key: cord-0976600-0dn45x5b
authors: Razipour, Shadi; El Hajjar, Abdel Hadi; Mekhael, Mario; Pottle, Christopher; Lim, Chan Ho; Zhang, Yichi; Noujaim, Charbel; Marrouche, Nassir F.
title: PO-689-05 PREDICTORS OF ARRHYTHMIA OCCURRENCE IN HOSPITALIZED COVID-19 PATIENTS
date: 2022-05-31
journal: Heart Rhythm
DOI: 10.1016/j.hrthm.2022.03.587
sha: e88746dd955e7bf99431af42a63ce3f1f27075d1
doc_id: 976600
cord_uid: 0dn45x5b

nan

receive a device implant. 2 Population largely underserved due to barriers including: é Patients' primary care provider is engaged outside of EP/Cardiology practice é Providers not understanding HRS/ACC/AHA guidelines é Patients lost to follow-up during 40-& 90-day waiting periods. Objective: Reduce deaths, hospitalizations, and suffering , use artificial intelligence to identify patients at risk proper EP consultation, assist hospitals to meet clinical guidelines, appropriate use, and healthcare disparities. Methods: Through utilization Mpirik's Cardiac IntelligenceÒ software, cardiovascular reports and clinician free text notes aids to identify patients with characteristics of SCA risk without appropriate consultation. Through the Cardiac IntelligenceÒ real-time platform, clinicians can view patient populations, manage identified patients with the purpose of eliminating undertreatment, and receive automated alert notifications on patients identified with no appropriate followup plan. Results: During 60-day period, 4,042 patients underwent cardiac function evaluation at a single site. Patients identified at risk for SCA was 176 (4.35%), of those patient patients 38 (21.6%) did not have appropriate follow-up. This equates to 228 primary prevention ICD patients annually. Conclusion: Utilization of artificial intelligence shows clear early value in identifying patients at risk for SCA. Cardiac Intelligence's EMR agnostic platform promises creative options to address healthcare disparities. For 2022, a minimum of 7 medical institutions will be fully operational and authors will provide further detail and impact. Background: COVID-19 is a highly transmissible virus that is known to spread in asymptomatic individuals. Electrophysiology procedures involve close contact with sedated patients increasing the risk of virus aerosolization. During the COVID pandemic, public health policies were implemented to decrease the spread of the virus and protect both patients and staff. However, the impact of such policies in the vaccine era is not well understood. Objective: To determine the utility of preprocedural COVID-19 screening for EP lab procedures based on vaccination status. Methods: Patients at the Durham VA Medical Center presenting for an elective or emergent EP procedure from 3/ 1/2020 to 12/1/2021 were evaluated. A positive COVID-19 screen resulted from (1) positive symptom questionnaire or (2) positive detection on polymerase chain reaction (PCR), antigen, or molecular (ID now) test by nasal swab. Patients with known COVID-19 infections were rescheduled when cleared by infection control, typically 2-4 weeks after initial case confirmation. Additionally, all patients were contacted 5-7 days post procedure and tracked for possible COVID symptoms or test positivity. The EP lab and peri-procedural area were continually monitored for potential cluster outbreaks among staff. Results: Of the 690 EP cases, 12 cases were cancelled due to a positive COVID-19 screen (1.7%). The average state test positivity rate during this period was 8.6% (p,0.001%). Ten of the 12 cases were cancelled due to positive pre-procedure test, two by screening questionnaire. One of those was confirmed with IgG testing, one was lost to follow up. All patients recorded being asymptomatic. 9/11 (82%) of the confirmed cases occurred in unvaccinated patients. The two vaccinated patients both received two doses of the Pfizer mRNA vaccine however had not received a booster dose. No patients screened positive in the week post-procedure. There was no documented transmission among staff or from patient to staff. Conclusion: Use of a standard protocol for screening asymptomatic patients in the pre-operative setting was effective in identifying asymptomatic COVID-19 carriers. Unvaccinated patients represented a significantly higher proportion of case positivity, however continued preprocedure testing is likely warranted regardless of vaccination status. , and QTc prolongation (20.0% vs. 11.1%, p,0.03) significantly correlated COVID-19 patients with the development of arrhythmias. Of the non-CV comorbidities measured, kidney disease (24.7% vs. 15.5%, p50.05) and chronic hematologic disorder (13.7% vs. 6.1%, p50.02) predisposed patients to arrhythmia development as opposed to patients who did not develop arrhythmias. Arrhythmias (11.8%) were the most common identified cardiac complication amongst the hospitalized COVID-19 patients in comparison to deep vein thrombosis (5.3%), chronic heart failure (5.3%), myocardial infarction (4.2%), cardiac arrest (10.0%), endocarditis/myocarditis/pericarditis (0.5%), ST elevation (1.1%), and stroke (2.6%). The development of arrhythmias was associated with a 42.7% mortality rate in patients hospitalized with COVID-19. Conclusion: Hospitalized COVID-19 patients with preexisting cardiac disease, hypertension, and QTc prolongation are more likely to develop arrhythmias. COVID-19 patients with heart diseases, hypertension and QTc prolongation should be closely monitored for the development of arrhythmias.

Background: Subcutaneous implantable cardioverter defibrillators (S-ICDs) are relatively new ICD technology and currently the manufacturer acknowledges that in patients with 'deep implants', magnet application may fail to elicit a magnet response (MR). However, there is no definition of a 'deep implant' or maximum recommended implant depth.The use of a magnet to inhibit therapies in ICDs is critical to inhibit therapies to avoid over-sensing and inappropriate therapies, at end-of-life and palliation or in acute clinical situations. Objective: The aim of this study was to determine if ICD generators implanted at greater tissue depth were more difficult to inhibit with standard clinical magnets. Methods: As part of routine device follow up, Sunshine Coast University Hospital's S-ICD cohort underwent MR evaluation; where bar and donut magnets were placed over the S-ICD and the evoked MR was recorded in three separate zones, guided by a template. Ordinal regression models and logistic regressions assessed the relationship between the evoked MR and the tissue depth (TD), measured via X-ray. The patient's ability to hear the audible tone was also recorded. Results: Patients (n539) with measurable TD (n530) were analysed. The relationship between bar MR and TD showed an OR of 0.89 (95% confidence interval: 0.82-0.97) p,0.01. Therefore, for every 1mm increase in TD the chance of inhibiting a higher number of zones decreased by approximately 11%. The relationship between donut MR and TD showed an OR of 0.84 (95% confidence interval: 0.73-0.96) p,0.01. Therefore, for every 1mm increase in TD the chance of inhibiting all 3 zones decreased by 16%. However, the donut magnet was able inhibit at least 2 zones for all TD values. BMI was not significant in predicting evoked MR. The patient's ability to hear the audible alert was noted to be 77.0%. Conclusion: We observed a statistically significant association between tissue depth and ability to evoke magnet response. We also found a significant proportion of patients were unable to hear the evoked auditory alert.

POSTER PO-690: Posters: Basic Science at Pod 2

Makiri Kawasaki MSc PhD; nicoline W.E. van den berg MD

Objective: a) To assess if EAT secretome activates human atrial fibroblasts in patients with and without AF (non AF). b) To identify profibrotic proteins and biological processes in EAT prior to future onset of AF, and in persistent AF. Methods: Patients' EAT samples were retrieved during thoracoscopic AF ablation or coronary artery bypass surgery. COL1A1 and FN1 gene expression was measured

EATand EAT secretome proteomes were explored by untargeted mass spectrometry (AF n53, non AF n53)