1025-100 Patients with WPW Syndrome and Paroxysmal Atrial Fibrillation Shows Prolonged Atrial Conduction Time by Signal-Averaged P-Wave Electrocardiogram

Background:Tissue fibrosis increases in the structure of the atrial tissue of atrial fibrillation patients. Prolidase enzyme regulates collagen synthesis. There may be an association between electrocardiography (ECG) findings and prolidase activity.Objective:This study investigated the association between atrial conduction time and prolidase activity, a collagen synthesis enzyme, and P-wave dispersion (PWD) in patients with Paroxysmal Atrial Fibrillation (PAF).Methods:Exclusion criteria included the age of <18 years, heart failure, diabetes, hypertension, hyperlipidemia, malignancy, cerebrovascular disease, chronic respiratory distress, osteoporosis, rheumatoid arthritis, renal disease, cirrhosis, and other types of arrhythmia. Patients diagnosed with PAF within 48 hours were considered to have a definite diagnosis. PWD was calculated using a 12-lead ECG, and inter- and intraatrial electromechanical delay (EMD) was assessed using tissue Doppler imaging and conventional echocardiography. Serum prolidase levels were measured in both groups.Results:A total of 43 patients with PAF (20 female, 23 male; mean age, 46.8 ± 5.7 years) and 42 healthy volunteers (21 female, 21 male; mean age, 43.9 ± 5.1 years) were included in the study.:Inter- and intraatrial EMD, PWD, minimum P-wave (Pmin), and maximum P-wave (Pmax) measurements were significantly higher (39.7 ± 2.7, 35.7 ± 2.3, p < 0.001; 13.2 ± 2.6, 8.5 ± 1.9, p < 0.001; 47.1 ± 11, 24.1 ± 7.1, p < 0.001; 69.8 ± 8.8, 66.7 ± 10.2, p < 0.130; 114.8 ± 13, 93.6 ± 8.6, p < 0.001, respectively) and serum prolidase levels were significantly lower in patients with PAF compared to healthy controls (3.96 ± 1.2, 8.5 ± 3.56, p < 0.001). In patients with PAF, correlation analysis showed a negative correlation between prolidase levels and intra- and interatrial EMD, PWD, and Pmax (r = -0.41, p < 0.05; r = -0.54, p < 0.05; r = -0.62, p < 0.05; r = -0.49, p < 0.05, respectively). Interatrial EMD showed a significant positive correlation with intraatrial EMD, Pmax, and PWD in patients with PAF (r = 0.90, p < 0.05; r = 0.574, p < 0.05; r = 0.43, p < 0.05, respectively). Additionally, the level of high-sensitivity C-reactive protein (hs-CRP) was significantly higher in patients with PAF (6.6 ± 8, 1.8 ± 1.6, p < 0.001).Conclusion:The decreased plasma prolidase activity in patients with PAF may explain the irregularity of the collagen metabolism of different extracellular components and may indicate the onset of atrial remodeling. Changes in PWD, interatrial EMD, and serum prolidase level may predict PAF before diagnosis.

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Assessment of left atrial electro-mechanical delay to predict atrial fibrillation in hypertrophic cardiomyopathy

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa174 ◽

2020 ◽

Author(s):

Catherina Tjahjadi ◽

Yasmine L Hiemstra ◽

Pieter van der Bijl ◽

Stephan M Pio ◽

Marianne Bootsma ◽

...

Keyword(s):

Atrial Fibrillation ◽

Hypertrophic Cardiomyopathy ◽

Left Atrial ◽

Tissue Doppler ◽

P Wave ◽

Doppler Imaging ◽

Conduction Time ◽

Atrial Conduction Time ◽

New Onset

Abstract Aims Atrial fibrillation (AF) is frequently observed in hypertrophic cardiomyopathy (HCM) and is associated with poor clinical outcome. Total atrial conduction time, estimated by tissue Doppler imaging (TDI), the so-called PA-TDI duration, reflects the left atrial (LA) structural and electrical remodelling. The aim of this study was to evaluate the association between PA-TDI and new-onset AF in patients with HCM. Methods and results From a large cohort of patients with HCM, 208 patients (64% male, mean age 53 ± 14 years) without AF were selected. PA-TDI duration was measured from the onset P wave on electrocardiogram to the peak A′ wave of the lateral LA wall using TDI. The incidence of new-onset AF was 20% over a median follow-up of 7.3 (3.5–10.5) years. Patients with incident AF had longer PA-TDI duration when compared with patients without AF (133.7 ± 23.0 vs. 110.5 ± 30.0 ms, P < 0.001). PA-TDI duration was independently associated with new-onset AF (hazard ratio: 1.03, 95% confidence interval: 1.01–1.05, P < 0.001). Conclusion Prolonged PA-TDI duration was independently associated with new-onset AF in patients with HCM. This novel parameter could be useful to risk-stratify patients with HCM who are at risk of having AF.

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Atrial fibrillation and diabetes mellitus: the effect of Type 2 diabetes on atrial conduction time using high-resolution ECG of the P wave.

Cor et Vasa ◽

10.33678/cor.2007.022 ◽

2007 ◽

Vol 49 (2) ◽

pp. 55-60

Author(s):

Ivan Vranka ◽

Ľudovít Gašpar ◽

Peter Penz ◽

Lujza Štrbová ◽

Andrej Dukát

Keyword(s):

Diabetes Mellitus ◽

Atrial Fibrillation ◽

Type 2 Diabetes ◽

High Resolution ◽

P Wave ◽

Conduction Time ◽

Atrial Conduction Time

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Splitting the P-Wave: Improved Evaluation of Left Atrial Substrate Modification after Pulmonary Vein Isolation of Paroxysmal Atrial Fibrillation

Sensors ◽

10.3390/s22010290 ◽

2021 ◽

Vol 22 (1) ◽

pp. 290

Author(s):

Aikaterini Vraka ◽

Vicente Bertomeu-González ◽

Fernando Hornero ◽

Aurelio Quesada ◽

Raúl Alcaraz ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Paroxysmal Atrial Fibrillation ◽

P Wave ◽

Conduction Time ◽

Wave Duration ◽

Substrate Modification ◽

P Wave Duration ◽

Before And After

Atrial substrate modification after pulmonary vein isolation (PVI) of paroxysmal atrial fibrillation (pAF) can be assessed non-invasively by analyzing P-wave duration in the electrocardiogram (ECG). However, whether right (RA) and left atrium (LA) contribute equally to this phenomenon remains unknown. The present study splits fundamental P-wave features to investigate the different RA and LA contributions to P-wave duration. Recordings of 29 pAF patients undergoing first-ever PVI were acquired before and after PVI. P-wave features were calculated: P-wave duration (PWD), duration of the first (PWDon-peak) and second (PWDpeak-off) P-wave halves, estimating RA and LA conduction, respectively. P-wave onset (PWon-R) or offset (PWoff-R) to R-peak interval, measuring combined atrial/atrioventricular and single atrioventricular conduction, respectively. Heart-rate fluctuation was corrected by scaling. Pre- and post-PVI results were compared with Mann–Whitney U-test. PWD was correlated with the remaining features. Only PWD (non-scaling: Δ=−9.84%, p=0.0085, scaling: Δ=−17.96%, p=0.0442) and PWDpeak-off (non-scaling: Δ=−22.03%, p=0.0250, scaling: Δ=−27.77%, p=0.0268) were decreased. Correlation of all features with PWD was significant before/after PVI (p<0.0001), showing the highest value between PWD and PWon-R (ρmax=0.855). PWD correlated more with PWDon-peak (ρ= 0.540–0.805) than PWDpeak-off (ρ= 0.419–0.710). PWD shortening after PVI of pAF stems mainly from the second half of the P-wave. Therefore, noninvasive estimation of LA conduction time is critical for the study of atrial substrate modification after PVI and should be addressed by splitting the P-wave in order to achieve improved estimations.

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P-Wave Configuration in the Signal Averaged Electrocardiogram: Which Filter Technique Differentiates Best Between Patients With Paroxysmal Atrial Fibrillation and Healthy Volunteers?

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(97)83917-4 ◽

1998 ◽

Vol 31 (2) ◽

pp. 47A

Author(s):

M Hofmann

Keyword(s):

Atrial Fibrillation ◽

Healthy Volunteers ◽

Paroxysmal Atrial Fibrillation ◽

P Wave ◽

Filter Technique

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Hypertrophic cardiomyopathy with paroxysmal atrial fibrillation misdiagnosed as WPW syndrome

International Journal of Arrhythmia ◽

10.1186/s42444-021-00033-z ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Sang-Hoon Seol ◽

Ki-Hun Kim ◽

Jino Park ◽

Yeo-Jeong Song ◽

Dong-Kie Kim ◽

...

Keyword(s):

Atrial Fibrillation ◽

Hypertrophic Cardiomyopathy ◽

Paroxysmal Atrial Fibrillation ◽

Conduction System ◽

Atrioventricular Conduction ◽

Wpw Syndrome ◽

Bypass Tract ◽

Hypertrophied Myocardium

AbstractHypertrophic cardiomyopathy (HCM) is associated with an increased incidence of Wolff–Parkinson–White (WPW) syndrome and atrial fibrillation. However, a delta-like wide QRS can be observed in the hypertrophied myocardium. When considering the rarity of the paraseptal bypass tract (BT), the normal QRS axis suggests a higher possibility of HCM origin. Otherwise, there is no known electrocardiographic clue indicating a wide QRS differentiation between HCM and WPW syndrome. Moreover, the atriofascicular, nodofascicular/ventricular or fasciculoventricular BT should be differentiated. In this case, atrioventricular conduction system incidental injury revealed a wide QRS origin from the HCM, but this method should be avoided except in some selected cases.

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