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Single Centre Experience of Left Atrial Appendage Closure in Patients with Non-Valvular Atrial Fibrillation and Contraindication to Anticoagulation
Abstracts
S281
ECG
Fitbit Blaze
Apple Watch
........................................... ALL HR (n = 54,030)
Mean HR (SD)
87 (±33)
Correlation r value
80 (±32)
86 (±31)
0.681*
0.912* 47, 0.912*
Low HR (<60)
Mean HR, r value
46
52, 0.785*
Mid HR (60-99)
Mean HR, r value
78
73, 0.296*
77, 0.896* *
*
High HR (≥100)
Mean HR, r value
122
104, 0.204
116, 0.459
AF
Mean HR, r value
103
75, 0.091*
96, 0.626*
Atrial Flutter
∗
Mean HR, r value
112
*
111, 0.981
*
112, 0.996
p< 0.001 comparison between ECG-HR and each device (2-tailed),
ACTRN:12616001374459
http://dx.doi.org/10.1016/j.hlc.2017.06.548 548 Point-of-Care Utilisation of Single Lead Smartphone Electrocardiogram in Screening for Arrhythmias: PULSE Trial A. Koshy 1,∗ , J. Sajeev 1 , C. Pham 1 , M. Wong 1 , S. Cooray 1 , Y. Khavar 1 , A. Hamer 1 , K. Rajakariar 1 , J. Cooke 1 , L. Roberts 1 , A. Teh 1,2 1 Monash University, Eastern Health Clinical School, Department of Cardiology, Melbourne, Australia 2 Austin Hospital, Department of Cardiology, Melbourne, Australia
Background: AliveCor Heart Rate Monitor (AHM) is an FDA approved hand-held ambulatory cardiac rhythm monitor that records a Lead-I ECG strip when paired with a smartphone. Having demonstrated efficacy in population screening for AF, these devices are marketed to patients as offering medical grade diagnostic capabilities. A paucity of data exists regarding accuracy of clinician interpretation of cardiac rhythm from smartphone-based electrocardiograms. Methods: Patients that underwent cardioversion between July 2016 and January 2017 for AF/atrial flutter were prospectively recruited. Three AHM traces and a 12-lead ECG was recorded- pre and post cardioversion. Two electrophysiologists and general practitioners, blinded to the clinical data, 12-lead-ECG and AHM interpretation assessed each AHM trace independently on an iPhone 6-Plus smartphone. Results: 408 ECG tracings (306 AHM, 102 12-lead ECGs) were recorded from fifty-one patients (mean age 63 ± 14 years). Accuracy of both clinician and automated device diagnosis were compared (Table). Only 2% of AHM tracings were uninterpretable by clinicians as opposed to 15% by the AHM algorithm.
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..
Conclusions: Clinician interpretation of a smartphonebased ECG has excellent accuracy for diagnosis of AF but poor sensitivity for diagnosis of atrial flutter. This supports its versatility as a point-of-care device by both cardiologists and GPs in an inpatient or outpatient setting. Rhythm (ECG)
Electrophysiologists
General Practitioners
AliveCor Auto-Dx
Sensitivity
Sensitivity
Sensitivity
Specificity
Specificity
Specificity
........................................... 96%
88%
94%
82%
78%
98%
AF
87%
97%
82%
91%
89%
78%
A. Flutter
28%
96%
14%
82%
43%
78%
Sinus Rhythm
http://dx.doi.org/10.1016/j.hlc.2017.06.549 549 Single Centre Experience of Left Atrial Appendage Closure in Patients with Non-Valvular Atrial Fibrillation and Contraindication to Anticoagulation A. Dashwood ∗ , H. Haqqani, D. Walters The Prince Charles Hospital, Brisbane, Australia Background: Patients who have a high CHA2 DS2 -VASc score associated with non-valvular atrial fibrillation (AF) would ordinarily benefit from anticoagulation. However, contraindications to anticoagulation may lead to a management dilemma. Left atrial appendage (LAA) closure was shown to be non-inferior to warfarin in preventing stroke in the PROTECT AF trial. We present a single centre study of 52 patients from 2011 to 2016 with contraindications to anticoagulation who had LAA closure. Results: The mean age was 70.62 years (range 49-89years) and mean CHA2 DS2 -VASc score was 3.62 (SD 1.22). 100% of patients received a closure device; 44 the WATCHMAN device, 7 the wavecrest and 1 was an Amplatzer duct occluder. The mean size was 25.4 mm (range 21 -33 mm). Occlusion rate was 100% and confirmed by intra operative transoesohageal echocardiogram. Mean procedure length was 66 minutes (range 31-147 minutes). Mean fluroscopy time was 18.22 minutes (SD 13.80 minutes). There was one intra operative death from tamponade with unsuccessful resuscitation following device deployment. One patient had intraoperative ventricular tachycardia (VT) with successful defibrillation. 43 of the 52 patients have had at least 1 year of follow-up. The expected stroke rate based on the mean CHA2 DS2 -VASc was 4%. One patient had a transient ischaemic attack (TIA) and no clinically significant bleeds (BARC ≥ 3) occurred. One patient developed a device thrombus, which resolved after subsequent anticoagulation. Conclusions: Given the results of this small cohort study, LAA closure offers a reasonable and efficient alternative to anticoagulation. However, it is not without risks as reflected in the one death that occurred. http://dx.doi.org/10.1016/j.hlc.2017.06.550
S281
ECG
Fitbit Blaze
Apple Watch
........................................... ALL HR (n = 54,030)
Mean HR (SD)
87 (±33)
Correlation r value
80 (±32)
86 (±31)
0.681*
0.912* 47, 0.912*
Low HR (<60)
Mean HR, r value
46
52, 0.785*
Mid HR (60-99)
Mean HR, r value
78
73, 0.296*
77, 0.896* *
*
High HR (≥100)
Mean HR, r value
122
104, 0.204
116, 0.459
AF
Mean HR, r value
103
75, 0.091*
96, 0.626*
Atrial Flutter
∗
Mean HR, r value
112
*
111, 0.981
*
112, 0.996
p< 0.001 comparison between ECG-HR and each device (2-tailed),
ACTRN:12616001374459
http://dx.doi.org/10.1016/j.hlc.2017.06.548 548 Point-of-Care Utilisation of Single Lead Smartphone Electrocardiogram in Screening for Arrhythmias: PULSE Trial A. Koshy 1,∗ , J. Sajeev 1 , C. Pham 1 , M. Wong 1 , S. Cooray 1 , Y. Khavar 1 , A. Hamer 1 , K. Rajakariar 1 , J. Cooke 1 , L. Roberts 1 , A. Teh 1,2 1 Monash University, Eastern Health Clinical School, Department of Cardiology, Melbourne, Australia 2 Austin Hospital, Department of Cardiology, Melbourne, Australia
Background: AliveCor Heart Rate Monitor (AHM) is an FDA approved hand-held ambulatory cardiac rhythm monitor that records a Lead-I ECG strip when paired with a smartphone. Having demonstrated efficacy in population screening for AF, these devices are marketed to patients as offering medical grade diagnostic capabilities. A paucity of data exists regarding accuracy of clinician interpretation of cardiac rhythm from smartphone-based electrocardiograms. Methods: Patients that underwent cardioversion between July 2016 and January 2017 for AF/atrial flutter were prospectively recruited. Three AHM traces and a 12-lead ECG was recorded- pre and post cardioversion. Two electrophysiologists and general practitioners, blinded to the clinical data, 12-lead-ECG and AHM interpretation assessed each AHM trace independently on an iPhone 6-Plus smartphone. Results: 408 ECG tracings (306 AHM, 102 12-lead ECGs) were recorded from fifty-one patients (mean age 63 ± 14 years). Accuracy of both clinician and automated device diagnosis were compared (Table). Only 2% of AHM tracings were uninterpretable by clinicians as opposed to 15% by the AHM algorithm.
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..
Conclusions: Clinician interpretation of a smartphonebased ECG has excellent accuracy for diagnosis of AF but poor sensitivity for diagnosis of atrial flutter. This supports its versatility as a point-of-care device by both cardiologists and GPs in an inpatient or outpatient setting. Rhythm (ECG)
Electrophysiologists
General Practitioners
AliveCor Auto-Dx
Sensitivity
Sensitivity
Sensitivity
Specificity
Specificity
Specificity
........................................... 96%
88%
94%
82%
78%
98%
AF
87%
97%
82%
91%
89%
78%
A. Flutter
28%
96%
14%
82%
43%
78%
Sinus Rhythm
http://dx.doi.org/10.1016/j.hlc.2017.06.549 549 Single Centre Experience of Left Atrial Appendage Closure in Patients with Non-Valvular Atrial Fibrillation and Contraindication to Anticoagulation A. Dashwood ∗ , H. Haqqani, D. Walters The Prince Charles Hospital, Brisbane, Australia Background: Patients who have a high CHA2 DS2 -VASc score associated with non-valvular atrial fibrillation (AF) would ordinarily benefit from anticoagulation. However, contraindications to anticoagulation may lead to a management dilemma. Left atrial appendage (LAA) closure was shown to be non-inferior to warfarin in preventing stroke in the PROTECT AF trial. We present a single centre study of 52 patients from 2011 to 2016 with contraindications to anticoagulation who had LAA closure. Results: The mean age was 70.62 years (range 49-89years) and mean CHA2 DS2 -VASc score was 3.62 (SD 1.22). 100% of patients received a closure device; 44 the WATCHMAN device, 7 the wavecrest and 1 was an Amplatzer duct occluder. The mean size was 25.4 mm (range 21 -33 mm). Occlusion rate was 100% and confirmed by intra operative transoesohageal echocardiogram. Mean procedure length was 66 minutes (range 31-147 minutes). Mean fluroscopy time was 18.22 minutes (SD 13.80 minutes). There was one intra operative death from tamponade with unsuccessful resuscitation following device deployment. One patient had intraoperative ventricular tachycardia (VT) with successful defibrillation. 43 of the 52 patients have had at least 1 year of follow-up. The expected stroke rate based on the mean CHA2 DS2 -VASc was 4%. One patient had a transient ischaemic attack (TIA) and no clinically significant bleeds (BARC ≥ 3) occurred. One patient developed a device thrombus, which resolved after subsequent anticoagulation. Conclusions: Given the results of this small cohort study, LAA closure offers a reasonable and efficient alternative to anticoagulation. However, it is not without risks as reflected in the one death that occurred. http://dx.doi.org/10.1016/j.hlc.2017.06.550