Background: Hypertension in patients with atrial fibrillation (AF) is a known independent risk factor for stroke. The Complete blood pressure (BP) monitor (Omron Healthcare, Kyoto, Japan) was developed as the first BP monitor with electrocardiogram (ECG) capability in a single device to simultaneously monitor ECG and BP readings. This study investigated whether the Complete can accurately differentiate sinus rhythm (SR) from AF during BP measurement. Methods and Results: Fifty-six consecutive patients with persistent AF admitted for catheter ablation were enrolled in the study (mean age 65.8 years; 83.9% male). In all patients, 12-lead ECGs and simultaneous Complete recordings were acquired before and after ablation. The Complete interpretations were compared with physician-reviewed ECGs, whereas Complete recordings were reviewed by cardiologists in a blinded manner and compared with ECG interpretations. Sensitivity, specificity, and κ coefficient were also determined. In all, 164 Complete and ECG recordings were simultaneously acquired from the 56 patients. After excluding unclassified recordings, the Complete automated algorithm performed well, with 100% sensitivity, 86% specificity, and a κ coefficient of 0.87 compared with physician-interpreted ECGs. Physician-interpreted Complete recordings performed well, with 99% sensitivity, 85% specificity, and a κ coefficient of 0.85 compared with physician-interpreted ECGs. Conclusions: The Complete, which combines BP and ECG monitoring, can accurately differentiate SR from AF during BP measurement.

Background and purpose Arrhythmias such as atrial fibrillation (AF) is often associated with depression, with vague anxiety about symptom and the risk of serious complication such as stroke or heart failure. In the geriatric population, geriatric depression often occurs with an increase of physical illness and has substantial costly and quality of life implications for functionality and life satisfaction. However, few studies have investigated relationship between geriatric depression and Quality of Life (QoL), and arrhythmia symptoms (palpitation, dyspnea and chest discomfort). Method Between November 2019 and October 2020, elderly people (≥65 years) who participated in the AF awareness symposium were enrolled in this study. They were divided into 4 groups according to the presence or absence of chest symptom and AF, and were examined geriatric depression by Geriatric depression scale (GDS)-15 and Quality of Life (QoL) by the 12-item Short- Form Health Survey (SF-12) including physical and mental health status. Results Of the 1511 subjects, 1364 were analyzed after excluding 147 with missing values. Among them, 911 were in the non-AF group without symptom (Group A), 43 in the AF group without symptom (group B), 323 in the non-AF group with symptom (group C), and 87 in the AF group with symptom (group D). Geriatric depression rates (defined as GDS-15 ≥10) were 2.7% in non-symptomatic group (2.7% in A [n=25] and 2.3% in B [n=1]) and 7.8% in symptomatic group (7.4% in C [n=24] and 9.2% in D [n=8]). (P<0.05) In multivariate regression analysis, an increased risk of geriatric depression was observed in groups C and D (group C: odds ratio [OR]=2.54, CI: 1.40, 4.61, P<0.01 and group D: OR=3.13 CI: 1.16, 7.57, P=0.02). The mean values of physical and mental health status in SF-12 were 48.5 (±7.9) and 56.7 (±6.8) in A, 44.6 (±10.7) and 57.3 (±7.3) in B, 45.0 (±9.9) and 53.8 (±7.7) in C, and 43.4 (±10.8) and 54.8 (±8.6) in D, respectively. Physical health status in SF-12 was associated with group C (C vs A: estimate −2.95 [CI: −4.03, −1.87], p<0.01) and D (D vs A: estimate −2.93 [CI: −4.88, −0.97], p<0.01), other than heart failure, older age and female. Mental health status in SF-12 was associated with group C (C vs A: estimated −2.34 [CI: −3.72, −1.42], p<0.01), heart failure, hypertension, older age, female and group D (D vs A: estimate −1.63 [CI: −3.31, 0.05], p=0.06), but not statistically significant. Individuals with arrhythmia symptom (group C and D) had lower physical and mental health status than those without (group A and B) (P<0.05). Conclusion Older adults with arrhythmia symptoms were more likely to have geriatric depression and low QoL, especially those with symptomatic AF, with a geriatric depressive complication rate of 9.2%. Further studies are needed to investigate whether improving physical health status can improve QoL and geriatric depression. FUNDunding Acknowledgement Type of funding sources: None.

Background Transcatheter aortic valve replacement (TAVR) has emerged as an important therapeutic option among intermediate- and high-risk patients with symptomatic severe aortic stenosis. Heart rhythm disorders frequently complicate TAVR, particularly atrial fibrillation (AF), which can affect >40% patients undergoing the procedure. There is wide variation in rates of new-onset AF (NOAF) following TAVR across the initial pivotal randomized trials and observational studies, but burden of AF in each patient is not well known. The aim of this study is to evaluate AF burden detected by continuous patch ECG monitor (WR-100; Fukuda-Denshi, Tokyo,Japan) in patients after TAVR. Method Among KPUM-TAVR cohort, 58 consecutive patients (mean age:85.5±5.5, 44 females) kept recording continuous patch ECG monitor for 14 days after the procedure of TAVR. We excluded 11 patients with ECG indicating AF before procedure (paroxysmal AF 5, persistent AF 6). Finally, 47 eligible patients were selected according to the study criteria. AF was defined as a presence of AF more than 30sec on ECG monitor. The incidence and burden of NOAF was assessed. Results We identified 9 of 47 patients (19.1%) who developed NOAF (94% of transfemoral access patients, 6% of non- transfemoral access patients). Patients developing NOAF and had higher Society of Thoracic Surgeons risk scores (5.9±3.8 vs 9.9±6.3 p=0.0187). AF was first observed from day1 to day13. Despite having a median CHA2DS2-VASc score of 5 (25th and 75th percentile: 5 to 6), only 33% of patients with NOAF were given oral anticoagulation during the follow-up. Conclusion By using continuous patch ECG monitor, NOAF can be identified in 19.1% of patients after TAVR, with wide variety of first onset of AF. Given the clinical significance of post-TAVR AF, additional studies are necessary to describe the optimal management strategy in this high-risk population. Figure 1 Funding Acknowledgement Type of funding source: None

Background Atrial fibrillation (AF) is associated with increased risks of stroke and heart failure. AF risk prediction can facilitate the efficient deployment of diagnosis or interventions to prevent AF. Purpose We sought to assess the combination prediction value of Holter electrocardiogram (Holter ECG) and the CHARGE-AF score (Cohorts for Aging and Research in Genomic Epidemiology-AF) for the new-onset of AF in a single center study. We also investigated the association between clinical findings and the new-onset of cerebral cardiovascular events. Methods From January 2008 and May 2014, 1246 patients with aged≥20 undergoing Holter ECG for palpitations, dizziness, or syncope were recruited. Among them, 350 patients were enrolled in this study after exclusion of 1) AF history at the time of inspection or before, 2) post cardiac device implantation, 3) follow-up duration <1 year, and 4) no 12-lead ECG records within 6 months around Holter ECG. Results During the 5.9-year follow-up, 40 patients (11.4%) developed AF incidence. Multivariate cox regression analysis revealed that CHARGE-AF score (hazard ratio [HR]: 1.59, 95% confidence interval (95% CI): 1.13–2.26, P<0.01), BMI (HR: 0.91, 95% CI: 0.83–0.99, P=0.03), frequent supraventricular extrasystoles (SVEs) ≥1000 beats/day (HR: 4.87, 95% CI: 2.59–9.13, P<0.001) and first-degree AV block (HR: 3.52, 95% CI: 1.63–7.61, P<0.01) were significant independent predictors for newly AF. The area under the ROC curve (AUC) of the combination of the CHARGE-AF score and frequent SVEs (≥1000) was greater than the CHARGE-AF score alone (0.73, 95% CI: 0.64–0.82 vs 0.66, 95% CI: 0.56–0.75, respectively). On the ROC curve, the CHARGE-AF score of 12.9 was optimum cut-off value for newly AF. Patients with both the CHARGE-AF score≥12.9 and SVEs≥1000 developed AF at 129.0/1000 person-years, compared with those with the CHARGE-AF score<12.9 and SVEs≥1000 (48.9), the CHARGE-AF score≥12.9 and SVEs<1000 (40.0) and the CHARGE-AF score<12.9 and SVEs<1000 (7.4), respectively. In multivariate cox regression analysis, age, past history of congestive heart failure and myocardial infarction, and antihypertensive medication were significant predictors of cerebral cardiovascular events (n=43), all of which signifying the components of the CHARGE-AF score. The AUC of the combination of the CHARGE-AF score and frequent SVEs (≥1000) was not different from the CHARGE-AF score alone (0.73, 95% CI: 0.64–0.81 vs 0.73, 95% CI: 0.64–0.82, respectively). Conclusion CHARGE-AF score has higher predictive power of both the new incident AF and cerebral cardiovascular events. The combination of CHARGE-AF score and SVEs≥1000 beats/day in Holter ECG can demonstrate the additional effect of prediction ability for the new incident AF, but not for cerebral cardiovascular events. FUNDunding Acknowledgement Type of funding sources: None.

No abstract