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de Leon A, Neira V, Alhammad N, Hopman W, Hansom S, Chacko S, Simpson C, Redfearn D, Abdollah H, Arauz A, Baranchuk A, Enriquez A. Electrocardiographic predictors of atrial fibrillation in patients with cryptogenic stroke. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 45:176-181. [PMID: 34862978 DOI: 10.1111/pace.14418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 10/27/2021] [Accepted: 11/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Empiric anticoagulation is not routinely indicated in patients with cryptogenic stroke without documentation of atrial fibrillation (AF). Therefore, identification of patients at increased risk of AF from this vulnerable group is vital. OBJECTIVES To identify electrocardiographic (ECG) predictors of AF in patients with cryptogenic stroke or transient ischemic attack (TIA) undergoing insertion of an implantable cardiac monitor (ICM). METHODS In this single-center study, 48 patients with cryptogenic stroke or TIA had an ICM implanted for detection of AF between January 2013 and September 2019. Patients with and without AF were compared in terms of p-wave duration and a novel index (MVP score). RESULTS During a mean follow-up of 16±14 months, AF was detected in 7 patients (15%). Diagnosis of AF was made after a mean of 10 ± 14 months, with time to first AF detection ranging between 1 and 40 months. Patients with AF had a longer p-wave duration (136±9 ms vs 116±10 ms; p = 0.0001) and a higher MVP score (4.5±1.2 vs 2.0±0.9, p = 0.0001) than those without AF. Advanced interatrial block was observed in 43% of patients with ICM evidence of AF and 0% of those without AF (p = 0.002). Age, LA size or LVEF were not predictors of AF. CONCLUSION An increased p-wave duration, advanced interatrial block and high MVP score are associated with AF occurrence in patients with cryptogenic stroke. Identifying patients with these markers may be helpful as they may benefit from more exhaustive and prolonged monitoring. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ana de Leon
- Division of Cardiology, Queen's University, Kingston Health Science Centre, Ontario, Canada
| | - Victor Neira
- Division of Cardiology, Queen's University, Kingston Health Science Centre, Ontario, Canada
| | - Nasser Alhammad
- Division of Cardiology, Queen's University, Kingston Health Science Centre, Ontario, Canada
| | - Wilma Hopman
- Division of Cardiology, Queen's University, Kingston Health Science Centre, Ontario, Canada
| | - Simon Hansom
- Division of Cardiology, Queen's University, Kingston Health Science Centre, Ontario, Canada
| | - Sanoj Chacko
- Division of Cardiology, Queen's University, Kingston Health Science Centre, Ontario, Canada
| | - Chris Simpson
- Division of Cardiology, Queen's University, Kingston Health Science Centre, Ontario, Canada
| | - Damian Redfearn
- Division of Cardiology, Queen's University, Kingston Health Science Centre, Ontario, Canada
| | - Hoshiar Abdollah
- Division of Cardiology, Queen's University, Kingston Health Science Centre, Ontario, Canada
| | - Antonio Arauz
- Instituto Nacional de Neurologia y Neurocirugia, Manuel Velasco Suarez, Mexico
| | - Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston Health Science Centre, Ontario, Canada
| | - Andres Enriquez
- Division of Cardiology, Queen's University, Kingston Health Science Centre, Ontario, Canada
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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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Iomini PA, Martínez-Sellés M, Elosua R, Bayés-de-Luna A, Baranchuk A. [Bayés Syndrome, Stroke and Dementia]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2021; 2:27-39. [PMID: 37727263 PMCID: PMC10506554 DOI: 10.47487/apcyccv.v2i1.126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/03/2021] [Indexed: 09/21/2023]
Abstract
Bayés's syndrome is a clinical entity based on the association between advanced interatrial block and the development of supraventricular tachyarrhythmia, being atrial fibrillation (AF) the most frequent. This association was discovered by Prof. Antoni Bayés de Luna in the '80s. Further studies by other groups found a strong relationship between Bayés's syndrome and thromboembolic phenomena, being stroke the most serious. Moreover, patients with this syndrome have an increased incidence of cognitive impairment and dementia. This observation triggered the question about whether the use of anticoagulation therapy prior to the documentation of AF could prevent A-IAB associated thromboembolic events. There are ongoing studies in different phases of development aiming to compare the efficacy of anticoagulation in patients with A-IAB with no prior documentation of AF. The outcomes of these studies will allow determining the efficacy of this early therapeutic intervention, and help deciding the role of anticoagulation in patients with A-IAB and no demonstrated AF.
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Affiliation(s)
- Pablo A. Iomini
- *Correspondencia: Balcarce 434, Morón (CP 1708), Buenos Aires, Argentina. Correo
| | - Manuel Martínez-Sellés
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV). EspañaCentro de InvestigaciónRed de Enfermedades Cardiovasculares (CIBERCV)España
- Hospital General Universitario Gregorio Marañón. Madrid, EspañaHospital General Universitario Gregorio MarañónMadridEspaña
- Universidad Europea de Madrid y Universidad Complutense de Madrid, EspañaUniversidad Europea de MadridUniversidad Europea de Madrid y Universidad Complutense de MadridSpain
| | - Roberto Elosua
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV). EspañaCentro de InvestigaciónRed de Enfermedades Cardiovasculares (CIBERCV)España
- Facultad de Medicina, Universidad de Vic-Universidad Central de Catalunya. Barcelona, EspañaFacultad de MedicinaUniversidad Central de CatalunyaBarcelonaEspaña
- Fundación Investigación Cardiovascular, Programa Cardiovascular-ICCC, Institut de Recerca del Hospital de la Santa Creu I Sant Pau, IIB-Sant Pau. Barcelona, EspañaFundación Investigación CardiovascularPrograma Cardiovascular-ICCCInstitut de Recerca del Hospital de la Santa Creu I Sant Pau, IIB-Sant PauBarcelonaEspaña
| | - Antoni Bayés-de-Luna
- Fundación Investigación Cardiovascular, Programa Cardiovascular-ICCC, Institut de Recerca del Hospital de la Santa Creu I Sant Pau, IIB-Sant Pau. Barcelona, EspañaFundación Investigación CardiovascularPrograma Cardiovascular-ICCCInstitut de Recerca del Hospital de la Santa Creu I Sant Pau, IIB-Sant PauBarcelonaEspaña
| | - Adrián Baranchuk
- Division of cardiology, Kingston Health Science Center, Kingston.Ontario, CanadaDivision of cardiologyKingston Health Science CenterOntarioCanada
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Carmona Puerta R. Bloqueos interauriculares: diagnóstico y significado clínico. Med Clin (Barc) 2020; 155:207-214. [DOI: 10.1016/j.medcli.2020.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/05/2020] [Accepted: 03/09/2020] [Indexed: 01/10/2023]
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Advanced interatrial block: A predictor of covert atrial fibrillation in embolic stroke of undetermined source. J Electrocardiol 2019; 58:113-118. [PMID: 31816563 DOI: 10.1016/j.jelectrocard.2019.11.050] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/12/2019] [Accepted: 11/23/2019] [Indexed: 12/28/2022]
Abstract
AIMS One third of ischemic strokes are of unknown etiology. Interatrial block (IAB) is a marker of atrial electromechanical dysfunction that may predispose to the development of atrial fibrillation (AF). We hypothesized that IAB, especially in its advanced form, could be a marker of covert AF in patients with embolic stroke of undetermined source (ESUS). METHODS We reviewed a single center cohort of ESUS patients with no prior history of AF. According to P-wave analysis of baseline ECG we distinguished 3 groups: normal P-wave duration (P-wave < 120 ms), partial IAB (P-IAB, P-wave ≥ 120 ms) and A-IAB (A-IAB, P-wave ≥ 120 ms with biphasic morphology in inferior leads). Follow-up was done 1, 6 and 12 months after discharge; then every 6 months. AF episodes, frequent premature atrial contractions (PACs) (>1%) and atrial tachyarrhythmias (runs of >3 consecutive PACs) were detected on 24 h Holter. The primary endpoint was new-onset AF detection on follow-up by any means. RESULTS A high prevalence of both P-IAB (n = 30, 40%) and A-IAB (n = 23, 31%) was found in 75 ESUS patients. After a 521 day mean follow-up, 14 patients (19%) were diagnosed of AF. A-IAB independently predicted AF diagnosis (p =0.042) on follow-up. 24 h Holter analysis showed greater frequency of PACs and atrial tachyarrhythmia episodes in patients with IAB (p = 0.0275). CONCLUSIONS In this hypothesis-generating study, A-IAB in the setting of ESUS is an independent risk predictor of covert AF. Although additional randomized clinical trials are warranted, A-IAB identifies ESUS patients with advanced atrial disease that could potentially benefit from early oral anticoagulation in secondary prevention.
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Alexander B, Milden J, Hazim B, Haseeb S, Bayes-Genis A, Elosua R, Martínez-Sellés M, Yeung C, Hopman W, Bayes de Luna A, Baranchuk A. New electrocardiographic score for the prediction of atrial fibrillation: The MVP ECG risk score (morphology-voltage-P-wave duration). Ann Noninvasive Electrocardiol 2019; 24:e12669. [PMID: 31184409 DOI: 10.1111/anec.12669] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 03/26/2019] [Accepted: 04/18/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common arrhythmia and has significant morbidity. A score composed of easily measured electrocardiographic variables to identify patients at risk of AF would be of great value in order to stratify patients for increased monitoring and surveillance. The purpose of this study was to develop an electrocardiographic risk score for new-onset AF. METHODS A total of 676 patients without previous AF undergoing coronary angiography were retrospectively studied. Points were allocated based on P-wave morphology in inferior leads, voltage in lead 1, and P-wave duration (MVP). Patients were divided into three risk groups and followed until development of AF or last available clinical appointment. RESULTS Mean age was 65 years, and 68% were male. The high- and intermediate-risk groups were more likely to develop AF than the low-risk group (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.3-4.4; p = 0.006 and OR 2.1, 95% CI 1.4-3.27; p = 0.009, respectively). The high-risk group had a significantly shorter mean time to development of AF (258 weeks; 95% CI 205-310 weeks) compared to the intermediate- (278 weeks; 95% CI 252-303 weeks) and low-risk groups (322 weeks 95% CI 307-338 weeks), p = 0.005. CONCLUSIONS A simple risk score composed of easy-to-measure electrocardiographic variables can help to predict new-onset AF. Further validation studies will be needed to assess the ability of this risk score to predict AF in other populations.
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Affiliation(s)
- Bryce Alexander
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Julia Milden
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Bachar Hazim
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Sohaib Haseeb
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | | | - Roberto Elosua
- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain.,CIBERCV, Barcelona, Spain.,Faculty of Medicine, Medicine Department, University of Vic-Central of Catalonia (UVic-UCC), Vic, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Cynthia Yeung
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Wilma Hopman
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Antoni Bayes de Luna
- Autonomous University of Barcelona, Institut Català Ciències Cardiovasculars-St. Pau Hospital, and Quiron Barcelona Hospital, Spain
| | - Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
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