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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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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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P Wave Duration/P Wave Voltage Ratio Plays a Promising Role in the Prediction of Atrial Fibrillation: A New Player in the Game. Cardiol Res Pract 2021; 2021:8876704. [PMID: 34194825 PMCID: PMC8181101 DOI: 10.1155/2021/8876704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/20/2020] [Accepted: 05/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice. Identification of patients at risk for developing AF and the opportunity for early targeted intervention might have a significant impact on morbidity and mortality. Prolonged P wave duration and decreased P wave voltage have been shown to be independent predictors of AF. The present study aimed to investigate the role of P wave duration/P wave voltage in predicting new-onset AF. Methods We screened a total of 640 consecutive patients who admitted to cardiology outpatient clinic with a complaint of palpitation between 2012 and 2014. 24-h Holter monitoring, echocardiography, and electrocardiography (ECG) recordings were reviewed to identify new-onset AF. Patients were assigned into two groups based on presence (n = 150) and absence (n = 490) of new-onset AF. Previous ECGs with sinus rhythm were analyzed. P wave duration was measured in inferior leads, and P wave voltage was measured in lead one. P wave duration/P wave voltage was also calculated for each patient. Results One hundred fifty subjects (23.4%) had new-onset AF among 640 patients. P wave duration (123.27 ± 12.87 vs. 119.33 ± 17.39 ms, p=0.024) and P wave duration/P wave voltage (1284.70 ± 508.03 vs. 924.14 ± 462.06 ms/mV, p < 0.001) were higher, and P wave voltage (0.12 ± 0.04 vs. 0.13 ± 0.04 mV, p < 0.001) was significantly lower in the new-onset AF group compared with non-AFs. P wave duration/P wave voltage, with a cut off of 854.5 ms/mV, had 83.3% sensitivity and 62.0% specificity in a receiver operating characteristic curve (AUC 0.728, 95% CI 0.687-0.769; p < 0.001). Their negative and positive predictive values were 78.7% and 68.6%, respectively. In a univariate regression analysis, age, smoking, C-reactive protein, brain natriuretic peptide, left atrial diameter, left atrial volume index, P wave duration, P wave voltage, and P wave duration/P wave voltage were significantly associated with the development of new-onset AF. Moreover, smoking (OR 4.008, 95% CI 1.707-9.409; p=0.001), left atrial volume index (OR 7.108, 95% CI 4.400-11.483; p < 0.001), and P wave duration/P wave voltage (OR 1.002, 95% CI 1.000-1.003; p=0.044) were found to be significant independent predictors of new-onset AF in a multivariate analysis, after adjusting for other risk parameters. Conclusion The P wave duration/P wave voltage ratio is a practical, easy-to-use, cheap, and reliable electrocardiographic parameter, which can play a promising role for both in predicting and elucidating a mechanism of new-onset AF.
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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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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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Bayés' Syndrome-A Comprehensive Short Review. ACTA ACUST UNITED AC 2020; 56:medicina56080410. [PMID: 32823777 PMCID: PMC7466178 DOI: 10.3390/medicina56080410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 01/05/2023]
Abstract
Prediction and early detection of atrial fibrillation (AF) remain a permanent challenge in everyday practice. Timely identification of an increased risk for AF episodes (which are frequently asymptomatic) is essential in the primary and secondary prevention of cardioembolic events. One of the noninvasive modalities of AF prediction is represented by the electrocardiographic P-wave analysis. This includes the study and diagnosis of interatrial conduction block (Bachmann’s bundle block). Bayés’ Syndrome (named after its first descriptor) denotes the association between interatrial conduction defect and supraventricular arrhythmias (mainly AF) predisposing to cardioembolic events. Our short review presents an update of the most important data concerning this syndrome: brief history, main ECG features, pathophysiological background and clinical implications.
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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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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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Wang Z, Qin H, Chen G, Mok VCT, Dai Y, Cai Y, Cheng X, Qian Y, Chu M, Lu X. Association between advanced interatrial block and small vessel diseases in the brain. Quant Imaging Med Surg 2020; 10:585-591. [PMID: 32269919 DOI: 10.21037/qims.2020.02.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background The latest evidence shows the association of atrial cardiopathy with embolic strokes of undetermined source. Advanced interatrial block (aIAB) is an electrophysiological mark of atrial cardiopathy. This study investigated the relationship between aIAB and the burden of silent cerebral small vessel diseases (SVD) on magnetic resonance imaging in the absence of atrial fibrillation (AF) and atrial flutter. Methods This cross-sectional study included 499 patients with normal left ventricular ejection fraction (LVEF), who were free of AF, atrial flutter, stroke, and acute coronary syndrome in our hospital. aIAB was ascertained by digital electrocardiograms. Left atrial diameter, LVEF, and left ventricular posterior wall thickness (LVPWT) were measured on echocardiograms. Based on the presence of 4 manifestations of SVD, including white matter hyperintensity (WMH), lacunes, microbleeds, and enlarged perivascular spaces (EPVS) on magnetic resonance imaging, an ordinal SVD score (range, 0-4) was devised to reflect the total burden of cerebral SVD. The ordinal regression model was used to explore the association of aIAB with SVD burden after adjusting for confounding factors. Results The mean age was 67.7 years, and 327 (65.5%) were male. A total of 23 (4.6%) patients had aIAB. The number of patients with cerebral SVD scores of 0, 1, 2, 3, and 4 was 92 (18.4%), 122 (24.4%), 190 (38.1%), 83 (16.6%), and 12 (2.4%), respectively. After adjusting for age, sex, hypertension, diabetes, hyperlipidemia, left atrial diameter, LVEF, and LVPWT, the regression model showed a significant association of aIAB with cerebral SVD score (OR =2.408, 95% CI, 1.082-5.366). Conclusions Atrial cardiopathy indexed by aIAB was independently associated with a high burden of SVD in the brain.
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Affiliation(s)
- Zhaolu Wang
- Department of Neurology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Huiyuan Qin
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Guilin Chen
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Vincent C T Mok
- Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, the Chinese University of Hong Kong, Hong Kong, China
| | - Yan Dai
- The First School of Clinical Medicine, Department of Geriatrics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yingyuan Cai
- Division of Neurology, Department of Geriatrics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xi Cheng
- Division of Neurology, Department of Geriatrics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yun Qian
- Division of Neurology, Department of Geriatrics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Ming Chu
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.,Department of Cardiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou 221006, China
| | - Xiaowei Lu
- Division of Neurology, Department of Geriatrics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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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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Guida G, Sorbo AR, Fenici R, Brisinda D. Predictive value of unshielded magnetocardiographic mapping to differentiate atrial fibrillation patients from healthy subjects. Ann Noninvasive Electrocardiol 2018; 23:e12569. [PMID: 29947446 DOI: 10.1111/anec.12569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/07/2018] [Accepted: 05/23/2018] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND P-wave duration, its dispersion and signal-averaged ECG, are currently used markers of vulnerability to atrial fibrillation (AF). However, since tangential atrial currents are better detectable at the body surface as magnetic than electric signals, we investigated the accuracy of magnetocardiographic mapping (MCG), recorded in unshielded clinical environments, as predictor of AF occurrence. METHODS MCG recordings, in sinus rhythm (SR), of 71 AF patients and 75 controls were retrospectively analyzed. Beside electric and magnetic P-wave and PR interval duration, two MCG P-wave subintervals, defined P-dep and P-rep, were measured, basing on the point of inversion of atrial magnetic field (MF). Eight parameters were calculated from inverse solution with "Effective Magnetic Dipole (EMD) model" and 5 from "MF Extrema" analysis. Discriminant analysis (DA) was used to assess MCG predictive accuracy to differentiate AF patients from controls. RESULTS All but one (P-rep) intervals were significantly longer in AF patients. At univariate analysis, three EMD parameters differed significantly: in AF patients, the dipole-angle-elevation angular speed was lower during P-dep (p < 0.05) and higher during P-rep (p < 0.001) intervals. The space-trajectory during P-rep and the angle-dynamics during P-dep were higher (p < 0.05), whereas ratio-dynamics P-dep was lower (p < 0.01), in AF. At DA, with a combination of MCG and clinical parameters, 81.5% accuracy in differentiating AF patients from controls was achieved. At Cox-regression, the angle-dynamics P-dep was an independent predictor of AF recurrences (p = 0.037). CONCLUSIONS Quantitative analysis of atrial MF dynamics in SR and the solution of the inverse problem provide new sensitive markers of vulnerability to AF.
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Affiliation(s)
- Gianluigi Guida
- Biomagnetism and Clinical Physiology International Center, Catholic University of Sacred Heart, Rome, Italy
| | - Anna Rita Sorbo
- Biomagnetism and Clinical Physiology International Center, Catholic University of Sacred Heart, Rome, Italy
| | - Riccardo Fenici
- Biomagnetism and Clinical Physiology International Center, Catholic University of Sacred Heart, Rome, Italy
| | - Donatella Brisinda
- Biomagnetism and Clinical Physiology International Center, Catholic University of Sacred Heart, Rome, Italy
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Alexander B, Haseeb S, van Rooy H, Tse G, Hopman W, Martinez-Selles M, de Luna AB, Çinier G, Baranchuk A. Reduced P-wave Voltage in Lead I is Associated with Development of Atrial Fibrillation in Patients with Coronary Artery Disease. J Atr Fibrillation 2017; 10:1657. [PMID: 29487682 DOI: 10.4022/jafib.1657] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/19/2017] [Accepted: 10/14/2017] [Indexed: 01/05/2023]
Abstract
Background Reduced P-wave voltage in lead 1 (PVL1) has been associated with atrial fibrillation (AF) recurrence.This study sought to determine the association between reduced PVL1 and AF in the NSTEMI population and the correlation between reduced PVL1 and interatrial block (IAB)/coronary artery disease (CAD). Methods Data were recorded for clinical, echocardiographic, angiographic, electrocardiographic and outcome variables. Patients were followed for a minimum of one year. Chi-square tests, independent samples t-tests and one-way ANOVA were used for the analysis, which was done using IBM SPSSResults:: A total of 322 consecutive patients were included in the analysis. Patients with new-onset AF had a significantly lower PVL1 (0.085 ± 0.030mV vs. 0.103 ± 0.037mV; p=0.007). There was a significant difference in mean PVL1 between those with no IAB, partial IAB and advanced IAB (p = <0.001). Those with any type of IAB had a significantly lower mean PVL1 than those without (0.094 ± 0.032 mV vs. 0.106 ± 0.038 mV; p=0.005). Patients who developed AF had a significantly longer P-wave duration (126 ± 20ms vs. 119 ± 17ms; p=0.022). Patients with IAB were more likely to develop new-onset AF (15.4% versus 7.5%, p=0.025). There were significant co-linear associations between reduced PVL1 and IAB (p=0.005); reduced PVL1 and diffuse CAD (p=0.031) and IAB and diffuse CAD (p=0.022).
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Affiliation(s)
- Bryce Alexander
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Sohaib Haseeb
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Henri van Rooy
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Gary Tse
- Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Wilma Hopman
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Manuel Martinez-Selles
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Antoni Bayés de Luna
- Institut Català Ciències Cardiovasculars (ICCC). Hospital de la Santa Creu i de Sant Pau. Barcelona. Spain
| | - Göksel Çinier
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Department of Cardiology, Kadikoy, Istanbul, Turkey
| | - Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
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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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Bayés de Luna A, Martínez-Sellés M, Bayés-Genís A, Elosua R, Baranchuk A. Surface ECG interatrial block-guided treatment for stroke prevention: rationale for an attractive hypothesis. BMC Cardiovasc Disord 2017; 17:211. [PMID: 28760133 PMCID: PMC5537952 DOI: 10.1186/s12872-017-0650-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 07/27/2017] [Indexed: 01/11/2023] Open
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with stroke, cognitive impairment, and cardiovascular death. Some predisposing factors − as aging, diabetes, hypertension − induce and maintain electrophysiological and ultrastructural remodeling that usually includes fibrosis. Interatrial conduction disturbances play a crucial role in the initiation of atrial fibrosis and in its associated complications. The diagnosis of interatrial blocks (IABs) is easy to perform using the surface ECG. IAB is classified as partial when the P wave duration is ≥120 ms, and advanced if the P wave also presents a biphasic pattern in II, III and aVF. IAB is very frequent in the elderly and, particularly in the case of the advanced type, is associated with AF, AF recurrences, stroke, and dementia. The anticoagulation in elderly patients at high risk of AF without documented arrhythmias is an open issue but recent data suggest that it might have a role, particularly in elderly patients with structural heart disease, high CHA2DS2VASc (Congestive heart failure/left ventricular dysfunction, Hypertension, Age ≥ 75 [doubled], Diabetes, Stroke [doubled] – Vascular disease, Age 65–74, and Sex category [female]), and advanced IAB. In this debate, we discuss the association of surface ECG IAB, a marker of atrial fibrosis, with AF and stroke. We also present the rationale that justifies further studies regarding anticoagulation in some of these patients.
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Affiliation(s)
- Antoni Bayés de Luna
- Fundació Investigació Cardiovascular, ICCC, Hospital de Sant Pau, Barcelona, Spain
| | - Manuel Martínez-Sellés
- Hospital General Universitario Gregorio Marañón. CIBERCV, Universidad Complutense, Universidad Europea, Madrid, Spain. .,Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Calle Dr. Esquerdo 46, 28007, Madrid, Spain.
| | | | - Roberto Elosua
- Hospital del Mar Medical Research Institute, Barcelona, Spain
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15
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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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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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