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Antoun I, Li X, Kotb A, Barker J, Mavilakandy A, Koev I, Vali Z, Somani R, Ng GA. Body surface mapping of P-waves in sinus rhythm to predict recurrence following cardioversion for atrial fibrillation. Front Cardiovasc Med 2024; 11:1417029. [PMID: 39119182 PMCID: PMC11306046 DOI: 10.3389/fcvm.2024.1417029] [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] [Received: 04/13/2024] [Accepted: 07/15/2024] [Indexed: 08/10/2024] Open
Abstract
Background Direct current cardioversion (DCCV) is used as elective and emergency rhythm control for atrial fibrillation (AF). We aimed to explore the role of P-wave parameters measured during sinus rhythm using body surface mapping (BSM) in predicting successful DCCV for persistent atrial fibrillation (persAF) at 12 months. Methods This case-control study included 56 males >18 years old who underwent DCCV for persAF. P-wave parameter collection after DCCV for AF was done using 128 unipolar leads. A band-pass filter of 1-50 Hz was utilised. Corrected P-wave duration (PWDc), P-wave amplitude, and P-wave dispersion were measured to predict 12-month outcomes and time of recurrence. Results The mean age was 64 ± 4 years, and 23 patients (44%) were on amiodarone. The 12-month success rate was 44% (n = 23), while the rest reverted to AF after 2.6 ± 0.4 months. The parameters were comparable between successful and failed DCCV in the entire cohort and patients not on amiodarone. In patients on amiodarone, patients with failed arms had higher PWDc than those with successful arms (188 vs. 150 ms, P = 0.04). Receiver operator characteristic curve analysis for PWDc in the amiodarone cohort showed an area under the curve (AUC) of 0.75 and P = 0.049. A recurrence cut-off >161 ms had a sensitivity of 69% and a specificity of 100%, with a hazard ratio of 10.7, P = 0.004. The parameters were not predictive of the time of recurrence. Conclusion In patients on amiodarone, increased PWDc measured using BSM was associated with higher AF recurrence at 12 months following DCCV for persAF.
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Affiliation(s)
- Ibrahim Antoun
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, United Kingdom
| | - Xin Li
- Department of Engineering, University of Leicester, Glenfield Hospital, Leicester, United Kingdom
| | - Ahmed Kotb
- Department of Cardiovascular Sciences, Clinical Science Wing, University of Leicester, Glenfield Hospital, Leicester, United Kingdom
| | - Joseph Barker
- Department of Cardiovascular Sciences, Clinical Science Wing, University of Leicester, Glenfield Hospital, Leicester, United Kingdom
| | - Akash Mavilakandy
- Department of Cardiovascular Sciences, Clinical Science Wing, University of Leicester, Glenfield Hospital, Leicester, United Kingdom
| | - Ivelin Koev
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, United Kingdom
| | - Zakariyya Vali
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, United Kingdom
| | - Riyaz Somani
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, United Kingdom
- Department of Cardiovascular Sciences, Clinical Science Wing, University of Leicester, Glenfield Hospital, Leicester, United Kingdom
| | - G. André Ng
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, United Kingdom
- Department of Cardiovascular Sciences, Clinical Science Wing, University of Leicester, Glenfield Hospital, Leicester, United Kingdom
- Department of Research, National Institute for Health Research Leicester Research Biomedical Centre, Leicester, United Kingdom
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Li JH, Xie HY, Chen YQ, Cao ZJ, Tang QH, Guo XG, Sun Q, Ma J. Risk of New-Onset Atrial Fibrillation Post-cavotricuspid Isthmus Ablation in Typical Atrial Flutter Without History of Atrial Fibrillation. Front Physiol 2021; 12:763478. [PMID: 34916957 PMCID: PMC8669788 DOI: 10.3389/fphys.2021.763478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/27/2021] [Indexed: 01/08/2023] Open
Abstract
Aims: The aim was to describe the incidence of atrial fibrillation (AF) after cavotricuspid isthmus (CTI) ablation in patients with typical atrial flutter (AFL) without history of AF and to identify risk factors for new-onset AF after the procedure. Methods: A total of 191 patients with typical AFL undergoing successful CTI ablation were enrolled. Patients who had history of AF, structural heart disease, cardiac surgery, or ablation or who received antiarrhythmic drug after procedure were excluded. Clinical and electrophysiological data were collected. Results: There were 47 patients (24.6%) developing new AF during a follow-up of 3.3 ± 1.9 years after CTI ablation. Receiver operating characteristic (ROC) curves indicated that the cut-off values of left atrial diameter (LAD) and CHA2DS2-VASc score were 42 mm and 2, with area under the curve of 0.781 and 0.550, respectively. The multivariable Cox regression analysis revealed that obstructive sleep apnea (OSA) [hazard ratio (HR) 3.734, 95% confidence interval (CI) 1.470–9.484, P = 0.006], advanced interatrial block (aIAB) (HR 2.034, 95% CI 1.017–4.067, P = 0.045), LAD > 42 mm (HR 2.710, 95% CI 1.478–4.969, P = 0.001), and CHA2DS2-VASc score > 2 (HR 2.123, 95% CI 1.118–4.034, P = 0.021) were independent risk factors of new-onset AF. Conclusion: A combination of OSA, aIAB, LAD > 42 mm, and CHA2DS2-VASc > 2 was a strongly high risk for new-onset AF after ablation for typical AFL, and it had significance in postablation management in clinical practice.
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Affiliation(s)
- Jia-Hui Li
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hai-Yang Xie
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan-Qiao Chen
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhong-Jing Cao
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qing-Hui Tang
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-Gang Guo
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Sun
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian Ma
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Kornej J, Magnani JW, Preis SR, Soliman EZ, Trinquart L, Ko D, Benjamin EJ, Lin H. P-wave signal-averaged electrocardiography: Reference values, clinical correlates, and heritability in the Framingham Heart Study. Heart Rhythm 2021; 18:1500-1507. [PMID: 33989782 PMCID: PMC8419007 DOI: 10.1016/j.hrthm.2021.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/21/2021] [Accepted: 05/06/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND P-wave signal-averaged electrocardiography (P-SAECG) quantifies atrial electrical activity. P-SAECG measures and their clinical correlates and heritability have had limited characterization in community-based cohorts. OBJECTIVE The purpose of this study was to (1) establish reference values; (2) identify clinical risk factors associated with P-SAECG; and (3) estimate genetic heritability for P-SAECG traits. METHODS We performed P-SAECG in 2 generations of Framingham Heart Study participants. We performed backward elimination regression models to assess associations of clinical factors with each SAECG trait (P-wave [PW] duration, root mean square voltage in terminal 40 ms [RMS40], terminal 30 ms RMS30, terminal 20 ms RMS20, RMS PW, and PW integral). We estimated the adjusted genetic heritability of P-SAECG measures using the Sequential Oligogenic Linkage Analysis Routines (SOLAR) program. RESULTS We included 4307 participants (age 55 ± 14 years; 56% female). The reference values were derived from 1752 participants without cardiovascular risk factors. Median (2.5th percentile; 97.5th percentile) total PW duration was 118 ms (93; 146) in women and 128 ms (104; 158) in men in the reference sample, and 121 ms (94; 151) in women and 129 ms (103; 159) in the entire study cohort (broad sample). In the broad sample, after adjusting for age and sex, total PW duration was positively associated with height, weight, prevalent heart failure, history of atrial fibrillation (AF), and atrioventricular node blockers, and negatively associated with smoking, waist circumference, heart rate, and diabetes. The estimated heritability of P-SAECG traits was moderate, ranging from 11.9% for RMS30 to 24.9% for PW integral. CONCLUSION P-SAECG traits are associated with multiple AF-related risk factors and are moderately heritable.
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Affiliation(s)
- Jelena Kornej
- National Heart, Lung, and Blood Institute and Boston University's Framingham Heart Study, Framingham, Massachusetts; Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.
| | - Jared W Magnani
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sarah R Preis
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center, Department of Epidemiology, and Department of Medicine-Section on Cardiology, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Ludovic Trinquart
- National Heart, Lung, and Blood Institute and Boston University's Framingham Heart Study, Framingham, Massachusetts; Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Darae Ko
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Emelia J Benjamin
- National Heart, Lung, and Blood Institute and Boston University's Framingham Heart Study, Framingham, Massachusetts; Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Honghuang Lin
- National Heart, Lung, and Blood Institute and Boston University's Framingham Heart Study, Framingham, Massachusetts; Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
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Tse G, Lakhani I, Zhou J, Li KHC, Lee S, Liu Y, Leung KSK, Liu T, Baranchuk A, Zhang Q. P-Wave Area Predicts New Onset Atrial Fibrillation in Mitral Stenosis: A Machine Learning Approach. Front Bioeng Biotechnol 2020; 8:479. [PMID: 32500070 PMCID: PMC7243705 DOI: 10.3389/fbioe.2020.00479] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/24/2020] [Indexed: 01/21/2023] Open
Abstract
Introduction: Mitral stenosis is associated with an atrial cardiomyopathic process, leading to abnormal atrial electrophysiology, manifesting as prolonged P-wave duration (PWD), larger P-wave area, increased P-wave dispersion (PWDmax—PWDmin), and/or higher P-wave terminal force on lead V1 (PTFV1) on the electrocardiogram. Methods: This was a single-center retrospective study of Chinese patients, diagnosed with mitral stenosis in sinus rhythm at baseline, between November 2009 and October 2016. Automated ECG measurements from raw data were determined. The primary outcome was incident atrial fibrillation (AF). Results: A total 59 mitral stenosis patients were included (age 59 [54–65] years, 13 (22%) males). New onset AF was observed in 27 patients. Age (odds ratio [OR]: 1.08 [1.01–1.16], P = 0.017), systolic blood pressure (OR: 1.03 [1.00–1.07]; P = 0.046), mean P-wave area in V3 (odds ratio: 3.97 [1.32–11.96], P = 0.014) were significant predictors of incident AF. On multivariate analysis, age (OR: 1.08 [1.00–1.16], P = 0.037) and P-wave area in V3 (OR: 3.64 [1.10–12.00], P = 0.034) remained significant predictors of AF. Receiver-operating characteristic (ROC) analysis showed that the optimum cut-off for P-wave area in V3 was 1.45 Ashman units (area under the curve: 0.65) for classification of new onset AF. A decision tree learning model with individual and non-linear interaction variables with age achieved the best performance for outcome prediction (accuracy = 0.84, precision = 0.84, recall = 0.83, F-measure = 0.84). Conclusion: Atrial electrophysiological alterations in mitral stenosis can detected on the electrocardiogram. Age, systolic blood pressure, and P-wave area in V3 predicted new onset AF. A decision tree learning model significantly improved outcome prediction.
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Affiliation(s)
- Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China.,Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, China
| | - Ishan Lakhani
- Laboratory of Cardiovascular Physiology, Li Ka Shing Institute of Health Sciences, Shatin, China
| | - Jiandong Zhou
- School of Data Science, City University of Hong Kong, Kowloon, China
| | | | - Sharen Lee
- Laboratory of Cardiovascular Physiology, Li Ka Shing Institute of Health Sciences, Shatin, China
| | - Yingzhi Liu
- Laboratory of Cardiovascular Physiology, Li Ka Shing Institute of Health Sciences, Shatin, 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, China
| | - Adrian Baranchuk
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Qingpeng Zhang
- School of Data Science, City University of Hong Kong, Kowloon, China
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Kharbanda RK, Özdemir EH, Taverne YJ, Kik C, Bogers AJ, de Groot NM. Current Concepts of Anatomy, Electrophysiology, and Therapeutic Implications of the Interatrial Septum. JACC Clin Electrophysiol 2019; 5:647-656. [DOI: 10.1016/j.jacep.2019.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/26/2019] [Accepted: 04/30/2019] [Indexed: 12/28/2022]
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Mouws EMJP, Kik C, van der Does LJME, Lanters EAH, Teuwen CP, Knops P, Bogers AJJC, de Groot NMS. Novel Insights in the Activation Patterns at the Pulmonary Vein Area. Circ Arrhythm Electrophysiol 2018; 11:e006720. [PMID: 30520348 DOI: 10.1161/circep.118.006720] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Extensiveness of conduction delay and block at the pulmonary vein area (PVA) was quantified in a previous study. We hypothesized that the combination of lines of conduction block with multiple concomitantly entering sinus rhythm wavefronts at the PVA may result in increased arrhythmogenicity and susceptibility to atrial fibrillation (AF). METHODS Intraoperative high-density epicardial mapping of PVA (N≈450 sites, interelectrode distances: 2 mm) was performed during sinus rhythm in 327 patients (241 male [74%], 67±10 [21-84] years) with and without preoperative AF. For each patient, activation patterns at the PVA were quantified, including the location of entry sites of wavefronts, direction of propagation, and their relative activation times. The association between activation patterns and the presence of AF was examined. RESULTS Excitation of the PVA occurred via multiple consecutive wavefronts in the vast majority of patient (N=216, 81%). In total, 561 wavefronts were observed, which mostly propagated through the septal or paraseptal regions towards the PVA (N=461, 82%). A substantial dissociation of consecutive wavefronts was observed with Δactivation times of 10.6±8.8 (0-46) ms. No difference was observed in Δactivation times of consecutive wavefronts during sinus rhythm between patients without and with AF. An excitation-based risk factor model, including conduction delay ≥6 mm, conduction block ≥6 mm, and conduction delay and block ≥16 mm, wavefronts via the posteroinferior to posterosuperior regions and multiple opposing wavefronts, demonstrated a 5-fold risk of AF when multiple risk factors were present. CONCLUSIONS In contrast to previous findings, quantification of activation patterns at the PVA on high-resolution scale demonstrated complex patterns with often multiple entry sites and high interindividual variability. Altered patterns of activation, consisting of multiple opposing wavefronts combined with long lines of conduction slowing, were associated with the presence of AF.
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Affiliation(s)
- Elisabeth M J P Mouws
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (E.M.J.P.M., L.J.M.E.v.d.D., E.A.H.L., C.P.T., P.K., N.M.S.d.G.).,Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands (E.M.J.P.M., C.K., A.J.J.C.B.)
| | - Charles Kik
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands (E.M.J.P.M., C.K., A.J.J.C.B.)
| | - Lisette J M E van der Does
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (E.M.J.P.M., L.J.M.E.v.d.D., E.A.H.L., C.P.T., P.K., N.M.S.d.G.)
| | - Eva A H Lanters
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (E.M.J.P.M., L.J.M.E.v.d.D., E.A.H.L., C.P.T., P.K., N.M.S.d.G.)
| | - Christophe P Teuwen
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (E.M.J.P.M., L.J.M.E.v.d.D., E.A.H.L., C.P.T., P.K., N.M.S.d.G.)
| | - Paul Knops
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (E.M.J.P.M., L.J.M.E.v.d.D., E.A.H.L., C.P.T., P.K., N.M.S.d.G.)
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands (E.M.J.P.M., C.K., A.J.J.C.B.)
| | - Natasja M S de Groot
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (E.M.J.P.M., L.J.M.E.v.d.D., E.A.H.L., C.P.T., P.K., N.M.S.d.G.)
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Rubio Campal JM, Benezet-Mazuecos J, Iglesias Bravo JA, Sánchez Borque P, Miracle Blanco Á, de la Vieja Alarcón JJ, Martínez Mariscal J, Baranchuk AM, Farré Muncharaz J. P-wave and interatrial block: New predictor for atrial high rate episodes in patients with cardiac implantable electronic devices. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:223-228. [PMID: 29327362 DOI: 10.1111/pace.13268] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 12/03/2017] [Accepted: 12/13/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND The presence of interatrial block (IAB) is associated with the development of atrial fibrillation (AF). The aim of this study was to determine whether P-wave duration and presence of IAB before the implantation of a cardiac implantable electronic device (CIED) are associated with the presence of atrial high rate episodes (AHRE), during long-term follow-up. METHODS 380 patients (57% men; 75 ± 10 years) were included. IAB was defined according to the International Consensus Criteria. AHRE was defined as an episode of atrial rate ≥225 beats/min with a minimum duration of 5 minutes. RESULTS Documented paroxysmal AF before the implantation was present in 24% of the patients; 80% had hypertension and 32% structural heart disease. Mean P-wave duration was 123 ± 23 ms, and 39% of the patients had IAB (32% partial, 7% advanced). After a mean follow-up of 18 ± 12 months, 33% of the patients presented AHRE. Patients with AHRE had a P-wave duration significantly longer (130 ± 24 ms vs 119 ± 21 ms; P < 0.001) and a greater prevalence of IAB (53% vs 32%; P < 0.001). In a multivariate analysis, predictors of AHRE were: IAB (odds ratio [OR] 2.1; 95% confidence interval [CI] [1.3-3.4], P < 0.001) and previous paroxysmal AF (OR 2.6; 95% CI [1.5-4.3], P < 0.001). In patients without previous AF, the presence of IAB was also a significant predictor of AHRE (OR 3.1; 95% CI [1.8-5.5], P < 0.001). CONCLUSIONS IAB is a strong predictor of AHRE in patients with CIED. This finding is independent of the presence of prior paroxysmal AF.
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Affiliation(s)
- José M Rubio Campal
- Arrhythmia Unit, Cardiology Department, Fundación Jiménez Díaz - Quirón Salud, Madrid, Spain
| | - Juan Benezet-Mazuecos
- Arrhythmia Unit, Cardiology Department, Fundación Jiménez Díaz - Quirón Salud, Madrid, Spain
| | | | - Pepa Sánchez Borque
- Arrhythmia Unit, Cardiology Department, Fundación Jiménez Díaz - Quirón Salud, Madrid, Spain
| | - Ángel Miracle Blanco
- Arrhythmia Unit, Cardiology Department, Fundación Jiménez Díaz - Quirón Salud, Madrid, Spain
| | | | - Jaime Martínez Mariscal
- Arrhythmia Unit, Cardiology Department, Fundación Jiménez Díaz - Quirón Salud, Madrid, Spain
| | - Adrian M Baranchuk
- Department of Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
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Kaypakli O, Koca H, Şahin DY, Okar S, Karataş F, Koç M. Association of P wave duration index with atrial fibrillation recurrence after cryoballoon catheter ablation. J Electrocardiol 2017; 51:182-187. [PMID: 29146378 DOI: 10.1016/j.jelectrocard.2017.09.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Indexed: 01/01/2023]
Abstract
AIM We aimed to investigate the relationship between the recurrence of AF and P wave duration index (PWDI) in patients with nonvalvular PAF. METHODS We included 114 patients who underwent cryoballoon catheter ablation with the diagnosis of paroxysmal atrial fibrillation (PAF) (55 male, 59 female; mean age 55.5±10,9years). PWDI was calculated by dividing the Pwd by the PR interval in DII lead of 12‑lead ECG. Patients had regular follow-up visits with 12-lead ECG, medical history and clinical evaluation. 24h Holter ECG monitoring had been recorded at least 12months after ablation. RESULTS AF recurrence was detected in 24 patients after 1year. Patients were divided into two groups according to the AF recurrence. All parameters were compared between the two groups. Age, DM, HT frequency, ACEI-ARB use, CHA2DS2VASc and HAS-BLED score, HsCRP, LA diameter, LA volume, LA volume index, Pwd and PWDI were related to AF recurrence. In binary logistic regression analysis, PWDI (OR=1.143, p=0.001) and HT (OR=0.194, p=0.020) were found to be independent parameters for predicting AF recurrence. Every 0,01 unit increase in PWDI was found to be associated with 14.3% increase in the risk of AF recurrence. The cut-off value of PWDI obtained by ROC curve analysis was 59,9 for prediction of AF recurrence (sensitivity: 75.0%, specificity: 69.0%). The area under the curve (AUC) was 0.760 (p<0.001). CONCLUSION Increased PWDI may help to identify those patients in whom electrical remodeling has already occurred and who will get less benefit from cryoablation.
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Affiliation(s)
- Onur Kaypakli
- Department of Cardiology, Mustafa Kemal University, - Faculty of Medicine, Hatay, Turkey.
| | - Hasan Koca
- Department of Cardiology, University of Health Sciences, - Adana Health Practices and Research Center, Adana, Turkey
| | - Durmuş Yıldıray Şahin
- Department of Cardiology, University of Health Sciences, - Adana Health Practices and Research Center, Adana, Turkey
| | - Sefa Okar
- Department of Cardiology, University of Health Sciences, - Adana Health Practices and Research Center, Adana, Turkey
| | - Fadime Karataş
- Department of Cardiology, University of Health Sciences, - Adana Health Practices and Research Center, Adana, Turkey
| | - Mevlüt Koç
- Department of Cardiology, University of Health Sciences, - Adana Health Practices and Research Center, Adana, Turkey
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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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Kawasaki M, Yamada T, Okuyama Y, Morita T, Furukawa Y, Tamaki S, Iwasaki Y, Kikuchi A, Sakata Y, Fukunami M. Eplerenone might affect atrial fibrosis in patients with hypertension. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:1096-1102. [DOI: 10.1111/pace.13169] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 07/10/2017] [Accepted: 07/14/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Masato Kawasaki
- Division of Cardiology; Osaka General Medical Center; Osaka Japan
| | - Takahisa Yamada
- Division of Cardiology; Osaka General Medical Center; Osaka Japan
| | - Yuji Okuyama
- Cardiovascular Division; Osaka Minami Medical Center; Osaka Japan
| | - Takashi Morita
- Division of Cardiology; Osaka General Medical Center; Osaka Japan
| | - Yoshio Furukawa
- Division of Cardiology; Osaka General Medical Center; Osaka Japan
| | - Shunsuke Tamaki
- Division of Cardiology; Osaka General Medical Center; Osaka Japan
| | - Yusuke Iwasaki
- Division of Cardiology; Osaka General Medical Center; Osaka Japan
| | - Atsushi Kikuchi
- Division of Cardiology; Osaka General Medical Center; Osaka Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine; Osaka University Graduate School of Medicine; Osaka Japan
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11
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Mugnai G, Chierchia GB, de Asmundis C, Juliá J, Conte G, Sieira-Moret J, Capulzini L, Wauters K, Rodriguez-Mañero M, Ciconte G, Baltogiannis G, Di Giovanni G, Saitoh Y, Brugada P. P-wave indices as predictors of atrial fibrillation recurrence after pulmonary vein isolation in normal left atrial size. J Cardiovasc Med (Hagerstown) 2016; 17:194-200. [PMID: 25490249 DOI: 10.2459/jcm.0000000000000220] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Prolonged P-wave duration and dispersion are universally accepted noninvasive markers for atrial electrical remodeling. Our aim was to analyze P-wave indices as predictors of atrial fibrillation recurrence after pulmonary vein isolation in patients with normal left atrial size. METHODS From January 2008 to December 2011, 426 patients with drug-resistant symptomatic paroxysmal atrial fibrillation underwent pulmonary vein isolation as an index procedure by conventional radiofrequency or cryoballoon ablation in our center. Patients with left atrial dilatation, poor-quality electrocardiograms, atrial pacemaker stimulation, and those undergoing repeat procedures were excluded. A total of 201 patients were analyzed during a mean follow-up of 22 ± 16 months. RESULTS Patients with prolonged P-wave duration had higher rates of atrial fibrillation recurrences compared with those without prolonged P-wave duration (49 vs. 14%; P < 0.001). Atrial fibrillation recurrence was significantly associated with prolonged P-wave duration (129 ± 13 vs. 119 ± 11 ms; P < 0.001) and P-wave dispersion (54 ± 12 vs. 42 ± 10 ms; P < 0.001) compared with those who remained in sinus rhythm. P-wave duration and dispersion were independently associated with atrial fibrillation recurrence (hazard ratio 1.045, 95% confidence interval 1.027-1.063, P < 0.001; and hazard ratio 1.049, 95% confidence interval 1.022-1.078, P < 0.001, respectively), after adjusting for left atrial size and age. CONCLUSION Prolonged P-wave duration and dispersion were found to be independently associated with higher recurrence rates of atrial fibrillation after pulmonary vein isolation in patients with normal left atrial dimension. Therefore, a prolongation of P-wave indices may help to identify those patients in whom electrical remodeling has already occurred and a more extensive ablation may be indicated.
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Affiliation(s)
- Giacomo Mugnai
- aHeart Rhythm Management Centre, UZ Brussel-VUB, Brussels, BelgiumbDepartment of Cardiology, University Hospital of Verona, Verona, Italy
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12
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Tse G, Lai ETH, Yeo JM, Yan BP. Electrophysiological Mechanisms of Bayés Syndrome: Insights from Clinical and Mouse Studies. Front Physiol 2016; 7:188. [PMID: 27303306 PMCID: PMC4886053 DOI: 10.3389/fphys.2016.00188] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 05/10/2016] [Indexed: 12/11/2022] Open
Abstract
Bayés syndrome is an under-recognized clinical condition characterized by inter-atrial block (IAB). This is defined electrocardiographically as P-wave duration > 120 ms and can be categorized into first, second and third degree IAB. It can be caused by inflammatory conditions such as systemic sclerosis and rheumatoid arthritis, abnormal protein deposition in cardiac amyloidosis, or neoplastic processes invading the inter-atrial conduction system, such as primary cardiac lymphoma. It may arise transiently during volume overload, autonomic dysfunction or electrolyte disturbances from vomiting. In other patients without an obvious cause, the predisposing factors are diabetes mellitus, hypertensive heart disease, and hypercholesterolemia. IAB has a strong association with atrial arrhythmogenesis, left atrial enlargement (LAE), and electro-mechanical discordance, increasing the risk of cerebrovascular accidents as well as myocardial and mesenteric ischemia. The aim of this review article is to synthesize experimental evidence on the pathogenesis of IAB and its underlying molecular mechanisms. Current medical therapies include anti-fibrotic, anti-arrhythmic and anti-coagulation agents, whereas interventional options include atrial resynchronization therapy by single or multisite pacing. Future studies will be needed to elucidate the significance of the link between IAB and atrial tachyarrhythmias in patients with different underlying etiologies and optimize the management options in these populations.
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Affiliation(s)
- Gary Tse
- Li Ka Shing Faculty of Medicine, School of Biomedical Sciences, University of Hong KongHong Kong, China
| | - Eric Tsz Him Lai
- Li Ka Shing Faculty of Medicine, School of Biomedical Sciences, University of Hong KongHong Kong, China
| | - Jie Ming Yeo
- School of Medicine, Imperial College LondonLondon, UK
| | - Bryan P. Yan
- Department of Medicine and Therapeutics, The Chinese University of Hong KongHong Kong, China
- Department of Epidemiology and Preventive Medicine, Monash UniversityMelbourne, VIC, Australia
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13
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German DM, Kabir MM, Dewland TA, Henrikson CA, Tereshchenko LG. Atrial Fibrillation Predictors: Importance of the Electrocardiogram. Ann Noninvasive Electrocardiol 2016; 21:20-29. [PMID: 26523405 DOI: 10.1111/anec] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 08/10/2015] [Accepted: 08/18/2015] [Indexed: 05/25/2023] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in adults and is associated with significant morbidity and mortality. Substantial interest has developed in the primary prevention of AF, and thus the identification of individuals at risk for developing AF. The electrocardiogram (ECG) provides a wealth of information, which is of value in predicting incident AF. The PR interval and P wave indices (including P wave duration, P wave terminal force, P wave axis, and other measures of P wave morphology) are discussed with regard to their ability to predict and characterize AF risk in the general population. The predictive value of the QT interval, ECG criteria for left ventricular hypertrophy, and findings of atrial and ventricular ectopy are also discussed. Efforts are underway to develop models that predict AF incidence in the general population; however, at present, little information from the ECG is included in these models. The ECG provides a great deal of information on AF risk and has the potential to contribute substantially to AF risk estimation, but more research is needed.
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Affiliation(s)
- David M German
- Department of Medicine, Oregon Health and Science University, Portland, OR
| | - Muammar M Kabir
- Department of Medicine, The Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR
| | - Thomas A Dewland
- Department of Medicine, The Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR
| | - Charles A Henrikson
- Department of Medicine, The Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR
| | - Larisa G Tereshchenko
- Department of Medicine, The Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR
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14
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German DM, Kabir MM, Dewland TA, Henrikson CA, Tereshchenko LG. Atrial Fibrillation Predictors: Importance of the Electrocardiogram. Ann Noninvasive Electrocardiol 2015; 21:20-9. [PMID: 26523405 DOI: 10.1111/anec.12321] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 08/10/2015] [Accepted: 08/18/2015] [Indexed: 01/19/2023] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in adults and is associated with significant morbidity and mortality. Substantial interest has developed in the primary prevention of AF, and thus the identification of individuals at risk for developing AF. The electrocardiogram (ECG) provides a wealth of information, which is of value in predicting incident AF. The PR interval and P wave indices (including P wave duration, P wave terminal force, P wave axis, and other measures of P wave morphology) are discussed with regard to their ability to predict and characterize AF risk in the general population. The predictive value of the QT interval, ECG criteria for left ventricular hypertrophy, and findings of atrial and ventricular ectopy are also discussed. Efforts are underway to develop models that predict AF incidence in the general population; however, at present, little information from the ECG is included in these models. The ECG provides a great deal of information on AF risk and has the potential to contribute substantially to AF risk estimation, but more research is needed.
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Affiliation(s)
- David M German
- Department of Medicine, Oregon Health and Science University, Portland, OR
| | - Muammar M Kabir
- Department of Medicine, The Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR
| | - Thomas A Dewland
- Department of Medicine, The Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR
| | - Charles A Henrikson
- Department of Medicine, The Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR
| | - Larisa G Tereshchenko
- Department of Medicine, The Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR
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15
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Developing a New Computer-Aided Clinical Decision Support System for Prediction of Successful Postcardioversion Patients with Persistent Atrial Fibrillation. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2015; 2015:527815. [PMID: 26120354 PMCID: PMC4450306 DOI: 10.1155/2015/527815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 02/12/2015] [Accepted: 02/17/2015] [Indexed: 11/17/2022]
Abstract
We propose a new algorithm to predict the outcome of direct-current electric (DCE) cardioversion for atrial fibrillation (AF) patients. AF is the most common cardiac arrhythmia and DCE cardioversion is a noninvasive treatment to end AF and return the patient to sinus rhythm (SR). Unfortunately, there is a high risk of AF recurrence in persistent AF patients; hence clinically it is important to predict the DCE outcome in order to avoid the procedure's side effects. This study develops a feature extraction and classification framework to predict AF recurrence patients from the underlying structure of atrial activity (AA). A multiresolution signal decomposition technique, based on matching pursuit (MP), was used to project the AA over a dictionary of wavelets. Seven novel features were derived from the decompositions and were employed in a quadratic discrimination analysis classification to predict the success of post-DCE cardioversion in 40 patients with persistent AF. The proposed algorithm achieved 100% sensitivity and 95% specificity, indicating that the proposed computational approach captures detailed structural information about the underlying AA and could provide reliable information for effective management of AF.
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16
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Tanindi A, Akgun N, Pabuccu EG, Gursoy AY, Yüce E, Tore HF, Duvan CI. Electrocardiographic P-Wave Duration, QT Interval, T Peak to End Interval and Tp-e/QT Ratio in Pregnancy with Respect to Trimesters. Ann Noninvasive Electrocardiol 2015; 21:169-74. [PMID: 26084968 DOI: 10.1111/anec.12285] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND P-wave duration helps to determine the risk of atrial arrhythmia, especially atrial fibrillation. QT interval, T peak to end interval (Tp-e), and Tp-e/QT ratio are electrocardiographic indices related to ventricular repolarization which are used to determine the risk of ventricular arrhythmias. We search for any alterations in electrocardiographic indices of arrhythmia in the pregnancy period with respect to trimesters. METHODS We enrolled 154 pregnant and 62 nonpregnant, healthy women into this cross-sectional study. Maximum and minimum P-wave durations (Pmax, Pmin), and QT intervals (QTmax, QTmin) were measured from 12 leads. QT measurements were corrected using Fridericia (QTc-Fr) and Bazett's (QTc-Bz) correction. Tp-e interval was obtained from the difference between QT interval, and QT peak interval (QTp) measured from the beginning of the QRS until the peak of the T wave. Tp-e/QT ratio was calculated using these measurements. RESULTS Pmax were 93.0 ± 9.1, 93.9 ± 8.9, 97.9 ± 5.6, 99.0 ± 6.1 in nonpregnant women, first, second, third trimesters of pregnancy, respectively (P = 0.001); whereas Pmin values were not significantly different. QTc-Fr max were 407.4 ± 14.2, 408.5 ± 16.1, 410.1 ± 13.1, 415.1 ± 10.1 (P = 0.007); Tp-e were 72.7 ± 6.2, 73.2 ± 6.5, 77.2 ± 8.9, 87.2 ± 9.6 (P < 0.001); and Tp-e/QT were 0.17 (0.14-0.20), 0.17 (0.14-0.20), 0.18 (0.15-0.23), 0.20 (0.16-0.25) in nonpregnant women, first, second, and third trimesters of pregnancy respectively (P < 0.001). None of the participants experienced any arrhythmic event. CONCLUSIONS P-wave duration is prolonged in the second trimester, and resumes a plateau thereafter. Maximum QTc interval, Tp-e interval and Tp-e/QT ratio are increased in the late pregnancy. Although these indices are altered during the course of pregnancy, they all remain in the normal ranges.
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Affiliation(s)
- Asli Tanindi
- Department of Cardiology, Ufuk University Faculty of Medicine, Ankara, Turkey
| | - Nilufer Akgun
- Department of Obstetrics and Gynecology, Turgut Özal University Faculty of Medicine, Ankara, Turkey
| | - Emre Goksan Pabuccu
- Department of Obstetrics and Gynecology, Ufuk University Faculty of Medicine, Ankara, Turkey
| | - Aslı Yarci Gursoy
- Department of Obstetrics and Gynecology, Ufuk University Faculty of Medicine, Ankara, Turkey
| | - Ebru Yüce
- Department of Obstetrics and Gynecology, Turgut Özal University Faculty of Medicine, Ankara, Turkey
| | - Hasan Fehmi Tore
- Department of Cardiology, Ufuk University Faculty of Medicine, Ankara, Turkey
| | - Candan Iltemir Duvan
- Department of Obstetrics and Gynecology, Turgut Özal University Faculty of Medicine, Ankara, Turkey
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17
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Enriquez A, Sarrias A, Villuendas R, Ali FS, Conde D, Hopman WM, Redfearn DP, Michael K, Simpson C, De Luna AB, Bayés-Genís A, Baranchuk A. New-onset atrial fibrillation after cavotricuspid isthmus ablation: identification of advanced interatrial block is key. Europace 2015; 17:1289-93. [PMID: 25672984 DOI: 10.1093/europace/euu379] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 11/25/2014] [Indexed: 12/19/2022] Open
Abstract
AIMS A significant proportion of patients develop atrial fibrillation (AF) following cavotricuspid isthmus (CTI) ablation for typical atrial flutter (AFl). The objective of this study was to assess whether the presence of advanced interatrial block (aIAB) was associated with an elevated risk of AF after CTI ablation in patients with typical AFl and no prior history of AF. METHODS AND RESULTS This study included patients with typical AFl and no prior history of AF that were referred for CTI ablation. Patients were excluded when they had received repeat ablations or did not demonstrate a bidirectional block. In all patients, a post-ablation electrocardiogram (ECG) in sinus rhythm was evaluated for the presence of aIAB, defined as a P-wave duration ≥120 ms and biphasic morphology in the inferior leads. New-onset AF was identified from 12-lead ECGs, Holter monitoring, and device interrogations. The cohort comprised 187 patients (age 67 ± 10.7 years; ejection fraction 55.8 ± 11.2%). Advanced interatrial block was detected in 18.2% of patients, and left atrium was larger in patients with aIAB compared with those without aIAB (46.2 ± 5.9 vs. 43.1 ± 6.0 mm; P = 0.01). Over a median follow-up of 24.2 months, 67 patients (35.8%) developed new-onset AF. The incidence of new-onset AF was greater in patients with aIAB compared with those without aIAB (64.7 vs. 29.4%; P < 0.001). After a comprehensive multivariate analysis, aIAB emerged as the strongest predictor of new-onset AF [odds ratio (OR) 4.2, 95% confidence interval (CI): 1.9-9.3; P < 0.001]. CONCLUSION Advanced interatrial block is a key predictor for high risk of new-onset AF after a successful CTI ablation in patients with typical AFl.
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Affiliation(s)
- Andres Enriquez
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Axel Sarrias
- Servicio de Cardiologia, Hospital Germans Trias I Pujol, Badalona, Catalunya, Spain
| | - Roger Villuendas
- Servicio de Cardiologia, Hospital Germans Trias I Pujol, Badalona, Catalunya, Spain Department of Medicine, Autonomous University Barcelona, Barcelona, Spain
| | - Fariha Sadiq Ali
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Diego Conde
- Insituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Wilma M Hopman
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Damian P Redfearn
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Kevin Michael
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | | | - Antoni Bayés De Luna
- Department of Medicine, Autonomous University Barcelona, Barcelona, Spain ICCC-Hospital Sant Pau, Barcelona, Catalunya, Spain Hospital de la Santa Creu i Sant Pau, Cardiovascular Research Center, CSIC-ICCC, Barcelona, Spain
| | - Antoni Bayés-Genís
- Servicio de Cardiologia, Hospital Germans Trias I Pujol, Badalona, Catalunya, Spain Department of Medicine, Autonomous University Barcelona, Barcelona, Spain
| | - Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
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18
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Enriquez A, Conde D, Hopman W, Mondragon I, Chiale PA, de Luna AB, Baranchuk A. Advanced interatrial block is associated with recurrence of atrial fibrillation post pharmacological cardioversion. Cardiovasc Ther 2014; 32:52-6. [PMID: 24417765 DOI: 10.1111/1755-5922.12063] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Management of atrial fibrillation (AF) is hampered by frequent recurrences after restoration of sinus rhythm. Delayed interatrial conduction has been associated with the development of AF in different clinical settings. The aim of our study was to assess whether advanced interatrial block (aIAB) was associated with AF recurrence after pharmacological cardioversion with two different antiarrhythmic drugs. METHODS We included 61 patients with recent onset AF without structural heart disease that underwent successful pharmacological cardioversion. Thirty-one patients received a single oral dose of propafenone, and 30 patients received iv vernakalant. A 12-lead ECG (filter 150 Hz, 25 mm/s, 10 mm/mV) after conversion was evaluated for the presence of interatrial block (IAB); partial (pIAB): P-wave duration > 120 ms, and advanced (aIAB): P-wave > 120 ms and biphasic morphology (±) in inferior leads. Clinical follow-up and electrocardiographic recordings were performed for a 12-month period. RESULTS Age was 58 ± 10.4 years and 50.8% were male. aIAB was present in 11 patients (18%) and pIAB in 10 (16.4%). At 1-year follow-up, 22 patients (36%) had AF recurrence. The recurrence rate with aIAB was 90.9% versus 70% in those with pIAB and 12.5% in normal P-wave duration (P = 0.001). The presence of aIAB was strongly associated with AF recurrence (odds ratio 18.4 in multivariable modeling). Recurrence was not affected by the drug used for cardioversion (P = 0.92). CONCLUSION Advanced interatrial block is associated with higher risk of AF recurrence at 1 year after pharmacological cardioversion, independent of the drug used.
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Affiliation(s)
- Andres Enriquez
- Division of Cardiology, Queen's University, Kingston, ON, Canada
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19
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Enriquez A, Conde D, Femenia F, de Luna AB, Ribeiro A, Muratore C, Valentino M, Retyk E, Galizio N, Hopman WM, Baranchuk A. Relation of interatrial block to new-onset atrial fibrillation in patients with Chagas cardiomyopathy and implantable cardioverter-defibrillators. Am J Cardiol 2014; 113:1740-3. [PMID: 24698463 DOI: 10.1016/j.amjcard.2014.02.036] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 02/21/2014] [Accepted: 02/21/2014] [Indexed: 01/05/2023]
Abstract
Chagas cardiomyopathy is an endemic disease in Latin America. A significant proportion of patients develop atrial fibrillation (AF), which may result in stroke and increased morbidity or mortality. Interatrial block (IAB) has been associated with the development of AF in different clinical scenarios. The aim of our study was to determine whether IAB can predict new-onset AF in patients with Chagas cardiomyopathy and implantable cardioverter-defibrillators (ICDs). We conducted a retrospective study of patients with Chagas cardiomyopathy and ICDs from 14 centers in Latin America. Demographics, clinical, and device follow-up were collected. Surface electrocardiograms were scanned at 300 dpi and maximized ×8. Semiautomatic calipers were used to determine P-wave onset and offset. Partial IAB was defined as a P wave of >120 ms and advanced IAB as a P wave of >120 ms with biphasic morphology (±) in inferior leads. AF events and ICD therapies were reviewed during follow-up by 2 independent investigators. A total of 80 patients were analyzed. Mean age was 54.6 ± 10.4 years, and 52 (65%) were male. Mean left ventricular ejection fraction was 40 ± 12%. IAB was detected in 15 patients (18.8%), with 8 (10.0%) partial and 7 (8.8%) advanced. During a follow-up of 33 ± 20 months, 11 patients (13.8%) presented with new AF. IAB (partial + advanced) was strongly associated with new AF (p <0.0001) and inappropriate therapy by the ICD (p = 0.014). In conclusion, IAB (partial + advanced) predicted new-onset AF in patients with Chagas cardiomyopathy and ICDs.
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Affiliation(s)
| | - Diego Conde
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | | | - Antoni Bayés de Luna
- Cardiovascular Research Center, CSIC-ICCC, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Antonio Ribeiro
- Universidade Federal de Minais Gerais, Belo Horizonte, Brazil
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Blanche C, Tran N, Carballo D, Rigamonti F, Burri H, Zimmermann M. Usefulness of P-wave signal averaging to predict atrial fibrillation recurrences after electrical cardioversion. Ann Noninvasive Electrocardiol 2014; 19:266-72. [PMID: 24397857 DOI: 10.1111/anec.12131] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Accurate markers of atrial fibrillation (AF) recurrences after electrical cardioversion (ECV) are lacking. This study was conducted to assess the value of P-wave signal averaging (SAPW) for predicting AF recurrences in a nonselected patients population submitted to ECV. METHODS A total of 133 patients (107 males, 26 females, mean age 66 ± 9 years) were included after successful ECV for persistent AF (mean duration of AF 3.6 ± 2.2 months). The mean ejection fraction (EF) was 60 ± 9%, and left atrial (LA) diameter was 44 ± 6 mm. SAPW ECG was obtained immediately after ECV and patients were prospectively followed. RESULTS During a mean follow-up of 8.9 ± 5.2 months, AF recurrences occurred in 40.6% (54/133). No SAPW parameters was statistically different between the group of patients with and the group without recurrences. Recurrences were less often observed in patients with a total P-wave duration <150 ms (16/52 or 31% vs 38/81 or 47% in patients with total P-wave duration ≥150 ms) but the difference was not statistically different (P = 0.07). P-wave duration was correlated with age (r = 0.32; P < 0.001) and left atrial diameter (r = 0.19; P = 0.02). Age, sex, structural heart disease, amiodarone therapy, or hypertension were not associated with AF recurrences but patients without recurrences had a shorter AF duration (P = 0.001) and more often had a history of previous ablation (P = 0.027). CONCLUSION In this unselected "real-life" group of patients submitted to ECV for persistent AF, none of the SAPW parameters, including total filtered P-wave duration, was able to predict AF recurrences.
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Affiliation(s)
- Coralie Blanche
- Cardiovascular Department, Hôpital de La Tour, Meyrin-Geneva, Switzerland
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21
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Prolonged P-wave duration is associated with atrial fibrillation recurrence after successful pulmonary vein isolation for paroxysmal atrial fibrillation. J Interv Card Electrophysiol 2013; 39:131-8. [PMID: 24306110 DOI: 10.1007/s10840-013-9851-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 10/14/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED Pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) is successful in ∼70-80 % after repeated procedures. This suggests a subgroup of PAF patients where electrical abnormalities outside the pulmonary veins are important. Prolonged P-wave duration (PWD), a marker of atrial remodelling, may identify this subgroup. This study's aim was to assess the association of PWD on standard 12 lead ECG with AF recurrence post PVI. METHODS Retrospectively, ECGs were blindly analysed on PVI patients from August 2007-August 2011; patients with persistent AF, mitral valve disease, undergoing redo procedures or no sinus rhythm (SR) ECG within 1 year of PVI were excluded. ECGs were directly uploaded at 300 dpi, amplified ×10, and then PWD measured in all leads. Prolonged PWD was as priori defined as maximum PWD ≥ 140 ms. RESULTS The selective cohort consisted of 100 patients out of a total of 170 PVI: age 58 ± 11 years, 72 % male, LVEF 62 ± 9 %, 18 % ischaemic heart disease and 13 % diabetic. Thirty-five had prolonged PWD, which was associated with greater AF recurrence rates compared to those without prolonged PWD (63 vs. 38 %, p < 0.05). Similarly, AF recurrence was associated with greater maximum PWD (139 ± 17 vs. 129 ± 14, p < 0.01), P-wave dispersion (58 ± 21 vs. 49 ± 15, p < 0.01), left atrium (LA) dimension (41 ± 6 vs. 38 ± 5, p < 0.05) and LA volumes (40 ± 14 vs. 34 ± 11, p < 0.05) compared to those who remained in SR. None of these variables were independent predictors of AF recurrence by multivariate analysis. CONCLUSION The presence of pre-existent prolonged PWD is associated with a higher risk of AF recurrence post PVI for paroxysmal AF.
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Censi F, Calcagnini G, Triventi M, Mattei E, Bartolini P, Corazza I, Boriani G. P-wave characteristics after electrical external cardioversion: predictive indexes of relapse. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2011; 2010:3442-5. [PMID: 21097258 DOI: 10.1109/iembs.2010.5627862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in the western countries and accounts for hundred thousand strokes per year. Electrocardiographic characteristics of AF have been demonstrated to help identify patients at risk of developing AF. Prolonged and highly fragmented P-waves have been observed in patients prone to AF, and time-domain. Morphological characteristics of the P-wave from surface ECG recordings turned out to significantly distinguish patients at risk of AF. The aim of this study is to evaluate the morphological and time-domain characteristics of the P-wave in patients with AF relapse after cardioversion, respect to patients without. 14 patients who underwent successful electrical cardioversion for persistent AF were enrolled. Five minute ECG recordings were performed for each subject, immediately post-successful cardioversion. ECG signals were acquired by using a 16-lead mapping system for high-resolution biopotential measurements (sample frequency 2 kHz, 31 nV resolution, 0-400 Hz bandwidth). From the 16 recordings, a standard 12-lead ECG was derived and analyzed in terms of signal-averaged P-wave. Time-domain and mor-phological characteristics were estimated from the averaged P-waves of each lead. Time-domain features were quantified as: maximum P-wave duration in any of the 12 leads (Pmax), minimum P-wave duration in any of the leads (Pmin), P-wave dispersion (Pdisp=Pmax-Pmin), and Pindex (standard devia-tion of P-wave duration in any of the 12 leads). Morphological characteristics were extracted from a Gaussian function-based model of the P-wave as: average model order (Nav), maximum number of zero-crossing (PCmax), and maximum and average number of maxima and minima (FCImax and FCIav) in any of the leads. The results obtained so far indicate that the morphological and time-domain characteristics distinguish between patients with AF relapse and patients without.
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Affiliation(s)
- Federica Censi
- Italian National Institute of Health, Viale Regina Elena 299, 00161 Roma, Italy.
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Holmqvist F, Olesen MS, Tveit A, Enger S, Tapanainen J, Jurkko R, Havmoller R, Haunso S, Carlson J, Svendsen JH, Platonov PG. Abnormal atrial activation in young patients with lone atrial fibrillation. Europace 2010; 13:188-92. [DOI: 10.1093/europace/euq352] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Stafford PJ. A new use for an old technique? Europace 2010; 12:768-9. [DOI: 10.1093/europace/euq057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Magnani JW, Williamson MA, Ellinor PT, Monahan KM, Benjamin EJ. P wave indices: current status and future directions in epidemiology, clinical, and research applications. Circ Arrhythm Electrophysiol 2009; 2:72-9. [PMID: 19808445 DOI: 10.1161/circep.108.806828] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jared W Magnani
- Section of Cardiology, Division of Medicine, Boston University School of Medicine, Boston, MA 01702-5827, USA
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Hegbom F, Tveit A, Grundvold I, Arnesen H, Smith P. Effects of angiotensin receptor blockade on serial P-wave signal-averaged electrocardiograms after electrical cardioversion of persistent atrial fibrillation. Europace 2009; 11:1301-7. [DOI: 10.1093/europace/eup220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Reactive oxidative metabolites are associated with atrial conduction disturbance in patients with atrial fibrillation. Heart Rhythm 2009; 6:935-40. [PMID: 19560081 DOI: 10.1016/j.hrthm.2009.03.012] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2008] [Accepted: 03/03/2009] [Indexed: 12/15/2022]
Abstract
BACKGROUND Oxidative stress is associated with atrial fibrillation (AF). However, little is known about the relationship between serum markers of oxidation and electrical activity in patients with AF. OBJECTIVE The purpose of this study was to investigate the possible association between serum markers of reactive oxidative metabolism and atrial remodeling in paroxysmal and persistent AF. METHODS Derivatives of reactive oxidative metabolites (DROM), an index of oxidative stress, were measured in 306 consecutive patients with AF (225 paroxysmal, 81 persistent) undergoing radiofrequency (RF) catheter ablation. Filtered P-wave duration by P-wave signal-averaged ECG and levels of high-sensitivity C-reactive protein (CRP) as an inflammatory marker also were measured. RESULTS Patients were followed up for 1.2 +/- 0.8 years. DROM levels in patients with persistent AF were significantly higher than in patients with paroxysmal AF (341.6 +/- 85.5 Carratelli [Carr] units vs 305.0 +/- 77.7 Carr units, P <.001). DROM levels showed a tighter, positive correlation with filtered P-wave duration in persistent AF patients (r = 0.56, P <.001) than in all AF patients (r = 0.13, P <.05). DROM levels also showed a weaker but significant correlation with high-sensitivity CRP in patients with AF. Kaplan-Meier analysis revealed that the highest quartile of basal DROM levels exhibited a significantly higher AF recurrence rate after RF catheter ablation in patients with paroxysmal AF (P <.01). CONCLUSION Serum markers of oxidative stress reflect atrial conduction disturbance and predict AF recurrence after RF catheter ablation in paroxysmal AF patients. DROM could serve as a biomarker for predicting risk of AF recurrence after RF catheter ablation.
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Kjølbye AL, Haugan K, Hennan JK, Petersen JS. Pharmacological modulation of gap junction function with the novel compound rotigaptide: a promising new principle for prevention of arrhythmias. Basic Clin Pharmacol Toxicol 2008; 101:215-30. [PMID: 17845503 DOI: 10.1111/j.1742-7843.2007.00123.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Existing anti-arrhythmic therapy is hampered by lack of efficacy and unacceptable side effects. Thus, ventricular tachycardia and fibrillation remains the strongest predictor of in-hospital mortality in patients with myocardial infarction. In atrial fibrillation, rhythm control with conventional ion channel blockers provide no therapeutic benefit relative to rate control. Several lines of research indicate that impaired gap junctional cell-to-cell coupling between neighbouring cardiomyocytes is critical for the development of cardiac re-entry arrhythmias. Rotigaptide is the first drug that has been developed to prevent arrhythmias by re-establishing gap junctional intercellular communication. During conditions with acute cardiac ischaemia, rotigaptide effectively prevents induction of both ventricular and atrial tachyarrhythmia. Moreover, rotigaptide effectively prevents ischaemia reperfusion arrhythmias. At the cellular level, rotigaptide inhibits ischaemia-induced dephosphorylation of Ser297 and Ser368, which is considered important for the gating of connexin43 gap junction channels. No drug-related toxicity has been demonstrated at plasma concentrations 77,000 times above therapeutic concentrations. In rats and dogs, rotigaptide reduces infarct size following myocardial infarction. A series of phase I trials has been completed in which rotigaptide has been administered intravenously to ~200 healthy persons. No drug-related side effects have been demonstrated in healthy human beings. Clinical safety, tolerability and efficacy in patients with heart disease are being evaluated in ongoing clinical trials. Rotigaptide represents a pioneering pharmacological principle with a highly favourable preclinical and clinical safety profile, which makes this molecule a promising drug candidate for the prevention of cardiac arrhythmias.
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Haugan K, Miyamoto T, Takeishi Y, Kubota I, Nakayama J, Shimojo H, Hirose M. Rotigaptide (ZP123) improves atrial conduction slowing in chronic volume overload-induced dilated atria. Basic Clin Pharmacol Toxicol 2006; 99:71-9. [PMID: 16867174 DOI: 10.1111/j.1742-7843.2006.pto_432.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Chronic atrial dilation is associated with atrial conduction velocity slowing and an increased risk of developing atrial tachyarrhythmias. Rotigaptide (ZP123) is a selective gap junction modifier that increases cardiac gap junctional intercellular communication. We hypothesised that rotigaptide treatment would increase atrial conduction velocity and reduce the inducibility to atrial tachyarrhythmias in a model of chronic volume overload induced chronic atrial dilatation characterized by atrial conduction velocity slowing. Chronic volume overload was created in Japanese white rabbits by arterio-venous shunt formation. Atrial conduction velocity and atrial tachyarrhythmias inducibility were examined in Langendorff-perfused chronic volume overload hearts (n=12) using high-resolution optical mapping before and after treatment with rotigaptide. Moreover, expression levels of atrial gap junction proteins (connexin40 and connexin43) were examined in chronic volume overload hearts (n=6) and compared to sham-operated controls (n=6). Rotigaptide treatment significantly increased atrial conduction velocity in chronic volume overload hearts, however, rotigaptide did not decrease susceptibility to the induction of atrial tachyarrhythmias. Protein expressions of Cx40 and Cx43 were decreased by 32% and 72% (P<0.01), respectively, in chromic volume overload atria compared to control. To conclude, rotigaptide increased atrial conduction velocity in a rabbit model of chromic volume overload induced atrial conduction velocity slowing. The demonstrated effect of rotigaptide on atrial conduction velocity did not prevent atrial tachyarrhythmias inducibility. Whether rotigaptide may possess antiarrhythmic efficacy in other models of atrial fibrillation remains to be determined.
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Affiliation(s)
- Ketil Haugan
- Zealand Pharma A/S, Smedeland 26B, Dk-2600 Glostrup, Denmark
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