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Kazemian S, Issaiy M, Hosseini K. Challenges in developing and validating machine learning models for transcatheter aortic valve implantation mortality risk prediction. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2024; 5:1-2. [PMID: 38264706 PMCID: PMC10802814 DOI: 10.1093/ehjdh/ztad059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Affiliation(s)
- Sina Kazemian
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran Heart Center, Kargar St. Jalal al-Ahmad Cross, 1411713138, Tehran, Iran
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Imam Khomeini Hospital Complex, Tohid Square, 1419733141, Tehran, Iran
| | - Mahbod Issaiy
- Advanced Diagnostic and Interventional Radiology Research Center (ADHR), Tehran University of Medical Sciences, Tehran, Iran
| | - Kaveh Hosseini
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran Heart Center, Kargar St. Jalal al-Ahmad Cross, 1411713138, Tehran, Iran
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Imam Khomeini Hospital Complex, Tohid Square, 1419733141, Tehran, Iran
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Persia-Paulino YR, Almendarez Lacayo M, Alperi A, Hernández-Vaquero D, Fernández Asensio R, Cuevas Pérez J, Adeba A, Flórez P, Vigil-Escalera M, Álvarez Velasco R, Renilla A, Del Valle Fernández R, Antuña P, Morís de la Tassa C, Avanzas P, Pascual I. Self-expanding TAVI using the cusp overlap technique versus the traditional technique: electrocardiogram changes and 1-year cardiovascular outcomes. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:29-38. [PMID: 37437882 DOI: 10.1016/j.rec.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/18/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES Transcatheter aortic valve implantation (TAVI) using the cusp overlap technique (COT) has shown a lower pacemaker implantation rate at 30 days. The objective of this study was to compare electrocardiogram changes and clinical outcomes between COT and the traditional technique (TT) at 1 year of follow-up. METHODS Observational, retrospective, nonrandomized study of consecutive patients undergoing TAVI between January 2015 and January 2021. Patients were matched using a propensity score and the TT was compared with COT. The primary endpoints were electrocardiogram changes and a combined endpoint including pacemaker implantation, hospitalization, or cardiovascular death at 1 year. RESULTS We included 254 patients. After propensity score matching, 184 patients (92 per group) remained. There were no statistically significant differences in baseline characteristics. At 1 year, COT patients showed a significant reduction in new onset left bundle branch block (49% vs 27%, P=.002) and less P wave (13.1±21.0 msec vs 5.47±12.5 msec; P=.003) and QRS prolongation (29.77±27.0 msec vs 16.38±25.4 msec, P <.001). COT was associated with a significant reduction in the occurrence of the primary endpoint (SHR, 0.39 [IC95%, 0.21-0.76]; P=.005). CONCLUSIONS At 1 year of follow-up, COT reduced the incidence of new onset left bundle branch block and diminished QRS and P wave widening compared with the TT. COT was also associated with a statistically significant reduction in the occurrence of the combined primary cardiovascular endpoint.
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Affiliation(s)
- Yván R Persia-Paulino
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Marcel Almendarez Lacayo
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Grupo de Investigación de Patología Cardiaca, Instituto de Investigación del Principado de Asturias, Oviedo, Asturias, Spain
| | - Alberto Alperi
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Grupo de Investigación de Patología Cardiaca, Instituto de Investigación del Principado de Asturias, Oviedo, Asturias, Spain
| | - Daniel Hernández-Vaquero
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Grupo de Investigación de Patología Cardiaca, Instituto de Investigación del Principado de Asturias, Oviedo, Asturias, Spain
| | | | - Javier Cuevas Pérez
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Antonio Adeba
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Pablo Flórez
- Servicio de Cardiología, Hospital Valle del Nalón, Langreo, Asturias, Spain
| | - María Vigil-Escalera
- Servicio de Cardiología, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| | - Rut Álvarez Velasco
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Grupo de Investigación de Patología Cardiaca, Instituto de Investigación del Principado de Asturias, Oviedo, Asturias, Spain
| | - Alfredo Renilla
- Servicio de Cardiología, Hospital Vital Álvarez-Buylla, Mieres, Asturias, Spain
| | | | - Paula Antuña
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - César Morís de la Tassa
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Grupo de Investigación de Patología Cardiaca, Instituto de Investigación del Principado de Asturias, Oviedo, Asturias, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Asturias, Spain
| | - Pablo Avanzas
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Grupo de Investigación de Patología Cardiaca, Instituto de Investigación del Principado de Asturias, Oviedo, Asturias, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Asturias, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Isaac Pascual
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Grupo de Investigación de Patología Cardiaca, Instituto de Investigación del Principado de Asturias, Oviedo, Asturias, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Asturias, Spain
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Yagel O, Belhassen B, Planer D, Amir O, Elbaz-Greener G. The R-wave amplitude in V1 on baseline electrocardiogram correlates with the occurrence of high-degree atrioventricular block following left bundle branch block after transcatheter aortic valve replacement. Europace 2023; 25:euad066. [PMID: 36938963 PMCID: PMC10227649 DOI: 10.1093/europace/euad066] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 02/26/2023] [Indexed: 03/21/2023] Open
Abstract
AIMS Several procedural and electrocardiogram (ECG) parameters have been associated with the occurrence of high-degree atrioventricular block (AVB) requiring permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR). We hereunder sought to assess if the baseline R-wave amplitude in V1 ECG lead of patients with normal QRS duration undergoing TAVR is associated with a higher patient's risk for developing high-degree AVB following left bundle branch block (LBBB). METHODS AND RESULTS In this retrospective single-centre study in 720 consecutive patients who underwent TAVR, 141 (19.6%) patients with normal QRS duration developed a new LBBB after TAVR. The 24 (17%) patients who underwent PPI for reasons other than high-degree AVB were excluded from further analysis. In the remaining 117 study patients, 14 (12%) developed high-degree AVB requiring PPI (Group 1) while the remaining 103 (88%) patients did not (Group 2). There were no significant differences in baseline demographic or procedural characteristics nor in PR interval, QRS duration, and QRS axis between these two groups. The incidence of left anterior hemiblock was higher in Group 1 (3 of 14, 21.4%) than that in Group 2 (9 of 103, 8.7%), but the difference was not statistically significant (P = 0.156). The R-wave amplitude in V1 was smaller in Group 1 than that in Group 2 (0.029 ± 0.04 mV vs. 0.11 ± 0.14 mV, P = 0.0316). In the receiver-operating characteristics analysis, the cutoff for R-wave amplitude pre-TAVR was 0.03 mV, area under the curve = 0.7219 (P = 0.0002). CONCLUSION The R-wave amplitude in lead V1 during baseline ECG in patients with normal QRS duration may predict the occurrence of high-degree AVB following new LBBB after TAVR.
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Affiliation(s)
- Oren Yagel
- Hadassah Medical Center, Heart Institute, Kyriat Hadassah, PO Box 12000, 91120 Jerusalem, Israel
- Hebrew University of Jerusalem, Jerusalem 91904, Israel
| | - Bernard Belhassen
- Hadassah Medical Center, Heart Institute, Kyriat Hadassah, PO Box 12000, 91120 Jerusalem, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel
| | - David Planer
- Hadassah Medical Center, Heart Institute, Kyriat Hadassah, PO Box 12000, 91120 Jerusalem, Israel
- Hebrew University of Jerusalem, Jerusalem 91904, Israel
| | - Offer Amir
- Hadassah Medical Center, Heart Institute, Kyriat Hadassah, PO Box 12000, 91120 Jerusalem, Israel
- Hebrew University of Jerusalem, Jerusalem 91904, Israel
| | - Gabby Elbaz-Greener
- Hadassah Medical Center, Heart Institute, Kyriat Hadassah, PO Box 12000, 91120 Jerusalem, Israel
- Hebrew University of Jerusalem, Jerusalem 91904, Israel
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Martínez-Sellés M. Cost-effectiveness of transcatheter aortic valve implants in 2022. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:853. [PMID: 35718723 DOI: 10.1016/j.rec.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain; Facultad de Ciencias Biomédica y de la Salud, Universidad Europea, Madrid, Spain; Facultad de Medicina, Universidad Complutense, Madrid, Spain.
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Martínez-Sellés M. Interatrial block, atrial fibrillation, and thrombotic events in COVID-19. Eur J Clin Invest 2022; 52:e13800. [PMID: 35474208 PMCID: PMC9111789 DOI: 10.1111/eci.13800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022]
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Herrera C, Bruña V, María Barrio J, Cuerpo G, Fernández-Avilés F, Bayés de Luna A, Martínez-Sellés M. Atrial myxoma surgery and p-wave remodeling. Pacing Clin Electrophysiol 2022; 45:1160-1164. [PMID: 35898158 DOI: 10.1111/pace.14573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/28/2022] [Accepted: 07/22/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Data regarding atrial electrocardiographic parameters in patients with atrial myxomas are scarce. METHODS We aimed to study atrial electrocardiographic features in patients with atrial myxomas, before and after surgery. We also analyze the incidence of atrial fibrillation during follow-up and its correlation with different P-wave indexes. 32 patients in sinus rhythm that underwent atrial myxoma surgery were included. RESULTS Mean age was 55.0±12.6 years and 18 (56.3%) were women. Ten patients had left atrial enlargement (31.3%). Only one myxoma was located in the right atrium. At baseline 7 cases of partial interatrial block (IAB) were detected (21.9%), two in the absence of left atrial enlargement. There were significant differences in atrial electrocardiographic indexes before and after surgery, including P-wave duration (108.9±17.9 ms vs. 93.0±12.4 ms; p < 0.001), partial IAB (21.9% vs 3.1%; p = 0.012) and duration of P-wave terminal force in lead V1 negativity (-0.6±0.3 vs -0.5±0.3 mm; p = 0.034). At a mean follow up of 10.0±5.5 years, 10 patients (31.3%) had experienced at least one episode of atrial fibrillation. Post-operative P-wave duration was associated with atrial fibrillation occurrence during follow-up (Hazard ratio: 0.90, 95% confidence interval: 0.83-0.98; p = 0.020). CONCLUSIONS Abnormalities in atrial electrocardiographic indexes are common in atrial myxomas and frequently improve after surgery. Post-operative P-wave duration is associated with atrial fibrillation occurrence during follow-up. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Cristian Herrera
- Department of Cardiology, Hospital General Universitario Gregorio Marañón. CIBER-CV, Madrid, Spain
| | - Vanesa Bruña
- Department of Cardiology, Hospital Universitario 12 de Octubre. CIBER-CV, Madrid, Spain
| | - Jose María Barrio
- Department of Anestesiology. Cardiac Surgery Postoperative Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Gregorio Cuerpo
- Department of Cardiac Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Francisco Fernández-Avilés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón. CIBER-CV, Madrid, Spain.,Universidad Complutense, Madrid, Spain
| | - Antonio Bayés de Luna
- Cardiovascular Research Foundation, Cardiovascular ICCC Program, Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Manuel Martínez-Sellés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón. CIBER-CV, Madrid, Spain.,Universidad Complutense, Madrid, Spain.,Universidad Europea, Madrid, Spain
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Martínez-Sellés M. Coste-efectividad del implante percutáneo de válvula aórtica en 2022. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Martínez-Sellés M, Bruña V, Lacalzada-Almeida J, Díez-Villanueva P, Ruiz-Ortiz M, Alzola E, Arnau MÁ, Tobar J, Hernández JM, Bonet A, Castro V, Rubín JM, García-Martín A, Pérez-David E. Rationale and design of the rigorous atrial analysis in advanced interatrial block (ARABIA) prospective study. J Electrocardiol 2021; 68:135-140. [PMID: 34419649 DOI: 10.1016/j.jelectrocard.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/04/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Advanced interatrial block (IAB) is present in 10% of subjects ≥75 years and is associated with the risk of clinical events. METHODS AND RESULTS Prospective multicenter study that will include subjects ≥75 years without exclusion criteria (indication for anticoagulation, cardiac devices, severe valve disease, systolic dysfunction, moderate or severe cognitive impairment, poor echocardiographic window, non-sinus rhythm or partial IAB, stroke, and life expectancy <2 years). A total of 356 subjects, 178 patients with advanced IAB (exposed) and 178 matched individuals with normal P-wave (non-exposed) will be included. Electrocardiogram and advanced transthoracic echocardiography will be performed. Two substudies will include magnetic resonance imaging: cardiac (86 subjects, 43 exposed, and 43 non-exposed) and brain (86 subjects, 43 exposed, and 43 non-exposed). The follow-up will be 2 years. Our main objective is to determine the association of advanced IAB, P-wave duration, and atrial imaging parameters (I] atrial global longitudinal strain, II] maximal left atrial volume index, III] left atrial ejection fraction, IV] left atrial fibrosis - % total left atrial area V] inter- and intra-atrial asynchrony/dyssynchrony) with clinical events (atrial fibrillation, stroke, cognitive impairment, and mortality). The secondary objective is to assess the association of the P-wave duration with atrial imaging parameters and of both with cerebral microemboli in magnetic resonance imaging. CONCLUSION Our study will provide data regarding the association of advanced IAB, P-wave duration, and atrial imaging parameters with clinical events. We will also assess the association P-wave duration-atrial imaging parameters-cerebral microemboli.
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Affiliation(s)
- Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Universidad Europea. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain.
| | - Vanesa Bruña
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain; Servicio de Cardiología, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Juan Lacalzada-Almeida
- Laboratorio de Imagen Cardíaca, Servicio de Cardiología, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
| | | | - Martin Ruiz-Ortiz
- Servicio de Cardiología, Hospital Universitario Reina Sofia, Córdoba, Spain
| | - Elisabete Alzola
- Servicio de Cardiología, Hospital Universitario de Cruces, Baracaldo, Bilbao, Spain
| | - Miguel Ángel Arnau
- Servicio de Cardiología, Hospital Universitario y Politécnico la Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Javier Tobar
- Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Jesús Manuel Hernández
- Servicio de Cardiología, Hospital Clínico Universitario de Salamanca, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Ana Bonet
- Servicio de Cardiología, Hospital Universitario de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Victor Castro
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Jose Manuel Rubín
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Ana García-Martín
- Servicio de Cardiología. Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Esther Pérez-David
- Servicio de Cardiología, Hospital Universitario de la Paz, Madrid, Spain
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Lindow T, Lindqvist P. The Prevalence of Advanced Interatrial Block and Its Relationship to Left Atrial Function in Patients with Transthyretin Cardiac Amyloidosis. J Clin Med 2021; 10:2764. [PMID: 34201866 PMCID: PMC8267751 DOI: 10.3390/jcm10132764] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/20/2021] [Accepted: 06/22/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Advanced interatrial block (aIAB), which is associated with incident atrial fibrillation and stroke, occurs in the setting of blocked interatrial conduction. Atrial amyloid deposition could be a possible substrate for reduced interatrial conduction, but the prevalence of aIAB in patients with transthyretin cardiac amyloidosis (ATTR-CA) is unknown. We aimed to describe the prevalence of aIAB and its relationship to left atrial function in patients with ATTR-CA in comparison to patients with HF and left ventricular hypertrophy but no CA. METHODS The presence of aIAB was investigated among 75 patients (49 patients with ATTR-CA and 26 with HF but no CA). A comprehensive echocardiographic investigation was performed in all patients, including left atrial strain and strain rate measurements. RESULTS Among patients with ATTR-CA, 27% had aIAB and in patients with HF but no CA, this figure was 21%, (p = 0.78). The presence of aIAB was associated with a low strain rate during atrial contraction (<0.91 s-1) (OR: 5.2 (1.4-19.9)), even after adjusting for age and LAVi (OR: 4.5 (1.0-19.19)). CONCLUSIONS Advanced interatrial block is common among patients with ATTR-CA, as well as in patients with heart failure and left ventricular hypertrophy but no CA. aIAB is associated with reduced left atrial contractile function.
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Affiliation(s)
- Thomas Lindow
- Kolling Institute, Royal North Shore Hospital, University of Sydney, Sydney, NSW 2065, Australia
- Department of Clinical Physiology, Research and Development, Växjö Central Hospital, Region Kronoberg, 351 88 Växjö, Sweden
- Clinical Physiology, Clinical Sciences, Lund University, 221 00 Lund, Sweden
| | - Per Lindqvist
- Department of Clinical Physiology, Surgical and Perioperative Sciences, Umeå University, 901 87 Umeå, Sweden;
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Carmona Puerta R, Lorenzo Martínez E, Rabassa López-Calleja MA, Padrón Peña G, Castro Torres Y, Cruz Elizundia JM, Rodríguez González F, García Vázquez LÁ, Chávez González E. New Parameter of the Second Half of the P-Wave, P-Wave Duration, and Atrial Conduction Times Predict Atrial Fibrillation during Electrophysiological Studies. Med Princ Pract 2021; 30:462-469. [PMID: 34348309 PMCID: PMC8562052 DOI: 10.1159/000518262] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 07/04/2021] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Several P-wave parameters reflect atrial conduction characteristics and have been used to predict atrial fibrillation (AF). The aim of this study was to determine the relationship between maximum P-wave duration (PMax) and new P-wave parameters, with atrial conduction times (CT), and to assess their predictive value of AF during electrophysiological studies (AF-EPS). SUBJECTS AND METHODS This was a cross-sectional study in 153 randomly selected patients aged 18-70 years, undergoing EPS. The patients were divided into 2 groups designated as no AF-EPS and AF-EPS, depending on whether AF occurred during EPS or not. Different P-wave parameters and atrial CT were compared for both study groups. Subsequently, the predictive value of the P-wave parameters and the atrial CT for AF-EPS was evaluated. RESULTS The values of CT, PMax, and maximum Ppeak-Pend interval (Pp-eMax) were significantly higher in patients with AF-EPS. Almost all P-wave parameters were correlated with the left CT. PMax, Pp-eMax, and CT were univariate and multivariate predictors of AF-EPS. The largest ROC area was presented by interatrial CT (0.852; p < 0.001; cutoff value: ≥82.5 ms; sensitivity: 91.1%; specificity: 81.1%). Pp-eMax showed greater sensitivity (79.5%) to discriminate AF-EPS than PMax (72.7%), but the latter had better specificity (60.4% vs. 41.5%). CONCLUSIONS Left atrial CT were directly and significantly correlated with PMax and almost all the parameters of the second half of the P-wave. CT, PMax, and Pp-eMax (new parameter) were good predictors of AF-EPS, although CT did more robustly.
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Affiliation(s)
- Raimundo Carmona Puerta
- Department of Electrophysiology and Arrhythmology, Cardiovascular Hospital “Ernesto Guevara”, Santa Clara, Cuba
- *Raimundo Carmona Puerta,
| | | | | | - Gustavo Padrón Peña
- Department of Electrophysiology and Arrhythmology, Cardiovascular Hospital “Ernesto Guevara”, Santa Clara, Cuba
| | - Yaniel Castro Torres
- Coronary Care Unit, San Juan de Dios Hospital, Santiago de Chile, Santiago, Chile
| | - Juan Miguel Cruz Elizundia
- Department of Electrophysiology and Arrhythmology, Cardiovascular Hospital “Ernesto Guevara”, Santa Clara, Cuba
| | - Fernando Rodríguez González
- Department of Electrophysiology and Arrhythmology, Cardiovascular Hospital “Ernesto Guevara”, Santa Clara, Cuba
| | | | - Elibet Chávez González
- Department of Electrophysiology and Arrhythmology, Cardiovascular Hospital “Ernesto Guevara”, Santa Clara, Cuba
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Vicent L, Fernández‐Cordón C, Nombela‐Franco L, Escobar‐Robledo LA, Ayesta A, Ariza Solé A, Gómez‐Doblas JJ, Bernal E, Tirado‐Conte G, Cobiella J, González‐Saldivar H, López‐Otero D, Díez‐Villanueva P, Sarnago F, Armario X, Bayés‐de-Luna A, Martínez‐Sellés M. Baseline ECG and Prognosis After Transcatheter Aortic Valve Implantation: The Role of Interatrial Block. J Am Heart Assoc 2020; 9:e017624. [PMID: 33140688 PMCID: PMC7763710 DOI: 10.1161/jaha.120.017624] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/25/2020] [Indexed: 01/03/2023]
Abstract
Background The clinical significance of conduction disturbances after transcatheter aortic valve implantation has been described; however, little is known about the influence of baseline ECGs in the prognosis of these patients. Our aim was to study the influence of baseline ECG parameters, including interatrial block (IAB), in the prognosis of patients treated with transcatheter aortic valve implantation. Methods and Results The BIT (Baseline Interatrial Block and Transcatheter Aortic Valve Implantation) registry included 2527 patients with aortic stenosis treated with transcatheter aortic valve implantation. A centralized analysis of baseline ECGs was performed. Patients were divided into 4 groups: normal P wave duration (<120 ms); partial IAB (P wave duration ≥120 ms, positive in the inferior leads); advanced IAB (P wave duration ≥120 ms, biphasic [+/-] morphology in the inferior leads); and nonsinus rhythm (atrial fibrillation/flutter and paced rhythm). The mean age of patients was 82.6±9.8 years and 1397 (55.3%) were women. A total of 960 patients (38.0%) had a normal P wave, 582 (23.0%) had partial IAB, 300 (11.9%) had advanced IAB, and 685 (27.1%) presented with nonsinus rhythm. Mean follow-up duration was 465±171 days. Advanced IAB was the only independent predictor of all-cause mortality (hazard ratio [HR], 1.48; 95% CI, 1.10-1.98 [P=0.010]) and of the composite end point (death/stroke/new atrial fibrillation) (HR, 1.51; 95% CI, 1.17-1.94 [P=0.001]). Conclusions Baseline ECG characteristics influence the prognosis of patients with aortic stenosis treated with transcatheter aortic valve implantation. Advanced IAB is present in about an eighth of patients and is associated with all-cause death and the composite end point of death, stroke, and new atrial fibrillation during follow-up.
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Affiliation(s)
- Lourdes Vicent
- Department of CardiologyHospital General Universitario Gregorio MarañónCIBERCVMadridSpain
- Department of CardiologyHospital General Universitario 12 de OctubreCIBERCVMadridSpain
| | - Clara Fernández‐Cordón
- Department of CardiologyHospital General Universitario Gregorio MarañónCIBERCVMadridSpain
| | | | - Luis Alberto Escobar‐Robledo
- Department of CardiologyHospital de la Santa Creu i Sant Pau. Fundación Investigación Cardiovascular. Programa‐ICCC CardiovascularInstitut de Recerca del Hospital de la Santa Creu I Sant PauIIB‐Sant Pau Barcelona, SpainBarcelonaSpain
| | - Ana Ayesta
- Department of CardiologyHospital Universitario Central de AsturiasOviedoAsturiasSpain
| | - Albert Ariza Solé
- Department of CardiologyBellvitge University Hospital. L’Hospitalet de LlobregatBarcelonaSpain
| | | | - Eva Bernal
- Department of CardiologyHospital Universitari Germans Trias i Pujol BadalonaBarcelonaSpain
| | | | - Javier Cobiella
- Cardiovascular InstituteHospital Clinico San Carlos, IdISSCMadridSpain
| | - Hugo González‐Saldivar
- Department of CardiologyHospital General Universitario Gregorio MarañónCIBERCVMadridSpain
| | - Diego López‐Otero
- Department of CardiologyHospital Cínico UniversitarioSantiago de CompostelaSpain
| | | | - Fernando Sarnago
- Department of CardiologyHospital General Universitario 12 de OctubreCIBERCVMadridSpain
| | - Xavier Armario
- Department of CardiologyHospital de la Santa Creu i Sant Pau. Fundación Investigación Cardiovascular. Programa‐ICCC CardiovascularInstitut de Recerca del Hospital de la Santa Creu I Sant PauIIB‐Sant Pau Barcelona, SpainBarcelonaSpain
| | - Antonio Bayés‐de-Luna
- Department of CardiologyHospital de la Santa Creu i Sant Pau. Fundación Investigación Cardiovascular. Programa‐ICCC CardiovascularInstitut de Recerca del Hospital de la Santa Creu I Sant PauIIB‐Sant Pau Barcelona, SpainBarcelonaSpain
| | - Manuel Martínez‐Sellés
- Department of CardiologyHospital General Universitario Gregorio MarañónCIBERCVMadridSpain
- Universidad EuropeaUniversidad ComplutenseMadridSpain
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