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Marzak H, Gennesseaux G, Hammann J, Ringele R, Fitouchi S, Severac F, Cardi T, Kanso M, Schatz A, Ohlmann P, Morel O, Jesel L. Left atrial remodeling and voltage-guided ablation outcome in persistent atrial fibrillation patients according to CHA 2DS 2-VASc score. BMC Cardiovasc Disord 2024; 24:347. [PMID: 38977958 PMCID: PMC11229227 DOI: 10.1186/s12872-024-04009-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 06/25/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND CHA2DS2-VASc score-related differences have been reported in atrial fibrotic remodeling and prognosis of atrial fibrillation (AF) patients after ablation. There are currently no data on the efficacy of low voltage zone (LVZ)-guided ablation in persistent AF patients according to CHA2DS2-VASc score. We assessed in a cohort of persistent AF patients the extent of LVZ, the regional distribution of LA voltage and the outcome of LA voltage-guided substrate ablation in addition to PVI according to CHA2DS2-VASc score. METHODS 138 consecutive persistent AF patients undergoing a first voltage-guided catheter ablation were enrolled. 58 patients with CHAD2DS2-VASc score ≥ 3 and 80 patients with CHAD2DS2-VASc score ≤ 2 were included. LA voltage maps were obtained using 3D-electroanatomical mapping system in sinus rhythm. LVZ was defined as < 0.5 mV. RESULTS In the high CHAD2DS2-VASc score group, LA voltage was lower (1.5 [1.1-2.5] vs. 2.3 [1.5-2.8] mV, p = 0.02) and LVZs were more frequently identified (40% vs. 18%), p < 0.01). Female with CHA2DS2-VASc score ≥ 3 (p = 0.031), LA indexed volume (p = 0.009) and P-wave duration ≥ 150 ms (p = 0.001) were predictors of LVZ. After a 36-month follow-up, atrial arrhythmia-free survival was similar between the two groups (logrank test, P = 0.676). CONCLUSIONS AF patients with CHAD2DS2-VASc score ≥ 3 display more LA substrate remodeling with lower voltage and more LVZs compared with those with CHAD2DS2-VASc score ≤ 2. Despite this atrial remodeling, they had similar and favorable 36 months results after one single procedure. Unlike male with CHAD2DS2-VASc score ≥ 3, female with CHAD2DS2-VASc score ≥ 3 was predictor of LVZ occurrence.
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Affiliation(s)
- Halim Marzak
- Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France.
| | - Gabrielle Gennesseaux
- Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Justine Hammann
- Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Romain Ringele
- Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Simon Fitouchi
- Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - François Severac
- Public Health Service, Groupe Méthodes en Recherche Clinique (GMRC), Strasbourg University Hospital, Strasbourg, France
| | - Thomas Cardi
- Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Mohamad Kanso
- Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Alexandre Schatz
- Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Patrick Ohlmann
- Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Olivier Morel
- Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, FMTS, Regenerative Nanomedicine, Strasbourg, France
| | - Laurence Jesel
- Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, FMTS, Regenerative Nanomedicine, Strasbourg, France
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Dykiert IA, Kraik K, Jurczenko L, Gać P, Poręba R, Poręba M. The Effect of Obesity on Repolarization and Other ECG Parameters. J Clin Med 2024; 13:3587. [PMID: 38930116 PMCID: PMC11205044 DOI: 10.3390/jcm13123587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/02/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Overweight and obesity are important risk factors in the development of cardiovascular diseases. New repolarization markers, such as the Tpeak-Tend interval and JTpeak intervals, have not yet been profoundly studied in obese patients. The study aims to analyze whether, in patients with obesity and overweight, repolarization markers, including the Tpeak-Tend interval, are prolonged and simultaneously check the frequency of other ECG pathologies in a 12-lead ECG in this group of patients. Methods: A study group consisted of 181 adults (90 females and 91 males) with overweight and first-class obesity. The participants completed a questionnaire, and the ECG was performed and analyzed. Results: When analyzing the classic markers, only QT dispersion was significantly higher in obese people. The Tpeak-Tend parameter (97.08 ms ± 23.38 vs. 89.74 ms ± 12.88, respectively), its dispersion, and JTpeak-JTend parameters were statistically significantly longer in the obese group than in the controls. There were also substantial differences in P-wave, QRS duration, and P-wave dispersion, which were the highest in obese people. Tpeak-Tend was positively correlated with body mass and waist circumference, while JTpeak was with BMI, hip circumference, and WHR. Tpeak/JT was positively correlated with WHR and BMI. In backward stepwise multiple regression analysis for JTpeak-WHR, type 2 diabetes and smoking had the highest statistical significance. Conclusions: Only selected repolarization markers are significantly prolonged in patients with class 1 obesity and, additionally, in this group, we identified more pathologies of P wave as well as prolonged QRS duration.
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Affiliation(s)
- Irena A. Dykiert
- Department of Physiology and Pathophysiology, Division of Pathophysiology, Wroclaw Medical University, 50-368 Wrocław, Poland
| | - Krzysztof Kraik
- Students’ Scientific Association of Cardiovascular Diseases Prevention, Wroclaw Medical University, 50-368 Wrocław, Poland
| | - Lidia Jurczenko
- Students’ Scientific Association of Cardiovascular Diseases Prevention, Wroclaw Medical University, 50-368 Wrocław, Poland
| | - Paweł Gać
- Department of Population Health, Division of Environmental Health and Occupational Medicine, Wroclaw Medical University, 50-372 Wrocław, Poland
| | - Rafał Poręba
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556 Wrocław, Poland
| | - Małgorzata Poręba
- Department of Paralympic Sport, Wroclaw University of Health and Sport Sciences, 51-617 Wrocław, Poland
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Sakellaropoulou A, Giannopoulos G, Tachmatzidis D, Letsas KP, Antoniadis A, Asvestas D, Filos D, Mililis P, Efremidis M, Chouvarda I, Vassilikos VP. Association of beat-to-beat P-wave analysis index to the extent of left atrial low-voltage areas in patients with paroxysmal atrial fibrillation. Hellenic J Cardiol 2024:S1109-9666(24)00115-5. [PMID: 38777086 DOI: 10.1016/j.hjc.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 04/16/2024] [Accepted: 05/11/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Left atrial (LA) fibrosis has been shown to be associated with atrial fibrillation (AF) recurrence. Beat-to-beat (B2B) index is a non-invasive classifier, based on B2B P-wave morphological and wavelet analysis, shown to be associated with AF incidence and recurrence. In this study, we tested the hypothesis that the B2B index is associated with the extent of LA low-voltage areas (LVAs) on electroanatomical mapping. METHODS Patients with paroxysmal AF scheduled for pulmonary vein isolation, without evident structural remodeling, were included. Pre-ablation electroanatomical voltage maps were used to calculate the surface of LVAs (<0.5 mV). B2B index was compared between patients with small versus large LVAs. RESULTS 35 patients were included (87% male, median age 62). The median surface area of LVAs was 7.7 (4.4-15.8) cm2 corresponding to 5.6 (3.3-12.1) % of LA endocardial surface. B2B index was 0.57 (0.52-0.59) in patients with small LVAs (below the median) compared to 0.65 (0.56-0.77) in those with large LVAs (above the median) (p = 0.009). In the receiver operator characteristic curve analysis for predicting large LVAs, the c-statistic was 0.75 (p = 0.006) for B2B index and 0.81 for the multivariable model including B2B index (multivariable p = 0.04) and P-wave duration. CONCLUSION In patients with paroxysmal AF without overt atrial myopathy, B2B P-wave analysis appears to be a useful non-invasive correlate of low-voltage areas-and thus fibrosis-in the LA. This finding establishes a pathophysiological basis for B2B index and its potential usefulness in the selection process of patients who are likely to benefit most from further invasive treatment.
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Affiliation(s)
- Antigoni Sakellaropoulou
- 2nd Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece.
| | - Georgios Giannopoulos
- 3rd Department of Cardiology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Tachmatzidis
- 3rd Department of Cardiology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos P Letsas
- 2nd Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Antonios Antoniadis
- 3rd Department of Cardiology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Asvestas
- 2nd Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Dimitrios Filos
- Laboratory of Computing, Medical Informatics and Biomedical Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Mililis
- 2nd Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Michael Efremidis
- 2nd Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Ioanna Chouvarda
- Laboratory of Computing, Medical Informatics and Biomedical Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassilios P Vassilikos
- 3rd Department of Cardiology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Tomomori S, Suenari K, Sairaku A, Higaki T, Dai K, Oi K, Kawase T, Ohashi N, Nishioka K, Masaoka Y, Shiode N, Nakano Y. Prolonged PR intervals are associated with epicardial adipose tissue and recurrence after catheter ablation in persistent atrial fibrillation. Heart Vessels 2024; 39:232-239. [PMID: 37813984 DOI: 10.1007/s00380-023-02323-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/20/2023] [Indexed: 10/11/2023]
Abstract
Epicardial adipose tissue (EAT) has been reported to promote myocardial fibrosis and to affect intracardiac conduction. The PR interval reflects the conduction from the atria to the Purkinje fibers and may be associated with the EAT volume, especially in persistent atrial fibrillation (AF) patients. We aimed to investigate the relationship between the EAT and PR interval in patients with persistent AF. We enrolled 268 persistent AF patients who underwent catheter ablation (CA) and divided the patients into two groups: the normal PR interval group (PR interval less than 200 ms: Group N) and long PR interval group (PR interval 200 ms or more: Group L). We then analyzed the association between the total EAT volume around the heart and PR interval and calculated the ratio of the duration of the P wave (PWD) to the PR interval (PWD/PR interval). Moreover, we investigated whether a long PR interval was associated with the outcomes after ablation. The total EAT volume was significantly larger in Group L than Group N (Group N: 131.4 ± 51.8 ml vs. Group L: 151.3 ± 63.3 ml, p = 0.039). A positive correlation was also observed between the PWD/PR interval and EAT volume in Group L (r = 0.345, p = 0.039). A multivariate analysis also revealed that a long PR interval was independently associated with AF recurrence after CA (hazard ratio [HR] 2.071, p = 0.032). The total EAT volume was associated with a long PR interval, and a long PR interval was a significant risk factor for recurrence after ablation in persistent AF patients.
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Affiliation(s)
- Shunsuke Tomomori
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Nakaku, Hiroshima, 730-8518, Japan.
| | - Kazuyoshi Suenari
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Nakaku, Hiroshima, 730-8518, Japan
| | - Akinori Sairaku
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Nakaku, Hiroshima, 730-8518, Japan
| | - Tadanao Higaki
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Nakaku, Hiroshima, 730-8518, Japan
| | - Kazuoki Dai
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Nakaku, Hiroshima, 730-8518, Japan
| | - Kuniomi Oi
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Nakaku, Hiroshima, 730-8518, Japan
| | - Tomoharu Kawase
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Nakaku, Hiroshima, 730-8518, Japan
| | - Norihiko Ohashi
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Nakaku, Hiroshima, 730-8518, Japan
| | - Kenji Nishioka
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Nakaku, Hiroshima, 730-8518, Japan
| | - Yoshiko Masaoka
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Nakaku, Hiroshima, 730-8518, Japan
| | - Nobuo Shiode
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Nakaku, Hiroshima, 730-8518, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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Yano M, Egami Y, Kawanami S, Ukita K, Kawamura A, Yasumoto K, Tsuda M, Okamoto N, Matsunaga-Lee Y, Nishino M. Ratio of P-Wave Duration to P-Wave Amplitude and Left Atrial Remodeling: Insights from Electrophysiological Findings and Myocardial Injury After Cryoballoon Ablation. Am J Cardiol 2024; 212:109-117. [PMID: 38036050 DOI: 10.1016/j.amjcard.2023.11.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/23/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023]
Abstract
The impact of the P-wave morphology on clinical outcomes postcatheter ablation (post-CA) and recurrent arrhythmia characteristics or electrophysiologic findings in patients with paroxysmal atrial fibrillation (PAF) remains unclear. Patients with PAF who underwent cryoballoon ablation were enrolled. In 12-lead electrocardiography recorded within 1 month before CA, the P-wave duration (Pd) and P-wave vector magnitude (Pvm) (square root of the sum of the squared P-wave amplitude in leads II, V6, and one-half of the P-wave amplitude in V2) were measured and divided into 2 groups: patients with high and low Pd/Pvm based on a statistically calculated cut-off value. We evaluated the incidence of late recurrence of atrial fibrillation (LRAF), myocardial injury (high-sensitive troponin I), and the electrophysiologic findings in repeat ablation sessions. This study included 269 patients with PAF. The median follow-up duration was 697 days. The cut-off value of the Pd/Pvm for predicting LRAF was 740.7 ms/mV (area under the curve = 0.81, sensitivity = 58.2%, and specificity = 89.6%). Multivariable Cox proportional hazards analysis showed that high Pd/Pvm (>740.7 ms/mV) was significantly associated with LRAF (p <0.001). The high-sensitive troponin I level was significantly lower, and the ratio of DR-FLASH score >3 was significantly higher in those with high than low Pd/Pvm (p = 0.044 and p = 0.002, respectively). In the repeat ablation sessions, the Pd/Pvm in patients with atrial tachycardia-induced or spontaneously occurring during the repeat CA sessions was significantly higher than in those without (p = 0.009). There was a significant difference between the Pd/Pvm and low-voltage area (p <0.001). In conclusion, the Pd/Pvm is significantly associated with LRAF after cryoballoon ablation in patients with PAF and predicts left atrial low-voltage areas and atrial tachycardia inducibility.
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Affiliation(s)
- Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan.
| | - Yasuyuki Egami
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Shodai Kawanami
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Kohei Ukita
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Akito Kawamura
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Koji Yasumoto
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Masaki Tsuda
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Naotaka Okamoto
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | | | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
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Giannopoulos G, Tachmatzidis D, Moysidis DV, Filos D, Petridou M, Chouvarda I, Vassilikos VP. P-wave Indices as Predictors of Atrial Fibrillation: The Lion from a Claw. Curr Probl Cardiol 2024; 49:102051. [PMID: 37640172 DOI: 10.1016/j.cpcardiol.2023.102051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 08/23/2023] [Indexed: 08/31/2023]
Abstract
The P wave, representing the electrical fingerprint of atrial depolarization, contains information regarding spatial and temporal aspects of atrial electrical-and potentially structural-properties. However, technical and biological reasons, including-but not limited to-the low amplitude of the P wave and large interindividual variations in normal or pathologic atrial electrical activity, make gathering and utilizing this information for clinical purposes a rather cumbersome task. However, even crude ECG descriptors, such as P-wave dispersion, have been shown to be of predictive value for assessing the probability that a patient already has or will shortly present with AF. More sophisticated methods of analyzing the ECG signal, on a single- or multi- beat basis, along with novel approaches to data handling, namely machine learning, seem to be leading up to more accurate and robust ways to obtain clinically useful information from the humble P wave.
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Affiliation(s)
- Georgios Giannopoulos
- 3rd Department of Cardiology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Laboratory of Computing, Medical Informatics and Biomedical Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Dimitrios Tachmatzidis
- 3rd Department of Cardiology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Laboratory of Computing, Medical Informatics and Biomedical Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios V Moysidis
- 3rd Department of Cardiology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Laboratory of Computing, Medical Informatics and Biomedical Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Filos
- 3rd Department of Cardiology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Laboratory of Computing, Medical Informatics and Biomedical Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Magdalini Petridou
- 3rd Department of Cardiology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Laboratory of Computing, Medical Informatics and Biomedical Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioanna Chouvarda
- 3rd Department of Cardiology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Laboratory of Computing, Medical Informatics and Biomedical Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasileios P Vassilikos
- 3rd Department of Cardiology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Laboratory of Computing, Medical Informatics and Biomedical Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Aarnink E, Zabern M, Boersma L, Glikson M. Mechanisms and Prediction of Ischemic Stroke in Atrial Fibrillation Patients. J Clin Med 2023; 12:6491. [PMID: 37892626 PMCID: PMC10607686 DOI: 10.3390/jcm12206491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in adults worldwide and represents an important burden for patients, physicians, and healthcare systems. AF is associated with substantial mortality and morbidity, due to the disease itself and its specific complications, such as the increased risk of stroke and thromboembolic events associated with AF. The temporal relation between AF episodes and stroke is nonetheless incompletely understood. The factors associated with an increased thromboembolic risk remain unclear, as well as the stroke risk stratification. Therefore, in this review, we intend to expose the mechanisms and physiopathology leading to intracardiac thrombus formation and stroke in AF patients, together with the evidence supporting the causal hypothesis. We also expose the risk factors associated with increased risk of stroke, the current different risk stratification tools as well as future prospects for improving this risk stratification.
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Affiliation(s)
- Errol Aarnink
- Department of Cardiology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
| | - Maxime Zabern
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
| | - Lucas Boersma
- Department of Cardiology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
- Department of Cardiology, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
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Koutalas E, Kallergis E, Nedios S, Kochiadakis G, Kanoupakis E. P-wave duration as a marker of atrial remodeling in patients referred to ablation for atrial fibrillation: A new stratification tool emerging? Hellenic J Cardiol 2023; 73:53-60. [PMID: 36863411 DOI: 10.1016/j.hjc.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 02/07/2023] [Accepted: 02/24/2023] [Indexed: 03/04/2023] Open
Abstract
Ablation of atrial fibrillation is one of the most widely applied invasive procedures in cardiovascular medicine, and populations with atrial fibrillation continuously rise. Recurrence rates are, however, consistently high, even in patients without severe comorbidities. Robust stratification algorithms to distinguish patients suitable for ablation are generally lacking. This is a fact caused by the inability to incorporate evidence of atrial remodeling and fibrosis, e.g., atrial remodeling, in the decision pathways. Cardiac magnetic resonance is a powerful tool in identifying fibrosis; however, it is costly and not routinely used. Electrocardiography has been generally underutilized in clinical practice during pre-ablative screening. One of the characteristics of the electrocardiogram that can give us valuable data depicting the existence and the extent of atrial remodeling and fibrosis is the duration of the P-wave. Currently, many studies support the implementation of P-wave duration in the routine practice of patient evaluation as a surrogate marker of existing atrial remodeling, that in turn predicts recurrence after ablation of atrial fibrillation. Further research is guaranteed to establish this electrocardiographic characteristic in our stratification quiver.
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Affiliation(s)
- Emmanuel Koutalas
- Department of Cardiology University Hospital of Heraklion, Crete, Greece.
| | | | - Sotirios Nedios
- Department of Arrhythmology, Leipzig Heart Center, Leipzig, Germany
| | - George Kochiadakis
- Department of Cardiology University Hospital of Heraklion, Crete, Greece
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Huang T, Schurr P, Muller-Edenborn B, Pilia N, Mayer L, Eichenlaub M, Allgeier J, Heidenreich M, Ahlgrim C, Bohnen M, Lehrmann H, Trenk D, Neumann FJ, Westermann D, Arentz T, Jadidi A. Analysis of the amplified p-wave enables identification of patients with atrial fibrillation during sinus rhythm. Front Cardiovasc Med 2023; 10:1095931. [PMID: 36910532 PMCID: PMC9993657 DOI: 10.3389/fcvm.2023.1095931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023] Open
Abstract
Aim This study sought to develop and validate diagnostic models to identify individuals with atrial fibrillation (AF) using amplified sinus-p-wave analysis. Methods A total of 1,492 patients (491 healthy controls, 499 with paroxysmal AF and 502 with persistent AF) underwent digital 12-lead-ECG recording during sinus rhythm. The patient cohort was divided into training and validation set in a 3:2 ratio. P-wave indices (PWI) including duration of standard p-wave (standard PWD; scale at 10 mm/mV, sweep speed at 25 mm/s) and amplified sinus-p-wave (APWD, scale at 60-120 mm/mV, sweep speed at 100 mm/s) and advanced inter-atrial block (aIAB) along with other clinical parameters were used to develop diagnostic models using logistic regression. Each model was developed from the training set and further tested in both training and validation sets for its diagnostic performance in identifying individuals with AF. Results Compared to standard PWD (Reference model), which achieved an AUC of 0.637 and 0.632, for training and validation set, respectively, APWD (Basic model) importantly improved the accuracy to identify individuals with AF (AUC = 0.86 and 0.866). The PWI-based model combining APWD, aIAB and body surface area (BSA) further improved the diagnostic performance for AF (AUC = 0.892 and 0.885). The integrated model, which further combined left atrial diameter (LAD) with parameters of the PWI-based model, achieved optimal diagnostic performance (AUC = 0.916 and 0.902). Conclusion Analysis of amplified p-wave during sinus rhythm allows identification of individuals with atrial fibrillation.
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Affiliation(s)
- Taiyuan Huang
- Arrhythmia Division, Clinic for Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Patrick Schurr
- Arrhythmia Division, Clinic for Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Bjoern Muller-Edenborn
- Arrhythmia Division, Clinic for Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Nicolas Pilia
- Arrhythmia Division, Clinic for Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Louisa Mayer
- Arrhythmia Division, Clinic for Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Martin Eichenlaub
- Arrhythmia Division, Clinic for Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Juergen Allgeier
- Arrhythmia Division, Clinic for Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Marie Heidenreich
- Arrhythmia Division, Clinic for Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Christoph Ahlgrim
- Arrhythmia Division, Clinic for Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Marius Bohnen
- Arrhythmia Division, Clinic for Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Heiko Lehrmann
- Arrhythmia Division, Clinic for Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Dietmar Trenk
- Arrhythmia Division, Clinic for Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Franz-Josef Neumann
- Arrhythmia Division, Clinic for Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Dirk Westermann
- Arrhythmia Division, Clinic for Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Thomas Arentz
- Arrhythmia Division, Clinic for Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Amir Jadidi
- Arrhythmia Division, Clinic for Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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Use of P wave indices to evaluate efficacy of catheter ablation and atrial fibrillation recurrence: a systematic review and meta-analysis. J Interv Card Electrophysiol 2022; 65:827-840. [PMID: 35488962 DOI: 10.1007/s10840-022-01147-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/31/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND To investigate the changes of P wave indices in atrial fibrillation (AF) patients after catheter ablation and the association between P wave indices and AF recurrence. METHODS PubMed, Embase, and Cochrane Database were searched through September 15th 2021 for studies on the association between P wave indices and AF with catheter ablation. Heterogeneity was estimated using the I2 statistic, the random effects model was used to calculate the pooled results, and summary receiver operating characteristic curve (SROC) was used to evaluate the predictive value. RESULTS Among included fourteen studies with 1674 AF patients, we found significantly decreased P wave dispersion (Pdis) (mean difference [MD]: - 6.5 ms, 95% confidence interval [95% CI]: - 11.81 to - 1.18, P = 0.02) after cryoballoon ablation (CBA) or radiofrequency ablation (RFA), and maximum P wave (Pmax) (MD: - 8.57 ms, 95% CI: - 17.03 to - 0.10, P = 0.05) after RFA only, but increased minimum P wave (Pmin) (MD: 3.43 ms, 95% CI: 1.07 to 5.79, P < 0.01) after CBA only. Pdis measured before ablation was remarkably higher (MD: 5.79 ms, 95% CI: 2.23 to 9.36, P < 0.01) in patients with recurrence than without; meanwhile, Pmax was higher measured both before and after ablation (MD: 6.49 ms, 95% CI: 2.30 to 10.69, P < 0.01 and MD: 11.2 ms, 95% CI: 2.88 to 19.52, P < 0.01). Furthermore, SROC analysis showed acceptable predictive efficiencies of Pdis (AUC = 0.776) and Pmax (AUC = 0.759) for AF recurrence. CONCLUSION Pdis was significantly decreased after AF catheter ablation. Higher Pdis and Pmax may have predictive values for AF recurrence.
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Intzes S, Zagoridis K, Symeonidou M, Spanoudakis E, Arya A, Dinov B, Dagres N, Hindricks G, Bollmann A, Kanoupakis E, Koutalas E, Nedios S. P-wave duration and atrial fibrillation recurrence after catheter ablation: a systematic review and meta-analysis. Europace 2022; 25:450-459. [PMID: 36413611 PMCID: PMC9935015 DOI: 10.1093/europace/euac210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 09/18/2022] [Indexed: 11/23/2022] Open
Abstract
AIMS Atrial fibrillation (AF) is a global health problem with high morbidity and mortality. Catheter ablation (CA) can reduce AF burden and symptoms, but AF recurrence (AFr) remains an issue. Simple AFr predictors like P-wave duration (PWD) could help improve AF therapy. This updated meta-analysis reviews the increasing evidence for the association of AFr with PWD and offers practical implications. METHODS AND RESULTS Publication databases were systematically searched and cohort studies reporting PWD and/or morphology at baseline and AFr after CA were included. Advanced interatrial block (aIAB) was defined as PWD ≥ 120 ms and biphasic morphology in inferior leads. Random-effects analysis was performed using the Review Manager 5.3 and R programs after study selection, quality assessment, and data extraction, to report odds ratio (OR) and confidence intervals. : Among 4175 patients in 22 studies, 1138 (27%) experienced AFr. Patients with AFr had longer PWD with a mean pooled difference of 7.8 ms (19 studies, P < 0.001). Pooled OR was 2.04 (1.16-3.58) for PWD > 120 ms (13 studies, P = 0.01), 2.42 (1.12-5.21) for PWD > 140 ms (2 studies, P = 0.02), 3.97 (1.79-8.85) for aIAB (5 studies, P < 0.001), and 10.89 (4.53-26.15) for PWD > 150 ms (4 studies, P < 0.001). There was significant heterogeneity but no publication bias detected. CONCLUSION P-wave duration is an independent predictor for AF recurrence after left atrium ablation. The AFr risk is increasing exponentially with PWD prolongation. This could facilitate risk stratification by identifying high-risk patients (aIAB, PWD > 150 ms) and adjusting follow up or interventions.
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Affiliation(s)
| | | | | | | | - Arash Arya
- Department of Electrophysiology, Heart Center, University of Leipzig, Struempellstr. 39, 04289 Leipzig, Germany
| | - Borislav Dinov
- Department of Electrophysiology, Heart Center, University of Leipzig, Struempellstr. 39, 04289 Leipzig, Germany
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center, University of Leipzig, Struempellstr. 39, 04289 Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center, University of Leipzig, Struempellstr. 39, 04289 Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center, University of Leipzig, Struempellstr. 39, 04289 Leipzig, Germany
| | | | - Emmanuel Koutalas
- Department of Cardiology, Heraklion University Hospital, Crete, Greece
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Saito D, Fukaya H, Oikawa J, Sato T, Matsuura G, Arakawa Y, Kobayashi S, Shirakawa Y, Ishizue N, Kishihara J, Niwano S, Ako J. Atrial late potentials are associated with atrial fibrillation recurrence after catheter ablation. J Arrhythm 2022; 38:991-996. [PMCID: PMC9745488 DOI: 10.1002/joa3.12786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/14/2022] [Accepted: 09/20/2022] [Indexed: 12/15/2022] Open
Abstract
Background Previous studies have identified noninvasive methods for predicting atrial fibrillation (AF) recurrence after catheter ablation (CA). We assessed the association between AF recurrence and atrial late potentials (ALPs), which were measured using P‐wave signal‐averaged electrocardiography (P‐SAECG). Methods Consecutive patients with paroxysmal AF who underwent their first CA at our institution between August 2015 and August 2019 were enrolled. P‐SAECG was performed before CA. Two ALP parameters were evaluated: the root‐mean‐square voltage during the terminal 20 ms (RMS20) and the P‐wave duration (PWD). Positive ALPs were defined as an RMS20 <2.2 μV and/or a PWD >115 ms. Patients were allocated to either the recurrence or nonrecurrence group based on the presence of AF recurrence at the 1‐year follow‐up post‐CA. Results Of the 190 patients (age: 65 ± 11 years, 37% women) enrolled in this study, 21 (11%) had AF recurrence. The positive ALP rate was significantly higher in the recurrence group than in the nonrecurrence group (86% vs. 64%, p = .04), despite the absence of differences in other baseline characteristics between the two groups. In the multivariate analysis, positive ALP was an independent predictor of AF recurrence (odds ratio: 3.83, 95% confidence interval: 1.05–14.1, p = .04). Conclusions Positive ALP on pre‐CA P‐SAECG is associated with AF recurrence after CA.
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Affiliation(s)
- Daiki Saito
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaKanagawaJapan
| | - Hidehira Fukaya
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaKanagawaJapan
| | - Jun Oikawa
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaKanagawaJapan
| | - Tetsuro Sato
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaKanagawaJapan
| | - Gen Matsuura
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaKanagawaJapan
| | - Yuki Arakawa
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaKanagawaJapan
| | - Shuhei Kobayashi
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaKanagawaJapan
| | - Yuki Shirakawa
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaKanagawaJapan
| | - Naruya Ishizue
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaKanagawaJapan
| | - Jun Kishihara
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaKanagawaJapan
| | - Shinichi Niwano
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaKanagawaJapan
| | - Junya Ako
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaKanagawaJapan
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13
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Luo S, Derbas LA, Chiang CJ, Huang HD, Volgman AS. Widely split P waves in a patient with atrial enlargement and prior atrial flutter catheter ablations. HeartRhythm Case Rep 2022; 8:688-691. [PMID: 36310729 PMCID: PMC9596355 DOI: 10.1016/j.hrcr.2022.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 07/04/2022] [Accepted: 07/14/2022] [Indexed: 12/01/2022] Open
Affiliation(s)
- Shengyuan Luo
- Address reprint requests and correspondence: Dr Shengyuan Luo, Department of Internal Medicine, Rush University Medical Center, 1700 W. Van Buren St, Fifth Floor, Chicago, IL 60612.
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Kataoka S, Ejima K, Yazaki K, Kanai M, Yagishita D, Shoda M, Hagiwara N. Impact of atrial fibrillation ablation on long‐term outcomes in patients with tachycardia‐bradycardia syndrome. J Arrhythm 2022; 38:598-607. [PMID: 35936036 PMCID: PMC9347207 DOI: 10.1002/joa3.12738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/23/2022] [Accepted: 05/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Shohei Kataoka
- Department of Cardiology Tokyo Women's Medical University Shinjuku‐ku Japan
| | - Koichiro Ejima
- Department of Cardiology Tokyo Women's Medical University Shinjuku‐ku Japan
- Clinical Research Division for Heart Rhythm Management, Department of Cardiology Tokyo Women's Medical University Shinjuku‐ku Japan
| | - Kyoichiro Yazaki
- Department of Cardiology Tokyo Women's Medical University Shinjuku‐ku Japan
| | - Miwa Kanai
- Department of Cardiology Tokyo Women's Medical University Shinjuku‐ku Japan
| | - Daigo Yagishita
- Department of Cardiology Tokyo Women's Medical University Shinjuku‐ku Japan
- Clinical Research Division for Heart Rhythm Management, Department of Cardiology Tokyo Women's Medical University Shinjuku‐ku Japan
| | - Morio Shoda
- Department of Cardiology Tokyo Women's Medical University Shinjuku‐ku Japan
- Clinical Research Division for Heart Rhythm Management, Department of Cardiology Tokyo Women's Medical University Shinjuku‐ku Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology Tokyo Women's Medical University Shinjuku‐ku Japan
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15
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Mining the P wave to predict recurrence after atrial fibrillation ablation: More than a simple wave! Int J Cardiol 2022; 352:63-64. [PMID: 35101538 DOI: 10.1016/j.ijcard.2022.01.055] [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: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 11/20/2022]
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Sato T, Fukaya H, Oikawa J, Saito D, Matsuura G, Arakawa Y, Kobayashi S, Shirakawa Y, Nishinarita R, Horiguchi A, Ishizue N, Kishihara J, Niwano S, Ako J. Reduced atrial conduction velocity is associated with the recurrence of atrial fibrillation after catheter ablation. Heart Vessels 2021; 37:628-637. [PMID: 34613425 DOI: 10.1007/s00380-021-01952-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/24/2021] [Indexed: 11/25/2022]
Abstract
The recurrence of atrial fibrillation (AF) after catheter ablation (CA) is still an unsolved issue. Although structural remodeling is relatively well defined, the method to assess electrical remodeling of the atrium is not well established. In this study, we evaluated the relationship between atrial conduction properties and recurrence after CA for AF. One hundred six consecutive patients (66 ± 11 years old, male: 68%) who underwent CA for AF with a CARTO system from July 2016 to July 2019 were enrolled in this study. An activation map of both atria was constructed to precisely evaluate the total conduction time, distance, and conduction velocity between the earliest and latest activation sites during sinus rhythm. All parameters were compared between the patients with or without AF recurrence. Of the patients, 27 had an AF recurrence (Rec group). The left atrial (LA) conduction velocity was significantly slower in the Rec group than in the non-Rec group (101.2 ± 17.9 vs. 116.9 ± 18.0 cm/s, P < 0.01). Likewise, the right atrial (RA) conduction velocity was significantly slower in the Rec group than in the non-Rec group (81.1 ± 17.5 vs. 103.6 ± 25.4 cm/s, P < 0.01). A multivariate logistic analysis demonstrated that the LA and RA conduction velocities were independent predictors of AF recurrence, with adjusted odds ratios of 0.95 (95% confidential interval: 0.91-0.98, P < 0.01) and 0.94 (0.89-0.98, P < 0.01), respectively. In conclusion, slower conduction velocity of the atrium was associated with AF recurrence after pulmonary vein isolation.
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Affiliation(s)
- Tetsuro Sato
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| | - Hidehira Fukaya
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan.
| | - Jun Oikawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| | - Daiki Saito
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| | - Gen Matsuura
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| | - Yuki Arakawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| | - Shuhei Kobayashi
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| | - Yuki Shirakawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| | - Ryo Nishinarita
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| | - Ai Horiguchi
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| | - Naruya Ishizue
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| | - Jun Kishihara
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
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Choi JH, Kwon HJ, Kim HR, Park SJ, Kim JS, On YK, Park KM. Electrocardiographic predictors of early recurrence of atrial fibrillation. Ann Noninvasive Electrocardiol 2021; 26:e12884. [PMID: 34333816 PMCID: PMC8588373 DOI: 10.1111/anec.12884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/28/2021] [Accepted: 07/13/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Electrical cardioversion (ECV) is an effective method for restoring sinus rhythm after atrial fibrillation (AF). However, early recurrence of AF occurs in a significant number of patients after ECV. This study aimed to identify electrocardiographic (ECG) predictors of early AF recurrence after ECV. METHODS A total of 272 patients with persistent AF undergoing successful ECV were consecutively enrolled in this study. We investigated clinical, echocardiographic, and ECG data. The 12-lead ECG parameters were measured during sinus rhythm right after ECV using a digital caliper. The early AF recurrence was defined as recurrence within 2 months. RESULTS Of the 272 patients, 165 patients (60.7%) experienced an early AF recurrence. Maximum P-wave duration (PWD) in limb leads (OR: 1.086; 95% CI: 1.019-1.157; p = .012) and P-terminal force (PTF) in V1 (OR: 1.019; 95% CI: 1.004-1.033; p = .011) were independent predictors of early AF recurrence after ECV. The optimal cutoff value of the maximum PWD in limb leads for predicting early AF recurrence was 134 ms, characterized by 90.3% sensitivity and 72.0% specificity. Likewise, the optimal cutoff value of PTF in V1 was 50 ms × mm, characterized by 80.0% sensitivity and 64.5% specificity. CONCLUSION A longer PWD (>134 ms) and a larger PTF (>50 ms × mm) were useful predictors of early recurrence of AF after successful ECV in clinical practice. A more effective rhythm control therapy such as catheter ablation or rate control strategy rather than a repeat ECV should be considered.
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Affiliation(s)
- Ji-Hoon Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hee-Jin Kwon
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hye Ree Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung-Jung Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - June Soo Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young Keun On
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyoung-Min Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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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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Auricchio A, Özkartal T, Salghetti F, Neumann L, Pezzuto S, Gharaviri A, Demarchi A, Caputo ML, Regoli F, De Asmundis C, Chierchia GB, Brugada P, Klersy C, Moccetti T, Schotten U, Conte G. Short P-Wave Duration is a Marker of Higher Rate of Atrial Fibrillation Recurrences after Pulmonary Vein Isolation: New Insights into the Pathophysiological Mechanisms Through Computer Simulations. J Am Heart Assoc 2021; 10:e018572. [PMID: 33410337 PMCID: PMC7955300 DOI: 10.1161/jaha.120.018572] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Short ECG P-wave duration has recently been demonstrated to be associated with higher risk of atrial fibrillation (AF). The aim of this study was to assess the rate of AF recurrence after pulmonary vein isolation in patients with a short P wave, and to mechanistically elucidate the observation by computer modeling. Methods and Results A total of 282 consecutive patients undergoing a first single-pulmonary vein isolation procedure for paroxysmal or persistent AF were included. Computational models studied the effect of adenosine and sodium conductance on action potential duration and P-wave duration (PWD). About 16% of the patients had a PWD of 110 ms or shorter (median PWD 126 ms, interquartile range, 115 ms-138 ms; range, 71 ms-180 ms). At Cox regression, PWD was significantly associated with AF recurrence (P=0.012). Patients with a PWD <110 ms (hazard ratio [HR], 2.20; 95% CI, 1.24-3.88; P=0.007) and patients with a PWD ≥140 (HR, 1.87, 95% CI, 1.06-3.30; P=0.031) had a nearly 2-fold increase in risk with respect to the other group. In the computational model, adenosine yielded a significant reduction of action potential duration 90 (52%) and PWD (7%). An increased sodium conductance (up to 200%) was robustly accompanied by an increase in conduction velocity (26%), a reduction in action potential duration 90 (28%), and PWD (22%). Conclusions One out of 5 patients referred for pulmonary vein isolation has a short PWD which was associated with a higher rate of AF after the index procedure. Computer simulations suggest that shortening of atrial action potential duration leading to a faster atrial conduction may be the cause of this clinical observation.
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Affiliation(s)
- Angelo Auricchio
- Division of Cardiology Cardiocentro Ticino Lugano Switzerland.,Center for Computational Medicine in Cardiology Università della Svizzera Italiana Lugano Switzerland
| | - Tardu Özkartal
- Division of Cardiology Cardiocentro Ticino Lugano Switzerland.,Department of Cardiology Ospedale San Giovanni Bellinzona Switzerland
| | - Francesca Salghetti
- Heart Rhythm Management Centre Postgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium
| | - Laura Neumann
- Division of Cardiology Cardiocentro Ticino Lugano Switzerland
| | - Simone Pezzuto
- Center for Computational Medicine in Cardiology Università della Svizzera Italiana Lugano Switzerland
| | - Ali Gharaviri
- Center for Computational Medicine in Cardiology Università della Svizzera Italiana Lugano Switzerland
| | - Andrea Demarchi
- Division of Cardiology Cardiocentro Ticino Lugano Switzerland
| | | | - François Regoli
- Division of Cardiology Cardiocentro Ticino Lugano Switzerland
| | - Carlo De Asmundis
- Heart Rhythm Management Centre Postgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre Postgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre Postgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium
| | - Catherine Klersy
- Service of Clinical Epidemiology & Biometry Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | | | - Ulrich Schotten
- Department of Physiology Cardiovascular Research Institute MaastrichtMaastricht University Maastricht The Netherlands
| | - Giulio Conte
- Division of Cardiology Cardiocentro Ticino Lugano Switzerland
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20
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Palano F, Adduci C, Cosentino P, Silvetti G, Boldini F, Francia P. Assessing Atrial Fibrillation Substrates by P Wave Analysis: A Comprehensive Review. High Blood Press Cardiovasc Prev 2020; 27:341-347. [PMID: 32451990 DOI: 10.1007/s40292-020-00390-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/13/2020] [Indexed: 12/20/2022] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia. Pharmacologic and non-pharmacologic rhythm control strategies impact on AF-related symptoms, while leaving largely unaffected the risk of stroke. Moreover, up to 20% of AF patients are asymptomatic during paroxysmal relapses of arrhythmia, thus underlying the need for early markers to identify at-risk patients and prevent cerebrovascular accidents. Indeed, non-invasive assessment of pre-clinical substrate changes that predispose to AF could provide early identification of at-risk patients and allow for tailored care paths. ECG-derived P wave analysis is a simple-to-use and inexpensive tool that has been successfully employed to detect AF-associated structural and functional atrial changes. Beyond standard electrocardiographic techniques, high resolution signal averaged electrocardiography (SAECG), by recording microvolt amplitude atrial signals, allows more accurate analysis of the P wave and possibly AF risk stratification. This review focuses on the evidence that support P wave analysis to assess AF substrates, predict arrhythmia relapses and guide rhythm-control interventions.
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Affiliation(s)
- Francesca Palano
- Division of Cardiology, Department of Clinical and Molecular Medicine, Sapienza University, Rome, Via di Grottarossa 1035, 00189, Rome, Italy.
| | - Carmen Adduci
- Division of Cardiology, Department of Clinical and Molecular Medicine, Sapienza University, Rome, Via di Grottarossa 1035, 00189, Rome, Italy
| | - Pietro Cosentino
- Division of Cardiology, Department of Clinical and Molecular Medicine, Sapienza University, Rome, Via di Grottarossa 1035, 00189, Rome, Italy
| | - Giacomo Silvetti
- Division of Cardiology, Department of Clinical and Molecular Medicine, Sapienza University, Rome, Via di Grottarossa 1035, 00189, Rome, Italy
| | - Francesca Boldini
- Division of Cardiology, Department of Clinical and Molecular Medicine, Sapienza University, Rome, Via di Grottarossa 1035, 00189, Rome, Italy
| | - Pietro Francia
- Division of Cardiology, Department of Clinical and Molecular Medicine, Sapienza University, Rome, Via di Grottarossa 1035, 00189, Rome, Italy
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21
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Huang Z, Zheng Z, Wu B, Tang L, Xie X, Dong R, Luo Y, Li S, Zhu J, Liu J. Predictive value of P wave terminal force in lead V1 for atrial fibrillation: A meta-analysis. Ann Noninvasive Electrocardiol 2020; 25:e12739. [PMID: 32022368 PMCID: PMC7358887 DOI: 10.1111/anec.12739] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 12/20/2019] [Indexed: 12/23/2022] Open
Abstract
Background Several studies have explored the association between P wave terminal force in lead V1 (PTFV1) and risk of atrial fibrillation (AF) occurrence, but the results were controversial. This meta‐analysis aimed to examine whether abnormal PTFV1 could predict AF occurrence. Methods We searched PubMed, Embase, and Cochrane Library databases for articles published before August 25, 2018. Pooled odds ratios (ORs) of AF occurrence were calculated using random‐effects models to explore the significance of PTFV1. Results A total of 12 studies examining 51,372 participants were included, with 9 studies analyzing PTFV1 as a categorical variable and 4 studies analyzing PTFV1 as a continuous variable. As a categorical variable, abnormal PTFV1 (>0.04 mm s) was significantly associated with AF occurrence with a pooled OR of 1.39 (95% confidence interval [CI] 1.08–1.79, p = .01). Subgroup analysis found that ORs of studies in hemodialysis patients (OR = 4.89, 95% CI 2.54–9.90, p < .001) and acute ischemic stroke patients (OR = 1.60, 95% CI 1.14–2.25, p = .007) were higher than general population (OR = 1.15, 95% CI 1.03–1.29, p = .01). Studies from Europe (OR = 1.05, 95% CI 0.91–1.20, p = .51) yielded lower OR of endpoints compared with Asia (OR = 1.89, 95% CI 1.38–2.60, p < .001) and United States (OR = 1.43, 95% CI 1.19–1.72, p < .001). As a continuous variable, PTFV1 was also significantly associated with AF occurrence with a polled OR per 1 standard deviation (SD) change of 1.27 (95% CI 1.02–1.59, p = .03). Conclusions PTFV1 was significantly associated with the risk of AF and was considered to be a good predictor of AF occurrence in population with or without cardiovascular diseases.
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Affiliation(s)
- Zhuoshan Huang
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhenda Zheng
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bingyuan Wu
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Leile Tang
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xujing Xie
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ruimin Dong
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yanting Luo
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Suhua Li
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jieming Zhu
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jinlai Liu
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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22
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Johner N, Namdar M, Shah DC. Individualised Approaches for Catheter Ablation of AF: Patient Selection and Procedural Endpoints. Arrhythm Electrophysiol Rev 2019; 8:184-190. [PMID: 31463056 PMCID: PMC6702473 DOI: 10.15420/aer.2019.33.2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Pulmonary vein isolation (PVI) is the cornerstone of AF ablation, but studies have reported improved efficacy with high rates of repeat procedures. Because of the large interindividual variability in the underlying electrical and anatomical substrate, achieving optimal outcomes requires an individualised approach. This includes optimal candidate selection as well as defined ablation strategies with objective procedure endpoints beyond PVI. Candidate selection is traditionally based on coarse and sometimes arbitrary clinical stratification such as AF type, but finer predictors of treatment efficacy including biomarkers, advanced imaging and electrocardiographic parameters have shown promise. Numerous ancillary ablation strategies beyond PVI have been investigated, but the absence of a clear mechanistic and evidence-based endpoint, unlike in other arrhythmias, has remained a universal limitation. Potential endpoints include functional ones such as AF termination or non-inducibility and substrate-based endpoints such as isolation of low-voltage areas. This review summarises the relevant literature and proposes guidance for clinical practice and future research.
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Affiliation(s)
- Nicolas Johner
- Cardiology Division, University Hospital of Geneva Geneva, Switzerland
| | - Mehdi Namdar
- Cardiology Division, University Hospital of Geneva Geneva, Switzerland
| | - Dipen C Shah
- Cardiology Division, University Hospital of Geneva Geneva, Switzerland
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23
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Chen Q, Gasperetti A, Della Rocca DG, Mohanty S, Gedikli O, Trivedi C, Chauca-Tapia A, Di Biase L, Natale A. The Value of Baseline and Arrhythmic ECG in the Interpretation of Arrhythmic Mechanisms. Card Electrophysiol Clin 2019; 11:219-238. [PMID: 31084848 DOI: 10.1016/j.ccep.2019.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Owing to the rapid development of new electrophysiologic techniques, our understanding of arrhythmias and their underlying mechanisms has reached unprecedented levels. In some cases, baseline ECG alterations can be identified before arrhythmia development; early recognition of these alterations is of utmost importance to start appropriate preventive therapies and stratify the risk according to patients' outcomes. Hereby, we report a systematic revision of main baseline ECG abnormalities and their implications on clinical outcomes.
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Affiliation(s)
- Qiong Chen
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; Henan Provincial People's Hospital, No. 7 Weiwu, Zhengzhou, Henan Province, China
| | - Alessio Gasperetti
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - Domenico G Della Rocca
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA.
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - Omer Gedikli
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - Alfredo Chauca-Tapia
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; Department of Internal Medicine, Dell Medical School, University of Texas, 1501 Red River Street, Austin, TX 78712, USA; Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas, 301 East Dean Keeton Street, Austin, TX 78712, USA; Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA; Department of Clinical and Experimental Medicine, University of Foggia, Via A. Gramsci 09/91, Apulia, Foggia 71122, Italy
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; Department of Internal Medicine, Dell Medical School, University of Texas, 1501 Red River Street, Austin, TX 78712, USA; Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas, 301 East Dean Keeton Street, Austin, TX 78712, USA; Interventional Electrophysiology, Scripps Clinic, 9898 Genessee Avenue, La Jolla, CA 92037, USA; Department of Cardiology, Metro Health Medical Center, Case Western Reserve University School of Medicine, 2109 Adelbert Road, Cleveland, OH 44106, USA; Division of Cardiology, Stanford University, 870 Quarry Road, Stanford, CA 94305, USA
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24
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Hari KJ, Nguyen TP, Soliman EZ. Relationship between P-wave duration and the risk of atrial fibrillation. Expert Rev Cardiovasc Ther 2018; 16:837-843. [DOI: 10.1080/14779072.2018.1533814] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Krupal J. Hari
- Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Thong P. Nguyen
- Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Elsayed Z. Soliman
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, and Department of Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston Salem, NC, USA
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25
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Higuchi S, Ejima K, Shoda M, Yamamoto E, Iwanami Y, Yagishita D, Hagiwara N. Impact of a prolonged interatrial conduction time for predicting the recurrence of atrial fibrillation after circumferential pulmonary vein isolation of persistent atrial fibrillation. Heart Vessels 2018; 34:616-624. [PMID: 30291411 DOI: 10.1007/s00380-018-1272-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 09/28/2018] [Indexed: 11/26/2022]
Abstract
There are some cases that are difficult to cure with only circumferential pulmonary vein isolation (CPVI) of persistent atrial fibrillation (PerAF). Recently, prolonged interatrial conduction times (IACTs), which seem to be associated with progressive remodeled atria, have been reported as a predictor of new-onset AF. This study aimed to investigate the prognostic value of a prolonged IACT for predicting AF recurrences after CPVI of PerAF. One hundred thirteen patients who underwent CPVI without an empirical substrate modification of PerAF were retrospectively analyzed. The IACT was defined as the interval from the earliest P-wave onset on the ECG to the latest activation in the coronary sinus and was measured after achieving the CPVI and conversion to sinus rhythm. During a mean 22.7-month follow-up after the initial procedure, 56 patients (50%) had AF recurrences. Patients with AF recurrence had a longer IACT than those without AF recurrence (p < 0.001). The best discriminative cut-off value for the IACT was 123 ms (sensitivity 53%, specificity 85%). In a Cox multivariate analysis, a prolonged IACT of ≥ 123 ms was the only independent predictor (hazard ratio: 2.38; 95% confidence interval: 1.36-4.16, p = 0.002) of being associated with the incidence of an AF recurrence. Even after multiple CPVI procedures, patients with an IACT ≥ 123 ms had a higher AF recurrence rate than those with an IACT < 123 ms (p = 0.002). In conclusion, a prolonged IACT of ≥ 123 ms may be a useful marker for predicting AF recurrences after both initial and multiple CPVI procedures for PerAF.
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Affiliation(s)
- Satoshi Higuchi
- Department of Cardiology, Tokyo Women'S Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Koichiro Ejima
- Department of Cardiology, Tokyo Women'S Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Morio Shoda
- Department of Cardiology, Tokyo Women'S Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Eri Yamamoto
- Department of Cardiology, Tokyo Women'S Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Yuji Iwanami
- Department of Cardiology, Tokyo Women'S Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Daigo Yagishita
- Department of Cardiology, Tokyo Women'S Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women'S Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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26
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Don't Neglect the Electrocardiogram: P-Wave Proves a Potent Predictor. JACC Clin Electrophysiol 2018; 4:544-546. [PMID: 30067495 DOI: 10.1016/j.jacep.2018.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 01/10/2018] [Indexed: 11/24/2022]
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27
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Diagnostic value of electrocardiographic P-wave characteristics in atrial fibrillation recurrence and tachycardia-induced cardiomyopathy after catheter ablation. Heart Vessels 2018; 33:1381-1389. [DOI: 10.1007/s00380-018-1179-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 04/27/2018] [Indexed: 10/17/2022]
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28
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Jadidi A, Müller-Edenborn B, Chen J, Keyl C, Weber R, Allgeier J, Moreno-Weidmann Z, Trenk D, Neumann FJ, Lehrmann H, Arentz T. The Duration of the Amplified Sinus-P-Wave Identifies Presence of Left Atrial Low Voltage Substrate and Predicts Outcome After Pulmonary Vein Isolation in Patients With Persistent Atrial Fibrillation. JACC Clin Electrophysiol 2018; 4:531-543. [DOI: 10.1016/j.jacep.2017.12.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 11/27/2017] [Accepted: 12/04/2017] [Indexed: 11/29/2022]
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29
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Furniss GO, Panagopoulos D, Kanoun S, Davies EJ, Tomlinson DR, Haywood GA. The Effect of Atrial Fibrillation Ablation Techniques on P Wave Duration and P Wave Dispersion. Heart Lung Circ 2018; 28:389-396. [PMID: 29501465 DOI: 10.1016/j.hlc.2018.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 01/10/2018] [Accepted: 02/04/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND A reduction in surface electrocardiogram (ECG) P wave duration and dispersion is associated with improved outcomes in atrial fibrillation ablation. We investigated the effects of different ablation strategies on P wave duration and dispersion, hypothesising that extensive left atrial (LA) ablation with left atrial posterior wall isolation would give a greater reduction in P wave duration than more limited ablation techniques. METHODS A retrospective analysis of ECGs from patients who have undergone atrial fibrillation (AF) ablation was performed and pre-procedural sinus rhythm ECGs were compared with the post procedure ECGs. Maximal P wave duration was measured in leads I or II, minimum P wave duration in any lead and values were calculated for P wave duration and dispersion. Left atrial dimensions and medications at the time of ECG were documented. Ablation strategies compared were; pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) and the persistent AF (PsAF) ablation strategies of pulmonary vein isolation plus additional linear lesions (Lines), left atrial posterior wall isolation via catheter (PWI) and left atrial posterior wall isolation via staged surgical and catheter ablation (Hybrid). RESULTS Sixty-nine patients' ECGs were analysed: 19 PVI, 21 Lines, 14 PWI, 15 Hybrid. Little correlation was seen between pre-procedure left atrial size and P wave duration (r=0.24) but LA size and P wave duration was larger in PsAF patients. A significant difference was seen in P wave reduction driven by Hybrid AF ablation (p<0.005) and Lines (<0.02). There was no difference amongst P wave dispersion between groups but the largest reduction was seen in the Hybrid ablation group. CONCLUSIONS P wave duration increased with duration of continuous atrial fibrillation. Hybrid AF ablation significantly reduced P wave duration and dispersion compared to other ablation strategies including posterior wall isolation via catheter despite this being the same lesion set.
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Affiliation(s)
- Guy O Furniss
- Musgrove Park Hospital, Taunton, UK; University of Plymouth, Plymouth, UK; Southwest Cardiothoracic Centre, Derriford Hospital, Plymouth, UK.
| | | | - Sadeek Kanoun
- Southwest Cardiothoracic Centre, Derriford Hospital, Plymouth, UK
| | - Edward J Davies
- Southwest Cardiothoracic Centre, Derriford Hospital, Plymouth, UK
| | | | - Guy A Haywood
- Southwest Cardiothoracic Centre, Derriford Hospital, Plymouth, UK
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