August 2014, a total of 145 patients underwent total arch replacement for acute type A aortic dissection. The hospital mortality was 5.5%.Of these 145 patients, 33 had patent false lumen at the descending aorta after surgery, and 94 had thrombosed false lumen. The perioperative variables and late results were statistically analyzed. RESULTS: The incidence of residual thoracic patent false lumen was 26.0%.No significant difference was observed in the cumulative survival rate between groups. The patent false lumen group was associated with significant higher risk of the descending aortic event than the thrombosed group. By multivariate analysis, younger age and non-resection of the primary tear were significant prospective factors for the patent false lumen at the descending aorta. CONCLUSIONS: The patent false lumen at the descending aorta was associated with the late aortic critical events after total arch replacement for aortic dissection.