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Tse G, Lai ETH, Yeo JM, Yan BP. Electrophysiological Mechanisms of Bayés Syndrome: Insights from Clinical and Mouse Studies. Front Physiol 2016; 7:188. [PMID: 27303306 PMCID: PMC4886053 DOI: 10.3389/fphys.2016.00188] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 05/10/2016] [Indexed: 12/11/2022] Open
Abstract
Bayés syndrome is an under-recognized clinical condition characterized by inter-atrial block (IAB). This is defined electrocardiographically as P-wave duration > 120 ms and can be categorized into first, second and third degree IAB. It can be caused by inflammatory conditions such as systemic sclerosis and rheumatoid arthritis, abnormal protein deposition in cardiac amyloidosis, or neoplastic processes invading the inter-atrial conduction system, such as primary cardiac lymphoma. It may arise transiently during volume overload, autonomic dysfunction or electrolyte disturbances from vomiting. In other patients without an obvious cause, the predisposing factors are diabetes mellitus, hypertensive heart disease, and hypercholesterolemia. IAB has a strong association with atrial arrhythmogenesis, left atrial enlargement (LAE), and electro-mechanical discordance, increasing the risk of cerebrovascular accidents as well as myocardial and mesenteric ischemia. The aim of this review article is to synthesize experimental evidence on the pathogenesis of IAB and its underlying molecular mechanisms. Current medical therapies include anti-fibrotic, anti-arrhythmic and anti-coagulation agents, whereas interventional options include atrial resynchronization therapy by single or multisite pacing. Future studies will be needed to elucidate the significance of the link between IAB and atrial tachyarrhythmias in patients with different underlying etiologies and optimize the management options in these populations.
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Affiliation(s)
- Gary Tse
- Li Ka Shing Faculty of Medicine, School of Biomedical Sciences, University of Hong KongHong Kong, China
| | - Eric Tsz Him Lai
- Li Ka Shing Faculty of Medicine, School of Biomedical Sciences, University of Hong KongHong Kong, China
| | - Jie Ming Yeo
- School of Medicine, Imperial College LondonLondon, UK
| | - Bryan P. Yan
- Department of Medicine and Therapeutics, The Chinese University of Hong KongHong Kong, China
- Department of Epidemiology and Preventive Medicine, Monash UniversityMelbourne, VIC, Australia
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202
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Abstract
The analysis of P-wave template has been widely used to extract indices of Atrial Fibrillation (AF) risk stratification. The aim of this paper was to assess the potential of the analysis of the P-wave variability over time in patients suffering from atrial fibrillation. P-wave features extracted from P-wave template together with novel indices of P-wave variability have been estimated in a population of patients suffering from persistent AF and compared to those extracted from control subjects. We quantify the P-wave variability over time using three algorithms and we extracted three novel indices: one based on the cross-correlation coefficients among the P-waves (Cross-Correlation Index, CCI), one associated to variation in amplitude of the P-waves (Amplitude Dispersion Index, ADI), one sensible to the phase shift among P-waves (Warping Index, WI). The control group resulted to be characterized by shorter P-wave duration and by a less amount of fragmentation and variability, respect to AF patients. The parameter CCI shows the highest sensitivity (97.3%) and a good specificity (95%).
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203
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Álvarez-García J, Vives-Borrás M, Gomis P, Ordoñez-Llanos J, Ferrero-Gregori A, Serra-Peñaranda A, Cinca J. Electrophysiological Effects of Selective Atrial Coronary Artery Occlusion in Humans. Circulation 2016; 133:2235-42. [PMID: 27151531 DOI: 10.1161/circulationaha.116.021700] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 04/20/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The arrhythmogenesis of ventricular myocardial ischemia has been extensively studied, but models of atrial ischemia in humans are lacking. This study aimed at describing the electrophysiological alterations induced by acute atrial ischemia secondary to atrial coronary branch occlusion during elective coronary angioplasty. METHODS AND RESULTS Clinical data, 12-lead ECG, 12-hour Holter recordings, coronary angiography, and serial plasma levels of high-sensitivity troponin T and midregional proatrial natriuretic peptide were prospectively analyzed in 109 patients undergoing elective angioplasty of right or circumflex coronary arteries. Atrial coronary branches were identified and after the procedure patients were allocated into two groups: atrial branch occlusion (ABO, n=17) and atrial branch patency (non-ABO, n=92). In comparison with the non-ABO, patients with ABO showed: (1) higher incidence of periprocedural myocardial infarction (20% versus 53%, P=0.01); (2) more frequent intra-atrial conduction delay (19% versus 46%, P=0.03); (3) more marked PR segment deviation in the Holter recordings; and (4) higher incidence of atrial tachycardia (15% versus 41%, P=0.02) and atrial fibrillation (0% versus 12%, P=0.03). After adjustment by a propensity score, ABO was an independent predictor of periprocedural infarction (odds ratio, 3.4; 95% confidence interval, 1.01-11.6, P<0.05) and atrial arrhythmias (odds ratio, 5.1; 95% confidence interval, 1.2-20.5, P=0.02). CONCLUSIONS Selective atrial coronary artery occlusion during elective percutaneous transluminal coronary angioplasty is associated with myocardial ischemic damage, atrial arrhythmias, and intra-atrial conduction delay. Our data suggest that atrial ischemic episodes might be considered as a potential cause of atrial fibrillation in patients with chronic coronary artery disease.
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Affiliation(s)
- Jesús Álvarez-García
- From Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Spain (J.A.-G., M.V.-B., A.F.-G., A.S.-P., J.C.); Department ESAII, EUETIB, Universidad Politécnica de Cataluña, Barcelona, Spain (P.G.); and Biochemistry and Molecular Biology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Spain (J.O.-L.).
| | - Miquel Vives-Borrás
- From Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Spain (J.A.-G., M.V.-B., A.F.-G., A.S.-P., J.C.); Department ESAII, EUETIB, Universidad Politécnica de Cataluña, Barcelona, Spain (P.G.); and Biochemistry and Molecular Biology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Spain (J.O.-L.)
| | - Pedro Gomis
- From Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Spain (J.A.-G., M.V.-B., A.F.-G., A.S.-P., J.C.); Department ESAII, EUETIB, Universidad Politécnica de Cataluña, Barcelona, Spain (P.G.); and Biochemistry and Molecular Biology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Spain (J.O.-L.)
| | - Jordi Ordoñez-Llanos
- From Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Spain (J.A.-G., M.V.-B., A.F.-G., A.S.-P., J.C.); Department ESAII, EUETIB, Universidad Politécnica de Cataluña, Barcelona, Spain (P.G.); and Biochemistry and Molecular Biology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Spain (J.O.-L.)
| | - Andreu Ferrero-Gregori
- From Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Spain (J.A.-G., M.V.-B., A.F.-G., A.S.-P., J.C.); Department ESAII, EUETIB, Universidad Politécnica de Cataluña, Barcelona, Spain (P.G.); and Biochemistry and Molecular Biology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Spain (J.O.-L.)
| | - Antoni Serra-Peñaranda
- From Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Spain (J.A.-G., M.V.-B., A.F.-G., A.S.-P., J.C.); Department ESAII, EUETIB, Universidad Politécnica de Cataluña, Barcelona, Spain (P.G.); and Biochemistry and Molecular Biology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Spain (J.O.-L.)
| | - Juan Cinca
- From Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Spain (J.A.-G., M.V.-B., A.F.-G., A.S.-P., J.C.); Department ESAII, EUETIB, Universidad Politécnica de Cataluña, Barcelona, Spain (P.G.); and Biochemistry and Molecular Biology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Spain (J.O.-L.)
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204
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Schenone E, Collin A, Gerbeau JF. Numerical simulation of electrocardiograms for full cardiac cycles in healthy and pathological conditions. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2016; 32:e02744. [PMID: 26249327 DOI: 10.1002/cnm.2744] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 07/29/2015] [Accepted: 08/03/2015] [Indexed: 06/04/2023]
Abstract
This work is dedicated to the simulation of full cycles of the electrical activity of the heart and the corresponding body surface potential. The model is based on a realistic torso and heart anatomy, including ventricles and atria. One of the specificities of our approach is to model the atria as a surface, which is the kind of data typically provided by medical imaging for thin volumes. The bidomain equations are considered in their usual formulation in the ventricles, and in a surface formulation on the atria. Two ionic models are used: the Courtemanche-Ramirez-Nattel model on the atria and the 'minimal model for human ventricular action potentials' by Bueno-Orovio, Cherry, and Fenton in the ventricles. The heart is weakly coupled to the torso by a Robin boundary condition based on a resistor-capacitor transmission condition. Various electrocardiograms (ECGs) are simulated in healthy and pathological conditions (left and right bundle branch blocks, Bachmann's bundle block, and Wolff-Parkinson-White syndrome). To assess the numerical ECGs, we use several qualitative and quantitative criteria found in the medical literature. Our simulator can also be used to generate the signals measured by a vest of electrodes. This capability is illustrated at the end of the article. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Elisa Schenone
- Sorbonne Universités UPMC, Paris, France
- Inria Paris-Rocquencourt, Paris, France
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205
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Russo V, Marano M. Letter to the Editor—Prevalence of interatrial block during lifetime. Heart Rhythm 2016; 13:e90-1. [PMID: 26744095 DOI: 10.1016/j.hrthm.2015.12.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Indexed: 11/27/2022]
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206
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Martínez-Sellés M, Fernández Lozano I, Baranchuk A, Bayes-Genis A, Bayés de Luna A. ¿Debemos anticoagular a pacientes en alto riesgo de sufrir fibrilación auricular? Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2016.01.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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207
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Martínez-Sellés M, Fernández Lozano I, Baranchuk A, Bayes-Genis A, Bayés de Luna A. Should We Anticoagulate Patients at High Risk of Atrial Fibrillation? ACTA ACUST UNITED AC 2016; 69:374-6. [PMID: 26944349 DOI: 10.1016/j.rec.2016.01.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 01/11/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Universidad Europea y Universidad Complutense, Madrid, Spain.
| | | | - Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Antoni Bayes-Genis
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
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208
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Martínez-Sellés M, Massó-van Roessel A, Álvarez-García J, García de la Villa B, Cruz-Jentoft AJ, Vidán MT, López Díaz J, Felix Redondo FJ, Durán Guerrero JM, Bayes-Genis A, Bayes de Luna A. Interatrial block and atrial arrhythmias in centenarians: Prevalence, associations, and clinical implications. Heart Rhythm 2016; 13:645-51. [PMID: 26520207 DOI: 10.1016/j.hrthm.2015.10.034] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Data are lacking on the characteristics of atrial activity in centenarians, including interatrial block (IAB). OBJECTIVE The aim of this study was to describe the prevalence of IAB and auricular arrhythmias in subjects older than 100 years and to elucidate their clinical implications. METHODS We studied 80 centenarians (mean age 101.4 ± 1.5 years; 21 men) with follow-ups of 6-34 months. Of these 80 centenarians, 71 subjects (88.8%) underwent echocardiography. The control group comprised 269 septuagenarians. RESULTS A total of 23 subjects (28.8%) had normal P wave, 16 (20%) had partial IAB, 21 (26%) had advanced IAB, and 20 (25.0%) had atrial fibrillation/flutter. The IAB groups exhibited premature atrial beats more frequently than did the normal P wave group (35.1% vs 17.4%; P < .001); also, other measurements in the IAB groups frequently fell between values observed in the normal P wave and the atrial fibrillation/flutter groups. These measurements included sex preponderance, mental status and dementia, perceived health status, significant mitral regurgitation, and mortality. The IAB group had a higher previous stroke rate (24.3%) than did other groups. Compared with septuagenarians, centenarians less frequently presented a normal P wave (28.8% vs 53.5%) and more frequently presented advanced IAB (26.3% vs 8.2%), atrial fibrillation/flutter (25.0% vs 10.0%), and premature atrial beats (28.3 vs 7.0%) (P < .01). CONCLUSION Relatively few centenarians (<30%) had a normal P wave, and nearly half had IAB. Our data suggested that IAB, particularly advanced IAB, is a pre-atrial fibrillation condition associated with premature atrial beats. Atrial arrhythmias and IAB occurred more frequently in centenarians than in septuagenarians.
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Affiliation(s)
- Manuel Martínez-Sellés
- Hospital General Universitario Gregorio Marañón y Universidad Europea y Universidad Complutense, Madrid, Spain.
| | | | - Jesús Álvarez-García
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - María Teresa Vidán
- Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | | | | | | | - Antoni Bayes-Genis
- Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
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209
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Gul EE, Baranchuk A. Advanced interatrial block as a predictor of atrial fibrillation following catheter ablation in the left atrium. J Cardiol 2016; 68:269. [PMID: 26917194 DOI: 10.1016/j.jjcc.2016.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 01/25/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Enes E Gul
- Division of Cardiology, Department of Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Adrian Baranchuk
- Division of Cardiology, Department of Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada.
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210
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Demirtas L, Turkmen K, Buyuklu M, Kocyigit I, Orscelik O. Atrial electromechanical delay and left atrial mechanical functions in hemodialysis and peritoneal dialysis patients. Int Urol Nephrol 2016; 48:781-9. [PMID: 26905405 DOI: 10.1007/s11255-016-1238-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 02/02/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Left atrium (LA) mechanical functions and atrial electromechanical delay (AEMD) times were considered independent predictors of cardiovascular morbidity in general population. Data are scant about these parameters in end-stage renal disease (ESRD) patients receiving hemodialysis (HD) and peritoneal dialysis (PD). We aimed to evaluate AEMD times and LA mechanical functions and associated risk factors in HD and PD patients. METHODS Forty-four healthy individuals, 62 HD and 50 PD patients were enrolled in the study. Echocardiography was performed before midweek dialysis session for HD patients and on admission for PD patients. Data were expressed as mean ± SD. Spearman's test was used to assess linear associations. Predictors of left intra-atrial EMD time and LA active emptying volume (LAaeV) were assessed by regression analysis. RESULTS Left intra-atrial-AEMD times were significantly longer in HD patients compared to PD patients. LAaeV was positively correlated with inter-atrial time, left intra-atrial time, systolic and diastolic BP, calcium and neutrophil-to-lymphocyte ratio (NLR) (r 0.22, p 0.016; r 0.28, p 0.002; r 0.34, p < 0.001; r 0.35, p < 0.001; r 0.37, p < 0.001; r 0.46, p < 0.001, respectively) and negatively correlated with serum uric acid (r -0.31, p 0.013) in ESRD patients. We found positive correlations between left intra-atrial time and LAaeV, LAVmax, LAVp and NLR (r 0.28, p 0.002; r 0.27, p 0.003; r 0.27, p 0.003; r 0.22, p 0.03, respectively) and negative correlations with albumin, uric acid and potassium (r -0.24, p 0.008; r -0.19, p 0.04; r -0.26, p 0.037, respectively). Advanced age, decreased serum albumin and increased NLR were found to be independent predictors of LAaeV; however, only NLR was found to be an independent predictor of AEMD time in this population. CONCLUSIONS Increased inflammation might be a risk factor of AEMD and LA mechanical dysfunction in ESRD patients.
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Affiliation(s)
- Levent Demirtas
- Department of Internal Medicine, Erzincan University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey
| | - Kultigin Turkmen
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Konya Necmettin Erbakan University, 42080, Konya, Turkey.
| | - Mutlu Buyuklu
- Department of Cardiology, Erzincan University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey
| | - Ismail Kocyigit
- Division of Nephrology, Department of Internal Medicine, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Ozcan Orscelik
- Department of Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey
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211
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Marano M, D'Amato A. Advanced interatrial block in hemodialysis patients. Hemodial Int 2016; 20:329-31. [DOI: 10.1111/hdi.12403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Marco Marano
- Hemodialysis Unit, Maria Rosaria Clinic; Pompeii Italy
| | - Anna D'Amato
- Hemodialysis Unit, Maria Rosaria Clinic; Pompeii Italy
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212
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Wu JT, Wang SL, Chu YJ, Long DY, Dong JZ, Fan XW, Yang HT, Duan HY, Yan LJ, Qian P, Yang CK. Usefulness of a Combination of Interatrial Block and a High CHADS 2 Score to Predict New Onset Atrial Fibrillation. Int Heart J 2016; 57:580-5. [DOI: 10.1536/ihj.15-505] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Jin-Tao Wu
- Department of Cardiology, Zhengzhou University People’s Hospital (Henan Provincial People’s Hospital)
| | - Shan-Ling Wang
- Department of Cardiology, Zhengzhou University People’s Hospital (Henan Provincial People’s Hospital)
| | - Ying-Jie Chu
- Department of Cardiology, Zhengzhou University People’s Hospital (Henan Provincial People’s Hospital)
| | - De-Yong Long
- Department of Cardiology, Center for Atrial Fibrillation, Beijing Anzhen Hospital, Capital Medical University
| | - Jian-Zeng Dong
- Department of Cardiology, Center for Atrial Fibrillation, Beijing Anzhen Hospital, Capital Medical University
| | - Xian-Wei Fan
- Department of Cardiology, Zhengzhou University People’s Hospital (Henan Provincial People’s Hospital)
| | - Hai-Tao Yang
- Department of Cardiology, Zhengzhou University People’s Hospital (Henan Provincial People’s Hospital)
| | - Hong-Yan Duan
- Department of Cardiology, Zhengzhou University People’s Hospital (Henan Provincial People’s Hospital)
| | - Li-Jie Yan
- Department of Cardiology, Zhengzhou University People’s Hospital (Henan Provincial People’s Hospital)
| | - Peng Qian
- Department of Cardiology, Zhengzhou University People’s Hospital (Henan Provincial People’s Hospital)
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213
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Conde D, Seoane L, Gysel M, Mitrione S, Bayés de Luna A, Baranchuk A. Bayés' syndrome: the association between interatrial block and supraventricular arrhythmias. Expert Rev Cardiovasc Ther 2015; 13:541-50. [PMID: 25907617 DOI: 10.1586/14779072.2015.1037283] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The past few years have given rise to extensive research on atrial conduction disorders and their clinical relevance. Most notably, an association between interatrial block and supraventricular arrhythmias has been discovered. This disorder, recently termed 'Bayés' syndrome', has important clinical implications. In this article, the authors review normal atrial conduction and associated disorders. A particular focus is placed on Bayés' syndrome and the relationship between interatrial block and supraventricular arrhythmias in different clinical scenarios. The report also outlines the current progress in the study of this syndrome and highlights areas requiring further investigation.
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Affiliation(s)
- Diego Conde
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
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214
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Wu JT, Long DY, Dong JZ, Wang SL, Fan XW, Yang HT, Duan HY, Yan LJ, Qian P, Yang CK. Advanced interatrial block predicts clinical recurrence of atrial fibrillation after catheter ablation. J Cardiol 2015; 68:352-6. [PMID: 26611936 DOI: 10.1016/j.jjcc.2015.10.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 10/15/2015] [Accepted: 10/18/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND It has been demonstrated that advanced interatrial block (IAB) is associated with an increased risk of atrial fibrillation (AF); however, the impact of advanced IAB on recurrence of paroxysmal AF after catheter ablation is not clear. METHODS 204 consecutive patients with paroxysmal AF who underwent index circumferential pulmonary vein (PV) isolation were prospectively enrolled. In all patients, a resting electrocardiogram in sinus rhythm was evaluated for the presence of advanced IAB, defined as a P-wave duration >120ms and biphasic (±) morphology in the inferior leads. Advanced IAB was detected in 20.1% of patients. AF recurrence was defined as the occurrence of confirmed atrial tachyarrhythmia lasting more than 30s beyond 3 months after the catheter ablation in the absence of any antiarrhythmic treatment. RESULTS During the mean follow-up period of 13.9±6.2 months (range, 3-27 months), 62 patients (30.4%) developed recurrence of AF. The recurrence rate was higher in patients with advanced IAB than those without advanced IAB (46.3% vs. 26.4%, p=0.006). Cox regression analysis with adjustment for age, P-wave duration, CHADS2 score, and PV isolation identified advanced IAB (hazard ratio, 2.111; 95% confidence interval, 1.034-4.308; p=0.040) and left atrial diameter (hazard ratio, 1.051; 95% confidence interval, 1.004-1.100; p=0.034) as two independent predictors of recurrence of AF. CONCLUSIONS Patients with advanced IAB were at an increased risk of AF recurrence after catheter ablation.
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Affiliation(s)
- Jin-Tao Wu
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - De-Yong Long
- Department of Cardiology, Center for Atrial Fibrillation, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jian-Zeng Dong
- Department of Cardiology, Center for Atrial Fibrillation, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shan-Ling Wang
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Xian-Wei Fan
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Hai-Tao Yang
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Hong-Yan Duan
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Li-Jie Yan
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Peng Qian
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Chao-Kuan Yang
- Department of Cardiology, Henan Medical College, Zhengzhou, China.
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215
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Affiliation(s)
- Larissa Fabritz
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom, and Department of Cardiovascular Medicine, University Hospital Münster, Germany.
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216
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Baranchuk A, de Luna AB, Breithardt G. To the Editor--The role of advanced interatrial block pattern as a predictor of atrial fibrillation. Heart Rhythm 2015; 13:e87. [PMID: 26598323 DOI: 10.1016/j.hrthm.2015.11.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada.
| | | | - Guenter Breithardt
- Department Kardiologie und Angiologie, Universitätsklinikum Münster (UKM), Münster, Germany
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217
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Sadiq Ali F, Enriquez A, Redfearn D, Baranchuk A. P-wave pseudonormalization after iatrogenic coronary sinus isolation. J Electrocardiol 2015; 49:13-4. [PMID: 26381799 DOI: 10.1016/j.jelectrocard.2015.08.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Indexed: 10/23/2022]
Abstract
We report a case of a 58 year old gentleman with prior history of catheter ablation for persistent atrial fibrillation (AF). His baseline ECG showed sinus rhythm with a broad and notched P-wave in lead II and biphasic P-wave (positive/negative) in leads III and aVF previously described as advanced interatrial block. A redo ablation procedure was performed due to AF recurrence. An iatrogenic isolation of the coronary sinus (CS) was observed during ablation with marked narrowing and loss of the terminal negative component of the P-wave on the surface ECG.
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Affiliation(s)
- Fariha Sadiq Ali
- Division of Cardiology, Department of Medicine, Kingston General Hospital, Queen's University, Kingston ON, Canada
| | - Andres Enriquez
- Division of Cardiology, Department of Medicine, Kingston General Hospital, Queen's University, Kingston ON, Canada
| | - Damian Redfearn
- Division of Cardiology, Department of Medicine, Kingston General Hospital, Queen's University, Kingston ON, Canada
| | - Adrian Baranchuk
- Division of Cardiology, Department of Medicine, Kingston General Hospital, Queen's University, Kingston ON, Canada.
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218
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Electrocardiographic Predictors of Cardiovascular Mortality. DISEASE MARKERS 2015; 2015:727401. [PMID: 26257460 PMCID: PMC4519551 DOI: 10.1155/2015/727401] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 06/20/2015] [Accepted: 07/02/2015] [Indexed: 01/26/2023]
Abstract
Cardiovascular diseases are the main causes of mortality. Sudden cardiac death may also appear in athletes, due to underlying congenital or inherited cardiac abnormalities. The electrocardiogram is used in clinical practice and clinical trials, as a valid, reliable, accessible, inexpensive method. The aim of the present paper was to review electrocardiographic (ECG) signs associated with cardiovascular mortality and the mechanisms underlying those associations, providing a brief description of the main studies in this area, and consider their implication for clinical practice in the general population and athletes. The main ECG parameters associated with cardiovascular mortality in the present paper are the P wave (duration, interatrial block, and deep terminal negativity of the P wave in V1), prolonged QT and Tpeak-Tend intervals, QRS duration and fragmentation, bundle branch block, ST segment depression and elevation, T waves (inverted, T wave axes), spatial angles between QRS and T vectors, premature ventricular contractions, and ECG hypertrophy criteria.
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219
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de Luna AB, Massó-van Roessel A, Robledo LAE. The Diagnosis and Clinical Implications of Interatrial Block. Eur Cardiol 2015; 10:54-59. [PMID: 30310424 PMCID: PMC6159419 DOI: 10.15420/ecr.2015.10.01.54] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 07/16/2015] [Indexed: 11/04/2022] Open
Abstract
Impaired interatrial conduction or interatrial block is now well-documented but is not described as an individual electrocardiographic (ECG) pattern in the majority of ECG literature. In fact the term atrial abnormality has been adopted to encompass both left atrial enlargement (LAE) and interatrial block. In this paper, we maintain that interatrial blocks and atrial enlargement are separate entities, and that interatrial blocks, similar to other types of blocks at sinoatrial, AV junctional, and ventricular level, exhibit a specific ECG pattern that may present first, second, and third degree types of conduction block. The third degree or advanced interatrial block (A-IAB) is frequently associated with atrial fibrillation/atrial flutter (AF/AFl), and constitutes a true newly-described syndrome.
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220
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Jacquemet V. Modeling left and right atrial contributions to the ECG: A dipole-current source approach. Comput Biol Med 2015; 65:192-9. [PMID: 26149374 DOI: 10.1016/j.compbiomed.2015.06.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 05/15/2015] [Accepted: 06/08/2015] [Indexed: 10/23/2022]
Abstract
This paper presents the mathematical formulation, the numerical validation and several illustrations of a forward-modeling approach based on dipole-current sources to compute the contribution of a part of the heart to the electrocardiogram (ECG). Clinically relevant applications include identifying in the ECG the contributions from the right and the left atrium. In a Courtemanche-based monodomain computer model of the atria and torso, 1000 dipoles distributed throughout the atrial mid-myocardium are found to be sufficient to reproduce body surface potential maps with a relative error <1% during both sinus rhythm and atrial fibrillation. When the boundary element method is applied to solve the forward problem, this approach enables fast offline computation of the ECG contribution of any anatomical part of the atria by applying the principle of superposition to the dipole sources. In the presence of a right-left activation delay (sinus rhythm), pulmonary vein isolation (sinus rhythm) or left-right differences in refractory period (atrial fibrillation), the decomposition of the ECG is shown to help interpret ECG morphology in relation to the atrial substrate. These tools provide a theoretical basis for a deeper understanding of the genesis of the P wave or fibrillatory waves in normal and pathological cases.
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Affiliation(s)
- Vincent Jacquemet
- Université de Montréal, Département de Physiologie Moléculaire et Intégrative, Montréal, Canada; Hôpital du Sacré-Coeur de Montréal, Centre de Recherche, 5400 boul. Gouin Ouest, Montréal, Quebec, Canada H4J 1C5.
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221
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van Oosten E, Baranchuk A. Interatrial Block Is Not a Predictor of Post-CABG Atrial Fibrillation. J Cardiothorac Vasc Anesth 2015; 29:e63. [PMID: 26006160 DOI: 10.1053/j.jvca.2015.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Erik van Oosten
- Division of Internal Medicine, London Health Sciences Centre, Western University, London, ON, Canada
| | - Adrian Baranchuk
- Division of Cardiology, Kingston General Hospital Queen's University, Kingston, ON, Canada
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222
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Park JK, Park J, Uhm JS, Joung B, Lee MH, Pak HN. Low P-wave amplitude (<0.1 mV) in lead I is associated with displaced inter-atrial conduction and clinical recurrence of paroxysmal atrial fibrillation after radiofrequency catheter ablation. Europace 2015; 18:384-91. [DOI: 10.1093/europace/euv028] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 01/27/2015] [Indexed: 11/14/2022] Open
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223
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Conde D, Baranchuk A, Bayés de Luna A. Advanced interatrial block as a substrate of supraventricular tachyarrhythmias: a well recognized syndrome. J Electrocardiol 2015; 48:135-40. [DOI: 10.1016/j.jelectrocard.2014.12.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Indexed: 11/29/2022]
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224
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Second-degree interatrial block in hemodialysis patients. Case Rep Cardiol 2015; 2015:468493. [PMID: 25755895 PMCID: PMC4338407 DOI: 10.1155/2015/468493] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 01/24/2015] [Indexed: 11/18/2022] Open
Abstract
Interatrial conduction delays manifest as a prolonged P-wave duration on surface ECG and the term interatrial block (IAB) has been coined. They are usually fixed, but cases of intermittent IAB have been described, suggesting functional conduction block at the Bachmann bundle region. We report 2 cases of patients on chronic hemodialysis therapy presenting with intermittent IAB.
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225
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Enriquez A, Sarrias A, Villuendas R, Ali FS, Conde D, Hopman WM, Redfearn DP, Michael K, Simpson C, De Luna AB, Bayés-Genís A, Baranchuk A. New-onset atrial fibrillation after cavotricuspid isthmus ablation: identification of advanced interatrial block is key. Europace 2015; 17:1289-93. [PMID: 25672984 DOI: 10.1093/europace/euu379] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 11/25/2014] [Indexed: 12/19/2022] Open
Abstract
AIMS A significant proportion of patients develop atrial fibrillation (AF) following cavotricuspid isthmus (CTI) ablation for typical atrial flutter (AFl). The objective of this study was to assess whether the presence of advanced interatrial block (aIAB) was associated with an elevated risk of AF after CTI ablation in patients with typical AFl and no prior history of AF. METHODS AND RESULTS This study included patients with typical AFl and no prior history of AF that were referred for CTI ablation. Patients were excluded when they had received repeat ablations or did not demonstrate a bidirectional block. In all patients, a post-ablation electrocardiogram (ECG) in sinus rhythm was evaluated for the presence of aIAB, defined as a P-wave duration ≥120 ms and biphasic morphology in the inferior leads. New-onset AF was identified from 12-lead ECGs, Holter monitoring, and device interrogations. The cohort comprised 187 patients (age 67 ± 10.7 years; ejection fraction 55.8 ± 11.2%). Advanced interatrial block was detected in 18.2% of patients, and left atrium was larger in patients with aIAB compared with those without aIAB (46.2 ± 5.9 vs. 43.1 ± 6.0 mm; P = 0.01). Over a median follow-up of 24.2 months, 67 patients (35.8%) developed new-onset AF. The incidence of new-onset AF was greater in patients with aIAB compared with those without aIAB (64.7 vs. 29.4%; P < 0.001). After a comprehensive multivariate analysis, aIAB emerged as the strongest predictor of new-onset AF [odds ratio (OR) 4.2, 95% confidence interval (CI): 1.9-9.3; P < 0.001]. CONCLUSION Advanced interatrial block is a key predictor for high risk of new-onset AF after a successful CTI ablation in patients with typical AFl.
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Affiliation(s)
- Andres Enriquez
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Axel Sarrias
- Servicio de Cardiologia, Hospital Germans Trias I Pujol, Badalona, Catalunya, Spain
| | - Roger Villuendas
- Servicio de Cardiologia, Hospital Germans Trias I Pujol, Badalona, Catalunya, Spain Department of Medicine, Autonomous University Barcelona, Barcelona, Spain
| | - Fariha Sadiq Ali
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Diego Conde
- Insituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Wilma M Hopman
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Damian P Redfearn
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Kevin Michael
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | | | - Antoni Bayés De Luna
- Department of Medicine, Autonomous University Barcelona, Barcelona, Spain ICCC-Hospital Sant Pau, Barcelona, Catalunya, Spain Hospital de la Santa Creu i Sant Pau, Cardiovascular Research Center, CSIC-ICCC, Barcelona, Spain
| | - Antoni Bayés-Genís
- Servicio de Cardiologia, Hospital Germans Trias I Pujol, Badalona, Catalunya, Spain Department of Medicine, Autonomous University Barcelona, Barcelona, Spain
| | - Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
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226
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Sadiq Ali F, Enriquez A, Conde D, Redfearn D, Michael K, Simpson C, Abdollah H, Bayés de Luna A, Hopman W, Baranchuk A. Advanced Interatrial Block Predicts New Onset Atrial Fibrillation in Patients with Severe Heart Failure and Cardiac Resynchronization Therapy. Ann Noninvasive Electrocardiol 2015; 20:586-91. [PMID: 25639950 DOI: 10.1111/anec.12258] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Advanced interatrial block (aIAB) on the surface electrocardiogram (ECG), defined as a P-wave duration ≥120 milliseconds with biphasic (±) morphology in inferior leads, is frequently associated with atrial fibrillation (AF). The aim of this study was to determine whether preoperative aIAB could predict new-onset AF in patients with severe congestive heart failure (CHF) requiring cardiac resynchronization therapy (CRT). METHODS Retrospective analysis of consecutive patients with CHF and no prior history of AF undergoing CRT for standard indications. A baseline 12-lead ECG was obtained prior to device implantation and analyzed for the presence of aIAB. ECGs were scanned at 300 DPI and maximized 8×. Semiautomatic calipers were used to determine P-wave onset and offset. The primary outcome was the occurrence of AF identified through analyses of intracardiac electrograms on routine device follow-up. RESULTS Ninety-seven patients were included (74.2% male, left atrial diameter 45.5 ± 7.8 mm, 63% ischemic). Mean P-wave duration was 138.5 ± 18.5 milliseconds and 37 patients (38%) presented aIAB at baseline. Over a mean follow-up of 32 ± 18 months, AF was detected in 29 patients (30%) and the incidence was greater in patients with aIAB compared to those without it (62% vs 28%; P < 0.003). aIAB remained a significant predictor of AF occurrence after multivariate analysis (OR 4.1; 95% CI, 1.6-10.7; P < 0.003). CONCLUSION The presence of aIAB is an independent predictor of new-onset AF in patients with severe CHF undergoing CRT.
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Affiliation(s)
- Fariha Sadiq Ali
- Division of Cardiology, Department of Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Andres Enriquez
- Division of Cardiology, Department of Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Diego Conde
- Cardiovascular Institute of Buenos Aires, Buenos Aires, Argentina
| | - Damian Redfearn
- Division of Cardiology, Department of Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Kevin Michael
- Division of Cardiology, Department of Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Christopher Simpson
- Division of Cardiology, Department of Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Hoshiar Abdollah
- Division of Cardiology, Department of Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Antoni Bayés de Luna
- Division of Cardiology, Department of Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.,Hospital of Santa Creu i Sant Pau, Cardiovascular Research Center, CSIC-ICCC, Barcelona, Spain
| | - Wilma Hopman
- Division of Cardiology, Department of Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Adrian Baranchuk
- Division of Cardiology, Department of Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
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227
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Marano M, D'Amato A, Tomasino G, Izzo F, Capasso M, Auletta E. Prevalence and determinants of interatrial block in hemodialysis patients. Int Urol Nephrol 2015; 47:571-2. [PMID: 25604146 DOI: 10.1007/s11255-015-0914-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 01/12/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Marco Marano
- Hemodialysis Unit, Maria Rosaria Clinic, via Colle San Bartolomeo 50, 80045, Pompeii, Naples, Italy,
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228
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Sarrias A, Villuendas R, Baranchuk A, de Luna AB, Bayes-Genis A. To the Editor--Interatrial block: Another risk to take into account after radiofrequency ablation of typical atrial flutter. Heart Rhythm 2015; 12:e119-20. [PMID: 25576778 DOI: 10.1016/j.hrthm.2015.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Axel Sarrias
- Hospital Germans Trias i Pujol Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Roger Villuendas
- Hospital Germans Trias i Pujol Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain.
| | - Adrian Baranchuk
- Division of Cardiology, Queen's University Kingston, Ontario, Canada
| | - Antoni Bayés de Luna
- Hospital de la Santa Creu i Sant Pau Cardiovascular Research Center CSIC-ICCC, Barcelona, Spain
| | - Antoni Bayes-Genis
- Hospital Germans Trias i Pujol Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
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229
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The time for naming the Interatrial Block Syndrome: Bayes Syndrome. J Electrocardiol 2014; 48:133-4. [PMID: 25620789 DOI: 10.1016/j.jelectrocard.2014.12.022] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Indexed: 11/21/2022]
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230
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Marano M, D'Amato A, de Luna AB, Baranchuk A. Hemodialysis affects interatrial conduction. Ann Noninvasive Electrocardiol 2014; 20:299-300. [PMID: 25545395 DOI: 10.1111/anec.12252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Marco Marano
- Hemodialysis Unit, Maria Rosaria Clinic, Pompeii, Italy
| | - Anna D'Amato
- Hemodialysis Unit, Maria Rosaria Clinic, Pompeii, Italy
| | | | - Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
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231
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Prolonged P wave duration predicts stroke mortality among type 2 diabetic patients with prevalent non-major macrovascular disease. BMC Cardiovasc Disord 2014; 14:168. [PMID: 25425321 PMCID: PMC4280689 DOI: 10.1186/1471-2261-14-168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 11/18/2014] [Indexed: 11/30/2022] Open
Abstract
Background Prolonged P wave duration is a marker of delayed inter-atrial conduction which may predict cardiovascular disease (CVD). Type 2 diabetes is a risk factor for all atherosclerotic manifestations including stroke. We evaluated the prognostic significance of prolonged P wave duration among middle-aged Finnish type 2 diabetes patients with and without prevalent non-major macrovascular disease (PNMMVD) with respect to total and stroke mortality. Methods We followed up for 18 years 739 type 2 diabetic patients without previous major CVD event at baseline. Participants were stratified according to P wave duration (<114 or ≥114 ms) and PNMMVD (i.e. coronary heart disease defined as ischaemic ECG changes and typical symptoms of angina pectoris, or claudication; yes or no). The Cox proportional hazards model was used to estimate the joint association between P wave duration, PNMMVD and the mortality risk. Results During the follow-up, 509 patients died, and 59 of them died from stroke. Those who had prolonged P wave duration had 2.45 (95% confidence interval: 1.11-5.37) increased stroke mortality among PNMMVD patients. In patients without PNMMVD, there was no relationship between P wave duration and stroke mortality. Conclusions As an easily measurable factor P wave duration merits further studies with higher number of patients to evaluate its importance in the estimation of stroke risk in type 2 diabetic patients with PNMMVD.
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232
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Tereshchenko LG, Henrikson CA, Sotoodehnia N, Arking DE, Agarwal SK, Siscovick DS, Post WS, Solomon SD, Coresh J, Josephson ME, Soliman EZ. Electrocardiographic deep terminal negativity of the P wave in V(1) and risk of sudden cardiac death: the Atherosclerosis Risk in Communities (ARIC) study. J Am Heart Assoc 2014; 3:e001387. [PMID: 25416036 PMCID: PMC4338733 DOI: 10.1161/jaha.114.001387] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Identifying individuals at risk for sudden cardiac death (SCD) is of critical importance. Electrocardiographic (ECG) deep terminal negativity of P wave in V1 (DTNPV1), a marker of left atrial abnormality, has been associated with increased risk of all‐cause and cardiovascular mortality. We hypothesized that DTNPV1 is associated with increased risk of sudden cardiac death (SCD). Methods and Results This analysis included 15 375 participants (54.1±5.8 years, 45% men, 73% whites) from the Atherosclerosis Risk in Communities (ARIC) study. DTNPV1 was defined from the resting 12‐lead ECG as presence of biphasic P wave (positive/negative) in V1 with the amplitude of the terminal negative phase >100 μV, or one small box on ECG scale. After a median of 14 years of follow‐up, 311 cases of SCD occurred. In unadjusted Cox regression, DTNPV1 was associated with an 8‐fold increased risk of SCD (HR 8.21; [95%CI 5.27 to 12.79]). Stratified by race and study center, and adjusted for age, sex, coronary heart disease (CHD), and ECG risk factors, as well as atrial fibrillation (AF), stroke, CHD, and heart failure (HF) as time‐updated variables, the risk of SCD associated with DTNPV1 remained significant (2.49, [1.51–4.10]). DTNPV1 improved reclassification: additional 3.4% of individuals were appropriately reclassified into a higher SCD risk group, as compared with traditional CHD risk factors alone. In fully adjusted models DTNPV1 was associated with increased risk of non‐fatal events: AF (5.02[3.23–7.80]), CHD (2.24[1.43–3.53]), HF (1.90[1.19–3.04]), and trended towards increased risk of stroke (1.88[0.99–3.57]). Conclusion DTNPV1 is predictive of SCD suggesting its potential utility in risk stratification in the general population.
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Affiliation(s)
- Larisa G Tereshchenko
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (L.G.T., W.S.P.) Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR (L.G.T., C.A.H.)
| | - Charles A Henrikson
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR (L.G.T., C.A.H.)
| | | | - Dan E Arking
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.E.A.)
| | - Sunil K Agarwal
- Department of Epidemiology, Internal Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins School of Public Health, Baltimore, MD (S.K.A., J.C.)
| | - David S Siscovick
- University of Washington, Seattle, WA (N.S., D.S.S.) The New York Academy of Medicine, New York, NY (D.S.S.)
| | - Wendy S Post
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (L.G.T., W.S.P.)
| | - Scott D Solomon
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.D.S.)
| | - Josef Coresh
- Department of Epidemiology, Internal Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins School of Public Health, Baltimore, MD (S.K.A., J.C.)
| | - Mark E Josephson
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (M.E.J.)
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Division of Public Health Sciences and Department of Medicine, Cardiology Section, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.)
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Enriquez A, Conde D, Hopman W, Mondragon I, Chiale PA, de Luna AB, Baranchuk A. Advanced interatrial block is associated with recurrence of atrial fibrillation post pharmacological cardioversion. Cardiovasc Ther 2014; 32:52-6. [PMID: 24417765 DOI: 10.1111/1755-5922.12063] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Management of atrial fibrillation (AF) is hampered by frequent recurrences after restoration of sinus rhythm. Delayed interatrial conduction has been associated with the development of AF in different clinical settings. The aim of our study was to assess whether advanced interatrial block (aIAB) was associated with AF recurrence after pharmacological cardioversion with two different antiarrhythmic drugs. METHODS We included 61 patients with recent onset AF without structural heart disease that underwent successful pharmacological cardioversion. Thirty-one patients received a single oral dose of propafenone, and 30 patients received iv vernakalant. A 12-lead ECG (filter 150 Hz, 25 mm/s, 10 mm/mV) after conversion was evaluated for the presence of interatrial block (IAB); partial (pIAB): P-wave duration > 120 ms, and advanced (aIAB): P-wave > 120 ms and biphasic morphology (±) in inferior leads. Clinical follow-up and electrocardiographic recordings were performed for a 12-month period. RESULTS Age was 58 ± 10.4 years and 50.8% were male. aIAB was present in 11 patients (18%) and pIAB in 10 (16.4%). At 1-year follow-up, 22 patients (36%) had AF recurrence. The recurrence rate with aIAB was 90.9% versus 70% in those with pIAB and 12.5% in normal P-wave duration (P = 0.001). The presence of aIAB was strongly associated with AF recurrence (odds ratio 18.4 in multivariable modeling). Recurrence was not affected by the drug used for cardioversion (P = 0.92). CONCLUSION Advanced interatrial block is associated with higher risk of AF recurrence at 1 year after pharmacological cardioversion, independent of the drug used.
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Affiliation(s)
- Andres Enriquez
- Division of Cardiology, Queen's University, Kingston, ON, Canada
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234
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Reply to the Editor— Interatrial Block: An Anatomic-Electrical Entity Still in Need of Compelling Prospective Data. Heart Rhythm 2014; 11:e198. [DOI: 10.1016/j.hrthm.2014.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Indexed: 11/20/2022]
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235
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MIKHAYLOV EVGENYN, MITROFANOVA LUBOVB, VANDER MARIANNAA, TATARSKIY ROMANB, KAMENEV ALEXANDERV, ABRAMOV MIKHAILL, SZILI-TOROK TAMAS, LEBEDEV DMITRYS. Biatrial Tachycardia Following Linear Anterior Wall Ablation for the Perimitral Reentry: Incidence and Electrophysiological Evaluations. J Cardiovasc Electrophysiol 2014; 26:28-35. [DOI: 10.1111/jce.12543] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 08/21/2014] [Accepted: 08/21/2014] [Indexed: 11/27/2022]
Affiliation(s)
- EVGENY N. MIKHAYLOV
- Department of Electrophysiology, Federal Almazov Medical Research Centre; Saint-Petersburg Russian Federation
- Department of Neuromodulation, Federal Almazov Medical Research Centre; Saint-Petersburg Russian Federation
| | - LUBOV B. MITROFANOVA
- Department of Pathology, Federal Almazov Medical Research Centre; Saint-Petersburg Russian Federation
| | - MARIANNA A. VANDER
- Department of Electrophysiology, Federal Almazov Medical Research Centre; Saint-Petersburg Russian Federation
- Department of Neuromodulation, Federal Almazov Medical Research Centre; Saint-Petersburg Russian Federation
| | - ROMAN B. TATARSKIY
- Department of Electrophysiology, Federal Almazov Medical Research Centre; Saint-Petersburg Russian Federation
| | - ALEXANDER V. KAMENEV
- Department of Electrophysiology, Federal Almazov Medical Research Centre; Saint-Petersburg Russian Federation
- Department of Neuromodulation, Federal Almazov Medical Research Centre; Saint-Petersburg Russian Federation
| | - MIKHAIL L. ABRAMOV
- Department of Electrophysiology, Federal Almazov Medical Research Centre; Saint-Petersburg Russian Federation
- Department of Neuromodulation, Federal Almazov Medical Research Centre; Saint-Petersburg Russian Federation
| | | | - DMITRY S. LEBEDEV
- Department of Electrophysiology, Federal Almazov Medical Research Centre; Saint-Petersburg Russian Federation
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236
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Francia P, Ricotta A, Balla C, Adduci C, Semprini L, Frattari A, Modestino A, Mercanti F, Sensini I, Caprinozzi M, Tocci G, Volpe M. P-wave duration in lead aVR and the risk of atrial fibrillation in hypertension. Ann Noninvasive Electrocardiol 2014; 20:167-74. [PMID: 25200638 DOI: 10.1111/anec.12197] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hypertension entails atrial remodeling that affect P-wave (PW) duration on electrocardiogram (ECG). PW indices (e.g., variance, dispersion, and terminal force) are associated with a higher risk for atrial fibrillation (AF), but their calculation requires multiple measurements of PW duration, limiting their use in clinical practice. We evaluated whether PW duration in specific ECG leads may identify patients with increased susceptibility to AF in a population of hypertensive patients. METHODS In a case-control study, AF and control subjects were matched for age, sex, and left atrial (LA) dimensions. PW duration was measured from digitally stored ECGs. Logistic regression was used to assess the association of PW duration and indices with AF. RESULTS We enrolled 44 hypertensive AF patients (16 paroxysmal and 28 persistent) and 44 hypertensive controls. AF and control subjects were matched for sex (males, n = 27), age (67 ± 8 years), LA diameter (40 ± 5 mm), and were comparable for left ventricular mass (45 ± 11 g/m(2.7) vs 48 ± 12 g/m(2.7) , P = 0.19), ejection fraction (58 ± 7% in both groups), and prevalence of mild valvular heart disease (7% vs 5%; P = 0.64). PW duration in lead aVR was significantly higher in AF patients as compared with controls (115 ± 18 ms vs 101 ± 14 ms; P < 0.0001) and was the best independent predictor of AF in multivariable logistic regression (PW ≥ 100 ms: RR = 3.7; 95% CI: 1.3-10.3; P = 0.02). CONCLUSIONS Simple measurement of PW duration in lead aVR allows effective identification of AF patients in a population of hypertensives. Confirmation of this finding in a larger population would provide a simple and effective risk marker of AF in hypertensive patients.
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Affiliation(s)
- Pietro Francia
- Division of Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University, Rome, Italy
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237
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Enriquez A, Conde D, Redfearn DP, Baranchuk A. Progressive interatrial block and supraventricular arrhythmias. Ann Noninvasive Electrocardiol 2014; 20:394-6. [PMID: 25201217 DOI: 10.1111/anec.12208] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Interatrial conduction disorders are frequent in patients with structural heart diseases, including hypertension, coronary disease, and hypertrophic cardiomyopathy, and they are strongly associated with atrial tachyarrhythmias, especially atrial fibrillation and flutter. Conduction delays lead to dispersion of refractory periods and participate in initiating and maintaining reentry circuits, facilitating atrial arrhythmias. In this case, the changing pattern over time is a manifestation of progressive atrial remodeling and conduction delay. The terminal negative component of the P wave in the inferior leads suggests block of the electrical impulse in the Bachman bundle zone, with retrograde activation of the left atria via muscular connections at the coronary sinus. This has been reproduced in experimental models and confirmed by endocardial mapping. Physicians should be aware of the association between advanced interatrial block and development of atrial arrhythmias as its recognition could prompt early and aggressive antiarrhythmic treatment.
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Affiliation(s)
- Andres Enriquez
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Diego Conde
- Cardiovascular Institute from Buenos Aires, Buenos Aires, Argentina
| | - Damian P Redfearn
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
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238
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La conduction intracardiaque. ANNALES FRANCAISES DE MEDECINE D URGENCE 2014. [DOI: 10.1007/s13341-014-0424-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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239
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Nikus K. Antonio Bayés de Luna — the man behind the BaMa ECG Symposia. J Electrocardiol 2014; 47:745-7. [DOI: 10.1016/j.jelectrocard.2014.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Indexed: 10/25/2022]
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240
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Chhabra L, Devadoss R, Chaubey VK, Spodick DH. Interatrial block in the modern era. Curr Cardiol Rev 2014; 10:181-9. [PMID: 24827803 PMCID: PMC4040870 DOI: 10.2174/1573403x10666140514101748] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 01/25/2013] [Accepted: 01/28/2014] [Indexed: 12/13/2022] Open
Abstract
Interatrial block (IAB; P-wave duration ≥ 110 ms), which represents a delay in the conduction between the atria, is a pandemic conduction abnormality that is frequently underappreciated in clinical practice. Despite its comprehensive documentation in the medical literature, it has still not received adequate attention and also not adequately described and discussed in most cardiology textbooks. IAB can be of varying degrees and classified based on the degree of P-duration and its morphology. It can transform into a higher degree block and can also manifest transiently. IAB may be a preceding or causative risk factor for various atrial arrhythmias (esp. atrial fibrillation) and also be associated with various other clinical abnormalities ranging from left atrial dilation and thromboembolism including embolic stroke and mesenteric ischemia. IAB certainly deserves more attention and prospective studies are needed to formulate a standard consensus regarding appropriate management strategies.
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241
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Tereshchenko LG, Shah AJ, Li Y, Soliman EZ. Electrocardiographic deep terminal negativity of the P wave in V1 and risk of mortality: the National Health and Nutrition Examination Survey III. J Cardiovasc Electrophysiol 2014; 25:1242-8. [PMID: 24837486 DOI: 10.1111/jce.12453] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/05/2014] [Accepted: 05/12/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Deep terminal negativity of P wave in V1 (DTNPV1), defined as negative P prime larger than one small box (1 mm, or 0.1 mV), could be easily detected by simple visual inspection of the resting 12-lead ECG. The objective of this study was to determine the relationship between DTNPV1 and all-cause-, cardiovascular disease (CVD), and ischemic heart disease (IHD) mortality in the National Health and Nutrition Examination Survey III (NHANES III). METHODS AND RESULTS After exclusion of participants with atrial fibrillation and missing data, DTNPV1 was automatically measured from standard 12-lead ECG in 8,146 participants. Minnesota and Novacode algorithms were used for the determination of major and minor ECG abnormalities. National Death Index was used to identify the date and cause of death. During a median follow-up of 13.8 years, a total of 2,975 deaths (1,303 CVD and 742 IHD deaths) occurred. After adjustment for age, gender, race/ethnicity, IHD, heart failure, chronic obstructive pulmonary disease, cancer, diabetes, body mass index, smoking, dyslipidemia, hypertension, use of antihypertensive and lipid-lowering medications, and ECG abnormalities, DTNPV1 was associated with significantly increased risk of all-cause death (HR [95% CI]: 1.30 [1.10, 1.53]; P = 0.002), CVD death (HR [95% CI]: 1.36 [1.08, 1.72]; P = 0.010), and IHD death (HR [95% CI]: 1.36 [1.00, 1.85]; P = 0.047). CONCLUSION In a large sample of the adult United States population, DTNPV1 is independently associated with increased risk of death due to all-cause, CVD, and IHD, findings suggesting its potential usefulness as a simple marker to identify individuals at risk of poor outcomes.
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Affiliation(s)
- Larisa G Tereshchenko
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
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242
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ALMEHAIRI MOHAMMED, BARANCHUK ADRIAN, JOHRI AMER, CALDWELL JANE. An Unusual Cause of Automatic Mode Switching in the Absence of an Atrial Tachyarrhythmia. Pacing Clin Electrophysiol 2014; 37:777-80. [DOI: 10.1111/pace.12296] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Revised: 09/12/2013] [Accepted: 09/13/2013] [Indexed: 11/30/2022]
Affiliation(s)
- MOHAMMED ALMEHAIRI
- Cardiology Division; Kingston General Hospital; Queen's University; Kingston Ontario Canada
| | - ADRIAN BARANCHUK
- Cardiology Division; Kingston General Hospital; Queen's University; Kingston Ontario Canada
| | - AMER JOHRI
- Cardiology Division; Kingston General Hospital; Queen's University; Kingston Ontario Canada
| | - JANE CALDWELL
- Cardiology Division; Kingston General Hospital; Queen's University; Kingston Ontario Canada
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243
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Enriquez A, Conde D, Femenia F, de Luna AB, Ribeiro A, Muratore C, Valentino M, Retyk E, Galizio N, Hopman WM, Baranchuk A. Relation of interatrial block to new-onset atrial fibrillation in patients with Chagas cardiomyopathy and implantable cardioverter-defibrillators. Am J Cardiol 2014; 113:1740-3. [PMID: 24698463 DOI: 10.1016/j.amjcard.2014.02.036] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 02/21/2014] [Accepted: 02/21/2014] [Indexed: 01/05/2023]
Abstract
Chagas cardiomyopathy is an endemic disease in Latin America. A significant proportion of patients develop atrial fibrillation (AF), which may result in stroke and increased morbidity or mortality. Interatrial block (IAB) has been associated with the development of AF in different clinical scenarios. The aim of our study was to determine whether IAB can predict new-onset AF in patients with Chagas cardiomyopathy and implantable cardioverter-defibrillators (ICDs). We conducted a retrospective study of patients with Chagas cardiomyopathy and ICDs from 14 centers in Latin America. Demographics, clinical, and device follow-up were collected. Surface electrocardiograms were scanned at 300 dpi and maximized ×8. Semiautomatic calipers were used to determine P-wave onset and offset. Partial IAB was defined as a P wave of >120 ms and advanced IAB as a P wave of >120 ms with biphasic morphology (±) in inferior leads. AF events and ICD therapies were reviewed during follow-up by 2 independent investigators. A total of 80 patients were analyzed. Mean age was 54.6 ± 10.4 years, and 52 (65%) were male. Mean left ventricular ejection fraction was 40 ± 12%. IAB was detected in 15 patients (18.8%), with 8 (10.0%) partial and 7 (8.8%) advanced. During a follow-up of 33 ± 20 months, 11 patients (13.8%) presented with new AF. IAB (partial + advanced) was strongly associated with new AF (p <0.0001) and inappropriate therapy by the ICD (p = 0.014). In conclusion, IAB (partial + advanced) predicted new-onset AF in patients with Chagas cardiomyopathy and ICDs.
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Affiliation(s)
| | - Diego Conde
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | | | - Antoni Bayés de Luna
- Cardiovascular Research Center, CSIC-ICCC, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Antonio Ribeiro
- Universidade Federal de Minais Gerais, Belo Horizonte, Brazil
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244
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Baranchuk A, Conde D, Enriquez A, de Luna AB. P-wave duration or P-wave morphology? Interatrial block: seeking for the Holy Grail to predict AF recurrence. Ann Noninvasive Electrocardiol 2014; 19:406-8. [PMID: 24829074 DOI: 10.1111/anec.12156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
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245
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Conde D, Baranchuk A. [Interatrial block as anatomical-electrical substrate for supraventricular arrhythmias: Bayés syndrome]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2014; 84:32-40. [PMID: 24529591 DOI: 10.1016/j.acmx.2013.10.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 10/23/2013] [Accepted: 10/23/2013] [Indexed: 12/17/2022] Open
Abstract
In this article we aimed to establish that interatrial block exists as an anatomical-electrical entity, which should be considered a true block. Interatrial block presents with different degrees as other blocks in the conduction system. It shows a correlation with the left atrium size, however, it can be seen in patients with normal atrial size too. Interatrial block is strongly associated with atrial arrhythmias and it could be considered a predictor of cardioembolic stroke. Interatrial block is an expression of atrial electrical remodeling and dysfunction. IAB can be transient and in certain clinical circumstances, may be reversible. The contribution of endocardial mapping has increased our knowledge of the anatomy and pathophysiology of interatrial block. Magnetocardiography could be a possible non-invasive procedure to further investigate this entity. The interatrial block classification should include first, second and third degree or alternatively, in order to simplify the terminology: partial or advanced. The P wave morphology should always be taking into consideration when diagnosing this condition. Finally, without the initial description of interatrial block made by Dr. Bayés de Luna, it would be impossible to understand interatrial block as an anatomical and electrical substrate for atrial arrhythmias. It is our opinion that this represents a major contribution to the knowledge of electrocardiography and electrophysiology, and makes commendable that this arrhythmic syndrome should be called «Bayés' syndrome»
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Affiliation(s)
- Diego Conde
- Cardiology Division, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina.
| | - Adrián Baranchuk
- Cardiology Division, Kingston General Hospital, Queen' University, Kingston, Ontario, Canada
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246
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Postmitral Valve Replacement Biatrial, Septal Macroreentrant Atrial Tachycardia Developing After Perimitral Flutter Ablation. Circ Arrhythm Electrophysiol 2014; 7:171-4. [DOI: 10.1161/circep.113.000656] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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247
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Conde D, van Oosten EM, Hamilton A, Petsikas D, Payne D, Redfearn DP, Hopman WM, Bayés de Luna A, Baranchuk A. Prevalence of interatrial block in patients undergoing coronary bypass graft surgery. Int J Cardiol 2014; 171:e98-9. [DOI: 10.1016/j.ijcard.2013.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 12/05/2013] [Indexed: 11/26/2022]
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248
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Prolonged P-wave duration is associated with atrial fibrillation recurrence after successful pulmonary vein isolation for paroxysmal atrial fibrillation. J Interv Card Electrophysiol 2013; 39:131-8. [PMID: 24306110 DOI: 10.1007/s10840-013-9851-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 10/14/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED Pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) is successful in ∼70-80 % after repeated procedures. This suggests a subgroup of PAF patients where electrical abnormalities outside the pulmonary veins are important. Prolonged P-wave duration (PWD), a marker of atrial remodelling, may identify this subgroup. This study's aim was to assess the association of PWD on standard 12 lead ECG with AF recurrence post PVI. METHODS Retrospectively, ECGs were blindly analysed on PVI patients from August 2007-August 2011; patients with persistent AF, mitral valve disease, undergoing redo procedures or no sinus rhythm (SR) ECG within 1 year of PVI were excluded. ECGs were directly uploaded at 300 dpi, amplified ×10, and then PWD measured in all leads. Prolonged PWD was as priori defined as maximum PWD ≥ 140 ms. RESULTS The selective cohort consisted of 100 patients out of a total of 170 PVI: age 58 ± 11 years, 72 % male, LVEF 62 ± 9 %, 18 % ischaemic heart disease and 13 % diabetic. Thirty-five had prolonged PWD, which was associated with greater AF recurrence rates compared to those without prolonged PWD (63 vs. 38 %, p < 0.05). Similarly, AF recurrence was associated with greater maximum PWD (139 ± 17 vs. 129 ± 14, p < 0.01), P-wave dispersion (58 ± 21 vs. 49 ± 15, p < 0.01), left atrium (LA) dimension (41 ± 6 vs. 38 ± 5, p < 0.05) and LA volumes (40 ± 14 vs. 34 ± 11, p < 0.05) compared to those who remained in SR. None of these variables were independent predictors of AF recurrence by multivariate analysis. CONCLUSION The presence of pre-existent prolonged PWD is associated with a higher risk of AF recurrence post PVI for paroxysmal AF.
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249
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Marano M. Electrocardiographic criteria for interatrial block. Int Urol Nephrol 2013; 45:1825. [DOI: 10.1007/s11255-013-0471-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 05/08/2013] [Indexed: 11/29/2022]
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250
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Baranchuk A, Villuendas R, Bayes-Genis A, Goldwasser D, Chiale P, Bayes de Luna A. Advanced interatrial block: a well-defined electrocardiographic pattern with clinical arrhythmological implications. Europace 2013; 15:1822. [DOI: 10.1093/europace/eut275] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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