BACKGROUND AND OBJECTIVE

COVID-19 has been associated with cardiac injury, often detectable through electrocardiographic (ECG) changes. This study seeks to characterize the cardiovascular and electrocardiographic profiles of adult patients diagnosed with COVID-19.

This study included adult patients with confirmed COVID-19 from June 2021 to June 2022. Clinical profiles and 12-lead ECG tracings were obtained from electronic medical records and reviewed independently by three cardiologists. Descriptive analysis was performed to summarize the cardiovascular and electrocardiographic findings in this population.

The study included 998 COVID-19 patients (mean age: 50 years; 53.7% male). The most common comorbidities were hypertension, diabetes, and dyslipidemia. A majority (31.36%) presented with severe COVID-19 infection. The most frequent significant ECG abnormalities observed at admission were sinus tachycardia (22.8%), and atrial fibrillation (11.02%). Additional ischemic findings included ST segment depression (2.91%), T-wave inversion (1.70%), and ST segment elevation (2.71%).

The baseline ECG findings among COVID-19 patients were predominantly normal; however, significant abnormalities were also identified. The most frequent abnormalities included sinus tachycardia, atrial fibrillation, and ischemic changes, all of which may have clinical implications.

BACKGROUND

Postoperative atrial fibrillation (POAF) is the most common arrythmia to occur after cardiovascular surgery. Inflammation being pivotal in POAF perpetuation has been utilized as a therapeutic target. Owing to their anti-inflammatory and anti-oxidant effects, beta-blockers (BB) and N-acetylcysteine (NAC) became research interests in the pursuit for an effective POAF prevention strategy.

To determine the efficacy of NAC plus BB versus BB alone in preventing POAF in cardiac surgery patients.

A literature search using the following search engines: PubMed/Medline, Cochrane Review Central, Clinical Trials Registry, ResearchGate, Mendeley and Google Scholar for relevant randomized trials were conducted. Published and unpublished studies indexed from inception until 2023 were included. Three independent reviewers evaluated the randomized clinical trials (RCTs) for eligibility. The pooled estimates for POAF prevention as primary outcome and MACE, mortality, myocardial infarction, stroke, ICU LOS and hospital LOS as secondary outcomes were measured using the RStudio statistical software.

Seven eligible RCTs allocated 1069 cardiac surgery patients to NAC + BB (n=539) and BB alone (N = 530) treatment arms. The effect estimate using random effect model disclosed significantly reduced POAF events (RR 0.62, 95% CI [0.44, 0.86], p = 0.005) in those on NAC + BB. While no statistical difference between the study arms were demonstrated in reducing mortality (RR 0.63, 95% CI [0.23, 1.73], p = 0.37); myocardial infarction (RR 1.02, 95% CI [0.49, 2.13], p = 0.96); stroke (RR 0.95, 95% CI [0.24, 3.68], p = 0.94); ICU LOS (std. mean difference 0.14, 95% CI [-0.43, 0.70], p = 0.41), and hospital LOS (std. mean difference 0.08, 95% CI [-0.06, 0.21], p = 0.19).

Among cardiac surgery patients, the use of NAC in combination with BB compared with BB alone significantly reduced POAF.

INTRODUCTION

Patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) poses a therapeutic dilemma for the attending physician. Standard anticoagulation with a vitamin K antagonist (VKA) plus dual antiplatelet therapy with a P2Y12 inhibitor and aspirin reduces the risk of stroke and thrombosis, but increases risk of bleeding. The effectiveness and safety of several novel oral anticoagulants are still unclear in these patients.

PubMed, Cochrane and Embase databases were systematically searched for studies from 2016 until 30 November 2023. The search key terms were ‘DOACs,’ ‘atrial fibrillation,’ ‘percutaneous coronary intervention’ and ‘bleeding.’ Two independent reviewers appraised eligible studies using well-defined criteria. The main outcomes of interest were International Society on Thrombosis and Haemostasis (ISTH) major bleeding, stent thrombosis and major adverse cardiovascular events (MACE). The random-effects model was used to derive pooled estimates.

The search yielded four studies which were all randomized controlled trials (RCTs). There were a total of 10,963 participants. Pooled estimates showed a statistically significant difference between direct oral anticoagulants (DOAC) + P2Y12 and VKA + DAPT for ISTH major bleeding (OR 0.62, 95% CI 0.57 – 0.69, p =DISCUSSION

In patients with AF who had undergone PCI, the risk of bleeding was lower among those who received dual therapy with DOAC + P2Y12 than among those who received triple therapy with warfarin, a P2Y12 inhibitor and aspirin. However, dual therapy was noninferior to triple therapy with respect to the risk of stent thrombosis and MACE.

OBJECTIVE

This study aims to determine the clinical profile and incidence of in-hospital outcomes of patients who underwent coronary artery bypass graft surgery (CABG) under the Philippine Health Insurance Corporation (Philhealth) Z Benefit Package (PZBP).

A retrospective descriptive cohort study. A review of medical records was done from July 2017 to October 2023 to collect data and in-hospital outcomes of patients who underwent CABG surgery under Z benefit package.

One hundred twenty-six patients were included in the study. The mean age of patients was 60 years and majority of them were male and came from NCR. Hypertension was the leading cause of comorbidity. The top two most common in-hospital outcomes were hospital-acquired pneumonia and postoperative atrial fibrillation. Most commonly observed caused of increased length in hospitalization was pneumonia. The mean Society of Thoracic Surgeons (STS) (operative mortality) and Euro scores were 1.04 ± 0.82 and 0.88 ± 0.56, respectively. All patients had successful surgical outcome with no mortality and an average length of stay in the hospital of six days.

This study will serve as a future reference to enhance screening criteria and improved in-hospital outcomes for those who will undergo CABG under Z benefit package. The study also showed insights on clinical profile and in-hospital outcomes of patients who underwent CABG in our own institution and this may give way to a larger scale of study involving multiple centers who also offer the said program.

BACKGROUND AND OBJECTIVE

COVID-19 has been associated with cardiac injury, often detectable through electrocardiographic (ECG) changes. This study seeks to characterize the cardiovascular and electrocardiographic profiles of adult patients diagnosed with COVID-19.

This study included adult patients with confirmed COVID-19 from June 2021 to June 2022. Clinical profiles and 12-lead ECG tracings were obtained from electronic medical records and reviewed independently by three cardiologists. Descriptive analysis was performed to summarize the cardiovascular and electrocardiographic findings in this population.

The study included 998 COVID-19 patients (mean age: 50 years; 53.7% male). The most common comorbidities were hypertension, diabetes, and dyslipidemia. A majority (31.36%) presented with severe COVID-19 infection. The most frequent significant ECG abnormalities observed at admission were sinus tachycardia (22.8%), and atrial fibrillation (11.02%). Additional ischemic findings included ST segment depression (2.91%), T-wave inversion (1.70%), and ST segment elevation (2.71%).

The baseline ECG findings among COVID-19 patients were predominantly normal; however, significant abnormalities were also identified. The most frequent abnormalities included sinus tachycardia, atrial fibrillation, and ischemic changes, all of which may have clinical implications.

BACKGROUND

As smartwatches with atrial fibrillation detection features gain popularity, it is important to assess the accuracy of these devices to guide decision-making.

Our study aimed to assess the sensitivity and specificity of the irregular rhythm notification and the electrocardiogram (ECG)–based detection features of a commonly used smart wearable device (Apple Watch) in detecting atrial fibrillation.

This was a prospective, pragmatic study conducted in Perpetual Succour Hospital–Cebu Heart Institute from August 2023 to January 2024. To assess the irregular rhythm notification feature, participants were asked to wear an Apple Watch alongside a 24-hour Holter monitor to verify notifications. For the ECG-based detection feature, participants had to tap the crown of the Apple Watch for 30 seconds to get a single-lead ECG similar to a lead I ECG tracing. They were instructed to get manual ECGs hourly, or more often while awake. Irregular rhythm notifications and ECG readings were then compared with that of the 24-hour Holter monitor. Sensitivity and specificity were then computed.

A total of 140 participants consented to join after full study disclosure. The irregular rhythm notification feature of the Apple Watch exhibited a low sensitivity of 21.4% but achieved a high specificity of 100% in detecting atrial fibrillation. Meanwhile, the ECG-based detection feature, analyzed from 1295 manually taken ECGs with interpretable sinus rhythm or atrial fibrillation, demonstrated a high level of agreement with the Holter monitor, with a sensitivity of 100% and a specificity of 99.1%.

The low sensitivity of the irregular rhythm notification feature of the Apple Watch in detecting atrial fibrillation cautions against relying on it as a primary screening tool. However, the high concordance of manually taken Apple Watch ECGs positions the device as a robust tool for detecting atrial fibrillation through manual ECG detection.

Background: The effect of atrial fibrillation (AF) patterns and clinical biomarkers among patients with AF-related stroke is still controversial. Objectives: The objective of this study is to determine the association of the pattern of AF and markers on routine blood tests with the outcome of patients after an AF-related stroke. Methods: This is a retrospective cohort study of patients with stroke and AF admitted in a tertiary hospital in Cebu City from 2015-2022. Patients’ baseline characteristics, laboratory tests, ECG, and radiologic data were collected. Descriptive statistics such as mean and frequency were computed. The Kaplan–Meier method and the log-rank test were used to calculate the incidence time. The Cox regression analysis was used to determine factors associated with survival. A stepwise regression technique was used in model building. Results: The mortality rate of patients with AF-related stroke was 0.02. A Kaplan Meier survival estimate shows that patients with paroxysmal AF have better survival. Upon model building of variables, age, red cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), platelet count, low density lipid cholesterol (LDL-C), and pattern of AF were predictive of mortality in patients with AF-related stroke. Conclusions Among AF-related stroke patients admitted at a tertiary hospital in Cebu City, pattern of AF, age, RDW, NLR, platelet count, and LDL-C were associated with mortality. The parameters associated with increased mortality could be easily assessed using an ECG, CBC, and lipid profile. These are all readily available and cost-efficient.
Atrial Fibrillation ; Prognosis ; Stroke

Humans ; Atrial Fibrillation/therapy* ; China

As a new energy source for atrial fibrillation ablation, electric pulse ablation has higher tissue selectivity and biosafety, so it has a great application prospect. At present, there is very limited research on multi-electrode simulated ablation of histological electrical pulse. In this study, a circular multi-electrode ablation model of pulmonary vein will be built on COMSOL5.5 platform for simulation research. The results show that when the voltage amplitude reaches about 900 V, it can make some positions achieve transmural ablation, and the depth of continuous ablation area formed can reach 3 mm when the voltage amplitude reaches 1 200 V. When the distance between catheter electrode and myocardial tissue is increased to 2 mm, a voltage of at least 2 000 V is required to make the depth of continuous ablation area reach 3 mm. Through the simulation of electric pulse ablation with ring electrode, the research results of this project can provide reference for the voltage selection in the clinical application of electric pulse ablation.
Humans ; Heart Rate ; Atrial Fibrillation/surgery* ; Electrodes ; Catheter Ablation ; Electricity

Atrial fibrillation is a common arrhythmia, and its diagnosis is interfered by many factors. In order to achieve applicability in diagnosis and improve the level of automatic analysis of atrial fibrillation to the level of experts, the automatic detection of atrial fibrillation is very important. This study proposes an automatic detection algorithm for atrial fibrillation based on BP neural network (back propagation network) and support vector machine (SVM). The electrocardiogram (ECG) segments in the MIT-BIH atrial fibrillation database are divided into 10, 32, 64, and 128 heartbeats, respectively, and the Lorentz value, Shannon entropy, K-S test value and exponential moving average value are calculated. These four characteristic parameters are used as the input of SVM and BP neural network for classification and testing, and the label given by experts in the MIT-BIH atrial fibrillation database is used as the reference output. Among them, the use of atrial fibrillation in the MIT-BIH database, the first 18 cases of data are used as the training set, and the last 7 cases of data are used as the test set. The results show that the accuracy rate of 92% is obtained in the classification of 10 heartbeats, and the accuracy rate of 98% is obtained in the latter three categories. The sensitivity and specificity are both above 97.7%, which has certain applicability. Further validation and improvement in clinical ECG data will be done in next study.
Humans ; Atrial Fibrillation/diagnosis* ; Support Vector Machine ; Heart Rate ; Algorithms ; Neural Networks, Computer ; Electrocardiography