Robust electrocardiogram delineation model for automatic morphological abnormality interpretation.

Knowledge of electrocardiogram (ECG) wave signals is one of the essential steps in diagnosing heart abnormalities. Considerable performance with respect to obtaining the critical point of a signal waveform (P-QRS-T) through ECG delineation has been achieved in many studies. However, several deficiencies remain regarding previous methods, including the effects of noise interference on the performance degradation of delineation and the role of medical knowledge in reaching a delineation decision. To address these challenges, this paper proposes a robust delineation model based on a convolutional recurrent network with grid search optimization, aiming to classify the precise P-QRS-T waves. In order to make a delineation decision, the results from the ECG waveform classification model are utilized to interpret morphological abnormalities, based on medical knowledge. We generated 36 models, and the model with the best results achieved 99.97% accuracy, 99.92% sensitivity, and 99.93% precision for ECG waveform classification (P-wave, QRS-complex, T-wave, and isoelectric line class). To ensure the model robustness, we evaluated delineation model performance on seven different types of ECG datasets, namely the Lobachevsky University Electrocardiography Database (LUDB), QT Database (QTDB), the PhysioNet/Computing in Cardiology Challenge 2017, China Physiological Signal Challenge 2018, ECG Arrhythmia of Chapman University, MIT-BIH Arrhythmia Database and General Mohammad Hossein Hospital (Indonesia) databases. To detect the patterns of ECG morphological abnormalities through proposed delineation model, we focus on investigating arrhythmias. This process is based on two inputs examination: the P-wave and the regular/irregular rhythm of the RR interval. As the results, the proposed method has considerable capability to interpret the delineation result in cases with artifact noise, baseline drift and abnormal morphologies for delivering robust ECG delineation.

Validity and Reliability Studies of the Indonesian Version of Arrhythmia-Specific Questionnaire in Tachycardia and Arrhythmia (ASTA).

BACKGROUND: The Arrhythmia-Specific Questionnaire in Tachycardia and Arrhythmia (ASTA) was developed in Sweden using English which may pose cultural and language barriers for Indonesian patients. As such, we aimed to translate the original ASTA into Indonesian, then assess its validity and reliability. METHODS: Translation of the ASTA from English to Indonesian was done using forward and backward translation. The final version was then validated with the Short Form-36 (SF-36) questionnaire. Test-retest reliability study was done in a 7-14-day interval. RESULTS: The Indonesian version of ASTA was deemed acceptable by a panel of researchers with Cronbach's α of 0.816 and Intraclass Correlation Coefficient (ICC) ranging from 0.856-0.983. In a comparison to the SF-36, the medication utilization domain was poorly correlated with role limitations due to physical health (r:0.384; p<0.01) and pain (r:-0.317; p<0.05). The arrhythmia-specific symptoms domain was poorly correlated with role limitations due to emotional problems (r:0.271; p<0.05). In addition, the health-related quality of life (HRQOL) domain was poorly correlated with role limitations due to physical health (r:0.359; p<0.01) and emotional problems (r:0.348; p<0.01), also total SF-36 score (r:-0.367; p<0.01). The ASTA total score was poorly correlated with role limitations due to physical health (r:0.37; p<0.01), and emotional problems (r:0.376; p<0.01), also total SF-36 score (r:-0.331; p<0.01). CONCLUSION: The Indonesian version of ASTA has good internal and external validity as well as good reliability. Both the physical and mental domains of ASTA are correlated with role limitations due to emotional problems and SF-36 total score.

Is T-Wave Alternans a Repolarization Abnormality Marker in COVID-19? An Investigation on the Potentialities of Portable Electrocardiogram Device.

Background: Cardiac arrhythmias are significantly associated with poor outcomes in coronavirus disease 2019 (COVID-19) patients. Microvolt T-wave alternans (TWA) can be automatically quantified and has been recognized as a representation of repolarization heterogeneity and linked to arrhythmogenesis in various cardiovascular diseases. This study aimed to explore the correlation between microvolt TWA and COVID-19 pathology. Methods: Patients suspected of COVID-19 in Mohammad Hoesin General Hospital were consecutively evaluated using Alivecor® Kardiamobile 6L™ portable electrocardiogram (ECG) device. Severe COVID-19 patients or those who are unable to cooperate in active ECG self-recording were excluded from the study. TWA was detected and its amplitude was quantified using the novel enhanced adaptive match filter (EAMF) method. Results: A total of 175 patients, 114 COVID-19 patients (polymerase chain reaction (PCR)-positive group), and 61 non-COVID-19 patients (PCR-negative group) were enrolled in the study. PCR-positive group was subdivided according to the severity of COVID-19 pathology into mild and moderate severity subgroups. Baseline TWA levels were similar between both groups during admission (42.47 ± 26.52 µV vs. 44.72 ± 38.21 µV), but higher TWA levels were observed during discharge in the PCR-positive compared to the PCR-negative group (53.45 ± 34.42 µV vs. 25.15 ± 17.64 µV, P = 0.03). The correlation between PCR-positive result in COVID-19 and TWA value was significant, after adjustment of other confounding variables (R2 = 0.081, P = 0.030). There was no significant difference in TWA levels between mild and moderate severity subgroups in patients with COVID-19, both during admission (44.29 ± 27.14 µV vs. 36.75 ± 24.46 µV, P = 0.34) and discharge (49.47 ± 33.62 µV vs. 61.09 ± 35.99 µV, P = 0.33). Conclusions: Higher TWA values can be observed on follow-up ECG obtained during discharge in the PCR-positive COVID-19 patients.

Microvolt T-wave alternans in early repolarization syndrome associated with ventricular arrhythmias: A case report.

Despite early repolarization (ER) syndrome being usually considered benign, its association with severe/malignant ventricular arrhythmias (VA) was also reported. Microvolt T-wave alternans (MTWA) is an electrocardiographic marker for the development of VA, but its role in ER syndrome remains unknown. A 90-second 6-lead electrocardiogram from an ER syndrome patient, acquired with the Kardia recorder, was analyzed by the enhanced adaptive matched filter for MTWA quantification. On average, MTWA was 50 µV, higher than what was previously observed on healthy subjects using the same method. In our ER syndrome patient, MTWA plays a potential role in VA development in ER syndrome.

DAE-ConvBiLSTM: End-to-end learning single-lead electrocardiogram signal for heart abnormalities detection.

BACKGROUND: The electrocardiogram (ECG) is a widely used diagnostic that observes the heart activities of patients to ascertain a heart abnormality diagnosis. The artifacts or noises are primarily associated with the problem of ECG signal processing. Conventional denoising techniques have been proposed in previous literature; however, some lacks, such as the determination of suitable wavelet basis function and threshold, can be a time-consuming process. This paper presents end-to-end learning using a denoising auto-encoder (DAE) for denoising algorithms and convolutional-bidirectional long short-term memory (ConvBiLSTM) for ECG delineation to classify ECG waveforms in terms of the PQRST-wave and isoelectric lines. The denoising reconstruction using unsupervised learning based on the encoder-decoder process can be proposed to improve the drawbacks. First, The ECG signals are reduced to a low-dimensional vector in the encoder. Second, the decoder reconstructed the signals. The last, the reconstructed signals of ECG can be processed to ConvBiLSTM. The proposed architecture of DAE-ConvBiLSTM is the end-to-end diagnosis of heart abnormality detection. RESULTS: As a result, the performance of DAE-ConvBiLSTM has obtained an average of above 98.59% accuracy, sensitivity, specificity, precision, and F1 score from the existing studies. The DAE-ConvBiLSTM has also experimented with detecting T-wave (due to ventricular repolarisation) morphology abnormalities. CONCLUSION: The development architecture for detecting heart abnormalities using an unsupervised learning DAE and supervised learning ConvBiLSTM can be proposed for an end-to-end learning algorithm. In the future, the precise accuracy of the ECG main waveform will affect heart abnormalities detection in clinical practice.

Short Single-Lead ECG Signal Delineation-Based Deep Learning: Implementation in Automatic Atrial Fibrillation Identification.

Physicians manually interpret an electrocardiogram (ECG) signal morphology in routine clinical practice. This activity is a monotonous and abstract task that relies on the experience of understanding ECG waveform meaning, including P-wave, QRS-complex, and T-wave. Such a manual process depends on signal quality and the number of leads. ECG signal classification based on deep learning (DL) has produced an automatic interpretation; however, the proposed method is used for specific abnormality conditions. When the ECG signal morphology change to other abnormalities, it cannot proceed automatically. To generalize the automatic interpretation, we aim to delineate ECG waveform. However, the output of delineation process only ECG waveform duration classes for P-wave, QRS-complex, and T-wave. It should be combined with a medical knowledge rule to produce the abnormality interpretation. The proposed model is applied for atrial fibrillation (AF) identification. This study meets the AF criteria with RR irregularities and the absence of P-waves in essential oscillations for even more accurate identification. The QT database by Physionet is utilized for developing the delineation model, and it validates with The Lobachevsky University Database. The results show that our delineation model works properly, with 98.91% sensitivity, 99.01% precision, 99.79% specificity, 99.79% accuracy, and a 98.96% F1 score. We use about 4058 normal sinus rhythm records and 1804 AF records from the experiment to identify AF conditions that are taken from three datasets. The comprehensive testing has produced higher negative predictive value and positive predictive value. This means that the proposed model can identify AF conditions from ECG signal delineation. Our approach can considerably contribute to AF diagnosis with these results.

AFibNet: an implementation of atrial fibrillation detection with convolutional neural network.

BACKGROUND: Generalization model capacity of deep learning (DL) approach for atrial fibrillation (AF) detection remains lacking. It can be seen from previous researches, the DL model formation used only a single frequency sampling of the specific device. Besides, each electrocardiogram (ECG) acquisition dataset produces a different length and sampling frequency to ensure sufficient precision of the R-R intervals to determine the heart rate variability (HRV). An accurate HRV is the gold standard for predicting the AF condition; therefore, a current challenge is to determine whether a DL approach can be used to analyze raw ECG data in a broad range of devices. This paper demonstrates powerful results for end-to-end implementation of AF detection based on a convolutional neural network (AFibNet). The method used a single learning system without considering the variety of signal lengths and frequency samplings. For implementation, the AFibNet is processed with a computational cloud-based DL approach. This study utilized a one-dimension convolutional neural networks (1D-CNNs) model for 11,842 subjects. It was trained and validated with 8232 records based on three datasets and tested with 3610 records based on eight datasets. The predicted results, when compared with the diagnosis results indicated by human practitioners, showed a 99.80% accuracy, sensitivity, and specificity. RESULT: Meanwhile, when tested using unseen data, the AF detection reaches 98.94% accuracy, 98.97% sensitivity, and 98.97% specificity at a sample period of 0.02 seconds using the DL Cloud System. To improve the confidence of the AFibNet model, it also validated with 18 arrhythmias condition defined as Non-AF-class. Thus, the data is increased from 11,842 to 26,349 instances for three-class, i.e., Normal sinus (N), AF and Non-AF. The result found 96.36% accuracy, 93.65% sensitivity, and 96.92% specificity. CONCLUSION: These findings demonstrate that the proposed approach can use unknown data to derive feature maps and reliably detect the AF periods. We have found that our cloud-DL system is suitable for practical deployment.

Small residual patent ductus arteriosus after surgical ligation in young adult: to close or not to close - a dilemmatic case report.

Percutaneous transcatheter closure has gained acceptance for patent ductus arteriosus (PDA) management ever since its introduction, including the management residual left-to-right shunts following surgical ligations. It is preferred than the more invasive surgical closure. While large PDA is closed to prevent heart failure, the decision to close a small hemodynamically insignificant PDA is still a debatable issue. We present a case of percutaneous transcatheter closure of small residual left-to-right shunt PDA using HeartR™ Lifetech PDA occluder with instantaneous closure in an asymptomatic adult patient. The justification of closure was made based on the previous history of infective endocarditis, followed by PDA ligation and endarterectomy surgery, at 1.5 year before admission.

Arrhythmia Risk Profile and Ventricular Repolarization Indices in COVID-19 Patients: A Systematic Review and Meta-Analysis.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) has been associated with cardiac arrhythmias. Several electrocardiographic markers have been used to predict the risk of arrhythmia in patients with COVID-19. We aim to investigate the electrocardiographic (ECG) ventricular repolarization indices in patients with COVID-19. METHODOLOGY: We performed a comprehensive systematic literature search from PubMed, EuropePMC, SCOPUS, Cochrane Central Database, and Google Scholar Preprint Servers. The primary endpoints of this search were: Tp-e (T-peak-to-T-end) interval, QTd (QT dispersion), and Tp-e/QTc ratio in patients with newly diagnosed COVID-19 from inception up until August 2020. RESULTS: There were a total of 241 patients from 2 studies. Meta-analysis showed that Tp-e/QTc ratio was higher in COVID-19 group (mean difference 0.02 [0.01, 0.02], p < 0.001; I2: 18%,). Tp-e interval was more prolonged in COVID-19 group (mean difference 7.76 [3.11, 12.41], p < 0.001; I2: 80%) compared to control group. QT dispersion (QTd) also was increased in COVID-19 group (mean difference 1.22 [0.61, 1.83], p < 0.001 ; I2:30%). CONCLUSIONS: Several electrocardiographic markers including Tp-e/QTc, Tp-e interval, and QTd are significantly increased in patients with COVID-19.

Differences in clinical characteristics and outcome of de novo heart failure compared to acutely decompensated chronic heart failure - systematic review and meta-analysis.

BACKGROUND: Recent evidence showed that the characteristics and outcome of those with de novo heart failure (HF) and acutely decompensated chronic heart failure (ADCHF) were different. We aimed to perform a comprehensive search on the clinical characteristics and outcome of patients with de novo HF and ADCHF. METHODS: We performed a comprehensive search on de novo/new onset acute HF vs ADCHF from inception up until December 2019. RESULTS: There were 38320 patients from 15 studies. De novo HF were younger and, had less prevalent hypertension, diabetes mellitus, ischaemic heart disease, chronic obstructive pulmonary disease, atrial fibrillation, and history of stroke/transient ischaemic attack compared to ADCHF. Five studies showed a lower NT-proBNP in de novo HF patients, while one study showed no difference. Valvular heart disease as aetiology of heart failure was less frequent in de novo HF, and upon sensitivity analysis, hypertensive heart disease was more frequent in de novo HF. As for precipitating factors, ACS (OR 2.42; I2:89%) was more frequently seen in de novo HF, whereas infection was less frequently (OR 0.69; I2:32%) in ADCHF. De novo HF was associated with a significantly lower 3-month mortality (OR 0.63; I2:91%) and 1-year (OR 0.59; I2:59%) mortality. Meta-regression showed that 1-year mortality did not significantly vary with age (p = .106), baseline ejection fraction (p = .703), or HF reduced ejection fraction (p = .262). CONCLUSION: Risk factors, aetiology, and precipitating factors of HF in de novo and ADCHF differ. De novo HF also had lower 1-year mortality and 3-month mortality compared to ADCHF.

Fragmented QRS is associated with intraventricular dyssynchrony and independently predicts nonresponse to cardiac resynchronization therapy-Systematic review and meta-analysis.

BACKGROUND: Fragmented QRS (fQRS) is postulated to be associated with ventricular dyssynchrony and might be able to predict a nonresponse to cardiac resynchronization therapy (CRT) implantation. In this systematic review and meta-analysis, we aim to assess whether fQRS can be a marker of intraventricular dyssynchronies in patients with ischemic and nonischemic cardiomyopathy and whether it is an independent predictor of nonresponse in patients receiving CRT. METHODS: We performed a comprehensive search on topics that assesses fQRS and its association with intraventricular dyssynchrony and nonresponse to CRT up until September 2019. RESULTS: Fragmented QRS is associated with intraventricular dyssynchrony (OR 10.34 [3.39, 31.54], p < .001; I2 : 80% with sensitivity 76.8%, specificity 77%, LR+ 3.3, and LR- 0.3). Subgroup analysis showed that fQRS is associated with intraventricular dyssynchrony in patients with narrow QRS complex (OR 20.92 [12.24, 35.73], p < .001; I2 : 0%) and nonischemic cardiomyopathy (OR of 19.97 [12.12, 32.92], p < .001; I2 : 0%). Fragmented QRS was also associated with a higher time-to-peak myocardial sustained systolic (Ts-SD) (OR 15.19 [12.58, 17.80], p < .001; I2 : 0% and positive Yu index (OR 15.61 [9.07, 26.86], p < .001; I2 : 0%). Fragmented QRS has a pooled adjusted OR of OR of 1.70 [1.35, 2.14], p < .001; I2 : 62% for association with a nonresponse to CRT. QRS duration is found to be higher in nonresponders group mean difference -8.54 [-13.38, -3.70], p < .001; I2 : 70%. CONCLUSION: Fragmented QRS is associated with intraventricular dyssynchrony and is independently associated with nonresponse to cardiac resynchronization therapy.

A Systematic Review of Jailed Balloon Technique for Coronary Bifurcation Lesion: Conventional-Jailed Balloon Technique vs Modified-Jailed Balloon Technique.

BACKGROUND: In this systematic review, we aim to evaluate the latest evidence on the efficacy and safety of conventional jailed balloon technique and modified jailed balloon technique for bifurcation lesion, and also whether the former or latter is more effective for preventing side branch occlusion during main branch stenting in bifurcation lesions. METHODS: We performed comprehensive search on studies assessing the efficacy and safety of conventional jailed balloon and modified jailed balloon technique for bifurcation lesion from several electronic databases. RESULTS: There were 908 patients from six studies comprising of 615 in conventional jailed balloon technique group and 293 in modified jailed balloon technique group. Side branch loss was lower in modified jailed balloon technique group, however, the proportion of lesions with TIMI flow <3 in the final percutaneous coronary intervention result was somewhat higher in the modified jailed balloon technique group. The efficacy issue regarding side branch dissection was reported as high as 3.4%, especially at proximal stent edge in conventional jailed balloon technique group, but not quantitatively described in the modified jailed balloon technique group. Zero percent major adverse cardiovascular events at 9-12 months follow up was demonstrated in modified jailed balloon technique group, and 1-5% in the conventional jailed balloon group at a longer observation period up to 2.7 years. CONCLUSION: Our study showed that modified jailed balloon technique is potentially better compared to conventional jailed balloon in terms of side branch loss, dissection, and major adverse cardiovascular events. Further controlled studies are warranted for definite conclusion.

A time-to-event analysis on air pollutants with the risk of cardiovascular disease and mortality: A systematic review and meta-analysis of 84 cohort studies.

OBJECTIVE: Air pollution is one of the most substantial problems globally. Aerodynamic toxic of particulate matter with <10 mm in diameter (PM10 ), or <2.5 mm (PM2.5 ), as well as nitric dioxide (NO2 ), have been linked with health issues. We aimed to perform a comprehensive analysis of the time-to-event for different types of air pollutants on cardiovascular disease (CVD) events based on cohort studies. METHODS: A comprehensive search on topics that assesses air pollution and cardiovascular disease with keywords up until July 2019 was performed. RESULTS: There were a total of 28 215 394 subjects from 84 cohorts. Increased PM2.5 was associated with composite CVD [HR 1.10 (1.02, 1.19)], acute coronary events [HR 1.15 (1.12, 1.17)], stroke [HR 1.13 (1.06, 1.19)], and hypertension [HR 1.07 (1.01, 1.14)], all-cause mortality [HR 1.07 (1.04, 1.09)], CVD mortality [HR 1.10 (1.07, 1.12)], and ischemic heart disease (IHD) mortality [HR 1.11 (1.07, 1.16)]. Association with AF became significant after removal of a study. Increased PM10 was associated with heart failure [HR 1.25 (1.04, 1.50)], all-cause mortality [HR 1.16 (1.06, 1.27)], CVD mortality [HR 1.17 (1.04, 1.30)], and IHD mortality [HR 1.03 (1.01, 1.05)]. Increased of NO2 was associated with increased composite CVD [HR 1.15 (1.02, 1.29)], atrial fibrillation [HR 1.01 (1.01, 1.02)], acute coronary events [HR 1.08 (1.02, 1.13)], all-cause mortality [HR 1.23 (1.14, 1.32)], CVD mortality [HR 1.17 (1.10, 1.25)], and IHD mortality [HR 1.05 (1.03, 1.08)]. CONCLUSION: Air pollutants are associated with an increased incidence of cardiovascular diseases, all-cause mortality, and CVD mortality.

Antibiotic envelope is associated with reduction in cardiac implantable electronic devices infections especially for high-power device-Systematic review and meta-analysis.

BACKGROUND: Infections after cardiac implantable electronic device (CIED) placement are associated with significant morbidity and mortality. The incidence of CIED is increasing overtime despite the optimal use of antimicrobial agents. This systematic review and meta-analysis will address the latest evidence on the use of AE to mitigate the risk of CIED infection, and which subset of patients will they benefit the most. METHODS: We performed a comprehensive search on topics that assesses antibiotic envelope and implantable cardiac electronic device up until August 2019. RESULTS: There were a total of 32,329 subjects from six studies. Antibiotic envelope was associated with a lower risk of major infection with OR 0.42 [0.19, 0.97], P = .04; I2: 58% and HR 0.52 [0.32, 0.85], P = .009; I2: 80%. Upon sensitivity analysis by removing a study, the OR became 0.40 [0.27, 0.59], P < .001; I2: 46%. Subgroup analysis for 12 months' infection was OR 0.65 [0.43, 0.99], P = .04; I2: 49%. Meta-analysis of propensity-matched cohort showed a reduced risk of infection with AE (OR of 0.14 [0.05, 0.41], P < .001; I2:0%). Mortality was similar in both AE and control groups. Antibiotic envelope reduced the incidence of infection in patients receiving high-power device (OR 0.44 [0.27, 0.73], P = .001; I2:0%) but not low-power device. CONCLUSION: Antibiotic envelope (TYRX) was found to be safe and effective in reducing the risk of major infections in high-risk patients receiving CIED implantation, especially in those receiving high-power CIED.

Transjugular Seldinger approach for permanent pacemaker implantation in octogenarian with inaccessible upper limbs venous system.

In up to 13.7% of device implants, lead entry through the cephalic, axillary, or subclavian veins might be unfeasible. Transjugular permanent pacemaker (PPM) implantation may be considered as a bailout strategy in the difficult anatomy of conventional veins, before resorting to epicardial pacing lead, which requires general anesthesia and thoracotomy. We described a case report of a single chamber PPM implantation in an 83-year-old man using transjugular Seldinger approach without surgical cut down of the internal jugular vein, due to spasm, stenosis, and thrombosis of the upper limbs venous systems. Acceptable lead impedance and threshold were maintained during 2 months follow-up.

Peri-left bundle branch pacing after atrioventricular node ablation and failed his bundle pacing in atrial fibrillation.

We described a case where peri-left bundle branch pacing (PLBP) may become an alternative approach in difficult His bundle pacing (HBP) following atrioventricular nodal ablation in a patient with atrial fibrillation. After atrioventricular nodal ablation, the HBP lead was removed to another LBB position distal to the first PLBP lead, due to acute threshold increase. At 3 month follow-up, PLBP exhibited acceptable pacing parameters without any adverse event.

The use of intermittent pneumatic compression to prevent venous thromboembolism in neurosurgical patients-A systematic review and meta-analysis.

OBJECTIVE: The incidence of venous thromboembolism (VTE) remains high despite the use of low-molecular weight heparin (LMWH) and compression stocking (CS). We aimed to evaluate the use of IPC as VTE prophylaxis in neurosurgical patients. PATIENTS AND METHODS: We conducted meta-analysis to assess the use of IPC as VTE prophylaxis in neurosurgical patients from several databases. RESULTS: There was a total of 7.515 subjects from 5 studies. Reduction in VTE incidence was demonstrated by the IPC group (OR 0.40 [0.31, 0.52], p < 0.001; I2: 44 %). IPC was shown to reduce the incidence of deep venous thrombosis (DVT) (OR 0.43 [0.32, 0.57], p < 0.001; I2: 0 %) compared to the control group. Incidence of pulmonary embolism (PE) was lower (OR 0.42 [0.25, 0.70], p < 0.001; I2: 80 %) in IPC. Upon sensitivity analysis, PE was significantly lower in IPC (OR 0.24 [0.13, 0.45], p < 0.001; I2: 0 %). Subgroup analysis on patients undergoing neurosurgical intervention (operation) and receiving LMWH + CS shows a markedly reduced incidence of VTE (OR 0.37 [0.28, 0.50], p < 0.001; I2: 3 %), DVT (OR 0.39 [0.28, 0.54], p < 0.001; I2: 0 %), and PE (OR 0.22 [0.11, 0.43], p < 0.001; I2: 0 %) in IPC. CONCLUSION: Intermittent pneumatic compression was associated with less VTE in neurosurgical patients, especially in those who received neurosurgical interventions, however, the certainty of evidence remained inadequate for creating a strong recommendation and further randomized controlled trials are needed before drawing a definite conclusion.

Serum Galectin-3 level and recurrence of atrial fibrillation post-ablation - Systematic review and meta-analysis.

BACKGROUND: Serum galectin-3, a circulating biomarker of fibrosis, has been associated with atrial remodelling. Recent studies investigating serum galectin-3 and AF recurrence post-ablation have shown mixed results. We aimed to analyze the latest evidence on the association between serum galectin-3 and AF recurrence after catheter ablation. METHODS: We performed a comprehensive search on topics that assesses serum galectin-3 and AF recurrence post-ablation up until August 2019. RESULTS: There were 597 patients from seven studies. The mean difference of serum galectin-3 was similar in both AF recurrence and non AF recurrence group (mean difference 0.78 ng/mL [-0.56, 2.13]; p = 0.25; I2: 69%. Upon removal of a study in sensitivity analysis, the serum galectin-3 became higher in AF recurrence group (mean difference 1.41 ng/mL [0.47, 2.34], p = 0.003; I2: 17%). Serum galectin-3 was associated with a higher risk for AF recurrence (HR 1.25 [1.01, 1.55]; p = 0.04; I2: 76%). Upon removal of a study in sensitivity analysis, HR became 1.45 [1.07, 1.96], p = 0.02; I2: 47%. Meta-analysis of adjusted HR demonstrated that high serum galectin-3 independently predicts AF recurrence (HR 1.15 [1.02, 1.29], p < 0.02; I2: 57%, p = 0.10) CONCLUSION: Serum galectin-3 is associated with an increased risk of AF recurrence post-ablation. Further studies are required, especially emphasis on the cut-off point should be given, before integrating it in routine risk stratification for AF ablation.