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Jia S, Mou H, Wu Y, Lin W, Zeng Y, Chen Y, Chen Y, Zhang Q, Wang W, Feng C, Xia S. A Simple Logistic Regression Model for Predicting the Likelihood of Recurrence of Atrial Fibrillation Within 1 Year After Initial Radio-Frequency Catheter Ablation Therapy. Front Cardiovasc Med 2022; 8:819341. [PMID: 35155619 PMCID: PMC8828909 DOI: 10.3389/fcvm.2021.819341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 12/14/2021] [Indexed: 12/23/2022] Open
Abstract
Background The clinical factors associated with the recurrence of atrial fibrillation (Af) in patients undergoing catheter ablation (CA) are still ambiguous to date. Purpose 1. To recognize preoperative serologic factors and clinical features associated with Af recurrence after the first ablation treatment. 2. To Develop a Logical Regression Model for Predicting the Likelihood of Recurrence Within 1 Year After the Initial Radio-Frequency Catheter Ablation (RFCA) Therapy. Methods Atrial fibrillation patients undergoing RFCA at our institution from January 2016 to June 2021 were included in the analysis (n = 246). A combined dataset of relevant parameters was collected from the participants (clinical characteristics, laboratory results, and time to recurrence) (n = 200). We performed the least absolute shrinkage and selection operator (Lasso) regression with 100 cycles, selecting variables present in all 100 cycles to identify factors associated with the first recurrence of atrial fibrillation. A logistic regression model for predicting whether Af would recur within a year was created using 70% of the data as a training set and the remaining data to validate the accuracy. The predictions were assessed using calibration plots, concordance index (C-index), and decision curve analysis. Results The left atrial diameter, albumin, type of Af, whether other arrhythmias were combined, and the duration of Af attack time were associated with Af recurrence in this sample. Some clinically meaningful variables were selected and combined with recognized factors associated with recurrence to construct a logistic regression prediction model for 1-year Af recurrence. The receiver operating characteristic (ROC) curve for this model was 0.8695, and the established prediction model had a C-index of 0.83. The performance was superior to the extreme curve in the decision curve analysis. Conclusion Our study demonstrates that several clinical features and serological markers can predict the recurrence of Af in patients undergoing RFCA. This simple model can play a crucial role in guiding physicians in preoperative evaluation and clinical decision-making.
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Affiliation(s)
- Sixiang Jia
- Department of Heart Center, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, China
| | - Haochen Mou
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yiteng Wu
- Department of Heart Center, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, China
| | - Wenting Lin
- Department of Heart Center, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, China
| | - Yajing Zeng
- Department of Heart Center, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, China
| | - Yiwen Chen
- Department of Heart Center, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, China
| | - Yayu Chen
- Department of Heart Center, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, China
| | - Qi Zhang
- Department of Heart Center, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, China
| | - Wei Wang
- Department of Heart Center, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, China
| | - Chao Feng
- Department of Heart Center, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, China
| | - Shudong Xia
- Department of Heart Center, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, China
- *Correspondence: Shudong Xia
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Risk factors for recurrence of atrial fibrillation. Anatol J Cardiol 2020; 25:338-345. [PMID: 33960309 DOI: 10.14744/anatoljcardiol.2020.80914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Atrial fibrillation (AF) is a progressive disease, associated with increased risk of mortality, stroke, heart failure, and worsens quality of life. There is a high incidence of AF recurrence despite the treatment. The aim of the study was to assess the time to recurrence of AF after sinus rhythm restoration with electrical or pharmacological cardioversion and to identify the risk factors. METHODS This study included 101 patients with AF (56% females) at a mean age of 68.02±7 years, after sinus rhythm restoration in a clinical observation of 1-year placebo-controlled treatment with spironolactone (1: 1). The patients were analyzed on the basis of AF recurrence, hospitalization, demographic parameters, comorbidities, embolic risk, and value of biomarker galectin-3 (Gal-3). RESULTS The average number of AF recurrences was1.62 per patient per year. The median time of occurrence of at least one new episode was 48 days, 95% confidence interval (CI) 14.24-81.76. Female patients experienced significantly more recurrences than male-53.3% vs. 28.6% hazard ration (HR) =1.76, 95% CI 1.02-3.03, p=0.036. The recurrences were more common with increased age, although not significantly. Patients with arterial hypertension had a threefold risk of recurrences than those without hypertension (p=0.025), independently of the treatment. CHA2DS2-VASc score was significantly associated with AF recurrent episodes. Patients with gout had a twofold increased risk, without statistical significance (p=0.15). There was no difference in the AF episodes according to treatment with spironolactone. The levels of Gal-3 did not affect the number of AF recurrences (p=0.9). CONCLUSION AF is associated with frequent recurrences after restoration of sinus rhythm in the majority of the patients. Most of them occurred within the first 3 months. Female sex, arterial hypertension, and CHA2DS2-VASc score were significant predictors of AF recurrence. Spironolactone did not reduce AF recurrences.
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Tsioufis C, Konstantinidis D, Nikolakopoulos I, Vemmou E, Kalos T, Georgiopoulos G, Vogiatzakis N, Ifantis A, Konstantinou K, Gennimata V, Tousoulis D. Biomarkers of Atrial Fibrillation in Hypertension. Curr Med Chem 2019; 26:888-897. [DOI: 10.2174/0929867324666171006155516] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 12/05/2017] [Accepted: 12/30/2017] [Indexed: 12/20/2022]
Abstract
Background:
Atrial fibrillation (AF) is the most frequently encountered cardiac
arrhythmia globally and substantially increases the risk for thromboembolic disease.
Albeit, 20% of all cases of AF remain undiagnosed. On the other hand, hypertension amplifies
the risk for both AF occurrences through hemodynamic and non-hemodynamic
mechanisms and cerebrovascular ischemia. Under this prism, prompt diagnosis of undetected
AF in hypertensive patients is of pivotal importance.
Method:
We conducted a review of the literature for studies with biomarkers that could
be used in AF diagnosis as well as in predicting the transition of paroxysmal AF to sustained
AF, especially in hypertensive patients.
Results:
Potential biomarkers for AF can be broadly categorized into electrophysiological,
morphological and molecular markers that reflect the underlying mechanisms of adverse
atrial remodeling. We focused on P-wave duration and dispersion as electrophysiological
markers, and left atrial (LA) and LA appendage size, atrial fibrosis, left ventricular
hypertrophy and aortic stiffness as structural biomarkers, respectively. The heterogeneous
group of molecular biomarkers of AF encompasses products of the neurohormonal
cascade, including NT-pro BNP, BNP, MR-pro ANP, polymorphisms of the ACE and
convertases such as corin and furin. In addition, soluble biomarkers of inflammation (i.e.
CRP, IL-6) and fibrosis (i.e. TGF-1 and matrix metalloproteinases) were assessed for predicting
AF.
Conclusion:
The reviewed individual biomarkers might be a valuable addition to current
diagnostic tools but the ideal candidate is expected to combine multiple indices of atrial
remodeling in order to effectively detect both AF and adverse characteristics of high risk
patients with hypertension.
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Affiliation(s)
- Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Dimitris Konstantinidis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Ilias Nikolakopoulos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Evi Vemmou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Theodoros Kalos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Georgios Georgiopoulos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Nikolaos Vogiatzakis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Aris Ifantis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Konstantinou Konstantinou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Vasiliki Gennimata
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
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El-Harasis MA, DeSimone CV, Yao X, Noseworthy PA. Prediction and Management of Recurrences after Catheter Ablation in Atrial Fibrillation and Heart Failure. Cardiol Clin 2019; 37:221-230. [PMID: 30926023 DOI: 10.1016/j.ccl.2019.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Catheter ablation is recommended in patients with symptomatic atrial fibrillation (AF) refractory to pharmacologic therapy. AF recurrence is common postablation, particularly in patients with heart failure, because of multiple structural and functional changes that can occur. Determining predictors of AF recurrence has become increasingly important. These include increased left atrial volume, termination of AF during the index ablation, electrocardiogram parameters, and serum biomarkers. Cardiac MRI can also determine the degree of scarring and left atrial sphericity, which is used in risk prediction scores. In patients with recurrence, further treatment options include pharmacologic therapy and atrioventricular nodal ablation with pacing.
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Affiliation(s)
- Majd A El-Harasis
- Division of Internal Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Christopher V DeSimone
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Xiaoxi Yao
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Peter A Noseworthy
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Prevalence, significance and reversal of abnormal P-wave indices in hypertension: A review and meta-analysis. J Electrocardiol 2019; 53:13-17. [DOI: 10.1016/j.jelectrocard.2018.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 11/23/2018] [Accepted: 12/12/2018] [Indexed: 11/23/2022]
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Korhonen M, Parkkonen J, Hedman M, Muuronen A, Onatsu J, Mustonen P, Vanninen R, Taina M. Morphological features of the left atrial appendage in consecutive coronary computed tomography angiography patients with and without atrial fibrillation. PLoS One 2017; 12:e0173703. [PMID: 28288200 PMCID: PMC5348027 DOI: 10.1371/journal.pone.0173703] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 02/25/2017] [Indexed: 01/01/2023] Open
Abstract
The majority of intracardiac thrombi form in the left atrial appendage (LAA). Enlargement of this structure, together with certain morphological features, may indicate a predisposition to the formation of thrombi and subsequent cardioembolic stroke. Thus far, studies on LAA morphology have largely focused on those patients with atrial fibrillation (AF). Taking a different approach, we investigated the variation in LAA morphology in a consecutive patient population with and without AF. We evaluated 808 consecutive patients (529 females; mean age 52.5±9.9 years) who underwent coronary artery computed tomography angiography (CCTA), the majority of whom (749) had no history of AF. We assessed the length, lobe number, and morphological classification of their LAAs. Demographic data and medical histories were collated from medical records and then correlated with LAA morphology. The proportions of each of the four morphological classes of LAA for the overall vs. non-AF population were: WindSock, 62.3/61.5%; Cactus, 18.6/18.8%; ChickenWing, 10.0/10.0%; and CauliFlower, 9.2/9.6%. Age (p<0.001; r = 0.156) and female gender (p<0.001) were both found to be associated with an increased body surface area (BSA)-related LAA length. Male patients were more likely to manifest multi-lobed (p = 0.003) LAAs, and overweight patients with a greater number of multi-lobed LAA morphological classes (p = 0.010). No associations with morphological LAA features could be found for patients with diabetes, hypertension, or dyslipidemia. Nor did the size of the left atrium exhibit any correlation with BSA-related LAA length. In the overall and non-AF populations, aging and female gender were associated with longer BSA-indexed LAAs.
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Affiliation(s)
- Miika Korhonen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- * E-mail:
| | - Johannes Parkkonen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Marja Hedman
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Antti Muuronen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Juha Onatsu
- Neuro Center, Kuopio University Hospital, Kuopio, Finland
| | - Pirjo Mustonen
- Department of Cardiology, Keski-Suomi Central Hospital, Jyväskylä, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mikko Taina
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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Russo V, Di Meo F, Rago A, Mosella M, Molino A, Russo MG, Nigro G. Impact of Continuous Positive Airway Pressure Therapy on Atrial Electromechanical Delay in Obesity-Hypoventilation Syndrome Patients. J Cardiovasc Electrophysiol 2015; 27:327-34. [PMID: 26552735 DOI: 10.1111/jce.12879] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 10/05/2015] [Accepted: 10/30/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Obesity-hypoventilation syndrome (OHS) is defined as daytime hypercapnia and hypoxemia in obese patients with sleep-disordered breathing. We evaluated the electrocardiographic P-wave duration and dispersion (PD) and echocardiographic noninvasive indicators of atrial conduction heterogeneity in OHS patients and the impact of CPAP on atrial conduction and atrial fibrillation incidence. METHODS AND RESULTS We enrolled 50 OHS patients and 50 sex- and age-matched obese subjects as control. Study population underwent cardiologic evaluation and polysomnography before enrollment, at 1- and 6-month follow-ups after CPAP therapy. The OHS group showed a significant increase in inter-atrial (35.2 ± 8 milliseconds vs. 20.1 ± 2.7 milliseconds, P < 0.0001), intra-left (30.5 ± 7.2 milliseconds vs. 16.5 ± 2 milliseconds, P < 0.0001), and intra-right atrial electromechanical delays (AEMD)(24.8 ± 10 milliseconds vs. 15 ± 2.6 milliseconds, P < 0.0001) as well as in Pmax (130 ± 7.4 milliseconds vs. 97 ± 7.2 milliseconds, P = 0.002) and PD (56.5 ± 8.5 milliseconds vs. 31 ± 7.2 milliseconds, P = 0.002) compared to the control group. Significant improvement was noted after 6 months of CPAP therapy in inter-atrial (35.2 ± 8 milliseconds vs. 24.5 ± 6.3 milliseconds, P < 0.0001), intra-left (30.5 ± 7.2 milliseconds vs. 20.6 ± 5 milliseconds, P = 0.003), and intra-right AEMD (24.8 ± 10 milliseconds vs. 17 ± 7.5 milliseconds, P < 0.0001), as well as in Pmax (130 ± 7.4 milliseconds vs. 95 ± 10 milliseconds, P < 0.0001) and in PD (56.5 ± 8.5 milliseconds vs. 32.5 ± 6 milliseconds, P < 0.0001) in the OHS group. External loop recorder monitoring detected paroxysmal AF in 19 OHS patients (38%) with significant reduction in paroxysmal AF episodes (12 ± 6 vs. 47 ± 12, P < 0.0001) after 6-month CPAP therapy. CONCLUSION Our findings showed a significant increase of electrocardiographic and echocardiographic indexes of atrial conduction heterogeneity in OHS patients. The CPAP therapy, having a positive impact on atrial conduction time, seems to reduce AF incidence in OHS patients.
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Affiliation(s)
- Vincenzo Russo
- Chair of Cardiology, Second University of Naples, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Federica Di Meo
- Chair of Cardiology, Second University of Naples, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Anna Rago
- Chair of Cardiology, Second University of Naples, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Marco Mosella
- Division of Pneumology, Department of Respiratory Diseases, University of Naples Federico II, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Antonio Molino
- Division of Pneumology, Department of Respiratory Diseases, University of Naples Federico II, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Maria Giovanna Russo
- Chair of Cardiology, Second University of Naples, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Gerardo Nigro
- Chair of Cardiology, Second University of Naples, AORN dei Colli-Monaldi Hospital, Naples, Italy
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8
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Russo V, Rago A, Di Meo F, Papa AA, Ciardiello C, Cristiano A, Calabrò R, Russo MG, Nigro G. Atrial Septal Aneurysms and Supraventricular Arrhythmias: The Role of Atrial Electromechanical Delay. Echocardiography 2015; 32:1504-14. [PMID: 25735318 DOI: 10.1111/echo.12908] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Paroxysmal supraventricular arrhythmias (SVAs) frequently occur in patients with atrial septal aneurysm (ASA). The aim of the current study was to evaluate the electrocardiographic (P-wave duration and dispersion) and echocardiographic (atrial electromechanical delay, AEMD) noninvasive indicators of atrial conduction heterogeneity in healthy ASA subjects without interatrial shunt and to assess the AEMD role in predicting the SVAs onset in this population. MATERIALS AND METHODS One hundered ASA patients (41 males, mean age of 32.5 ± 8 years) and 100 healthy subjects used as controls, matched for age and gender, were studied for the occurrence of SVAs during a 4-year follow-up, through 30-day external loop recorder (ELR) monitoring performed every 3 months. ASAs were diagnosed by transthoracic echocardiography based on the criteria of a minimal aneurismal base of ≥15 mm and an excursion of ≥10 mm. Intra-AEMD and inter-AEMD of both atria were measured through tissue Doppler echocardiography. P-wave dispersion (PD) was carefully measured using 12-lead electrocardiogram (ECG). RESULTS Compared to the healthy control group, the ASA group showed a statistically significant increase in inter-AEMD, intra-left AEMD, maximum P-wave duration, and PD. Dividing the ASA group into 2 subgroups (patients with or without SVAs), the inter-AEMD, intra-left AEMD, P max, and PD were significantly higher in the subgroup with SVAs compared to the subgroup without SVAs. There were significant good correlations of intra-left AEMD and inter-AEMD with PD. A cutoff value of 40.1 msec for intra-left AEMD had a sensitivity of 82% and a specificity of 83% in identifying ASA patients at risk for SVA. CONCLUSION Our results showed that the echocardiographic AEMD indices (intra-left and inter-AEMD) and the PD were significantly increased in healthy ASA subjects without interatrial shunt. PD and AEMD represent noninvasive, inexpensive, useful, and simple parameters to assess the SVAs' risk in ASA patients.
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Affiliation(s)
- Vincenzo Russo
- Chair of Cardiology, Second University of Naples, Naples, Italy
| | - Anna Rago
- Chair of Cardiology, Second University of Naples, Naples, Italy
| | - Federica Di Meo
- Chair of Cardiology, Second University of Naples, Naples, Italy
| | | | | | - Anna Cristiano
- Chair of Cardiology, Second University of Naples, Naples, Italy
| | | | | | - Gerardo Nigro
- Chair of Cardiology, Second University of Naples, Naples, Italy
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Continuous positive airway pressure therapy converted atrial fibrillation in a patient with obstructive sleep apnea. J Arrhythm 2014. [DOI: 10.1016/j.joa.2013.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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10
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Vizzardi E, Curnis A, Latini MG, Salghetti F, Rocco E, Lupi L, Rovetta R, Quinzani F, Bonadei I, Bontempi L, D'Aloia A, Dei Cas L. Risk factors for atrial fibrillation recurrence: a literature review. J Cardiovasc Med (Hagerstown) 2014; 15:235-53. [PMID: 23114271 DOI: 10.2459/jcm.0b013e328358554b] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Atrial fibrillation is the most common arrhythmia managed in clinical practice and it is associated with an increased risk of mortality, stroke and peripheral embolism. Unfortunately, the incidence of atrial fibrillation recurrence ranges from 40 to 50%, despite the attempts of electrical cardioversion and the administration of antiarrhythmic drugs. In this review, the literature data about predictors of atrial fibrillation recurrence are highlighted, with special regard to clinical, therapeutic, biochemical, ECG and echocardiographic parameters after electrical cardioversion and ablation. Identifying predictors of success in maintaining sinus rhythm after cardioversion or ablation may allow a better selection of patients to undergo these procedures. The aim is to reduce healthcare costs and avoid exposing patients to unnecessary procedures and related complications. Recurrent atrial fibrillation depends on a combination of several parameters and each patient should be individually assessed for such a risk of recurrence.
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Affiliation(s)
- Enrico Vizzardi
- Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy
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Russo V, Rago A, Pannone B, Papa AA, Mayer MC, Spasiano A, Calabro R, Russo MG, Gerardo N. Atrial Fibrillation and Beta Thalassemia Major: The Predictive Role of the 12-lead Electrocardiogram Analysis. Indian Pacing Electrophysiol J 2014; 14:121-32. [PMID: 24948851 PMCID: PMC4032779 DOI: 10.1016/s0972-6292(16)30753-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Paroxysmal atrial tachyarrhythmias frequently occur in beta-thalassemia major (β-TM) patients.The aim of our study was to investigate the role of maximum P-wave duration (P max) and dispersion (PD), calculated trough a new manually performed measurement with the use of computer software from all 12-ECG-leads,as predictors of atrial-fibrillation (AF) in β-TM patients with conserved systolic or diastolic cardiac function during a twelve-months follow-up. MATERIALS AND METHODS 50 β-TM-patients (age38.4±10.1; 38M) and 50-healthy subjects used as controls, matched for age and gender, were studied for the occurrence of atrial arrhythmias during a 1-year follow-up, through ECG-Holter-monitoring performed every three months. The β-TM-patients were divided into two groups according to number and complexity of premature-supraventricular-complexes at the Holter-Monitoring (Group1: <30/h and no repetitive forms, n:35; Group2: >30/h or couplets, or run of supraventricular tachycardia and AF, n:15). RESULTS Compared to the healthy control-group, β-TM patients presented increased P-max (107.5± 21.2 vs 92.1±11ms, P=0.03) and PD-values (41.2±13 vs 25.1±5 ms,P=0.03). In the β-TM population, the Group2 showed a statistically significant increase in PD (42.8±8.6 vs 33.2±6.5ms, P<0.001) and P-max (118.1±8.7 vs 103.1±7.5ms, P<0.001) compared to the Group1. Seven β-TM patients who showed paroxysmal AF during this study had significantly increased P-max and PD than the other patients of the Group2. Moreover, P-max (OR:2.01; CI:1.12-3.59; P=0.01) and PD (OR=2.06;CI:1.17-3.64;P=0.01) demonstrated a statistically significant association with the occurrence of paroxysmal AF,P min was not associated with AF-risk (OR=0.99; CI:0.25-3.40; P=0.9) in β-TM-patients. A cut-off value of 111ms for P-max had a sensitivity of 80% and a specificity of 87%, a cut-off value of 35.5ms for PD had a sensitivity of 90% and a specificity of 85% in identifying β-TM patients at risk for AF. CONCLUSION Our results indicate that P-max and PD are useful electrocardiographic markers for identifying the β-TM-high-risk patients for AF onset, even when the cardiac function is conserved.
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Affiliation(s)
- Vincenzo Russo
- Chair of Cardiology, Second University of Naples, Naples, Italy
| | - Anna Rago
- Chair of Cardiology, Second University of Naples, Naples, Italy
| | - Bruno Pannone
- Internal Medicine Unit, Cardarelli Hospital, Naples, Italy
| | | | | | - Anna Spasiano
- Internal Medicine Unit, Cardarelli Hospital, Naples, Italy
| | | | | | - Nigro Gerardo
- Chair of Cardiology, Second University of Naples, Naples, Italy
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Blanch Gracia P, Freixa Pamias R, Codinach Huix P, Martin Baranera M, Armario García P. Predictores electrocardiográficos y ecocardiográficos de fibrilación auricular en pacientes hipertensos. HIPERTENSION Y RIESGO VASCULAR 2013. [DOI: 10.1016/j.hipert.2012.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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13
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Russo V, Rago A, Pannone B, Di Meo F, Papa AA, Mayer MC, Spasiano A, Russo MG, Golino P, Calabrò R, Nigro G. Early electrocardiographic evaluation of atrial fibrillation risk in beta-thalassemia major patients. Int J Hematol 2011; 93:446-451. [PMID: 21512730 DOI: 10.1007/s12185-011-0801-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 02/15/2011] [Accepted: 02/15/2011] [Indexed: 02/01/2023]
Abstract
Although previous studies have documented a variety of electrocardiogram abnormalities in beta-thalassemia major (β-TM), little is known about P-wave dispersion (PD), an independent risk factor for development of atrial fibrillation. The aim of our study was to evaluate PD in β-TM patients with conserved systolic and diastolic functions. The study involved 40 β-TM patients (age 37.5 ± 10.2; 33 M) and 40 healthy subjects used as controls, matched for age and gender. PD was carefully measured using a 12-lead electrocardiogram. Cardiac iron levels were measured by cardiac magnetic resonance T2 star (CMR T2*) imaging. Comparing to the healthy control group, β-TM group presented increased values of the PD (40.1 ± 12.9 vs. 24 ± 7 ms; P < 0.004) and decreased CMR T2* imaging (29 ± 15 vs. 55 ± 13 ms; P = 0.03). We found a significant correlation between PD and CMR T2* values. Our study showed a significant increase of PD in β-TM patients with conserved systolic and diastolic cardiac functions. Our results indicate that PD is correlated to myocardial iron deposit, as assessed by CMR T2* imaging.
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Affiliation(s)
- Vincenzo Russo
- Department of Cardiology, Second University of Naples, Via Leonardo Bianchi, 80100, Naples, Italy.
| | - Anna Rago
- Department of Cardiology, Second University of Naples, Via Leonardo Bianchi, 80100, Naples, Italy
| | - Bruno Pannone
- Internal Medicine Unit, Cardarelli Hospital, Naples, Italy
| | - Federica Di Meo
- Department of Cardiology, Second University of Naples, Via Leonardo Bianchi, 80100, Naples, Italy
| | - Andrea Antonio Papa
- Department of Cardiology, Second University of Naples, Via Leonardo Bianchi, 80100, Naples, Italy
| | | | - Anna Spasiano
- Microcitemia Center, Cardarelli Hospital, Naples, Italy
| | - Maria Giovanna Russo
- Department of Cardiology, Second University of Naples, Via Leonardo Bianchi, 80100, Naples, Italy
| | - Paolo Golino
- Department of Cardiology, Second University of Naples, Via Leonardo Bianchi, 80100, Naples, Italy
| | - Raffaele Calabrò
- Department of Cardiology, Second University of Naples, Via Leonardo Bianchi, 80100, Naples, Italy
| | - Gerardo Nigro
- Department of Cardiology, Second University of Naples, Via Leonardo Bianchi, 80100, Naples, Italy
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