[Telemedicine in arrhythmology].

Telemedicine can be defined as a health care service that, specifically in the field of diagnostics, employs remote transfer of a large volume of data from a large number of subjects at the same time. This data is subsequently processed on a central basis and returned to a large number of health care providers by whom the service was ordered on national or international level. In arrhythmology, telemedicine is used particularly in long-term ECG monitoring to diagnose arrhythmias and check out treatment outcome via external recorders, smart watch, and implantable devices.

QRS detection and classification in Holter ECG data in one inference step.

While various QRS detection and classification methods were developed in the past, the Holter ECG data acquired during daily activities by wearable devices represent new challenges such as increased noise and artefacts due to patient movements. Here, we present a deep-learning model to detect and classify QRS complexes in single-lead Holter ECG. We introduce a novel approach, delivering QRS detection and classification in one inference step.

Catheter ablation versus antiarrhythmic drugs with risk factor modification for treatment of atrial fibrillation: a protocol of a randomised controlled trial (PRAGUE-25 trial).

Introduction: Atrial fibrillation (AF), with a prevalence of 2%, is the most common cardiac arrhythmia. Catheter ablation (CA) has been documented to be superior to treatment by antiarrhythmic drugs (AADs) in terms of sinus rhythm maintenance. However, in obese patients, substantial weight loss was also associated with AF reduction.

Exploring novel algorithms for atrial fibrillation detection by driving graduate level education in medical machine learning.

During the lockdown of universities and the COVID-Pandemic most students were restricted to their homes. Novel and instigating teaching methods were required to improve the learning experience and so recent implementations of the annual PhysioNet/Computing in Cardiology (CinC) Challenges posed as a reference. For over 20 years, the challenges have proven repeatedly to be of immense educational value, besides leading to technological advances for specific problems.

[Long-term ECG monitoring].

ECG recording represents an essential method for the diagnosis of heart rhythm disturbances. Long-term monitoring helps to identify arrhythmias that have not been detected by means of standard 12-lead ECG or 24-48 hour ECG Holter. With time, ECG monitoring facilities improve, the ECG recorders are becoming smaller, and the recording time is prolonging.

Comparison of two modes of long-term ECG monitoring to assess the efficacy of catheter ablation for paroxysmal atrial fibrillation.

Aims: Optimal ECG monitoring in detecting recurrences of atrial fibrillation (AF) or atrial tachycardia (AT) after catheter ablation has not been well established. The purpose of this prospective study was to compare the utility of daily ECG monitoring with episodic card recorder (ECR) vs. periodic monitoring with episodic loop recorder (ELR) for the detection of post-blanking AF/AT recurrences during early (Months 4-6) and late (Months 7-12) periods after catheter ablation for paroxysmal AF.

Functional improvement after successful catheter ablation for long-standing persistent atrial fibrillation.

Aims: Identifying patients who benefit from restored sinus rhythm (SR) would optimize the selection of candidates for ablation of long-standing persistent atrial fibrillation (LSPAF). This prospective study sought to identify the hitherto unknown factors associated with global functional improvement after successful radiofrequency catheter ablation of LSPAF.

Methods And Results: In 171 LSPAF patients (84% of the total consecutive 203 patients) who were examined in SR 12 months after ablation, the individual per cent change from baseline value in maximum oxygen consumption at exercise test (VO2 max), left ventricular ejection fraction (LVEF), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and five-dimensional descriptive system (EQ-5D) of quality-of-life questionnaire were classified in quartiles by 0 (worse) to 3 (best) grades.

Sinus rhythm restoration and arrhythmia noninducibility are major predictors of arrhythmia-free outcome after ablation for long-standing persistent atrial fibrillation: a prospective study.

Background: The impact of restoring sinus rhythm (SR) by initial ablation in patients with long-standing persistent atrial fibrillation (LSPAF) is not fully established.

Objective: The purpose of this study was to investigate the prognostic value of SR restoration at the initial procedure and arrhythmia noninducibility at the final repeat procedure for long-term outcome.

Methods: A total of 203 patients (22% female; age 59 ± 9 years) underwent stepwise catheter ablation for LSPAF.

Improvement in quality of life after catheter ablation for paroxysmal versus long-standing persistent atrial fibrillation: a prospective study with 3-year follow-up.

Background: Changes in quality of life (QoL) after catheter ablation for long-standing persistent atrial fibrillation (LSPAF) are not well described. We sought to compare QoL improvement after catheter ablation of paroxysmal atrial fibrillation (PAF) versus that after LSPAF.

Methods And Results: A total of 261 PAF and 126 LSPAF ablation recipients were prospectively followed for arrhythmia recurrence, QoL, hospital stay, and sick leave.

A prospective evaluation of haemodynamics, functional status, and quality of life after radiofrequency catheter ablation of long-standing persistent atrial fibrillation.

Aims: Clinical benefit from ablation for long-standing persistent atrial fibrillation has remained unknown. We hypothesized that successful ablation of long-standing persistent atrial fibrillation would improve haemodynamics, functional status, and quality of life.

Methods And Results: A total of 160 patients (aged 59 ± 9 years, 23% females) undergoing ablation of long-standing (median of 28 months) persistent atrial were enrolled in this prospective study.

Atrial fibrillation ablation: a cost or an investment?

In the last decade, catheter ablation (CA) became a viable therapeutic approach for symptomatic patients with atrial fibrillation (AF) non-responsive to antiarrhythmic drugs (AAD). The economic analysis of CA is complex due to the presence of several confounding factors, such as the pattern of AF (paroxysmal AF, persistent or long-term persistent AF), the patient population (age, presence/absence of underlying structural heart disease, comorbidities, etc.), the different techniques for ablation (with impact on complexity and cost of the procedure, as well as on efficacy and safety), and the learning curve and experience of an individual centre (with impact on efficacy and cost effectiveness).

Septal ventricular tachycardia with alternating LBBB-RBBB morphology in isolated ventricular noncompaction.

Knowledge on ventricular tachycardia (VT) in isolated ventricular noncompaction (IVNC) is limited. We report on a patient with IVNC who presented with cardiogenic shock due to an incessant drug-resistant VT that was cured by radiofrequency ablation. The VT had characteristics of a deep septal focal arrhythmia, which was distinctive by ablation-induced alternation of the rightward and leftward exits, and was difficult to ablate from either side of the ventricular septum.

Left atrial voltage during atrial fibrillation in paroxysmal and persistent atrial fibrillation patients.

Background: Left atrial (LA) endocardial voltage characteristics assessed during atrial fibrillation (AF) have not been previously compared in different AF types. This study was aimed at investigating the LA voltages and volumes in patients with paroxysmal and persistent AF.

Methods: LA electroanatomic voltage maps acquired during AF were compared between consecutive patients without major structural heart disease undergoing first catheter ablation for paroxysmal AF (n = 100) or persistent AF (n = 100).

Results of complex left atrial ablation of long-lasting persistent atrial fibrillation.

Purpose: The aim of the study was to identify variables associated with successful long-term maintenance of sinus rhythm (SR) after a single ablation of long-lasting persistent atrial fibrillation (AF).

Methods: Complex left atrial (LA) ablation was performed in 100 patients. Restoration of SR by ablation was the desired procedure endpoint.

Heart rate turbulence after atrial premature complexes depends on coupling interval and atrioventricular nodal conduction.

Background: Positive Turbulence onset (TO) after atrial premature complexes (APCs) was found temporally related to spontaneous episodes of atrial fibrillation. This study tested the hypothesis that heart rate turbulence (HRT) after APCs is influenced by APC prematurity independently of the prematurity of conducted ventricular complexes.

Methods: We studied 33 patients (mean age = 58 +/- 16 years, 19 men), 11 of whom had structural heart disease, who were referred for electrophysiological studies of supraventricular or ventricular arrhythmias.

Heart rate dependence of the QT interval duration: differences among congenital long QT syndrome subtypes.

Introduction: The heart rate dependence of QT interval duration is abnormal in patients with congenital long QT syndrome. Patients with LQT1 have a defective I(Ks) current, a major determinant of QT response to heart rate.

Methods And Results: We studied the heart rate dependence of QT interval duration in different long QT syndrome genotypes and control subjects using computerized QT measurements obtained from Holter recordings.