Feasibility and reliability of whintings scanwatch to record 4-lead Electrocardiogram: A comparative analysis with a standard ECG.

The recent technological advances allowed us to produce some new wearable devices, such as smartphones and smartwatches (SW). These devices provide different services to their users through different software applications installed even in the SW or smartphones. Health monitoring functionalities, among these services, are nowadays the new technological fashion. In fact, the monitoring is ensured by the sensor incorporated in the SW. The SW allows the record of only one single lead Electrocardiogram (ECG), which is sufficient to screen or diagnosis of rhythm and conduction disorders, especially during the onset of cardiac symptoms, but insufficient for the detection of ischemic disease and cardiomyopathies. In this context, this paper aims to evaluate the feasibility, and reliability of a SW to obtain ECG recordings in comparison with a standard ECG. For that purpose, 140 patients were recruited for this analysis. At the first step, the 12 lead ECG followed with four lead SW-ECG; using the Withings Scanwatch device, were recorded in the same resting conditions. The four lead SW-ECG consists of Einthoven DI lead recorded with the SW, where the SW was on the left wrist and the right index finger on the crown, and three Wilson-type leads, in the which the V1 was recorded in the fourth right parasternal intercostal space, V3 was recorded in the fifth intercostal space on the midclavicular line, and V6 was recorded in the fifth intercostal space on the left midaxillary line with the right index finger placed on the crown and the left hand encompassing the right wrist. 700 ECGs recordings were collected and statistically analyzed in this study. In total, 97 % of the patients were able to obtain an ECG through the SW. A strong correlation was observed between the two recording methods concerning the duration of the studied parameters (r >90 %). The correlation coefficient showed that 33 out of 44 parameters have a strong correlation with the standard ECG. The similarity of the combined leads in the 4 established subgroups was significantly higher, meaning that increasing the number of leads would improve the detection of electrical anomalies. Our findings confirm the existing data on the high similarity between SW and standard 12-leads ECG. Despite SW not having the accuracy and utility of the standard ECG machine, they should be considered as an interesting screening tool for cardiac rhythm disorders, and a compelling solution to electrical documentation of general cardiac symptoms.

Pacemakers implantation and radiofrequency catheter ablation procedures during medical missions in Morocco: an 8-year experience.

AIMS: Radiofrequency catheter ablation (RFCA) for arrhythmias in the context of short-term medical missions (MM) in a developing country has not been reported so far. We describe here our experience with RFCA and pacemaker implantation in Morocco with a fully portable electrophysiological (EP) system under the auspice of the Monaco-Morocco Cardiology Association. METHODS AND RESULTS: Since November 2007, two to three MM (mean duration 4 days including transportation) per year were conducted (including two physicians and one nurse from Monaco) and were alternately located in Marrakech, Fes, Agadir, Casablanca, Rabat, Essaouira, and Oujda. All patients' files were sent by local teams and/or referring Moroccan cardiologists before MM. Each case was discussed with the Monaco EP team before the MM. Pacemakers and leads were donated by companies (Sorin Group, Medtronic, Saint-Jude Medical). The EP system (EP Tracer, CardioTek) as well as diagnostic/ablation catheters were brought for RFCA procedures. After the procedures, follow-up was performed by local teams. Procedures took place in gynaecological or orthopaedic operating room, or, when available, in the interventional cardiology cathlab. Thirty-one RFCA were performed during 11 MM (atrioventricular node re-entrant tachycardia = 12; atrioventricular re-entrant tachycardia/Mahaïm fibre = 15; typical atrial flutter = 3; ventricular ectopy = 1). Acute success was 93.5% for RFCA. Two major RFCA-related complications occurred (air embolism and complete atrioventricular block). No complication was related to pacemaker implantations (n = 44; mean 4 pacemakers per mission). CONCLUSION: Radiofrequency catheter ablation for arrhythmias in developing countries is technically challenging but feasible, despite technical and cultural difficulties.

Early hemodynamic changes versus peak values: what is more useful to predict occurrence of dyspnea during stress echocardiography in patients with asymptomatic mitral stenosis?

BACKGROUND: In asymptomatic mitral stenosis (MS), the usefulness of peak exercise Doppler echocardiography (DE) values is acknowledged, but the role of values recorded during the first stage of DE remains unclear. METHODS: DE was analyzed in 48 asymptomatic patients with significant MS and revealed dyspnea in 22 patients (46%). RESULTS: MS severity and rest and peak systolic pulmonary artery pressures (SPAPs) were not different between patients who did and did not develop dyspnea. Progressions of mean gradient and relative SPAP (ratio of SPAP/baseline SPAP) were significantly greater in patients who developed dyspnea compared with those who did not (P < .01), whereas no difference was observed for absolute SPAP progression (P = .28). Onset of dyspnea was associated with a high increase of relative SPAP (>90% at 60W, OR 2.31; CI, 1.2-4.8; P = .02) but not with the 60 mm Hg peak SPAP threshold (OR 1.3; CI, 0.7-43.1; P = .40). CONCLUSION: DE reveals symptoms in 46% of patients who are considered asymptomatic. Despite similar peak values, these patients have different hemodynamic parameters during the first level of exercise compared with patients remaining asymptomatic. This may lead to the integration of early hemodynamic changes in the evaluation of exercise tolerance.