1
|
Bohlen B, Franzen D. Cardiac Damage After SARS-CoV2 Infection. Cureus 2024; 16:e60641. [PMID: 38903385 PMCID: PMC11187443 DOI: 10.7759/cureus.60641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2024] [Indexed: 06/22/2024] Open
Abstract
COVID-19 is a viral disease that can manifest acutely in the respiratory tract and other organs. In this study, we aimed to investigate potential long-term damage to the heart from COVID-19. For this study, we divided 97 consecutive unselected COVID-19 patients aged 18-80 years at a cardiology practice in Cologne, Germany, into two groups based on the severity of their infection. We performed a resting ECG and a resting transthoracic echocardiography three and six months after SARS-CoV2 infection. The key discriminator determining disease severity was bed confinement or hospital admission. Group 1 included patients with less severe COVID-19, whereas group 2 contained more severe cases. Heart rate as the primary ECG endpoint was lower by a statistically significant amount for the entire study population (p=0.024), subdivided by gender (pwomen <0.001, pmen <0.001) and in group 1 p =0.003 compared to three months. QTc time and repolarization disturbances as primary ECG endpoints and the echocardiographic primary endpoints, left ventricular ejection fraction, and left ventricular end-diastolic diameter (LVEDD), showed no relevant difference between the subgroups at three and six months or between the measurements taken at each point. In contrast, LVEDD normalized to body surface area was statistically significantly lower at six months in women in group 1 compared to group 2 (p=0.048) and in the overall study population at six months compared with the data after three months (p=0.034). E/E' was statistically lower at six months than at three months in the whole population (p=0.004) and in women (p=0.031). All measured echocardiographic and electrocardiographic mean values were within the normal range in all groups and follow-up controls. Overall, the prospective study conducted showed no significant evidence of long-term cardiac damage from COVID-19 disease, as evidenced by electrocardiographic and echocardiographic examinations at three and six months after infection.
Collapse
Affiliation(s)
- Ben Bohlen
- Cardiology, Medizinisches Versorgungszentrum (MVZ) Franzen Institut, Cologne, DEU
| | - Damian Franzen
- Cardiology, Medizinisches Versorgungszentrum (MVZ) Franzen Institut, Cologne, DEU
| |
Collapse
|
2
|
Segev A, Maor E, Goldenfeld M, Itelman E, Grossman E, Beinart R, Leshem E, Klempfner R, Klang E, Rahman N, Halabi N, Sabbag A. Atrial fibrillation in young hospitalized patients: Clinical characteristics, predictors of new onset, and outcomes. J Cardiol 2023; 82:408-413. [PMID: 37116647 DOI: 10.1016/j.jjcc.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 04/14/2023] [Accepted: 04/19/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) in young adults is an uncommon and not well studied entity. METHODS Consecutive patients aged 18-45 years admitted to internal or cardiology services in a large tertiary medical center (January 1, 2009 through December 31, 2019) were included. Clinical, electrocardiographic, and echocardiographic data were compared between patients with and without AF at baseline. Predictors of new-onset AF in the young were identified using multivariate Cox regression model among patients free of baseline AF. RESULTS Final cohort included 16,432 patients with median age of 34 (IQR 26-41) years of whom 8914 (56 %) were men. Patients with AF at baseline (N = 366; 2 %) were older, more likely to be men, and had higher proportion of comorbidities and electrocardiographic conduction disorders. Male sex, increased age, obesity, heart failure, congenital heart disease (CHD) and the presence of left or right bundle branch block were all independently associated with baseline AF in a multivariate model (p < 0.001 for all). Sub-analysis of 10,691 (98 %) patients free of baseline AF identified 85 cases of new-onset AF during a median follow up of 3.5 (IQR 1.5-6.5) years. Multivariate model identified increased age, heart failure, and CHD as independent predictors of new-onset AF. Finally, the CHARGE-AF risk score outperformed the CHA2DS2-VASc score in AF prediction [AUC of ROC 0.75 (0.7-0.8) vs. 0.56 (0.48-0.65)]. CONCLUSIONS AF among hospitalized young adults is not rare. Screening for new-onset AF in young post hospitalization patients may be guided by specific clinical predictors and the CHARGE-AF risk score.
Collapse
Affiliation(s)
- Amitai Segev
- Cardiovascular Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - Elad Maor
- Cardiovascular Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - Miki Goldenfeld
- Cardiovascular Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - Edward Itelman
- Internal Medicine Wing, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Ehud Grossman
- Internal Medicine Wing, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Roy Beinart
- Cardiovascular Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - Eran Leshem
- Cardiovascular Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - Robert Klempfner
- Cardiovascular Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - Eyal Klang
- ARC Innovation Center, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Nisim Rahman
- ARC Innovation Center, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Nitsan Halabi
- ARC Innovation Center, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Avi Sabbag
- Cardiovascular Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel.
| |
Collapse
|
3
|
Freund O, Caspi I, Alcalay I, Brezis MR, Frydman S, Bornstein G. An old diagnostic tool for new indications: inpatient Holter ECG for conditions other than syncope or stroke. Sci Rep 2023; 13:12510. [PMID: 37532808 PMCID: PMC10397303 DOI: 10.1038/s41598-023-39803-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 07/31/2023] [Indexed: 08/04/2023] Open
Abstract
Holter electrocardiography (ECG) assists in the diagnosis of arrhythmias. Its use in the inpatient setting has been described solely for the evaluation of stroke and syncope. Our aim was to assess its diagnostic value for other conditions in the internal medicine department. We included all hospitalized patients between 2018 and 2021 in a tertiary referral center. The primary outcome was a diagnostic Holter recording a new arrhythmia that led to a change in treatment. Overall, 289 patients completed a 24-h inpatient Holter ECG for conditions other than syncope or stroke, with 39 (13%) diagnostic findings. The highest diagnostic value was found in patients admitted for pre-syncope (19%), palpitations (18%), and unexplained heart failure exacerbation/dyspnea (17%). A low diagnostic yield was found for the evaluation of chest pain (5%). Heart failure with preserved ejection fraction (adjusted OR 2.3, 95% CI 1.1-5.4, p = 0.04), and baseline ECG with either a bundle branch block (AOR 4.2, 95% CI 1.9-9.2, p < 0.01) or atrioventricular block (first or second degree, AOR 5, 95% CI 2.04-12.3, p < 0.01) were among the independent predictors for a diagnostic test. Inpatient Holter ECG monitoring may have value as a diagnostic tool for selected patients with conditions other than syncope or stroke.
Collapse
Affiliation(s)
- Ophir Freund
- Internal Medicine B, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Wizman 6, Tel Aviv, Israel.
| | - Inbar Caspi
- Internal Medicine B, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Wizman 6, Tel Aviv, Israel
| | - Idan Alcalay
- Internal Medicine B, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Wizman 6, Tel Aviv, Israel
| | - Miriam R Brezis
- Internal Medicine B, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Wizman 6, Tel Aviv, Israel
| | - Shir Frydman
- Internal Medicine B, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Wizman 6, Tel Aviv, Israel
| | - Gil Bornstein
- Internal Medicine B, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Wizman 6, Tel Aviv, Israel
| |
Collapse
|
4
|
Zhao R, Xiong F, Deng X, Wang S, Liu C, Xu M, Tan K, Wang X. Early assessment of ventricular synchronization and function after left bundle-branch-area pacing with right bundle-branch block. BMC Cardiovasc Disord 2022; 22:380. [PMID: 35989329 PMCID: PMC9394046 DOI: 10.1186/s12872-022-02818-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022] Open
Abstract
Aim To evaluate ventricular synchronization and function in patients with right bundle-branch block after left bundle-branch-area pacing (LBBAP) by echocardiography. Methods Forty patients who successfully received LBBAP were selected and divided into the right bundle-branch block group (RBBB group) and the non-RBBB group by pre-operation ECG. Echocardiography and follow-up were performed 1 month after operation. Interventricular synchronization was evaluated by tissue Doppler (TDI), tissue mitral annular displacement (TMAD), and interventricular mechanical delay. The tricuspid annular plane systolic excursion (TAPSE), right ventricular fractional area change (RVFAC), tricuspid annulus sidewall systolic velocity (TV-s’), left ventricular global ventricular longitudinal strain (GLS), right ventricular free wall longitudinal strain (LS-RV), standard deviation of left ventricular 18 segments peak time difference (SDt-L) and standard deviation of right ventricular free wall 3 segments peak time difference (SDt-R) were applied to evaluate intraventricular synchronization and ventricular function. Results The difference of displacement peak time of the tricuspid and mitral valves, namely ΔPTTV-MV measured by TMAD, the difference of systolic time to peak of the tricuspid and mitral valves, namely ΔTsTV-MV measured by TDI, were statistically different between the two groups (P < 0.05). Compared with the non-RBBB group, there were no statistically significant differences in the GLS, RVFAC, LS-RV, TAPSE, TV-s’, SDt-L, SDt-R (P > 0.05). Conclusion Echocardiography technology including two-dimensional speckle tracking imaging (2D-STI), TDI, and TMAD can effectively analyze interventricular synchronization, intraventricular synchronization, and ventricular function. Although the movement of the right ventricular myocardium in the RBBB group was slightly later than that of the left ventricular myocardium after LBBAP, LBBAP could still be applied in RBBB patients with pacing indication. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02818-z.
Collapse
|
5
|
Zhang FT, Liu XJ, Zhao DQ, Wu JT, Zhang LM, Hu J, Fan XW, Yang HT, Yan LJ, Liu JJ, Wang SL. Association between complete right bundle branch block and atrial fibrillation development. Ann Noninvasive Electrocardiol 2022; 27:e12966. [PMID: 35567783 PMCID: PMC9296786 DOI: 10.1111/anec.12966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/15/2022] [Accepted: 04/21/2022] [Indexed: 12/04/2022] Open
Abstract
Background Complete right bundle branch block (CRBBB) is an important predictor of atrial fibrillation (AF) recurrence after pulmonary vein isolation. However, the association between CRBBB and AF development remains unclear. Methods We performed a retrospective study of 2639 patients (male, n = 1549; female, n = 1090; mean age, 58 ± 13 years). CRBBB was defined as a late R (R′) wave in lead V1 or V2 with a slurred S wave in lead I and/or lead V6 with a prolonged QRS duration (≥120 ms). Results Among the 2639 patients, CRBBB was detected in 40 patients (1.5%), and the prevalence of AF was 7.4% (196/2639). The proportion of patients with AF and CRBBB was higher than the proportion of patients with AF without CRBBB (22.5% vs. 7.2%; p = 0.001). In the forward multivariate logistic analysis, CRBBB (odds ratio [OR], 3.329; 95% confidence interval [CI], 1.350–8.211; p = 0.009), complete left bundle branch block (OR, 2.209; 95% CI, 1.238–3.940; p = 0.007), age (OR, 1.020; 95% CI, 1.005–1.035; p = 0.009), valvular heart disease (OR, 2.332; 95% CI, 1.531–3.552; p < 0.001), left atrial diameter (OR, 1.133; 95% CI, 1.104–1.163; p < 0.001), left ventricular ejection fraction (OR, 1.023; 95% CI, 1.006–1.041; p = 0.007), and class I or III anti‐arrhythmic drug use (OR, 10.534; 95% CI, 7.090–15.651; p < 0.001) were associated with AF. Conclusion Complete right bundle branch block was significantly associated with AF development in hospitalized patients with cardiovascular diseases.
Collapse
Affiliation(s)
- Fu-Tao Zhang
- Department of Cardiology, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Xiao-Jie Liu
- Department of Cardiology, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Dan-Qing Zhao
- Department of Cardiology, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Jin-Tao Wu
- Heart Centre of Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai 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
| | - 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
| | - Shan-Ling Wang
- Heart Centre of Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
6
|
Biton S, Gendelman S, Ribeiro AH, Miana G, Moreira C, Ribeiro ALP, Behar JA. Atrial fibrillation risk prediction from the 12-lead electrocardiogram using digital biomarkers and deep representation learning. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 2:576-585. [PMID: 36713102 PMCID: PMC9707938 DOI: 10.1093/ehjdh/ztab071] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 07/20/2021] [Accepted: 08/04/2021] [Indexed: 02/01/2023]
Abstract
Aims This study aims to assess whether information derived from the raw 12-lead electrocardiogram (ECG) combined with clinical information is predictive of atrial fibrillation (AF) development. Methods and results We use a subset of the Telehealth Network of Minas Gerais (TNMG) database consisting of patients that had repeated 12-lead ECG measurements between 2010 and 2017 that is 1 130 404 recordings from 415 389 unique patients. Median and interquartile of age for the recordings were 58 (46-69) and 38% of the patients were males. Recordings were assigned to train-validation and test sets in an 80:20% split which was stratified by class, age and gender. A random forest classifier was trained to predict, for a given recording, the risk of AF development within 5 years. We use features obtained from different modalities, namely demographics, clinical information, engineered features, and features from deep representation learning. The best model performance on the test set was obtained for the model combining features from all modalities with an area under the receiver operating characteristic curve (AUROC) = 0.909 against the best single modality model which had an AUROC = 0.839. Conclusion Our study has important clinical implications for AF management. It is the first study integrating feature engineering, deep learning, and Electronic medical record system (EMR) metadata to create a risk prediction tool for the management of patients at risk of AF. The best model that includes features from all modalities demonstrates that human knowledge in electrophysiology combined with deep learning outperforms any single modality approach. The high performance obtained suggest that structural changes in the 12-lead ECG are associated with existing or impending AF.
Collapse
Affiliation(s)
- Shany Biton
- Faculty of Biomedical Engineering, Technion-IIT, Haifa, Israel
| | | | - Antônio H Ribeiro
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| | - Gabriela Miana
- Telehealth Center, Hospital das Clínicas, Belo Horizonte, Brazil,Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Carla Moreira
- Telehealth Center, Hospital das Clínicas, Belo Horizonte, Brazil
| | - Antonio Luiz P Ribeiro
- Telehealth Center, Hospital das Clínicas, Belo Horizonte, Brazil,Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Joachim A Behar
- Faculty of Biomedical Engineering, Technion-IIT, Haifa, Israel,Corresponding author. Tel: (+972) 4 829 4125,
| |
Collapse
|
7
|
Floria M, Parteni N, Neagu AI, Sascau RA, Statescu C, Tanase DM. Incomplete right bundle branch block: Challenges in electrocardiogram diagnosis. Anatol J Cardiol 2021; 25:380-384. [PMID: 34100724 DOI: 10.5152/anatoljcardiol.2021.84375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Mariana Floria
- Internal Medicine Clinic, "Dr. Iacob Czihac" Military Emergency Clinical Hospital; Iasi-Romania;Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy; Iasi-Romania
| | - Noela Parteni
- Internal Medicine Clinic, "Dr. Iacob Czihac" Military Emergency Clinical Hospital; Iasi-Romania;Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy; Iasi-Romania
| | - Alexandra Ioana Neagu
- Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy; Iasi-Romania;"Prof. Dr. George I.M. Georgescu" Institute of Cardiovascular Disease; Iasi-Romania
| | - Radu Andy Sascau
- Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy; Iasi-Romania;"Prof. Dr. George I.M. Georgescu" Institute of Cardiovascular Disease; Iasi-Romania
| | - Cristian Statescu
- Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy; Iasi-Romania;"Prof. Dr. George I.M. Georgescu" Institute of Cardiovascular Disease; Iasi-Romania
| | - Daniela Maria Tanase
- Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy; Iasi-Romania;Internal Medicine Clinic, "St. Spiridon" County Clinical Emergency Hospital; Iasi-Romania
| |
Collapse
|
8
|
Rankinen J, Haataja P, Lyytikäinen LP, Huhtala H, Lehtimäki T, Kähönen M, Eskola M, Pérez-Riera AR, Jula A, Rissanen H, Nikus K, Hernesniemi J. Long-term outcome of intraventricular conduction delays in the general population. Ann Noninvasive Electrocardiol 2020; 26:e12788. [PMID: 32804416 PMCID: PMC7816813 DOI: 10.1111/anec.12788] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/07/2020] [Accepted: 06/22/2020] [Indexed: 11/29/2022] Open
Abstract
Background Previous population studies have presented conflicting results regarding the prognostic impact of intraventricular conduction delays (IVCD). Methods We studied long‐term prognostic impact and the association with comorbidities of eight IVCDs in a random sample of 6,299 Finnish subjects (2,857 men and 3,442 women, mean age 52.8, SD 14.9 years) aged 30 or over who participated in the health examination including 12‐lead ECG. For left bundle branch block (LBBB) and non‐specific IVCD (NSIVCD), two different definitions were used. Results During 16.5 years’ follow‐up, 1,309 of the 6,299 subjects (20.8%) died and of these 655 (10.4%) were cardiovascular (CV) deaths. After controlling for known clinical risk factors, the hazard ratio for CV death, compared with individuals without IVCD, was 1.55 for the Minnesota definition of LBBB (95% confidence interval 1.04–2.31, p = .032) and 1.27 (95% confidence interval 0.80–2.02, p = .308) for the Strauss’ definition of LBBB. Subjects with NSIVCD were associated with twofold to threefold increase in CV mortality depending on the definition. While right bundle branch block, left anterior fascicular block and incomplete bundle branch blocks were associated with seemingly higher mortality, this was no longer the case after adjustment for age and sex. The presence of R‐R’ pattern was not associated with any adverse outcome. Conclusions In a population study with long‐term follow‐up, NSIVCD and Minnesota definition of LBBB were independently associated with CV mortality. Other IVCDs had no significant impact on prognosis. The prognostic impact of LBBB and NSIVCD was affected by the definition of the conduction disorder.
Collapse
Affiliation(s)
- Jani Rankinen
- Faculty of Medicine and Health Technology, Tampere University, and Finnish Cardiovascular Research Center, Tampere, Finland
| | - Petri Haataja
- Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | - Leo-Pekka Lyytikäinen
- Faculty of Medicine and Health Technology, Tampere University, and Finnish Cardiovascular Research Center, Tampere, Finland.,Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland.,Department of Clinical Chemistry, Tampere University Hospital, and Fimlab Laboratories, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Terho Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, and Finnish Cardiovascular Research Center, Tampere, Finland.,Department of Clinical Chemistry, Tampere University Hospital, and Fimlab Laboratories, Tampere, Finland
| | - Mika Kähönen
- Faculty of Medicine and Health Technology, Tampere University, and Finnish Cardiovascular Research Center, Tampere, Finland.,Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Markku Eskola
- Faculty of Medicine and Health Technology, Tampere University, and Finnish Cardiovascular Research Center, Tampere, Finland.,Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | | | - Antti Jula
- The Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Harri Rissanen
- The Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Kjell Nikus
- Faculty of Medicine and Health Technology, Tampere University, and Finnish Cardiovascular Research Center, Tampere, Finland.,Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | - Jussi Hernesniemi
- Faculty of Medicine and Health Technology, Tampere University, and Finnish Cardiovascular Research Center, Tampere, Finland.,Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| |
Collapse
|
9
|
Detection and Classification of Cardiac Arrhythmias by a Challenge-Best Deep Learning Neural Network Model. iScience 2020; 23:100886. [PMID: 32062420 PMCID: PMC7031313 DOI: 10.1016/j.isci.2020.100886] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/15/2020] [Accepted: 01/30/2020] [Indexed: 01/16/2023] Open
Abstract
Electrocardiograms (ECGs) are widely used to clinically detect cardiac arrhythmias (CAs). They are also being used to develop computer-assisted methods for heart disease diagnosis. We have developed a convolution neural network model to detect and classify CAs, using a large 12-lead ECG dataset (6,877 recordings) provided by the China Physiological Signal Challenge (CPSC) 2018. Our model, which was ranked first in the challenge competition, achieved a median overall F1-score of 0.84 for the nine-type CA classification of CPSC2018's hidden test set of 2,954 ECG recordings. Further analysis showed that concurrent CAs were adequately predictive for 476 patients with multiple types of CA diagnoses in the dataset. Using only single-lead data yielded a performance that was only slightly worse than using the full 12-lead data, with leads aVR and V1 being the most prominent. We extensively consider these results in the context of their agreement with and relevance to clinical observations. Accurate AI diagnosis of cardiac arrhythmia on ECG data from 11 hospitals Capable of diagnosing concurrent cardiac arrhythmias An ensemble model combining 12- and 1-lead models ranked first in CPSC2018 aVR and V1 found to be the best-performing single leads
Collapse
|
10
|
Alventosa-Zaidin M, Guix Font L, Benitez Camps M, Roca Saumell C, Pera G, Alzamora Sas MT, Forés Raurell R, Rebagliato Nadal O, Dalfó-Baqué A, Brugada Terradellas J. Right bundle branch block: Prevalence, incidence, and cardiovascular morbidity and mortality in the general population. Eur J Gen Pract 2019; 25:109-115. [PMID: 31339387 PMCID: PMC6713172 DOI: 10.1080/13814788.2019.1639667] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: Right bundle branch block (RBBB) is among the most common electrocardiographic abnormalities. Objectives: To establish the prevalence and incidence of RBBB in the general population without cardiovascular events (CVE) and whether RBBB increases cardiovascular morbidity and mortality compared with patients with a normal electrocardiogram (ECG). Methods: A historical study of two cohorts including 2981 patients from 29 primary health centres without baseline CVE. Cox (for CVE) and logistic (for cardiovascular factors) regression was used to assess their association with RBBB. Results: Of the patients (58% women; mean age 65.9), 92.2% had a normal ECG, 4.6% incomplete RBBB (iRBBB) and 3.2% complete RBBB (cRBBB). Mean follow-up was five years. Factors associated with appearance of cRBBB were male sex (HR = 3.8; 95%CI: 2.4-6.1) and age (HR = 1.05 per year; 95%CI: 1.03-1.08). In a univariate analysis, cRBBB was associated with an increase in all-cause mortality but only bifascicular block (BFB) was significant after adjusting for confounders. cRBBB tended to increase CVE but the results were not statistically significant. Presence of iRBBB was not associated with adverse outcomes. Patients with iRBBB who progressed to cRBBB showed a higher incidence of heart failure and chronic kidney disease. Conclusion: In this general population cohort with no CV disease, 8% had RBBB, with a higher prevalence among men and elderly patients. Although all-cause mortality and CVE tended to increase in the presence of cRBBB, only BFB showed a statistically significant association with cRBBB. Patients with iRBBB who progressed to cRBBB had a higher incidence of CVE. We detected no effect of iRBBB on morbidity and mortality.
Collapse
Affiliation(s)
- M Alventosa-Zaidin
- a Centre d'Atenció Primària Arenys de Mar, Servei d'atenció Primària Barcelonès Nord- Maresme, Institut Català de la Salut , Barcelona , Spain
| | - L Guix Font
- b Centre d'Atenció Primària Berga, Servei d'atenció Primària Bages- Berguedà-Solsonés, Institut Català de la Salut , Barcelona , Spain
| | - M Benitez Camps
- c Centre d'Atenció Primària Gòtic, Servei d'atenció Primària Barcelona Litoral, Institut Català de la Salut , Barcelona , Spain
| | - C Roca Saumell
- d Centre d'Atenció Primària El Clot, Servei d'atenció Primària Barcelona Dreta-Muntanya, Institut Català de la Salut , Barcelona , Spain.,e Faculty of Medicine, University of Barcelona , Barcelona , Spain
| | - G Pera
- f Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) , Barcelona , Spain
| | - M Teresa Alzamora Sas
- f Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) , Barcelona , Spain.,g Centre d'Atenció Primària Riu-Nord Riu-Sud Santa Coloma de Gramenet, Servei d'atenció Primària Barcelonès Nord i Maresme, Institut Català de la Salut , Barcelona , Spain
| | - R Forés Raurell
- f Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) , Barcelona , Spain.,g Centre d'Atenció Primària Riu-Nord Riu-Sud Santa Coloma de Gramenet, Servei d'atenció Primària Barcelonès Nord i Maresme, Institut Català de la Salut , Barcelona , Spain
| | - O Rebagliato Nadal
- c Centre d'Atenció Primària Gòtic, Servei d'atenció Primària Barcelona Litoral, Institut Català de la Salut , Barcelona , Spain.,f Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) , Barcelona , Spain
| | - A Dalfó-Baqué
- c Centre d'Atenció Primària Gòtic, Servei d'atenció Primària Barcelona Litoral, Institut Català de la Salut , Barcelona , Spain
| | - J Brugada Terradellas
- e Faculty of Medicine, University of Barcelona , Barcelona , Spain.,h Departament de Cardiologia, Hospital Clínic de Barcelona , Barcelona , Spain
| |
Collapse
|
11
|
Seifert MB, Olesen MS, Christophersen IE, Nielsen JB, Carlson J, Holmqvist F, Tveit A, Haunsø S, Svendsen JH, Platonov PG. Genetic variants on chromosomes 7p31 and 12p12 are associated with abnormal atrial electrical activation in patients with early-onset lone atrial fibrillation. Ann Noninvasive Electrocardiol 2019; 24:e12661. [PMID: 31152482 DOI: 10.1111/anec.12661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 05/04/2019] [Accepted: 05/05/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Abnormal P-wave morphology (PWM) has been associated with a history of atrial fibrillation (AF) in earlier studies. Although lone AF is believed to have substantial genetic basis, studies on associations between single nucleotide polymorphisms (SNP) linked to lone AF and PWM have not been reported. We aimed to assess whether SNPs previously associated with lone AF (rs2200733, rs13376333, rs3807989, and rs11047543) are also linked to P-wave abnormalities. METHODS Four SNPs were studied in 176 unrelated individuals with early-onset lone AF (age at onset <50 years), median age 38 years (19-63 years), 149 men. Using sinus rhythm ECG, orthogonal PWM was classified as Type 1-positive in leads X and Y and negative in lead Z, Type 2-positive in leads X and Y and biphasic (-/+) in lead Z, Type 3-positive in lead X and biphasic in lead Y (+/-), and the remaining as atypical. RESULTS Two SNPs were found to be significantly associated with altered P-wave morphology distribution: rs3807989 near the gene CAV1/CAV2 and rs11047543 near the gene SOX5. Both SNPs were associated with a higher risk of non-Type 1 P-wave morphology (rs3807989: OR = 4.8, 95% CI = 2.3-10.2, p < 0.001; rs11047543: OR = 4.7, 95% CI = 1.1-20.5, p = 0.04). No association was observed for rs2200733 and rs13376333. CONCLUSION In this study, the two variants rs3807989 and rs11047543, previously associated with PR interval and lone AF, were associated with altered P-wave morphology distribution in patients with early-onset lone AF. These findings suggest that common genetic variants may modify atrial conduction properties.
Collapse
Affiliation(s)
- Mariam B Seifert
- The Center for Integrative Electrocardiology, Arrhythmia Clinic Skåne University Hospital, Lund University (CIEL), Lund, Sweden.,Department of Cardiology, Frederiksberg Hospital, Copenhagen, Denmark
| | - Morten S Olesen
- Danish National Research Foundation Center for Cardiac Arrhythmia, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ingrid E Christophersen
- The Department of Medical Genetics, Oslo University Hospital, Oslo, Norway.,Department of Medical Research, Baerum Hospital, Vestre Viken Hospital Trust, Rud, Norway
| | - Jonas B Nielsen
- Danish National Research Foundation Center for Cardiac Arrhythmia, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jonas Carlson
- The Center for Integrative Electrocardiology, Arrhythmia Clinic Skåne University Hospital, Lund University (CIEL), Lund, Sweden
| | - Fredrik Holmqvist
- The Center for Integrative Electrocardiology, Arrhythmia Clinic Skåne University Hospital, Lund University (CIEL), Lund, Sweden
| | - Arnljot Tveit
- Department of Medical Research, Baerum Hospital, Vestre Viken Hospital Trust, Rud, Norway
| | - Stig Haunsø
- Danish National Research Foundation Center for Cardiac Arrhythmia, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jesper H Svendsen
- Danish National Research Foundation Center for Cardiac Arrhythmia, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pyotr G Platonov
- The Center for Integrative Electrocardiology, Arrhythmia Clinic Skåne University Hospital, Lund University (CIEL), Lund, Sweden
| |
Collapse
|
12
|
Alventosa-Zaidin M, Pera G, Roca Saumell C, Mengual Miralles N, Zamora Sanchez MV, Gros Garcia T, Guix Font L, Benitez Camps M, Francisco-Pascual J, Brugada Terradellas J. Diagnosis of right bundle branch block: a concordance study. BMC FAMILY PRACTICE 2019; 20:58. [PMID: 31060516 PMCID: PMC6501399 DOI: 10.1186/s12875-019-0946-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 04/15/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Right bundle branch block is one of the most common electrocardiographic abnormalities. Most cases of right bundle branch block are detected in asymptomatic patients in primary care, so a correct interpretation of electrocardiograms (ECGs) at this level is necessary. The objective of this research is to determine the degree of concordance in the diagnosis of incomplete and complete right bundle branch block between four primary care researchers and a cardiologist. METHODS The research design is a retrospective cohort study of patients over 18 years of ages of patients over 18 years of ages who underwent an ECG for any reason and were diagnosed with right bundle branch block by their physician. The physicians participating, 4 primary care researchers and a cardiologist were specialized in interpreting electrocardiographic records. The diagnosis of incomplete and complete right bundle branch block was recorded and other secondary variables were analysed. In case of diagnostic discordance between the researchers, the ECGs were reviewed by an expert cardiologist, who interpreted them, established the diagnosis and analysed the possible causes for the discrepancy. RESULTS We studied 160 patients diagnosed with right bundle branch block by their general practise. The patients had a mean age of 64.8 years and 54% of them were men. The concordance in the diagnosis of incomplete right bundle branch block showed a Fleiss' kappa index (k) of 0.71 among the five researchers and of 0.85 among only the primary care researchers. The k for complete right bundle branch block was 0.93 among the five researchers and 0.96 among only the primary care researchers. CONCLUSION The interobserver agreement in the diagnosis of right bundle branch block performed by physicians specialized in ECG interpretation (primary care physicians and a cardiologist) was very good. The variability was greater for the diagnosis of incomplete right bundle branch block.
Collapse
Affiliation(s)
- M Alventosa-Zaidin
- Bon Pastor, Primary Healthcare Center, Catalan Health Institute, Barcelona, Catalonia, Spain.
| | - G Pera
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Mataró, Spain
| | - C Roca Saumell
- EAP El Clot, Primary Healthcare Center, Catalan Health Institute, University of Barcelona, Barcelona, Spain
| | - N Mengual Miralles
- EAP Ronda Cerdanya, Primary Healthcare Center, Catalan Health Institute, Mataró, Barcelona, Spain
| | - M V Zamora Sanchez
- EAP El Gòtic, Primary Healthcare Center, Catalan Health Institute, Barcelona, Spain
| | - T Gros Garcia
- EAP Ronda Cerdanya, Primary Healthcare Center, Catalan Health Institute, Mataró, Barcelona, Spain
| | - L Guix Font
- EAP Berga, Primary Healthcare Center, Catalan Health Institute, Berga, Barcelona, Spain
| | - M Benitez Camps
- EAP El Gòtic, Primary Healthcare Center, Catalan Health Institute, Barcelona, Spain
| | - J Francisco-Pascual
- Unity of arithmies. Servei de cardiologia. University Hospital Vall Hebrón, Research Institut, Universitat Autònoma de Barcelona, CIBER-CV, Barcelona, Spain
| | - J Brugada Terradellas
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| |
Collapse
|
13
|
Right bundle branch block and cardiovascular morbidity and mortality in healthy patients. Med Clin (Barc) 2018; 151:402-411. [PMID: 30139583 DOI: 10.1016/j.medcli.2018.04.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/15/2018] [Accepted: 04/16/2018] [Indexed: 11/21/2022]
Abstract
The clinical significance of a right bundle branch block (RBBB) in an asymptomatic adult without evidence of cardiovascular disease is controversial. To establish the relationship between the appearance of the RBBB and the increase of cardiovascular morbidity and mortality in healthy patients, we have carried out a literature review of documents available until September 2017 through a systematic search on the Pubmed database, Cochrane library and a manual search of the mentioned literature and related articles. From the 29 articles included in the study sample, eight showed mortality and 16 morbidity outcomes. An increase of risk of death is observed is eight articles and an increase of cardiovascular events is observed in 11 articles. The most recent publications suggest that the appearance of an RBBB in healthy individuals should not be underestimated, thus further studies are needed to analyse the type of follow-up that should be carried out in these patients.
Collapse
|
14
|
Conduction disturbance after isolated surgical aortic valve replacement in degenerative aortic stenosis. J Thorac Cardiovasc Surg 2017; 154:1556-1565.e1. [DOI: 10.1016/j.jtcvs.2017.05.101] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 05/07/2017] [Accepted: 05/24/2017] [Indexed: 11/18/2022]
|
15
|
Heiberg J, Nyboe C, Hjortdal VE. Permanent chronotropic impairment after closure of atrial or ventricular septal defect. SCAND CARDIOVASC J 2017; 51:271-276. [DOI: 10.1080/14017431.2017.1337216] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Johan Heiberg
- Department of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Camilla Nyboe
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Anesthesiology & Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Vibeke E. Hjortdal
- Department of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
16
|
Diederichsen SZ, Haugan KJ, Køber L, Højberg S, Brandes A, Kronborg C, Graff C, Holst AG, Nielsen JB, Krieger D, Svendsen JH. Atrial fibrillation detected by continuous electrocardiographic monitoring using implantable loop recorder to prevent stroke in individuals at risk (the LOOP study): Rationale and design of a large randomized controlled trial. Am Heart J 2017; 187:122-132. [PMID: 28454796 DOI: 10.1016/j.ahj.2017.02.017] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 02/06/2017] [Indexed: 02/05/2023]
Abstract
Atrial fibrillation (AF) increases the rate of stroke 5-fold, and AF-related strokes have a poorer prognosis compared with non-AF-related strokes. Atrial fibrillation and stroke constitute an intensifying challenge, and health care organizations are calling for awareness on the topic. Previous studies have demonstrated that AF is often asymptomatic and consequently undiagnosed. The implantable loop recorder (ILR) allows for continuous, long-term electrocardiographic monitoring with daily transmission of arrhythmia information, potentially leading to improvement in AF detection and stroke prevention. METHODS The LOOP study is an investigator-initiated, randomized controlled trial with 6,000 participants randomized 3:1 to a control group or to receive an ILR with continuous electrocardiographic monitoring. Participants are identified from Danish registries and are eligible for inclusion if 70years or older and previously diagnosed as having at least one of the following conditions: hypertension, diabetes mellitus, heart failure, or previous stroke. Exclusion criteria include history of AF and current oral anticoagulation treatment. When an AF episode lasting ≥6minutes is detected, oral anticoagulation will be initiated according to guidelines. Expected follow-up is 4years. The primary end point is time to stroke or systemic embolism, whereas secondary end points include time to AF diagnosis and death. CONCLUSION The LOOP study will evaluate health benefits and cost-effectiveness of ILR as a screening tool for AF to prevent stroke in patients at risk. Secondary objectives include identification of risk factors for the development of AF and characterization of arrhythmias in the population. The trial holds the potential to influence the future of stroke prevention.
Collapse
Affiliation(s)
- Søren Zöga Diederichsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ketil Jørgen Haugan
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Højberg
- Department of Cardiology, Bispebjerg Hospital, Copenhagen University Hospital, Bispebjerg, Denmark
| | - Axel Brandes
- Department of Cardiology, Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christian Kronborg
- Centre of Health Economics Research (COHERE), Department of Business and Economics, University of Southern Denmark, Odense, Denmark
| | - Claus Graff
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Anders Gaarsdal Holst
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; The Danish National Research Foundation Center for Cardiac Arrhythmia, Copenhagen, Denmark
| | - Jonas Bille Nielsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Derk Krieger
- University Hospital Zurich, Switzerland; Mediclinic City Hospital, Dubai, United Arabic Emirates
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; The Danish National Research Foundation Center for Cardiac Arrhythmia, Copenhagen, Denmark.
| |
Collapse
|
17
|
Pérez-Riera AR, de Abreu LC, Barbosa-Barros R, Grindler J, Fernandes-Cardoso A, Baranchuk A. P-wave dispersion: an update. Indian Pacing Electrophysiol J 2016; 16:126-133. [PMID: 27924760 PMCID: PMC5197451 DOI: 10.1016/j.ipej.2016.10.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/20/2016] [Indexed: 11/30/2022] Open
Abstract
P-wave dispersion (PWD, Pd or Pdis) is a noninvasive electrocardiographic (ECG) marker for atrial remodeling and predictor for atrial fibrillation (AF). PWD is defined as the difference between the widest and the narrowest P-wave duration recorded from the 12 ECG leads. Increased P-wave duration and PWD reflect prolongation of intraatrial and interatrial conduction time with lack of a well-coordinated conduction system within the atrial muscles, with inhomogeneous, asynchronic, pro-inflammatory and anti-inflammatory effect mediated by interleukin-6 (IL-6) in patients with the CG + GG genotype IL-6 -634C/G polymorphism [1] and discontinuous propagation of sinus impulses mainly between the left and right atria, interstitial/extracellular fibroblast activation and collagen deposition with fibrosis (via TGF-β) in atrial tissue, insufficient blood supply, significant not isotropic myoelectric activity, and thin wall thickness and consequent expansion tendency all well-known electrophysiological characteristics in patients with atrial arrhythmias and especially paroxysmal atrial fibrillation (PAF) [2].
Collapse
Affiliation(s)
- Andrés Ricardo Pérez-Riera
- Design of Studies and Scientific Writing Laboratory in the ABC Medicine Faculty, Santo André, São Paulo, Brazil.
| | - Luiz Carlos de Abreu
- Design of Studies and Scientific Writing Laboratory in the ABC Medicine Faculty, Santo André, São Paulo, Brazil; Program in Molecular and Integrative Physiological Sciences (MIPS), Department of Environmental Health, Harvard T.H. Chan School of Public Health, USA
| | - Raimundo Barbosa-Barros
- Coronary Center of the Messejana Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | - José Grindler
- Electrocardiology Sector, Central Institute of Clínicas Hospital, Faculty of Medicine, University of São Paulo (HCFMUSP), Brazil
| | - Acácio Fernandes-Cardoso
- Electrocardiology Sector, Central Institute of Clínicas Hospital, Faculty of Medicine, University of São Paulo (HCFMUSP), Brazil
| | - Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| |
Collapse
|
18
|
Heiberg J, Redington A, Hjortdal VE. Postoperative right bundle branch block after closure of ventricular septal defect predicts lower peak heart rate in adulthood. Int J Cardiol 2016; 204:40-1. [DOI: 10.1016/j.ijcard.2015.11.148] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 11/22/2015] [Indexed: 11/28/2022]
|
19
|
FRONTERA ANTONIO, CARPENTER ALEXANDER, AHMED NAUMAN, FASIOLO MATTEO, NELSON MARTIN, DIAB IHAB, CRIPPS TIM, THOMAS GLYN, DUNCAN EDWARD. Demographic and Clinical Characteristics to Predict Paroxysmal Atrial Fibrillation: Insights from an Implantable Loop Recorder Population. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:1217-22. [DOI: 10.1111/pace.12692] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 06/09/2015] [Accepted: 07/05/2015] [Indexed: 11/29/2022]
Affiliation(s)
- ANTONIO FRONTERA
- Cardiology Department; Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust; Bristol UK
| | - ALEXANDER CARPENTER
- Cardiology Department; Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust; Bristol UK
| | - NAUMAN AHMED
- Cardiology Department; Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust; Bristol UK
| | - MATTEO FASIOLO
- Mathematical Sciences Department; University of Bath; Bath UK
| | - MARTIN NELSON
- Cardiology Department; Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust; Bristol UK
| | - IHAB DIAB
- Cardiology Department; Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust; Bristol UK
| | - TIM CRIPPS
- Cardiology Department; Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust; Bristol UK
| | - GLYN THOMAS
- Cardiology Department; Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust; Bristol UK
| | - EDWARD DUNCAN
- Cardiology Department; Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust; Bristol UK
| |
Collapse
|
20
|
Baturova MA, Lindgren A, Carlson J, Shubik YV, Olsson SB, Platonov PG. Predictors of new onset atrial fibrillation during 10-year follow-up after first-ever ischemic stroke. Int J Cardiol 2015. [PMID: 26209828 DOI: 10.1016/j.ijcard.2015.07.047] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Paroxysmal atrial fibrillation (AF) may be underdiagnosed in ischemic stroke patients but may be pivotal for initiation of oral anticoagulation therapy. We assessed clinical and ECG predictors of new-onset AF during 10-year follow-up (FU) in ischemic stroke patients. METHODS The study sample comprised of 227 first-ever ischemic stroke patients without AF (median age 73, interquartile range 25%-75% 63-80years, 92 female) and 1:1 age- and gender-matched controls without stroke and AF enrolled in the Lund Stroke Register from March 2001 to February 2002. New-onset AF during FU was assessed by screening through regional ECG database and by record linkage with Swedish National Patient Register. The standard 12-lead sinus rhythm ECGs at stroke admission were retrieved from electronic database and digitally processed. Clinical baseline characteristics were studied using medical records. RESULTS During FU, AF was found in 39 stroke patients and 30 controls, p=0.296. In stroke patients in multivariate Cox regression analysis AF was associated with hypertension (HR 3.45 CI 95% 1.40-3.49, p=0.007) and QRS duration (HR 1.02 CI 95% 1.00-1.03, p=0.049). High cardiovascular risk was predictive for AF development: for CHADS2≥4 HR 2.46 CI 95% 1.45-4.18, p=0.001 and for CHA2DS2-VASc≥5 HR 2.29 CI 95% 1.43-3.68, p=0.001. New onset AF was not associated with baseline ischemic stroke: HR 1.46 95% CI 0.90-2.35, p=0.121. CONCLUSION High CHADS2 and CHA2DS2-VASc scores, but not baseline ischemic stroke, predict new onset AF in FU. QRS duration might be considered a potential risk marker for prediction of AF after ischemic stroke.
Collapse
Affiliation(s)
- Maria A Baturova
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden; St. Petersburg University Clinic, St. Petersburg, Russia; Cardiology Research, Clinical and Educational Center, St. Petersburg State University, St. Petersburg, Russia.
| | - Arne Lindgren
- Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences Lund, Neurology, Lund University, Sweden
| | - Jonas Carlson
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Yuri V Shubik
- St. Petersburg University Clinic, St. Petersburg, Russia; Cardiology Research, Clinical and Educational Center, St. Petersburg State University, St. Petersburg, Russia
| | - S Bertil Olsson
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Pyotr G Platonov
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden; Arrythmia Clinic, Skåne University Hospital, Lund, Sweden
| |
Collapse
|
21
|
Hoshino T, Nagao T, Shiga T, Maruyama K, Toi S, Mizuno S, Ishizuka K, Shimizu S, Uchiyama S, Kitagawa K. Prolonged QTc Interval Predicts Poststroke Paroxysmal Atrial Fibrillation. Stroke 2015; 46:71-6. [DOI: 10.1161/strokeaha.114.006612] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background and Purpose—
Paroxysmal atrial fibrillation (PAF) is often difficult to detect in patients with acute ischemic stroke. We aimed to assess the predictive value of a prolonged QT interval corrected for heart rate (QTc) in PAF detection after acute ischemic stroke.
Methods—
We enrolled 972 patients with acute ischemic stroke consecutively extracted from our observational stroke registry system. Exclusion criteria were as follows: (1) AF on the initial 12-lead ECG (n=171); (2) previously diagnosed PAF (n=47); and (3) the use of a cardiac pacemaker (n=10). Of the 972 patients, 744 (mean age, 67.6 years; men, 62.6%) were eligible for analysis. The clinical characteristics and 12-lead ECG findings of the patients with and without PAF were compared, and multiple logistic regression analysis was performed to identify predictors of poststroke PAF.
Results—
The poststroke cardiac work-up yielded 69 (9.3%) de novo PAF cases among the 744 patients. The QTc interval was significantly longer in patients with PAF than in those without PAF (436 versus 417 ms;
P
<0.001). Each 10-ms increase in the QTc interval was associated with an increased risk of PAF after multivariate adjustments (odds ratio, 1.41; 95% confidence interval, 1.24–1.61;
P
<0.001). The optimal threshold value of QTc interval calculated by a receiver-operating characteristic curve was 438 ms, and the area under the curve was 0.73 in this data set.
Conclusions—
The QTc interval prolongation is potentially a strong and useful predictor for poststroke PAF.
Collapse
Affiliation(s)
- Takao Hoshino
- From the Department of Neurology (T.H., T.N., K.M., S.T., S.M., K.I., S.U., K.K.), Department of Cardiology (T.S.), and Medical Research Institute (S.S.), Tokyo Women’s Medical University, Tokyo, Japan; Clinical Research Center for Medicine, International University of Health and Welfare, Tokyo, Japan (S.U.); and Center for Brain and Cerebral Vessels, Sanno Hospital Sanno Medical Center, Tokyo, Japan (S.U.)
| | - Takehiko Nagao
- From the Department of Neurology (T.H., T.N., K.M., S.T., S.M., K.I., S.U., K.K.), Department of Cardiology (T.S.), and Medical Research Institute (S.S.), Tokyo Women’s Medical University, Tokyo, Japan; Clinical Research Center for Medicine, International University of Health and Welfare, Tokyo, Japan (S.U.); and Center for Brain and Cerebral Vessels, Sanno Hospital Sanno Medical Center, Tokyo, Japan (S.U.)
| | - Tsuyoshi Shiga
- From the Department of Neurology (T.H., T.N., K.M., S.T., S.M., K.I., S.U., K.K.), Department of Cardiology (T.S.), and Medical Research Institute (S.S.), Tokyo Women’s Medical University, Tokyo, Japan; Clinical Research Center for Medicine, International University of Health and Welfare, Tokyo, Japan (S.U.); and Center for Brain and Cerebral Vessels, Sanno Hospital Sanno Medical Center, Tokyo, Japan (S.U.)
| | - Kenji Maruyama
- From the Department of Neurology (T.H., T.N., K.M., S.T., S.M., K.I., S.U., K.K.), Department of Cardiology (T.S.), and Medical Research Institute (S.S.), Tokyo Women’s Medical University, Tokyo, Japan; Clinical Research Center for Medicine, International University of Health and Welfare, Tokyo, Japan (S.U.); and Center for Brain and Cerebral Vessels, Sanno Hospital Sanno Medical Center, Tokyo, Japan (S.U.)
| | - Sono Toi
- From the Department of Neurology (T.H., T.N., K.M., S.T., S.M., K.I., S.U., K.K.), Department of Cardiology (T.S.), and Medical Research Institute (S.S.), Tokyo Women’s Medical University, Tokyo, Japan; Clinical Research Center for Medicine, International University of Health and Welfare, Tokyo, Japan (S.U.); and Center for Brain and Cerebral Vessels, Sanno Hospital Sanno Medical Center, Tokyo, Japan (S.U.)
| | - Satoko Mizuno
- From the Department of Neurology (T.H., T.N., K.M., S.T., S.M., K.I., S.U., K.K.), Department of Cardiology (T.S.), and Medical Research Institute (S.S.), Tokyo Women’s Medical University, Tokyo, Japan; Clinical Research Center for Medicine, International University of Health and Welfare, Tokyo, Japan (S.U.); and Center for Brain and Cerebral Vessels, Sanno Hospital Sanno Medical Center, Tokyo, Japan (S.U.)
| | - Kentaro Ishizuka
- From the Department of Neurology (T.H., T.N., K.M., S.T., S.M., K.I., S.U., K.K.), Department of Cardiology (T.S.), and Medical Research Institute (S.S.), Tokyo Women’s Medical University, Tokyo, Japan; Clinical Research Center for Medicine, International University of Health and Welfare, Tokyo, Japan (S.U.); and Center for Brain and Cerebral Vessels, Sanno Hospital Sanno Medical Center, Tokyo, Japan (S.U.)
| | - Satoru Shimizu
- From the Department of Neurology (T.H., T.N., K.M., S.T., S.M., K.I., S.U., K.K.), Department of Cardiology (T.S.), and Medical Research Institute (S.S.), Tokyo Women’s Medical University, Tokyo, Japan; Clinical Research Center for Medicine, International University of Health and Welfare, Tokyo, Japan (S.U.); and Center for Brain and Cerebral Vessels, Sanno Hospital Sanno Medical Center, Tokyo, Japan (S.U.)
| | - Shinichiro Uchiyama
- From the Department of Neurology (T.H., T.N., K.M., S.T., S.M., K.I., S.U., K.K.), Department of Cardiology (T.S.), and Medical Research Institute (S.S.), Tokyo Women’s Medical University, Tokyo, Japan; Clinical Research Center for Medicine, International University of Health and Welfare, Tokyo, Japan (S.U.); and Center for Brain and Cerebral Vessels, Sanno Hospital Sanno Medical Center, Tokyo, Japan (S.U.)
| | - Kazuo Kitagawa
- From the Department of Neurology (T.H., T.N., K.M., S.T., S.M., K.I., S.U., K.K.), Department of Cardiology (T.S.), and Medical Research Institute (S.S.), Tokyo Women’s Medical University, Tokyo, Japan; Clinical Research Center for Medicine, International University of Health and Welfare, Tokyo, Japan (S.U.); and Center for Brain and Cerebral Vessels, Sanno Hospital Sanno Medical Center, Tokyo, Japan (S.U.)
| |
Collapse
|
22
|
Bidstrup S, Salling Olesen M, Hastrup Svendsen J, Bille Nielsen J. Role of PR-Interval In Predicting the Occurrence of Atrial Fibrillation. J Atr Fibrillation 2013; 6:956. [PMID: 28496913 DOI: 10.4022/jafib.956] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 11/09/2013] [Accepted: 11/12/2013] [Indexed: 01/24/2023]
Abstract
The identification of individuals at high risk of developing atrial fibrillation (AF) is important to prevent potentially lethal and invalidating complications of this arrhythmia. Recently, several studies have investigated the association between PR-interval and the risk of AF and have tested the value of PR-interval in personalized risk scores for AF. However, the results of these studies are generally conflicting. When looking for an association between a prolonged PR-interval (first-degree atrioventricular [AV] block vs. normal PR-interval) and an increased risk of AF, not all studies were able to find a consistent and statistically significant association. In two recent studies, however, the investigators were able to show an increased risk of AF for individuals with PR-intervals in the short range compared with individuals in the middle range. The existence of a true U-shaped relationship could potentially explain part of the conflicting results from investigators only looking for an increased risk for longer PR-intervals. However, regardless of these speculations, the association seems relatively weak. The significance of PR-interval in risk prediction of AF has been tested in three independent risk scores where model selection primarily was based on improvement in c-statistics. In one risk score, PR-interval improved the predictive value of the risk model, whereas it did not in the other two risk scores. Further studies are warranted before any final conclusion can be drawn, although based on the current evidence, it is reasonable to conclude that the predictive value of PR-interval in AF risk prediction is limited.
Collapse
Affiliation(s)
- Signe Bidstrup
- Laboratory for Molecular Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), Copenhagen, Denmark
| | - Morten Salling Olesen
- Laboratory for Molecular Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), Copenhagen, Denmark
| | - Jesper Hastrup Svendsen
- Laboratory for Molecular Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jonas Bille Nielsen
- Laboratory for Molecular Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), Copenhagen, Denmark
| |
Collapse
|
23
|
Nielsen JB, Pietersen A, Graff C, Lind B, Struijk JJ, Olesen MS, Haunsø S, Gerds TA, Ellinor PT, Køber L, Svendsen JH, Holst AG. Risk of atrial fibrillation as a function of the electrocardiographic PR interval: results from the Copenhagen ECG Study. Heart Rhythm 2013; 10:1249-56. [PMID: 23608590 DOI: 10.1016/j.hrthm.2013.04.012] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prolongation of the PR interval has been associated with an increased risk of incident atrial fibrillation (AF). OBJECTIVE To determine if there was a nonlinear relation between PR interval duration and the risk of AF. METHODS We included 288,181 individuals, corresponding to one third of the population in the greater region of Copenhagen. These individuals had a digital electrocardiogram (ECG) recorded in a general practitioner's core facility from 2001 to 2010. Data on drug use, comorbidity, and outcomes were collected from Danish registries. RESULTS During a median follow-up period of 5.7 years, 11,087 developed AF. Having a PR interval ≥95th percentile (≥196 ms for women, ≥204 ms for men) was associated with an increased risk of AF as evidenced by a multivariable-adjusted hazard ratio (HR) of 1.18 (95% confidence interval [CI] 1.06-1.30, P = .001) for women and 1.30 (1.17-1.44, P < .001) for men compared with the respective reference groups (PR interval between 40th and 60th percentile). Having a short PR interval <5th percentile (≤121 ms for women, ≤129 ms for men) was also associated with an increased risk of AF for women (HR 1.32, 95% CI 1.12-1.56, P = .001), but this was not significant for men (HR 1.09, 95% CI 0.92-1.29, P = .33). CONCLUSION In this large ECG study, we found an increased risk of AF for longer PR intervals for both women and men. With respect to short PR intervals, we also observed an increased risk of AF for women.
Collapse
Affiliation(s)
- Jonas Bille Nielsen
- Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), Copenhagen, Denmark.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Olesen MS, Bentzen BH, Nielsen JB, Steffensen AB, David JP, Jabbari J, Jensen HK, Haunsø S, Svendsen JH, Schmitt N. Mutations in the potassium channel subunit KCNE1 are associated with early-onset familial atrial fibrillation. BMC MEDICAL GENETICS 2012; 13:24. [PMID: 22471742 PMCID: PMC3359244 DOI: 10.1186/1471-2350-13-24] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 04/03/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common arrhythmia. The potassium current IKs is essential for cardiac repolarization. Gain-of-function mutations in KV7.1, the pore-forming α-subunit of the IKs channel, have been associated with AF. We hypothesized that early-onset lone AF is associated with mutations in the IKs channel regulatory subunit KCNE1. METHODS In 209 unrelated early-onset lone AF patients (< 40 years) the entire coding sequence of KCNE1 was bidirectionally sequenced. We analyzed the identified KCNE1 mutants electrophysiologically in heterologous expression systems. RESULTS Two non-synonymous mutations G25V and G60D were found in KCNE1 that were not present in the control group (n = 432 alleles) and that have not previously been reported in any publicly available databases or in the exom variant server holding exom data from more than 10.000 alleles. Proband 1 (female, age 45, G25V) had onset of paroxysmal AF at the age of 39 years. Proband 2 (G60D) was diagnosed with lone AF at the age of 33 years. The patient has inherited the mutation from his mother, who also has AF. Both probands had no mutations in genes previously associated with AF. In heterologous expression systems, both mutants showed significant gain-of-function for IKs both with respect to steady-state current levels, kinetic parameters, and heart rate-dependent modulation. CONCLUSIONS Mutations in KV7.1 leading to gain-of-function of IKs current have previously been described in lone AF, yet this is the first time a mutation in the beta-subunit KCNE1 is associated with the disease. This finding further supports the hypothesis that increased potassium current enhances AF susceptibility.
Collapse
Affiliation(s)
- Morten S Olesen
- The Danish National Research Foundation Centre for Cardiac Arrhythmia, Copenhagen, Denmark
| | | | | | | | | | | | | | | | | | | |
Collapse
|