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Müller-Edenborn B, Chen J, Allgeier J, Didenko M, Moreno-Weidmann Z, Neumann FJ, Lehrmann H, Weber R, Arentz T, Jadidi A. Amplified sinus-P-wave reveals localization and extent of left atrial low-voltage substrate: implications for arrhythmia freedom following pulmonary vein isolation. Europace 2021; 22:240-249. [PMID: 31782781 DOI: 10.1093/europace/euz297] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/18/2019] [Indexed: 11/14/2022] Open
Abstract
AIMS Presence of arrhythmogenic left atrial (LA) low-voltage substrate (LVS) is associated with reduced arthythmia freedom rates following pulmonary vein isolation (PVI) in persistent atrial fibrillation (AF). We hypothesized that LA-LVS modifies amplified sinus-P-wave (APW) characteristics, enabling identification of patients at risk for arrhythmia recurrences following PVI. METHODS AND RESULTS Ninety-five patients with persistent AF underwent high-density (>1200 sites) voltage mapping in sinus rhythm. Left atrial low-voltage substrate (<0.5 and <1.0 mV) was quantified in a 10-segment LA model. Amplified sinus-P-wave-morphology and -duration were evaluated using digitized 12-lead electrocardiograms (40-80 mm/mV, 100-200 mm/s). 12-months arrhythmia freedom following circumferential PVI was assessed in 139 patients with persistent AF. Left atrial low-voltage substrate was most frequently (84%) found at the anteroseptal LA. Characteristic changes of APW were related to the localization and extent of LA-LVS. At an early stage, LA-LVS predominantly located to the LA-anteroseptum and was associated with APW-prolongation (≥150 ms). More extensive LA-LVS involved larger areas of LA-anteroseptum, leading to morphological changes of APW (biphasic positive-negative P-waves in inferior leads). Severe LA-LVS involved the LA-anteroseptum, roof and posterior LA, but spared the inferior LA, lateral LA, and LA appendage. In this advanced stage, widespread LVS at the posterior LA abolished the negative portion of P-wave in the inferior leads. The delayed activation of the lateral LA and LA appendage produced the late positive deflections in the anterolateral leads, resulting in the "late-terminal P"-pattern. Structured analysis of APW-duration and -morphology stratified patients to their individual extent of LA-LVS (Grade 1: mean LA-LVS 4.9 cm2 at <1.0 mV; Grade 2: 28.6 cm2; Grade 3: 42.3 cm2; P < 0.01). The diagnostic value of APW-duration for identification of LA-LVS was significantly superior to standard P-wave-amplification (c-statistic 0.945 vs. 0.647). Arrhythmia freedom following PVI differed significantly between APW-predicted grades of LA-LVS-severity [hazard ratio (HR) 2.38, 95% confidence interval (CI) 1.18-4.83; P = 0.015 for Grade 1 vs. Grade 2; HR 1.79, 95% CI 1.00-3.21, P = 0.049 for Grade 2 vs. Grade 3). Arrhythmia freedom 12 months after PVI was 77%, 53%, and 33% in Grades 1, 2 and 3, respectively. CONCLUSION Localization and extent of LA-LVS modifies APW-morphology and -duration. Analysis of APW allows accurate prediction of LA-LVS and enables rapid and non-invasive estimation of arrhythmia freedom following PVI.
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Affiliation(s)
- Björn Müller-Edenborn
- Department of Electrophysiology, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen Campus, Südring 15, 79189 Bad Krozingen, Germany
| | - Juan Chen
- Department of Electrophysiology, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen Campus, Südring 15, 79189 Bad Krozingen, Germany
| | - Jürgen Allgeier
- Department of Electrophysiology, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen Campus, Südring 15, 79189 Bad Krozingen, Germany
| | - Maxim Didenko
- Cardiovascular Surgery Department, Military Medical Academy Named After S.M. Kirov, Saint-Petersburg, Russia.,Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, The Netherlands
| | - Zoraida Moreno-Weidmann
- Department of Electrophysiology, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen Campus, Südring 15, 79189 Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Department of Cardiology, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen Campus, Bad Krozingen, Germany
| | - Heiko Lehrmann
- Department of Electrophysiology, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen Campus, Südring 15, 79189 Bad Krozingen, Germany
| | - Reinhold Weber
- Department of Electrophysiology, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen Campus, Südring 15, 79189 Bad Krozingen, Germany
| | - Thomas Arentz
- Department of Electrophysiology, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen Campus, Südring 15, 79189 Bad Krozingen, Germany
| | - Amir Jadidi
- Department of Electrophysiology, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen Campus, Südring 15, 79189 Bad Krozingen, Germany
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Tse G, Wong CW, Gong M, Wong WT, Bazoukis G, Wong SH, Li G, Wu WKK, Tse LA, Lampropoulos K, Xia Y, Liu T, Baranchuk A. Predictive value of inter-atrial block for new onset or recurrent atrial fibrillation: A systematic review and meta-analysis. Int J Cardiol 2017; 250:152-156. [PMID: 29017777 DOI: 10.1016/j.ijcard.2017.09.176] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 09/18/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Inter-atrial block (IAB) is characterized by a delay of inter-atrial conduction and is defined electrocardiographically by a P-wave duration (PWD)>120ms. Several studies have implicated IAB in the development of new onset atrial fibrillation (AF), whereas others have reported no significant associations. Moreover, there has been no systematic evaluation of the predictive value of IAB in AF recurrence. Therefore, we conducted a systematic review and meta-analysis to examine whether IAB predicts new onset AF or AF recurrence. METHODS PubMed and Embase databases were searched through 30th July 2017 for studies investigating the relationship between IAB and AF. RESULTS The initial search identified 260 studies, of which 16 studies met the inclusion criteria. This meta-analysis included 18,204 patients (mean age 56±13, 48% male) with a mean follow-up period of 15.1years. IAB significantly predicted new onset AF (hazard ratio [HR]: 2.42, 95% confidence interval [CI]: 1.44 to 4.07, P=0.001; 84%). For partial IAB, the risk of new onset AF did not reach statistical significance (HR: 1.42, 95% CI: 0.85 to 2.34; P=0.18; I2=13%). Contrastingly, advanced IAB was a significant predictor of new onset AF with a pooled HR of 2.58 (95% CI: 1.35 to 4.96; P<0.01; I2=67%). IAB also predicted AF recurrence after ablation (HR: 2.59, 95% CI: 1.35 to 4.96; P<0.01; I2=67%). CONCLUSIONS IAB is a significant predictor of both new onset AF and AF recurrence.
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Affiliation(s)
- Gary Tse
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.
| | - Cheuk Wai Wong
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Mengqi Gong
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Wing Tak Wong
- School of Life Sciences, Chinese University of Hong Kong, Hong Kong, China
| | - George Bazoukis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Sunny Hei Wong
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Guangping Li
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - William K K Wu
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China; Department of Anaesthesia and Intensive Care, State Key Laboratory of Digestive Disease, LKS Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Lap Ah Tse
- Division of Occupational and Environmental Health, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Konstantinos Lampropoulos
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Yunlong Xia
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Adrian Baranchuk
- Division of Cardiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
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Teuwen CP, Yaksh A, Lanters EAH, Kik C, van der Does LJME, Knops P, Taverne YJHJ, van de Woestijne PC, Oei FBS, Bekkers JA, Bogers AJJC, Allessie MA, de Groot NMS. Relevance of Conduction Disorders in Bachmann's Bundle During Sinus Rhythm in Humans. Circ Arrhythm Electrophysiol 2016; 9:e003972. [PMID: 27153879 DOI: 10.1161/circep.115.003972] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 04/07/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Bachmann's bundle (BB) is considered to be the main route of interatrial conduction and to play a role in development of atrial fibrillation (AF). The goals of this study are to characterize the presence of conduction disorders in BB during sinus rhythm and to study their relation with AF. METHODS AND RESULTS High-resolution epicardial mapping (192 unipolar electrodes, interelectrode distance: 2 mm) of sinus rhythm was performed in 185 patients during coronary artery bypass surgery of whom 13 had a history of paroxysmal AF. Continuous rhythm monitoring was used to detect postoperative AF during the first 5 postoperative days. In 67% of the patients, BB was activated from right to left; in the remaining patients from right and middle (21%), right, central, and left (8%), or central (4%) site. Mean effective conduction velocity was 89 cm/s. Conduction block was present in most patients (75%; median 1.1%, range 0-12.8) and was higher in patients with paroxysmal AF compared with patients without a history of AF (3.2% versus 0.9%; P=0.03). A high amount of conduction block (>4%) was associated with de novo postoperative AF (P=0.02). Longitudinal lines of conduction block >10 mm were also associated with postoperative AF (P=0.04). CONCLUSIONS BB may be activated through multiple directions, but the predominant route of conduction is from right to left. Conduction velocity across BB is around 90 cm/s. Conduction is blocked in both longitudinal and transverse direction in the majority of patients. Conduction disorders, particularly long lines of longitudinal conduction block, are more pronounced in patients with AF episodes.
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Affiliation(s)
- Christophe P Teuwen
- From the Deparment of Cardiology (C.P.T., A.Y., E.A.H.L., L.J.M.E.v.d.D., P.K., M.A.A., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (C.K., Y.J.H.J.T., P.C.v.d.W., F.B.S.O., J.A.B., A.J.J.C.B.), Erasmus University Medical Center, Rotterdam; and Department of Physiology, Cardiovascular Research Institute, Maastricht, The Netherlands (M.A.A.)
| | - Ameeta Yaksh
- From the Deparment of Cardiology (C.P.T., A.Y., E.A.H.L., L.J.M.E.v.d.D., P.K., M.A.A., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (C.K., Y.J.H.J.T., P.C.v.d.W., F.B.S.O., J.A.B., A.J.J.C.B.), Erasmus University Medical Center, Rotterdam; and Department of Physiology, Cardiovascular Research Institute, Maastricht, The Netherlands (M.A.A.)
| | - Eva A H Lanters
- From the Deparment of Cardiology (C.P.T., A.Y., E.A.H.L., L.J.M.E.v.d.D., P.K., M.A.A., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (C.K., Y.J.H.J.T., P.C.v.d.W., F.B.S.O., J.A.B., A.J.J.C.B.), Erasmus University Medical Center, Rotterdam; and Department of Physiology, Cardiovascular Research Institute, Maastricht, The Netherlands (M.A.A.)
| | - Charles Kik
- From the Deparment of Cardiology (C.P.T., A.Y., E.A.H.L., L.J.M.E.v.d.D., P.K., M.A.A., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (C.K., Y.J.H.J.T., P.C.v.d.W., F.B.S.O., J.A.B., A.J.J.C.B.), Erasmus University Medical Center, Rotterdam; and Department of Physiology, Cardiovascular Research Institute, Maastricht, The Netherlands (M.A.A.)
| | - Lisette J M E van der Does
- From the Deparment of Cardiology (C.P.T., A.Y., E.A.H.L., L.J.M.E.v.d.D., P.K., M.A.A., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (C.K., Y.J.H.J.T., P.C.v.d.W., F.B.S.O., J.A.B., A.J.J.C.B.), Erasmus University Medical Center, Rotterdam; and Department of Physiology, Cardiovascular Research Institute, Maastricht, The Netherlands (M.A.A.)
| | - Paul Knops
- From the Deparment of Cardiology (C.P.T., A.Y., E.A.H.L., L.J.M.E.v.d.D., P.K., M.A.A., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (C.K., Y.J.H.J.T., P.C.v.d.W., F.B.S.O., J.A.B., A.J.J.C.B.), Erasmus University Medical Center, Rotterdam; and Department of Physiology, Cardiovascular Research Institute, Maastricht, The Netherlands (M.A.A.)
| | - Yannick J H J Taverne
- From the Deparment of Cardiology (C.P.T., A.Y., E.A.H.L., L.J.M.E.v.d.D., P.K., M.A.A., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (C.K., Y.J.H.J.T., P.C.v.d.W., F.B.S.O., J.A.B., A.J.J.C.B.), Erasmus University Medical Center, Rotterdam; and Department of Physiology, Cardiovascular Research Institute, Maastricht, The Netherlands (M.A.A.)
| | - Pieter C van de Woestijne
- From the Deparment of Cardiology (C.P.T., A.Y., E.A.H.L., L.J.M.E.v.d.D., P.K., M.A.A., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (C.K., Y.J.H.J.T., P.C.v.d.W., F.B.S.O., J.A.B., A.J.J.C.B.), Erasmus University Medical Center, Rotterdam; and Department of Physiology, Cardiovascular Research Institute, Maastricht, The Netherlands (M.A.A.)
| | - Frans B S Oei
- From the Deparment of Cardiology (C.P.T., A.Y., E.A.H.L., L.J.M.E.v.d.D., P.K., M.A.A., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (C.K., Y.J.H.J.T., P.C.v.d.W., F.B.S.O., J.A.B., A.J.J.C.B.), Erasmus University Medical Center, Rotterdam; and Department of Physiology, Cardiovascular Research Institute, Maastricht, The Netherlands (M.A.A.)
| | - Jos A Bekkers
- From the Deparment of Cardiology (C.P.T., A.Y., E.A.H.L., L.J.M.E.v.d.D., P.K., M.A.A., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (C.K., Y.J.H.J.T., P.C.v.d.W., F.B.S.O., J.A.B., A.J.J.C.B.), Erasmus University Medical Center, Rotterdam; and Department of Physiology, Cardiovascular Research Institute, Maastricht, The Netherlands (M.A.A.)
| | - Ad J J C Bogers
- From the Deparment of Cardiology (C.P.T., A.Y., E.A.H.L., L.J.M.E.v.d.D., P.K., M.A.A., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (C.K., Y.J.H.J.T., P.C.v.d.W., F.B.S.O., J.A.B., A.J.J.C.B.), Erasmus University Medical Center, Rotterdam; and Department of Physiology, Cardiovascular Research Institute, Maastricht, The Netherlands (M.A.A.)
| | - Maurits A Allessie
- From the Deparment of Cardiology (C.P.T., A.Y., E.A.H.L., L.J.M.E.v.d.D., P.K., M.A.A., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (C.K., Y.J.H.J.T., P.C.v.d.W., F.B.S.O., J.A.B., A.J.J.C.B.), Erasmus University Medical Center, Rotterdam; and Department of Physiology, Cardiovascular Research Institute, Maastricht, The Netherlands (M.A.A.)
| | - Natasja M S de Groot
- From the Deparment of Cardiology (C.P.T., A.Y., E.A.H.L., L.J.M.E.v.d.D., P.K., M.A.A., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (C.K., Y.J.H.J.T., P.C.v.d.W., F.B.S.O., J.A.B., A.J.J.C.B.), Erasmus University Medical Center, Rotterdam; and Department of Physiology, Cardiovascular Research Institute, Maastricht, The Netherlands (M.A.A.).
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