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Zein ELAbdeen SG, El-Dosouky II, M ELShabrawy A, Mohammed El Maghawry L. Atrial electromechanical delay in post-COVID-19 postural orthostatic tachycardia: Innocent bystander or pathologic factor. Indian Heart J 2023; 75:292-297. [PMID: 37321349 PMCID: PMC10263230 DOI: 10.1016/j.ihj.2023.06.001] [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: 01/07/2023] [Revised: 05/04/2023] [Accepted: 06/11/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Post-COVID-19 syndrome represents a wide range of ongoing symptoms that persist beyond weeks or even months, after recovery from the acute phase. Postural orthostatic tachycardia (POT) is one of these symptoms with a poorly recognized underlying pathophysiology. PURPOSE We aimed to investigate atrial electromechanical delay (AEMD), demonstrated by electrocardiographic P wave dispersion (PWD) and tissue Doppler echocardiography (TDE) in patients with POST-COVID-19 POT (PCPOT). METHODS 94 post-COVID-19 patients were enrolled and classified into two groups; PCPOT group, 34 (36.1%) patients, and normal heart rate (NR group), 60 (63.9%) patients. 31.9% of them were males and 68.1% were females, with a mean age of 35 ± 9 years. Both groups were compared in terms of PWD and AEMD. RESULTS As compared to the NR group, the PCPOT group showed a significant increase in PWD (49 ± 6 versus 25.6 ± 7.8, p < 0.001), higher CRP (37 ± 9 versus 30 ± 6, p = 0.04), prolonged left-atrial EMD, right-atrial EMD and inter-atrial EMD at (p = 0.006, 0.001, 0.002 respectively). Multivariate logistic regression analysis revealed that P wave dispersion (β 0.505, CI (0.224-1.138), p = 0.023), PA lateral (β 0.357, CI (0.214-0.697), p = 0.005), PA septal (β 0.651, CI. (0.325-0.861), p = 0.021), and intra-left atrial EMD (β 0.535, CI (0.353-1.346) p < 0.012) were independent predictors of PCPOT. CONCLUSION Atrial heterogenicity in the form of prolonged AEMD and PWD seems to be a reasonable underlying pathophysiology of PCPOT. This could provide a new concern during the management and novel pharmacological approaches in these patients.
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Ozturk HM, Erdogan M, Alsancak Y, Yarlioglues M, Duran M, Boztas MH, Murat SN, Ozturk S. Electrocardiographic alterations in patients consuming synthetic cannabinoids. J Psychopharmacol 2018; 32:296-301. [PMID: 29108464 DOI: 10.1177/0269881117736918] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The aim of this study was to investigate the electrocardiographic parameters in patients consuming synthetic cannabinoids. METHODS Thirty-five patients who were consuming synthetic cannabinoids were enrolled to the study, prospectively. The control group included 35 healthy age and sex-matched volunteers. The standard 12-lead surface electrocardiograms of the study population were recorded. P maximum (Pmax), P minimum (Pmin), P wave dispersion, interatrial duration, P wave area in D2 derivation, abnormal P terminal force in V1 derivation, heart rate, QT interval, corrected QT, QT dispersion, PR interval duration and macrovolt T-wave alternans were evaluated by two experienced cardiologists. The intra-observer and inter-observer variations for all measurements were non-significant. RESULTS Pmax and Pmin duration was not different between the groups ( p=0.96, p=0.15, respectively). However, P wave dispersion was higher in the patient group compared to control group (34±9.4, 29.5±6.6, p=0.02, respectively). QT interval was significantly higher in the patient group than the control group (380.3±25, 365.6±22.8, p=0.01, respectively). Besides, corrected QT was higher in the patient group compared to control group (415±36.8, 392±15.5, p=0.001, respectively). QT dispersion was also higher in the patient group than the control group (39.8±10.0, 29.2±5.4, p<0.001, respectively). CONCLUSION Altered electrocardiography parameters linked with atrial and ventricular arrhythmia development may be observed in patients consuming synthetic cannabinoids. These patients should be evaluated regularly for cardiovascular disease and arrhythmia development. The electrocardiogram, which is a cheap and easy test to apply, can be used to determine the pro-arrythmic risk in patients consuming synthetic cannabinoids.
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Affiliation(s)
- Hayriye M Ozturk
- 1 Department of Psychiatry, Ankara Numune Education and Research Hospital, Turkey
| | - Mehmet Erdogan
- 2 Department of Cardiology, Ankara Education and Research Hospital, Turkey
| | - Yakup Alsancak
- 3 Department of Cardiology, Ankara Atatürk Education and Research Hospital, Turkey
| | - Mikail Yarlioglues
- 2 Department of Cardiology, Ankara Education and Research Hospital, Turkey
| | - Mustafa Duran
- 2 Department of Cardiology, Ankara Education and Research Hospital, Turkey
| | - M Hamid Boztas
- 4 Department of Psychiatry, Abant Izzet Baysal University Izzet Baysal Mental Health and Disorders Education and Research Hospital, Bolu, Turkey
| | - Sani N Murat
- 2 Department of Cardiology, Ankara Education and Research Hospital, Turkey
| | - Selcuk Ozturk
- 2 Department of Cardiology, Ankara Education and Research Hospital, Turkey
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Hernandez-Betancor I, Izquierdo-Gómez MM, García-Niebla J, Laynez-Cerdeña I, García-González MJ, Irribarren-Sarriá JL, Jimenez-Rivera JJ, Lacalzada-Almeida J. Bayes Syndrome and Imaging Techniques. Curr Cardiol Rev 2017; 13:263-273. [PMID: 28707575 PMCID: PMC5730959 DOI: 10.2174/1573403x13666170713122600] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 06/23/2017] [Accepted: 07/03/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Interatrial block (IAB) is due to disruption in the Bachmann region (BR). According to whether interatrial electrical conduction is delayed or completely blocked through the BR, it can be classified as IAB of first, second or third degree. On the surface electrocardiogram, a P wave ≥ 120 ms (partial IAB) is observed or associated to the prolongation of the P wave with a biphasic (positive / negative) morphology in the inferior leads (advanced IAB). Bayes syndrome is defined as an advanced IAB associated with atrial arrhythmia, more specifically atrial fibrillation. Objective and Conclusion: The purpose of this review is to describe the latest evidence about an entity considered an anatomical and electrical substrate with its own name, which may be a predictor of supraventricular arrhythmia and cardioembolic cerebrovascular accidents, as well as the role of new imaging techniques, such as echocardiographic strain and cardiac magnetic resonance imaging, in characterizing atrial alterations associated with this syndrome and generally in the study of anatomy and atrial function.
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Affiliation(s)
- Iván Hernandez-Betancor
- Departamento de Cardiología, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Tenerife, España
| | | | - Javier García-Niebla
- Centro de Salud Valle del Golfo, Servicios Sanitarios del Área de Salud de El Hierro, Frontera-El Hierro, Santa Cruz de Tenerife, Tenerife, España
| | - Ignacio Laynez-Cerdeña
- Departamento de Cardiología, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Tenerife, España
| | | | - Barragan-Acea
- Departamento de Cardiología, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Tenerife, España
- Centro de Salud Valle del Golfo, Servicios Sanitarios del Área de Salud de El Hierro, Frontera-El Hierro, Santa Cruz de Tenerife, Tenerife, España
- Departamento de Unidad de Cuidados Intensivos, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Tenerife, España
| | - A.
- Departamento de Cardiología, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Tenerife, España
| | - Jose Luis Irribarren-Sarriá
- Departamento de Unidad de Cuidados Intensivos, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Tenerife, España
| | - Juan José Jimenez-Rivera
- Departamento de Unidad de Cuidados Intensivos, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Tenerife, España
| | - Juan Lacalzada-Almeida
- Departamento de Cardiología, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Tenerife, España
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Assessment of atrial electromechanical delay and P-wave dispersion in patients with type 2 diabetes mellitus. J Cardiol 2016; 67:378-83. [DOI: 10.1016/j.jjcc.2015.06.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 06/04/2015] [Accepted: 06/07/2015] [Indexed: 02/05/2023]
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Sokmen A, Acar G, Sokmen G, Akcay A, Akkoyun M, Koroglu S, Nacar AB, Ozkaya M. Evaluation of atrial electromechanical delay and diastolic functions in patients with hyperthyroidism. Echocardiography 2013; 30:1194-201. [PMID: 23742676 DOI: 10.1111/echo.12277] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
AIM Hyperthyroidism is a well-known cause of atrial fibrillation (AF) which is associated with increased morbidity and mortality. Atrial electromechanical delay (EMD) is a significant predictor of AF. The aim of this study was to assess the atrial EMD and diastolic functions in subclinical and overt hyperthyroidism by using tissue Doppler imaging (TDI). METHODS AND RESULTS The study population consisted of 3 groups: group I (30 healthy subjects), group II (38 patients with subclinical hyperthyroidism), and group III (25 patients with overt hyperthyroidism). Atrial electromechanical coupling was measured with TDI. Standard echocardiographic measurements and parameters of diastolic function were obtained by conventional echocardiography and TDI. Intra- and inter-atrial EMD were significantly prolonged in subclinical and overt hyperthyroidism compared with control group (P = 0.03 and P < 0.001 for intra-atrial EMD; P < 0.001 for inter-atrial EMD). In groups II and III, mitral A velocity (P = 0.005 and P = 0.001) and mitral E-wave deceleration time (P < 0.001 and P = 0.02) were significantly increased, and mitral E/A ratio (P = 0.005 and P = 0.001) was significantly decreased compared with the control group. The lateral mitral Em /Am ratio in group II and group III was significantly lower than controls (P = 0.001). Mitral Em /Am ratio (β = -0.32, P = 0.002) and thyroid stimulating hormone (TSH) level (β = -0.27, P = 0.009) were negatively and independently correlated with inter-atrial EMD. CONCLUSION This study showed that intra- and inter-atrial electromechanical intervals were prolonged and diastolic function was impaired in both overt and subclinical hyperthyroidism. TSH level and mitral Em /Am ratio were found as independent predictors of atrial EMD.
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Affiliation(s)
- Abdullah Sokmen
- Department of Cardiology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
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Ayhan S, Ozturk S, Alcelik A, Ozlu MF, Erdem A, Memioglu T, Ozdemir M, Yazici M. Atrial conduction time and atrial mechanical function in patients with impaired fasting glucose. J Interv Card Electrophysiol 2012; 35:247-52; discussion 252. [DOI: 10.1007/s10840-012-9722-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Accepted: 08/12/2012] [Indexed: 12/31/2022]
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Caglar IM, Dasli T, Turhan Caglar FN, Teber MK, Ugurlucan M, Ozmen G. Evaluation of atrial conduction features with tissue Doppler imaging in patients with chronic obstructive pulmonary disease. Clin Res Cardiol 2012; 101:599-606. [PMID: 22391986 DOI: 10.1007/s00392-012-0431-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 02/20/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The electrical activity of atria can be demonstrated by P waves on surface electrocardiogram (ECG). Atrial electromechanical delay (AEMD) measured with tissue Doppler imaging (TDI) echocardiography can be a useful non-invasive method for evaluating atrial conduction features. We investigated whether AEMD is prolonged in patients with chronic obstructive pulmonary disease (COPD). PATIENTS AND METHODS Study consisted of 41 (15 female, 26 male, mean age 62 + 12 years) patients with COPD and 41 healthy subjects. Pulmonary function tests,12 lead surface ECG and echocardiographic examination were performed and recorded. P wave changes on surface ECG, minimum (P (min)) and maximum (P (max)) duration of P wave and its difference as P wave dispersion (P (wd)) were measured and recorded. Atrial electromechanic delay (AEMD) was calculated from colored-TDI recordings. RESULTS Pulmonary functions were significantly lower in COPD group than the control group as expected. Right atrial areas and pulmonary arterial systolic pressures (PAP) were significantly higher in COPD group than the controls (right atrial area: 11.9 ± 3.4 cm(2) and 8.2 ± 2.2 cm(2), p < 0.0001 and PAP: 38.4 ± 12.2 and 19.0 ± 3.2 mmHg p < 0.0001, respectively). P wave intervals on surface ECG were significantly increased in COPD patients than the control group (P (max): 105 ± 11 and 90 ± 12 ms, p < 0.0001; P (min): 60 ± 12 and 51 ± 10 ms, p = 0.003 and P (wd): 39 ± 10 and 31 ± 7 ms, p < 0.0001). According to the AEMD measurements from different sites by TDI, there was a significant delay between the onset of the P wave on surface ECG and the onset of the late diastolic wave in patients with COPD when compared with controls measured from tricuspid lateral septal annulus (TAEMD) (COPD: 41.3 ± 9.8 ms, control: 36 ± 4.5 ms; p = 0.005). There was a positive correlation between TAEMD and right atrial area (r = 0.63, p < 0.0001) and also between TAEMD and PASP (r = 0.43, p < 0.0005) and a negative correlation between TAEMD and forced expiratory volume (FEV1) (r = -0.44, p = 0.04). CONCLUSIONS Right atrial electromechanical delay is significantly prolonged in patients with COPD. The right atrial area, PAP and FEV1 levels are important factors of this prolonged delay. Also the duration of atrial depolarization is significantly prolonged and propagation of depolarization is inhomogeneous in patients with COPD. These may be the underlying mechanisms to explain the atrial premature beats, multifocal atrial tachycardia, atrial flutter and fibrillation often seen in patients with COPD secondary to these changes.
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Affiliation(s)
- Ilker Murat Caglar
- Department of Cardiology, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Atakoy, 9. Kisim, B 6 Blok, Daire: 40, Atakoy, Bakirkoy, Istanbul, Turkey.
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Sengul C, Cevik C, Ozveren O, Oduncu V, Sunbul A, Kılıcarslan F, Semiz E, Dindar I. Telmisartan decreases atrial electromechanical delay in patients with newly diagnosed essential hypertension. J Electrocardiol 2012; 45:123-8. [DOI: 10.1016/j.jelectrocard.2011.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Indexed: 10/16/2022]
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Cagirci G, Cay S, Gulsoy KG, Bayindir C, Vural MG, Firat H, Kilic H, Yeter E, Akdemir R, Ardic S. Tissue Doppler atrial conduction times and electrocardiogram interlead P-wave durations with varying severity of obstructive sleep apnea. J Electrocardiol 2011; 44:478-82. [PMID: 21704224 DOI: 10.1016/j.jelectrocard.2011.03.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Obstructive sleep apnea (OSA) has been reported to be associated with an increased risk of atrial fibrillation. The aim of this study was to investigate atrial electromechanical couplings in patients with OSA and the relationship between these parameters and P-wave dispersion (Pd). METHODS One hundred twenty-six patients were enrolled in this study. All patients underwent polysomnographic examination. The apnea-hypopnea index (AHI) was defined as the number of apneas and hypopneas per hour of sleep. An AHI score of 5 or more was diagnosed as OSA, and an AHI score of less than 5 was diagnosed as OSA (-). Thirty-nine of the patients had an AHI score of less than 5 (group 1), 42 of the patients had AHI score between 5 and 30 (mild and moderate, group 2), 45 of the patients had an AHI score more than 30 (severe, group 3). Atrial electromechanical coupling (PA), intra-atrial, and interatrial electromechanical delay were measured with tissue Doppler imaging. P-wave dispersion was calculated from 12-lead electrocardiogram. RESULTS Maximum P-wave duration was higher in group 3 compared with groups 2 and 1 (126.0 ± 16.7 vs 111.0 ± 12.5 [P < .001] and 126.0 ± 16.7 vs 99.9 ± 10.0 [P < .001], respectively). Maximum P-wave duration was higher in group 2 than in group 1 (111.0 ± 12.5 vs 99.9 ± 10.0, P < .001). P-wave dispersion was higher in group 3 compared with groups 2 and 1 (50.9 ± 11.5 vs 37.0 ± 8.6 [P < .001] and 50.9 ± 11.5 vs 27.9 ± 6.8 [P < .001], respectively). P-wave dispersion was higher in group 2 than in group 1 (37.0 ± 8.6 vs 27.9 ± 6.8, P < .001). Minimum P-wave duration did not differ between the groups. Atrial PA at the left lateral mitral annulus (lateral PA), septal mitral annulus (septal PA), and right ventricular tricuspid annulus (RV PA) were significantly higher in group 3 than in group 2 (P < .001, P = .001, and P = .009, respectively). Lateral PA, septal PA, and RV PA were higher in group 2 compared with group 1 (P < .001, P = .003, and P = .009, respectively). Interatrial electromechanical delay (lateral PA - RV PA) was significantly longer in group 3 compared with groups 2 and 1 (33.6 ± 12.1 vs 22.4 ± 9.4 [P < .001] and 33.6 ± 12.1 vs 14.9 ± 9.2 [P < .001], respectively). Interatrial electromechanical delay was longer in group 2 than in group 1 (22.4 ± 9.4 vs 14.9 ± 9.2, P = .001). There was a positive correlation between AHI and Pd, lateral PA, septal PA, RV PA, interatrial electromechanical delay, and left-sided intra-atrial electromechanical delay. CONCLUSION Prolongation of electromechanical delay and increased Pd are associated with apnea-hypopnea index (AHI) and hence the severity of disease.
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Affiliation(s)
- Goksel Cagirci
- Ministry of Health Antalya Education and Research Hospital, Cardiology Clinic, Antalya, Turkey.
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Pala S, Tigen K, Karaahmet T, Dundar C, Kilicgedik A, Güler A, Cevik C, Kirma C, Basaran Y. Assessment of atrial electromechanical delay by tissue Doppler echocardiography in patients with nonischemic dilated cardiomyopathy. J Electrocardiol 2010; 43:344-50. [DOI: 10.1016/j.jelectrocard.2009.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Indexed: 01/09/2023]
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