{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T07:52:03Z","timestamp":1781596323773,"version":"3.54.5"},"reference-count":29,"publisher":"IOP Publishing","issue":"6","license":[{"start":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T00:00:00Z","timestamp":1781568000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T00:00:00Z","timestamp":1781568000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/iopscience.iop.org\/info\/page\/text-and-data-mining"}],"funder":[{"DOI":"10.13039\/501100004329","name":"Slovenian Research Agency","doi-asserted-by":"crossref","award":["J3-50116"],"award-info":[{"award-number":["J3-50116"]}],"id":[{"id":"10.13039\/501100004329","id-type":"DOI","asserted-by":"crossref"}]},{"name":"General and Teaching Hospital Celje, Slovenija"}],"content-domain":{"domain":["iopscience.iop.org"],"crossmark-restriction":false},"short-container-title":["Physiol. Meas."],"published-print":{"date-parts":[[2026,6,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    <jats:italic>Objective.<\/jats:italic>\n                    Atrial fibrillation (AF) is common in critically ill patients and is associated with increased mortality. Two treatment strategies are used: rhythm control and heart rate (HR) control; however, the optimal HR target in the latter remains uncertain. This study aimed to develop and compare methods for determining the target HR range using transthoracic echocardiography and physiological-signal analysis.\n                    <jats:italic>Approach.<\/jats:italic>\n                    The study was performed in a level 3 medical ICU. A custom software tool (OIIM_Python) was developed to analyse ECG, arterial pressure, and respiratory waveforms; to compute HR (HR_py) and cardiac output (CO) (CO_py). These measurements were compared with echocardiography, which provided five consecutive left ventricular outflow tract velocity\u2013time integrals (VTI_echo) and corresponding HR (HR_echo). In phase one, 7 patients in sinus rhythm were assessed, yielding 31 paired measurements under variable preload and afterload conditions. In phase two, 13 patients with AF contributed 101 paired measurements. For both methods, mean and maximal CO were calculated, and the target HR was defined as the HR at which CO reached its maximum.\n                    <jats:italic>Main Results.<\/jats:italic>\n                    In sinus rhythm, HR_py and CO_py showed minimal bias relative to echocardiography (\u20131.48 bpm and\u20140.0003 l min\n                    <jats:sup>\u22121<\/jats:sup>\n                    , respectively) with clinically acceptable agreement. In AF, maximal CO_echo was significantly higher than mean CO_echo (5.24 \u00b1 1.30 vs 4.79\u202f \u00b1 1.42\u202fl min\n                    <jats:sup>\u22121<\/jats:sup>\n                    ; +9%,\n                    <jats:italic>p<\/jats:italic>\n                    \u202f&lt;\u202f0.001), and target HR was significantly lower than mean HR_echo (98\u202f \u00b1 19 vs 110 \u00b1 15 bpm;\u201411%,\n                    <jats:italic>p<\/jats:italic>\n                    \u202f&lt;\u202f0.001). Physiological-signal analysis similarly showed higher maximal CO_py compared with mean CO_py (6.03 \u00b1 1.59 vs 5.32 \u00b1 1.41\u202fl min\n                    <jats:sup>\u22121<\/jats:sup>\n                    ; +12%,\n                    <jats:italic>p<\/jats:italic>\n                    \u202f&lt;\u202f0.001), and target HR was substantially lower than mean HR_py (89 \u00b1 17 vs 114 \u00b1 15 bpm;\u201422%,\n                    <jats:italic>p<\/jats:italic>\n                    \u202f&lt;\u202f0.001).\n                    <jats:italic>Significance.<\/jats:italic>\n                    This feasibility study demonstrates that target HR associated with maximal CO can be estimated in critically ill patients with AF using echocardiography and\/or physiological-signal analysis. These methods may support individualized HR-targeted management but require validation in larger multicentre interventional studies.\n                  <\/jats:p>","DOI":"10.1088\/1361-6579\/ae779a","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T22:56:10Z","timestamp":1780527370000},"page":"065002","update-policy":"https:\/\/doi.org\/10.1088\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Individualized target heart rate in critically ill atrial fibrillation patients: insights from echocardiography and physiological signal analysis"],"prefix":"10.1088","volume":"47","author":[{"given":"Kolar Kus","family":"Petra","sequence":"first","affiliation":[{"name":"General and Teaching Hospital Celje"},{"name":"University of Ljubljana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D\u2019Angelo","family":"Andrea","sequence":"additional","affiliation":[{"name":"General and Teaching Hospital Celje"},{"name":"University of Naples Federico II."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u017dgavc","family":"Borut","sequence":"additional","affiliation":[{"name":"General and Teaching Hospital Celje"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Podbregar","family":"Lev","sequence":"additional","affiliation":[{"name":"University of Ljubljana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mati Djuraki","family":"Ur\u0161a","sequence":"additional","affiliation":[{"name":"University of Ljubljana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7750-415X","authenticated-orcid":true,"given":"Podbregar","family":"Matej","sequence":"additional","affiliation":[{"name":"General and Teaching Hospital Celje"},{"name":"University of Ljubljana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"266","published-online":{"date-parts":[[2026,6,16]]},"reference":[{"key":"pmeaae779abib1","unstructured":"(Available at: https:\/\/repozitorij.uni-lj.si\/IzpisGradiva.php?id=179165&lang=eng )","type":"dataset"},{"key":"pmeaae779abib2","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/840615","type":"journal-article","article-title":"Management of atrial fibrillation in critically ill patients","volume":"2014","author":"Arrigo","year":"2014","journal-title":"Crit. 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A multicenter randomized clinical trial (Landi-SEP)","volume":"50","author":"Rehberg","year":"2024","journal-title":"Intensive Care Med."},{"key":"pmeaae779abib19","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2023.131673","type":"journal-article","article-title":"Atrial fibrillation and survival on a medical intensive care unit","volume":"399","author":"Rottmann","year":"2024","journal-title":"Int. J. Cardiol."},{"key":"pmeaae779abib20","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1016\/j.phrs.2017.06.004","type":"journal-article","article-title":"Effectiveness of heart rate control on hemodynamics in critically ill patients with atrial tachyarrhythmias managed by amiodarone","volume":"122","author":"Salem","year":"2017","journal-title":"Pharmacol. 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Neurol."},{"key":"pmeaae779abib28","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcha.2021.100742","type":"journal-article","article-title":"Rhythm-control therapy for new-onset atrial fibrillation in critically ill patients: a post hoc analysis from the prospective multicenter observational AFTER-ICU study","volume":"33","author":"Yoshida","year":"2021","journal-title":"IJC Heart Vasc."},{"key":"pmeaae779abib29","doi-asserted-by":"publisher","first-page":"1395","DOI":"10.1016\/j.jacep.2024.03.006","type":"journal-article","article-title":"Rhythm vs rate control strategy for atrial fibrillation: a meta-analysis of randomized controlled trials","volume":"10","author":"Zafeiropoulos","year":"2024","journal-title":"JACC Clin. 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Published on behalf of Institute of Physics and Engineering in Medicine by IOP Publishing Ltd","name":"copyright_information","label":"Copyright Information"},{"value":"2026-03-31","name":"date_received","label":"Date Received","group":{"name":"publication_dates","label":"Publication dates"}},{"value":"2026-06-03","name":"date_accepted","label":"Date Accepted","group":{"name":"publication_dates","label":"Publication dates"}},{"value":"2026-06-16","name":"date_epub","label":"Online publication date","group":{"name":"publication_dates","label":"Publication dates"}}]}}