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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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Kaimori R, Iwakawa H, Suzuki N, Aokawa M, Tashiro H, Terata K, Watanabe H. Asymmetric remodeling between the left and right atria in patients with advanced interatrial block and atrial fibrillation. J Electrocardiol 2023; 80:63-68. [PMID: 37257248 DOI: 10.1016/j.jelectrocard.2023.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 05/01/2023] [Accepted: 05/18/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Advanced interatrial block (A-IAB) on electrocardiography (ECG) represents the conduction delay between the left and right atria. We investigated the association of A-IAB with left and right atrial (LA/RA) remodeling in patients with atrial fibrillation (AF). METHODS We enrolled 74 patients who underwent ECG, cardiac computed tomography (CCT), and echocardiography during sinus rhythm before catheter ablation of AF. A-IAB was defined as P-wave duration ≥120 ms with a biphasic morphology in leads III and aVF or notched morphology in lead II. We compared the maximum and minimum LA/RA volume indices (max and min LAV/RAVI), LA/RA expansion index (LAEI/RAEI), and total, passive, and active LA/RA emptying fraction (LAEF/RAEF) between patients with and without A-IAB. RESULTS Of the 74 patients (mean age, 64.3 ± 9.6 years), 35 (47%) showed A-IAB. Patients with A-IAB had a significantly higher likelihood of hypertension and left ventricular diastolic dysfunction than those without. Patients with A-IAB had significantly larger max (69.2 [60.7-79.7]mL/m2 vs. 60.9 [50.4-68.3]mL/m2, P < 0.01) and min (44.0 [37.2-52.1]mL/m2 vs. 34.1 [29.2-43.5]mL/m2, P < 0.01) LAVI than those without. The max and min RAVI were not significantly different between groups. LAEI (55.1 [48.2-78.5]% vs. 72.1 [57.8-84.8]%, P < 0.05), total LAEF (35.5 [32.5-44.0]% vs. 41.9 [36.6-45.9]%, P < 0.05), and passive LAEF (12.2 [10.0-14.4]% vs. 15.5 [11.2-19.6]%, P < 0.05) were significantly lower in patients with A-IAB than without. CONCLUSIONS A-IAB was associated with LA, but not RA enlargement, in patients with AF. A-IAB may indicate LA functional remodeling in the reservoir and conduit phases.
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Affiliation(s)
- Ryota Kaimori
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Hidehiro Iwakawa
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Nobuhiro Suzuki
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Mako Aokawa
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Haruwo Tashiro
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Ken Terata
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Hiroyuki Watanabe
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Akita, Japan.
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Zhao D, Zhang F, Liu X, Li M, Zhang L, Hu J, Li F, Wu J. Efficacy of catheter ablation for atrial fibrillation in patients with significant functional mitral regurgitation. Medicine (Baltimore) 2023; 102:e33231. [PMID: 36897680 PMCID: PMC9997827 DOI: 10.1097/md.0000000000033231] [Citation(s) in RCA: 1] [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: 12/25/2022] [Accepted: 02/16/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Catheter ablation has been established to be an effective therapy for paroxysmal atrial fibrillation (AF) and is recommended as the treatment of choice for many patients, including those with clinically significant functional mitral regurgitation (MR). However, there is little information available about the clinical efficacy of catheter ablation for paroxysmal AF in patients with significant functional MR. METHODS We performed a retrospective study of 247 patients with paroxysmal AF who underwent AF ablation. The study included 28 (11.3%) patients with significant functional MR and 219 (88.7%) without significant functional MR. AF recurrence was defined as the occurrence of confirmed atrial tachyarrhythmia lasting >30 seconds beyond 3 months after catheter ablation. RESULTS During a mean follow-up of 20.1 ± 7.4 months (range, 3-36 months), 45 (18.2%) patients developed recurrence of AF. The recurrence rate of AF was higher in patients with significant functional MR than in those without significant functional MR (42.9% vs 15.1%; P < .001). Univariable Cox proportional hazards regression analysis showed that significant functional MR (hazard ratio [HR], 3.46; 95% confidence interval [CI], 1.78-6.72; P < .001), age (HR, 1.04; 95% CI, 1.01-1.08; P = .009), the CHA2DS2-VASc score (HR, 1.28; 95% CI, 1.05-1.56; P = .017), and heart failure (HR, 4.71; 95% CI, 1.85-11.96; P = .001) were associated with the risk of recurrence. Multivariable analysis showed that significant functional MR (HR, 2.48; 95% CI, 1.21-5.05; P = .013), age (HR, 1.04; 95% CI, 1.00-1.07; P = .031), and heart failure (HR, 3.39; 95% CI, 1.27-9.03; P = .015) were independent predictors of AF recurrence. CONCLUSION Patients with significant functional MR have an increased risk of AF recurrence after catheter ablation.
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Affiliation(s)
- Danqing Zhao
- Department of Cardiology, Anyang People’s Hospital, Anyang, China
- Department of Cardiology, Henan University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Futao Zhang
- Department of Cardiology, Henan University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Xiaojie Liu
- Department of Cardiology, Henan University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Muzhang Li
- Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Central China Fuwai Hospital, Zhengzhou, China
| | - Leiming Zhang
- Heart Centre of Henan Provincial People’s Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Juan Hu
- Heart Centre of Henan Provincial People’s Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Feifei Li
- Human Resource Department, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jintao Wu
- Heart Centre of Henan Provincial People’s Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
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Atrial cardiomyopathy: Diagnosis, clinical implications and unresolved issues in anticoagulation therapy. J Electrocardiol 2023; 76:1-10. [PMID: 36370545 DOI: 10.1016/j.jelectrocard.2022.10.012] [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: 04/19/2022] [Revised: 10/15/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
Atrial cardiomyopathy (AC) is an evolving pathophysiological entity that has expanded our understanding regarding the atrium and its role in arrhythmogenesis and cardiac thromboembolism. The pathological myocardium in AC promotes arrhythmogenesis through mechanical dysfunction (hypocontractility, fibrosis), adverse alterations of the endothelium and secretion of prothrombotic factors (IL-6, IL-8, TNF-a). 'Red flags', indicative of AC, can be recognized either non-invasively by electrocardiography, echocardiography and cardiac magnetic resonance imaging or invasively by high-density electroanatomical mapping as low bipolar voltage areas of the affected myocardium. Signs of AC have been strongly associated with an increased risk of ischemic stroke, even embolic strokes of undetermined source, regardless of the coexistence of atrial fibrillation (AF). The underlying existence of AC has been negatively correlated with the success rate of catheter ablation of AF. The clinical value of AC is the provision of a novel pathway regarding the potential mechanisms of cerebrovascular events of cardiac thromboembolic origin. In addition, AC may serve as a risk stratification tool to predict the long-term responders of AF catheter ablation.
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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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Wang H, Cai L, Guo Y, Shuai L, Shi Y, Si Q. Advanced Interatrial Block Predicts Recurrence of Atrial Fibrillation and Ischemic Stroke in Elderly Patients With Hypertension. Front Physiol 2022; 13:913454. [PMID: 35784875 PMCID: PMC9243526 DOI: 10.3389/fphys.2022.913454] [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: 04/05/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background: This study aimed to investigate whether advanced interatrial block (IAB) is a predictor of recurrent atrial fibrillation (AF) and/or ischemic stroke in elderly patients with AF and hypertension.Methods and objectives: Five hundred and sixteen elderly inpatients (mean age 85.53 ± 9.08 years; 5.43% women) with concurrent paroxysmal AF and hypertension were enrolled in this retrospective observational study. Data on comorbidity, medication, digital electrocardiograms (ECG), and outcomes were obtained from the medical records and follow-up examinations. IAB was classified as partial IAB or advanced IAB according to 12-lead surface ECG analysis on admission. Advanced IAB was defined as a maximum P wave duration of >120 ms with biphasic (±) morphology in leads II, Ⅲ, and aVF by two blinded investigators. The endpoints were recurrent AF and ischemic stroke.Results: We enrolled 120 patients (23.26%) with partial IAB and 187 (36.24%) with advanced IAB. The mean follow-up duration was 19 months. A total of 320 patients (62.02%) developed AF recurrence, and 31 (6.01%) experienced ischemic stroke. Significant predictors of advanced IAB in multivariate analysis were older age (>80 years), increased left atrial diameter (>40 mm), and being overweight (body mass index >25 kg/m2). In the multivariable comprehensive Cox regression analyses, partial IAB was associated with AF recurrence. Advanced IAB was an independent predictor of increased risk of AF recurrence and ischemic stroke.Conclusion: Both partial and advanced IAB are associated with AF recurrence in elderly patients with hypertension. Furthermore, advanced IAB is an independent predictor of ischemic stroke.
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Affiliation(s)
- Haijun Wang
- Department of Cardiology, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Lili Cai
- Department of Laboratory Medicine, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Yan Guo
- Department of Cardiology, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Li Shuai
- Department of Cardiology, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Yang Shi
- Department of Cardiology, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
- *Correspondence: Yang Shi, ; Quanjin Si,
| | - Quanjin Si
- Department of the Third Health Care, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
- *Correspondence: Yang Shi, ; Quanjin Si,
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P wave duration ≥150 ms predicts poor left atrial function and ablation outcomes in non-paroxysmal atrial fibrillation. J Electrocardiol 2021; 69:124-131. [PMID: 34695779 DOI: 10.1016/j.jelectrocard.2021.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/03/2021] [Accepted: 10/08/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND It remains unknown whether P wave duration (PWD) ≥ 150 ms measured after extensive radiofrequency catheter ablation (RFCA) can identify non-paroxysmal atrial fibrillation (non-PAF) patients at increased risk of atrial tachyarrhythmia recurrence. We investigated the predicting power of PWD and its association with left atrial (LA) reverse remodeling in patients with non-PAF undergoing pulmonary vein isolation with LA linear ablation. METHODS We retrospectively evaluated 136 patients who underwent RFCA for drug-refractory non-PAF. Electroanatomic mapping was acquired during AF. Low-voltage area (LVA) was defined as an area with bipolar voltage ≤0.5 mV. Electrocardiography and echocardiography were performed during sinus rhythm 1 day and 3 months after RFCA. PWD was measured using amplified 12‑lead electrocardiography. Prolonged PWD was defined as maximum PWD ≥ 150 ms. RESULTS Over a mean follow-up duration of 48 ± 35 months, 28 patients experienced atrial tachyarrhythmia recurrence. PWD was positively correlated with LVA (r = 0.527, p < 0.001) and inversely correlated with LA emptying fraction (r = -0.399, p < 0.001). PWD was shortened and LA emptying fraction (LAEF) was increased in patients without atrial tachyarrhythmia recurrence during follow-up. Atrial tachyarrhythmia-free survival was significantly more likely in patients without a prolonged PWD (83.5% vs 60.7%, p = 0.002). Multivariate analysis showed that LAEF and PWD were independent predictors of atrial tachyarrhythmia recurrence. CONCLUSIONS PWD ≥ 150 ms measured after RFCA can identify patients with non-PAF at increased risk of atrial tachyarrhythmia recurrence. PWD is correlated with LVA and LAEF and reflects LA reverse remodeling.
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Eyuboglu M, Celik A. Frontal plane QRS-T angle predicts early recurrence of acute atrial fibrillation after successful pharmacological cardioversion with intravenous amiodarone. J Clin Pharm Ther 2021; 46:1750-1756. [PMID: 34480487 DOI: 10.1111/jcpt.13529] [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: 05/21/2021] [Revised: 07/28/2021] [Accepted: 08/26/2021] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Although restoration of sinus rhythm is the integral part of the atrial fibrillation (Af) management, recurrence frequency of Af is high after cardioversion. However, little is known about the association of electrocardiography (ECG) parameters with Af recurrence after restoration of sinus rhythm. The present study aimed to investigate whether frontal plane QRS-T (fQRST) angle, as a marker of ventricular repolarization heterogeneity, predicts Af recurrence after successful pharmacological cardioversion. METHODS One hundred and sixty-five paroxysmal Af patients with an acute Af episode who underwent successful pharmacological cardioversion with intravenous amiodarone infusion were included into the study. Patients were divided into two groups according to presence or absence of in-hospital Af recurrence. The association between fQRST angle and Af recurrence was investigated. RESULTS AND DISCUSSION Af recurrence was observed in 42 (25.4%) patients. The mean fQRST angle was significantly higher in patients with Af recurrence compared to those without Af recurrence (90 ± 45.8 vs. 51 ± 38.2, p < 0.001). Also, Af recurrence was more frequent in patients who had fQRST angle >90˚, compared to patients with fQRST angle ≤90˚ (54.1% vs. 13.7%, p < 0.001). Moreover, ROC curve analysis demonstrated that an increased fQRST angle >92.5˚ predicted in-hospital Af recurrence with a sensitivity of 76.2% and a specificity of 81.4% (AUC:0.728, p < 0.001). Furthermore, multivariate analysis demonstrated that fQRST angle was an independent predictor of in-hospital Af recurrence after successful pharmacological cardioversion (OR: 1.892, 95% CI: 1.361-2.917, p < 0.001). WHAT IS NEW AND CONCLUSION As a parameter that can be easily calculated from automated ECG recordings, fQRST angle may be useful in the prediction of early Af recurrence after successful pharmacological cardioversion with amiodarone.
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Affiliation(s)
- Mehmet Eyuboglu
- Department of Cardiology, School of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Atac Celik
- Department of Cardiology, School of Medicine, Gaziosmanpasa University, Tokat, Turkey
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Long P-wave duration immediately after pulmonary vein isolation on radiofrequency catheter ablation for atrial fibrillation predicts clinical recurrence: correlation with atrial remodeling in persistent atrial fibrillation. Heart Vessels 2021; 37:476-488. [PMID: 34432100 DOI: 10.1007/s00380-021-01932-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/20/2021] [Indexed: 01/22/2023]
Abstract
P-wave morphology reflects atrial remodeling and indicates prognosis after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF). The impact of p-wave morphology after excluding the effect of pulmonary vein (PV) substrate on outcomes is unknown. We evaluated the p-wave morphology on electrocardiography immediately after PV isolation for clinical outcomes. Eighty-four consecutive patients (47 with paroxysmal AF and 37 with persistent AF) who underwent RFCA were included. P-wave duration (PWD) and amplitude in all leads were examined during sinus rhythm immediately after PV isolation. We evaluated the relationship between electrocardiogram parameters and AF recurrence, according to the type of AF and following ablation, and the correlation with left atrial (LA) volume, low voltage ratio, and fixed conduction time. During 12 months of follow-up, 20 patients experienced recurrence. The cut-off value of PWD > 120 ms in lead I showed a sensitivity of 75% and specificity of 69% for predicting recurrence. PWD was significantly correlated with LA volume, low voltage, and conduction velocity. Significantly higher recurrence rates were observed in patients with PWD > 120 ms than in those with PWD ≤ 120 ms (p < 0.001), and the difference was more pronounced in patients with persistent AF. Multivariate analysis demonstrated that PWD > 120 ms was independently associated with recurrence in the total population (hazard ratio 2.00; 95% confidence interval 1.27-3.22; p = 0.003) and in patients with persistent AF. In conclusion, long PWD after PV isolation predicts AF recurrence, which might be associated with the extent of the LA substrate in persistent AF.
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Zink MD, Chua W, Zeemering S, di Biase L, Antoni BDL, David C, Hindricks G, Haeusler KG, Al-Khalidi HR, Piccini JP, Mont L, Nielsen JC, Escobar LA, de Bono J, Van Gelder IC, de Potter T, Scherr D, Themistoclakis S, Todd D, Kirchhof P, Schotten U. Predictors of recurrence of atrial fibrillation within the first 3 months after ablation. Europace 2021; 22:1337-1344. [PMID: 32725107 PMCID: PMC7478316 DOI: 10.1093/europace/euaa132] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 01/19/2020] [Indexed: 11/23/2022] Open
Abstract
Aims Freedom from atrial fibrillation (AF) at 1 year can be achieved in 50–70% of patients undergoing catheter ablation. Recurrent AF early after ablation most commonly terminates spontaneously without further interventional treatment but is associated with later recurrent AF. The aim of this investigation is to identify clinical and procedural factors associated with recurrence of AF early after ablation. Methods and results We retrospectively analysed data for recurrence of AF within the first 3 months after catheter ablation from the randomized controlled AXAFA–AFNET 5 trial, which demonstrated that continuous anticoagulation with apixaban is as safe and as effective compared to vitamin K antagonists in 678 patients undergoing first AF ablation. The primary outcome of first recurrent AF within 90 days was observed in 163 (28%) patients, in which 78 (48%) patients experienced an event within the first 14 days post-ablation. After multivariable adjustment, a history of stroke/transient ischaemic attack [hazard ratio (HR) 1.54, 95% confidence interval (CI) 0.93–2.6; P = 0.11], coronary artery disease (HR 1.85, 95% CI 1.20–2.86; P = 0.005), cardioversion during ablation (HR 1.78, 95% CI 1.26–2.49; P = 0.001), and an age:sex interaction for older women (HR 1.01, 95% CI 1.00–1.01; P = 0.04) were associated with recurrent AF. The P-wave duration at follow-up was significantly longer for patients with AF recurrence (129 ± 31 ms vs. 122 ± 22 ms in patients without AF, P = 0.03). Conclusion Half of all early AF recurrences within the first 3 months post-ablation occurred within the first 14 days post-ablation. Vascular disease and cardioversion during the procedure are strong predictors of recurrent AF. P-wave duration at follow-up was longer in patients with recurrent AF. Trial registration Clinicaltrials.gov identifier NCT02227550
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Affiliation(s)
- Matthias Daniel Zink
- Department of Internal Medicine I, University Hospital RWTH Aachen, Aachen, Germany.,Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Universiteitsingel 50, 6229 ER Maastricht, Netherlands
| | - Winnie Chua
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Stef Zeemering
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Universiteitsingel 50, 6229 ER Maastricht, Netherlands
| | - Luigi di Biase
- Department of Medicine (Cardiology), Albert Einstein College of Medicine at Montefiore Hospital, Montefiore-Einstein Center for Heart & Vascular Care New York, NY, USA
| | - Bayes de Luna Antoni
- Autonomous University of Barcelona and Institut Català Ciències Cardiovasculars (ICCC)-St. Pau Hospital, Barcelona, Spain
| | - Callans David
- Cardiology Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Hussein R Al-Khalidi
- Department of Cardiac Electrophysiology, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC, USA
| | - Jonathan P Piccini
- Department of Cardiac Electrophysiology, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC, USA
| | - Lluís Mont
- Arrhythmia Section, Universitat de Barcelona, Hospital Clinic, Barcelona, Catalonia, Spain
| | | | - Luis Alberto Escobar
- Autonomous University of Barcelona and Institut Català Ciències Cardiovasculars (ICCC)-St. Pau Hospital, Barcelona, Spain
| | - Joseph de Bono
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Isabelle C Van Gelder
- Department of Cardiology and Thorax Surgery, UMCG Thorax Center, University of Groningen, Groningen, The Netherlands
| | - Tom de Potter
- Department of Cardiology, Electrophysiology section, Cardiovascular Center, OLV Hospital, Aalst, Belgium
| | - Daniel Scherr
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Universiteitsingel 50, 6229 ER Maastricht, Netherlands.,Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Sakis Themistoclakis
- Unit of Electrophysiology and Cardiac Pacing, Dell'Angelo Hospital, Mestre-Venice, Italy
| | - Derick Todd
- Department of EP, Devices and ICC, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Ulrich Schotten
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Universiteitsingel 50, 6229 ER Maastricht, Netherlands
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12
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A specific combination of P wave duration and morphology accurately predicts the presence of left atrial low voltage area in patients with atrial fibrillation. J Electrocardiol 2020; 63:173-180. [DOI: 10.1016/j.jelectrocard.2019.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/03/2019] [Accepted: 10/11/2019] [Indexed: 01/03/2023]
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13
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Wu JT, Zhao DQ, Li FF, Zhang LM, Hu J, Fan XW, Hu GL, Yang HT, Yan LJ, Liu JJ, Xu XJ, Wang SL, Chu YJ. Effect of pulmonary vein isolation on atrial fibrillation recurrence after accessory pathway ablation in patients with Wolff-Parkinson-White syndrome. Clin Cardiol 2020; 43:1511-1516. [PMID: 33002216 PMCID: PMC7724218 DOI: 10.1002/clc.23470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/08/2020] [Accepted: 09/17/2020] [Indexed: 01/08/2023] Open
Abstract
Background Although successful ablation of the accessory pathway (AP) eliminates atrial fibrillation (AF) in some of patients with Wolff‐Parkinson‐White (WPW) syndrome and paroxysmal AF, in other patients it can recur. Hypothesis Whether adding pulmonary vein isolation (PVI) after successful AP ablation effectively prevents AF recurrence in patients with WPW syndrome is unknown. Methods We retrospectively studied 160 patients (102 men, 58 women; mean age, 46 ± 14 years) with WPW syndrome and paroxysmal AF who underwent AP ablation, namely 103 (64.4%) undergoing only AP ablation (AP group) and 57 (35.6%) undergoing AP ablation plus PVI (AP + PVI group). Advanced interatrial block (IAB) was defined as a P‐wave duration of >120 ms and biphasic (±) morphology in the inferior leads, using 12‐lead electrocardiography (ECG). Results During the mean follow‐up period of 30.9 ± 9.2 months (range, 3‐36 months), 22 patients (13.8%) developed AF recurrence. The recurrence rate did not differ in patients in the AP + PVI group and AP group (15.5% vs 10.5%, respectively; P = .373). Univariable and multivariable Cox regression analyses showed that PVI was not associated with the risk of AF recurrence (hazard ratio, 0.66; 95% confidence interval, 0.26‐1.68; P = .380). In WPW patients with advanced IAB, the recurrence rate was lower in patients in the AP + PVI group vs the AP group (90% vs 33.3%, respectively; P = .032). Conclusions PVI after successful AP ablation significantly reduced the AF recurrence rate in WPW patients with advanced IAB. Screening of a resting 12‐lead ECG immediately after AP ablation helps identify patients in whom PVI is beneficial.
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Affiliation(s)
- Jin-Tao Wu
- Heart Centre of Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Dan-Qing Zhao
- Department of Cardiology, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Fei-Fei Li
- Human Resource Department, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lei-Ming Zhang
- Heart Centre of Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Juan Hu
- Heart Centre of Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Xian-Wei Fan
- Heart Centre of Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Guang-Ling Hu
- Heart Centre of Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Hai-Tao Yang
- Heart Centre of Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Li-Jie Yan
- Heart Centre of Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing-Jing Liu
- Heart Centre of Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Xian-Jing Xu
- Heart Centre of Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Shan-Ling Wang
- Heart Centre of Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Ying-Jie Chu
- Heart Centre of Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
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Bayés de Luna A, Martínez-Sellés M, Bayés-Genís A, Elosua R, Baranchuk A. Síndrome de Bayés. Lo que todo clínico debe conocer. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2020.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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15
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Carmona Puerta R. Bloqueos interauriculares: diagnóstico y significado clínico. Med Clin (Barc) 2020; 155:207-214. [DOI: 10.1016/j.medcli.2020.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/05/2020] [Accepted: 03/09/2020] [Indexed: 01/10/2023]
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16
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Bayés de Luna A, Martínez-Sellés M, Bayés-Genís A, Elosua R, Baranchuk A. What every clinician should know about Bayés syndrome. ACTA ACUST UNITED AC 2020; 73:758-762. [PMID: 32684442 DOI: 10.1016/j.rec.2020.04.026] [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: 03/27/2020] [Accepted: 04/03/2020] [Indexed: 10/23/2022]
Abstract
Bayés syndrome is a new clinical entity, characterized by the association of advanced interatrial block (IAB) on surface electrocardiogram with atrial fibrillation (AF) and other atrial arrhythmias. This syndrome is associated with an increased risk of stroke, dementia, and mortality. Advanced IAB is diagnosed by the presence of a P-wave ≥ 120ms with biphasic morphology (±) in inferior leads. The cause of IAB is complete Bachmann bundle blockade, leading to retrograde depolarization of the left atrium from areas near the atrioventricular junction. The anatomic substrate of advanced IAB is fibrotic atrial cardiomyopathy. Dyssynchrony induced by advanced IAB is a trigger and maintenance mechanism of AF. This alteration of the atrial architecture produces atrial remodeling, blood stasis and hypercoagulability, triggering the thrombogenic cascade. The presence of advanced IAB, even in patients without documented atrial arrhythmias, has also been associated with AF, stroke, dementia, and mortality. However, in these patients, there is no evidence to support the use of anticoagulation. Therefore, in patients with advanced IAB, a proactive search for AF is recommended.
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Affiliation(s)
- Antoni Bayés de Luna
- Fundación de Investigación Cardiovascular ICCC, Instituto de Investigación Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain.
| | - Antoni Bayés-Genís
- Instituto del Corazón, Hospital Universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Barcelona, Spain
| | - Roberto Elosua
- Instituto Hospital del Mar de Investigaciones Médicas (IMIM), CIBERCV, Facultad de Medicina, Universidad de Vic-Universidad Central de Cataluña, Vic, Barcelona, Spain
| | - Adrián Baranchuk
- Department of Medicine, Queens University, Kingston, Ontario, Canada
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17
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Yang N, Yan N, Cong G, Yang Z, Wang M, Jia S. Usefulness of Morphology-Voltage-P-wave duration (MVP) score as a predictor of atrial fibrillation recurrence after pulmonary vein isolation. Ann Noninvasive Electrocardiol 2020; 25:e12773. [PMID: 32564491 PMCID: PMC7679828 DOI: 10.1111/anec.12773] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/24/2020] [Accepted: 05/09/2020] [Indexed: 12/26/2022] Open
Abstract
Background Atrial fibrillation (AF) is known to be the most common arrhythmia, and the successful rate of long‐term ablation can vary comparatively. Therefore, a clinical scoring system to predict rhythm outcome remains a critical unmet need. The electrocardiographic (ECG) risk score which is named Morphology‐Voltage‐P‐wave duration (MVP) score was reported to be useful for predicting new‐onset AF. The goal of the current study was to investigate whether the MVP score was a useful scheme in the prediction of rhythm outcome following pulmonary vein isolation (PVI) in paroxysmal atrial fibrillation (PAF). Methods We retrospectively analyzed baseline characteristics, risk scores, and rates of AF recurrence 12 months postablation in the medical records of 207 consecutive patients with PAF undergoing PVI in General Hospital of Ningxia medical University from 2010 to 2018. Results Two hundred and seven patients (71 females, median age 58.7 years) with symptomatic PAF underwent PVI. From the cohort, 32.3% (67) had a recurrence of AF within 1 year of the PVI. The area of the MVP score under the curve in the receiver operating characteristics (ROC) analysis was 0.789 (95% CI 0.730–0.840, p < .001). A score cut‐off value of >3 showed the best predictive ability for AF recurrence within 1 year after PVI, with sensitivity (53.03%) and specificity (89.87%). Conclusions The results of our study suggest that the easy‐to‐measure ECG MVP score can be used to predict recurrence of PAF after PVI.
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Affiliation(s)
- Na Yang
- School of Clinical Medicine, Clinical Medicine, Ningxia Medical University, Yinchuan, China
| | - Ning Yan
- Department of Heart Centre, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Guangzhi Cong
- Department of Heart Centre, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Zhen Yang
- Department of Heart Centre, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Mohan Wang
- School of Clinical Medicine, Clinical Medicine, Ningxia Medical University, Yinchuan, China
| | - Shaobin Jia
- Department of Heart Centre, General Hospital of Ningxia Medical University, Yinchuan, China
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18
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Abstract
Pathology affecting the atria have a significant impact on the occurrence of arrhythmias and the risk of stroke. The causal relationship between atrial fibrillation (AF) and ischaemic stroke has been challenged by the recent uncovering of the lack of temporal association between thrombo-embolic cerebral events and paroxysmal AF or tachycardia. General conditions, such as the one considered in the definition of the CHA2DS2-VASc score, or specific atrial pathology (also independently occurring), could predispose to cerebral embolism.
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Affiliation(s)
- Alessandro Boccanelli
- Casa di Cura Quisisana, Via Gian Giacomo Porro 5, 00153 Roma, Italy
- Corresponding author. Tel: +39 3333217938,
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ALTUNBAŞ G, VURUŞKAN E, YILMAZ COŞKUN F, SUCU M. ST-segment elevasyonlu akut miyokard infarktüsü ile başvuran hastalarda interatrial ileti bozuklukları. EGE TIP DERGISI 2020. [DOI: 10.19161/etd.697843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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20
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Bajraktari G, Bytyçi I, Henein MY. Left atrial structure and function predictors of recurrent fibrillation after catheter ablation: a systematic review and meta-analysis. Clin Physiol Funct Imaging 2020; 40:1-13. [PMID: 31556215 DOI: 10.1111/cpf.12595] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 09/17/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Catheter ablation (CA) has become a conventional treatment for atrial fibrillation (AF), but remains with high recurrence rate. The aim of this meta-analysis was to determine left atrial (LA) structure and function indices that predict recurrence of AF. METHODS We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar and the Cochrane Central Registry, up to September 2017 in order to select clinical trials and observational studies which reported echocardiographic predictors of AF recurrence after CA. Eighty-five articles with a total of 16 126 patients were finally included. RESULTS The pooled analysis showed that after a follow-up period of 21 ± 12 months, patients with AF recurrence had larger LA diameter with weighted mean difference (WMD: 2·99 ([95% CI 2·50-3·47], P<0·001), larger LA volume index (LAVI) maximal and LAVI minimal (P<0·0001 for both), larger LA area (P<0·0001), lower LA strain (P<0·0001) and lower LA total emptying fraction (LA EF) (P<0·0001) compared with those without AF recurrence. The most powerful LA predictors (in accuracy order) of AF recurrence were as follows: LA strain <19% (OR: 3·1[95% CI, -1.3-10·4], P<0·0001), followed by LA diameter ≥50 mm (OR: 2·75, [95% CI 1·66-4·56,] P<0·0001), and LAVmax >150 ml (OR: 2·25, [95% CI, 1.1-5·6], P = 0·0002). CONCLUSIONS Based on this meta-analysis results, a dilated left atrium with diameter more than 50 mm and volume above 150 ml or myocardial strain below 19% reflect an unstable LA that is unlikely to hold sinus rhythm after catheter ablation for atrial fibrillation.
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Affiliation(s)
- Gani Bajraktari
- Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
- Medical Faculty, University of Prishtina, Prishtina, Kosovo
| | - Ibadete Bytyçi
- Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
| | - Michael Y Henein
- Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Molecular & Clinical Sciences Research Institute, St George University, London, UK
- Brunel University, London, UK
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21
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Wu J, Zhao D, Li F, Wu R, Fan X, Hu G, Bai M, Yang H, Yan L, Liu J, Xu X, Wang S, Chu Y. Advanced interatrial block predicts recurrence of atrial fibrillation after accessory pathway ablation in patients with Wolff-Parkinson-White syndrome. Clin Cardiol 2019; 42:806-811. [PMID: 31243791 PMCID: PMC6727880 DOI: 10.1002/clc.23222] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/14/2019] [Accepted: 06/20/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Paroxysmal atrial fibrillation (AF) frequently occurs in patients with Wolff-Parkinson-White (WPW) syndrome. Although successful ablation of the accessory pathway (AP) eliminates paroxysmal AF in some patients, in other patients it can recur. HYPOTHESIS We investigated the clinical utility of advanced interatrial block (IAB) for predicting the risk of AF recurrence in patients with verified paroxysmal AF and WPW syndrome after successful AP ablation. METHODS This retrospective study included 103 patients (70 men, 33 women; mean age, 44 ± 16 years) with WPW syndrome who had paroxysmal AF. A resting 12-lead electrocardiogram was performed immediately after successful AP ablation to evaluate the presence of advanced IAB, which was defined as a P-wave duration of >120 ms and biphasic [±] morphology in the inferior leads. RESULTS During the mean follow-up period of 30.9 ± 20.0 months (range, 2-71 months), 16 patients (15.5%) developed AF recurrence. Patients with advanced IAB had significantly reduced event-free survival from AF (P < .001). Cox regression analysis with adjustment for the left atrial diameter and CHA2 DS2 -VASc score identified advanced IAB (hazard ratio, 9.18; 95% confidence interval [CI], 2.30-36.72; P = .002) and age > 50 years (hazard ratio, 12.64; 95% CI, 1.33-119.75; P = .027) as independent predictors of AF recurrence. CONCLUSIONS Advanced IAB was an independent predictor of AF recurrence after successful AP ablation in patients with WPW syndrome.
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Affiliation(s)
- Jin‐Tao Wu
- Department of Cardiology, Henan Provincial People's HospitalHenan Provincial People's Hospital of Henan University, Zhengzhou University People's Hospital, Central China Fuwai HospitalZhengzhouChina
| | - Dan‐Qing Zhao
- Department of Cardiology, Henan Provincial People's HospitalHenan Provincial People's Hospital of Henan University, Zhengzhou University People's Hospital, Central China Fuwai HospitalZhengzhouChina
| | - Fei‐Fei Li
- Department of Internal MedicineThe Third Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Rui Wu
- Department of Cardiology, Henan Provincial People's HospitalHenan Provincial People's Hospital of Henan University, Zhengzhou University People's Hospital, Central China Fuwai HospitalZhengzhouChina
| | - Xian‐Wei Fan
- Department of Cardiology, Henan Provincial People's HospitalHenan Provincial People's Hospital of Henan University, Zhengzhou University People's Hospital, Central China Fuwai HospitalZhengzhouChina
| | - Guang‐Ling Hu
- Department of Cardiology, Henan Provincial People's HospitalHenan Provincial People's Hospital of Henan University, Zhengzhou University People's Hospital, Central China Fuwai HospitalZhengzhouChina
| | - Min‐Fu Bai
- Department of Cardiology, Henan Provincial People's HospitalHenan Provincial People's Hospital of Henan University, Zhengzhou University People's Hospital, Central China Fuwai HospitalZhengzhouChina
| | - Hai‐Tao Yang
- Department of Cardiology, Henan Provincial People's HospitalHenan Provincial People's Hospital of Henan University, Zhengzhou University People's Hospital, Central China Fuwai HospitalZhengzhouChina
| | - Li‐Jie Yan
- Department of Cardiology, Henan Provincial People's HospitalHenan Provincial People's Hospital of Henan University, Zhengzhou University People's Hospital, Central China Fuwai HospitalZhengzhouChina
| | - Jing‐Jing Liu
- Department of Cardiology, Henan Provincial People's HospitalHenan Provincial People's Hospital of Henan University, Zhengzhou University People's Hospital, Central China Fuwai HospitalZhengzhouChina
| | - Xian‐Jing Xu
- Department of Cardiology, Henan Provincial People's HospitalHenan Provincial People's Hospital of Henan University, Zhengzhou University People's Hospital, Central China Fuwai HospitalZhengzhouChina
| | - Shan‐Ling Wang
- Department of Cardiology, Henan Provincial People's HospitalHenan Provincial People's Hospital of Henan University, Zhengzhou University People's Hospital, Central China Fuwai HospitalZhengzhouChina
| | - Ying‐Jie Chu
- Department of Cardiology, Henan Provincial People's HospitalHenan Provincial People's Hospital of Henan University, Zhengzhou University People's Hospital, Central China Fuwai HospitalZhengzhouChina
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Çinier G, Tekkeşin Aİ, Çelik TY, Mercan Ö, Tanboğa Hİ, Günay MB, Türkkan C, Hayıroğlu Mİ, Alexander B, Alper AT, Baranchuk A. Value of Interatrial Block for the Prediction of Silent Ischemic Brain Lesions. J Atr Fibrillation 2019; 11:2037. [PMID: 31139269 DOI: 10.4022/jafib.2037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 08/19/2017] [Accepted: 09/14/2017] [Indexed: 01/04/2023]
Abstract
Introduction Previous studies demonstrated that interatrial block (IAB) is associated with atrial fibrillation (AF) in different clinical scenarios. The aim of our study was to determine whether IAB could predict silent ischemic brain lesions (sIBL), detected by magnetic resonance imaging (MRI). Methods Patients presented to a neurology clinic with transient ischemic attack (TIA) symptoms and underwent brain MRI were included to the study. sIBL were defined as lesions without corresponding clinical symptoms regarding lesion localization evaluated by two neurologists. A 12-lead surface ECG was obtained from each patient. IAB was defined as P-wave duration > 120 ms with (advanced IAB) or without (partial IAB) biphasic morphology in the inferior leads. Results sIBL was detected in 61 (49.6%) patients. Patients with sIBL were older (P<0.001), had more left ventricular hypertrophy (LVH) (P=0.02) and higher CHA2DS2-VASc score compared to those without (P<0.001). P-wave duration was significantly longer in patients with sIBL (124 [110.5 - 129] msvs 107 [102 - 116.3] ms) (P<0.001). IAB was diagnosed in 36 patients (59%) with sIBL (+) and in 11 patients (18%) with sIBL (-); p<0.001. Multivariate logistic regression analysis identified age [Odds ratio (OR), 1.061; 95% confidence interval (CI), 1.012 - 1.113; p=0.014], CHA2DS2-VASc score (OR, 1.758; 95% CI, 1.045 - 2.956; p=0.034), LVH (OR, 3.062; 95% CI, 1.161 - 8.076; p=0.024) and IAB (including both partial and advanced) (OR, 5.959; 95% CI, 2.269 - 15.653; p<0.001) as independent predictors of sIBL. Conclusion IAB is a strong predictor of sIBL and can be easily diagnosed by performing surface 12-lead ECG.
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Affiliation(s)
- Göksel Çinier
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, Department of Cardiology, Kadikoy, Istanbul, Turkey
| | - Ahmet İlker Tekkeşin
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, Department of Cardiology, Kadikoy, Istanbul, Turkey
| | - Tuğba Yanar Çelik
- HaydarpasaNumuneEgitimveArastırmaHastanesi, Department of Neurology, Kadikoy, Istanbul, Turkey
| | - Özlem Mercan
- HaydarpasaNumuneEgitimveArastırmaHastanesi, Department of Neurology, Kadikoy, Istanbul, Turkey
| | - Halil İbrahim Tanboğa
- Hisar Intercontinental Hospital, Department of Cardiology, Umraniye, Istanbul, Turkey
| | - Muhammed Burak Günay
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, Department of Cardiology, Kadikoy, Istanbul, Turkey
| | - Ceyhan Türkkan
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, Department of Cardiology, Kadikoy, Istanbul, Turkey
| | - Mert İlker Hayıroğlu
- Haydarpaşa Sultan Abdulhamit Han EğitimveAraştırmaHastanesi, Department of Cardiology, Kadikoy, Istanbul, Turkey
| | - Bryce Alexander
- Haydarpaşa Sultan Abdulhamit Han EğitimveAraştırmaHastanesi, Department of Cardiology, Kadikoy, Istanbul, Turkey
| | - Ahmet Taha Alper
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, Department of Cardiology, Kadikoy, Istanbul, Turkey
| | - Adrian Baranchuk
- Kingston General Hospital, Department of Cardiology, Queen's University, ON, Canada
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23
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Bruña V, Velásquez-Rodríguez J, Valero-Masa MJ, Pérez-Guillem B, Vicent L, Díez-Delhoyo F, Devesa C, Sousa-Casasnovas I, Juárez M, Bayés de Luna A, Bayés-Genís A, Baranchuk A, Fernández-Avilés F, Martínez-Sellés M. Prognostic of Interatrial Block after an Acute ST-Segment Elevation Myocardial Infarction. Cardiology 2019; 142:109-115. [PMID: 31117073 DOI: 10.1159/000499501] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/10/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The influence of interatrial block (IAB) in the prognosis after an acute ST-segment elevation myocardial infarction (STEMI) is unknown. OBJECTIVES To assess the prognostic impact of IAB after an acute STEMI regarding long-term mortality, development of atrial fibrillation, and stroke. METHODS Registry of 972 consecutive patients with STEMI and sinus rhythm at discharge, with a long-term follow-up (49.6 ± 24.9 months). P wave duration was analyzed using digital calipers, and patients were divided into three groups: normal P wave duration (<120 ms), partial IAB (pIAB) (P wave ≥120 ms and positive in inferior leads), and advanced IAB (aIAB) (P wave ≥120 ms plus biphasic [positive/negative] morphology in inferior leads). RESULTS Mean age was 62.6 ± 13.5 years. A total of 708 patients had normal P wave (72.8%), 207 pIAB (21.3%), and 57 aIAB (5.9%). Patients with aIAB were older (mean age 73 years) than the rest (62 years in the other two groups, p < 0.001). They also had a higher rate of hypertension (70 vs. 55% in pIAB and 49% in normal P wave, p = 0.006) and higher all-cause mortality (26.3 vs. 12.6% in pIAB and 10.3% in normal P wave, p = 0.001). However, multivariable analysis did not show an independent association between IAB and prognosis. CONCLUSION About a quarter of patients discharged in sinus rhythm after an acute STEMI have IAB. Patients with aIAB have a poor prognosis, although this is explained mainly by the association of aIAB with age and other variables.
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Affiliation(s)
- Vanesa Bruña
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | | | - María Jesús Valero-Masa
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | | | - Lourdes Vicent
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Felipe Díez-Delhoyo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Carolina Devesa
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Iago Sousa-Casasnovas
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Miriam Juárez
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Antoni Bayés de Luna
- Fundació d'Investigació Cardiovascular, ICCC, Hospital de Sant Pau, Barcelona, Spain
| | | | | | - Francisco Fernández-Avilés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain.,Universidad Complutense Madrid, Madrid, Spain
| | - Manuel Martínez-Sellés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain, .,Universidad Europea Madrid, Madrid, Spain, .,Universidad Complutense Madrid, Madrid, Spain,
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Pranata R, Yonas E, Vania R. Prolonged P-wave duration in sinus rhythm pre-ablation is associated with atrial fibrillation recurrence after pulmonary vein isolation-A systematic review and meta-analysis. Ann Noninvasive Electrocardiol 2019; 24:e12653. [PMID: 30983090 DOI: 10.1111/anec.12653] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 02/20/2019] [Accepted: 03/19/2019] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION A prolonged P-wave duration (PWD) in sinus rhythm pre-ablation has been hypothesized to be a non-invasive ECG marker associated with increased atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI). This systematic review and meta-analysis will assess the latest evidence on the association of prolonged PWD pre-ablation with AF recurrence after PVI. HYPOTHESIS Prolonged PWD pre-ablation is associated with AF recurrence after PVI. METHODS The inclusion criteria for this study are all cohort studies that assess prolonged PWD on ECG during sinus rhythm pre-ablation and its association with AF recurrence in post-PVI patients. RESULTS There were 1,482 patients with AF post-PVI from twelve cohort studies. The cut-off points for prolonged PWD ranges from >120 ms to >150 ms. Meta-analysis on six studies showed a pooled mean difference of PWD in subjects with recurrent AF and non-recurring AF was 12.54 ms [8.76-16.31], p < 0.001; I2 78%. Pooled odds ratio was 4.17 [2.10-8.31], p < 0.001; I2 72% and pooled hazard ratio was 1.93 [1.10-3.39], p = 0.02; I2 80%. Upon subgroup analysis, the association between prolonged PWD and AF recurrence was significant in signal-averaged ECG, 12-lead ECG, paroxysmal AF, >120-130 ms, and >140-150 ms PWD cut-off point subgroups. CONCLUSION These findings suggest that prolonged PWD with a cutoff of >120 ms to >150 ms in sinus rhythm before ablation may be associated with AF recurrence after PVI regardless of age, gender, left atrial size, and the presence of structural heart disease. We also encouraged further studies that investigate predicting models to include prolonged PWD as one of their parameters.
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Affiliation(s)
- Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Emir Yonas
- Faculty of Medicine, Universitas YARSI, Jakarta, Indonesia
| | - Rachel Vania
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
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Wu JT, Fan XW, Yang HT, Yan LJ, Xu XJ, Wang SL, Chu YJ, Long DY, Dong JZ. Association Between CHADS 2 Score and the Development of Interatrial Block. Int Heart J 2018; 59:1261-1265. [PMID: 30369573 DOI: 10.1536/ihj.17-616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Interatrial block (IAB) is associated with a multitude of medical conditions. The aim of this retrospective study was to investigate whether CHADS2 (congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, prior stroke) score is positively associated with the development of IAB. A total of 1072 patients (men, 555; women, 517; mean age, 61 ± 14 years) were included in the study. P-wave duration was measured manually using a caliper. IAB was defined as a P-wave duration of ≥ 120 ms on a 12-lead electrocardiogram. CHADS2 scores were calculated retrospectively. Among the 1072 patients, the prevalence of IAB was 36.1% (387/1072). In multivariate analysis, increased CHADS2 score (odds ratio [OR], 1.810; 95% confidence interval [CI], 1.577-2.077; P < 0.001), coronary artery disease (OR, 1.536; 95% CI, 1.065-2.216; P = 0.022), and increased left atrial diameter (OR, 1.039; 95% CI, 1.008-1.071; P = 0.013) were independently associated with IAB. The percentages of patients with IAB among those with a CHADS2 score of 0, 1, 2, 3, 4, 5, and 6 were 20.6%, 33.0%, 45.0%, 55.9%, 61.9%, 77.8%, and 100%, respectively (P < 0.001). There was a greater percentage of patients with a CHADS2 score of ≥ 2 with IAB compared with a CHADS2 score of < 2 (26.5% vsrsus 52.0%; P < 0.001). In receiver operating curve (ROC) analysis, CHADS2 score (area under the curve, 0.670; 95% CI, 0.636-0.704; P < 0.001) was predictive of IAB. In conclusion, CHADS2 score was significantly associated with the development of IAB in this study population.
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Affiliation(s)
- Jin-Tao Wu
- Department of Cardiology, Henan Provincial People's Hospital (Zhengzhou University People's Hospital)
| | - Xian-Wei Fan
- Department of Cardiology, Henan Provincial People's Hospital (Zhengzhou University People's Hospital)
| | - Hai-Tao Yang
- Department of Cardiology, Henan Provincial People's Hospital (Zhengzhou University People's Hospital)
| | - Li-Jie Yan
- Department of Cardiology, Henan Provincial People's Hospital (Zhengzhou University People's Hospital)
| | - Xian-Jing Xu
- Department of Cardiology, Henan Provincial People's Hospital (Zhengzhou University People's Hospital)
| | - Shan-Ling Wang
- Department of Cardiology, Henan Provincial People's Hospital (Zhengzhou University People's Hospital)
| | - Ying-Jie Chu
- Department of Cardiology, Henan Provincial People's Hospital (Zhengzhou University People's Hospital)
| | - De-Yong Long
- Department of Cardiology, Center for Atrial Fibrillation, Beijing Anzhen Hospital, Capital Medical University
| | - Jian-Zeng Dong
- Department of Cardiology, Center for Atrial Fibrillation, Beijing Anzhen Hospital, Capital Medical University
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Intra- and interatrial conduction abnormalities: hemodynamic and arrhythmic significance. J Interv Card Electrophysiol 2018; 52:293-302. [DOI: 10.1007/s10840-018-0413-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/11/2018] [Indexed: 10/28/2022]
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Wu J, Fan X, Yang H, Yan L, Xu X, Duan H, Wang S, Chu Y. Usefulness of a Low Resting Heart Rate to Predict Recurrence of Atrial Fibrillation After Catheter Ablation in People ≥65 Years of Age. Am J Cardiol 2018; 122:97-101. [PMID: 29685573 DOI: 10.1016/j.amjcard.2018.03.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 03/12/2018] [Accepted: 03/16/2018] [Indexed: 10/17/2022]
Abstract
A low resting heart rate (RHR) is associated with an increased risk of atrial fibrillation (AF), and this is common in older people. Whether a low RHR in older people can predict recurrence of AF after catheter ablation is unclear. A total of 329 consecutive patients ≥65 years of age with paroxysmal AF who underwent index circumferential pulmonary vein isolation were prospectively enrolled. A 10-second standard resting 12-lead electrocardiogram in sinus rhythm was recorded to measure the RR interval, P-wave duration, and PR interval. The RHR was calculated based on the mean RR interval. During a mean follow-up period of 17.0 ± 8.3 months (range, 3 to 32 months), 96 (29.2%) patients developed recurrence of AF. The AF recurrence rate was 46.2%, 32.3%, and 25.4% in patients with an RHR <50, 50 to 59, and ≥60 beats/min, respectively (log-rank test, p = 0.009). Cox regression analysis with adjustment for P-wave duration and the CHADS2 score showed that an RHR <50 beats/min (hazard ratio [HR] 1.92, 95% confidence interval [CI] 1.12 to 3.28, p = 0.017), advanced interatrial block (HR 1.82, 95% CI 1.09 to 3.04, p = 0.022), and left atrial diameter (HR 1.05, 95% CI 1.00 to 1.09, p = 0.029) were independent predictors of recurrence of AF after catheter ablation. In conclusion, in people ≥65 years of age, an RHR <50 beats/min is an independent predictor of AF recurrence in patients who have undergone catheter ablation for paroxysmal AF.
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García-Izquierdo Jaén E, Cobo Rodríguez P, Solís Solís L, Pham Trung C, Jiménez Sánchez D, Sánchez García M, Castro Urda V, Toquero Ramos J, Fernández Lozano I. [Bayes' syndrome in cardiac surgery: prevalence of interatrial block in patients younger than 65 years undergoing cardiac surgery and association with postoperative atrial fibrillation]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2017; 88:369-375. [PMID: 29108780 DOI: 10.1016/j.acmx.2017.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 09/01/2017] [Accepted: 09/27/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Interatrial block (IAB) is a well-known entity that is associated with an increased risk of atrial fibrillation (AF). This association is called Bayes' syndrome. The aim of our study was to define the prevalence of IAB among patients younger than 65 years undergoing cardiac surgery and determine whether there is an association between the presence of interatrial conduction delay and postoperative atrial fibrillation (POAF). METHOD A total of 207 patients were enrolled. Partial IAB was defined as P-wave>120ms. Advanced IAB was defined as P-wave>120ms+biphasic morphology in the inferior leads. Ocurrence of POAF was assessed and a comparative analysis was conducted between patients that did and did not develop AF. RESULTS IAB prevalence was 78.3% (partial 66.2%, advanced 12.1%). POAF occurred in 28.5% of all patients, and was more frequent among patients with advanced IAB (44%) compared to 27.7% and 24.4% of POAF among patients with partial IAB and without IAB, respectively. Patients who developed POAF were significantly older, had significantly higher NTproBNP, higher prevalence of atrial enlargement and thyroid disease. After multivariate analysis, advanced IAB was found to be independently associated with POAF. CONCLUSIONS IAB is a frequent finding among patients undergoing cardiac surgery. According to our results, advanced IAB is independently associated with POAF in younger patients (<65 years) undergoing cardiac surgery.
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Affiliation(s)
| | - Pablo Cobo Rodríguez
- Unidad de Arritmias, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - Luis Solís Solís
- Unidad de Arritmias, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - Chinh Pham Trung
- Unidad de Arritmias, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - Diego Jiménez Sánchez
- Unidad de Arritmias, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - Manuel Sánchez García
- Unidad de Arritmias, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - Victor Castro Urda
- Unidad de Arritmias, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - Jorge Toquero Ramos
- Unidad de Arritmias, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
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Tse G, Wong CW, Gong M, Wong WT, Bazoukis G, Wong SH, Li G, Wu WKK, Tse LA, Lampropoulos K, Xia Y, Liu T, Baranchuk A. Predictive value of inter-atrial block for new onset or recurrent atrial fibrillation: A systematic review and meta-analysis. Int J Cardiol 2017; 250:152-156. [PMID: 29017777 DOI: 10.1016/j.ijcard.2017.09.176] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 09/18/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Inter-atrial block (IAB) is characterized by a delay of inter-atrial conduction and is defined electrocardiographically by a P-wave duration (PWD)>120ms. Several studies have implicated IAB in the development of new onset atrial fibrillation (AF), whereas others have reported no significant associations. Moreover, there has been no systematic evaluation of the predictive value of IAB in AF recurrence. Therefore, we conducted a systematic review and meta-analysis to examine whether IAB predicts new onset AF or AF recurrence. METHODS PubMed and Embase databases were searched through 30th July 2017 for studies investigating the relationship between IAB and AF. RESULTS The initial search identified 260 studies, of which 16 studies met the inclusion criteria. This meta-analysis included 18,204 patients (mean age 56±13, 48% male) with a mean follow-up period of 15.1years. IAB significantly predicted new onset AF (hazard ratio [HR]: 2.42, 95% confidence interval [CI]: 1.44 to 4.07, P=0.001; 84%). For partial IAB, the risk of new onset AF did not reach statistical significance (HR: 1.42, 95% CI: 0.85 to 2.34; P=0.18; I2=13%). Contrastingly, advanced IAB was a significant predictor of new onset AF with a pooled HR of 2.58 (95% CI: 1.35 to 4.96; P<0.01; I2=67%). IAB also predicted AF recurrence after ablation (HR: 2.59, 95% CI: 1.35 to 4.96; P<0.01; I2=67%). CONCLUSIONS IAB is a significant predictor of both new onset AF and AF recurrence.
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Affiliation(s)
- Gary Tse
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.
| | - Cheuk Wai Wong
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Mengqi Gong
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Wing Tak Wong
- School of Life Sciences, Chinese University of Hong Kong, Hong Kong, China
| | - George Bazoukis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Sunny Hei Wong
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Guangping Li
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - William K K Wu
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China; Department of Anaesthesia and Intensive Care, State Key Laboratory of Digestive Disease, LKS Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Lap Ah Tse
- Division of Occupational and Environmental Health, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Konstantinos Lampropoulos
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Yunlong Xia
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Adrian Baranchuk
- Division of Cardiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
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Affiliation(s)
- Manuel Martínez-Sellés
- Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain
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31
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Bayés de Luna A, Baranchuk A, Martínez‐Sellés M, Platonov PG. Anticoagulation in patients at high risk of stroke without documented atrial fibrillation. Time for a paradigm shift? Ann Noninvasive Electrocardiol 2017; 22:e12417. [PMID: 27982498 PMCID: PMC6931884 DOI: 10.1111/anec.12417] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Atrial fibrillation (AF) is currently considered a risk factor for stroke. Depending on the severity of clinical factors (risk scores) a recommendation for full anticoagulation is made. Although AF is most certainly a risk factor for ischemic stroke, it is not necessarily the direct cause of it. The causality of association between AF and ischemic stroke is questioned by the reported lack of temporal relation between stroke events and AF paroxysms (or atrial high-rate episodes detected by devices). In different studies, only 2% of patients had subclinical AF > 6 minutes in duration at the time of stroke or systemic embolism. Is it time to consider AF only one more factor of endothelial disarray rather than the main contributor to stroke? In this "opinion paper" we propose to consider not only clinical variables predicting AF/stroke but also electrocardiographic markers of atrial fibrosis, as we postulate this as a strong indicator of risk of AF/stroke. We ask if it is time to change the paradigm and to consider, in some special situations, to protect patients (preventing stroke) who have no evidence of AF.
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Affiliation(s)
| | - Adrian Baranchuk
- Heart Rhythm ServiceKingston General HospitalQueen's UniversityKingstonONCanada
| | - Manuel Martínez‐Sellés
- Cardiology DepartmentHospital Universitario Gregorio MarañónUniversidad EuropeaUniversidad ComplutenseMadridSpain
| | - Pyotr G. Platonov
- Center for Integrative Electrocardiology at Lund University (CIEL), and Arrhythmia Clinic SwedenSkåne University HospitalLundSweden
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Wang YS, Chen GY, Li XH, Zhou X, Li YG. Prolonged P-wave duration is associated with atrial fibrillation recurrence after radiofrequency catheter ablation: A systematic review and meta-analysis. Int J Cardiol 2017; 227:355-359. [DOI: 10.1016/j.ijcard.2016.11.058] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/23/2016] [Accepted: 11/05/2016] [Indexed: 11/15/2022]
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Gul EE, Pal R, Caldwell J, Boles U, Hopman W, Glover B, Michael KA, Redfearn D, Simpson C, Abdollah H, Baranchuk A. Interatrial block and interatrial septal thickness in patients with paroxysmal atrial fibrillation undergoing catheter ablation: Long-term follow-up study. Ann Noninvasive Electrocardiol 2016; 22. [PMID: 28019054 DOI: 10.1111/anec.12428] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/17/2016] [Accepted: 11/26/2016] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Interatrial block (IAB) is a strong predictor of recurrence of atrial fibrillation (AF). IAB is a conduction delay through the Bachman region, which is located in the upper region of the interatrial space. During IAB, the impulse travels from the right atrium to the interatrial septum (IAS) and coronary sinus to finally reach the left atrium in a caudocranial direction. No relation between the presence of IAB and IAS thickness has been established yet. OBJECTIVE To determine whether a correlation exists between the degree of IAB and the thickness of the IAS and to determine whether IAS thickness predicts AF recurrence. METHODS Sixty-two patients with diagnosis of paroxysmal AF undergoing catheter ablation were enrolled. IAB was defined as P-wave duration ≥120 ms. IAS thickness was measured by cardiac computed tomography. RESULTS Among 62 patients with paroxysmal AF, 45 patients (72%) were diagnosed with IAB. Advanced IAB was diagnosed in 24 patients (39%). Forty-seven patients were male. During a mean follow-up period of 49.8 ± 22 months (range 12-60 months), 32 patients (51%) developed AF recurrence. IAS thickness was similar in patients with and without IAB (4.5 ± 2.0 mm vs. 4.0 ± 1.4 mm; p = .45) and did not predict AF. Left atrial size was significantly enlarged in patients with IAB (40.9 ± 5.7 mm vs. 37.2 ± 4.0 mm; p = .03). Advanced IAB predicted AF recurrence after the ablation (OR: 3.34, CI: 1.12-9.93; p = .03). CONCLUSIONS IAS thickness was not significantly correlated to IAB and did not predict AF recurrence. IAB as previously demonstrated was an independent predictor of AF recurrence.
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Affiliation(s)
- Enes E Gul
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Raveen Pal
- Department of Cardiology, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Jane Caldwell
- Hull & East Yorkshire NHS Trust and Hull York Medical School, Hull, United Kingdom
| | - Usama Boles
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Wilma Hopman
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Benedict Glover
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Kevin A Michael
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Damian Redfearn
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Chris Simpson
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Hoshiar Abdollah
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Adrian Baranchuk
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, ON, Canada
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Wu JT, Wang SL, Chu YJ, Long DY, Dong JZ, Fan XW, Yang HT, Duan HY, Yan LJ, Qian P. CHADS 2 and CHA 2DS 2-VASc Scores Predict the Risk of Ischemic Stroke Outcome in Patients with Interatrial Block without Atrial Fibrillation. J Atheroscler Thromb 2016; 24:176-184. [PMID: 27301462 PMCID: PMC5305678 DOI: 10.5551/jat.34900] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Aim: To evaluate the role of CHADS2 and CHA2DS2-VASc scores in predicting the risk of ischemic stroke or transient ischemic attack (TIA) outcomes in patients with interatrial block (IAB) without a history of atrial fibrillation (AF). Methods: A retrospective study was conducted, including 1,046 non-anticoagulated inpatients (612 males, 434 females; mean age: 63 ± 10 years) with IAB and without AF. IAB was defined as P-wave duration > 120 ms using a 12-lead electrocardiogram. CHADS2 and CHA2DS2-VASc scores were retrospectively calculated. The primary outcomes evaluated were ischemic stroke or TIA. Results: During the mean follow-up period of 4.9 ± 0.7 years, 55 (5.3%) patients had an ischemic stroke or TIA. Receiver operating characteristic (ROC) curve analysis showed that the CHADS2 score [area under the curve (AUC), 0.638; 95% confidence interval (CI), 0.562–0.715; P = 0.001] and the CHA2DS2-VASc score (AUC, 0.671; 95% CI, 0.599–0.744; P <0.001) were predictive of ischemic strokes or TIA. Cut-off point analysis showed that a CHADS2 score ≥ 3 (sensitivity = 0.455 and specificity = 0.747) and a CHA2DS2-VASc score ≥ 4 (sensitivity = 0.564 and specificity = 0.700) provided the highest predictive value for ischemic stroke or TIA. The multivariate Cox regression analysis showed that CHADS2 [hazard ratio (HR), 1.442; 95% CI, 1.171–1.774; P = 0.001] and CHA2DS2-VASc (HR, 1.420; 95% CI, 1.203–1.677; P <0.001) scores were independently associated with ischemic stroke or TIA following adjustment for smoking, left atrial diameter, antiplatelet agents, angiotensin inhibitors, and statins. Conclusions: CHADS2 and CHA2DS2-VASc scores may be predictors of risk of ischemic stroke or TIA in patients with IAB without AF.
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Affiliation(s)
- Jin-Tao Wu
- Department of Cardiology, Henan Provincial People's Hospital (Zhengzhou University People's Hospital)
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