An improved method to detect arrhythmia using ensemble learning-based model in multi lead electrocardiogram (ECG).

Arrhythmia is a life-threatening cardiac condition characterized by irregular heart rhythm. Early and accurate detection is crucial for effective treatment. However, single-lead electrocardiogram (ECG) methods have limited sensitivity and specificity. This study propose an improved ensemble learning approach for arrhythmia detection using multi-lead ECG data. Proposed method, based on a boosting algorithm, namely Fine Tuned Boosting (FTBO) model detects multiple arrhythmia classes. For the feature extraction, introduce a new technique that utilizes a sliding window with a window size of 5 R-peaks. This study compared it with other models, including bagging and stacking, and assessed the impact of parameter tuning. Rigorous experiments on the MIT-BIH arrhythmia database focused on Premature Ventricular Contraction (PVC), Atrial Premature Contraction (PAC), and Atrial Fibrillation (AF) have been performed. The results showed that the proposed method achieved high sensitivity, specificity, and accuracy for all three classes of arrhythmia. It accurately detected Atrial Fibrillation (AF) with 100% sensitivity and specificity. For Premature Ventricular Contraction (PVC) detection, it achieved 99% sensitivity and specificity in both leads. Similarly, for Atrial Premature Contraction (PAC) detection, proposed method achieved almost 96% sensitivity and specificity in both leads. The proposed method shows great potential for early arrhythmia detection using multi-lead ECG data.

Validity of MENARI plus (self-pulse assessment and clinical scoring) mobile apps for detecting atrial fibrillation in high-risk population.

Background: Even before it is clinically diagnosed, atrial fibrillation (AF) can cause a stroke. This study validates self-pulse assessment and clinical scoring (MENARI Plus) based on android apps. Objective: The aim of this study was to examine the validity of AF screening using MENARI Plus compared with an ECG recording. Methods: We collected a total of 1385 subjects from high-risk population according to CHA2DS2-VASc score ≥2, attending 8 primary care centers (PCCs) in Malang between July 2021 and December 2021. Every participant underwent self-pulse assessment, and then was evaluated for MENARI Plus Score on android Apps. These cases had been classified as low or high probability for AF (cut-off score 7). After that, electrocardiography examinations were performed and classified with AF and Sinus Rhythm group. Results: In this study, the mean age of these patients was 61.5 ± 6.9 years old. We found that 156/1385 (11%) patients had AF. There were 68/156 (43.5%) new cases of AF. The sensitivity for self-pulse palpation was 73.1% (95% CI: 68%-76%) and specificity was 68.3% (95% CI: 65%-72%). MENARI Plus had an area under the receiver operating curve (AUC) of 0.86 (95% CI: 0.82-0.89) with sensitivity per measurement occasion was (84%, 95% CI: 82%-88%) and specificity was (87.9%, 95% CI: 82%-90%). Conclusion: In this study, we found that MENARI Plus has high sensitivity and specificity for AF. It is therefore useful for ruling out AF. It may also be a useful screen that can be applied opportunistically for previously undetected AFs.

Identification of microRNAs as diagnostic biomarkers for atrial fibrillation: a systematic review and meta-analysis.

Background: Genetic factors contribute to the AF pathophysiology by altering the structural and functional properties of proteins involved in different cellular activities. MicroRNAs (miRNAs), which take part in structural and electrical remodeling during the AF evolution, are important genetic elements that must be considered. The aim of study is to determine correlation between the expression of miRNAs and the development of AF, as well as to explain any potential importance of genetic factors in the AF diagnosis. Methods and Results: Online scientific databases, including Cochrane, ProQuest, PubMed, and Web of Science were used to conduct the literature search. The keywords were associated with or characterized the relationship between miRNAs and AF. The pooled sensitivity and specificity statistical parameters were analyzed using a random-effects model. The miRNAs had a combined sensitivity and specificity of 0.80 (95% CI = 0.70-0.87) and 0.75 (95% CI = 0.64-0.83) for the diagnosis of AF, respectively. The area under the SROC was 0.84 (95% CI = 0.81-0.87). The DOR was 11.80 (95% CI = 6.79-20.50). This study also revealed that miRNAs had a pooled PLR of 3.16 (95% CI = 2.24-4.45) and NLR of 0.27 (95% CI = 0.18-0.39) for the diagnosis of AF. The miR-425-5p demonstrated the highest sensitivity (0.96, 95% CI, 0.89-0.99). Conclusion: The meta-analysis revealed substantial connection between miRNA expression dysregulation and AF, supporting the potential diagnostic role of miRNAs. The miR-425-5p has potential role as a biomarker for AF.

Prophylactic Cavotricuspid Isthmus Ablation in Atrial Fibrillation without Documented Typical Atrial Flutter: A Systematic Review and Meta-analysis.

Background: The advantage of prophylactic cavotricuspid isthmus (CTI) ablation for AF patients without documented atrial flutter is still unclear. The present study aimed to evaluate the role of prophylactic CTI ablation in this population. Methods: A systematic review and meta-analysis study was conducted. The overall effects estimation was conducted using random effects models. The pooled effects were presented as the risk difference and standardised mean difference for dichotomous and continuous outcomes, respectively. Results: A total of 1,476 patients from four studies were included. The risk of atrial tachyarrhythmias following a successful catheter ablation procedure was greater in the pulmonary vein isolation + CTI ablation group than pulmonary vein isolation alone group (34.8% versus 28.2%; risk difference 0.08; 95% CI [0.00-0.17]; p=0.04). Prophylactic CTI ablation was associated with a higher recurrent AF rate (33.8% versus 27.1%; risk difference 0.07; 95% CI [0.01-0.13]; p=0.02). Additional prophylactic CTI ablation to pulmonary vein isolation significantly increased the radio frequency application time (standardised mean difference 0.52; 95% CI [0.04-1.01]; p=0.03). Conclusion: This study suggested that prophylactic CTI ablation was an ineffective and inefficient approach in AF without documented typical atrial flutter patients.

A Systematic Review and Meta-Analysis of the Direct Comparison of Second-Generation Cryoballoon Ablation and Contact Force-Sensing Radiofrequency Ablation in Patients with Paroxysmal Atrial Fibrillation.

The superiority of second-generation cryoballoon (2G-CB) ablation versus contact force-sensing radiofrequency (CF-RF) ablation in patients with paroxysmal atrial fibrillation (AF) was assessed in this systematic review and meta-analysis. Freedom from atrial tachyarrhythmias (ATAs) (OR = 0.89; 95% confidence interval [CI] = 0.68 to 1.17; p = 0.41), freedom from AF (OR = 0.93; 95% CI = 0.65 to 1.35; p = 0.72), and acute pulmonary vein isolation (PVI) (OR = 1.17; 95% CI = 0.54 to 2.53; p = 0.70) between 2G-CB ablation and CF-RF ablation were not different. The procedure time for the 2G-CB ablation was shorter (MD = -18.78 min; 95% CI = -27.72 to -9.85 min; p < 0.01), while the fluoroscopy time was similar (MD = 2.66 min; 95% CI = -0.52 to 5.83 min; p = 0.10). In the 2G-CB ablation group, phrenic nerve paralysis was more common (OR = 5.74; 95% CI = 1.80 to 18.31; p = < 0.01). Regarding freedom from ATAs, freedom from AF, and acute PVI, these findings imply that 2G-CB ablation is not superior to CF-RF ablation in paroxysmal AF. Although faster than CF-RF ablation, 2G-CB ablation has a greater risk of phrenic nerve paralysis.

The superiority of high-power short-duration radiofrequency catheter ablation strategy for atrial fibrillation treatment: A systematic review and meta-analysis study.

BACKGROUND: Radiofrequency catheter ablation (RFCA) using the high-power short duration (HPSD) results in better ablation lesion formation in the swine model. This systematic review and meta-analysis purposed to investigate the safety and efficacy profile between HPSD and low-power long-duration (LPLD) ablation strategies to treat atrial fibrillation (AF) patients. METHODS: We completed the literature review after identifying the relevant articles comparing HPSD and LPLD ablation methods for AF recorded in ClinicalTrials.com, CENTRAL, PubMed, and ScienceDirect until February 2021. The overall effects were calculated using pooled risk ratio (RR) and mean difference (MD) for categorical and continuous data, respectively. We also estimated the 95% confidence interval (CI). RESULTS: The HPSD strategy took shorter procedure time (MD = -33.75 min; 95% CI = -44.54 to -22.97; P < .01), fluoroscopy time (MD = -5.73 min; 95% CI = -8.77 to -2.70; P < .001), and ablation time (MD = -17.71; 95% CI = -21.02 to -14.41) than LPLD strategy. The HPSD RFCA was correlated with lower risk of esophageal thermal injury (RR = 0.75; 95% CI = 0.59 to 0.94; P = .02). The HPSD method resulted in higher first-pass pulmonary vein isolation (PVI) (RR = 1.36; 95% CI = 1.13 to 1.64; P < .01), lower PV reconnection (RR = 0.47; 95% CI = 0.34 to 0.64; P < .01), and lower recurrent AF (RR = 0.72; 95% CI = 0.54 to 0.96; P = .02) than LPLD strategy. CONCLUSION: HPSD RFCA was superior to the conventional LPLD RFCA in terms of safety and efficacy in treating AF patients.

Direct comparison of non-vitamin K antagonist oral anticoagulant versus warfarin for stroke prevention in non-valvular atrial fibrillation: a systematic review and meta-analysis of real-world evidences.

BACKGROUND: To overcome the several drawbacks of warfarin, non-vitamin K antagonist oral anticoagulants (NOACs) were developed. Even though randomized controlled trials (RCTs) provided high-quality evidence, the real-world evidence is still needed. This systematic review and meta-analysis proposed to measure the safety and efficacy profile between warfarin and NOACs in non-valvular atrial fibrillation (NVAF) patients in preventing stroke. RESULTS: We collected articles about the real-world studies comparing warfarin and NOACs for NVAF patients recorded in electronic scientific databases such as Embase, ProQuest, PubMed, and Cochrane. The pooled hazard ratio (HR) and 95% confidence interval (CI) were estimated using the generic inverse variance method. A total of 34 real-world studies, including 2287288 NVAF patients, were involved in this study. NOACs effectively reduced the stroke risk than warfarin (HR 0.77; 95% CI 0.69 to 0.87; p < 0.01). Moreover, NOACs effectively lowered all-cause mortality risk (HR 0.71; 95% CI 0.63 to 0.81; p < 0.01). From the safety aspect, compared to warfarin, NOACs significantly reduced major bleeding risk (HR 0.68; 95% CI 0.54 to 0.86; p < 0.01) and intracranial bleeding risk (HR 0.54; 95% CI 0.42 to 0.70; p < 0.01). However, NOACs administration failed to decrease gastrointestinal bleeding risk (HR 0.78; 95% CI 0.58 to 1.06; p = 0.12). CONCLUSIONS: In NVAF patients, NOACs were found to be more effective than warfarin at reducing stroke risk. NOACSs also lowered the risk of all-cause mortality, cerebral hemorrhage, and severe bleeding in NVAF patients compared to warfarin.

Indonesian registry on atrial fibrillation (OneAF).

BACKGROUND: Data on the optimal therapeutic international normalized ratio (INR) for non-valvular and valvular atrial fibrillation (AF) in Indonesia is currently unavailable. Therefore, we designed the Indonesian Registry on Atrial Fibrillation (OneAF) registry in order to seek a safe and beneficial range of INR in Indonesian patients with non-valvular and valvular AF. METHODS/DESIGN: The OneAF registry is a nationwide collaboration of the Indonesian Heart Rhythm Society (InaHRS) enrolling all hospitals with cardiac electrophysiologists in Indonesia. It is a prospective, multicentre, nationwide, observational study aiming to recruit non-valvular and valvular AF patients in Indonesia. The registry was started in January 2020 with a planned 2 years of recruitment. There are 2 respondents for this registry: non-cohort and cohort respondents. Non-cohort registry respondents are AF patients at hospitals who fulfill inclusion and exclusion criteria but did not consent for a 24 month follow up. Whereas patients who consented for a 24 month follow up were included as cohort registry respondents. Key data collected includes basic sociodemographic information, symptoms and signs, medical history, results of physical examination and laboratory test, details of diagnostics and treatment measures and events. RESULTS: Currently, a total of 1568 respondents have been enrolled in the non-cohort registry, including 1065 respondents with non-valvular AF (67.8%) and 503 respondents with valvular AF (32.2%). We believe that the OneAF registry will provide insight into the regional variability of anticoagulant treatment for AF, the implementation of rhythm/rate control approaches, and the clinical outcomes concerning cardiocerebrovascular events. TRIAL REGISTRATION: Registered at clinicaltrials.gov (NCT04222868).

Additional complex fractionated atrial electrogram ablation does not improve the outcomes of non-paroxysmal atrial fibrillation: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Non-paroxysmal atrial fibrillation (AF) has a complex pathophysiological process. The standard catheter ablation approach is pulmonary vein isolation (PVI). The additional value of complex fractionated electrogram (CFAE) ablation is still unclear. We aimed to investigate the additional value of CFAE ablation for non-paroxysmal AF. METHODS: We performed a systematic review and meta-analysis of randomized controlled studies up to May 2020. Articles comparing pulmonary vein isolation (PVI) plus CFAE ablation and PVI alone for AF were obtained from the electronic scientific databases. The pooled mean difference (MD) and pooled risk ratio (RR) were assessed. RESULTS: A total of 8 randomized controlled trials (RCTs) including 1034 patients were involved. Following a single catheter ablation procedure, the presence of any atrial tachyarrhythmia (ATA) with or without the use of antiarrhythmic drugs (AADs) between both groups were not significantly different (RR = 1.1; 95% confidence interval [CI] = 0.97-1.24; p = 0.13). Similar results were also obtained for the presence of any ATA without the use of AADs (RR = 1.08; 95% CI = 0.96-1.22; p = 0.2). The additional CFAE ablation took longer procedure times (MD = 46.95 min; 95% CI = 38.27-55.63; p = < 0.01) and fluoroscopy times (MD = 11.69 min; 95% CI = 8.54-14.83; p = < 0.01). CONCLUSION: Additional CFAE ablation failed to improve the outcomes of non-paroxysmal AF patients. It also requires a longer duration of procedure times and fluoroscopy times.

The Benefit of Atrioventricular Junction Ablation for Permanent Atrial Fibrillation and Heart Failure Patients Receiving Cardiac Resynchronization Therapy: An Updated Systematic Review and Meta-analysis.

BACKGROUND: Atrial fibrillation (AF) is correlated with a poor biventricular pacing and inadequate response to cardiac resynchronization therapy (CRT). Biventricular pacing improvement can be achieved by conducting the atrioventricular junction ablation (AVJA). We aimed to investigate the benefit of AVJA for permanent AF and heart failure with reduced ejection fraction (HFrEF) patients receiving CRT. METHODS: In August 2020, a systematic review and meta-analysis study comparing CRT plus AVJA versus CRT for permanent AF and HFrEF patients was conducted. Relevant articles were identified through the electronic scientific database such as ClinicalTrials.gov, ProQuest, ScienceDirect, PubMed, and Cochrane. The pooled risk ratio (RR) and pooled mean difference (MD) were estimated. RESULTS: A total of 3199 patients from 14 cohort studies were involved in this study. Additional AVJA reduced cardiovascular mortality (RR = 0.75, 95% confidence interval [CI] = 0.61 to 0.93, P < 0.01) in permanent AF and HFrEF patients receiving CRT. Biventricular pacing rate was higher in CRT plus AVJA group (MD = 8.65%, 95% CI = 5.62 to 11.67, P < 0.01) than in CRT alone group. The reverse remodeling characterized by the reduction of left ventricular end-diastolic diameter (LVEDD) was greater in the CRT plus AVJA group (MD = -2.11 mm, 95% CI = -3.79 to -0.42, P = 0.01). CONCLUSION: In permanent AF and HFrEF patients receiving CRT, AVJA effectively increased the biventricular pacing rate. Adequate biventricular pacing rate provided a better response to the CRT marked by the greater ventricular reverse remodeling and survival from cardiovascular mortality.

Coronary Angiography Characteristics as Predictor of Successful Chronic Total Occlusion Recanalization.

Although remarkable progress in percutaneous coronary intervention (PCI) has been achieved over the last decade, the success rate of chronic total occlusion (CTO) recanalization varies greatly. Coronary angiography characteristics may affect the success rate of CTO recanalization. This study sought to establish a scoring model to predict successful CTO recanalization based on coronary angiography characteristics. We analyze 287 angiography data from patients who underwent elective PCI. Angiography characteristics being measured were lesion location, blunt stump, calcification, ostial lesion, bridging collateral, bending, side branch, tortuosity, previous stent attempt, and lesion length of >20 mm. Data were analyzed using SPSS 25.0. Multivariate analysis shows that side branch lesion ( p = 0.000), proximal vessels tortuosity ( p = 0.015), calcified lesion ( p = 0.000), lesion length of >20 mm ( p = 0.000), and blunt stump ( p = 0.000) can predict the successful PCI in the CTO. ROC curve analysis of the score ability to predict successful PCI in the CTO showed area under curve of 0.89 (confidence interval 95%), the cutoff point of ≤2 with a sensitivity of 93.33%, and specificity of 88.23%. We concluded that the five angiography characteristics that strongly associate with successful PCI in the CTO are calcified lesion, blunt stump, lesion length >20 mm, proximal vessel tortuosity, and side branch lesion. This score may help cardiologists to predict the success probability of PCI in the CTO.

Intermittent Pacemaker Malfunction Caused by Continuous Compression of the Lead by the Clavicle (Subclavian Crush Syndrome).

Subclavian vein access is still one of the most favoured access options for cardiac implantable electronic device (CIED) implantation. For the physician, the technique is reasonably familiar and easy to carry out. However, this has several potential complications. In this case, we present a late complication of subclavian access. The patient presented with intermittent loss of pacemaker output, which caused him to experience several syncopal events. In the acute setting, we changed the lead polarity and achieved a good outcome. Further management of this situation consisted of removal and replacement of the damaged lead. LEARNING POINTS: Subclavian vein access is still one of the most favoured access options for cardiac device implantation.Intermittent loss of output can be a sign of pacemaker malfunction due to subclavian crush syndrome.Damaged lead extraction may be difficult to perform.