Digital devices for heart rhythm monitoring in atrial fibrillation patients scheduled for elective electrical cardioversion

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CV: cardioversión; ETE: ecocardiograma transesofágico; FA: fibrilación auricular; RS: ritmo sinusal." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Juan Benezet-Mazuecos, Pau Alonso, José Miguel Lozano, Jefferson Salas, Oscar González Lorenzo, Moisés Rodríguez-Mañero, Irene Narváez, Álvaro Lozano, Ángel Miracle, Julián Crosa, Isabel Barrio" "autores" => array:11 [ 0 => array:2 [ "nombre" => "Juan" "apellidos" => "Benezet-Mazuecos" ] 1 => array:2 [ "nombre" => "Pau" "apellidos" => "Alonso" ] 2 => array:2 [ "nombre" => "José Miguel" "apellidos" => "Lozano" ] 3 => array:2 [ "nombre" => "Jefferson" "apellidos" => "Salas" ] 4 => array:2 [ "nombre" => "Oscar" "apellidos" => "González Lorenzo" ] 5 => array:2 [ "nombre" => "Moisés" "apellidos" => "Rodríguez-Mañero" ] 6 => array:2 [ "nombre" => "Irene" "apellidos" => "Narváez" ] 7 => array:2 [ "nombre" => "Álvaro" "apellidos" => "Lozano" ] 8 => array:2 [ "nombre" => "Ángel" "apellidos" => "Miracle" ] 9 => array:2 [ "nombre" => "Julián" "apellidos" => "Crosa" ] 10 => array:2 [ "nombre" => "Isabel" "apellidos" => "Barrio" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020624004935" "doi" => "10.1016/j.medcle.2024.07.008" "estado" => "S200" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020624004935?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775324004780?idApp=UINPBA00004N" "url" => "/00257753/unassign/S0025775324004780/v1_202408270419/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S2387020624005102" "issn" => "23870206" "doi" => "10.1016/j.medcle.2024.05.025" "estado" => "S200" "fechaPublicacion" => "2024-11-04" "aid" => "6735" "copyright" => "Elsevier España, S.L.U." 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"etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario San Cecilio, Granada, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Cardiología, Hospital Sur Alcorcón, Alcorcón, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servicio de Cardiología, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Unidad de Arritmias, Complejo Hospitalario Universitario de Santiago de Compostela (CHUS), Santiago de Compostela, A Coruña, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Servicio de Cardiología, Hospital Quirónsalud Toledo, Toledo, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dispositivos digitales para la monitorización del ritmo cardíaco en pacientes con fibrilación auricular programados para cardioversión eléctrica ambulatoria" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2157 "Ancho" => 2417 "Tamanyo" => 236791 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Flow chart and results of the study. AF, atrial fibrillation; CV, cardioversion; SR, sinus rhythm ; TEE, transoesophageal echocardiogram." ] ] ] "textoCompleto" => "IntroductionAtrial fibrillation (AF) is the most common arrhythmia in clinical practice and in population-based studies. It is a chronic disease whose prevalence increases with age and represents a growing economic burden on healthcare systems. Treatment of patients with AF often consists of restoring sinus rhythm (SR) by outpatient electrical or pharmacological cardioversion (CV).<a class="elsevierStyleCrossRef" href="#bib0005">1</a> However, since AF often returns to SR spontaneously, CV is usually not required.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> It is not uncommon for patients scheduled for outpatient electrical CV to be in SR, rendering a planned admission and/or transoesophageal echocardiogram (TEE) unnecessary and resulting in poor use of healthcare resources.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>In recent years, many digital devices have been developed for heart rhythm monitoring that are widely available to the general population and allow recording of an electrocardiographic rhythm strip. Several studies have evaluated the ability to detect AF using these devices showing high diagnostic accuracy.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> Their ability varies with the techniques used, settings, and study populations, and evaluation by a physician experienced in interpreting electrocardiograms (ECGs) is still required to make a definitive diagnosis of AF.<a class="elsevierStyleCrossRefs" href="#bib0025">5,6</a>The main objective of our study was to assess whether the use of these devices in patients scheduled for outpatient electrical CV allows accurate and reliable detection of spontaneous conversion to SR in these patients, which may lead to a more rational use of healthcare resources: providing an earlier approach, avoiding unnecessary admissions and saving costs.MethodsStudy designThis is a multicentre observational study that included AF patients scheduled for outpatient electrical CV in the cardiology departments of 7 hospitals in Spain between February 2023 and January 2024. The study was designed to evaluate the use of a cardiac rhythm monitoring device (Kardia, AliveCor, USA) to detect spontaneous conversion to SR before scheduled admission. This study complied with the Declaration of Helsinki and received approval from the local ethics review committee. Patient data were processed in accordance with the current General Data Protection Regulation 2016/679 of the European Parliament (EU-GDPD) and of the Council of 27 April 2016 on the Protection of Personal Data, as well as with national and local regulations regarding patient autonomy, and rights and obligations regarding clinical information and documentation.Study populationThe population consisted of patients over 18 years of age with AF scheduled for outpatient electrical CV, with or without planned TEE, and able to use the cardiac rhythm monitoring device and follow the protocol for ECG transmissions. Patients with AF with estimated duration >3 months, severe left atrial dilatation, cardiac pacing devices (pacemakers or defibrillators), recent electrical CV (<1 month) or serious medical conditions that could affect protocol adherence were excluded. Initiation or continuation of adequate anticoagulation was mandatory for all high-risk patients. The indication for TEE was according to each centre's clinical practice. All patients were instructed on the aim, methodology and flow of the study, and gave informed consent for participation.Electrocardiogram acquisition and CoreLabAll patients were trained on the use of Kardia devices to record a single-channel ECG (lead I) for 30 s. Subjects were asked to hold the Kardia device in close proximity to a smartphone with the Kardia app and apply 2 fingers of each hand to each electrode to initiate the recording. The electrodes transmitted the ECG wirelessly to the smartphone, which then sent the recording to a CoreLab for anonymised analysis. The CoreLab panel consisted of 3 accredited electrophysiologists who blindly evaluated all ECG tracings and agreement was required for each ECG interpretation. Two electrophysiologists independently interpreted each tracing and assigned a diagnosis of SR, AF or atrial flutter, or unclassified. If the 2 electrophysiologists disagreed on the diagnosis, a third electrophysiologist reviewed the tracing and assigned a final diagnosis.Patients were asked to transmit ECG recordings twice a day (morning and evening) and whenever they experienced symptoms or felt a normal heart rhythm, until admission for outpatient CV and one week later. In case of spontaneous conversion to SR, reference centres were notified by CoreLab, admission for CV aborted and patients managed according to each centre's usual practice. Patients also underwent follow-up one week after spontaneous CV. Similarly, investigators were contacted when AF recurrence was detected after CV. The reference centres were able to assess the patients and modify medical treatment according to their clinical practice (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Data collectionPatient demographic and clinical data were obtained from medical records. The following baseline parameters were analysed: age, sex, body mass index, history of arterial hypertension, diabetes mellitus, stroke or transient ischaemic attack, cardiomyopathy (ischaemic heart disease, moderate or severe valvular heart disease, left ventricular systolic dysfunction, severe ventricular hypertrophy), sleep apnoea syndrome, type of AF (first diagnosed, paroxysmal or persistent), previous AF ablation or previous CV, treatment with antiarrhythmic drugs and echocardiographic data including left atrial dilatation. The CHA2DS2-VASc score was also collected.Patients' overall satisfaction with the use of this digital device for cardiac rhythm monitoring was assessed using a questionnaire of perceived usefulness and value, convenience and accessibility. Five items were evaluated with a score from 1 to 10 (0–2 extremely dissatisfied, 3–4 dissatisfied, 5–6 indifferent, 7–8 satisfied, 9–10 extremely satisfied) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).Statistical methodsContinuous variables are presented as mean ± standard deviation (SD). Categorical variables are presented as percentages. Statistical analyses were conducted using IBM's Statistical Package for the Social Sciences (SPSS®).ResultsBaseline patient characteristicsA total of 76 patients scheduled for AF outpatient electrical CV were assessed for eligibility. After excluding 2 of them (after detection of exclusion criteria), 74 participants were recruited for the study. The clinical characteristics of the population are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Fifty-four males (73%) were included and the mean age was 62 ± 10 years. The mean CHA2DS2VASc score was 1.6 ± 1.4. AF was of first diagnosis in 32 (43%) patients, paroxysmal in 11 (15%) patients and persistent in 31 (42%) patients. Twenty-two (30%) patients had a history of previous CV and 12 (16%) patients had undergone an AF ablation procedure. Echocardiographic data were recorded in 58 patients showing mild/moderate left atrial enlargement in 59%.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>CardioversionDuring follow-up prior to admission for outpatient CV, 22 (30%) patients spontaneously cardioverted to SR. The mean follow-up to spontaneous CV in these patients was 4.5 ± 5 days. Nineteen (86%) of these patients cardioverted to SR in the first week of monitoring. All these episodes were correctly detected with the Kardia devices, the reference centres were informed and admissions (with or without scheduled TEE) were cancelled. Due to early detection of spontaneous conversion to SR, a total of 22 admissions and 16 TEEs were avoided and resources were used for other patients. There were 9 spontaneous CVs in patients with first diagnosis AF (28%), 6 in patients with paroxysmal AF (54%) and 7 in patients with persistent AF (22%). There was no difference between the group of patients who presented with spontaneous CVs to SR and those who remained in AF and were admitted for outpatient electrical CVs (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Fifty-two (70%) patients were admitted for scheduled electrical CV after a mean follow-up of 15 ± 6 days. Thirty-three (65%) patients were on antiarrhythmic therapy. One CV was cancelled due to detection of atrial thrombus on TEE. Fifty-one patients underwent electrical CVs with successful acute conversion to SR in 48 (94%) patients and early AF recurrence before discharge in 3 patients. Forty-five (88%) of these patients admitted for electrical CV were discharged in SR.At 1-week follow-up after spontaneous or electrical CV to SR, 51 (69%) patients remained in SR at the end of the study. Twenty-four (34%) patients of those with spontaneous or successful electrical CV to SR had intermittent or permanent AF recurrences during this follow-up, correctly detected by the Kardia devices. All AF recurrences that remained in AF at the end of the study were documented in patients undergoing electrical CV (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>ECG recording transmissionsPatient adherence to the protocol with respect to ECG recording transmissions was high, with CoreLab receiving 92% of the expected transmissions. A total of 19 (0.8%) of the 2490 ECG recordings received were determined to be uninterpretable by CoreLab, and these were predominantly due to artefacts. The main cause of transmission failure was patient omission of technical aspects. A simple questionnaire was used to assess patient satisfaction with the cardiac rhythm monitoring system. Different aspects were evaluated with the following results: ease of ECG recording (8.9 out of 10 points), ease of ECG transmission (8.5 out of 10 points), feeling of usefulness (9.0 out of 10 points), and feeling of safety (9.2 out of 10 points). The overall satisfaction score was 9.1 out of 10 points.DiscussionOutpatient electrical CV is an effective, safe and well-established technique to restore SR. On the other hand, electrical CV requires multiple healthcare resources, such as hospital admission, healthcare professionals, sedation and often TEE.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> These circumstances may hinder the prompt performance of CV, especially as CV in a clinically stable patient is not usually considered an emergency procedure. Therefore, healthcare resources are often overwhelmed by the demand for outpatient CV, resulting in procedural delays that can often last for weeks. As a consequence, there may be potential risks associated with delayed CV, such as persistence of symptoms, development of heart failure, syncope, cardiac or cerebral ischaemic events, or progression to persistent AF.<a class="elsevierStyleCrossRefs" href="#bib0015">3,7–9</a> On the other hand, spontaneous conversion to SR is common, and it is not unusual for patients scheduled for outpatient CV to come to the hospital in SR, resulting in cancellation of the procedure, which could include TEE, with the resulting misuse of healthcare resources.<a class="elsevierStyleCrossRefs" href="#bib0010">2,10,11</a> The ENCARFA registry analysed the current situation of AF CV in Spain. This is an observational, cross-sectional, multicentre study conducted in 73 cardiology and emergency departments throughout Spain in which 10,949 cardioversions were performed. Of these, 60% were conducted in cardiology departments while 40% were performed in emergency departments. Data from this study show that logistical difficulties have an impact on the restoration of SR in Spain, with 46% of patients receiving electrical CV between 3 weeks and 2 months and 10% of patients waiting more than 2 months for CV.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> In addition, many CVs are performed in intensive care units and coronary units, requiring the availability of very limited resources (physical space and healthcare personnel). Therefore, CV currently represents an overload of care with significant delays in some centres in our country. In this context, having tools that allow us to monitor the patient's heart rhythm prior to scheduled admission would allow us to optimise resources by cancelling the admission of those patients in whom a spontaneous CV to SR has occurred, offering them early treatment in that sense, and continuing with scheduled admission for those patients who remain in AF.Ongoing technological advances have led to a rapid adaptation of the use of digital devices in clinical practice. Wearable heart rhythm recorders, which can record an electrocardiographic heart rhythm strip using smartphone technology, have been developed and made accessible to the general population. These recorders have proven to be very useful and dependable for the detection of AF.<a class="elsevierStyleCrossRefs" href="#bib0020">4–6</a> Avoiding unnecessary electrical CV scheduling has been suggested as a clinical application for these heart rate monitors.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> The Kardia device is a validated and European regulatory approved tool to record ECG signals and detect the presence of AF and SR with high sensitivity and specificity.<a class="elsevierStyleCrossRefs" href="#bib0070">14–17</a>In the present study, we aimed to assess whether the use of these new cardiac rhythm monitoring techniques could reliably differentiate the transition from AF to SR in patients scheduled for outpatient electrical CV and thus prevent unnecessary admissions, provide an early medical approach and optimise the use of healthcare resources. In a real-life population of patients scheduled for outpatient CV, our study showed that 30% of patients spontaneously converted to SR. This was correctly detected by the use of these Kardia devices and consequently 16 TEEs and 22 CV admissions were cancelled and could be rescheduled for other patients. The Rate Control versus Electrical Cardioversion Trial 7-Acute Cardioversion versus Wait and See (RACE 7 ACWAS) study evaluated whether a "wait and see" strategy could be non-inferior to early CV in restoring SR in patients with paroxysmal AF. This study showed spontaneous CV to SR within 48 h in 69% of patients in the delayed CV group receiving heart rate control medication alone.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> Another study involving patients with first diagnosis AF showed spontaneous CV to SR in 54% of patients. AF duration was a strong predictor of spontaneous CV to SR, when AF onset was estimated < 48 h it showed spontaneous CV in 77% of cases, compared to 36% in the > 48 h group.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> In contrast to the RACE 7 ACWAS Trial, our study included only 15% of patients with a diagnosis of paroxysmal AF and, therefore, the rate of conversion to SR was closer to that described for patients with first-diagnosis or persistent AF. The rate of spontaneous CV to SR in our patients with previously diagnosed paroxysmal AF was 54%, compared to 28% in patients with newly diagnosed AF and 22% in patients diagnosed with persistent AF. This study lacked the power to identify other clinical variables that could predict spontaneous CV to SR in this type of patient. However, given the high rates of spontaneous CV to SR in patients scheduled for outpatient electrical CV, it would be reasonable to consider cardiac rhythm monitoring with these new techniques, at least in those with a presumably shorter duration of AF episodes, either symptom-driven in cases of initial diagnosis or when the patient has already been diagnosed with paroxysmal AF. 86% of our patients who spontaneously cardioverted to SR did so within the first week of monitoring. More studies are needed to assess whether monitoring limited to this period would be the most efficient strategy.Having assessed the efficacy of this device in providing more effective healthcare, it was also important to consider its feasibility in routine clinical practice. In this regard, it was necessary to assess adherence and patient perception. Our study demonstrated high patient adherence with more than 90% of expected transmissions, high quality recordings with only 0.8% considered uninterpretable and a very positive perception of usefulness and patient satisfaction with a score of more than 9 out of 10.This study has the inherent limitations of an observational study. However, this is the first evaluation of a digital device for cardiac rhythm monitoring in AF patients scheduled for outpatient electrical CV in a multicentre study involving a real-life population with first diagnosed AF or already diagnosed non-permanent AF. However, this is still a select population that does not have severe comorbidities, does not have a cardiac pacing device, and is able to take advantage of the new technology. It is also possible that patients with AF of uncertain data with undetected paroxysmal or persistent behaviour who could have benefited from this monitoring system were excluded. On the other hand, the device analysed in our study requires active patient participation for recording and sending the ECG for evaluation. Therefore, digital barriers and internet connectivity are important limitations that may affect the applicability of this diagnostic technique. Furthermore, since this system is not a continuous cardiac rhythm monitoring, other spontaneous conversions to recurrent SR and/or AF may not have been recorded and reported. Finally, the scoring system developed to assess patient satisfaction is generic, not specifically designed for the Kardia device and largely based on the patient's subjective interpretation and experience during the study. On the other hand, it reflects a positive perception of usefulness and is consistent with the high adherence shown during the study. Future studies should assess the economic aspects related to the cost of this monitoring system and the savings related to the optimisation of healthcare resources.ConclusionsDigital devices for medically supervised cardiac rhythm monitoring allow accurate detection of spontaneous cardioversion to SR in patients with AF who are scheduled for outpatient electrical CV. This diagnostic technique can optimise the management of these patients, avoiding unnecessary admissions and providing a more rational use of healthcare resources.FundingThis study is an investigator-driven initiative with no financial support or sponsorship from industry.Ethical considerationsThe local Ethics Committee approved the study. All patients were informed of the nature of the study and signed the informed consent form." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres2290737" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1903113" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2290738" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1903112" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0015" "titulo" => "Methods" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Study design" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Study population" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Electrocardiogram acquisition and CoreLab" ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Data collection" ] 4 => array:2 [ "identificador" => "sec0040" "titulo" => "Statistical methods" ] ] ] 6 => array:3 [ "identificador" => "sec0045" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Baseline patient characteristics" ] 1 => array:2 [ "identificador" => "sec0055" "titulo" => "Cardioversion" ] 2 => array:2 [ "identificador" => "sec0060" "titulo" => "ECG recording transmissions" ] ] ] 7 => array:2 [ "identificador" => "sec0065" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0070" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0075" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0080" "titulo" => "Ethical considerations" ] 11 => array:2 [ "identificador" => "xack786167" "titulo" => "Acknowledgements" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2024-03-14" "fechaAceptado" => "2024-07-03" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1903113" "palabras" => array:4 [ 0 => "Ambulatory electrocardiographic monitoring" 1 => "Cardioversion" 2 => "Atrial fibrillation" 3 => "Digital health" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1903112" "palabras" => array:4 [ 0 => "Monitorización electrocardiográfica ambulatoria" 1 => "Cardioversión eléctrica" 2 => "Fibrilación auricular" 3 => "Evaluación de las tecnologías de salud" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Introduction and objectivesManagement in recent-onset atrial fibrillation (AF) is to achieve sinus rhythm (SR) by cardioversion (CV). However, frequently SR is spontaneously restored, making scheduled admission unnecessary and causing misutilization of healthcare resources. Emerging medical technology allows accurate heart rhythm monitoring. This study evaluated this technology in these patients, preventing unnecessary admission and providing an earlier management. MethodsA multicenter study was designed including patients with AF scheduled for elective electrical CV. Patients submitted ECG recordings to a central Corelab daily, twice a day and whenever they present symptoms, until CV (spontaneous or scheduled) and a week afterwards. Whenever a spontaneous conversion to SR was detected, investigators were contacted to confirm SR and abort admission. Patients’ satisfaction was evaluated using a test for perceived utility, convenience, and accessibility. Results74 patients were enrolled (age 62 ± 10 years). Twenty-two patients (30%) showed spontaneous conversion to SR. A total of 22 admissions and 16 transesophageal echocardiograms were prevented. Among 52 patients admitted for CV, 45 (88%) were discharged in SR. During follow-up after conversion to SR (spontaneous or electrical), recurrences of AF occurred in 24 patients (34%). At the end of the follow-up 51 patients (69%) remained in SR. The CoreLab received 93% of the expected ECG transmissions. Patient’s overall satisfaction score was 9.1 over 10. ConclusionDigital devices for heart rhythm monitoring can optimise the management of AF patients scheduled for elective CV, preventing unnecessary admissions and providing a more rational use of healthcare resources." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "Antecedentes y objetivosHabitualmente el abordaje de la fibrilación auricular (FA) persigue restaurar el ritmo sinusal (RS) mediante la cardioversión (CV) ambulatoria. Sin embargo, frecuentemente el RS se restablece espontáneamente, lo que puede ocasionar una mala utilización de recursos sanitarios. La tecnología médica emergente permite una monitorización precisa del ritmo cardíaco. Este estudio pretende evaluar el papel de esta tecnología en estos pacientes, evitando ingresos innecesarios y proporcionando un abordaje precoz. MétodosSe diseñó un estudio multicéntrico incluyendo pacientes con FA programados para CV eléctrica ambulatoria en 7 centros. Los pacientes enviaron registros ECG diariamente, hasta la CV (espontánea o programada) y una semana después. Ante una CV espontánea, se contactaba con los investigadores para confirmar el RS y abortar el ingreso. La satisfacción de los pacientes se evaluó mediante un cuestionario. ResultadosSe incluyeron 74 pacientes (62 ± 10 años). Veintidós pacientes (30%) presentaron CV espontánea. Se evitaron 22 ingresos y 16 ecocardiogramas transesofágicos. De 52 pacientes ingresados para CV eléctrica, 45 (88%) fueron dados de alta en RS. Durante el seguimiento tras la CV a RS (espontánea o eléctrica), hubo recurrencias de FA en 24 pacientes (34%). Al final del seguimiento, 51 pacientes (69%) permanecían en RS. Se recibieron el 93% de las transmisiones esperadas. La puntuación de satisfacción general fue de 9,1 sobre 10. ConclusiónLos dispositivos digitales de monitorización del ritmo cardíaco permiten optimizar el abordaje de pacientes con FA programados para CV ambulatoria, evitando ingresos innecesarios y proporcionando un uso más racional de los recursos sanitarios." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1402 "Ancho" => 3333 "Tamanyo" => 277562 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Study design and overview. The images represent the workflow of the study. CV: cardioversion; AF: atrial fibrillation." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2157 "Ancho" => 2417 "Tamanyo" => 236791 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Flow chart and results of the study. AF, atrial fibrillation; CV, cardioversion; SR, sinus rhythm ; TEE, transoesophageal echocardiogram." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Values expressed as mean ± SD or number (%).AF: atrial fibrillation; BMI: body mass index; CHA2DS2-VASc: acronym for heart disease (ventricular dysfunction/heart failure), hypertension, age > 75 years (2 points), diabetes mellitus, stroke (2 points), vascular disease, age 65–74 years and sex (female); LA: left atrium; LV: left ventricle RA: right atrium; SD: standard deviation." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Baseline characteristics \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study population (n = 74) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age, years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62 ± 10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Males, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">54 (73) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CHA2DS2VASc \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.6 ± 1.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BMI, (mean SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 ± 4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypertension, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 (47) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diabetes mellitus, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (11) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vascular disease, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (11) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Stroke, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sleep apnoea syndrome, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (14) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ventricular dysfunction/heart failure, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AF, n (%)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">First diagnosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32 (43) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Paroxysmal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (15) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Persistent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31 (42) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Previous Cardioversion, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 (30) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Previous AF ablation, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (16) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Antiarrhythmic treatment, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 (54) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Symptomatic AF, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 (41) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Echocardiogram \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">n = 58 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LV Dysfunction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate/severe valve disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Valve prosthesis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate/severe ventricular hypertrophy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (10) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mild/moderate RA dilatation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (17) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mild/moderate LA dilatation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34 (59) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate/severe pulmonary hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pericardial effusion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3711042.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Patient characteristics." ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Values expressed as mean ± SD or number (%).AF: atrial fibrillation; BMI: body mass index; CHA2DS2-VASc, acronym for heart disease (ventricular dysfunction/heart failure), hypertension, age > 75 years (2 points), diabetes mellitus, stroke (2 points), vascular disease, age 65–74 years, and sex (female); LV: left ventricle; SD: standard deviation." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Spontaneous Cardioversion to SR (n = 22) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Admission for electrical cardioversion (n = 52) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age, years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62 ± 11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62 ± 10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.90 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Males, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 (77) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37 (71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.58 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CHA2DS2VASc \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.8 ± 1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.5 ± 1.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.35 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BMI, (mean SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 ± 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 ± 5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypertension, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (45) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 (48) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.83 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diabetes mellitus, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.18 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vascular disease, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.25 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Stroke, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.88 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sleep apnoea syndrome, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.14 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ventricular dysfunction/heart failure, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.84 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AF, n (%)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">First diagnosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (41) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 (44) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.25 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Paroxysmal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (27) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Persistent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (32) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 (46) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Previous Cardioversion, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (35) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Previous AF ablation, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.07 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Antiarrhythmic treatment, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (45) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 (58) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.33 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Symptomatic AF, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (32) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 (44) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.32 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3711041.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Patient characteristics according to the presence or absence of spontaneous cardioversion." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:17 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "ESC Scientific Document Group" "etal" => true "autores" => array:6 [ 0 => "G. 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Original article

Digital devices for heart rhythm monitoring in atrial fibrillation patients scheduled for elective electrical cardioversion

Dispositivos digitales para la monitorización del ritmo cardíaco en pacientes con fibrilación auricular programados para cardioversión eléctrica ambulatoria

Juan Benezet-Mazuecosa,

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jbenezet@quironsalud.es

Corresponding author.

, Pau Alonsob, José Miguel Lozanoc, Jefferson Salasd, Oscar González Lorenzoe, Moisés Rodríguez-Mañerof, Irene Narváezg, Álvaro Lozanoa, Ángel Miraclea, Julián Crosaa, Isabel Barrioa

a Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario La Luz, Madrid, Spain

b Unidad de Arritmias, Servicio de Cardiología, Hospital de Manises, Manises, Valencia, Spain

c Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario San Cecilio, Granada, Spain

d Servicio de Cardiología, Hospital Sur Alcorcón, Alcorcón, Madrid, Spain

e Servicio de Cardiología, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain

f Unidad de Arritmias, Complejo Hospitalario Universitario de Santiago de Compostela (CHUS), Santiago de Compostela, A Coruña, Spain

g Servicio de Cardiología, Hospital Quirónsalud Toledo, Toledo, Spain

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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Flow chart and results of the study&#46; AF&#44; atrial fibrillation&#59; CV&#44; cardioversion&#59; SR&#44; sinus rhythm &#59; TEE&#44; transoesophageal echocardiogram&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Atrial fibrillation &#40;AF&#41; is the most common arrhythmia in clinical practice and in population-based studies&#46; It is a chronic disease whose prevalence increases with age and represents a growing economic burden on healthcare systems&#46; Treatment of patients with AF often consists of restoring sinus rhythm &#40;SR&#41; by outpatient electrical or pharmacological cardioversion &#40;CV&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However&#44; since AF often returns to SR spontaneously&#44; CV is usually not required&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> It is not uncommon for patients scheduled for outpatient electrical CV to be in SR&#44; rendering a planned admission and&#47;or transoesophageal echocardiogram &#40;TEE&#41; unnecessary and resulting in poor use of healthcare resources&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In recent years&#44; many digital devices have been developed for heart rhythm monitoring that are widely available to the general population and allow recording of an electrocardiographic rhythm strip&#46; Several studies have evaluated the ability to detect AF using these devices showing high diagnostic accuracy&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Their ability varies with the techniques used&#44; settings&#44; and study populations&#44; and evaluation by a physician experienced in interpreting electrocardiograms &#40;ECGs&#41; is still required to make a definitive diagnosis of AF&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The main objective of our study was to assess whether the use of these devices in patients scheduled for outpatient electrical CV allows accurate and reliable detection of spontaneous conversion to SR in these patients&#44; which may lead to a more rational use of healthcare resources&#58; providing an earlier approach&#44; avoiding unnecessary admissions and saving costs&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Methods</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Study design</span><p id="par0020" class="elsevierStylePara elsevierViewall">This is a multicentre observational study that included AF patients scheduled for outpatient electrical CV in the cardiology departments of 7 hospitals in Spain between February 2023 and January 2024&#46; The study was designed to evaluate the use of a cardiac rhythm monitoring device &#40;Kardia&#44; AliveCor&#44; USA&#41; to detect spontaneous conversion to SR before scheduled admission&#46; This study complied with the Declaration of Helsinki and received approval from the local ethics review committee&#46; Patient data were processed in accordance with the current General Data Protection Regulation 2016&#47;679 of the European Parliament &#40;EU-GDPD&#41; and of the Council of 27 April 2016 on the Protection of Personal Data&#44; as well as with national and local regulations regarding patient autonomy&#44; and rights and obligations regarding clinical information and documentation&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Study population</span><p id="par0025" class="elsevierStylePara elsevierViewall">The population consisted of patients over 18 years of age with AF scheduled for outpatient electrical CV&#44; with or without planned TEE&#44; and able to use the cardiac rhythm monitoring device and follow the protocol for ECG transmissions&#46; Patients with AF with estimated duration &#62;3 months&#44; severe left atrial dilatation&#44; cardiac pacing devices &#40;pacemakers or defibrillators&#41;&#44; recent electrical CV &#40;&#60;1 month&#41; or serious medical conditions that could affect protocol adherence were excluded&#46; Initiation or continuation of adequate anticoagulation was mandatory for all high-risk patients&#46; The indication for TEE was according to each centre&#39;s clinical practice&#46; All patients were instructed on the aim&#44; methodology and flow of the study&#44; and gave informed consent for participation&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Electrocardiogram acquisition and CoreLab</span><p id="par0030" class="elsevierStylePara elsevierViewall">All patients were trained on the use of Kardia devices to record a single-channel ECG &#40;lead I&#41; for 30&#8239;s&#46; Subjects were asked to hold the Kardia device in close proximity to a smartphone with the Kardia app and apply 2 fingers of each hand to each electrode to initiate the recording&#46; The electrodes transmitted the ECG wirelessly to the smartphone&#44; which then sent the recording to a CoreLab for anonymised analysis&#46; The CoreLab panel consisted of 3 accredited electrophysiologists who blindly evaluated all ECG tracings and agreement was required for each ECG interpretation&#46; Two electrophysiologists independently interpreted each tracing and assigned a diagnosis of SR&#44; AF or atrial flutter&#44; or unclassified&#46; If the 2 electrophysiologists disagreed on the diagnosis&#44; a third electrophysiologist reviewed the tracing and assigned a final diagnosis&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Patients were asked to transmit ECG recordings twice a day &#40;morning and evening&#41; and whenever they experienced symptoms or felt a normal heart rhythm&#44; until admission for outpatient CV and one week later&#46; In case of spontaneous conversion to SR&#44; reference centres were notified by CoreLab&#44; admission for CV aborted and patients managed according to each centre&#39;s usual practice&#46; Patients also underwent follow-up one week after spontaneous CV&#46; Similarly&#44; investigators were contacted when AF recurrence was detected after CV&#46; The reference centres were able to assess the patients and modify medical treatment according to their clinical practice &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Data collection</span><p id="par0040" class="elsevierStylePara elsevierViewall">Patient demographic and clinical data were obtained from medical records&#46; The following baseline parameters were analysed&#58; age&#44; sex&#44; body mass index&#44; history of arterial hypertension&#44; diabetes mellitus&#44; stroke or transient ischaemic attack&#44; cardiomyopathy &#40;ischaemic heart disease&#44; moderate or severe valvular heart disease&#44; left ventricular systolic dysfunction&#44; severe ventricular hypertrophy&#41;&#44; sleep apnoea syndrome&#44; type of AF &#40;first diagnosed&#44; paroxysmal or persistent&#41;&#44; previous AF ablation or previous CV&#44; treatment with antiarrhythmic drugs and echocardiographic data including left atrial dilatation&#46; The CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc score was also collected&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Patients&#39; overall satisfaction with the use of this digital device for cardiac rhythm monitoring was assessed using a questionnaire of perceived usefulness and value&#44; convenience and accessibility&#46; Five items were evaluated with a score from 1 to 10 &#40;0&#8211;2 extremely dissatisfied&#44; 3&#8211;4 dissatisfied&#44; 5&#8211;6 indifferent&#44; 7&#8211;8 satisfied&#44; 9&#8211;10 extremely satisfied&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Statistical methods</span><p id="par0050" class="elsevierStylePara elsevierViewall">Continuous variables are presented as mean&#8239;&#177;&#8239;standard deviation &#40;SD&#41;&#46; Categorical variables are presented as percentages&#46; Statistical analyses were conducted using IBM&#39;s Statistical Package for the Social Sciences &#40;SPSS&#174;&#41;&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Results</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Baseline patient characteristics</span><p id="par0055" class="elsevierStylePara elsevierViewall">A total of 76 patients scheduled for AF outpatient electrical CV were assessed for eligibility&#46; After excluding 2 of them &#40;after detection of exclusion criteria&#41;&#44; 74 participants were recruited for the study&#46; The clinical characteristics of the population are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Fifty-four males &#40;73&#37;&#41; were included and the mean age was 62&#8239;&#177;&#8239;10 years&#46; The mean CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>VASc score was 1&#46;6&#8239;&#177;&#8239;1&#46;4&#46; AF was of first diagnosis in 32 &#40;43&#37;&#41; patients&#44; paroxysmal in 11 &#40;15&#37;&#41; patients and persistent in 31 &#40;42&#37;&#41; patients&#46; Twenty-two &#40;30&#37;&#41; patients had a history of previous CV and 12 &#40;16&#37;&#41; patients had undergone an AF ablation procedure&#46; Echocardiographic data were recorded in 58 patients showing mild&#47;moderate left atrial enlargement in 59&#37;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Cardioversion</span><p id="par0060" class="elsevierStylePara elsevierViewall">During follow-up prior to admission for outpatient CV&#44; 22 &#40;30&#37;&#41; patients spontaneously cardioverted to SR&#46; The mean follow-up to spontaneous CV in these patients was 4&#46;5&#8239;&#177;&#8239;5 days&#46; Nineteen &#40;86&#37;&#41; of these patients cardioverted to SR in the first week of monitoring&#46; All these episodes were correctly detected with the Kardia devices&#44; the reference centres were informed and admissions &#40;with or without scheduled TEE&#41; were cancelled&#46; Due to early detection of spontaneous conversion to SR&#44; a total of 22 admissions and 16 TEEs were avoided and resources were used for other patients&#46; There were 9 spontaneous CVs in patients with first diagnosis AF &#40;28&#37;&#41;&#44; 6 in patients with paroxysmal AF &#40;54&#37;&#41; and 7 in patients with persistent AF &#40;22&#37;&#41;&#46; There was no difference between the group of patients who presented with spontaneous CVs to SR and those who remained in AF and were admitted for outpatient electrical CVs &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Fifty-two &#40;70&#37;&#41; patients were admitted for scheduled electrical CV after a mean follow-up of 15&#8239;&#177;&#8239;6 days&#46; Thirty-three &#40;65&#37;&#41; patients were on antiarrhythmic therapy&#46; One CV was cancelled due to detection of atrial thrombus on TEE&#46; Fifty-one patients underwent electrical CVs with successful acute conversion to SR in 48 &#40;94&#37;&#41; patients and early AF recurrence before discharge in 3 patients&#46; Forty-five &#40;88&#37;&#41; of these patients admitted for electrical CV were discharged in SR&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">At 1-week follow-up after spontaneous or electrical CV to SR&#44; 51 &#40;69&#37;&#41; patients remained in SR at the end of the study&#46; Twenty-four &#40;34&#37;&#41; patients of those with spontaneous or successful electrical CV to SR had intermittent or permanent AF recurrences during this follow-up&#44; correctly detected by the Kardia devices&#46; All AF recurrences that remained in AF at the end of the study were documented in patients undergoing electrical CV &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">ECG recording transmissions</span><p id="par0075" class="elsevierStylePara elsevierViewall">Patient adherence to the protocol with respect to ECG recording transmissions was high&#44; with CoreLab receiving 92&#37; of the expected transmissions&#46; A total of 19 &#40;0&#46;8&#37;&#41; of the 2490 ECG recordings received were determined to be uninterpretable by CoreLab&#44; and these were predominantly due to artefacts&#46; The main cause of transmission failure was patient omission of technical aspects&#46; A simple questionnaire was used to assess patient satisfaction with the cardiac rhythm monitoring system&#46; Different aspects were evaluated with the following results&#58; ease of ECG recording &#40;8&#46;9 out of 10 points&#41;&#44; ease of ECG transmission &#40;8&#46;5 out of 10 points&#41;&#44; feeling of usefulness &#40;9&#46;0 out of 10 points&#41;&#44; and feeling of safety &#40;9&#46;2 out of 10 points&#41;&#46; The overall satisfaction score was 9&#46;1 out of 10 points&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">Outpatient electrical CV is an effective&#44; safe and well-established technique to restore SR&#46; On the other hand&#44; electrical CV requires multiple healthcare resources&#44; such as hospital admission&#44; healthcare professionals&#44; sedation and often TEE&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> These circumstances may hinder the prompt performance of CV&#44; especially as CV in a clinically stable patient is not usually considered an emergency procedure&#46; Therefore&#44; healthcare resources are often overwhelmed by the demand for outpatient CV&#44; resulting in procedural delays that can often last for weeks&#46; As a consequence&#44; there may be potential risks associated with delayed CV&#44; such as persistence of symptoms&#44; development of heart failure&#44; syncope&#44; cardiac or cerebral ischaemic events&#44; or progression to persistent AF&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;7&#8211;9</span></a> On the other hand&#44; spontaneous conversion to SR is common&#44; and it is not unusual for patients scheduled for outpatient CV to come to the hospital in SR&#44; resulting in cancellation of the procedure&#44; which could include TEE&#44; with the resulting misuse of healthcare resources&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;10&#44;11</span></a> The ENCARFA registry analysed the current situation of AF CV in Spain&#46; This is an observational&#44; cross-sectional&#44; multicentre study conducted in 73 cardiology and emergency departments throughout Spain in which 10&#44;949 cardioversions were performed&#46; Of these&#44; 60&#37; were conducted in cardiology departments while 40&#37; were performed in emergency departments&#46; Data from this study show that logistical difficulties have an impact on the restoration of SR in Spain&#44; with 46&#37; of patients receiving electrical CV between 3 weeks and 2 months and 10&#37; of patients waiting more than 2 months for CV&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> In addition&#44; many CVs are performed in intensive care units and coronary units&#44; requiring the availability of very limited resources &#40;physical space and healthcare personnel&#41;&#46; Therefore&#44; CV currently represents an overload of care with significant delays in some centres in our country&#46; In this context&#44; having tools that allow us to monitor the patient&#39;s heart rhythm prior to scheduled admission would allow us to optimise resources by cancelling the admission of those patients in whom a spontaneous CV to SR has occurred&#44; offering them early treatment in that sense&#44; and continuing with scheduled admission for those patients who remain in AF&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Ongoing technological advances have led to a rapid adaptation of the use of digital devices in clinical practice&#46; Wearable heart rhythm recorders&#44; which can record an electrocardiographic heart rhythm strip using smartphone technology&#44; have been developed and made accessible to the general population&#46; These recorders have proven to be very useful and dependable for the detection of AF&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;6</span></a> Avoiding unnecessary electrical CV scheduling has been suggested as a clinical application for these heart rate monitors&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> The Kardia device is a validated and European regulatory approved tool to record ECG signals and detect the presence of AF and SR with high sensitivity and specificity&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#8211;17</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">In the present study&#44; we aimed to assess whether the use of these new cardiac rhythm monitoring techniques could reliably differentiate the transition from AF to SR in patients scheduled for outpatient electrical CV and thus prevent unnecessary admissions&#44; provide an early medical approach and optimise the use of healthcare resources&#46; In a real-life population of patients scheduled for outpatient CV&#44; our study showed that 30&#37; of patients spontaneously converted to SR&#46; This was correctly detected by the use of these Kardia devices and consequently 16 TEEs and 22 CV admissions were cancelled and could be rescheduled for other patients&#46; The Rate Control versus Electrical Cardioversion Trial 7-Acute Cardioversion versus Wait and See &#40;RACE 7 ACWAS&#41; study evaluated whether a <span class="elsevierStyleItalic">&#34;wait and see&#34;</span> strategy could be non-inferior to early CV in restoring SR in patients with paroxysmal AF&#46; This study showed spontaneous CV to SR within 48&#8239;h in 69&#37; of patients in the delayed CV group receiving heart rate control medication alone&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Another study involving patients with first diagnosis AF showed spontaneous CV to SR in 54&#37; of patients&#46; AF duration was a strong predictor of spontaneous CV to SR&#44; when AF onset was estimated &#60;&#8239;48&#8239;h it showed spontaneous CV in 77&#37; of cases&#44; compared to 36&#37; in the &#62;&#8239;48&#8239;h group&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> In contrast to the RACE 7 ACWAS Trial&#44; our study included only 15&#37; of patients with a diagnosis of paroxysmal AF and&#44; therefore&#44; the rate of conversion to SR was closer to that described for patients with first-diagnosis or persistent AF&#46; The rate of spontaneous CV to SR in our patients with previously diagnosed paroxysmal AF was 54&#37;&#44; compared to 28&#37; in patients with newly diagnosed AF and 22&#37; in patients diagnosed with persistent AF&#46; This study lacked the power to identify other clinical variables that could predict spontaneous CV to SR in this type of patient&#46; However&#44; given the high rates of spontaneous CV to SR in patients scheduled for outpatient electrical CV&#44; it would be reasonable to consider cardiac rhythm monitoring with these new techniques&#44; at least in those with a presumably shorter duration of AF episodes&#44; either symptom-driven in cases of initial diagnosis or when the patient has already been diagnosed with paroxysmal AF&#46; 86&#37; of our patients who spontaneously cardioverted to SR did so within the first week of monitoring&#46; More studies are needed to assess whether monitoring limited to this period would be the most efficient strategy&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Having assessed the efficacy of this device in providing more effective healthcare&#44; it was also important to consider its feasibility in routine clinical practice&#46; In this regard&#44; it was necessary to assess adherence and patient perception&#46; Our study demonstrated high patient adherence with more than 90&#37; of expected transmissions&#44; high quality recordings with only 0&#46;8&#37; considered uninterpretable and a very positive perception of usefulness and patient satisfaction with a score of more than 9 out of 10&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">This study has the inherent limitations of an observational study&#46; However&#44; this is the first evaluation of a digital device for cardiac rhythm monitoring in AF patients scheduled for outpatient electrical CV in a multicentre study involving a real-life population with first diagnosed AF or already diagnosed non-permanent AF&#46; However&#44; this is still a select population that does not have severe comorbidities&#44; does not have a cardiac pacing device&#44; and is able to take advantage of the new technology&#46; It is also possible that patients with AF of uncertain data with undetected paroxysmal or persistent behaviour who could have benefited from this monitoring system were excluded&#46; On the other hand&#44; the device analysed in our study requires active patient participation for recording and sending the ECG for evaluation&#46; Therefore&#44; digital barriers and internet connectivity are important limitations that may affect the applicability of this diagnostic technique&#46; Furthermore&#44; since this system is not a continuous cardiac rhythm monitoring&#44; other spontaneous conversions to recurrent SR and&#47;or AF may not have been recorded and reported&#46; Finally&#44; the scoring system developed to assess patient satisfaction is generic&#44; not specifically designed for the Kardia device and largely based on the patient&#39;s subjective interpretation and experience during the study&#46; On the other hand&#44; it reflects a positive perception of usefulness and is consistent with the high adherence shown during the study&#46; Future studies should assess the economic aspects related to the cost of this monitoring system and the savings related to the optimisation of healthcare resources&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conclusions</span><p id="par0105" class="elsevierStylePara elsevierViewall">Digital devices for medically supervised cardiac rhythm monitoring allow accurate detection of spontaneous cardioversion to SR in patients with AF who are scheduled for outpatient electrical CV&#46; This diagnostic technique can optimise the management of these patients&#44; avoiding unnecessary admissions and providing a more rational use of healthcare resources&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Funding</span><p id="par0110" class="elsevierStylePara elsevierViewall">This study is an investigator-driven initiative with no financial support or sponsorship from industry&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Ethical considerations</span><p id="par0115" class="elsevierStylePara elsevierViewall">The local Ethics Committee approved the study&#46; All patients were informed of the nature of the study and signed the informed consent form&#46;</p></span></span>"
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    "fechaRecibido" => "2024-03-14"
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            0 => "Monitorizaci&#243;n electrocardiogr&#225;fica ambulatoria"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and objectives</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Management in recent-onset atrial fibrillation &#40;AF&#41; is to achieve sinus rhythm &#40;SR&#41; by cardioversion &#40;CV&#41;&#46; However&#44; frequently SR is spontaneously restored&#44; making scheduled admission unnecessary and causing misutilization of healthcare resources&#46; Emerging medical technology allows accurate heart rhythm monitoring&#46; This study evaluated this technology in these patients&#44; preventing unnecessary admission and providing an earlier management&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Methods</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">A multicenter study was designed including patients with AF scheduled for elective electrical CV&#46; Patients submitted ECG recordings to a central Corelab daily&#44; twice a day and whenever they present symptoms&#44; until CV &#40;spontaneous or scheduled&#41; and a week afterwards&#46; Whenever a spontaneous conversion to SR was detected&#44; investigators were contacted to confirm SR and abort admission&#46; Patients&#8217; satisfaction was evaluated using a test for perceived utility&#44; convenience&#44; and accessibility&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Results</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">74 patients were enrolled &#40;age 62&#8239;&#177;&#8239;10 years&#41;&#46; Twenty-two patients &#40;30&#37;&#41; showed spontaneous conversion to SR&#46; A total of 22 admissions and 16 transesophageal echocardiograms were prevented&#46; Among 52 patients admitted for CV&#44; 45 &#40;88&#37;&#41; were discharged in SR&#46; During follow-up after conversion to SR &#40;spontaneous or electrical&#41;&#44; recurrences of AF occurred in 24 patients &#40;34&#37;&#41;&#46; At the end of the follow-up 51 patients &#40;69&#37;&#41; remained in SR&#46; The CoreLab received 93&#37; of the expected ECG transmissions&#46; Patient&#8217;s overall satisfaction score was 9&#46;1 over 10&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclusion</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Digital devices for heart rhythm monitoring can optimise the management of AF patients scheduled for elective CV&#44; preventing unnecessary admissions and providing a more rational use of healthcare resources&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Antecedentes y objetivos</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Habitualmente el abordaje de la fibrilaci&#243;n auricular &#40;FA&#41; persigue restaurar el ritmo sinusal &#40;RS&#41; mediante la cardioversi&#243;n &#40;CV&#41; ambulatoria&#46; Sin embargo&#44; frecuentemente el RS se restablece espont&#225;neamente&#44; lo que puede ocasionar una mala utilizaci&#243;n de recursos sanitarios&#46; La tecnolog&#237;a m&#233;dica emergente permite una monitorizaci&#243;n precisa del ritmo card&#237;aco&#46; Este estudio pretende evaluar el papel de esta tecnolog&#237;a en estos pacientes&#44; evitando ingresos innecesarios y proporcionando un abordaje precoz&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Se dise&#241;&#243; un estudio multic&#233;ntrico incluyendo pacientes con FA programados para CV el&#233;ctrica ambulatoria en 7 centros&#46; Los pacientes enviaron registros ECG diariamente&#44; hasta la CV &#40;espont&#225;nea o programada&#41; y una semana despu&#233;s&#46; Ante una CV espont&#225;nea&#44; se contactaba con los investigadores para confirmar el RS y abortar el ingreso&#46; La satisfacci&#243;n de los pacientes se evalu&#243; mediante un cuestionario&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 74 pacientes &#40;62&#8239;&#177;&#8239;10 a&#241;os&#41;&#46; Veintid&#243;s pacientes &#40;30&#37;&#41; presentaron CV espont&#225;nea&#46; Se evitaron 22 ingresos y 16 ecocardiogramas transesof&#225;gicos&#46; De 52 pacientes ingresados para CV el&#233;ctrica&#44; 45 &#40;88&#37;&#41; fueron dados de alta en RS&#46; Durante el seguimiento tras la CV a RS &#40;espont&#225;nea o el&#233;ctrica&#41;&#44; hubo recurrencias de FA en 24 pacientes &#40;34&#37;&#41;&#46; Al final del seguimiento&#44; 51 pacientes &#40;69&#37;&#41; permanec&#237;an en RS&#46; Se recibieron el 93&#37; de las transmisiones esperadas&#46; La puntuaci&#243;n de satisfacci&#243;n general fue de 9&#44;1 sobre 10&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusi&#243;n</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Los dispositivos digitales de monitorizaci&#243;n del ritmo card&#237;aco permiten optimizar el abordaje de pacientes con FA programados para CV ambulatoria&#44; evitando ingresos innecesarios y proporcionando un uso m&#225;s racional de los recursos sanitarios&#46;</p></span>"
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          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Values expressed as mean&#8239;&#177;&#8239;SD or number &#40;&#37;&#41;&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">AF&#58; atrial fibrillation&#59; BMI&#58; body mass index&#59; CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc&#58; acronym for heart disease &#40;ventricular dysfunction&#47;heart failure&#41;&#44; hypertension&#44; age &#62;&#8239;75 years &#40;2 points&#41;&#44; diabetes mellitus&#44; stroke &#40;2 points&#41;&#44; vascular disease&#44; age 65&#8211;74 years and sex &#40;female&#41;&#59; LA&#58; left atrium&#59; LV&#58; left ventricle RA&#58; right atrium&#59; SD&#58; standard deviation&#46;</p>"
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                  \t\t\t\t">1&#46;6&#8239;&#177;&#8239;1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">BMI&#44; &#40;mean SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#8239;&#177;&#8239;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Hypertension&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Diabetes mellitus&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Vascular disease&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Stroke&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sleep apnoea syndrome&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Ventricular dysfunction&#47;heart failure&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">AF&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>First diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Paroxysmal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Persistent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Previous Cardioversion&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Previous AF ablation&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Antiarrhythmic treatment&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;54&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Symptomatic AF&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Echocardiogram</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n&#8239;&#61;&#8239;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LV Dysfunction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moderate&#47;severe valve disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Valve prosthesis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moderate&#47;severe ventricular hypertrophy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mild&#47;moderate RA dilatation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mild&#47;moderate LA dilatation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34 &#40;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moderate&#47;severe pulmonary hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pericardial effusion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Values expressed as mean&#8239;&#177;&#8239;SD or number &#40;&#37;&#41;&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">AF&#58; atrial fibrillation&#59; BMI&#58; body mass index&#59; CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc&#44; acronym for heart disease &#40;ventricular dysfunction&#47;heart failure&#41;&#44; hypertension&#44; age &#62;&#8239;75 years &#40;2 points&#41;&#44; diabetes mellitus&#44; stroke &#40;2 points&#41;&#44; vascular disease&#44; age 65&#8211;74 years&#44; and sex &#40;female&#41;&#59; LV&#58; left ventricle&#59; SD&#58; standard deviation&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Spontaneous Cardioversion to SR &#40;n&#8239;&#61;&#8239;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Admission for electrical cardioversion &#40;n&#8239;&#61;&#8239;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P value&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Age&#44; years</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&#8239;&#177;&#8239;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&#8239;&#177;&#8239;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">BMI&#44; &#40;mean SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Hypertension&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Diabetes mellitus&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Sleep apnoea syndrome&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;14&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Ventricular dysfunction&#47;heart failure&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">2 &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;84&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">AF&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>First diagnosis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;41&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">23 &#40;44&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Paroxysmal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;27&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Persistent&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7 &#40;32&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">24 &#40;46&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Previous Cardioversion&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18 &#40;35&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;15&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Previous AF ablation&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;07&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Antiarrhythmic treatment&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;45&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">30 &#40;58&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;33&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Symptomatic AF&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">7 &#40;32&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">23 &#40;44&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab3711041.png"
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          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Patient characteristics according to the presence or absence of spontaneous cardioversion&#46;</p>"
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      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
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            0 => array:3 [
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Article information

ISSN: 23870206
Original language: English

DOI:10.1016/j.medcle.2024.07.008

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