Introduction: Silent atrial fibrillation (AF) is a common cause of cryptogenic ischemic stroke (CIS). The 24-h-Holter is insufficient to reveal an occult arrhythmic cause of stroke and the strategy to select the patients for long-term monitoring is missing. Objectives: The aim of the study was to evaluate 7-day-Holter monitoring to identify cases with the arrhythmic cause of stroke in CIS patients in whom 24-h-Holter was free from arrhythmia, and to assess the relation between supraventricular (SV) runs in baseline Holter and the incidence of AF in a 3-year follow-up period. Methods: 78 patients (aged 60 ± 9 years, 45 males) with CIS and no arrhythmic findings in 24-h-Holter were enrolled. All patients had 7-day-Holter monitoring after stroke and were followed up for 36 months, and then 7-day Holter was repeated. We assessed SV runs (≥5 QRS) in the initial 7-day Holter and analyzed the relation of the findings with clinical characteristics of novel AF episodes revealed early after stroke and during a 3-year follow-up. Results: Baseline 7-day-Holter revealed SV runs in 36% of patients and AF in 9% of cases. During a 3-year follow-up, 8 additional cases were confirmed, both in standard care and in repeated Holter (a total of 19% of AF cases). There was no difference with regard to CHADS2VASc score (3.6 ± 1.1 vs. 3.4 ± 1.5; p = NS) and left atrium parameters between patients with SV runs and the non-arrhythmic group. Patients with SV runs had a higher incidence of AF both after stroke and in a 3-year follow-up (46% vs. 4%, RR 11.6, p < 0.001). In 8 cases, patent foramen ovale was detected during follow-up. Conclusions: A strategy of baseline 7-day-Holter monitoring after stroke allows for disclosing SV runs in every third case and AF in 9% of stroke survivors. Patients with SV runs have a higher incidence of AF (RR 11.6, p < 0.001) and should be considered for extended continuous ECG monitoring.

Background/Objectives: COVID-19 is associated with various arrhythmias that continue into a post-COVID period and become a concern for patients and healthcare a long time after the infection. This study aimed to assess the incidence of arrhythmias and their relationship to presented symptoms in patients with no history of rhythm disturbances who underwent severe COVID-19 within the past 6 months. Methods: A total of 54 severe COVID-19 survivors with no history of known arrhythmia were enrolled in the study 3–6 months after discharge. All subjects underwent echocardiography, 24 h Holter monitoring, and received a handheld ECG event recorder for 14 days of ambulatory single-lead ECG recording, which was evaluated for supraventricular and ventricular arrhythmias and patient-reported events. After 12 months of follow-up (FU), Holter monitoring and ECG recordings were repeated. Results: The incidence of palpitations was high at baseline and halved after 12 months (65% vs. 36%, p = 0.018), as was the symptom-induced utilization of the event monitor (36% vs. 12%, p0.012). Palpitations were more common in patients with CAD, diabetes, and hypertension, but were not related to any rhythm disturbances except sinus tachycardia (OR of 5.8 for each 10 bpm increase in HR; CI: 1.3–26.5, p = 0.02). Holter monitoring revealed a higher burden of PVCs 3–6 months after COVID vs. FU (PVCs > 200/d in 36% vs. 17%, p < 0.05), and PVCs were more commonly recorded events in symptomatic patients. Symptomatic subjects more frequently reported sinus tachycardia (48% vs. 13%, p < 0.05) and PVC (21% vs. 0%, p < 0.05). Neither arrhythmias nor palpitations were related to the severity of the infection. Conclusions: Palpitations are common after severe COVID-19, but the symptoms are related to sinus tachycardia rather than actual arrhythmia and are more pronounced in patients with cardiovascular conditions. Ventricular ectopy was the predominant finding early after severe COVID-19 and might have been responsible for symptoms in a fraction of symptomatic subjects. Both symptoms and sinus tachycardia resolved over time.

Wstęp: Choroby układu krążenia, powodowane głównie miażdżycą i jej powikłaniami, są najczęstszą przyczyną chorobowości i śmiertelności na świecie. Miażdżyca rozwija się już we wczesnym wieku dziecięcym, a u około 50% młodych osób występują cechy miażdżycy tętnic wieńcowych. W związku z tym podejmuje się wiele działań zmierzających do wczesnego jej wykrywania i identyfikacji osób o podwyższonym ryzyku powikłań sercowo-naczyniowych, u których wdrożenie zasad prewencji może zapobiegać progresji choroby oraz rozwojowi powikłań. Subkliniczna miażdżyca to wczesny etap rozwoju choroby z obecnością niewielkich zmian w ścianie tętnic wieńcowych. Wykazano związek wczesnej miażdżycy ze zwiększonym ryzykiem choroby wieńcowej i występowaniem powikłań w postaci zgonów z przyczyn wieńcowych, zawałów serca niezakończonych zgonem oraz objawowej dławicy piersiowej. Celem pracy była obserwacja odległa osób z wczesną miażdżycą tętnic wieńcowych.Materiał i metody: Z pierwotnej grupy 45 chorych (100%) we wczesnym etapie zaawansowania miażdżycy tętnic wieńcowych – obejmującej pacjentów, u których w koronarografii uwidoczniono prawidłowy obraz tętnic wieńcowych lub jedynie drobne zmiany przyścienne, natomiast w 64-rzędowej tomografii komputerowej wskaźnik uwapnienia tętnic wieńcowych był dodatni (CACS powyżej 0) – obserwacji odległej poddano 29 osób (64,5%).Wyniki: W analizowanej grupie 29 chorych w 48-miesięcznej obserwacji stwierdzono dobre rokowanie ogólne. Nie występowały zgony z przyczyn sercowo-naczyniowych ani poważne zdarzenia sercowo-naczyniowe niezakończone zgonem. Ponadto chorzy dobrze współpracowali w zakresie procesu terapeutycznego, stosowali się do zaleceń oraz kontrolowali choroby współistniejące. U większości badanych doszło do poprawy w zakresie objawowości niedokrwienia mięśnia sercowego.Wnioski: Uzyskane dane pozwalają uznać subpopulację pacjentów we wczesnym etapie zaawansowania miażdżycy tętnic wieńcowych za obarczoną pośrednim ryzykiem sercowo-naczyniowym.

Background: Postoperative atrial fibrillation (POAF) after cardiac surgery is common and clinically relevant, yet optimal postdischarge ECG surveillance remains undefined. We assessed the incidence of POAF after isolated coronary artery bypass grafting (CABG) and surgical aortic valve replacement (SAVR) using a dual-modality ambulatory strategy. Methods: In an exploratory, single-center study, consecutive adults without pre-operative AF undergoing elective isolated CABG or SAVR received dual-modality monitoring after discharge: continuous patch-Holter for ~10 days and a patient-activated single-lead recorder for up to 30 days. Early POAF was AF/AFl during index hospitalization; late POAF was first AF/AFL detected postdischarge by either modality. Results: Fifty-five patients were enrolled (CABG 30 [54.5%], SAVR 25 [45.5%]; mean age 64.6 ± 9.8 years; 38.2% women). Early POAF occurred in 10/49 (20.4%); late POAF was detected in 21/55 (38.2%). By modality, late AF was identified on the 10-day Holter in 11/51 (21.6%) and on the 30-day recorder in 19/51 (37.3%). Cumulative detection reached 20.0% by day 7, 30.9% by day 10, and 38.2% thereafter, demonstrating that a substantive proportion of late POAF occurred after day 10, and 19/21 (90%) were captured by event monitoring. Female sex was independently associated with late POAF (OR 3.70, 95% CI 1.17–11.72); longer aortic cross-clamp time was related to late POAF in the SAVR subset, while larger LA size was related to POAF incidence in the CABG group. Early (in-hospital) POAF was associated with subsequent late POAF (p = 0.025). The difference in late POAF frequency between CABG and SAVR (33.3% vs. 44.0%; p = 0.42) was not significant. Conclusions: Among patients without prior AF undergoing CABG or SAVR, late POAF is frequent and often manifests beyond 10 days after discharge. Extending ambulatory surveillance to 30 days—or adopting a 10-day continuous plus patient-activated to day 30 hybrid—materially improves case finding and should be considered in routine postoperative pathways.

The study aims to provide an initial assessment of the safety and efficacy of using an angioplasty balloon to facilitate paravalvular leak passage. Original Contribution from Journal of Invasive Cardiology. Paravalvular leak transcatheter intervention