Search

Aims: Smartphone applications for heart rate and rhythm assessment are increasingly used for the management of atrial fibrillation (AF). Although the use of a photoplethysmography (PPG)-based smartphone application with subsequent (tele)consultations for AF management has been proven feasible in the TeleCheck-AF project, specific needs, and expectations of patients with AF are unclear. The aim of this study is to evaluate patients' perspectives on the use of remote PPG-based electronical health (eHealth) integrated in regular care pathways for AF., Methods and Results: A qualitative study was conducted among patients with known AF, who have used a PPG-based smartphone application around scheduled (tele)consultations. Semi-structured interviews were audio-recorded and transcribed verbatim. Data were analysed according to conventional content analysis.In total, 14 patients were interviewed. Five main themes were defined after analysis, i.e. smartphone application usability, requirements for eHealth implementation, remote self-assessment, patient engagement, and blended care (i.e. combining digital and face-to-face care). Overall, the participants were positive about the use of the PPG-based smartphone application and subsequent (tele)consultation. Using this application made the participants feel involved and led to active participation. In addition, the healthcare provider-patient relationship appeared an important aspect for adequate implementation. Particularly, timely consultation was found important, to discuss the results with their healthcare provider., Conclusion: The results of this study emphasize the importance of blended care for the implementation of remote PPG-based eHealth in AF management. The use of a PPG-based smartphone application in regular care can support patient engagement and subsequently the process of shared decision making., Competing Interests: Conflict of interest: none declared., (© The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Background: Sleep-disordered breathing (SDB) is prevalent in up to 50% of patients referred for atrial fibrillation (AF) catheter ablation (CA). Currently, it remains unclear how to improve pre-selection for SDB screening in patients with AF., Aim: We aimed to (1) assess the accuracy of the STOP-Bang screening questionnaire for detection of SDB within an AF population referred for CA; (2) derive a refined, AF-specific SDB score to improve pre-selection., Methods: Consecutive AF patients referred for CA without a history of SDB and/or SDB screening were included. Patients were digitally referred to the previously implemented Virtual-SAFARI SDB screening and management pathway including a home sleep test. An apnoea-hypopnoea index (AHI) of  ≥ 15 was interpreted as moderate-to-severe SDB. Logistic regression analysis was used to assess characteristics associated with moderate-to-severe SDB to refine pre-selection for SDB screening., Results: Of 206 included patients, 51% were diagnosed with moderate-to-severe SDB. The STOP-Bang questionnaire performed poorly in detecting SDB, with an area under the receiver operating characteristic curve (AUROC) of 0.647 (95% Confidence-Interval (CI) 0.573-0.721). AF-specific refinement resulted in the BOSS-GAP score. Therein, BMI with cut-off point ≥ 27 kg/m 2  and previous stroke or transient ischaemic attack (TIA) were added, while tiredness and neck circumference were removed. The BOSS-GAP score performed better with an AUROC of 0.738 (95% CI 0.672-0.805) in the overall population., Conclusion: AF-specific refinement of the STOP-Bang questionnaire moderately improved detection of SDB in AF patients referred for CA. Whether questionnaires bring benefits for pre-selection of SDB compared to structural screening in patients with AF requires further studies., Trial Registration Number: ISOLATION was registered NCT04342312, 13-04-2020., (© 2023. The Author(s).)

Introduction: Continuous progress in atrial fibrillation (AF) ablation techniques has led to an increasing number of procedures with improved outcome. However, about 30-50% of patients still experience recurrences within 1 year after their ablation. Comprehensive translational research approaches integrated in clinical care pathways may improve our understanding of the complex pathophysiology of AF and improve patient selection for AF ablation., Objectives: Within the "IntenSive mOlecular and eLectropathological chAracterization of patienTs undergoIng atrial fibrillatiOn ablatioN" (ISOLATION) study, we aim to identify predictors of successful AF ablation in the following domains: (1) clinical factors, (2) AF patterns, (3) anatomical characteristics, (4) electrophysiological characteristics, (5) circulating biomarkers, and (6) genetic background. Herein, the design of the ISOLATION study and the integration of all study procedures into a standardized pathway for patients undergoing AF ablation are described., Methods: ISOLATION (NCT04342312) is a two-center prospective cohort study including 650 patients undergoing AF ablation. Clinical characteristics and routine clinical test results will be collected, as well as results from the following additional diagnostics: determination of body composition, pre-procedural rhythm monitoring, extended surface electrocardiogram, biomarker testing, genetic analysis, and questionnaires. A multimodality model including a combination of established predictors and novel techniques will be developed to predict ablation success., Discussion: In this study, several domains will be examined to identify predictors of successful AF ablation. The results may be used to improve patient selection for invasive AF management and to tailor treatment decisions to individual patients., Competing Interests: CM received consultancy fees for Bayer Healthcare. SS received grants from Boehringer Ingelheim, AstraZeneca and GlaxoSmithKline, honorary fees for presentations from AstraZeneca and Chiesi, consultancy fees from GlaxoSmithKline, payment for advisory boards from Chiesi and GlaxoSmithKline, all outside the submitted work, and payed to his institution. KV was consultant for Medtronic, Abbott, Philips, Biosense Webster. US received consultancy fees or honoraria from Università della Svizzera Italiana (USI, Switzerland), Roche Diagnostics (Switzerland), EP Solutions Inc. (Switzerland), Johnson & Johnson Medical Limited (United Kingdom), Bayer Healthcare (Germany). US was co-founder and shareholder of YourRhythmics BV, a spin-off company of the University Maastricht. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Verhaert, Linz, Chaldoupi, Westra, den Uijl, Philippens, Kerperien, Habibi, Vorstermans, ter Bekke, Beukema, Evertz, Hemels, Luermans, Manusama, Lankveld, van der Heijden, Bidar, Hermans, Zeemering, Bijvoet, Habets, Holtackers, Mihl, Nijveldt, van Empel, Knackstedt, Simons, Buhre, Tijssen, Isaacs, Crijns, Maesen, Vernooy and Schotten.)

Aims: In atrial fibrillation (AF) patients, untreated sleep-disordered breathing (SDB) is associated with lower success rates of rhythm control strategies and as such structured SDB testing is recommended. Herein, we describe the implementation of a virtual SDB management pathway in an AF outpatient clinic and examine the utility and feasibility of this new approach., Methods and Results: Prospectively, consecutive AF patients accepted for AF catheter ablation procedures without previous diagnosis of SDB were digitally referred to a virtual SDB management pathway and instructed to use WatchPAT-ONE (ITAMAR) for one night. Results were automatically transferred to a virtual sleep laboratory, upon which a teleconsultation with a sleep physician was planned. Patient experience was measured using surveys. SDB testing was performed in 119 consecutive patients scheduled for AF catheter ablation procedures. The median time from digital referral to finalization of the sleep study report was 18 [11-24] days. In total, 65 patients (55%) were diagnosed with moderate-to-severe SDB. Patients with SDB were prescribed more cardiovascular drugs and had higher body mass indices (BMI, 29 ± 3.3 vs. 27 ± 4.4kg/m2, P < 0.01). Patients agreed that WatchPAT-ONE was easy to use (91%) and recommended future use of this virtual pathway in AF outpatient clinics (86%). Based on this remote SDB testing, SDB treatment was recommended in the majority of patients., Conclusion: This novel virtual AF management pathway allowed remote SDB testing in AF outpatient clinics with a short time to diagnosis and high patient satisfaction. Structured SDB testing results in a high detection of previously unknown SDB in AF patients scheduled for AF ablation., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.)

Background: The utility of long-term intermittent heart rhythm monitoring after atrial fibrillation (AF) ablation remains unclear. Therefore, we compared the efficacy and usability of long-term intermittent (AliveCor Kardia® (ACK)) versus short continuous (Holter) heart rhythm monitoring for the detection of AF recurrences after AF ablation and evaluated ACK accuracy to detect AF., Methods: Patients were provided with Holter (for ≥24 h) simultaneously with an ACK (4 weeks) used three times a day and in case of symptoms. The primary endpoint was the difference in proportion of patients diagnosed with recurrent AF by ACK as compared to Holter monitoring. Secondary endpoints were the usability (System Usability Scale and a four-item questionnaire) of ACK and Holter monitoring; and the accuracy of the ACK algorithm for AF detection., Results: Out of 126 post-ablation patients, 115 (91.3%; 35 females, median age 64.0 [58.0-68.0] years) transmitted overall 7838 ACK ECG recordings. ACK and Holter monitoring detected 29 (25.2%) and 17 (14.8%) patients with AF recurrences, respectively (p < 0.001). More than 2 weeks of ACK monitoring did not have additional diagnostic yield for detection of AF recurrences. Patients graded ACK higher than Holter monitoring and found ACK more convenient in daily usage than Holter (p < 0.001). Sensitivity and specificity of ACK for AF detection were 95.3% and 97.5%, respectively., Conclusions: Long-term intermittent monitoring by ACK more effectively detects AF recurrences after AF ablation and has a higher patients' usability than short continuous Holter monitoring. ACK showed a high accuracy to detect AF., Competing Interests: Declaration of competing interest JGLM is a consultant for Medtronic. The remaining authors declare that there is no conflict of interest., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Recently, we introduced the TeleCheck-AF approach, an on-demand mobile health (mHealth) infrastructure using app-based heart rate and rhythm monitoring for 7 days, to support long-term atrial fibrillation (AF) management through teleconsultation. Herein, we extend the mHealth approach to patients with recent-onset AF at the emergency department (ED). In the proposed TeleWAS-AF approach, on-demand heart rate and rhythm monitoring are used to support a wait-and-see strategy at the ED. All stable patients who present to the ED with recent-onset symptomatic AF and who are able to use mHealth solutions for heart rate and rhythm monitoring are eligible for this approach. Patients will receive both education on AF and instructions on the use of the mHealth technology before discharge from the ED. A case coordinator will subsequently check whether patients are able to activate the mHealth solution and to perform heart rate and rhythm measurements. Forty hours after AF onset, the first assessment teleconsultation with the physician will take place, determining the need for delayed cardioversion. After maximal 7 days of remote monitoring, a second assessment teleconsultation may occur, in which the rhythm can be reassessed and further treatment strategy can be discussed with the patients. This on-demand mHealth prescription increases patient involvement in the care process and treatment decision-making by encouraging self-management, while avoiding excess data-load requiring work-intensive and expensive data management. Implementation of the TeleWAS-AF approach may facilitate the management of AF in the ED and reduce the burden on the ED system, which enhances the capacity for health care utilization., (© 2021 S. Karger AG, Basel.)

Competing Interests: Supported by Heart Foundation Limburg, FibriCheck and Biosense Webster.

In fruit growing preharvest sprayings in the orchard are mainly applied to protect fruit from decaying. Next to multisite fungicides (captan, thiram, tolylfluanid) the most commonly used products recognized for the Belgium market are Bellis (pyraclostrobin & boscalid) and the combination of Topsin M (thiophanate-methyl) and Frugico (diethofencarb). In general the spraying schedule varies depending on weather conditions (infection risk), preharvest interval of available fungicides, fruitgrower and cultivar of pome fruit (apple/pear). Facing the climatological conditions before picking the residue loading on the fruit surface can differ enormously. Also wet (pre)grading is considered to decrease the product residue resulting to fruits which are less protected before entering the cold storage room. In this context a partially replacement of the preharvest treatments by one postharvest application could offer a reliable alternative to the PPP reduction program (Plant Protection Products) in the orchard. A standardized application method by dipping or drenching will cover the fruits homogenically resulting in a rationalized fungicide use compared to the preharvest sprayings in the orchard. For the Belgium market Philabuster (imazalil & pyrimethanil) is registered for postharvest treatments since for this product a proper solution for the waste water of postharvest uses was developed to protect surface waters (Funds technology). Philabuster provides an advanced mould control towards fruit rot pathogens Gloeosporium spp., Botrytis cinerea and Penicillium spp. In this context several trials were set up to evaluate the biological efficacy of Philabuster alone or in combination with preharvest sprayings in the orchard. In concrete different preharvest spraying schedules were applied in the last six weeks before harvest on apple and pear facing parameters as rational fungicide use, antifungal effectiveness and cost price. The purpose was to select the optimal combination in use of preharvest fungicides with Philabuster as postharvest treatment, which offer full protection towards all key pathogens in apple and pear.

As new fungicides are mainly unisite action fungicides, the problem of fungicide resistance development is becoming more important every year. Combining chemical fungicides, which is the best anti-resistance strategy, is not always possible or recommended in the case when the number of available chemical fungicides are limited or a reduction in fungicide use is asked for. Therefore the use of salts as an anti-resistance strategy was looked upon. The salts evaluated were K(HCO3), KH2PO3, KHPO4 and K2SiO3. When using these salts as an anti-resistance strategy the efficacy obtained when spraying the compounds alone was often to low to be used in rotation with chemical fungicides. Only with K(HCO3)2 a good efficacy can be observed in some years. The variation in efficacy with K(HCO3)2 observed is higher for powdery mildew. Chitosan was also included in the trials against powdery mildew, however chitosan had no effect on the infestation.

Stemphylium conidia and Pleospora ascospores were monitored in pear orchards in the region of Haspengouw in Belgium during the infectious periods of brown spot disease (end May - end August) in the years 2002, 2004 and 2005. The seasonal and daily dynamics of the captured fungal spores are discussed and a correlation analysis was performed to determine possible correlation with weather parameters. Furthermore the fungicide cover obtained by spraying upon climatological infection risk is compared with the inoculum pressure in the orchards. Pleospora ascospores were found until the end of May and discharge took place during rain events at the same time-points when Venturia inaequalis ascospores were detected. Although the fungi ejected during the same time period, the relative importance of the different spore peaks differed. The first conidia were detected at the end of May. After that date conidia were found almost every day. Seasonal dynamics of the conidia clearly differed between the years and also the number of spores retrieved differed. No spores were found below 7.5 degrees C and only at a temperature above 12.5 degrees C an increase in conidia was observed. When looking at the daily dynamics, a significant negative correlation was found between the aerial spore concentration and relative humidity and leaf wetness, and a significant positive correlation with wind, temperature and water vapor pressure deficit. When spraying upon a BSP-cast CR threshold value of 0.4, all days with spore discharges above 3 conidia/m3/day were covered in 2002 and 2004. In 2005, a year with very low infection risk and infestation, two periods with high spore discharge were not covered. The observations made show that incorporation of the inoculum pressure into the infection models will probably not lead to a big improvement of the infection models.

PHILABUSTER is a new post-harvest fungicide developed by Janssen Pharmaceutica N.V.. It provides an advanced mould control by post-harvest treatments of citrus and pome fruit. The product is formulated as a stable suspension concentrate intended for dilution in water before use. PHILABUSTER 400 SC contains 200 g/L imazalil and 200 g/L pyrimethanil. Both active ingredients have a different single site mode of action. Imazalil inhibits ergosterol biosynthesis (DMI), whereas pyrimethanil interferes with fungal enzyme secretion and methionine biosynthesis. Due to the combination of these low risk fungicides a good anti-resistance management can be obtained. In case of existing reduced sensitivity of a population to DMI or MBC fungicides, no cross-resistance with pyrimethanil was observed. PHILABUSTER showed good activity by post-harvest treatment against key pathogens on apple and pear Penicillium expansum (blue mold), Botrytis cinerea (gray mold) and Gloeosporium spp. (lenticel rot) in small and large scale experiments with artificial or natural infections. By dip treatment of large volumes of fruit (up to 50 tons) the depletion of both active ingredients in the treatment water was low, both when plastic or wooden bins were used. Lower dose rates resulted in an inferior and inconsistent residue level of both active ingredients on fruit. Possible advantages of post-harvest treatments versus field treatments for the control of storage diseases are discussed.