Supermarket/hypermarket opportunistic screening for atrial fibrillation (SHOPS-AF) using sensors embedded in the handles of supermarket trolleys: A feasibility study.

BACKGROUND: Atrial fibrillation (AF) increases the risk of death, stroke, heart failure, cognitive decline, and healthcare costs but is often asymptomatic and undiagnosed. There is currently no national screening program for AF. The advent of validated hand-held devices allows AF to be detected in non-healthcare settings, enabling screening to be undertaken within the community. METHOD AND RESULTS: In this novel observational study, we embedded a MyDiagnostick single lead ECG sensor into the handles of shopping trolleys in four supermarkets in the Northwest of England: 2155 participants were recruited. Of these, 231 participants either activated the sensor or had an irregular pulse, suggesting AF. Some participants agreed to use the sensor but refused to provide their contact details, or consent to pulse assessment. In addition, some data were missing, resulting in 203 participants being included in the final analyses. Fifty-nine participants (mean age 73.6 years, 43% female) were confirmed or suspected of having AF; 20 were known to have AF and 39 were previously undiagnosed. There was no evidence of AF in 115 participants and the remaining 46 recordings were non-diagnostic, mainly due to artefact. Men and older participants were significantly more likely to have newly diagnosed AF. Due to the number of non-diagnostic ECGs (n = 46), we completed three levels of analyses, excluding all non-diagnostic ECGs, assuming all non-diagnostic ECGs were masking AF, and assuming all non-diagnostic ECGs were not AF. Based on the results of the three analyses, the sensor's sensitivity (95% CI) ranged from 0.70 to 0.93; specificity from 0.15 to 0.97; positive predictive values (PPV) and negative predictive values (NPV) ranged from 0.24 to 0.56 and 0.55 to 1.00, respectively. These values should be interpreted with caution, as the ideal reference standard on 1934 participants was imperfect. CONCLUSION: The study demonstrates that the public will engage with AF screening undertaken as part of their daily routines using hand-held devices. Sensors can play a key role in identifying asymptomatic patients in this way, but the technology must be further developed to reduce the quantity of non-diagnostic ECGs.

Doxorubicin cardiotoxicity and Camellia sinensis cardioprotection determined by speckle-tracking echocardiography

Abstract Doxorubicin (Dox) is a medication used in the treatment of cancerous tumors and hematologic malignancies with potentially serious side effects, including the risk of cardiotoxicity. Flavonoids are plant metabolites with antioxidant properties and can be extracted from Camellia sinensis (CS). The aim of this study is to evaluate the possible cardioprotective effect of CS against injuries induced by Dox in rats. A total of 32 animals were distributed into four groups: (1) control - intraperitoneal injection (I.P.) of 0.5 mL saline weekly and 1.0 mL water by gavage daily; (2) CS - 0.5 mL saline I.P. weekly and 200 mg/kg CS by gavage daily; (3) Dox - 5.0 mg/kg Dox I.P. weekly and 1.0 mL water by gavage daily; and (4) Dox+CS -5.0 mg/kg Dox I.P. weekly and 200 mg/kg CS by gavage daily. Clinical examinations, blood profiles, electrocardiograms, echocardiograms, and histological analyses of hearts were performed over 25 days. The animals in the Dox group showed changes in body weight and in erythrogram, leukogram, electrocardiography, and echocardiography readings. However, animals from the dox+CS group had significantly less change in body weight, improved cardiac function, and showed more preserved cardiac tissue. This study demonstrated that CS prevents dox-induced cardiotoxicity, despite enhancing the cytotoxic effect on blood cells

Cardioneuroablación como tratamiento del síncope reflejo: reporte de un caso

Resumen: El síncope mediado neuralmente es un trastorno causado por un reflejo autónomo anormalmente amplificado que involucra componentes tanto simpáticos como parasimpáticos. Es la causa más frecuente de síncope en personas jóvenes y su tratamiento sigue siendo un desafío, ya que no se ha demostrado que alguna terapia farmacológica prevenga por completo su recurrencia. En los últimos años ha surgido una técnica denominada cardioneuroablación, que consiste en la ablación por radiofrecuencia de los plexos ganglionares (PG) parasimpáticos, con buenos resultados a corto y largo plazo en la prevención de síncope recurrente, según los diferentes grupos de investigación. Presentamos el primer caso en Chile de un hombre joven con síncopes mediados neuralmente recurrentes que fue tratado con esta técnica en el Hospital Regional de Concepción.

Abstract: Cardioneuroablation is a novel method that can be used to treat reflex syncope. Although the experience with this technique is relatively limited it provides a more physiological way to treat this condition. The first case in Chile is herein reported along with a discussion of the subject.

A Clinician's Guide to Smartwatch "Interrogation".

PURPOSE OF REVIEW: Wearable technology is rapidly evolving and the data that it can provide regarding an individual's health is becoming increasingly important for clinicians to consider. The purpose of this review is to help inform health care providers of the benefits of smartwatch interrogation, with a focus on reviewing the various parameters and how to apply the data in a meaningful way. RECENT FINDINGS: This review details interpretation of various parameters found commonly in newer smartwatches such as heart rate, step count, ECG, heart rate recovery (HRR), and heart rate variability (HRV), while also discussing potential pitfalls that a clinician should be aware of. Smartwatch interrogation is becoming increasingly relevant as the continuous data it provides helps health care providers make more informed decisions regarding diagnosis and treatment. For this reason, we recommend health care providers familiarize themselves with the technology and integrate it into clinical practice.

Wearable technology for electrocardiogram and vectocardiogram using the Dower Transformation / Tecnologia vestível para exames de eletrocardiograma e vetocardiograma utilizando a transformada de Dower / Tecnología vestible para exámenes de electrocardiograma y vetocardiograma utilizando de la transformada de Dower

Objectives: Thousands of people suffer from cardiovascular diseases. Even though the electrocardiogram is an exam consolidated. The lack of methodological observation in the placement of sensors can compromise the results. This article proposes a wearable vest capable of conditioning cardiac signals from three simultaneous channels, reducing the chance of failures in the exam due to the smaller number of electrodes attached to the patient's body. Methods: It adds the vectorcardiogram technique to the electrocardiogram wearable, which consists of three orthonormal derivations Vx, Vy, and Vz, measuring dynamic components of the heart vector. Results: The display of the cardiac biopotential in the web-mobile application represents the visualization of the twelve derivations synthesized from the Dower transform and the spatial projections of the cardiac loop under a three-dimensional view. Conclusion: Feasibility of integrating the vectorcardiogram with the electrocardiogram exam.

Objetivos: Milhares de pessoas sofrem com doenças cardiovasculares, apesar do Eletrocardiograma ser um exame consolidado, a falta de observação metodológica na colocação dos sensores pode comprometer os resultados. O presente artigo propõe um colete vestível capaz de condicionar sinais cardíacos de três canais simultâneos, reduzindo a chance de falhas na execução do exame em função da menor quantidade de eletrodos fixados ao corpo do paciente. Métodos: Acrescenta a técnica do vetocardiograma ao vestível de eletrocardiograma, que consiste em três derivações ortonormais Vx, Vy e Vz, medindo componentes dinâmicos do vetor coração. Resultados: Exibição do biopotencial cardíaco na aplicação web-mobile representa de forma satisfatória a visualização das doze derivações sintetizadas a partir da transformada de Dower, bem como, as projeções espaciais do loop cardíaco sob uma visão tridimensional. Conclusão: Viabilidade de integração do vetocardiograma ao exame de eletrocardiograma.

Objetivos: Miles de personas padecen enfermedades cardiovasculares, a pesar de que el electrocardiograma es un examen consolidado, la falta de observación metodológica en la colocación de sensores puede comprometer los resultados. Este artículo propone una tecnología vestible capaz de acondicionar las señales cardíacas de tres canales simultáneos, reduciendo la posibilidad de fallas en el examen por la menor cantidad de electrodos adheridos al cuerpo del paciente. Métodos: Agrega la técnica del vetocardiograma al electrocardiograma vestible, que consta de tres derivaciones ortonormales Vx, Vy y Vz, midiendo los componentes dinámicos del vector cardíaco. Resultados: La visualización del biopotencial cardíaco en la aplicación web-móvil representa satisfactoriamente la visualización de las doce derivaciones sintetizadas a partir de la transformada de Dower, así como las proyecciones espaciales del bucle cardíaco bajo una vista tridimensional. Conclusión: Viabilidad de integrar el vetocardiograma con el examen electrocardiográfico.

Novel tech throws knock-out punch to ECG improving GP referral decisions to cardiology.

PURPOSE: In a comparator study, designed with assistance from the Food and Drug Administration, a State-of-the-Art (SOTA) ECG device augmented with automated analysis, the comparator, was compared with a breakthrough technology, Cardio-HART (CHART). METHODS: The referral decision defined by physician reading biosignal-based ECG or CHART report were compared for 550 patients, where its performance is calculated against the ground truth referral decision. The ground truth was established by cardiologist consensus based on all the available measurements and findings including echocardiography (ECHO). RESULTS: The results confirmed that CHART analysis was far more effective than ECG only analysis: CHART reduced false negative rates 15.8% and false positive (FP) rates by 5%, when compared with SOTA ECG devices. General physicians (GP's) using CHART saw their positive diagnosis rate significantly increased, from ~10% to ~26% (260% increase), and the uncertainty rate significantly decreased, from ~31% to ~1.9% (94% decrease). For cardiology, the study showed that in 98% of the cases, the CHART report was found to be a good indicator as to what kind of heart problems can be expected (the 'start-point') in the ECHO examination. CONCLUSIONS: The study revealed that GP use of CHART resulted in more accurate referrals for cardiology, resulting in fewer true negative or FP-healthy or mildly abnormal patients not in need of ECHO confirmation. The indirect benefit is the reduction in wait-times and in unnecessary and costly testing in secondary care. Moreover, when used as a start-point, CHART can shorten the echocardiograph examination time.

Fructus Xanthii-Inspired Low Dynamic Noise Dry Bioelectrodes for Surface Monitoring of ECG.

The microstructured surfaces of bioelectrical dry electrodes are important aspects of dry electrode design. However, traditional surfaces for microstructured bioelectrical dry electrodes are costly to produce and require complex fabrication methods. In this study, a novel stacked-template method is proposed for the first time, rapidly producing microstructured dry electrodes at a low cost and with a large surface area. Three types of microstructured Ag/AgCl thermoplastic polyurethane (TPU) electrodes with a Fructus xanthii-inspired barb structure (FXbs) are prepared using this method; then, the dynamic friction, hair interference resistance, electrochemical, and electrocardiogram (ECG) signal acquisition performance of the electrodes are tested, and the dynamic noise characteristics of the electrodes are comprehensively evaluated with simulated instruments. Compared to the plate structure, the dynamic friction coefficient of the FXbs electrode improved by about 38.8%, exhibiting strong hair interference resistance. In addition, the FXbs electrode exhibits low dynamic noise and comparable performance to the wet electrode, in terms of signal acquisition, when it is tested using simulated instruments. Therefore, the prepared FXbs electrode increases the friction coefficient between the electrode and the skin, which effectively resolves issues related to dynamic noise in bioelectrical signals, making it suitable for dynamic measurements.

Left ventricular systolic dysfunction predicted by artificial intelligence using the electrocardiogram in Chagas disease patients-The SaMi-Trop cohort.

BACKGROUND: Left ventricular systolic dysfunction (LVSD) in Chagas disease (ChD) is relatively common and its treatment using low-cost drugs can improve symptoms and reduce mortality. Recently, an artificial intelligence (AI)-enabled ECG algorithm showed excellent accuracy to detect LVSD in a general population, but its accuracy in ChD has not been tested. OBJECTIVE: To analyze the ability of AI to recognize LVSD in patients with ChD, defined as a left ventricular ejection fraction determined by the Echocardiogram ≤ 40%. METHODOLOGY/PRINCIPAL FINDINGS: This is a cross-sectional study of ECG obtained from a large cohort of patients with ChD named São Paulo-Minas Gerais Tropical Medicine Research Center (SaMi-Trop) Study. The digital ECGs of the participants were submitted to the analysis of the trained machine to detect LVSD. The diagnostic performance of the AI-enabled ECG to detect LVSD was tested using an echocardiogram as the gold standard to detect LVSD, defined as an ejection fraction <40%. The model was enriched with NT-proBNP plasma levels, male sex, and QRS ≥ 120ms. Among the 1,304 participants of this study, 67% were women, median age of 60; there were 93 (7.1%) individuals with LVSD. Most patients had major ECG abnormalities (59.5%). The AI algorithm identified LVSD among ChD patients with an odds ratio of 63.3 (95% CI 32.3-128.9), a sensitivity of 73%, a specificity of 83%, an overall accuracy of 83%, and a negative predictive value of 97%; the AUC was 0.839. The model adjusted for the male sex and QRS ≥ 120ms improved the AUC to 0.859. The model adjusted for the male sex and elevated NT-proBNP had a higher accuracy of 0.89 and an AUC of 0.874. CONCLUSION: The AI analysis of the ECG of Chagas disease patients can be transformed into a powerful tool for the recognition of LVSD.

Diagnostic performance of a wearing dynamic ECG recorder for atrial fibrillation screening: the HUAMI heart study.

BACKGROUND: Atrial fibrillation (AF) is the most prevalent cardiac dysrhythmia with high morbidity and mortality rate. Evidence shows that in every three patients with AF, one is asymptomatic. The asymptomatic and paroxysmal nature of AF is the reason for unsatisfactory and delayed detection using traditional instruments. Research indicates that wearing a dynamic electrocardiogram (ECG) recorder can guide accurate and safe analysis, interpretation, and distinction of AF from normal sinus rhythm. This is also achievable in an upright position and after exercises, assisted by an artificial intelligence (AI) algorithm. METHODS: This study enrolled 114 participants from the outpatient registry of our institution from June 24, 2020 to July 24, 2020. Participants were tested with a wearable dynamic ECG recorder and 12-lead ECG in a supine, an upright position and after exercises for 60 s. RESULTS: Of the 114 subjects enrolled in the study, 61 had normal sinus rhythm and 53 had AF. The number of cases that could not be determined by the wristband of dynamic ECG recorder was two, one and one respectively. Case results that were not clinically objective were defined as false-negative or false-positive. Results for diagnostic accuracy, sensitivity, and specificity tested by wearable dynamic ECG recorders in a supine position were 94.74% (95% CI% 88.76-97.80%), 88.68% (95% CI 77.06-95.07%), and 100% (95% CI 92.91-100%), respectively. Meanwhile, the diagnostic accuracy, sensitivity and specificity in an upright position were 97.37% (95% CI 92.21-99.44%), 94.34% (95% CI 84.03-98.65%), and 100% (95% CI 92.91-100%), respectively. Similar results as those of the upright position were obtained after exercise. CONCLUSION: The widely accessible wearable dynamic ECG recorder integrated with an AI algorithm can efficiently detect AF in different postures and after exercises. As such, this tool holds great promise as a useful and user-friendly screening method for timely AF diagnosis in at-risk individuals.

Recording an ECG With a Smartwatch in Newborns and Young Children: Feasibility and Perspectives.

Correlating symptoms with arrhythmia in neonates and young children is often difficult because of their sporadic and unpredictable nature. We show that it is possible to register an ECG with a smartwatch in neonates and young children and provide illustrative cases of supraventricular tachycardia and complete atrioventricular block identified with this technology.

Usefulness of Mobile Electrocardiographic Devices to Reduce Urgent Healthcare Visits.

Mobile electrocardiogram (mECG) devices are being used increasingly, supplying recordings to providers and providing automatic rhythm interpretation. Given the intermittent nature of certain cardiac arrhythmias, mECGs allow instant access to a recording device. In the current COVID-19 pandemic, efforts to limit in-person patient interactions and avoid overwhelming emergency and inpatient services would add value. Our goal was to evaluate whether a mECG device would reduce healthcare utilization overall, particularly those of urgent nature. We identified a cohort of KardiaMobile (AliveCor, USA) mECG users and compared their healthcare utilization 1 year prior to obtaining the device and 1 year after. One hundred and twenty-eight patients were studied (mean age 64, 47% female). Mean duration of follow-up pre-intervention was 9.8 months. One hundred and twenty-three of 128 individuals completed post-intervention follow-up. Patients were less likely to have cardiac monitors ordered (30 vs 6; p <0.01), outpatient office visits (525 vs 382; p <0.01), cardiac-specific ED visits (51 vs 30; p <0.01), arrhythmia related ED visits (45 vs 20; p <0.01), and unplanned arrhythmia admissions (34 vs 11; p <0.01) in the year after obtaining a KardiaMobile device compared to the year prior to obtaining the device. Mobile technology is available for heart rhythm monitoring and can give feedback to the user. This study showed a reduction of in-person, healthcare utilization with mECG device use. In conclusion, this strategy would be expected to decrease the risk of exposure to patients and providers and would avoid overwhelming emergency and inpatient services.

QT Interval Monitoring with Handheld Heart Rhythm ECG Device in COVID-19 Patients.

Background: QTc prolongation is an adverse effect of COVID-19 therapies. The use of a handheld device in this scenario has not been addressed. Objectives: To evaluate the feasibility of QTc monitoring with a smart device in COVID-19 patients receiving QTc-interfering therapies. Methods: Prospective study of consecutive COVID-19 patients treated with hydroxychloroquine ± azithromycin ± lopinavir-ritonavir. ECG monitoring was performed with 12-lead ECG or with KardiaMobile-6L. Both registries were also sequentially obtained in a cohort of healthy patients. We evaluated differences in QTc in COVID-19 patients between three different monitoring strategies: 12-lead ECG at baseline and follow-up (A), 12-lead ECG at baseline and follow-up with the smart device (B), and fully monitored with handheld 6-lead ECG (group C). Time needed to obtain an ECG registry was also documented. Results: One hundred and eighty-two COVID-19 patients were included (A: 119(65.4%); B: 50(27.5%); C: 13(7.1%). QTc peak during hospitalization did significantly increase in all groups. No differences were observed between the three monitoring strategies in QTc prolongation (p = 0.864). In the control group, all but one ECG registry with the smart device allowed QTc measurement and mean QTc did not differ between both techniques (p = 0.612), displaying a moderate reliability (ICC 0.56 [0.19-0.76]). Time of ECG registry was significantly longer for the 12-lead ECG than for handheld device in both cohorts (p < 0.001). Conclusion: QTc monitoring with KardiaMobile-6L in COVID-19 patients was feasible. Time of ECG registration was significantly lower with the smart device, which may offer an important advantage for prevention of virus dissemination among healthcare providers.

Registered report protocol: Developing an artifact index for capacitive electrocardiography signals acquired with an armchair.

Continuous monitoring of an electrocardiogram (ECG) in private diagnostic spaces such as vehicles or apartments allows early detection of cardiovascular diseases. We will use an armchair with integrated capacitive electrodes to record the capacitive electrocardiogram (cECG) during everyday activities. However, movements and other artifacts affect the signal quality. Therefore, an artifact index is needed to detect artifacts and classify the cECG. The unavailability of cECG data and reliable ground truth information requires new recordings to develop an artifact index. This study is designed to test the hypothesis: an artifact index can be devised, which intends to estimate the signal quality of segments and classify signals. In a single-arm study with 44 subjects, we will record two activities of 11-minute duration: reading and watching television. During recording, we will capture cECG, ECG, and oxygen saturation (SpO2) with time synchronization as well as keypoint-based movement indicators obtained from a video camera. SpO2 provides additional information on the subject's health status. The keypoint-based movements indicate artifacts in the cECG. We will combine all ground truth data to evaluate the index. In the future, we aim at using the artifact index to exclude cECG segments with artifacts from further analysis. This will improve cECG technology for the measurement of cardiovascular parameters.

Smartwatch-based detection of cardiac arrhythmias: Beyond the differentiation between sinus rhythm and atrial fibrillation.

Within the span of a few years, watches have functionally morphed from objects that tell time to wearable minicomputers that allow real-time recording of electrocardiograms (ECGs). Considerable information can be deduced from these single lead tracings, and it is now not uncommon to see patients in whom diagnostic tracings of clinically relevant but elusive arrhythmias are captured using a smartwatch. Empowering individuals to record their own ECG tracings in scenarios such as palpitations, syncope, and for risk stratification of sudden death intuitively has considerable potential, but its value remains to be robustly demonstrated. The main objective of this review is to describe the information that can be obtained from smartwatch-based single-lead ECG recordings beyond simply differentiating between sinus rhythm and atrial fibrillation. We also review the strengths and limitations of using these devices in clinical settings and offer potential solutions to address the latter.

The effect of colour on reading performance in children, measured by a sensor hub: From the perspective of gender.

In recent decades reported findings regarding gender differences in reading achievement, cognitive abilities and maturation process in boys and girls are conflicting. As reading is one of the most important processes in the maturation of an individual, the aim of the study was to better understand gender differences between primary school students. The study evaluates differences in Heart Rate Variability (HRV), Electroencephalography (EEG), Electrodermal Activities (EDA) and eye movement of participants during the reading task. Taking into account that colour may affect reading skills, in that it affects the emotional and physiological state of the body, the research attempts to provide a better understanding of gender differences in reading through examining the effect of colour, as applied to reading content. The physiological responses of 50 children (25 boys and 25 girls) to 12 different background and overlay colours of reading content were measured and summarised during the reading process. Our findings show that boys have shorter reading duration scores and a longer Saccade Count, Saccade Duration Total, and Saccade Duration Average when reading on a coloured background, especially purple, which could be caused by their motivation and by the type of reading task. Also, the boys had higher values for the Delta band and the Whole Range of EEG measurements in comparison to the girls when reading on coloured backgrounds, which could reflect the faster maturation of the girls. Regarding EDA measurements we did not find systematic differences between groups either on white or on coloured/overlay background. We found the most significant differences arose in the HRV parameters, namely (SDNN (ms), STD HR (beats/min), RMSSD (ms), NN50 (beats), pNN50 (%), CVRR) when children read the text on coloured/overlay backgrounds, where the girls showed systematically higher values on HRV measurements in comparison to the boys, mostly with yellow, red, and orange overlay colours.

Measurement of the QT interval using the Apple Watch.

The inherited and acquired long QT is a risk marker for potential serious cardiac arrhythmias and sudden cardiac death. Smartwatches are becoming more popular and are increasingly used for monitoring human health. The present study aimed to assess the feasibility and reliability of evaluating the QT interval in lead I, lead II, and V2 lead using a commercially available Apple Watch. One hundred nineteen patients admitted to our Cardiology Division were studied. I, II, and V2 leads were obtained after recording a standard 12-lead ECG. Lead I was recorded with the smartwatch on the left wrist and the right index finger on the crown. Lead II was obtained with the smartwatch on the left lower abdomen and the right index finger on the crown. The V2 lead was recorded with the smartwatch in the fourth intercostal space left parasternal with the right index finger on the crown. There was agreement among the QT intervals of I, II, and V2 leads and the QT mean using the smartwatch and the standard ECG with Spearman's correlations of 0.886; 0.881; 0.793; and 0.914 (p < 0.001), respectively. The reliability of the QTc measurements between standard and smartwatch ECG was also demonstrated with a Bland-Altman analysis using different formulas. These data show that a smartwatch can feasibly and reliably assess QT interval. These results could have an important clinical impact when frequent QT interval monitoring is required.

Preparation of conductive cellulose fabrics with durable antibacterial properties and their application in wearable electrodes.

Electroless silver plating on fabrics can obtain conductive and antibacterial bifunctional materials which can be used as electrodes in wearable electronic products. However, these activities are deteriorated easily after washing because of the falling off of silver coating resulted from the weak adhesion. In order to improve the binding force between silver and cellulose fabrics, 3-mercaptopropytrimethoxysilane (MPTS) was applied to modify cellulose fabrics before silver electroless plating to develop the durable conductive fabrics with excellent antibacterial. The silver nanoparticles (Ag NPs) deposition process was observed via field emission scanning electron microscopy (FESEM), thermal properties were evaluated by thermogravimetric analysis (TGA). A dense and uniform silver layer was formed on the fabric. The initial electrical resistance of the conductive fabric was 0.04 Ω/sq and lowered than 2 Ω/sq after 200 washing cycles. The antibacterial efficiency of the fabric after 200 washing cycles remained 92.82%, compared to 100% with the fabric before washing. Moreover, the inhibition rate was determined by optical density of bacteria suspension at 260 nm and further substantiated by releasing of Ag+ from the fabric. The conductive fabrics were applied as wearable electrodes to capture electrocardiogram (ECG) signals of human in static states and running states.