European Heart Journal

Artificial intelligence (AI) has given the electrocardiogram (ECG) and clinicians reading them super-human diagnostic abilities. Trained without hard-coded rules by finding often subclinical patterns in huge datasets, AI transforms the ECG, a ubiquitous, non-invasive cardiac test that is integrated into practice workflows, into a screening tool and predictor of cardiac and non-cardiac diseases, often in asymptomatic individuals. This review describes the mathematical background behind supervised AI algorithms, and discusses selected AI ECG cardiac screening algorithms including those for the detection of left ventricular dysfunction, episodic atrial fibrillation from a tracing recorded during normal sinus rhythm, and other structural and valvular diseases. The ability to learn from big data sets, without the need to understand the biological mechanism, has created opportunities for detecting non-cardiac diseases as COVID-19 and introduced challenges with regards to data privacy. Like all medical tests, the AI ECG must be carefully vetted and validated in real-world clinical environments. Finally, with mobile form factors that allow acquisition of medical-grade ECGs from smartphones and wearables, the use of AI may enable massive scalability to democratize healthcare.

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AV junction ablation and cardiac resynchronization for patients with permanent atrial fibrillation and narrow QRS: the APAF-CRT mortality trial

Michele Brignole, Francesco Pentimalli, Pietro Palmisano, Maurizio Landolina, Fabio Quartieri, Eraldo Occhetta, Leonardo Calò, Giuseppe Mascia, Lluis Mont, Kevin Vernooy, Vincent van Dijk, Cor Allaart, Laurent Fauchier, Maurizio Gasparini, Gianfranco Parati, Davide Soranna, Michiel Rienstra, Isabelle C Van Gelder, for the APAF-CRT Trial Investigators

doi : 10.1093/eurheartj/ehab569

European Heart Journal, Volume 42, Issue 46, 7 December 2021, Pages 4731–4739

In patients with atrial fibrillation (AF) and heart failure (HF), strict and regular rate control with atrioventricular junction ablation and biventricular pacemaker (Ablation?+?CRT) has been shown to be superior to pharmacological rate control in reducing HF hospitalizations. However, whether it also improves survival is unknown.

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Pace and ablate better than drugs in patients with heart failure and atrial fibrillation: lessons from the APAF-CRT mortality trial

Cecilia Linde

doi : 10.1093/eurheartj/ehab695

European Heart Journal, Volume 42, Issue 46, 7 December 2021, Pages 4740–4742

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Mutation location and IKs regulation in the arrhythmic risk of long QT syndrome type 1: the importance of the KCNQ1 S6 region

Peter J Schwartz, Cristina Moreno, Maria-Christina Kotta, Matteo Pedrazzini, Lia Crotti, Federica Dagradi, Silvia Castelletti, Kristina H Haugaa, Isabelle Denjoy, Maria A Shkolnikova, Paul A Brink, Marshall J Heradien, Sandrine R M Seyen, Roel L H M G Spätjens, Carla Spazzolini, Paul G A Volders

doi : 10.1093/eurheartj/ehab582

European Heart Journal, Volume 42, Issue 46, 7 December 2021, Pages 4743–4755

Mutation type, location, dominant-negative IKs reduction, and possibly loss of cyclic adenosine monophosphate (cAMP)-dependent IKs stimulation via protein kinase A (PKA) influence the clinical severity of long QT syndrome type 1 (LQT1). Given the malignancy of KCNQ1-p.A341V, we assessed whether mutations neighbouring p.A341V in the S6 channel segment could also increase arrhythmic risk.

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Does knowledge of the mutation in hereditary long QT syndrome aid risk stratification?

Andrew Tinker

doi : 10.1093/eurheartj/ehab668

European Heart Journal, Volume 42, Issue 46, 7 December 2021, Pages 4756–4758

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Lower risk of stroke after alcohol abstinence in patients with incident atrial fibrillation: a nationwide population-based cohort study

So-Ryoung Lee, Eue-Keun Choi, Jin-Hyung Jung, Kyung-Do Han, Seil Oh, Gregory Y H Lip

doi : 10.1093/eurheartj/ehab315

European Heart Journal, Volume 42, Issue 46, 7 December 2021, Pages 4759–4768

The aim of this study was to evaluate the association between alcohol consumption status (and its changes) after newly diagnosed atrial fibrillation (AF) and the risk of ischaemic stroke.

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